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What age group is at greatest risk of STDs and why?
Adolescents and young women. Risk taking behavior and women may have a physiologically cervical immaturity and lack of immunity
What is the process of DKA? (5)
- Sympathetic nervous system response: additional glucose converted from glycogen
- Glycogen depleted; body burns fat & protein for energy
- Fat metabolisms produce acidic substances called ketone bodies which
- Accumulate in blood and urine and lead to metabolic acidosis
- Protein metabolism results in loss of lean muscle mass and negative nitrogen balance
- High osmotic pressure created by excess glucose leads to osmotic diuresis (polyuria leads to dehydration and fluid and electrolyte deficits)
What is hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)?
A serious condition seen in elderly patients of type 2 (may occur in type 1 but less often) the basic defect is lack of effective insulin
What happens when blood glucose rises?
The body sends a signal to the pancreas, which releases insulin.
Explain blood glucose regulation
- When blood glucose levels rise above a set point,
- The pancreas secretes insulin into the blood.
- Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels.
- When glucose levels drop below a set point,
- The pancreas secretes glucagon into the blood.
- Glucagon promotes the breakdown of glycogen and the release of glucose into the blood.
- (The pancreas signals distant cells to regulate levels in the blood = endocrine function.)
What is the parathyroid hormone?
- PTH is a regulator of serum calcium
- Acts directly on bone and the kidneys
- The overall effects of PTH is to increase serum calcium and to decrease serum phosphate concentration
What is the role of TSH?
- Stimulates the thyroid to produce TH (thyroxine and triiodothyronine), which regulates the bodys metabolic activities
- Thyroxine increases the heart rate, the basal metabolic rate (temperature), and improves brain development
What is oxytocin? How does it relate to the pituitary gland?
- Causes uterine contractions and milk ejection in lactating women. Used clinically to induce uterine contractions
- Antidiuretic effect similar to that of ADH
What is the role of calcitonin?
- Lowers serum calcium by opposing bone resorbing effects of PTH, prostaglandins, and calciferols. Lowers serum phosphate levels
- Used for treatment of osteoporosis, osteoarthritis, paget bone disease, hypercalcemia, osteogenesis imperfecta, and metastatic cancer of the bone
What is aldosterone and why do we need it?
- Aldosterone is the most potent of the naturally occuring mineralocorticoids. Acts to conserve sodium retention and potassium and hydrogen loss
- Aldosterone helps to regulate sodium and potassium levels in the body. Helps control blood pressure and the balance of fluids and electrolytes in the body
What is the SIADH hormone?
Characterized by high levels of ADH in the absence of normal physiologic stimuli for its release
What is DI?
- DI is an insufficiency of ADH, leading to polyuria and polydipsia
- Increased sodium, increased peeing
What is acromegaly?
- Acromegaly occurs in adults who are exposed to continuously excessive levels of GH and concomitant elevation of IGF-1
- Children whose epiphyseal plates have no closed yet - is termed gigantism
What is graves disease
an autoimmune disease that results in stimulation of the thyroid land and resultant hyperthyroidism
What abnormal lab values will be associated with graves disease?
- Increased TH, iodine, T3 and T4
- Low TSH and TRH
What is hypoparathyroidism?
Abnormally low PTH levels. Low calcium levels, increased phosphate level. Caused by damage to the parathyroid glands during thyroid surgery
What is HHNKS?
a life threatening emergency most often precipitated by infections, medications, nonadherence to diabetes treatment, or coexisting disease
Why do diabetics develop retinopathy?
- The retina is the most metabolically active structure per weight tissue in the body. Thus the retina is a vulnerable target for microvascular disease in DM.
- Diabetic retinopathy appears to be a response to retinal ischemia resulting from blood vessel changes and red blood cell aggregation
What does breast milk contain?
Immune cells, specific immunoglobulins, especially immunoglobulin A (IgA), and nonspecific antimicrobial factors, such as lysozymes and lactoferrin, that protect the infant against infection and allergies and asthma
What is the patho of the s/sx of menopause?
- Menorrhagia - high E2 level the week before the menses. Estrogen thickens endometrial tissue
- Hot flashes/flushes (vasomotor flush) - a rapid change in estrogen levels (withdrawal or increase)
What delays puberty?
- Physiologic delay- hormonal levels are normal and the hypothalamic pituitary-gonadal (HPG) axis is intact
- Gonadotropic deficiency
- Chronic conditions that delay bone aging (lung disease, renal failure, cystic fibrosis)
What is primary amenorrhea?
Failure of menarche and absence of menstruation by age 14 years w/o development of secondary sex characteristics or by age 15 years regardless of the presence of secondary sex characteristics
What is secondary amenorrhea?
absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated
What does PCOS cause?
- infrequent of absence of ovulation
What STD is caused by Treponema pallidum?
The presence of ______ and obesity have been linked to early puberty
How is SIADH treated?
- Administration of hypertonic saline
- Most IMPORTANTLY= fluid restriction of 600-800 ml/day
What are the symptoms associated with SIADH?
- serum hypo-osmolalility
- urine hyperosmolality
A woman experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. Which hormone deficiency does she most likely have?
Why does weight loss occur in diabetes mellitus?
Occurs from lack of insulin (glucose accumulation) leads to --> fat and protein breakdown
The presence of which hormone has been linked with early puberty?
Which of the following hormones stimulates the ovary to release the ova and secrete progesterone?
Luteinizing hormone (LH)
Which structure secretes a thin milky substance with an alkaline pH that helps sperm survive the alkaline environment?
the prostate gland
A woman presents with hirsutism, amenorrhea, and infertility. She is also very obese. What is the most likely cause of her symptoms?
Treponema pallidum causes which infection and what does it look like?
- Corkscrew-shaped anaerobe that cannot be cultured
Which stage of syphilis is characterized by a systemic illness and skin lesions?
Which disease is associated with the bacterium Haemophilus ducreyi?
Insulin stimulates the production of _____ and ____.
glycogen and fat
What is the main difference between HHNKS and DKA?
HHNKS is characterized by lack of ketosis
Diabetes insipidus is caused by insufficient amounts of ______
Myxedema coma is caused by severe ______
The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute:
A.retention and water retention
B.dilution and water retention
C.dilution and water loss.
D.retention and water loss
B. Dilution and water retention
(this multiple choice question has been scrambled)
The most common cause of elevated levels of antidiuretic hormone (ADH) secretion is:
a.ectopically produced ADH.
b.inflammation of the hypothalamus.
c.posterior pituitary tumor.
d.inflammation of the nephrons
ectopically produced ADH
The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the:
If the target cells for antidiuretic hormone (ADH) do not have receptors, the result is which type of diabetes insipidus (DI)?
Which of the following laboratory values is consistently low in a client with diabetes insipidus (DI)?
a.Urine specific gravity
d.Serum total protein
urine specific gravity is consistently low
Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)?
Hyperpituitarism is generally caused by:
a.a pituitary adenoma.
c.autoimmune disorder of the pituitary.
d.a neurohypophysial tumor.
a pituitary adenoma
A primary adenoma causes thyroid and adrenal hypofunction because the tumor:
a.metastasizes to the thyroid and adrenal glands through the lymphatic system causing reduced secretion of necessary hormones.
b.has a paradoxical effect on adjacent cells, which results in hyposecretion of other anterior pituitary hormones.
c.invades the hypothalamus adjacent to it and causes a reduction in the amount of hormones produced.
d.releases tumor markers that occupy the hormone receptor sites of other endocrine organs
has a paradoxical effect on adjacent cells, which results in hyposecretion of other anterior pituitary hormones
Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a:
a.posterior pituitary adenoma.
d.growth hormone adenoma.
The most common cause of hypoparathyroidism is:
c.parathyroid gland damage.
d.autoimmune parathyroid disease
parathyroid gland damage
Polyuria occurs with diabetes mellitus because of:
a.the formation of ketones.
b.chronic insulin resistance.
c.an elevation in serum glucose.
d.an increase in antidiuretic hormone
an elevation in serum glucose
The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is:
a.dipstick test for urine ketones.
b.increase in serum creatinine and blood urea nitrogen (BUN).
c.protein on urinalysis.
d.cloudy urine on the urinalysis.
protein on urinalysis
Patients with diabetes mellitus develop hyperlipidemia because of:
a.increases in both low-density lipoproteins (LDLs) and triglycerides (TGs).
b.decreased low-density lipoproteins (LDLs) and increased triglycerides (TGs).
c.decreased low-density lipoproteins (LDLs) and increased high-density lipoproteins (HDLs).
d.increased high-density lipoproteins (HDLs) and decreased triglycerides (TGs)
Inrease in both LDLs and triglycerides
what causes microvascular complications of clients with diabetes mellitus?
the capillary basement membrane thickens and endothelial hyperplasia occurs
hypersecretion of adrenocorticotropic hormone (ACTH)
hypersecretion of adrenal medulla hormones
The major hormonal determinant of sexual differentiation in utero is:
Which of the following shows a correct sequence in the hormonal stimulation
of the reproductive systems leading to puberty in the female?
a.GnRH, FSH, LH
b.Hypothalamus, FSH, anterior pituitary
c.Anterior pituitary, FSH, LH
d.GnRH, hypothalamus, FSH, LH
GnRH, hypothalamus, FSH, LH
Which hormone is linked to obesity and early puberty?
The function of Bartholin glands is to secrete mucus in order to:
a.lubricate inner labial surfaces and enhance motility of sperm.
b.lubricate the urinary meatus and vestibule.
c.maintain the acid-base balance to discourage proliferation of pathogenic bacteria.
d.lubricate the cervix and enhance movement of the penis during intercourse
lubricate the inner labial surfaces and enhance motility of sperm
Where is the usual site of fertilization of an ovum?
a.Distal end of the fallopian tubes
b.Fimbriae of the fallopian tubes
c.Ampulla of the fallopian tubes
d.Os of the fallopian tubes
ampulla (distal third) of the fallopian tube
Which immunoglobulin is secreted by mucosal secretions of the cervix?
The equivalent to the ovaries in women is the _____ in men.
A surge of which hormone changes the ovulatory follicle into the corpus luteum?
During the menstrual cycle, ovulation is directly caused by a:
a.gradual decrease in estrogen levels.
b.sudden increase of LH.
c.sharp rise in progesterone.
d.gradual increase in estrogen levels
sharp rise in progesterone
Which immunoglobulin is contained in breast milk?
What causes the vasomotor flushes (hot flashes) that are associated with declining ovarian function with age?
a.Decreased estrogen levels
b.Increased progesterone levels
c.Increased estrogen levels
d.Rapid changes in estrogen levels
Rapid changes in estrogen levels
Which of the following is NOT a normal characteristic of aging of the male reproductive system?
a.Reduced sperm count
b.Slower, less forceful ejaculations
c.Testicular atrophy and softening
d.Longer time to achieve full erection
reduced sperm count
stimulates theca cells of the ovarian follice to produce androgens
relaxes the myometrium and prevents lactation until fetus is born
induces the conversion of androgens to estrogens
acts of leydig cells to regulate testosterone secretion
in combination with progesterone, controls menstrual cycle
most epithelial __________ arise from a single cell and involve the loss of tumor suppressor genes and activation of oncogenes
The clinical manifestations of a woman include the following: irregular or
heavy bleeding, passage of large clots, and depletion of iron stores. This person is experiencing:
b.dysfunctional uterine bleeding (DUB).
c.polycystic ovary syndrome.
dysfunctional uterine bleeding (DUB)
Considering the pathophysiology of primary amenorrhea, what anatomic structure is involved in compartment II?
Considering the pathophysiology of primary amenorrhea, what anatomic structure is involved in compartment IV?
DUB secondary to ovarian dysfunction is abnormal uterine bleeding resulting from:
b.progesterone deficiency or relative estrogen excess.
c.sexually transmitted infections.
d.congenital abnormalities in the uterine structure.
progesterone deficiency or relative estrogen excess
The pathogenesis of polycystic ovarian syndrome is described as:
a.a decrease in leptin levels that reduces the hypothalamic pulsatility of gonadotropin-releasing hormone, which reduces the number of follicles that mature.
b.a disorder in the anterior pituitary that
increases the follicle-stimulating hormone, which reduces the luteinizing hormone released.
c.excessive androgens that affect
follicular decline by suppressing apoptosis, enabling follicles, which normally disintegrate to survive.
d.testosterone that stimulates androgen secretion by the ovarian stroma and reduces sex hormone-binding globulin indirectly.
excessive androgens that effect follicular decline by suppressing apoptosis, enabling follicles, which normally disintegrate to survive
_____ are benign uterine tumors that develop from smooth muscle cells
in the myometrium and are commonly called uterine fibroids.
The common clinical manifestations of endometriosis include:
a.back and flank pain.
b.infertility and dysmenorrhea.
c.dysuria and absent menstrual flow.
d.painless, vaginal bleeding between menstrual periods.
infertility and dysmenorrhea
_____ is a condition in which the foreskin cannot be retracted over the glans penis.
Which cancers are associated with alterations of the BRCA1 gene?
a.Endometrial and ovarian
b.Endometrial and cervical
c.Cervical and breast
d.Breast and ovarian
Breast and ovarian
T or F: A virally transmitted STI is incurable
During the _____ stage of syphilis, blood-borne bacteria spread to all the major organ systems.
In which stage of syphilis would the following clinical manifestations be found: destructive skin, bone and soft tissue lesions, aneurysms, heart failure, and neurosyphilis?
Which organism causes syphilis?
a.Neisseria syphilis, an anaerobic bacterium
b.Treponema pallidum, a spirochete
c.Haemophilus ducreyi, a bacterium
d.Chlamydia trachomatis, an intracellular parasite
treponema pallidum, a spirochete
Which is a lesion of secondary syphilis?
What is haemophilus ducreyi associated with?
Glucagon is synthesized by the ____ cells of the pancreas
Aldosterone secretion is secreted by _______
Regulation of the release of epinephrine from the adrenal medulla is an example of _____ regulation.
hormone (TSH) is released to stimulate thyroid hormones and is
inhibited when plasma levels of thyroid hormone are adequate. This is an
Where is antidiuretic hormone (ADH) synthesized and where does it act?
a.Synthesized in the hypothalamus; acts in renal collecting ducts
b.Synthesized in the renal tubules; acts in renal collecting ducts
c.Synthesized in the anterior pituitary; acts in the posterior pituitary
d.Synthesized in the posterior pituitary; acts in loop of Henle
synthesized in the hypothalamus; acts in renal collecting ducts
Where is oxytocin synthesized?
The releasing hormones that are made in the hypothalamus travel to the anterior pituitary via the:
a.vessels of the zona fasciculata.
d.portal hypophysial blood vessels.
portal hypophysial blood vessels
Norepinephrine stimulates the release of which hormone?
b.Adrenocorticotropic hormone (ACTH)
c.Growth hormone (GH)
Growth Hormone (GH)
What effect does hyperphosphatemia have on other electrolytes?
a.It increases serum calcium.
b.It decreases serum calcium.
c.It decreases serum magnesium.
d.It increases serum magnesium
it decreases serum calcium
Which of the following is secreted by the adrenal medulla?
What are actions of glucocorticoids?
a.Protein catabolism and liver gluconeogenesis
b.Fat storage and glucose use
c.Decreased blood glucose and fat mobilization
d.Fat, protein, and carbohydrate anabolism
protein catabolism and liver glucogenesis
What are the effects of high levels of aldosterone?
a.Hypokalemia and alkalosis
b.Hyperkalemia and alkalosis
c.Hyperkalemia and acidosis
d.Hypokalemia and acidosis
hypokalemia and alkalosis
What effect does aldosterone have on fluid and electrolyte imbalances?
a.It directly increases magnesium reabsorption.
b.It directly increases calcium reabsorption.
c.It directly increases sodium reabsorption.
d.It directly increases water reabsorption.
directly increases sodium reabsorption
Which of the following is an expected change in an older patient?
a.Thyroid-stimulating hormone (TSH) secretion below normal
b.Triiodothyronine (T3) level below normal
c. Cortisol level above normal
d.Adrenocorticotropic hormone (ACTH) level above normal
TSH below normal
Where is calcitonin secreted?