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How would you describe the different mechanisms of cell injury?
- Ischemia- lack of blood flow
- infectious agents- bacteria/virus
- immune reactions- allergy (pollen)
- genetic factors- sickle cell anemia
- nutritional factors- vitamin deficient
- physical factors- dehydration, trauma
what are some of the ways cells can adapt?
- atrophy- wasting away
- hypertrophy- cell gets bigger
- hyperplasia- increase in number
- metaplasia- change in function
- dysplasia- combo of hyper and meta-plasia
what are some causes for atrophy?
- vascular insufficiency
- reduction in hormone levels
- pain limiting function
- chronic inflammation
How can hypertrophy be an adaptation?
through working out
how can hypertrophy be pathological?
cardiac cells; high blood pressure
What is the only way that a cell can only under go hyperplasia?
if the cells is still able to undergo mitosis.
what are some examples of hyperplasia?
- menstrual cycle - uterine response to increased hormones
- skin callous formation
- prostate enlargement
What affect does smoking have on the epithelial tissue in the throat?
metaplasia- this is a change in morphology and function due to conversion of one type of adult cell to another type.
smoking causes cilated pseudostratified columanr epithelial cells to convert to stratified squamous epithelium.
A pre-neoplastic state would be considered what type of cellular adaptation? How would you describe this adaptation?
dysplasia- increased cell numbers that also has altered cell morphology and loss of histological function.
What is the main purpose of inflammation?
It is essential for healing to occur.
When might it be common to see chronic inflammation?
- overuse/repeated trauma
- autoimmune diseases
How is chronic inflammation different than acute inflammation?
- the cellular response involves lymphocytes and macrophages instead of neutrophils.
- The scar formation is > and the tissue is very different than before.
You know the phases of tissue repair. What are they?
Basically, what does autoimmune mean?
The body is unable to recognize self from non-self. It can affect any cell or organ in the body.
T/F: if an injury is bad enough a wound can hang around in the inflammatory phase a little bit longer?
What goes on during the inflammatory phase?
- phagocytosis-1-4 days
- mitosis- endothelial cells
What phase of tissue repair does hyperplasia take place?
How long does the proliferative phase last?
day 3- 3 weeks
What happens to connective tissue during the proliferative phase?
fibroblasts migrate into the wound along fibrin strands and secrete collagen and mucopolysaccharides.
How would you describe granulation during the proliferative phase?
endothelial buds develop from intact capillaries and connect with other buds to form new vasulature.
What is wound contraction and when does it take place?
myofibroblasts accumlate in wound margins; proliferative
erythemia, heat, edema, pain, decreased function/loss ROM, and increased muscle tone or spasm are?
cardinal s/s of inflammation
what are the potential systemic effects of inflammation?
- elevated vital signs
- metabolic, hemodynamic, and hemolytic changes
There are 4 stages of acute inflammation. What are they?
What are the ways you can have a vascular response?
what is the purpose of acute inflammation?
mobilize and transport the bodys defenses
What are the chemicals that phagocytic cells are very attractive to during the vascular response?
When do platelets form?
What is the main purpose of the cellular response?
draw leukocytes to the area to initiate phagocytosis. leukocytes release enzymes to kill, inactivate, and degrade microbial agents, foreign antigens, and necrotic tissue.
polymorphonulear leukocytes, what are they?
- neutrophils that inhibit microbial growth. they have a 10-24 hr lifespan and then are replaced by monocytes/macrophages.
- Monocytes clean house and release growth factors that promote healing and regeneration
What sets off the acquired immune response?
T&B cells that underwent hyperplasia.
t-lymphocytes are what kind of immune response?
b-lymphocytes are what kind of immune response?
During the remodeling phase, collagen orientation depends upon what?
random, final orientation dependent upon loads placed on healing tissue.
what is the time frame for the remodeling/maturation phase?
day 9 and onward. can take 3-18 months depending on the damaged tissue.
What is the study of blood and the blood forming tissues?
T/F: blood is a connective tissue.
Blood has 3 important jobs. What are they?
- delivery system- takes away the bad stuff
- regulatory- carries hormones
- defense- fights off foreign invaders
What makes up blood?
- plasma: "water" of the blood 55% of blood volume
- formed elements: RBC's WBC's, platelets
What hematocrit would it not be safe for exercise?
What hematocrit would light exercise be indicated?
what hematocrit would resistive exercise as-tol be indicated?
What is the INR and what do you want it to be?
international ratio; how fast their blood clots; 2-3
What is hematopoiesis and where does it take place?
it is blood cell formation and it takes place in the red bone marrow.
What is a hemocytoblast?
a stem cell for all blood types
what is erythropoiesis and what is its production dependent upon?
- it is the production of the hormone erythroietin that is produced in the kidneys in response to decreased O2 levels and increased androgen levels.
- its production is dependent upon: iron B12, and folate
What is the main function of erythrocytes?
they carry O2 and CO2.
what is the life span of a erythrocyte?
120 days; 1 week to go from stem cell to reticulocyte, then released into the stream, then24-48 hrs to become mature RBC.
break down the word "hemoglobin" into its componets
- Heme: iron containing
- gobin: protein; 4 chains with an atom of iron in the middle that binds O2.
T/F: the main function of leukocytes are to be a defense mechanism for the body.
There are two types of lymphocytes. What are they and what do they do?
- acquired immunity by :
- T-cells: direct cell attack
- B-cells: production of antibodies
What are your first line defenders?
- The phils:
T/F: polymorphonuclear leukocytes are part of our innate immunity and they attack any invader regarless of previous exposure. They phagocytize a broad range of bacteria and infectious agents based upon very common characteristics of those agents.
what acts as a "plug" to an injury?
What can affect your ability to clot?
- anti-coagulation drugs (aspirin)
- liver disease
What is the lifespan for a platelet?
What would some s/s that would make you suspicous of leukemia?
- fever and night sweats
- easily bruised or bleed
- bone or joint pain
- enlarged spleen
- swollen lymphnodes in the axilla, neck, or groin
- frequent infections
- tired or weak
- loss of weight and loss of hunger
what is the distingyishing characteristic of hodgkins lymphona?
what other sites can hodgkins lmphoma spread to?
- bone marrow
What are the clinical manifestiations of hodgkins lymphoma?
- irregular fever
- night sweats
- in some cases s/s of pulmonary and spleen involvement
What are the two initial locations for hodgkins lymphoma?
- classic: cervical, axillary, para-aortic lymph nodes
- lymphocyte predominant: usually in one lymph node rather than in groups and does not follow an orderly pattern of spreading
What are the treatment paths for hodgkins lymphoma?
chemo and radiation
T/F: hodgkins lymphoma is considered one of the most cureable cancers?
How would you assess lymph nodes?
What would make you suspicious of nodes?
- firm consistency
- non-tender to palpation
- fixed mobility
What are erythocyte disorders?
- sickle cell
what are leukocyte disorders?
- hodgkins/non-hodgkins lymphoma
T/F: anemia is a diagnosis
FALSE! it is a manifestation of another disorder or disease
What are some of the common causes of anemia that you will see in PT?
- iron deficiency due to GI bleed associated with NSAID use
- chronic inflammatory disease (RA)
- renal failure
- infectious diseases (TB & AIDS)
- neoplastic bone disease
What are some of the S/S with anemia?
- skin pallor or yellow tinged skin
- fingernail changes; brittle or concave
- fatigue or listlessness
- dyspnea on exertion with heart palpitations or rapid pulse
- decreased diastolic blood pressure
What are the CNS manifestations with anemia?
- apathoy or depression
- slow thought processing
- can result in polyneuropathies of periheral nerves if anemia persists over an extended time period
What are the medical treatments for anemia?
- RBC transfusion
- vitamin B, folic acid, iron supplements
- bone marrow transplant
- androgens or cortiosterioids to stimulate bone marrow
in laymens terms what is sickle cell anemia?
blood cell is shaped like a C and it doesn't flow as easily. It can get caught up in the vessel and cause ischemia.
What is polycythemia/erythrocytosis?
excessive RBC's; can progress to leukemia.
What is leukocytosis and what can cause it?
- increase in the number of leukocyctes in the blood.
- Causes: bacterial infections, inflammation, acute emorrhage, malignancies, appendicitis, splenectomy, myeloproliferative disorders.
What is leukopenia and is it a good thing?
low WBC's; <5,000/mm3- NOT A GOOD THING!
What are some of the causes of leukopenia?
- overwhelming infection
- chemotherapy or radiation therapy (7-14 days after treatment)
- autoimmune disease
- dietary deficiencies
- bone marrow failure
Basically, what is leukemia?
- Form of CA-release of immature WBC's that accumulate and interfere with other blood cell production
- they take over healthy cells and kill healthy cells
There are 4 main types of leukemias. What are they?
- acute lymphoblastic
- acute myelogenous
- chronic lymphocytic
- chronic myelogenous
If you have thrombocytopenia what are you deficient in? What s/s would you monitor for?
- you would have insufficient amount of platelets.
- you would look for severe bruising, eternal hematomas, petechiae
You have a patient with thrombocytopenia, what would you take caution with during exercise?
- strenuous exercise or bearing down can precipitate hemorrhage patricularyly in the brain and eyes
- BP cuffs
- soft tissue mobes is contraindicated
- s/s of infection
Why are aspirins and NSAIDS bad for platelets?
- they inactivate platelets
- a single dose can of aspirin can suppress platelet aggregation for 48 hrs and up to 1 week leaving it inactive for the remainder of it's life
- less potent impact, but it can still lead to easy bruising and bleeding confined to the skin
What are some things that would put you at risk for a DVT?
- previous DVT
- Hx of CA (or receiving chemo)
- Hx of CHF
- Hx systemic lupus
- major surgery
- major trauma
- limb paralysis
- age >60
- women who are preggo, on birth control or hormone replacement therapy
What specific S/S would we cluster to consider it a clinical manifestation for DVT?
- ache, tightness, tenderness
- general edema
- pitting edema
- prominent superficial venous plexus
- increased local skin temperature
What would be an immediate referral to the MD for an immunologic response?
- s/s of anaphylaxis
- new onset of jt pain within 6 wks of surgery (reactive arthritis)
- exquisit TTP with blue hue or erythema of a jt with Hx of recent infection
When might you refer someone for a non-emergency immunologic response?
- unexplained jt pain with constitutional s/s
- symmetrical swelling and jt pn (RA)
- progressive neurological symptoms within 1-3 wks of an infection or vaccination (guillain Barre)
- evidence of spinal cord compression in a pt with RA
What are the constitutional S/S?
- night sweats
What is an organism capable of producing a disease?
What are serum proteins prodced by b-lymphocytes that bind to and destroy specific antigens?
What is an antigen?
any cell in the body that is recognized as foreign because it does not have the cell marker of that specific individual.
T/F: immunology is the study of the physiologic mechanisms by which the body recognizes "foreign" and the mechanisms to neurtalize/eliminate "foreign"
What is the study of how unregulated immune responses cause disease?
What is your first line of defense of the innate immune system?
mechanical and chemical barriers: skin, mucosal membranes, tears, urine
What is the second line of defense of the innate immune system?
inflammatory response and phagocytosis
T/F: part of your acquired immunity can come from mothers breast milk?
would having chicken pox as a child result in an innate immunity or acquired?
What is your third line of defense for immunity and what does it do?
acquired; reognizes and destroys foreign stuff (bacteria, fungi, viruses) It has a memory and produces specific immune responses.
What are the 3 important aspects of immunity?
- specific recognition of self and non self (protein markers)
- memory for non self (acquired immunity)
- self regulation of responses
What are your central lymphoid organs?
- bone marrow (b-cells; where they are born)
- thymus (t-cells; where they mature)
What are the peripheral lymphoid organs?
- lymphatic system- filters antigens from interstitial fluid
- spleen- cleans wastes from the bloodstream
- tonsils-big filter; t-cells
- peyers patches-tonsils of the intestines
What are the polymorphonuclear leukocytes?
- neutrophils-kill invaders
- basophils- allergic disorders
- eosinophils-release histamine and increase blood flow
what are tattle-tale pac-men?
monocytes/macrophages- they eat invaders and release cytokines
What do T-cells do?
turn on or off the immune response. produced in the red marrow and mature in the thymus.
There are 3 types of T-cells. What are they and what do they do?
- helper t-cells: stimulate b cells to mature and produce antibodies
- natural killers: directly attack and kill invaders
- suppressor t-cells: reduce the immune response by suppressing the other t-cells.
What becomes immunocompetent in the bone marrow?
What are self regulating proteins released by macrophages?
The specific cytokine that influences function of mature lymphocytes is the __________.
colony stimulating factor
What specific cytokine can inhibit tumor growth and protect non-infected cells from viruses?
What does the tumor necrosis factor do?
eliminate blood supply to tumors
What specific cytokine prompts t-cells to recognize pathogens?
potential causes for dysfunctions of the immune system include:
- developmental defects
- metabolic disorders
- drug use
congenital failure of organ development necessary for lymphocyte maturation or born without certain antibody types is?
primary immunodeficieny diseases
malnutrition, stress, CA treatment, leukemia, chronic deseases such as DM and renal failure are examples of what?
anaphylactic hypersensitivity and typical allerigies are examples of what type of hypersensitivity disorders?
What are some examples of type 2 hypersensitivity disorders?
cytotoxic reactions; blood transfusion, autoimmune hemolytic anemia
an immune complex mediated hypersensitivity disorder is what type?
If you have no reaction until your second exposure, what type of hypersensitivity do you have?
T/F: typical S/S of a type 1 hypersensitivity would include redness, swelling, itiching and runny nose due to for example, hay fever.
You have a pt. who after just a few minutes of exercising with a ther-band starts wheezing, turning blue, swelling of the hands and has difficulty breathing.
what should you automatically suspect?
allergic to latex and anaphylaxis
clinical s/s of type 2 hypersensitivity include?
- chest pain
- back/flank pain
- tachcardia and hypotension
- nausea and vomiting
What is it called when antigen-antibody complexes are deposited in tissue rather than be cleared from the body?
immune complex disease- type 3 hypersensitivity
What are some of the common sites for the "immune complex disease" to deposit the antigens/antibodies?
- skin (urticaria)
- joints (RA)
- kidneys (nephritits)
- pleura (pleuritis)
- pericardium (pericarditis)
Fever, arthralgias, synovitis, lymphadeonpathy, urticaria, and visceral inflammation are all examples of what?
clinical S/S for type 3 hypersensitivity
contact dermatitis and transplant rejection are examples of what type of hypersensitivity?
What do immunosuppressive drugs do?
they "dumb down" the immune system. Used during organ and blood transplants that are very closely matched to the receipent so that rejection is less likely to occur.
T/F: we don't treat patients pathologies, we treat patients with a protocol to their specific pathologies.
What is the combination of factors for an autoimmunity disorder?
genetic, hormonal, and environmental.
What are some organ specific autoimmunities?
- addisons- adrenal cortex-
- graves- thyroid- over functioning of the thyroid
- diabetes-pancreas-type 1( decreased insulin) type 2 (resistance to insulin)
- pernicious anemia
- ulcerative colitis
S/S of hyperglycemia:
- gradual onset
- flushed face
- fruity odor to breath
- abdominal pain and distntion
- blood glucose level >250
S/S of hypoglycemia (insulin shock)
- rapid onset
- blurred vision, numbness of lips and tongue
- nervousness, iritability, increased HR
- difficulty speaking or concentrating
- poor coordination
What glucose levels would you not exercise a pt?
What do ulcerative coitis and crohns have in common?
they are both inflammatory bowel conditions (IBD's)
T/F: IBD's can have referred pain to LB, hip or groin?
T/F: there is a high prevalence of osteoporosis with IBD's?
A chronic, systemic inflammatory disorder of unknown eitology typicall involving synovial joints but can also affect other organs is known as ___________.
How many of the criteria must be met for a positive diagnosis of RA?
4 out of 7 and must be present for 4-6 weeks.
What do you monitor for with a RA pt?
- gait disturbances
- upper motor neuron signs (babinskis, shimizu..)
What is a chronic, systemic, inflammator rheumatic conncective tissue disease that is characterized by multiple autoantibodies?
systemic lupus erythematosus (SLE)
What is a common rash shape you will see with SLE pt's and where would you find this rash?
What is sclerosis and what can if affect?
Hardening; skin, blood vessels, tendons, joints, skeletal muscles, and other organ systems
since there is no cure for systemic sclerosis/scleroderma, we focus on treating the S/S. How would you go about treating them?
- skin: control itching and watch for infection
- musculoskeletal: strength and ROM to manage myositis and fibrotic myopathy
- jt and tendons: activity and stretching
what is inflammatory myopathy that results in symmetrical weakness of striated skeletal muscle and primarily affects proximal muscles of the shoulder and pelvic girdle?
non-infectious, inflammatory and erosive rheumatic disease are all characteristics of ___________ that target 1.____________, 2_____________, and 3. ______________.
- 1. SI joints
- 2. connections bw disc and bone
- 3.facet joints
The most common s/s for a spondyloarthropathie is?
inflammation of the fibrous part of the joint capsule and ligaments (via the synovium) that leads to fusion is known as ____________.
You have a patient with ankylosing spondylitis what should you address during intervention?
- postural training focusing on extension and rotation
- breathing exercises (diaphragmatic)
What are some of the common sites affected by ankylosing spondylitis?
- SI jt
Sterile inflammatory arthropathy distant in time and space to the initial inciting infective process (commonly follows veneral disease or bacilary dysentery) is known as ____________.
the classic triad of symptoms with reiters syndrome include:
T/F: there is a genetic predisposition to psoriatic arthritis and it mostly affects the DIP joints of the hands. It can affect the axial skeleton 20 yrs after the initial involvement.
what do MRSA, VRE, and myobacterium tuberculosis have in common?
they are superbugs
What are the first two things you should do to prevent the spread of diseases?
- wash those dirty hands!
what are infections predisposers for?
- heart disease
- mental illness
- autoimmune diseases
There are a bunch of systemic symptoms of infection, but what are the 3 main ones?
Bacterial infections cause what kind of changes within the blood composition?
What affect does viral infections have on blood composition?
leukopenia- decrease number of WBC's.
What happens to lymph nodes during acute infection?
they are tender asymmetrically, enlarged and matted together. Overlying skin may be red and warm and it can cause a regional muscle spasm.
S/S of infection can present in multiple systems of the body. What are they and give an example.
- skin: rash, purulent drainage, red streaks
- cardiovascular: petechial lesions, tachycardia, HTN
- CNS: confusion, HA's, memory loss
- GI: nausea, vomiting, diarrhea
- GU: flank pain, dysuria, hematuria
- Upper resp: cough, hoarse, runny nose
Like everything else within the human body, there are many reasons for a fever. Name a few.
- immunologically mediated diseases
- neoplastic conditions
- brain tumors
- hypothalamaic abnormalitites
What fever pattern lasts for only 7-10 days?
T/F: a fever pattern that lasts greater than 10 days is sepsis or an ongoing infection.
What is a fever of unknown origin (FUO)
A fever that lasts at least 6 weeks. The most common cause is leukemia and lymphoma.
The ability of an organism to induce disease is known as _____________ and what factors does it depend on?
- rate of reproduction
- strength of toxin
- extent of tissue damage
What are the different groups for the virulence (potency) of an infectious agent?
- benefit the host: bacteria produce B12 and used to make RBC's
- normal flora: has no affect and low virulence
- low pathogenicity: has some normal flora as in the colon, mouth, nose, throat
- high pathogenicity: cause disease
(#microbes*virulence)/host defenses represents what?
severity of disease
What are some of your first line defenses against infectious diseases?
- cilia in the throat
- gag and cough reflex
- saliva and mucous
inflammatory response; polymorphonuclear leukocytes are what line of defense against infectious diseases?
There are some other natural defenses against infectious diseases. What are they?
What is the chain of transmission?
pathogen --> reservoir --> portal of entry --> transmission --> portal of exit
Name some of the ways you can control the transmission of infectious diseases
- isolation and barriers (PPE)
- improved nutrition, living condtions and sanitation
- controlling environmental factors (water treatment)
- HAND WASHING!!
are viruses affected by antibiotics?
How to you become "sick" with a viral infection?
- invasion of the body
- attaches to receptors on the call membrane
- release enzymes to penetrate the cell
- becomes uncoated
- stimulates hose cell to synthesize the virus
- escapes from the cell
We have all had some form of viral infections and there are quite a few, what are the most common ones?
- blood born: Hep B and C, HIV
- Herpes: cold sores/genital, chicken pox, mono
- respiratory: flu, RSV
- childhood: chickenpox, mumps, measles
What is the difference between HSV1 and HSV2?
HSV1 are coldsores and are found on the lips. HSV2 are found on the genital and are sexually trasnmitted. There is no cure for either.
What is varicella zoster and what is the only way that you can get it?
Shingles; if you had chicken pox as a child. It will come back in the form of shingles.
T/F: a shingles outbreak will usually follow a certain myotomal route?
What is mono?
epstein barr virus- a form of herpes; self limitying lymphoproliferative disorder. transmitted through saliva. takes 4-8 weeks for incubation.
what are some of the common findings with mono and what implication do they have on a young athlete?
splenomegaly, hepatomegaly (liver) that usually resolves without permanent damage, can take up to 3 months. For young athletes there is a return to play protocol.
How does cytomegalovirus present in babies and how might they become infected?
fever, splenomegaly, hepatitis, pneumonitits, respiratory distress syndrome, interinal ulcerations, calcification around the ventricles of the brain in babies with CNS infection.
breast milk, congenitally, peri or post-natally.
What s/s would someone have to make you suspect they had the flu?
- non productive cough
- sore throat
T/F: in adults RSV is a mild respiratory infection. In babies however it is a sever life threatning infection.
T/F: viral meningitis is worse than bacterial meningitis and the prognosis is slim.
SO FALSE! The exact opposite it true!
What happens to the meninges if you have viral meningitis?
they become inflamed due to infectious agent crossing the blood brain barrier and entering the CSF.
Which are the biggins, mumps or measles?
what are single cell organisms that do not need another living organism for growth and reproduction?
Why does bacteria thrive in the human body?
warmth and an excellent source of nutrition
what is the most common bacterial pathogen that resides on the skin?
How does staph spread?
direct contact with people or surfaces; burns, surgical wounds, IV devices, malnourished, new borns, elderly, and diabetics are at greater risk.
T/F: scarlet fever usually follows untreated streptococcal?
basically what is strept pharyngitis?
bacterial sore throat
_____________________ is an invasive infection of fascia with infectious thrombosis of vessels that pass between the skin and deep circulation resulting in skin necrosis.
What are the S/S of necrotizing fascitis?
initially skin is red, shiny swollen, hot, tender and painful with sharp margins.
acute inflammation of the skin ans sucutaneous tissue with resultant lymphangitis and systemic s/s of fatigue, malaise, and HA.
____________ is a rare but life threatening disease that results in severe pain, inflammation in the affected muscle and is treated with surgical debridement and IV penicillin
How is group B of strept acquired?
passing through the birth canal.
Who does bacterial meningitis primarily affect?
immunosupressed, young and old. Prompt diagnosis is critical in infants as death is common.
T/F: tuerculosis is treatable but highly contageious.
What is a form of bronchopneumonia caused be legionella pneumonophila? Where are you most likley to come in contact with it?
legionnaires disease; warm standing water
The endocrine system plays a role in many parts of life. What are they?
- growth and development
- sexual differeniation and reproduction
- adaptation to changing environment
What secretes hormones directly into the blood stream and lymphatic system as a means to regulate and intergrate body functions?
chemical messangers that moduate (not iniate) cellular and systemic responses by interacting with high affinity receptors of specific cells are known as what?
T/F: can one hormone have different affects depending on the target tissue?
T/F: a single body function can be regulated by several different hormones.
How does the endocrine and neurologic system work together?
regualte metabolism, water and salt balance, BP, response to stress, and sexual reproduction.
what is the bridge by which multiple body systems relay messages to the pituitary gland?
What are the two ways that they hypothalmus controls functions of the endocrine organs?
- neural pathways
- hormonal pathways
There are 8 major endocrine glands. What are they?
- pituitary (anterior and posterior)
- adrenal (cortex and medulla)
what are the hormones produced in the anterior pituitary?
- GH- growth of bones and muscles
- TSH- secretory activity in the thyroid
- gonadotrophs- FSH and LH
- lactotrophs- make prolactin
- ACTH- secretory activity of adrenal cortex
ADH and oxytocin are produced where?
What are the 3 hormones produced in the thyroid?
- T3- tri-iodothyroine
parathyroid hormone (PTH) increases serum calcium levels by acting on?
- intestinal tract
What two hormones are produced in the adrenal cortex?
- aldosterone (mineralcocorticoid)
- cortisol "hydrocortisone"
What two hormones are produced in the adrenal medulla?
epinephrine and norepinephrine
What hormone defect can cause dwarifism and gigantism?
growth hormone- pituitary disorder
What would acromegaly look like?
bones of face, jaw, hands and feet become broader and heavier.
_____________ is an inadequate ADH level that leads to inadequate H2O re-sorption from the kidneys
A goiter is an example of what type of endocrine disorder?
Briefly describe graves disease?
form of hyperthyroidism. S/S include tachycardia, nervousness, heat intolerance
what is the most common type of thyroid disorder?