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Clin Med II, Part 1
QUIZ 1: 3/30 Adrenal Dysfuntion, 3/30 thyroid disorders, 4/1 DM, 4/2 Nutritional Disorders, 4/6 Acute Abdomen
133
Medical
Graduate
03/30/2010

Additional Medical Flashcards

 


 

Cards

Term
Hormones secreted by adrenal gland
Definition

Cortex:

a) Mineralcorticoids (aldosterone)

b) glucocorticoids (cortisol)

c) androgens (DHEA)

 

Medulla:

a) catecholamines (epi, NE)

[image]

[image]

Term
What hormones regulate cortisol release?
Definition

CRH (hypothalamus) secreted with stress, fever, surgery, trauma, hypoglycemia, SNS -->

ACTH (ant pituitary) secreted in relation to circadian rhythm (highest levels just before waking) -->

cortisol (adrenal cortex)

[image]

Term
Catabolic effect on bone, muscle, adipose tissue.  Inhibits GH.  Insulin antagonist.  Increases vascular response to NE.  Influences behavior and mood.  Controls immune inflamm response and immune suppression.
Definition
Cortisol
Term

Aldosterone

1) secreted by

2) acts where? doing what?

3) impact of serum K

 

Definition

1) secreted by adrenal cortex (*doesn´t belong to hypoth/pituitary heirarchy)

 

2) acts on the renal tubule. Na+ reabsorbed (H2O follows, incr BP), K+ excreted.

 

3) hyperkalemia = aldosterone secretion.

hypokalemia suppresses ald secretion.

Term
Prolonged or excessive use of therapeutic glucocorticoids
Definition

Iatrogenic Cushing's (hypercortisolism):

MOST COMMON CAUSE OF CUSHING'S

Term
Pituitary adenoma secreting excess ACTH
Definition
cushing's DISEASE
Term
Ectopic causes of hypercortisolism
Definition
carcinoid tumors, lung CA (small cell) resulting in ectopic excess ACTH.
Term
Wt gain, impaired glucose tolerance, menstrual irregularities, HTN, bruising, and muscle weakness are signs/symptoms of...
Definition

Cushing's Syndrome

[image]

Term
You use a dexamathasone supression test to confirm this diagnosis
Definition
Cushing's Syndrome
Term
How do you confirm diagnosis of Cushing's disease?
Definition
MRI (or CT)
Term
What drug is used to lower serum cortisol concentration prior to transphenoidal surgery (cushings disease), tumor removal (ectopic ACTH), & adrenalectomy (adrenal adenoma)?
Definition
Ketoconazole
Term
What has a 100% cure rate for adrenal cushing's syndrome?
Definition
Adrenalectomy with lifelong HRT.  (get rid of the adrenal adenoma.
Term
Describe the cause of Cushings Disease and Cushings Syndrome (3 kinds of the syndrome)
Definition

Cushing’s Disease: pituitary adenomas

Cushing’s Syndrome:

-Iatrogenic cushing’s syndrome by glucocorticoid administration (#1)
-Adrenal cushing’s syndrome:
-adrenal adenomas
-Hyperplastic adrenal glands
-Ectopic Cushing’s Syndrome: tumors outside pituitary-adrenal system
-small cell lung cancer
-Carcinoid tumors

Term

What does chronic exogenous glucosteroid administration do to the HPA?

 

 

 

 

 

Definition

FYI: HPA = hypothalamic-pituitary-adrenal axis: CRH-->ACTH-->cortisol


Iatrogenic Cushing's Syndrome (excess exogenous cortisol)

 

Term
What happens if exogenous glucocorticoid therapy is suddenly stopped? And how do you prevent this effect?
Definition

Adrenal Insufficiency b/c there is no stimulus to restart cortisol release.

 

Solution:

1) Taper down doses while monitoring HPA axis as well as cortisol alert bracelets.

2) Use short tx of steroids with alternate days.

Term

Diagnostic Triad for Primary

Hyperaldosteronism (conn's disease).

 

What is the cause?

Definition

1) HTN (180/110)

2) hypernatremia

3) hypokalemia

 

Adrenal Adenoma is cause.

[image]

Term

Cause: high aldosterone

Effect: low renin

Definition
Primary Hyperaldosteronism (Conn's Disease)
Term

Cause: high renin

Effect: high aldosterone

 

What disorder? Name some causes.

Definition

Secondary Hyperaldosteronism

 

Caused by: renal artery stenosis & edema states (CHF, cirrhosis, nephrotic syndrome)

Term
Catopril Test for dx of what?  State the process and results for nml and abnormal.
Definition

Conn's Disease

 

Catopril is ACEi.

Measure baseline plasma aldosterone (PA), give catopril, measure PA after 90 min.

 

Nml: Suppression of RAAS = decr PA

Abml: incr PA = aldosterone secretion independent of RAAS.

Term

Conn's Disease Diagnosis.

 

1) PRA level

2) PA level

3) electrolytes

4) pH balance?

5) BP

6) Specific Drug test

Definition

1) PRA level: decr plasma renin activity

2) PA level: incr plasma ald

3) electrolytes & pH: hypokalemia (w/ assoc metabolic alkalosis), hypernatremia

5) BP= HTN

6) Specific Drug test: Captopril

Term
chronic destruction/dysfunction of adrenal cortices resulting in chronic adrenal insuff (deficiency of cortisol, aldosterone, androgens)
Definition
Addison's Disease
Term
Pathophys of Addison's Disease ( in the Western world and Worldwide).
Definition

Western World: 70% cases are autoimmune

 

Worldwide: infectious diseases more common (TB, fungal, CMV)

 

 

2º adrena insuff due to pituitary failure from sudden cessation of corticosteroids is ACUTE ADRENAL INSUFF and life threatening

Term

Lab results:

-Low cortisol, high ACTH

-Low Ald, low K, high Na

Definition
Addison's Disease
Term
Failure to give added steroids in a pt who is on steroid treatment prior to undergoing surgery, trauma, infection.
Definition

 

acute adrenal insuff

 

¨

Term
hypotension, dizziness, syncope, decr level of conciousness, circulatory failure, N/V, FUO, hypoglycemia, abdominal/flank pain
Definition
acute adrenal insufficiency
Term
weakness, fatigue, anorexia, wt loss, hypotension with orthostatic changes (80/50), pigmentation changes (on sun-exposed areas, axillae, nipples, palmar creases, mucous membranes)
Definition
1º chronic adrenal insuff: addison's disease
Term

Lab results:

low ACTH, low cortisol

nml electrolytes

Definition
2º adrenal insuff (from abrupt cessation of exogenous steroids)
Term
Which drug diagnostic test is used to dx adrenal insuff?
Definition
Cosyntropin (ACTH) stimulation test.
Term

Mngt/Tx of Addison's Disease

 

 

Definition

HRT-

-replace glucosteroids w/ hydrocortisone (**can cause cushings syndrome**).

-replace mineralcorticoids with fludrocortisone (monitor with PRA/PA).

Term
During HRT, when administering hydrocortisone, what adv rxns should you beware of?
Definition
bone density decr, cushings syndrome
Term

Glucocorticoid replacement doses:

1) during acute illness, surgery, trauma

2) intercurrent illness

3) severe illness

4) post-HRT

Definition

1) during acute illness, surgery, trauma - stress doses

2) intercurrent illness - double maintainence dose

3) severe illness- possibly 4-5x maintainence dose at times

4) post-HRT - possible requierment of stress doses up to 1 yr.

Term
where is epi and NE stored and synthesized? 
Definition
Adrenal medulla
Term
Paroxysmal HTN, palpitations, diaphroesis, H/A, apprehension, N/V in a young/middle-aged pt.
Definition

Pheochromocytoma (catecholamine secreting tumor of the adrenal medulla).

 

Rare, 80% unilat.

FYI: Paroxysmal hypertension is episodic HTN

 

Term

Lab results:

Incr plasma normetanephrine & metanephrine.

Definition

pheochromocytoma dx (almost)

 

Must get CT/MRI to check for tumor and administer clonidine test.

Term
Clonidine supression test for dx of....  what is nml response?
Definition

Dx of Pheochromocytoma:

 

-clonidine, a centrally-acting alpha-2 agonist used to treat HTN. Clonidine mimics catecholamines in the brain, causing it to reduce the activity of the sympathetic nerves controlling the adrenal medulla. A healthy adrenal medulla will respond to the clonidine suppression test by reducing catecholamine production; the lack of a response is evidence of pheochromocytoma.

Term
Mngt of Pheochromocytoma involved surgical removal of the tumor.  What must you beware of, pharmacologically, pre-op?
Definition
Use alpha blocker first, and beta-blocker ONLY AFTER alpha blocker administration....or risk excessive HTN.
Term

Where are the following found and what do they do?:

1) follicles

2) parafollicular cells

Definition

THYROID GLAND: composed of....

1) follicles: selectively absorb iodine (as iodide ions) from blood.

-Colloid, a rich protein called thyroglobulin, inside of the follicles synthesizes (iodine + thyrosine w/ TPO enzyme) and stored thyroid hormones.

2) parafollicular cells (aka C Cells) secrete calcitonin*

[image]

 

*Calcitonin: reduces serum calcium, opposing PTH effects. 

Term
Inactive and active forms of thyroid hormone.
Definition

T3 & T4 bound to TBG = inactive.

Unbound = active.

Term
Thyroid Hormone control
Definition

TRH (Hypothalamus) -->

TSH (Anterior Pituitary) -->

T3/T4 (Thyroid Gland)

Term

Hypothyroidism:

 

What is the most common form in the US?  Worldwide? 

Definition

US: Hashimoto's thyroiditis (primary hypothyroidism) aka chronic lymphocytic thyroiditis

 

Worldwide: iodine def

 

 

Term

antibodies against thyroid peroxidase and/or thyroglobulin cause gradual destruction of follicles in the thyroid gland.

 

What is this condition and what are 2 risk factors?

Definition

Hashimoto's Thyroiditis (primary hyperthyroidism)

 

Risks: white, female

Term
  • Lethargy/fatigue
  • Hoarse Voice
  • Impaired memory/decr cognitive function
  • Cold Intolerance
  • Weight Gain
  • CHF symptoms
  • dry skin/eyes
  • anorexia, nausea, constipation
  • decr libido/fertility, menorrhagia

 

Definition
Hypothyroidism
Term

Pt presents tired and sleepy with slurred speech b/c of macroglossia (enlarged tongue).  Eyes are dry.

 

Skin/Hair/Nails: course, dry, cold skin; lateral eyebrow thinning, peri-orbital non-pitting edema

 

CV: BP is 125/110, bradycardic, distant cardiac sounds

 

Abdomen: distended, decr bowel sounds

 

Musculoskeletal: decr strength, delayed DTR, carpal tunnel syndrome.

 

What is your dx?  What do you want to palpate and how would it feel?

Definition

Hypothyroidism

 

Thyroid gland may be non-palpaple or diffusely enlarged w/ rubbery/asym nodules (at first), then small.

Term
Keratoconjuctivitis sicca (KCS), macroglossia, and carpal tunnel are seen in what condition
Definition

Hypothyroidism:

 

FYI-

Macroglossia is the medical term for unusual enlargement (hypertrophy) of the tongue.

Keratoconjunctivitis sicca (KCS), also called keratitis sicca, sicca syndrome, xerophthalmia, dry eye syndrome (DES), or simply dry eyes

Term

Pt presents with impaired mentation, hypothermia, hyponatremia, hypoglycemia.

 

Infection, cold exposure, trauma, CNS depressents, and old age can be causes of this condition. 

Definition
Myxedema coma (severe hypothyroidism)
Term
In what populations is it important to screen for subclinical hypothyroidism (this is asymptomatic). Why?  What are the lab results if positive?
Definition

Menopausal females b/c they are at higher risk for CV events. 

 

Incr TSH, T3/T4 nml.

Term
This condition is associated with severely stunted physical and mental growth.
Definition
Congenital Hypothyroidism due to maternal iodine def (if left untreated, it is called Cretinism)
Term

Lab results:

-high titers of antiTPO, antiTSH, antiTg

-decr: total T4, free T4

-elevated TSH

-incr chol, TG

-Pernicious Amenia

Definition
Hashimoto's Thyroiditis
Term

-Decr total T4

-decr free T4 (FT4)

-Incr TSH

Definition
Hypothyroidism
Term
3 populations to screen for hypothyroidism.
Definition

1) neonates - congenital hypothroidism can lead to cretinism if untreated - dwarfism w/ mental retardation)

 

2) postmenopausal women - to lower CV/osteoporosis risks. (15% of subclinical cases)

 

3) elderly - to rule out hypothyroidism as a cause of dementia and depression.

Term
Management of hypothyroidism.  Drugs, monitoring, dosing in pregnant women and elderly, contraindications.
Definition

Levothyroxine replacement therapy.  Monitor TSH 6-8wks after beginning/changing therapy. 

Preggers: incr dose b/c prenatal vitamines/iron decr TH absorption.

Elderly: lower dose

 

Contraindications: slow, small doses, esp with CV risks....angina/MI/CHF pts not started on TH until CV problems are stabilized (think of the function of TH on CV: similar to catecholamines...)

Term

Most common cause of hyperthyroidism.

 

 

Definition

Graves disease- is an autoimmune disorder, in which the body produces antibodies to the receptor for thyroid-stimulating hormone (TSH) These antibodies cause hyperthyroidism because they bind to the TSH receptor and chronically stimulate it, resulting in

abnormally high production of T3 and T4. This in turn causes the clinical symptoms of hyperthyroidism, and the enlargement of the thyroid gland visible as goitre.

Term
3 Other causes of hyperthyroidism besides autoimmune (graves)
Definition
early thyroiditis (gland enlarges), exogenous TH (dieting females), toxic goiters.
Term

-irritability, anxiety, restlessness, difficultly concentrating, insomnia

-fine tremor

-Eye: injection, lacrimation, diplopia

-wt loss, loss stools, incr appetite

-CV: SOB, palps, possible angina/HF/afib w/ underlying condition

-heat intol, diaphoresis

-oligomenorrhea (never get pd)

-tetany of hands (low Ca b/c malabsorption)

Definition
Thyrotoxicosis (hyperthyroidism)
Term
Elderly pt presents with apathetic/depressed mood, lethargy, demensia-like sx.  What are 3 differentials?
Definition
Dementia, Depression, THYROTOXICOSIS
Term
wide pulse pressure, fever, hyperactivity, rapid speech, anxiousness, pretibial mxyedema, proximal muscle weakness, hyperactive DTR. Possible goiter, HF, afib.
Definition
Thryotoxicosis
Term

Precpitating factors (infection, trauma, surgery) can cause high fever, delerium, N/V, dehydration, afib, hypotension.

Lab: catecholamine levels nml.

 

Dx and tx?

Definition

Thyroid storm - life threatening, severe thyrotoxicity.

 

Tx- IV iodide to decr TH release, steroids to inhibit T4 to T3 conversion.

 

 

Term

incr T3, FT3, T4

decr TSH

Definition
thyroitoxicosis
Term

Tx:

-propythiouracil (PTU), methimazole (antiTH drugs)

-b-blocker (sx relief)

-radioactive iodine therapy (choice for adults)

 

What is this tx for?  When would you do surgery?

Definition

Thyrotoxicosis.

 

Surgery - subtotal thyroidectomy:

-no response to meds

-pregnancy (radioactive iodine ablation C/I)

-large goiters

Term
goiter is symmetrical, soft or firm, smooth, moderately tender, venous hum, arterial bruit
Definition
graves disease goiter
Term
goiter is large, asymm, firm, irregular, with nodules
Definition
toxic (multinodular) goiter
Term
moderate size goiter, tender, asymmetric
Definition
subacute thyroiditis
Term
thyroid enlargement preceded by URI, usually of viral cause.  Self limited.  Begins with thyrotoxicosis, followed by hypofunction.
Definition
Subacute (de Quervain's) thyroiditis
Term
This condition starts with thyrotoxicosis, followed by hypofunction (enlargment to atrophy of thyroid gland).  It appears in women with Hashimoto's thyroiditis.
Definition
POst partum/silent thyroiditis
Term

Pt presents with neck pain radiating to jaw/ear, fever, myalgia, lymphocytosis, incr ESR, T3/T4 initially high then low, low RIAU.  Acute illness.

 

-What condition?

-Duration?

-Tx (3 drugs)? (what is NOT effective?)

 

 

Definition

Subacute thyroiditis

subsides in 2-8 wks

NSAIDS

Initial stage - b blocker (if severe)

second stage - TH replacement

Not effective - antiTH meds

Term

pt presents with mailaise, fatigue, weight loss, nml/slightly elevated ESR, painless.

 

What condition?

Tx? (what is not effective?)

Definition

postpartum thyroiditis

 

Usually no need to treat b/c its mild.

Second stage - TH replacement.

Not effective - antiTH meds

Term

Thyroid nodules:

-what % is cancer?

-common

-rare (3)

-sx

 

Definition

Thyroid nodules:

-what % is cancer? 10-20%

-common nodule: colloid nodules

-rare (3) nodules: adenoma, cyst, CA.

-sx: usu asx.  Dysphagia, sx/signs of hyper/hypothyroidism.

Term

You find a fixed, rapidly growing thyroid nodule w/o mov't upon swallowing in a male elderly pt. 

 

What do you suspect?

How would you make the dx?

Definition

Thyroid cancer

Dx with fine needle aspiration (biopsy)

Term

lWhich of the following is true about TH replacement therapy?
A. always associated with iodine to suppress TSH
B. bradycardia is the main side effect
C. doses may be increased every 2 weeks
D. patients with CHF should be monitored carefully
E. glucocorticosteroids enhance TH effect

Definition

lWhich of the following is true about TH replacement therapy?
A. always associated with iodine to suppress TSH
B. bradycardia is the main side effect
C. doses may be increased every 2 weeks
D. patients with CHF should be monitored carefully
E. glucocorticosteroids enhance TH effect

 

Term

 

The physical exam of a 29 yo asymptomatic, euthyroid man shows 2 fixed nodules.  The best diagnostic test is:
A. TBG
B. free T4, T3
C. TSH, free T4, T3
D. fine-needle aspiration
E. chest x-ray
Definition

The physical exam of a 29 yo asymptomatic, euthyroid man shows 2 fixed nodules.  The best diagnostic test is:

A. TBG
B. free T4, T3
C. TSH, free T4, T3
D. fine-needle aspiration
E. chest x-ray
Term
Antibodies vs. pancreatic beta cells possibly caused by viral insult.  Genetic and environmental factors.
Definition
Type I DM
Term
Screening for DM begins at what age if no other comorbidities exist?  At what intervals after that?
Definition
45 and every 3 yrs after than
Term
Insulin's target and function there?
Definition
Liver, muscle, fat...glucose uptake
Term
Decreased insulin and tissue insulin resistance.
Definition
Type II DM
Term

Hyperglycemia, ketosis, acidosis...caused by the breakdown of fatty acids into ketones  (liver converts to glucose/ketone bodies) when there is too little insulin/too much counter regulatory hormones.

 

Dx? (in what pt population?)

Causes?

Definition

Diabetic Ketoacidosis (acute complication of mostly Type I DM)

 

Causes: acute stress or decr insulin

Term

Sx: polyuria, polydipsia, lethargy, weakness, nausea, anorexia. 

PE: decr turgor, tachycardia, orthostatic HTN, sweet odor

Lab: low electrolytes, incr serum glucose

Definition
DKA
Term
Many times DKA (hyperglycemia) can present similar to hypoglycemia because of obtunded mentation.  How do you differentiate in a jam?
Definition
Give short acting sublingual glucose.  Hypoglycemics respond quick and great.  Hyperglycemics...nothing.
Term

Sever hyperosmolarity and severe hyperglycemia are the hallmarks.

 

What dx and in what pt population?  Mortality?

Definition

Hyperosmolar Hyperglycemic State (HHS) - acute complication of mostly type II diabetics.

 

Mortality up to 50%.

Term
DKA/HHS tx (3)?
Definition

1) rehydrate

2) gradually correct hyperglycemia

3) K supplement

Term
what is the most common complication of insulin therapy.  What are the lab result standards for dx.  What happens if it goes untreated.
Definition

Hypoglycemia

bg<60...you get sx.

bg<50...obtunded mentation.

Prolonged state= IRREVERSIBLE BRAIN DAMAGE.

Term
Sx: h/a, sweating, impaired vision, dizziness, fast heartbeat, hunger, shaking, irritability, anxiety, weakness, fatigue
Definition

Hypoglycemia

[image]

Term
What DM med can cause hypoglycemia
Definition
sulfonyureas - some have long half life and lower bg too much
Term
Nocturnal hypoglycemia leading to increased glucose production in the ealry morning.
Definition
Somogyi effect - over shooting of counter reg hormones.  DON'T MAKE THE MISTAKE OF GIVING MORE INSULIN @ BEDTIME TO CORRECT THIS.
Term
decr tissue sensitivity to insulin in the early morning (early morning hyperglycemia)
Definition
dawn phenomenon
Term
Chronic Complications of DM (3)
Definition

1) microvascular (retinopathy & nephropathy)

2) Neuropathic

3) Macrovascular (atherosclerosis)

Term
leading cause of blindness in 24-78 y/o pts in the US
Definition
DM retinopathy
Term
In poorly controlled DM, retinopathy occurs in what % of pts (How many yr after dx?)?
Definition
>95% DM pts 15 yrs after dx
Term

DM nephropathy is the leading cause of ESRD in the US.

 

Affects what % of what type of diabetics?

1st sign?

 

Definition

30-35% type I diabetics

Microalbuminuria is 1st sign.

Term
What pharmas are used for tx of DM nephropathy?
Definition
ACEi, ARBs
Term
Diabetics are very susceptible to renal complications association with what procedure?  What is important when doing this procedure?
Definition
IV contrast procedures: aggressive pre/post hydration is IMPORTANT
Term
This DM neuropathy presents with pain at oculomotos, median, radial, lateral popliteal sites.  Self limited.
Definition
Focal neuropathy
Term

This DM neuropathy is distal and symmetric.  Pain and tingling in stocking-glove formation.

 

What is it and what do you see in its late stages?

Definition

Diffuse DM neuropathy.

 

Late stages: severe sensory loss, smooth muscle wasting, neuropathic arthropathy, focal ulceration.

Term
What is the most common neurological syndrome see in DM?
Definition
Diffuse, distal, symmetric neuropathy.
Term

DM autonomic neuropathy has a poor prognosis.  List the sx assoc with the following organ systems

-Cardiac

-Vascular

-GI

-GU

Definition

-Cardiac: incr HR (decr HR responsiveness), incr silent ischemia risk/CHF/sudden death.

-Vascular: orthost HTN

-GI: constipation, hypo/hypermotility, pancreatic insuff

-GU: overflow incont, ED, bladder hypomotility

Term
What % of diabetics experience clinically significant foot ulcerations?
Definition
15%
Term
What is the predominant cause of diabetic mortality?
Definition
Atherosclerois of coronary, cerebral, and lower extremity arteries.  (Begins earlier and more severe in diabetics).
Term
combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes
Definition

Metabolic syndrome is also known as syndrome X, insulin resistance syndrome.

Term
estimate of glucose levels during previous 6-12 weeks
Definition
HgA1c
Term
Tx for all type I DM pts, some type II DM pts.
Definition
Injectable insulin
Term
Ultra short acting insuline (Novolog, Humalog) can be injected how much time pre-prandial?
Definition
15 min
Term
An insulin pump administers insulin where?
Definition

Into abdominal fat via catheter

[image]

Term
DM ¨oral¨meds - drugs that incr insulin secretion by the pancreas
Definition

Sulfonylurea (GLYBURIDE)

Meglitanide (REPAGLANIDE)

Term
Non insulin DM drugs are also called
Definition
Oral medication (FYI: this is an old name, because a lot of these are injectable now)
Term
DM oral meds - these affect insulin action in peripheral tissues
Definition

Biguanide (METFORMIN)

Thiazolidinediones - TZDs (¨GLITAZONES¨)

 

Term
What is the 1st line DOC for type II DM?
Definition
Metformin (biguanides) - oral meds that affect insulin action in peripheral tissues.
Term
Alpha-glucosidase inhibitors (MIGLITOL)
Definition
Oral DM meds that affect glucose absorption in GI (delay carb absorption).
Term
Incretins (eg Exenatide-parenteral, Sitaglipton-po)
Definition
DM drugs that mimic GI hormones
Term

 

a synthetic version of Amlyn, which is produced by pancreatic beta cells in response to meals. given sc; for type I, or type II who use insulin; may cause hypoglycemia

Definition
Pramlintide
Term
Prevalence of overweight, obese, individuals in the US
Definition

Adults (2005-2006 stats)

34% obese

33% overweight

 

Term
BMI interpretation (kg/ m2)
Definition

 

  BMI
Underweight Below 18.5
Normal 18.5 - 24.9
Overweight 25.0 - 29.9
Obesity

30.0 and Above

 

**BMI can

vary 40%!!!!**

Term
Soluble vs. Insoluble fiber
Definition

Soluble: attracts water, forms gell, trapping carbs to slow glucose absorption - BG regulator; increase transit time, decr nutrient absorption because active enzyme activity, high binding capacity for ions and lipids

 

Insoluble: decr transit time, facilitiate regularity (incr fecal bulk), lignin is the only binder.

[image]

[image]

Term
Due to def in vit B12, folate, thiamin, pyridoxine
Definition
Macrocytic anemias
Term
due to def in protein, iron, vit A, vit C, pyridoxine, copper, manganese, toxicity (heavy metal poisoning)
Definition
Microcytic anemia
Term
4 lab tests for anemia
Definition

 

CBC:  Hgb, Hct, MCV, MCH,
Serum Iron, Total Iron Binding Capacity (TIBC),
Transferrin: Serum Fe/TIBC, ferritin,
B-12, Folate
Term
Reflects protein nutritional status over previous 3 mos.  18-20 d half life.
Definition
Albumin
Term
2 d half life (responds to acute intervention).  Not often tested for because of high cost.  Could detect 44% more protein malnutrition.
Definition
Pre albumin (transthyretin)
Term

Acute phase of protein during stress, infection, inflammation. 

 

What is it?

Increased when...

High levels signify...

Definition

C-Reactive Protein (CRP)

Incr CRP when alb/prealb decr

Incr CRP sign of nutritional risk during stress/trauma

Term

Lab Assessment:

1) Protein metab

2) carb metab

3) lipid metab

Definition

1) Protein metab: creat/BUN

2) carb metab: glucose, prot bound glucose (1 wk), HbA1c (2-3 mos)

3) lipid metab: Tot Chol, HDL, LDL, TG

Term

SKIN Clinical Sx of Nutritional Disorder

1) obesity/DM

2) vit K/C def

3) marasmus, niacin, biotin, riboflavin, zinc, essential FAs

4) zinc

5) DM, kwashiokor

Definition

1) obesity/DM acanthosis nigricans

[image]

2) vit K/C defcy ecchymosis

3) marasmus, niacin, biotin, riboflavin, zinc, essential FAs defcy dermatitis

4) zinc defcy psoriasisform rash

[image]

5) DM, kwashiokor pressure ulcers

[image]

ulcerating dermatosis on a Malawian child suffering from kwashiorkor

Term
an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates.
Definition
Kwashiorkor
Term

Clinical Sx of Nutritional Disorders:

1) hair sx of zinc, biotin def

2) nail sx of iron def

3) lack of iodine

4) mouth: lack of riboflavin

5) mouth: lack of fluoride

6) neuro: niacin, thiamin, vit E def

7) Neuro: thiamin

8) neuro: vit D, Ca

Definition

1) hair sx of zinc, biotin def - alopecia

2) nail sx of iron def- spoon nails (koilonychia)

[image]

3) lack of iodine - goiter

4) mouth: lack of riboflavin +... angular stomatitis (Fe), cheilosis(niacin, pyridoxine), bleeding gums(vit C, K)

5) mouth: lack of fluoride - caries

6) neuro: niacin, thiamin, vit E def - dementia/delirium

7) Neuro: thiamin - wrist/foot drop

8) neuro: vit D, Ca - tetany

Term
Define soluble/insoluble fiber
Definition

water-soluble – fermented in colon into gases/active byproducts
Insoluble absorbs water through digestive system and eases defecation

Term

Hunger/Satiety Regulation:

 

1) incr w/ fasting, decr with feeding, short-term hunger signal

2) gut hormone made in small intestine lining in response to food intake (esp fat).  Short term satiation signal

3) released from distal sm intestine post-prandial.  short term satiation signal.  Reduced in DM II.

Definition

Hunger/Satiety Regulation:

 

1) incr w/ fasting, decr with feeding, short-term hunger signal.  Ghrelin.


2) gut hormone made in small intestine lining in response to food intake (esp fat).  Short term satiation signal.  Cholecystokinin (CKK).

 

3) released from distal sm intestine post-prandial.  short term satiation signal.  Reduced in DM II.  Glucagon Peptide-1 (GLP-1).

Term

What quandrant are the following abdominal parts found:

1)liver

2)kidney

3)esophagus

4) spleen

5) stomach

6) pancreas

7) duodenum

8) sigmoid

9) cecum

10) jejunum

Definition

1) liver RUQ

2) kidney ALL QUANDRANTS

3) esophagus LUQ

4) spleen LUQ

5) stomach LUQ

6) pancreas Upper Quandrants

7) duodenum LUQ

8) sigmoid LLQ

9) cecum RLQ

10) jejunum Lowe Quandrants

Term

Referred pain to where?

1) AAA

2) gallbladder

3) ureter

4) pancreatitis

5) perforated ulcer

Definition

1) AAA to lower back

2) gallbladder to shoulder

3) ureter to groin

4) pancreatitis to back

5) perforated ulcer to RLQ

Term

bruising of the flanks and periumbical cords signify what?

[image]

Definition

acute hemorrhagic pancreatitis

-flank: Grey Turner's sign

-periumb: Cullen's Sign: Cullen's sign may appear 1 to 2 days after the onset of anorexia and the severe, poorly localized abdominal pains that are characteristic of acute hemorrhagic pancreatitis. It is also present in massive upper GI hemorrhage and ruptured ectopic pregnancy.

Term

An umbilical node as a sign of malignancy in the pelvic of abdomen

[image]

Definition

Sister Mary-Joseph Sign

 

Term

Insicions on the abdomen suggest what previous surgeries:

1) subcostal (kocher)

2) pfannenstiel

3) Mcburney

4) what is this scar called?

[image]

 

Definition

1) subcostal (kocher) - biliary/hepatic

[image]

2) pfannenstiel - bladder/uterus/fallop tubes/ovarian

[image]

3) Mcburney - appendectomy

[image]

4) Chevron

Term
20 y/o pt presents with low grade fever, obstipation, anorexia, nausea, visceral periumbilical pain.  Later, he begins to vomit, spikes a fever, pain pinpointed to RLQ.  Then the pain stops.  What is your dx.
Definition
acute appendicitis w/ rupture
Term

1) RLQ tenderness with LLQ palp

2) pain w/ right hip extension

3) pain with right hip flex and internal rotation

Definition

ACUTE APPENDICITIS abdominal exam findings:

 

1) Rosvig's sign - RLQ tenderness with LLQ palp

2) Psoas sign - pain w/ right hip extension

3) Obturator sign - pain with right hip flex and internal rotation

Term

biliary disease lingo:

1) gallbladder stones

2) common bile duct stone

3) gallbladder inflammation

4) biliary tract infection

Definition

1) gallbladder stones cholelithiasis

2) common bile duct stone choledocholithiasis

3) gallbladder inflammation cholecystitis

4) biliary tract infection cholangitis

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