Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Patho II > Endocrine Pt. 2 > Flashcards

Endocrine Pt. 2 Flashcards

1
Q

Which form of Ca is physiologically active?

A

Ionized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

_____ causes depression of CNS.
Ca >12 mg/dL
⬇️ neural ecitability
Constipation d/t ⬇️ motility of GIT

A

Hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_____ causes excitation of CNS
Ca= 6 mg/dL
⬆️ neural excitability (⬇️ threshold)
Causes tetany, carpopedal spasm, laryngospasm, bronchospasm. & apnea

A

Hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why does hypocalcemia cause muscle spasm?

A

Increases Na permeability lowering the threshold potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Actions of PTH

A
  1. ⬆️ bone resorption of Ca (from bone to ECF)
  2. ⬆️ excretion of phosphate (Phosphate Trashing Hormone PTH)
  3. ⬆️ Renal Ca reabsorption in kidney
  4. ⬆️ production of Vit D by stimulating kidney a 1 hydroxylase —> ⬆️ intestinal absorption of Ca & phosphate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Primary hyperparathyroidism “moans, bones, stones, & groans”

A
  1. Hypercalcemia -> CNS depression (serum > 5.5, ionized > 2.5)
  2. ⬇️ serum phosphate/ ⬆️ phosphate excretion
  3. ⬆️ urinary Ca excretion (d/t ⬆️ filtered load) -> Ca stone
  4. ⬆️ bone resorption -> bone pain/fractures & osteitis fibrosa cystica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Occurs in end-stage renal disease.
⬇️ production of 1,25 (OH)2 by kidneys
⬇️ GFR -> phosphate retention & hyperphosphatemia
⬆️ phosphate binds w/ Ca = ⬇️ Ca which stimulates PTH secretion -> renal osteodystrophy

A

Secondary Hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Caused by PTH-related peptide (PTH-rp) secreted by malignant tumprs (squamous cell lung ca, breast ca, etc)
hypercalcemia, hypophosphatemia, ⬆️ urinary Ca excretion & stone
Has ⬇️ PTH level. Why?

A

Humoral Hypercalcemia of malignancy;

Low b/c of the PTH-rp coming from the cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hypoparathyroidism

A 
⬇️ Ca & tetany.
⬆️ Phosphate (binds w/ Ca)
Hypotension, CHF
Neuromuscular excitability, numbness/tingling, ⬆️ DTR.
Could have laryngospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tapping in front of ear (VII) causes muscle twitch

A

Chvostek’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tetanic spasm after applying BP cuff

A

Trousseau’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dx & Tx for hypoparathyroidism

A

⬇️ Ca, ⬆️ Phosphorus;

10% calcium gluconate IV + Vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anesthetic considerations for hyperparathyroidism

A 
Avoid fluids with Ca (LR), hydrate & loop diuretics to ⬆️ Ca excretion;
⬆️ dose of NDNMB;
Avoid hypoventilation(acidosis ⬆️ ionized Ca > arrhythmias)
Caution of fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Complications of parathyroidectomy

A

Hypocalcemia > muscle spasm, laryngospasm, tetany, bronchospasm, apnea
Recurrent laryngeal nerve damage (immediate intubation)
Hematoma, pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A group of autosomal dominant syndromes in whcih more than one endocrine organ is hyperfunctional

A

Multiple Endocrine Neoplasia (MEN) syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Includes Pancreas (Zollinger-Ellison syndrome, insulinomas, VIPomas) Parathyroid and Pituitary tumors (3 P’s)

A

MEN type I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Includes Medullary carcinoma of thyroid, Pheochromocytoma, and Hyperparathyroidism.
Pheochromocytoma can give rise to hypertensive crisis during induciton of GA.
(MPH)

A

MEN type IIA (Sipple’s syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Includes Mucocutaneous neuromas, Medullary carcinoma of thyroid and Pheochromocytoma.
Does NOT induce hyperparathyroidism (MMP)

A

MEN type IIB (or type III)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vit D deficiency causes ____ in children and _____ in adults

A

Rickets; osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vitamin D actions

A

⬆️ Ca & phosphate in ECF to mineralize new bone
⬆️ intestinal absorption of Ca & PO4
⬆️ renal reabsorption of Ca & PO4
⬆️ bone resorption (break down) whic provides Ca & phosphate from “old” bone to mineralize “new” bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Calcitonin is synthesized and secreted by the _____ of the thyroid gland. Stimulated by?

A

Parafollicular cells; increase in serum Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Calcitonin action

A

Takes the Ca into the bone.
Inhibits bone resorption & promotes deposition of Ca in the bones which decreases Ca level.
⬆️ urinary excretion of Ca
Can be used to treat hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

D/t release of vasoactive substances from eterchromoffin tumors; mostly GIT like appendix

A

Carcinoid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you diagnose carcinoid syndrome?

A

Increased level of 5- hydroxyindolacetic acid (5-HIAA) in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

S/sx of carcinoid syndrome

A

Cutaneous flushing, bronchospasm, recurrent diarrhea, large swings in BP, SVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management of carcinoid syndrome

A

Octreotide (inhibitory hormone)
Avoid anesthetic techniques that could activate tumor.
Avoid hypotension
Avoid catecholamine admin that may trigger release of kallikreins
Avoid histamine releasing drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Central islets of Langerhans that secrete insulin

A

Beta cells

28
Q

Outer rims of islets of Langerhans that secrete glucagon

A

Alpha cells

29
Q

Intermixed islets of langerhans that secrete somatostatin

A

Delta cells

30
Q

Insulin contains an _____ and a _____ joined by 2 disulfide bonds

A

A-chain & B-chain

31
Q

What is used to monitor Beta cell function in DM?

A

C-peptide

32
Q

MOA of insulin

A

Glucose binds to GLUT-2 receptor on B cells. Inside glucose is oxidized to ATP which closes K channels > Depolarization > opening of Ca channels > secretion of insulin

33
Q

________ depend on insulin for increased glucose uptake while _____ take up glucose independent of insulin level

A

Muscles & adipose tissue (GLUT-4); brain cells & RBCs (GLUT-1)

34
Q

Actions of insulin

A
  1. ⬆️ uptake of glucose into target cells & promotes utilization of glucose for energy
  2. Promotes formation of glycogen (from glucose in muscle & liver)
  3. Inhibits glycogenolysis (breakdown of glycogen)
  4. ⬇️ gluconeogenesis (formation of glucose from non-carb sources like fats & proteins)
35
Q

Insulin _____ blood fatty acids & ketoacid concentraion & _____ blood K concentration

A

Decreases; decreases

36
Q

Destruction of beta cells. Shift of carb to fat metabolism increases ketone body formation -> DKA.
No familial hx

A

Type I DM

37
Q

Non-insluin dependent. Insulin resistance d/t obesity; fat makes muscle more reisistant to insulin. More glucose produciton in liver.
Genetic predisposition

A

Type II DM

38
Q

Gold standard test for DM dx

A

FBG 110-126, 2 hrs postprandial 140-200

39
Q

Rebound response to nocturnal hypoglycemia leading to morning hyperglycemia. BG ⬇️ at 3am. Tx?

A

Somogyi effect; decrease evening insulin dose

40
Q

Fastening hyperglycemia d/t ⬆️ GH. ⬆️ BG at 3am. Tx?

A

Dawn phenomenon; increase evening insulin dose

41
Q

S/sx of DKA

A 
Rapid deep breathing (kussmaul to blow off CO2)
Hyperthermia
N/V
Abd pain
Psychosis, drowsiness, coma
Marked dehydration -> hypotension
Fruity (acetone) breath
42
Q

Labs a/w DKA

A 
⬆️ BG (>250)
Met acidosis w/ high anion gap
⬇️ HCO3
⬆️ blood ketone level
⬆️ K (transcellular shift)
43
Q

DKA tx

A

IV insulin until anionic gap closes
Fluids- NS
Give K (to replete intracellular stores)

44
Q

Severe hyperglycemia that causes profound osmotic diuresis w/ severe dehydration. No acidosis bc enough insulin is present. Tx?

A

Hyperosmolar non-ketotic coma.

Treat as DKA but requires more fluid

45
Q

Anesthetic considerations with DM

A

Check FBG & HbA1c.
Rule out silent MI
Check for diabetic auotonomic dysfunction (postinduction hypotension, arrythmia, sudden cardiac death)
Gastroporesis = increased risk of aspiration (give reglan)
Stop oral hypoglycemic 24-48 hrs before sx

46
Q 
⬆️ insulin in presence of hypoglycemia
⬆️ SNS stimulation (HTN , sweating, hunger, impending doom)
⬆️ C peptide
⬆️ Proinsulin level
A/w MEN I syndrome
A

Adenoma of islet of langerhans (B cell tumors)

47
Q

Episodic hypoglycemia
Sympathetic activation
CNS dysfunctions (confusion, anxiety, coma)
A/w insulinoma

A

Whipple’s triad

48
Q

Tx of insulinoma

A

Glucose administration

49
Q

Hormone of “starvation” (mirror image of insulin). Promotes mobilization and utilization of metabolic fuels.
Regulated by secretion of a-cells

A

Glucagon

50
Q

Actions of glucagon

A

Increases BG by: ⬆️ glycogenolysis & gluconeogensis
Increases FFA & ketoacids by ⬆️ lipolysis
Inhibits gastric motility,⬇️ gastric acid secretion, ⬆️ bile secretion, ⬆️ blood flow & urinary excretion of electrolytes
Smooth muscle relaxation

51
Q

5a-reducatase inhibitor, used in BPH. Prevents testosterone turning into dihydrotestosterone (active form)

A

Finasteride

52
Q

____ cells produce testosterone (stimulated at first step by LH). Testosterone diffuses to the nearby ____ cells which contain _____ and convert testosterone to 17-B-estradiol (stimulated by FSH)

A

Theca; granulosa; aromatase

53
Q

Causes maturation & maintenance of fallopian tubes, uterus, Cx, & vagina
Casues development of femal sexondary sex characteristics at puberty
Development of breasts
Proliferation & development of ovarian cells
Maintains pregnancy
Lowers uterine threshold to contractile stimuli
Stimulates prolactin secretion (but blocks action on breast)

A

Estrogen

54
Q
  • fb on FSH & LH secretion during luteal phase
    Maintains secretory activity of uterus during luteal phase
    Maintains pregnancy
    Decreases myometrial excitability
    Participates in breast development
A

Progesterone

55
Q

High ____ level causes high surge of ____ —> release of egg.

A

Estrogen; LH

56
Q

Corpus luteum releases ______ preparing the body for implantation. Death occurs after ______ weeks leading to menstrual bleeding

A

Progesterone; 2

57
Q

A primordial follicle develops. LH & FSH receptors upregulate.
Estradiol ⬆️ causing proliferation of uterus.
FSH/LH levels are suppressed by - fb of estradiol on anterior pituitary.
Progesterone low

A

Follicular phase (days 1-14)

58
Q

Occurs 14 days before menses.

Burst of estradiol at end of follicular phase has a + fb on secretion of FSH/LH surge.

A

Ovulation (day 15)

59
Q

Corpus luteum develops synthesizing estrogen & progesterone. Vascularity & secretory activity of endometrium increase.
Basal body temp increases.
Corpus luteum shrinks to nothing if fertilization does not occur

A

Luteal phase (days 15-28)

60
Q

Hormone, fb & site for follicular phase

A

Estrogen;
- fb;
Anteior pituitary

61
Q

Hormone, fb & site for mid-cycle

A

Estrogen;
+ fb;
Anterior pituitary

62
Q

Hormone, fb & site for luteal phase

A

Estrogen & progesterone;

  • fb at anterior pituitary;
  • fb at hypothalamus
63
Q

_____ indicates ovulation; _____ is tested for pregnancy

A

LH; HCG

64
Q

If fertilization occurs, the corpus luteum is rescued from regression by ________, which is produced by the placenta

A

Human chorionic gonadotropin (HCG)

65
Q

In the second & third trimester, estrogen is produced by what?

A

The interplay of the fetal adrenal gland & placenta (fetoplacental unit)

66
Q

________ is produced throughout the pregnacny and acts similar to GH & prolactin

A

Human placental lactogen

Patho II (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions