Pnp Boards 3

Front 1

Intermittent asthma

Back 1

Symptoms <2 days/week, brief exacerbations, nighttime symptoms <2 nights/month

Tx: Only when symptoms occur, quick reliever med=SABA (albuterol), systemic oral steroids if needed during exacerbation

Front 2

Mild persistent asthma

Back 2

Symptoms >2x/wk but <1x day, exacerbations affect activity, nighttime symptoms >2x/month

Tx: low dose inhaled steroid daily (Flovent), alt: cromolyn, singulair, theophylline, + SABA (albuterol) for acute exacerbations

Front 3

Moderate persistent asthma

Back 3

Daily symptoms, exacerbations are long and severely affect activity level, symptoms >1x wk at night

Tx: medium dose inhaled steroid and long acting B2 agonist, alt=singulair or theophylline + SABA (albuterol) for acute symptoms, +systemic steroids if needed

Front 4

Severe persistent asthma

Back 4

continuous symptoms, uses SABA multiple times per day, frequent exacerbations, limited physical activity

Tx: high dose ICS + long acting B2 agonist systemic steroids if needed, SABA for acute symptoms

Front 5

Dyskinetic cilia syndrome

Back 5

Causes bronchiecstasis and chronic sinusitis, a/w male infertility, if seen with situs inversus look for Kartagener’s syndrome (situs inversus, chronic sinusitis, bronchiecstasis)

Front 6

Steroids

Back 6

Reverses regulation of B receptors, prevents migration of inflammatory cells, prevents cytokine and histamine production

S/E: cough, thrush, growth suppression

Front 7

Inhaled steroids

Back 7

Fluticasone, used for long term prevention of symptoms

Front 8

Systemic

Back 8

Prednisone, use in short bursts or to prevent symptoms in severe asthmatics

Front 9

B2 Agonist

Back 9

Stimulates B2 receptors causing bronchodilation, stabilize mast cells

S/E: tachycardia, palpitations, tremors, dizziness, HA, nausea, decreased potassium, increased glucose

Front 10

Short acting B2 Agonist

Back 10

Albuterol, epinephrine used to stop symptoms of asthma

Front 11

Long acting B2 Agonist

Back 11

Formoterol/salmeterol, used to prevent symptoms, long-term

Front 12

Mast cell stabilizers

Back 12

Inhibits degranulation of mast cells and mediator release from eosinophils, neutrophils, macrophages, monocytes, do not dilate bronchioles Cromolyn/nedocromil, can be used before exercise to prevent EIA or as an additional

Tx for asthma S/E: bad taste, dry mouth, pharyngitis, cough, N, HA

Front 13

Leukotriene modifiers

Back 13

Block leukotriene synthesis to prevent allergy response, broncho constriction and mucous production Montelukast/zafirlukast/zileuton (Singulair) Used to prevent allergic rhinitis/persistent asthma

S/E: HA, nausea, abdominal pain, infection, dyspepsia, Increased ALT

Front 14

Bronchiolitis

Back 14

Bronchiole inflammation caused by viral infection, RSV, common in children <2 years, increased risk for preemies, neonates, underlying disease

Front 15

Bronchiolitis (S/S)

Back 15

Rhinitis, cough, development of respiratory distress (tachypnea, use of accessory muscles, noisy/rasp breathing, wheezes, fever), hyperinflation seen on chest X-ray

Front 16

Bronchiolitis (Tx)

Back 16

Supportive care and hospitalize if needed, Synagis to prevent RSV in high risk infants,

Front 17

Bronchitis

Back 17

Inflammation of the lower airways, can be acute or chronic

Front 18

Bronchitis (Causes)

Back 18

Viral: rhinovirus, RSV, parainfluenza

Bacterial: mycoplasma, pneumo, chlamydiophilia pneumo, pseudomonas (in kids with CF)

Front 19

Bronchitis (S/S)

Back 19

Dry cough, substernal discomfort, SOB, possible productive cough, low or no fever, URI symptoms, fine/moist rales, rhonchi

Front 20

Bronchitis (Tx)

Back 20

Supportive, antibiotics

Front 21

Croup

Back 21

Acute upper airway inflammation and obstruction, 6-36 months (peak incidence at age 2)

Front 22

Croup (S/S)

Back 22

Barking cough, URI symptoms, fever, stridor, symptoms worse at night, possible dyspnea, STEEPLE SIGN (radiologic sign)

Front 23

Croup (Tx)

Back 23

Symptomatic relief: cold, steam, humidity, corticosteroids: dexamethasone 2 mg/kg/day, bronchodilator, hospitalize if severe

Front 24

Pneumonia (Viral)

Back 24

RSV, CMV, influenza, rhinovirus (ALL AGES)

Front 25

Pneumonia (Bacterial)

Back 25

Group B strep gram (-)
Neonates: listeria

1-3 months: staph, chlamydia, strep. pneumo

4mos-5yrs: strep. pneumo, HIB, M. pneumo

>5yrs: Mycoplasma pneumo, chlamydiophilia pneumo, strep. pneumo Mycoplasma is usually mild

Front 26

Pneumonia (S/S)

Back 26

Cough, wheeze, URI symptoms, chest pain, high fever (bacterial), GI symptoms, tachypnea, crackles, pleural effusion, dullness, retractions, nasal flaring

Front 27

Cystic fibrosis

Back 27

Autosomal recessive, dysregulation of chloride channels –dehydrated viscous secretions in the airways, bile ducts, pancreas, intestines, vas deferens, sweat glands Leads to chronic pulmonary disease, nasal polyps, malnutrition, steatorrhea, biliary cirrhosis, male infertility, increased sweat production, pancreatitis, poor growth, diabetes, rectal prolapse

Front 28

Cystic fibrosis (Dx)

Back 28

Sweat test (could be from newborn screen), family history, and mutation detection

Front 29

Cystic fibrosis (Tx)

Back 29

Refer to CF center, abx to cover pseudomonas (Cipro + aercolized tobra) chest PT, pancreatic enzymes, nut support

Front 30

Hyaline membrane disease/respiratory distress syndrome

Back 30

Deficiency of surfactant=poor lung compliancy, tachypnea, grunting, nasal flaring, chest retractions, cyanosis, ground glass appearance, most common respiratory illness of the newborn

Tx: oxygen, CPAP, surfactant

Front 31

Transient tachypnea of the newborn

Back 31

Results from incomplete evacuation of fetal lung fluid in FT infants, common in C sections (no big squeeze), tachypnea, grunting, retractions, rare cyanosis

Tx: oxygen, will resolve 24-48 hours

Front 32

Bronchopulmonary dysplasia

Back 32

Infant requires oxygen at 36 weeks or greater with radiographic changes=chronic lung disease Increased incidence in LBW infants, caused by multifactorial (lung immaturity, barotrauma) Respiratory distress (cough/wheeze), poor growth/feeding, cyanotic episodes, fluid overloading

Tx: supplemental oxygen, supplemental nutrition/fluids, bronchodilators, diuretics, immunize, Synagis, decrease risk factors in environment

Front 33

Meconium aspiration syndrome

Back 33

Meconium is aspirated in utero of with first breath

Term or PT at highest risk due to placental insufficiency, tachypnea, retractions, grunting, cyanosis,

Supportive care and management of respiratory distress

Front 34

Foreign body aspiration

Back 34

Rapid onset of gagging, coughing, choking w/ subsequent stridor, wheezing, cyanosis, can be asymptomatic if object is small and non-obstructive but will cause secondary infections/symptoms

Chronic recurrent pneumonia if retained in the lung

Front 35

Intussusception

Back 35

Invagination of the bowel, sausage mass in RUQ, with emptiness in the RLQ (DANCE SIGN)

Front 36

Intussusception (S/S)

Back 36

Intermittent colicky abdominal pain, vomiting, bloody mucous stool, currant jelly stool, screaming and drawing up the legs with episodes of calm in between

Front 37

Intusussception (Tx)

Back 37

Air/barium enema to reduce DANCE SIGN—RLQ concavity due to missing bowel

Front 38

Physiologic GER

Back 38

Normal in infancy, infrequent, episodic vomiting after feeds, caused by over-feeding or lack of burping, painless, effortless with no growth abnormalities

Front 39

Pathologic GERD

Back 39

Frequent vomiting that causes FTT, esophagitis, aspiration pneumonia, Sandifer syndrome (turning head/arching back), related to other neurological disease

Dx: esophageal pH monitoring pH<4= reflux

Front 40

Treatment for GER/GERD

Back 40

Empiric therapy should be tried based on symptoms Most physiologic GER will resolve, Thicken formula, prone position after feeding, small/frequent feedings, probiotics, acid suppression therapy (antacid, H2 blockers, PROTON PUMP INHIBITORS RECOMMENDED FOR CHILDREN AS 1ST LINE AGENT) Nissen fundoplication if severe

Front 41

Clinical characteristics of lactose intolerance

Back 41

Abdominal pain, diarrhea, nausea, flatulence, and bloating occur after ingesting lactose, can be due to primary or secondary lactase deficiency

Front 42

Lactose intolerance (Dx)

Back 42

Lactose/sucrose, breath hydrogen ion testing, lactose free trial resolves symptoms

Front 43

Cow’s milk protein intolerance

Back 43

Non-IgE mediated, CMP not broken down

Front 44

Cow’s mile protein allergy

Back 44

IgE mediated, causes antibody production, can have GI symptoms (bloody stool, diarrhea, vomiting, food refusal) skin symptoms (atopy, hives) resp (cough/wheeze) or anaphylaxis

Front 45

Cow’s milk protein intolerance/allergy (Dx)

Back 45

Food challenge, clinical improvement on CMP free diet, CMPI resolves by 1-3 years, CMA will continue for life

Front 46

Toddler’s diarrhea

Back 46

Chronic diarrhea with no definite cause in a child 6-24 months, with normal growth, usually caused by increased carbs, decreased fat & protein—causing osmotic diarrhea

Tx: Normalize diet, eliminate sorbitol containing fluids, remove offending foods/fluids

Front 47

Appendicitis

Back 47

Pain preceded vomiting—usually only one or two times, vague periumbilical pain that moves to the RLQ, Can be complicated by variable bowel changes, anorexia, and fever, if perforates pain will improve but fever will develop and abdomen will be tense Guarding/rebound tenderness over McBurney’s (RLQ) point (+) Rovsing, obdurator, markle jar heel test, heel strike, and psoas signs

Front 48

Appendicitis (Dx)

Back 48

Ultrasound, CT is gold standard, may have increased WBC

Front 49

Rovsing sign

Back 49

Pressure on LLQ causes pain in RLQ

Front 50

Psoas sign

Back 50

Patient on left side, extend/flex right leg/hip causes pain = (+)

Front 51

Obdurator sign

Back 51

Internally rotate right leg/hip causes pain = (+)

Front 52

Markle jar heel test

Back 52

Stand on toes, drop to heels=pain

Front 53

Celiac disease

Back 53

Most common malabsorption syndrome, inflammatory reaction caused by gluten=intestinal damage Impaired growth, diarrhea, steatorrhea, abdominal distention, wasting, fatigue, delayed puberty, anemia, dermatitis herpeticum, enamel hypoplasia

Front 54

Celiac disease (Dx)

Back 54

Endoscopy/biopsy=definitive diagnosis Lab testing: preferred test: Anti-tissue transglutaminase antibodies (tTG)-IgA, total IgA level

Front 55

Celiac disease (Tx)

Back 55

Restrict gluten from diet

Front 56

Infantile colic

Back 56

Persistent crying in an infant <3 months of age, cries 3 hours/day 3 days/week, is inconsolable and keeps legs stiff and fists clenched

Tx: is supportive, colic will resolve over time Diet alterations, limit overstimulation, use crib vibrators, infant massage as needed, provide support to parents, swaddle

Front 57

Ulcerative colitis

Back 57

Inflammation of the colon

Front 58

UC (S/S)

Back 58

Bloody diarrhea, weight loss, delayed growth, anorexia, arthritis, abdominal pain, oral ulcers, skin lesions

Front 59

UC (Dx)

Back 59

ESR, CRP, CBC, colonoscopy, endoscopy=definitive dx

Front 60

UC (Tx)

Back 60

Elemental diet, aminosalicylates, steroids, immune modulators, surgery, monitor nutrition/growth, refer to ophthalmology, stool for fecocalprotectin

Front 61

Meckel diverticula

Back 61

Ectopic gastric mucosa within the diverticulum, common source of significant lower GI bleeding—usually painless but can cause large blood loss

Front 62

Giardia

Back 62

Flagellate protozoan, found in contaminated water and food, fecal-oral spread, seen in childcare and deviation disability settings, incubation 1-4 weeks, may be asymptomatic

Front 63

Giardia (S/S)

Back 63

Cramps, flatulence, bloating, anorexia, weight loss, diarrhea is watery/greasy. foul can be debilitating and long term

Front 64

Giardia (Tx)

Back 64

Metronidazole 15 mg/kg/day for 5 days alt: nitazoxanide, tinidazole

Front 65

Peptic ulcer disease

Back 65

Mucosal defects in the stomach/duodenum; can be idiopathic PRIMARY (DUODENUM) SECONDARY (STOMACH), H.pylori and CMV can also be a cause

Front 66

Peptic ulcer disease Major Criteria

Back 66

Abdominal pain and recurrent vomiting

Front 67

Peptic ulcer disease Minor criteria

Back 67

Hematemesis, heartburn, anorexia, nausea, increased belching/hiccups, anemia, guaiac +

Front 68

Peptic ulcer disease (Dx)

Back 68

Endoscopy=standard + biopsy (stool antigen test can be used in primary care)

Front 69

Peptic ulcer disease (Tx)

Back 69

Antacids (1st line), Amoxicillin, clarithromycin, omeprazole

Front 70

Pinworms (enterobious vermicularis)

Back 70

Pinworms (nematodes), roundworms (white, threadlike 1 cm) Preschool most common, often occurs in families, causes perianal/vaginal itching, urthritis, vaginitis, salpingitis rare complications

Tx: Mebendazole 100 mg/dose, repeat in 2 weeks, pyrantel pamoate 11 mg/kg, repeat in 2 weeks Wash hands/sheets/bedding

Front 71

Pyloric stenosis

Back 71

Thickening of the pylorus muscle leading obstruction—PYLORIC OLIVE—RUQ hard mobile mass Presents between 3 weeks and 4 months of age, vigorous, projectile vomiting after eating with weight loss, constipation, dehydration—Surgically corrected

Front 72

Pyloric stenosis

Back 72

STRING SIGN, elongated pyloric channel and delayed emptying seen on upper GI

Front 73

Crohn’s disease

Back 73

Chronic IBD, causes skip areas, can affect entire GI tract

Hx: Weight loss, delayed growth, large joint pain, abdominal pain, bloating after meals, diarrhea, jaundice, mouth sores, extraintestinal signs can be seen—eye involvement, +family history

Front 74

Crohn’s Dx

Back 74

ESR and CRP, nutrition labs, CBC, LFT, stool culture, bone age, upper GI, CT with contrast, endoscopy= definitive dx

Front 75

Crohns Tx

Back 75

Anti-diarrheals, corticosteroids, aminosalicylates, immune modulators, probiotics, antibiotics, surgery PRN, refer to optho

Front 76

Hirschsprungs disease

Back 76

Aganglionic megacolon, no stool in first 48 hours of life, severe constipation, FTT, abdominal distention, abnormal rectal anatomy, ant scrotal placement, vomiting, abnormal stool quality, empty ampulla upon exam with exposure evacuation upon removal—less common today, consider with intractable constipation

Front 77

Mild dehydration

Back 77

3-5% weight loss, thirst, cap refill >2 sec, slight decrease in urine production

Front 78

Moderate dehydration

Back 78

5-10% weight loss, slight increase in HR, >10 mmHg change in BP, irritable/thirsty, dry membranes/tears, norm-sunken fontanel, decreased cap refill (2-4 sec), decreased urine output >8-12 hours, SG >1.02

Front 79

Severe dehydration

Back 79

10-15% weight loss, increased HR, orthostatic BP (shock), irritability-lethargic, intense thirst, dry MM, sunken eyes/fontanel, cap refill >4 sec, oliguria/anuria

Front 80

Shock

Back 80

15% weight loss, increased HR, weak, unresponsive, dizzy cap refill >4 sec, anuria, acrocyanotic

Front 81

UTI

Back 81

Most common organism is E.Coli

Front 82

UTI Infants/Neonates

Back 82

Jaundice, hypothermia, FTT, sepsis, V/D, abdominal distension, lethargy, malaise, poor feeding, fever, malodor urine, dribbling

Front 83

UTI Toddlers/Young children

Back 83

Malodor urine, change in voiding, abdominal or flakn pain, enuresis, V/D (think pyelo), fever, diaper rash

Front 84

UTI School age/adolescent

Back 84

Dysuria with frequency, malodor, enuresis, abdominal or flank pain, fever, V/D (think pyelo), malaise

Front 85

UTI Dx

Back 85

Sterile cath in young children (+) nitrites, (+) leukocytes= suspicious, culture must conform diagnosis

Front 86

UTI Tx

Back 86

Afebrile UTI: Bactrim, alt Amoxil x 10 days, other alt= Augmentin, nitrofurantoin, Follow up culture: 48-72 hours after tx is started, pyridium can be given for >6 years for dysuria, pyelonephritis: hospitalize for IV abx

Front 87

Hypospadias

Back 87

Congenital abnormality of the urethral meatus, can be located anywhere along the penis or perineum Tx: surgical repair and circumcision

Front 88

Hydrocele

Back 88

Painless collection of serous fluid in the scrotal sac, can be communicating (fluid moves from abdomen to scrotum) or non-communicating (fluid only in scrotum)

Front 89

Hydrocele (S/S)

Back 89

Asymmetry of the scrotum, unilateral swelling, translucent on transillumination, can be tense, blue, and non-reducible if non-communicating

Front 90

Hydrocele (Tx)

Back 90

Non-communicating (no Tx, fluid will reabsorb, refer if fluid persists) communicating (refer for surgical repair due to HERNIA risk)

Front 91

Cryptorchidism

Back 91

Testicle that does not reside/manipulate into the scrotum, can be gliding/ectopic/or ascended, #1 GU d/o in males, empty scrotum, testicle that moves in and out of scrotum

Front 92

Cryptorchidism (Tx)

Back 92

Refer for surgical repair, esp. if age >6 mos, after 1 year requires immediate referral

Front 93

Phimosis

Back 93

Foreskin too tight to be retracted, tight pinpoint opening to foreskin, thickened rolled foreskin

Front 94

Paraphimosis

Back 94

Retracted foreskin that cannot be reduced, edema/blue color of the glans

Front 95

Phimosis/paraphimosis (Tx)

Back 95

Cleanse foreskin, betamethasone cream for phimosis, ice, surgical release for paraphimosis

Front 96

Varicocele

Back 96

Benign enlargement/dilation of testicular veins, “bag of worms,” painless scrotal mass S/S painless swelling, bag of worms texture,

Dx: US to r/o malignancy Tx: monitor, refer if large or painful

Front 97

Testicular torsion

Back 97

Twisting of the testis leads to ischemic injury S/S: unilateral pain that starts acutely and gradually worsens, ill-appearing, anxious, testis can be swollen/erythematous, absent cremastearic reflex on affected side

tx: surgical emergency

Front 98

Epididymitis

Back 98

Painful/acute inflammation of the epididymis often cause by n. gonorrhea, or chlamydia

S/S: scrotal edema/erythema, epididymis is hard, indurated and tender, PREHN’s sign (elevation of testis relieves pain), possible urethral discharge

Tx: bed rest, scrotal support, site baths, NSAIDS, abx tx (ceftriaxone & doxy, alt=Levofloxacin) refer if does not resolve

Front 99

Labial fusion

Back 99

Fusion of the tissue between labia minora, most common in girls 3 mo-6 years

S/S: think, flat membrane found of varying length, degree of opening varies

Tx: Observation (can resolve with puberty) A&D ointment with pressure, estrogen cream 1%, only need to separate if impending vaginal/urine drainage, parental concern or prolonged

Front 100

Vulvovaginitis

Back 100

Inflammation with discharge from infection or irritation caused by non-specific, bacterial, fungal, FB or pinworms

S/S: itching, irritation, discharge, urinary complaints

Tx: Depend on cause, abx, anti-fungals, avoid exacerbating factors

Front 101

Bacterial vaginosis

Back 101

Caused by gardnerella vaginosis/anaerobic bacteria, can be sexually transmitted, replaces normal vaginal fauna S/S foul odor, milky/white discharge, can be asymptomatic

Dx: pH >4.5, (+) whiff test= fish odor + clue cells

Tx: metronidazole 500 mg BID PO x & days or metronidazole gel X 5 days or clindamycin cream X 7 days

Front 102

Primary amenorrhea

Back 102

Absence of menarche by 16 years with normal puberty or by 14 years with no sexual secondary characteristics, caused by: delayed puberty, chronic illness, eating disorder, exercise, outflow obstruction, PCOS tumor, medications, drugs

Front 103

Secondary amenorrhea

Back 103

Absence of menses for 3 cycles or 6 months, caused by: pysch d/o, eating d/o, pituitary dz, pregnancy, exercise, PCOS, hypothyroid

Front 104

Pregnancy

Back 104

Amenorrhea, light short bleeding, N/V, urinary frequency, breast pain, abdominal fullness, weight gain/weight loss Dx: Serum HCG, post conception 48 hours, urine HCG 2-4 days post conception

Front 105

Hegar sign

Back 105

Cervical softening (2-3 months pregnant)

Front 106

Goodell sign

Back 106

softening of vaginal portion of the cervix

Front 107

Chadwick sign

Back 107

Blue cervix, vaginal, vulva

Front 108

Turners Syndrome

Back 108

XO karyotype with developmental cardiac, reproductive, genetic, and psyh issue; female with unexplained growth or pubertal delay, males can transmit gene (many affected embryos don’t live to term)

Front 109

Turners (S/S)

Back 109

Edema of hands/feet, nuchal folds (webbed neck), left sided cardiac anomalies, esp CO-ARC or HLH, low hairline, high palate, low ears, small mandible, short stature, Increased FSH, cubitus valgus, multiple pigmented nevi, short 4th metacarpal, no secondary sex characteristics

Front 110

Turners (Tests and Tx)

Back 110

Endocrine, psych, special ed if needed, cardio, ophtho, ENT, orthodontist, urology, screen for celiac

Front 111

Short stature pathological causes

Back 111

Chromosomal abnormalities, chronic disease, malnutrition, psychosocial deprivation, drugs, endocrine d/o’s (growth hormone deficiency, glucocorticoid excess, hypothyroidism)

Front 112

History factors that are important to elicit

Back 112

Signs of illness or malnutrition, chronic illness, timing of puberty, familial growth pattern, social stressor, use of medication

Front 113

Physical exam: short stature

Back 113

Signs of illness or malnutrition, stigma of Cushing’s syndrome, hypothyroidism, prader-willi, turner

Front 114

Hypothyroidism S/S @ birth

Back 114

No obvious signs during the first month of life; as infancy progresses: lethargy, growth deceleration, large fontanels, bradycardia, hypotonia, large tongue

Front 115

Hypothyroidism (older children)

Back 115

Weakness, muscle fatigue, poor growth, arthralgias, cramps, cold intolerance, constipation, weight gain, mental physical sluggishness, poor motor coordination, dry skin, thinning hair and brittle nails, puffy eyes, thick tongue, edema of hands and feet, alopecia, decreased DTR, hypoactive bowel sounds and diminished heart sounds

Front 116

Work up for short stature

Back 116

Bone age is helpful in making sure that the child does not have constitutional growth delay, Insulin growth factor (IGF-1), karyotype, thyroid functions, tissue transglutaminase for celiac disease, stool for O &P, sweat test, UA, head MRI

Front 117

Workup for hypothyroidism

Back 117

Elevated TSH, T4 and free T4 are both low or normal, increased liver enzymes, hyponatremia, hypoglycemia, anemia, T3 is not a good test for hypothyroidism

Front 118

Signs of constitutional growth delay

Back 118

While familial short stature looks like constitutional growth delay early on there is a difference in both bone age and pubertal staging.

Children with constitutional growth delay, there is a delay in bone age as well as puberty and they attain normal adult height

Familial short stature: normal pubertal timing, bone age is the same as chronological age, final heigh is decreased from normal

Front 119

Signs of abnormal growth in children

Back 119

If the growth falls off the curve by 2 SD, and is not between the mid parental height

Front 120

Growth failure

Back 120

Height falling from >2 SD below mean or from previously established growth, failure to grow more than 4 cm per year, being at 5th percentile or lower

Front 121

Type 1 diabetes

Back 121

Human leukocyte antigens, circulation islet cell antibodies can be found during the first few weeks

Front 122

Triggers Type 1 DM

Back 122

Infectious or toxic agents are thought to trigger the pancreatic B cells in predisposed people

Front 123

S/S type 1 DM

Back 123

Polydypsia, polyphagia, polyuria, nocturnal enuresis, weight loss and hunger, fatigue, weakness, and paresthesia, loss of subcutaneous fat and muscle wasting, peripheral neuropathy, skin & vaginal infection

Front 124

Diagnostic testing type 1 DM

Back 124

Serum fasting blood sugar >126 mg/dL on 2 separate occasions, random sugar of greater than 200 with polyuria, polydipsia, and weight loss, plasma ketones, BUN, creatinine may be elevated

Front 125

Impaired glucose tolerance

Back 125

Fasting blood glucose between 100 and 125

Front 126

Conventional split dose insulin

Back 126

2/3NPH and 1/3 regular insulin in AM, evening dose of ½ NPH and ½ regular.

Front 127

Somogyi effect

Back 127

Early AM hyperglycemia due to nocturnal hypoglycemia, hypoglycemia stimulates a surge of counter regulatory hormones that raise blood sugar, hypoglycemic at 3 AM and elevated BS at 7AM

Tx: reduce or eliminate the HS insulin

Front 128

Dawn phenomenon

Back 128

Tissue is desensitized to insulin nocturnally, blood sugar is progressively higher through the night and is elevated at 7Am, due to presence of growth hormone at night.

Tx: Add or increase the dose of HS insulin

Front 129

Type 2 DM

Back 129

90% of diabetes, not linked to HLA or islet cell antibodies, obesity & family history are factor

Front 130

Type 2 DM tx

Back 130

Metformin 500 mg TID or 850 BID

Front 131

Hyperthyroidism or graves disease

Back 131

Diffuse enlargement of the thyroid, can be from toxic adenoma, subacute thyroiditis, TSH secreting tumor, high dose amiodarone

Front 132

Hyperthyroidism Tx

Back 132

Propanalolol for symptoms, methimazole 30-60 mg per day, proplthiouracil 300 mg to 600 mg daily, radioactive iodine