Endocrinology & Diabetes UK Medical PG Flashcards - Medical Study Cards
Master Endocrinology & Diabetes with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Endocrinology & Diabetes Flashcard Deck - 10 Cards
Flashcard 51: What is the first-line investigation in suspected primary hyperaldosteronism?
Answer:
• Aldosterone/renin ratio
Flashcard 52: What is the maximum dose of metformin in T2DM management?
Answer: 2550 mg/day (often rounded to 2.5g) for immediate release; 2000 mg/day for extended release.
Extra: Standard dosing usually starts at 500mg once or twice daily and is titrated up. The FDA-approved maximum for immediate-release metformin is 2550 mg/day given in divided doses.
Flashcard 53: What would excess PTH do to Calcium and Phosphate levels?
Answer:
• Calcium raised
• Phosphate low
Flashcard 54: In T2DM management when should SGLT-2 inhibitors be introduced?
Answer: • Established Cardiovascular Disease (e.g., IHD, Stroke, PAD)
• Heart Failure
• Chronic Kidney Disease (CKD)
• QRISK3 score ≥ 10%
Extra: Current NICE guidelines (NG28) recommend early introduction of SGLT-2 inhibitors (alongside metformin) for patients with T2DM and chronic heart failure or established atherosclerotic cardiovascular disease. They should also be offered if the QRISK3 is ≥ 10% or if the patient has CKD.
Flashcard 55: What diabetes medication may cause fluid retention?
Answer:
• Pioglitazone
*Thiazolidinedione
Flashcard 56: With hypercalcaemia caused by malignancy, what will PTH and PTHrP be?
Answer:
• PTH low -> negative feedback of hypercalcaemia
• PTHrP high -> released from the tumour e.g. sqamous cell lung cancer
Flashcard 57: Which diabetes medication may have to be stopped in AKI due
to risk of toxicity (but doesn’t usually worsen AKI itself)?
Answer: Metformin
Flashcard 58: What is the next step in imaging for a patient with biochemically confirmed Cushing's Syndrome?
Answer: Imaging depends on the etiology (after biochemical confirmation):
- Cushing Disease (Pituitary): MRI Brain/Pituitary
- Adrenal Cushing: CT Adrenals
- Ectopic ACTH: CT Chest/Abdomen/Pelvis
Extra: Cushing's syndrome imaging should only be performed AFTER biochemical confirmation of hypercortisolism.
1. If ACTH is low (<5 pg/ml) -> ACTH-independent -> CT Adrenals.
2. If ACTH is high (>20 pg/ml) -> ACTH-dependent -> MRI Pituitary (first-line).
'CT Adrenals' alone is incorrect as the most common cause of endogenous Cushing's is a pituitary adenoma (Cushing Disease).
Flashcard 59: Best test to diagnose Cushing's syndrome?
Answer: Any of the following (First-line screening):
1. Low-dose dexamethasone suppression test (LDDST)
2. 24-hr urinary free cortisol
3. Late-night salivary cortisol
Extra: Once hypercortisolism is confirmed with at least two abnormal first-line tests, the next step is checking plasma ACTH levels to differentiate between ACTH-dependent and ACTH-independent causes.
Flashcard 60: What is the pre-diabetes glycaemic control HbA1c range?
Answer: 42-47 mmol/mol (6.0-6.4%)
Extra: Note: In the US (ADA guidelines), the pre-diabetes range starts slightly lower at 5.7% (39 mmol/mol).
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