Endocrine

Question 1

Endocrine pancreas - alpha cells secrete what?

Answer 1

Glucagon

Question 2

Endocrine pancreas - beta cells secrete what?

Answer 2

Insulin

Question 3

Endocrine pancreas - delta cells secrete what?

Answer 3

Somatostatin (decreases GI motility and HCl)

Question 4

Exocrine pancreas secretes what?

Answer 4

digestive enzymes & NaHCO3

Question 5

How much insulin is secreted by beta cells per day?

Answer 5

50 units - if someone is on more insulin than that, know the pancreas is not functioning much if at all

Question 6

Glycogenolysis

Answer 6

Breakdown of glycogen

Question 7

Gluconeogensis

Answer 7

Generation of glucose from non-CHO metabolism (of lactate, pyruvate, etc)

Question 8

Ketogenesis

Answer 8

Formation of ketones by breakdown of fatty acids

Question 9

Lipolysis

Answer 9

Breakdown of lipids into free fatty acids

Question 10

Protein catabolism

Answer 10

breakdown of proteins into amino acids

Question 11

What mediates the activity of insulin receptors

Answer 11

tyrosine kinase- the rate limiting step

Question 12

Anesthesia goal of blood glucose

Answer 12

140-200

Question 13

Hypoglycemia level

Question 14

HgA1C target before surgery

Answer 14

> 6,

Question 15

1st manifestation of nephropathy in diabetic patients

Answer 15

proteinuria/microalbuminuria “prediabetic” - microalbuminuria is earlier sign - start on ACE-I’s now

Question 16

Nephropathic patient with DM has higher risk of what

Answer 16

Ischemic heart disease

Question 17

Autonomic Nervous System Neuropathy & DM

Answer 17

Hypoglycemic unawareness, thermoregulatory problems, increased resting HR, orthostatic, vagal denervation, decreased response to atropine & propanolo, short QT, decreased sensation to angina

Question 18

Sudden death syndrome

Answer 18

Sudden profound decreased HR & BP only responsive to epi - high incidence of cardiorespiratory arrest - high suspicion if preop orthostatic

Question 19

Prayer sign

Answer 19

glycosylation of tissue proteins - likely atlanto-occipital joint involvement

Question 20

Do you hold or not hold noninsulin injectables before surgery

Answer 20

Hold, they are like oral antidiabetics

Question 21

Differentiation of diabetic ketoacidosis

Answer 21

Will have urine/plasma ketones with or without lactic acidosis, increased lipolysis causes more ketone bodies which creates high anion-gap metabolic acidosis

Question 22

DKA treatment

Answer 22

Fluid, insulin to decrease glucose by 10% by hour, correct K+ deficit

Question 23

Hyperosmolar Hyperglycemic Nonketotic differentiation

Answer 23

No ketones, increased glucose causes hyperosmolar diuresis causing dehydration/hyponatremia = renal failure, lactic acidosis & thromboses

Question 24

HHNK treatment

Answer 24

NaCl, K supplement, minimal insulin

Question 25

Counterregulatory failure of diabetes

Answer 25

At about 10 years body is unable to secrete glucagon, epinephrine, cortisol & growth hormone

Question 26

Insulin to take day of surgery?

Answer 26

Usual long-acting, 50% of NPH & continue basal rate

Question 27

Protamine & diabetic patient considerations

Answer 27

If patient on NPH may have anaphylactic shock when given protamine- give 1-5 mg test dose over 5-10 minutes

Question 28

Hyperthyroid diagnosis

Answer 28

Decrease TSH, increased T4 & Total T3/T4

Question 29

Thyroid storm manifestations

Answer 29

Increased temp, HR, decreased BP, K. NO muscle rigidity, increase in CK, or acidosis (that's MH!)

Question 30

Thyroid storm tx

Answer 30

100% oxygen, fluid, esmolol or propanolol, propylthiouracil, hydrocortisone, cooling, correction of cause

Question 31

Is MAC changed with thyroid disease?

Answer 31

NO, hypothyroid with decreased CO may increase speed of inhalation onset

Question 32

Accidental parathyroid removal results in what symptoms?

Answer 32

Tingling fingertips & lips, tetany, seizures, laryngospasm from hypocalcemia

Question 33

Hypothyroid diagnosis

Answer 33

Increased TSH, decreased T3/T4

Question 34

When should myxedema coma NOT go to surgery (even emergent)

Answer 34

T4