Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adult Primary Care > T3 - DM/Thyroid - Endocrine/GI > Flashcards

T3 - DM/Thyroid - Endocrine/GI Flashcards

1
Q

MODY and LADA

A

Mature Onset Diabetes of the Young
Late Autoimmune DM in Adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AGBI

A

Alpha cells - glucose
Beta cells - insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In DM2, initially there is _______ levels of insulin, and then as the cells tire out, insulin levels _______

A

High
Drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is c-peptide? Are levels high or low in T1DM? T2DM?

A

The part that gets cleaved during enzymatic activation of insulin. If 0 insulin is produced (T1DM), then it makes sense that c-peptide levels would be LOW.
T2DM would be. Hight.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ominous Octet of DM

A

Impaired insulin secretion from Beta cells
Increased glucagon secretion from alpha cells
NT dysfunction (satiety)
Decreased glucose uptake in muscles
Increased glucose reabsorption by kidneys
Increased lypolysis
Decreased incretin effects
Increased hepatic glucose production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

According to ADA, who should get screened for DM?

A

Adults over 35 who have a BMI >25 and at least 1 risk (risks = 1st deg relative with DM, high risk race, Hx CVD, HTN, HDL <35 or TG >250, Hx PCOS, physical inactivity, preDM A1c >5.6)
Test q3 years or yearly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How often should pre-diabetics get checked for DM?

A

Yearly screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A1C for pre-diabetes and diabetes

A

Pre = 5.7-6.4
DM= >=6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should kids get screened for DM?

A

Kids 10yo or at the onset of puberty who are overweight/obese (85% or more) with 1 or more RF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fasting plasma glucose is ____ in pre-dm and _____ in DM. Goal for diabetics is ______
Goal A1c for diabetics is _______
OGTT after 2 hours of 75G glucose load for pre-DM is _______ and DM is _______.
Goal post prandial BG for diabetics is ______

A

100-125, >=126, 80-130
<7%
140-199, >=200
<180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should pregnant patients get their OGTT?

A

24-28wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PP women who had GDM should have an OGTT at ______

A

4-12 wks PP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Women who had GDM should be screened ______

A

For DM every 3 years for life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hemaglobinopathies and anemias - why do these matter in DM?

A

They can cause a falsely low A1C since the RBCs turn over more rapidly than every 3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Insulin is initiated at _______ u/kg/day and titration. Most are at around _________ u/kg/day

A

0.2-0.6
0.4-1.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

“-tides” are ________ and “-flozin” are _______

A

GLP1
SGLT-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

An expected _____ bump in creatinine happens with the initiation of ACEi/ARB therapy. Anything more than this should be investigated.

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If the patient has proteinuria, what Rx should be considered?

A

Control glucose (<7%)
Control BP (<140/90)
ACEi/ARB
SGLT2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diabetic neuropathy can “goof up” proprioception which can lead to more ______

A

Falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NAFLD + NASH can lead to

A

Cirrhosis, hepatic ca, portal HTN, liver failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Level 1, 2 and 3 hyPOglycemia.

A

1 = 54-70
2 <54
3 severe event requiring treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If you’re a diabetic, you should expect to burn between ______ CHO per 30min of moderate exercise

A

1-20.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

More episodes of hypoglycemia you have, the less your brain recognizes hypoglycemia.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acidosis in diabetics -
RR?
Na?
K?

A

Increased
Falsely decreased
Falsely high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you calculate the anion gap? What is normal?

A

Take the number of cations (+Na) minus the sum of the number of anions (- CL and HCO3)
Normal is 8-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Urine dipstick doesn’t read the MAIN ketone in DKA, only the other 2, so if ketones are low, or neg, it could still have ketones.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the SICK acronym for DM?

A

On sick days:
Sugar: Check your Sugar every 2-3 hours or as necessary
Insulin: Always take your Insulin
Carbs: Drink lots of fluids. If sugars are high drink sugar free beverages. If sugars are low, drink Carb containing beverages.
Ketones: check your urine ketones every 4 hours. Take rapid acting insulin if ketones are present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

For DM, the PCV pneumococcal vaccine is recommended for 19-65yo.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Too much thyroid hormone during development = _________ stature. Why?

A

Short. Because the bones mature and ossify sooner than normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What will you see in TSH and T4 in Hashimoto’s?

A

Increase TSH and decrease T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If TSH is high and T3/T4 are normal/low, then what is the condition?

A

Hypothyroidism or sub clinical hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

If TSH is low and T3/T4 are normal/high, what is the conditions?

A

Hyperthyroidism or sub clinical hyperthyroid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In Central hypopthyroidism, what differs from primary hypothyroidism?

A

Central = normal/low or slightly high TSH with low or low-normal t3/T4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Single best test of thyroid function?

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Titration TSH at a 6-8wk follow up.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Young adults will start at _______% predicted dose calculated by ______
Middle age start at ______ % predicted dose _______
Elderly or Cardiopulmonary disease start at _________

A

79-90% (1.5-2.2mcg/kg ideal body weight)
65-75% (1.5-2.0mcg/kg ideal body weight)
12.5-25mcg/d and add 25mcg every 6 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Restoring a euthyroid state in some one with hypothyroidism especially elderly and those with cardiopulmonary disease can cause ________

A

Tachycardia
Increased O2 consumption/demand
Exacerbation of underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should we consider in every patient newly diagnosed with hypothyroidism?

A

Adrenal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How should you take synthroid?

A

On an empty stomach first thing in the morning (only water- no food OR COFFEE!) and wait at least 30 minutes prior to any food or other medications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Your patient has been put on the starting dose of synthroid for hypothyroidism. They are back for their 6 week follow up and their TSH level is <0.5. What should you do?
What if their level was >4?

A

<0.5, then decrease dose by 12.5-25mcg
If > 4, then increase dose by 12.5-25mcg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the therapeutic TSH range while on medication?

A

0.5-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

TSH will be >___ but < ____ in subclinical hypothyroidism. Should you treat?

A

5 less than 10
Treat if symptomatic. Monitor for worsening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is Pemberton’s sign?

A

If a patient has a goiter or enlarged thyroid gland, if they raise their hands up to their ears and leave for 1-2 minutes, their face will flush due to compression of the veins and can’t empty from the face.

44
Q

Are “cold” or “hot” thyroid nodules more concerning?

A

Cold. More likely to be cancerous (1/20)
Hot are generally benign.

45
Q

______% of post partum thyroiditis regain normal function

A

80%

46
Q

H.Pylori triune treatment:

A

PPI, Amoxicillin and clarithromycin for 10 days.

47
Q

IBS (as opposed to just regular constipation or diarrhea) must have:

A

BLOATING.

48
Q

Difference between UC and CD

A

UC - superficial layer only, 3x more common than chron’s, colon only,
CD - all layers of the intestine and all areas including oral mucosa, strictures and fistulas, erythema nodosium.
Both- fatigue, tenesmus, anemia, bowel urgency.

49
Q

What is a good test for patients who come in with nausea.

A

PO challenge. Can they keep fluid and meds down?

50
Q

Associated symptoms with n/v

A

Eating disorders, pain, headache, dizziness, tinnitus, diarrhea, fever, anxiety, AMS, pregnancy, new medication (SE), recent bad food intake.

51
Q

Some DDX for N/v

A

Acute abdomen, morning sickness, eating disorder, pregnancy, constipation, infection, pain, med SE, migraine, metabolic cause (DKA/HHS), Meniere’s MI, cholecystitis.

52
Q

Buttaro pg 744 - antiemetic meds

A
53
Q

Upper abd pain UPPERSTOMACH acronym

A

Urinary - stone, infx
Pancreas - pancreatitis, mass
Pulmonary. - PNA/PE
Ectopic - pregnancy
Really early appendicitis

Stomach - GI, perf, ulcer
Twisting - volvulous, ischemic bowel
Obstruction - bowel, FB
MI - ACS, myocarditis/pericarditis, aneurysm
Aorta - AAA, dissection
Cholecystitis/cholangitis
Hepatic - hepatitis.

54
Q

What 3 things should be done first if you have an abd pain complaint?

A

ABCs, sick or not sick, ECG.

55
Q

What type of pain main increase with cough?

A

Parietal pain (irritation of the peritoneum)

56
Q

What type of pain is dull, cramping, poorly localized?

A

Visceral

57
Q

How does referred pain typically present?

A

Aching

58
Q

Www.merkmanual.com

A
59
Q

classic triad for appendicitis

A

RLQ pain, anorexia and nausea

60
Q

4 PE tests for appendicitis

A

Psoas sign
Obturator sign
McBurney’s point
Rovsing’s sign (palpate LLQ and pain is felt in RLQ)

61
Q

What percentage of patients have increased WBC in appendicitis?

A

75-90%

62
Q

Most common cause of GI obstruction?

A

Adhesions post surgery, hernias and tumors.

63
Q

T/F: Ileus is the same as obstruction

A

False. Ileus can lead to an obstruction

64
Q

RF for pancreatitis

A

ETOH, gallstones, HLD

65
Q

In 50% of pancreatitis patients, pain radiates to the _______

A

Back

66
Q

__________% of pancreatitis patients have associated N/v

A

90

67
Q

A 3 fold increase in lipase can indicate pancreatitis, but not what KIND.

A
68
Q

Murphy’s sign is used to assess for cholecystitis. How do you test?

A

Inspiratory arrest with palpation of RUQ under ribs.

69
Q

Peritonitis is usually secondary to another cause. Patients appear _____ and don’t want to ______

A

Very sick
Move

70
Q

GER can be normal physiology. GERD is ______ with troublesome symptoms

A

> 2weeks

71
Q

Some DDX for GERD

A

MI, esophagitis, peptic ulcer, post nasal drip, H.Pylori.

72
Q

If someone has Barrett’s esophagus, how often should they get their EGD?

A

1-2years WITH biopsy.

73
Q

Peptic ulcers - _____% caused by chronic NSAID use. Pain ________ and relieved by __________

A

25
Wakens patient’s at night.
Relieved by eating or vomiting.

74
Q

PPI should not be used for more than a few months. Assess for chronic PPI OTC use.

A
75
Q

Constipation is a ______ not a _______

A

Symptoms
Disease.

76
Q

What is the Rome IV criteria for constipation?

A

Must have 2 or more of the following:

2 or less stools/week
Hard or lumpy stool
Straining
Feeling of obstruction or incomplete evacuation
Manual assistance >25% of the time
NOT meet criteria for IBS-C.

77
Q

Difference between NAFLD and NASH

A

NonAlcoholic Fatty Liver Disease - Non-inflammatory no S/s. No Treatment. Lifestyle modification.
NASH - NonAlcoholic Steatohepatitis- inflammatory. No s/s but rarely fatigue, malaise or vague RUQ discomfort

78
Q

With NASH or NAFLD, you will see an increase in what labs?

A

AST and ALT 2-5x normal ratio and elevated ALK phos.

79
Q

What is the Fib-4 test for NASH risk?

A

Age (35-65)
AST
ALT
Platelet count

80
Q

How do patients present with cirrhosis?
CV
Derm
Neuro
GI
Hem
Repro

A

CV - esophageal varices, capital Medusa, ankle edema
Derm - spider nevi, clearly icterus, jaundice
Neuro - coma, liver flap (course hand tremor)
GI - femoral hepaticus, jaundice, hemorrhoids, splenomegaly, hematemesis, peptic ulcers, melena
Hem - anemia, bleeding tendency
Repro - testicular atrophy, Gynecomastia,

81
Q

5 categories of diarrhea

A

Infection
Inflammatory
Secretory
Malabsorption/osmotic
Increased motility

82
Q

Carcinoid tumor or VIPomas would be an example of. _______ diarrhea.

A

Secretory

83
Q

IBS-D would be an example of _____ diarrhea

A

Increased motility

84
Q

UC and CD would be examples of _____ diarrhea

A

Inflammatory

85
Q

Celiac disease, lactose intolerance, post-op short bowel or pancreatic insufficiency (CF) would be examples of ____ diarrhea.

A

Malabsorption.

86
Q

What is a BRAT diet?

A

Banana, rice, apples, toast

87
Q

If someone has a malabsorption condition, what should you check/replenish ?

A

Fat sol vitamins (DEAK), poor absorption of carbs (underweight), Iron, minerals like B12 and proteins.

88
Q

What is celiac disease often miss diagnosed as?

A

IBS

89
Q

What is dermatitis herpetiformis?

A

Skin condition associated with celiac disease.

90
Q

How do you screen for Celiac Disease?

A

tTG-IgA and total IgA

91
Q

Clinical considerations for Celiac disease?

A

GFD for life, registered dietician referral, test and treat for nutrient deficiencies (iron, folic acid, VitD, vit B12), screen for osteoporosis (70% develop osteopenia), and repeat tTGA 6mo post GFD

92
Q

IBD has a peak onset of ________ and another peak at _______

A

20/30
50s

93
Q

Imaging results using the terms “string sign”, “rectal sparing”, “thumb printing” “ skip lesions” or “cobblestone mucosa” suggests _________

A

Chron’s Disease

94
Q

Dietary management of Chron’s disease?

A

Increased fiber
Low fat
Trial dairy restriction
Rheum and dietician referral
Vitamin/mineral supplements

95
Q

Bloody diarrhea, arthritis, skin lesions, tenesmus and tachycardia/orthostatic hypotention could be signs of _____

A

UC

96
Q

Low grade fever, watery diarrhea, perianal fissures, fistulas are signs of ____

A

Chron’s disease

97
Q

Lubiprostone. (Amitiza) is a ______ and FDA approved for treatment of ______ in ______ only, not ______

A

Chloride channel activator
IBS-C
Women
Men

98
Q

1st line tx for IBS-D
2nd line

A

Loperamide
Bile acid sequestrants and antispasmodics PRN and prophy.

99
Q

What are carcinoid syndrome and VIPoma?

A

Carcinoid syndrome - serotonin secreting cancerous tumors
VIPoma - neuroendocrine tumor that secrete vasoactive intestinal polypeptide (VIP)
These both cause secretory type diarrhea

100
Q

RF for colon CA

A

Age >50
Smoking
IBD
Family Hx
Obesity
Diet high in red meat and fats.

101
Q

Colon cancer screening

A

Grade A for 50-75
Grade B for age 45-49 and Grade C for age 75

102
Q

One main cause of GI bleeds?

A

Diverticulosis

103
Q

Constellation of LLQ tenderness, w/w/out peritoneal s/s, fever and leukocytosis could suggest?

A

Sigmoid diverticulitis

104
Q

Avoid these 4 things in diverticular disease:

A

Laxatives, enemas, opioids and NSAIDS.

105
Q

90% of NON-STI or IBD related anal fissures are posterior midline. A lateral midline anal fissure often indicates ____, ____ or _____

A

UC, CD STI.

Adult Primary Care (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions