Exam 6 Flashcards

Question

Protruded Disk Clinical Manifestations

Answer 1

Pain Altered sensation -Numbness -tingling Motor weakness Diminished reflexes

Answer 2

-Bedrest -Narcotic pain medications -Muscle relaxers -Cortisone injections -Heat or ice -Traction -Ultrasound -Electrical stimulation -Short-term bracing for the neck or lower back -Surgery

Answer 3

Considerable tissue damage -Possible ligament tear -Rupture Subluxation: displacement from normal position; not as severe as a dislocation Dislocation: Articulating surface loses contact Commonly dislocated joints -Fingers -Patella -Shoulder

Answer 4

Pain Alteration in normal contour of the joint Change in extremity length Loss of normal mobility

Answer 5

-Immobilization -Reduction -Pain control -Treatment must include consideration of local soft-tissue trauma

Answer 6

Often occur when range of motion is exceeded Damage to surrounding tissue may occur Classified by the extent of tear Common site of injury is the knee (anterior cruciate ligament -ACL) -athletes

Answer 7

Sudden "tearing" or "popping" sensation Pain with weight bearing Acute swelling

Answer 8

Geared toward relief of symptoms Protection of the ligament Recovery is usually complete May require surgery

Answer 9

Minor strain -A few fibers of the tendons/muscle are torn -Usually from excessive physical effort Sprain -Traumatic injury to tendons, muscles, or ligaments >>>Pain >>>Swelling >>>Treatment varies with extent of injury TREATMENT: RICE: -R-EST -I-CE -C-OMPRESSION -E-LEVATION

Answer 10

Excessive use Rupture of tendon in rotator cuff under acromion bone Impingement syndrome: inflammation around joint causing severe characteristic pain with movement

Answer 11

PAIN! Limited range of motion Treatment -injected steroids -repair

Answer 12

A break in the continuity of bone, an epiphyseal plate, or a cartilaginous joint surface Trauma generates enough energy to fracture a bone also produces force enough to traumatize adjacent soft tissue Types of fractures -Transverse -Spiral -Longitudinal -Oblique -Comminuted -Impacted -Greenstick -Stress -Avulsion

Answer 13

extent and depth

Answer 14

End of fracture fragments separated

Answer 15

Fracture fragments remain in alignment and position

Answer 16

Fracture displaced below the level of the surface of the bone (skull)

Answer 17

Fracture line disrupts bone continuity through whole thickness

Answer 18

Bone cracks but continuity is not disrupted

Answer 19

Bone is broken and an external wound leads to the fracture site Increased risk for infection Osteomyelitis Difficult to manage

Answer 20

Fragments do not extend through mucous membranes or skin Skin is not broken

Answer 21

Pain Swelling Loss of function Discoloration Deformity +/- Muscle spasm and shortening of extremity

Answer 22

Main goals: 1. Reduction -Restoring to normal anatomical position 2. Immobilization -Maintain proper alignment until bone healing occurs -External fixation -ORIF -Casts/splints/braces Rehabilitation

Answer 23

Delayed healing Compartment syndrome Neurovascular injury Fat emboli Deep Vein Thrombosis (DVT) -Pulmonary embolus Osteomyelitis -Severe bone infection Osteonecrosis -Avascular necrosis -Compromised circulation-> ischemia->bone death

Answer 24

-Smoking -Malnutrition -Use of corticosteriods -Poor circulation -Infection -Elderly -Diabetes -Coronary heart disease

Answer 25

-Triggered by injury to the tissues surrounding bone leading to inflammation, swelling, and sometimes hemorrhage -High pressure in a muscle compartment in the closed fascial space -Leads to decreased blood flow -Tissue hypoxia -Tissue death >>>Pain >>>Paralysis >>>Paresthesia >>>Pallor >>>Pulselessness

Answer 26

-Damage related to casts/splints -Hemorrhage -Edema -Manipulation at the time of reduction

Answer 27

-Fat from bone or adipose enters the venous system -Most common in long bone factures -Within 24 to 72 hours of trauma -Can affect any organ system -S&S: depend on system affected

Answer 28

Major health problem of elderly Female/Caucasian Most result from falls Risk Factors -Alcohol & caffeine -Inactivity -Tall stature -Low body weight -Psychotropic drugs -Dementia -Osteoporosis

Answer 29

Usually fracture is proximal femur Location is important in terms of blood supply

Answer 30

Return to pre-injury function as soon as possible ORIF Surgical hip replacement -Early mobilization!

Answer 31

Lateral curvature of the spine resulting in an S or a C-shaped spinal column Detected from asymmetry of the shoulders, hips, and chest wall Consequence of congenital, connective tissue, or neuromuscular disorder Majority ideopathic

Answer 32

Structural -Fails to correct on forced bending -More serious-progressive -Involves deformity of vertebrae and changes in hip, shoulder, and rib cage positions Nonstructural -Resolves when the patient bends to the affected side -Condition not progressive Related to postural problems Body image disturbances -Uneven shoulders of hips -Shoulder or scapular prominence -Rib or chest hump when bending over -C or S shaped spine Respiratory difficulties Pain

Answer 33

Surgical (for 40-50 degrees curvature or greater) -Spinal realignment -Fusion -Internal appliances Non-surgical -Braces -Exercises

Answer 34

Most common metabolic bone disease 10 million people >50 Fractures of hip & spine -Increased mortality -740,000 deaths annually Specific cause unknown Contributing factors -Age -Risk Factors: >>>Low body weight >>>Smoking >>>Alcoholism >>>Low calcium intake >>>Prolonged immobilization -Genetics -Estrogen >>>Stimulating bone resorption over bone formation

Answer 35

Rate of bone resorption accelerates and the rate of bone formation decelerates Decreased density and loss of trabeculae A reduction in bone mass predisposes to fractures (brittle, porous bones) Bone Mineral Density (BMD) by Dual-energy absorptiometry (DXA) -T score <2.5

Answer 36

May be asymptomatic until fracture occurs Bone fractures Kyphosis (Dowager's hump) Shortened stature Muscle wasting or spasms of back muscles Difficulty bending over May complain of impaired breathing

Answer 37

Exercise -Moderate, regular -Walking, stationary bike -PT Calcium and Vitamin D -1000-1500 mg daily (calcium) -D3 400-1000 IU Antiresorptive Agents -bisphosphonates Prevent falls

Answer 38

Inadequate and delayed bone mineralization results in spongy bone -Growing skeleton-Rickets -Mature skeleton-Osteomalacia Due to Vitamin D deficiency Deficient vitamin D → ↑Ca++ pulled from the bone Characterized by soft, weak bones

Answer 39

Kyphosis genu valgum ("knock knee") genu varum ("bowleg") Bone pain Fractures

Answer 40

Correction of underlying deficiency -Vitamin D supplements >>>Especially D3 -Adequate intake of calcium and phosphate -Exposure to sunlight >>>Increases Vitamin D absorption especially for elderly individuals

Answer 41

Slowly progressive metabolic bone disease characterized by an initial phase of excessive bone resportion (osteoclasts) followed by excessive bone formation Disorganized laying down of bone End result-new bone that is less compact, more vascular, and more fragile Cause unknown -May be genetic -May be a viral infection

Answer 42

Early in the disease no symptoms Severe and persistent pain Initial phase- affected bones soften and bend Later phase-bones hard and thick -Thick cranial bones result in vertigo, blindness, deafness, headaches and facial paralysis

Answer 43

Reduce pain Preventing deformity and fracture -Calcitonin -Bisphosphonates These medications have been shown to decrease bone resorption, stabilize the fragile bone lesions, reduce pain, and the risk for fractures

Answer 44

Severe infection of bone and local tissue requiring immediate attention May be acute or chronic More common in children Organisms reach bone by -Bloodstream (hematogenous) -Adjacent tissue (contiguous) -Direct introduction of organism into the bone >>>Trauma >>>Surgery >>>Hardware

Answer 45

Organisms may begin to grow in a hematoma (from a recent trauma) or a weakened area (site of localized infection) Pathogen provokes inflammation → thrombosis of small distal vessels seal canaliculi→exudate enters the marrow → lifting of the periosteum →deprivation of underlying bone of O2 →necrosis and death of the infected tissue (sequestrum) Lifting also stimulates osteoblastic activity → deposition of new bone (involucrum) over the sequestrum Even after meticulous treatment the organism can appear years later

Answer 46

Acute Children -High fever -Pain at the site -Muscle spasms, redness, swelling -May not move the limb Adults -Fever -Malaise -Anorexia -Night sweats -Weight loss -Pain at rest

Answer 47

Acute 4-6 weeks of parenteral antibiotics for acute phase Analgesics Intracavity instillation of antibiotics Antibiotic choice based on C&S Debridement -Abscesses or extensive necrosis -Dead space filled with packing, bone grafts, muscle pedicles, or skin grafts Removal of infected hardware More chronic -Hyperbaric oxygen -Placement of antibiotic beads -Possible amputation

Answer 48

Oxygen under greater than atmospheric pressure. Because of the heightened pressure, the pure oxygen is taken in by the body more rapidly. The oxygen is saturated into the blood at a much higher rate and is absorbed by every single muscle, tissue and cell of the body HBO2 has six actions which have been used to combat clinical infection: 1. Tissue rendered hypoxic by infection is supported 2. Neutrophils are activated and rendered more efficient 3. Macrophage activity is enhanced 4. Bacterial growth is inhibited 5. Release of certain bacterial endotoxins is inhibited 6. The effect of antibiotics is potentiated.

Answer 49

Extrapulmonary Infection is spread via lung or lymphohematogenous drainage NOT communicable UNLESS an open wound exists Patients with skeletal TB may have a history of: -Pulmonary TB -Drug abuse -Crowded and poor living conditions -Immunosuppressive diseases -Immigration to US before 1991

Answer 50

Mycobacterium tuberculosis is the organism responsible for bone and joint destruction Organism initially transmitted via airborne route Infectious droplets are inhaled and infect lungs M. tuberculosis spreads hematogenously from lung or lymphatic drainage to bone May lie dormant before it is detected

Answer 51

Most common site of infection is vertebral column-particularly thoracic and lumbar Other common sites -Hips -Knees -Ankles Symptoms -Pain -Joint swelling -Low-grade fever -Possible neurologic symptoms from impingement

Answer 52

Long term antibiotics/TB drugs Surgical intervention in cases of spinal TB when severe deformities or neurologic deficits are seen

Answer 53

May be malignant or benign Benign tumors often go undiagnosed because there is no pain Malignant tumors are called sarcomas Most bone tumors are secondary to metastasis from another site most commonly from: -Breast -Prostate -Lung -Kidney

Answer 54

Most common primary bone cancer Rapid growth-destroys cortex Extremely malignant Formation of bone by tumor cells Common sites of involvement are active epiphyseal growth areas -Distal end of femur -Proximal end of tibia, fibula -Proximal end of humerus Occurs most in adolescents and young adults...from 20-30 years

Answer 55

Pain-progressive to intense Pathologic fracture Compromised joint function Metastasis to lung

Answer 56

Conservative surgery Chemotherapy *5 year survival rate using combination of above near 70% Amputation

Answer 57

Primary malignant cartilage forming tumor Diagnosed in 30-60 year old age group Slow rate of development Formation of cartilage by tumor cells Tend to develop in proximal ends of long bones

Answer 58

Pain (but not initially) Will eventually metastasize (usually to the lung)

Answer 59

Rapidly growing round cell primary tumor Most common in long bones of children and young adults 5-25 Metastasizes early to the lungs and other bones Tumor perforates the cortex of the shaft producing a painful soft tissue mass overlying the affected bone Tumor favors: -Femur -Tibia -Proximal fibula -Humerus

Answer 60

Pain -Because of rapid growth rate Systemic effects -Fever -Anemia -Leukocytosis

Answer 61

Radiation Possible surgery

Answer 62

Slowly growing bone marrow malignancy Proliferation of a single clone of plasma cell

Answer 63

Takes a long time to be symptomatic because of slow growth Bone pain: -Chest & back -Excessive accumulation of abnormal plasma cells I the bone marrow Hypercalcemia Pathologic fractures TREATMENT -Aggressive combination chemotherapy -Local radiation -Bisphosphonates <10% survival 2-3 years

Answer 64

Enables bones to move at the joint Provides strength, stability, and protection Distributes loads and absorbs shock

Answer 65

Composed of thousands of muscle fibers Each fiber is a single muscle cell (myofibril) Muscle fibers are grouped together in bundles call fasciculi Individual muscles are composed of many fasciculi

Answer 66

Most common and most severe Affects only males-X-linked 1 in 5,000 live births A weakened muscle cell membrane allows extracellular fluid to leak into the cell -Due to genetic mutation -Deficiency in dystrophin Inflammatory processes lead to muscle fiber necrosis and muscle degeneration Disease begins at birth and is usually apparent by the age of 3

Answer 67

Calf muscles are notably enlarged Distal muscle involvement leads to frequent falls by the age of 5-6 years Wheelchair by 12-14 years Survival to 20s early 30s Muscles of hands, face, jaw, pharynx, larynx, eyes are usually spared to the end Death usually from cardiac failure or pulmonary complications

Answer 68

Education of patient and family Preservation of function as long as possible Prevention of contractures In some cases, corticosteriod therapy may prolong muscle strength and independent ambulation

Answer 69

Autoimmune disease Affects neuromuscular function of voluntary muscles Women affected more than men Antibodies affect transmission of acetylcholine across neuromuscular junction

Answer 70

Profound muscle weakness -Ocular and cranial muscles first-drooping eyelids -Then proximal limb muscles -Exacerbated by repetitive muscle use -Improves with rest Fatigability Respiratory muscles may be involved during times of stress

Answer 71

Corticosteriods Anticholinesterase Inhibitors Immunosuppressive agents Plasmapheresis Mechanical ventilation Thymectomy -Fail to respond to medications -Usually less than 45 years old

Answer 72

Cause unknown -No abnormal labs -Muscle biopsy non-specific -Normal psychological testing More females "Pain syndrome" -Changes in central nervous system may lead to amplification of pain fiber impulses

Answer 73

-Chronic pain often months or years in duration -Stiffness -Sleep dysfunction -Fatigability -Depression

Answer 74

Focus on maintaining functionality and reducing symptoms -Exercise -Medications

Answer 75

Degenerative joint disease Most common arthritis worldwide Progressive loss of articular cartridge Etiology varies: -Abnormal wear and tear -Repetitive stress -Obesity -Joint trauma -Congenital disorders Occupation (stress to joints) Age Postmenopausal -Knees -Hands Genetic predisposition

Answer 76

Initial injury release of proteolytic enzymes Breakdown of collagen Decreased hydration of cartilage (aging) Microfracture with weight bearing Ability to absorb shock decreased Fissures and erosion Bone spur formation Synovium inflamed causes joints to distend (weight bearing joints often affected

Answer 77

Localized: NOT systemic Crepitus with movement Morning stiffness less than 30 minutes (improves with mobility) Pain with function Weight bearing joints most affected Bouchard nodes: -Proximal interphalangeal joint bone spur Heberden nodes: -Distal interphalangeal joint bone spur

Answer 78

Decrease stress on joint -Weight loss -Crutches, braces, canes, shoes insoles, heel lifts Pain relief -Acetaminophen (DOC) -NSAIDS Physical therapy -Strengthening exercises Surgery -Severe cases

Answer 79

Systemic/chronic autoimmune inflammatory disease Affects all races More women Specific cause idiopathic -80% test rheumatoid factor (RF) positive Most likely an abnormal autoimmune response triggered by a bacterial or viral antigen Marked by remissions and exacerbations Potentially crippling disease

Answer 80

T and B cell lymphocytes are activated by antigen and develop altered IgG antibodies The body does not recognize these antibodies as "self" so B cells produce rheumatoid factor (RF) antibodies Inflammatory response occurs in the synovium which creates Cytokines (inflammation & growth factor) Pannus occurs -Thickened layer of granulation tissue -Accumulation of cells erode and destroy articular cartilage Destruction of joint -Bone erosion -Bone cysts -Fissures

Answer 81

Morning stiffness lasting at least one hour Malaise Fatigue Diffuse musculoskeletal pain Soft-tissue swelling Usually bilateral/Symmetrical swelling of wrists, fingers, elbows, knees, ankles, hands Presence of rheumatoid factor Swan-neck deformity Boutonniere deformity

Answer 82

Alleviate pain and swelling Disease-modifying antirheumatic drugs (DMARDS) -methotrexate NSAIDs -ibuprofen -Celebrex Corticosteroids Antimalarial drugs

Answer 83

Chronic, multisystem inflammatory autoimmune disease affecting connective tissues Genetic More common in women between 15-40 Environmental: sunlight may initiate the development Abnormal immune reaction of the body against its own tissues, cells, and serum proteins No cure/may affect multiple organs/may be fatal

Answer 84

B-lymphocyte overactivity leads to excessive autoantibody production Antinuclear antibodies (ANA) found in 98% of patients Antigen-antibody complexes form within the membranes of the kidneys, heart, skin, brain, and joints Trigger inflammatory response which destroys tissue

Answer 85

Exacerbation and remission Arthralgias Morning stiffness Sunlight worsens Neurologic -Seizures -Confusion Renal -Renal failure -UTI and renal failure-leading cause of death Cardiopulmonary -Chest pain -Pericarditis -Atherosclerosis -Pleuritis -Pleural effusions Skin lesions -Classic butterfly (malar) rash in 80% -Patchy alopecia

Answer 86

Lab work -ANA+ -Anemia -Leukopenia -Lymphopenia -Thrombocytopenia -Proteinuria -Hematuria Treat with NSAIDs, corticosteroids, avoid sun, disease modifying anti-rheumatic drugs (DMARDs)

Answer 87

Multisystem inflammatory connective tissue disease characterized by skin thickening and large amt of collagen deposits which cause fibrosis Can affect skin, blood vessels, synovium, skeletal muscle, and microvasculature of internal organs Etiology unknown

Answer 88

Inflammation and immune cell infiltration can be found in skin, lungs, and tissues Vascular wall thickening and lumen obliteration of small arteries, arterioles, capillaries Tissue ischemia Tissue fibrosis Cytokines cause increased collagen and other connective tissue components

Answer 89

Raynaud phenomenon (early) Thick, tight skin begins distally and progresses proximally (sclerodactyly) Contractures (from tight skin) Polyarthritis Gastrointestinal -Difficulty swallowing -Gastric reflux -Malabsorption/constipation Atrophy of muscles -Decreased movement Pulmonary fibrosis CHF Renal

Answer 90

Organ specific Avoid cold temperatures -Raynauds Vasodilators Calcium channel blockers H2 antagonists, PPI

Answer 91

Most often in summer months Caused by the Borrelia burgdorferi tick-borne spirochete Carried by the deer tick Antigenic fragments of the dead organism trigger the inflammatory responses The initial infection stimulates an autoimmune inflammatory response

Answer 92

Red macule or papule -Expand to annular lesion Flulike illness Headache Stiff neck Splenomegaly More than 10% develop chronic arthritis Neurologic and Cardiac -Meningitis -LV dysfunction -Cardiomegaly Treat with antibiotics -Oral or parenteral

Answer 93

Underlying cause unknown Risk increases with age Disturbance of uric acid metabolism leads to deposition of urate salts in articular, periarticular, and subcutaneous tissue Hyperuricemia-hallmark of gout Lack of enzyme to metabolize uric acid Uric acid is a normal waste product filtered by kidneys When production of uric acid exceeds removal, hyperuricemia results Often triggered by: -Traumatic event -Surgical procedure -Acute illness -Starvation -Alcohol -Medications

Answer 94

Middle-aged men Postmenopausal women Manifestations Acute gouty arthritis: -Great toe! (podagra) -Articular inflammation >>>Extreme pain >>>Swelling >>>Tenderness >>>Hyperuricemia Chronic(advanced stage) -Accumulation of tophi (crystalline deposits) in bony connective tissue -Complications: >>>Renal impairment >>>Deforming arthritis >>>Uric acid calculi

Answer 95

Aggressive anti-inflammatory medications -NSAIDS -Corticosteroids -Colchicine -Allopurinol

Answer 96

Together with the nervous system, the endocrine system (the glands and the hormones they secrete) regulates body processes involving growth, maturation, metabolism, fluid balance, responses to stress, and reproduction. Hormones: chemical messengers that travel though the bloodstream to exert physiologic effects on specific target cells and tissues In the healthy state, hormones are released by endocrine glands when their action is needed and inhibited when their effect is attained. Hyperfunction -excessively high blood concentration hormone Hypofunction -Depressed levels of concentrated hormone

Answer 97

May originate in: Hypothalamus (Releasing hormones) -Secondary endocrine disease Pituitary (Stimulating hormones) -Secondary endocrine disease Hormone producing gland (i.e. pancreas, thyroid) -Primary endocrine disease

Answer 98

Posterior Lobe Pituitary: -Antidiuretic hormone (ADH): Kidneys, osmolality -Oxytocin: Uterus and breast Anterior Lobe Pituitary: -Somatotropes: secrete growth hormone (GH): Liver, bones, muscle, metabolism -Gonadotropes: secrete luteinizing and follicle-stimulating hormone (LH and FSH): Ovaries, estrogen -Thyrotropes: secrete thyroid stimulating hormone (TSH): Thyroid gland, T3 T4 -Corticotropes: secrete adrenocorticotropic hormone (ACTH): Adrenal Cortex, Cortisol -Lactotropes: secrete prolactin (PRL):Breast, lactation

Answer 99

Pituitary gland secretes stimulating hormones In response to the stimulating hormones, the target gland responds by secreting its hormone. So... If there are normal to high levels of stimulating hormone present and low levels of target gland hormone available, the cause is the target gland because the target gland is not responding.

Answer 100

Produced in the anterior pituitary gland under the influence of hypothalamic releasing (growth hormone-releasing hormone) and inhibiting (somatostatin) factors. Primary target organ is the liver Affects body mass Causes liver to release glucose Induces lipolysis Increases rate of protein synthesis Hypoglycemia stimulates the release of GH

Answer 101

Most relevant in children HX of prolonged labor Midline craniocerebral defects Should be considered in children with nystagmus, retinal abnormalities, cleft lip or palate.

Answer 102

Variety of presentations Depend on the age at onset May be caused by failure of hypothalamus to stimulate pituitary GH secretions or failure of the pituitary to produce GH Midline brain tumors common cause

Answer 103

Normal birth length and weight Hypoglycemia GH needed to maintain adequate glucose levels Undescended testicles Delayed dental eruption Thin hair, poor nails

Answer 104

hormone replacement

Answer 105

Nearly always due to uncontrolled production of the hormone by a benign somatotropic tumor in the pituitary gland. GH stimulates the liver and this causes an upregulated growth of soft and bony tissues

Answer 106

Tumor present in childhood before epiphyses are closed: giantism. Rapid growth. Exceed 95% on growth charts. May be taller than 8 feet. May have heart failure or die Tumor present after epiphyses are closed: acromegaly. Fourth or fifth decade. Growth of short bones

Answer 107

Acromegaly -Increased ring/shoe sz -Lrg frontal sinus/brow -Lrg mandible -Internal organs increase in size -Increased ICP -Does NOT affect height in adults

Answer 108

Surgical removal of tumor Medications

Answer 109

Secretion of thyroid hormones T3 and T4 is under control of thyroid-stimulating hormone (TSH) secretion from the anterior pituitary gland Thyroid hormones are important for metabolism Needed for normal growth and development of tissues

Answer 110

Most cases are primary (thyroid gland dysfunction) Congenital Irradiation of the Thyroid Surgical removal of Thyroid Lithium inhibits TH synthesis

Answer 111

Lymphocytic thyroiditis (Hashimoto thyroiditis) most common -Characterized by an enlarged thyroid gland (Goiter) due to lymphocytic infiltration. TH decreased producing increased TSH from pituitary gland.

Answer 112

Goiter Hypometabolic state Weakness Lethargy Cold intolerance Constipation Myxedema (Facial edema) Coarse hair Bradycardia

Answer 113

Return to euthyroid state Synthroid

Answer 114

Newborns Congenital ↑TSH↓T4 Deficiency →mental retardation Psychomotor deficits Rx - thyroid replacement

Answer 115

Occurs in severe prolonged thyroid deficiency Generalized, non-pitting edema Fluid retention due to accumulation of glycosaminoglycans in interstitial spaces Present to emergency room with: -AMS, thermoregulation problems -Hx of sepsis, trauma, certain medication use "Myxedema coma" happens if left untreated -Medical emergency -60% mortality rate

Answer 116

-Life threatening -Older women -Cold months -CO2 retention & hypoxia -F & E imbalances -Hypothermia

Answer 117

-Hypoventilation -Lactic acidosis -Hyponatremia -Hypoglycemia -Cardiovascular collapse -Coma -Hypothermia

Answer 118

-Prevention is #1 -Supportive -No re-warming -Thyroid replacement

Answer 119

Thyroid gland hyperfunction with increased synthesis and secretion of T4 and T3 MC is from autoantibodies that stimulate TSH. This causes toxic goiter. End result-Graves Disease

Answer 120

More common in women In response to high circulating T3 and T4 levels, the pituitary stops producing TSH. TSH then falls very low.

Answer 121

-Hypermetabolic state -Insomnia -Restlessness, palpitations -Heat intolerance -Weight loss -Thyromegaly -Exophthalmos-(enlarged retro-orbital muscles) **Thyroid storm-life threatening

Answer 122

When excessive amounts of hormone are released in circulation. -Increased temperature -Severe tachycardia -Cardiac dysrhythmias -N/V/D Treatment: Beta Blockers Surgical removal of thyroid Life threatening surge of TH Stress response -DKA -Trauma (physical or emotional) -Thyroid manipulation during surgery Life threatening- hypermetabolic state Rx - cooling, supportive measures, βblockers, steroids, antithyroid meds

Answer 123

Goiters are present in both hyper and hypothyroidism

Answer 124

The adrenal cortex synthesizes three different classes of steroid hormones: -Glucocorticoids (Cortisol) -Mineralocorticoids (Aldosterone) -Sex Steroids (Androgens) -Sugar, Salt, Sex Steroid hormones: provide negative feedback regulation of the hypothalamus and pituitary gland to suppress "turn off" adrenocorticotropic hormone (ACTH).

Answer 125

Hyposecretion of adrenocortical hormones (ACTH) can result from disease of the adrenal cortex (primary adrenocortical insufficiency, Addison disease) Inadequate secretion of ACTH from the anterior pituitary. (secondary) OR Lack of releasing hormone from the hypothalamus Caused by destruction of the adrenal gland through idiopathic or autoimmune mechanisms (trauma or hemorrhage) Addisonian crisis or acute adrenal insufficiency is a true emergency. Could be severe in patients who take corticosteroids routinely and then abruptly stop.

Answer 126

Most severe manifestations are r/t inadequate levels of circulation cortisol and aldosterone. Reduced CO Diminished vascular tone Inadequate circulating volume Early signs: -Weight loss, weakness, malaise, apathy, electrolyte imbalances

Answer 127

Replace the absent of deficient hormone In adrenal crisis: give glucocorticoids IV

Answer 128

Hyperpigmentation of skin -Darkened skin folds and creases -Oral mucus membranes become bluish

Answer 129

Hyperfunction of the adrenal cortex. Adrenal adenoma (primary) Hyperfunction of anterior pituitary ACTH-secreting cells (secondary).

Answer 130

Excessive production of pituitary ACTH by adenomas stimulate the adrenal glands to overproduce hormones In the US, exogenous steroids used in respiratory disease is the most common cause of Cushing syndrome

Answer 131

-Moon face -Weight gain -Muscle weakness -Cortisol increases tissue resistance to the effects of insulin and may contribute to glucose intolerance. -HTN -Hypokalemia -Depression

Answer 132

Reduce doses of steroids Transsphenoidal hypophysectomy or laser ablation of the pituitary tumor

Answer 133

Adrenal medulla secretes catecholamines in response to the Sympathetic Nervous System (SNS) Malignant in 10% of patients

Answer 134

Pheochromocytoma is a tumor of the adrenal medulla that results in excessive production of catecholamines Symptoms?

Answer 135

-Intermittent or persistent HTN (most common) -Headache -Tachycardia -Diaphoresis

Answer 136

Surgical removal of tumor Beta blockers

Answer 137

Four, small glands located at the upper and lower poles of the thyroid. Detect serum calcium (Ca+) concentrations in serum Regulate calcium absorption and resorption from bone Serum Ca+ levels provide feedback to regulate the parathyroid hormone (PTH) Normal (for me and you) relationship: -Decrease in serum Ca+ causes a release of PTH -Elevated serum Ca+ leads to suppression PTH -Normally inverse to one another PTH is not under the control of the hypothalamic-pituitary system like the others PTH acts on bones, intestines, and renal tubules

Answer 138

Unclear etiology Despite elevate serum Ca+, PTH continues to be secreted (both elevated) Genetic Parathyroid adenoma (MC)

Answer 139

Bone resorption and formation rates are increased In chronic RF, hyperparathyroidism results from reduced production of Vitamin D (needed for Ca+ absorption) from impaired GFR. Lithium may increase Ca+ levels.

Answer 140

-May be asymptomatic -Prone to kidney stones. Why? -Osteoporosis -Bradycardia -Cardiac arrest -Ca+ elevated -Phosphorus levels low -Calcium and Phos always inversely related

Answer 141

Surgery Volume replacement -Improve GFR -Increase Ca+ excretion -Diuretics

Answer 142

Happens after parathyroid or thyroid surgery May be temp or permanent Congenital Autoimmune

Answer 143

Low serum Ca+ (<7mg/dl) Neuromuscular irritability -Paresthesia, cramps, seizure Chvostek sign -Tetany of the facial nerve. When facial nerve is tapped, causes muscle contraction Trousseau sign -BP cuff is place to obliterate arterial flow. Hand/forearm flexes due to hypoxia and neuromuscular irritability Tx: Give IV CALCIUM

Answer 144

ADH (vasopressin) is secreted from the posterior pituitary gland in response to changes in blood osmolality. ADH does not affect Na+ regulation ADH does affect water regulation When body water "too thick" -Pituitary release ADH When body water "too thin" -Pituitary suppress ADH

Answer 145

Disorder of insufficient ADH Excessive loss of water in urine ADH acts directly on distal tubules Damage to the hypothalamus in head injuries 30 % idiopathic in adults Surgical treatment of brain tumors Brain trauma

Answer 146

Damage to posterior pituitary gland →deficient ADH Urine cannot concentrate without ADH Free water is lost Hyperosmolality (thick) Hypernatremia -Cells shrivel -Increased concentration of extracellular fluid causes water to move out of cells by osmosis

Answer 147

Polyuria Polydipsia May void 15 L per day Specific gravity decreased Drink up to 15 L to correct Hypernatremia (due to water loss) -Thirst -Dry mouth

Answer 148

Give ADH Monitor labs -BUN -Serum Creatinine -Serum Electrolytes -sodium

Answer 149

Too much ADH Tumors Medications

Answer 150

Results in hyponatremia (water overload) Free water dilutes sodium Hyponatremia -Cells swell -Decreased concentration of extracellular fluid causes water to move into cells by osmosis

Answer 151

Increased water reabsorption Low osmolality (too thin) Weakness Muscle cramps Orthostatic hypotension Low lab values due to dilution Hyponatremia -Confusion -Lethargy -Coma

Answer 152

Free water restriction will result in slow increase in serum Na+ levels and increased osmolality (concentration) Treat hyponatremia slowly to avoid rapid changes in brain cell volume from fluid compartment shifts

Answer 153

21 million people in US - Diabetes Mellitus (DM) Only 70% aware they have it Costs healthcare $176 billion per year 6th leading cause of death With dx of DM there is increase risk: -Heart disease -End Stage Renal Disease (ESRD) -Blindness -Amputation -Pregnancy complications

Answer 154

broken down carbohydrates for energy. Sugar

Answer 155

hormone produced by alpha cells of pancreas. Stimulates glycogenolysis and gluconeogenesis in liver

Answer 156

carbohydrate consists of glucose produced in muscle and liver from stored glucose

Answer 157

hormone produced by beta cells of pancreas. Energy metabolism

Answer 158

breakdown of sugar so cells can use

Answer 159

production of glucose from breakdown of glycogen in liver and muscle tissue

Answer 160

production of glycogen from glucose in liver in muscle tissue

Answer 161

production of glucose from amino acids in liver

Answer 162

Glycogen Glycogenesis Glycogenolysis Gluconeogenesis *Insulin stimulates the diffusion of glucose into adipose and muscle tissue and inhibits the production of glucose by the liver

Answer 163

Insulin Glucagon

Answer 164

DM affects utilization of ALL energy Glucose and fats= human energy Glucose is produced by: -Glycogen stores in muscles and liver -Amino acids and lactate Glucose is supplied to blood stream by GI tract and liver Glucose enters cell through diffusion and semipermeable membrane Heart, adipose, and skeletal muscle possess insulin receptors

Answer 165

Protein and fat metabolism are regulated by the effects of insulin Insulin is synthesized in pancreas in Beta cells of the islets of Langerhans Normal glucose metabolism is describe as fed and fasting state (absorptive and post absorptive)

Answer 166

After eating, rise in blood glucose and insulin Presence of insulin stimulates glucose diffusion into adipose and muscle tissue and inhibits production of glucose by liver Glycolysis (sugar is broken down)-energy use for cell Glycogenesis-glycogen production muscle/liver

Answer 167

Fasting state: dominated by glucagon Glucose is produced: -by glycogenolysis (breakdown of stored glycogen) in liver and muscles -By gluconeogenesis (production of glucose in liver) Glucagon-stimulated glycogenolysis and gluconeogenesis responsible for 75% of glucose production Lipolysis, stimulated by the fall in plasma insulin, is primary source of energy to muscles

Answer 168

Increase activity requires increase fuel Onset of exercise insulin drops and glucagon rises Glycogenolysis is stimulated due to above Muscle switch to using stored glycogen After 10-40 minutes, glucose use by muscles increase 7 to 20 times Muscle contraction increases insulin sensitivity for up to 16 hours

Answer 169

Injury, illness, pain and stress hormones: All increase production of glucose Catecholamines and corticosteroids increase: -Glucagon levels -Liver production of glucose -But decreases the use of glucose in muscle/fat tissue -"Stress hyperglycemia"

Answer 170

Normal Blood Glucose level: -FPG 70-110 mg/dl (this varies per resource) Diagnosing Pre-Diabetes -Impaired fasting glucose tolerance test >>>FPG 100-125 mg/dl -Impaired glucose tolerance test >>>2 hours post glucose ingestion 140-200mg/dl Diagnosing DM -Fasting Plasma Glucose (FPG) >126 OR -Symptoms of hyperglycemia or random >200 OR -2-hour plasma glucose during an Oral Glucose Tolerance Test (OGTT) after drinking 75g sugar

Answer 171

Diabetes Mellitus - disease in which the body doesn't produce enough insulin—hyperglycemia Normally insulin allows glucose into cells Then it can be used for energy or stored as glycogen -Type I -Type II -Gestational -Pre-Diabetes

Answer 172

Characterized by destruction of the Beta cells of the pancreas Can occur at any age: Most common between 5 and 20 years of age Affect 5% to 10% of people with diabetes Caucasian most prevalent

Answer 173

Immune-mediated: result of autoimmune attack on the beta cells of the pancreas Presence of hyperglycemia indicates that autoimmune destruction of beta cells has reached the point at which insulin secretion is inadequate

Answer 174

Absolute insulin deficiency Thus glucose cannot enter muscle and adipose tissue Liver glucose production is no longer opposed by insulin Overproduction of glucagon by pancreatic alpha cells stimulates glycogenolysis and gluconeogenesis Plasma glucose levels rise When the maximal tubular absorptive capacity (renal threshold) of the kidney is exceeded, glucose is lost in the urine Glycosuria and osmotic fluid loss leads to hypovolemia Neural tissue in the brain responds to this emergency by promoting eating behavior Metabolic acidosis ensues as bicarbonate concentration decreases Diabetic Ketoacidosis (DKA) occurs Hyperkalemia due to excretion of fluid Lactic acid, a product of glucose metabolism, in excess Hypovolemic shock Respiratory compensation: Kussmaul respirations Continued insulin deficiency leads to lipolysis in the body tissues Metabolism of fats from storage leads to fatty acid production These are turned into keto acids in the liver PH falls below normal Ketone bodies in urine which causes osmotic fluid loss

Answer 175

-Polyuria -Polydipsia -Polyphagia

Answer 176

Decreased -Bicarbonate ions -Sodium -Magnesium -Phosphorus -Total body water (hypovolemia) >>>Leads to increased K=, H&H, protein, creatinine, lactic acid. Kussmaul respiration to correct metabolic acidosis "fruity breath" Classic Triad: Polydipsia, Polyuria, Polyphagia

Answer 177

Normally insulin levels rise in response to high glucose levels In DM II, insufficient insulin is produced or the cells resist insulin. This makes it difficult for glucose to enter the cell. Cells don't get energy and glucose builds up in the blood stream and blood vessels (this is why we have organ and vessel damage)

Answer 178

Relative lack of insulin Insulin resistance and beta-cell dysfunction A requirement for more insulin Decreased number of insulin receptors Impaired glycogen syntheses Impaired production of insulin by pancreas

Answer 179

Resistant to the action of insulin on peripheral tissues 90-95% of affected individuals Non-caucasian and elderly Obese teenagers Risk factors -Sedentary lifestyle -Obesity -Abdominal adipose -c/o 3 "P's": 1. Polyuria 2. Polydipsia 3. Polyphagia

Answer 180

Insulin deficient Insulin resistance Progressive disease-at first it is compensated by increased insulin production and hyperinsulinemia Impaired Beta cells are unable to produce sufficient insulin to overcome insulin resistance

Answer 181

-Polyuria -Polydipsia -Polyphagia DKA uncommon: due to endogenous insulin which suppresses the lipolysis that leads to ketone body formation Nonketotic hyperglycemic hyperosmolar coma -Severe hyperglycemia and dehydration W/O ketones

Answer 182

Impaired Glucose Tolerance Impaired Fasting Glucose Tolerance Screen every 3 years once 45 years old

Answer 183

-MC caused by alteration in nutrition, inactivity, inadequate use of antidiabetic meds

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3 P's: 1. Polyuria 2. Polydipsia 3. Polyphagia DKA Fluid imbalance problems Skin infections Blurred vision

Answer 185

Nausea Fatigue Decreased sense of well being Rapid deep breathing- Kussmaul respirations

Answer 186

Anxiety Tachycardia Sweating/Diaphoresis Constriction of the skin vessels- Cold and clammy skin Mental confusion Decreased LOC

Answer 187

Damage to the large blood vessels providing circulation to the brain, heart, and extremities CVD Stroke Risk factors -Dyslipidemia -HTN -Impaired fibrinolysis

Answer 188

Retinopathy -blindness Nephropathy-ESRD Abnormal thickening of basement membrane in capillaries Hyperglycemia disrupts platelet function

Answer 189

Diabetic neuropathy produces symptoms in 60-70% of DM Autonomic: bladder, tachycardia, postural hypotension, erectile dysfunction Sensory: paresthesia in feet, lower extremity amputations

Answer 190

Type I in pregnancy has increased risk for perinatal infant mortality Untreated in pregnancy results in macrosomia, shoulder dystocia, pre-eclampsia.

Answer 191

Nutrition -Protein -Fat -Carbohydrates -Alcohol -Obesity and Eating Disorders Exercise Stress Management Assessment of Efficacy Education Pharmacologic Agents -Oral antidiabetic agents -Insulin

Answer 192

HbA1c is a measure of glycosylated Hgb Glycosylated Hgb is hemoglobin(Hgb) that has glucose attached to it. The glucose attaches to the Hgb only when blood glucose levels are high. The amount of glucose that attaches to Hgb is proportional to the amount of glucose in the blood. HbA1c reflects the average blood glucose levels over the previous 100-120 days. HbA1c is used to measure long term control of blood sugar levels. A HbA1c of 7 or less indicates good blood glucose control for the 100-120 day period.

Answer 193

Diabetes has been diagnosed in 176,500 children and adolescents younger than 20 years old One in every 400 to 600 children have Type I DM Goal: achieve normal growth and development, avoiding acute and chronic complications, addressing psychosocial issues, and educating children regarding self-care. Insulin requirements are 1.0 unit per Kg per day. Diet Counseling

Answer 194

The prevalence of type II DM increases with age Adults older than 60 years old constitute 50 % of the diabetic population in the United States Goal: prevention of acute complications, prevention and management of chronic complications, attention to psychosocial issues, and education regarding self-care Treatment -Oral antidiabetic agents -Insulin