Other Systems 1 Lecture

A review of the patient’s medical chart shows blood pressure of 168/90 mmHg, triglyceride level of 160 mg/dL, and a fasting blood glucose level of 115 mg/dL. The patient’s body mass index is 40 kg/m2 and waistline is 54 inches. What are these findings suggestive of?

a. chronic heart disease

b. type 2 diabetes

c. metabolic syndrome

d. stage 1 hypertension

c. metabolic syndrome

metabolic syndrome

consists of signs and symptoms that are risk factors and are strongly linked to type 2 diabetes, cardiovascular disease, and stroke

need 3 or more S/S present:

• waist circummference (>40 M, >35 F)

• triglycerides 150 mg/dL or higher

• HDL (<40 M, <50 W)

• blood pressure 130 mmHg systolic or higher, 85 mmHg or higher diastolic

• fasting plasma glucose >100 mg/dL

Metabolic Syndrome Mnemonic

WEIGHHT

Hypothalamus

regulation of ANS

body temperture, thirst, sweating, sexual behavior, rage, fear, blood pressure, sleep

Pituitary Gland

secretes endrophins and reduces a person’s sensitivity to pain

controls ovulation

works as catalyst for testes and ovaeries to create sex hormones

Thyroid Gland

produces hormones that act to control the rate at which cells burn the fuel from food

parathyroid gland

regulate calcium and phosphate metabolism

adrenal gland

produces corticosteroids that will regulate water and sodium balance , body’s response to stress, immune system, metabolism

Addison’s Disease cause

infections, neoplasm, hemorrhage, autoimmune process

Addison’s disease is an insufficiency of the

adrenal gland

Addison’s disease S/S

decrease BP, dehydration

hyperkalemia

decreased glucose

bronze pigmented skin

weight loss, anorexia, GI disturbances

generalized weakness

intolerance to cold and stress, anxiety and depression

Addison Disease Mnemonic

Miss Addison

brown old petite lady walking with a stick

Cushing Disease Cause

pituitary tumor with increased ACTH secretion

Cushing Disease causes

elevated cortisol and aldosterone

Cushing Disease S/S

increased BP, water retention

hypokalemia

increased glucose

ruddy appearance, striae on skin

weight gain, centripetal obesity, round moon face

proximal muscle weakness and atrophy

increased susceptibility to infection, osteoporosis (buffalo hump), poor wound healing

Cushing Disease Mnemonic

Mr. Cushing

Santa Claus

a white chubby boy who loves chugging beer, pink cheeks, big belly

a patient reports having significant weight gain in their abdomen and face. lab shows high levels of cortisol and high levels of ACTH secreted by the pituitary gland. What is the MOST LIKELY diagnosis?

a. addison’s disease

b. hashimoto’s disease

c. cushing disease

d. cushing syndrome

c. cushing disease

Cushing Disease

pituitary adenoma - more ACTH secreted by pituitary gland - stimulates adrenal gland - more cortisol released

cushing syndrome

adrenal gland tumor - adrenal gland secretes more cortisol - drug toxicity

Hyperthyroidism

increased T3 and T4, low TSH

increased HR

high BMR

heat intolerance

increased glucose absorption

restlessness, insomnia

diarrhea

silky hair, moist palm

weight loss and increased appetitie

increased perspiration

hyperreflexia

Exophthalmos, Graves’ disease

Hypothyroidism

decreased T3 T4, increased TSH

decreased HR

low BMR

cold intolerance

decreased glucose absorption

sleepiness, tiredness, proximal muscle weakness

constipation

brittle nails, dry skin and hair

weight gain and decreased appetite

decreased perspiration

prolonged DTR

Myxedema, Hashimoto’s disease

hypothyroidism example

lazy person laying on couch all day watching TV in sidelying

patient reports persistent fatigue, recent weight gain despite decreased appetitie, constipation, and dry skin due to a thyroid gland disorder. Which of the following findings BEST correlates with this presentation?

a. increased HR, low BP, heat intolerance

b. decreased HR, high BP, cold intolerance

c. increased HR, low BP, cold intolerance

d. decreased HR, high BP, heat intolerance

b. decreased HR, high BP, cold intolerance

Hyperparathyroidism

elevated calcium and decreased serum phosphate

can demineralize bone - bone weakness and decreased density

hyperparathyroidism symptoms

osteopenia, gout, arthralgia, kidney stones, renal insufficiency, peptic ulcers, proximal muscle weakness, fatigue, depression, confusion, drowsiness, glove/stocking sensory loss

hyperparathyroidism mnemonic

bones, stones, groans, moans, sensory

hypoparathyroidism

low calcium and high phosphorus

hypoparathyroidism symptoms

convulsions, cardiac arrhythmias, muscle twitching, tetany, muscle cramps, muscle spasms, paresthesia of fingertips and mouth, fatigue, weakness

hypoparathyroidism mnemonic

CATS are numb

a patient presents to the clinic with hyperfunction of the fland shown. Which of the following signs and symptoms are MOST LIKELY to be associated with this condition

a. hypocalcemia and hyperphosphatemia

b. convulsions and tetany

c. osteopenia and peptic ulcers

d. weight gain and decreased appetite

c. osteopenia and peptic ulcers

Type 1 Diabetes Mellitus

pancreas produces no insulin - insulin dependent DM

diagnosed mostly at childhood, but can be any age

Type 1 Diabetes Mellitus Symptoms

polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision and dehydration

Type 2 Diabetes Mellitus

body resistance to insulin - insulin resistant DM

occurs secondary to other dysfunctions

Type 2 Diabetes Mellitus Symptoms

similar to type 1

rare occurance of ketoacidosis

Diagnosis of DM

Fasting blood glucose level >126

Random blood glucose level >200

Hb1AC levels > 7%

Hypoglycemia Glucose Levels

<70 mg/dL

Hypoglycemia Early Signs

pallor, sweating

shakiness

poor coordination and unsteady gait

tachycardia and palpitations

dizziness, fainting

excessive hunger

Hypoglycemia Mnemonic

TIRED

Hypoglycemia Late Signs

slurred speech, drowsiness, confusion

loss of consciousness and coma

Hyperglycemia Glucose Levels

> 300 mg/dL

Hyperglycemia Early Signs

dry mouth

frequent, scant urination

deep and rapid respirations

dull sense, confusion, diminished reflexes

excessive thirst

Hyperglycemia Late Signs

fruity odor (acetone breath)

hyperglycemia coma

Unsafe Blood Glucose Levels to Exercise (low)

<70 mg/dL

70-100 mg/dL

give them a carb snack and wait til it reaches 100

then able to exercise

100-250 mg/dL

safe to exercise

250-300 mg/dL

without ketone

exercise with caution

250 mg/dL with ketones

emergency

above 300 mg/dL

never exercise

avoid exercise during peak insulin hours which is

2-4 hours after absorption

insulin is absorbed quicker in an active extremity

insulin dosage reduced after exercise

Diabetic Footcare

screening

wash feet daily in warm water

keep toenails cut straight across

clean, white socks, avoid wrinkles

alternate shoes

snug fit laces or velcro

a patient who is obese (33 kg/m2) with type 2 DM, is working out on the treadmill in hospital setting. While exercising, the patient suddenly develops lightheadedness, dizziness, and instability. Which of the following is the MOST APPROPRIATE action to be taken by the PT?

a. stop the treadmill and call the PCP

b. stop the treadmill and give patient orange juice

c. stop treadmill and give patient insulin injection

d. stop the treadmill and give patient a slice of whole grain bread

b. stop the treadmill and give patient orange juice

Which of the following diagnosis is MOST LIKELY based on patient presentation

a. stress incontinence

b. overflow incontinence

c. functional incontinence

d. urge incontinence

a. stress incontinence

stress incontinence

involuntary leakage of urine during cough, sneezing or exertion

can be seen postpartum pelvic floor muscle weakness

urge incontinence

involuntary contraction of the detrusor muscle with a strong desire to void (urgency)

can be seen with infections, Parkinson’s disease, UMN lesions

overflow incontinence

incontinence caused by acontractile or underactive detrusor muscle

bladder is overdistended, can not empty completely and urine dribbles or leaks out

can be seen with benign prostatic hyperplasia, DM

functional incontinence

incontinence due to mobility, dexterity or cognitive deficits

can be seen with dementia, lower extremity weakness

which of the following is MOST APPROPRIATE intervention for this patient?

a. use of absorbent pads

b. pelvic floor exercises targeting levator ani muscles

c. scheduled toileting and prompted voiding

d. continuous catheterization

b. pelvic floor exercises targeting levator ani muscles

stress incontinence treatment

strengthen pevlic floor muscles

urge incontinence treatment

treat infections, voiding schedule

functional incontinence treatment

clear clutter, improve accessibility, and prompted voiding

overflow incontinence treatment

behavioral modification like double voiding, medication and catheterization

What is the BEST initial physical therapy intervention?

a. supine, perform contractions held for 3 seconds each

b. left sidelying and perform contractions held for 5 seconds

c. right sidelying and perform contractions held for 5 seconds

d. sitting and perform contractions held for 10 seconds each

b. left sidelying and perform contractions held for 5 seconds