PC3 EXAM 3 GI; Endocrine; Neuro. ENDOCRINE
The nurse practitioner receives a thyroid nuclear scan report that states there are multiple "cold" nodules present in the thyroid. The nurse practitioner is aware that "cold" nodules:
have an increased risk of malignancy
Cold nodules = HYPOFUNCTIONING = INCREASED risk of being malignant
The NP draws labs on a new female patient in her late 40's. In reviewing the results, the NP finds that the TSH is high and the free T4 are low. All other results are within expected ranges. This indicates that the patient most likely has
primary hypothyroidism
Which of the following is the appropriate starting dose of Levothyroxine when treating an elderly person for hypothyroidism?
25 mcg/day
Levothyroxine is administered with caution especially with the elderly because of potential worsening of which of the following conditions?
Hypertension
Which diagnostic test provides the most direct information about a thyroid nodule?
A. plain film x ray
B. ultrasound
C. Fine needle aspiration
D. CT scan
A large fleshy thyroid gland with large follicles lined by active cells is most likely indicative of
A. Hashimoto’s
B. Graves
C. Toxic goiter
D. Thyroid cancer
Increased parathyroid hormone secretion is most usually due to
A. Parathyroid adenoma
B. Toxic goiter
C. Increased TSH
D. Excessive blood levels of calcium
The NP orders a dexascan for the patient. When the results return, the test revealed a T- 2.5 result which indicates
A. normal bone scan result
B. osteoporosis
C. mild osteopenia
D. moderate osteopenia DIABETES
Therapeutic Lifestyle Changes (TC) include all the following components: TRUE
- TLC Diet: - Saturated fat <7% of calories, Cholesterol <200 mg/day
- Consider increased viscous (soluble) fiber (10-25 g/day) & plant stanols/sterols (2g/day) as therapeutic options
- Weight management
- Increased physical activity
There are several risk factors that place a patient at high risk of developing type 2 diabetes. Identify the risk factors associated directly with type 2 DM:
A. 1st degree relative DM
B. elevated BP
C. obesity or being overweight
D. All the above
The NP notes that the patient's fasting plasma glucose consistently runs between 100 - 125mg/dl. This finding is consistent with
A. Type 2 Diabetes
B. Type 1 diabetes
C. episodic hypoglycemia
D. Impaired oral glucose tolerance
Diabetes and prediabetes utilize fasting glucose to determine if the condition is present. There are several diagnostics tests to evaluate glucose. The impaired fasting glucose is one of the two conditions to determine prediabetes. The impaired fasting glucose is characterized by fasting glucose levels between:
A. 100 to 125mg/dL
B. none
C. 140-199
D. 125-140
True or False = The ADA and the WHO agree that the appropriate 2 hour post prandial plasma glucose level is 180. TRUE (<180 for diabetics and <140 for non-diabetics)
ID the risk factor from the list that is associated with more severe symptoms of diabetic neuropathy
A. decreased lipid absorption
B. young age of DM onset
C. being tall
D. newly diagnosed DN
Neuropathies are a common complication of diabetes and effect up to 50% of all diabetics. ID the most common form of neuropathy in most patients with diabetes.
A. focal neuropathies
B. cranial neuropathies
C. Distal polyneuropathy
D. plexopathies Identify the noninvasive test that provides the highest specificity for neuropathy.
A. fine microfilament
B. tuning fork
C. biothesiameter
D. coarse microfilament
All the following are secondary symptoms for DM, except:
A. Interstitial ileus
B. cardiac arrythmias
C. foot fractures
D. hammer toes
The most important treatment for slowing the progression of diabetic neuropathy is generally recognized as:
A. immediate surgical correction for s/s complications
B. Treatment with aldose reductase inhibitors
C. Tight & stable glycemic control
D. dietary supplementation
Which of the following is characterized by impaired beta cell function and diminished sensitivity to insulin
A. recurrent hypoglycemia
B. impaired glucose tolerance
C. Type 2 diabetes
D. Type 1 diabetes
Which of the following drug classes represents drugs that sensitize the body to insulin and or controls hepatic glucose production?
A. sulfonylureas
B. meglitinides
C. biguanides
D. alpha glucosidase
Thiazolidinediones and biguanides decrease glucose production in the liver & increase insulin sensitivity in peripheral body tissues. Sensitize the body to insulin = improve glucose uptake by cells --> Glucophage/Metformin! Biguaniudes = Riomet, Glumetza, Glucophage XR, and Fortamet
Thiazolidinediones = rosiglitazone, and pioglitazone
Sulfonylureas and Meglitinides stimulate the pancreatic beta cells to make more insulin. Meglitinides + Sulfonylureas = stimulate insulin. Sulfonylureas are useful only in patients with some beta cell function. Adverse effects may include weight gain and hypoglycemia. Sulfonylureas = (Glyburide, glipizide, and glimepiride)
Meglitinides = Prandin (repaglinide) and Starlix (nateglinide)
Alpha-glucosidase inhibitors slow the absorption of starches in the gut, reducing the amount of glucose that enters the bloodstream. Alpha glucosidase inhibits the breakdown of starches. Sulfonylureas are a class of drugs to treat type 2 diabetes. The key advantage of these medications is:
A. decreased insulin secretion
B. improved insulin secretion when A1c is <7.8% C. decreased insulin resistance
D. improved lipid profile
The NP starts insulin on a new type 1 diabetic using the basal/bolus approach method. The patient weighs 176 pounds. What is the starting dose of insulin glargine?
A. 18 units per day
B. 40 units per day
C. 15 units per day
D. 20 units per day
*Slide 33 of ppt DM1 describes the calculation for TDD as 0.3 to 0.5 units/kg
*Dose for initiation therapy is 1/2 TDD
176/2.2 = 80(kg) → 80*0.5 = 40 → 40/2 = 20
I’m assuming she wanted 50/50 basal/bolus? The NP will start a 72 kg new diabetic (Type 1) patient on a basal/bolus regimen. The INITIAL dose of insulin glargine for this patient would be:
a.18 Units q day
b.20 Units BID
c.22 Units q day
d.10 Units q day
Answer: 18 Units q day (72 divided by 2 divided by 2=18)
John B is a 55yo 95kg man who is newly diagnosed with type 2 DM. His A1C = 10.5%. You decide to prescribe insulin glargine to manage his DM. The recommended initial starting dose for the insulin glargine is:
A. 19 units
B. 15 units
C. 10 units
D. 5 units
Total Daily insulin Dose (TDD) = 0.3-0.5 unit/kg
Initiation = TDD/2
95*0.4 = 38 → 38/2 = 19
Managing DM can be difficult with the many options available. Identify which of the following agents is most effective in reducing the A1C levels:
A. Glitazones
B. Insulin
C. Secretagogues
D. Metformin
20 y/o male presents to the clinic for an athletic physical. He is obese BMI >85% for his age and sex. What 2 other factors would indicate the need to screen this child for Type 2 dm?
A. cousin with type 1 & obese parents
B. parents with HTN & hyperlipidemia
C. acanthosis nigricans & grandmother with type 2
D. Caucasian ethnicity and parents with hyperlipidemia
The nurse practitioner receives a thyroid nuclear scan report that states there are multiple "cold" nodules present in the thyroid. The nurse practitioner is aware that "cold" nodules:
have an increased risk of malignancy
Cold nodules = HYPOFUNCTIONING = INCREASED risk of being malignant
The NP draws labs on a new female patient in her late 40's. In reviewing the results, the NP finds that the TSH is high and the free T4 are low. All other results are within expected ranges. This indicates that the patient most likely has
primary hypothyroidism
Which of the following is the appropriate starting dose of Levothyroxine when treating an elderly person for hypothyroidism?
25 mcg/day
Levothyroxine is administered with caution especially with the elderly because of potential worsening of which of the following conditions?
Hypertension
Which diagnostic test provides the most direct information about a thyroid nodule?
A. plain film x ray
B. ultrasound
C. Fine needle aspiration
D. CT scan
A large fleshy thyroid gland with large follicles lined by active cells is most likely indicative of
A. Hashimoto’s
B. Graves
C. Toxic goiter
D. Thyroid cancer
Increased parathyroid hormone secretion is most usually due to
A. Parathyroid adenoma
B. Toxic goiter
C. Increased TSH
D. Excessive blood levels of calcium
The NP orders a dexascan for the patient. When the results return, the test revealed a T- 2.5 result which indicates
A. normal bone scan result
B. osteoporosis
C. mild osteopenia
D. moderate osteopenia DIABETES
Therapeutic Lifestyle Changes (TC) include all the following components: TRUE
- TLC Diet: - Saturated fat <7% of calories, Cholesterol <200 mg/day
- Consider increased viscous (soluble) fiber (10-25 g/day) & plant stanols/sterols (2g/day) as therapeutic options
- Weight management
- Increased physical activity
There are several risk factors that place a patient at high risk of developing type 2 diabetes. Identify the risk factors associated directly with type 2 DM:
A. 1st degree relative DM
B. elevated BP
C. obesity or being overweight
D. All the above
The NP notes that the patient's fasting plasma glucose consistently runs between 100 - 125mg/dl. This finding is consistent with
A. Type 2 Diabetes
B. Type 1 diabetes
C. episodic hypoglycemia
D. Impaired oral glucose tolerance
Diabetes and prediabetes utilize fasting glucose to determine if the condition is present. There are several diagnostics tests to evaluate glucose. The impaired fasting glucose is one of the two conditions to determine prediabetes. The impaired fasting glucose is characterized by fasting glucose levels between:
A. 100 to 125mg/dL
B. none
C. 140-199
D. 125-140
True or False = The ADA and the WHO agree that the appropriate 2 hour post prandial plasma glucose level is 180. TRUE (<180 for diabetics and <140 for non-diabetics)
ID the risk factor from the list that is associated with more severe symptoms of diabetic neuropathy
A. decreased lipid absorption
B. young age of DM onset
C. being tall
D. newly diagnosed DN
Neuropathies are a common complication of diabetes and effect up to 50% of all diabetics. ID the most common form of neuropathy in most patients with diabetes.
A. focal neuropathies
B. cranial neuropathies
C. Distal polyneuropathy
D. plexopathies Identify the noninvasive test that provides the highest specificity for neuropathy.
A. fine microfilament
B. tuning fork
C. biothesiameter
D. coarse microfilament
All the following are secondary symptoms for DM, except:
A. Interstitial ileus
B. cardiac arrythmias
C. foot fractures
D. hammer toes
The most important treatment for slowing the progression of diabetic neuropathy is generally recognized as:
A. immediate surgical correction for s/s complications
B. Treatment with aldose reductase inhibitors
C. Tight & stable glycemic control
D. dietary supplementation
Which of the following is characterized by impaired beta cell function and diminished sensitivity to insulin
A. recurrent hypoglycemia
B. impaired glucose tolerance
C. Type 2 diabetes
D. Type 1 diabetes
Which of the following drug classes represents drugs that sensitize the body to insulin and or controls hepatic glucose production?
A. sulfonylureas
B. meglitinides
C. biguanides
D. alpha glucosidase
Thiazolidinediones and biguanides decrease glucose production in the liver & increase insulin sensitivity in peripheral body tissues. Sensitize the body to insulin = improve glucose uptake by cells --> Glucophage/Metformin! Biguaniudes = Riomet, Glumetza, Glucophage XR, and Fortamet
Thiazolidinediones = rosiglitazone, and pioglitazone
Sulfonylureas and Meglitinides stimulate the pancreatic beta cells to make more insulin. Meglitinides + Sulfonylureas = stimulate insulin. Sulfonylureas are useful only in patients with some beta cell function. Adverse effects may include weight gain and hypoglycemia. Sulfonylureas = (Glyburide, glipizide, and glimepiride)
Meglitinides = Prandin (repaglinide) and Starlix (nateglinide)
Alpha-glucosidase inhibitors slow the absorption of starches in the gut, reducing the amount of glucose that enters the bloodstream. Alpha glucosidase inhibits the breakdown of starches. Sulfonylureas are a class of drugs to treat type 2 diabetes. The key advantage of these medications is:
A. decreased insulin secretion
B. improved insulin secretion when A1c is <7.8% C. decreased insulin resistance
D. improved lipid profile
The NP starts insulin on a new type 1 diabetic using the basal/bolus approach method. The patient weighs 176 pounds. What is the starting dose of insulin glargine?
A. 18 units per day
B. 40 units per day
C. 15 units per day
D. 20 units per day
*Slide 33 of ppt DM1 describes the calculation for TDD as 0.3 to 0.5 units/kg
*Dose for initiation therapy is 1/2 TDD
176/2.2 = 80(kg) → 80*0.5 = 40 → 40/2 = 20
I’m assuming she wanted 50/50 basal/bolus? The NP will start a 72 kg new diabetic (Type 1) patient on a basal/bolus regimen. The INITIAL dose of insulin glargine for this patient would be:
a.18 Units q day
b.20 Units BID
c.22 Units q day
d.10 Units q day
Answer: 18 Units q day (72 divided by 2 divided by 2=18)
John B is a 55yo 95kg man who is newly diagnosed with type 2 DM. His A1C = 10.5%. You decide to prescribe insulin glargine to manage his DM. The recommended initial starting dose for the insulin glargine is:
A. 19 units
B. 15 units
C. 10 units
D. 5 units
Total Daily insulin Dose (TDD) = 0.3-0.5 unit/kg
Initiation = TDD/2
95*0.4 = 38 → 38/2 = 19
Managing DM can be difficult with the many options available. Identify which of the following agents is most effective in reducing the A1C levels:
A. Glitazones
B. Insulin
C. Secretagogues
D. Metformin
20 y/o male presents to the clinic for an athletic physical. He is obese BMI >85% for his age and sex. What 2 other factors would indicate the need to screen this child for Type 2 dm?
A. cousin with type 1 & obese parents
B. parents with HTN & hyperlipidemia
C. acanthosis nigricans & grandmother with type 2
D. Caucasian ethnicity and parents with hyperlipidemia
