Metabolic IM Flashcards
(42 cards)
Symptoms of Hypothyroidism?
Cold intolerance
Weight gain
Lethargy
Bradycardia
Constipation
Proximal myopathy
Slow relaxing reflexes
Nerve entrapment
Impaired cognition
Coarse, smooth skin
Menorrhagia
Infertility
Symptoms of Myxoedema coma?
Hypothermia
Pericardial effusion
Cardiac failure
Altered mental status
Hypoventilation
Symptoms of Hyperthyroidism?
Heat intolerance
Weight loss
Irritability, insomnia
Palpitations
AF
Diarrhoea
Anxiety
Rest tremor
Lid lag
Proximal myopathy
Brisk reflexes
Sweaty, warm skin
Oligomenorrhoea
Symptoms of thyroid storm/thyrotoxicosis?
Hyperpyrexia
Tachycardia
Cardiac failure
Vomiting
Diarrhoea
Jaundice
Delirium, seizure, coma
2 phases of thyroiditis?
Hyperthyroid phase at first, then hypothyroid.
Thyroid inflammation initially causes release of pre-formed hormones. After gland damage, hypoT arises. With continued antibody stimulation (e.g. Hashimoto’s), a goitre will grow.
Goitres are initially ____, but may become____ with time. Similar to idiopathic MNG
Goitres due to longstanding iodine deficiency are usually initially diffuse. But can become Multinodular over time cuz some thyroid follicles grow faster than others.
Which biochemical test has highest sensitivity and specificity in diagnosing thyroid disorders?
TSH
Normal TSH makes thyroid disorder unlikely
Difference between DKA vs HHS?
HHS = still abit of insulin secretion. Sufficient to prevent DKA by suppressing lipolysis and in turn, ketogenesis.
DKA affects T1DM, HHS affects T2DM
DKA is acute onset, HHS usu over days.
Pathophysiology is similar tho
How does pituitary adenoma cause secondary hyperthyroidism?
Pit adenoma can suppress other pituitary hormones. Gonadotropins are lost first and TSH is only suppressed very late.
Reproductive-aged patients will have amenorrhea or loss of libido before hypoT manifests.
What does pituitary gland produce?
Prolactin
Follicle-stimulating hormone (FSH)
Luiteinising hormone (LH)
ACTH
ADH (release only)
Growth Hormone
Oxytocin
Typical clinical features of DKA and HHS?
Polyuria, polydipsia, N/V, volume depletion, eventually altered mental state and coma.
DKA uniquely has fruity breath, hyperventilation, abdo pain.
Principles of treatment of DKA and HHS?
IV fluid resuscitation, electrolyte repletion, insulin therapy
What is acromegaly?
Pituitary adenomas cause excess secretion of GH and IFG-1.
Signs of acromegaly?
Headache, vision loss, CN palsies
Coarsening of facial features
Soft tissue overgrowth e.g. enlarged nose, widened hands fingers feet
Need to increase shoe/ring sizes?
5 ‘P’s of Phaeochromocytoma?
high blood Pressure
head Pain
Perspiration
Palpitations
Pallor
3 criterias for Pyrexia of unknown origin?
T >38.3
3 weeks
Have undergone workup
Stigmata of dyslipidemia?
Xanthelesma
Xanthomas
Arcus cornealis
Thick achilles tendon
What is corneal arcus and what does it mean?
Blue ring around cornea.
Sign of HTN, high CRL, atherosclerosis
Causes of hypoglycemia in diabetics?
Insulin overdose/non-compliance/not eating
Increased physical activity
Alcohol consumption
Concomitant kidney/liver dysfunction
Infection / operation / body stress
Infection can cause hypoglycemia even in well controlled DM
How often to trend HbA1c in diabetics?
What should pre-meal blood glucose be for good control?
Trending HbA1c should be at least every 3-6 months.
Pre-meal blood glucose should be below 7
Symptoms of proteinuria?
Swelling of eyes and legs
Urinary frequency
Cramping muscle
SOB on exertion
Mnemonic SUCS
What cancer is acromegaly associated with?
Colorectal Cancer
What is hot vs cold nodule on Tc-99 thyroid scintography?
Thyroid nodules that absorb the radioiodine are usually not cancerous (called hot)
Thyroid nodules that do not absorb the radioiodine are called cold and have a 5% risk of being cancerous.
95% of thyroid nodules are cold.
4 specific signs of Graves?
Chemosis
Exophthalmos
Pretibial myxedema
Thyroid acropachy
