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Spring ClinMed > Exam 1- Diabetes, Thyroid, Lipids > Flashcards

Exam 1- Diabetes, Thyroid, Lipids Flashcards

1
Q

What PO med is first line treatment for Type II pts

A

Metformin

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2
Q

Every 1% the HGBA1C increases is approx. _____ increase in serum glucose

A

30

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3
Q

What reflects the state of glycemic control for the last 1-2 weeks

A

Serum Fructosamine

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4
Q

What PO med is preferred in renal therapy?

A

Meglitinide Analogs:

Mitiglinide, Repaglinide

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5
Q

What PO med is contraindicated in stage III and IV heart failure?

A

Thiazolidinediones (Pioglitazone)

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6
Q

What PO med is best for type 2 overweight pts?

A

Incretins (Liraglutide)

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7
Q

If type II pt already on sulfonylurea and is not manage what other PO med is best to add?

A

Thiazolinedione (Pioglitazone)

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8
Q

What PO meds require caution or are contraindicated at certain renal clearance levels?

A

Metformin (can cause lactic acidosis)
Sulfonylureas
Miglitol

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9
Q

What PO meds require caution or are contraindicated in liver disease

A

Metformin
Thiazolidinediones
Sulfonylurea
caution w/ LF and DPP IV-Inhibitors

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10
Q

Which PO meds carry risk for hypoglycemia?

A

Sulfonylureas
Alpha- glucosidase Inhib if used in combo w/others
~Pramlintide

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11
Q

When should diabetic patients receive annual ophthalmology consults?

A

Type 1: 3-5 yrs post diagnosis

Type 2: at diagnosis

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12
Q

Which “situation” would cause prebreakfast hyperglycemia with blood glucose rates as follows:
10pm- 110
3am- 110
7 am- 150

A

Dawn phenomenon

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13
Q

Which “situation” would cause prebreakfast hyperglycemia with blood glucose rates as follows:
10pm- 90
3am- 40
7 am- 200

A

Somogyi Effect

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14
Q

Name a drug that could help prevent/slow diabetic nephropathy

A

ACEI- Captopril

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15
Q

What diabetic patients should receive daily ASA?

A

If their 10 year risk for cardiovascular events is >10%

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16
Q

Decreasing what could help clear cutaneous xanthomas?

A

Triglycerides

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17
Q

What kind of patients are at an increased risk for non-vertebral fractures?

A

All type 2, type 1 women

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18
Q

What risk factors could be addressed to help decrease risk for fracture?

A

Glycemic control
HTN
Dyslipidemia
Obesity

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19
Q

How would you treat dawn phenomenon?

A

Increase p.m. insulin

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20
Q

How would you treat somogyi effect?

A

decrease p.m. insulin

and/or more food at bedtime

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21
Q

What are cotton-wool spots and when are they seen? What patients have higher incidence of this?

A

small infarcted areas of the retina
seen during proliferative retinopathy
proliferative retinopathy is more common in Type 1

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22
Q

What is the leading cause of blindness in the U.S.?

A

Proliferative Retinopathy

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23
Q

What is the most common visual impairment in type 2 patients related to?

A

Macular Edema

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24
Q

What PO med group carries the highest risk for hypoglycemia?

A

Sulfonylureas (Tolbutamide, Glyburide)

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25
What is the MOA for Meglitinide Analogs?
closes ATP sensitive k channels | causes a brief rapid pulse of insulin
26
What long acting insulin should be avoided during pregnancy?
Levemir (insulin detemir)
27
What insulin covers meals eaten within 30-60 minutes or injection?
Regular (R) Humulin or novolin
28
How should Type 1 pts manage insulin when they know they will be participating in strenuous exercise?
Reduce insulin or eat more carbohydrates
29
What should type 1 pts do with insulin dosage during infection?
Supplement with rapid acting insulin as needed
30
To dx DM need:
``` HbgA1C >6.5 classic sxs w/glucose >200 Fasting >126 or 2hrs post glucose >=200 - 2 separate occasions Abnormal glucose tolerance tests ```
31
Normal TSH value
0.5-5
32
TSH >5 | FT4 low
Hypothyroidism
33
Thyroid produces and excretes what hormones
T3-triiodothyronine T4- tetraiodothyronine aka thyroxine Calcitonin
34
TSH elevated in
primary hypothyroidism rarely increased pituitary secretions recovery of other diseases Dopamine antagonist
35
Increased calcitonin seen in what thyroid disease
medullary thyroid cancer
36
MCC hypothyroidism
Hashimoto's
37
What antibody is highest in Hashimoto's?
TMAb antithyroid peroxidase atb
38
Subclinical hypothyroidism mc affects what population?
age >65
39
When should tx be considered in subclinical hypothyroidism?
VERY high TSH thyroid atbs present if pt becomes symptomatic
40
What meds should be used with caution during myxedema crisis?
Opioids
41
Common ECG finding seen in hyperthyroidism
PACs, sinus tachy, forceful heart beat
42
MCC hyperthyroidism
Grave's Disease
43
What disease has autoantibodies to TSH receptor in thyroid cell membranes
Graves
44
What population is MC in Graves
Women 20-40s | familial
45
What HLA is associated with Graves
HLA- B8, DR3
46
How is Graves distinguishable from thyroiditis?
normal to high radioiodine uptake "hot"
47
What tumors cause hyperthyroidism?
Thyroid Adenoma -singular or toxic multinodular Struma ovarri Met follicular thyroid CA
48
multiple thyroid nodules mc seen in
Graves Multinodular goiter Thyroiditis
49
solitary thyroid nodules mc seen in
adenoma malignancy cysts
50
MC thyroid CA
Papillary
51
Thyroid CA w/worst prognosis
Undifferentiated/Anaplastic
52
What thyroid CA may cause thyrotoxicosis and have increased uptake?
Follicular
53
What lab can monitor for thyroid CA reoccurrence?
Thyroglobulin
54
What can not be done prior to RAI scan or therapy
CT contrast
55
What is chvostek sign?
facial muscle contraction on tapping facial nerve in front of ear seen in hypoparathyroidism
56
What is trousseau phenomenon
carpal spasm after application of the sphygmomanometer cuff | seen in hypoparathyroidism
57
What metabolic derangements could be expected with hypoparathyroidism?
low serum Ca increased phosphate low PTH
58
TX for hypoparathyroidism?
calcium replacement Vitamin D (calcitrol, foreto) make sure Mg is correct too
59
MCC hyperparathyroidism
parathyroid adenoma
60
sxs of hyperparathyroidism
"stones, bones, moans, & psychological groans" | asymp, kidney stones, fracture, fatigue, constipation, depression, anorexia
61
Tx for hyperparathyroidism
Fluids +/- bisphosphonates +/- Vit D
62
VLDL=
triglycerides/5
63
LDL=
TC- (HDL+VLDL)
64
Healthy adult get lipid panel when?
At 20 and q5yrs
65
Obesity is associated with what lipid changes
Increased TG | Decreased HDL
66
Framingham includes what risk factors?
``` Age Gender Total Cholesterol HDL Smoking status Systolic BP ```
67
Med to decrease LDL
statin- Simvastatin
68
Med to increase HDL
fibrate- gemfibrizol
69
Med to decrease triglycerides
Niacin (OTC) | or fibrate- gemfibrizol
70
Bad med for high triglycerides
bile acid resins- cholestyramine
71
Lipid med contraindicated in pregnancy
Statins
72
Lipid med bad for coagulopathies
omega 3 fatty acids (Fish Oil)
73
Diabetes is associated with what lipid changes
Increased triglycerides
74
Name a sulfonylurea
Tolbutamide | Glyburide
75
Name a Meglitinide
Repaglinide | Mitiglinide
76
Name a D-phenylalanine derivative
Nateglinide
77
Name a thiazolidinedione
Rosiglitazone | Pioglitazone
78
Name an alpha-glucosidase inhibitor
Acarbose | Migitol
79
Name an incretin/GLP-1 Agonist
Exatide | Liraglutide
80
Name an incretin/DPP-IV inhibitor
Sitagliptan, etc.
81
Name a PO med for Type I that decreases postprandial glucose
Pramlintide
82
Name possible med list to consider for Type 1 diabetic pt
``` Insulin ACEI ASA Lipid Lowering Pramlintide ```
83
What would anemia do to HBA1C levels
falsely lower
84
Non-diabetics have an HBA1C of
<5.7
85
MC meds to consider causing hypothyroidism
Amiodarone Interferon (Hep C tx) HIV pts on HDRT
86
Elevated TSH, normal FT4, pts feels okay
Subclinical hypothryoidism
87
What antithyroid medication is preferred in pregnancy?
Propylthiouracil | as opposed to methimazole
88
What is often the cause of subacute (deQervain) Thyroiditis?
Viral infection (MC coxsackie)

Spring ClinMed (4 decks)

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