Endocrine

Question 1

Causes and outcomes of stress induced hyperglycemia

Answer 1

Cause: compex interplay of regulatroy hormones including catecholamines, cytokines; growth hormone; glucagon; cortsiol leads to increased mobilisation of glucose from the liver and insulin resistance Also role of TPN; steroids; enterla feeds; inotropes/vasopressors Has been assocaited with increased mortialty; increased adverse events and increased orgain failure

Question 2

Causes of Adrenal insufficiency

Answer 2

Classify as primary (adrenal), secondary (affecting pituitary), tertiary (hypothalamus Primary: adrenal destruction due to infection, hemmorhage, trauma, tumour, autoimmune, sarcoid, Secondary: CNS tumour; infarction; infection; trauma; Tertiary: most common; due to HPA axis surpression from abrupt cessation of steroid therapy; CNS causes as above Also get a functional adrenal insfucciency of cirtical illness, mechanism poorly understood

Question 3

Causes of hyperglycemia in ICU

Answer 3

Known Diabetes and associated DKA, HHS
Secondary causes: pancreatitis; Cushing syndrome; hemachromatosis;
insulin resisitance: sepsis; SIRS; stress response;
Carbohydrate load (enteral feeding, TPN)
Beta agonists (endogenous and exogenous)
Steroid therapy

Question 4

Complication of HHS (hyperglycemic hyperosmolar state)

Answer 4

Coma cerebral oedema seizures electrolyte imbalances arrymthmias infection VTE MI

Question 5

Complications of DKA

Answer 5

cerebral oedema hypernatremia arrythmias infection DVT hyperchloremic acidosis

Question 6

Definition of Stress induced hyperglyemia

Answer 6

transient hyperglyemia occuring during acute illness, returning to normal on/prior to discahrge

Question 7

Predictor of outcomes in TBI

Answer 7

Age>55 initial GCS hypotension, hypoxia pupillary abnormalities nature of injury (best: SAH; extradural; subdural worst) Midline shift; effacement of cisterns on CT B Co-morbidities (SSEP; NSE: are experimental)

Question 8

Treatment of phaechromocytoma

Answer 8

ICU - resuscitate and invasive monitoring SNP/ GTN for hypertensive crisis Alpha blockade and then beta blockade Magnesium IV - effective Treat hypotension with fluids, adrenaline, /noradrenaline Prepate for surgery