Neuro Endocrine Quiz: Anesthetic Implications of Pituitary Diseases, Exercises of Pathology

Download Neuro Endocrine Quiz: Anesthetic Implications of Pituitary Diseases and more Exercises Pathology in PDF only on Docsity! Verghese Cherian, MD, FFARCSI Penn State Hershey Medical Center, Hershey, PA Neuro Quiz 21 START This quiz is being published on behalf of the Education Committee of the SNACC Quiz Team Shobana Rajan, M.D; Suneeta Gollapudy, M.D, Angele Marie Theard, M.D 1. Which of the following are due to endocrine hypo-secretion secondary to pituitary disease? A. Addison’s disease B. Graves disease C. Diabetes Insipidus D. Galactorrhea Next Question 1 C. Diabetes insipidus Diabetes Insipidus (DI) results due to failure of Anti-Diuretic Hormone secretion ADH or Vasopressin is a peptide hormone that increases water permeability of the kidney's collecting duct and distal convoluted tubule by inducing translocation of aquaporin, water channels in the plasma membrane of collecting duct cells Desmopressin, a synthetic analogue of ADH, longer half-life and lacking the vasoconstrictor action, is used to treat DI NEXT Back to Question 1 D. Galactorrhea Hyper-prolactinemia causes galactorrhea and menstrual dysfunction in women and hypogonadism, reduced libido and erectile dysfunction in men Treatment of hyper-prolactinemia is dopamine agonists, such as bromocriptine & cabergoline INCORRECT TRY AGAIN 2. Which of the following combinations of endocrinal dysfunction and medical management are INCORRECT? A. Acromegaly – Octreotide B. Cushing’s disease – Ketoconazole C. Prolactinoma – Cabergoline D. Thyrotropinoma – L-iodothyronine Next Question 2 C. Prolactinoma - Cabergoline The first line of treatment for prolactinomas is dopamine agonists like cabergoline and bromocriptine Surgery is indicated only if medical therapy fails or is not tolerated INCORRECT TRY AGAIN 2 D. Thyrotropinoma – L-iodothyronine Pituitary tumor secreting TSH will cause increased production of tri-iodo-thyronine (T3) and T4 from the thyroid gland, causing hyperthyroidism Management of thyrotropinoma are Surgery – excision of pituitary tumor Anti-thyroid drugs – block production of T3, T4 Methimazole Propylthiouracil Beta-blockers NEXT Back to Question 3. Anesthetic implications of Acromegaly include all, EXCEPT A. Upper airway obstruction B. Hypertension C. Cardiomyopathy D. Reactive airway disease Next Question 3 C. Cardiomyopathy Patients with acromegaly may have ischemic heart disease, arrhythmias, heart block, cardiomyopathy, and bi-ventricular dysfunction Preoperative echocardiography is useful to assess left ventricular size and function INCORRECT TRY AGAIN 3 D. Reactive airway disease Along with a high incidence of obstructive sleep apnea, the respiratory function may be additionally compromised by kyphoscoliosis and proximal myopathy, resulting in a restrictive respiratory pathology. Reactive airway disease is not a feature of acromegaly NEXT Back to Question 4. Anesthetic implications of Cushing’s disease include all, EXCEPT A. Systemic hypertension B. Obstructive sleep apnea C. Glucose intolerance D. Increased sensitivity to succinylcholine Next Question 4 C. Glucose intolerance Impaired glucose tolerance is seen in almost two-thirds of patients with Cushing’s disease, half of whom have diabetes INCORRECT TRY AGAIN 4 D. Increased sensitivity to succinylcholine Cushing’s disease is associated with myopathy and proximal muscle weakness, however, a change in susceptibility to depolarizing or non- depolarizing muscle relaxants has not been documented NEXT Back to Question 5. Which of the following statements about use of a Lumbar Intrathecal catheter during trans- sphenoidal pituitary surgery is FALSE? A. Can be used to assist visualization of the tumor by injecting air B. Injection of saline through the catheter can aid to ‘push’ the tumor into the surgical field C. Can be used postoperatively to reduce inadvertent CSF rhinorrhea D. Can be used to administer antibiotics for postoperative meningitis 5 C. Can be used postoperatively to reduce inadvertent CSF rhinorrhea One of the complications of trans-sphenoidal pituitary surgery is CSF rhinorrhea Draining the CSF through the intrathecal catheter, helps lower the CSF pressure and thus the rhinorrhea, aiding in the early healing of the dural tear INCORRECT TRY AGAIN 5 D. Can be used to administer antibiotics for postoperative meningitis In the unfortunate event of a patient developing meningitis in the postoperative period, the intrathecal catheter is removed so as to remove the possible source of infection Systemic antibiotics is used to manage meningitis following trans-sphenoid surgery 1 2 3 4 5 End of Set Back to Question References Smith M, Hirsch NP. Pituitary disease and anaesthesia. BJA 2000; 85: 3-14 Menon R, Murphy PG, Lindley AM. Anaesthesia and pituitary disease. Continuing education in Anaesthesia, Critical Care & Pain 2011; 11:133-37 Horvat A, Kolak J, Gopcevic A,Ilej M, Gnjidic Z. Anesthetic management of patients undergoing pituitary surgery. Acta Clin Croat 2011; 50:209-16