Which of the following systemic changes does diabetes cause?
Delayed gastric emptying
Altered airway anatomy
Autonomic changes (such as decreased HR variability)
Increased risk of wound infection
Increased risk of nerve injury
Development of hypothyroidism
Insulin therapy is 1 of the 6 predicators for a major adverse cardiac event (MACE) on the RCRI scale
Diabetic patients should take their prescribed sulfonyurea on the morning of surgery
When should an diabetic patient hold their prescribed metformin preoperatively?
If they are completing a bowel prep before surgery
If they have renal impairment
If the fasting period is brief
Both A & B
Preoperatively, diabetic patients should take their long acting insulin and hold their short acting insulin
Which of the following is important consideration for patients with hyperthyroidism who report dysphagia and dyspnea when lying flat?
Ensure patient takes morning dose of thyroxine on the morning of surgery
Be prepared to administer glucocorticoids intraoperatively
Have a dose of magnesium drawn up in case the patient goes into Torsades
Do NOT administer a paralytic to these patients
All of the above
Your patient has Hashimoto thyroiditis. During your preop assessment, you notice they are bradycardic. What should you do?
Obtain labs (TSH & T4 levels) and proceed with surgery if they are normal
Order a transesophogeal echocardiogram (TEE)
Reschedule the surgery and refer them to their endocrinologist
Proceed with surgery as this is a normal finding of Hashimotos
If your preoperative patient took glucocorticoids within the last _________, you should complete a thorough assessment (what steroid they took, for how long, if they tapered, etc) due to concern for development of adrenal insufficiency
2 weeks
1 month
3 months
1 year
20 mg prednisone per day is considered high dose glucocorticoids
Your patient has adrenal insufficiency and develops severe hypotension immediately after induction. What should you do?
Administer stress dose steroids
Administer fluid boluses
Start vasopressors immediately
There is not a need to do anything as the hypotension will likely self resolve within minutes
What are symptoms of adrenal insufficiency?
Fatigue
Myalgias & arthralgias
Nausea/vomiting & loss of appetite
CNS stimulation & anxiety
Weight gain
Development of goiter
Hypotension refractory to vasopressor therapy & fluid
In a patient with acromegaly, what assessment finding would indicate compression of the left recurrent laryngeal nerve?
Severe hypertension
Presence of a "buffalo hump"
Voice hoarseness and stridor
Narrowing of the subglottic opening
If a patient has a carcinoid tumor and develops carcinoid syndrome, what are their symptoms and where does the tumor drain?
Symptoms are flushing, diarrhea, tachycardia, and bronchospasm. The tumor drains into portal circulation
Symptoms are flushing, diarrhea, tachycardia, and bronchospasm. The tumor does NOT drain into portal circulation
Symptoms are cold intolerance, constipation, and bradycardia. The tumor drains into portal circulation
Symptoms are cold intolerance, constipation, and bradycardia. The tumor does NOT drain into portal circulation
What are the three symptoms of a pheochromocytoma?
Headache
Hypoglycemia
Presence of a goiter
Diaphoresis
Bradycardia
Tachycardia
Which of the following is an appropriate consideration for a patient with a pheochromocytoma?
Prepare to discharge patient home several hours after surgery
Ensure patient is appropriately alpha blocked (with phenoxybenzamine) prior to operating
Instruct patient to hold morning meds the day of surgery
Continue octreotide drip throughout entire surgery
Your patient is confused, lethargic, and is having seizures. They are euvolemic and do not appear fluid overloaded, but their urine is concentrated. What do you suspect?
Hyponatremia due to SIADH
Hyponatremia due to diabetes insipidus
Pheochromocytoma
Adrenal insufficiency
At what rate should you correct hyponatremia?
0.5 mEq/L/hr
1 mEq/L/hr
5 mEq/L/hr
As quickly as possible to avoid neurologic injury
Hypoparathyroidism is the most common cause of hypercalcemia
Intraoperatively, your patient's labs come back showing a calcium of 3.5 mg/dL. Which is the most important consideration?
You will monitor the ECG closely for ST segment changes, T wave abnormalities, or a shortened QT interval
You will aggressively treat the hypertension that is likely to ensue
You will correct the calcium slowly to prevent neurological damage
You will not plan on extubating this patient due to risk of laryngospasm
Your patient has a BMI of 37. What is their BMI classification?
Normal
Overweight
Obese
Severely obese
Morbidly obese
What is the single biggest indicator of a difficult airway?
BMI over 40
Male gender
Presence of metabolic syndrome
Large neck circumference
For which condition would you want your patient on an octreotide drip going into surgery?
Acromegaly
Carcinoid tumor
Your patient has a(n) __________ diagnosis. Prior to surgery, you must ensure they have a recent echocardiogram (within one year) to evaluate their ejection fraction due to risk of left ventricular hypertrophy.
Cushing Syndrome
