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E2T2 > Parrott DSA CMDT > Flashcards

Parrott DSA CMDT Flashcards

1
Q

Thyroid tests- screening

A
  • serum TSH!!!

- free T4

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2
Q

Thyroid tests- for hypothyroidism

A
  • serum TSH

- antithyroglobulin and antithyroperoxidase ab’s (Hashimoto)

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3
Q

Thyroid tests- for hyperthyroidism

A
  • serum TSH!!!
  • T3 or free T3 iodine uptake and scan
  • antithyroperoxidase and antithyroglobulin ab’s
  • TSI
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4
Q

Thyroid tests- for thyroid nodules

A
  • fine-needle aspiration (FNA) biopsy
  • I uptake and scan (cancer is usually cold)
  • Tc scan (vascular vs avascular)
  • ultrasonography (assist FNA biopsy)
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5
Q

hypothyroidism- common manifestations

A
  • nonspecific- weight gain, fatigue, lethargy, depression, weakness, dyspnea on exertion, constipation, dry skin, cold intolerance
  • bradycardia, thin brittle nails, thinning of hair, peripheral eema, yellowing of skin, puffy fae
  • palpably enlarged goiter
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6
Q

hypothyroidism- lab

A
  • screening- TSH

- primary- inc TSH, dec T4

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7
Q

subclinical hypothyroidism

A
  • normal serum FT4 with a serum TSH above range

- transient

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8
Q

hypothyroidism- tx

A
  • levothyroxine!!!

- myxedema crisis- need larger dose of levothyroxine

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9
Q

hypothyroidism- monitoring and optimizing tx

A
  • elevated TSH indicates the need for a higher dose of levothyroxine
  • many drugs interfere with levothyroxine!
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10
Q

hypothyroidism- elevated serum TSH level- tx

A
  • confirm that the pt is taking the levothyroxine as directed and doesnt have angina
  • exclude malabs of levothyroxine
  • usually indicates a under replacement of levothyroxine
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11
Q

hypothyroidism- normal serum TSH level- tx

A

-some pts with CAD or recurrent a fib- lower doses of levothyroxine- keep TSH in high-normal range

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12
Q

hypothyroidism- low serum TSH level- tx

A
  • low (0.04-0.4)- inc risk of a fib and osteoporosis

- suppressed (< 0.03)- if hyperthyroidism sx’s- reduce dose of levothyroxine

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13
Q

Hyperthyroidism- causes

A
  • Graves disease

- postpartum and silent thyroiditis

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14
Q

postpartum thyroiditis

A
  • in first 12 months afer delivery
  • in 5% of postpartum women
  • over 80% have antithyroid ab’s
  • hyperthyroidism followed by hypothyroidism (22%)
  • thyrotoxicosis (30%)
  • hypothyroidism (48%)
  • recurrence with more pregnancies!
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15
Q

silent thyroiditis

A

(subacute lymphocytic thyroiditis)

-spontaneously or triggered by medications

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16
Q

hyperthyroidism- sx’s, signs

A
  • nervousness, heat intolerance, inc sweating, fatigue, m cramps, weight loss
  • menstrual irregularities
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17
Q

hyperthyroidism- thyroid examination

A
  • Graves dz- diffusely enlarged thyroid, often with a bruit, asymmetric
  • subacute thyroiditis- enlarged, tender
  • toxic multinodular goiter- palpable nodules
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18
Q

hyperthyroidism- cardio pulm manifestations

A
  • forceful heartbeat, PACs, sinus tachycardia
  • exertional dyspnea
  • A fib or a tachycardia (8%)
  • pulm HTN (49%)
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19
Q

hyperthyroidism- lab findings

A
  • FT4, T3, FT3, T4, thyroid resin uptake- inc
  • TSH dec
  • Graves- TSI
  • subacute thyroiditis- inc WBC, ESR, CRP
  • hyperthyroidism during pregnancy- elevated T4 and FT4 and dec TSH
  • amiodarone- inc T4 and FT4, dec TSH
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20
Q

Graves disease- tx

A
  • propranolol
  • Thiourea drugs (methimazole, PTU)
  • iodinated contrast agents
  • radioactive iodine
  • thyroid surgery
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21
Q

hyperthyroidism from thyroiditis- tx

A
  • propranolol (during hyperthyroid phase)
  • ipodate sodium (corrects elevated T3 levels)
  • NO thioureas (TH production is low)
22
Q

subacute thyroiditis

A

(de Quervain thyroiditis, granulomatous)

  • after a URI
  • summer
23
Q

Hashimoto thyroiditis- sx, signs

A
  • diffusely enlarged, firm, nodular thyroid gland
  • sx’s related to levels of TH
  • depression, fatigue
  • dry mouth
24
Q

subacute thyroiditis- sx, signs

A
  • painful enlargement of thyroid gland
  • pain may radiate to ears
  • fever, fatigue
  • hypothyroidism lasts 4-6 months
25
Q

Hashimoto- lab

A
  • antithyroid peroxidase or anti thyroglobulin ab’s
  • TSH inc
  • ab’s assoc with celiac dz (15%)
  • T4 is usually higher than T3 levels- passive release of stored H (vs Graves dz- T3 more elevated)
26
Q

subacute thyroiditis- lab

A

-ESR elevated, antithyroid ab’s low

27
Q

Hashimoto- tx

A
  • levothyroxine (if hypothyroidism)
  • large goiter and normal/elevated TSH- shrink the goiter by admin levothyroxine to dec the serum TSH- suppressive doses of T4!!
28
Q

Subacute thyroiditis- tx

A
  • aspirin!!!
  • thyrotoxic sx’s- propranolol
  • iodinated contrast agents- decreases serum T3- improves thyrotoxic sx’s
  • sodium ipodate- given until serum FT4 levels return to normal
29
Q

hypoparathyroidism- caused by?

A
  • acquired (after thyroidectomy)
  • APECED (Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy)
  • heavy metals- copper, iron
30
Q

hypoparathyroidism- sx’s, signs

A
  • hypocalcemia- tetany, m cramps, carpopedal spasm, altered mental status, tingling of hands, feet
  • chvostek’s sign
  • trousseau sign
31
Q

hypoparathyroidism- lab

A
  • low calcium, high phosphate
  • low urinary calcium, normal alk phos
  • low PTH
32
Q

Hyperparathyroidism- caused by

A
  • primary- adenoma, hyperplasia, carcinoma
  • MEN
  • secondary- chronic kidney dz
33
Q

Hyperparathyroidism- clinical findings- skeletal

A
  • low bone density- wrist
  • osteitis fibrosa cystica- fractures
  • brown tumors
  • arthralgias, bone pain
34
Q

hyperparathyroidism- clinical findings- hypercalcemia

A
  • neuromuscular- paresthesias, m cramps and weakness, dec DTRs
  • CNS- HA, fatigue, depression
  • CV- HTN, prolonged PR interval, shortened QT interval
  • renal- hypercalcemia-induced nephrogenic DI; calculi
  • GI
  • pruritus
  • calcium in corneas, arteries (calciphylaxis)
35
Q

hyperparathyroidism- complications

A
  • long bone fractures
  • UTI- stone and obstruction
  • MEN type 1 assoc
36
Q

drugs contraindicated in hyperparathyroidism

A

-avoid thiazide diuretics, large doses of Vit A, calcium-containing antacids or supplements

37
Q

osteoporosis- bone densitometry

A

DXA (dual-energy x-ray absorptiometry)
-determines the bone density of the lumbar spine, hip, distal radius
T score:
> -1: normal
-1 to -2.5: osteopenia (low bone density)
< -2.5: osteoporosis
< -2.5 with a fracture: severe osteoporosis

38
Q

osteoporisis- tx

A
  • diet- protein, total calories, calcium, vit D
  • exercise
  • meds
39
Q

osteoporosis- essentials of dx

A
  • fracture propensity of spine, hip, pelvis, and wrist from demineralization
  • serum PTH, calcium, phosphorus, and alk phos usually normal
  • serum 25-hydroxyvitamin D levels often low as a comorbid condition
40
Q

osteoporosis- meds

A
  • Vit D and calcium
  • sex H’s- prevents osteoporosis in hypogonadal women and men
  • Bisphosphonates- inhibit osteoclast-induced bone resorption
  • Denosumab (ab that inhibits maturation of preosteoblasts into mature osteoclasts)
  • Teriparatide- analog of PTH
  • SERMs (selective estrogen R modulators)- prevent osteoporosis- Raloxifene for postmenopausal women
  • Calcitonin- not as effective; analgesic for vertebral fractures
41
Q

Osteomalacia- essentials of dx

A
  • painful proximal m weakness (esp pelvic girdle); bone pain and tenderness
  • dec bone density from defective mineralization
  • inc alk phos, dec 25-hydroxy-vitamin D, hypocalcemia, hypocalciuria, hypophosphatemia, secondary hyperparathyroidism
  • classic radiologic features
42
Q

osteomalacia- kids and adults

A
  • kids- rickets

- adults- osteomalacia

43
Q

osteomalacia- etiology

A
  • vit D def and resistance- most common cause!!
  • def calcium intake
  • phosphate def
  • aluminum toxicity
  • hypophosphatasia
  • fibrogenesis imperfecta ossium
44
Q

phosphate deficiency- genetic disorders

A
  • AD- mutation in FGF23
  • X-linked- mutation in PHEX endopeptidase
  • AR- mutation in DMP1
  • all 3 cause high serum FGF23 levels!!
45
Q

phosphate deficiency- tumor-induced osteomalacia

A

-mesenchymal tumors secrete FGF23 and cause hypophosphatemia due to renal phosphate wasting

46
Q

hypophosphatasia

A

(severe def of bone alkaline phosphatase)

-rare genetic cause of osteomalacia that is commonly misdx’ed as osteoporosis

47
Q

Paget Disease of Bone (Osteitis Deformans)- essentials of dx

A
  • often asx
  • bone pain may be the 1st sx
  • kyphosis, bowed tibias, large head, deafness, and frequent fractures
  • serum calcium and phosphate normal; alk phos elevated; urinary hydroxyproline elevated
  • dense, expanded bones on radiographs
48
Q

Paget Disease of Bone (Osteitis Deformans)- where?

A

UK and European migration

  • usually dx in pts > 40 yo
  • unkown cause; may be a genetic component
49
Q

Paget Disease of Bone (Osteitis Deformans)- sx and signs

A
  • often mild and asx
  • mult bones in 72%- pelvis, vertebrae, femur, humerus, skull
  • pain- 1st sx- aching, deep, worse at night
  • affecfts long bones proximally then goes distally
  • bones become soft- bowed tibias, kyphosis, “chalk stick” fractures
50
Q

Paget Disease of Bone (Osteitis Deformans)- tx

A

-bisphosphonates- IV zoledronate is tx of choice

E2T2 (6 decks)

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