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Rotation 1: Pediatrics > Endocrinology (3%) > Flashcards

Endocrinology (3%) Flashcards

(55 cards)

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1
Q

What is the development of DM during pregnancy called?

A

Gestational DM

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2
Q

What are some examples of Alpha Glucosidase Inhibitors?

A

Acarbose, Miglitol

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3
Q

What will be seen on ECG of a pt with hypercalcemia?

A

Shortened QT interval, prolonged PR interval, QRS widening

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4
Q

Hyperglycemia is observed in both DKA and HHS with sx such as….

With sx of ______ seen in pts with DKA and ______ in pts with HHS

A

thirst, polyuria, polydipsia, nocturia, weakness, fatigue, confusion, nausea, vomiting, CP

abd pain: DKA

mental status changes: HHS

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5
Q

What are the tx goals for DKA?

HHS?

A

Closing of the anion gap in DKA

Normal mental status in HHS

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6
Q

_____ and _____ are results of INSULIN DEFICIENCY and counterregulatory hormonal excess in diabetics as a direct response to stressful triggers (most commonly ______)

A

DKA and HHS

infection

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7
Q

Lab values that indicate DKA?

HHS?

A
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8
Q

Describe the HPT (hypothalamus, pituitary, thyroid) axis

A
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9
Q

What medications can cause hypothyroidism?

A

Amiodarone (contains iodine)

Lithium

Alpha interferon

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10
Q

What is the dawn phenomenon?

Management?

A

Normal glucose until rise in serum glucose levels between 2am - 8 am

Results from decreased insulin sensitivity and nightly surge of counter regulatory hormones (during nighttime fasting)

Management: bedtime injxn of NPH, avoiding carb heacy snacks before bed, insulin pump use early in the AM

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11
Q

What is HHS?

How is it different from DKA?

A

Hyperosmolar hyperglycemic state (HHS) is a complication of DM in which high blood sugar results in high osmolarity w/o significant ketoacidosis

Sx include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness

Differences: see picture

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12
Q

What are some examples of Thiazolidinediones?

A

Pioglitazone, Rosiglitazone

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13
Q

What are some examples of SGLT-2 Inhibitors?

A

Canagliflozin, Dapagliflozin

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14
Q

What is Cretinism?

What would a pt with this condition present with?

How to tx?

A

Congenital hypothyroidism due to maternal hypothyroidism or infant hypopituitarism

Macroglossia, hoarse cry, coarse facial features, umbilical hernia, weight gain

Mental development abnormalities may all develop if not corrected

Thyroid hormone replacement: Levothyroxine

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15
Q

_______ is the most common cause of end stage renal dz

A

DM

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16
Q

Tx for mild hypercalcemia?

Tx for severe/sx hypercalcemia?

A

No tx for mild

Sx: IV saline, Furosemide 1st line, avoid HCTZ (causes increased calcium), Calcitonin, bisphophonates for severe cases, steroids

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17
Q

What are possible causes of hypercalcemia that are not related to the parathyroid gland?

A

Malignancy (secretes PTH-related protein), decreased amounts of intact PTH

Vit D excess (granulomatous dz, vit intoxication)

Vit A excess, milk alkali syndrome

Thiazides

Lithium

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18
Q

Will Free T3 and Free T4 be elevated or low in hyperthyroidism?

Hypothyroidism?

A

Elevated in Hyperthyroidism

Low in Hypothyroidism

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19
Q

What are some examples of pre mixed insulins?

A

Humulin 7/30

Novolin 70/30

Novolog 70/30

Humulin 50/50

<em>administered 2x daily before meals</em>

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20
Q

What are potential risk factors for developing Type II DM?

What does CHAOS stand for?

A

H/o impaired glucose tolerance, FHx, 1° relative, Hispanic, African American, Pacific Islander, HTN, HLD, delivery of baby >9lbs

Syndrome X/insulin resistance: CHAOS –> Chronic HTN, Atherosclerosis, Obesity (central), Stroke

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21
Q

What is the triad of hyperparathyroidism?

A

Increased calcium

Increased intact PTH

Decreased phosphate

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22
Q

Why are pts with DM at an increased risk of infections?

A

D/t vascular insufficiency and immunosuppresion from hyperglycemia

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23
Q

What are some examples of DPP-4 Inhibitors?

Study These Flashcards
A

Sitagliptin, Linagliptin, Saxagliptin

24
Q

What are some examples of Meglitinides?

Study These Flashcards
A

Repaglinide, Nateglinide

25
What are classic sx of pts with Type I DM?
polyuria, polydipsia, polyphagia, weight loss Diabetic ketoacidosis, HHS
26
What are some examples of Biguanides?
Metformin
27
What two findings on PE are pathognomonic for DKA?
KETOTIC BREATH (fruity with acetone smell) & KUSSMAUL RSESPIRATIONS (deep and labored)
28
90% of cases of hypercalcemia are due to ________ or \_\_\_\_\_\_\_
primary hyperparathyroidism malignancy
29
What will TSH levels be in Hyperthyroidism? Hypothyroidism?
Low in Hyperthyroidism High in Hypothyroidism
30
What are some examples of Sulfonylureas?
Glipizide, Glyburide, Glimepiride
31
What is the recommended managment for and goals of DM?
**Diet, exercise, lifestyle changes: should be tried first in Type II DM** - ± insulin if unable to control glucose with trial of diet, exercise, lifestyle changes, meds Insulin therapy initiated in Type I DM Insulin preferred for glucose control in gestational DM _Glucose control_: Hgb A1c \<7.0% _Lipid control_: LDL\<100; HDL 40; TG\<150 _Neuropathy_: Gabapentin, ±TCAs, Foot care (wide, loose-fitting shoes, nail trimming, podiatrist monitoring at least yearly) _Retinopathy_: DM control, laser photocoagulation tx, Bevacizumab (proliferative), Vitrectomy, Yearly eye screening by an ophthalmologist _Nephropathy_: DM control, ACE Inhibitors if microalbuminuria, Low sodium diet, yearly screening for microalbuminemia, yearly checks of BUN & creatinine
32
What are some examples of GLP-1 Agonists?
Exenatide, Liraglutide
33
Most pts with hypercalcemia are asymptomatic, but if sx may present with...
STONES, BONES, ABD GROANS, PSYCHIC MOANS kidney stones, polyuria, painful bones, fxs (d/t bone remodeling increase), ileus, constipation, decreased DTRs
34
What is a normal fasting blood glucose level?
70-100 mg/dL
35
\_\_\_\_\_\_: younger pts with type I DM \_\_\_\_\_\_: usually older w/ T2DM (higher mortality)
DKA HHS
36
Dx of hypoglycemia: Random blood sugar \_\_\_\_-\_\_\_\_ mg/dL Sx occur at ____ mg/dL Brain dysfunction begins at ____ mg/dL
50-60 mg/dL 60 50
37
What results on each of the following tests will help make the dx of DM in a pt? Fasting plasma glucose 2 hour glucose tolerance test Hemoglobin A1c Random plasma
Fasting plasma glucose: \>/= 126 2 hour glucose tolerance test: \>/= 200 Hemoglobin A1c: \>/= 6.5% Random plasma: \>/= 200
38
What four things are recommended for management of DKA and HHS?
1. **IV FLUIDS**: Critical 1st step 2. **INSULIN** (REGULAR) 3. **POTASSIUM**: (1st verify renal output) Despite serum K levels, patient is always total body potassium deficient Correction of DKA invariably will cause hypokalemia 4. **Bicarbonate**: only in severe acidosis (especially since the acidosis usually resolves w/ IV fluids & insulin) Associated w/ many complications (ex. increased rate of cerebral edema)
39
Tx for hypothyroidism?
Levothyroxine
40
What are some examples of hypothyroid d/o?
Hashimoto's Silent (lymphocytic) thyroiditis Postpartum thyroiditis deQuervain's Thyroiditis Medicaiton induced Acute thyroiditis Riedel's thyroiditis
41
What are some examples of hyperthyroid d/o?
Grave's Dz Toxic multinodular goiter Toxic adenoma TSH Secreting pituitary adenoma
42
What is the somogyi effect? Management?
Nocturnal hypoglycemia followed by rebound hyperglycemia (due to surge in growth hormone) MANAGEMENT: prevent hypoglycemia by decreasing nighttime NPH dose or give bedtime snack
43
What are potential complications of DM?
**_Neuropathy_**: "stocking glove", orthostatic hypotension, CN III palsy w/ nml pupil size **_Retinopathy_**: _cotton wool spots_, hard exudates, neovascularization, central vision loss **_Nephropathy_**: microalbuminuria, kimmelstiel wilson on kidney bx (condition associated w/ long-standing DM that affects the network of tiny blood vessels in the glomerulus, which is critically necessary for the filtration of the blood --\> "**nodular glomerulosclerosis**") **_Macrovascular_**: CAD
44
Toxic multinodular goiter, Grave's, toxic adenoma, or normal RAIU?
A. Normal B. Grave's C. Toxic multinodular goiter D. Toxic adenoma
45
The MC cause of hypothyroidism in the US... The MC cause of hypothyroidism worldwide is...
Hashimoto's thyroiditis iodine deficiency
46
What are some examples of Rapid Acting Insulins? Short Acting? Intermediate? Long Acting?
**Rapid**: Lispro (humalog), Aspart (Novolog) **Short**: Regular (Humulin-R) **Intermediate**: NPH (Humulin N, Novolin N), Lente (Humulin L, Novolin L) **Long**: Detemir (Levemir), Glargine (Lantus)
47
How to tell the difference between DKA and HHS?
DKA: Ketoacidosis HHS: higher severity of hyperglycemia
48
Describe the pathophysiology of HHS
Usually occurs in pts with type 2 DM w/ some illness leading to reduced fluid intake (MC infection) dehydration, increased osmolarity, hyperglycemia potassium deficit absence of severe ketosis (Type II DM make enough insulin to prevent ketogenesis usually)
49
\_\_\_\_\_\_ thyroiditis = fibrous thyroid
Riedel's thyroiditis
50
Describe the pathophysiology of DKA
Insulin deficiency hyperglycemia dehydration ketonemia (*high anion gap metabolic acidosis*) potassium deficit Usually occurs in Type I (may occur in some type 11).
51
\_\_\_\_\_\_\_ is a complication of the management of DM
Hypoglycemia ## Footnote *usually d/t too much insulin use, too little food, or excess exercise*
52
What condition is described below? Caused by **pancreatic beta cell destruction** (*pt no longer able to produce insulin)* Most commonly presents in children/young adults (*onset usually \<30y*) Type 1A autoimmune beta cell destruction triggered by 1+ environmental factors Type 1B: non-autoimmune beta cell destruction
Type 1 DM
53
Which type of hypothyroidism occurs post-virally?
deQuervain's thyroiditis
54
What condition is described below? Combo of insulin resistance and relative impairment of insulin secretion Etiology likely due to genetic and environmental factors: especially weight gain and decreased physical activity 90% of pts are overweight MC \>40y/o
Type II DM
55
Tx for Grave's? Tx for Toxic multinodular goiter? Tx for toxic adenoma? Tx for pituitary adenoma?
**Grave's**: Radioactive iodine, Methimazole, Propylthiouracil, BB for sx relief **TMG** **and** **TA**: Radioactive iodine, Methimazole, PTU, BB for sx **Pituitary** **adenoma**: Transspenoidal surgery to remove

Rotation 1: Pediatrics (13 decks)

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