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Co-Existing Disease 1 > Thyroid And Adrenal Disorders > Flashcards

Thyroid And Adrenal Disorders Flashcards

1
Q

The thyroid are 2 lobes joined by what?

A

Isthmus

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2
Q

2 hormones produced by the thyroid?

A

T3 (triiodothyronine) and T4 (tetraiodothyronine)

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3
Q

Iodine plus tyrosine makes up what percent of T3 and T4?

A

T3: 20%
T4: 80%

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4
Q

Goiter (enlarged thyroid) is the first sign of what?

A

Iodine deficiency

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5
Q

What is the most common cause of hyperthyroidism?

A

Graves’ disease

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6
Q

In Graves’ disease, what is the TSH level?

A

Decreased

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7
Q

Common sign of hyperthyroidism?

A

Exophthalmos

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8
Q

4 other causes of hyperthyroidism?

A
  1. Toxic multi modular goiter
  2. Thyroiditis (hashimoto’s thyroid nodule)
  3. Pituitary tumors secrete TSH
  4. Overdose of replacement hormone
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9
Q

Increased T3 effect on minute oxygen consumption, beta adrenergic sensitivity, cardiac cholinergic receptors, CO and BP?

A

Increase minute oxygen consumption
Increased number and sensitivity to beta adrenergic
Decreased cardiac cholinergic receptors
Increase CO but BP remains unchanged

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10
Q

Medical treatments for hyperthyroidism (4)

A
  1. Iodine
  2. Radio ablation
  3. Propylthiouracil (PTU), methimazole
  4. BB (propranolol)
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11
Q

What drug should be avoided for thyroidectomy?

A

Anticholinergics

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12
Q

Preop testing in musculoskeletal will should what 2 things?

A
  1. Myalgia and elevated creatine kinase (CK)

2. Increased urine myoglobin indicating muscle damage

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13
Q

What is best vasopressor for hyperthyroidism?

A

Direct acting as indirect acting can cause exaggerated response

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14
Q

Hyperthyroidism causes Increased minute oxygen consumption effect of thyroid hormones occurs in nearly all tissues but what?

A

Brain

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15
Q

Is intraop paralysis routine for intraop anesthetic for hyperthyroidism?

A

NO

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16
Q

For tracheomalacia, the trachea normal does what during inspiration and expiration?

A

Inspiration: dilates slightly
Expiration: narrows slightly

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17
Q

The usual symptom of tracheomalacia is what?

A

Expiratory stridor or laryngeal crow

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18
Q

Horner’s syndrome is characterized by what 4 things?

A
  1. Mitosis (constrict pupil)
  2. Partial ptosis (weak, droopy eyelid)
  3. Apparent anhirosis (decreased sweating)
  4. Apparent enophthalmos (inset eyeball)
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19
Q

For horner’s syndrome, the s/s occur on what side of the lesion of the sympathetic trunk?

A

Same side

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20
Q

A combo of symptoms that arises when the sympathetic trunk is damaged?

A

Horner’s syndrome (oculo-sympathetic paresis)

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21
Q

Electrodes are designed to make contact with the pts vocal cords to facilitate EMG monitoring of the recurrent laryngeal nerve when connected to the multi channel EMG monitoring device

A

NIM nerve monitoring

22
Q

During NIM nerve monitoring, red and blue wire pair is contacted with what?

A

Red: anterior and posterior of right true vocal cord
Blue: anterior and posterior of left true vocal cord

23
Q

What drug inhibit accurate EMG readings?

A

Lidocaine

24
Q

What 4 things are different between MH and thyroid storm?

A
  1. No muscle rigidity
  2. No lactic acidosis
  3. No hypercapnia
  4. Occurs in PACU after emergent surgery
25
Q

Commons hypothyroidism disease?

A

Hashimoto’s

26
Q

Hashimoto’s disease with CO?

A

Decrease 50% by reduce of SV and HR

27
Q

Term used synonymously with sever hypothyroidism and also used to describe a dermatological change that can occur to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area (non-pitting edema)

A

Myxedema

28
Q

Is myxedema necessarily seen in myxedema coma?

A

No

29
Q

Myxedema coma is seen because of what?

A

Decompensated hypothyroidism

30
Q

Standard treatment for hypothyroidism? (2)

A

Levothroid and synthroid

31
Q

Condition that affects only female, results when one of the X chromosomes is missing or partially missing. Can cause short ht, failure of the ovaries to develop and heart defects

A

Turner syndrome

32
Q

Hypothyroidism hypotension is best treated how?

A

Directly: ephedrine, dopamine, Epi (not neo )

33
Q

Is ketorolac good for post op pain control in hypothyroidism?

A

Yes

34
Q

What is the sole purpose of parathyroid gland?

A

Control Ca++ within blood in very tight range between 9-10

35
Q

What is a post op complication due to parathyroid surgery?

A

Hungry bones because extremes hypocalcemia resulting in tetany, hypomagnesemia

36
Q

During major surgery cortisol release may increase from 15-25 /day to what with plasma cortisol levels of 30-50?

A

75-150/day

37
Q

How often is ACTH dependent?

A

80%; pituitary tumors and lung cancers

38
Q

How often is ACTH independent?

A

20%; benign adrenal tumors (adenoma) and malignant adrenal tumors (adrenal cell carcinoma)

39
Q

What is the cause of Cushing’s syndrome?

A

Chronic glucocorticoid administration

40
Q

What has been described as a complication of almost any type of laparoscopic surgery for cushing’s disease?

A

Pneumothorax

41
Q

What is Addison’s disease?

A

Combined mineral and glucocorticoid deficiency

42
Q

Steroid replacement therapy for Addison’s disease?

A

5mg of prednisone

43
Q

Acute hemodynamic instability especially in those unresponsive to fluids and pressers; lack of cortisol for stress of surgery-poor response

A

Addisonian crisis

44
Q

What is the primary hyperaldosteronism?

A

Conn’s syndrome

45
Q

Catecholamine secreting tumor generally on the adrenal medulla and has a chronic state of vasoconstriction and hypovolemia (HTN, diaphoresis, headache, tachycardia, wt loss)

A

Pheochromocytoma

46
Q

Pheochromocytoma stimulation of alpha1, alpha2, beta1, beta2, beta3:

A

Alpha 1: vasoconstriction
Alpha2: decrease
Beta 1: increase HR/contractility, lipolysis, renin secretion
Beta 2: vasodilation, bronchodilation, glycogenolysis
Beta 3: increase lipolysis and brown fat thermogenesis

47
Q

Main symptoms different between pheochromocytoma and MH:

A

Sever headache

Chest and abdominal pain

48
Q

Preop pheochromocytoma treatment: (4)

A
  1. Alpha blockers (phenoxybenzamine; dibenzyline)
  2. BB AFTER alpha blocker
  3. CCB
  4. Adequate volume replacement LR
49
Q

Intraop pheochromocytoma treatment for HTN and arrhythmias?

A

HTN: nipride
Arrhythmias: BB or lidocaine

50
Q

What to avoid for intraop pheochromocytoma? (7)

A

Avoid sympathetic NS stimulation, inhibitors of parasympathetic NS, histamine releasing drugs

  1. Ephedrine
  2. ketamine
  3. hypoventilation
  4. pancuronium
  5. sux
  6. glyco
  7. atropine
51
Q

What disease deals with pituitary hormone deficiencies?

A

Acromegaly

52
Q

Norma blood sugar levels but kidneys are not able to balance fluid in the body?

A

Diabetes insipidus

Co-Existing Disease 1 (8 decks)

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