112 Questions
What is the emphasis on lifestyle modifications in managing type two diabetes?
Lifestyle modifications should be mentioned at every visit to the patient.
Why does the text suggest setting short and simple weight loss goals for diabetic patients?
Because small increments in weight loss have been shown to make a significant difference in A1C levels.
How often should glycemic targets be adjusted for diabetic patients?
About every 3 months
What is the recommended A1C level for optimal management in diabetic patients?
Less than or equal to 6.5%
Why is it essential to individualize glycemic targets for diabetic patients?
To tailor treatment based on each patient's GMAR, T, fasting blood glucose, and postprandial glucose levels
What is the suggested frequency for checking hemoglobin A1C in diabetic patients?
Every 3 months
What is the recommended LDL target for individuals at high risk with type two diabetes?
Less than 70
Which of the following is NOT considered a major risk factor according to the ICE SCV risk reduction algorithm for dyslipidemia?
Obesity
What is the recommended triglycerides level for individuals at very high risk?
Less than 150
When should individuals be monitored to achieve their lipid goal according to the text?
Every three to six months
What additional therapy should be considered if an individual has not reached their target LDL?
Niacin
What is the recommended initial blood pressure for starting therapy in diabetic patients?
150 over 100
What is the first-line medication recommendation for elderly patients with diabetes?
Metformin
In diabetic patients with high risk for heart failure, which medication class is recommended?
GLP-1 receptor antagonist
What is the recommended minimum duration for aerobics activity per week for individuals with a BMI less than or equal to 25?
150 minutes
What is the glycaemic target advised for most patients according to the text?
6.5% or less
At what BMI range is structured exercise with oversight and accountability advised, along with consideration of weight loss medications and screening for sleep disturbances?
Greater than 25 to 27
Which medication class should be avoided in diabetic patients at risk of hypoglycemia?
Sulfonylureas
What is the primary goal of lifestyle interventions in the prediabetes algorithm?
Prevent progression to diabetes
What medication is recommended as an alternative for diabetic patients who cannot afford GLP-1 receptor antagonists or SGLT-2 inhibitors due to cost?
Insulin
Which medication is NOT specifically mentioned as an option for individuals with persistent hypoglycemia in the context provided?
GLP-1 receptor antagonist
At what BMI stage is the consideration of bariatric surgical options mentioned in the text?
> 35
What should individuals with a BMI greater than 27 to 30 be referred for as part of their care?
Sleep study
How often should insulin be titrated to reach glycaemic goals with a fixed regimen?
Every 2-5 days
When should prandial insulin be considered in the treatment regimen?
With severe hypoglycemia
Which type of insulin is preferred over regular insulin when adding prandial insulin?
Rapid-acting analogs
What is the total daily dose range of basal insulin recommended for patients with a HbA1c less than 8%?
0.1 to 0.2 units per kilogram
What percentage of the total daily dose should be added if fasting blood glucose is between 140 to 180 mg/dL?
10% of total daily dose
In what scenario should prandial insulin be initiated before the largest meal?
10 percent of basal or 5 units
What is the purpose of vaccine recommendations for persons with Type two diabetes?
To make sure individuals with compromised immune systems are up to date on necessary vaccines
What change was highlighted regarding Prevnar vaccines?
The dosage has been increased from Prevnar 15 to Prevnar 20
Why is it important to assess the immunization status of individuals with Type two diabetes at every encounter?
To keep track of their vaccine history and ensure they are protected
What is the significance of staying up to date on the latest CDC recommendations for vaccines?
To ensure individuals receive the most effective vaccines available
Why is it important to strongly recommend vaccines based on age or risk factors?
To ensure individuals receive necessary protection against diseases.
Which statement is true about administering vaccines to individuals with Type two diabetes?
Administering vaccines should be done regularly based on CDC recommendations.
What should be done if an individual has started on a specific vaccine but the recommendation changes?
Refer to an algorithm based on the new recommendation.
How often should one check for changes in vaccine recommendations according to the text?
Frequently but not specified
What is meant by 'highlight positive experiences and benefits of vaccines' mentioned in the text?
Encouraging patients by focusing on positive aspects of vaccination.
How can one document receipt of a vaccine according to the text?
By entering it into an immunization registry or electronic health record.
Which hormone stimulates the production and release of TSH from the pituitary gland?
TRH
Which thyroid hormone is four times more potent than T4?
T3
Which protein serves as the major carrier for thyroid hormones in the blood?
TBG
Which hormone controls thyroid function through a pulsatile circadian secretion pattern?
TSH
Which gland synthesizes a glycoprotein hormone that controls thyroid function?
Pituitary gland
In what form are thyroid hormones stored within the thyroid gland?
Thyroglobulin
Which hormone stimulates the production and release of T4 from the thyroid gland?
TSH
What is the primary function of thyroglobulin in the thyroid gland?
Hormone storage
Which hormone is synthesized in the hypothalamus and controls TSH production?
TRH
What are the primary functions regulated by thyroid hormones?
Energy and heat production
Which aspect of cellular activity is NOT influenced by thyroid hormones?
Insulin secretion
What is the classification of thyroid dysfunction based on the portion of the HPT axis that is dysfunctional?
Primary, secondary, and tertiary
Which autoimmune disease causes hyperthyroidism?
Graves' disease
What is the primary location of dysfunction in secondary thyroid dysfunction?
Pituitary gland
Which gland is primarily impacted by tertiary thyroid dysfunction?
Hypothalamus
What are the two most common autoimmune problems affecting the thyroid gland?
Graves' disease and Hashimoto's thyroiditis
Which aspect of cellular activity is affected by an increase in the number and size of mitochondria due to thyroid hormones?
$\text{ATP production}$
What is the most common cause of thyroid disease?
Autoimmune disease
When should TSH be re-evaluated after changing the dose of levothyroxine?
6-8 weeks
What is the recommended timing for giving drugs that interfere with the absorption of levothyroxine?
3-4 hours after taking levothyroxine
How often should measurement of TSH be done until a patient is euthyroid?
Every 6 weeks
For which condition is referral to an endocrinologist indicated according to the text?
Congenital hypothyroidism
What is the recommended administration instruction for levothyroxine in terms of the stomach condition?
Take on an empty stomach
At what age should TSH be monitored annually according to the text?
< 12 years old
How long does it take to achieve a steady state after changing the dose of levothyroxine?
6-8 weeks
What is the time frame for referral to an endocrinologist for congenital hypothyroidism?
< 6 months old
When should individuals be examined periodically for signs of thyrotoxicity?
> 6 months after starting medication
Which clinical state is a result of resistance to the action of the thyroid hormone?
Hypothyroidism
What symptom is NOT typically associated with hypothyroidism?
Increased sweating
What is the initial test recommended for assessing thyroid function?
TSH
What is a common risk factor for hypothyroidism?
Autoimmune diseases
What is the typical presentation of hypothyroidism?
Periorbital edema
Which medication may interfere with thyroid metabolism?
Amiodarone
What symptom is NOT a common symptom of hypothyroidism?
High blood pressure
What is the next step if TSH is abnormal during thyroid function testing?
Check Free T4
What is the significance of maternal hypothyroidism largely being limited to the first trimester?
The fetus cannot produce its own thyroid hormones in the first trimester.
Why is it recommended to monitor TSH levels every 6-8 weeks when adjusting levothyroxine dosage?
To know whether the deficiency is permanent or transient.
What can congenital hypothyroidism in newborns lead to?
All of the above.
Why is levothyroxine dosage adjustment necessary during pregnancy?
To ensure adequate supply of thyroid hormones to the fetus.
What is the concern regarding treatment of subclinical hypothyroidism with levothyroxine?
Potential development of osteoporosis.
Why is dosing adjusted based on ideal weight in obese patients receiving levothyroxine?
To maintain proper thyroid hormone levels.
What distinguishes Armour Thyroid from Levothyroxine?
Armour Thyroid contains both T3 and T4.
What is an implication of congenital hypothyroidism if left untreated?
'Dwarfish' stature and mental development delay.
'Start low and go slow' refers to what approach in treating elderly patients with levothyroxine?
Initiating therapy at a low dose and gradually increasing as needed.
What distinguishes Liothyronine sodium [Cytomel] from Levothyroxine?
Liothyronine sodium [Cytomel] replaces T3 only while Levothyroxine replaces T4 only.
What is a notable disadvantage of I-131 treatment according to the text?
Delayed treatment response
In which situation is I-131 treatment contraindicated?
Pregnancy
What adverse effects are associated with the Lugol solution?
Brassy taste, burning sensation, headache
Which thyroid disorder is I-131 used for diagnosing according to the text?
Goiter
What is indicated by a fixed, firm, non-tender nodule found in the thyroid gland?
Malignancy
Which thyroid function tests are used for diagnostics according to the text?
Thyroid scintigraphy and needle aspiration biopsy
What symptoms may be present in patients with a thyroid nodule?
Hoarseness and cough
What is a significant risk factor for developing a thyroid nodule according to the text?
Iodine deficiency
What is the primary management recommendation for patients with multiple nodules in their thyroid?
Observation and follow-up
When should individuals with a suspicious thyroid nodule be referred to an endocrinologist?
Upon detection of a fixed, firm nodule
What is the most dangerous toxicity associated with methimazole?
Agranulocytosis
Which drug is preferred during the first trimester of pregnancy due to its lower risk of crossing the placenta?
Propylthiouracil (PTU)
What is the potential consequence of using high doses of methimazole?
Hypothyroidism
Which thyroid medication has the property of blocking the conversion of T4 to T3 in the periphery?
Propylthiouracil (PTU)
What is the half-life of radioactive iodine 131?
8 days
Why is methimazole considered the first-line drug for hyperthyroidism?
It does not cause liver damage associated with PTU
What effect can radioactive iodine have on thyroid tissue?
Destruction
What is the main difference between the properties of PTU and methimazole?
Placental crossing ability
What is the primary mechanism by which Grave's disease causes hyperthyroidism?
Autoimmune stimulation of TSH receptors
Which condition results from an expansion of clonogenic cells with an activating TSH receptor mutation?
Toxic adenoma
What is the characteristic feature of transient thyroiditis?
Autoimmune destruction of thyroid tissue
Which of the following is NOT a common cause of hyperthyroidism?
Drug-induced hypothyroidism
What autoimmune process stimulates the TSH receptor in Grave's disease?
Antibodies acting on the TSH receptor
Which medication is commonly associated with drug-induced thyroiditis?
Amiodarone
What distinguishes toxic multinodular goiter from transient thyroiditis?
Clonogenic cells expansion
What is the primary cause of painless or transient thyroiditis?
Viral infection triggering hormone release
What is the characteristic feature of a toxic adenoma (Plummer disease)?
Somatic mutation in GS alpha gene
Which condition is characterized by an activating TSH receptor mutation and expansion of clonogenic cells?
Toxic multinodular goiter
Test your knowledge on managing blood pressure in diabetic patients, including the use of combination therapy, dose titration, and considerations for renal protection. Explore strategies for achieving target blood pressure goals in diabetic individuals.
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