11/15

Question 1

THYROID STORM MEDICATIONS

Answer 1

Administer medications in order

1- Propranolol / esmolol
2- Propylthiouracil / Methimazole
3- Iodine
4- Hydrocortisone

Question 2

Thyroid storm is almost always associated with __________ that should be investigated

Answer 2

A Trigger:
sepsis, pregnancy, recent surgery, discontinuation of anti-thyroid medication, etc.

It is important to look for and treat an inciting event in addition to treating the hyperthyroidism

Question 3

________________ is the most common vital sign abnormality and is present in ~90% of patients with decompensated hypothyroidism.

Answer 3

Hypothermia at lower than 94°F

Question 4

Given the high likelihood of _________ as the inciting factor in decompensated hypothyroidism, _______________ are recommended in initial treatment

Answer 4

Hypothermia at lower than 94°F

Question 5

HUS shares some clinical features with TTP. Both manifest as

Answer 5

Shares: microangiopathic hemolytic anemia and thrombocytopenia

HUS emphasizes renal injury
TTP instead causes neurologic dysfunction

Question 6

Hemolytic uremic syndrome (HUS) - should you use antibiotics?

Answer 6

the current recommendation is not to use antibiotics due to evidence that they may increase shiga toxin production or release

Question 7

HUS and TTP are thrombotic microangiopathies that have very similar presentations. TTP is more common in what age group?

Answer 7

Adult

Question 8

TTP is caused by ?

Answer 8

loss of ADAMTS-13, an enzyme that cleaves von Willebrand factor.

Question 9

______________ may increase likelihood of HUS and are not recommended for patients with Shiga toxin-producing E. coli infection.

Answer 9

Antibiotics and antimotility agents

Question 10

Outcomes are best if N-acetylcysteine is started within ______ time of APAP overdose

Answer 10

8 hours

If ingestion occurred more than 8 hours ago, an initial dose of N-acetylcysteine can be administered while awaiting acetaminophen concentration and comparison to Rumack Matthew nomogram to determine need for continuation.

Question 11

Treat with N-acetylcysteine if __________________ when the time of ingestion is unknown or chronic in nature.

Answer 11

-AST and ALT levels are elevated
-Any detectable APAP concentration
-Hx of APAP poisoning

Admit all patients receiving N-acetylcysteine