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Physical & Health Assessment (Spring 2023) > Endocrine (Exam II) > Flashcards

Endocrine (Exam II) Flashcards

1
Q

What is the purpose of the pancreas?
What general types of cells does it have?

A
  • Digestion, metabolism, utilization & energy storage
  • Exocrine & endocrine (Islet of Langherhans)
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2
Q

What types of endocrine cells are there and what principal hormone/substance is produced by each?

A
  • Αlpha (20%): Glucagon
  • Βeta (75%): Insulin
  • Delta (5%): Somatostatin
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3
Q

What three areas use 85% of glucose? (per lecture)

A
  • Brain
  • GI tract
  • RBCs

this seems wrong…

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4
Q

What characterizes the pathophysiology of Type I DM?

A
  • T-cell autoimmune destruction of βcells
  • 80-90% βeta cell loss
  • Insulin required.
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5
Q

What characterizes the pathophysiology of Type II DM?

A
  • β cell insufficiency & insulin resistance
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6
Q

What are the two primary ways that a diabetes diagnosis is made (outside of symptoms)?

A
  • A1C ≥ 6.5%
  • Fasting blood glucose ≥ 126 mg/dL
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7
Q

Differentiate biguanides and sulfonylureas in the treatment of diabetes.

A
  • Biguanides (metformin): ↓ gluconeogenesis and ↑ glucose use by muscle and adipose
  • Sulfonylureas (glipizide): ↑ insulin secretion from β cells.
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8
Q

What are the signs/symptoms of DKA?

A
  • Tachypnea (Kussmaul respirations)
  • N/V
  • LOC changes
  • Dehydration
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9
Q

What is the treatment for DKA?

A
  • IVF
  • Regular Insulin gtt (BG q1h)
  • Replace electrolytes
  • Na⁺HCO₃⁻ if pH < 7
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10
Q

How does Hyperosmolar hyperglycemic syndrome differ from DKA?

A
  • Hyperosmolar state w/ metabolic acidosis
  • Treatment includes hypotonic saline to treat the ↑mOsm plasma.
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11
Q

What structure connects the two parts of the thyroid?

A

Isthmus

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12
Q

How many parathyroid glands are there?

how many bitches does Mario get?

A

4

all of them

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13
Q

What is a normal TSH level?

A

0.4 - 5 milliunits/L

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14
Q

What are symptoms of thyrotoxicosis?

A
  • Fever
  • ↑HR
  • Dehydration
  • LOC changes
  • Extreme anxiety
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15
Q

What is the treatment of thyrotoxicosis (thyroid storm)?

A
  • Crystalloids
  • Dexamethasone
  • Propylthiouracil
  • Phenylephrine
  • βblockers
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16
Q

A diagnosis of Grave’s disease is consistent with:

A. Somnolence
B. Weight loss
C. Elevated TSH
D. Decreased T₄

A

B. Weight loss

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17
Q

Anesthetic considerations for syndrome of inappropriate anti-diuretic hormone (SIADH) include:
(Select 2)

A. Measurement of urine osmolality
B. Administration of pre-operative midazolam
C. Stress dosing of dexamethasone
D. Titrating IV fluid

A

A. Measurement of urine osmolality
D. Titrating IV fluid

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18
Q

All of the anesthetic considerations are indicated in a patient with hyperparathyroidism EXCEPT:

A. Pre-operative ECG
B. Avoiding the use of midazolam pre-operatively.
C. IV fluid administration
D. Administration of 40mg of rocuronium.

A

D. Administration of 40mg of rocuronium.

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19
Q

Which statement BEST describes acromegaly?

A. An insufficiency of growth hormone.
B. Occurs due to a tumor in the posterior pituitary gland.
C. Hypoglycemia is frequent concern.
D. Decreased amounts of neuromuscular blockers is recommended.

A

D. Decreased amounts of neuromuscular blockers is recommended.

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20
Q

What hormones/substances are produced in the adrenal cortex?

A
  • Glucocorticoids
  • Mineralcorticoids
  • Androgens
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21
Q

What hormones/substances are produced in the adrenal medulla?

A

Epi and NE

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22
Q

What are some bodily functions regulated by cortisol?

A
  • Macromolecule metabolism
  • Gluconeogenesis enchancement
  • Immune response
  • BP maintenance
  • Appetite promotion
  • Na⁺/K⁺ maintenance
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23
Q

What portion of the adrenal gland is secreting excess catecholamines in pheochromocytoma?

A
  • Chromaffin cells of the adrenal medulla
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24
Q

What signs/symptoms present with pheochromocytoma?

A
  • Extreme HTN
  • Headache, sweating, pallor, & palpitations
  • ECG changes
25
Q

What EKG changes might be seen with pheochromocytoma?

A
  • ST segment elevation or depression
  • Dysrhythmias
26
Q

What non-competitive α-blocker treats pheochromocytomas?
Does this drug need to be kept on for the surgery?

A
  • Phenoxybenzamine
  • No, DC 24-48 hrs prior to surgery.
27
Q

For a pheochromocytoma, should an α blocker or a β blocker be given?

A
  • Both; but give the α-blocker before the β-blocker.
28
Q

What drugs (other than phenoxybenzamine) can be utilized for treatment of pheochromocytomas?

A
  • Prazosin (α1 competitive blocker)
  • Metyrosine (catecholamine synthesis blocker)
  • CCBs
  • ACE-inhibitors
29
Q

What is Cushing syndrome?

A

Hypercortisolism

  • Overproduction of ACTH → excess cortisol
30
Q

What signs/symptoms might be seen with cushing syndrome?

A
  • Truncal obesity
  • Hyperglycemia
  • HTN
  • Muscle weakness
  • Osteoporosis
  • Hypokalemia
31
Q

How is Cushing’s syndrome treated surgically?

A
  • Transphenoidal microadenomectomy
32
Q

What are the primary anesthetic considerations with Cushing syndrome?

A
  • Glucose and blood pressure control
  • Muscle weakness
  • K⁺ replacement
33
Q

What syndrome is characterized by the following symptoms?

  • Hypokalemic HTN
  • Muscle weakness
  • Headaches
  • Polyuria/Nocturia
A

Conn syndrome (Primary Hyperaldosteronism)

34
Q

Excess of __________ defines Conn syndrome.

A

Aldosterone (mineralcorticoid)

35
Q

What are the treatments and anesthetic considerations associated with Conn’s syndrome?

A
  • HTN control
  • Restrict Na⁺ intake
  • Spironolactone
  • K⁺ replacement
  • Volume replacement
36
Q

What is the underlying pathophysiology of Addison’s disease?
What does this result in?

A

Primary Adrenal Insufficiency

  • ↓ mineral- and glucocorticoids
  • ↓ androgens
37
Q

What are the signs/symptoms of Addison’s disease?

A
  • Fatigue
  • Weakness
  • Anorexia
  • N/V
  • Hyperpigmentation “tan-look”
  • Low Na⁺ & volume
  • ↑ K⁺
38
Q

What are the anesthetic considerations associated with primary adrenal insufficiency?

A
  • Preoperative glucocorticoid coverage
  • Electrolytes/hydration
  • ↓ doses of narcotics
39
Q

What does parathyroid hormone control?

A
  • Ca⁺⁺ levels
  • Bone remodeling
  • Vitamin D
40
Q

What should total serum Ca⁺⁺ be?
Give mg/dL and mEq/L

A
  • 9.5 - 10.5 mg/dL
  • 4.5 - 5.5 mEq/L (roughly half)
41
Q

What should ionized serum Ca⁺⁺ be?
Give mg/dL and mEq/L

A
  • 4.8 - 5.6 mg/dL
  • 2.3 - 2.5 mEq/L (roughly half)
42
Q

What is the primary symptom of hyperparathyroidism?

A
  • Hypercalcemia (serum Ca⁺⁺ > 5.5 mEq/L)
43
Q

What is the treatment for hyperparathyroidism?

A

Parathyroidectomy

44
Q

What are anesthetic considerations for hyperparathyroidism?

A
  • NMBDs are unpredictable
  • Positioning
  • Confusion
  • EKG changes
45
Q

What are the signs/symptoms of hypoparathyroidism?

A
  • Fatigue
  • Seizures
  • Tetany & muscle spasms
  • Stridor
  • Prolonged QT
46
Q

What two hormones are produced by the neurohypophysis?

A
  • Vasopressin
  • Oxytocin
47
Q

What hormones are produced by the adenohypophysis?

A
  • Corticotropin Releasing hormone (CRH)
  • TRH
  • Gonadotropin releasing hormone
  • Growth hormone releasing hormone
  • Dopamine
  • Somatostatin
48
Q

What causes acromegaly?

A
  • Excessive growth hormone (GH) secretion
49
Q

What airway symptoms are seen with acromegaly?

A

Tongue and epiglottic enlargement

50
Q

What is the treatment for acromegaly?

A

Transphenoidal surgery

51
Q

What anesthetic considerations exist for acromegaly?

A
  • Airway obstruction
  • Hoarseness, stridor
  • Muscle weakness
  • Blood glucose monitoring needed.
52
Q

What differentiates neurogenic vs nephrogenic diabetes insipidus?

A

Patient response to desmopressin.

If the patient responds to administered desmopressin, then you know that the kidney’s are fine and its neurogenic DI.

53
Q

What characterizes neurogenic diabetes insipidus?
How is it treated?

A
  • Lack of synthesis and release of ADH from the neurohypophysis.
  • Treated with desmopressin (DDAVP)
54
Q

What characterizes nephrogenic diabetes insipidus?
How is it treated?

A
  • Resistance of renal tubules to endogenous ADH.
  • NSAIDs and thiazide diuretics
55
Q

What symptoms/signs would be seen with diabetes insipidus?

A
  • Dilute urine (duh)
  • Polydipsia
  • ↑ serum osmolality
  • AMS/seizures
  • Fatigue
  • Hemodynamic instability
56
Q

What syndrome is characterized by excessive secretion of ADH?

A
  • Syndrome of Inappropriate ADH (SIADH)
57
Q

What kind of lab changes are seen with SIADH?

A
  • Hyponatremia
  • ↓ serum osmolality
  • ↑ urine osmolality
58
Q

What is the treatment for SIADH?

A
  • Free water restriction
  • Demeclocycline
59
Q

What are anesthetic considerations for SIADH?

A
  • Frequently measure urine and plasma osmolality.
  • Keep an eye on Na⁺ levels
  • Avoid IVF when possible

Physical & Health Assessment (Spring 2023) (24 decks)

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