Test #2 Endocrine ARTICLES - Dwayne Flashcards Preview

BioScience II > Test #2 Endocrine ARTICLES - Dwayne > Flashcards

Flashcards in Test #2 Endocrine ARTICLES - Dwayne Deck (66):
1

Glucogneogenesis?

The break down of fat and muscle for energy

2

Glycogenolysis?

The breakdown of glycogen into glucose

3

Type 2 Diabetes

Non insulin dependent

4

Type 1 Diabetes

Insuiln dependent

5

Type 2 diabetes sub catagories

Obese and nonobese

6

Slow progressing adult insulin dependent DM is called?

(LADA) Latent autoimmune diabetes adult

7

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

Type 2

8

Signs and symptoms of DM

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

9

Type 2 DM results from?

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

10

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

Under weight

11

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

Over weight

12

T3 or T4 are more potent?

T3

13

T3 or T4 is released more from the thyroid?

T4

14

Anterior or posterior pituitary secretes TSH

anterior

15

Hypothyroid can be caused by?

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

16

Hypothyroid S/S?

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

17

Preop managment

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

18

Intra-op

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

19

Hyperthyroidism?

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

20

clinical manifestations?

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

21

Treatment

methimozole, propylthiourcil, propranolol

22

Anesthetic Implications

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.

23

Anesthetic Implications intr-op

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

24

Post-op : Thyroid storm

most likely onset 6-24 hrs post-op

25

Post-op Hypocalcemia:

due to removal of parathyroid glands, check in 24 hrs

26

Post-op Stridor

Bilat recurrent laryngeal nerve damage

27

Adrenal gland cortex secretes?

mineralcorticoids (aldosterone), androgens and glucocorticoids (cortisol)

28

Adrenal gland medula secretes?

catecholamine's ( epi, norepi, dopamine)

29

Phenochromocytoma

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

30

Phenochromocytoma

80% in the adrenal medulla 20% external

31

Phenochromocytoma S/S

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

32

Phenochromocytoma Pre-op

Phenoxybenzamine the most common prescribed alpha blocker OR may use Metyrosine

33

Phenochromocytoma

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

34

alpha blockade stopped when

24-48 hrs before surgery

35

Surgery parameters

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

36

Intra-op

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

37

adrenal insuffiency

Addison's disease, septicemia, autoimmune disorders

38

adrenal insuffiency

Assoc. w glucocorticoid and mineralcorticoid deficiency

39

adrenal insuffiency Anesthetic considerations

Avoid etomidate R/t Adrenal suppression

40

Addison crisis Treatment

Fluids w dextrose, steroid replacement, inotropes, electrolyte correction

41

Cushing's

Glucocorticoid excess

42

Cushing's

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

43

Cushing's Anesthetic Implications

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

44

Hyperparathyroidism

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

45

Phenochromcytoma provoking agents, AVOID

glucogon, histamine, reglan

46

Stress response (surgery)

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

47

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

Type 1 DKA
Type 2 HHS

48

HbA1c measures what

Average glucose concerntration over 3 mths

49

Metformin should be stopped haw many days in advance

2-3 days and for 48 hr after

50

Metformin should be stopped for what procedures

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

51

Insulin administration:

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

52

Hyperglycemia reduces what drugs effect?

Morphine

53

Primary motor inervation of the larynx is from what nerve

RLN (recurrent)

54

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

Posterior cricoarytenoid and the lateral arytenoid muscles

55

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

Cricothyroid

56

80 % of metabolism activity is from what hormone??

unbound T3

57

T3 is composed of

1 di-iodotyrosine compounds link w a mono-iodotyrosine

58

Thyrotropin releasing hormone is secreted by what?

hypothalamus

59

Thyrotropin releasing hormone stimulates the production of what?

TSH from the anterior pituitary

60

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

T3, T4

61

3 most common complications of a thyroidectomy?

hypocalcemia, RLN damage and hematoma at the site

62

Hypocalcemia causes

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

63

Chvostek sign? Hypocalcemia

facial contraction with facial nerve tapping

64

Trousseau sign? Hypocalcemia

carpalpedal spasm after BP cuff inflation

65

Hypocalcium Tx

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

66

RLN damage, what will you see?

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