Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia 101 > Basic ENDO/Metabolic > Flashcards

Basic ENDO/Metabolic Flashcards

1
Q

Glucagon is secreted by pancreatic alpha cells in response to hypoglycemia and INHIBITS (Gluconeogenesis/Glycolysis) to IMPROVE blood glucose concentration

A

Glycolysis

*glucagon STIMULATES glycogenolysis and gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Glucagon raises blood sugar indirectly how? (3)

A
  1. Stimulates lipolysis
    - produces glycerol and FFA
  2. Inhibits Glycolysis
    - stops consumption of glucose
  3. Inhibits glycogen synthesis
    - available glucose can be released into bloodstream instead of being stored in liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does glucagon affect the heart?

A

inotropic and chronotropic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to differentiate Malignant hyperthermia from Thyroid storm?

A
  1. Muscle rigidity
  2. Rate of EtCO2 ( MH&raquo_space; TS)
  3. Temperature (MH&raquo_space; TS)
  4. MH (hyperkalemia), TS (hypokalemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for MH vs Thyroid storm?

A

MH: Dantrolene

Thyroid storm: Sodium iodide and PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AVP (aka ADH) regulates diuresis and antidiuresis. The most potent trigger for its release is ____

A

systemic arterial hypotension (mediated by aortic and carotid baroreceptors)
-> AVP vasoconstricts by stim V1a receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AVP (aka ADH) acts on receptors in the collecting ducts to induce water and Na reabsorption that causes what changes to urine and plasma osmolality?

A

Increases urine osmolality

Decreases plasma osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are clinically hypothyroid pts susceptible to hypotensive effects of anesthesia?

A
  1. Decreased CO
  2. Blunted autonomic reflexes
  3. Decreased Intravascular volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Primary vs secondary hypothyroidism

  • TSH, T4
  • primary dysfunction?
A

Primary

  • High TSH, low T4
  • primary dysfunction: lack of T4 feedback on pituitary (ie: hashimotos, iodine deficiency)

Secondary

  • Low TSH, Low T4
  • primary dysfunction: pituitary gland (ie: adenoma, hemorrhage, radiation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a bad idea for management of pts with thyrotoxicosis (hypermetabolic state d/t Thyroid hormone?

A

RAI

- destroys thyroid gland - can worsen thyrotoxicosis bc thyroid hormone is released into the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can you pretreat hyperthyroid pts with prior to RAI to prevent thyrotoxicosis (aka thyrostatic medications)?

A

Methimazole or propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for Hashimotos (thyroid gland is attacked by immune system)?

A

L-thyroxine (levothyroxine)

*pts are hypothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment for Graves disease (thyroid gland is hyperfunctioning)?

A

Methimazole, or PTU, or Iodide

*Pts are hyperthyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why are pts hyperglycemic after surgery/stress?

A

Body release hormones (cortisol, catecholamines, glucagon) that are counter-regulatory to insulin -> insulin resistance –> increase production and release of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diabetic autonomic neuropathy results in resting tachycardia that does NOT compensate well for changing hemodynamics, which can cause ______

A

orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is starting a BB prior to a-blocker dangerous in pts with pheochromocytoma?

A

Hypertensive emergency
- unopposed alpha vasoconstriction

Ideally: initiate a-adrenergic receptor antagonist (phenoxybenzamine, phentolamine, doxazosin, terazosin, or prazosin) 10-14 days prior to and including morning of surgery.
- can add BB only if indicated (persistent tachycardia, hypertension, dysrhythmias)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In DKA pts, what is recommended once plasma glucose is approximately down to 200 mg/dL?

A

Switch from 0.45% NaCl to D5 in 0.45% NaCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

________ is the combination of euvolemia, hypotonic plasma (low serum osm), hypertonic urine (urine osm > 100mOsm), and high urine sodium (>20 mEq/L).

A

Hallmark of SIADH
- Hypotonic plasma d/t increased free water retention from ADH

INAPPropriate ADH
- Increased NA in the PP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ADH is released from the _______ in response to _____

A

Posterior pituitary

Hyperosmolar state or hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ADH can be inappropriately be released by ______

A
  1. Stress
  2. Major trauma
  3. Severe pain
  4. Use of opioids
  5. Sepsis
  6. Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Primary hyperaldosteronism (Conn syndrome) is most commonly caused by _____

A

unilateral adrenal adenoma

- mineralocorticoid excess (aldosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

________ increases the reabsorption of Na and secretion of K in the distal tubule for volume expansion. What happens to Na and K if a pt has hyperaldosteronism?

A

Aldosterone

  • Hypernatremia
  • Hypokalemia
  • (Metabolic alkalosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stress dosing steroids.

- Low risk for pts taking < ____

A

< 5 mg prednisone

*conflicting data on superiority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Steroid Trivia

  • Mineralocorticoids regulate
  • Glucocorticoids regulate
  • Corticosteroids regulate
A
  • Mineralocorticoids regulate: sodium and water levels (aldosterone)
  • Glucocorticoids regulate: metabolism and inflammation (cortisol)
  • Corticosteroids regulate: both gluco/mineralocorticoid effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Adrenal cortex three diff layers and what they secrete
1. Outer: zona glomerulosa - Mineralocorticoids (aldosterone) 2. Middle: zona fasiculata - Glucocorticoids (cortisol) 3. Inner: zona reticularis - Gonadocorticoids
26
Adrenal medulla is made of ______ and secretes ____
chromaffin cells catecholamines (adrenaline, noradrenaline)
27
Best way to intraoperatively manage diabetic pt's insulin pumps
Continue at programmed rate in uncomplicated surgery If complicated surgery/expecting large hemodynamic shifts, electrolyte imbalances, and acid-base balance, turn OFF basal rate, and start continuous insulin infusion
28
_____ is the most common cause of hyponatremia in pts with CNS disturbances
SIADH
29
What condition looks exactly like SIADH, but is treated differently? - Hyponatremic (<280) - High ur Na (>40) - High ur Osm (>100)
Cerebral salt wasting *Cerebral salt wasting is either euvolemic or hypovolemic In SIADH: treatment is fluid restriction, PO NaCl, Lasix
30
What type of acid base disturbances do loop and thiazide diuretics cause?
Hypochloremic metabolic alkalosis
31
What type of electrolyte is needed in the treatment of alkalosis?
Potassium - since alkalosis causes hypokalemia - K+ is driven into cells and exchanged for intracellular H+ in attempt to buffer alkalosis
32
Most pts with primary hyperparathyroidism are asymptomatic, but what is the most common presenting symptom if any?
nephrolithiasis | - secondary to elevated calcium levels
33
Aldosterone (mineralocorticoid) and cortisol (glucocorticoid) promote renal potassium (uptake/secretion)
secretion | - hypokalemia
34
Insulin and thyroid hormones promote cellular potassium (uptake/secretion)
uptake | - hyperkalemia
35
What happens to Na and K with glucocorticoid administration?
Stimulate Na reabsorption and K excretion | - Hypernatremia and hypokalemia
36
How to change the non-depolarizing neuromuscular blocker in pts with hyperparathyroidism?
Increase the dose | - Hypercalcemia antagonizes effects of non-depolarizing NMB
37
How can hyperparathyroidism lead to respiratory insufficiency?
Hypercalemia is assoc w/ muscle weakness
38
Most common cause of stridor 24-96 hours post thyroidectomy?
hypocalcemia *recurrent laryngeal n damage is more likely to cause early stridor and difficulty with phonation
39
Why does damage to the superior laryngeal n cause change in pitch of pts voice?
SLN innervates cricothyroid muscle
40
The normal pulse rate variability that occurs with inhalation and exhalation is 10/min. Baroreceptors sense changes to preload with inspiration -> increase pulse rate, and expiration -> decrease rate. Loss of this variability is a sign of _____
early autonomic neuropathy.
41
(T3/T4) exerts direct effects on the myocardium and may result in thyrotoxic cardiomyopathy
T3
42
In primary hyperthyroidism, what levels are increased and decreased (TSH, T3, T4, THBR)
TSH: decreased T3 and T4: increased Thyroid hormone binding ratio (amt of free T4 circulating): increased *The hormones themselves are affected
43
Most common initial presentation of pts with primary hyperaldosteronism?
1. hypokalemia metabolic alkalosis - urinary loss of K+ and H+ in exchange for absorbing Na+ 2. Increased BP 3. Reduced renin
44
MEN I tumors
Pituitary tumor Parathyroid tumors Pancreatic tumors
45
MEN IIa tumors
Parathyroid tumors Thyroid tumor (medullary) Pheochromocytoma
46
MEN IIb tumors
Ganglioneuromas Parathyroid tumors Thyroid tumor (medullary) Pheochromocytoma
47
Glucagon release is triggered by (hyper/hypoglycemia) and its release is stimulated by ______
Hypoglycemia - indicated in cases of insulin overdose Epinephrine (catecholamines)
48
________ are the most effective drugs to block release of thyroid hormone from the thyroid gland
Iodides, but should only be used after a thyrostatic agent is given (ie: PTU or methimazole) d/t the "escape phenomenon" where new thyroid hormones are actually synthesized and worsen the hyperthyroidism
49
________ consists of episodic flushing, diarrhea, wheezing and R sided heart disease
carcinoid syndrome
50
Pancuronium (stimulates/blunts) the sympathetic nervous system
stimulates | - use with caution in pts with hyperthyroidism
51
When can you stop BB in hyperthyroid pts getting thyroidectomy
several weeks | - half life of T4 is 7-8 days
52
Primary adrenal insufficiency (addison disease) is characterized by: (5)
1. Hyponatremia 2. Hyperkalemia 3. Metabolic acidosis 4. Hyperpigmentation 5. Hypocortisolism
53
Primary adrenal insufficiency develops adrenal gland dysfunction/exacerbation. What is treatment?
100mg IV hydrocortisone q6h for 24hrs *adrenal gland is unable to produce sufficient mineralocorticoid, glucocorticoid, and androgens
54
Primary vs secondary disorders
Primary: something affects the production or quantity or quality of the hormone itself Secondary: Something disrupts the hormone axis that is usually able to respond to fluctuating hormone level
55
Destruction of ___% of the adrenal glands must occur before clinical signs of adrenal insufficiency appear
>90%
56
Type 1 diabetes occurs d/t injury to ____ in the pancreaas
Beta cells, responsible for insulin production
57
Statins are _____ inhibitors. Which
HMG-CoA reductase inhibitors | - increase HDL:LDL
58
How does metformin help control blood sugars in pts with diabetes?
Decreases hepatic gluconeogenesis and increases insulin sensitivity
59
Malignant hyperthermia is closely associated to which 3 diseases?
1. Central core disease 2. Multi-minicore disease 3. King-Denborough syndrome
60
Lipolysis will increase or decrease with: - alpha 2 stimulation - beta 2 and 3 stimulation
- alpha 2 stimulation: inhibit | - beta 2 and 3 stimulation: stimulate
61
Benefits of carbohydrate rich drinks given 2h before surgery ?
increases insulin sensitivity (decrease insulin resistance) Stress of sx = hyperglycemia Fasting state = low insulin
62
What catecholamine predominates in this type of pheochromocytoma? - Paroxysmal - Sustained
Paroxysmal: EPi Sustained: Norepi
63
How does a pt's insulin regimen get affected perioperatively if they are on: - Rapid/short acting: - Intermediate: - Long acting:
Rapid/short acting: - continue Intermediate: - take 75% nl dose night before sx - take 50% nl dose day of sx Long acting: - take 50% nl dose morning of sx
64
Concern about pts on chronic glucocorticoid therapy?
Can suppress the hypothalamic-pituitary adrenal axis -> | insufficient response by adrenal glands to the stress of major sx
65
Categories of risk of adrenal insufficiency: (what dose of steroids are they on) Low Intermediate High
Low: - Any dose GC < 3 weeks - Prednisone <5mg/d or 10mg q other day Intermediate: - Prednisone 5-20mg/d > 3 weeks - Chronic inhaled or topical GC High: - Cushing syndrome 2/2 to GC - Prednisone >20mg/d > 3 weeks *High risk pts should be considered for periop stress dose steroids
66
During a stress response (ie. surgery), which hormones decrease?
T3/T4 Growth RELEASING hormone *almost every other hormone increases or stays same
67
Insulin effects on: | Adipocytes
Increase glucose uptake Increase Fatty acid storage/synthesis *insulin has primarily anabolic effects and inhibits catabolic processes
68
Insulin effects on: | myocytes
Increase glucose uptake Increase amino acid uptake Increase glycogen storage Increase protein synthesis *insulin has primarily anabolic effects and inhibits catabolic processes
69
Insulin effects on: | Hepatocytes
Increase macronutrient uptake Increase Fatty acid storage/synthesis Increase glycogen synthesis *insulin has primarily anabolic effects and inhibits catabolic processes
70
During surgical stress, the body enters a state of insulin resistance d/t what?
release of stress hormones (catecholamines, cortisol, glucagon)
71
insulin has primarily ______effects and inhibits ______ processes
anabolic | catabolic
72
Glucagon STIMULATES _______ and _______
glycogenolysis - break down glycogen to glucose gluconeogenesis - glucose synth by liver *both improve blood glucose [ ]
73
How does glucagon affect gastric motility and biliary sphincter and lower esophageal sphincter tone?
DECREASE
74
Lab derangements with corticosteroid use
1. Leukocytosis 2. Polycythemia 3. Hyperglycemia 4. Mild hypernatremia 5. Hypokalemia 6. Hypercalciurea
75
Insulin is secreted by ____, and is metabolized by _____
B-islet cells of pancreas Kidneys and liver
76
How does hyperparathyroidism affect neuromuscular blockers?
Hypercalcemia Antagonizes nondepolarizing NMBs | - need to increase dose of Roc
77
Which cell is MOST dependent on insulin for the majority of the cells' glucose uptake?
Cardiac myocyte ``` (Remember insulin's effects on myocytes: Increase glucose uptake Increase amino acid uptake Increase glycogen storage Increase protein synthesis) ```
78
Which cells are dependent on insulin for the majority of glucose uptake?
1. Hepatocytes 2. Immune cells 3. Erythrocytes 4. Brain neurons 5. Cardiac *Cardiac cells are MOST dependent on insulin for the majority of the cells' glucose uptake?
79
Which foods are associated with a latex allergy?
1. Avocados 2. Bananas 3. Chestnuts 4. Kiwi 5. Papayas 6. Potatoes 7. Tomatoes
80
The majority of latex allergies are d/t what type of reaction?
Irritant contact dermatitis *NOT d/t immune mediated hypersensitivity reactions
81
If you suspect a pt is having a latex allergy, what lab should be drawn?
serum mast cell tryptase level w/in 15-60min and again after 24 hr - Increased if +
82
Primary vs secondary disorders
Primary: something affects the production or quantity or quality of the hormone itself Secondary: Something disrupts the hormone axis that is usually able to respond to fluctuating hormone level
83
(Hyperthyroidism / Hypothyroidism) is more commonly associated with pleural effusions
Hypothyroidism
84
Hyperthyroidism is associated with hematologic effects?
Anemia | Thrombocytopenia
85
Insulin and glucagon utilizes the ____ pathway within the _____
cAMP signaling hepatocyte
86
Which cells in the body specifically use the Inositol triphosphate-3 (IP-3) second messenger pathway?
Cardiac myocytes - increase cytoplasmic calcium ions -> activates ryanodine receptor on sarcoplasmic reticulum -> calcium induced calcium release form SR
87
How does cortisol directly influence potassium homeostasis?
- Enhances sodium and potassium exchange | - Enhances renal potassium secretion
88
Etomidate inhibits the synthesis of cortisol transiently and should be avoided in pts with ______
adrenal insufficiency - ie: addison disease aka primary adrenal insufficiency - adrenal glands unable to produce sufficient quantities of glucocorticoid
89
What happens in secondary adrenal insufficiency?
failure in adequate production of CRH or ACTH secondary to hypothalamic/pituitary disease or suppression *Unlike Addison disease, there is only glucocorticoid deficiency with secondary disease

Anesthesia 101 (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions