Exam 4

Question 1

Most pituitary tumors are malignant/benign resulting in over secretion of the hormones supplied by the gland

Answer 1

benign

Question 2

Removal of the pituitary is called

Answer 2

transphenoidal hypophysectomy

Question 3

Patients who have had a transphenoidal hypophysectomy will likely need lifelong replacement of what?

Answer 3

thyroid hormones, glucocorticoids, and mineralcorticoids

Question 4

Nose drip pad with glucose indicates what?

Answer 4

CSF leak

Question 5

After pituitary removal, lack of ADH may cause what condition, requiring need to monitor urine specific gravity?

Answer 5

Diabetes Insipidus

Question 6

What should a pt NOT do s/p transphenoidal hypophysectomy?

Answer 6

No blowing nose, coughing, sneezing, straining to BM, brushing teeth, or bending. Elevate HOB & report post nasal drip.

Question 7

Vasopressin is also known as what? Also, it is a potent what?

Answer 7

Anti diuretic hormone; potent vasoconstrictor

Question 8

S/S of Diabetes Insipidus are:

Answer 8

thirst (polydispsia)   
nocturia  
tachycardia   
fatigue    
5-20L a day (up to 1,000 cc/hr)   Can not concentrate urine

Question 9

SIADH is a syndrome of what?

Answer 9

Inappropriate ADH- too much anti diuretic hormone.

Question 10

Problems caused by SIADH are:

Answer 10

< UO   
weight gain (water weight)   
<Na (lost in urine)/hyponatremia   
non pitting edema  
confusion  
seizures

Question 11

Tx for SIADH

Answer 11

fluid restrict; may give 3% saline; lasix if Na 125 or >, HOB flat

Question 12

Pheochromocytoma is

Answer 12

a benign tumor = severe hypertention

Question 13

Addisons Disease

Answer 13

adrenocortical insufficiency- auitoimmune

Question 14

Addison’s Disease is a decrease in:

Answer 14

cortisol, mineralcorticoids, and androgens

Question 15

Adrenal insufficiency has:

Answer 15

K

Question 16

Tx for Addison’s

Answer 16

hydrocortisone…pts should have 100 IM hydrocortisone on them and wear a medi alert bracelet
Times of stress call for > of hydrocortisone & >Na

Question 17

Testing for Addison’s includes

Answer 17

ACTH stimulation test- adrenals will release cortisol if they’re working

Question 18

Addisonian crisis s/s are

Answer 18

sudden, penetrating pain in lower back, abdomen, legs
severe vomiting/diarrhea
low BP
often triggered by stress, infection, or surgery

Question 19

Tx for Addisonian crisis

Answer 19

rapid admin of NS
Hydrocortisone IV
Insulin and dextrose

Question 20

Cushings Disease and Syndrome have:

Answer 20

> Na
BS
BP

<K

Question 21

Cushings/hypercortisolisms causes

Answer 21

fluid retention & weight gain
CHF
insomnia psychosis
hyperglycemia (glucose intolerance and insulin resistance)
osteoporosis
muscle wasting
fragile skin
peptic ulcer

Question 22

To Dx Cushings, do a

Answer 22

dexamethasone suppression test

Question 23

Tx for Cushings

Answer 23

Hydrate
Meds
Radiation
surgically remove primary adenomas
Hypophysectomy
Adrenalectomy

Question 24

If both adrenals are removed (bilateral adrenalectomy), what must be replaced for life?

Answer 24

glucocorticoids

Question 25

Teaching for adrenalectomy

Answer 25

``` glucocortioid replacement if bilateral medi alert bracelet daily weights regular f/u visits Avoid NSAIDs, caffeine, ETOH, and smoking ```

Question 26

S/S of hypokalemia are

Answer 26

muscle weakness, paresthesias, fatigue

Question 27

S/S of hypernatremia are

Answer 27

HTN, headache, visual changes

Question 28

Hyperaldosteronism affects the renal tubules causing

Answer 28

hypernatremia (>Na) | hypokalemia ( pH due to hydrogen loss)

Question 29

Tx for hyperaldosteronism

Answer 29

``` remove adrenals (adrenalectomy) diuretics ```

Question 30

Pheochromocytoma is

Answer 30

an adrenal tumor that releases catecholamines (epinephrine and nor epinephrine- most often benign

Question 31

S/S of a Pheochromocytoma are

Answer 31

``` intermittent HTN episodes severe headaches palpitations diaphoresis flushing apprehension impending doom can be triggered by abdominal palpation ```

Question 32

Tx for Pheochromocytoma

Answer 32

remove one or both adrenal glands do not palpate abdomen pre op monitor for BP changes

Question 33

The best time to take exogenous glucocorticoids is

Answer 33

in the AM before 9 to minimize HPA suppression

Question 34

Someone with Cushing syndrome should eat a diet that is

Answer 34

high in protein high in potassium low in sodium