Endocrine and Neuromuscular

Question 1

What are causes of hyperthyroidism?

Answer 1

intrinsic causes, Graves, thyroiditis, extra-thyroid

Question 2

What is dysphagia?

Answer 2

difficulty swallowing or sensation that food is stuck in the throat

Question 3

What are intrinsic causes of hyperthyroidism?

Answer 3

toxic multi-nodular goiter, adenoma

Question 4

What are extra-thyroid causes of hyperthyroidism?

Answer 4

iatrogenic, iodine, TSH tumor, carcinoma

Question 5

Which is the active form - T4 or T3?

Answer 5

T3

Question 6

Is more T4 or T3 secreted?

Answer 6

T4 (90%)

Question 7

T4 and T3 are a product of what two things? (simplified)

Answer 7

iodine and tyrosine

Question 8

What’s the difference between thyrotoxicosis and thyroid storm?

Answer 8

thryotoxicosis is any disorder of increased thyroid hormone concentration; thyroid storm is whe a patient’s metabolic, thermoregulatory and CV compensatory mechanisms fail

Question 9

What are symptoms of thyroid storm?

Answer 9

hyperpyrexia, tachycardia, supraventricular arrhythmias, CHF, increased risk of stroke, possible hepatic failure

Question 10

What can precipitate thyroid storm?

Answer 10

trauma/thyroid manipulation/surgery, withdrawing anti-thyroid drugs, iodinated drugs (radioiodine therapy, iodinated contrast dye, amiodarone), CVA, CHF, PE, pregnancy, DKA, infection, bowel infarction

Question 11

What drugs block periperal T4-T3 conversion?

Answer 11

PTU, propanolol, glucocorticoids such as Decadron and hydrocortisone, thiopental decreases T4-T3 conversion

Question 12

Which NSAID is preferred for the treatment of fever associated with hyperthyroid conditions? which is not and why?

Answer 12

Tylenol preferred; ASA is bad choice because it increases the amount of free thyroid hormone

Question 13

How does one treat the stormy stormy thyroid?

Answer 13

propanolol (for tachychardia, anxiety, tremor, T4-T3 inhibition), Decadron (to reduce thyroid secretion and inhibit T4-T3 conversion), PTU/methimazole, NaI/KI, cooling, Tylenol, catecholamine depleting drugs (reserpine or guanethidine)

Question 14

Insult to the parathyroid would result in what electrolyte disturbance?

Answer 14

hypocalcemia (may manifest up to 96 hrs later)

Question 15

What are the typical symptoms of myasthenia gravis?

Answer 15

fluctuating muscle weakness: eyes (ptosis, diplopia), bulbar (dysarthia, dysphagia, difficulty chewing), possible limb weakness, respiratory (dyspnea esp in supine)

Question 16

What is the pathoph of myasthenia gravis?

Answer 16

caused by antibody to T-cell and blockade of nicotinic ACh receptors of motor endplate

Question 17

85% of MG patients have pathologic alterations of what gland?

Answer 17

thymus

Question 18

What are NMB considerations for MG?

Answer 18

sensitive to non-depolarizing, resistant to depolarizing

Question 19

What are NMB considerations for Lambert-Eaton?

Answer 19

sensitivity to depolarizing and non-depolarizing

Question 20

Which disease features a presence of antibodies to ACh receptors?

Answer 20

MG

Question 21

What is the effect of anticholinesterases on Lambert-Eaton syndrome?

Answer 21

no effect

Question 22

What is the effect of reserpine?

Answer 22

antipsychotic and antihypertensive

Question 23

What is nadolol?

Answer 23

non-selective beta-blocker

Question 24

Why is ASA not a good drug for treating thyroid storm?

Answer 24

it promotes the release of thyroid hormone from its carrier protein

Question 25

What induction agent decreases peripheral conversion of T4-T3?

Answer 25

thiopental

Question 26

Why is dexamethasone used to treat thyroid storm?

Answer 26

reduces thyroid secretion and inhibits T4 –> T3 conversion

Question 27

In regards to the course of surgery, when in thyroid storm most likely to occur?

Answer 27

6-18hrs post-op