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(OMS1) PCM 2 Exam 1 > Lecture 1: Approach to Endocrine Disorders I > Flashcards

Lecture 1: Approach to Endocrine Disorders I Flashcards

1
Q

What defines Diabetes Mellitus Type II?

A

-Insulin resistance leading to hyperglycemia, leading to organ damage

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2
Q

About what percent of the US population is estimated to have diabetes?

A

8% of population with 25-40% undx

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3
Q

What are some risk factors for diabetes?

A 
Age > 45
BMI > 25
family hx
History of gestational diabetes
Dyslipidemia
HbA1c > 5.7 or fasting glucose > 100
Polycystic ovary syndrome
History of vascular disease
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4
Q

What are some clinical presentations of diabetes?

A

Polyuria
Polydipsia
Polyphagia: excessive hunger

Rapid weight loss
Fatigue
Blurry vision 
Fruity breath
Tingling pain in extremities
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5
Q

What is acanthosis nigricans?

A

Brown to black, poorly defined, hyperpigmentation of the skin normally found around neck, armpits, navel, and other body folds

Sign for diabetes

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6
Q

What criteria has to be met to diagnose diabetes according to ADA?

A
  1. HbA1c > 6.5%
  2. Fasting glucose > 126 mg/dL
  3. 2 hour glucose > 200 mg/dL on oral glucose tolerance test
  4. Random glucose > 200 mg/dL

Any one of these is enough for dm dx

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7
Q

What specific tests and exams would you perform, if you suspect a patient having diabetes?

A
  • Fasting lipids
  • Liver enzymes
  • Renal function
  • Microalbuminuria
  • Dilated eye exam
  • Foot exam
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8
Q

What do you check for diabetic foot exam?

A
  • calluses, breaks in skin, erythema, and dryness

- also pulses, sensation and insurance coverage of diabetic footwear

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9
Q

What is the first course of tx for DM?

What is the follow up mgt for DM?

A
  • Lifestyle changes
  • Oral metformin
  • Insulin
  • Checking HbA1c levels every 3 months
  • Smoking cessation
  • Blood pressure control
  • Hyperlipidemia control
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10
Q

What is DKA associated with?

A

usually Type 1, but can also happen in Type 2

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11
Q

What are symptoms of diabetic ketoacidosis?

A
  • Mental changes
  • Nausea, vomiting
  • Abdominal pain
  • Dehydration
  • Kussmaul respirations (deep breathes/working hard to breathe)
  • Fruity smelly breath
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12
Q

What is the difference between DKA and HHS (Hyperosmolar hyperglycemic state)?

A

DKA:
glucose >200, in metabolic acidosis with pH <7.3 and <15 bicarb + ketones in blood and urine]

HHS:
glucose >600 - marked hyperglycemia, minimal acidosis with pH > 7.3 and bicarb >15, absent or mild ketosis, >320 serum osmolality

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13
Q

How do you treat a patient for DKA?

A

Admit to hospital! do not send home!

-IV fluids, IV insulin, and potassium replacement

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14
Q

What is metabolic syndrome?

A

Cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes

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15
Q

What are risk factors for metabolic syndrome?

A
  • Overweight or obese
  • Sedentary lifestyle
  • Genetics
  • Aging
  • Diabetes
  • CVD
  • Lipodystrophy
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16
Q

How do you diagnose metabolic syndrome?

A

Must have 3 of the following conditions:

  • Abdominal obesity
  • Triglycerides > 150
  • HDL < 40 in men and < 50 in women
  • BP > 130/85
  • Fasting glucose > 100
17
Q

Complications of Type II DM

A 
microvascular dz (retinopathy, nephropathy, neuropathy)
macrovascular dz (MI, stroke, PVD)
increase in infections
18
Q

How would you manage metabolic syndrome?

A

Lifestyle changes is primary resort

-weight loss meds, surgery, statins, fibrates, BP meds and metformin

19
Q

What conditions are associated with metabolic syndrome?

A

PCOS
Sleep apnea
Fatty liver dz
hyperuricemia

20
Q

What are symptoms of Type I diabetes?

Main management of type 1 DM?

A
  • Polydipsia
  • Polyuria
  • Weight loss with hyperglycemia and ketonemia or ketonuria
  • DKA

-education and insulin, admit to hospital if presenting with DKA

21
Q

How would you differentiate dx of type 1 DM with type 2?

A

Age at presentation (kids for Type 1)

Ketosis at presentation, usually acute severe (more common for type 1)

22
Q

What conditions are associated with Type 1 DM?

A

thyroiditis, celiac dz, addison’s dz

(OMS1) PCM 2 Exam 1 (14 decks)

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