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Clinical Medicine LAB - Professor Sample > Endo #2 > Flashcards

Endo #2 Flashcards

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1
Q

Thyroid Scanning (Thyroid Scintiscan) what is it ?

A

Radioactive substance is given to patient and the thyroid uptakes the isotope

Camera is passed over the neck and thyroid can be visualized

**the T uptakes the isotope and it makes it glow when u take images and you are looking for thyroid nodules **

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2
Q

Thyroid Scanning (Thyroid Scintiscan) when is it used ?

A

Evaluate for thyroid nodules

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3
Q

Thyroid Scan Classifies the nodule or mass: nonfunctioning ?

A

Cold

  • *nonfucniton or inactive - cold
  • *
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4
Q

Thyroid Scan Classifies the nodule or mass functioning ?

A

Hot

** active - hot

functioning like T NL functions - HOT

not function NL like T then it will not pick up the Isotope

HOT - lighting up even after the rest of the T is done with the isotope **

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5
Q

Thyroid Scan: Hot result ?

A

Graves disease
Ig attacking TSH receptors making the area more active

Toxic goiter
is it functioning or not, G enlarged cause T was over active = toxic, or is it there from inflammation or destruction - differenacite between the two

Functional adenoma

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6
Q

Thyroid Scan: Cold result ?

A

Thyroiditis

Non-toxic Goiter

Carcinoma - not normal functioning tha T normally does

Cyst

Nonfunctional Adenoma

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7
Q

Thyroid Scan own notes ?

A

Iodine deficiency - non toxic - over worked over time

US = FNA - feel a mass do this test to see if it is H or C and, a US to see if it is a cysts or not and put a needle in the area and get a bx sample

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8
Q

Glucose Testing own notes ?

A

L - gametogenesis

H blood glucose levels makes insulin releases from the P which drive G into the cell and it makes the L take G out of the blood and store it as glycogen

L blood glucose it acts on the P to cause glycogen release and release G into the blood

frequency I use and no eating - hypo

Dm is actually a high blood sugar problem

to high G they can go into ketoacidosis and electrolyte distrunabces

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9
Q

Glucose Testing types ?

A

Random Blood Glucose

2 hour post-prandial glucose

Fasting Blood Glucose

Hemoglobin A1C

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10
Q

Who should get tested: Testing for TII Diabetes and Prediabetes in asxs. adults ?

A

TII Diabetes testing should be done in all adults who are overweight or obese

BMI > equal to 25 or 23 in sia americans, who have > or equal to 1 diabetes risk factor.

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11
Q

Diabetes risk factors ?

A

Physical inactivity

first degree relative with D

high risk ethnicity

Women who delivered a baby > 9 lbs or dx with GDM

HDL-C <35 +- TG >250

HTN (>140/90)

A1C > or equal to 5.7%, IGT or IFG

condition associated with insulin resistance: obesity, acanthuses nigerians, PCOS

CVD hx.

**impaired glucose tolerance - IGT

PCOS - polycystic ovarian syncrome **

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12
Q

Who should get tested? Age ?

A

Testing should begin at age 45, especially if individual is overweight or obese

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13
Q

Who should get tested? If NL results ?

A

repeat testing in > or equal to 3 yr intervals

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14
Q

Hgb A1C what is it ?

A

About 7% of Hgb A can combine with glucose in a process called glycosylation (not easily reversed)

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15
Q

Hgb A1C when is it used ?

A

Diagnose and/or monitor diabetes

Takes 3 weeks to rise and 4 weeks to decrease

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16
Q

Hgb A1C what does it mean ?

A

Gives a percentage (glucolyciyaed in the serum) that corresponds to an average blood glucose range

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17
Q

Average daily blood sugar - 135 = what A1C level ?

A

6%

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18
Q

Average daily blood sugar - 170 = what A1C level ?

A

7%

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19
Q

Average daily blood sugar - 205 = what A1C level ?

A

8%

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20
Q

Average daily blood sugar - 240 = what A1C level ?

A

9%

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21
Q

Average daily blood sugar - 275 = what A1C level ?

A

10%

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22
Q

Average daily blood sugar - 310 = what A1C level ?

A

11%

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23
Q

Average daily blood sugar - 345 = what A1C level ?

A

12%

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24
Q

Hgb A1C own notes ?

A

typically it is quarterly - every three months

great patients and young and health - 6 months

lover than 7 for non preg.

anything about 6.5% is Diabete and we want to keep out D around 7% ( more stringent = <6.5%)

5.7-6.4% pre DM - they are become insulin resistance - body is need more I to do the job it used to do

Need I to open the door for G to get into the cell

No Insulin then TI DM
TII - rusty dorr hinges - I used to be able to open door , now there need two big men to open door cause the door is resistant ( adipose, fat cell - reduce insulin = obese patients, diet - attack P with high glucose over and over build resistance)

drugs to increase I from the P or used the I they have in a more effective way

Impaired fasting glucose - pre DM

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25
2 hr post-prandial glucose (PPG) what is it ?
Measurement of the amount of glucose in the blood 2 hrs after a meal is ingested. Meal acts as a glucose challenge. Usually glucose levels return to “pre-meal” range after 2 hours
26
2 hr post-prandial glucose (PPG) when is it used ?
Evaluate for diabetes
27
2 hr post-prandial glucose (PPG) NL ?
≤ 140 mg/dL
28
2 hr post-prandial glucose (PPG) Diabetes value ?
≥ 200 mg/dL
29
2 hr post-prandial glucose (PPG): Values between ___-___ should be rechecked with another test ( this is the impariened fasting glucose level )
140-200
30
2 hr post-prandial glucose (PPG) own notes ?
2 hours after a meal is ingested used they will retrun to pr meal levels around 2 hours - NL = less then 140 in 2 hours normally
31
Oral Glucose Tolerance Test (OGTT) ?
Similar to the post-prandial glucose although in this test a glucose “load” is administered. Usually 75 g of anhydrous glucose given PO Same values as 2 hr PPG **75 G is the 2 hours test - after 2 hours it should be less then 140 - over 200 is DM **
32
OGTT
 Gestational DM Testing own notes ?
for pregos we give 50 g load for 1 hour ( need to be 8 hours fasting) if failed then need to come back in another day with a 100 g test ( test at 1 hr, 2 hr, and 3 hr) stick with the NDDG #’s ( anything over the numbers is DM)
33
OGTT
 Gestational DM Testing: fasting NDDG # ?
105
34
OGTT
 Gestational DM Testing: 1 hour NDDG # ?
190
35
OGTT
 Gestational DM Testing: 2 hour NDDG # ?
165
36
OGTT
 Gestational DM Testing: 3 hour NDDG # ?
145
37
Fasting Plasma Glucose (FPG) NL ?
70-100(99) mg/dL
38
Fasting Plasma Glucose (FPG) pre-diabetic ?
100-126
39
Fasting Plasma Glucose (FPG) diabetes ?
> or equal to 126 ** THIS IS FASTING!!!** **have them come in i the morning w/o eating or drinking anything**
40
Fasting is defined as ?
no caloric intake for more than or equal to 8 hours
41
Random Plasma Glucose (RPG) diabetes number ?
Any value ≥200 mg/dL = diabetes
42
DM Autoantibody Panel what is it ?
Panel used to discover autoantibodies Useful in diagnosing Type I DM
43
DM Autoantibody Panel when is it used ?
Diagnosing juvenile diabetes or Late onset Autoimmune Diabetes of the Adult Correlate with progression to Type I DM Increased risk of developing DM in 1st degree relatives in TI DM
44
Insulin Autoantibody (IAA) ?
Antibodies to insulin
45
Islet Cell Antibody (ICA) ?
Antibodies attacking islet cells
46
Glutamic Acid Decarboxylase Antibody (GAD Ab) presence ?
Type I DM Gestational DM may need insulin for life. ( highly likely ) **TII DM have lower Neg. titers get all three with the panel
47
Insulin what is it ?
Measures serum levels of insulin
48
Insulin when is it used ?
Used to diagnose insulinoma Used to evaluate patients with fasting hypoglycemia **more insulin then it should ( opposite prob then DM) and they are constant dropping BS, hypoglycemia when fasting always **
49
Insulin increased ?
Insulinoma Cushing syndrome: -Overproduction of cortisol Obesity: -Insulin resistance causes persistent highs Acromegaly: - Overproduction of growth hormons - somatmetings
50
Insulin decreased ?
IDDM -insulin dependent DM Hypopituitarism: -Reduced thyroid and adrenal functions
51
C-Peptide what is it ?
Cleaved off of proinsulin molecule to create insulin Measurement of endogenous insulin production **measure meant out endogenous Insulin - insulin being made in the body CP is discarded remnant with I is made and it is cleave off when making I - good indicator of how much I is being produced **
52
C-peptide increased ?
Insulinoma Pancreas transplant Renal failure Oral hypoglycemic agents
53
C-peptide decreased ?
Factitious hypoglycemia IDDM Pancreatectomy
54
Adrenal Hormones: Zona glomerulosa , examples?
Mineralcorticoids (regulate mineral balance) Aldosterone
55
Adrenal Hormones: Zona fasciculata, examples?
Glucocorticoids (regulate glucose metabolism) Cortisol, Corticosterone, Cortisone **C - stress, increase glucose , decrease inflammation , **
56
Adrenal Hormones: Zona reticularis , examples?
Androgens (stimulate masculinization) Dehydroepiandrosterone
57
Adrenal Hormones: Adrenal medulla , examples?
Stress hormones (stimulate sympathetic ANS) Epinephrine, Norepinephrine
58
Cortisol is a ?
Potent glucocorticoid **excess cortison - cushing decrease - addisons **
59
↑ Cortisol from what ?
prolonged stress ``` Surgery Trauma Chronic infection or disease Hypo- or hyperthermia Restraint ```
60
↑ Cortisol effects on the body ?
↑ Plasma glucose ↑ Plasma fatty acids ↑ Plasma amino acids ↓ Inflammatory response
61
↑ Cortisol own notes ?
body is trying to cope with increase Inflamma response in the body prolong period of stress = inflammation - body thinks it is under attack and raise G levels and give u things to fight stress off by lower inflammation levels and battle the stress off
62
Cortisol Testing ?
Serum cortisol Saliva for cortisol 24 Urine free cortisol Dexamethasone suppression test ACTH stimulation test **8am = highest ( peak) lowest at 4 pm ( tough) **
63
Primary adrenal insufficiency ?
due to impairment of the adrenal glands Addisons Disease q
64
Secondary adrenal insufficiency ?
Is caused by impairment of the pituitary gland or hypothalamus * *secondary - pituitary level * *
65
Tertiary adrenal insufficiency ?
is due to hypothalamic disease and decrease run corticotropin releasing factor (CRF)
66
Laboratory Testing for Adrenal Insufficiency | initial testing ?
Measure early morning serum cortisol * *initial tets is morning C level at 8 am - if higher then 5 then it is less likes for Adrenal insufficiency * *
67
Measure early morning serum cortisol: __________ µg/dL makes primary adrenal insufficiency less likely
Cortisol ≥5 If serious consideration is given to this diagnosis, perform stimulation testing
68
Follow abnormal cortisol results with ?
adrenocorticotropic hormone (ACTH) testing
69
If ACTH _____ pg/dL – adrenal failure likely
>300 **Pituitary is making it but Adrenal Gland is not working ( adrenal failure primary)**
70
If ACTH ____ pg/dL – pituitary failure likely.
<10 **- ACTH is not being produce - prob. a pituitary problem **
71
If ACTH _____ pg/dL – administer ACTH (cosyntropin) stimulation test
<300
72
Testing based on ACTH result ?
ACTH stimulation test (cosyntropin)
73
ACTH stimulation test (cosyntropin) measures ?
Measures cortisol response to cosyntropin (250 µg using serial cortisol measures )
74
ACTH stimulation test (cosyntropin): _______ µg/dL ( with synthetic ACTH) – primary severe adrenal failure
Cortisol <5
75
ACTH stimulation test (cosyntropin):_______ µg/dL – normal; primary adrenal insufficiency unlikely ( cause it is responding to ACTH being put into the system)
Cortisol >20
76
Abnormal cortisol testing ?
abnormal Cortisol results and think adrenal INsufficencit, then follow initiall test with ACH level = is it pituitary fault or hypothalamus fault
77
ACTH Stimulation Test: ACTH = decreased (negative feedback) Cortisol = increased condition ?
NL response
78
ACTH Stimulation Test: ACTH = decreased (negative feedback) Cortisol = decreased condition ?
Primary Adrenal insufficiency
79
ACTH = ↑ Cortisone = ↓ Aldosterone = ↓ Basal secretion ?
Primary the adrenal gland is the problem
80
ACTH = ↓ Cortisone = ↓ Aldosterone = NL Basal secretion ?
Secondary pituitary problem , it is not making it
81
ACTH = ↓ Cortisone = ↓ Aldosterone = NL Basal secretion ?
Tertiary Hypothalamus problem ,
82
24 hour urine for free cortisol ?
Collect 24-hour urine specimen Measure cortisol excreted in the urine If high, suggests Cushings
83
24 hour urine for free cortisol ? dont to dx ?
cushings
84

Evaluating for Cushings

Serum Cortisol and ACTH: Endogenous examples ?
Pituitary adenoma Tumors producing ACTH (carcinoid) Adrenal tumors
85

Evaluating for Cushings

Serum Cortisol and ACTH: Exogenous examples?
Exogenous steroids | prednisone, glucocrticoids
86

Evaluating for Cushings

: endogenous ACTH ?
↑ elevated ↑ elevated ↓ decreased ( ACTH trying to shut off)
87

Evaluating for Cushings

: endogenous basal cortisol ?
8am: elevated 4pm: elevated
88

Evaluating for Cushings

: exogenous ACTH ?
↓ decreased | because no fluctuation, constant High C levels cause we are giving it to them
89

Evaluating for Cushings

: exogenous basal cortisol ?
Loss of diurnal variation
90
Evaluating for Cushings: Dexamethasone Suppression Test ?
Synthetic steroid similar to cortisol Suppresses ACTH secretion Results in drop of 50% or more of plasma cortisol **give them a steroid and see what C levels do , it should suppress ACTh and drop plasma cortisol levels **
91
ACTH = decreased Cortisol = decreased condition ?
Normal Response
92
ACTH = elevated Cortisol = elevated condition ?
Pituitary Tumor ( no response to Dx)
93
ACTH = decreased Cortisol = elevated condition ?
Adrenal Tumor
94
ACTH = decreased Cortisol = increase condition ?
Steroid treatment

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