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Endocrine > Diabetes and Thyroid Problems > Flashcards

Diabetes and Thyroid Problems Flashcards

1
Q

What is the most common type of DM below age 40? Above?

A 
Below = DM I
Above = DM II
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2
Q

What is maturity onset diabetes of youth (MODY)?

A

DM occurring before 18 yo

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3
Q

What are the HLA haplotypes that are associated with DM I?

A

HLA-DRB1 and DQB1

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4
Q

What are the environmental factors that can cause DM I in susceptible individuals?

A

Viral disease
Chemicals
Early cow’s milk

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5
Q

What is the rate of DM I in an identical sibling if the other has it?

A

35-50%

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6
Q

What is the drug that may be able to preserve beta islet cells in newly diagnosed pts with DM I?

A

Cyclosporine

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7
Q

What are the histological characteristics of islet cells of DM I?

A

WBCs, insulin auto-antibodies

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8
Q

Which is the more common presentation: DKA or polydipsia/polyphagia

A

Polydipsia/polyphagia

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9
Q

What is the fasting glucose level that is diagnostic for DM?

A

More than 126 mg/dL (200 for him)

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10
Q

What is the random glucose measurement that is diagnostic of DM?

A

More than 300 mg/dL

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11
Q

What are the two most important factors of the prognosis for kids with DM I?

A

Parental and pt education

Stress management

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12
Q

What should happen to insulin doses with emesis?

A

May need to tone back d/t loss of sugar

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13
Q

What, generally, is the dosing scheme for insulin?

A

2/3 daily dose NPH in AM, 1/3 regular before dinner

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14
Q

What foods should be avoided with DM I pts?

A
  • High salt
  • Fatty
  • High protein
  • High cholesterol
  • Pure sugar
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15
Q

What type of food should be increased in the diets of DM I pts?

A

Fibrous

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16
Q

What is the role of regular aerobic exercise with DM I?

A

Increases insulin sensitivity

Improves circulation

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17
Q

What role does stress play in DM I?

A

Need to avoid d/t BG elevation that can occur

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18
Q

In general, how often should BG be measured with DM I?

A

twice daily, but more if sick

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19
Q

What is the target BG level for 0-4, 5-12, and 13+ two hours after a meal?

A 
0-4 = 100-200
5-12 = 80-180
13+ = 70-150
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20
Q

When should urine ketone monitoring be performed? (3)

A

Illness
Emesis
BG above 250 mg/dL

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21
Q

HbA1C level below what value are associated with reduced risk of renal/retinal complications?

A

10%

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22
Q

What are the ssx of hypoglycemia?

A

Hunger, weakness, drowsiness, HA, confusion

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23
Q

What are the components of preventing hypoglycemia? (4)

A
  • Consistent eating schedules
  • Insulin dosing
  • BG monitoring
  • Edu
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24
Q

What are the two criteria for DKA?

A

BG more than 200

VBG with pH less than 7.3 or HCO3 less than 15

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25
Q

What other common medical condition leads to low HCO3 levels?

A

Emesis

26
Q

What are the IVF goals with DKA?

A

Correct shock and/or ~15 ml/kg of NS or LR

27
Q

What is the problem with bolusing fluids too fast with DKA?

A

Too much will start to pool fluids in the brain d/t the slower diffusion of glucose through the BBB

28
Q

How is insulin administered to patients in DKA?

A

IV insulin at 0.1 nits/kg/hr until 100 mg/dL.

Add D5 to IVF when BG is less than 300 mg/dL, to ensure a slow decline in BG

29
Q

What happens to K with acidosis?

A

H+ is exchanged for K in an attempt to bring pH of the blood back up.

30
Q

What type of fluids should be used for DKA: NS or LR?

A

NS initially to prevent hyperkalemia, then switch to LR once urine output is adequate to maintain K levels

31
Q

What is the effect of insulin on the acidosis of DKA?

A

Reduces ketone body production, and thus acidosis

32
Q

When should HCO3 be used with DKA?

A

iff severely acidotic. Otherwise will overshoot and cause a rapid fall in K

33
Q

True or false: all pts with DKA have some degree of cerebral edema

A

True

34
Q

How do you prevent the cerebral edema with treating DKA?

A

Close monitoring, and administer NS then LR slowly

35
Q

How do you prevent the long term complications from DM? (3)

A
  • HbA1C less than 10%
  • BP less than 90th
  • no nicotine
36
Q

What week of gestation is the thyroid capable of hormone synthesis?

A

14 weeks

37
Q

True or false: maternal and fetal pituitary-thyroid axes are dependent on one another

A

False–totally independent

38
Q

Can anti-thyroid hormones like PTU and methimazole cross the placenta?

A

Yes

39
Q

How can hyperthyroid mothers cause thyrotoxicosis in their fetuses?

A

Human specific thyroid stimulator immunoglobin can cross the placenta, and produce thyrotoxic newborns

40
Q

What are the proteins that bind T3/T4 in the serum? Which binds more readily?

A

Thyrobinding hormone

T4 binds more readily

41
Q

What is the most accurate measure of thyroid function? What is the situation in which this is not true?

A

TSH

Not true if there is a pituitary problem

42
Q

True or false: if there is a normal TSH level, then the patient does not have thyroid issues

A

True

43
Q

What should be added to the orders if TSH is high?

A

Free T4 to evaluate for hypothyroidism

44
Q

What should be added to the orders if TSH is low?

A

Free T3 and T4 to determine degree of hyperthyroidism

45
Q

What is the most common cause of acquired hypothyroidism?

A

Chronic lymphocytic thyroiditis (Hashimoto’s)

46
Q

What are the ssx of hypothyroidism in children?

A

Growth retardation
Sluggishness
Poor perfusion
Macroglossia

47
Q

What is the classic x-ray finding of hypothyroidism in children?

A

Epiphyseal stippling

48
Q

What type of anemia is usually found with hypothyroidism, assuming there is not dietary uptake issues 2/2 to it?

A

Normocytic

49
Q

What happens to cholesterol and carotene levels with hypothyroidism?

A

Increased

50
Q

What happens to CrCl with hypothyroidism?

A

Decreased

51
Q

What are the three major congenital thyroid issues?

A

Aplasia
Hypoplasia
Maldescent

52
Q

What is the inheritance pattern of inborn errors of thyroid hormone metabolism?

A

AR

53
Q

What are the lab values that should be followed with Levothyroxine administration?

A

Free T4 and TSH

54
Q

What is acute suppurative thyroiditis?

A

TTP thyroid in a toxic appearing child d/t infection with GAS or Staph Aureus

55
Q

What are the TFTs like with acute suppurative thyroiditis?

A

Normal

56
Q

What is the treatment for acute suppurative thyroiditis?

A

Abx

57
Q

What causes the exophthalmos and pretibial myxedema in hypothyroidism and Grave’s disease?

A

TSH receptors on fibroblasts in these areas.

  • If hypothyroid, elevated TSH
  • If graves, autoantibodies stimulate these receptors
58
Q

What are the ssx of hyperthyroidism in children?

A
  • premature closure of suture lines

- Advanced bone age

59
Q

What is the cause of congenital hyperthyroidism?

A

Placental passage of TSI IgG from a thyrotoxic mother, causing hyperthyroidism in the infant

60
Q

What is the short and long term prognosis with congenital hyperthyroidism?

A 
Short = significant death rate
Long= will be normal
61
Q

In whom does idiopathic hyperthyroidism usually occur?

A

12-14 yo with a 5:1 female to male ratio

62
Q

What is the natural history of idiopathic hyperthyroidism?

A

Cyclic spontaneous exacerbations and remissions

Endocrine (32 decks)

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