Non-Systems

Pathophysiology of Addison’s disease?

• Adrenal insufficiency

  • decreased Cortisol & Aldosterone

Pathophysiology of Cushing’s disease?

• Pituitary tumor & increase ACTH secretion

• elevated cortisol & aldosterone

Addison’s disease

• Decreased BP, dehydration

• hyperkalemia

• decreased glucose

• bronze pigmentation skin

• weight loss, anorexia, GI disturbance

• generalized weakness (asthenia)

• intolerance to cold & stress

• anxiety & depression

Cushing’s disease

• increased BP, water retention

• hypokalemia

• increased glucose

• ruddy appearance, striae on skin (stretch marks)

• weight gain, centripetal obesity, round moon face, buffalo hump

• proximal weakness & atrophy

• increased susceptibility to infection & osteoporosis

• poor wound healing

Hyperthyroidism

• Increased T3 & T4; Low TSH

• Increased HR

  • BG & BP decreases

• high BMR (basal metabolic rate)

• heat intolerance

• increased glucose

• restless, insomnia (decreased BMD)

• diarrhea

• silky hair, moist palm

• weight loss & increased appetite

  • increased osteoporosis

• increased perspiration (sweat)

• hyperreflexia

• exophthalmos, Graves’ disease (eyes bulging)

Hypothyroidism

• decreased T3 & T4, high TSH

• decreased HR

  • Increase BP & BG

• Low BMR (basal metabolic rate)

• cold intolerance

• decreased glucose

• sleeplessness, tiredness, proximal muscle weakness

• constipation

• brittle nails, dry skin & hair

• weight gain & decreased appetite

• decreased perspiration (sweating)

• prolonged deep tendon reflexes

• myxedema, hashimoto’s disease

Pathophysiology of Hyperparathyroidism

• elevated calcium & decreased serum phosphate in blood

• demineralized bone

Pathophysiology of hypoparathyroidism

• low calcium & high phosphorus in blood

Hyperparathyroidism

“Bones, Stones, Moans, Groans”

• Bones - osteopenia, gout, arthralgia

• Stones - Kidney stones, renal insufficiency

• Moans - proximal weakness, fatigue, depression

• Groan - peptic ulcers

• Sensory - glove/stock sensory loss

Hypoparathyroidism

“CATS are numb”

• C - convulsion

• A - arrhythmias

• T - twitching

• S - spasms

• numb = paresthesia of fingers and mouth

• Trousseau sign: Carpopedal spasms

• Chvostek sign: tingling/numbness in facial nerve

Hypoglycemia

• Glucose level: < 70 mg/dL

• “TIRED”

  • tachycardia

  • irritability

  • restless

  • excessive hunger

  • dizziness

Hyperglycemia

• Glucose level: > 300 mg/dL

• weakness

• dry mouth

• frequent urination

• deep & rapid respirations (Kaussmal breathing)

• dull senses, confusion, diminished reflexes

• excessive thirst

• fruity breath (acetone)

should you avoid exercise during peak insulin hours? (2-4 hours)

Yes

Is insulin absorbed more quickly in active extremities?

yes

How much should insulin be reduced after exercise?

10-30%

Should a patient exercise in the afternoon to avoid hypoglycemia?

No, exercise in the morning is recommended

What is a safe blood glucose level to exercise?

100-250 mg/dL

What is the blood glucose level when exercise contraindicated?

• < 70 mg/dL or > 300 mg/dL

What should you do if a patient’s BG level is 70-100 mg/dL prior to exercise?

• give them carb snack & wait until it gets to 100 mg/dL before exercising

What should you do if a patient’s BG level is 100-250 mg/dL prior to exercise?

Nothing, patient is safe to exercise

What should you do if a patient’s BG level is 250-300 mg/dL without ketone prior to exercise?

exercise with caution

What should you do if a patient’s BG level is 250-300 with ketone bodies mg/dL prior to exercise?

• emergency situation, no exercise

What should you do if a patient’s BG level is > 300mg/dL prior to exercise?

Don’t exercise

Stress incontinence

involuntary leakage of urine during cough, sneezing, exertion

What levator Ani Muscles are involved with stress incontinence?

• pubococcygeus

• Iliococcygeus

• Pubo Rectalis

What is the treatment for Stress incontinence?

• strengthen pelvic floor muscles

Urge incontinence

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

• can be seen with infections, PD, UMN lesion

What is the treatment for Urge incontinence?

• treat infections

• voiding schedule

Overflow incontinence

• incontinence caused by acontractile or underactive detrusor muscles

• bladder is overdistended & cannot empty completely

• seen with BPH, DM

What is the treatment for overflow incontinence?

• behavioral modification like double voiding, medication & catherization

Functional incontinence

• incontinence due to mobility, dexterity, cognitive deficits

• seen with dementia & LE weakness

Treatment for functional incontinence

• clear clutter in environment

• improve accessibility

• prompted voiding

What are cardiovascular changes in pregnancy?

• increase blood volume

• increase venous pressure in LE in standing

• increase pressure in vena cava

• heart size increase

• BP decrease

• CO increases

• resting HR increase

What are pulmonary changes in pregnancy?

• depth of respiration increase

  • RR unchanged

• tidal volume & minute ventilation increases

  • TLC remain unchanged

• work of breathing increases

• dyspnea with mild exertion at 20 weeks

What are thermoregulatory changes in pregnancy?

• Metabolic rate & heat production increases

• fasting blood glucose level decreases

Preeclampsia

• pregnancy induced acute Hypertension

• increase in protein in urine, hyperreflexia, edema, headache, sudden weight gain

• BP > 140/90

• Emergency situation

What are treatment for Diastasis Recti?

• head lift

• head lift with pelvic tilt

What are treatment for > 2cm Diastasis recti?

• abdominal bracing & head lift

What are treatment for > 4cm Diastasis recti?

• abdominal bracing & breathing exercises

GERD

• heart burn ~ 30 minutes after eating & at night lying down

• dysphagia

• sour taste

• hoarseness of voice

• atypical pain of the head & neck

• left shoulder pain

What are complications of GERD?

• aspiration pneumonia, asthma

• Esophagitis

What are treatment for GERD?

• maintain upright position

• eat meals at least 3-4 hours before sleep

• Avoid supine

• sleep on left side

• Exercise 2-3 hours before meals or after eating

• Avoid spicy food, chocolate, fatty food, peppermint

What drugs can be used to treat GERD?

• Antacid

• H2 receptor blockers

• proton pump inhibitor

Which muscles refer pain to the mid back/scapula?

“PEGS”

• Pancreas

• esophagus

• gall bladder

• stomach

What muscles refer pain to the left shoulder?

“Don’t Shrug Too Hard”

• diaphragm

• Spleen

• Tail of pancreas

• Heart

What muscles refer pain to the right shoulder?

“Good Luck Harry”

• Gallbladder

• Liver

• Head of pancreas

What muscles refer pain to the pelvis/low back/ sacrum?

“CAP”

• Colon

• appendix

• pelvic viscera

Pancoast Tumor

• Pain referred in C8-T2 nerve distribution

• Mimics TOS

• pain on top of shoulder & ipsilateral shoulder

• systemic symptoms (SOB, weight loss, night pain)

What are causes of right upper quadrant pain? (RUQ)

“Good Luck Harry Potter Kid”

• Gall bladder

• Liver

• Head of pancreas

• Peptic ulcer

• Kidney

What are causes of right lower quadrant pain? (RLQ)

“AC”

• Appendix

• Crohn’s disease

What are causes of left upper quadrant pain? (LUQ)

“Don’t Be Silly Kid Harry”

• Diaphragm

• Body & tail of pancreas

• Spleen

• Kidney

• Heart

What are causes of left lower quadrant pain? (LLQ)

“DUI”

• Diverticulitis

• Ulcerative colitis

• IBS

Where does Hiatal hernia refer pain to?

• Left shoulder

• symptoms similar to GERD

Where does femoral hernia refer pain to?

lateral pelvic wall pain & groin pain

Where does inguinal hernia refer pain to?

Groin

Where does umbilical hernia refer pain to?

umbilical ring in mid to lower abdomen

What is Cholecystitis?

blockage or impaction of gallstones in the cystic duct resulting inflammation of the gallbladder

What are symptoms of Cholecystitis?

• Pain in RUQ, radiating to right scapula

• nausea, vomiting, low grade fever

• pain increases with ingestion of fatty food

• Positive Murphy Sign

What test is used to diagnosed Cholecystitis?

• Murphy sign

  • palpate near right subcostal margin as patient takes deep breath

  • Test is positive If pain & tenderness is elicited during inspiration

What are signs of peptic ulcers?

• burning, cramping in epigastric area

  • can refer to right shoulder

• coffee ground emesis (vomit)

• black tarry stools

What are symptoms of Crohn’s disease?

• pain relieve by passing gas

• reactive arthritis

  • Conjunctivitis (can’t see)

  • Urethritis (can’t pee)

  • OA of big joints (knee & hip)

What are symptoms of IBS?

• abdominal cramping

• ribbon like stools

• pain relieve by passing stools and at rest

What are symptoms of liver disease?

• palmar erythema

• asterixis (flapping tremor of hand)

• easy bruising

• dark color urine

• light (clay) colored stools

What are symptoms of appendicitis?

• anorexia, nausea, vomiting, elevated temperature, leukocytosis, fever

• positive mcburney’s point, rovsing’s sign, blumberg’s sign

What are special tests for appendicitis?

• Mcburney’s point

  • tenderness at RLQ

• Rovsing’s sign

  • palpate LLQ leads to pain in RLQ

• Blumberg’s sign

  • rebound tenderness

  • Apply pressure at tenderness spot and let go very quickly; patient reports more pain when letting go

• Obturator sign

  • PROM IR of flexed tight

• Psoas sign

  • PROM extension of thigh

• Single hop test

  • hopping on right LE reproduce pain

• Markle’s sign

  • heel drop reproduces pain

  • can be done in standing or supine