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Endocrine Exam > Adult Endocrinology > Flashcards

Adult Endocrinology Flashcards

1
Q

What is basal insulin?

A
  • The long acting insulin to achieve more steady state of glucose control (to mimic baseline insulin levels in non-diabetics)
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2
Q

What is bolus insulin?

A
  • Can be adjusted at mealtime and based on FSG (sliding scale) +/- carbohydrate count anticipated
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3
Q

What are some signs and symptoms of DM?

A
  • Polyuria
  • Polydipsia
  • Nocturia
  • Blurred vision
  • Weight loss (unintentional)
  • Frequent recurrent infections even with appropriate treatment and documented clearance
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4
Q

What are the guidelines for diagnosis of DM?

A
  • Fasting plasma glucose values ≥126 mg/dL
  • Two hour plasma glucose values of ≥200 mg/dL during a 75g OGTT
  • HbA1C values ≥6.5 percent
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5
Q

What are some ways to get an average 3 months glucose?

A
  • Hemoglobin A1C
  • HbA1C
  • GHbA1C
  • Glycosylated hemoglobin
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6
Q

How is an A1C retrieved?

A
  • Typically venipuncture sample, but fingerstick machines available
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7
Q

What is the acronym for the differential diagnosis for mental status changes?

A
  • AEIOUTIPS
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8
Q

What does AEIOUTIPS stand for?

A
  • Alcohol
  • Epilepsy with seizure activity
  • Infection
  • Overdose
  • Uremia
  • Trauma
  • Insulin (high or low blood sugar)
  • Poisoning/psychosis
  • Stroke
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9
Q

What is the acronym for the differential diagnosis for abdominal pain?

A
  • BAD GUT PAINS
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10
Q

What does BAD GUT stand for?

A
  • Bowel obstruction
  • Appendicitis, adenitis
  • Diverticulitis, Diabetic ketoacidosis, dysentery
  • Gastroenteritis
  • UTO/UTI
  • ## Testicular torsion/toxins
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11
Q

What does PAINS stand for?

A
  • Pneumonia/pleurisy/pancreatitis/ perforated bowel/peptic ulcer/porphyria
  • Abdominal aneurysm
  • Infarcted bowel, infarcted myocardium, incarcerated hernia, IBD
  • Splenic rupture/infarction
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12
Q

What are some acute complications seen in DM?

A
  • DKA
  • Non-ketotic hyperosmolar state (NKHS) –> AKA: Hyperosmolar non-ketotic coma (HNKC) or hyperglycemic hyperosmolar state (HHS)
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13
Q

Who is DKA more likely seen in?

A
  • Type 1 diabetics but could occur in type 2
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14
Q

Who is NKHS more likely seen in?

A
  • Type 2 diabetics
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15
Q

What are some etiologies of DKA?

A
  • Inadequate insulin administration
  • Infection (pneumonia, UTI, gastroenteritis, sepsis)
  • Infarction in any location (coronary, cerebral, mesenteric, peripheral)
  • Surgery
  • Drugs (cocaine)
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16
Q

What are some initial symptoms of DKA?

A
  • Anorexia
  • Nausea
  • Vomiting
  • Polyuria
  • Thirst
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17
Q

What are some progression of symptoms of DKA?

A
  • Abdominal pain
  • Altered mental function
  • Coma
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18
Q

What are some signs of DKA?

A
  • Kussmaul respirations
  • Acetone (fruity) breath odor
  • Dry mucous membranes
  • Poor skin turgor
  • Tachycardia
  • Hypotension
  • Fever
  • Abdominal tenderness
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19
Q

What does MUDPILES stand for?

A
  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Paraldehyde
  • Isopropyl alcohol, iron, INH
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates
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20
Q

What is MUDPILES an acronym for?

A
  • High anion gap acidosis
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21
Q

What is the treatment of DKA?

A
  • ICU
  • Frequent monitoring of general status, vital signs, glucose and other labs
  • Acid base status
  • Renal function
  • Potassium and other electrolytes
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22
Q

What is the 1-2-3 rule?

A
  • 2-3 liters normal saline over first 1-3 hours
  • Then 1/2 strength saline at 150 ml/hr
  • When glucose reaches 250 mg/dl, switch to D51/2 NS at 100-200 ml/hr
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23
Q

What is the fluid deficit in DKA?

A
  • Often 3-5 liters
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24
Q

What is the initial insulin administration in DKA?

A
  • 10-20 units IV or IM
  • Then, 5-10 units/hr continuous IV
  • Increase if no response in 1-2 hours - orders can be written with guideline to titrate
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25
What initial monitoring is done in DKA?
- Bloodwork: BSG at least hourly and electrolytes q2-4 hours | - Clinical status at least hourly: VS, Mental status, Fluid I&O
26
When should you consider potassium replacement in DKA?
- When serum K is <5.5 mEq/L
27
What do you need to keep in mind when supplementing potassium?
- Renal function - Baseline EKG and continuous cardiac monitoring for changes - Verify urinary output and measure hourly -- likely will need indwelling foley catheter initialy
28
What are the treatment goals for DKA?
- Increase the rate of glucose utilization in insulin dependent tissues (glucose goal is 150-250) - Reverse ketonemia and acidosis - Correct depletion of water and electrolytes
29
When is intermediate or long acting insulin started?
- When patient is able to eat as shown by mental status improved, no N/V, or no abdominal pain - Anion gap normalized - Allow overlap timing of IV with SQ insulin
30
What are some etiologies of NKHS?
- Insulin deficiency - Inadequate fluid intake - Osmotic diuresis induced by hyperglycemia
31
What are some precipitating factors for NKHS?
- Sepsis - Myocardial infarction - Glucocorticoids - Phenytoin - Thiazide diuretics - Impaired access to water
32
What are some symptoms of NKHS?
- Polyuria - Thirst - Altered mental status
33
What is absent in NKHS that is typically seen in DKA?
- N/V - Abdominal pain - Kussmaul respirations - Acidosis and ketonemia
34
What is the fluid deficit in NKHS?
- Often 8-10L
35
What is the fluid replacement in NKHS?
- 2-3 liters NS over first 1-3 hours | - When glucose reaches 250 mg/dl, switch to D51/2 NS at 100-200 ml/hr
36
What is the treatment for NKHS?
- Regular insulin at 5-10 units IV bolus or 3-7 units continuous infusion - Transition when eating as with DKA - Monitor, replace K, investigate, and address underlying causes as with DKA
37
What are some differences between DKA and HHS?
- Fluid deficit is much greater in NKHS | - Some drugs can contribute to NKHS
38
What are some similarities between DKA and HHS?
- Insulin deficiency -- absolute or relative - Glucagon excess -- absolute or relative - Volume depletion - Mental status change - Both are critical conditions that need invasive monitoring
39
What is the major cause of mortality in T2DM?
- Cardiovascular disease
40
What is the average increase in glucose with each percentage of the A1C?
- Starts at 5% = 80 mg/dl | - Each percentage is 30 mg/dl higher
41
What is seen in diabetic gastropathy?
- Pacemaker area of stomach is dysfunctional | - Since gastric emptying varies, the absorption also varies
42
What can diabetic gastropathy?
- Causes insulin requirements to also be extremely variable and unpredictable
43
What is the screening for proteinuria?
- Spot (random) urine sample | - Standard urine dipstick not sensitive if proteinuria <300 mg/24 hr
44
What is the most common type of protein in diabetic nephropathy?
- Albumin
45
What is the earliest measurable sign of proteinuria?
- Microalbumin/creatinine ratio
46
What is microalbuminemia?
- 30mg-300mg
47
What is 24 hour urine collection used for?
- More advanced/complex kidney disease
48
What can be problematic in 24 hours urine collection?
- Difficult to remember to save all urine - Dexterity required to get it into container - Leak in container
49
What is done in the quarterly diabetes monitoring?
- Hgb A1C - Review SGM log - Foot inspection for ulcerations
50
What is done in the annual diabetes monitoring?
- Dilated eye exam - Urine protein screening (microalbumin/creatinine ratio) - Monofilament testing
51
What is the foot care for diabetes?
- Daily inspection -- often difficult for patient with dexterity and visual problems - Never go barefoot - Moisturize -- but NOT in between or under toes - Prescription shoes - Podiatry
52
What are some lifestyle modifications for diabetes treatments?
- Physical activity - Dietary modification - Weight loss - Psychosocial - Initial and follow-up diabetic education
53
What are some common complications of diabetes?
- Retinopathy - Heart disease, widespread vascular disease (cigarette smoking is the single most additive risk for vascular disease) - Neuropathy: autonomic, peripheral
54
What are some qualities of T1DM?
- Insulin deficiency - absolute - Glucagon excess - absolute - Volume depletion - Mental status changes - Autoimmune
55
What are some qualities of T2DM?
- Insulin deficiency - relative - Glucagon excess - relative to body's utilization/formation - Volume depletion - Mental status changes - Obesity/inactivity/lifestyle
56
What are some signs and symptoms of hyperthyroidism?
- Lid lag/exophthalmos - Bruits - Goiter vs. nodules - Heart rate and rhythm quality - Tremor - Warm, moist skin - Gynecomastia - Muscle weakness
57
What are some additional findings to look for in hyperthyroidism?
- Perspiration - Diarrhea - Polyuria - Weight loss - Fatigue and weakness - Oligomenorrhea - Hyperactivity - Heat intolerance, sweating - Palpitations
58
What is the dysfunction in primary thyroid disorder?
- Organ itself is the source of dysfunciton
59
What is the dysfunction in secondary thyroid disorder?
- Pituitary dysfunction
60
What is the dysfunction in tertiary thyroid disorder?
- Hypothalamic dysfunction
61
What are the TSH and FT4 levels in primary hypothyroidsim?
- TSH: increase | - FT4: decrease
62
What are the TSH and FT4 levels in primary hyperthyroidism/
- TSH: decrease | - FT4: increase
63
What are the TSH and FT4 levels in TSH producing tumor?
- TSH: increase | - FT4: increase
64
What are the TSH and FT4 levels in central hypothyroidism?
- TSH: decrease | - FT4: decrease
65
What is euthyroid sick?
- Critically ill patient | - Lab results don't fit a pattern for primary, secondary, or tertiary dysfunction
66
What may cause euthyroid sick?
- May be due to protein shifts, protective effect of decreased metabolism or a maladaptive process -- all of which are still being studied
67
What is a concern with surgery of the thyroid?
- Recurrent laryngeal nerve damage
68
What are the different classification of causes of hypercalcemia?
1. Parathyroid-related 2. Malignancy-related 3. Vitamin D related 4. Associated with high bone turnover 5. Associated with renal failure
69
What is the treatment for hypercalcemia of malignancy with mental status changes &/or EKG changes?
- Aggressive volume expansion with isotonic saline is the first measure
70
What is done for bone density testing?
- DEXA scan for osteoporosis and excessive bone turn-over

Endocrine Exam (11 decks)

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