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endocrine Flashcards

1
Q

Type one

A

ketone development occurs
weight loss
believed to be the result of an ifectious or toxic envrionment insult to pancreatic B cells

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2
Q

type two

A

random over 200

fasting x 2 > 126

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3
Q

bun

A

10-20 fluctuates indipendant of kidney function

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4
Q

creat

A

.5-1.5

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5
Q

metabolic syndrome

A 
waist circumferance >40 in men and 35 in women
BP >130/85
Triglycerides >150
FBG >100
HDL <40 in men and <50 in women

any 3 equals + diagnosis

super high rish of sudden cardiac death

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6
Q

AIC

A

5.5-7 6 is goal

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7
Q

normal fasting glucose

A

60-99

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8
Q

dm diet

A

total carbs 55-60%
fats 20-30
fiber 25g or 1000ca
protein 10-20%

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9
Q

if pt presents with ketons then

A

insulin is most likely warented

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10
Q

insulin admin split dose

A

05u kg/da 2/3 am (2/3 nph and 1/3 R)pm (1/2 nph 1/2 regular)

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11
Q

type two therapy for obese

A

start with weight loss

consider early oral antidiabetics

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12
Q

oral antadiabetics sulfonyureas

A

most widley prescribed stimulate pancreasee to produce insulin (glipizide, glyburide lglimiperide)

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13
Q

biguanides

A

good adjunc but can be used alone for obese pts

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14
Q

standard of care oral on type two diagnosis

A

etformin (biguininide-glucaphage) Lactic acidosis is a potential side effect.

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15
Q

symogi effect

A

nocturnal hypoglycemia leads to surge of counter regulatory hormones which increase the blood sugar, low at 0300 but high at 0700 - dc or reduce bedtime dose

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16
Q

dawn phenomenon

A

tissue becomes desentized to insulin nocturnally progressive increase through the day and elevated glucose at 0700 the dawn is rising - add or increase pm insulin dose.

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17
Q

syndrome x

A

HTN obesity and abnormal liid profile Hig trig and low HDL’s

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18
Q

DM 2 beyond the polys

A

recurrant vaginitis
blurred vision
neruopathy
chronic skin infections including prutius

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19
Q

sulfonyureas

A

stim pancreas to release insulin

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20
Q

alpha glucosidase inhibitors -

A

less sugar absorption in the gut

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21
Q

thiazolidediones

A

decrease glycogeniss - less production of glucose
avandia - increase in heart failure
actos same

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22
Q

non sulfonurea insulin reales stims –

A

mimics the effect of insulin - prandid and starliz

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23
Q

Major complication of Type 1

A

DKA

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24
Q

Type one DKA what is it

A

intracellular dehydration as a result of elevated blood glucose levels

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25
type one DKA S&S
``` poly and nocturia weak N&V Kussmals altered LOC orthostatic hypo poor turgur ```
26
Type one DKA labs and diagnosits
``` Hyperglycemia- serum glu >250-300 Ketones acidosis ph <7.30 low bicarb low pco2 elevated hct elevated BUN Hyperkalemia leukocytosis Hyperosmololity 2(nameq/L +Kmeq/L+Glucose/18) ```
27
type one DKA managemnt
protect airway admin 02 isotonic flu (NS) at least 1 L in he frist hr and then 500ml per hr is glu is less that 500 use 1/2 after first hour when glu is below 250 change to d51/2 to preent hypoglycemia 0.1u/kg rugular insulin bolus followed by 0.1u/kg/hr if glucose dose not fall bu at least 10% after the first hours, repeat the bolus correct acidosis- if PH <7.1 with bicarb gtt 44-48meqin 900ml 1/2nss untill ph goes >7.1 do not treat hyperkalemia monitor hourly uop
28
normal serum osmo
thumbnail is like 2 times the NA 140x2 is 280
29
HHNK
no ketones greatley elevated glu like >1000
30
HHNK (2) signs
normal anion gap,crazy high glucose
31
HHNK treatment
NS IV for massive fluid recussitation ns then 1/2 then D51/2
32
may give insulin but this is contraversial
HHNK II
33
HYPER thyroid
most common in women 8:1 young onset 20-40 GRAVES DISEASE IS MOST COMMON PRESENTATION other causes of hyper- toxic adenoma, subacute thyroiditis, TSH secreting tumor of pituitary, high dose amiodarone
34
HYPER thyroid S and S
``` UP - nervous sweaty (tired) emotion temor hyper reflexes increased appetite weight loss SMOOTH WARM MOIST VELVETY SKIN FINE/THIN HAIR lid lag tacchy heat intolerance increased a-fib ```
35
Labs, diagnostics for HYPER thryroid
TSH assay is the most sensitive test and is LOW in most cases sometimes T4 is normal but T3 is elevated 80-230ng/dl) sereum ANA usually up (no lupus or collagen disease)
36
HYPER thyroid and iodine
high iodine uptake is graves | low iodine uptkae is subacute thyroiditis
37
prefered exam to visualize the eyes in graves
MRI of the orbitz
38
HYPO thyroid
``` primary disease of the tyroid gland pituitary defficiency of tsh hypothalmic defficiency of TRH iodine deficiency hashimotos thryroiditis damage to gland ```
39
HYPOTHYROID
``` down extreme weakness muscle fatigue arthalgias COLD INTOLERANCE briiittle nails edema in hads and face slowed DTRs ```
40
HYPO thryoid LABS
TSH is elevated in HYPO T4 is low or normal hyponatremia and hypoglycemia
41
most common presentation of hyper thryorid
graves
42
most common presentation of HYPO thyroid
hashimotos thyroids
43
HYPERthyroid labs
TSH down T3 is up
44
Hyperthyroid meds-
propanolol - 10-80mg four times daily treats the shakes | thiourea drugs for small goiters and fear of isotopes
45
Hyper thyroid meds methimazole
tapazole - 30-60 daily in 3 divided doses
46
HYPERTHYROID meds radioactive iodine
131 used to destroy goiters
47
HYPERTHYROID meds lugols solution
2-3 drops por every day x10 days to reduce vascularity of the gland
48
patients with subacute thyroiditis are treated with
propanolol
49
treatment of thyroid crisis
propylthiouracil 150-250- q6 or methimazole or tapazole 15-25mg q6 with the followign in one hour lugols solution 10gtt sodium iodine 1g slow iv propanolol 05-2gm iv q4 or 20-120 po q6 hydrocortizone 50 q6 with reduction on improvment.
50
HYPER THYROID cRISIS Avoid
ASA
51
HYPO thyroid meds
SYNthroid, 50-100 mcg Qday, increasing dose by 25mcg, every 1-2 weeks untill symptoms stabelize, >60 years of age decrease dose
52
HYPO thyroid in patient manageet of myxedema coma
``` protect airway fluid replacement synthroid 400mcgIVx1 then 100mcg qday support hypotension slow rewrm ```
53
cushings
ATCH is hyperselected by the pituitary adrenal tumors chronic admin of glucocorticoids
54
Cushings s and s
``` central obesity MOON FACE AND BUFFALO HUMP acne poor wound healing purple straie hirstuism hypertension weakess amenorrhea impotence headache polyuria and thirst labile mood frequent infections ```
55
lab and diagnostics cushings
``` hyperglycemia hypernatremia hyperkalemia glycosuria leukocytosis ELEVATED PLASMA CORTISOL IN AM serum ACTH Dexamethasone supression test to differentiate cause ```
56
cushings treatment
``` depends on the cause discontinue meds inducing the symptoms transphenoidal resection of a pituitary adenoma surgical removal of adrenal tumor resection of ACTH secreting umor treat E imbalance ```
57
myxedema is functionally
a varried breathing state
58
Adreno cortico trophic hormone
ACTH
59
cushings pressure
high
60
cushings lab triad
HIgh sodium K and sugar
61
addisons cause
low cortisone (rare) destriction of adrenal glan defficiencey of cortisol , aldosterone and androgen anticoag adrenal hemmorage
62
Addisons s and s
hyperpigmentation in the buccal mucosa and skin creases: knuckels nipples skin creases palms diffuse tanning anf freckles, orthostasis and hypotension scant axillary and pubic hari
63
addisons acute
fever, change in LOC, rapid change in chronic symptoms
64
addisons lab
Low sugar, NA and K elevated ESR PLASMA CORTICOL <5mcg/dl at 8a cosyntropin
65
addisons management
secilist referral GLUCOCORTICOID AND MINERALOCORTICOID REPLACEMENT hyrodcortisone flroinef
66
addisons inpatient management
HYDROCORTISONE (SOLUCORTEF 100-300MCG iv WITH NSS | REPLACE VOLUME WITH d5nss at 500cchr/4hrs and then taper
67
addisons and vasopressors
usually dont work
68
assisons common underlying cause
infections
69
SIADH
``` release of ADH occurs independent of osmolaity or volume dependent stim INNAPRORIATE WATER RETENTION tumors producing ADH skull frx or head trauma CNS disorder chronic lung disease ```
70
Siadh
low NA and temp COLD INTOLERENCE decreased DTR
71
SIADH volume and sodium
euvolemic by low sodium
72
SIADS serum osmo vs urine osmo
<280mOsm/kg (Low) urine osmo >100mOsm/kg (high) normal renal cardiac and thyroid function
73
DI Central
related to pituitary or hypothalmus damage resulting in ADH defficiency damage to above infection surgical damage metastatic tumor
74
Di Nephrogenic
due to a defect in the real tubules where renal tubules are insensitive to ADH antidiuretic hormone x-link trait aquired due to pylenephrotis, sickle cell anemia, chronic hyper K
75
SIADH treatmet >120
If serum NA is Less than 120 1000ml fluid restrictions for24hrs
76
SIADH NA 110-120
without symptoms 500 fluid restriction q24
77
SIADH NA <110
or neuro symptoms present replace with hypertonic na and lasix at 1-2meq/hr monitor NA and k
78
DI s and S
``` Thirst 5-10 L per day 2-20L per day peeing weigh loss fatigue changes in LOC dizzy HIGH TEMP tacchy hypotension poor turgor and dry ``` THIRST PEEING DRY
79
Nephrogenic DI caused by meds
lithium and methicillin
80
DI labs
DRY HIgh NA elevated BUN and creat
81
DI LABS
serum osmo high >290 urine osmo is low <100 urine specific gravity <1.005 peeing water
82
DI determination if central is suspected
DDAVP vasopressen test- 0.05-0.1ml nasally or 1 uq sq or iv with measurement of urine volume. if urine osmo goes up its central if it does not then its nephro
83
urine normal specific gravity
1.10-1.03
84
if no clear cause for DI then
MRI
85
DI tx NA over 150
if serum na is over 150 then D5w to replace 1/2 volume deficit in 24 hours, dont lower na quickly can cause neuro damage
86
DI tx NA less than 150 substitute 1/2 or .9nss
substitute 1/2 or .9nss
87
DI maintence dose of DDAVP
10ug every 12-24hrs intranasal
88
DI acute DDAVP dose
1-4ug IV or sq Q24
89
pheocromocytoma
rare but serious disease from excess catecholamine release causing parox or sustained HTN almost always from ADRENAL MEDULLA TUMOR
90
pheocromocytoma S and S
``` labile HTN sweating high sugar SEVERE HA palpitations tremor tacchy postural hypotension ```
91
pheocromocytoma LAB AND DIAG
TSH NORMAL | NORMATENEPHRINE AND METANEPHERINELEVATED
92
pheocromocytoma DIAG
CT OF ADRENALS USED TO CONFIRM AND LOCALIZE TUMOR
93
Pheocromocytom vs hyperthyroid differentiation
check TSH
94
pheocromocytoma lab test
plasma free metanephrine
95
pheocromocytoma non emergent
``` test urine 24hrs chatacholimine creat VMA and metaniphrine ```
96
pheocromocytoma TX
surgical removal of tumor is treatment of choice
97
Pheocromocytoma
alpha adrenergic meds can be used pre op
98
Pheocromocytoma post op
HYPOtension adrenal insufficiency (HYpotension) hemmorhage

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