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35 Cards in this Set
- Front
- Back
Name differential dx in someone presenting with headache, HTN, elevated RR, BP, HR
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Pheo, hypo/hyper glycemia, MI, thyroid storm, HTN, stroke
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What is the normal percent of circulating epi to norep?
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80% and 20%
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What is the ratio of circulating catecholamines in pheochromocytomas?
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9:1, more norepi
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Name the symptom triad found in pheo
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headache, diaphoresis, tachycardia
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What is the conclusive (but subjective) test for pheo
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elevated plasma norepi
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What is another test for pheo?
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24 hr urine for metanephrines. 95% of pheo have increased levels. If elevated, test for free catecholamines. If all 3 negative, - pheo.
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What drug can be given to test for pheo?
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Clonidine bc of A2 antagonism. If BP doesn't go down= + pheo
Also phentolamine (regitan) |
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What is MIBG scintography?
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test where dye will concentrate in cromaffin cells bc of similarity to NE. 85% sensitive, 97% specific
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What drug must be stopped 1-2 weeks before pheo removal?
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MAOI- blocks breakdown of dopamine and norepi.
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Name minimul preoperative criteria for pheo surgery
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BP <160/90 for 48 hrs before surgery, no ST changes for 1 wk, no more than 1 PVC/5 mins
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What to avoid during pheo surgery
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histamine releasing drugs, possibly Des, pancuronium, droperidol (toursades) ketamine, narcan, succ contraversial d/t catecholamine release
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Name possible anesthetic plan for pt with pheo surg
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GETA + epidural, preoperative benzos, deep induction for DL, succ contraversial, use of nitroprusside, narcotics.
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What do you anticipate post tumor removal?
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hypo/hyperglycemia, hypotension treated with direct A1 agonist, HTN if residual catecholamines
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Name S/S of Cushing's disease
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Truncal obesity, thin extremities, buffalo hump, osteopenia, hyperglycemia, HTN from fluid overload, emotional liability, increased risk of infection
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Name S/S of Addison's
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primary adrenal insufficiency- skeletal muscle weakness, hypoglycemia, hemoconcentration, wt loss, hypotension, dehydration, needs steroid dose before surgery
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Characteristics of T3 and T4
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T3- more potent, in peripheral tissues
T4- more in circulation overall, less potent |
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Drugs used in hyperthyroidism
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Thioamindes to inhibit thyroid peroxidase, PTU, methimazole. Iodides inhibit production and release of thyroid hormone. T3 and T4 because of negative feedback mechanism
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What is the role of beta blockade in hyperthyroidism?
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Inhibits peripheral conversion of T4 to T3 and decreases tachycardia associated with increased SNS activity
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What is the role of corticosteroids in hyperthyroidism?
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Inhibits TSH and peripheral conversion of T4 to T3
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Name intraoperative considerations during thyroidectomy
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thiopental (dose dependent antithyroid activity), propofol, etomidate, (no ketamine), positioning, des contraversial, N20 ok, DL can cause ball valve obstruction
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Name S/S of thyroid storm
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hyperthemia, tachycardia, tachydysrythmias, altered mentation (part of differential)
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Name causes of thyroid storm
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6-18 hrs postop. Precipitating factors- infection, surgery, DKA, CHF, pregnancy, extreme stress.
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What disease is thyroid storm linked to?
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Non-euthyroid preoperative Grave's disease
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Name differential dx of MH
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hyperthermia, tachycardia, HTN, hypercarbia, elevated CO2, Masseter spasm
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Name differential dx of thyroid storm
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hyperthermia, tachycardia, tachydysrythmias, HTN, altered mentation
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Name differential dx of pheo
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Tachycardia, paroxysmal HTN, headaches
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Why is ASA dangerous in thyroid storm?
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Displaces thyroid hormone from protein and increases circulating free levels
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Name postoperative complications of thyroidectomy
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RLN damage, acute hypoglycemia (parathyroid removal), pneumo, hematoma (airway compression, especially in tracheomalacia)
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Name S/S hypothyroidism
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lethargy, cold intolerance, decreased CO and HR, peripheral vasoconstriction, decreased platelet adhesion, anemia, impaired renal concentration, adrenal cortex suppression
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Preop concerns of hypothyroidism
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low cardiac reserve and stress response, possible CV collapse with CHF, down regulation of baroreceptors, chronic hypovolemia, more sensitive to hypotension causing meds, less response to hypoxia and hypercapnea, delayed gastric empyting
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anesthetic concerns of hypothyroidism
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anemia, hypothermia, low dose induction agent with no change in MAC, delayed emergence from low drug metabolism. Respond weill to direct acting agents when treating hypotension
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Myxedema coma
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Extreme hypothyroidism, impaired mentation, hypoventilation, hyponatremia, CHF, hypoglycemia, may have bowel obstruction. 80% mortality
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Hyperparathyroidism
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adenoma, CA, hyperplasia of parathyroid that causes hypersecretion. Hypercalcemia= kidney stones, confusion, HTN, arrythmias
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What is amitiza?
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prokinetic with no anticholinergic effects
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Transphenoidal Adenohypophysectomy
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Possiblity of DI,steroid prep, Rae tube, mouth pack, avoid hyperventilation, mannitol, and N20, awake extubation
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