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Endocrine Two > final > Flashcards

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1
Q

Tx of hypothyroid

A

levothyroxine

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2
Q

Goal TSH

A

0.5-2.5 (LESS than 2.5 if tx hypothyroid)

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3
Q

Do not take levothyroxine at same time as what?

A

Calcium, multivitamins, food supplements, antacids

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4
Q

If what is high, subclinical hypothyroid will most likely progress to clinical hypothyroid?

A

If borderline thyroid peroxidase test (high end). Consider tx with levothyroxine

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5
Q

Labs in hypothyroid

A

elevated TSH, low/normal free T4/3

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6
Q

***A-fib=likely what? (Bush)

A

hyperthyroid –> tx thyroid and afib will go away

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7
Q

What do these do?

Estrogens. BCPs, Pregnancy, acute liver disease, congenital protein abnormalities, hypothyroidism

A

Six things that increase binding proteins, thus increase the amount of BOUND/INACTIVE thyroid hormone.
TSH, Free T4, free T3 unaffected).

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8
Q

What do these do?

androgens, steroids, protein malnutrition, nephrotic syndrome, hyperthyroidism

A

Five things that decrease binding proteins. TSH/Free T4/Free T3 not affected.

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9
Q

What thyroid test most accurately reflects pituitary response to circulating active/free hormone? In what case do you NOT draw this

A

TSH

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10
Q

Ophthamopathy/lid lag/etc. = ?

A

Grave’s disease

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11
Q

What autoimmune process is responsible for Grave’s?

A

Thyrotropin receptor Blocking antibodies (TRAb) = hyperthyroid

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12
Q

Do not tx pregnant woman with hyperthyroid with what two things?

A

Methimazole and RAI

PTU is ok.

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13
Q

High thyroid uptake - tx with?

Low thyroid uptake - tx with?

A
  • low dose RAI

- PTU (or high dose RAI)

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14
Q

Diffuse uptake seen in?
Patchy uptake seen in?
Low uptake seen in?

A

**Diffuse RAI uptake = Graves
Patchy RAI uptake = Multinodular goiter
**Low RAI uptake = postpartum thyroiditis

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15
Q

Describe postpartum thyroiditis

A

Self limiting, decreased uptake, releasing pre-formed thyroid

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16
Q

What drug can cause hypothyroid?

A

1) amiodarone - high iodine content
(low uptake (bc you have so much already), hyper/hypothyroid)
-PTU to tx
2) lithium (goiter)

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17
Q

***Trust TSH except in: In euthyroid sick, when should you not draw TSH levels, and in what phase will TSH be elevated?

A

Do not draw in ICU bc:

  • Sick phase = TSH low/normal; T3/T4 low (everything shut down)
  • Recovery phase = TSH elevated
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18
Q

biopsy based upon what size and type of nodule?

A
  • size: 1+cm

- cold nodule (NOT hot nodule)

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19
Q

Only do RAI in what setting?

A

hyperthyroid

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20
Q

Two most common causes of hypercalcemia

A
  1. primary hyperparathyroidism

2. malignancy

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21
Q

Tetany, carpal pedal spasm, parasthesia of finger/toes, QT interval prolongation, laryngospams, bronchospams, death

A

HYPOcalcemia

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22
Q

***Evaluate hypocalcemia with

A
  • Chvostek (Facial nerve = mouth mm spasm)

- Trousseau - BP cuff, carpopedal spasm

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23
Q

What type of hormone is lipid soluble, cytoplasm/nuclear receptor, mRNA MOA, no storage,

A

Steroids and thyroid hormones

24
Q

What type of hormone is water soluble, surface membrane receptors, second messenger MOA, storage

A

Peptides and Protein hormones

25
Plasma proteins bind to what type of hormones to prolong half life?
steroid and thyroid hormones
26
Glandular tissue, portal vasculature via hypothalamus, neurohormone control
Ant pit
27
Neuronal tissue, direct vasculature
Post pit
28
Young female just gave brith, needed excessive blood transfusion - what is this?
Sheehan syndrome - hemorrhagic infarction of the anterior pituitary associated with excessive bleeding and HYPOfunction
29
Intracranial HTN and atrophy and pituitary - what is this?
Empty Sella Syndrome - anterior pituitary HYPOfunction.
30
Empty Sella Syndrome - describe pituitary labs/
normal labs, but possible slight increase in PRL
31
Pt presents with polydipsia, polyuria, hypotonic urine, high serum osmolarity, hypernatremia
DI
32
****Compare serum osmolarity in DI v. psychogenic polydipsia
``` DI = hyper-osmolar (hyperNa) Psychogenic = hypo-osmolar (dilutional hypoNa) ```
33
Lactotroph adenoma - tx with?
Dopamine agonist (bromocriptine) or transphenoidal surgery
34
Nelson Syndrome
After b/l adrenalectomy for Cushing Dz. Pt has pre-existing ACTH producing tumor. W/o the high cortisol/GC levels, no feedback inhibition, so tumor can grow --> HA, bitemporal hemianopsia, hyperpigmentation
35
What 3 complications/things have increased incidence in acromegaly?
Vascular dz (DM + HTN), sleep apnea, malignant colon polyps
36
GH is released in what fashion?
Pulsatile
37
These are caused by? -Oligo/amenorrhea, -galactorrhea Treat?
- hyperPRL ---> suppresses GnRH - estrogen Treat with dopamine agonist
38
DM labs
HbA1c = >6.5% (~200 average plasma glucose every day) Fasting plasma glucose = 126 Random plasma glucose = >200
39
HbA1c is affected by
Affected by reduced lifespan of red cells, like hemolytic anemia. - Increased red cell lifespan (i.e. iron deficiency anemia = falsely high), ***longer exposure to glucose*** - Acute blood loss = falsely low HbA1c. (shorter exposure to glucose)
40
Charcot foot - define
Sensory impariment dt peripheral neuropathy and reduced perfusion. Infection-->osteomyelitis-->amputate foot. **Altered foot mechanics lead to repeated fractures that destroy normal foot architecture**
41
LDL for anyone with established coronary vascular dz (i.e. bypass surgery), or multiple risk factors
LDL should be 70 or less
42
tx for DKA
insulin and fluids
43
Autoimmune adrenalitis
Addison's (hypONa; HypERK) --.
44
Hyperpigmentation in Addison's
Increased ACTH
45
adrenal insufficiency
Addison's
46
Do Addison's have adrenal reserves? So what?
no - so give exogenous CS when sick.
47
dehydration, hypotension, shock out of severity of current illness
Adrenal Shock - give CS
48
Supraclavicular Fat pads
Cushing's Disease
49
Cushing Dz v. Cushing Syndrome
Disease - pituitary ACTH dependent (pituitary adenoma) | Syndrome - iatrogenic
50
Proximal mm wasting and weakness, bone loss, glucose intolerance, thromboembolic events, immunity/infection, androgen excess in women
Cushing Syndrome
51
Screen adrenal incidentalomas for...
Cushing's and pheo
52
Primary hyperaldosteronism
conn syndrome - adrenal adenoma (idiopathic adrneal hyperplasia) = incr ald/dec renin
53
androgen/estrogen secreting tumors - malignant or benign?
malignant
54
HA, sweating, tachy
pheochromocytoma - adrenal medulla chromaffin cells
55
Discontinue what meds before testing for pheo?
antidepressants - amytryptaline, etc.
56
Small cell or oat cell carcinoma of the lung secrete?
ACTH
57
Tx of HTN in diabetics
ACE inhibitors (cheaper, AE cough) and ARBs to protect kidneys

Endocrine Two (16 decks)

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