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PCM II Exam 1 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Thyroid gland regulates the body’s _________

. Parathyroid glands regulate _________ levels. It DOES/DOES NOT effect on the body’s metabolism

A

metabolism

Ca2+

Does not

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2
Q

Role of PTH

A
  1. Increases Ca2+ absorption. in the kidney and activates [25-hydroxyvitamin D ->1,25 dihydroxyvitamine D] so. that it can go into the intestines and increase Ca2+ absorption in the GI tract.
  2. Increases bone resorption
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3
Q

Hypoparathyroidism: ____calcemia

A

HYPO

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4
Q

Hypoparathyroidism: Hypocalcemia

Causes:

A
  1. -Surgical removal of glands during thyroidectomy,
  2. DiGeorge Syndrome,
  3. hereditary autoimmunity syndrome.
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5
Q

-___________ is most common cause of hypocalcemia.

A

Hyparathyriodidm

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6
Q

Hypoparathyroid/Hypocalcemia Signs & Symptoms:

A
  • Neuropsych: Seizures, dementia, anxiety, depression, extrapyramidal symptoms (parkinsonism most common), papilledema •
  • Neuromuscular: Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms •
  • CV: CHF, hypotension, prolongation of QT interval •
  • Autonomic: Biliary colic, bronchospasm, diaphoresis •
  • Other: Cataracts, dry coarse skin, hyperpigmentation, eczema, steatorrhea
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7
Q

How to check hypoparathyroidism

A
  1. Chvostek Sign- pt relaxes facial nerve, then tap it. + sign is twitching and spasm
  2. Trousseau’s Sign- inflate BP cuff and see carpo-pedal shuffling
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8
Q

work up for hypoparathyroid

A
  • Check: Serum calcium, albumin, magnesium and PTH level
    1. hour calcium
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9
Q

manage and tx hypoparathyroidism

A

Calcium and Vitamin D

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10
Q

Hyperparathyroidism: Hypercalcemia

Causes of primary hyperparathyroidism (caused by. high PTH)

A
  1. Adenomas (MC 80%) –tumor: may be associated with MEN 1
  2. Multiple endocrine neoplasia (MEN)–endocrine gland(s) overactive or forms a tumor.
  3. Hyperplasia (15%) – gland enlargement (chief cells)
  4. Carcinoma (rare)
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11
Q

Hyperparathyroidism: Hypercalcemia

Causes of secondary hyperparathyroidism (caused by ____)

A

low calcium causes high PTH

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12
Q

Hyperparathyroidism: Hypercalcemia

Causes of secondary hyperparathyroidism (caused by low calcium -> high PTH)

A
    1. renal failure
    1. Vit D def
    1. malabsorption
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13
Q

About 90% of hypercalcemia is caused by _________ or ________.

A
  1. hypercalcemia
  2. malignancy
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14
Q

Hyperparathyroidism: Hypercalcemia sx

A
  1. CNS: Lethargy, weakness, confusion, coma
  2. Renal: Polyuria, making him dehydration, nocturia, renal stones, renal failure
  3. GI: Constipation, nausea, anorexia, gastric ulcer, pancreatitis
  4. Cardiac: Syncope from arrhythmias
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15
Q

Hyperparathyroidism: Hypercalcemia

mneumonic

A

Mnemonic

  • Stones (kidney or biliary calculus)
  • Bones (bone pain)
  • Groans (abdominal pain, N/V)
  • Thrones (polyuria) resulting in dehydration.
  • Psychiatric overtones (Depression 30-40%)
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16
Q

work up for hyperPTH

A
  1. Serum calcium, albumin, magnesium and PTH level
    1. hour ca2+
  3. Workup for malignancy, genetic disorder, evaluate patient’s medications, evaluate patient diet if indicated
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17
Q

tx. for hyperPTH

A
  1. Monitor dietary and medication high in calcium and Vit D –
  2. Keep well hydrated –
  3. Maintain physical activity –
  4. Surgery
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18
Q

TH active form

A

T4 (inactive form) -> T3 (active form)

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19
Q

Hypothyroidism (low thyroid)

hormone levels

A

TSH is high in response to low T4, low T3

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20
Q

Hyperthyroidism (high thyroid)

hormone levels

A

TSH is low in response to high T4, high T3

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21
Q

conduct a thyroid. exam

A

To locate thyroid, use cues from visual inspection.

Isthmus overlies 2nd -4 th tracheal rings.

  1. Have patient flex neck slightly to relax SCM 
  2. Place fingers of both hands on patient’s neck so that index fingers lie just below cricoid cartilage.
  3. Have patient swallow so thyroid rises up under fingerpads.
  4. Observe for contour and symmetry. 
  5. Displace trachea to right and palpate right lobe. Repeat for left lobe.
  6. Anterior surface of lateral lobe is approximately the size of distal phalanx of thumb and feels somewhat rubbery. 
  7. If enlarged, listen over lateral lobes to detect bruit, which may be heard in hyperthyroidism or toxic multinodular goiter.
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22
Q

palpation of thyroid should be done from. what angle

A

anterior or posterior section

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23
Q

findings for thyroid

Goiter

Graves

hashimotos thyroidits and malignancy

thyroiditis

A

Goiter: simple (non-0nodular) or multinodular

 Graves disease: soft

Hashimoto’s thyroiditis and malignancy: firm

Thyroiditis: tender

24
Q

Exophthalmos/Proptosis (abnormal protrusion of the eyeball) may. be seen with

A

hyperthyroidism (graves

25
Q

Hypothyroidism: High TSH, Low T3 and T4

Causes:

A
  1. Hashimoto’s thyroiditis – Autoimmune (most common cause of hypothyroidism)
  2. Medications (i.e. lithium)
  3. Pregnancy (during or after) – can recur with subsequent pregnancies
  4. Treatment for hyperthyroidism
  5. Thyroidectomy
26
Q

most cmomon cause of hypothyroididm

A

hashimoto (autoimmune*)

27
Q

Hypothyroidism: High TSH, Low T3 and T4

A
  • Depression
  • Weight gain
  • Fatigue
  • Dry, brittle hair and and nails and skin
  • Cold-intolerance
  • high cholesterol
28
Q

work up for hypothyrodism

tx:

A
  1. TSH, T4
  2. synthetic TH replacement and monitor TSH levels
29
Q

Hyperthyroidism: Low TSH, High T3 and T4

Causes:

A
  1. Graves’ Disease – autoimmune (most common cause of hyperthyroidism)
  2. Toxic nodular or multinodular goiter
  3. Thyroiditis (autoimmune or viral)
  4. Excessive consumption of iodine or meds (like amiodarone) that contain iodine
  5. Pregnancy or first year after birth (some women)
30
Q

(most common cause of hyperthyroidism)

A

Graves’ Disease – autoimmune

31
Q

Hyperthyroidism: Low TSH, High T3 and T4

sx

A
    1. fatigue/muscle weakness
    1. heat intolerance
    1. heart palpitations
    1. trouble sleeping
  • 5 weight loss
    1. need to poop more
    1. light. or missing periods
    1. irritability
    1. tremors.
32
Q

work up for hyperthyroididm

A
  • 1. TSH, T4
  • 2. Radioiodine uptake
33
Q

tx for hyperthyroididm

A
  1. Methimazole –
  2. Radioiodine ablation –
  3. Thyroidectomy – surgical removal of thyroid glands
34
Q

Adrenal Insufficiency is called __________

A

addisons disease

35
Q

Addison’s Disease is underproduction of _________

A

CORTISOL

36
Q

Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)

Causer: Primary

A

90% of cases

1. 70% are autoimmune

2. 20% are. d/t TB

  1. Other: infectrions, surgical removal, cancer
37
Q

Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)

Causer: secondary

A

d/t lack of ACTH

  1. Suddenly stopping exogenous glucocorticoids (like prednisone)
  2. Surgical removal of ACTH-producing tumors from pituitary
  3. Pituitary gland suddenly stops producing ACTH (as in cancerous processes)
38
Q

Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)

Sx.

A
  1. Hyperpigmentation
  2. NVD is 50%. of cases
  3. Crave salty foods
  4. HYPOTENSION
  5. fatgiue
  6. Weight loss:
  7. menstraul irregulatiries
39
Q

adrenal criss

A

fatigue, dehydration, decrease BP, renal shut dpwm: low Na. highK

40
Q

Addisonian Crisis/Acute Adrenal Insufficiency

A
  • appears at time of stress (illness, surgery, etc.) and causes Sudden penetrating pain of back, extremities, vomiting, diarrhea
  • -If left untreated, could lead to death
41
Q

work up for addisons

A
  • cortisol level, ACTH level •
  • Management/Treatment: – Steroids
42
Q

Cushing Syndrome is what

A

adrenal (cortisol) OVERPRODUCTION

43
Q

Cushing’s syndrome has ____________causes

-Cushing’s disease is the most common cause of ________ form

A

Cushing syndrome: exogenous and endodenous

Cushings disease: endogenous

44
Q

When Cushing’s syndrome is caused by a ________, it is called Cushing’s disease.

A

pituitary tumor

45
Q

Cushing Syndrome - (Adrenal (Cortisol) Overproduction) Symptoms (how they feel):

A

sx: Fatigue and sleeping problems. HA, weight gain, bruise easily. (poor ealing wounds), hair thinning/loss, Backaches (d/t buff hump) Swelling

46
Q

Cushing Syndrome - (Adrenal (Cortisol) Overproduction) Signs (what you see):

A

moon face

purple streaks on skin

buffalo hump

unusual fat build up in adomen

easy. bruising

hirutism in. W

47
Q

______ causes Abdominal Striae

A

cushings

48
Q

cushing work up and tx

A

Workup: Salivary cortisol levels or 24 hour urinary cortisol levels – overnight 1 mg dexamethasone suppression test •

Management/ Treatment: – Surgery if it is due to tumor – Adrenal enzyme inhibitor

49
Q

AP hormones

A

FLAT PEG

LH- stimulates T secretion in males and ovulation in F

50
Q

PP hormones

A

ADH

Oxytocin

51
Q

Benign tumors of the pituitary may cause many different symptoms. Consider symptoms based on hormones affected

(3)

A
  1. too much secretion
  2. def in secretion
  3. mass affect (compression caused by a large tumor)
52
Q

Mass Effect can cause

A
  1. HA
  2. Visual disturbance
  3. loss of balance
  4. szurs
53
Q

Most common pituitary adenoma: _____

sx:

A

Hyperprolactinemia

  1. Galactorrhea (milk discharge), menstrual abnormalities, hypogonadism, erectile dysfunction, inferectiliy, if mass if large, HA and vision issues
54
Q

w/u for hyperprolactinemia

A
  1. prolactin levels, MRI
    tx: meds (dopamine AGO), surgery
55
Q

Amenorrhea (no menses) can be caused by

A

too much prolactin secretion

PCM II Exam 1 (5 decks)

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