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Endocrine Two > final > Flashcards

final Flashcards

1
Q

Tx of hypothyroid

A

levothyroxine

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2
Q

Goal TSH

A

0.5-2.5 (LESS than 2.5 if tx hypothyroid)

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3
Q

Do not take levothyroxine at same time as what?

A

Calcium, multivitamins, food supplements, antacids

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4
Q

If what is high, subclinical hypothyroid will most likely progress to clinical hypothyroid?

A

If borderline thyroid peroxidase test (high end). Consider tx with levothyroxine

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5
Q

Labs in hypothyroid

A

elevated TSH, low/normal free T4/3

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6
Q

***A-fib=likely what? (Bush)

A

hyperthyroid –> tx thyroid and afib will go away

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7
Q

What do these do?

Estrogens. BCPs, Pregnancy, acute liver disease, congenital protein abnormalities, hypothyroidism

A

Six things that increase binding proteins, thus increase the amount of BOUND/INACTIVE thyroid hormone.
TSH, Free T4, free T3 unaffected).

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8
Q

What do these do?

androgens, steroids, protein malnutrition, nephrotic syndrome, hyperthyroidism

A

Five things that decrease binding proteins. TSH/Free T4/Free T3 not affected.

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9
Q

What thyroid test most accurately reflects pituitary response to circulating active/free hormone? In what case do you NOT draw this

A

TSH

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10
Q

Ophthamopathy/lid lag/etc. = ?

A

Grave’s disease

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11
Q

What autoimmune process is responsible for Grave’s?

A

Thyrotropin receptor Blocking antibodies (TRAb) = hyperthyroid

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12
Q

Do not tx pregnant woman with hyperthyroid with what two things?

A

Methimazole and RAI

PTU is ok.

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13
Q

High thyroid uptake - tx with?

Low thyroid uptake - tx with?

A
  • low dose RAI

- PTU (or high dose RAI)

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14
Q

Diffuse uptake seen in?
Patchy uptake seen in?
Low uptake seen in?

A

**Diffuse RAI uptake = Graves
Patchy RAI uptake = Multinodular goiter
**Low RAI uptake = postpartum thyroiditis

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15
Q

Describe postpartum thyroiditis

A

Self limiting, decreased uptake, releasing pre-formed thyroid

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16
Q

What drug can cause hypothyroid?

A

1) amiodarone - high iodine content
(low uptake (bc you have so much already), hyper/hypothyroid)
-PTU to tx
2) lithium (goiter)

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17
Q

***Trust TSH except in: In euthyroid sick, when should you not draw TSH levels, and in what phase will TSH be elevated?

A

Do not draw in ICU bc:

  • Sick phase = TSH low/normal; T3/T4 low (everything shut down)
  • Recovery phase = TSH elevated
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18
Q

biopsy based upon what size and type of nodule?

A
  • size: 1+cm

- cold nodule (NOT hot nodule)

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19
Q

Only do RAI in what setting?

A

hyperthyroid

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20
Q

Two most common causes of hypercalcemia

A
  1. primary hyperparathyroidism

2. malignancy

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21
Q

Tetany, carpal pedal spasm, parasthesia of finger/toes, QT interval prolongation, laryngospams, bronchospams, death

A

HYPOcalcemia

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22
Q

***Evaluate hypocalcemia with

A
  • Chvostek (Facial nerve = mouth mm spasm)

- Trousseau - BP cuff, carpopedal spasm

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23
Q

What type of hormone is lipid soluble, cytoplasm/nuclear receptor, mRNA MOA, no storage,

A

Steroids and thyroid hormones

24
Q

What type of hormone is water soluble, surface membrane receptors, second messenger MOA, storage

A

Peptides and Protein hormones

25
Q

Plasma proteins bind to what type of hormones to prolong half life?

A

steroid and thyroid hormones

26
Q

Glandular tissue, portal vasculature via hypothalamus, neurohormone control

A

Ant pit

27
Q

Neuronal tissue, direct vasculature

A

Post pit

28
Q

Young female just gave brith, needed excessive blood transfusion - what is this?

A

Sheehan syndrome - hemorrhagic infarction of the anterior pituitary associated with excessive bleeding and HYPOfunction

29
Q

Intracranial HTN and atrophy and pituitary - what is this?

A

Empty Sella Syndrome - anterior pituitary HYPOfunction.

30
Q

Empty Sella Syndrome - describe pituitary labs/

A

normal labs, but possible slight increase in PRL

31
Q

Pt presents with polydipsia, polyuria, hypotonic urine, high serum osmolarity, hypernatremia

A

DI

32
Q

**Compare serum osmolarity in DI v. psychogenic polydipsia

A 
DI = hyper-osmolar (hyperNa)
Psychogenic = hypo-osmolar (dilutional hypoNa)
33
Q

Lactotroph adenoma - tx with?

A

Dopamine agonist (bromocriptine) or transphenoidal surgery

34
Q

Nelson Syndrome

A

After b/l adrenalectomy for Cushing Dz. Pt has pre-existing ACTH producing tumor. W/o the high cortisol/GC levels, no feedback inhibition, so tumor can grow –> HA, bitemporal hemianopsia, hyperpigmentation

35
Q

What 3 complications/things have increased incidence in acromegaly?

A

Vascular dz (DM + HTN), sleep apnea, malignant colon polyps

36
Q

GH is released in what fashion?

A

Pulsatile

37
Q

These are caused by?
-Oligo/amenorrhea,
-galactorrhea
Treat?

A
  • hyperPRL —> suppresses GnRH
  • estrogen

Treat with dopamine agonist

38
Q

DM labs

A

HbA1c = >6.5% (~200 average plasma glucose every day)
Fasting plasma glucose = 126
Random plasma glucose = >200

39
Q

HbA1c is affected by

A

Affected by reduced lifespan of red cells, like hemolytic anemia.

  • Increased red cell lifespan (i.e. iron deficiency anemia = falsely high), longer exposure to glucose
  • Acute blood loss = falsely low HbA1c. (shorter exposure to glucose)
40
Q

Charcot foot - define

A

Sensory impariment dt peripheral neuropathy and reduced perfusion. Infection–>osteomyelitis–>amputate foot.
Altered foot mechanics lead to repeated fractures that destroy normal foot architecture

41
Q

LDL for anyone with established coronary vascular dz (i.e. bypass surgery), or multiple risk factors

A

LDL should be 70 or less

42
Q

tx for DKA

A

insulin and fluids

43
Q

Autoimmune adrenalitis

A

Addison’s (hypONa; HypERK) –.

44
Q

Hyperpigmentation in Addison’s

A

Increased ACTH

45
Q

adrenal insufficiency

A

Addison’s

46
Q

Do Addison’s have adrenal reserves? So what?

A

no - so give exogenous CS when sick.

47
Q

dehydration, hypotension, shock out of severity of current illness

A

Adrenal Shock - give CS

48
Q

Supraclavicular Fat pads

A

Cushing’s Disease

49
Q

Cushing Dz v. Cushing Syndrome

A

Disease - pituitary ACTH dependent (pituitary adenoma)

Syndrome - iatrogenic

50
Q

Proximal mm wasting and weakness, bone loss, glucose intolerance, thromboembolic events, immunity/infection, androgen excess in women

A

Cushing Syndrome

51
Q

Screen adrenal incidentalomas for…

A

Cushing’s and pheo

52
Q

Primary hyperaldosteronism

A

conn syndrome - adrenal adenoma (idiopathic adrneal hyperplasia) = incr ald/dec renin

53
Q

androgen/estrogen secreting tumors - malignant or benign?

A

malignant

54
Q

HA, sweating, tachy

A

pheochromocytoma - adrenal medulla chromaffin cells

55
Q

Discontinue what meds before testing for pheo?

A

antidepressants - amytryptaline, etc.

56
Q

Small cell or oat cell carcinoma of the lung secrete?

A

ACTH

57
Q

Tx of HTN in diabetics

A

ACE inhibitors (cheaper, AE cough) and ARBs to protect kidneys

Endocrine Two (16 decks)

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