Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
51 Cards in this Set
- Front
- Back
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?
|
A100. Subacute Thyroiditis; other: Silent thyroiditis
|
|
Q101. Dx: fever with severe neck pain, focal tenderness of involved portion of thyroid
|
A101. Suppurative Thyroiditis
|
|
Q102. Dx: slowly enlarging rock hard mass in anterior neck, tight and stiff neck, fibrosis of mediastinum
|
A102. Riedel's Thyroiditis
|
|
Q103. what labs allow you to distinguish b/t Subacute, Silent and suppurative thyroiditis?
|
A103. Silent: high serum Thyroglobulin levels only (and possible Antimicrosomal Ab); Subacute: high serum Thyroglobulin levels and WBC left shift; Suppurative: WBC with left shift only
|
|
Q104. What is Tx for: 1. Pain from Subacute thyroiditis; 2. Suppurative thyroiditis; what should never be given to any thyroiditis patient?
|
A104. 1. NSAIDs (or steroids); 2. IV Abx and drainage of abscess; Never give PTU to thyroiditis
|
|
Q105. *Best test to evaluate a thyroid nodule
|
A105. Fine-needle aspiration
|
|
Q106. If thyroglobulin levels return to normal after a thyroidectomy, what does that suggest?
|
A106. Absence of metastatic thyroid tissue
|
|
Q107. what test distinguishes b/t Hot and Cold thyroid nodules?; what is the difference b/t them?; which is more likely malignant?
|
A107. Thyroid Scan with t-99; Hot: Hyperfunctioning thyroid; less likely malignancy; Cold: Hypofunctioning thyroid; more likely malignant
|
|
Q108. (4) Types of thyroid Cancer; which is most common?; has best prognosis?; worst prognosis (0% survival in 5 yrs)?; Seen in MEN II and III?
|
A108. 1. Papillary - MC; best prognosis; 2. Follicular; 3. Anaplastic - worst prognosis; 4. Parafollicular (Medullary) - in MEN II and III
|
|
Q109. Thyroid CA: ground-glass "Orphan Annie" nuclei and psammoma bodies
|
A109. Papillary
|
|
Q110. Thyroid CA: good prognosis but commonly bloodborne mets to bone and lungs
|
A110. Follicular
|
|
Q111. Thyroid CA: cancer of the "C" cells, derived from branchial pouch 5 and secretes Calcitonin; (2 names)
|
A111. Parafollicular; (Medullary thyroid CA)
|
|
Q112. Tx for any thyroid CA; (2)
|
A112. Thyroidectomy; Oral thyroxine supplements after surgery
|
|
Q113. Definition: hypersecretion of PTH by the parathyroid gland
|
A113. Primary Hyperparathyroidism
|
|
Q114. Definition: Glandular hyperplasia and elevated PTH in an inappropriate response to hypocalcemia
|
A114. Secondary Hyperparathyroidism
|
|
Q115. Definition: continued elevation of PTH after the disturbance causing secondary hyperparathyroidism has been corrected
|
A115. Tertiary Hyperparathyroidism
|
|
Q116. Etiology of Hyperparathyroidism; (3)
|
A116. Hyperplasia of all 4 glands;; Adenoma/carcinoma;; MEN II and III
|
|
Q117. Pathophysiology of the parathyroid gland; (4 ways to increase Calcium)
|
A117. PTH increases serum Ca levels: 1. stimulates renal hydroxylation of Vit-D (needed for GI to absorb Ca); 2. Increases renal resorption of Ca; 3. Decreases renal resorption of phosphorus;; 4. Increases Osteoclastic resorption of bone (via osteoblast receptors)
|
|
Q118. what do lab tests show to Dx Hyperparathyroidism?; (3)
|
A118. high serum calcium (low phos);; high serum PTH;; hypercalciuria
|
|
Q119. what are the indications for surgery with Dx of hyperparathyroidism?; (2)
|
A119. Adenomas should be removed;; Hyperplasia of all four glands: remove and reinsert a small portion of one on the SCM so that it is accessable if problems arise
|
|
Q120. Emergent measures taken (PRN) with hyperparathyroidism; (3)
|
A120. 1. Hydration with Lasix; 2. Bisphosphonates to block bone resorption; 3. Calcitonin
|
|
Q121. When is Mg deficiency seen?; (3)
|
A121. SAP: SIADH;; Alcoholism;; Pancreatitis
|
|
Q122. Etiology of Hypoparathyroidism; (3)*
|
A122. HID Parathyroids: Hypomagnesium;; Infiltrative CA / Irradiation;; DiGeorge Syndrome;; Post-surgical
|
|
Q123. Dx: 30-yo woman presents with perioral paresthesia and long QT interval. She recently had surgery on her goiter.
|
A123. Hypoparathyroidism
|
|
Q124. Dx: seizures, perioral paresthesia, tetany, fasciculations, muscle weakness, CNS depression, faint heart sounds, bronchospasm
|
A124. Hypoparathyroidism
|
|
Q125. What is seen in hypoparathyroidism on the EKG?
|
A125. QT prolongation
|
|
Q126. Tx for hypoparathyroidism; (life-threatening versus maintenance)
|
A126. Life-threatening: IV Calcium; Maintenance: Calcitriol and oral calcium
|
|
Q127. Dx: Similar characteristics to Hypoparathyroidism, but tissue is resistant to PTH, causing an INCREASE in serum PTH
|
A127. Pseudohypoparathyroidism
|
|
Q128. What is pseudohypoparathyroidism assoc with?
|
A128. Albright's hereditary osteodystrophy
|
|
Q129. If you suspect over-the-counter thyroid hormone abuse, TSH is low and T4 is high, what other lab test can you check?
|
A129. Thyroglobulin levels will be low.
|
|
Q130. Radioactive iodine uptake scan is increased in (3)
|
A130. Graves' disease; toxic adenoma/toxic nodules; multinodular goiter
|
|
Q131. Radioactive iodine uptake scan is decreased in (4)
|
A131. subacute thyroiditis (hyperthyroid stage),; hashimotos thyroiditis (hypothyroid stage),; exogenous T3/T4/levo,; postpartum thyroiditis
|
|
Q132. In which conditions are thyroglobulin levels high?
|
A132. Thyroiditis,; iodine-induced thyrotoxicosis,; amiodarone-induced thyrotoxicosis
|
|
Q133. Medications that increase the need for thyroid hormone are (4)
|
A133. estrogen,; rifampin,; carbamazepine,; phenytoin
|
|
Q134. TSH and Free T4 are both decreased in these two conditions:
|
A134. pituitary hypothyroidism,; hypothalamic hypothyroidism
|
|
Q135. Most cases of hyperthyroidism can be treated with (2)
|
A135. propylthiouracil or methimazole. Severe cases require radioactive ablation.
|
|
Q136. Why can't you give methimazole during pregnancy to treat hyperthyroidism?
|
A136. It can cause aplasia cutis in the fetus
|
|
Q137. Another name for Primary Adrenal insufficiency
|
A137. Addison's Dz
|
|
Q138. Dx: shock, dehydration, confusion, vomiting, hyperK and Hypoglycemia; What are the (3) causes?
|
A138. Addisonian (or adrenal) crisis causes: Hemorrhage;; Sepsis;; Trauma
|
|
Q139. (2) main causes of Addison's Dz
|
A139. Autoimmune (80%);; TB (15%)
|
|
Q140. MCC of Secondary adrenal insufficiency; (2) other causes
|
A140. MCC: Exogenous steroid drugs others: Sheehan's syndrome;; Pituitary infarct
|
|
Q141. How is Aldosterone made?; (2) functions
|
A141. Angiotensin II acts on the zoNa glomerulosa to convert cortisone to aldosterone Functions: Increase sodium reabsorption;; secretion of K+ and H+
|
|
Q142. What does a deficiency in aldosterone cause with electrolytes?; (2)
|
A142. HyperK; HypoN
|
|
Q143. Dx: 18-yo man with hemophilia A who was recently mugged (receiving multiple blows to head and abdomen) is now complaining of dizziness, abdominal pain, dark patches on his elbows and knees, and uncontrollable cravings for pizza and french fries
|
A143. Primary Adrenal Insufficiency; (Addison's Dz)
|
|
Q144. How is secondary insufficiency distinguished from Addison's Dz?; (3)
|
A144. No hyperpigmentation;; Normal aldosterone secretion;; Signs of hypopituitarism (hypothyroidism or hypogonadism)
|
|
Q145. What is Cortisol's relation to glucose?; (2)
|
A145. Stimulates gluconeogenesis by increasing protein and fat catabolism;; Decreases utilization of glucose and sensitivity to insulin
|
|
Q146. How does cortisol promote an anti-inflammatory state?; (3)
|
A146. Inhibits Arachidonic Acid;; Inhibits IL-2 production;; Inhibits release of histamine from Mast cells
|
|
Q147. Definition: Hemorrhagic necrosis of the adrenal medulla during the course of meningococcemia
|
A147. Waterhouse-Friderichsen Syndrome
|
|
Q148. Dx: hyperpigmentation, salt cravings, orthostatic hypotension, amenorrhea
|
A148. Addison's Dz; (primary adrenal insufficiency)
|
|
Q149. Describe the ACTH (Cortrosyn) test to Dx Adrenal insufficiency etiology; How does it distinguish b/t primary and secondary?
|
A149. Give ACTH and measure at zero and 30 minutes. A level of < 18 at 30 = adrenal insufficiency; Measure plasma ACTH after test: Primary = high ACTH; Secondary = low ACTH
|
|
Q150. Tx for adrenal insufficiency; what additional Tx for Addison's only?
|
A150. Tx: Glucocorticoid replacement (especially at times of stress); additional for Addisons: Mineralcorticoid replacement
|