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Endo/Repro Exam 1 > 11. CIS > Flashcards

11. CIS Flashcards

1
Q

What are responses to short term stress responses:

A
  1. Glycogenolysis -> increase blood glucose
  2. increased BP, RR, BMR
  3. Increased altertness
  4. decreased digestive and kidney fx.
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2
Q

What are responses to long term stress responses:

A
  1. Relase of mineralcorticoids (increase in Na+, water and BP)
  2. Release of cortisol: glycogenlysis and gluconeogenesis, protein breakdown, lipolysis, immune system compromisation
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3
Q

What is relative adrenal insufficiency (adrenal crisis)?

A

Inability of HPA axis to keep up with demand; causing insufficient mineralcorticoids.

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4
Q

How can we determine if a case is [primary acute adrenal insufficiency]?

A
  1. Look at ACTH levels: should be elevated.
  2. ACTH stimulation (cosyntropin) test: ACTH administration should not cause a rise in cortisol.
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5
Q

Primary adrenocortical insuffiency is also called what?

A
  1. acute adrenal crisis
  2. relative adrenal insuffiency
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6
Q

What sx will you see in pts with primary chronic adrenocortical insuffiency (__________)?

A

Addisons disease

  1. Malaise
  2. Fatigue
  3. Weight loss or anorexia
  4. Hyperpigmentation
  5. Can have normal levels of things because the body has had time to compensate.
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7
Q

In the U.S , the most common etiology of Addisons dz is _____

A

autoimmune

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8
Q

If a patient comes in with Addisons disease and they have a serious illness or trauma, particularly if they lose trauma, what should the doc do?

A

GIVE THEM CORTICOSTERIODS

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9
Q

PTH directly releases Ca2+ from the bone and promotes synthesis of 1,25 (OH)2 D in the kidney. What does that do?

A
  1. Increase Ca2+ from bone
  2. Absorb Ca2+ in the intestines.
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10
Q

What does end stage renal disease cause?

A
  • secondary hyperparathyroidism d/t end stage renal disease-

Low Ca2+, increased Pi, High PTH, increased bone turnover (renal osteodystrophy)

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11
Q

In secondary hyperparathyroidism d/t ESRF we can see what occur?

A

renal osteodystrophy- alternative areas of scleros and osteoporosis that looks “Striped”. It is caused by a high bone turnover.

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12
Q

If a patient has secondary hyperparathyroidism, we will see enlargement of all 4 or 1 PT gland?

A

Low Ca2+ -> enlargement of all glands.

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13
Q

If a patient has primary hyperparathyroidism, will we see enlargement in one PT gland or all?

A

One: just the hyperfunctioning one. Indicative of a neoplasm.

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14
Q

What is type 1 DM?

A

Autoimmune disease caused by failure of T-cells self-tolerance. Thus, they attach antigens in the pancreatic beta cells. This is called insulinitis.

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15
Q

What does insulin do via the MAPK pathway and PI-3K pathway?

A
  • MAPK: cell growth, proliferation and gene expression
  • PI-3K: make lipids, proteins and glycogen; cell survival and proliferation and insert GLUT4 vesicle on membrane
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16
Q

What are the 4 T’s of T1DM?

A
  1. Toilet
  2. Thirsty- excess sugar in blood pulls fluid from tissues, causing child to drink and pee more.
  3. Tired- lack of sugar in cells makes kids tired
  4. Thinner- eat more than usual but lose weight bc without energy sugar, muscle tissue and fat stores shrink.
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17
Q

What kind of appetite will someone with T1DM have?

A

Extreme hunger because without enough insulin into cells; childs muscles and organs lack NRG -> triggers hunger.

18
Q

What is diabetic ketoacidosis?

A

Complication seen in T1DM. Without insulin, glucose cannot be used as fuel for cells. Thus, FFA -> Ketoacids in the liver -> causing acidosis. This results in:

    1. Labored breathing, which can cause abdominal pain.
    1. N/V
    1. Fruity breath
19
Q

Does an enlarged thyroid (goiter) always have to cause physiological problems?

Such as altered levels of TSH, T3 and T4.

A

No. It can be euthyroid (non-toxic goiter).

For example, it can move the trachea to the side and cause difficulty breathing.

20
Q

What is Pembertons sign?

A

Facial flushing and venous dilation when the arms are raised.

Indicated a goiter.

21
Q

What are effects seen in hyperthyroidism?

A

Increase in BMR, weight loss, heat intolerance, palpitations and tachycardia.

22
Q

Why are cardiac effects of hyperthyroidism important? (3)

A
  1. 1st sx noticed by pts
  2. 1st sx noticed by DOC
  3. Cause dz and death in the patient d/t CAH or cardiac arrest
23
Q

What are effects seen in hypothyroidism?

A
  1. Mental and physical sluggish (slowing
  2. Weight gain
  3. Cold intolerance
  4. Decrease CO.
24
Q

Why do goiters develop?

A
  • Iodine deficiency,
  • Goitrogens
  • Genetics
  • Alcohol, smoking, obesity/insulin resistance.
25
Q

What causes a non-toxic goiter (euthyroid)?

A

If you will have impaired thyroid synthesis.

As a result, your thyroid must grow so it can maintain normal physiological function

26
Q

Why do you tx a non-toxic goiter (euthyroid)?

A

Can cause

    1. Obstructive problems, such as dysphagia (diff swallowing) and dyspnea
    1. Increased risk for cancer.
27
Q

Tx for non-toxic goiter?

A

1. Radioative iodine therapy

2. Surgery is preferred.

28
Q

Loss of lateral visual fields is called what?

A

Bitemporal hemianopsia

BITEMPORAL HEMI-AH-NOP-SIA

29
Q

Bilateral papilledema on the opthalmascope is indicative of what

A

increased intracranial pressure.

30
Q

Pt has no PH of chronic HA or poor vision. Reports seeing double, pounding HA for 6. hours, no trauma. Vitals normal and has visual field defects. What is wrong?

A

Pituitary mass -> + ICP -> compress optic chiasm and causing HA.

31
Q

Can pituitary adenomas affect hormonal function?

A

YES!

32
Q

ACTH secreting-pituitary adenoma can cause what?

A

Hypercortisolism -> cushing dz

33
Q

TSH-secreting pituitary adenoma can cause what?

A

Increased T3/T4 -> hyperparathyroidism -> secondary hyperparathyroidism.

34
Q

GH-secreting pituitary adenoma (pitutary somatroph adenoma) can cause what?

A

Acromegaly

35
Q

How do test levels to see if uncontrolled GH secretion?

A
  1. Measure serum IGF-1
  2. If elevated, perform oral glucose tolerance test for GH response.

In a normal person, glucose will decrease GH secretion.

36
Q

If serum IGF-1 levels are hig, however the oral glucose tolerance test causes GH supression, can we assume acromegaly?

A

No.

37
Q
  • High IGF-1
  • Inadequate GH supression of glucose tolerance test

can be indicative of what?

A
  1. GH-secreting adenoma.
  2. Conduct pituiary MRI
38
Q

What can a pituitary adenoma do and what can they secrete and what will it cause?

A
  1. 1. Compress optic nerve
  2. 2. Increase ICP-> HA and N/V

They can secrete GH (cause acromegaly), ACTH (cause cushing dz) or TSH (cause secondary hyperthyroidism).

39
Q

How to remove pituiary adenoma?

A

1. ***Transphenoidal resection of pituitary adenoma.

2. Somatostatin analogue to supress GH.

40
Q

Ppl with acromegaly. can have what happen to bones?

A

Accelerated arthritis.

Endo/Repro Exam 1 (14 decks)

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