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ACE > ACE Review - Endocrine > Flashcards

ACE Review - Endocrine Flashcards

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1
Q

questions

A

Answers

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2
Q

what vascular problem is likely seen in hashimoto patients

A

increased svr

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3
Q

what gender is more likely to have hashimotos

A

women are 7x more likely

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4
Q

why do hashimotos have more svr

A

they have less beta adrenergic receptor stimulation, so their alpha is unopposed

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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

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6
Q

what is the consequence of hypothyroid assoc. increase svr

A

increased myocardial demand>prolong qt> arrythmia

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7
Q

what arrythmia can arrise in hashimoto hypothyroidism

A

torsades

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8
Q

what can help hashimoto arrythmia resolve

A

fixing the hypothyroidism/with hormone replacement

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9
Q

a patient with history of Graves’ disease is presenting with fever, tachycardia and htn, what should you suspect

A

thyrotoxicosis crisis

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10
Q

what are factors that might precipitate a thyrotoxocisis

A

preop period, stressors, infection

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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

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12
Q

what is a good drug to decrease sympathetic storm thyrotocosis crisis

A

propranolol because it also decreases t4 to t3 conversion

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13
Q

how do you decrese t3 and t4 production in thyroid storm patients

A

give thioamides that inhibit the enzyme thyroperoxidase

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14
Q

what drugs inhibit thyroperoxidase

A

methimazole and ptu

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15
Q

what is a drug that also decreases t3 and t4 production

A

iodine

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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

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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

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18
Q

xxxxxxxxxxxxxxxxxxxxxxxxxx

A

xxxxxxxxxxxxxxxxxxxxxxxxxx

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19
Q

What are the signs found in carcinoid syndrome

A

Wheezing flushing diarrhea

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20
Q

What causes carcinoid signs

A

Serotonin - diarrhea, substance p vasoactive substance somatostatin histamine - flushing and wheezing

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21
Q

What is found in 1/2 of carcinoids

A

Right sided cardiac lesions. Pulm stenosis tricuspid regurge

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22
Q

What urine test is used for carciniod diagnosis

A

5 hydroxyindolacetic acid.

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23
Q

Can you use metanephrine urine test for carcinoid?

A

No. That is for pheochromocytoma

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24
Q

Can symptom severity predict operative complications?

A

No. Even mild symptom patients can have poor outcomes.

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25
Q

What tests are needed for carcinoid patients

A

Electrolytes and echo. Electrolytes because of diarrhea causing depletions

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26
Q

Why is it important to fix dehydration in carcinoid patients

A

The diarrhea causes dehydration and may lead to carcinoid crisis

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27
Q

What are the symptoms of carcinoid crisis

A

Tachycardia hyper or hypotension flushing. Abdominal pain

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28
Q

What should be administered to pt in preop time to prevent carcinoid crisis

A

Octreotide 24-48hr before surgery

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29
Q

What meds can precipitate carcinoid crisis

A

Succ, mivacurium( histamine release) atricurium( histamine release) isoproterenol epi norepi dopamine. Thiopental

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30
Q

How is the awakening of carcinoid patients

A

Delayed awakening

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31
Q

Is zofran ok to use in carcinoid patients

A

Yes. It is actually a serotonin antagonist

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32
Q

What is trigeminal neuralgia

A

It is sudden unilateral pain in the distribution of the fifth cranial nerve

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33
Q

What gender is more likely to get trigeminal neralgia

A

Females. It is more common over age of 50 and increases risk with age

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34
Q

Which branch of the facial nerve 5 is more commonly affected by trigeminsl neuralgia

A

The maxillary branch is the most common

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35
Q

What is the first medication used to treat trigeminal neuralgia

A

Carbamazepine

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36
Q

What block can be done for trigeminal neuralgia

A

Local anesthetic to the gasserian ganglion block

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37
Q

What ekg finding do you have in primary hyperparathyroidism

A

Shortened qt

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38
Q

What symptoms to look out for in primary hyperparathyroid inorder to know how to treat

A

Look for polydipsia and polyuria

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39
Q

What is the mainstay treatment of primary hyperparathyroidism

A

Normal saline

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40
Q

What to do once patient is euvolemic in primary hyperparathyroidism

A

Treat them with LASIx to diurese the calcium

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41
Q

What kind of diuretic is lasix

A

It is a loop diuretic

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42
Q

Should hydrochlorothiazide be used in hyperparathyroidism

A

No because it increases renal absorption of calcium

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43
Q

In emergency hypercalciemia, what modes do you have to treat it

A

Bisphosphonates, calcitonin, hemodialysis

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44
Q

What are examples of bisphosphonates

A

Pamidronate and zoledronate

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45
Q

How fast does calcitonin work

A

It works within minutes in life threatening hypercalcemia

46
Q

How do you get fast acting calcitonin

A

Intravenous

47
Q

What are possible reasons for hyponatremia

A

Siadh, diabetes insipidous, hyperglycemia, cerebral salt wasting, water intoxication.

48
Q

What three things do you need to look at for diagnosis of hyponatremia

A

Serum osmolarity, urine sodium, volume status

49
Q

What is the first step in solving hyponatremia

A

Look at the serum osmolarity

50
Q

What is normal serum osmolarity

A

280 to 300

51
Q

What if the serum osmolarity is high…

A

It could be hyperglycemia….or pt is getting non sodium hyperosmolar fluid

52
Q

What if the serum osmolarity is normal

A

Hyperlipidemia or hyperprotienemia

53
Q

What if the serum osm is low

A

Look at the urine sodium

54
Q

What is the normal urine sodium

A

20

55
Q

What if the urine sodium is low

A

Water intoxication

56
Q

What if the urine sodium is high

A

Check the volume status to diagnose

57
Q

Low serum osm, high urine na, euvolemic

A

Saidh, hypothyroid,adrenal insufficiency

58
Q

Low serum osm, high urine na, hypovolemic

A

Cerebral salt wasting , diarrhea. Diuretics

59
Q

Low serum osm, high urine na, hypervolemic

A

Cirrhosis heart failure nephrotic syndrome

60
Q

What is the inital treatment of symptomatic hypercalcemia

A

Hydration with normal saline

61
Q

What does normal saline hydration do to hypercalcemia patient

A

It treats the associated hypovolemia in pt as well as increase renal excretion of calcium

62
Q

What are other treatments to reduce calcium in hypercalcemic patients once volume status has been treated

A

The use Of loop diuretics like furosemide to excrete the calcium…but only when volume status is resolved

63
Q

What are the EKG changes of hypercalciemia

A

Prolong pr interval…shorten qt

64
Q

What are the preoperative treatments for hypercalcemia

A

Bisphosphonates, calcitonin, steroids, hemodialysis

65
Q

How is the blood pressure of hypercalcemic patients

A

Hypertensive

66
Q

Can you use thiazides diuretics it hypercalcemic pt

A

No because they increase the absorption of calcium

67
Q

Is there a decrease or increase need of anesthetic in symptomatic hypercalcemic pt

A

Decrease

68
Q

Hyperthyroid. What are the treatments for it.

A

Anthithyroid medications, inorganic iodine, radiated iodine , thyroidectomy

69
Q

Hyperthyroid. When should inorganic iodine be given

A

After anti thyroid meds to prevent thyrotoxicosis

70
Q

Hyperthyroid. What med is good to treat hemodynamic alterations of hyperthyroidism

A

Beta blockers

71
Q

Hyperthyroid. What other med besides beta blockers can help during a thyroid storm

A

Corticosteroids because they decrease the secretion of thyroid hormone

72
Q

normoglycemia. what is normal fasting

A

90-130

73
Q

normoglycemia. what is normal postprandial

A

below 140

74
Q

normoglycemia. what is the goal range for intensive insulin therapy

A

80-110

75
Q

nomoglycemia. what is the roange for standard insulin therapy

A

180-200

76
Q

normoglycemia. is there a difference between the intensive vs standard insulin therapy

A

there is no difference in medical icu pt but in surgical icu pts, there is a difference

77
Q

nomoglycemia. what are the advantages of strict insulin therapy in icu pt who have stays greater than 3 days

A

in surgical icu pt, there is a reduction of mortality (8%down to 4%), decrease infection rate, decrease icu stay, decrease polyneuropathy

78
Q

normoglycemia. in neurotrauma pt, what is recommendation.

A

to treat glucose if value is above 200

79
Q

normoglycemia. what is goal range for neurotrauma pt

A

140 to 180

80
Q

normoglycemia. what should the glucose be above in neurotrauma pt

A

above 110

81
Q

hyperaldosteronism. what is the hemodynamic manifestation

A

hypertension

82
Q

hyperaldosteronism. what is the electrolyte disturbance

A

hypokalemia

83
Q

hyperaldosteronism. what is the classification

A

primary or secondary

84
Q

hyperaldosteronism. what are the 3 causes of primary

A

adrenal tumor. adrenal hyperplasia. glucocoriticoid responsive hyper aldosterone

85
Q

hyperaldosteronism. what is the cause of glucocorticoid respoonsive hyperaldosterone

A

genetic

86
Q

hyperaldosteronism. what is the clinical presentation of glucocorticoid responsive hyperaldosteronism

A

usually htn in pts younger than 20 yrs old

87
Q

hyperaldosteronism. what is the treatment of primary hyperaldos based on

A

whether or not it is unilateral or not…

88
Q

hyperaldosteronism. unilateral. how is it treated

A

these patients show better benefit with surgical removal of adrenal gland than the bilateral pts

89
Q

hyperaldosteronism. bilateral. how is it treated

A

these patients do not benefit much from surgery and is treated with medical management

90
Q

hyperaldosteronism. bilateral. what are drug options to treat primary hyperaldost bilateral

A

potassium sparing diuretics…

91
Q

hyperaldosteronism. bilateral. which is better. amilioride or spironolactone for medical management

A

spironoloactone is better than amilioride

92
Q

hyperaldosteronism. bilateral. medical management. what is eplerenone

A

it is another k-sparing duretic..but is only 60% effect as spironolactone

93
Q

hyperaldosteronism. glucocorticoid responsive hyperaldost. how is the treatment for this differnt than that of bilateral adrenal tumors

A

it is treated with a night dose of prednisone or dexamethasone. if this doesnt work, then u start spironolactone.

94
Q

adrenal insufficiency. what is the most common manifestation

A

hypotension

95
Q

adrenal insufficiency. does it respond to fluids

A

no, bc svr is also decreased

96
Q

adrenal insufficiency. what was the electrolyte disorder

A

hyponatremia, hyperK and hyperCa

97
Q

pheochromocytoma. what is used preop to treat htn

A

alpha blocker such as phenoxybenzamine

98
Q

pheochromocytoma. what is an alternative drug to phenoxybenzamine

A

doxazosin…a long acting alpha 1 blocker dosed 1 time daily

99
Q

pheochromocytoma. what are criteria to make sure pt is ready for surgery

A
  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
Q

pheochromocytoma. what is the difficulty with chf pts getting preop bp management

A

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
Q

pheochromocytoma. what are alternative preop htn meds that can be used in chf pts

A

alpha-methylpara-tyrosine…that inhibits tyrosine hydroxylase…thus decreasing catecholamine production

102
Q

pheochromocytoma. what preop htn med can be used that has both alpha and beta block

A

labetalol

103
Q

pheochromocytoma. after what is occluded do you see hypotension

A

venous drainage of adrenal gland clamping will shut off body supply of catecholamines…

104
Q

pheochromocytoma. how is the blood glucose control in these patients

A

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
Q

siadh. what is the most common form

A

idopathic

106
Q

siadh. what kind of injury can it happen after

A

subarachnoid hemorrhage.

107
Q

siadh. where is adh made

A

posterior pituitary

108
Q

siad. what is decreased in lab value

A

hyponatremia, decreased serum osmolality

109
Q

siadh, what is increased in lab value

A

urine somolaity, urine sodium, urine specific gravity

110
Q

siadh. what are the values of the decreased lab values

A

na <280

111
Q

siadh. what are the values of the increased lab values

A

urine osmolality >200, urine na >20, urine sg >1.005

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