ENDOCRINOLOGY Flashcards
HIGH YIELD*
17 YO ABD PAIN
AMS W/ NO FOCAL SIGNS = AMS OF UNCLEAR ETIOLOGY
HIGH YIELD
DIM:
IN ORDER OF FREQUENCY:
DRUGS
INFECTIONS
METABOLIC
DZ X
ENCEPHALITIS DIABETES UROSEPSIS RENAL FAILURE DRUG OVERDOSE
IWU: ALWAYS
CBC BMP * Na HCO3- BUN/CREA K CL GLU* UA* KETONES, 60 WBC X FIELD LP- CSF U TOXICOLOGY BLOOD B OH BUTIRATE AND ACETOACETATE
FM:
ADMIT TO ICU OBTUNDED PATIENTS W/O GAG REFLEX POSITIONING AVOID ASPIRATION INSULIN COVERAGE AGGRESSIVE INTRAVENOUS HYDRATION W/ NSS BLOOD C & S CONFIRM KETONES IN URINE START ABX FOR PRESUMED UROSEPSIS
FU:
e /2 hrs
GAP ANION
FINGERTIP GLUCOSE
CBC: K+
AGGRESSIVE HYDRATION TILL GLUCOSE 250 mg/dl
CONTINUOUS W/ D 5% - Na Cl 0.9%
0.3 U/kg INSULIN AND WHILE CONTINUING IVF
PHOSPHATE FOR RE FEEDING SYNDROME
SOMOGYI 3 AM HYPO AM HYPO
DAWN 3 AM HYPER AM HYPO
HONEYMOON
GLYCOSILATED Hb A1 8- 12 WKS CONTROL
-
A DIABETIC IS COMPLAINING ABOUT LOW GLUCOSE LEVEL AM 112104 98 103 PM 85 92 87 91 PM 62 40 35 37 BED TIME 88 82 89 93
DD X
HYPOGLYCEMIA SECONDARY TO INSULIN OVER DOSE
HYPOGLYCEMIA SECONDARY TO RENAL FAILURE
LIVER
RENAL
CONTEREGULATORY ISLET CELL TUMOR
IWU:
U SULFONYLUREA C PEPTIDE ANTI INSULIN ANTIBODIES LFT BMP INSULIN LEVELS
TX:
DECREASE INSULIN NPH AM.
CONTINUOUS EXERCISE PROGRAM
BASIC METABOLIC PANEL
NO EVIDENCE OF RENAL IMPAIRMENT
CONFUSION
*DIFFERENCES WITH KETO ACIDOSIS
GLUCOSE 1000
EXTREMELY HIGH
SERUM OSMOLARITY
2 Na + BUN /2.8+ SERUM GLUCOSE/18
A MILD METABOLIC ACIDOSIS W/ HCO3- AROUND 20
DZ X:
NKHS
KETOACIDOSIS
IWU:
BMP GLUC 998* CBC UA NEG FOR KETONES* CXR LP CSF TOXICOLOGY SCREEN IM: IVF LARGE RESUSCITATION NSS SMALL DOSE 0.1 /kg* INSULIN
INCREASED SERUM CALCIUM ON ROUTINE MEDICAL EVALUATION
PMH: RENAL STONES
HYPERCALCEMIA
MALIGNANCY PTH r SARCOIDOSIS VIT D THIAZIDES LITHIUM GRANULOMATOUS DISEASE VIT D PRIMARY HYPERPARATHYROIDISM IMMOBILIZATION FAMILIAL HIPOCALCIURIC HYPERCALCEMIA BENIGN U Ca < 200 CON PTH NORMAL
IN ACUTE SETTING
AMS
CHRONIC SETTING CONSTIPATION DIABETES INSIPIDUS NEPHROGENIC COGNITIVE IMPAIRMENT MOST STRONG SURGICAL INDICATION NEPHROCALCINOSIS AND STONES
IWU: BMP CXR SERUM CALCIUM 11.3 U CA FM: INMMUNOASSAY FOR PTH LOCALIZED ADEMOMA CON SESTAMIBI SCAN PARATHYROIDECTOMY BECAUSE OF THE HX OF RENAL STONES
ACUTE SETTING Ca > 12 AMS
6 L NSS IVA IVF (NEPHROGENIC D. INSIPIDUS)
FUROSEMIDE IF OVERLOAD
FU: 6 HRS AFTER PARATHYROIDECTOMY SPASM FACIAL HUNGRY BONES: TX: GLUCONATE CALCIUM IV
I FEEL TIRED ALL THE TIME
HYPOTHYROIDISM
CAD 3 VESSEL WAITING FOR CABG
IWU:
TSH
FREE T4
FM:
CORRECT FIRST CABG
THEN
REPLACEMENT THERAPY CARDIOTOXICITY OF LEVOTHYROXIN
NECK SWELLING
BOCIO MULTINODULAR LARGE DOMINANT NODULE
DZ X
MEDULAR
IIa SIPPLE :PHEO MEDULAR 1/3 HYPERPLASIA PARA
PHEO MEDULAR AND NEUROMA / MARFANOID
PAPILLARY
ANAPLASIC
FOLLICULAR
IWU:
TSH EUTHYROID
NON FUNCTIONAL NODULES ARE THE CONCERN
SO;
FNA: BENIGN
TX:
OBSERVE*
HIGH YIELD*
DM HBP OBESITY
CUSHING
IWU: 11PM OVERNIGHT DOSE SUPPRESSION WITH DEXAMETASONE CORTISOL AM < 5 RULE OUT HYPERCORTISOLISM FM: CORTISOL U 24 HR SUPPRESSION HIGH DOSE DEXAMETASONE FAIL: ECTOPIC OR ADRENAL SUPPRESS: CENTRAL CUSHING DISEASE ACTH: HIGH LOW: ADRENAL SCAN/US \+ 4 CM 17 CETOSTEROIDES U DHEAS ADREMAL SCAN - 4 CM VEIN ADRENAL SAMPLING FM: HEAD MRI SURGERY ADENOMA PITUITARY FU: GLUCOSE AND BP MONITORING HCTZ ADA DIET
10 % EXTRA ADRENALES
5 % SON MEN II
PHEO
H YIELD*
HYPOTENSION CRISIS* JUST FLUIDS HE DOES NOT RESPOND TO PRESSERS HE IS BLOCKADE
DXZ ESENTIAL RASS HYPERALDOSTER 1
IM:
24 HRS URINE AVM METANEPHRINES AND UNCONJUGATED FREE CATHECOLAMINES
ABDOMINAL CT SCAN
ALPHA BLOCKADE FIRST
PHENTOLAMINE PHENOXIBENZAMINA*
IV FLUIDS
SURGERY CONSULT
B BLOCKERS ONLY* IF ALPHA BLOCKED FIRST
RA STENOSIS FIBROMUSCULAR DYSPLASIA
RENINA >> ALDOSTERONE > K< CAPTOPRIL SCAN DOPPLER ANGIO MRA STENT IT OR PLASTY
HA FEELS WEAK* AND TIRED
PE: HBP*
PRIMARY ALDOSTERONISM ACEI-SGX
DZX PHEO RAS ESENTIAL
IWU: BMP K* LOW HCO3-: 32 TREAT AS HTN URGENCY ALDOSTERONE TO PLASMA RENIN ACTIVITY NORMAL< 20* CT ADRENALS GLANDS
FM
ADMIT REPLACE POTASSIUM*
FOSINOPRIL*
SURGERY CONSULT
STATINS ATHORVASTATIN*
FIBRIC ACID DERIVATES
NIACIN
LDL= TOTAL COL- (VLDL+ HDL)
VDRL 1/5 TOTAL TAG IF TAG < 400
FASTING LIPID PROFILE LDL CAD EQUIVALENTS DM CAROTID AAA PAD MAJOR CAD FACTORS: 0-1 / 2 o MAS LOW HDL<40 CAD PREMATURE FIRST 55 - 65 SMOKE HTN HDL > 60 MENOS 1 RF
ESTABLISH RISK CATEGORY TO LDL LEVEL
FU:
SIN CAD
MENOS DE 160 PARA 0-1 RF FU: 5 YRS
MENOS DE 130 PARA 2 o + FU: 1-2 YRS
CAD OR CAD EQUIVALENT <100
MONITOR EVERY 4 TO 6 MOS ONCE THE GOAL HAS BEEN ACHIEVED
