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Endocrine Flashcards

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1
Q

Metabolic syndrome is a/w which disease?

A

DM type 2

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2
Q

Metabolic syndrome criteria:

A
  1. waist circumference >40 in (101.6cm) in M & >/=35 in (88.9cm) in W 2. BP >130/85 3. Triglycerides >/=150 4. FBG >/= 100 5. HDL: <40 M & <50 W
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3
Q

Recurrent vaginitis may often be the first symptom in women with this disease>\?

A

DM2

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4
Q

Normal HgA1C

A

5.5-7%

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5
Q

Diagnostic criteria for DM

A
  • Random plasma glucose >/= 200 w/ polyuria, polydipsia, & weight loss
  • serum fasting (at least 8hrs) BG >/=126 on 2 separate occasions
  • oral glucose tolerance test >/=200 2 hrs postprandial (rarely used)
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6
Q

Impaired glucose tolerance

A

FBG >/=100 & < 125

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7
Q

Dietary teaching for Diabetes:

Total carbs:

Fats:

Fiber:

Protein:

A

total carbs: 55-60% total caloric intake

fats: 20-30%
fiber: 25g/1000 cal
protein: 10-20% total cal

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8
Q

In treating patient with ketones, how should insulin be dosed?

A

0.5u/kg/d , giving 2/3 of dose in am & remaining 1/3 in evening

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9
Q

Which oral antidiabetic medication class is considered the gold standard?

A

Biguanides (**metformin)

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10
Q

What must the provider instruct the patient to do in order to differentiate between the somogyi effect & dawn phenomenon?

A

check BG at 0300 *somogyi effect: will be hypoglycemic at 0300

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11
Q

Somogyi effect

A

*nocturnal hypoglycemia develops stimulating a surge of counter regulatory hormones (somogyi effect) which raise BG

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12
Q

Treatment for somogyi effect

A

reduce or omit the at bedtime dose of insulin

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13
Q

Dawn phenomenon

A

** “dawn is rising” results when tissue becomes desensitized to insulin nocturnally. BG progressively rise throughout the night, resulting in inc BG at 0700

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14
Q

Treatment of dawn phenonmenon

A

add or increase the at bedtime dose of insulin

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15
Q

Calculation for osmolality

A

2(Na + K) + (glucose/18) *short hand 2(Na) NL osmo: 275-285, *280

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16
Q

Dosage of insulin in tx of DKA

A

0.1u/kg regular insulin bolus followed by 0.1u/kg/hr

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17
Q

most common presentation of hyperthryroidism

A

Graves disease

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18
Q

Usual onset of hyperthyroidism

A

20-40yrs, ** more common in women (8:1)

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19
Q

LAB findings in hyperthyroidism

A

TSH low, T3 high

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20
Q

Diagnosis of hyperthyroidism

A

thyroid radioactive iodine uptake

high uptake= Graves low uptake=subacute thyroiditis

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21
Q

Most common cause of hypothyroidism

A

Hashimotos thyroiditis

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22
Q

LAB findings in hypothyroidism

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A

TSH high T4: low hyponatremia hypoglycemia

23
Q

Symptomatic treatment for hyperthyroidism

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A

Propanolol -begin dosing w/10mg PO

24
Q

Treatment of hyperthyroidism

Study These Flashcards
A
  • Methimazole (tapazole) 30-60mg qd x 3 divided doses
  • PTU 300-600mg daily in 4 divided doses
  • thyroid sx (*must be euthyroid preop)
  • Lugols solution 2-3 gtts PO qd x 10 d (reduces vascularity of gland)
25
Treatment of thyroid crisis
PTU 150-250mg IV q6hr OR Methimazole (tapazole) 15-25mg q6hr + Lugols solution 10gtts TID OR Na Iodine 1gm slow IV + Propanolol 0.5-2g IVq4hr or 20-120mg PO q6hr + Hydrocortisone 50mg IV q6hr
26
Which medication should be avoided in thyroid crisis as it causes increase in circulating thyroid hormones?
ASA
27
Treatment of hypothyroidism
Synthyroid 50-100mcg qD, increasing dosage by 25mcg q1-2wk until sxs stabilize \*\>60 yrs --\> dec dose
28
In patient management of myxedema coma
- Synthroid: 400mcg IV x 1, then 100mcg daily - protect airway: MV PRN -fluid PRN/support hypotension -slow rewarming with blankets
29
LAB derangements seen in cushings syndrome
- hyperglycemia - hypernatremia - hypokalemia - glycosuria - leukocytosis - elevated plasma cortisol in am
30
Diagnosis of cushings syndrome
dexamethasone suppression test to differentiate cause -serum ACTH
31
Hyperpigmentation, orthotasis/hypotension and scant axillary/pubic hair are seen with which disease?
addisions disease (hypoaldosteronism)
32
LAB derangements in addisons disease
hypoglycemia hyponatremia hyperkalemia hypercalcemia elevated ESR lymphocytosis
33
Diagnosis of addisons disease
\*gold standard= cosyntropin test (ACTH stim test) 0800 plasma cortisol \<5mcg/dL
34
Inpatient management of addisons disease
Hydrocortisone 100-300mgIV \*replace volume: initally w/NS--\> D5NS 500ccx 4hr, then taper per condition
35
Outpatient management of addisons disease
Glucocorticoid & mineralcorticoid replacement: -hydrocortisone -Fludrocortisone (florinef)
36
SIADH is due to?
inappropriate WATER RETENTION
37
S&S of SIADH
- neuro changes: mild HA, seizures, coma - decreased DTRs - hypothermia - weight gain/edema - N/V - cold intolerance
38
LAB findings in SIADH
-hyponatremia (yet euvolemic) -decreased serum osmo ( \<280) -increased urine osmo (\>100) -UNa \>20
39
Treatment of SIADH, if Na \>120
restrict total fluid to 1L/24hr
40
Treatment of SIADH if Na 110-120 wo/neuro sxs
restrict fluid to 500ml/24hr
41
Treatment of SIADH if Na \<110 or + neuro sxs
Replace w/isotonic or hypertonic fluids at 1-2meq/hr + Lasix -monitor & replace electrolytes
42
Central Diabetes inspidus is due to ?
ADH deficiency
43
S&S of central DI
-polydipsia -polyuria -weight loss, fatigue -AMS -dizziness -tachycardia -hypotension -poor turgor/dry mucous membranes
44
LAB findings in DI
hypernatremia inc serum osmo (\>290) dec urine osmo (\<100) low urine specific gravity, \<1.005
45
Diagnosis of central DI
desmopression (DDAVP) challenge test , 0.05-0.1 ml nasally or 1mcg SQ or IV \*\*if decrease in urine volume--\> + central DI
46
Treatment of DI if Na \>150
D5W to replace 1/2 vol deficit in 12-24hr
47
Treatment of DI if Na \<150
use 1/2 NS or NS
48
dose of DDAVP in acute situations
1-4mcg IV or SQ q12-24hr
49
maintenance dose of DDAVP
10mcg q12-24hr intranasally
50
Pheochromocytoma is due to?
tumor of adrenal medulla causing excess catecholamine release
51
Diagnosis of pheochromocytoma
plasma free metanephrines: -normetanephrine \>2.5pmol/ml OR metanephrine levels \>1.4 pmol/ml **assay of urine catecholamines**: 24hr \>2.2 mcg metanephrine per mg Cr AND \>5.5mcg VMA per mg Cr
52
Management of pheochromocytoma
Phentolamine (Regitine) 1-2mg IV q5min until controlled, then 1-5mg IV q12-24hr \*convert to PO asap, Phenoxybenzamine (dibenzyline)
53
Treatment of choice for pheochromocytoma
surgical removal

Endocrine (1 decks)

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