endo

Question 1

how often do we screen for t2dm

Answer 1

ADA recommends fasting BGL q3yrs in adults regardless of risk

R: T2DM is unlikely to develop in 3 yr time frame if initial BGL WNL

Question 2

when to begin screening for t2dm

Answer 2

age 45 if w/o high risk

Question 3

testing recommendations for high risk t2dm

Answer 3

Physical inactivity
FH and H/O high birthweight babies or gestational DM
High risk ethnicity
HTN 140/90 and above, or treated
HDL < 35 or TG > 250
PCOS- polycystic ovary disease
CVD

Question 4

what can affect glucose levels

Answer 4

what we ate, exercise, sickness

Question 5

what is diagnostic of t2dm

Answer 5

1. FBS no intake for >8 hrs ./=126 diagnostic of risk (98% spec, 88% sens)
2. random bgl >/= 200 with symptoms- polys, wt loss, hyperglycemic crisis

Question 6

criteria for pre dm

Answer 6

a1c 5.7-6.4

fasting bgl 100-125

glucose post standardized glucose lose 140-199

Question 7

testing for complications with diabetes

Answer 7

Renal function: Creatinine, microalbuminuria(MRU) at least yearly
neuropathy - usually done yearly; vibration, monofilament, temp, pulses
fasting lipid panel-
every 5 years starting at age 10 unless there is a strong family history when screening begins at age 2
Q6 mo-1 yr in a diabetic
DM goal is LDL < 100 mg/dl (cardiac <80), HDL > 50 mg/dl (men), >45 (female) and triglycerides < 150 mg/dl
Opthalmalogy & dentist: at least yearly

Question 8

what is the main fx of parathyroid glands

Answer 8

regulate calcium through parathyroid hormone release

/raises serum calcium through calcium sensing receptors

Question 9

how does parathyroid hormones regulate serum calcium levels

Answer 9

1. direct action on bone to release calcium into extracellular fluid
2. direct action on kidney to decrease renal loss of calcium
3. indirect action on GI tract by activating vit D to increase dietary calcium absorption

Question 10

hyperparathyroid dysfuction is what

Answer 10

over-secretion of PTH

Question 11

what is primary hyperparathyroid dysfx

Answer 11

inappropriate secretion of PTH in setting of hypercalcemia

80% dt parathyroid adenoma

Question 12

secondary hyperparathyroid dysfx

Answer 12

appropriately increased secretion of PTH in setting of low or normal serum calcium usually d/t vit D deficiency or renal failure

Question 13

tertiary hyperparathyroid dysfx

Answer 13

prolonged secondary that leads to hypercalcemia

Question 14

what is hypoparathryoid dysfx

Answer 14

under secretion of PTH

inappropriately low secretion of PTH in setting of hypocalcemia

result of destruction of parathyroid gland dt surgery, radiation, infiltration- amyloidosis, hemochromotasis

Question 15

what does hyperparathyroidism present as

Answer 15

asymptomatic hypercalcemia

nonspecific neurocongnitive symptoms based on degree of hypercalcemia

weakness, fatigue, depression, loss of initiative
anxiety, irritability, insomnia

HTN, CAD

kidney stones, hematuria, nocturia, polyuria, osteoporosis

Question 16

diagnostics for hyperparathyroidism and hypo

Answer 16

1. PTH
2. Serum ca
3. albumin
4. fasting phosphorus
5. serum 1,25-dihydroxyvitamin D
6. serum 25-hydroxyvitamin D

24 hr urine calcium for hyper

mag for hypo

Question 17

high PTH and high calcium

Answer 17

primary hyperparathyroidism or secondary hyperparathyroidism from vit d def

Question 18

low PTH and high ca

Answer 18

PTH production is suppressed dt high calcium

possibly from metastic disease to bone, sarcoidosis, vit d intoxication

Question 19

low PTH and low calcium

Answer 19

dt surgical excision of parathyroid

Question 20

high PTH and low calcium

Answer 20

pts witch chronic refnal failure do not excrete phosphates normally

Question 21

when to test for hyperthryoidism

Answer 21

New onset of tachycardia, afib, arrhythmias, unexplained weight loss, exophthalmos, elevated temp (mild), thyroid nodule, heat intolerance, change in hair

Question 22

when to test for hypothyroidism

Answer 22

Fatigue, dyslipidemia that is hard to control, hypotension that is unexplained, bradycardia, weight gain, depression, sexual dysfunction, puffy eyes, cold intolerance, aching joints, hair thinning

Question 23

anti-TPO antibodies

Answer 23

In autoimmune thyroid disease, proteins mistakenly attack the thyroid peroxidase enzyme, which is used by the thyroid to make thyroid hormones. Used for diagnosing Hashimotos Disease

Question 24

thyroid US

Answer 24

probe is placed on the skin of the neck, and reflected sound waves can detect abnormal areas of thyroid tissue. Used to detect nodules and during needle biopsy of nodules

Question 25

thyroid scan

Answer 25

small amount of radioactive iodine is given by mouth to get images of the thyroid gland. Radioactive iodine is concentrated within the thyroid gland (GRAVES)

Question 26

thyroglobulins

Answer 26

substance secreted by the thyroid gland that can be used as a marker of thyroid cancer. It is often measured during follow-up in patients that have undergone treatment for thyroid cancer. High levels indicate recurrence of the cancer.

Question 27

other imaging for thyroid disease

Answer 27

If thyroid cancer has spread (metastasized), tests such as Thyroid scan, CT scans, MRI scans, or PET scans can help identify the extent of spread

Question 28

what to do when TSH is abnormal

Answer 28

FT3, FT4 are needed for establishing a diagnosis
FT3 assists when you suspect hyperthyroidism
Graves disease along with thyroid antibodies
FT4 directly measures unbound thyroxine, NL 1.1-4.3

Question 29

diagnostics for thyroid

Answer 29

1. TSH
2. Free T3
3. free T4
4. Thyroglobulin
5. Anti-thyroid antibody
6. Thyroid scan
7. ultrasound

Question 30

diagnostics for parathyroid

Answer 30

1. PTH
2. Calcium phosphate
3. vitamin D-25