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Top Notchers ☝🏻 > ENDO > Flashcards

ENDO Flashcards

1
Q

CUSHING’S Ano mataas at mababa sa cushings

A

⬆️ salt, sex, sugar ⬇️Ca, K, Immunity

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2
Q

CUSHING’S Aside from steroids and tumor as causes ano pa isang cause

A

LUNG CA

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3
Q

CUSHING’S Sx (CUSH)

A
  • Cushion (truncal obesity, moon face, buffalo hump, Gynecomastia
  • Unusual hair growth (hirsutism)
  • Skin acne, purple striae, butterfly mark
  • High BP+ osteoporosis + muscle weakness
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4
Q

CUSHING’S meds

A
  • Mitotane
  • Metyrapone
  • Ketoconazole
  • Levoketoconazole
  • Spirinolactone
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5
Q

CUSHING’S Dx
1. What type of urine test
2. done at night
3. Pag binigay to tas mataas parin postive sa cushing
4. Tatlong dx na sa blood naman extraction

A

24H URINE CORTISOL TEST
SALIVA CORTISOL TEST
DEXAMETHASONE SUPPRESSION TEST
SERUM NA, SERUM K, FBS

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6
Q

CUSHING’S list K rich foods (C BROAS)

A

CANTALOUPE/MELON
BANANA/BROCOLLI
RAISIN
ORANGE (highest)
APPLE/AVOCADO/ASPARAGUS
STRAWBERRY/SPINACH

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7
Q

CUSHING’S rx for?

A

INFECTION

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8
Q

CUSHING’S * Type of isolation * Restrict __ * Diet: * Compli: * 2 surgical tx

A
  • REVERSE ISOLATION
  • NA
  • ⬇️CHO & FATS ⬆️K & CHON
  • DM 2 & INFECTION
  • HYPOPHYSECTOMY & BILATERAL ADRENALECTOMY
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9
Q

CUSHING’S 3 important assessments

A

WEIGH DAILY
EDEMA ASSESSMENT
WOF HYPOKALEMIA SX

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10
Q

AKA PRIMARY ADRENAL INSUFFICIENCY

A

ADDISON’S DSE

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11
Q

ADDISON’S HALL MARK

A

BRONZE SKIN

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12
Q

ADDISON’S ano mataas at mababa in this dse

A

⬇️salt sex sugar ⬆️Ca K + bronze skin

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13
Q

ADDISON’S Sx (ADDS)

A
  • Added tan & K
  • Dec weight
  • Dec hair, BP, energy
  • Sodium Loss/ salt craving
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14
Q

ADDISON’S diet

A
  • ⬆️CHO CHON ⬇️ K
  • Inc Na on hot weather
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15
Q

ADDISON’S Iwa watch out

A

HYPERK
ADDISONIAN/ ADRENAL CRISIS/ ACUTE ADRENAL FAILURE

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16
Q

ADISSONIAN CRISIS bawal magbigay ng steroids if?

A

drop in BP 89/40 less (shock)

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17
Q

ADISSONIAN CRISIS sx

A
  • Severe headache, low back pain, abd pain, leg pain
  • Extreme weakness and HypoNa
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18
Q

ADISSONIAN CRISIS mngt

A
  • IV fluid (shock)
  • Fludrocortisone
  • Hydrocortisone (po, maintenance)
  • avoid infection
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19
Q

ADDISON’S med

A

ADD-sone + Kayexelate and Insulin
* Fludrocortisone (mineralocorticoid)
* Dexa, Hydrocortisone, Prednisone (glucocorticoids)

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20
Q

STEROIDS anong 7S tatandaan

A
  1. stress & surgery- inc the dose
  2. Slowly taper off
  3. Sugar inc
  4. Sepsis/ low WBC
  5. sight rx (cataract)
  6. Skinny (muscles & osteoporosis)
  7. Swollen (water gain)
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21
Q

what disorder ung ⬆️ADH but mababa sa osmolality and Na

A

SIADH

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22
Q

SIADH URINE SPECIFIC GRAVITY RESULT?

A

Concentrated

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23
Q

SIADH ⬇️Na early sx

A

HEADACHE

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24
Q

SIADH seizure early sx

A

HEAD AND CONFUSION (WATER INTOXICATION/CEREBRAL EDEMA)

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25
Q

SIADH Mngt

A
  • 800-1k ml/ day of fluids lang per day
  • Give salt
  • Loop diuretics w 3% saline (hypertonic)
  • Seizure precautions & IO
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26
Q

SIADH meds

A

Aquaretics/ Vasopressin 2 receptor antagonists (-vaptan)
++Urea & Demeclocycline (ADH antagonist) for chronic

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27
Q

Most accurate measure for fluid balance

A

DAILY WEIGHTS

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28
Q

what disorder ung ⬇️ADH but mataas sa osmolality and Na

A

DI

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29
Q

DI specific gravity

A

Diluted

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30
Q

DI compli

A

Hypovolemic shock

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31
Q

DI mga bawal

A

Caffeined beverages, alcohol, parsley, celery

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32
Q

Late sx of hypovolemic shock

A

ANURIA <100ml/day

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33
Q

Too much release of ⬆️Ca but⬇️Phosphorus

A

HYPERPARATHYROIDISM

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34
Q

HYPERPARATHYROIDISM SX

A

STONES=KIDNEY
MOANS= FRACTURE & BONE PAIN
GROAND= CONSTIPATION
muscle weakness, arrythmia, hypoactive DTR, altered LOC

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35
Q

HYPERPARATHYROIDISM Diet

A

Lean meats- Rich in Phosphorus

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36
Q

HYPERPARATHYROIDISM tx

A
  • Morphine/demerol for bone pain
  • Amiodarone for arrhythmia
  • Calcitonin
  • IV phosphate
  • Furesomide
  • Magsul
  • Parathyroidectomy
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37
Q

⬇️Ca but ⬆️Phosphorus

A

HYPOPARATHYROIDISM

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38
Q

HYPOPARATHYROIDISM HALLMARKS and other sx

A
  • TROUSSEAU’S AND CHOVSTEK’S SX + diarrhea
  • Arrythmia din
  • SPASMS
  • Seizure
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39
Q

HYPOPARATHYROIDISM Anong mineral pede caused nito

A

Hypomagnesemia

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40
Q

HYPOPARATHYROIDISM med

A
  • Ca gluconate, Ca carbonate, Ca lactate
  • Vit D (calcitriol)
  • Phenobarbital for seizure
  • Teriparatide to dec phosphate inc Ca
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41
Q

HYPOPARATHYROIDISM Mngt

A

Tracheo set at bedside
Breathe w paper bag
NO lean meats (rich in Phosphate), NO dairy products like milk and egg yolks bc may phosphate parin. ✅green leafy, anchovies, tuna

42
Q

Parathyroid diseases dx

A
  • Serum Ca & Phosphate
  • Lengthened QT interval
  • Prolonged ST segment
  • X ray (⬇️bone density)
43
Q

⬆️T3 &T4 ⬇️TSH

A

everything is high

44
Q

HYPERTHYROIDISM is aka?

A

GRAVE’S DSE

45
Q

HYPERTHYROIDISM HALLMARK and mngt

A

EXOPTHALMOS
- Tape eyes/ eye patch
- Dark sun glass
- Eyedrops/artificial tears
- Eye exercise

46
Q

HYPERTHYROIDISM other sx

A

Hyperphagia (⬆️metabolism)
HEAT INTOLERANCE (MOIST SKIN)
DIARRHEA
W GOITER

47
Q

HYPERTHYROIDISM IIWASAN KASI NAKAKATRRIGER MAG THYROID STORM

A
  • DIM LIGHTS/ STIMULANTS
  • SODIUM (EYE SWELLING)—HOB elevated
  • SMOKING, STRESS, SEPSIS, SICKNESS/INFECTION
  • DO NOT TOUCH THE NECK
48
Q

THYROID STORM sx

A

HAT
- HYPERTHERMIA
- AGITATION
- TACHYCARDIA

49
Q

HYPERTHYROIDISM MEDS

A

ANTI THYROID/ PLM
PROPYLTHIOURACIL (bby safe) & PROPANOLOL
LUGOL’s SOL/POTASSIUM IODIDE- straw, 1h apart w other meds
TAPAZOLE/METHIMAZOLE (1ST LINE, NOT BBY SAFE)

50
Q

HYPERTHYROIDISM Diet

A

⬆️cal, protein, carbs
No spicy, caffeine, fiber

51
Q

Thyroidectomy Complications and mngt

A
  1. STRIDOR- ET and tracheo at bedside
  2. Thyroid storm
  3. Accidental removal of parathyroid (TETANY)- ✅Ca gluconate
  4. Accidental removal of larynx (HOARSENESS)
  5. Laryngeal spasm (SOB) tracheo at bedside
  6. Bleeding (freq swallowing, feeling of fullness, bloods sa nape, upper chest, pillow, incision site)- neutral head and neck alignment
52
Q

Thyroidectomy
1. Position
2. Neck position
3. Preop meds to prevent thyroid storm

A

Semi fowlers
Neutral
Anti thyroid, propanolol, Glucocorticoids

53
Q

THYROID DISORDERS DX

A
  • RADIOACTIVE IODINE UPTAKE
  • TSH
  • Serum T4
  • Thyroid scan
54
Q

HYPERTHYROIDISM kelan lang tataas TSH nito

A

If 2nd-3tiary hyperthyroidism

55
Q

before and after gagawin sa RADIOACTIVE IU

A

Before:
* PT (no pregnant)
* Remove jewelries and dentures
* pt should be awake (❎anes or sedation)
* 5-7 days HOLD anti thyroid meds
* NPO 2-4 h

After:
* NPO 1-2 h
* private room w private bathroom
* Flush 3x
* Sariling food utensils
* No crowds
* Linen radioactive

56
Q

⬇️T3 & T4 ⬆️TSH; everything is low, slow, dry

A

HYPOTHYROIDISM

57
Q

HYPOTHYROIDISM aka and mc cause

A

HashimOtos
Pituitary tumor

58
Q

HYPOTHYROIDISM classic sx

A
  • cOld intolerance
  • chOlesterol⬆️= MI
  • cOnstipation
  • Cretinism
  • Alopecia
  • Amenorrhea

Late sx
- Non pitting edema
- Brittle hair/nails
- ⬇️libido & lethargy
- Hoarseness

59
Q

HYPOTHYROIDISM Kelan lang bababa TSH

A

If 2nd/3rtiary hypothyroid bc hypothalamus prob na here

60
Q

HYPOTHYROIDISM med and considerations

A

(-thy) LEVOTHYROXINE. Pneumonic: LEVO no
* LOW SLOW ONSET
* EARLY MORNING EMPTY STOMACH 1x daily
* VERY ⬆️HR & BP and insomnia (SE)
* Oh bby is fine
* NO DOUBLING DOSES, STOP ABRUPT — MYXEDEMA COMA

61
Q

Myxedema Coma sx?

A

All are ⬇️ lalo na Na, CBG, Temp so check RR & temp q 1h. Prio is resp failure so tracheo at ET at bedside

62
Q

HYPOTHYROIDISM COMPLI and diet

A

HYPOVOLEMIC SHOCK BC ⬇️Na
Low Cal

63
Q

Tumor of adrenal gland that pump out high amounts of CATCHOLAMINES that may lead to HPN crisis

A

PHEOCHROMOCYTOMA

64
Q

PHEOCHROMOCYTOMA doc

A

PHENTOLAMINE & BETA BLOCKERS

65
Q

PHEOCHROMOCYTOMA mngt

A

No changing positions rapidly (put pressure to tumor so squirt catecho)

66
Q

Hypersecretion of aldosterone from adrenal gland so excrete K but Na and water retention

A

HYPERALDOSTERONISM

67
Q

HYPERALDOSTERONISM Hypernatremia sx and Hypokalemia sx and other sx

A

Hypernatremia
- Inc muscle tone
- Polydispsia
- Swollen dry tongue

Hypokalemia
- U waves, ST depression
- Dec DTRs
- Consti and hypoactive bowels

HPN, polyuria and low urine gravity/ diluted

68
Q

HYPERALDOSTERONISM tx

A
  • Spironolactone
  • Adrenalectomy
  • Na restriction
  • K supplements/ foods
69
Q

DI sx

A
  • 3P’s
  • Hypotachytachy
  • Glycosuria
  • Wt loss, caxechia (T1), neuropathys
  • Heart attack & stroke
70
Q

DM 2 initial sx

A
  • Acanthosis Nigricans (Hyperpigmentation)
  • PCOS
  • ASYMPTOMATIC
71
Q

Tx sa DM 1 and 2

A

DM 1- insulin
DM 2- OHA

72
Q

Hypoglycemia papakain sa conscious? Unconscious?

A
  • Simple sugars: Hard candy/ 4 tsp sugar/4 sugarcubes/ 1/2 c juice/soda/ crackers/ LOW fat milk
  • or Complex CHO/CHON (meal to)
  • 15:15 FOC (15 g of sugar in 15 mins check.

Unconscious: Glucagon or D50, or sugar sublingual (at home)

73
Q

bat bawal sa may DKA ang juice

A

Kasi may acidosis na

74
Q

DM a natural insulin sa lahat hormonal effect, no hypoglycemia at night but sa GABI HYPERGLY SO ⬆️NPH at night and limit bedtime snacks

A

DAWN PHENOMENON

75
Q

DM Man made insulin that’s common to DM 1, rebound effect, hypoglycemia at night so ⬇️ NPH and have snack bedtime

A

SOMOGYI EFFECT

76
Q

DM age ng prone and compli

A
  • DM 1: child— DKA
  • DM 2: >30 y.o— HHNS
77
Q

4 dx of DM

A
  1. Random- non fasting
  2. Fasting- NPO 8h
  3. GTT tolerance-NPO 8h
  4. Hgb A1c
78
Q

Most sensitive tool common for GDM/Pregnant

A

GTT tolerance

79
Q

DM Diet what to avoid

A

Simple sugars like soda, candy, white bread/rice, juices kasi ito is for hypogly

80
Q

DM peripheral neuropathy/diabetic foot mngt

A
  • No high heels, nylon, flip flops, etc, removal of ingrown or callous, rubbing feet hard, hot bath/ hot pads but warm is ok
  • cut nails STRAIGHT
  • DAILY inspection
  • Lanolin lotion
  • Podiatrists
  • BKA/ AKA
81
Q

DM retinopathy and nephropathy prevention

A

ANNUAL eye and kidney exam

82
Q

DM when to take insulin and OHA

A

30 mins before breakfast

83
Q

DM Diet

A
  • CHO: 50-60 %
  • fats 20-30
  • CHON 10-20
  • Individualized Food exchange list based
  • No skipping meals
84
Q

DM kelan exercise

A

After meals

85
Q

Insulin w or without food

A

Without or before meals

86
Q

Di mo alam if hypo/hypergly bibigay parin simple sugar?

A

YES

87
Q

DM1 pede exercise?

A

NO mas delikado sila sa hypogly, TYPE 2 lng dat mag wt reduction.. dat nga mas more food sila

88
Q

OHA (DM 2 only) meds and considerations

A
  1. Metformin (wt loss and lactic acidosis)
  2. Glipizide and Glyburide (No sa may CHF, sunburn, hepatorenal toxic)
  3. Thiazolidinedone/ Pioglitazone (NO sa heart and liver failure pts)
89
Q

Insulin adm mga bawal

A
  • Massage/exercise/ heat: rapid absorption so di maobserve hypogly sa peak
  • Scar- delay naman
  • Posterior thigh- hit sciatic nerve—paralyze
  • Same site —✅rotate 1-1.5 inch apart with horse shoe pattern
  • Shake —Air embolism
  • Right after sa ref inject agad—lipodystrophy
90
Q

Insulin adm sites/ region

A
  • Abd
  • ANTERIOR thigh
  • POSTERIOR Deltoid
  • Buttocks
  • Hips
91
Q

Insulin adm y withdraw first sa regular bago NPH

A

To prevent cross contamination

92
Q

Kelan lang maga 90 degrees turok ng insulin

A

If obese

93
Q

Bat NPH lang ung minimix sa iba/regular

A

Bc suspension at may halong protein derivatives

94
Q

Insulin storage and considerations

A
  • Ref not freezer
  • Travel? Lagyan ice but not frozen
  • After gamit ref uli or if nabuksan na ket san basta room temp (multiple dose naman insulin + airtight)
95
Q

No. Cause of DKA

A

SEPSIS (infection)

96
Q

DKA Sx

A

DKAA
* Dry and high sugar >300
* Ketone + fruity breath & Kussmaul resp, K⬆️
* Abd pain
* Acidosis

97
Q

DKA Tx

A

DKA
* DHN first- 0.9 NSS (Isotonic) without insulin na kasabay
* Kill the sugar w IV regular bolus if >300. If <300 SQ insulin + 1/2 NS w D5W
* Add K bc naga polyuria and Na bicarbonate (acidosis)

** Added na ung K sa insulin bc insulin puts the sugar & K into the cell

98
Q

child w NV and not eating still give insulin?

A

Yes kasi sugar is high during may illness

99
Q

Which is sudden onset and sino gradual progressive bet. DKA and HHNS

A
  • Sudden onset- DKA
  • Gradual progressive- HHNS
100
Q

HHNS sx

A
  • High sugar >800
  • High fluid loss (extreme DHN)
  • No ketones/kussmaul/fruity breath/abd pain
  • Stable K and slower onset
101
Q

HHNS tx

A

HS
* Hydration isotonic 0.9 NS muna then maga hypOtonic
* Stabilize sugar (IV regular insulin only!)

102
Q

DKA patients die from __. HHNS patients die from __

A
  • HYPOKALEMIA
  • HYPOVOLEMIA

Top Notchers ☝🏻 (13 decks)

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