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Primary > Endocrine Issues and Disorders > Flashcards

Endocrine Issues and Disorders Flashcards

1
Q

___ ______
Definition: represents a syndrome with disordered metabolism and inappropriate hyperglycemia due to either an absolute deficiency of insulin secretion or a reduction in its biologic effectiveness.

A

Diabetes Mellitus

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2
Q

Type ____ Diabetes Mellitus (DMI)

  1. Acute onset
  2. Human leukocyte antigens (HLA-DR3 or HLA-DR4) strongly associated
  3. Destruction of pancreatic islet cells by islet cell antibodies (autoimmune process)
  4. Ketones in blood and urine
A

1

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3
Q

Signs/Symptoms for ________
I. Polyuria, polydipsia, and polyphagia are classic
symptoms
2. Nocturnal enuresis
3. Weight loss, with increased hunger
4. Fatigue, weakness, paraesthesia
5. Level of consciousness (LOC) changes ranging from irritability to coma
6. Loss of subcutaneous (SQ) fat and muscle wasting suggestive of insidious onset
7. Dysfunction of peripheral sensory nerves
8. In advanced disease:
a. An ophthalmic exam may reveal _______ or
cotton wool spots
b. Evidence of peripheral vascular insufficiency
c. Diminished ____ ____ ____
9. May show evidence of dehydration

A

Diabetes

8) a) microaneurysms
8) c) deep tendon reflexes (DTRs)

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4
Q

Laboratory/Diagnostics for Diabetes:

  1. Serum fasting blood sugar > ___ mg/dL on 2 separate occasions is diagnostic.
  2. Random blood sugar > ___ mg/dL and polydipsia, polyuria, mad weight loss indicate the need to confirm the diagnosis by fasting studies
  3. Glucosuria and ketonuria
  4. Plasma ketones
  5. Serum blood urea nitrogen (BUN) and creatinine may be elevated
  6. Elevated hemoglobin (Hgb) Alc (normal: __ to ___%)
  7. Impaired glucose tolerance (IGT): Fasting blood glucose (FBG) > ___ and < 125 mg/dl
A
  1. > 126
  2. 200
  3. 5.5 to 7%
  4. 100
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5
Q

Management Diabetes:

  1. Need to establish baseline studies
  2. Family history, age of onset of DM, presence of obesity, whether insulin required Note presence of cardiac risk factors
  3. Note diagnostic markers such as _____ and antibodies
  4. Baseline fasting triglycerides, cholesterol, renal studies, ECG
  5. Baseline physical exam including peripheral pulses, neuro exam, foot exam
A
  1. ketones
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6
Q

Dietary teaching: May consult dietitian (Diabetes)
a. Total carbohydrate intake: ___ to ___% of total caloric
intake
b. Fats: 25 to 30% of total calories
c. Fiber: 25 g/1,000 calories
d. Protein: 10 to 20% of total calories
e. Total caloric intake to achieve ideal body weight

A

50 to 60%

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7
Q
  1. Patients presenting with ketones must start insulin. The role of thumb is, to begin with, ____ u/kg/day, giving 2/3 of the dose in the morning and the remaining 1/3 in the evening.
A

0.5 u/ kg/ day

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8
Q

The _____ ______results when nocturnal hypoglycemia stimulates a surge of counter-regulatory hormones that raise blood sugar. This patient is hypoglycemic at 3 a.m. and rebounds with elevated blood sugar at 7 a.m.
a. Treatment: Reduce or eliminate the HS dose of
insulin

A

Somogyi effect

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9
Q

The ____ ____ results when the tissue
becomes desensitized to insulin nocturnally.
Blood sugar gets progressively higher throughout the
night and is elevated at 7 a.m. This desensitization is
felt to be due to the presence of growth hormone,
which spikes at night.
a. Treatment: Add or increase the dose of HS
insulin

A

Dawn Phenomenon

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10
Q

Type ____ Diabetes Mellitus (DM2)

  1. Previously referred to as non-insulin-dependent diabetes mellitus [(non-IDDM) or adult-onset DM]
  2. Not linked to the human leukocyte antigen system (HLA)
  3. No islet cell antibodies identified
  4. Presence of obesity or family history increases risk
A

2

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11
Q

Signs/Symptoms of diabetes:
1. Insidious onset of ______ may be asymptomatic.
2. Generalized pruritus
3. Recurrent vaginitis is often the first symptom in women.
4. Peripheral neuropathies and recurrent blurred vision are
more common than in DM ____.
5. Chronic skin infections
6. Acanthosis nigricans
7. Polydipsia, polyphagia, polyuria may be present but less
common symptoms for DM ___.
8. In early disease, physical findings are unremarkable.

A
  1. hyperglycemia
  2. 1
  3. 2
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12
Q

Laboratory/Diagnostics for diabetes type 2:

  1. Same as for type 1 DM except for the presence of ____ in blood/urine
  2. Screening: Same baseline evaluations
A
  1. ketones
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13
Q

Consider screening for DM2 if:
1. Obesity and has two of the following risk factors:
a. Family history of type 2 DM
b. Race/ ethnicity of African American, Native American,
Hispanic, or Asian/Pacific Islanders
c. Signs associated with insulin resistance:
i. Acanthosis Nigricans
ii. _________
iii. Dyslipidemia
iv. Polycystic ovarian disease
2. Screening, if done, should begin at age ____ or onset of puberty (whichever occurs first) and repeat every two years.

A

c) ii) Hypertension

2. 10

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14
Q

Management type 2 DM:
1. Obtain baseline data as outlined for type DM1
2. Weight management
3. Oral ______
4. Insulin therapy in addition to oral therapy for severe
hyperglycemia and ketoacidosis

A
  1. antidiabetics
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15
Q

Oral Antidiabetics
1. ______ (____), is currently FDA-approved for use in children
a. Does not stimulate insulin action, but it reduces
gluconeogenesis.
b. Should not be given in hepatic or renal failure, or to
those prone to hypoxia
c. Significant gastrointestinal upset (however, typically
transient)
d. Little or no hypoglycemia
e. Needs to be discontinued ___ hours before a
procedure

A
  1. Metformin (Glucophage)

e. 48

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16
Q

Hypothalamus –> _________ –> Anterior pituitary–> Tyroid stimulating hormone –> thyroid gland –> T3 and T4 –> return cycle

A

TRH (Thyroid Releasing Hormone)

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17
Q

T3 stands for _______

A

Triiodothyronine

18
Q

T4 stands for _______

A

Thyroxine

19
Q

___________
Hyperthyroidism or thyrotoxicosis denotes a series of clinical disorders associated with increased circulating levels of free thyroxine or triiodothyronine.

A

Hyperthyroidism

20
Q
  1. ____ _____: Most common in children, associated with:
    a. Diffuse enlargement of thyroid
    b. Hyperactivity of the gland
    c. Presence of antibodies against different fractions of
    the thyroid gland
A

Grave’s disease

21
Q

Causes/Incidence

  1. More common in females (8:1)
  2. Onset between ____ and ____ years of age
  3. Other causes of hyperthyroidism (e.g. toxic adenoma, subacute thyroiditis, thyroid-stimulating hormone (TSH)-secreting pituitary tumor, high dose amiodarone)
A

12 and 14

22
Q

Signs/Symptoms of hyperthyroidism:

  1. Nervousness, restlessness
  2. Heat intolerance, increased sweating, warm moist skin
  3. _____ _____
  4. Frequent basilar migraine
  5. Weight changes (usually a loss)
  6. Palpitations, chest pain
  7. Menstrual irregularities
  8. _____ ____
A
  1. Muscle cramps

8. Fine hair

23
Q

Other Physical Findings of hyperthyroidism:

  1. _____ ______
  2. Tachycardia
  3. Thyroid goiter (often without bruit) Grave’s ophthalmopathy may be present _______deep tendon reflexes (DTRs)
A
  1. Atrial fibrillation

3. Hyperactive

24
Q

Laboratory/Diagnostics of hyperthyroidism:
1. ____ is the most sensitive test and will be decreased.
2. Elevated:
a. Free thyroxine index (T4)
b. Triiodothyronine T3
3. Serum antinuclear antibodies (ANA) usually elevated
without evidence of lupus

A
  1. TSH
25
Q

Management hyperthyroidism:
1. Refer to pediatric endocrinology
2. Therapy/Treatment:
a. Medications for hyperthyroidism include:
i. ________ for symptomatic relief: Begin dosing
with 10 mg, may go to 80 mg 4 times daily
ii. ______ _______ for patients
with mild cases, small goiters or fear of
isotopes

A

2) a) i) Propranolol

ii) Thiourea drugs (PTU and tapazole)

26
Q

b. Treatments hyperthyroidism with:
i. Radioactive iodine _____
ii. ______ surgery (must be euthyroid
preoperatively)
iii. Two to three drops of Lugol’s solution every
day for 10 days can reduce the vascularity of
the gland.

A

b) i) 131-I

ii) Thyroid

27
Q

____________
Definition: a condition resulting in a lack of circulating thyroid hormone
1. May be due to disease of the thyroid gland itself, or to a deficiency of pituitary thyroid-stimulating hormone (TSH) or hypothalamic thyrotropin-releasing hormone (TRH)
2. Most often due to autoimmune thyroiditis; other causes include iodine deficiency, deficient pituitary, and destruction of the gland by surgery, external radiation, or trauma.

A

Hypothyroidism

28
Q

Causes/Incidence: Hypothyroidism

  1. ___________
    a. May affect the fetus in the first-trimester
    b. Absence or underdevelopment of the thyroid gland
    c. Inherent dysfunction in transport/assimilation of iodine
    d. Hypothalamic or pituitary disorder
    e. Occurs in 1: 4,000 live births
A
  1. Congenital
29
Q

Causes/Incidence: Hypothyroidism

  1. ________ acquired
    a. Hashimoto’s thyroiditis
    b. Pituitary deficiency of TSH
    c. Hypothalamic deficiency of TRI-I
    d. Iodide deficiency
    e. Damage to the gland
A
  1. Juvenile acquired
30
Q

Signs/Symptoms: Neonates/Infants: hypothyroidism

  1. No obvious symptoms in the first month of life
  2. _______, poor feeding, prolonged bilirubin elevation
  3. Growth deceleration
  4. Large fontanels
  5. Bradycardia
  6. __________
A
  1. Lethargy

6. Hypotonia

31
Q

Sigmas/Symptoms: Older Children: hypothyroidism

  1. Weakness, muscle fatigue
  2. Arthralgias, cramps
  3. _____ _____
  4. Constipation
  5. Weight gain
  6. Mental/physical sluggishness, poor motor coordination 7. Delayed bone age, poor growth
  7. Dry skin, thinning hair, brittle nails
  8. ___ ___ and thick tongue
  9. Edema of the hands and face, ascites
  10. Slowed deep tendon reflexes (DTRs)
  11. Diminished ____ sounds
A
  1. Cold intolerance
  2. Puffy eyes
  3. heart
32
Q

Laboratory/Diagnostic Findings: hypothyroidism

  1. The newborn is screening mandatory.
  2. Elevated ____
  3. The following will be _____
    a. T4 (thyroxine)
    b. Free T4 (Free thyroxine)
  4. _____ serum cholesterol and liver enzymes
  5. Hyponatremia, hypoglycemia
  6. Anemia
A
  1. TSH
  2. decreased
  3. Increased
33
Q

Management: hypothyroidism

  1. Refer to a pediatric ________
  2. Hormone replacement therapy with _____ (brand specific), rather than generic levothyroxine, is preferred for maintaining thyroid level consistency.
A
  1. endocrinologist

2. Synthroid

34
Q

_____ _____

  1. Height falling > two standard deviations (SD) below mean, or a marked deviation from the previously established growth curve
  2. Failure to grow more than 4 cm per year
  3. 5% of the population
A

Short Stature

35
Q

Normal Variants: Short Stature
1. Familial genetic variant
a. Normal linear growth velocity and a short target
height
2. ________ delay: Bone age consistent with the height age
a. The slow growth rate for the first 2 to 3 years of life,
then a low-normal growth velocity
b. Family history of short stature and delayed puberty
are often present.

A
  1. Constitutional
36
Q

Proportional Short Stature

  1. Intrauterine growth retardation (IUGR)
  2. Maternal/fetal _____
  3. Chromosomal abnormalities
  4. Failure to thrive
  5. Variety of endocrine diseases
    a. Hypopituitarism
    b. Growth hormone (GH) deficiency
    c. ___________
    d. Hypothyroidism
A
  1. infection

5. c. Diabetes

37
Q

Disproportionate Stature: Short Stature

  1. Dwarfism
  2. ______
A
  1. Rickets
38
Q

Signs/ Symptoms: Short Stature

  1. Assess for chronic disease, neglect, endocrine deficiencies
  2. ______ underlying causes based upon the proportion
A
  1. Investigate
39
Q

Laboratory/Diagnostics: Short Stature

  1. CBC, liver function tests (LFTs), electrolytes, erythrocyte sedimentation rate (ESR)
  2. ____ ____ (consider skeletal survey for disproportionate features).
  3. Urinalysis
  4. Thyroid function test
  5. Anti-endomysial and antigliadin antibodies for celiac disease
  6. Stool for ova and parasites (O & P)
  7. Growth ____ level
  8. Sweat test if recurrent bronchitis (rule out cystic fibrosis)
A
  1. Bone age

7. hormone

40
Q

Management: Short Stature

  1. Depends upon _____
  2. Refer to appropriate sub-specialist
  3. Family support
A
  1. cause

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