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AGACNP Board Review > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is Diabetes Mellitus

A

A metabolic disease resulting from the breakdown in the ability of the body to produce or utiliza insulin

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2
Q

Pathophysiology of Diabeties Mellitus type 1

A
  1. Most commonly seen in adolecent
  2. Associated with the presence of human leukocyte antigens
  3. Islet cell antibodies found in approximately 90% of patients within the first year
  4. Ketone development usually occurs
  5. Believed to be the result of an infectious or toxic insult to pancreatic B cells
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3
Q

Signs and symptoms of T1DM

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Nocturnal enuresis
  5. Weight loss
  6. Weakness/Fatigue
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4
Q

Lab/Diagnostivs for T1DM & T2DM

A
  1. Fasting glucose greater than 126
  2. Random plasma glucose greater than 200 with signs of hyperglycemia
  3. Plasma glucose great that 200 after glucose load
  4. Hgb A1C greater than 6.5%
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5
Q

Management of T1DM

A
  1. Obtain baseline of the following
  2. Age of onset
  3. Obesity
  4. Cardiac risk factors
  5. Presence of ketomnes
  6. Diagnostic markers
  7. Lipid panel
  8. ECG
  9. Renel Studies
  10. Baseline Physical Exam
  11. Basal Insulin in addition to Mealtime doses and correction factor insulin
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6
Q

What is the somgyi effect?

A

Nocturnal hypoglycemia stimulates a surge of counter regulatory hormones which raise blood pressue

Treatment: Reduce or omit the at bedtime dose of insulin

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7
Q

What is the Dawn Phenomenon?

A

Happens when the tissues becomes desentized to insulin.Glucose gradually increases overnight resulting in a high AM blood sugar

Treatment: Add or increase the at bedtime dose of insulin

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8
Q

Pathophysiology of T2DM

A
  1. Most common type of diabeties
  2. Circulating insulin is not enouigh to meet metabolic needs
  3. Main cause is tissue insensitivity or insulin secretory defect
  4. Associated with obesity and metabolic syndrome
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9
Q

Signs and symptoms of T2DM

A
  1. Insidious onset of hyperglycemia
  2. Polyuria
  3. Polydipsia
  4. Reccurent vaginitis
  5. Peripheral neuropathy
  6. Blurred vision
  7. Chronic skin infections
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10
Q

Management for T2DM

A
  1. Obtain baseline data
  2. Weight control and exercise
  3. Pharmacotherapy
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11
Q

Pharmacotherapy for diabeties

A
  1. Biguanide
  2. GLP-1
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12
Q

What medication are biguanide?

A

Metformin

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13
Q

What medication are GLP-1 agonists

A
  1. Dulaglutide
  2. Exanatide
  3. Liraglutide
  4. Semaglutide
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14
Q

What is DKA?

A

Diabetic ketoacidosis is a state of intracellular dehydrationas result of elevated blood glucose levels

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15
Q

Signs and symptoms of DKA

A
  1. Polyuria
  2. Nocturia
  3. Polydipsia
  4. Weakness
  5. Fatigue
  6. Nausea/Vomiting
  7. Kussmauls Breathing
  8. ALOC
  9. Fruity Breath
  10. Orthostatic hypotension with tachycardia
  11. Poor skin turgor
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16
Q

What is HHS?

A

Hyperosmolar hyperglycemic state is a condition of marked elevated glucose with severe intracellular dehydration without ketone production

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16
Q

Lab/Diagnostics of DKA

A
  1. Hyperglycemia
  2. Ketonemia
  3. Ketonuria
  4. Glycosuria
  5. Metabilic Acidosis
  6. Elevated Hct
  7. Elevated BUN/Creat
  8. Hyperkalemia
  9. Leukocytosis
  10. Hyperosmoality
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16
Q

Management of DKA

A
  1. Protect the airway
  2. Administer O2
  3. At least 1 L of normal saline within the first hour
  4. Transition to 250-500 mL/h until euvolemic
  5. When gllucose is less than 250, transition to D51/2NS to prevent hypoglycemia
  6. Initiate insulin therapy at 0.1u/kg
  7. Correct acidosis with NACHO3
  8. Hourly urinary output monitoring
  9. Supportive care
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17
Q

Hyperosmoality conversion

A

2[Na(mEq/L) + K (mEq/L)] + glucose (mg per dL/18) + BUN (mg per dL)/2.8

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18
Q

Signs and symptoms of HHS

A
  1. Polyuria
  2. Weakness
  3. ALOC
  4. Hypotension
  5. Tachycardia
  6. Poor skin turgor
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19
Q

Lab/Diagnositcs of HHS

A
  1. Serum glucose greater than 600
  2. Hyperosmolality
  3. Elevated BUN and Cr
  4. Elevated Hgb A1c
  5. Normal pH
  6. Normal AG
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20
Q

Management of HHS

A
  1. Protect the airway
  2. Administer O2
  3. Same fluid protocol as DKA
  4. Same Insulin protocol as DKA
  5. Supportive care
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21
Q

What is hyperthyroidism

A
  1. Commonly seen in women
  2. Onset between 20-60
  3. Usually presents as Grave Disease
22
Q

What are some causes of hyperthyroidism

A
  1. Toxic adenoma
  2. subacute thyroiditis
  3. TSH secreting tumor
  4. High dose amiordarone
23
Q

Signs and symptoms of hyperthyroidism

A
  1. Nervousness
  2. Anxiety
  3. Increased sweating
  4. Fatigue
  5. Emotional Lability
  6. Fine tremors
  7. Hyperflexion of DTR
  8. Increased appetite
  9. Smooth, warm, moist velvety skin
  10. Fine/thin hair
  11. Exophthalmos
  12. Lid lag
  13. Tachycardia
  14. Heat intolerance
  15. Atrial Fibrillation
24
Q

Lab/Diagnostics for Hyperthyroidism

A
  1. TSH assay is low
  2. Serum T3, T4, free thyroxine is elevated
  3. T3 will definitely be elevated
  4. Serum ANA is elevated
  5. Thyroid radioactive iodine uptake and scan to identifiy cause
  6. MRI of the orbits to assess for Grave’s Disease
25
Q

Management for hyperthyroidism

A
  1. Specialist referral
  2. Propranolol up to 80 mg QID
  3. Thiourea drugs like Methimazole
  4. Radioactive iodine 131-1 to destroy goiters
  5. Thyroid surgery
  6. Lugol solution
26
Q

Treatment for thyroid crisis

A

Propylthiouracil 150-250 every 6 hours
Methimazole 15-25 every 6 hours
Logol or Sodium iodine + Propranolol + Hydrocortisone

27
Q

Etiology of hypothyroidism

A

Primary disease of the thyroid gland
Pituitary deficiency of TSH
Deficiency of TRH
Iodine deficiency
Hashimotos Thyoiditis
Damage to the gland

28
Q

Signs and symptoms of hypothyroidism

A
  1. Weakness
  2. Muscle fatigue
  3. Arthralgia
  4. Cramps
  5. Cold intolerance
  6. Constipation
  7. Weight gain
  8. Dry skin
  9. Hair loss
  10. Brittle nails
  11. Puffy eyes
  12. Edema of the face and hands
  13. Bradycardia
  14. Slowed DTRs
  15. Hypoactive bowel sounds
29
Q

Lab/Diagnostics for hypothyroidism

A
  1. Elevated TSH
  2. Low T4
  3. Resin T3
  4. Hyponatremia
  5. Hypoglycemia
30
Q

Management of hypothyroidism

A

Levothyroxine

31
Q

Management of Myxdema coma

A
  1. Protect airway
  2. Fluid replacement
  3. Synthroid 400 mcg IV loading dose and then 100 QD
  4. Support hypotension
  5. Rewarming blankets
  6. Symptomatic care
32
Q

Etiology of Cushing syndrome

A

It is usually caused by adrenocorticotropic hormone hypersecretiono by the pituitary
Adrenal tumors
Chronic administration of glucocorticoids

33
Q

Signs and symptoms of Cushing Syndrome

A
  1. Central obesity
  2. Moon face with buffalo hump
  3. Acne
  4. Poor wound healing
  5. Purple striae
  6. Hirsutism
  7. Hypertension
  8. Weakness
  9. Amenorrhea
  10. Impotence
  11. Headache
  12. Polyuria
  13. Thirst
  14. Labile mood
  15. Frequent Infections
34
Q

Lab/Diagnostics for Cushing Syndrome

A

Hyperflycemia
Hypernatremia
Hypokalemia
Glycosuria
Leukocytosis
Elevated plasma cortisol
Dexamethasone suppresion
Serum ACTH elevation

35
Q

Management of Cushing Syndrome

A
  1. Discontinue medication induing the adrenal crisis
  2. Transsphenoidal resection of a pituitary adenoma
  3. Surgical removal of adreanal tumors
  4. Resection of ACTH secreting tumors
  5. Manage electrolyte balance
36
Q

Causes of Addisons disease or Adrenal Crisis

A
  1. Deficient cortisol, adrogens, and aldosterone
  2. Autoimmune destruction of the adrenal gland
  3. Metastatic cancer
  4. Bilateral adrenal hemorrhage
  5. Pituitary failure resulting in decreased ACTH
37
Q

Signs/Symptoms of Adrenocortical Insufficiency

A
  1. Hypigmentation in the buccal mucosa and skin creases
  2. Diffuse tanning and freckles
  3. Orthostasis and hypotension
  4. Scant axillary and pubic hair
  5. Rapid worsening of chronic signs and symptoms
  6. Fever
  7. ALOC
38
Q

Lab/Diagnostics for Adrenocortical insufficiency

A
  1. Hypoglycemia
  2. Hyponatremia
  3. Hyperkalemia
  4. Elevated ESR
  5. Lymphocytes
  6. Plasma cortisol
  7. Cosyntropin
40
Q

Inpatient management of adrenocortical insufficiency

A

Hydrocortisone
D5NS at 500mL/h
Treat underlying cause which is usually infection

41
Q

Etiology of SIADH

A
  1. Release of ADH occurs independently of osomolality or volume dependent stimulation
  2. Innapropiate water retention
  3. Tumore production of ADH
  4. Skull fracture/Head trauma
  5. CNS disorder
  6. Chronic Lung disease
42
Q

Signs and symptoms of SIDAH

A
  1. Neurologic changes
  2. Headache
  3. Seizure
  4. Coma
  5. Decreased DTRs
  6. Weight Gain
  7. Edema
  8. Nausea
  9. Vomiting
  10. Cold Intolerance
43
Q

Lab/Diagnostics for SIADH

A
  1. Hyponatremia
  2. Decreased serum osmolality
  3. Increased urine osmoality
  4. Urine sodium greater than 20
  5. Renal, cardiac, and thyroid function is normal
44
Q

Management for SIADH

A
  1. Treat underlying cause
  2. If serum NA is greater than 120, restrict total fluids to 1000 mL/24h and monitor
  3. If serum NA is between 110-120 without neuro symptoms, restrict fluids to 500 mL/24h and monitor
  4. If serum NA is less than 100 or neuro symtpoms are present, replace with isotonic or 3% normal saline and furosemide. Replace NA and K losses hourly and replace
45
Q

What are the different types of DI

A
  1. Central
  2. Nephrogenic
  3. Psychogenic
46
Q

Etiology of central diabeties insipidus

A
  1. Damage to hypothalamus or pituitary
  2. Surgical damage
  3. Accidental trauma
  4. Infections
  5. Metastatic carcinoma
47
Q

Etiology of nephrogenic diabeties insipidus

A
  1. Genetic X-linked trait
  2. Pyelonephritis
  3. K+ depletion
  4. Sickle cell anemia
  5. Chronic hypercalcemia
  6. Medications
48
Q

Signs and symptoms of diabeties insipidus

A
  1. Thirst/craving for water
  2. Polyuria
  3. Nocturia
  4. Weight loss
  5. Fatigue
  6. ALOC
  7. Dizziness
  8. Elevated temperture
  9. Tachycardia
  10. Hypotension
  11. Poor turgor
  12. Dry mucous membranes
    13.
49
Q

Lab/Diagnostics for diabeties insipidus

A
  1. Hypernatremia
  2. Elevated BUN/Creatinine
  3. Elevated serum osmolality
  4. Decreased urine osmoalilty
  5. Low urine spevific gravity
  6. Vasopressin challenge test for central DI
  7. Consider MRI for lesion
50
Q

Management of diabeties insipidus

A
  1. If serum sodium is above 150, give D5W IV to replace 1/2 volume deficit in 12-24 hours
  2. DDAVP 1-4 mcg IV or SQ QD or Q12
  3. Maintenance dose of DDAVP 10 ug every 12-24h intranasally
51
Q

What is a pheochromocytoma?

A

A pheochromocytoma is a rare, serious disease resulting from excess catecholamine release, characterized by paroxysmal or sustained hypertension. Usually due to a tumor of the adrenal medulla

52
Q

Signs/symptoms of pheochromocytoma

A
  1. Hypertension
  2. Diaphoresis
  3. Hyperglycemia
  4. Severe Headaches
  5. Palpitations
  6. Diaphoresis
  7. Tremor
  8. Tachycardia
  9. Wegiht loss
  10. Postural hypotension
53
Q

Lab/Diagnostics for pheochromocytoma

A
  1. TSH is normal
  2. Plasma-free metanephrines
  3. 24-hour metanephrine urine
  4. CT of adrenal glands

AGACNP Board Review (5 decks)

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