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HSC2008 Pathology & Pharmacology > Week 5 > Flashcards

Week 5 Flashcards

(97 cards)

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1
Q

what is used as a screening test for DM

A

HbA1c

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2
Q

DM treatment

A

lifestyle = diet, exercise, weight loss

pharma = glucose lowering like insulin

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3
Q

acute diabetes related complications

A

diabetic emergencies, hypoglycemia, infections

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4
Q

chronic diabetes related complications

A

macrovascular = IHD, stroke, peripheral arterial disease

microvascular = retinopathy, nephropathy, neuropathy

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5
Q

during foot examinations for DM, what do u inspect for

A

foot ulcers
palpate pedal pulses
sensations

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6
Q

Hb1Ac indicates

A

glycated hemoglobin

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7
Q

pre-meal glucose target should be __

A

4.4 - 7.2 mmol/L

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8
Q

2H post meal glucose target should be __

A

<10.0 mmol/L

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9
Q

ABC targets

A

Hb1Ac < 7.0%

Blood pressure <140/80mmHg

LDL cholesterol <2.6mmol/L

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10
Q

how to manage macrovascular diabetes complications

A

blood pressure monitoring, lipid management, smoking cessation

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11
Q

how to manage microvascular diabetes complications

A

urine albumin / creatinine ratio

retinal photo

diabetes foot screening

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12
Q

diet for diabetics

A

lots of fruits & veg, low GI carbs, lean protein & fish, water

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13
Q

effects of exercise

A

stimulates glucose transport & metabolism

increases blood flow to muscles

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14
Q

exercise recommendations

A

> 150 mins per week of moderate activity

> 75 mins per week of vigorous activity

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15
Q

ideal characterisitcs of diabetes drug

A

efficacy, safe, cheap, no side effects + hypoglycemia, weight gain

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16
Q

what is insulin associated with

A

painful, weight gain, hypoglycemia, visual impairment

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17
Q

glucose toxicity leads to

A

beta cell dysfunction & insulin resistance

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18
Q

when to use early insulin therapy

A

diabetic emergencies, uncontrolled hyperglycemia, symptomatic hyperglycemia, catabolic features

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19
Q

diabetic emergencies

A

diabetic ketoacidosis, hyperglycemic hyperosmolar state

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20
Q

diagnostic criteria for diabetes ketoacidosis

A

glucose > 14mmol/L

urine ketones 3/4+
blood ketones > 1

HCO3 < 18mmol/L
pH<7.3

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21
Q

diagnostic criteria for hyperglycemic hyperosmolar state

A

glucose > 33.3 mmol/L

effective serum osmolarity > 320mOsm/kg

altered sensorium

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22
Q

Symptomatic hypoglycaemia

A

symptoms & CBG < 4 mmol/L

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23
Q

Asymptomatic hypoglycaemia

A

no symptoms & low CBG < 4 mmol/L

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24
Q

Severe hypoglycaemia

A

another person needed to administer treatment

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25
relative hypoglycaemia
symptoms but CBG > 3.9 mmol/L
26
symptoms of autonomic hypoglycemia
* Palpitations * Tremors * Anxiety * Sweating * Hunger PATHS
27
symptoms of neuroglycopenic hypoglycemia
* Cognitive impairments * Behavioural changes * Blurring of vision * Seizure * Coma
28
hypoglycemia consequences
IQ drop, sudden death due to QT interval abnormality & MI
29
if hypoglycemic patient alert, give them __
glucose drink (15 - 20g)
30
if hypoglycemic patient drowsy or vomitting, give them __
IV D50% bolus 40 mls
31
when to begin monitoring of hypoglycemic patient
capillary glucose 30 mins after correction & every 2-4 hourly thereafter
32
hyperthyroidism TSH & T4 levels
TSH low T4 high
33
hypothyroidism TSH & T4 levels
TSH high T4 low
34
hypothyroidism secondary TSH & T4 levels
TSH low T4 low
35
primary hyperthyroidism causes
graves' disease, toxic adenoma, toxic multinodular goitre, subacute thyroiditis, medicated induced thyrotoxicosis
36
fasting plasma glucose for diabetes according to MOH
>7 mmol/L
37
2 hr plasma glucose after 75g according to MOH
> 11.1 mmol/L
38
random plasma glucose according to MOH
> 11.1 mmol/L
39
skin examination for DM includes
acanthosis nigricans & insulin injection sites
40
CGM glucose sensor measures __
interstitial glucose
41
medication factors influencing aherence
1) side effect & safety profile 2) costs 3) route & frequency of administration
42
fruity scented breath associated with
diabetic ketoacidosis
43
capillary glucose "HI" or > 33.3 mmol/L associated with
hyperglycemic hyperosmolar syndrome
44
diff between DKA & HHS in terms of patient profile
DKA = may occur in both but T1 prone to DKA HHS = usually T2 and elderly
45
diff between DKA & HHS in terms of rate of development
DKA: fast - hours to days HHS: days to weeks
46
diff between DKA & HHS in terms of degree of dehydration
DKA: ~100ml/kg HHS: ~100 - 220ml/kg
47
diff between DKA & HHS in terms of mortality
DKA < 1% HHS 5 - 20%
48
what hormones lead to hyperglycemia
decreased glucose utilization, increased gluconeogenesis & glycogenolysis
49
DM confirmed diagnosis is done via
- serum glucose - arterial blood gas - urine + blood ketones
50
DM investigation for precipitating factor
- blood + urine cultures - ECG + cardiac enzymes - CXR - lipids, amylase
51
DM management includes
hydration, decrease serum glucose + blood + ketones, correct electrolyte imbalances, treat precipitating event
52
role of TSH & T4
TSH stimulates thyroid and T4 turns off TSH in pituitary gland
53
hyperthyroidism effects
- atrial fibrillation - heart failure - osteoporosis - neuropsychiatric effects - diarrhea & abdominal cramps - menstrual irregularities
54
hypothyroidism effects
- atherosclerosis - pericardial effusion - cognitive impairment - muscle cramps - menstrual irregularities
55
thyroid eye disease indicates __
graves' disease
56
pain & tender thyroid + preceding URTI / fever indicates __
subacute thyroiditis
57
enlarged thyroid nodule indicates __
toxic MNG/adenoma
58
graves' ophthalmopathy includes __
- proptosis - exophthalmos - lid retraction & lag - restricted extraocular muscle movement
59
thyroid examination includes __
enlargement, tenderness
60
if Graves' disease suspected, use __
FT4, TSH & TSH receptor ab
61
if toxic nodule/MNG suspected, use __
FT4, TSH + thyroid US & uptake scan
62
graves' disease treated using __
- thioamides: start high & taper down - treat for 12-18 months KIV withdraw
63
thioamides act on
peroxidase
64
iodides act on
proteolysis
65
side effects of thioamides
rashes commonly but serious cases include - agranulocytosis - hepatotoxicity - vasculitis
66
thyroid storm tests assesses for
CVS, gastrointestinal-hepatic, CNS, thermoregulation, history
67
patient stabilization includes
ABC = airway, breathing, circulation
68
what drug decreases thyroid hormone synthesis
thioamides
69
what drug prevents thyroid hormone release
Lugol's iodine
70
what drug decreases peripheral actions of thyroid hormone
corticosteroids, beta-blockers
71
physical examination for thyroidism
weight, thyroidectomy scar, bradycardia, goitre, dry skin
72
primary hypothyroidism caused by
- hashimoto thyroiditis - other thyroiditis - drugs - post RAI / thyroidectomy
73
if hashimoto thyroiditis suspected, use __
FT4, TSH, thyroid peroxidase antibody
74
__ empirically cover for adrenal insufficiency
IV glucocorticoids
75
thyroid storm
life threatening endocrine emergency by exaggerated symptoms of hyperthyroidism & evidence of multiorgan decompensation
76
ABCs of patient stabilization
airway, breathing, circulation
77
hashimoto's thyroiditis treatment involves __
thyroxine which is titrated to keep TSH normal
78
myxedema coma
decompensated hypothyroidism
79
tested criteria for myxedema coma
thermoregulation dysfunction, CNS effects, GI findings, precipitating events, CVS dysfunction, metabolic disturbances
80
thyroid specific therapy for myxedema coma involves the use of __
IV glucocorticoids for adrenal insufficiency IV levothyroxine; switch to oral when patient more alert
81
empirical cover for hypocortisolism includes
IV hydrocortisone
82
IV levothyroxine loading dose of ___ to saturate receptors followed by maintenance
200 - 400 mcg
83
primary hypothyroidism treatment is ___
levothyroxine replacement therapy
84
when is levothyroxine replacement therapy taken
1 hr before meal / 4 hrs after last meal
85
things that interfere with levothyroxine absorption
diet (meals, Ca2+, grapefruit juice) bile acid sequestrants (cholestyramine) oral bisphosphonates, ferrous sulphate, calcium carbonate/citrate/acetate
86
thyroid storm treatments include
decrease thyroid hormone synthesis using thioamides prevent thyroid hormone release using Lugol's iodine decrease peripheral action of thyroid hormone using corticosteroids & beta-blockers
87
thioamide solution for thyroid storm includes
propylthiouracil 400 mg stat then 200 mg Q6H
88
propylthiouracil inhibits __
T4 to T3 conversion in thyroid & peripheral tissues
89
wolff chaikoff effect
autoregulatory phenomenon where large amount of ingested iodine inhibits thyroid hormone synthesis
90
Lugol's idoine is administered __
1H after 1st dose of PTU to prevent iodine from being a substrate for synthesis
91
corticosteroids work by __
inhibiting peripheral conversion of T4 to T3
92
definitive therapy includes __
thyroidectomy & radioiodine
93
major toxicities of anti-thyroid drugs
agranulocytosis, liver toxicities, ANCA positive vasculitis
94
metabolic syndrome diagnosis criteria
1. waist circumference 2. plasma triglycerides 3. plasma HDL cholesterol 4. BP 5. FPG
95
key features of metabolic syndrome
significant abdominal fat, changes in glucose & lipoprotein metabolism
96
treating hypoglycemia using __
15g of fast acting carbs and recheck glucose levels 15 mins after ingestion
97

HSC2008 Pathology & Pharmacology (14 decks)

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