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SU 17: Wine regions of South America > endocrine practice quiz > Flashcards

endocrine practice quiz Flashcards

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1
Q

Which of the following hormones are released from the anterior lobe of the pituitary gland? (select four)

        A. calcitonin
 	B. prolactin
 	C. antidiuretic hormone
 	D. luteinizing hormone
 	E. oxytocin
 	F. follicle-stimulating hormone
 	G. adrenocorticotropic hormone
 	H. insulin
A

B. prolactin
D. luteinizing hormone
F. follicle-stimulating hormone
G. adrenocorticotropic hormone

Hormones released from the anterior pituitary gland include: growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. Antidiuretic hormone and oxytocin are released from the posterior pituitary gland. Calcitonin is released from the thyroid gland.

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2
Q

Antidiuretic hormone increases the absorption of solute-free water in the

    A. glomerulus
B. loop of Henle
C. collecting ducts
D. proximal convoluted tubule
A

C. collecting ducts

Antidiuretic hormone (ADH), also known as arginine vasopressin, works in the distal tubule/collecting tubule and duct. ADH is secreted in response to dehydration and renders the lumen of the collecting tubule permeable to water through the expression of water channel proteins called aquaporin-2 channels. Adequate hydration suppresses the release of ADH, rendering the lumen of the collecting tubule impermeable to water.

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3
Q

What is the most potent mineralocorticoid produced by the adrenal gland?

    A. Aldosterone
B. Cortisol
C. ACTH
D. PTH
A

A. Aldosterone

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4
Q

Which is the most potent endogenous glucocorticoid and produced by the adrenal cortex?

    A. Aldosterone
B. Cortisol
C. ACTH
D. PTH
A

B. Cortisol

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5
Q

Select two catecholamines that the adrenal medulla synthesizes and secretes.

A. Epinephrine
 	B. Dopamine
 	C. Norepinephrine
 	D. Cortisol
A

A. Epinephrine

C. Norepinephrine

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6
Q

Select two hormones secreted by posterior pituitary.

    A. Growth hormone
 	B. Oxytocin
 	C. Vasopressin
 	D. TSH
A

B. Oxytocin
C. Vasopressin

the are secreted by the posterior pituitary, but synthesized in the hypothalamus

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7
Q

All of the following are symptoms of hypoglycemia except

    A. Hypotension
B. Tachycardia
C. Diaphoresis
D. Lacrimation
A

A. Hypotension

Hypoglycemia is associated with a sympathetic response and symptoms such as hypertension, tachycardia, diaphoresis, and lacrimation.

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8
Q

Which of the following is a likely cause of hypocalcemia?

    A. Hyperparathyroidism
B. Hypermagnesemia
C. Malignancy
D. Hypoalbuminemia
A

D. Hypoalbuminemia

Total blood calcium levels parallel the serum albumin. If the serum albumin decreases, the total blood calcium level will decrease as well. Hypoalbuminemia is the most common cause of hypocalemia.

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9
Q

All of the following should be avoided in the patient with symptomatic hypoparathyroidism except

A. Hyperventilation
B. Sodium bicarbonate
C. Ketamine
D. Citrated blood products
A

C. Ketamine

The symptoms of hypoparathyroidism are due to the underlying hypocalcemia. These patients will have some degree of myocardial depression making etomidate and ketamine appropriate choices for induction. Hyperventilation should be avoided due to the risk of further reducing ionized calcium levels. Sodium bicarb and citrated blood products can also lead to decreases in ionized calcium levels. Finally, careful titration of muscle relaxants in parathyroid dysfunction patients is prudent due to the unpredictable responses that they may elicit.

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10
Q

Which of the following patients would be most likely to exhibit delayed gastric emptying as a symptom of their condition?

    A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism
A

B. Hypothyroidism

One of the hallmark gastrointestinal symptoms of hypothyroidism is delayed gastric emptying. Gastrointestinal symptoms associated with hyperparathyroidism include anorexia, nausea, vomiting, constipation, and epigastric pain. Hyperthyroidism is commonly associated with diarrhea.

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11
Q

What is the best predictor of silent coronary artery disease in diabetic patients?

    A. U waves on the electrocardiogram
B. Autonomic neuropathy
C. First degree heart block
D. Obesity
A

B. Autonomic neuropathy

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12
Q

A hormone response that initiates signals which amplify the release of the same hormone is referred to as a

    A. positive feedback mechanism
B. negative feedback mechanism
C. target-control amplifier
D. circadian rhythm
A

A. positive feedback mechanism

A positive feedback mechanism is a hormone-regulating system in which the release of a hormone triggers changes which amplify the release of the same hormone.

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13
Q

Which of the following is a cause of secondary hyperparathyroidism?

    A. Chronic renal failure
B. Parathyroid hyperplasia
C. Hashimoto's thyroiditis
D. Malignant hyperthermia
A

A. Chronic renal failure

Secondary hyperparathyroidism is defined as a normal, compensatory increase in parathyroid hormone secretion in response to a disease process or condition that produces hypocalcemia, such as the increased parathyroid hormone secretion associated with chronic renal disease. Because it is a compensatory mechanism, it rarely produces hypercalcemia.

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14
Q

What conditions comprise the biochemical triad of diabetic ketoacidosis?

    A. Proteinuria, hyperglycemia, acidemia
B. Ketonemia, hyperglycemia, alkalemia
C. Acidemia, ketonemia, hyperglycemia
D. Proteinuria, ketonemia, acidemia
A

C. Acidemia, ketonemia, hyperglycemia

Diabetic ketoacidosis is described as the biochemical triad of hyperglycemia, acidemia, and ketonemia.

Although, DKA is more common in Type I DM, it is usually mild to moderate hyperglycemia. Dehydration and electrolyte derangements are more severe.

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15
Q

A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?

    A. Induction and intubation
B. Maintenance of anesthesia
C. Emergence
D. After the case is finished
A

D. After the case is finished

Patients can experience thyrotoxic crisis at any point during an anesthetic, but it is most likely to occur within 6 to 18 hours postoperatively.

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16
Q

Following induction and intubation of a patient with hypothyroidism, the blood pressure falls to 80/40 mmHg. The most appropriate intervention for this patient would be to administer

    A. Atropine 0.4 mg IV
B. Glycopyrrolate 0.4 mg IV
C. Phenylephrine 40 mcg IV
D. Ephedrine 5 mg IV
A

D. Ephedrine 5 mg IV

In patients with hypothyroidism, the administration of alpha agonists such as phenylephrine could substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. The best option for these patients is to administer epinephrine, ephedrine, or dopamine.

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17
Q

Which of the following laboratory findings would be consistent with a diagnosis of hyperparathyroidism?

    A. Serum calcium = 10.5 mg/dL
B. Serum calcium = 7.0 mg/dL
C. Serum potassium = 4.5 mEq/L
D. Serum potassium = 2.9 mEq/L
A

A. Serum calcium = 10.5 mg/dL

Hyperparathyroidism is the most common cause of hypercalcemia, which is defined as a serum calcium level greater than 10.4 mg/dL.

18
Q

You are performing a general anesthetic on a patient undergoing a parathyroidectomy. Which of the following signs and symptoms would be most closely associated with hyperparathyroidism?

A. Shortened QT interval
B. Hyperreflexia
C. Hypotension
D. Metabolic alkalosis
A

A. Shortened QT interval

The principal pathologic feature of hyperparathyroidism resulting in symptoms is hypercalcemia. The elevated serum calcium concentrations can result in a shortened QT interval, prolonged PR interval, hypotonia and skeletal muscle weakness (as opposed to hyperreflexia). Hyperparathyroidism is often associated with hypertension and the influence of parathyroid hormone on the renal excretion of bicarbonate results in increased serum chloride concentrations which results in a mild metabolic acidosis.

19
Q

he most common nerve injury in patients undergoing subtotal thyroidectomy is damage to the

A. internal laryngeal nerve
B. recurrent laryngeal nerve
C. ulnar nerve
D. common peroneal nerve
A

B. recurrent laryngeal nerve

The most common nerve injury associated with subtotal thyroidectomy is damage to the recurrent laryngeal nerve. Unilateral surgical damage results in hoarseness and a single paralyzed vocal cord. Bilateral damage results in aphonia and total airway obstruction requiring mechanical ventilation. The patency of vocal cord function can be assessed postoperatively by viewing the cords through a fiberoptic scope or by having the patient say ‘e’.

20
Q

Which of the following laboratory derangements is associated with hypoaldosteronism?

    A. Hyperchloremic metabolic acidosis
B. Hypochloremic metabolic alkalosis
C. Hypokalemia
D. Hypernatremia
A

A. Hyperchloremic metabolic acidosis

Hypoaldosteronism is associated with hyperkalemia, hyponatremia, hyperchloremic metabolic acidosis, and often, hyperglycemia.

21
Q

Which of the following clinical findings would be consistent with a diagnosis of hyperaldosteronism?

A

C. Diastolic blood pressure of 125 mmHg

Hyperaldosteronism (Conn’s syndrome) exhibits signs and symptoms including headache, systemic hypertension (diastolic blood pressure often between 100 mmHg and 125 mmHg), hypokalemia, hypernatremia, hypomagnesemia, and abnormal glucose tolerance. Normal serum potassium levels are between 3.5 and 5.5 mEq/L, serum sodium levels are between 135 and 145 mEq/L, and magnesium levels are between 1.7 and 2.1 mEq/L.

22
Q

Which of the following interventions would be an appropriate initial treatment for the derangement in serum potassium caused by hyperaldosteronism?

    A. Furosemide
B. Spironolactone
C. Dextrose and insulin infusion
D. Bumetanide
A

B. Spironolactone

Hyperaldosteronism is associated with hypokalemia (serum potassium less than 3.5 mEq/L). The administration of furosemide, bumetanide, or dextrose and insulin infusions would worsen the hypokalemia. Spironolactone is a competitive aldosterone antagonist that, unlike furosemide and bumetanide will induce diuresis while sparing serum potassium levels.

23
Q

All of the following findings are consistent with a diagnosis of pheochromocytoma except:

    A. Increased plasma metanephrine levels
B. Left ventricular hypertrophy on ECG
C. Normal serum magnesium level
D. Decreased hematocrit
A

B. Left ventricular hypertrophy on ECG

Pheochromocytoma is associated with ECG changes such as left ventricular hypertrophy, nonspecific T wave changes, and evidence of ischemia, urinary excretion of vanillylmandelic acid (a byproduct of catecholamine metabolism), and increased hematocrit due to volume contraction resulting from chronic hypertension. Alterations in serum magnesium level are not necessarily associated with pheochromocytoma.

24
Q

All of the following would be appropriate initial treatments for hypertension due to pheochromocytoma in preparation for surgical removal of the tumor except

A. Metoprolol
B. Nitroprusside
C. Phenoxybenzamine
D. Doxazosin
A

A. Metoprolol

Preoperative management of pheochromocytoma centers on control of the hyperdynamic state induced by increased serum levels of catecholamines. Because decreased myocardial contractility in the face of an elevated systemic vascular resistance can result in heart failure, it is important to decrease the SVR prior to instituting beta blockade. Nitroprusside, phenoxybenzamine, and doxazosin decrease SVR without decreasing myocardial contractility.

Alpha blockade before beta blockade

25
Q

Which of the following would be an appropriate change to your anesthetic plan in a patient undergoing bilateral adrenalectomy for Cushing’s disease?

   A. Avoid the use of etomidate for induction
B. Avoid supplemental steroid administration prior to induction
C. Avoid mechanical ventilation
D. Avoid high doses of non-depolarizing muscle relaxants
A

D. Avoid high doses of non-depolarizing muscle relaxants

Patients with Cushing’s disease have increased serum cortisol levels resulting in hypokalemia, hyperglycemia, and skeletal muscle relaxation which may require a decreased non-depolarizing muscle relaxant dose. Etomidate may decrease adrenal function temporarily, and although it does not need to be avoided, it is unlikely it would produce any therapeutic effect in these patients. Because patients undergoing bilateral adrenalectomy exhibit rapid decrease of serum cortisol levels, steroid replacement therapy should be initiated prior to or during surgery. Because of the tendency toward skeletal muscle weakness, it is recommended that patients with Cushing’s disease be mechanically ventilated whenever possible.

26
Q

All of the following are associated with Addisons disease except:

    A. Hyperpigmentation
B. Hyperkalemia
C. Increased androgen production
D. Increased urinary sodium concentration
A

C. Increased androgen production

Addisons disease is characterized by autoimmune destruction of the adrenal glands causing a decrease in glucocorticoid and mineralocorticoid production. This results in hyperpigmentation, hyperkalemia, increased urinary sodium excretion, and decreased androgen production.

27
Q

During induction for a parathyroidectomy for relief of hyperparathyroidism, which ECG alteration would you most expect to see?

    A. Prolonged QT Interval
B. Shortened QT Interval
C. Shortened PR Interval
D. Prominent U wave
A

B. Shortened QT Interval

Hyperparathyroidism results in hypercalcemia and hypophosphatemia which can distort the ECG resulting in a shortened QT Interval and prolonged PR interval. It is also associated with hypertension.

28
Q

Which of the following intraoperative interventions is NOT appropriate for the patient undergoing surgical excision of an insulinoma?

A. Infuse a glucose-containing fluid
B. Check serum glucose levels every 1-2 hours
C. Establish two large-bore IV lines
D. Have insulin and a dextrose ampule on hand
A

B. Check serum glucose levels every 1-2 hours

Because of the high-risk of hypoglycemia in the patient with an insulinoma, it is appropriate to infuse a solution containing glucose to help maintain normal serum glucose levels. Because the liver is a common site for metastasis of insulinomas, it appropriate to establish two large-bore intravenous lines. Because of the extremes in insulin release by these tumors, especially during surgical manipulation, the serum glucose should be checked at least every 15 minutes, and if possible, using glucometers that provide continuous readings of glucose levels. Having dextrose ampules and insulin on hand would be a prudent measure to address dangerous fluctuations in serum glucose levels.

29
Q

Which of the following is NOT a potential complication of hypoparathyroidism?

    A. Congestive heart failure
B. Hypertension
C. Muscle weakness
D. Irritability
A

B. Hypertension

The signs and symptoms of hypoparathyroidism (most commonly caused by surgical excision of the gland) are due to the resulting hypocalcemia and include hypotension, congestive heart failure, muscle weakness, cramps, and irritability.
30
Q

Which of the following are signs of hyperparathyroidism? (select four)

        A. Decreased serum ionized calcium
 	B. Polyuria
 	C. Ventricular arrhythmias
 	D. Increased glomerular filtration rate
 	E. Hyperchloremic alkalosis
 	F. Hyperphosphatemia
 	G. Bone demineralization
 	H. Muscle weakness
A

B. Polyuria
C. Ventricular arrhythmias
G. Bone demineralization
H. Muscle weakness

Patients with hyperparathyroidism will exhibit signs and symptoms related to an underlying hypercalcemia (elevated serum ionized calcium level). These signs and symptoms include renal stones, polyuria, hypertension, ventricular arrhythmias, muscle weakness, and osteoporosis. Surgical excision is the standard treatment for the condition.

31
Q

A patient scheduled for breast reduction surgery has preoperative labwork which demonstrates severe hypothyroidism. You should

    A. Proceed with the surgery as scheduled
B. Proceed with the surgery but administer hydrocortisone 100 mg IV on induction
C. Proceed with the surgery after administration of propylthiouracil
D. Cancel the surgery
A

D. Cancel the surgery

A patient presenting for elective surgery with uncorrected hypothyroidism should be canceled until further evaluation and correction of the problem (until they are euthyroid). If the patient presents for emergency surgery, thyroid hormone should be administered in an attempt to correct the hypothyroidism if at all possible.

32
Q

Metabolic alkalosis can be the result of

A. renal failure
B. cyanide poisoning
C. hyperaldosteronism
D. aspirin intoxication
A

C. hyperaldosteronism

Causes of metabolic alkalosis include: hyperaldosteronism, vomiting, diarrhea, nasogastric suction, diuretic therapy, and hypovolemia.

Cyanide poisoning, renal failure, and aspirin intoxication all result in metabolic acidosis.

33
Q

Which of the following laboratory values are inconsistent with a diagnosis of diabetic ketoacidosis?

A. Serum bicarbonate of 24 mEq/L
B. Serum glucose of 350 mg/dL
C. Serum osmolarity of 291 mOsm/L
D. Serum pH of 7.2
A

A. Serum bicarbonate of 24 mEq/L

A serum glucose > 300 mg/dL, pH < 7.3, serum bicarbonate < 18 mEq/L, serum somolarity < 320 mOsm/L, and elevated serum and urine ketones are consistent with diabetic ketoacidosis.

34
Q

Addison’s disease is characterized by the inadequate release of (select three)

        A. glucocorticoid
 	B. insulin
 	C. mineralocorticoid
 	D. androgen hormones
 	E. growth hormone
 	F. thyroid-stimulating hormone
 	G. norepinephrine
 	H. dopamine
A

A. glucocorticoid
C. mineralocorticoid
D. androgen hormones

Primary adrenal insufficiency results in the inadequate release of glucocorticoid, mineralocorticoid, and androgen hormones.

Secondary adrenal insufficiency results in the inadequate release of glucocorticoid only.

35
Q

What are the symptoms of hyperglycemic hyperosmolar syndrome? (select four)

	A. Bradycardia
 	B. Mesenteric thrombosis
 	C. Hypertension
 	D. Tachycardia
 	E. Polyuria
 	F. Polydipsia
 	G. Metabolic Alkalosis
 	H. Plasma osmolarity < 300 mOsm/L
A

B. Mesenteric thrombosis
D. Tachycardia
E. Polyuria
F. Polydipsia

Polyuria, polydipsia, hypotension, tachycardia, hyperosmolarity (>340 mOsm/L) and hypoperfusion of major organs. Intravascular coagulation and mesenteric thrombosis are a significant risk in hyperglycemic hyperosmolar syndrome.

36
Q

What are the diagnostic features of diabetic ketoacidosis? (select four)

	A. Serum glucose > 300 mg/dL
 	B. pH < 7.3
 	C. Hypervolemia
 	D. Serum bicarbonate level < 18
 	E. Hypernatremia
 	F. Plasma osmolarity < 320
 	G. Increased central venous pressure
 	H. Metabolic alkalosis
A

A. Serum glucose > 300 mg/dL
B. pH < 7.3
D. Serum bicarbonate level < 18
F. Plasma osmolarity < 320

Patients in diabetic ketoacidosis exhibit a serum glucose > 300 mg/dL, hypovolemia, hyponatremia, a pH < 7.3, a serum bicarbonate level < 18, an osmolarity < 320, and a high level of ketones in the blood.

37
Q

What lab finding is most associated with hypoaldosteronism?

    A. Hyperkalemia
B. Hypernatremia
C. Hypochloremia
D. Hyponatremia
A

A. Hyperkalemia

Hyperkalemia that occurs in a patient with normal renal function suggests hypoaldosteronism. Hyponatremia is also present in these patients.

38
Q

What alteration in anesthetic response would expect to see in a patient who suffers from hyperaldosteronism?

    A. Increased MAC
B. Decreased MAC
C. Increased nondepolarizing muscle relaxant dose requirements
D. Decreased nondepolarizing muscle relaxant dose requirements
A

D. Decreased nondepolarizing muscle relaxant dose requirements

The hypokalemia associated with hyperaldosteronism can result in skeletal muscle weakness and potentiation of nondepolarizing muscle relaxants.

39
Q

What electrolyte abnormality is associated with hypothyroidism?

A. Hyponatremia
B. Hypermagnesemia
C. Hyperkalemia
D. Hypophosphatemia
A

A. Hyponatremia

Hyponatremia and impaired free water excretion are common findings in hypothyroidism.

40
Q

What are the ECG changes often seen with hypothyroidism? (select three)

	A. Peak T waves
 	B. Flattened T waves
 	C. Peak P waves
 	D. Low-voltage P waves
 	E. Sinus bradycardia
 	F. Sinus tachycardia
 	G. ST depression
 	H. ST elevation
A

B. Flattened T waves
D. Low-voltage P waves
E. Sinus bradycardia

The ECG may exhibit flattened or inverted T waves, low-voltage P waves and QRS complexes, and sinus bradycardia. They are also more prone to the development of ventricular dysrhythmias.

41
Q

Which of the following signs and symptoms are consistent with hypoaldosteronism? (select four)

        A. Hypernatremia
 	B. Hyponatremia
 	C. Hyperkalemia
 	D. Hypokalemia
 	E. Metabolic acidosis
 	F. Hypertension
 	G. Orthostatic hypotension
 	H. Pulmonary hypertension
A

B. Hyponatremia
C. Hyperkalemia
E. Metabolic acidosis
G. Orthostatic hypotension

Hyperkalemia that occurs in a patient with normal renal function suggests hypoaldosteronism. Hyponatremia is also present in these patients. Orthostatic hypotension occurs due to the hyponatremia. Hyperchloremic metabolic acidosis and heart block may also be present.

42
Q

What is the treatment of choice for hypertension under anesthesia for a patient with a pheochromocytoma if the tumor secretes primarily epinephrine rather than norepinephrine?

    A. Clonidine
B. Esmolol
C. Nitroglycerin
D. Verapamil
A

B. Esmolol

beta blockers are the drug of choice for treating HTN related to epinephrine-secreting pheochromocytoma

SU 17: Wine regions of South America (10 decks)

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