Patho II final
What is the most common cause of hyperthyroidism in the US?
Answer: Grave's disease
An 88-year-old woman with marked kyphosis and loss of height that had been gradually progressive over many years experiences the sudden onset of acute back pain following a sudden change in position. Radiographic examination demonstrates generalized osteopenia and a fracture of a lower thoracic vertebra. Which of the following is an association or characteristic of the patient's generalized bone disorder? (A) Increased serum calcium and phosphate levels (B) Postmenopausal state and estrogen deficiency (C) Physical inactivity (D) Hypothyroidism (E) Excessive calcium intake
(B) Postmenopausal state and estrogen deficiency
A 65-year-old man with a history of acromegaly complains of recurrent epigastric pain and dark-colored tarry stools. Laboratory studies reveal moderate hypercalcemia, hyperlipidemia, and elevated serum levels of PTH and gastrin. Serum glucose is within normal limits. Abdominal ultrasound shows a mass in the tail of the pancreas. Which of the following is the most likely diagnosis? (A) Glucagonoma (B) Insulinoma (C) Multiple endocrine neoplasia type 1 (D) Multiple endocrine neoplasia type 2 (E) Pancreatic carcinoid
(C) Multiple endocrine neoplasia type 1
Who/whom is mainly affected by type 2 DM?
• strong genetic component • occurs most commonly in adults; increases in prevalence with age • in Native American, Mexican American, and African American populations in the United States
A 25-year-old African American woman presents with a complaint of rapid weight loss despite a voracious appetite. Physical examination reveals tachycardia (pulse rate 110 bpm at rest), fine moist skin, symmetrically enlarged thyroid, mild bilateral quadriceps muscle weakness, and fine tremor. These findings strongly suggest:
Answer: Hyperthyroidism
A 47-year-old man presents complaining of nervousness, difficulty concentrating, restlessness, and insomnia. He has lost 25 pounds over the past 6 weeks and complains of heat intolerance.
Answer: Hyperthyroidism
What is the most common cause of primary hyperparathyroidism?
Answer: Parathyroid adenoma
A 45-year-old woman presents complaining of fatigue, 30 pounds of weight gain despite dieting, constipation, and menorrhagia. On physical examination, the thyroid is not palpable; the skin is cool, dry, and rough; the heart sounds are quiet; and the pulse rate is 50 bpm. The rectal and pelvic examinations show no abnormalities, and the stool is negative for occult blood. The clinical findings suggest .
Answer: hypothyroidism
Common cause of hypocalcemia in hypoparathyroidism.
• the amount of PTH released is inadequate • reduced PTH secretion
When does gestational diabetes occur?
• usually occurs in the second half of gestation
What can precipitate type 1 DM?
• viral infections, such as congenital exposure to rubella • coxsackievirus infections
Clinical features of adrenocortical insufficiency.
• weakness, lethargy, easy fatigability, anorexia (weight loss), nausea, joint pain, and abdominal pain. Hypoglycemia occurs occasionally. Hyperpigmentation. Hyperkalemia
A 34-year-old Caucasian female presents with truncal obesity, a rounded "moon face ", and a "buffalo hump". Serum analysis shows hyperglycemia. It is determined that a pituitary adenoma is the cause of these symptoms. Adrenal examination is expected to show? 1. Atrophy of the adrenal cortex 2. Diffuse hyperplasia of the adrenal cortex 3. Atrophy of the adrenal medulla 4. Adrenal adenoma 5. Atrophy of the adrenal gland
2. Diffuse hyperplasia of the adrenal cortex
Nurse Oliver should expect a client with hypothyroidism to report which health concerns ? A. Increased appetite and weight loss B. Puffiness of the face and hands C. Nervousness and tremors D. Thyroid gland swelling
B. Puffiness of the face and hands
A 22-year-old woman presents with an 8-month history of amenorrhea. The patient is also experiencing backaches, headaches, and acne. Physical examination reveals a female patient with a moon-shaped facies, multiple purple striate, and significant central obesity What is the most likely diagnosis? Answer Choices 1. Diabetes type II 2. Hypothyroidism 3. Cushing syndrome 4. Hyperthyroidism 5. Diabetes insipidus
3. Cushing syndrome
Which of the following strategies promotes improved carbohydrate metabolism and is recommended for all Type 2 diabetic patients? A. Low-carbohydrate, high protein diet B. Routine aerobic exercise C. Metformin (Glucophage) D. Acupuncture
B. Routine aerobic exercise
You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? A) Risk for injury related to weakness B) Ineffective breathing pattern related to muscle weakness C) Risk for loneliness related to disturbed body image D) Autonomic dysreflexia related to neurologic changes
A) Risk for injury related to weakness
Which of the following conditions may result in hypokalemia? Answers A. Adrenal adenoma B. Hypoparathyroidism C. Hyperthyroidism D. Adrenal insufficiency
A. Adrenal Adenoma
A patient is diagnosed with hyperparathyroidism. Which of the following signs and symptoms would you NOT find in this patient? Select all that apply: A. Calcium level 6 mg/dL B. Bone fracture C. Positive Trousseau's Sign D. Tingling and numbness of lips and fingers E. Calcium level of 15 mg/dL F. Phosphate level 1.2 G. Renal calculi
A. Calcium level 6 mg/dL C. Positive Trousseau's Sign D. Tingling and numbness of lips and fingers
The nurse correlates which clinical manifestation to the pathophysiology of hypothyroidism? A. Cold intolerance B. Weight loss C. Insomnia D. Diarrhea
A. Cold intolerance
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit? A. Complaints of extreme fatigue and hair loss. B. Exophthalmos and complaints of nervousness. C. Complaints of profuse sweating and flushed skin. D. Tetany and complaints of stiffness of the hands.
A. Complaints of extreme fatigue and hair loss.
Patients with primary adrenal insufficiency will have which of the following electrolyte abnormalities? A. Hyperkalemia B. Hypernatremia C. Hypercalcemia D. Hyperosmolality
A. Hyperkalemia
After a visit to the health care provider's office, a patient is diagnosed with general thyroid enlargement and elevate thyroid hormone level. Which condition do these findings indicate? A. Hyperthyroidism and goiter b. Hypothyroidism and goiter c. Nodules on the parathyroid gland d. Thyroid or parathyroid cancer
A. Hyperthyroidism and goiter
An adult presents with a three month history of progressive severe muscle cramps, extremity paresthesias and lethargy which began shortly after a thyroidectomy for a malignant thyroid lesion. Which of the following is the most likely diagnosis? A. Hypoparathyroidism B. Hypothyroidism C. Hyperparathyroidism D. Hyperthyroidism
A. Hypoparathyroidism
A 53 year-old female who is well known to the practice presents to the office complaining of increasing fatigue, constipation, and a weight gain of 10 lb (4.5 kg) over the past year. She also states others have noticed a recent hoarseness to her voice, and she is bothered by "charley horses" in her legs that wake her up at night. Her past medical history is unremarkable except for a history of hyperthyroidism treated by radioactive iodine 5 years ago. She is currently taking no medications and has no known drug allergies. Which of the following is the most likely cause of the patient's symptoms? A. Hypothyroidism B. Hypoparathyroidism C. Vocal cord paralysis D. Radiation thyroiditis Explanations
A. Hypothyroidism
Which of the following are common findings for DM type 2? A. Insulin resistance, obesity, strong genetic (familiar) component B. Immunological, idiopathic C. Insulin dependent D. Diabetic ketoacidosis
A. Insulin resistance, obesity, strong genetic (familiar) component
A 61-year-old female is found to have a serum calcium level of 11.6 mg/dL (N 8.6-10.2) on routine laboratory screening. To confirm the hypercalcemia you order an ionized calcium level, which is 1.49 mmol/L (N 1.14-1.32). Additional testing reveals an intact parathyroid hormone level of 126 pg/mL (N 15-75) and a urine calcium excretion of 386 mg/24 hr (N 100-300). Which one of the following is the most likely cause of the patient's hypercalcemia? ( check one) A. Primary hyperparathyroidism B. Malignancy C. Familial hypocalciuric hypercalcemia D. Hypoparathyroidism E. Hyperthyroidism
A. Primary Hyperparathyroidism
Which of the following are characteristics of Cushing's syndrome? A. central obesity, glucose intolerance, and easy bruising B. attacks of severe headaches, hypertension, and glucosuria C. hyperpigmentation, hypoglycemia, and orthostasis D. tetany, hypocalcemia, and cataracts
A. central obesity, glucose intolerance, and easy bruising
What can stimulate the overproduction of thyroid hormone in Grave's disease ?
ANTIBODIES/ TSH receptor auto-antibody TSH-R [stim] Ab stimulates the thyroid follicular cells to produce excessive amounts of T 4 and T 3
Primary adrenocortical insufficiency is also known as what?
Addisons disease
Patient with loss of blood, low blood pressure and kidneys release renin which triggers production of angiotensin I. What hormone is released to correct situation?
Aldosterone
A 32 year-old male presents with a one-month history of weakness, anorexia, and weight loss. On physical examination, he is hypotensive and his skin has diffuse hyperpigmentation. Plasma cortisol levels drawn at 8 am are low. Which of the following is the most likely diagnosis? A. Pituitary insufficiency B. Addison disease C. Cushing syndrome D. Primary aldosteronism
B. Addison Disease
Mineralocorticoids play a critical role in fluid and electrolyte balance in the body. A normal response to aldosterone is to increase acid secretion in the kidney. The hyperaldosteronism that occurs with some adrenal tumors has interesting and profound effects on acid-base balance as a result of increased renal H+ secretion. Which of the following would be the most likely result of hyperaldosteronism? A. Excretion of excess bicarbonate B. Generation of metabolic alkalosis C. Hyperkalemia caused by renal K+ resorption D. Increased H+ resorption by renal tubular cells E. Movement of K+ out of cells in exchange for H+
B. Generation of metabolic alkalosis
A 59-year-old male reports nausea, vomiting, and progressive fatigue for the past few months. At his last visit, 6 months ago, his blood pressure was poorly controlled and hydrochlorothiazide was added to his β-blocker therapy. At this visit he appears moderately dehydrated on examination. Laboratory testing reveals a serum calcium level of 12.5 mg/dL (N 8.0-10.0), a BUN level of 36 mg/dL (N 6-20), and a creatinine level of 2.2 mg/dL (N 0.6-1.1). A CBC, albumin level, and electrolyte levels are normal. His intact parathyroid hormone level is reported a few days later, and is 60 pg/mL (N 10- 65). What is the most likely cause of his hypercalcemia? (check one) A. Renal failure B. Hyperparathyroidism C. Milk alkali syndrome D. Sarcoidosis
B. Hyperparathyroidism
Which of the following laboratory values would be noted in a patient with hypothyroidism? A. Increased TSH, increased free T4 B. Increased TSH, decreased free T4 C. Decreased TSH, increased free T4 D. Decreased TSH, decreased free T4
B. Increased TSH, decreased free T4
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations? A) Neurologic irritability B) Declining urine output C) Lethargy and weakness D) Hyperactive bowel sounds
C) lethargy and weakness
A 30 year-old female presents with amenorrhea, proximal muscle weakness, weight gain, and increased emotional lability. Her physical examination consists of central obesity, full face, and protuberant abdomen with thin extremities. Her blood pressure is 150/96 mmHg. Which of the following is the most likely diagnosis? A. Addison disease B. Hypothyroidism C. Cushing syndrome D. Pituitary insufficiency
C. Cushing syndrome
Which of the following laboratory values would be noted in a patient with primary hyperthyroidism? A. Increased TSH, increased free T4 B. Increased TSH, decreased free T4 C. Decreased TSH, increased free T4 D. Decreased TSH, decreased free T4
C. Decreased TSH, increased free T4
Chronic excess thyroid hormone replacement over a number of years in postmenopausal women can lead to: (check one) A. Diffuse nontoxic goiter B. Osteoarthritis C. Osteoporosis D. Hyperparathyroidism
C. Osteoporosis
72 year-old female is being evaluated for recurrent kidney stones. Physical examination reveals no abnormal findings. Laboratory findings show elevated calcium and decreased phosphate levels. Which of the following is the most likely diagnosis? A. pheochromocytoma B. adrenal insufficiency C. hyperparathyroidism D. vitamin D deficiency
C. hyperparathyroidism
Person with abdominal obesity, proximal muscle weakness, rounding of face/supra-clavicular and temporal filling has what condition?
Cushing Syndrome
When glucocorticoid excess is due to pituitary dependent conditions, it's called?
Cushing's disorder
Elevated plasma calcitonin is seen with a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma
D. Anaplastic thyroid carcinoma
In what organs are tumors characteristically found in individuals with MEN type 1? A. Adrenal, thyroid, and parathyroid B. Kidneys, adrenal, and liver C. Liver, pancreas, and small intestines D. Parathyroid, pineal, and pancreas E. Pituitary, parathyroid, and pancreas
E. Pituitary, parathyroid, and pancreas
Primary hyperparathyroidism is often associated with: A. development of renal calculi. B. bone pain. C. constipation. D. fatigue. E. all of the above.
E. all of the above.
Most common causes of Cushing syndrome
Excess secretion of ACTH from anterior pituitary gland
What can result due to an excessive mineralocorticoid secretion?
Excessive mineralocorticoid secretion in hyperaldosteronism leads to Na + retention, usually without edema, and K + depletion, resulting in hypertension, muscle weakness, polyuria, hypokalemia, metabolic alkalosis, and sometimes hypocalcemia and tetany. Makes you retain SODIUM, but inversely makes you lose POTASSIUM.
Most common cause of goiter. ____ deficiency remains the most common cause of goiter worldwide
Iodine deficiency
What occurs due to Grave's disease?
Most commonly, thyroid hormone overproduction is due to Grave's disease
What is the most common cause of hyperthyroidism? A. Radiation to thyroid b. Graves' disease c. Thyroid cancer d. Thyroiditis
b. Graves' disease
The most common cause of goiter in developing nations is a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter
a. Iodine deficiency
Which statements about hyperthyroidism are accurate? (SATA) a. It is most commonly caused by Graves' disease b. It can be caused by overuse of thyroid replacement medication c. It occurs more often in med between the ages of 20-40 d. Weight gain is a common manifestation e. Serum T3 and T4 results will be elevated
a. It is most commonly caused by Graves' disease b. It can be caused by overuse of thyroid replacement medication e. Serum T3 and T4 results will be elevated
A client is diagnosed with hypothyroidism. The nurse performs an assessment on the client, expecting to note which findings? Select all that apply. a. weight loss b. bradycardia c. hypotension d. dry, scaly skin e. Heat tolerance f. Decreased body temperature
b. bradycardia c. hypotension d. dry, scaly skin f. Decreased body temperature
Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.
b. monitoring blood glucose levels. e. protecting patient from exposure to infection.
A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a. "The cause of Graves' disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."
c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones."
A patient is admitted to the hospital with thyrotoxicosis (hyperthyroidism). On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Elevated temperature and signs of heart failure d. Lethargy progressing suddenly to impairment of consciousness
c. Elevated temperature and signs of heart failure
An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: a. Thyroid storm. b. Cretinism. c. Myxedema coma. d. Hashimoto's thyroiditis.
c. Myxedema coma.
You are performing an ultrasound exam on a patient with parathyroid hyperplasia. How many glands are usually involved in this condition? a. 1 b. 2 c. 3 d. 4 e. 5
d. 4
The DRI Committee recommends ________ of calcium daily for women older than 50 years and men older than 70 years. a. 1000 milligrams b. 800 milligrams c. 600 milligrams d. 400 milligrams e. 1200 milligrams
e. 1200 milligrams
Cushing syndrome is also known as what?
hypercorticolism
Estimated calcium requirement for people over age of 65.
• 1200 milligrams
Common causes of hypoparathyroidism.
• Accidental removal, trauma, or devascularization of the parathyroid glands during thyroid or parathyroid surgery • Thyroid surgery( thyroidectomy)
What can cause adrenal failure by total or near-total destruction of both adrenal glands?
• Adrenal Tuberculosis— Tuberculosis causes adrenal failure by total or near- total destruction of both glands • Addison's disease
What are clinical findings/associations due to deficiency in mineralocorticoid secretion?
• Associated mineralocorticoid deficiency leads to renal Na + wasting and K + retention and can produce manifestations of severe dehydration, hypotension , decreased cardiac size, hyponatremia, hyperkalemia, and metabolic acidosis. Makes you retain POTASIUM, but inversely makes you lose SODIUM.
Common features found in MEN-1 syndromes.
• Benign parathyroid • Parathyroid hyperplasia • Recurrent hyperparathyroidism, even after initially successful surgery, is common in these patients
Test to determine presence and extent of medullary carcinoma.
• Calcitonin level • The most important laboratory test in determining the presence and extent of medullary carcinoma is the calcitonin level.
Most common cause of primary hyperparathyroidism.
• Chief cell adenomas = Parathyroid adenoma
Clinical findings in adult hypothyroidism (mxdema).
• Cold intolerance/ Hypothermia • Diminished food intake; weight gain • Lethargy, decreased vigor • Hoarsenes • Puffiness of the face and hands • Dry skin
Postmenopausal women are more prone to suffer from osteoporosis due to?
• Decreased estrogen level
Most common disease of endocrine pancreas.
• Diabetes mellitus
What condition is managed by the replacement of water/electrolytes and administration of insulin?
• Diabetic ketoacidosis
Clinical findings in hyperthyroidism.
• Elevated T3 and T4 // Low TSH • Heat intolerance/ Increased temp • Voracious appetite, weight loss • Hyperkinesia, rapid speech • Moist skin • Poor concentration • Palpitations
Causes of development and acceleration of osteoporosis in post-menopausal women.
• Estrogen deficiency
In early stages of goiter, what causes enlargement of gland accompanied by hyperplasia?
• Excessive TSH release and stimulation In the early stages of goiter, there is diffuse enlargement of the gland, with cellular hyperplasia caused by the TSH stimulation
Most common causes of hyperthyroidism along with enlargement of gland and increase in thyroid hormone.
• Graves disease. Goiter with hyperthyroidism is usually due to Graves' disease.
Hyperglycemia is due to what?
• Hyperglycemia in all cases is due to a functional deficiency of insulin action
Condition where an excessive secretion of PTH is seen compared to the level of serum calcium.
• Hyperparathyroidism
What can result due to increase in VLDL production and decrease in VLDL clearance in type's 1 & 2 diabetics?
• Hypertriglyceridemia (increase levels of triglycerides)
What links obesity to type 2 DM?
• Insulin Resistance
True hallmark of type 2 DM.
• Insulin resistance
Hormone levels in hypothyroidism
• Low T3 and T4/ High TSH
Type 2 DM is usually associated with what?
• Obesity (is associated with increased resistance to the effects of insulin at its sites of action as well as a decrease in insulin secretion by the pancreas)
Condition that result due to deficiency of vitamin D, deficiency of phosphate, deficiency in alkaline phosphatase, or agents that have adverse effects on bone.
• Osteomalacia
Common findings in hyperparathyroidism.
• PTH elevated/ Serum Calcium levels elevated (Hypercalcemia) / Phosphate levels decreased o Signs of hypercalcemia include polyuria, constipation, nausea and vomiting, lethargy, and muscle weakness. • Bone pain, bone demineralization/loss, pathologic fractures, and muscle weakness • Kidney stones Answer: Increased serum calcium levels (hypercalcemia) and hypophosphatemia Or Answer: Causes body to put more calcium into the blood (hypercalcemia)
Reference to enlargement or abnormality of all four parathyroid glands.
• Parathyroid hyperplasia refers to an enlargement or abnormality of all four glands
Causes of excessive secretion of ACTH resulting in Cushing syndrome. • Pituitary adenoma • 95% of the cases are ACTH-dependent: abnormal secretion of ACTH from the pituitary or a tumor outside the pituitary gland/adrenal gland releases ACTH (ectopic) • %5 of the cases are ACTH non-dependent: autonomous adrenocortical hyperplasia or a cortisol secreting tumor (adrenal tumors)
• Pituitary adenoma • 95% of the cases are ACTH-dependent: abnormal secretion of ACTH from the pituitary or a tumor outside the pituitary gland/adrenal gland releases ACTH (ectopic) • %5 of the cases are ACTH non-dependent: autonomous adrenocortical hyperplasia or a cortisol secreting tumor (adrenal tumors)
Condition characterized by autoimmune destruction of pancreatic beta cells with insulin deficiency.
• Type 1 diabetes
What confirms hypercortisolism?
• a 24-hour urine free cortisol measurement confirms hypercortisolism
What are clinical findings/associations with excessive glucocorticoid secretion?
• a moon-faced, plethoric appearance, with truncal obesity, purple abdominal striae, hypertension, osteoporosis, mental aberrations, protein depletion, and glucose intolerance
Lifestyle modification in management of type 2 DM.
• diet, exercise, weight management
Causes of primary adrenocortical insufficiency.
• due to autoimmune destruction of the adrenal cortex • tuberculosis • Other less common causes include histoplasmosis, adrenal hemorrhage or infarction, genetic diseases, metastatic carcinoma, and AIDS-related (cytomegalovirus) adrenalitis.
What can cause chloride-resistant alkalosis?
• increased aldosterone effect • mineralocorticoid excess