Endocirne 2

Question 1

myxedema crisis

Answer 1

severe multi organ decompensation in a HYPOTHYROID pt

mental status changes, HoTN, HoThermia

Question 2

myxedema crisis clinical features

Answer 2

bradycardia 
HoTN 
HoThermia 
AMS 
Coma 

may have infection w/o signs due to masking by bradycardia and HoThermia

clinical shock, systolic <100 MAY present in coma

Question 3

neuro exam finding myxedema crisis

Answer 3

delayed DTRs
dementia
psychosis
paresthesia
depression
poor memory
confusion
ataxia

Question 4

cardiopulmonary exam findings myxedema crisis

Answer 4

angina
bradycardia
distant heart sounds
low voltage ECG
pericardial effusion
cardiomyopathy 
Hoventilation

Question 5

derm findings myxedema crisis

Answer 5

dry skin
hair loss
non pitting edema
facial swelling ptosis 
macroglossia
periorbital edema

Question 6

lab eval myxedema crisis

primary hypothyroid

Answer 6

high TSH

low T3/T4

Question 7

lab eval myxedema crisis

secondary hypothyroid

Answer 7

low TSH

Low T3/T4

Question 8

myxedema crisis tx

Answer 8

initiate tx without waiting for lab confirmation

1. support tx
2. thyroid hormone replacement
3. identification and tx of precipitating factors

Question 9

supportive care in myxedema crisis

Answer 9

ABCD
IV dextrose tx 
vasopressors
hypothermia rewarming 
steroids

Question 10

thyroid replacement myxedema crisis severe

Answer 10

T3 +/- T4

caution in pts with myocardial compromise

Question 11

myxedema crisis thyroid replacement IV drugs

Answer 11

levothyroxine (T4) OR liothryonine or triodothyronine (T3)

T3- no more than 10 micrograms for elderly or CAD

Question 12

myxedema crisis disposition

Answer 12

high mortality rate

ICU admission

Question 13

elderly and myxedema crisis

Answer 13

age
cardiac comorbidities
thyroid replacement = WORSE outcome

T4 and T3 avoiding for arrhythmia (std doses)

start with HALF normal dose

Question 14

cardiac instability myxedema crisis

Answer 14

T4 is better for cardiac safety

Question 15

thyroid hormone fxn

Answer 15

increase metabolic rate, HR, ventricle contractility, muscle and CNS excitability

T3 and T4 are 2 types (T4 more common, T3 more potent)

Question 16

thyrotoxicosis

Answer 16

excess circulating thyroid hormone (any cause)

Question 17

thyroid storm

Answer 17

extreme thyrotoxicosis

acute, severe life threatening state of thyrotoxicosis

Question 18

cause of thyroid storm

Answer 18

untreated hyperthyroidism
surgery 
infecton
trauma
acute iodine load
childbirth 
exogenous thyroid hormone One Direction

Question 19

precipitants of thyroid storm

Answer 19

systemic insult
CV insult
unknown

MC overall is infection

Question 20

thyroid storm clinical features

Answer 20

fever
tachycardia
ams

Question 21

thyroid storm palpitations

Answer 21

tachycardia
direct inotropic and chronotropic effects of thyroid hormone

increased contractility and output

AFib

water hammer pulse

Question 22

CNS findings of thyroid storm

Answer 22

anxiety 
agitation 
delirum 
stypor 
coma 
seizure

Question 23

thyroid lab evaluation

Answer 23

not always acutely elevated when transition from thyrotoxicosis occurs

low TSH and elevated T4 confirms diagnosis

Question 24

order of tx for thyroid storm

Answer 24

thionamide must be initiated 1 hr BEFORE iodine

Question 25

tx list of thyroid storm

Answer 25

1. supportive care (airway, fever control. nutrition, BB) 2. inhibit hormone production 3. inhibit hormone release 4. B-adrenergic R blockade 5. inhibition of T4 conversion pts are admitted to ICU

Question 26

list of thionamide

Answer 26

block production 1. PTU 2. Methimazole PTU preferred (blocks T4 conversion)

Question 27

prevention of hormone release (list)

Answer 27

1. Lugol solution | 2. potassium iodide (SSKI)

Question 28

BETA-adrenergic R blockers in thyroid storm

Answer 28

1. propanolol 2. esmolol 3. reserpine 4. guanethidine

Question 29

how do we block peripheral T4-T3 conversion in thyroid storm

Answer 29

PTU and glucocorticoids Hydrocortisone, Dexamethasone

Question 30

amiodarone and thyroid storm

Answer 30

precipitant of thyroid storm chronic use of amiodaron causes hypothyroid or thyrotoxic state in 20-30% of patients

Question 31

hormones secreted by adrenal gland

Answer 31

cortisol alderstone gonadocorticoids

Question 32

types of adrenal insufficiency

Answer 32

primary/Addison's dz (decreased cortisol and aldosterone) secondary: central dysfunction, decreased ACTH production, ONLY decreased cortisol

Question 33

adrenal crisis

Answer 33

exacerbation of adrenal insufficiency due to 1. increased demand (infection, trauma, MI..) 2. decreased cortisol supply adrenal gland fails to mount a stress response occurs in primary or secondary

Question 34

major stressors adrenal crisis

Answer 34

``` acute MI sepsis sx truama other illness ```

Question 35

MC cause of adrenal crisis

Answer 35

rapid withdrawal of steroids in pt with adrenal atrophy secondary to long term steroid administration

Question 36

clinical features of adrenal crisis

Answer 36

``` HoTN refractory to pressers syncope dehydration hyperpigmentation abdominal pain, n/v ```

Question 37

when to suspect adrenal crisis

Answer 37

unexplained HoTN in pts w/: long term glucocorticoid therapy + acute stress event, known dz rapid withdrawal or non compliance with steroid AIDs pt severe head trauma severe infection

Question 38

labs adrenal crisis

Answer 38

ACTH random cortisol level aldosterone and renin levels underlying pathology

Question 39

tx of adrenal crisis

Answer 39

1. IV fluids (5% dextrose in NS) correct Hoglycemia, HoNatremia 2. Steroids (hydrocortisone) 3. Vasopressors

Question 40

adrenal supplementation in adrenal crisis minor stress

Answer 40

25 mg/d of hydrocortisone I.e. mild fever, n/v

Question 41

adrenal supplementation in adrenal crisis moderate stress

Answer 41

50-75 mg/D PNA, pancreatitis

Question 42

adrenal supplementation in adrenal crisis severe stress

Answer 42

100-150 mg of hydrocortisone for 1 to 3 days sepsis, shock