Chapter 11: Screening for Endocrine and Metabolic Disease

*Is it safe to administer a source of sugar to a lethargic or unconscious person with diabetes?*

*Yes.* If their glucose levels are high, you will not endanger them any further with a small amount of sugar, and you may help someone who is experiencing hypoglycemia associated with diabetes mellitus.

*List three of the most common symptoms of diabetes mellitus.* (hint: 3 P's)

- Polydipsia, - Polyuria, - Polyphagia

*What are the most common musculoskeletal symptoms associated with endocrine disorders?*

- Proximal muscle weakness - Myalgia - Carpal tunnel syndrome - Periarthritis - Adhesive capsulitis (frozen shoulder) (see Table 11-1)

*Which glycosylated hemoglobin (A1C) value is within the recommended range?* a. 6% b. 8% c. 10% d. 12%

A) 6% The American Diabetes Association recommends that people with diabetes maintain a level of 7% or below on the A1C; this reflects average blood-sugar levels over a period of 2 to 3 months.

*Clients with diabetes insipidus (DI) would most likely come to the therapist with which of the following clinical symptoms?* a. Severe dehydration, polydipsia b. Headache, confusion, lethargy c. Weight gain d. Decreased urine output

A) Severe dehydration, polydipsia good way to remember diabetes in*sip*idus : "sip" = they always want to sip water = polydipsia = excessive thirst

*Parathyroid hormone (PTH) secretion is particularly important in the metabolism of bone. The client with an oversecreting parathyroid gland would most likely have:* a. Increased blood pressure b. Pathologic fractures c. Decreased blood pressure d. Increased thirst and urination

B) Pathologic fractures

*A 38-year-old man comes to the clinic for low back pain. He has a new diagnosis of Graves' disease. When asked if there are any other symptoms of any kind, he replies "increased appetite and excessive sweating." When you perform a neurologic screening examination, what might be present that would be associated with the Graves' disease?* a. Hyporeflexia but no change in strength b. Hyporeflexia with decreased muscle strength c. Hyperreflexia with no change in strength d. Hyperreflexia with decreased muscle strength

D) Hyperreflexia with decreased muscle strength

*Signs and symptoms of Cushing's syndrome in an adult taking oral steroids may include:* a. Increased thirst, decreased urination, and decreased appetite b. Low white blood cell count and reduced platelet count c. High blood pressure, tachycardia, and palpitations d. Hypertension, slow wound healing, easy bruising

D) Hypertension, slow wound healing, easy bruising

*All of the following are common signs or symptoms of insulin resistance except:* a. Acanthosis nigricans b. Drowsiness after meals c. Fatigue d. Oliguria

D) Oliguria *oliguria* = production of abnormally small amounts of urine *acanthosis nigricans* = A skin condition characterized by dark, velvety patches in body folds and creases

*Clients who are taking corticosteroid medications should be monitored for the onset of Cushing's syndrome. You will need to monitor your client for which of the following problems?* a. Low blood pressure, hypoglycemia b. Decreased bone density, muscle wasting c. Slow wound healing d. b and c

D) b and c - Decreased bone density, muscle wasting & - Slow wound healing

*What are the mechanisms by which carpal tunnel syndrome occurs?*

Depends on the underlying disease process. For example, thickening of the transverse carpal ligament is associated with acromegaly and myxedema. Increased volume of the contents of the carpal tunnel occurs with pregnancy, neoplasm, gouty tophi deposits, and lipids in diabetes mellitus. Hormonal changes (e.g., menopause, pregnancy) can also result in carpal tunnel syndrome (CTS). See also liver-related causes in Chapter 9).

*What systemic conditions can cause carpal tunnel syndrome?*

Endocrine disorders, infectious diseases, collagen disorders, cancer, liver disease (see Table 11-2)

*Disorders of the endocrine glands can be caused by:* a. Dysfunction of the gland b. External stimulus c. Excess or insufficiency of hormonal secretions d. a and b e. b and c f. All the above

F) All the above

*What is the primary difference between the two hyperglycemic states: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)?*

The major differentiating factor between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) is the absence of ketosis in HHS. (see pg 408)