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NURS 5315 > M8 Endocrine > Flashcards

M8 Endocrine Flashcards

Don't Fail Endocrine 🤣😭 (104 cards)

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1
Q

T3 has what impact on the cardiac system?

A

T3 stimulates contractile protein and ion pumps (N+/K+ ATPase; Ca++ ATPase; and ß-adrenergic receptors).

This relationship can lead to heart failure if thyroid levels are imbalanced.

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2
Q

Which of these is not a causitive factor for primary hypothyroidism?

A)Congenital defect

B)Thyroidectomy

C)Iodine deficiency

D)Hashimoto’s

E)None of the above

A

Answer E (none of the above)

All of the answer choices are consistent with primary hypothyroidism. Other causes include thyroid radiation, anti-thyroid medication.

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3
Q

Which is correct of the three types of diabetes type I? Type 1A is _____, 1B is_____, and 3C is _____.

A)autoimmune, insulin triggered, c-peptide induced

B)alpha, beta, c-peptide

C)amylin, beta, calcitonin

D) autoimmune, idiopathic, chronic pancreatitis

A

Answer: D

1A: autoimmune

1B: idiopathic

3C: chronic pancreatitis

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4
Q

Ghrelin is ______ (increased/decreased) in obesity.

A

Decreased

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5
Q

Which cell in the pancreas is responsible for secreting amylin?

A)alpha

B)beta

C)delta

D)F-cells

A

Answer: B (beta)

Beta cells also secrete insulin

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6
Q

High levels of leptin will increase or decrease appetite?

A

Inhibit=decrease appetite via neuronal action

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7
Q

Subclinical hypothyroidism is defined as:

A

Mild thyroid failure with elevated TSH and normal T3/T4.

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8
Q

True or false, amylin is released by the GI?

A

False (released by the pancreas)

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9
Q

Which is NOT a function of T3/T4?

A) Increase metabolism

B)Increase muscle

C)Produce heat

D)Increase Insulin

E)Regulate RR and oxygen usage

A

Choice D: increase insulin.

T3/T4 does the opposite by antagonizing insulin.

Other functions of T3/T4 include: regulate CO, HR/contractility, GI secretion, Ca++ mobilization, lipid metabolism/usage, RBC

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10
Q

What lab values are consistent with primary hypothyroidism?

A)Low T3/T4

B)Low TSH

C)High TRH

D)Elevated TSH

E)One or more of the above

A

Answer choice: E (one or more of the above)

In primary hypothyroidism the issue is from the thyroid gland itself, because the T3/T4 are low** and the feedback mechanism **elevates TSH, but the thyroid will not respond.

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11
Q

Which is not a symptom of primary hypothyroidism?

A)Confusion

B)Decreased renal perfusion

C)High cholesterol

D)Hypernatremia

E)Syncope

A

Answer: D (hypernatremia)

Primary hypothyroidism is linked to hyponatremia (low sodium).

Other symptoms of primary hypothyroidism include: slowed speech, bradycardia, anemia, decreased appetite, weight gain, cold intolerance, etc

Think low=slowed processes

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12
Q

Where is iodine trapped for use with thyroxine?

A)Pancreas

B)Hypothalamus

C)Anterior pituitary

D)Thalamus

E)None of the above

A

Choice E: It is trapped in the thyroid gland and its’ uptake is regulated by TSH.

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13
Q

Type ____ diabetes is insulin dependent and type ____ diabetes is insulin resistant.

A

Type I=insulin dependent

Type II=insulin resistant

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14
Q

Which of the following is not a function of incretin?

A)Stimulate insulin

B)Inhibit glucagon

C)Encourage GI emptying

D)Increase intracellular insulin

E)Control glucose after a meal

A

Answer C (encourage GI emptying).

Incretin works to control glucose after a meal via stimulating insulin, inhibiting glucagon, slowing GI empty, and increasing intracellular insulin.

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15
Q

True or false, Leptin is released by the GI tract?

A

True

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16
Q

What transporter does insulin use to move into cell?

A

GLUT4

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17
Q

Angiotensinogen is _______ (increased/decreased) in obesity.

A

Increased

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18
Q

The term used when leptin increases in conjunction with adipocyte numbers but the elevated level is not effective at appetite suppression.

A

Leptin resistance

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19
Q

True or false, ghrelin is released by the GI?

A

True

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20
Q

As we age what change(s) are seen in the adrenal gland?

a) Higher levels of cortisol circulate
b) TSH increased
c) Adrenal cortex is fibrous
d) Decreased clearance of glucocorticoids
e) Less cortisol used

A

Answer: A, C, D, E

Note: TSH involves the thyroid not the adrenal

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21
Q

Low thyroid hormone stimulates _________ from ________ (organ/tissue). The THRH will stimulate ___________ to secrete _________(more/less) TSH which will in turn __________(increase/decrease) T3/T4.

A

Low T3/T4 will stimulate thyroid hormone releasing hormone from the hypothalamus. The THRH will stimulate the anterior pituitary to secrete more TSH which will in turn increase T3/T4.

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22
Q

What is the precursor for T3/T4?

A)Albumin

B)Thyroxine-binding globulin (TBG)

C)Thyroglobulin (TG)

D)Glucagon-like peptide 1 (GLP-1)

E)None of the above

A

Answer Choice: C (thyroglobulin)

Note: thyroxine-binding globulin (TBG) transports T3/T4 to the cell; glucagon-like peptide 1 (GLP-1) is an incretin hormone that’s lower than normal in people with type 2 diabetes; albumin is a protein found within the body.

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23
Q

Which peptide of proinsulin can be measured to see how much insulin is secreted?

A)A peptides

B)B peptides

C)C peptides

D)D peptides

A

Answer: C (C peptides)

Proinsulin (precursor to insulin) is made of A,B,C peptides. The C peptide is cleaved (A+B bonded with insulin), thus the C levels can be measured to determine how much insulin is secreted.

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24
Q

Peptide YY is ______ (increased/decreased) in obesity.

A

Decreased

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25
What type of hormone is GLP-1 (glucagon like peptide 1)?
Incretin GLP-1 is low in DM type 2 and drugs can target the GLP-1 and GIP peptides. GLP-1 augments glucose-induced insulin secretion and inhibits glucagon secretion.
26
Age changes with pancreas
Beta cell function decline, cell regeneration decline, growth hormone decrease
27
Which hormone is less prevalent T3 or T4, and more potent?
T3 is more potent but availability is ~10%
28
Ghrelin will normally: _______ with hunger and \_\_\_\_\_\_after eating.
Increase with hunger, and decrease after eating.
29
Which disorder causes the pituitary to over-stimulate the thyroid to secrete T3/T4? In this scenario, TSH is elevated and T3/T4 is elevated.
Secondary hyperthyroidism. Remember: the issue is from outside the thyroid (e.g. in the pituitary)
30
Which of these is not a symptom of a toxic nodule? A)Tachycardia B)Pretibial Myxedema C)Exopthalmos D)One or more of the above listed
Answer: D (one ore more of the above listed) Toxic nodules do not have the eye issues and and pretibial myxedema (those symptoms are consistent with Grave's disease)
31
Adiponectin normally does what for insulin sensitivity and inflammation?
Will increase insulin sensitivity and has anti-inflammatory properties (in someone not managing obesity). Thus, in **obese** patients it is **decreased** and linked to insulin issues/ DM2/ inflammation/ CAD.
32
What life-threatening event occurs with the worsening of hyperthyroid state due to T3/T4 release?
Thyrotoxic crisis (thyroid storm)
33
Adipokines are produced by?
WAT (White adipose tissue)
34
Adiponectin is ______ (increased/decreased) in obesity.
Decreased
35
How many months can the thyroid fail for before symptoms appear? A)1-2 B)2-3 C)3-4 D)4-5 E) None of the above
Choice: B The thyroid can fail for 2-3 months due to the stored hormone which will last ~2-3 months.
36
Which is worse for WAT, visceral or peripheral?
Visceral
37
Metabolic syndrome requires which of the following for a diagnosis: A) Hypertension B) High HDL C) A1C \>6.5 D) None of the above
Answer: A (hypertension) Metbolic syndrome requires 3 of the following for a diagnosis: large waist circumference, elevated triglycerides, low HDL, HTN, fasting glucose elevated (100-125)
38
What causes a thyrotoxic crisis? A)low blood sugar B)thyroid infarction C)infection D)Low T3/T4
Answer (c): infection Thyrotoxic crisis can be ignited by: trauma, cardiopulmonary, burn, seizure, sx. The situation involves a worsening of hyperthyroidism.
39
What disease process involves a follicular hypertrophy which causes the thyroid to act independently? ## Footnote A) Grave's disease B) Myxedema coma C)Toxic nodule D)Thyrotoxic crisis
Answer: C (toxic nodule) The toxic nodule will cause the thyroid to secrete excess T3/T4
40
Amylin is responsible for: A)Releasing growth hormone B)Supressing glucagon C)Increasing WAT D)Delaying gastric emptying E)One or more of the above
Answer: E Amylin is responsible for suppressing glucagon, and delaying gastric emptying.
41
Symptoms of Graves disease include: A)seizure B)dyspnea C) exophalmos D) bradycardia
Answer choice: C Graves disease also causes: exophthalmos, periorbital edema, and extraocular muscle weakness. Seizures are seen with a worsening of hyperthyroidism in what's deemed a "thyrotoxic crisis/thyroid storm" Bradycardia, and dyspnea would be seen in hypothyroidism (think low=slow)
42
Which disorder causes the thyroid to oversecrete T3/T4 with secondary feedback on pituitary TSH. In this scenario the TSH will be low and T3/T4 elevated.
Primary hyperthyroidism.
43
Triggers for myxedema coma include: A)Infection B)Discontinuation of thyroid medications C)Initiation of thyroid medications D)Narcotics/sedatives E)One or more of the above
Answer E (one or more of the above) Myxedema coma is triggered by infection, d/c thyroid medications, narcotics/sedatives
44
What thyroid issue can cause a decreased LOC, and lead to lactic acidosis? A)Thyrotoxic crisis B)Myxedema coma C)Grave's disease D)None of the above
Answer: (B) myxedema coma Myxedema coma occurs with low thyroid levels and will decrease the LOC (especially in the elderly). Other symptoms include: hypoventilation, low BP, hypothermia, hypoglycemia, lactic acidosis
45
Leptin resistance linked to: A) Low cholesterol B)Anti-inflammatory processes C)Proinflammatory processes D)Cancer E)CV Disease
Answer: C, D, E. Also linked to insulin/sugar issues, and high cholesterol.
46
Which of these is not a symptom of hyperthyroidism? A)IBS B)Decreased LOC C)Dyspnea D)Anorexia
Answer: B (decreased LOC) Decreased LOC is consistent with hypothyroidism (think low=slow).
47
When the PNS stimulates beta cells, insulin ________ (increases/decreases) and when the SNS stimulates beta cells, insulin \_\_\_\_\_\_\_\_\_(increases/decreases). A)Increase, decrease B)Decrease, increase C)Increase, increase D)Decrease, decrease
Answer: A When the PNS stimulates beta cells, insulin **_increases**_ and when the SNS stimulates beta cells, insulin _**decreases_**.
48
The management of which type of diabetes is more difficult, and associated with hypoglycemia?
Diabetes type I
49
Endocannabinoids will ____ appetite, _____ energy use, and _____ WAT.
Increase appetite, inhibit energy use, increase WAT.
50
What cells in the pancreas release glucagon? A) alpha B) beta C) delta D) F-cell
Answer: A (alpha) **_Alpha cells release glucagon_** and glucagon works to release sugar in liver via glycogenolysis and break down fatty acids via lipolysis.
51
What is not a true statement regarding DM Type 1 Subtype 1A: A) Autoimmune process where the body attacks beta cells B) 10-20% of beta cells destroyed before patient is hyperglycemic C) Glucose accumulates and spills into urine D) Less amylin is produced E) Glucagon is stimulated
Answer B (10-20% of beta cells destroyed before patient is hyperglycemic) In subtype 1a: The body attacks beta cells in an autoimmune process which will decrease insulin production, 80-90% of beta cells will be destroyed by time patient is hyperglycemic, less amylin is available, low insulin will trigger glucagon, and glucose spills into urine from the blood.
52
Antibodies attach to TSH receptors in thyroid cells & mimic TSH function in what disorder?
Primary hyperthyroidism
53
Thyroid gland C-cells are resonsible for what? A)Chronic hypothyroidism B)Calcitonin secretion C)Cardiac failure D)Two or more of the above E)None of the above
Choice B: Thyroid gland C-cells **_secrete calcitonin_** which lowers serum calcium by blocking osteoclastic activity.
54
What BMI is considered obese?
30 or more
55
Angiotensinogen is linked to what complications related to obesity?
Vasoconstriction, renal reabsorption of Na+ and H20 (aldosterone), inflammation, lipogenesis, insulin issues, cancer.
56
True or false, adiponectin is released by the pancreas?
False
57
True or false, thyroid imbalances can lead to heart failure.
True.
58
What is true of secondary hypothyroidism? A)High TSH B)Issue stems from hypothalamus gland C)Normal T3/T4 D)Low TSH E)One or more of the above
Answer E: one or more of the above Secondary hypothyroidism involves an issue outside of the thyroid gland (pituitary or **_hypothalamus_** malfunction). **_TSH and T3/T4 are all low._**
59
Normally, peptide YY will _____ gastric motility and \_\_\_\_\_\_appetite.
**_Inhibit_** gastric motility and **_decrease_** appetite.
60
GI tract releases what hormones (adipokines)? A)Peptide YY B)Endocannabinoids C)Amylin D)Adiponectin E) Incretin
Leptin, adiponectin, endocannabinoids, angiotensinogen, ghrelin, peptide YY, incretin (GI endocrine) Note: Amylin is released by the pancreas ß-cells (along with insulin)
61
Which of these is/are not a symptom(s) of hyperthyroidism? A)High metabolism B)Heat intolerance C)Heart failure D)ADHD E)None of the above
Answer E (all of the above) are symtpoms of hyperthyroidism. Other symptoms include: tachycardia, dyspnea, IBS, hair loss, anorexia, heart failure. Grave's hyperthyroidism (exopthalamos and pretibial edema).
62
Which process is correct for hormonal transmission? A) Anterior Pituitary⇒Hypothalamus⇒Thyroid B)Thyroid⇒Posterior Pituitary⇒Hypothalamus C)Hypothalamus⇒Anterior Pituitary⇒Thyroid D) Hypothalamus⇒Posterior Pituitary⇒Thyroid E)None of the above
Choice C Hypothalamus (releases a "releasing" hormone called TRH/THRH)→Pituitary (release stimulating hormone called TSH)→stimulates thyroid (release T3/T4)
63
A patient presents with agitation, nausea, vomiting, diarrhea, hyperthermia, and seizure. What medical emergency is occurring? A)DKA B)Addison's disease exacerbation C)Myxedema coma D)Thyrotoxic crisis
Answer: D (thyrotoxic crisis) Other symptoms include: restlessness, delirium, tachycardia, heart failure. If left untreated for 48 hours, death can occur.
64
Which of the following are examples of primary hyperthyroidism? A)Grave's disease B)Myexedema coma C)Toxic Nodule D)One or more answer choices listed
Answer: D Primary hyperthyroidism can be caused by Grave's disease or a toxic nodule.
65
Thyroxine-binding globulin (TBG) and albumin do what for the thyroid/thyroid hormones?
Bind with T3/T4 and transport to cell where they release the T3/T4.
66
What cells release incretin? A) Liver B) Pancreas C) GI D) Thyroid
Answer: C (GI)
67
The _____ (T3/T4) is converted to ______ (T3/T4) before entering what part of the cell?
**_T4_** is converted to **_T3_** before entering the **_cell nucleus_**.
68
A patient aged 17 is admitted to the ED with hyperglycemia, polyuria, polydipsia and no family history of diabetes. What is the most likely diagnosis?
Answer: Diabetes type I DM type I is seen usually before age 30 and does not have the correlation to family history in the way that DM II does. S&S of type I include: hyperglycemia, polyuria, polydipsia, polyphagia, weight loss, altered protein/fat metabolism, ketosis
69
Osteoclasts are responsible for bone build-up or bone breakdown?
Breakdown. Think Osteo**_C_**last=more bone breakdown so more **_Ca_**++
70
Which choice(s) is/are incorrect regarding the function of T3/T4? A)Decreasing metabolism B)GI secretion C)Ca++ mobilization D)Lipid storage E)Antagonize insulin
Choices A and D are NOT true regarding T3/T4. T3/T4 is responsible for increasing metabolism, lipid metabolism/usage, GI secretion, Ca++ mobilization, and antagonizing insulin.
71
High levels of leptin will ____ appetite and low levels of leptin will ______ appetite.
High levels **_inhibit_** appetite by blocking neurons. Low levels **_increase_** appetite.
72
Ghrelin works by: A)Releasing growth hormone B)Releasing gastric acid C)Anti-inflammatory processes D)Inhibit gastric motility E)Indirectly releasing insulin
Answer: choice A, B, E Note: Ghrelin encourages release of growth hormone, gastric acid, GI movement, and insulin. It promotes satiety and has cardioprotective properties. It will also stimulate food intake.
73
TSH low and T3/T4 elevated would be consistent with what diagnosis? A) Primary hypothyroidism B) Secondary hyperthyroidism C)Subclinical thyroid disease D)Primary hyperthyroidism
Choice D: primary hyperthyroidism In primary hyperthyroidism the issue is with the thyroid itself. Elevated T3/T4 distinguish it from hypothyroidism. The low TSH tells us that even though the negative feedback to the hypothalamus is occuring (hence the low TSH), the thyroid is not responding and is still secreting too much T3/T4.
74
Which group is likely to have hypothyroidism? A)Women B)Children C)Men D)None of the above
Answer choice: A (women) Hypothyroidism is seen more in women and elderly
75
Which patient is at the greatest risk for DM type II? A)Patient with an A1C of 6.7 B)A patient with a fasting glucose of 95 C)A patient with no family history D)A patient with a glucose tolerance test of 125 E)A woman in her 40s
E) A "middle aged" woman would be at the most risk Risk factors include: family history, middle age, minority, metabolic syndrome, and genes
76
True or false, hyperinsulin is present for many years in diabetes type I which causes it to go undiagnosed for years.
False. This statement is true regarding type II diabetes. The hyperinsulin will go on for years, but eventually the beta cells will fail.
77
Obesity associated with Type II DM causes: A) inflammation, insulin issues, intracellular signaling issues B) inflammation, insulin issues, increased adiponectin C) decreased adiponectin, decreased response to incretin , and intracellular signaling issue D)None of the above E)One or more of the above
Answer: E Obesity associated with type 2 DM is liked to elevated fats causing **inflammation, insulin isues, intracellular signaling issue, decreased adiponectin and decreased response to incretin**.
78
Type II diabetes is linked to _______ (increased/decreased) glucagon as a result of alpha cells being responsive to glucose inhibition.
Answer: increased
79
In DM type II what causes glucagon to be increased (what other cell within the pancreas)?
Decreased amylin (usually released from the beta-cells of the pancreas which works to supress glucagon)
80
Initial signs and symptoms of DM 2: A) Polydipsia B) DKA C) Metabolic acidosis D) Decreased appetite
Answer: A (polydipsia) Other s&s include: polyphagia, polyuria, and usually no DKA/metabolic acidosis
81
Late signs/complications of DM type II: A) Weight gain B) Blood sugar of \>400-900 C) DKA D) Bicarb \<18
Answer: B (BS\>400-900) Other late s&s of DM type II include: fatigue, frequent infections, visual changes, weight loss, neuropathy, pruritis
82
True or false, high risk women with diabetes at first prenatal check should be assigned a diagnosis of type I or type 2?
True
83
True or false, all pregnant women should be screened at 24-28 weeks for GDM?
True, and those with GDM should be screened 6-12 postpartum.
84
Which is a risk of GDM? A) teen pregnancy B) low BMI C) obesity D) multiple gestation (twins, triplets)
Answer: C (obesity) Risks include: history, obesity, and advanced maternal age
85
Islet cell hyperplasia and hypoglycemia is caused by what mechanism related to pregnancy/post-natal changes?
Answer: infants of DM mothers may have islet cell hyperplasia and hypoglycemia as a result of the increased glucose in utero
86
Which of the following lab values is abnormal? A) A1C 5.6 B) Fasting blood glucose 95 C) Oral glucose tolerance test 130 D) Fasting blood glucose 130
Answer: D (fasting blood glucose 130) Prediabetic fasting blood glucose range is 100-125. Diabetic fasting blood glucose is anything greater than or equal to 126.
87
What is the prediabetic, and diabetic lab range for A1C?
Prediabetic=5.7-6.4 Diabetic is greater than or equal to 6.5
88
What is the prediabetic, and diabetic lab range for oral glucose tolerance?
Prediabetic values are 140-199 and diabetic values are anything greater than or equal to 200.
89
What lab value for random plasma glucose would merit a diagnosis of diabetes?
S&S of diabetes with a random plasma glucose of greater than or equal to 200.
90
Hypoglycemia lab values in newborn and adult?
Newborn \<47 and \<70 for adults.
91
True or false, beta blockers can mask the signs and symptoms of hypoglycemia?
True.
92
Cold and clammy, need some candy is an easy way to remember which glucose issue?
Hypoglycemia. Think "TIRED" tachycardia, irritable, restless, excessive hunger, diaphoresis
93
Which of the following symptoms are consistent with DKA? A) Low sodium B) Usually seen in Type II DM C) Low potassium D) hypoventilation
Answer: C (low potassium) Other S&S of DKA include: Kussmaul respirations (hyperventilation), CNS depression, N/V, acetone breath, thirst, polyuria. Lab values: pH \<7.3, Bicarb \<18, Glu \>250; elevated anion gap
94
What disease process does this scenerio describe: Poor glucose control causes an elevated glucose level, followed by increased serum osmotic pressure and osmotic diuresis.
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHS)
95
In DKA a _______ (lack/excess) of insulin causes other hormones such as _____ to be released to provide the body with alternative forms of energy.
Answer: lack of insulin will cause hormones such as glucagon to be released. DKA can lead to metabolic acidosis and coma Risk factors include: illness, trauma, sx, MI, med noncompliance, ethnic, lack of insurance, low BMI
96
True or false, hyperosmolar hyperglycemic nonketotic syndrome is seen more in diabetes type I?
False. It is more common in DM type II and the elderly. It can cause dehydration, low BP, poor perfusion as the osmotic diuresis increases.
97
Glucose 650, bicarb 24, serum osmol \>320, pH 7.40. Which diagnosis would the NP give this patient? A)Cushing disease B)Uncontrolled DM type I C)Hyperosmolar hyperglycemic non-ketotic syndrome (HHS) D) DKA
Answer: C (HHS) In HHS glucose will be \>600, bicarb will be normal, serum osmol \>320, and no ketones will be present. Glycosuria and polyuria can cause volume depletion and electrolyte issues including K+ and neurological changes.
98
True or false, a loss of electrolytes such as K+ can have neurological impacts?
True. This is seen in hyperosmolar hyperglycemic non-ketotic syndrome.
99
What term(s) would be an accurate diagnosis for this scenario: Early morning blood sugar rise caused by nighttime elevation in growth hormone (which decrease metabolism of glucose)?
Dawn phenomenon
100
What term(s) would be an accurate diagnosis for this scenario: Hypoglycemia at 0300 caused by NPH given at dinner, followed by rebound hyperglycemia due to early morning secretion of counter-regulatory hormones which stimulate gluconeogenesis.
Somogyi Effect
101
Microangiopathy is seen in which areas: A) retina B) nerves C) kidney D) brain
Answer: A,B,C Microangiopathy is atherosclerosis in small vessels due to elevated glucose. It is seen ~10 years after a diagnosis.
102
True or false, microangiopathic ischemia and oxidative stress would cause: autonomic neuropathy and peripheral neuropathy?
True. Peripheral neuopathy increases injury risk whereas autonomic involves the GI (slows motility), bladder (incontinence), heart (**_silent MI_**).
103
True or false, macrovascular injury would impact the kidney, nerves, and retina?
False. Macrovascular injury involves the brain, heart (aorta), femoral arteries. The elevated glucose causes atherosclerosis in small/medium vessels.
104

NURS 5315 (4 decks)

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