Patho Exam 2

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Patho Exam 2
2011-02-19 18:48:57
Patho Exam

Patho Exam 2
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  1. SIADH What organ/tissue is involved in
    Posterior Pituitary
  2. SIADH What Hormone is involved and is it hyper or hypo
    Hypersecretion ADH
  3. SIADH What is the cause
    • High levels of ADH with out physiologig stimuli
    • Pituitary Surg
    • Infectious pulmonary diseases
    • Psychiatric disease after drug treatment
  4. SIADH Clinical Manifestations
    Thirst, dyspnea on exertions, fatigue, dulled consciousness, progressing abdominal cramps, vomiting, confusion and seizures
  5. What must exist for diagnosis of SIADH
    • Normal adrenal and thyroid function must exist
    • Serum hypo-osmolarity and hyponatremis
    • Urine hyperosmolarity
  6. Diabetes Insipidus
    What organ/tissue is involved
    Posterior Pituitary
  7. Diabetes Insipidus

    What Hormone is involved with and is it Hyper or Hypo
    Hyposecretion of ADH
  8. Diabetes Insipidus

    What is the cause
    Insufficiency of ADH leading to polyuria and polydipsia
  9. Diabetes Insipidus
    Name the 3 causes
    • Neurogenic
    • Nephrogenic
    • Psychogenic
  10. Diabetes Insipidus
    What is neurogenic
    • Insufficient amounts of ADH
    • a lesion on hyopthalamus or posterior pituitary interferes with ADH synthesis, transport or release
  11. Diabetes Insipidus
    What is Nephrogenic
    • Inadequate response to ADH
    • insensitivity of renal tubule to ADH, Kidney not responding
  12. Diabetes Inspipidus
    What is Psychogenic
    • Partial resistance to ADH
    • Cause by an extremely large volume of fluid intake
  13. Hypopituitarism

    What organ/tissue is involved
    Anterior Pituitary
  14. What Hormone is involved with and is it Hyper or Hypo
    Hyposecretion Any of the hormones
  15. Hypo pituitarism

    What is the cause
    • Pituitary infarction
    • Sheehan syndrome
    • hemorrhage
    • Shock
    • Head trauma
    • Infections
    • tumors
  16. What is panhypopituitarsim
    All hormones are low
  17. Pantypopituitarism
    ACTH Target and
    Effects of ACTH Deficiency
    Target adrenal gland to release corisol

    Cortisol deficeincy = decreased immunity
  18. Pantypopituitarism
    TSH Target and Effects of TSH Deficiency
    Target Thyroid gland

    Thyroid deficiency= decreased metabolism (in children this makes them short)
  19. Pantypopituitarism
    FSH and LH Target and Effects of FSH and LH Deficiency
    • Target Gonads
    • Loss of secondary sex characteristics, Gonadal failure, decreased fertility levels
  20. Growth Hormone Deficiency in children =
    Normal intelligence, short stature, obesity with immature facial features and puberty is often delayed
  21. Growth Hormone Excess what happens if it occurs in children (pre-puberty)
  22. Growth Hormone Excess what happens if it occurs as adult
    Bones have already fused so results in Acromegaly
  23. Acromegaly manifestations
    • Soft tissues grow
    • Lowered protruding jaw
    • Enlargement of heart
    • teeth are splayed
  24. Prolactinomas

    What organ/tissue is involved
    Anterior Pituitary
  25. Prolactinomas

    What Hormone is involved with and is it Hyper or Hypo
    Hypersecreation of Prolactin
  26. Protactimomas

    What is the cause
    hormonally active pituitary tumor
  27. Prolactinomas
    Female manifestations
    • amenorrhea (lose of mensies) galactorrhea (produce milk)
    • hirsutism (male pattern hair growth)
    • osteopenia (brittle bones)
  28. Prolactinomas
    Male manifestations
    hypogonadism, erectile sysfunction, impaird libido, oliospermia, diminished ejaculate volume
  29. Thyrotoxicosis (aka hyperthyroidism)
    What is it
    Hight than normal levels of TH
  30. Graves disease cause
    • Autoimmune
    • abnormal stimulation of thyroid glad by IgG antibodies
  31. Graves Disease Manifestations
    skinny, alway shot, irritable, fatigue, exophthalmos
  32. Describe Thyrotoxic Crisis
    • death within 48 hours with out treatment
    • symptoms hyperthermia, tachycardia, agitation, delirium, nausea, vomiting or diarrehea
  33. Describe Primary Hypothyroidism
    Loss of thryoid tissue, decreased TH, Increas TSH and goiter
  34. What is Iatrogenic Hypothyroidism
    Loss of thyroid tissue- medication causes atrophy of tissue

    Its a treatment for hyperthyroidism
  35. Manifestations of Hypothryoidism
    person is heavier, sensitive to cold, lathargic
  36. Describe congenital Hypothryoidism
    • common cause of preventable mental retardation
    • appears normal at birth due to maternal TH

    Results in cretinism- TH essential for normal breain development and growth
  37. Manifestations of cretinism
    dwarfism, absent axillary and scant pubic hair, poorly developed breasts, pot belly, small umbilical hernia.
  38. What causes goiter
    low TH excessive TSH
  39. Myxedema is a manafestation of ______

    What is Myzedema


    nonpitting mucous edema

    eye and facial puffiness Enlarged tongue
  40. Acute Thyroiditis cause
    Due to a bacterial infection
  41. Subacute Thyroiditis cause
    Due to viral infection
  42. Autoimmune thyroiditis is also know as
    Hashimoto disease
  43. Hasimoto disease
    antibodies attack the TH
  44. Painless thyroiditis
    a combo of sub acute and Hashimoto- Can have auto antibodies that are triggered by a virus
  45. Postpartum thyroiditis
    occurs up to 6 months after delivery
  46. Myxedema coma
    is a medical emergency

    hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, and lactic acidosis
  47. What is secondary Hypothyroidism
    failure to synthesize adequate TSH
  48. Hyperparathyroidism is an increase of what hormone
  49. Primary hyperparathyroidism is
    excess secreation of PTH from one or more parathyroid gland
  50. Secondary hyperparathyroidsim is
    • increase in PTH secondary to a chronic disease
    • example renal failure
  51. Why is there a connection between renal failure and secondary hyperparathyroidsim
    Function of parathyroid hormone is incease blood calcium.

    The organ that makes the decision about how much calcium we need is the Kidney

    If the kidney is in renal failure it constantly is thinking we need more calcium, sending a message to the PTH to release more calcium
  52. Clinical manifestations of Hyperparathyroidism
    • Hypercalcemia
    • Bone resorption cause increased susceptibility to fracture
    • Calcium stones
  53. Hypoparathyroidsim is
    abnormally low PTH levels
  54. Hypoparathyroidism is usually caused by
    parathyroid damang in thyroid surgery
  55. Clinical manifestations of hypoparathyroidsim
    • Hypocalcemia
    • lowered nerve and muscle excitation
    • spasms, hyper reflexia and clonic tonic convulsions

    Bone deformities
  56. Diabetes Mellitus is a dysfuncation of
    the pancreas
  57. To get the Dx of Diabetes Mellitus you must have
    More than one eleveated fasting plasma glucose level

    Elevation plasma glucose levels in resposne to oral glucose tolerance test

    classic symptoms of plydipsia, poly phagia and polyuria

    Glycosylated hemoglobin (a lot of sugar in blood- glucose binds with hemoglobin)
  58. Type 1 diabetes Mellitus is
    Insulin Dependent Diabetes

    lack of insulin and relative excess of glucagon
  59. Epidemiology of Type 1 diabetes
    most commonly diagnosed in those younger than 18
  60. Eitiology of Type 1 Diabetes
    beta cells destroyed due to autoantibodies
  61. Manifestations of Type 1 Diabetes
    polydipsia and polyuria resulting from osmotic diuresis (glucose is attracting water to it) weight loss and polyphagia.

    Ketoacidosis due to increase matabolism of fats and proteins
  62. TYpe II diabetes is
    Insuling dependent or non-insulin dependent?
    Non-Insulin Dependent

    They do make insulin just done have the receptors to use it
  63. Epidemiology of Type II Diabets
    Native Americans, Hispanics, black and alaskan natives

    Most are over 40 and many are obese
  64. Etiology of Type II diabetes
    • 3 main reasons why Type II
    • Impaired Beta Cell Function
    • Peripheral Insulin Resistance
    • Increased Hepatic Glucose Production
  65. Type II Diabetes
    Describe Impaired Beta Cell Funcation
    Pancreas is making some insulin but is not making enough
  66. Type II diabetes
    Describe Peripheral Insulin Resistance
    Insulin can't bind;glucose can't go into cell stays in blood stream

    Most common reason for Type II
  67. Type II Diabetes
    Describe Increased Hepatic Glucose Production
    liver doesn't know when to stop releasing glucagon released suger you don't need
  68. Type II Diabetes Manifestations
    Puritus, recurrent infections, visual changes, and parethesias

    also plydipsia
  69. Gestational Diabetes mellitus
    because excess stress on pancreas and growing a baby increased sugar
  70. Epidemology of Gestational Diabetes
    family history of diabetes, high-risk ethnic group, advances maternal age, prior hx of GDM, overweight
  71. Acute Complications of Diabetes
    • Hypoglycemis (insulin shock)
    • Diabetic Ketoacidosis
    • HHNK
    • Somogyi Effect
    • Dawn Phenomenon
  72. Acute Complication of Diabetes
    Hypoglycemia (insulin shock)
    Type I or Type II
    What is the blood glucose
    90% are Type I

    blood glucose of 46-60

    pallor, tremor,anxiety, tachycardia, palpitations, diaphoresis(sweating), HA, Dizziness, fatiue, confusion, seizures, coma

    Nervous system- Brain needs glucose for energy

    Treatment- juice, fruit, candy bar
  73. Acute Complication of Diabetes Diabetic Ketoacidosis
    What is it and is it type I or Type II
    • Type I
    • High sugar low insulin
    • not enough insulin makes body release glucose more
  74. Acute COmplication of Diabetes

    Diabetic Ketoacidosis Manifestations
    • Slow onset
    • metabolic acidosis producing ketone bodies
    • Thirsty, confusion, fatigue

    Alot of urine
  75. Acute Complications of Diabetes

    Hyperosmolar Hyperglycemic Nonketotic Syndrome HHNK

    Is it type I or Type II
    Type II
  76. Acute Complications of DiabetesHyperosmolar Hyperglycemic Nonketotic Syndrome HHNK

    Glucose level and why it's a problem


    Who doesn't in commonly effect
    • Slow onset
    • High mortality due to high serum glucose (More than 500) leading to sever dehydration

    Treatment: manage fluid/electrolytes and glucose control

    Older adults who binge on sweet and didn't adjust meds
  77. Acute Complications of Diabetes

    Somogyi effect

    what is it
    combination of hypoglycemia follwed by rebound hyperglycemia

    Startes with Hypo but body kicks in a raises glucose/stress hormone ends up in hyper
  78. Acute Complications of Diabetes

    Dawn phenomenon

    What is it
    early morning rise in blood glucose with no hypoglycemia during the night due to nocturnal elevation of GH

    GH increases blood sugar in the night= high morning blood sugar
  79. Chronic Complications of Diabetes
    Microvasular disease due to
    due to capillary basement membrane thickening, ischemia hypoxia
  80. Chronic Complications of Diabetes
    Retinopahty due to
    blood vessel changes and RBC aggregation

    Increase sugar= retina vessels rupture= blindness

    More likely in Tpe II as a result of Hyperglycemia
  81. Chronic Complications of Diabetes

    Nephropathy most common cause of
    end stage renal disease
  82. Chronic Complications of Diabetes.

    nephropathy death from renal failure more commin in Type ____ as a result of ____
    Type I

  83. Chronic Complications of Diabetes

    Macrovasular Complications
    Coronary Artery Disease (most common cause for death in Type II)

    Stroke (2x as common with diabetics)

    Peripheral Vascular Disease (PVD) due to occlusions of small vessels (may result in gangrene in lower extremities)
  84. Chronic Complications of Diabetes

    Infections- why?
    increased risk due to senses impairment (don't know you have a cut)

    WBC can't function right when there is too much sugar

    poor circulation

    microbes love sugar so they increase in number
  85. Cushing disease is a disorder of what organ/tissue
    Adrenal cortex
  86. Cushings Syndrome cause
    Excessive level of cortisol
  87. Cushings Disease cause
    excessive anterior pituitary secreation of ACTH
  88. Cushings manifestations
    • Altered fat metabolism -Moon face and buffalo hump
    • Muscle weakness due to protein breakdown
    • deranged glucose metabolism
    • susceptibility to infection
  89. Conn disease, primary aldosteronism
    hypertension, renal potassium wasting, hypokalemia, and neuromuscular manifestations
  90. Primary adrenal insufficiency is termed
    addison's disease
  91. Addison disease is caused by
    and is more common in ______
    Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women.
  92. Addisons manifestaions
    Feminizations- boys become girl like

    Virilization- girls become boy like
  93. Uncommon disease cause by continuously high GH Levels
  94. Most common cause of hyperthyroidism
    graves disease
  95. high concentration of blood glucose with severe dehydration
  96. Ketosis prone insuline dependent glucose intolerance syndrome
    Type I Diabetes mellitus
  97. non insulin dependent glucose intolerance syndrome, typically adult onset
    Type II diabetes
  98. disorder of the posterior pituitary involving high levels of ADH
  99. early morning rise in blood glucose concentration with no hypoglycemia durning the night
    Dawn Phenomenon
  100. Hypopituitarism in an adult male likely includes all of the following except:
    A. dwarfism
    B. muscular mass decrease
    C. skin pallor
    D. impotence
    A. dwarfism
    (this multiple choice question has been scrambled)
  101. Excessive secretion of GH in an adult may cause:
  102. A manifestation shared by both diabetes mellitus and diabetes insipidus is:
    a. elevated blood and uring glucose levels

    b. inability to produce ADH

    c. Inability to produce insulin

    d. polyuria

    e. elevated blood uring and keton body levels
    d. polyuria
  103. The manifestations of hyperthyrodism include all of the following except:
    A. diarrhea
    B. constipation
    C. heat intolerance
    D. weight losse. wakefulness
    B. constipation
    (this multiple choice question has been scrambled)
  104. Hypothyroidism ciris is:
    A. graves disease
    B. cushing disease
    C. myxedema coma
    D. cretinism
    E. addison disease
    C. myxedema coma
    (this multiple choice question has been scrambled)
  105. Graves Disease is:
    a. hyperthyroidism
    b. associated with autoimmunity
    c. manifested by ophthamopathy
    d. all of the above
    d. all of the above
  106. Inadequate levels of thyroid hormones at birth may cause:
    a mental retardation
    b. immediate death
    c. thyroid ciris
    d. myxedema
    e. dwarfism
    a. mental retardation
  107. Hyperparathyroidism causes:
    A. increased phosphorus absorption form GI
    B. increased osteoclastic activity
    C. decreased plasma calcium
    D. hypocalcemia
    B. increased ostoclastic activity
    (this multiple choice question has been scrambled)
  108. A manifestation of hypocalcemia is:
    A. lethargy
    B. tetany
    C. myopathy
    D. bone cysts
    E. hypertension
    B. tetany
    (this multiple choice question has been scrambled)
  109. What is the most common cause of acromegaly
    A. over producation of ACTH
    B. pituitary atrophy
    C. Overproduction of TSH
    D. anterior pituitary adenoma
    D. anterior pituitary adenoma
    (this multiple choice question has been scrambled)
  110. If a 19 yr old woman were suffering from shortness of breath, weight loss, excessive sweating, exophthalmos, and irritability which hormone would you expect to find elecatied in her serum?
    A. acth
    B. thyroxine
    C. cortisol
    d 17 ketosteroid
    B. thyroxine
    (this multiple choice question has been scrambled)
  111. A 24 year old femail with a history of juvenile onset diabetes is found in a stuporous state.She is hypotensice and has cold, clammy skin. What is the likely etiology of her condition?
    A. insulin shock
    B. hyperglycemia
    C. peripheral neuropathy
    D. renal failure
    A. insulin shock
    (this multiple choice question has been scrambled)
  112. A 10 year old male was brought into the emergency room comatose, suffering from metabolic acidosis with a blood glucose level of 800. The most probable disease causeing his condition is

    A. cretinism
    B. Type II diabetes
    C. type I diabetes
    D. IGT
    E GDM
    C. type I diabetes
    (this multiple choice question has been scrambled)