Exam part 4

Question 1

what patients have goiter

Answer 1

hypo and hyperthyroidism, graves disorder

Question 2

Thyroid Storm/Thyroid Crisis

Answer 2

Extreme case of thyroidtoxicosis. Seen in undiagnosed cases or in patients who have not inadequate treatment

Question 3

Thyroid Storm/Thyroid Crisis causes

Answer 3

Caused by stress
- infection
- Diabetic ketoacidosis
- Physical or emotional trauma
- Manipulation of a hyperactive thyroid gland during thyroidectomy

Question 4

Thyroid Storm/Thyroid Crisis manifestations

Answer 4

Very high fever (104-106)
Extreme tachycardia (exceeds 140)
CHF
Angina
Agitation
Delirium
High mortality rate

Question 5

Thyroid Storm/Thyroid Crisis treatment

Answer 5

Peripheral cooling without shivering Glucose - due to hypermetabolic state
Electrolytes - due to hypermetabolic state
FIVE Bs

Question 6

addison disease

Answer 6

primary adrenal insufficiency
- deficient in cortisol and aldosterone

Question 7

effects of addison disease

Answer 7

decreased blood glucose
poor stress response
low serum sodium, high potassium
low blood volume
hypotension
hyperpigmentation

Question 8

cushings disease

Answer 8

Glucocorticoid hormone excess - high cortisol
- hypokalemia and metabolic acidosis

Question 9

s/s of cushings

Answer 9

Moon face
Heavy trunk with fat at back of neck
Muscle wasting in limbs
Osteoporosis
Suppression of immune response  increased risk of infection
hyperglycemia

Question 10

ambiguous genitalia in girls

Answer 10

Deficiency in any enzyme necessary for synthesis of cortisol
- High ACTH levels which stimulates production of adrenal androgens

Question 11

diabetic treatment

Answer 11

Diet: avoid simple sugars, complex carbohydrates
Exercise: regular exercise program  lose weight and increase glucose uptake into skeletal muscle
Oral and injectable anti-diabetic agents

Question 12

type 1 diabetes

Answer 12

autoimmune destruction of pancreatic beta cells
Hypoglycemia/ketoacidosis: common

Question 13

type 2 diabetes

Answer 13

insulin resistance and a relative insulin deficiency
Hypoglycemia/ketoacidosis: uncommon

Question 14

three Ps of diabetes

Answer 14

polyuria polydipsia polyphagia

Question 15

A1C levels - glycosylated hemoglobin

Answer 15

diagnostic test: measures glucose management from past 2-3 months (RBCs attached to glucose)
6.5 or above = diabetes

Question 16

What are the different criteria used to diagnose a patient with diabetes

Answer 16

Fasting (8hr+) >= 126 mg/dL
Glucose tolerance test : >= 200 mg/dL after 2 hours
A1C levels: >=6.5%

Question 17

Diabetic ketoacidosis

Answer 17

insufficient insulin  metabolism of lipid (IDDM). The acidosis develops over a few days
may start with an infection or stress in which the demand for insulin by the body increases
error in dosing
diabulimia

Question 18

polyuria

Answer 18

glucose in the urine exerts an osmotic pressure on the filtrate resulting in large volumes of urine being excreted

Question 19

cause of polydipsia

Answer 19

fluid loss through the urine and high blood glucose levels draws fluid from cells - dehydration

Question 20

polyphagia

Answer 20

lack of nutrients entering cells stimulates appetite

Question 21

Microagniopathy

Answer 21

basement membrane of arteries become thick and hard - obstruction and rupture of capillaries and small arteries - necrosis
- Retinopathy, nephropathy

Question 22

Macroangiopathy

Answer 22

atherosclerosis - leading to heart attacks, strokes

Question 23

axial hiatal hernia

Answer 23

bulging all around esophageal hiatus

Question 24

paraesophageal hiatal hernia

Answer 24

bulging on one side of the esophageal hiatus

Question 25

Diverticular Disease

Answer 25

Pockets in the colon (usually sigmoid) If infected and inflamed, they have diverticulitis Typically no fever for diverticulosis

Question 26

appendicitis

Answer 26

LRQ pain Obstruction caused by fecalith, gallstones, twisting, or spasms Fluid build up - microbes proliferate Appendiceal wall becomes inflamed and a purulent exudate forms Increased pressure leads to ischemia and necrosis - gangreen

Question 27

metabolic syndrome

Answer 27

Hyperglycemia* Intra-abdominal obesity Increased blood triglyceride levels Decreased HDL levels Increased blood pressure Systemic inflammation: C-reactive peptide Decreased fibrinolysis: inhibition of tPA Microvascular disease  coronary, cerebrovascular and peripheral arterial disease

Question 28

know how oral hypoglycemic might work

Answer 28

- Either decreases glucose output by the live r - Decreases glucose absorption in gut - Increasing glucose uptake into cells - Increasing secretion of insulin by the beta cells - Decrease glucose reabsorption by kidney (SGLT2)

Question 29

hypoglycemia s/s

Answer 29

Those related to altered brain activity Headache, difficulty problem solving, poor concentration, slurred speech, lack of coordination, staggered gait, seizures, coma Those related to activation of the sympathetic nervous system Increased hunger, anxiety, tachycardia, sweating, cool/moist skin