Endocrine Flashcards
(123 cards)
1
Q
what are the 3 types of hormones? (P,A,S)
A
peptides/proteins, amines/AA, steroids
2
Q
most hormones are what type?
A
peptides/proteins
3
Q
Tryptophan and tyrosine are what type of hormones?
A
amines/AA
4
Q
tryptophan converts into what hormone?
A
serotonin
5
Q
tyrosine converts into what 2 hormone types? (T,C)
A
thyroid hormones, catecholamine hormones
6
Q
reporductive hormones are what type of hormones?
A
steroids
7
Q
steroid hormones come form where?
A
adrenal cortex
8
Q
what 2 hormone types bind to intracellular hormone receptors? (T,S)
A
thyroid and steroid hormones
9
Q
are hormone receptor number inversely or directly related to the amount of circulating hormone?
A
inversely
10
Q
what is downregulation?
A
decreased number of receptors d/t an increased number of hormones
11
Q
what is upregulation?
A
increased number of receptors d/t an decreased number of hormones
12
Q
what hormones does the anterior pituitary secrete? (P,T,F,L,A,G)
A
prolactin, TSH, FSH, LH, ACTH, GH
13
Q
what are 5 symptoms of anterior pituitary hyposecretion? (D,VL,FN/P,S)
A
diplopia, visual loss, facial numbness/pain, seizures
14
Q
Transsphenoidal adenohypophysectomy is a combined approach from what 2 services?
A
ENT, NSG
15
Q
why is the LLE prepped for Transsphenoidal adenohypophysectomy?
A
for fat harvesting and packing of the sinuses
16
Q
Avoid what breathing pattern and what drug during maintenance of Transsphenoidal adenohypophysectomy? (H,N)
A
hyperventilation, N2O
17
Q
Goal of anesthesia for a Transsphenoidal adenohypophysectomy is a smooth, rapid emergence to permit a what assessment? (N)
A
neuro assessment
18
Q
what are the 2 most common postop complications with Transsphenoidal adenohypophysectomy? (CR,DI)
A
csf rhinorrhea, diabetes insipidus
19
Q
what 3 hormones are the most common produced in anterior pituitary hypersecretion? (P,A,G)
A
prolactin, ACTH, GH
20
Q
what are the 3 airway difficulties with acromegaly? (SN, EV, NTE)
A
subglottic narrowing, enlarged VCs, nasal turbinate enlargement
21
Q
what are the 2 hormones secreted by the posterior pituitary? (A,O)
A
ADH, oxytocin
22
Q
ADH:
- acts on renal collecting ducts to reabsorb what?
- does it increase or decrease urine osmolarity and blood volume?
- vasodilator or vasoconstrictor?
- promotes hemostasis by increasing what 2 factors?
A
- H2O
- increase
- vasoconstrictor
- vWF & factor VIII
23
Q
is DI too much or not enough ADH?
A
not enough
24
Q
is SIADH too much or not enough ADH?
A
too much
25
DI:
1. Polyuria or oliguria?
2. serum osmolarity > what? (mOsm/L)
3. urine osmolarity < what? (mOsm/L)
4. specific gravity < what?
5. urine output is > how mL/kg/day?
6. diagnosed when urine osmolarity increases after what is administered? (V)
1. polyuria
2. 290 mOsm/L
3. 300 mOsm/L
4. 1.010
5. 30 mL/kg/day
6. vasopressin
26
DI treatment:
| 1. what is intraop vasopressin dose range? (units/hr)
0.1-0.2 units/hr
27
for DI, avoid what VA d/t renal dysfunction?
sevoflurane
28
when giving vasopressin, prepare for what and what should be monitored? (LB, EFI)
labile blood pressure, ECG for ischemia
29
SIADH:
1. serum sodium < what? (mEq/L)
2. edema where causes HA, lethargy and nausea?
3. is urine hypotonic or hypertonic?
4. what drug is an antagonist of vasopressin? (D)
5. correct serum Na what range per hour? (mEq/hr)
6. correct serum Na what range per day? (mEq/L/day)
1. 130 mEq/L
2. cerebrum
3. hypertonic
4. demeclocycline
5. 0.5 mEq/hr
6. 6 mEq/L/day
30
why is anti-nausea prophylaxis important in SIADH pts?
nausea stimulate ADH release
31
thyroid cartilage is located at what 2 number tracheal rings?
2nd, 4th
32
Thyroid gland secretes what 3 hormones? (C,T,T)
calcitonin, T3, T4
33
Hypothyroidism:
1. T3 & T4 levels increased or decreased?
2. TSH levels increased or decreased?
1. decreased
| 2. increased
34
Causes of hypothyroidism
1. what 2 meds? (A,L)
2. what autoimmune disease? (HT)
3. severe deficiency in what mineral? (I)
4. what congenital condition? (C)
1. amiodarone, lithium
2. hashimoto's thyroiditis
3. iodine
4. cretinism
35
hypothyroidism is associated with what 2 effusions? (P,P)
percaridal, pleural
36
hypothyroidism can have tracheal deviation from what? (EG)
enlarged glands
37
hypothyroid pts with what disease may not tolerate the full replacement dose of thyroid hormone?
CAD
38
caution giving what 3 drug types with hypothyroidism pts? (B,O,ID)
benzos opioids, induction drugs
39
what drug may be a better induction drug choice for hypothyroidism?
ketamine
40
should you use direct or indirect BP meds to treat hypotension in hypothyroidism pts?
direct
41
Myxedema coma is a loss of brain function in pts with a long history of what? (H)
hypothyroidism
42
Hyperthyroidism:
1. what is the one eye sign? (E)
2. what 3 BP measurements are increased?
3. what 2 C/V symptoms are seen? (P,D)
4. is blood volume increased or decreased?
5. is CO increased or decreased?
6. myocardial depression d/t what? (PC)
1. exophthalmos
2. SBP, DBP, pulse pressure
3. palpitations, dysrhythmias
4. increased
5. increased
6. protein catabolism
43
for hypothyroidism and hyperthyroidism what 2 things should always be assessed? (A, VQ)
airway, vocal quality
44
Hyperthyroidism:
1. what 3 drugs should be avoided? (P,K,A)
2. what type of obstruction can a tumor causes? (BVO)
3. direct or indirect agents for hypotension?
4. hypotension can occur from stimulating what artery? (C)
5. what is the most common dysrhythmia?
1. pancuronium, ketamine, atropine
2. ball-valve obstruction
3. direct
4. carotid
5. A fib
45
MH vs thyroid storm:
1. what 2 electrolytes increase in MH?
2. what one sign is seen in MH?
1. increased K
2. increased Ca
3. muscle rigidity
46
what 3 complications of a thyroidectomy can cause airway compromise? (RD, T, H)
RLN damage, tracheomalacia, hematoma
47
acute hypoparathyroidism is seen as what sign 24-48 hours postop? (S)
stridor
48
thyroid storm can mimic what 3 conditions? (MH, LA, P)
MH, light anesthesia, pheochromocytoma
49
Normal Ca levels:
1. serum (range)
2. ionized (range)
1. 8-10
| 2. 0.8-1.0
50
does PTH increase or decrease Ca levels?
increase
51
what ion is inversely related to Ca?
phosphate
52
PTH controls final conversion of what vitamin?
vitamin D
53
Calcitonin opposes what hormone?
PTH
54
does calcitonin increase or decrease Ca?
decrease
55
what are 7 S/S of hypoparathyroidism d/t hypocalcemia? (NMI, MC, LMS, PQTI, D, DCC, H)
neuromuscular irritability, muscle cramps, laryngeal muscle spasms, prolong QT interval, dysrhythmias, decrease cardiac contractility, hypotension
56
is chvostek's sign and trousseau for hypercalcemia or hypocalcemia?
hypocalcemia
57
is chvostek's sign and trousseau for hypoparathyroidism or hyperparathyroidism?
hypoparathyroidism
58
what range of mg/kg/hr of Ca should be given to pts with symptomatic hypocalcemia?
1-2 mg/kg/hr
59
Mg of elemental Ca in 10 mL of 10% solution:
1. Calcium gluconate
2. Calcium chloride
1. 93 mg
| 2. 272 mg
60
What sign is the trousseau: BP cuff or facial twitch?
BP cuff
61
What sign is the chvostek: BP cuff or facial twitch?
facial twitch
62
hypocalcemia happens after what surgery?
hypoparathyroidectomy
63
Conduction in hyperparathyroidism:
1. short or long QT?
2. narrow or wide T wave?
1. short
| 2. wide
64
what are the 4 "-ones" S/S of hyperparathyroidism? (G, M, B, S)
1. groans (constipation)
2. moans (psych distress)
3. bones (bone pain)
4. stones (renal stones)
65
are pts having a parathyroidectomy at an increased risk of PONV?
yes
66
what do these RLN trauma sound like?
1. unilateral
2. bilateral
1. hoarse
| 2. aphonia
67
adrenal cortex secretes what 3 things? (M,A,G)
mineralocorticoids, androgens, glucocorticoids
68
adrenal medulla secretes what? (C)
catecholamiens
69
what are the 3 zones of the adrenal cortex? (G,F,R)
glomerulosa, fasciculata, reticularis
70
what does the glomerulosa secrete?
mineralcorticoids
71
what does the fasciculata secrete?
cortisol
72
what 2 things does the reticularis secrete?
androgenic hormones, glucocorticoids
73
Aldosterone:
1. reabsorption of what ion?
2. excretion of what 2 ions?
3. secreted from what zone of the adrenal cortex?
1. Na
2. K and H
3. glomerulosa
74
what are 5 S/S of primary aldosteronism? (H, MW, MA,LR, P)
HTN, M weakness, metabolic alkalosis, low renin, polyuria
75
Does primary aldosteronism cause an increase or decrease in K?
decrease
76
do pts with primary aldosteronism have an increased or decreased response to muscle relaxants?
increased
77
why do pts with primary aldosteronism have an increased response to muscle relaxants?
decreased potassium
78
what is the surgical option for cushing's syndrome?
transsphenoidal adenohypophysectomy
79
pts with cushings have an increased level of what? (G)
glucocorticoids
80
pre treated pts with cushing syndrome with steroids minimizes what changes?
C/V
81
hyperventilation may worsen what in pts with cushing's syndrome?
hypokalemia
82
NMB may be shortened or prolonged in post op cushing's syndrome?
prologned
83
why are NMB prolonged in post op cushing's syndrome?
decrease potassium
84
treatment of adrenocortical insufficiency with how many mg/day of prednisone?
7.5 mg/day
85
Acute adrenal insufficiency:
1. avoid what induction med?
2. increase or decrease response to catecholamines?
3. increase or decrease BP after induction?
4. increase risk of what type of arrest? (H)
1. etomidate
2. decrease
3. decrease
4. hyperkalemia
86
what are 4 postop risk of acute adrenal insufficiency related to steroid use? (U, I, LBP, H)
ulcers, infection, labile BP, hyperglycemia
87
pancreatitis is a postop risk for acute adrenal insufficiency d/t increased what? (D)
demands
88
what is pheochromocytoma?
a tumor in the adrenal gland chromaffin tissue secreting catecholamine
89
what 2 catecholamines does a pheochromocytoma secrete?
epinephrine, NE
90
what is the triad of S/S of pheochromocytoma? (P,H,D)
palpitations, HA, diaphoresis
91
what are the 2 cardinal preop steps before pheochromocytoma surgery? (VE, ABFBBB)
1. volume expansion
| 2. alpha block followed by a beta block
92
what 2 C/V things are assessed before pheochromocytoma?
1. dilated CM
| 2. CHF
93
pheochromocytoma surgery intraop:
1. what position?
2. do you use cell saver?
3. avoid what 2 types of meds and one med? (V,S,S)
4. avoid drugs that release what?
1. lateral
2. no
3. vagolytics, sympathomimetics, succs
4. histamine
94
pheochromocytoma BP has to be less than what for 48 hours:
1. SBP
2. DBP
1. 165
| 2. 90
95
catecholamines are increased for how many days post pheochromocytoma surgery?
10 days
96
cautious replacing fluids for pheochromocytoma surgery d/t what risk? (C)
CHF
97
diabetes mellitus:
1. check for what sign?
2. why use aspiration prophylaxis? (G)
3. use direct or indirect agents?
4. may see increase sensitivity to what med? (P)
1. prayers sign
2. gastroparesis
3. direct
4. protamine
98
1 unit of insulin lowers glucose what range of mg/dL?
50 mg/dL
99
what are 4 postop complications for diabetes mellitus pts? (BO, WI, D, PVF)
1. bowel obstruction
2. wound infection
3. dehiscence
4. prosthetic valve failure
100
positive pray sign indicates what?
decreased neck mobility
101
Carcinoid syndrome causes tumors to arise in what 4 areas? (L, B, SB, O)
lungs, bronchi, small bowel, ovaries
102
Carcinoid syndrome tumors secrete what substances? (V)
vasoactive
103
what med is give for 24 hours preop for someone with Carcinoid syndrome?
octreotide
104
Carcinoid syndrome intraop:
1. avoid meds that cause what to be released? (H)
2. avoid what one med and what type of med? (S, AA)
1. histamine
| 2. succs, adrenergic agonists
105
Carcinoid syndrome postop:
1. No what type of med? (S)
2. what med for hypotension?
1. sympathomimetics
| 2. octreotide
106
treatment of adrenocortical insufficiency with how many mg/day of hydrocortisone?
30 mg/day
107
because adrenal insufficiency is supplemented with steroids and causes hyperglycemia, what organ can have inflammation because of increased demand?
pancreas
108
Cushings: hyper or hypokalemia?
hypokalemia
109
hemodynamic criteria for pheochromocytoma resection is a SBP and DBP less than what for how many hours?
<165/90 for 48 hours
110
nausea stimulates what hormone to be released?
ADH
111
what syndrome has the manifestations of pericardial and pleural effusions?
hypothyroidism
112
what is the one s/s of acute hypoparathyroidism? (S)
stridor
113
what groans, moans, bones, and stones are s/s for what syndrome?
hyperparathyroidism
114
what 2 surgeries can cause damage to the RLN?
thyroidectomy, parathyroidectomy
115
what 2 syndromes have increased effects of NMBs d/t hypokalemia?
1. primary aldosteronism
| 2. cushing's disease
116
avoid etomidate in what syndrome?
adrenal insufficiency
117
avoid succs for what 2 syndromes?
pheochromocytoma, carcinoid
118
DM:
1. we want preop glucose between what? (mg/dL)
2. we want glycosylated hgb less than what %?
1. 120-180 mg/dL
| 2. <7.5%
119
pretreat carcinoid syndrome with octreotide for how many hours?
24 hours
120
give ketamine for hyperthyroidism?
no
121
give ketamine for hypothyroidism?
yes
122
what is the cushing's surgery?
transsphenoidal adenohypophysectomy
123
avoid sevo for what syndrome?
DI
