endocrine

Question 1

adrenal medulla

Answer 1

10% of gland and secretes catecholamines

Question 2

Adrenal cortex

Answer 2

90% of gland and secretes Salt, Sugar, Sex

Question 3

adrenal stimulation

Answer 3

CRH form hypothalamus and ACTH from pituitary

Question 4

Primary adrenal insufficiency

Answer 4

Addisons disease is autoimmune issue common in women (CRH and ACTH high), leads to skin hyperpigmentation due to ACTH

Question 5

Secondary adrenal insufficiency

Answer 5

ACTH secretion deficiency (Low CRH, ACTH and cortisol)
Exogenous glucocoritoid therapy (Low everything)

Question 6

adrenal insufficiency Sx

Answer 6

weakless/lethargy
weight loss
nausea/vomiting
hypoglycemia
Mineralocorticoid deficiency

Question 7

adrenal insufficiency diagnosis

Answer 7

Give synthetic ACTH and see if cortisol increases or not

Question 8

Short acting steroids

Answer 8

8-12h
Hydrocortisone 1:1
cortisone 0.8:0.8

Question 9

intermediate steroids

Answer 9

12-36h
prednisone 4:0.4

Question 10

long acting

Answer 10

36-72h
betamethasone 40-0.01

Question 11

Steroid dose for primary

Answer 11

Hydrocortisone 15-25mg daily split 2/3 Qam and 1/3 Qhs
add fludrocortisone 0.05-0.1mg qd for mineralocorticoid action

Question 12

adrenal crises management

Answer 12

for when you are sick, take double dose during febrile illness and continue till feeling better

Question 13

Hot water adrenal management

Answer 13

have to increase dose of mineralocorticoid 2-3 fold to account for water loss

Question 14

Cushing syndrome

Answer 14

Issue with the adrenal gland producing too much or exogenous steroids

Question 15

cushings disease

Answer 15

from too much ACTH from pituitary only

Question 16

Cushings Sx

Answer 16

Fatigability and weakness
increased central body weight
HTN
Hair growth
muscle wasting
skin thinning

Question 17

diagnosis of cushings

Answer 17

dexamethasone supression test <50nmol rules out cushings
>50nmol confirms cushings

Question 18

cushings disease treatment

Answer 18

Cut out or irradiate adrenals
enzyme inhibitors (ketoconazole)
decrease ACTH production from pituitary (cabergoline or pasireotide)

Question 19

cushings syndrome treatment

Answer 19

Does this patient really need exogenous steroids
monitor patients on >20mg prednisone for >3 weeks

Question 20

drugs that can inhibit dopamine

Answer 20

antipsychotics, antidepressants, metoclopramide, domperidone

Question 21

TSH >10

Answer 21

Overt hypothyroidism

Question 22

TSH 6.5-10

Answer 22

subclinical hypo, can order a T4 to confirm but not recommended
Order a thyroid peroxidase Aby test to look for progression to overt

Question 23

TSH <0.1

Answer 23

Then also test T4 if it is high than hyperthyroidism
if T4 is normal then order T3 to search for the various types of hyper

Question 24

thyroid screening

Answer 24

not recommended in asymptomatic people
only for people with symptoms or increased risk (pregnant, lithium or amiodarone, other autoimmune, family history)

Question 25

thyroid risk factors

Answer 25

(pregnant, lithium or amiodarone, other autoimmune, family history)

Question 26

hypothyroidism Sx (5)

Answer 26

swelling of thyroid hoarseness/deeping of voice persistent dry sore throat difficulty swallowing infertility

Question 27

types of primary hypothyroidism (5(

Answer 27

Hashimotos lactogenic iodine excess lithium/amiodarone congenital

Question 28

types of secondary hypothyroidism (2)

Answer 28

pituitary or hypothalamic disease

Question 29

Synthroid counselling notes

Answer 29

Take 60min before first meal don't take with iron, calcium or aluminum don't take with rifampin, carbamazepine and phenytoin

Question 30

Synthroid dosing

Answer 30

Normal people start at 1.6mcg/day then test in 6-8 weeks and titrate by 12.5 to 25 mcg old people start at 1mcg/day people with heart issues start at 25mcg

Question 31

synthroid over treatment

Answer 31

atrial fibrillation and stroke bone loss and fracture sleep disturbance and irritability

Question 32

synthoid under treatment

Answer 32

increased lipids slow heart rate low BP memory loss mood impairment

Question 33

are different brands of levothyroxine interchangeable

Answer 33

no

Question 34

hypothyroid while pregnant

Answer 34

need to increase dose by 20% and keep TSH <2.5 1st and <3.5 for rest of preg

Question 35

types of hyperthyroidism (6)

Answer 35

graves disease toxic nodules tumors subacute thyroiditis hashitoxicosis excessive dosage

Question 36

Beta-blockers for hyper

Answer 36

Can be used before diagnosis for symptom control, will decrease HR and BP will reduce heat intolerance and anxiety

Question 37

Propylthiouracil (PTH)

Answer 37

second line but used for 1st trimester of pregnancy, needs more frequent dosing

Question 38

methimazole

Answer 38

first line and can be used for longer

Question 39

antithyroid drugs

Answer 39

inhibit thyroid peroxidase to prevent secretion of T4 and T3

Question 40

antithyroid drug monitoring

Answer 40

Test T4 and T3 every 4 weeks, once normal add TSH and monitor for 2-3 months then taper to 30-50% of dose and continue for 12-18 months

Question 41

radioactive iodine

Answer 41

to be used instead of surgery but not in pregnancy people or 6 months before/ after. needs 6-18 weeks for full affect