623 Adult Endocrine/Metabolic chapter 16 2023 with complete solution

a. painful contraction of the hands or feet pg 830 carpopedal spasm is: a. painful contraction of the hands or feet b. painful flexion of the hands or feet c. spasm of the carpels it is one of the neuromuscular signs indicating hypocalcemia and is a significant sign of tetany pg 830 what does carpopedal spasm indicate? a. 9-11 mg/dL pg 830 what is the normal serum calcium values in adults? a. 9-11 mg/dL b. 6-8 mg/dL c. 13-14 mg/dl d. 0.2-.09 mg/dl Trousseau's sign (carpal spasm) Chvostek's sign (spasm of the facial muscle) pgs 830-831 what are two neuromuscular signs that can be tested and are indicative of hypocalcemia? tapping the facial nerve below the zygomatic arch anterior to the ear lobe pg 831 how do you test for Chvostek's sign? with BP cuff 20mmHg above the normal systolic, inflate, hold for 3 minutes pg 830 how do you test for Trousseau's sign? IV replacement of calcium and is guided by the severity of hypocalcemia paired with the pt's s/s pg 831 what is the emergency tx of hypocalcemia? 6.5mg/dL pg 830 at what level should you immediately treat hypocalcemia? b. emergency care pg 831 when a patient is exhibiting either Trousseau's or Chvostek's signs and accompanied by respiratory distress(stridor, loud crowing noises and cyanosis), what type of care do they need? a. home care b. emergency care c. ibuprofen d. rest with calcium gluconate (94 mg of elemental calcium) in bolus and maintenance infusion pg 831 how is tetany, dyrhythmias, or seizures tx with hypocalcemia? usually resistive and ropy in texture pg 831 what does the glandular enlargement of gynecomastia feel like? a. 20 to 40 yrs pg 837 hyperthyroidism peaks at what ages? a. 20 to 40 yrs b. 40-60 yrs c. 15 to 20 yrs d. no peaks, can affect at any age free T4 assay when the TSH level is either undetectable or 10 mU/L or higher pg 837 the sensitive TSH level should be followed by a spontaneously and from result of excessive intake of thyroid hormones pg 837 hyperthyroidism can occur Grave's disease pg 837 what is the most common cause of spontaneous hyperthyroidism in the U.S. antithyroid drugs, radioactive iodine, and surgery pg 842 what are the three tx options for Graves' disease? PTU propylthiouracil MMI methimazole pg 843 what are the two antithyroid medications used today? 2-8 wks pg843 how long does it take for the medications PTU or MMI to achieve their peak levels? PTU, because it is less likely to cross the placenta pg 843 which antithyroid medication would you use in a pregnant women and why? a. fine needle aspiration pg 842 Which of the following is essential for diagnosing thyroid malignancy? a. fine needle aspiration b. thyroid ultrasound c. computed tomography (CT) scan d. magnetic resonance imaging (MRI) d. magnetic resonance imaging (MRI) pg 842 what is the preferred test assess for ophthalmopathy resulting from Graves' disease? a. fine needle aspiration b. thyroid ultrasound c. computed tomography (CT) scan d. magnetic resonance imaging (MRI) when the thyroid gland is hard and enlarged or when nodules are palpated pg 842 when should thyroid cancer be considered? c. Add a dosage of long-acting insulin at bedtime to the regimen. quiz 624 Morton has Type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is insufficient to achieve acceptable glycemic control. Your next course of action is to: a. Discontinue the oral antidiabetic agents and start insulin therapy. b. Suggest treatment using an insulin pump. c. Add a dosage of long-acting insulin at bedtime to the regimen. d. Increase the dosage of the oral antidiabetic agents. a. Watchful waiting with an annual follow-up. quiz 624 Alice, age 48, has a benign thyroid nodule. The most common treatment involves: a. Watchful waiting with an annual follow-up. b. Surgery. c. Administration of levothyroxine therapy. d. Radioactive iodine therapy. b. Brittle hair. quiz 624 Which of the following is a sign of hypothyroidism? a. Warm, smooth, moist skin. b. Brittle hair. c. Gynecomastia. d. A thyroid bruit. b. Persistent proteinuria. quiz 624 ACE inhibitors are given to clients with diabetes who have a. Insulin sensitivity. b. Persistent proteinuria. c. An elevated serum creatinine level. d. An elevated glycohemoglobin level. a. Metformin (Glucophage). quiz 624 A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? a. Metformin (Glucophage). b. Glipizide. c. Sitagliptin (Januvia). d. Exenatide (Byetta). a. fine needle aspiration Which of the following is essential for diagnosing thyroid cancer? a. fine needle aspiration b. thyroid ultrasound c. computed tomography (CT) scan d. magnetic resonance imaging (MRI) asymptomatic pg 831 gynecomastia lasting longer than 1 year is usually: 12-14 yrs, duration is six months and then regression is expected pg 831 gynecomastia associated with puberty begins at evaluated by an endocrinologist pg 831 gynecomastia that presents before or after puberty and cannot be associated with physiologic againg, drug, or chronic disease, must be when it is accompanied by other breast abnormalities, especially if it is unilateral, a disc than 4cm in diameter, does not resolve after two years after puberty, occurs in the presence of abnormal serum levels of free testosterone and luteinizing hormones or abnormal testis pg 831-832 when is a mammogram indicated in gynecomastia? an enlarged thyroid gland pg 833 what is the most common cause of neck size? hypothyroidism, Cushing's syndrome, renal, hepatic disease, CHF, premenstrual syndrome, pregnancy, medication use, depression, and excessive calorie intake pg 835 major differential dx for weight gain are: BMI 18 or 15-20% below ideal weight pg 835 underweight is defined as: hypothyroidism in the U.S., more common in women and the average age at onset from 30-60 yrs pg 846-847 Hashimoto's thyroiditis is the most common etiology of non-Hodgkin's lymphome pg 855 a rare type of thyroid cancer that should be consider in person with a rapidly growing goiter is: d. all of the above pp 882-883 A patient with type 2 diabetes comes to the clinic after reading about Metformin. Which of the following conditions that the patient also has would be a contraindication to taking Metformin? a. ketoacidosis b. cirrhosis or alcoholic patient c. hypoglycemic episodes d. all of the above d. every visit pg 875 How often should the healthcare provider examine the feet of a person with diabetes? a. annually b. every 6 months c. every 3 months d. every visit b. Charcot joint pg 875 can be confused with cellulitis Mr. YM, 55 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with "fairly good" control on twice-daily insulin. He denies injury but states that he tripped a few months previous and that his foot is sore when he walks. Physical examination reveals an edematous, erythemic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis? a. fallen arch b. Charcot joint c. arthritis d. sprained ankle a. tricyclic antidepressants pg 875 A 64-year-old male with type 2 diabetes comes to the clinic with c/o "my feet feel like they are on fire." He has loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment? a. tricyclic antidepressants b. capsacin cream c. vitamin B12 injections d. insulin annually pg 874 how often should a diabetic have his/her eyes checked? b. mild obese pg 895 a patient who is 5 feet tall and weighs 150 pounds (29.3kg/m2). How would the healthcare provider classify this patient? a. overweight b. mild obese c. moderate obese d. morbid obese c. moderate obese pg 895 a patient who is 5 feet tall and weighs 170 pounds (33.2kg/m2). How would the healthcare provider classify this patient? a. overweight b. mild obese c. moderate obese d. morbid obese d. morbidly obese pg 895 a patient who is 5 feet tall and weighs 205 pounds (40kg/m2). How would the healthcare provider classify this patient? a. overweight b. mild obese c. moderate obese d. morbidly obese a. elevated uric acid level pg 899 elevated wbc count, elevated temperature, elevated serum uric acid or normourecemia (acute phase, pg 900) Mr. KY presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The healthcare provider suspects acute gout. Which of the following should the healthcare provider suspect in the initial test results for this patient? a. elevated uric acid level b. elevated blood urea nitrogen (BUN) c. decreased urine pH d. decreased C-reactive protein (CRP)