Ambulatory Endocrinology

1.During the Ambulatory Endocrinology study course, the medical resident must deepen their theoretical knowledge of the aetiology, pathogenesis, clinical manifestation of endocrine diseases, as well as acquire practical skills in the diagnosis and treatment of these diseases in the ambulatory stage, differential diagnosis of emergency conditions, the ability to assess the patient’s ability to work and implement prevention.

1.To diagnose the endocrine diseases and conditions listed below, to be able to perform the specified manipulations, to be able to prescribe appropriate examinations and interpret them. During the ambulatory study course, the medical resident must learn how to perform and interpret the following manipulations. To consult, examine and follow up on: At least 50 patients with diabetes mellitus: • Patients at high risk of developing diabetes mellitus • Metabolic syndrome • Impaired fasting glycaemia and impaired glucose tolerance (prediabetes) • Type 1 diabetes mellitus • Type 2 diabetes mellitus • Gestational diabetes • Diabetes mellitus in case of other conditions At least 30 patients with various thyroid pathologies: • Thyrotoxicosis • Hypothyroidism • Nodular goiter • Autoimmune thyroiditis • Subacute thyroiditis • Acute thyroiditis • Thyroid cancer • Primary, secondary and tertiary hyperparathyroidism • Hypoparathyroidism • Thyroid damage in case of MEN syndromes At least 15 patients with adrenal gland pathology: • Pheochromocytoma • Cushing’s syndrome • Aldosteronoma • MEN syndromes At least 5-8 patients with pituitary gland pathology: • Acromegaly • Cushing’s syndrome • Hyperprolactinemia At least 8-10 patients with other endocrine pathology: • PCOS • Hypoaldosteronism • Osteoporosis • Rare endocrine syndromes Ability to interpret hormone and antibody test results Determination of body mass index and waist circumference (for at least 50 patients) Glucose tolerance test, its execution and evaluation (for at least 15 patients) To learn to work with different (available in Latvia) insulin administration devices - injectors (pens) To learn the operation of the insulin pump (available in Latvia), replacing or filling the insulin reservoir, setting the insulin concentration Work with glucose meters by different manufacturers (available in Latvia) and test strips for determination of glycemia, ketones, cholesterol 24-hour glycemic measurement and analysis by computer Examination of neurological condition in diabetic patients (any patient with diabetic polyneuropathy): o Work with different monofilaments o Using a tuning fork o Thermosensation test o Feel test with cotton wool o Foot examination Diabetic foot care Principles of diabetes training (to participate in training classes): o Bread units o Principle of plates (portions) Indirect ophthalmoscopy (to know the principles of performance) Management of diabetes mellitus during pregnancy Various drug tests: o To test for thyroid diseases o To test for adrenal diseases o To test for pituitary/hypothalamic diseases Principles of performing X-ray and ultrasonoscopy densitometry and data interpretation X-ray evaluation of the vertebrae (semi-quantitative X-ray evaluation of the vertebrae) Ability to assess arterial pressure and orthostasis (to measure for every patient) Ambulatory 24-hour arterial blood pressure measurement (ABPM) Knowing how to interpret the X-ray, computed tomography and magnetic resonance images of the hypothalamus and pituitary gland Principles of patient preparation for surgery on patients with: o Diabetes mellitus o Thyrotoxicosis o Hypothyroidism o Pheochromocytoma o Cushing’s syndrome o Acromegaly Interpretation of radiological thyroid examinations: o Thyroid scintigraphy o I131 and Tc99 accumulation in the thyroid gland o I131 therapy (to know specific stages of treatment and prescribing technology) To understand male reproductive endocrine function, its possible problems, including infertility and erectile dysfunction. Work with an orchidometer To be able to start and lead a conversation with a man about possible problems with erectile function, sexual activity. To be able to draw up an examination and treatment plan for patients with erectile dysfunction problems. To be able to see situations where it is possible to correct erectile dysfunction with medication, to restore normal testosterone levels with medication. To evaluate the effectiveness of applied treatment (psychological, medicinal, surgical) of erectile dysfunction.

1.Ability to diagnose endocrine diseases, prescribe the appropriate examination and treatment plan, interpret examination data, make the right decisions about patient care in dynamics.