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Review > Endocrine Review* > Flashcards

Endocrine Review* Flashcards

1
Q

Thyroid storm - when TH levels become very high!

One major sign of thyroid storm that differentiates it from hyperthyroidism is ?

A

marked elevation of body temp (105-106 degrees F)

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2
Q

Management of Thyroid Storm: (4)

A
  • cooled IV crystalloids
  • esmolol gtt
  • PTU
  • potassium iodide
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3
Q

Preoperative Management of Hyperthyroidism/Grave’s Disease:

  • AVOID ?
  • Administer ?
  • Avoid ??
A
  • Anti-cholinergics!!
  • anxiolytics, midazolam 2-5 mg
  • hypercarbia and hypoxia
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4
Q

Hyperthyroidism-Choice of Induction Drugs:

  • Ok = ____
  • Good with appropriate dosing = ____
  • May see increases in BP with ___
  • NO ___!
A
  • TPL
  • Propofol
  • Etomidate
  • Ketamine
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5
Q

Intubation Considerations with Hyperthyroidism:
-With possible difficult airway consider ___
-Non-depolarizers avoid ___ due to possible increase in HR
-PNS - assure complete relaxation to avoid ?
-Lidocaine gooood
Secure tube and tube connections, and PROTECT EYES and NOSE

A
  • Depolarizers (succ 1 mg/kg)
  • Pancuronium
  • bucking
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6
Q

Preop Management of Hyperthyroidism:
Emergency surgery =
-Give ?
-Thyrotoxicosis

A

esmolol 100-300 mcg/kg/min

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7
Q

Maintenance of Hyperthyroidism/Grave’s Disease:

  • Goal?
  • Accelerated Drug Metabolism clinically relevant due to ___
  • __ = __ increase in MAC when one degree increase in body temp > ?
  • Avoid?
  • Treat hypotension-exaggerated response to ___
  • ___ = avoid SNS stimulation, prolonged response
A
  • Avoid stimulation of SNS
  • increased CO
  • Hyperthermia, 5%
  • 37 degrees celsius
  • local with epi
  • direct acting pressors
  • Muscle relaxants
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8
Q

Emergence-Hyperthyroidism/Grave’s Disease:

  • Thyroidectomy
  • Concern with ___
  • Damage to adductor fibers of ___ (if bilat = ___, unilat = ___)
  • ___ possible, weak rings collapse
  • awake BUT NO ___ (xylocaine helpful)
A

-Vocal cord paralysis
-RLN
obstruction (need to reintubate)
hoarseness (oxygen and assure)
-Tracheomalacia
-bucking

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9
Q

Anesthesia Management-Hypothyroidism:

  • Cardiac = ___, decreased (3), increased ___, systemic HTN, narrow pulse pressure, decreased voltage and prolonged PR/QRS/QT interval, potential for ___ and conduction abnormalities
  • Respiratory = Decreased response to ___ and ___
  • These patients will have a ___ intolerance - peripheral ___ to ___
  • Puffy face, macroglossia - issues with airway??
A
  • Bradycardia
  • CO, SV, contractility
  • SVR
  • pericardial effusion
  • hypoxia and hypercapnia
  • cold intolerance - peripheral vasoconstriction to preserve heat
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10
Q

Preop Management of Hypothyroidism:

  • Replacement therapy~postpone surgery?
  • ___ = common for adrenal insufficiency
  • Caution with ___ (avoid or 1/2 dose)
  • fluid replacement
  • delayed gastric emptying (Reflux? RSI?)
A
  • Cortisol

- Benzos

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11
Q

Induction-Hypothyroidism:

  • Keep warm and need to Avoid ___!
  • PreO2 impaired vent. response to decreased O2 and increased CO2
  • Meds = ___ good
  • ___ low end of dosing
  • ___ potential for hypotension esp. in fluid deficit
  • prolonged response to ___ go on lower end of dosing
A
  • Sedation
  • Ketamine
  • Thiopental
  • Propofol
  • Muscle relaxants
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12
Q 
Maintenance of Hypothyroidism:
-\_\_\_ alone or with \_\_\_, \_\_\_, \_\_\_
-Keep warm avoid hypothermia 
-Monitor for early recognition of ???
-Treat hypotension with \_\_\_
Emergence = recovery may be delayed-somnolent, hypothermia will ?
A
  • N2O alone or with low dose benzos
  • Opioids
  • Ketamine
  • Cardiac depression, CHF, hypothermia
  • ephedrine 2.5-5 mg IV
  • delay MR metabolism
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13
Q

Hyperparathyroidism = ___ is the hallmark of Primary Hyperparathyroidism.

  • These patients will thus have ___
  • Cardiac = (4)
  • GI (___, pain, vomiting, ___) and Renal (polydipsia, polyuria, ___, ___)
A
  • hypercalcemia
  • SM weakness
  • Prolonged PR, short QT, systemic HTN, anemia
  • peptic ulcers, pancreatitis
  • stones, decreased GFR
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14
Q

Preop Management of Hyperparathyroidism:

  • Manage hypercalcemia for symptomatic hypercalcemia administer?
  • Give ?
A
  • Saline infusion 150 mL/hr

- Loop diuretics (lasix)

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15
Q

Anesthetic Management Hyperparathyroidism:

  • Patient will be ___ = decrease induction meds, decreased pain sensation, may have personality changes if they do AVOID ?
  • Maintain ___, no IV solution with ___.
  • Monitor UOP
  • Unpredictable responses with ___ due to increased sensitivity and muscle weakness. Need to ??
A
  • somnolent
  • Ketamine
  • hydration
  • Calcium (no LR)
  • MRs
  • decrease dose and use PNS
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16
Q

Coexisting renal dysfunction with ___ = decreased GFR and stones.
-AVOID ___ and ___!

A

Hyperparathyroidism

  • Sevoflurane
  • Enflurane
17
Q

See Chvostek’s and Trousseau’s Signs with ___!

A

Acute Hypoparathyroidism

removal with thyroidectomy

18
Q

Hypoparathyroidism = ___

  • Chronic = fatigue and ___, EKG with ___, lethargy, personality changes
  • Acute = oral ___, restlessness, NM irritability, + chvostek/trousseau, airway ___
A

Hypocalcemia

  • muscle cramps
  • prolonged QT (normal PR, QRS and rhythm)
  • paresthesias
  • stridor
19
Q

Preop Management of Hypoparathyroidism:
-Infusion of ___ until symptoms of NM irritability dissipate.
-Give ___ to increase serum calcium concentration
*With induction dose on ___
-Positioning risk for ___ (leak of calcium from bone leads to degeneration)
-AVOID further decreases in calcium - NO ??
Administer ___ IV and correct other electrolytes

A
  • 10 mL of 10% calcium gluconate
  • thiazide diuretics (HCTZ)
  • low end (lethargic and fatigued)
  • osteitis fibrosa cystica
  • no massive blood transfusion, no hyperventilation
  • CaCl/calcium gluconate 1-4 gm
20
Q

Anesthetic Considerations NIDDM:

  • ___ = can induce hypoglycemia up to ___ after administration.
  • Can increase effectiveness of ___.
  • ___ metabolized by the liver.
  • ___ metabolism is dependent on renal excretion.
A
  • Sulfonylureas
  • 50 hours
  • Barbs
  • Tolbutamide
  • Chlorpropamide
21
Q

30-40% of patients with IDDM show evidence of this, correlates to degree of difficult laryngoscopy due to limited atlanto-occipital mobility and laryngeal rigidity?

A

Stiff Joint Syndrome

22
Q

This is secondary to diabetes (affects 20-40% of diabetic patients) - present with orthostatic hypotension, resting tachycardia, impotence, peripheral neuropathy, loss of HR variability, gastroparesis, altered regulation of breathing, cardiac dysrhythmias, sudden death syndrome???

A

Diabetic Autonomic Neuropathy

23
Q

Anesthetic Considerations for the Diabetic Patient:

  • Avoid ___ agents
  • ___ may be appropriate (concern with AN-peripheral neuropathy, hypotension)
  • Aggressively treat severe bradycardia with ___ in patients with suspected autonomic neuropathy
A
  • nephrotoxic
  • Regional anesthesia
  • Epinephrine
24
Q

Technique for Non-tight Management of the Diabetic: -Fasting BG

  • 2nd IV infusion of D5W at ___
  • ___ of normal AM intermediate insulin SQ
  • 1st IV for fluid replacement as required -Check BS Q ___, adjust D5W
  • If BS greater than ___ administer IV regular insulin on sliding scale
  • One unit of regular insulin can decrease BS ___ mg/dl
A
  • 100-125 cc/hr
  • 30-50%
  • 1-2 hours
  • greater than 200-250
  • 40-50
25
Q

Tight Glucose Management:
-Fasting BG, start D5W infusion at ___ and maintain throughout surgery
-2nd IV started for normal fluid replacement
-Infusion of ___ of reg insulin in ___ cc NS bag piggybacked-(0.2 u/ml)
~divide hourly BS by ___to get infusion rate
-Check ___ levels frequently and add ___ to each liter of glucose infusate

A
  • 100-150 cc/hr
  • 50 units
  • 250 cc
  • 150
  • K+, 20meq
26
Q

Diabetes - cancel procedure if BS greater than?

-Common meds for NIDDM patients to be on (2)

A

300

-metformin (glucophage), acarbose

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