Endocrine Anesthesia MCQs

8/10/2019 Endocrine Anesthesia MCQs

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what test must be done prior to radial artery catheter

placement in a pt with acromegaly? Why?

Allens test- carpal ligament enlargement may cause

inadequate ulnar artery flow

Pre-op workup of acromegalic patient reveals

impairment of adrenal and/or thyroid axis What should

be implemented in perioperative period?

stress-level glucocorticoid therapy ! thyroid replacement

What two important peptide hormones does the posterior

pituitary hormone secrete?

A"# $%asopressin&

'xytocin

What is the function of A"#?A"# controls water excretion and reabsorption in the kidney

and is a ma(orregulator of serumk osmolarity

What effect does A"# have on renal collecting ducts? "ecreases permeability

What stimulates the release of A"#? )a and plasma osmolality

What effect does A"# have on the vasculature? Potent vasoconstriction

What effect does A"# have on blood volume? *ncreases

#ow does A"# affect hemostasis? promotes hemostasis by increasing vW+ and +%***

Will A"# release be increased, decreased or unchanged

in the perioperative period?

*ncreased "/ stress, hemmorrhage, anemia, medications,

hypotension

What is diabetes insipidus? $"*&

what are the two types?

)eurogenic "*-*nadequate A"# secretion from the posterior

pituitary

)ephrogenic "*-inability of renal collecting duct tubule

receptors to respond to A"#

What are causes of "*?

genetic,

hypercalcemia

hypokalemia

medication-induced nephrotoxicity.'#

What perioperative management will be taken with "*?

electrolyte evaluation

volume status-0'W restoration of volume pre-op $12-23

hrs&

What is *A"#?#igh vasopressin level despite hyponatremia and plasma

hypotonicity

What are clinical manifestations of *A"#? cerebral edema-4lethargy, #/A, )/%, sei5ures coma

#ow is *A"# managed? 6ild *A"#7 fluid restriction)a899:7 0'W *% infusion of hypertonic saline $no more

than :-;m.q/hr&

What negative sequelae may result from rapid infusion

of hypertonic saline?


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What is the effect of alkalosis on >?Alkalosis $think hyperventilation& reduces ioni5ed > by

allowing more to bind with proteins

What three hormones work in concert to regulate the

plasma concentratin of calcium?

%it "

Parathyroid #ormone $P#&

? decreases >

#ow does a decreased P# affect nerve function?decreased > -4 lowered threshold potential-4neuromuscular excitability-4muscle spasm and tetany

What sx will be seen in hypocalcemia?

variable severity7 cramps, perioral perissthesias, numbness in

feet or toes, hyperactive deep tendon reflexes

Acute laryngeal muscle spasm-4stridor

What are two classic manifestations of latent

hypocalcemia?


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#LP.GHbone pain, pathologic fx, muscle weakness,

Jatrophy

#LP'H)6 excitability

).MG'0'I*

What is necessary for aldosterone secretion but has little

effect in controlling the rate of secretion?A


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What are the causes of


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What two drugs can cortisol be inhibited by? etomidate, ketocona5ole

When is addsisons disease apparent?usually not until @= of adrenal cortex has been destroyed

ometimes pt is in crisis when medical attention if sought

signs and symptoms of addisons disease are?

severe fatique and weakness, loss of weight, increased

pigmentation of skin, faintness and low bp, nausea andvomiting, abdominal pain, salt cravings, cravings for licorice,

painful muscles and (oints, mouth leasions on the inside of

cheek

What causes secondary addisons disease?

most cases secondary hormone control is still maintained

can be caused by pituitary problem

can be caused by long term dose steroid drugs which cause

temporary or permanent loss of adrenal function

What are signs and symptoms of addisons crisis?

sudden penetrating pain in lower back, abdomen, or legs

severe nausea and vomiting

dehydrationlow bp

loss of consciousness

difficulty breathing

reatment of addisons disease is? hydrocortisone

#ydrocortisone 1@mg is equal to what in other steroids?


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Gare catecholamine secreting tumors derived from

chromaffin cells of the embryonic neural crest?pheochromocytoma

Where do pheos arise? #ow about PI0s or

paragangliomas?

Pheos arise from adrenal medulla

PI0s are from adomen, pelvis, thorax, and neck

What produces significant amounts of catecholaminesand give rise to the classic P#.' clinical picture?

adrenal and extra adrenal paragangliomas$PI0&

What rarely produce signifant amounts ofcatecholamines?

parasympathetic PI0 of head and neck

*n -1F= of cases of pheo, the tumors develop from

what?

"evelop from extra adrenal chromaffin tissue and are referred

to as PI0

6alignant Pheos account for what percentage ? 1-F:=

About 9@= of pts with P#.'s present with what at

inital workup?metastatic disease

What is 6.) 9?

Austosomal dominant syndrome characteri5ed by primary

hyperparathyrodism, pancreatic islet cell neoplasms, andpituitary adenomas

When 6.)9 is associated with P#.'s what are the

manifestations?

rarely associated

all unilateral

rarely malignant

most characteri5ed by #)

Predominant ). production


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What are safe medications to use with Pheos

mida5olam

etomidate

propofol

lidocaine

fentanyl

sufentanil

remifentanil

nitrous

isosevo

vec

roc

cistacurium

What drugs to avoid with Pheos?morphine,atracurium, atropine, pan, ketamine, ux,

halothane, droperidol, reglan, des

What are the periods of greatest danger intraoperative

with Pheos?

*nduction, *ntubation

exploration of tumor

after venous ligation of tumor

Preferred method of removal of Pheo tumors is? 0aproscoptic

Cenefits of 0aproscoptic tumor removal of Pheo tumors?

shorter hospital stay and recovery time

decreased requirements for analgesics

cosmetically better result

yndrome that occurs from tumors that may occur in

small intestine, colon, bronchial tubes, or appendix

hese are from enterochromaffin cells

carcinoid tumor

Endocrine Anesthesia MCQs

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