May 30, | nursing, med, NURS, Paper
How to write a bibliographic essay: Best Guide
How do you feel when you get a bibliographic essay as an assignment? If you feel challenged on how to write a bibliographic essay, it is understandable. You have written other essays, and this is another one of them, but writing a bibliographic essay! What is it?
What is a bibliographic essay? Do you know the word bibliography? If you do, you can guess the content of a bibliographic essay. A bibliographic essay is a review of the literature on a given topic. A bibliographic essay offers an introduction to several key sources of a topic.
A bibliographic essay is different from a literature review where the author only addresses the merits of a recently published single source. A bibliographic essay enumerates several sources like an annotated bibliography. It further describes and analyses them.
A bibliographic essay also compares, contrasts, and evaluates the relationship among works in the available materials. It hence draws the picture of the literature topic, taking a stand, and establishing an interpretive viewpoint.
What is a bibliographic essay?
A bibliographic essay is a literature analysis. If a piece of literature is in the hands of a person unfamiliar with it, they should be able to quickly understand its history, content, extent, and methodologies.
The analysis breaks down the literature into sub-groupings, explain issues leading to the sub-group, informs the reader about the general content concerning specific issues, and provides a sense of which article or books to read depending on the project and questions.
A bibliographic essay is a research tool developed by an author for use by others interested in that topic. It helps the reader move quickly to the analyzed literature. At the end of the analysis, there should be an annotated bibliography. It provides the reader with citations for the books and articles discussed.
Annotated means a sentence or two should be at the entry of each bibliography at the end of an analytical essay, describing the article or book that describes the statement’s significance.
How long should a bibliography essay be
There is no exact number of pages; however, anything under twenty-five is too short, and anything over forty pages is too long. Aim for thirty to thirty-five ages without counting the annotated bibliography at the end.
Essays should begin with an introduction and conclude with a summary. The introduction sets the stage by describing the topic and the state of literature supporting it. It should also briefly describe the body of selected resources, explaining why it makes core literature for that field of study. It should further describe the organization of the essay and explain the reason for that organization.
How many books should a bibliography essay cover
There should be enough books and articles to cover thirty to thirty-five pages of work material analysis. You should, however, have enough space to be informative complete your analysis. The more books there are, the shorter the bibliography will be, while the more articles, the longer it will be.
You don’t need to discuss all the books, at least not at length. Some books are more important than others, and you should discuss them at greater length. Others will compare more books than others in the bibliography. While subgrouping, place each book in the category you think it should be and explain why you think it belongs there.
Compiling a bibliographic essay
While compiling a bibliographic essay, ask yourself two questions
Who is writing, what are they writing, where are they publishing it, and who is it intended for? Further, ask these questions:
Who is their writer? Are they professional writers, amateurs, professional academics, men or women
Does their background have impacted their writing of the material work
What documentation or information is the author using in creating their work
What organizations are publishing, are they commercial, scholarly or private and who is their audience
2. What are they writing about, and how are they writing? elaborate and ask more questions”:
What theories, images, conclusions and points of view are in these materials
Are there assumptions made, and do they question
Has anything been left out
What issues, debates and problems are there
How has the material been presented, what evidence, traditions, expectations, and call do they provoke
Additionally, to these respective sources’ questions, you will account for similarities and differences among works. Investigate overtime changes, demography and geography as to what ideas and whose work, points of view and images how materials have developed in emphases, modes, school of thoughts and themes etc.
These questions enable you to build the “compare and contrast” structure that characterizes the bibliographic essay.
How to gather reading sources for a bibliography essay
Once you figure out who is writing and what they are writing about, you need to know how to gather sources to read.
Survey several work materials
A survey is an excellent way to identify reading sources. Other than hits from discussion and advice from your lecturer, there are two ways in which you can conduct a survey.
using reference works, like, dictionaries and encyclopedias
using various databases available through the Smathers library webpage
Reference and secondary literature is a vital part of your research, and it should be the first step you take
2. legwork and scanning
you will need to decide which books you will include in your bibliographic essay. You will further look at the table of content and indexes, read the introduction of each of those books and get a glimpse of what they are about.
The books you choose not to focus on make up for the footnotes, and you will only mention them in passing. The primary fundamental purpose is to educate people on what to read. You will have to demonstrate your command of the topic equally by telling them the book they don’t need to read.
The books you choose to concentrate on will be the tip of the iceberg, the body you aim to sketch.
You can write a bibliographic essay on virtually any topic. To select a topic, ensure sources are written on the work available. If not, your topic is too narrow. Don’t settle for a topic that is on its last leg. Pick one that is ever added on through archival discoveries. Critical thinking is paramount when you are choosing a topic.
How to write a bibliographic essay
To write a bibliographic essay that will get you a good grade, you need to structure it well and follow the writing principles for this type of essay.
Choose reliable sources only
Find sources that are recommended for your topic only. Though encyclopedias provide good sources, they have relatively short and incomplete information. On the other hand, the website offers unreliable publications and, in most cases, is not verified. Only choose publications in reputable journals and provide your reader with relevant and reliable information.
The library is another place you can visit. There are online and offline sources whose principle is the same. Please include it in your essay once you have a reliable and trustworthy source. Other places you can get information for your bibliography are:
the heading of an article
the content page of a magazine
the header or footer of a website
Check your style guide for your essay
Different institutions, disciplines and journals use different referencing styles. Before writing, consult the relevant style guide. When turning in your bibliography paper, type your sources into a list using the required format as your bibliographic essay template to ensure you have formatted it correctly.
List details for your essay as you go
At the start of your bibliographic essay, list a biography that you will use to record your sources. It is easier to note down details of each text you read during your research. List the sources in an alphabetical order using the author’s last name. If there is more than one author, alphabetize using the first name. If the author is unknown, alphabetize the source using the title.
Write the following information for each source you find for printed sources and websites
Author name
Title of the publication
date of publication
place of publication
number of magazines printed
number of pages
author and editor names, if available
title of the page, if available
the organization that posted the website
the web address for the page
the last date you looked at the page
Do not discuss or analyze the opinion of the author
The objective of your bibliographic essay is to give your reader the idea of which sources to use. The primary task is to summarize the thoughts and ideas of others without expressing your view on those opinions.
You don’t need to discuss them to discredit the authors or prove that your opinion is correct. Provide information without stating with whom you agree or disagree.
Be thorough
Your reader should be able to identify your sources quickly through the information you have included in your biography. Provide sufficient biographic detail for each text listed. If you are citing journal articles, include the page numbers.
Be consistent
Consistency is as important as being thorough. For clarity purposes, you need to use the same format for all sources of the same type.
How to structure your bibliographic essay
Research on the topic and brainstorm search terms
Skim and review articles
Evaluate your sources
Write your bibliographic essay
Introduction:
Summarize the focus of your essay
Introduce the texts to be summarized
Give the title of each source
Name the author of each source
Give a background information of the author, texts and general topic where the texts have been drawn
Body
Include information form more than one source in each paragraph
Use citations and indicate from which source the material comes from
Indicate similarities and differences
Conclusions
Remind the reader the most significant themes you found and the ways they connect to the overall topic.
Bibliographic essay format
Though different journals use a different format for a bibliography, they contain the same basic information. There are standards for documenting sources of information in research papers. The basic information that each reference should have is the author’s name, date, and source.
Different sources have different formatting. Citing an essay depends on the format required. The commonly used guidelines are the MLA (Modern Language Association) and the APA (American Psychology Association). The bibliography is called works cited in the MLA guidelines, while in the APA guidelines, the bibliography is called the reference list.
Below is a bibliographic essay example in MLA form.
Basics
The work cited list should begin at the end of the paper but on a new page with the centred title. Alphabetize the entries by the author’s name using a letter-by-letter system. If the author’s name is unknown, alphabetize the title.
For dates, the names of months should be spelt out in the text of your paper. You should, however, abbreviate them in the list of works cited, except for May, June and July, use either the day-month-year style or the month-day-year style and paramount consistency. Add a comma after the year with the month-day-year style, unless a punctuation mark goes there.
Italics or underlining
If you are writing the bibliographic essay by hand, underline the names of publications. If you are using a computer, publication names should be in italics. Always enquire from your instructor on which prefer to use.
Hanging indentation
All MLA citations use hanging indents. The first line of an entry is flush left while the second and subsequent lines are indented to1/2”.
Capitalization, abbreviation and punctuation
The MLA guidelines use title case capitalization-capitalize the first words, last words and principal words, including those that follow hyphens in compound terms. The guideline also abbreviates the lowercase to identify the parts of work unless a period follows. Always use the proper abbreviated forms of the publisher’s name whenever possible.
MLA template contains the following details
Author (last name, first name)
Title of the source
Title of the container
Other contributors (names and roles)
Version
number publisher
publication date
location of the source (URL or page range)
summary of the analysis
Bibliographical essay example APA
In this formatting style, the reference is styled differently. Websites, newspaper articles, websites and other publications have their reference structure. Look for the following basic information from various sources.
Type of source
Author (last name, first name)
Title of source
Title of where the source was found
Other contributors (names and roles)
Version
Number
Publisher
Publication date
Location of the source (URL, DIO or page range)
Summary of analysis
How to start a bibliography essay
The key to writing a successful bibliography essay is to define a topic that will generate the correct number of sources. A bibliography should discuss the items in the relevant literature without being exhaustive.
You may get assistance for your professor on how to define a topic. Still, as you compile the bibliography, you will be required to alter the size of the literature by either expanding or contracting the topic.
The best idea for starting your essay is to consult several most recent publications on the topic to help you identify the main literature contributors. If this doesn’t provide the needed information, consider other sources to add up to your research.
You don’t need a comprehensive discussion on every piece of literature. A topic may have many books written over the years, but you only need to discuss the most recent books plus the first that defined the topic and probably a few others that were important in later developments.
You will still be left with a few books which will not be discussed in your annotated bibliography. In this case, the annotation will place them.
What things should be included in the actual essay
There are several parts to an essay, and the first is the introduction. An introduction provides a concise topic that needs to be reviewed, and it explains the significance of the topic and its literature. The second part, the body, lays out the categories that emerge upon reading the literature defined by the topic. It is in the body that you will analyze the essay topics independently.
In the second part, you can mention a history of literature development to lay out how categories emerged over time and identify significant contributors. Follow this up with a category that discusses the books by explaining why they belong in that category.
Generally, give a sense of how each book proceeds, comparing the book to each other within a category in terms of similarities and differences. Discuss the unique aspects in each book that might make it relate to other books in a different category.
There will most likely be a summary of each book’s content; however, do not lapse into a simple summary that lacks analysis and comparison. On average, discuss at length six to eight books in each category. Some books may be in more than one category for comparison’s sake.
Finally, in your conclusion, provide an overall assessment of the literature. What are the strengths and weaknesses, where nest should it go and, who and on issues central to the literature, who seems to have the best handle on the works?
Nursing bibliographic essay
Several things make writing integral in nursing, among them, learning different nursing skills, patient care, issues of nursing liability, and these rely upon writing as a communication tool. Writing happens in nurses’ notes, clinical studies and scholarly research.
If you have been assigned an annotated assignment, you will be required to describe a list of resources focusing on the common theme. You have to fully cite and annotate each entry, ranging from a few to several paragraphs. Your annotation should be concise and descriptive in summarizing and evaluating the contents of a resource.
Bibliographic analysis essay
You analyze a bibliographic essay by comparing multiple articles and books. You provide your reader with context from the topic you are studying and recommend reputable sources on the subject.
How to analyze a bibliographic essay?
Seeking sources
You are primarily summarizing a list of sources. Use credible scholarly sources before you start writing. Do not use articles from the encyclopedias as they may not provide in-depth information on a subject.
During your research, skim a reference page to each source page. Some sources may not provide in-depth information but may reference other scholarly works that focus on the topic.
Use a function statement.
Use a function statement at the beginning of your essay since you will be providing the reader with an overview of the literature on the subject. A thesis statement mainly describes an argument you are trying to prove, while a function statement is the purpose of your essay.
Do not analyze, restate
Your goal is to summarize what others have written. Include both the description and evaluation of what each source states and consider the subject’s most essential aspect.
Keep it short
A bibliographic analysis essay requests you to summarize several sources, including your comparison of different sources, in under six pages. Keep your writing concise and avoid repetitive statements. Author background is not necessary unless it is relevant to the source directly.
Annotated bibliography vs literature review
If you have written an essay, a thesis or a research paper, you are probably familiar with an annotated bibliography and how to create and use it. You may also have experienced a literary review. These two are an essential part of any thesis or research paper.
Both annotated bibliography and literature review summarizes a specific topic, its content and sources. They, however, differ in how these facts are presented. Both can be about any topic, but the literature review aims to answer a particular question about a particular subject, while annotated bibliography is about the importance of the sources of information.
The annotated bibliography informs the reader about the sources’ quality, accuracy, and relevance. At the same time, the literature review informs the reader about the topic’s pros and cons also how the author’s views differ and conform to previous arguments about the topic.
An annotated bibliography allows the reader to choose if they want to explore available sources independently. At the same time, a literature review directs the reader to understand the sources available.
Bibliographic essay vs literature review
There are notable distinctions between a bibliographical essay and a literature review. First, those in social sciences and humanities tend to be authors of bibliographical essays, while literature reviews are more often authored by those in sciences and social sciences.
Second, a bibliographical essay offers a detailed view of the current understanding of a particular area of research. This helps identify gaps that other scholars can use in their projects. The essay indicates what is known and what needs to be done. On the other hand, the literature review discusses significant research and theoretical work about the research objective that a particular scholar is studying.
Both genres, however, address the same kind of questions:
what have others said about this area(s)
what theories address it, and what do they say
what research has been done or not done previously
Are the findings consistent, and do past studies disagree?
Are there gaps that scholars should attend to
What is an example of a good topic?
This s rather hard to say since you are supposed to examine the relevant literature to determine which topic to choose based on, among other things, the availability of sources for the work material.
It is, however, imperative that you consider the length of your paper. The longer the assignment, the more complex your topic may be. For shorter papers, limit topics and make the strongest argument.
Select a topic you can handle within your time limitations. Your idea might be broad, pick an aspect of a topic which interests you. Familiarize yourself with the topic by several reference source. A good reference will also help you identify the best books and article for the subject.
Bibliographic essay topics examples
Example 1:
Literature on the role of social media in keeping people connected
Literature on how mainstream media is contributing to chaos in the society
Literature o the role of 5Gtechnology in advancing the world
Example 2:
Literature on the view of capital punishment by different countries?
Literature on how society be encouraged to be gender-neutral?
Literature on the role of evolution in explaining the origin of man
Example 3:
The literature on American voting behaviour
The literature on voting behaviours in the American states
Impact of religion on American voting behaviour
Example 4:
Literature on psychotherapy effectiveness
Literature on positive psychology
Literature on statistical methods used in psychology
Example 5:
Literature o transcultural nursing
Literature on evidence-based nursing practice
Literature on the role of emotional intelligence in healthcare
Bottom line
A crucial role is played in information studies by a bibliographic essay. It is a tool used in research to develop the collection or dive into recommended readings to increase personal knowledge. Much as a bibliographic essay is characterized by writing that borders book review, academic article, and annotated bibliography, pay attention to its composition and structure.
With the guide on how to write a bibliographic essay and the examples given, you will be inspired to be a prospective contributor in this format. While there may be no room to contain potential books that might be written, there certainly is space for bibliographic essays to assist the way through stacks. Are you up for the challenge?
May 30, | nursing, med, NURS, Paper
NURS 6501 Advanced Pathophysiology Module 4 Knowledge Check
Question 1
Needs Grading
A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.
PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago
Social/family hx – non contributary except for 30 pack/year history tobacco use.
Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago
Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L,
K+4.2 mmol/L, CO237 m mol/L, Cl–97 mmol/L.
The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).
Question:
Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.
Correct Answer:
SIADH is a group of symptoms that occurs when antidiuretic hormone (ADH, arginine vasopressin) is secreted in the absence of osmotic or physiologic stimuli. These stimuli include: Increased serum osmolality, decreased plasma volume, and hypotension. A decrease in plasma osmolality normally inhibits ADH production and secretion. SIADH is characterized by fluid retention, dilutional hyponatremia, hypochloremia, concentrated urine, and lack of intravascular volume depletion. SIADH is characterized by normal to increased blood volume in normoproteinemia, nonedematous, and hyponatremic patients with normal renal and endocrine function. ADH regulates the body’s water balance. It is synthesized in the hypothalamus and stored in the posterior pituitary gland. When released into the circulation, it acts on the kidney’s distal tubules and collecting ducts, increasing their permeability to water. This decreases urine volume because more water is being reabsorbed and returned to the circulation. It also serves to produce more concentrated urine.
Question 2
Needs Grading
A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.
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?
Correct Answer:
An adrenal insufficiency requires some type of trigger or stressor such as surgery, trauma, infection or acute withdrawal of glucocorticoids. The patient had several factors contributing to her present situation. She had RA x 20 years that necessitated oral prednisone. Increased levels of both glucocorticoids (primarily cortisol) and mineralocorticoids (primarily aldosterone) are needed for the body to adapt to the stress Corticotropin-releasing hormone (CRH) from the hypothalamus eventually prompts release of ACTH from the anterior pituitary gland. ACTH then stimulates release and 3 synthesis of cortisol from the adrenal cortex. Cortisol mobilizes amino acids from skeletal muscle and generally enhances the liver’s capacity for gluconeogenesis as well as enhances normal immune activity and maintenance of cardiovascular integrity. It also influences fat, carbohydrate and protein. Catecholamines cause vasoconstriction, which in the kidney, probably initiates release of renin, stimulating the rennin-angiotensionaldosterone-system (RAAS). Antidiuretic hormone (ADH, also called vasopressin), is released from the hypothalamus and posterior pituitary during periods of stress. Both aldosterone and ADH attempt to conserve water and electrolytes to sustain a sufficient vascular volume.
Question 3
Needs Grading
A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.
The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN 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:
What is the role of parathyroid hormone in the development of primary hyperparathyroidism?
Correct Answer:
Primary hyperparathyroidism is the unregulated overproduction of parathyroid hormone (PTH) resulting in abnormal calcium balance. PTH secretion is increased and is not under the usual feedback control mechanisms. The Ca++ level in the blood increase because of increased resorption and GI absorption of calcium but fails to inhibit PTH secretion at normal levels of calcium because the feedback threshold for calcium is set at a higher level in the abnormal parathyroid tissues. Hypercalcemia and hypophosphatemia are the clinical hallmarks of hyperparathyroidism.
Question 4
Needs Grading
A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.
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.
Correct Answer:
Increased renal filtration load of calcium leads to hypercalciuria. Hypercalcemia also affects proximal renal tubular functions, causing metabolic acidosis and production of abnormally alkaline urine. PTH hypersecretion enhances real phosphate excretion and results in hypophosphatemia and hyperphosphatemia. The combination of hypercalciuria, alkaline urine, and hyperphosphaturia leads to the formation of renal stones
Question 5
Needs Grading
A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.
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 2 of 2:
Explain how a patient with hyperparathyroidism is at risk for bone fractures.
Correct Answer:
Excessive osteoclastic and osteocytic activity results in increased bone reabsorption that weakens the bone. Kyphosis of the dorsal spine and compression fractures of the vertebral bodies are also seen in patients with hyperparathyroidism.
Question 6
Needs Grading
A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).
Question:
What serious consequences of hypoparathyroidism occur and why?
Correct Answer:
Hypoparathyroidism occurs when there is destruction of the parathyroid glands (autoimmune, surgical), abnormal parathyroid gland development, altered regulation of PTH production, or impaired PTH action. The acute manifestations of hypoparathyroidism (postsurgical hypoparathyroidism) are due to acute hypocalcemia. The hallmark of acute hypocalcemia is tetany, which is a disorder of neuromuscular irritability. The symptoms of tetany may be mild (perioral numbness, paresthesia of the hands and feet, muscle cramps) or severe (carpopedal spasm, laryngospasm, and focal or generalized seizures, which must be distinguished from the generalized tonic muscle contractions that occur in severe tetany). The classic physical findings in patients with neuromuscular irritability due to latent tetany are Trousseau’s and Chvostek’s signs.
Question 7
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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.”
Correct Answer:
Because elevated blood glucose levels, water is osmotically attracted from body cells which results in intracellular dehydration and hypothalamic stimulation of thirst.
Question 8
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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.”
Correct Answer:
Hyperglycemia acts as an osmotic diuretic. The amount of glucose filtered by the glomeruli of the kidneys exceeds the amount that can be reabsorbed by the renal tubules. Glycosuria results accompanied by large amounts of water lost in the urine.
Question 9
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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 3 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”
Correct Answer:
Depletion of cellular stores of carbohydrates, fats, and proteins results in cellular starvation and a corresponding increase in hunger.
Question 10
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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.”
Correct Answer:
Weight loss occurs because of fluid loss in osmotic diuresis and the loss of body tissue as fat and proteins are used for energy as a result of the effects of insulin deficiency.
Question 11
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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 5 of 6:
The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”
Correct Answer:
Metabolic change result in poor use of food products, contributing to lethargy and fatigue. Sleep loss from severe nocturia also contributes to fatigue.
Question 12
Needs Grading
A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.
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 6 of 6:
How do genetics and environmental factors contribute to the development of Type 1 diabetes?
Correct Answer:
Islet cell autoantibodies (ICAs) were detected in serum from patients with autoimmune polyendocrine deficiency. They have subsequently been identified in 85 percent of patients with newly diagnosed type 1 diabetes and in prediabetic people.
Autoantigens form on insulin producing beta cells and circulate in the blood and lymphatics. This leads to processing and presentation of autoantigen by antigen presenting cells
There is activation of T helper 1 lymphocytes and T helper 2 lymphocytes There is activation of macrophages that release IL-1 and TNFα and activation of autoantigen specific T cytotoxic CD8 cells.
There is activation of B lymphocytes to produce islet cell autoantibodies and antiGAD65 antibodies. This cascade results in destruction of beta cells with decreased insulin production.
Question 13
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A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.
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.
Correct Answer:
The most important concept is that DKA is caused by insulin deficiency and an increase in counterregulatory hormones that include glucagon, catecholamines, cortisol, and growth hormone. These counter regulatory hormones normally antagonize insulin buy increasing glucose production and decreasing tissue use of glucose. Insulin deficiency results in decreased glucose uptake, increased fat mobilization with release of fatty acids and accelerated gluconeogenesis, glycogenesis, and ketogenesis. In the absence of insulin, the release of free fatty acids from adipocytes increases production of ketone bodies by the mitochondria of the liver that exceeds peripheral use. Accumulation of ketone bodies causes a drop in pH and triggers the buffering system associated with metabolic acidosis. Hyperketonemia may result from impaired use of ketones by peripheral tissue, which permits strong organic acids to circulate freely. Bicarbonate buffering then does not occur and the individual develops a metabolic acidosis.
Question 14
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A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).
Question:
Explain the underlying processes that lead to HHNKS or HHS.
Correct Answer:
HHNKS differs from DKA in the degree of insulin deficiency (more profound I DKA) and the elevation of glucose levels and degree of fluid deficiency which are more marked in HHKS.
The basic underlying mechanism of HHS is a relative reduction in effective circulating insulin with a concomitant rise in counterregulatory hormones. Unlike patients with DKA, most patients with HHS do not develop significant ketoacidosis. Insulin remains available in amounts sufficient to inhibit lipolysis and ketogenesis but insufficient to prevent hyperglycemia. Hyperosmolarity itself may also decrease lipolysis, limiting the amount of free fatty acids available for ketogenesis.
Patients with HHS have a very high serum glucose concentration, a near normal serum bicarbonate level and pH, a serum osmolarity that is usually greater than 320 mOsm/L (normal 275–295 mOsm/L), and either absent or low levels of ketones in both the urine and serum. Electrolyte imbalances are common, with severe potassium deficits that need to be corrected, usually over several days. Phosphorous and sodium replacement may also be needed.
Question 15
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A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.
Question:
How would you differentiate Cushing’s disease from Cushing’s syndrome?
Correct Answer:
Cushing’s syndrome is a rare disease that is caused by the over production of cortisol by the adrenal glands. This can be caused by a tumor of the adrenal glands, the lungs, or the pituitary gland. When the tumor produces too much ACTH, it causes over production of cortisol by the adrenal glands. If the source is the pituitary, it is called Cushing’s disease. Cushing’s disease occurs more often in women than men and more often occurs between the ages of 20 and 40.
ACTH dependent hypercortisolism, the excess ACTH stimulates excess production of cortisol and loss of the negative feedback control of ACTH secretion. People with Cushing’s syndrome do not have diurnal or circadian secretion patterns of ACTH and cortisol, and they do not increase ACTH and cortisol secretion in response to stressors.
Question 16
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A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.
Question:
What is the pathogenesis of primary hyper-aldosteronism?
Correct Answer:
Primary hyperaldosteronism can be caused by either hyperactivity in one adrenal gland (unilateral disease) or both (bilateral disease). Unilateral disease is usually caused by an aldosterone producing adenoma (benign tumor) and less commonly by adrenal cancer or hyperplasia (when the whole gland is hyperactive). Excessive autonomous secretion of aldosterone without its principle regulator, angiotension II, causes hypokalemia and induces insulin resistance; promotes inflammation, endothelial dysfunction, and cardiovascular remodeling (increased left ventricular wall and carotid intima thickness. It also affects adipose tissue differentiation and function. Therefore, primary hyperaldosteronism can influence the features of metabolic syndrome, including hypertension, obesity, dyslipidemia, insulin resistance and hyperglycemia.
Question 17
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A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb. He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.
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?
Correct Answer:
There are very complex interactions that result in the development of Type II diabetes. The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure. Type 2 diabetes mellitus consists of a constellation of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. It is often associated with obesity.
Question 18
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A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.
Question:
What causes diabetes insipidus (DI)?
Correct Answer:
Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). There are 2 major forms: Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP]). Nephrogenic DI characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.
AVP is the primary determinant of free water excretion in the body. Its main target is the kidney, where it acts by altering the water permeability of the cortical and medullary collecting tubules. Water is reabsorbed by osmotic equilibration with the hypertonic interstitium and returned to the systemic circulation.
Question 19
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A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.
Question:
Explain how the negative feedback loop controls thyroid levels.
Correct Answer:
Hyperthyroidism is a set of disorders that involve excessive synthesis and secretion of thyroid hormones T3 and T4. This unregulated release causes a hypermetabolic state that can lead to a serious condition called thyrotoxicosis. The thyroid gland is regulated by thyroid stimulating hormone (TSH) from the pituitary gland, which, in turn, is regulated by the hypothalamus via a negative feedback loop. Calcitonin, a hormone that affects blood calcium levels, is also secreted by the thyroid gland. Hyperthyroidism is known as Graves’ Disease. Genetic factors interacting with the environment
