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Emed > #8: Endocrine > Flashcards

#8: Endocrine Flashcards

1
Q

hyperthyroidism

  1. MC cause
  2. levels of TSH and T3/4
A

Hyperthyroidism

  1. MC cause =Graves Dz
  2. Low TSH and high T3/4
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2
Q

Graves Dz

  1. What types of Abs present
A

Gaves Dz

- TSI antiboides

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3
Q

Pt presents w/ palpitations, heat intolerance, tremor, moist skin, wt loss, anxiety, exophthalmos, pretibial myxedma, acropachy, lid lag, goiter, thyroid nodule, brisk reflexes

Dx?

A

Dx = Hyperthyroidism

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4
Q

Tx of Hyperthyroidism/Graves

  1. Tx for Sx control
  2. Main 2 meds given
A

Tx of Hyperthyroidism/Graves

  1. Tx for Sx control= beta blocker
  2. 2 meds given = MMI and PTU
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5
Q
  1. infxn
  2. trauma/surgery
  3. MI
  4. radioiodine
  5. IV contrast w/iodine
  6. pregnancy

these things often precipitate what d/o

A

Preciptating factors for thyroid storm

  1. infxn
  2. trauma/surgery
  3. MI
  4. radioiodine
  5. IV contrast w/iodine
  6. pregnancy
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6
Q

Presents w/ AMS, palpitations, anxiety, high fever. Exam reveals tachypnea, systolic HTN, dehydration, and hyperthermia w/ hot diapohretic skin. Labs reveal hyperglycemia, leukocytosis, abn LFTs. EKG shows SVT. Pt recent had thyroid surgery

Dx?

A

Dx = Thyroid storm

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7
Q

Supportive Tx of Thyroid Storm

  1. what fluids to give, what should you do if pt still hypotensive after
  2. what can be given for sedation (stim TH clearance)
  3. how to tx fever
A

Supportive Tx of Thyroid Storm

  1. fluids = 1L NS
    - if pt still hypotensive after –> vasopressors
  2. Phenobarbital for sedation (stim TH clearance)
  3. tx fever aggressively (cool IV fluids, cool blankings, antipyretics)
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8
Q

Medical Tx of Thyroid Storm

  1. 1st line med –> what med given 1 hr after
  2. med for Sx control
  3. What 2 types of CCS given
  4. what other type of med given (decr recycling of THs)
A

Medical Tx of Thyroid Storm

  1. 1st line med = PTU –> Lugol’s Iodine drops 1 hr after
  2. med for Sx control= beta blockers
  3. CCS = GCCs, hydrocortisone
  4. bile acid sequesterant (decr recycling of THs)
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9
Q

Hypothyroidism

  1. MC cause
  2. levels of TSH and T3/4
  3. what 2 meds can cause it
A

Hypothyroidism

  1. MC cause = Hashimoto’s Dz
  2. high TSH and low T3/4
  3. medication causes = amiodarone, lithium
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10
Q

What type of Abs seen w/Hashimoto’s dz

A

Hashimoto’s dz = TPO antibodies

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11
Q

Pt presents w/ weakness, fatigue, dry skin, coarse hari, cold intolerance, wt gain, constipation, depression. On PE pt is bradycardic, has puffy dry skin and delayed reflexes

Dx?

A

Dx = Hypothyroidism

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12
Q

Myxedema Coma

  1. MC in what pop and what months
  2. what is it often precipitated by in elderly
  3. what is charac by
A

Myxedema Coma

  1. MC in elderly in winter months
  2. often precipitated by infxn (PNA) in elderly
  3. charac by multi organ failure
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13
Q

elderly pt in december presents w/ hypothermia, BP 90/56, anorexia abd pain/distension, constipation. On exam you note pre-orbital edema and pt displays some inapprop humor. On EKG you see ST changes, torsades and long QT. CXR shows cardiomegaly.

Dx?

A

Dx = Myxedema coma

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14
Q

Lab Values in Myxedema coma

  1. what 2 values decr
  2. what 3 values incr
A

Lab Values in Myxedema coma

  1. decr Na and gluc
  2. incr Urine Na, Cr, LDH
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15
Q

Tx of Myxedema Coma

  1. what is mainstay of med tx
  2. what type of fluid to give and what trying to replace
  3. hypoglycemia and hypothermia Tx
  4. what type of ABXs to give
  5. what other med given (for assoc hypopituitarism or 2ndary adrenal insuffic)
A

Tx of Myxedema Coma

  1. what is mainstay of med tx = RAPID replacement of TH
  2. 3% saline to replace Na
  3. hypoglycemia and hypothermia Tx = gluc + active rewarming
  4. broad spectrum ABX (Vanc + Zosyn)
  5. GCCs (for assoc hypopituitarism or 2ndary adrenal insuffic)
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16
Q

Adrenal insufficiency

  1. MC cause of primary
  2. primary has decr levels of
  3. 2ndary is d/t _____ and MC cause is _____
  4. 2ndary has decr levels of
A

Adrenal insufficiency

  1. MC cause of primary = Addison’s dz (autoimmune)
  2. primary = decr levels of cortisol
  3. 2ndary is d/t pituitary/hypothal and MC cause = chronic steroids
  4. 2ndary = decr levels of ACTH + Cortisol
17
Q

Pt presents w/ fatigue, weakness, anorexia, wt loss, irritability, myalgias, arthralgias, amenorrhea, sensory HS and salt craving. On PE pt has orthostatic HoTN, delayed reflexes and bronzed skin on palms/skin folds

Dx?
What test is diagnostic for this d/o?

A

Dx = Addison’s Dz

Dx test = Low 8 am cortisol and high ACTH

18
Q

Tx of Addison’s Dz

  1. 2 med options
  2. what given only if primary dz
  3. what types of Abs present in Addisons
A

Tx of Addison’s Dz

  1. 2 med options = PO hydrocortisone or prednisone
  2. fludrocortisone only if primary dz
  3. anti-adrenal Abs
19
Q

Addisonian Crisis Hx/Causes

  1. H/o ____
  2. times of ____
  3. stopped what meds
A

Addisonian Crisis Hx/Causes

  1. H/o adrenal insuffic
  2. times of stress
  3. stopped CCS
20
Q

MC presentation of Addisonian Crisis

A

MC presentation of Addisonian Crisis

- shock refractory to fluids and vasopressors

21
Q

Diagnostics for Addisonian Crisis

  1. what it ToC
  2. primary vs secondary and ACTH levels
  3. what 2 lab values high
  4. what 3 lab values low
A

Diagnostics for Addisonian Crisis

  1. ToC = ACTH stimulation test
  2. primary = high ACTH vs secondary = low ACTH
  3. high K, Ca
  4. low Na, gluc, BUN
22
Q
  1. low voltage in all leads
  2. peaked T waves
  3. prolonged QRS
  4. no p waves

EKG findings in ______

A

EKG findings in addisonian crisis

  1. low voltage in all leads
  2. peaked T waves
  3. prolonged QRS
  4. no p waves
23
Q

Tx of Addisonian Crisis

  1. IVF choice (what may be added)
  2. Tx if no prior dx of adrenal insuff
  3. Tx otherwise
A

Tx of Addisonian Crisis

  1. IVF choice = NS w/ +/- D5 added
  2. Tx if no prior dx of adrenal insuff = dexamethasone
  3. Tx otherwise = hydrocortisone
24
Q

High levels of circulating catecholamines due to chromaffin cells of adrenal medulla secreting tumor

A

Pheochromocytoma

25
Q

Pheo

- classic triad of Sxs

A

Pheo triad= episodic Ha, sweating tachycardia

26
Q

25 y/o pt presents w/ episodic HA, sweating, anxiety, palpitations, impending sense of doom. On exam BP = 160/90, HR = 120. Pt is pale, diaphoretic, has a tremor, abd pain and AMS.

Dx?

A

Pheo/Catecholamine Crisis

27
Q

Dx test for Pheo/Catecholamine Crisis

A

24 hr urine catecholamine and metanephrines

Note: screening = plasma metanep

28
Q

Tx of Pheo/Catecholamine Crisis

  1. main med given
  2. med for HTN
  3. med given to decr symp response
A

Tx of Pheo/Catecholamine Crisis

  1. main med given = IV phentolamine
  2. med for HTN = CCB
  3. decr symp response w/BZs
29
Q

Pt presents w/fatigue, dry skin, dehydration, HTN, AMS, acanthosis nigrans and polydipsia/uria

Dx?
Tx?

A

Dx = Hyperglycemia

Tx= metformin

30
Q

hyperglycemia + ketosis + metabolic acidosis

A

DKA

31
Q

DKA

- what is produced in the body that leads to metabolic acidosis

A

DKA

- ketone bodies produced –> metabolic acidosis

Emed (10 decks)

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