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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
Q

What is the MOA for Meglitinide Analogs?

A

closes ATP sensitive k channels

causes a brief rapid pulse of insulin

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26
Q

What long acting insulin should be avoided during pregnancy?

A

Levemir (insulin detemir)

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27
Q

What insulin covers meals eaten within 30-60 minutes or injection?

A

Regular (R) Humulin or novolin

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28
Q

How should Type 1 pts manage insulin when they know they will be participating in strenuous exercise?

A

Reduce insulin or eat more carbohydrates

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29
Q

What should type 1 pts do with insulin dosage during infection?

A

Supplement with rapid acting insulin as needed

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30
Q

To dx DM need:

A 
HbgA1C >6.5
classic sxs w/glucose >200
Fasting >126 or 2hrs post glucose >=200
    - 2 separate occasions
Abnormal glucose tolerance tests
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31
Q

Normal TSH value

A

0.5-5

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32
Q

TSH >5

FT4 low

A

Hypothyroidism

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33
Q

Thyroid produces and excretes what hormones

A

T3-triiodothyronine
T4- tetraiodothyronine aka thyroxine
Calcitonin

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34
Q

TSH elevated in

A

primary hypothyroidism
rarely increased pituitary secretions
recovery of other diseases
Dopamine antagonist

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35
Q

Increased calcitonin seen in what thyroid disease

A

medullary thyroid cancer

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36
Q

MCC hypothyroidism

A

Hashimoto’s

37
Q

What antibody is highest in Hashimoto’s?

A

TMAb antithyroid peroxidase atb

38
Q

Subclinical hypothyroidism mc affects what population?

A

age >65

39
Q

When should tx be considered in subclinical hypothyroidism?

A

VERY high TSH
thyroid atbs present
if pt becomes symptomatic

40
Q

What meds should be used with caution during myxedema crisis?

A

Opioids

41
Q

Common ECG finding seen in hyperthyroidism

A

PACs, sinus tachy, forceful heart beat

42
Q

MCC hyperthyroidism

A

Grave’s Disease

43
Q

What disease has autoantibodies to TSH receptor in thyroid cell membranes

A

Graves

44
Q

What population is MC in Graves

A

Women 20-40s

familial

45
Q

What HLA is associated with Graves

A

HLA- B8, DR3

46
Q

How is Graves distinguishable from thyroiditis?

A

normal to high radioiodine uptake “hot”

47
Q

What tumors cause hyperthyroidism?

A

Thyroid Adenoma
-singular or toxic multinodular
Struma ovarri
Met follicular thyroid CA

48
Q

multiple thyroid nodules mc seen in

A

Graves
Multinodular goiter
Thyroiditis

49
Q

solitary thyroid nodules mc seen in

A

adenoma
malignancy
cysts

50
Q

MC thyroid CA

A

Papillary

51
Q

Thyroid CA w/worst prognosis

A

Undifferentiated/Anaplastic

52
Q

What thyroid CA may cause thyrotoxicosis and have increased uptake?

A

Follicular

53
Q

What lab can monitor for thyroid CA reoccurrence?

A

Thyroglobulin

54
Q

What can not be done prior to RAI scan or therapy

A

CT contrast

55
Q

What is chvostek sign?

A

facial muscle contraction on tapping facial nerve in front of ear
seen in hypoparathyroidism

56
Q

What is trousseau phenomenon

A

carpal spasm after application of the sphygmomanometer cuff

seen in hypoparathyroidism

57
Q

What metabolic derangements could be expected with hypoparathyroidism?

A

low serum Ca
increased phosphate
low PTH

58
Q

TX for hypoparathyroidism?

A

calcium replacement
Vitamin D (calcitrol, foreto)
make sure Mg is correct too

59
Q

MCC hyperparathyroidism

A

parathyroid adenoma

60
Q

sxs of hyperparathyroidism

A

“stones, bones, moans, & psychological groans”

asymp, kidney stones, fracture, fatigue, constipation, depression, anorexia

61
Q

Tx for hyperparathyroidism

A

Fluids
+/- bisphosphonates
+/- Vit D

62
Q

VLDL=

A

triglycerides/5

63
Q

LDL=

A

TC- (HDL+VLDL)

64
Q

Healthy adult get lipid panel when?

A

At 20 and q5yrs

65
Q

Obesity is associated with what lipid changes

A

Increased TG

Decreased HDL

66
Q

Framingham includes what risk factors?

A 
Age
Gender
Total Cholesterol
HDL
Smoking status
Systolic BP
67
Q

Med to decrease LDL

A

statin- Simvastatin

68
Q

Med to increase HDL

A

fibrate- gemfibrizol

69
Q

Med to decrease triglycerides

A

Niacin (OTC)

or fibrate- gemfibrizol

70
Q

Bad med for high triglycerides

A

bile acid resins- cholestyramine

71
Q

Lipid med contraindicated in pregnancy

A

Statins

72
Q

Lipid med bad for coagulopathies

A

omega 3 fatty acids (Fish Oil)

73
Q

Diabetes is associated with what lipid changes

A

Increased triglycerides

74
Q

Name a sulfonylurea

A

Tolbutamide

Glyburide

75
Q

Name a Meglitinide

A

Repaglinide

Mitiglinide

76
Q

Name a D-phenylalanine derivative

A

Nateglinide

77
Q

Name a thiazolidinedione

A

Rosiglitazone

Pioglitazone

78
Q

Name an alpha-glucosidase inhibitor

A

Acarbose

Migitol

79
Q

Name an incretin/GLP-1 Agonist

A

Exatide

Liraglutide

80
Q

Name an incretin/DPP-IV inhibitor

A

Sitagliptan, etc.

81
Q

Name a PO med for Type I that decreases postprandial glucose

A

Pramlintide

82
Q

Name possible med list to consider for Type 1 diabetic pt

A 
Insulin
ACEI
ASA
Lipid Lowering
Pramlintide
83
Q

What would anemia do to HBA1C levels

A

falsely lower

84
Q

Non-diabetics have an HBA1C of

A

<5.7

85
Q

MC meds to consider causing hypothyroidism

A

Amiodarone
Interferon (Hep C tx)
HIV pts on HDRT

86
Q

Elevated TSH, normal FT4, pts feels okay

A

Subclinical hypothryoidism

87
Q

What antithyroid medication is preferred in pregnancy?

A

Propylthiouracil

as opposed to methimazole

88
Q

What is often the cause of subacute (deQervain) Thyroiditis?

A

Viral infection (MC coxsackie)

Spring ClinMed (4 decks)

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