Adult Endocrine

Question 1

Hypothyroidism (myxedema)

Answer 1

• low T4; high TSH
• flattened affect
• constipation
• weight gain
• pedal edema
• low HR and BP

Question 2

Myxedema coma

Answer 2

• severely low thyroid levels

Question 3

Hyperthyroidism

Answer 3

• excessive T3 and T4
• agitation
• weight loss
• insomnia
• HR and BP up
• heat interlorance
• injected (red) cojunctiva

Question 4

Cushing’s disease

Answer 4

• Hypersecretion of ACTH from the pituitary gland
• excessive corticosterioids
  
  • causes suppresion of white blood cells
  • immune suppresion
• thyroid labs not affected
• osteoporosis

Question 5

Cushing disease symptoms

Answer 5

• sodium and water retention
• low hematocrit
• hypernatremia
• weight gain
• fatigue
• hyperglycemia
• thirst
• delayed wound healing
• sexual dysfunction
• acne

Question 6

Cushing disease care

Answer 6

• modify diet to low glycemic and sodium foods
• increasing potassium rich foods
• Low impact, weight bearing exercises to increase bone density

Question 7

Main symptom?

Addison’s disease

Answer 7

• decrease in androgens (sex hormones) and glucocorticoids
• shock and hypoglycemic**
• hyper-pigmented (very tan)
• do not adapt to stress
• hyponatremia

Question 8

Adrenal crisis

Answer 8

• abrupt end to steriods (prednisone)
• severe dehydration (fluid volume deficit)
  
  • tachycardia
  • hypotension
  • hyponatremia
  • weakness/fatigue
• henoconcentration (high hematocrit)
• hyperkalemia
  
  • peaked T wave
  • give sodium polystyrene
• adjust dose of steroids if planning serious exercise

Question 9

Give what?

Addisons Crisis

Answer 9

• Add a SONE (give steroids)

Question 10

pathophysiology of diabetes mellitus

Answer 10

Destruction of pancreatic beta-cells

Question 11

Pheochromocytoma

Answer 11

• Tumor in adrenal glands
  
  • too much of epinephrine and norepinephrine
• diagnose through 24-hour urine test
  
  • measure catecholamines (stress hormone)
  • elevated = positive
• classic triad
  
  • hypertension
  • hyperglycemia
  • headache
• weight loss

Question 12

pheochromocytoma high risk for

Answer 12

• hypertensive emergency
• avoid diet that can raise BP like cheese
• avoid caffeine, smoking
• avoid stress
• cardiac dysrhythmias
• panic (sweating, headache)

Question 13

Regular Insulin peak

Answer 13

• IV
  
  • 15-30 min
• Sub Q
  
  • 2-3 hours

Question 14

Most common cause of hyperthyroidism

Answer 14

Grave’s disease

Question 15

Grave’s disease

Answer 15

• HIGH LEVEL of thyrotropin receptor antibodies (TRAbs)
• give radioactive iodine
  
  • UNLESS PREGNANT/BREASTFEEDING
• exophthalmos/redness
  
  • no blinking
  • cool compress
  • elevate HOB
  • sunglasses
  • artifical tears
  • stop smoking
• risk for thyorid storm
• tachcardia
• excessive sweating
• weight loss
• agitation
• heat intolerance
• fatigue
• shortness of breath
• muscle tremors
• thin hair

Question 16

Myxedema

Answer 16

• severe, non-pitting edema
• puffy face and periorbital area (around eyes)
• coarse facial features
• dry skin and hair (coarse)

hypothyroidism w/ skin involvement

Question 17

Hypophysectomy

Answer 17

• neurosurgical technique for removing pituitary tumors
• urine output greater than 300 mL/hr is alarming
• Semi-Fowlers/Fowlers position is appropriate
• prophylactic nausea vomiting needed
  
  • Ondansetron!
• CSF leakage is serious
• risk for meningitis!
• increased ICP
• decreased smell is expected for a few months
• do not brush teeth = foul-smelling breath

Question 18

severe complication from neurosurgery around the pituitary

Answer 18

• Diabetes insipidus
• daily weights
• too much urine output can lead to shock

Question 19

Diabetic nephropathy

Answer 19

• proteinuria > 300 mg
• kidney fails
• monitor high BP

Question 20

Hyperglycemia

Answer 20

• glucose over 250
  
  • if over than check for serum ketones
• excessive thirst
• flushed, dry skin
• abdominal cramping
• orthotic hypotension
• hot and dry, your sugars high

Question 21

Jaundice in dark-skin

Answer 21

• examine
  
  • mucous mebranes
  • hard palate
  • sclera

Question 22

BMI + waist size

Answer 22

• BMI
  
  • 25-30 = overweight
  • 30+ = obese
• obese waist size
  
  • men
    
    • 40 inches (102 cm) or greater
  • women
    
    • 35 inches (88 cm) or greater

Question 23

Acanthosis nigricans

Answer 23

• darkening patches in skin folds
• happens with insulin resistance
• can indicate diabetes mellitus

Question 24

Thyroid panel test

Answer 24

• given for
  
  • constipation
  • decreased sex drive
  • reduced activity tolerance

Question 25

PSA test

Answer 25

- test for potential prostate cancer - start at age 55

Question 26

Metabolic syndrome

Answer 26

- hypertension - hyperglycemia - hyperlipidemia - obesity - precursor to acute coronary syndrome and diabetes type 2 - pregnant —> significant risk for gestational diabetes

Question 27

Serum cardiac enzymes

Answer 27

- diagnose acute coronary syndrome - given with angina

Question 28

C-reactive protein

Answer 28

- diagnose atherosclerosis

Question 29

Water deprivation test

Answer 29

- diagnose diabetes insipidus (DI)

Question 30

Hypoglycemia

Answer 30

- mild - less than 70 - 15g of carbohydrates - moderate - less than 40 - 30g of rapidly absorbed carbohydrates - UNLESS LETHARGIC AND SLURRED SPEECH = ASPIRATION RISK - severe - less than 20 - give glucagon - lethargy - garbled speech - KEEP THEM NPO - ASPIRATION RISK - hypertension - blurred vision - can look like stroke

Question 31

Essential hypertension

Answer 31

Hypertension without a known cause

Question 32

Metabolic panel

Answer 32

- information about fluid balance - electrolytes - sodium, potassium - how kidneys are working

Question 33

Diabetes insipidus

Answer 33

- lifelong treatment of Desmopressin - intranasally or by mouth - MAY NEED ADDITIONAL DOSE IF POLYURIA PERSISTS - can cause water intoxication - risk for water toxicity = EMERGENCY - headache, confusion, n/v - daily weights at same time - monitor intake and output - drink equal to amount losing