Endocrine Prodigy Flashcards
1
Q
What is acromegaly and what is the most common cause?
A
Acromegaly is the excessive release of growth hormone.
It is most commonly due to an adenoma in the anterior pituitary gland.
2
Q
What are the most common clinical features of acromegaly? (3)
A
- Enlargement of the jaw, hands, and feet
>increased GH levels stimulate release of insulin-like growth factor I.
>These hormones increase proliferation of cartilage, bone, protein synthesis, and lipolysis. - DM
>d/t decreased insulin sensitivity - HTN
>promotion of sodium retention
3
Q
what are the cardiac manifestations of acromegaly? (4)
A
chronic HTN leads to
>ventricular dysfunction
>enlarged heart
>ischemic heart disease
>dysrhythmias
4
Q
How does acromegaly affect the peripheral nervous system?
A
Overgrowth of soft tissue traps peripheral nerves
>carparal tunnel syndrome is common
>from decreased ulnar artery flow due to compression by soft tissue
5
Q
How does acromegaly affect the integumentary system?
(2)
A
thick, oily skin & hyperhidrosis
6
Q
How does acromegaly affect the respiratory system? (2)
A
increased lung volumes & VQ mismatching
7
Q
How is the musculoskeletal system affected by acromegaly?
What’s the effect on NMB on these patients?
A
Osteoarthritis & Osteoporosis
*skeletal muscle weakness and increased sensitivity to muscle relaxants
8
Q
Symptoms of Addison’s disease (9)
A
weakness
hypotension
hypovolemia
hyponatremia
hyperkalemia
anorexia/n/v
hyperpigmentation
9
Q
What are the 2 types of adrenal insufficiency?
A
Primary and Secondary
Primary- adrenal glands cannot produce enough hormones (Addison’s)
Secondary- due to suppression or disease of the HPA
10
Q
How do the effects of primary adrenal insufficiency differ from secondary insufficiency?
A
Primary adrenal insufficency results in the inadequate release of glucocorticoid, mineralocorticoid, and androgen hormones.
Secondary adrenal insufficiency results in the inadequate release of glucocorticoid only.
11
Q
What is the most potent mineralocorticoid produced by the adrenal gland?
A
Aldosterone
12
Q
Which is the most potent endogenous glucocorticoid and produced by the adrenal cortex?
A
Cortisol
13
Q
What are the most common causes of secondary adrenal insufficiency? (3)
A
administration of synthetic glucocorticoids
-pituitary surgery
-radiation
14
Q
What patients are at risk for adrenal insufficiency?
A
Pt’s on chronic steroid therapy during periods of stress such as surgery.
15
Q
*Which induction agent would be least appropriate for a patient in acute Addisonian crisis?
A
*Etomidate - can supress the HPA axis and even a single dose should be avoided in patients prone to adrenal insufficiency
*Nagelhout
16
Q
How long after d/c of long-term steroid use will it take for adrenal function to return to normal?
A
6-12 months.
17
Q
What is carcinoid syndrome and what are its 2 most common symptoms?
A
a massive release of serotonin, histamine, and kinins/killikreans
*Flushing and diarrhea
18
Q
What diagnostic test is usually indicative of carcinoid syndrome?
A
5-hydroindoleacetic acid in the urine
19
Q
*Not all patients with a carcinoid tumor experience side effects from the release from the tumor. Why not?
A
- Usually, hepatic-first pass metabolism elimates the hormones from the circulatory system before they can exert any deleterious effects
*Nagelhout
20
Q
Carcinoid syndrome often causes right-sided cardiac lesions and typically spares the left-side (unless a shunt is present) - why?
A
- elevated serotonin levels can result in right-sided heart failure.
-the lungs metabolize serotonin and therefore spare the left side of the heart.
21
Q
What are the cardiac manifestations of carcinoid syndrome?
A
Pulmonic Stenosis and TR
> from fibrosis of the endocardium (on the right side of the heart- remember serotonin gets metabolized in the lungs and wont affect left unless shunt)
22
Q
How can carcinoid syndrome mimic an allergic reaction?
A
Histamine and kallikrein release
>hypotension
>tachycardia
>bronchospasm
23
Q
What medications relieve the diarrhea associated with carcinoid syndrome?
A
5-HT3 antagonists
24
Q
*What anesthetic drugs should be avoided in patients with carcinoid syndrome?
A
Sympathomimetics
>Ephedrine, Epi, NE, dopa, isoproterenol
Histamine releasing drugs
>MMAST
*Nagelhout
25
*Why shouldn't hypotension be tolerated in someone with carcinoid tumors?
It can trigger the release of hormones from the tumor.
*Nagelhout
26
*Which agent is an analog of somatostatin that is administered to blunt the bronchoconstriction and vasoactive effects of carcinoid tumor products?
Octreotide
*Nagelhout
27
Is Cushing's Disease the same as Cushing's Syndrome?
"Cushing's disease" refers to "Cushing's syndrome" that is caused by oversecretion of ACTH by the anterior pituitary.
28
What are the 2 types of Cushing's Syndrome?
ACTH-dependent and ACTH-independent Cushing's syndrome
29
What are the three zones of the adrenal gland and what hormones does each produce?
innermost= zona glomerulosa (produces mineralocorticoids such as aldosterone)
the zona fasciculata (produces glucocorticoids such as cortisol)
the zona reticularis (which produces sex steroids such as androgens).
30
What is the pathophysilogy behind ACTH-depedent Cushing's syndrome?
-extremely high plasma ACTH levels which stimulate the adrenal gland to produce excessive amounts of cortisol
31
What is the pathophysilogy behind ACTH-independent Cushing's syndrome?
Excessive production of cortisol is due to an abnormal adrenal gland and suppresses secretion of corticotropin releasing hormone and ACTH
32
What are the anesthetic considerations for a patient undergoing bilateral adrenalectomy for Cushing's disease?
increased cortisol levels = hypokalemia, hyperglycemia, and skeletal muscle relaxation.
>this may require a decreased NON-depolarizing dose of MR.
-low dose etomidate infusion may be helpful.
-steroid replacement before or during surgery
33
What is the difference between type I and type II diabetes?
Type I diabetes is caused by a T cell-mediated destruction of beta cells in the pancreas.
Type II diabetes is not immune-related and results from a deficiency of insulin and/or a defect in insulin receptors.
34
Why should you be cautious in administering a high neuraxial block to a patient with chronic hepatic disease?
High (T5) neuraxial blocks are associated with a decrease in hepatic blood flow that may not be reversed with the administration of catecholamines.
35
What percent of patients with diabetes mellitus are type I?
5-10%
36
What is the function of insulin?
Insulin facilitates the transport of glucose and potassium into the cell, and is important for the cellular uptake of glucose with the exception of the brain and liver where it does not affect glucose transport.
37
How is insulin metabolized?
Insulin is metabolized by both the liver and kidneys
38
What is the normal insulin production in a day?
40 to 50 units per day
39
*How do sulfonylureas help control glucose?
increase insulin secretion by beta cells*
*Nagelhout
40
Which oral diabetic agents work by decreasing postprandial glucose absorption?
Alpha-glucosidase inhibitors
Arcabose & miglitol
41
*What are the sympathetic symptoms of hypoglycemia?
*HTN, tachycardia, diaphoresis, lacrimation
*Nagelhout
42
Elective surgery should be postponed if there is an acute rise in glucose to what value?
400mg/dL
43
What percent of type I and type II diabetics develop end-stage renal disease?
30-40% of type I diabetics and about 5-10% of type II diabetics develop end-stage renal disease.
44
What is the hallmark sign of severe glomerulosclerosis in the diabetic patient?
Proteinuria
(pt's can be asympatomatic for as long as 15 years)
45
What percentage of diabetics will develop peripheral neuropathy?
~50% of diabetics over the course of 25 years
46
How does diabetic retinopathy occur and how can it be prevented?
result of microvascular pathologies. Strict maintenance of glucose within normal ranges helps prevent these alterations.
47
*How does blood glucose affect global ischemia?
*Studies have correlated elevated glucose levels with poor short-term and long-term outcomes in patients with brain damage from global ischemia.
*Nagelhout
48
*What are the symptoms of autonomic neuropathy due to diabetes and why is this important? (4)
*lack of orthostatic change in heart rate
-early satiety
-lack of sweating
-impotence
*these pts are at increased risk for gastroparesis and silent MI
*Nagelhout
49
What laboratory values are consistent with diabetic ketoacidosis? (5)
serum glucose > 300mg/dL
pH < 7.3
Bicarb < 18
Serum os < 320mOsm/L
elevated serum and urine ketones
50
What is different about the serum os in DKA vs hyperosmolar syndrome?
DKA- <320mOsm/L
HH- >340mOsm/L
51
What are 2 significant risks in HHS?
intravascular coagulation and mesenteric thrombosis
52
What athe the diagnostic features of HHS? (4)
Glucose > 600
pH > 7.3
Bicarb > 15
Serum Os > 350
53
Over what period of time does hyperglycemic hyperosmolar syndrome occur?
over days to weeks
54
What electrolye abnormalities usually occur with diabetic ketoacidosis? (4)
Hyperglycemia results in:
-hyponatremia
-hypophosphatemia
-hypokalemia (?)
-hypomagnesemia
55
Cushing disease is distinct from Cushing syndrome in that it Cushing disease is a direct result from what?
An anterior pitutiary tumor
Cushing syndrome refers to any condition involving corticosteroid excess.
56
incidence of PE in patient's with Cushing's Disease
3%
57
The hallmark signs of DI are:
Urine SG:
Urine Os:
Urine SG < 1.005
Urine Os < 200mOsm/kg
58
Which oral diabetic agent can increase ADH levels in someone with DI?
chlorpropamide (sulfonyurea)
-hypoglycemic effects limits it's usefulness clinically
59
Type II diabetes accounts of ___% of all cases of diabetes
90%
60
What is a normal A1C?
Between 4-6%
61
Treatment of hypoglycemia
10-25g of IV D50 to prevent irreversible brain damage
62
What 3 things characterize HHS?
-severe hyperosmolarity
-hyperglycemia
-dehydration
63
On average, pt's with HHS have a water deficit of what?
9 Liters!
64
HHS carries of mortality rate of ____%
15%
65
What is Grave's disease?
An autoimmune disorder where thyroid-stimulating antibodies produce hyperplasia of the thyroid gland.
*most common cause of hyperthyroidism, accounting for 60-80% of all cases
66
What are the symptoms of hyperthyroidism mosty related to?
The hypermetabolic state
67
Where are the parathyroid glands located?
Behind the thyroid gland
>2 superior, and 2 inferior
68
What are the two types of cells found in the parathyroid glands?
Chief cells (secrete PTH)
& Oxyphil cells (?)
69
What is the primicpal function of the parathyroid glands?
PTH release to regulate calcium balance.
70
How does parathyroid hormone decrease serum phosphate?
By increasing the renal excretion of phosphate.
71
How does parathyroid hormone act on the kidneys?
Parathyroid hormone can cause a rapid loss of phosphate ions in the urine by its effect on the proximal tubule. As more phosphate is excreted, calcium is retained.
The increased calcium reabsorption takes place primarily in the collecting tubules and the late distal tubules.
72
What are the cardiac signs and symptoms of hyperparathyroidism? (3)
1. HTN
2. Prolonged PR
3. Shortened QT
73
What are the renal signs and symptoms of hyperparathyroidism? (6)
Polyuria
Polydyspia
Decreased GFR
hypophos
hyperchloremic acidosis
renal stone
74
What is the cause of primary hyperparathyroidism 90% of the time
Benign tumor
75
*What is secondary hyperparathyroidism?
*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.
(Nagelhout)
76
*How should you adjust your anesthetic for the patient with primary hyperparathyroidism?
*should be aimed at dealing with underlying hypercalcemia. Because of this, hydration with normal saline and monitoring of urinary output is essential.
Because hypercalcemia is associated with somnolence, the anesthetic requirement may be decreased.
If personality changes due to chronic hypercalcemia are present, then ketamine may need to be avoided.
Baseline skeletal weakness may necessitate a decreased dose of nondepolarizing muscle relaxants, however the increased calcium can antagonize muscle relaxants--in short, hyperparathyroidism is associated with an increased sensitivity to succinylcholine and a resistance to nondepolarizing muscle relaxants.
Acidosis increases the serum calcium level, so hypoventilation should be avoided.
As with thyroidectomy, there is a risk of damage to the recurrent laryngeal nerve during surgery, so a Nim(Registered) tube or similar device should be used to monitor nerve function during surgery.
It is important to position patients with a risk of pathologic fractures carefully. Normal saline is preferred over Lactated Ringer's solution for fluid management.
The patient may be more sensitive to the effects of digoxin.
*Nagelhout
77
S/S Hypoparathyroidism (4)
- same as hypocalcemia
1. Prolonged QT
2. Muscle spasm
3. Hypotension
4. Decreased responsiveness to beta agonists
78
Treatment options for hypoparathyroidism (3)
-aimed at restoring low calcium levels to normal
1. 10mL of Calcium gluconate 10% IV until NM irritability resolves
2. Resp or metabolic alkalosis should be normalized
3. Thiazide diuretics
>they deplete sodium without the loss of potassium which tends to increase calcium levels
79
What is the primary function of aldosterone?
Promotes sodium reabsorption and secretion of potassium in the renal tubule.
80
What is Conn's syndrome another name for?
Primary hyperaldosteronism due to excess aldosterone secretion due to a functional tumor.
81
What are your concerns cardiac-wise for a patient with hyperaldosteronism?
they have a high incidence of ischemic heart disease and preop eval should be aimed at that with close monitoring during procedure.
82
Should patients undergoing surgery for excision of an aldosteronoma receive supplementary exogenous corticosteroids?
A patient undergoing surgery for an isolated adenoma of the adrenal gland that is secreting aldosterone probably will not need exogenous corticosteroids. A patient presenting for excision of bilateral aldosteronomas, however, will likely need supplementation with corticosteroids.
83
What are the signs and symptoms of hyperaldosteronism?
1. HTN and headache
>from sodium retention
2. Polyuria, skeletal muscle weakness, nocturia, and muscle cramps, hypokalemic metabolic acidosis
>from potassium loss
3. hypomagnesemia and abnormal glucose tolerance test may be present
84
What is the most common cause of primary hyperaldosteronism?
unilateral adenoma in the adrenal gland. About 25% of these patients, though, may exhibit bilateral adenoma.
85
How can hyperaldosteronism affect the use of nondepolarizing muscle relaxants?
The resultant hypokalemia can result in skeletal muscle weakness and potentiation of NONdepolarizing muscle relaxants .
86
How is hyperaldosteronism treated? (2)
K+ supplement and an aldosterone antagonist such as spironolactone.
87
What lab findings are associated with HYPOaldosteronism (2)
1. Hyperkalemia in pts with normal renal function
2. Hyponatremia
88
2 cardiac symptoms of HYPOaldosteronism?
1. Heart block
2. Orthostatic hypotension
89
5 Potential causes of HYPOaldosteronism
1. Adrenalectomy
2. Prolonged heparin administration
3. Diabetes
4. Renal failure
5. Congential condition
90
How is acid-base balance affected by HYPOaldosteronism?
it produces a hyperkalemic metabolic acidosis
91
How are plasma renin levels affected by hypoaldosteronism?
-decreased renin levels
92
How is hypoaldosteronism treated? (2)
Fludrocortisone and a high sodium diet
93
What's the most common cause of hypoparathyroidism?
Surgical removal of the parathyroid glands
94
What acid-base state should be avoided in pts with HYPOparathyroidism
Respiratory alkalosis
(an increased pH further decreases ionized calcium levels)
95
What electrolyte abnormality is associated with hypothyroidism?
Hyponatremia and impaired free water excretion
96
Why are patients with hypothyroidism more prone to respiratory depression from anesthetics and narcotics?
Due to their decreased ventilatory response to hypoxia and hypercarbia
(everything slowsssss down)
97
What are the integumentary changes seen with hypothyroidism? (3)
Thick skin, periorbital and peripheral edema
98
What are the ECG changes often seen with hypothyroidism? (3)
1. Flattened or inverted T-waves
2. Low voltage P's and QRS's
3. sinus bradycardia
(also more prone to ventricular dysrhythmias)
99
What is another name for hypothyroidism?
Myxedema
100
Normal TSH level
0.5-5.0mU/L
101
What is the typical TSH level in a patient with hypothyroidism?
5-15 mU/L
-normal= 0.5-5
102
How does hypothyroidism affect mental status?
Mental sluggishness: slow speech, apathy, and listlessness
103
How does hypothyroidism affect cardiac status?
-decreased CO due to reductions in both HR and SV.
-pericardial effusions are common
104
How is peripheral vascular resistance affected by hypothyroidism?
PVR is INCREASED and blood volume is reduced
105
What is the best approach for treating hypotension following induction of a patient with hypothyroidism?
-Epi, ephedrine, or dopamine
(No neo due to decreased contracility)
106
How is secondary hypothyroidism diagnosed?
decreased T3, T4, R-T3U
increased TSH
107
Is the cardiomyopathy seen with hypothyroidism reversible?
Yes - pts who take levothyroxine will exhibit improvement in myocardial function within 2-4 months.
108
How do patients with hypothyroidism respond to anesthetic drugs?
they are highly sensitive to the effects of narcotics, sedatives and inhalational agents
109
Airway concerns in a patient with hypothyroidism?
- more prone to airway compromise:
1. edema of airway and vocal cords
2. possible goiter
3. prolonged gastric transit time (aspiration risk)
110
How does hypothyroidism affect temp maintenance under anesthesia?
More prone to hypothermia which occurs quickly and is difficult to correct once it does occur.
111
What is myxedema coma? (7 sxs)
an uncommon and severe form of hypothyroid which the patient exhibits
1. change in MS
2. unconsciousness
3. Hypothermia
4. hypoventilation
5. Bradycardia
6. hypotension
7. dilutional hyponatremia
112
In what population of patients does myxedema most commonly occur?
elderly females with a longstanding history of hypothyroidism
113
What is the cardinal feature of myxedema coma?
NOT unconsciousness (relatively uncommon suprinsingly)
-->Hypothermia which may be as low as 80 degrees F
114
What is the only indication for IV levothyroxine?
Myxedema coma.
300-500mcg load
+50-200mcg/day
115
What is a goiter?
hypertrophy of the follicular epithelium of the thyroid gland that occurs in response to a reduction in thyroid gland function.
116
What is primary hypothyroidism?
A decrease in the amount of thyroid hormone produced despite adequate levels of TSH
117
What are the 3 most common causes of HYPERthyroidism?
1. Graves disease
2. Toxic multinodular goiter
3. Toxic adenoma
118
What population is most affected by HYPERthyroidism?
females between 20-40
119
a patient exhibits thyroid storm postop, what interventions should you take? (4)
1. tx dehydration with D5NS
2. cooling measures
3. betablockers titrated to HR < 90
4. Steroids and antithyroid medications
120
At what point during the perioperative period is a patient with hyperthyroidism most likely to experience thyrotoxicosis?
it can occur any time during the anesthetic but is most likely to occur in the post-op period.
121
What is thyroid storm?
A life-threatening exacerbation of hyperthyroidism
122
What is the most important goal in the anesthetic management of the thyrotoxic patient?
-To render the patient euthyroid prior to surgery
123
Is the onset of hypothyroidism in adults usually acute or insidious?
slow, insidious progression
124
What drug regiment is typically used in thyrotoxic patients prior to surgery to gain control of their symptoms? (2)
Propanolol &
Potassium iodine
125
What are the general s/s of hyperthyroidism?(8)
1. anxiety
2. emotional lability
3. heat intolerance
4. insomnia
5. fatigue
6. tremors
7. exopthalmos
8. weight loss
126
What is the origin of graves disease?
-autoimmune syndrome where thyroid stimulating ANTIBODIES attach to TSH receptors and stimulate the hyperplasia of thyroid tissue
127
How is hyperthyroidism diagnosed? (3)
elevated T3, T4, R-T3U;
increased radioactive iodine uptake
3. low TSH
128
How does hyperthyroidism affect the hematocrit and platelet count?
anemia and thrombocytopenia
129
First-line treatment for hyperthyroidism?
1. Propylthiouracil or methimazole (block the synthesis of thyroid hormone)
130
What is an insulinoma?
An insulin secreting adenoma of the pancreatic beta cells
131
What are the presenting symptoms of insulinoma known as and what are they ? (3)
Whipple's triad
-Hypoglycemia with fasting,
-gluclose level < 50
-relief of symptoms with glucose administration
132
What does preoperative medical mangement usually require for patients with insulinoma?
Diazoxide
(inhibits the release of insulin from beta cells)
133
During the perioperative period, at which point is a patient with insulinoma most likely to exhibit hypoglycemia?
intraoperatively.
134
*What are the principal manifestations of an insulinoma?
sever hypoglycemia resulting in depression, seizures, and coma
*Nagalhout
135
*What is the primary treatment for an insulinoma?
What about in advanced cases?
-surgical excision of the metastatic tumor.
in advanced cases, the entire distal pancreas may have to be excised, referred to as Child procedure
*Nagalhout
136
Do pheocrhomocytomas primarily secrete epi or norepi?
Norepi
137
What is the most sensitive test for pheo?
a measurement of plasma free metanephrines.
138
Two important things preop for pheo patients
1. alpha blockers
2. correct hypovolemia
139
What factors should be avoided in pheo patients?
any factors that stimulate release of catecholamines: anxiety, shivering, hypoxia, hypercarbia.
140
For patients who's pheo primarily secretes epinephrine, what are the preferred "downer" agents?
labetalol and esmolol
141
In pheo patients, is the patient at greatest risk for significant hypotension?
when the tumor vein is ligated
142
What is the most common cause of death following resection of a pheo?
hypotension
143
What is pheochromocytoma?
a catecholamine secreting tumor that occurs from neural crest cells.
144
Where are pheo's located?
At any location that's derived from the neural crest ranging from the neck to the inguinal ligament
145
What are 2 s/s indicative of pheo?
1. Extremely labile HTN
2. HTN/sweating/HA combo
146
Where are most pheo's located?
in the medulla of one of the adrenal glands (85%)
-other places: spleen, ovary, right atrium, bifurcation of the aorta
147
Incidence of pheo's according to age and gender
equally between men and females
ages: 30-50
148
what complex disorders are pheo's associated with (5)
1. multiple endocrine neoplasia (consists of thyroid cancer and parathyroid hyperplasia)
2. neurofibromatosis
3. tuberous sclerosis
4. Sturge-Weber syndrome
5. von Hippel-Lindau disease
149
What is the preferred vasodilator for hypertensive episodes during a surgical excision of a pheochromocytoma?
Nitroprusside
(nitroglycerin will decrease BP but the amount required to control the BP often results in reflex tachycardia)
150
How does phenoxybenzamine affect alpha-1 and alpha-2 receptors?
it produces NONcompetitive alpha-1 blockade with mild blockade of alpha-2 receptors
151
What side effect can occur from the alpha-2 receptor blockade produced by phenoxybenzamine. What is the recommended treatment for this side effect?
Tachyarrhythmias
>betablockers
152
In what proprotions do pheochromocytomas release NE and epi?
85% epi
15% Ne
153
What is the ost sensitive test for pheo?
Plasma free metanephrine levels > 220pg/mL
or
free normetanephrine levels > 400pg/mL
154
What condition is expressed by elevated vasopressin levels?
SIADH
155
What are the hallmark clinical manifestations of SIADH? (3)
1. decreased UOP with high osmolality
2. decreased serum osmolality
3. hyponatremia
156
What is the typical indication for thymectomy?
tx of myasthenia gravis patients
157
*Where do T-lymphocytes mature vs B- lymphocytes?
*T- thymus
B- bone marrow
*Nagalhout
158
What type of anesthetic is used for thymectomy?
GA
159
Anesthetic concerns for a patient undergoing thymectomy pertain to what underlying disease?
(depolarizers vs nondepolarizers)
- myasthenia gravis
*HIGH RESISTANCE TO SUX
*HIGH SENSITIVITY TO NDMR
*AVOID NMB ENTIRELY WHENEVER POSSIBLE
160
What type of incision is typically made for thymectomy?
A complete sternotomy if thymoma is present.
otherwise, a transcervical incision or video-assisted thoracoscopy.
161
A patient with carcinoid syndrome demonstrates left-sided cardiac complications as a result. You would suspect that this patient also has
A. Cushing's syndrome
B. increased venous return
C. tricuspid stenosis
D. a right-to-left shunt
D. a right-to-left shunt
162
Which agent is an analog of somatostatin that is administered to blunt the bronchoconstrictive and vasoactive effects of carcinoid tumor products?
A. Octreotide
B. Neuropeptide
C. Pancreatic polypeptide
D. Prostaglandins
A. Octreotide
163
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. Hypotension
B. Hyperreflexia
C. Metabolic alkalosis
D. Shortened QT interval
D
164
What is the cause of Graves' disease?
A. Toxic adenoma
B. Thyroid-stimulating antibodies
C. Decreased T3 levels
D. Decreased T4 levels
B
165
A patient with a diagnosis of incomplete diabetes insipidus is treated with chlorpropamide 500 mg per day. Which laboratory test would be the most appropriate to assess prior to surgery?
A. Glucose
B. Serum potassium
C. Arterial blood gas
D. Chest x-ray
A. Glucose
166
What is the most potent mineralocorticoid produced by the adrenal gland?
A. Aldosterone
B. Cortisol
C. ACTH
D. PTH
A. Aldosterone
167
Which of the following is caused by an anterior pituitary tumor?
A. Hepatocellular syndrome
B. Cushing's disease
C. Cushing's syndrome
D. Conn's syndrome
B. Cushing's disease
168
Administration of synthetic glucocorticoids is one of the most common causes of
A. hypoglycemia
B. secondary adrenal insufficiency
C. iatrogenic thyroiditis
D. primary adrenal insufficiency
B. secondary adrenal insufficiency
169
What drug would be preferred for the treatment of hypertension under anesthesia for a patient with a pheochromocytoma if the tumor secretes primarily epinephrine rather than norepinephrine?
A. Clonidine
B. Verapamil
C. Nitroglycerin
D. Esmolol
Esmolol - short acting
Not sure why this matters in regards to primarily epi vs norepi secreting but ok
170
What alteration in anesthetic response would you expect to see in a patient who suffers from Conn's syndrome (hyperaldosteronism)?
A. Decreased MAC
B. Decreased nondepolarizing muscle relaxant dose requirements
C. Increased nondepolarizing muscle relaxant dose requirements
D. Increased MAC
B. Decreased nondepolarizing muscle relaxant dose requirements
171
What medical treatment may be used as a temporizing measure prior to surgical excision of an insulinoma?
A. potassium
B. diazoxide
C. spironolactone
D. regular insulin
B. diazoxide
172
The most common symptom of carcinoid syndrome is
A. flushing
B. tachycardia
C. jaundice
D. hypotension
A. flushing
173
During induction for a parathyroidectomy for relief of hyperparathyroidism, which ECG alteration would you most expect to see?
A. Shortened QT Interval
B. Prominent U wave
C. Shortened PR Interval
D. Prolonged QT Interval
A. Shortened QT Interval
174
What electrolyte abnormality is associated with hypothyroidism?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypophosphatemia
D. Hyponatremia
D. Hyponatremia
175
Which of the following symptoms is consistent with Addison's disease?
A. hyperkalemia
B. hypocalcemia
C. hypernatremia
D. polycythemia
A. hyperkalemia
176
Which of the following respiratory changes occurs with hypothyroidism?
A. The ventilatory response to hypercarbia is increased
B. Minute ventilation increases slightly
C. Diffusion capacity is increased
D. The ventilatory response to hypoxia is decreased
D. The ventilatory response to hypoxia is decreased
177
You are preparing to induce a patient undergoing general anesthesia for resection of a carcinoid tumor. If possible, all of the following drugs should be avoided in this patient except:
A. Atracurium
B. Vecuronium
C. Morphine
D. Pancuronium
B. Vecuronium
178
Metabolic alkalosis can be the result of
A. renal failure
B. aspirin intoxication
C. hyperaldosteronism
D. cyanide poisoning
Not D...
Renal failure?
C i think- increased aldosterone = increased sodium, decreased potassium and hydrogen ions
