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test 3 Flashcards

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1
Q

cushings syndrome causes

A

excess steroids, pituitary

adenoma

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2
Q

cushings syndrome S/S

A

central obesity, weight gain, round
face, buffalo hump, thin and brittle skin,
easy bruising, acne, hirsutism,
osteopenia/porosis, HTN, low K, HLD,
glucose intolerance, irritable, emotional
lability, depression, prone to infections

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3
Q

cushings diagnostics

A

24 hour urinary free cortisol,
cortisol level, dexamethasone overnight
test, if + MRI pituitary, CRH test, if ACTH
low CT of adrenals

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4
Q

cushings treatment

A

dc tumor

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5
Q

addisons disease causes

A

autoimmune, drug induced,

infections, congenital, tumor/cancer

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6
Q

addisons disease S/S

A 
S/S: fatigue, weight loss, anorexia,
myalgia, joint pain, fever, anemia,
postural hypotension, low BP, GI
symptoms, craves salt, low Na, high K,
itchy and dry skin
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7
Q

addisons disease dx

A

short cosyntropin test, CBC, BMP, TSH

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8
Q

addisons disease treatment

A

hyrdrocortisone 100-200 mg over 24 hours IV or IM, monitor

resolution by s/

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9
Q

DM normal A1C

A

<5.6

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10
Q

Prediabetic A1C

A

5.7-6.4

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11
Q

Diabetic A1C

A

> 6.5

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12
Q

when to screen for DM

A

> 45 years old every 3 years and earlier if BMI is over >25

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13
Q

DM therapy goal

A

• Goal of therapy is to reduce hyperglycemia and prevent long term
microvascular and macrovascular complications

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14
Q

DM complications

A

retinopathy, nephropathy, neuropathy

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15
Q

DM medical therapy

A

Comprehensive medical therapy includes glycemic control , eye exam,
foot exam, BP monitoring, vaccines, lipids and renal function
monitoring, education

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16
Q

Type 1 DM cause

A

Caused by pancreatic islet B cell
destruction > either
autoimmune or idiopathic

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17
Q

Type 1 DM fasting glucose score vs random glucose score to dx and urine

A

Fasting glucose > 126 mg/dl on
more than 1 occasion

Random glucose > 200 mg/dl
with polyuria, polydipsia, and
weight loss
• + ketones

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18
Q

Type 2 Diabetes

A

Circulating endogenous insulin is
inadequate to prevent
hyperglycemia (insulin resistance)

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19
Q

type 2 DM

age
symptoms
fasting glucose score
a1c score

normal co morbidity

A 
> 40 and obese
• Polyuria and polydipsia
• Fasting glucose > 126 mg/dl on
more than 1 occasion
• HbA1C > 6.5%
• HTN, HLD, and atherosclerosis are
usually present
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20
Q

type 1 DM S/S

A

• S/S: polyuria and polydipsia as a result of osmotic diuresis, blurred
vision, weight loss, postural hypotension, parasthesias

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21
Q

type 1 DM treatment

A

Treatment: insulin
• Short acting: lispro, regular
• Long acting: NPH, detemir
• Combos: 75/25, 70/30, 50/50

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22
Q

Insulin dosing

units/kg/day

A

Calculate total daily dose (0.5-0.7 units/kg/day)
• Divide total insulin into basal and bolus dosing
• Basal = long acting insulin
• Bolus = short acting insulin, divide out before meals

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23
Q

type 2 dm S/S

A

S/S: polyuria and polydipsia, unexplained candida vulvovaginitis in
women, central obesity

24
Q

dm 2 treatment

A

Treatment is three-fold

  1. Glycemic control
  2. Co-morbidities
  3. Screen for complications
25
Q

medications dm 2

A

Medications: oral agents such as biguanides (metformin),
sulfonylureas (glipizide), thiazolidinedione (pioglitazone), insulin
under certain conditions

26
Q

type 2 dm management

goal FBS and random sugar and when to start oral agent

A
  1. Start with diet and exercise for weight loss for FBS <200 or random <250
  2. Begin oral agent if FBS 250-300 or random 250-350
27
Q

type 2 dm oral agents

A

Metformin first line or
2. Glitazone second line for obese patients, sulfonylurea for lean patients
3. 3 months re-eval if not improved, start dual therapy > metformin with sulfonyurea or
glitazone
4. Add a 3rd medication if still not improved.
5. Insulin therapy for A1C > 10%, FBG >300 or random >350

28
Q

DKA

cause
S/S
Exam

A

Insulin deficient and glucagon excess increase blood sugar
• S/S: n/v, polyuria, polydipsia, abd pain, SOB
• Exam: tachy, hypotension, dehydrated, tachypnea, Kussmaul Respirations,
abd tenderness, lethargy to coma

29
Q

DKA lab findings

lab findings

treatment

A

Lab findings: elevated glucose, hyponatremia, hypokalemic, AKI, + ketones,
increased anion gap, increased osmolality
• Treatment: ACUTE emergency, likely admit to ICU, check labs,
• IVF at 2-3 L NS over first 1-3 hours, then ½ NS at 250-500 ml/hour until FBS is 250
then switch to D5 ½ NS at 150-250 ml/hr
• Insulin bolus of 0.1 unit/kg then Insulin drip 0.1 units/kg per hour and increase each
hour until glucose begins to drop, hold insulin drip if K is not WNL.
• Treat electrolyte abnormalities

30
Q

Hyperglycemic hyperosmolar state

definition

A

• Insulin deficiency increases hepatic glucose production and impair
glucose utilization

31
Q

Hyperglycemic hyperosmalar state

A

• Labs: hyperglycemia (>600), normal Na, AKI, likely no ketones, slightly
increased anion gap
• S/S: polyuria, weight loss, diminished oral intake, underlying cause
such as infection

32
Q

Hyperglycemic hyperosmolar state treatment

A

Treatment: 1-3 liters of NS over first 2-3 hours, watch Na, change to
½ NS if Na > 150, similar to DKA start insulin drip at 0.1 units/kg per
hour after a bolus of 0.1 units/kg

33
Q

DM special considerations

ICU PT
Med surge Pt
TPN
Glucocorticoids
Preggers
old heads
A

ICU patient – switch regimen to insulin drip to maintain glucose 140-
180
• Med/surg patient – keep outpatient regimen and adjust accordingly
• TPN – insulin added to TPN
• Glucocorticoids – increase insulin, oral agent likely not helpful
• Pregnancy – requires planning and strict regimens
• Older adults – 50% of usual starting dose

34
Q

Diabetic Complications

A

Microvascular
• Retinopathy
• Macular edema
• Autonomic neuropathy

Macrovascular
• CAD
• PAD
• CVA

35
Q

dm complications

other

A 
Other
• GI issues
• Sexual dysfunction
• Infections
• Glaucoma
• Hearing loss
• Periodontal disease
36
Q

Hypoglycemia

usual cause
SS
Tx

A

Usually caused by medications
• S/S: cognitive and behavioral changes, diaphoresis, pallor,
palpitations, tremor, anxiety, hunger, paresthesia
• Treatment: identify cause, oral glucose, IV glucose, glucagon IM

37
Q

Syndrome of inappropriate secretion of
antidiuretic hormone

definition
causes
S/S
TX

A

Inappropriate secretion of AVP
• Causes: Cancer, head trauma, infections, CVA, neuro disorders,
medications, pneumothorax, asthma
• S/S: headache, confusion, anorexia, n/v, coma, convulsions
• Treatment: identify cause, treat underlying cause, fluid restriction,
diuretic to increase urine production (rids body of excess salt and
water), treat hyponatremia gradually (1% an hour)

38
Q

thyroid disorders

hyper

A

Hyperthyroidism
• Low TSH
• Normal to high T4

39
Q

thyroid disorders

hypo

A

Hypothyroidism
• Elevated TSH
• Low free T4

40
Q

Hypothyroidism

causes

A

• Causes: autoimmune, iatrogenic, medications, congenital, iodine
deficiency, postpartum

41
Q

hypothyroidism S/S

A

• S/S: fatigue, dry skin, cold, hair loss, poor memory, constipation,
weight gain with poor appetite, dyspnea, hoarse voice, hearing loss

42
Q

hypothyroidism
exam
dx
management

A

Exam: myxedema, bradycardia, delayed tendon relaxation, carpal
tunnel syndrome
• Diagnostics: Check TSH, free T4, thyroid ultrasound
• Management: levothyroxine 1.6 mcg/kg 30 mins before breakfast

43
Q

autoimmune hypothyroidism

AKA definition

A

AKA Hashimoto’s or autoimmune hypothyroidism > marked

lymphocytic infiltration of the thyroid causing atrophy and fibrosis

44
Q

hashimotos decline in functions

symptoms

dx

A

Gradual decrease in function
• Minor symptoms (see prior slide)

S/S: fatigue, dry skin, cold, hair loss, poor memory, constipation,
weight gain with poor appetite, dyspnea, hoarse voice, hearing loss

• Diagnostics: TSH, if elevated check unbound T4, TPO antibodies,
Thyroid US , FNA biopsy to confirm

45
Q

Myxedema coma

what is it
s/s
tx
special considerations

A

Severe hypothyroidism
• S/S: decreased LOC, seizures, hypothermia
• Treatment: IV bolus levothyroxine 500 ug

Special considerations:
• Pregnancy > frequent monitoring
• Elderly > likely need lower dose

46
Q

hyperthyroidism

causes

A

Causes: Grave’s Disease, goiter, adenoma, CA, thyroiditis, medications, gestational

47
Q

hyperthyroidism s/s

A

S/S: hyperactive, irritable, palpitations, fatigue, weakness, weight loss with increased appetite,
diarrhea, polyuria, loss of libido, oligomenorrhea

48
Q

hyperthyroidism

exam
dx
tx

A

Exam: tachy, tremors, goiter, warm, moist skin, muscle weakness, gynecomastia, lid retraction or lag
• Diagnostics: TSH, unbound T4, unbound T3, US
• Management: thionamides

49
Q

Complications of hyperthyroidism

A 
• Complications: Optic nerve compression, use NO SPECS scoring
N (0) = no signs or symptoms
O (1) = only signs no symptoms
S (2) = soft tissue involvement
P (3)= proptosis
E (4)= extraocular involvement
C (5) = Corneal involvement
S (6) = sight loss
50
Q

graves disease treatment

A

Start antithyroid drug and check levels every 4-6 weeks
• PTU 100-200 mg every 6-8 hours and reduce dose as symptoms and labs
improve
• Propranolol controls adrenergic symptoms
• Radioiodine to destroy thyroid cells
• Subtotal or total thyroidectomy for relapse after medications or if goiter is too big

51
Q

thyroid storm
definition
s/s
management

A

Life threatening
Severe hyperthyroidism
• S/S: Fever, delirium, seizures, coma, vomiting, diarrhea, jaundice,
cardiac failure, arrhythmia, hyperthermia
• Management: ICU, supportive care, large doses of PTU given via NGT
or rectally, propranolol

52
Q

opthalmopathy

A

Mild to moderate no treatment needed
• Management: Stop smoking, control thyroid hormone, artificial tears
for discomfort, eye ointment, dark glasses with side frames, sleep
upright for edema or diuretics, patches while sleeping to protect
cornea, optic nerve involvement needs emergency surgery, IV
methylprednisolone preferred for moderate, orbital decom

53
Q

thyroitis

causes
s/s
tx

A

Causes: infection, radiation, drug induced, autoimmune
• S/S: throat pain, tender goiter, fever, dysphagia, erythema,
lymphadenopathy
• Treatment: high dose ASA or NSAIDs to control pain, steroids if not
resolving and tapered over 6-8 weeks, low dose levothyroxine
• Can be acute, subacute or chronic

54
Q

goiter

A 
Goiter
• Asymptomatic
• Can be diffuse nontoxic or multinodular nontoxic
• On exam thyroid will feel abnormal
• Treat labs
55
Q 
hyperpara thyroid disorder 
PTH
calcium and phosphate 
cause
monitor
tx
A 
Hyperparathyroid
• Increased PTH
• Hypercalcemic,
hypophosphatemia,
• Caused by tumors, adenomas,
genetics
• Monitor Ca, urinary calcium, cr.
Clearance, serum creatinine, bone
density
• Treatment – remove abnormal tissue
56
Q

hypoparathroid
PTH

calcium phosphatemia
cause
tx

A 
Absent PTH
• Hypocalcemia,
hyperphosphatemia
• Caused by genetics, surgical
removal of gland
• Treatment – vitamin D, oral
Calcium intake, treat concurrent
issues such as CKD, low

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