endocrinologie Flashcards

Question

Quels sont les symptômes du coma myxedoemateux

Answer 1

LOC/letargie Hypothermie Hypotension Bradycardie Hyponatrémie Hypoventilation C'est une Dx clinique

Answer 2

Synthroid IV : 200-400 mcg x1 puis 1.6 msg / kg / jour (PO) * si donné IV, on multiplie par 75% IV glucorticoide (HC 100mg IV q 8hr) IV liothyronine 5-20 mcg x1 puis 2.5-10mcg q 8hr SUpportive measure

Answer 3

TSH > 2.5 On fait les TPO Ab pour guider notre traitement.

Answer 4

On a besoins de 30-35% LT4 de plus en grossesse On dit dont de prendre une pillule en plus le samedi et dimanche dès qu'ils sont enceinte On vise TSH < 2.5 On retourne à la dose usuelle après la grossesse

Answer 5

TSH-R Ab qui peuvent traverser le placenta Check Ab titer in second trimester. If very high (3x ULN), need increased fetal monitoring for fetal Graves’. Long-term treatment with β-blockers has been associated with intrauterine growth restriction, fetal bradycardia, and neonatal hypoglycemia Watch for post partum exacerbations Could also be post partum thyroiditis.

Answer 6

* voir le graphique* Conditions associated with OP - type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption and chronic liver disease

Answer 7

– Low trauma (e.g. from standing height at walking speed or less, bend, sneeze, cough) – Major osteoporotic fracture: Fractures of the hip, vertebra, humerus or pelvis (NOT of the hands, feet, craniofacial bones) – Vertebral fractures, even asymptomatic, associated with increased risk of fractures at all skeletal sites

Answer 8

Hip, vertebra or ≥ 2 osteoporosis-related fractures * 10-yr major osteoporotic fracture risk ≥ 20% * ≥ 70 yo and have a T-score ≤ –2.5 (femoral neck, total hip or lumbar spine)

Answer 9

* 10-yr major osteoporotic fracture risk between 15% and 19.9% * < 70 yr and have a T-score ≤ –2.5 (femoral neck, total hip or lumbar spine) Other treatment decision factors to consider: * a fracture in the last 2 years (risk of subsequent fracture highest) * ongoing risk factors On devrait donc considérer un traitement (on doit le suggérer)

Answer 10

* If stop at ≤ 4 doses, transition to bisphosphonate 6 mo after the last dose of denosumab (reduces risk of rapid bone loss. Bisphosphonate therapy for 1 yr and then reassessing). * If stop at ≥ 5 doses (risk of rapid bone loss or vertebral fractures is high): refer to OP expert

Answer 11

Nonhealing wound in oral mucosa with exposed bone that lasts >8 weeks Increased risk if jaw surgery

Answer 12

* Autoimmune thyroid disease develops in 10% (up to 30% of females) – Check TSH, anti-TPO Ab at diagnosis and q2-5 years thereafter * Autoimmune adrenal insufficiency is rare – Screen if symptoms, unexplained hypoglycemia * Celiac disease in about 5%, asymptomatic – Screen if any symptoms, including iron deficiency, unexplained hypoglycemia, vitamin D deficiency, osteoporosi

Answer 13

Suggests a state of relative or absolute insulin deficiency. * Polyuria * Polydipsia * Blurry Vision * Unintentional Weight loss * Volume depletion * Ketosis * HHS/DK On doit alors partir d'emblée de l'insuline +/- metformin jusqu'à ce que le contrôle glycémie soit atteints (ensuite on peut penser à enlever l'insuline avec l'ajout d'un agent orale)

Answer 14

Symptômes hypoglycémie, Hypoglycémie au moment des symptômes Correction des symptômes lorsque l'hypoglycémie est corrigé

Answer 15

48 - 72 hour fast with capillary glucose monitoring until glucose drops (<3.3 mmol/L), increase to q1hr bloodwork If venous glucose confirmed < 3 mmol/L, send samples for diagnostic workup (next slide)

Answer 16

We akness, lethargy, GI symptoms – not very specific Hyponatremia, hyperkalemia Orthostatic hypotension, hypoglycemia, uremia Hyperpigmentation – 1ère AI only Primaire: ACTH HAUT et Cortisol bas

Answer 17

Inferior Petrosal Sinus Sampling (IPSS): Gold standard for differentiating pituitary (CD) vs. ectopic ACTH secretion (usually paraneoplastic) Concernant le test dexamethasone 8mg: Poor test characteristics, thus 8mg Dex no longer recommended by newer guidelines; MRI +/- IPSS is used instead

Answer 18

Alpha blockade: Phenoxybenzamine or Doxazosin * Beta blockade ONLY AFTER high dose alpha blockade * Avoid surgery until at least two weeks of adequate alpha blockade, with liberal salt and fluid intake Periopératoire: Phentolamine IV PRN

Answer 19

On fait un CT sans contraste

Answer 20

– Disruption of the stalk à decreased dopamine; Prl rarely >100 – Lactotroph adenoma (prolactinoma); if ~1cm in size, Prl ~100 – Anti-dopaminergic drugs à antipsychotics especially – Hypothyroidism, renal failure – Physiologic stimuli – nipple, chest wall trauma, sex – Estrogen effect on lactotrophs->OCP

Answer 21

Avec de la carbegoline: plus efficace, mieux toléré (Pas étudier en grossesse) Bromocriptine : older, Plus d'effet secondaire, moins cher

Answer 22

Magrognathia, macroglossie, OSA, carpal tunnel, osteoartrite, DB2, visual field defects, cranial neuropathies Screening test: IGF-1 lever Test diagnostic : 75 g glucose suppression

Answer 23

- Women ≥40 years of age (or postmenopausal) * Men ≥40 years of age * Consider earlier in ethnic groups at increased risk such as South Asians or Indigenous individuals * In women with pregnancy-related complication (GDM, HTN, Pre-term birth, LowBW), screen with complete lipid profile in late postpartum period (incr. risk of premature CVD and stroke 10-15yr post-delivery)

endocrinologie Flashcards

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