NR 565 (NR 565 ) Final Exam MIDTERM Actual Questions and Correct
Answers
Q1
What labs are used to diagnose Thyroid?
Answer: TSH, total T4 and T3, free T4 and T3
Q2
Timeframe for re-check of labs after starting levothyroxine
Answer: 6-8 wks after starting therapy
Q3
Signs and symptoms of hypothyroidism
Answer: Face: Pale, puffy, expressionless Skin: Cold and dryHair: Brittle and hair lossHeart rate
and temp are
lowered Complaints by patient: lethargy, fatigue, intolerance to coldMentation may be
impairedThyroid enlargement if ↓'d levels of T3 and T4 promoting excessive release of TSH
Q4
Result of not treating hypothyroidism during pregnancy
Answer: permanent neurological defects, ↓'d IQ, large protruding tongue, potbelly dwarfish
stature, impaired
development of nervous system bone teeth and muscles
Q5
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the
hyperthyroidism itself)
Answer: Metoprolol could be used to treat tachycardia experienced with hyperthyroidism, but it
does not treat
hyperthyroidism itself
, Q6
Drug/Food/Supplement interactions with levothyroxine Absorption REDUCED by
Answer: Histamine 2 receptor blockers (Cimetidine [Tagamet])Proton pump inhibitors
(Lansoprazole) Sucralfate
(Carafate)Cholestyramine (Questran) Colestipol (Colestid)Aluminum containing antacids (maalox,
mylanta) Calcium supplements (tums, os-cal)Iron supplements Magnesium salts Orlistat (Xenical)*
4
hours between levothyroxine and the above meds is recommended and food reduces absorption
as
well
Q7
How to confirm a diagnosis of DM prior to beginning treatment
Answer: Hemoglobin A1C > 6.5%,Fasting plasma glucose 126 mg/dL, Random plasma glucose 200
mg/dL plus
symptoms of diabetes,Oral glucose tolerance test (OGTT): 2-h plasma glucose 200 mg/dL
Q8
A1C General goals
Answer: less than 7%, less than 8% in patients with severe hypoglycemia, limited life expectancy,
or advanced
microvascular or macrovascular complications
Q9
When should insulin be considered?
Answer: Type 1 Diabetics All are on insulin Type 2 DiabeticsStep 3 - Three drug combination
(inclusive of
metformin)Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-6 months
injectable regimen inclusive of insulin and possibly GLP-1 receptor agonist.EXCEPTIONS: patient
with
A1C greater than 9% or greater start dual therapy (start at step 2) and patients with A1C greater
than
10 % and fasting blood glucose of 300 or more or symptomatic may be started on combination
injectable therapy immediately
Q10
At what time interval should A1c be re-checked?
Answer: every 3 months until A1C drops below 7% and then every 6 months thereafter
Answers
Q1
What labs are used to diagnose Thyroid?
Answer: TSH, total T4 and T3, free T4 and T3
Q2
Timeframe for re-check of labs after starting levothyroxine
Answer: 6-8 wks after starting therapy
Q3
Signs and symptoms of hypothyroidism
Answer: Face: Pale, puffy, expressionless Skin: Cold and dryHair: Brittle and hair lossHeart rate
and temp are
lowered Complaints by patient: lethargy, fatigue, intolerance to coldMentation may be
impairedThyroid enlargement if ↓'d levels of T3 and T4 promoting excessive release of TSH
Q4
Result of not treating hypothyroidism during pregnancy
Answer: permanent neurological defects, ↓'d IQ, large protruding tongue, potbelly dwarfish
stature, impaired
development of nervous system bone teeth and muscles
Q5
Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the
hyperthyroidism itself)
Answer: Metoprolol could be used to treat tachycardia experienced with hyperthyroidism, but it
does not treat
hyperthyroidism itself
, Q6
Drug/Food/Supplement interactions with levothyroxine Absorption REDUCED by
Answer: Histamine 2 receptor blockers (Cimetidine [Tagamet])Proton pump inhibitors
(Lansoprazole) Sucralfate
(Carafate)Cholestyramine (Questran) Colestipol (Colestid)Aluminum containing antacids (maalox,
mylanta) Calcium supplements (tums, os-cal)Iron supplements Magnesium salts Orlistat (Xenical)*
4
hours between levothyroxine and the above meds is recommended and food reduces absorption
as
well
Q7
How to confirm a diagnosis of DM prior to beginning treatment
Answer: Hemoglobin A1C > 6.5%,Fasting plasma glucose 126 mg/dL, Random plasma glucose 200
mg/dL plus
symptoms of diabetes,Oral glucose tolerance test (OGTT): 2-h plasma glucose 200 mg/dL
Q8
A1C General goals
Answer: less than 7%, less than 8% in patients with severe hypoglycemia, limited life expectancy,
or advanced
microvascular or macrovascular complications
Q9
When should insulin be considered?
Answer: Type 1 Diabetics All are on insulin Type 2 DiabeticsStep 3 - Three drug combination
(inclusive of
metformin)Step 4 - Three drug therapy and basal insulin fails to reach goals after 3-6 months
injectable regimen inclusive of insulin and possibly GLP-1 receptor agonist.EXCEPTIONS: patient
with
A1C greater than 9% or greater start dual therapy (start at step 2) and patients with A1C greater
than
10 % and fasting blood glucose of 300 or more or symptomatic may be started on combination
injectable therapy immediately
Q10
At what time interval should A1c be re-checked?
Answer: every 3 months until A1C drops below 7% and then every 6 months thereafter
