endocrine

Question 1

testing to dx DM

Answer 1

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

Question 2

somogyi effect

Answer 2

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

Question 3

what is GAD-65

Answer 3

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

Question 4

when do ketone usually develop

Answer 4

type I DM

along with weight loss

Question 5

tx for somogyi effect

Answer 5

reduce or omit the at bedtime dose of insulin

Question 6

dawn phenomenon

Answer 6

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

Question 7

tx for dawn phenomenon

Answer 7

add or increase the at bedtime dose insulin

Question 8

metabolic syndrome

Answer 8

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

Question 9

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

Answer 9

ketones in urine/blood
DM II

Question 10

what is the starter drug for Type II DM

Answer 10

biguamide (Metformin, glucophage, glumetza)

black box warning: lactic acidosis c/o muscle pain

Question 11

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

Answer 11

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

REMS - risk and evaluation and mitigation streagegy: pancreatitis

Question 12

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

Answer 12

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

Question 13

s/s of DKA

Answer 13

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

Question 14

tx of DKA

Answer 14

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

Question 15

s/s of HHS

Answer 15

change in LOC
greatly elevated glucose > 1000
hyperosmolality

relatively normal ph
normal anion gap

Question 16

tx of HHS

Answer 16

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

Question 17

elevated TSH and decreased T3 and T4

Answer 17

hypothyroidism

Question 18

most common presentation of hyperthyroidism

Answer 18

graves disease

Question 19

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

Answer 19

TSH - elevated

t3 & t4 - decreased
hyperthyroidism

Question 20

what is a common disease associated with hypothyroidism

Answer 20

hashimotos thyroiditis

Question 21

s/s of hypothyroidism

Answer 21

cold intolerance
muscle fatigue
puffy eyes
edema of hands and face

Question 22

elevated TSH and decreased t4

Answer 22

hypothyroidism

Question 23

mtg of hypothyroidism

Answer 23

levothyroxine

Question 24

mtg of hyperthyroidism

Answer 24

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

Question 25

tx of thyroid crisis

Answer 25

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

Question 26

complication of hypothyroidism and mtg

Answer 26

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

Question 27

labs associated with Cushing syndrome

Answer 27

hyperglycemia hypernatremia hypokalemia elevated ACTH

Question 28

test performed for cushing

Answer 28

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

Question 29

s/s of cushign dx

Answer 29

central obesity moon face with buffalo hump acne hirustism HTN

Question 30

hyper secretion of ACTH by pituitary

Answer 30

Cushing syndrome

Question 31

deficiency in cortisol, androgen and aldosterone

Answer 31

addisons disease

Question 32

s/s of addisons disease

Answer 32

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

Question 33

labs associated with addisons disease

Answer 33

hypoglycemia hyponatremia hyperkalemia plasma cortisol < 5mcg/dl @ 0800

Question 34

what test do you administer to determine Addison disease

Answer 34

cosyntropin (synthetic ACTH) stimulation test

Question 35

mtg of Addison disease

Answer 35

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

Question 36

disease of water retention and increased release of ADH

Answer 36

SIADH -syndrome of inappropriate antidiuretic hormone

Question 37

s/s of SIADH

Answer 37

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

Question 38

labs associated with SIADH

Answer 38

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

Question 39

mtg of SIADH

Answer 39

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

Question 40

mtg of DI

Answer 40

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

Question 41

decrease ADH resulting in volume depletion and inability to concentrate urine

Answer 41

diabetes insipidus (DI)

Question 42

s/s of DI

Answer 42

increased thrifty polyuria

Question 43

labs r/t DI

Answer 43

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

Question 44

test administered with DI

Answer 44

desmopression challenge - determine if central DI if positive

Question 45

excess catecholamine releases with paroxysmal HTN

Answer 45

pheochromocytoma almost always due to tumor of adrenal medulla

Question 46

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

Answer 46

TSH.-will be normal pheochromocytoma

Question 47

labs/DX of pheochromocytoma

Answer 47

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

Question 48

MTG and monitoring of pheochromocytoma

Answer 48

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