Module 9

Question 1

What are the main presenting symptoms of DM Type I

Answer 1

Usually present after a brief period of PROFOUND symptoms polyuria, polydipsia, polyphagia, wt loss, blurred vision, fatigue.

Question 2

What are the main presenting symptoms of DM Type II if any?

Answer 2

May have no symptoms or subtle symptoms. Symptoms include polyuria, polydipsia, polyphagia, blurred vision, fatigue, and slow healing wounds, and frequent infections

Question 3

What lab tests would you order in DM type 1 and DM type II?

Answer 3

Diabetes I
C-peptide level
Insulin level
1A autoantibodies

Diabetes II
Serum glucose or random fasting
Oral glucose tolerance test
HbA1c

Question 4

What may cause a non-toxic simple goiter

Answer 4

iodine deficiency, Grave’s disease, neoplasia, or thyroiditis

Question 5

In non-toxic simple goiters what would the lab tests show?

Answer 5

low or normal free T4 and a high or normal TSH level

Question 6

What could you use to assess the size and number of nodules?

Answer 6

Ultrasound

Question 7

How do you measure nontoxic simple goiters?

Answer 7

surgical or radioiodine to reduce thyroid volume

Question 8

What is a thyroid nodule?

Answer 8

Distinct lesion within the thyroid that is radiologically different from the rest of the thyroid. Include both solid and cysts.

Question 9

What might cause a thyroid nodule?

Answer 9

adenomas, cysts, carcinomas, multinodular goiters, Hashimoto thyroiditis, and subacute thyroiditis

Question 10

How do you manage a thyroid nodule or suspicious lesion?

Answer 10

If TSH elevated then start levothyroxine

If suspicious lesions pt is referred for surgery

For solitary lesions pt is referred for lobectomy

Question 11

What is the most common cause of hyperthyroidism?

Answer 11

Graves disease

Question 12

What are the symptoms of hyperthyroidism?

Answer 12

Dry eyes, SOB, diffuse goiter (in Graves), wt loss, hyper-defecation, amenorrhea, tremor, heat intolerance, anxiety pruritis

Question 13

What is the best screening for hyperthyroidism?

Answer 13

TSH is the best screening for primary hyperthyroidism. Levels will be low or undetectable.

Question 14

What is the most common presenting symptom of Hypothyroid?

Answer 14

Fatigue

Question 15

What are some other symptoms of hypothyroid?

Answer 15

increased sensitivity to cold, wt gain, hoarseness, puffiness of face, irregular menstrual cycles, dry and brittle hair, depression, numbness and tingling, constipation.

Question 16

What do subclinical levels of hypothyroid show on lab work?

Answer 16

elevated TSH and normal free T4

Question 17

What do more advanced levels of hypothyroid show on lab work?

Answer 17

TSH elevated and LOW T4 and T3 levels

Question 18

What is the most serious condition that can occur in hypothyroid?

Answer 18

myxedema coma with slowed mentation and visible symptoms

Question 19

How often do you assess the thyroid levels of someone on levothyroxine?

Answer 19

annually or biannual screening

Question 20

What types of people are greater risk of subclinical hypothyroidism?

Answer 20

Pts with autoimmune diseases such as diabetes type 1

Question 21

When do you start screening for DM type II?

Answer 21

Begin screening at age 45 and 40-70 for those who are overweight and or have ONE or MORE of risk factors: physical inactivity, family hx of diabetes, hx of gestational diabetes, HTN, dyslipidemia, POS, hx of cardiovascular disease

*if neg then repeat every 3 years or if a change in risk

Question 22

Recognize the criteria for diagnosis of metabolic syndrome (this is an exact L.O.)

Answer 22

Insulin resistance with hyperinsulemia

HTN

abd obesity

dyslipidemia

hypertriglyceridemia

low HDL

high LDL.

Question 23

Contrast the signs and symptoms of hyper and hypothyroidism (I have a pic in my L.O.)

Answer 23

Hypothyroidism:

Hair loss
Goiter
slow HR
fatigue
cold sensitivity 
constipation
memory issues
depression
joint/ muscle aches
irregular menstrual cycles 

Hyperthyroidism:

hair loss
bulging eyes
goiter
heart palpitations
tremors
heat intolerance
diarrhea
wt loss
sleep disturbances
muscles weakness
anxiety/nervousness
sweating

Question 24

WHat are some history questions you would ask for type II diabetic at their annual visit?

Answer 24

DO you have increased thirst and urination (may be the first symptoms but some are asymptomatic initially).

May have hyperglycemia as one of the symptoms.

May have no symptoms or subtle symptoms.

Symptoms include polyuria, polydipsia, polyphagia, blurred vision, fatigue, and slow healing wounds, and frequent infections

Question 25

What would you assess for on physical exam for type II diabetic at their annual visit?

Answer 25

Assess for dehydration, weight loss, precipitating causes ie: infection, illness, stress.

1) evaluate glucose control (poor control leads to end organ complications)
2) assess the presence or progression of end organ damage
3) assess associated diseases (CAD risk factors or other autoimmune diseases)

Question 26

What investigations would you order for a type II diabetic at their annual visit?

Answer 26

Urine glucose
Urine and blood ketones
Fasting or serum glucose
Oral glucose tolerance test
	HbA1C
	Self-monitoring blood glucose

Question 27

What are the non-pharm and pharm managment approaches to the type II diabetic?

Answer 27

Management:
Non-Pharm: diet and lifestyle changes
Glucose monitoring
Pharm:
1st choice metformin
Metformin + another agent (if HgA1c not reached after 3 mo)
Metformin + 2 other agents (if HgA1c not reached after those 3 mo)
Metformin + more complex insulin regime + or – other noninsulin agent

Question 28

When would you refer a type II diabetic?

Answer 28

Poorly controlled
Yearly ophthalmology visits
Cardiologist for secondary prevention of CAD
Consultation with dieticians
Exercise physiologist
Social work to manage emotional, financial, etc

Question 29

What are the endocrine disorders in which a specialist needs to be involved?

Answer 29

Acromegaly- endocrinologist

Addison’s disease

Cushing’s syndrome

Pheochromocytoma

Hirsutism- enhanced androgen-dependent sensitivity to increased levels of circulating androgens

Hyperkalemia-levels lower than 3 or higher than 6
May be caused from hyperaldosteronism, renal failure, Addison’s disease, acidosis, sickle cell anemia rhabdomyolysis, MEDS: (ie: NSAIDS, ACE inhibitors, trimethoprim-sulfamethoxazole

Hyponatremia- referral for levels >125mEq/L

Hypertriglyceridemia and elevated liver and pancreatic enzymes, chest pain, resp issues, or rhabdo need to go to ED stat

Parathyroid disorders

Thyroid disorders- Large goiters, thyroid nodules, thyroid storm, thyrotoxic crisis, rapid A fib, SEVERE primary hypothyroidism and central hypothyroidism

Question 30

How would you address the spiritual and emotional well-being of patients with endocrine disorders?

Answer 30

Pts with type II diabetes are more likely to be depressed further impacting their healthy lifestyle choices. SSRI’s are better choices as THEY DO NOT CAUSE hyperglycemia.

Encouraged to share with their family and seek support from friends and family.