NCCAOM List Diagnoses Flashcards
*Arrhythmias
- 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
Types of Arrhythmias
-
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
*Hypertension
- 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)
*Hypertensive Crisis
- 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
*Hypotension
- 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)
Atherosclerosis
- 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
Coronary Artery Disease
- 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.)
- 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
*Myocardial Infarction
- 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
*Angina Pectoris
- 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)
*Heart Failure
- 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
*Deep Vein Thrombosis
- 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
Raynaud’s Disease
- 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
*Aneurysms
- 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
*Aortic Aneurysm
-
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
*Cerebral Aneurysm
-
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
Non-Contagious Skin Conditions
-
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
Cellulitis
(Non-contagious Skin Conditions)
- 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
(Non-contagious Skin Conditions)
- 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
(Non-contagious Skin Conditions)
- 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)
(Non-Contagious Skin Conditions)
- 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
(Non-Contagious Skin Conditions)
- 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
(Non-Contagious Skin Condition)
- 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
*Contagious Skin Conditions
-
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
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
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
*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
*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
*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
*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
*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
*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)
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)
-
First-degree or partial thickness:
-
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
*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
CHART COMPARISON:
Hyperthyroidism vs. Hypothyroidism
Hyperthyroidism
Hypothyroidism
- ⬆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
- ⬇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
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
-
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)
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)
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
*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
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
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
COMPARISON CHART
Hyperparathyroid vs. Hypoparathyroid
Hyperparathyroid
Hypoparathyroid
- ⬆⬆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)
- ⬇PTH → ⬇ serum Ca⁺ (Hypocalcemia)
- Hypocalcemia → tetany (uncontrollable spasms)
- TESTS:
- X-Ray (Bones appear “moth eaten”)
- ⬆ serum Ca⁺, ⬆⬆PTH
- 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
Pancreatic Disorders
-
Diabetes Mellitus
- Type 1
- Type 2
- Gestational
- Type 3
-
Pancreatitis
- Acute
- Chronic
Pancreatitis
- Inflammation of pancrease
- Acute or chronic
- Pancreas is both endocrine & exocrine gland
- Endocrine: (no duct)
- Islets of Langerhand:
- Insulin
- Glucose
- Islets of Langerhand:
- Endocrine: (no duct)
- Exocrine: (duct)
- Sphincter of Oddi
- Protease
- Amylase
- Lipase
- Sphincter of Oddi
- 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
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
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
Abnormal Blood Glucose
Hypoglycemia
Hyperglycemia
S/S:
- Blood glucose < 50-60 mg/dL
- Skin pale, cool, diaphoretic
- Disoriented or agitated
- Headache
- Blurred vision
- Slurred speech
- Tachycardic w/ palpitations
- Weak/shaky
- Lip/tongue numbness
- LOC (loss of consciousness)
S/S:
- Blood glucose > 180 mg/dL
- Skin dry & flushed
- Fruity breath odor
- Blurred vision
- Dizziness
- Weakness
- Nausea
- Vomiting
- Cramping
- Increased urination
- 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)
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
-
Acromegaly
-
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)
- Decreased secretion of one or more of 8 hormones normally produced by pituitary gland
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
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
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
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
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)