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Anesthesia MM/TL > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What happens in response to surgical stress?

A

The hypothalamus activates the SNS and HPA AXIS

SNS releases norepinephrine from adrenal medulla

Glucagon secretion from alpha cells in pancreas

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2
Q

What hormone decreases in response to stress?

A

T3 because TSH is decreased and cortisol is a suppressant of these hormones

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3
Q

What is the rarest complication of pituitary adenomas?

A

Diabetes insipidus

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4
Q

Which part of the pituitary is more affected in an adenomas?

A

Anterior - so ADH, and oxytocin are not affected

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5
Q

Why do patients with pituitary adenomas get galactorrhea?

A

Prolactin is normally inhibited by the hypothalamus so interruption of hypothalamic control leads to secretion

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6
Q

What hormones are affected in pituitary adenomas?

A 
ACTH
GH
TSH
FSH
LH
prolactin
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7
Q

What will a patient have with over secretion of ACTH?

A

Cushing’s

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8
Q

What is seen in carcinoid syndrome?

A

Right-sided heart disease
Wheezing (histamine)
Flushing
Diarrhea

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9
Q

What causes right sided heart disease in carcinoid?

A

Serotonin

It is broken down in the lungs so only causes right sided heart failure

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10
Q

What is the treatment of carcinoid?

A

Octreotide

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11
Q

What do carcinoid tumors secrete?

A

Histamine
Serotonergic
Kallikrein
Bradykinin

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12
Q

What are the lab findings of hyperparathyroidism

A

High PTH
Hypercalcemia
Low phosphate
Normal calcium in urine

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13
Q

What does PTH do?

A

Decreases renal absorption of phosphate
Decreases renal bicarbonate reclamation
Increases alpha-1 hydroxylase in the kidney

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14
Q

What medications cause hypercalcemia?

A

Thiazides diuretics
Lithium
Theophylline
Vitamin A

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15
Q

What conditions can cause hypercalcemia?

A 
Hyperthyroidism
Acromegaly
Pheochromocytoma
Addison's disease
Immobilization
Par enteral nutrition
Hyperparathyroidism 
PTHRp (paraneoplastic)
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16
Q

What are the causes of secondary hyperparathyroidism?

A 
Decreased intake
Calcium malabsorption (vit D deficiency, celiac, bariatric surgery)
Loop diuretics
Idiopathic hypercalciuria 
Renal failure
His phosphorites
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17
Q

What is the most potent alpha 2 blocker?

A

Phentolamine

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18
Q

What is Conn syndrome?

A

Primary hyperaldosteronism

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19
Q

How does aldosterone work?

A

Up regulates Na/K pumps on the renal distal tubules and collecting ducts

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20
Q

What is the treatment of Conn’s?

A

Spironolactone

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21
Q

What is midodrine?

A

An alpha 1 agonist

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22
Q

How can malignant hyperthermia be distinguished from thyroid storm?

A 
By presence of muscle rigidity
Rate of rise of ETCO2 is greater
Temperature is greater
Hyper tension is less
Hyperkalemia
Elevated CK
Lactic acidosis 
Myoglobinemia/uria
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23
Q

What is the treatment for thyroid storm?

A

Sodium iodide

Propylthiouracil

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24
Q

How does PTH work?

A

It stimulate osteoclast activity, thereby releasing calcium into the bloodstream from binds
Activates vit D via alpha 1 hydroxylase in the kidneys to improve absorption of calcium

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25
Q

What are the symptoms of hypocalcemia?

A 
Tetany
Seizures
Hypotension
Heart failure
QT prolongation
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26
Q

What does glucagon inhibit?

A

Glycolysis

27
Q

What does glucagon stimulate?

A

Gluconeogenesis
Glycogenolysis
Lipolysis

28
Q

What does glucagon do to gastric motility?

A

Decreases it

29
Q

What does glucagon do to smooth muscle?

A

Relaxes it - decreases LES, biliary sphincter
Vasodilation hepatic and splanchnics
Antagonizes catecholamines

30
Q

What is acromegaly?

A

Increased GH production which causes hepatic production on insulin-like growth factor which leads to increased protein synthesis, fatty acid production, glucose intolerance
Bone thickening
CHF
HTN
Hypertrophic heart with diastolic dysfunction
Recurrent laryngeal nerve due to stretching
Carpal tunnel
Peripheral neuropathies

31
Q

What are the airway problems associated with acromegaly?

A

Prognathism
Subglottic stenosis
Soft tissue hypertrophy: tongue, lips, epiglottis, cords

32
Q

What is the medical treatment of acromegaly?

A

Dopamine agonists : bromocriptine, cabergoline

33
Q

What ph abnormality can hyperparathyroidism cause?

A

Bicarbonate loss so high chloride and acidosis with normal AG

34
Q

What are the hormone levels in sick euthyroid?

A

Decreased T3

Normal TSH

35
Q

What are the levels of thyroid hormone in early critical illness?

A

Decreased T3/T4

Normal TSH

36
Q

What cell are insulin independent?

A

Hepatocytes
Erythrocytes
Brain neurons
WBC

37
Q

How does the insulin receptor work?

A

Tyrosine kinase which phosphorylation a lot of downstream proteins

38
Q

What does GH do?

A

Stimulate the release of insulin-like growth factor
Causes lipolysis
Bone formation
Protein synthesis
Glucose uptake
Sensitize tissues to lipolytic effect of catecholamines

39
Q

When does acute hypocalcemia present after surgery?

A

24-48 hours with stridor

40
Q

What acute phase reactant decreases PTH?

A

Endothelin-1

41
Q

What are the signs of hypocalcemia?

A 
Tingling of lips and fingertips
Muscle spasms
Laryngospasm 
Seizures 
QT prolongation --> heart block
Cardiac arrest
42
Q

When would you see respiratory distress due to laryngeal edema

A

Immediately post op

43
Q

What are the most common symptoms of hyperosmolar hyperglycemia?

A

Stupor
Coma
Seizures

44
Q

What are the lab values in HHS?

A

Serum osmolality over 320
Ph > 7.3
Bicarbonate > 18

45
Q

How does myxedema coma present?

A

Hypothermia
Non-pitting edema
AMS

46
Q

How much cortisone does an adult secrete per day?

A

20 mg

47
Q

How much aldosterone does an adult secrete in a day?

A

0.1 mg

48
Q

What are the symptoms of Addison’s?

A 
Nausea
Fatigue
Weakness
Anorexia
Pigmentation 
Hyponatremia
Hyperkalemia
49
Q

What is the first step in the treatment of DKA?

A

IV hydration to prevent worsening electrolyte abnormalities

50
Q

What are the lab values of primary hyperthyroidism?

A

High thyroid hormone binding ratio ( because more free T is floating around and not biund to TBG)
Elevate T3, T4
Low or normal TSH

51
Q

What are signs of autonomic neuropathy?

A 
Diminished sweating
Dysthymias
 Lack of heart rate variability
Gastroparesis
Impaired ventilatory responses
52
Q

What is the earliest sign of autonomic neuropathy?

A

Resting tachycardia with no variability during deep breaths

53
Q

What is the second messenger for insulin and glucagon?

A

CAMP

54
Q

When can effects of hypoparathyroidism and hypocalcemia be seen after thyroidectomy?

A

24-96 hours

55
Q

What are the anesthetic considerations for RA?

A
  1. TMJ movement, narrow glottis opening from arthritic damage to cricoarytenoid joints
  2. Pericarditis, tamponade
  3. Pulm fibrosis
  4. Aa subluxation
  5. Gastric ulcers 2/2 NSAIDs
  6. RENAL 2/2 NSAIDS
56
Q

What contributes to hypercarbia in COPD patients?

A

The haldane effect

Impairment if hypoxic pulmonary vasoconstriction leading to V/Q mismatch

57
Q

When is PVR lowest in normal individuals?

A

Around FRC when breathing at normal lung volumes

58
Q

Why does PVR increase with decreased lung volumes?

A

With collapsed alveoli the vessels can become kinked

Volume of blood in the larger vessels decreases

59
Q

What will be seen on CXR in a bronchopleural fistula after a chest tube has been removed

A

Air-fluid level

60
Q

What is seen in the chest tube with bronchopleural fistula?

A

Constant air leak

61
Q

When ventilating a patient with a bronchopleural fistula, what should you make sure of?

A

That the chest tube is to water seal

62
Q

What is the most common anesthetic problem with anterior mediastinal mass?

A

Compression of the tracheobronchial tree

63
Q

What should you have available when getting ready to induce a patient with an anterior mediastinal mass?

A 
CPB
Rigid bronchoscope
Thoracic surgeon
Femoral artery cannula 
Avoid muscle paralysis 
Awake FO
64
Q

How do you place a double lumen tube?

A

Mac blade

Once the tip is past the cords, rotate 90 degrees to the side (left side if it is a left sided tube and vice versa)

Anesthesia MM/TL (36 decks)

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