Endocrine

Question 1

Hyperthyroidism increases the risk for atrial fibrillation which additionally increases the risk for ___

Answer 1

thromboembolic stroke

Question 2

Risk of AF is increased up to (3)_________ in patients with(4) __________ hyperthyroid (low TSH with normal free T4)

Answer 2

Risk of AF is increased up to (3) 3x in patients with(4) subclinical hyperthyroidism hyperthyroid (low TSH with normal free T4).

Question 3

Two possible places to admit a new onset afib (hyperthyroid) pt.

Answer 3

acute telemetry or ICU

Question 4

four tx considerations for someone in afib with hyper thyroid - rate v. rhythm

Answer 4

(1) rate control - diltiazem/verapamil (CCB), digoxin, propanolol (BB)
(2) rhythm control - cardioversion (amiodarone or shock or spontaneous) [*amiodarone can cause hyperthyroid]
(3) antiarrhythmics
(4) anticoag (hep)

Question 5

Before __hrs is it ok to sitll do cardioversion?

Answer 5

onset less than 48 hours ago

Question 6

Measure TSI - thyrotropin receptor Ab in what autoimmune thyroid disorder?

Answer 6

grave’s

Question 7

Measure TPOab in what autoimmune thyroid disorder?

Answer 7

Hashimoto

Question 8

chapman point for?

bilateral 2nd intercostal spaces just lateral to sternum

Answer 8

myocardium

Question 9

SNS for what? T1-5

Answer 9

H/N/cardiac (increased warmth, mm tension, moisture)

Question 10

PSNS for what? vagus

Answer 10

OA F RRSL, AA RL

Question 11

Define: rapid and deep respirations

Answer 11

kussmaul respirations

Question 12

increased hunger

Answer 12

polyphagia

Question 13

AG metabolic acidosis

Answer 13

M Methanol
U Uremia
D Diabetic Ketoacidosis
P Paraldehyde
I Infection
L Lactic Acidosis
E Ethylene Glycol
S Salicylates

Question 14

Admit DKA where?

Answer 14

**ICU, always!

Question 15

Most important treatment for DKA.

Answer 15

**IV Fluids and correct the anion gap.

Question 16

Why do you want to include potassium in electrolyte replacement in DKA, even it pt’s K is initially elevated?

Answer 16

Insulin/IVF [correction of

pH] will drive K into cells and they usually become hypokalemic)

Question 17

What is the equation used for?

Na + [(glucose -100) x 0.016]

Answer 17

To correct sodium when glucose is high

Question 18

Initally, IV fluid tx for DKA is ____. Then it is swtiched to _____. Why?

Answer 18

Initially normal saline, switch to D5 1/2 NS when following protocol with insulin gtt when their
glucose gets to 250 prevent hypoglycemia (can cause hypoosmolarity, herniation, death).

Question 19

Goal of DKA tx

Answer 19

fix acid base disturbance and NOT until sugar level is normal

Question 20

why do you not want to tx DKA until sugar is normal?

Answer 20

bc they will go right back to DKA if you stop too soon - better to keep glucose slightly high until anion gap is corrected

Question 21

Notable findings in a pt with… diffuse abdominal pain, fruity breath, unintentional weight loss, ketonuria, hyperglycemia.

Answer 21

DKA

Question 22

When can you end DKA tx protocol?

Answer 22

when anion gab closes - Switch to subQ insulin, stop gtt 2 hours after administration of SQ long acting (they will go right back into DKA if you stop too soon. )

Question 23

What is this the chapman point of?

R 7th intercostal space tissue texture changes

Answer 23

Pancreas

Question 24

What is this the SNS of?

T5-9 (increased warmth, tension, and moisture)

Answer 24

Pancreas

Question 25

What is this the PSNS for?

OA E RLSR, AA RR, restricted thoracic inlet

Answer 25

Pancreas

Question 26

if pt has HF, cannot give what for AFib?

Answer 26

CCBs - verapamil, diltiazem