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Principles2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what are the 3 types of hormones? (P,A,S)

A

peptides/proteins, amines/AA, steroids

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2
Q

most hormones are what type?

A

peptides/proteins

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3
Q

Tryptophan and tyrosine are what type of hormones?

A

amines/AA

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4
Q

tryptophan converts into what hormone?

A

serotonin

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5
Q

tyrosine converts into what 2 hormone types? (T,C)

A

thyroid hormones, catecholamine hormones

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6
Q

reporductive hormones are what type of hormones?

A

steroids

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7
Q

steroid hormones come form where?

A

adrenal cortex

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8
Q

what 2 hormone types bind to intracellular hormone receptors? (T,S)

A

thyroid and steroid hormones

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9
Q

are hormone receptor number inversely or directly related to the amount of circulating hormone?

A

inversely

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10
Q

what is downregulation?

A

decreased number of receptors d/t an increased number of hormones

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11
Q

what is upregulation?

A

increased number of receptors d/t an decreased number of hormones

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12
Q

what hormones does the anterior pituitary secrete? (P,T,F,L,A,G)

A

prolactin, TSH, FSH, LH, ACTH, GH

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13
Q

what are 5 symptoms of anterior pituitary hyposecretion? (D,VL,FN/P,S)

A

diplopia, visual loss, facial numbness/pain, seizures

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14
Q

Transsphenoidal adenohypophysectomy is a combined approach from what 2 services?

A

ENT, NSG

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15
Q

why is the LLE prepped for Transsphenoidal adenohypophysectomy?

A

for fat harvesting and packing of the sinuses

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16
Q

Avoid what breathing pattern and what drug during maintenance of Transsphenoidal adenohypophysectomy? (H,N)

A

hyperventilation, N2O

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17
Q

Goal of anesthesia for a Transsphenoidal adenohypophysectomy is a smooth, rapid emergence to permit a what assessment? (N)

A

neuro assessment

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18
Q

what are the 2 most common postop complications with Transsphenoidal adenohypophysectomy? (CR,DI)

A

csf rhinorrhea, diabetes insipidus

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19
Q

what 3 hormones are the most common produced in anterior pituitary hypersecretion? (P,A,G)

A

prolactin, ACTH, GH

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20
Q

what are the 3 airway difficulties with acromegaly? (SN, EV, NTE)

A

subglottic narrowing, enlarged VCs, nasal turbinate enlargement

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21
Q

what are the 2 hormones secreted by the posterior pituitary? (A,O)

A

ADH, oxytocin

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22
Q

ADH:

  1. acts on renal collecting ducts to reabsorb what?
  2. does it increase or decrease urine osmolarity and blood volume?
  3. vasodilator or vasoconstrictor?
  4. promotes hemostasis by increasing what 2 factors?
A
  1. H2O
  2. increase
  3. vasoconstrictor
  4. vWF & factor VIII
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23
Q

is DI too much or not enough ADH?

A

not enough

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24
Q

is SIADH too much or not enough ADH?

A

too much

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25
Q

DI:

  1. Polyuria or oliguria?
  2. serum osmolarity > what? (mOsm/L)
  3. urine osmolarity < what? (mOsm/L)
  4. specific gravity < what?
  5. urine output is > how mL/kg/day?
  6. diagnosed when urine osmolarity increases after what is administered? (V)
A
  1. polyuria
  2. 290 mOsm/L
  3. 300 mOsm/L
  4. 1.010
  5. 30 mL/kg/day
  6. vasopressin
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26
Q

DI treatment:

1. what is intraop vasopressin dose range? (units/hr)

A

0.1-0.2 units/hr

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27
Q

for DI, avoid what VA d/t renal dysfunction?

A

sevoflurane

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28
Q

when giving vasopressin, prepare for what and what should be monitored? (LB, EFI)

A

labile blood pressure, ECG for ischemia

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29
Q

SIADH:

  1. serum sodium < what? (mEq/L)
  2. edema where causes HA, lethargy and nausea?
  3. is urine hypotonic or hypertonic?
  4. what drug is an antagonist of vasopressin? (D)
  5. correct serum Na what range per hour? (mEq/hr)
  6. correct serum Na what range per day? (mEq/L/day)
A
  1. 130 mEq/L
  2. cerebrum
  3. hypertonic
  4. demeclocycline
  5. 0.5 mEq/hr
  6. 6 mEq/L/day
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30
Q

why is anti-nausea prophylaxis important in SIADH pts?

A

nausea stimulate ADH release

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31
Q

thyroid cartilage is located at what 2 number tracheal rings?

A

2nd, 4th

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32
Q

Thyroid gland secretes what 3 hormones? (C,T,T)

A

calcitonin, T3, T4

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33
Q

Hypothyroidism:

  1. T3 & T4 levels increased or decreased?
  2. TSH levels increased or decreased?
A
  1. decreased

2. increased

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34
Q

Causes of hypothyroidism

  1. what 2 meds? (A,L)
  2. what autoimmune disease? (HT)
  3. severe deficiency in what mineral? (I)
  4. what congenital condition? (C)
A
  1. amiodarone, lithium
  2. hashimoto’s thyroiditis
  3. iodine
  4. cretinism
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35
Q

hypothyroidism is associated with what 2 effusions? (P,P)

A

percaridal, pleural

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36
Q

hypothyroidism can have tracheal deviation from what? (EG)

A

enlarged glands

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37
Q

hypothyroid pts with what disease may not tolerate the full replacement dose of thyroid hormone?

A

CAD

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38
Q

caution giving what 3 drug types with hypothyroidism pts? (B,O,ID)

A

benzos opioids, induction drugs

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39
Q

what drug may be a better induction drug choice for hypothyroidism?

A

ketamine

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40
Q

should you use direct or indirect BP meds to treat hypotension in hypothyroidism pts?

A

direct

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41
Q

Myxedema coma is a loss of brain function in pts with a long history of what? (H)

A

hypothyroidism

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42
Q

Hyperthyroidism:

  1. what is the one eye sign? (E)
  2. what 3 BP measurements are increased?
  3. what 2 C/V symptoms are seen? (P,D)
  4. is blood volume increased or decreased?
  5. is CO increased or decreased?
  6. myocardial depression d/t what? (PC)
A
  1. exophthalmos
  2. SBP, DBP, pulse pressure
  3. palpitations, dysrhythmias
  4. increased
  5. increased
  6. protein catabolism
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43
Q

for hypothyroidism and hyperthyroidism what 2 things should always be assessed? (A, VQ)

A

airway, vocal quality

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44
Q

Hyperthyroidism:

  1. what 3 drugs should be avoided? (P,K,A)
  2. what type of obstruction can a tumor causes? (BVO)
  3. direct or indirect agents for hypotension?
  4. hypotension can occur from stimulating what artery? (C)
  5. what is the most common dysrhythmia?
A
  1. pancuronium, ketamine, atropine
  2. ball-valve obstruction
  3. direct
  4. carotid
  5. A fib
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45
Q

MH vs thyroid storm:

  1. what 2 electrolytes increase in MH?
  2. what one sign is seen in MH?
A
  1. increased K
  2. increased Ca
  3. muscle rigidity
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46
Q

what 3 complications of a thyroidectomy can cause airway compromise? (RD, T, H)

A

RLN damage, tracheomalacia, hematoma

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47
Q

acute hypoparathyroidism is seen as what sign 24-48 hours postop? (S)

A

stridor

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48
Q

thyroid storm can mimic what 3 conditions? (MH, LA, P)

A

MH, light anesthesia, pheochromocytoma

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49
Q

Normal Ca levels:

  1. serum (range)
  2. ionized (range)
A
  1. 8-10

2. 0.8-1.0

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50
Q

does PTH increase or decrease Ca levels?

51
Q

what ion is inversely related to Ca?

52
Q

PTH controls final conversion of what vitamin?

53
Q

Calcitonin opposes what hormone?

54
Q

does calcitonin increase or decrease Ca?

55
Q

what are 7 S/S of hypoparathyroidism d/t hypocalcemia? (NMI, MC, LMS, PQTI, D, DCC, H)

A

neuromuscular irritability, muscle cramps, laryngeal muscle spasms, prolong QT interval, dysrhythmias, decrease cardiac contractility, hypotension

56
Q

is chvostek’s sign and trousseau for hypercalcemia or hypocalcemia?

A

hypocalcemia

57
Q

is chvostek’s sign and trousseau for hypoparathyroidism or hyperparathyroidism?

A

hypoparathyroidism

58
Q

what range of mg/kg/hr of Ca should be given to pts with symptomatic hypocalcemia?

A

1-2 mg/kg/hr

59
Q

Mg of elemental Ca in 10 mL of 10% solution:

  1. Calcium gluconate
  2. Calcium chloride
A
  1. 93 mg

2. 272 mg

60
Q

What sign is the trousseau: BP cuff or facial twitch?

61
Q

What sign is the chvostek: BP cuff or facial twitch?

A

facial twitch

62
Q

hypocalcemia happens after what surgery?

A

hypoparathyroidectomy

63
Q

Conduction in hyperparathyroidism:

  1. short or long QT?
  2. narrow or wide T wave?
A
  1. short

2. wide

64
Q

what are the 4 “-ones” S/S of hyperparathyroidism? (G, M, B, S)

A
  1. groans (constipation)
  2. moans (psych distress)
  3. bones (bone pain)
  4. stones (renal stones)
65
Q

are pts having a parathyroidectomy at an increased risk of PONV?

66
Q

what do these RLN trauma sound like?

  1. unilateral
  2. bilateral
A
  1. hoarse

2. aphonia

67
Q

adrenal cortex secretes what 3 things? (M,A,G)

A

mineralocorticoids, androgens, glucocorticoids

68
Q

adrenal medulla secretes what? (C)

A

catecholamiens

69
Q

what are the 3 zones of the adrenal cortex? (G,F,R)

A

glomerulosa, fasciculata, reticularis

70
Q

what does the glomerulosa secrete?

A

mineralcorticoids

71
Q

what does the fasciculata secrete?

72
Q

what 2 things does the reticularis secrete?

A

androgenic hormones, glucocorticoids

73
Q

Aldosterone:

  1. reabsorption of what ion?
  2. excretion of what 2 ions?
  3. secreted from what zone of the adrenal cortex?
A
  1. Na
  2. K and H
  3. glomerulosa
74
Q

what are 5 S/S of primary aldosteronism? (H, MW, MA,LR, P)

A

HTN, M weakness, metabolic alkalosis, low renin, polyuria

75
Q

Does primary aldosteronism cause an increase or decrease in K?

76
Q

do pts with primary aldosteronism have an increased or decreased response to muscle relaxants?

77
Q

why do pts with primary aldosteronism have an increased response to muscle relaxants?

A

decreased potassium

78
Q

what is the surgical option for cushing’s syndrome?

A

transsphenoidal adenohypophysectomy

79
Q

pts with cushings have an increased level of what? (G)

A

glucocorticoids

80
Q

pre treated pts with cushing syndrome with steroids minimizes what changes?

81
Q

hyperventilation may worsen what in pts with cushing’s syndrome?

A

hypokalemia

82
Q

NMB may be shortened or prolonged in post op cushing’s syndrome?

83
Q

why are NMB prolonged in post op cushing’s syndrome?

A

decrease potassium

84
Q

treatment of adrenocortical insufficiency with how many mg/day of prednisone?

A

7.5 mg/day

85
Q

Acute adrenal insufficiency:

  1. avoid what induction med?
  2. increase or decrease response to catecholamines?
  3. increase or decrease BP after induction?
  4. increase risk of what type of arrest? (H)
A
  1. etomidate
  2. decrease
  3. decrease
  4. hyperkalemia
86
Q

what are 4 postop risk of acute adrenal insufficiency related to steroid use? (U, I, LBP, H)

A

ulcers, infection, labile BP, hyperglycemia

87
Q

pancreatitis is a postop risk for acute adrenal insufficiency d/t increased what? (D)

88
Q

what is pheochromocytoma?

A

a tumor in the adrenal gland chromaffin tissue secreting catecholamine

89
Q

what 2 catecholamines does a pheochromocytoma secrete?

A

epinephrine, NE

90
Q

what is the triad of S/S of pheochromocytoma? (P,H,D)

A

palpitations, HA, diaphoresis

91
Q

what are the 2 cardinal preop steps before pheochromocytoma surgery? (VE, ABFBBB)

A
  1. volume expansion

2. alpha block followed by a beta block

92
Q

what 2 C/V things are assessed before pheochromocytoma?

A
  1. dilated CM

2. CHF

93
Q

pheochromocytoma surgery intraop:

  1. what position?
  2. do you use cell saver?
  3. avoid what 2 types of meds and one med? (V,S,S)
  4. avoid drugs that release what?
A
  1. lateral
  2. no
  3. vagolytics, sympathomimetics, succs
  4. histamine
94
Q

pheochromocytoma BP has to be less than what for 48 hours:

  1. SBP
  2. DBP
95
Q

catecholamines are increased for how many days post pheochromocytoma surgery?

96
Q

cautious replacing fluids for pheochromocytoma surgery d/t what risk? (C)

97
Q

diabetes mellitus:

  1. check for what sign?
  2. why use aspiration prophylaxis? (G)
  3. use direct or indirect agents?
  4. may see increase sensitivity to what med? (P)
A
  1. prayers sign
  2. gastroparesis
  3. direct
  4. protamine
98
Q

1 unit of insulin lowers glucose what range of mg/dL?

99
Q

what are 4 postop complications for diabetes mellitus pts? (BO, WI, D, PVF)

A
  1. bowel obstruction
  2. wound infection
  3. dehiscence
  4. prosthetic valve failure
100
Q

positive pray sign indicates what?

A

decreased neck mobility

101
Q

Carcinoid syndrome causes tumors to arise in what 4 areas? (L, B, SB, O)

A

lungs, bronchi, small bowel, ovaries

102
Q

Carcinoid syndrome tumors secrete what substances? (V)

A

vasoactive

103
Q

what med is give for 24 hours preop for someone with Carcinoid syndrome?

A

octreotide

104
Q

Carcinoid syndrome intraop:

  1. avoid meds that cause what to be released? (H)
  2. avoid what one med and what type of med? (S, AA)
A
  1. histamine

2. succs, adrenergic agonists

105
Q

Carcinoid syndrome postop:

  1. No what type of med? (S)
  2. what med for hypotension?
A
  1. sympathomimetics

2. octreotide

106
Q

treatment of adrenocortical insufficiency with how many mg/day of hydrocortisone?

107
Q

because adrenal insufficiency is supplemented with steroids and causes hyperglycemia, what organ can have inflammation because of increased demand?

108
Q

Cushings: hyper or hypokalemia?

A

hypokalemia

109
Q

hemodynamic criteria for pheochromocytoma resection is a SBP and DBP less than what for how many hours?

A

<165/90 for 48 hours

110
Q

nausea stimulates what hormone to be released?

111
Q

what syndrome has the manifestations of pericardial and pleural effusions?

A

hypothyroidism

112
Q

what is the one s/s of acute hypoparathyroidism? (S)

113
Q

what groans, moans, bones, and stones are s/s for what syndrome?

A

hyperparathyroidism

114
Q

what 2 surgeries can cause damage to the RLN?

A

thyroidectomy, parathyroidectomy

115
Q

what 2 syndromes have increased effects of NMBs d/t hypokalemia?

A
  1. primary aldosteronism

2. cushing’s disease

116
Q

avoid etomidate in what syndrome?

A

adrenal insufficiency

117
Q

avoid succs for what 2 syndromes?

A

pheochromocytoma, carcinoid

118
Q

DM:

  1. we want preop glucose between what? (mg/dL)
  2. we want glycosylated hgb less than what %?
A
  1. 120-180 mg/dL

2. <7.5%

119
Q

pretreat carcinoid syndrome with octreotide for how many hours?

120
Q

give ketamine for hyperthyroidism?

121
Q

give ketamine for hypothyroidism?

122
Q

what is the cushing’s surgery?

A

transsphenoidal adenohypophysectomy

123
Q

avoid sevo for what syndrome?

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