ER Cases

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1.

2.

3.

4.

Elevated lipase
indicates what?

Pancreatitis

High T-waves on EKG

indicates what?

High potassium levels

High TSH points to

(primary/secondary)
hypothyroidism

PRIMARY hypothyroidism

Numbess, tingling
around the mouth,
Chvostek's sign and
Trousseau's sign point
to what endocrine
disorder?

HYPOcalcemia

13.

Most likely cause: Accidental

removal of parathyroid!

What is the most likely

cause if these
symptoms come on
after thyroid surgery?
5.

6.

7.

8.

9.

10.

11.

12.

14.

15.

On physical exam,
what would you look
for in a patient with
adrenal insufficiency?

Hyperpigmentation of the skin

(too much ACTH)

The respiration rate of

a patient with DKA is
(high/low). Why?

HIGH, because a patient with

DKA has excess H+ (acidic), so
hyperventilation excretes more
CO2 which H+ will naturally
follow, thus compensating for the
acidosis

16.

TEST: If you suspect

the patient has
primary adrenal
insufficiency, what test
would you run to
confirm it?

Cosyntropin stimulation test

TEST: Never let

someone with a low
______ _____ get by
you

BLOOD SUGAR

TRUE or FALSE:
Steroids usually does
not cause adrenal
insufficiency

FALSE!!!! Steroids suppresses

adrenal function!

TRUE or FALSE: You

don't get an ACTH
increase with
secondary adrenal
insufficiency

TRUE!!

What are some DDx

for loss of
consciousness?

Diabetes --> Diabetic ketoacidosis

Urinary tract infection
Adrenal Insufficiency

17.

What are some

treatment options
for treating the
elderly patient
who is
unconscious?

IV fluids (Normal saline)

Steroids (takes a while to work)
Labs

What are the 3 Ps

of diabetes?

Polyuria
Polydipsia
Polyphagia

What are we going

to find that is
positive for a
patient suspected
with diabetic
ketoacidosis?

High blood and urinary glucose

High urinary ketones
Tinting of skin (dehydration)
Dry tongue (dehydration)
Collapsed veins (dehydration)
High specific gravity

What class of
drugs would you
use to control
blood pressure in
a patient with
hyperthyroidism?

Beta blockers!

What is the class

of drugs used to
treat
hyperthyroidism?

Thioamines! (PTU and Methimazole)

What is the
mechanism of
DKA?

Low insulin --> high blood glucose -->

high urinary glucose (producing
symptoms of dehydration)
Low insulin --> lipolysis (remember,
insulin wants to form fat, so a lack of
insulin breaks down fat) --> elevated
free fatty acids --> conversion to
ketones --> ketones have low pKa -->
metabolic acidosis
DKA results when glucose cannot be
used for energy so the body turns to
using fatty acids for energy, and
ketones is a byproduct of elevated fatty
acids

18.

What is the
treatment for
DKA?

IV fluids for rehydration

Insulin to suppress ketone production