Parrot CIS 2

Question 1

What did the First Lady have?

Answer 1

Some kind of hypothyroidism

Question 2

Differential for First Lady

Answer 2

• Hashimotos
• multinodular goiter
• neoplasm
• thyroid adenoma
• iodine deficiency
• diet high in goitrogens

Question 3

What labs should we order for First Lady?

Answer 3

• TSH, CBC, FT4, CMP, TPO, TGB abs,
• discussion about checking urine?… Can screen urine for iodine
• rads: sono at minimum

Question 4

On a radioactive iodine screen, is cold good or back?

Answer 4

Cold is bad

Hot is good

Question 5

Is RAI uptake scan useful for Hashimoto’s thyroiditis?

Answer 5

No

Question 6

What complication can come from a thyroidectomy?

Answer 6

Don’t bag the recurrent laryngeal nerve!

Question 7

Second case: lady that lives alone, seems like she’s a little high strung…. Differential?

Answer 7

• Graves disease
• toxic multinodular goiter
• thyroiditis
• stress
• pheochromocytoma
• afib
• toxic follicular adenoma

Question 8

The lady also had pretibial myxedema and proptosis and a lot of things having to do with hyperthyroidism…. What stays on our differential dx?

Answer 8

• pheochromocytoma (prob can exclude based on vitals)

- can’t really rule out a lot of the heart or thyroid things because we don’t have a TSH or EKG

Question 9

What labs should we get?

Answer 9

• TSH
• serum metanephrines
• FT4
• TSI
• ultrasound
• EKG

Question 10

Normal range for Ft4?

Answer 10

0.8-2.2

Question 11

Normal range for TSH

Answer 11

0.4-4.0

Question 12

Normal for TSI

Answer 12

Not present

Question 13

What will Graves’ disease look like on ultrasound

Answer 13

Diffusely enlarged

Question 14

Case 3, 45 y/o Native American male…. He had a tender to palpation thyroid nodule and had a bad viral cold for a couple of weeks… DDx?

Answer 14

• dequervains

- remember that this is transient and we don’t really do anything for it

Question 15

Labs for this guy?

Answer 15

-CRP would be high

-

Question 16

What do we do with someone if they get a thyroidectomy

Answer 16

They get to stay in the hospital for a night

Question 17

If someone has hypocalcemia from a complete thyroidectomy, what will that look like

Answer 17

• chvostek sign
• trousseau’s sign
• hypocalcemic tetany

Question 18

What labs would be elevated in someone who had a complete thyroidectomy?

Answer 18

• Phosphate

- ….look in book for the rest of these… Know what will be high, normal, and low

Question 19

If we have someone with hyperparathyroidism and kidney stones, what labs will be high and low?

Answer 19

• Ca2+ would be high
• PTH would be high
• low P
• high Vit D

Question 20

67 y/o female with a fractured hip… Slipped on wet kitchen floor… Small in stature and very thin (think osteoporosis)… What will she probably have to have in the near future?

Answer 20

-DXA scan! That’s the work up for osteoporosis

Question 21

What score are we looking for in DXA scans?

Answer 21

T-scores!

Question 22

What is the significant value for the T score

Answer 22

• 2.5!
• if less than this, then it is osteoporosis
• if a fracture is also involved, then it’s severe osteoporosis
• I think between -1.5 and -2.5 is osteopenia

Question 23

What is the treatment for osteoporosis?

Answer 23

• bisphosphanates
• MUST be taken on empty stomach 30 minutes before a meal
• you have to be upright as well…. Because it affects your esophageal mucosa

Question 24

What if she just gently bumped her hip on a car door and it broke? What disease?

Answer 24

-Paget’s disease of the bone vs. osteomalacia