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Sum25 AdvPrin B > Endocrine (Exam II) > Flashcards

Endocrine (Exam II) Flashcards

1
Q

What provides sensory innervation above the vocal cords?

A

Internal laryngeal branch of the superior laryngeal branch of the vagus nerve.

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2
Q

What provides sensory innervation below the vocal cords?

A

Recurrent Laryngeal Nerve

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3
Q

All intrinsic muscles of the larynx except the _______ muscle are supplied by the ______ ______ nerve.

A

Cricothyroid : Recurrent laryngeal nerve

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4
Q

What muscle gets its motor innervation from the external laryngeal branch of the superior laryngeal nerve?

A

Cricothyroid Muscle

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5
Q

What stores thyroglobulin?

A

Colloid filled follicles

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6
Q

What produces calcitonin?

A

Parafollicular cells

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7
Q

Do parasympathetic or sympathetic nerve fibers run with the blood vessels of the thyroid?

A

Sympathetic

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8
Q

What is the innervation of the thyroid gland?

A
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9
Q

What are the three sources of arterial blood to the thryoid gland?

A
  • Superior thyroid artery (branch of external carotid).
  • Inferior thyroid artery (branch of subclavian artery)
  • Throid ima artery (Only in 3-10% of people)
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10
Q

What would be the expected diagnosis from the following labs?

  • ↑ T₃
  • ↑ T₄
  • ↔ or ↓ TSH
A

Hyperthyroidism

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11
Q

What would be the expected diagnosis from the following labs?

  • ↑ T₃
  • ↔ T₄
  • ↔ TSH
A

Pregnancy

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12
Q

What would be the expected diagnosis from the following labs?

  • ↓ T₃
  • ↓ or ↔ T4
  • ↑ TSH
A

Primary Hypothyroidism

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13
Q

What would be the expected diagnosis from the following labs?

  • ↓ T₃
  • ↓ T₄
  • ↓ TSH
A

Secondary Hypothyroidism

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14
Q

What is a normal TSH level?

A

0.4 - 5.0 milliunits/L

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15
Q

What occurs with unilateral recurrent laryngeal nerve injury?

A
  • Hoarseness
  • Globus sensation

Rarely an airway issue.

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16
Q

What is a normal T₄ level?

A

60 - 120 nmole / L

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17
Q

What is a normal T₃ level?

A

0.92 - 3 nmole / L

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18
Q

What are indications for thyroidectomy?

A
  • Large goiter
  • Compression
  • Children/young
  • Cancer
  • Allergy to anti-thyroid drugs
  • Pregnant patients
  • Moderate - severe opthalmopathy
  • Cosmetic desire of patient
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19
Q

Patient must be rendered _____ prior to thyroidectomy.

A

euthyroid

Goal of 85 - 90 bpm.

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20
Q

What VAA is the choice anesthetic for thyroidectomy?

A

Isoflurane

21
Q

What is our “triad of concerns” with hyperthyroidism patients?

A
  • Airway obstruction
  • Tetany
  • Recurrent Laryngeal Nerve injury
22
Q

What is the treatment for hypoparathyroidism?

A
  • High dose Ca⁺⁺
  • Calcitriol
  • Vitamin D
23
Q

Low ____ post-operatively can predict hypocalcemia.

A

PTH

24
Q

Why should most hypothyroid patients be deferred for elective surgeries?

A

↑ risk of CV complications vcv

25
Q

What cells do pheochromocytoma’s originate from?

A

Chromaffin cells of the adrenal medula

26
Q

What is the biochemical pathway for epinephrine development?

A

Phenylalanine → tyrosine
→ dopa → dopamine → NE → Epi

27
Q

Catecholamines will increase/decrease the following:

________ glycogenolysis
________ gluconeogenesis
________ glucagon secretion
________ glucose uptake

A

↑ glycogenolysis
↑ gluconeogenesis
↑ glucagon secretion
↓ glucose uptake

28
Q

How do pheochromocytomas present?

A

Signs: HTN, ↑HR
Symptoms: Headaches, sweating, N/V, anxiety

29
Q

What are our goals for perioperative managment of pheochromocytoma?

A
  • Treat HTN (α blockers)
  • Volume Expansion (fluids)
  • Control arrhythmias (β blockers)
30
Q

When should phenoxybenzamine be initiated prior to pheochromocytoma resection?

A

1 - 3 weeks preoperatively.

31
Q

What drug is use for α blockade alongside phenoxybenzamine?

A

Doxazosin

32
Q

What should be started first for pheochromocytoma patient? Why?

A

α blocker before a β blocker

If a βblocker is started first then the unopposed α of the catecholamine can worsen vasoconstriction and precipitate HTN crisis & pulm edema.

33
Q

α antagonists should be titrated to mild ____ ______.

A

Orthostatic hypotension

34
Q

Which VAA’s would be a good choice for pheochromocytoma?

A

Isoflurane or enflurane

Least cardiac depressant.

35
Q

If a pregnant patient is diagnosed with pheochromocytoma, then when should it be resected?

A

2ⁿᵈ trimester (surgery)
1st trimester (medical therapy)

36
Q

If a pheochromocytoma is developed or diagnosed late in a pregnancy, what should be done?

A

Elective c-section as vaginal delivery may precipitate HTN crisis.

37
Q

The parathyroid gland is composed primarily of ___ cells.

A

Chief

38
Q

What cells secrete PTH?

A

Chief cells

39
Q

Which parathyroid cells begin to appear at puberty and have an unknown function?

A

Oxyphyl cells

40
Q

PTH is secreted in response to ____ Ca⁺⁺.

A

low

41
Q

Lithium will ____ PTH secretion and _____ cell sensitivity to Ca⁺⁺.

A

↑ PTH : ↓ cell sensitivity

42
Q

1,25 (OH)₂D will _____ PTH secretion.

A

↓

43
Q

What common psychiatric drug will increase PTH secretion and decrease cell sensitivity to Ca⁺⁺?

A

Lithium

44
Q

What effects does PTH have on Ca⁺⁺?

A
  • ↑ activity of osteoclasts = release of Ca⁺⁺ from bones
  • ↑ Ca⁺⁺ reabsorption in the kidneys
  • ↑ GI absorption of Ca⁺⁺
45
Q

What are the renal effects of PTH?

A
  • ↑ urinary phosphate excretion
  • ↑ renal production of Vitamin D (increases GI absorption of Ca⁺⁺).
46
Q

How should the signs/symptoms of Hyperparathyroidism be remembered?

A

Stones, bones, groans, and moans

47
Q

What drugs are used for hypercalcemia? Are these a fix for hyperparathyroidism?

A
  • Biphosphonates (↓ Ca⁺⁺ but ↑ PTH)
  • Cinacalcet (↓ Ca⁺⁺ , does not ↑ Ca⁺⁺ secretion)

No, these are only stop-gap measures until surgery can be performed.

48
Q

What is parathyroid crisis? How is this managed?

A
  • ↑ Ca⁺⁺ = 15 or greater
  • Fluids to dilute Ca⁺⁺ and then lasix to “flush” out the Ca⁺⁺.
49
Q

> ____% decline in PTH of the after the gland has been removed indicates a successful surgery.

A

> 50%

Sum25 AdvPrin B (8 decks)

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