NURS 5338 Final Exam | UPDATED Questions with 100%
Verified Answers
Q1: hypothyroidism
A: hashimoto's
insufficient thyroid hormones (T3 + T4)
primary hypothyroid - elevated TSH, low T4, low T3
subclinical hypothyroid - elevated TSH, normal T4 & T3
congenital hypothyroidism - present at birth
Causes - can be caused by meds like amiodarone or lithium, by iodine deficiency,
iatrogenic (thyroidectomy or radioactive iodine)
S/S -- Think "everything slows down"
Fatigue, weight gain
Cold intolerance
Constipation
Depression
Dry skin, hair loss
Bradycardia
Menstrual irregularities
Dry, coarse skin
Periorbital edema
S/S in babies: lethargy, poor feeding, hypotonia, jaundice, hoarse cry, macroglossia,
coarse face hairs, constipation, umbilical hernia
Q2: Hypothyroid treatment
A: Levothyroxine - healthy adults <60 - 1.6mcg/kg/day
Elderly/Comorbidities - 12.5-25mcg/kg/day
TSH determines levothyroxine dosage
subclinical - treat if TSH >10
Adjust dose q4-6 weeks, once stable every 6-12 months
Pregnancy - increase levothyroxine dose by 30%
Synthroid - synthetic treatment containing T4
Armour Thyroid (Desiccated) - unpredictable, derived from pig, less stable, contains
T3+T4
Take first thing in the morning on an empty stomach
Avoid taking with calcium or iron supplements
Q3: Myxedema Coma
A: Emergency!
Severe hypothyroidism
AMS, hypothermia, bradycardia
Q4: Hyperthyroidism
A: excess T3 and T4
Primary hyperthyroid - low TSH, elevated T3/T4
,S/S: goiter, exophthalmos, pretibial myxedema, heat intolerance, weight loss, tremors,
tachycardia, palpitations, tachycardia, fatigue, tremor, depression, light periods,
hyperreflexia, insomnia, anxiety
clonus: abnormal reflex movements of the foot by sudden dorsiflexion causing
contraction and relaxation
Q5: Hyperthyroidism Treatment
A: 1st line: methimazole - inhibits thyroid hormone synthesis
Pregnancy - use PTU in first trimester
Other options
Beta blocker to manage tachycardia
Radioactive iodine - treatment of graves
Surgery to remove goiter, nodules, malignancy
Q6: Addison's Disease
A: Primary Adrenal Insufficiency - damage to the adrenal gland decreases cortisol and
aldosterone
Primary - caused by autoimmune, TB, HIV, CMV, fungal, tumors, congenital adrenal
hyperplasia, hemorrhage
Secondary - caused by pituitary dysfunction leading to decreased ACH and adrenal
atrophy, can be from chronic steroid use with abrupt withdrawal
S/S: fatigue, weight loss, hypotension, salt craving, hyperpigmentation
Q7: Addisonian Crisis
A: life threatening cortisol deficiency
triggered by stress, illness, steroid withdrawal
s/s: hypotension, shock, hyponatremia, hyperkalemia
Tx: IV hydrocortisone, fluids, correct electrolytes, give glucose
Q8: Cushing's Syndrome
A: chronic cortisol excess
Tx: gradual taper of steroids
Q9: Cushing's Disease
A: pituitary adenoma causing increased ACTH leading to increased cortisol
s/s: moon face, buffalo hump, central obesity, HTN, hyperglycemia, muscle weakness,
purple striae, skin thinning, easy bruising, poor wound healing
Untreated can cause osteoporosis, infections, severe hypertension
Dx
1st line tests - 24 hour urinary free cortisol and low dose dexamethasone suppression test
Tx: transsphenoidal surgery (remove adenoma)
Q10: Hyperparathyroidism
,A: Primary: increased PTH and calcium, decreased Phos
Secondary: increased PTH and phos, decreased or normal calcium
Tx: parathyroidectomy
Q11: Hypoparathyroidism
A: decreased PTH and calcium, increased phos
Tx: calcium and Vitamin D
Q12: TSH
A: produced by anterior pituitary in response to thyrotropic releasing hormone
stimulated by thyrotropin releasing hormone (TRH)
stimulates thyroid gland to produce T3 and T4
regulated by negative feedback loop
inhibited by somatostatin
Q13: T3
A: active thyroid hormone responsible for regulating metabolism, HR, body temp
mostly derived from peripheral conversion of T4
More potent than T4, shorter 1/2 life
Q14: T4
A: major hormone produced by thyroid
prohormone that gets converted to T3
Q15: Diabetes Diagnosis
A: A1c >/= 6.5
Random glucose >/=200
Fasting glucose >/=126
Oral glucose tolerance test >/=200
Q16: causes of goiter
A: lack of iodine
hypothyroidism
hyperthyroidism
nodules
thyroid cancer
pregnancy
thyroiditis
sporadic goiter
Q17: Graves disease
A: hyperthyroidism
autoimmune, thyrotropin receptor antibiodies
, females > males
age 40-60
family hx
triggered by stress, too much iodine, or recent pregnancy
exopthalamos - smoking increases risk of progression to orbitopathy, can be unilateral or
bilateral
Q18: ACTH
A: adrenocorticotropin
produced in anterior pituitary
controls secretion of adrenal cortex hormones (cortisol)
stimulated by stress and corticotropin releasing hormone
inhibited by increased levels of cortisol (neg feedback) and by substance P
Q19: Growth Hormone
A: produced by anterior pituitary
regulates metabolic processes related to growth, bone/cartilage growth and protein
building
stimulated by GHRH and substance P
inhibited by somatostatin
Q20: prolactin
A: produced in anterior pituitary
involved in milk production, modulates immunity and inflammatory responses, mammary
gland development
stimulated by substance P, prolactin releasing hormone, and serotonin growth factors
inhibited by prolactin inhibiting hormone and dopamine
Q21: Thyrotropin releasing hormone
A: produced by hypothalamus
stimulates release of TSH, modulates prolactin secretion
stimulated by low T3/T4 levels, cold temps
inhibited by high T3/T4, stress, and cortisol
Q22: Corticotropin releasing hormone
A: produced by hypothalamus
stimulates release of ACTH and beta endorphin
stimulated by low cortisol levels, stress, diurnal rhythm (levels rise in morning)
inhibited by high cortisol levels
Q23: oxytocin
A: produced in posterior pituitary
stimulates contraction of the uterus and milk ejection in lactating women
Verified Answers
Q1: hypothyroidism
A: hashimoto's
insufficient thyroid hormones (T3 + T4)
primary hypothyroid - elevated TSH, low T4, low T3
subclinical hypothyroid - elevated TSH, normal T4 & T3
congenital hypothyroidism - present at birth
Causes - can be caused by meds like amiodarone or lithium, by iodine deficiency,
iatrogenic (thyroidectomy or radioactive iodine)
S/S -- Think "everything slows down"
Fatigue, weight gain
Cold intolerance
Constipation
Depression
Dry skin, hair loss
Bradycardia
Menstrual irregularities
Dry, coarse skin
Periorbital edema
S/S in babies: lethargy, poor feeding, hypotonia, jaundice, hoarse cry, macroglossia,
coarse face hairs, constipation, umbilical hernia
Q2: Hypothyroid treatment
A: Levothyroxine - healthy adults <60 - 1.6mcg/kg/day
Elderly/Comorbidities - 12.5-25mcg/kg/day
TSH determines levothyroxine dosage
subclinical - treat if TSH >10
Adjust dose q4-6 weeks, once stable every 6-12 months
Pregnancy - increase levothyroxine dose by 30%
Synthroid - synthetic treatment containing T4
Armour Thyroid (Desiccated) - unpredictable, derived from pig, less stable, contains
T3+T4
Take first thing in the morning on an empty stomach
Avoid taking with calcium or iron supplements
Q3: Myxedema Coma
A: Emergency!
Severe hypothyroidism
AMS, hypothermia, bradycardia
Q4: Hyperthyroidism
A: excess T3 and T4
Primary hyperthyroid - low TSH, elevated T3/T4
,S/S: goiter, exophthalmos, pretibial myxedema, heat intolerance, weight loss, tremors,
tachycardia, palpitations, tachycardia, fatigue, tremor, depression, light periods,
hyperreflexia, insomnia, anxiety
clonus: abnormal reflex movements of the foot by sudden dorsiflexion causing
contraction and relaxation
Q5: Hyperthyroidism Treatment
A: 1st line: methimazole - inhibits thyroid hormone synthesis
Pregnancy - use PTU in first trimester
Other options
Beta blocker to manage tachycardia
Radioactive iodine - treatment of graves
Surgery to remove goiter, nodules, malignancy
Q6: Addison's Disease
A: Primary Adrenal Insufficiency - damage to the adrenal gland decreases cortisol and
aldosterone
Primary - caused by autoimmune, TB, HIV, CMV, fungal, tumors, congenital adrenal
hyperplasia, hemorrhage
Secondary - caused by pituitary dysfunction leading to decreased ACH and adrenal
atrophy, can be from chronic steroid use with abrupt withdrawal
S/S: fatigue, weight loss, hypotension, salt craving, hyperpigmentation
Q7: Addisonian Crisis
A: life threatening cortisol deficiency
triggered by stress, illness, steroid withdrawal
s/s: hypotension, shock, hyponatremia, hyperkalemia
Tx: IV hydrocortisone, fluids, correct electrolytes, give glucose
Q8: Cushing's Syndrome
A: chronic cortisol excess
Tx: gradual taper of steroids
Q9: Cushing's Disease
A: pituitary adenoma causing increased ACTH leading to increased cortisol
s/s: moon face, buffalo hump, central obesity, HTN, hyperglycemia, muscle weakness,
purple striae, skin thinning, easy bruising, poor wound healing
Untreated can cause osteoporosis, infections, severe hypertension
Dx
1st line tests - 24 hour urinary free cortisol and low dose dexamethasone suppression test
Tx: transsphenoidal surgery (remove adenoma)
Q10: Hyperparathyroidism
,A: Primary: increased PTH and calcium, decreased Phos
Secondary: increased PTH and phos, decreased or normal calcium
Tx: parathyroidectomy
Q11: Hypoparathyroidism
A: decreased PTH and calcium, increased phos
Tx: calcium and Vitamin D
Q12: TSH
A: produced by anterior pituitary in response to thyrotropic releasing hormone
stimulated by thyrotropin releasing hormone (TRH)
stimulates thyroid gland to produce T3 and T4
regulated by negative feedback loop
inhibited by somatostatin
Q13: T3
A: active thyroid hormone responsible for regulating metabolism, HR, body temp
mostly derived from peripheral conversion of T4
More potent than T4, shorter 1/2 life
Q14: T4
A: major hormone produced by thyroid
prohormone that gets converted to T3
Q15: Diabetes Diagnosis
A: A1c >/= 6.5
Random glucose >/=200
Fasting glucose >/=126
Oral glucose tolerance test >/=200
Q16: causes of goiter
A: lack of iodine
hypothyroidism
hyperthyroidism
nodules
thyroid cancer
pregnancy
thyroiditis
sporadic goiter
Q17: Graves disease
A: hyperthyroidism
autoimmune, thyrotropin receptor antibiodies
, females > males
age 40-60
family hx
triggered by stress, too much iodine, or recent pregnancy
exopthalamos - smoking increases risk of progression to orbitopathy, can be unilateral or
bilateral
Q18: ACTH
A: adrenocorticotropin
produced in anterior pituitary
controls secretion of adrenal cortex hormones (cortisol)
stimulated by stress and corticotropin releasing hormone
inhibited by increased levels of cortisol (neg feedback) and by substance P
Q19: Growth Hormone
A: produced by anterior pituitary
regulates metabolic processes related to growth, bone/cartilage growth and protein
building
stimulated by GHRH and substance P
inhibited by somatostatin
Q20: prolactin
A: produced in anterior pituitary
involved in milk production, modulates immunity and inflammatory responses, mammary
gland development
stimulated by substance P, prolactin releasing hormone, and serotonin growth factors
inhibited by prolactin inhibiting hormone and dopamine
Q21: Thyrotropin releasing hormone
A: produced by hypothalamus
stimulates release of TSH, modulates prolactin secretion
stimulated by low T3/T4 levels, cold temps
inhibited by high T3/T4, stress, and cortisol
Q22: Corticotropin releasing hormone
A: produced by hypothalamus
stimulates release of ACTH and beta endorphin
stimulated by low cortisol levels, stress, diurnal rhythm (levels rise in morning)
inhibited by high cortisol levels
Q23: oxytocin
A: produced in posterior pituitary
stimulates contraction of the uterus and milk ejection in lactating women
