Week 10 Quiz (Greg Study Guide) Flashcards
How does obesity affect respiratory function?
compression of fat on structures, kyphosis/lordosis, impaired rib movement, decreased lung compliance, increased metabolic demand, CO2 retention, CC>FRC, OSA, impaired gas exchange
What is Pickwickian syndrome?
obesity hypoventilation syndrome- characterized by OSA, hypercapnia, daytime hypersomnolence, hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, and R sided heart failure
What are some considerations when intubating an obese patient with OSA?
conservative sedation (may use dexmedetomidine), extensive airway assessment, STOP BANG, regional when able, use ramp, CPAP during preoxygenation, use short acting agents, have another provider available
What are some considerations when preparing to extubate an obese patient with OSA?
use CPAP, avoid opiates, anticipate longer monitoring in PACU
What is non-alcoholic fatty liver disease?
excess of intrahepatic triglycerides, impaired insulin activity, and release of inflammatory cytokines as a result of obesity–> leads to destruction of hepatocytes and disruption of hepatic physiology
Patients with nonalcoholic fatty liver disease are at increased risk for?
cardiovascular disease and diabetes, cirrhosis
What is the concern in those with OHS/Pickwickian syndrome?
even light sedation can cause complete airway collapse/respiratory arrest
What endocrine disorder is characterized by insulin deficiency, young onset, autoimmune, and destruction of beta cells?
Type 1 diabetes
what endocrine disorder is characterized by relative insulin deficiency, insulin resistance, impaired insulin secretion, and excessive hepatic glucose production?
Type 2 diabetes
What endocrine condition is characterized by rapid onset, ketosis, hypoveolemia, and is precipitated by acute illness and stress?
DKA
How is HHS different than DKA?
no ketosis, more often with T2DM, slower onset
What endocrine disorder is characterized by abdominal pain and distention, N/V, fever, dehydration, hypotension, hypocalcemia, renal failure and pleural effusion?
acute pancreatitis
What are some causes of acute pancreatitis?
GB disease, ETOH, trauma, elevated lipids and calcium, infection, drugs, ERCP, abdominal and cardiac surgery
What endocrine disorder is characterized by steatorrhea, pancreatic calcifications, and DM?
chronic pancreatitis
What are some causes of chronic pancreatitis?
chronic ETOH use, chronic biliary tract disease, pancreatic injury
What endocrine disorder is characterized by vague symptoms such as pain, anorexia, weight loss, fatigue, and biliary tract obstruction?
pancreatic tumors
What are some characteristics of insulinomas?
tumor of beta cells, causes increased insulin secretion and hypoglycemia
What are some characteristics of gastrinoma (Zollinger-Ellison syndrome)?
causes hypersecretion of gastrin and gastric ulcer disease
What endocrine disease did JFK have?
Addison’s
What is DI?
neurogenic- inadequate secretion of ADH from posterior pituitary
nephrogenic- resistance to ADH in renal tubules
What are symptoms of DI?
polydipsia, hypernatremia, high output of poorly concentrated urine, hypovolemia
What are some causes of DI?
intracranial trauma, infiltrating lesions, surgery, damage to kidney
What is SIADH? What are the symptoms?
excessive ADH; dilutional hyponatremia, decreased serum osmolality, decreased uo with high osmolality
What are some etiologies of hyperthyroidism?
Graves disease (most common- overproduction of TH), benign follicular adenomas, thyrotoxicosis (usually iatrogenic from excessive iodine)
What are some etiologies of hypothyroidism?
primary hypothyroidism, autoimmune (Hashimoto’s), secondary hypothyroidism (pituitary or hypothalamic disorder)
What is Graves characterized by?
diffuse glandular enlargement, exopthalmos, skin disorders, clubbed fingers
What is the difference between a “hot” and “cold” thyroid adenoma?
hot- produces excessive TH
cold- does not
What are some less common causes of hyperthyroidism?
pregnancy, iodine therapy, TSH secreting pituitary adenomas, TH replacement, iodide exposure (radiocontrast dye), amiodarone
What are s/s of hyperthyroidism?
hypermetabolic state, tachycardia, weight loss, tremors, difficulty sleeping, fatigue, muscle weakness, heat intolerance, exopthalmos, goiter
What is thyroid storm?
acute stress in hyperthyroidism- causes tachycardia, hyperthermia, hypercarbia, HTN, dysrythmias, CHF, sweating, agitation (can be confused with MH)
What are s/s of hypothyroidism?
weakness, fatigue, weight gain, puffy appearance (myxedema), dry skin, cold intolerance, coarse brittle hair and nails, slow mental function, loss of lateral 1/3 of eyebrows
What are CV effects of hypothyroidism?
vasoconstriction, hypertension, bradycardia, dysrhythmias, cardiomegaly, CHF, labile BP
What are patients with hypothyroidism at risk for?
effusions of pleura, pericardium, and peritoneum
What is myxedema coma?
end stage of severe hypothyroidism, hypothermia, hypoventilation, hyponatremia–> coma
What is hypoparathyroidism and what is it caused by?
inadequate secretion of PTH or resistance to its effect (parathyroidectomy, gland injury, chronic Mg deficiency)
What are some s/s of hypoparathyroidism?
restlessness, Chvostek’s and Trousseau sign, stridor (laryngospasm)
Hypoparathyroidism may be a transient effect after?
renal transplant
What is the most common cause of chronic hypoparathyroidism? What are s/s?
chronic renal failure; fatigue, cramps, prolonged QT, lethargic, cataracts, personality changes, skull thickening, candida infections, impaired clotting
, What is primary hyperparathyroidism caused by? What are the s/s?
adenoma, hyperplasia, cancer; bone demineralization, increased alk phos, pancreatitis, kidney stones, HTN, dysrhythmias, ulcers, lethargy, confusion, N/V, hyperchloremic metabolic acidosis, polyria, renal stones
What does the anterior pituitary secrete?
FSH, LH, ACTH, GH, TSH, M(o)SH, prolactin (“FLAT PeG”)
What does the posterior pituitary secrete?
ADH and oxytocin
What can a deficiency in growth hormone cause?
dwarfism
What can an excess in growth hormone cause?
acromegaly, gigantism (before puberty)
What is primary aldosteronism (Conn’s syndrome)?
mineralcorticoid (aldosterone) excess from hyperplasia or carcinoma; characterized by HTN and hypokalemia
What is Cushing’s disease?
glucocorticoid (cortisol) excess from overproduction by adrenal cortex or exogenous administration; results in muscle atrophy, central obesity, moon face, striae, weakness
What is Addison’s disease?
primary adrenocortical insufficiency due to destruction of adrenal glands- characterized by wasting, hyperpigmentation, fagitue, weight loss, hypoglycemia, hyponatremia
