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STEP 2 Endocrine > Mehlman IM/FM 16 + Im consp. THYROID 11-01 (1) > Flashcards

Mehlman IM/FM 16 + Im consp. THYROID 11-01 (1) Flashcards

1
Q

thyroid cancer. FIRST step?

A

PALPATE thyroid

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2
Q

thyroid cancer. NEXT BEST step?

A

TSH

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3
Q

thyroid cancer. Nodule + TSH normal/high –> what to do?

A

ULTRASOUND over FNA

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4
Q

thyroid cancer. Nodule + TSH normal/high. UG vs FNA answer?

A

If both listed –> UG
If Ug not listed –> FNA

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5
Q

thyroid cancer. Nodule + TSH low –> ?

A

Radioiodine uptake scan (NOT UG)

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6
Q

Since carcinomas are non-secretory of thyroid hormone, if a patient is hyperthyroid, we’re not concerned about carcinoma, which is why we don’t go the ultrasound then FNA route. We just do uptake to better see
if the patient’s etiology for hyperthyroidism is Graves (diffuse), toxic adenoma (single nodular uptake), or toxic multinodular goiter (multifocal nodular uptake).

A

.

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7
Q

thyroid cancer.
NO NODULE + TSH low (aka hyperthyroidism) –> ?

A

DO ULTRASOUN

annoying, bet taip yra. jeigu hyperthyroidism and nodule, tada uptake scan

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8
Q

TSH is screening for everyone except….

A

Pregnant

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9
Q

What can be ordered after TSH?

A

T3 and T4, but usmle often omits this

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10
Q

Screening for pregnancy?

A

Free-T4

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11
Q

What is most diagnostic/accurate for everyone?

A

Free T4

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12
Q

2CK hypothyroidism presentation. mood + treatment?

A

Low mood (dysthymia) –> mood improve with administration of thyroid hormone

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13
Q

2CK hypothyroidism presentation. muscles + what lab?

A

proximal muscle weakness: difficulty getting up from chair unassisted +/- increased CK

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14
Q

2CK hypothyroidism presentation. cholesterol?

A

Increased total cholesterol, eg 300mg/dl

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15
Q

2CK hypothyroidism presentation. hepatic?

A

incr. AST

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16
Q

2CK hypothyroidism presentation. heart?

A

BRADYCARDIA 55-60 k/min.
nera taip, kad cia nenormalu, nes yra kas turi reta dazni, bet prie hypothyroid bus brady

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17
Q

If patient is pscyh. you have two options for initian: check suicidal ideation vs TSH?

A

in pshych: check suicidal ideation FIRST

do simple investigation before ordering investigation

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18
Q

If patient is not pscyh and suspect hypothyroidism, what investigation?

A

TSH is correct for hypothyroidism initial screening

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19
Q

Hashimoto?

A

T3 low, T4 low, TSH high
iodine uptake decreased

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20
Q

Subclinical hypothyroidism?

A

normal T3, normal T4, TSH high
uptake normal/reduced

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21
Q

Euthyroid sick syndrome?

A

decr T3, high reverse T3, normal T4, normal TSH

22
Q

Graves?

A

high T3, high T4, TSH low
uptake diffuse

23
Q

Toxic multinodular goiter?

A

high T3, high T4, TSH low
high multifocal uptake

24
Q

Toxic adenoma?

A

high T3, high T4, TSH low
high uptake isolated to one nodule

25
Q

Factitious thyrotoxicosis with levothyroixine (T4)?

A

high T3, high T4, TSH low
low uptake

26
Q

Factitious thyrotoxicosis with triiodothyronine (T3)?

A

high T3, low T4, TSH low
low uptake

T4 is converted to T3 peripherally, but not the other way around

27
Q

Subacute thyroiditis (subacute granulomatous thyroiditis; DeQuervain)?

A

can be hypo/hyper

Key: uptake is decreased always no matter what
So, if patient is hyper, choose high T3, T4, low TSH, DECREASED UPTAKE.

28
Q

Is 16 lecture yra apie depresija dar dalis, tai cia kortose nera.

A

.

29
Q

Hashimoto assoc. with autoimmune diseases

A

.

30
Q

Hashimoto antibodies?

A

anti-microsomal (aka anti TPO) and anti-thyroglobulin antibodies

31
Q

Hashimoto Tx?

A

levothyroxine or trijodtironine

32
Q

Graves antibodies?

A

antibodies against TSH receptors=thyroid stimulating imunoglobulin (TSI)

33
Q

Graves Tx?

A

thionamides

34
Q

Thyroid storm what is it?

A

acute exacerbation of graves in case of stress –> severely increased production of thyroid hormone

35
Q

Thyroid storm Tx tetrad?

A

BAB - propranolol
PTU
potassium iodide
Glucocorticoids (eg hydrocortisone, to decr. peripheral T4 -> T3 conversion and improve vasomotor stability)

36
Q

wolf-chaikof? definition and Tx?

A

transient decr. of thyroid synthesis in the setting of acute incr. in iodine exposure.
Tx - potassium iodine

37
Q

Factitious thyrotoxicosis. pacient will be lets say pharmacist - has access to hormone

A

.

38
Q

Factitious: Q will give hyperthyroid patient with small, non-palpable thyroid gland
(atrophic due to suppressed TSH).

A

.

39
Q

drug in first thimester?

A

PTU

Methimazole is teratogen in 1st trimester

40
Q

hepati failure which drug?

A

PTU

41
Q

Radioiodine ablation adverse?3

A

Permanent hypothyroidism
Worsening ophthalmopathy
Possible radiation side effect

42
Q

Surgery for graves adverse?3

A

permanent hypothyroidism
Risk of laryngeal reccurent nerve damage
Risk of hypoparathyroidism

43
Q

anti-thyroid drug+fever+sore throat –>?

A

agranulocytosis

44
Q

anti-thyroid drug+fever+sore throat –>agranulocytosis –> what to do?

A

discontinue drug
measure WBC

If WCB < 1000 = dicontinue permanently

Ir WBC > 1500 = drug toxicity is unlikely cause of sore throat

45
Q

anti-thyroid induced agranulocytosis. management?3

A

discontinue drug

broad spectrum abs (covering pseudomonas)

granulocyte stimulating factors

46
Q

Graves. antithyroid drugs. indications table?4

A

mild hyperthyroidism

Older age with limited life expectancy

preparation for radioactive iodine or thyroidectomy

Pregnacy (PTU in first trimester)

47
Q

Graves. radioactive iodine. indications table?2

A

moderate to severe hyperthyroidism with/without mild ophthalmopathy

Patient preference in mild hyperthyroidism

48
Q

Graves. thyroidectomy. indication table 6?

A

very large goiter
Suspicion of thyroid cancer
coexsisting primary hyperparathyroidism
pregnant patients who cannot tolerate thionamides
Severe ophthalmopathy
Retrosternal goiter with obstructive symptoms

49
Q

Graves + worsening ophthalmo –> Tx?

A

radioactive iodine

50
Q

definitive Tx for severe ophthalmopathy?

A

surgery

51
Q

what cannot do if severe ophthalmopathy?

A

dont give radioactive iodine (its contraindicated)

52
Q

Oral prednisolone for Tx of exophthalmos (anti-thyroid drugs are not effective!!!!!)

A

.

STEP 2 Endocrine (3 decks)

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