11/9

Question 1

THYROID STORM MEDICATIONS

Answer 1

Administer medications in order

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

Pro-PTU - I - m

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

If you are going to discharge, this needs to always be a step

Answer 3

2-3 follow up planning

Question 4

Fever management nin thyroid storm

Answer 4

APAP

NSAIDs remove the thyroid hormone from the protein binding site, freeing the thyroid hormone to be readily converted into active hormone. Therefore, NSAIDs should not be used for the management of fever.

Question 5

Critical medications in myxedema coma

Answer 5

Levothyroxine
Hydrocortisone
Dextrose-containing fluids for hypoglycemia and hypotension

Question 6

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

Answer 6

sepsis

broad-spectrum antibiotics

Question 7

NAT basics- imaging/ labs

Answer 7

Perform a head computed tomography (CT) in a child <1 y old if non-accidental trauma head trauma is suspected

Skeletal survey may be considered

Labs: CBC, coagulation panel, CMP, amylase, lipase, and urinalysis.

Question 8

5 diagnoses related to thrombocytopenia of which the emergency physician should be aware

Answer 8

1- immune thrombocytopenia (ITP)
2- thrombotic thrombocytopenic purpura (TTP)
3- disseminated intravascular coagulation (DIC)
4- hemolytic uremic syndrome (HUS)
5- heparin-induced thrombocytopenia (HIT)

Question 9

With the exception of patients with ______________, thrombocytopenic patients with life-threatening bleeding should be transfused to a platelet count of 50

Answer 9

Thrombotic thrombocytopenic purpura (TTP)

Question 10

ITP is defined as a platelet count below 100 × 109/L caused by _______________

Answer 10

immune-mediated destruction of platelets.

immune thrombocytopenia (ITP)

Question 11

In children, a _____________ is classically reported prior to the onset of ITP

Answer 11

viral villness

immune thrombocytopenia (ITP)

Question 12

DIC is a clinical syndrome with a wide array of presentations/etiologies caused by:

Answer 12

Intravascular coagulation cascade activation, with a subsequent loss of inhibitory control mechanisms

Question 13

Diagnosis of DIC involves a combination of laboratory tests and clinical evaluation. Laboratory findings suggestive of DIC include

Answer 13

low platelets
elevated D-dimer
decreased fibrinogen
prolongation of clotting times ie PT

Question 14

The overlying principles of the treatment of TTP are these 2 principals

Answer 14

replenishment of ADAMTS13 and removal and/or reduction of the offending antibody (in acquired cases).

Question 15

HUS shares some clinical features with TTP. Both manifest as microangiopathic hemolytic anemia and thrombocytopenia; however, HUS emphasizes renal injury while TTP shows minimal renal injury, instead causing ______________________

Answer 15

neurologic dysfunction in up to 50% of affected patients.

Question 16

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

Answer 16

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