Endocrine Diseases
Jean Kwo and Edward Bittner
1. Type 1 diabetes mellitus
A. Is characterized by a relative lack of insulin plus resistance to endogenous insulin
B. Always requires insulin
C. Affects 95% of patients with diabetes
D. Can be controlled with diet, weight loss, and oral hypoglycemic agents
2. Preoperative assessment of patients with diabetes mellitus should include
A. An assessment of functional status
B. 24-Hour creatinine clearance
C. Pulmonary function testing
D. Cancellation of the surgical case if HbA1c >10%
3. Preferred anesthetic agent in a patient with hyperthyroidism includes
A. Desflurane
B. Ketamine
C. Sevoflurane
D. Meperidine
4. Multiple endocrine neoplasia (MEN) I syndrome includes
A. Pheochromocytoma, medullary thyroid carcinoma, parathyroid hyperplasia
B. Pancreas tumors, medullary thyroid carcinoma, pituitary adenoma
C. Pheochromocytoma, medullary thyroid carcinoma, mucosal neuromas
D. Pancreas tumors, pituitary adenoma, parathyroid hyperplasia
5. Laboratory findings in primary hypothyroidism are
A. Low TSH, elevated T3, elevated T4
B. Low TSH, low T3, low T4
C. Normal TSH, low T3, low T4
D. Elevated TSH, low T3, low T4
6. Obese patients may experience rapid oxygen desaturation during induction of general anesthesia because of
A. A decrease in lung compliance
B. A reduction in functional residual capacity (FRC)
C. A history of obstructive sleep apnea
D. Restrictive lung disease
7. A 39-year-old woman with a history of headaches, hypertension, palpitations, and nephrolithiasis is undergoing a parathyroidectomy for parathyroid adenoma. During induction, she develops severe hypertension and tachycardia. The most likely diagnosis for these signs is
A. Adrenal insufficiency
B. Carcinoid syndrome
C. Thyroid storm
D. Pheochromocytoma
8. Phenoxybenzamine is a
A. Selective α1-receptor antagonist and a nonselective β-adrenergic receptor antagonist
B. Reversible α1-receptor antagonist
C. Irreversible, nonselective α-adrenergic receptor antagonist
D. Selective α2-receptor agonist
9. A 40-year-old woman with a history of Graves disease is in the recovery room after undergoing a CT scan under general anesthesia. While in the recovery room, her blood pressure drops to 80/55 mm Hg, her heart rate increases to 140 bpm, and she becomes agitated and complains of difficulty breathing and feeling hot. The most likely diagnosis for these signs is
A. Thyroid storm
B. Carcinoid syndrome
C. Malignant hyperthermia
D. Pheochromocytoma
10. Treatment of thyroid storm includes
A. Dantrolene
B. Phenoxybenzamine
C. Octreotide
D. Propylthiouracil
11. During a postoperative check on a 53-year-old patient who underwent a total thyroidectomy earlier in the day, you notice that he is stridorous and is complaining of muscle cramps. The best treatment for these symptoms is
A. Administration of calcium gluconate
B. Opening the neck wound
C. Reintubation for airway protection
D. Administration of sodium bicarbonate
12. Patients with obstructive sleep apnea (OSA)
A. Are at increased risk of left-heart failure
B. Have the same perioperative complication rate as patients without OSA
C. May have an increased likelihood of difficult intubation
D. Rarely require continuous positive airway pressure (CPAP) after bariatric surgery
13. A 39-year-old patient with a BMI of 45 kg/m2 is scheduled for a Roux-en-Y gastric bypass. She has a history of hypertension. Your perioperative concerns include
A. Preparation for a rapid sequence induction, since she is at increased risk for aspiration of gastric contents
B. Placing her in the reverse Trendelenburg position to reduce atelectasis in dependent areas of the lung and move the chest and breast tissue caudally to allow easier access to the mouth for endotracheal intubation
C. Need to dose water-soluble drugs (e.g., neuromuscular-blocking agents) to actual body weight
D. More frequent administration of lipid-soluble drugs will be needed
14. During the preoperative evaluation of a critically ill patient with ischemic bowel scheduled for a second look laparotomy and possible abdominal closure, you notice multiple electrolyte abnormalities including hypophosphatemia, hypokalemia, and hypomagnesemia. A possible cause for these electrolyte abnormalities is
A. Renal failure
B. Hypoventilation
C. Hypoparathyroidism
D. Refeeding syndrome
15. Complications of cricoid pressure include
A. Esophageal obstruction
B. Displacement of thoracic spine
C. Worsening of view of airway in patients with difficult airway
D. Need for less pressure in parturients
16. You are evaluating a 55-year-old patient with type 2 diabetes mellitus for a total knee replacement. His diabetes is controlled on a regimen of Glucophage (metformin), NPH insulin twice a day, and insulin sliding scale. Perioperative instructions for glucose management should include
A. Give half of the NPH dose if morning blood glucose level is at least 150 mg/dL
B. Give regular insulin dose according to morning blood glucose level
C. Holding metformin for 48 hours preoperatively to avoid risk of fatal lactic acidosis
D. Starting insulin infusion with target glucose range of 81 to 108 mg/dL
17. Carcinoid tumors
A. Grow rapidly, and patients are often symptomatic with carcinoid syndrome
B. Synthesize epinephrine and norepinephrine
C. Can cause left-sided heart failure due to mitral and aortic valve damage
D. Can cause right-sided heart failure due to tricuspid and pulmonary valve damage
18. You are taking care of a 67-year-old patient undergoing a parathyroidectomy. The patient is hypercalcemic with a serum calcium of 20 mg/dL. Anesthetic considerations should include all of the following, except
A. Hypoventilation to decrease ionized calcium level
B. Careful titration of neuromuscular-blocking agents
C. Hydration with normal saline and diuresis with furosemide
D. Care with laryngoscopy because of risk of vertebral compression
19. Clinical manifestations of mineralocorticoid excess include
A. Hypotension
B. Metabolic acidosis
C. Hypokalemia
D. Tetany
20. Normal daily cortisol production (mg/day) in adults is
A. 10 to 15
B. 20 to 30
C. 50 to 60
D. 75 to 100
21. A 75-year-old patient with coronary artery disease, hypertension, and chronic obstructive pulmonary disease (COPD) is undergoing a left colectomy for cancer. He had a COPD exacerbation 4 months ago and was on steroids for a week at the time. Steroid replacement
A. Should be given at a dose greater than 10 times the normal daily cortisol production rate
B. Should not exceed 100 to 150 mg of cortisol equivalent per day
C. Is not necessary in this patient
D. Should include 100 mg of cortisol, tapered over 5 to 7 days
22. Physiologic effects of chronically elevated corticosteroid levels (Cushing syndrome) include all of the following, except
A. Hypotension
B. Muscle wasting
C. Hypokalemia
D. Glucose intolerance
23. You are taking care of a 45-year-old patient undergoing a left adrenalectomy for a pheochromocytoma. Intraoperative management includes
A. Use of ketamine as an induction agent to counteract the effects preoperative of α-adrenergic blockade
B. Long-acting antihypertensive agents should be available to treat hypertension
C. Judicious fluid replacement as these patients are usually volume-overloaded
D. Magnesium sulfate infusion to treat hypertension
24. A 75-year-old, 110-kg patient is scheduled for a radical prostatectomy. He has a history of hypertension and type 2 diabetes mellitus. His preoperative ECG is significant for Q waves in leads II, III, and aVF, though the patient denies having a previous myocardial infarction. His medications include insulin, Glucophage (metformin), a β-blocker, and an angiotensin-receptor blocker. Upon induction, his blood pressure drops from 150/80 to 65/40. The most likely cause of hypotension is
A. Use of angiotensin-receptor blocker
B. Diabetic autonomic neuropathy
C. Volume depletion
D. Myocardial ischemia
25. Patients with type 1 diabetes mellitus may be difficult to intubate because of
A. Increased supraglottic soft tissue due to chronic hyperglycemia
B. An association between type 1 diabetes and an anterior larynx
C. Limited joint mobility
D. An increased incidence of obesity in patients with type 1 diabetes
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