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ENR Biweekly 3 > CABS-Thyroid Storm > Flashcards

CABS-Thyroid Storm Flashcards

1
Q

why is temperature increased during thyroid storm

A

due to hypermetabolic state and excess heat being generated

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2
Q

what can cause thyroid storm

A

illness, stress

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3
Q

score of _____ is highly suggestive of thyroid storm

A

> /= 45

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4
Q

Why cold saline in Rx for thyroid storm?

A

to reduce hyperthermia

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5
Q

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

A

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

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6
Q

Why use IODINE for thyroid storm Rx?

A

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

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7
Q

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

A

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

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8
Q

Why NOT AMIODARONE for arrhythmia during thyroid storm?

A

contains 40% iodine

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9
Q

Why hypercortisolemia in thyroid storm?

A

increased stress leading to increased production of ACTH

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10
Q

Why hyperglycemia in thyroid storm?

A

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

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11
Q

Why hypercalcemia in thyroid storm?

A

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

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12
Q

enzyme used to convert T4 to T3 in peripheral tissues

A

deiodinase

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13
Q

inhibits T4 and T3 synthesis

A

Methimazole and PTU

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14
Q

blocks T4 and T3 release

A

SSKI
Lugol’s Iodine

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15
Q

block hormone action

A

beta blockers

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16
Q

block peripheral conversion of T4 to T3

A

PTU
glucocorticoids
propranolol

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17
Q

blocks proteolysis of thyroglobulin to T3 and T4 in follicular cell

A

Iodides

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18
Q

blocks organification and coupling by iodine and thyroid peroxidase

A

Iodides
Thioamides

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19
Q

inhibits thyroid peroxidase (blocks iodide formation and tyrosine iodination)

A

Methimazole and PTU

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20
Q

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

A

Methimazole

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21
Q

_____ 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

A

Methimazole

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22
Q

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

A

Iodine/Iodide

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23
Q

lid lag
lid retraction
tachycardia

A

thyrotoxicosis from any cause

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24
Q

exophthalmos, chemosis, periorbital edema, ophthalmoplegia, pretibial myxedema

A

thyrotoxicosis specific for Grave’s disease

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25
Q

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

A

TEPROTUMUMAB

26
Q

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

A

B1

27
Q

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

A

acute decompensated heart failure

28
Q

_______ 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)

A

T3 and T4

29
Q

why is there a dilated IVC (>2.1 diameter)

A

IVC dilated due to increased back pressure due to pump failure

30
Q

other causes for high output heart failure

A

thyrotoxicosis, beriberi, and anemia

31
Q

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

A

thiamine deficiency (beriberi)

32
Q

tachycardia because O2 supply/demand mismatch –> HF

A

anemia

33
Q

polyneuropathy, symmetric muscle wasting
deficiency in vitamin B1

A

dry beriberi

34
Q

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

A

wet beriberi

35
Q

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

A

flash pulmonary edema

36
Q

to treat flash pulmonary edema

A

furosemide
nitrates

37
Q

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

A

α

38
Q

______ also acts on TSHR, leading to gestational thyrotoxicosis

A

hCG

39
Q

Anti-TSHR antibody diffusion into placenta → neonatal ______

A

thyrotoxicosis

40
Q

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

A

anti-TSHR (TSH receptor)

41
Q

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

A

antithyroglobulin

42
Q

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

A

anti-thyroid peroxidase (anti-TPO)

43
Q

I-_____ is for imaging

A

I-123

44
Q

I-____ used for radioactive ablation of thyroid gland

A

I-131

45
Q

___nodule = carcinoma

A

cold

46
Q

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

A

cold nodule

47
Q

generalized low uptake

A

thyroiditis

48
Q

generalized high uptake (diffuse)

A

Grave’s

49
Q

Single hot spot on uptake

A

toxic adenoma

50
Q

multiple hot spots on uptake

A

toxic multinodular

51
Q

Lid retraction/lag in ___

A

thyrotoxicosis

52
Q

Ptosis in ____

A

myasthenia gravis

53
Q

Enophthalmos in ___

A

Homer

54
Q

Proptosis (Exophthalmos) in _____

A

Graves

55
Q

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

A

thyroid

56
Q

hormone also increases uncoupler protein expression (UCP1/2)

A

thyroid

57
Q

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

A

Amiodarone

58
Q
A

e

59
Q
A

c

60
Q
A

e

61
Q
A

b

62
Q
A

d

ENR Biweekly 3 (14 decks)

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