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Flashcards in Endocrine Deck (40)
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1

What are common GU complications associated with diabetes?

nephropathy
glomerulonephritis
chronic renal failure

2

What are some common GI symptoms associated with diabetes?

gastroparesis
nocturnal diarrhea

3

What are some common CNS complications of diabetes?

strokes
paresthesias
autonomic and peripheral neuropathy

4

What are some common CV complications related to diabetes?

HTN
CAD
cardiomyopathy
retinopathy

5

What are some common miscellaneous complications associated with diabetes?

*hint: musculoskeletal and immune

joint stiffness and infections

6

What are some signs and symptoms of autonomic neuropathy?

resting tachycardia
loss of HR variability
orthostatic hypotension
altered regulation of breathing
sudden death syndrome

7

Why might it be useful to obtain a hemoglobin A1C level?

glucose binds to an RBC for its lifespan and so results of this lab test may tell you about average glucose control over the last 90 days in a patient who has labile blood sugars currently

8

Why might "stiff joint syndrome" pose a difficulty to the anesthesia provider?

TMJ, atlanto-axial joint, other cervical spine joints, etc. may all be affected and could create a difficult airway

9

How can the CRNA assess for stiff joint syndrome in a Type 1 diabetic?

ask the patient to attempt "prayers sign". if they cannot completely close their hands together, it may be a sign of cervical spine immobility and would possibly require an awake fiberoptic intubation

10

What are some questions the CRNA could ask about insulin use?

have you taken your oral hypoglycemic or insulin the day of surgery?
how often do you check your blood sugar?
will the patient require an insulin drip during the procedure?
should we have a glucose containing IV solution hanging?
how will the blood sugar be managed post-op?
do you have an insulin pump?

11

What are the signs and symptoms of DKA?

N/V, lethargy, dehydration, abdominal pain, fruity breath, kussmaul's breathing, coma

12

What are the signs and symptoms of cushing's disease?

thickening of facial fat
moon face
hump on back
increased body hair
hyperglycemia
hypertension
decreased libido
amenorrhea
skeletal muscle wasting
depression

13

What are the anesthetic considerations for managing a patient with Cushing's disease?

manage HTN intra op and plan for blood loss (get type and screen)
careful with fluid overload r/t activation of RAA
may be treated with lasix so monitor K+ levels
careful control of hyperglycemia intra op
monitor for metabolic alkalosis and electrolyte changes

14

What are the signs and symptoms of Addison's disease?

tan skin
hyperkalemia, hyponatremia
hypovolemia
hypotension
weight loss
muscle weakness
abdominal and back pain
hypoglycemia

15

What are the anesthetic considerations when managing a patient with Addison's disease?

carefully monitor for hypotension

plan to give exogenous steroids, and should take home dose the day of the procedure.

16

What are some common clinical manifestations of diabetes?

polydypsia
polyuria
polyphagia
weight loss
recurrent infections
visual changes
paresthesias
lethargy and fatigue

17

What is an example of a stress steroid dose?

minor surgery - 25 mg hydrocortisone

major surgery - 100 mg hydrocortisone q8h x 3

18

What are the CRNAs concerns when caring for a patient with Conn's disease?

severe systemic HTN with diastolic BPs over 100 which may be resistant to treatment

hypokalemia and muscle weakness are other symptoms that may warrant close monitoring of electrolytes and a lowered dose of NMB.

19

What are the symptoms of a pheochromocytoma?

headache, diaphoresis, palpitations

*also associated with anxiety, tremor, pallor, chest pain, epigastric pain, flushing, etc.

20

How can you treat a patient with a pheochromocytoma?

combined alpha and beta block (alpha 1st to prevent CV collapse)

restore fluid volume

restore insulin release with an alpha block

21

Give examples of some of the drugs that you may use to treat pheochromocytoma patients?

alpha block - phentolamine, phenoxybenzamine, prazosin

beta block - propranolol, atenolol, esmolol

alpha + beta blocker - labetalol

22

How is primary hyperparathyroidism diagnosed?

serum calcium greater than 5.5, often presents as kidney stones

*high Ca++ > 7.5 mEq/L is usually indicative of cancer

23

What are the signs and symptoms of hyperparathyroidism?

skeletal muscle weakness, polyuria and polydipsia, anemia, prolonged PR interval, short QT interval, systemic HTN, vomiting, abd pain, pathologic fractures, decreased pain sensation

24

Describe the medical management for hypercalcemia associated with hyperparathyroid.

NS infusion at 150 mL/hr
loop diuretics to inhibit Ca++ reabsorption
biphosphonates - prevent osteoclast action
hemodialysis for life threatening Ca++ increase
mithramycin - inhibits osteoclasts but can cause thrombocytopenia and renal toxicity

25

How is hypoparathyroidism diagnosed?

serum calcium less than 4.5 or ionized calcium less than 2

26

What are the signs and symptoms of acute hypoparathyroidism?

oral parasthesias
restlessness
neuromuscular irritability
Chovstek and Trousseau's sign
airway stridor

27

What are the signs and symptoms of chronic hypoparathyroidism?

fatigue
muscle cramps
prolonged QT interval
lethargy
personality changes

28

What is Chvosteks sign?

tapping on the facial nerve and eliciting a muscle twitch when the patient has hypocalcemia

29

What is trousseau's sign?

compression of the forearm in a patient with neuromuscular irritability associated with low Ca++ will cause muscle spasm in the hand and wrist

30

What is the treatment of hypoparathyroidism?

10% calcium gluconate until neuromuscular irritability dissipates

thiazide diuretics to increase serum Ca++ concentration