Endocrine Flashcards
(36 cards)
The most appropriate screen for diabetic nephropathy is
a. creatinine clearance
b. microalbuminuria
c. BUN/CR
d. serum creatinine
b. microalbuminuria
Microalbuminuria means small amounts of protein in the urine. This is a sensitive and early measure of kidney disease in diabetics. it is an appropriated screen fro undiagnosed diabetic nephropathy. Microalbuminuria is screened annually in Type 2 diabetics who are atleast 12 years. If microalbuminuria is positive, it should be reassessed in 3-6 months. many false positives can occur. However, if it is positive after repeating once or twice, it is likely a true positive.
What is the earliest detectable glycemic abnormality in a patient with T2DM?
a. postprandial glucose elevation
b. Nighttime hyperglycemia
c. fasting glucose elevation
d. Abnormal hgba1c
a. postprandial glucose elevation
Which choice best describes the most common presentation of a patient with T2DM>
a. Acute onset of hyperglycemia with other symptoms
b. hyperlipidemia and presence of retinopathy
c. Insidious onset of hyperglycemia with weight gain
d. Microalbuminuria
Insidious onset of hyperglycemia with weight gain,
It is a slow progress
choice a Acute onset… is type 1
Microalbuminuria usually happens after several years of DM.
Ideally a patient should have a fasting glucose that is
a. between 60-100 mg/dl
b. less than 126
c. less than 100
d. repeated in a non-fasting state
less than 100
HgbA1C is 9.2%. What is the relationship between Hgb A1c and the patients lipid values?
a. There is no specific relationship
b. Elevated lipids will increase as HgbA1c increases
c. HgbA1c decreases as triglycerides decrease.
d. HgbA1c will decrease as HDL values increase.
HgbA1c decreases as triglycerides decrease.
2 factors contribute to elevated HgbA1c values: Glucose and excessive alcohol consumption. Diabetics with elevated triglyceride levels and elevated HgbA1c can usually expect to have improved triglyceride levels as Hgb A1C levels begin to normalize.
Hyperthyroidism may affect the BP:
a. by producing an increase in systolic BP and diastolic readings.
b. by producing a decrease in DBP
c. when the Heart rate is increased
d. with unpredictable results.
a. by producing an increase in systolic BP and diastolic readings.
Hyperthyroidism causes secondary hypertension.
How is diagnosis of microalbuminuria made?
two positive screens on urine dipstick at least 3-6 months apart.
Which lab abnormality very commonly accompanies hypothyroidism?
a. hypernatremia
b. polycythemia
c. dyslipidemia
d. Hypoprolactinemia
c. dyslipidemia
especially when TSH values>10
consequently patients with dyslipidemia should have their TSH values evaluated.
Think hypothyroidism with its weight gain causes dyslipidemia.
What is used to evaluate most ambulatory patients with primary hypothyroidism?
a. TSH only
b. TSH and T4
c. TSH, T4 and T3
d. TSH and TRH
TSH only
a 30 year old female patient who complains of fatigue has a screening TSH performed. Her TSH value is 8 m U/L. What should be done next?
a. Begin thyroid supplementation
b. Repeat the TSH and T4
c. Begin supplementation and repeat the TSH in 4-6 weeks
d. Measure the T4 and consider repeating the test in a month.
b. Repeat the TSH and T4
TSH value levels rise and fall continuously. Consequently, TSH levels are repeated and an average is usually calculated. A diagnosis of hypothyroidism can be made after a second abnormal TSH unless the initial value was very elevated and the patient is symptomatic. When an elevated TSH is discovered, it should be repeated and a serum free T4 can be measured. Depending on these results, a diagnosis of thyroid disease can be made.
Which of the following should be periodically monitored with the use of a biguanide?
a. Creatine kinase (CK)
b. alkaline phosphatase
c. ALT
d. creatinine
creatinine
Which of the following should be periodically monitored with the use of a thiazolidinedione?
a. Creatine kinase (CK)
b. alkaline phosphatase
c. ALT
d. creatinine
c. ALT
The meglitinide analogues are particularly helpful adjuncts in T2DM care to minimize risk of a fasting hypoglycemia b. nocturnal hyperglycemia c. postprandial hyperglycemia d. postprandial hypoglycemia
c. postprandial hyperglycemia
Which of the following statement best describes the Somogyi effect?
a. Insulin induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia.
b. early morning elevated blood glucose levels result in part from growth hormone and cortisol-triggering hepatic glucose release
c. late evening hyperglycemia is induced by inadequate insulin dose.
d. episodes of postprandial hypoglycemia occur as a result of inadequate food intake.
a. Insulin induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia.
Somogyi or dawn Phenomenon?
1. Early morning hyperglycemia results when nocturnal hypoglycemia stimulates a surge of counter regularity hormones that raise blood sugar. This patient is hypoglycemia at 3 am and rebounds with and elevated blood sugar at 7 am.
Treatment: reduce or eliminate the HS dose of insulin
- Somogyi
Somogyi or dawn Phenomenon?
1. Early morning hyperglycemia results when tissue becomes desensitized to insane nocturnally, blood sugar gets progressively higher throughout the night and is elevated at 7 am. This desensitization is felt to be due to the presence of growth hormone which spikes at night.
Treatment: add or increase the dose of HS insulin.
. Dawn Phenomenon
The use of exenatide (GLP 1-agonist like byte, victoza, bydureon injection only) has been associated with the development of:
a. leukopenia
b. pancreatitis
c. lymphoma
d. Vitiligo
b. pancreatitis
Lab findings in heatstroke usually include:
a. elevated total creatine kinase
b. anemia
c. metabolic alkalosis
d. hypokalemia.
a. elevated total creatine kinase
due to skeletal muscle injured by muscle cramping and convulsion releasing this enzyme. because of the release of this intracellular electrolyte with tissue damage, hyperkalemia is common.
Obesity is defined as having a BMI equal to or greater than
a. 25
b. 30
c. 35
d. 40
30
The commonly recommended physical activity level of 10,000 steps per day is roughly the equivalent of walking ___ miles:
a. 1 to 2
b. 2 to 3
c. 3 to 4
d. 4 to 5
d. 4 to 5
The findings of a painless thyroid mass and TSH level of less than 0.1 IU/ml in a 35 year old woman is most consistent with:
a. autonomously functioning adenoma
b. Graves disease
c. Hashimotos disease
d. thyroid malignancy
a. autonomously functioning adenoma
A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of a; adenomatous lesion b. Graves disease c. Hashimotos disease d. thyroid malignancy
d. thyroid malignancy
Which of the following medication is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism?
a. propranolol
b. diazepam
c. carbamazepine
d. verapamil
propanolol
As part of an evaluation of a 3 cm round, mobile thyroid mass, you obtain thyroid US scan revealing a fluid-filled structure. the most likely diagnosis is:
a. adenoma
b. thyroid cyst
c. multinodular goiter
d. vascular lesion
b. thyroid cyst
