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endocrine Flashcards

1
Q

testing to dx DM

A

blood glucose >= 126 fasting on more than one occasion
A1C >= 6.5

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2
Q

somogyi effect

A

nocturnal hypoglycemia
patient is hypoglycemia at 0300 but rebound with an elevated BS @ 0700

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3
Q

what is GAD-65

A

glutamic acid decarboxylase found in 80% of patient with type I DM

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4
Q

when do ketone usually develop

A

type I DM

along with weight loss

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5
Q

tx for somogyi effect

A

reduce or omit the at bedtime dose of insulin

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6
Q

dawn phenomenon

A

blood glucose becomes progressively elevated throughout the night resulted in elevated blood glucose at 0700 (the dawn is rising)

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7
Q

tx for dawn phenomenon

A

add or increase the at bedtime dose insulin

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8
Q

metabolic syndrome

A

BP 130/85
waist circumference: Men >= 40 “ ; women >=35 “
FBG: >130
Triglycerides >= 150
HDL: men <40 and <50 in women

must have 3 to dx

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9
Q

pt present with recurrent vaginitis upon assessment you discover she is also having blurred vision and pruritus . what do you test and dx

A

ketones in urine/blood
DM II

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10
Q

what is the starter drug for Type II DM

A

biguamide (Metformin, glucophage, glumetza)

black box warning: lactic acidosis c/o muscle pain

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11
Q

this medication can increase risk of thyroid cancer and is part of REMS

A

GLP-1 agonists
trulicity, betta, Victoza, ozemic, semaglutide

REMS - risk and evaluation and mitigation streagegy: pancreatitis

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12
Q

how do you determine if pt is having dawn effect or somogyi effect

A

test 0300 BS - if pt is hypoglycemic it is somogyi effect

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13
Q

s/s of DKA

A

kussmaul breathing
fruity breath
glucose > 300
ketonemia
glycosuria
low bicarb HCO3
low CO2
hyperkalcemia
hyperosomolality

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14
Q

tx of DKA

A

fluid
0.1 u/kg regular insulin IV bolus following by 0.1 u/kg/hr - if glucose does not fall by at least 10% in first hour repeat bolus

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15
Q

s/s of HHS

A

change in LOC
greatly elevated glucose > 1000
hyperosmolality

relatively normal ph
normal anion gap

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16
Q

tx of HHS

A

0.1 u/kg regular insulin IV bolus followed by 0.1 u/kg/hr infusion . repeat bolus if glucose doesn’t fall by 10% in first hour

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17
Q

elevated TSH and decreased T3 and T4

A

hypothyroidism

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18
Q

most common presentation of hyperthyroidism

A

graves disease

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19
Q

pt presents with increased appetite, weight loss, palpitation and exophthalmos what do you test and dx

A

TSH - elevated

t3 & t4 - decreased
hyperthyroidism

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20
Q

what is a common disease associated with hypothyroidism

A

hashimotos thyroiditis

21
Q

s/s of hypothyroidism

A

cold intolerance
muscle fatigue
puffy eyes
edema of hands and face

22
Q

elevated TSH and decreased t4

A

hypothyroidism

23
Q

mtg of hypothyroidism

A

levothyroxine

24
Q

mtg of hyperthyroidism

A

propranolol for symptoms
thiourea drugs for mild cases, goiters - methimazole, propylthiouracil

25
Q

tx of thyroid crisis

A

over drive of hyperthyroidism
propylthiouracil 150-250 q 6
methimazole 15-25 mg q 6
AVOID ASA/NSAIDs

26
Q

complication of hypothyroidism and mtg

A

myxedema coma
protect airway
fluid replace prn
levothyroxine 400mcg IV x1 then 100mcg daily
slow rewarming with blankets-avoid circulatory collapse

27
Q

labs associated with Cushing syndrome

A

hyperglycemia
hypernatremia
hypokalemia
elevated ACTH

28
Q

test performed for cushing

A

dexamethasone suppression test to detremne cause- administer dexamethasone and cortical is still elevated

29
Q

s/s of cushign dx

A

central obesity
moon face with buffalo hump
acne
hirustism
HTN

30
Q

hyper secretion of ACTH by pituitary

A

Cushing syndrome

31
Q

deficiency in cortisol, androgen and aldosterone

A

addisons disease

32
Q

s/s of addisons disease

A

hyperpigmentation in buccal mucosa and skin teases
diffuse tanning /freckles
scant axially and pubic hair
hypotension

33
Q

labs associated with addisons disease

A

hypoglycemia
hyponatremia
hyperkalemia

plasma cortisol < 5mcg/dl @ 0800

34
Q

what test do you administer to determine Addison disease

A

cosyntropin (synthetic ACTH) stimulation test

35
Q

mtg of Addison disease

A

replace glucocorticoid and mineralocorticoid - hydrocortisone and fludrocortisone acetate (Florinef)

36
Q

disease of water retention and increased release of ADH

A

SIADH -syndrome of inappropriate antidiuretic hormone

37
Q

s/s of SIADH

A

change in LOC r/t hyponatremia
seizure, coma
decreased DRTs

38
Q

labs associated with SIADH

A

hyponatremia , decreased serum osmolarity
increased urine osmolality (thick urine )
increased urine sodium > 20

39
Q

mtg of SIADH

A

NA >120 - restrict fluid, 1000ml/day
NS <110 or neuro s/s : replace with hypertonic or isotonic saline and lasix
goal 1-2 mEq/h increase per hour

40
Q

mtg of DI

A

serum Na >150- administer D5W to replace fluid loss over 12-24 hours
serum Na <150, administer 1/2 NS or 0.9 NS

DDAVP 1-4mcg IV or Sq q 12-24 hours

maintenance dose of DDAVP is intransally

41
Q

decrease ADH resulting in volume depletion and inability to concentrate urine

A

diabetes insipidus (DI)

42
Q

s/s of DI

A

increased thrifty
polyuria

43
Q

labs r/t DI

A

hypernatremia - increased serum osmolarity
decreased urine osmolality (thin urine)
hypokalemia

44
Q

test administered with DI

A

desmopression challenge - determine if central DI if positive

45
Q

excess catecholamine releases with paroxysmal HTN

A

pheochromocytoma

almost always due to tumor of adrenal medulla

46
Q

pt presents with palpitations, weight loss, labile BP what test do you order and dx

A

TSH.-will be normal

pheochromocytoma

47
Q

labs/DX of pheochromocytoma

A

TSH normal
Plasma-free metanephrines in blood
24 hour urine: catecholamines, metanephrines, vanillylmandelic acid (VMA), and creatine
CT used to confirm

48
Q

MTG and monitoring of pheochromocytoma

A

surgical removal of tumor
monitor for Hypotension (depleted catecholamines), adrenal insufficiency , hemorrhage

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