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Clinical Nursing May Exam > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

what is aetiology for feline hyperthyroidism?

A

adenoma of thyroid tissues
adenocarcinoma
mostly bilateral

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2
Q

what are potential causes of feline hyperthyroidism?

A

high iodine in diet
pesticides in environment
genetics
circulation thyroid growth stimulating immunoglobulins

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3
Q

describe signalment for feline hyperthyroidism

A

middle aged or older

same for both sexes

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4
Q

list clinical signs of feline hyperthyroidism

A 
enlarged thyroid glands
weight loss
PUPD
tachycardia
lethargy
muscle weakness
anorexia
tachypnoea
CHF
pyrexia
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5
Q

what are signs of apathetic feline hyperthyroidism?

A

lethargy
inappetence
weight loss
obtundation

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6
Q

what is meant by apathetic feline hyperthyroidism?

A

reflects underling comorbidity, often severe cardiac abnormalities

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7
Q

describe how to nurse cats with hyperthyroidism

A

hand off approach
quiet dark room
oxygen
monitor RR

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8
Q

how is feline hyperthyroidism diagnosed?

A 
clinical signs
blood tests
high liver enzymes
urinalysis
BP
serum total thyroxine elevated
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9
Q

list treatment options for feline hyperthyroidism

A

anti-thyroid drugs
iodine restricted diet
thyroidectomy
radioactive iodine treatment

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10
Q

list examples of anti-thyroid drugs

A

methimazole BID

slow release carbimazole SID

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11
Q

what are advantages of anti-thyroid drugs?

A

readily available
rapid effect
inexpensive
practical

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12
Q

list disadvantages of anti-thyroid drugs

A

life long
can become resistant
side effects

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13
Q

state some side effects of anti-thyroid drugs

A 
vomiting
anorexia
lethargy
GI signs
leukopenia 
anaemia
thrombocytopenia
dermatitis
myasthenia gravis
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14
Q

what is the benefit of iodine restricted diets?

A

when fed exclusively can become euthyroid in 3 weeks

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15
Q

list presurgical considerations for feline hyperthyroidism

A

systemic effects of hyperthyroidism
cardiac disease
hypertension
other disease present

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16
Q

what are advantages of thyroidectomy to treat hyperthyroidism?

A

rapidly curative

quick recovery

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17
Q

list disadvantages of thyroidectomy to treat hyperthyroidism

A

need GA
cost
complications
need to preserve parathyroid

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18
Q

list complications following thyroidectomy

A

hypoparathyroidism if parathyroid tissue damaged
laryngeal paralysis
sympathetic trunk damage
recurrence if unilateral

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19
Q

how does radioiodine treat hyperthyroidism?

A

administered IV to concentrate in thyroid

beta causes local cell death of thyroid tissue

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20
Q

list advantages of radioiodine

A

curative
simple
high doses can treat adenocarcinoma
no GA

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21
Q

state disadvantages of radioiodine treatment

A 
limited availability
isolation needed
irreversible
longer to achieve euthyroid
can cause hypothyroidism
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22
Q

how are feline hyperthyroid patients monitored?

A

6 monthly check ups when stable

monitor for recurrence, hypertension and CKD

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23
Q

what is prognosis for feline hyperthyroidism?

A

depends on severity of concurrent disease

good if curative treatment in uncomplicated patients

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24
Q

how are feline hyperthyroidism and CKD related?

A

hyperthyroidism can mask underlying CKD so treating can reveal it

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25
Q

how is risk of CKD managed in feline hyperthyroidism?

A

medical management before curative treatment to assess

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26
Q

what usually causes feline iatrogenic hypoparathyroidism?

A

bilateral thyroidectomy

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27
Q

list clinical signs of feline iatrogenic hypoparathyroidism

A 
inappetence
weakness
tremors
pawing face
seizures
coma
death
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28
Q

how is feline iatrogenic hypoparathyroidism treated?

A

IV 10% calcium gluconate
monitoring for arrhythmia and bradycardia
oral therapy

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29
Q

what are common types of canine thyroid neoplasia?

A

carcinoma
adenoma
locally invasive with possible metastasis

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30
Q

list clinical signs of canine thyroid neoplasia

A

old
mass in ventral neck
cough
dyspnoea

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31
Q

how is canine thyroid neoplasia diagnosed?

A

FNA and histopathology of mass

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32
Q

how is canine thyroid neoplasia treated?

A

surgical removal
chemo
radiation
high dose radioactive iodine

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33
Q

what is prognosis for canine thyroid neoplasia?

A

poor if large invasive masses

good if surgical removal of small carcinoma

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34
Q

what do thyroid glands produce?

A

thyroxine/T4 and triiodothyronine/T3 from tyrosine AA by action of thyroid peroxidase oxidating iodine

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35
Q

describe the structure of thyroid glands

A

vascular bilobed structures lateral to proximal tracheal rings

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36
Q

what do thyroid hormones effect?

A

metabolic processes
enzymes
tissues

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37
Q

how is T4 found in the body?

A

protein bound in circulation

biologically active unbound in circulation is fT4

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38
Q

what is the function of T4?

A

negative feedback on TSH production

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39
Q

how is T3 formed?

A

in thyroid cell fT4 is deiodoinated to form T3

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40
Q

what controls production of thyroid hormones?

A

hypothalamus pituitary thyroid axis
TRH in hypothalamus stimulates TSH in pituitary which stimulates T4 and T3 production
T4 and T3 are inhibitory for TRH and TSH

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41
Q

state causes of primary hypothyroidism in dogs

A

lymphocytic thyroiditis

thyroid atrophy

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42
Q

what is lymphocytic thyroiditis?

A

destructive immune mediated process where lymphocytes, macrophages, plasma and fibrous tissue infiltrate

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43
Q

what is thyroid atrophy?

A

degeneration and progressive replacement by adipose and connective tissue

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44
Q

what are causes of secondary canine hypothyroidism?

A

pituitary hypoplasia

suppression of TSH secretion by glucocorticoids or hyperadrenocorticism

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45
Q

what is signalment for canine hypothyroidism?

A

middle aged

breed dispositions to lymphocytic thyroiditis including setter, retriever, ridgeback, cocker, boxer

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46
Q

list signs of canine hypothyroidism

A 
decreased metabolic rate
endocrine alopecia
facial oedema
persistent anoestrus
bradycardia
NMD
myxoedema coma
ocular issues
SIBO
low intestinal peristalsis
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47
Q

how is canine hypothyroidism diagnosed?

A 
history
clinical sign s
mild anaemia
hypercholesterolaemia
hypertriglyceridemia
low T4 
high TSH
anti-thyroglobulin antibodies
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48
Q

how is canine hypothyroidism treated?

A

synthetic T4
prohormone for T3
sodium levothyroxine

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49
Q

how are dogs with hypothyroidism monitored?

A 
6-8 weeks after treatment
2-4 weeks after changing doses
TT4 measured after 6 hours after admin
monitor fT4 if chronic prednisolone admin
monitor cTSH
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50
Q

list complications of canine hypothyroidism treatment

A

thyrotoxicosis

myxoedema coma

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51
Q

what are signs of thyrotoxicosis?

A 
panting
anxiety
PUPD
weight loss
polyphagia
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52
Q

what is produced in each area of the adrenal glands?

A

zona glomerulosa- mineralocorticoids
zona fasciculata and reticularis- glucocorticoids and sex hormones
adrenal medulla- catecholamines

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53
Q

describe the physiology of aldosterone

A

mineralocorticoid

main site of action is late distal and collecting tubules

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54
Q

what is the action of aldesterone?

A

reabsorption of NaCl and water

secretion of K+ and H+

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55
Q

how is aldosterone production stimulated?

A

hyperkalaemia

increased angiotensin II

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56
Q

what causes primary hypoadrenocorticism?

A

lack of MC and GC

suspected immune mediated destruction of adrenal cortex

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57
Q

what are main causes of secondary hypoadrenocorticism?

A 
neoplasia
inflammation
infection
iatrogenic
cause lack of GC only
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58
Q

list clinical features of canine hypoadrenocorticism

A 
young female
breeds including poodle and great dane
history
lack of cortisol and aldosterone
weakness
vomiting
anorexia
diarrhoea
PUPD
low Na
addisonian crisis
59
Q

what are signs of addisonian crisis?

A 
collapse
severe dehydration 
hypovolaemia
pre-renal azotaemia
cardiac arrhythmia
hyperkalaemia
bradycardia
60
Q

how is canine hypoadrenocorticism diagnosed?

A 
history
clinical signs
non-regenerative anaemia
absent stress leukogram
low neutrophils
high lymphocytes and eosinophils
hyperkalaemia and calcaemia 
pre-renal azotaemia
hypoglycaemia and natraemia 
high liver enzymes
low albumin and cholesterol
61
Q

how is canine hypoadrenocorticism diagnosis ruled out?

A

basal cortisol over 55nmol/l

62
Q

how is canine hypoadrenocorticism diagnosis confirmed?

A

ACTH stimulation test
if has disease pre and post ACTH cortisol concentrations are below 20nmol/l
cortisol is given and ACTH measured before and 1 hour after

63
Q

how is Addisonian crisis treated?

A

IVFT
hydrocortisone or dexamethasone
slow correction of hyponatraemia
treat hypoglycaemia and hyperkalaemia

64
Q

what is long term management for canine hypoadrenocorticism?

A

GC usually prednisolone
MC desoxycortone privalate
fludrocortisone but cant manage MC and GC separately

65
Q

what is prognosis for canine hypoadrenocorticism?

A

good if managed but long term medication needed

more GC needed in stress

66
Q

how does canine hyperadrenocorticism happen?

A

excess production of cortisol

67
Q

what are causes of canine hyperadrenocorticism?

A

pituitary tumour causing excess ACTH production and loss of negative feedback
adrenal tumour causing excess cortisol so suppression of ACTH production
iatrogenic

68
Q

list clinical signs of canine hyperadrenocorticism

A 
abdominal distension
hepatomegaly
lethargy
panting
alopecia
polydipsia
polyphagia
69
Q

state complications of canine hyperadrenocorticism

A 
DM from insulin resistance
progression of major signs
pulmonary thromboembolism
neuro signs
pancreatitis
secondary infection
hypertension
70
Q

how is canine hyperadrenocorticism diagnosed?

A 
mild erythrocytosis and thrombosis
high neutrophils and monocytes
low eosinophils and lymphocytes
increased liver enzymes
lipolysis
hyperglycaemia
increased bile acids
USG lower than 1.015
urolithiasis 
ACTH stimulation test
LDDST 
urine cortisol to creatinine ratio
71
Q

define specificity

A

probability of negative result if not affected

72
Q

define sensitivity

A

probability of positive result if affected

73
Q

how is LDDST carried out?

A

collect serum for basal cortisol
inject dexamethasone IV
collect samples 4 and 8 hours later

74
Q

what are negatives of treating canine hyperadrenocorticism?

A

expensive
may unmask other disease
can cause pituitary lesions to expand causing CNS signs

75
Q

how is pituitary and adrenal dependent hyperadrenocorticism differentitated?

A 
LDDST
HDDST
imaging
PDH- symmetrical adrenal glands
AT- asymmetrical adrenal glands
76
Q

how is PD canine hyperadrenocorticism treated?

A

trilostane
hypophysectomy
bilateral adrenalectomy
radiation

77
Q

how is AD canine hyperadrenocorticism treated?

A

adrenalectomy

trilostane

78
Q

what is prognosis for canine hyperadrenocorticism?

A

depends on age and health

usually survive less than few years after diagnosis

79
Q

list signs of feline hypoadrenocorticism

A

cachexia
fragile skin syndrome
alopecia

80
Q

how is feline hypoadrenocorticism diagnosed?

A

HDDST

ACTH stimulation test

81
Q

what is treatment for feline hypoadrenocorticism?

A

adrenalectomy
some success with hypophysectomy, trilostane
poor prognosis

82
Q

what is aetiology for canine DM?

A

destruction of pancreatic beta cells due to genetics, immune mediated, pancreatitis, idiopathic
beta cell exhaustion due to obesity, diet, drugs

83
Q

what type of diabetes is canine DM?

A

insulin dependent

84
Q

state signalment for canine DM

A

middle aged to old
females
breeds such as schnauzer and bichon

85
Q

what are signs of canine DM?

A 
PUPD
glucosuria
polyphagia 
weight loss
cataracts
diabetic ketoacidosis
86
Q

what are signs of ketacidosis?

A

vomiting
collapse
dehydration

87
Q

how is canine DM diagnosed?

A

glycosuria
hyperglycaemia
fructosamine to show average glycaemia for previous 2-3 weeks

88
Q

what are ways to manage canine DM?

A

insulin
spaying females
diet

89
Q

what are commonly used insulin to treat canine DM?

A

lenate for immediate length action, caninsulin

PZI for long action

90
Q

how should insulin be cared for?

A

store in fridge
replace bottle every 4 weeks
mix before use

91
Q

why should intact females with canine DM be spayed?

A

progesterone causes insulin resistance

92
Q

what should be components of diets to manage canine DM?

A

non simple sugar to limit hyperglycaemia post feeding
calories from complex carbs and protein
high fibre
consistent feeding in line with insulin

93
Q

how are canine DM patients initially stabilised?

A

takes weeks to months
low dose insulin 2x daily
first day of inulin in practice monitoring BG to avoid hypoglycaemia

94
Q

what are the ways of monitoring BG?

A

spot monitoring

continuous glucose monitoring

95
Q

how does urinalysis help monitor canine DM patients?

A

usually mild glucosuria before insulin
no glucosuria for 24 hours may suggest insulin overdose
ketones may indicate poor control

96
Q

what are short term complications of insulin therapy?

A

hypoglycaemia
somogyi overswing
short or prolonged duration of action
inadequate action

97
Q

what BG is considered hypoglycaemic?

A

less than 3mmol/l

98
Q

define somogyi overdose

A

rebound hyperglycaemia caused by physiologic response to hypoglycaemia
BG over 3.6mmol/l

99
Q

what are long term complications of insulin therapy?

A 
hypoglycaemia
cateracts
diabetic neuropathy
hypertension
diabetic ketoacidosis
100
Q

what is prognosis for canine DM?

A

good when well managed

survival average 3-5 years after diagnosis

101
Q

state aetiology for feline DM

A 
old age
obesity
male 
indoors
burmese
maine coon
102
Q

what type of diabetes is feline DM?

A

non-insulin dependent

103
Q

what causes feline DM?

A

insulin resistance

reduced insulin secretion from beta cell damage, chronic high glucose and FAs

104
Q

what are causes of insulin resistance?

A 
obesity
genetics
pancreatitis
UTIs
CKD
dental disease
enteropathy
hyperthyroidism
hypercortisolism
105
Q

what is meant by feline pre-DM?

A

BG consistently over 6.5mmol/l

106
Q

what is sub-clinical feline DM?

A

BG between 10 and 16mmol/l

107
Q

how can you manage sub-clinical feline DM to help prevent progression to overt DM?

A

low carb diet

weight loss

108
Q

what is overt DM in cats?

A

BG over 16 mmol/l
high fructosamine
glycosuria

109
Q

list clinical signs of feline DM

A 
PUPD
weight loss
polyphagia
DKA
peripheral neuropathy
cataracts
110
Q

how is feline DM diagnosed?

A

hyperglycaemia
glycosuria
fructosamine
history and clinical signs

111
Q

how is feline DM treated?

A

insulin
diet
exercise
consistency and commitment of owner

112
Q

what insulin are used for treating feline DM?

A

prozinc
caninsulin
glargine insulin

113
Q

how can oral hypoglycaemic drugs help treat feline DM?

A

increases insulin secretion

used alongside diet

114
Q

how does diet help manage feline DM?

A

weight loss

reduce or prevent need for insulin dose

115
Q

what are components of diets to manage feline DM?

A

wet
high protein
low carbs

116
Q

what happens during DKA?

A

increased production of glucoregulatory hormones
lack of insulin allows unopposed glucogenic effects of stress hormones in liver, muscle and adipose
excess FFA breakdown
excess ketone formation

117
Q

list clinical signs of DKA?

A 
PUPD
PP
weight loss
lethargy
anorexia
strong odour of acetone on breath
dehydration 
hypovolaemia
118
Q

how is DKA managed?

A 
restore water and electrolytes
insulin to turn off ketone production
correct acidosis 
identify underlying disease
analgesia
feeding support
monitoring
119
Q

what is prognosis for DKA?

A

hard to treat
often have underlying disease
can become healthy diabetics or enter remission
25% dont survive

120
Q

what are diseases associated with DKA?

A

heart failure
sepsis
pancreatitis

121
Q

what is believed to cause PPID?

A

decrease in production of dopamine due to decreased inhibition, pituitary adenoma, overproduction of hormones

122
Q

list clinical signs of PPID?

A 
long curly coat
laminitis
PUPD
weight loss
neurological impairment
altered fat distribution
infertility
skin disease
periodontal disease
123
Q

how is PPID diagnosed?

A

clinical signs
post mortem
ACTH test
TRH stimulation test

124
Q

what is the response to positive tests for PPID?

A

treat but re test in 4-6 weeks for dose

retest annually as disease progresses

125
Q

what should you do if negative test for PPID?

A

if clinically indicated start treatment and recheck

126
Q

how is PPID managed?

A 
farriery
clipping
parasite control
dental care
dopamine agonist
127
Q

what are the effects of EMS?

A

obesity
insulin resistance or dysregulation
laminitis

128
Q

what horses is PPID seen in?

A

older horses mainly over 15s

129
Q

what is compensated insulin dysregulation?

A

high insulin

normal glucose

130
Q

what is uncompensated insulin dysregulation?

A

high insulin and glucose
glucosuria
type 2 diabetes

131
Q

how do genetics affect insulin dysregulation in horses?

A

hardy breeds genetically predisposed
poor diet so ID facilitating breakdown of glucose and fat and stimulating hepatic gluconeogenesis keeps glucose supply to vital tissue

132
Q

how are obesity and insulin resistance related in wild horses?

A

plenty of food in summer so get fat and IR

loose weight over summer so restore insulin sensitivity by spring

133
Q

why are horses not subject to the same insulin resistance phases as wild horses?

A

dont have seasonal weight loss

have chronic obesity so stay IR and get laminitis

134
Q

list clinical signs of EMS

A 
obesity
regional adiposity
laminitis
lipoma
hyperlipemia
135
Q

how is EMS diagnosed?

A

resting insulin and glucose after overnight starving

IR seen by hyperinsulinemia and normoglycemia

136
Q

how is EMS managed?

A 
low carb diet
no grass
multivitamin and mineral supplement
exercise considering laminitis
weight loss feeding 1/3 less
metformin to block SI carb absorption so decreases IR by weight loss
137
Q

how does hyperlipemia in horses happen?

A

stress or negative energy balance triggers fatty acid metabolism
triggers catecholamine and GC release
lots of fat moves into circulation

138
Q

list risk factors for equine hyperlipemia

A 
obesity
ponies
pregnancy
excess FA stores
IR
139
Q

what is the effect of hyperlipemia in horses?

A 
hepatic lipidosis
liver failure not enough hormones for fat
fat embolism
kidney failure
pancreatitis
140
Q

how is hyperlipemia in horses diagnosed?

A 
identify if risk
prevention better
depression
anorexia
ataxia
icterus
141
Q

what are aims of treating hyperlipemia in horses?

A 
improve energy intake and balance
treat hepatic disease
eliminate stress
treat concurrent diseases
inhibit fat metabolism from adipose
increase triglyceride uptake by peripheral tissues
142
Q

how is hyperlipemia in horses treated?

A 
manage hepatic and underlying disease
wean foal
tempt to eat
supportive nutrition
glucose infusion
143
Q

what is prognosis for hyperlipemia in horses?

A

60-100% mortality

144
Q

how can equine hyperlipemia be prevented?

A

client education
identify risk
glucose infusion and insulin

Clinical Nursing May Exam (22 decks)

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