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NPTE Final Frontier > Other Systems 1 > Flashcards

Other Systems 1 Flashcards

1
Q

Practice!
Pts medical chart shows BP 168/90, triglycerides lvl 160, FBG lvl 115. BMI= 40 and waistline 54in. ALL findings suggestive of?

A

Metabolic Syndrome (cluster of sx’s)
Other answers:
- CHD
- TIIDM–FBG will be >126 for T2DM
- Stage I HTN= 130-139 OR 80-89

3/5 factors in this question for Metabolic Syndrome!

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2
Q

Metabolic Syndrome think….

A

ALL of the LEAD causes of death/disease in US!!!

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3
Q

Metabolic Syndrome

This is SPECIFIC list of things assocd w/ Metabolic Syndrome

S/S risk factors for/strongly linked to T2DM, CV Dis, Stroke

A

Dx is made if THREE OR MORE present:
1. Fasting plasma glucose lvl >100 mg/dL
2. SBP= 130 and/or DBP= 85
3. Triglyceride lvl of 150 mg/dL or HIGHER
4. HDL lvl <40 mg/dL in MEN or <50mg/dL in WOMEN
5. Waist circumf >40in MEN; >35in WOMEN

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4
Q

Glands of Endocrine System
See pic and correlate w/ your chart!

A

see chart

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5
Q

Leader: Hypothalamus
- Anterior Pituitary
- Posterior Pituitary

How many hormones total and where?

A

8 hormones
Ant Pit== 6
- ACTH, TSH, FSH/LH, GH, Prolactin
Post Pit== 2
- ADH/Vasopressin, Oxytocin

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6
Q

Hormone Chart: Leader= Hypothalamus

Anterior Pituitary
(6):
Hormone–> Gland–> Produces

A
  1. ACTH (adrenocorticotrophic)–> Adrenal cortex–> Cortisol, Aldosterone
  2. TSH (thyroid stim)–> Thyroid–> T3 & T4
    3/4. FSH (follicle) & LH (lutenizing)–> Ovaries/Tests–> Estrogen, Progesterone, Testosterone (think Gonads)
  3. GH–> Bones & Tissues–> Growth, metabolism
  4. Prolactin–> Milk production in breasts
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7
Q

Hormone Chart: Leader=Hypothalamus

Posterior Pituitary
(2):
Hormone–> Gland–> Produces

A
  1. ADH (Anti-Diuretic)/Vasopressin–> Regulates water and mineral balance, water retention
  2. Oxytocin–> Stimulates uterine contractions during birth
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8
Q

Glands of Endocrine System
Hypothalamus (Leader)

A

Regulates ANS
- body temp, appetite, sweating, thirst, sex behaviors, rage, fear, BP, sleep

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9
Q

Glands of Endocrine System
Pituitary: Ant (6) vs Post (2)

A

Secretes endorphins and reduces sensitivity to pain.
Controls ovulation and works as catalyst for testes/ovaries to create sex hormones

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10
Q

Glands of Endocrine System
Thyroid

A

Hormones act to control rate @ which cells burn fuel from food

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11
Q

Glands of Endocrine System
Parathyroid (think Ca and phosphate)

A

Regulates Ca+ and Phosphate metabolism

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12
Q

Glands of Endocrine System
Adrenal
IMPORTANT!!!

A

NORMAL DEFINITION:
- produces corticosteroids that will regulate **water and sodium balance, body’s response to STRESS, immune system, metabolism

Think Cortisol and Aldosterone

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13
Q

Glands of Endocrine System
Adrenal
IMPORTANT!!!

Cortisol vs Aldosterone

A

Cortisol
- Stress
- Regulates BP
- Glucose regulation**
- Anti-inflamm

Aldosterone
- H20/mineral balance
- RETAINS H20 + Sodium**
- REMOVEs K+ from body

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14
Q

Practice!
Pt c/o sig wt gain in abdomen and face. Labs show HIGH lvls of cortisol and ELEVATED blood GLU and HIGH lvls ACTH from pituitary (ANTERIOR). Most likely dx?

A

Cushings Disease (DISEASE== problem in Pituitary)
- Moon face, buffalo hump== INC cortisol, “Cushings like Cushion (round)”

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15
Q

Other answers:
- Addisons Dis
- Hashimoto’s Dis
- HypOthyroidism

A
  • Addisons–> Adrenal INsuff== DEC cortisol
  • Hashimoto’s–> AI disorders of thyroid== HypOthryoid
  • HypOthyroid–>

The answer was Cushings Dis== INC cortisol, Addisons is DEC cortisol—> you will see DECd BG, DEC BP, anxiety/depress, Lose Na/water (dehydration), RETAIN K+

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16
Q

Addison’s Dis vs Cushing’s Dis

Mrs. Addison– “Old weak thin brown lady walking w/ a stick”
Mr. Cushings– “White chubby boy who likes drinking beer”

A

Addisons== Adrenal INsuff
Cushing’s== Adrenal OVERsecretion

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17
Q

Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone

Mrs. Addison’s Disease
“Old brown lady walking with a stick”

Adrenal INsuff

A

Causes: Infx, neoplasm, hemorrhage, AI process
Adrenal INsuff: DECd cortisol and aldosterone
- DECd BP, dehydration (bc losing water)
- HypERkalemia (bc not getting rid of K+
- DECd glucose (bc DEC cortisol (regs BG)
- Bronze pigmented skin (“Brown Lady”)
- Wt loss, anorexia, GI disturbs (“thin lady”)
- Generalized weakness (asthenia– “walking with a stick”)
- INtol to cold and stress, anxiety and depress (bc no cortisol to regulate stress)

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18
Q

Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone

Mr. Cushing’s Disease
“Chubby white boy who loves to drink beer”

ELEVATED cortisol & aldosterone

A

Causes: Pituitary tumor w/ INCd ACTH secretion
Elevated cortisol & aldosterone
- INCd BP, water RETENTION (opp Addison’s, bc INC cortisol and aldosterone)
- HypOkalemia** (getting rid of K+)**
- INCd glucose (bc INC cortisol)
- Ruddy appearance, striae on skin (rosy cheeks–“happy bc beer”
- Wt GAIN, centripetal obesity, round moon face
- Proximal mm weakness and atrophy (same as long term corticosteroids, so makes sense)
- Incd susceptibility to infx, osteoporosis (buffalo hump), poor wound healing (same as long term corticosteroids, so makes sense)

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19
Q

Cushings Disease vs Cushings Syndrome
In a nutshell…

A
  • Disease think problem in Pituitary
  • Syndrome think problem in Adrenal glands
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20
Q

Cushing’s Disease vs Syndrome

Sx’s common for BOTH
Explain…

A

Cushings Disease (prob in Pituitary)
- Pit. Adenoma–> more ACTH secreted by PIT gland–> stims adrenal gland==> MORE cortisol release

Cushings Syndrome (prob in Adrenal glands)
- Adrenal glands tumor–> Adrenal glands secrete more cortisol–> drug toxicity

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21
Q

Thyroid Conditions

see charts

A

HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”
HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter

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22
Q

Thyroid Conditions

HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”

Think metabolic processes INCREASE

A

INCd T3 and T4- so LOW TSH (bc signaled to LOWER TSH)–> feedback loop
- INCd HR (LOW BP, bc NOT sedentary, everything sped up, so lower BP)
- HIGH BMR
- Heat INtolerance (sped up, sweating all the time)
- INCd glucose absorption (dec BG in blood, hyper-using BG all the time!)
- Restlessness, Insomnia
- Diarrhea (bc everything sped up)
- Silky hair, Moist palm (bc sweat alot)
- Wt LOSS/INCd appetite (David who never gains wt)
- INCd perspiration (bc running around everywhere)
- HypERreflexia (bc they’re hyper!)
- Exopthalmos (bulging eyeballs), Grave’s Dis

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23
Q

HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter

A

DECd T3/T4- HIGH TSH (bc signaled to INC TSH)- Feedback loop
- DEC HR, INC BP (bc sedentary)
- LOW BMR (everything slows)
- Cold intolerance (laying w/ comforter)
- DECd glucose absorb (more BG, bc not using it)
- Sleepy, Tired, Proximal mm weak (bc laying down on shoulder)
- Constipation (bc no digestion, not eating)
- Brittle nails, dry skin and hair (bc everything slows)
- Wt GAIN, DECd appetite (bc not active, not hungry)
- DECd perspiration (not active)
- Proloonged DTRs (delayed DTRs–just opp to hyperthyroid)
- Myxedema (puffy/swelled face, hands, feet), Hashimotos (AI disorder causing HypOthyroid)

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24
Q

Hyperthyroid assocd disease

A

Grave’s Disease

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25
Q

HypOthyroid assocd Disease

A

Hashimoto’s

26
Q

Practice!
Pt referred w/ dx of chronic periarthritis of shoulder. Pt feels tired all time, recent wt LOSS in spite of INCd appetite (think high BMR). What else assocd w/ this if thyroid lvls ELEVATED?

A

A: INCd DTR, INCd HR, LOW BP (bc not sedentary), Heat intolerance (bc running around everywhere)

27
Q

Parathyroid conditions…
What should you immediately think about?

A

Calcium

Phosphate

28
Q

Parathyroid Conditions:

HypERparathyroid
“Bones, Stones, Groans, Moans and Sensory”

A

ELEVATED Ca+ and DECd serum (blood) phosphate–> elevated Ca+ in blood which means Ca+ loss from bone
- Demineralizes bone= bone weakness and decd density

Sx’s (“Bones, Stones, Groans, Moans and Sensory”)
- Osteopenia, gout, arthralgia (bones)
- kidney stones, renal insuff (stones)
- peptic ulcers (groans)
- proximal mm weakness, fatigue, depression (moans)
- confusion, drowsy
- glove/stocking sensory loss (sensory)

29
Q

Parathyroid Conditions:

HypOparathyroidism
CATS are NUMB

A

LOW Ca+ and HIGH phosphorous in blood
Sx’s- CATS are NUMB
- Convulsions, Arrhythmias, Tetany/Twitching mm’s, Spasms/Cramps
- Parasthesias- fingertips and mouth (NUMB)
- Fatigue/weakness

30
Q

Parathyroid Conditions:

HypER vs HypOparathyroid
The HypER and HypO refer to what always?

A

Serum Ca+ lvls
aka HypER is always HIGH Ca+ (which is taken from the bone= bone demineralization)
HypO is always LOW Ca+

refers the Ca+ lvls!!! and then Phosphorous is just opp

31
Q

Practice!
Pt presents w/ hypERfunction of parathyroid (INC Ca+). S/S assocd?
Bones, Stones, Groans, Moans, Sensory

A

Osteopenia (bones) and peptic ulcers (groans)

32
Q

Diabetes
BG lvls that ==> DM?
Fasting BG > __
Random BG > __

A

Fasting BG >126 mg/dL
Random BG >200 mg/dL

33
Q

Diabetes
Type I

Think Juvenile onset

A

Pancreas produces NO insuline–> Insulin Dependent DM
- Dx’d mostly @ childhood–can be any age though
- S/S: polyphagia (inc hunger), Wt LOSS, Ketoacidosis, polyuria (inc urination), polydipsia (inc thirst), blurred vision and dehydration (peeing alot bc sugar)

NOTE: Ketoacidosis MOSTLY T1DM, fat cells break down

34
Q

Diabetes
Type II

Think insulin-RESISTANT

A

Body’s resistance to insulin==> Insulin Resistant DM (aka Tissues do not absorb insulin)
- Occurs SECONDARY to other dysf’s
- S/S: SIMILAR to Type I– although Ketoacidosis is RARE!

35
Q

HypOglycemia vs HypERglycemia

Talk about the Glucose lvls
HypO vs HypER

A

HypO=> Glu < 70
HypER=> Glu > 300

36
Q

HypOglycemia vs HypERglycemia

HypOglycemia
“HE is TIRED”
H- HA, E- Excess hunger, is T- Tachy, I- Irritable, R-, E, D-Dizzy
“Hangry”– think about YOU when you haven’t eaten (HE is TIRED)

Cold, Clammy Skin

A

Early s/s:
- Pallor, sweating
- shakiness
- Poor coord and unsteady gait
- Tachy + Palpitations
- Dizzy, fainting
- Excessive hunger

Late s/s:
- slurred speech, drowsy, confusion**
- Loss of consciousness & Coma** EMERGENCY!!!

37
Q

HypOglycemia vs HypERglycemia

HypERglycemia
“Hot and Dry Sugar High

Hot and Dry skin

A

BG > 300
Early s/s:
- Weakness
- DRY mouth
- Freq, scant urination (bc peeing out sugar)
- Deep and rapid respirations– Kussmaul
- Dull senses, confusion, diminished reflexes
- Excessive thirst (bc all that sugar)

Late s/s:
- Fruity odor (Acetone breath)=> DIABETIC KETOACIDOSIS!!! BIG INC GLUCOSE
- HypERglycemic coma**

38
Q

Fruity odor/breath
(Acetone breath)
Think…

A

Diabetic Ketoacidosis!!!
DMT1 mostly
EMERGENCY!!!

39
Q

Practice!
45yo OBESE male (BMI 33kg/m^2) w/ DMT2 is working out on TM in hospital. Pt suddently develops light-headed, dizzy (HE is TIRED) and instability (poor coord/gait). MOST approp?

A

STOP TM (DEFINITELY STOP!) and have hospital nurse check BG
*can also give juice if that’s in w/ rest of correct answer, but def stop!!!
HypO= BG <70mg/dL

40
Q

Exercise and DM
MAIN point

A

Exercise INCs insulin sensitivity–> BG will DROP (bc being used by mm’s)
Exercise does SAME JOB as insulin–> pulls things INTO cells
This is why TIMING of ex and insulin is important!!

41
Q

Exercise and DM
Exercise may result in _

A

HypOglycemia!
- AVOID ex. during peak insulin hrs (2-4hrs) Ex. If insulin @ 9a, NO ex. from 11a-1p**
- Insulin absorbed MUCH more quickly in active extremity. Always apply insulin inj’s in abdomen/NON-active extremity
- Insulin dosage should reduced after ex.–> bc exercise already drops BG–> or else post-ex hypOglycemia

42
Q

Exercise and DM
More main topics:

A
  • Do NOT ex. in extremem cold or hot temps–pt should be well hydrated
  • Exercise in MORNING recommended to avoid hypOglycemia resulting from fluctuations in insulin sensitivity
43
Q

Exercise and DM
Safe BG lvls and when NOT to Ex.
GOLD VALUES!!!

A

BELOW 70==> NO exercise
70-100==> Give them CHO snack and wait until 100, exercise
100-250==> Safe to exercise
250-300 w/out ketones==> Caution
250 w/ ketones==> NO exercise, EMERGENCY!
>300==> NO exercise, refer to phys.

Remember High ketones== Acetone/fruity breath

44
Q

Diabetic foot care?

A
  • White socks
  • No soaking feet w/ water
  • Safe shoe laces or velcrow
  • Nails cut
  • Alternate shoes
45
Q

Practice!
PT reviewing lab values of 58yo male. Appropriate GLU monitoring?

A

HypOglycemia is doc’d for Fasting BG value of 40 (remember hypO is < 70)
Glycosylated Hemoglobin (HBA1C) norm ref is 4-6%– HBA1C is avg BG over 3mos (Norm= 4-6%)
HBA1C > 10 == immediate insulin therapy

46
Q

FITT Principle for DM Pts

A

F: 3-7d/wk
I: 11-13 RPE (can go up to 17), remember start @ 13 then SHVEM; 13 down= reverse SHVEM
T: min of 150min/wk, progress to 300min/week
T: MOD intensity aerobic ex’s involving larger mm groups

47
Q

Endocrine Recap!

A
  • Bronze pigment skin– Mrs Addison’s
  • BP in met. syndrome?– 130/85
  • Grave’s Dis?– HypERthryoid
  • Diabetic Ketoacidosis?– HypERglycemia, DMT1
48
Q

Urinary Incont aka

A

Leaking of urine

49
Q

Urinary Incont
Types + Key Words to remember

A
  1. Stress–> exertion
  2. Urge–> urgency
  3. Overflow–> dribbles
  4. Functional–> mobility deficits (just cant make it there)
50
Q

Urinary Incontinence

Stress

think exertion

A
  • INvolunt leakage during cough, sneeze, EXERTION
  • post-partum, pelvic floor weakness
51
Q

Urinary Incontinence

Urge–> Urgency

think urgency, OVERactive detrusor

A
  • INvolunt contraction of detrusor w/ strong desire to void (urgency).
  • Infxs, PD, UMN lesions
52
Q

Urinary Incontinence

Overflow

think DRIBBLES, UNDERactive detrusor (so dribbles)

A
  • Acontractile or UNDERactive detrusor mm
  • Bladder OVERdistended, can not empty completely=> dribbles, or leaks out
  • ## BPH, DM**
53
Q

Urinary Incontinence

Functional

think mobility deficits, just cannot make it there

A
  • Incont due to mobility, dexterity, or COG defs
  • Dementia, LE weakness (cannot make it to bathroom)
54
Q

Practice!
After NORM delivery, woman comes to PT clinic w/ complaint of leaking involuntary during cough/sneeze w/ climbing stairs (exertion). Most likely Dx?

A

STRESS incont
- exertion, involuntary leaking
Remember!
- Overflow– Underactive detrusor (LMN), dribbles
- Functional= cog defs
- Urge= hyperactive bladder, overactive (UMN)

55
Q

Practice!
48yo female w/ c/o urinary incont. PT suspects overflow incont. What do you ask?

A

A: Do you dribble urine day or night? bc overflowing!

56
Q

Incontinence Tx Themes

Stress

A

Strengthen pelvic floor

57
Q

Incontinence Tx Themes

Urge

A

Treat infxs, Voiding schedule (aka treat the problem!)

58
Q

Incontinence Tx Themes

Functional

A

Clear clutter, improve accessibility, prompted voiding, LE strength
- Prompted voiding==> reminders, post-its, cueing

59
Q

Incontinence Tx Themes

Overflow (“Dribbles”)

A

Behavorial mods like double-voiding, meds, catheterization
- Double-voiding== voiding again after first

60
Q

Practice!
68yo comes to clinic w/ Alzheimer’s and cog defs. CC is urinary incont. Most approp intervention?

Remember functional think prompted voiding!

A

Scheduled toileting and prompted voiding!
- cues, reminders, etc

NPTE Final Frontier (19 decks)

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