EXAM 2 PART 2

Question 1

According to the American Association of Clinical Endocrinologists, the usual dose of levothyroxine per day for full replacement?

Answer 1

1.6 mcg/kg per day 50-100 MCG DAY

Question 2

What pt education do you give with levothyroxine?

Answer 2

Take meds on empty stomach 30 mins before morning meal (may cause insomnia if taken at night)

Question 3

How would you alter the dose for initiating synthetic thyroid replacement with an older patient with hx of cardiac issues?

Answer 3

Begin with one-half of the expected replacement dose or 25 to50 mcg/day PO, increasing the dose gradually by 25 mcg/day once every 4 to 6 weeks; cardiac start at 12.5 mcg/day

Question 4

What is the long standing effects of HYPERthyroidism?

Answer 4

OSTEOPOROSIS CONSIDER BONE DENSITY TESTING, VIT D, & CALCIUM SUPPLEMENTS IN OLDER PT

Question 5

How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism?

Answer 5

FOR LIFE

Question 6

Which treatment FOR hyperthyroidism is recommended for middle age and older adults?

Answer 6

Radioactive iodine 131

Question 7

WHAT works by inhibiting thyroid hormone synthesis at multiple steps. They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment)

Answer 7

ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI)

Question 8

What should those treated with radioactive dye be aware of?

Answer 8

AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR 7 DAYS

Question 9

What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave’s disease and subacute thyroiditis and toxic nodular goiters?

Answer 9

RADIO IODINE UPTAKE SCAN

Question 10

What is the gold standard test for confirming Hashimoto’s?

Answer 10

THYROID PEROXIDASE [TPO] ANTIBODY

Question 11

What is the most common type of autoimmune hypothyroid in the US?

Answer 11

HASHIMOTO’S

Question 12

What would make you suspicious of thyroid cancer (clinical presentation)? What is the reliable method of diagnosis?

Answer 12

PAINLESS LUMP OR NODULE IN THE NECK; FINE NEEDLE BIOPSY

Question 13

What type of hypothyroidism does more than 95% of patients have where there is dysfunction or atrophy of the thyroid gland due to failure of pituitary and/or hypothalamus?

Answer 13

CENTRAL HYPOTHYROIDISM

Question 14

What is an endocrine emergency with signs and symptoms of slowed cognitive thinking, poor short-term memory, depression or dementia, hypotension and hypothermia with a mortality rate of 30-40%?

Answer 14

MYXEDEMA (SEVERE HYPOTHYROIDISM)

Question 15

What are the common causes of hypercalcemia?

Answer 15

PRIMARY HYPERPARATHYROIDISM AND MALIGNANCY

Question 16

the twitching of the facial muscles in response to tapping over the facial nerve 2 cm anterior to ear canal is considered a positive sign; what does it indicate?

Answer 16

CHVOSTEK’S SIGN; HYPOCALCEMIA

Question 17

When should a referral be considered for patient with HYPERparathyroidism?

Answer 17

CALCIUM STARTS BECOMING HIGH

Question 18

May be caused by cortisol hypersecretion by the adrenal cortex due to cortical hypertrophy from a tumor of the adrenal gland or heavy use of glucosteriods

Answer 18

CUSHING’S SYNDROME

Question 19

Refers specifically to pituitary adrenoCORTICtropic hormone (ACTH) excess caused by a pituitary tumor (adenoma) Too much cortisol!

Answer 19

CUSHING’S DISEASE

Question 20

What labs are done to screen for Cushing’s?

Answer 20

serum and urine cortisol (two measurements), CMP (GLUCOSE, HYPOKALEMIA
CBC (LEUKOCYTOSIS)

Question 21

What is the clinical presentation of Cushing disease?

Answer 21

GENERALIZED OR CENTRAL OBESITY MOON FACE
BUFFALO HUMP
red face, AND STRIAE, HYPERGLYCEMIA

Question 22

What is ADDISON’S DISEASE?

Answer 22

primary adrenal insufficiency
Autoimmune; adrenal glands do not produce enough cortisol. NEED TO “ADD” ADRENAL HORMONES/ CORTISOL

Question 23

Describe the clinical presentation OF ADDISON’S

Answer 23

BRONZE SKIN, hirsutism, HYPOGLYCEMIA, POSTURAL HYPOTENSION, WEIGHT LOSS

Question 24

Clinical presentation of Addison’s crisis

Answer 24

Profound fatigue dehydration
vascular collapse (↓B/P) renal shutdown

Question 25

What are the diagnostic criteria for DM2? List all the criteria.

Answer 25

• FPG > 126
  -RANDOM PLASMA GLUCOSE >200
  -GTT (2HR) > 200
  -A1C > 6.5

Question 26

Which of the following can be initial testing to confirm diagnosis of DM2? (select all that apply) -FASTING BLOOD (PLASMA) GLUCOSE
-HGA1C
-ORAL GLUCOSE TOLERANCE TEST

Answer 26

-FASTING BLOOD (PLASMA) GLUCOSE
-HGA1C
-ORAL GLUCOSE TOLERANCE TEST

Question 27

Are there any contraindications for starting the recommended first choice oral hyperglycemic medication? If so, what are the contraindications?

Answer 27

-LIVER DISEASE
- HX ALCOHOLIC
-KIDNEY DISEASE (GFR <30)
-cardiopulmonary insufficiency

Question 28

WHAT CONDITION PRESENTS WITH LACK OF INSULIN acute decompensation; (MORE IN TYPE I DM)
S/S: HYPERGLYCEMIA, KETONEMIA, ACIDOSIS; ANOREXIA, THIRST, N/V, ABDO CRAMP, KUSSMAUL RESP, DEHYDRATED, ALTERED CONSCIOUSNESS

Answer 28

DKA

Question 29

WHAT POPULATION IS MORE LIKE TO PRESENT WITH DKA?

Answer 29

TYPE I DM

Question 30

When a patient is diagnosed with DM I what are they likely to present with?

Answer 30

DKA