Other Systems Flashcards
Metabolic Syndrome criteria
3 or more of:
1. Waist Circumference >40 (M) or >35 (F).
2. HDL <40 (M) or <50 (F).
3. Triglyceride >150.
4. SBP >130 and/or DBP >85.
5. Glucose >100.
The anterior & posterior Pituitary Glands are controlled by…
Hypothalamus
Anterior Pituitary secretes what hormones? (Just list them)
- ACTH
- TSH
- FSH & LH
- GH
- Prolactin
Posterior Pituitary secretes what hormones? (Just list them)
- ADH & Vasopressin
- Oxytocin
ACTH stimulates…
Adrenal cortex to secrete Cortisol & Aldosterone
TSH stimulates…
Thyroid to secrete T3 & T4
FSH & LH stimulate…
Ovaries/Testes to secrete Estrogen, Progesterone, Testosterone.
GH stimulates…
Bone/tissue growth & metabolism
Prolactin stimulates…
Breasts to produce milk
ADH & Vasopressin stimulate…
Kidneys to retain water & manage water/mineral balance.
Oxytocin stimulates…
Uterine contractions & breast milk ejection
Cortisol functions
Glucose production
Regulates BP
Decrease stress
Decrease inflammation
Aldosterone functions
Retains Na & water
Kicks out K
Addison’s Disease definition
Adrenal insufficiency (not enough cortisol & aldosterone).
Cushing’s Disease definition
Elevated cortisol & aldosterone.
Addison’s Disease is caused by…
Infections
Tumors
Autoimmune
Cushing’s Disease is caused by…
Pituitary tumor = increased ACTH production
Addison’s Disease symptoms
Decreased glucose
Decreased BP
Weight loss
Poor tolerance to cold & stress
Bronze skin tone
Generalized weakness
Cushing’s Disease symptoms
Increased glucose
Increased BP
Weight gain
Infections, poor wound healing
Red skin
Moon face
Proximal muscle weakness
Osteoporosis
How do adrenal conditions affect potassium levels?
Addisons = hyperkalemia
Cushings = hypokalemia
Difference between Cushing’s Syndrome & Cushing’s Disease
Syndrome = problem at the adrenal gland. Only cortisol is elevated.
Disease = problem at the pituitary gland. Both cortisol and ATCH elevated.
Symptoms are the same.
Examples of HYPER-Thyroid conditions
Grave’s
Exophthalmos
Examples of HYPO-thyroid conditions
Hashimoto’s
Myxedema
HYPER-Thyroidisim: hormone levels
High T3 & T4
Low TSH
HYPO-thyroidisim: hormone levels
Low T3 & T4
High TSH
HYPER-Thyroidisim: BMR
High
HYPO-thyroidisim: BMR
Low
HYPER-thyroidisim: HR & BP
HR high
BP low
HYPO-thyroidisim: HR & BP
HR low
BP high
HYPER-thyroidisim: glucose
Increased absorption
Lower blood glucose levels
HYPO-thyroidisim: glucose
Decreased absorption
Higher blood glucose levels
HYPER-thyroidisim: DTRs
Hyperreflexia
HYPO-thyroidisim: DTRs
Delayed/prolonged
HYPER-thyroidisim: symptoms
Diarrhea
Silky hair
Moist palms
Increased sweating
Restlessness, insomnia
Heat intolerance
HYPO-thyroidisim: symptoms
Constipation
Brittle, dry skin/hair
Decreased sweating
Proximal mm weakness
Cold intolerance
HYPER-thyroidism increases risk of…
Osteoporosis
Adhesive capsulitis
HYPO-thyroidism increases risk of…
Diabetes
Adhesive capsulitis
Parathyroid function
Calcium & phosphate metabolism
HYPER-Parathyroid Conditions: serum calcium & phosphate levels
Calcium high
Phosphate low
HYPO-Parathyroid Conditions: serum calcium & phosphate levels
Calcium low
Phosphate high
HYPER-Parathyroid Conditions: symptoms
Osteopenia, gout, arthralgia.
Kidney stones, renal insufficiency.
GI ulcers.
Fatigue, confusion.
Weakness.
HYPO-Parathyroid Conditions: symptoms
Convulsions.
Arrhythmias.
Mm twitching/tetany.
Mm spasms.
HYPER-Parathyroid Conditions: sensory changes
Glove & stocking loss
HYPO-Parathyroid Conditions: sensory changes
Fingers & mouth paresthesias.
Type 1 vs Type 2 Diabetes: definitions
Type 1: insulin dependent (pancreas does not PRODUCE insulin).
Type 2: insulin resistant (body does not RESPOND to insulin).
Common symptoms of diabetes (both Type 1 and 2)
3 P’s: Polyphagia (hunger), Polydipsia (thirst), Polyuria.
Weight loss.
Blurred vision.
Dehydration.
Ketoacidosis (rare with Type 2).
Diabetes diagnosis (lab values)
Fasting glucose >126
Random glucose >200
HbA1c elevated (normal = 4-6%).
When is immediate insulin therapy indicated?
HbA1c >10%
Hypoglycemia glucose level
<70
Hyperglycemia glucose level
> 300
Hypoglycemia sxs
Early: tachycardia, irritable, restless, excessive hunger, dizzy.
Late: slurred speech, confusion, loss of consciousness, coma.
Mnemonic = cold and clammy, give them a candy.
Hyperglycemia sxs
Early: more exaggerated 3 P’s, deep rapid breathing, diminished reflexes.
Late: fruity odor breath, coma.
Mnemonic = hot & dry means sugar high.
Exercise considerations w/ diabetes & insulin injections
-Avoid exercise during peak insulin hours (2-4hrs after dose).
-OK to exercise 1hr after dose or 5hrs after dose.
-Following exercise, next insulin dose should be decreased.
-Injections in abdomen or non-active extremity.
Safest pre-exercise glucose levels
100-250
Avoid exercise if pre-exercise glucose levels are…
<70 or >300
What to do if pre-exercise glucose level is 70-99
Give 15g carb snack, re-check glucose after 10-15mins.
Continue to give snacks every 20mins.
What to do if pre-exercise glucose level is 250-300
Exercise with caution, as long as not in ketoacidosis.
No exercise if ketoacidosis.
Diabetes FITT
F: 3-7 days/wk.
I: Moderate, RPE 11-13 (progress to 17).
T: >150min/wk (progress to 300min/wk).
T: Aerobic & large mm groups.
Diabetes foot care considerations
-Wash daily, but do NOT soak (bc risk of maceration).
-Soft sole shoes.
-Shoe shopping later in the day to ensure snug fit w/ swelling.
Stress Incontinence: definition, causes, & treatment
Definition: leakage when stress on pelvic floor (cough, sneeze, exertion).
Cause: weak pelvic mm, typically d/t pregnancy.
Treat: pelvic floor strengthening.
Urge Incontinence: definition, causes, & treatment
Definition: bladder contracts too much.
Cause: infections, PD, UMN lesion.
Treat: voiding schedule.
Overflow Incontinence: definition, causes, & treatment
Definition: underactive bladder (not contracting enough). Bladder fills too much & does not completely empty.
Cause: diabetes, prostate enlargement.
Treat: behavioral modificiation (e.g., double voiding).
Functional Incontinence: definition, causes, & treatment
Definition: unable to get to bathroom in time and/or can’t remember to go.
Cause: mobility, dexterity, or cognitive deficits.
Treat: clear clutter, improve access, prompted voiding (e.g., alarms).
MSK changes with pregnancy
Weight gain 25-35lb.
Forward head, kyphosis, lordosis, anterior pelvic tilt (continues postpartum w/ lifting/carrying baby).
COM shifts upward & anterior.
Relaxin.
Cardiopulmonary changes with pregnancy
Increased CO & blood volume.
Decreased BP in 1st & 2nd trimester.
Increased BP in 3rd trimester.
HRrest increases 10-20bpm.
Increased O2 consumption.
Positioning concerns w/ pregnancy
NO SUPINE after 1st trimester - risk of Supine Hypotensive Syndrome (compression of IVC = decreased CO).
LEFT sidelying ideal - maximizes CO, limits IVC compression, decreases GERD.
Gestational Diabetes definition
DM during pregnancy.
Same dx criteria as regular DM.
Resolves post-partum.
Preeclampsia definition
Acute HTN during pregnancy in 3rd trimester (BP>140/90).
EMERGENCY.
Eclampsia definition
Seizures after giving birth in patient with preeclampsia.
EMERGENCY.
Sxs of preeclampsia
Increased protein in urine.
Hyperreflexia.
Headaches.
Sudden weight gain.
Edema.
How is a preeclampsia diagnosis confirmed?
After first abnormal BP reading, must have a second reading 4hrs later.
Key difference between preeclampsia & eclampsia
Eclampsia ALWAYS characterized by seizures.
Preeclampsia MAY have seizures.
Pregnancy: contraindications to exercise
Medical History:
-Hemodynamically significant heart disease.
-Restrictive lung disease.
-Severe anemia.
-Uncontrolled Type 1 DM.
Pregnancy-Related:
-Incompetent cervix.
-Vaginal bleeding.
-Placenta previa.
-Preeclampsia.
-Premature labor (before 37wks).
Diastasis Rectus: how to measure
Do a curl-up (clear the scapula).
Palpate the gap.
(+) if >2cm.
Diastasis Rectus: treatment for 2-4cm
Stabilization & bracing.
Start w/ head lifts.
Progress to head lift + posterior pelvic tilts.
Diastasis Rectus: treatment for >4cm
Abdominal bracing & breathing exercises ONLY.
Diastasis Rectus: treatment for >6cm
Refer to MD
Diastasis Rectus: key consideration with exercise
NO VALSALVA
Always exhale during ab contractions.
GERD: definition
Gastric contents reflux up into esophagus.
Due to weak lower esophageal sphincter.
GERD: symptoms
-Heartburn (especially 30min after eating & when lying supine).
-Dysphagia.
-Sour taste.
-Hoarseness.
-Head/neck P!
GERD: how to differentiate from cardiac issue?
GERD pain relief with movement & exercise.
GERD pain worsened by lying down.
Cardiac symptoms would be opposite.
GERD: treatment
-Maintain upright as much as possible.
-Sleep on L side.
-Eat 3-4hrs before sleep.
-Exercise 2-3hrs after eating.
-Avoid: spicy, fatty, peppermint, chocolate.
Pancoast Tumor: definition & presentation
Upper lung tumor.
Mimics TOS: pain refers to C8-T2 distribution & top of ipsilateral shoulder.
Dyspnea.
Coughing.
Weight loss.
Night pain.
Kehr’s Sign
Procedure: supine, raise leg.
(+) = pain with elevating leg.
Indicates blood in abdomen, typically spleen rupture.
Hiatal Hernia: presentation
Diaphram weakness
L shoulder P!
Similar sxs to GERD
Hiatal Hernia: considerations post-surgical repair
NO VALSALVA.
Avoid abdominal strengthening for 6-8wks.
Femoral Hernia: pain location
Lateral pelvic wall
Groin
Inguinal Hernia: pain location
Groin
Umbilical Hernia: pain location
Mid-low abdomen
Cholecystitis (gall stones) symptoms & test
Pain: RUQ & R scapula.
Agg: fatty foods.
Nausea, vomiting, fever.
Murphy’s Sign: palpate subcostal angle while pt takes deep breath. (+) = pain/tenderness during inspiration.
Peptic Ulcers (gastric & duodenal) symptoms
R shoulder P!
Burning/cramping in epigastric region.
Coffee ground emesis.
Dark tarry stool.
Gastric Peptic Ulcers: causes
-Chronic NSAID use.
-Stress/anxiety.
-H. Pylori.
Aggs of Gastric vs. Duodenal Peptic Ulcers
Gastric: presence of food (after eating).
Duodenal: absence of food (in the morning, btwn meals).
Duodenal Peptic Ulcers: causes
H. Pylori
Treatment of Peptic Ulcers
Gastric: antacids
Duodenal: medical treatment of H. Pylori infection
UC vs. Crohn’s: inflammation characteristics
UC: large intestine & rectum, continuous.
Crohn’s: anywhere in GI tract, discontinuous.
UC vs. Crohn’s: pain location
UC: LLQ
Crohn’s: RLQ
UC symptoms
-Bloody diarrhea
-Mucous/pus
-LBP
-Weight loss
-Fecal urgency
Crohn’s symptoms
-Abdominal pain
-Weight loss
-Reactive arthritis
-Passing gas = pain relief
Reactive Arthritis involves…
-Conjunctivitis
-Urethritis
-OA of LEs
Mnemonic: can’t see, can’t pee, can’t climb a tree
IBS: definition, causes, & presentation
Definition: spastic, nervous, irritable colon.
Causes: stress/anxiety, high fat, lactose.
Pain: LLQ.
Ribbon-like stool.
Relief w/ defecation.
Appendicitis presentation
RLQ pain
Nausea, fever
Elevated WBC
Tests for Appendicitis
All (+) if pain in RLQ.
-McBurney’s Point: pain when palpating RLQ.
-Rosving’s Sign: pain in RLQ when palpating LLQ.
-Blumberg’s Sign: pain when pressure released.
-Psoas Sign: resisted R hip flex or passive ext.
-Obturator Sign: resisted R hip ER or passive IR.
-Hop Sign: hop on R leg.
-Markle’s Sign: stand on toes & drop suddenly.
-Pinch an Inch: pinch skin & release.
Pinch an Inch Test
Pinch skin & release.
For appendicitis: RLQ.
For diverticulitis: LLQ.
(+) = pain.
Signs of liver or pancreas issue
Dark colored urine
Clay colored stool
