Endocrine

Question 1

The ___ is the primary source of glucose production via glycogenolysis & gluconeogenesis

Answer 1

liver

Question 2

__% of the glucose released by the liver is freely metabolized by tissues in the brain, GI tract, and red blood cells

Answer 2

75

Question 3

__-__ hours after eating, when glucose usage exceeds availability, endogenous production occurs to maintain a normal plasma glucose level​

During this time, insulin production ____ to maintain normal blood glucose

Answer 3

2-4; diminishes

Question 4

Glucagon plays a primary role by:​

___ glycogenolysis ​

____ gluconeogenesis​

____ glycolysis​

Answer 4

Glucagon plays a primary role by:​

Stimulating glycogenolysis ​

Simulating gluconeogenesis​

Inhibiting glycolysis​

Question 5

describe type 1a, type 1b, and type 2 diabetes

Answer 5

Type 1a DM is caused by an autoimmune destruction of pancreatic β cells, leading to minimal or absent insulin production​

Type 1b DM is a rare, non-immune disease of absolute insulin deficiency​

Type 2 DM is also non-immune, and results from defects in insulin receptors and signaling pathways​

Question 6

in type 1 DM what percent of B cell function must be lost before hyperglycemia happens

Answer 6

80-90%

Question 7

hyperglycemia SX

Answer 7

w/ fatigue, weight loss, polyuria, polydipsia, blurry vision, hypovolemia, ketoacidosis​

​

Question 8

what type of DM does this describe:
In initial stages, tissues become desensitized to insulin, leading to ↑secretion​

Answer 8

type 2 DM

Question 9

3 main abnormalities in 2 DM

Answer 9

Impaired insulin secretion​

↑hepatic glucose release *c/b a reduction in insulin’s inhibitory effect on liver ​

Insufficient glucose uptake in peripheral tissues​

Question 10

what is usually the first sign of 1 DM

Answer 10

polyuria, kids will wet the bed

Question 11

Causes of insulin resistance include: ​(3)

Answer 11

Abnormal insulin molecules​

Circulating insulin antagonists​

Insulin receptor defects​

Question 12

what 3 areas require insulin to bring glucose into the tissues

Answer 12

skeletal muscle
adipose tissue
liver

Question 13

A1C of 5.7-6.4 =

Answer 13

pre-diabetic

Question 14

A1C > 6.5 =

Answer 14

diabetes

Question 15

FBG > _____mg/dl is diagnostic for DM (fasting for 8 hr)

Answer 15

126

Question 16

what does diet and exercise improve

Answer 16

improves hepatic & peripheral insulin sensitivity​

Question 17

what does metformin do?

Answer 17

Metformin: A biguanide, preferred initial drug tx​

Enhances glucose transport into tissues​

↓TGL & LDL levels​

Question 18

what do sulfonylureas do? when are the no longer effective?

Answer 18

Sulfonylureas: ​

Stimulate insulin secretion​

Enhances glucose transport into tissues​

d/t diabetic progressive loss of B cell function, Sulfonylureas not effective long term​

SE’s include hypoglycemia, weight gain & cardiac effects​

​

Question 19

if the pt is compliant with diet and exercise we can see a __-___ % drop in A1C

Answer 19

1-2

same as metformin`

Question 20

metformin is contraindication with ____ insufficient

Answer 20

renal

Question 21

name the regular, short, intermediate, and long acting insulins

Answer 21

Question 22

hypoglycemia is exacerbated by

what specific medications

Answer 22

Exacerbated by ETOH, metformin, sulfonylureas, ACE-I’s, MAOI’s, Non-selective BB’s​

Question 23

what is hypoglycemia unawareness

Answer 23

Repetitive hypoglycemia lead to “hypoglycemia unawareness”​

Pt becomes desensitized to hypoglycemia and doesn’t show autonomic sx​

Neuroglycopenia ensues→fatigue, confusion, h/a, seizures, coma​

Tx: PO or IV glucose (may give SQ or IM if unconscious)​

Question 24

High glucose exceeds the threshold for _____ reabsorption​

Answer 24

renal

Creating osmotic diuresis & hypovolemia​

The liver overproduces of ketoacids​

Question 25

DKA has serum glucose > ____ pH < ____ HCO3 < Serum osmolarity < _____ serum urine ketone level ______

Answer 25

Question 26

insulin loading dose

Answer 26

0.1u/kg + low dose infusion @ 0.1u/kg/hr

Question 27

HHS is characterized by what 3 symptoms

Answer 27

Characterized by severe hyperglycemia, hyperosmolarity & dehydration​ Sx: polyuria, polydipsia, hypovolemia, HoTN, tachycardia​

Question 28

HHS can have acidosis T or F

Answer 28

T

Question 29

TX of HHS

Answer 29

Tx: fluid resuscitation, insulin bolus + infusion, e-lytes​

Question 30

symptoms of nephropathy?

Answer 30

Sx: HTN, proteinuria, peripheral edema,↓GFR ​

Question 31

When GFR < 15-20, kidneys no longer clear ____

Answer 31

potassium ---> hyperkalemic acidosis

Question 32

what drug slows progression of proteinuria and the drop in GFR ​

Answer 32

ACE-I’s

Question 33

Peripheral Neuropathy starts in the ____ and progresses ___

Answer 33

Starts in toes/feet, progresses proximally​ Loss of large sensory & motor fibers, reducing light touch & proprioception​ Loss of small nerve fibers decreases pain/temp perception​

Question 34

can retionpathy be reversed?

Answer 34

yeah, just do what you are supposed to and dont be a doodoo head

Question 35

Cardiovascular sx in DM

Answer 35

Cardiovascular sx: abnormal cardiovascular dynamics, loss of HR variability, ortho-HoTN & dysrhythmias​

Question 36

GI problems in DM

Answer 36

gastroparesis sx: bloating, epigastric pain

Question 37

Silent ischemia is possible w/____ neuropathy​

Answer 37

autonomic

Question 38

Autonomic neuropathy predisposes pt's to peri-op ____ and ____​

Answer 38

Autonomic neuropathy predisposes pt's to peri-op dysrhythmia and HoTN​

Question 39

Gastroparesis may ↑aspiration rx, regardless of ____ status​

Answer 39

NPO

Question 40

PO diabetic drugs should be _____ to avoid hypoglycemia​

Answer 40

held

Question 41

what is an Insulinoma​

Answer 41

Rare, benign insulin-secreting pancreatic tumor​ Occurs 2x more in women than men, normally in 50s-60s​

Question 42

what is a whipple triad with an Insulinoma​

Answer 42

Dx based on Whipple triad:​ Hypoglycemia w/fasting​ Blood glucose <50 w/sx​ Sx relief w/glucose​

Question 43

diazoxide is given in preop to ________

Answer 43

Preop- Diazoxide, which inhibits insulin release from B cells​ Other tx: verapamil, phenytoin, propranolol, glucorticoids, octreotide​

Question 44

can see ___ during the insulinoma removal surgery when the surgeon is manipulating the tumor

Answer 44

hypoglycemia

Question 45

what nerves are you worried about with thyroid surgery

Answer 45

The Recurrent Laryngeal N and external motor branch of the SLN are in close proximity to the thyroid​

Question 46

Production of thyroid hormones dependent on the availability of exogenous _____​

Answer 46

iodine

Question 47

The T4/T3 ratio is __:__

Answer 47

10:1

Question 48

Iodine is reduced to iodide in the _____ tract, rapidly ____, then transported into thyroid follicular cells​

Answer 48

Iodine is reduced to iodide in the GI tract, rapidly absorbed, then transported into thyroid follicular cells​

Question 49

Thyroid function is regulated by the (3)

Answer 49

hypothalamus, anterior pituitary, and thyroid glands​

Question 50

Iodide binds to ____ and yields inactive monoiodotyrosine and diiodotyrosine​

Answer 50

Iodide binds to thyroglobulin and yields inactive monoiodotyrosine and diiodotyrosine​

Question 51

____ _____ is best test of thyroid action at the cellular level​

Answer 51

TSH Assay

Question 52

normal TSH is ____-___

Answer 52

0.4-5.0 milliunits/L​

Question 53

TRH stimulation test used to test _____ function and TSH-secretion​

Answer 53

pituitary

Question 54

Main 3 causes of hyperthyroidism

Answer 54

Graves disease​ toxic goiter​ toxic adenoma​

Question 55

T__ affects the myocardium and peripheral vasculature

Answer 55

T3

Question 56

Extreme thyroid enlargement may cause _______

Answer 56

dysphagia, difficulty swallowing, and inspiratory stridor from tracheal compression​

Question 57

graves disease is an ____ disease causing.....

Answer 57

autoimmune; thyroid-stimulating antibodies, stimulating growth, vascularity, and hypersecretion

Question 58

graves disease labs

Answer 58

Dx labs: +TSH antibodies, low TSH, high T3 & T4​

Question 59

first line tx for graves disease

Answer 59

Treatment: 1st line is antithyroid drug, methimazole or propylthiouracil (PTU)​

Question 60

___ therapy is temporary, reserved for acute situations, like going to surgery

Answer 60

iodine

Question 61

Propranolol impairs the peripheral conversion of ____ to ____

Answer 61

T4 to T3​ BB will treat sx not the cause

Question 62

Surgical complications on thyroidectomy

Answer 62

hypothyroidism, hemorrhage, hematoma, tracheal compression, RLN damage, and parathyroid damage​

Question 63

laryngeal spasm can be causes by hypo____ if the parathyroid is resected

Answer 63

calcemia

Question 64

Elective cases may need to wait ___-___ weeks for antithyroid drugs to take effect ​

Answer 64

6-8

Question 65

In emergent cases what drugs will you give for someone with graves disease

Answer 65

IV BBs, glucocorticoids, and PTU usually necessary​

Question 66

thyroid storm is triggered by

Answer 66

stress, infection, trauma, surgery

Question 67

Primary hypothyroidism results in ↓___ & ___ despite adequate TSH​

Answer 67

T3 T4

Question 68

Hashimoto thyroiditis is an ______ hypothyroidism, often involving a ____ and usually affects middle-aged ____​

Answer 68

autoimmune hypothyroidism, goiter ; women​

Question 69

strong correlation with ___ and hypothyroidism

Answer 69

SIADH

Question 70

Treatment of hypothyroidism is

Answer 70

L-thyroxine is DOC​

Question 71

Pre-op implications for hypothyroidism: ​

Answer 71

Pre-op implications: ​ Assess for airway compromise, swelling, edematous vocal cords, goiter​ Expect slower gastric emptying, aspiration rx​ Cardiovascular system may be hypodynamic​ Respiratory function may be compromised​ More prone to hypothermia​ Electrolyte imbalances possible​ If elective case, Thyroid tx should be initiated at least 10 days prior​ If emergent surgery: IV Thyroid replacement along with steroids ASAP​

Question 72

what is Myxedema Coma what? What symptoms?

Answer 72

Rare, severe form of hypothyroidism characterized by delirium, hypoventilation, hypothermia, bradycardia, HoTN, and dilutional hyponatremia​

Question 73

If elective case with hypothyroid, Thyroid tx should be initiated at least ___ days prior​

Answer 73

10

Question 74

Myxedema Coma is more likely to affect what population

Answer 74

Occurs most commonly in elderly women w/ long hx of hypothyroidism​

Question 75

Myxedema Coma​ treatment

Answer 75

Tx: IV L-thyroxine or L-triiodothyronine ​ IV hydration w/glucose solutions, temp regulation, e-lyte correction, and supportive care​ Mechanical ventilation is frequently required​

Question 76

Myxedema Coma​ is triggered by

Answer 76

Triggered by infection, trauma, cold, and CNS depressants ​

Question 77

causes of a goiter are

Answer 77

Causes: lack of iodine, ingestion of goitrogen, or a hormonal defect​

Question 78

when is surgery of a goiter indicated

Answer 78

Surgery indicated only if medical tx is ineffective, and goiter compromises AW or is cosmetically unacceptable​

Question 79

____ scan must be examined to assess the extent of the tumor​ with a goiter

Answer 79

CT

Question 80

Limitations in the inspiratory limb of the loop indicate _____ obstruction​ Delayed flow in the expiratory limb indicates an ____ obstruction​

Answer 80

Limitations in the inspiratory limb of the loop indicate extra-thoracic obstruction​ Delayed flow in the expiratory limb indicates an intra-thoracic obstruction​

Question 80

___ in upright or supine position is predictive of AW obstruction during GA​

Answer 80

Dyspnea

Question 81

complications of thyroid surgery

Answer 81

Question 82

The adrenal cortex synthesizes:

Answer 82

glucocorticoids, mineralocorticoids (aldosterone), and androgens​

Question 83

Hypothalamus sends _____ to the ___ pituitary, which stimulates release of ____ ## Footnote regarding the adrenal gland

Answer 83

corticotropin-releasing hormone (CRH); anterior; corticotropin (ACTH) ​

Question 84

_____ stimulates the adrenal cortex to produce cortisol​

Answer 84

ACTH Cortisol helps convert NE to EPI, and induces hyperglycemia

Question 85

a Pheochromocytoma is a Catecholamine-secreting tumor that originates from ____ cells in adrenal medulla​

Answer 85

chromaffin can lead to HTN, CVA, and MI

Question 86

Most Pheo’s secrete NE:EPI ratio __:___ the inverse of normal adrenal secretion​

Answer 86

85:15

Question 87

Pheochro. attack can result from ....

Answer 87

may occur spontaneously or triggered by injury, stress, or meds​

Question 88

Pheo are dx how

Answer 88

Dx: 24h urine collection for metanephrines and catecholamines​ also can be a mass on the kidney

Question 89

TX of Pheo

Answer 89

Question 90

Never give nonselective BB before α blocker​. WHY??

Answer 90

blocking vasodilatory β2 receptors results in unopposed α agonism, leading to vasoconstriction and hypertensive crises​

Question 91

differentiate ACTH dependent and ACTH independent Cushings

Answer 91

ACTH-dependent Cushings: high plasma ACTH stimulates adrenal cortex to produce excess cortisol ​ ACTH-independent Cushings: excessive cortisol production by abnormal adrenocortical tissue that is not regulated by CRH and ACTH​

Question 92

dx of cushing disease

Answer 92

24hr urine cortisol

Question 93

Treatment of choice for Cushings is

Answer 93

transsphenoidal microadenomectomy if resectable​ for a pituitary adenoma

Question 94

Hallmark sx of Conn Syndrome (hyperaldosteronism) is

Answer 94

Spontaneous HTN w/hypokalemia

Question 95

In secondary hyper-aldosteronism is due to an increase in ___

Answer 95

renin in primary the renin will be suppressed

Question 96

Long term ingestion of ____ can cause a syndrome that mimics hyperaldosteronism

Answer 96

licorice

Question 97

TX of hyperaldosteronsim

Answer 97

Tx: Aldosterone antagonist (Spironolactone), K+ replacement, antihypertensives, diuretics, tumor removal, possible adrenalectomy​

Question 98

Hypoaldosteronism hallmark sign is

Answer 98

high K without renal issues

Question 99

what kind of metabolic acidosis is common with hypoaldosteronism

Answer 99

Hyperchloremic

Question 100

Indomethacin-induced prostaglandin deficiency is a _____ cause​ of hypoaldo.

Answer 100

reversable

Question 101

Primary AI (Addison dz): Autoimmune ____ gland suppression ​

Answer 101

adrenal

Question 102

Secondary AI: hypothalamic-pituitary suppression leading to a lack of ___ or ___ production​

Answer 102

CRH or ACTH production​ Unlike Addison’s, there is only a glucocorticoid deficiency ​ Most cases are iatrogenic, with causes including synthetic glucocorticoids, pituitary surgery, or radiation​ These pts lack hyperpigmentation​ ​

Question 103

Dx with Addisons disease is baseline cortisol < ___ μg/dL and remains <___ μg/dL after ACTH stimulation​

Answer 103

20

Question 104

Absolute AI is characterized by a ____ baseline cortisol level and a positive ACTH stimulation test​ Relative AI is indicated when the baseline cortisol level is _____, but the ACTH stimulation test is positive​

Answer 104

low; higher

Question 105

___ parathyroid glands located behind the upper & lower poles of the thyroid​

Answer 105

4

Question 106

Hypocalcemia ____ the release of PTH, whereas hypercalcemia ____ PTH synthesis and release​

Answer 106

stimulates; suppresses

Question 107

Primary hyperparathyroidism is caused by: ​

Answer 107

benign parathyroid adenoma (90%)​ carcinoma (<5%)​ parathyroid hyperplasia​ sx are basically hypercalcemia

Question 108

Secondary Hyperparathyroidism: _____ response of the parathyroid glands to counteract a separate disease process involving hypocalcemia s/a CRF​

Answer 108

compensatory example: renal issue where you are spilling Ca

Question 109

Pseudohypoparathyroidism is a disorder where ____ is adequate, but the kidneys are unable to respond to it​

Answer 109

PTH

Question 110

Dx labs for hypoparathyroid : __PTH, __Ca++,__phos​

Answer 110

↓PTH, ↓Ca++,↑phos​

Question 111

what 6 hormones does the anterior pituitary gland secrete

Answer 111

GH, ACTH, TSH, FSH, LH, prolactin

Question 112

Posterior pituitary stores ____ and ___ after being synthesized in the hypothalamus

Answer 112

vasopressin and oxytocin

Question 113

Acromegaly is Excessive growth hormone, most often seen with _____ pituitary adenomas​

Answer 113

anterior

Question 114

acromegaly can cause what airway problems

Answer 114

obstruction; RLN paralysis Distorted facial anatomy may interfere with mask placement ​ Enlarged tongue & epiglottis predisposes to upper AW obstruction and interferes w/visualization of vocal cords on DL​ Increased distance btw the lips and vocal cords d/t mandible overgrowth ​ Glottic opening may be narrowed d/t vocal cord enlargement ​ May require smaller ETT, VL, awake fiberoptic intubation​ ​

Question 115

What is DI and the treatment

Answer 115

Question 116

what is SIADH and the treatment

Answer 116

Question 117

Neurogenic and nephrogenic DI are differentiated b/o response to ______,

Answer 117

DDAVP which causes urine-concentration in neurogenic, but not nephrogenic, DI​