Endocrine Flashcards
What disorder can be ruled out using the Cosyntropin stimulation test?
Adrenal insufficiency
What side effect of levothyroxine is most likely to lead to non-compliance when first initiated?
Alopecia
You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/synthroid effectiveness?
TSH
What method should you use to treat hyponatremia related to SIADH?
3% hypertonic saline, calculated
For the past few months, 29 year old Janine has been gaining weight while experiencing amenorrhea and increasingly severe acne. She has gained more than 20 pounds, and you note that she is carrying her weight around the midline, w/BL purplish striae across both flanks. You suspect Cushing’s syndrome. Which of the following findings would not contribute to a Dx?
After a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol (In Cushings, pituitary does not respond to dexamethasone)
Which of the following is not a criteria of Metabolic Syndrome?
BP > 140/90 (it’s ≥130/85)
Cushing labs, symptoms:
↑BG, ↑Na, ↓K. S/S: central obesity, moon face with buffalo hump.
Addison’s disease labs & Tx: :
↓BG, ↓Na, ↑K. Tx: florinef, hydrocortisone, Steroid bolus. Test: Cosyntropin, + if serum cortisol < 18 mcg/dL in the morning.
Pt is hypotensive + Addison’s. Tx?:
dopamine/pressors don’t work, so choose IVF (D5NS).
SIADH
inappropriate water retention, CNS d/o, retain water, hypothermia, hyponatremia, ↓sOSm, ↑ urine osmolality (concentrated), urine sodium >20meq (kidneys trying to excrete water via salt), need 3% hypertonic fluids calculated
Urine Na 28, serum osmo 250, urine osmo 115. What is the suspected cause?
SIADH
23 yo F presents with DKA. ABD pH 7.3, glucose 520, BP 90/65, HR 120 and confused. Which of the following are not included in the initial management of DKA? Isotonic fluids, insulin infusion, sodium bicarb, or supportive care?
Sodium bicarb is only indicated for DKA if pH <7.1
24 yo M presents with DKA. Now confused and irritable. ABG Ph 7.29/33/22. Received isotonic fulids x 1 hour, BP 110/70, HR 90. Blood glucose 550. What is the best IV fluid indicated
½ NS (d/t BG >500)
HHNK: fluids to use:
NS for massive fluid volume deficit, then ½ NS to hydrate the cell, then D5 ½ NS if on insulin gtt
Hyperthyroid labs
high T3, T4, resin uptake TSH >5;
Hypothyroid labs
low T4, low resin uptake (T3 not reliable test)
S/S of thyroid storm/crisis:
fever, goiter, tachycardia, low TSH
Myxedema coma treatment:
loading synthroid followed by maintenance dose
Pt w/BP 210/110 + HA, then BP ↓ 160’s, what is 1st Tx:
pheochromocytoma: alpha blockers preop Regitine/Phentolamine
What is the first test you run when you see s/s of pheochromocytoma
TSH
Diagnostic test confirmative for pheochromocytoma
CT
DKA pt FIRST tx
IVF first (1L in 1st hr, then 500 ml/hr, use ½ NS if BG >500)
Somogyi Effect
Low at 3am and rebounds to high at 7am
15-year-old pt with DM1 reports ↑BG in am. The ACNP determines hyperglycemia is d/t dawn phenomenon
increases the insulin dosage at bedtime.
