ACE Review - Endocrine Flashcards
1
Q
questions
A
Answers
2
Q
what vascular problem is likely seen in hashimoto patients
A
increased svr
3
Q
what gender is more likely to have hashimotos
A
women are 7x more likely
4
Q
why do hashimotos have more svr
A
they have less beta adrenergic receptor stimulation, so their alpha is unopposed
5
Q
what is the consequence of increased svr in hashimoto
A
diastolic pressure is increased and there is a decrease pulse pressure as a result of increased alpha stim
6
Q
what is the consequence of hypothyroid assoc. increase svr
A
increased myocardial demand>prolong qt> arrythmia
7
Q
what arrythmia can arrise in hashimoto hypothyroidism
A
torsades
8
Q
what can help hashimoto arrythmia resolve
A
fixing the hypothyroidism/with hormone replacement
9
Q
a patient with history of Graves’ disease is presenting with fever, tachycardia and htn, what should you suspect
A
thyrotoxicosis crisis
10
Q
what are factors that might precipitate a thyrotoxocisis
A
preop period, stressors, infection
11
Q
what needs to be done before a patient goes to surgery when they are suspected of a thyrotoxic crisis
A
inhibition of the thyroid hormone, fluid resuscitation, supportive therapy
12
Q
what is a good drug to decrease sympathetic storm thyrotocosis crisis
A
propranolol because it also decreases t4 to t3 conversion
13
Q
how do you decrese t3 and t4 production in thyroid storm patients
A
give thioamides that inhibit the enzyme thyroperoxidase
14
Q
what drugs inhibit thyroperoxidase
A
methimazole and ptu
15
Q
what is a drug that also decreases t3 and t4 production
A
iodine
16
Q
shoud we give iodine early on to treat a thyroid storm as well?
A
no…it may initially cause n increase of t3 and t4…start it only after starting a thioamide therapy
17
Q
what should you use to treat hyperthermia in thyroid storm …acetaminophen or asa..
A
acetaminophen with cooling blankets…asa causes protien decoupling and may actually increase free t3 and t4
18
Q
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A
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19
Q
What are the signs found in carcinoid syndrome
A
Wheezing flushing diarrhea
20
Q
What causes carcinoid signs
A
Serotonin - diarrhea, substance p vasoactive substance somatostatin histamine - flushing and wheezing
21
Q
What is found in 1/2 of carcinoids
A
Right sided cardiac lesions. Pulm stenosis tricuspid regurge
22
Q
What urine test is used for carciniod diagnosis
A
5 hydroxyindolacetic acid.
23
Q
Can you use metanephrine urine test for carcinoid?
A
No. That is for pheochromocytoma
24
Q
Can symptom severity predict operative complications?
A
No. Even mild symptom patients can have poor outcomes.
25
What tests are needed for carcinoid patients
Electrolytes and echo. Electrolytes because of diarrhea causing depletions
26
Why is it important to fix dehydration in carcinoid patients
The diarrhea causes dehydration and may lead to carcinoid crisis
27
What are the symptoms of carcinoid crisis
Tachycardia hyper or hypotension flushing. Abdominal pain
28
What should be administered to pt in preop time to prevent carcinoid crisis
Octreotide 24-48hr before surgery
29
What meds can precipitate carcinoid crisis
Succ, mivacurium( histamine release) atricurium( histamine release) isoproterenol epi norepi dopamine. Thiopental
30
How is the awakening of carcinoid patients
Delayed awakening
31
Is zofran ok to use in carcinoid patients
Yes. It is actually a serotonin antagonist
32
What is trigeminal neuralgia
It is sudden unilateral pain in the distribution of the fifth cranial nerve
33
What gender is more likely to get trigeminal neralgia
Females. It is more common over age of 50 and increases risk with age
34
Which branch of the facial nerve 5 is more commonly affected by trigeminsl neuralgia
The maxillary branch is the most common
35
What is the first medication used to treat trigeminal neuralgia
Carbamazepine
36
What block can be done for trigeminal neuralgia
Local anesthetic to the gasserian ganglion block
37
What ekg finding do you have in primary hyperparathyroidism
Shortened qt
38
What symptoms to look out for in primary hyperparathyroid inorder to know how to treat
Look for polydipsia and polyuria
39
What is the mainstay treatment of primary hyperparathyroidism
Normal saline
40
What to do once patient is euvolemic in primary hyperparathyroidism
Treat them with LASIx to diurese the calcium
41
What kind of diuretic is lasix
It is a loop diuretic
42
Should hydrochlorothiazide be used in hyperparathyroidism
No because it increases renal absorption of calcium
43
In emergency hypercalciemia, what modes do you have to treat it
Bisphosphonates, calcitonin, hemodialysis
44
What are examples of bisphosphonates
Pamidronate and zoledronate
45
How fast does calcitonin work
It works within minutes in life threatening hypercalcemia
46
How do you get fast acting calcitonin
Intravenous
47
What are possible reasons for hyponatremia
Siadh, diabetes insipidous, hyperglycemia, cerebral salt wasting, water intoxication.
48
What three things do you need to look at for diagnosis of hyponatremia
Serum osmolarity, urine sodium, volume status
49
What is the first step in solving hyponatremia
Look at the serum osmolarity
50
What is normal serum osmolarity
280 to 300
51
What if the serum osmolarity is high...
It could be hyperglycemia....or pt is getting non sodium hyperosmolar fluid
52
What if the serum osmolarity is normal
Hyperlipidemia or hyperprotienemia
53
What if the serum osm is low
Look at the urine sodium
54
What is the normal urine sodium
20
55
What if the urine sodium is low
Water intoxication
56
What if the urine sodium is high
Check the volume status to diagnose
57
Low serum osm, high urine na, euvolemic
Saidh, hypothyroid,adrenal insufficiency
58
Low serum osm, high urine na, hypovolemic
Cerebral salt wasting , diarrhea. Diuretics
59
Low serum osm, high urine na, hypervolemic
Cirrhosis heart failure nephrotic syndrome
60
What is the inital treatment of symptomatic hypercalcemia
Hydration with normal saline
61
What does normal saline hydration do to hypercalcemia patient
It treats the associated hypovolemia in pt as well as increase renal excretion of calcium
62
What are other treatments to reduce calcium in hypercalcemic patients once volume status has been treated
The use Of loop diuretics like furosemide to excrete the calcium...but only when volume status is resolved
63
What are the EKG changes of hypercalciemia
Prolong pr interval...shorten qt
64
What are the preoperative treatments for hypercalcemia
Bisphosphonates, calcitonin, steroids, hemodialysis
65
How is the blood pressure of hypercalcemic patients
Hypertensive
66
Can you use thiazides diuretics it hypercalcemic pt
No because they increase the absorption of calcium
67
Is there a decrease or increase need of anesthetic in symptomatic hypercalcemic pt
Decrease
68
Hyperthyroid. What are the treatments for it.
Anthithyroid medications, inorganic iodine, radiated iodine , thyroidectomy
69
Hyperthyroid. When should inorganic iodine be given
After anti thyroid meds to prevent thyrotoxicosis
70
Hyperthyroid. What med is good to treat hemodynamic alterations of hyperthyroidism
Beta blockers
71
Hyperthyroid. What other med besides beta blockers can help during a thyroid storm
Corticosteroids because they decrease the secretion of thyroid hormone
72
normoglycemia. what is normal fasting
90-130
73
normoglycemia. what is normal postprandial
below 140
74
normoglycemia. what is the goal range for intensive insulin therapy
80-110
75
nomoglycemia. what is the roange for standard insulin therapy
180-200
76
normoglycemia. is there a difference between the intensive vs standard insulin therapy
there is no difference in medical icu pt but in surgical icu pts, there is a difference
77
nomoglycemia. what are the advantages of strict insulin therapy in icu pt who have stays greater than 3 days
in surgical icu pt, there is a reduction of mortality (8%down to 4%), decrease infection rate, decrease icu stay, decrease polyneuropathy
78
normoglycemia. in neurotrauma pt, what is recommendation.
to treat glucose if value is above 200
79
normoglycemia. what is goal range for neurotrauma pt
140 to 180
80
normoglycemia. what should the glucose be above in neurotrauma pt
above 110
81
hyperaldosteronism. what is the hemodynamic manifestation
hypertension
82
hyperaldosteronism. what is the electrolyte disturbance
hypokalemia
83
hyperaldosteronism. what is the classification
primary or secondary
84
hyperaldosteronism. what are the 3 causes of primary
adrenal tumor. adrenal hyperplasia. glucocoriticoid responsive hyper aldosterone
85
hyperaldosteronism. what is the cause of glucocorticoid respoonsive hyperaldosterone
genetic
86
hyperaldosteronism. what is the clinical presentation of glucocorticoid responsive hyperaldosteronism
usually htn in pts younger than 20 yrs old
87
hyperaldosteronism. what is the treatment of primary hyperaldos based on
whether or not it is unilateral or not...
88
hyperaldosteronism. unilateral. how is it treated
these patients show better benefit with surgical removal of adrenal gland than the bilateral pts
89
hyperaldosteronism. bilateral. how is it treated
these patients do not benefit much from surgery and is treated with medical management
90
hyperaldosteronism. bilateral. what are drug options to treat primary hyperaldost bilateral
potassium sparing diuretics...
91
hyperaldosteronism. bilateral. which is better. amilioride or spironolactone for medical management
spironoloactone is better than amilioride
92
hyperaldosteronism. bilateral. medical management. what is eplerenone
it is another k-sparing duretic..but is only 60% effect as spironolactone
93
hyperaldosteronism. glucocorticoid responsive hyperaldost. how is the treatment for this differnt than that of bilateral adrenal tumors
it is treated with a night dose of prednisone or dexamethasone. if this doesnt work, then u start spironolactone.
94
adrenal insufficiency. what is the most common manifestation
hypotension
95
adrenal insufficiency. does it respond to fluids
no, bc svr is also decreased
96
adrenal insufficiency. what was the electrolyte disorder
hyponatremia, hyperK and hyperCa
97
pheochromocytoma. what is used preop to treat htn
alpha blocker such as phenoxybenzamine
98
pheochromocytoma. what is an alternative drug to phenoxybenzamine
doxazosin...a long acting alpha 1 blocker dosed 1 time daily
99
pheochromocytoma. what are criteria to make sure pt is ready for surgery
1. no bp above 160/90 before surgery for 24hrs. 2. ekg free of st changes for 1 week , 3. no more than 1 pvc per 5 min ;4. orthosatic hypotension...if it does occur, bp should be above 80/45 (aka needs volume)
100
pheochromocytoma. what is the difficulty with chf pts getting preop bp management
the alpha blockers can cause reflex tachycardia that can decrease cardiac output and cause worsening of chf. the beta blocker that can be used in non chf pts may slow down hr to the point where chf is worsened too
101
pheochromocytoma. what are alternative preop htn meds that can be used in chf pts
alpha-methylpara-tyrosine...that inhibits tyrosine hydroxylase...thus decreasing catecholamine production
102
pheochromocytoma. what preop htn med can be used that has both alpha and beta block
labetalol
103
pheochromocytoma. after what is occluded do you see hypotension
venous drainage of adrenal gland clamping will shut off body supply of catecholamines...
104
pheochromocytoma. how is the blood glucose control in these patients
in the high catecholamine state. norepi is insulin antagonist...so u get hyperglycemia...intraop..when the adrenal gland is venous clamped, u get no more norepi...and you might get rebound hyperinsulin effect...hypoglycemia
105
siadh. what is the most common form
idopathic
106
siadh. what kind of injury can it happen after
subarachnoid hemorrhage.
107
siadh. where is adh made
posterior pituitary
108
siad. what is decreased in lab value
hyponatremia, decreased serum osmolality
109
siadh, what is increased in lab value
urine somolaity, urine sodium, urine specific gravity
110
siadh. what are the values of the decreased lab values
na <280
111
siadh. what are the values of the increased lab values
urine osmolality >200, urine na >20, urine sg >1.005
