Endocrine Disorders Quiz

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Questions and Answers

Which clinical feature is NOT typically associated with Hyperthyroidism?

Weight loss

Exophthalmos

Edema (correct)

Tachycardia

What is the primary management strategy for a patient experiencing Thyroid Storm?

High-calorie diet

Glucose administration

Low-fiber diet

Antithyroid medications (correct)

What is a common cause of Hypoparathyroidism?

Dehydration

Obesity

Hyperthyroidism

Parathyroid surgery (correct)

Which diet is recommended for patients with Hypothyroidism?

High-fiber, low-calorie Signup and view all the answers

What is the effect of Thiazide diuretics in patients with Hypoparathyroidism?

Increases calcium reabsorption Signup and view all the answers

Which sign would indicate increased neuromuscular irritability in a patient with Hypoparathyroidism?

Chvostek's sign Signup and view all the answers

What vital sign change may be observed in Myxedema Coma?

Bradycardia Signup and view all the answers

Which of the following is a characteristic of Hyperparathyroidism?

Increased Calcium levels Signup and view all the answers

What dietary changes are recommended for managing Cushing's disease?

High protein, high calcium, high potassium, low sodium Signup and view all the answers

Which of the following is a primary diagnostic test for Cushing's disease?

Dexamethasone suppression test Signup and view all the answers

What is the oxygen flow rate for a nasal cannula?

1-6 L/min Signup and view all the answers

What effect does the removal of the adrenal cortex typically have on vital signs?

Decreases vital signs Signup and view all the answers

What stage of hypertension is classified as 130-139 systolic OR 80-89 diastolic?

Stage 1 Hypertension Signup and view all the answers

Which of the following symptoms is NOT associated with pheochromocytoma?

Brittle bones Signup and view all the answers

Which medication type is a potassium-sparing diuretic?

Spironolactone Signup and view all the answers

What is a possible complication of hypophysectomy in the management of Cushing's disease?

Diabetes Insipidus Signup and view all the answers

What type of medications are typically used in the management of pheochromocytoma?

Alpha-adrenergic blocking agents Signup and view all the answers

What is a potential side effect of ACE-Inhibitors like Lisinopril?

Angioedema Signup and view all the answers

Which type of mask provides the highest oxygen concentration possible?

Non-rebreather mask Signup and view all the answers

Which of the following is an early sign of laryngeal cancer?

Hoarseness of voice Signup and view all the answers

What environmental factor is a known risk for developing lung cancer?

Exposure to chemicals Signup and view all the answers

What is the normal blood pressure range?

Less than 120/80 Signup and view all the answers

What dietary approach is recommended for managing hypertension?

DASH diet Signup and view all the answers

What heart rate should be monitored for patients on beta-blockers?

Less than 60 BPM Signup and view all the answers

What is the primary treatment goal for atrial flutter?

Reduce ventricular rate Signup and view all the answers

Which medication class is first-line treatment for ventricular dysrhythmias like PVC?

Beta blockers Signup and view all the answers

Which of the following symptoms is most characteristic of unstable angina?

Chest pain lasting more than 15 minutes Signup and view all the answers

What should be monitored in a patient on Warfarin to ensure safe dosing?

INR levels Signup and view all the answers

What are the saw-toothed P waves indicative of?

Atrial flutter Signup and view all the answers

Which of these factors can lead to premature ventricular contractions (PVCs)?

Hypoxia Signup and view all the answers

What is a primary characteristic of stable angina compared to unstable angina?

Chest discomfort is triggered by exertion Signup and view all the answers

What should be avoided if the apical pulse is less than 60 BPM?

Beta blockers Signup and view all the answers

What is the correct advice for a patient administering nitroglycerin at home?

Call 911 if there is no pain relief after one tablet. Signup and view all the answers

Which medication requires careful monitoring of the patient's apical pulse?

Metoprolol Signup and view all the answers

What dietary consideration should be made for a patient taking Warfarin?

Decrease intake of green leafy vegetables. Signup and view all the answers

Which symptom is NOT typically associated with angina?

Cold, clammy skin Signup and view all the answers

What is a common misinterpretation of myocardial infarction symptoms in women?

They may not experience chest pain. Signup and view all the answers

What is the primary function of anticoagulants like Heparin?

Prevent venous clots. Signup and view all the answers

What is the antidote for Heparin if a patient experiences adverse effects?

Protamine Sulfate Signup and view all the answers

Which condition is characterized by relief only through opioids?

Myocardial infarction Signup and view all the answers

What is the primary reason for administering oxygen in cases of myocardial infarction?

To promote myocardial tissue oxygenation Signup and view all the answers

What is the purpose of performing cardiac catheterization?

To assess arterial circulation and detect any blockage Signup and view all the answers

Which echocardiography method may be more challenging in obese patients?

Transthoracic echocardiography (TTE) Signup and view all the answers

What is the maximum heart rate calculation method during a stress test?

220 - age Signup and view all the answers

Which medical intervention is indicated for STEMI if chest pain is unrelieved by nitroglycerin for more than 30 minutes?

Thrombolytics Signup and view all the answers

Which of the following is NOT a medical intervention for managing NSTEMI/STEMI?

Antibiotics Signup and view all the answers

What should be monitored after administering ACE-inhibitors within 48 hours of an event?

Urine output, hypotension, and cough Signup and view all the answers

What type of position is recommended for a patient needing bed rest after a cardiac procedure?

Supine position Signup and view all the answers

Study Notes

Endocrine: Thyroid Disorders

Hyperthyroidism (Grave's): Increased T3 and T4, decreased TSH (high metabolism). Symptoms include hypertension, tachycardia, exophthalmos (bulging eyes), diarrhea, warm/moist skin, and weight loss.
Management: Anti-thyroid medications (PTU and Methimazole), iodine solutions (Lugol's iodine solution or SSKI to decrease thyroid size and vascularity, before surgery), radioactive iodine 131 (to destroy thyroid tissue), or thyroidectomy (thyroid removal). Lifestyle changes include increasing caloric intake and a low-fiber diet, and eye care with eye drops for exophthalmos. Monitor vital signs (weight, etc.).
Thyroid Storm (URGENT): Agitation, confusion, hypertension, tachycardia, and fever require immediate management.

Endocrine: Hypothyroidism (Hashimoto's)

Hypothyroidism (Hashimoto's): Decreased T3 and T4, increased TSH (low metabolism). Symptoms include weight gain, edema, low metabolism, low energy, alopecia, hypotension, constipation, and low mood.
Management: Hormone replacement therapy (levothyroxine or liothyronine). Lifestyle modifications, such as increasing caloric intake, low-fiber diet and weight bearing exercise, might support hormone balance. Monitor weight and vital signs.

Parathyroid Disorders: Hypoparathyroidism

Hypoparathyroidism: Decreased PTH, decreased calcium, increased phosphate. Symptoms include neuromuscular irritability (spasms), Trousseau’s sign (hand spasms with blood pressure), Chvostek's sign (facial spasm), tingling, numbness, and seizures.
Risk Factors: Thyroid surgery, parathyroid surgery, autoimmune conditions.
Management: Calcium supplements, thiazide diuretics, and vitamin D supplements. Dietary changes are important, including high calcium (dark leafy vegetables) and low phosphate diet (fruits, pasta). Avoid dairy products.

Hyperparathyroidism

Hyperparathyroidism: Increased PTH, increased calcium (PTH weakens bones). Symptoms include decreased neuromuscular irritability, muscle weakness, fatigue, constipation, psychiatric/bizarre behaviours, fractures, kidney stones, ulcers, and pancreatitis.
Management: Hydration (2L/day), furosemide (to remove calcium), calcitonin (decreases calcium), and bisphosphonates (increase bone density). Dietary changes include low-calcium (chicken, non-green vegetables) diet, and weight-bearing exercise for calcification. Parathyroidectomy (removal) is a last resort option.

Diabetes Insipidus (DI)

DI (Decreased ADH): Increased sodium (dehydrated). Symptoms include polyuria, polydipsia, dehydration, dry mucous membranes, sunken eyes, and hypotension. Diagnostics are done via a water deprivation test.
DI (Increased ADH): Decreased sodium (retaining fluid). Symptoms include headache, weakness, anorexia, muscle cramps, weight gain, nausea, vomiting, diarrhea, hypertension, and seizures. Diagnostics include decreased urine output, increased urine specific gravity (1.030), increased urine osmolality, and decreased blood serum osmolality.
Management: Desmopressin/Vasopressin (synthetic ADH - intranasally or IV), fluids, monitor vitals, daily weight, and fluid intake.

Adrenal Gland Disorders: Addison's Disease

Addison's disease: Decreased ACTH, hyperkalemia. Symptoms include thin (weight loss), dehydration, hyperpigmentation, hyponatremia, hypoglycemia, and hypotension. Addisonian Crisis occurs with a sudden drop in blood pressure due to lack of steroids.
Management: Fluid replacement (0.9 NS, D5W, D5NS), and IV steroid administration is necessary in the case of a crisis. Long-term care includes hormone replacement therapy.

Steroid Use (Corticosteroids)

Steroids (Hydrocortisone, Prednisone): Suppress the immune system and need to be given with food. Vasopressors (Epinephrine and Dopamine) are used to increase blood pressure.
Monitor: Vital signs, fluid balance. Diet should include high carbohydrate, high protein, high sodium, and low potassium. Monitor for infection due to steroid use.

Cushing's Disease

Cushing's disease: Increased ACTH, hypokalemia. Symptoms include buffalo-trunk (weight gain), moon face, hirsutism, acne, purple striae, brittle bones, edema, hypertension, hyperglycemia, hypernatremia. Diagnostics include dexamethasone suppression test.
Management: Radiation (to shrink cortex), hypophysectomy (removal of the pituitary), adrenalectomy (removal of adrenal glands and cortex), or adrenal enzyme inhibitors (such as ketoconazole). A high protein, high calcium, vitamin D, high potassium diet and low sodium/low glucose is crucial. Slowly tapering steroid use and fluid restrictions are necessary to prevent infections.

Pheochromocytoma

Pheochromocytoma: Increased epinephrine and norepinephrine. Symptoms include hypertension, hyperglycemia, hypermetabolism, hyperhidrosis, headache, tremors, flushing, anxiety, and palpitations.
Diagnosis: Clonidine suppression test, elevated metanephrines (MN), and elevated vanillylmandelic acid (VMA).
Management: Alpha-adrenergic blocking agents (Phentolamine), Calcium Channel Blockers (Nifedipine), or vasodilators (Nipride; nitroglycerin). Adrenalectomy (removal of the adrenal glands) and monitor vital signs closely.

Laryngeal Cancer

Causes: Smoking, alcohol use, vitamin deficiencies, and chronic irritation.
Assessment: Hoarseness (early sign), burning sensation with hot or citrus liquids, lumps in the neck, dysphagia, dyspnea, and pain.
Management: Laryngectomy (subtotal or total removal), safety precautions for the irradiated site, radiation, and rest. Chemotherapy with antiemetics.

Lung Cancer

Causes: Smoking, chemical exposure, high-fat low-fiber diet, age, genetics, environment. Lung lesions from TB or fibrosis.
Assessment: Chronic cough (early sign), chest pain, hemoptysis (coughing up blood), dyspnea, increased tactile fremitus (inflamed lung tissue), dull sound on percussion, recurring infection, pleural effusion.
Management: Lung surgery (pneumonectomy, lobectomy, segmentectomy, wedge resection), chest tube post-op (except pneumonectomy).

Pleural Effusion

Causes: Iatrogenic due to other medical conditions (infections or tumors).
Assessment: Symptoms of the underlying disease. Dyspnea, cough, diminished breath sounds, flat/dull percussion, decreased tactile fremitus, tracheal deviation
Diagnosis: Thoracentesis, pleural fluid analysis, pleural biopsy, and chest x-ray
Management: Semi-Fowler's position, thoracentesis, pleurodesis, or pleurectomy, chest tube, or pleuroperitoneal shunt.

Pulmonary Embolism (PE)

Causes: Blood clots, deep vein thrombosis (DVT), trauma, atrial fibrillation, heart disease.
Assessment: Sudden onset of dyspnea, chest pain, tachycardia, and low oxygen saturation. Hemoptysis (coughing up blood) is possible.
Diagnosis: Pulmonary angiography, Chest CT, V/Q scan, or D-dimer assay.
Management: Prevention of blood clots (anticoagulants: heparin, warfarin, alteplase, streptokinase, or urokinase) and oxygen therapy. Monitor labs.

Tuberculosis (TB)

Causes: Mycobacterium tuberculosis
Assessment: Low-grade fever, night sweats, persistent cough, diaphoresis, hemoptysis, chest pain, anorexia, and weight loss.
Diagnosis: PPD + Mantoux test (greater than 10 mm or 5 mm for immunocompromised individuals). Sputum exam for acid-fast bacilli. Chest x-ray.
Management: Antibacterial medications (rifampin, isoniazid, pyrazinamide, ethambutol). Initial and continuous regimens. Negative pressure room and N95 respirator needed.

Oxygen Therapy

Methods: Nasal cannula (1-6 L/min), simple face mask (5-6 L/min), face tent (10-15 L/min), or non-rebreather mask (10-15 L/min).
Monitoring: Respiratory status, pulse oximetry, ABG's, and humidity. Provide at the lowest necessary for the patient and situation.

Hypertension

Types: Primary/essential (idiopathic), secondary (related to other disease).
Assessment: Asymptomatic, possible chest pain, headache, neck pain, palpitations, cardiac workload, dyspnea and blurred vision.
Management: Diuretics (-ide), such as furosemide and hydrochlorothiazide; monitor fluid intake, blood pressure, and electrolyte levels. Vasodilators (-zosin), such as prazosin, monitor for complications.

Dysrhythmias

Telemetry Electrodes: RA (white), RL (green), LA (black), LL (red).
Management: Beta Blockers (-lol), such as atenolol or metoprolol; Calcium Channel Blockers (-dipine), such as amlodipine or nifedipine; ACE Inhibitors (-pril), such as lisinopril. ARP blockers (-sartan), such as Losartan.
Weight management: 1kg of weight loss can decrease blood pressure by 1mmHg.

Sinus Rhythms (Bradycardia/Tachycardia)

Bradycardia: Less than 60 BPM; possible causes: lower metabolic needs, vagal stimulation, increased intercranial pressure, certain medications (beta blockers or calcium channel blockers).
Tachycardia: Greater than 100 BPM; possible causes: increased metabolic needs, physiological or psychological stress, certain medications (bronchodilators or atropine), thyroid replacement, stimulants.
Treatment: Treat the underlying cause. For bradycardia, Atropine Sulfate IV, transcutaneous pacing. For tachycardia, vagal maneuvers, medications (Beta Blockers or Calcium Channel Blockers), synchronized cardioversion (persistent tachycardia causing hemodynamic instability). Treat underlying cause.

Atrial/Ventricular Dysrhythmias

Atrial Fibrillation (A-Fib): Rapid, disorganized, uncoordinated twitching of atrial musculature.
Atrial Flutter (A-Flutter): Rapid atrial rate (250-400 BPM) with ventricular rate of 75-150. Saw-toothed P waves. Causes include conduction defects, thyrotoxicosis, pulmonary HTN, and open heart surgeries.
Treatment: Vagal maneuvers, adenosine, amiodarone, diltiazem, propranolol, or metoprolol; cardiac glycosides (digoxin); anti-coagulants (warfarin, aspirin); or catheter ablation (preferred if non-medically controlled).
Assessment: Monitor potassium levels; hypokalemia increases risk for digoxin toxicity. Limit green leafy vegetables if on Warfarin. Cardiac glycoside toxicity may have severe cardiovascular side effects.

Acute Myocardial Infarction (MI/ Heart Attack)

NSTEMI: ST depression/T wave inversion.
STEMI: ST elevation/T wave inversion; occurs rapidly within 60-90 minutes from cause to presentation.
Management: Thrombolytics (Streptokinase, urokinase), antiplatelets (Aspirin), beta blockers (-lol), and anticoagulants (Heparin). Monitor for bleeding and cardiac markers/electrolytes.

Peripheral Arterial Disease (PAD)

Assessment: Intermittent claudication, numbness/burning pain in feet during rest or exercise, pain relieved by placing legs in dependent position, decreased peripheral pulses, loss of hair on lower extremities, cold and cyanotic extremities, and distal gangrene.
Diagnostics: Ankle-brachial index (ABI), arteriography, exercise tolerance testing.
Management: Rest, dependent positions, avoid crossing legs, elastic compression stockings, and warm compresses. Medications and surgery are also considerations.

Aneurysm

Causes: Atherosclerosis, genetic, congenital, traumatic, and infection.
Risk factors: Hypertension, infection, trauma, smoking, and age (predominately older adult population).
Thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA): Atherosclerosis is common. Symptoms include chest pain, dyspnea, dysphagia, and possibly an audible murmur.
Management: Control blood pressure, prevent lifting/bending, watch for ruptures with increased pain. Surgical repair (endovascular grafts or open repair) as needed.

Peripheral Venous Disorders

Venous Thromboembolism (VTE): Risk factors include hip/total knee replacements, heart failure, extended periods of immobility, pregnancy, and oral contraceptives.
Venous insufficiency: Risk factors include sitting or standing for long periods, obesity, and pregnancy.
Varicose veins: Risk factors include women over 30, pregnancy, and family history.
Assessment: Calf pain or tenderness, warmth, edema, variable limb changes, dyspnea/chest pain, and around ankle/foot areas.
Management: Rest, elevated leg positioning, avoid crossing legs and prolonged standing, avoid heavy lifting, and compression stockings. Anticoagulants (as needed) and/or surgical intervention (as needed).

Urolithiasis/Nephrolithiasis

Causes: Related to urine pH, urine stasis, immobility, and hypercalcemia, structural defects, and infections.
Assessment: Colicky pain (mainly in urolithiasis), hematuria, pyuria, nausea, vomiting, diarrhea, urinary retention.
Diagnosis: CT scan, IV pyelography, blood chemistry, 24-hour urine, and stone analysis.
Management: Pain relief (opioids or NSAIDs), hot baths, hydration, ambulation, dietary changes (low-calcium, low-purine, low-protein, low-oxalate), medical intervention, or lithotripsy.

Urinary Bladder Cancer

Causes: Age, male gender, race. Tobacco use, chronic UTI, high cholesterol, high urine PH.
Assessment: Painless hematuria, change in voiding patterns. Diagnostics include cystoscopy, CT-scan, ultrasonography, biopsy.
Management: Transurethral resection or fulguration, BCG vaccine, radiation therapy, chemotherapy. Complete cystectomy (surgical removal of the bladder) is a possible approach.

Benign Prostatic Hyperplasia (BPH)

Causes: Obstructs urinary flow, resulting in incomplete bladder emptying.
Assessment: Frequency, nocturia, urgency, hesitancy, decrease in volume, and force of the urinary stream, difficulty starting urine flow.
Management: Medication (such as tamulosin), surgical techniques (TURP, prostatectomy procedures), or minimally invasive procedures (e.g. DaVinci). Monitor for complications following surgical approaches.

Diagnostic Procedures - General

Digital rectal exam: To assess prostate and surrounding region;
Prostate specific antigen (PSA): Blood test to check for prostate cancer;
Transrectal ultrasound: To visualize prostate.
Imaging: X-ray, CT, MRI, ultrasound, colonoscopy, endoscopy, barium studies.

Post-Op Considerations (general)

Monitor: Vital signs, assess for pain and complications including incision care, bleeding, infection. DVT/VTE and fluid balance issues. Increased ICP, especially with spinal and head trauma patients or elderly patients.
Diet: Encourage appropriate nutrition in post-op phase.
Activity: Monitor activity as per surgical instructions, with any risk of infection, tissue injury or bleeding.
Patient education: Encourage self-care such as wound care, medication compliance, prevention of complications, diet, and exercise, as appropriate.

Digestive Disorders - general assessment

History: Dietary habits, pain patterns, changes in bowel habits, and stool characteristics.
Physical Exam: Inspection, auscultation, percussion, and palpation of the abdominal quadrants.

Gastroesophageal Reflux Disease (GERD)

Cause: Incompetent LES (lower esophageal sphincter). Stomach contents back up into esophagus due to pressure differences.
Assessment: Pain, dysphagia, odynophagia and epigastric pain
Management: Lifestyle changes to elevate head of bed at night, avoid irritants (caffeine, fatty foods, chocolate, etc). elevate HOB for comfort, meds (antacids, H2 blockers, or PPI's), possible surgery (Nissen fundoplication)

Peptic Ulcer Disease (PUD)

Causes: H.pylori, NSAIDS, and chronic acid buildup (gastric ulcers are most associated with chronic acid buildup and duodenal ulcers from rapid increase of acid).
Assessment: Pain after meals and on empty stomach, and/or middle pain (LUQ for gastric, or right upper quadrant for duodenal). Possible nausea, vomiting, melena. Complications such as perforation or peritonitis may occur.
Management: Lifestyle changes such as avoiding/reducing non-steroidal anti-inflammatory drugs. Medication such as antibiotics, antacids, proton pump inhibitors, or H2-receptor blockers are often used.

Cholecystitis/Cholelithiasis

Symptoms: RUQ pain radiating to right shoulder; nausea, vomiting, indigestion, jaundice, clay-coloured stool, and/or pruritus, fatty-food intolerance, and sometimes fever
Assessment: Assess for RUQ pain, tenderness, possible nausea, vomiting and/or fever.
Diagnostics: Ultrasound or other radiological imaging (x-ray, cholangiogram, MRCP). Blood labs showing elevated liver function tests or inflammatory markers are common.
Management: Surgical (Cholecystectomy) or medical with conservative management. Medication (analgesics such as opioids) and supportive care (regular exercise, weight loss/management, low fat diet).

Intestinal Obstruction

Causes: Mechanical (adhesions, tumors/masses), or non-mechanical (paralytic ileus/post-surgical)
Types: Small vs. Large Bowel
Assessment: Abdominal distention, visible peristaltic waves, projectile vomiting, cramping, diarrhea.
Treatment: Decompression (NGT or rectal tube). NPO/IV fluids for managing fluid balance, potentially surgery. Monitoring bowel sounds, electrolytes, and fluid balance is crucial.

Inflammatory Bowel Disease (IBD)

Types: Crohn's disease and ulcerative colitis
Symptoms: Abdominal pain, diarrhea, rectal bleeding, presence of blood or pus, fever, anemia, and/or dehydration.
Medical Management: Medications (steroids, immunosuppressants, and/or antibiotics); and/or surgery
Nursing Management: Assess for symptoms and monitor for abdominal distention or for other complications. Encourage patient intake of fluids, monitor for electrolyte imbalances, and avoid medications that may contribute to GI distress.

Diverticulitis/Diverticulosis

Symptoms: LLQ pain, fever, nausea, and/or vomiting.
Assessment: Assess for symptoms and monitor other symptoms such as fever, abdominal distention, nausea, vomiting.
Medical Management: Surgical interventions for serious complications (such as bowel resection, abscess drainage). Antibiotics and pain management.

Complications following surgery and/or procedure

Post-op considerations/complications: Includes assessment and monitoring of patient vitals (blood pressure, heart rate, respiratory rate, pulse oximetry, etc). Complications to monitor can include bleeding, fluid imbalances, infection, thromboembolism (DVT/VTE), pain, and/or nausea and vomiting.

Trauma and Emergency situations

Complications: These may include (but are not limited to) shock (early phase), compartment syndrome, blood loss, and the need for surgical intervention.
Management: Patient stabilization and initiation of treatment to manage underlying cause(s) causing the trauma and emergency situation.

Orthopedic Procedures

Assessment: Monitor for complications such as infection and/or loss of function, and assess the patients ability to follow post-operative instructions and pain management strategy.

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Description

Test your knowledge on various endocrine disorders, including hyperthyroidism, hypothyroidism, and Cushing's disease. This quiz covers clinical features, management strategies, dietary recommendations, and diagnostic tests related to these conditions. Challenge yourself to see how well you understand the intricacies of endocrine health.