Approach to Endocrine 1

Question 1

Insulin resistance leading to ineffective glucose transport OUT OF the blood and into the cells, leads to the HYPERglycemia in people with unmanaged?

A. Type I Diabetes

B. Type II Diabetes

C. Type III Diabetes

D. SIADH

Answer 1

Type II Diabetes

NOTE: Type II as a long asymptomatic period so screening tests are very important

Question 2

Which of the following ethnicities is not high-risk for developing Type 2 Diabetes?

A. African Americans

B. Hispanic

C. Native Americans

D. Asian Americans

E. Pacific Islanders

F. European (Caucasian)

Answer 2

European (Caucasian)

how convienient…

Question 3

All of the following are risk factors for Type II Diabetes, except?

A. Fasting glucose >100

B. HbA1c >5.7

C. Polycistic ovary syndrome

D. Sedintary lifestyle

E. BMI > 20

Answer 3

E. BMI > 20

Correct: BMI >=25

Question 4

What are the 3 P’s of Type II Diabetes?

Answer 4

Polyuria

Polydypsia

Polyphagia

Other symptoms: Rapid weightloss, increased huger, weight gain, dhydration, fatigue, impaired healing, fruity breath, acanthosis nigricans, recurrent UTIs, tingling, pain, numbness

Question 5

Are you aware of any visual indicators of Diabetes Mellitus that you might come across during inspection?

Answer 5

Now you are

Question 6

What are some criteria for diagnosis of Type II DM, as declared by the American Diabetes Association (ADA)?

Answer 6

HbA1c > 6.5%

Fasting Glucose > 126

2-hour glucose >200 (on oral glucose tolerance test)

Random glucose >200 with classic symptoms of hyperglycemia

Remember: 6.5, 126, 200, 200

Question 7

An initial wokrup after diabetes diagnosis includes: Fasting lipids, Liver enzymes, Renal Fxn, Microalbuminuria, Dilated eye exam, foot exam. What should you look for in the foot exam?

Answer 7

• calluses/corns, breaks in skin, dryness
• pulses
• sensation, including vibratory and monofilament testing

Question 8

All of the following are management procedures for type II diabetes, EXCEPT?

A. Lifestyle changes, insulin, oral metformin (sans-contraindication)

B. Smoking cessation

C. Check HbA1c every 3 days until stable, then every 6 days

D. Blood pressure and hyperlipidemia control

Answer 8

C. Check HbA1c every 3 days until stable, then every 6 days

CORRECT:

Check HbA1c every 3 months while adjusting treatment, then every 6 months when stable

Question 9

Look at this

Answer 9

Good job

Question 10

What are the 3 main categories of complications associated with DM?

Place the following pathologies under each disease category you correctly (hopefully) stated.

• 1. retinopathy, nephropathy (CKD), neuropathy*
• 2. MI, stroke, peripheral vascular disease*
• 3. Necrotizing fasciitis, Malignant otitis externa*

Answer 10

Microvascular Disease

1. retinopathy, nephropathy (CKD), neuropathy

Macrovascular disease

2. MI, stroke, peripheral vascular disease

Increased Infections

3. Necrotizing fasciitis, Malignant otitis externa

Question 11

Which of the following is true of Diabetic Ketoacidosis (DKA)?

A. Often associated with Type 1, but can be associated with Type 2 DM

B. Signs of dehydration (hypotension, techycardia, decreased skin tugor, dry oral mucosa)

C. Kussmaul respirations (deep respirations using accessory muscles)

D. Nausea, Vomiting, abdominal pain

E. All the above are correct

F. Some of the above are correct

Answer 11

All the above are correct

Question 12

There is a difference between DKA and Hyperosmolar Hyperglycemic State (HHS). DKA would have blood glucose >200, metabolic acidosis with venous pH <7.3 or serum bicarb <15, and ketosis w/variable serum osmolarity.

Comparing the bolded information, what values or signs might you see in a patient with HHS?

Answer 12

Blood glucose: >600

Minimal acidosis: venous blood >7.25, serum bicarb >15

mild ketosis: serum osmolarity >320

isk how high yoeld this is but it’s in the slides and could fall under developing a DDx

Question 13

For management of a DKA/HHS patient you would do all of the following EXcept?

A. Admit to hospital for fluid and electrolyte correction

B. Manage as outpatient

C. Give IV fluids

D. Give IV insulin and potassium replacement

Answer 13

B. Manage as outpatient

What you SHOULD do

1. give IV fluids, insulin, and replace potassium
2. admit to hospital for fluid and electrolyte correction
3. DO NOT manage as outpatient

Question 14

When verbally presenting a case you want to frontload your first few sentences with pertinent subjective info like?

Answer 14

PMH, SH, Meds, PSH

Question 15

What are the 2 main risk factors for development of DM Type I?

Answer 15

Genetics

Environment

Question 16

As stated in the lecture slides, which of the following 4 clinical presentations of someone with uncontrolled Type I DM is INCORRECT?

A. Polydipsia

B. Polyuria

C. Weightloss with hypoglycemia and ketonemia or ketonuria

D. DKA

Answer 16

Weightloss with hypoglycemia and ketonemia or ketonuria

Correct:

Weightloss with Hyperglycemia and ketonemia or ketonuria

Question 17

The diagnosis for Type I and Type II diabetes is the same, but which of the following is a good differentiator?

A. Ethnicity

B. Insulin dependence

C. Presence of Acanthosis Nigricans

D. Presence of Pancreatic Antibodies

Answer 17

Presence of Pancreatic Antibodies

Question 18

What are 3 associated conditions with Type I DM, as stated in lecture?

Answer 18

Addison’s Disease

Celiac Disease

Autoimmune Thyroditis

“Type I Diabetic patients ACT up”

Question 19

Which of the following are management methods for PTs with Type I DM?

A. Education and oral metformin

B. Insulin and oral medications

C. Education and Insulin

D. Insulin and high carb diet

Answer 19

Education and Insulin

• oral medications are not necessary for PTs with Type I DM

Question 20

According to our professor this is a working differential for PTs who might be presenting with Type I DM.

Gastroenteritis, Cholecystitis, Appendicitis, Pancreatitis, DKA

Answer 20

According to our professor this is a working differential for PTs who might be presenting with Type I DM.

Gastroenteritis, Cholecystitis, Appendicitis, Pancreatitis, DKA

Question 21

Metabolic syndrome is a constellation of metabolic abnormalities that confer increased risk of CVD and DM. According to the lecture, what are 6 risk factors of Metabolic Syndrome developement?

Answer 21

DM Type 2

Overweight/Obese

CVD

Genetics

Aging

Lipodystrophy

Sedentary Lifestyle

Metabolic syndrome is dx’d by DOC GALS

Question 22

Diagnosis of Metabolic syndrome requires meeting any 3/5 the guidelines declared by the ATPIII Guideline. What are those 5 guidelines? (HINT: they are values)

Answer 22

Abdominal Obesity (>40” in men and >35” women)

TAGs > 150

HDL <40 in men <50 in women

BP >130/85

Fasting Glucose >100

150 130/85 100 50 40 35

Question 23

What are the associated conditions of Metabolic Syndrome? (4)

Answer 23

Polycystic Ovary Syndrome

Obstructive Sleep Apnea

Non-alcoholic fatty liver disease

Hyperuricemia

Thinking Metabolic Syndrome? –> PHONe it in

Question 24

Here are the Management suggestions for Metabolic Syndrome:

Lifestyle changes

Weight loss medication and surgery

Statin medication

Fibrate medication

BP medication

Metformin

Answer 24

Cool

Met Life States Weight-loss, Feels Best