Test #2 Endocrine ARTICLES - Dwayne

Question 1

Glucogneogenesis?

Answer 1

The break down of fat and muscle for energy

Question 2

Glycogenolysis?

Answer 2

The breakdown of glycogen into glucose

Question 3

Type 2 Diabetes

Answer 3

Non insulin dependent

Question 4

Type 1 Diabetes

Answer 4

Insuiln dependent

Question 5

Type 2 diabetes sub catagories

Answer 5

Obese and nonobese

Question 6

Slow progressing adult insulin dependent DM is called?

Answer 6

(LADA) Latent autoimmune diabetes adult

Question 7

The highest percent of those that have DM have what type?

Answer 7

Type 2

Question 8

Signs and symptoms of DM

Answer 8

polydipsia, polyuria, polyphagia, tiredness, irritability, fungal infections, poor wound healing, deterioration in vision

Question 9

Type 2 DM results from?

Answer 9

Insulin resistance leading to elevated BGL and over working and eventually failing of the beta cells

Question 10

NORMALLY type 1 DM Pt’s are under or over weight?

Answer 10

Under weight

Question 11

NORMALLY type 2 DM Pt’s are under or over weight?

Answer 11

Over weight

Question 12

T3 or T4 are more potent?

Answer 12

T3

Question 13

T3 or T4 is released more from the thyroid?

Answer 13

T4

Question 14

Anterior or posterior pituitary secretes TSH

Answer 14

anterior

Question 15

Hypothyroid can be caused by?

Answer 15

Hashimoto thyroiditis, thyroidectoy, radioactive iodine anti-thyroid medication and iodine deficiency, Myxedema

Question 16

Hypothyroid S/S?

Answer 16

hypoactive reflexes, depression cold intolerance, muscle fatigue and weight gain
Myocardial contraction, HR, Stroke volume and cardiac output decrese

Question 17

Preop managment

Answer 17

Hypothyroid require less sedation and are prone to resp depression, premedicate w H2 blocker and reglan R/T decrease GI motility

Question 18

Intra-op

Answer 18

Blunted baroreceptor reflex, more susceptible to hypotension with induction agents. Ketamine is recommended, drug metabolism maybe slower

Question 19

Hyperthyroidism?

Answer 19

Graves disease (most common 60-80%), toxic multinodular goiter, toxic adenoma, thyroiditis, TSH secreting pituitary tumor, overdose of thyroid hormone

Question 20

clinical manifestations?

Answer 20

weight loss, hyperactive reflexes, fine tremors, exopthalmos, or goiter

Question 21

Treatment

Answer 21

methimozole, propylthiourcil, propranolol

Question 22

Anesthetic Implications

Answer 22

preferably Euthyroid, antithyroid drugs and beta blockers continue through day of surgery. NO NMB R/T inability to assess the RLN. Treat Hypotension with Neo, not ephedrine, it releases catacholamines.

Question 23

Anesthetic Implications intr-op

Answer 23

Avoid SNS stimulating drugs: ketamine, panc, ephedrine
usually vasodilated and chronically hypovolemic producing sever hypotension during induction
NMB administer w caution R/T thyrotoxicosis is linked to myopathies and mysthenia gravis

Question 24

Post-op : Thyroid storm

Answer 24

most likely onset 6-24 hrs post-op

Question 25

Post-op Hypocalcemia:

Answer 25

due to removal of parathyroid glands, check in 24 hrs

Question 26

Post-op Stridor

Answer 26

Bilat recurrent laryngeal nerve damage

Question 27

Adrenal gland cortex secretes?

Answer 27

mineralcorticoids (aldosterone), androgens and glucocorticoids (cortisol)

Question 28

Adrenal gland medula secretes?

Answer 28

catecholamine's ( epi, norepi, dopamine)

Question 29

Phenochromocytoma

Answer 29

tumor of the chromaffin cells secreting maninly norepi, some epi and dopaimine

Question 30

Phenochromocytoma

Answer 30

80% in the adrenal medulla 20% external

Question 31

Phenochromocytoma S/S

Answer 31

Cardinal signs: HA, HTN, sweating and tachycardia, | Acute onset: pulmonary edema, MI CVA

Question 32

Phenochromocytoma Pre-op

Answer 32

Phenoxybenzamine the most common prescribed alpha blocker OR may use Metyrosine

Question 33

Phenochromocytoma

Answer 33

NEVER Beta block before alpha blocking R/T the unopposed alpha leads to Vasoconstriction and HTN Crisis. Most common Beta blocker propranolol used

Question 34

alpha blockade stopped when

Answer 34

24-48 hrs before surgery

Question 35

Surgery parameters

Answer 35

``` NO BP > 160/90 NO BP < 80/45 when standing NO ST changes NO S/S of excessive catacholamines, no more then 1 PVC q 5 min. GOAL HR 60-80 ```

Question 36

Intra-op

Answer 36

Nipride to lower BP R/T vasodillatory effect speed of onset and short durration Magnesuim to block catacholamines betablock w esmolol or labetalol nicardipine most common CCB used

Question 37

adrenal insuffiency

Answer 37

Addison's disease, septicemia, autoimmune disorders

Question 38

adrenal insuffiency

Answer 38

Assoc. w glucocorticoid and mineralcorticoid deficiency

Question 39

adrenal insuffiency Anesthetic considerations

Answer 39

Avoid etomidate R/t Adrenal suppression

Question 40

Addison crisis Treatment

Answer 40

Fluids w dextrose, steroid replacement, inotropes, electrolyte correction

Question 41

Cushing's

Answer 41

Glucocorticoid excess

Question 42

Cushing's

Answer 42

Anterior pituitary tumor secreting to much ACTH moon face, truncal obesity, HTN, OSA, Elevated Na, Bicarb, low Ca and K

Question 43

Cushing's Anesthetic Implications

Answer 43

Volume overloaded, Hypo K, metabloic acidosis | consider spironolactone and K supplements

Question 44

Hyperparathyroidism

Answer 44

Number 1 symptom in MEN1 (multiple endocrine neoplasm) | Ca level > 5.5

Question 45

Phenochromcytoma provoking agents, AVOID

Answer 45

glucogon, histamine, reglan

Question 46

Stress response (surgery)

Answer 46

inhibits secretion of insulin and increases resistance, releases catacholamines and increases metabolism

Question 47

Pair the disease process with the correct DM Hyperglycemic Hyperosmolar syndrome HHS, DKA DM type 1, DM type 2

Answer 47

Type 1 DKA | Type 2 HHS

Question 48

HbA1c measures what

Answer 48

Average glucose concerntration over 3 mths

Question 49

Metformin should be stopped haw many days in advance

Answer 49

2-3 days and for 48 hr after

Question 50

Metformin should be stopped for what procedures

Answer 50

those w contrast dye, hypoperfusion of the kidneys, lactate accumulation or tissue hypoxia

Question 51

Insulin administration:

Answer 51

If given once a day they take their dose If given twice a day they half the AM dose and take the full PM dose Omit short acting doses for the day of the procedure

Question 52

Hyperglycemia reduces what drugs effect?

Answer 52

Morphine

Question 53

Primary motor inervation of the larynx is from what nerve

Answer 53

RLN (recurrent)

Question 54

The RLN controls the opening and closing of the vocal cords by which muscles

Answer 54

Posterior cricoarytenoid and the lateral arytenoid muscles

Question 55

The Superior Laryngeal Nerve controls the opening and closing of the vocal cords by which muscles

Answer 55

Cricothyroid

Question 56

80 % of metabolism activity is from what hormone??

Answer 56

unbound T3

Question 57

T3 is composed of

Answer 57

1 di-iodotyrosine compounds link w a mono-iodotyrosine

Question 58

Thyrotropin releasing hormone is secreted by what?

Answer 58

hypothalamus

Question 59

Thyrotropin releasing hormone stimulates the production of what?

Answer 59

TSH from the anterior pituitary

Question 60

TSH is transported to the thyroid and stimulates the release of what?

Answer 60

T3, T4

Question 61

3 most common complications of a thyroidectomy?

Answer 61

hypocalcemia, RLN damage and hematoma at the site

Question 62

Hypocalcemia causes

Answer 62

excitability in sensory and motor nerves perioral numbness and tingling, ABD pain, paresthesia in extremities, carpalpedal spasms, SZ, laryngospasms, mental status changes.

Question 63

Chvostek sign? Hypocalcemia

Answer 63

facial contraction with facial nerve tapping

Question 64

Trousseau sign? Hypocalcemia

Answer 64

carpalpedal spasm after BP cuff inflation

Question 65

Hypocalcium Tx

Answer 65

10 ml of 10% calcium IV over several minutes the 2 mg/kg/hr

Question 66

RLN damage, what will you see?

Answer 66

ipsilateral vocal cord will remain midline with inspiration unilateral- hoarsness Bilateral - stridor, resp distress and aphonia due to unopposed adduction of the cords and closure of the glotic aperature