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NPTE Final Frontier > Other Systems 1 > Flashcards

Other Systems 1 Flashcards

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1
Q

Practice!
Pts medical chart shows BP 168/90, triglycerides lvl 160, FBG lvl 115. BMI= 40 and waistline 54in. ALL findings suggestive of?

A

Metabolic Syndrome (cluster of sx’s)
Other answers:
- CHD
- TIIDM–FBG will be >126 for T2DM
- Stage I HTN= 130-139 OR 80-89

3/5 factors in this question for Metabolic Syndrome!

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2
Q

Metabolic Syndrome think….

A

ALL of the LEAD causes of death/disease in US!!!

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3
Q

Metabolic Syndrome

This is SPECIFIC list of things assocd w/ Metabolic Syndrome

S/S risk factors for/strongly linked to T2DM, CV Dis, Stroke

A

Dx is made if THREE OR MORE present:
1. Fasting plasma glucose lvl >100 mg/dL
2. SBP= 130 and/or DBP= 85
3. Triglyceride lvl of 150 mg/dL or HIGHER
4. HDL lvl <40 mg/dL in MEN or <50mg/dL in WOMEN
5. Waist circumf >40in MEN; >35in WOMEN

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4
Q

Glands of Endocrine System
See pic and correlate w/ your chart!

A

see chart

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5
Q

Leader: Hypothalamus
- Anterior Pituitary
- Posterior Pituitary

How many hormones total and where?

A

8 hormones
Ant Pit== 6
- ACTH, TSH, FSH/LH, GH, Prolactin
Post Pit== 2
- ADH/Vasopressin, Oxytocin

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6
Q

Hormone Chart: Leader= Hypothalamus

Anterior Pituitary
(6):
Hormone–> Gland–> Produces

A
  1. ACTH (adrenocorticotrophic)–> Adrenal cortex–> Cortisol, Aldosterone
  2. TSH (thyroid stim)–> Thyroid–> T3 & T4
    3/4. FSH (follicle) & LH (lutenizing)–> Ovaries/Tests–> Estrogen, Progesterone, Testosterone (think Gonads)
  3. GH–> Bones & Tissues–> Growth, metabolism
  4. Prolactin–> Milk production in breasts
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7
Q

Hormone Chart: Leader=Hypothalamus

Posterior Pituitary
(2):
Hormone–> Gland–> Produces

A
  1. ADH (Anti-Diuretic)/Vasopressin–> Regulates water and mineral balance, water retention
  2. Oxytocin–> Stimulates uterine contractions during birth
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8
Q

Glands of Endocrine System
Hypothalamus (Leader)

A

Regulates ANS
- body temp, appetite, sweating, thirst, sex behaviors, rage, fear, BP, sleep

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9
Q

Glands of Endocrine System
Pituitary: Ant (6) vs Post (2)

A

Secretes endorphins and reduces sensitivity to pain.
Controls ovulation and works as catalyst for testes/ovaries to create sex hormones

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10
Q

Glands of Endocrine System
Thyroid

A

Hormones act to control rate @ which cells burn fuel from food

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11
Q

Glands of Endocrine System
Parathyroid (think Ca and phosphate)

A

Regulates Ca+ and Phosphate metabolism

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12
Q

Glands of Endocrine System
Adrenal
IMPORTANT!!!

A

NORMAL DEFINITION:
- produces corticosteroids that will regulate **water and sodium balance, body’s response to STRESS, immune system, metabolism

Think Cortisol and Aldosterone

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13
Q

Glands of Endocrine System
Adrenal
IMPORTANT!!!

Cortisol vs Aldosterone

A

Cortisol
- Stress
- Regulates BP
- Glucose regulation**
- Anti-inflamm

Aldosterone
- H20/mineral balance
- RETAINS H20 + Sodium**
- REMOVEs K+ from body

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14
Q

Practice!
Pt c/o sig wt gain in abdomen and face. Labs show HIGH lvls of cortisol and ELEVATED blood GLU and HIGH lvls ACTH from pituitary (ANTERIOR). Most likely dx?

A

Cushings Disease (DISEASE== problem in Pituitary)
- Moon face, buffalo hump== INC cortisol, “Cushings like Cushion (round)”

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15
Q

Other answers:
- Addisons Dis
- Hashimoto’s Dis
- HypOthyroidism

A
  • Addisons–> Adrenal INsuff== DEC cortisol
  • Hashimoto’s–> AI disorders of thyroid== HypOthryoid
  • HypOthyroid–>

The answer was Cushings Dis== INC cortisol, Addisons is DEC cortisol—> you will see DECd BG, DEC BP, anxiety/depress, Lose Na/water (dehydration), RETAIN K+

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16
Q

Addison’s Dis vs Cushing’s Dis

Mrs. Addison– “Old weak thin brown lady walking w/ a stick”
Mr. Cushings– “White chubby boy who likes drinking beer”

A

Addisons== Adrenal INsuff
Cushing’s== Adrenal OVERsecretion

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17
Q

Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone

Mrs. Addison’s Disease
“Old brown lady walking with a stick”

Adrenal INsuff

A

Causes: Infx, neoplasm, hemorrhage, AI process
Adrenal INsuff: DECd cortisol and aldosterone
- DECd BP, dehydration (bc losing water)
- HypERkalemia (bc not getting rid of K+
- DECd glucose (bc DEC cortisol (regs BG)
- Bronze pigmented skin (“Brown Lady”)
- Wt loss, anorexia, GI disturbs (“thin lady”)
- Generalized weakness (asthenia– “walking with a stick”)
- INtol to cold and stress, anxiety and depress (bc no cortisol to regulate stress)

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18
Q

Addison’s vs Cushings (ACTH)–Adrenal Gland – Cortisol & Aldosterone

Mr. Cushing’s Disease
“Chubby white boy who loves to drink beer”

ELEVATED cortisol & aldosterone

A

Causes: Pituitary tumor w/ INCd ACTH secretion
Elevated cortisol & aldosterone
- INCd BP, water RETENTION (opp Addison’s, bc INC cortisol and aldosterone)
- HypOkalemia** (getting rid of K+)**
- INCd glucose (bc INC cortisol)
- Ruddy appearance, striae on skin (rosy cheeks–“happy bc beer”
- Wt GAIN, centripetal obesity, round moon face
- Proximal mm weakness and atrophy (same as long term corticosteroids, so makes sense)
- Incd susceptibility to infx, osteoporosis (buffalo hump), poor wound healing (same as long term corticosteroids, so makes sense)

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19
Q

Cushings Disease vs Cushings Syndrome
In a nutshell…

A
  • Disease think problem in Pituitary
  • Syndrome think problem in Adrenal glands
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20
Q

Cushing’s Disease vs Syndrome

Sx’s common for BOTH
Explain…

A

Cushings Disease (prob in Pituitary)
- Pit. Adenoma–> more ACTH secreted by PIT gland–> stims adrenal gland==> MORE cortisol release

Cushings Syndrome (prob in Adrenal glands)
- Adrenal glands tumor–> Adrenal glands secrete more cortisol–> drug toxicity

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21
Q

Thyroid Conditions

see charts

A

HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”
HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter

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22
Q

Thyroid Conditions

HypERthyroidism- “Really hyper friend, David, Who DOESN’T gain weight”

Think metabolic processes INCREASE

A

INCd T3 and T4- so LOW TSH (bc signaled to LOWER TSH)–> feedback loop
- INCd HR (LOW BP, bc NOT sedentary, everything sped up, so lower BP)
- HIGH BMR
- Heat INtolerance (sped up, sweating all the time)
- INCd glucose absorption (dec BG in blood, hyper-using BG all the time!)
- Restlessness, Insomnia
- Diarrhea (bc everything sped up)
- Silky hair, Moist palm (bc sweat alot)
- Wt LOSS/INCd appetite (David who never gains wt)
- INCd perspiration (bc running around everywhere)
- HypERreflexia (bc they’re hyper!)
- Exopthalmos (bulging eyeballs), Grave’s Dis

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23
Q

HypOthyroidism- “Priyams husband! “Lazy Person Laying on the Couch All Day w/ a Comforter

A

DECd T3/T4- HIGH TSH (bc signaled to INC TSH)- Feedback loop
- DEC HR, INC BP (bc sedentary)
- LOW BMR (everything slows)
- Cold intolerance (laying w/ comforter)
- DECd glucose absorb (more BG, bc not using it)
- Sleepy, Tired, Proximal mm weak (bc laying down on shoulder)
- Constipation (bc no digestion, not eating)
- Brittle nails, dry skin and hair (bc everything slows)
- Wt GAIN, DECd appetite (bc not active, not hungry)
- DECd perspiration (not active)
- Proloonged DTRs (delayed DTRs–just opp to hyperthyroid)
- Myxedema (puffy/swelled face, hands, feet), Hashimotos (AI disorder causing HypOthyroid)

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24
Q

Hyperthyroid assocd disease

A

Grave’s Disease

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25
HypOthyroid assocd Disease
Hashimoto's
26
Practice! Pt referred w/ dx of **chronic periarthritis of shoulder.** Pt feels **tired all time, recent wt LOSS in spite of INCd appetite (think high BMR).** What else assocd w/ this if thyroid lvls ELEVATED?
A: INCd DTR, INCd HR, LOW BP (**bc not sedentary)**, Heat intolerance (**bc running around everywhere)**
27
Parathyroid conditions... What should you immediately think about?
Calcium Phosphate
28
# Parathyroid Conditions: HypERparathyroid **"Bones, Stones, Groans, Moans and Sensory"**
ELEVATED **Ca+** and DECd **serum (blood) phosphate**--> elevated Ca+ in blood which means **Ca+ loss from bone** - Demineralizes bone= bone weakness and decd density Sx's ("Bones, Stones, Groans, Moans and Sensory") - Osteopenia, gout, arthralgia (bones) - kidney stones, renal insuff (stones) - peptic ulcers (groans) - proximal mm weakness, fatigue, depression (moans) - confusion, drowsy - glove/stocking sensory loss (sensory)
29
# Parathyroid Conditions: HypOparathyroidism **CATS are NUMB**
LOW **Ca+** and HIGH phosphorous in blood Sx's- **CATS are NUMB** - **C**onvulsions, **A**rrhythmias, **T**etany/**T**witching mm's, **S**pasms/Cramps - **P**arasthesias- fingertips and mouth (**NUMB)** - Fatigue/weakness
30
# Parathyroid Conditions: HypER vs HypOparathyroid The HypER and HypO refer to what always?
**Serum Ca+ lvls** aka HypER is always HIGH Ca+ (which is taken from the bone= bone demineralization) HypO is always LOW Ca+ | refers the **Ca+ lvls!!!** and then Phosphorous is just opp
31
Practice! Pt presents w/ hypERfunction of parathyroid (INC Ca+). S/S assocd? Bones, Stones, Groans, Moans, Sensory
Osteopenia (bones) and peptic ulcers (groans)
32
Diabetes **BG lvls that ==> DM?** Fasting BG > __ Random BG > __
Fasting BG >126 mg/dL Random BG >200 mg/dL
33
Diabetes **Type I** | Think **Juvenile** onset
**Pancreas produces NO insuline--> *Insulin Dependent DM*** - Dx'd **mostly @ childhood**--can be any age though - **S/S:** polyphagia (inc hunger), Wt LOSS, **Ketoacidosis**, polyuria (inc urination), polydipsia (inc thirst), blurred vision and dehydration (peeing alot bc sugar) | NOTE: **Ketoacidosis MOSTLY T1DM, fat cells break down**
34
Diabetes **Type II** | Think **insulin-RESISTANT**
Body's **resistance to insulin==> *Insulin Resistant DM*** (aka Tissues do not absorb insulin) - Occurs **SECONDARY** to other dysf's - **S/S:** SIMILAR to **Type I**-- although Ketoacidosis is RARE!
35
# **HypOglycemia vs HypERglycemia** Talk about the Glucose lvls HypO vs HypER
**HypO=> Glu < 70** **HypER=> Glu > 300**
36
# HypOglycemia vs HypERglycemia HypOglycemia **"HE is TIRED"** H- HA, E- Excess hunger, is T- Tachy, I- Irritable, R-, E, D-Dizzy "Hangry"-- think about YOU when you haven't eaten (HE is TIRED) | Cold, Clammy Skin
**Early s/s:** - Pallor, sweating - shakiness - Poor coord and unsteady gait - Tachy + Palpitations - Dizzy, fainting - Excessive hunger **Late s/s:** - slurred speech, drowsy, confusion**** - Loss of consciousness & Coma**** EMERGENCY!!!
37
# HypOglycemia vs HypERglycemia HypERglycemia **"Hot and Dry Sugar High** | Hot and Dry skin
BG > 300 **Early s/s:** - Weakness - DRY mouth - Freq, scant urination (bc peeing out sugar) - Deep and rapid respirations-- **Kussmaul** - Dull senses, confusion, diminished reflexes - Excessive **thirst (bc all that sugar)** **Late s/s:** - **Fruity odor (Acetone breath)=> DIABETIC KETOACIDOSIS!!!** BIG INC GLUCOSE - HypERglycemic coma****
38
Fruity odor/breath (Acetone breath) Think...
Diabetic Ketoacidosis!!! DMT1 mostly **EMERGENCY!!!**
39
Practice! 45yo OBESE male (BMI 33kg/m^2) w/ DMT2 is working out on TM in hospital. Pt suddently develops light-headed, dizzy (HE is TIRE**D**) and instability (**poor coord/gait)**. MOST approp?
STOP TM (DEFINITELY STOP!) and have hospital nurse check BG *can also give juice if that's in w/ rest of correct answer, but def stop!!! HypO= BG <70mg/dL
40
Exercise and DM **MAIN point**
Exercise INCs **insulin sensitivity**--> BG will DROP (bc being used by mm's) Exercise does **SAME JOB** as insulin--> pulls things INTO cells This is why TIMING of ex and insulin is important!!
41
Exercise and DM Exercise may result in _
**HypOglycemia!** - AVOID ex. during **peak insulin hrs (2-4hrs)** Ex. If insulin @ 9a, NO ex. from 11a-1p**** - Insulin absorbed MUCH more quickly in active extremity. **Always apply insulin inj's in abdomen/NON-active extremity** - Insulin dosage should **reduced after ex.**--> bc exercise already drops BG--> or else **post-ex hypOglycemia**
42
Exercise and DM **More main topics:**
- Do NOT ex. in extremem cold or hot temps--pt should be **well hydrated** - Exercise in **MORNING** recommended to **avoid hypOglycemia** resulting from fluctuations in insulin sensitivity
43
Exercise and DM **Safe BG lvls and when NOT to Ex.** GOLD VALUES!!!
BELOW 70==> NO exercise 70-100==> Give them CHO snack and **wait until 100, exercise** 100-250==> Safe to exercise 250-300 **w/out ketones**==> Caution 250 **w/ ketones**==> NO exercise, EMERGENCY! >300==> NO exercise, refer to phys. | Remember High ketones== Acetone/fruity breath
44
Diabetic foot care?
- White socks - No soaking feet w/ water - Safe shoe laces or velcrow - Nails cut - Alternate shoes
45
Practice! PT reviewing lab values of 58yo male. Appropriate GLU monitoring?
HypOglycemia is doc'd for Fasting BG value of 40 (remember hypO is < 70) **Glycosylated Hemoglobin (HBA1C) norm ref is 4-6%**-- HBA1C is avg BG over 3mos (Norm= 4-6%) HBA1C > 10 == immediate insulin therapy
46
FITT Principle for **DM Pts**
**F:** 3-7d/wk **I:** 11-13 RPE (can go up to 17), remember start @ 13 then **SHVEM;** 13 down= **reverse SHVEM** **T:** min of 150min/wk, progress to 300min/week **T:** MOD intensity **aerobic ex's** involving **larger mm groups**
47
Endocrine Recap!
- Bronze pigment skin-- Mrs Addison's - BP in met. syndrome?-- 130/85 - Grave's Dis?-- HypERthryoid - Diabetic Ketoacidosis?-- HypERglycemia, DMT1
48
Urinary Incont aka
Leaking of urine
49
Urinary Incont Types + **Key Words to remember**
1. **Stress--> exertion** 2. **Urge--> urgency** 3. **Overflow--> dribbles** 4. **Functional--> mobility deficits (just cant make it there)**
50
# Urinary Incontinence **Stress** | think **exertion**
- INvolunt leakage during **cough, sneeze, EXERTION** - post-partum, pelvic floor weakness
51
# Urinary Incontinence **Urge--> Urgency** | think **urgency, OVERactive detrusor**
- INvolunt contraction of **detrusor** w/ strong desire to void (**urgency)**. - Infxs, PD, UMN lesions
52
# Urinary Incontinence **Overflow** | think **DRIBBLES, UNDERactive detrusor (so dribbles)**
- Acontractile or UNDERactive detrusor mm - Bladder OVERdistended, can not empty completely=> **dribbles, or leaks out** - BPH, DM**** -
53
# Urinary Incontinence **Functional** | think **mobility deficits, just cannot make it there**
- Incont due to **mobility,** dexterity, or COG defs - Dementia, LE weakness (cannot make it to bathroom)
54
Practice! After NORM delivery, woman comes to PT clinic w/ complaint of **leaking involuntary during cough/sneeze w/ climbing stairs (exertion).** Most likely Dx?
STRESS incont - exertion, involuntary leaking **Remember!** - Overflow-- Underactive detrusor (LMN), **dribbles** - Functional= cog defs - Urge= hyperactive bladder, overactive (UMN)
55
Practice! 48yo female w/ c/o urinary incont. PT suspects **overflow incont.** What do you ask?
A: Do you **dribble** urine day or night? **bc overflowing!**
56
# Incontinence Tx Themes **Stress**
Strengthen pelvic floor
57
# Incontinence Tx Themes **Urge**
Treat infxs, Voiding schedule (aka treat the problem!)
58
# Incontinence Tx Themes **Functional**
Clear clutter, improve accessibility, **prompted voiding,** LE strength - Prompted voiding==> reminders, post-its, cueing
59
# Incontinence Tx Themes **Overflow ("Dribbles")**
Behavorial mods like **double-voiding,** meds, catheterization - Double-voiding== voiding again after first
60
Practice! 68yo comes to clinic w/ Alzheimer's and cog defs. CC is urinary incont. Most approp intervention? | Remember **functional think prompted voiding!**
Scheduled toileting and **prompted voiding!** - cues, reminders, etc

NPTE Final Frontier (19 decks)

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