Term
| Drugs to avoid during thyroid storm |
|
Definition
ASA -> increases T3 & T4
Sedatives -> obscures CNS picture
Atropine -> Incr HR / counteracts b-blockade |
|
|
Term
| Work up for a child w/pituitary deficits |
|
Definition
|
|
Term
| Nitroprusside test is a test for? |
|
Definition
| Test for urine/serum ketone (ONLY ACETOACETATE) |
|
|
Term
| Physicial findings of hypothyroidism |
|
Definition
Bradycardia
Thyroidectomy scar
Thin eyebrows/scant body hair
Dry, scally, yelow skin
puffy eyes
abd distention 2ry to fecal impaction
Urinary retention
Ascites
Ileus
Cheyne's reflexes - brink upstrokes w/slow relaxation phace, expecially @ ankles |
|
|
Term
| Tx of PSVT 2ry to hyperthyroidism |
|
Definition
| Propranolol - partially blocks conversion of T3 & T4 |
|
|
Term
| Precipitating events i thyroid storm |
|
Definition
Infxn - MC pulmonary
DKA, Incr osmolar coma
Graves
Any event that incr. thyroid hormone synthesis (synthroid O/D) |
|
|
Term
| Thyroid storm mortality rate if untreated |
|
Definition
100% in 72 hrs
CHF-> refractory pulm edema -> CV collapse->
Progress CNS dysfxn->obtunded->coma |
|
|
Term
| Conditions that may precipitate NKHC |
|
Definition
| MI, Infxn (Gram (-) sepsis), CVA, GIB, Pyelo, Uremia, SDH |
|
|
Term
|
Definition
Tx the cause, (i.e. bronchogenic CA, meningitis)
Symptomatic:
3% Na 3ml/kg q 10-20 min
Lasik 1mg/kg
PTN 5-10 mh/kg
Asymptomatic: fluid restriction (<1000ml daily) |
|
|
Term
|
Definition
Decreased: serum Na+ & ormolality (<280 mOsm), hypouricemia
Increased: Urine Na+ (20-30 mEq/L) & urine osmolality (>100 mOsm/kg of water) |
|
|
Term
| Rx thyroid storm & their mech of action |
|
Definition
PTU: block thyroid hormones synthesis & inhibits conversion T4 to T3
Iodide: inhibits thyroidal release of stored hormones
Propranolol: decr. sypathetic hyperactivity, blocks peripheral conversion T4 to t3 |
|
|
Term
| Exogenous causes of hypoglycemia |
|
Definition
MC in diabetics: Insulin
Sulfonylureas
Alcohol: decr. NAD+->inhibition of gluconeogenesis
Salicyalte
Propranolol & other BB
Haldol
Penothiazines
Disopyramide (elderly)
Pehenylbutazone
MAOI |
|
|
Term
| Clinical conditions assoc. w/hyponatremic (hypotonoic) dehydration |
|
Definition
Diuretic excess
Fluid space losses
Vomiting
Adrenocortical insufficiency |
|
|
Term
| Dx criteria for thyroid storm |
|
Definition
|
|
Term
|
Definition
| ❑ Supportive ❑ IV thyroxine 400-500 microgr slow infussion, then 50-100 microgr/day |
|
|
Term
| Which process losses more K+: DKA or NKHOC? |
|
Definition
|
|
Term
| Pathophys of neonatal thyrotoxicosis |
|
Definition
| • 1-5% infants born to hyperthyr. mothers • AAP: "Antibodies to the thyroid-stimulating hormone receptor (TSH-R) (stimulating or blocking) freely cross the placenta and can act in the fetal thyroid gland during the second half of pregnancy." |
|
|
Term
| Meds that may precipitate NKHOC |
|
Definition
| Thyazides, prazoxide, phenytoin, steroids, mannitol, cimetidine, inderal, CCB, immunosuppressives |
|
|
Term
| Why may we underestimate the degree of dehydration n diabetes insipidus |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Male presentation of congenital adrenal hyperplasia |
|
Definition
| • Ambiguous genitalia • Thought to be a boy w/bilateral cryptorchidism |
|
|
Term
| Female presentation of congenital adrenal hyperplasia |
|
Definition
| • Acute salt losing crisis or precocious puberty caused by ↑ virilization in uterus |
|
|
Term
| Labs findings in adrenal insufficiency |
|
Definition
|
|
Term
|
Definition
| Abrupt cessation of steroid in a chronic steroid user |
|
|
Term
|
Definition
|
|
Term
| Initial management of SIADH |
|
Definition
| H2O restriction + 3% saline (to avoid Sz & dysrhythmias) |
|
|
Term
| Initial management of SIADH |
|
Definition
| H2O restriction + 3% saline (to avoid Sz & dysrhythmias) |
|
|
Term
| DDX fasting hypoglycemia (endogenous) |
|
Definition
| Islet cell tumor, extrapancreatic tumor, hypopituitary, hepatic dz, Reye's Synd, CRF, starvation, myxedema, autoimmune, prolonged strenuous exercise |
|
|
Term
|
Definition
| 90% - 21-hydroxylase def : recessive inheritance; 1 in 15k birth |
|
|
Term
|
Definition
| Newborn, thymic aplasia (CXR), hypoparathyroidism, hypocalcemia |
|
|
Term
|
Definition
|
|
Term
| DDx in Acute Adrenal Inuff in child |
|
Definition
| • 1°: CAH, autoimmune, TB, meningo, adrenal hemo •2°: ACTH supress by steroids, pit or hypothal tumor, congenital hypopitui., CNS Sx or imad, septo-optic dysplasia |
|
|
Term
|
Definition
| Also called DIDMOAD: Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness |
|
|
Term
| Management of acute adrenal crisis |
|
Definition
| • Rapid volume expansion •Hydrocortisone 50-100 mg •Na •D10 •Tx hyperK •Tx stressors |
|
|
Term
| 95% of all hypothyroidism |
|
Definition
|
|
Term
|
Definition
| • Prior tx of Graves w/radioactive iodine or subtotal thyroidectomy • Autoimmune d/o |
|
|
Term
| Neuro findings in NKHOC directly correlates with? |
|
Definition
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