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Adult Primary Care > T3 - DM/Thyroid - Endocrine/GI > Flashcards

T3 - DM/Thyroid - Endocrine/GI Flashcards

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1
Q

MODY and LADA

A

Mature Onset Diabetes of the Young
Late Autoimmune DM in Adults

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2
Q

AGBI

A

Alpha cells - glucose
Beta cells - insulin

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3
Q

In DM2, initially there is _______ levels of insulin, and then as the cells tire out, insulin levels _______

A

High
Drop

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4
Q

What is c-peptide? Are levels high or low in T1DM? T2DM?

A

The part that gets cleaved during enzymatic activation of insulin. If 0 insulin is produced (T1DM), then it makes sense that c-peptide levels would be LOW.
T2DM would be. Hight.

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5
Q

Ominous Octet of DM

A

Impaired insulin secretion from Beta cells
Increased glucagon secretion from alpha cells
NT dysfunction (satiety)
Decreased glucose uptake in muscles
Increased glucose reabsorption by kidneys
Increased lypolysis
Decreased incretin effects
Increased hepatic glucose production

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6
Q

According to ADA, who should get screened for DM?

A

Adults over 35 who have a BMI >25 and at least 1 risk (risks = 1st deg relative with DM, high risk race, Hx CVD, HTN, HDL <35 or TG >250, Hx PCOS, physical inactivity, preDM A1c >5.6)
Test q3 years or yearly

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7
Q

How often should pre-diabetics get checked for DM?

A

Yearly screening

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8
Q

A1C for pre-diabetes and diabetes

A

Pre = 5.7-6.4
DM= >=6.5

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9
Q

When should kids get screened for DM?

A

Kids 10yo or at the onset of puberty who are overweight/obese (85% or more) with 1 or more RF.

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10
Q

Fasting plasma glucose is ____ in pre-dm and _____ in DM. Goal for diabetics is ______
Goal A1c for diabetics is _______
OGTT after 2 hours of 75G glucose load for pre-DM is _______ and DM is _______.
Goal post prandial BG for diabetics is ______

A

100-125, >=126, 80-130
<7%
140-199, >=200
<180

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11
Q

When should pregnant patients get their OGTT?

A

24-28wks

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12
Q

PP women who had GDM should have an OGTT at ______

A

4-12 wks PP

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13
Q

Women who had GDM should be screened ______

A

For DM every 3 years for life.

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14
Q

Hemaglobinopathies and anemias - why do these matter in DM?

A

They can cause a falsely low A1C since the RBCs turn over more rapidly than every 3 months.

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15
Q

Insulin is initiated at _______ u/kg/day and titration. Most are at around _________ u/kg/day

A

0.2-0.6
0.4-1.0

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16
Q

“-tides” are ________ and “-flozin” are _______

A

GLP1
SGLT-2

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17
Q

An expected _____ bump in creatinine happens with the initiation of ACEi/ARB therapy. Anything more than this should be investigated.

A

10%

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18
Q

If the patient has proteinuria, what Rx should be considered?

A

Control glucose (<7%)
Control BP (<140/90)
ACEi/ARB
SGLT2

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19
Q

Diabetic neuropathy can “goof up” proprioception which can lead to more ______

A

Falls

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20
Q

NAFLD + NASH can lead to

A

Cirrhosis, hepatic ca, portal HTN, liver failure.

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21
Q

Level 1, 2 and 3 hyPOglycemia.

A

1 = 54-70
2 <54
3 severe event requiring treatment

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22
Q

If you’re a diabetic, you should expect to burn between ______ CHO per 30min of moderate exercise

A

1-20.

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23
Q

More episodes of hypoglycemia you have, the less your brain recognizes hypoglycemia.

A
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24
Q

Acidosis in diabetics -
RR?
Na?
K?

A

Increased
Falsely decreased
Falsely high

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25
How do you calculate the anion gap? What is normal?
Take the number of cations (+Na) minus the sum of the number of anions (- CL and HCO3) Normal is 8-12
26
Urine dipstick doesn’t read the MAIN ketone in DKA, only the other 2, so if ketones are low, or neg, it could still have ketones.
27
What is the SICK acronym for DM?
On sick days: Sugar: Check your Sugar every 2-3 hours or as necessary Insulin: Always take your Insulin Carbs: Drink lots of fluids. If sugars are high drink sugar free beverages. If sugars are low, drink Carb containing beverages. Ketones: check your urine ketones every 4 hours. Take rapid acting insulin if ketones are present.
28
For DM, the PCV pneumococcal vaccine is recommended for 19-65yo.
29
Too much thyroid hormone during development = _________ stature. Why?
Short. Because the bones mature and ossify sooner than normal.
30
What will you see in TSH and T4 in Hashimoto’s?
Increase TSH and decrease T4
31
If TSH is high and T3/T4 are normal/low, then what is the condition?
Hypothyroidism or sub clinical hypothyroidism.
32
If TSH is low and T3/T4 are normal/high, what is the conditions?
Hyperthyroidism or sub clinical hyperthyroid.
33
In Central hypopthyroidism, what differs from primary hypothyroidism?
Central = normal/low or slightly high TSH with low or low-normal t3/T4.
34
Single best test of thyroid function?
TSH
35
Titration TSH at a 6-8wk follow up.
36
Young adults will start at _______% predicted dose calculated by ______ Middle age start at ______ % predicted dose _______ Elderly or Cardiopulmonary disease start at _________
79-90% (1.5-2.2mcg/kg ideal body weight) 65-75% (1.5-2.0mcg/kg ideal body weight) 12.5-25mcg/d and add 25mcg every 6 weeks.
37
Restoring a euthyroid state in some one with hypothyroidism especially elderly and those with cardiopulmonary disease can cause ________
Tachycardia Increased O2 consumption/demand Exacerbation of underlying cause
38
What should we consider in every patient newly diagnosed with hypothyroidism?
Adrenal insufficiency
39
How should you take synthroid?
On an empty stomach first thing in the morning (only water- no food OR COFFEE!) and wait at least 30 minutes prior to any food or other medications.
40
Your patient has been put on the starting dose of synthroid for hypothyroidism. They are back for their 6 week follow up and their TSH level is <0.5. What should you do? What if their level was >4?
<0.5, then decrease dose by 12.5-25mcg If > 4, then increase dose by 12.5-25mcg.
41
What is the therapeutic TSH range while on medication?
0.5-2
42
TSH will be >___ but < ____ in subclinical hypothyroidism. Should you treat?
5 less than 10 Treat if symptomatic. Monitor for worsening.
43
What is Pemberton’s sign?
If a patient has a goiter or enlarged thyroid gland, if they raise their hands up to their ears and leave for 1-2 minutes, their face will flush due to compression of the veins and can’t empty from the face.
44
Are “cold” or “hot” thyroid nodules more concerning?
Cold. More likely to be cancerous (1/20) Hot are generally benign.
45
______% of post partum thyroiditis regain normal function
80%
46
H.Pylori triune treatment:
PPI, Amoxicillin and clarithromycin for 10 days.
47
IBS (as opposed to just regular constipation or diarrhea) must have:
BLOATING.
48
Difference between UC and CD
UC - superficial layer only, 3x more common than chron’s, colon only, CD - all layers of the intestine and all areas including oral mucosa, strictures and fistulas, erythema nodosium. Both- fatigue, tenesmus, anemia, bowel urgency.
49
What is a good test for patients who come in with nausea.
PO challenge. Can they keep fluid and meds down?
50
Associated symptoms with n/v
Eating disorders, pain, headache, dizziness, tinnitus, diarrhea, fever, anxiety, AMS, pregnancy, new medication (SE), recent bad food intake.
51
Some DDX for N/v
Acute abdomen, morning sickness, eating disorder, pregnancy, constipation, infection, pain, med SE, migraine, metabolic cause (DKA/HHS), Meniere’s MI, cholecystitis.
52
Buttaro pg 744 - antiemetic meds
53
Upper abd pain UPPERSTOMACH acronym
Urinary - stone, infx Pancreas - pancreatitis, mass Pulmonary. - PNA/PE Ectopic - pregnancy Really early appendicitis Stomach - GI, perf, ulcer Twisting - volvulous, ischemic bowel Obstruction - bowel, FB MI - ACS, myocarditis/pericarditis, aneurysm Aorta - AAA, dissection Cholecystitis/cholangitis Hepatic - hepatitis.
54
What 3 things should be done first if you have an abd pain complaint?
ABCs, sick or not sick, ECG.
55
What type of pain main increase with cough?
Parietal pain (irritation of the peritoneum)
56
What type of pain is dull, cramping, poorly localized?
Visceral
57
How does referred pain typically present?
Aching
58
Www.merkmanual.com
59
classic triad for appendicitis
RLQ pain, anorexia and nausea
60
4 PE tests for appendicitis
Psoas sign Obturator sign McBurney’s point Rovsing’s sign (palpate LLQ and pain is felt in RLQ)
61
What percentage of patients have increased WBC in appendicitis?
75-90%
62
Most common cause of GI obstruction?
Adhesions post surgery, hernias and tumors.
63
T/F: Ileus is the same as obstruction
False. Ileus can lead to an obstruction
64
RF for pancreatitis
ETOH, gallstones, HLD
65
In 50% of pancreatitis patients, pain radiates to the _______
Back
66
__________% of pancreatitis patients have associated N/v
90
67
A 3 fold increase in lipase can indicate pancreatitis, but not what KIND.
68
Murphy’s sign is used to assess for cholecystitis. How do you test?
Inspiratory arrest with palpation of RUQ under ribs.
69
Peritonitis is usually secondary to another cause. Patients appear _____ and don’t want to ______
Very sick Move
70
GER can be normal physiology. GERD is ______ with troublesome symptoms
>2weeks
71
Some DDX for GERD
MI, esophagitis, peptic ulcer, post nasal drip, H.Pylori.
72
If someone has Barrett’s esophagus, how often should they get their EGD?
1-2years WITH biopsy.
73
Peptic ulcers - _____% caused by chronic NSAID use. Pain ________ and relieved by __________
25 Wakens patient’s at night. Relieved by eating or vomiting.
74
PPI should not be used for more than a few months. Assess for chronic PPI OTC use.
75
Constipation is a ______ not a _______
Symptoms Disease.
76
What is the Rome IV criteria for constipation?
Must have 2 or more of the following: 2 or less stools/week Hard or lumpy stool Straining Feeling of obstruction or incomplete evacuation Manual assistance >25% of the time NOT meet criteria for IBS-C.
77
Difference between NAFLD and NASH
NonAlcoholic Fatty Liver Disease - Non-inflammatory no S/s. No Treatment. Lifestyle modification. NASH - NonAlcoholic Steatohepatitis- inflammatory. No s/s but rarely fatigue, malaise or vague RUQ discomfort
78
With NASH or NAFLD, you will see an increase in what labs?
AST and ALT 2-5x normal ratio and elevated ALK phos.
79
What is the Fib-4 test for NASH risk?
Age (35-65) AST ALT Platelet count
80
How do patients present with cirrhosis? CV Derm Neuro GI Hem Repro
CV - esophageal varices, capital Medusa, ankle edema Derm - spider nevi, clearly icterus, jaundice Neuro - coma, liver flap (course hand tremor) GI - femoral hepaticus, jaundice, hemorrhoids, splenomegaly, hematemesis, peptic ulcers, melena Hem - anemia, bleeding tendency Repro - testicular atrophy, Gynecomastia,
81
5 categories of diarrhea
Infection Inflammatory Secretory Malabsorption/osmotic Increased motility
82
Carcinoid tumor or VIPomas would be an example of. _______ diarrhea.
Secretory
83
IBS-D would be an example of _____ diarrhea
Increased motility
84
UC and CD would be examples of _____ diarrhea
Inflammatory
85
Celiac disease, lactose intolerance, post-op short bowel or pancreatic insufficiency (CF) would be examples of ____ diarrhea.
Malabsorption.
86
What is a BRAT diet?
Banana, rice, apples, toast
87
If someone has a malabsorption condition, what should you check/replenish ?
Fat sol vitamins (DEAK), poor absorption of carbs (underweight), Iron, minerals like B12 and proteins.
88
What is celiac disease often miss diagnosed as?
IBS
89
What is dermatitis herpetiformis?
Skin condition associated with celiac disease.
90
How do you screen for Celiac Disease?
tTG-IgA and total IgA
91
Clinical considerations for Celiac disease?
GFD for life, registered dietician referral, test and treat for nutrient deficiencies (iron, folic acid, VitD, vit B12), screen for osteoporosis (70% develop osteopenia), and repeat tTGA 6mo post GFD
92
IBD has a peak onset of ________ and another peak at _______
20/30 50s
93
Imaging results using the terms “string sign”, “rectal sparing”, “thumb printing” “ skip lesions” or “cobblestone mucosa” suggests _________
Chron’s Disease
94
Dietary management of Chron’s disease?
Increased fiber Low fat Trial dairy restriction Rheum and dietician referral Vitamin/mineral supplements
95
Bloody diarrhea, arthritis, skin lesions, tenesmus and tachycardia/orthostatic hypotention could be signs of _____
UC
96
Low grade fever, watery diarrhea, perianal fissures, fistulas are signs of ____
Chron’s disease
97
Lubiprostone. (Amitiza) is a ______ and FDA approved for treatment of ______ in ______ only, not ______
Chloride channel activator IBS-C Women Men
98
1st line tx for IBS-D 2nd line
Loperamide Bile acid sequestrants and antispasmodics PRN and prophy.
99
What are carcinoid syndrome and VIPoma?
Carcinoid syndrome - serotonin secreting cancerous tumors VIPoma - neuroendocrine tumor that secrete vasoactive intestinal polypeptide (VIP) These both cause secretory type diarrhea
100
RF for colon CA
Age >50 Smoking IBD Family Hx Obesity Diet high in red meat and fats.
101
Colon cancer screening
Grade A for 50-75 Grade B for age 45-49 and Grade C for age 75
102
One main cause of GI bleeds?
Diverticulosis
103
Constellation of LLQ tenderness, w/w/out peritoneal s/s, fever and leukocytosis could suggest?
Sigmoid diverticulitis
104
Avoid these 4 things in diverticular disease:
Laxatives, enemas, opioids and NSAIDS.
105
90% of NON-STI or IBD related anal fissures are posterior midline. A lateral midline anal fissure often indicates ____, ____ or _____
UC, CD STI.

Adult Primary Care (18 decks)

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