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NURS 623 EXAM 2 MARYVILLE UNIVERSITY
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What drug is the treatment of choice in pregnant women with hyperthyroidism? ------CORRECT ANSWER---------------PTU (propylthiouracil) because they are less likely to cross the placenta How long does it take antithyroid medications like PTU(prophylthiouracil) and MMI (tapazole) to take effect? ------CORRECT ANSWER--------------- 2 - 8 weeks What symptoms should patients be told to report immedicatly if taking antithyroid medications? ------CORRECT ANSWER---------------signs of infection, fever, or sore throat, malaise or mouth sores (could be agranulocytisis, aplastic anemia, or hepatitis) What is the treatment choice for hyperthyroidism? ------CORRECT ANSWER---------------radioactive iodine therapy How long should women wait to get pregnant after receiving radioactive iodine therapy? ------CORRECT ANSWER---------------4 months after therapy What is the most common cause of hypothroidism worldwide? and the most common in the US? ------CORRECT ANSWER---------------worldwide: iodine; US: autoimmune (hashimotos thyroiditis)
What is the average age onset of hypothyroidism? ------CORRECT ANSWER--------------- 30 - 60 years In hypothyroidism what causes the goiter? ------CORRECT ANSWER-------- -------when T4 production is inadequate the thyroid gland enlarges due to increasing levels of pituitary TSH; hypertrophy and hyperplasia of the thyroid glad Fatigue, weight gain, cold intolerance, hair loss or thinnig, constipation, enlargement of neck and inability to exercise are all symptoms of? ------ CORRECT ANSWER---------------Hypothyroidism What are some specific findings for Hashimotos thyroiditis? ------CORRECT ANSWER---------------painless thyroid enlargement, neck pain sore throat, feeling of fullness in throat, low grade fever and exhaustion What is the classification of the recommended first choice of oral antihyperglycemic medication in Type 2 DM? ------CORRECT ANSWER---- -----------BIGUANIDE - METFORMIN What periodic testing should you order if a patient has been on the first choice oral antihyperglycemic medicine long term and complains of neuropathy? Why? (hint: hematological) ------CORRECT ANSWER----------- ----●Vitamin B12 annually (CAN CAUSE B12 DEF)
What are the PRIMARY risk factors for gout? ------CORRECT ANSWER---- -----------PRIMARY: ENZYME DEFECT & DECREASED RENAL CLEARANCE OF URIC ACID What are the SECONDARY risk factors for gout? ------CORRECT ANSWER---------------EXCESSIVE PURINE OBESITY STARVATION ALCOHOL ABUSE MEDS: THIAZIDES, NIACIN What diagnostic results would be seen with gout? ------CORRECT ANSWER---------------elevated serum uric acid levels, ESR and WBCs; What is the initial management for an acute attack of gout? ------CORRECT ANSWER---------------COLCHICINE 1.2mg PO X 1 then 0.6mg in 1 hour (within 36 hrs of onset up to 0.6 mg) NSAIDs, AND CORTICOSTEROIDS; rest, elevation, immobilization What is the subsequent pharmacological management used to prevent further attacks of prophylaxis? ------CORRECT ANSWER--------------- ALLOPURINOL (wait 4-6 week to after acute attack to start) What educational information should you discuss with a patient diagnosed with gout? ------CORRECT ANSWER---------------AVOID FOODS HIGH IN PURINE (MEAT & SEAFOOD, YEAST, BEER/ALCOHOL, BEANS, PEAS, LENTILS, OATS, SPINACH, ASPARAGUS, CAULIFLOWER, MUSHROOMS
How is obesity classified? ------CORRECT ANSWER---------------BMI >30, WAIST >40" MEN & >35" WOMEN What are the consequences of obesity? ------CORRECT ANSWER----------- ----CAD, CHF, HTN, HYPERLIPIDS, TYPE II DM, SLEEP APNEA, RESTRICTIVE LUNGS, GOUT, VENOUS INSUFF, GERD, GALLBLADDER, BLOOD CLOTS The cluster of factors for metabolic syndrome include? ------CORRECT ANSWER---------------HTN, HYPERLIPIDEMIA, INSULIN RESISTANCE Patients with metabolic syndrome are twice at risk for developing _____ over 5 yrs and have a 5-fold risk of ____? ------CORRECT ANSWER--------- ------CVD; DM II Brittle, coarse hair might be a sign of what thyroid disorder ------CORRECT ANSWER---------------hypothyroidism A thyroid bruit, gynomastia, fine hair, warm, smoot, moist skin are all associated with what thyroid disorder ------CORRECT ANSWER--------------- hyperthyroidism Hirsutism, Purple striae over the abdomen is seen with what condition and hyperpigmentation are seen with what disease? ------CORRECT ANSWER- --------------Cushings syndrome
What lab value findings would you see in a patient with Cushings syndrome? ------CORRECT ANSWER---------------increased cortisol, increased sodium, decreased K+, decreased glucose, normal BUN What is a carpopedal spasm and what is it a sign of? ------CORRECT ANSWER---------------violent, painful contraction of the hands or feet; neuromuscular sign indicating hypocalcemia With gout what will your labs indicate? ------CORRECT ANSWER------------- --ESR and WBC elevated, uric acid level >7.5, BUN normal, WBC >10, What is the follow up for an acute gout attach? ------CORRECT ANSWER-- -------------reevaluate in 1-2 weeks and antihyperuricemia therapy needs to be followed every 4-6 weeks to adjust medications What are some classic findings in an x-ray of an affected joint with gout -----
- CORRECT ANSWER---------------tophi, normal mineralization of bone, joint space preservation, asymmetric polyarticular distribution, overhanging edge cortex and punched out erosion of bone Which of the serum laboratory findings are present in the client with Cushing's syndrome? ------CORRECT ANSWER---------------Increased cortisol, HYPERnatremia, and HYPOkalemia
Alice, age 48, has a benign thyroid nodule. The most common treatment involves: ------CORRECT ANSWER---------------Watchful waiting with an annual follow-up ACE inhibitors are given to clients with diabetes who have ------CORRECT ANSWER---------------persistent proteinuria A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? --- ---CORRECT ANSWER---------------metformin An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? ------CORRECT ANSWER---------------a-fib, depression, weight loss Diane has had Cushing's disease for 20 years and has been taking hydrocortisone since her diagnosis. Today, she appears with a thick trunk and thin extremities. She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a number of bruises that appear to be slow in healing. To what do you attribute these symptoms? ------CORRECT ANSWER---------------excessive levels of cortisol The following is a client's self-monitoring blood glucose log. The client receives 20 units Novolin 70/30 in the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m. pre-dinner: 90, 150, 105, 144, 101, 172, 98, 201. What changes would you make? ------CORRECT ANSWER---------------increase A.M. insulin
What controls the amount of calcium in the blood? ------CORRECT ANSWER---------------Parathyroid Thyroid hormones regulate ------CORRECT ANSWER--------------- metabolism Which tests should you order to confirm a diagnosis of hypothyroidism? ---- --CORRECT ANSWER---------------t3 & Free T4 (preferred over T4) What are the hallmark signs of Grave's disease? ------CORRECT ANSWER---------------enlarged thyroid and increased T What is the gold standard screening for thyroid TUMOR/NODULE? ------ CORRECT ANSWER---------------ULTRASOUND What is the diagnostic screening for thyroid cancer? ------CORRECT ANSWER---------------FINE NEEDLE BIOPSY What is the preferred treatment of Grave's disease in pregnancy ------ CORRECT ANSWER---------------Propylthiouracil (PTU): Before starting anti-thyroid meds what should be checked? ------CORRECT ANSWER---------------LIVER FUNCTIONS
what is the goal of thyroid treatment ------CORRECT ANSWER--------------- euthyroid state What are signs and symptoms of hypothyroidism overtreatment? ------ CORRECT ANSWER---------------hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema. Hyperthyroidism causes an excessive secretion of which thyroid hormones? ------CORRECT ANSWER---------------T3 & T What are S/S of hyperthyroidism? ------CORRECT ANSWER--------------- "Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN, enlarged thyroid What are S/S of HYPOthyroidism? ------CORRECT ANSWER--------------- "cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle nail/hair What is the most common cause of hyperthyroidism? ------CORRECT ANSWER---------------Graves disease Name the two thyroid hormones produced by the thyroid gland? ------ CORRECT ANSWER---------------T3 & T
What is the long standing effects of HYPERthyroidism? ------CORRECT ANSWER---------------OSTEOPOROSIS CONSIDER BONE DENSITY TESTING, VIT D, & CALCIUM SUPPLEMENTS IN OLDER PT How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism? ------CORRECT ANSWER-------- -------FOR LIFE Which treatment FOR hyperthyroidism is recommended for middle age and older adults? ------CORRECT ANSWER---------------Radioactive iodine 131 WHAT works by inhibiting thyroid hormone synthesis at multiple steps. They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment) ------ CORRECT ANSWER---------------ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI) What should those treated with radioactive die be aware of? ------ CORRECT ANSWER---------------AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR 7 DAYS What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? ------CORRECT ANSWER--------------- RADIO IODINE UPTAKE SCAN
What is the gold standard test for confirming Hashimoto's? ------CORRECT ANSWER---------------THYROID PEROXIDASE [TPO] ANTIBODY What is the most common type of autoimmune hypothyroid in the US? ------ CORRECT ANSWER---------------HASHIMOTO'S What would make you suspicious of thyroid cancer (clinical presentation)? What is the reliable method of diagnosis? ------CORRECT ANSWER--------- ------PAINLESS LUMP OR NODULE IN THE NECK; FINE NEEDLE BIOPSY What type of hypothyroidism does more than 95% of patients have where there is dysfunction or atrophy of the thyroid gland due to failure of pituitary and/or hypothalamus? ------CORRECT ANSWER---------------CENTRAL HYPOTHYROIDISM What is an endocrine emergency with signs and symptoms of slowed cognitive thinking, poor short-term memory, depression or dementia, hypotension and hypothermia with a mortality rate of 30-40%? ------ CORRECT ANSWER---------------MYXEDEMA (SEVERE HYPOTHYROIDISM) What are the common causes of hypercalcemia? ------CORRECT ANSWER---------------PRIMARY HYPERPARATHYROIDISM AND MALIGNANCY the twitching of the facial muscles in response to tapping over the facial nerve 2 cm anterior to ear canal is considered a positive _________ sign;
What is ADDISON'S DISEASE? ------CORRECT ANSWER--------------- primary adrenal insufficiency Autoimmune; adrenal glands do not produce enough cortisol. NEED TO "ADD" ADRENAL HORMONES/ CORTISOL Describe the clinical presentation OF ADDISON'S ------CORRECT ANSWER---------------BRONZE SKIN, hirsutism, HYPOGLYCEMIA, POSTURAL HYPOTENSION, WEIGHT LOSS, Clinical presentation of Addison's crisis ------CORRECT ANSWER------------ ---Profound fatigue dehydration vascular collapse (↓B/P) renal shutdown What are the diagnostic criteria for DM2? List all the criteria. ------ CORRECT ANSWER----------------FPG > 126
- RANDOM PLASMA GLUCOSE >
- GTT (2HR) > 200
- A1C > 6. Which of the following can be initial testing to confirm diagnosis of DM2? (select all that apply)
- FASTING BLOOD (PLASMA) GLUCOSE
- HGA1C
- ORAL GLUCOSE TOLERANCE TEST ------CORRECT ANSWER------------ ----FASTING BLOOD (PLASMA) GLUCOSE
- HGA1C
- ORAL GLUCOSE TOLERANCE TEST
Are there any contraindications for starting the recommended first choice oral hyperglycemic medication? If so, what are the contraindications? ------ CORRECT ANSWER----------------LIVER DISEASE
- HX ALCOHOLIC
- KIDNEY DISEASE (GFR <30)
- cardiopulmonary insufficiency WHAT CONDITION PRESENTS WITH LACK OF INSULIN acute decompensation; (MORE IN TYPE I DM) S/S: HYPERGLYCEMIA, KETONEMIA, ACIDOSIS; ANOREXIA, THIRST, N/V, ABDO CRAMP, KUSSMAUL RESP, DEHYDRATED, ALTERED CONSCIOUSNESS ------CORRECT ANSWER---------------DKA WHAT POPULATION IS MORE LIKE TO PRESENT WITH DKA? ------ CORRECT ANSWER---------------TYPE I DM When a patient is diagnosed with DM I what are they likely to present with? ------CORRECT ANSWER---------------DKA Clinical presentation of DMI ------CORRECT ANSWER--------------- polydipsia, polyuria, polyphagia, anorexia, and weight loss. WHAT CONDITION PRESENTS WITH INSIDIOUS ONSET SUBTLE INITIAL SYMPTOMS (MORE IN TYPE II DM) S/S: HYPERGLYCEMIA, NO KETOSIS, HYPEROSMOLALITY; POLYURIA •POLYDIPSIA •WEAKNESS •NO KETOACIDOSIS •LETHARGY AND CONFUSION, COMA ------ CORRECT ANSWER---------------HHS
Podagra is gout of the ------CORRECT ANSWER---------------first metatarsophalangeal joint A metabolic disease that produces an inflammatory arthritis? ------ CORRECT ANSWER---------------gout What are the two primary factors of gout? ------CORRECT ANSWER--------- ------*enzyme defects and decreased renal clearance What are secondary risk factors for gout? ------CORRECT ANSWER--------- ------excessive daily intake of purine, starvation, obesity, alcohol, medications(thiazide diuretics, ethambutol, nicotinic acid, pyrazinamide, low dose salicylates, cyclosporine), pagets disease, chronic hemolytic anemis, psoriasis, cytoxic drugs, carcinoma and sarcome, CRD, hypothyroidism, lead poisoning, DI DKA, hyperparathyroidism What uric acid level would be indicative of gout? ------CORRECT ANSWER--------------->7 in men and >6 in women Explain the pathophysiology of a gout flare? ------CORRECT ANSWER------ ---------Urate deposits in the joints and the crystallization of urate triggers the inflammatory response What is the most common trigger of an acute gout attack? ------CORRECT ANSWER---------------trauma or surgery
What is the typical presentation of gout? ------CORRECT ANSWER----------- ----excruciating pain that often awakens the person at night, joint is usually warm or hot to touch, pain with palpation and ROM maybe limited What drugs should you ask about if there is a gout flare? ------CORRECT ANSWER---------------ASA, cyclosporine When there is large joint involvement with gout what symptoms might you see? ------CORRECT ANSWER---------------elevated temp, tachycardia, malaise, headache and chills Acute management of gout includes ------CORRECT ANSWER--------------- generalized rest elevation, and immobilization of affected joint What is the pharmacological management of gout? ------CORRECT ANSWER---------------NSAIDs (indomethacin or naproxen), colchicine (if less than 36 hours) and corticosteroids If administering colchicine to a patient for an acute gout flare what time frame must it be given in? ------CORRECT ANSWER--------------- administered within 36 hours of initial onset of symptoms When are corticosteroids contraindicated in gout? ------CORRECT ANSWER---------------in septic conditions, must draw a synovial aspirate to test fluid
