Other Systems 1 Flashcards
Practice!
Pts medical chart shows BP 168/90, triglycerides lvl 160, FBG lvl 115. BMI= 40 and waistline 54in. ALL findings suggestive of?
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!
Metabolic Syndrome think….
ALL of the LEAD causes of death/disease in US!!!
Metabolic Syndrome
This is SPECIFIC list of things assocd w/ Metabolic Syndrome
S/S risk factors for/strongly linked to T2DM, CV Dis, Stroke
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
Glands of Endocrine System
See pic and correlate w/ your chart!
see chart
Leader: Hypothalamus
- Anterior Pituitary
- Posterior Pituitary
How many hormones total and where?
8 hormones
Ant Pit== 6
- ACTH, TSH, FSH/LH, GH, Prolactin
Post Pit== 2
- ADH/Vasopressin, Oxytocin
Hormone Chart: Leader= Hypothalamus
Anterior Pituitary
(6):
Hormone–> Gland–> Produces
- ACTH (adrenocorticotrophic)–> Adrenal cortex–> Cortisol, Aldosterone
- TSH (thyroid stim)–> Thyroid–> T3 & T4
3/4. FSH (follicle) & LH (lutenizing)–> Ovaries/Tests–> Estrogen, Progesterone, Testosterone (think Gonads) - GH–> Bones & Tissues–> Growth, metabolism
- Prolactin–> Milk production in breasts
Hormone Chart: Leader=Hypothalamus
Posterior Pituitary
(2):
Hormone–> Gland–> Produces
- ADH (Anti-Diuretic)/Vasopressin–> Regulates water and mineral balance, water retention
- Oxytocin–> Stimulates uterine contractions during birth
Glands of Endocrine System
Hypothalamus (Leader)
Regulates ANS
- body temp, appetite, sweating, thirst, sex behaviors, rage, fear, BP, sleep
Glands of Endocrine System
Pituitary: Ant (6) vs Post (2)
Secretes endorphins and reduces sensitivity to pain.
Controls ovulation and works as catalyst for testes/ovaries to create sex hormones
Glands of Endocrine System
Thyroid
Hormones act to control rate @ which cells burn fuel from food
Glands of Endocrine System
Parathyroid (think Ca and phosphate)
Regulates Ca+ and Phosphate metabolism
Glands of Endocrine System
Adrenal
IMPORTANT!!!
NORMAL DEFINITION:
- produces corticosteroids that will regulate **water and sodium balance, body’s response to STRESS, immune system, metabolism
Think Cortisol and Aldosterone
Glands of Endocrine System
Adrenal
IMPORTANT!!!
Cortisol vs Aldosterone
Cortisol
- Stress
- Regulates BP
- Glucose regulation**
- Anti-inflamm
Aldosterone
- H20/mineral balance
- RETAINS H20 + Sodium**
- REMOVEs K+ from body
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?
Cushings Disease (DISEASE== problem in Pituitary)
- Moon face, buffalo hump== INC cortisol, “Cushings like Cushion (round)”
Other answers:
- Addisons Dis
- Hashimoto’s Dis
- HypOthyroidism
- 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+
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”
Addisons== Adrenal INsuff
Cushing’s== Adrenal OVERsecretion
Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone
Mrs. Addison’s Disease
“Old brown lady walking with a stick”
Adrenal INsuff
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)
Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone
Mr. Cushing’s Disease
“Chubby white boy who loves to drink beer”
ELEVATED cortisol & aldosterone
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)
Cushings Disease vs Cushings Syndrome
In a nutshell…
- Disease think problem in Pituitary
- Syndrome think problem in Adrenal glands
Cushing’s Disease vs Syndrome
Sx’s common for BOTH
Explain…
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
Thyroid Conditions
see charts
HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”
HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter
Thyroid Conditions
HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”
Think metabolic processes INCREASE
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
HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter
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)
Hyperthyroid assocd disease
Grave’s Disease
HypOthyroid assocd Disease
Hashimoto’s
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: INCd DTR, INCd HR, LOW BP (bc not sedentary), Heat intolerance (bc running around everywhere)
Parathyroid conditions…
What should you immediately think about?
Calcium
Phosphate
Parathyroid Conditions:
HypERparathyroid
“Bones, Stones, Groans, Moans and Sensory”
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)
Parathyroid Conditions:
HypOparathyroidism
CATS are NUMB
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
Parathyroid Conditions:
HypER vs HypOparathyroid
The HypER and HypO refer to what always?
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
Practice!
Pt presents w/ hypERfunction of parathyroid (INC Ca+). S/S assocd?
Bones, Stones, Groans, Moans, Sensory
Osteopenia (bones) and peptic ulcers (groans)
Diabetes
BG lvls that ==> DM?
Fasting BG > __
Random BG > __
Fasting BG >126 mg/dL
Random BG >200 mg/dL
Diabetes
Type I
Think Juvenile onset
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
Diabetes
Type II
Think insulin-RESISTANT
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!
HypOglycemia vs HypERglycemia
Talk about the Glucose lvls
HypO vs HypER
HypO=> Glu < 70
HypER=> Glu > 300
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
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!!!
HypOglycemia vs HypERglycemia
HypERglycemia
“Hot and Dry Sugar High
Hot and Dry skin
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**
Fruity odor/breath
(Acetone breath)
Think…
Diabetic Ketoacidosis!!!
DMT1 mostly
EMERGENCY!!!
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?
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
Exercise and DM
MAIN point
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!!
Exercise and DM
Exercise may result in _
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
Exercise and DM
More main topics:
- 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
Exercise and DM
Safe BG lvls and when NOT to Ex.
GOLD VALUES!!!
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
Diabetic foot care?
- White socks
- No soaking feet w/ water
- Safe shoe laces or velcrow
- Nails cut
- Alternate shoes
Practice!
PT reviewing lab values of 58yo male. Appropriate GLU monitoring?
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
FITT Principle for DM Pts
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
Endocrine Recap!
- Bronze pigment skin– Mrs Addison’s
- BP in met. syndrome?– 130/85
- Grave’s Dis?– HypERthryoid
- Diabetic Ketoacidosis?– HypERglycemia, DMT1
Urinary Incont aka
Leaking of urine
Urinary Incont
Types + Key Words to remember
- Stress–> exertion
- Urge–> urgency
- Overflow–> dribbles
- Functional–> mobility deficits (just cant make it there)
Urinary Incontinence
Stress
think exertion
- INvolunt leakage during cough, sneeze, EXERTION
- post-partum, pelvic floor weakness
Urinary Incontinence
Urge–> Urgency
think urgency, OVERactive detrusor
- INvolunt contraction of detrusor w/ strong desire to void (urgency).
- Infxs, PD, UMN lesions
Urinary Incontinence
Overflow
think DRIBBLES, UNDERactive detrusor (so dribbles)
- Acontractile or UNDERactive detrusor mm
- Bladder OVERdistended, can not empty completely=> dribbles, or leaks out
- ## BPH, DM**
Urinary Incontinence
Functional
think mobility deficits, just cannot make it there
- Incont due to mobility, dexterity, or COG defs
- Dementia, LE weakness (cannot make it to bathroom)
Practice!
After NORM delivery, woman comes to PT clinic w/ complaint of leaking involuntary during cough/sneeze w/ climbing stairs (exertion). Most likely Dx?
STRESS incont
- exertion, involuntary leaking
Remember!
- Overflow– Underactive detrusor (LMN), dribbles
- Functional= cog defs
- Urge= hyperactive bladder, overactive (UMN)
Practice!
48yo female w/ c/o urinary incont. PT suspects overflow incont. What do you ask?
A: Do you dribble urine day or night? bc overflowing!
Incontinence Tx Themes
Stress
Strengthen pelvic floor
Incontinence Tx Themes
Urge
Treat infxs, Voiding schedule (aka treat the problem!)
Incontinence Tx Themes
Functional
Clear clutter, improve accessibility, prompted voiding, LE strength
- Prompted voiding==> reminders, post-its, cueing
Incontinence Tx Themes
Overflow (“Dribbles”)
Behavorial mods like double-voiding, meds, catheterization
- Double-voiding== voiding again after first
Practice!
68yo comes to clinic w/ Alzheimer’s and cog defs. CC is urinary incont. Most approp intervention?
Remember functional think prompted voiding!
Scheduled toileting and prompted voiding!
- cues, reminders, etc
