Endocrine Flashcards
(231 cards)
1
Q
What are the normal thyroid values?
A
0.4-4.0
2
Q
What is prediabetes A1c?
A
5.7-6.4
3
Q
What is diabetes A1c
A
6.4 and up
4
Q
What is normal fasting blood sugar?
A
Less than 100 is normal.
5
Q
What fasting blood sugar is prediabetes?
A
100-125
6
Q
What blood sugar is diabetes?
A
If it’s 126 on 2 or more readings, then diabetes.
7
Q
What is goal A1c in someone young i.e. Type 1?
A
6%
8
Q
What is the goal A1c in someone normal aged 20 and up?
A
7%
9
Q
What is the goal A1c in someone elderly?
A
8%
10
Q
Blood glucose less than 50 mg. Complains of weakness feels like passing out, headache, clammy hands, and anxiety. difficulty concentrating and thinking. If not corrected it will progress to coma
A
Severe hypoglycemia
11
Q
School-aged child with the recent history of viral illness complains of excessive hunger and thirst. Urinating more than normal polyuria. Start losing weight despite eating a large amount of food. Breath has a fruity order. Large amount of ketones in urine
A
Type one diabetes
12
Q
Age greater than or equal to 45, BMI greater than 25, family history i.e. 1st° relative, habitual physical inactivity, hypertension, HDL less than or equal to 35 or triglycerides greater than or equal to 250, Women with PCOS, history of vascular disease, delivery of a macrosomic infant (9 lbs) Or gestational diabetes, African-American, Hispanic, Native American, Asian American, pacific islanders, previously identified a1C greater than or equal to 5.7%, impaired glucose tolerance, impaired fasting glucose are all risk factors for
A
Diabetes mellitus
13
Q
How often do you screen for diabetes in patients with a BMI greater than or equal to 25 and one or more risk factors for DM
A
Annually
14
Q
How often do you screen for DM the entire population greater than or equal to 45 years old if screening is normal
A
Every three years
15
Q
What is the A1 C level for type two diabetes diagnosis
A
Greater than or equal to 6.5%
16
Q
What is the fasting plasma glucose for type two diabetes diagnosis
A
Greater than or equal to 126
17
Q
What is the two hour glucose tolerance test diagnostic criteria for type two diabetes
A
Greater than 200 mg
18
Q
What is the A1 C to diagnose prediabetes
A
Greater than or equal to 5.7% to 6.4%
19
Q
What is the fasting blood glucose in order to diagnose prediabetes
A
100 to 125 mg
20
Q
What is the two hour glucose tolerance test for pre-diabetes diagnosis
A
140 to 199 mg
21
Q
When do you administer a glucose tolerance test
A
To pregnant patients and PCOS patients
22
Q
What is the initial management of impaired fasting glucose
A
Lifestyle modifications such as weight loss 7% of body weight, physical activity to at least 150 minutes per week of moderate activity.
23
Q
With impaired fasting glucose when should metformin be considered
A
A-1C 5.7% to 6.4%, less than 60 years old, BMI greater than or equal to 35, women with history of gestational diabetes
24
Q
If a patient is diagnosed with type two diabetes with a BMI of 35 and an A1 C of 8.2 what should be the initial action
A
Establish a target A-1 C goal
25
What is the reasonable and A1C for a 72-year-old or elderly patient
A1C less than 8%
26
What medications are associated with an increased risk of development of type two diabetes
Glucocorticoids, HCTZ, atypical antipsychotics, statins (HMG Co-A reductase inhibitors)
27
For most patients with type two diabetes what is the suggested A1C goal
Less than 7%
28
For patients with type one diabetes what is their A1C goal
Less than 6%
29
For most pregnant patients what is the suggested A1C goal
Less than 6%
30
What is the initial management of type two diabetes
Set A1C goal, reduce cardiovascular risk factors, evaluate use of Metformin, physical exam and monitoring
31
What is recommended for reducing risks from type two diabetes and impaired fasting glucose
Increased physical activity, weight loss as needed, smoking cessation, nutrition intervention i.e. less saturated fat, more omega-3 and fiber, statins for type two diabetic’s
32
What are the exercise recommendations for type two diabetic’s
Light activity every 30 minutes while awake for blood glucose, exercise of at least eight weeks duration shown to decrease A-1 C0 .6% and type two diabetic’s even if no weight loss plus many other benefits
33
How often should a diabetic patient have their height, weight, BMI, blood pressure measure
Every visit
34
How often should a diabetic patient have a foot exam
Every three months unless PVD or neuropathy present then every visit
35
How often should a diabetic patient have a dilated eye exam
Annually at onset for type two diabetic’s and after five years of diagnosis of type one
36
How often should a diabetic patient have a funduscopic exam
At diagnosis but does not take the place of dilated eye exam
37
How often should a diabetic patient have thyroid palpation
At diagnosis and then annually
38
How often should diabetic patient have skin examination
Add diagnosis and annually
39
How often should a diabetic patient have dental examination
Annually
40
How often should a diabetic patient have a fasting serum lipid profile i.e. total, LDL, HDL, trigs
Annually and patience greater than 40 should consider moderate intensity Staten and lifestyle modifications
41
How often should a diabetic patient have their A1c measure
Every three months if not at goal, otherwise twice annually
42
What is the A1 C goal in most diabetic patients
Less than 7%
43
How often should a diabetic patient have urinary albumin to creatinine ratio measure
Annually
44
How often should a diabetic patient have their serum creatinine and eGFR and TSH measure
Annually
45
What is the first line of treatment according to the ADA for type two diabetes
Metformin is the first choice for oral treatment unless there is a contraindication. Metformin reduced CV risks. Older adults avoid hypoglycemia
46
Is Metformin safe for patients with active hepatitis C or binge drinking
No because of lactic acidosis
47
If a patient has a GFR of 60 and is taking Metformin how often should renal function studies be done
Annually
48
If a patient has a GFR of 45 to 59 and is taking Metformin how often should Renal function studies be done
Every 3 to 6 months
49
If a patient has a GFR of 30 to 44 and takes met formin how often should renal function studies be done
Every three months don’t start metformin but can continue if renal function drops
50
I have a patient has a GFR of less than 30 can they take metformin
No
51
Affect on glucose, absence of weight gain or hypoglycemia, low incidence of side effects, low-cost, reduction in all cause mortality are all reasons that which drug is often chosen for type two diabetes
Metformin
52
What are the most common side effects of Metformin
Diarrhea, flatulence, nausea
53
Mrs. Smith is a newly diagnosed type two diabetic. She has been started on Metformin and is tolerating a dose of 1000 mg b.i.d. How much is her A1 C expected to decrease in the next three months?
1 to 2%
54
The primary mechanism of action for Metformin is
Decreases hepatic glucose production
55
What is the drug name for a biguanide
Metformin
56
What is the drug name for a sulfonylurea
Glimepiride, glipizide, glyburide,
57
What are the drug names if megllitinides
Repaglinide, nateglinide
58
What are the drug names of DPP-4 Inhibitor
Alogliptin, inaglipton, saxagliptin, sitagliptin
59
What are the drug names of GLP-1
Exenatide, Liraglutide, Dulaglutide, Albiglutide
60
What are the drug names of TZD
Pioglitazone, Rosiglitazone
61
What are the drug names of SGLT2
Canagliflozin, dapaiflozin, empagliflozin
62
Which diabetic medication potentiates insulin secretion, may cause hypoglycemia and tend to cause weight gain, Ideal use in insulinopenic patients, not obese/mild obesity, used in combination or as monotherapy, reduce his A1 C about 1 to 2%, cheap
sulfonylurea
63
What diabetics medication ends in -ide
Sulfonylurea
64
What diabetic medication slows inactivation of the incretin hormones which lowers blood glucose, use in combination or as monotherapy but not initial, reduces A1c about 0.7% and costs $300-$400 a month
DPP-4 agents
65
Which diabetic medication ends in -gliptin
DPP-4 agents
66
Which diabetic medication is a glucagon like peptide, increases production of insulin in response to elevated blood glucose levels, decreases A-1 C1 to 1.5%, almost never hypoglycemia, average weight loss is 2 to 6 pounds and is expensive
GLP-1 Agonists
67
What diabetic medication ends in -tide
GLP-1 agonists
68
Which diabetic medication preserves beta cell function, improves insulin insensitivity, high dose associated with bone fractures and osteopenia, contra indicated in heart failure, reduce his A1 C about 0.7%, cost is $200-$400 a month
TZDs
69
Which diabetic medication ends in -azone
TZD
70
Which diabetes medication is associated with bone fractures and osteopenia
TZDs -azone
71
Which diabetes medication is Contra indicated in heart failure
TZDs -azone
72
Which diabetes medication prevents reabsorption of renal glucose, increases glucose excretion, increased risk of UTI vaginal yeast infections, weight loss. Cost of $450 per month and 90% glucose blocked by inhibiting SGLT-2
SGLT2 Inhibitor
73
What diabetes medication ends in -flozin
SGLT2 inhibitors
74
What diabetes medication increases the risk of UTI, vaginal yeast infection, and weight loss
SGLT2 inhibitors
75
All type two diabetic’s get which drug unless contraindicated
Metformin
76
If a patient has an A1 C greater than or equal to nine what must be considered
Dual therapy initially
77
If a patient has an A1 C greater than or equal to 10 to 12 what must be considered
Injectable insulin until less glucose toxic
78
If a patient has a blood glucose of greater than 300 what must be considered
Injectable insulin until less glucose toxic
79
If a patient has an a regular eating schedule what can be prescribed
Meglitinides
80
What medication is discontinued after initiating insulin
Sulfonylurea and glitazones
81
Which diabetes medication excretes glucose in the urine
SGLT2 inhibitors
82
A 35-year-old female has an A1 C of 5.9% and is newly diagnosed with impaired fasting glucose. What medication is first choice
Metformin
83
It’s 55-year-old female diagnosed six weeks ago, A1c goal less than 7%, intolerant of Metformin . A-1 C now 9.2%. What is primary prescribing strategy
Dual therapy
84
79-year-old male with an A1 C of 9.5% is newly diagnosed diabetes type two. What is a A1C goal
Less than 8%
85
What occurrence must be avoided with a 79-year-old man with an A1 C of 9.5% and newly diagnosed with type two diabetes
Hypoglycemia
86
What is the age related prescribing strategy with 9.5% A1c for a 79-year-old male
One medication
87
A 62-year-old female taking Metformin has an A1 C of 7.9% and is on a fixed budget. A1c goal is less than 7%. What medication is first choice
sulfonylurea
88
A 27 year-old male with an A1 C of 6.9% and newly diagnosed type two diabetes. What medication is first choice
Metformin
89
35-year-old female with A1 C of 6%, newly diagnosed with impaired fasting glucose contemplating pregnancy. What medication is first choice
Metformin
90
35-year-old obese female on Metformin A-1 C8 .9%, A-1 C goal of less than 7%, Cadillac insurance. What are two medication considerations
GLP-1 and insulin
91
79-year-old male on Met Forman with A1 C7 .9%, needleful back. Do we need a med? If not how do you handle?
No. Lifestyle modifications
92
55-year-old female takes metformin plus glipizide, A-1 C is 10.2%, A-1 C goal is less than 7%. What medication is first choice?
Insulin. Stop glipizide which is a sulfonylurea
93
50-year-old self-employed male who drives a bread truck can’t tolerate hypoglycemia and is taking met foreman at the highest dose, has limited medical fun, A-1 C is 8%, goal is less than 7%. What medication
Lifestyle modifications
94
What should be considered initially when an A1 C level is greater than 10% or in the double digits
Insulin
95
What must be considered when the fasting glucose is greater than 300 mg
Insulin
96
What must be considered after maxing out oral medication, symptoms of hyper glycemia, and pregnant patients
Insulin
97
What diabetes medication preserves pancreatic function
Basal insulin
98
NovoLog, Humalog, Apidra are examples of
Immediate insulin
99
Humulin and Novolin are examples of
Regular insulin
100
Lantus, Levemir, and Toujeo are examples of
Long acting insulin
101
NPH is
Long acting insulin
102
Peakless insulin, mimics basal insulin secretion, action is predictable from day to day, greatly improved A1C levels, duration up to 24 hours, expensive
Long acting insulin
103
How do you initiate basal insulin
Start at 10 units per day. Adjust 2-four units once to twice weekly to reach fasting blood glucose goal. If hypoglycemic, determine and address cause, and decrease by four units
104
If insulin level is not controlled after fasting blood glucose target is reached then what should be added to basal insulin
Basal plus short acting insulin given before biggest meal or basal bolus at each meal but this requires frequent blood glucose checks so the patient needs to be motivated
105
A single large nodule greater than 2.5 cm on one lobe of the thyroid gland, size greater than 2.5 cm. The 24 hour radio active iodine uptake test will show a cold nodule. May have a history of facial, neck, or chest radiation therapy
Thyroid cancer
106
Random episodes of severe hypertension with a systolic blood pressure greater than 200 mm or diastolic greater than 110 mm associated with abrupt onset of severe headache, tachycardia, and anxiety. Episodes resolve spontaneously but occur at random. In between the attacks, patients vital signs are normal
Pheochromocytoma
107
Can be a sign of pituitary adenoma. Slow onset. When tumor is large enough to cause a mass effect, the patient will complain of headaches.
Hyperprolactinemia
108
Where is the pituitary gland located
It is located at the sella turcica (base of brain)
109
What stimulates the pituitary gland
Hypothalamus
110
What hormones are produced in the hypothalamus
FSH, LH, TSH, adrenocorticotropin hormone and growth hormone
111
Secretes vasopressin i.e. antidiuretic hormone and oxytocin, which are made by the hypothalamus but stored and secreted by the posterior pituitary
Posterior pituitary gland
112
This hormone is responsible for the calcium balance of the body by regulating the calcium loss/gain from the bones, kidneys, and G.I. tract i.e. calcium absorption
Parathyroid hormone
113
What is thyroxine
T4
114
What is triiodothyronine
T3
115
Is T3 greater or less than T4
Greater than
116
Where is TSH produced
Anterior pituitary
117
What is used for screening of the thyroid
TSH
118
Reduction in the amount of circulating free thyroid hormone, resistance to the action of thyroid hormone, common cause is Hashimoto’s thyroiditis, 5 to 8 times more common in women especially over the age of 50, common in patients with diabetes, second most common endocrine problem
Hypothyroidism
119
Inflammation of the thyroid gland and does not produce thyroid hormones and this is an autoimmune disease
Hashimoto’s thyroiditis
120
Presence of high serum concentration of antibodies to thyroid peroxidase and thyroglobulin
Hashimoto’s thyroiditis
121
The symptoms of thyroid disease are
Very variable
122
The initial test to screen for thyroid disease should be
TSH
123
It’s 35-year-old female complains of fatigue. A TSH was just ordered and is 6.8. What should be done next?
Re-check a TSH and T4 level
124
If the TSH is elevated, and T4 is decreased and the T3 is normal to low, what does the patient have
Primary hypothyroidism
125
If the TSH is elevated, the T4 is normal and the T3 is normal what does the patient have
Subclinical hypothyroidism
126
If the patient has a decreased TSH, usually high T4, and normal or high T3 what does the patient have
Primary hyper thyroidism
127
If the patient has a decreased TSH, normal T4 and normal T3 what does the patient have
Subclinical hyperthyroidism
128
For Primary hypothyroidism how do we replace
Levothyroxin i.e. synthetic T4 PO daily, in a.m., on empty stomach 30 to 60 minutes. Adults need 1.6 µg per kilogram per day. Based on ideal body weight not necessarily actual. Start with full Replacement dose and healthy, younger patients. Use clinical judgment when prescribing
129
How do you calculate kilograms from pounds
Pounds divided by 2.2
130
How do you replace T4 in a hypothyroid patient in middle to older age
Patient 50 to 60 years old should start at 50 µg daily. Older adults, multiple co-morbids, Cardiac disease consider 25 µg daily. Increase every 3 to 6 weeks by 25 µg until normal TSH. Small decreases in fibroid replacement dose may be needed as the patient ages.
131
Upper limit of normal in TSH in 80-year-old is how much
7.5
132
If the TSH is elevated and a T4 is normal what does the patient have
Subclinical hypothyroidism
133
How do you treat subclinical hypothyroidism
If the TSH is greater than 10, treat to prevent conversion to primary hypothyroidism. If TSH is 4.5 to 10 most do not recommend treatment. Monitor 6 to 12 months unless patient becomes more symptomatic.
134
A 45-year-old patient has subclinical hypothyroidism. TSH is 6.2. What are the major risks of prescribing levothyroxin
Accelerated bone loss, atrial fib
135
What will happen if a patient takes their levo thyroxine with food
The TSH will increase
136
What will happen if a patient takes two pills of levothyroxine instead of one
Decreased TSH do to self induced hyper thyroidism
137
What will happen if a patient takes levothyroxin with vitamins
Increased TSH
138
What would happen if a patient’s switches to a generic form of levothyroxin
TSH can go up or down or stay the same
139
When should a patient diagnosed with hypothyroidism follow up
Recheck TSH 4 to 6 weeks after replacement starts, and then after each dose change until euthyroid. Monitor TSH annually unless symptoms develop
140
Bodies tissues are exposed to an increased level of circulating thyroid hormone i.e. T3 and T4, most common cause is graves disease
Hyperthyroidism
141
What is the most common cause of symptomatic hyperthyroidism
Graves disease
142
What common condition causes velvety, hyper pigmented plaques on the skin and what is the name of this
Diabetes mellitus, acanthosis nigra cans
143
What is the BMI cut point for screening adults with one or more risk factors for diabetes
25 kg
144
Who is at high-risk for Graves’ disease men or women
Women
145
Women with graves disease are also at risk for
Other autoimmune diseases such as rheumatoid arthritis and pernicious anemia and osteoporosis
146
If there is a thyroid mass or nodule what would you do
Order thyroid ultrasound and referred to endocrinology
147
What is the confirmatory test for graves disease
Antibody tests such as thyroid stimulating immunoglobulin
148
What medications are indicated for hyperthyroidism
propylthiouracil (PTU), Methimazole (Tapazole)
149
What are side effects of propylthiouracil (PTU) and Methimazole (Tapzole)
Skin rash, granulocytopenia, hepatic necrosis monitor CBC and LFTs
150
What medication is given as adjunctive therapy for hyperthyroidism
Beta blockers for anxiety, tachycardia, and palpitations
151
What are some indications for patients thatReceive radio active iodine
Contra indicated during pregnancy and lactation. Permanent destruction of thyroid gland results in hypothyroidism for life. These patients need thyroid supplementation for life after thyroid is destroyed.
152
What is the preferred treatment in pregnancy for hyper thyroidism
PTU is preferred treatment. Give lowest effective dose possible
153
Acute worsening of symptoms due to stress or infection. Look for decreased level of consciousness, fever, abdominal pain. Life-threatening and immediate hospitalization is needed
Thyroid storm or thyrotoxicosis
154
Single painless nodule greater than 2.5 cm, history of neck radiation in childhood.
Thyroid cancer
155
Shows metabolic activity of thyroid gland
Thyroid scan 24 hour thyroid scan with RAIU
156
Not metabolically active. More worrisome, rule out thyroid cancer. Biopsy
Call spot
157
Metabolically active nodule with homogeneous uptake and is usually benign
Hotspot
158
What is the normal range for TSH
0.01-6.0
159
If the TSH is abnormal what is the next step
Order T3 and T4
160
What drugs can cause drug-induced thyroid disease
Lithium, amiodarone, interferon – alpha, dopamine. Monitor thyroid function by periodically checking of a TSH
161
What is the classic lab finding for hypothyroidism
Hi TSH with low free T4 levels
162
What is the gold standard test for diagnosing Hashimoto’s thyroiditis
Antimicrosomal antibodies which are elevated
163
What is the starting dose of levothyroxine
25 to 50 µg per day
164
What is the dosing for elderly patients or patients with a history of heart disease i.e. Angina, acute myocardial infarction, atrial fib
25 µg per day
165
How much should levothyroxine be increased every few Weeks until TSH is normalized
25 µg
166
How often should the TSH be checked once a patient is on Synthroid
Recheck TSH every 6 to 8 weeks until TSH is normalized less than 6
167
What are some signs that the Synthroid dose is too high
Palpitations, nervousness or tremors. Decreased dose until symptoms are gone and TSH is in normal range
168
Starting dose of synthroid is
25 mcg daily
169
Chronic amenorrhea and hypermetabolism results in
Osteoporosis. Supplement with calcium and vitamin D, weight-bearing exercises
170
Elevated TSH and normal serum free T4 is
Subclinical hypothyroidism
171
Obesity, hypertension, hyper glycemia, and dyslipidemia all put you at risk for
Metabolic syndrome
172
A1c between 5.7 and 6.4%
Pre diabetes
173
Fasting blood glucose 100-125
Prediabetes
174
To our OGTT of 140 to 199
Prediabetes
175
A1c is equal to or greater than 6.5
Diabetes
176
Fasting blood glucose equal or greater than 126
Diabetes
177
Symptoms of hyperglycemia such as polyuria, polydipsia, polyphagia plus random blood glucose equal to or greater than 200
Diabetes
178
To our plasma glucose greater than or equal to 200
Diabetes
179
Fasting blood glucose norms in adult
70-100
180
How do you check a diabetic patient feet vibration sense
Check vibration sense with 120 Hz tuning fork. Please on bony prominence of the big toe at the MTP joint
181
Blood glucose 50mg or less, sweaty palms, tiredness, dizziness, rapid pulse, strange behavior, confusion, and weakness are all signs of
Hypoglycemia
182
What is the treatment plan for hypoglycemia
Glucose 15-20g. 4oz of orange juice, regular soft drink, hard candy. Recheck blood glucose 15 minutes after treatment. When glucose is normalized, eat a meal or snack afterward (complex carbs, protein)
183
An elevation in the fasting blood glucose occurs daily earlier in the morning. This is due to an increase in insulin resistance between 4 and 8 AM caused by the physiologic spike in growth hormone glucagon epinephrine and cortisol
Dawn phenomenon
184
Severe nocturnal hypoglycemia simulates counterregulatory hormones such as glucagon to be released from the liver. The high levels of glucagon in the systemic circulation result in high fasting blood glucose by 7 AM. This condition is due to over treatment with the evening and or bedtime insulin. More common in type one diabetic’s
Somogyi Effect
185
how do you diagnose Somogyi Effect
Check blood glucose very early in the AM 3am for 1-2 weeks
186
How do you treat Somogyi Effect
Snack before bedtime, or eliminate dinner time immediate Acting insulin (NPH) dose or lower the bedtime dose for both NPH and regular insulin
187
Microaneurysms due to neovascularization. Cotton wool exudates are associated with
Diabetic retinopathy
188
Should diabetic patients with peripheral neuropathy avoid excessive running or walking to minimize the risk of foot injury
Yes
189
What should you do with metformin if you are having IV contrast dye testing
Hold Metformin on day of procedure and 48 hours after. Check baseline creatinine and recheck after procedure. If serum creatinine remains elevated after the procedure, do not restart Metformin . Serum creatinine must be normalized before drug can be resumed.
190
Hypoglycemia, increased risk of photosensitivity, waking, blood dyscrasias are all adverse affects of
Sulfonylurea
191
What diabetic medications should be avoided in patients with impaired hepatic and renal function
Biguanides such as Metformin and sulfonylurea such as glipizide
192
The most appropriate screen for diabetic nephropathy Is
Urinary albumin to creatinine ratio and EGFR
193
What laboratory abnormality commonly accompanies hypothyroidism
Dyslipidemia
194
When the blood glucose level exceed 300 mg what should be initiated
Insulin
195
Patients with type one diabetes should be screened for real nephropathy how many years after diagnosis
Five years
196
Can impetigo be a symptom of type two diabetes
Yes
197
Acanthosis nigricans is associated with
Insulin resistance
198
Adjustments in dosing of basal insulin are typically based on
AM fasting glucose values
199
How soon can the anti proteinuria effect of the ACE Inhibitor be realized in a patient with albuminuria
6-8 weeks
200
In older adults what must the postprandial glucose level Be while on insulin
Less than 180 mg
201
Nonfasting glucose values less than how much are considered normal values
125 mg
202
After initiating levothyroxine when should the patients TSH level be rechecked
6 weeks
203
What is a common finding when TSH values exceed 10ml
Dyslipidemia
204
When the serum free T4 concentration falls, what happens to TSH
The TSH rises
205
When a patient has Graves’ disease. What happens to T3 and T4
Elevated
206
What is the earliest detectable glycemic abnormality in a patient with Type 2 diabetes
Postprandial glucose elevation
207
What is the relationship between A1c and triglycerides
As A1c decreases, triglycerides decrease
208
The earliest recognizable clinical manifestation of cystic fibrosis in an infant is
Salty taste on the skin
209
Breastfeeding is contraindicated under what condition
Galactosemia
210
Hyperpigmentation of the skin and mucous membranes are usually seen in
Addison’s disease
211
A patient has an enlarged thyroid gland with an audible bruit. The examiner should suspect
Hyperthyroidism
212
What is the earliest recognizable clinical manifestation of cystic fibrosis in a child
Clubbing, frequent respiratory infection, and rectal prolapse
213
If a newborn is suspected of having hypothyroidism which clinical manifestation would be evident
Enlarged anterior fontanel
214
An adrenal gland tumor that causes increased production of the hormones adrenaline and noradrenaline that causes long term elevation in blood pressure
Pheochromocytoma
215
Which lymph node characteristic should raise concern if palpated by the examiner
Firm and nontender
216
A nurse practitioner is providing guidance to a newly diagnosed diabetic patient who is being treated with insulin. The nurse practitioner would be correct to tell the patient to self treat signs and symptoms of hypoglycemia with
15 g of sugar or five Lifesavers
217
Does the hyperinsulinemia and insulin resistance associated with syndrome X cause tachyarrhythmias and angina
Yes
218
The obesity associated with type two diabetes is
A truncal android distribution
219
A palpable thyroid nodule is benign. How does it feel on palpation?
Smooth
220
Standards of practice are
Minimum levels of acceptable performance
221
What information should a 42-year-old patient with newly diagnosed diabetes receive about exercise
Snack before exercise
222
And obese hyperlipidemic patient newly diagnosed with type two diabetes has a fasting blood glucose value of 180 to 250. What is the most appropriate initial treatment to consider
A sulfonylurea or Metformin
223
What clinical finding is consistent with a diagnosis of parathyroid tumor
Positive Chvosteks sign
224
What test would you expect to be increased if a patient has hyperglycemia
Osmolality
225
What type of drugs can cause hypoglycemia in diabetic patients
Sulfa antibiotics
226
What drug class is the most effective in decreasing elevated triglyceride levels
Fibrates
227
Constipation, cold intolerance, weekend, and Lethargy are indicative of
Hypothyroidism
228
What is the most common cause of Cushing’s syndrome
Administration of a glucocorticoid or AC TH
229
The most accurate measure of diabetes control is
Hemoglobin A-1 C
230
The reason beta blockers should be avoided in patients with diabetes is because they may
Mask symptoms of hypoglycemia
231
When do microaneurysms occur in the eyes
Diabetic retinopathy
