Endo

Question 1

Cardiac syndrome x

Answer 1

Angina w clear coronaries thought to be to distal microvascular disease in the coronaries

Question 2

One unit of insulin

Answer 2

Drops sugar 25 mg/dl

Want to keep blood sugar less then 180 in periop period

Question 3

Nph and glargine

Answer 3

Take a 1-4 hrs to take affect last 18-24 hrs without spikes

Question 4

Hhs hyper osmolar non ketotic acidosis

Answer 4

Due to lactic acid from hypoperfusion and insability of insulin to deliver glucose but still enough to prevent ketone formation

Question 5

Type one doabetic emergency

Answer 5

Dec glucose into cells leads to beta hydroxy butirate release which releases aceoatic acid leading to metabolic acidosis

This leads to hyperosmolar state because of the acid and glucose causing increased diruesis

Thats causes decrease of all electrolytes because of the increased water in the samlple

Also causes extreme glucose from anywhere 250-1000

Question 6

Bicarb in dka

Answer 6

Give if ph is less then 7.0

Question 7

Insulin

Answer 7

Acts via pkb cia pip to pip3

Not camp, because b blockers work via beta receptors which work via camp and decrease insulin release

Question 8

Hyperthyroidism

Answer 8

Ptu takes days to take affect
For surgery use a beta blocker. Decrease sympathetic as well as conversionof t4-t3

Chronic use of amiodidone can lead to hypothyroidism because of the iodine

Avoid sympatheto mimetics

Methimazole or ptu are used to control thyroid hormone production.

Question 9

After thyroid surgery

Answer 9

following thryoid surgery one should worry about reccurent layrngeal injury. Recurent laryngeal nerve innervates all muscles except cricothryoid which is innervated by superior laryngeal nerve external branch.

If parathyroid is removed hypoparathryoidism occurs 6-12 hrs later

Question 10

Hypothyroidism

Answer 10

Myxedema coma has decrease in contractility sv and hr. All lower cardiac output

Pleural effusion are common as well as pericardial effusion lead to restrictive lung disease

Patients retain water leading edema and hyponatrenia

Question 11

Cushing disease

Answer 11

Cushing disease is tumor of the pituitary gland increasing release of acth

Classic manifestation is hyperglycemia from insulin resistance, htn 2/2 hypervolemia osteoporosis, and hypokalemic alkalosis. And associated arthymias

Too much cortisol
Addisons is too little cortisol
Conn is too much alderstone

Question 12

Pheochromocytoma

Answer 12

Patients need to have alpha blocker phenoxzynbenazime started weeks before then fluids and beta blocker

Safe drugs in pheo: propofol
Cant give ketamine or ephedrine because they will directly stimulate the sympathetics
Cant give pancuronium becuase it is vagolyitic and causes histamine release which can precipitate a pheo crisis
Cant give succyncholine because convulsions dan leas to increased release of catecholamines

Question 13

During pheo surgery increased catechol release when manipulated

Answer 13

Treated with short acting drugs like nitroprusside or nicardipine

Question 14

Diseases woth pheo

Answer 14

Vhl nf-1 and men2a

Question 15

Carcinoid syndrome

Answer 15

Release of vasoactive substances serotonin kallikrein and histamine can lead to profound hyoptension and bronchospam

Chronic affects of carcinoid include fibrotic patches on right heart endocardium as well as profound tricuspid regurg

Management revolves around decreasing sympathetic stimulation with regional. And avoid hypotension so aggressive fluid resustication. Avoid drugs that cause histamine releas like morphine and meperidine

Question 16

Anaphylactoid vs anaphylaxis

Answer 16

Both result in mast cell releas of histamine tryptase and proteoglycans and inflamatory mediators except ige. Both are found in increased rates in atopic indivjduals.

Because serum trypase is released from mast cells both reactions have elevated levels

Question 17

Latex allergies

Answer 17

Most common fornpeople exposed to latex gloves in the past

And food: bannanas avacados passion fruit mango kiwi

Question 18

Ankolosying spondolitis

Answer 18

Is an inflammatory disease that makes spinal epidural harder. Usually cervical stenosis causes increases dofficulty of intubation

Question 19

Rhemotoid arthritis

Answer 19

Joints hurt in morning. Get better throughout day

There is a 25% chance of atlanto axial instability. Cervical spine films are recommended.

Involvement of cricoarytneoid joints cause difficult intubation

Restrictive lung disease is more common then obstructive. This happens because of fibrosis and pleural effusion.

Pericarditis endocarditis and valvulitis with lvh and diastolic dysfunction is more common mot dilated. Mi and conduction problems are also associated

Basically anything inflammatory.