Endocrine System

Question 1

How are most hormones regulated? Positive or negative feedback loop?

Answer 1

Negative feedback loop

Question 2

The interactions within the endocrine system constitute the ____________ a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes.

Answer 2

hypothalamic-pituitary axis

Question 3

The endocrine system helps regulate: (7)

Answer 3

Chemical composition and volume of interstitial fluid
Metabolism and energy balance
Biological clock or circadian rhythms
Contraction of smooth and cardiac muscle fibers
Glandular secretions
Some immune system activities
Operations of reproductive system

Question 4

Does the endocrine system control growth and development?

Answer 4

Yes

Question 5

Identify:

Answer 5

Question 6

Thyroid Feedback Loop

The thyroid senses low levels of thyroid hormones ___ and ___ which then responds by releasing what hormone?

Answer 6

T3 and T4

thyrotropin-releasing hormone (TRH)

Question 7

The TRH (thyroid-releasing hormone) stimulates the pituitary to produce what?

Answer 7

thyroid-stimulating hormone (TSH)

Question 8

What hormone is released from the hypothalamus?

Answer 8

TRH (thyroid releasing hormone)

Question 9

What hormone is released from the anterior pituitary gland?

Answer 9

TSH

Question 10

________ stimulates the thyroid gland to secrete the hormone thyroxine (T4) (inactive form) which is converted to triiodothyronine (T3), which is the active hormone that stimulates metabolism.

Answer 10

TSH

Question 11

________ is also produced by the hypothalamus, and has an opposite effect on the pituitary production of TSH, decreasing or inhibiting its release.

Answer 11

Somatostatin

Question 12

The concentration of thyroid hormones (T3 and T4) in the blood regulates the pituitary release of TSH. True or false?

Answer 12

true

Question 13

When T3 and T4 concentrations are low, the production of TSH is ______ and vice-versa.

Answer 13

increased

Note: This is known as a negative feedback loop.

Question 14

T4 and T3 (controlled by TSH) levels peak in the early morning. True or false?

Answer 14

false

Diurnal peaks in late evening.

Question 15

What factors influence secreted amounts of T3 and T4? (6)

Answer 15

Gender
Pregnancy
Gonadal- and adrenal cortical-increased steroids (increase)
Exposure to cold (increase)
Nutritional state
Chemicals (dopamine, catecholamines)

Question 16

What are the functions of T3 and T4? (9)

Answer 16

Regulate protein, fat, and carbohydrate catabolism in cells
Regulates metabolic rate and body heat production
Insulin antagonist
Maintains growth hormone secretion, skeletal maturation
Affects CNS development
Maintains cardiac rate, force, and output
Affects respiratory rate and oxygen utilization
Affects RBC production
Enhances cholesterol excretion in the bile

Question 17

What type of thyroid condition results in a goiter?

Answer 17

Hyperthyroidism

Question 18

What type of thyroid condition results in exophthalmos?

Answer 18

Hyperthyroidism

Question 19

What are the symptoms of hyperthyroidism? (10)

Answer 19

Nervousness or anxiety
Increased sweating
Heat intolerance
Palpitations
Dyspnea
Fatigue and weakness
Weight loss or gain
Increased appetite
Hyperdefication or loose stools
Menstrual irregularity

Question 20

What are the signs and symptoms of hyperthyroidism? (5)

Answer 20

Thyroid enlargement (goiter)
Tachycardia
Atrial fibrillation
Hyperkinesis (state of overactive restlessness)
Eye signs (exophthalmos)

Question 21

For hyperthyroidism, we would expect the following increase/decrease in labs:

_________ T3 and T4

________ free thyroxine or T4

___________ TSH

Answer 21

elevated T3 and T4

elevated free thyroxine or T4

decreased TSH

Question 22

What other labs could you expect for a pt with hyperthyroidism? (5)

Answer 22

Hypercalcemia
Increased alkaline phosphatase
Anemia
Decreased granulocytes
Increased erythrocyte sedimentation rate

Question 23

What is the treatment for hyperthyroidism? (4)

Answer 23

Thioamides

Iodine

Beta-adrenergic blockade

Thyroid surgery

Question 24

What are preoperative considerations for pts with hyperthyroidism? (2)

Answer 24

Airway exam is important, especially if a goiter is present.

Ptoptosis will require diligent eye protection.

Question 25

In an emergency surgery situation, what drugs will we need to have available for a pt with hyperthyroidism? (4)

Answer 25

Propythiouracil (PTU) Propanolol Potassium iodide Corticosteroids

Question 26

What are the symptoms of hypothyroidism? (10)

Answer 26

Cold intolerance Dyspnea Anorexia Constipation Decreased libido Menorrhagia, amenorrhea Oliguria Arthalgias, myalgias, muscle stiffness and cramps Dryness Fatigue

Question 27

What are the signs of hypothyroidism? (5)

Answer 27

Weight gain (or loss) Bradycardia Diastolic hypertension Cardiac rub or soft heart tones causes by pericardial effusion Ileus

Question 28

For hypothyroidism, we would expect the following increase/decrease in labs: \_\_\_\_\_ Free T4 \_\_\_\_\_\_\_\_ TSH in primary hypothyroidism \_\_\_\_\_\_\_ or normal TSH in pituitary insufficiency

Answer 28

Decreased free T4 Increased TSH Decreased or normal TSH

Question 29

What other labs could you expect for a pt with hypothyroidism? (4)

Answer 29

Increased serum cholesterol, liver enzymes, creatine Hyponatremia Hypoglycemia Anemia

Question 30

What is a major complication of severe hypothyroidism?

Answer 30

Myxedema coma

Question 31

What are the complications of myxedema coma? (5)

Answer 31

hypothermia hypoventilation hyponatremia hypoxia hypertension

Question 32

What factors may induce myxedema coma? (4)

Answer 32

infection, cardiac or respiratory CNS illness cold exposure drug use

Question 33

Elderly men are more at risk for myxedema coma. True or false?

Answer 33

false elderly women

Question 34

How is hypothyroidism treated? (2)

Answer 34

Thyroid hormone replacement--synthetic levothyroxine Treatment monitored closely with lab values and titrated.

Question 35

What hormone raises serum Ca++ levels while promoting bone reabsorption?

Answer 35

Parathyroid hormone

Question 36

The following would increase/decrease for pts with hyperparathyroidism: \_\_\_\_\_\_\_ parathyroid hormone \_\_\_\_\_\_\_ calcium levels

Answer 36

increased PTH increased calcium

Question 37

What are the consequences of hypercalcemia? (7)

Answer 37

renal stones polyuria hypertension constipation fatigue mental changes bone pain

Question 38

What is the most common cause of hyperparathyroidism?

Answer 38

parathyroid adenoma

Question 39

Is parathyroid cancer common?

Answer 39

No

Question 40

What are the signs of hypocalcemia? (8)

Answer 40

tetany carpopedal spasms tingling of lips and hands muscle and abdominal cramps psychological changes positive Chvostek’s and Trousseau’s signs defective nails and teeth cataracts

Question 42

What condition may common be seen after thyroidectomy, but may only be transient?

Answer 42

hypoparathyroidism

Question 43

What is the treatment for hypoparathyroidism? (4)

Answer 43

IV calcium gluconate oral calcium Vit D Magnesium

Question 44

What are the tests for hypocalcemia? (2)

Answer 44

Chvostek's sign Trousseau's sign

Question 45

What labs are ordered for parathyroid issues? (6)

Answer 45

Serum calcium Ionized calcium Albumin Serum magnesium Alkaline phosphatase Serum phosphate

Question 46

What is the most common endocrine disease?

Answer 46

Diabetes Mellitus

Question 47

What are long-term complications of diabetes mellitus?(4)

Answer 47

Injury to: Eyes Kidneys Nerves Blood vessels

Question 48

What are the major risks for those with diabetes? (5)

Answer 48

Heart disease Stroke Kidney disease Blindness Nontraumatic amputations

Question 49

What type of diabetes? NO insulin production – thought to be an autoimmune destruction of islet cells in pancreas

Answer 49

Type 1 Note: They become dependent on exogenous insulin.

Question 50

What type of diabetes? Relative deficiency in insulin – insulin resistance Associated findings include – obesity, abnormal insulin levels, strong genetic component

Answer 50

Type 2

Question 51

What type of diabetes? Complicates about 4% of pregnancies Glucose intolerance that is identified during pregnancy

Answer 51

Gestational DM

Question 52

What are the treatments for DM? (4)

Answer 52

Diet Oral hypoglycemic drugs Exercise Exogenous insulin

Question 53

What are anesthetic considerations for DM pts? (4)

Answer 53

Autonomic lability (Temp, BP, HR dysfunction) Silent ischemia or CAD Inhibited motility of GI Glucose control--may affect healing

Question 54

Perform a pregnancy test for any female of childbearing age which is \_\_\_\_-\_\_\_\_ YO.

Answer 54

15-50

Question 55

What are 2 major types of pregnancy test?

Answer 55

Urine Blood

Question 56

How accurate are home urine pregnancy tests?

Answer 56

97%

Question 57

What blood pregnancy test measures the exact amount of hCG in the blood?

Answer 57

quantitative blood test

Question 58

What blood test gives a simple yes or no answer to whether one is pregnant or not?

Answer 58

qualitative blood test

Question 59

When are hCG levels at their peak from time of inception?

Answer 59

1-2.5 months

Question 60

Surgery is only conducted during pregnancy when it is absolutely necessary for the wellbeing of the mother, fetus, or both. True or false?

Answer 60

true

Question 61

All general anesthetic drugs cross the placenta. True or false?

Answer 61

true

Question 62

Regional anesthesia is usually preferred in pregnancy when it is practical for the medical and surgical condition. True or false?

Answer 62

true

Question 63

What are the most common surgeries for pregnant patients not related to the pregnancy? (3)

Answer 63

acute appendicitis maternal trauma surgery for maternal malignancy

Question 64

Surgery should be done at an institution with neonatal and pediatric services. True or false?

Answer 64

true

Question 65

An obstetric care provider with cesarean delivery privileges should be readily available. True or false.

Answer 65

true

Question 66

A qualified individual should be readily available to interpret the fetal heart rate patterns. True or false?

Question 67

What are the cardiovascular changes that occur during pregnancy? (5)

Answer 67

increased CO increased blood volume increased HR decreased peripheral resistance decreased blood pressure

Question 68

What are the pulmonary changes that occur during pregnancy? (4)

Answer 68

increased RR increased tidal volume decreased FRC respiratory alkalosis

Question 69

What are risks presented by a pregnant patient intra-op? (4)

Answer 69

difficult intubation due to swelling hypoxia hyptension due to aortocaval compression aspiration

Question 70

If the fetus is considered pre-viable, it is sufficient to ascertain the fetal heart rate by Doppler before and after the procedure. True or false?

Answer 70

true

Question 71

Intraoperative electronic fetal monitoring may be appropriate when all of the following apply: (5)

Answer 71

The fetus is viable. It is physically possible to perform intraoperative electronic fetal monitoring. A health care provider with obstetric surgery privileges is available and willing to intervene during the surgical procedure for fetal indications. When possible, the woman has given informed consent to emergency cesarean delivery. The nature of the planned surgery will allow the safe interruption or alteration of the procedure to provide access to perform emergency delivery.