A recently diagnosed patient with type 2 diabetes presents today with fever
and burning with urination. She is diagnosed with a urinary tract infection
(UTI). Her urine dipstick is positive for protein. Which statement is correct?
- ANS ✓No specific conclusions can be drawn about the proteinuria
No conclusion can be drawn from this particular finding of proteinuria.
Transient proteinuria can be found in the setting of fever, during the course
of UTI, after intense exercise, poor glycemic control, and other systemic
conditions. A diagnosis of microalbuminuria must be made after two
positive screens on dipstick at least 3-6 months apart.
Which laboratory abnormality very commonly accompanies
hypothyroidism? - ANS ✓Dyslipidemia
Hypothyroidism adversely affects lipid metabolism. A finding of elevated
lipids, specifically dyslipidemia, is common when TSH values exceed 10
mU/L. Consequently, patients with dyslipidemia should also have a TSH
evaluated. Dyslipidemia should not be treated until the TSH decreases to 10
mU/L or less. Other abnormal laboratory findings associated with
hypothyroidism are hyponatremia, hyperprolactinemia,
hyperhomocysteinemia, anemia, and elevated creatinine phosphokinase.
Hyperthyroidism may affect the blood pressure: - ANS ✓by producing an
increase in systolic and diastolic readings
A common effect of hyperthyroidism on blood pressure is an increase in
both systolic and diastolic readings over the patient's usual readings. In
fact, hyperthyroidism is a common endocrine cause of secondary
ENDOCRINE EXAM
, 2
END
hypertension. Other endocrine causes of secondary hypertension are
pheochromocytoma, Cushing's syndrome, and neuroblastoma. It is very
common to measure a resting heart rate of greater than 100 bpm in
patients who have untreated hyperthyroidism
Ideally, a patient should have a fasting glucose that is: - ANS ✓less than 100
mg/dL
The ideal screening glucose is done during a fasting state and should be less
than 100 mg/dL. Abnormal values should always be repeated. If a patient is
non-fasting and the glucose value is less than 125 mg/dL, most authorities
consider this to be normal.
The most appropriate time to begin screening for renal nephropathy in a
patient with Type 1 diabetes is: - ANS ✓5 years after diagnosis
Patients with type 1 diabetes should be screened for renal nephropathy 5
years after diagnosis. Since nephropathy takes several years to develop, it
is highly improbable that a newly diagnosed patient will have nephropathy
secondary to diabetes. Nephropathy develops in about 30% of patients with
diabetes. Diabetic nephropathy is defined as the presence of diabetes and
more than 300 mg/d of albuminuria on at least 2 occasions separated by 3-
6 months.
A 37 year-old overweight male is diagnosed today with Type II diabetes. His
fasting glucose is 159 mg/dL. He is hyperlipidemic (LDL = 210 mg/dL) and
hypertensive (146/102). What medications should be initiated today? - ANS
✓Metformin, atorvastatin, ramipril, ASA
This patient needs several medications started today. American Diabetes
Association recommends starting treatment with metformin. This should
be initiated today. The drug class of choice for treatment of his LDL
cholesterol is a statin. Dietary modifications are usually attempted for 3
months prior to initiation of a statin. However, considering this patient's
LDLs of 210 mg/dL (goal of less than 100 mg/dL), strong consideration
should be given to initiating therapy today with a statin. An ACE inhibitor is
ENDOCRINE EXAM
, 3
END
the preferred antihypertensive medication to treat blood pressure
elevations in this patient. An aspirin should be initiated if there are no
contraindications.
A 45 year-old female patient has a screening TSH performed. Her TSH value
is 13 mU/L. It was repeated in one week and found to be 15 mU/L. What
explains this finding? - ANS ✓Hypothyroidism
This patient has hypothyroidism because her TSH exceeds 5 mU/L.
Common symptoms associated with hypothyroidism include fatigue, weight
gain, dry skin, cold intolerance, constipation, menstrual irregularities, and
hair and nails that break easily. The diagnosis should be easily realized
since the TSH is elevated on two occasions.
A pregnant patient took L-thyroxin prior to becoming pregnant. What
should be done about the L-thyroxin now that she is pregnant? - ANS ✓She
should continue it and have monthly TSH levels
L-thyroxin is thyroid supplement used to treat patients with
hypothyroidism. It is safe to use during pregnancy and should be continued.
However, during pregnancy, thyroid hormone needs increase and so she
will need frequent monitoring because if levels drop to a hypothyroid state,
growth of the fetus can be severely affected.
In order to determine how much T4 replacement a patient needs to re-
establish a euthyroid state, the nurse practitioner considers: - ANS ✓the
patient's body weight
Replacement is based on body weight and is usually calculated in
kilograms. The patient's weight is calculated in kilograms and multiplied
by 1.6 to determine the replacement needed in one day. This is the amount
that should be prescribed provided the patient is otherwise healthy, is less
than 50 years old, and has no evidence of underlying cardiac disease.
ENDOCRINE EXAM
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