Endocrine, Metabolic, Immunologic, Cancer Flashcards
What system affects many body systems simultaneously due to hormone transport through bloodstream?
endocrine system
What endocrine gland can produce Diabetes Insipidus, SIADH, and Acromegaly?
pituitary
What endocrine gland can cause Addison’s disease and Cushing’s syndrome?
adrenal gland
What endocrine gland can cause Goiter, Thyroiditis, and Neoplasms?
thyroid
If the body is producing too much of a hormone, what needs to happen?
It needs to be either cut out (leading to supplementation due to resulting in deficiency) or distributed to an area deficient of the hormone(s)
What causes diabetes insipidus?
Decreased vasopressin (ADH)
What happens when diabetes insipidus occurs? What are the s/s?
a. unabsorbed water will be lost in the urine
b.
- increased urine and thirst –> dehydration
- fatigue
- irritability
What is the primary type of diabetes insipidus?
idiopathic
What is the secondary type of diabetes insipidus associated with?
trauma, head injury, infection
What gland regulates levels of vasopressin (ADH)?
pituitary
What is SIADH?
Excess release of vasopressin
What does SIADH result in? What are the s/s?
- decreased water retention –> altering electrolyte levels
- decreased urine
- weight gain WITHOUT edema
- HA
- confusion and lethargy
What gland regulates the levels of human growth hormone?
pituitary
What is acromegaly?
Excess secretion of human growth hormone leading to the enlargement of the extremities
What are the s/s of acromegaly?
- CTS
- back pain (osteophytes in the T-spine)
What bones are most affected by acromegaly in children?
long bones (causes gigantism)
What bones are most affected by acromegaly in adults?
face, jaw, hands, feet
What endocrine gland regulates levels of cortisol and aldosterone?
adrenal gland
What is addison’s disease?
Hypofunction of the adrenal cortex leading to decreased cortisol and aldosterone
What is a diagnosis that is described by adrenal insufficiency?
Addison’s disease
Symptoms:
- dark pigmentation (only in primary cases)
- hypotension
- progressive fatigue
- GI distrubances
- Tendon calcification
- arthralgia (Secondary only)
- myalgia (secondary only)
Addison’s disease
What is considered as the stress hormone?
cortisol
What is cushing’s syndrome?
Hyperfunction of the adrenal cortex leading to excess cortisol
What are the causes of cushing’s syndrome?
- corticosteroids
- large doses of cortisol
- cortisol derivatives
- iontophoresis
symptoms:
- moon face
- buffalo hump at the neck
- abdominal stretch marks
- masculine traits in women
Cushing’s syndrome
What is Goiter? What causes goiter?
Enlargement of the thyroid gland due to hypersecretion of TSH and iodine
What are potential s/s of goiter?
- dysphagia
- hoarseness
- difficulty breathing
It is common for those with thyroiditis to develop (hyper/hypo) functioning thyroid gland
hypo
What is thyroiditis?
- inflammation of the thyroid gland due to infection/autoimmune processes
What is chronic thyroiditis called?
Hashimoto’s thyroiditis
What population does hashimoto’s thyroiditis commonly manifest in?
females 30-50 y/o
What are s/s of thyroiditis?
- dysphagia
- difficulty breathing
- hoarseness
–> the same as goiter
What causes grave’s disease?
excessive secretion of thyroid hormone
With grave’s disease, metabolism (increases/decreases)
increases
–> leads to a thin stature
What are s/s of those > 70 y/o with grave’s disease?
- tachycardia
- fatigue
- weight loss
What are s/s of graves disease in those < 50 y/o?
- tachycardia
- hyperreflexia
- increased sweating
- heat intolerance
- weight loss
- tremors
- bulging eyes
- painful shoulder motion (periarthritis)
What is the difference between Graves disease and goiter?
Graves disease is HYPERthyroidism leading to excessive secretion of the THYROID hormone
Goiter is HYPERsecretion of the THYROID STIMULATING HORMONE
Is hyperthyroidism or hypothyroidism more common?
HYPOthyroidism
There is a (decrease/increase) in metabolism when hypothyroidism is present.
decreased metabolism
What are s/s of hypothyroidism?
- puffiness
- CTS
- anemia
What are risk factors for hypothyroidism?
- women
- medication
- radiation –> most common in women with breast cancer due to destroying the thyroid
What is hyperparathyroidism?
Excessive secretion of PTH leading to calcium in the blood
- decreased bone strength
- pathologic Fx
- muscle weakness and atrophy
hyperparathyroidism
What is hypoparathyroidism?
Decreased secretion of PTH causing a decrease of calcium in the blood
What is a result of hypoparathyroidism?
NM and cardiac irritability
- muscle spasms
- paresthesias
- Tetany
- cardiac arrythmias
hypoparathyroidism
What is the level of glucose leading to hyperglycemia?
> 300
–> severe if more than 350-400
What are s/s of hyperglycemia?
- fruity breath
- confusion
- lethargy
What is the ideal range of blood glucose?
70-300
(true/false) once you get to a point in hyperglycemia, your body creates MORE (doesn’t know when to stop) –> hard to stop production
true
What is the level of glucose leading to hypoglycemia?
< 70
What are s/s of hypoglycemia?
- pallor
- sweating
- shakiness
- HA
- blurred vision
What is the treatment for hypoglycemia?
10-15 grams of carbs
Metabolic syndrome is a precursor for ____.
DM
Metabolic syndrome is characterized by what? What does this increase the risk of?
a. Insulin resistance
–> insulin is working hard but not producing the same effect
b. greater risk to develop diabetes
What are s/s of metabolic syndrome?
- abdominal obesity
- increased triglycerides, decreased HDL, increased LCL
- increased BP (130/85)
- insulin resistance
What is the primary culprit of high glucose?
sugary drinks
Gout is characterized by elevated ___.
serum uric acid (hyperuricemia)
–> uric acid crystals collected in the joints –> causes an inflammatory response
When is gout most common to manifest in a person’s life?
40-50 y/o
–> can be seen from 60-70 y/o as well
What are differential diagnoses to gout?
- turf toe (EXT based) - closer presentation
- reverse turf toe (FLX based)
- Bunions (lateral drifting of the hallux)
What is pseudogout?
Arthritic condition caused by calcium pyrophosphate dihydrate (CPPD) crystals
Where is the primary location of pseudogout?
knee
What is the most common location for gout to occur?
1st MTP joint
What is a differential diagnosis to pseudogout?
OA
What is hemochromatosis?
Lack of regulation in iron absorption/metabolism
–> Intestinal tract absorbs excess iron producing tissue damage
What are risk factors for hemochromatosis?
Men > 50 y/o
Women > 60 y/o
What are s/s of hemochromatosis?
- CHF
- edema
- DM
- decreased body hair
Where is iron most absorbed?
RBCs (hemoglobin)
What is osteomalacia?
Softening of the bones
What is osteomalacia caused by?
Vitamin D deficiency
What is the name of osteomalacia in children?
Rickets
What are s/s of osteomalacia/rickets?
bowing of the long bones
What is Paget’s disease?
Focal inflammatory condition of the skeleton characterized by disordered bone remodeling
What is the most common skeletal disease? What is the second most common?
- osteoporosis
- Paget’s Disease
What bones are more affected by Paget’s disease?
long bones in the axial skeleton
What is another name for Reiter’s syndrome?
Reactive arthritis
What are the 3 common s/s of reiter’s syndrome?
Conjunctivitis, arthritis, inflammation of the cervix
(true/false) Family Hx of systemic inflammatory/related disorders may be the only available “Red Flag”
true
What diagnoses have a global clinical presentation?
- rheumatic disorders
- Seronegative Spondyloarthropathies
- ankylosing spondylitis
- reactive arthritis (Reiter’s syndrome)
- psoriatic arthritis
- SYMMETRICAL soft tissue/joint pain
- stiffness
- swelling
- weakness
- constitutional s/s
- Raynaud’s
- sleep disturbance
rheumatic disorders
What is Seronegative Spondyloarthropathies?
Inflammation of the spine
What is the difference between Seronegative Spondyloarthropathies and rheumatic disorders?
Seronegative Spondyloarthropathies have ASYMMETRICAL pain
Rheumatic disorders have SYMMETRICAL pain
- asymmetric peripheral arthritis
- connective tissue disorder
- inflammatory eye disease
- MSK and cutaneous features
Seronegative spondylarthropathies
What is the average amount of time for AIDS to develop after HIV exposure?
10 years
What type of virus is HIV?
Neurotropic virus
What are the s/s of HIV?
- decreased concentration/memory
- personality change
- HA
- Sz
- neuropathy
- weakness
- paralysis
- motor dysfunction
What are differential Dx for HIV?
Seizures and brain tumors
What are the groups at risk for TB?
- 25 to 44 y/o using injectible drugs
- minorities
- prison occupants/workers
- homeless
- immigrants
What is a problem with TB vaccinations?
There are now multi-resistant forms of TB
When is a standard TB test unreliable?
If HIV/AIDS is present
(true/false) can’t really Dx fibromyalgia other than exclusion of other possible Dx
true
What is fibromyalgia?
Non-inflammatory condition presenting w/ generalized MSK pain w/ TTP globally
Fibromyalgia is more common in (males/females)
females
–> preadolescent - early postmenopausal women
What syndrome has questionable Dx via 18 tender points in the body? How many are needed for Dx?
Fibromyalgia
(must report as actual pain, not tenderness) - 11/18 points
(true/false) Fibromyalgia has inflammation that is marked on blood tests
FALSE (no inflammation to be marked on blood tests)
definition: Chronic, systemic inflammatory disorder predominantly effecting diarthrodial jt synovium
rheumatoid arthritis
What joints are commonly affected by rheumatoid arthritis?
small joints of the wrists, hands, and feet
(true/false) rheumatoid arthritis is asymmetrical
FALSE (symmetrical)
Stiffness in the morning caused by rheumatoid arthritis lasts how long?
> 1 hour
What relieves pain/stiffness caused by rheumatoid arthritis?
activity
–> pain/stiffnessreoccurs when trying to resume an activity (“gel phenomenon”)
Some patients look like they’re wearing a low of bulky jewelery which is actually a splint for _____.
rheumatoid arthritis
What are the s/s of rheumatoid arthritis? What is the mnemonic?
SERIOUS
Swelling in 1+ joints
Early morning stiffness
Recurring pain/tenderness in any joint
Inability to move a joint normally
Obvious redness and warmth at a joint
Unexplained weight loss/fever/muscle weakness, joint pain
Symptoms > 2 weeks
Polymyalgia Rheumatica is a systemic rheumatic inflammatory disorder w/o known cause ~ linked w/ ________
Giant cell arteritis
If a patient > 50 y/o has a pounding HA on the temporal side of the head… suspect ____________.
polymyalgia rheumatica
What population is polymyalgia rheumatica most commonly found in?
postmenopausal women (> 55 y/o)
- Severe muscle aches and stiffness
- neck, shoulder, or pelvic girdle pain that is worse in the morning
- temporal HA
- weakness
polymyalgia rheumatica
definition: Type of lupus that is confined to the skin (rashes)
Discoid lupus
What type of lupus is more severe?
systemic lupus
What is the cause of lupus?
unknown
What can systemic lupus butterfly rash can be mistaken as?
acne or dry skin
What can Discoid Lupus be mistaken as?
ring worm, lymes disease, psoriasis, MRSA
What is scleroderma?
Inflammation and fibrosis of many body parts
What structures are affected by scleroderma?
- skin
- BV
- synovium
- skeletal muscle
- kidneys
- lung
- heart
What population is scleroderma commonly found in?
25-55 y/o women
What is the mild form of scleroderma? Does it have a rapid or gradual onset?
Limited scleroderma- gradual onset
What is the type of scleroderma that has an acute onset?
diffuse scleroderma
What is a precursor for limited scleroderma?
raynaud’s phenomenon
What are s/s of scleroderma?
- waxy appearance (“fountain of youth”)
- ape hand (atrophy of the first webbed space in the hand)
What are the s/s of lyme disease?
- bullseye rash
- flu-like s/s
- MSK pain
How long does it take a bullseye rash to progress?
Expands over days to weeks
Why is it common for someone to not realize they have a bullseye rash?
May not see rash due to ticks gravitating to warm, wet areas (hair, low back, groin)
Ankylosing spondylitis is a chronic progressive inflammatory disorder that predominantly affects what?
fibrous tissue
SI joints, spine, large peripheral joints
What is the cause of ankylosing spondylitis?
unknown
What population commonly presents with reiter’s syndrome?
males 20-40 y/o
When do s/s of reiter’s syndrome present themselves?
2-4 weeks after viral infection or GI issues
What diagnosis can plantar fasciitis be associated with?
reiter’s syndrome
What is psoriatic arthritis?
Chronic, recurrent, erosive, inflammatory arthritis assoc w/ the skin disease psoriasis
What location(s) are commonly affected by psoriatic arthritis?
distal joints of the hands and feet
(True/false) psoriatic arthritis is symmetrical
false (asymmetrical)
- swelling of the fingers
- possible RA
psoriatic arthritis
What type of drift is commonly observed in those with psoriatic arthritis?
ulnar drift
What is the most common inflammatory demyelinating disease of the CNS?
MS
Who commonly develops MS?
women 20-40 y/o
What is the biggest risk factor for MS?
family Hx
- unilateral vision impairment (“floaters”)
- pain in multiple areas
MS
What are differential Dx for MS and GBS?
- transverse myelitis
- B12 deficiency
- brain tumor
Guillain-Barre Syndrome is a ____ disease that affects the (CNS/PNS).
demyelination
PNS – causes a stocking glove presentation
(true/false) Guillain-Barre Syndrome affects all age groups/race/sex.
true
Guillian-Barre Syndrome becomes more serious if it affects what?
respiratory muscles/diaphragm
_________ is caused by Antibodies produced by the immune system blocking acetylcholine muscle receptors
myasthenia gravis
When are the peaks of myasthenia gravis?
20-30 y/o and 50+ y/o
symptoms:
- muscle fatigue
- resp. failure
- ptosis
- diplopia
myasthenia gravis
(men/women) are more likely to produce myasthenia gravis
women
What is a differential Dx for myasthenia gravis?
bell’s palsy
What percent of males and females will develop cancer in their lifetime?
Females: 46%
Males: 38%
(true/false) Children have increased cancer survival rates but they are at risk of developing cancer later on
true
What population has a higher death rate when Dx with cancer?
african americans
What population has a higher incidence and mortality rate when having cancer w/ an infectious etiology?
Hispanics ~ lower incidence & mortality w/ major CAs, but higher w/ infectious etiology
Cancer prevalence increases with age and plateaus around ____ y/o
mid-80s.
What major group of cancer makes up 85% of all cancer cases?
carcinoma
Where can carcinoma be found?
Skin, large intestine, stomach, breast
The large intestine, stomach, and breast can produce mets due to what?
lymphatics
What does sarcoma affect?
connective tissue (cartilage and bone)
How does sarcoma commonly metastasize?
blood
How do cancers of the bone and lymph system commonly metastasize?
blood
What are the general characteristics of cancer?
- fatigue > 2-4 weeks
- constant night pain
- PMH
- > 50 y/o
- 10% of unexplained weight loss in 4 weeks
What organs are commonly affected by cancer? Why?
Liver and kidneys commonly are affected by cancer in the blood due to being filtering organs. (ischemia –> necrosis –> infection)
What are nonspecific characteristics of CA?
- lumps (lymph node)
- unexplained bleeding
- proximal muscle weakness
- suspicious skin lesions
- pleural pain/SOB
What cancers commonly cause pulmonary problems such as pleural pain and SOB due to metastasizing?
METS to the brain and some bone cancer
What type of cancer is lung, breast, and melanoma?
neurologic cancers
- HA
- personality changes
- cord compression
- altered DTRs
- peripheral neuropathy
- traditional CA signs
neurologic cancers
What can peripheral neuropathy be caused by in a cancer case?
chemotherapy
What are conditions associated with neurologic cancers?
- lambert eaton
- polymyositis
What is lambert Eaton?
Autoimmune disease that causes the immune cells to attack tissues at the NMJ
Does lambert eaton syndrome commonly affect the UEs or LEs more?
LEs
What condition is commonly associated with lung cancer?
Lambert Eaton (50%)
What is polymyositis?
inflammation of multiple muscle groups
(true/false) polymyositis can occur before a tumor is detected
true
How long does it take for polymyositis to occur?
weeks to months
symptoms:
- proximal muscle weakness
- joint pain
- pulmonary involvement
- unexplained fevers
- anorexia
polymyositis
Bone cancers are commonly caused by what?
METs
What portion of the spine is commonly affected by bone cancers?
thoracic spine
What increases pain with bone cancers?
WB and heel strike
What can cause lethargy and/or HTN with bone cancers?
increased calcium
What population is commonly affected by Ewing Sarcoma?
5-16 y/o boys
What locations does Ewing’s sarcoma commonly affect?
pelvis and femur
–> can involve any bone
What are the 2 peaks for osteosarcoma?
10-25 y/o and adulthood
What locations are commonly affected with osteosarcoma?
thigh and knee
Leukemia is caused by what?
increase in abnormal WBCs which leads to inhibiting other cells
What are the peaks of leukemia?
2-4 y/o and 65+ y/o
Symptoms:
- infections
- fatigue
- bleeding
- enlarged lymph nodes (may be painless)
- joint pain (looks like RA)
leukemia
What are the risk factors for leukemia?
chemotherapy, radiation, chemicals
What causes multiple myeloma?
uncontrolled cell growth from bone marrow
What is the common population for multiple myeloma?
50-70 y/o
Symptoms:
- bone/joint pain and/or destruction
- renal involvement
- neurologic (CTS and LBP with radicular sxs)
Multiple myeloma
Where is bone/join pain and/or destruction found with multiple myeloma?
pelvis, spine, ribs
What is the most common cancer that affects the T-spine?
multiple myeloma
What can hodgkin’s lymphoma look like?
flu
What are the peaks for Hodgkin’s lymphoma?
15-34 y/o
> 50 y/o
symptoms:
- enlarged PAINLESS lymph nodes (> 1 cm)
- pruritis
- cyclical, unexplained fevers
- non-productive cough
hodgkin’s lymphoma
What virus is often present with hodgkin’s lymphoma?
Epstein-barr
What age group can get non-hodgkin’s lymphoma?
All ages (esp. 40-60 y/o)
symptoms:
- enlarged PAINLESS lymph nodes
- extranodal manifestations in the CNS, GI, and bone
non-hodgkin’s lymphoma
What are the risk factors for non-hodkin’s lymphoma?
- immuno-compromised (HIV)
- radiation
- increased age
- immunosuppressed
Non-hodgkin’s lymphoma leads to 3% of all ____ diagnoses.
AIDS
What is the prognosis of non-hodgkin’s lymphoma dependent on?
Initial immune system status
If a person is severely compromised and has non-hodgkin’s lymphoma, what is their prognosis?
4-7 months
If a person has non-hodgkin’s lymphoma in addition to a diagnosis of HIV-related brain lymphomas, what is their prognosis?
very poor
What will happen to muscle if a person has too much radiation exposure?
The muscles lose their elasticity
