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Flashcards in ACE Review - Endocrine Deck (111)
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

31

Is zofran ok to use in carcinoid patients

Yes. It is actually a serotonin antagonist

32

What is trigeminal neuralgia

It is sudden unilateral pain in the distribution of the fifth cranial nerve

33

What gender is more likely to get trigeminal neralgia

Females. It is more common over age of 50 and increases risk with age

34

Which branch of the facial nerve 5 is more commonly affected by trigeminsl neuralgia

The maxillary branch is the most common

35

What is the first medication used to treat trigeminal neuralgia

Carbamazepine

36

What block can be done for trigeminal neuralgia

Local anesthetic to the gasserian ganglion block

37

What ekg finding do you have in primary hyperparathyroidism

Shortened qt

38

What symptoms to look out for in primary hyperparathyroid inorder to know how to treat

Look for polydipsia and polyuria

39

What is the mainstay treatment of primary hyperparathyroidism

Normal saline

40

What to do once patient is euvolemic in primary hyperparathyroidism

Treat them with LASIx to diurese the calcium

41

What kind of diuretic is lasix

It is a loop diuretic

42

Should hydrochlorothiazide be used in hyperparathyroidism

No because it increases renal absorption of calcium

43

In emergency hypercalciemia, what modes do you have to treat it

Bisphosphonates, calcitonin, hemodialysis

44

What are examples of bisphosphonates

Pamidronate and zoledronate

45

How fast does calcitonin work

It works within minutes in life threatening hypercalcemia

46

How do you get fast acting calcitonin

Intravenous

47

What are possible reasons for hyponatremia

Siadh, diabetes insipidous, hyperglycemia, cerebral salt wasting, water intoxication.

48

What three things do you need to look at for diagnosis of hyponatremia

Serum osmolarity, urine sodium, volume status

49

What is the first step in solving hyponatremia

Look at the serum osmolarity

50

What is normal serum osmolarity

280 to 300

51

What if the serum osmolarity is high...

It could be hyperglycemia....or pt is getting non sodium hyperosmolar fluid

52

What if the serum osmolarity is normal

Hyperlipidemia or hyperprotienemia

53

What if the serum osm is low

Look at the urine sodium

54

What is the normal urine sodium

20

55

What if the urine sodium is low

Water intoxication

56

What if the urine sodium is high

Check the volume status to diagnose

57

Low serum osm, high urine na, euvolemic

Saidh, hypothyroid,adrenal insufficiency

58

Low serum osm, high urine na, hypovolemic

Cerebral salt wasting , diarrhea. Diuretics

59

Low serum osm, high urine na, hypervolemic

Cirrhosis heart failure nephrotic syndrome

60

What is the inital treatment of symptomatic hypercalcemia

Hydration with normal saline

61

What does normal saline hydration do to hypercalcemia patient

It treats the associated hypovolemia in pt as well as increase renal excretion of calcium

62

What are other treatments to reduce calcium in hypercalcemic patients once volume status has been treated

The use Of loop diuretics like furosemide to excrete the calcium...but only when volume status is resolved

63

What are the EKG changes of hypercalciemia

Prolong pr interval...shorten qt

64

What are the preoperative treatments for hypercalcemia

Bisphosphonates, calcitonin, steroids, hemodialysis

65

How is the blood pressure of hypercalcemic patients

Hypertensive

66

Can you use thiazides diuretics it hypercalcemic pt

No because they increase the absorption of calcium

67

Is there a decrease or increase need of anesthetic in symptomatic hypercalcemic pt

Decrease

68

Hyperthyroid. What are the treatments for it.

Anthithyroid medications, inorganic iodine, radiated iodine , thyroidectomy

69

Hyperthyroid. When should inorganic iodine be given

After anti thyroid meds to prevent thyrotoxicosis

70

Hyperthyroid. What med is good to treat hemodynamic alterations of hyperthyroidism

Beta blockers

71

Hyperthyroid. What other med besides beta blockers can help during a thyroid storm

Corticosteroids because they decrease the secretion of thyroid hormone

72

normoglycemia. what is normal fasting

90-130

73

normoglycemia. what is normal postprandial

below 140

74

normoglycemia. what is the goal range for intensive insulin therapy

80-110

75

nomoglycemia. what is the roange for standard insulin therapy

180-200

76

normoglycemia. is there a difference between the intensive vs standard insulin therapy

there is no difference in medical icu pt but in surgical icu pts, there is a difference

77

nomoglycemia. what are the advantages of strict insulin therapy in icu pt who have stays greater than 3 days

in surgical icu pt, there is a reduction of mortality (8%down to 4%), decrease infection rate, decrease icu stay, decrease polyneuropathy

78

normoglycemia. in neurotrauma pt, what is recommendation.

to treat glucose if value is above 200

79

normoglycemia. what is goal range for neurotrauma pt

140 to 180

80

normoglycemia. what should the glucose be above in neurotrauma pt

above 110

81

hyperaldosteronism. what is the hemodynamic manifestation

hypertension

82

hyperaldosteronism. what is the electrolyte disturbance

hypokalemia

83

hyperaldosteronism. what is the classification

primary or secondary

84

hyperaldosteronism. what are the 3 causes of primary

adrenal tumor. adrenal hyperplasia. glucocoriticoid responsive hyper aldosterone

85

hyperaldosteronism. what is the cause of glucocorticoid respoonsive hyperaldosterone

genetic

86

hyperaldosteronism. what is the clinical presentation of glucocorticoid responsive hyperaldosteronism

usually htn in pts younger than 20 yrs old

87

hyperaldosteronism. what is the treatment of primary hyperaldos based on

whether or not it is unilateral or not...

88

hyperaldosteronism. unilateral. how is it treated

these patients show better benefit with surgical removal of adrenal gland than the bilateral pts

89

hyperaldosteronism. bilateral. how is it treated

these patients do not benefit much from surgery and is treated with medical management

90

hyperaldosteronism. bilateral. what are drug options to treat primary hyperaldost bilateral

potassium sparing diuretics...

91

hyperaldosteronism. bilateral. which is better. amilioride or spironolactone for medical management

spironoloactone is better than amilioride

92

hyperaldosteronism. bilateral. medical management. what is eplerenone

it is another k-sparing duretic..but is only 60% effect as spironolactone

93

hyperaldosteronism. glucocorticoid responsive hyperaldost. how is the treatment for this differnt than that of bilateral adrenal tumors

it is treated with a night dose of prednisone or dexamethasone. if this doesnt work, then u start spironolactone.

94

adrenal insufficiency. what is the most common manifestation

hypotension

95

adrenal insufficiency. does it respond to fluids

no, bc svr is also decreased

96

adrenal insufficiency. what was the electrolyte disorder

hyponatremia, hyperK and hyperCa

97

pheochromocytoma. what is used preop to treat htn

alpha blocker such as phenoxybenzamine

98

pheochromocytoma. what is an alternative drug to phenoxybenzamine

doxazosin...a long acting alpha 1 blocker dosed 1 time daily

99

pheochromocytoma. what are criteria to make sure pt is ready for surgery

1. no bp above 160/90 before surgery for 24hrs. 2. ekg free of st changes for 1 week , 3. no more than 1 pvc per 5 min ;4. orthosatic hypotension...if it does occur, bp should be above 80/45 (aka needs volume)

100

pheochromocytoma. what is the difficulty with chf pts getting preop bp management

the alpha blockers can cause reflex tachycardia that can decrease cardiac output and cause worsening of chf. the beta blocker that can be used in non chf pts may slow down hr to the point where chf is worsened too

101

pheochromocytoma. what are alternative preop htn meds that can be used in chf pts

alpha-methylpara-tyrosine...that inhibits tyrosine hydroxylase...thus decreasing catecholamine production

102

pheochromocytoma. what preop htn med can be used that has both alpha and beta block

labetalol

103

pheochromocytoma. after what is occluded do you see hypotension

venous drainage of adrenal gland clamping will shut off body supply of catecholamines...

104

pheochromocytoma. how is the blood glucose control in these patients

in the high catecholamine state. norepi is insulin antagonist...so u get hyperglycemia...intraop..when the adrenal gland is venous clamped, u get no more norepi...and you might get rebound hyperinsulin effect...hypoglycemia

105

siadh. what is the most common form

idopathic

106

siadh. what kind of injury can it happen after

subarachnoid hemorrhage.

107

siadh. where is adh made

posterior pituitary

108

siad. what is decreased in lab value

hyponatremia, decreased serum osmolality

109

siadh, what is increased in lab value

urine somolaity, urine sodium, urine specific gravity

110

siadh. what are the values of the decreased lab values

na <280

111

siadh. what are the values of the increased lab values

urine osmolality >200, urine na >20, urine sg >1.005