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PNCB CPNP-PC > Endocrine > Flashcards

Endocrine Flashcards

1
Q

DM
Def: A -1- with disordered metabolism and inappropriate hyperglycemia due to either a -2- secretion or a -3- in its biologic -4-
> DM is classified as iether -5-

A
  1. chronic syndrome
  2. deficiency of insulin
  3. reduction
  4. effectiveness
  5. Type 1 or Type 2
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2
Q

DM
> Age of onset is not a criterion; -1- is usually -2- and -3-. Type 2 most often develops in -4- years; however, development in children, -5- is also common (usually related to obesity).

A
  1. Type 1
  2. diagnosed in childhood
  3. early adolescence
  4. adults > 45
  5. teens/young adults
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3
Q

DM
> -1- is -2-; Type 1 is usually dx in childhood and early adolescence. -3- most often develops in adults older than -4-; however, development in children, teens, and young adults is also common (usually related to -5-).

A
  1. Age of onset
  2. not a criterion
  3. Type 2
  4. 45 years
  5. obesity
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4
Q

DM - Dx

> -1- in the untreated state, and -2-

A
  1. T1DM produces ketosis

2. Type 2 usually doesn’t

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5
Q

T1DM
> -1- onset
> -2- are strongly associated

A
  1. acute

2. human leukocyte antigens (HLS-DR3 or HLA-DR4)

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6
Q

T1DM
> Pathophys: -1- islet cells by islet cell antibodies (autoimmune process)
> Dx: -2- in the -3- and -4-

A
  1. Destruction of pancreatic
  2. Ketones
  3. blood
  4. urine
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7
Q 
T1DM - S/S
> -1- are classic symptoms
> -2-
> -3-, despite -4-
> -5-, weakness, paresthesia
A
  1. polyuria/-dipsia/-phagia
  2. nocturnal enuresis
  3. Weight loss
  4. increased appetite
  5. Fatigue
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8
Q

T1DM - S/S
> -1- changes ranging from irritability to -2-
> -3- fat and -4- suggestive of insidious onset
> Dysfunction of -5-

A
  1. Consciousness
  2. coma
  3. Loss of subQ
  4. muscle wasting
  5. peripheral sensory nerves
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9
Q 
T1DM - S/S
> in -1-:
>> ophthalmic exam may reveal microaneurysms or cotton wool spots
>> -2- vascular insufficiency
>> Diminished -3-
A
  1. advanced disease
  2. evidence of peripheral
  3. DTRs
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10
Q 
T1DM - S/S
> in advanced disease:
>> -1- may reveal microaneurysms or -2-
>> evidence of peripheral vascular -3-
>> Diminished -4-
A
  1. ophthalmic exam
  2. cotton wool spots
  3. insufficiency
  4. DTRs
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11
Q

T1DM - S/S

> may show…

A

…evidence of dehydration

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12
Q

T1DM - Lab/dx
> Serum -1- on -2- is diagnostic
> -3- and -4- indicate the need to confirm the dx -5-

A
  1. FBG 126+ mg/dL
  2. 2 separate occasions
  3. RBG 200+
  4. polyuria/-dipsia and weight loss
  5. with fasting studies
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13
Q 
T1DM - Lab/dx
> -1-: FBG 100-125
> -2-
> UA: -3-
> Serum -4- and -5- may be elevated
A
  1. Impaired glucose tolerance
  2. Hgb A1C (Glycated hgb): 6.5+%; (physio < 5.7%; prediabetes = 5.7-6.4)
  3. glucosuria & ketonuria
  4. BUN
  5. creatinine
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14
Q 
T1DM - Mgmt
> Need to establish the following -1-
>> Fasting trigs/cholesterol and -2-
>> -3-
>> Physical exam including -4-, and -5- exams
A
  1. Baseline (studies)
  2. renal studies
  3. ECG
  4. peripheral pulses
  5. neuro & foot
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15
Q

T1DM - Mgmt
> -1-: may consult -2-
» Total -3-: about 45% of total caloric intake

A
  1. Dietary teaching
  2. dietitian
  3. carb intake
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16
Q

T1DM - Mgmt
> Patients presenting with ketones -1- (long-acting or rapid). The rule of thumb is to begin with -2-, usually using -3-.
> -4-: lifestyle mods r/t -5-

A
  1. must start insulin
  2. 0.5 u/kg/day
  3. an insulin pump
  4. AG
  5. diet/exercise and complications
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17
Q

T1DM - Somogyi Effect and the Dawn Phenomenon

Two conditions that result in …, but have different etiologies an different mgmt strategies

A

early morning HYPERglycemia

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18
Q

T1DM - Somogyi Effect and the Dawn Phenomenon
> The Somogyi effect: Results when -1- stimulates a surge of counter regulatory hormones that -2-. This pt is hypoglycemic at -3- rebounds with a(n) -4- blood sugar -5-

A
  1. nocturnal hypoglycemia
  2. raise blood sugar (Tsunami!)
  3. 3 AM, but
  4. elevated
  5. at 7 AM
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19
Q

T1DM - Somogyi Effect

|&raquo_space; Treatment: -1- the bedtime -2-

A
  1. Reduce/eliminate

2. dose of insulin

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20
Q

T1DM - Somogyi Effect and the Dawn Phenomenon
> The Dawn Phenomenon: Results when -1- to -2-. Blood sugar gets -3- the night and is elevated at 7 AM.
» Tx: -4- bedtime -5-

A
  1. tissue becomes desensitized (HGH)
  2. insulin nocturnally
  3. progressively higher throughout (dawn is gradual)
  4. Add new/increase the
  5. dose of insulin
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21
Q

T2DM
> Not linked to -1-
> -2- Ab identified
> Presence of -3- or diabetic -4-

A
  1. the HLA system
  2. No islet cell
  3. obesity
  4. FMH increases risk
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22
Q

T2DM - S/S
> Insidious onset of -1- may be -2-
> -3- (more common in T2DM)
> -4- may be present, but -5-

A
  1. hyperglycemia
  2. asymptomatic
  3. Acanthosis Nigricans
  4. polydipsia/-phagia/-uria
  5. less common in T2DM
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23
Q

T2DM - Lab/Dx
> -1- as for -2-, except for -3- screening in the blood/urine
> Screening: -4-

A
  1. Same as
  2. T1DM
  3. ketone
  4. same as baseline
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24
Q

T2DM - Considerations for Screening
> Patient has BMI classified as -1-, as well as two of the following risk factors:
» -2- of T2DM
» -3-

A
  1. “overweight” (>85%) or “obese” (>95%)
  2. Family history
  3. Persons of color (specifically AFAM, native americans, hispanics, and API)
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25
Q

T2DM - Considerations for Screening
> Risk Factors
» -1- of -2-

A
  1. Maternal history

2. gestational diabetes

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26
Q 
T2DM - Considerations for Screening
> Risk Factors
>> Signs -1- resistance:
>>> Acanthosis Nigricans
>>> -2-
>>> dyslipidemia
>>> -3-
>>> SGA birthweight
A
  1. associated with insulin
  2. HTN
  3. polycystic ovary syndrome
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27
Q 
T2DM - Considerations for Screening
> Risk Factors
>> Signs associated with insulin resistance:
>>> -1-
>>> HTN
>>> -2-
>>> polycystic ovary syndrome
>>> -3- birthweight
A
  1. Acanthosis Nigricans
  2. dyslipidemia
  3. SGA
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28
Q

T2DM - Considerations for Screening

> Screening, -1-, should begin -2- or -3- (whichever occurs -4-) and repeat -5-

A
  1. if done
  2. at age 10
  3. onset of puberty
  4. first
  5. every 2 years
29
Q 
T2DM - Mgmt
> Obtain similar -1- to T1DM
> -2- mgmt
> Oral -3-
> -4- in addition to oral therapy for severe -5-
A
  1. baseline data
  2. weight (nutrition)
  3. antidiabetics
  4. insulin therapy
  5. hyperglycemia & ketoacidosis
30
Q

T2DM - Oral Antidiabetics

> -1- is approved by -2- for use in -3-; a -4- is available for children -5-

A
  1. Metformin (glucophage)
  2. the FDA
  3. children
  4. liquid form
  5. unable to swallow tablets
31
Q

T2DM - Oral Antidiabetics
> Metformin
» -1- insulin action, but -2-
» -3- given in those with -4-, or to those prone to hypoxia

A
  1. Does not stimulate
  2. reduces gluconeogenesis
  3. Should not be
  4. hepatic/renal failure
32
Q 
T2DM - Oral Antidiabetics
> Metformin
>> SE: -1-; however, typically -2- (-3-)
>> -4- hypoglycemia
>> To be -5-
A
  1. significant GI upset
  2. transient
  3. 2-3 months
  4. Little or no
  5. administered w/ food
33
Q

T2DM - Oral Antidiabetics
> Metformin
» Needs to be -1- before -2-; force fluids -3- following -2- using -4-, as interaction with metformin could cause -5-

A
  1. discontinued 48 hours
  2. procedures
  3. for 48 hours
  4. dye
  5. Acute kidney failure
34
Q

Hyperthyroidism

Def: Series of clinical disorders assoc. w/ -1- of -2- or -3-; also known as thyrotoxicosis (-4- TSH)

A
  1. increased circulating levels
  2. free thyroxine (T4)
  3. triiodothyronine (T3)
  4. Everything’s elevated except
35
Q

Hyperthyroidism
> -1- (most common in children) is associated with the following:
» -2- of the thyroid
» -3- of the gland
» -4- against different fractions of the thyroid gland

A
  1. Graves’ disease
  2. Diffuse enlargement
  3. hyperactivity
  4. presence of antibodies
36
Q

Hyperthyroidism - Causes/Incidence
> More common in -1-
> Causes of -2- (e.g., thyroid growths, -3-, -4-)

A
  1. females (8:1)
  2. hyperthyroidism
  3. subacute thyroiditis
  4. TSH-secreting pituitary tumor
37
Q 
Hyperthyroidism - S/S
> -1-, restlessness
> -2-, increased -3-
> -4- changes
> -5- irregularities
A
  1. Nervousness
  2. heat intolerance
  3. sweating
  4. Weight (usually weight loss)
  5. menstrual
38
Q

Hyperthyroidism - S/S
> -1-
> Thyroid -2-
> -3- may be present (-4-)

A
  1. tachycardia
  2. goiter
  3. Graves’ ophthalmopathy
  4. exophthalmos
39
Q

Hyperthyroidism - Lab/Dx
> -1- is the -2- and -3-
> Serum -4-, thyroid resin update, and free thyroxine index will all be -5-

A
  1. TSH
  2. most sensitive test
  3. will be low
  4. T3 & T4
  5. high
40
Q

Hyperthyroidism - Mgmt

> Refer…

A

…to peds endocrine

41
Q

Hyperthyroidism - Mgmt
> Medications
» -1- relief: 0.5-2 mg/kg/day divided into 3-4 doses
» -2- advantages: cardioselective, less risk of bronchospasm, dosed once daily

A
  1. Propranolol for symptomatic

2. Atenolol

42
Q

Hyperthyroidism - Mgmt - Meds
» Thiourea drugs [e.g., propylthiouracil (PTU) and -1-]: for pts with mild cases, small goiters, or fear of isotopes; avoid -1- use in -2- age due to -3-.

A
  1. methimazole (Tapazole)
  2. women of child-bearing
  3. teratogenic effects
43
Q

Hyperthyroidism - Mgmt - Meds
» Thiourea drugs [e.g., propylthiouracil (PTU) and methimazole (Tapazole)]: for pts with mild cases, -1-, or -2-; warning: methimazole is -3-.

A
  1. small goiters
  2. fear of isotopes
  3. conceptionally teratogenic (not to be given to women of child-bearing age)
44
Q

Hyperthyroidism - Mgmt
> Defnitive treatments
» -1- (can affect fertility)
» -2- (must be -3- preoperatively)

A
  1. radioactive iodine 131-I
  2. Thyroid surgery
  3. euthyroid
45
Q

Hyperthyroidism - Mgmt - Definitive treatments7
» -1- solution every day for -2- can reduce the -3- of the gland prior to the surgery
» Diet: use -4- instead of -5-

A
  1. 5-7 drops Lugol’s
  2. 10 days
  3. vascularity
  4. non-iodized salt
  5. iodized salt
46
Q

Hypothyroidism
Def: a condition resulting in the -1- thyroid -2-
> May be due to -3- of the -4-, or to a deficiency of pituitary TSH or hypothalamic TRH
> MOst foten due to -5-; other causes include iodine deficiency, deficient pituitary, and destruction of the gland by surgery, external radiation, or trauma.

A
  1. lack of circulating
  2. hormone
  3. disease
  4. thyroid gland itself
  5. autoimmune thyroiditis (often comorbid with T1D, celiac, or other autoimmune disorders)
47
Q 
Hypothyroidism - Causes/Incidence
> -1-
>> Absence or -2- of the -3-
>> -4- in transport/assimilation of iodine
>> Occurs in about -5- children
A
  1. Congenital
  2. underdevelopment
  3. thyroid gland
  4. inherent dysfunction
  5. 1 in 2,000-4,000
48
Q 
Hypothyroidism - Causes/Incidence
> -1-
>> -2- thyroiditis
>> Pituitary -3-
>> -4- deficiency
>> -5- to the gland
A
  1. Juvenile acquired
  2. Hashimoto’s
  3. TSH deficiency
  4. Iodide
  5. Damage
49
Q 
Hypothyroidism - S/S: Neonates & Infants
> -1- in the first month of life
> Prolonged bili elevation
> -2-, -3-
> Large -4-
>  Lethargy, -5-
A
  1. no obvious symptoms
  2. poor feeding
  3. growth deceleration
  4. fontanels
  5. hypotonia
50
Q 
Hypothyroidism - S/S: **Older children**
> -1- intolerance
> -2-
> -3-, poor growth
> -4-, thinning hair, brittle nails
A
  1. Cold
  2. constipation
  3. delayed bone age
  4. dry skin
51
Q

Hypothyroidism - S/S: Older children
> -1- and -2-
> Slowed -3-
> -4- Sounds

A
  1. Puffy eyes
  2. thick tongue
  3. DTRs
  4. diminished heart
52
Q 
Hypothyroidism - Lab/Dx
> -1- mandatory
> Elevated -2-
> The following will be decreased:
>> -3-
>> -4- (Not -5-)
A
  1. newborn screening is
  2. TSH
  3. T4 (or low physio)
  4. T3
  5. reliable/non-diagnostic
53
Q

Hypothyroidism - Lab/Dx
> -1- serum -2- enzymes
> -3-, -4-
> -5-

A
  1. Increased
  2. cholesterol & liver
  3. hyponatremia
  4. hypoglycemia
  5. anemia
54
Q

Hypothyroidism - Mgmt
> Refer to -1-
> -2-

A
  1. pediatric endocrine

2. Levothyroxine!

55
Q

Short Stature
Def: height -1- deviations or more below the -2- of that sex, or age, or a marked deviation from previously established growth; -3- more than -4- (-5-)

A
  1. falling two standard
  2. mean for children
  3. failure to grow
  4. 4 cm/year
  5. 1.5 inches
56
Q

Short Stature - Causes/Incidence
> Occurs in -1- population
> -2- variant

A
  1. 2.5% of the

2. Familial genetic (physio linear growth, short target height)

57
Q

Short Stature - Causes/Incidence
> Constitutional Delay: -1- w/ -2- age
» -3- for the first two to three years of life, then a -4- velocity

A
  1. bone age consistent
  2. height
  3. slow growth rate
  4. low-physiologic growth
58
Q

Short Stature - Causes/Incidence
> -2- Stature: -1- are -2- to -3-
» -4- restriction
» -5- pathophysiology

A
  1. limbs
  2. proportionate
  3. the torso
  4. intrauterine growth
  5. chromosomal
59
Q 
Short Stature - Causes/Incidence - Proportionate Stature
> -1-
> Variety of -2-
>> -3- deficiency
>> -4-
A
  1. FTT
  2. endocrine disorders
  3. HGH
  4. DM
60
Q

Short Stature - Causes/Incidence
> Disproportionate stature: limbs are -1- to torso
» -2-
» -3-

A
  1. smaller in proportion
  2. dwarfism
  3. rickets
61
Q

Short Stature - Causes/Incidence
Assessment
> Assess for -1-, -2-, neglect
> Investigate -3- based upon proportion

A
  1. chronic disease
  2. endocrine deficiencies
  3. underlying causes
62
Q

Short Stature - Lab/Dx

> -1-, liver function tests, -2-, -3-

A
  1. CBC
  2. Electrolytes
  3. ESR
63
Q

Short Stature - Lab/Dx
> -1-: consider skeletal survey for disproportionate features
> -2- test
> -3- level

A
  1. bone age
  2. thyroid function
  3. HGH
64
Q 
Short Stature - Mgmt
> Depends -1-
> Refer -2-
> Further testing may inlcude
>> -3- and -4-
A
  1. upon cause
  2. to endocrine
  3. IGF-1
  4. IGFBP-3
65
Q

Short Stature - Mgmt
> Further testing may inlcude
» -1- through karyotype and comparative genomic hybridization
» anti-endomysial and anti-gliadin antibodies -2-
» Sweat test if recurrent bronchitis (-3-)

A
  1. Turner syndrome r/o
  2. for celiac disease
  3. r/o CF
66
Q

-1-, a class of antidiabetic drugs, should not be given to heavy consumers of alcohol or to those -2-. Patients who take -1- can become sick if they consume more than two to four alcoholic drinks a week. -3- and -4- do not adversely interact with alcohol and are, therefore, safe. -5- is not given orally.

A
  1. Biguanides
  2. prone to hypoxia
  3. Dipeptidyl-peptidase 4 inhibitors
  4. alpha-glucosidase inhibitors
  5. Insulin
67
Q

For patients presenting with ketones, the rule of thumb is to begin with -1-, giving -2-, of the dose in the morning and -3- in the evening. A -4- is sometimes used in other patients, such as those splitting their treatment between regular human insulin and -5-, but it is not recommended for patients who present with ketones.

A
  1. 0.5 u/kg/day
  2. 0.34 u/kg (2/3)
  3. 0.16 u/kg (the remaining 1/3)
  4. half dose
  5. NPH
68
Q

-1- is recommended for the relief of symptoms associated with hyperthyroidism. -2- benefit the condition, but the benefit does not compound with multiple types. -3- is usually performed, as long as the patient is -4- preoperatively. -5- is used to reduce the vascularity of the gland and is used for more chronic therapy rather than acute.

A
  1. Propranolol
  2. Thiourea drugs (like methimazole)
  3. Thyroid surgery
  4. euthyroid (asymptomatic on exam)
  5. Lugol’s solution

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