NPs N6830 Rosh 7 Endo

Crohn disease

- Genetic marker: NOD2

Type 1 diabetes mellitus

- Genetic markers: HLA-DQA and HLA-DQB - S/S: polydipsia, polyphagia, polyuria, weight loss, DKA - Dx test: fasting BG ≥ 126 twice, random BG ≥ 200 with hyperglycemia symptoms, or an A1C ≥ 6.5% - Tx: basal insulin, routine BG monitoring, edu - exercise, nutrition, insulin pumps - Tx goal: A1C <7.5% or less if hypoglycemia can be avoided

Graves disease

- S/S: Pretibial myxedema

Vitamin D deficiency

- S/S: often asymptomatic in children, skeletal changes in children, - Complications: Rickets, hypocalcemia, osteomalacia - Dx test: 25-hydroxyvitamin D (25OHD) [less than 12 ng/mL (less than 30 nmol/L)] - Tx: vitamin D supplements, frequently monitored - Prevention: supplement vit D in breastfed infants & breastfeeding moms, exposure to sunlight

A 32-year-old man presents to the clinic for weight management. Considering his elevated BMI, elevated blood pressure, increased waist circumference, and elevated fasting blood glucose, the clinician diagnoses him with metabolic syndrome. In addition to blood pressure control, the clinician recommends a low-calorie diet of 1,500 kcal/day and an exercise regimen. What is the recommended weight reduction for this patient?

10% decrease in body weight within 6 months

A 50-year-old woman with a history of type 2 diabetes mellitus is taking metformin. Her HbA1C today is 8.5%. She started on glipizide today. Which of the following is the most appropriate time frame to retest her HbA1C?

3 months

Which of the following patients is at greatest risk for renal artery stenosis?

A 68-year-old smoker

A 37-year-old woman presents to the clinic to establish care. She has no current concerns and no significant medical history. She is unemployed, drinks alcohol socially, eats a high-carbohydrate diet, and is physically inactive. On exam, you note obesity, a high level of abdominal fat distribution, and acanthosis nigricans. Which of the following is most likely to confirm the diagnosis of the suspected condition?

A1C level of 7.5%

Dyslipidemia

Abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels - Complication: ASCVD (atherosclerotic cardiovascular disease)

A 10-year-old boy presents to the clinic for a new consult. There is no remarkable history in his previous records. His vital signs today are within normal limits, but his body mass index is at the 95th percentile. What common dermatologic finding is associated with a common complication related to this disease process?

Acanthosis nigricans

Subacute thyroiditis

Acute, painful, glandular enlargement with dysphagia. Gland is woody, hard, tender - S/S: dyspnea, tenderness - Tx: ASA and NSAIDs, beta blockers

Primary hyperaldosteronism

Adrenal hyperplasia or adenoma, hypersecrete aldosterone (mineralocorticoid from zona glomerulosa on outer adrenal cortex), usually unilateral Job of aldosterone is sodium reabsorption - S/S: asymptomatic, difficult-to-manage hypertension (dizziness, headache, chest pain, dyspnea) - Complications: secondary hypertension, unprovoked hypokalemia - Dx test: low plasma renin activity (PRA) or plasma renin concentration (PRC) [draw first thing in the morning] (PAC/PRA ratio is > 20 ng/dL) - Tx: adrenalectomy, depends on etiology Bilateral hyperplasia may be managed with a mineralocorticoid receptor antagonist, such as spironolactone

A 65-year-old man presents to the clinic for a follow-up after initiating multiple hypertriglyceridemia therapies. His triglycerides continue to be significantly elevated. What element could be contributing to persistently elevated triglycerides?

Alcohol use disorder

A 40-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the clinic for a routine follow-up. His recent basic metabolic panel and urinalysis show no abnormalities. He is taking metformin, empagliflozin, amlodipine, chlorthalidone, and lisinopril. Which of the following best describes the first-line medications for hypertension that this patient is on?

All of his blood pressure medications are considered first-line therapy

In adolescent girls, menarche begins when which of the following occurs?

Areola and papilla form a mound projecting from the breast contour

Which of the following is the most common cause of acquired hypothyroidism in children in the United States?

Autoimmune thyroiditis

A 7-year-old boy who is otherwise healthy presents to the clinic and is accompanied by his concerned caregiver who reports that the child seems to have begun pubertal development. On the physical assessment, there is symmetrical testicular growth and sparse hair growth at the base of the penis. The clinician will formulate a plan of care based on which of the following most probable causes for the suspected condition?

Central nervous system lesion

An otherwise healthy 36-year-old man reports 6 months of decreased libido and inability to maintain erections. He still experiences spontaneous nighttime erections. Vital signs include BP 130/84 mm Hg, HR 65 bpm, RR 15/min, and T 98.6° F. His physical exam is normal, and laboratory testing reveals a low total testosterone level on two separate mornings. Which of the following is the most appropriate next step?

Checking luteinizing hormone and follicle-stimulating hormone

A 60-year-old man with a new diagnosis of hyperlipidemia presents to the clinic for follow-up. The clinician reviews the patient's food diary and makes some dietary suggestions to reduce the patient's low-density lipoprotein consumption. Which of the following should the patient try to eliminate from his diet?

Chicken with skin

A new thyroid nodule is found in an 82-year-old man. He questions the risk of this nodule being malignant. You perform a detailed history and discover that his maternal uncle worked as a nuclear energy technologist and had "some kind" of head and neck cancer. As a child, the patient received radiation treatments for severe acne. He has had 6 CT scans throughout his life. He is retired, but worked as a plumber in a hydroelectric plant for 35 years. Which of the following risk factors places him at highest risk for a malignant thyroid nodule?

Childhood acne treatment

A 68-year-old man presents to the primary care clinic for a blood pressure follow-up. His at-home blood pressure readings for the past 2 weeks show an average of 160/90 mm Hg. His current blood pressure is 164/88 mm Hg. His recent laboratory tests, including a complete metabolic panel and complete blood count, are within normal limits. Which of the following is the most appropriate initial pharmacologic therapy to manage this patient's hypertension?

Chlorthalidone

What is the most common cause of adrenal insufficiency, regardless of type?

Chronic corticosteroid therapy

A 61-year-old woman presents to the clinic for a reevaluation after 6 months of diet and lifestyle interventions for dyslipidemia. She is not diabetic, has no family history of premature atherosclerotic cardiovascular disease, and medications include omeprazole and levothyroxine. At her initial exam 6 months ago, findings included total cholesterol 276 mg/dL, HDL 64 mg/dL, LDL-C 176 mg/dL, triglycerides 117 mg/dL, and BP 134/82 mm Hg. Her 10-year risk of heart disease, using the atherosclerotic cardiovascular disease (ASCVD) Risk Estimator Plus, scored at 7.8%. Today, she reports she is following a heart-healthy diet and has been walking three times per week for 40 minutes. Her exam findings now include total cholesterol 240 mg/dL, HDL 78 mg/dL, LDL-C 162 mg/dL, triglycerides 51 mg/dL, BP 138/78 mm Hg, and a 10-year risk of heart disease 6.8%. After a discussion about risk, the patient is unsure about starting a medication. What is the best next step for this patient?

Consider a coronary artery calcium

A 36-year-old woman has required multiple courses of oral steroids over the last six months for management of her asthma. She now reports a 20-pound weight gain, hair growth on her face, easy bruising, striae, and increased roundness of the face. What is the most likely diagnosis?

Cushing's syndrome

A 45-year-old woman with a history of Hashimoto thyroiditis, obesity, and dyslipidemia presents to the community clinic for a routine physical examination. She takes levothyroxine 150 mcg daily and atorvastatin 40 mg daily. She reports that she has been eating healthier foods, exercising more regularly, and has lost 20 lbs in the past year. Her previsit laboratory tests show a TSH of 0.3 mU/L, FT4 of 2.6 ng/dL, total cholesterol of 165 mg/dL, LDL of 100 mg/dL, and HDL of 45 mg/dL. What is the best next step in managing this patient's condition?q

Decrease dose of levothyroxine by 12 mcg daily

A 78-year-old woman complains of a progressive burning sensation in both feet. She has a history of hypertension, type 2 diabetes, and severe COPD. Her examination is significant for ankle weakness, diminished ankle reflexes, and intrinsic foot muscle atrophy. Which of the following is the most likely diagnosis?

Diabetic polyneuropathy

Follicular carcinoma

Differentiated from other types by its rapid uptake of iodine (12% of thyroid maligancies) - S/S: hoarseness, well differentiated - Dx test: FNA & CNB - Tx: Sx, radioablasion, TSH suppression - Prognosis: Very good

Heart failure (HF)

Disorder that occurs when the heart is unable to effectively pump the quantity of blood required by the body - S/S: Edema, dyspnea, - Tx: Furosemide, metoprolol succinate,

A 56-year-old woman with a 10-year history of type 2 diabetes mellitus presents to the primary care clinic complaining of intermittent burning and tingling in her feet that started 1 year ago. She takes metformin 1,000 mg twice per day and glyburide 5 mg daily. She has a hemoglobin A1C of 8.2%. On examination, she has absent ankle reflexes bilaterally, reduced vibration sense on the dorsum of her great toes, and a score of 6 out of 10 bilaterally on the monofilament test. Which of the following is the most likely diagnosis?

Distal symmetric polyneuropathy

Primary hypogonadism (testosterone deficiency)

Dysfunction of the testes

Subacute thyroiditis is an inflammatory process of the thyroid gland. Which of the following is a symptom of this condition?

Dyspnea

A 25-year-old woman presents to the clinic for evaluation of fatigue, headaches, cold intolerance, and weight gain. She also reports some "brain fog" and trouble concentrating. Her symptoms have been ongoing for approximately 1 month. Which of the following is most likely to confirm the diagnosis of primary hypothyroidism?

Elevated TSH and low free thyroxine (T4)

Hypercholesterolemia / hyperlipidemia

Elevation of total serum cholesterol > 240 mg/dL - Genetic markers: APOB & PCSK9 - Complications: CAD

A 6-year-old girl presents to the clinic with her mother for frequent urination. The mother states the patient just recovered from influenza and seems to need to urinate more frequently than normal. She states that the child has even been wetting the bed at night even though she has been potty trained since she was 3 years old. During the exam, the child vomits in the trash can. Her urinalysis is negative for infection. Which of the following laboratory findings would confirm the suspected diagnosis?

Fasting plasma glucose 136 mg/dL

A 10-year-old boy presents to the primary care clinic with complaints of blurry vision. He is also found to have recent weight loss of 5 lbs and his parent reports increased thirst and frequent urination. He is found to have an HgA1C of 7.0% and is diagnosed with type 1 diabetes mellitus. Which of the following genetic markers would be helpful in assessing the risk of type 1 diabetes mellitus for this patient's sister?

HLA-DQA and HLA-DQB

Which of the following risk factors is associated with childhood obesity?

Having a television in the bedroom

A 28-year-old woman presents for a routine physical and tells the nurse practitioner (NP) that she is planning to become pregnant within the next year. She has type 2 diabetes mellitus and hypercholesterolemia. Her current medications are metformin 500 mg twice daily and atorvastatin 20 mg daily. Physical exam reveals BP 130/84 mm Hg, BMI 29 kg/m2, HgA1C 8.8%, and TSH 4.7 mU/L. Which of the following patient findings puts her at most risk for adverse maternal and fetal outcomes?

HgA1C 8.8%

Primary hypertension (essential)

High blood pressure, the cause of which is unknown - Risks: advanced age, FH, sedentary lifestyle, obesity, high-sodium diet, and excessive alcohol intake - Complications: CVD morbidity & mortality - Tx: - Tx goals: <150/90 if >60yo without CKD or DM <140/90 if <60 with CKD or DM - Geriatric considerations: Start with Thiazide diuretics d/t efficacy in elderly, initiated at low doses and titrated slowly to minimize the risk of SE (orthostatic hypotension, falls)

A 30-year-old woman with no significant history and a normal body mass index presents to the clinic for her yearly wellness visit. The patient explains that she has been laid off from work for the past 6 months. During this time, she has been relying on eating foods that are inexpensive and high in saturated fats. She states that she has not been exercising since she had to cancel her gym membership because she could no longer afford it. Which of the following diagnoses is she most likely at risk for?

Hyperlipidemia

Which of the following laboratory findings would you expect to find in primary hyperaldosteronism?

Hypokalemia

A 47-year-old woman presents to your office for follow up on her newly diagnosed hypothyroidism. Six weeks ago you prescribed levothyroxine after her thyroid-stimulating hormone was found to be elevated. She has been taking her medication as instructed and her symptoms improved, but retesting of her thyroid-stimulating hormone shows that it is still elevated. Which of the following is the next best step in management?

Increase dose of levothyroxine and repeat TSH testing in 6 weeks

Which of the following laboratory results is consistent with Addison disease?

Increased ACTH level and decreased cortisol level

A 52-year-old woman presents to the clinic for follow-up on her hyperlipidemia. Which of the following dietary modifications made by the patient will most likely decrease her LDL-C?

Increasing fiber intake

A 47-year-old woman presents to the clinic to discuss management of type 2 diabetes. The diagnosis was made six months ago. At diagnosis, her glycosylated hemoglobin was 8.2%. She has been treated with metformin 1000 mg twice per day for six months. Her glycosylated hemoglobin is now 7.1%. She currently smokes eight cigarettes per day. Her BMI is 36. Which of the following is an appropriate recommendation for this patient?

Individualized medical nutrition therapy

Type 2 diabetes mellitus

Insufficient insulin production or insulin resistance - S/S: signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, and polycystic ovary syndrome)

Type 1 diabetes is an absolute deficiency of insulin caused by failure of the beta cells of the pancreas. Treatment is the replacement of insulin. What is the best example of long-acting basal insulin?

Insulin glargine

Which of the following levels would indicate vitamin D deficiency in a 4-year-old patient?

Less than 12 ng/mL (less than 30 nmol/L)

A 59-year-old man presents with fatigue. He reports the symptoms have been ongoing for the past year and appear to be getting worse. He reports no chest pain, shortness of breath, or exercise intolerance. He has a 10-year history of hyperlipidemia, hypertension, and coronary artery disease. He takes a daily aspirin, lisinopril, amlodipine, and atorvastatin. On physical examination, his vital signs and examination are normal. Lab work reveals a normal complete blood count and chemistry panel. His thyroid-stimulating hormone is 25.0 µU/mL (25.0 mU/L) and free thyroxine (T4) is 0.4 ng/dL (5.1 pmol/L). He weighs 175 pounds. Which of the following is the best next step in the management of this patient's condition?

Levothyroxine 50 mcg daily

When suspecting adrenal insufficiency in a pediatric patient, which of the following test results would indicate central rather than primary adrenal insufficiency?

Low adrenocorticotropic hormone levels

Anaplastic carcinoma

Most aggressive thyroid cancer and usually presents in an older patient with a rapidly enlarging mass (1% of thyroid malignancies) - S/S: SOB, hoarseness, lymphadenopathy, poorly differentiated - Dx test: CNB, surgical biopsy - Tx: Sx, chemo, radiation - Prognosis: Poor

Distal symmetric polyneuropathy

Most common form of neuropathy (30% of diabetics), affects hands and/or feet bilaterally - S/S: Loss of sensation, abnormal sensations, pain, paresthesias, weakness bilaterally, electric shock sensation that is worse at night - Complications: Stocking-glove pattern = ascends from the feet up to the mid-calf, then in the hands, decreased or absent ankle or patellar reflexes - Causes: inflammation, oxidative stress, and mitochondrial dysfunction - Dx test: monofilament = loss of vibratory sensation - Tx: duloxetine, venlafaxine, amitriptyline, pregabalin, or gabapentin

Papillary carcinoma

Most common form of thyroid cancer (85% of thyroid malignancies) Slow-growing, remaining confined for years, normal thyroid tests - S/S: single non-tender, firm nodule (only 5% of palpable nodules of the thyroid are carcinomas), hoarseness, lymphadenopathy, well differentiated - Risks: genetic mutations, childhood exposure to head or neck radiation - Dx test: Fine needle aspiration***, US followed by MRI or PET to check for mets - Tx: surgical resection or thyroidectomy, followed by radioactive iodine ablation and levothyroxine - Prognosis: Excellent (98% in 10 years)

A 52-year-old man presents to the clinic for a follow-up on his hyperlipidemia. He was prescribed simvastatin 1 month ago. Which of the following would require immediate discontinuation of the medication?

New muscle pain

A 45-year-old woman presents to clinic to discuss her recent diagnoses of diabetes mellitus and hypertriglyceridemia. Which of the following is true regarding her glucose and triglyceride control?

Optimizing glycemic control may improve hypertriglyceridemia

A 64-year-old woman had routine lab testing before her yearly complete physical exam. The results demonstrate an elevated calcium level. Which of the following is the next best step in managing this patient?

Order a serum parathyroid hormone level

A 50-year-old man with a history of stroke and memory impairment who was diagnosed with hypothyroidism 3 months ago presents to the clinic for a follow-up post-levothyroxine initiation. A thyroid-stimulating hormone test is done before the visit and is 0.1 µU/mL (normal 0.5-5.0 µU/mL). Which of the following symptoms might you expect the patient to experience during this visit?

Palpitations

A 43-year-old woman is diagnosed with thyroid cancer. The oncologist tells the patient that she has the most common form of thyroid cancer and also the least aggressive form, quoting a 10-year survival rate of 97%. What type of thyroid cancer does the patient have?

Papillary carcinoma

A 25-year-old woman presents for a routine visit. During the physical exam, the provider notes a mobile, nontender 2 cm nodule on the left lobe of her thyroid. The patient reports no cough, hoarseness, or radiation exposure and has no family history of thyroid cancer. Laboratory results show TSH 5.4 mU/L, and an ultrasound reveals a 1.7 cm partially cystic nodule with eccentric solid areas, without microcalcifications. What is the best next step of management for this patient?

Perform fine-needle aspiration

You are chart auditing the records of a 70-year-old woman with an unknown medical history. During her previous visit, she was prescribed rosuvastatin 20 mg daily. Which of the diagnoses and corresponding low-density lipoprotein values would be most appropriate to warrant this medication during the previous visit?

Peripheral artery disease with low-density lipoprotein 90 mg/dL

A 40-year-old man with a history of hypertension presents to the clinic for follow-up. The history and physical exam reveal the patient has been experiencing intermittent headaches, drenching diaphoresis, flushing, chest palpitations, abdominal pain, nausea, and elevated blood pressures. Which of the following is the most likely diagnosis?

Pheochromocytoma

A 45-year-old woman with diabetes type 2, hypertension, coronary artery disease, and obesity class 2 presents to the clinic for a follow-up on obesity. She has undergone comprehensive lifestyle interventions, which included dietary, exercise, and behavioral modifications, for the last 12 months. She lost 2% of her body weight with these interventions. Which of the following is the most appropriate next step in the management of her obesity?

Prescribe liraglutide

What would indicate a diagnosis of type 2 diabetes mellitus rather than type 1 diabetes mellitus to the pediatric clinician?

Presence of acanthosis nigricans or polycystic ovary syndrome

A 30-year-old woman presents to the clinic for a follow-up on her hypertension. Her blood pressure is 162/98 mm Hg, and she is taking lisinopril, hydrochlorothiazide, and metoprolol. Her laboratory studies reveal a potassium level of 3.0 mEq/L. She has no complaints and has no other significant past medical history. Which of the following is the most likely diagnosis?

Primary hyperaldosteronism

A 32-year-old woman with a history of Graves' disease presents to your office with a question about her medication. She just found out she is pregnant and wants to know if any changes need to be made to her treatment regimen during her pregnancy. Which of the following is the most appropriate therapy?

Propylthiouracil

A 14-year-old girl presents to the clinic for an annual checkup. The physical examination reveals no development of secondary sex characteristics, and the patient reports that she has not started her menstrual cycle. Which of the following is the most appropriate next step in this patient's plan of care?

Referral to endocrinology

Secondary hypogonadism (testosterone deficiency)

Result of disease of the hypothalamus or pituitary

A 46-year-old-man with a history of type 2 diabetes mellitus presents to your office to review his lab results. He does not have a known history of atherosclerotic cardiovascular disease. His lipid panel shows the following results: total cholesterol 203 mg/dL, HDL cholesterol 32 mg/dL, LDL cholesterol 151 mg/dL, and triglycerides 278 mg/dL. He is not currently taking any lipid-lowering medication therapy. Which of the following is the best option for lipid management for this patient?

Rosuvastatin 10 mg PO qd

A 13-year-old girl with a history of type 1 diabetes mellitus presents for her routine follow-up. The clinician has been working with her since she was 6 years old. She explains that she has joined her school's basketball team. The clinician wants to evaluate her knowledge on blood glucose management because this is the first time she is participating in vigorous exercise. Which of the following responses indicates she understands how to manage her blood glucose?

Routinely check blood glucose prior to, during, and after exercise

A 12-year-old girl presents to the clinic with her mother for a routine checkup. The clinician notes breast budding with slight areola enlargement and sparse growth of pubic hair over the labia. The mother asks if she is developing normally. How should the clinician respond?

She is developing normally

What is the best anticipatory guidance to give parents of a 4-year-old girl who was recently diagnosed with Graves disease?

The patient will require lifelong monitoring of thyroid function, even if remission is achieved

A 29-year-old G1 woman at 11 weeks gestation with a family history of hypothyroidism not currently on medication has baseline TSH levels 0.2 mU/L below the normal reference range. What is the best next step in management?

Therapy is not indicated

A 35-year-old woman presents to her primary care provider with a three-month history of insomnia, palpitations, and unintentional weight loss. A friend mentioned to her that her eyes seemed to be protruding from their sockets. Which of the following is the most appropriate diagnostic test?

Thyroid stimulating hormone (TSH) level

A 50-year-old woman presents to the primary care clinic for a routine physical examination with no concerns. On exam, she is noted to have a 3 cm left upper pole thyroid nodule. The nodule is mobile, soft, and nontender, and there is no cervical lymphadenopathy. In addition to laboratory studies, what is the most appropriate initial diagnostic tool for this patient?

Thyroid ultrasound

A 17-year-old girl who is sexually active presents to the clinic, accompanied by her parents, with complaints of hyperactivity, constantly feeling nervous, diaphoresis, increased appetite, muscle weakness, and proptosis. Which of the following tests should the clinician order?

Triiodothyronine and thyroxine

A 16-year-old boy presents to the clinic with increased thirst and increased urination for six months. He reports feeling thirsty once an hour and needing to use the bathroom once every two hours. He also reports frequent nocturia, and on one occasion he had an episode of enuresis after having an exhausting and stressful day. He notes that he has been more tired lately. He denies painful or burning urination, abdominal pain, headache, confusion, palpitations, blurred vision, recent weight changes, or feelings of depression. He has never had loss of consciousness or been hospitalized. His past medical history is significant for obesity, and his current body mass index is 28 kg/m2. He tries to exercise regularly and eat a healthy diet, and he takes no regular medications. His family history is significant for heart disease and stroke, but not for diabetes mellitus. Vital signs include BP 126/83 mm Hg, HR 79 bpm, and RR 15/minute. The physical examination, including fundoscopy, is normal. Laboratory tests are ordered, revealing a fasting plasma glucose of 131 mg/dL and hemoglobin A1C of 7.1%. Which of the following is this patient's most likely diagnosis?

Type 2 diabetes mellitus

Which of the following diagnostic tests should be ordered if you suspect suppurative thyroiditis in an adolescent patient?

Ultrasonography

A 65-year-old woman presents to the clinic for a well visit. She is not on hormone replacement and is a current smoker with a 40 pack-year history. She is 5'2" tall and weighs 115 pounds. The nurse practitioner recommends a bone densitometry measurement and assesses for risk factors related to bone loss. Which of the following is a clinical manifestation of age-related osteoporosis?

Vertebral fracture

Pituitary adenoma is a lesion of the pituitary gland that is often found incidentally. Which of the following is a common symptom of this condition and tends to correlate with tumor size?

Visual disturbances

A 50-year-old woman presents to the community clinic with diffuse bone pain, low back pain, and aching in her legs. These symptoms have progressively worsened over the past 6 months, and she reports no injury. She takes ibuprofen 400 mg daily with no relief. Her vital signs are within normal limits, and her physical examination reveals proximal muscle weakness and tenderness to palpation of the tibia. Which of the following is an important aspect of the history-taking for this patient?

Vitamin D intake and sun exposure

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine. Most often benign, some malignant. Most spontaneous, some familial. - S/S: Secondary hypertension, paroxysmal sympathetic discharge (drenching diaphoresis, bilateral headache, palpitations), hypermetabolic state, hyperhidrosis, hyperglycemia, abdominal pain, N/V/D, tremor, flushing - Complications: cardiomyopathy, myocarditis, pulmonary edema, - Dx tests: 24-hour urinary fractionated metanephrines and normetanephrines (labs to detect catecholamines in the blood and urine), and imaging studies to identify the tumor's location - Tx: *Refer to endocrinologist, adrenalectomy

Cushing's syndrome

a condition caused by prolonged exposure to high levels of cortisol - Tx: pituitary tumor resection

Peripheral mononeuropathy

asymmetric or unilateral neuropathy caused by damage to a single nerve or nerve group

Coarctation of the aorta

congenital cardiac condition characterized by a narrowing of the aorta - S/S: hypertension, presence of claudication, decreased blood pressure in the lower extremities, delayed femoral pulses, and notching of the ribs on a chest X-ray. - Complication: secondary hypertension

Chronic inflammatory demyelinating polyneuropathy

immune-mediated, symmetric neuropathy that presents with both proximal and distal muscle weakness

Lumbosacral polyradiculopathy

low back pain that radiates into the lower extremities in a dermatomal pattern

PCOS (polycystic ovarian syndrome)

multiple eggs develop, but none ovulate; amount of estrogen production not normal; related to weight gain and diabetes - S/S: unable to conceive, irregular periods, acanthosis nygrans, excess hair distribution

Medullary carcinoma

neoplastic growth, One third are sporadic, one third are familial and one third are associated with multiple endocrine neoplasia (MEN) type 2 or 3 (2% of thyroid malignancies)

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone - S/S: pigmented skin, unexplained weight loss - Dx tests: serum ACTH, serum electrolytes, TB skin test (r/o)

Claudication

pain in the legs or arms that occurs while walking or using the arms