Endocrine 2

Question 1

Anesthetic considerations for the patient with diabetes insipidus include:
a. sodium restriction
b. DDAVP
c. three percent sodium chloride
d. demeclocycline

Answer 1

b. DDAVP

Question 2

The most common cause of diabetes insipidus is

Answer 2

pituitary surgery

Question 3

Syndrome of inappropriate ADH secretion is caused by

Answer 3

an excessive level of ADH in the blood

Question 4

Diabetes insipidus is caused by

Answer 4

too little ADH in the blood

Question 5

The most common cause of SIADH is

Answer 5

traumatic brain injury

Question 6

Describe urine output for SIADH

Answer 6

low urine output

Question 7

Describe urine output for DI.

Answer 7

high urine output

Question 8

Treatment of SIADH includes

Answer 8

fluid restriction, demeclocycline, and hypertonic saline if the patient is severely hyponatremic

Question 9

Treatment of DI includes

Answer 9

DDAVP or vasopressin along with supportive measures

Question 10

__________ can complicate airway management

Answer 10

Acromegaly

Question 11

Considerations with acromegaly include

Answer 11

distorted facial features (difficult mask)
large tongue, teeth, and epiglottis (difficult laryngoscopy
subglottic narrowing and vocal cord enlargement (difficult ETT placement)
turbinate enlargement (risk of epistaxis)

Question 12

Comorbidities associated with acromegaly include

Answer 12

glucose intolerance
OSA
CAD
skeletal muscle weakness
entrapment neuropathies

Question 13

Other conditions that can cause SIADH include

Answer 13

cancer (small-cell lung carcinoma)
noncancerous lung disease
carbamazepine

Question 14

Other conditions that can cause DI include

Answer 14

TBI
SAH

Question 15

Acromegaly results from

Answer 15

over secretion of growth hormone after adolescence

Question 16

Nearly all cases of acromegaly are caused by

Answer 16

pituitary adenoma

Question 17

When compared to T4, which statements BEST describe T3? (select 2)
a. shorter half-life
b. higher concentration in the blood
c. more protein-bound
d. higher potency

Answer 17

a. shorter half-life
d. higher potency

Question 18

The thyroid gland stores and secretes three hormones:

Answer 18

T4= thyroxine
T3= triiodothyronine
calcitonin

Question 19

Thyroxine is a

Answer 19

prohormone synthesized from tyrosine

Question 20

Triiodothyronine is an

Answer 20

active thyroid hormone

Question 21

Calcitonin leads to

Answer 21

reduced serum Ca2+

Question 22

The thyroid requires ______ to synthesize T3 and T4

Answer 22

iodine

Question 23

When iodine is not available due to __________, the thyroid gland cannot

Answer 23

dietary deficiency; produce enough T3 and T4

Question 24

The recurrent laryngeal nerve courses along

Answer 24

the lateral border of each thyroid lobe

Question 25

RLN is at risk for injury during

Answer 25

thyroid or parathyroid surgery

Question 26

Describe the source of T4 & T3

Answer 26

T4 is directly released from the thyroid T3 is mostly extra-thyroid conversion of T4 to T3

Question 27

Which has more protein binding T4 or T3

Answer 27

T4

Question 28

Which has more potency T4 or T3?

Answer 28

T3

Question 29

Which has a shorter half-life?

Answer 29

T3

Question 30

In the patient with hypoactive thyroid, there

Answer 30

isn't enough thyroid hormone to suppress TSH so TSH remains chronically elevated--> goiter

Question 31

The following are consequences of excess thyroid hormone EXCEPT: a. vasodilation b. diarrhea c. hypoventilation d. tremors

Answer 31

c. hypoventilation

Question 32

Increased thyroid hormone--> ___BMR--> ______O2 consumption --> ______ Co2 production

Answer 32

increases all of them

Question 33

Thyroid hormone increases

Answer 33

myocardial performance independent of ANS input- increased HR, increased contractility, increased lusitropy, and decreased SVR

Question 34

Thyroid disorders ______ MAC

Answer 34

do NOT

Question 35

Instead of affecting MAC, thyroid disorders affect

Answer 35

cardiac output which impacts the speed of anesthetic onset

Question 36

How do hypothyroidism and hyperthyroidism affect the speed of anesthetic onset?

Answer 36

hypothyroidism--> increases speed of onset hyperthyroidism--> reduces the speed of onset

Question 37

_________ is the most common cause of hyperthyroidism

Answer 37

Grave's disease

Question 38

____________ is the most common cause of hypothyroidism

Answer 38

Hashimoto's thyroiditis

Question 39

Etiologies of hyperthyroidism include

Answer 39

Grave's disease MG multinodular goiter carcinoma pregnancy pituitary adenoma amiodarone

Question 40

Diagnosis of hyperthyroidism includes

Answer 40

Low TSH high T3 & T4

Question 41

Cardiac symptoms of hyperthyroidism include

Answer 41

hypertension tachyarrhythmias atrial fibrillation

Question 42

Pulmonary symptoms of hyperthyroidism include

Answer 42

increased minute ventilation

Question 43

General findings of hyperthyroidism include

Answer 43

goiter weight loss muscle weakness moist and warm skin heat intolerance fine hair diarrhea tremor exophthalmos hypercalcemia

Question 44

Etiologies of hypothyroidism include

Answer 44

Hashimoto's thyroiditis iodine deficiency hypothalamic-pituitary dysfunction neck radiation thyroidectomy amiodarone

Question 45

Diagnosis of hypothyroidism includes

Answer 45

high TSH and low T3 and T4

Question 46

Cardiac symptoms of hypothyroidism include

Answer 46

peripheral vasoconstriction decreased heart rate decreased contractility heart failure pericardial effusion

Question 47

Pulmonary symptoms of hypothyroidism include

Answer 47

decreased minute ventilation reduced response to hypoxia reduced response to hypercarbia pleural effusion

Question 48

General findings with hypothyroidism include

Answer 48

goiter weight gain muscle fatigue/lethargy dry and thick skin cold intolerance dry, brittle hair constipation delayed gastric emptying large tongue

Question 49

What is thyroid storm?

Answer 49

in response to stressful events the thyroid glands increase hormone output

Question 50

When can thyroid storm occur?

Answer 50

hyper and euthyroid patients

Question 51

During the perioperative period, thyroid storm is most likely to happen

Answer 51

6-18 hours after surgery

Question 52

_________ is a complication of severe hypothyroidism

Answer 52

myxedeme coma

Question 53

_______ is a complication of neonatal hypothyroidism that leads to limited physical and mental development

Answer 53

Cretinism