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SU-18 ER > Endocirne 2 > Flashcards

Endocirne 2 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

myxedema crisis

A

severe multi organ decompensation in a HYPOTHYROID pt

mental status changes, HoTN, HoThermia

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2
Q

myxedema crisis clinical features

A 
bradycardia 
HoTN 
HoThermia 
AMS 
Coma

may have infection w/o signs due to masking by bradycardia and HoThermia

clinical shock, systolic <100 MAY present in coma

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3
Q

neuro exam finding myxedema crisis

A 
delayed DTRs
dementia
psychosis
paresthesia
depression
poor memory
confusion
ataxia
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4
Q

cardiopulmonary exam findings myxedema crisis

A 
angina
bradycardia
distant heart sounds
low voltage ECG
pericardial effusion
cardiomyopathy 
Hoventilation
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5
Q

derm findings myxedema crisis

A 
dry skin
hair loss
non pitting edema
facial swelling ptosis 
macroglossia
periorbital edema
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6
Q

lab eval myxedema crisis

primary hypothyroid

A

high TSH

low T3/T4

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7
Q

lab eval myxedema crisis

secondary hypothyroid

A

low TSH

Low T3/T4

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8
Q

myxedema crisis tx

A

initiate tx without waiting for lab confirmation

  1. support tx
  2. thyroid hormone replacement
  3. identification and tx of precipitating factors
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9
Q

supportive care in myxedema crisis

A 
ABCD
IV dextrose tx 
vasopressors
hypothermia rewarming 
steroids
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10
Q

thyroid replacement myxedema crisis severe

A

T3 +/- T4

caution in pts with myocardial compromise

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11
Q

myxedema crisis thyroid replacement IV drugs

A

levothyroxine (T4) OR liothryonine or triodothyronine (T3)

T3- no more than 10 micrograms for elderly or CAD

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12
Q

myxedema crisis disposition

A

high mortality rate

ICU admission

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13
Q

elderly and myxedema crisis

A

age
cardiac comorbidities
thyroid replacement = WORSE outcome

T4 and T3 avoiding for arrhythmia (std doses)

start with HALF normal dose

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14
Q

cardiac instability myxedema crisis

A

T4 is better for cardiac safety

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15
Q

thyroid hormone fxn

A

increase metabolic rate, HR, ventricle contractility, muscle and CNS excitability

T3 and T4 are 2 types (T4 more common, T3 more potent)

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16
Q

thyrotoxicosis

A

excess circulating thyroid hormone (any cause)

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17
Q

thyroid storm

A

extreme thyrotoxicosis

acute, severe life threatening state of thyrotoxicosis

18
Q

cause of thyroid storm

A 
untreated hyperthyroidism
surgery 
infecton
trauma
acute iodine load
childbirth 
exogenous thyroid hormone One Direction
19
Q

precipitants of thyroid storm

A

systemic insult
CV insult
unknown

MC overall is infection

20
Q

thyroid storm clinical features

A

fever
tachycardia
ams

21
Q

thyroid storm palpitations

A

tachycardia
direct inotropic and chronotropic effects of thyroid hormone

increased contractility and output

AFib

water hammer pulse

22
Q

CNS findings of thyroid storm

A 
anxiety 
agitation 
delirum 
stypor 
coma 
seizure
23
Q

thyroid lab evaluation

A

not always acutely elevated when transition from thyrotoxicosis occurs

low TSH and elevated T4 confirms diagnosis

24
Q

order of tx for thyroid storm

A

thionamide must be initiated 1 hr BEFORE iodine

25
Q

tx list of thyroid storm

A
  1. supportive care (airway, fever control. nutrition, BB)
  2. inhibit hormone production
  3. inhibit hormone release
  4. B-adrenergic R blockade
  5. inhibition of T4 conversion

pts are admitted to ICU

26
Q

list of thionamide

A

block production

  1. PTU
  2. Methimazole

PTU preferred (blocks T4 conversion)

27
Q

prevention of hormone release (list)

A
  1. Lugol solution

2. potassium iodide (SSKI)

28
Q

BETA-adrenergic R blockers in thyroid storm

A
  1. propanolol
  2. esmolol
  3. reserpine
  4. guanethidine
29
Q

how do we block peripheral T4-T3 conversion in thyroid storm

A

PTU and glucocorticoids

Hydrocortisone, Dexamethasone

30
Q

amiodarone and thyroid storm

A

precipitant of thyroid storm

chronic use of amiodaron causes hypothyroid or thyrotoxic state in 20-30% of patients

31
Q

hormones secreted by adrenal gland

A

cortisol
alderstone
gonadocorticoids

32
Q

types of adrenal insufficiency

A

primary/Addison’s dz (decreased cortisol and aldosterone)

secondary: central dysfunction, decreased ACTH production, ONLY decreased cortisol

33
Q

adrenal crisis

A

exacerbation of adrenal insufficiency due to

  1. increased demand (infection, trauma, MI..)
  2. decreased cortisol supply

adrenal gland fails to mount a stress response

occurs in primary or secondary

34
Q

major stressors adrenal crisis

A 
acute MI
sepsis
sx
truama 
other illness
35
Q

MC cause of adrenal crisis

A

rapid withdrawal of steroids in pt with adrenal atrophy secondary to long term steroid administration

36
Q

clinical features of adrenal crisis

A 
HoTN refractory to pressers 
syncope
dehydration 
hyperpigmentation 
abdominal pain, n/v
37
Q

when to suspect adrenal crisis

A

unexplained HoTN in pts w/:

long term glucocorticoid therapy + acute stress event, known dz

rapid withdrawal or non compliance with steroid

AIDs pt
severe head trauma
severe infection

38
Q

labs adrenal crisis

A

ACTH
random cortisol level
aldosterone and renin levels

underlying pathology

39
Q

tx of adrenal crisis

A
  1. IV fluids (5% dextrose in NS) correct Hoglycemia, HoNatremia
  2. Steroids (hydrocortisone)
  3. Vasopressors
40
Q

adrenal supplementation in adrenal crisis

minor stress

A

25 mg/d of hydrocortisone

I.e. mild fever, n/v

41
Q

adrenal supplementation in adrenal crisis

moderate stress

A

50-75 mg/D

PNA, pancreatitis

42
Q

adrenal supplementation in adrenal crisis

severe stress

A

100-150 mg of hydrocortisone for 1 to 3 days

sepsis, shock

SU-18 ER (11 decks)

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