Podcast
Questions and Answers
What is Cirrhosis most likely caused by?
What is Cirrhosis most likely caused by?
- Alcoholic hepatitis (correct)
- Viral hepatitis
- Non-alcoholic fatty liver disease
- Smoking
Which types of hepatitis are most likely to cause cirrhosis?
Which types of hepatitis are most likely to cause cirrhosis?
- Hep A
- Hep B & C (correct)
- Hep C & E
- Hep E
Which complication is most likely to occur due to cirrhosis?
Which complication is most likely to occur due to cirrhosis?
- Cholecystitis
- Diabetes
- Liver cancer
- Portal hypertension (correct)
What is ascites?
What is ascites?
Xanthelasma is associated with which of the following conditions?
Xanthelasma is associated with which of the following conditions?
What is the best way to treat cirrhosis? (Click all that apply)
What is the best way to treat cirrhosis? (Click all that apply)
What is the diagnostic tool used for Portal Hypertension?
What is the diagnostic tool used for Portal Hypertension?
What are common signs and symptoms of esophageal varices? (Select all that apply)
What are common signs and symptoms of esophageal varices? (Select all that apply)
Asterixis is associated with which condition?
Asterixis is associated with which condition?
What is Hepatic Encephalopathy?
What is Hepatic Encephalopathy?
In order to get Hepatitis D, which Hepatitis virus is required?
In order to get Hepatitis D, which Hepatitis virus is required?
Which Heps are the most severe? (Choose all that apply)
Which Heps are the most severe? (Choose all that apply)
What does the 2 hit model of MASH propose?
What does the 2 hit model of MASH propose?
Which cancer usually presents with vague signs of abdominal pain, fatigue, loss of weight, and appetite?
Which cancer usually presents with vague signs of abdominal pain, fatigue, loss of weight, and appetite?
What is the difference between Cholelithiasis and Cholecystitis?
What is the difference between Cholelithiasis and Cholecystitis?
The most common type of stones in Cholelithiasis is:
The most common type of stones in Cholelithiasis is:
What is the preferred treatment for cholecystitis?
What is the preferred treatment for cholecystitis?
What is the main difference between Primary Biliary Cholangitis and Primary Sclerosing Cholangitis?
What is the main difference between Primary Biliary Cholangitis and Primary Sclerosing Cholangitis?
Ursodeoxycholic acid (UDCA or ursodiol) is used for which condition in treatments?
Ursodeoxycholic acid (UDCA or ursodiol) is used for which condition in treatments?
What is pancreatitis?
What is pancreatitis?
Chronic pancreatitis is associated with which of the following?
Chronic pancreatitis is associated with which of the following?
What is Grey Turner Sign and what condition is it associated with?
What is Grey Turner Sign and what condition is it associated with?
How is pancreatitis diagnosed?
How is pancreatitis diagnosed?
A patient comes into a RMT's clinic stating that they recently got a massive bruise on the flank and they have been having tenderness in the abdominal region. What is the patient showing signs of and what should the RMT do in this situation?
A patient comes into a RMT's clinic stating that they recently got a massive bruise on the flank and they have been having tenderness in the abdominal region. What is the patient showing signs of and what should the RMT do in this situation?
Which organ does cystic fibrosis primarily affect?
Which organ does cystic fibrosis primarily affect?
Which condition often develops due to cystic fibrosis (CF) within the GI system?
Which condition often develops due to cystic fibrosis (CF) within the GI system?
Which condition causes the thickening of pancreatic secretions that can block the duct or even the gland completely, resulting in scarring of the pancreas?
Which condition causes the thickening of pancreatic secretions that can block the duct or even the gland completely, resulting in scarring of the pancreas?
When testing for cystic fibrosis (CF), what do people look for in the sweat?
When testing for cystic fibrosis (CF), what do people look for in the sweat?
What is the prognosis of cystic fibrosis (CF)?
What is the prognosis of cystic fibrosis (CF)?
As a Registered Massage Therapist (RMT) who is feeling a bit sick, what should you do when scheduled to see a patient with Cystic Fibrosis?
As a Registered Massage Therapist (RMT) who is feeling a bit sick, what should you do when scheduled to see a patient with Cystic Fibrosis?
What is the confirmation method used to diagnose carcinoma of the pancreas?
What is the confirmation method used to diagnose carcinoma of the pancreas?
What is the treatment approach for carcinoma of the pancreas?
What is the treatment approach for carcinoma of the pancreas?
What is the Whipple procedure?
What is the Whipple procedure?
A patient presents with persistent hyperglycemia, diagnosed as Diabetes Mellitus type 1. Considering the endocrine system's role in disease, which of the following mechanisms is most directly implicated in the pathogenesis of this condition?
A patient presents with persistent hyperglycemia, diagnosed as Diabetes Mellitus type 1. Considering the endocrine system's role in disease, which of the following mechanisms is most directly implicated in the pathogenesis of this condition?
In the context of hyperpituitarism, a functional pituitary adenoma is identified as the most common cause. If such an adenoma primarily secretes growth hormone (GH) before the closure of epiphyseal plates, which of the following conditions is most likely to manifest?
In the context of hyperpituitarism, a functional pituitary adenoma is identified as the most common cause. If such an adenoma primarily secretes growth hormone (GH) before the closure of epiphyseal plates, which of the following conditions is most likely to manifest?
A 45-year-old patient is diagnosed with acromegaly. Which diagnostic test is considered the gold standard for confirming this condition, and what is the expected hormonal response in a patient with acromegaly?
A 45-year-old patient is diagnosed with acromegaly. Which diagnostic test is considered the gold standard for confirming this condition, and what is the expected hormonal response in a patient with acromegaly?
Prolactinomas are classified based on 'efficiency' and 'proportionality'. What does 'efficiency' in this classification primarily refer to regarding the tumor's function?
Prolactinomas are classified based on 'efficiency' and 'proportionality'. What does 'efficiency' in this classification primarily refer to regarding the tumor's function?
A patient presents with symptoms suggestive of prolactinoma. Which of the following conditions should be considered in the differential diagnosis due to its potential to mimic hyperprolactinemia?
A patient presents with symptoms suggestive of prolactinoma. Which of the following conditions should be considered in the differential diagnosis due to its potential to mimic hyperprolactinemia?
Cushing's syndrome and Cushing's disease are both forms of hypercortisolism, but differ in etiology. What is the critical distinction between Cushing's disease and Cushing's syndrome?
Cushing's syndrome and Cushing's disease are both forms of hypercortisolism, but differ in etiology. What is the critical distinction between Cushing's disease and Cushing's syndrome?
A patient is undergoing a dexamethasone suppression test for suspected Cushing's syndrome. If the test reveals no suppression of ACTH following dexamethasone administration, but cortisol levels remain elevated, what is the most likely primary source of hypercortisolism?
A patient is undergoing a dexamethasone suppression test for suspected Cushing's syndrome. If the test reveals no suppression of ACTH following dexamethasone administration, but cortisol levels remain elevated, what is the most likely primary source of hypercortisolism?
Hypopituitarism can result from various etiologies affecting the pituitary gland or hypothalamus. Which of the following conditions primarily represents a hypothalamic cause of hypopituitarism?
Hypopituitarism can result from various etiologies affecting the pituitary gland or hypothalamus. Which of the following conditions primarily represents a hypothalamic cause of hypopituitarism?
In diagnosing hypopituitarism, both basal and dynamic laboratory tests are crucial. What is the primary purpose of 'dynamic' testing in the evaluation of suspected hypopituitarism?
In diagnosing hypopituitarism, both basal and dynamic laboratory tests are crucial. What is the primary purpose of 'dynamic' testing in the evaluation of suspected hypopituitarism?
Empty sella syndrome is characterized by the flattening or shrinking of the pituitary gland within the sella turcica. Which of the following mechanisms is most directly involved in the pathogenesis of primary empty sella syndrome?
Empty sella syndrome is characterized by the flattening or shrinking of the pituitary gland within the sella turcica. Which of the following mechanisms is most directly involved in the pathogenesis of primary empty sella syndrome?
Pituitary dwarfism is caused by decreased growth hormone (GH) secretion before puberty. What is a key differentiating feature of pituitary dwarfism compared to other forms of dwarfism regarding body proportions?
Pituitary dwarfism is caused by decreased growth hormone (GH) secretion before puberty. What is a key differentiating feature of pituitary dwarfism compared to other forms of dwarfism regarding body proportions?
Central diabetes insipidus (DI) and nephrogenic DI both result in polyuria and dilute urine, but they differ in their underlying pathophysiology. What is the fundamental difference between central and nephrogenic diabetes insipidus?
Central diabetes insipidus (DI) and nephrogenic DI both result in polyuria and dilute urine, but they differ in their underlying pathophysiology. What is the fundamental difference between central and nephrogenic diabetes insipidus?
The adrenal cortex is divided into three zones, each producing distinct hormones. Which zone of the adrenal cortex is primarily responsible for the synthesis and secretion of cortisol?
The adrenal cortex is divided into three zones, each producing distinct hormones. Which zone of the adrenal cortex is primarily responsible for the synthesis and secretion of cortisol?
The regulation of hormone secretion from the adrenal glands involves several feedback loops and regulatory systems. Which of the following regulatory mechanisms primarily stimulates the zona fasciculata to secrete cortisol?
The regulation of hormone secretion from the adrenal glands involves several feedback loops and regulatory systems. Which of the following regulatory mechanisms primarily stimulates the zona fasciculata to secrete cortisol?
Cushing's syndrome can arise from various etiologies, including exogenous administration of glucocorticoids and endogenous overproduction. Among the endogenous causes, which is the most common?
Cushing's syndrome can arise from various etiologies, including exogenous administration of glucocorticoids and endogenous overproduction. Among the endogenous causes, which is the most common?
In the diagnosis of Cushing's syndrome, the dexamethasone suppression test is utilized. If a patient with suspected Cushing's syndrome shows suppression of cortisol levels with low-dose dexamethasone but no suppression with high-dose dexamethasone, what does this pattern typically indicate?
In the diagnosis of Cushing's syndrome, the dexamethasone suppression test is utilized. If a patient with suspected Cushing's syndrome shows suppression of cortisol levels with low-dose dexamethasone but no suppression with high-dose dexamethasone, what does this pattern typically indicate?
Adrenal insufficiency is categorized into primary and secondary types based on the location of the primary pathology. In primary adrenal insufficiency (Addison's disease), where is the primary site of dysfunction?
Adrenal insufficiency is categorized into primary and secondary types based on the location of the primary pathology. In primary adrenal insufficiency (Addison's disease), where is the primary site of dysfunction?
An Addisonian crisis is a severe and potentially life-threatening complication of adrenal insufficiency. Which of the following physiological stressors is most likely to precipitate an Addisonian crisis in a patient with chronic adrenal insufficiency?
An Addisonian crisis is a severe and potentially life-threatening complication of adrenal insufficiency. Which of the following physiological stressors is most likely to precipitate an Addisonian crisis in a patient with chronic adrenal insufficiency?
In differentiating between primary and secondary adrenal insufficiency, serum cortisol and ACTH levels are measured. What hormonal profile is characteristic of secondary adrenal insufficiency?
In differentiating between primary and secondary adrenal insufficiency, serum cortisol and ACTH levels are measured. What hormonal profile is characteristic of secondary adrenal insufficiency?
Hyperaldosteronism is characterized by excessive aldosterone secretion. What is the primary difference in the etiology between primary and secondary hyperaldosteronism?
Hyperaldosteronism is characterized by excessive aldosterone secretion. What is the primary difference in the etiology between primary and secondary hyperaldosteronism?
Secondary hyperaldosteronism can be triggered by various conditions that affect renal perfusion and systemic hemodynamics. Which of the following conditions is most likely to cause secondary hyperaldosteronism?
Secondary hyperaldosteronism can be triggered by various conditions that affect renal perfusion and systemic hemodynamics. Which of the following conditions is most likely to cause secondary hyperaldosteronism?
In diagnosing hyperaldosteronism, the serum aldosterone to renin ratio is a key initial test. What hormonal ratio is typically observed in primary hyperaldosteronism?
In diagnosing hyperaldosteronism, the serum aldosterone to renin ratio is a key initial test. What hormonal ratio is typically observed in primary hyperaldosteronism?
Pheochromocytoma is a tumor of chromaffin cells, typically located in the adrenal medulla. What is the primary pathophysiological consequence of pheochromocytoma?
Pheochromocytoma is a tumor of chromaffin cells, typically located in the adrenal medulla. What is the primary pathophysiological consequence of pheochromocytoma?
A provocative test involving beta-blockers is mentioned in the diagnosis of pheochromocytoma. Why is the administration of a beta-blocker considered a paradoxical and potentially risky diagnostic approach in suspected pheochromocytoma?
A provocative test involving beta-blockers is mentioned in the diagnosis of pheochromocytoma. Why is the administration of a beta-blocker considered a paradoxical and potentially risky diagnostic approach in suspected pheochromocytoma?
Hyperparathyroidism is defined by the overproduction of parathyroid hormone (PTH). What is the primary electrolyte imbalance resulting from hyperparathyroidism?
Hyperparathyroidism is defined by the overproduction of parathyroid hormone (PTH). What is the primary electrolyte imbalance resulting from hyperparathyroidism?
Primary and secondary hyperparathyroidism differ in their etiology. What is the most common cause of primary hyperparathyroidism?
Primary and secondary hyperparathyroidism differ in their etiology. What is the most common cause of primary hyperparathyroidism?
Secondary hyperparathyroidism is often a compensatory response to chronic hypocalcemia or vitamin D deficiency. Which of the following conditions is a common underlying cause of secondary hyperparathyroidism?
Secondary hyperparathyroidism is often a compensatory response to chronic hypocalcemia or vitamin D deficiency. Which of the following conditions is a common underlying cause of secondary hyperparathyroidism?
Hypoparathyroidism is characterized by insufficient parathyroid hormone (PTH) production. What is the primary electrolyte imbalance resulting from hypoparathyroidism?
Hypoparathyroidism is characterized by insufficient parathyroid hormone (PTH) production. What is the primary electrolyte imbalance resulting from hypoparathyroidism?
What is the most common iatrogenic cause of hypoparathyroidism?
What is the most common iatrogenic cause of hypoparathyroidism?
Which of the following is a shared sign or symptom commonly associated with both gigantism and acromegaly due to their shared etiology of growth hormone (GH) excess?
Which of the following is a shared sign or symptom commonly associated with both gigantism and acromegaly due to their shared etiology of growth hormone (GH) excess?
A patient with acromegaly exhibits excessive thickening of the appendages. Which of the following anatomical areas is characteristically affected by this thickening?
A patient with acromegaly exhibits excessive thickening of the appendages. Which of the following anatomical areas is characteristically affected by this thickening?
Which of the following is a common sign or symptom of prolactinoma in people assigned female at birth, directly related to the effects of hyperprolactinemia?
Which of the following is a common sign or symptom of prolactinoma in people assigned female at birth, directly related to the effects of hyperprolactinemia?
Which of the following is a characteristic sign or symptom commonly observed in Cushing's disease, directly attributable to the excess cortisol levels?
Which of the following is a characteristic sign or symptom commonly observed in Cushing's disease, directly attributable to the excess cortisol levels?
Hyperpigmentation (bronzing of skin) is a distinctive clinical feature associated with which specific endocrine disorder discussed?
Hyperpigmentation (bronzing of skin) is a distinctive clinical feature associated with which specific endocrine disorder discussed?
Massive polyuria with dilute urine is the hallmark symptom of diabetes insipidus. What is the typical daily urine output volume that is suggestive of diabetes insipidus in adults?
Massive polyuria with dilute urine is the hallmark symptom of diabetes insipidus. What is the typical daily urine output volume that is suggestive of diabetes insipidus in adults?
Hypertension is a prominent sign in several endocrine disorders. In which of the following adrenal gland disorders is hypertension a primary and characteristic symptom?
Hypertension is a prominent sign in several endocrine disorders. In which of the following adrenal gland disorders is hypertension a primary and characteristic symptom?
Muscle weakness and muscle cramps are significant symptoms in hyperaldosteronism. Which electrolyte imbalance directly contributes to these neuromuscular manifestations in this disorder?
Muscle weakness and muscle cramps are significant symptoms in hyperaldosteronism. Which electrolyte imbalance directly contributes to these neuromuscular manifestations in this disorder?
In older adults, thyroid disorders, particularly hyper- and hypothyroidism, are often underdiagnosed. Which factor most significantly contributes to this diagnostic challenge?
In older adults, thyroid disorders, particularly hyper- and hypothyroidism, are often underdiagnosed. Which factor most significantly contributes to this diagnostic challenge?
A patient is diagnosed with primary hypothyroidism. Which of the following pathophysiological mechanisms is the most direct cause of this condition?
A patient is diagnosed with primary hypothyroidism. Which of the following pathophysiological mechanisms is the most direct cause of this condition?
Hashimoto's thyroiditis, the most common cause of hypothyroidism in North America, is characterized by which primary immunological process?
Hashimoto's thyroiditis, the most common cause of hypothyroidism in North America, is characterized by which primary immunological process?
Iodine deficiency is a significant global cause of hypothyroidism. Which of the following mechanisms explains how iodine deficiency leads to reduced thyroid hormone production?
Iodine deficiency is a significant global cause of hypothyroidism. Which of the following mechanisms explains how iodine deficiency leads to reduced thyroid hormone production?
Myxedema, a severe manifestation of hypothyroidism, is characterized by dermatological changes. Which of the following best describes the underlying pathophysiology of myxedema?
Myxedema, a severe manifestation of hypothyroidism, is characterized by dermatological changes. Which of the following best describes the underlying pathophysiology of myxedema?
A patient with long-standing, untreated hypothyroidism is at risk of developing myxedema coma. Which of the following physiological changes is a primary concern in myxedema coma?
A patient with long-standing, untreated hypothyroidism is at risk of developing myxedema coma. Which of the following physiological changes is a primary concern in myxedema coma?
In the interpretation of thyroid function tests (TFTs), a pattern of elevated TSH and decreased free T4 and T3 is indicative of primary hypothyroidism. Which of the following best explains this hormonal profile?
In the interpretation of thyroid function tests (TFTs), a pattern of elevated TSH and decreased free T4 and T3 is indicative of primary hypothyroidism. Which of the following best explains this hormonal profile?
Levothyroxine (Synthroid), a synthetic T4, is the standard treatment for hypothyroidism. Why is T4, rather than T3, typically preferred for hormone replacement therapy?
Levothyroxine (Synthroid), a synthetic T4, is the standard treatment for hypothyroidism. Why is T4, rather than T3, typically preferred for hormone replacement therapy?
Congenital hypothyroidism, if untreated, can lead to severe developmental delays. What is the most critical period for thyroid hormone replacement therapy to prevent irreversible neurological damage in infants?
Congenital hypothyroidism, if untreated, can lead to severe developmental delays. What is the most critical period for thyroid hormone replacement therapy to prevent irreversible neurological damage in infants?
In Hashimoto's thyroiditis, which antibodies are most commonly detected in serum as diagnostic markers of the autoimmune process?
In Hashimoto's thyroiditis, which antibodies are most commonly detected in serum as diagnostic markers of the autoimmune process?
While iodine deficiency is a global concern, it is relatively rare in North America primarily due to dietary fortification. Which food product is most commonly fortified with iodine in North America?
While iodine deficiency is a global concern, it is relatively rare in North America primarily due to dietary fortification. Which food product is most commonly fortified with iodine in North America?
In iodine deficiency, a goiter may develop as a compensatory mechanism. What is the physiological rationale behind goiter formation in this condition?
In iodine deficiency, a goiter may develop as a compensatory mechanism. What is the physiological rationale behind goiter formation in this condition?
Hyperthyroidism is characterized by excessive thyroid hormone action. Which of the following is a common cardiovascular manifestation of hyperthyroidism?
Hyperthyroidism is characterized by excessive thyroid hormone action. Which of the following is a common cardiovascular manifestation of hyperthyroidism?
Grave's disease is the most common cause of hyperthyroidism. What is the primary pathophysiological mechanism underlying thyroid hormone excess in Grave’s disease?
Grave's disease is the most common cause of hyperthyroidism. What is the primary pathophysiological mechanism underlying thyroid hormone excess in Grave’s disease?
Toxic thyroid nodules (Plummer's disease) are another cause of hyperthyroidism. How do these nodules lead to thyroid hormone excess?
Toxic thyroid nodules (Plummer's disease) are another cause of hyperthyroidism. How do these nodules lead to thyroid hormone excess?
Thyroid storm is a severe, life-threatening exacerbation of hyperthyroidism. Which of the following clinical features is most characteristic of thyroid storm?
Thyroid storm is a severe, life-threatening exacerbation of hyperthyroidism. Which of the following clinical features is most characteristic of thyroid storm?
In primary hyperthyroidism, thyroid function tests typically show a suppressed TSH level and elevated free T4 and T3. What is the mechanism behind the suppressed TSH in this condition?
In primary hyperthyroidism, thyroid function tests typically show a suppressed TSH level and elevated free T4 and T3. What is the mechanism behind the suppressed TSH in this condition?
Beta-blockers are often used in the initial management of hyperthyroidism symptoms. What is the primary therapeutic effect of beta-blockers in this context?
Beta-blockers are often used in the initial management of hyperthyroidism symptoms. What is the primary therapeutic effect of beta-blockers in this context?
Radioactive iodine therapy is a common treatment for hyperthyroidism. How does radioactive iodine effectively reduce thyroid hormone production?
Radioactive iodine therapy is a common treatment for hyperthyroidism. How does radioactive iodine effectively reduce thyroid hormone production?
Thyroidectomy, surgical removal of the thyroid gland, is a treatment option for hyperthyroidism. What is a common long-term complication following a total thyroidectomy?
Thyroidectomy, surgical removal of the thyroid gland, is a treatment option for hyperthyroidism. What is a common long-term complication following a total thyroidectomy?
Exophthalmos, or proptosis of the eyeballs, is a unique sign in Grave's disease. What is the underlying mechanism leading to exophthalmos in this condition?
Exophthalmos, or proptosis of the eyeballs, is a unique sign in Grave's disease. What is the underlying mechanism leading to exophthalmos in this condition?
Diabetes mellitus is characterized by hyperglycemia. In Type 1 diabetes mellitus, what is the primary etiological factor leading to this hyperglycemia?
Diabetes mellitus is characterized by hyperglycemia. In Type 1 diabetes mellitus, what is the primary etiological factor leading to this hyperglycemia?
Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus, more commonly seen in Type 1 diabetes. What is the main metabolic derangement that defines DKA?
Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus, more commonly seen in Type 1 diabetes. What is the main metabolic derangement that defines DKA?
Polydipsia, polyuria, and polyphagia are classic symptoms of uncontrolled diabetes mellitus. Which of the following physiological mechanisms best explains polyuria in diabetes?
Polydipsia, polyuria, and polyphagia are classic symptoms of uncontrolled diabetes mellitus. Which of the following physiological mechanisms best explains polyuria in diabetes?
HbA1c is a crucial diagnostic and monitoring tool for diabetes mellitus. What does HbA1c level reflect?
HbA1c is a crucial diagnostic and monitoring tool for diabetes mellitus. What does HbA1c level reflect?
Type 2 diabetes mellitus is characterized by insulin resistance. Which of the following best describes insulin resistance?
Type 2 diabetes mellitus is characterized by insulin resistance. Which of the following best describes insulin resistance?
Metformin is a commonly prescribed first-line medication for Type 2 diabetes. What is the primary mechanism of action of metformin?
Metformin is a commonly prescribed first-line medication for Type 2 diabetes. What is the primary mechanism of action of metformin?
Dyslipidemia, often associated with Type 2 diabetes and metabolic syndrome, typically involves which lipid profile abnormality?
Dyslipidemia, often associated with Type 2 diabetes and metabolic syndrome, typically involves which lipid profile abnormality?
Acanthosis nigricans, a skin condition characterized by dark, velvety patches, is often associated with insulin resistance. Where is acanthosis nigricans typically observed on the body?
Acanthosis nigricans, a skin condition characterized by dark, velvety patches, is often associated with insulin resistance. Where is acanthosis nigricans typically observed on the body?
Compared to Type 1 diabetes, Diabetic Ketoacidosis (DKA) is less common in Type 2 diabetes. However, in Type 2 diabetes, a different hyperglycemic emergency, Hyperosmolar Hyperglycemic State (HHS), is more prevalent. What is the key differentiating factor in the pathophysiology of HHS compared to DKA?
Compared to Type 1 diabetes, Diabetic Ketoacidosis (DKA) is less common in Type 2 diabetes. However, in Type 2 diabetes, a different hyperglycemic emergency, Hyperosmolar Hyperglycemic State (HHS), is more prevalent. What is the key differentiating factor in the pathophysiology of HHS compared to DKA?
Nerve damage (neuropathy) is a common long-term complication of both Type 1 and Type 2 diabetes. Which of the following is a typical pattern of diabetic peripheral neuropathy?
Nerve damage (neuropathy) is a common long-term complication of both Type 1 and Type 2 diabetes. Which of the following is a typical pattern of diabetic peripheral neuropathy?
Retinopathy is a significant microvascular complication of diabetes mellitus. What is the primary mechanism leading to diabetic retinopathy?
Retinopathy is a significant microvascular complication of diabetes mellitus. What is the primary mechanism leading to diabetic retinopathy?
Nephropathy (diabetic kidney disease) is another major microvascular complication of diabetes. What is the earliest clinical manifestation of diabetic nephropathy that is typically monitored?
Nephropathy (diabetic kidney disease) is another major microvascular complication of diabetes. What is the earliest clinical manifestation of diabetic nephropathy that is typically monitored?
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with diabetes mellitus. What is the most significant risk factor linking diabetes and cardiovascular disease?
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with diabetes mellitus. What is the most significant risk factor linking diabetes and cardiovascular disease?
In the context of massage therapy for individuals with diabetes mellitus, what is a primary consideration regarding insulin injection sites?
In the context of massage therapy for individuals with diabetes mellitus, what is a primary consideration regarding insulin injection sites?
A 70-year-old patient presents with new onset fatigue, mild constipation, and difficulty tolerating cold temperatures. They deny significant weight gain or changes in appetite. Considering age-related changes in thyroid function, which of the following is the MOST appropriate initial step in evaluating this patient?
A 70-year-old patient presents with new onset fatigue, mild constipation, and difficulty tolerating cold temperatures. They deny significant weight gain or changes in appetite. Considering age-related changes in thyroid function, which of the following is the MOST appropriate initial step in evaluating this patient?
In primary hypothyroidism due to Hashimoto's thyroiditis, which of the following hormonal profiles is expected?
In primary hypothyroidism due to Hashimoto's thyroiditis, which of the following hormonal profiles is expected?
A patient with hypothyroidism is prescribed levothyroxine. What is the primary rationale for gradually increasing the dosage of this medication rather than starting at the full replacement dose?
A patient with hypothyroidism is prescribed levothyroxine. What is the primary rationale for gradually increasing the dosage of this medication rather than starting at the full replacement dose?
Untreated congenital hypothyroidism can lead to severe developmental delays. What is the MOST critical reason for early diagnosis and treatment of congenital hypothyroidism in newborns?
Untreated congenital hypothyroidism can lead to severe developmental delays. What is the MOST critical reason for early diagnosis and treatment of congenital hypothyroidism in newborns?
In Hashimoto's thyroiditis, the autoimmune process primarily targets which component of the thyroid gland?
In Hashimoto's thyroiditis, the autoimmune process primarily targets which component of the thyroid gland?
Which statement BEST describes the compensatory mechanism behind goiter formation in iodine deficiency?
Which statement BEST describes the compensatory mechanism behind goiter formation in iodine deficiency?
A patient presents with weight loss, palpitations, heat intolerance, and anxiety. Thyroid function tests reveal low TSH and elevated free T4 and T3. Which of the following conditions is the MOST likely diagnosis?
A patient presents with weight loss, palpitations, heat intolerance, and anxiety. Thyroid function tests reveal low TSH and elevated free T4 and T3. Which of the following conditions is the MOST likely diagnosis?
In Grave's disease, the excessive thyroid hormone production is primarily driven by:
In Grave's disease, the excessive thyroid hormone production is primarily driven by:
Beta-blockers are often used in the initial management of hyperthyroidism. What is their MAIN therapeutic effect in this context?
Beta-blockers are often used in the initial management of hyperthyroidism. What is their MAIN therapeutic effect in this context?
Radioactive iodine (RAI) is a common treatment for hyperthyroidism. How does RAI therapy reduce thyroid hormone production?
Radioactive iodine (RAI) is a common treatment for hyperthyroidism. How does RAI therapy reduce thyroid hormone production?
Which of the following is the MOST significant risk factor for the development of thyroid cancer?
Which of the following is the MOST significant risk factor for the development of thyroid cancer?
In Type 1 Diabetes Mellitus, hyperglycemia is primarily a result of:
In Type 1 Diabetes Mellitus, hyperglycemia is primarily a result of:
Diabetic ketoacidosis (DKA) is a serious complication more commonly associated with Type 1 diabetes. What is the KEY metabolic derangement that defines DKA?
Diabetic ketoacidosis (DKA) is a serious complication more commonly associated with Type 1 diabetes. What is the KEY metabolic derangement that defines DKA?
Polydipsia, a classic symptom of diabetes mellitus, is BEST explained by which physiological mechanism?
Polydipsia, a classic symptom of diabetes mellitus, is BEST explained by which physiological mechanism?
HbA1c reflects the average blood glucose level over what period?
HbA1c reflects the average blood glucose level over what period?
Insulin resistance, a hallmark of Type 2 Diabetes Mellitus, is BEST described as:
Insulin resistance, a hallmark of Type 2 Diabetes Mellitus, is BEST described as:
Metformin is a first-line medication for Type 2 diabetes. What is its PRIMARY mechanism of action?
Metformin is a first-line medication for Type 2 diabetes. What is its PRIMARY mechanism of action?
Acanthosis nigricans, a skin condition associated with insulin resistance, is characterized by:
Acanthosis nigricans, a skin condition associated with insulin resistance, is characterized by:
Compared to Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS) in Type 2 diabetes is characterized by:
Compared to Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS) in Type 2 diabetes is characterized by:
Diabetic peripheral neuropathy typically follows which pattern?
Diabetic peripheral neuropathy typically follows which pattern?
Flashcards
Hypofunction
Hypofunction
Loss of reserve, hyposecretion, agenesis, atrophy, or active destruction of a gland causing decreased function.
Hyperfunction
Hyperfunction
Hypersecretion, loss of suppression, hyperstimulation, or hyper/neoplastic changes causing increased gland function.
Hyperpituitarism Definition
Hyperpituitarism Definition
Primary hypersecretion of pituitary hormones, most often from a functional pituitary adenoma.
Gigantism
Gigantism
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Acromegaly
Acromegaly
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Prolactinoma
Prolactinoma
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Cushing's Syndrome
Cushing's Syndrome
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Cushing's Disease
Cushing's Disease
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Hypopituitarism
Hypopituitarism
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Empty Sella Syndrome
Empty Sella Syndrome
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Pituitary Dwarfism
Pituitary Dwarfism
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Diabetes Insipidus
Diabetes Insipidus
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Adrenal Glands
Adrenal Glands
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Cortex
Cortex
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Medulla
Medulla
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Primary adrenal insufficiency
Primary adrenal insufficiency
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Hyperaldosteronism
Hyperaldosteronism
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Pheochromocytoma
Pheochromocytoma
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Hyperparathyroidism
Hyperparathyroidism
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Hypoparathyroidism
Hypoparathyroidism
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Hypothyroidism
Hypothyroidism
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Hashimoto's Thyroiditis
Hashimoto's Thyroiditis
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Iodine Deficiency
Iodine Deficiency
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Hyperthyroidism
Hyperthyroidism
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Grave's Disease
Grave's Disease
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Thyroid Cancer
Thyroid Cancer
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Congenital Hypothyroidism
Congenital Hypothyroidism
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Myxedema
Myxedema
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Grave's disease definition
Grave's disease definition
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The definition of hyperthyroidism?
The definition of hyperthyroidism?
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Goiter
Goiter
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Diabetes Mellitus
Diabetes Mellitus
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Diabetes Mellitus Type I
Diabetes Mellitus Type I
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Diabetes Mellitus Type II
Diabetes Mellitus Type II
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Exophthalmos
Exophthalmos
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Aging Thyroid Changes
Aging Thyroid Changes
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TSH Screening Age
TSH Screening Age
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What is Myxedema?
What is Myxedema?
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Myxedema Coma
Myxedema Coma
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Thyroid Blood Panel
Thyroid Blood Panel
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Hashimoto definition
Hashimoto definition
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Hashimoto's Etiology
Hashimoto's Etiology
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Hashimoto's Epidemiology
Hashimoto's Epidemiology
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Hashimoto's Diagnosis
Hashimoto's Diagnosis
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Hashimoto's Treatment
Hashimoto's Treatment
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Iodine Deficiency Risk Factors
Iodine Deficiency Risk Factors
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Iodine Deficiency Results
Iodine Deficiency Results
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Iodine Deficiency Treament
Iodine Deficiency Treament
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Grave's Disease Epidemiology
Grave's Disease Epidemiology
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Graves' Specific Signs
Graves' Specific Signs
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Graves' Diagnosis
Graves' Diagnosis
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Grave's Treatment
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Type I Treatment
Type I Treatment
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Capital of France (example flashcard)
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Study Notes
A note on the thyroid gland related to increasing age
- Gland shrinks and shifts lower in neck with age
- Hormone levels may fall slightly, but the speed of vital function changes very little
- Disorders of the thyroid increase with age
- Hyper- and hypothyroidism are underdiagnosed in older people and symptoms can mimic signs of aging
- Dysfunction of the thyroid has a greater impact on older persons, like malaise and an inability to complete the activities of daily living (ADL)
- Adults 65+ should have yearly screening for TSH levels
Hypothyroidism definition
- Underactivity of the thyroid gland caused by any structural or functional change, resulting in inadequate production of thyroid hormones
- Dysfunction can occur anywhere along the hypothalamic-pituitary-thyroid axis.
- Primary hypothyroidism: thyroid gland issue
- Secondary hypothyroidism: pituitary gland issue
- Tertiary hypothyroidism: hypothalamus gland issue
- Very common, especially among older people and women.
- 10% of the female population is affected
Causes of hypothyroidism
- Primary
- Autoimmune (Hashimoto thyroiditis) is most common in North America
- Absence/loss of thyroid parenchyma or hypertrophy of the thyroid gland
- Iodine deficiency is the most common worldwide
- Surgical or radiation-induced ablation of tissue
- Congenital agenesis/dysgenesis
- Drugs like lithium and iodides
- Secondary
- Pituitary failure (lesion, tumour)
- Tertiary (rare)
- Hypothalamic failure
General Signs and Symptoms of Hypothyroidism
- Most common signs and symptoms:
- Fatigue
- Weight gain
- Trouble tolerating cold
- Joint and muscle pain
- Dry skin or dry, thinning hair
- Heavy or irregular menstrual periods
- Fertility issues
- Slowed heart rate
- Constipation
- Depression
- Other signs and symptoms include:
- May be mistaken for depression/dementia, especially in older persons
- Mental slowing, apathy, tiredness
- Potential goiter
- Hoarsening of voice
- Drooping eyelids
- Pale, puffy face
- Muscle weakness in the extremities
- Carpal Tunnel Syndrome
- May be mistaken for depression/dementia, especially in older persons
Hypothyroidism: Myxedema
- A word used to describe severe hypothyroidism
- Also used to describe dermatological changes with severe hypothyroidism
- Though the mechanism is not fully understood, high levels of TSH lead to the deposition of mucopolysaccharides in the dermis
- This produces a non-pitting edema
- Can occur in the face, leading to puffiness around the eyes
- Can occur in the lower limb (pretibial myxedema)
- Though the mechanism is not fully understood, high levels of TSH lead to the deposition of mucopolysaccharides in the dermis
Hypothyroidism complications
- Cardiovascular disease
- Infertility
- Myxedema coma (decompensated thyroid)
- Bradypnea, seizures, LBP, hyponatremia and decreased blood flow to the brain
- Triggered by physical stress, infection, injury, surgery
Hypothyroidism diagnosis
- Thyroid blood panel: TSH, T3, T4, and free T4
- Often includes antithyroid antibody tests as well
- Yearly test for people 65+
- Suggested every 5 years in healthy individuals 35 and up
Hypothyroidism Interpretation of Lab Results
- Increased TSH; Decreased T4, T3 = Hypothyroidism
- Decreased TSH; Increased T4, T3 = Hyperthyroidism
- Decreased TSH; Decreased T4, T3 = Hypopituitarism
- Increased TSH; Increased T4, T3 = TSH secreting tumour
Hypothyroidism Treatment
- Hormone replacement
- Often synthetic T4 (Synthroid)
- Dosage starts low and is gradually increased until TSH levels are within normal levels (WNL)
- May need increased dosage during pregnancy
- Emergency situations may require IV T3 and T4
Congenital Hypothyroidism Definition
- Hypothyroidism that develops in infancy or early childhood
- Cause:
- Prolonged iodine deficiency in the Himalayas, China, Africa, and mountainous regions
- Congenital errors in metabolism and enzyme deficiencies
- Signs and Symptoms:
- Stunted physical and mental growth
- Impaired development of skeletal system and central nervous system
- Coarse facial features
- Protruding tongue
Hashimoto’s Thyroiditis Definition
- aka Hashimoto’s disease
- Chronic, autoimmune inflammation of the thyroid gland.
- Body is unable to recognize its own thyroid gland/enzymes
- Antibodies attack and destroy gland
- Anti-TPO antibodies
- Anti-Tg antibodies
- Most common type of thyroiditis and the most common cause of Hypothyroidism in North America
- Chronic, autoimmune inflammation of the thyroid gland.
Hashimoto’s thyroiditis etiology
- Autoimmune disorder with family predisposition
- People often have other endocrine disorders, like diabetes, underactive adrenals, and underactive parathyroid glands
- People often have other autoimmune disorders, like pernicious anemia, RA, Sjögren's syndrome, and systemic lupus erythematosus
Hashimoto’s thyroiditis epidemiology
- 7x more common in women, especially older women
- Incidence: 0.8 per 1000 per year in men and 3.5 per 1000 per year in women
- Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50
Hashimoto’s thyroiditis signs and symptoms
- Usually, will have classic hypothyroid symptoms
- Fatigue
- Depression
- Weight gain
- Pale, puffy face
- Bradycardia
- Cold intolerance
- Constipation
- Dry, thinning hair and skin
- May lead to a goiter
Hashimoto’s thyroiditis diagnosis
- Physical exam w/ palpable thyroid (physical changes are not always palpable)
- Serum thyroid panel measures TSH, T3, and T4
- Serum antibody tests and high inflammatory markers
- Anti-thyroglobulin and anti-TPO
- CRP level and ESR
Hashimoto’s thyroiditis treatment
- No specific treatment for the autoimmune reaction
- Most develop hypothyroidism needing lifelong hormone replacement (Synthroid)
Hashimoto’s Thyroiditis, massage
- No contraindications
Iodine definitions
- The thyroid contains most of the body’s iodine, an essential component of T4 and T3
- Found in ocean/sea water
- Through evaporation and rain, iodine enters the soil near the sea
- In North America, table salt is fortified with iodine
Iodine Deficiency
- Rare in North America, d/t table salt fortification
- Risk factors: high altitudes, far from the sea
- Deficiency causes goiter, as the thyroid tries to "capture” more iodine
- May result in:
- Hypothyroidism a result of the inability to make T4 and T3
- Hyperthyroidism as a result of increase incidence of diffuse and nodular goiter, where autonomous growth and function may occur leading to toxic goiter/hyperthyroidism
Iodine deficiency diagnosis
- Serum thyroid hormone tests showing high TSH, low T3/T4
- Urine iodine test
- Thyroid ultrasound
Iodine deficiency Treatment
- Oral iodine supplementation
- and/or obtain through diet
Iodine Deficiency, Massage
- No contraindications
Hyperthyroidism Definition
- Overactivity of the thyroid gland that leads to high levels of thyroid hormone
- Affects ~1% of the population
- 10x more common in women; more common in those over 60
- Most common cause: Grave’s disease
Hyperthyroidism Causes
- Grave’s disease is the most common cause
- Autoimmune hyperthyroid disease
- Toxic thyroid nodules (Plummer’s disease) is the second most common
- Thyroid gland nodules that secrete TH without stimulation
- Thyroiditis
- Inflammation of thyroid gland
- Eventual hypothyroidism due to depletion of hormones
- Potential to return to normal function
- Inflammation due to toxic substances or radiation
- Overactive pituitary gland (rare)
Hyperthyroidism General Signs and Symptoms
- Weight loss
- Increased HR and BP, arrhythmias
- Hyperhidrosis
- Feeling of nervousness/anxiety
- Higher body temperature
- Tremors
- Frequent BM and diarrhea
- Uncontrolled hyperthyroidism can lead to a thyroid storm
- High blood pressure
- High fever
- Vomiting/diarrhea
- Myocardial infarction
Hyperthyroidism Diagnosis
- Suspected based on symptoms
- Thyroid blood panel: TSH, T3, T4, and free T4
- Often includes antithyroid antibody tests as well
- Primary: low TSH, high T3 and T4
- Pituitary: high TSH, high T3 and T4
- Depending on the cause, may use imaging to scan the thyroid
Hyperthyroidism Treatment
- Beta-blockers which slows heart rate, thus controlling BP, tremors, and anxiety.
- Anti-thyroid drugs that inhibit the production of thyroid hormone
- Radioactive iodine (po)
- Destroys part of the thyroid gland without effecting the body as a whole
- Not given to pregnant/nursing women
- Crosses the placenta and breastmilk, destroys infant thyroid
- May set off radiation alarms for several weeks.
- Thyroidectomy
- Candidates: young persons, large goiter, or drug allergy
- Often results in hypothyroidism and lifelong hormone replacement
Hyperthyroidism Complications
- If untreated, places undue stress on the heart and other organs, possibly resulting in CHF, stroke, and renal failure
Grave’s Disease
- Overproduction of thyroid hormone due to autoimmune stimulation of the thyroid gland
- Anti-TSH receptor antibodies that stimulate the thyroid
- Most common cause of hyperthyroidism in North America
Grave’s disease etiology
- Autoimmune disorder with family predisposition
- People often have other endocrine disorders, like diabetes, underactive adrenals, and underactive parathyroid glands
- People often have other autoimmune disorders, like pernicious anemia, RA, Sjögren's syndrome, and systemic lupus erythematosus
Grave’s disease epidemiology
- 4x more common in women
- Affects about one in 200 people
- Although the disease may occur at any age, it more often develops in over 30 years old
Grave’s disease Signs and Symptoms
- Will have classic hyperthyroid symptoms
- Weight loss
- Increased HR and BP, arrhythmias
- Hyperhidrosis
- Feeling of nervousness/anxiety
- Higher body temperature
- Tremors
- Frequent BM and diarrhea
- Signs and Symptoms Specific to Grave’s Disease:
- Myxedema
- Because TSH stimulates fibroblasts
- Deposition of excessive connective tissue components leading to edema
- Commonly occurs on the shins (pretibial myxedema)
- Puffiness around eyes
- When occurring behind the eyes, it leads to exophthalmos
- Because TSH stimulates fibroblasts
- Exophthalmos
- Forward protruding eyes and the presence of staring
- Myxedema
Grave’s disease Diagnosis
- Serum thyroid panel to measure TSH, T3, and T4
- Serum antibody tests and high inflammatory markers
- Anti-TSH receptor antibodies
- CRP level and ESR
Grave’s disease Treatment
- No specific treatment for the autoimmune reaction
- Beta-blockers
- Antithyroid medications
- Reduction of iodine in the diet
- Possible thyroidectomy
Grave’s Disease, massage
- No contraindications
Thyroid Cancer Definition
- Malignant tumour of the thyroid gland
Thyroid Cancer Etiology
- The most significant risk factor is exposure to radiation, especially during childhood
Thyroid Cancer Epidemiology
- 53,990 new cases and 2060 cancer deaths per year in the US
- Women are 3x more likely to develop
Thyroid cancer signs and symptoms
- The most common sign is a solitary nodule on the anterior throat
- Dysphagia
- Hoarseness
- Neck pain
Thyroid cancer Diagnosis
- Imaging and biopsy used to confirm diagnosis
Thyroid cancer Treatment
- Surgical excision of the tumour or of the thyroid
- Will require lifelong HRT with thyroid hormone
- Chemotherapy, radiation, radioactive iodine may all be used
Thyroid cancer Prognosis
- Localized (only in the thyroid): 100% 5-year survival rate
- Regional (cancer has spread to nearby lymph nodes: 98% 5-year survival rate
- Distant (metastasis to other organs): 54% 5-year survival rate
Thyroid Cancer, Massage
- No contraindications
Disorders of the Pancreas
- Some disorders of the pancreas were already covered in GI pathologies such as pancreatitis, cystic fibrosis, pancreatic cancer
- Attention will focus on the endocrine function of the pancreas, focusing mainly on diabetes mellitus
Diabetes Mellitus
- Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia
- There are two main types, in which the underlying cause is different.
- Type I diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells leading to insulin deficiency
- Type II diabetes mellitus is caused by insulin resistance and is related to metabolic syndrome
- Both disorders involve the continuing surveillance of blood glucose levels, but the underlying cause and treatment is different
Diabetes Mellitus Type I
- Definition: Autoimmune destruction of the pancreatic beta cells leading to the absence of insulin and therefore hyperglycemia
- One of the most common chonic disease in childhood
- Onset can be in childhood or adulthood, but is more common in childhood
- Genetics play a role but less so than in type II diabetes
Diabetes Mellitus Type I Etiology
- Autoimmune destruction of the pancreatic beta cells leading to absolute insulin deficiency
- Genetics play a role but less so than in type II diabetes
Diabetes Mellitus Type I Epidemiology
- Approximately 300,000 Canadians have type 1 diabetes
Diabetes Mellitus Type I Signs and Symptoms
- Most common signs and symptoms:
- polydipsia, polyuria, polyphagia
- Weight loss
- Opportunistic infections like candidiasis and acute visual disturbances
- Diabetic Ketoacidosis
- Severe polydipsia, polyuria, weight loss + acidosis
- Acidosis presents as fruity smelling breath, possible neurologic findings (drowsiness, lethargy)
- Symptoms evolve rapidly over a 24hr period
Diabetes Mellitus Type I Diagnosis
- Fasting glucose (on more than one occasion)
- Random glucose
- OGTT
- Insulin or C-peptide
- Testing for autoantibodies
- HbA1c
Diabetes Mellitus Type I Treatment
- Continual glucose monitoring with insulin therapy
- Patient education (Hypoglycemia symptoms, CGM, blood glucose monitoring)
Diabetes Mellitus Type I, massage
- Local contraindications around areas of insulin injection and glucose monitor/insulin pump
Diabetes Mellitus Type II
- The development of insulin resistance due to long standing metabolic syndrome
- Characterized by hyperglycemia due to insulin resistance can result in the progressive loss of insulin secretion from the pancreatic beta cells
- More common than type I diabetes
Diabetes Mellitus Type II Etiology
- Strong genetic role in etiology
- DMII often found accompanied by other signs of metabolic syndrome:
- HTN
- Dyslipidemia (elevated TG, lowered HDL)
- Central obesity
Diabetes Mellitus Type II Signs and Symptoms
- Asymptomatic (40%)
- Common SSX (which are d/t hyperglycemia):
- Polyuria
- Polydipsia
- Nocturia
- Acanthosis nigricans
- HTN, dyslipidemia
- DMII very rarely can present as DKA
Diabetes Mellitus Type II Diagnosis
- Fasting glucose (on more than one occasion)
- Random glucose
- OGTT
- Insulin or C-peptide
- Testing for autoantibodies
- HbA1c
Diabetes Mellitus Type II Complications
- Cardiovascular disease
- Nerve damage in periphery
- Other nerve damage
- Arrhythmias, digestive upset, ED
- Kidney disease
- Eye damage
- Skin conditions
- Slow healing
Diabetes Mellitus Type II Treatment
- Healthy eating
- Regular exercise
- Weight loss
- Possibly, diabetes medication or insulin therapy
- Metformin
- Sulfonylureas (glyburide)
- Advanced disease may require insulin therapy
Diabetes Mellitus Type II, massage
- No contraindications unless patient is using insulin or has a glucose monitor (local contraindications)
Type I vs Type 2 Diabetes Mellitus
- DMI
- DKA presentation more likely
- The presence of pancreatic autoAb
- Typically thin and has difficulty gaining weight or history of recent weight loss
- Typically before 10 yrs of age
- May have insulin resistance, but rare
- Genetics play a mild role
- DMII
- RARE to have DKA but a possibility
- No pancreatic autoAb
- Typically obese or overweight
- Typically present after onset of puberty
- Have insulin resistance and the associated symptoms such as - acanthosis nigricans, HTN, dyslipidemia
- Strong genetic role
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