Question:
Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.
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1 points
Allergies: none known to drugs or food or environmental
Medications-20 mg prednisone po qd, omeprazole 10 po qam
PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries.
Social-denies alcohol, illicit drugs, vaping, tobacco use
Physical exam
Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.
ROS negative other than GI symptoms.
Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.
Question:
Explain why the patient exhibited these symptoms?
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1 points
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1 points
The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis.
Question 1 of 2:
Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism.
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0.5 points
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0.5 points
Question:
What serious consequences of hypoparathyroidism occur and why? — Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)– Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family —- Font size —Path: pWords:0
1 points
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child
Allergies-none know
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.
Labs in office: random glucose 220 mg/dl.
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.
Question 1 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”
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1 points
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child
Allergies-none know
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.
Labs in office: random glucose 220 mg/dl.
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.
Question 2 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”
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1 points
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1 points
PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child
Allergies-none know
Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.
Labs in office: random glucose 220 mg/dl.
Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.
Question 4 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”
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0.5 points
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0.5 points
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1 points
BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA
Admission labs: Hgb 14.6 g/dl; Hct 58%
CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;
Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;
Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L.
Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air)
HCO3-7.5mmol/L; anion gap 19.4
A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.
Question:
The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.
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1 points
Question:
Explain the underlying processes that lead to HHNKS or HHS.
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1 points
Question:
How would you differentiate Cushing’s disease from Cushing’s syndrome?
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1 points
Question:
What is the pathogenesis of primary hyper-aldosteronism?
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1 points
Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.
Question:
What is the basic underlying pathophysiology of Type II DM?
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1 points
Question:
What causes diabetes insipidus (DI)?
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0.5 points
Question:
Explain how the negative feedback loop controls thyroid levels.
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1 points
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