Medical Conditions and Treatments: Diabetes, Urology, Pediatrics, Genetics, and Endocrinology

What is the first line treatment for Type 2 Diabetes? What it the first drug that is commonly used?

- treat first with diet, exercise, and weight loss

Metformin (↑ insulin sensitivity)

What are the medications used for Type 1 Diabetes?

Exogenous insulin (rapid acting, short acting, intermediate acting, long acting)

What is Type 1 diabetes mellitus?

Insulin deficiency from autoimmune destruction of beta cells.

What are 4 common symptoms of Type 1 diabetes?

Polydipsia (thirst)

Polyuria (pee)

Acetone Breath-fruity

Glucosuria

What is Type 2 diabetes mellitus?

Insulin-resistant diabetes that accounts for 90% of all cases.

What are the initial symptoms of Type 1 Diabetes in children? What's an easy way to diagnose it?

Polyuria and polydipsia.

Take a Glucose test.

What are the adverse effects of antibiotics used for UTIs? (6)

GI distress

Neurotoxicity

Breathing problems

Tendon rupture

Photosensitivity

Impaired bone formation.

What antibiotic may cause tendon rupture

fluroquinolones

What is a major risk of exercising with diabetes?

Hypoglycemia risk.

Exercise ↑ glucose uptake by muscles → blood sugar can plummet.

What 2 tests may indicate pyelonephritis?

Costovertebral percussion test

Clinical diagnosis; CT

What is the common cause of acute pyelonephritis? What are the 4 common symptoms?

E. coli.

Fever, Chills, Headache, Flank pain

What imaging is used for prostate cancer diagnosis? How about Bladder pathology?

Prostate = MRI

Bladder = Ultrasound

What is benign prostatic hyperplasia (BPH)?

Age-related, non-malignant enlargement of the prostate that compresses the urethra

Medication for BPH

alpha blockers relax prostate muscles and bladder neck

What symptoms are associated with BPH?

Decreased urinary flow, urinary retention, dysuria, weak urinary stream.

What 3 big things can lead to kidney stones?

Chronic dehydration, gout, acidic urine pH

4 Nutrient factors for developing kidney stones

Excess intake of calcium, sodium, animal protein, and sucrose.

What is a big marker for Prostate Cancer

Steep rise in prostate-specific antigen (PSA) *a marker for prostate cancer

What are the 4 signs and symptoms of acute prostatitis?

fever, chills, pelvic pain, steep rise in PSA.

What are the 4 signs and symptoms of chronic prostatitis?

Pelvic pain with urinary symptoms, pain worsened by sitting or squatting.

Relieved or irritated by ejaculation

What do children with UTI experience

enuresis (bed-wetting)

What is Functional incontinence?

normal urine control but difficulty reaching a toilet in time due to muscle or joint dysfunction

What is Stress incontinence?

loss of urine during activities such as coughing, lifting, or laughing

What is Urge incontinence?

sudden unexpected urge to urinate, often related to reduced bladder capacity or detrusor instability

What is Overflow Incontinence?

constant leaking of urine from a bladder that is full

What are the 4 muscle relaxants used for spasticity in congenital disorders like CP?

Baclofen

Dantrolene sodium

Diazepam

Botox

Spastic cerebral palsy

Most common type; Muscles are tight, stiff, and overactive

Dyskinetic cerebral palsy

Involuntary, uncontrolled movements; Movements can be jerky

Ataxic cerebral palsy

poor with balance, coordination, depth perception; Movements shaky/unsteady

What are the long-term effects of radiation treatment for pediatric cancer?

Fibrosis and tissue injury.

What are the 6 long-term effects of chemotherapy for pediatric cancer?

Pulmonary, cardiac, endocrine, reproductive dysfunction, osteoporosis, neurocognitive loss.

What role does iodine play in thyroid function?

allows the thyroid to produce hormones T3 and T4, regulating metabolism and growth.

When should you refer a physician for urogenital concerns? (3)

Unexplained or Disproportionate pelvic regional pain

4 Ps for DM

What are the 4 Ps for DM

Polyuria

Polydipsia

Polyneuropathy

Polyphagia

When should you refer a physician for Endocrine concerns? (3)

Uncontrolled HTN

Uncontrolled blood sugar

Thyroid storm.

What symptoms may indicate a need for physician referral in hematological concerns? (5)

Fainting, delayed processes, severe onset of headaches

Cyanosis, Paleness,

Unexplained hemosiderin staining.

How can exercise intensity be monitored in patients taking beta blockers?

Using the RPE (Rate of Perceived Exertion) or talk test.

What is primary hypercortisolism?

An adrenal tumor that autonomously secretes cortisol.

What is secondary hypercortisolism?

A tumor that secretes ACTH.

What are 3 adverse effects of untreated hypercortisolism?

Hyperglycemia, hypertension, muscle wasting.

What is cystic fibrosis?

A genetic defect in how chloride and mucus are transported, leading to salty sweat.

What are the 2 clinical presentations of cystic fibrosis?

Hyper viscosity of mucus and malnutrition in children.

What is Marfan syndrome?

A structural protein defect in fibrillin.

What are the 5 clinical presentations of Marfan syndrome?

Slender skeleton, elongated head, vertebral deformity, hyper-laxity, long fingers.

What causes Down syndrome?

An extra copy of chromosome 21.

PT consideration for Down Syndrome

Instability of the atlantoaxial joint; careful w rotation

What are the 5 clinical presentations of Down syndrome?

Congenital heart defects

Early-onset Alzheimer's

Shorter limbs, low bridge nose, macroglossia.

What is Turner's syndrome?

A defect on the 45th chromosome affecting the X chromosome.

What are the 5 clinical presentations of Turner's syndrome?

Only females, webbed neck, heart-shaped face, infertility, no puberty.

What is spina bifida?

A condition with incomplete fusion of the posterior vertebral arch.

Spina bifida Occulta

incomplete fusion of the posterior vertebral arch

Spina Bifida Meningocele

external protrusion of the meninges

Spina Bifida Myelomeningocele

protrusion of the meninges and spinal cord

What are 3 Nutritional risk factors for anemia?

Deficiencies in iron, folate, vitamin B12.

What is sickle cell anemia?

A condition caused by a single point mutation in the β-globin gene.

What are the 4 clinical manifestations of sickle cell anemia?

Jaundice, pallor, fatigue, irritability.

What is the first line of therapy for sickle cell anemia?

Hydroxyurea.

What is leukopenia?

A drop in WBC, leading to immunosuppression.

What is polycythemia?

An increase in whole blood viscosity and volume.

What is hemophilia?

A bleeding disorder due to a missing clotting factor.

What are the 4 signs and symptoms of hemophilia?

Warmth, swelling, palpable hematoma, numbness.

What is thrombocytopenia?

A condition with too few platelets, increasing the risk of bruising and bleeding.

What are 3 potential effects of long-term steroid use?

Muscle wasting, avascular necrosis, myopathy.

What is Cushing's syndrome?

Iatrogenic hypercortisolism.

What are the 2 clinical manifestations of Cushing's syndrome?

Hyperglycemia and hypertension.

3 concerns to note when screening the thyroid

Node enlargements, firmness, tenderness.

What are 3 signs of hyperthyroidism (Graves Disease)?

Exophthalmos

Heat intolerance

Tremors/Cardiac Arryhtmias

T3, T4, TASH, and TRH in Hyperthyroidism

high T3 and T4.

low TASH and TRH

What are 3 signs of hypothyroidism?

Cold intolerance

Myxedema (puffy face)

Bradycardia

Pharm Management of Hyperthyroidism

Radioactive iodine therapy

Methimazole or propylthiouracil (block thyroid synthesis)

Pharm Management of Hypothyroidism

Oral-Thyroid Hormone

What causes osteogenesis imperfecta?

Mutations in the COL1A1 or COL1A2 genes leading to insufficient collagen.

What are the 2 clinical manifestations of osteogenesis imperfecta?

Frequent fractures, bone deformities.

What is the pharmacological management for Hypercortisolism (Cushing's) or Hypocortisolism (Addison's Disease)

Glucocorticoids as anti-inflammatory agents and for replacement therapy.

What are 3 symptoms of hypocortisolism (Addison's Disease)?

Decreased gluconeogenesis, hypoglycemia, weakness, fatigue.