Review Questions 1B

Front 1

What would be included in the clinical presentation of Cushing’s syndrome?

Back 1

Rapid weight gain, loss of menses, decreased libido, bruising, hypertension, glucose intolerance, weakness, insomnia, memory disturbances, and mental health disturbances.

Cushing’s syndrome almost always presents with chronic changes. Rapid weight loss, loss of menses, decreased libido, weakness, and bruising are all possible presenting symptoms. Many have hypertension, glucose intolerance, and insomnia. Memory and mental health disturbances occur in 50% of patients.

Front 2

Stephanie is a 37 year old female at a follow up appointment for HbA1C of 8%. You begin her on metformin and lifestyle modifications. What would be the most effective Step 2 intervention to implement to the management of her type 2 diabetes?

Back 2

Basal insulin.

If HbA1C >7% go to Step 2 of Management of type 2 diabetes; this step includes basal insulin as most effective compared to sulfonylurea and thiazolidinedione.

Front 3

Chris is a 29 year old female who presents to the clinic with complaints of irregular menses with a lighter flow than usual and thinning hair. She has been on a strict weight loss program and has lost 30 pounds in the past two months. Upon further questioning she informs you that she has been sweating excessively and especially notices it at night when she needs to change her pajamas in the middle of the night. Her lab work shows her T4 and T3 level is increased and her TSH level is decreased. What is the most likely diagnosis for Chris?

Back 3

Hyperthyroidism

Although clinical presentation of hyperthyroidism varies, the symptoms are secondary to hyper stimulation of the sympathetic nervous system and increased catabolism, it commonly presents in women between the ages of 20 to 40 years, and thyroid function tests reveal elevated T4 and T3 levels with a significantly diminished TSH level (Braimon & Hislop-Chestnut, 2013).

Front 4

Signs of virilism vs. hirsutism are:

Back 4

Voice deepening, terminal hair on the upper back, shoulders, or upper abdomen, increased muscle mass, and clitoromegaly.

Terminal hair on the upper back, shoulders, or upper abdomen delineates virilism, as does a deepened voice, increased muscle mass, and clitoromegaly (Buttaro, 2008, p. 1086).

Front 5

You are meeting a patient in your primary care practice for the first time. The patient complaints and exam lead to an assessment diagnosis of Addison’s disease. Your note would include which of the following?

A. Patient complains of joint pain, excess sweating, headache, snoring, deepening voice and weight gain. PE findings include: enlarged facial features, enlarged tongue and uvula, hypertension
B. Patient reports feeling tired and dizzy. Describes chronic abdominal pain, nausea, and muscle cramps. Patient reports weight loss and constant salt craving. On PE patient appears chronically ill, dehydrated and displays skin darkening on palms, elbows, knees, and lips.
C. Patient reports rapid weight gain, weakness, insomnia, and multiple bruises appearing without injury. PE shows central obesity, thickening facial fat, muscle weakness, and hirsutism.
D. Patient complains of headache, diaphoresis, and palpitations occurring a 1-2 times per week over the last month. On PE you discover new onset of severe HTN.

Back 5

A. Patient complains of joint pain, excess sweating, headache, snoring, deepening voice and weight gain. PE findings include: enlarged facial features, enlarged tongue and uvula, hypertension. These all would be expected findings in acromegaly.

**B. Patient reports feeling tired and dizzy. Describes chronic abdominal pain, nausea, and muscle cramps. Patient reports weight loss and constant salt craving. On PE patient appears chronically ill, dehydrated and displays skin darkening on palms, elbows, knees, and lips. These are expected clinical findings of Addison’s Disease.

C. Patient reports rapid weight gain, weakness, insomnia, and multiple bruises appearing without injury. PE shows central obesity, thickening facial fat, muscle weakness, and hirsutism. These are all findings of Cushing's Syndrome.

D. Patient complains of headache, diaphoresis, and palpitations occurring a 1-2 times per week over the last month. On PE you discover new onset of severe HTN. These findings are typical presentation of a patient with Pheochromocytoma.

Front 6

You are caring for a newly diagnosed Type 2 diabetic patient in your clinical setting. Your preceptor asks you what the first step of your plan to manage this condition would be. Which of the following would the best response?

A.“I would recommend lifestyle modifications along with starting a metformin”
B. “ I recommend lifestyle modifications and starting low dose basal insulin”
C.“I recommend we encourage the patient to eat healthy, get regular exercise, and loose weight”
D. “ I recommend lifestyle modifications along with starting glipizide”

Back 6

**A. “I would recommend lifestyle modifications along with starting a metformin.”

Front 7

A condition where there is an excessive secretion of growth hormone that results in excessive bone growth and soft tissue growth is?

Back 7

Acromegaly

Acromegaly is usually caused by a pituitary adenoma which causes excess secretion of growth hormone. The excess growth hormone in turn causes excess growth of bone and soft tissue (Buttaro, 2011).

Front 8

A 40 year old obese male presents to the clinic for his annual wellness check. Along with an H&P you decide to draw an A1C due to some concerns on his part about familial diabetes and his weight. His A1C is 7.2%. What is the best course of action?

Back 8

Lifestyle modification and metformin

Lifestyle modification should be standard for any medical condition and this includes eating a healthy diet and regular exercise. Metformin is the most common first line oral medication for type 2 diabetes (Buttaro, 2011).

Front 9

Mr. Adams, a 55 year old patient with type 2 diabetes and heart failure, has been under your care for several years. His diabetes has been well controlled with metformin 1,000mg BID, and lifestyle interventions. After a routine follow-up with Mr. Adams you note his A1C is 7.5. What is the appropriate response to this lab value?

Back 9

Addition of basal insulin or a sulfonyureal.

An A1C value ≥ 7% should be “a call to action.” According to Wood (2013), if A1C is not controlled with metformin and lifestyle changes the next step is to add basal insulin, a sulfonyureal, or a TZD. However, TZDs are contraindicated in HF.

Front 10

Due to the disease process, your patient with Cushing's syndrome might require which test at an earlier age than usual? A. DEXA scan B. EKG C. Pap Smear D. Colonoscopy

Back 10

A. DEXA scan

Patients with Cushing's syndrome have chronically high glucocorticoid levels, and these high levels are associated with osteoporosis (Robinson, 2008, p. 1060). The timing of an EKG, Pap smear, or colonoscopy would not be affected by Cushing's syndrome.

Front 11

Sara is a 23 year old female. She presented to clinic a month and a half ago with complaint of “always feeling cold and tired.” She also had a 10lb weight gain despite eating healthy and exercising regularly. Her TSH level was above normal and Sara was diagnosed with hypothyroidism and started on Synthroid (100mcg daily). She is back today for a follow up and lab work. Her TSH level is 2.0 µIU/L. Based on her TSH level, would in increase, decrease, or continue her current dose of Synthroid?

Back 11

Continue current dose of synthroid.

A TSH level less than 0.3 indicates hyperthyroidism, a TSH > 4 indicates hypothyroidism and a TSH of 0.3-4 indicates euthyroid (normal). Based on a TSH of 2.0 µIU/L, patient is therapeutic on the current dose of Synthroid and no medication adjustments are necessary.

Front 12

Dennis is a 50 year old male who was diagnosed with diabetes after his hemoglobin A1C level was found to be 7.5%. Dennis does not drink alcohol and does not have a past cardiac history. You would like to start him on an oral hypoglycemic agent. Since Metformin is typically used as a first line medication, you are inclined to prescribe metformin. However, you decide it would be a good idea to obtain a baseline comprehensive metabolic panel before making a final decision. His baseline comprehensive metabolic panel is normal, except for a slightly elevated creat of 1.34. Would metformin still be an appropriate medication for this patient?

Back 12

Yes

Metformin is contraindicated in men who have serum creatinine >1.5. Since this patient has a creatinine of 1.34, metformin is not contraindicated. However, this patient’s kidney function should be monitored closely (Buttaro, et al., 2013, p. 1069).

Front 13

A patient presents to the clinic with c/o weight gain over past 3 months, she didn’t get her period this past month, and now she is feeling weak. You examine her and note a rounded body shape, a “moon face”, and reddened-purplish skin. She reports a history of asthma. Considerations should include, but your differential diagnosis may also include:

Back 13

This may be Cushing Syndrome which is an adrenal gland disorder. However, it is often mistaken for chronic obesity or depression.

Although diagnosis may be difficult; a practitioner should obtain a 24-hour urine, creatinine, serum cortisol and serum ACTH. (Buttaro, 2013, p. 1058-1061.)

Front 14

After graduating from NP school, you decided to move to Canada (eh) and took a job in a primary care clinic. You are taking care of Ed. He is a 68 year old male. He’s in clinic today for a complaint of dyspnea. He has a history of heart failure, hypertension, and diabetes. When reviewing his medication list, you note that he is on metoprolol 50mg BID, Actos 15mg once daily, glipizide 10mg daily, Lasix 20mg once daily, and lisinopril 20mg. You note that one of the above medications is contraindicated based on his medical history and you discontinue the medication immediately. Which medication did you discontinue?

Back 14

Actos

Thiazolidinediones, including Actos may cause or exacerbate heart failure. Use of Actos is NOT recommended for patients with symptomatic heart failure. Although in the U.S. it is acceptable (in some instances) to prescribe a thiazolidinedione in a patient with heart failure, in Canada, use is contraindicated in patients with ANY stage of heart failure.

Front 15

The overproduction of cortisol is often related to Cushing’s Syndrome. When is the diagnosis of Cushing’s Disease used?

Back 15

When the disorder is the result of pituitary dysfunction.

Cushing’s Disease is reserved for those patients in which the symptoms of cortisol overproduction are pituitary-caused symptoms. (Buttaro, 2013, p. 1058).

Front 16

A normal hemoglobin A1C in an adult with no history of diabetes is what?

Back 16

<5.7%

Normal A1C levels in a non-diabetic patient should be below 5.7%, levels between 5.7-6.4% indicate pre-diabetes, levels equal to or above 6.5% indicate diabetes (Buttaro, 2013, p. 1064).

Front 17

Which of the following conditions is NOT a known cause of secondary hyperparathyroidism? A. renal failure B. vitamin D deficiency C. treatment with proton pump inhibitors or glucocorticoids D. anemia

Back 17

D. anemia

Hyperparathyroidism occurs as a response to the wasting of serum calcium seen in renal failure, vitamin D deficiency, and treatment with proton pump inhibitors (which block calcium absorption) or glucocorticoids (Malabanan, 2008, pp. 1118-1119). Anemia does not cause hyperparathyroidism.

Front 18

Mrs. Johnson is a 58 yo who is 10 years status post kidney transplant. She was grocery shopping when she slipped and fell on her arm, breaking her wrist and arm in three places. She also has a history of having issues with two kidney stones in the past three years. There is some concern that her transplanted kidney is slowly rejecting as her GFR has steadily increased over the past three years as well. In light of her kidney dysfunction, her easy arm break, and her frequent kidney stones, is there a suspicion for another disorder going on?

Back 18

Hyperparathyroidism

Secondary hyperparathyroidism is found commonly in patients with chronic kidney disease especially when the GFR falls below 50 ml/min. The condition affects women more than men (3:1) and is due to the increased serum calcium concentration, kidney stones become more frequent in these patients. Also, hyperparathyroidism often causes a degradation of skeletal bone especially cortical bone which can be found in the wrist and radius.

Front 19

A 57-year old woman presents with a complaint of aching shin bones, increasing irritability, and insomnia over the past month. She denies any activities out of the ordinary for her. During exam, you note a white cloudiness at the temporal border of her right eye and you note that she is mildly hypertensive although at her annual exam 6 months ago she was 105/70 and her cholesterol levels were normal. She has no history of renal disease. Fasting lab results show elevated levels of serum calcium and parathyroid hormone as well as hypophosphatemia. The most likely cause for her primary hyperparathyroidism would be a ____.

Back 19

Parathyroid adenoma

80% of cases of primary hyperparathyroidism result from a parathyroid adenoma secreting excessive amounts of PTH (Buttaro et al., 2013, p. 1119).

Front 20

Most patients with diabetes are encouraged to exercise on a regular bases. When should a patient with type 1 diabetes avoid exercise?

Back 20

Patients with type 1 diabetes should not exercise if their blood glucose is 250 mg/dl or greater and ketones are present in the urine or blood.

Patients with type 1 diabetes should not exercise if their blood glucose is 300mg/dl or greater with or without the presents of ketones.

Front 21

The effects of excessive growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are associated with high mortality rates related to increased cardiovascular morbidity and mortality as a result of what conditions?

Back 21

Hypertension, diabetes, and sleep apnea

Research evidence has revealed that among those who received early diagnosis of acromegaly hypertension was present in 37% of patients, as were diabetes and sleep apnea, 18% and 13% respectively (Buttaro, 2013, p. 1055).

Front 22

When determining the cause of hyperthyroidism, what results would you expect to find with Graves’ disease when drawing a full set of thyroid function tests?

Back 22

Increased T3, increased T4/Free T4 index, and decreased TSH.

The thyroid stimulating immunoglobins (TSIs), present as a result of this autoimmune disorder, compete with TSH receptors on the thyroid. The TSIs occupy the receptors on the thyroid causing the production of T3 and T4 (Buttaro, 2013, p. 1129).

Front 23

Which differential diagnosis should be considered first for excessive male pattern hair grown in women of reproductive age?

Back 23

Polycystic Ovarian Syndrome

The most common pathologic cause of hirsutism is PCOS, usually related to the excessive androgens circulating in the body (Buttaro, 2013, p. 1084).

Front 24

When no other risk factors for diabetes are present, screening for diabetes should begin at what age?

Back 24

Age 45

Screening for diabetes using fasting plasma glucose, 2-hour 75-g oral glucose tolerance test, or HbA1C should begin at age 45 years when no other risk factors are present

Front 25

Periodic examinations of patients with diabetes serve three main purposes: to evaluate blood glucose control, assess for end-organ damage and assess for associated diseases. When reviewing a patient’s blood glucose levels, you find that their pre-meal blood glucose levels have been 97-128mg/dL and their peak post-meal blood glucose levels have been 161-178 mg/dL. Is this patient’s blood glucose properly controlled?

Back 25

Yes

The target pre-meal blood glucose level is 70-130 mg/dL, and the target peak post-meal blood glucose level is less than 180 mg/dL. This patient’s blood glucose values fall within these normal limits.

Front 26

What is the most common clinical presentation of primary hyperparathyroidism?

Back 26

Asymptomatic elevation of serum calcium.

Fasting hypophosphatemia is also commonly present. Other possible symptoms include weakness, easy fatigability, depression, intellectual weariness, cognitive impairment, loss of initiative, anxiety, irritability and insomnia.

Front 27

Mr. Hopper, a 40 year old male, presents to the clinic with polyuria, polydipsia, fatigue, a wound that has been slow to heal, and frequent infections. He has also had numbness in his hands and feet. These symptoms have been slowly noticeable over the last several years. Upon your assessment, his glucose comes back at 230. What is your diagnosis?

Back 27

Type 2 diabetes @Type 2 diabetes presents with polyuria, polydipsia, blurred vision, fatigue, slowly healing wounds, frequent infections, numbness in hands and feet. The symptoms may be subtle or absent and persist for months to years before diagnosis (Wood, 2013). A glucose > 200 is a diagnostic for diabetes (Wood, 2013).

Front 28

A 32-year old man with a history of joint pain, weight gain and paresthesias comes for an annual exam and is now found to be hypertensive. He mentions an increased frequency of headaches and says his family members complain of his snoring. During physical exam, you note spaces between his teeth and macroglossia and you begin to suspect acromegaly. The diagnostic test of choice would be _____and its results should be evaluated alongside _____.

Back 28

Oral glucose tolerance test (OGTT), insulin-like growth factor 1 (IGF-1)

Growth hormone (GH) is secreted in a pulsatile fashion so cannot be relied on to diagnose acromegaly. IGF-1 is proportional to the 24-hour serum level of GH and is a better indicator of elevated levels of GH. For normal individuals, the OGTT suppresses GH secretion but for those with acromegaly the GH level will likely (but not always) exceed 1 ng/ml. Together, the two results provide a more complete picture of GH levels (Buttaro et al., 2013, p. 1056).

Front 29

Metformin (Glucophage), a biguanide, is commonly the first line oral medication for type 2 diabetes. It does not cause hypoglycemia and may promote weight loss. However, if this is ineffective the next step to consider would be:

Back 29

Basal insulin (most effective, but requires time and commitment); or add a sulfonylurea (least expensive, but can cause hypoglycemia and weight gain); or consider a thiazolidinedione (no risk of hypoglycemia, cannot use with CHF and may cause weight gain, monitor LFTs) (Buttaro, 2013, p. 1068-1071).

Front 30

You are completing your assessment of an 18 year old, male patient, thyroid at the clinic. The patient denies any health concerns. On exam you note a small lump. You chart the nodule size, consistency, mobility, and associated lymphadenopathy. The remainder of your assessment is unremarkable. Initial diagnosis and management of your findings now include:

Back 30

Thyroid nodule and management should include a TSH level, US of thyroid and referral.

A biopsy may be necessary. Thyroid examinations should be performed every 6 to 12 months. Age younger than 20 years or over 60, and male gender, are additional risk factors for thyroid cancer. Additional factors include family history and history of head and neck radiation. (Buttaro, 2013, p. 1126).

Front 31

What are the positive effects of the use of Metformin in Diabetes Type II?

Back 31

Lowers HbA1c by 1.5%, does not cause hypoglycemia, may promote weight loss, lowers fasting glucose levels.

Metformin suppresses the glucose production in the liver, which helps result in lower fasting glucose levels. A reduction of 1.5% can be expected in the HbA1c level. In comparison to other diabetic agents, Metformin does not cause hypoglycemia and may even promote weight loss (Buttaro, 2013, p. 1069).

Front 32

What is the single most important diagnosis to exclude when diagnosing parathyroid hyperparathyroidism?

Back 32

Familial hypocalciuric hypercalcemia (FHH)

FHH is an autosomal dominant trait that is characterized by hyperparathyroidism and hypercalcemia. A family history of FHH, hypercalcemia and mild hypermagnesemia point to FHH (Malabanan, 2013).

Front 33

Your 61-year-old female patient suffered a seizure and has been diagnosed with hypoparathyroidism. Would you expect her labs to show abnormally low or abnormally high serum calcium?

Back 33

Abnormally low serum calcium.

Parathyroid hormone works on the kidneys, bones, and intestines to recruit more calcium into the blood (Malabanan, 2008, p. 1118). Hypoparathyroidism interrupts this process and the low serum calcium level stays unresolved.

Front 34

How often should TSH levels be checked in pregnancy?

Back 34

Once per trimester, including at the initial prenatal visit

TSH levels should be measured at the initial prenatal visit and once in every trimester after that. Frequently, thyroid hormone requirements increase during pregnancy and dosages of thyroid medications may need to be changed to ensure appropriate thyroid functioning during pregnancy (Buttaro, 2013, p. 1135).

Front 35

Follow up care for an average diabetic patient should include what (in addition to the standard blood pressure check, height, and weight)?

Back 35

A review of blood glucose log, HbA1C test every 3 months, yearly lipid panel (unless abnormal or are being medically treated. Also yearly screening for complications including microablumin, UA, BUN, Cr, ECG if over the age of 40, and referral for ophthalmologic .

Review of blood glucose log and A1C gives you an idea of patient’s glucose ranges and well as areas of highs or lows. Yearly screening allows for the prevention or early intervention of complications of diabetes.

Front 36

You see an 84 year old female with a history of hypothyroidism, hypertension, and osteoporosis. Medications include: lisinopril 10mg PO QD, Tylenol 1000mg PO TID, and Levothyroxine 112mcg PO QD which she takes independently. This patient is seen in the assisted living by a nurse practitioner. Staff has reported she has been more confused and more hard of hearing. The nurse states, "I think she may need her ears checked for wax or her hearing aids adjusted because she is more hard of hearing. I also think she may need a dementia pill." With these clinical suggestions, the NP should consider which laboratory test to address the confusion and worsening hearing?

Back 36

TSH level

Hypothyroidism symptoms may be more vague and subtle in older adults and include deafness, confusion, dementia, and ataxia (Buttaro, 2008, p. 1133).

Front 37

A 57-year-old female patient presents in urgent care with severe upper leg pain after “stepping off a curb wrong.” An Xray shows a femoral fracture. In the EMR, her problem list includes treatment for kidney stones. For what underlying disorder should she be evaluated?

Back 37

Hyperparathyroidism

The fracture of a femur with minor trauma is highly suggestive of osteoporosis, which can be the result of increased osteoclast-mediated bone degradation due to elevated parathyroid hormone (PTH). Elevated PTH is also associated with the development of kidney stones. Also, women are at increased risk of development, and the incidence peaks in the sixth decade of life.

Front 38

A 69-year-old female patient present for a wellness exam. In the past year, she has gained 5 kilograms. When you ask about her weight gain during the review of symptoms, she states, “I have no idea why I gained the weight. I haven’t changed how I eat at all. But I do feel so tired all the time.” Additional questions reveal she frequently feels cold and she’s been suffering with intermittent constipation. Your patient may be suffering from what common endocrine disease?

Back 38

Hypothyroidism

Six percent of women older than 60 years have hypothyroidism. The most common presenting symptom is fatigue. Other symptoms include sensitivity to cold and weight gain.

Front 39

Salome, a 54 year-old woman, presents to the office with reports of fatigue, weight gain, hoarseness, feeling cold, dry skin, puffiness in the face and hands, achy muscles, constipation, difficulty hearing, and dry, brittle hair. The differential diagnosis is wide, so you begin asking numerous clarifying questions. Nevertheless, in the back of your mind you suspect:

Back 39

Hypothyroidism

The constellation of signs and symptoms for thyroid disorders can be quite broad and vague since the thyroid gland acts on all organs.

Front 40

If a patient presents with hirsutism, what conditions should you assess for?

Back 40

Polycystic ovary syndrome, Cushing’s syndrome, congenital adrenal hyperplasia, ovarian or adrenal tumors, medications that cause hirsutism

Imbalances in sex hormones can cause male-pattern hair growth in women. (Freshman, 2013)

Front 41

The classic symptoms of primary hyperparathyroidism (PHPT) are referred to as the “bones, stones, abdominal moans, and psychic groans.” What are signs and symptoms of PHPT?

Back 41

Nephrolithiasis, bone disease, anorexia, nausea, constipation, polydipsia, polyuria, osteitis fibrosa cystica, weakness, fatigue, and hypercalciuria

Front 42

If a patient presents to the clinic with lymphadenopathy, when is it appropriate to perform a biopsy?

Back 42

If it is found that it isn’t related to infection or inflammation and has been persistent for greater than one month.

Front 43

Because it is the earliest sign of renal damage due to diabetes, patients should be tested for the presence of _____ annually.

Back 43

Microalbuminia

As the earliest sign of renal damage this should be checked annually for patients, beginning at onset for those with type 2 diabetes and with type I diabetes 5 years after onset.

Front 44

______ patients are 2-3 times more likely to have silent MIs, two to fivefold times more likely to develop CHF, and two- fivefold more times likely to have a stroke.

Back 44

Diabetic patients

CAD in patients with diabetes occurs earlier and more extensively than in patients without diabetes, and these patients have 2-4x the risk for CAD.

Front 45

What class of medication should be used to alleviate the alpha adrenergic symptoms of hyperthyroid in Grave’s disease?

Back 45

Beta-blockers

Propanolol can be used at dosages between 10-40 mg orally q 6 hours, or longer acting doses, and should be titrated to symptom relief.

Front 46

Down’s syndrome, Ellis-van Creveld syndrome, Fanconi’s anemia, Klienfelter’s syndrome, Bloom’s syndrome and ataxia-telangiectasia as well as exposure to ionizing radiation put patients at higher risk for what acute illness?

Back 46

Acute leukemia

Exposure to ionizing radiation is the most conclusive predisposing factor associated with leukemia in humans.

Front 47

Education for the patient with leukemia is crucial. In speaking with your patient recently diagnosed with leukemia and their family, you are sure to tell them which of the following?

Back 47

Please don’t hesitate to call the clinic if you notice any of the following symptoms: elevated temperature above 100F, productive cough, mouth sores, increased bleeding or bruising, blood in your urine or stool, shortness of breath, fainting, pounding heart or palpitations.

The patient with leukemia needs to be keenly aware of symptoms of possible life-threatening conditions such as sepsis and infection, thrombocytopenia and anemia.

Front 48

A 65-year-old man presents to your clinic with complaints of lymphadenopathy, fevers, night sweats and weight loss. His exam reveals enlarged lymph nodes, and enlarged liver and spleen. You suspect either Hodgkin’s or non-Hodgkin’s lymphoma and want to help differentiate between these two diagnoses. What lab tests and diagnostics would aid in this decision?

Back 48

CBC and differential, serum electrolytes, ESR, glucose, calcium, albumin, lactate dehydrogenase, beta2-microglobulin, liver function tests, BUN, creatinine and serologic evaluation for Epstein-Barr virus. More invasive diagnostics may include a lymph node biopsy or bone marrow biopsy.

The lab tests will help to rule out other causes such as infection or inflammation. EBV is drawn because those with a history of mono have a threefold chance of developing Hodgkin’s lymphoma. The invasive diagnostics, particularly the lymph node biopsy, aids in a pathologic diagnosis. The Reed-Sternberg cell is present only in Hodgkin’s lymphoma.

Front 49

You have been managing a 35-year-old man with well-controlled type II diabetes for the past 4 years. He is on Metformin 500mg BID. Blood sugars are generally 100-150. He has been home sick for the past three days with an upper respiratory infection and is unsure how he should manage his diabetes while he is sick. He calls in to the clinic to ask you. What is the most appropriate response?

Back 49

Because you have been sick for the past few days your blood sugars have probably been higher than usual. I would like you to monitor your blood sugar every 4 hours and with any symptoms of nausea or poor appetite. I also would like you to drink at least 8-oz of water each hour while you are awake. You should continue to take your Metformin even if you feel like you don’t want to eat. If you have any trouble breathing, persistent diarrhea or vomiting or blood sugars that you cannot control I would like you to call me.

During a time of illness glucose levels are often elevated and ketones may be present. Patients should continue to take their oral diabetic medications, maintain hydration and monitor for any signs of complications.

Front 50

A 75-year-old woman with a history of atrial fibrillation presents to your clinic with fatigue, cold intolerance, weight gain, depression, constipation and dry skin. After ordering several diagnostics, you note that her TSH is 7uU/L. You understand that she is exhibiting signs of hypothyroidism and decide to start her on Levothyroxine. What factors should you consider in determining an initial dose and what impact will that have on your treatment plan?

Back 50

The factors of consideration in this patient are her age and history of atrial fibrillation. Because of these factors, you should start at a dose of 12.5-25mcg/day and increase by 25mcg every 8 weeks.

Initial dosing may be 50mcg/day but in patients with ischemic heart disease, atrial fibrillation or in older patients in whom these conditions may become apparent with treatment, initial dosing should be 12.5-25mcg/day and increase by 25mcg every 8 weeks.

Front 51

Diabetic ketoacidosis (DKA) is a medical emergency caused by a deficiency in insulin. Subjective and objective exam findings of DKA include Kussmaul’s respirations, nausea and vomiting, acute onset of abdominal pain, dehydration, tachycardia, hypotension, and changes in consciousness. Lab findings in a patient with DKA will typically reveal acidemia, ketonemia, and hyperglycemia. Adherence to what type of guidelines will support the patient with Type I diabetes in taking responsibility for actively preventing of DKA?

Back 51

Sick-day management guidelines will support the patient with diabetes in taking responsibility for actively preventing DKA.

Patients with diabetes should be taught the following during illness, infection, pain, or unexplained elevated glucose levels: A. monitor blood glucose (BG) levels at least every 4 hours B. if BG is > 250 mg/dL, test for ketones C. with elevated BG levels and when necessary, take rapid-acting insulin every 2-4 hours D. maintain adequate hydration E. continue to take medications even if not eating F. when necessary, contact their healthcare provider (Buttaro, 2013).

Front 52

Nonspecific, neurocognitive symptoms of hypercalcemia include cognitive impairment, weakness, insomnia, irritability, depression, and easy fatigability. It is not uncommon to mistake some of these symptoms for the normal aging process. However, if objective findings also reveal a white cloudiness at the temporal and nasal borders of the cornea (band keratopathy), kidney stones, and/or cardiac or valvular calcifications, what diagnosis should the provider be considering?

Back 52

Hyperparathyroidism.

Hyperparathyroidism is the over secretion of parathyroid hormone (PTH). An excess of PTH can be attributed to a single parathyroid adenoma in 80% of all primary hyperparathyroidism cases (Buttaro, 2013).

Front 53

Two benefits of exercise in the diabetic patient include improved insulin sensitivity, as well as increased glucose uptake in skeletal muscles. The provider should teach his or her diabetic patient the importance of making adjustments to insulin doses and food intake in order to effectively manage the positive effects of exercise. Name the effect that can occur in the diabetic patient after exercise, when pre-exercise food intake and insulin doses have not been accounted for.

Back 53

The name of the effect is the exercise lag effect.

The exercise lag effect refers to a low blood sugar concentration that can occur hours after exercise when the diabetic patient has not adequately balanced activity with food intake and insulin dosing. A therapeutic adjustment to account for activity in the type II diabetic patient includes decreasing the insulin that is peaking during time of exercise (Buttaro, 2013).

Front 54

Hyperthyroidism is a condition of excess production and release of thyroid hormone. In contrast, hypothyroidism in a condition in which the thyroid is not making enough thyroid hormone. What is a common screening test for both conditions, and what will they each reveal?

Back 54

A common screening test conducted for both conditions is the thyroid stimulating hormone (TSH) lab test. The TSH will be low or undetectable in hyperthyroidism, and elevated in hypothyroidism.

In patients with suppressed or elevated TSH levels, T4 levels should also be obtained in order to determine the degree of pathology (Buttaro, 2013).

Front 55

In a patient with CML who is undergoing active treatment, symptoms of acute hyperuricemia, hyperkalemia, hypocalcemia, and hyperphosphatemia need to be recognized as symptoms of

Back 55

Tumor Lysis Syndrome

When receiving cytotoxic chemotherapy, tumor cell membranes lysis and release their intracellular contents in the bloodstream. This results in potential fluid and electrolyte imbalances listed above.

Front 56

Your patient's serum lab values are the following: Na+ = 140, Cl- = 108, and HCO3- = 22. Calculate the anion gap. Is it within normal limits?

Back 56

Yes, it is within the normal range of 8-12 mEq/L.

The anion gap is 10. The formula is Na+ - ( Cl- + HCO3- ) = anion gap (Goren & Kogan, 2010).

Front 57

An 18-year-old female presents to the clinic today with concerns related to a new onset of hair growth on her chin and upper lip. Upon examination you note her BMI to be 35 and she presents with pustular acne of the face, irregular menses and a receding hairline. Your suspicions point to an androgen excess possibly related to polycystic ovarian syndrome, but what is one congenital, potentially life-threatening disorder related to androgen excess that must be included in the differential?

Back 57

Late-onset, nonclassic congenital adrenal hyperplasia

Nonclassic congenital adrenal hyperplasia is a rare and potentially life threatening enzymatic disorder of the adrenal glands that results in hyperandrogenism. Although congenital, it may have a late onset in adolescence and can be easily mistaken for polycystic ovarian syndrome.

Front 58

What lab test is a good screening tool for Acromegaly?

Back 58

IGF-1

IGF- 1 is a good screening test and it’s measurement is a reflection of the previous days growth hormone levels.

Front 59

A 46 year old female patient presents to your office with a complaint of dry eyes, blurry vision, shortness of breath, racing heart, weight loss, and a complaint of not being able to tolerate warm temperatures. On exam you notice that she has labored respirations, tachycardia, smooth velvety, warm skin, a tremor and a goiter. What is your leading diagnosis?

Back 59

Graves’ Disease

Dry eyes, with blurry vision, shortness of breath, labored respirations, tachycardia, palpations, weight loss, anorexia, heat intolerance, smooth velvety, warm skin, tremor , hyperreflexia, goiter, anxiety, irritability nervousness, sleeplessness and menstrual irregularities are some of the signs and symptoms associated with hyperthyroidism and Graves’ disease (Buttaro et al., 2013, p. 1129).

Front 60

According to the American Diabetes Association (ADA), what are the recommended targets for glycemic control for adults?

Back 60

HgbA1C <7%, pre-meal blood glucose level 70-130mg/dL, peak post-meal blood glucose level <180mg/dL

Front 61

Your patient has type 2 diabetes and is interested in losing weight by exercising regularly at the gym. She is insulin dependent. How should she adjust her insulin on her exercise days?

Back 61

She should decrease her insulin that is peaking at the time of exercise and possibly plan to adjust her basal insulin also (decrease).

It is ideal to decrease insulin as opposed to recommend an increase in food intake for the patient with type 2 DM in order to promote weight loss. However, the increased insulin sensitivity effect of exercise can last up to 48 hours. Your patient should expect to plan for possible food intake adjustments to maintain balance.

Front 62

A 54 year old Asian female presents to the clinic for a complete physical examination. She has concerns about a feeling of pressure on her neck but reports no difficulty breathing. Upon examination of the thyroid you note an enlargement to the goiter as well as a soft moveable nodule to the right lateral aspect of the thyroid. Prior to the examination you had ordered a TSH with free T3 and T4 which returned within range. The next diagnostic tool you select will be:

Back 62

Ultrasound

Laboratory studies may show low or normal free T4 and high or most often, normal TSH in goiters. Thyroid ultrasound examination allows identification of gland size and the number and size of any nodules. If necessary for diagnosis, FNA may be performed. Isotope scans are not indicated as the first imaging study in patients with goiters (Buttaro, 2008, p. 1125).

Front 63

A 48 year old female presents to the clinic for follow up of her Type 2 diabetes mellitus. Her blood sugars pre-prandial run from 70-110’s and post-prandial from 140’s-150’s. According to the ADA, are these blood sugars are considered within glycemic control for adults with diabetes?

Back 63

Yes

Glycemic control for non-pregnant adults include pre-meal blood glucose level from 70-110 mg/dL. Peak post meal blood glucose level includes <180 mg/dL.

Front 64

A 40 year old Hispanic male presents to the clinic with concerns of a sinus infection. Upon review of his chart you notice he has a family history of diabetes and a BMI of 35. You decide to screen for diabetes in this male by a fasting plasma glucose, 2 hour 75 – g oral glucose tolerance test, or HbA1c. Does this patient scenario warrants screening for diabetes in an asymptomatic adult?

Back 64

Yes

Screen with fasting glucose, OGTT, or HbA1c in asymptomatic patients beginning at age 45 years and for all ages for those who are overweight (BMI >25) and have one or more of the following risk factors: sedentary lifestyle,family history of diabetes, high risk heritage (African American, Hispanic, Native American, Asian American, Pacific Islander), history of gestational diabetes or delivered a baby > 9lbs, HTN, Dyslipidemia HDL <35 mg/dL and/or triglyceride >250mg/dL, presence of PCOS, presence of acanthosis nigricans,

Front 65

Suzie, age 45, presents to you today for her annual wellness exam. She reports to you a recent history of 2 kidney stones, aching bones (especially the sternum), constipation, fatigue and depression. Recalling what you learned in N6502, you run some labwork. Her serum calcium is >10.5mg/dL, her serum phosphate is <2.5 and her parathyroid hormone level is elevated (elevated or high normal range is diagnostic). You determine that Suzie has _______ and therefore must be referred to a physician or endocrinologist.

Back 65

Hyperparathyroidism

Hyperparathyroidism is diagnosed by elevated calcium and PTH levels. Elevated levels of PTH cause the kidneys to excrete phosphate causing low phosphate levels.

Front 66

True or false: Acute leukemias display a surplus of mature appearing, ineffective cells.

Back 66

False

Acute leukemia have an abnormal production of immature white blood cells (blasts) whereas Chronic leukemias have a surplus of mature but ineffective cells.

Front 67

Your patient presents to clinic and states that they have hypothyroidism. You ask them to tell you their symptoms you would expect them to state?

Back 67

Fatigue, sensitivity to cold, weight gain, hoarseness, puffiness in their hands and face, heavy and irregular menstrual cycles, dry skin, dry and brittle hair, depression, numbness, muscle aches, and constipation.

These are the most common symptoms of hypothyroidism not all patients will present with all or any of these symptoms. In the elderly symptoms may be vaguer such as confusion or dementia.

Front 68

Paul is 51 year old Desert Storm war veteran who gets his medication at the VA hospital but has established primary care with you. His medical history includes diabetes, hypertension, dyslipidemia. He comes to your clinic for routine checkup and complains of fatigue, headache, and dizziness. He has been urinating a lot and feels hot. He usually walks to from his parking lot to his car within 5 minutes but lately it has been taking him more time. Vital signs: T99.7 P88 R20 BP 90/70 WT 180 lbHt 5’ 6”. The labs ordered came back as follows. Blood sugar 811, measured osmolality 343, anion gap 10. What is the most likely diagnosis for Paul?

Back 68

Hyperosmolar hyperglycemic state (HHS)

HHS has elevated blood sugar typically greater than 600 and serum osmolality greater than 300 with normal anion gap indicating no urine ketones.

Front 69

A 40 year old man presents to the clinic to establish care for hypertension management. He recently moved to the area from out of state. Together you review his medications as well as his medical/ surgical/ family/ social history. As the interview and subsequent physical exam proceeds, you take note of the following constellation of findings: protuberant nose and forehead, large hands and feet with thickened skin, sweating during the visit, regular NSAID use for intermittent joint pain, deep voice, acne, and history of snoring. You start to consider the possibility of:

Back 69

Acromegaly

The mean age at time of diagnosis of acromegaly is 40 years in men. Acromegaly may variably produce the following signs and symptoms: hypertension, diabetes mellitus, enlarged hands and feet, enlarged facial features, excessive sweating, joint pains, snoring due to upper airway obstruction, vision problems, macroglossia, increased spacing between teeth, paresthesias, acne, and mood instability. Women may also experience irregular menstrual cycles and hirsutism.

Front 70

The mainstay of therapy for Type 2 diabetes mellitus includes education, diet counseling, exercise, and maintenance of a desirable body weight. When HbA1C remains elevated, however, the first-line treatment for an individual without contraindications is commonly: A. A biguanide B. Short-acting insulin C. Sulfonylurea D. Thiazolidinedione (TZD)

Back 70

A biguanide (Metformin)

This medication suppresses hepatic glucose production, can reduce the HbA1C approximately 1.5%, does not cause hypoglycemia, and may promote weight gain. It can be used alone or in combination with other oral antihyperglycemics or insulin.

Front 71

Sharron, an active, non-smoking, 43 year-old woman with Type 1 diabetes mellitus, is coming into the clinic for a 3-month follow-up. Together you discuss her glucose log, medications, vital signs and her questions. She is doing very well controlling her blood sugars and maintaining a healthy weight. Your physical exam will focus on the presence or progression of end-organ changes of the:
A. Mouth, stomach, colon, and rectum
B. Eye, mouth, neck, heart, skin, and feet
C. Hair, ears, teeth, hands, and skeletal muscle
D. Bruising, bleeding, jaundice, and abdominal distension

Back 71

B. Eye, mouth, neck, heart, skin, and feet

Diabetes mellitus is a systemic disease with many possible complications. Potential sequelae of long-term or poorly controlled diabetes mellitus detectible by physical exam may include retinopathy, oral fungal disease, heart disease, skin ulcers, vascular disease compounding poorly healing foot wounds, or peripheral neuropathy.

Front 72

A 23 year old female presents with fertility issues. She and her significant other have been trying to get pregnant for the past 2 years. She reports irregular periods since their onset at age 12. When you ask her if she has facial hair, she blushes and tells you she waxes it almost weekly. You also note that her BMI is 32. What is your most likely diagnosis for this patient?

Back 72

Polycystic ovarian syndrome or PCOS

The Rotterdam criteria for diagnosing PCOS states a woman must have two out of the following three criteria to be diagnosed with PCOS: 1. Clinical or bio- clinical signs of hyperandrogenism 2. Irregular ovulatory function; and 3. Ultrasonic, morphologic evidence of multifollicular ovaries. This patient has irregular menses and difficulties becoming pregnant which are signs of ovulatory dysfunction. She also has hirsutism which is a sign of hyperandrogenism. People with PCOS are also commonly obese, (Buttaro,2013).

Front 73

A 60 year old woman comes to you from Turkey with limited English abilities to establish care. Her brother is serving as an interpreter. She says she has a thyroid problem. She thinks her disease is called Graves’ disease in English. She says it makes her heart beat too fast. She has brought the two pills with her that her doctors in Turkey gave her to treat this illness. The first is propanolol and she is supposed to take one 10 mg tablet twice a day. The second pill is call propylthiouracil and she is supposed to take two 50 mg tablets twice a day. What is your plan for this patient?

Back 73

Call a Turkish interpreter, order thyroid labs, and liver function tests.

Only professional interpreters should be used in order to insure full and accurate disclosure of information. Propylthiouracil was commonly prescribed for Graves’ disease, but has been found to cause liver failure. Thyroid problems themselves can also cause abnormal liver function tests. For these reasons it is crucial to know her current liver functioning. It is also important to know what her current levels of thyroid hormones are so as to better manage her condition. (Buttaro,2013).

Front 74

A 34 year old female presents today for annual exam. Patient’s current medications include MVI, Prilosec 20mg daily (GERD), Nuva Ring (birth control), Propranolol 40mg (migraine prevention) and Topamax 20mg BID (migraine prevention). Patient reports her migraine is much better and she has never had aura before. Works as flight attendant. Patient just had L knee surgery 3 weeks ago after hockey accident. Patient quit smoking 2 years ago. Otherwise, patient reports doing well. Family history positive for DVT (mother), migraine (mother and sister). Upon medication review, you will discontinue:
A. Prilosec
B. Nuva Ring
C. Propranolol
D. Topamax

Back 74

B. Nuva Ring

Nuva Ring is estrogen/progestin combination birth control. First degree relative family history of DVT and smoking under the age of 35 are considered as risk level 2 (benefits generally outweigh proven risks). Surgery, especially orthopedic procedure on knee as a major risk factor for DVT. Long airplane ride is also considered as a risk factor for DVT. Although Nuva Ring may be considered as risk level 2, with other risk factors, patient should not be using Nuva Ring for increased risk of DVT.

Front 75

Acute leukemia is characterized by what phenomena?

Back 75

Abnormal production of immature white blood cells, called blasts and rapid disease progression of about 6 months characterize acute leukemia.

Front 76

A 40 year old male presents to the clinic with lymphadenopathy, fevers, night sweats, and weight loss. Histologic presentation includes the Reed-Sternberg B lymphocyte. Which type of lymphoma does your patient present with?

Back 76

Hodgkin’s Lymphoma

Hodgkin’s lymphoma has a histologic presentation of mononucleated Hodgkin cell and the multinucleated Reed-Sternberg B lymphocyte.

Front 77

A 25 year old female presents to the clinic with dry eyes, blurry vision, and shortness of breath, heart palpitations, rapid heart rate, weight loss and sleeplessness.. You believe that she has a thyroid problem, so you run some test. Her T3, T4/Free T4 Index are increased and her TSH is decreased. What thyroid disorder does your patient present with?

Back 77

Graves’ Disease

These are some of the symptoms associated with Graves’ Disease along with a diffuse goiter, angina, hyperphagia, hyperdefication, anorexia in older adults, amenorrhea, menstrual irregularities, infertility, proximal muscle weakness, heat intolerance, tremor, pruritus, warm, moist palms, osteoporosis, anxiety, irritability, and nervousness. Also a radioiodine uptake helps distinguish Graves’ disease from thyroiditis.

Front 78

What are the three phases of CML?

Back 78

Chronic, accelerated and terminal blast crisis

The chronic phase lasts from 3-5 years. The last two phases vary in length.

Front 79

You are about to treat a 30 year old female patient with hirsutism. What would you prescribe?
A. Somatomedin C
B. Levothyroxine
C. Spirolactone
D. There are no medications that can treat hirsutism.

Back 79

C. Spirolactone

Although known as a potassium-sparing diuretic, spirolactone inhibits pituitary gonadotropin secretion and binds with testosterone and DHT to receptors in such a way that helps with metabolic clearance. Spirolactone is an androgen production inhibitor and is commonly combined with oral contraceptives to treat hirsutism.

Front 80

A 42 year old female presents to you with dry eyes, palpitations, hyperdefecation, weight loss, heat intolerance, and menstrual irregularities. Though vitals are stable, she is slightly anxious and would like to know what is wrong with her. You ordered labs. Her TSH was abnormally low, but her T3 an T4 levels are high. You diagnose her with hyperthyroidism. What is your first line of therapy?
A. Methimazole 15mg by mouth daily
B. Radioiodine therapy
C. Propylthiouracil 50mg by mouth every 6 hours daily
D. Levothyroxine

Back 80

A. Methimazole 15mg by mouth daily

The thioamides (antithyroid drugs) include methimazole (MMI, Tapazole) and propylthiouracil (PTU). They inhibit thyroid hormone synthesis by blocking organification.

Front 81

A 54-year-old male with a body mass index (BMI) of 30 kg/m2 presents for his annual wellness exam. His review of systems is essentially negative. Labs drawn with the visit reveal fasting plasma glucose 124 mg/dL. He returns one week later for repeat fasting plasma glucose which is 120 mg/dL. Is there evidence to diagnose diabetes?

Back 81

The results of these two fasting plasma glucoses are not diagnostic for diabetes, but do meet the criteria for pre-diabetes.

Fasting plasma glucose greater than or equal to 126 mg/dL where fasting is defined as at least eight hours without food prior to the test. This needs to be confirmed by repeat testing on a different day. Fasting plasma glucose of 100-125 mg/dL is diagnostic of pre-diabetes. Patients with pre-diabetes are at risk of diabetes and increased cardiovascular risk.

Front 82

Mr. Smith was recently diagnosed with Hodgkin’s Lymphoma and presents to your office for follow up of his recent diagnostic testing. If his results indicate that there is spleen involvement what stage of disease process is Mr. Smith?

Back 82

Stage III

The Cotswald modification of the Ann Arbor staging system produces four stages. Stage III progresses to both sides of the diaphragm and involves lymph regions and can involve disease of the spleen.

Front 83

A 24 year old man is referred by his eye doctor to see his primary care provider after flame-shaped hemorrhages are noted during a fundoscopic exam. A CBC with differential reveals results consistent with ______ and you refer him to a specialist. The specialist later sends you the patient’s visit note with findings of a chromosome 9 & 22 translocation and a plan to start the patient on imatinib mesylate (Gleevac).

Back 83

Chronic myelogenous leukemia

Fifty percent of leukemia patients have ocular involvement; the initial treatment for CML is Gleevac and has been found to correct the translocation of

Front 84

A 58 year old female patient comes to your office with fevers and night sweats for the last month, as well as a small weight loss of 10 lbs over the same time period. As you talk to her she tells you that has also found larger lymph nodes to the front right side of her neck. They are not painful, but she has noticed they have been achy and itchy after having a couple glasses of wine a week ago. Her history is negative any recent illnesses. She is positive for fatigue that is limiting her ability to go out with friends lately. What is likely the cause of her symptoms? A. Chronic lymphocytic leukemia (CLL) B. Acute lymphocytic leukemia (ALL) C. Hodgkin's lymphoma (HL) D. Myelodysplastic syndrome (MDS)

Back 84

Hodgkin's lymphoma (HL)

HL typically manifests with painless lymphadenopathy to a singular group of lymph nodes and associated fevers, night sweats, and unexplained weight loss. Pain and pruritus is often noted with the consumption of alcohol.

Front 85

True or False: Hirsutism refers to an excessive male pattern hair growth in women.

Back 85

True

Hirsutism presents with changes in pigmentation, thickness, and pattern of hair mediated by localized androgen sensitivity within the predetermined hair follicles (Buttaro, 2008, p.1083).

Front 86

You receive a call from a patient of yours who is a 17 year old female newly diagnosed Type 1 diabetic. The patient states she has caught a cold at school and is feeling ill and has missed school. She is concerned about her blood sugars which are rising since she has been sick. You recommend the following at home instruction to this patient:

Back 86

Monitor blood glucose at least every 4 hours, if glucose is above 250 test for ketones, supplement rapid acting insulin every 2 to 4 hours for correction, maintain adequate hydration, and continue to take diabetic medications.

Raising blood sugar levels may be the first sign of impending illness. With unexplained high BG levels, illness, infection or pain, BG should be checked at least every 4 hours with symptoms of nausea, anorexia, illness, or rising glucose levels. If the BG is above 250 supplemental rapid-acting insulin can be given every 2-4 hours. The patient should also drink 8 ounces of calorie free fluid hourly while awake (can be alternated with sodium-rich fluid and alternate fluids containing carbohydrates if not eating). Call MD if: concerns of difficulty breathing, vomiting persisting for more than 6 hours, elevated BG of 300 or higher unresponsive to increased insulin on two occasions, moderate or large urinary ketones or blood ketones above 0.6mmol/L (Buttaro, 2008, p. 1077).

Front 87

What would be included in the treatment plan for a person newly diagnosed with Type I Diabetes Mellitus?

Back 87

Nutritional therapy: match insulin doses to carb intake; Exercise and physical activity: ensure education on appropriate adjustments in food intake and insulin in lieu of exercise; Insulin therapy: based on a personalized basal/bolus therapy

Exercise improves glycemic control by increasing the uptake of glucose into muscles. Type I DM patients need to be educated on how to adequate adjust their insulin dosing for their level of activity. Since insulin is absent in Type I DM, a patient needs to be educated on their personal required level of insulin. An average person makes between 20-40 units/day; Type I diabetics need to administer this same amount of insulin using a basal/bolus dosing over a 24 hour period to mimic that of adequate insulin control.

Front 88

What is the American Diabetes Association (ADA) criteria to diagnose someone with Diabetes Mellitus?

Back 88

TWO confirming results of: Hgb A1c of ≥6.5% OR FPG ≥126mg/dL OR 2h plasma glucose of ≥200mg/dL OR A patient that has classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose of ≥200mg/dL

According to the ADA’s Standards of Medical Care in Diabetes from 2012, since 2010 the Hgb A1c has been the test of choice. With any other abnormal test results, a second test measure should be completed to confirm abnormality.