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endocrine Flashcards

1
Q

Which type of DM is insulin dependent and typically develops in a younger patient?

A

type 1

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2
Q

Which type of DM is associated with unintentional weight loss?

A

type one DM

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3
Q

Which type of DM is associated with ketone development? (ketonemia, Ketonuria)

A

type one DM

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4
Q

Name three differentials for unintended weight loss

A

cancer

DM type 1

TB

hyperthyroidism

HIV/AIDS

Depression

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5
Q

What are the normal values for BUN?

A

10-20

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6
Q

What are the normal values for creatinine?

A

0.5-1.5

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7
Q

Name three causes of elevated BUN

A

dehydration

GI bleeding

high protein diet

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8
Q

What is the most sensitive indicator of renal function?

A

Serum creatinine

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9
Q

normal hgb A1c

A

5.5-7

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10
Q

normal fasting BG

A

60-99

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11
Q

How much of a diet should be carbohydrates?

A

55-60%

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12
Q

When do you start somebody on insulin?

A

If they present with ketoneuria or ketonemia

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13
Q

How do you begin insulin therapy?

A

0.5units/kg/day

giving 2/3 of the dose in the morning and 1/3 in the evening

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14
Q

What are two causes of early morning hyperglycemia?

A

Dawns phenomenon

Somogyi phenomenon

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15
Q

If a patient is hypoglycemic at 03:00 and then their BG rebounds and surges to hyperglycemia is their problem somogyi or dawns phenomenon?

A

Somogyi, because it is opposite, the treatment is to reduce or omit the PM dose of insulin

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16
Q

If a patient is hypoglycemic at 03:00 and then their BG is high and it continues to rise. Is their problem somogyi or dawns phenomenon?

A

Dawns, it rises, treatment is to increase the insulin

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17
Q

What are diagnostic criteria for metabolic syndrome?

A

BP > or = 130/85

obesity

fasting BG > or = to 100

waist circumference (visceral adiposity)

elevated triglyceride level >150

HDL<40 in men

HDL< 50 in women

*you need three of these criteria for diagnosis

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18
Q

What is the step-wise approach to the treatment of DM II?

A

weight reduction

dietary changes

oral antidiabetics

insulin therapy

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19
Q

Which type of DM has an insidious onset, pt may present with repeated vagitnitis, chronic cellulitis, recurrent prescription glassess changes?

A

type 2 DM

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20
Q

What are some examples of sulfonyureas and what is their mechanism of action?

A

glipizide, glyburide

stimulate the pancreas to release more insulin

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21
Q

What is an example of a biguinide and what is its mechanism of action and what is a side effect?

A

metformin

side effect: lactic acidosis

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22
Q

What is the standard of care per ADA for the treatment of type II DM?

A

metformin

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23
Q

What would you consider in a presention of intracellular dehydration with elevated BG>250, hyperkalemia, ketonemia, ketonuria?

A

type one diabetes, DKA

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24
Q

What would you consider in a presentation of dehydration, BG>1200?

A

HHNK

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25
Q

What is normal serum osmolality?

A

275-285

26
Q

When the patient is acidotic is the potassium high or low?

A

high, low pH = high K+

27
Q

How do you resuscitated DKA patient?

A

1st isotonic (NS or LR) until stable

2nd hypotonic (to treat intracellular dehydration)

1/2NS

3rd once BG trends down D5 1/2

28
Q

How do you start an insluin gtt?

A

0.1units/kg of regular followed by 0.1units/kg/hr

29
Q

Which has a normal anion gap, DKA or HHNK?

A

HHNK

30
Q

What is the most common presentation of hyperthyroidism?

A

Graves disease

31
Q

What is the most common cause of HYPOthyroidism?

A

Hashimoto’s thyroiditis

32
Q

What are causes of hyperthyroidism?

A

TSH secreting tumor

pituitary tumor

high dose amiodarone

Graves disease

33
Q

Symptoms of hyperthyroidism

A

bulging eyes

heat intolerance

increased appetite with associated weight loss

34
Q

Labs associated with hyperthyroidism

A

TSH is low

T3 elevated

T4 can be elevated

35
Q

Medications used for hyperthyroidism

A

propranolol for symptoms (for shakes and palpitations)

PTU for treatment of hyperthyroidism

36
Q

Iodine deficiency can be caused by:

A

iodine deficiency

37
Q

What are the labs associated with hypothyroidism?

A

TSH elevated

T4 low

T3 is not definately associated with hypothyroidism diagnosis

38
Q

Extreme hypothyroidism can lead to:

A

Myxedema coma

39
Q

ACTH hypersecretion

A

Cushings

40
Q

Cushings is caused by:

A

hypersecretion of ACTH

adrenal tumors

chronic administration of glucocorticoids (like in transplant patients)

41
Q

Moon face, buffalo hump, risk for infections, acne, hirtuism

A

chronic steroid users

and/or

cushings

because of increase in androgens

42
Q

Who will have HTN, the patient with cushings or the patient with addisons?

A

Cushings because ACTH–> steroids–> vasoconstriction

43
Q

What are the triad of labs for cushings?

A

hyperglycemia (because steroids prevent the uptake of glucose in the cell)

hypernatremia

hypokalemia

44
Q

What are the triad of labs for addisons disease?

A

hypoglycemia

hyponatremia

hyperkalemia

45
Q

What is the product of aldosterone and androgen?

A

mineralocorticoids

46
Q

What is the treatment of addisons?

A

glucocorticoids and mineralocorticoids

47
Q

Innapropriate water retention, hyponatremia, caused by skull fracture brain tumor and lung disease.

A

SIADH (too much ADH)

48
Q

In SIADH the urine osmolality is high or low?

A

high

49
Q

If patient is hyponatremic and Na is greater than 120 what is the treatment?

A

limit fluid to one liter a day

50
Q

If sodium is 110-120 and patient is symptomatic how do you treat?

A

3% or hypertonic IV fluids

51
Q

What are the three types of DI?

A

central (hypothalmic or pituitary)

nephrogenic (acquired from pylo)

psychogenic

52
Q

Signs and symptoms of DI

A

polyuria

excessive thirst

signs of dehydration

dilute urine

53
Q

Is the serum osmo high or low in DI?

A

high

54
Q

How do you discern central from nephrogenic DI?

A

Vasopressin challenge:

+ in central

  • in nephrogenic
55
Q

How do you treat hypernatremia?

A

D5W

56
Q

How do you teach a patient to use outpatient DDAVP?

A

intranasally

57
Q

Pheocromocytoma

A

adrenal medulla tumor

characterized by paroxysmal or sustained HTN due to excssive circulating catecholamines

58
Q

labile BP applies to pt’s with hyperthyroidism OR pheochromocytoma

A

pheochromocytoma

59
Q

Tests of pheochromocytoma

A

plasma free metanephrines

urine metanephrines (24 hour), urine cr, catecholamine, VMA

To confirm pheochromocytoma CT scan

60
Q

management of pheochromocytoma involves

A

surgical incision of the tumor, watch for adrenal insufficiency and hemorrhage post-op

61
Q
A

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