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Health Assessment > Endocrine Pt 1 > Flashcards

Endocrine Pt 1 Flashcards

1
Q

where is the primary source of endogenous glucose production via glycogenolysis and gluconeogenesis

A

liver

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2
Q

a normal glucose level requires

A

a balance between glucose usage and endogenous production or dietary carb intake

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3
Q

what percent of glucose released by the liver is metabolized by insulin-insenstive tissues such as the brain, GI tract, and RBCs

A

70-80%

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4
Q

how long after meals is there a transition from exogenous glucose usage to endogenous production

A

2-4 hours - this is necessary to maintain a normal plasma glucose

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5
Q

which hormones can cause hyperglycemia (4)

A

glucagon, epinephrine, growth hormone, and cortisol

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6
Q

glucagon ______ glycogenolysis and gluconeogenesis; while _____ glycolysis

A

glucagon stimulates glycogenolysis and gluconeogenesis; while inhibiting glycolysis

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7
Q

Diabetes mellitus results from

A

an inadequate supply of insulin and or an inadeqaute tissue response to insulin

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8
Q

increased circulating glucose levels leads to eventual

A

microvascular and macrovascular complications

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9
Q

Type IA Diabetes is caused by

A

T-cell mediated autoimmune destruction of beta cells within pancreatic islets, resulting in minimal or absent circulating insulin levels

1a - autoimmune

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10
Q

Type 1B diabetes is a rare disease of

A

absolute insulin deficiency not immune mediated

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11
Q

Type 2 diabetes results from

A

defects in insulin receptors and post-receptor intracellular signaling pathways

also not immune-mediated

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12
Q

with type I diabetes, how long is the pre-clinical period of B-cell antigen production before onset of symptoms

A

9-13 years

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13
Q

what percent of Beta cell function is lost before hyperglycemia ensues in Type I diabetes

A

at least 80-90%

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14
Q

hyperglycemia over several days/weeks associated symptoms (7)

A

fatigue, weight loss, polyuria, polydipsia, blurry vision, hypvolemia, ketoacidosis

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15
Q

since type II diabetes is very underrecognized, how long do patients go before being diagnosed

A

4-7 years

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16
Q

in the inital stages of type II diabetes, insensitivity to insulin in peripheral tissues leads to

A

increased pancreatic insulin secretion

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17
Q

as DM progresses, pancreatic function decreases and insulin levels become

A

inadequate

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18
Q

what are the 3 abnormalities seen in DM2

A

increased hepatic glucose release (caused by reduction in insulin’s inhibitory effect on the liver)
impaired insulin secretion
insufficent glucose uptake in peripheral tissues

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19
Q

in DM2, where is insulin resistance characterized to

A

skeletal muscle, adipose, and liver

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20
Q

causes of insulin resistance (3)

A

abnormal insulin molecules
circulating insulin antagonists
insulin receptor defects

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21
Q

what are 2 contributing factors to DM2

A

obesity and sedentary lifestyle

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22
Q

diagnosis of DM

A

fasting blood glucose
HbA1C

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23
Q

diabetes diagnostic HbA1C criteria
normal?
Prediabetes?
Diabetes?

A

normal < 5.7%
prediabetes 5.7-6.4%
diabetes >6.5%

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24
Q

other criteria for diagnosis of diabetes

A

fasting blood glucose > 126 mg/dL
2-hour plasma glucose > 200 mg/dL during an oral glucose tolerance test (OB)
symptoms of hyperglycemia with a random plasma glucose > 200 mg/dL

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25
Q

DM2 treatment

A

diet
exercise/weight loss
PO antidiabetic drugs

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26
Q

metformin - biguanide

A

enhances glucose transport into tissues

decreases triglycerides and LDL levels

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27
Q

sulfonylureas

A

stimulate insulin secretion
enhances glucose transport into tissues
not effective long term due to progressive loss of B cell function
:( hypoglycemia, weight gain and cardiac effects

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28
Q

hypoglycemia with insulin can be exacerbated by what substances (6)

A

ETOH
metformin
sulfonyureas
ACE-Is
MAOIs
non-selective BB

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29
Q

repetitive hypoglycemic episodes can lead to what?

A

hypoglycemia unawareness - patient becomes desensitized to hypoglycemia and doesn’t show autonomic symptoms

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30
Q

what are signs of neuroglycopenia and treatment

A

fatigue, confusion, headache, seziures, coma
PO/IV/IM glucose

Kahoot Q

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31
Q

DKA is more common in which type of diabetes, what is its trigger

A

DM1, triggered by infection/illness

Kahoot Q

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32
Q

high glucose exceeding the threshold for renal reabsorption creates a

A

osmotic diuresis and hypovolemia

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33
Q

why does the liver start producing ketoacids in DKA

A

tight metabolic coupling of gluconeogenesis and ketogenesis

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34
Q

in DKA, excessive glucose - counterregulatory hormones with glucagon activate what?

A

lipolysis and free fatty acids which are substrates for ketogenesis

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35
Q

diagnostic features of DKA

serum glucose ?
pH ?
HCO3?
serum osmol ?
serum and urine ketones?

A

serum glucose > 300 mg/dL
pH < 7.3
HCO3 < 18 mEq/L
serum osmol < 320 mOsm/L
serum and urine ketones mod to high

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36
Q

DKA treatment

A

IV volume replacement
insulin
correct acidosis - NaHCO3
lyte replacement (K+, Phos, Mg++, Na+)

kahoot Q

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37
Q

insulin dose for treating DKA

A

loading dose 0.1 units/kg Regular Insulin
infusion @ 0.1 unit/kg/hr

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38
Q

T/F correction of glucose without correcting Na+ may result in cerebral edema

A

True

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39
Q

characteristics of hyperglycemic hyperosmolar syndrome

A

severe hyperglycemia, hyperosmolarity, and dehdyration

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40
Q

who is most likely to experience hyperglycemic hyperosmolar syndrome

A

DM2 > 60 years old

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41
Q

hyperglycemic hyperosmolar syndrome evolves over days to weeks with persistent glucosuric diuresis… why

A

when glucose loads exceeds max renal glucose absorption, mass solute diuresis occurs

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42
Q

symptoms of HHS

hyperglycemic hyperosmolar syndrome

A

polyuria, hypovolemia, HypoTN, tachycardia, organ hypoperfusion

pts have some degree of acidosis but not DKA

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43
Q

treatment of HHS

A

fluid resuscitation, insulin bolus and infusion, electrolyte replacement

mortality 10-20%

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44
Q

DM complications

nephropathy occurs because the kidneys develop what 3 things

A

glomerulosclerosis, arteriosclerosis, and tubulointerstitial disease

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45
Q

symptoms of nephropathy

A

HTN, proteinuria, peripheral edema, decreased GFR

GFR < 15-20; no longer clearing K+ patient becomes hyperK and acidotic

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46
Q

what drug can slow the progression of proteinuria and the rate of GFR slowing

A

ACE inhibitors

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47
Q
A
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48
Q

transplantaion of what organ with the kidney can help prevent recurrent nephropathy

A

pancreas

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49
Q

peripheral neuropathy is distal symmetric diffuse sensory motor polyneuropathy.. where does it start and progress

A

starts in toes/feet and progresses proximally

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50
Q

loss of large sensory and motor fibers produces

A

decreased light touch and proprioception

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51
Q

loss of small nerve fibers leads to

A

decreased pain/temp perception leading to neuropathic pain

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52
Q

treatment for peripheral neuropathy

A

optimal glucose control, NSAIDs, antidepressants, anticonvulsants

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53
Q

retinopathy with DM is caused by (4)

A

microvascular changes including vessel occlusion, dilation, increased permeability and microaneursysms

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54
Q

what are the visual changes with retinopathy

A

color loss to blindness

glycemic control and BP management reduces the progression

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55
Q

autonomic neuropathy is caused by

A

damaged vasoconstrictor fibers, impaired baroreceptors, ineffective cardiovascular activity

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56
Q

CV symptoms of autonomic neuropathy

A

abnormal HR control and vascular dynamics, resting tachycardia, loss of HR variability, orthostatic hypotension and dysryhtmias

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57
Q

autonomic neuropathy in the GI tract cause decreased gastric secretion, and motility leading to what
what are symptoms and treatment

A

gastroparesis
symptoms: N/V, early satiety, bloating, epigastric pain
treatment: glucose control, small meals, prokinetics

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58
Q

in DM preop evaluation what is possible with autonomic neuropathy

A

silent ischemia

consider stress test

59
Q

in DM preop evaluation how can you help the kidneys

A

attention to hydration status, avoid nephrotoxins, and preserve RBF

60
Q

autonomic neuropathy predisposes patients to

A

dysthymias and hypotension

61
Q

gastroparesis may increase ____ risk regardless of ______

A

aspiration, NPO status

62
Q

which DM meds should be held day of surgey

A

hypoglycemics and noninsulin injectable drugs

63
Q

insulinoma is diagnosed based on what triad

A

whipple triad
hypoglycemia with fasting
glucose < 50 with symptoms
symptom relief with glucose

kahoot Q

64
Q

preop what med(s) can you give to inhibit insulin release from beta cells to help insulinoma patients undergoing surgery

A

diazoxide
other: verapamil, phenytoin, propanolol, glucorticoids, octeroide

65
Q

with the rare, benign insulin secreting pancreatic islet tumor.. during what periods will patients have hyperglycemia and hypoglycemia

A

hypoglycemia can occur intra op, followed by hyperglycemia once the tumor is removed

tight glycemic control is paramount

66
Q

thyroid gland weighs how much and is composed of two lobes joined by an

A

20g
isthmus

67
Q

where is the thyroid gland located

A

closely affixed to the anterior and lateral trachea with upper boarder below the cricoid cartilage

68
Q

parathyroid glands in relation to thryoid gland

A

located on posterior aspects of each lobe

69
Q

a rich capillary permeates the entire thyroid gland and is innervated by which ANS

A

adrenergic and cholinergic nervous systems

70
Q
A
71
Q

which nerves are in initmate proximity to the thyroid gland

A

recurrent laryngeal nerve and external motor branch of superior laryngeal nerve

72
Q

what is thyroglobulin

A

an iodinated glycoprotein that is a substrate for thryoid hormone synthesis

73
Q

which portion of the thyroid gland produces calcitonin

A

parafollicular C cells

74
Q

production of normal thyroid hormone quantity is depending on exogenous

A

iodine

75
Q

after ingesting iodine what happens to it in the body

A

iodine is reduced in GI tract to iodide and is absorbed into the blood, then transported from the plasma into the thryoid follicular cells

76
Q

the binding of iodide to thyroglobulin is catalyzed by which enzyme

A

iodinase

77
Q

T/F the thyroid contains a small store of horomones and has a fast turnover rate

A

FALSE! there is a large store with a low turnover rate, allowing protection against depletion if hormone synthesis is impaired

78
Q

what is the normal T4/T3 ratio

A

10:1

79
Q

3 major proteins that T3/T4 bind reversibly to

A

thyroxine binding globulin (80%)
prealbumin (10-15%)
albumin (5-10%)

80
Q

thyroid hormone influences what metabolic processes in the body

A

growth and maturation of tissues, enhance tissue function, and stimulate protein syntesis and carbohydrate and lipid metabolism

81
Q

thyroid function is controlled by

A

hypothalmus, pituitary and thryoid glands

82
Q

____ is released from hypothalamus; _____ is released from the anterior pituitary

A

TRH- thyrotropin releasing hormone from hypothalmus;
TSH - thyroid stimulating hormone from the anterior pituitary

83
Q

a decrease in TSH causes a decreased T3/T4 synetheisis which also decreases what

A

follicular cell size and vascularity

84
Q

an increase in TSH yields an increase in hormone production, gland cellularity and

A

vascularity

85
Q

how do thermal thyroid scans evaluate thyroid nodules

A

warm - normal function
hot - hyperfunctioning
cold- hypofunctioning

86
Q

what are the 3 pathologies of hyperthryoidism

A

graves disease
toxic multinodular goiter
toxic adenoma

87
Q

symptoms of hyperthryoidism

A

hypermetabolic state: sweating, heat intolerance, fatigue, inability to sleep
osteoporosis and weight loss
CV responses

88
Q

more symptoms of hyperthryoidism

A
89
Q

graves disease

A

autoimmune caused by thryoid stimulating antibodies that bind to TSH receptors stimulating growth, vascularity, and hypersecretion

females ages 20-40 y/o

90
Q

presentations of graves disease

A

enlargement of goiter causing dysphagia, globus sensation, and possibly inspiratory stridor from tracheal compression

91
Q

RX treatment for graves disease

A

methimazole or propylthiouracil (PTU)
high concentrations of iodine - short lived inhibition of release of thyroid hormone
beta blockers - may relieve symptoms
*propanolol impairs peripheral conversion of T4-T3

92
Q

when is ablative therapy or surgery recommeneded for Graves disease

A

when medical therapy has failed
surgery - subtotal thryoidectomy is effective and low incidence of hypothyroidism than radioactive iodine

93
Q

surgical complications of thyroidectomy

A

hypothyroidism, hemorrhage with tracheal compression, recurrent laryngeal nerve damage, damage to indavertent removal of parathyroid glands

94
Q

emergent cases with a Graves disease patient preop consideratiosn

A

IV BBs, glucocorticoids, and PTU
evaluate upper airway for evidence of tracheal compression or deviation caused by a goiter

95
Q

thyroid storm

A

exacerbation of hyperthryoidism precipitated by trauma, infection, medical illness, or surgery

96
Q

when do thryoid storms most often occur

A

postop period in untreated or inadeqautely treated hyperthryoid patients after emergency surgery
Treatment - alleviation of thyrotoxicosis and supportive care

mortality is 20%

97
Q

SIADH can occur in the presence of which pathologies

A

Intracranial tumors, hypothyroidism, porphyria, and lung carcinoma

kahoot Q

98
Q

what signs are suggestive of SIADH

A

increased urine sodium and osmolarity in the presence of hyponatremia and decreased serum osmol

abrupt decrease in serum sodium can cause cerebral edema and seizures

99
Q

treatment for SIADH

A

fluid restriction
salt tablets
loop diuretics
vasopressin antagonists
hyponatremia- hypertonic saline @ < 8 mEq/L within 24hrs

w hypertonic solution i though it <6mEq/L/24 hr from the renal lecture

kahoot Q

100
Q

DI reflects

A

the absence of vasopressin (ADH)

101
Q

causes of DI

A

destruction to posterior pituitary (neurogenic) or failure of renal tubules to respond to ADH (nephrogenic)

102
Q

which form of DI (nephro/neuro) responds to desmopressin

A

neurogenic

103
Q

symptoms of DI

A

polydipsia, and high output of poorly concentrated urine despite increased serum osmol

kahoot Q

104
Q

treatment for DI
neuro vs nepro

A

intial - IV electrolytes to offset polyuria
neuro: DDAVP
nephro: low salt diet, low protein diet, diuretics, NSAIDs

anesthesia: monitor UOP/lytes

105
Q

acromegaly and anesthesia implications

A
  • distorted facial anatomy may interfere with placement of face mask
  • enlarged tongue and epiglottis predisposes to upper airway obstruction and interferes with visualization of vocal cords on DL
  • glottic opening narrowed due to vocal cord enlargement
  • increased distance between lips and vocal cords

kahoot Q

106
Q

considerations for acromegaly and intubation

A

smaller ETT
video laryngoscopy
awake fiberoptic intubation

107
Q

what is acromegaly

A

excessive secretion of growth hormone in adults caused by adenoma in the pituitary gland

108
Q

abnormal labs in the acromegaly pt

A

elevated serum insulin- like growth factor (IGF-1)
OGTT

109
Q

which hormones are synthesized in the hypothalmus and then transported and stored in the posterior puitary

A

ADH (vasopressin) and oxytocin

stimulus for release from the posterior pituitary arises from osmoreceptors in the hypothalamus that sense plasma osmolarity

110
Q

Overproduction of anterior pituitary hormones is often assoc w/

A

hypersecretion of ACTH (Cushing syndrome) by anterior pituitary adenomas

111
Q

T/F thyroid hormone levels in thryoid storm are 5 fold than basic hyperthryoidism

A

false - they may not be much higher than basic hyperthyroidism

112
Q

primary hypothyroidism

A

decreased T3 & T4 despite adequate TSH

113
Q

2 most common causes of hypothyroidism

A
  1. abation of the gland by radioactive iodine or surgery
  2. iodiopathic and prolly autoimmune (antibodies blocking TSH)
114
Q

hashimoto thyroiditis

A

autoimmune disorder characterized by goitrous enlargement and hypothyroidism that usually effects middle age women

115
Q

symptoms of hypothyroidism

A

cold intolerance, weight gain, nonpitting edema

116
Q

what is also common with hypothyroidism

A

SIADH, along with fluid overload, plueral effusions, and dyspnea
GI function is slow, and an adynamic ileus may occur

117
Q

additional symptoms of hypothryoidism

A
118
Q

secondary hypothryoidism diagnosis

A

reduced T3, T4, & TSH

119
Q

TRH stimulation tests can confirm if the pituitary is the cause of hypothyroidism

T/F in primary hypothryoidsim, TRH elevates TSH

T/F with pituitary dysfunction, there is no repsonse to TRH

A

true
true

120
Q

what is euthryoid sick syndrome

A

abnormal thyroid function tests in critically ill patients
low T3/T4/ normal TSH

likely a response to stress, can be induced by surgery

121
Q

drug of choice for hypothryoidism

A

L-thyroxine (synthroid)

122
Q

airway considerations for hypothyroidism

A

airway compromise due to swelling, edematous vocal cords, goitrous enlargement

123
Q

additional preop considerations in hypothyroidism

A

decreased gastric emptying (aspiration risk)
CV system may be hypodynamic
resp function may be compromised
prone to hypothermia
lyte imbalances

124
Q

hypothryoidism in an elective procedure vs emergent surgery

A

elective - thryoid therapy should be initiated 10 days prior
emergent- IV thryoid replacement with steroids ASAP

125
Q

myxedema coma

A

severe form of hypothryoidism - delirium, hypoventilation, hypothermia, bradycardia, hypotension, and dilutional hyponatremia

126
Q

triggers for myxedema coma

A

infection, trauma, cold, and CNS depressants

commonly occurs in elderly women with a long history of hypothyroidism

127
Q

what is a cardinal feature due to impaired thermoregulation with myxedema coma/hypothryoidism

A

hypothermia

128
Q

treatment for myxedema coma

A

IV Levothyroxine or L-triiodothryonine
IV hydration with glucose- saline solutions, temp regulation, correction of lyte imbalances, and stabilization of cardiac and pulmonary systems

129
Q

how do goiters form

A

swelling of thryoid due to hypertrophy and hyperplasia of follicular epithelium

130
Q

causes of a goiter (patho)

A

lack of iodine, ingestion of goitrogen (cassava, phenylbutazone, lithium) or defect in hormonal biosynthetic pathway

131
Q

T/F a goiter is associated with a decompensated euthyroid state

A

false - its associated with a compensated euthyroid state

132
Q

when is surgery for goiter indicated

A

medical therapy ineffective and goiter compromises the airway or cosmetically unacceptable

133
Q

what is a predictor of airway obstuction during GA with a goiter

A

history of dyspnea in upright or supine position

flow-volume loops in upright & supine will demonstrate the site degree

134
Q

limits in the inspiratory limb of the flow volume loop indicate

A

extra thoracic obstruction

135
Q

delayed flow in the expiratory limb of the flow volume loop indicates

A

intrathoracic obstruction

136
Q

complications of thryoid surgery

A

Recurrent Laryngeal Nerve injury be unilater or bilatreral; temperoray or permenant

137
Q

if a patient experiences unilteral trauma to the recurrent laryngeal nerve how long will they experience hoarsness without airway obstruction

A

3-6 months

138
Q

_____ or _____ of the recurrent laryngeal nerve results in permenant hoarsesness

A

ligation or transection

139
Q

bilateral recurrent laryngeal nerve injury may cause

A

airway obstruction and problems with coughing/pulmonary toilet

may warrant tracheostomy

140
Q

hypoparathyroidism may resuly from inadvertant parathyroid damage - symptoms of what electrolyte imbalance may occur in the first 24-48hours postop

A

hypocalcemia

141
Q
A
142
Q

immediate postop thryoid surgery needs what at the bed side due to what complication

A

hematoma - trach set

143
Q

adrenal gland consists of

A

cortex and a medulla

Health Assessment (16 decks)

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