A 30 year-old female patient who complains of fatigue has a screening TSH performed. Her TSH value is 8 mU/L. What should be done next? - answerRepeat the TSH and add T4 TSH values rise and fall continuously. Consequently, TSH levels are repeated and an average is usually calculated. A diagnosis of hypothyroidism can be made after a second abnormal TSH unless the initial value is very elevated and the patient is symptomatic. When an elevated TSH is discovered, it should be repeated and a serum free T4 can be measured. Depending on these results, a diagnosis of thyroid disease can be made. A patient who has been treated for hypothyroidism presents for her annual exam. Her TSH is 14.1 (normal = 0.4- 3.8). She complains of weight gain and fatigue. How should the NP proceed? - answerAsk if she is taking her medication Her TSH is elevated. This is usually caused by insufficient supplementation in a patient with hypothyroidism. If the TSH was within normal range following her last annual exam, something has changed. The first point that must be established is whether the patient is still taking her medication. If she is still taking her medication, determining when she is taking it is very important. It should be taken on an empty stomach for absorption. These two important facts must be established BEFORE increasing her current dose. The TSH is usually repeated when an abnormal value is measured, but this patient has symptoms of an abnormal TSH. What is the AM fasting glucose goal for a 75 year-old patient who has diabetes? - answer90-130mg/dL Considering the patient's age, with few coexisting conditions, the ADA 2016 Standards of Care recommend a target fasting glucose goal of 90-130 mg/dL. For those with complex/intermediate (multiple coexisting conditions) health status, target is 90-150mg/dL and very complex (end stage chronic illness or mod-severe cognitive impairment) is 100-180 mg/dL. A female patient has the following characteristics. Which one represents a risk factor for Type II diabetes? - answerHistory of gestational diabetes History of gestational diabetes conveys an 83% chance of developing Type II diabetes (within 17 years of delivery). Hyperlipidemia by itself is not a risk factor for diabetes, though it is commonly seen in conjunction with diabetes. Infrequent, regular exercise increases the risk of increased BMI, but by itself is not a risk factor for Type II diabetes. A family history of Type II diabetes increases the risk of developing it, but this is not true of Type I diabetes. Which choice best describes the most common presentation of a patient with Type 2 diabetes? - answerInsidious onset of hyperglycemia with weight gain Most patients with type 2 diabetes mellitus are asymptomatic at presentation. They are identified because of screening and identification of risk factors. Hence, diabetes usually has an insidious onset and is associated with weight gain, especially in adults and adolescents after puberty. An acute onset is typical of patients with type 1 diabetes. Microalbuminuria develops after several years of having diabetes. A patient who is 73 years old was diagnosed with diabetes several years ago. His A1C has remained elevated on oral agents and a decision to use insulin has been made. What is the goal post prandial glucose for him? - answerLess than 180 mg/dL In older adults, strong consideration must be given to the risk associated with hypoglycemic states. Falls, accidents, and stroke are more likely; and these are more deleterious in older adults than younger adults who have episodes of hypoglycemia. A1C levels should be < 7> 7% for frail adults. Good clinical judgment must be exercised in setting a goal A1C for this patient due to age. A patient with newly diagnosed Type 2 diabetes asks what his target blood pressure should be. The most correct response is: - answerless than 140/90 The 2016 American Diabetes Association's target blood pressure for "most patients with diabetes" is less than 140/90 mm Hg. More stringent blood pressure control may not be required unless there are other comorbidities present. A 52 year-old presents with symptoms of diabetes today. His glucose is 302 mg/dL. How should this be managed today? - answerStart insulin This patient can be diagnosed with diabetes today because his glucose exceeds 200 mg/dL and he is symptomatic. Most learned authorities would describe him as glucose toxic. Oral agents will have