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Flashcards in Gen Med Deck (128)
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1

Most common cause of hypothyroid

Hashimoto

2

HPT axis

1. Hypothalamus secretes TRH
2. TRH stimulates ant pit to release TSH
TSH acts on thyroid to release T3/T4

3

Investigation of primary hypothyroid

High TSH, low T4

4

Ix of 2ndary hypothyroid

Low TSH and T4

5

Ix of subclinical hypothyroidism

High TSH, normal T4

6

Ix of poor thyroxine compllaiance

High TSH, normal T4 - Take thyroxine on day of appt but TSH lags behind and reveals poor compliance

7

Ix of hashimoto

• Anti-TPO (thyroid peroxidase) antibody

8

S&S of hypothyroid

• Systemic:
○ Weight gian
○ Lethargy
○ Cold intolerance
• Skin:
○ Dry
○ Non pittine oedema
○ Dry coarse hair
GI - constipation

9

Tx of hypothyroid

Levothyroxine

10

Tx of hyperthyroid

• Propanolol - to control symptoms
• Radioiodine tx
• Carbimazole:
○ Prevents iodinisation of thyroglobulin

11

ADR of carbimazole

agranulocytosis

12

S&S of hyperthyroid

• Systemic:
○ Weight loss
○ Restlessness
○ Heat intolerance
• Cardiac:
○ Palpitations
• Skin - Increased sweating, clubbing
• GI - diarrhoea
• Neuro - anxiety, tremor

13

Ix of graves

TSH receptor antibodies

14

Precipitating factors of DKA

• Infection
• Missed insulin doses
MI

15

S&S off DKA

• Abdo pain
• Polyuria, polydipsia, dehydration
• Deep hyperventilation - Kussmaul resp
Pear drop smelling breath

16

Ix of DKA

• Glucose >11
• pH <7.3
• Bicarb <15mmol
Ketones >3mmol or urine ketones ++

17

Tx of DKA

• Saline fluids
• Insulin IV infusion
Correct hypokalaemia (due to insulin)

18

Ix of hyperosmolar hyperglycemic state

• Dehydration
• Osmolality >320mOsmol/kg
• >30mmol BM
• pH >7.3
Bicarb >15mmol

19

S&S of hyperosmolar hyperglycemic state

• Focal CNS signs - tremors, motor or sensory impaired
• DIC
Leg ischemia

20

Tx of Hyperosmolar hyperglycemic state

• LMWH
• Saline fluids
• Replace potassium
ONLY USE INSULIN IF BM NOT FALLING WITH ABOVE

21

S&S of hypoglyc

• Autonomic:
○ Sweating
○ Anxiety
○ Hunger
○ Tremor
○ Palpitations
○ Dizziness
• Neuro:
○ Confusion
○ Aggression
○ Drowsiness
○ Visual trouble
Seizures

22

Tx of hypoglyc

Tx:
1. Conscious - 250ml of lucozade, 3 glucose tablets, glucogel
2. IV glucose 200 ml of 10% solution in 50 ml aliquots
3. Repeat glucose testing every 10 mins until stable
4. Review reasons for hypoglyc

23

Ix of gestational diabetes

• Urine dipstick - Glycosuria
• Glucose tolerance test:
○ Fasting >5.6mmol
2 hr glucose >7.8mmol

24

What proportion of women with gestational diabetes will develop diabetes?

50% in 10 years

25

Tx of gestational diabetes

• Managed with insulin
• Perform glucose tolerance test post delivery
Advice on reducing risk of developing T2DM

26

RFs on gestational diabetes

• BMI >30
• Previous gestational diabetes
• FHx of diabetes
Middle eastern, black, south asian

27

Patho of diabetic retinopathy

• Increase retinal blood flow
• Therefore, Abnormal metabolism and damage to retinal vessel walls
Increase vascular permeability

28

Classification of diabetic retinopathy

Background - microaneurysms, blot hemorrhages (3 or less), hard exudates

Pre-proliferative - Cotton wool spots, 3+ blot hemorrhages, cluster hemorrhages

Proliferative - Fibrous tissue anterior to retinal disc, retinal neovascularisation

29

Tx of diabetic retinopathy

Laser photocoagulation

30

Tx of hyperlipidaemia - primary and secondary prevention

• Primary prevention - atorvastatin 20
Secondary prevention (known IHD or CVD or PAD) - atorvastatin 80