Patho Exam 2 Review PDF

Review Guide Unit II: Chapter 5 Oncology Key Terms Benign and malignant tumors- naming and characteristics Warning signs of cancer, cancer staging, common risk factors as related to PT Chapter 12 Central Nervous System Axon - a long cylindrical process that conducts information away from the c...

Review Guide Unit II: Chapter 5 Oncology Key Terms Benign and malignant tumors- naming and characteristics Warning signs of cancer, cancer staging, common risk factors as related to PT Chapter 12 Central Nervous System Axon - a long cylindrical process that conducts information away from the cell body Brainstem - The lower extension of the brain, where it connects with the spinal cord; divided into the midbrain, pons, and medulla, it contains nerves, and helps control respiration, swallowing, wakefulness and other activities Cerebellum - The portion of the brain that helps control fine motor movements and coordination Cerebrum - the primary portion of the brain, divided into two lobes, each of which have specialized lobes Dendrite - branched, tapered process from most neurons which receives information at junctions called synapses. Diencephalon - the portion of the brain that houses the thalamus and hypothalamus Arachnoid - the middle layer of the meninges, covering the brain and spinal cord Dura mater - the outermost layer of the meninges, covering the brain and spinal cord Pia mater - innermost layer of the meninges Babinski Sign - a reflex movement of the big toe upward instead of the downward when the plantar aspect of the foot is stroked; it tests for the injury or disease related to the upper motor neurons Brown-Sequard syndrome - paralysis and loss of discriminatory and joint sensation on one side of the body, and of pain and temperature sensation on the other, due to a lesion involving one side of the spinal cord Central cord syndrome - injury to the central portion of the cervical spinal cord, resulting in the disproportionately more weakness or paralysis in the upper extremities than in the lower; due to hemorrhage or edema Posterior cord syndrome - a condition due to the loss of the vibration and position sense below a lesion of the posterior spinal cord, accompanied by a positive romberg sign, tingling, sensory ataxia, hypotonia, and preserved pain and temperature sensation Chorea - continuing and rapid complex body movements Hemiparesis - weakness of one side of the body Paraplegia - paralysis of the legs and lower part of the torso Quadriplegia - paralysis of the arms and legs. Also called tetraplegia Nuchal rigidity - impaired neck flexion resulting from muscle spasm of the extensor neck muscles usually attributed to meningeal irritation Cranial & Spinal Nerves and function Nervous System disorders: Dementia mental status, sleep disorders Diseases of CNS o CVA – Hemorrhagic vs Ischemia, general treatments for each Stroke is a sudden impairment of cerebral circulation in one or more blood vessels. This event interrupts or lessens oxygen supply, causing necrosis in brain tissue. Stroke typically results from one of three common causes: cerebral embolism, thrombus, or hemorrhage. Hemorrhage - rupture of an artery that fills surrounding tissue with blood, usually due to arteriosclerosis and hypertension, but sometimes caused by an aneurysm. Treatment - anticoagulant and hypertensive medications. Physical disability may require long term physical and speech therapy. Controllable and lifestyle choices are smoking, obesity, elevated cholesterol and lipids, physical inactivity, excessive alcohol use, and illegal drug use. o Alzheimer’s disease - degenerative disorder of the cerebral cortex, especially the frontal lobe, which accounts for more than half of all cases of dementia. Factors linked to its development include hereditary, autoimmunity, aluminum or manganese toxicity, and viral infections. HEad trauma. Warning signs include memory loss that disrupts memory loss and developing problems with words when speaking or writing. Treatment - avoiding high fat diets and vitamin and mineral supplements. Role of PTA - assist in exercises designed to increase fitness, including cardiorespiratory endurance and strength. Exercise has shown to maintain motor skills, decrease falls, and reduce the rate of decline of mental skills. o Parkinson’s - Slow and progressive brain degeneration. Produces progressive muscle rigidity, no movement, and involuntary tremors of resting muscles. They produce less dopamine and the amount of connections between nerve cells in the basal ganglia decreases. Cause is unknown but deficiency of dopamine and exposure to toxins such a manganese dust or carbon monoxide and chemicals and by head injuries. Treatment - symptomatic, usually involving dopamine replacement, which helps reduce symptoms but cannot cure the disease. Physical therapy may alleviate muscle pain and provide many other benefits. Role of PTA - assist patients in learning new movement techniques, strategies, and the use of medical equipment. Fall prevention and balance. Goal is to promote function and maintain the ability to live as normally as possible. PT can assist with balance problems, lack of coordination, fatigue, gait, immobility and weakness. o ALS - degenerative disease affects the upper and lower motor neurons. ALS is a chronic, progressively debilitating disease that may be fatal in less than 1 year or may contribute for 10 years or more. The disease causes muscles to become weak and wasted resulting in movement that becomes stiff, awkward and clumps. Muscle strength is affected, usually in the hands initially and less often in the feet, mouth, or throat. Treatment - medication can help lessen symptoms. Physical therapy can help maintain muscle strength. Some assistance when eating to prevent choking and for some patients. Medications include baclofen, phenytoin, quinine, anticholinergics, antidepressants, cough suppressants quinine and newer drugs such as riluzole or edaravone which target nerve cells. Role of PTA - gentle, low impact exercise, such as passive and active assisted ROM exercises, supervised walking, often with an assistive device, swimming, and stationary equipment. Stretching exercises and breathing are also indicated. Helpful equipment may include braces, ramps, walkers, and wheelchairs. o MS - chronic inflammatory disease involving demyelination of the white matter of the brain and spinal cord. The cause of MS may be genetically linked. MS symptoms include lack of coordination, muscle weakness or numbness, unsteady gait, paresthesia, vertigo, difficulty speaking, dysphagia loss of bladder function, facial numbness or pain. Treatment - Acute attacks are treated with corticosteroids. Chronic forms are treated with interferons, immune modulators, and antineoplastic agents. Muscle relaxants, vitamin supplements, braces, walking devices, PT, and adequate rest and diet. Role of PTA - assist MS patients in exercise regimens that include core stabilization training balance and energy conservation. Activities must be monitored to avoid fatigue. Warm up and cool down phases should be incorporated along with fall interventions. Exercises include water aerobics, aquatic therapy and yoga. o Dystonia - sustained involuntary muscle contractions. Some symptoms include shutting of eyelids, spasmodic torticollis of the neck or back, grimacing puckering of the lips, tongue protrusion and writhing of the limbs. Focal dystonias affect only one body part. Segmental dystonia affects two or more parts. Multifocal dystonias affect two or more body parts that are not next to each other. General dystonias affect the trunk as well as two other body parts. Treatment - Symptoms can be relieved by mild sedatives, levodopa/carbidopa of botulinum. Role of PTA is patient education for exercises and activities that increase ROM following a botox injection in order to maintain ROM and ADLs. o Huntington’s Chorea - genetic disease affects half of children in families in which one parent has the dominant gene. It does not appear until middle age. Symptoms include progressive brain deterioration, loss of muscle control and chorea. Mood and personality changes, loss of memory, and dementia. There is no cure and treatment and family education is supported. o TBI - Trauma to the brain, neck. And spinal cord can cause many types of disabilities and even death. Head trauma can lead to edema, increased ICP, hemorrhage, and infection. Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury for longer than 24 hours. o Transient Ischemic Attack - mini stroke, warning sign of impending stroke. Common symptoms include dizziness, weakness of limbs, numbness, slurring of speech, and brief or mild loss of consciousness; usually there is not a total loss of consciousness. Treatment - A common surgery to correct blood flow for TIA is carotid endarterectomy. Role of PTA - assist patients in reestablishing body control and movements that were lost due to stroke. Repetitive practice in which a patient is learning how to live normally when the use of one hand is affected or when speech is compromised. Passive or active limb movements are encouraged to help with contractures. Chapter 13 Peripheral Neuropathies Ankle-jerk - Also called achilles reflex; it occurs when the achilles tendon is tapped while the fot is dorsiflexed. Knee-jerk reflex - A simple reflex; when the knee is tapped, the nerve receiving this stimulus sends an impulse to the spinal cord, where it is relayed to a motor nerve, causing the quadriceps muscle to contract. Ascending paralysis - Spinal paralysis that progresses upward Claw Hand deformity - also called intrinsic minus hand, characterized by hyperextension of the metacarpophalangeal joint and flexion of the proximal and distal interphalangeal joint. Phalen sign - also called phalen's maneuver or test; maximum passive flexion of the wrist for one minute causes paraesthesia over the median nerve, finding in entrapment neuropathy such as carpal tunnel syndrome. Sleep palsy - temporary paralysis due to radial nerve compression within the arm, from direct pressure while sleeping; also called radial neuropathy and saturday night palsy Spondylolisthesis - the anterior displacement of a vertebra or vertebral column in relation to the vertebrae blow Tinel sign - an indication of nerve irritability; a distal tingling sensation caused by percussion of a damaged nerve. Common conditions of PNS: o Diabetic neuropathy with paresthesia, dysesthesia, o Thyroid Dysfunction o CTS o Sciatica - a form of radiculopathy due to nerve root changes that are usually linked to compression. Most common in people from 40 to 60 years of age. Signs and symptoms include pain radiating along the course of the sciatica nerve, usually down the buttocks and posterior aspect of the leg to below the knee. L5 to S1 affects ankle jerk and L3 and L4 herniation may affect knee jerk reflex. Treatment - epidural injection of steroids at the target roots. Role of PTA - nerve mobilization techniques such as flossing to reduce nerve tension and restore normal mobility. o Tardy Ulnar Palsy - characterized by atrophy of the first dorsal interosseus muscle with difficulty performing fine manipulations. People with diabetes have a much higher incidence of tardy ulnar palsy. Signs and symptoms are aggravated by flexion of the elbow. The hand has a claw shape. MCP and IP flexion of the ring and little fingers due to unopposed action of the extensor. To assess the ulnar nerve clinical test include the card test for froment's sign. Treatment - moderate to severe compression requires surgery. Decompression is preferred over transposition of the ulnar nerve to the anterior elbow aspect. o TOS - involves symptoms that may be difficult to identify and interpret. Because of complexities involved, patients have often been diagnosed with some type of neurosis instead of an actual PNS disorder. Chronic compression of the nervous or the proximal plexus and arteries between the clavicle and the first rib. Neurogenic form involves compression of the brachial plexus. Vascular form involves compression of the subclavian artery, vein, or both. Disputed form is non specific. Symptoms might be pain at night. Maybe related to frozen shoulder, carpal tunnel or cerebrovascular arterial insufficiency. Treatment - stretching, OT, PT, medications. Role of PTA - diaphragmatic breathing and reduced use of accessory muscle in the beck during respiration. Soft tissue mobilization, massage and stretching of scalenes muscles. o Sleep Palsy - related to radial nerve compression within the arm, from direct pressure, often during sleeping.Other terms for this condition include radial neuropathy and saturday night palsy. It is also linked to lipoma that compresses the radial nerve. Damage to the armpit nerve is called crutch palsy. Signs and symptoms include paralysis of wrist extensors, finger and thumb extensors, diminished grip strength, and alteration of sensation in the dorsum of hand. Treatment - rigid splints to keep affected area immobile until function returns o Morton Neuroma - interdigital nerve irritation, or persistent and benign enlargement of the perineurium,. It develops near the ball of the foot due to poor footwear. Affects more women than men. Signs and symptoms include pain on weightbearing, shooting pain affecting the toes, a feeling of something being in the shoes, sharpness, burning, numbness, paresthesia and an origination irving a tingling sensation in the ball of foot. Treatment - orthotic devices and corticosteroid injections. o Charcot-Marie-Tooth - disease inherited motor and sensory neuropathy. It is the most common inherited disorder of this type. It first affects the peroneal fibular nerve as well as the muscles of feet and lower legs. It is inherited in autosomal dominant autosomal recessive or x linked patterns. Signs and Symptoms are varied if in families with defective genes this is known as variable expressivity. X linked forms male are affected with signs of demyelination as well as axonal degeneration. Slow progressive. Muscle atrophy, distally symmetric weakness and hammer toes. Walkin involves a foot drop or steppage gait pattern. In CMT2 sensory loss is only slight. Symptoms include foot and leg tingling and brining with impaired proprioception. Treatment - Important to maintain movement, flexibility and muscle strength. Braces help with foot drop. A Podiatrist is sometimes required. o Botulism - rare condition but is fatal in 20% of cases. Due to ingesting a strong neurotoxins produced by clostridium botulinum, which exist in foods that are improperly canned or preserved and also in wounds that are contaminated. There are four stages: foodborne, wound, infant and unclassified. Signs and symptoms begin 12 to 36 hours after ingesting the neurotoxin. They include malaise, blurred and double vision, weakness, dry mouth , nausea, and vomiting. Respiratory failure can happen in 6 to 8 hours. Maybe difficulty in swallowing slurred speech and light sensitivity. Motor weakness of facial and neck muscles professes. Secondary effects include severe muscle wasting, pressure sores, and aspiration pneumonia. Treatment - observation, activated charcoal and endotracheal intubation if needed, For feeding nasogastric intubation is preferred. Patients with wound botulism require wound debridement and parenteral antibiotics o Lead Neuropathy (Toxic/poisoning) - o Bell’s Palsy - also known as idiopathic facia paralysis sof facial nerve palsy. Possible causes include meningitis, tumors, diabetes stroke head trauma. Drooping of one corner Treatment - prophylactic high dose corticosteroids for 5 days followed by tapered doses for 5 days. Role of PTA - application of mild heat to warm up muscles prior to soft tissue mobilization. Self care education and neuromuscular re education. Perfect practice initiates movement on the involved side by attempting slow and small movements, Perfect practice is emphasized to discourage synthetic patterns such as an eye narrowing. o Trigeminal Neuralgia - also known as tic douloureux. Disorder of the trigeminal nerve. Patient experiences intense attacks of lancinating pain of the nerves distribution. Sudden onset described as sharp and stabbing and lasting for seconds to minutes. Pain is only in maxillary division. Clusters of pain triggered by chewing, smiling, and mechanical stimulation or even slight breezes of wind. Treatment - oral carbamazepine is preferred medication. Chapter 7 Inflammation and Healing Acute inflammation - Inflammation that develops immediately and lasts for a short time; self-limited. Chronic inflammation - Collagen formation - process by which cells produce collagen, a protein that provides structure and support to the body; occurring in fibroblasts. Fibroblast - cells that synthesize the extracellular matrix and collagen and play an important role in wound healing Granulation tissue - perfused, fibrous connective tissue that replaces the fibrin clot in wounds that are healing. Inflammation - a normal body defense mechanism that localizes and removes harmful agents; it is signified by swelling, redness, heat, pain, and occasional loss of function Phagocytosis - cell-eating; the engulfing of solid particles by a cellular membrane Pyrexia - fever, which may be mild or severe Scar - an area of fibrous tissue that replaces normal skin or other tissue after injury or disease Ulcer - sores or lesions that results from erosion to areas of organs or tissues Know the 3 stages of healing and describe process for each stage Inflammatory stage (2-4 weeks after fracture) - A hematoma forms within the fracture site during the first few hours and days. Inflammatory cells infiltrate the bone. Granulation tissue, vascular tissue, and immature tissue is formed. Repair stage (1-2 months after fracture) - the bone ends become joined and stabilized. New bone tissue is formed but it is weak and requires protection. New blood vessels develop. Smokers should stop their habit during this phase because nicotine greatly slows down the process. Late modeling (remodeling) stage (months to years after fracture) - body changes weak bone material into strong bone material. Mbody remodels the fracture callus down to normal size bone. Bone is restored to its original shape, structure and mechanical strength. Mechanical stress (weight bearing) helps during this stage and must endure weight placed upon it, strengthening it. Chapter 17 Integumentary System Disorders Abscesses - localized infections that cause pockets of pus Athlete’s foot - a fungal infection of the foot that usually starts between two toes and spreads to other toes; also known as tinea pedis Atomic - displaced or ectopic Boil - a skin abscess, a collection of pus localized deep in the skin. Bullae - more than one bullae; which is a blister more than 5 mm in diameter with thin walls, that is full of fluid. Carbuncles - deep-seated abscesses that form in hair follicles Furuncle - localized suppurative staphylococcal skin infections that originate in gland or hair follicle; characterized by pain, redness, and swelling. Impetigo - a bacterial skin infection most commonly seen in children; it is highly contagious. Kaposi sarcoma - a skin cancer that most commonly appears in people with damaged immune systems, particularly in those with AIDS Tinea - a general term used to describe fungal infections of the skin Explain the various types of burns First degree burn - affect the epidermis only, causing pain, erythema and edema. Ex; include mild auburn and a steam burn without the formation of vesicles Second degree burn (partial thickness burns) - affect the epidermis and dermis, causing pain, erythema, edema, and blistering. Infections commonly result and hair follicles Third Degree burn (full-thickness burns) - affect all tissue layers, causing white or blackened, charred skin may be numb. Infections are a major concern, and nerve endings are usually destroyed. Ch. 15 Blood Disorders Aplastic Anemia - The type of anemia in which bone marrow does not produce sufficient new cells to replenish blood cells Hematocrit - the proportion of cells (mostly red blood cells) in blood Leukocytosis - an increase in circulating white blood cells Leukopenia - a decrease in leukocytes, often caused by certain viral infections, radiation, and chemotherapy. Phlebotomy - the act or practice of opening a vein by incision or puncture to remove blood. Rh factor - Genetically determined antigens (agglutinogens) present on the surface of erythrocytes; if one of these is present, the individual blood type is “RH positive”, which has implications in blood transfusions.; mixing rh positive and negative blood results in agglutination and destruction of red blood cells. Thrombocytopenia - the presence of relatively few platelets in the blood RBC vs WBC disorder Key Lab Values (Appendix A) CH. 16 Lymphatic Disorders Lymphoid tissue disorders o Lymphedema - abnormal collection of lymph fluid in soft tissues. This usually occurs in the extremities but may occur in the trunks. “Look at patho for stages*. Most often caused by inflammation, obstruction, or removal of lymph channels, obstruction of lymph drainage due to malignant tumors or an infestation of lymph vessels with adult filarial parasites. Swelling and heaviness in the arms, hands, finers, legs, feet, and toes are common signs. Mild swelling of foot and may spread in the bloodstream. Treatment - Antibiotics, raising the affected area above heart level, exercise, wearing loose clothing compression therapy, and surgery. For secondary lymph. Patients can reduce risk by protecting arms or legs from cuts, rating the arms or legs during recovery, avoid applying heat, elevate arms and legs, avoid tight clothing and keep arms clean including nails to avoid infection. Role of PTA - identify behaviors such as prolonged standing or sitting that may aggravate lymph. Increase exercise by improving mobility, ROM, and endurance ro reduce and avoid obesity. Gentle massage while limbs are elevated in order for gravity to assist lymph flow and drainage. o Lipidemia - symmetric swelling of both legs that extends from the hips to the ankles. It is caused by deposits of subcutaneous adipose tissue. Stage 1 causes nodular skin changes that may be palpated, stage 2 is skin becoming more nodular and tough, with fatty lobules forming. Fat in lower extremities tends to flapover the feet, which are not affected themselves. Skin color may change and elasticity of skin would decrease. Increased venous or blood capillary pressure causes increased ultrafiltration. Treatment - no effective medical treatment. It can be improved or altered by diet because it causes weight gain. o Infectious mononucleosis - affects lymphocytes and is caused by an epstein barr virus. Common in young adults and is usually mild. Transmitted by direct contact with infected sa;iva and named the kissing disease. Signs and symptoms include sore throat, headache, fever, fatigue, malaise, enlarged lymph nodes, enlarged spleen and ris on trunk, increased lymphocytes and moncurs in blood. Possible complications include hepatitis and meningitis. Treatment - bed rest, self limiting but sleep and rest Role of PTA - educate patients on avoiding sports. Physical activity or exercise of any kind until cleared. If the patient's spleen is enlarged, excessive movement can rupture. Avoid contact 3-4 weeks o Lymphoma - malignant neoplasm involves the proliferation of lymphocytes in lymph nodes. Two types hodgkin's and non hodgekins with a third kind of Burkitt's lymphoma are rare in North america. o Hodgkin’s Disease/Lymphoma - originates in the lymphocytes usually involves a single lymph node in the neck and then spreads adjacent nodes. Lymphocytes nodes are decreased and t lymphocytes happen to be defective. 4 subtypes; nodular sclerosing, mixed cellularity, lymphocyte-rich, and lymphocyte depleted. Stage 1 - affecting a single lymph, stage 2 - affected two or more lymph regions on the same side, stage 3 - involved nodes on both sides of diaphragm and spleen, stage 4 - represents diffuse extra;ymphatic involvement. Treatment - radiation, chemotherapy, and surgery. Combination of drugs “ABVD” adriamycin, blenoxane, velban, DTIC - Dome. Role of PTA - assist patients with regular exercise as tolerable. Light activities and borg rating of pierced exertion. o Non-Hodgkin’s lymphomas - blood cancers that include all types of lymphoma. Enlarged but painless lymph nodes. Multiple node involvement throughout the body and none organized pattern of metastasis. Treatment - Similar to hodgkins, more difficult to treat when tumors are nor localized. Role of PTA - tx is based upon impairments and mobility limitations. PTA assist with the implementation of the plan of care o Multiple myeloma - occurs mostly in older adults and involves plasma cells that replace bone marrow and erode the bone. Also called plasma cell myeloma. Initial signs may include frequent infections, followed by bone pain, which is not alleviated by rest. Treatment - chemotherapy, analgesic for bone pain, blood transfusions Role of PTA - assisting with regular weight bearing exercise, designed to improve bone strength. Walking and mild resistance training and low impact aerobics are indicated. Ch. 22 Endocrine System Key Terms & Common Diseases: Acromegaly: Hypersecretion of pituitary (if it begins AFTER puberty) Aldosterone: hormone that increases reabsorption of water and sodium and the release of potassium n the kidneys. Asphyxiation: Suffocation; the inability to breathe normally. Cretinism: severely sustained physical and mental growth due to untreated congenital hypothyroidism Diabetes Insipidus: condition of excessive thirst and secretion of large amount of severely diluted urine, most common caused by a deficiency of antidiuretic hormone. Diabetes Mellitus: Condition of abnormally high blood sugar, either due to inability of the body to produce enough insulin or because body cells do not respond to the insulin that is produced. Diabetic Ketosis: condition wherein, as a result of diabetes, the body has elevated levels of ketone bodies in the blood: these bodies are formed when glycogen sores in the liver depleted. Dwarfism: Abnormally short stature due to a variety of conditions, most commonly abnormally low amounts of human growth. Euphoria: profound sense of well being o Pituitary Gland- Dwarfism/ Hypopituitarism - abnormal decrease in pituitary activity, which leads to a deficiency or absence of some or all tropic hormones. A decrease in growth hormone leads to impaired growth of the entire body. Males show lowered testosterone levels, decreased libido, abnormal loss of facial hair and metabolic disorder. SHoer stature and proportional body size reduction. Mental retardation Treatment - hormone replacement therapy and monitoring hormones. Replacement of thyroid and adrenal hormones. Sex hormones may need to be administered. Role of PTA - address impairments for the musculoskeletal system. o Thyroid Gland – know supplements/medications for each subtype in treatment o Goiter - involves an enlarged thyroid gland caused by attempted production of T in adequate amounts. Causes of simple goiter include family history, eating large amounts of foods that inhibit production of thyroid hormone. More prevalent in females. Front of the neck appears to bulge with extreme cases causing pressure on trachea and can lead to dyspnea. Treatment - Administration of potassium iodide. If sx is due to iodine deficiency, the patient could increase iodized salt. o Hashimoto’s - also called chronic lymphocytic thyroiditis, occurs when antibodies destroy thyroid gland tissue. Chronic disease of the immune system that attacks the thyroid gland. Cause is unknown and is believed to have a genetic component. Primarily affects women between 45-65, it is the leading cause of non-simple goiter and hypothyroidism. Other symptoms include weakness, fatigue, forgetfulness, sensitivity to cold, mental apathy, unexplained weight gain, and constipation. Treatment - lifelong replacement of thyroid hormone is indicated and to prevent further growth. Role of PTA - achieve weight loss and improve overall fitness to help reduce total cholesterol and improve HDL cholesterol. o hyperthyroid (Graves’ Disease) – Exophthalmos, Thyroid storm defined as excessive secretion of T4. Also known as thyrotoxicosis. Graves disease as a condition of primary hyperthyroidism. Onset ages of 20-40 with women being 5 times more likely to develop the disease than men. Signs and Symptoms include increased metabolic changes resulting in tachycardia, hypertension, palpitation, nervousness, excitability, insomnia, weight loss even with excessive appetite, profuse perspiration, excessive thirst, nausea, vomiting, muscle weakness, tremor, hair loss. Advanced grave disease causes exophthalmos. If symptoms are exacerbated, thyroid store may occur which is life threatening. Treatment - reducing formation and secretion of thyroid hormone by administering propylthiouracil or methimazole. Tachycardia and hypertension are treated by beta blockers. If a patient does not respond to these treatments, radioactive therapy or surgery is recommended. Role of PTA - assist pt with moderate exercise. Too much exercise can increase undesired cardiovascular responses, monitor vital signs. Instruction for diaphragmatic breathing may be helpful if feeling anxious or insomnia. o Adrenal (Addison’s Disease and Cushing’s syndrome) - Cushing Syndrome - hypercortisolism. The pituitary form (Cushing's disease) results from excessive adrenocorticotropic hormone production by a tumor of the pituitary gland. The second form is the adrenal form (Cushing's syndrome) caused by a benign or malignant adrenal tumor. May be caused by pituitary gland or adrenal cortex tumor. It can also develop after prolonged doses of cortisone. Major manifestations are a rounded or moon shaped face and a buffalo hump on the upper back. Symptoms include fatigue, poor wound healing, rounded abdomen, very thin arms and legs, weakness, hypertension, stretch marks, and osteoporosis. Cortisol increased gastric acid secretion. Treatment - surgical removal of the pituitary or adrenal cortex tumor followed by lifetime hormone therapy. Medications include spironolactone, metyrapone mitotane, ketoconazole, and sometimes somatostatin analogs, dopamine agonists. Role of PTA- educate patients about exercises such as water aerobics, walking and cycling. Start mild and then increase intensity based on patients tolerance. Addison's disease - Primary adrenal hypofunction or insufficiency. Signs and symptoms include fatigue, weakness, anorexia, weight loss, and gastrointestinal complications. Conspicuous bronze discoloration of the skin may occur, especially in the creases of the hands, elbows, and knees. Primary hypofunction is associated with cardiovascular abnormalities such as irregular pulse and cardiac output. Causes anxiety, depression. Patients may not be able to retain salt. Becomes life threatening after dehydration, electrolyte imbalance and hyperkalemia. Treatment - glucocorticoid and mineralocorticoid drugs control of salt and potassium intake, and eating larger amounts of carbohydrates and proteins. Hormone replacement therapy must continue throughout life. Life threatening emergency called Addisonian crisis may occur due to decrease in adrenocortical hormone levels. Symptoms are increased heat and respiratory rate, nausea, headache, dehydration, and confusion. o Diabetes Insipidus – Antidiuretic hormone (ADH) - o Diabetes Mellitus – Type I & II - Chronic metabolic disorder characterized by hyperglycemia, in which results from lack or decrease of insulin, a lack of normal effects of insulin or both. Type 1 - absolute insufficiency, type 2 - insulin resistance with varying degrees of insulin secretory defects. Gestational diabetes: emerges during pregnancy. Type 1 primary children and young adults. Affected pts develop diabetic ketosis caused by lack of insulin. Appear thin. Type 2 occurs in obese adults after 40 but can develop in obese children and teenangers. Type 1 results from pancreas failing to produce insulin. Type 2 begins with insulin resistance, in which the body cells fail to respond to insulin normally. Diabetes causes polyuria, polydipsia, polyphagia, glycosuria hyperglycemia. Other signs and symptoms include headache, fatigue, weakness, and reduced energy levels. Type 1 - slower than usual breathing, and sweet, fruity odor of the breath,. Signs of insulin shock include sweating, lightheadedness, and trembling. Long term is MI, cva, blindness, kidney failure. Type 2 - controllable through diet, exercise, and oral medications. Gestational diabetes are same as type 2 Treatment - diet, medication, exercise. Monitor blood glucose levels. Treatment for type 1 includes exercise, and insulin therapy. Role of PTA - continuing education and importance of exercise. Help find patients with consistent aerobic exercise. o Diabetic ketosis - a condition wherein, as a result of diabetes, the body has elevated levels of ketone bodies in the blood; these bodies are formed when glycogen stores in the liver are depleted.