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endocrine Flashcards

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1
Q

Which type of DM is insulin dependent and typically develops in a younger patient?

A

type 1

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2
Q

Which type of DM is associated with unintentional weight loss?

A

type one DM

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3
Q

Which type of DM is associated with ketone development? (ketonemia, Ketonuria)

A

type one DM

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4
Q

Name three differentials for unintended weight loss

A

cancer

DM type 1

TB

hyperthyroidism

HIV/AIDS

Depression

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5
Q

What are the normal values for BUN?

A

10-20

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6
Q

What are the normal values for creatinine?

A

0.5-1.5

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7
Q

Name three causes of elevated BUN

A

dehydration

GI bleeding

high protein diet

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8
Q

What is the most sensitive indicator of renal function?

A

Serum creatinine

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9
Q

normal hgb A1c

A

5.5-7

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10
Q

normal fasting BG

A

60-99

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11
Q

How much of a diet should be carbohydrates?

A

55-60%

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12
Q

When do you start somebody on insulin?

A

If they present with ketoneuria or ketonemia

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13
Q

How do you begin insulin therapy?

A

0.5units/kg/day

giving 2/3 of the dose in the morning and 1/3 in the evening

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14
Q

What are two causes of early morning hyperglycemia?

A

Dawns phenomenon

Somogyi phenomenon

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15
Q

If a patient is hypoglycemic at 03:00 and then their BG rebounds and surges to hyperglycemia is their problem somogyi or dawns phenomenon?

A

Somogyi, because it is opposite, the treatment is to reduce or omit the PM dose of insulin

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16
Q

If a patient is hypoglycemic at 03:00 and then their BG is high and it continues to rise. Is their problem somogyi or dawns phenomenon?

A

Dawns, it rises, treatment is to increase the insulin

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17
Q

What are diagnostic criteria for metabolic syndrome?

A

BP > or = 130/85

obesity

fasting BG > or = to 100

waist circumference (visceral adiposity)

elevated triglyceride level >150

HDL<40 in men

HDL< 50 in women

*you need three of these criteria for diagnosis

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18
Q

What is the step-wise approach to the treatment of DM II?

A

weight reduction

dietary changes

oral antidiabetics

insulin therapy

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19
Q

Which type of DM has an insidious onset, pt may present with repeated vagitnitis, chronic cellulitis, recurrent prescription glassess changes?

A

type 2 DM

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20
Q

What are some examples of sulfonyureas and what is their mechanism of action?

A

glipizide, glyburide

stimulate the pancreas to release more insulin

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21
Q

What is an example of a biguinide and what is its mechanism of action and what is a side effect?

A

metformin

side effect: lactic acidosis

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22
Q

What is the standard of care per ADA for the treatment of type II DM?

A

metformin

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23
Q

What would you consider in a presention of intracellular dehydration with elevated BG>250, hyperkalemia, ketonemia, ketonuria?

A

type one diabetes, DKA

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24
Q

What would you consider in a presentation of dehydration, BG>1200?

A

HHNK

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25
What is normal serum osmolality?
275-285
26
When the patient is acidotic is the potassium high or low?
high, low pH = high K+
27
How do you resuscitated DKA patient?
1st isotonic (NS or LR) until stable 2nd hypotonic (to treat intracellular dehydration) 1/2NS 3rd once BG trends down D5 1/2
28
How do you start an insluin gtt?
0.1units/kg of regular followed by 0.1units/kg/hr
29
Which has a normal anion gap, DKA or HHNK?
HHNK
30
What is the most common presentation of hyperthyroidism?
Graves disease
31
What is the most common cause of HYPOthyroidism?
Hashimoto's thyroiditis
32
What are causes of hyperthyroidism?
TSH secreting tumor pituitary tumor high dose amiodarone Graves disease
33
Symptoms of hyperthyroidism
bulging eyes heat intolerance increased appetite with associated weight loss
34
Labs associated with hyperthyroidism
TSH is low T3 elevated T4 can be elevated
35
Medications used for hyperthyroidism
propranolol for symptoms (for shakes and palpitations) PTU for treatment of hyperthyroidism
36
Iodine deficiency can be caused by:
iodine deficiency
37
What are the labs associated with hypothyroidism?
TSH elevated T4 low T3 is not definately associated with hypothyroidism diagnosis
38
Extreme hypothyroidism can lead to:
Myxedema coma
39
ACTH hypersecretion
Cushings
40
Cushings is caused by:
hypersecretion of ACTH adrenal tumors chronic administration of glucocorticoids (like in transplant patients)
41
Moon face, buffalo hump, risk for infections, acne, hirtuism
chronic steroid users and/or cushings because of increase in androgens
42
Who will have HTN, the patient with cushings or the patient with addisons?
Cushings because ACTH--\> steroids--\> vasoconstriction
43
What are the triad of labs for cushings?
hyperglycemia (because steroids prevent the uptake of glucose in the cell) hypernatremia hypokalemia
44
What are the triad of labs for addisons disease?
hypoglycemia hyponatremia hyperkalemia
45
What is the product of aldosterone and androgen?
mineralocorticoids
46
What is the treatment of addisons?
glucocorticoids and mineralocorticoids
47
Innapropriate water retention, hyponatremia, caused by skull fracture brain tumor and lung disease.
SIADH (too much ADH)
48
In SIADH the urine osmolality is high or low?
high
49
If patient is hyponatremic and Na is greater than 120 what is the treatment?
limit fluid to one liter a day
50
If sodium is 110-120 and patient is symptomatic how do you treat?
3% or hypertonic IV fluids
51
What are the three types of DI?
central (hypothalmic or pituitary) nephrogenic (acquired from pylo) psychogenic
52
Signs and symptoms of DI
polyuria excessive thirst signs of dehydration dilute urine
53
Is the serum osmo high or low in DI?
high
54
How do you discern central from nephrogenic DI?
Vasopressin challenge: + in central - in nephrogenic
55
How do you treat hypernatremia?
D5W
56
How do you teach a patient to use outpatient DDAVP?
intranasally
57
Pheocromocytoma
adrenal medulla tumor characterized by paroxysmal or sustained HTN due to excssive circulating catecholamines
58
labile BP applies to pt's with hyperthyroidism OR pheochromocytoma
pheochromocytoma
59
Tests of pheochromocytoma
plasma free metanephrines urine metanephrines (24 hour), urine cr, catecholamine, VMA To confirm pheochromocytoma CT scan
60
management of pheochromocytoma involves
surgical incision of the tumor, watch for adrenal insufficiency and hemorrhage post-op
61

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