Spring 2019 Final Endocrine

normal potassium levels

3.5-5.0 mEq/L

normal serum calcium

8.6 - 10.1 mg/dL

After the onset of action, lispro (Humalog) occurs in A. Less than 30 minutes B. approximately 1 hr C. 1-2 hours D. 3 to 4 hours

A

You consider prescribing insulin glargine (Toujeo, Lantus) because of its a. extended duration of action b. rapid onset of action C. Ability to prevent diabetic end-organ damage D. ability to preserve pancreatic function

A

The mechanism of action of metformin (Glucophage) is as: A. An insulin production enhancer B. A product virtually identical in action to sulfonylureas C. A drug that increases insulin action in the peripheral tissues and reduces hepatic glucose function D. A facilitator of renal glucose excretion

A drug that increases insulin action in the peripheral tissues and reduces hepatic glucose function

parathyroid hormone

A hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body. Increases blood calcium levels

Addison's disease

A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones.

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

Which of the following characteristics applies to Type I Diabetes? A. Significant hyperglycemia and ketoacidosis result from lack of insulin B. This condition is commonly diagnosed on routine examination or workup for other health problems C. Initial response to oral sulfonylureas is usually favorable D. Insulin resistance is a significant part of the disease

A.

Which of the following characteristics applies to type 2 DM? A. Major risk factors are heredity and obesity B. Pear-shaped body type is commonly found C. Exogenous insulin is needed for control of the disease D. Physical activity enhances insulin resistance

A.

Epidemiological studies show that Hashimotos disease occurs most commonly in: A. Middle to older women B. Smokers C. Obese individuals D. Older men

A. Hashimotos is an autoimmune disease. An enlarged thyroid is most often the first sign of disease. Hashimotos disease is about 7 times more commin in women than men, It can occur in teens and younger women, but is more common in middle age

Which of the following should be the goal measurement of treating a 45year-old man with DM and HTN? A. A blood pressure less than 145 mmHg systolic and less than 90mg Hg diastolic B. HgA1C equal or greater than 7% C. Triglyceride 200 to 300 D. HDL 35-40mg/dL

A. A blood pressure less than 145 mmHg systolic and less than 90mg Hg diastolic

Diagnostics for Addisons disease

AM Cortisol level K+, Na+, ACTH Abdominal CT for adrenal glands, MRI pituitary gland

Diagnostics for cushings

AM Cortisol level Syndrome caused by tumor Urine, blood and saliva can evaluate cortisol levels MRI or CT pituitary gland

1. Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? a. 0.2 uIU/L b. 0.4 uIU/L c. 2.4 uIU/L d. 4.2 uIU/L

ANS: A A TSH less than 0.3 uIU/L indicates hyperthyroid; greater than 4.0 uIU/L indicates hypothyroid, and between 0.3 to 4.0 uIU/L indicates euthyroid.REF: Thyroid Function Tests

1. A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? a. Adrenocortical deficiency b. Alcoholism c. Hypertension d. Malabsorption syndrome

ANS: A Hyperkalemia without underlying renal disorder may be caused by Addison's disease, which is an adrenocortical deficiency. Alcoholism, hypertension, and malabsorption syndromes all contribute to hypokalemia.REF: Hyperkalemia

1. A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? a. Annual monitoring of calcium, creatinine, and bone density b. Avoidance of weight-bearing exercises c. Decreasing calcium and vitamin D intake until values normal d. Parathyroidectomy

ANS: A Medical management of primary hyperparathyroidism involves close monitoring of serum calcium and creatinine and bone density screenings. Weight-bearing exercises should be encouraged and vitamin D and calcium intake should be adequate, not decreased. This patient does not meet criteria for parathyroidectomy because of age less than 50 years and serum calcium less than 1 mg/dL above the upper limit of normal.REF: Management

1. A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by the primary care provider is indicated for management of this patient? a. Consulting with a nephrologist b. Limiting protein intake c. Prescribing an antihypertensive medication d. Referring to an ophthalmologist

ANS: A Patients with diabetes who have elevated blood pressure and reduced renal function should be referred to a nephrologist. Limiting protein intake and giving an antihypertensive medication may be recommended, but evaluation by a nephrologist is essential. Ophthalmology referral will be made as well to assess concurrent ocular damage.REF: Management/Microvascular Complications

2. A patient with sleep apnea is noted to have a large tongue and uvula along with deepening of the voice. What will the primary care provider do initially to evaluate these findings? a. Obtain an insulin-like growth factor-1 level b. Order a random serum growth hormone level c. Recommend an orthopedic consult for bone age evaluation d. Refer the patient to an otolaryngologist

ANS: A The IGF-1 level is a good screening test when acromegaly is suspected. This patient has symptoms characteristic of acromegaly. Referral to an ENT is not the first step in evaluation of symptoms. Random serum GH levels are not useful in diagnosis because of the pulsatile nature of GH secretion. Bone age evaluation is not indicated.REF: Clinical Presentation/Diagnostics

3. A patient has unexplained weight loss and the provider notes increased skin pigmentation on light-exposed skin folds along with darkened palmar creases. Which laboratory tests will the provider order? Select all that apply. a. Serum ACTH b. Serum cortisol c. Serum electrolytes d. TB skin testing e. Urine cortisol

ANS: A, C, D This patient has symptoms of Addison's disease. Serum ACTH will be elevated in patients with Addison's disease. Hyponatremia and hyperkalemia may occur and are sometimes the initial finding. TB skin testing is done to exclude tuberculosis. Serum and urine cortisol levels are evaluated with Cushing's syndrome is suspected.REF: Physical Examination/Diagnostics

2. A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit? a. C-peptide level b. Hemoglobin A1C c. Random serum glucose d. Thyroid studies

ANS: B HbA1C, along with fasting plasma glucose or a 2-hour plasma glucose during an OGTT are diagnostic of diabetes. This patient is probably not fasting, so a glucose level will not be helpful. C-peptide levels help to distinguish type 1 from type 2 diabetes and may be performed after a diagnosis of diabetes is made and if there is uncertainty about the cause. Thyroid studies are helpful in evaluating comorbidity.REF: Clinical Presentation/Diagnostics

2. A hospitalized patient with renal failure is accidently given parenteral potassium and has a potassium level of 7.0 mEq/L. An ECG reveals a normal QRS interval. What is the initial recommended treatment for this patient? a. Calcium chloride b. Insulin and glucose infusion c. Sodium bicarbonate d. Sodium polystyrene sulfate

ANS: B Patients with severe hyperkalemia should have IV administration of glucose and insulin to lower potassium levels quickly. If life-threatening sequelae, such as a widening QRS interval, are present, calcium chloride is given. Sodium bicarbonate is occasionally used, but should be used cautiously to prevent metabolic alkalosis. Sodium polystyrene sulfate is used when oral medications may be given.REF: Acute Hyperkalemia

3. A patient has a serum potassium level of 3 mEq/L and a normal blood pressure. Which test should be performed initially to assist with the differential diagnosis? a. Plasma aldosterone b. Plasma renin activity c. Serum bicarbonate d. Serum magnesium

ANS: C In patients with hypokalemia with normal blood pressure, serum bicarbonate should be assessed to evaluate for diabetic ketoacidosis, metabolic acidosis, or renal tubular acidosis. If bicarbonate is normal, the magnesium level may be assessed. Plasma aldosterone and renin activity are assessed in patients with hypokalemia who are hypertensive.REF: Hypokalemia

2. A woman who has hirsutism with acne, and oligomenorrhea will most likely be treated with which medication to control these symptoms? a. Finasteride b. Levonorgestrel c. Norgestimate d. Spironolactone

ANS: C Norgestimate is a progestin with low androgenic activity and is used to suppress testosterone and control symptoms. Finasteride, which decreases the peripheral conversion of testosterone to DHT is not approved for this use. Levonorgestrel is an androgenic OCP and should be avoided. Spironolactone is a second-line medication approved for this purpose.REF: Management

1. A young adult woman is unable to conceive after trying to get pregnant for over 6 months. The woman reports having had irregular periods since the onset of menarche. The provider notes that the woman is overweight, has acanthosis nigricans, and an excess hair distribution. What does the provider suspect as the most likely primary cause of these symptoms? a. Congenital adrenal hyperplasia b. Cushing's syndrome c. Polycystic ovarian syndrome d. Type 2 diabetes

ANS: C PCOS is the most likely cause of oligo- or amenorrhea, so this is the most likely cause. The other conditions are possible, but less likely.REF: Polycystic Ovarian Syndrome

2. A patient carpal spasm when a blood pressure cuff is inflated. Which diagnostic testing will the provider consider to evaluate the cause of this finding? a. Calcitriol level b. C-reactive protein c. Magnesium and vitamin D d. Protein electrophoresis ANS: C The Trousseau's sign indicates neuromuscular irritability, which occurs with hypocalcemia. Because hypomagnesemia and vitamin D deficiency may cause hypocalcemia, these should be evaluated to help determine a cause. Calcitriol levels are used to assess hypercalcemia. Inflammatory markers are not indicated. Protein electrophoresis is used in the evaluation of hypercalcemia.REF: Hypocalcemia/Physical Examination/Diagnostics Hypercalcemia/Management

ANS: C The Trousseau's sign indicates neuromuscular irritability, which occurs with hypocalcemia. Because hypomagnesemia and vitamin D deficiency may cause hypocalcemia, these should be evaluated to help determine a cause. Calcitriol levels are used to assess hypercalcemia. Inflammatory markers are not indicated. Protein electrophoresis is used in the evaluation of hypercalcemia.REF: Hypocalcemia/Physical Examination/Diagnostics Hypercalcemia/Management

1. A patient has IGF-1 screening showing age- and gender-matched elevation and the provider orders a fasting oral glucose tolerance test (OGTT). The patient's GH level drops to 1.1 ng/mL 120 minutes after the oral glucose is given. What will the provider conclude about these results? a. Acromegaly is certain b. Acromegaly is excluded c. Acromegaly is likely d. Acromegaly is possible

ANS: D Acromegaly may be diagnosed when an OGTT suppresses GH to less than 1.0 mg/mL, but studies have shown that failure to suppress GH in the presence of elevated IGF-1 does not rule out acromegaly, so the diagnosis is still possible.REF: Diagnostics

3. An obese adolescent female patient reports irregular periods and excessive acne. The provider notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What will the provider do, based on these findings? a. Consider treatment with oral contraceptive pills b. Counsel her about diet, exercise, and weight loss c. Recommend cosmetic laser hair removal d. Refer to an endocrinologist for evaluation

ANS: D All patients with suspected hirsutism should be referred to a specialist to determine the cause. OCPs, lifestyle changes, and cosmetic treatments may be part of the treatment, but the underlying causes must be determined first to ensure that a life-threatening condition is not present.REF: Polycystic Ovarian Syndrome

4. A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient: a. it is necessary because the patient cannot comply with the previous regimen. b. that strict diet and exercise measures may be relaxed with insulin therapy. c. the use of insulin therapy may be temporary. d. this is because of the natural progression of the disease.

ANS: D Even after several years of therapy for type 2 DM well controlled with oral diabetic medications, diet, and exercise, the natural progression of the disease may require patients to become insulin dependent. Patients must understand that this does not represent failure on their part. Adding insulin may cause weight gain, so continuing lifestyle measures is essential. The addition of insulin is not temporary.REF: Management/Type 2 Diabetes

2. A patient has new-onset hypertension with a systolic blood pressure of 180 mm Hg. Which test will the provider order to diagnose this patient? a. ACTH suppression testing b. Adrenal antibody tests c. Cortisol excretion studies d. Fractionated metanephrine levels

ANS: D Patients with pheochromocytoma may present with new-onset hypertension with systolic pressure >170 mm Hg. Fractionated metanephrine will be elevated when the diagnosis is confirmed. ACTH suppression testing and cortisol excretion studies are performed to diagnose Cushing's syndrome. Adrenal antibody tests are performed as part of the evaluation for Addison's disease.REF: Physical Examination/Diagnostics

3. A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? a. A thyroidectomy will be necessary. b. She should be referred to an endocrinologist. c. She will need lifelong medication. d. This condition may be transient.

ANS: D Postpartum hypothyroidism may be a transient condition and does not require surgical intervention, referral to a specialist, or lifelong medication unless it proves to be long-standing or refractory to treatment.REF: Hypothyroidism/Management

1. A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? a. Antihypertensive therapy b. Mineralocorticoid replacement c. Oral hydrocortisone d. Pituitary tumor resection

ANS: D This patient has symptoms of Cushing's syndrome. When indicated, pituitary tumor resection is performed as the first choice. Antihypertensive therapy is initiated in patients with pheochromocytoma. Mineralocorticoids and glucocorticoids are given to patients with Addison's disease.REF: Physical Examination/Management

4. A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? a. Radionucleotide imaging b. Serum calcitonin c. Serum TSH level d. Thyroid ultrasound

ANS: D Thyroid ultrasound evaluation should be performed for all patients with known thyroid nodules; high-resolution sonography can clearly distinguish between solid and cystic components. Radionucleotide imaging is not specific; many cold nodules are benign. The routine measurement of serum calcitonin levels is not useful or cost-effective. TSH levels are not specific to malignancy.REF: Diagnostics and Differential Diagnosis

1. A patient is in the emergency department with confusion and fatigue and a corrected serum calcium concentration is 10.8 mg/dL. What is the initial treatment for this patient prior to admission to the inpatient unit? a. Administration of furosemide b. Correction of potassium and magnesium levels c. Parenteral salmon calcitonin d. Rapid administration of intravenous normal saline

ANS: D To help the kidneys excrete calcium, intravenous normal saline should be given initially. Furosemide may not be effective as once thought and is used less often today. Correction of other electrolytes may be done when these imbalances are assessed. Parenteral salmon calcitonin may be used later to enhance calcium losses.REF: Hypercalcemia/Management

Generally testing for type 2 DM in asymptomatic, undiagnosed individuals older than 45 years should be conducted every _____. A. year B. 3 years C. 5 years D. 10 years (Ch. 11 Fitzgerald)

B

3. Which findings are symptoms of hyperparathyroidism? Select all that apply. a. Chvostek's sign b. Cognitive impairment c. Left ventricular hypertrophy d. Perioral paresthesias e. Renal calculi

B, C, E Cognitive impairment, left ventricular hypertrophy, and renal calculi all occur with hyperparathyroidism. Chvostek's sign and perioral paresthesias occur with hypoparathyroidism.REF: Clinical Presentation

The mechanism of action of sulfonylureas is as A. An antagonist of insulin receptor site activity B. A product that enhances insulin release C. A facilitator of renal glucose excretion D. An agent that can reduce hepatic glucose production

B. A product that enhances insulin release

Which of the following medications should be used with caution in a person with a severe sulfa allergy? A. Metformin B. Glyburide C. Rosiglitazone D. NPH insulin

B. Glyburide

2. A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? a. Beta blocker medications b. Radioiodine therapy c. Surgical resection of the thyroid gland d. Thionamide therapy

Beta blockers should be initiated for patients with Graves' disease to alleviate the alpha-adrenergic symptoms of the hyperthyroidism. Radioiodine therapy is used for patients with Graves' ophthalmopathy. Surgical resection is performed for pregnant women who cannot be managed with thioamides or for patients who refuse radioiodine therapy. Thioamide therapy is recommended for patients younger than 20 years old, pregnant women, those with a high likelihood of remission, and those with active Graves' Orbitopathy.REF: Management/Graves' Disease

2. Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? a. Appropriately high PTH along with hypocalcemia b. Appropriately increased PTH and low or normal serum calcium c. Inappropriate secretion of PTH along with hypercalcemia d. Prolonged inappropriate secretion of PTH with subsequent hypercalcemia

C Primary hyperparathyroidism is characterized by the inappropriate secretion of PTH in the setting of hypercalcemia. Appropriately high PTH with hypocalcemia characterizes hypoparathyroidism. An appropriately increased secretion of PTH with low or normal serum calcium is characteristic of secondary hyperparathyroidism. Prolonged inappropriate secretion of PTH in which hypercalcemia develops is tertiary hyperparathyroidism.REF: Definition and Epidemiology

A mechanism of action of pioglitazone is as A. An insulin-production enhancer B. A reducer of pancreatic glucose output C. an insulin sensitizer D. a facilitator of renal glucose excretion

C. An insulin sensitizer

You are seeing 12-year-old Amanda. As part of the visit, you consider her risk factors for type 2 DM would likely include all of the following except? A. Obesity B. Native American ancestry C. Family history of Type 1 DM D. personal history of PCOS

C. Family history of Type 1 DM

In caring for a patient with DM, microalbuminuria measurement should be obtained A. Annually if urine protein is present B. periodically in relationship to glycemic control C. yearly D. with each office visit related to DM

C. Yearly

What serum levels address hypercalcemia and what is used in the evaluation of hypercalcemia

Calcitrol levels/Protein electropphoresis

Chvostek's sign

Cheek, facial spasm when Cheek is tapped associates with hypocalcemia

Addisons treatments and concerns

Corticosteroid replacement therapy Ample sodium during heavy exercise, hot climates and GI upsets. During crisis, an immediate injection of hydrocortisone is needed along with support for low BP Glucocorticoids (Cortisol) Mineralocorticoid (Aldosterone)

Criteria for the diagnosis of Type 2 DM include A. classic symptoms regardless of fasting plasma glucose measuremens B. Plasma glucose levels of 126mg/dL (7mmol/L) as a random measurement C. a 2-hr glucose measurement of 156 mg/dL (8.6 mmol/L) after 75g anhydrous glucose load D. a plasma glucose level of 126ml/dL (7mmol/L) or greater after an 8 hours or greater fast on more than one occasion

D. a plasma glucose level of 126ml/dL (7mmol/L) or greater after an 8 hours or greater fast on more than one occasion

diagnostics for cushings

Dexamethasone suppression test, plasma cortisol in AM, salivary cortisol at 12 am, 24 hour urine cortisol cortisol will be >100

A middle-aged patient newly diagnosed with type 2 diabetes wants to start an exercise program. All of the following statements are true except:

Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. When exercising, the patient should monitor blood sugar closely, especially if using insulin, to avoid hypoglycemia.

Nodes seen with Osteoarthritis and their location

Heberden's nodes (nodules on DIP) ' Bouchard's nodes (nodules on PIP)

The Somogyi effect is characterized by what?

High fasting blood glucose in the morning that is caused by the secretion of glucagon The Somogyi phenomenon/effect occurs when nocturnal hypoglycemia (2am-3am) stimulates the pancreas to secrete glucagon, which causes the liver to convert glycogen to glucose. Fasting blood glucose then becomes elevated. It is also known as the "rebound effect"

What 2 deficiencies can cause hypocalcemia

Hypomagnesemia and Vitamin D deficiency

how does glucose and insulin lower potassium levels quickly?

Insulin administered with glucose facilitate uptake of glucose into the cell, which results in an intracellular shift of potassium

How does calcium chloride help a widened QRS from hyperkalemia

Membrane stabilization: Calcium antagonizes the cardiac effects of hyperkalemia. It raises the cell depolarization threshold and reduces myocardial irritability.

65-year-old man presents to the clinic complaining of random recurrent episodes of dizziness with nausea. The patient describes it as the sensation of the room moving or of the room spinning. It is worsened by sudden head movement. During the episodes, he becomes very nauseated. He also has tinnitus with hearing loss in his right ear. The patient has type 2 diabetes and is on a prescription of metformin 500 mg PO BID and an angiotensin-converting enzyme (ACE) inhibitor. The blood glucose level during his visit is 80 mg/dL. Which of the following conditions is most likely?

Ménière's disease The classic triad of symptoms of Meniere's disease are episodic vertigo, tinnitus, and sensorineural hearing loss (low frequency). Tinnitus is usually low pitch (like listening to a conch shell). One may have a strong sensation of ear fullness. The condition can resolve spontaneously or may be chronic. Pathologic lesion in the middle ear is called endolymphatic hydrops. Vasovagal syncope does not cause hearing loss or tinnitus, nor is it episodic. Hypoglycemia is not associated with episodic vertigo, tinnitus, and hearing loss.

Addisons signs and symptoms

Symptoms vary and develop over months. Chronic diarrhea, N/V, loss of appetite, Symptoms vary and develop over months. Chronic diarrhea, N/V, loss of appetite, paleness or darkening of the skin with a possible patchy appearance, muscle fatigue, weakness, slow or sluggish movement, hypoglycemia, low BP, fainting and salt craving. During crisis, symptoms appear suddenly

A female patient, who has a BMI (body mass index) of 29 has a 20-year history of primary hypertension. She has been taking hydrochlorothiazide 25 mg PO daily with excellent results. On this visit, she complains of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. She reports to the nurse practitioner that she has been having this problem for about 6 months. Upon reading the chart, the nurse practitioner notes that the last fasting blood glucose level was 140 mg/dL. Which of the following is the appropriate action to follow at this visit?

Order an A1C level The next step is to check the A1C level. The treatment goal is an A1C less than 7%. But if the patient is frail or has frequent hypoglycemic episodes, the American Diabetes Association allows a goal of up to 8%. If the A1C level is 6.5 or higher, the patient has type 2 diabetes.

3. A patient has low serum calcium associated with low serum albumin. What is the recommended treatment for this patient? a. Calcium supplementation only b. Correction of other serum electrolytes c. Thiazide diuretics and sodium restriction d. Vitamin D and calcium supplementation

Patients with hypocalcemia associated with hypoalbuminemia do not require calcium replacement. Serum pH, potassium, magnesium, and phosphorus levels should be monitored and corrected if needed. Thiazide diuretics with sodium restriction may be used to lower urinary calcium excretion to allow lower dosing of calcium and vitamin D when these are given.REF: Hypocalcemia/Management

Addison's Disease

Primary: ↓ cortisol and sometimes aldosterone produced by adrenal glands Secondary: pituitary gland is diseased

Cushings signs and symptoms

Progressive weight gain and fatty tissue deposits, particularly around midsection and upper back, in the face (moon face) and between shoulders (buffalo hump), Striae on abdomen, thinning fragile skin that bruises easily, slow healing. Fatigue, muscle weakness, hirsutism

Rheumatoid Arthritis vs Osteoarthritis

Rheumatoid arthritis is autoimmune and is always on both sides. May begin at any time, rapid progression, joints are painful/swollen/stiff, Heberden's nodes are absent. early morning joint stiffness that lasts longer than 30 minutes Osteoarthritis is due to wear and tear, and is only on a specific joint. OA=One Arm. Occurs later in life, slow progression, joints ache and are tender with little to no swelling, Heberdeens nodes are present, early-morning joint stiffness w/ inactivity. Short duration (<15 min)

Cushings treatment and concerns

Taper steroids as soon as possible; Can lead to heart failure or MI, osteoporosis, HTN, DM, frequent infections and loss of muscle ***Spironolactone- treat for hirsutism (can cause galactorrhea or gynecomastia) ↑ in school work so central obesity - very uncush

3. A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? a. Dipstick urinalysis for ketones b. Giving a rapid-acting carbohydrate c. Injection of rapid-acting insulin d. Performing a hemoglobin A1C

This patient has signs of hypoglycemia, so a rapid-acting carbohydrate should be given once this is confirmed. Assessing for ketones is done if the patient is hyperglycemic, as is insulin administration. Hemoglobin A1C gives information about long-term and not immediate glucose control.REF: Table 206-5: Hypoglycemia

Which of the following groups has been recommended to be screened for thyroid disease?

Women have a greater risk of developing thyroid disease than men. Being age 50 or older increases the risk of thyroid disease for both men and women. Screening for thyroid disease is therefore recommended for women 50 years of age and older.

Grave's Disease/ hyperthyroidism

accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.

Trousseau's sign

arm/carpal spasm associated with hypocalcemia

acromegaly

enlargement of the extremities caused by excessive secretion of growth hormone after puberty

adrena medulla

epinephrine and norepinephrine

hyperparathyroidism

excessive levels of parathyroid hormone

growth hormone

hormone secreted by anterior pituitary gland that stimulates growth of bones

Cushing's syndrome

hypersecretion of cortisol

Pheochromocytoma

hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor of adrenal medulla)

how does hypertension contribute to hypokalemia

the most common cause is diuretic use. By enhancing urinary flow and sodium delivery through the collecting tubule, bot thiazide and loop diuretics promote renal potassium secretion

Hypothyroidism

↑ TSH, ↓ free T4 (normal or low T3) ** subclinical hypothyroidism has elevated TSH and normal free T4 & T3

Cushings disease

↑ levels of cortisol for extended period (long term steroid use) or overproduction of ACTH; pituitary tumor