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Endocrine

  1. What 3 criteria must be present to diagnose metabolic syndrome?
    • Abdominal Obesity (>40 inches men, > 35 inches in women)
    • HTN
    • Hyperlipidemia
  2. How many hours must you be fasting prior to a lipid profile?
    9-12 hours
  3. Fatty liver disease is associated with what elevated labs?
    Elevated ALT/AST with absence of Hepatitis or alcoholism
  4. Waist to hip ratio in males?
    1 or higher
  5. Waist to hip ratio in females?
    .8 or higher
  6. What BMI is considered overweight?
    27
  7. A pt has an elevated or very low TSH, what should be your next step?
    Order Free T3 & T4
  8. Free T4 is high or low in hypothyroidism?
    Low
  9. Starting dose of levothyroxine (Synthroid)?
    25mcg/day
  10. When monitoring Synthroid treatment, how often should you recheck TSH?
    Check every 6-8 weeks (no earlier than 6 weeks)
  11. Chronic amenorrhea & hypermetabolism can result in what?
    What is the treatment?
    Osteoporosis

    -give calcium with Vitamin D & weight bearing exercises
  12. What are 2 risk factors for thyroid cancer?
    • History of neck irradiation as child
    • Painless nodule larger than 2.5cm
  13. What is the preferred medication for treating hyperthyroidism in pregnant patients?
    Prophlthiouracil (PTU)
  14. Risk factors for Type DMII?
    Age >
    BMI >
    Hx
    BP
    HDL < or Trigs >
    Women with
    • Age >45
    • BMI >25; Asian >23
    • First Degree Relative
    • Physical Inactivity
    • HTN >140/90
    • HDL <35; Trigs >250
    • Women w/ PCOS or gestational DM
    • CVD
  15. ADA Diagnostic Criteria says that the entire population >45 years of age should be screeened for DMII how often?
    Every 3 years
  16. How often should annual screening for BMI > 25 with one or more risk factors for DM be screened?
    Annually
  17. ADA Diagnostic Criteria: A1C >
    6.5
  18. ADA Diagnostic Criteria: FPG > ____
    126
  19. ADA Diagnostic Criteria: Random BG > ___
    200
  20. ADA Diagnostic Criteria 2h GTT should only be used in what population?
    Pregnant/PCOS patients only
  21. Which is the only ADA Diagnostic Criteria that doesn’t need repeat confirmatory testing?
    Random BG >200 (A1C & FPG need repeat testing)
  22. For a patient with IFG, metformin should be considered if:
    A1C ____ - _____%
    Younger than ____
    BMI > ____
    Women w/ hx of _______
    • 5.7-6.4
    • 60
    • 35
    • Gestational DM
  23. What is the first thing you do in initial management of DMII?
    Next?
    • Set A1C Goal
    • Next - Reduce CV risk factors
  24. ADA A1C Goal: Most Adults < _____%
    7%
  25. ADA A1C Goal: Older Adults <______%
    8
  26. ADA A1C Goal: Type 1 DM <_____%
    6
  27. ADA A1C Goal: Pregnant pt <____%
    6
  28. How much moderate activity should a patient do in a week?
    150 min/week
  29. A patient has impaired fasting glucose, what medication has been proven to reduce cardiac risks?
    Metformin
  30. What are contraindications of starting Merformin in a newly diagnosed patient with DM?
    • -ETOH Abuse
    • -Liver Disease (Hep C)
    • -Increased Serum Creatinine
    • -CHF
  31. What are the benefits of Merformin: Effect of glucose & Weight? Cost?
    • -Doesn’t cause hypoglycemia but prevents hyperglycemia & doesn’t make your patient gain weight
    • -Cheap
  32. Biggest side effects of Metformin?
    • Diarrhea
    • Weakness
    • (Lactic Acidosis - rare)
  33. How much is Metformin expected to decrease A1C in moderate doses?
    1-2%

    (Exercise will also decrease by 1-2%)
  34. How often should a foot exam be done in a DM patient?
    Every 3 months; every visit if PVD/Neuropathy
  35. Every DM patient should be referred for what annually?
    • Dilated Eye Exam
    • Dental Exam
    • Nutritional Exam
  36. What is the benefit & risk of starting a patient on Sulfonylurea?
    • Benefit - Cheap & Drops A1C
    • Risk - Hypoglycemia & Weight Gain
  37. A patient’s eGFR is >_____ it is safe to start Metformin.
    45
  38. What are he benefit/risk of starting GLP-1?
    • Benefit - no hypoglycemia, weight loss, good A1C reduction
    • Risk - Expensive
  39. Another name for Metformin?
    Biguanide
  40. Examples of Sulfonylureas?
    End in -ide

    • Glimepiride (Amaryl)
    • Glipizide (Glucotrol)
    • Glyburide (DiaBeta, Micronase)
  41. What lab must be monitored when taking Metformin? Why?
    ALT/AST because the drug is metabolized by the liver
  42. When should dual therapy be initially considered ?
    Dual If A1C>9
  43. How much do you expect Sulfonyulrea to decrease A1C?
    1-2%
  44. If insulin is initiated what is typically discontinued?
    Sulfonylurea because of weight gain & cost savings (Continue Metformin)
  45. When should insulin be considered in DM patient?
    • **A1C >10%
    • **Fasting BG > 300mg/dL
    • After making out orals
    • Symptoms of hyperglycemia
    • Pregnancy
    • Consider it early not as a last resort
  46. Why should insulin be considered earlier?
    Preserves pancreatic function
  47. What are the 2 long acting insulins?
    Lantus & Levemir
  48. What is the onset of action for Long Acting (Lantus or Levemir) Insulin?
    Duration?
    Onset of Action - 1 hr

    Duration - 24 hours
  49. When initiating Basal Insulin what should you start at?
    0.1u/kg or 10 units
  50. What is an AM fasting glucose in patients on insulin?
    80 -130
  51. How much should you increase basal insulin to reach FBG goal of 80-130?
    Go up 2-4 units 1-2 times a week
  52. If hypoglycemia is induced through insulin, how much should insulin be decreased by?
    Decrease by 4u (10-20%)
  53. What is the most sensitive measure of thyroid disease?
    TSH
  54. Most common cause of hypothyroidism?
    Hashimoto’s Disease (autoimmune)
  55. Hypothyroidism can cause what 4 lab abnormalities?
    • Hyponatremia
    • Increase LDL (lipids)
    • Macrocytic Anemia’s (increased MCV)
    • Elevated CK
  56. Most common form of hyperthyroidism?
    Grave’s Disease
  57. Normal TSH level?
    0.5-4.5 mU/mL
  58. Normal Free T4 level?
    0.8-1.8
  59. In a patient who has an elevated TSH the patient has what?
    Hypothyroidism
  60. A decreased TSH is indicative of what?
    Hyperthyroidism
  61. What should you do if you get an high TSH level?
    Retest then add a T4 level
  62. What should you do if you get a low TSH level?
    Retest & add T3 & T4
  63. A patient has primary hypothyroidism what do you expect the TSH &T4 to be?
    T4 will be Low.... TSH will be high
  64. A patient has primary hyperthyroidism what do you expect the TSH & T4 to be?
    T4 will be High... TSH will be low
  65. When should Levothyroxine (synthetic T4) be given?
    First thing in the AM on empty stomach, an hour before breakfast
  66. If patient has subclinical thyroidism, what do you expect the T3/T4 to be?
    Normal
  67. What is the half life of levothyroxine?
    1 week - therefore be careful with thyroid replacement
  68. In subclinical hypothyroidism, when should a patient be treated?
    -if TSH >10

    OR

    -Symptomatic
  69. What is the risk with treating subclinical hypothyroidism if the TSH <10?
    • Osteoporosis
    • Cardiac Irregularity (AFib - increased stroke risk)
  70. A patient who has hyperthyroidism should be managed how?
    Referred to endocrine & possibly prescribe the patient propranolol
  71. What skin symptom suggest the patient has insulin insensitivity?
    Acanthosis Nigracans
  72. Random episodes of severe HTN associated with abrupt onset of severe headache, tachycardia, and anxiety. Episodes resolve spontaneously, but occur randomly.
    Pheochromocytoma
  73. Can be a sign or pituitary Adenoma & the patient may develop headaches?
    Hyperprolactinemia
  74. School aged child with recent viral illness with excessive hunger/thirst & is urinating more than normal. Patient is losing weight and has a fruity odorous breath with large amount of ketones in urine.
    DMI
  75. A patient has a goiter, it is a classic finding in what thyroidism?
    Hyperthyroidism
  76. A patient who has a positive thyroid stimulating immunoglobulin would be diagnosed with what?
    Grave’s Disease
  77. Radioactive Iodine for Hyperthyroidism is contraindicated during?
    Pregnancy & Lactation
  78. A patient has chosen radioactive iodine as treatment which results injQuery112403506560914325666_1551673719053
    Hypothyroidism for life, will need life long Synthroid replacement
  79. What medication can mask hypoglycemia?
    Beta Blockers
  80. A physiologic effect that is due to an increase in insulin resistance between 4-8AM caused by the physiologic spike is growth hormone, glucagon, epinephrine, and cortisol.
    Dawn Phenomenon (spike AM BG)
  81. Severe nocturnal hypoglycemia stimulates counterregulatory hormones such as glucagon to be released from the liver resulting in a high fasting blood glucose. It is caused by overtreament with evening insulin. More common in type 1 DM.
    Somogi Effect (Rebound Hyperglycemia)

    Tx by check 1-3AM BG and give snack before bed and/or reduce insulin intake
  82. Merformin should be held how long before giving contrast dye?
    On day of & 48 hours after
  83. Rapid acting insulin covers?
    One meal at a time
  84. Regular insulin lasts?
    From meal to meal
  85. NPH insulin lasts?
    From breakfast to dinner
  86. What is a contraindication of glitizone drugs?
    Heart failure because they cause water retention
  87. Goals for pts for have DM?
    HDL ___
    LDL ___
    Triglycerides ___
    Total ____
    • HDL > 50
    • LDL < 100
    • Triglycerides < 150
    • Total < 200
  88. BP goal for DM?
    <130/80
  89. What is typically the earliest detectable glycemic abnormality in DMII?
    Postprandial Glucose Elevation
  90. Hyperthyroidism has what affect on BP?
    Can increase SBP & DBP
  91. As triglycerides improve a patient can expect their A1C to do what?
    Also improve
  92. T4 replacement is based on what?
    Pts body weight
  93. Graves’ disease goes with which type of thyroid disorder?
    Hypothyroidism
  94. Myxedema is associated with which thyroid disorder?
    Hypothyroid
  95. Patient appears tan & complains of weakness, nausea, anorexia with diarrhea & abdominal pain. Electrolyte label shows hyperkalemia & hyponatremia. What condition does the patient have?
    Addison’s disease (low cortisol & aldosterone, high ACTH)
Author
Brt25874
ID
345738
Card Set
Endocrine
Description
Endocrine
Updated

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