CABS-Thyroid Storm

Question 1

why is temperature increased during thyroid storm

Answer 1

due to hypermetabolic state and excess heat being generated

Question 2

what can cause thyroid storm

Answer 2

illness, stress

Question 3

score of _____ is highly suggestive of thyroid storm

Answer 3

> /= 45

Question 4

Why cold saline in Rx for thyroid storm?

Answer 4

to reduce hyperthermia

Question 5

Why NOT propranolol in a patient with asthma when treating thyroid storm?

Answer 5

exacerbate asthma
(its a non-selective B1 and B2 blocker)

Question 6

Why use IODINE for thyroid storm Rx?

Answer 6

leads to selective feedback inhibition due to overexpression of iodine in the gland

Question 7

Why NOT iodine before PTU/ METHIMAZOLE to treat thyroid storm?

Answer 7

Need to inhibit thyroid peroxidase with PTU first, otherwise iodine will be more available to be used as a substrate for T3/T4

Question 8

Why NOT AMIODARONE for arrhythmia during thyroid storm?

Answer 8

contains 40% iodine

Question 9

Why hypercortisolemia in thyroid storm?

Answer 9

increased stress leading to increased production of ACTH

Question 10

Why hyperglycemia in thyroid storm?

Answer 10

insulin release is impaired and cortisol is increased causing increase in blood glucose

Question 11

Why hypercalcemia in thyroid storm?

Answer 11

increased osteoclastic function—-> bone resorption—-> hypercalcemia

Question 12

enzyme used to convert T4 to T3 in peripheral tissues

Answer 12

deiodinase

Question 13

inhibits T4 and T3 synthesis

Answer 13

Methimazole and PTU

Question 14

blocks T4 and T3 release

Answer 14

SSKI
Lugol’s Iodine

Question 15

block hormone action

Answer 15

beta blockers

Question 16

block peripheral conversion of T4 to T3

Answer 16

PTU
glucocorticoids
propranolol

Question 17

blocks proteolysis of thyroglobulin to T3 and T4 in follicular cell

Answer 17

Iodides

Question 18

blocks organification and coupling by iodine and thyroid peroxidase

Answer 18

Iodides
Thioamides

Question 19

inhibits thyroid peroxidase (blocks iodide formation and tyrosine iodination)

Answer 19

Methimazole and PTU

Question 20

10 times more potent than PTU and is drug of choice for thyroid storm

Answer 20

Methimazole

Question 21

_____ causes these 2 things if given in 1st trimester of pregnancy
Aplasia cutis = absence of scalp skin
Choanal atresia = of posterior nasal cavity, leaves a membrane

Answer 21

Methimazole

Question 22

has a transient effect
reduces vascularity
inhibits proteolysis of thyroglobulin and disrupts organification of iodine

Answer 22

Iodine/Iodide

Question 23

lid lag
lid retraction
tachycardia

Answer 23

thyrotoxicosis from any cause

Question 24

exophthalmos, chemosis, periorbital edema, ophthalmoplegia, pretibial myxedema

Answer 24

thyrotoxicosis specific for Grave’s disease

Question 25

IGF-1R blocker IGF-1R overexpressed in orbital fibroblasts and immune cells Used when corticosteroids/ radiation fails or in severe cases

Answer 25

TEPROTUMUMAB

Question 26

Thyrotoxicosis –> increase the expression and activation of _______receptors –> more blood pumping (high output HF) so it appears to compensate for the heart failure

Answer 26

B1

Question 27

Exacerbation of already existing CHF (history of high output cardiac failure); both pulmonary and systemic congestion/CO variable

Answer 27

acute decompensated heart failure

Question 28

_______ increases abundance of beta1 receptors in heart and also increases sensitivity of these receptors to Epi and NE Heart beats faster and increases inotropy (contractile strength) and eventually gets tired and fails increase metabolism and metabolic demands of tissues-- imposes demands on heart (increases CO to supply and remove metabolic products form tissues)

Answer 28

T3 and T4

Question 29

why is there a dilated IVC (>2.1 diameter)

Answer 29

IVC dilated due to increased back pressure due to pump failure

Question 30

other causes for high output heart failure

Answer 30

thyrotoxicosis, beriberi, and anemia

Question 31

impairs heart muscles ability to produce energy due to lack of thiamine

Answer 31

thiamine deficiency (beriberi)

Question 32

tachycardia because O2 supply/demand mismatch –> HF

Answer 32

anemia

Question 33

polyneuropathy, symmetric muscle wasting deficiency in vitamin B1

Answer 33

dry beriberi

Question 34

high output cardiac failure (due to systemic vasodilation); vitamin B1 deficiency

Answer 34

wet beriberi

Question 35

pulmonary edema developing in very short period of time due to severe acute decompensation of HF

Answer 35

flash pulmonary edema

Question 36

to treat flash pulmonary edema

Answer 36

furosemide nitrates

Question 37

The pituitary glycoprotein hormones FSH, LH, TSH, and hCG have common ___ subunits

Answer 37

α

Question 38

______ also acts on TSHR, leading to gestational thyrotoxicosis

Answer 38

hCG

Question 39

Anti-TSHR antibody diffusion into placenta → neonatal ______

Answer 39

thyrotoxicosis

Question 40

mostly stimulating TSHR, but can be blocking. Graves and other autoimmune diseases

Answer 40

anti-TSHR (TSH receptor)

Question 41

present in more than 85% of patients with Hashimoto thyroiditis and in more than 30% of patients with Graves disease

Answer 41

antithyroglobulin

Question 42

All patients with Hashimoto thyroiditis, in about 85% of patients with Graves disease, and in some patients with other autoimmune diseases like type 1 DM, celiac disease, and Addison disease

Answer 42

anti-thyroid peroxidase (anti-TPO)

Question 43

I-_____ is for imaging

Answer 43

I-123

Question 44

I-____ used for radioactive ablation of thyroid gland

Answer 44

I-131

Question 45

___nodule = carcinoma

Answer 45

cold

Question 46

no uptake Indicates a non-functioning tumor and thus is unlikely to be an adenoma

Answer 46

cold nodule

Question 47

generalized low uptake

Answer 47

thyroiditis

Question 48

generalized high uptake (diffuse)

Answer 48

Grave's

Question 49

Single hot spot on uptake

Answer 49

toxic adenoma

Question 50

multiple hot spots on uptake

Answer 50

toxic multinodular

Question 51

Lid retraction/lag in ___

Answer 51

thyrotoxicosis

Question 52

Ptosis in ____

Answer 52

myasthenia gravis

Question 53

Enophthalmos in ___

Answer 53

Homer

Question 54

Proptosis (Exophthalmos) in _____

Answer 54

Graves

Question 55

____hormones ↑ permeability of membranes and ↑ expression of Na-K-ATPase and Ca2+-ATPase Increased activity of ATPases → Release of some energy as heat.

Answer 55

thyroid

Question 56

hormone also increases uncoupler protein expression (UCP1/2)

Answer 56

thyroid

Question 57

Class III K-channel blocker antiarrhythmic drug; has 37% iodine causes thyrotoxicosis and pulmonary fibrosis

Answer 57

Amiodarone

Question 58

Answer 58

e

Question 59

Answer 59

c

Question 60

Answer 60

e

Question 61

Answer 61

b

Question 62

Answer 62

d