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MKSAP - Internal > Endocrine > Flashcards

Flashcards in Endocrine Deck (77)
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1

how can you establish a dx. of DM?

1. FPG > 126 mg/dL (7 mmol/L)
2. random PG > 200 mg/dL (11.1 mmol/L)
and symptoms OR
3. OGTT > 200 mg/dL (11.1 mmol/L)
4. HbA1c > 6.5%

2

impaired fasting glucose

fasting plasma glucose 100-125 mg/dL (5.6-6.9 mmol/L)

3

impaired glucose tolerance

OGTT at 2 hrs is 140-199 mg/dL (7.8 to 11.0 mmol/L)

4

diagnosis of metabolic syndrome

1. BP > 130/85
2. TG > 150, HDL < 40
3. FPG > 110
4. waist circumference > 40 in

5

Tx. for pt with impaired fasting glucose or impaired glucose toleracnce

intensive lifestyle change - 30 minutes of exercise daily and calorie-restricted diet

6

first line agent for newly diagnosed type II DM

metformin

7

in whom is metformin contraindicated in?

renal insufficiency pts
- Cr > 1.4 mg/dL for women and > 1.5 in men

8

side-effects/cons of rosiglitazone/pioglitazone

edema, weight gain
increased fracture risk in women
increased CV morbidity
high costs

9

what is exenatide approved for?

combination regimens with oral agents (tx. of DM 2) - inappropriate as monotherapy

10

hospitalized pt with uncontrolled diabetes - what should you tx with?

basal bolus insulin regiment consisting of long-acting insulin and rapid-acting insulin before meals

11

diabetic pt presents to eye doctor; on exam, hard exudates, microaneurysms and minor hemorrhages are seen; when questioned, the patient does not report any decline in vision

non-proliferative diabetic retinopathy

12

diabetic pt presents to eye doctor with loss of vision; on exam, cotton wool spots and neovascularization are visible - dz?

proliferative diabetic retinopathy
- fibrosis causes retinal detachment and vision loss

13

macular edema

new vessels in the eye become more permeable and leak serum (diabetic retinopathy)

14

what two interventions can decrease incidence and progression of diabetic retinopathy?

tight glycemic control
BP control

15

Tx. of proliferative diabetic retinopathy and macular edema

timed laser photocoagulation

16

what is the ideal insulin regimen to reduce episodes of hypoglycemia?

long acting basal insulin + rapid-acting insulin

17

long acting basal insulins

glargine
detemir
NPH - intermediate acting; 2x daily dosing

18

rapid acting preprandial insulins

lispro
aspart
glulisine

19

tests to establish dx. of DKA?

serum glucose, electrolytes, ketones and arterial blood gases

20

diagnostic criteria for DKA (4)

1. blood glucose < 250 mg/dL
2. anion gap metabolic acidosis (ph < 7.30)
3. serum HCO3 < 15
4. positive serum or urine ketones

21

diagnostic criteria for hyperosmolar hyperglycemic syndrome (5)

1. blood glucose > 600 mg/dL
2. arterial pH > 7.30
3. serum HCO3 > 15
4. serum osmolarity > 320
5. absent serum or urine ketones

22

first step in management of hyperglycemia hyperosmolar syndrome

IVF with normal saline
- once volume status is restored, switch to hypotonic solutions for maintenance therapy

23

most effective Tx. of DKA (After IVF)

insulin drip (IV)
- measure plasma glucose every 1-2 hours and adjust dose accordingly

24

can xanthelasma occur w/o hyperlipidemia?

yes, but it is mostly assoc with familial dyslipidemias

25

clusters of erythematous papules typically on extensor surfaces associated with extremely high TG levels (> 3000)

eruptive xanthomas

26

tendon xanthomas

subcutaneous nodules on extensor tendons; assoc with familial hypercholesterolemia

27

plane xanthomas

yellow-red plaques found in skin folds of neck and trunk; assoc with familial dyslipidemias and hematologic malignancies

28

which endocrine disorder is assoc with elevated lipid levels?

hypothyroidism

29

first step in management of patients with isolated low HDL cholesterol

lifestyle interventions - exercise, tobacco cessation, weight reduction

30

non-HDL cholesterol goal

30 mg/dL above the patients LDL goal (so. approx 160)