Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
Best lab value for: 1. screen hypo-thyroid 2. thyroid function 3. HYPER-thyroid severity 4. Hashimoto thyroiditis |
1. TSH - general screen of thyroid fxn + hypo-thyroid 2. FT4- best for thyroid fxn 3. T3 - HYPER-thyroid severity 4. thyroid ANTIBODIES- hashimoto hypo-thyroid (serum levels) |
|
|
thyroid uses ? to make T3/T4 |
iodine from diet |
|
|
best dx for thyroid CA |
ultrasound w/guide fine needle aspiration (FNA) |
|
|
PT: low HR + tibial myxedema + cold intol. + memory loss + no lateral eyebrows + fat + constipation - eti - 2? |
hypo-thyroid: low basal metabolic rate + low activity + low memory - iodine deficiency - hashimoto |
|
|
Pt: tremors + increase HR + skinny + heat intol + palpitations + diarrhea - eti? |
HYPER-thyroid: increased basal metabolic rate + increase sym stimulation - graves |
|
|
Pt: bulging eyeballs + nodules on shins + Lid lag + clubbing + LARGE GOITER + increase BMR sxs
- patho? - lab levels T3/T4 + TSH + ? |
Graves disease: opthalmopathy + pretibial myxedema - MC cause of HYPER-thyroid - AI dz: auto-ANTIBODIES bind TSH-receptors on thyroid and stimulates release of T3/T4 - high T3/T4 + low TSH + antibodies |
|
|
Tx: HYPER-thyroidism - generally safer + easier - tx preferred in pregnancy - tx inc. sym sxs - procedure ? |
HYPER-thyroid meds - reduce thyroid production of T3/T4 MMI - generally preferred + easier to take - PKU: pregnancy - beta blocker (propanolol) for symp. sxs - radio-iodine destroys thyroid tissue |
|
|
Pt: elderly patient w/ benign goiter + weight loss - labs: TSH + T4? - TOC? |
plummers disease - toxic multinodular goiter - nodules produce excess thyroid hormone low TSH N/high T4 - 313 I: radio-iodine |
|
|
Pt: bitemporal hemianopsia + diffuse, enlarged thyroid - Labs: TSH + T4? - dx? - tx? |
TSH secreting PITUITARY ADENOMA - high TSH - high T3/T4 - MRI pituitary adenoma - transphenoidal sx to remove pit. tumor |
|
|
Pt: thyroid pain + tender goiter + fever + dysphagia + lymphadenopathy - MC organism? - tx? |
acute thyroiditis - bacterial STAPH - abx tx |
|
|
Pt: young/mid age F w/ thyroid pain + goiter + fever + hx URI - organism? - HM diagnostic? - tx? - MC dz name |
SUBacute thyroiditis - viral infection - supportive aspirin + NSAID + steroids - increase ESR (viral inflammation) - HM - DeQuervians |
|
|
Pt: painless, enlarged thyroid + high TSH + low T3/T4 - lab also see ? - biopsy shows? 3 - tx? |
Hashimoto - chronic thyroiditis - AI disease against thyroid peroxidase (TPO) + thyroglobulin (TG) in thyroid gland = lymphocyte infiltrate + DESTROY THYROID FOLLICLE cell - mc eti hypo-thyroidism - lab + AB TPO + TG - biopsy: lymphocytes + germ.follicles + HURTHLE cells - tx: syn T4: levothyroxine |
|
|
2 drugs that alter thyroid levels - pt presents with ? |
1. amiodarone (contains iodine) 2. lithium ( inhibits T3/T4 secretion) - PAINLESS, enlarged thyroid |
|
|
Pt: psychosis + tremor + agitation + AMS + tachycardia + high fever + shock - precipitated by stress/trauma/ infection/surgery - tx? |
Thyroid storm - medical EMERGENCY from untreated Graves - HYPERthyroidism - admit + high dose PKU + b-blockers + steroids |
|
|
Pt: AMS + seizure + bradycardia + hypothermia + hypoglycemia - precipitated by stress/infection/ surgery - tx? |
Myxedema Crisis/coma - medical EMERGENCY - untreated hypo-thyroidism - AMS is HM - Admit + high dose LEVOTHYROXINE |
|
|
Cold nodule on RAIU scan highly suspicious for ? - MC type of ? - increase RF? |
thyroid carcinoma - malignancy - MC type of endocrine malignancy - radiation exposure + large nodule size + FAMILY HX |
|
|
thyroid nodules are mostly: benign vs malignant |
thyroid nodules are mostly benign and increase finding in elderly patients |
|
|
Thyroid CA: metastasis to lung, bone, brain and liver + slow growing + treatable
|
follicular thyroid CA |
|
|
Thyroid CA: genetic mutation/ translocation due to radiation exposure + treatable + slow growing + good prognosis |
papillary thyroid CA |
|
|
Thyroid CA: poor prognosis + MEN syndrome + produces CALCITONIN |
MEDULLARY thyroid CA - CA of para-follicular (C) cells |
|
|
Thyroid CA: very aggressive + rock hard nodule + dysphagia/ vocal cord paralysis |
anaplastic thyroid CA |
|
|
PTH: is secreted in response to ? - MOA - 3 organs - PTH aka ? |
PTH is secreted in response to low calcium levels 1. simulates osteoclast bone break release Ca+ 2. distal kidney tubule reabsorb calcium 3. converts into active vit D in intestine absorb Ca - phosphate trashing hormone |
|
|
HYPER - para-thyroid: causes ? + saying ? |
HYPER - para = HYPER - calcemia 'stones, bones, moans, groans, psych tones' |
|
|
calcium levels: less stimulus needed for nerve/muscle activation/contraction (lower threshold) - EKG finding ? |
HYPO-calcemia - low calcium levels= more muscle spasms + GI mobility/cramping + SEIZURES - prolong QT interval w/ low calcium |
|
|
Pt: mouth twitch + carpal spasm + seizure + diarrhea + muscle cramps - HM sx? |
hypo-calcemia - trousseus: carpal BP twitch - chvostek: cheek twitch - TETANY = muscle spasms |
|
|
Pt: kidney stones + bone fractures + constipation + AMS - EKG finding? - saying? |
HYPER-calcemia - short QT - "bones, stones, groans, moans, psych tones" |
|
|
adrenal cortex: saying + hormones/zones |
GFR: it gets sweeter the deeper you go G: aldosterone - salt F : cortisol - sugar R: sex - androgen/estrogen |
|
|
MC cause of primary adrenal insufficiency: industrialized countries + world wide - secondary adrenal insufficiency? |
primary adrenal insufficiency - MC causes -US: AI Addisons disease: destroys a.cortex - world: TB infection secondary: pituitary dysfx - oral steroids |
|
|
Pt: hyperpigmentation/bronze skin + dark oral mucosa + hypoglycemia + hypotension + amenorrhea labs: ACTH + ald + cort + sex |
Addisons - primary adrenal insuff. - adrenal cortex destroyed - high ACTH - low ald - low cortisol - low sex h |
|
|
Pt: muscle ache + weight loss/anorexia + NVD + SALT craving + hypoglycemia labs: ACTH + ald + cort |
secondary adrenal insuff - pituitary dysfx - only sxs of low cortisol levels low ACTH low cortisol normal aldosterone (bc of RAAS system) |
|
|
Adrenal insufficiency: screening test - cortisol levels ? - tx primary + secondary? |
screen: rapid ACTH test: COSYNTROPIN - give 250mcg push - measure cortisol level @30/60min LESS THAN 18mcg/dL = adrenal insuff. - tx primary: glucocort: hydrocort/pred + min.cort: fludrocortisone - tx secondary: just glucocort: hydrocorti/pred |
|
|
Pt: NV + fever >40.6 + SEVERE DEHYDRATION + SHOCK + hypoglycemia + hyponatremia + hyperkalemia + confusion - post "stressful"event: trauma/infx - MC cause? |
Adrenal Crisis - insufficiency (addisonian crisis) - medical EMERGENCY - MC cause: abrupt stop of glucocorticoid tx - MUST TAPER STEROID TX |
|
|
TX: adrenal crisis - 3 |
medical EMERGENCY 1. draw plasma cortisol level 2. glucocorticoid - HYDROCORTISONE 100mg IV STAT 3. IV fluids to correct SHOCK |
|
|
Pt: truncal obesity + moon face + buffalo hump + high BP + high glucose + low potassium - primary lab: ACTH + dx - secondary lab: ACTH + dx |
Cushing's disease/syndrome: excess CORTISOL 1. primary - DISEASE: PITUITARY mass inc. ACTH - HIGH DEX test suppresses disease 2. secondary - syndrome: ectopic lung mass inc. ACTH or adrenal mass inc. cortisol - overnight dex test >5 + 24h urine cortisol >300 |
|
|
Tx: cushings disease - definitive - syndrome: ectopic/adrenal tumor - drug to decrease excess cortisol level |
cushings disease: transphenoidal surgery - remove pituitary tumor syndrome: remove ectopic/adrenal tumor KETOCONAZOLE decreases cortisol levels |
|
|
Pt: high BP + HA + flushing + muscle weakness + fatigue + polyuria + hypokalemia - primary? - secondary ? - lab differentiate? |
hyper-aldosterone 1. primary: adrenal tumor - CONNS syndrome 2. secondary: renal artery stenosis + RENIN/RAAS (mad kidney) - primary = ARR ald:renin ratio > 20 + ald > 20 + low renin - secondary: high renin |
|
|
Tx: hyper-aldosterone - primary - secondary - drug that blocks aldosterone |
1. primary: cut adrenal tumor - CONNS syndrome 2. secondary: renal angioplasty (fix artery stenosis) SPIRONOLACTONE blocks aldosterone |
|
|
Pt: girl + galactorrhea + amenorrhea + infertility + decrease vaginal lubrication (male: decrease libido + hypogonadism) - MC type of ? - drug that inhibits |
prolactinoma [when breast feeding, you dont want to get pregnant again: prolactin suppress FSH + gonadotropins - no periods + no vag wet] - MC type of pituitary tumor - DOPAMINE blocks prolactin (bromo/caber) |
|
|
Dx: prolactinoma - 2 tx: drug tx: procedure |
Dx prolactinoma = MRI + high prolact > 300 - tx: BROMOcriptine (decrease tumor + lower PL + preg safe (dopamine agonist) (cabergoline: better tol but $$$) - transsphenoidal surgery |
|
|
Pt: doughy, moist hands + protruded jaw + cardiomegaly + hyperglycemia Dx: 2 Tx: drug + TOC |
acromegaly: excess GH ( somatotropinoma - pituitary adenoma secreting GH) Dx: high IGF1 + OGTT w/ high GH >1 Tx: SOMATO- STATIN (octreotide) or bromo/caber TOC: transphenoidal surgery (MACROadenoma can lead to compressive sx aff. vision) |
|
|
normal: GH levels vs. glucose levels |
normal: when glucose level is high, GH is not secreted ( GH protects against hypoglycemia) acromegaly: GH excess: risk of HYPERglycemia + DM (GH excess like cortisol excess - same OGTT test) |
|
|
Pt: polyuria + polydipsia + nocturia - central organ? - second organ affect - dx study - TOC |
diabetes insipidus - pee tons of dilute urine 1. central: low ADH (pituitary AI, head trauma) 2. nephrogenic DI: insensi to ADH 3. Vasopressin challenge test aka desmopressin (ADH) stimulation test: IN DDVP = decrease urination for central DI 4. Central DI TOC: DDVP intranasal |
|
|
Pt: central obesity + high BP + low HDL + high triglycerides + non-responsive to insulin |
insulin - resistant syndrome aka metabolic syndrome aka syndrome x (apple person + low HDL + high TRI = key) |
|
|
Pt: severe dehydration + AMS + kussmal + fruity breath -pH? - glucose? - tx 3 |
DKA - life threatening - DM insulin deficiency - metabolic ketoacidosis + anion gap - hyperglycemia - tx: 1. give fluids 2. correct potassium level > 3.3 mEq BEFORE!!! 3. insulin therapy (prevent death by hypokalemia <3.3) |
|
|
Same as DKA but no ketoacidosis (same management) - glucose level? - osmo level |
HHS: hyperglycemic hyperosmolar state glucose > 600 osmolarity > 320 |
