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DT4-Exam 1 > Adult Diabetes/Ca Disorders-Leah > Flashcards

Adult Diabetes/Ca Disorders-Leah Flashcards

1
Q

Hypercalcemia:

Signs and Symptoms (3)

A
  • confusion
  • dehydration
  • muscle wasting
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2
Q

Hypercalcemia:

assc lab findings (3)

A
  • pre-renal failure (BUN:Cr OVER 20:1)
  • Na high
  • concentrated urine (dehydration)
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3
Q

Hypercalcemia

  • 4 assc cancers
  • common assc medication
A

Cancers:

  • myeloma
  • squamous cell lug cancer (PTHRP)
  • breast ca.
  • lymphomas (others also possible)

Med cause:
- HCTZ

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4
Q

3 disorders (non-cancerous) that may cause hypercalcemia

A
  • milk akali syndrome***
  • granulomatous disorders (cause ^^ Vitamin D)
  • hyperparathyroidism
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5
Q

Most common cause of incidental ^^Ca?

How do you work up incidental Ca?

A
  • parathyroid adenoma

- should retest, then if ^^ Ca on second test, check PTH levels

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6
Q

EKG findings assc with Ca abnormalities?

A
  • short QT with ^^ Ca

- long QT with low Ca

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7
Q

How does multiple myeloma cause ^^ Ca?

How does lymphoma cause ^^ Ca?

A
  • myeloma activates osteoclasts (IL-6)

- lymphomas increase vitamin D

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8
Q

How do you treat hypercalcemia?

A
  • saline (rehydrates, improves renal function)

- bisphosphonates

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9
Q

What is zoledronic acid?

pamidronate?

A

-bisphosphonates, treat hypercalcemia

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10
Q

***Milk Alkali syndrome:
Whats the cause?
What are the assc electrolyte abnormalities?

A
  • ^^ Ca intake
  • Sodium bicarb/ milk for peptic ulcers
  • Ca supplements post menopause (more common)

Electrolytes:

  • Ca HIGH
  • PTH/ vitamin D LOW
  • PO4 variable
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11
Q

HyperPTH:

4 assc conditions?

A
  • kidney stones
  • osteoporosis
  • gout
  • HTN

“painful bones, renal stones, abdominal groans, psychotic overtones”
(This isn’t exactly what he has on his slide, but its the traditional menomic. I would say this nmeonic + the things I listed can be present)

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12
Q 
#1 imaging for parathyroids? 
Treatment for adenomas/ hyperplasia?
A

99 SESTAMIBI

no treatment other than cutting them out! If you don’t cut them out, kidneys will fail.

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13
Q

Criteria for parathyroid surgery? (5)

A
  • poor renal function
  • under 50
  • osteoporosis
  • ^^^^^^^Ca
  • renal stones
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14
Q

Gastric bypass is a risk for?

A

-HYPOcalcemia

poor absorption

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15
Q

Two classic PE findings assc with hypocalcemia

A

Chvostek’s Sign and Trousseau’s Sign

tapping on cheek, BP cuff

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16
Q

hypocalcemia assc electrolyte abnormalities (3)

A
  • low vitamin D often the CAUSE!
  • *If vitamin D intake is totally normal/ synthesis works, I would assume it would increase in the face of low calcium.
  • low Ca
  • high PTH
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17
Q

When does hypoparathyroid occur?

What electrolyte abnormality does it cause?

A
  • after surgery (thyroid or parathyroid)
  • autoimmune hypoparathyroidism

causes low Ca

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18
Q

What is hungry bone syndrome?

A

-thyroid/ parathyroid surgery –> sudden increase in bone uptake of minerals due to lost PTH!! –> transient severely low Ca

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19
Q

What are Mg/ PO4 levels like in hungry bone syndrome?

A

-low Mg and PO4 along with low Ca (bones don’t just eat up the Ca)

20
Q

In the case of mildly low Ca, esp in the hospital, what lab test should you do to confirm?

A

-ionized Ca

21
Q

PTH secretion is dependent on what?

What are the actions of PTH?

A
  • depends on extracellular Ca
  • renal: ^^ Ca absorption, lowers PO4 absorption
  • ^^osteoclasts
  • ^^calcitriol synthesis, lowers its degradation

**Keeps Ca available

22
Q

Vitamin D functions

A

Ca: ^^ absorption from gut, bone, kidney
PO4: INCREASES renal phosphate retention (opposite of PTH)

**Keeps BOTH Ca/PO4 available

23
Q

What factors increase vitamin D synthesis? (2)

A
  • PTH

- hypophosphatemia

24
Q 
How does chronic kidney disease effect the levels of: 
PO4-
vitamin D-
Ca-
PTH-
pH-
A 
PO4- high
vitamin D- low 
Ca-low 
PTH- high 
pH-mild acidosis
25
How are the electrolyte abnormalities assc with chronic kidney disease treated?
- phopshate binders (to lower PO4) | - oral vitamin D to ^^ vit D/Ca
26
What does the ^^PTH in Chronic Kidney Disease cause?
-osteitis fibrosa (bone disease)
27
Insulin resistance: | two contributing factors
- visceral adipose (has high insulin requirements, causes chronically ^^ insulin) - lack of exercise (decrease SKM glu uptake)
28
Major manifestation of insulin resistance in the body?
-lipolysis even in the fed state | cells can't eat the glucose, theyre starving
29
High risk ethnic groups for DM2?
- blacks - hispanics - pacific islanders
30
Prediabetes: Fasting blood sugar levels? Assc disease process?
100-126 FBG | these patients have atherosclerotic changes already, as diabetic vascular disease starts early!!
31
A1c assc with pre-diabetes? diabetes?
-5.7 (pre) -6.5 diabetics side note: -6.5-7.0 goal range for diagnosed diabetics
32
How do diabetic patients usually present? | What are the classic findings?
-usually patients are asymptomatic due to ^^ screening requirements -classically have the "3 Ps" + weight loss (polyuria, polydypsia, polyphagia) -may also have early neuropathy
33
Reccomended exercise for all of us, especially those with diabetes?
-30 mins/day, 5x/ week (150 mins/ week) aerobic exercise ^^^Getting better about this, but not quite there yet! I don't want fatty diseases!😱
34
At what blood glucose level does glucosuria occur?
180
35
How often should A1c be checked?
every three months, goal is 6.5-7
36
DM2 treatment
initially oral hypoglycemic agent --> late state will require injectible insulin
37
How do we decrease mortality in diabetics?
give them statins, they all have atherosclerosis
38
What oral hypoglycemic is assc with lactic acidosis? | When don't you give it?
-metformin | cant use in CHF, renal, liver failure
39
Why doesn't Dr. Meadows like sulfonylureas?
They have no good effects except lowering BG and they tend to make little old ladies 👵🏽really hypoglycemic 😰
40
Target BP for DM patients? | cholesterol?
- lower than 130/80 BP | - lower than 100 cholesterol
41
How can renal function be preserved in diabetics?
-control BP, give ACEi
42
Which is a greater risk factor for MI: | Previous MI or DM
same risk
43
What worsens hyperglycemia in diabetics?
- steroids - stress - infection
44
Why are DM patients more likely to die in the event of: | sepsis, MI, pneumonia, CVA?
They are immunosupressed
45
What is given for prevention of macrovascular disease?
aspirin
46
DM1: How is it Dx'ed? How is it treated? What bad condition does it cause?
- Ab's against GAD in islet cells - treat with insulin - assc with ketoacidosis

DT4-Exam 1 (17 decks)

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