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Flashcards in Endocrine System Deck (71):
1

How are most hormones regulated? Positive or negative feedback loop?

Negative feedback loop

2

The interactions within the endocrine system constitute the ____________ a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes.

hypothalamic-pituitary axis

3

The endocrine system helps regulate: (7)

Chemical composition and volume of interstitial fluid
Metabolism and energy balance
Biological clock or circadian rhythms
Contraction of smooth and cardiac muscle fibers
Glandular secretions
Some immune system activities
Operations of reproductive system

4

Does the endocrine system control growth and development?

Yes

5

Identify:

Q image thumb

A image thumb
6

Thyroid Feedback Loop

The thyroid senses low levels of thyroid hormones ___ and ___ which then responds by releasing what hormone?

T3 and T4

thyrotropin-releasing hormone (TRH)

7

The TRH (thyroid-releasing hormone) stimulates the pituitary to produce what?

thyroid-stimulating hormone (TSH)

8

What hormone is released from the hypothalamus?

 

TRH (thyroid releasing hormone)

 

9

What hormone is released from the anterior pituitary gland?

TSH

10

________ stimulates the thyroid gland to secrete the hormone thyroxine (T4) (inactive form) which is converted to triiodothyronine (T3), which is the active hormone that stimulates metabolism. 

TSH 

11

________ is also produced by the hypothalamus, and has an opposite effect on the pituitary production of TSH, decreasing or inhibiting its release.

Somatostatin

12

The concentration of thyroid hormones (T3 and T4) in the blood regulates the pituitary release of TSH.  True or false?

true

13

When T3 and T4 concentrations are low, the production of TSH is ______ and vice-versa.

increased

Note: This is known as a negative feedback loop.

14

T4 and T3 (controlled by TSH) levels peak in the early morning.  True or false?

false

Diurnal peaks in late evening.

15

What factors influence secreted amounts of T3 and T4? (6)

Gender
Pregnancy
Gonadal- and adrenal cortical-increased steroids (increase)
Exposure to cold (increase)
Nutritional state
Chemicals (dopamine, catecholamines)

16

What are the functions of T3 and T4? (9)

Regulate protein, fat, and carbohydrate catabolism in cells
Regulates metabolic rate and body heat production
Insulin antagonist
Maintains growth hormone secretion, skeletal maturation
Affects CNS development
Maintains cardiac rate, force, and output
Affects respiratory rate and oxygen utilization
Affects RBC production
Enhances cholesterol excretion in the bile

17

What type of thyroid condition results in a goiter?

Hyperthyroidism

18

What type of thyroid condition results in exophthalmos?

Hyperthyroidism

19

What are the symptoms of hyperthyroidism? (10)

Nervousness or anxiety
Increased sweating
Heat intolerance
Palpitations
Dyspnea
Fatigue and weakness
Weight loss or gain
Increased appetite
Hyperdefication or loose stools
Menstrual irregularity

20

What are the signs and symptoms of hyperthyroidism? (5)

Thyroid enlargement (goiter)
Tachycardia
Atrial fibrillation
Hyperkinesis (state of overactive restlessness)
Eye signs (exophthalmos)

21

For hyperthyroidism, we would expect the following increase/decrease in labs:

_________ T3 and T4

________ free thyroxine or T4

___________ TSH

 

elevated T3 and T4

elevated free thyroxine or T4

decreased TSH

22

What other labs could you expect for a pt with hyperthyroidism? (5)

Hypercalcemia
Increased alkaline phosphatase
Anemia
Decreased granulocytes
Increased erythrocyte sedimentation rate

23

What is the treatment for hyperthyroidism? (4)

Thioamides

Iodine

Beta-adrenergic blockade

Thyroid surgery

24

What are preoperative considerations for pts with hyperthyroidism? (2)

Airway exam is important, especially if a goiter is present.

Ptoptosis will require diligent eye protection.

 

25

In an emergency surgery situation, what drugs will we need to have available for a pt with hyperthyroidism? (4)

Propythiouracil (PTU)

Propanolol

Potassium iodide

Corticosteroids

26

What are the symptoms of hypothyroidism? (10)

Cold intolerance
Dyspnea
Anorexia
Constipation
Decreased libido
Menorrhagia, amenorrhea
Oliguria
Arthalgias, myalgias, muscle stiffness and cramps
Dryness
Fatigue

27

What are the signs of hypothyroidism? (5)

Weight gain (or loss)
Bradycardia
Diastolic hypertension
Cardiac rub or soft heart tones causes by pericardial effusion
Ileus

28

For hypothyroidism, we would expect the following increase/decrease in labs:

_____ Free T4

________ TSH in primary hypothyroidism

_______ or normal TSH in pituitary insufficiency

Decreased free T4

Increased TSH

Decreased or normal TSH

29

What other labs could you expect for a pt with hypothyroidism? (4)

Increased serum cholesterol, liver enzymes, creatine 
Hyponatremia
Hypoglycemia
Anemia

30

What is a major complication of severe hypothyroidism?

Myxedema coma

31

What are the complications of myxedema coma? (5)

hypothermia

hypoventilation

hyponatremia

hypoxia

 

hypertension

32

What factors may induce myxedema coma? (4)

infection, cardiac or respiratory

CNS illness

cold exposure

drug use

33

Elderly men are more at risk for myxedema coma.  True or false?

false

elderly women

34

How is hypothyroidism treated? (2)

Thyroid hormone replacement--synthetic levothyroxine

Treatment monitored closely with lab values and titrated.

35

What hormone raises serum Ca++ levels while promoting bone reabsorption?

Parathyroid hormone

36

The following would increase/decrease for pts with hyperparathyroidism:

_______ parathyroid hormone

_______ calcium levels

increased PTH

increased calcium

37

What are the consequences of hypercalcemia? (7)

renal stones

polyuria

hypertension

constipation

fatigue

mental changes

bone pain

38

What is the most common cause of hyperparathyroidism?

parathyroid adenoma

39

Is parathyroid cancer common?

No

40

What are the signs of hypocalcemia? (8)

tetany

carpopedal spasms

tingling of lips and hands

muscle and abdominal cramps

psychological changes

positive Chvostek’s and Trousseau’s signs

defective nails and teeth

cataracts

41

42

What condition may common be seen after thyroidectomy, but may only be transient?

hypoparathyroidism

43

What is the treatment for hypoparathyroidism? (4)

IV calcium gluconate

oral calcium

Vit D

Magnesium

44

What are the tests for hypocalcemia? (2)

Chvostek's sign

Trousseau's sign

45

What labs are ordered for parathyroid issues? (6)

Serum calcium
Ionized calcium
Albumin
Serum magnesium
Alkaline phosphatase
Serum phosphate

46

What is the most common endocrine disease?

Diabetes Mellitus

47

What are long-term complications of diabetes mellitus?(4)

Injury to:

Eyes
Kidneys
Nerves
Blood vessels

48

What are the major risks for those with diabetes? (5)

Heart disease
Stroke
Kidney disease
Blindness
Nontraumatic amputations

49

What type of diabetes?

NO insulin production – thought to be an autoimmune destruction of islet cells in pancreas

Type 1

Note: They become dependent on exogenous insulin.

50

What type of diabetes?

Relative deficiency in insulin – insulin resistance
Associated findings include – obesity, abnormal insulin levels, strong genetic component

Type 2 

51

What type of diabetes?

Complicates about 4% of pregnancies
Glucose intolerance that is identified during pregnancy

Gestational DM

52

What are the treatments for DM? (4)

Diet
Oral hypoglycemic drugs
Exercise
Exogenous insulin

53

What are anesthetic considerations for DM pts? (4)

Autonomic lability (Temp, BP, HR dysfunction)

Silent ischemia or CAD

Inhibited motility of GI 

Glucose control--may affect healing

54

Perform a pregnancy test for any female of childbearing age which is ____-____ YO.

15-50

55

What are 2 major types of pregnancy test?

Urine

Blood

56

How accurate are home urine pregnancy tests? 

97%

57

What blood pregnancy test measures the exact amount of hCG in the blood?

quantitative blood test

58

What blood test gives a simple yes or no answer to whether one is pregnant or not?

qualitative blood test

59

When are hCG levels at their peak from time of inception?

1-2.5 months 

60

Surgery is only conducted during pregnancy when it is absolutely necessary for the wellbeing of the mother, fetus, or both. True or false?

true

61

All general anesthetic drugs cross the placenta. True or false?

true

62

Regional anesthesia is usually preferred in pregnancy when it is practical for the medical and surgical condition. True or false?

true

63

What are the most common surgeries for pregnant patients not related to the pregnancy? (3)

acute appendicitis

maternal trauma

surgery for maternal malignancy

64

Surgery should be done at an institution with neonatal and pediatric services. True or false? 

true

65

An obstetric care provider with cesarean delivery privileges should be readily available. True or false. 

true

66

A qualified individual should be readily available to interpret the fetal heart rate patterns. True or false?

67

What are the cardiovascular changes that occur during pregnancy? (5)

increased CO

increased blood volume

increased HR

decreased peripheral resistance

decreased blood pressure

68

What are the pulmonary changes that occur during pregnancy? (4)

increased RR

increased tidal volume

decreased FRC

respiratory alkalosis

69

What are risks presented by a pregnant patient intra-op? (4)

difficult intubation due to swelling

hypoxia

hyptension due to aortocaval compression

aspiration

70

If the fetus is considered pre-viable, it is sufficient to ascertain the fetal heart rate by Doppler before and after the procedure.  True or false?

true

71

Intraoperative electronic fetal monitoring may be appropriate when all of the following apply: (5) 

The fetus is viable.

It is physically possible to perform intraoperative electronic fetal monitoring.

A health care provider with obstetric surgery privileges is available and willing to intervene during the surgical procedure for fetal indications.

When possible, the woman has given informed consent to emergency cesarean delivery.

The nature of the planned surgery will allow the safe interruption or alteration of the procedure to provide access to perform emergency delivery.