Font size
WorksheetsER - Endocrine
Total questions: 37
Worksheet time: 20mins
What is the MC acute life-threatening complication of diabetes?
DKA
HHNC
Myxedema Coma
Thyroid Storm
What has the pathophysiology of insulin deficiency and glucagon excess?
DKA
HHNC
Myxedema Coma
Thyroid Storm
What is NOT one of the essentials of DKA diagnosis?
Alkalosis (pH > 7.45 and high HCO3-)
Elevated blood glucose (BG > 250)
Significant dehydration
Electrolyte abnormalities
Develops w/in hours to days
Pt presents with fatigue, tachypnea (Kussmaul respirations), tachycardia, altered mental status, abd pain, vomiting, polyuria, polydipsia, dry tongue, diaphoresis, weight loss, and N/V. What do you suspect?
DKA
HHNC
Myxedema Coma
Thyroid Storm
What is the MC (#1) major stressor of DKA?
GI bleed
Infection (Gastroenteritis, UTI, Pneumonia)
MI/Meds
Stroke/Sepsis
Pregnancy
In DKA, K+ levels read __(1)__ on BMP when actually these patients have total body stores of K+ that are __(2)__.
(1) Low
(1) High
(2) Low
(2) High
In HHNC, your readings are more true at 4-5 meq/l because your pH is above 7.3.
True
False
What is NOT one of the forces that cause hypokalemia with treatment of DKA?
Fluid promotes renal execretion
Dilutional effect (NSS)
Increase of blood glucose
Resolving acidosis drives K+ intracellular
Insulin drives K+ intracellular
DKA: The anion gap is the difference between primary measured cations (__1__) and the primary measured anions (__2 __).
(1) Na+ and K+
(1) Cl- and HCO3-
(2) Na+ and K+
(2) Cl- and HCO3-
DKA is diagnosed by an arterial pH _(1) and anion gap _(2)_.
(1) < 7.30
(1) > 7.45
(2) < 8
(2) > 12
What is the correct anion gap formula?
AG = [HCO3] - ([Cl] + [Na])
AG = [Cl] - ([Na] + [HCO3])
AG = [Na] - ([Cl] + [HCO3])
AG = [HCO3 - ([Na] + [Cl])
What is the normal anion gap value?
< 8
> 12
8-16
12-16
Pt presents with fatigue, tachypnea (Kussmaul respirations), tachycardia, altered mental status, abd pain, vomiting, polyuria, polydipsia, dry tongue, diaphoresis, weight loss, and N/V. What is NOT part of the treatment?
Fluid replacement w/ normal saline IV
Manage potassium
Insulin therapy w/ bolus of regular IV insulin
Serial BMPs q 2 hr
Always bolus insulin w/ pediatric pts
When treating DKA you need to check K+ levels before starting K+ supplementation
True
False
What is the most important part of DKA treatment?
Fluid replacement w/ normal saline IV
Manage potassium
Insulin therapy w/ bolus of regular IV insulin
Serial BMPs q 2 hr
What is NOT an essential of diagnosis for HHNC?
Serum osmolality > 315 mOsm/kg
Significant ketosis
Elevated BG > 600 mg/dL
pH > 7.3
Bicarbonate level > 18
What are the most important precipitating factors in HHNC? (choose 2)
MI
Pregnancy
Infection
Trauma
Noncompliance with insulin and meds
What is NOT true about the patho of HHNC?
Increase gluconeogensis
Decrease glycogenolysis
Increased blood glucose, cellular lack of glucose
Decrease peripheral uptake of glucose
Severe dehydration from sustained hyperglycemic diuresis
What is NOT true about HHNC?
Prodrome is longer
Lack of insulin is driving force
Not full blown until the urinary volume has decreased
Higher mortality
Higher BG> 600 mg/dL
What is the average fluid deficit in HHNC?
20-26 L
5-8 L
8-12 L
0.5 - 2.0 L
What is the NOT part of HHNC treatment?
Rapid fluid replacement with normal saline
Potassium replacement
Insulin therapy
Hyperglycemia, ketosis, acidemia. Mortality < 1%.
DKA
HHS
Hyperglycemia, hyperosmolarity, altered mental status. Mortality 5-10%.
DKA
HHS
Most pts with DKA or HHS have Type 1.
True
False
Polyuria, polydipsia, dyspnea, abd pain, N/V, develops < 1 day
DKA
HHS
Polyuria, polydipsia, confusion/lethargy, develops > 1 day
DKA
HHS
Elderly female pt presents to ER in January with dry skin, delayed reflex relaxation, generalized weakness, edema, cold intolerance, change in voice, weight gain, constipation, irregular menses, muscle cramps, paresthesias, and change in mentation. You notice a transverse scar across the low anterior neck. PE shows hypotension, bradycardia, and hypothermia (, 95.9F). Of note, she recently was treated for an infection. What do you suspect?
DKA
HHNC
Myxedema Coma
Thyroid Storm
Change in mentation is key to what disorder?
DKA
HHNC
Myxedema Coma
Thyroid Storm
What is NOT true about myxedema coma?
Vasodilation effects to cool down
Skin dry and cool to touch
Reduced metabolic rate
Reduced cardiac output and blood volume
Mild hypertension
What labs are NOT inlcuded in workups for myxedema coma?
ABGs
High serum free T4 and T3
Blood and urine cultures
Blood glucose assessed initially
Serum creatinine kinase may be elevated
What is the NOT part of Myxedema Coma treatment?
Large amounts of IV fluids with isotonic solutions
Glucocorticoids (Solucortef)
ABX
Active rewarming
Thyroid replacement w/ levothyroxine
Pt presents with fever, tachycardia, atrial arrhythmias, confusion, delirium, coma, psychosis, thyromegaly, ophthalmopathy, tremor, stare, diaphoresis, and agitation. You suspect an emergent complication of hyperthyroidism. What do you suspect?
DKA
HHNC
Myxedema Coma
Thyroid Storm
What is NOT a diagnostic finding for thyroid storm?
T4 elevated
EKG abnormal w/ sinus tach, increased QRS, increased P, afib, a flutter
TSH markedly elevated
Electrolyte and glucose abnormalities
What is NOT part of the treatment for thyroid storm?
ABX
ABCs and volume replacement
Propylthiouracil or methimazole
β-blocking agents
Iodide before antithyroid meds
What is the beta blocker of choice for thyroid storm?
Carvedilol
Bisoprolol
Metoprolol
Propranolol
Corticosteroids can be used in treatment of myxedema coma because they inhibit peripheral conversion of T4 to T3 and block release of hormone from thyroid gland.
True
False
You should NOT aggresively try to change the body temperature of thyroid storm or myxedema coma patients.
True
False
