Family med Aquifer Exam Study Guide
Questions And Answers Verified 100% Correct
Describe the thyroid signalling pathway: - ANSWER- T4 feeds back to hypothalamus
=> affects levels TRH, which stimulates ant. pit to release TSH, which stimulates
thyroid to produce thyroid hormone
Subclinical hypothyroidism: - ANSWER- normal T4 but mildy elevated TSH (5-10mlU/L)
Thyroid labs during pituitary adenoma: - ANSWER- TSH normal, T4 elevated
who is most likely to get graves disease? - ANSWER- woman that is aged 40-60 and
has family history of thryoid problems and/or autoimmune problems
NOTE: triggers can include stress, high iodine intake, recent pregnancy
Signs of hypothyroidism: - ANSWER- Wt gain
cold intolerance
heavy periods
fatigue
NOTE: fatigue is common to both hyper and hypothyroidism
Two options for treating graves: - ANSWER- methimizole
radioactive iodine
Describe methimizole efficacy: - ANSWER- typically reduces Sx within 1 mo but takes 3
mo to be fully effective
need to take medication for many years
May cause agranulocytosis
Effective dose fluctuates over time => constantly check levels
clinical course of radioactive iodine treatment: - ANSWER- Most develop
hypothyroidism after several months, be sure to check TSH levels at least 2x/yr to
ensure adequate replacement of thyroid hormone
NOTE: overall, has very few side effects
,Things to watch for leading up to and immediately after radioactie iodine treatment: -
ANSWER- get a pregnancy test
Avoid kids and pregnant women for several days after to avoid exposure in urine and
feces.
May have neck pain that resolves (and is normal)
can have *worsening* of graves ophthalmopathy
What should be done with follow up after radioactive iodine treatment? - ANSWER-
Check to see if need to discontinue propranolol and or increase TSH
Check TSH every 2-3 mo. until stabilized, with counseling of patient on signs of
hypothryoidism
Considerations for when starting thyroid hormone replacement: - ANSWER- Typical
starting dose for primary hypothyroidism = 1.5-1.8 mcg/kg
titrate up SLOWLY, with TSH drawn every 6 wks
once titrated to adequate levels, can do 6 mo visits
Name a case where TSH is not adquate to diagnosing hypothyroidism: - ANSWER-
Primary pituitary pathology => pituitary is not releasing TSH in response to levels of T4
=> TSH levels are lower than normal in the presence of low T4
Normal radioactive iodine uptake: - ANSWER- 15-30%
pathologies with decreased radioactive iodine uptake: - ANSWER- Subacute thyroiditis
Silent thyroiditis
Iodine induced
Exogenous thyroxine
Struma ovarii
amio
DDx for palpitations: - ANSWER- Cardiovascular
Pysch: anxiety, panic attacks
Medications: caffeine, theophylline, albuterol
Substances: tobacco, cocaine
Endocrine: hyperthryoidism, Pheo, hypoglycemia
Hemotoligic: anemia
,Infectious: febrile illness
Contrast orthopnea and paroxsyamal nocturnal dyspnea: - ANSWER- orthopnea =
immediately after lying down, very rapid resolution
PND: due to CHF, wakes patient HOURS after falling asleep and is SLOWER to resolve
Contrast acute and chronic bronchitis: - ANSWER- acute = 1-3 weeks of productive
cough
Chronic = 3 months of last two years productive cough
Classic exam findings in COPD: - ANSWER- increased AP diameter
decreased diaphragmatic excursion
Wheezing -- esp. end expiratory
prolonged expiratory phase
How is COPD diagnosis confirmed? - ANSWER- spirometry, both before and after a
bronchodilator
NOTE: asthma responds to bronchodilator and COPD does NOT
Contrast maintenance of moderate vs. severe COPD: - ANSWER- Moderate = 50-80%
of expected FEV1, FEV/FRC <.70 tiotropium/ ipratropium inhaled
Severe = FEV1 30-50% of expected, give long acting anticholinergic plus long acting
inhaled corticosteroid
treatment of mild COPD: - ANSWER- metered dose albuterol, can step up to long acting
+ short acting if inadequately controlled
Vaccinations for all adults with COPD: - ANSWER- flu
pneumococcal
Tdap if overdue
Who should get the flu vaccine? - ANSWER- all perons older than 6 months old
recommendation for who gets pneumoccal vaccine? - ANSWER- all persons older than
65
19-64 if you have a chronic disease (COPD, asthma included)
, Treatment of acute COPD exacerbations: - ANSWER- Inhaled bronchodilators + oral
corticosteroids
antibiotics if: increased sputum, more purulent sputum, if exacerbation requires
mechanical ventilation
Screening for COPD: - ANSWER- only do PFTs in symptomatic patients, DO NOT
screen asymptomatic patients
DDx of SOB in man who smokes: - ANSWER- Acute bronchitis
Asthma
COPD
Lung Cancer
PHQ2 screening: - ANSWER- for depression:
"over the last two weeks, how often have you experienced any of the following?"
1. little interest or pleasure doing things
2. Feeling down, depressed, or hopeless
0 = not at all
1 = several days
2 = more than half the days
3 = nearly every day
frequency of mammogram: - ANSWER- every two years in aged 50-74
NOTE: ages 40-49 should be discussed and decided on as a team
colon cancer screening: - ANSWER- colonoscopy starting at age 50 and ending at age
75
repeated 10 years if NOTHING
5-10 if only 1-2 adenomas removed
Name cancers that have screenings that are not recommended: - ANSWER- testicular
pancreatic
ASYMPTOMATIC prostate cancer -- can screen if Sx
DDx in bright red blood in stool of adult male: - ANSWER- Colorectal carcinoma
colonic polyps
Questions And Answers Verified 100% Correct
Describe the thyroid signalling pathway: - ANSWER- T4 feeds back to hypothalamus
=> affects levels TRH, which stimulates ant. pit to release TSH, which stimulates
thyroid to produce thyroid hormone
Subclinical hypothyroidism: - ANSWER- normal T4 but mildy elevated TSH (5-10mlU/L)
Thyroid labs during pituitary adenoma: - ANSWER- TSH normal, T4 elevated
who is most likely to get graves disease? - ANSWER- woman that is aged 40-60 and
has family history of thryoid problems and/or autoimmune problems
NOTE: triggers can include stress, high iodine intake, recent pregnancy
Signs of hypothyroidism: - ANSWER- Wt gain
cold intolerance
heavy periods
fatigue
NOTE: fatigue is common to both hyper and hypothyroidism
Two options for treating graves: - ANSWER- methimizole
radioactive iodine
Describe methimizole efficacy: - ANSWER- typically reduces Sx within 1 mo but takes 3
mo to be fully effective
need to take medication for many years
May cause agranulocytosis
Effective dose fluctuates over time => constantly check levels
clinical course of radioactive iodine treatment: - ANSWER- Most develop
hypothyroidism after several months, be sure to check TSH levels at least 2x/yr to
ensure adequate replacement of thyroid hormone
NOTE: overall, has very few side effects
,Things to watch for leading up to and immediately after radioactie iodine treatment: -
ANSWER- get a pregnancy test
Avoid kids and pregnant women for several days after to avoid exposure in urine and
feces.
May have neck pain that resolves (and is normal)
can have *worsening* of graves ophthalmopathy
What should be done with follow up after radioactive iodine treatment? - ANSWER-
Check to see if need to discontinue propranolol and or increase TSH
Check TSH every 2-3 mo. until stabilized, with counseling of patient on signs of
hypothryoidism
Considerations for when starting thyroid hormone replacement: - ANSWER- Typical
starting dose for primary hypothyroidism = 1.5-1.8 mcg/kg
titrate up SLOWLY, with TSH drawn every 6 wks
once titrated to adequate levels, can do 6 mo visits
Name a case where TSH is not adquate to diagnosing hypothyroidism: - ANSWER-
Primary pituitary pathology => pituitary is not releasing TSH in response to levels of T4
=> TSH levels are lower than normal in the presence of low T4
Normal radioactive iodine uptake: - ANSWER- 15-30%
pathologies with decreased radioactive iodine uptake: - ANSWER- Subacute thyroiditis
Silent thyroiditis
Iodine induced
Exogenous thyroxine
Struma ovarii
amio
DDx for palpitations: - ANSWER- Cardiovascular
Pysch: anxiety, panic attacks
Medications: caffeine, theophylline, albuterol
Substances: tobacco, cocaine
Endocrine: hyperthryoidism, Pheo, hypoglycemia
Hemotoligic: anemia
,Infectious: febrile illness
Contrast orthopnea and paroxsyamal nocturnal dyspnea: - ANSWER- orthopnea =
immediately after lying down, very rapid resolution
PND: due to CHF, wakes patient HOURS after falling asleep and is SLOWER to resolve
Contrast acute and chronic bronchitis: - ANSWER- acute = 1-3 weeks of productive
cough
Chronic = 3 months of last two years productive cough
Classic exam findings in COPD: - ANSWER- increased AP diameter
decreased diaphragmatic excursion
Wheezing -- esp. end expiratory
prolonged expiratory phase
How is COPD diagnosis confirmed? - ANSWER- spirometry, both before and after a
bronchodilator
NOTE: asthma responds to bronchodilator and COPD does NOT
Contrast maintenance of moderate vs. severe COPD: - ANSWER- Moderate = 50-80%
of expected FEV1, FEV/FRC <.70 tiotropium/ ipratropium inhaled
Severe = FEV1 30-50% of expected, give long acting anticholinergic plus long acting
inhaled corticosteroid
treatment of mild COPD: - ANSWER- metered dose albuterol, can step up to long acting
+ short acting if inadequately controlled
Vaccinations for all adults with COPD: - ANSWER- flu
pneumococcal
Tdap if overdue
Who should get the flu vaccine? - ANSWER- all perons older than 6 months old
recommendation for who gets pneumoccal vaccine? - ANSWER- all persons older than
65
19-64 if you have a chronic disease (COPD, asthma included)
, Treatment of acute COPD exacerbations: - ANSWER- Inhaled bronchodilators + oral
corticosteroids
antibiotics if: increased sputum, more purulent sputum, if exacerbation requires
mechanical ventilation
Screening for COPD: - ANSWER- only do PFTs in symptomatic patients, DO NOT
screen asymptomatic patients
DDx of SOB in man who smokes: - ANSWER- Acute bronchitis
Asthma
COPD
Lung Cancer
PHQ2 screening: - ANSWER- for depression:
"over the last two weeks, how often have you experienced any of the following?"
1. little interest or pleasure doing things
2. Feeling down, depressed, or hopeless
0 = not at all
1 = several days
2 = more than half the days
3 = nearly every day
frequency of mammogram: - ANSWER- every two years in aged 50-74
NOTE: ages 40-49 should be discussed and decided on as a team
colon cancer screening: - ANSWER- colonoscopy starting at age 50 and ending at age
75
repeated 10 years if NOTHING
5-10 if only 1-2 adenomas removed
Name cancers that have screenings that are not recommended: - ANSWER- testicular
pancreatic
ASYMPTOMATIC prostate cancer -- can screen if Sx
DDx in bright red blood in stool of adult male: - ANSWER- Colorectal carcinoma
colonic polyps
