7. Coex Exam 2 Flashcards
1
Q
T1DM is what % of all DM
A
5-10%
2
Q
Type 1a
A
T-cell mediated
autoimmune destruction of beta cells
3
Q
Type 1b
A
absolute insulin deficiency
not immune mediated
4
Q
T2D
A
insensitivity of insulin in peripheral tissues
beta cell insufficiency
5
Q
3 defects in T2D
A
- incr rate of hepatic glu release
- impaired basal/stimulated insulin secretion
- insulin resistance
6
Q
normal serum glu
A
70-100 mg/dL
7
Q
normal Hgb A1C
A
4-6%
8
Q
intraop glu goals
A
80-180 mg/dL
9
Q
1 unit of insulin lowers glu
A
30 mg/dL
10
Q
50 ml of D50 raises glu
A
100 mg/dL
11
Q
insulin prior to surgery
A
continue basal rates
supplement with short acting boluses
12
Q
metformin prior to surgery
A
STOP day of surgery
13
Q
SGLT2 inhibitors prior to surgery
A
STOP 3-4 days prior
14
Q
oral glu lowering agents prior to surgery
A
STOP day of surgery
15
Q
periop glu monitoring in diabetic pts should occur every
A
2-4 hours
16
Q
biguanides
A
metformin
17
Q
biguanides indication
A
first line therapy for T2D
18
Q
biguanide mech
A
suppress hepatic glu release
incr glu use by muscle/adiopse
19
Q
biguanide SE
A
lactic acidosis
20
Q
GLP1 agonists
A
semaglutide
21
Q
GLP1 mech
A
stimulated glu-dependent insulin secretion from beta cells
slows gastric emptying
inhibits post-meal glucagon release
22
Q
GLP1 SE
A
delayed gastric emptying
acute pancreatitis
acute renal failure/insufficiency
23
Q
GLP1 should be held ______ before surgery
A
weekly GLP1 dose should be held 1 week prior to surgery
24
Q
DPP4 inhibitor
A
sitagliptin
25
DPP4 inhibitor mechanism
DPP4 deactivated peptides
26
DPP4 SE
delayed gastric emptying
27
secretagogues
glyburide
repaglinide
28
secretagogues mech
incr insulin availability
29
secretagogues only work on what pts?
pt with beta cell function
30
secretagogues SE
hypoglycemia
31
SGLT2
canagliflozin
32
SGLT2 mech
decr blood glu by incr urinary glu excretionS
33
SGLT2 SE
osmotic diuresis
hypovolemia
AKI
34
insulin indication
1st line treatment for T1D
35
basal insulin
suppress hepatic glu production
36
bolus insulin
controls glu peaks
given before meals
37
insulin most dangerous SE
hypoglycemia < 50 mg/dL
38
hypoglycemia symptoms
sweating
tachycardia
palpitations
pallor
fatigue
confusion
convulsions
39
treat hypoglycemia
25g of D50w
40
cushing's syndrome
hypercortisolism
41
cushing's syndrome is associated with
hypernatremia
hypokalemia
hyperglycemia
metabolic alkalosis
42
hypercortisolism: ACTH dependent
innappropriately high ACTH stimulate adrenal cortex to incr cortisol
42
treat ACTH depended hypercortisolism
transsphenoidal dissection or irradiation of the anterior pituitary
42
Cushing's
pituitary tumor excessively stimulates ACTH
43
treat cushing's
transphenoidal resection of microadenoma
44
ACTH independet hypercortisolism
excessive production of cortisol secondary to abnormal adrenocortical tissue
45
ACTH independent regulation
not regulated by secretion of CRH or ACTH
46
ACTH independent treatment
adrenalectomy
47
conn's syndrome
primary hyperaldosteronism
48
conn's is associated with
hypernatremia
hypokalemia
metabolic alkalosis
49
hypoaldosteronism SE
hyponatreamia
hyperkalemia
possible dehydration
possible metabolic acidosis
50
hyperthyroid
graves
toxic multinodular goiter
toxic adenoma
51
grave's
autoimmune
hypersecretion of T4 and T3
52
grave's SE
opthalmopathy
53
toxic multinodular goiter
extreme thyroid enlargement
54
toxic multinodular goiter SE
dysphagia
stridor
55
toxic adenoma
benign lesions
56
toxic adenoma pts are at an incr risk of
iodine deficiency
57
hyperthyroid treatment
PTU
beta blockers
iodine
58
hypothyroid diseases
hashimoto's
primary hypothyroidism
pituitary dysfunction
myxedema coma
59
hashimotos
autoimmue
w/goiter enlargement
60
primary hypothyroid
basal TSH are elevated
61
pituitary dysfunction
bluted/absent responses to TRH
62
myxedema coma
impaired thermoregulation caused by defective hypothalamus
63
myxedema coma SE
delerium
hypoventilation
hypothermia
brady
hypotension
hyponatremia
64
hypothyroid treatment
IV L-thyroxine
or L-triiodothyonine
65
hyperparathyroid
benign parathyroid adenoma
results in excessive secretion of parathyroid
66
hyperparathyroid s+s
hypercalcemia
sk muscle weakness
decr GFR
anemia
prolonged PR
short QT
HTN
sk demineralization
67
hyperparathyroid treatment
saline
loop diuretics
disodium etidronate
+/- dialysis
68
hyperparathyroid surgery complications
hypocalcemic tetany
hyperchloremic metabolic acidosis
69
secondary hyperparathyroidism
compensatory response of parathyroid in disease that produce hypocalcemia
70
secondary hyperparathyroid is rare because
it is adaptive not autonomous
71
ectopic hyperparathyroidsm
secretion of parathyroid hormone by tissues other than parathyroid
72
hypoparathryoid
secretion of PTH is absent or deficieny
peripheral tissues are resistant to PTH
73
hypoparathyroid can be caused by
accidental removal of parathyroid during thyroidectomy
74
hypoparathyroid serum Ca
< 4.5
75
hypoparathyroid ionized ca
< 2
76
hypoparathyroid acute S+S
parestehsias
restlessness
neuromuscular irritability
77
hyperarathryoid chronic s+s
fatigue
sk muscle cramps
prolong QT
lethargy
cataracts
78
hypoparathyroid managemetn
prevent decr Ca
avoid hyperventilation
79
PTH relationship with serum ca
PTH is inversely proportional to serum Ca
80
PTH bone
bone breakdown
ca2+ release
81
PTH kidneys
incr ca2+ reabsorption
stimulates Vit D formation
82
PTH intestines
no direct effect
83
what incr ca2+ absorption in gut
vit D
84
what stops PTH production
incr serum ca2+ are negative feedback to stop PTH
85
calcitonin
hormone produced by thyroid that inhibits osteoclasts
decr serum ca2+ by incr bone ca2+
86
what is calcitonin indicated for
treating osteoporosis
treating hypercalcemic emergencies
87
Addison's
autoimmune adrenal destruction
affects cortisol and aldosterone production
88
addison's is associated with
hyponatremia
hyperkalemia
dehydration
met acidosis
hypoglycemia
89
secondary adrenal insufficiency
glucocorticoid deficiency due to decr ACTH
normal aldosterone
90
aldosterone in secondary adrenal insufficiency
normal
91
secondary adrenal insufficeincy SE
hypoglycemia
92
hypokalemia
< 3.5 mEq/L
93
treat hypokalemia
potassium chloride < 20 mEq/hr peripheral
94
hyperkalemia
> 5.5 mEq/L
95
treat hyperkalemia
CaCl
IV insulin + glucose
albuterol
96
hypocalcemia
< 8.8 mg/dL
97
treat hypocalcemia
10 mL of 10% CaGlu
10 mL of 10% CaCl
98
hypercalcemia
> 12 mg/dL
99
hypercalemia treat
fluid
parathyroidectomy
calcitonin (4 u/kg)
100
thyroid storm s+s
hyperpyrexia
tachycardia
hypermetabolism
101
thyroid storm treat
IV fluids
cooling
beta blockers
decadron
PTU
iodine
102
adrenal cortex zones
glomerulosa
fasciculata
reticularis
103
zona glomerulosa
mineralcoricoids
(aldosterone)
104
zona fasciculata
glucocorticoids
(cortisol)
105
zona reticularis
androgens
106
what produces catecholamines
adrenal medulla
107
pheochromocytoma
catecholamine-secreting tumor
typical NE
108
which drug should you give first for pheos
alpha blockade
- phenoxybenzamine
- prazosin
109
phenoxybenzamine
non-competitive a1 antag with some a2
110
when should you stop phenoxybenxamine
24-48 hrs prior to surgery
111
prazosin
competitive a1 blocker
112
prazosin advantage
less tachycardia
113
what should you give for BP control in HTN for pheo pts
nipride
cleviprex
NTG
114
when do catecholamine levels return to level in pheo post-op
7-10 days post-op
115
what is the most frequent cause of death in pheo pts
hTN post-op
116
SIADH
incr ADH
117
SIADH SE
hyponatremia
decr serum osm
incr urine Na+
incr urine osm
118
treat SIADH
restrict fluids
demeclocycline
hypertonic saline (0.5 mEq/L/hr)
119
diabetes insipidus
decr ADH
120
diabetes insipidus SE
hypovolemia
high volume of low concentrated urine
normal-high Na+
121
neurogenic DI causes
trauma
neurosurgery
tuymors
idipathic destruction of hypothalamus
122
neurogenic DI treatment
DDAVP
123
nephrogenic DI
hereditary
lithium tox
hypercalcemia
hypokalemia
CKD
124
nephrogenic DI treat
thiazide
chloropropamide
125
acromegaly
incr GH
126
acromegaly SE
difficult airway
narrow glottic opening
longer mandible = longer blade
possible poor collateral flow through ulnar
127
why do obese pts have incr DVT risk?
polycythemia
incr abdomial pressure
incr fibrinogen
incr tPA causing decr fibrinolysis
immobile
128
does obesity incr risk for delayed gastric emptying?
no
129
does obesity incr risk for GERD?
no
130
obesity hypoventilation syndrome AKA
pickwikian
131
obesity hypoventilation syndrome
obestity
daytime hypercapnia
OSA
132
why do obese pts have systemic HTN?
hyperinsulinemia incr NE
RAAS activation
133
BMI =
BMI = weight / (height^2)
134
overweight BMI
25-30
135
obese BMI
> 30
136
android
abdominal fat
137
gynoid
peripheral fat
138
which type of fat leads to more metabolic distrubance?
android (abdominal fat)
139
what does waist to hip ratio predict?
CAD
stroke
DM
140
male waist-to-hip
< 1.0
141
female waist-to-hip
< 0.8
142
GLP-1 daily dose should be help
day of procedure
143
GLP-1 weekly dose should be held
1 week prior to procedure
144
options if pt did not hold GLP-1
consider gastric ultrasound
treat as full stomach
145
which drugs have a different volume of distribution in obese pts?
highly lipophilic drug has incr Vd
146
lipophilic drugs should be dosed based on
total body weight
147
liophilic drug DOA
may be longer
148
LBW =
1.3*IBW
149
which drug may be able to treat roc-induced anaphylaxis
sugammadex
150
does propofol cause allergic rxn in pts
rarely - even with soy and egg allergies
151
NSAIDs can have a _____ reaction
psuedoallergenic reaction
152
pts with what triad of symptoms are at higher risk for NSAID reaction
asthma
hyperpastic sinusitis
nasal polyps
153
latex allergy is _______ mediated
IgE - mediated
154
which pts are at higher risk for latex allergies
spina bifida
tropical fruits
healthcare workers
155
what pts are more likely to react to protamine?
seafood allergies
diabetics w/NPH insulin
post-vasectomy pts
156
protamine SE
direct histamine release
bronchoconstriction
pulm HTN
157
which opioids have a direct histamine response
morphine
codeine
meperidine
158
are opiate histamine responses immune mediated
no
159
which opioid cannot degranulate mast cells
fentanyl
160
does penicillin allergy correlated with cephalosporin allergy
no
161
vancomycin reaction
non-igE mediated direct histamine release
162
which local anesthetics are more likely to cause an allergic reaction
esters >> amides
163
what causes rxn in local anesthetics
ester breakdown releases PABA
or
preservatives
164
which drug category is the most common allergic reaction?
neuromuscular blockers
- roc
- sux
165
2 types of angioedema
1. mast cell mediated
2. serpin deficiency/dysfunction
166
mast cell mediated angioedema mech
histamine release
167
mast-cell mediated angioedema treatment
epi
antihistamines
glucocorticoids
168
serpin deficiency angioedema mech
bradykinin incr vascular permeability
169
serpin deficiency angioedema treatment
C1 inhibitor concentrate
bradykinin receptor antagonist
170
anaphylaxis pt positioning
supine
elevate lower extremities
171
anaphylaxis treatment
IV crystalloid
Epi
consider:
vasopressin
glucagon
MB
ECMO
antihistamines
corticosteroids
172
anaphylaxis crystalloid dose
10-25 mL/kg over 20 mins
173
anaphylaxis Epi IM dose
0.01 mg/kg
174
anaphylaxis Epi IV dose
0.5-1 mg bolus
0.1 mcg/kg/min infusion
175
anaphylactic reaction
igE dependent
requires previous exposure
176
anaphylactoid reaction
IgE independent
can occur on 1st exposure
177
acanthosis nigricans
thick dark velvet skin associated w/underlying condition
178
acanthosis nigricans mechanism
activation of inulin-like growth factor receptors
proliferation of keratinocytes and fibroblasts
179
acanthosis nigricans is associated with
DM
obesity
drugs
cancer
180
atopic dermatitis AKA
eczema
181
atopic dermatitis mechanism
type 1 hypersensitivity
IgE mediated immune response to allergen
182
atopic dermatitis clinical sig
protect lesions
manage asthma/sinusitis
therapuetic adjustment based on treatment
183
epidermolysis bullosa
hereditary disorder
blistering of skin and mucous membranes
184
epidermolysis bullosa mechanism
fibrils that anchor the epidermis to dermis are damaged or absent
185
epidermolysis bullosa is most common in
peds
186
epidermolysis bullosa clinical sig
protect skin
pad BP cuff
remove EKG adhesive
IV suture
gentle airway management
minimize suctioning
187
epidermolysis bullosa are ______ infection risk
high infection risk
188
epidermolysis bullosa pts might need
stress dose of steroids
189
pemphigus
autoimmune condistion
fluid filled lesions involving skin and mucus membranes
painful oropharynx lesions
190
pemphigus mechanism
autoantibodies attach desmogleins in skin and membranes causing friction lesions
191
pemphigus pts are typically taking
immunosuppressants
and/or
steroids
192
scleroderma
autoimmune
involves the skin and other tissues or organs
193
3 processes in scleroderma
inflammation/autoimmunity
vascular injury
fibrosis
194
which disorder is associated with CREST syndrome
scleroderma
195
CREST syndrome
Calcinosis
Raynauds
Esophageal hypomobility
Scleodactyly
Telangiectasia
196
scleroderma pts are often a difficult
airway
and
IV
197
scleroderma pts lung function
decr lung compliance
decr O2 reserve
198
scleroderma pts have high risk of
esophageal rupture
199
most common and severe form of childhood progressive myopathies
duchenne muscular dystrophy
200
duchenne MD symptoms
myocardial degeneration
resp muscle weakness
pulm HTN
mitral regurge
201
what drug can we not give duchenne MD pts
Sux - causes rhabdo and hyperkalemia
202
duchenne pts are a higher risk for
MH
aspiration
203
rheumatoid arthritis
long term autoimmune disorder affecting the joints
chronic inflammation
204
RA pts can have
CV manifestations
decr neck mobility
TMJ
205
RA pts may be taking
NSAIDS
206
SLE
multisystem autoimmune disease
chronic inflammation
207
what is produced in SLE
ANA
208
SLE management is dependent on
amount of organ systems involved
209
SLE pts may have
laryngeal nerve palsy
baseline stridor
phonation defects
210
achondroplasia
decr rate of endochondral ossification
short tubular bones
211
achondroplasia is responsible for _____% of dwarfism
70%
212
achondroplasia tube sizing
based on weight not age
213
achondroplasia intubation
midline stabilization
+/- video scope
214
achondroplasia pts have difficult
epidurals
215
prader willi
genetic defect on chromosom 15
216
prader willi pts have decr ability to
decr ability to cough
= incr risk of atelectasis/pneumonia
217
prader willi pts require lower doses of what drugs
lower doses of muscle relaxant
218
can you use sux with prader willi
yes
219
how should you dose drugs for prader willi
IBW
220
klippel feil
cervical vertebral fusion syndrome
short neck w/lmited mobility
221
klippel feil pts will have a difficult
difficult airway
222
osteogeneis imperfecta
autosomal dominant
impairs production of type 1 collagen
223
osteogenesis imperfecta treatment
biphosphonates
224
osteogenesis imperfecta managment
protect bones
midline stabilization
225
osteogenesis imperfecta pts should avoid what drug
sux
226
osteogenesis imperfecta pts might have
mild hyperthermia not associated with MH
227
most common disease affecting NMJ
myasthenia gravis
228
myasthenia gravis treatment
pyridostigmine (anticholinesterase)
229
MG pts have ________ sensitivity to NDMB
incr sensitivity to NDMB
decr dose required
230
MG pts have ______ sensitivity to depolarizing MB
decr sensitivity to Sux
normal intubation dose is sufficient
231
Myasthenic syndrome aka
eaton lambert
232
eaton lambert
acquired immune mediated myopathy
IgG antibodies decr Ach release
233
eaton lambert treatment
3, 4 DAP
234
eaton lambert _______ sensitivity to NDMB
incr sensitivity to NDMB
235
eaton lambert ________ sensitivity to deoparlizing MB
incr sensitivity to sux
236
CPP =
CPP = MAP - ICP
237
CPP < 50 mmHg
cerebral max vasodilation
238
CBF is dependent on
CPP
239
CPP > 150 mmHg
cerebral edema
240
CBF is proportional to
PaCO2
241
PaCO2 20 mmHg causes
50% decr in CBF
242
when is CBF affected by PAo2
below 50 mmHg
243
why is hypocapnia not a long term solution for intracranial HTN
pH eventually compensates
244
incr venous pressure will
incr CBV
incr ICP
245
HTN will ______ cerebral autoregulation
right shift
246
head trauma will _____ cerebral autoregulation
widen
247
intracranial tumors will ______ cerebral autoregulation
narrow
248
normal ICP
< 15 mmHg
249
when should you treat ICP
sustained incr in ICP > 20 mmHg
250
methods to lower ICP
elevated head 30 deg above heart
hyperventialtion
CSF drain
mannitol
hypertonic saline
loop diuretics
steroids
barbituates/propofol
surgical decompression
251
what EtCo2 to lower ICP
30-35 mmhg
252
how long will hyperventilations lower ICP
6-12 hrs
253
mannitol dose to lwoer ICP
0.25-0.5 g/kg over 15-30 mins
254
mannitol ICP duration of action
6 hrs
255
mannitol requires what to work
in tact BBB
256
mannitol is CI
brain trauma
TBI
257
furosemide ICP dosing
0.5-1 mg/kg
258
loop diuretics are ideal for what pts
pts who will not tolerate incr in IV volume
259
steroids for ICP are best in which pts
brain tumor pts
260
which tumors are more likely to bleed during resection
metastatic brain tumor
261
what capnia state for brain tumor resection
normocapnia
30-35 mmhg
avoid hypoventilation
262
induction paralytic for brain tumor resectuion
non-depolarizer
263
why shouldnt you use sux in brain tumor resection
transient incr in ICP
264
which med for HTN in brain tumor resection
esmolol
265
PEEP and ICP
high PEEP can change ICP
266
when can you use vasodilators in brain tumor resection
after craniotomy and dura opening
267
why is hyperglycemia bad in brain tumor pts
hyperglycemia can exacerbate neuronal injury
268
what is a common SE of posterior fossa craniotomy
apnea
269
what can cause this apnea?
hematoma formation
tension pnuemocephalis
cranial nerve injury
270
which surgeries have incr risk of venous air embolism
any time operative site is above the level of the heart
271
how much air needs to be entrained to produce symtopms
5 mL/kg
272
the air causes a
RVOT preventing flow
273
ways to detect VAE
TEE
doppler
sudden decr EtCO2
incr RA or PA pressures
sudden gasps by pt
274
late signs of VAE
hypotension
tachycardia
cardiac
dysrythmmias
275
VAE treatment
flood field w/fluid
aspirate through central line
BP support
hyperbaric therapy
LLD (right side up)
276
VAE pt positioning
LLD (right side Up)
277
how to treat VAE bronchospams
beta 2 agonists
278
intracerebral hemorrhage
hematoma within parenchyma
279
treat intracerebral hemorrhage
IV factor VII
surgical hematoma evac
BP management
280
subarachnoid hemorrhage
ruptured intracranial aneurysm
281
subarachnoid hemorrhage presents with
thunderclap headach
282
subarachnoid hemorrhage pts have a high risk of
vasospasm
283
vasospasm triad
HTN
hypervolemia
hemodilution
284
3 goals for intracranial aneurysm surgery
limit risk of rupture
prevent cerebral ischemia
facilitate surgical exposurre
285
GCS lowerst score
3
286
GCS coma
< 8
287
GCS 3-8
severe
288
GCS 9-12
mod
289
GCS 13-15
mild
290
TBI treatment
high MAPs > 70
low ICP
normocapnia
avoid hyperventialtion
