endocrine

Question 1

severe hypoglycemia

Answer 1

glucose

Question 2

DM 1

Answer 2

school aged,
eats but still loses weight
“fruity odor breath”

Question 3

thyroid cancer

Answer 3

nodule >2.5cm

24 hour radioactive iodine uptake (RAIU) will show “cold” nodule

Question 4

FSH

Answer 4

estrogen

Question 5

LH

Answer 5

progesterone

stimulates testicles to produce testosterone

Question 6

hyperthyroidism

Answer 6

very low TSH, >t3 t4.

graves disease is most common cause

Question 7

grave’s disease

Answer 7

Look for LOW TSH (women (8:1)
>risk for osteoporosis, RA, pernicious anemia

classic case: middle age female, weight loss, hyperactive, lower stool, amenorrhea

Question 8

radioactive iodine

Answer 8

permanent distruction of thyroid
PTU treatment
do not give during pregnancy

Question 9

thyroid storm (thyrotoxicosis)

Answer 9

dt stress/infection

Question 10

cold vs hot spot

Answer 10

cold- not metabolically active (concern is cancer). biopsy

hot- active and usually benign

Question 11

normal range of TSH

Answer 11

.01-6.0

check q6-8wks

Question 12

drug induced thyroid disease

Answer 12

lithium, dopamine, amiodarone, interferon alfa (cancer)

Question 13

hypothyroid most common cause

Answer 13

hashimotos
other: postpartum,

most have elevatd antimicrosomal antibody titers, goiter

classic case: overweight woman, fatigue, constipation. a fib in older adult.

** Heavy menstrual, irregular bleeding

Question 14

myxedema

Answer 14

severe HYPOthyroid

puffy hands, face, feet. thickening of the skin, thinning of outer 1/3 eyebrow,

Question 15

tx plan for hypothyroid

Answer 15

synthroid 25-50 mcg

increase every few weeks prn, re check 6-8 wks TSH until normalized (

Question 16

preferred tx for pregnant women

Answer 16

PTU

Question 17

thyroid cancer risk

Answer 17

hx of neck irradiation in childhood

PAINLESS nodule >2,5 cm

Question 18

supplement in chronic amenorrhea (hyper thyroid)

Answer 18

calcium , vit D, weight bearing exercise ( dt osteoporosis)

Question 19

metabolic syndrome aka..

Answer 19

aka: insulin resistance syndrome or syndrome x

obesity, HTN, Hyperglycemia, Hyperlipidemia.
High risk for DM 2 and CVD

Question 20

prediabetes a1c

Answer 20

a1c

Question 21

diabetes a1c/glucose fasting/random glucose

Answer 21

> 6.5%
126mg/dl (fasting, no food 8 hours)
200 random glucose (plus polyuria, polydipsea, polyphagia)

Question 22

a1c elderly

Answer 22

8% ok

Question 23

high risk hypoglycemia

Answer 23

50mg/dl or less

Question 24

dawn phenomenon

Answer 24

hypoglycemia

>in FBG early in the morning dt INCREASE insulin resistance between 4-8am

Question 25

somogyi effect (rebound hyperglycemia)

Answer 25

S=sugar noctornal hypoglycemia stimulates glucagon to be released by liver= high FBG by 7am. ** DUE TO over treatment bedtime insulin. dsg- check glucose 3am for 1-2 weeks tx: snack before bedtime, or

Question 26

diabetic retinopathy

Answer 26

microaneurysms, cotton wool exudates, neovasculariazion (can rupture in the eye) (cotton wool also with HTN)

Question 27

first line DM rx

Answer 27

metformin (glucophage) | decrease new glucose, decrease insulin resistance

Question 28

contraindications for metformin

Answer 28

hepatic disease, alcoholics | risk for lactic acidosis (PH

Question 29

sulfonylureas

Answer 29

beta cells to MAKE more insuin- risk of hyPOglycemia!!! glipizide (glucotrol) glyberide (diabeta) glimepriride (amaryl) ``` increaser risk sun sensitivity (use spf) blood dyscrasias ( monitor cbc) ```

Question 30

Thiazolidinedoines TZD

Answer 30

z=zone rosiglitazone (avandia) pioglitazone (actos) ``` AVOID in CHF (nyha class 3/4) associated with rare bladder cancer (UA, cytology) ```

Question 31

key points for insulin

Answer 31

rapid acting - 1/2 day work ( 4 hours). "one meal at a time" regular insulin ( or short acting) - covers work day ( 8 hours) "meal to meal " NPH - extra work shift almost all day (16 Plus hours) breast fast to dinner lantus- once a day 24 hours

Question 32

rapid acting drugs

Answer 32

(Log=Lispro) humalog (insulin lispro)

Question 33

short acting (regular)

Answer 33

humulin R

Question 34

NPH

Answer 34

humulin N

Question 35

lantus

Answer 35

insulin glargine, levimir (insulin detimir) considered a "basal insulin" no peaks. lasts 24 hours.

Question 36

incretin mimetic or glycogen like peptide 1 (glp-1)

Answer 36

exenatide (byetta) victoza (once a day injection) risk for pancreatitis monitor amylas/lipase! incretin inhancer (januvia, onyglyza)- don't mix.

Question 37

when does regular insulin peak

Answer 37

1-5 hours aka: meal to meal (breakfast to lunch) by lunch time its gone

Question 38

type 1 DM usually takes what insulin before each meal

Answer 38

rapid acting (humalog/lispro)

Question 39

premixed mostly for type 1 or 2 DM

Answer 39

2

Question 40

metformin dosage

Answer 40

500mg daily bid ( max dose is 2550 mg/dl) if metformin is at max at blood sugar still high, add SU (risk for hypoglycemia)

Question 41

if pt is on BOTH metformin and SU max dose (metformin 2550mg/dl and gloctrol XL 20mg) and glucose still high..

Answer 41

add basil insulin (LANTUS)

Question 42

other options beside insulin

Answer 42

thioglitazone (avandia, actos)- don't use in CHF | byetta - risk for pancreatitis (incretin mimetic)

Question 43

which DM causes weight loss

Answer 43

``` metofmrin incretin mimetic (byetta) amyin analog (symlin) ```

Question 44

which DM causes weight gain

Answer 44

SU, TZD (actos, avandia), insulin

Question 45

DM lifestyle management

Answer 45

weight loss, fiber whole grains exercises increases cellular glucose uptake ``` weight loss- 7% of body weight physical activity (150/min/week) ```

Question 46

somogyi versus dawn phenomenon

Answer 46

somogyi is also called "rebound hyperglycemia." Although the cascade of events and end result -- high blood sugar levels in the morning -- is the same as in the dawn phenomenon, the cause is more "man-made" in the Somogyi effect (a result of poor diabetes management). dawn phenomenon happens to everyone, 3a-8a blood hormones cause >glucogon=>glucose. tx: give insulin, earlier dinner, exercise after dinner.

Question 47

what is considered "low blood sugar"

Answer 47

Your blood sugar is considered low when it drops below 70 mg/dL.