Endocrine/Allergy

Question 1

Whats the equivalent of prednisone or hydrocortisone of the normal daily cortisol secreted in non-stressed person?

Answer 1

5 mg/day prednisone

20 mg/day hydrocortisone

Question 2

How much hydrocortisone given for glucocorticoids dependent patients should be given? and for how long preoperative?

Answer 2

major surgery (100-150 mg/day hydrocortisone for 2-3 days)

moderate procedures (75-100mg/day hydrocortisone for 1-2 days)

Question 3

Do you consider hydrocortisone in patients previously glucocorticoide dependant going to surgery?

Answer 3

Yes, the HPA axis may recover quickly or not fully recover for 9-12 months.

Question 4

Miniralcorticoids vs glucocorticoids

Answer 4

Mineralocorticoids are aldosterone which secreted from glomerulosa regulated by renin system

Glucocorticoids are the cortisol secreted from fasciculata and regulates by ACTH

Question 5

Corrected Ca levels formula

Answer 5

Corrected calcium in mg/dL = (measured total calcium) + 0.8 (4.0 g/dL - measured serum albumin in g/dL).

Question 6

SIADH

Answer 6

Hyponatremia due to SIADH is characterized by serum hypotonicity (<275 mOsm/kg H2O), inappropriately high urine osmolality (>100 mOsm/kg H2O), and clinical euvolemia; there is high urine sodiumconcentration (>40 mEq/L) as the kidneys do not aggressively retain salt in the setting of euvolemia.

Question 7

Causes of SIADH

Answer 7

Pneumonia and a number of psychiatric medications (eg, selective serotonin reuptake inhibitors, carbamazepine, valproic acid) are common precipitants of SIADH.

Question 8

Metabolic Syndrome is

Answer 8

At least 3 of the following

• FBG > 110 mg/dL
• Abdominal obesity (waist > 35 inches)
• TG > 150 mg/dL
• HDL < 40 or 50 in female
• BP > 130/85

Question 9

Single IV insulin drops BG by …

Answer 9

25 points.

Question 10

Target blood glucose perioperative

Answer 10

<180

Question 11

Ankylosing spondylitis airway Risk? And neuroaxial ?

Answer 11

Cervical neck stenosis (vs instability in RA)

TMJ issue can limit mouth opening

Reduced ossified and intervertebral space

Question 12

Percentage of cross/reaction between penicillin and cephalosporins is

Answer 12

<2%

Question 13

Why Epi given in anaphylaxis instead of NorEpi?

Answer 13

Because NorEpi has little effect on B2 and so dose not address bronchospasm where Epi is direct B2 agonist

Question 14

2 most congenital disorders might associated with latex allergy?

Answer 14

Spina bifida

Congenital urinary tract disorder

Question 15

Anaphylaxis vs Anaphylactoid

Answer 15

Both rxns result from mast cell release histamine, tryptase, proteiglycans, and others.

Anaphylaxis is IgE mediated.

Question 16

Most common intraop anaphylaxis due to ..

Answer 16

NMBs > latex > Antibiotics

Question 17

Treat the sudden hypertension after pheochromocytoma resection with

Answer 17

Short acting nitroprusside or esmolol.

Never labetalol or hydralazine.

Because the patient will become hypotension very quickly and you need short acting titrable

Question 18

Mgmt of pheochromocytoma

Answer 18

These ptn have high SVR -> so starting alpha blocker to produce vasodilation then adding BB.

If BB given first leads unopposed alpha agonist from catacholamine surge which results MI and low CO

Question 19

Total cortisol made in normal person? And when stressed?

Answer 19

20 per day and up to 300 a day in stressed ptn