Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex Review > Endocrine 3 > Flashcards

Endocrine 3 Flashcards

1
Q

A patient with untreated hyperthyroidism and atrial fibrillation presents for emergency surgery. What is the BEST intervention at this time?
a. amiodarone
b. esmolol
c. propylthiouracil
d. delay surgery until a euthyroid state is achieved

A

b. esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Medical management for hyperthyroidism includes

A

thionamides (propylthiouracil)
beta-blockers (propranolol)
potassium iodide
radioactive iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Surgical treatment for hyperthyroidism includes

A

subtotal or total thyroidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complications of surgery for hyperthyroidism include

A

hypothyroidism
hemorrhage
tracheal compression
hypocalcemia
recurrent laryngeal nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Elective surgery should be

A

delayed until the patient is euthyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Successful medical management of hyperthyroidism may require

A

upwards of 6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If the patient has a goiter, you should

A

choose the most conservative airway management (e.g. awake intubation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

_________ should be titrated carefully in the patient with hyperthyroidism because there’s an increased incidence of ___________ & ____________

A

titrate NMBs; myasthenia gravis and myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

__________due to resection of parathyroid glands most commonly occurs _________after surgery

A

hypocalcemia; 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypocalcemia can lead to

A

laryngospasm
muscle spasm
hypotension
prolonged QT interval
mental status changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The treatment for hypocalcemia is

A

IV calcim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

__________ & ____________ indicate hypocalcemia

A

Chvostek’s sign & Trousseau’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Under anesthesia, thyroid storm can mimic

A

MH
pheochromocytoma
neuroleptic malignant syndrome
light anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Don’t give ___- to treat hyperpyrexia in a patient with thyroid storm because it can dislodge T4 from plasma proteins

A

aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Remember the four B’s when treating the patient with thyroid storm:

A

block synthesis (methimazole, carbimazole, PTU, potassium iodide)
block release (radioactive iodine, potassium iodide)
block T4 to t3 conversion (PTU, propranolol, glucocorticoids)
block beta receptors (propranolol, esmolol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Thionamides require

A

6-7 weeks to achieve a euthyroid sate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Serious side effects of thionamides include

A

hepatitis
agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Thionamides include

A

propylthiouracil
methimazole
carbimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Potassium iodide needs to be given

A

10 days before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

radioactive iodine can cause

A

hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contraindications to radioactive iodine include

A

pregnancy
breast feeding mothers

22
Q

Emergency surgery in the setting of hyperthyroid warrants administration of

A

a beta-blocker
potassium iodide
glucocorticoids
PTU should be started at this time

23
Q

A goiter can cause

A

tracheal deviation or tracheomalacia

24
Q

Exophthalmos increases the risk of

A

corneal abrasion

25
Q

Signs and symptoms of thyroid storm include

A

fever >38.5 degrees C
tachycardia/tachyarrhythmias
HTN
CHF
shock
confusion and agitation
N/V

26
Q

Additional treatments for thyroid storm include

A

cardiopulmonary support
active cooling measures
tylenol for fever
glucocorticoids

27
Q

All of the following are anesthetic considerations for myxedema EXCEPT:
a. restrictive lung disease
b. low cardiac output
c. hypernatremia
d. impaired drug metabolism

A

c. hypernatremia

28
Q

How should you proceed with surgery for hypothyroidism?

A

mild to moderate hypothyroidism okay to proceed with elective surgery
severe hypothyroidism should cancel

29
Q

Patients with hypothyroidism are at risk for

A

airway obstruction due to a large tongue, swollen vocal cords, and goiter

30
Q

______________ function is common with hypothyroidism

A

decreased adrenal function

31
Q

Hypotension unresponsive to catecholamines can be treated with _________ in hypothyroidism

A

corticosteroids

32
Q

Patients may be more sensitive to ___________ with hypothyroidism

A

the effects of neuromuscular blockers

33
Q

What happens to the hemodynamics of the patient with hypothyroidism?

A

hypodynamic–> decreased HR, SV, contractility, cardiac output, and baroreceptor responsiveness

34
Q

Hemodynamic support for hypothyroidism is best provided with

A

sympathomimetics that improve myocardial performance (not phenylephrine)

35
Q

Medical management of hypothyroidism includes thyroid hormone is replaced with

A

synthetic T4 (levothyroxine)

36
Q

The initial response to therapy for hypothyroidism is

A

natriuresis and decreased TSH

37
Q

Patients with hypothyroidism are at risk of

A

aspiration due to delayed gastric emptying

38
Q

Clinical features of primary hyperparathyroidism include: (select 2)
a. pathologic fractures
b. laryngospasm
c. myocardial depression
d. shortened QT interval

A

a. pathologic fractures
d. shortened QT interval

39
Q

What two hormones act antagonistically to regulate the ionized Ca2+ level

A

calcitonin and PTH

40
Q

Calcitonin and PTH affect Ca2+ regulation in the

A

bone, intestine, and kidneys

41
Q

PTH is produced in the

A

parathyroid gland (chief cells)

42
Q

What is the effect of parathyroid hormone on ionized calcium and phosphate

A

increases ionized calcium
decreases serum phosphate

43
Q

Calcitonin is produced in the

A

thyroid gland (C cells)

44
Q

What effect does calcitonin have on ionized calcium and serum phosphate?

A

decreases ionized calcium and increases serum phosphate

45
Q

The most common cause of hypercalemia is

A

primary hyperparathyroidism

46
Q

The most common cause of primary hyperparathyroidism is

A

parathyroid adenoma

47
Q

The best treatment for parathyroid adenoma is

A

surgical resection of the parathyroid glands

48
Q

Secondary hyperparathyroidism is caused by

A

something that stimulates the parathyroid glands to increase PTH output (the glands themselves are normal)

49
Q

The most common cause of secondary hyperparathyroidism is

A

chronic kidney disease

50
Q

Hypoparathyroidism causes

A

hypocalcemia

51
Q

The most common cause of primary hypoparathyroidism is

A

iatrogenic gland removal during thyroidectomy

52
Q

Treatment of primary hypoparathyroidism includes

A

supplementation of Ca2+
vitamin D
Mg2+

Apex Review (224 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions