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WorksheetsSIADH and DI Worksheet
Total questions: 79
Worksheet time: 40mins
Which laboratory pattern is most consistent with SIADH?
Hyponatremia, low serum osmolality, high urine specific gravity
Hyponatremia, high serum osmolality, low urine specific gravity
Hypernatremia, low serum osmolality, low urine specific gravity
Hypernatremia, high serum osmolality, high urine specific gravity
Priority initial management for symptomatic SIADH with severe hyponatremia includes:
Rapid 3% saline bolus to normalize sodium immediately
Slow hypertonic IV fluids with careful monitoring
Increase free water intake to flush solute
Discontinue all diuretics and give isotonic saline freely
Which clinical pattern best describes Diabetes Insipidus (DI)?
Low urine output, weight gain, seizures
Polyuria, polydipsia, hypotension, tachycardia
Edema, hyponatremia, concentrated urine
Bradycardia, hypertension, oliguria
A patient with DI most likely has which set of labs?
Low sodium, low serum osmolality, high urine specific gravity
High sodium, high serum osmolality, low urine specific gravity
Normal sodium, high serum osmolality, high urine specific gravity
High sodium, low serum osmolality, high urine specific gravity
First-line pharmacologic therapy for central DI is:
Desmopressin
Levothyroxine
Propranolol
Methimazole
Appropriate diet advice for DI emphasized on the slides:
Low sodium diet (<3 g/day)
High protein diet
No carb diet
High potassium diet
Which patient is at highest risk for SIADH?
Patient with COPD on certain meds and head trauma history
Healthy adolescent athlete
Patient with dehydration from heat exposure
Post-thyroidectomy patient day 1
SIADH and DI precautions include:
SIADH—airway; DI—bleeding
SIADH—seizure precautions; DI—fluid replacement
SIADH—neutropenic precautions; DI—reverse isolation
SIADH—NPO; DI—NPO
Classic hyperthyroidism manifestations emphasized include:
Weight gain, constipation, cold intolerance
Weight loss, palpitations, heat intolerance, tremor
Bradycardia, depression, dry skin
Hypotension, hypothermia, coma
Which test helps differentiate causes of hyperthyroidism per slides?
Serum cortisol
Radioactive iodine uptake (RAIU)
HbA1c
AST/ALT
Antithyroid drugs that inhibit thyroid hormone synthesis include:
Propranolol and methimazole
Levothyroxine and PTU
PTU and methimazole
Iodine and levothyroxine
Key teaching for iodine solutions (SSKI/Lugol) includes:
Take on an empty stomach before bed
Mix with water or juice, take after meals, sip through a straw
Avoid all fluids for 2 hours after dosing
Crush tablets and sprinkle on food
Which beta-blocker is listed for symptomatic hyperthyroidism?
Metoprolol
Propranolol
Atenolol
Carvedilol
Radioactive iodine therapy (RAI) counseling includes:
Immediate full effect within 24 hours
Avoid pregnant women/children for about 7 days and use separate linens
No need for any radiation precautions at home
Stop all antithyroid meds permanently before dose
Severe thyrotoxicosis (thyroid storm) findings include:
Hypothermia and bradycardia
Seizures, very high temp, heart failure, shock
Typical hypothyroid 'slowing down' symptoms include:
Heat intolerance and diarrhea
Weight loss and insomnia
Dry skin, fatigue, constipation, cold intolerance
Exophthalmos and tremor
Initial levothyroxine teaching includes:
Take with food to avoid GI upset
Start high dose immediately to reverse symptoms
Take 30–60 minutes before breakfast on an empty stomach
Alternate with liothyronine every other day
A life-threatening complication of hypothyroidism stressed on slides is:
Myxedema coma with low temp, low BP, low respirations
Addisonian crisis with hyperkalemia
DKA with Kussmaul respirations
Thyroid storm
Hashimoto thyroiditis expected labs are:
High T3/T4 and low TSH
Low T3/T4, high TSH, positive antithyroid antibodies
High cortisol and low ACTH
High PTH and high phosphate
Acute infectious thyroiditis management may include:
Antibiotics and anti-inflammatory therapy
RAI dose immediately
High-dose levothyroxine
Emergent thyroidectomy for all cases
Primary effect of increased PTH on labs per slides:
↓ Calcium, ↑ Phosphate
↑ Calcium, ↓ Phosphate
↑ Calcium, ↑ Phosphate
No change in either
A listed cause of hyperparathyroidism was:
Parathyroid tumor
Pituitary adenoma secreting TSH
Long-term iodine therapy
Hepatitis C infection
In CKD, secondary hyperparathyroidism is often related to:
Hypophosphatemia
Hyperphosphatemia and vitamin D deficiency
High calcium intake
Excess aldosterone
A musculoskeletal consequence associated with parathyroid disorders includes:
Osteoarthritis exacerbation
Tremor
Synovitis
Muscle hypertrophy
Core definition of diabetes on slides:
Hypoglycemia due to low insulin
Hyperglycemia from abnormal insulin production, impaired use, or both
Autoimmune attack on adrenal cortex
Insulinoma with excess insulin
Normal insulin actions include:
Increase hepatic gluconeogenesis and lipolysis
Allow cellular glucose entry and promote fat storage
Block cellular glucose entry and increase protein breakdown
Stimulate ketone production in liver
Low insulin state promotes:
Hepatic glucose release, fat release from adipose, and protein catabolism
Glycogen synthesis and lipogenesis
Beta-cell proliferation
Gluconeogenesis inhibition
Which is TRUE per slides:
Type 2 accounts for 5–10% of cases
Type 1 onset is typically gradual over years
Type 1 usually requires lifelong exogenous insulin
Type 2 never produces insulin
Classic new-onset Type 1 triad is:
Polyuria, polydipsia, polyphagia
Weight gain, fatigue, constipation
Night sweats, tremor, diarrhea
Cold intolerance, bradycardia, edema
Which of the following is a characteristic of Type 2 Diabetes Mellitus?
A) Absolute insulin deficiency only
B) Insulin resistance with inadequate secretion
C) Autoimmune islet cell destruction always
D) No relation to family history
Prediabetes is characterized by:
Impaired fasting glucose and/or impaired glucose tolerance
Persistent fasting glucose <70 mg/dL
Ketosis at diagnosis
Always symptomatic
A major non-modifiable risk factor emphasized for Type 2 DM:
Race/ethnicity and family history
Daily soda intake
Sedentary job last month
Eating after 8 PM
An interprofessional priority across visits for DM complications includes:
Annual foot exam by HCP and daily self foot checks
Avoid all vaccines
Monthly colonoscopies
No lipid testing needed
For retinopathy prevention/monitoring, the slide recommends:
Eye exam every 5 years
Annual dilated eye exam
Only check if symptomatic
Home Snellen chart only
Nephropathy surveillance includes:
Daily BMP
Annual urine/kidney testing
Only renal ultrasound
MRI every 2 years
Cardiovascular risk in DM care includes:
Check BP and lipids at every visit; consider further testing as needed
Only check BP annually
Lipids only if chest pain present
No urine testing ever
Hypoglycemia hallmark threshold noted:
BG < 90 mg/dL
BG < 80 mg/dL
BG cut-off for hypoglycemia is:
BG < 80 mg/dL
BG < 90 mg/dL
BG < 70 mg/dL
BG < 60 mg/dL
Early symptoms of hypoglycemia include:
Palpitations, diaphoresis, shakiness
Bradycardia, constipation
Hyperthermia, flushing
Abdominal distention only
If BG remains <70 after 15 minutes following 15–20 g fast carbs, next step is:
Repeat the 15 g fast-acting carbs and recheck in 15 min
Give IV insulin
Administer furosemide
Start beta-blocker
In hospital for severe hypoglycemia, you may give:
50% dextrose IV or glucagon IM
Normal saline only
Levothyroxine IV
Iodine solution
CDC BMI cut-off for obesity on slides is:
≥25
≥27
≥30
≥35
Obesity pathophysiology includes:
Energy deficit and reduced adipocytes
Energy surplus with increased adipocyte number and size
Ketone overproduction with weight loss
Autoimmune adipocyte lysis
A listed obesity health risk is:
Hypotension
Type 2 diabetes
Tetanus
Hyperthyroidism
Recommended approach to weight history per slides:
Judgmental interviewing to motivate change
Sensitive, non-judgmental history with leading questions like ‘can you tell me more?’
Avoid discussing diet
Focus only on BMI number
Besides BMI, other measures include:
Waist circumference and hip-to-waist ratio
Head circumference
Tibia length
Chest expansion
Nutrition/exercise for obesity primarily addresses:
Energy imbalance
Iodine deficiency
Sodium restriction exclusively
High-calorie supplementation
Metabolic syndrome is listed under obesity as a:
Cancer therapy
Health risk cluster
Lab artifact
Surgical technique
Which respiratory issue is associated with obesity on slides?
Hyperventilation only
Sleep apnea and hypoventilation
Asthma only
COPD only
Cirrhosis pathophysiology includes:
Acute reversible fatty change
Extensive hepatocyte degeneration with fibrosis over decades
Portal vein agenesis from birth
Purely autoimmune cholangitis
Common early presentation of cirrhosis may be:
Asymptomatic
Seizures
Hypoglycemia only
Acute renal colic
A bold slide warning for liver patients states:
'LIVER PATIENTS BLEED' due to hematologic problems
'LIVER PATIENTS BRADYCARDIC'
'LIVER PATIENTS ARE IMMUNE'
'LIVER PATIENTS HYPERKALEMIC'
Which of the following is NOT a complication of cirrhosis?
Portal hypertension and varices
Ascites
Hepatic encephalopathy
Pheochromocytoma
Which diagnostic is the gold standard for confirming cirrhosis per slides?
Liver ultrasound
CT scan
Liver biopsy
Fibroscan
How do AST/ALT typically trend in very late cirrhosis?
Remain markedly elevated
Normalize in very late disease
Always low
Undetectable from onset
Typical lab pattern in advanced cirrhosis includes:
High albumin, low bilirubin
Low albumin, high bilirubin, prolonged clotting time
High albumin, normal INR
Normal albumin, low bilirubin
Ascites first-line noninvasive management includes:
Sodium restriction ~2 g/day and diuretics (spironolactone ± furosemide)
High-sodium diet
Daily NSAIDs
No fluid removal
For tense ascites, a listed procedure is:
Endoscopy
Paracentesis
Cholecystectomy
ERCP
Variceal bleeding prevention advice includes:
Avoid NSAIDs and alcohol; consider nonselective beta-blockers
Start aspirin daily
Increase heavy lifting
High-protein supplements only
Acute varice management options on slides include:
Banding or sclerotherapy; shunt procedures in select cases
RAI therapy
Portal hypertension pharmacologic option listed:
Vasopressin
Levothyroxine
PTU
Desmopressin
Hepatic encephalopathy prevention/treatment includes:
Lactulose to decrease ammonia and promote bowel movements
High-protein diet without restriction
Morphine for confusion
NSAIDs for sedation
A key nursing monitoring item with lactulose therapy:
Monitor for adequate bowel movements and mental status improvement
Check TSH daily
Encourage fluid restriction to zero
Stop if diarrhea occurs once
Which statement about LFTs is TRUE per slides?
AST/ALT are always high in late disease
AST/ALT may be high early but can be normal in very late disease
Albumin always rises with cirrhosis
Bilirubin always stays low
Liver cirrhosis patients often develop which skin finding?
Spider angiomas
Malar rash
Café-au-lait spots
Hirsutism
Peripheral neuropathy is listed under cirrhosis:
Clinical manifestation
Diagnostic test
Surgical cure
None of the above
A variceal patient education point:
Avoid high-risk bleeding procedures when possible
Start NSAIDs for pain control
All alcohol in moderation is safe
No need for follow-up endoscopy
Hormonal regulation concept refers to:
Renal autoregulation only
Physiologic mechanisms that control secretion and action of hormones
Neural synapse transmission exclusively
GI motility reflexes
An endocrine gland is best defined as:
A ducted gland that secretes enzymes
A specialized tissue/organ that makes and secretes hormone into blood
Any organ with exocrine function
A synovial tissue
Negative feedback in endocrine control means:
A) A rise in hormone causes more release of the same hormone
B) Blood levels determine increased or decreased secretion to maintain balance
C) CNS always inhibits hormones
D) Biologic rhythms never affect secretion
A positive feedback example is:
Increasing hormone A triggers more hormone B, which increases A further
Rising glucose suppresses insulin release
Thyroid suppression with iodine
RAAS activation lowering aldosterone
With aging, a common change listed is:
Increased ADH causing water retention
Reduced hormone production such as ADH; reproductive hormones rise in adolescence only
No change in hormone secretion
Improved receptor sensitivity universally
Primary prevention strategies emphasized include:
Education, diet, exercise, weight control, stress management, sleep, injury avoidance
Annual surgery
Radiation for all
No lifestyle focus
Secondary prevention examples include:
A) Newborn congenital screening and adult thyroid or DM screening
B) Only imaging studies
C) Routine biopsies for all
D) No lab tests
A general risk factor for endocrine problems listed:
Young age alone
Obesity, genetics/family history, autoimmune disease, chronic conditions, cancer treatment, stress/trauma
Daily exercise
Meditation
Key components of assessment for endocrine issues include:
Vitals, H/W, skin/hair/nails, body composition, genitalia/thyroid exam, and diagnostic tests
Vitals only
Symptoms only
Imaging only
Glucose regulation definition on slides is:
Balance of nutrient intake, hormonal signaling, and cellular uptake to maintain euglycemia
Balance of dietary fat only
Insulin independence
Ketone production control only
Management of endocrine disorders may include all EXCEPT:
Pharmacotherapy
Radiation and surgery
Psychosocial support and patient education
Universal high-calorie diet
Which adult screening is included under endocrine secondary prevention?
Thyroid and diabetes screening
Universal RAI uptake test
Annual pituitary MRI
Routine adrenal biopsy
