Endocrine and Metabolic Screening

Question 1

the _____ system works with the nervous system to regulate metabolism, water and salt balance, BP, stress response, and sexual reproduction

Answer 1

endocrine system

-is slower in response when compared to nervous system

Question 2

the ______ and _____ form an integrated axis that maintains control over much of the endocrine system

Answer 2

hypothalamus and pituitary

-called psychoneuroimmunology

Question 3

What are some early manifestations of thyroid/parathyroid, acromegaly, diabetes, Cushing’s syndrome, and osteomalacia

Answer 3

muscle weakness, myalgia, fatigue

Question 4

_____ is the deposition of calcium salts in cartilage of joints

Answer 4

chondrocalcinosis

-MS sign of endocrine and metabolic disease

Question 5

______ is the inflammation of tendons, ligaments, and joint capsule

Answer 5

periarthritis

-MS sign of endocrine and metabolic disease

Question 6

bilateral _____ is an early sign of endocrine and metabolic disease

Answer 6

carpal or tarsal tunnel

Question 7

Polyuria, polydipsia, dehydration, decreased urine, nocturia/fatigue/irritability, and increased serum sodium all indicate _______

Answer 7

Diabetes Insipidus

-is a lack of secretion or vasopressin.

Question 8

HA, confusion, lethargy, decreased urine, weight gain, edema, seizures, muscle cramps, vomiting, diarrhea, increased urine specific gravity, decreased serum sodium indicate ___________

Answer 8

syndrome of inappropriate secretion of antidiuretic hormone

• results from excess or inappropriate secretion of vasopressin resulting in increased sodium retention

Question 9

bony enlargements, amenorrhea, DM, profuse sweating, HTN, carpal tunnel, hand pain/stiffness, back pain, myopathy and poor exercise tolerance indicate ______

Answer 9

acromegaly

• result of hypersecretion of GH
• CTS in 50%

Question 10

Dark pigmentation, hypotension, progressive fatigue, hyperkalemia, GI issues, anorexia, weight loss, nausea, vomiting, arthralgias, myalgias, tendon calcification, hypoglycemia indicate _______

Answer 10

Adrenal Insufficiency

-referred to Addison’s disease. often visible over extensor surfaces

Question 11

Moonface, buffalo hump, protuberant abdomen, muscle wasting, decreased bone density, HTN, kyphosis, easy bruising, emotional disturbance, impaired reproduction, DM, slow wound healing all indicate ________

Answer 11

Cushing Syndrome

-generally is increased secretion of cortisol by adrenal cortex. Corticosteroids would also cause this. Overproduction of cortisol = protein catabolism.

Question 12

the main hormones produced by the thyroid are _______, _________, __________

Answer 12

thyroxine (T4), triiodothyronine (T3), and calcitonin

-they help regulate metabolic rate and increase protein synthesis. Alterations in levels produce changes in hair, nails, skin, eyes, vessels, nervous tissue, bone, and muscle. Fatigue and weakness are initial symptoms

Question 13

increased neck size, adjacent tissue pressure, difficulty breathing, dysphagia, hoarseness all suggest _______

Answer 13

goiter

-often from iodine deficiency

Question 14

Painless thyroid enlargement dysphagia, “tight” sensation w/ swallowing, anterior neck/shoulder/rib biomechanical changes, gland warm/tender/swollen, and fatigue/weight gain/dry hair all suggest _________

Answer 14

thyroiditis

-usually both sides enlarged

Question 15

excessive amounts of thyroid hormone creates a generalized elevation in body metabolism. this is called ________

Answer 15

hyperthyroidism

• can be paired w/ chronic periarthritis.
• proximal weakness in 70%
• painful shoulder motion
• also sensitivity to light, vision loss/spasm, increased appetite, weight loss, increased peristalsis, polyuria, amenorrhea, tremors, hyperkinesia, irritability, fatigue, weakness and muscle atrophy, tachycardia, arrhythmias, increased RR, low BP

Question 16

_______ is a life threatening complication of hyperthyroidism caused by it being unknown or untreated. Will see severe tachycardia, heart failure, shock, hyperthermia, restlessness, agitation, chest/abdomen pain, nausea, vomiting

Answer 16

thyroid storm

Question 17

______ is the result of insufficient thyroid hormone creating a generalized depression in metabolism.

Answer 17

hypothyroidism

Question 18

Slowed speech/mentation, anxiety, fatigue, increased sleep, HA, proximal muscle weakness, myalgias, TPs, CTS, paresthesias, joint edema, decreased BMD, dyspnea, pleural effusion, bradycardia, poor peripheral circulation, severe atherosclerosis, angina, HTN, anemia, myxedema, cool/dry skin, carotenosis, cold intolerance, anorexia, weight gain, decreased metabolism, infertility are all potential symptoms of _________

Answer 18

hypothyroidism

Question 19

another name for hypothyroidism is _______

Answer 19

Grave’s disease

-common symptoms are myxedema, CTS, cold intolerance, excessive fatigue, dry skin

Question 20

Presence of asymptomatic nodule, hoarseness, hemoptysis, dyspnea, and HTN suggest ________

Answer 20

Thyroid Carcinoma

Question 21

female gender, age over 40, Caucasian, iodine deficiency, family history all are risk factors for _____

Answer 21

neoplasms of thyroid

Question 22

Symptoms of lethargy, drowsiness, slow mentation, fatigue, hyperreflexia, glove/stocking sensory loss, proximal weakness, atrophy, decrease BMD, gout, arthralgia, myalgia, peptic ulcer, pancreatitis, renal colic, kidney infections, hypercalcemia all suggest ________

Answer 22

hyperparathyroidism

-primary cause is tumor of parathyroid gland

Question 23

Symptoms of personality changes, hypocalcemia (neuromuscular excitability), spasms of intercostals, positive Chvostek’s sign (facial twitch), arrhythmias, heart falure, dry skin, thin hair, brittle fingernails, nausea, vomiting, constipation all suggest _______

Answer 23

hypoparathyroidism

-primary cause is accidental removal or injury of parathyroid gland

Question 24

__________ is the leading cause of end-stage renal disease

Answer 24

diabetes

-issue is glucose is not taken up in blood after meal so it accumulates creating a hyperosmotic condition

Question 25

Polyuria, polydipsia, polyphagia, weight loss, hyperglycemia, glycosuria, ketonuria, fatigue, weakness, blurred vision, irritability , numbness/tingling, slow healing all suggest _____

Answer 25

Untreated or uncontrolled DM

-to diagnose must have FPG of 126 mg/dlk

Question 26

Motor and Sensory Diabetic Neuropathy

Answer 26

sensory/vibratory impairment, burning/stabbing/pain/numbness in distal extremity, extreme sensitivity, weakness, atrophy, areflexia, balance loss, CTS

Question 27

Autonomic S/S of Diabetic Neuropathy

Answer 27

gastro paresis, constipation, erectile dysfunction, urinary tract infection/incontinence, profuse sweating, lack of oil production, pupillary adjustment, orthostatic hypotension, loss of heart variability

Question 28

Severe unilateral swelling, increased skin warmth, redness, deep pressure sensation, normal x-rays but change over time, joint deformity suggest _______

Answer 28

Charcot’s joints

• can also get stiff hand or Dupuytren’s contracture
• good glycemic control helps greatly

Question 29

Exercise should be postponed until blood glucose is between which levels??

Answer 29

100-250 mg/dL

for prolonged activities, a 10-15 g carb snack is recommended for each 30 minutes.

Question 30

If any diabetic arrives for appointment in confused or lethargic state or exhibiting mental function change….

Answer 30

immediate physician referral is needed

Question 31

Thirst, weight loss, poor skin turgor, mouth dryness, absence of sweating, increased temp, decreased urine output, dizziness w/ standing, confusion, increased hematocrit all suggest ________

Answer 31

dehydration or fluid loss

Question 32

decreased mental alertness, sleepiness, anorexia, poor motor coordination, confusion and, if severe convulsions, sudden weight gain, hyperventilation, increased intracranial pressure (increased systolic, decreased diastolic, slow pulse), edema, low hematocrit all suggest _________

Answer 32

water intoxication

Question 33

Muscle weakness, fatigue, cardiac arrhythmias, abdominal distention, nausea, vomiting all suggest ________

Answer 33

potassium depletion

Question 34

Abdominal obesity, atherogenic dyslipidemia, HTN, insulin resistance, prothrombic state, proinflammatory state all suggest ________

Answer 34

Metabolic Syndrome

-often considered prediabetes

Question 35

Nausea, prolonged vomiting, diarrhea, confusion, irritability, muscle twitch/cramp, weakness, paresthesias, convulsions, slow/shallow breathing, and eventual coma suggest ______

Answer 35

metabolic alkalosis

-causes of excessive vomiting, diuretics

Question 36

HA, fatigue, drowsy, nausea, vomiting, diarrhea, muscle twitch, convulsions, hyperventilation, and coma suggest _______

Answer 36

metabolic acidosis

-causes of DKA, lactic acidosis, renal failure, severe diarrhea, chemical/drug toxicity

Question 37

Tophi (lumps under skin or eruption through skin), joint pain, swelling, fever, chills, malaise, redness suggest ______

Answer 37

gout

-elevated serum uric acid. Associated with middle age, menopause, obesity, white race, high meat intake

Question 38

Arthropathy, arthralgias, myalgias, weakness, bilateral pitting edema, abdominal pain, hypogonadism, CHF, hyperpigmentation, loss of hair, DM all suggest ______

Answer 38

Hemochromatosis

-inborn error of iron metabolism

Question 39

Back pain, compression fracture, fractures, decrease in height, kyphosis, dowager’s hump, decreased activity tolerance, early satiety suggest _______

Answer 39

osteoporosis

-calcium intake, sedentary life, smoking all increase risk

Question 40

Bone pain, skeletal deformities, fractures, severe muscle weakness, myalgia suggest ______

Answer 40

osteomalacia

-spine, pelvis, LE most common

Question 41

Pain, stiffness, fatigue, HA, dizzy, bone fractures, vertebral compressions, deformity, bowing of long bones, increased size clavicles, osteoarthritis of adjacent joints, acetabular protrusion, periosteal tenderness, increased skin temp over long bones, spinal stenosis, weakness all suggest ________

Answer 41

Paget’s Disease

-inflammatory condition with disordered bone remodeling

Question 42

Immediate Medical Attention

Answer 42

• confused/lethargic person w/ DM
• hypoglycemia
• signs of potassium depletion
• signs of thyroid storm

Question 43

Guidelines of Physician Referral

Answer 43

• unexplained fever
• palpable nodules or mass
• hypoglycemia episode
• multiple eruptive xanthomas
• fluid loss or dehydration
• recurrent arthritic symptoms