Labs of Endocrine- Schoenwald

Question 1

What is DM Type 1?

Answer 1

• Autoimmune destruction of pancreatic islet B cells

- Insulin DEPENDENT

Question 2

What is DM Type 2?

Answer 2

• Tissue insensitivity to insulin

- Obesity and adult onset

Question 3

What is the MC endocrine disorder in the US?

Answer 3

DM Type 2

Question 4

Do patients with gestational diabetes have a higher chance of developing type 1 or type 2 diabetes?

Answer 4

-30-50% chance of developing type 2 diabetes later

Question 5

What test is used to screen for diabetes?

Answer 5

• Glucose

- Usually measured fasting and 2 hour post prandial

Question 6

PEARL: What test should you perform if glucose is abnormal?

Answer 6

-assess if fasting vs nonfasting

Question 7

What is a normal fasting glucose level?

Answer 7

< 110 mg/dl

Question 8

What fasting glucose result would indicate dx for diabetes?

Answer 8

Fasting glucose >126 on 2 separate occasions diagnostic for diabetes

Question 9

What is a post prandial glucose?

Answer 9

Measures glucose 2 hours after a meal

Question 10

If post prandial glucose level remains elevated at 2 hours what does this indicate?

Answer 10

Diabetes

Question 11

A glucose level of > ____ mg/dl confirms dx of diabetes?

Answer 11

200

Question 12

If a glucose level is 140 to 200 mg/dl what test should you do?

Answer 12

Glucose tolerance test

Question 13

When do you order a glucose tolerance test (two most common reasons)?

Answer 13

1. Pregnancy/women with hx of large birth weights or stillbirths
2. Abnormal 2 hour post prandial glucose not diagnostic of diabetes (140mg/dl-200 mg/dl)

Question 14

What are the normal glucose tolerance test results (fasting, 1 hr, 2 hr, 3 hr)?

Answer 14

• fasting <110 mg/dl
• 1 hour <200 mg/dl
• 2 hour <140 mg/dl
• 3 hour 70-115 mg/dl

Question 15

What is the glucose tolerance test criteria for dx diabetes?

Answer 15

• Fasting glucose >126 mg/dl

- 2 hour glucose >200 mg/dl

Question 16

What are 6 things that can cause elevated glucose?

Answer 16

1. Stress
2. Caffeine
3. IV fluids containing dextrose (should not be given to diabetic pts)
4. Pregnancy
5. Drugs (prednisone, estrogen)
6. Smoking

Question 17

What are 3 things to remind patients before a glucose tolerance test?

Answer 17

1. Fast for 8-12 hours
2. Don’t smoke during the test
3. No exercise 24 hours prior to test

Question 18

HbA1c allows for a ____ month measurement of glucose levels

Answer 18

3

Question 19

What is a normal HbA1c %?

Answer 19

4-5.7% roughly

Question 20

What is a HbA1c % that indicates poor glucose control?

Answer 20

> 6.5% roughly

Question 21

Is fasting required for an HbA1c?

Answer 21

No

Question 22

What HbA1c % is prediabetic?

Answer 22

5.7% to 6.4%

Question 23

What three tests diagnose diabetes?

Answer 23

• HgbA1c>6.5% or
• Fasting glucose >126 mg/dl or
• OGTT with 2 hour level at 200 mg/dl or higher.

Question 24

Is ketoacidosis more common in Type 1 or Type 2 diabetes?

Answer 24

Type 1

Question 25

What causes ketoacidosis?

Answer 25

Insulin deficiency resulting in protein breakdown and increased hepatic glucose production

Question 26

In ketoacidosis, lipolysis ocurrs and causes free fatty acid conversion to what two ketone bodies?

Answer 26

beta-hydroxybutyric acid & acetoacetic acid

Question 27

What are 4 symptoms of ketoacidosis?

Answer 27

1. Dehydration 2. Lethargy 3. Acetone smelling breath 4. Occasionally coma

Question 28

A glucose level of > 300 mg/dl is indicative of what medical condition?

Answer 28

Ketoacidosis

Question 29

Are bicarbonate and pH levels in ketoacidosis low or high?

Answer 29

Low

Question 30

PEARL: What is the initial treatment of ketoacidosis?

Answer 30

insulin administration with K+ | We need K+ to bring insulin into the cells (K+ is like a carrier for insulin)

Question 31

How is ketoacidosis detected? (what test)

Answer 31

Urinalysis (urine ketone test)

Question 32

A urine ketone test is able to dect _______________ & unable to detect _____________

Answer 32

Acetoacetatic acid, beta-hydrohybutyrate

Question 33

What does a microalbumin test indicate?

Answer 33

glomerular damage, predictive of nephropathy

Question 34

What is a microalbumin test?

Answer 34

A urine microalbumin test is a test to detect very small levels of a blood protein (albumin) in your urine.

Question 35

A microalbumin test is used to detect early signs of what?

Answer 35

A microalbumin test is used to detect early signs of kidney damage in people who are at risk of developing kidney disease.

Question 36

Why do we check urine albumin annually in diabetics?

Answer 36

- to look for any kidney damage | - diabetes causes glomerular permeability to exceed reabsorption

Question 37

Microalbumin can be affected by ________________

Answer 37

hydration status

Question 38

What calculation corrects for hydration status?

Answer 38

Correct for hydration status by utilizing: | (urine microalbumin/urine creatinine) x 1000

Question 39

TSH is secreted by the __________ | __________

Answer 39

Anterior pituitary

Question 40

What regulates the release of T3 and T4?

Answer 40

TSH from the anterior pituitary

Question 41

Hypothyroidism causes _______ TSH and _______ T4

Answer 41

Elevated, decreased (deficiency)

Question 42

Hyperthyroidism causes _______ TSH and _______ T4

Answer 42

Low, Excessive

Question 43

What lab test would you order to test for Hypo/Hyperthyroidism?

Answer 43

TSH

Question 44

What does a low T4 indicate?

Answer 44

Hypothyroidism

Question 45

What does a high T4 indicate?

Answer 45

Hyperthyroidism

Question 46

What is the most accurate measure of thyroid status?

Answer 46

``` Free T4 (measures unbound T4) -determines how well T4 is working ```

Question 47

What does a high T3 indicate?

Answer 47

hyperthyroidism

Question 48

What does a low T3 indicate?

Answer 48

hypothyroidism

Question 49

What does a T3 measure?

Answer 49

Indirectly estimates number of binding sites on thyroid bound by T3

Question 50

Hyper or Hypothyroidism is a major contributor to new onset AFib?

Answer 50

Hyperthyroidism

Question 51

If someone has new onset AFib, what lab test should you order?

Answer 51

TSH

Question 52

The parathyroid is responsible for ________ _________

Answer 52

calcium metabolism

Question 53

What is the mc cause of primary hyperparathyroidism?

Answer 53

Adenoma of the parathyroid gland. Results in hypercalcemia.

Question 54

______ & calcium are directly related

Answer 54

Albumin

Question 55

What is the calculation that is used to determine calcium levels?

Answer 55

Serum calcium + (0.8 x (4-albumin))