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Health Assessment Spring 2025 (Mine) > Endocrine (exam 4) > Flashcards

Endocrine (exam 4) Flashcards

1
Q

What is required for a normal glucose level?

A

A balance between glucose usage, endogenous production, and dietary intake.

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2
Q

What is the primary source of glucose production in the body?

A

The liver via glycogenolysis and gluconeogenesis.

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3
Q

What percentage of glucose released by the liver is metabolized by tissues?

A

75%.

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4
Q

What occurs 2-4 hours after eating in terms of glucose levels?

A

Endogenous production occurs to maintain normal plasma glucose level.

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5
Q

Which hormones help regulate blood glucose levels?

A
  • Glucagon
  • Epinephrine
  • Growth hormone
  • Cortisol
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6
Q

What is diabetes mellitus?

A

The most common endocrine disease affecting 1 in 10 adults, resulting from inadequate insulin supply and/or insulin resistance.

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7
Q

What are the main types of diabetes mellitus?

A
  • Type 1a DM
  • Type 1b DM
  • Type 2 DM
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8
Q

What causes Type 1a diabetes mellitus?

A

Autoimmune destruction of pancreatic β cells leading to minimal or absent insulin production.

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9
Q

What is a characteristic of Type 2 diabetes mellitus?

A

Defects in insulin receptors and signaling pathways.

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10
Q

What percentage of all diabetes cases does Type 1 diabetes account for?

A

5-10%.

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11
Q

What are the common symptoms of hyperglycemia (7)?

A
  • Fatigue
  • Weight loss
  • Polyuria
  • Polydipsia
  • Blurry vision
  • Hypovolemia
  • Ketoacidosis
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12
Q

What are the three main abnormalities seen in Type 2 diabetes?

A
  • Impaired insulin secretion
  • Increased hepatic glucose release (c/b reduction in insulins inhibitory effect on liver)
  • Insufficient glucose uptake in peripheral tissues
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13
Q

What is the preferred initial treatment for Type 2 diabetes?

A

Metformin.

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14
Q

What are the side effects of sulfonylureas?

A
  • Hypoglycemia
  • Weight gain
  • Cardiac effects
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15
Q

What is the most dangerous complication of long-acting insulin (Glargine)?

A

Hypoglycemia.

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16
Q

What is diabetic ketoacidosis (DKA)?

A

A complication of decompensated diabetes, more common in DM1, often triggered by infection/illness.

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17
Q

What is the treatment for diabetic ketoacidosis?

A
  • IV volume replacement
  • Regular insulin: loading dose 0.1u/kg + infusion 0.1u/kg/hr
  • Correct acidosis
  • Electrolyte supplementation
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18
Q

What characterizes Hyperglycemic Hyperosmolar Syndrome (HHS)?

A

Severe hyperglycemia, hyperosmolarity, and dehydration.

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19
Q

What are common microvascular complications of diabetes?

A

*Nonocclusive microcirculatory disease w/impaired blood flow
* Nephropathy
* Retinopathy
* Peripheral neuropathy
*Autonomic neuropathy: dysrhythmias, ortho-HoTN, gastroparesis

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20
Q

What is the most common cause of end-stage renal disease (ESRD) in diabetes?

A

Nephropathy.

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21
Q

What triggers myxedema coma?

A

Infection, trauma, cold, and CNS depressants.

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22
Q

What is the cardinal feature of myxedema coma?

A

Hypothermia.

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23
Q

What are the symptoms of hyperthyroidism (6)?

A
  • Sweating
  • Heat intolerance
  • Fatigue
  • Insomnia
  • Osteoporosis
  • Weight loss
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24
Q

What is the leading cause of hyperthyroidism?

A

Graves disease.

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25
Q

What is the 1st line treatment for Graves disease?

A
  • Antithyroid drugs (methimazole or PTU). PTU = propylthiouracil
  • Iodine therapy
  • Surgery (subtotal thyroidectomy)
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26
Q

What is the Whipple triad used for in diagnosing insulinoma?

A
  • Hypoglycemia with fasting
  • Blood glucose <50 with symptoms
  • Symptoms relief with glucose
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27
Q

What is the normal range for TSH levels?

A

0.4-5.0 milliunits/L.

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28
Q

What is the ratio of T4 to T3 in the thyroid hormones produced?

A

10:1.

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29
Q

What are the causes of goiter?

A
  • Lack of iodine
  • Ingestion of goitrogens
  • Hormonal defects
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30
Q

What is the effect of thyroid hormones on metabolic processes?

A

They stimulate virtually all metabolic processes.

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31
Q

What is a common symptom of diabetic neuropathy?

A

Loss of pain and temperature perception.

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32
Q

What is the role of glucagon in glucose metabolism?

A
  • Stimulating glycogenolysis
  • Stimulating gluconeogenesis
  • Inhibiting glycolysis
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33
Q

What lifestyle factors contribute to insulin resistance (2)?

A
  • Obesity
  • Sedentary lifestyle
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34
Q

What should be assessed preoperatively in diabetic patients (4)?

A
  • Cardiovascular system
  • Renal system
  • Neurologic system
  • Musculoskeletal system
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35
Q

What is the treatment for myxedema coma (severe hypothyroidism)?

A
  • IV L-thyroxine (DOC) or L-triiodothyronine
  • IV hydration with glucose solutions
  • Temp regulation
  • Electrolyte correction
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36
Q

What is the effect of thyroid-stimulating antibodies in Graves disease?

A

They stimulate growth, vascularity, and hypersecretion of the thyroid.

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37
Q

What is the mortality rate for a medical emergency involving cold and CNS depressants?

A

> 50%

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38
Q

What is the treatment for a medical emergency involving cold and CNS depressants?

A

IV L-thyroxine or L-triiodothyronine, IV hydration with glucose solutions, temperature regulation, electrolyte correction, and supportive care

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39
Q

What is commonly required for patients experiencing a medical emergency with cold and CNS depressants?

A

Mechanical ventilation

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40
Q

What causes a goiter?

A

Lack of iodine, ingestion of goitrogen, or a hormonal defect

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41
Q

What is the typical state associated with most cases of goiter?

A

Compensated euthyroid state

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42
Q

What is the first-line treatment for goiter?

A

L-thyroxine

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43
Q

When is surgery indicated for goiter?

A

If medical treatment is ineffective, and goiter compromises airway or is cosmetically unacceptable

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44
Q

What imaging study is essential to assess the extent of a thyroid tumor?

A

CT scan

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45
Q

True or False: Dyspnea in upright or supine position is predictive of airway obstruction during general anesthesia.

A

True

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46
Q

What do flow-volume loops indicate in assessing airway obstruction?

A

Location and degree of obstruction

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47
Q

What indicates extra-thoracic obstruction in flow-volume loops?

A

Limitations in the inspiratory limb

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48
Q

What indicates intra-thoracic obstruction in flow-volume loops?

A

Delayed flow in the expiratory limb

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49
Q

What can an echocardiogram assess in relation to thyroid surgery?

A

Degree of cardiac compression

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50
Q

What kind of injury may occur during thyroid surgery?

A

Recurrent laryngeal nerve (RLN) injury

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51
Q

What are the potential outcomes of unilateral RLN injury?

A

Vocal hoarseness without obstruction, usually resolves in 3-6 months

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52
Q

What is a possible complication of bilateral RLN injury?

A

Airway obstruction requiring tracheostomy

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53
Q

What condition may result from inadvertent parathyroid damage during thyroid surgery?

A

Hypoparathyroidism

54
Q

When do symptoms of hypocalcemia typically occur postoperatively?

A

Within 48 hours

55
Q

What may a hematoma during thyroid surgery lead to?

A

Tracheal compression

56
Q

What should be kept at the bedside during the immediate postoperative period after thyroid surgery?

A

A tracheostomy set

57
Q

What are the two main components of each adrenal gland?

A

Cortex and medulla

58
Q

What hormones does the adrenal cortex synthesize (3)?

A

Glucocorticoids, mineralocorticoids (aldosterone), and androgens

59
Q

What does ACTH stimulate in the adrenal cortex? Where is ACTH produced?

A

Production of cortisol
Anterior pituitary

60
Q

What condition is characterized by a tumor causing excess catecholamine secretion from chromaffin cells?

A

Pheochromocytoma

**Norepi, epi, and rarely dopamine

61
Q

What can excess catecholamines lead to?

A

Malignant hypertension, CVA, and myocardial infarction

62
Q

Where do 80% of pheochromocytomas occur?

A

In the adrenal medulla

63
Q

What is the typical NE:EPI secretion ratio in most pheochromocytomas?

64
Q

What symptoms may occur during a pheochromocytoma attack?

A

Headache, pallor, sweating, palpitations, hypertension, orthostatic hypotension

65
Q

What diagnostic test is used for pheochromocytoma?

A

24-hour urine collection for metanephrines and catecholamines

66
Q

What is the preoperative treatment for pheochromocytoma?

A

Alpha blocker to lower blood pressure and decrease intravascular volume

67
Q

What is the most frequently used preoperative alpha-blocker? It is used to treat pheochromocytoma

A

Phenoxybenzamine

**It is a noncompetitive alpha 1 antagonist with some alpha 2 properties

68
Q

What should never be given before an alpha-blocker in pheochromocytoma patients?

A

Nonselective beta-blockers

**Blocking vasodilatory B2 receptors results in unopposed alpha antagonism, leading to vasoconstriction and hypertensive crisis

69
Q

What is the hallmark symptom of primary hyperaldosteronism?

A

Spontaneous hypertension with hypokalemia

70
Q

What is the treatment for primary hyperaldosteronism (6)?

A

Aldosterone antagonist (Spironolactone), potassium replacement, antihypertensives, diuretics, tumor removal, possible adrenalectomy

71
Q

What is the hallmark of hypoaldosteronism?

A

Hyperkalemia in the absence of renal insufficiency

72
Q

What is the treatment for adrenal insufficiency?

73
Q

What are the two types of adrenal insufficiency?

A

Primary and secondary

74
Q

What characterizes primary adrenal insufficiency (Addison’s disease)?

A

Autoimmune adrenal gland suppression

**>90% of the glands must be involved before signs appear

75
Q

What is a common cause of secondary adrenal insufficiency?

A

Iatrogenic factors such as synthetic glucocorticoids, pituitary surgery, or radiation

76
Q

What is the diagnostic criteria for adrenal insufficiency?

A

Baseline cortisol < 20 μg/dL and remains < 20 μg/dL after ACTH stimulation

77
Q

What is the role of parathyroid hormone (PTH)?

A

Maintains normal plasma calcium levels by promoting calcium movement across GI tract, renal tubules, and bone

78
Q

What is the most common cause of primary hyperparathyroidism?

A

Benign parathyroid adenoma (90%)

79
Q

What are the symptoms of hyperparathyroidism?

A

Lethargy, weakness, nausea/vomiting, polyuria, renal stones, peptic ulcer disease, cardiac disturbances

80
Q

What is the treatment for hyperparathyroidism?

A

Surgical removal of abnormal portions of the gland

81
Q

What is the difference between primary and secondary hyperparathyroidism?

A

Primary is due to increased secretion of PTH, while secondary is a compensatory response to hypocalcemia caused by something else, i.e chronic renal failure

82
Q

What is the hallmark of hypoparathyroidism?

A

Deficient PTH, usually iatrogenic

83
Q

What are the typical symptoms of acute hypocalcemia?

A

Inspiratory stridor or laryngospasm

84
Q

What is the common treatment for chronic hypoparathyroidism?

A

Calcium replacement and Vitamin D

85
Q

What hormones does the anterior pituitary secrete (6)?

A

GH, ACTH, TSH, FSH, LH, prolactin

86
Q

What condition is characterized by excessive growth hormone?

A

Acromegaly

87
Q

What is the typical diagnostic lab finding in acromegaly?

A

Elevated insulin-like growth factor 1 (IGF-1)

88
Q

What are anesthesia implications for patients with acromegaly?

A

Distorted facial anatomy may interfere with mask placement, and upper airway obstruction is a risk (i.e enlarged tongue & epiglottis)

89
Q

What is diabetes insipidus (DI) caused by?

A

Vasopressin (ADH) deficiency

90
Q

What distinguishes central/neurogenic DI from nephrogenic DI?

A

Response to DDAVP

**DDAVP is the treatment for neurogenic DI

91
Q

What is the initial treatment for diabetes insipidus?

A

IV electrolytes to offset polyuria

92
Q

What syndrome can result from intracranial tumors or lung cancer?

A

Syndrome of Inappropriate ADH

93
Q

What is the treatment for severe hyponatremia?

A

Hypertonic saline

94
Q

Glucagon:

Stimulates ________ and _______

Inhibits _______

A

Glycogenolysis; gluconeogenesis

Glycolysis

95
Q

What is characteristic of type 1b DM?

A

rare, non-immune disease of absolute insulin deficiency

96
Q

(3) causes of insulin resistance

A
  1. abnormal insulin molecules
  2. circulating insulin antagonists
  3. insulin receptor defects
97
Q

What is the MOA of sulfonylureas?

A

Stimulates insulin secretion from the pancreas

98
Q

What is the MOA of Metformin (2)?

A
  1. Enhances glucose transport into tissues
  2. Decreases triglyceride and LDL levels
99
Q

Repetitive hypoglycemia can lead to _______

A

Hypoglycemia unawareness —-> leads to neuroglycopenia (fatigue, confusion, HA, seizures, coma)

100
Q

T/F: DKA is more common in DM2 than DM1

A

False: more common in DM1

101
Q

T/F: hyperglycemic hyperosmolar syndrome (HHS) occurs more frequently in DM2 than DM1

102
Q

A rare, benign insulin-secreting pancreatic tumor

A

Insulinoma

103
Q

A insulinoma is diagnosed based on the whipple triad, which is?

A
  1. Hypoglycemia with fasting
  2. Blood glucose <50 with symptoms
  3. Symptom relief with glucose
104
Q

What is the MOA of diazoxide? Given preop before insulinoma removal

A

Inhibits insulin release from B cells

**Other treatments include verpamil, phenytoin, propranolol, glucocorticoids, octreotide

105
Q

Production of thyroid hormones depends on which element?

106
Q

T4 and T3 are also known as?

A

Monoiodotyrosine, diiodotyrosine

107
Q

Thyroid function is regulated by _______, _______, and _______

A

Hypothalamus, pituitary, and thyroid glands

108
Q

_______ _______ is the best test of thyroid action at the cellular level

109
Q

Used to test pituitary function and TSH-secretion

A

TRH (thyrotropin releasing hormone) stimulation test

110
Q

The (3) major causes of hyperthyroidism

A
  1. Grave’s disease
  2. toxic goiter
  3. toxic adenoma
111
Q

T/F: Grave’s disease is much more common in men

A

False: more common in women

112
Q

_______ (medication) impairs the peripheral conversion of T4 to T3. Relieves symptoms of Grave’s disease

A

Propranolol

113
Q

A life-threatening hyperthyroid exacerbation. What can trigger it?

A

Thyroid storm
Stress, trauma, infection, medical illness, or surgery

114
Q

The hypothalamus sends ______ - ______ hormone to the anterior pituitary, which stimulates the release of ACTH

A

Corticotropin-releasing hormone

115
Q

In pheochromocytoma, NE and EPI is released in what ratio (reverse of normal secretion)?

A

85:15 (NE:EPI)

116
Q

T/F: pheochromocytoma can result in coronary vasoconstriction, cardiomyopathy, CHF & EKG changes

117
Q

High plasma ACTH stimulates adrenal cortex to produce excess cortisol

A

ACTH-dependent Cushing’s

118
Q

Excessive cortisol production by abnormal adrenocortical tissue that is not regulated by CRH and ACTH

A

ACTH-independent Cushing’s

**CRH and ACTH levels are actually suppressed

119
Q

The most common cause of ACTH-independent Cushing’s

A

Adrenocortical tumors

120
Q

What is the treatment of choice for hypercortisolism (Cushing syndrome)?

A

Transsphenoidal microadenomectomy

**alternatively, subtotal resection of the anterior pituitary

121
Q

Sudden central weight gain, moon face, ecchymoses, HTN, glucose intolerance, muscle wasting, depression, and insomnia are S&S of _______

A

Hypercortisolism (Cushing syndrome)

122
Q

Excess secretion of aldosterone caused by a tumor (aldosteronoma)

**Renin activity is suppressed

A

Primary hyperaldosteronism

123
Q

caused by elevated renin levels

A

Secondary hyperaldosteronism

124
Q

What is the hallmark symptom of hypoaldosteronism?

A

Hyperkalemis in the absence of renal insufficiency

125
Q

T/F: heart block, orthostatic HoTN, and hyponatremia are S&S of hypoaldosteronism

126
Q

What characterizes secondary adrenal insufficiency?

A

Hypothalamic-pituitary supression leading to a lack of CRH or ACTH production

**So ACTH leads to cortisol production/release

127
Q

How is adrenal insufficiency diagnosed?

A

Baseline cortisol <20 micrograms/dl even after ACTH stimulation

**Relative adrenal insufficiency is indicated when the baseline cortisol level is higher but the ACTH stimulation test is positive

128
Q

What are the typical symptoms of chronic hypocalcemia?

A

Fatigue, cramps, prolonged QT, cataracts, SQ calcifications, and neurological defects

129
Q

What does the posterior pituitary store (2)?

A
  1. vasopressin
  2. oxytocin

*after being synthesized in the hypothalamus

130
Q

Low-salt, low-protein diet, thiazide diuretics, and NSAIDS are the treatment for _______ ________ _______

A

Nephrogenic diabetes insipidus

131
Q

Characterized by hyponatremia, decreased serum osmolarity, and increased urine sodium and osmolarity

A

Syndrome of inappropriate ADH (SIADH)

Health Assessment Spring 2025 (Mine) (5 decks)

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