third-MKSAP Flashcards
in older adult whom you JUST diagnosed with hypothyroidism, what dose levothyroxine should you start them on?
Why?
25-50
due to cardiovascular risk
what is typical starting dose strenght in new Dx hypothyroidsim
1.6mcg/kg
*** _____ must be abnormal to diagnose cushings syndrome *********
2 or the 3:
- overnight Urine Cortisol >100
- late night saliva cortisol
- dexam suppression test
___ helps distinguish Grave’s from Toxin nodular goiter
RAIU
innapropriately normal in Grave’s
HIGH (>30%) in Toxin Nodular goiter
after confrming cushings, what is next step****
ACTH level
vitamin D-dependent hypercalcemia is associated with normal to elevated serum ______ levels because of ___ pathophys
phosphorus
Vit D causes INCREASE Ca and P intestinal absorption
Your patient has cushings and the MRI head that you ordered did not show pituitary tumor(but you still suspect it), next step for diagnosis?
8mg Dexam suppression test
- result >50% drop in cortisol: PITUITARY
- result no change/no drop in cortisol: ECTOPIC
causes of gynecomastia:
GENETIC ____
Renal ____
Medication _____
Thyroid _____
GI ______
Behavior ______
Genetic : hypogonadism
Renal : ckd
Medication : spirono, finasteride/dutasteride, estrogen, OTC tea tree oil/Lavender oil
Thyroid : hyperthyroidism
GI : cirrhosis, malnutrition
Behavior : substance use disorder
- alcohol
in ____ hypothyoidism, ____ level should never be tested
secondary (pituitary insufficiency/removal)
TSH
_____ level is good test in seondary hypothyroidism
FT4
pathophys of destructive thyroiditis
unregulated release of pre-formed Thyroid hormone
(from thyroid follicles as a result of inflammation)
how to tell there is Destructive Thyroiditis in a patient who presents with thyrotoxicosis
RAIU—-you will see LOW uptake <10%
(means iodine uptake is appropriately low due to low TSH–opposed to grave’s were thyroidoid is autonomous)
comparison of DEXA scan from current vs a few years ago, focus on ___ not ____
focus on: bone density change
dont focus on: Tscore
Patient on bisphosphonate therapy gets fracture, does that mean treatment failure?
Not necessarity if there isnt a decrease in Bone Mineral Density (BMD) seen in subsequent DEXA scans when compared to Old
Keep taking the bisophosphonate even if BMD does not change
patient was getting evaluated for weight gain, thyroid studies show subclinical hypothyroidism, what is next step?
repeat TSH in 6-8wks
(Bcs you can have random transient changes in TSH–>some may progress to overt hypothyroidism VS some may go back to normal)
____ TSH is NORMAL in older patients >80years if you see sublinical hypothyroisism
UP TO 10
what is type I vs Type II amiodarone induced thyrotoxicosis
Type I: they had underlying grave’s or toxic nodular goiter
Type II: no underlying thyroid dysfunction
(all happen after initiating amio)
how to tell apart type I vs Type ii amod induced thyrotoxicosis
u/s w/ doppler of thyroid
increased vascularity means Type I
decreased means type II
diabetics should definitely recieve ____ vaccination due to increase likelihood of getting this disease
HepB
___ level should be checked for patient on estrogen therapy
Prolactin
Hematocrit/Hg should be checked every ____ for patient on testostereon
3mo
for patient on testosterone therapy, levels should remain ____ which is normal male physiologic range
300-800
lab abnormalities as a result of testosterone supplementation
Elevated lipid
Erythrocytosis
Na retention
decr FSH LH
___ pulmonary problem can result from testosterone supplementation
OSA
what conditions can cause Unregulated conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D
Sarcoidosis
TB
Lymphoma
Fungal infection
(all are granulomatous disease associated)
