NUR MISC Week 3 – Chronic Endocrine & Metabolic Diseases Part 2 (SOLVED ) 100% CORRECT ANSWERS

Week 3 – Chronic Endocrine & Metabolic Diseases Part 2 A 25-year-old patient presents for annual blood tests. His A1C is 4.9%. His LDL is 195 mg/dl. He is a nonsmoker and has no personal history of CAD. What should be the next step in terms of clinical management? Select the best answer. Lipid therapy is not indicated. Initiate screening for lipid disorders at age 40. Lipid therapy is not indicated. Repeat lipid panel and reassess risk annually. Start simvastatin 20 mg daily. Start atorvastatin 40 mg daily. Diagnostic study results that confirm a diagnosis of primary hypothyroidism are: Increased highly sensitive TSH and decreased free T4 Decreased highly sensitive TSH and decreased Free T4 Abnormal thyroid ultrasound and elevated antithyroid antibodies Normal thyroid ultrasound and increased free T3 All of the following are considered secondary disorders of lipid metabolism, except: Hypothyroidism Immunoglobulin excess Pregnancy Familial combined hyperlipidemia You are concerned that a person presenting with fatigue, altered menses, and weight changes may have a thyroid disorder. To rule in/rule out thyroid dysfunction, the initial diagnostic test(s) that you should order is/are: Free T4 and serum antithyroid antibodies Thyroid ultrasound Highly sensitive thyroid-stimulating hormone (TSH) Free T3 and thyroid scintigraphy A patient who is taking a statin drug to treat dyslipidemia has begun a diet and exercise program. The patient reports new onset of muscle pain several weeks after beginning therapy. What is the initial action by the provider? Discontinue the statin drug immediately Obtain a creatine kinase level Prescribe acetaminophen or ibuprofen Recommend reducing exercise intensity A person with subclinical hypothyroidism will usually have: Mild symptoms of thyroid dysfunction and mildly decreased levels of free T4 No symptoms of thyroid dysfunction and an elevated TSH level Mild symptoms of thyroid dysfunction and normal thyroid function tests None of the above Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.) Decreased plasminogen activator inhibitor 1 levels Elevated waist circumference Fasting plasma glucose ≧100 mg/dL HDL cholesterol ≧45 mg/dL Triglycerides ≧150 mg/dL What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause increased insulin resistance. They increase the risk of arterial thrombosis. They lower the risk of hypertension. They predispose patients to dyslipidemia. When using the 2013 ACC/AHA “Guideline on the Assessment of Cardiovascular Risk” to treat patients with hyperlipidemia, the practitioner understands that it provides information about: goals for treatment for low-density lipoprotein levels. how to titrate statin drugs to achieve goal levels. use of non-statin therapy for primary prevention. which patients will benefit from statin therapy. Which of the following statements about thyroid nodules is false? Most thyroid nodules are benign. A predominant nodule in a multinodular gland should be biopsied. Thyroid nodules are more common in women than men. A multinodular thyroid gland is often associated with a malignant process. A medication that should be immediately ordered to blunt symptoms of hyperthyroidism is: Radioactive iodine (123I) Propylthiouracil Propanolol Amiodarone For which of the following patients would you not recommend starting statin therapy? 55-year-old female with diabetes, history of myocardial infarction (MI), and an LDL of 50 55-year-old male with diabetes and LFTs twice the normal limits 65-year-old female with diabetes and end-stage renal disease on dialysis three times per week 70-year-old male with a history of statin myopathy on simvastatin and on fish oil The most significant potential benefit in CHD mortality risk reduction comes from modifying which of the following? Obesity Diet Exercise Smoking Ms. S is a 55-year-old woman with diabetes and an estimated 10- year risk 7.5%. At her last visit, she was started on Atorvastatin 10 mg and her LDL has reduced from 110 mg/dl to 90 mg/dl. How do you proceed? Increase Atorvastatin to 20 mg daily A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Serum TSH level Thyroid ultrasound Radionucleotide imaging Serum calcitonin Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Aspirin Atorvastatin Metformin Niacin Premature CAD is almost always due to secondary lipid disorders, so work-up for primary lipid disorders is unnecessary. FALSE A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Thionamide therapy Surgical resection of the thyroid gland Beta blocker medications Radioiodine therapy An 80-year-old patient is seeing you after a recent hospitalization for MI. Her blood pressure is 130/85. Her lipid panel today shows an LDL of 90 mg/dl. She takes aspirin but no other medications. Provide education, but do not initiate statin therapy given her age. No additional lipid monitoring required. Provide education and repeat lipid panel in 1 year Start atorvastatin 20 mg daily Start atorvastatin 80 mg daily Tendon xanthomas are most likely to be seen in which patients? Patients with primary hyperlipidemias Patients with hypertriglyceridemia Patients with chronic, untreated hyperlipidemias Pregnant patients with hyperlipidemia A patient with type 2 diabetes has a low-density lipoprotein (LDL) level of 110 gm/dL. What is recommended to manage this patient? Dietary and lifestyle changes to modify risk Initial treatment with a low intensity statin medication Prescription of a moderate or high intensity statin Statin therapy until the LDL level is below 75 mg/dL Mr. H. is 70-year-old person who has been started on levothyroxine for the treatment of hypothyroidism following radioactive treatment for a toxic uninodular goiter. Mr. H should be told that: Hypothyroidism is a chronic condition and will require lifetime use of levothyroxine. His thyroid gland will return to normal in a few years at which time he can stop the levothyroxine. He should avoid taking iodine-rich food while taking levothyroxine. He should take potassium iodide while his body is acclimating to levothyroxine. There are several risk factors associated with thyroid cancer. Which one of the factors is not specifically associated with thyroid cancer? A nonnodule Ingestion of dietary goitrogens Recent growth of single nodule Head or neck irradiation A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? This condition may be transient. A patient with hypertriglyceridemia requests education about how to prevent pancreatitis. How do you counsel? Limit excessive alcohol intake Eat a diet high in plant stanols Starts a statin Stop smoking Which of the following symptoms and signs are consistent with a person with primary hypothyroidism? Dysthymia and weight gain Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? 0.2 uIU/L A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? This condition may be transient For which of the following patients would you not recommend starting statin therapy? 65-year-old female with diabetes and end-stage renal disease on dialysis three times per week A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Beta blocker medications Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels? Metformin Ms. W is a 35-year-old female with a diagnosis of toxic multinodular goiter. She has decided to proceed with a course of methimazole. The best test for assessing an adequate response to this treatment would be: TSH receptor antibodies A free T4 A radioactive iodine uptake scan A highly sensitive TSH A patient who is taking a statin drug to treat dyslipidemia has begun a diet and exercise program. The patient reports new onset of muscle pain several weeks after beginning therapy. What is the initial action by the provider? Obtain a creatine kinase level A patient hypertriglyceridemia requests education about how to prevent pancreatitis. How do you counsel? Limit excessive alcohol intake A patient hypertriglyceridemia requests education about how to prevent pancreatitis. How do you counsel? Eat a diet high in plant stanols Stop smoking Start a statin Limit excessive alcohol intake Ms. W is a 35-year-old female with a diagnosis of toxic multinodular goiter. She has decided to proceed with a course of methimazole. The best test for assessing an adequate response to this treatment would be: A radioactive iodine uptake scan A free T4 A highly sensitive TSH TSH receptor antibodies A patient with type 2 diabetes has a low-density lipoprotein (LDL) level of 110 gm/dL. What is recommended to manage this patient? Dietary and lifestyle changes to modify risk Statin therapy until the LDL level is below 75 mg/dL Prescription of a moderate or high intensity statin Initial treatment with a low intensity statin medication A medication that should be immediately ordered to blunt symptoms of hyperthyroidism is: Amiodarone Radioactive iodine (123I) Propanolol Propylthiouracil All of the following are considered secondary disorders of lipid metabolism, except: Pregnancy Hypothyroidism Immunoglobulin excess Familial combined hyperlipidemia Which of the following symptoms and signs are consistent with a person with primary hypothyroidism? Constipation and exophthalmos Nervousness and hyperactive bowel sounds Dysthymia and weight gain Palpitations and fine tremor What is important about increased PAI-1 levels in patients with metabolic syndrome? They increase the risk of arterial thrombosis. They lower the risk of hypertension. They predispose patients to dyslipidemia. They cause increased insulin resistance. Which of the following statements about thyroid nodules is false? Most thyroid nodules are benign. A predominant nodule in a multinodular gland should be biopsied. A multinodular thyroid gland is often associated with a malignant process. Thyroid nodules are more common in women than men. A patient with type 2 diabetes has a low-density lipoprotein (LDL) level of 110 gm/dL. What is recommended to manage this patient? Statin therapy until the LDL level is below 75 mg/dL Dietary and lifestyle changes to modify risk Prescription of a moderate or high intensity statin Initial treatment with a low intensity statin medication Diagnostic study results that confirm a diagnosis of primary hypothyroidism are: Normal thyroid ultrasound and increased free T3 Increased highly sensitive TSH and decreased free T4 Decreased highly sensitive TSH and decreased Free T4 Abnormal thyroid ultrasound and elevated antithyroid antibodies