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Medical Conditions 1 > Endocrine and Metabolic system disorders > Flashcards

Endocrine and Metabolic system disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the functions of the endocrine system

A
  • differentiation of the reproductive and central nervous system of the developing fetus
  • stimulation of sequential growth and development during childhood and adolescence
  • coordination of the male and female reproductive system
  • maintenance of optimal internal environment throughout the life span
  • initiation of corrective and adaptive responses when emergency demand occurs
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2
Q

What organ is considered the main integrative center for the endocrine and autonomic nervous system

A

hypothalamus

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3
Q

Pituitary gland disorder types

A

Anterior lobe:
- hypopituitarism
- hyperpituitarism
Posterior lobe
- diabetes insipidus
- Syndrome of inappropriate antidiuretic hormone secretion

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4
Q

What are clinical manifestations of hypopituitarism

A
  • growth hormone deficiency
  • adrenocortical insufficiency
  • hypothyroidism
  • gonadal failure
  • neurological signs (produced by a tumor)
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5
Q

Growth hormone deficiency

A
  • short stature
  • delayed growth
  • delayed puberty
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6
Q

adrenocortical insufficiency effects

A
  • hypoglycemia
  • anorexia
  • nausea
  • abdominal pain
  • orthostatic hypotension
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7
Q

Hypothyroidism

A
  • fatigue
  • lethargy
  • sensitive to cold
  • menstrual disturbances
  • decreased metabolism
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8
Q

Gonadal failure

A
  • secondary amenorrhea
  • impotence
  • infertility
  • decreased libido
  • absent secondary sec characteristics
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9
Q

Neurological signs produced by a tumor that cause hypopituitarism

A
  • headache
  • bilateral temporal hemianopia
  • loss of visual acuity
  • blindness
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10
Q

hypopituitarism of posterior pituitary

A
  • rare
  • decrease in ADH = no water retention
  • imbalance of water
  • polydipsia
  • polyuria
  • glucose in blood triggers thirst
  • problems regulating blood pressure
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11
Q

treatment for hypopituitarism of posterior pituitary

A
  • treatment: vasopressin or pitressin
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12
Q

Acromegaly

A
  • hyperpituitary function
  • more common in adults (in children it is called giantism)
  • bones grow thicker
  • more commonly in jaw, hands and feet
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13
Q

Adrenal gland hormones

A
  • mineralocorticoids
  • glucocorticoids
  • androgens
  • catecholamines
  • peptides:
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14
Q

Affects of catecholamines

A
  • dilation of bronchioles
  • increase HR
  • liver converts glycogen to glucose
  • high blood pressure
  • decreased digestive system activity
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15
Q

Affects of cortisol

A
  • increased blood sugar
  • suppress immune system
  • decrease serotonin
  • heightened memory and attention
  • increase in blood pressure
  • decrease sensitivity to pain
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16
Q

Adrenal gland disorders: general types

A
  • adrenal insufficiency
  • adrenal cortical hyperfunction
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17
Q

Primary adrenal insufficiency

A
  • addison’s disease
  • adrenal gland is insufficient
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18
Q

Secondary adrenal insufficiency

A
  • other causes of adrenal insufficiency
  • ex: hypothalamic or pituitary tumors
  • too rapid withdrawal of corticosteroid drugs
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19
Q

adrenal cortical hyperfunction disorders

A
  • cushing syndrome: too much cortisol
  • conn syndrome: hypersecretion of aldosterone
  • adrenal hyperplasia: over growth
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20
Q

Addison’s disease causes

A
  • insufficient cortisol release from adrenal glands
  • used to be a complication of TB but not more commonly idiopathic or autoimmune
  • other: adrenalectomy, adrenal hemorrhage, malignant adrenal neoplasm, infections, meds
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21
Q

Addison’s disease: symptoms

A
  • bronze pigment
  • changes in body hair distribution
  • GI disturbances
  • weakness
  • hypoglycemic
  • othrostatic hypotension
  • weight loss
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22
Q

Addison’s disease: PT implications

A
  • caution using aquatic therapy- trouble maintaining body temp
  • monitor vitals
  • signs of crisis
  • need to wear a bracelet and carry dexamethasone or hydrocortisone
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23
Q

adrenal crisis symptomes

A
  • profound fatigue
  • dehydration
  • vascular collapse (decrease BP)
  • renal shut down
  • increase serum NA and decrease serum K
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24
Q

Cushing’s disease

A
  • over-secretion of ACTH from pituitary
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25
Q

Cushing’s syndrome

A
  • adrenal gland over-secretion of cortisol
    or
  • too high of dose of corticosteroid meds
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26
Q

Cushing’s disease/syndrome treatment

A
  • irradiation of pituitary or tumor,
  • drug therapy
  • surgery
  • depends on underlying cause
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27
Q

Cushing’s disease/syndrome symptomes

A
  • personality changes
  • hyperglycemic
  • red face
  • increase susceptibility to infection
  • Males: gynecomastia
  • fat deposition in abdomen and back of neck
  • osteoporosis
  • bruises
  • thin skin
  • females: amenorrhea, hirsutism
  • purple striae on abdomen
  • GI distress/increase acid
  • thin extremities
  • fluid retention
  • fat round moon face
  • CNS irritability
28
Q

thyroid gland disorders

A
  • hyperthyroidism: graves disease
  • hypothyrodism: type 1 = hormone deficient or type 2 = hormone resistant
  • goiter
  • thyroiditis
  • cancer
29
Q

hypothyroidism symptoms

A
  • intolerance to cold
  • receding hairline
  • facial and eyelid edema
  • dull-blank expression
  • extreme fatigue
  • thick tongue/slow speech
  • anorexia
  • brittle nails and hair
  • menstrual disturbances
  • constipation
  • muscle aches/weakness
  • dry skin
  • lethargy
  • apathy
  • hair loss
30
Q

hyperthyroidism symptoms

A
  • intolerance to heat
  • fine straight hair
  • bulging eyes
  • facial flushing
  • enlarged thyroid
  • tachycardia
  • increase systolic BP
  • breast enlargement
  • weight loss
  • muscle wasting
  • menstrual changes
  • tremors/increase diarrhea
  • finger clubbing
31
Q

treatment for hypothyroidism

A
  • correct hormone deficiency
  • synthroid, levethyroid, levoxyl
32
Q

treatment for hyperthyroidism

A
  • antithyroid medication
  • radioactive iodine
  • surgery
33
Q

Parathyroid function

A

PTH secretion: (increase Ca in blood)
- bones release calcium
- kidneys: reduce calcium clearance and vitamin D activation
- intestines: activated vitamin D helps absorb calcium in gut

34
Q

Hyperparathyroidism

A
  • increase bone resorption
  • elevated serum Ca levels
  • depressed serum phosphate levels
  • hypercalciuria and hyperphosphaturia
  • decreased neuromuscular irritability
35
Q

Hypoparathyroidism

A
  • decreased bone resorption
  • depressed serum Ca levels
  • elevated serum phosphate levels
  • hypocalciuria and hypophosphaturia
  • increased neuromuscular activity which may progress to tetany
36
Q

Adipose tissue hormones

A
  • adiponectin: improves insulin sensitivity and decrease inflammation
  • leptin: increases inflammation
37
Q

Implications of adipose tissue for PT

A
  • females > 35 inch wasit increased risk for DM
  • males >40 inches waist increase risk of DM
  • waist:heigh wt<1/2 ht
  • educate about the importance of exercise
  • BMI
38
Q

metabolic syndrome

A
  • large waistline
  • high blood pressure
  • low HDL
  • high triglycerides
  • high blood sugar
  • insulin resistance
  • dyslipidemia
39
Q

Glucose regulation: pancreas

A

islet of langerhans
- alpha cells - glucagon (glucose into blood)
- beta cells: insulin (glucose into cells)
- delta cells: somatostatin which regulates glucagon and insulin production

40
Q

Glucose regulation: adrenal gland

A

increases blood glucose
- medulla: stress response, release epinephrine which stimulates glycogenolysis in liver and muscles
- cortex: glucoocorticoids promote flow of amino acids to live where glucose is synthesized

41
Q

Glucose regulation: pituitary

A

increases blood glucose
- ACTH: increases blood glucose
- GH: insulin antagonist: blocks action of insulin

42
Q

Glucose regulation: thyroid

A
  • may raise of lower glucose
43
Q

Insulin facilitated trasnport

A
  1. insulin binds to cells
  2. causes glucose transporters (GLUTs) to become part of cell membrane
  3. GLUTs allow glucose to enter
44
Q

Prediabetes

A
  • increased insulin resistance and decreases insulin sensitivity
  • borderline diabetic
  • glucose fasting blood test: 100-125 mg/dL
  • A1c blood test 5-6.5%
  • insulin resistance syndrome = metabolic syndrome
45
Q

Type 1 diabetes mellitus

A
  • deficient insulin production and secretion
  • 1.5: genetic and developed later on than type 1
46
Q

type 2: diabetes mellitus

A
  • producing insulin but it is ineffective
  • insulin resistent
47
Q

Diabetic ketoacidosis

A
  • glucose > 300 for extended time
  • develop slowly
  • early symptoms: thirsty and frequent urination
  • more sever symptoms: fast/deep breathing, dry skin and mouth, flushed face, fruity breath, headache, muscle stiffness/aches, tired, nausea and vomiting, stomach pain
  • more common in type 1
48
Q

Diagnostic criteria for diabetes mellitus
- classic symptoms and test values

A
  • classic symptoms: polyuria, polydipsia and weight loss
  • Fasting plasma glucose >125
  • 2 hour postload glucose >200
  • glucose tolerance test return to normal within 2 hours
  • A1c: >6.5
49
Q

Goals of treatment for DM

A
  • A1c <7%
  • BP<130/80
  • LDL <70 mg/dL
  • triglycerides <150 mg/dL
50
Q

Treatment for type 1 DM

A
  • insulin
  • fast-acting: breakfast, lunch, dinner through subcutaneous pump or injection
  • long acting: 1x/day (lantus and levemir) usually night time
51
Q

treatment for type 2 DM

A
  • diet and exercise
  • medication that is usually not insulin until they are on 3 oral agents simultaneously
52
Q

Hyperglycemia

A
  • > 300 mg/dL
  • Diabetic ketoacidosis
  • hyperosmolar hyperglycemia state
53
Q

Diabetic Ketoacidosis
- most common
-Signs
- Treatment

A
  • most common in type 1 from severe insulin deficiency from infection or stress Or not adhering to diet/treatment
  • acetone breath, dehydration, weak, and rapid pulse, reparations
  • treatment: fluid, fast acting insulin, and correct metabolic abnormalities
54
Q

Hyperosmolar hyperglycemic state

A
  • extreme hyperglycemia (800-2000) = crisis
  • no ketosis
  • Polyphagia, polydipsia, polyuria, glycosuria, dehydration, weakness, coma, hypotension, shock
  • treatment: short acting insulin, electrolyte replacement, careful fluid replacement
55
Q

kussmaul respirations

A
  • rapid deep breathing
  • acidosis = trying to get rid of CO2
56
Q

Long term complications of hyperglycemia

A
  • atherosclerosis
  • cardiovascular complications (risk of CVD, PVD)
  • retinopathy and nephropathy
  • infection/impaired healing
  • musculoskeletal problems
  • sensory, moto, and autonomic neuropathy
  • causes damage to endothelial tissue when glucose is high in circulation
57
Q

Complications with insulin

A
  • hypoglycemia
  • lipogenic effect of insulin
  • diabetic ketoacidosis
58
Q

complications with metformin

A
  • vitamin B12 deficiency
  • report any neurological signs
59
Q

Hypoglycemia

A
  • sweating
  • weakness
  • shaking
  • nausea
  • headache
  • difficulty concentrating
60
Q

lipogenic effect of insulin

A

thickening of subcutaneous tissue
- rotate injection site and pump

61
Q

diabetic ketoacidosis signs

A
  • acetone breath
  • dehydration
  • weak and rapid pulse
  • kussmaul breathing
62
Q

DM key point: safe glucose levels

A
  • 100-250
  • > 120 should be closely monitored
  • 250-300 = caution zone
  • <100 carb snack and retest
63
Q

How to plan exercise around food intake and insulin/oral hyperglycemic agents

A
  • no exercise during peak insulin times
  • avoid unusual night exercise
64
Q

What should occur in DM patients before exercise

A
  • 16 oz of fluid
  • monitor glucose pre-exercise
  • no exercise if blood glucose is near 250 with urinary ketones and caution >300 with no ketones
  • exercise 30 minutes
  • do not use muscles of injection site with 1 hour
  • type 1 DM may need to reduce insulin Orr increase food intake
  • do not use drugs that may cause hypoglycemia (beta blocker, alcohol, diuretics, estrogens, phenytoin)
  • increase insulin during menses
65
Q

DM during exercise

A
  • regular and consistent time of day 5x/week
  • 40-60 min is optimal but 20-30 min has shown benefits in glucose regulation
  • prolonged activity plan for easily absorb carb snack every 30 minutes
  • replace fluids
  • monitored glucose every 30 minutes
  • don’t exercise alone
66
Q

DM after exercise

A
  • monitor glucose 15 minutes after exercise
  • increase caloric intake for 12-24 hours after activity
  • reduce insulin, which peaks at night according to intensity and duration
67
Q

insulin resistance syndrome

A
  • euglycemia test to truly determine insulin resist but expensive so typically if pre-diabetic then considered IR
  • high levels of both insulin and glucose circulating in blood stream
  • metabolic syndrome: HTN, carbohydrate intolerance, abdominal obesity, dyslipidema, accelerated atherosclerosis all associated with type 2 DM
  • IRS = FGL between 100-126

Medical Conditions 1 (16 decks)

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