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endorepro remediation > Adult Endocrine > Flashcards

Adult Endocrine Flashcards

1
Q

Guidelines for diagnosis of DM

A
  • FPG (Fasting plasma glucose) values ≥126 mg/dL (7.0 mmol/L).
  • Two-hour plasma glucose values of ≥200 mg/dL (11.1 mmol/L) during a 75 g OGTT (Oral Glucose Tolerance Test).
  • HbA1C values ≥6.5 percent (48 mmol/mol).
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2
Q

What is the recommended monitering for long term care of DM

A
  • Hemoglobin A1c
  • HbA1c
  • GHbA1c
  • Glycosylated hemoglobin
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3
Q

Differential for mental status changes

A

AEIOUTIPS

  • A – Alcohol
  • E – Epilepsy with seizure activity
  • I – Infection
  • O – Overdose
  • U- Uremia
  • T – Trauma
  • I – Insulin (high or low blood sugar)
  • P – Poisoning/Psychosis
  • S – Stroke
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4
Q

Differential for abdominal pain mnemonic

A

BAD GUT PAINS

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5
Q

BAD GUT in abdominal pain differential

A 
B - Bowel obstruction
A - Appendicitis, Adenitis (mesenteric)
D - Diverticulitis
Diabetic Ketoacidosis
Dysentary/Diarrhea Drug withdrawal
G - Gastroenteritis
Gall bladder disease/stones/obstruction/infection
U - Urinary tract obstruction or infection
T - Testicular Torsion
Toxins - Lead, black widow spider bite
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6
Q

PAIN in abdominal pain differential

A

P - Pneumonia/Pleurisy/Pancreatitis Perforated
bowel/Peptic ulcer/Porphyria
A - Abdominal aneurysm
IN - Infarcted bowel
Infarcted myocardium (AMI-Acute Myocardial Infarction)
Incarcerated hernia
Inflammatory bowel disease
S - Splenic rupture/infarction
Sickle cell pain crisis/Sickle sequestration crisis

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7
Q

High Anion gap acidosis differential

A

MUDPILES

  • Methanol
  • Uremia
  • Diabetic Ketoacidosis
  • Paraldehyde
  • Isopropyl Alcohol, Iron, INH (Isoniazid)
  • Lactic Acidosis
  • Ethylene Glycol
  • Salicylates
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8
Q

Treatment of DKA

A 
•Intensive Care Unit
• Frequent monitoring of general status, vital
signs, glucose and other labs
• Acid-base status
• Renal function
• Potassium and other electrolytes
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9
Q

What is the 123 rule of fluid replacement in DKA

A
  • 2 – 3 liters NS (Normal Saline) (0.9 %) over first 1-3 hours (5-10 ml/kg/hr)
  • Then, ½ strength saline (0.45%) at 150 ml/hr
  • When glucose reaches 250 mg/dl, switch to D51/2 NS (5% dextrose and 0.45% saline) at 100 – 200 ml/hr
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10
Q

What is the fluid deficit in DKA

A

Fluid deficit is often 3 – 5 liters

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11
Q

Insulin administration in DKA

A

Regular Insulin
• 10 – 20 units IV or IM (or 0.15/kg)
• Then, 5-10 units/hr continuous IV (or 0.05 – 0.1/kg/hr
• Increase if no response in 1-2 hrs – orders can be written with guidelines to titrate

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12
Q

When do you consider replacing potassium in DKA

A

When serum K <5.5 mEQ/L

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13
Q

Initial monitering in DKA

A
  • Bloodwork
  • BSG at least hourly
  • Electrolytes q 2 – 4 hrs +/- ABG’s
  • Clinical status at least hourly
  • Vital signs
  • B/P, P, R
  • Mental status
  • Fluid I & O
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14
Q

When do you start intermediae or long acting insulin in the treatment of DKA

A
  • When patient is able to eat as shown by the following:
  • Mental status improved
  • No nausea/vomiting
  • No abdominal pain
  • Anion gap normalized
  • Allow overlap timing of IV with SQ insulin – usually by 30 – 60 minutes
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15
Q

Symptoms of NKHS

A
  • Polyuria
  • Thirst
  • Altered mental state
  • NOTE: Typically ABSENT are nausea, vomiting, abdominal pain and kussmaul respirations (these and acidosis & ketonemia are more typically seen in DKA)
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16
Q

Fluid replacement in NKHS

A

• 2 – 3 liters NS (Normal Saline) (0.9 %) over first 1-3 hours
(5-10 ml/kg/hr)
• Fluid deficit is often 8 – 10L
• Reverse over next 24 – 48 hrs using ½ strength saline (0.45%)
• When glucose reaches 250 mg/dl, switch to D51/2 NS (5%
dextrose and 0.45% saline) at 100 – 200 ml/h

17
Q

What are the differences between DKA and HHS

A
  • Fluid deficit is much greater in NKHS
  • Some drugs can contribute to NKHS
  • Nausea, vomiting, abdominal pain, ketoacidosis and kussmaul respirations typically absent in NKHS
18
Q

What are the similarities between DKA and HHS

A
  • Insulin deficiency – absolute or relative
  • Glucagon excess – absolute or relative
  • Volume depletion
  • Mental status changes
  • Both are critical conditions needing intensive monitoring
19
Q

What is the earliest measurable sign of

proteinuria and diabetic effect of nephropathy

A

Microalbumin

20
Q

What is done/checked in quarterly diabetes monitoring

A
  • Hgb A1C
  • Review SGM (Self Glucose Monitoring) log –download if possible
  • Foot inspection for ulcerations etc
21
Q

What is done/checked in annual diabetes monitoring

A
  • Dilated eye exam
  • Urine protein screening (microalbumin/creatinine ratio)
  • Monofilament testing
22
Q

Foot care in diabetes

A

• Daily inspection – often difficult for patient with dexterity
and visual problems
• Can use “plastic” (to avoid injury from glass) mirror on floor when
getting out of bed
• Family assistance
• Never go barefoot
• Moisturize – but NOT in between or under toes
• Prescription shoes – Medicare will pay for one pair per year
• Podiatry

23
Q

Most important lifestyle modification in diabetes

A

physical activity

24
Q

What is the singe most additive risk for vascular disease in diabetes

A

cigarette smoking

25
Q

List TSH and Free T4 levels in

  1. primary hypothyroidism
  2. primary hyperthyroidism
  3. TSH producing tumor
  4. Central hypothyroidism
A
  1. High TSH, low FT4
  2. Low TSH, high FT4
  3. High TSH, High FT4
  4. Low TSH, Low FT4
26
Q

What does EUthyroid sick look like

A

• Critically ill patient
• Lab results don’t fit a pattern for primary, secondary or tertiary
dysfunction

27
Q

Classification of causes of hypercalcemia

A
  1. Parathyroid-related
  2. Malignancy-related
  3. Vitamin D-related
  4. Associated with High Bone Turnover
  5. Associate with Renal Failure
28
Q

what is the first measure in the treatment of hypercalcemia of malignancy

A

aggressive volume expansion with isotonic saline

29
Q

How do you test for bone density for osteoporosis and excessive bone turnover

A

• DEXA (aka DXA, Dual-Energy X-ray Absorptiometry) scan

  • Central: lower spine and hip
  • Peripheral (p-DEXA) used for screening only: wrist, heel, leg, fingers

endorepro remediation (21 decks)

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