Endo 2

Question 1

ADA criteria for the diagnosis of DM
4

Answer 1

1. hgb a1c greater than or equal to 6.5 (need 2 tests elevated)
2. FPG greater than or equal to 126 (need 2 tests elevated)
3. 2 hour plasma glucose greater than or equal to 200 during an OGTT with 75 g glucose load
4. random plasma glucose greater than or equal to 200 PLUS presence of classic symptoms of hyperglycemia crisis (need polyuria, polydipsia, or polyphagia)

Question 2

which lipids are sensitive to nonfasting states and will give an abnormally elevated value if performed in a nonfasting patient

Answer 2

triglycerides

Question 3

what tests are critical to assessing a patient’s diabetic status (besides blood sugar and a1c)
3

Answer 3

1. BP
2. fasting lipids
3. microalbuminuria

Question 4

when serum free T4 falls, what does TSH doe

Answer 4

increases as the TSH stimulates the thyroid gland to increase T4 secretion

Question 5

thyroid replacement dose recommendation for someone 50-60 years old

Answer 5

50 mcg

Question 6

metabolic processes increase after supplementation of thyroid hormone - this includes what

Answer 6

myocardial oxygen demand with the potential of angina and arrhythmias

Question 7

older adults, especially with cardiac issues should start on what dose of thyroid hormone for hypothyroid

Answer 7

25 mcg

Question 8

thyroid hormone can be increases by what and how often

Answer 8

12.5-25 increments every 4-6 weeks

Question 9

the ADA recommends what nephropathy screening in all patients who have type 2 DM and how often

Answer 9

urinary albumin-to-creatinine ratio and an eGFR at least once a year in all patients who have type 2 DM

Question 10

After starting on basal insulin what do you tell them to monitor

Answer 10

once insulin has been initiated, 3 days of AM fasting glucose measurements should be collected and insulin dose adjusted so that the AM fasting glucose levels are 80-130

Question 11

goal AM fasting glucose levels of those with type 2 DM

Answer 11

80-130

Question 12

ADA recommends what target BP for most patients with DM and HTN

Answer 12

less than 140/90

Question 13

TSH is high but free T4 is normal =

Answer 13

subclinical hypothyroidism

Question 14

replacement of T4 in subclinical hypothyroidism

Answer 14

T4 is not normally replaced until TSH is > 10

Question 15

normal serum free thyroxine (T4) level and an elevated TSH level =

Answer 15

subclinical hypothyroidism

Question 16

s/sx in patients who have subclinical hypothyroid with TSH < 10

Answer 16

it is unlikely that patients present with s/sx of hypothyroidism at this level but some many report mild symptoms

Question 17

repeating TSH levels time frame and why when trying to dx

Answer 17

due to frequent fluctuations in serum concentrations of TSH, a repeated TSH level should be obtained after 1-3 months to confirm the dx

Question 18

why do we tx for subclinical hypothyroidism when TSH >10

Answer 18

increases the patient’s risk for associated complications and progression to overt hypothyroidism is highly likely

Question 19

pioglitazone class

Answer 19

TZD

Question 20

pioglitazone - check what after starting

Answer 20

liver function studies in 2-3 months as TZDs can cause hepatotoxicity

Question 21

TZDs - check what after starting and when

Answer 21

liver function studies in 2-3 months as TZDs can cause hepatotoxicity

Question 22

check liver function studies in 2-3 months of starting this med and why

Answer 22

TZD - hepatotoxicity

Question 23

nephropathy develops in what percent of patients with DM

Answer 23

20-40%

Question 24

when to screen for nephropathy in type 2 DM patients

Answer 24

at time of diagnosis

Question 25

screening for albuminuria is most easily accomplished by performing what

Answer 25

a random urine collection

Question 26

albuminuria may be considered when?

Answer 26

if 2-3 specimens of urinary albumin-to-creatinine ratio collected within 3-6 months are abnormal

Question 27

normal UACR is

Answer 27

< 30 mg/gm Cr

Question 28

two factors that are known to contribute to elevated triglyceride levels are what

Answer 28

elevated glucose levels excessive alcohol consumption

Question 29

a1c and trigs relationship

Answer 29

as a1c decreases, trigs decrease

Question 30

increased risk for DM - age

Answer 30

45 or older

Question 31

increased risk for DM - BMI

Answer 31

25 or greater

Question 32

increased risk for DM - ethnicity 5

Answer 32

asain latino AA pacific islander native american

Question 33

increased risk for DM - pregnancy

Answer 33

delivered baby weight > 9 lb or dx with GDM

Question 34

increased risk for DM - lipids

Answer 34

HDL-C <35 and/or TG >250

Question 35

increased risk for DM - BP

Answer 35

HTN - BP greater than or equal to 140/90 or on therapy for HTN

Question 36

increased risk for DM - conditions associated with insulin resistance 3

Answer 36

1. severe obesity 2. acanthosis nigricans AN 3. PCOS

Question 37

normal fasting glucose in nondiabetic patient

Answer 37

< 100

Question 38

thyroid hormone replacement therapy is based on

Answer 38

patients body weight in kg - multiplied by 1.6

Question 39

proteinuria can be found in the urine in the setting of 5

Answer 39

fever during the course of UTI after intense exercise poor glycemic control other systemic conditions

Question 40

candida and DM

Answer 40

candida is part of the normal vaginal flora - when glucose levels rise, candida dramatically increases which can cause recurrent vaginal candidiasis