Term
| Type 2 diabetes, or glucose intolerance, is part of a dysmetabolic syndrome (Syndrome X) what are the components of this syndrome? |
|
Definition
Insulin resistance
Hyperinsulinemia
Obesity
Hypertension
Dyslipidemia |
|
|
Term
| What are the components metabolic syndrome? |
|
Definition
Waist circumference over 40 in. in men and over 35 in. in women.
Serum triglycerides 150 mg/dl or above.
HDL cholesterol 40mg/dl or lower in men and 50mg/dl or lower in women.
Blood pressure of 130/85 or more.
Fasting blood glucose of 110 mg/dl or above. (Some groups say 100mg/d |
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|
Term
| what are the acute complications of diabetes? |
|
Definition
| hypoglycemia, DKA, hyperosmolar nonketotic state |
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|
Term
| Which type of diabetics are MC affected by DKA? |
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Definition
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|
Term
| Which type of diabetics are MC affected by HNS (Hyperosmolar Non-ketotic State)? |
|
Definition
|
|
Term
| what are the pH differences in DKA vs. HNS? |
|
Definition
|
|
Term
| what are the microvascular complications of diabetes? |
|
Definition
| retinopathy, nepropathy, neuropathy |
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|
Term
| Which type of diabetes is described as absolute insulin deficiency? |
|
Definition
|
|
Term
| Which type of diabetes is described as relative insulin deficiency? |
|
Definition
|
|
Term
| When is the age of onset in type 1 diabetes, what about type 2 diabetes? |
|
Definition
juvenile onset=type 1
age >35=type 2 |
|
|
Term
|
Definition
| insulin, fluids, potassium |
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|
Term
| what's the most reliable indicator of DKA? |
|
Definition
|
|
Term
| what are microvascular complications due to? |
|
Definition
| basement membrane thickening |
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|
Term
| what are macrovascular complications due to? |
|
Definition
| accelerated atherosclerosis |
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|
Term
| If a type 1 diabetic presents with light-headness, confusion, dizziness, shakiness, HA and diaphoresis, what condition should you suspect? |
|
Definition
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|
Term
| What are some of the complications of hypoglycemia? |
|
Definition
| coma, seizure, permanent neurological damage, MI, stroke |
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|
Term
| how do u tx hypoglycemia? |
|
Definition
| glucose, glucagon, dextrose |
|
|
Term
|
Definition
ketones >5
blood glucose >250
ph <7.2 w/ high anion gap
bicarb <18 |
|
|
Term
| what results in ketones accumulation in DKA? |
|
Definition
| hepatic metabolism of free fatty acids |
|
|
Term
| what kind of breathing is associated w/ DKA? |
|
Definition
| kussmaul respiration (rapid shallow breathing) |
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|
Term
| What is the fruity breath odor due to? |
|
Definition
|
|
Term
| what's the typical free water loss in DKA? |
|
Definition
|
|
Term
| what's the most characteristic disturbance in DKA? |
|
Definition
|
|
Term
| what's the leading cause of bacterial infections precipitating DKA? |
|
Definition
|
|
Term
| what's the rule w/ reducing hyperglycemia? |
|
Definition
| don't allow the blood glucose to fall <200 during the first 2-5 hrs of tx |
|
|
Term
| what are some complications of DKA? |
|
Definition
| cerebral edema, dysrhythmia, pulmonary edema, nonspecific myocardial injury |
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|
Term
| what's the criteria for HNS? |
|
Definition
serum osmolality of 320 mOsm
glucose >600 (often >1000)
profound dehydration
pH >7.3
HCO3 >15
absence of severe ketosis |
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|
Term
| what's the first thing to do in HNS? |
|
Definition
| rehydrate!!!!! even before insulin |
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|
Term
| MCC of blindness, kidney failure, nontraumatic lower limb amputations? |
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Definition
|
|
Term
| how do we manage nephropathy? |
|
Definition
| control hyperglycemia, HTN, low protein diet |
|
|
Term
| what's the criteria for nephropathy? |
|
Definition
| >300 mg/day of albumin confirmed on @ least 2 occasions @ least 3 mon. apart |
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|
Term
| In what stages of nephropathy do u see microalbuminemia? |
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Definition
|
|
Term
| what's the pathophysiology behind neuropathy? |
|
Definition
oxidative stress
excessive neuronal intracellular glucose
glycation end product disruption of cellular metabolism in the setting of microvascular injury |
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|
Term
| what's the most consistent predictor of progression to diabetes? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what do people w/ Type A insulin resistance exhibit? |
|
Definition
acanthosis nigricans
hyperandrogenism |
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|
Term
| what are some endocrine diseases associated w/ excess production of insulin antagonists? |
|
Definition
| acromegaly, cushing's, glucagonoma, pheochomocytoma, hyperthyroidism |
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|
Term
| what are some meds that can cause glucose intolerance? |
|
Definition
| thiazides, glucocorticoids, OC's, beta adrenergic agonists, nicotinic acid, thyroid hormone |
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|
Term
| what are the 3 genetic syndromes associated w/ glucose intolerance |
|
Definition
down syndrome
klinefelter syndrome
turner's |
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|
Term
| what is the preferred diagnostic test for diabetes? |
|
Definition
|
|
Term
| What results for HA1c are indicative of diabetes? |
|
Definition
|
|
Term
| What HA1c are indicative of pre-diabetes? |
|
Definition
|
|
Term
| what is the criteria for diabetes? |
|
Definition
FPG >126
random >200 on 2 occasions
classic sx's plus 2 hr >200 |
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|
Term
| What is considered impaired fasting glucose? |
|
Definition
|
|
Term
| What is considered impaired glucose tolerance? |
|
Definition
|
|
Term
| what's normal fasting glucose and OGTT? |
|
Definition
|
|
Term
| What is the marker for early renal impairment & endothelial dysfunction? |
|
Definition
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|
Term
| What condition is described as hyperglycemia in the morning due to nocturnal spikes in GH causing insulin resistance? |
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Definition
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|
Term
| What condition is described as rebound hyperglycemia from nocturnal hyperglycemia? |
|
Definition
|
|
Term
| how do you tx dawn/somogyi phenonmenon? |
|
Definition
| administer intermediate insulin @ bed time |
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|
Term
| which labs are indicative of type 1 DM? |
|
Definition
insulin <5
high GAD antibodies
islet cell antibdoies |
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|
Term
| Which MEN is medullary thyroid carcinoma associated with? |
|
Definition
|
|
Term
| Which MEN is pheochromocytoma associated with? |
|
Definition
|
|
Term
| Which MEN are parathyroid glands, gastrinomas, insulinomas, prolactinomas, and carcinoid tumors associated with? |
|
Definition
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|
Term
| Which MEN is wermer syndrome associated with? |
|
Definition
|
|
Term
| Which MEN is sipple syndrome associated with? |
|
Definition
|
|
Term
| what are the MC types of endocrine tumors associated w/ MEN 1 |
|
Definition
| parathyroid hormones that cause hyperparathyroidism & hypercalcemia |
|
|
Term
| what's usually the first presentation of MEN 1? |
|
Definition
| cutaneous tumors like mutliple angiofibromas, collagenomas, lipomas |
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|
Term
| what are complications of MEN 1? |
|
Definition
| neprhocalcinosis, osteoporosis, zollinger-ellison syndrome |
|
|
Term
| what occurs in 99% of MEN 2A? |
|
Definition
| medullary thyroid carcinoma |
|
|
Term
| when should RET mutation testing be done in MEN type 2? |
|
Definition
|
|
Term
| what if RET mutation tests are + in MEN 2 what do we do? |
|
Definition
| prophylactic thyroidectomy w/ lympg node dissection recommended |
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|
Term
| with which type of MEN is marfanoid habitus MC? |
|
Definition
|
|
Term
| what are the associated abnormalities of MEN 2B? |
|
Definition
mucosal neuromas
ganglioneuromas
marfanoid habitus |
|
|
Term
| what are the 2 MC tumors in MEN 1? |
|
Definition
| parathyroid, facial angiofibromas |
|
|
Term
| which 2 tumors occur primarily in MEN 2B? |
|
Definition
medullary thyroid cancer
intestinal ganglioneuroma |
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|
Term
| Which condition has characteristic test result of elevated (fasting AM) PRL? |
|
Definition
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|
Term
| If a female presents with oligomenorrhea, galactorrhea and infertility what condition should you suspect? |
|
Definition
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|
Term
| If a male presents with hypogonadism, decreased libido, ED, infertility, what condition should you suspect? |
|
Definition
|
|
Term
| What effect can hyperprolactinemia have on the bones, if left untreated? |
|
Definition
| Osteoporosis/Osteopenia and Pathologic Fx |
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|
Term
| What are some pharmocologic causes of hyperprolactinemia? |
|
Definition
Ranitidine (Zantac)
Amphetimines
Cimetidine (Tagamet)
Estrogens
Opioids
Nicotine
Verapamil
Cocaine
Marijuana - causes galactorrhea |
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|
Term
| If a pt presents with psychological changes, muscle wasting, thin skin, hyperglycemia, and central obesity, what condition should be suspected? |
|
Definition
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|
Term
| What condition is described by excess secretion of ACTH from the anterior pituitary? |
|
Definition
|
|
Term
| What condition is characterized by excess secretion of cortisol and normal levels of ACTH? |
|
Definition
|
|
Term
| What condition is characterized by hyper-secretion of ACTH and the appearance of a pituitary adenoma following a bilateral adrenalectomy for Cushing's? |
|
Definition
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|
Term
| If a patient complains of hyperpigmentation, HA, and visual changes post-op for bilateral adrenalectomy, what condition is suspected? |
|
Definition
|
|
Term
| If a pt presents with CVA tenderness, HTN, constipation, mental changes, bone aches and fatigue, what condition should you suspect? |
|
Definition
|
|
Term
| If a patient's labs have elevated ACTH and cortisol levels, what condition should you suspect? What tests should be done to confirm diagnosis? |
|
Definition
Cushing's disease
Desmopressin Suppression test |
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|
Term
| If on a pts x-rays a "rugger jersey" spine or "salt and peppering" of the skull are noted, along with complaints of bone pain, fatigue, and N/V, what condition should you suspect? |
|
Definition
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|
Term
| If a pts serum PTH, Ca, & Alk Phos are elevated along with elevated urine Ca and PO4, what condition should you suspect? |
|
Definition
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|
Term
| If on EKG a pt has shortened QT interval, prolonged PR, and complains of HTN, numerous infections, polyuria, polydipsia, Anorexia and weight loss, what condition should you suspect? |
|
Definition
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|
Term
| In which condition are Chvostek's and Trousseau's phenomenon characteristic indicators? |
|
Definition
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|
Term
| If a pt presents with low urine Ca excretion, high serum PO4, low serum Mg, low serum Ca, and Alk Phos WNL, what condition would you expect? |
|
Definition
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|
Term
| If a pt presents with muscle cramps, tetany, abdominal cramps, and tingling of the feet, lips and hands, what condition should you suspect? |
|
Definition
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|
Term
| Which condition has signs and symptoms including loss of eyebrow hair, cutaneous calcifications, cataracts, dry and scaly skin, brittle nails, irritability and anxious state? |
|
Definition
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|
Term
| If a pt has an irregular EKG showing prolonged QT intervals with T-wave abnormalities, as well as x-rays showing increased bone density and cutaneous calcifications, what condition should be suspected? |
|
Definition
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|
Term
| What are the indications for Levothyroxine (synthroid)? |
|
Definition
| Hypothyroidism, Suppression TSH secretion |
|
|
Term
| What is the treatment for Addison's disease? |
|
Definition
| Hydrocortisone 15 - 20mg PO AM, 10 mg PO 4-5 PM |
|
|
Term
| What is the treatment for Hyperprolactinemia? |
|
Definition
| Cabergoline (Dostinex) 0.25mg PO 2x per week, then increase by .25 twice weekly after 4 weeks; Max Dose 1mg 2x per week |
|
|
Term
| What is the treatment for Hyperparathyroidism? |
|
Definition
IV Hydration
IV Biphosphenates -Zoledronic acid 2 - 4 mg IV over 15 - 20 min
Calcimimetics - Cinacalcet hydrochloride 30 - 250mg PO qid (decreases secretion of PTH)
Vitamin D 800 - 2000 units orally qd |
|
|
Term
| What is the treatment for Hypoparathyroidism? |
|
Definition
IV Calcium gluconate: 10% solution 10 - 20mL given slowly until tetany ceases then IV drip 10 - 50mL of 10% calcium gluconate in 1L of 5% glucose saline until serum Ca is 8 - 9 mg/dL
Calcium Salts PO 1-2g qd
Calcitriol PO 0.25mcg q AM then titrate to .5 - 2mcg/d
Magnesium sulfate IV 1 - 2 g q6h then d/c and give Magnesium oxide tabs 600mg PO 1-2x qd |
|
|
Term
| What is the treatment for Hypoaldosteronism? |
|
Definition
| Fludrocortisone 0.05 - 0.10 mg PO qid |
|
|
Term
| What is a obvious physical symptoms of MEN 1 or Wermer's? |
|
Definition
|
|
Term
| What endocrine d/o is found in the majority of pts with MEN 1? |
|
Definition
| hyperparathyroidism and facial angiofibromas |
|
|
Term
|
Definition
Managing in an ICU during the first 24-48 hrs
Goals of treatment include:
Correct fluid loss c IV fluids
“ hyperglycemia with insulin
“ electrolyte disturbances, particularly potassium loss
“ acid-base balance
Tx of infxn if present. |
|
|
Term
| Pt presents with c/o of waistline increase, HTN, poor wound healing, and amenorrhea. Lab tests reveals a slightly elevated ACTH level and a high cortisol level. What condition do you suspect? What are the possible complications of this condition? |
|
Definition
Cushing's Dz
Complications include DM, increased infections, osteoporosis, aseptic necrosis, nephrolithiasis, visual field impairment and psychosis |
|
|
Term
| Pt presents c/o weakness, abdominal pain, confusion, N/V/D, dehydration, low BP and an extremely high fever. On Labs the ACTH is makedly high. What condition do you suspect? |
|
Definition
| Acute Adrenal Insufficiency (Adrenal Crisis) |
|
|
Term
| A pt presents dizziness, N/V/D, weakness, depression, Hyperpigmentation, fatigue, cold intolerance, and hair loss. Labs found high ACTH, and low cortisol levels. What condition should you suspect? |
|
Definition
Chronic Adrenocortical Insufficiency
aka Addison’s Disease/Chronic AI |
|
|
Term
| What is the treatment for acute adrenal insufficiency? |
|
Definition
ER, ICU Admit, Endo Referral ASAP
ABC - IV access
Hydrocortisone 100 - 300 mg IV and saline (containing 5% dextrose) |
|
|
Term
| What is the treatment for chronic adrenocortical insufficiency? |
|
Definition
Referral to Endo
DOC - Hydrocortisone 15 -20 mg PO q AM and 10 mg PO at 4 -5 PM |
|
|
Term
| Patient present with c/o HTN (uncontrollable), polyuria, polydipsia, muscle weakness, and elevated plasma and urine aldosterone. The plasma renin is also low. What condition do you suspect? |
|
Definition
Primary Adrenal Insufficiency
aka Conn’s Syndrome (aldosteronoma), Primary Hyperaldosteronism |
|
|
Term
| If a pt presents with makedly high ACTH (>200pg/mL), low cortisol levels, and serum K and BUN high, what condition should you suspect? |
|
Definition
|
|
Term
| If a pt presents with a high fever, N/V/D, Lasitude, Abdominal pain, confusion, coma, HA, and Low BP, what condition should you suspect? |
|
Definition
|
|
Term
| What condition is characterized by excess secretion of cortisol due to a tumor in the adrenal glands? |
|
Definition
|
|
Term
| major drug used in type 2 DM |
|
Definition
|
|
Term
| only drug that reliably facilitates modest weight loss/mild improvement of all aspects of lipid profile |
|
Definition
|
|
Term
| most common class of drugs to cause hypoglycemia |
|
Definition
|
|
Term
| which thiazolidinedione was removed due to increased MI risk? |
|
Definition
|
|
Term
| what's the main SE of acarbose? |
|
Definition
|
|
Term
| what are the 2 rapid acting insulin's? |
|
Definition
|
|
Term
| what are the intermediate acting insulin's? |
|
Definition
|
|
Term
| what are the long acting insulin's? |
|
Definition
glargine (lantus)-->No peak
ultralente
levemir |
|
|
Term
| in adjusting insulin dose what do u want to maintain the pre-prandial plasma glucose at? |
|
Definition
|
|
Term
| first line therapy for type I DM? |
|
Definition
|
|
Term
| when are rapid/short acting insulin's used? |
|
Definition
before meals OR
blood glucose >250 |
|
|
Term
| what meds would be given to rapidly relieve diabetic sx's? |
|
Definition
|
|
Term
| this sulfonylurea suggests greater potential safety in pt's w/ ischemic heart disease |
|
Definition
|
|
Term
| only oral diabetic drug that reliably facilitates modest weight loss |
|
Definition
|
|
Term
| contraindications of metformin |
|
Definition
1. renal or significant hepatic insufficiency
2. decompensated CHF requiring pharm therapy |
|
|
Term
| what are some of the reasons for increased insulin requirements during pregnancy |
|
Definition
1. insulin antagonists (human placental lactogen or chorionic somatomammotropin & cortisol)
2. insulinase by placenta |
|
|
Term
| what are the secretagogues (stimulate insulin release) |
|
Definition
| sulfonylureas & meglitinides |
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