ENDOCRINE Flashcards
How to treat hyperthyroidism in first trimester preg
PTU
How to treat hyperthyroid in 2nd and 3rd trimester pregnancy
Methimazole
Teratogenic effects of methimazole when used during first trimester of pregnancy
Aplasia cutis
Scalp defects
Omphalocele
TE fistula
Cause of 60-90% of congenital heart block
Neonatal lupus
Girl missed her period for 2 months and prig test is negative. Next step?
TSH or prolactin.
Treatment for heart failure and/or a fib in thyroid storm
Digoxin
If pt is hyperthyroid based on TSH and thyroid sono, next step?
radionucleotide uptake scan
If radio nucleotide uptake scan shows a hot nodule?
Treat as hyperthyroid
If radio nucleotide uptake scan shows a cold nodule?
FNA
If hypothyroid based on thyroid sono and TSH, next step?
Replace thyroid hormone and monitor for decrease in nodule size. If nodule persists AFTER thyroid replacement, do an FNA.
What to do if FNA of thyroid is non diagnostic
Repeat FNA.
If FNA of thyroid is benign …
Repeat sono q 6m-1 yr to make sure no increase in size. If size does end up increasing, repeat FNA.
Somogyi effect
Evening NPH is too high so pt ends up bottoming out overnight and the release of stress hormone GREATLY increases morning glucose.
Treatment of somogyi effect
Decrease nighttime dose of NPH or give it later.
What is the dawn phenomenon?
Too low dose of evening NPH so glucose creeps up throughout the night, causing very high morning glucose.
Treatment of dawn phenomenon
Increase nighttime dose of NPH.
How to distinguish between dawn and smoggy effect
Check a 3am glucose.
Which 2 oral DM agents have the most common SE of hypoglycemia
Sulfonylurea, meglutinides
Which is the oldest and cheapest of DM oral agents?
Sulfonylureas
Which oral DM agent also helps lower TG and LDL
Metformin
Which oral DM agent is not safe in settings of CHF
TZD
Which 2 oral DM agents should not be used in pts with elevated serum creatinine
Metformin, sulfonylureas
Which oral DM agent should not be used in pts with IBD
Alpha glucosidase inhibitors (acarbose)
Hepatic serum transaminase levels should b carefully monitored when using these oral DM agents.
Metformin or TZDs