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07. Endo II > Adult Endocrine Cases Kirila > Flashcards

Adult Endocrine Cases Kirila Flashcards

1
Q

Methods of Capillary Glucose monitory

A

FSG - Fingerstick glucose
BSG - Bedside glucose
“Accucheck” - most common glucose monitor

Outpatient setting:
HGM - Home glucose monitoring
GSM - Glucose self-monitoring
SBGM - Self blood glucose monitoring

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2
Q

Basal Insulin

A

Long acting insulin that achieves a steady state of glucose control

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3
Q

“Bolus” Insulin

A

Used to adjust insulin levels at mealtimes based on FSG and carbohydrate count in meal

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4
Q

Signs and Symptoms of Diabetes Mellitus

A 
Polyuria
Polydipsia
Nocturia
Blurred vision
Weight loss
Frequent recurring infections
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5
Q

Guidelines for DM Diagnosis

A

Fasting plasma glucose > 126 mg/dL (7 mmol/L)

Two-hour plasma glucose values >200 mg/dL (11 mmol/L) during a 75 OGTT

HbA1C > 6.5 (48 mmol/mol)

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6
Q

Recommendations for long-term care of DM

A

Schedule appointment to check patient’s A1C every 3-4 months

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7
Q

Differential Diagnosis for a DM patient with Mental Status Change

A

AEIOU TIPS

A - Alcohol
E - Epilepsy
I - Infection
O - Overdose
U - Uremia
T - Trauma
I - Insulin
P - Poisoning/Psychosis
S - Stroke
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8
Q

Differential Diagnosis for a DM patient with Abdominal Pain

A

BAD GUT PAINS

B - Bowel Obstruction
A - Appendicitis, Adenitis (mesenteric)
D - Diabetic ketoacidosis, Diverticulitis, Dysentary/Diarrhea, Drug withdraw
G - Gastroenteritis, Gallbladder disease/stones/obstruction/infection
U - Urinary tract infection or obstruction
T - Testicular Torsion, Toxins (lead, black widow spider bite)
P - Pneumonia/Pleurisy/Pancreatitis, Perforated bowel/Peptic Ulcer/Polyphyria
A - Aortic aneurysm
IN - Infarcted bowel, MI, incarcerated hernia, IBD
S - Splenic rupture/infarction, Sickle cell pain/crisis, Sickle sequestration crisis

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9
Q

Acute Complications of DM

A

Diabetic Ketoacidosis (DKA) - more common in Type 1 DM

Non-ketotic Hyperosmolar State (NKHS) - most commonly seen in Type 2 DM

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10
Q

Common Causes of DKA

A 
Inadequate insulin administration
Infections (Pneumonia, UTI, Gastroenteritis, Sepsis)
Infarction
Surgery
Drugs (Cocaine)
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11
Q

Initial Symptoms of DKA

A 
Anorexia
Nausea
Vomiting
Polyuria
Thirst
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12
Q

Progressive Symptoms of DKA

A

Abdominal Pain
Altered mental status
Coma

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13
Q

Signs of DKA

A 
Kussmaul respirations - rapid and deep
Acetone (fruity) odor breat
Dry mucous membranes
Poor skin turgor
Tachycardia
Hypotension
Fever
Abdominal tenderness
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14
Q

Differential Diagnosis with High Anion Gap Acidosis

A

MUDPILES

Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Isopropyl alcohol, Iron, INH (isoniazid)
Lactic acidosis
Ethylene Glycol
Salicylated
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15
Q

Treatment for DKA

A

ICU admission

Frequent monitoring of general status, vital signs, glucose and other labs

Acid-base status, renal function, potassium and other electrolytes

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16
Q

Fluid Replacement in DKA

A

1-2-3 rule

2-3 liters of normal saline over 1-3 hours
Then 1/2 NS at 150 ml/hr
When glucose reaches 250 mg/dl switch to D5 1/2 NS at 100-200 ml/hr

Fluid deficit is usually 3-5 L

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17
Q

Initial Insulin Administration during DKA

A

10-20 units IV or IM
Then give 5-10 units/hour via continuous IV

Increase if no response in 1-2 hrs

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18
Q

Evaluation for Underlying Cause of DKA

A 
Cultures
EKG
CXR
Drug screen
Seek additional history
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19
Q

Initial Monitoring in DKA

A

Bloodwork
BSG hourly if not more
Electrolytes q2-4 hour +/- ABG

Check status
Vitals
Mental Status
Fluid in and out

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20
Q

Potassium Replacement in DKA

A

Consider K+ replacement if K< 5.5 mEq/L

Monitor renal function
Baseline EKG with continuous cardiac monitoring
Measure urine output

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21
Q

Goals of Treatment for DKA

A

Increase the rate of glucose utilization in insulin-dependent tissues - 150-250 meq/dL
Reverse ketonemia and acidosis
Correct depletion of H2O and electrolytes

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22
Q

When do you start to give long-acting or intermediate insulin and allow to eat

A

When patient is able to eat and has improved mental status, no nausea/vomiting, and no abdominal pain

Normal anion gap

Allow overlap timing of IV with SQ insulin - usually 30-60 min

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23
Q

Causes of Non-ketotic Hyperosmolar State

A

Insulin deficiency
Inadequate fluid intake
Osmotic diuresis induced by hyperglycemia

Sepsis
MI
Glucocorticoids
Phenytoin
Thiazide diuretics
Impaired access to H2O
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24
Q

Symptoms of NKHS

A

Polyuria
Thirst
Altered mental status

Typically doesn’t have abdominal pain, nausea, vomiting, or Kussmaul respirations

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25
Q

Fluid Replacement in NKHS

A

2-3 liters of normal saline over 1-3 hours
Then 1/2 NS for the next 24-48 hr
When glucose reaches 250 mg/dl switch to D5 1/2 NS at 100-200 ml/hr

Fluid deficit is usually 8-10 L

26
Q

Insulin Administration in NKHS

A

Give regular insulin
5-10 units IV bolus
3-7 units continuous infusion

When patient is able to eat and has improved mental status, no nausea/vomiting, and no abdominal pain

Normal anion gap

Allow overlap timing of IV with SQ insulin - usually 30-60 min

27
Q

K+ Replacement in NKHS

A

Same as in DKA

Consider K+ replacement if K< 5.5 mEq/L

Monitor renal function
Baseline EKG with continuous cardiac monitoring
Measure urine output

28
Q

Main Difference between DKA and NKHS

A

Fluid deficit is greater in NKHS

Some drugs cause NKHS

Nausea, vomiting, abdominal pain, ketoacidosis, and Kussmaul respiration typically absent in NKHS

29
Q

Similarities between DKA and NKHS

A

Insulin deficiency
Glucagon excess

Volume depletion
Mental status changes

Both are critical conditions needing intensive monitoring

30
Q

Long Term Complications of DM

A

Increased risk of Cardiovascular disease
Neuropathy - 9%
Nephropathy - 8%
Retinopathy - 20%

31
Q

HbA1C Range and Interpretations

A

Averages of 3-4 month of blood sugar
> 6.5 is considered “good control” but not too low

Transfusions may alter A1C results

32
Q

Levels of A1C and Corresponding Average Glucose

A 
5% - 80
6% - 110
7% - 140
8% - 180
9% - 210
10% - 240
11% - 280
12% - 310
13% - 340
14% - 380
33
Q

Diabetic Gastropathy

A

Form of autonomic neuropathy

Pacemakers of peristalsis in stomach are messed up

Gastric emptying is variable and inconsistent

Decreased kidney function with decreased insulin clearance

Sugars not as high

34
Q

Increased Kidney Dysfunction Result

A

Declining Insulin Requirements due to decreased insulin clearance

35
Q

Evaluate Nephropathy

A

Screen for proteinuria

Screen for albumin:creatinine ratio

36
Q

Definition of Micro and Macroalbuminuria

A

Micro = 30-300 mg

Macro > 300 mg

37
Q

When to Use 24 hr Urine Collection

A

Not routinely used

Used to monitor advanced/complex kidney disease

38
Q

Quarterly Diabetes Monitoring

A

Hgb A1C
Review Self-glucose monitoring
Foot inspection for ulcerations etc

39
Q

Annual Diabetes Monitoring

A

Dilated eye exam
Urine protein screening (microalbuminuria/creatining ratio)
Monofilament testing

40
Q

Foot Care

A 
Daily inspection
Never go barefoot
Moisturize - not between or under toes
Prescription shoes - medicare pays for 1 pair of shoes per year
Podiatry
41
Q

Diabetes Treatment Option

A 
Lifestyle modification
Physical activity - most important
Dietary modification
Weight loss
Psychosocial
Initial and follow-up diabetic education

Medication

42
Q

Common complications

A

Retinopathy
Heart disease - increased exponentially by cigarette smoking
Neuropathy - autonomic and peripheral

43
Q

Signs and Symptoms of Hyperthyroidism

A 
Lid lag
Exopthalmos
Bruits - due to thyroid enlargment
Goiter/Nodule
HR increase
Tremor
Warm, moist skin
Gyneocomastia
Muscle weakness
44
Q

Definition of Primary Hyperthyroidism

A

Organ itself is the source of dysfunction

45
Q

Definition of Secondary Hyperthyroidism

A

Pituitary dysfunction

46
Q

Definition of Tertiary Hyperthyroidism

A

Hypothalamic dysfunction

47
Q

Labs for Primary Hypothyroidism

A

TSH - Increased

FT4 - Decreased

48
Q

Labs for Primary Hyperthyroidism

A

TSH - Decreased

FT4 - Increased

49
Q

Labs for TSH producing Tumor

A

TSH - Increased

FT4 - Increased

50
Q

Labs for Central Hypothyroidism

A

TSH - Decreased

FT4 - Decreased

51
Q

Euthyroid Sick

A

Critically ill patient

Lab results doesn’t fit any of the categories

Could be due to protein shifts, protective effect of decreased metabolism or maladaptive process

52
Q

Cold Nodules Malignancy Potential

A

85% Benign

15% Malignant

53
Q

Hot Nodules Malignancy Potential

A

95% Benign

5% Malignant

54
Q

Specificity and Sensitivity of Fine Needle Aspiration

A

Sens - 80%
Spec - 90%

Limitations - poor technique

55
Q

Danger of Thyroid Surgery

A

Can damage recurrent laryngeal N.

Can damage parathyroid glands

56
Q

Relationship between Calcium and PO4

A

PTH levels cause them to move in opposite directions

Vit D causes them to move in the same direction

57
Q

Classifications of Hypercalcemia (5)

A 
Parathyroid related
Malignancy related - tumors secrete PTHrP
Vitamin D- related
Associated with high bone turnover
Associated with Renal Failure
58
Q

Changes in EKG in hypercalcemia

A

Shortened QT interval

59
Q

Bone Density Scan

A

DEXA (aka DXA, Dual-energy X-ray Absorption) scan

Central - Scans lower spine and hips
Peripheral - Scans wrists, heel, leg, finger

60
Q

Interpration of DEXA results

A

Normal > -1
Osteopenia -1-2.5
Osteoporosis < 2.5

07. Endo II (5 decks)

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