MVU Nurs 623 Exam 2 with correct answers

MVU Nurs 623 Exam 2 Common endocrine problems - correct answer Hirsutism Alopecia Gynecomastia Increased neck mass Polydipsia Polyphagia Polyuria Unexplaned weight gain/loss Organize endocrine disorders - correct answer Glandular Disorders Thyroid parathyroid pituatary adrenal Diabetes DM1 DM@ hypoglycemia Metabolic disorders Obesity Gout Pituatary gland - correct answer the endocrine system's most influential gland. Under the influence of the hypothalamus, it regulates growth and controls other endocrine glands. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary decreases TSH production. When theres a problem in the pituatary you will see tsh and T4 both down. How to differentiate hypothyroid and hyperthyroidism. - correct answer What differentiates one from the other •Causes •Clinical presentation •Diagnostic tests •Treatment Hyperthyroidism - correct answer •Excess secretion & synthesis of one or both: Thyroxine (t4) triiodothroinine (t3) Long term effects without treatment: Heart disease osteoporosis Mental disease infertility Hyperthyroidism clinical findings - correct answer "Hot/buldging/fast" -intolerance to heat -thin fine hair -bulging eyes (exopthalmus) -thryomegaly -tachycardia -HTN -weight loss -Tremors. -pretibial myxedema (thickening of skin on shins usually) -decreased visual acuity -photophobia. Hypothyroid clinical manifestations - correct answer "cold/slow/tired" -Intolerance to cold, coarse hair/ hair loss, extreme -fatigue, lethargy, slow speech, constipation, brittle -hair/ nails. -High TSH -Low free T4 levels -Once confirmed diagnosis of hypothyroidism, -thyroid peroxidase antibody (TPO) to confirm -Hashimoto's thyroiditis (gold standard for diagnosis of Hashimoto's) hyperthyroidism causes - correct answer Graves disease (diffuse toxic goiter) is most common. Subacute or painless thyroiditis. Toxic nodular goiter. Factitious hyperthyroidism. Hypothyroidism causes - correct answer Hashimoto thyroiditis (90% of cases) Subacute painless lymphocytic thyroiditis Hypopituitarism, iodine deficiency, enzyme deficiency Drugs: Amiodarone, lithium, sulfonamides, phenylbutazone Hypothalamic dysfunction/hypopituitarism Diagnostic tests for thyroid problems - correct answer TSH Free T 4 - meds can alter labs: Steroids, adrogens, estrogens, salicylates, heparine, iodine containing coumpounds. If Ft4 normal, then do FT3 Also do CBC and LFT Further testing after initial thyroid testing - correct answer TSH receptor antibody Nuc med scan 24 hour iodine uptake ultrasound fine needle biopsy Hyperthyroid (graves disease) Labs TSH level would be __ T3/T4 would be ___ - correct answer TSH would be low Serum free T3 and T4 would be elevated. Remember the knocking on the door analogy: the pituitary gland recognizes that the t3 and t4 are elevated, so it will not send anyone to knock on the thyroids door to increase it (aka will not send out any more TSH) Hypothyroidism (hashimotos's) labs TSH level would be __ T3/T4 would be ___ - correct answer TSH level is high T3& T4 are low. This is because the TSH is trying to get the thyroid to produce more T3 and T4, but the thyroid cant. Hence the patient will need synthetic T4. (synthroid) Pituitary abnormality labs TSH would be and T3/T4 would be - correct answer TSH would be elevated T3/T4 would also be elevated This is how you know its the pituitary because the negative feedback system is failing. Treatment of hyperthyroidism - correct answer TREATMENT: Hyperthyroidism First treat patients symptoms (potentially beta blockers) Then: ●Anti-Thyroid Medications: Importance for timely dosing and Side effect of drowsiness ● Methimazole ● Propylthiouracil- okay for pregnant in reduced doses. ● Radioactive Iodine 131: only gland to absorb iodine ● Surgery removal of thyroid tissue with thyroid hormone supplement taken for life Follow up treatment for hyperthyroidism - correct answer •Thyroid tests at least twice a year •Initially check 1 month and 3 months unless symptomatic •Anti-thyroid medications: continue 6-24 months after euthyroid state •Gradually taper •Watch for relapse •TFTs after Radioactive iodine therapy •4-6 weeks, 12 weeks •6 months •Annually Hypothroidism S/S - correct answer -extreme weakness -muscle fatigue -cramps/arthralgias -cold intolerance -wt gain, constipatin, dry skin, hair loss, brittle nails, puffy eyes, edema of hands and face -bradycardia -slowed DTRs- esp achilles -hypoactive bowel sounds hypothyroidism treatment - correct answer Lifelong thyroid hormone replacement therapy levothyroxine (synthroid) •1.6 mcg/kg per day •<60y.o 50-100mcg daily •Older adults or with CAD -begin with ½ expected (25-50mcg/d) replacement and increase gradually every 4-6 weeks. •Severe illness, major surgery, pregnancy may alter dosing Follow up for thyroid replacement - correct answer TSH every 4-6 weeks after starting (target is .3-2.4) Once stable annually with labs, unless there is overtreatment symptoms or weight gain...illness. Additional testing once hypothyroidism is confirmed - correct answer CBC CMP UA Lipid panel EKG, CXR Patient education for hypothroidsim - correct answer disease process medication- when to take, not to take any new drugs without telling the provider they are on synthyroid, symptoms of hyperthyroidism. nutrition constipation prevention. labs- how often and importance. differentiate between diabetes type one and type two - correct answer Type one most likely is autoimmune, insulin deficiency, earlier onset, not typically over weight. Type two is insulin resistant, later onset, patient is often obese. Type one diabetes s/s - correct answer Polydipsia, polyuria, polyphasia, anorexia & wt loss Diagnostics for diabetes - correct answer A1C 6.5 or higher, fasting blood glucose greater than 126 on two different occurrences Type one diabetes one management - correct answer Insulin therapy •Initial goal: normalize blood glucose •Plasma glucose levels at 80 to 120 mg/dL before meals •Plasma glucose levels of 100 to 140 mg/dL at bedtime •A1C below 7% •New-onset type 1 diabetic often presents in crisis and requires hospitalization •Requires diligent and frequent blood glucose monitoring •Doses of regular insulin before meals with an evening dose of NPH (or glargine or detemir) •Intensive insulin regimens •Increases chance of hypoglycemic episodes Type one diabetes management cont - correct answer Check blood sugar levels 3-4X a day Urine ketone testing as needed Meal planning (dietitian) Exercise and insulin- check blood sugars before and after. avoid exercise is sugar is over 250, also if less than 100 they should eat a little extra carbs. Patient education for type one diabetes - correct answer all insulin devices- pumps, syringes, pens, monitors... Foot care Diet- carb counting, mealtime insulin dosage. Adjusting the dose during illness signs of DKA and when to go to the hospital DKA - correct answer High levels of ketones in the urine, symptoms are excessive thirst, frequent urination, SOB, fruity breath, vomiting. HHS symptoms - correct answer •"Hugely High" blood sugar > 600 mg/dL •Dry, parched mouth •Extreme thirst (although this may gradually disappear) •Warm, dry skin that does not sweat •High fever (over 101 degrees Fahrenheit, for example) •Sleepiness or confusion •Loss of vision •Hallucinations (seeing or hearing things that are not there) •Weakness on one side of the body •Occurs in Type 2 DM •Profound dehydration •No ketones •Body tries to get rid of excess sugar through urine •Occurs when sick or in older adults (with infection) hypoglycemia in type one DM - correct answer •Can occur for a variety of reasons •Excessive exogenous insulin •Missed meals or inadequate food intake •Exercise, alcohol ingestion, drug interactions, and a decrease in liver or kidney function •Signs and symptoms •Diaphoresis, tachycardia, hunger, shakiness, altered mentation (ranging from inability to concentrate to coma), slurred speech, and seizure •Goal: normalize the plasma glucose promptly •Accomplished by the ingestion of 15 g of carbohydrate •Blood glucose should be checked 15 minutes after treatment •Additional carbohydrate should be given if the blood glucose results remain less than 60 mg/dL •For severe hypoglycemia and if the patient is unconscious or unable to swallow, 1 mg of glucagon can be given subcutaneously (prescribe glucagon kit for all individuals at risk) DM type 2 - correct answer •Poor diet •Genetic predisposition peripheral insulin resistance •Glucose overload -Which- •Alters insulin receptor sites -Which- •Reducing amount of glucose in cells •( what happens to cellular respiration?) •Look for another source (fatty acids -oxidized-liver) -Then leads to- ketones diagnosis of type 2 DM - correct answer Random glucose > 200 Fasting Glucose > 126 Glucose tolerance test > 200 two hours after glucose load A1C 6.5% or higher on two occasions management of type 2 diabetes - correct answer Remember to treat the patient, not all the guidelines fit everyone. Consider barriers to treatment consider co-morbitities lifestyle modifications treatment for type 2 diabetes - correct answer A1C less than 9% then monotherapy with oral agent oral antidiabetic agents: 5 classes: 1. Sulfonyluresas (oldest): first and second generations (Tolazamide) (Lipozide) stimulates the beta cells to produce more insulin 2. Biguanides ***inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin may be given with sulfonylureas (*Metformin) 3. Meglitinides stimulate the beta cells to secrete insulin minimal risk of hypoglycemia (Starlix) 4. Alpha-glucosidases inhibits an enzyme called alpha-glucosidase must be taken with meals may be given with sulfonylureas (Precose) 5. Thiazolidinediones decrease insulin resistance monitor for hepatic toxicity may be given with sulfonylureas (actos, avandia) An 8-year-old boy with type 1 diabetes is been seen for 3-day history of Urine Frequency and Nocturia. He denies flank pain and is afebrile. The UA result is negative for blood and nitrates but positive for a large amount of leukocytes and ketones. He has a trace amount of Protein. Which is the following is the best test to order initially? A. Urine for C/S B. 24-hour urine for protein and creatinine clearance C. 24-hour urine for microalbumin D. IV pyelogram - correct answer Urine C/S A 21-year-old new mother reports that she has been feeling irritable and jittery almost daily for the past few months. She complaints of frequent palpitations and more frequent bowel movements along with weight loss. Her BP is 160/70 mmHg, pulse is 110 bpm, and is afebrile. All of the following conditions should be considered in the differential diagnosis for this patient except: A. Mitral regurgitation B. Grave's Disease C. Generalized anxiety disorder D. Illicit drug use - correct answer Mitral regurgitation The nurse practitioner who suspects that one of her hypertensive patients has Cushing's syndrome would expect to find which of the following lab results? A. Hyponatremia B. Hypoglycemia C. Elevated serum cortisol levels D. Decreased urine 17 ketosteroids - correct answer Elevated Serum cortisol levels A 55-year-old woman who has had type 2 diabetes for 20 years is concerned about her kidneys. She has a history of three UTI's within the last 8 months but is currently asymptomatic. Which of the following is the best course to follow? A. Recheck urine during visit, send urine specimen for culture and sensitivity, an refer to a nephrologist B. Order UA dipstick test to be repeated monthly C. Order CT scan of kidneys D. Provide empiric treatment for UTI - correct answer Recheck urine during visit and send for culture. A 30-year-old woman with type 2 DM uses regular and NPH insulin the am and in the evening. She denies changes to her diet or any illness but recently started attending aerobic classes in the afternoon. Her fasting blood glucose level before breakfast and is now elevated. Which of the following is best described? A. Somogyi phenomenon B. Dawn phenomenon C. Raynaud's phenomenon D. Insulin resistance - correct answer Somogyi Phenomenon Which of the following would you recommend on an annual basis for an elderly patient with typoe two diabetes? A. Eye exam with an ophthalmologist B. Follow up visit with a urologist C. Periodic visits to an optometrist D. Colonoscopy - correct answer Eye exam A male patient has type 2 DM and a "sensitive stomach". Which medication is least likely cause him GI distress? A. Naproxen sodium B. Aspirin C. Erythromycin D. Sucralfate - correct answer Sucralfate An obese Asian patient with BMI of 33 complains of fatigue, and excessive thirst and hunger. You suspect Type 2 DM. Initial testing to confirm diagnosis can include: A. Fasting plasma glucose level B. Glycated hemoglobin level (A1C) C. Oral glucose tolerance testing D. All of the above. - correct answer All of them Which of the following groups have been recommended to be screened for thyroid disease? A. Women aged 50 and older B. Adolescent girls C. Elderly men D. School aged children - correct answer Women aged 50 and older A 65-year-old Hispanic woman has a history of type 2 DM. A routine UA reveals a few epithelial cells and negative for leukocytes, nitrates, and protein. The serum creatinine is 1.5 mg/dL. Which of the following actions would you recommend next? A. Order a urine test for culture and sensitivity (C and S) B. Order a spot urine for microalbumin to creatinine ration C. Because the urinalysis is negative, no further testing necessary. D. Recommend a screening IV pyelogram - correct answer Order spot urine for microalbumin Which of the following findings is associated with thyroid hypofunction? A. Graves' Disease B. Eye Disorder C. Thyroid Storm D. Myxedema - correct answer myxedema Which of the following is used to confirm a diagnosis of Hashimoto's thyroiditis? A. Serum TSH B. Free T4 test C. Anti-thyroid peroxidase and anti-thyroglobulin antibodies D. Thyroid Ultrasound - correct answer Anti thyroid peroxidase and anti-thyroglobulin antibodies. The best screening test for both hyperthyroidism and hypothyroidism is: A. Free T4 B. TSH C. Thyroid Profile D. Palpation of the thyroid gland - correct answer TSH A 10-year-old boy has type 1 DM. His late afternoon blood sugars over the past 2 weeks have ranged from 210 to 230. HE currently injects 10 units of regular insulin and 25 unites of NPH in the am. And 15 units of regular insulin and 10 units of NPH in the evening. Which of the following is the best treatment plan for this patient? A. Increase both types of morning dose B. Increase only the NPH insulin in the am C. Decrease the afternoon dose of NPH D. Decrease both NPH and regular insulin in the am - correct answer Increase only the NPH insulin in the am A new patient who is a 40-year-old female postal worker is being evaluated for complaints of new onset erythematous rash on both cheeks and on the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with Synthroid 1.25 mg daily. Which of the following conditions is most likely? A. Atopic dermatitis B. Thyroid disease C. Lupus erythematosus D. Rosacea - correct answer Lupus erythematosus A female patient who has BMI of 29 has a 20-year history of primary hypertension. She has been taking HCTZ 25 mg po daily with excellent results. On this visit, she complaints of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. She reports to the NP that she has been having this problem for about 6 months. Upon reading the chart, the NP notes that the last two fasting Blood sugars have been 140 and 168. The result of the random blood glucose test is 210. Which of the following is the appropriate action to follow at this visit? A. Order another random blood glucose in 2 weeks B. Initiate prescription for metformin 500 mg po BID C. Order 3-hour glucose tolerance test D. Order A1C - correct answer Order an A1C A middle-aged patient newly diagnosed with type 2 DM wants to start an exercise program. All of the following statements are true except: A. If the patient is unable to eat due to illness, antidiabetic agents can be continued with frequent glucose monitoring B. Strenuous exercise is contraindicated for type 2 DM patient's because of higher risk of hypoglycemic episodes. C. Exercise increases the body's ability to metabolize glucose D. Patient's who exercise routinely in the afternoon may have hypoglycemic episodes in the evening or at night if they do not eat. - correct answer Strenuous exercise is contraindicated for type 2 DM patient's because of higher risk of hypoglycemic episodes. A 35-year-old woman is complaining of gradual weight gain, lack of energy, and amenorrhea. The urine pregnancy test is negative. A CBC count shows that hemoglobin of 13.5 and MCV 84. The NP suspects that the patient may have hypothyroidism. The TSH level is 10. Which of the following is the next step in the evaluation? A. Check Thyroid profile B. Check total T3 level C. Check FSH level D. Recheck TSH in 4-6 months - correct answer Check Thyroid profile A 28-year-old woman with history of hypothyroidism presents to urgent care clinic complaining of numbness and tingling in the fingertips of both her hands for several hours. On examination, both radial pulses are at +2 and equal bilaterally. The patient reports that over the past few months she has had identical episodes, each lasting several hours. During these episodes, the skin changes color from blue to white, and then to dark red. Eventually, it returns to normal and the tingling and numbness disappear. Which of the following conditions is best described? A. Hashimoto's disease B. Raynaud's phenomenon C. Peripheral neuropathy D. Vitamin B 12 deficiency anemia. - correct answer Raynaud's phenomenon Cushing syndrome - correct answer group of signs and symptoms produced by excess cortisol from the adrenal cortex Cushing Syndrome: ● ACTH independent: Prolonged use of exogenous glucocorticoid hormones ● Tumors/dysplasia of the adrenal coretx Cushing's disease - correct answer The term Cushing's disease refers specifically to pituitary adrenocorticotropic hormone (ACTH) excess caused by a pituitary tumor (adenoma), which, in turn, causes over secretion of cortisol by the adrenal gland and is a form of Cushing's syndrome. Cushing Disease: more common in women ● ACTH dependent: related to excess ACTH caused by pituitary adenoma causes adrenal cortex to over secrete cortisol. Cushing's causes - correct answer -Corticosteroid drugs = MC cause of syndrome -Pituitary adenoma = MC cause of disease (too much ACTH) -Small lung cell cancer -Adrenal tumor Cushing's SS - correct answer hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump Diagnostic for cushings - correct answer One of the following four to be used in initial testing for cushings syndrome 1. Urine free cortisol ( at least two measurments) 2. Late night salivary cortisol ( 2 measurements) 3. 1mg overnight dexamethasone suppression test 4. Or longer low dose dexamethasone suppression test 2mg/day for 48 hrs. ● Additional lab: ○ CBC: leukocytosis, anemia ○ CMP: hypokalemia ○ Fasting glucose level ○ Serum cortisol level Addison's disease - correct answer Primary: Autoimmune addison's: destruction of adrenal cortex, low cortisol levels Secondary: Pituitary adenoma or abruptly stopping corticosteroids Addison's S/S - correct answer Subjective ● Fatigue ● Weakness ● Wt loss ● Abd pain ● Diarrhea Objective: ● Hypoglycemia ● Hypotension ● Hyperpigmentation ● Loss of axillary hair and pubic hair in women Diagnostic for addisons - correct answer ● Plasma cortisol level: 8am cortisol level less than 3 is consistent with addison's disease ● Diagnosis is confirmed by cosyntropin stimulation test: synthetic form of ACTH is given IM and serum cortisol level is obtained 45 minutes later. ● CT scan: small non-calcified adrenal glands are indicative of autoimmune addison's disease. Name the two thyroid hormones produced by the thyroid? - correct answer Thyroxine and T3 (triiodothyronine) What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? - correct answer 24 hour radio-absorbed iodine uptake (RAIU) test Which of the above treatments is recommended for middle age and older adults? - correct answer Radioactive iodine 131, cannot do if pregnant How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism? - correct answer For life According to the American Association of Clinical Endocrinologists, the usual dose of levothyroxine _______mcg/kg/day for full replacement. - correct answer 1.6 mcg/kg/day How would you alter the dose for initiating synthetic thyroid replacement with older patient with hx of cardiac issues - correct answer Start replacement therapy lower and slowly increase (slower than with patients who have no cardiac history); begin with half of the recommended starting dose and increase gradually every 4-6 weeks What would make you suspicious of thyroid cancer (clinical presentation)? - correct answer Painless, lump or nodule in throat-fixed nontender, firm, irregular, tight feeling , DOB, hoarseness, hemoptysis, swollen lymph nodes, may involve oropharynx/tongue What is the difference between Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Syndrome (HHS)? - correct answer DKA- seen in Type I, high level of ketones in the urine, excessive thirst, frequent urination, SOB, dry mouth, fruit-smelling breath, can lead to diabetic coma, vomiting, generally BS<800 between 350-450, seek help if consistently higher than 300 HHS- usually occurs in older people (type II), BS >600, weakness on one side of the body which can look like a stroke, dry parched mouth, extreme thirst (may disappear), warm/dry skin, high fever>101, sleepy, confused, los of vision, hallucinations, profound dehydration, no ketones, occurs when sick/with stress/trauma/in older adults with infection What is the diagnostic criteria for DM2 Random plasma glucose greater than: Fasting plasma glucose greater than: (on 2 occasions) or A1C greater than: - correct answer 200 126 6.5 . Are there any contraindications for starting the recommended first choice oral hyperglycemic medication? Yes/ no? If so, what are the contraindications? - correct answer Yes-Impaired renal function (GFR<30), liver dz, ETOH abuse, unstable or acute HF, past hx of lactic acidosis during metformin therapy, decreased tissue perfusion or hemodynamic instability due to infections or other causes the primary cause of mortality in DM patients - correct answer Ischemic heart failure-leading cause of death Complications: Diabetic retinopathy, Cataracts, blindness, hyperlipidemia, hypertension, CAD, MI, peripheral neuropathy, infection, ulcers, amputation, renal disease/failure, Balanitis (candida infxn of glans of penis), candida vaginitis, ommon causes of hypercalcemia - correct answer Among all causes of hypercalcemia, primary hyperparathyroidism and malignancy are the most common, accounting for greater than 90 percent of cases. Also consider: sarcoidosis or medications such as lithium, thiazide diurectics, excessive vit A, or theophylline toxicity. Vit D intoxication can also cause hypercalcemia. patient education regarding sulfonylureas - correct answer Choice of sulfonylurea — When a decision has been made to treat with a sulfonylurea, we suggest a shorter-duration sulfonylurea, such as glipizide, gliclazide, or glimepiride. There is a relatively high incidence of hypoglycemia and other adverse effects in patients taking glyburide or chlorpropamide, especially in older patients [8]. However, there are a paucity of trials comparing the relative effectiveness and safety of the individual sulfonylureas. ●For patients with nondialysis chronic kidney disease, glipizide or glimepiride is a good choice as they are metabolized by the liver and primarily excreted in the urine as inactive metabolites. testing to differentiate between Graves, Subacute Thyroiditis and toxic nodular goiters - correct answer Graves Very low (or undectectable) TSH High free T4 & T3 If graves, will have positive thyrotropin receptor antibodies (TRAb) AKA thyroid stimulating immunoglobulin (TSI). Thyroid peroxidase antibody (TPO) is positive with both Graves and Hashimoto's Subacute thyroiditis- The diagnosis of subacute thyroiditis is based primarily upon clinical manifestations (the presence of neck pain, often radiating upward to the jaw; marked thyroid tenderness; and a diffuse goiter). In patients with suspected subacute thyroiditis, thyroid function tests (thyroid-stimulating hormone [TSH], free thyroxine [T4], triiodothyronine [T3]) should be obtained. Although symptoms and signs of hyperthyroidism may or may not be present, the serum TSH is usually suppressed (typically <0.1 mU/L) and free T4 and T3 concentrations elevated ESR/ CRP elevated. Toxic Nodular goiters hyperthyroid patients with physical examination or ultrasound findings suggesting nodular thyroid disease, we obtain a radioactive iodine uptake scan as our initial test to distinguish toxic nodular goiter and toxic adenoma from Graves' disease diagnostic testing for gout - correct answer Hallmark Signs: excruciating pain, tenderness, erythema and swelling in monoarticular joint (podagra). Usually great toe, but can affect other joints. • Diagnostic: Clinical presentation is usually diagnostic. Serum uric acid levels and x rays provide some confirmation. Level >7.5mg/dl, can be normal in up to 15% of people. DEFINITIVE confirmation requires aspiration of sodium urate crystals from the joint. ESR AND WBC may be elevated in some cases. • Labs: Uric Acid, CBC, ESR, synovial fluid analysis if need to diff. between arthritis and gout dx Graves disease, Cushings, Addisons, and Hashimotos based on S/S and based on lab data - correct answer Graves: s/s: "Hot/buldging/fast" intolerance to heat, thin fine hair, bulging eyes (exopthalmus), thryomegaly, tachycardia, HTN, weight loss, tremors. pretibial myxedema (thickening of skin on shins usually Cushings: Moon Face, obese trunk with thin extremities, buffalo hump, pink/purple striae, hyperglycemia, amenorrhea, edema, Hypernatremia/ hypokalemia, osteoporosis. Too much cortisol! Addisons: Bronze skin pigmentation, hypoglycemia, postural hypotension, weight loss, weakness. Hyponatremia/ hyperkalemia. Need to ADD adrenal hormones/ cortisol Hashimotos: High TSH Low free T4 levels Once confirmed diagnosis of hypothyroidism, thyroid peroxidase antibody (TPO) to confirm Hashimoto's thyroiditis (gold standard for diagnosis of Hashimoto's) • Most common cause is Hashimoto's thyroiditis, postpartum thyroiditis & thyroid ablation with radioactive iodine (used to treat hyperthyroidism). s/s: "cold/slow/tired" Intolerance to cold, coarse hair/ hair loss, extreme fatigue, lethargy, slow speech, constipation, brittle hair/ nails. Myxedema (Severe hypothyroidism): endocrine emergency! Rare. s/s: cognitive sx-slowed thinking, poor short-term memory, depression or dementia, hypotension and hypothermia. Mortality rate of 30-40%. which meds and drug class are used in the treatment of an acute gout attack - correct answer Acute phase: Pain management- NSAIDS: Indocin/ naproxen BID. Can add colchicine (if NSAIDS do not provide relief) 1.2mg PO X1 then 0.6mg in 1 hour. Continue colchicine QD-BID until sx resolve. S/E- diarrhea. Avoid narcotics- do not work for gout pain After acute phase is over wait 4-6 weeks before initiating maintenance tx. (allopurinol). For pts already on allopurinol; may continue through acute phase. Avoid: Foods high in purine such as: Beer and grain liquors (like vodka and whiskey) Red meat, lamb, and pork Organ meats, such as liver and kidney, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads) Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food which meds can cause DM and iatrogenic hyperglycemia - correct answer Corticosteroids. Thiazide diuretics. Beta-blockers. Antipsychotics What are the risk factors for Gout? - correct answer Men, African American, ages 40-50, use of diuretics, family history, people from US, Pacific islands, and countries with abundant lifestyles, primary risk factors: enzyme defects, decreased renal clearance of uric acid; secondary