Endocrine/Metabolic Disease

Question 1

Endocrine system function is to maintain __ __ __ through coordination of __ that relay info/instructions b/w cells.

Answer 1

1) whole body homeostasis
2) hormones

Question 2

Name 5 body functions the endocrine system regulates.

Answer 2

1) Metabolism
2) Water/salt balance
3) BP
4) stress response
5) sexual reproduction

Question 3

Endocrine system is composed of __. Name 4 of these.

Answer 3

1) Glands
2) Pituitary, Thyroid, Parathyroid, Adrenal, Pineal glands, Thymus, Pancreas, Testes/Ovaries

Question 4

Endocrine/Metabolic disease S&S include muscle weakness / myalgia / cramps / fatigue, periarthritis & calcific tendinitis, and bilateral carpal tunnel syndrome. What are 3 NM/MSK S&S assoc. w/ endocrine disease.

Answer 4

1) Chondrocalcinosis
2) Spondyloarthropathy & Osteoarthritis
3) Hand Stiffness & Hand Pain

Question 5

1) What is DM?
glucose levels >/=126 mmg/dL
2) What is it caused by?
3) What can it result in?

Answer 5

1) hyperglycemia + disrupted metabolism of carbs, fats, & proteins
2) deficient insulin or defective insulin action
3) vascular complications & neuropathies

Question 6

Some S&S of DM are
Polydipsia, Hyperglycemia, Glycosylated hemoglobin (A1C levels ≥6.5%), Glycosuria, & Ketonuria.
1) Name 5 more S&S.
2) What 2 S&S are usually seen in type 1 DM cases?

Answer 6

1) Polyuria, Fatigue/weakness, Blurred vision, Irritability, Recurring infections, Numbness/tingling in hands and feet, delayed wound healing
2) Usually Type 1: Polyphagia (excessive hunger), Weight loss

Question 6

DM leading cause of end-stage __ disease, nontraumatic LE __, & new cases of __. It’s also a major cause of __ __ and stroke.

Answer 6

1) renal
2) amputations
3) blindness
4) heart disease

Question 7

Type __ DM is defective insulin or impaired binding of insulin. It’s common in the >40 y/o population.
Type __ DM is when little/no insulin is produced. It’s common among kids or young adults.

Answer 7

1) type 2 DM

2) type 1 DM

Question 8

DM Physical complications include periarthritis, infection/impaired wound healing, and __(3).

Answer 8

1) Atherosclerosis
2) Hand stiffness
3) Neuropathy

Question 9

__ is the most common complication of chronic DM that may affect CNS, PNS, or ANS. The most common type of this is ___.

Answer 9

1) Diabetic Neuropathy
2) Chronic Sensorimotor Distal Symmetric Polyneuropathy (DPN)

Question 10

Diabetic neuropathy S&S include sensory impairments of extremities, weakness, hypo/areflexia, LOB, & CTS (carpal tunnel). What are 4 autonomic S&S of diabetic neuropathy?

Answer 10

GI S&S, Erectile dysfunction, UTI, urinary incontinence, diaphoresis, dry, cracked skin, incr. infection risk, restricted pupillary adjustment, OH,
no HR variability

Question 11

Charcot’s Joint is a neuropathic arthropathy seen in pts w/ DM. What is it characterized by? Name 3 S&S of Charcot’s Joint.
Shoulder, hand, and foot disorders are very common

Answer 11

1) Loss of proprioception –> repetitive stress & degenerative joint pathology
2) unilat. severe swelling, S&S of inflammation, impair deep pressure, joint deformity (PIP ext/DIP flex)

Question 12

2 S&S of DM are periarthritis and hand stiffness. Periarthritis is common in these body regions __(2). Hand stiffness can present as __ tenosynovitis, __ contracture, & CRPS.

Answer 12

1) hand & shoulder
2) flexor tenosynovitis
3) Dupuytren’s contracture

Question 13

W/ DM pts, STOP exercise if glucose is >___ mg/dL. Have pt eat snack before exercise is glucose is <___mg/dL.
Retest glucose prior to initiation of exercise

Answer 13

1) STOP = >250mg/dL

2) Snack = <100mg/dL

Question 14

Severe Hyperglycemia = >___mg/dL and can lead to DKA.
Diabetic ketoacidosis is common with Type __ DM pts. DKA S&S include coma, incr. temp, muscle cramp, dehydration, polyuria, & __(4).

Answer 14

1) >400mg/dL
2) Type 1 DM
3) Thirst, Hyperventilation, Fruity breath, Flushed face & hot/dry skin

Question 15

Hypoglycemia = <__mg/dL & is a complication of insulin or oral hypoglyemic agent use. Its commonly due to decr. __ intake or __ physical activity.

Answer 15

1) <70mg/dL
2) decr. food intake
3) incr. physical activity
O2 consumption in NS interrupted; can lead to brain damage & death

Question 16

Name 4 S&S of hypoglycemia that are NOT S&S of hyperglycemia.

Answer 16

Pallor, irritability / nervousness, weakness, hunger, shakiness, headache, Double/blurred vision, Slurred speech, fatigue

Question 17

T/F: Acromegaly is abnormal enlargement of axial skeleton. Its d/t GH hypersecretion & can be caused by a tumor in the pituitary gland. In adulthood it mostly affects bones of the face/jaw, hands, & feet..

Answer 17

False; everything is true except it is actually the enlargement of EXTREMITIES of the skeleton

Question 17

Other than bone enlargement, CTS, hand pain/stiffness, & diaphoresis, name 4 more S&S of acromegaly.

Answer 17

Amenorrhea
DM
HTN
Mid/LBP
Prox. myopathy & poor exercise tolerance
Fibromyalgia

Question 18

Addison’s disease is chronic ___ insufficiency d/t hyposecretion by the __ glands. Some S&S of this is hypotension, progressive fatige, hyperkalemia, & __(4).

Answer 18

1) adrenocortical
2) adrenal glands
3) Dark skin around mouth & scars, GI, anorexia/wt loss, N/V, arthralgia/myalgias, tendon calcification, hypoglycemia

Question 19

Cushing’s Syndrome is increased adrenal gland secretion of __, which suppresses the __ response. B/c of this, a warning flag for referral is any unexplained ___ w/out other S&S.

Answer 19

1) cortisol
2) inflammatory
3) fever

Question 20

Cushing’s Syndrome S&S include __ effect for women, slow wound healing, DM/HTN, easy bruising, muscle wasting/weakness, & __(4).

Answer 20

-“Moonface”
-Buffalo hump at the neck
-Protuberant abdomen with fat accum. + stretch marks
-Decreased BMD/OP
-Kyphosis and back pain
-Psych/emotional disturbances
-Impaired reproductive fxn

Question 21

Thyroid gland enlargement is called a __. S&S include incr. neck size, pressure on adj. structure, & (3).
dietary iodine deficiency

Answer 21

1) goiter
2) difficulty in breathing, dysphagia, hoarseness

Question 22

Another name for hyperthyroidism is __.
__ disease is a common hyperfunction disease. 2 common S&S of this disease are __.

Answer 22

1) thyrotoxicosis
2) Grave’s Disease
3) Goiter and Exopthalmos (bulging of the eyes)

Question 23

Hyperthyroidism causes a generalized elevation is body __. Some S&S seen in older adults are tremors, palpitations, anxiety, & _(2). S&S seen in younger pts are __ intolerance, weight __, dry skin, & _(2).

Answer 23

1) metabolism
2) wt loss, heat intolerance
3) Cold intolerance
4) Wt gain
5) Constipation, mental/physical slowing

Question 24

4 Main complications that can arise w/ hyperthyroidism is __.
Acronym: CPDP

Answer 24

1) Calcific tendinitis
2) Periarthritis
3) Decr. BMD/OP
4) Prox. Muscle weakness/atrophy

Question 25

What is a life-threatening complication of hyperthyroidism that requires immediate referral if detected? What are 5 S&S to lookout for?

Answer 25

1) Thyroid Storm
2) Severe tachycardia with heart failure, Shock, Hyperthermia, Restlessness, Agitation, Chest & abd pain, N/V, Coma

Question 26

T/F: Hyperthyroidism is more common than hypothyroidism.

Answer 26

False

Question 27

1) Name 3 RFs for hypothyroidism.
2) Name 4 S&S of hypothyroidism.

Answer 27

1) Women, older age, surg. remove of thyroid gland external irradiation, some meds
2) Puffy/puppy face, Cold intolerance, Excessive fatigue/drowsiness, HAs, Wt gain, irreg. menstrual bleeding, worsening PMS, dry skin, thin/brittle hair and nails

Question 28

Name 5 Hypothyroidism MSK effects.

Answer 28

1) INCREASED BMD
2) DECREASED bone formation/resorption
3) Edema (muscle + joint)
4) Prolonged DTRs (or delayed onset)
Prox. muscle weakness, Myalgia, Trigger pts, Stiffness, cramps, CTS, Subjective report of paresthesias without supportive objective findings, back pain

Question 29

Name 4 metabolic pathologies we discuss.

Answer 29

1) Dehydration (Fluid imbalance)
2) Gout
3) Osteoporosis
4) Paget’s Disease

Question 30

Early S&S of dehydration are _(2). As condition worsens other S&S include incr. temp, LOW urine output, Postural hypotension, & _(4),

Answer 30

1) Thirst Wt loss
2) Poor skin turgor, dryness of mouth / throat / face, NO SWEAT, Dizziness when standing, Confusion, Increased hematocrit

Question 31

Gout is when excess __ acid in blood results in tiny crystals that collect in __, which triggers a painful __ response.
4 RFs of gout are __.

Answer 31

1) uric
2) joints
3) inflammatory
4) male, 40-50s, menopause, obesity, white, stress, alc consumption, meat/seafood consumption, excess intake of sugar, purine-rich, or high-fructose foods

Question 32

Other than fever/chills, malaise, & redness, what are 2 more S&S of gout

Answer 32

1) Tophi: lumps under skin or eruptions thru skin of chalky urate crystals
2) Joint pain/swelling esp. 1st MTP joint

Question 33

If a pt answers yes to >__ items on the OP screening evaluation form, they have an incr. risk for OP and need to be refered to BMD testing.

Answer 33

> 3 items

Question 34

Name 5 RFs for OP.

Answer 34

1) women
2) older/post menopausal
3) smoking, alc, decr. Ca, little WB exercise
4) early menopause
5) prolonged exposure to certain meds (corticosteroids)
Thin, chronic diseases affecting kidneys/lungs/ stomach/intestines / hormones

Question 35

T-Scores for normal BMD, osteopenia, OP, and severe OP

Answer 35

Normal = -1 or above
Osteopenia = -1 to -2.5
OP = -2.5 or less
Severe OP = -2.5 or less + fragility fx(s)

Question 36

3 Prominent S&S for OP.

Answer 36

1) Back pain: episodic, low T/high L pain
2) Kyphosis
3) Dowager’s Hummp
Early satiety, decr. activity tolerance, height decr., bone fx, spine compression fx

Question 37

Paget’s Disease is a NONinflammatory, metabolic, skeletal disorder when excessive osteo__ bone __ is f/b incr. osteo__ activity. This leads to formation of unstable bone that is __, less __, more __, & incr. risk for fx.

Answer 37

1&2) osteoclastic bone resorption
3) osteoblastic activity
4-6) bone is larger, less compact, more vascular, & incr. risk for fx

Question 38

T/F: Most pts with Paget’s disease are asymptomatic.

Answer 38

True

Question 39

Name 4 S&S of Paget’s Disease

Answer 39

1) bowing of long bones
2) spinal stenosis
3) decr. auditory acuity
4) incr. temp over long bones

Question 40

Name 3 red flags when working with pts with endocrine/metabolic disease that require medical attn.

Answer 40

1) Pt w/ DM is confused, lethargic, altered mental status, profuse sweating, S&S of DKA
2) Hypoglycemia
3) S&S of thyroid storm

Question 41

General Endocrine/Metabolic disease guidelines:
1) 2 physical signs ?
2) favorable PMHx ? (1)
3) 3 S&S ?

Answer 41

1a) nodes/nodules in scalene triangle + hoarseness, hemotysis, incr. BP
1b) muscle fasciculation & cramping w/ antacid use
2) long-term use of corticosteroids
3) arthralgia, hand pain/stiffness, muscle weakness