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S7- Differential Diagnosis > Week 11- Screening for Endocrine and Metabolic Disease > Flashcards

Week 11- Screening for Endocrine and Metabolic Disease Flashcards

1
Q

PART 1

A

PART 1

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2
Q

What is the endocrine system?

A

Ductless glands that produce hormones.

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3
Q

What are the (5) things that the endocrine system regulates?

A
  • Metabolism
  • Water/salt balance
  • BP
  • Stress response
  • Sexual reproduction
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4
Q

Endocrine System:

  • Complex and integral interactions with the ___________. (______ response from endocrine system compared to nervous system)
  • _________ mechanisms exist to keep hormones at normal levels.
A
  • nervous system (slower)

- feedback mechanisms

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5
Q

What are the organs of the endocrine system? (9)

A
  • Hypothalamus
  • Pineal Gland
  • Pituitary Gland
  • Thyroid Gland
  • Parathyroid Glands
  • Thymus
  • Adrenal Glands
  • Pancreas
  • Testes/Ovaries
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6
Q

Endocrine Pathophysiology:

  • Disorder can be classified as ________ or _________. Describe each.
  • Results in either ________ or ________ secretion of hormones.
A
  • primary (dysfunction of gland itself) or secondary (dysfunction of an outside stimulus to gland)
  • excessive or insufficient
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7
Q

Endocrine/Metabolic Disease S/Sx. (5)

A
  1. ) Muscle Weakness/Myalgia, and Fatigue
  2. ) Bilateral Carpal Tunnel Syndrome
  3. ) Periarthritis and Calcific Tendonitis
  4. )Spondyloarthropathy and OA
  5. ) Hand Stiffness/Pain
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8
Q
  1. ) Muscle Weakness, Myalgia, and Fatigue can be ______ manifestation of endocrine/metabolic disease. Is it always restored after treatment of underlying condition?
  2. ) Bilateral Carpal Tunnel Syndrome can be due to a thickening of _________ _________ __________.
  3. ) Periarthritis and Calcific Tendonitis most often occurs in the __________ in patients with endocrine disease.
  4. ) Spondyloarthropathy and OA occurs in individuals with various __________/_________ diseases.
  5. ) Hand stiffness/pain can occur due to _______ __________.
A
  1. ) early manifestation, NO
  2. ) transverse carpal ligament
  3. ) shoulders
  4. ) metabolic/endocrine
  5. ) flexor tenosynovitis
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9
Q

What is done if a cluster of S/Sx are found associated with endocrine disorder?

A

Endocrine ROS

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10
Q

PART 2: ENDOCRINE PATHOLOGIES

A

PART 2: ENDOCRINE PATHOLOGIES

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11
Q

List some endocrine pathologies. (6)

A

Pituitary
-Acromegaly

Adrenal Glands

  • Addison’s Disease
  • Cushing’s Syndrome

Thyroid Gland

  • Hyperthyroidism/Grave’s Disease
  • Hypothyroidism

Pancreas
-DM

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12
Q

What disease(s) are associated with the pituitary gland?

A

-Acromegaly

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13
Q

Acromegaly:

  • What is acromegaly?
  • What areas of the body does it most commonly affect?
  • Occurs in adults usually due to what?
A
  • HYPERSECRETION of GROWTH HORMONE (GH) resulting in abnormal enlargement of the extremities of the skeleton.
  • Face, jaw, hands, and feet
  • Pituitary gland tumor
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14
Q

Acromegaly S/Sx. (9)

A
  • Bony enlargement (face, jaw, hands, feet)***
  • Carpal tunnel***
  • Hand pain/stiffness***
  • Myopathy and poor exercise tolerance***
  • Degenerative arthropathy (large joints)***
  • Amenorrhea
  • DM
  • Profuse sweating
  • HTN
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15
Q

What disease(s) are associated with the adrenal glands?

A
  • Addison’s Disease

- Cushing’s Syndrome

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16
Q

What is the difference between Addison’s Disease and Cushing’s Syndrome?

A
  • Addison’s Disease = Adrenal INSUFFICIENCY (hyposecretion of adrenal gland)
  • Cushing’s Syndrome = Adrenal OVERSUFFICIENCY (hypersecretion of CORTISOL by the adrenal cortex.
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17
Q

What are the effects of cortisol on connective tissue? (3)

A
  1. ) Poor wound healing
  2. ) Generalized muscle weakness/wasting
  3. ) Osteoporosis
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18
Q

Cortisol suppresses the inflammatory response of the body, what does this mean?

A

-Early signs of infection may not be present. (Any unexplained fever without other symptoms should warrant MD referral)

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19
Q

Addison’s Disease S/Sx. (10)

A
  • Dark pigmentation of the skin, especially mouth and scars***
  • Progressive fatigue (improves with rest)***
  • Hyperkalemia (results in generalized weakness and muscle flaccidity)***
  • Arthralgias, myalgias (secondary only)***
  • Tendon calcification***
  • Hypotension
  • GI disturbances
  • Anorexia and weight loss
  • N/V
  • Hypoglycemia
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20
Q

Cushing’s Syndrome S/Sx. (10)

A
  • “Moonface” appearance***
  • Buffalo hump***
  • Protuberant abdomen w/ accumulation of fatty tissue and stretch marks***
  • Muscle wasting and weakness, thin extremities***
  • Decreased bone density, kyphosi, and back pain***
  • HTN
  • Easy bruising and slow wound healing
  • Psychiatric and/or emotional disturbance
  • Impaired reproductive function; masculinizing effects
  • DM
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21
Q

What disease(s) are associated with the thyroid gland?

A
  • Hyperthyroidism/Grave’s Disease

- Hypothyroidism

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22
Q

Hyperthyroidism:

  • Disorder in which the thyroid secretes excessive amounts of ________ hormone.
  • Results in generalized ________ in body metabolism affecting every system in the body.
  • What are some MSK implications of Hyperthyroidism/Grave’s Disease? (3)
A
  • thyroid hormone
  • elevation in body metabolism
  • Periarthritis (most common in SHOULDER, can progress to ADHESIVE CAPSULITIS), Acute calcific tendonitis of the wrists, PROXIMAL muscle weakness and myopathy (pelvic girdle/thigh)
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23
Q

Hyperthyroidism S/Sx. (7)

A
  • Exophthalmos***
  • Enlarged thyroid
  • Tachycardia
  • Weight loss
  • Diarrhea
  • Warm skin, sweaty palms
  • Hyperreflexia
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24
Q

Hypothyroidism:

  • Disorder in which the thyroid has under production of _______ hormone.
  • Results in generalized _________ of body metabolism.
  • Are men or women more likely to have hypothyroidism?
  • What are (2) other things hypothyroidism can result in?
A
  • thyroid hormone
  • depression in body metabolism
  • women (10x more likely)
  • Carpal Tunnel Syndrome (usually bilateral), Proximal muscle weakness
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25
Q

Hypothyroidism S/Sx. (8)

A
  • Excessive fatigue and drowsiness
  • Dry skin, ichthyosis
  • Thin and brittle hair and nails
  • Hoarseness and thick, slurred speech
  • Weight gain
  • Headaches
  • Cold intolerance
  • Edema of the extremities
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26
Q

Thyroid Storm:

  • Is it associated with hyperthyroidism or hypothyroidism?
  • What is it?
  • What are the (3) main precipitating factors?
A
  • Hyperthyroidism (Grave’s Disease)
  • Rare, life threatening complication of hyperthyroidism that can present when the disease is untreated or the disease is incorrectly treated.
  • TRAUMA, INFECTION, SURGERY
27
Q

Thyroid Storm S/Sx. (8)

A
  • Severe tachycardia with HF
  • Shock
  • Hyperthermia (up to 105.3 degrees)
  • Restlessness
  • Agitation
  • Abdominal pain
  • N/V
  • Coma
28
Q

What disease(s) are associated with the pancreas?

A

-Diabetes Mellitus

29
Q

Diabetes Mellitus (DM):

  • Deficient or defective _______ action in the body.
  • Characterized by ______glycemia.
  • What is the difference between Type I and Type II?
A
  • deficient of defective INSULIN action
  • hyperglycemia
  • Type I (little/no insulin produced in pancreas), Type II (defective insulin and/or impaired cell receptor binding of insulin)
30
Q

How is DM diagnosed?

A
  1. ) Two different days of fasting blood glucose levels at >126mg/dL
  2. ) Values >100mg/dL are considered “pre-diabetic”
31
Q

PT can offer clients with pre-diabetes or diabetes education regarding ___________ and _________ as a means of lowering their risk of diabetes or reducing the risk of complications from diabetes.

A

physical activity and exercise

32
Q
  • What specific drugs have a contribution to hyperglycemia due to their glucogenic effect?
  • Otherwise controlled diabetes can become uncontrolled during times of ________.
A
  • Corticosteroids (also epinephrine, glucocorticoids, and growth hormone)
  • Stress (surgery, trauma, pregnancy, puberty, or infectious states)
33
Q

Diabetes Mellitus S/Sx. (4)

A
  • Xanthomas (fat buildup under skin)***
  • Numbness/tingling in hands and feet***
  • Wounds that are slow to heal***
  • Fatigue and weakness
34
Q

What are some physical complications of DM? (5)

A
  • Impaired wound healing/infection***
  • Neuropathy (diabetic neuropathy, carpal tunnel, Charcot’s)***
  • Periarthritis***
  • Hand stiffness (limited joint mobility syndrome, flexor tenosynovitis, Dupuytren’s contracture, complex regional pain syndrome)***
  • Atherosclerosis
35
Q

Diabetic Neuropathy:

  • What is the most common chronic complication of long-term DM?
  • Caused by decreased ________ _________ to nerve tissue.
  • What nervous system does it affect first?
  • How does peripheral sensory neuropathy present?
  • How does peripheral motor neuropathy present?
A
  • Diabetic Neuropathy
  • vascular perfusion
  • PNS
  • Burning/itching/numbness/sensitivity in the FEET and HANDS (stocking/glove syndrome)
  • Weakness, atrophy, and foot drop resulting in decreased balance and absence of DTRs.
36
Q

Diabetic Neuropathy:

  • Can also result in Charcot joints. What is this?
  • Results in _____, _______ and _____ disorders.
  • Increases the likelihood of _________ development.
A
  • Loss of proprioception and sensation predisposing joints to repeated trauma and progressive joint destruction.
  • hand, shoulder, and foot disorders
  • ulceration development
37
Q

Periarthritis:

  • What is it?
  • Does it regress, stay stable, or progress?
  • Higher incidence in ________ _________.
A
  • Inflammation of the structures around a joint.
  • May regress, remain stable, or progress spontaneously.
  • Adhesive Capsulitis
38
Q

Hand Stiffness:

  • Syndrome of limited joint mobility (SLJM or LJM) is painless stiffness and limitation of the _____ joints. Results in development of _______ contractures.
  • Stiff hand syndrome is seen more frequently in Type __ DM and those with poorly controlled blood glucose. Paresthesia progressing to pain, subcutaneous tissue changes.
A
  • finger joints, flexion contractures

- Type I

39
Q

Flexor Tenosynovitis:

  • What is it?
  • Results in formation of _________.
A
  • Accumulation of excessive dermal collagen in the tendon sheath.
  • nodules
40
Q

Dupuytren’s Contracture:

  • What is it?
  • Strong association with ____.
  • Usually involves ____/____ digits.
  • Presentation of _____ and decreased _____.
A
  • Characterized by formation of flexion contracture and thickening band of palmar fascia.
  • DM
  • 3rd/4th
  • pain and decreased ROM
41
Q

Chronic Regional Pain Syndrome:

  • May develop in patients with DM in the _____ or _____.
  • Does it get better or worse over time?
A
  • hands or feet

- Can spontaneously improve or result in permanent loss of function.

42
Q

PT Role In Screening For DM. (7)

A
  • Assess for neuropathy
  • Assess for signs of neuropathic arthropathy
  • Monitor for signs/symptoms of changes in blood glucose levels during exercise
  • Monitor vital signs
  • Conduct periodic lower extremity vascular examination
  • Screen for depression
  • Encourage regular screenings with other disciplines
43
Q

DM Exercise Related Considerations:

  • Blood glucose >____mg/dL = hold exercise
  • Blood glucose
A
  • > 250 = hold exercise

- <100 = eat snack before exercise

44
Q
  • ____________ is a severe insulin deficiency resulting in severe hyperglycemia caused by undiagnosed DM or situation where insulin need becomes greater than usual.
  • It is more common with Type I or II?
A
  • Diabetic Ketoacidosis (DKA)

- DM Type I

45
Q

DKA S/Sx. (13)

A
  • Fruity Breath***
  • Gradual onset
  • Thirst
  • Hyperventilation
  • Lethargy/confusion
  • Coma
  • Muscle/abdominal cramps
  • Polyuria/dehydration
  • Flushed face
  • Hot/dry skin
  • Elevated temperatures
  • Blood glucose >300mg/dL
  • Serum pH <7.3
46
Q

-Hypoglycemia = blood sugar

A
  • <70mg/dL

- Treated via sugar administration (10-15g)

47
Q

Hypoglycemia S/Sx. (13)

A

Sympathetic Activity

  • Pallor
  • Perspiration
  • Irritability/nervousness
  • Weakness
  • Hunger
  • Shakiness

CNS Activity

  • HA
  • Double/blurred vision
  • Slurred speech
  • Fatigue
  • Numbness of lips/tongues
  • Confusion
  • Convulsion/coma
48
Q

DM Key Points:

  • Clients taking __________ medication must be monitored for changes in blood glucose levels.
  • ________ must be carefully planned because significant complications can result from strenuous exercise.
  • Insulin requirements often _______ for clients under physical, emotional, or physiological stress. Symptoms may present even though diabetes normally controlled.
A
  • corticosteroid
  • exercise
  • increase
49
Q

PART 3: METABOLIC DISEASE

A

PART 3: METABOLIC DISEASE

50
Q

What are the 2 main metabolic pathologies?

A
  • Gout

- Osteoporosis

51
Q

Gout:

  • What is it?
  • What joint is affected first 90% of the time?
  • When should a PT refer anyone being treated for gout?
A
  • TINY URIC ACID CRYSTALS forming that collects in the joints, triggering a PAINFUL INFLAMMATORY RESPONSE.
  • first MTP 90%
  • Therapist should refer anyone being treated for gout who has recurrent symptoms.
52
Q

Gout S/Sx. (5)

A
  • Joint pain and swelling (esp 1st MTP)***
  • Redness***
  • Fever/chills
  • Malaise
  • Tophi
53
Q

Osteoporosis:

  • What is it?
  • Postmenopausal osteoporosis particularly involves the ________.
  • What may be the only (2) early signs of osteoporosis?
  • What are the (3) cardinal signs of established osteoporosis?
A
  • Decreased mass per unit of normally mineralized bone compared with age- and gender-matched controls.
  • vertebrae
  • mild-severe back pain and loss of height
  • bone fracture, pain, and deformity
54
Q

Osteoporosis Risk Factors:

  • Caucasian or Asian ___________
  • ___________ (older than 65)
  • Early or surgically induced ____________
  • Family Hx of _________ or ________
  • _________ habits including smoking, excessive alcohol, inadequate Ca+, and little-no WB exercise
  • Prolonged exposure to what medications?
  • Thin-small frame
  • Chronic disease that affects the kidneys, lungs, stomach, and intestines
A
  • females
  • postmenopause
  • menopause
  • osteoporosis or fractures
  • lifestyle habits
55
Q

Osteoporosis S/Sx. (4)

A
  • Back Pain (episodic, acute LBP)***
  • Compression Fx of spine***
  • Decreased height***
  • Severe kyphosis, Dowager’s hump***
  • Bone Fx
56
Q

What are some clues to recognize osteoporosis? (5)

A
  • Severe, localized pain to Fx site.
  • Aggravating factors: prolonged sitting/standing/bending, Valsalva.
  • Not accompanied by sciatic or nerve root impingement pain.
  • Rib/spinal deformity, Dowager’s hump
  • Loss of height
57
Q

Patient is at increased risk for osteoporosis if they answer “Yes” to ________ questions on the Osteoporosis Screening Evaluation.

A

-3 or more

58
Q

Vertebral Compression Fracture:

  • Back pain with highest incidence at levels __-__ and __-__.
  • What position relieves symptoms?
  • What aggravates symptoms?
  • May note _______ thoracic kyphosis.
  • Describe common MOI?
A
  • T7-T8 and T12-L1
  • lying in supine
  • standing/walking, TTP
  • increased
  • MOI: Typically secondary to trauma, can be as simple as sneezing.
59
Q

Vertebral Compression Fracture Nonmodifiable Risk Factors. (7)

A
  • Advanced age
  • Female
  • Caucasian
  • Presence of dementia
  • Susceptibility to falling
  • Hx of fracture in adulthood
  • Hx of fracture in a 1st degree relative
60
Q

Vertebral Compression Fracture Modifiable Risk Factors. (8)

A
  • Alcohol/tobacco use
  • Presence of osteoporosis and/or estrogen deficiency
  • Early menopause
  • Frailty
  • Impaired eye-sight
  • Insufficient physical activity
  • Low BW
  • Ca+ and/or Vitamin D deficiency
61
Q

PMH Clues to Screen for Endocrine/Metabolic Disease. (5)

A
  • Previously diagnosed endocrine/metabolic disorder.
  • Bilateral carpal tunnel syndrome.
  • Proximal muscle weakness.
  • Periarthritis of shoulders.
  • Long term corticosteroid use.
62
Q

Guidelines for immediate medical attention with diabetes?

A

confusion, lethargy, changed mental function, profuse sweating, signs of DKA

63
Q

Guidelines for Physician Referral:

  • Presence of multiple eruptive _________ on anyone with DM.
  • Signs of fluid loss/dehydration in anyone taking _________.
  • Recurrent arthritic symptoms in client with _____ who is already taking urate-lowering drugs.
  • Any episode or suspected episode of ______glycema.
A
  • zanthomas
  • diuretics
  • gout
  • hypoglycemia

S7- Differential Diagnosis (15 decks)

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