227 Other Systems: Endocrine/metabolic

Front 1

What is Addison's Disease?

Back 1

Autoimmune process that causes the adrenal glands to underproduce cortisol and aldosterone

Front 2

What are early symptoms of Addison's Disease?

Back 2

Nonspecific weakness and fatigue

Front 3

what is the screening for Addison's disease

Back 3

ACTH stimulation testing

measures reserve capacity of the adrenal gland for steroid production

Front 4

Symptoms of Addison's Disease include

Back 4

1. Hyperpigmentation of skin &; mucous membranes
2. Progressive fatigue
3. GI disturbance
4. Nausea & vomiting
5. Weight loss
6. Tendon calcification
7. Hypoglycemia

8. Potassium elevation leading to ascending myopathy causing flaccid paralysis & polyneuropathy

Front 5

What is Cushing's syndrome?

Back 5

-Oversecretion of cortisol by the adrenal cortex or long-term use of corticosteroids due to inflammatory disorders

Front 6

Symptoms of Cushing's syndrome include:

Back 6

1. Moon face appearance
2. Cervical fat pad
3. Truncal obesity
4. Muscle wasting and weakness
5. Osteoporosis
6. Hypertension
7. Easy bruising
8. Depression
9. Excessive facial hair
10. Ruddy complexion
11. Slow wound healing

Front 7

Thyroid function is regulated by what?

Back 7

Hypothalamus and pituitary feedback controls

intrinsic regulatory mechanism within gland itself

Front 8

What is Hypothyroidism?

Back 8

-Decreased thyroid hormone condition causing generalized depression of the metabolism
Diagnosed if TSH (thyroid-stimulating hormone) level is elevated

Front 9

Symptoms of Hypothyroidism include:

Back 9

1. Cold intolerance
2. Excessive fatigue and lethargy
3. Headaches
4. Weight gain
5. Dry skin
6. Increasing thinness/brittleness of hair and nails
7. Peripheral edema
8. Peripheral neuropathy
9. Proximal weakness

Front 10

What is Hyperthyroidism?

Back 10

Excessive production of thyroid hormone (Graves' disease), resulting in a generalized elevation of the body metabolism
-Occurs in countries where iodine is insufficiently present in diet
-Diagnosed if TSH level is depressed

Front 11

Symptoms of Hyperthyroidism include:

Back 11

1. Tachycardia
2. Heat intolerance & Increased sweating
3. Increased appetite
4. Dyspnea
5. Weight loss & inability to gain weight
6. Anxiety
7. Goiter (enlargement of the thyroid gland)
8. Exophthalmia

Front 12

what is exophthalmia and what is it caused by?

Back 12

eyes seem to be bulging out

occurs with hyperthyroidism (Grave's Disease)

-caused by hypertrophy of the eye muscles coupled with incr in connective tissue in the orbit.

Front 13

what does the parathyroid gland do?

Back 13

secretes parathyroid hormone, which regulates calcium and phosphorus metabolism

Front 14

what is hyperparathyroidism

Back 14

-Excess PTH leads to an elevated calcium level and decreased serum phosphate level
-This causes demineralization of the bone and subsequent loss of bone strength and density

Front 15

Symptoms of Hyperparathyroidism include:

Back 15

1. Proximal weakness
2. Fatigue
3. Drowsiness
4. Arthralgia/myalgia
5. Depression
6. Glove/stocking sensory loss
7. Osteopenia/fractures
8. Confusion/memory loss
9. Pancreatitis
10. Gout
11. Osteitis fibrosa cystica (bone lesions called Brown tumors)

Front 16

What is Hypoparathyroidism?

Back 16

Decreased or absent production of PTH
Diagnosed with a low serum calcium, low serum PTH and high phosphorous

Front 17

Symptoms of Hypoparathyroidism include:

Back 17

1. Neck stiffness/muscle cramps
2. Seizures
3. Irritability & Depression
4. Skeletal muscle twitching
5. Cardiac arrhythmias
6. Paresthesias (tingling finger tips and mouth)
7. Chvostek's sign (twitching of facial muscles with tapping of facial nerve in front of ear)

Front 18

Functions of pancreas:

Back 18

Exocrine gland: produces digestive enzymes
Endocrine gland: produces insulin & glucagons

Front 19

what is diabetes mellitus?

Back 19

Chronic systemic disorder caused by defective or deficient insulin action in the body and disruption of the metabolism of carbohydrates, fats, and proteins

Front 20

What is Type I Diabetes?

Back 20

1. Insulin-dependent diabetes mellitus (IDDM) or juvenile onset
2. Immune mediated, causes beta cell destruction that usually results in absolute insulin deficiency
3. ADA diagnostic criteria include fasting glucose level of >126 mg/dL or "casual" blood glucose level of >200 plus symptoms of DM

Front 21

What is Type 2 Diabetes?

Back 21

1.. Non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset
2. Characterized by defective insulin production and/or impaired receptor binding of insulin
3. Occurs mainly in adults >30 years of age with a gradual onset and slow progression of symptoms
4. Obesity, family history, race, or women with high birth weight babies can be factors

-same diagnostic criteria as IDDM

Front 22

what is blood glucose level for hypoglycemia and symptoms of hypoglycemia?

Back 22

1. <50-60mg/dL

2. Skin is pale, cool, and diaphoretic
3. Disoriented or agitated
4. Headache
5. Blurred vision
6. Slurred speech
7. Tachycardia with palpitations;

8. weak/shaky
9. Loss of consciousness

Front 23

what is blood glucose level for hyperglycemia and symptoms of hyperglycemia?

Back 23

>180mg/dL

1. Skin is dry and flushed
2. Fruity breath odor
3. Frequent urination (polyuria)
4. Unusual thirst (polydipsia)
5. Extreme hunger
6. Unusual weight loss (10 lbs in 1 month)
7. Extreme fatigue
8. Irritability
9. Blurred vision
10. Fungal infections (toenails, skin folds)
11. Dizziness

Front 24

Complications of Diabetes Mellitus include:

Back 24

1. Atherosclerosis

2. Infection/impaired wound healing

3. neuropathy

4. Periarthritis (bilat hands and shoulder pain

5. Hand stiffness (limited joint mobility; flexor tenosynovitis; Dupuytren's contracture; complex regional pain syndrome (CRPS))

6. Depression

Front 25

what are the types of atherosclerosis complications that occur with DM?

Back 25

Macrovascular disease:

1. CVD (cerebrovascular disease)

2. CAD,

3. renal artery stenosis,

4. PVD

Microvascular disease:

1. nephropathy,

2. retinopathy,

3. decreased microcirculation to skin/organ

Front 26

what types of neuropathy are complications of DM?

Back 26

1. autonomic (postural hypotension, decreased HR),

2.peripheral (polyneuropathy; diabetic foot),

3. diabetic amyotrophy,

4. carpal tunnel syndrome

5. Charcot's joint

Front 27

what are interventions for DM?

Back 27

Maintaining blood glucose levels within the range of 80-120 mg/dl by diet, exercise, an medication

Front 28

Exercise produces what in a diabetic?

Back 28

An insulin like effect on the body by accelerating the movement of glucose out of the bloodstream & into peripheral tissues where it is needed

-increases glucose uptake

-combination of insulin and exercise can result in hypoglycemia

Front 29

when is exercise contraindicated for pts with DM?

Back 29

1. Blood glucose is >250 with evidence of urinary ketones
2. Blood glucose is at or near 300 with/without urinary ketones
3. Do not exercise during peak insulin times

Front 30

Exercise strategies for Diabetes:

Back 30

1. Best time to exercise: 1 hour after a meal

-increase complex carb intake at least 24 hours before and after exercise
2. Check pt blood glucose prior to exercise
3. Administer insulin well before exercise starts
4. Take carb snacks before, during, and after depending upon exercise intensity

Front 31

when should you not exercise DM patient on insulin to prevent hypoglycemia?

Back 31

1. do not exercise 2-4 hours after insulin injection due to insulin being at its peak concentration in the blood

2. Decrease insulin dose by 30%-35% before anticipated exercise

3. Inject insulin into a non-exercising limb or body part & do not exercise that part for at least 1 hour following injection
4. Exercising an injected limb too soon could result in increased insulin uptake & result in hypoglycemia
5. Reduce post-exercise insulin dose by up to 30%
6. Short-acting or continuous subcutaneous insulin infusion may have to be eliminated immediately before or after exercise

Front 32

what actions should be taken with different blood glucose readings taken during exercise?

Back 32

1. if blood glucose level is 70 mg/dL, a carb snake should be given and retest pt after 15 min

2. if >250, pt should not exercise

3. if between 70-100 and symptoms of hypoglycemia are present, food should be given

Front 33

what puts DM patients at risk for foot conditions?

Back 33

1. vascular deficiencies

2. diminished sensation

-put at risk for developing plantar ulcerations and other deformities such as claw toes

Front 34

Foot care program for diabetes:

Back 34

1. Wash (do not soak) feet daily in warm water

2. After wash apply petroleum jelly or lotion
3. Cut toenails straight across by a podiatrist
4. Wear clean, white socks with minimal wrinkles, 5. Wide jogging or walking shoes
6. Use different shoes or alternate shoes each day

Front 35

what are symptoms of fluid deficit/dehydration?

Back 35

1. Initially, thirst & weight loss
Progressed condition:
2. Dryness of mouth, throat, & face
3. Absence of sweat
4. Increased body temperature
5. Low urine output
6. Postural hypotension -incr HR with 10 beats/min; Systolic BP drop of 20 mm/Hg with sit to stand
7. Dizziness when standing
8. Increased hematocrit

Front 36

What is Water intoxication?

Back 36

-Excess of extracellular water in relationship to solutes
-Results in hyponatremia
-Potassium may also be lost in this process

-water shifts into the brain and dilutes sodium in the vascular space causing neurological symptoms

Front 37

what are the neurological symptoms that occur with fluid excess/hyponatremia?

Back 37

1. Decreased mental alertness
2. Sleepiness
3. Anorexia
4. Poor motor coordination
5. Confusion and convulsions
6. Sudden weight gain
7. Warm, moist skin
8. Hyperventilation
9. Mild peripheral edema
10. Low serum sodium; low hematocrit

11. signs of increased intracerebral pressure

Front 38

what are Signs of increased intracerebral pressure:

Back 38

1. Slow pulse
2. INC SBP (>10 mmHg)
3. DEC DBP (>10 mmHg)

Front 39

what are causes of edema?

Back 39

excess of solutes/water caused by:

1. decreased CO

2. endocrine imbalances

3. loss of serum proteins

4. vein obstruction

Front 40

what are symptoms of edema?

Back 40

1. weight gain

2. excess fluid

3. pitting edema

4. increased BP

5. jugular venous distention

6. CHF

7. effusions

Front 41

what are treatments for edema?

Back 41

diuretics (thiazide diuretics)

-inhibit sodium and water resorption by kidneys

-may also cause loss of potassium resulting in hypokalemia

Front 42

what are symptoms of hypokalemia?

Back 42

1. Muscle weakness, fatigue
2. Cardiac arrhythmias
3. Abdominal distention
4. Nausea and vomiting

Front 43

Metabolic alkalosis occurs when?

Back 43

When either an abnormal loss of acid or excess accumulation of bicarbonate occurs

1. vomiting

2. diuretics

3. steroids

4. adrenal disease

5. upper GI suctioning

6. Diabetic therapy
7. Ingestion of large amounts of base substances like antacids

Front 44

Symptoms of Metabolic alkalosis include:

Back 44

1. Nausea & prolonged vomiting
2. Diarrhea
3. Confusion
4. Irritability, agitation, & restlessness
5. Paresthesias
6. Convulsions
7. Slow shallow breathing, eventual coma
6. Muscle weakness, fasciculation and cramping

Front 45

Metabolic acidosis occurs when?

Back 45

When there is an accumulation of acids or a deficit of bases

1. Diabetic ketoacidosis

2. Renal failure
3. Severe diarrhea
4. Drug or chemical toxicity
5. Blood pH decreases below 7.35

6. lactic or uremic acidosis

Front 46

Symptoms of Metabolic acidosis

Back 46

1. Headache
2. Fatigue
3. Drowsiness & lethargy
4. Nausea & vomiting
5. Diarrhea
6. Muscular twitching
7. Convulsions
8. Coma
9. Rapid deep breathing and hyperventilation

Front 47

What is Gout?

Back 47

Excess uric acid in the blood results in the deposition of urate crystals in the joints, soft tissues, and kidneys, causing a painful inflammatory response

Front 48

Gout primarily affects what?

Back 48

peripheral joints
1. MTP joint of great toe
2. Instep
3. Ankle
4. Heel
5. Knee
6. Wrist

7. hand

Front 49

Symptoms of gout include:

Back 49

1. Acute monoarticular inflammatory arthritis
2. Redness
3. Swelling
4. Low-grade fever, malaise

Front 50

what are treatments for gout?

Back 50

1. urate lowering drugs such as colchicines, NSAIDs, or steroids

2. allopurinol to reduce hyperuricemia

Front 51

what are treatments for gout in acute phases?

Back 51

rest, elevation, and joint protection

Front 52

what is metabolic syndrome?

Back 52

Syndrome X

-cluster of risk factors that incr likelihood of developing heart disease, stroke, and type 2 DM

Front 53

what are the risk factors/diagnostic criteria for metabolic disease/syndrome X?

Back 53

3 or more of the following

1. abdominal obesity: large waist size.

M: ≥ 40 inches; F: ≥ 35 inches

2. Elevated Triglycerides: ≥150

3. Low HDL:

M: <40 F: <50

4. High BP: SBP ≥135 &/or DBP ≥85

5. Blood sugar: Fasting ≥100

Front 54

What is hemochromatosis?

Back 54

-Hereditary disorder, characterized by excessive absorption of iron by the small intestines
-Early stages: asymptomatic
Progression: irreversible tissue/organ damage in heart, pancreas, liver, endocrine glands, joints, bone, and skin

Front 55

Symptoms of Hemochromatosis include:

Back 55

1. Arthropathy
2. Arthralgias
3. Myalgias
4. Progressive weakness
5. (B) pitting edema LE
6. Hyperpigmentation of skin
7. CHF
8. Loss of body hair
9. Diabetes mellitus

Front 56

What is Osteomalacia?

Back 56

Softening of the bones without loss of the bone matrix,

-caused by Vitamin D deficiency in adults
-X-ray examination reveals transverse, fracture-like lines in the affected bones

Front 57

Osteomalacia occurs primarily where?

Back 57

Spine
Pelvis
LE

Front 58

Symptoms of osteomalacia include:

Back 58

1. Bone pain
2. Skeletal deformities
3. Fractures
4. Severe muscle weakness
5. Myalgia

Front 59

Similar condition as osteomalacia in children, before epiphyseal plate closure, is called what?

Back 59

Rickets
It presents itself at the metaphyseal ends of long bones as well as sternal ends of ribs

Front 60

What is Paget's disease characterized by?

Back 60

Excessive bone resorption & formation in a haphazard fashion,

-producing bone that is larger, less compact, more vascular, and more susceptible to fractures
-Clinical presentation varies greatly from asymptomatic to a disabling, painful form where bones are extremely deformed and fracture easily

Front 61

Bones most commonly affected by Paget's Disease are:

Back 61

1. Skull
2. Pelvis
3. Spine
4. Sacrum
5. Femur
6. Tibia

Front 62

Symptoms of Paget's disease

Back 62

1. Pain
2. Stiffness
3. Fatigue
4. Headache and dizziness
5. Vertebral compression and collapse
6. Fractures
7. Deformity
8. Bowing of the long bones
9. Periosteal tenderness