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FNP: Systems Review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Risk factors for Type II diabetes includes

A
  • Family History
  • History of Gestational Diabetes
  • Obesity
  • Sedentary Lifestyle (which promotes weight gain)
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2
Q
  • Rand. BG or 2-hr plasma BG > 200mg.dL
  • Fasting glucose > 126mg/dL
  • Hemoglobin A1C > 6.5%
  • ** The above mentioned are all criteria to diagnose **
A
  • DIABETES
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3
Q

Undiagnosed diabetes can increase _______ in women and men.

A
  • Candida/Yeast
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4
Q

The most appropriate screen for “Diabetic Nephropathy” is:

A
  • Microalbuminuria - screened annually in diabetic patients.

* If positive, it should be re-assessed in 3 to 6 months

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5
Q
  • The earliest detectable glycemic abnormality in a patient with Type II diabetes is
A
  • Postprandial Glucose Elevation
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6
Q

Acanthosis Nigricans is commonly associated with

A
  • Insulin Resistance
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7
Q

A normal TSH level is ______

A
  • 1 - 4
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8
Q

The “GOLD STANDARD” for diagnosing Hashimoto’s Thyroiditis

A
  • Elevated Antimicrosomal Antibodies
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9
Q

Diabetic patients are placed on which medication to preserve the kidneys (Renal System)

A
  • ACE-Inhibitors: ACE Inhibitors have a anti-proteinuric effect that is usually seen as early as 6 - 8 weeks
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10
Q
  • Elevated TSH
  • Low Free T4 (Thyroxine)
  • The above mentioned are classic findings for:
A
  • Hypothyroidsim
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11
Q

Two known factors contribute to ↑ Hgb A1C, they are…

A
  • Elevated Blood Glucose

* Excessive ETOH consumption

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12
Q

A common effect of hyperthyroidism on blood pressure is …

A
  • Increased SBP and DBP
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13
Q

When Hgb A1C ↓, _______ also decreases

A
  • Triglycerides
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14
Q

Replacement of T4 to bring a patient back to a euthyroid state is based on

A
  • Ideal Body Weight (body weight x 1.6 = replacement dose/day)
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15
Q
  • Weakness ( A “passing out” feeling )
  • Headache
  • Clammy hands/Skin
  • Difficulty thinking and concentrating
  • ** All above mentioned are Signs and Symptoms of ***
A
  • Hypoglycemia (BG
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16
Q
  • Low TSH, and…
  • Elevated T4 (Thyroxine) and T3 (Triiodothyroxine)
  • **All above mentioned is indicative of ***
A
  • Hyperthyroidism
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17
Q
  • Most common in juveniles
  • Abrupt cessation of insulin production
  • Presence of Ketones
  • All above mentioned are indicative of*
A
  • Type I Diabetes
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18
Q

The most common cause of Hypothyroidism is:

A
  • Hashimoto’s Thryoiditis
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19
Q

1st line pharmacological treatment for Type II Diabetes includes:

A
  • Biguanides (Metformin)
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20
Q

How often should TSH be monitored in a patient who has started pharmacological therapy for hypothyroidsim

A
  • Every 4 to 6 weeks
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21
Q

Macrovascular damage from Diabetes includes:

A
  • Atherosclerosis

* Heart Disease (C.A.D and M.I)

22
Q

Medications that can cause Hypothyroidism

A
  • Post Radioactive Iodine
  • Lithium
  • Amiodarone
23
Q

How often should patients with Type II diabetes get an eye exam

A
  • Annually
24
Q

Common cause of Hyperthyroidism

A
  • Graves Disease (Thyrotoxicosis)
25
Q
  • Obesity, HTN, and dyslipidemia
  • Also known as Insulin-resistant syndrome or “Syndrome X
  • Higher risk for Type II diabetes and Cardiovascular Dx
A
  • Metabolic Syndrome
26
Q

Microvascular changes associated with diabetes

A
  • Retinopathy
  • Nephropathy
  • Neuropathy
27
Q

A normal free T4 (Thyroxine) is:

A
  • 10 - 27
28
Q
  • “Covers one meal at a time”
  • Insulin’s onset is 15-30 minutes
  • Peaks at 30 minutes - 2 hours
A
  • Immediate Acting Insulin (Lispro or Aspart)
29
Q

Metformin is contraindicated in which patient population

A
  • Reduced Kidney Function/Kidney Failure
30
Q

Medication for Hyperthyroidism

A
  • Propylthiouracil (PTU)

* Beta-blockers (Tachycardia)

31
Q
  • Insulin’s onset is 1-2 hours
  • Peaks at 6-14 hours
  • “Lasts from breakfast to dinner”
A
  • NPH (Humulin N/Novolin N)
32
Q

A fluctuation in what hormone causes hot flashes

A
  • Estrogen
33
Q

When switching levothyroxine (Synthroid) for a off brand will cause

A
  • A elevation/fluctuation in TSH
34
Q
  • Onset is 30-60 minutes
  • Peaks at 1-5 hours
  • Covers from “meal to meal” (breakfast to lunch, lunch to dinner)
A
  • Regular Insulin/Short Acting (Humulin R)
35
Q

It is considered the master gland

A
  • Hypothalmus
36
Q

A possible clinical finding during an eye exam of a diabetic includes

A
  • Microaneurysms (diabetic retinopathy).
  • Cool wool exudates.
  • Neovascularization.
37
Q
  • Lab abnormalities found in hypothyroidism includes:
A
  • Increased LDL (↑ LDL)
  • Hyponatremia (↓ Na+)
  • Macrocytosis (↑ MCV)
  • Elevated CK (↑ CK)
38
Q

The initial management of diabetics include:

A
  • Set A1C goal
  • Reduce cardiovascular risk factors
  • Evaluate use of metformin
  • Physical exam and monitoring
39
Q
  • An elevated TSH, with…
  • A normal T4 and T3
  • The above mentioned is considered as*
A
  • Subclinical Hypothyroidsim
40
Q

How does Metformin affect glucose

A
  • Metformin
  • Reduces hepatic glucose production and glucose absorption.
  • Insulin sensitizer via increased peripheral glucose uptake.
41
Q
  • Taking Levothyroxine with food will do what?
A
  • Increase (↑) TSH - Due to decreased absorption of the medication
42
Q
  • What population is an A1C of less than 8%
A
  • Older patients with Diabetes
43
Q
  • Metformin is often chosen as 1st line due to it’s:
A
  • Effect on glucose
  • Absence of weight gain effect
  • Absence of Hypoglycemic adverse reactions
  • Low cost
  • Reduction in all-cause mortality
44
Q
  • What is the screening for Hyperthyroidism or Hypothyroidism?
A
  • TSH (TSH only)
45
Q
  • When should Insulin (Basal insulin) be started?
A
  • When A1C is in the double digits
46
Q
  • Known as secretagogues (potentiates insulin secretion)
  • This medication may cause weight gain and/or hypoglycemia.
  • To be used in combo or as monotherapy
A
  • Sulfonylureas (Glipizides/Glimipiride/Glyburide)
47
Q

A patient with cardiac disease or co-morbidities should be started at what dose of Levothyroxine (Synthroid)?

A
  • 25mcg daily: always start low and go slow.
48
Q
  • Contraindications of Metformin use includes:
A
  • Renal and/or Hepatic disease
  • Alcoholism
  • Advanced Age
  • Hypoxia (associated with Cardiac or Pulmonary problems)
  • Sepsis
  • Dehydration
49
Q
  • This happens with “nocturnal hypoglycemia (2am-3am)” , stimulates the liver to produce glucagon to raise blood sugar.
  • The fasting glucose from this production will be elevated from this effect.
  • Normally due to overtreatment of insulin at bedtime.
A
  • Somogyi Phenomenon (normally happens “early” in the morning
50
Q
  • Random episodes of severe hypertension (SBP > 200 or DBP > 110) along with…
  • Abrupt onset of severe headache, tachycardia, and anxiety.
A
  • Pheochromocytoma

FNP: Systems Review (10 decks)

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