(hans) endocrine p125 - 131

Question 1

what are the 3 causes of hypothyroidism?

Answer 1

Hashimoto, Idodine def, Amiodarone

Question 2

symptoms of hypothyroidism is characterized all bodily process being slowed down except for

Answer 2

menstrual flow

Question 3

a 55 y/o female comes in for high cholesterol with chronic fatigue. blood work shows high TSH (less than double) with normal T4, what is the best next step

Answer 3

order antithyroid peroxidase/antithyroglobulin antibodies to check Hashimoto

Question 4

how would you differentiate Graves dz from other types of hyperthyroidism?

Answer 4

only Graves has eyes (proptosis) and skin symptoms such as pretibial myxedema

Question 5

what type of brain malignancy can cause hyperthyroidism?

Answer 5

pituitary adenoma by increasing TSH

Question 6

what is the one thing that is commonly shared by all hyperthyroidism?

Answer 6

elevated T4

Question 7

dx?

a pt comes in for recent hyperreflexia and you suspect hyperthyroidism and order T4, TSH, To your surprise both T4 and TSH were elevated.

Answer 7

pituitary adenoma the only cause of hyperthyroidism with elevated TSH

Question 8

dx?

a pt comes in with hyperthyroidism with tender thyroid

Answer 8

subacute thyroiditis

Question 9

dx?

a healthcare professional studying for step 2 ck who has access to a hospital pharmacy comes in with hyperthyroidism with involuted gland that is not palpable.

Answer 9

exogenous thyroid hormone use

Question 10

in terms of the lab finding what is unique about Graves dz among other causes of hyperthyroidism?

Answer 10

only Graves has TSH receptor antibodies

Question 11

a young female pt comes in with hyperthyroidism symptoms and you suspect Graves and want to test for antibody, however, before that you want to do one exam to differentiate, what would you do

Answer 11

radioactive iodine uptake (will be elevated unlike in other causes of hyperthyroidism)

Question 12

best initial therapy for Graves ophthalmopathy?

Answer 12

steroids

Question 13

in terms of clinical symptoms, what are signs you can differentiate low vs high calcium

Answer 13

low Ca2+ –> twitchy and hyperexcitable

high Ca2+ –> slow and lethargic

Question 14

a pt with chronic liver dz comes in and you noticed that the pt has hypocalcemia, you want to treat, but before that what needs to be done?

Answer 14

check albumin, low albumin brings down total calcium but free Ca2+ is normal.

Question 15

what are the 6 clinical symptoms of hyperexcitability in hypocalcemia?

Answer 15

1. chvostek sign (facial nerve hyperexcitability)
2. carpopedal spasm
3. perioral numbness
4. mental irritability
5. seizures
6. tetany (Trousseau sign)

Question 16

if blood test is not readily available how would you diagnose hypocalcemia?

Answer 16

QT prolongation

Question 17

name 3 causes for hypocalcemia

Answer 17

1. primary hypoparathyroidism from prior neck surgery such as thyroidectomy where parathyroids gland is removed
2. hypomagnesemia
3. renal failure

Question 18

what are the 2 diagnostic steps for thyroid nodule?

Answer 18

1. perform thyroid function test (TSH, T4)

2. if normal, must biopsy the gland

Question 19

treatment for acute hypercalcemia?

Answer 19

1. saline hydration at high volume

2. bisphosphonate: pamidronate, zoledronic acid

Question 20

what are the 2 major causes for hypercalcemia?

Answer 20

primary hypercalcemia and cancer

Question 21

a pt with hyperthyroidism present with tender node, dx?

also what is the tx?

Answer 21

subacute thyroiditis, aspirin

Question 22

treatment for Graves dz?

Answer 22

radioactive iodine

Question 23

what are the 2 mech of propranolol for acute hyperthyroidism and “thyroid storm”

Answer 23

blocks target organ effect, inhibits peripheral conversion of T4 –> T3

Question 24

what are the 7 causes for hypercalcemia

Answer 24

1. primary hyperparathyroidism
2. cancer
3. vit D intoxication
4. sarcoidosis/other granulomatosis dz
5. thiazide diuretics
6. hyperthyroidism
7. metastases to bone and multiple myeloma

Question 25

test of choice for bone effects of high PTH?

Answer 25

DEXA densitometry

Question 26

primary hyperparathyroidism is from (3places)

Answer 26

1. solitary adenoma (80-85%)
2. hyperplasia of all 4 glands (15-20%)
3. parathyroid malignancy (1%)

Question 27

most common presentation of hyperparathyroidism?

Answer 27

asymptomatic elevation of calcium level found on routine blood work

Question 28

what are the 4 slower manifestations of hyperparathyroidism?

Answer 28

1. osteoporosis
2. nephrolithiasis and renal insufficiency
3. muscle weakness, anorexia, nausea, abdominal pain
4. peptic ulcer dz (calcium stimulates gastrin)

Question 29

what 2 drugs are used to stop the hormone production for hyperthyroidism?

Answer 29

methimazole and propylthiouracil