Endocrine

Question 1

What happens in response to surgical stress?

Answer 1

The hypothalamus activates the SNS and HPA AXIS

SNS releases norepinephrine from adrenal medulla

Glucagon secretion from alpha cells in pancreas

Question 2

What hormone decreases in response to stress?

Answer 2

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

Question 3

What is the rarest complication of pituitary adenomas?

Answer 3

Diabetes insipidus

Question 4

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

Answer 4

Anterior - so ADH, and oxytocin are not affected

Question 5

Why do patients with pituitary adenomas get galactorrhea?

Answer 5

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

Question 6

What hormones are affected in pituitary adenomas?

Answer 6

ACTH
GH
TSH
FSH
LH
prolactin

Question 7

What will a patient have with over secretion of ACTH?

Answer 7

Cushing’s

Question 8

What is seen in carcinoid syndrome?

Answer 8

Right-sided heart disease
Wheezing (histamine)
Flushing
Diarrhea

Question 9

What causes right sided heart disease in carcinoid?

Answer 9

Serotonin

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

Question 10

What is the treatment of carcinoid?

Answer 10

Octreotide

Question 11

What do carcinoid tumors secrete?

Answer 11

Histamine
Serotonergic
Kallikrein
Bradykinin

Question 12

What are the lab findings of hyperparathyroidism

Answer 12

High PTH
Hypercalcemia
Low phosphate
Normal calcium in urine

Question 13

What does PTH do?

Answer 13

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

Question 14

What medications cause hypercalcemia?

Answer 14

Thiazides diuretics
Lithium
Theophylline
Vitamin A

Question 15

What conditions can cause hypercalcemia?

Answer 15

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

Question 16

What are the causes of secondary hyperparathyroidism?

Answer 16

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

Question 17

What is the most potent alpha 2 blocker?

Answer 17

Phentolamine

Question 18

What is Conn syndrome?

Answer 18

Primary hyperaldosteronism

Question 19

How does aldosterone work?

Answer 19

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

Question 20

What is the treatment of Conn’s?

Answer 20

Spironolactone

Question 21

What is midodrine?

Answer 21

An alpha 1 agonist

Question 22

How can malignant hyperthermia be distinguished from thyroid storm?

Answer 22

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

Question 23

What is the treatment for thyroid storm?

Answer 23

Sodium iodide

Propylthiouracil

Question 24

How does PTH work?

Answer 24

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

Question 25

What are the symptoms of hypocalcemia?

Answer 25

``` Tetany Seizures Hypotension Heart failure QT prolongation ```

Question 26

What does glucagon inhibit?

Answer 26

Glycolysis

Question 27

What does glucagon stimulate?

Answer 27

Gluconeogenesis Glycogenolysis Lipolysis

Question 28

What does glucagon do to gastric motility?

Answer 28

Decreases it

Question 29

What does glucagon do to smooth muscle?

Answer 29

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

Question 30

What is acromegaly?

Answer 30

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

Question 31

What are the airway problems associated with acromegaly?

Answer 31

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

Question 32

What is the medical treatment of acromegaly?

Answer 32

Dopamine agonists : bromocriptine, cabergoline

Question 33

What ph abnormality can hyperparathyroidism cause?

Answer 33

Bicarbonate loss so high chloride and acidosis with normal AG

Question 34

What are the hormone levels in sick euthyroid?

Answer 34

Decreased T3 | Normal TSH

Question 35

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

Answer 35

Decreased T3/T4 | Normal TSH

Question 36

What cell are insulin independent?

Answer 36

Hepatocytes Erythrocytes Brain neurons WBC

Question 37

How does the insulin receptor work?

Answer 37

Tyrosine kinase which phosphorylation a lot of downstream proteins

Question 38

What does GH do?

Answer 38

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

Question 39

When does acute hypocalcemia present after surgery?

Answer 39

24-48 hours with stridor

Question 40

What acute phase reactant decreases PTH?

Answer 40

Endothelin-1

Question 41

What are the signs of hypocalcemia?

Answer 41

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

Question 42

When would you see respiratory distress due to laryngeal edema

Answer 42

Immediately post op

Question 43

What are the most common symptoms of hyperosmolar hyperglycemia?

Answer 43

Stupor Coma Seizures

Question 44

What are the lab values in HHS?

Answer 44

Serum osmolality over 320 Ph > 7.3 Bicarbonate > 18

Question 45

How does myxedema coma present?

Answer 45

Hypothermia Non-pitting edema AMS

Question 46

How much cortisone does an adult secrete per day?

Answer 46

20 mg

Question 47

How much aldosterone does an adult secrete in a day?

Answer 47

0.1 mg

Question 48

What are the symptoms of Addison's?

Answer 48

``` Nausea Fatigue Weakness Anorexia Pigmentation Hyponatremia Hyperkalemia ```

Question 49

What is the first step in the treatment of DKA?

Answer 49

IV hydration to prevent worsening electrolyte abnormalities

Question 50

What are the lab values of primary hyperthyroidism?

Answer 50

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

Question 51

What are signs of autonomic neuropathy?

Answer 51

``` Diminished sweating Dysthymias Lack of heart rate variability Gastroparesis Impaired ventilatory responses ```

Question 52

What is the earliest sign of autonomic neuropathy?

Answer 52

Resting tachycardia with no variability during deep breaths

Question 53

What is the second messenger for insulin and glucagon?

Answer 53

CAMP

Question 54

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

Answer 54

24-96 hours

Question 55

What are the anesthetic considerations for RA?

Answer 55

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

Question 56

What contributes to hypercarbia in COPD patients?

Answer 56

The haldane effect | Impairment if hypoxic pulmonary vasoconstriction leading to V/Q mismatch

Question 57

When is PVR lowest in normal individuals?

Answer 57

Around FRC when breathing at normal lung volumes

Question 58

Why does PVR increase with decreased lung volumes?

Answer 58

With collapsed alveoli the vessels can become kinked | Volume of blood in the larger vessels decreases

Question 59

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

Answer 59

Air-fluid level

Question 60

What is seen in the chest tube with bronchopleural fistula?

Answer 60

Constant air leak

Question 61

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

Answer 61

That the chest tube is to water seal

Question 62

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

Answer 62

Compression of the tracheobronchial tree

Question 63

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

Answer 63

``` CPB Rigid bronchoscope Thoracic surgeon Femoral artery cannula Avoid muscle paralysis Awake FO ```

Question 64

How do you place a double lumen tube?

Answer 64

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)