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Flashcards in endocrine Deck (61):
1

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

type 1

2

Which type of DM is associated with unintentional weight loss?

type one DM 

3

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

type one DM

4

Name three differentials for unintended weight loss

cancer

DM type 1

TB

hyperthyroidism

HIV/AIDS

Depression

5

What are the normal values for BUN?

10-20

6

What are the normal values for creatinine?

0.5-1.5

7

Name three causes of elevated BUN

dehydration

GI bleeding

high protein diet

8

What is the most sensitive indicator of renal function?

Serum creatinine

9

normal hgb A1c

5.5-7

10

normal fasting BG

60-99

 

11

How much of a diet should be carbohydrates?

55-60%

12

When do you start somebody on insulin?

If they present with ketoneuria or ketonemia

13

How do you begin insulin therapy?

0.5units/kg/day 

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

14

What are two causes of early morning hyperglycemia?

Dawns phenomenon

Somogyi phenomenon

15

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

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

16

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?

Dawns, it rises, treatment is to increase the insulin

17

What are diagnostic criteria for metabolic syndrome?

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

 

18

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

weight reduction

dietary changes

oral antidiabetics

insulin therapy

19

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

type 2 DM

20

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

glipizide, glyburide

stimulate the pancreas to release more insulin

21

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

metformin

side effect: lactic acidosis

22

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

metformin

23

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

type one diabetes, DKA

24

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

HHNK

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