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Endocrine Disorders > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are the normal thyroid values?

A

0.4-4.0

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2
Q

What is prediabetes A1c?

A

5.7-6.4

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3
Q

What is diabetes A1c

A

6.4 and up

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4
Q

What is normal fasting blood sugar?

A

Less than 100 is normal.

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5
Q

What fasting blood sugar is prediabetes?

A

100-125

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6
Q

What blood sugar is diabetes?

A

If it’s 126 on 2 or more readings, then diabetes.

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7
Q

What is goal A1c in someone young i.e. Type 1?

A

6%

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8
Q

What is the goal A1c in someone normal aged 20 and up?

A

7%

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9
Q

What is the goal A1c in someone elderly?

A

8%

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10
Q

Blood glucose less than 50 mg. Complains of weakness feels like passing out, headache, clammy hands, and anxiety. difficulty concentrating and thinking. If not corrected it will progress to coma

A

Severe hypoglycemia

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11
Q

School-aged child with the recent history of viral illness complains of excessive hunger and thirst. Urinating more than normal polyuria. Start losing weight despite eating a large amount of food. Breath has a fruity order. Large amount of ketones in urine

A

Type one diabetes

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12
Q

Age greater than or equal to 45, BMI greater than 25, family history i.e. 1st° relative, habitual physical inactivity, hypertension, HDL less than or equal to 35 or triglycerides greater than or equal to 250, Women with PCOS, history of vascular disease, delivery of a macrosomic infant (9 lbs) Or gestational diabetes, African-American, Hispanic, Native American, Asian American, pacific islanders, previously identified a1C greater than or equal to 5.7%, impaired glucose tolerance, impaired fasting glucose are all risk factors for

A

Diabetes mellitus

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13
Q

How often do you screen for diabetes in patients with a BMI greater than or equal to 25 and one or more risk factors for DM

A

Annually

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14
Q

How often do you screen for DM the entire population greater than or equal to 45 years old if screening is normal

A

Every three years

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15
Q

What is the A1 C level for type two diabetes diagnosis

A

Greater than or equal to 6.5%

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16
Q

What is the fasting plasma glucose for type two diabetes diagnosis

A

Greater than or equal to 126

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17
Q

What is the two hour glucose tolerance test diagnostic criteria for type two diabetes

A

Greater than 200 mg

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18
Q

What is the A1 C to diagnose prediabetes

A

Greater than or equal to 5.7% to 6.4%

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19
Q

What is the fasting blood glucose in order to diagnose prediabetes

A

100 to 125 mg

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20
Q

What is the two hour glucose tolerance test for pre-diabetes diagnosis

A

140 to 199 mg

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21
Q

When do you administer a glucose tolerance test

A

To pregnant patients and PCOS patients

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22
Q

What is the initial management of impaired fasting glucose

A

Lifestyle modifications such as weight loss 7% of body weight, physical activity to at least 150 minutes per week of moderate activity.

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23
Q

With impaired fasting glucose when should metformin be considered

A

A-1C 5.7% to 6.4%, less than 60 years old, BMI greater than or equal to 35, women with history of gestational diabetes

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24
Q

If a patient is diagnosed with type two diabetes with a BMI of 35 and an A1 C of 8.2 what should be the initial action

A

Establish a target A-1 C goal

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25
Q

What is the reasonable and A1C for a 72-year-old or elderly patient

A

A1C less than 8%

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26
Q

What medications are associated with an increased risk of development of type two diabetes

A

Glucocorticoids, HCTZ, atypical antipsychotics, statins (HMG Co-A reductase inhibitors)

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27
Q

For most patients with type two diabetes what is the suggested A1C goal

A

Less than 7%

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28
Q

For patients with type one diabetes what is their A1C goal

A

Less than 6%

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29
Q

For most pregnant patients what is the suggested A1C goal

A

Less than 6%

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30
Q

What is the initial management of type two diabetes

A

Set A1C goal, reduce cardiovascular risk factors, evaluate use of Metformin, physical exam and monitoring

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31
Q

What is recommended for reducing risks from type two diabetes and impaired fasting glucose

A

Increased physical activity, weight loss as needed, smoking cessation, nutrition intervention i.e. less saturated fat, more omega-3 and fiber, statins for type two diabetic’s

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32
Q

What are the exercise recommendations for type two diabetic’s

A

Light activity every 30 minutes while awake for blood glucose, exercise of at least eight weeks duration shown to decrease A-1 C0 .6% and type two diabetic’s even if no weight loss plus many other benefits

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33
Q

How often should a diabetic patient have their height, weight, BMI, blood pressure measure

A

Every visit

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34
Q

How often should a diabetic patient have a foot exam

A

Every three months unless PVD or neuropathy present then every visit

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35
Q

How often should a diabetic patient have a dilated eye exam

A

Annually at onset for type two diabetic’s and after five years of diagnosis of type one

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36
Q

How often should a diabetic patient have a funduscopic exam

A

At diagnosis but does not take the place of dilated eye exam

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37
Q

How often should a diabetic patient have thyroid palpation

A

At diagnosis and then annually

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38
Q

How often should diabetic patient have skin examination

A

Add diagnosis and annually

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39
Q

How often should a diabetic patient have dental examination

A

Annually

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40
Q

How often should a diabetic patient have a fasting serum lipid profile i.e. total, LDL, HDL, trigs

A

Annually and patience greater than 40 should consider moderate intensity Staten and lifestyle modifications

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41
Q

How often should a diabetic patient have their A1c measure

A

Every three months if not at goal, otherwise twice annually

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42
Q

What is the A1 C goal in most diabetic patients

A

Less than 7%

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43
Q

How often should a diabetic patient have urinary albumin to creatinine ratio measure

A

Annually

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44
Q

How often should a diabetic patient have their serum creatinine and eGFR and TSH measure

A

Annually

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45
Q

What is the first line of treatment according to the ADA for type two diabetes

A

Metformin is the first choice for oral treatment unless there is a contraindication. Metformin reduced CV risks. Older adults avoid hypoglycemia

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46
Q

Is Metformin safe for patients with active hepatitis C or binge drinking

A

No because of lactic acidosis

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47
Q

If a patient has a GFR of 60 and is taking Metformin how often should renal function studies be done

A

Annually

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48
Q

If a patient has a GFR of 45 to 59 and is taking Metformin how often should Renal function studies be done

A

Every 3 to 6 months

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49
Q

If a patient has a GFR of 30 to 44 and takes met formin how often should renal function studies be done

A

Every three months don’t start metformin but can continue if renal function drops

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50
Q

I have a patient has a GFR of less than 30 can they take metformin

A

No

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51
Q

Affect on glucose, absence of weight gain or hypoglycemia, low incidence of side effects, low-cost, reduction in all cause mortality are all reasons that which drug is often chosen for type two diabetes

A

Metformin

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52
Q

What are the most common side effects of Metformin

A

Diarrhea, flatulence, nausea

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53
Q

Mrs. Smith is a newly diagnosed type two diabetic. She has been started on Metformin and is tolerating a dose of 1000 mg b.i.d. How much is her A1 C expected to decrease in the next three months?

A

1 to 2%

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54
Q

The primary mechanism of action for Metformin is

A

Decreases hepatic glucose production

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55
Q

What is the drug name for a biguanide

A

Metformin

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56
Q

What is the drug name for a sulfonylurea

A

Glimepiride, glipizide, glyburide,

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57
Q

What are the drug names if megllitinides

A

Repaglinide, nateglinide

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58
Q

What are the drug names of DPP-4 Inhibitor

A

Alogliptin, inaglipton, saxagliptin, sitagliptin

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59
Q

What are the drug names of GLP-1

A

Exenatide, Liraglutide, Dulaglutide, Albiglutide

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60
Q

What are the drug names of TZD

A

Pioglitazone, Rosiglitazone

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61
Q

What are the drug names of SGLT2

A

Canagliflozin, dapaiflozin, empagliflozin

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62
Q

Which diabetic medication potentiates insulin secretion, may cause hypoglycemia and tend to cause weight gain, Ideal use in insulinopenic patients, not obese/mild obesity, used in combination or as monotherapy, reduce his A1 C about 1 to 2%, cheap

A

sulfonylurea

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63
Q

What diabetics medication ends in -ide

A

Sulfonylurea

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64
Q

What diabetic medication slows inactivation of the incretin hormones which lowers blood glucose, use in combination or as monotherapy but not initial, reduces A1c about 0.7% and costs $300-$400 a month

A

DPP-4 agents

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65
Q

Which diabetic medication ends in -gliptin

A

DPP-4 agents

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66
Q

Which diabetic medication is a glucagon like peptide, increases production of insulin in response to elevated blood glucose levels, decreases A-1 C1 to 1.5%, almost never hypoglycemia, average weight loss is 2 to 6 pounds and is expensive

A

GLP-1 Agonists

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67
Q

What diabetic medication ends in -tide

A

GLP-1 agonists

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68
Q

Which diabetic medication preserves beta cell function, improves insulin insensitivity, high dose associated with bone fractures and osteopenia, contra indicated in heart failure, reduce his A1 C about 0.7%, cost is $200-$400 a month

A

TZDs

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69
Q

Which diabetic medication ends in -azone

A

TZD

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70
Q

Which diabetes medication is associated with bone fractures and osteopenia

A

TZDs -azone

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71
Q

Which diabetes medication is Contra indicated in heart failure

A

TZDs -azone

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72
Q

Which diabetes medication prevents reabsorption of renal glucose, increases glucose excretion, increased risk of UTI vaginal yeast infections, weight loss. Cost of $450 per month and 90% glucose blocked by inhibiting SGLT-2

A

SGLT2 Inhibitor

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73
Q

What diabetes medication ends in -flozin

A

SGLT2 inhibitors

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74
Q

What diabetes medication increases the risk of UTI, vaginal yeast infection, and weight loss

A

SGLT2 inhibitors

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75
Q

All type two diabetic’s get which drug unless contraindicated

A

Metformin

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76
Q

If a patient has an A1 C greater than or equal to nine what must be considered

A

Dual therapy initially

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77
Q

If a patient has an A1 C greater than or equal to 10 to 12 what must be considered

A

Injectable insulin until less glucose toxic

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78
Q

If a patient has a blood glucose of greater than 300 what must be considered

A

Injectable insulin until less glucose toxic

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79
Q

If a patient has an a regular eating schedule what can be prescribed

A

Meglitinides

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80
Q

What medication is discontinued after initiating insulin

A

Sulfonylurea and glitazones

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81
Q

Which diabetes medication excretes glucose in the urine

A

SGLT2 inhibitors

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82
Q

A 35-year-old female has an A1 C of 5.9% and is newly diagnosed with impaired fasting glucose. What medication is first choice

A

Metformin

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83
Q

It’s 55-year-old female diagnosed six weeks ago, A1c goal less than 7%, intolerant of Metformin . A-1 C now 9.2%. What is primary prescribing strategy

A

Dual therapy

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84
Q

79-year-old male with an A1 C of 9.5% is newly diagnosed diabetes type two. What is a A1C goal

A

Less than 8%

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85
Q

What occurrence must be avoided with a 79-year-old man with an A1 C of 9.5% and newly diagnosed with type two diabetes

A

Hypoglycemia

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86
Q

What is the age related prescribing strategy with 9.5% A1c for a 79-year-old male

A

One medication

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87
Q

A 62-year-old female taking Metformin has an A1 C of 7.9% and is on a fixed budget. A1c goal is less than 7%. What medication is first choice

A

sulfonylurea

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88
Q

A 27 year-old male with an A1 C of 6.9% and newly diagnosed type two diabetes. What medication is first choice

A

Metformin

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89
Q

35-year-old female with A1 C of 6%, newly diagnosed with impaired fasting glucose contemplating pregnancy. What medication is first choice

A

Metformin

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90
Q

35-year-old obese female on Metformin A-1 C8 .9%, A-1 C goal of less than 7%, Cadillac insurance. What are two medication considerations

A

GLP-1 and insulin

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91
Q

79-year-old male on Met Forman with A1 C7 .9%, needleful back. Do we need a med? If not how do you handle?

A

No. Lifestyle modifications

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92
Q

55-year-old female takes metformin plus glipizide, A-1 C is 10.2%, A-1 C goal is less than 7%. What medication is first choice?

A

Insulin. Stop glipizide which is a sulfonylurea

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93
Q

50-year-old self-employed male who drives a bread truck can’t tolerate hypoglycemia and is taking met foreman at the highest dose, has limited medical fun, A-1 C is 8%, goal is less than 7%. What medication

A

Lifestyle modifications

94
Q

What should be considered initially when an A1 C level is greater than 10% or in the double digits

A

Insulin

95
Q

What must be considered when the fasting glucose is greater than 300 mg

A

Insulin

96
Q

What must be considered after maxing out oral medication, symptoms of hyper glycemia, and pregnant patients

A

Insulin

97
Q

What diabetes medication preserves pancreatic function

A

Basal insulin

98
Q

NovoLog, Humalog, Apidra are examples of

A

Immediate insulin

99
Q

Humulin and Novolin are examples of

A

Regular insulin

100
Q

Lantus, Levemir, and Toujeo are examples of

A

Long acting insulin

101
Q

NPH is

A

Long acting insulin

102
Q

Peakless insulin, mimics basal insulin secretion, action is predictable from day to day, greatly improved A1C levels, duration up to 24 hours, expensive

A

Long acting insulin

103
Q

How do you initiate basal insulin

A

Start at 10 units per day. Adjust 2-four units once to twice weekly to reach fasting blood glucose goal. If hypoglycemic, determine and address cause, and decrease by four units

104
Q

If insulin level is not controlled after fasting blood glucose target is reached then what should be added to basal insulin

A

Basal plus short acting insulin given before biggest meal or basal bolus at each meal but this requires frequent blood glucose checks so the patient needs to be motivated

105
Q

A single large nodule greater than 2.5 cm on one lobe of the thyroid gland, size greater than 2.5 cm. The 24 hour radio active iodine uptake test will show a cold nodule. May have a history of facial, neck, or chest radiation therapy

A

Thyroid cancer

106
Q

Random episodes of severe hypertension with a systolic blood pressure greater than 200 mm or diastolic greater than 110 mm associated with abrupt onset of severe headache, tachycardia, and anxiety. Episodes resolve spontaneously but occur at random. In between the attacks, patients vital signs are normal

A

Pheochromocytoma

107
Q

Can be a sign of pituitary adenoma. Slow onset. When tumor is large enough to cause a mass effect, the patient will complain of headaches.

A

Hyperprolactinemia

108
Q

Where is the pituitary gland located

A

It is located at the sella turcica (base of brain)

109
Q

What stimulates the pituitary gland

A

Hypothalamus

110
Q

What hormones are produced in the hypothalamus

A

FSH, LH, TSH, adrenocorticotropin hormone and growth hormone

111
Q

Secretes vasopressin i.e. antidiuretic hormone and oxytocin, which are made by the hypothalamus but stored and secreted by the posterior pituitary

A

Posterior pituitary gland

112
Q

This hormone is responsible for the calcium balance of the body by regulating the calcium loss/gain from the bones, kidneys, and G.I. tract i.e. calcium absorption

A

Parathyroid hormone

113
Q

What is thyroxine

A

T4

114
Q

What is triiodothyronine

A

T3

115
Q

Is T3 greater or less than T4

A

Greater than

116
Q

Where is TSH produced

A

Anterior pituitary

117
Q

What is used for screening of the thyroid

A

TSH

118
Q

Reduction in the amount of circulating free thyroid hormone, resistance to the action of thyroid hormone, common cause is Hashimoto’s thyroiditis, 5 to 8 times more common in women especially over the age of 50, common in patients with diabetes, second most common endocrine problem

A

Hypothyroidism

119
Q

Inflammation of the thyroid gland and does not produce thyroid hormones and this is an autoimmune disease

A

Hashimoto’s thyroiditis

120
Q

Presence of high serum concentration of antibodies to thyroid peroxidase and thyroglobulin

A

Hashimoto’s thyroiditis

121
Q

The symptoms of thyroid disease are

A

Very variable

122
Q

The initial test to screen for thyroid disease should be

A

TSH

123
Q

It’s 35-year-old female complains of fatigue. A TSH was just ordered and is 6.8. What should be done next?

A

Re-check a TSH and T4 level

124
Q

If the TSH is elevated, and T4 is decreased and the T3 is normal to low, what does the patient have

A

Primary hypothyroidism

125
Q

If the TSH is elevated, the T4 is normal and the T3 is normal what does the patient have

A

Subclinical hypothyroidism

126
Q

If the patient has a decreased TSH, usually high T4, and normal or high T3 what does the patient have

A

Primary hyper thyroidism

127
Q

If the patient has a decreased TSH, normal T4 and normal T3 what does the patient have

A

Subclinical hyperthyroidism

128
Q

For Primary hypothyroidism how do we replace

A

Levothyroxin i.e. synthetic T4 PO daily, in a.m., on empty stomach 30 to 60 minutes. Adults need 1.6 µg per kilogram per day. Based on ideal body weight not necessarily actual. Start with full Replacement dose and healthy, younger patients. Use clinical judgment when prescribing

129
Q

How do you calculate kilograms from pounds

A

Pounds divided by 2.2

130
Q

How do you replace T4 in a hypothyroid patient in middle to older age

A

Patient 50 to 60 years old should start at 50 µg daily. Older adults, multiple co-morbids, Cardiac disease consider 25 µg daily. Increase every 3 to 6 weeks by 25 µg until normal TSH. Small decreases in fibroid replacement dose may be needed as the patient ages.

131
Q

Upper limit of normal in TSH in 80-year-old is how much

A

7.5

132
Q

If the TSH is elevated and a T4 is normal what does the patient have

A

Subclinical hypothyroidism

133
Q

How do you treat subclinical hypothyroidism

A

If the TSH is greater than 10, treat to prevent conversion to primary hypothyroidism. If TSH is 4.5 to 10 most do not recommend treatment. Monitor 6 to 12 months unless patient becomes more symptomatic.

134
Q

A 45-year-old patient has subclinical hypothyroidism. TSH is 6.2. What are the major risks of prescribing levothyroxin

A

Accelerated bone loss, atrial fib

135
Q

What will happen if a patient takes their levo thyroxine with food

A

The TSH will increase

136
Q

What will happen if a patient takes two pills of levothyroxine instead of one

A

Decreased TSH do to self induced hyper thyroidism

137
Q

What will happen if a patient takes levothyroxin with vitamins

A

Increased TSH

138
Q

What would happen if a patient’s switches to a generic form of levothyroxin

A

TSH can go up or down or stay the same

139
Q

When should a patient diagnosed with hypothyroidism follow up

A

Recheck TSH 4 to 6 weeks after replacement starts, and then after each dose change until euthyroid. Monitor TSH annually unless symptoms develop

140
Q

Bodies tissues are exposed to an increased level of circulating thyroid hormone i.e. T3 and T4, most common cause is graves disease

A

Hyperthyroidism

141
Q

What is the most common cause of symptomatic hyperthyroidism

A

Graves disease

142
Q

What common condition causes velvety, hyper pigmented plaques on the skin and what is the name of this

A

Diabetes mellitus, acanthosis nigra cans

143
Q

What is the BMI cut point for screening adults with one or more risk factors for diabetes

A

25 kg

144
Q

Who is at high-risk for Graves’ disease men or women

A

Women

145
Q

Women with graves disease are also at risk for

A

Other autoimmune diseases such as rheumatoid arthritis and pernicious anemia and osteoporosis

146
Q

If there is a thyroid mass or nodule what would you do

A

Order thyroid ultrasound and referred to endocrinology

147
Q

What is the confirmatory test for graves disease

A

Antibody tests such as thyroid stimulating immunoglobulin

148
Q

What medications are indicated for hyperthyroidism

A

propylthiouracil (PTU), Methimazole (Tapazole)

149
Q

What are side effects of propylthiouracil (PTU) and Methimazole (Tapzole)

A

Skin rash, granulocytopenia, hepatic necrosis monitor CBC and LFTs

150
Q

What medication is given as adjunctive therapy for hyperthyroidism

A

Beta blockers for anxiety, tachycardia, and palpitations

151
Q

What are some indications for patients thatReceive radio active iodine

A

Contra indicated during pregnancy and lactation. Permanent destruction of thyroid gland results in hypothyroidism for life. These patients need thyroid supplementation for life after thyroid is destroyed.

152
Q

What is the preferred treatment in pregnancy for hyper thyroidism

A

PTU is preferred treatment. Give lowest effective dose possible

153
Q

Acute worsening of symptoms due to stress or infection. Look for decreased level of consciousness, fever, abdominal pain. Life-threatening and immediate hospitalization is needed

A

Thyroid storm or thyrotoxicosis

154
Q

Single painless nodule greater than 2.5 cm, history of neck radiation in childhood.

A

Thyroid cancer

155
Q

Shows metabolic activity of thyroid gland

A

Thyroid scan 24 hour thyroid scan with RAIU

156
Q

Not metabolically active. More worrisome, rule out thyroid cancer. Biopsy

A

Call spot

157
Q

Metabolically active nodule with homogeneous uptake and is usually benign

A

Hotspot

158
Q

What is the normal range for TSH

A

0.01-6.0

159
Q

If the TSH is abnormal what is the next step

A

Order T3 and T4

160
Q

What drugs can cause drug-induced thyroid disease

A

Lithium, amiodarone, interferon – alpha, dopamine. Monitor thyroid function by periodically checking of a TSH

161
Q

What is the classic lab finding for hypothyroidism

A

Hi TSH with low free T4 levels

162
Q

What is the gold standard test for diagnosing Hashimoto’s thyroiditis

A

Antimicrosomal antibodies which are elevated

163
Q

What is the starting dose of levothyroxine

A

25 to 50 µg per day

164
Q

What is the dosing for elderly patients or patients with a history of heart disease i.e. Angina, acute myocardial infarction, atrial fib

A

25 µg per day

165
Q

How much should levothyroxine be increased every few Weeks until TSH is normalized

A

25 µg

166
Q

How often should the TSH be checked once a patient is on Synthroid

A

Recheck TSH every 6 to 8 weeks until TSH is normalized less than 6

167
Q

What are some signs that the Synthroid dose is too high

A

Palpitations, nervousness or tremors. Decreased dose until symptoms are gone and TSH is in normal range

168
Q

Starting dose of synthroid is

A

25 mcg daily

169
Q

Chronic amenorrhea and hypermetabolism results in

A

Osteoporosis. Supplement with calcium and vitamin D, weight-bearing exercises

170
Q

Elevated TSH and normal serum free T4 is

A

Subclinical hypothyroidism

171
Q

Obesity, hypertension, hyper glycemia, and dyslipidemia all put you at risk for

A

Metabolic syndrome

172
Q

A1c between 5.7 and 6.4%

A

Pre diabetes

173
Q

Fasting blood glucose 100-125

A

Prediabetes

174
Q

To our OGTT of 140 to 199

A

Prediabetes

175
Q

A1c is equal to or greater than 6.5

A

Diabetes

176
Q

Fasting blood glucose equal or greater than 126

A

Diabetes

177
Q

Symptoms of hyperglycemia such as polyuria, polydipsia, polyphagia plus random blood glucose equal to or greater than 200

A

Diabetes

178
Q

To our plasma glucose greater than or equal to 200

A

Diabetes

179
Q

Fasting blood glucose norms in adult

A

70-100

180
Q

How do you check a diabetic patient feet vibration sense

A

Check vibration sense with 120 Hz tuning fork. Please on bony prominence of the big toe at the MTP joint

181
Q

Blood glucose 50mg or less, sweaty palms, tiredness, dizziness, rapid pulse, strange behavior, confusion, and weakness are all signs of

A

Hypoglycemia

182
Q

What is the treatment plan for hypoglycemia

A

Glucose 15-20g. 4oz of orange juice, regular soft drink, hard candy. Recheck blood glucose 15 minutes after treatment. When glucose is normalized, eat a meal or snack afterward (complex carbs, protein)

183
Q

An elevation in the fasting blood glucose occurs daily earlier in the morning. This is due to an increase in insulin resistance between 4 and 8 AM caused by the physiologic spike in growth hormone glucagon epinephrine and cortisol

A

Dawn phenomenon

184
Q

Severe nocturnal hypoglycemia simulates counterregulatory hormones such as glucagon to be released from the liver. The high levels of glucagon in the systemic circulation result in high fasting blood glucose by 7 AM. This condition is due to over treatment with the evening and or bedtime insulin. More common in type one diabetic’s

A

Somogyi Effect

185
Q

how do you diagnose Somogyi Effect

A

Check blood glucose very early in the AM 3am for 1-2 weeks

186
Q

How do you treat Somogyi Effect

A

Snack before bedtime, or eliminate dinner time immediate Acting insulin (NPH) dose or lower the bedtime dose for both NPH and regular insulin

187
Q

Microaneurysms due to neovascularization. Cotton wool exudates are associated with

A

Diabetic retinopathy

188
Q

Should diabetic patients with peripheral neuropathy avoid excessive running or walking to minimize the risk of foot injury

A

Yes

189
Q

What should you do with metformin if you are having IV contrast dye testing

A

Hold Metformin on day of procedure and 48 hours after. Check baseline creatinine and recheck after procedure. If serum creatinine remains elevated after the procedure, do not restart Metformin . Serum creatinine must be normalized before drug can be resumed.

190
Q

Hypoglycemia, increased risk of photosensitivity, waking, blood dyscrasias are all adverse affects of

A

Sulfonylurea

191
Q

What diabetic medications should be avoided in patients with impaired hepatic and renal function

A

Biguanides such as Metformin and sulfonylurea such as glipizide

192
Q

The most appropriate screen for diabetic nephropathy Is

A

Urinary albumin to creatinine ratio and EGFR

193
Q

What laboratory abnormality commonly accompanies hypothyroidism

A

Dyslipidemia

194
Q

When the blood glucose level exceed 300 mg what should be initiated

A

Insulin

195
Q

Patients with type one diabetes should be screened for real nephropathy how many years after diagnosis

A

Five years

196
Q

Can impetigo be a symptom of type two diabetes

A

Yes

197
Q

Acanthosis nigricans is associated with

A

Insulin resistance

198
Q

Adjustments in dosing of basal insulin are typically based on

A

AM fasting glucose values

199
Q

How soon can the anti proteinuria effect of the ACE Inhibitor be realized in a patient with albuminuria

A

6-8 weeks

200
Q

In older adults what must the postprandial glucose level Be while on insulin

A

Less than 180 mg

201
Q

Nonfasting glucose values less than how much are considered normal values

A

125 mg

202
Q

After initiating levothyroxine when should the patients TSH level be rechecked

A

6 weeks

203
Q

What is a common finding when TSH values exceed 10ml

A

Dyslipidemia

204
Q

When the serum free T4 concentration falls, what happens to TSH

A

The TSH rises

205
Q

When a patient has Graves’ disease. What happens to T3 and T4

A

Elevated

206
Q

What is the earliest detectable glycemic abnormality in a patient with Type 2 diabetes

A

Postprandial glucose elevation

207
Q

What is the relationship between A1c and triglycerides

A

As A1c decreases, triglycerides decrease

208
Q

The earliest recognizable clinical manifestation of cystic fibrosis in an infant is

A

Salty taste on the skin

209
Q

Breastfeeding is contraindicated under what condition

A

Galactosemia

210
Q

Hyperpigmentation of the skin and mucous membranes are usually seen in

A

Addison’s disease

211
Q

A patient has an enlarged thyroid gland with an audible bruit. The examiner should suspect

A

Hyperthyroidism

212
Q

What is the earliest recognizable clinical manifestation of cystic fibrosis in a child

A

Clubbing, frequent respiratory infection, and rectal prolapse

213
Q

If a newborn is suspected of having hypothyroidism which clinical manifestation would be evident

A

Enlarged anterior fontanel

214
Q

An adrenal gland tumor that causes increased production of the hormones adrenaline and noradrenaline that causes long term elevation in blood pressure

A

Pheochromocytoma

215
Q

Which lymph node characteristic should raise concern if palpated by the examiner

A

Firm and nontender

216
Q

A nurse practitioner is providing guidance to a newly diagnosed diabetic patient who is being treated with insulin. The nurse practitioner would be correct to tell the patient to self treat signs and symptoms of hypoglycemia with

A

15 g of sugar or five Lifesavers

217
Q

Does the hyperinsulinemia and insulin resistance associated with syndrome X cause tachyarrhythmias and angina

A

Yes

218
Q

The obesity associated with type two diabetes is

A

A truncal android distribution

219
Q

A palpable thyroid nodule is benign. How does it feel on palpation?

A

Smooth

220
Q

Standards of practice are

A

Minimum levels of acceptable performance

221
Q

What information should a 42-year-old patient with newly diagnosed diabetes receive about exercise

A

Snack before exercise

222
Q

And obese hyperlipidemic patient newly diagnosed with type two diabetes has a fasting blood glucose value of 180 to 250. What is the most appropriate initial treatment to consider

A

A sulfonylurea or Metformin

223
Q

What clinical finding is consistent with a diagnosis of parathyroid tumor

A

Positive Chvosteks sign

224
Q

What test would you expect to be increased if a patient has hyperglycemia

A

Osmolality

225
Q

What type of drugs can cause hypoglycemia in diabetic patients

A

Sulfa antibiotics

226
Q

What drug class is the most effective in decreasing elevated triglyceride levels

A

Fibrates

227
Q

Constipation, cold intolerance, weekend, and Lethargy are indicative of

A

Hypothyroidism

228
Q

What is the most common cause of Cushing’s syndrome

A

Administration of a glucocorticoid or AC TH

229
Q

The most accurate measure of diabetes control is

A

Hemoglobin A-1 C

230
Q

The reason beta blockers should be avoided in patients with diabetes is because they may

A

Mask symptoms of hypoglycemia

231
Q

When do microaneurysms occur in the eyes

A

Diabetic retinopathy

Endocrine Disorders (2 decks)

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