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What are the signs of hyperthyroid?
- - goiter (with or without bruit)
- - atrial fibrillation/tachycardia
- - proximal myopathy
- - bowel frequency
- - hot sweaty hands
- - tremor
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What are the signs of hypothyroid?
- gruff voice
- dry skin
- coarse features
- goiter without bruit
- pericardial effusion
- ascites
- bradycardia
- carpal tunnel
- hypothermia
- delay in tendon relaxation time
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The endocrine physical examination should include inspection of the skin for:
- Inspection of skin
- hirsutism
- dry/oily skin
- sallow skin
- striae
- foot ulcers
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The endocrine physical examination should include inspection of the face for:
- facial edem
- moon facies
- coarse facial features
- prognathism
- exophthalmos
- "Queen Anne's eyebrows"
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The endocrine physical exam should include inspection of body habitus for:
- central obesity
- supraclavicular fat bad
- "buffalo hump"
- large hands and feet
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The endocrine physical exam of the neck includes:
- Inspection of the neck - static and on swallowing
- Palpation of the thyroid - static and on swallowing
- palpation of the thyroid's isthmus and lobe margins, noting size, symmetry, consistency, nodularity, tenderness
- auscultation of the thyroid for bruits
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DDx to consider for galactorrhea
- Metabolic - drugs, breast-feeding, acromegaly, hypothyroidism
- idiopathic/iatrogenic - liver failure
- neoplastic - prolactinoma
- pregnancy (true or false)
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How can the elderly's presentation of hyperthyroid differ from the average patient?
may present as an apathetic pt rather than in a hypermetabolic state
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What is a thyroid storm? Signs and Symptoms? Precipitants?
- life threatening emergency
- profound thyrotoxicosis
- fever
- weakness
- cardiovascular collapse
- shock
caused by infection, trauma, surgery
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Other physical exam skills to remember for endocrine stems
- Vitals
- Neuro: CN - especially extra-occular mov'ts, reflexes, tremor, papilledema, peripheral senses for DM
- Peripheral pulses
- consider breast exam and DRE depending on your DDx
- lymphatics
- Abdo exam - esp look for rebound tenderness, signs of functional liver changes
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What are some complications to watch out for with DM?
- Use the mnemonic BEANN
- Bugs: infections
- Eyes: retinopathy, cataracts, glaucoma
- Arteries: HTN, ischemic heart disease, PVD, stroke, TIA
- Nephropathy
- Nerves: altered proprioception, mononeuropathies, peripheral neuropathy, automic neuropathy
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What is a myxedema coma? Signs and symptoms? Precipitants?
life threatening complication of hypothyroidism - state of hypometabolism, can cause tissues to be infiltrated by mucopolysaccharides
- hypothermia
- coma
- resp depression
- infection
- trauma
- exposure to cold (plus more)
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What should your DDx for Hypothyroidism include?
- Traumatic: radioactive thyroid ablation, thyroidectomy
- Autoimmune/Allergic: Hashimoto's thyroiditis
- Metabolic: Hypopituitarism
- Idiopathic/Iatrogenic: Idiopathic thyroid atrophy
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What should your DDx for Hirsutism include?
- metabolic: cushing's syndrome, androgen-secreting ovarian tumors, PCOS, CAH, acromegaly, drugs
- idiopathic/iatrogenic: obesity
- congenital/genetic: familial
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Signs/Symptoms of Virilization (as caused by PCOS, androgen secreting tumour, CAH)
- acne
- oligo/amenorrhea
- deepened voice
- breast atrophy
- male muscle pattern
- temporal balding
- clitoral enlargement
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signs/symptoms of pituitary edenoma
- h/a
- galactorrhea
- bitemporal hemianopsia
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signs/symptoms of cushing's syndrome
- truncal obesity
- menstrual irregularity
- moon facies
- striae
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signs/symptoms of acromegaly
- thick, coarse, oily skin
- acne
- prognathism
- increased space between teeth
- increased shoe, hat, glove, ring sizes
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symptoms of hypoglycemia
- pallor
- sweating
- anxiety
- tachycardia
- palpitations
- tremor
- h/a
- hunger/abdo pain
- decreased LOC
- syncope
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symptoms of hyperglycemia
- polyuria
- polydypsia
- fatigue
- polyphagia
- blurred vision
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What should your DDx of an anterior neck lump include?
- vascular: carotid aneurysm
- neoplastic: thyroid nodule
- congenital/genetic: thyroglossal cyst
- enlarged lymph node
- enlarge salivary gland
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What features of a thyroid nodule would make you suspicious of malignancy?
- age (<20, > 60)
- male
- rapid growth
- associated hoarseness or dysphagia
- hx of radiation to area
- nodule is firm, fixed, nontender
- nodule >2cm
- associated lymphadenopathy
- 'cold' on thyroid scan
- complex cystic nodule
- family hx of medullary ca of thyroid or MEN II
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what are the clinical features of DKA?
- polyuria
- young pt with DMI
- polydipsia
- LOC
- anorexia
- nausea
- vomiting
- fatigue
- abdo pain
- Kussmaul's breathing
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what are the clinical precipitants of DKA?
- infection
- noncompliance
- initial presentation
- idiopathic causes
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give four helpful pieces of advice for a DM pt wrt exercise
- use proper footwear and inspect feet daily
- avoid exercise over periods of unstable metabolic control
- take blood sugar readings b/f exercise and consume simple rapidly absorbed CHO if bs<5
- avoid exercise in extreme hot or cold conditions
- administer insulin in a site away from those muscle groups being exercised
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describe EKG changes common to obese pts
- leftward shift of p-waves, t-waves and qrs complexes
- low qrs voltages
- LVH
- LAH
- flattening of t-waves in the inferior and lateral leads
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identify 3 advantages of wt loss
- lowers elevated bp
- improves lipid profiles (lowers total chol, LDL and TG and increases HDL)
- lowers elevated BG levels and reduces insulin resistance
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identify 4 disadvantages of wt loss
- hypovitaminosis due to reduction of food intake
- initial wt loss can cause dosing problems
- gallstones
- rebound wt gain
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medical complications of severe obesity (BMI>40)
- sudden death
- OSA
- CHF
- nephrotic syndrome
- renal vein thrombosis
- immobility
- Pickwickian syndrome:
- somnolence
- polycythemia
- daytime hypoventilation
- cor pulmonale
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