🏥- Thyroid & Seizure Test Flashcards
1
Q
What hormones are secreted by the posterior pituitary (neurohypophysis)
A
- ADH
- Oxytocin
2
Q
What time of day should hormone supplements (such as GH) be taken
A
In the morning
3
Q
Acromegaly
A
Thickening of bones; particularly hands, feet and facial bones
4
Q
Clinical manifestations of acth in hyperpituitarism
A
- increased glucocorticoids (hyperglycemia, increased cortisol levels)
- increased mineralcorticods (hypernatremia, hypertension, hypokalemia)
5
Q
Metabolism in hypo vs hyperpituitarism
A
Hypo- decreased (weight gain)
Hyper- increased (weight loss)
6
Q
Clinical manifestations of acth in hypopituitarism
A
- decreased glucocorticoid (hypoglycemia, decreased cortisol levels and decreased ability to handle stress)
- decreased mineralcorticoids (hyponatremia, hypotension, hyperkalemia)
7
Q
Bromocriptine mesylate
A
Parlodel
(Dopamine agonist)
Inhibits release of anterier pituitary hormones
8
Q
Octreotide
A
Sandostatin
(Somatostatin analog)
Inhibit release of growth hormone
9
Q
Transsphenoidal hypophysectomy
A
Removal of hypersecreting tumors of the pituitary gland
“Mustache dressing”
10
Q
Complications of hyperpituitarism
A
- hyperglycemia , hypertension
- thyroid storm
- CSF leaks (related to transsphenoidal surgery) = increases risk of meningitis
11
Q
Desmopressin
A
DDAVP
has an antidiuretic effect which will increase blood volume and blood pressure
Synthetic analog of ADH
12
Q
What are the primary clinical manifestations seen in a patient with diabetes insipidus
A
Polyuria, polydipsia, nocturia
13
Q
A patient with DI may present with
A
Hypotension and tachycardia secondary to hypovolemia
Hemoconcentration observed with elevated Na and hematocrit
14
Q
What 2 things are the key indicators of DI
A
- urine osmolality of less than 200
- specific gravity of less than 1.005
15
Q
Pitressin
A
Synthetic vasopressin
Used to treat DI
Require frequent monitoring of fluid status, electrolytes and urine output
16
Q
Clinical manifestations of SIADH
A
Headache
Irritability
Confusion
Weakness
17
Q
What is a complication of decreasingly low Na levels associated with SIADH
A
Seizures or comatose
**seizure precautions implemented with a Na less than 120
18
Q
A patient with SIADH may present with
A
- scant urine output
- elevated specific gravity
- decreased serum Na and osmolarity
19
Q
Demeclocycline
A
Declomycin
A tetracycline derivative
Used in SIADH because it increases water excretion by the kidneys
20
Q
Clinical manifestations of adrenal cortex insufficiency
A
Hyperpigmentation, mood changes, dehydration, hypotension
21
Q
Normal range of cortisol
A
5-25 mcg/dL (morning)
3-16 mcg/dL (afternoon)
22
Q
What is the definitive treatment for adrenal insufficiency
A
Replacement of cortisol
23
Q
How can hyperkalemia be treated
A
With potassium binging or excreting agents (Kayexalate)
24
Q
Complications of adrenal cortex insufficiency
A
Acute adrenal insufficiency or adrenal crisis - life threatening emergency that leads to sever hypovolemia and hypotension
**decrease in aldosterone and cortisol, loses Na and water. At risk for hyperkalemia and hypoglycemia
25
Conn's syndrome
Hyperaldosteronism
Aldosterone- Na and water reabsorption; K excretion
In hyperaldosteronism - hypertension and hypokalemia develop
**MOST PREVALENT IN BLACK WOMEN
26
Clinical manifestations of cushing's disease
Hyperglycemia , fluid retention , hypokalemia , abnormal fat distribution , decreased muscle mass
Females: virilization , breast atrophy , vocal changes (deepening) , amenorrhea
** moon face , buffalo hump , thin skin , truncal obesity , poor wound healing **
27
Virilization
Make sexual characteristics developing in females
28
Name 3 medications used to treat hypercortisolism
Aminogluthethimide
Cyproheptadine
Pasireotide (signifor)
29
What types of medications are used to treat hyperaldosteronism
Spironolactone
Potassium supplements
30
Complications of hypercortisolism
Osteoporosis , GI bleed
31
Complications of hyperaldosteronism
Hypertension , severe hypokalemia = cardiac dysrhythmias
32
Pheochromocytoma
Catecholamine (epinephrine and norepinephrine) producing tumors
-intermittent episodes of hypertension
33
Hashimoto's thyroiditis
Most common type of hypothyroidism and is caused by an autoimmune response that leads to destruction of the thyroid gland by immunological processes
34
Hypothyroidism occurs most often in what demographic
Women between ages 30 and 60
35
Clinical manifestations of hypothyroidism
Goiter , decreased energy , weight gain , COLD INTOLERANCE , decreased appetite , constipation
36
What is the primary treatment for hypothyroidism
Replacement of thyroid hormone -dot commonly prescribed is levothyroxine (synthroid)
37
At what time of day should levothyroxine be taken
Synthroid
Should be taken in the morning , and at the same time every day
38
Complications of hypothyroidism
Myxedema coma
Characterized by hypoxia and carbon dioxide retention (secondary to hypoventilation), fluid and electrolyte imbalances and hypothermia
*bradycardic and hypotensive , hypoglycemia and hyponatremia develop
39
What types of medications have to be closely monitored if given to a patient with hypothyroidism
Sedatives, hypnotics and narcotics because the metabolism of the medication is slower and respiratory compromise may occur with normal dosages
40
Myxedema coma is characterized by/manifests as
Generalized nonpitting edema, particularly in the hands, feet, between the shoulder blades and around the eyes - edema of the tongue and around the larynx results in changes in speech and a husky tone
41
Grave's disease
Most common cause of hyperthyroidism and is an autoimmune disorder involving antibodies that bind to the thyroid gland
42
Hyperthyroidism is most commonly diagnosed in which demographic
Women age 20-40
43
Clinical manifestations of hyperthyroidism
```
Elevated heart rate
Heat intolerance
Increased appetite
Weight loss
Nervousness
Hair loss
Increased GI activity
Goiter
Exopthalmus
```
44
Complications of hyperthyroidism
Thyroid storm
Clinical manifestations: tachycardia , fever , systolic hypertension , abdominal pain , tremors and changes in LOC
*airway management and fluid resuscitation are priorities
45
List 4 drugs used to treat hyperthyroidism
- propyithiouracil (ptu)
- methimazole (tapazole)
- lithium carbonate (lithonate)
- iodine (potassium iodide, sski)
46
Lab values in a patient with hyperthyroidism would reflect what
Elevated T3 and T4 - decreased TSH
47
Clinical manifestations of hypoparathyroidism
Hypocalcemia
Numbness , tingling around mouth or hands and feet , severe muscle cramps , spasms of hands and feet and tetany
48
Normal range of magnesium
1.6-2.6
49
Normal range of phosphorus
2.5-4.5
50
Two specific assessments observed in hypocalcemia are
Chvostek's - abnormal reaction to stimulation of facial nerve
Trousseau's - an indication of latent tetany in which carpal spasm occurs when the upper arm is compressed
51
Diagnostic results consistent with hypoparathyroidism
Low calcium, high phosphate, low PTH
52
Clinical manifestations of hyperparathyroidism
Polyuria , anorexia , constipation and generalized bone pain
53
Diagnostic results consistent with hyperparathyroidism
High PTH and high ionized Ca
54
Which type of diuretic should be avoided in patients with hyperparathyroidism
Thiazide diuretics because they increase absorption of Ca in the kidney
55
Type 1 diabetes
Autoimmune process in which the insulin-producing beta cells of the pancreas are destroyed , resulting NO insulin
**requires insulin therapy
56
Clinical manifestations of type 1 diabetes
Polyuria, polydipsia, polyphagia, fatigue and weight loss
57
Fasting blood glucose
Prediabetes range: 100-125 mg/dL
DM: greater than 126
58
2-hr post prandial (ogtt)
Prediabetes range: 140-199 mg/dL
DM: greater than 200
59
Hemoglobin A1c
Prediabetes range: 5.7% - 6.4%
DM: greater than 6.5
60
Random blood glucose
Greater than 200 - if accompanied by classic signs of hyperglycemia
61
What are the 4 complications of type 1 DM
DKA , hypoglycemia , dawn phenomenon and somogyi effect
62
DKA
Inadequate insulin for cells to obtain adequate glucose for normal metabolism
-the body attempts to obtain energy by the rapid breakdown of fat stores
63
Kussmauls respirations
Rapid deep respirations that occur as a compensatory mechanism for the acidosis
*associated with DKA / fruity acetone smell to the breath
64
List the 5 factors for a positive diagnosis of DKA
- blood sugar greater than 250
- ketonuria
- pH less than 7.3
- bicarb less than 15
- positive anion gap
65
Hypoglycemia
Blood sugar less than 65
66
Dawn phenomenon
Results in increased blood sugar in the early morning
Naturally occurring release of hormones such as glucagon, cortisol and gh in the early morning
67
Somogyi effect
Results in increased blood sugar in the early morning
Due to an excessive insulin dosage at night
68
What drugs are used for prevention of cluster headaches
- beta blockers: propranalol (inderal) and atenolol (tenormin)
- anticonvulsants: valporic acid (depakote) and gabapentin (neurontin)
- tricyclic antidepressants: amitriptyline (elavil) and imipramine (tofranil)
69
Behaviors seen in cluster headaches
Often paces, walks, sits and rocks
70
Behaviors seen in tension headaches
Neck and shoulder muscle tenderness and bilateral pain at the base of the skull and in the forehead "bandlike"
71
Tonic-clonic seizure
Last 2-5 minutes begins with stiffening/rigidity of arms and legs usually and immediate loss of consciousness, clonic or rhythmic jerking then begins
72
Tonic seizure
Abrupt increase in muscle tone, loss of consciousness and autonomic changes lasting 30 seconds to several minutes
73
Clonic seizure
Muscle contraction and relaxation , lasts several minutes
74
Absence seizure
Mostly in children, briefly periods of loss of consciousness and blank staring as though daydreaming; automatisms (involuntary behaviors lip smacking, picking at clothes)
75
Myclonic seizure
Brief jerking or stiffening of extremities that may occur singly or in groups lasting a few seconds
76
Atonic seizure
Sudden loss of muscle tone, falls, postical confusion
*most resistant to therapy
77
2 types of partial seizures
Focal , one cerebral hemisphere
Complex and simple
78
What is something important to note with topamax and zonergran
Carry increased risk of metabolic acidosis , use caution if taking metformin
79
Serum levels and toxicity of phenytoin
Dilantin
Serum level: 10-20
Toxic: 30-50
80
Signs of phenytoin toxicity
```
Double vision
Eye movements
Dizziness
Drowsiness
Lack of coordination
Slurred speech
N/v
Decreased appetite
Bloating
```
81
Seizure precautions
- oxygen and suctioning equipment should be readily available
- saline lock (INT) may be necessary
- siderails should be up at all times
- place bed in lowest position
NEVER insert padded tongue blades into the patients mouth during a seizure
82
Status Epilepticus
Prolonged seizures lasting more than 5 mins
IV push lorazepam , diazepam - loading dose IV Dilantin
83
Kernigs sign
Flex hip = pain
84
Causes of encephalitis
Enterovirus, herpes, hiv, west nile, animal-borne illness
85
Florinef
Replaces aldosterone
86
Apraxia
Inability to use objects correctly
87
Aphasia
Inability to speak or understand
88
Anomia
Inability to find words
89
Agnosia
Loss of sensory comprehension
90
What hormones does the anterior pituitary (adenohypophysis) secrete
- growth hormone
- adrenocorticotropic hormone
- thyroid stimulating hormone
- follicle stimulating hormone
- luteinizing hormone
- prolactin
