Endocrine 5

Question 1

Signs of Cushing’s syndrome include: (select 4)
a. hypertension
b. hypotension
c. hyperkalemia
d. hypokalemia
e. metabolic alkalosis
f. metabolic acidosis
g. hyperglycemia
h. hypoglycemia

Answer 1

a. hypertension
d. hypokalemia
e. metabolic alkalosis
g. hyperglycemia

Question 2

Cushing’s syndrome is caused by

Answer 2

cortisol excess either from overproduction or exogenous administration

Question 3

Cushing’s disease is the result of excess

Answer 3

ACTH

Question 4

What properties does cortisol have?

Answer 4

glucocorticoid
mineralocorticoid
androgenic effects

Question 5

Glucorticoid effects of Cushing’s syndrome include

Answer 5

hyperglycemia
weight gain
osteoporosis
increase in infection

Question 6

Mineralocorticoid effects of Cushing’s syndrome include

Answer 6

HTN
hypokalemia
metabolic alkalosis

Question 7

Androgenic effects of Cushing’s syndrome include

Answer 7

hirsutism
hair thinning
acne
gynecomastia
impotence

Question 8

Anesthetic implications for Cushing’s disease include

Answer 8

post-op steroid supplementation
aseptic technique
careful positioning to reduce skin and bone injury
DI may follow resection
considerations for hyperaldosteronism

Question 9

Treatment options for Cushing’s disease include

Answer 9

transsphenioidal resection of the pituitary gland
pituitary radiation
adrenalectomy

Question 10

A patient with adrenal insufficiency and sepsis requires an emergency intubation in the intensive care unit. Which drug should be avoided?
a. etomidate
b. propofol
c. ketamine
d. thiopental

Answer 10

a. etomidate

Question 11

Adrenal insufficiency is characterized by the

Answer 11

destruction of all cortical zones

Question 12

Adrenal insufficiency manifests as

Answer 12

decreased production of mineralocorticoids, glucocorticoids, and androgens

Question 13

By inhibiting _____________ etomidate causes dose-dependent adrenocortical suppresion

Answer 13

11-beta-hydroxylase

Question 14

Adrenal insufficiency is a _______ state but it can deteriorate into ________________ when the patient faces _________

Answer 14

chronic; acute adrenal crisis; stress

Question 15

Stress that can lead to acute adrenal crisis includes

Answer 15

infection
illness
sepsis
surgery

Question 16

______________ suppresses ACTH release from the anterior pituitary gland

Answer 16

Exogenous steroid supplementation

Question 17

Patients on chronic steroid therapy may require

Answer 17

“stress” dose steroids to help combat perioperative stress

Question 18

________ also inhibits cortisol synthesis

Answer 18

Ketoconazole

Question 19

Superficial surgery (dental, biopsy) steroid dosing

Answer 19

none

Question 20

Minor surgery (colonoscopy, inguinal hernia repair) hydrocortisone dosing

Answer 20

25 mg IV

Question 21

Moderate surgery (colon resection, total joint replacement, total abdominal hysterectomy) hydrocortisone dosing

Answer 21

50-75 mg IV taper over 1-2 days

Question 22

Major surgery (CV, thoracic, liver, Whipple) hydrocortisone dosing includes

Answer 22

100-150 mg IV taper over 1-2 days

Question 23

When should patients receive stress dosing?

Answer 23

> 5-20 mg/day for >3 weeks

Question 24

Causes of primary adrenal insufficiency (Addison’s) include

Answer 24

destruction of both adrenal glands (autoimmune)
HIV
TB

Question 25

Causes of secondary adrenal insufficiency include

Answer 25

exogenous steroid administration, HPA disease due to tumor, infection, surgery, and radiation

Question 26

Clinical features of adrenal insufficiency include

Answer 26

muscle weakness/fatigue hypotension hypoglycemia hyponatremia hyperkalemia metabolic acidosis N/V hyperpigmentation

Question 27

Clinical features of acute adrenal crisis includes

Answer 27

hemodynamic instability/collapse fever hypoglycemia impaired mental status

Question 28

Treatment of adrenal insufficiency includes

Answer 28

steroid replacement therapy (15-30 mg cortisol equivalent/day)

Question 29

Treatment of acute adrenal crisis includes

Answer 29

hemodynamic support ECF volume expansion (D5NS is the best choice) steroid replacement therapy (hydrocortisone 100 mg + 100-200 mg q24h)

Question 30

What are the two broad types of hormones secreted by the pancreas?

Answer 30

exocrine hormones endocrine hormones

Question 31

_______________ are secreted into the duodenum for digestion

Answer 31

Exocrine

Question 32

_______________ are secreted into the systemic circulation for metabolism

Answer 32

Endocrine hormones

Question 33

Glucagon is secreted from

Answer 33

alpha cells

Question 34

Glucagon __________ blood glucose

Answer 34

increases

Question 35

Insulin is secreted from

Answer 35

beta cells

Question 36

Insulin __________ blood glucose

Answer 36

decreases

Question 37

Somatostatin is secreted from

Answer 37

delta cells

Question 38

Somatostatin works by

Answer 38

inhibiting insulin and glucagon splanchnic blood flow, gastric motility, and gallbladder contraction

Question 39

Pancreatic polypeptide is secreted from

Answer 39

PP cells

Question 40

Pancreatic polypeptide inhbits

Answer 40

pancreatic exocrine secretion gallbladder contraction gastric acid secretion gastric motility

Question 41

____________ is the primary stimulator of insulin release from the pancreatic beta cells

Answer 41

Glucose

Question 42

Cerebral function generally declines when serum glucose falls below

Answer 42

50 mg/dL

Question 43

Glucagon (1-5 mg IV) increases

Answer 43

myocardial contractility, heart rate, and AV conduction by increasing the intracellular concentration of cAMP

Question 44

Glucagon may be used for

Answer 44

beta-blocker overdose CHF low CO after MI or CPB improving MAP during anaphylaxis during ERCP to relax the biliary sphincter

Question 45

Things that stimulate glucagon release include

Answer 45

hypoglycemia stress trauma sepsis beta agonsits

Question 46

Things that reduce glucagon release include

Answer 46

insulin somatostatin

Question 47

Things that stimulate insulin release

Answer 47

PNS stimulation SNS stimulation hormones: glucagon, catecholamines, cortisol, GH beta agonists

Question 48

Things that reduce insulin release

Answer 48

hormones- insulin drugs volatile anesthetics, beta antagonists