Exam 5 - Endo Flashcards by Ashley Burkhalter

what is pheochromcytoma

tumor of medulla (center) of adrenal glands

can be a single tumor or multiple

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what occurs with pheochromcytoma

excessive production of catecholomines (epi, norepi)

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are men or women more likely to have pheochromcytoma

equally common in men and women

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pheochromcytoma age

can occur at any age, rarely after 60

textbook says peak is 40-60 years

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are pheochromcytoma tumors malignant or benign

90% are benign

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risk factors for pheochromyctoma

family hx
tumors in other glands
hormonal disorders
genetic disease

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s/sx of pheochromyctoma is directly related to which type of bodily response

fight or flight

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s/sx of pheochromyctoma

hyperglyemic
HTN (rapid onset, abrupt cessation)
HA ** (#1 s/sx)
N/V
abdominal, CP
tachycardia
agitation
emotional instability
diaphoresis
increased metabolic rate

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acute attacks r/t pheochromyctoma

profuse diaphoresis
dilated pupils
cold extremities
severe HTN (can lead to stroke, sudden blindness)
c/o black floaters

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normal range for urinary catecholamines

14g/100 mL of urine

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normal vanillylmandelic acid (VMA)

< 7 mg over 24 hours

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how will does alpha blockers help with pheochromcytoma

relax muscles
keep small blood vessels open

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alpha blocker SE

orthostasis
nasal stuffiness
increased fatigue
retrograde ejaculation

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how do beta blockers help with pheochromcytoma

heart beast more slowly, less forceful
stops norepi

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pheochromcytoma complications

HTN
MI
HF
stroke
kidney failure
cognitive decline
dementia
visual impairment

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pheochromcytoma treatment if medication therapy is not effective

adrenalectomy

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should you palpate the abdomen is a person has or suspected to have pheochromcytoma

no bc it can cause a release in additional catecholamines

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5 H’s of pheochromcytoma

HTN
HA
hypermetabolism
hyperglycemia
hyperhidrosis

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what type of drinks should be avoided prior to adrenalectomy

caffeine

coffee, tea, cola, energy drinks

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adrenalectomy requires what for life

cortical replacement therapy

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diabetes insipidus (DI) is a disorder of what gland

posterior pituitary gland

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what is there a deficiency of with DI

ADH (vasopressin)

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DI results in the inability to conserve what

water

will have a large amount of UOP

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what are the 4 types of DI

neurogenic
nephrogenic
dipsogenic
gestagenic

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neurogenic vs. nephrogenic DI

neuro: deficiency of ADH nephro: insensitivity of the kidneys to the effect of ADH

what occurs with dipsogenic DI

form of primary polydipsia abnormal thirst, excessive intake of liquids

causes of DI

head injury ** family hx idopathic neurosurgery damage to hypothalamic areas

DI causes extreme ___ and ___

polydipsia polyuria

DI causes a risk for ___ if there is an impaired thirst mechanism

dehydration

how does ethanol and phenytoin cause DI

inhibits ADH secretion

how does lithium and demecyocycline cause DI

inhibits ADH action in the kidneys

DI plasma osmolality will be > ___

> 295

DI urine osmolality will be < ___

< 500

will DI cause hypo or hypernatremia

HYPERnatremia

what is a normal specific gravity

1.01-1.025

DI urine specific gravity

1.001-1.005

what needs to be monitored HOURLY with a fluid deprivation test

VS UOP urine specific gravity

what leads to a positive DI dx with a fluid deprivation test

specific gravity remains low continued large UOP continued rise in serum osmolality continued decline in urine osmolality continued rise in serum sodium

DDAVP is a synthetic form of ___

desmopressin

how is DDAVP administered

SQ intranasally

SE of DDAVP

chest tightness nasal ulcerations allergy

medications for mild/moderate ADH deficit

Tegretol PO Atromid PO

how does tegretol and atromid work

augment action of existing ADH

how to know DI meds are effective

UOP will decrease osmolarity will increase

what occurs with syndrome of inappropriate ADH (SIADH)

sustained secretion of ADH (water intoxication) too much ADH is released = water retention

SIADH urine osmolarity will be > __

> 11

SIADH urine sodium concentration will be > __

> 20

causes of SIADH

PNA TB asthma small cell lung cancer CHF Positive-pressure ventilation excessive exogenous vasopressin

meds that can cause SIADH

morphine barbituates vincristine general anesthetics thiazides NSAIDs MAOIs oxytocin haldol ASA tylenol beta adrenergic agonists

malignancies r/t SIADH

bronchiogenic pancreatic duodenal lymphoid tissue prostate thymus colon brain

nonmalignant causes of SIADH

hypothyroid TB lung abscesses PNA COPD status astmaticus SLE

SIADH s/sx will be r/t ____

HYPOnatremia s/sx irritable lethargic impaired memory

SIADH daily UOP will be <

< 500 cc/24 hours

with SIADH there will be weight gain with or without edema

without edema

precautions needed if Na is < 119

seizure precautions

what to do if low Na is a new finding

report to HCP

SIADH fluid restriction

800-1000 mL

how does declomycin work for SIADH

blocks action of ADH but can cause nephrotoxic DI

SIADH intervention if pt is on a fluid restriction and c/o of thirst

suck on hard candies

what type of IVF can be administered with SIADH

3% NS hypErtonic: Enters vessels from the cells

how can phenytoin help with SIADH

inhibits ADH release

with SIADH, HOB should not be > __ degrees

10 degrees

acute inflammation of demyelinating disorder of peripheral nervous system; acute onset of ascending motor paralysis

GBS

GBS occurs how long after infectious onset

1-3 weeks

viruses r/t GBS

epstein barre cytomegalovirus (CMV) shingles chickenpox textbook: epstein barre, campylobacter jejuni, mycoplasma pneumoniae, HiB, Zika virus

GBS recovery is usually ___

spontaneous

will the body be inflamed with GBS

no, only nerves

GBS onset is ___ but recovery is ___

ascending; descending

does GBS affect cognitive function or LOC

stage 1: acute stage GBS

severe, rapid weakness loss of muscle strength quadriplegia respiratory failure decrease deep tendon reflex paresthesia numbness pain

stage 2: stablizing/plateau stage GBS

2-3 weeks after onset marks end of condition autonomic function returns

stage 3: recovery stage GBS

several months to years marked by improvement of s/sx muscle strength, function return in descending order

is GBS muscle weakness symmetrical or asymmetrical

symmetrical

what can be the first s/sx of a compromised airway

drooling

what test can be done to confirm GBS dx

electromyogram (EMG)

these 2 forms of treatment are most effective for GBS if performed within the first 2 weeks of symptom onset

plasmapheresis (plasma exchange) IVIG

GBS primary focus is on ___

ventilation be ready for intubation PRN

lyme disease is caused by spirochete borrelia burgdorferi which is transmitted primary by ___

ticks may be carried by mice, deer, dogs, and cats

lyme disease outbreaks are commonly seen when

summer months

lyme disease incubation period

30 days

what is erythema mirgrans

flat or slightly raised (bullseye shaped) red lesion that expands over several days

systemic s/sx of lyme disease

fatigue malaise fever chills myalgia

lyme disease can cross the BBB and lead to ___

meningitis dx: LP precautions: droplet

what test is used to dx lyme disease within the first 2-4 weeks of initial skin lesion

ELISA or Western blot

abx for lyme disease

doxycycline tetracycline amoxicillin erythromycin

how to remove a tick

tweezers use a straight, upward pull

what to use to disinfect skin after removing a tick

soap + water rubbing alcohol H2O2

lyme disease prevention education

use insect repellents that contains DEET on clothing and exposed skin

what is scleroderma

overproduction of collagen autoimmune disoder

systemic scleroderma is aka ___ ___ ___ ___

hardening of the skin

is scleroderma more common in men or women

women onset 25-50 y/o

CREST r/t scleroderma

Calcinosis Raynauds phenomenon Esophageal dysfunction Sclerodactyly Telangiectasias **must have 4/5 for dx

prognosis for localized scleroderma is ___

good because it is just on the skin, organs are not affected

which med group is used for raynauds

CCB

scleroderma room temp should be ___

constant; keep warm

how long should a pt with scleroderma sit up after meals

1-2 hours

scleroderma education re: foods + drinks

small frequent meals avoid spicy foods avoid caffeine, alcohol

what is sjogrens syndrome

autoimmune disorder that causes inflammation and dysfunction of the exocrine glands throughout the body

sjogrens syndrome is often associated with other ___ diseases

rheumatic RA SLE scleroderma hashimotos thyroiditis

does sjogrens syndrome commonly occur in women or men

women

most common s/sx of sjogrens syndrome

xerophthalmia (dry eyes) xerostomia (dry mouth) can also cause dryness in the nose, bronchi, vagina, and skin

sjogrens will cause the paratoid gland to become ___

enlarged

how is sjogren's dx

H&P lacrimal or salivary gland tissue bx

sjorgen's treatment is ___

supportive