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BioScience II > Test #2 Endocrine ARTICLES - Dwayne > Flashcards

Test #2 Endocrine ARTICLES - Dwayne Flashcards

1
Q

Glucogneogenesis?

A

The break down of fat and muscle for energy

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2
Q

Glycogenolysis?

A

The breakdown of glycogen into glucose

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3
Q

Type 2 Diabetes

A

Non insulin dependent

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4
Q

Type 1 Diabetes

A

Insuiln dependent

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5
Q

Type 2 diabetes sub catagories

A

Obese and nonobese

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6
Q

Slow progressing adult insulin dependent DM is called?

A

(LADA) Latent autoimmune diabetes adult

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7
Q

The highest percent of those that have DM have what type?

A

Type 2

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8
Q

Signs and symptoms of DM

A

polydipsia, polyuria, polyphagia, tiredness, irritability, fungal infections, poor wound healing, deterioration in vision

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9
Q

Type 2 DM results from?

A

Insulin resistance leading to elevated BGL and over working and eventually failing of the beta cells

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10
Q

NORMALLY type 1 DM Pt’s are under or over weight?

A

Under weight

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11
Q

NORMALLY type 2 DM Pt’s are under or over weight?

A

Over weight

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12
Q

T3 or T4 are more potent?

A

T3

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13
Q

T3 or T4 is released more from the thyroid?

A

T4

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14
Q

Anterior or posterior pituitary secretes TSH

A

anterior

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15
Q

Hypothyroid can be caused by?

A

Hashimoto thyroiditis, thyroidectoy, radioactive iodine anti-thyroid medication and iodine deficiency, Myxedema

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16
Q

Hypothyroid S/S?

A

hypoactive reflexes, depression cold intolerance, muscle fatigue and weight gain
Myocardial contraction, HR, Stroke volume and cardiac output decrese

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17
Q

Preop managment

A

Hypothyroid require less sedation and are prone to resp depression, premedicate w H2 blocker and reglan R/T decrease GI motility

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18
Q

Intra-op

A

Blunted baroreceptor reflex, more susceptible to hypotension with induction agents. Ketamine is recommended, drug metabolism maybe slower

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19
Q

Hyperthyroidism?

A

Graves disease (most common 60-80%), toxic multinodular goiter, toxic adenoma, thyroiditis, TSH secreting pituitary tumor, overdose of thyroid hormone

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20
Q

clinical manifestations?

A

weight loss, hyperactive reflexes, fine tremors, exopthalmos, or goiter

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21
Q

Treatment

A

methimozole, propylthiourcil, propranolol

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22
Q

Anesthetic Implications

A

preferably Euthyroid, antithyroid drugs and beta blockers continue through day of surgery. NO NMB R/T inability to assess the RLN. Treat Hypotension with Neo, not ephedrine, it releases catacholamines.

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23
Q

Anesthetic Implications intr-op

A

Avoid SNS stimulating drugs: ketamine, panc, ephedrine
usually vasodilated and chronically hypovolemic producing sever hypotension during induction
NMB administer w caution R/T thyrotoxicosis is linked to myopathies and mysthenia gravis

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24
Q

Post-op : Thyroid storm

A

most likely onset 6-24 hrs post-op

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25
Q

Post-op Hypocalcemia:

A

due to removal of parathyroid glands, check in 24 hrs

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26
Q

Post-op Stridor

A

Bilat recurrent laryngeal nerve damage

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27
Q

Adrenal gland cortex secretes?

A

mineralcorticoids (aldosterone), androgens and glucocorticoids (cortisol)

28
Q

Adrenal gland medula secretes?

A

catecholamine’s ( epi, norepi, dopamine)

29
Q

Phenochromocytoma

A

tumor of the chromaffin cells secreting maninly norepi, some epi and dopaimine

30
Q

Phenochromocytoma

A

80% in the adrenal medulla 20% external

31
Q

Phenochromocytoma S/S

A

Cardinal signs: HA, HTN, sweating and tachycardia,

Acute onset: pulmonary edema, MI CVA

32
Q

Phenochromocytoma Pre-op

A

Phenoxybenzamine the most common prescribed alpha blocker OR may use Metyrosine

33
Q

Phenochromocytoma

A

NEVER Beta block before alpha blocking R/T the unopposed alpha leads to Vasoconstriction and HTN Crisis. Most common Beta blocker propranolol used

34
Q

alpha blockade stopped when

A

24-48 hrs before surgery

35
Q

Surgery parameters

A 
NO BP > 160/90
NO BP < 80/45 when standing
NO ST changes
NO S/S of excessive catacholamines, no more then 1 PVC q 5 min.
GOAL HR 60-80
36
Q

Intra-op

A

Nipride to lower BP R/T vasodillatory effect speed of onset and short durration
Magnesuim to block catacholamines
betablock w esmolol or labetalol
nicardipine most common CCB used

37
Q

adrenal insuffiency

A

Addison’s disease, septicemia, autoimmune disorders

38
Q

adrenal insuffiency

A

Assoc. w glucocorticoid and mineralcorticoid deficiency

39
Q

adrenal insuffiency Anesthetic considerations

A

Avoid etomidate R/t Adrenal suppression

40
Q

Addison crisis Treatment

A

Fluids w dextrose, steroid replacement, inotropes, electrolyte correction

41
Q

Cushing’s

A

Glucocorticoid excess

42
Q

Cushing’s

A

Anterior pituitary tumor secreting to much ACTH
moon face, truncal obesity, HTN, OSA,
Elevated Na, Bicarb, low Ca and K

43
Q

Cushing’s Anesthetic Implications

A

Volume overloaded, Hypo K, metabloic acidosis

consider spironolactone and K supplements

44
Q

Hyperparathyroidism

A

Number 1 symptom in MEN1 (multiple endocrine neoplasm)

Ca level > 5.5

45
Q

Phenochromcytoma provoking agents, AVOID

A

glucogon, histamine, reglan

46
Q

Stress response (surgery)

A

inhibits secretion of insulin and increases resistance, releases catacholamines and increases metabolism

47
Q

Pair the disease process with the correct DM
Hyperglycemic Hyperosmolar syndrome HHS, DKA
DM type 1, DM type 2

A

Type 1 DKA

Type 2 HHS

48
Q

HbA1c measures what

A

Average glucose concerntration over 3 mths

49
Q

Metformin should be stopped haw many days in advance

A

2-3 days and for 48 hr after

50
Q

Metformin should be stopped for what procedures

A

those w contrast dye, hypoperfusion of the kidneys, lactate accumulation or tissue hypoxia

51
Q

Insulin administration:

A

If given once a day they take their dose
If given twice a day they half the AM dose and take the full PM dose
Omit short acting doses for the day of the procedure

52
Q

Hyperglycemia reduces what drugs effect?

A

Morphine

53
Q

Primary motor inervation of the larynx is from what nerve

A

RLN (recurrent)

54
Q

The RLN controls the opening and closing of the vocal cords by which muscles

A

Posterior cricoarytenoid and the lateral arytenoid muscles

55
Q

The Superior Laryngeal Nerve controls the opening and closing of the vocal cords by which muscles

A

Cricothyroid

56
Q

80 % of metabolism activity is from what hormone??

A

unbound T3

57
Q

T3 is composed of

A

1 di-iodotyrosine compounds link w a mono-iodotyrosine

58
Q

Thyrotropin releasing hormone is secreted by what?

A

hypothalamus

59
Q

Thyrotropin releasing hormone stimulates the production of what?

A

TSH from the anterior pituitary

60
Q

TSH is transported to the thyroid and stimulates the release of what?

A

T3, T4

61
Q

3 most common complications of a thyroidectomy?

A

hypocalcemia, RLN damage and hematoma at the site

62
Q

Hypocalcemia causes

A

excitability in sensory and motor nerves
perioral numbness and tingling, ABD pain, paresthesia in extremities, carpalpedal spasms, SZ, laryngospasms, mental status changes.

63
Q

Chvostek sign? Hypocalcemia

A

facial contraction with facial nerve tapping

64
Q

Trousseau sign? Hypocalcemia

A

carpalpedal spasm after BP cuff inflation

65
Q

Hypocalcium Tx

A

10 ml of 10% calcium IV over several minutes the 2 mg/kg/hr

66
Q

RLN damage, what will you see?

A

ipsilateral vocal cord will remain midline with inspiration
unilateral- hoarsness
Bilateral - stridor, resp distress and aphonia due to unopposed adduction of the cords and closure of the glotic aperature

BioScience II (39 decks)

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