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Apex Review > Endocrine 5 > Flashcards

Endocrine 5 Flashcards

1
Q

Signs of Cushing’s syndrome include: (select 4)
a. hypertension
b. hypotension
c. hyperkalemia
d. hypokalemia
e. metabolic alkalosis
f. metabolic acidosis
g. hyperglycemia
h. hypoglycemia

A

a. hypertension
d. hypokalemia
e. metabolic alkalosis
g. hyperglycemia

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2
Q

Cushing’s syndrome is caused by

A

cortisol excess either from overproduction or exogenous administration

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3
Q

Cushing’s disease is the result of excess

A

ACTH

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4
Q

What properties does cortisol have?

A

glucocorticoid
mineralocorticoid
androgenic effects

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5
Q

Glucorticoid effects of Cushing’s syndrome include

A

hyperglycemia
weight gain
osteoporosis
increase in infection

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6
Q

Mineralocorticoid effects of Cushing’s syndrome include

A

HTN
hypokalemia
metabolic alkalosis

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7
Q

Androgenic effects of Cushing’s syndrome include

A

hirsutism
hair thinning
acne
gynecomastia
impotence

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8
Q

Anesthetic implications for Cushing’s disease include

A

post-op steroid supplementation
aseptic technique
careful positioning to reduce skin and bone injury
DI may follow resection
considerations for hyperaldosteronism

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9
Q

Treatment options for Cushing’s disease include

A

transsphenioidal resection of the pituitary gland
pituitary radiation
adrenalectomy

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10
Q

A patient with adrenal insufficiency and sepsis requires an emergency intubation in the intensive care unit. Which drug should be avoided?
a. etomidate
b. propofol
c. ketamine
d. thiopental

A

a. etomidate

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11
Q

Adrenal insufficiency is characterized by the

A

destruction of all cortical zones

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12
Q

Adrenal insufficiency manifests as

A

decreased production of mineralocorticoids, glucocorticoids, and androgens

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13
Q

By inhibiting _____________ etomidate causes dose-dependent adrenocortical suppresion

A

11-beta-hydroxylase

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14
Q

Adrenal insufficiency is a _______ state but it can deteriorate into ________________ when the patient faces _________

A

chronic; acute adrenal crisis; stress

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15
Q

Stress that can lead to acute adrenal crisis includes

A

infection
illness
sepsis
surgery

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16
Q

______________ suppresses ACTH release from the anterior pituitary gland

A

Exogenous steroid supplementation

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17
Q

Patients on chronic steroid therapy may require

A

“stress” dose steroids to help combat perioperative stress

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18
Q

________ also inhibits cortisol synthesis

A

Ketoconazole

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19
Q

Superficial surgery (dental, biopsy) steroid dosing

A

none

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20
Q

Minor surgery (colonoscopy, inguinal hernia repair) hydrocortisone dosing

A

25 mg IV

21
Q

Moderate surgery (colon resection, total joint replacement, total abdominal hysterectomy) hydrocortisone dosing

A

50-75 mg IV taper over 1-2 days

22
Q

Major surgery (CV, thoracic, liver, Whipple) hydrocortisone dosing includes

A

100-150 mg IV taper over 1-2 days

23
Q

When should patients receive stress dosing?

A

> 5-20 mg/day for >3 weeks

24
Q

Causes of primary adrenal insufficiency (Addison’s) include

A

destruction of both adrenal glands (autoimmune)
HIV
TB

25
Q

Causes of secondary adrenal insufficiency include

A

exogenous steroid administration, HPA disease due to tumor, infection, surgery, and radiation

26
Q

Clinical features of adrenal insufficiency include

A

muscle weakness/fatigue
hypotension
hypoglycemia
hyponatremia
hyperkalemia
metabolic acidosis
N/V
hyperpigmentation

27
Q

Clinical features of acute adrenal crisis includes

A

hemodynamic instability/collapse
fever
hypoglycemia
impaired mental status

28
Q

Treatment of adrenal insufficiency includes

A

steroid replacement therapy (15-30 mg cortisol equivalent/day)

29
Q

Treatment of acute adrenal crisis includes

A

hemodynamic support
ECF volume expansion (D5NS is the best choice)
steroid replacement therapy (hydrocortisone 100 mg + 100-200 mg q24h)

30
Q

What are the two broad types of hormones secreted by the pancreas?

A

exocrine hormones
endocrine hormones

31
Q

_______________ are secreted into the duodenum for digestion

A

Exocrine

32
Q

_______________ are secreted into the systemic circulation for metabolism

A

Endocrine hormones

33
Q

Glucagon is secreted from

A

alpha cells

34
Q

Glucagon __________ blood glucose

A

increases

35
Q

Insulin is secreted from

A

beta cells

36
Q

Insulin __________ blood glucose

A

decreases

37
Q

Somatostatin is secreted from

A

delta cells

38
Q

Somatostatin works by

A

inhibiting insulin and glucagon
splanchnic blood flow, gastric motility, and gallbladder contraction

39
Q

Pancreatic polypeptide is secreted from

A

PP cells

40
Q

Pancreatic polypeptide inhbits

A

pancreatic exocrine secretion
gallbladder contraction
gastric acid secretion
gastric motility

41
Q

____________ is the primary stimulator of insulin release from the pancreatic beta cells

A

Glucose

42
Q

Cerebral function generally declines when serum glucose falls below

A

50 mg/dL

43
Q

Glucagon (1-5 mg IV) increases

A

myocardial contractility, heart rate, and AV conduction by increasing the intracellular concentration of cAMP

44
Q

Glucagon may be used for

A

beta-blocker overdose
CHF
low CO after MI or CPB
improving MAP during anaphylaxis
during ERCP to relax the biliary sphincter

45
Q

Things that stimulate glucagon release include

A

hypoglycemia
stress
trauma
sepsis
beta agonsits

46
Q

Things that reduce glucagon release include

A

insulin
somatostatin

47
Q

Things that stimulate insulin release

A

PNS stimulation
SNS stimulation
hormones: glucagon, catecholamines, cortisol, GH
beta agonists

48
Q

Things that reduce insulin release

A

hormones- insulin
drugs
volatile anesthetics, beta antagonists

Apex Review (224 decks)

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