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AP2: Exam 3 > Exam 3, Day 1 Lecture > Flashcards

Exam 3, Day 1 Lecture Flashcards

1
Q

An anesthetic technique allowing for ________ and _____ is desirable in transsphenoidal surgical approach.

A

smooth intubation and extubation rapid neurological assessment

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1
Q

ACTH controls secretion of adrenal cortex hormones which affect _____, _____ and ____ metabolism

A

carbohydrates, protein, and lipid metabolism

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2
Q

The name of the portal system involved at the hypothalamus and pituitary glands.

A

hypothalamo-hypophyseal portal system ….. or hypophyseal portal system

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2
Q

6 Factors known to increase GH secretion

A
  1. Starvation 2. Hypoglycemia or low fatty acids 3. Exercise 4. Excitement 5. Trauma 6. the 1st 2 hours of deep sleep
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2
Q

Components of bone matrix (2)

A

protein and minerals

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2
Q

Prolactin-secreting macroadenomas respond frequently to medication such as (3)

A

bromocriptine cabergoline pergolide (damages heart valves)

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2
Q

Post GH theapy, IGF-1 level are checked after ____ month(s)

A

one

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2
Q

Acquired Causes of Hypopituitarism (5)

A

Cranial irradiation Lymphocytic hypophysitis Infiltrative disorders Pituitary Apoplexy Empty Sella Syndrome

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2
Q

The symptoms of pituitary apoplexy may occur immediately or may develop over ___ days

A

1 - 2 days

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3
Q

Secretion of adenohypophyseal hormones is controlled by _______ which are secreted from the hypothalamus and traveling through the hypophyseal portal veins to the capillaries of the anterior pituitary.

A

hypothalamic releasing and hypothalamic inhibiting hormones.

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3
Q

This i referred to as the master gland.

A

Anterior pituitary gland

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4
Q

The growth promoting action of GH requires both ____ and ____.

A

insulin and carbohydrates

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5
Q

The anterior pituitary is glandular develops from _____ of pharyngeal epithelium

A

Rathke’s pouch

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6
Q

This blood vessel is located in the cavernous sinus

A

internal carotid artery

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7
Q

This is located superior to the pituitary stalk.

A

Optic chiasm

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8
Q

This is a channel for venous blood anterior to the sphenoid bone

A

carvernous sinuses.

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8
Q

Some cases of dwarfism are due to panhypopituitarism. This condition is specifically called ___.

A

pituitary dwarfism.

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8
Q

Mass effect: Lateral extension may compress CN 3,4,6, V1,V2 leading to ___.

A

Diplopia

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9
Q

True or False: Hormone resistance may be due to mutation at the receptor site.

A

True

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10
Q

A cartilage at both ends of the bone which is the site for new bone deposition.

A

Epiphyseal plate

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11
Q

This condition has an excessive growth and height significantly above average due to an excess of growth hormone during childhood, BEFORE the epiphyseal plates have closed.

A

Gigantism

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13
Q

4 Causes of panhypopituitarism

A

Congenital Tumors (adenoma, craniopharyngioma) TBI Thrombosis of pituitary vessel

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14
Q

What occurs when chondrocytes are converted to osteogenic cells?

A

bone deposition

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16
Q

Safest approach in surgically removing tumors of the pituitary gland.

A

transsphenoidal via nasal cavity

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16
Q

Type of intubation which should be considered for patients with acromegaly

A

fiberoptic-guided intubation. (Endotracheal intubation may present a challenge)

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17
Q

The most common cause of hyper secretion of anterior pituitary.

A

hyperfunctioning pituitary adenoma

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18
Q

What is the indirect effect of GH?

A

GH causes the liver to make at least 4 insulin-like growth factors (IGF-1 is the most important)

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19
Q

The hypothalamic-pituitary portal plexus allows transmission of _____ without significant systemic dilution. Consequently, pituitary cells are exposed to sharp spikes of releasing factors and in turn release their hormones as discrete pulses.

A

hypothalamic peptide pulses

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21
Q

Nerves associated with proximity to the pituitary gland. (5)

A

CN 3,4,6: for extrinsic eye movement Opthalmic nerve V1 Maxillary nerve V2

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22
Q

The axon terminals of the dorsal medial, ventral medial, and infundibular nuclei terminates at _____.

A

median eminence of the infundibulum.

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23
Q

The 3 most common hypersecreting pituitary tumors are those that produce

A

Prolactin (most common), ACTH, GH

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24
Q

6 Clinical presentation of Pituitary Apoplexy

A

Nausea, vomiting Vertigo Meningismus Variable onset of severe headache +/- visual defects +/- altered consciousness

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25
Q

The major blood source of anterior Pituitary gland.

A

Hypothalamic-pituitary portal plexus.

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26
Q

These cells (2) increase protein deposition in the bone matrix

A

Chondrocytes: cartilage-making cells Osteocytes: bone-making cells

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28
Q

Other name for posterior pituitary gland

A

Neurohypohysis

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29
Q

Inflammation of the hypophysis due to influx of lymphocytes

A

Lymphocytic hypophysitis

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30
Q

Achondroplasia is directly related to mutations in _____ and is unrelated to pituitary disorder.

A

Fibroblast growth factor receptor 3 (FGFR3)

31
Q

This medication is used to treat acromegaly. It is a GH receptor antagonist (GHIH)

A

Pegvisomant (somavert)

33
Q

This results when the pituitary gland produces excess growth hormone AFTER epiphyseal plate closure at puberty.

A

Acromegaly

34
Q

This is referred to as the bone formation within the cartilage model.

A

Endochondral ossification (Bone growth)

35
Q

Hypothalamic releasing and inhibiting hormones travel through the _____ to the capillaries of the Anterior pituitary gland.

A

hypophyseal portal veins

36
Q

This is a branch of the cavernous part of the internal carotid artery

A

Inferior hypophyseal artery

36
Q

True or False: In empty sella syndrome, hypopituitarism may develop insidiously.

A

True

36
Q

Cranial nerves that move the eyeballs.

A

CN 3 (oculomotor) ,4 (Trochlear),6 (Abducens)

38
Q

Top 4 tissues where Growth Hormone receptor is significantly expressed.

A
  1. B lymphoblasts 2. Adipocyte 3. Liver 4. Prostate
39
Q

This are glial-like cells supporting the function of the neurons the projects down to the neurohypophysis. They don’t secrete hormones.

A

Pituicytes

41
Q

This is a sequence of chemical reactions that constructs or synthesizes molecules from smaller units, usually requiring input of energy (ATP) in the process.

A

Anabolism

42
Q

Bone elongation continues until a person reaches their full adult height, but bones can become ______.

A

thicker throughout life due to GH.

43
Q

True or False: Empty sella syndrome is often an incidental MRI Finding

A

true

45
Q

Main symptom if any of the CN are accidentally damaged from pituitary surgery.

A

double vision

46
Q

Pituitary masses may undergo clinically silent infarction with development of a partial or totally empty sella by ______ filling the dural herniation.

A

CSF

47
Q

This is a decreased secretion of all pituitary hormones.

A

panhypopituitarism

48
Q

Symptomatic patients who have suboptimal response to medical therapy benefit from ____.

A

microsurgical removal of the tumor.

49
Q

Test peroformed prior to radial arterial catherter insertion.

A

Allen’s test

50
Q

Part of pituitary gland which contains cells that make hormones.

A

Anterior pituitary (Adenohypophysis, glandular part)

51
Q

How many skeletal muscles attached to each eyeballs

A

6 (4 rectus muscles, 2 obliques muscles)

52
Q

Incidence of Pituitary tumor

A

17 - 22% or 1 in 5 people

54
Q

The highest concentration of any hypothalamic inhibiting and releasing hormones will be at which vein?

A

Primary plexus of the hypothalamic-hypophyseal portal system or at the hypophyseal portal veins. (they both have the same concentrations)

55
Q

The neurosecretory cell’s axon terminal for anterior pituitary gland is located in the ____.

A

hypothalamus.

56
Q

GH promotes growth via ____, _____, and _____.

A

protein anabolism, mitosis, and differentiation

57
Q

The main hormone for production of gamete (sex cells).

A

Luteinizing Hormone

59
Q

This gland develops from an evangination of the hypothalamus.

A

Neurohypohysis

60
Q

This syndrome is associated with postpartum shock causing hyposecretion of anterior pituitary gland.

A

Sheehan’s Syndrome

61
Q

Meningeal irritation with symptoms suggesting meningitis.

A

Meningismus

62
Q

Mass effect: Inferior extension may lead to ____.

A

CSF rhinorrhea.

63
Q

When does Epiphyseal plate closure occurs?

A

Puberty

64
Q

The most important function of GH is ___.

A

Increased DNA transcription into mRNA

66
Q

Growth hormone therapy is indicated when evoked GH level is ____.

A

< 3 micrograms/ L

67
Q

Acromegaly progression characteristics (5)

A

Cardiomyopathy Hypertension Accelerated atherosclerosis Coarse facial features Overgrowth of internal organs Limited exercise tolerance

68
Q

This is noticeably absent from the list of effects of panhypopituitarism onset in adulthood

A

GH deficiency.

69
Q

When does growth hormone level starts decreasing?

A

after puberty

70
Q

True or False: Rarely, functional pituitary adenomas may arise within the rim of pituitary tissue, and these are not always visible on MRI.

A

True

72
Q

Two hormones needed for nursing successfully.

A

oxytocin and prolactin

73
Q

Mass effect: Superior extension may compromise ____.

A

optic pathways leading to impaired visual acuity and visual field defects. May also produce hypothalamic syndrome (disturbed sleep,thirst, satiety, temperature regulation)

74
Q

This occur with venous occlusions where blood can collect in infarcted zones.

A

Red infarct

75
Q

Name 2 gonadotropins. They target the testes and ovaries.

A

FSH and LH

75
Q

Medications used in evoked GH test (2)

A

Arginine GH-releasing hormone

76
Q

True or False: Panhypopituitarism is more common than just a single hormone hypo secretion.

A

true

77
Q

This hormone is responsible for mammary development and milk production.

A

Prolactin

79
Q

The most common type of dwarfism is due to ___.

A

achondroplasia

80
Q

This tests measures the ability of the pituitary gland to release GH after administration of a medication.

A

Evoked GH

81
Q

Adeno means relating to a ____.

A

gland

82
Q

This is a branch of the cerebral part of the internal carotid artery

A

Superior hypophyseal artery

83
Q

One way that bone grows is by replacing the _____ with bone. (type of bone formation)

A

hyaline cartilage model

84
Q

The decrease in glucose reuptake in skeletal muscle and adipose tissue is a result from _____.

A

GH-induced insulin resistance (similar to type 2 DM)

86
Q

Pituitary glands are encased by ____. It is a depression in the sphenoid bone.

A

Sella turcica

87
Q

The main effect of Growth hormone is __.

A

promotion of protein anabolism

88
Q

Other name of IGF-1

A

Somatomedin C

89
Q

Hormones of the supraoptic and paraventricular nuclei are released at the ____.

A

Pars nervosa

90
Q

This is a neurosurgical emergency caused by hemorrhagic infarction of a pituitary adenoma or tumor.

A

Pituitary apoplexy

AP2: Exam 3 (3 decks)

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