AHN 552 Endo Exam Latest Update
Medication that can be used preoperatively and intraoperatively for hypertensive crisis -
ANSWER Nitroprusside
Clinical scenarios where pheochromocytoma should be considered - ANSWER
malignant htn
poor response to antihypertensives
Htn during induction of anesthesia
In a pt that has neurofibromatosis
Diagnostic imaging for locating pheochromocytomas - ANSWER Ct Abdomen
S/s of pheochromocytoma - ANSWER HA,
HTN,
Perspiration
heart palpitations
anxiety
Treatment of choice for a pheochromocytoma - ANSWER Surgical resection
Side effects of long-term steroid use - ANSWER HTN,
Weight gain,
reactivation of infection
metabolic abnormalities
osteoporosis
eyes (glaucoma, cataracts)
peptic ulcer
suppression of hypothalamic-pituitary-adrenal axis
prophylactic measure and monitoring for long-term steroid use - ANSWER Blood
pressure (baseline; repeat with each visit)
Weight (baseline; repeat with each visit)
, Purified protein derivative or interferon-gamma release assay; hepatitis screen;
consider Pneumocystis jiroveci pneumonia prophylaxis
Electrolytes, lipids, glucose (baseline; repeat early after starting therapy; repeat
annually; more frequent monitoring with known factors [eg, diabetes, hyperlipidemia])
Refer for ophthalmologic evaluation and consider more frequent screening if history of
cataracts or glaucoma
Single, early morning doses, preferably every other day
GI ulcer prophylaxis in steroid therapy - ANSWER In patients on concomitant
nonsteroidal antiinflammatory drugs, initiate prophylaxis with a proton pump inhibitor;
with 2 or more risk factors, consider prophylaxis with proton pump inhibitor
Screening for prior to starting beginning long-term steroid use - ANSWER Bone density
(baseline; repeat annually); instruct about diet, exercise; initiate calcium and vitamin D
supplementation; start bisphosphonate for men, postmenopausal women based on bone
mineral density evaluation
S/S of DKA - ANSWER drowsiness, stuporous, rarely frank coma, rapid deep breathing
(Kussmaul) with "fruity" odor, hypotension with tachycardia, possibly abdominal pain.
Usually preceded by a day or more of polyuria and polydipsia with marked fatigue and
N/V
S/s of HHS - ANSWER Hyperglycemic hyperosmolar syndrome (HHS) is a
life-threatening complication of diabetes mellitus characterized by marked
hyperglycemia >600, dehydration, electrolyte derangements, and hyperosmolality with
or without mental obtundation, all in the absence of significant ketoacidosis. The main
drivers of HHS are extreme hyperglycemia and resultant osmotic diuresis.
diagnostic criteria for DM - ANSWER o Fasting blood glucose levels >126 on 2 occasions
different days
o Random plasma glucose level >200 with symptoms
o 2-hour OGTT 75g glucose load with a glucose level > 200
o A1C > or equal 6.5
How to calculate serum osmolality - ANSWER mOsm/kg= 2(NA) + Glucose/ 18
treatment for DKA - ANSWER •Hydration: initially NS as soon as diagnosis established at
1 L/hr for first 2 liters then 300-400 mL/h. If serum Na >150*, use ½ NS
•Insulin: Initially 0.1 unit/kg bolus then 0.1 unit/kg/h continuously infused or given hourly
IM. Run it as an IVPB to fluids.
•Give KCl in doses of 10-30 mEq/h should be infused during the second and third hours
after beginning therapy as acidosis begins to resolve
Medication that can be used preoperatively and intraoperatively for hypertensive crisis -
ANSWER Nitroprusside
Clinical scenarios where pheochromocytoma should be considered - ANSWER
malignant htn
poor response to antihypertensives
Htn during induction of anesthesia
In a pt that has neurofibromatosis
Diagnostic imaging for locating pheochromocytomas - ANSWER Ct Abdomen
S/s of pheochromocytoma - ANSWER HA,
HTN,
Perspiration
heart palpitations
anxiety
Treatment of choice for a pheochromocytoma - ANSWER Surgical resection
Side effects of long-term steroid use - ANSWER HTN,
Weight gain,
reactivation of infection
metabolic abnormalities
osteoporosis
eyes (glaucoma, cataracts)
peptic ulcer
suppression of hypothalamic-pituitary-adrenal axis
prophylactic measure and monitoring for long-term steroid use - ANSWER Blood
pressure (baseline; repeat with each visit)
Weight (baseline; repeat with each visit)
, Purified protein derivative or interferon-gamma release assay; hepatitis screen;
consider Pneumocystis jiroveci pneumonia prophylaxis
Electrolytes, lipids, glucose (baseline; repeat early after starting therapy; repeat
annually; more frequent monitoring with known factors [eg, diabetes, hyperlipidemia])
Refer for ophthalmologic evaluation and consider more frequent screening if history of
cataracts or glaucoma
Single, early morning doses, preferably every other day
GI ulcer prophylaxis in steroid therapy - ANSWER In patients on concomitant
nonsteroidal antiinflammatory drugs, initiate prophylaxis with a proton pump inhibitor;
with 2 or more risk factors, consider prophylaxis with proton pump inhibitor
Screening for prior to starting beginning long-term steroid use - ANSWER Bone density
(baseline; repeat annually); instruct about diet, exercise; initiate calcium and vitamin D
supplementation; start bisphosphonate for men, postmenopausal women based on bone
mineral density evaluation
S/S of DKA - ANSWER drowsiness, stuporous, rarely frank coma, rapid deep breathing
(Kussmaul) with "fruity" odor, hypotension with tachycardia, possibly abdominal pain.
Usually preceded by a day or more of polyuria and polydipsia with marked fatigue and
N/V
S/s of HHS - ANSWER Hyperglycemic hyperosmolar syndrome (HHS) is a
life-threatening complication of diabetes mellitus characterized by marked
hyperglycemia >600, dehydration, electrolyte derangements, and hyperosmolality with
or without mental obtundation, all in the absence of significant ketoacidosis. The main
drivers of HHS are extreme hyperglycemia and resultant osmotic diuresis.
diagnostic criteria for DM - ANSWER o Fasting blood glucose levels >126 on 2 occasions
different days
o Random plasma glucose level >200 with symptoms
o 2-hour OGTT 75g glucose load with a glucose level > 200
o A1C > or equal 6.5
How to calculate serum osmolality - ANSWER mOsm/kg= 2(NA) + Glucose/ 18
treatment for DKA - ANSWER •Hydration: initially NS as soon as diagnosis established at
1 L/hr for first 2 liters then 300-400 mL/h. If serum Na >150*, use ½ NS
•Insulin: Initially 0.1 unit/kg bolus then 0.1 unit/kg/h continuously infused or given hourly
IM. Run it as an IVPB to fluids.
•Give KCl in doses of 10-30 mEq/h should be infused during the second and third hours
after beginning therapy as acidosis begins to resolve
