Endocrine Cases DSA 1/6 Flashcards by Amanda Beach

how are length and height measured in infants and toddelrs

firm box
then against wall
the nearest 0.1 cm and measured twice, with results of the 2 measurements falling within a 4-mm range.6 If the difference between the 2 values is >4 mm, then a third measurement should be obtained

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do children in different countries growth differently

no
The MGRS was based on the hypothesis, later proven, that young children have similar growth potential independent of ethnicity and place of birth.

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rule of 5s for height velocity

25 cm/ year from birth to 1y.o
10 cm/yr 1-4 years old
5-7 cm/year from 4-8

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second peak of height velocity in adolescence

5 y.o girls

13. 5 y.o boys

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when is it best to obtain HV measurements

9-12 mo intervals after age 2

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formulations for target height in girls

fathers height - 13 cm + moms height /2

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formulations for target height in boys

mothers height + 13 + fathers height/2

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important parts of exam if child has abnormal growth pattern (could suggest a slow in growth)

PMH (including in utero Hx)
FMH: genetics and including mothers pregnancy
Soc Hx: depression, stress, anxiety

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how to tell is short stature is proportionate

arm span, sitting height to standing height
upper to lower segment ratios
BMI
head circumference if <3-4 years old

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labs to order for screening of growth failure

CBC with SED rate
CRP
CMP

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infant born SGA, when will growth catch up

usually in 2 years

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how do glucocorticoids decrease bone growth

reduced E levels, inhibited IGF-1 production and R to IGF-1

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growth impairedment from CF or celiacs is best detected when recording what

weight trajections

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3 principal uses of chapmans reflexes

Dx
influencing motion of fluids
inflencing visceral function through nervous system

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how do posterior chapmans feel

edematous with string feel deeper

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endocrine group of chapmans includes what

prostate, broad ligament, uterus, gonads, thyroid and adnrelas

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the GI group of chapmans includes what

colon, thyroid, pancreas, duodenum, small intestine on L liver, small intestine on R

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infectious group for chapmans

liver, spleen and adrenals

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anterior and posterior points for thyroiditis

ant: intercostal space between 2nd and 3rd ribs close to sternum
post: across face of transverse process of second dorsal vertebra, midway between the spinous process and tip of transverse process

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Ant and post points for kidneys

ant: laterally inch either side of median of abdomen and inch above umbilicus
post: intertransverse space 12th dorsal and 1st lumbar vertebrae
midway between the spins and tips of transverse processes

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points for adrenals

ant: 2 -2.5 inches above umbilicus and 1 inch lateral
post: intertransverse spaces on both sides 11th and 12th dorsal vertebra
midway between spinous processes and tips of transverse

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points for pancreas

ant: intercostal space 7th and 8th ribs on R side close to approximation of cartilages
post: between transverse processes of 7th and 8th dorsal vertebra midway between spinous and transverse processes on R side

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points for congestion of liver and gall bladder

Ant: intercostal space mid mamillary line up to sternum on R side between 6th and 7th ribs
post: between transverse processes of 6th and 7th vertebrae between spinous and transverse on R side

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45 y.o F with weight loss, fatigue, vomiting, diarrhea, dec cold tolerance and salt craving
ddx?

adrenal fatigue

addisons

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labs to order for addisons

basal plasma cortisol and ACTH | ACTH stimulation test

what will basal plasma cortisol and ACTH be in addisons

low cortisol and high ACTH

what will ACTH stimulation test show in addisons

low to normal cortisol levels that do not rise after ACTH administration

what are the 5 Ss to manage in adrenal crisis

salt, sugar, steroids, support and search for precipitating illness

arterial supply to adrenal gland

superior middle and inferior suprarenal aa

venous drainage adnreal gland

suprarenal vv

lymph drainage for adrenals

para-aortic nodes | driven by resp diaphragm

sympathetics to adrenals

T6-L2 | T8-T10 NBOME

PArasympathetic control to adrenals

vagus

OMT areas for addisons

lymph- thoracic inlet, resp diaphragm sympathetics:T6-L2 PANS: vagal function (temporal bone, occipitomastoid suture, OA AA C2

48 y.o M with fatigue, cold intolerance, constipation, migrating muscle aches, weight gain, course dry skin dec DTRs dx?

hypothyroidism

labs to order if suspect hypothyroidism

TSH T3 T4 TSH would be increased and free T4 dec in primary both dec in central TSH elevated and T4 normal in subclinical

medical management of hypothyroidism

levothyroxine

if levo not working in hypothyroid patient what drug can you try

liothyronine

arterial supply thyroid gland

superior and inferior thyroid aa

venous drainage of thyroid gland

superior middle and inferior thyroid vv

lymphatic drainage of thyroid gland

prelaryngeal, pre tracheal and paratracheal

what drive lymph flow from thyroid

resp diaphragm

SAN to thyroid

upper thoracic T1 | contributions from C3 C2 and C6

role of sympathetic fibers to thyroid

vasomotor

OMT for thyroid dysfunction

``` lymph: thoracic inlet, resp diaphragm SAN: T1 (flexed segment) compensatory segments T3-4 1st ribe (elevated) to Tx the inferior cervical stellate ganglion cervical spine cranial ```

65 y.o F HTN HLD DM II atorvastatin, ramipril and metformin overweight dx?

metabolic syndrome

what is metabolic syndrome

constellation of altered function: abdominal obesity dyslipidemia, HTN and insuline R possible impaired glucose tolerance

What organs contribute to metabolic syndrome

thyroid, adrenals, pancreas, liver kidneys

arterial supply to pancreas

superior and inferior pancreaticoduodenal aa

venous drainage of pancreas

superior and inferior pancreaticoduodenal vv

lymph drainage of pancreas

pancreaticosplenic and pre-aortic nodes

SAN to pancreas

T6-9 | vasomotor

PAN to pancreas

vagus- secretomotor | results in secretion insulin, bicarb, somatostatin and glucagon

functions of liver

metabolizes, detoxifies and inactivates substances | stores carbs, lipids, vitamins and minerals

liver activates what

hormones T4 to T3 and vitamines

liver synthesizes

albumin, glucose, cholesterol, phospholipids and fatty acids for TG

arterial supply to liver

hepatic artery

venous drainage liver

portal venous system and hepatic vv

lymph drainage of liver

nodes above and below diaphragm

SAN liver

T6-9 | stimulation inc breakdown of glycogen to glucose

PAN liver

vagus | stimulation dec breakdown glycogen to glucose

arterial supply to kidney

renal aa

venous drainage kidney

renal vv

lymph drainage kidney

renal v to drain to lateral aortic nodes

SAN kidney

T10-L1 vasomotor (frequently flexed at thoracolumbar)

PAN kidney

vagus most likely

SAN does what to kdiney

vasoconstriction enhanced Na reabsorption from prox tubule increased renin secretion increased fluid retention inc BP

OMT metabolic syndrome

lymph autonomics myofascial restrictions of involved organs chapmans