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Flashcards in ACE Review - Endocrine Deck (111)
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1

questions

Answers

2

what vascular problem is likely seen in hashimoto patients

increased svr

3

what gender is more likely to have hashimotos

women are 7x more likely

4

why do hashimotos have more svr

they have less beta adrenergic receptor stimulation, so their alpha is unopposed

5

what is the consequence of increased svr in hashimoto

diastolic pressure is increased and there is a decrease pulse pressure as a result of increased alpha stim

6

what is the consequence of hypothyroid assoc. increase svr

increased myocardial demand>prolong qt> arrythmia

7

what arrythmia can arrise in hashimoto hypothyroidism

torsades

8

what can help hashimoto arrythmia resolve

fixing the hypothyroidism/with hormone replacement

9

a patient with history of Graves' disease is presenting with fever, tachycardia and htn, what should you suspect

thyrotoxicosis crisis

10

what are factors that might precipitate a thyrotoxocisis

preop period, stressors, infection

11

what needs to be done before a patient goes to surgery when they are suspected of a thyrotoxic crisis

inhibition of the thyroid hormone, fluid resuscitation, supportive therapy

12

what is a good drug to decrease sympathetic storm thyrotocosis crisis

propranolol because it also decreases t4 to t3 conversion

13

how do you decrese t3 and t4 production in thyroid storm patients

give thioamides that inhibit the enzyme thyroperoxidase

14

what drugs inhibit thyroperoxidase

methimazole and ptu

15

what is a drug that also decreases t3 and t4 production

iodine

16

shoud we give iodine early on to treat a thyroid storm as well?

no...it may initially cause n increase of t3 and t4...start it only after starting a thioamide therapy

17

what should you use to treat hyperthermia in thyroid storm ...acetaminophen or asa..

acetaminophen with cooling blankets...asa causes protien decoupling and may actually increase free t3 and t4

18

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19

What are the signs found in carcinoid syndrome

Wheezing flushing diarrhea

20

What causes carcinoid signs

Serotonin - diarrhea, substance p vasoactive substance somatostatin histamine - flushing and wheezing

21

What is found in 1/2 of carcinoids

Right sided cardiac lesions. Pulm stenosis tricuspid regurge

22

What urine test is used for carciniod diagnosis

5 hydroxyindolacetic acid.

23

Can you use metanephrine urine test for carcinoid?

No. That is for pheochromocytoma

24

Can symptom severity predict operative complications?

No. Even mild symptom patients can have poor outcomes.

25

What tests are needed for carcinoid patients

Electrolytes and echo. Electrolytes because of diarrhea causing depletions

26

Why is it important to fix dehydration in carcinoid patients

The diarrhea causes dehydration and may lead to carcinoid crisis

27

What are the symptoms of carcinoid crisis

Tachycardia hyper or hypotension flushing. Abdominal pain

28

What should be administered to pt in preop time to prevent carcinoid crisis

Octreotide 24-48hr before surgery

29

What meds can precipitate carcinoid crisis

Succ, mivacurium( histamine release) atricurium( histamine release) isoproterenol epi norepi dopamine. Thiopental

30

How is the awakening of carcinoid patients

Delayed awakening