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Principles B > Exam 2 (Endocrine) > Flashcards

Exam 2 (Endocrine) Flashcards

1
Q

What are the peripheral effects of the thyroid function?

A
  • Heat generation
  • stimulates ATP formation in mitochondria
  • influences flux of ions
  • stimulates metabolic processes (basal metabolic rate, protein synthesis regulation of protein, fat & carb metabolism
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2
Q

Thyroid hormone regulates the metabolism of ___, ___, & ___.

A

protein, fat & carbs

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3
Q

The thyroid sympathetic fibers pass through what to get to the thyroid?

A
  • Cardiac periaterial plexus &
  • superior & inferior thyroid plexus
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4
Q

What are the 2 main blood supply sources for the thyroid?

A
  • The superior thyroid artery ( branch of the external carotid)
  • inferior thyroid artery ( branch of the subclavian artery)
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5
Q

Decreased T3 levels can be due to?

A

Hypothyroidism,
cirrhosis,
uremia &
malnutrition

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6
Q

Decreased T4 levels can be due to?

A

Hypothyroidism,
androgens,
salicylates,
sulphonamides

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7
Q

What are some anti-thyroid drugs?

A
  • PTU (Propylthiouracil),
  • methimazole,
  • carbimazole (inhibit the action of peroxidase enzyme)
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8
Q

Why are glucocorticoids given in hyperthyroidism?

A

They inhibit conversion from T4 to T3 & decrease the release of thyroid hormone

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9
Q

How does radioactive iodine work?

A

Destroys the follicular cells

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10
Q

How is a temporary hypoparathyroidism treated?

A
  • High dose calcium,
  • calcitrol (Vitamin D)
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11
Q

What post-op lab can predict hypocalcemia?

A

Low PTH

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12
Q

What is myxedema & S/S?

A
  • Severe form of hypothyroidism
  • S/S: stupor, coma, hypotension, hyponatremia, hypoventilation, hypothermia
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13
Q

Where does a pheochromocytoma arise from?

A

Chromaffin cells of the adrenal medulla.

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14
Q

What is a paraganglioma?

A

An extra-adrenal pheochromocytoma

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15
Q

What is stored in the adrenal medulla?

A
  • 80% epinephrine &
  • 20% norepinephrine
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16
Q

Epi & Norepi derive from?

A

Tyrosine

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17
Q

Alpha-2 receptor stimulation leads to?

A
  • Inhibits release of NE, vasoconstriction.
  • Stimulates cognition
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18
Q

Stimulation of which receptor causes glycogenolysis & insulin secretion?

A

Beta-2

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19
Q

Stimulation of which receptor causes sodium reabsorption?

A

Alpha-1

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20
Q

A pheochromocytoma is also called what?

A

The 10% tumor

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21
Q

What are the symptoms of pheochromocytomas?

A

HA, diaphoresis, N/V, anxiety

22
Q

What do we look at when testing for pheochromocytoma?

A

Plasma Metanephrines

23
Q

What metabolites are elevated in a 24hr urine test in a Pt with a Pheo?

A

Metanephrine, normetanephrine & vanillylmandelic acid

24
Q

When is phenoxybenzamine initiated?

A

1-3 weeks before resection

25
Q

What is another drug besides phenoxybenzamine?

A

Doxazosin

26
Q

What does a medication plan for a pheo look like?

A
  • Start alpha-1 med and wait for adequate blockade until starting a beta antagonist.
  • Starting beta antagonist too early may lead to HTN crisis & pulmonary edema
27
Q

What is the best VA for pheochromocytoma, & why?

A

Isoflurane d/t it being the least cardiac depressant

28
Q

What is generally avoided in a parturient with a pheochromocytoma?

A

Vaginal delivery as it can lead to HTN crisis

29
Q

The parathyroid primarily consists of ____.

A

Chief cells

30
Q

What effect does lithium have on the parathyroid?

A
  • Increases PTH secretion &
  • decreases cell sensitivity to calcium.
31
Q

What effect does vitamin D have on the parathyroid?

A

Decreases PTH secretion

32
Q

PTH is what kind of amino acid?

A

An 84 polypeptide amino acid

33
Q

What is the effect of PTH on bones?

A

Increase activity of osteoclasts causing calcium release from bones

34
Q

What are the effects of PTH on the kidneys?

A
  • Increase calcium reabsorption from urine.
  • Increases urinary phosphate excretion.
  • Increases renal production of 1,25 (OH) D (Vitamin D3), which causes increased GI absorption of calcium
35
Q

What population is most at risk for hyperparathyroidism?

A

Age early 50’s & Female

36
Q

What is the most common cause of outpatient hypercalcemia?

A

Primary hyperparathyroidism

37
Q

What is the major cause of primary hyperparathyroidism?

A

85% caused by single adenoma

38
Q

What are the 3 causes of primary hyperparathyroidism?

A
  • Single adenoma,
  • diffuse hyperplasia,
  • multiple adenomas
39
Q

What are the S/S of hyperparathyroidism?

A
  • Stones, bones, groans, moans
  • (renal, skeletal, abdominal, cardiovascular, psychiatric & neuromuscular)
40
Q

What are the neuropsychiatric S/S of hyperparathyroidism?

A
  • Easy fatigue.
  • Depression.
  • Inability to concentrate.
  • Memory problems.
  • Proximal myopathy (symmetric weakness in muscles close to body’s center)
41
Q

What does bisphosphonate do?

A

It lowers calcium but may increase PTH

42
Q

What does Cinacalcet do?

A
  • It lowers calcium but only modestly lowers PTH.
  • It does not decrease calcium excretion.
43
Q

What is the downside to parathyroid imaging?

A

All are very poor at multi-gland disease

44
Q

What is done for a patient who presents for parathyroidectomy and has an increased calcium level?

A

Dilute calcium with NS and maybe give loop diuretic.

45
Q

What kind of ventilation is avoided intraop for a Pt undergoing parathyroidectomy & why?

A
  • Hypoventilation
  • acidosis can lead to increased ionized calcium → cardiac arrhythmias
46
Q

How is a parathyroid crisis managed?

A
  • Hydration to dilute calcium.
  • Diuresis with loop diuretics.
  • Glucocorticoids,
  • calcitonin,
  • dialysis
47
Q

What is the half-life of PTH?

A

~ 4mins

48
Q

When are PTH levels drawn?

A
  • At baseline before incision.
  • During manipulation of the suspected gland.
  • 5, 10, 20 mins after gland excision.
49
Q

What is indicative that all offending glands have been removed?

A

A PTH decline of >50% from baseline

50
Q

What innervates the larynx sensory above the vocal cords?

A

Internal branch of the SLN

51
Q

What innervates the larynx sensory below the vocal cords?

A

Recurrent laryngeal nerve

52
Q

What & where is released in response to increased calcium & how does it work?

A
  • Calcitonin from the parafollicular cells.
  • Inhibits osteoclastic activity in the bones & inhibits renal tubular cell reabsorption of calcium.

Principles B (4 decks)

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