Endocrine 1b

Question 1

Why might you need to give insulin to a patient with low glucose? How is it administered?

Answer 1

A patient with DKA might have low glucose but high ketones. Give that patient insulin and glucose at the same time.

Question 2

What is AGEs?

Answer 2

Advanced Glycosylation Endproducts. Intermediate and Advanced glycosylation endproducts are irreversible and can lead to microvascular disease.

Question 3

What is mononeuropathy?

Answer 3

dysfunction of a single nerve, often reversible with time.

Question 4

What is mononeuropathy?

Answer 4

dysfunction of a single nerve, often reversible with time.

Question 5

What is polyradiculopathy?

Answer 5

Affects nerve roots and commonly hits anterior thigh. Muscle weakness, atrophy and pain.

Question 6

What is autonomic neuropathy?

Answer 6

Affects autonomic nervous system: bladder, GI, genitals, etc.

Question 7

What is symmetric polyneuropathy?

Answer 7

Numbness, tingling, pain, etc. in the feet.

Question 8

What is symmetric polyneuropathy?

Answer 8

Numbness, tingling, pain, etc. in the feet. This is the most common form of neuropathy.

Question 9

What is symmetric polyneuropathy?

Answer 9

Numbness, tingling, pain, etc. in the feet. This is the most common form of neuropathy.

Question 10

Where is 5’ deiodinease found?

Answer 10

liver
kidney
thyroid
target organs

Question 11

Where is 5’ deiodinease found?

Answer 11

liver
kidney
thyroid
target organs

Question 12

Which disease has diffuse uptake on thyroid scan? Which has patchy uptake?

Answer 12

Diffuse: Graves

Patchy: Toxic Multinodular Goiter

Question 13

Which disease has diffuse uptake on thyroid scan? Which has patchy uptake?

Answer 13

Diffuse: Graves

Patchy: Toxic Multinodular Goiter

Question 14

If a patient is taking amiodarone, can you do a thyroid uptake scan?

Answer 14

No. Amiodarone has iodine in it already, so the thyroid is already saturated with iodine.

Question 15

When is PTU always used?

Answer 15

First trimester of pregnancy.

Question 16

In absence of TSH, what color should the uptake scan be?

Answer 16

Clear. The thyroid should not be uptaking iodine if there is no TSH.

Question 17

What has germinal centers in the histology?

Answer 17

Hashimotos hypothyroidism.

Question 18

What has germinal centers in the histology?

Answer 18

Hashimotos hypothyroidism.

Question 19

Where is d1 located?

Answer 19

Plasma membrane of target cell.

Question 20

Where is d2 located?

Answer 20

ER of target cell. Has a short half life and is major activating hormone.

Question 21

Where is d3 located?

Answer 21

Plasma membrane of target cell. Major deactivated.

Question 22

When is the fetus entirely dependent on maternal hormone?

Answer 22

Before 18 weeks the fetus is entirely dependent onmaternal thyroid hormone

Question 23

What is thyroid storm?

Answer 23

A life-threatening condition manifested by severe
hyperthyroidism plus decompensation of one or more organ systems
-  Occurs in 0.2% of hyperthyroid patients
-  Mortality is 11%
-  Precipitated by a sudden release of thyroid hormone or increase in metabolic stress
•  Symptoms may include fever, marked tachycardia, arrhythmias, heart failure, metabolic encephalopathy and hepatic failure

Question 24

Which drug I nhibits the action of 5’ deiodinase D1

Answer 24

Put

Question 25

Myxedema Coma

Answer 25

Typical case

•   Elderly woman, often with mild dementia
•   History of treated hypothyroidism
•   Thyroid hormone discontinued or taken erratically -  Presents with apparently unrelated systemic illness

Question 26

For women who become pregnant while taking L-T4…

Answer 26

As soon as a period is missed and pregnancy is suspected increase from 7 to 9 L-T4 tablets/week (a 29% increase)

Don’t wait to check TSH !

Question 27

What has germinal centers in the histology?

Answer 27

Hashimotos hypothyroidism.

Question 28

What is the role of methimazole and PTU? How does PTU differ?

Answer 28

They do everything (decrease iodination and T4/3 formation) except prevent the secretion of stored T3/4.

PTU is different bc it inhibits the action of D1 and decreases conversion of T4 to T3.