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OPP IV midterm > Endocrine Cases DSA 1/6 > Flashcards

Endocrine Cases DSA 1/6 Flashcards

1
Q

how are length and height measured in infants and toddelrs

A

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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2
Q

do children in different countries growth differently

A

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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3
Q

rule of 5s for height velocity

A

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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4
Q

second peak of height velocity in adolescence

A
  1. 5 y.o girls

13. 5 y.o boys

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5
Q

when is it best to obtain HV measurements

A

9-12 mo intervals after age 2

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6
Q

formulations for target height in girls

A

fathers height - 13 cm + moms height /2

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7
Q

formulations for target height in boys

A

mothers height + 13 + fathers height/2

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8
Q

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

A

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

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9
Q

how to tell is short stature is proportionate

A

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

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10
Q

labs to order for screening of growth failure

A

CBC with SED rate
CRP
CMP

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11
Q

infant born SGA, when will growth catch up

A

usually in 2 years

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12
Q

how do glucocorticoids decrease bone growth

A

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

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13
Q

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

A

weight trajections

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14
Q

3 principal uses of chapmans reflexes

A

Dx
influencing motion of fluids
inflencing visceral function through nervous system

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15
Q

how do posterior chapmans feel

A

edematous with string feel deeper

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16
Q

endocrine group of chapmans includes what

A

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

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17
Q

the GI group of chapmans includes what

A

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

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18
Q

infectious group for chapmans

A

liver, spleen and adrenals

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19
Q

anterior and posterior points for thyroiditis

A

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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20
Q

Ant and post points for kidneys

A

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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21
Q

points for adrenals

A

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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22
Q

points for pancreas

A

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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23
Q

points for congestion of liver and gall bladder

A

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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24
Q

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

A

adrenal fatigue

addisons

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25
Q

labs to order for addisons

A

basal plasma cortisol and ACTH

ACTH stimulation test

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26
Q

what will basal plasma cortisol and ACTH be in addisons

A

low cortisol and high ACTH

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27
Q

what will ACTH stimulation test show in addisons

A

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

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28
Q

what are the 5 Ss to manage in adrenal crisis

A

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

29
Q

arterial supply to adrenal gland

A

superior middle and inferior suprarenal aa

30
Q

venous drainage adnreal gland

A

suprarenal vv

31
Q

lymph drainage for adrenals

A

para-aortic nodes

driven by resp diaphragm

32
Q

sympathetics to adrenals

A

T6-L2

T8-T10 NBOME

33
Q

PArasympathetic control to adrenals

A

vagus

34
Q

OMT areas for addisons

A

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

35
Q

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

A

hypothyroidism

36
Q

labs to order if suspect hypothyroidism

A

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

37
Q

medical management of hypothyroidism

A

levothyroxine

38
Q

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

A

liothyronine

39
Q

arterial supply thyroid gland

A

superior and inferior thyroid aa

40
Q

venous drainage of thyroid gland

A

superior middle and inferior thyroid vv

41
Q

lymphatic drainage of thyroid gland

A

prelaryngeal, pre tracheal and paratracheal

42
Q

what drive lymph flow from thyroid

A

resp diaphragm

43
Q

SAN to thyroid

A

upper thoracic T1

contributions from C3 C2 and C6

44
Q

role of sympathetic fibers to thyroid

A

vasomotor

45
Q

OMT for thyroid dysfunction

A 
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
46
Q

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

A

metabolic syndrome

47
Q

what is metabolic syndrome

A

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

48
Q

What organs contribute to metabolic syndrome

A

thyroid, adrenals, pancreas, liver kidneys

49
Q

arterial supply to pancreas

A

superior and inferior pancreaticoduodenal aa

50
Q

venous drainage of pancreas

A

superior and inferior pancreaticoduodenal vv

51
Q

lymph drainage of pancreas

A

pancreaticosplenic and pre-aortic nodes

52
Q

SAN to pancreas

A

T6-9

vasomotor

53
Q

PAN to pancreas

A

vagus- secretomotor

results in secretion insulin, bicarb, somatostatin and glucagon

54
Q

functions of liver

A

metabolizes, detoxifies and inactivates substances

stores carbs, lipids, vitamins and minerals

55
Q

liver activates what

A

hormones T4 to T3 and vitamines

56
Q

liver synthesizes

A

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

57
Q

arterial supply to liver

A

hepatic artery

58
Q

venous drainage liver

A

portal venous system and hepatic vv

59
Q

lymph drainage of liver

A

nodes above and below diaphragm

60
Q

SAN liver

A

T6-9

stimulation inc breakdown of glycogen to glucose

61
Q

PAN liver

A

vagus

stimulation dec breakdown glycogen to glucose

62
Q

arterial supply to kidney

A

renal aa

63
Q

venous drainage kidney

A

renal vv

64
Q

lymph drainage kidney

A

renal v to drain to lateral aortic nodes

65
Q

SAN kidney

A

T10-L1
vasomotor
(frequently flexed at thoracolumbar)

66
Q

PAN kidney

A

vagus most likely

67
Q

SAN does what to kdiney

A

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

68
Q

OMT metabolic syndrome

A

lymph
autonomics
myofascial restrictions of involved organs
chapmans

OPP IV midterm (6 decks)

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