test 3

Question 1

cushings syndrome causes

Answer 1

excess steroids, pituitary

adenoma

Question 2

cushings syndrome S/S

Answer 2

central obesity, weight gain, round
face, buffalo hump, thin and brittle skin,
easy bruising, acne, hirsutism,
osteopenia/porosis, HTN, low K, HLD,
glucose intolerance, irritable, emotional
lability, depression, prone to infections

Question 3

cushings diagnostics

Answer 3

24 hour urinary free cortisol,
cortisol level, dexamethasone overnight
test, if + MRI pituitary, CRH test, if ACTH
low CT of adrenals

Question 4

cushings treatment

Answer 4

dc tumor

Question 5

addisons disease causes

Answer 5

autoimmune, drug induced,

infections, congenital, tumor/cancer

Question 6

addisons disease S/S

Answer 6

S/S: fatigue, weight loss, anorexia,
myalgia, joint pain, fever, anemia,
postural hypotension, low BP, GI
symptoms, craves salt, low Na, high K,
itchy and dry skin

Question 7

addisons disease dx

Answer 7

short cosyntropin test, CBC, BMP, TSH

Question 8

addisons disease treatment

Answer 8

hyrdrocortisone 100-200 mg over 24 hours IV or IM, monitor

resolution by s/

Question 9

DM normal A1C

Answer 9

<5.6

Question 10

Prediabetic A1C

Answer 10

5.7-6.4

Question 11

Diabetic A1C

Answer 11

> 6.5

Question 12

when to screen for DM

Answer 12

> 45 years old every 3 years and earlier if BMI is over >25

Question 13

DM therapy goal

Answer 13

• Goal of therapy is to reduce hyperglycemia and prevent long term
microvascular and macrovascular complications

Question 14

DM complications

Answer 14

retinopathy, nephropathy, neuropathy

Question 15

DM medical therapy

Answer 15

Comprehensive medical therapy includes glycemic control , eye exam,
foot exam, BP monitoring, vaccines, lipids and renal function
monitoring, education

Question 16

Type 1 DM cause

Answer 16

Caused by pancreatic islet B cell
destruction > either
autoimmune or idiopathic

Question 17

Type 1 DM fasting glucose score vs random glucose score to dx and urine

Answer 17

Fasting glucose > 126 mg/dl on
more than 1 occasion

Random glucose > 200 mg/dl
with polyuria, polydipsia, and
weight loss
• + ketones

Question 18

Type 2 Diabetes

Answer 18

Circulating endogenous insulin is
inadequate to prevent
hyperglycemia (insulin resistance)

Question 19

type 2 DM

age
symptoms
fasting glucose score
a1c score

normal co morbidity

Answer 19

> 40 and obese
• Polyuria and polydipsia
• Fasting glucose > 126 mg/dl on
more than 1 occasion
• HbA1C > 6.5%
• HTN, HLD, and atherosclerosis are
usually present

Question 20

type 1 DM S/S

Answer 20

• S/S: polyuria and polydipsia as a result of osmotic diuresis, blurred
vision, weight loss, postural hypotension, parasthesias

Question 21

type 1 DM treatment

Answer 21

Treatment: insulin
• Short acting: lispro, regular
• Long acting: NPH, detemir
• Combos: 75/25, 70/30, 50/50

Question 22

Insulin dosing

units/kg/day

Answer 22

Calculate total daily dose (0.5-0.7 units/kg/day)
• Divide total insulin into basal and bolus dosing
• Basal = long acting insulin
• Bolus = short acting insulin, divide out before meals

Question 23

type 2 dm S/S

Answer 23

S/S: polyuria and polydipsia, unexplained candida vulvovaginitis in
women, central obesity

Question 24

dm 2 treatment

Answer 24

Treatment is three-fold

1. Glycemic control
2. Co-morbidities
3. Screen for complications

Question 25

medications dm 2

Answer 25

Medications: oral agents such as biguanides (metformin), sulfonylureas (glipizide), thiazolidinedione (pioglitazone), insulin under certain conditions

Question 26

type 2 dm management goal FBS and random sugar and when to start oral agent

Answer 26

1. Start with diet and exercise for weight loss for FBS <200 or random <250 2. Begin oral agent if FBS 250-300 or random 250-350

Question 27

type 2 dm oral agents

Answer 27

Metformin first line or 2. Glitazone second line for obese patients, sulfonylurea for lean patients 3. 3 months re-eval if not improved, start dual therapy > metformin with sulfonyurea or glitazone 4. Add a 3rd medication if still not improved. 5. Insulin therapy for A1C > 10%, FBG >300 or random >350

Question 28

DKA cause S/S Exam

Answer 28

Insulin deficient and glucagon excess increase blood sugar • S/S: n/v, polyuria, polydipsia, abd pain, SOB • Exam: tachy, hypotension, dehydrated, tachypnea, Kussmaul Respirations, abd tenderness, lethargy to coma

Question 29

DKA lab findings lab findings treatment

Answer 29

Lab findings: elevated glucose, hyponatremia, hypokalemic, AKI, + ketones, increased anion gap, increased osmolality • Treatment: ACUTE emergency, likely admit to ICU, check labs, • IVF at 2-3 L NS over first 1-3 hours, then ½ NS at 250-500 ml/hour until FBS is 250 then switch to D5 ½ NS at 150-250 ml/hr • Insulin bolus of 0.1 unit/kg then Insulin drip 0.1 units/kg per hour and increase each hour until glucose begins to drop, hold insulin drip if K is not WNL. • Treat electrolyte abnormalities

Question 30

Hyperglycemic hyperosmolar state definition

Answer 30

• Insulin deficiency increases hepatic glucose production and impair glucose utilization

Question 31

Hyperglycemic hyperosmalar state

Answer 31

• Labs: hyperglycemia (>600), normal Na, AKI, likely no ketones, slightly increased anion gap • S/S: polyuria, weight loss, diminished oral intake, underlying cause such as infection

Question 32

Hyperglycemic hyperosmolar state treatment

Answer 32

Treatment: 1-3 liters of NS over first 2-3 hours, watch Na, change to ½ NS if Na > 150, similar to DKA start insulin drip at 0.1 units/kg per hour after a bolus of 0.1 units/kg

Question 33

DM special considerations ``` ICU PT Med surge Pt TPN Glucocorticoids Preggers old heads ```

Answer 33

ICU patient – switch regimen to insulin drip to maintain glucose 140- 180 • Med/surg patient – keep outpatient regimen and adjust accordingly • TPN – insulin added to TPN • Glucocorticoids – increase insulin, oral agent likely not helpful • Pregnancy – requires planning and strict regimens • Older adults – 50% of usual starting dose

Question 34

Diabetic Complications

Answer 34

Microvascular • Retinopathy • Macular edema • Autonomic neuropathy Macrovascular • CAD • PAD • CVA

Question 35

dm complications other

Answer 35

``` Other • GI issues • Sexual dysfunction • Infections • Glaucoma • Hearing loss • Periodontal disease ```

Question 36

Hypoglycemia usual cause SS Tx

Answer 36

Usually caused by medications • S/S: cognitive and behavioral changes, diaphoresis, pallor, palpitations, tremor, anxiety, hunger, paresthesia • Treatment: identify cause, oral glucose, IV glucose, glucagon IM

Question 37

Syndrome of inappropriate secretion of antidiuretic hormone definition causes S/S TX

Answer 37

Inappropriate secretion of AVP • Causes: Cancer, head trauma, infections, CVA, neuro disorders, medications, pneumothorax, asthma • S/S: headache, confusion, anorexia, n/v, coma, convulsions • Treatment: identify cause, treat underlying cause, fluid restriction, diuretic to increase urine production (rids body of excess salt and water), treat hyponatremia gradually (1% an hour)

Question 38

thyroid disorders hyper

Answer 38

Hyperthyroidism • Low TSH • Normal to high T4

Question 39

thyroid disorders hypo

Answer 39

Hypothyroidism • Elevated TSH • Low free T4

Question 40

Hypothyroidism causes

Answer 40

• Causes: autoimmune, iatrogenic, medications, congenital, iodine deficiency, postpartum

Question 41

hypothyroidism S/S

Answer 41

• S/S: fatigue, dry skin, cold, hair loss, poor memory, constipation, weight gain with poor appetite, dyspnea, hoarse voice, hearing loss

Question 42

hypothyroidism exam dx management

Answer 42

Exam: myxedema, bradycardia, delayed tendon relaxation, carpal tunnel syndrome • Diagnostics: Check TSH, free T4, thyroid ultrasound • Management: levothyroxine 1.6 mcg/kg 30 mins before breakfast

Question 43

autoimmune hypothyroidism AKA definition

Answer 43

AKA Hashimoto’s or autoimmune hypothyroidism > marked | lymphocytic infiltration of the thyroid causing atrophy and fibrosis

Question 44

hashimotos decline in functions symptoms dx

Answer 44

Gradual decrease in function • Minor symptoms (see prior slide) S/S: fatigue, dry skin, cold, hair loss, poor memory, constipation, weight gain with poor appetite, dyspnea, hoarse voice, hearing loss • Diagnostics: TSH, if elevated check unbound T4, TPO antibodies, Thyroid US , FNA biopsy to confirm

Question 45

Myxedema coma what is it s/s tx special considerations

Answer 45

Severe hypothyroidism • S/S: decreased LOC, seizures, hypothermia • Treatment: IV bolus levothyroxine 500 ug Special considerations: • Pregnancy > frequent monitoring • Elderly > likely need lower dose

Question 46

hyperthyroidism causes

Answer 46

Causes: Grave’s Disease, goiter, adenoma, CA, thyroiditis, medications, gestational

Question 47

hyperthyroidism s/s

Answer 47

S/S: hyperactive, irritable, palpitations, fatigue, weakness, weight loss with increased appetite, diarrhea, polyuria, loss of libido, oligomenorrhea

Question 48

hyperthyroidism exam dx tx

Answer 48

Exam: tachy, tremors, goiter, warm, moist skin, muscle weakness, gynecomastia, lid retraction or lag • Diagnostics: TSH, unbound T4, unbound T3, US • Management: thionamides

Question 49

Complications of hyperthyroidism

Answer 49

``` • Complications: Optic nerve compression, use NO SPECS scoring N (0) = no signs or symptoms O (1) = only signs no symptoms S (2) = soft tissue involvement P (3)= proptosis E (4)= extraocular involvement C (5) = Corneal involvement S (6) = sight loss ```

Question 50

graves disease treatment

Answer 50

Start antithyroid drug and check levels every 4-6 weeks • PTU 100-200 mg every 6-8 hours and reduce dose as symptoms and labs improve • Propranolol controls adrenergic symptoms • Radioiodine to destroy thyroid cells • Subtotal or total thyroidectomy for relapse after medications or if goiter is too big

Question 51

thyroid storm definition s/s management

Answer 51

Life threatening Severe hyperthyroidism • S/S: Fever, delirium, seizures, coma, vomiting, diarrhea, jaundice, cardiac failure, arrhythmia, hyperthermia • Management: ICU, supportive care, large doses of PTU given via NGT or rectally, propranolol

Question 52

opthalmopathy

Answer 52

Mild to moderate no treatment needed • Management: Stop smoking, control thyroid hormone, artificial tears for discomfort, eye ointment, dark glasses with side frames, sleep upright for edema or diuretics, patches while sleeping to protect cornea, optic nerve involvement needs emergency surgery, IV methylprednisolone preferred for moderate, orbital decom

Question 53

thyroitis causes s/s tx

Answer 53

Causes: infection, radiation, drug induced, autoimmune • S/S: throat pain, tender goiter, fever, dysphagia, erythema, lymphadenopathy • Treatment: high dose ASA or NSAIDs to control pain, steroids if not resolving and tapered over 6-8 weeks, low dose levothyroxine • Can be acute, subacute or chronic

Question 54

goiter

Answer 54

``` Goiter • Asymptomatic • Can be diffuse nontoxic or multinodular nontoxic • On exam thyroid will feel abnormal • Treat labs ```

Question 55

``` hyperpara thyroid disorder PTH calcium and phosphate cause monitor tx ```

Answer 55

``` Hyperparathyroid • Increased PTH • Hypercalcemic, hypophosphatemia, • Caused by tumors, adenomas, genetics • Monitor Ca, urinary calcium, cr. Clearance, serum creatinine, bone density • Treatment – remove abnormal tissue ```

Question 56

hypoparathroid PTH calcium phosphatemia cause tx

Answer 56

``` Absent PTH • Hypocalcemia, hyperphosphatemia • Caused by genetics, surgical removal of gland • Treatment – vitamin D, oral Calcium intake, treat concurrent issues such as CKD, low ```