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547 > Week 3 endo > Flashcards

Week 3 endo Flashcards

1
Q

hypercalcemia: possible etiologies

RHINOS

A

R: renal insufficiency

H: hyperparathyroidism

I: immobilization and iatrogenic

N: neoplasms

O: other endocrinopathies (MEN 1 and 2)

S: sarcoidosis

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2
Q

symptoms of hyperparathyroidism

groans
stones
thrones
bones
psychiatric overtones
A

“Groans” - constipation and muscle weakness from decreased contractility

“Stones” - calcium based kidney/gallbladder stones

“Thrones” - (refers to a toilet) polyuria due to impaired sodium, water absorption

“Bones” - pain from chronic demineralization

“Psychiatric Overtones” - depressed mood, confusion

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3
Q

secondary hyperthyroidism

parathyroid gland is normal/abnormal
usually caused by \_\_\_\_\_\_\_
\_\_\_\_ calcium
\_\_\_\_ phosphate
\_\_\_\_ vit D
A 
parathyroid normal
chronic kidney disease
low calcium
high phosphate
low vit D

In secondary hyperparathyroidism the parathyroid gland is normal, but chronic hypocalcemia causes excess PTH to be released to try to correct the low calcium levels

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4
Q

what kind of foods are high in purine?

what food increases purine production?

A

red meat
shellfish
anchovies
organ meat

high fructose corn syrup INCREASES purine production

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5
Q

ALLOPURINOL

drug class?
MOA?
indication?

A

xanthine oxidase inhibitor

XO is enzyme that breaks down purine –> uric acid

LOWERS uric acid level

used in chronic gout to prevent future attacks
(tophi, >3 attacks/year, kidney stones, hyperuricemia)
-do not stop taking during/after flare

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6
Q

gout risk factors?

which meds?

A 
Positive Family History 
Older Age 
Male 
Overweight 
CKD, Hypothyroidism, HTN, CV disease
Post-surgery 
DEHYDRATION
Medications (thiazide diuretics, low dose ASA) 
Alcohol (BEER)
chemo, radiation
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7
Q

COLCHICINE

MOA?
side effects?

A

binds to neutrophils to disrupt function
neutrophils cannot travel to site of injury to cause inflammation

  • nausea
  • abdominal pain
  • diarrhea
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8
Q

what is a common complication of chronic gout?

A

tophi
**destructive and deforming joint disease

nephrolithiasis (kidney stones) and chronic urate nephropathy

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9
Q

DDX gout

A

Septic arthritis, trauma

pseudogout (CPPD), cellulitis, rheumatoid arthritis, dactylitis, osteomyelitis

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10
Q

Gout

diagnostic test

A

JOINT ASPIRATION
monosodium urate crystals and WBC

labwork:
CBC, Cr, urate, CRP, ALT, glucose, RF, ANA

*do urate >2 weeks after gout attack

*urate levels often normal during acute attack, not helpful for diagnosis
urate level >6.8 is supportive but not diagnostic or required for diagnosis

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11
Q

Gout lifestyle counselling

A 
weight loss
ETOH decrease
screen for HTN and DM
AVOID ASA
stay well hydrated
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12
Q

colchicine

dosing?
contraindications?

A

0.6 mg BID - start within first 36 hours, stop when symptoms resolve for 2-3 days

contraindicated if severe renal/hepatic impairment

eGFR <30

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13
Q

treatment options for acute gout?

CNS

A

-colchicine 0.6 mg BID until attack subsides
-NSAIDS
naproxen 250-500 mg BID
-steroids (po or intraarticular)
prednisone 30 mg po OD x 5 days

*steroids safer in elderly than NSAIDS or colchicine

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14
Q

indications for urate lower therapy?

target serum urate?

A
  • 2-3 acute attacks in 1-2 years
  • Radiographic evidence of joint damage
  • tophi
  • CKD stage 2 or worse
  • urate renal stones

URATE <360
<300 if tophi

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15
Q

allopurinol

caution?
most common drug interaction?

A

RASH, RASH, RASH
fever, decreased platelets, elevated liver enzyme (must stop ASAP if allopurinol rash)
HLA-B58:01 testing for asian pts

azathioprine
also warfarin, thiazide

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16
Q

food and drug precipitants of gout?

Drugs are FACT
Foods are SALT

A

Furosemide
ASA (low)
Cyclosporine
Thiazide

Seafood
Alcohol
Liver and kidney
Turkey

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17
Q

pseudogout is caused by precipitation of what type of crystals?

A

calcium pyrophosphate dihydrate

18
Q

consequence of pseudogout?

A

acute inflammatory arthritis

inflammatory and degenerative chronic arthropathies

radiographic cartilage calcification

19
Q

risk factors for pseudogout

A
  • age!
  • hemochromatosis
  • hyperparathyroidism
  • gout
  • hypomagnesemia
  • joint trauma
  • genetics
20
Q

acute CPPD arthritis

triggers?

A

trauma
surgery
(esp parathyroidectomy)
severe medical illness

21
Q

acute CPPD pseudogout arthritis

signs and symptoms?

location?

A

-1 or several joints

intense pain, redness, warm, swelling (like acute gout)

may also have inflammation of adjacent joints (cluster attacks)

tends to be larger joints
KNEE affected in >50% acute attacks
-wrist, shoulders, elbows, ankles, feet

22
Q

chronic CPPD arthritis

AKA

signs and symptoms?

A

AK pseudorheumatoid arthritis

morning stiffness
fatigue
synovial thickening
localized edema, and restricted joint motion

often symmetric, multiple peripheral joints of upper and lower extremities

23
Q

diagnosis of pseudogout?

A

synovial fluid analysis:
CPPD crystals

imaging:
chondrocalcinosis (cartilage calcification)

24
Q

how is hyperuricemia defined?

A

serum UA >404-416 mmol/L

concentration >420 mmol abnormal

25
Q

CV symptoms in hypothyroidism

hyperthyroidism

A

HYPO

  • bradycardia
  • isolated diastolic HTN

HYPER

  • palpitations, tachy
  • afib
  • isolated systolic HTN
26
Q

thermoregulation in hypothyroidism

hyperthyroidism

A

HYPO

  • decreased sweating
  • cold intolerance

HYPER

  • increased sweating
  • heat intolerance
27
Q

menstrual bleeding changes in hypothyroidism

hyperthyroidism

A

HYPO
-menorrhagia

HYPER

  • amenorrhea
  • oligomenorrhea
28
Q

risk factors for thyroid dysfunction

A

Risk factors:

  • men: age ≥ 60 years
  • women: age ≥ 50 years
  • personal history or strong family history of thyroid disease
  • diagnosis of other autoimmune diseases

past history of neck irradiation

  • previous thyroidectomy or radioactive iodine ablation
  • drug therapies such as lithium and amiodarone
  • dietary factors (iodine excess and iodine deficiency in patients from developing countries)
  • certain chromosomal or genetic disorders (e.g., Turner syndrome, Down syndrome and mitochondrial disease).
29
Q

HYPOTHYROIDISM

TSH will be high/low?
T4 will be high/low?

when to recheck TSH?

A

high TSH
low T4

recheck 6 weeks after changing dose/starting med

30
Q

subclinical HYPOthyroidism

TSH?
T4?

when to treat?

A 
high TSH (<10)
normal T4

treat if:Treat:

TSH >10 OR

= 10 with hypothyroid symptoms, ↑TPO antibodies, evidence of CVD/HF/risk of CVD or HF, or preggers

Treatment of subclinical hypothyroidism can shorten survival rates for older adults

31
Q

subclinical HYPERthyroid

TSH?
T4?

when to screen?

when to treat?

A

TSH <0.1
normal T3

SCREEN if afib or osteoporosis

*increase risk of bone loss

treat if TSH <0.1

32
Q

what medications can affect thyroid function?

A

lithium

amiodarone

33
Q

hyperthyroidism

TSH will be high/low?
T4 will be high/low?

A

TSH low

T4 high

34
Q

how often to check TSH?

A

6 weeks after dose change

once stable annual

if on lithium/amiodarone:
check q3-6 months

35
Q

TRH (thyrotropin releasing hormone) is created in _____ and acts on _____ to stimulate release of _____

A

TRH

  • created in hypothalamus
  • acts on anterior pituitary
  • release of TSH
36
Q

in normal functioning, TSH stimulates thyroid to make 90% T4 and 10% T3

which one is more active?

99% of thyroid hormones is bound to_____?

A

T3 +++active

T3 is active hormone
T4 is pro hormone

99% bound to plasma proteins (thyroxine-binding globulins

37
Q

what is the starting dose of levothyroxine?

if CVD hx?

A

generally 50 mcg dose

CVD: 12.5-25 mcg

38
Q

what is the target TSH for age 60-70?

>75?

A

TARGET TSH
3-4 age 60-70
4-6 age >75

39
Q

overtreating hypothyroidism can lead to what 2 sequelae?

A 
afib
bone loss (postmenopausa women)
40
Q

patient teaching for hypothyroidism?

A

take med on empty stomach (1 hour before eating)

avoid taking with calcium

recheck labs in 6 weeks

547 (11 decks)

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