NCCAOM List Diagnoses Flashcards
1
Q
*Arrhythmias
A
- Irregular HT beat rhythm
-
TEST:
- ECG/EKG (Electrocardiogram)
- Auscultation
-
TX: Depends on type arrythmia and severity ∴ (least to most severe TX):
- Monitoring the condition
- Medications (ex: Antidysrhythmics)
- Sinoatrial node replacement (“pacemaker”)
-
RED FLAG S/S:
- Sensation of fluttering, flopping, or racing heartbeat in chest
- Acute dizziness
- Chest pain
- SOB
- Hypotension
- Abnormal pulse (too fast, too slow, or irregular)
-
TYPES:
- Fibrillations
- Atrial Fibrillation
- Ventricular Fibrillation
- Premature ventricular contraction (PVC)
- Heart Block
- Tachycardia
- Bradycardia
- Fibrillations
2
Q
Types of Arrhythmias
A
-
Fibrillations: extremely rapid, uncoordinated shuddering of HT muscle
- Atrial Fibrillation (A-fib; AF): irregular contraction of atrial muscle tissue
-
Ventricular Fibrillation (V-fib; VF): irregular contractions of ventricular muscle tissue
- Most common arrhythmia in cardiac arrest
- Electrical dysfunction following ventricular tachycardia
- Commonly associated w/ MI, CHR, shock, or other HT dx
- S/S: Chest pain, SOB, sudden death
- TX: Direct Current (DC) Cardioversion
- Premature ventricular contraction (PVC): an extra contraction of ventricular muscle prior to its normal contraction. Sensation of skipped beat or “flip-flopping” in chest.
- Heart block: disease or inherited condition w/ obstruction in electrical conduction system of HT, creating longer gap between HT sounds. Includes Sinoatrial nodal black (SA block), Atrioventricular block AV block), intra-Hisian blocks, infra-Hisian blocks, Bundle branch blocks, & Fasicular or Hemiblocks
-
Tachycardia: Rapid HT rate. Sensation HT racing or beating very fast, even w/o exertion
-
Ventricular Flutter:
- A tachycardia affecting ventricles- possible transition stage between tachycardia and Vfib
- HR > 250-350 BPM
- Associated w/ hypoxia or ischemic insults
- Hypotension, sudden death
- TEST: ECG: sinusoidal waveform without clear definition of the QRS and T waves.
- TX: defibrillation
-
Ventricular Flutter:
- Bradycardia: substantially slower HT rate
3
Q
*Hypertension
A
- high blood pressure, 140/90 or higher. Extremely high BP can damage blood vessels
-
Causes of Secondary Hypertension:R.E.N.D.S.
- Renal failure (Renin-Angiotensin Cycle)
- Endocrine disease (i.e. Cushing’s, Pheochromocytoma)
- Neurogenic
- Drugs (i.e. Birth control)
- Sleep apnea
-
RED FLAG S/S:
- Often asymptomatic
- Headache
- Nocturia
- Nosebleeds
-
Complications Uncontrolled Hypertension:St.A.KD.Blind.Legs
- Stroke (CVA-cerebrovascular accident)
- ASHD (atherosclerotic heart disease)
- KD disease/failure
- Blindness (intraocular pressure)
- Legs: Peripheral arterial insufficiency
- TX: Dietary changes (low fat, low sodium- DASH diet), increased exercise, weight-loss, quit smoking, medications (diuretics, antihypertensives, and/or antihyperlipidemic)
4
Q
*Hypertensive Crisis
A
- very high BP, 180/120 or higher. Will damage blood vessels
-
RED FLAG S/S:
- Blood pressure over 180/120
- Severe headache
- Confusion
- Blurred vision
- Severe chest pain
- Seizures
- Nausea, vomiting
- SOB
- &/Or unresponsiveness
- Medical emergency- call 911
5
Q
*Hypotension
A
- low blood pressure, less than 90/60
- Most common cause: dehydration
- Also caused by heat exhaustion, hypothyroidism, significant blood loss, side effects of other medications, or complication of surgery
- Maybe no symptoms or severe symptoms
-
RED FLAG S/S: (esp. in elderly)
- Dizziness
- Fainting
- Lightheadedness
- Cold skin & extremities
- Nausea
- Blurry visions
- Orthostatic hypotension (Postural hypotension): dizziness, lightheadedness, or fainting when patient goes from sitting to standing or from lying to sitting
- TX: Ranges: administering fluids (dehydration), wearing compression stockings (improve circulation), increasing salt intake (raises BP), medications (postural hypotension)
6
Q
Atherosclerosis
A
- Thickened, hardened blood vessel walls from deposited fats and cholesterol
- Occlusion of vessel leads to arteriosclerosis, formation of scar tissue and additional deposit of calcium salts
-
TYPES:
- Coronary artery disease: atherosclerosis in the arteries of HT
- Peripheral vascular disease: Atherosclerosis in any artery which is not in the HT or brain
7
Q
Coronary Artery Disease
A
- AKA: Coronary HT Disease or CAD
- atherosclerosis in the arteries of HT
- Can compromise blood flow to myocardium and impact HT function
- CAD can lead to angina or myocardial infarction (HT attack)
-
TESTS:
- Coronary Angiography with Cardiac Catheterization
- ECG/EKG
- Exercise stress test
- Echocardiogram
-
TX:
- life style changes (exercise, quit smoking, dietary- low fat, low sodium)
- Medicaitons (antihyperlipidemic, antihypertensives, diuretics)
- Surgery (angioplasty- endovascular widening arteries/veins using balloon catheter) (Cardiac artery bypass surgery- great saphenous v. from leg or left internal thoracic a.)
8
Q
A
- Peripheral Artery Dx or PAD
- Atherosclerosis in any artery which is not in the HT or brain
- Decreases blood flow through affected artery and reduces blood flow to tissue or organ served by damaged artery
- Causes organ or tissue to perform poorly d/t ischemia (lack of oxygen and glucose/nutrients)
-
Risk Factors:
- Over the age of 50
- Smoking
- Overweight
- High cholesterol
- Diabetes mellitus
-
S/S:
- Depend on arteries and body parts affected
- Many are asymptomatic
- Intermittent Claudication (pain in legs w/ walking, improves w/ rest)
-
TEST:
- Angiography/arteriography
9
Q
*Myocardial Infarction
A
- MI or “HT Attack”
- When myocardium is deprived of oxygen (ischemia), leading to crushing chest pain and eventual death of ischemic cells.
- Does not** respond to **nitroglycerine (vs. Angina will respond nitroglycerine)
-
Red Flag S/S:
- Pain in the chest lasting more than a few minutes (may come and go)
- Pressure or squeezing sensation in chest
- SOB
- Pain that radiates into arm (esp. Left), neck, jaw, or back
- Medical Emergency: Call 911
- TEST: Troponin T&I ↑↑, CK-MB (Creatine Kinase-Muscle Type-Brain Type), ECG (T-wave inversion, ST elevation, Q-Wave)
- TX: O₂, aspirin, morphine, beta-blocker
10
Q
*Angina Pectoris
A
- Temporary lack of oxygen to cardiac muscle
-
RED FLAG S/S:
- Chest pain and discomfort in middle 1/3 of sternum
- Pain may radiate to left jaw, neck & arm
- Pain follows exertion, eating, meals, or during periods of stres
- Pain relieved by rest
-
Unstable Angina: anginal attack occurring at rest or increasing in frequency
- High risk of subsequent MI
- TX: medication (Nitroglycerine)
11
Q
*Heart Failure
A
- Congestive Heart Failure- CHF
- Not a specific disease, usually end result of other disease weakening HT
- Makes HT less effective in pumping blood
- Often result of atherosclerosis of coronary arteries (Coronary artery disease/CAD), high blood pressure (Hypertension), and/or a heart attack (Myocardial Infarction)
- Left sided HT failure may cause fluid build up in lungs, causing breating difficulties
- Right sided HT failure may cause fluid (edema) in extremities or abdomen
-
RED FLAG S/S:
- Fatigue
- SOB (esp. lying down)
- Swelling in legs/ankles/feet/abdomen
- Weight gain
- Persistent cough (esp. w/ pink frothy mucus)
- Wheezing
- Irregular heartbeats
- TX: Hard to reverse, prevention is key
-
Prevention:
- Exercise
- Dietary changes (low fat, low sodium)
- Weightloss
- No smoking
12
Q
*Deep Vein Thrombosis
A
- Blood clot in one of deep veins of body- commonly the leg
- Main concern clot will detach, become mobile, and lodge in another vessel, often the lung, forming a Pulmonary Embolism
- Associated w/ cancer, estrogen therapy, birth control, prolonged immobility
- Phlegmasia Cerulea Dolens: massive DVT resulting in ischemia
- Virchow’s triad: venostasis, hypercoagulability, endothelial injury/dysfunction
- Homan’s sign: pain in calf on dorsiflexion of foot w/ knee extended (not accurate, Ultrasound better diagnostic)
-
RED FLAG S/S:
- Swelling in ankle or lower leg (if clot in leg)
- Cramp-like pain in calf
- Increased warmth to area
- Color changes of skin in area (red or blue)
- May be asymptomatic
- DX: Ultrasound
- TX: Thrombolytic drugs or anticoagulant (Heparin, Warfarin, Coumadin) medications
13
Q
Raynaud’s Disease
A
- Most commonly affects women
- SNS causes excessive constriction of small arteries in hands, feet, ears, nose
- Often triggered by cold exposure
- Skin area changes color with blood flow disruption
- Pale then blue
- Eventually back to red once blood flow returns
14
Q
*Aneurysms
A
- A weak bulge in blood vessel wall at risk to rupture
- Rupture maybe fatal in very short period time
- Most common: aortic aneurysm, cerebral aneurysm
- Grow slowly, therefore asymptomatic or slow development S/S
- DX: ultrasound or MRI
15
Q
*Aortic Aneurysm
A
-
RED FLAG S/S:
- Throbbing feeling in abdomen (felt by patient or by physician on physical exam)
- Pain in the abdomen or back
- W/ Rupture: Severe pain
-
Risk Factors:
- Male
- Smoking family history aneurysm
- Hypertension
- Atherosclerosis
- DX: ultrasound or MRI
16
Q
*Cerebral Aneurysm
A
-
RED FLAG S/S:
- Vision difficulties
- Pain in the eye
- Numbness or drooping on one side of face
- Dilated pupil
- W/ Rupture: sudden, severe headache
-
Risk Factors:
- Female (esp. post-menopausal)
- Head trauma
- Smoking
- Hypertension
- Atherosclerosis
- Drug abuse
- Alcohol abuse
- DX: ultrasound or MRI
17
Q
Non-Contagious Skin Conditions
A
-
Cellulitis:
- Bacterial infection of skin (usually Streptococcus or Staphylococcus)
- Gradually spreads through hypodermis and dermis
- Usually develops in area where wound to skin
- Skin becomes red & swollen
- Area gradually spreads and enlarges
-
Shingles:
- Caused by Herpes varicella zoster virus (chicken pox virus)
- Lives in dorsal root of spinal nerves
- During outbreak, virus travels along nerve pathway (root of nerve to surface of skin)
- Blistering lesions along sensory nerve dermatomes
- Can be intense pain w/ lesions
-
Acne:
- Bacteria P. acnes active infection of blocked sebaceous glands
- Causes open comedos (blackheads) or closed comedos (whiteheads)
-
TX:
- topical antibiotics
- vitamin-A derivatives (retinol/-al)
- peeling agents
- Accutane Rx to reduce oil gland activity
-
Eczema: (Atopic Dermatitis)
- Triggered by temperature changes, fungi, chemical irritants (detergents, etc.), & stress
- Predisposition d/t hereditary factors, environmental factors, or both
- S/S: Itchy skin, red bumps that can crust when scratched, red or brown dry area, cracked skin
-
Psoriasis:
- Chronic skin condition
- Stem cells in stratum germinativum/basale (innermost layer) show increased activity, causing hyperkeratosis
- Normal stem cell division= 1:20 days
- Psoriasis stem cell division= 1:1 1/2 days
- S/S: Reddened epidermal lesions covered w/ dry, silvery scales, severe cases may be disfiguring & debilitating
- Common areas: scalp, elbows, palms, soles, groin, nails
- Triggers: trauma, infection, hormonal changes, stress
-
Alopecia:
- An autoimmune or genetic disease causing hair loss on scalp (or elsewhere)
- Occurs in men or women
- Males: can cause male pattern hair loss
- Females: can cause thinning of hair throughout head
- TX: Rogaine or corticosteroids
18
Q
Cellulitis
(Non-contagious Skin Conditions)
A
- Bacterial infection of skin (usually Streptococcus or Staphylococcus)
- Gradually spreads through hypodermis and dermis
- Usually develops in area where wound to skin
- Skin becomes red & swollen
- Area gradually spreads and enlarges
19
Q
Shingles
(Non-contagious Skin Conditions)
A
- Caused by Herpes varicella zoster virus (chicken pox virus)
- Lives in dorsal root of spinal nerves
- During outbreak, virus travels along nerve pathway (root of nerve to surface of skin)
- Blistering lesions along sensory nerve dermatomes
- Can be intense pain w/ lesions
20
Q
Acne
(Non-contagious Skin Conditions)
A
- Bacteria P. acnes active infection of blocked sebaceous glands
- Causes open comedos (blackheads) or closed comedos (whiteheads)
-
TX:
- topical antibiotics
- vitamin-A derivatives (retinol/-al)
- peeling agents
- Accutane Rx to reduce oil gland activity
21
Q
Eczema (Atopic Dermatitis)
(Non-Contagious Skin Conditions)
A
- Triggered by temperature changes, fungi, chemical irritants (detergents, etc.), & stress
- Predisposition d/t hereditary factors, environmental factors, or both
- S/S: Itchy skin, red bumps that can crust when scratched, red or brown dry area, cracked skin
22
Q
Psoriasis
(Non-Contagious Skin Conditions)
A
- Chronic skin condition
- Stem cells in stratum germinativum/basale (innermost layer) show increased activity, causing hyperkeratosis
- Normal stem cell division= 1:20 days
- Psoriasis stem cell division= 1:1 1/2 days
- S/S: Reddened epidermal lesions covered w/ dry, silvery scales, severe cases may be disfiguring & debilitating
- Common areas: scalp, elbows, palms, soles, groin, nails
- Triggers: trauma, infection, hormonal changes, stress
23
Q
Alopecia
(Non-Contagious Skin Condition)
A
- An autoimmune or genetic disease causing hair loss on scalp (or elsewhere)
- Occurs in men or women
- Males: can cause male pattern hair loss
- Females: can cause thinning of hair throughout head
- TX: Rogaine or corticosteroids
24
Q
*Contagious Skin Conditions
A
-
Lice: (Pediculus humanus)
- body and scalp lice
- Bites cause redness and itching
- Lice are small but seen with eye
- Eggs laid at base of hairs near skin
-
RED FLAG S/S HEAD LICE:
- Small whitish flecks on shaft of hair, near scalp
- Seeing lice crawling on hair
- Tickling sensation on head
- Itching
-
Lice: Phthirus pubis: (pubic lice or “crabs”)
-
RED FLAG S/S PUBIC LICE:
- Itching in genital area
- Tickling sensation
- Seeing darker and larger lice crawling on skin and hair
-
RED FLAG S/S PUBIC LICE:
Fungal infections:
-
*Athlete’s Foot:
- Fungal infection tinea pedis
-
RED FLAG S/S:
- Dry, itchy cracked skin on feet
- Commonly skin between toes, on soles, or top of foot
- Deep cracks in skin can lead to bleeding
- Fungal infection other areas of body goes by different names:
- Head: tinea capitis
- Trunk: “ring worm”- tinea corporis
- Groin: “jock itch”- tinea cruris
- Nails: tinea ungulum
-
*Scabies:
- Parasitic infection of Sarcoptes scaibei
- Highly contagious
- Might burrows under skin and lays eggs
-
RED FLAG S/S:
- Intense itching
- Redness seen in area of infection
- Burrows seen under skin
- Commonly affected areas: fingers, wrists, groin
25
**Pediculus humanus (Head Lice)**
| (**\*Contagious** Skin Conditions)
* _body_ and _scalp_ lice
* Bites cause redness and itching
* Lice are small but seen with eye
* Eggs laid at base of hairs near skin
* ***RED FLAG S/S _HEAD_ LICE:***
* Small whitish flecks on shaft of hair, near scalp
* Seeing lice crawling on hair
* Tickling sensation on head
* Itching
26
**Phthirus pubis (Pubic Lice/"Crabs")**
| (**\*Contagious** Skin Conditions)
* pubic lice or "crabs"
* ***RED FLAG S/S PUBIC LICE***:
* Itching in genital area
* Tickling sensation
* Seeing darker and larger lice crawling on skin and hair
27
**\*Athlete's Foot** (***Tinea pedis***)
| (**\*Contagious** Skin Conditions)
* Fungal infection tinea pedis
* ***RED FLAG S/S:***
* Dry, itchy cracked skin on feet
* Commonly skin between toes, on soles, or top of foot
* Deep cracks in skin can lead to bleeding
* **Fungal infection other _areas of body_ goes by _different names_:**
* _Head_: **tinea capitis**
* _Trunk_: "ring worm"- **tinea corporis**
* _Groin_: "jock itch"- **tinea cruris**
* _Nails_: **tinea ungulum**
28
**\*Scabies**
| (**\*Contagious** Skin Conditions)
* Parasitic infection of **Sarcoptes scaibei**
* _Highly contagious_
* Might burrows under skin and lays eggs
* ***RED FLAG S/S:***
* Intense itching
* Redness seen in area of infection
* Burrows seen under skin
* ***Commonly affected areas:*** fingers, wrists, groin
29
**\*Skin Cancers**
* **Basal cell carcinoma:**
* Least malignant and most common
* Rarely metastasizes (spreads)
* **Squamous cell carcinoma**:
* Capable of metastasis
* Appears most often on scalp, ears, dorsal surfaces of hands, and lower lip
* **Malignant Melanoma**:
* Cancer of melanocytes, usually d/t too much sun exposure
* *Least common, most deadly*
* metastasizes rapidly, low survival rate if not caught early
30
**\*Basal cell carcinoma**
| (**\*Skin Cancers**)
* *Least malignant* and *most common*
* Rarely metastasizes (spreads)
* ***RED FLAG S/S:***
* Shiny, dome-shaped lesions
* Later develop a central ulcer w/ pearly beaded edge
* Most often in sun-exposed areas of face
31
**\*Squamous cell carcinoma**
| (**\*Skin cancers**)
* Capable of metastasis
* Appears most often on _scalp_, _ears_, _dorsal_ _surfaces_ of _hands_, and _lower lip_
* ***RED FLAG S/S:***
* Lesions are scaly, reddened papules (small, round elevations)
* Often on scalp, ears, dorsal surfaces of hands, lower lip
32
**\*Malignant Melanoma**
| (**\*Skin Cancers**)
* Cancer of melanocytes, usually d/t too much sun exposure
* *Least common*, *most deadly*
* Metastasizes rapidly, low survival rate if not caught early
* ***RED FLAG S/S:***
* Lesions appear as spreading brown or black patches
* Can arise spontaneously or develop from a mole or pigmented spot
* ***ABCDE:***
* A=Assymetry
* B=Border
* C=Color
* D=Diameter (6mm)
* E=evolving over time (changes)
33
**Burns**
* Tissue damage and cell death d/t intense heat, electricity, UV radiation, or chemicals (ex: acids)
* Severe burns prone to infection, reduce thermoregulation, and cause dehydration leading to electrolyte imbalance and circulatory shock (inadequate blood circulation)
* ***Classification by Severity:***
* **First-degree or partial thickness:**
* Damage to epidermis only
* Redness (erythema)
* **Second-degree burn:**
* Affects epidermis and upper part of dermis
* Blistering, pain and erythema
* **Third-degree or full thickness:**
* Usually involves entire thickness of skin
* Less pain and discomfort d/t complete damage to nerves
* Extensive 3rd degree burns cannot heal alone- skin grafts must be used
34
**\*Thyroid Disorders**
* **Hyperthyroidism:**
* ⬆BMR
* Tachycardia
* Hyperactive reflexes
* ⬆ Diaphoresis
* Heat intolerance
* Fatigue
* Tremor (fast, fine, persistent)
* Nervousness
* Polydipsia
* Weakness
* ⬆ Appetite
* Dyspnea (SOB)
* Weight loss
* Diarrhea
* Apathy
* Depression
* Muscular atrophy
* Anorexia
* ⬇TSH, ⬆Free T4
* **Hypothyroidism:**
* ⬇BMR (Basal metabolic rate)
* Dry skin
* Muscle/joint pain
* Proximal weakness
* Lethargy, depression, apathy
* Confusion
* Weight gain
* Edema around eyes
* Loss lateral eyebrow
* Cardiomegaly
* Constipation
* Cold intolerance
* Brittle nails
* Sparse/coarse hair
* Peripheral edema
* Joint effusion w/ Ca⁺deposits
* CTS (carpal tunnel syndrome)
* Slow healing
* Hoarseness
* Pulse rate \< 60 (non-athletic)
* ⬆TSH, ⬇Free T4
* **Myxedema:**
* HYPOTHYROIDISM in adults
* **Hashimoto's thyroiditis:**
* Autoimmune hypothyroidism
* Immune system damages thyroid, causing decrease in function and performance
* Most common cause of hypothyroidism in USA
* **Graves' disease:**
* Autoimmune hyperthyroidism
* Immune system attacks thyroid, causing excess production of thyroxine
* Results abnormally high basal metabolic rate (BMR)
* **Thyroid Storm:**
* Excessive thyroid function
* Caused by stressful situation w/ underlying subclinical hyperthyroidism
* **Cretinism:**
* Hyposecretion of thyroid hormone in babies/children
* Body proportions are distorted (head & trunk are 1 1/2 times length of legs)
* Swollen tongue
* Possible mental retardation
* Often d/t improperly formed thyroid gland
35
**CHART COMPARISON:**
**Hyperthyroidism vs. Hypothyroidism**
Hyperthyroidism
Hypothyroidism
* ⬆BMR
* Tachycardia
1. Hyperactive reflexes
2. ⬆ Diaphoresis
3. Heat intolerance
4. Fatigue
5. Tremor (fast, fine, persistent)
6. Nervousness
7. Polydipsia
8. Weakness
9. ⬆ Appetite
10. Dyspnea (SOB)
11. Weight loss
12. Diarrhea
13. Apathy
14. Depression
15. Muscular atrophy
16. Anorexia
17. ⬇TSH, ⬆Free T4
1. ⬇BMR (Basal metabolic rate)
2. Dry skin
3. Muscle/joint pain
4. Proximal weakness
5. Lethargy, depression, apathy
6. Confusion
7. Weight gain
8. Edema around eyes
9. Loss lateral eyebrow
10. Cardiomegaly
11. Constipation
12. Cold intolerance
13. Brittle nails
14. Sparse/coarse hair
15. Peripheral edema
16. Joint effusion w/ Ca⁺deposits
17. CTS (carpal tunnel syndrome)
18. Slow healing
19. Hoarseness
20. Pulse rate \< 60 (non-athletic)
21. ⬆TSH, ⬇Free T4
36
**Hyperthyroidism**
* ⬆BMR
* Tachycardia
* Hyperactive reflexes
* ⬆ Diaphoresis
* Heat intolerance
* Fatigue
* Tremor (fast, fine, persistent)
* Nervousness
* Polydipsia
* Weakness
* ⬆ Appetite
* Dyspnea (SOB)
* Weight loss
* Diarrhea
* Apathy
* Depression
* Muscular atrophy
* Anorexia
* ⬇TSH, ⬆Free T4
37
**Hypothyroidism**
* ⬇BMR (Basal metabolic rate)
* Dry skin
* Muscle/joint pain
* Proximal weakness
* Lethargy, depression, apathy
* Confusion
* Weight gain
* Edema around eyes
* Loss lateral eyebrow
* Cardiomegaly
* Constipation
* Cold intolerance
* Brittle nails
* Sparse/coarse hair
* Peripheral edema
* Joint effusion w/ Ca⁺deposits
* CTS (carpal tunnel syndrome)
* Slow healing
* Hoarseness
* Pulse rate \< 60 (non-athletic)
* ⬆TSH, ⬇Free T4
38
**Myxedema**
Hypothyroidism in adults
39
**Hashimoto's thyroiditis**
* Autoimmune hypothyroidism
* Immune system damages thyroid, causing decrease in function and performance
* Most common cause of hypothyroidism in USA
* ***S/S:***
* Goiter
* Low basal metabolic rate (BMR)
* Weight gain
* Feeling of sluggishness/fatigue
* Decreased body temperature (always feels chilled)
* ***DX:*** ⬆TSH, ⬇Free T4, +Antibodies: TgAb/Anti-thyroglobulin, Anti-TPO/Anti-thyroid peroxidase
* ***TX:*** Thyroid medications (ex: Synthroid)
40
**Graves' disease**
* Autoimmune hyperthyroidism
* Immune system attacks thyroid, causing excess production of thyroxine
* Results abnormally high basal metabolic rate (BMR)
* ***S/S:***
* Weight loss
* Anxiety
* Goiter
* Sweating
* Increased body temperature
* Exophthalmoses (protrusion of eyeballs from socket)
* Tremor (fast, fine, persistent)
* ***GV→Thyroid Storm RED FLAG S/S:***
* Agitation
* Anxiety
* Confusion
* Palpitation
* Arrhythmia
* Diaphoresis
* Heat intolerance
* Diarrhea
* **Exopthalmos**
* **Pretibial Myxedema**
* (1-5% Pts, preceded by ocular signs, presents as waxy, orange peel appearance on anterior aspect lower legs, spreading to dorsum of feet, or as non-localized, non-pitting edema of skin in same areas; lesions resolve very slowly, with burning and itching
* ***TEST:*** ⬇TSH, ⬆Free T4, +**TSI** (Thyroid Stimlating Immunoglobulin), **anti-TPO** (Anti-thyroid peroxidase antibody- like Hashimoto's)
* ***TX:*** Radioactive iodine, surgery, or anti-thyroid medications (**methimazole**, **prophylthiouracil**)
41
**Cretinism**
* _Hyposecretion_ of thyroid hormone in _babies/children_
* Body proportions are distorted (head & trunk are 1 1/2 times length of legs)
* Swollen tongue
* Possible mental retardation
* Often d/t improperly formed thyroid gland
* TX: **thyroxine**
* If within first month after birth, can be treated before permanent mental retardation and growth abnormalities
* If not treated w/in timely manner, mental retardation and growth abnormalities
42
**\*Thyroid Storm**
* **Excessive** thyroid function
* Caused by stressful situation w/ underlying subclinical hyperthyroidism
* ***RED FLAG S/S:***
* Agitation
* Anxiety
* Confusion
* Palpitation
* Arrhythmia
* Diaphoresis
* Exopthalmos
* Heat intolerance
* Diarrhea
* ***TX:*** *Antithyroid* medications (**Propylthiouracil**, **methilmazole**) radioiodine, surgery
43
**Hyperparathyroid**
* ⬆⬆PTH → massive bone destruction
* Bones become very fragile & fracture easily
* Bones appear "moth eaten" on X-ray
* Osteitis fibrosa cystica (d/t chronic bone reabsorption)
* 80% cases d/t single benign tumor (parathyroid adenoma)
* ***TESTS***:
* X-Ray (Bones appear "moth eaten")
* ⬆ serum Ca⁺, ⬆⬆PTH
44
**Hypoparathyroid**
* ⬇PTH → ⬇ serum Ca⁺ (Hypocalcemia)
* Hypocalcemia → tetany (uncontrollable spasms)
* ***TESTS:***
* ⬇ serum Ca⁺, ⬇PTH
* **Chvostek Sign(**+)
* Facial muscle spasms when facial nerve tapped
* **Trousseau's Sign** (+)
* latant tetany d/t ⬇ Ca⁺BP cuff around arm & inflated to pressure \> systolic BP & held in place for 3 minutes
* Occlusion of brachial artery → spasm or hand/forearm muscles→ crane hand
* ⬆ deep tendon reflexes
45
**COMPARISON CHART**
**Hyperparathyroid vs. Hypoparathyroid**
Hyperparathyroid
Hypoparathyroid
1. ⬆⬆PTH → massive bone destruction
2. Bones become very fragile & fracture easily
3. Bones appear "moth eaten" on X-ray
4. Osteitis fibrosa cystica (d/t chronic bone reabsorption)
5. 80% cases d/t single benign tumor (parathyroid adenoma)
1. ⬇PTH → ⬇ serum Ca⁺ (Hypocalcemia)
2. Hypocalcemia → tetany (uncontrollable spasms)
1. TESTS:
* X-Ray (Bones appear "moth eaten")
* ⬆ serum Ca⁺, ⬆⬆PTH
1. TESTS:\< \>⬇ serum Ca⁺, ⬇PTHChvostek Sign(+)Facial muscle spasms when facial nerve tappedTrousseau's Sign (+) latant tetany d/t ⬇ Ca⁺BP cuff around arm & inflated to pressure \> systolic BP & held in place for 3 minutesOcclusion of brachial artery → spasm or hand/forearm muscles→ crane hand⬆ deep tendon reflexes
46
**Pancreatic Disorders**
* **Diabetes Mellitus**
* **Type 1**
* **Type 2**
* **Gestational**
* **Type 3**
* **Pancreatitis**
* **Acute**
* **Chronic**
47
**Pancreatitis**
* Inflammation of pancrease
* Acute or chronic
* Pancreas is both endocrine & exocrine gland
* Endocrine: (no duct)
* Islets of Langerhand:
* Insulin
* Glucose
* Exocrine: (duct)
* Sphincter of Oddi
* Protease
* Amylase
* Lipase
* Exocrine productions released via Sphincter of Oddi (→Hepatopancreatic sphincter)- controls flow of bile & pancreatic juice through Ampula of Vater into 2nd part of duodenu
* Hepatopancreatic duct= union of pancreatic duct & common bile duct
* Sphincter of Oddi (hepatopancreatic sphincter)→ Ampula of Vater (hepatopancreatic duct)→ 2nd part of duodenum
* Secretion of Secretin in duodenum stimulates exocrine function of pancreas
* **80%** of cases d/t Alcohol or Gallstones/Cholelithiasis
* _Alcohol:_ **#1** cause **Acute**
* _Gallstones_: **#1** cause **Chronic**
48
**Acute Pancreatitis**
* ***Common causes:***
* Gallstones (#1)
* Alcohol
* Trauma
* Infections (Mumps, Viral Hepatitis, Cytomegalovirus…)
* Metabolic disorders (hereditary pancreatitis, hypercalcemia…)
* Post-ERCP (Endoscopic retrograde cholangiopancreatography)
* Penetrating ulcers
* Carcinoma of pancreatic head (&other cancers)
* Medications (Diuretics: thiazides, furosemides; gliptins; estrogens; tetracycle; salicylates; steroids…)
* Structural abnormalities (choledochocele…)
* Radiation, X-ray
* Autoimmune pancreatitis (More Chronic…Sjogrens, IBS, etc.)
* ***S/S:***
* Upper (above umbilicus) abdominal pain
* Abd. Pain radiates to back
* Abd. Pain worse w/ eating
* Nausea/Vomiting
* Tenderness when touching abdomen
* ***TEST:***
* Amylase⬆, Lipase⬆, WBC⬆ (w/ infection)
* ***TX:*** pain meds, IV fluids, no solids
* ***CAUTION:*** ruptured tubal/ectopic pregnancy
49
**Chronic Pancreatitis**
* ***CAUSES:***
* Alcohol (#1)
* Autoimmune disorders
* Intraductal obstruction
* Idiopathic pancreatitis
* Tumors
* Ischemia
* Calcific stones
* Cystic fibrosis (almost all Px)
* ***S/S:***
* Chronic diarrhea (10-12x/day)
* Malnutrition (d/t malabsorption)
* Emaciation (d/t"")
* Vitamin Xu (d/t"")
* Dehydration (d/t persistent diarrhea)
* Steatorrhea (excess fat in stools)
* Pain w/ eating (esp. high % fats & proteins)
* ***TEST:***
* Stools: Muscle fibers
* Secretin Stimulation Test
* Measures ability of pancreas to respond to secretin produced by duodenum (2nd part)
* ***TX:***
* Pancreas enzymes
* Pain meds
* IV fluids
* No solids
50
**Abnormal Blood Glucose**
Hypoglycemia
Hyperglycemia
S/S:
1. Blood glucose \< 50-60 mg/dL
2. Skin pale, cool, diaphoretic
3. Disoriented or agitated
4. Headache
5. Blurred vision
6. Slurred speech
7. Tachycardic w/ palpitations
8. Weak/shaky
9. Lip/tongue numbness
10. LOC (loss of consciousness)
S/S:
1. Blood glucose \> 180 mg/dL
2. Skin dry & flushed
3. Fruity breath odor
4. Blurred vision
5. Dizziness
6. Weakness
7. Nausea
8. Vomiting
9. Cramping
10. Increased urination
11. LOC/seizure
Some excess glucose will be stored in LR, rest will be converted to fat and stored in adipose tissue
Cause: Main=alcoholism. Can also be d/t fasting, too much insulin medication, or a pancreatic tumor (insulinoma)
Cause: Long term or pathological hyperglycemia could indicate glucose metabolic disorder (Ex: Diabetes Mellitus)
D/D Test: A1C (DM ≥7), Fasting Blood Sugar (DM ≥ 126)
51
**Pituitary Disorders**
* **Diabetes Insipidus**
* Hyposecretion of ADH (posterior pituitary)
* **Growth Hormone Disorders**
* **Acromegaly**
* Hypersecretion GH during adulthood
* **Gigantism:**
* Hypersecretion GH during growth
* **Dwarfism:**
* Hyposecretion of GH during growth
* **Hypopituitarism**
* Decreased secretion of one or more of 8 hormones normally produced by pituitary gland
* Anterior: ACTH, TSH, LH, FSH, MSH, GH
* Posterior: Oxytocin, ADH/Vasopressin
* **Craniopharyngioma** (Children)
* **Pituitary Adenoma** (Adults)
52
**Diabetes Insipidus**
* **Hyposecretion** of **ADH** (antidiuretic hormone) by posterior pituitary gland
* ADH=vasopressin (i.e. VP, AVP, ADH)
* Blood sugar levels and insulin are NORMAL
* ***S/S:*** polyuria, polydypsia
* ***TX:*** Desmopressin
53
**Growth Hormone Disorders**
* **Acromegaly:**
* Hypersecretion of GH during adulthood (after closure growth plate)
* ***S/S:***
* Age of onset: 30-50
* Normal height, w/ facial bones, hands and feet enlarged
* ***DX:*** ⬆GH
* ***TX:***Surgery, radiation therapy, GH receptor agonists(ex: Somavert)
* **Gigantism:**
* Hypersecretion of GH during growth/ childhood
* ***S/S:*** Extremely tall, w/ normal body proportions (tall torso, long arms, long legs)
* ***DX:*** ⬆GH
* ***TX:*** Surgery, radiation therapy, GH receptor agonists (ex: Somavert)
* **Dwarfism:**
* Hyposecretion of GH during growth/
childhood
* ***S/S:*** Body proportions are normal, w/ maximum height 4ft
* ***DX:*** ⬇GH
* ***TX:*** GH injections
54
**Hypopituitarism**
* **Pituitary adenoma** (in adults) or **craniopharyngioma** (in children)
* Decreased secretion of one or more of 8 hormones normally produced in pituitary gland
* *Anterior*: ACTH, TSH, LH, FSH, MSH, GH
* *Posterior*: Oxytocin, ADH/Vasopressin
* ***S/S:***
* Hypotension
* Cold intolerance
* Bitemporal hemianopsia (partial blindness B outer 1/2 visual field)
* ***TEST:***
* ↓ACTH, ↓TSH, ↓LH, ↓FSH
* X-Ray: Widening of sella turcica on skull x-ray
* ***TX:*** Hormone replacement
55
**Obesity**
* Excess body fat accumulation, generally with a BMI over 30
* Increases likelihood of various diseases, esp. HT disease, Type II Diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis
* Most commonly caused by: excessive food intake, lack of physical activity, and genetic susceptibility
* May also be d/t genetics, endocrine disorders (ex: hypothyroid), medications, or mental illness
* Leading preventable cause of death worldwide
56
**Hyperlipidemia**
* Elevated levels of lipids in blood
* Most commonly cholesterol levels and triglyceride levels are measured
* ***TX:***
* Dietary changes (low fat, low cholesterol, no trans-fats, increased fiber)
* Weight loss
* Increase in exercise
* Medication (statins- antihyperlipidemic medications)
