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46 Cards in this Set
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37 year old, fatigue, weakness, "charley horses", if she got up to quick she felt like she was going to fall and pass out, in fact she did when she got out of bed this morning. Also she has cramps, dizzy spells, stopped having menstrual cycles. Thyroid was smooth, diffusely enlarged. Tanned appearance, "freckling" of the buccal mucosa, biatch says she craves salt.
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Addison's disease
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What times should you measure cortisol?
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8am
and between 11-12 at night |
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if you suspect Addison's disease, what blood test must you order? how does it work
***TEST |
Cosyntropin (ACTH) Stimulation Test
250 ug injected IM or IV Cortisol levels are measured at 0, 30 and 60 minutes. Normal response is a rise in cortisol to > 20 ug/dl. (or double from base number***) if it doesn't go above 20 then you have adrenal insufficiency |
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if you have both Addisons and thyroid disease, which one should you treat first?
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try and take care of the Addison's first and see if the thyroid corrects
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What are some of the things that can mess up a Cosyntropin (ACTH) Stimulation Test
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DHEA, estrogen, spironolactone
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What is the most likely underlying cause of Addisons in the US?
sarcoidosis tuberculosis autoimmune invasive carcinoma meningococcal septicemia |
autoimmune--most common cause in US
other countries--TB |
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Effects of glucorticoids? (what do they do)
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gluconeogenesis
immune suppression anti-inflammatory BP affects |
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what do mineralcorticoids do?
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water management
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Primary adrenal insufficiency is also known as? what is affected?
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Addison's
adrenal cortex |
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Where does secondary adrenal insufficiency occur? what is happening?
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Pituitary
not secreting enough ACTH caused by: infarct, adenoma, aneurysm, surgery, congenital |
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most common cause of secondary hypocorticolism (adrenal insufficiency)?
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Taking a person off exogenous steroids quickly
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where does tertiary hypocorticolism occur? what is going on?
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Hypothalamus
decrease in CRH (and resulting ACTH and cortisol) |
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hypoglycemia is more common in primary or secondary adrenal insufficiency?
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SECONDARY
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Which of the following suggests a primary adrenal insufficiency rather than secondary?
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Hyperpigmentation
(also you will have effects on mineralocorticoids) |
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why do you get hyperpigmentation in primary adrenal insufficiency
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ACTH is increased because you have low cortisol
a breakdown product is MSH this hits the melanocyte receptors |
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symptoms of chronic adrenal insufficiency
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Fatigue
Weight Loss Weakness |
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dehydration, hypotension, shock. Nausea, vomiting with weight loss and anorexia. Abdominal pain, so called "acute abdomen". Unexplained hypoglycemia and fever. Hyponaterima, hyperkalemia, azotemia, hyperpigmentation... all findings suggestive of...
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adrenal crisis
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what is a good steroid to start with as tx for adrenal insufficiency
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Dexamethasone
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tx for primary adrenal insufficiency?
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Glucocorticoids: Predinozone, Hydrocortizone, Dexamethazone
Mineralocorticoids: Fludrocortizone |
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tx for secondary adrenal insufficiency?
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just the Glucocorticoids
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26 year old lady comes with increased facial fullness and increased facial hair. Episode of depression and acute psychosis following the delivery. Her menses have been irregular since they resumed after the birth, she is not breast feeding. Proximal muscle weakness, easy bruising. She is on SSRI and prenatal vitamins. She is obese with striae present since pregnancy. She has a full face with mild acne and a dorsocervical fat pad. What test should you order? what do you think they have?
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24 hour urine for free cortisol or Dexamethazone suppression test
Cushing |
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What is Cushing's DISEASE
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ACTH secreting tumor in ant pituitary
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what is the most common cause of cushings SYNDROME
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Exogenous steroids
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alcoholism can cause what type of cortisol problem?
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PSEUDOCUSHINGS
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Tx for Cushing's syndrome?
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depends on cause
surgery, medicine, etc |
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spinal levels for adrenal glands?
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T8-T10
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lady has lump in the neck for about 3 years. She was unaware of other nodules, denies weight loss/gain, fatigue, dysphagia. Mother was dx with multinodular goiter when she was 40
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papillary carcinoma
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are thyroid nodules common?
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you bet your booty
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most common thyroid cancer? prognosis?
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paipillary carcinoma
prognosis is good even though you often see mets! |
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besides papillary carcinoma of the thyroid, what other cancers are there? Which is worst?
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follicular, medullary, anaplastic (WORST)
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if someone is undergoing a thyroidectomy what do you have to do post surgery?
***TEST |
monitor Ca! you might have taken out the parathyroid
pt may complain of weakness |
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who is more likely to die of thyroid cancer?
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MEN
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after thyroidectomy pt says they are gaining weight, dry skin, menstrual cycles were unusually heavy and prolonged..what is going on? how would you tell?
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hypothyroid
get TSH and T4 |
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what can cause primary hypothyroid
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Hashimoto's--autoimmune, most common in US
Iodine deficiency--most common world wide drugs, surgery, etc |
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elevated TSH shows what?
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HYPOTHYROID
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when do you recheck TSH levels?
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6-8 weeks
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life threatening complication of hypothyroidism?
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Myexedma coma
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who do you see Myexedema coma in? What causes it?
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old folk
not taking their meds correct |
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which of the following shows hypothyroid
normal t4 low TSH normal T4 high tsh Low T4 high TSH normal T4 normal TSH Low t4 borderline low TSH |
Low T4 high TSH
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pt is jittery, nervous, weight loss, heat intolerance...
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Hyperthyroid
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what is thyroid storm? causes?
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extreme hyperthyroidism...life threatening
caused by stress: surgery, infection, radioiodine tx mortality is about 30% |
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how do you treat thyroid storm?
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get underlying cause
B-blockers can help symptoms iodine salts |
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OPP tx areas for thyroid
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T1-5 (head and neck)
also consider sternum (could be twisted) |
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**OPP**
Sympathetics for Kidneys and Adrenals? |
Kidneys: T10-11
Adrenals: T8-10 ipsilateral |
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**OPP**
Chappman's points for kidneys? |
Anterior: 1" superior, 1" lateral to umbilicus
Posterior: L1 transverse process |
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**OPP**
Chappman's points for adrenals? |
Anterior: 2" superior, 1" lateral to umbilicus
Posterior: T11 transverse process |