endocrine practice quiz Flashcards
Which of the following hormones are released from the anterior lobe of the pituitary gland? (select four)
A. calcitonin B. prolactin C. antidiuretic hormone D. luteinizing hormone E. oxytocin F. follicle-stimulating hormone G. adrenocorticotropic hormone H. insulin
B. prolactin
D. luteinizing hormone
F. follicle-stimulating hormone
G. adrenocorticotropic hormone
Hormones released from the anterior pituitary gland include: growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. Antidiuretic hormone and oxytocin are released from the posterior pituitary gland. Calcitonin is released from the thyroid gland.
Antidiuretic hormone increases the absorption of solute-free water in the
A. glomerulus B. loop of Henle C. collecting ducts D. proximal convoluted tubule
C. collecting ducts
Antidiuretic hormone (ADH), also known as arginine vasopressin, works in the distal tubule/collecting tubule and duct. ADH is secreted in response to dehydration and renders the lumen of the collecting tubule permeable to water through the expression of water channel proteins called aquaporin-2 channels. Adequate hydration suppresses the release of ADH, rendering the lumen of the collecting tubule impermeable to water.
What is the most potent mineralocorticoid produced by the adrenal gland?
A. Aldosterone B. Cortisol C. ACTH D. PTH
A. Aldosterone
Which is the most potent endogenous glucocorticoid and produced by the adrenal cortex?
A. Aldosterone B. Cortisol C. ACTH D. PTH
B. Cortisol
Select two catecholamines that the adrenal medulla synthesizes and secretes.
A. Epinephrine B. Dopamine C. Norepinephrine D. Cortisol
A. Epinephrine
C. Norepinephrine
Select two hormones secreted by posterior pituitary.
A. Growth hormone B. Oxytocin C. Vasopressin D. TSH
B. Oxytocin
C. Vasopressin
the are secreted by the posterior pituitary, but synthesized in the hypothalamus
All of the following are symptoms of hypoglycemia except
A. Hypotension B. Tachycardia C. Diaphoresis D. Lacrimation
A. Hypotension
Hypoglycemia is associated with a sympathetic response and symptoms such as hypertension, tachycardia, diaphoresis, and lacrimation.
Which of the following is a likely cause of hypocalcemia?
A. Hyperparathyroidism B. Hypermagnesemia C. Malignancy D. Hypoalbuminemia
D. Hypoalbuminemia
Total blood calcium levels parallel the serum albumin. If the serum albumin decreases, the total blood calcium level will decrease as well. Hypoalbuminemia is the most common cause of hypocalemia.
All of the following should be avoided in the patient with symptomatic hypoparathyroidism except
A. Hyperventilation B. Sodium bicarbonate C. Ketamine D. Citrated blood products
C. Ketamine
The symptoms of hypoparathyroidism are due to the underlying hypocalcemia. These patients will have some degree of myocardial depression making etomidate and ketamine appropriate choices for induction. Hyperventilation should be avoided due to the risk of further reducing ionized calcium levels. Sodium bicarb and citrated blood products can also lead to decreases in ionized calcium levels. Finally, careful titration of muscle relaxants in parathyroid dysfunction patients is prudent due to the unpredictable responses that they may elicit.
Which of the following patients would be most likely to exhibit delayed gastric emptying as a symptom of their condition?
A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Hypoparathyroidism
B. Hypothyroidism
One of the hallmark gastrointestinal symptoms of hypothyroidism is delayed gastric emptying. Gastrointestinal symptoms associated with hyperparathyroidism include anorexia, nausea, vomiting, constipation, and epigastric pain. Hyperthyroidism is commonly associated with diarrhea.
What is the best predictor of silent coronary artery disease in diabetic patients?
A. U waves on the electrocardiogram B. Autonomic neuropathy C. First degree heart block D. Obesity
B. Autonomic neuropathy
A hormone response that initiates signals which amplify the release of the same hormone is referred to as a
A. positive feedback mechanism B. negative feedback mechanism C. target-control amplifier D. circadian rhythm
A. positive feedback mechanism
A positive feedback mechanism is a hormone-regulating system in which the release of a hormone triggers changes which amplify the release of the same hormone.
Which of the following is a cause of secondary hyperparathyroidism?
A. Chronic renal failure B. Parathyroid hyperplasia C. Hashimoto's thyroiditis D. Malignant hyperthermia
A. Chronic renal failure
Secondary hyperparathyroidism is defined as a normal, compensatory increase in parathyroid hormone secretion in response to a disease process or condition that produces hypocalcemia, such as the increased parathyroid hormone secretion associated with chronic renal disease. Because it is a compensatory mechanism, it rarely produces hypercalcemia.
What conditions comprise the biochemical triad of diabetic ketoacidosis?
A. Proteinuria, hyperglycemia, acidemia B. Ketonemia, hyperglycemia, alkalemia C. Acidemia, ketonemia, hyperglycemia D. Proteinuria, ketonemia, acidemia
C. Acidemia, ketonemia, hyperglycemia
Diabetic ketoacidosis is described as the biochemical triad of hyperglycemia, acidemia, and ketonemia.
Although, DKA is more common in Type I DM, it is usually mild to moderate hyperglycemia. Dehydration and electrolyte derangements are more severe.
A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?
A. Induction and intubation B. Maintenance of anesthesia C. Emergence D. After the case is finished
D. After the case is finished
Patients can experience thyrotoxic crisis at any point during an anesthetic, but it is most likely to occur within 6 to 18 hours postoperatively.
Following induction and intubation of a patient with hypothyroidism, the blood pressure falls to 80/40 mmHg. The most appropriate intervention for this patient would be to administer
A. Atropine 0.4 mg IV B. Glycopyrrolate 0.4 mg IV C. Phenylephrine 40 mcg IV D. Ephedrine 5 mg IV
D. Ephedrine 5 mg IV
In patients with hypothyroidism, the administration of alpha agonists such as phenylephrine could substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. The best option for these patients is to administer epinephrine, ephedrine, or dopamine.
Which of the following laboratory findings would be consistent with a diagnosis of hyperparathyroidism?
A. Serum calcium = 10.5 mg/dL B. Serum calcium = 7.0 mg/dL C. Serum potassium = 4.5 mEq/L D. Serum potassium = 2.9 mEq/L
A. Serum calcium = 10.5 mg/dL
Hyperparathyroidism is the most common cause of hypercalcemia, which is defined as a serum calcium level greater than 10.4 mg/dL.
You are performing a general anesthetic on a patient undergoing a parathyroidectomy. Which of the following signs and symptoms would be most closely associated with hyperparathyroidism?
A. Shortened QT interval B. Hyperreflexia C. Hypotension D. Metabolic alkalosis
A. Shortened QT interval
The principal pathologic feature of hyperparathyroidism resulting in symptoms is hypercalcemia. The elevated serum calcium concentrations can result in a shortened QT interval, prolonged PR interval, hypotonia and skeletal muscle weakness (as opposed to hyperreflexia). Hyperparathyroidism is often associated with hypertension and the influence of parathyroid hormone on the renal excretion of bicarbonate results in increased serum chloride concentrations which results in a mild metabolic acidosis.
he most common nerve injury in patients undergoing subtotal thyroidectomy is damage to the
A. internal laryngeal nerve B. recurrent laryngeal nerve C. ulnar nerve D. common peroneal nerve
B. recurrent laryngeal nerve
The most common nerve injury associated with subtotal thyroidectomy is damage to the recurrent laryngeal nerve. Unilateral surgical damage results in hoarseness and a single paralyzed vocal cord. Bilateral damage results in aphonia and total airway obstruction requiring mechanical ventilation. The patency of vocal cord function can be assessed postoperatively by viewing the cords through a fiberoptic scope or by having the patient say ‘e’.
Which of the following laboratory derangements is associated with hypoaldosteronism?
A. Hyperchloremic metabolic acidosis B. Hypochloremic metabolic alkalosis C. Hypokalemia D. Hypernatremia
A. Hyperchloremic metabolic acidosis
Hypoaldosteronism is associated with hyperkalemia, hyponatremia, hyperchloremic metabolic acidosis, and often, hyperglycemia.
Which of the following clinical findings would be consistent with a diagnosis of hyperaldosteronism?
C. Diastolic blood pressure of 125 mmHg
Hyperaldosteronism (Conn’s syndrome) exhibits signs and symptoms including headache, systemic hypertension (diastolic blood pressure often between 100 mmHg and 125 mmHg), hypokalemia, hypernatremia, hypomagnesemia, and abnormal glucose tolerance. Normal serum potassium levels are between 3.5 and 5.5 mEq/L, serum sodium levels are between 135 and 145 mEq/L, and magnesium levels are between 1.7 and 2.1 mEq/L.
Which of the following interventions would be an appropriate initial treatment for the derangement in serum potassium caused by hyperaldosteronism?
A. Furosemide B. Spironolactone C. Dextrose and insulin infusion D. Bumetanide
B. Spironolactone
Hyperaldosteronism is associated with hypokalemia (serum potassium less than 3.5 mEq/L). The administration of furosemide, bumetanide, or dextrose and insulin infusions would worsen the hypokalemia. Spironolactone is a competitive aldosterone antagonist that, unlike furosemide and bumetanide will induce diuresis while sparing serum potassium levels.
All of the following findings are consistent with a diagnosis of pheochromocytoma except:
A. Increased plasma metanephrine levels B. Left ventricular hypertrophy on ECG C. Normal serum magnesium level D. Decreased hematocrit
B. Left ventricular hypertrophy on ECG
Pheochromocytoma is associated with ECG changes such as left ventricular hypertrophy, nonspecific T wave changes, and evidence of ischemia, urinary excretion of vanillylmandelic acid (a byproduct of catecholamine metabolism), and increased hematocrit due to volume contraction resulting from chronic hypertension. Alterations in serum magnesium level are not necessarily associated with pheochromocytoma.
All of the following would be appropriate initial treatments for hypertension due to pheochromocytoma in preparation for surgical removal of the tumor except
A. Metoprolol B. Nitroprusside C. Phenoxybenzamine D. Doxazosin
A. Metoprolol
Preoperative management of pheochromocytoma centers on control of the hyperdynamic state induced by increased serum levels of catecholamines. Because decreased myocardial contractility in the face of an elevated systemic vascular resistance can result in heart failure, it is important to decrease the SVR prior to instituting beta blockade. Nitroprusside, phenoxybenzamine, and doxazosin decrease SVR without decreasing myocardial contractility.
Alpha blockade before beta blockade
