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Patho II > Endocrine Pt. 2 > Flashcards

Endocrine Pt. 2 Flashcards

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1
Q

Which form of Ca is physiologically active?

A

Ionized

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2
Q

_____ causes depression of CNS.
Ca >12 mg/dL
⬇️ neural ecitability
Constipation d/t ⬇️ motility of GIT

A

Hypercalcemia

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3
Q

_____ causes excitation of CNS
Ca= 6 mg/dL
⬆️ neural excitability (⬇️ threshold)
Causes tetany, carpopedal spasm, laryngospasm, bronchospasm. & apnea

A

Hypocalcemia

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4
Q

Why does hypocalcemia cause muscle spasm?

A

Increases Na permeability lowering the threshold potential

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5
Q

Actions of PTH

A
  1. ⬆️ bone resorption of Ca (from bone to ECF)
  2. ⬆️ excretion of phosphate (Phosphate Trashing Hormone PTH)
  3. ⬆️ Renal Ca reabsorption in kidney
  4. ⬆️ production of Vit D by stimulating kidney a 1 hydroxylase —> ⬆️ intestinal absorption of Ca & phosphate
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6
Q

Primary hyperparathyroidism “moans, bones, stones, & groans”

A
  1. Hypercalcemia -> CNS depression (serum > 5.5, ionized > 2.5)
  2. ⬇️ serum phosphate/ ⬆️ phosphate excretion
  3. ⬆️ urinary Ca excretion (d/t ⬆️ filtered load) -> Ca stone
  4. ⬆️ bone resorption -> bone pain/fractures & osteitis fibrosa cystica
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7
Q

Occurs in end-stage renal disease.
⬇️ production of 1,25 (OH)2 by kidneys
⬇️ GFR -> phosphate retention & hyperphosphatemia
⬆️ phosphate binds w/ Ca = ⬇️ Ca which stimulates PTH secretion -> renal osteodystrophy

A

Secondary Hyperparathyroidism

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8
Q

Caused by PTH-related peptide (PTH-rp) secreted by malignant tumprs (squamous cell lung ca, breast ca, etc)
hypercalcemia, hypophosphatemia, ⬆️ urinary Ca excretion & stone
Has ⬇️ PTH level. Why?

A

Humoral Hypercalcemia of malignancy;

Low b/c of the PTH-rp coming from the cancer

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9
Q

Hypoparathyroidism

A 
⬇️ Ca & tetany.
⬆️ Phosphate (binds w/ Ca)
Hypotension, CHF
Neuromuscular excitability, numbness/tingling, ⬆️ DTR.
Could have laryngospasm
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10
Q

Tapping in front of ear (VII) causes muscle twitch

A

Chvostek’s sign

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11
Q

Tetanic spasm after applying BP cuff

A

Trousseau’s sign

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12
Q

Dx & Tx for hypoparathyroidism

A

⬇️ Ca, ⬆️ Phosphorus;

10% calcium gluconate IV + Vit D

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13
Q

Anesthetic considerations for hyperparathyroidism

A 
Avoid fluids with Ca (LR), hydrate & loop diuretics to ⬆️ Ca excretion;
⬆️ dose of NDNMB;
Avoid hypoventilation(acidosis ⬆️ ionized Ca > arrhythmias)
Caution of fractures
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14
Q

Complications of parathyroidectomy

A

Hypocalcemia > muscle spasm, laryngospasm, tetany, bronchospasm, apnea
Recurrent laryngeal nerve damage (immediate intubation)
Hematoma, pneumo

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15
Q

A group of autosomal dominant syndromes in whcih more than one endocrine organ is hyperfunctional

A

Multiple Endocrine Neoplasia (MEN) syndrome

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16
Q

Includes Pancreas (Zollinger-Ellison syndrome, insulinomas, VIPomas) Parathyroid and Pituitary tumors (3 P’s)

A

MEN type I

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17
Q

Includes Medullary carcinoma of thyroid, Pheochromocytoma, and Hyperparathyroidism.
Pheochromocytoma can give rise to hypertensive crisis during induciton of GA.
(MPH)

A

MEN type IIA (Sipple’s syndrome)

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18
Q

Includes Mucocutaneous neuromas, Medullary carcinoma of thyroid and Pheochromocytoma.
Does NOT induce hyperparathyroidism (MMP)

A

MEN type IIB (or type III)

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19
Q

Vit D deficiency causes ____ in children and _____ in adults

A

Rickets; osteomalacia

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20
Q

Vitamin D actions

A

⬆️ Ca & phosphate in ECF to mineralize new bone
⬆️ intestinal absorption of Ca & PO4
⬆️ renal reabsorption of Ca & PO4
⬆️ bone resorption (break down) whic provides Ca & phosphate from “old” bone to mineralize “new” bone

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21
Q

Calcitonin is synthesized and secreted by the _____ of the thyroid gland. Stimulated by?

A

Parafollicular cells; increase in serum Ca

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22
Q

Calcitonin action

A

Takes the Ca into the bone.
Inhibits bone resorption & promotes deposition of Ca in the bones which decreases Ca level.
⬆️ urinary excretion of Ca
Can be used to treat hyperglycemia

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23
Q

D/t release of vasoactive substances from eterchromoffin tumors; mostly GIT like appendix

A

Carcinoid syndrome

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24
Q

How do you diagnose carcinoid syndrome?

A

Increased level of 5- hydroxyindolacetic acid (5-HIAA) in urine

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25
S/sx of carcinoid syndrome
Cutaneous flushing, bronchospasm, recurrent diarrhea, large swings in BP, SVT
26
Management of carcinoid syndrome
Octreotide (inhibitory hormone) Avoid anesthetic techniques that could activate tumor. Avoid hypotension Avoid catecholamine admin that may trigger release of kallikreins Avoid histamine releasing drugs
27
Central islets of Langerhans that secrete insulin
Beta cells
28
Outer rims of islets of Langerhans that secrete glucagon
Alpha cells
29
Intermixed islets of langerhans that secrete somatostatin
Delta cells
30
Insulin contains an _____ and a _____ joined by 2 disulfide bonds
A-chain & B-chain
31
What is used to monitor Beta cell function in DM?
C-peptide
32
MOA of insulin
Glucose binds to GLUT-2 receptor on B cells. Inside glucose is oxidized to ATP which closes K channels > Depolarization > opening of Ca channels > secretion of insulin
33
________ depend on insulin for increased glucose uptake while _____ take up glucose independent of insulin level
Muscles & adipose tissue (GLUT-4); brain cells & RBCs (GLUT-1)
34
Actions of insulin
1. ⬆️ uptake of glucose into target cells & promotes utilization of glucose for energy 2. Promotes formation of glycogen (from glucose in muscle & liver) 3. Inhibits glycogenolysis (breakdown of glycogen) 4. ⬇️ gluconeogenesis (formation of glucose from non-carb sources like fats & proteins)
35
Insulin _____ blood fatty acids & ketoacid concentraion & _____ blood K concentration
Decreases; decreases
36
Destruction of beta cells. Shift of carb to fat metabolism increases ketone body formation -> DKA. No familial hx
Type I DM
37
Non-insluin dependent. Insulin resistance d/t obesity; fat makes muscle more reisistant to insulin. More glucose produciton in liver. Genetic predisposition
Type II DM
38
Gold standard test for DM dx
FBG 110-126, 2 hrs postprandial 140-200
39
Rebound response to nocturnal hypoglycemia leading to morning hyperglycemia. BG ⬇️ at 3am. Tx?
Somogyi effect; decrease evening insulin dose
40
Fastening hyperglycemia d/t ⬆️ GH. ⬆️ BG at 3am. Tx?
Dawn phenomenon; increase evening insulin dose
41
S/sx of DKA
``` Rapid deep breathing (kussmaul to blow off CO2) Hyperthermia N/V Abd pain Psychosis, drowsiness, coma Marked dehydration -> hypotension Fruity (acetone) breath ```
42
Labs a/w DKA
``` ⬆️ BG (>250) Met acidosis w/ high anion gap ⬇️ HCO3 ⬆️ blood ketone level ⬆️ K (transcellular shift) ```
43
DKA tx
IV insulin until anionic gap closes Fluids- NS Give K (to replete intracellular stores)
44
Severe hyperglycemia that causes profound osmotic diuresis w/ severe dehydration. No acidosis bc enough insulin is present. Tx?
Hyperosmolar non-ketotic coma. | Treat as DKA but requires more fluid
45
Anesthetic considerations with DM
Check FBG & HbA1c. Rule out silent MI Check for diabetic auotonomic dysfunction (postinduction hypotension, arrythmia, sudden cardiac death) Gastroporesis = increased risk of aspiration (give reglan) Stop oral hypoglycemic 24-48 hrs before sx
46
``` ⬆️ insulin in presence of hypoglycemia ⬆️ SNS stimulation (HTN , sweating, hunger, impending doom) ⬆️ C peptide ⬆️ Proinsulin level A/w MEN I syndrome ```
Adenoma of islet of langerhans (B cell tumors)
47
Episodic hypoglycemia Sympathetic activation CNS dysfunctions (confusion, anxiety, coma) A/w insulinoma
Whipple’s triad
48
Tx of insulinoma
Glucose administration
49
Hormone of “starvation” (mirror image of insulin). Promotes mobilization and utilization of metabolic fuels. Regulated by secretion of a-cells
Glucagon
50
Actions of glucagon
Increases BG by: ⬆️ glycogenolysis & gluconeogensis Increases FFA & ketoacids by ⬆️ lipolysis Inhibits gastric motility,⬇️ gastric acid secretion, ⬆️ bile secretion, ⬆️ blood flow & urinary excretion of electrolytes Smooth muscle relaxation
51
5a-reducatase inhibitor, used in BPH. Prevents testosterone turning into dihydrotestosterone (active form)
Finasteride
52
____ cells produce testosterone (stimulated at first step by LH). Testosterone diffuses to the nearby ____ cells which contain _____ and convert testosterone to 17-B-estradiol (stimulated by FSH)
Theca; granulosa; aromatase
53
Causes maturation & maintenance of fallopian tubes, uterus, Cx, & vagina Casues development of femal sexondary sex characteristics at puberty Development of breasts Proliferation & development of ovarian cells Maintains pregnancy Lowers uterine threshold to contractile stimuli Stimulates prolactin secretion (but blocks action on breast)
Estrogen
54
- fb on FSH & LH secretion during luteal phase Maintains secretory activity of uterus during luteal phase Maintains pregnancy Decreases myometrial excitability Participates in breast development
Progesterone
55
High ____ level causes high surge of ____ —> release of egg.
Estrogen; LH
56
Corpus luteum releases ______ preparing the body for implantation. Death occurs after ______ weeks leading to menstrual bleeding
Progesterone; 2
57
A primordial follicle develops. LH & FSH receptors upregulate. Estradiol ⬆️ causing proliferation of uterus. FSH/LH levels are suppressed by - fb of estradiol on anterior pituitary. Progesterone low
Follicular phase (days 1-14)
58
Occurs 14 days before menses. | Burst of estradiol at end of follicular phase has a + fb on secretion of FSH/LH surge.
Ovulation (day 15)
59
Corpus luteum develops synthesizing estrogen & progesterone. Vascularity & secretory activity of endometrium increase. Basal body temp increases. Corpus luteum shrinks to nothing if fertilization does not occur
Luteal phase (days 15-28)
60
Hormone, fb & site for follicular phase
Estrogen; - fb; Anteior pituitary
61
Hormone, fb & site for mid-cycle
Estrogen; + fb; Anterior pituitary
62
Hormone, fb & site for luteal phase
Estrogen & progesterone; - fb at anterior pituitary; - fb at hypothalamus
63
_____ indicates ovulation; _____ is tested for pregnancy
LH; HCG
64
If fertilization occurs, the corpus luteum is rescued from regression by ________, which is produced by the placenta
Human chorionic gonadotropin (HCG)
65
In the second & third trimester, estrogen is produced by what?
The interplay of the fetal adrenal gland & placenta (fetoplacental unit)
66
________ is produced throughout the pregnacny and acts similar to GH & prolactin
Human placental lactogen

Patho II (11 decks)

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