Final

Question 1

Path of Graves

Answer 1

Hyperthyroidism

Question 2

Risks of hyper parathyroid

Answer 2

High risk of path fractures

Question 3

Effects of Aging on the Endocrine System

Answer 3

Altered biologic activity of hormones.
Altered circulating levels of hormones.
Altered secretory responses of endocrine glands.
Altered metabolism of hormones.
Loss of circadian control of hormone release
Changes in secretion of hypothalamic regulatory hormones.
Atrophy of the thyroid gland and diminished secretion of thyroid hormones.
Pancreatic fat deposition, decrease in insulin secretion and in insulin sensitivity.

Question 4

Goal Of DM Treatment

Answer 4

Goal of treatment is to prevent complications.

Question 5

HgbA1C Levels

Answer 5

Normal: 4% - 5.6%
Increased risk for diabetes: 5.7% - 6.4%
Diagnosis of diabetes: 6.5% or higher

Question 6

Diagnosis Gestational Diabetes

Answer 6

Initial glucose challenge test: Blood test done one hour after drinking a glucose solution.

Normal: <130 – 140 mg/dL, or 7.2 – 7.8 mmol/L

Follow-up glucose tolerance testing: Ingest a higher concentration glucose solution after fasting overnight.

Blood glucose gets measured every hour for 3 hours. Diagnosis of gestational diabetes based on at least 2 of the readings being elevated

Question 7

Clinical Symptoms of Diabetic ketoacidosis (DKA):

Answer 7

Polyuria & dehydration.
Kussmaul respirations (deep, labored breathing pattern).
Sweet or “fruity” breath odor.
Nausea & vomiting.
Abdominal pain. 
Weakness/fatigue.
Lethargy, confusion.
Hyperglycemia.

Question 8

Clinical Symptoms Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS):

Answer 8

Dehydration, polyuria, polydipsia,
Warm dry skin that does not sweat.
Fever (over 101 degrees Fahrenheit).
Lethargy/confusion.
Loss of vision, hallucinations, 
Weakness.  

Labs: Serum glucose > 600, absent or low urine ketones.

Delayed sexual maturation (adolescents).

Immunosuppression leading to increased risk of infection and impaired wound healing

Question 9

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): Most common in?

Answer 9

More common in type 2 diabetes.

Question 10

Diabetic ketoacidosis (DKA): Most common in?

Answer 10

More common in type 1 diabetes.

Question 11

Clinical Symptoms Hypoglycemia

Answer 11

Altered mental status
Tachycardia.
Hypotension
Pale, cool, clammy skin; coma.

In neonates onset may be a few hours to 1 week after birth:

Jitteriness; convulsions; episodic cyanosis; apnea or tachycardia; lethargy & poor feeding; high-pitched cry; diaphoresis; pallor; hypothermia

Question 12

Criteria for diagnosing rheumatoid arthritis (4 or more)

Answer 12

Evaluation (four or more of the following)
Morning joint stiffness lasting at least 1 hour
Arthritis of three or more joint areas
Arthritis of the hand joints
Symmetric arthritis
Rheumatoid nodules
Abnormal amounts of serum RF
Radiographic changes

Question 13

Test for Carpal Tunnel

Answer 13

Tinel’s sign: Positive if symptoms are reproduced by tapping median nerve at the wrist

Carpal compression test: Positive if numbness & tingling develop with direct pressure over carpal tunnel

Question 14

Pathophysiology of carpal tunnel syndrome

Answer 14

Entrapment neuropathy of median nerve at the wrist.

Question 15

How to test for scoliosis

Answer 15

Adam’s Forward Bend Test —(Most Common and easiest to perform) With feet and knees together, ask the child to bend forward with their arms dangling. The nurse will stand first behind the child and then in front of child to check for any visible curvature, or any uneven appearance in your ribcage, hipbones, or shoulder blades.

Scoliometer —This device is used to measure the actual degree of curvature of the child’s spine. Ask the child to stand with feet and knees together, and bend forward until you, the examiner can see curvature in the child’s upper spine. The inclinometer is then placed on the child’s back, and a measurement is taken.

Question 16

Bone density levels for diagnosing osteoporosis

Answer 16

Normal bone - 833 mg/cm2

Osteopenic bone - 833 to 648 mg/cm2

Osteoporosis - <648 mg/cm2

Question 17

Which cranial nerve is affected in trigeminal neuralgia

Answer 17

Caused by compression of the 5th cranial nerve root usually by vascular structure or malformation

Question 18

Differentiate types of cerebral palsy

Answer 18

Spastic - Tense contraed ( Most common).
Athetoid - Constant uncontrolled motion of limbs head eyes. 
Rigidity - tight muscles that resist.
Tremor - uncontrollable shaking.
Ataxic - Poor semi of balance.

Question 19

Pathophysiologic changes seen in Alzheimer’s disease

Answer 19

Progresses from mild short-term memory deficits and culminates in a total loss of cognition and executive functions; exhibits different stages.
Includes forgetfulness; emotional upset; disorientation; confusion; lack of concentration; and declines in abstraction, problem solving, and judgment.
Has an insidious onset.

Question 20

Clinical manifestations of Bell’s palsy

Answer 20

Usually due to inflammation of the 7th cranial nerve.
Most patients have sudden onset of a unilateral facial droop, accompanied by drooling (especially in young children) and failure to completely close the affected eye

Question 21

Area of brain affected by Parkinson’s disease

Answer 21

Severe degeneration of the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway

Question 22

Parkinson’s disease Neurotransmitter

Answer 22

Dopamine deficiency

Question 23

Clinical Manifestations of Parkinson’s disease:

Answer 23

Wide-eyed, unblinking, staring expression with immobile facial muscles
Frequent drooling
Slow gait
Short, shuffling steps
Flexed and abducted arms held stiffly at the side
Slightly forward bending trunk

Question 24

Causes of vertigo

Answer 24

Peripheral vestibular dysfunction:
Benign positional vertigo: debris in semicircular canal.
Occurs with change in position with a delay between movement & symptoms.
Inner ear infection
Meniere’s disease: Swelling of the endolymphatic system

Question 25

Differentiate types of seizures

Answer 25

Generalized seizures: Neurons bilaterally Partial (focal) seizures: Neurons unilaterally Secondary generalization: Partial moves to generalized Status epilepticus - Is a medical emergency. (5min - 30)

Question 26

Most common form of epilepsy in children

Answer 26

Rolandic Epilepsy of Childhood

Question 27

Symptoms of post-concussive syndrome

Answer 27

``` Headache Nervousness or anxiety Irritability Insomnia Depression Inability to concentrate, forgetfulness Fatigability ```

Question 28

3 Stages of Lyme disease and clinical manifestations associated with each stage

Answer 28

1 (acute localized): Within 1 month of bite, a bull’s eye rash with flulike symptoms 2 (systemic infection): Cardiac and neurologic manifestations 3 (chronic stage): Arthritis with paraesthesias, radiculopathy, cognitive deficits, memory loss

Question 29

Pathophysiology of gout

Answer 29

Is a metabolic disorder that disrupts the body’s control of uric acid production or excretion. Exhibits high levels of uric acid in the blood and other body fluids. Occurs when the uric acid concentration increases to high enough levels to crystallize. Crystals deposit in connective tissues throughout the body. If prolonged in joints: Gouty arthritis Tophi: Small, white visible nodules

Question 30

Acute gouty arthritis clinical manifestations

Answer 30

A single peripheral joint is almost always involved in all initial episodes. Typically local irritation and aching proceeds to tissues becoming swollen, red, hot, shiny and extremely painful. The pain is often describes as the worst ever experienced. By 24 hours inflammation is maximal, and it then resolves slowly over a week or so, often with itching and flaking of overlying skin. Increase in serum urate concentration: Hyperuricemia

Question 31

Physiologic changes caused by osteoarthritis

Answer 31

Common age-related disorder of synovial joints Inflammatory joint disease Loss of articular cartilage, sclerosis of underlying bone, and formation of bone spurs (osteophytes)

Question 32

Tension-type headache

Answer 32

Most common Mild-to-moderate bilateral headache with a sensation of a tight band or pressure around the head Acute and chronic forms

Question 33

Cluster headache

Answer 33

Several attacks occurring during the day for days, followed by a long period of spontaneous remission Trigger factors Activation of the trigeminal system Two forms: Acute and chronic Clinical manifestations Pain: Unilateral, intense, tearing, and burning Sympathetic nervous system underactivity and parasympathetic overactivity

Question 34

Migraine headache

Answer 34

Lasts 4 to 72 hours. Trigger factors; may or may not have an aura. Most common in women between ages 30-45 Occur in 3%-5% of children before puberty; increases to 10%-20% during 2nd decade of life Risk factors: Stress, alcohol, caffeine, menstruation, chocolate, caffeine/nicotine withdrawal, too much or too little sleep; missing meals. When any two symptoms occur: Unilateral head pain, pulsating pain, pain worsening with activity, moderate or severe pain One of the following symptoms: Nausea or vomiting, or both, photophobia, phonophobia

Question 35

Pathophysiology of multiple sclerosis

Answer 35

Progressive, chronic, inflammatory, demyelinating, autoimmune disorder of the CNS Occurs in white and gray matter Degeneration of the myelin sheath in CNS neurons, scarring, and loss of axons Most affected: Women

Question 36

Pathophysiology of amyotrophic lateral sclerosis

Answer 36

Lou Gehrig disease. Is a degenerative disorder diffusely involving the lower and upper motor neurons. Progressive muscle weakness leads to respiratory failure and death usually 2 to 5 years from symptom onset. Lower motor neuron syndrome of flaccid paresis consists of a weakness of individual muscles, progressing to paralysis, hypotonia, and primary muscle atrophy (atrophy caused by denervation). Upper motor neuron syndrome of spastic paresis consists of a weakness of movement patterns, progressing to paralysis.

Question 37

Risks for developing osteomyelitis

Answer 37

Is usually caused by a staphylococcal infection. Is often outside the body (exogenous); can be from a bloodborne (endogenous) infection. Diseases that impair blood circulation include: Poorly controlled diabetes. Peripheral arterial disease, often related to smoking. Sickle cell disease.

Question 38

Stages of Lyme Disease (3)

Answer 38

1 -(acute localized): Within 1 month of bite, a bull’s eye rash with flulike symptoms 2 - (systemic infection): Cardiac and neurologic manifestations 3 - (chronic stage): Arthritis with paraesthesias, radiculopathy, cognitive deficits, memory loss

Question 39

Function of the parathyroid hormone

Answer 39

Produce parathyroid hormone (PTH) Regulates serum calcium. Increases serum calcium concentration. Decreases serum phosphate level. Serves as co-factor with vitamin D to increase calcium absorption. Is an antagonist of calcitonin (helps regulate calcium & involved with bone building). Parathyroid hormone–related peptide (PTHrP) Has properties similar to PTH. Plays a role in placental calcium transport, lactation, and fetal tooth development

Question 40

Dawn Phenomenon (Diabetes Complication)

Answer 40

Early morning rise in glucose levels caused by nocturnal decrease in insulin and elevation of glucagon.

Question 41

Somogyi Effect (Diabetes Complication)

Answer 41

Combination of hypoglycemia with rebound hyperglycemia caused by the effects of counter-regulatory hormones. Most common in in type 1 diabetes and in children.

Question 42

Macrovascular Diabetes Complications 1

Answer 42

Associated with hyperglycemia, hyperlipidemia, inflammation, and altered endothelial function. Due to atherosclerosis. Coronary artery disease: Results from accelerated atherosclerosis, hypertension and increased risk for thrombus formation.

Question 43

Macrovascular Diabetes Complications 2

Answer 43

Associated with hyperglycemia, hyperlipidemia, inflammation, and altered endothelial function. Due to atherosclerosis. Increased risk for stroke & myocardial infarction (“silent” or asymptomatic MI) Peripheral vascular disease: Consequence of neuropathy and occlusion of large and small arteries with an increased risk of ischemia, necrosis, and amputation

Question 44

Diabetes: Micro- and Macrovascular Complications | Diabetic retinopathy

Answer 44

responsible for ~10,000 new cases of blindness each year. Mechanisms include microvascular changes & thrombosis that lead to microvascular occlusion, retinal ischemia, increased vascular permeability, microaneurysm formation, hemorrhages, and neovascularization (formation of functional microvascular networks with red blood cell perfusion) resulting in loss of vision.

Question 45

Diabetes: Micro- and Macrovascular Complications | Diabetic nephropathy

Answer 45

Leading cause of renal failure in the U.S. Mechanisms include hyperglycemia, hyperperfusion, oxidative stress, and inflammation with glomerular enlargement & glomerular basement membrane thickening, diffuse intercapillary glomerulosclerosis, and expansion of the mesangial matrix resulting in progressive renal failure. Caused by vascular and metabolic mechanisms or by a combination of both, with axonal and Schwann cell degeneration, abnormalities in sensory and motor nerve conduction velocity, and involvement of the autonomic nervous system.

Question 46

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): (Diabetes Complication)

Answer 46

Relative or absolute reduction in effective circulating insulin with a concomitant elevation of counter-regulatory hormone. More common in type 2 diabetes. Symptoms: Dehydration, polyuria, polydipsia, warm dry skin that does not sweat, fever (over 101 degrees Fahrenheit), lethargy/confusion, loss of vision, hallucinations, weakness. Labs: Serum glucose > 600, absent or low urine ketones. Delayed sexual maturation (adolescents). Immunosuppression leading to increased risk of infection and impaired wound healing

Question 47

``` Diabetic ketoacidosis (DKA): (Diabetes Complication) ```

Answer 47

Develops when there is an absolute or relative deficiency of insulin and an increase in the amounts of insulin counter-regulatory hormones of catecholamines, cortisol, glucagon, and GH, increased lipolysis, and accelerated gluconeogenesis and ketogenesis. More common in type 1 diabetes. Symptoms: Polyuria & dehydration, Kussmaul respirations (deep, labored breathing pattern); sweet or “fruity” breath odor; nausea & vomiting, abdominal pain, weakness/fatigue, lethargy, confusion, hyperglycemia. Labs: serum glucose level >250 mg/dL; serum pH < 7.30; urine (+) for ketones, total body (not serum) potassium depletion.

Question 48

Pathophysiology of type 2 diabetes

Answer 48

Characterized by a relative insufficiency of insulin due to resistance to the action of insulin in target tissues, decrease in insulin receptors, and/or impairment of insulin secretion. Etiology & Incidence: Heterogenous disorder with familial pattern. Influenced by environmental factors, lack of physical activity, diet high in refined carbohydrate and fat, with low fiber. No human leukocyte antigen or islet cell antibodies. Syndrome of hyperinsulinemia and insulin resistance resulting in hyperglycemia, hypertension, and hyperlipidemia. Type 2 accounts for 90% of all diabetes cases in the U.S. 29.1 million Americans (9.3% of the population) Children account for 20% of all newly diagnosed cases 

Question 49

Clinical manifestations of Cushing disease

Answer 49

``` Thinning scalp hair Facial Flush Acne Increased Body & facial hair Moon face Purple striae Pendulous abd Easy Bruising Subclavicular fat Truck obesity Thin extremities Hyper pigmentation ```

Question 50

Causes of hypothyroidism

Answer 50

Deficient production of thyroid hormone by the thyroid gland.

Question 51

Hypothyroidism Adults

Answer 51

Anorexia, dry skin, coarse dry hair, alopecia, receding hairline, constipation, cold intolerance, lethargy, increase in weight, irregular/heavy menses, memory loss, depression, muscle aches, myxedema (nonpitting, boggy edema, especially around the eyes, hands, and feet; thickening of the tongue). Myxedema coma: Medical emergency, diminished level of consciousness; hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis, and coma

Question 52

Hypothyroidism Neonates:

Answer 52

Persistent jaundice, constipation, poor feeding, lethargy/somnolence, prolonged gestation, increased birthweight.

Question 53

Hypothyroidism Children

Answer 53

Children: Family history, poor growth, learning disability, fatigue, constipation, weight gain, cold intolerance.

Question 54

Impact of gestational diabetes on baby

Answer 54

Insulin does not cross the placenta but glucose does resulting in high glucose levels in the baby. Causes baby’s pancreas to make extra insulin to get rid of the glucose. Excess energy gets stored as fat – can lead to macrosomia (“fat” baby). Health risks to the baby include shoulder damage during birth; hypoglycemia at birth; increased risk of breathing problems; risk for childhood obesity and adult onset type 2 diabetes.

Question 55

Symptoms of hypothyroidism

Answer 55

``` Hypo Function Loss of hair, brittle hair. Periorbital edema Puffy face Normal to small thyroid Bradycardia (HF) Constipation Cold intolerance Muscle weakness Osteoporosis Edema of extremities ```

Question 56

Symptoms of hyperthyroidism

Answer 56

``` Hyper Function Thin Hair Exophthalmos Normal of enlarged thyroid (warm & nodular) Tachycardia (HF) Weight loss Diarrhea Warm skin Hyper reflexia Pretibial myxedema ```

Question 57

Lab value diagnostic for adrenal insufficiency

Answer 57

Low plasma cortisol <5 mcg/dL in early morning. The ACTH stimulation test is the most commonly used test for diagnosing adrenal insufficiency Sodium, chloride, glucose and bicarbonate levels low, with high potassium level. BUN, plasma renin, ACTH, calcium – all elevated. CBC – decreased hemoglobin, neutrophils, and eosinophils. Abdominal CT scan: Small adrenals. Chest x-ray: Small heart size and adrenal calcification.

Question 58

Functions of insulin

Answer 58

Regulated by chemical, hormonal, and neural mechanisms. Synthesized from proinsulin. Secretion is promoted by increased blood glucose levels. Facilitates the rate of glucose uptake into the body’s cells. Facilitates the intracellular transport of potassium. Anabolic hormone: Synthesizes proteins, carbohydrates, lipids, and nucleic acids.

Question 59

Functions of Glucagon

Answer 59

Insulin antagonist. Secretion is promoted by decreased blood glucose levels. Increases glucose by stimulating glycogenolysis (breakdown of glycogen) and gluconeogenesis (generation of glucose from non-carbohydrate carbon substrates such as pyruvate, lactate, glycerol, and glucogenic amino acids.. Stimulates lipolysis.