Im Endo Diabetes Usmle 2

Front 1

What are the corresponding blood glucose levels to HbA1c of:
1. 6
2. 7
3. 8
4. 9

Back 1

1. 120

2. 150

3. 180

4. 210

Front 2

Definition:
Hyperglycemia resulting from the autoimmune distruction of the insulin-producing beta cells of the pancreas

Back 2

DM-1

Front 3

most common HLA genotypes in DM-1
(2)

Back 3

HLA DR3

HLA DR4

Front 4

Dx:
woman has a recurrent vaginal candidiasis that is refractory to treatment

what test should be done?

Back 4

Diabetes mellitus


Get a blood glucose

Front 5

Antibody types for DM-1
(2)

Back 5

Anti-cytoplasmic Ab against:

Beta cells

and

Glutamic Acid Carboxylate (GAD)

Front 6

(2) environmental factors that may play a role in the etiology of DM-1

Back 6

Viral infection


Exposure to cow's milk during infancy

Front 7

(3) Viral infections that may play a role in the etiology of DM-1

Back 7

Congenital Rubella

Mumps

Coxsackie B

Front 8

Dx:
polyuria, polydipsia, weight loss, dehydration, blurred vision, fatigue

Back 8

DM-1

Front 9

Dx tests for Diabetes
(3)

Back 9

1. Fasting glucose > 126

2. Random plasma glucose > 200

3. HbA1c > 7%

Front 10

(4)* Bugs that occur in DM patients due to their decreased efficacy of granulocytes

Back 10

MA and PA:

Mucormycoses;

Actinomycoses;

Pseudomonas;

Aspergillosis (pneumonia)

Hint 10

MA and PA

Front 11

How do you determine the time the daily dose of insulin (NPH or 70/30 preparations) is given for a DM-1 patient?

Back 11

Give 2/3 daily dose before breakfast

Give 1/3 daily dose before dinner

Front 12

How should new DM-1 patients monitor their glucose?

Back 12

Finger-stick levels 5 times a day:
morning fasting;
breakfast postprandial;
lunch postprandial;
dinner postprandial;
before bed

Front 13

Which insulin preparation is considered "Rapid-acting" and used right before meals?
(2)

List:
- Onset of action
- Peak action
- Duration of action

Back 13

Humalog or Lispro

Onset of action = 15 min

Peak action = 60 min (ave 30-90 min)

Duration of action = 3 hr (ave 2-4 hr)

Front 14

Regular insulin:

- Onset of action

- Peak action

- Duration of action

Back 14

Onset of action = 30-60 min

Peak action = 2-4 hr

Duration of action = 6-8 hr

Front 15

(2) Intermediate-acting Insulin preparations
List:
- Onset of action
- Peak action
- Duration of action

Back 15

NPH and Lente

Onset of action = 1-3 hr

Peak action = 6-12 hr

Duration of action = 18-26 hr

Front 16

(2) Long-Acting Insulin preparations
List:
- Onset of action
- Peak action
- Duration of action

Back 16

Ultralente and PZI

Onset of action = 4-8 hr

Peak action = 14-24 hr

Duration of action = 24+

Front 17

Longest acting Insulin preparation
(2 names)
List:
- Onset of action
- Peak action
- Duration of action

Back 17

Glaragine (Lantus)

Onset of action = 1 hr

Peak action = no peak

Duration of action = 24+

Front 18

Definition:
exaggeration of the normal tendancy of plasma glucose to rise in the early morning hours before breakfast

what may it be caused by?

First step in Tx?

Back 18

Dawn phenomenon


By: inc in GH secretion

Tx:
move nighttime insulin closer to bedtime

Front 19

what is "postprandial"?

Back 19

2 hours after meal

Front 20

Definition:
nighttime hypoglycemia followed by dramatic inc in fasting glucose levels and inc plasma ketones

what confirms dx?

Tx?

Back 20

Somogyi Effect

confirms: Hypoglycemia at 3am

Tx: give Long-acting insulin at bedtime (instead of NPH)

Front 21

Dx:
patient presents w/ persistent morning hyperglycemia, despite increasing his nighttime NPH insulin dose. He complains of frequent nightmares and his wife witnessed him having a seizure in the middle of the night

Back 21

Somogyi effect

Front 22

MC negative complication w/:

1. DM-1

2. DM-2

Back 22

1. DKA


2. Non-Ketonic Hyperglycemic Hyperosmolar Coma (NKHC)

[either can occur w/ either DM]

Front 23

What type of immunity is impaired w/ diabetes?

what type of infections can this lead to?

Back 23

Cell-mediated immunity


leads to: Fungal infections

Front 24

What should be done if the am finger-sticks show hypoglycemia?

Back 24

decrease the bedtime NPH even if the bedtime finger-sticks are high

Front 25

(3) causes of DM-2 hyperglycemia

Back 25

1. Impaired secretion of Insulin

2. Decreased insulin effectiveness at glucose uptake

3. Impaired inhibition of hepatic gluconeogenesis

Front 26

How can hyperglycemia cause further glucose intolerance?
(2)

Back 26

1. it Decreases insulin sensitivity

2. it Increases hepatic glucose production

Front 27

Drug class of Metformin

MOA (3)

AE

Back 27

Biguanides

MOA:
sensitizes skeletal muscle and fat to insulin;
Dec hepatic gluconeogenesis;
Dec GIT absorption

AE: Lactic Acidosis

Front 28

(4)* drugs in Sulfonylurea class

Back 28

Goes To Cancel Glucose:

Glyburide;

Tolbutamide;

Chlorpropamide;

Glipizide

Hint 28

Goes To Cancel Glucose

Front 29

MOA of Sulfonylureas

AE

Back 29

MOA:
increase postprandial insulin secretion from beta cells

AE:
Hypoglycemia

Front 30

(3) drugs in the Thiazolidinediones class

Back 30

GLITAZONES:

Troglitazone;

Rosiglitazone;

Pioglitazone

Front 31

(2) MOA of the Thiazolidinediones

AE

Back 31

MOA:
Reduces insulin resistance;
dec. hepatic glucose output

AE:
Hepatotoxicity

Front 32

Example of an Alpha-glucosidase inhibitor

MOA

AE

Back 32

Example:
Acarbose

MOA:
inhibits monosaccharides and oligosaccharide hydrolysis in the small intestines

AE:
Diarrhea and nausea (and farting)

Front 33

MC combination of DM oral drugs
(plus 2 drugs in it)

Back 33

Glucovance

(Metformin + Glyburide)

Front 34

Basic Etiology behind DKA

Back 34

Severe insulin deficiency causes body to switch from metabolizing carbs to metabolizing and oxidizing lipids

Front 35

What (2) ketones are produced w/ DKA?

what is normal raio of these two?

ratio in DKA?

Back 35

Beta-hydroxybutyric Acid (BOH)

Acetoacetic Acid

Normal ratio: 3:1

DKA ratio: 8:1

Front 36

Pathophysiology of DKA and how it leads to "fruity breath"
(4)

Back 36

1. insulin deficiency causes hyperglycemia -> osmotic diuresis
2. loss of fluids, Na and K
3. inhibition of FFA oxidation in liver -> ketosis
4. Met Acidosis results in respiratory compensation and blowing off of breakdown products (acetone)

Front 37

Dx:
dehydration, polyuria, N/V, rapid deep (Kussmal) breathing, + anion gap, scent to breath

Back 37

DKA

Front 38

(3) main parts of Dx DKA

Back 38

D: high glucose (400-800 mg)

K: + Ketones

A: pH < 7.3 (inititially casues K to rise)

Front 39

(3) Tx rules for DKA

Back 39

1. Hydrate (usu 3-4L loss): replace w/ NS

2. Insulin (and glucose if pt becomes normoglycemic)

3. Replace K

Front 40

Causes of death w/ DKA
(3)

Back 40

circulatory failure;

HypoK;

Infection

Front 41

MC DM-2 patient profile to get Nonketotic Hyperosmolar Coma

Back 41

DM-2 nursing home patient

Front 42

Etiology of Nonketotic Hyperosmolar Coma
(4--2 are drugs)

Back 42

Sepsis;

Dehydration;

Diuretics;

Glucocorticoids

Front 43

Sx:
Altered mental status, signs of profound dehydration, neurologic deficits, DM-2

Back 43

Nonketotic Hyperosmolar Coma

Front 44

What is serum glucose levels for Nonketotic Hyperosmolar Coma?
serum Osmolarity?
what is the other indicator, with relation to the kidneys?

Back 44

glucose > 1000 mg/dL

serum osmloarity around 385 mOsm/kg

Pre-renal Azotemia: BUN/creatinine levels are increased

Front 45

Tx for Nonketotic Hyperosmolar Coma
(3)

Back 45

1. Expand IV volume: infuse 2-3L NS over 1-2hrs

2. K replacement

3. withhold insulin therapy for up to 1 hour
(to help w/ IV osmolality)

Front 46

Whipple's triad of Hypoglycemia

Back 46

1. plasma glucose < 60mg/dL

2. Sx of hypoglycemia

3. improvement of Sx w/ Glucose

Front 47

MCC of altered mental status in Healthcare environments

Back 47

Hypoglycemia

Front 48

Etiology of Hypoglycemia
(6)*

Back 48

DIAL HI:
1. Drug induced
2. Islet cell tumor/adenoma
3. Adrenal insufficiency
4. Liver/renal Dz (severe)
5. Hypopituitarism from low GH and cortisol
6. Insulin receptor Ab

Hint 48

DIAL HI

Front 49

Dx:
possible Hx of insulin or sulfonylurea Tx, adrenergic Sx (diaphoresis, anxiety, tremor, hunger, palpitations); confusion, inappropriate behavior, mistaken for alcohol intoxication

Back 49

Hypoglycemia

Front 50

Dx Tests for Hypoglycemia
(2)

Back 50

1. Low serum glucose < 50mg/dL

2. ask lab to test C-peptide to distinguish b/t Endogenous insulin (high C-peptide) or Exogenous insulin(low)

Front 51

If alcoholism or nutritional deficiency is a suspected reason for hypoglycemia, what should be placed w/ the IV of dextrose?
Why?

Back 51

Thiamine

to prevent Wernicke's encephalopathy

Front 52

Hospital Tx for Hypoglycemia
(3 steps)

Back 52

1. IV amp of 50% dextrose

2. if no improvement, give a second amp

3. continue to infuse 10% dextrose until serum glucose is > 100mg/dL

Front 53

if hypoglycemia is refractory after Tx and there are associated signs of adrenal insufficiency, what is Tx?

Back 53

give Hyrdocortisone 100-200mg IV

Front 54

what is used to resuscitate hypoglycemic coma?

what type of patient will this Tx not work on?

Back 54

Glucagon IM

won't work on Alcoholic w/ liver failure

Front 55

What does a glucagonoma present with?
(3)

Back 55

1. new-onset DM

2. weight loss

3. characteristic rash (necrolytic migratory erythema)

Front 56

How is insulin related to Catecholamines?
(2)

Back 56

1. Inc insulin leads to hypoglycemia, leading to tachycardia, sweating and anxiety

2. Pheochomocytoma patient have inc risk of hyperglycemia and DM

Front 57

How does Cortisol relate to glucose levels?
(2)

Back 57

1. Too much cortisol (Cushings) leads to hyperglycemia and DM

2. Too little cortisol (Addisons) leads to hypoglycemia

Front 58

How does GH relate to glucose levels?
(2)

Back 58

1. high GH in acromegaly, leads to hyperglycemia and DM

2. neonatal hypoglycemia is a cardinal sign of GH deficiency

Front 59

List the 5 signs (any 3 of which can confirm Dx) to properly Dx Metabolic syndrome

Back 59

1. Fasting glucose > 110 mg/dL
2. Abdominal obesity
3. Serum TG > 150 mg/dL
4. HDL-C < 40 in men and < 50 in women
5. Blood Pressure > 130/85 (or on BP meds)