5- palpitations

Question 1

CV causes of palpitations

Answer 1

Arrhythmia, cardiomyopathy, hypovolemia

Question 2

psych causes of palpitations

Answer 2

Anxiety, panic attacks

Question 3

meds causes of palpitations

Answer 3

Caffeine, stimulants, theophylline, and albuterol use

Question 4

substances causes of palpitations

Answer 4

Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine

Question 5

endocrine causes of palpitations

Answer 5

Hyperthyroidism, pheochromocytoma, hypoglycemia

Question 6

Hematologic causes of palpitations

Answer 6

anemia

Question 7

infectious causes of palpitations

Answer 7

Febrile illness

Question 8

are cardiac arrythmias associated with associated with systemic symptoms such as weight loss, oligomenorrhea, and loose stools,

Answer 8

no

Question 9

In patients under the age of 50, the most common signs and symptoms of hyperthyroidism are:

Answer 9

Heat intolerance (92%)
Tachycardia (96%) 
Fatigue (84%)
Weight loss (50%) 
Tremor (84%)
Increased sweating (96%)
Exertional dyspnea 

Depression and hyperreflexia are less common but can be present.
Diarrhea and light periods can also occur with hyperthyroidism.

Question 10

causes of goiter

Answer 10

A. Lack of iodine
B. Hypothyroidism
C. Hyperthyroidism
D. Nodules
E. Cancer
F. Pregnancy
G. Thyroiditis

Question 11

What is the most common cause of hyperthyroidism in adults and children?

Answer 11

Toxic diffuse goiter (Graves disease)

Question 12

Toxic nodular goiter

Answer 12

Causes about 5% of cases of hyperthyroidism.

common, but most are not symptomatic, and only 4% to 5% are cancerous.

Thyroid nodules are more common in patients over 40.

These older patients more often have multi nodular disease, whereas, solitary nodules are seen more often in younger patients and can be associated with iodine deficiency.

Question 13

thyroiditis

Answer 13

Thyroid hormone leaks from an inflamed thyroid.

Happens after a viral illness or pregnancy.

Question 14

Studies to Determine the Etiology of Hyperthyroidism

Answer 14

Radioactive iodine uptake (RAIU) test and scan

Anti-thyrotropin releasing antibodies (TRAb)

Question 15

Radioactive iodine uptake (RAIU) test and scan

Answer 15

measures the amount and pattern of radioactive iodine taken up by the thyroid in the 24 hours following ingestion of a set dose.

Normal RAIU uptake is 15% to 30% of the ingested dose.

Question 16

Anti-thyrotropin releasing antibodies (TRAb)

Answer 16

pathologic mechanism for Graves disease and can be detected in the vast majority of patients with this condition

Question 17

A thyroid ultrasound is used in the evaluation of

Answer 17

thyroid nodules and thyroid enlargement

Question 18

“Cold” (non-thyroxine producing) nodules can be caused by

Answer 18

cancer

Question 19

Diffuse increased uptake suggests

Answer 19

graves (as opposed to nodular)

Question 20

examples of High RAIU (>30%) thyroid problems

Answer 20

Graves
multi nodular goiter
toxic solitary nodule
TSH secreting pituitary tumor
HCG secreting tumor

Question 21

examples of Low RAIU (<15%) thryoid problems

Answer 21

sub acute thyroiditis
Silent thyroiditis
iodine induced
Exogenous L-Thyroxine
struma ovarii
Amiodarone

Question 22

which antibodies in graves disease

Answer 22

thyrotropin receptor antibodies (also called thyroid stimulating immunoglobulins)

Question 23

ages in graves

Answer 23

40-60

Question 24

graves triggers

Answer 24

stressful life events, high iodine intake, or a recent pregnancy

Question 25

eyes in graves

Answer 25

ophthalmopathy (eye problems) are eyelid retraction and exophthalmos.

related to corneal irritation from eyelid retraction.

mostly bilateral, can be unilateral.

Question 26

most commonly used medication to suppress thyroid hormone production.

Answer 26

Methimazole

Question 27

how many months to suppress thyroid production

Answer 27

3, but start to notice improvement after 1

Question 28

rare serious side effect of methimazole

Answer 28

agranulocytosis

Question 29

alternative med: radioactive iodine but popular in US

Answer 29

During the course of a few months the iodine destroys most of the overactive thyroid cells and the level of thyroid hormone falls and the thyroid gland shrinks in size.

Eventually most people who have this treatment start
having too little thyroid in their bloodstream so that they need to start taking small doses of thyroid hormone to replace it.

come in less frequently for bloodwork

Question 30

what do you need to obtain before initiating radioactive iodine treatment.

Answer 30

pregnancy test

dont even be near pregnant women with this med

Question 31

radioactive iodine side effects

Answer 31

transient soreness of the neck or brief worsening of symptoms but they should resolve within a few days. Furthermore, people with ophthalmopathy can have worsening of eye symptoms.

Question 32

is fatigue common in hyper or hypothyroidism

Answer 32

both

Question 33

A typical starting dose of thyroxine in primary hypothyroidism

Answer 33

1.5 to 1.8 mcg per kilogram.

Question 34

TSH should be repeated after starting thyroid replacement therapy after how many weeks

Answer 34

6

then once stable, 1-2 a year

Question 35

why is Gynecomastia seen in 10% to 40% of patients with Graves disease

Answer 35

sex hormone binding globulins being increased in Graves disease.

Question 36

why would you have palpitations with this presentation: abdominal pain, weakness, tachycardia, diastolic murmur, and tar-like stools

Answer 36

anemia from GI blood loss

Question 37

how much time would it take to feel symptoms of hypothyroidism after radioactive iodine treatment

Answer 37

few months

Question 38

what med helps with the symptoms of hyperthyroidism

Answer 38

propranolol