endocrine Flashcards
What. stage of diabetes is this pt with A1C 6.3 and GTT 155 in?
Pre-diabetic
Pt has random BG >200 and 2 h GTT>200 also presenting with polydipsia. Can you base your diagnosis of diabetes for this pt?
This presentation qualifies the pt for diagnosis of diabetes
What conditions or characteristics qualify a child to be screened for diabetes? Select all those apply
Acanthosis nigricans
HTN
PCOS
Small for gestational birth weight
All these conditions qualifies a child to be screened for diabetes after puberty or at age 10 whichever comes earlier
Which signs/symptoms of severe hypoglycemia will prompt you to send the pt to ER? Select all that apply
Visual disturbance or blurred vision
Confusion
LOC
seizures
All these signs are of severe emergency and pt needs to be sent to ER
When you assess a pt with diabetes what parts of physical exam you want to make sure you include in your exam
Vision exam
foot exam
What tests will you order as a provider in the clinic for mild to moderate signs and symptoms of diabetes?
POCT
Urinalysis
Plasma glucose level-fasting, postprandial, 8 hour fast (75 mg challenge)
Hemoglobin A1C
Can you list some of the contributing factors to diabetic ketoacidosis?
illnesses
surgeries
infections
medications
illicit drug use
pregnancy
bleeding disorders
ischemic incidents
What is the key difference as far as presentation between hypoglycemia and DKA?
In DKA your pt will present with deep rapid breathing called Kussmaul respirations
When body is not able to produce enough insulin the liver processes fat into fuel called ketones. This is associated with?
Diabetic ketoacidosis, predominantly with type 1 diabetes and can occur in newly diagnosed type 2 diabetes
How would commonly a pt with DKA present to your primary clinic? What symptoms will he or she have?
Frequent urination
excessive thirst
dry skin/mouth
Make sure you ask pertinent questions to reveal the answers
For example elderly pt may not report that they have excessive thirst
What are the key three systems you want to assess when you do physical and ROS on pt coming to your clinic with symptoms of hypoglycemia or DKA?
PMH should include:
Heart
Eye…. vision check
Kidney
What tests will you order for DKA in severe emergencies or moderate cases?
Point of care blood glucose testing
Urinalysis
ECG
CBC
CMP or electrolytes
What are some symptoms of metabolic acidosis?
body’s pH drops below the normal range, which can lead to symptoms such as nausea, vomiting, confusion, and rapid breathing
What is the indication of anion gap test in DKA patients?
A high anion gap (above the normal range of 8-16 mmol/L) can be indicative of metabolic acidosis, as it suggests that there are more unmeasured anions (such as lactate or ketones) in the blood, which can cause an increase in acid levels.
What are the two labs you want to order to assess pancreas function?
Serum lipase and amylase are two laboratory tests that can be used to help diagnose and monitor acute pancreatitis, which is a potential complication of diabetic ketoacidosis (DKA).
In caring for a diabetic patient, how often should you obtain a urine microalbuminuria measurement
YEARLY
You see an obese 25 year old male with acanthosis nigricans and consider ordering:
ESR
Why do you want to administer thiamine before dextrose in alcoholic patients?
giving glucose without first giving thiamine can lead to a rapid increase in glucose metabolism, which can worsen thiamine deficiency and lead to the development of Wernicke-Korsakoff syndrome.
What is the difference between Hyperosmolar hyperglycemic state and DKA?
In HHS, the body has enough insulin to prevent the breakdown of fats and the production of ketones, which is a key feature of diabetic ketoacidosis (DKA). However, insulin resistance may still be present, which can make it difficult to bring blood glucose levels down to a safe range.
What are typical causes of hypothyrodism?
autoimmune disease
medication interaction
over response to thyroid medications
thyroid surgery
radiation therapy
What is the most common inflammatory disease of the thyroid and leading cause of hypothyroidism?
Hashimoto’s thyroiditis and in this condition iodine deficiency is not a problem
The most common precipitating cause of thyroid storm is
infection
Skin thinning and fine brittle hair are signs of hypo or hyperthyrodism/?
hyperthyrodism
What do thyroid antibody titers mean?
What are the normal ranges?
What results indicate?
If TPO antibody levels are elevated, it may indicate an autoimmune thyroid disease. In Hashimoto’s thyroiditis, for example, TPO antibodies target and damage the thyroid gland, leading to hypothyroidism (an underactive thyroid). In Graves’ disease, TPO antibodies stimulate the thyroid gland, leading to hyperthyroidism (an overactive thyroid).
Normal——Titer less than 9 IU/mLco.
physical exam in pt with Grave’s disease include
eyelid retraction
TSH is released by which gland?
Anterior part of pituitary gland
Know how to manage synthroid
TSH of 24 free T4 of 3 is indicative of hypothyroidism
TSH of <0.15, free T4 of 79 is indicative of hyperthyroid
These questions will see on the test and know how to adjust the medications like syntrhoid if your TSH LOW you will lower the dose if it is high u will increase the dose of Synthroid
Know this
You should know this for test.
If calcium is elevated parathyroid gland is affected, PTH is ordered and ionized calcium, also we see it in pts with metast-c disease, bone and cancer, paget’s disease know these conditions as far as reasons for high calcium levels,
Check in female pts and routine mammogram for pts,,, pap smear for uterine cancer
Male check PSA,
If PTH is elevated and ionized calcium is elevated then it is parathyroid disease.
PTH, ionized calcium, mammogram.
Renal ultrasound….. Kidney stones has calcium,
Numbness. Tingling, for low calcium when parathyroid gland was taken out. If suspected lung cancer do chest xray and ct after….
Which adults will you screen for diabetes?
