Test Your Knowledge 3

Question 1

What is myxedema?

Answer 1

Connective tissue changes due to increased mucopolysaccharides and proteins

Question 2

What are some of the s/s of myxedema?

Answer 2

• boggy, pitting edema
• thickening of tongue and oropharyngeal complex with slurred speech
• bulge sign at the knee

Question 3

Myxedema: where is the pitting edema commonly seen?

Answer 3

• eyes
• hands
• feet
• supraclavicular area

Question 4

Myxedema: bulge sign

Answer 4

• dense, viscous synovial fluid at the knee

- may include calcium crystals associated with chondrocalcinosis

Question 5

Name some common NM manifestations of hypothyroidism

Answer 5

• flexor tenosynovitis with stiffness and accompanies CTS
• fibromyalgia
• inflammatory arthritis
• proximal muscle weakness
• prolonged DTRs
• persistent TrPs
• diffuse aches and cramps

Question 6

A pt with the dx of hypothyroidism will likely be prescribed with what pharmacological agent?

Answer 6

Synthroid

Question 7

The side effects of synthroid are negligible.
A. True
B. False

Answer 7

B. False

Question 8

What are 2 serious potential side effects of Synthroid?

Answer 8

• A-fib

- Osteoporosis

Question 9

Where are the parathyroid glands? How many does each person possess?

Answer 9

• Within the thyroid

- We have 4 (2 in left lobe, 2 in right lobe)

Question 10

What is the function of the parathyroid?

Answer 10

Secretes PTH, which regulates calcium and phosphorus metabolism

Question 11

How does PTH exert its effects?

Answer 11

• Bone demineralization
• increased absorption of calcium and excretion of phosphate by the kidneys
• promoting calcium absorption in GI tract

Question 12

How does the parathyroid exert an effect on bone demineralization?

Answer 12

Increases release of calcium and phosphate from the bone

Question 13

What does prolonged and continuous release of PTH cause?

Answer 13

Acceleration of bone breakdown

Question 14

Normal intermittent PTH enhances

Answer 14

Bone formation

Question 15

Why are kidney stones prevalent in hyperparathyroidism?

Answer 15

abn PTH production related to release of bone calcium into the bloodstream, leads to kidney damage

• Large amts of phosphorus and calcium excreted and lost through the RENAL system
  »»» Deposits of calcium phosphate left in renal tubules »»» kidney stones

Question 16

What is the medical tx of choice for hyperparathyroidism

Answer 16

Surgery to remove parathyroids

Question 17

Why is surgery the preferred tx of choice for hyperparathyroidism?

Answer 17

Prolonged effects of hyperparathyroidism can be detrimental to all organ systems
(High serum calcium)

Question 18

In hypoparathyroidism, insufficient PTH causes serum calcium to be

Answer 18

Decreased

Question 19

In hypoparathyroidism, insufficient PTH causes serum phosphate to be

Answer 19

Increased

Question 20

With hypoparathyroidism, the relationship of decreased serum calcium and increased serum phosphate can result in:

Answer 20

Muscular irritability (tetany)

Question 21

Hypoparathyroidism: acute tetany

Answer 21

This is an emergency

Question 22

Hyperparathyroidism occurs most commonly with

Answer 22

Postmenopausal women

Question 23

Hypoparathyroidism is most commonly caused by

Answer 23

• injury

- accidental removal or genetic autoimmune destruction

Question 24

Hyperparathyroidism: major manifestations

Answer 24

• excessive PTH
• excessive bone demineralization
• excessive calcium in blood
• kidney stones
• decreased bone density/strength

Question 25

Hypoparathyroidism: major manifestations

Answer 25

• hypocalcemia
• hyperphosphatemia
• NM irritability (tetany)
• cardiac irritability

Question 26

Describe the interaction between the thyroid and parathyroid, starting with what happens with calcium rises above set point

Answer 26

1. Calcium level rises above set point
2. Thyroid gland releases calcitonin
3. Blood calcium levels fall
4. If calcium levels fall below set point, parathyroids release PTH
5. Blood calcium levels rise
6. If calcium levels rise above set point, thyroid releases calcitonin again.

BOOM