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Emergency Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

What is Hypothyroidism

A

Decreased T3/T4

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2
Q

Sx of Hypothyroidism

A 
Decreased metabolic rate
Cold Intolerance
Dry, thickened rough skin, Goiter, Hypoactivity like fatigue sluggishness, memory loss, depression, Decreased DTR
Bradycardia, Decreased CO
Menorrhagia
Hypoglycemia
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3
Q

What are causes of Hypothyroidism

A

Iodine Deficiency

Hashimoto’s Thyroiditis

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4
Q

What is Hyperthyroidism

A

Increased T3/T4

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5
Q

Sx of Hyperthyroidism

A

Increased metablic rate
Heat Intolerance
Weight loss, skin warm moist, soft, fine hair
Hyperactivity like anxiety, tremors, weakness
Diarrhea
Tachycardia, Palpitations
Hyperglycemia

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6
Q

What are causes of Hyperthyroidism

A

Grave’s Disease
Toxic Multinodular Goiter
TSH secreting tumor

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7
Q

What is Grave’s Disease

A

Hyperthyroidism

Circulating TSH Receptor Antibodies

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8
Q

Sx of Grave’s Disease

A

Diffuse, enlarged thyroid
Thyroid Bruits
Opthalmopathy: Lid lag, Exophthalmos, Proptosis
Pretibial Myxedema

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9
Q

Dx of Grave’s Disease

A

Positive TSH Immunoglobulin Antibodies
Increased T4/T3
Decreased TSH

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10
Q

Tx of Grave’s Disease

A

RAdioactive Iodine
Methimazole/Propylthiouracil
Beta Blockers: Propranolol for sx
Thyroidectomy

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11
Q

What is Toxic Multinodular Goiter

A

Autonomous functioning nodules

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12
Q

Sx of Toxic Multinodular Goiter

A

Hyperthyroidism

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13
Q

Dx of Toxic Multinodular Goiter

A

Increased T3/T4
Decreased TSH
RAIU: Patchy areas of both increased and decreased uptake

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14
Q

Tx of Toxic Multinodular Goiter

A

Radioactive Iodine

Methimazole/PTU

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15
Q

What is Hashimoto’s

A

Autoimmune disorder

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16
Q

Sx of Hashimoto’s

A

Hypothyroidism

Painless, enlarged thyroid

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17
Q

Dx of Hashimoto’s

A

Positive Thyroid Antibodies present: Thyroglobulin Antibodies, Antimicrosomial and thyroid peroxidase antibodies

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18
Q

Tx of Hashimoto’s

A

Levothyroxine

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19
Q

What is De Quervain’s

A

Hypothyroidism that is painful and subacute

Usually post-vira

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20
Q

What is a Thyroid Storm

A

Potentially fatal complication of untreated thyrotoxicosis usually after a precipitating event

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21
Q

Sx of Thyroid Storm

A

Hyper Metabolic State

Palpitations, Atrial Fibrillation, Tachycardia, High fevers, N/V, psychosis, delirium, tremors

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22
Q

Dx of Thyroid Storm

A

Increased T3/T4

Decreased TSH

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23
Q

Tx of Thyroid Storm

A

Methimazole, PTU
Beta Blockers for x
Supportive IV fluids
Glucocorticoids

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24
Q

What is a Myxedema Crisis

A

An Extreme form of hypothyroidism

Usually seen in elderly women with long standing hypothyroidism in winter

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25
Q

Sx of Myxedema Crisis

A

Sever signs of Hypothyroidism

Bradycardia, CNS depression, Respiratory depression, hypothermia, hypotension

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26
Q

Dx of Myxedma Crisis

A

Decreased T3/T4

Increased TSH

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27
Q

Tx of Myxedema Crisis

A

IV Levothyroxine
Supportive: Saline, Abx, Steroids
Passive Warming (blankets in warm room)

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28
Q

What are the 4 types of Thyroid Carcinomas in order of least aggressive to most aggressive

A

Papillary, Follicular, Medullary, Anaplastic

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29
Q

What is Primary Hyperparathyroidism

A

Excess Inappropriate Increased PTH production

Usually due to a Parathyroid Adenoma

30
Q

What is Secondary Hyperparathyroidism

A

Increased PTH response to hypocalcemia or Vitamin D deficiency
Usually due to Chronic Kidney Failure

31
Q

Sx of Primary Hyperparathyroidism

A

Signs of Hypercalcemia
Stones, Bones, Groans, Moans
Decreased DTR

32
Q

Dx of Primary Hyperparathyroidism

A

Hypercalcemia + Increased PTH + Decreased Phosphate
24 hour urine Calcium Excretion
Osteopenia on bone scan

33
Q

Tx of Hyperparathyroidism

A

Surgery: Parathyroidectomy if Primary

If secondary, Vitamin D/Calcium Supplement

34
Q

What is Hypoparathyroidism

A

Low PTH or insensitivity to its action

Due to Postsurgical damage (like thyroidectomy), or autoimmune destruction of parathyroid gland

35
Q

Sx of Hypoparathyroidism

A

Signs of Hypocalcemia

Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR

36
Q

Dx of Hypoparathyroidism

A

Hypocalcemia, Decrased PTH, Increased Phosphate

37
Q

Tx of Hypoparathyroidism

A

Calcium Supplements + Vitamin D (Ergocalciferol or Calcitriol)

38
Q

What is Chronic Adrenocortical Insufficiency

A

Disorder where adrenal gland does not produce enough hormones

39
Q

What is Primary (Addison’s Disease) Adrenocortical Insufficiency

A

Adrenal Gland destruction which causes a lack of Cortisol and Alodsterone

40
Q

What causes Primary Adrenocortical Insufficiency

A

Autoimmune
Infection like TB
Thrombosis or Hemorrhage
Meds like Ketoconazole, Rifampin

41
Q

What is Secondary Adrenocortical Insufficiency

A

Pituitary failure of ACTH secretion, leads to lack of Cortisol only
Aldosterone is intact because it is controlled via RAAS system

42
Q

What causes Secondary Adrenocortical Insufficiency

A

Exogenous Corticosteroid use

43
Q

Sx of Primary Adrenocortical Insufficiency

A

Hyperpigmentation due to increased ACTH stimulation, which in turn stimulates melanocytes
Decreased Aldosterone marked by orthostatic hypotension, severe hyponatremia, hyperkalemia and non-anion gap metabolic acidosis, hypoglycemia
Decreased sex hormone in women leads to loss of libido, amenorrhea, loss of axillary and public hair

44
Q

Sx of Secondary Adrenocorticol Insufficiency

A

Sx due to lack of Cortisol

Weakness, muscle ache, myalgias, fatigue, weight loss, anorexia, N/V

45
Q

Dx of Adrenocortical Insufficiency

A

Get baseline ACTH first

  1. High dose ACTH stimulation test
    - Normal response is rise in blood/urine cortisol levels after ACTH is given
    - If no increase in cortisol after ACTH given = Adrenal Insufficiency
  2. CRH Stimulation Test
    - If high levels of ACTH but low Cortisol = Primary
    - If Low ACTH and low Cortisol = Secondary (pituiatiry can’t produce enough ACTH)
46
Q

Tx of Adrenocortical Insufficiency

A

Primary: Glucocorticoids + Mineralocorticoids
Secondary: Only Glucocorticoids
Glucocorticoids: Hydrocortisone, Presdnisone, Dexamethasone
Mineralocorticoids: Fludrocortisone

47
Q

What is Adrenal (Addisonian) Crisis

A

Sudden worsening of adrenal insufficiency due to a “stressful” event like surgery, trauma, volume loss, MI, fever, sepsis

48
Q

What causes Addisonian Crisis

A

Abrupt withdrawal of glucocorticoids
Previously undiagnosed patients with Addison’s disease
Exacerbation of known ADdison Disease (who didn’t increase glucocorticoid during stress)

49
Q

Sx of Addisonian Crisis

A

Shock, Decreased BP, Hypotension, Hypovolemia, Abdominal Pain, N/V, fever, weakness, lethargy, coma

50
Q

Dx of Addisonian Crisis

A

BMP: Hyponatremia, Hyperkalemia, Hypoglycemia

Cortisol levels, ACTH, CBC

51
Q

Tx of Addisonian Crisis

A 
IV fluids (NS)
Glucocortoids, Reverse electrolyte abnormalities, Fludrocortisone
52
Q

What is Cushing’s Syndrome vs. Cushing’s Disease

A

Syndrome: Signs and sx related to cortisol excess
Disease: Cortisol excess caused by pituatiry increased ACTH secretion

53
Q

Sx of Cushing’s

A

Central trunk obesity, moon facies, buffalo hump, supraclavicular fat pads, wasting of extremities, skin atrophy, striae, HTN, weight gain, osteoporosis, hypokalemia, acanthosis nigricans, depression, mania, psychosis, Hirsuitism, oily facial skin

54
Q

What causes Cushing’s

A

Long term high dose corticosteroid therapy
Cushing’s Disease: Pituitary Adenoma that secretes ACTH
Ectopic ACTH: ACTH screting tumor like small cell lung cancer, medullary thyroid cancer
Adrenal Tumor: Cortisol secreting adrenal adenoma

55
Q

Dx of Cushing’s

A
  1. First test for Cushings by doing one of the 3 below
    A. Low dose dexamthasone suppression
    -No suppression = Cushing’s Syndrome
    B.Increased 24 hour urine cortisol evels
    -Elevated urinary cortisol = Cushing’s Syndrome
    C. Increased Salivary Cortisol levels
    -Increased in Cushing’s Syndrome (done at night)
  2. What is causing Cushing’s
    A. High Dose Dexamethasone Suppression
    -If suppressed = Cushing’s Disease = Pituitary Tumor that is secreting ACTH
    -No Suppression = Adrenal or Ectopic ACTH producing tumor
    B. ACTH Levels
    -If decreased ACTH: Adrenal Tumor
    -If normal or increased ACTH: Cushing’s Disease or Ectopic ACTH producing tumor
56
Q

Tx of Cushing’s Syndrome

A

If Pituitary Tumor: Transsphenoidal Surgery
If Ectopic or Adrenal TUmor: REmove Tumor or Ketoconazole in inoperable patients
If due to Excess Steroid Intake: Stop taking steroids GRADUALLy

57
Q

What is Diabetes Insipidus

A

Inability of kidney to concentrate urine which leads to production of large amounts of dilute urine
Due to Vasopressin Deficiency (Central)
or
Due to Insensitivity to ADH (Nephrogenic)

58
Q

Sx of Diabetes Insipidus

A

Polyuria, Polydipsia, Nocturia

Hypernatremia if severe or decreased oral water intake

59
Q

Dx of Diabetes Insipidus

A

Fluid Deprivation Test
-Normal response is progressive urine concentration
-DI will show continued production of dilute urine
Desmopressin (ADH) Stimulation Test
-Central: Reduction in urin output indicates response to ADH
-Nephrogenic: Continued production if dilute urine

60
Q

Tx of Diabetes Insipidus

A

Central: Desmopressin, Carbamazepine
Nephrogenic: Na/Protein Restriction, Hydrochlorothiazide, Indomethacin
If sx: Pure water orally, D5w, or 1/2 NS

61
Q

What is Diabetic Ketoacidosis

A

Insulin deficiency leads to Hyperglycemia, Dehydration, Ketonemia (anion gap metabolic acidosis), and Potassium Deficit

62
Q

Sx of DKA

A

Hyperglycemia: Thirst, Pollyuria, Polydipsia, Nocturia, Weakness, Fatigue, Confusion, N/V, Abdominal Pain
Tachycardia, Ketotic Breath, Kussmaul’s Respiration

63
Q

Dx of DKA

A 
Plasma Glucose >250
Arterial pH <7.3
Serum Bicarbonate 15-18
Positive Ketones
Variable Serum Osmolarity
64
Q

Tx of DKA

A

IV Fluids, usually Isotonic NS
Regular Insulin
Potassium
Bicarbonate only in severe acidosis

65
Q

What is Diabetes Mellitus

A

Hyperglycemia due to inability to produce insulin and insulin resistance or both

66
Q

What is DM type I

A

Pancreatic Beta-Cell Destruction
The patient can’t produce insulin
Usually presents in kids

67
Q

What is DM Type II

A

Insulin Resistance with eventual imparment to insulin secretion
Common risk factors are family hx, AA, HTN, Hyperlipidemia, Obesity, Atherosclerosis, Strokes

68
Q

Sx of DM Type I

A

Polyuria, Polydipsia, Polyphagia, Weight Loss, DKA

69
Q

What are complications of DM

A

Stcoking Glove proprioception pattern, pain, Decreased DTR, Parasthesias, Orthostatic Hypotension, Constipation
Retinopathy: Microaneurysms, Cotton Wool Spots, REtinal VEnous Beading, Neovascularization, Central Vision Loss
Nephropathy: Microalbuminuria

70
Q

Dx of DM

A

Fasting Glucose <126 is GOLD STANDARD
HgA1C >6.5%
2 hour plasma gluocse >200
Plasma glucose >220

71
Q

Tx of DM

A

Diet, Exercise, Lifestyle Changes

Glucose Control, Lipid Control

Emergency Medicine (6 decks)

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