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51 Cards in this Set
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- Back
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Q050. Dx Tests for Hypoglycemia; (2)
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A050. 1. Low serum glucose < 50mg/dL; 2. ask lab to test C-peptide to distinguish b/t Endogenous insulin (high C-peptide) or Exogenous insulin(low)
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Q051. If alcoholism or nutritional deficiency is a suspected reason for hypoglycemia, what should be placed with the IV of dextrose?; Why?
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A051. Thiamine to prevent Wernicke's encephalopathy
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Q052. Hospital Tx for Hypoglycemia; (3 steps)
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A052. 1. IV amp of 50% dextrose; 2. if no improvement, give a second amp; 3. continue to infuse 10% dextrose until serum glucose is > 100mg/dL
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Q053. if hypoglycemia is refractory after Tx and there are associated signs of adrenal insufficiency, what is Tx?
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A053. give Hyrdocortisone 100-200mg IV
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Q054. what is used to resuscitate hypoglycemic coma?; what type of patient will this Tx not work on?
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A054. Glucagon IM; won't work on Alcoholic with liver failure
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Q055. What does a glucagonoma present with?; (3)
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A055. 1. new-onset DM; 2. weight loss; 3. characteristic rash (necrolytic migratory erythema)
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Q056. How is insulin related to Catecholamines?; (2)
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A056. 1. Inc insulin leads to hypoglycemia, leading to tachycardia, sweating and anxiety; 2. Pheochomocytoma patient have inc risk of hyperglycemia and DM
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Q057. How does Cortisol relate to glucose levels?; (2)
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A057. 1. Too much cortisol (Cushings) leads to hyperglycemia and DM; 2. Too little cortisol (Addisons) leads to hypoglycemia
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Q058. How does GH relate to glucose levels?; (2)
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A058. 1. high GH in acromegaly, leads to hyperglycemia and DM; 2. neonatal hypoglycemia is a cardinal sign of GH deficiency
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Q059. List the 5 signs (any 3 of which can confirm Dx) to properly Dx Metabolic syndrome
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A059. 1. Fasting glucose > 110 mg/dL; 2. Abdominal obesity; 3. Serum TG > 150 mg/dL; 4. HDL-C < 40 in men and < 50 in women; 5. Blood Pressure > 130/85 (or on BP meds)
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Q060. (3) causes of Macroglossia
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A060. Acromegaly;; Myxedema;; Amyloidosis
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Q061. Definition: Increased synthesis and secretion of free thyroid hormones resulting in hypermetabolism
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A061. Hyperthyroidism
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Q062. Etiology of Hyperthyroidism; (4)
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A062. Grave's Dz;; Toxic Nodular Goiter;; Plummer's Dz (toxic adenoma);; Subacute thyroiditis
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Q063. Dx: heat intolerance, sweating, palpitations, weight loss, tremor, nervousness, weakness, hyperdefication
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A063. Hyperthyroidism
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Q064. When is the only time TSH is increased and TRH is decreased?
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A064. Pituitary tumor (secretes TSH)
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Q065. When is the only time TSH and TRH are both increased (with T3 and T4 decreased)?
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A065. Primary Hypothyroidism
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Q066. Definition: A medical emergency consisting of an exaggerated manifestation of hyperthyroidism
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A066. Thyroid Storm
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Q067. Etiology of a Thyroid Storm; (4)
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A067. 1. Trauma, infection;; 2. DKA;; 3. MI, CVA, PE;; 4. Withdrawl from anti-hyperthyroid meds
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Q068. Dx: fever, tachycardia, high-output CHF and volume depletion, exhaustion, diarrhea, abdominal pain, agitation and confusion, possible jaundice
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A068. Thyroid Storm
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Q069. What is the BP change with hyperthyroidism?
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A069. Isolated systolic HTN
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Q070. (4) Primary stabilization Tx for a Thyroid Storm
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A070. Airway protection;; Oxygenation;; Assess circulation and BP;; IV hydration
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Q071. Aside from primary stabilization, how is a Thyroid Storm treated?; (4 together)
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A071. 1. Beta-blocker - block adrenergic effects;; 2. Acetaminophen - fever;; 3. PTU - block new thyroid hormones; 4. Iodine - 1.5 hrs after PTU to decrease release of preformed thyroid hormones
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Q072. Definition: Autoimmune Dz causing hyperthyroidism due to Ab, which stimulates TSH receptor
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A072. Graves Dz
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Q073. Dx: diffusely enlarged thyroid, exopthalamos, pretibial myxedema, tachycardia
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A073. Graves Dz
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Q074. Dx tests for Graves Dz; (4)
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A074. 1. High radioactive iodine uptake; (if present but low, then Dx is thyroiditis); 2. high Free thyroid hormones;; 3. Undetectable TSH levels;; 4. High thyroglobulin levels
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Q075. what is the Long-term anti-thyroid therapy?; complication?
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A075. PTU; complication: Leukopenia
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Q076. what is the preferred Tx for Graves Dz?; AE?
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A076. Radioactive Iodine Ablation Therapy; AE: can result in Hypothyroidism over time
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Q077. what should be used as adjunctive therapy for Graves Dz?
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A077. Adrenergic Antagonist: Propranolol
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Q078. Definition: TSH levels are more then twice the upper limit of normal
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A078. Hypothyroidism
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Q079. Etiology of Primary Hypothyroidism; (5)
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A079. Hashimoto's thyroiditis;; Radiation to neck;; Subacute thyroiditis;; Iodine deficiency (or excess);; Medications: Lithium
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Q080. Etiology of Secondary Hypothyroidism; (3)
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A080. Secondary = Pituitary problem: Sheehan's syndrome;; Pituitary neoplasm;; Infiltrating Dz (TB) causing TSH deficiency
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Q081. Etiology of Tertiary Hypothyroidism; (3)
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A081. Tertiary = Hypothalamic problem: Granuloma;; Neoplasm;; Radiation
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Q082. Dx: fatigue, lethargy, weakness, weight gain, constipation, cold intolerance, slow speech, dry skin, brittle hair, delayed deep tendon reflexes
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A082. Hypothyroidism
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Q083. Because muscle weakness and cramps are associated with both hyper and hypothyroidism, how can you tell the difference with CPK level?
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A083. Hyper: CPK is normal; Hypo: CPK is elevated
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Q084. what additional lab tests may be elevated or decreased with hypothyroidism?; (4 categories)
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A084. Increased: 1. Cholesterol and TG; 2. LFTs: LDH, AST, ALT, MM of CPK; Decreased: 3. Hct and Hb; 4. serum sodium
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Q085. If a patient presents with high cholesterol, what should you consider testing?
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A085. thyroid function tests; (since high cholesterol is a sign of hypothyroidism)
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Q086. what test is useful from distinguishing secondary from tertiary hypothyroidism?; what are the results of each?
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A086. TRH stimulation test: Secondary: Low; Tertiary: normal
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Q087. Tx for Hypothyroidism; How often do you check meds?; How is therapy monitored (b/t primary and secondary hypothyroidism)?
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A087. Low-dose Levothyroxine (increase dose every 6 to 8 weeks, depending on patient's response); Primary: measure TSH levels; Secondary: measure T-4 levels
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Q088. Definition: elevated TSH with normal thyroid hormone levels in the absence of overt clinical symptoms; what are the (2) possible prognosis?
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A088. Subclinical Hypothyroidism; 1. can become Primary Hypothyroidism; 2. become Euthyroid
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Q089. Tx parameters for replacement therapy for Subacute Hypothyroidism; (3)
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A089. 1. All patients with TSH > 10; 2. Patients with TSH > 5 and Goiter or Anti-thyroid Ab; 3. All patients with History of Iodine therapy
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Q090. (2) Antibody tests that are positive in Hashimoto's thyroiditis
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A090. Anti-thyroglobulin; Anti-microsomal
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Q091. Definition: Life-threatening complication of Hypothyroidism with profound lethargy or worse, usually assoc. with hypothermia
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A091. Myxedema Coma
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Q092. Etiology of Myxedema coma; (4)
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A092. Sepsis;; Prolonged exposure to cold weather;; CNS depressants;; Trauma/surgery
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Q093. Dx: hypothermia with rectal temp < 95; bradycardia or circulatory collapse; severe lethargy; delayed relaxation of DTR or Areflexia
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A093. Myxedema Coma
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Q094. Tx for Myxedema coma (in order); (5)
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A094. 1. Airway management; 2. Prevent further heat loss; 3. Glucocorticoids; 4. IV Levothyroxine; 5. IV hydration (D5 1/2 NS)
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Q095. Why are glucocorticoids given before levothyroxine in the Myxedema patient?
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A095. due to the concern that the patient may have associated Addison's Dz. Giving only thyroxine could initiate an Addisonian crisis
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Q096. In Hashimoto's Thyroiditis, what destroys the thyroid?
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A096. CD-4 lymphocytes
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Q097. What PE finding distinguishes Hashimoto's from other forms of Thyroiditis?
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A097. Thyroid is not tender
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Q098. Etiology of Thyroiditis types: 1. Subacute; 2. Silent; 3. Suppurative; 4. Riedel's
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A098. 1. Subacute: Post-viral (usu a UTI); 2. Silent: Postpartum (autoimmune); 3. Suppurative: Bacterial or fungal (commonly seen with PCP in HIV pt); 4. Riedel's: Fibrous infiltration of unknown etiology
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Q099. Dx: 35-yo female with History of hyperthyroidism and recent flu presents with neck pain and elevated ESR
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A099. Subacute Thyroiditis
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Q100. Dx: tender, enlarged thyroid, fever and signs of hyperthyroidism; jaw or tooth pain; hypothyroidism may develop; what other Dx is similar to this without tenderness?
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A100. Subacute Thyroiditis; other: Silent thyroiditis
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