Endocrine

Question 1

What are the 4 major clinical signs of DM? What distinguishes this from Cushing’s in a dog?

Answer 1

Polyuria
Polydipsia
Polyphagia
Weight loss - not in Cushing’s

Question 2

What are the 4 major clinical signs of DM? What distinguishes this from hyperthryoidism or CKD in a cat?

Answer 2

Polyuria
Polydipsia
Polyphagia - not in CKD
Weight loss
Same clinical signs for hyperthyroidism

Question 3

What clinpath abnormalities are associated with DM?

Answer 3

Elevated glucose, ALP, cholesterol
Glucosuria

Question 4

What are the diagnostics for DM?

Answer 4

Glucosuria (UA) with hyperglycemia (glucometer)
May need fructosamine in cats

Question 5

What is the initial treatment plan for DM in a cat?

Answer 5

Glargine 1-2U BID with U100 syringes
Diet: >40% ME protein, low carbohydrate, canned preferred

Question 6

What is the initial treatment plan for DM in a dog?

Answer 6

Vetsulin 0.25-5U BID with U40 syringes
Diet: high fiber (soluble and insoluble)

Question 7

When should the first DM recheck occur? What should happen at that appointment?

Answer 7

@ 7 - 14 days
Spot glucose + urine dipstick
+/- fructosamine, BGC
If glucose < 150 g/dL, obtain samples every hour

Question 8

What does the ideal BGC look like in a dog?

Answer 8

Question 9

What does the ideal BGC look like in a cat?

Answer 9

Question 10

Troubleshoot each BGC

Answer 10

Question 11

What cutoffs are considered insulin resistance in the dog and the cat?

Answer 11

Question 12

What are owner/insulin issues that could be causing apparent insulin resistance?

Answer 12

Question 13

What are the counterregulatory hormones relevant to DM?

Answer 13

Question 14

What 2 data points do you always need in a diabetic dog?

Answer 14

Insulin type and dose
Current weight

Question 15

What is the Somogyi effect?

Answer 15

Question 16

How do we troubleshoot a Somogyi effect curve?

Answer 16

Question 17

What is the treatment for DKA?

Answer 17

Fluids
Potassium if hypokalemic
Regular insulin CRI
Look for underlying cause!!

Question 18

What should be monitored when treating a patient for DKA?

Answer 18

Weakness: hypokalemia
Pale mm: hypophosphatemia
Mentation changes: rapid drop in glucose

Question 19

What is the difference between typical and atypical Addison’s?

Answer 19

Typical: no cortisol or aldosterone
Low Na, High K
Atypical: no cortisol

Question 20

What clinical signs are associated with lack of cortisol?

Answer 20

Slightly thin
Abdominal pain
Blood/melena on rectal

Question 21

What clinical signs are associated with lack of aldosterone?

Answer 21

Shock due to hypovolemia and hypotension
Bradycardia despite hypotension

Question 22

What is the emergency workup for Addison’s disease?

Answer 22

EKG
BP
VBG (glu, cr, pH, Na, K, iCa)
PCV/TS
USG

Question 23

What CBC findings are associated with Addison’s disease?

Answer 23

Lack of stress leukogram
Anemia

Question 24

What biochemistry findings are associated with Addison’s disease?

Answer 24

Decreased:
*Glucose
*Cholesterol
*Na/Cl
*Bicarb
*+/- Albumin
Increased:
*Azotemia
*Potassium
*Calcium
*+/- Liver enzymes

Question 25

What test rules **out** Addison's disease?

Answer 25

Baseline cortisol

Question 26

What additional diagnostics can be run to diagnose Addison's disease?

Answer 26

Question 27

What is the emergency treatment for an Addisonian crisis?

Answer 27

Fluids Dexamethasone Correct hyperkalemia: fluids, dextrose +/- insulin, calcium gluconate

Question 28

How is Addison's disease treated long-term?

Answer 28

Question 29

When should you **not** test for Cushing's?

Answer 29

Do not test sick animals Animals must have clinical signs

Question 30

What are the screening tests for HAC?

Answer 30

Urine Cortisol:Creatinine ACTH stim Low dose dex suppression test

Question 31

What are the discriminatory tests for HAC?

Answer 31

High dose dex suppression Endogenous ACTH Imaging (US, CT, MRI)

Question 32

How is the LDDST performed?

Answer 32

Question 33

How is the ACTH stim performed?

Answer 33

Question 34

How is HAC ruled **out**?

Answer 34

Urine cortisol:creatinine

Question 35

What is the treatment for HAC?

Answer 35

Trilostane

Question 36

How do we monitor trilostane efficacy?

Answer 36

Question 37

What is seen on UA with HAC?

Answer 37

Decreased USG +/- Proteinuria UTI (bacteriuria without pyuria)

Question 38

What is the recommended test to diagnose HAC?

Answer 38

LDDST

Question 39

What does a normal LDDST look like in a healthy dog?

Answer 39

Question 40

How is the LDDST interpreted?

Answer 40

Question 41

What is the treatment for hyperthyroidism?

Answer 41

Methimazole 2.5mg per cat

Question 42

What are the guidelines for hypothyroid diagnosis?

Answer 42

Question 43

What are the results of tT4, fT4, and TSH with primary hypothyroidism?

Answer 43

Low tT4, fT4 High TSH

Question 44

What are the results of tT4, fT4, and TSH with euthyroid sick syndrome?

Answer 44

Low tT4 Normal fT4 Normal or low TSH

Question 45

What is the treatment for hypothyroidism?

Answer 45

L-thyroxine 0.02 mg/kg BID