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1
Q

What is indicated by the arrow?

A

Lateral limb of adrenal gland

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2
Q

What are the restrictive options for bariatric surgery?

A

Gastric banding, sleeve gastrectomy

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3
Q

What is adaptive thermogenesis?

A

Resting metabolic rate of someone who is overweight will adjust down by more than you would expect simply on the basis of change in body composition

Body perceives weight loss as a threat to survival, so adaptive thermogenesis acts as a brake on further weight loss

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4
Q

What is indicated by the arrow?

A

Sella turcica

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5
Q

What dietary changes are necessary to prevent side effects of orlistat?

A

Hypocaloric and low fat diet

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6
Q

What is the target BG level for a diabetic individual before exercise?

A

7 and 15 mmol/L before exercise

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7
Q

Name two observational interventional designs

A

Interrupted time series, non-randomised cohort

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8
Q

What are the blood glucose targets for pregnant women with diabetes?

A

Fasting: <5.4 mmol/l

1 hour after meals: below 7.8 mmol/l

2 hours after meals: below 6.4 mmol/l

Intrapartum: 4-7 mmol/l (reduces risk of neonatal hypoglycaemia post delivery)

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9
Q

What is the mechanism of action of orlistat?

A

Lipase inhibitor - blocks absorption of dietary fat

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10
Q

When is the maximum period of time orlistat can be prescribed?

A

Prescribing guidance says 2 years

Evidence of safety for 4 years

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11
Q

What is indicated by the arrows?

A

Hypothalamus

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12
Q

What is a critical appraisal?

A

Interpreting conflicting conclusions in the literature to obtain consensus, ultimately to inform guidelines e.g. SIGN

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13
Q

What is an non-randomised cohort design?

A

Main design before and after, can be improved with addition of controls but always have unknown confounding variables so difficult to determine causality

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14
Q

What is indicated by the arrow?

A

Oesophagus

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15
Q

What is intention-to-treat analysis?

A

Patient is analysed in the group they were randomised to irrespective of subsequent changes - reflects the real clinical world

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16
Q

What is indicated by the arrow?

A

Trachea

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17
Q

What is indicated by the arrows?

A

Common carotid arteries

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18
Q

What is the strongest form of scientific evidence?

A

Meta-analyses and systemic reviews

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19
Q

What is indicated by the arrow?

A

Medial limb of adrenal gland

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20
Q

How can an individual prevent hyperglycaemia during/after exercise?

A

Avoid exercise if BG > 14 mmol/L or ketones present

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21
Q

What is the aim of ketone monitoring?

A

Aim to detect risk of diabetic ketoacidosis

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22
Q

Discuss the 4 phases of drug development

A

Phase 1: safety, dose finding, volunteers (3-30)

Phase 2: safety, how effective, how often? (30-50)

Phase 3: efficacy, safety (100+)

Phase 4: post approval in large population (1000+)

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23
Q

What are the blood glucose targets for T2DM?

A

Before meals: 4-7 mmol/l

Two hours after meals: <8.5 mmol/l

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24
Q

Discuss the genes implicated in obesity

A

In an evolutionary context being able to optimise response to feeding opportunities was an advantage (‘thrifty genotype’), however this is maladaptive in today’s environment - a subset of the population may have a stronger ‘thifty genotype’ (e.g. insulin resistance) and therefore be more susceptible to put on weight

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25
How can an individual with T1DM reduce the risk of hypoglycaemia?
Carry an emergency supply of CHO and diabetic ID Check BG frequently (especially before bed) Never consume alcohol on an empty stomach Be aware that stress, illness and exercise can affect BG levels
26
What is indicated by the arrow?
Pituitary stalk
27
What is a parallel group RTC?
Each subject is randomized to one of two or more distinct treatment/intervention groups Stratification is the partitioning of subjects and results by a factor other than the treatment given
28
What are the blood glucose targets for children with T1DM?
On waking and before meals: 4-7 mmol/l After meals: 5-9 mmol/l
29
What is HbA1c?
Formed by non-enzymatic glycation of haemoglobin on exposure to glucose Increases in a predictable way in response to prevailing glucose, and can be used to measure average glycaemic control over a prolonged period of time (6-8 weeks)
30
Name the gold standard method to assess efficacy of treatment or develop causal relationship
Randomised controlled trials
31
How would you manage early hypoglycaemia?
15-20g rapidly absorbed carbohydrate
32
What is a cluster randomisation RTC?
Intervention at the group level e.g. new appointment system in general practice
33
What is the HbA1c target for diabetic individuals?
\< 53 mmol/mol
34
What is a contract?
Agreement to do something or allow someone to do something to them
35
Name the most effective long-term intervention for weight loss
Bariatric surgery
36
Discuss the dietary and lifestyle recommendations for a patient with T1DM
Adjusting insulin to carbohydrate intake ('carbohydrate counting') Fixed insulin regimes - aim for consistent quantities of carbohydrates on a day-to-day basis Increased physical activity
37
Define consent
Agreement to do something or allow someone to do something to them Can be withdrawn by the consented anytime without penalties
38
What is a retrospective cohort study?
Cohort formed in the past and followed up to the present
39
What is indicated by the arrow?
Isthmus
40
What is indicated by the arrows?
Internal jugular veins
41
What percentage weight loss would a patient on orlistat need to loose in order for continued therapy to be indicated?
Patients lose ≳5% of bodyweight in first 3 months Patients lose ≳10% of bodyweight in first 6 months
42
What are the restrictive and malabsorptive options for bariatric surgery?
Gastric bypass
43
Discuss the dietary and lifestyle recommendations for an overweight patient with T2DM
600kcal deficit, ≳150 mins per week of moderate to vigorous physical activity over at least 3 days per weak
44
Name 3 methods of blood glucose monitoring
Self-monitoring of blood glucose, continuous glucose monitoring, flash glucose monitoring
45
What is indicated by the arrows?
Carotid arteries
46
What is indicated by the arrow?
Inferior vena cava
47
What are the blood glucose targets for hospitalised patients?
6-10 mmol/L
48
What is the most common insulin regimen?
Basal (long acting - between meals) bolus (rapid acting - glucose from meals)
49
Why are diabetics who use insulin/SUs at risk of a hypo if they consume alcohol?
Alcohol increases activity of insulin While the liver is processing alcohol it cannot release glucagon to reverse a hypo
50
What does this scan indicate?
Thyroiditis - homogenously reduced tracer uptake
51
How does carbohydrate counting work?
Identify which foods contain carbohydrate (CHO) Calculate/estimate the CHO content of the meal Calculate insulin dose needed to 'cover' CHO eaten (e.g. ratio 10:1)
52
What is a crossover RTC?
Each patient receives all treatments Order of receipt is randomised
53
What does a p-value at least \<0.05 mean?
The result is statistically significant and the null hypothesis can be rejected
54
What is a case-control design?
Group of subjects with disease or condition are identified (cases) A suitabe control group is identified without the condition (controls) Frequency of exposure or risk factor extracted and compared in cases and controls
55
What is a cross-sectional design?
Carried out at a single point in time, so exposure and outcome measured at same time e.g. census
56
What is a prospective cohort study?
Cohort followed forward in time from present
57
What are the blood glucose targets for adults with T1DM?
On waking 5-7 mmol/l Before meals at other times of the day: 4-7 mmol/l 90 mins after meals: 5-9 mmol/l 6-8 mmol/l before bedtime
58
What is per-protocol analysis?
Patient analysed in the treatment group they actually received (not necessarily randomised group) - may not reflect the real clinical world, more concerned with science
59
What is indicated by the arrow?
Sphenoid sinus
60
What clinical features would indicate a hereditary endocrine disease?
Young age of onset Tumour multiplicity Positive FHx Pathognomonic clinical features
61
What does this scan indicate?
Graves - homogenously increased tracer uptake
62
What is a stepped wedge RTC?
Form of cluster randomisation in which order in which each unit receives intervention is randomised, like in crossover design Used with cluster randomised studies where efficacy already fairly established
63
What is indicated by the arrow?
Diaphragmatic crus
64
What is indicated by the arrows?
Strap muscles
65
What is an interrupted time series design?
Method of statistical analysis involving tracking a long-term period before and after a point of intervention to assess the intervention's effects
66
What is a randomised factorial trial RTC?
Two (or more) intervention comparisons are carried out simultaneously e.g. participants may be randomized to receive aspirin or placebo, and also randomized to receive a behavioural intervention or standard care
67
What is indicated by the arrow?
Aorta
68
What does this scan indicate?
Multinodular goitre with dominant nodule
69
When would you prescribe orlistat?
BMI ≳30 kg/m² or ≳28 kg/m² with co-morbid conditions In Tayside patient must be attending Adult Weight Management Service
70
How can an individual on insulin prevent a hypo after exercise?
Prevent by adjusting insulin and/or CHO (1g CHO/ky body weight per hour of exercise
71
What are the 'sick day rules' for diabetics?
Take plenty of fluid Check ketones and BG regularly Continue taking insulin, even if not eating, may require more insulin than normal
72
What is indicated by the arrow?
Optic chiasm

MBChB YR2 Endocrine (23 decks)

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