Approach to Endocrine 1 Flashcards
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
Type II Diabetes
NOTE: Type II as a long asymptomatic period so screening tests are very important
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)
European (Caucasian)
how convienient…
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
E. BMI > 20
Correct: BMI >=25
What are the 3 P’s of Type II Diabetes?
Polyuria
Polydypsia
Polyphagia
Other symptoms: Rapid weightloss, increased huger, weight gain, dhydration, fatigue, impaired healing, fruity breath, acanthosis nigricans, recurrent UTIs, tingling, pain, numbness
Are you aware of any visual indicators of Diabetes Mellitus that you might come across during inspection?
Now you are
What are some criteria for diagnosis of Type II DM, as declared by the American Diabetes Association (ADA)?
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
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?
- calluses/corns, breaks in skin, dryness
- pulses
- sensation, including vibratory and monofilament testing
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
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
Look at this
Good job
What are the 3 main categories of complications associated with DM?
Place the following pathologies under each disease category you correctly (hopefully) stated.
- retinopathy, nephropathy (CKD), neuropathy*
- MI, stroke, peripheral vascular disease*
- Necrotizing fasciitis, Malignant otitis externa*
Microvascular Disease
1. retinopathy, nephropathy (CKD), neuropathy
Macrovascular disease
2. MI, stroke, peripheral vascular disease
Increased Infections
3. Necrotizing fasciitis, Malignant otitis externa
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
All the above are correct
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?
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
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
B. Manage as outpatient
What you SHOULD do
- give IV fluids, insulin, and replace potassium
- admit to hospital for fluid and electrolyte correction
- DO NOT manage as outpatient
When verbally presenting a case you want to frontload your first few sentences with pertinent subjective info like?
PMH, SH, Meds, PSH
What are the 2 main risk factors for development of DM Type I?
Genetics
Environment
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
Weightloss with hypoglycemia and ketonemia or ketonuria
Correct:
Weightloss with Hyperglycemia and ketonemia or ketonuria
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
Presence of Pancreatic Antibodies
What are 3 associated conditions with Type I DM, as stated in lecture?
Addison’s Disease
Celiac Disease
Autoimmune Thyroditis
“Type I Diabetic patients ACT up”
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
Education and Insulin
- oral medications are not necessary for PTs with Type I DM
According to our professor this is a working differential for PTs who might be presenting with Type I DM.
Gastroenteritis, Cholecystitis, Appendicitis, Pancreatitis, DKA
According to our professor this is a working differential for PTs who might be presenting with Type I DM.
Gastroenteritis, Cholecystitis, Appendicitis, Pancreatitis, DKA
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?
DM Type 2
Overweight/Obese
CVD
Genetics
Aging
Lipodystrophy
Sedentary Lifestyle
Metabolic syndrome is dx’d by DOC GALS
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)
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
What are the associated conditions of Metabolic Syndrome? (4)
Polycystic Ovary Syndrome
Obstructive Sleep Apnea
Non-alcoholic fatty liver disease
Hyperuricemia
Thinking Metabolic Syndrome? –> PHONe it in
Here are the Management suggestions for Metabolic Syndrome:
Lifestyle changes
Weight loss medication and surgery
Statin medication
Fibrate medication
BP medication
Metformin
Cool
Met Life States Weight-loss, Feels Best
