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ENDO > Adult Endocrine > Flashcards

Adult Endocrine Flashcards

1
Q

What are the guidelines for diagnosing DM based on

Fasting Plasma glucose:

Two hour plasma glucose:

HbA1C:

A

FPG: >126

OGTT: >200

HbA1C: >6.5%

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2
Q

What test should be ordered every three months on diabetic patients that is a measure of the “average” glucose levels

A

HbA1C

(aka hemoglobin A1c, glycosylated hemoglobin)

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3
Q

What are three common presenting signs and symptoms that may be caused by DM?

A

Mental status change

Abdominal Pain

Dehydration

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4
Q

Why could DM present with altered mentation?

A

Due to high or low glucose levels

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5
Q

Why could DM present with abdominal pain?

A

due to diabetic ketoacidosis

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6
Q

What are the possible etiologies of DKA?

A

Inadequate Insulin

Infection

Infarction

Surgery

Drugs

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7
Q

What are the initial signs of DKA?

A

anorexia

n/v

polyuria/polydipsia

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8
Q

What are some serious signs and symptoms of DKA?

A

Coma

AMS

Kussmaul respirations

Acetone breath

Dehydration

Tachycardia

Hypotension

Fever

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9
Q

Which type of metabolic disturbance will be seen with DKA?

A

HAGMA

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10
Q

What is the treatment for DKA?

A

ICU admit

monitor status, vitals, glucose, renal fxn, a/b status, K and other electrolytes

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11
Q

What is one method of fluid replacement in DKA?

A

1-2-3 rule

2-3L if NS over the first 1-3 hours

then, 1/2 strength saline at 150ml/h

fluid deficit is usually 3-5L

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12
Q

what is the insulin dosing for DKA?

A

10-20 units IV or IM

then, 5-10 units/hr cont. IV

increase if no response in 1-2hrs, can be written to titrate

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13
Q

What labs/imaging are ordered to look for the cause of DKA?

A

Cx

EKG

CXR

Drug screen

hx from family/pt

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14
Q

What is the monitoring protocol for DKA?

A

BSG hourly

Electrolytes q2-4hrs +/- ABG

Vitals, mental status, and fluids hourly

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15
Q

When should K be replaced in DKA?

A

when serum K drops below <5.5

monitor renal fxn, EKG, and urinary output (hourly)

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16
Q

What are the three main goals of treating DKA?

A

increase rate of glucose utilization (gluc: 120-250)

reverse ketonemia and acidosis

correct depletion of water and electrolytes

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17
Q

When DKA is resolving, and pt is able to tolerate food, when should intermediate or long-acting insulin be added?

A

once anion gap has normalized and overlap IV and SQ insulin by about 30-60min

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18
Q

What is Non-Ketotic Hyperosmolar State (NKHS)?

A

Insulin def.

Inadequate fluid inake

Osmostic diuresis induced by hyperglycemia

NO KETONES

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19
Q

What are some precipitating factors for NKHS?

A

sepsis

MI

glucocorticoids

Phenytoin

thiazides

dehydration

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20
Q

What are the sypmtoms of NKHS?

A

polyuria/polydipsia

AMS

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21
Q

What is the fluid replacement protocol for NKHS?

A

2-3L of NS over first 1-3hrs

correct the deficit of 8-10L over the next 24-48hrs with 1/2NS

when glucose reaches 250, switch to D5 1/2NS at 100-200ml/hr

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22
Q

What is the insulin administration for NKHS?

A

regular insulin at 5-10u IV

3-7u cont.

transition when able to tolerate PO

monitor, replace K, investigate cause as with DKA

23
Q

What are the main differences between NKHS and DKA?

A

fluid deficit is much greater in NKHS

drugs can contribute to NKHS

N/v, abdominal pain, ketoacidosis and kussmail resp. are absent in NKHS

24
Q

What are the similiarities between NKHS and DKA?

A

insulin def. and glucagon excess (absolute or relative)

volume depletion

AMS

critical conditions

25
Q

What are some of the long term complications of DM?

A

cardiovascular disease (main cause or mortality)

coronary artery disease

26
Q

What HbA1C value indicates good control?

A

6.5 or less

lower is usually better, but consider hypoglycemia contributing to syncope and falls, esp. in elderly

27
Q

What is a form of autonomic neuropathy?

A

Diabetic Gastropathy

variable stomach emptying can require varying amounts of insulin

28
Q

How can nephropathy be screened for?

A

random urine sample

protein should be <300mg/24hr

29
Q

What is the earliest measurable sign of proteinuria and nephropaty?

A

microalbuminuria

30-300mg

can do a random urine sample or a microalbumin/creatinine ratio which is more accurate

30
Q

When is a 24hr urine collection used?

A

Not routinely, only in screening/monitoring for more advanced kidney disease

can measure large amounts of protein, but need to obtain a serum creatinine at same time to determine creatinine clearance

can be difficult to remember to collect urine/difficult to preform

31
Q

What should be ordered quarterly on diabetic patients?

A

HbA1C

Revire SGM log

Foot inspection

32
Q

What should be done annually for diabetic monitoring?

A

dilated eye exam

urine protein screening (microalbumin/cr ratio)

monofilament testing

33
Q

What are some general foot care recomendations?

A

Daily inspection

Wear prescription shoes

Moisturize but avoid under/between toes

See podiatry

34
Q

What behavior is the single most additive risk for vascular disease?

A

Smoking

35
Q

What are the major characteristics of type I DM?

A

Absolute insulin def

Absolute glucagon excess

Volume depletion

AMS

autoimmune dz

36
Q

What are the characteristics of type 2 DM?

A

Relative Insulin def.

Relative Glucagon excess

Volume depletion

AMS

obesity/inactivity

37
Q

What are the s/s of hyperthyroidism?

A

“Hyped”

lid lag/exophthalmos

bruits

tachycardia

tremor

diaphoresis

gynecomastia

heat intolerance

weight loss

diarrhea

38
Q

What is the source of dysfunction in 1’, 2’, and 3’ thyroid disorders

A

1’: thyroid itself is dysfunctional

2’: pituitary dysfunction

3’: central/hypothalamic dysfunction

39
Q

Name the Condition:

Increased TSH

Decreased FT4

A

Primary Hypothyroid

40
Q

Name the Condition?

Decreased TSH

Increased FT4

A

Primary Hyperthyroidism

41
Q

Name the condition

Increased TSH

Increased FT4

A

TSH producing tumor

42
Q

Name the condition

Decreased TSH

Decreased FT4

A

Central hypothyroidism

43
Q

What should be done if thyroid labs are abnormal in critically ill patients?

A

Be cautious diagnosing thyroid conditions in critically ill patients as protein shifts, metabolism and maladaptive processes can be contributing to the abnormal results

44
Q

Are thyroid nodules typically benign or malignant?

A

benign (even the “cold” ones)

45
Q

Are cold or hot nodules more likley to be malignant?

A

When compared, cold nodules are more likely to be malignant than warm or hot nodules

46
Q

What nerve can be damaged with thyroid surgery?

A

Recurrent laryngeal nerve

47
Q

What other endocrine structure can be damaged with thyroid surgery?

A

Parathyroids

48
Q

What are the factors that affect calcium and vitamin D homeostasis?

A

bon, kidney and intestines respond to low Ca levels by increasing PTH

PTH increases tubular reabsorption of Ca and stimulates renal 1,25(OH)2D production which helps intestinal absorption of Ca

49
Q

If Ca and PO4 are moving in opposite directions, what is the issue?

A

PTH imbalance

50
Q

If Ca and Po4 are moving in the same direction, what is the issue?

A

Vitamin D issue

51
Q

What are five causes of hypercalcemia?

A

parathyroid related

malignancy related

vitamin d related

associated with high bone turnover

associated with renal failure

52
Q

What EKG change may be seen on hypercalcemia?

A

shortened QT interval

53
Q

What is the treatment for hypercalcemia of malignancy?

A

When presenting with AMS and/or EKG changes, treat with aggressive volume expansion with isotonic saline

ENDO (6 decks)

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