Ap Ii Diabetes

Front 1

AP II DIABETES

Back 1

AP II DIABETES

Front 2

What is the pathophysiology of hyperthroidism?

Back 2

Excessive secretion of T3, T4 or both.

Front 3

Causes of hyperthyroidism?

Back 3

1. Graves disease
2. TSH secreting pituitary tumors
3. iatrogenic
4. thyroiditis

Front 4

Symptoms of hyperthyroidism?

Back 4

1. wt. loss
2. fatigue
3. arrhythmias
4. anxiety

Front 5

Treatment of hyperthyroidism?

Back 5

1. medical: antithyroids, beta antagonists
2. surgical: thyroidectomy

Front 6

Thyrotoxic crisis

Back 6

Hyperthyroidism caused by trauma, infection, or surgery.

Front 7

When does thyrotoxic crisis usually appear?

Back 7

In post-op period

Front 8

Symptoms of thyrotoxic crisis?

Back 8

1. anxiety
2. fever
3. tachycardia
4. cardiovascular instability

Front 9

Treatments of thyrotoxic crisis?

Back 9

1. immediate--> supportive
2. decrease circulating hormone levels.

Front 10

Hypothyroidism pathyphysiology

Back 10

1. primary: destruction of thyroid tissue.

2. hypothalamic-pituitary axis dysfunction.

Front 11

Symptoms of hypothyroidism?

Back 11

1. lethargy
2. wt. gain
3. cold intolerance
4. hypoactive reflexes

Front 12

Treatment?

Back 12

PO T4 (synthroid)

Front 13

What are the perioperative considerations?

Back 13

.




.

Front 14

Function of parathyroid hormone?

Back 14

1. increases serum Ca
2. dec. serum PO4

NOTE: there are 4 small glands

Front 15

Pathophysiology of hyperparathyroidism?

Back 15

1. primary: adenoma, carcinoma, hyperplasia of parathyroid glands.

2. secondary: compensatory inc. in PTH secretion due to hypocalcemia (by renal disease or GI malabsorption).

Front 16

Symptoms of hyperparathyroidism?

Back 16

1. renal stones
2. hypertension
3. constipation
4. fatigue

NOTE: usually due to hypercalcemia

Front 17

Tx of hyperparathyroidism?

Back 17

Medical or surgical

Front 18

Pathophysiology of hypoparathyroidism?

Back 18

1. decreased PTH

NOTE: almost always iatrogenic)

Front 19

Symptoms of hypoparathyroidism?

Back 19

From hypocalcemia

Front 20

NOTE: hypercalcemia's effect on the body?

Back 20

1. skeletal muscle weakness
2. kidney stones
3. anemia
4. systemic HTN
5. vomiting
6. peptic ulcer
7. calcifications in ocular region

Front 21

Chvostek's Sign

Back 21

Due to hypocalcemia

Abnormal rxn to stimulation of Facial Nerve.

Front 22

Trousseau's sign

Back 22

Due to hypocalcemia also.

Spasm of the hand and forearm.

Front 23

Hypoplasia

Back 23

Incomplete development of tissue or organ.

Front 24

Pathyophysiology of DiGeorge syndrome

Back 24

Hypoplasia/aplasia of parathyroid and thymus

Congenital thymic hypoplasia

Front 25

What does the adrenal cortex synthesize?

Back 25

1. glucocorticoids (cortisol)
2. minerocorticoids (aldosterone)
3. androgens

Front 26

What does the adrenal medulla synthesize?

Back 26

NorEpi

Epin

Dopamine

Front 27

Glucocorticoid excess and its pathyophysiology

Back 27

1. Cushing's syndrome

2. excessive cortisol

Front 28

Symptoms of glucocorticoids excess:

Back 28

1. obesity
2. HTN
3. muscle wasting and weakness
4. glucose intolerance

Front 29

Treatment of glucocorticoids excess?

Back 29

1. radiotherapy

2. transsphenoidal resection

Front 30

Pathophysiology of Primary Hyperaldosteronism (Conn Syndrome)

Back 30

Excessive secretion of aldosterone usually by tumor.

Front 31

Symptoms of Conn Syndrome?

Back 31

1. headache
2. muscle cramps
3. metabolic alkalosis

Front 32

Pathophysiology of adrenocorticoid deficiency?

Back 32

1. primary--> Addison's dz

2. secondary--> cortisol deficiency with normal aldosterone).

Front 33

Symptoms of adrenocorticoid deficiency?

Back 33

1. hypotension
2. hyponatremia
3. hypovolemia
4. hyperkalemia
5. fatigue

Front 34

Treatment?

Back 34

Steroid adm.

Front 35

Pathophysiology of pheochromocytoma?

Back 35

Catecholamine secreting tumor of adrenal medulla

Front 36

Symptoms of pheochromocytoma?

Back 36

1. sudden onset of malignant HTN.
2. cardiac dysrhythmias
3. headache
4. perspiration

Front 37

Tx?

Back 37

Excision

Front 38

Periop considerations?

Back 38

Hemodynamic instability

Front 39

Cause of acromegaly?

Back 39

Excessive GH

Front 40

Diabetes Insipidus pathophysiology?

Back 40

Deficiency or resistance of vasopressin (ADH).

Front 41

Symptoms of DI?

Back 41

1. extreme thirst
2. excessive urination

Front 42

Cause of Diabetes Mellitus

Back 42

Caused by abnormal glucose metabolism.

Front 43

Innervation causing insulin inhibition?

Back 43

Sympathetic T5-T10

Front 44

Innervation causing insulin release?

Back 44

Parasympathetic via vagus

Front 45

Effects of insulin

Back 45

1. inc glucose uptake by cells or decrease blood glucose.
2. inc glycogen synthesis
3. inc protein synthesis and storage.
4. inc fath synthesis and storage
5. dec gluconeogenesis

Insulin favors storage over making new glucose.

Front 46

Effects of glucagon

Back 46

1. inc glucose output from liver
2. inc glycogenolysis
3. inc gluconeogenesis (from a.a)
4. inc adipose cell lipase

Basically, it favors making new glucose over storage.

Front 47

Causes of DM?

Back 47

1. dec. secretion of insulin from beta cells (Type I)
2. inc. resistance of receptors to insulin (Type II)

NOTE:
5-10% are of TYPE I

90% TYPE II

2-3% Gestational

Front 48

Symptoms of DM?

Back 48

1. polyurea
2. polydypsia (thirst)
3. polyphagia (excessive hunger)
4. wt loss
5. asthenia (weakness)
6. sweet breath
7. genital pruritis
8. vision impairment

Front 49

Long term complications of DM?

Back 49

1. HTN
2. CAD
3. MI
4. CHF
5. diastolic dysfunction
6. vascular disease
7. neuropathy
8. renal failure

Front 50

Acute complications of DM?

Back 50

1. diabetic ketoacidosis (DKA)
2. hyperosmolar nonketotic coma
3. hypoglycemia

Front 51

End Organ Pathology on heart due to DM?

Back 51

1. CHF
2. CAD

Front 52

End Organ Pathology on vasculature due to DM?

Back 52

HTN

Atherosclerosis

Front 53

End Organ Pathology on kidneys due to DM?

Back 53

Dec. GFR

Front 54

Other End Organ Pathology on due to DM?

Back 54

1. bladder
2. GI
3. eyes
4. lower extremeties
5. joints

Front 55

What is the cause of diabetic ketoacidosis (DKA)?

Back 55

Dec. insulin activity--> metabolism of FA--> accum. of organic acids by products.

Front 56

Clinical signs of DKA?

Back 56

1. tachypnea
2. abdominal pain
3. fatigue
4. polyuria
5. N/V
6. altered mental status

Front 57

Tx?

Back 57

No Lactated Ringer

Front 58

What is Hyperosmolar Nonketotic Coma?

Back 58

Hyperglycemic diuresis that results in dehydration and hyperosmolality.

Front 59

Symptoms of hyperosmolar nonketotic coma?

Back 59

1. high blood sugar
2. thirst

Front 60

Tx?

Back 60

1. insulin
2. hypotonic saline

Front 61

Causes of hypoglycemia?

Back 61

Caused by insulin > Carbo intake

blood glucose < 50 mg/dL

Front 62

Treatment for hypoglycemia?

Back 62

D50 IV with glucose

Front 63

Drug therapy in DM?

Back 63

Insulin: IV

Oral hypoglycemics

Front 64

Oral hypoglycemics

Back 64

Treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of insulin, exenatide, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents.

Front 65

Treatment for Type II?

Back 65

1. agents that would increase release of insulin.
2. agents ... inc. receptor sensitivity.
3. agents... dec absorption rate of glucose from GI tract.

Front 66

INTRAoperative control of serum glucose?

Back 66

Start treating at > 150 mg/dL

Front 67

Bolus adm for Tx of DM during preop?

Back 67

D5W (1.5 cc/kg/hr) + NPH insulin (half the usual AM dose)

Front 68

Bolus adm for Tx of DM during intraop?

Back 68

Regular insulin

1 Unit will lower plasma glucose by 25-30 mg/dL

Front 69

Bolus adm for Tx of DM during postop?

Back 69

Same as intraop

Front 70

Continuous infusion for Tx of DM during preop?

Back 70

D5W (1cc/kg/hr) + regular insulin

1U/hr = plasma glucose/150

Front 71

Continuous infusion for Tx of DM during intraop?

Back 71

Same as preop

Front 72

Continuous infusion for Tx of DM during postop?

Back 72

Same as preop