Test 3 Reproductive, Pulmonary, Endocrine Flashcards

Question

J-Receptors

Answer 1

Juxtapulonary Capillary Receptors Located in the alveolar capillaries Sense increased pulmonary capillary pressure due to acidosis Initiates rapid deep breathing to reduce CO2 and cause alkalosis with lowers pulmonary pressure

Answer 2

* Life-threatening thyrotoxicosis that occurs when excessive amounts of thyroid hormones are acutely released into circulation * Clinical manifestations * Elevated temperatures, tachycardia, arrhythmias, congestive heart failure * Extreme restlessness, agitation, and psychosis * Precipitating event: stress, gland manipulation

Answer 3

Lift threatening condition Rapid cellulitis of epiglottis and surrounding soft tissue Air blockage into the trachea Children ages 2-4

Answer 4

* Regulates calcium absorption and resorption from bone * Serum calcium levels provide the feedback to regulate parathyroid hormone (PTH) secretion. * **Decrease in calcium causes PTH release.** * **Elevated calcium levels lead to suppression of PTH secretion.**

Answer 5

Cytomegalovirus (CMV) Trans primarily saliva Viral - no abx Incubation is 4-6 weeks

Answer 6

Located on top of each kidney * Has inner medulla and outer cortex * Hypothalamus regulates function

Answer 7

* Obstruction from conditions in the wall of the lumen (Asthma/Bronchitis) * Obstruction resulting from increasing pressure around the outside of the airway lumen (Emphysema) * Obstruction of the airway lumen

Answer 8

* DM: endocrine disorder diagnosed by the presence of chronic hyperglycemia * Diagnosis: if any two of the following conditions occurs * Random sampling of blood glucose above 200 mg/dL with classic signs and symptoms * Fasting blood glucose level of greater than 126 mg/dL * Blood glucose concentration greater than 200 mg/dL 2 hours after a 75-g oral glucose load * **HgbA1c : 6.5% or higher (normal \<5.7%)**

Answer 9

Venous stasis/sluggish blood flow Hypercoagulability Damage to the venous wall

Answer 10

* Produced by corticotropes in the anterior pituitary in response to hypothalamic corticotropin-releasing hormone (CRH) * Binds to G protein-coupled receptors on cells in the adrenal cortex and stimulates the production of **_cortisol and adrenal androgens_**

Answer 11

* Result from decreased lung expansion * Alterations in lung parenchyma, pleura, chest wall, or neuromuscular function * Represent acute or chronic patterns of lung dysfunctions (not a single disease) * ALS, Guillaine-Barre Syndrome * Fibrotic Interstitial Lung Disease * Pulmonary Fibrosis, Sarcoidosis

Answer 12

Controls growth and metabolism. Hypothalamus releases thyrotropin-releasing hormone (TRH) which stimulates anterior pituitary to release thyroid-stimulating hormone (TSH) which stimulates the thyroid to release T3 and T4 Only 10% of T3 is produced in the thyroid - T4 converts to T3 in body tissues Iodine needed to synthesize the T3 and T4 Thyroid hormones are bound to thyroglobulin (protein) until they are released

Answer 13

Increased eosinophil count, elevated sedimentation rate (ESR), liver enzymes, angiotensin-converting enzyme in active disease Transbronchial lung biopsy shows Noncaseating granulomas (definitive diagnosis) Stages 0 to 4 Progressing from normal to advanced fibrosis with evidence of honeycombing, hilar retraction, bullae, cysts, and emphysema

Answer 14

Steroid (lipid) hormones diffuse easily through the lipid bilayer of the cell membrane; cell membrane carriers transport thyroid hormones Thyroid and steroid receptors located in the cytoplasm or in the nucleus of the target cell Once inside the cell lipid hormones have to go through gene expression to have the effect amplified. Lipid acts slower than water-soluble bc of the multiple steps and gene expression that has to take place before amplification can take place.

Answer 15

_•Posterior_ ADH (vasopressin) Oxytocin

Answer 16

* Glycosylated hemoglobin (HbgA1c) to determine long-term glycemic control and to evaluate therapeutic goals * Glucose freely attaches to RBCs. * Not useful for day-to-day management, reflects glucose average over the past 100 to 120 days * Values of less than 7% without adverse effect are considered desirable. * Capillary glucose testing (\<120 mg/dL) * For day-to-day management * Testing for ketones through urine testing * If glucose \>300; pregnant; ill; suspect ketoacidosis

Answer 17

Breakdown of glucose for energy

Answer 18

* Blood from right ventricle goes to pulmonary arteries (unoxygenated) and then to pulmonary arterioles to the capillary membrane for gas exchange. * Pulmonary venous blood – oxygenated – flows back into the left atrium

Answer 19

A - no symptoms or hospitalizations B - mod symptoms no hospitalizations C - have been hospitalizations

Answer 20

* Paresthesias of the distal extremities, muscle cramps, spasms, fatigue, hyperirritability, anxiety, depression, prolonged Q-T intervals, increases in intracranial pressure * Severe symptoms: carpopedal spasm, laryngospasm, and seizures * **Tetany: Chvostek or Trousseau sign** * Manifestations result from low serum calcium levels; increased neuromuscular excitability.

Answer 21

Airways become inflamed and narrowed from capillary dilation Swelling from fluid exudation Infiltration with inflammatory cells Increased mucus production Loss of ciliary function

Answer 22

Common physical findings * Thin, wasted individual hunched forward * Using accessory muscles * Decreased breath sounds, lack of crackles and rhonchi * Prolonged expiration * Decreased heart sounds * Hyperresonance - loud b/c of trapped air * Decreased diaphragmatic excursion * Chronic morning cough

Answer 23

Persistent cough that changes Dyspnea Hemoptysis Hoarseness Frequent URIs

Answer 24

* Most common: autoantibodies bind and stimulate TSH receptors leading to diffuse toxic goiter (Graves disease) * Thyromegaly * Exophthalmos (immune mediated so may not resolve with treatment) * Widening of the palpebral fissure resulting in exposed sclera * Lid lag, vision changes, photophobia

Answer 25

Galactorrhea Amenorrhea Headache

Answer 26

Somoatotropes secrete GH Gonadotropes secrete LH/FSH Thyrotropes secrete ACTH Lactropes secrete prolactin (PRL)

Answer 27

The pituitary gland is located at the base of the brain and controls hormones. Anterior and Posterior pituitary gland Posterior gland is connected to the hypothalamus by the pituitary stalk When the hypothalamus wants to communicate with the Anterior pituitary it has to put hormones out into the system for pituitary gland to receive b/c there is not a direct connection Functions as a intermediary between the hypothalamus and the target organs

Answer 28

* Goals * Achieving metabolic control of blood glucose levels * Preprandial blood glucose level between 70 and 130 mg/dL * Postprandial blood glucose level less than 180 mg/dL for adults (\<160 2 hrs post prandial) * Preventing acute and chronic complications * Accomplished by diet, exercise, medication, and such hygiene practices as daily foot care and smoking cessation

Answer 29

CURB-65 Scores * Confusion * BUN\>20 * Respiratory Rate \>30 * BP:SBP \<90mmHg or DBP \<60mmHg * Age\>65 Total Points 0-2 outpatient (2 may have short-stay inpatient) 3 Inpatient 4 most likely ICU 5 Inpatient ICU

Answer 30

Fibrotic interstitial lung disease Interstitial lung disease Group of disorders (more than 180 disease entities) Characterized by acute, subacute, or chronic infiltration of alveolar walls by cells, fluid, and connective tissue If left untreated, may progress to irreversible fibrosis Characterized by thickening of alveolar interstitium

Answer 31

Classifications * Centriacinar (centrilobular) * Associated with smoking and chronic bronchitis * Destroys respiratory **bronchioles** * Panacinar (panlobular) * Destroys the **alveoli** * Paraseptal * Affects the peripheral lobules

Answer 32

Generally milder Isloated primarily to humans

Answer 33

Measurement of pulmonary artery pressure during exercise Stress testing ECHO Big R wave or Inverted T wave

Answer 34

How much air can be expelled in 1 sec \>80% Normal \<70% is obstructive \>70% is normal or restrictive

Answer 35

Etiology and pathogenesis •Thyroid hyperfunction with increased secretion of T4 and T3 (Graves disease) Thyroid follicular cell destruction with release of preformed T4 and T3 (Hashimoto thyroiditis)

Answer 36

Rise in AM glucose as a rebound effect of hypoglycemia

Answer 37

Dependant lung fields

Answer 38

Throat is NOT red Hoarseness Weak voice Aphonia

Answer 39

Etiology and pathogenesis * Uncontrolled GH production by a benign tumor of the pituitary (adenoma) * Stimulates liver to produce IGF-1 * Cause up-regulated growth of soft and bony tissues

Answer 40

Carried in circulation by transport proteins (globulin) poorly soluble Activate intracellular receptors Thyroid hormones (T3, T4) with iodine attached Steroids - derived from cholesterol Hormone detaches at the site of the target cell

Answer 41

Intrinsic - Nonatopic Common in children and adolescents * Bronchospasm often occurs within 10-15 minutes after the end of exercise; usually resolves in 60 minutes. * Heat loss, water loss, and increased osmolarity of the lower respiratory mucosa stimulate mediator release from basophils and tissue mast cells causing smooth muscle contraction.

Answer 42

High fever Drooling Stridor

Answer 43

* Immunohistopathologic features * Edema **_•Mast cell activation starting reaction_** * Inflammatory cell infiltration by neutrophils, eosinophils, and lymphocytes * Inflammation of the airway * Acute bronchospasm (bronchoconstriction) * **_Normal respiratory epithelium replaced by goblet cells,_** resulting in mucosal edema, mucus plug formation - like a callus in respiratory system * Airway wall remodeling: thickening of basement membrane

Answer 44

* Enhance protein synthesis and prevent muscle breakdown * Inhibit gluconeogenesis * Enhance fat deposition by preventing fat breakdown (lipolysis) and inducing lipid formation * Stimulate growth by enhancing secretion of IGF-1 (somatomedin)

Answer 45

amount of gas left in the lungs after expiration – 1.2 L can't breathe everything out

Answer 46

Emergency Abscess of one tonsil can displace uvula Caused by staph or strep Clinical manifestations: drooling, dysphasia

Answer 47

•Parasympathetic stimulation (mediated by acetylcholine) via the vagus nerve leads to constriction of muscle.

Answer 48

* Continued insulin deficiency leads to lipolysis of body tissues—metabolism of fats leads to free fatty acids (FFA). * FFAs are transformed into ketones, leading to ketoacidosis.

Answer 49

* Pulmonary function tests * Forced expiratory volumes decrease * Peak expiratory flow rate (PEFR) determines index of airway function ratio of FEV1/FVC before and after administration of short-acting bronchodilator * Skin testing * Young patients with extrinsic asthma * Elevated WBCs and eosinophils

Answer 50

\>70% = Mild 60-69% = Moderate 50-59% = Moderate severe 35-49% = Severe \<35% = Very severe

Answer 51

Produced by corticotropes in the anterior pituitary in response to hypothalamic corticotropin-releasing hormone (CRH) Binds to receptors on cells in the adrenal cortex and stimulates the production of **cortisol and adrenal androgens** CRH and ACTH have a _significant diurnal pattern_, with a peak on wakening in the morning and a valley in the evening.

Answer 52

by the hypothalamus

Answer 53

Glucose is stimulus for insulin release from vesicles. Insulin then binds to its receptor on insulin-sensitive cells (not all cells do this) and it triggers glucose uptake Insulin needs access to insulin receptor cells to allow it to function

Answer 54

Pathogenesis * May be idiopathic or related to tumors, radiation, or trauma * Resection of pituitary tumors or head injuries

Answer 55

Airway **_obstruction_** that is reversible Airway inflammation Leukotriene reaction of bronchoconstriction Increase in bronchial responsiveness to a variety of stimuli

Answer 56

Steroid (Lipid) Hormones are formed on-demand from cholesterol that is stored in the cell or retrieved from the circulating lipoproteins.

Answer 57

* Located in the medullary center * Responds to changes in CO2 and pH * Normal stimulus to breathe is small increase in arterial carbon dioxide tension. * Alveolar ventilation can increase tenfold with acute rise in PaCO2.

Answer 58

Type B COPD "blue bloater" Overweight Dyspnea on exertion Excess sputum Chronic cough - WORSE IN AM Cyanosis - late sign

Answer 59

HYPOSECRETION * Too little secretion of hormone * Primary hyposecretion occurs when an endocrine gland releases an inadequate amount of hormone to meet physiologic needs. * Secondary hyposecretion occurs when secretion of a tropic hormone is inadequate to cause the target gland to secrete adequate amounts of hormone.

Answer 60

Means the anterior pituitary is telling the adrenals to put out a high level of cortisol level and they do this by stimulating it with a High level of ACTH

Answer 61

•Benign pituitary adenomas as most common cause * Manifestations * usually headache and visual field loss * Hormonal manifestations * Diagnosis * History and physical exam with **_vision testing_** * MRI of the brain , CT of the brain, hormone levels

Answer 62

IN PATIENTS WITH FEV1/FVC RATIO \< 0.70 - This is the guide BASE ON PREDICTED LEVEL GOLD 1 MILD - \>80% GOLD 2 MOD - FEV1 is between 50% and 79% predicted GOLD 3 SEVERE - FEV1 is between 30% and 49% predicted GOLD 4 VERY SEVERE - FEV1 \<30% predicted

Answer 63

Movement of air in and out of the lungs

Answer 64

low level of hormone then we need more of it so the body increases the # of receptors to it Ex: Oxytocin (labor and delivery)

Answer 65

Etiology and pathogenesis * Excessive ADH from ectopic production from tumors, notably primary lung malignancies * Excess ADH stimulates renal tubules to reabsorb water despite decreased blood osmolality. * Adrenal insufficiency and hypothyroidism can cause increased ADH secretion and hyponatremia.

Answer 66

Etiology and pathogenesis Insufficient ADH activity; excessive loss of water in urine Damage to hypothalamus ADH-producing cells Brain injury, tumors, or procedures Some pharmacologic agents Means large diuresis of inappropriately dilute urine Central: involves hypothalamus or pituitary gland Nephrogenic: involves kidneys

Answer 67

Restlessness Pain on inspiration Tachycardia Hemoptysis Anxiety

Answer 68

CAT score-Impact level \< 10 Low 10 – 20Medium 21 – 30 High \> 30 Very high

Answer 69

* Idiopathic, genetic, parathyroid adenoma, hyperplasia of parathyroid glands, chronic renal failure (reduced vitamin D) * Bone resorption and formation rates are increased. * Malignant cells can release PTH-like hormones; are a more frequent cause of hypercalcemic crisis. * Despite an elevated calcium level, PTH continues to be secreted. * During pregnancy it can lead to perinatal and neonatal complications. * **Newborn’s PTH production will be suppressed by maternal hypercalcemia, leading to neonatal hypocalcemia and tetany.** * **Some drugs such as lithium and thiazides can increase calcium levels.**

Answer 70

Central: involves hypothalamus or pituitary gland Nephrogenic: involves kidneys

Answer 71

Decreased secretion of ACTH Pituitary is not telling the adrenals what to do and the adrenal does not know what to do Secondary - lose weight anorexic pigmented skin

Answer 72

CT of chest with contrast to light up vessels Pulse OX

Answer 73

* Most common form of DM * Non-Caucasian and elderly disproportionately affected * **Insulin resistance and β cell dysfunction** lead to a relative lack of insulin. * Suspect decreased number of insulin receptors or abnormal translocation of glucose transporters * As disease progresses, insulin production may be impaired.

Answer 74

Growth hormone * Insulin-like growth factor-1 (IGF-1) also called Somatomedin is stimulated by hypoglycemia, starvation, and exercise to stimulate GH secretion * Affected by estrogen, testosterone, thyroid hormone

Answer 75

Gravity affects lung: * Upright position – blood flow is decreased in the apices and increased in the bases. * Supine position - blood flow is decreased anteriorly and increased posteriorly perfusion

Answer 76

Sudden onset Significant fatigue Significant myalgia (muscle pain) Headache Fever \>100 Chest congestion and non-productive cough Clear nasal secretions

Answer 77

Excess circulating glucose is converted into glycogen and stored in the liver and muscle cells

Answer 78

Decrease in tissue oxygenation

Answer 79

* •Wheezing - Dyspnea * •Feeling of tightness of chest * •Cough (dry or productive) * •Increased sputum * •Decreased breath sounds * **_•Prolonged expiration_** * •Use of accessory muscles of respiration * •Intercostal retractions * •Distant breath sounds with inspiratory or expiratory wheezing * •Orthopnea, tachypnea * •Tachycardia

Answer 80

Bronchial epithelial cell origin Smoking (85%) Asbestosis Radon gas Pollutant Bronchoalveolar (5%) in peripherals metastasize from lymphatics - no correlation to smoking

Answer 81

Chronic inflammation and swelling of the LARGE bronchial airway mucosa causing bronchial wall thickness and scarring Goblet cell hypertrophy of bronchial mucous r/i increased prod of mucus w/formation of mucus plugs Increased bronchial wall thickness - increases work of breathing and O2 demands **Ventilation-perfusion mismatch w/hypoxemia and hypercarbia increases pulmonary artery resistance** **Pulmonary hypertension leads to R sided heart failure**

Answer 82

You have a decreased glucagon secretion (Glucagon comes from the pancreas to raise our sugar. Insulin comes from the pancreas to lower our sugar. So when our body is having an issue with to high of sugar it is because the pancreas puts out too much glucagon)

Answer 83

Kussmaul respirations and they occur in diabetic ketoacidosis

Answer 84

Cigarette smoking (90%) Repeated airway infections Genetic predisposition Inhalation of physical or chemical irritants

Answer 85

•Clinical manifestations * Pancreatic insufficiency, cirrhosis of the liver, diabetes mellitus, gallstones, nasal polyps, and failure of development of the vas deferens in males * Nutritional assessment * Depleted fat stores * Steatorrhea (fatty stools) * Anorexia * Decreased growth rate in children (wt, ht, head circ)

Answer 86

Flu Viruses RSV Adenovirus

Answer 87

Viral infection of the upper and lower respiratory tract Common Oct - March

Answer 88

•Hypertriglyceridemia, obesity, smoking, and hypertension enhance development of neuropathy.

Answer 89

Clinical manifestations in adults * Decreased basal metabolic rate * Weakness, lethargy, cold intolerance, decreased appetite * Bradycardia, narrowed pulse pressure, and mild/moderate weight gain * Elevated serum cholesterol and triglycerides * Enlarged thyroid, dry skin, constipation * Depression, difficulties with concentration/memory * Menstrual irregularity - amenorrhea * **Myxedema - generalized facial puffiness**

Answer 90

*_Microvascular:_* retinopathy and nephropathy from abnormal thickening of the basement membrane in capillaries; may lead to blindness and renal failure * Hyperglycemia disrupts platelet function and growth of the basement membrane. * Thickening of basement membrane may improve with glycemic control. * Urine protein loss occurs in nephropathy. * Preventive: control blood glucose and hypertension

Answer 91

1 POINT 68 YO 1 POINT HYPOTENSIVE 1 POINT BUN ELEVATED CUT OFF FOR RESPIRATORY IS 30 TO GET A POINT

Answer 92

Oat cell (Extremely aggressive) Central bronchial region Doubles every 30 days Poor prognosis usually found incidentally

Answer 93

* Hypertension (persistent or intermittent) * **Headache, tachycardia, diaphoresis (classic triad)** * Tremor, nervousness, emotional lability, pallor, fatigue, orthostatic hypotension * Hypermetabolic state with fever, weight loss **Diagnosis** * Abdominal CT/MRI * 24 hour urine for catecholamines

Answer 94

Producing and storing glycogen from the breakdown of excess glucose

Answer 95

7 years old

Answer 96

* **_Decrease_** in vital capacity (VC), total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV) * The greater the decrease in lung volume, the greater the severity of disease.

Answer 97

Hypothalamus secretes releasing and inhibiting hormones and it regulates what the pituitary gland does. It connects the nervous and endocrine systems

Answer 98

Chronic complications * Heart and blood vessel disease * Foot disease * Avoiding foot problems can be challenging from the frequent presence of orthopedic deformity and other common aging-related changes, as well as the decreased ability to perform appropriate foot care. * Eye disease * Kidney disease

Answer 99

Movement of air into the lungs and distributing air to the alveoli for maintenance of oxygenation and removal of carbon dioxide

Answer 100

* Develops in middle age with less favorable prognosis * No history of allergies **_•High eosinophil reaction –not allergic_** * Repeated respiratory infections * Aspirin exacerbated asthma reaction * Occupational exposure * Exercise induced

Answer 101

Diagnosis: High IGF-1 and an elevated GH level that is not suppressed by administration of oral glucose

Answer 102

•Diagnosis * TSH levels are low * Elevated serum T4 and T3 (confirm) * 24-hour radioactive iodine uptake study can confirm diagnosis of Graves disease and exclude presence of thyroid neoplasms.

Answer 103

Stretch receptors in the alveolar septa, bronchi, and bronchioles keep you from taking too deep of a breath that cold rupture your lung

Answer 104

HTN progresses rapidly (women\>men) Long term prognosis poor as med trmt is ineffective

Answer 105

* Tuberculin skin test – Mantoux test (PPD) * Local reaction typical to a small amount of bacilli 5mm _compromised immunity_ 10mm _at risk_ 15mm _no risk factors_ based on risk * Not used in prior BCG immunization or prior + test * Interferon gamma release assays (Interferon Gold)

Answer 106

Acute or chronic systemic disease of unknown cause Immunologic basis First degree relative increases risk 5 fold Development of multiple noncaseating epithelioid granulomas Abnormal T-cell fx

Answer 107

Breakdown of glucose for energy

Answer 108

Distinct hallmark is recent onset of acute cough Usually mild and self limiting (7-10 days) Cough (productive or nonproductive) Wheezing Low-grade fever Sore throat Postnasal drip Fatigue

Answer 109

Complications * Infant: metabolic abnormalities, stillbirth, macrosomia, and neonatal hypoglycemia * Mother: development of type 2 diabetes mellitus or impairment in glucose tolerance later in life * All pregnant women older than 25 years should be screened during the 24th to 28th weeks.

Answer 110

Stems from a known disease Mitral stenosis Mitral regurgitation LV heart failure Chronic lung diseases Vasculitis

Answer 111

Congenital adrenal hyperplasia: rare cause in pediatric populations, because of specific enzymatic defects in the biosynthesis of cortisol by the adrenals Causes severe and life-threatening symptoms Overproduction of ACTH leads to hyperplasia of the adrenal glands and excessive androgen secretion.

Answer 112

Cannot get air in

Answer 113

Breathing first - alveolar ventilation Perfusion is the second process of respiration Diffusion is third

Answer 114

Causes: Primary Pituitary Secondary Hypothalamus General Manifestations: * GH deficiency * FSH/LH deficiency * TSH deficiency * ACTH deficiency * ADH deficiency

Answer 115

Pathogenesis * Recurrent infection of bronchial walls leads to persistent dilation. * Bronchial wall thickening * Inflammation results in the destruction of walls. * Destructive process leads to loss of ciliated epithelium. * Transforms to squamous cell and pus formation * Leads to bronchial obstruction

Answer 116

Hyperthyroidism

Answer 117

Rise in glucose in early morning hours from growth hormone, cortisol, glucagon, and epinephrine release

Answer 118

Atelectasis Pneumonia ARDS example: 3L/5L = 0.6VQ

Answer 119

Diagnosis * Decreased plasma cortisol levels * ACTH provocation test (chronic AI) * Serum cortisol levels increase following this stimulus if adrenal cortex is normal; failure to produce cortisol indicates primary adrenal insufficiency. * Abdominal CT/MRI to evaluate adrenal gland size

Answer 120

Crackles and decreased breath sounds over affected area Dull to percussion over infilitrate Chills and fever Cough, purulent sputum Dyspnea and tachypnea

Answer 121

•Secondary—stimulation of TSH receptors by TSH (hypersecretion of TSH)

Answer 122

* Approximately 90% of the thyroid hormone is in the form of T4, whereas 10% is T3. * Remain attached to thyroglobulin until stimulated by TSH * Released T4 and T3 are lipid soluble and diffuse from the follicle into circulation. * Once in the cell, T3 binds to its receptor and exerts its actions.

Answer 123

Water-soluble hormones - Finds their way out in urine Lipid- soluble hormones are bound to plasma proteins and stored in adipose tissue so they remain in circulation for longer periods of time Metabolized by kidney and liver; degraded by target cell after binding to receptors

Answer 124

Closes the airway to prevent food from going into trachea

Answer 125

* Causes * Insufficient food intake, unplanned activity, or an inappropriate insulin or sulfonylurea dose * Manifestations: * Pallor, tremor, diaphoresis, palpitations, and anxiety * Hunger, visual disturbance, weakness, paresthesias, confusion, agitation, coma, death

Answer 126

Acute adrenocortical Insufficiency ## Footnote * Life-threatening condition caused by inadequate levels of glucocorticoids and mineralocorticoids, leading to circulatory collapse * May occur with acute withdrawal of corticosteroids or may be caused by periods of stress/trauma

Answer 127

Chronic Hyperglycemia * May lead to systemic changes over time and increase the risk of other diseases, including metabolic syndrome, hypertension, cardiovascular disease, and stroke * Complications are categorized as vascular and neuropathic.

Answer 128

Diagnosis * ACTH measurement * Primary = low ACTH * Secondary = high ACTH * Plasma cortisol increased * 24-hour urinary free cortisol levels * Renal US/CT ABD can detect adrenal tumor * Dexamethasone suppression test * Differentiate between pituitary causes and ectopic causes

Answer 129

Duration of hormone activity in circulation expressed in minutes, hours, or days its the time for a hormone to reach one half of its original concentration in the blood and is influenced by the rate uptake by cells, degradation, and excretion Lipids usually have a longer half life Heavier people with more adipose tissue may hold onto hormones a lot longer than someone with no adipose tissue

Answer 130

* Myxedema occurs in severe or prolonged hypothyroidism. * Generalized, non-pitting edema * Decreased level of consciousness, hypotension, hypothermia, history of precipitating event (trauma, sepsis, certain drugs) * May progress to myxedema coma, a life-threatening condition if treatment not received

Answer 131

Feeding-fasting cycle Light dark cycle Sleep-wake cycle 24 hour (circadian cycle) Longer cycles (28-day menstrual cycle)

Answer 132

Pulmonary vessels become thickened from an increase in the muscle. Pulmonary artery wall becomes fibrotic. Sustained PHTN results in the formation of a network of blood vessels that impedes blood flow

Answer 133

Irreversible airway or alveolar abnormalities Chronic Bronchitis Emphysema OBSTRUCTIVE * Damage from prolonged inflammation * Smoking history or secondhand smoke exposure * Pollution and chemical irritants * Symptomatic around 60 years of age * Equal presentation in men and women * **_Alpha 1 Antitrypsin presentation – 30 to 40 years of age_**

Answer 134

Incretins are released after a meal to stimulate insulin release and inhibit glucagon release Incretins slow gastric emptying and decrease appetite Dipeptidyl Peptidase 4 (DPP-4) causes breakdown of the Incretins There is a new diabetic med that inhibits the breakdown of DPP-4 allowing the incretins to work and natural glucose metabolism

Answer 135

* Primary—Graves disease, autoimmune, tumor related, inflammatory; also malignancy * Autoimmune—related to TSH receptor antibodies

Answer 136

Subglottic (under epiglottis) area edema leading to airway narrowing and obstruction Children 3 month - 3 years Occurs autumn and early winter

Answer 137

* Primary: may be idiopathic, autoimmune * Secondary: parathyroid or thyroid surgery; may be temporary or permanent * Can occur with removal of parathyroid gland * Congenital lack of parathyroid tissue and idiopathic hypoparathyroidism are causes of hypoparathyroidism in children and infants.

Answer 138

Intrinsic: non-allergic, adult-onset Extrinsic: allergic, pediatric-onset

Answer 139

Cells have been exposed to a high concentration of a hormone so the body to protect itself decreased the # of receptor sites available, so it doesn't have excessive activity example: insulin receptors Chronic high glucose levels so the body is putting out a lot of insulin trying to fix the level so the body shuts down insulin receptor cells. This is how insulin resistance occurs

Answer 140

* Glucose ingested food causes a brief rise in insulin release (first phase). * Continued glucose causes the second phase: insulin secretion. * Ingestion of nutrients stimulates release of glucose–dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) from cells in the gut. * Effect on blood glucose known as incretin effect

Answer 141

Insulin is synthesized in the pancreas by the β cells of the islets of Langerhans. (beta)

Answer 142

Movement of gas between air spaces in the lungs and bloodstream

Answer 143

Has to come from something after the lungs so it would be the left side of the heart that would cause secondary pulmonary HTN

Answer 144

C peptide level is low along with low insulin levels

Answer 145

In the fasting state, glucose is produced by glycogenolysis, gluconeogenesis, and insulin falls to basal level. Glucagon is responsible for most glucose production in fasting state

Answer 146

* Located in the aortic arch and carotid bodies * Respond to decrease in arterial O2 * Also respond to increases in: * Increased Hydrogen ion concentration (decreased pH) * Arterial carbon dioxide level (PaCO2)

Answer 147

Blood-borne chemical messengers that affect target cells anatomically distant from the secreting cell * Regulates: Growth and development * Metabolism * Sexual function * Reproduction * Mood stability

Answer 148

GIP and GLP-1 stimulate the production of insulin and GLP-1 inhibits glucagon Insulin stimulates diffusion of glucose into adipose and muscle tissue; inhibits production of glucose by liver.

Answer 149

Most common type Sicker presentation Responsible for epidemics and pandemics Found in humans and animals Went to bed fine woke up very ill Transmission through airborne droplets Incubation 1-4 days Continual antigen changes with gene mutations dev new strains

Answer 150

Clinical manifestations – active primary ## Footnote * Gradual onset * Productive cough * Night sweats, fever, chills * Fatigue * Unexplained weight loss, anorexia

Answer 151

Etiology and pathogenesis * Adrenal medulla secretes catecholamines, norepinephrine, and epinephrine, in response to SNS stimulation. * Catecholamines increase heart rate, blood pressure, and glucose release from the liver. * Pheochromocytoma: adrenal medulla tumor resulting in excessive production and release of catecholamines

Answer 152

* Microadenomas or adenomas causing excessive production of pituitary ACTH * Nonpituitary tumors can cause ectopic ACTH production (malignancies) * **Exogenous steroid use is the most common cause of Cushing syndrome in the US related to use with allergic and autoimmune diseases**

Answer 153

gas that can be expired with a maximal expiration – 1.2 L DEEP expiration beyond normal TV

Answer 154

•Autonomic nervous system: control bronchi and bronchiole musculature

Answer 155

Acute inflammation of the trachea and bronchi Viral 90% of the time Not infectious Sx will improve 7-10 days Cough will linger 3-4 weeks

Answer 156

Viral - RSV, Adenovirus, Influenza, Rhinovirus Bacterial not common is usually a secondary infection Inhalation of chemical irritants - bleach Allergic reactions

Answer 157

Community acquired (gram positive - strep pneumonia) Hospital acquired Atypical pneumonia (mycoplasma, legionella-breeds in water) Ventilator associated

Answer 158

Aspirin NSAIDS Beta Blockers Tartrazine (yellow #5) MSG Sodium or K Hops in beer Obesity (fat stores of cytokines)

Answer 159

Symptoms: Daily Nighttime awakenings: 1x week but not nightly Uses inhaler: Daily Interference with normal activity: Some limitation

Answer 160

Excess circulating glucose is converted into glycogen and stored in the liver and muscle cells Opposite of Glycogenolysis

Answer 161

gas that can be inspired with maximal inspiration - 2.5 - 3 L Deep inspiration beyond normal TV 2.5 - 3L

Answer 162

* When capillary hydrostatic pressure exceeds colloid osmotic pressure, fluid moves from capillaries into the interstitial space. * If fluid shift is not controlled, fluid will move into the alveoli causing alveolar edema leading to poor gas exchange.

Answer 163

Excessive glucose is thought to interfere with myoinositol in neurons and reduced myoinositol in peripheral nerves.

Answer 164

Enteroviruses, particularly Coxsackievirus Incubation 4-6 weeks (respiratory, contaminated hands, fecal matter)

Answer 165

Chronic complications * Rarely manifested before adolescence * Screening for neuropathy/nephropathy ongoing * Counseling on metabolic control before initiation of pregnancy

Answer 166

Based on symptoms and Risk of exacerbation Whether exacerbation landed them in the hospital or not Exacerbation is acute worsening of resp sx/ URI usually * Group A: low risk (0-1 exacerbation per year, not requiring hospitalization) and fewer symptoms (mMRC 0-1 or CAT \<10) * Group B: low risk (0-1 exacerbation per year, not requiring hospitalization) and more symptoms (mMRC≥ 2 or CAT≥ 10) * Group C: high risk (≥2 exacerbations per year, or one or more requiring hospitalization) and fewer symptoms (mMRC 0-1 or CAT \<10) * Group D: high risk (≥2 exacerbations per year, or one or more requiring hospitalization) and more symptoms (mMRC≥ 2 or CAT≥ 10).

Answer 167

* Hypothalamus releases thyrotropin-releasing hormone (TRH) which stimulates anterior pituitary to release thyroid-stimulating hormone (TSH) which stimulates the thyroid to release T3 and T4 * Only 10% of T3 is produced in thyroid – T4 converts to T3 in body tissues * Iodine needed to synthesize the T3 and T4 * Thyroid hormones are bound to thyroglobulin (protein) until they are released

Answer 168

Pituitary gigantism: occurs in childhood before the skeletal epiphyses close * Accelerated growth velocity (\>95 percentile on pediatric growth chart) * Left untreated, may grow \>8 feet tall with increased risk of cardiomegaly and heart failure Acromegaly: growth hormone excess in adults; progressive over several years

Answer 169

* Mineralocorticoids - Aldosterone (salt and water) * Glucocorticoids – Cortisol (sugar) * Gnadocorticoids - Androgens and Estrogens (sex)

Answer 170

Symptoms: Throughout the day Nighttime awakenings: Often 7x week Uses inhaler: Several times a day Interference with normal activity: Extremely limited

Answer 171

* Alpha cells – secrete glucagon * Glucagon (opposite of insulin) tells the liver to break down glycogen stores into glucose - raises sugar * Beta cells – secrete insulin and amylin * Insulin works with amylin to control glucose * Delta cells – secrete somatostatin and gastrin * Somatostatin inhibits growth hormone * Gastrin stimulates the stomach to release gastric acid

Answer 172

Yes example is a crushing injury

Answer 173

* Primary hyperparathyroidism: * Serum calcium levels elevated with low to normal phosphorus * Urinary excretion of calcium and phosphorus are elevated; serum PTH levels are elevated * Intact PTH and Ionized calcium * Thyroid US and parathyroid nuclear scan

Answer 174

Sever pharyngitis; exudate (mimics strep) Fever - high Tonsillar and cervical lymphadenopathy Hepatosplenomegaly and elevated LFTs Thrombocytopenia (spleen), elevated WBCs

Answer 175

ADH (vasopressin) Oxytocin

Answer 176

The "fit" of a hormone into a receptor binding pocket

Answer 177

* Exocrine secretions for digestion * Endocrine functions

Answer 178

High flow LOW pressure Coming from the Right Ventricle should be low pressure \<25mm/Hg

Answer 179

Breakdown of glycogen into glucose for energy

Answer 180

Fever \>100.4 Bacterial - Strep A Viral - RSV

Answer 181

Emergency Absess of one tonsil, can displace uvula Caused by staph or strep Clinical manifestations: drooling, dysphasia

Answer 182

Activity intolerance Fatigue Hemoptysis (excess pressure leaks back into alveoli) Syncope Chest pain on exertion When sx appear cannot be reversed focus on prevention

Answer 183

Thyroid hormones (lipid-soluble) are formed on demand but are trapped attached to thyroglobulin and sit and wait until they are told its time to be released by the hypothalamus or anterior pituitary

Answer 184

* Serum calcium (low); phosphorus (high) * Antibodies to parathyroid gland present if autoimmune mechanism involved

Answer 185

* Primary: disease of the adrenal cortex * Secondary: hyperfunction of anterior pituitary ACTH-secreting cells * Tertiary: hypothalamic dysfunction or injury * Iatrogenic - long term steroid use * Ectopic ACTH producing tumor – small cell lung cancer

Answer 186

Screening for Diabetes -USPSTF * All adults older than age 40 should be screened at least every 3 years for type 2. * Individuals with risk factors should be screened earlier or more frequently. No screening requirements for type 1

Answer 187

May cause persistent hyperglycemia and increased insulin production (GH called a diabetogenic hormone)

Answer 188

Primary: intrinsic malfunction of the hormone-producing gland In primary, gland fails; an inadequate hormone produced, low levels of circulating hormone, but blood levels of the corresponding trophic pituitary hormone levels very elevated.

Answer 189

First thing in the morning when its at the highest

Answer 190

Type 2 Diabetes Mellitus * Risk factors: female sex, obesity, aging, and sedentary lifestyle * Polyuria, polydipsia, and polyphagia may be more subtle

Answer 191

•Clinical manifestations in infants Routine screening in newborns has resulted in increased treatment for congenital hypothyroidism. * Dull appearance, thick, protuberant tongue, and thick lips * Prolonged neonatal jaundice * Poor muscle tone, umbilical hernia * Bradycardia, mottled extremities * Hoarse cry * Mental retardation unless treated early

Answer 192

Increased prevalence of type 2 DM Increased adiposity, decreased lean body mass, decreased activity levels, decreased insulin secretion, hyperglycemic effect of certain medications

Answer 193

Initially insulin levels drop and glucagon and catecholamine levels rise, increasing production of free fatty acids (FFAs) and stimulating glycogenolysis. Glucose from liver meets energy demands. (Glycogenolysis) Muscle contractions increase insulin sensitivity, maintaining normal blood glucose levels in the presence of lower insulin levels.

Answer 194

* **Smoking \>70 packs/year (2pk/dayX30years)** * Air pollution * Certain occupations (mining, welding, working with or near asbestos) * **α1-Antitrypsin deficiency** * Expanded "floppy" lungs

Answer 195

•Cushing syndrome—term used to describe any other reason for hypercortisolism

Answer 196

Primary effect on **glucose metabolism** **Oppose the effects of insulin** and raise blood glucose levels by decreasing glucose uptake by many body cells (decreased glycogenesis) and increasing glucose synthesis in the liver from glycogen and amino acid and glycerol substrates in fat stores (glycogenolysis, gluconeogenesis)

Answer 197

Most clinically relevant in children **_Associated with:_** Birth history of prolonged labor or breech delivery, congenital chromosomal anomaly; nystagmus, retinal abnormalities, midline or midfacial abnormalities (cleft lip or palate) **_Clinical manifestations in children:_** Hypoglycemia Growth below the third percentile Dental eruption delayed Irregular setting of permanent teeth Thin hair, poor nail growth Greater fat mass, decreased muscle mass and delayed bone formation Delayed puberty **_Clinical manifestations in adults:_** Diminished lean body mass Hypercholesterolemia Decreased bone density **_Diagnosis_** Confirmed by decreased serum GH

Answer 198

Clinical manifestations * Progressive dyspnea with irritating, nonproductive cough * Rapid-shallow breathing * Clubbing of nail beds * Bibasilar end-expiratory crackles * Cyanosis (late finding) * Anorexia, weight loss * Inability to increase cardiac output with exercise

Answer 199

Stems from a known disease Mitral stenosis Mitral regurgitation LV heart failure Chronic lung diseases Vasculitis

Answer 200

* Growth hormone (GH) produced in anterior pituitary gland * Regulated by hypothalamic: * Release of growth hormone-releasing hormone (GHRH) * **_Inhibited by Somatostatin_** * Primary target organ is the liver. * Increases lean body mass, reduces fat mass, and induces liver to release glucose under conditions of hypoglycemia * GH acts opposite of insulin and raises glucose

Answer 201

amount of forced air exhaled over 1 second Normal – generally 80% of Forced Vital Capacity

Answer 202

Normal range 4 - 5.7% ## Footnote 1% reduction decreases microvascular risks by 10%

Answer 203

* Glucose ingested food causes a brief rise in insulin release (first phase). * Continued glucose causes increased insulin secretion (second phase) * Ingestion of nutrients stimulates release of **glucose–dependent insulinotropic polypeptide (GIP)** and **glucagon-like peptide 1 (GLP-1) from cells in the gut.**_(Incretins stimulates insulin release and inhibits glucagon to lower sugar)_ * Effect on blood glucose known as **incretin effect**

Answer 204

Clinical manifestations * Hyponatremia \< 135 mEq/L (135-145) * High urine osmolality * Low serum osmolality * Weakness, muscle cramps, N/V, postural BP changes, poor skin turgor, fatigue, anorexia, lethargy * Confusion, hemiparesis, seizures, coma

Answer 205

Physiologic hormones are extremely low due to amplification Pharmacologic levels are much higher Tissue response to pharmacologic hormone concentrations may be significantly different from physiologic levels

Answer 206

* Characterized by destruction of the β cells of the pancreas * Usually diagnosed between 5 and 20 years of age * Etiology may be immune-mediated or idiopathic (without autoimmune markers or HLA association). * Autoimmune markers: chromosome 6 * HLA: MHC genes

Answer 207

* May be congenital or acquired * **Majority are primary,** because of intrinsic thyroid gland dysfunction * Congenital hypothyroidism (cretinism) typically caused by thyroid dysgenesis (lack of development) **•Secondary, as a result of defects in TSH production (hyposecretion)**

Answer 208

Widespread inflammation of the bronchioles (smaller bronchioles) RSV most common cause Winter to spring Common in children Adults for smoking, toxic fumes

Answer 209

* Impaired glucose tolerance * 2-hour post-glucose value of 140 to 200 mg/dL * Impaired fasting glucose tolerance * Fasting plasma glucose value of 100 to 125 mg/dL

Answer 210

Functional disorders - Caused by nonendocrine disease such as chronic renal failure, liver disease, or heart failure Tissue resistance - Occurs when target tissue fails to respond to a hormone (hormone resistance or target tissue resistance) Iatrongenic - Induced by medical treatments such as chemotherapy, radiation therapy, or surgical removal of glands

Answer 211

Hormones exert their action by binding to target cell receptor proteins Water-soluble hormones have a hormone-binding site located on the external portion of a specific cell surface receptor Once binding takes place, receptor protein conveys a signal to the interior of the cell to produce a response

Answer 212

Clinical manifestations * Hypogonadism * Premenopausal female infertility, oligomenorrhea, and galactorrhea * Male decreased libido, impotence, infertility, gynecomastia, and galactorrhea

Answer 213

Steroids - androgens glucocorticoids, thyroid (lipids) Proteins/polypeptides - Insulin, growth hormone (water) Amines/amino acids - epinephrine (water) Fatty acid derivatives - prostaglandins

Answer 214

Increased pulmonary blood flow Increased resistance to blood flow Increased left atrial pressures

Answer 215

* Acute complications * Hyperglycemia: often asymptomatic; dehydration; increased risk of infection; * Non-ketotic hyperglycemic hyperosmolar coma Glucose \>500-600, dehydrated, electrolyte imbalances; arrhythmias, seizures, coma * Hypoglycemia may be atypical and can lead to injury. * Lethargy or focal neurologic dysfunction * Age-related decreases in counter-regulatory function or an inability to report hypoglycemic symptoms

Answer 216

•Sympathetic stimulation (mediated by β2-adrenergic receptors); leads to relaxation of the smooth muscle

Answer 217

Why you can have a very small amount of circulating protein and it can cause a tremendous effect on the body. Progressively larger numbers of chemical reactions occur at each step, resulting in the activation of numerous G proteins

Answer 218

One receptor site will respond to two or more different hormones. May occur between hormones Example is growth hormone and prolactin both can bind to a prolactin receptor so if growth hormone take up all the receptors their won't be any for prolactin

Answer 219

Glycemic control may prevent or improve symptoms of diabetic neuropathy.

Answer 220

Lump on testicle that is painless and moveable

Answer 221

Resistance influenced by airway radius and the pattern of gas flow

Answer 222

Movement of air in and out of the lungs

Answer 223

\> 70% Normal Ratio of how much you exhaled in the first second divided by how much you exhale Less than 70% is obstructive Greater than 70% is either normal or restrictive (FVC \<80%)

Answer 224

* Calcitonin produced by thyroid parafollicular cells; also influences the processing of calcium by bone cells * Calcitonin increases bone formation by osteoblasts and inhibits bone breakdown by osteoclasts. * Calcitonin decreases blood calcium levels and promotes conservation of hard bone matrix.

Answer 225

Low oxygen in bloodstream

Answer 226

* 4 glands * Located behind the thyroid glands * Secrete parathyroid hormone (PTH) _{•PTH – regulates calcium} * Can cause calcium release from bones when serum calcium levels are low (makes bones weak) * Can increase calcium absorption from the GI tract and in the renal system * PTH stimulates Vitamin D which is needed for calcium GI absorption

Answer 227

Most likely precipitated by placental hormones and weight gain Risk factors Severe obesity, history of gestational diabetes, previous offspring weighing more than 9 lbs at birth, presence of glycosuria, or a strong family history of type 2 diabetes

Answer 228

•Clinical manifestations * Kidney stones * Bone demineralization (osteoporosis) * Polyuria and dehydration * Anorexia, nausea, vomiting, constipation * Bradycardia, heart block, and cardiac arrest * Manifestations result from high serum calcium levels and bone demineralization. * High serum calcium levels decrease neuromuscular excitability.

Answer 229

Bacterial, viral, fungi Aspiration of secretions or gastric contents Inhalation of smoke or chemicals

Answer 230

Bind to cell surface receptors Peptides (small proteins) majority of endocrine hormones Easily transported in the bloodstream ACTH FSH LH, Growth Hormone, TSH PTH

Answer 231

Total expiration of air

Answer 232

Haemophilus influenzae type b (HIB) GABHS bacteria Throat trauma Hot liquids Foreign objects

Answer 233

Etiology and pathogenesis * Primary: hyposecretion caused by disease of adrenal cortex; idiopathic or autoimmune (Addison disease), surgical removal * Secondary: inadequate secretion of ACTH from anterior pituitary; usually iatrogenic, related to corticosteroid therapy (suppresses ACTH) followed by sudden withdrawal of steroids * Tertiary: lack of secretion of CRH from hypothalmus * Cortisol insufficiency is most clinically relevant

Answer 234

Quadrivalent (2 strains both A and B) Intranasal for ages 2-49 its a live vaccine (no for pregnant, immunocompromised or chronic resp prob) If over 65 4 dose series of not live vaccine

Answer 235

* Clinical manifestations * Insomnia, restlessness, tremor, irritability, palpitations, heat intolerance, diaphoresis, diarrhea, inability to concentrate that interferes with work performance; enlarged thyroid gland * Increased basal metabolic rate leads to weight loss, although appetite and dietary intake increase. * Amenorrhea/scant menses

Answer 236

Pathogenesis * Dysfunction of CFTR gene * Normally CFTR encodes a membrane chloride channel and is in sweat glands, lungs, and pancreas * CFTR gene mutations result in alteration in chloride and water transport across epithelial cells. * Primarily affects the pancreas, intestinal tract, sweat glands, and lungs, and in males causes infertility * High concentrations of sodium and chloride in sweat, salivary, and lacrimal secretions

Answer 237

T3 (75 - 195 ng/ml) T4 (5-12 mcg/dL)

Answer 238

Most infections are viral Acute sx \<4 weeks Chronic sx =12 weeks Recurrent \>4 year

Answer 239

Epinephrine Norepinephrine

Answer 240

* Hyperglycemia from insulin production and/or action defects * Type 1 diabetes - autoimmune * Destruction of pancreatic beta cells * Type 2 diabetes - herideratary * Insulin resistance and loss of insulin production * Gestational diabetes * Glucose intolerance during pregnancy * Ineffective pancreatic function to overcome insulin resistant state

Answer 241

High (under perfused) Ventilation \> perfusion - Alveolar unit is ventilated, but not perfused. Happens with PE (lack of blood flow) Low (underventilated) Ventilation

Answer 242

0 minimal sx 1-2 slowing down 3 -4 - symptomatic to very symptomatic

Answer 243

* Located in muscles and tendons of movable joints * Respond to body movement (exercise) and increase rate and depth of respiration Muscle movement stimulates you to take a breath HTN slows down respiration Hypotension increases respiration - venous return

Answer 244

* Mucous-producing glands in the GI tract enlarge * Generates excessive secretions * Thick eosinophilic mucus secretions plud the glands and ducts of the GI tract, causing dilation and fibrosis * Leads to decreased production of pancreatic enzymes, causing increased FAT and PROTEIN IN THE STOOL

Answer 245

* Maintain normal salt and water balance by promoting sodium retention and potassium excretion at the distal renal tubules * Aldosterone secretion regulated primarily by the renin-angiotensin system associated with the juxtaglomerular cells of the kidney * Released in response to low blood pressure, reduced renal perfusion and a high serum potassium level

Answer 246

Diagnosis * Chest x-ray * Increased bronchial vascular markings * Congested lung fields * Evidence of previous pulmonary infection * Pulmonary function tests * Normal total lung capacity (TLC) * **Increased residual volume (RV)** * **Decreased FEV1** * ECG - right ventricular hypertrophy * CBC – polycythemia due to hypoxia * Chronic or recurrent productive c**ough \>3 months** \>2+ successive years * Persistent, **irreversible** when paired with emphysema

Answer 247

Diagnosis •Primary: elevated TSH (0.5-4.5 normal levels) May have elevated TPO/Thyroglobulin * Secondary: decreased TSH (Pituitary failure) * Low levels of T3 and T4 may not occur until later in the disease course. * T3 (75-195 ng/ml) T4 (5 -12 mcg/dL)

Answer 248

* Malaise, fatigue * Weight loss * Fever * Dyspnea of insidious onset * Dry, nonproductive cough * Erythema nodosum * Macules, papules, hyperpigmentation, and subcutaneous nodules * Hepatosplenomegaly, lymphadenopathy

Answer 249

Caused by Mycobacterium tuberculosis Transmission via aerosol droplets with active TB patient Can survive weeks in dry sputum Florida 4th state for positive cases

Answer 250

CURB - 65 WBC \>15,000 (bacterial) Chest Xray shows white shadows (Parenchymal infiltrates)

Answer 251

Immobility Trauma Pregnancy Cancer Heart Failure Estrogen Use Smoking

Answer 252

1. Stiff lungs (can't inflate) 2. Stiff chest wall (kyphosis, obesity, rigidity) 3. Elasticity of lungs (can't snap back) -Decreased (COPD) Increased - (Pulmonary fibrosis, Sarcoidosis, SLE, Asbestos)

Answer 253

**_•Anterior_** ## Footnote Somoatotropes secrete GH Gonadotropes secrete LH/FSH Thyrotropes secrete TSH Corticotropes secrete ACTH Lactropes secrete prolactin (PRL)

Answer 254

1/3 to 1/2 of asthma cases A genetic IgE-mediated exaggerated response in many cases Allergic rhinitis, atopic dermatitis and eczema

Answer 255

Primary is a disorder of the anterior pituitary Secondary is a disorder of the hypothalamus Normal range = Men 10-20 Women 10-25

Answer 256

Respiration Movement of gas between air spaces in the lungs and the bloodstream

Answer 257

Peptide hormones are contained within the bilayer of the vesicles and stored until a trigger results in the exocytosis of the hormone into the extracellular space

Answer 258

Action - the effect they have (insulin lowers glucose) Source - Anterior or posterior pituitary Chemical structure

Answer 259

Lymphocytic thyroiditis (Hashimoto or autoimmune thyroiditis); may result in a goiter Irradiation of the thyroid gland Surgical removal of thyroid tissue Iodine deficiency

Answer 260

Energy requirements are met by glucose and fats Glucose is produced from glucose stores or glycogen in liver primarily it is coming from the bloodstream from the GI tract and liver

Answer 261

amount of gas entering or leaving in a normal breath – 500 ml Increases with exercise

Answer 262

Clinical manifestations * Round face with flushed cheeks, “moon face” * Weight gain with excess total body fat, particularly in the abdomen, thin extremities * Cervical fat pad, capillary friability, thin skin with formation of purple striae and ecchymosis over the abdomen, arms, and thighs * Decreased muscle mass, muscle weakness * Glucose intolerance, hyperglycemia * Hypertension (salt-retaining activity of cortisol) * Demineralization of bone (osteoporosis) * Increased androgen production causing excessive hair production, acne, menstrual irregularities * Emotional lability, anxiety, irritability, depression

Answer 263

Secondary pneumonia Reye Syndrome in children

Answer 264

Collection of fluid or pus in pleural cavity as a result of another disease process Changes in pleural capillary hydrostatic pressure, colloid oncotic pressure, or intrapleural pressure Imbalance in pressure associated with fluid formation exceeding fluid removal

Answer 265

Movement of blood into and out of the capillary beds of the lungs to body organs and tissues

Answer 266

Body is breaking down sugar so the cells can use it

Answer 267

* Dehydration: diabetic ketoacidosis * When blood glucose is \>240 mg/dL or during illness, test for ketones. * Hypoglycemia may be difficult to detect; subtle behavioral changes. * Lethargy, pallor, and sleep disturbances

Answer 268

Thickening of alveolar cap membrane - pneumonia, pulm edema; also aging Surface – Emphysema – areas destroyed Activity - less blood flow time in the lungs Elderly – decreased lung capacity, blood flow Newborn - thick alveolar membrane

Answer 269

HYPERSECRETION * Excess secretion of hormone * Primary hypersecretion occurs when there is a dysfunction of the endocrine gland that results in abnormally high secretion of hormone. * Secondary hypersecretion occurs when there is an elevation in the tropic level of one hormone that results in an increased plasma concentration of another hormone.

Answer 270

No sugar in system and glycogen used up so the body gets sugar from other non sugar substances

Answer 271

Autosomal recessive disorder of exocrine glands Most common genetic lung disease in the US Classified as airflow or suppurative (pus-forming) Hypersecretion of abnormal, thick mucus that obstructs exocrine glands and ducts Median survival age: 31 years

Answer 272

Diabetic neuropathy * Autonomic dysfunction: GI disturbances, bladder dysfunction, tachycardia, postural hypotension, and sexual dysfunction * Sensory dysfunction includes carpal tunnel syndrome, paresthesias in extremities, especially feet. * Amputation 15 to 40 times higher than in nondiabetic individuals

Answer 273

Clinical manifestations of acromegaly * Increased ring or shoe size * Enlargement of frontal sinus causes prominent brow. * Growth of mandible leads to progressive underbite (prognathism). * Coarse facial features and skin tags * Increased size of internal organs * Deepening of the voice and enlarged tongue

Answer 274

Diagnosis * Dilute urine, hypernatremia along with abnormally low serum ADH levels (diagnostic of central DI) * Renal US or MRI Brain

Answer 275

The degree of "tightness" or the hormone receptor bond or the inclination of the hormone to remain bound to the receptor i.e. Old key locks you put key in a jiggle it around present-day locks have a high affinity with tight locks only fitting the intended key When you have a high affinity you don't need as much of the hormone you can use a very small amount

Answer 276

Hyperkalemia

Answer 277

Pulmonary emboli SLE Sarcoidosis Alveolar carcinoma example: 4L/3L = 1.3VQ

Answer 278

Generation of glucose from non-sugars

Answer 279

Obstructive (OSA) or Central (CSA) ## Footnote OSA - associated with obesity oral or pharyngeal obstruction CSA - associated with heart or brain abnormalities (rare) Risk factors - neck circumference 17" in men 16" in women

Answer 280

Congenital ## Footnote Inborn genetic defect that causes excessive production of hormone precursors Autoimmune Involves genetic predisposition and environmental trigger; antibodies made against antigens on self-tissue cells Neoplastic Hormones may be produced by abnormal tissue sites (ectopic) such as malignancies.

Answer 281

The body says it need so much of a hormone the body reacts to it and it sends a signal back to the anterior pituitary and hypothalamus that fx at a good level. If we don't need as much hormones it will send a message back that to the anterior pituitary to slow down production If deficient in hormone sends signal to anterior pituitary and hypothalamus that we need more How we keep hormone level fx and at level we want

Answer 282

β cells produce proinsulin. ## Footnote * Stored in granules, where it is cleaved into insulin and C-peptide * 1:1 RATIO OF INSULIN AND C-PEPTIDE

Answer 283

Pathogenesis Begins with injury to alveolar epithelial or capillary endothelial cells Persistent alveolitis leads to obliteration of alveolar capillaries, reorganization of lung parenchyma, irreversible fibrosis Leads to large air-filled sacs (cysts) with dilated terminal and respiratory bronchioles (honey-comb lung)

Answer 284

Diagnosis * Pulmonary function tests (PFTs) -BIG LUNGS- * Increased functional residual capacity * Increased RV, TLC * Decreased FEV1, FVC * Chest x-ray * Hyperventilation * Low, flat diaphragm * Presence of blebs or bullae * Narrow mediastinum * ECG * Normal, show **tall P waves** * Sinus tachycardia: first sign of decreased oxygenation * Supraventricular and ventricular arrhythmias

Answer 285

Hyposecretion Hypersecretion Target cell hypo-responsiveness

Answer 286

Somatostatin (counteracts growth hormone)

Answer 287

•Cushing disease—term only used for pituitary hyperstimulation of adrenal cortex; secretes excess cortisol

Answer 288

Breakdown of glycogen into glucose for energy Opposite of Glycogenesis

Answer 289

Cell response to a hormone depends on the presence of specific receptors on very specific cells for that hormone on the cell called the target cells A cell can change how it wants to respond to a hormone by changing the # of receptors or an affinity for the hormones

Answer 290

Glucose levels rise, leading to polyuria (increased urination), polydipsia (thirst), and polyphagia (hunger): classic signs.

Answer 291

Inflammation of the larynx - vocal cord Noninfectious - screaming, singing, vomiting Infectious form - Rhinovirus, Strep

Answer 292

*_Macrovascular:_* damage to large blood vessels; leads to cardiovascular disease, peripheral vascular disease, and stroke * Preventive: caloric restriction, exercise, possibly drugs, control dyslipidemia, and hypertension * DM is an independent risk factor for coronary artery disease (CAD). * Dyslipidemia, hypertension, and impaired fibrinolysis are present in uncontrolled DM; improve with blood glucose control.

Answer 293

Glycogenolysis and Gluconeogenesis

Answer 294

* Cluster of risk factors * Hyperglycemia, hypertension, hypercholesterolemia, increased waist circumference * Chronic complications * Directly result from long-term excessive glucose levels * Thickening and hardening of vessel walls * Causing diffuse ischemia and necrosis * Macrovascular complications * Microvascular complications * Miscellaneous complications

Answer 295

* Lymphocytes and macrophages form a granuloma around bacilli to contain it * Caseating granuloma * Intact immune system inhibits granuloma formation and develop Ghon complexes that calcify * Latent TB – infected but asymptomatic and not contagious

Answer 296

CRH and ACTH have a significant diurnal pattern, with a peak on wakening in the morning and a valley in the evening.

Answer 297

Excess fluid

Answer 298

Ventilation 4L/min Perfusion 5L/min 4/5-0.8

Answer 299

* Thyroxine – T4 * Triiodothyronine – T3 * Thyrocalcitonin – Calcitonin (regulates calcium levels)

Answer 300

Mild X2 week Moderate X1 day Severe multiple X a day

Answer 301

Impaired glucose tolerance and impaired fasting glucose tolerance Intermediate stages between normal glucose metabolism and diabetes •HgbA1c : 5.7 – 6.4%

Answer 302

* Secondary: malfunction of the hypothalamus/pituitary cells that control the target gland * In secondary, pituitary gland fails to release trophic hormone, secondarily reducing primary gland production, so both levels are abnormally low. * Since clinical manifestations are similar, laboratory results can help distinguish between primary and secondary.

Answer 303

Symptoms: \>2 days a week, but not daily Nighttime awakenings: 3-4x month Uses inhaler: \>2 days/week but not daily, and not more than 1x day Interference with normal activity: Minor limitation

Answer 304

Diagnosis * Chest x-ray * PFTs (decreased VC, TLC; normal FEV1/FVC ratio * Open lung or transbronchial biopsy * Gallium-67 scan lung scan * High-resolution computed tomography (HRCT) and bronchoalveolar lavage

Answer 305

Clinical manifestations * Persistent, daily, chronic, productive cough * Purulent, foul-smelling, green, or yellow sputum * Hemoptysis * Fever, night sweats * Moist crackles, rhonchi * Halitosis (bad breath) * Skin pallor