Endocrine
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| What is carpopedal spasm? | A violent painful contraction of the hands or feet caused by decreased calcium and a significant sign of tetany.
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| Acute transient causes of hypocalcemia are: | burns, severe sepsis, pregnancy, extensive blood transfusions, acute pancreatitis, acute renal failure
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| What is trousseau's sign? | The first neuromuscular sign or carpal spasm. Indicative of hypocalcemia
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| What is Chvostek's sign? | 2nd neuromuscular sign assoc. with hypocalcemia. Abnormal unilateral spasm of facial muscle
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| Name some s/s of hypercalcemia. | confusion, abdominal pain, dehydration, weakness, polydipsia, anorexia, HTN n/v/constipation, PUD, pancreatitis, polyuria
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| Name GI manifestations of hypocalcemia include? | dysphasia, nausea, vomiting, abd. pain, cramping, biliary colic
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| Cardiovascular symptoms of hypocalcemia incude? | hypotension, bradycardia, chf, dysrhythmias, and prolonged QT intervals.
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| How does hypocalcemia affect the skin, nails, and hair? | dry, coarse, scaly skin, nails are rigid, brittle, and thin with grooves. alopecia may include thinning hair, eyebrows, lashes.
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| Gynecomastia results from an imbalance in what? | androgen and estrogen, or increase in prolactin
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| Name some medications implicated in gynecomastia. | highly antiviral therapy, CCB's, tricyclic antidepressants, SSRI's
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| What is hirsutism? | Increase in terminal hair growth on the face, chest, back, lower abdomen, pubic area, axilla, and inner thighs
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| What is vellus hair? | fine, soft, unpigmentedhair found all over the body
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| What is terminal hair? | dark, coarse, pigmented, thick. found on scalp, brows, axillary, pubic areas
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| A testosterone level of greater than ___ indicates the need for an ovarian tumor workup | 200ng/dL
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| If the DHEA-S level is above _____, an adrenal tumor workup is indicated | 700ng/dL
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| The LH/FSH levels are ______, in ___% of cases of polycystic ovarian disease | Increased
75
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| Women of _____ and _____ descent are likely to have increased terminal hair growth. | European / Mediterranean
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| Treatment of idiopathic hirsutism results from | POCS polycystic ovarian syndrome
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| Name some symptoms of laryngeal cancer. | cervical lymphadenopathy, increased neck size, pain, dyspnea, dysphagia, hemoptysis, stridor, hoarseness
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| Management of the pt. with increased neck size is to _____________ | treat the underlying cause.
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| Elevated T4 levels increase __________ causing _________ | metabolism, polyphagia
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| Name some differential diagnoses for polydipsia, polyuria, polyphagia. | DM, DI, diuretic abuse, head trauma, psychiatric disorders
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| Accompanying symptoms that indicate diabetes mellitis include: | weight loss, fatigue, increased susceptibility
to infections and nocturia
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| True or false. unintentional weight loss of >5% within 6-12 mos. may reflect a physical or psychological illness. | True
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| True or False. Underweight is defined as being 40% or more below ideal body weight. | False. 15-20%
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| True or False. BMI of 18 or lower is considered underweight. | True
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| True or False. a loss of 10% in 1-2 months is predictive of a poor clinical outcome. | True
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| Long term effects of hyperthyroidism include: | heart disease, osteoporosis, mental illness, and infertility
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| What age does hyperthyroidism peak? | 20-40 years
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| True or False. Hyperthyroidism is more prevalent in men than in women. | False. (8:1) Women
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| What disease is by far the most common cause of spontaneous hyperthyroidism in the US. | Graves Disease
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| What is Graves Disease? | An autoimmune disorder characterized by autoreactive, anonistic antibodies to the TSH receptor.
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| What is Plummer Disease? | A toxic multinodular goiter accounting for 15-20% of thyrotoxicosis cases
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| Other causes of hyperthyroidism, not so common, are: | iodine-containing drugs such as certain expectorants, amiodarone, seaweed-containing health food supplements, hydatiform molar pregnancy, ovarian teratomas, testicular cancinoma
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| Name some manifestations of thyrotoxicosis. | palpitations, diaphoresis, heat intolerance, anxiety
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| Symptoms of thyrotoxicosis in younger people. | tremors, anxiety, hyperactivity
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| Symptoms of thyrotoxicosis in older people. | afib, dyspnea, weight loss
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| What test demonstrates scattered areas of both increased & decreased iodine uptake. | nuclear scintigraphy
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| What is the Jod-Basedow effect? | autoregulation of the thyroid normally prevents thyrotoxicosis in the face of dietary iodine excess.
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| Radiation of the head and neck can increase the risk for what? | thyroid cancer
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| Cardiovascular manifestations of hyperthyroidism may include what? | tachycardia, irregular pulse, systolic murmurs, widening of the pulse pressure
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| What is thyroid storm? | severe, sometimes fatal form of hyperthyroidism, and requires immediate emergency medical care
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| Name some progressive symptoms of thyroid storm. | severe agitation, occasional psychosis, elevated temp, diaphoresis, tachycardia, heart failure, afib, aflutter, confusion, malignant expoththalmos, elevated free T4
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| Initial symptoms of thyroid storm | fever >100.4, nausea, vomiting. abdominal pain
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| contributing factors for thyroid storm. | acute infection, trauma, stress in patient with hyperthyroidism, uncontrolled DM, severe drug reaction, following withdrawal of antithyroid medication or radioactive iodine therapy
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| management of thyroid storm includes: | hospitalization and reversal of thyrotoxins: to block thyroid hormone synthesis, PTU is given daily in 2-4 divided doses. Methiamazole is generally not given during storm bc it does not prevent peripheral conversion of T4 to T3
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| What is the preferred test to assess for ophthalmopathy resulting from Graves Dx? | MRI. It is expecially helpful to r/o an orbital tumor
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| What is the goal of treatment for hyperthyroidism? | euthyroid
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| Patients intolerant of beta blockers can be treated with -------- | CCB's as an alternate therapy
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| What are the 3 treatment options for Graves disease? | antithyroid drugs, radioactive iodine, surgery. None of which alters the underlying autoimmune process of Graves disease
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| 2 Antithyroid drugs are being used at present. Name these. | l. PTU (propylthiouracil)
2. MMI (methimazole)
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| On findings of multi/uninodular goiters, what is the next step? | referral to an endocrinologist for possible malignancy
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| What is the preferred treatment in patients without significant thyroid gland enlargement? | Antithyroid drugs
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| Once a patient has achieved a euthyroid state, how often should they be seen? | every 4-6 weeks for 3-4 months
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| Common adverse reactions to antithyroid medications include what? | rash, urticaria, arthralgias
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| Rare but serious adverse reactions include: | agranulocytosis, aplastic anemia, hepatitis
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| How long are antithyroid drugs used after achievement of euthroid state? | 6-24 months
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| How long should women wait before becoming pregnant after receiving radioactive iodine therapy? | 4 months
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| What is subacute thyroiditis? | A self limiting condition treated with anti-inflammatory agents and prednisone
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| Patients need to be instructed that it takes how long to notice an improvement in symptoms bc of the amt. of stored hormone in the thyroid gland | 4 to 6 weeks
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| Persons receiving radioactive iodine, should avoid contact with what population? | infants, children, pregnant women
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| What is hypothyroidism? | a common treatable disorder in which there is a slow progression of thyroid hypofunction, followed by s/s indicating thyroid failure
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| Thyroid hormone deficiency beginning in early infancy and childhood is characterized by: | growth retardation, mental deficiency, and delayed dentition
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| Incidence of hypothyroidism is greater in men or women? | women 2-8 times higher
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| What is Hashimoto's thyroiditis? | A type of primary hypothyroidism; the most common form of autoimmune thyroid disease
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| Failure of the pituitary gland, hypothalamus, or both is called? | central hypothyroidism
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| Common symptoms of hypothyroidism include? | hoarseness, deafness, confusion, frank psychosis, dementia, ataxia, depression, cold intolerance, dry skin, hair loss
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| What is an iodine-containing antiarrhythmic drug that is a leading offender due to its effects directly on the thyroid gland? | Amiodarone
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| Early classic symptoms of hypothyroidism include: | dry skin, fatigue, slight weight gain, cold intolerance, constipation, & heavy menses.
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| What symptom/manifestation is seen with hypothyroidism? | a thick tongue
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