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Undeleted > 2nd Endocrine exam > Flashcards

2nd Endocrine exam Flashcards

1
Q

Enzyme PTH acts on in kidneys

A

1alpha-hydroxylase

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2
Q

What prevents PTH secretion?

A

Ca2+ binds receptors
Gq inhibits exocytosis
Gi inhibits PTH secretion

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3
Q

Bone cells with PTH receptors

A

Osteoblasts

Osteophytes

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4
Q

Precursor of Vit D in skin

A

in lower dermis

7-dehydrocholesterol

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5
Q

Storage forms of Vit D

A

lumisterol

tachysterol

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6
Q

Calcitonin source and use for marker

A

C cells of thyroid

marker for medullary carcinoma of thyroid

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7
Q

Sx of hypercalcemia

A

renal stones/bone pain/abd pain/polyuria constipation
short QT interval
decreases neuronal excitability

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8
Q

Different b/t hypercalcemia with malignancy and primary hyperparathyroidism

A

malignancy-high PTHrp, low PTH

hyperparathryoid-low PTHrp, high PTH

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9
Q

Tx for severe hypercalcemia

A

saline
bisphosphonates
loop diuretics
mithramycin

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10
Q

Use of mithramycin

A

RNA inhibitor of osteoclasts
for hypercalcemia
do not use with liver/renal dysfxn or coagulopathy

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11
Q

MOA of gallium nitrate

A

decreases solubility of hydroxyapatite crystals

used for hypercalcemia

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12
Q

Use and risk with phosphate

A

rapid/profound hypercalcemia tx

risk with renal azotemia

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13
Q

Effects of PTH depending on administration

A

1-3hrs daily-builds bone

continuous-bone resorption

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14
Q

MOA of teriparatide

A

active PTH

for osteoporosis

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15
Q

Oral phosphate binders

A

Ca2+ carbonate/acetate- inhibit phosphate absorption
sevelamer-binds intestinal phosphate
used with CKD

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16
Q

MOA of cinacalet

A

calcimimetic
binds Ca2+ receptor on parathyroid
inhibits PTH release

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17
Q

Pro and con of bisphosphonates

A

long t1/2

poor GI absorption

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18
Q

Risk with etidronate long term use

A

osteomalacia

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19
Q

Use for calcitonin

A

osteoporosis

Paget’s disease

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20
Q

Pros and cons of estrogen/hormone replacement for osteoporosis

A

pro-decreased LDL, increased HDL and TG’s

con-increased endometrial hyperplasia/cancer

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21
Q

MOA of raloxifene

A

estrogen agonist
no endometrial stimulation
decreases LDL and cholesterol

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22
Q

Adverse effects of raloxifene

A

muscle cramps
DVT
peripheral edema

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23
Q

MOA of thyroid peroxidase

A

oxidizes I- to I
adds I to tyrosine
conjugates DIT/MIT

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24
Q

Transports of I in thryoid

A

basal-Na/I symport

apical-pendrin (I uniport)

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25
Q

Labs seen with iodine deficiency

A

decreaseds overall T3 and T4

increased T3/T4 ratio

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26
Q

Carriers of thyroid hormones

A

TBG-affected by heparin
transthyretin-affinity for T4
albumin

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27
Q

Types of deiodinase enzymes

A

type 1-provides T3 from T4
type 2-T3 levels in CNS
type 3-inactivates T3/T4 in placenta/glial cells

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28
Q

What extends the t1/2 of TSH?

A

glycosylation

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29
Q

T3 transport in cells

A

into via MCT8/10 or OATP1C1

binds Zn finger in DNA

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30
Q

Molecules decreasing T3/T4 release

A

dopamine
somatostatin
glucocorticoids

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31
Q

MOA of thyroid hormones

A

increase mitochondrial genes

use MAPK and STAT pathways

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32
Q

Actions of T3/T4

A

CNS-increase excitability/maturity
Bone growth
beta1 receptor upregulation

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33
Q

Impact of secondary hyperparathyroidism

A

renal osteodystrophy

calciphylaxis (vascular calcification)

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34
Q

Abs seen with Hashimoto’s thyroiditis

A

anti-microsomal Abs
anti-thyroid peroxidase Abs
anti-thyroglobulin Abs

35
Q

What is seen with Hashimoto’s thyroiditis?

A

Huerthle cells
lymphocyte infiltrate
gradual failure
anti-microsomal/anti-TPO

36
Q

What is seen with De Quervain’s thyroiditis?

A

aka subacute granulomatous thyroiditis
painful goiter
previous coxsackie/echovirus infection
hyper (1-3wks) followed by hypothyroidism

37
Q

Post-partum thyroiditis

A

anti-TPO

2-10 post birth

38
Q

Cause of proptosis in Grave’s disease

A

hyaluronic acid deposition around the eye

39
Q

What is seen with Grave’s disease?

A

TSI
exophthalmos
pretibial myxedema
onycholysis of 4th/5th digit

40
Q

Risk with antithyroid drugs

A

agranulocytosis

41
Q

What helps with thyroid nodule dx?

A

MoAB 47 increases accuracy with needle aspiration

42
Q

When are psammona bodies seen?

A

papillary carcinoma of thyroid
papillary renal cell carcinoma
papillary serous carcinoma
mesothelioma

43
Q

Medullary thyroid carcinoma asscs

A

MEN 2A and 2B

44
Q

Cause of subacute granulomatous thyroiditis

A

in summer
coxsackie/measles/mumps/adenovirus
triggered by URT infection

45
Q

Microscopy of Grave’s disease

A

scalloped margins of colloid

46
Q

Assc with papillary thyroid carcinoma

A

ionizing radiation
Orphan Anne’s eyes
psammona bodies
lymphatic spread

47
Q

Spread of follicular thyroid carcinoma

A

hematogenous

48
Q

Microscopy of Medullary thyroid carcinoma

A

amyloid deposits

secretes calcitonin

49
Q

Risk with liothyronine

A

cardiotoxicity

50
Q

Risk with thyroid agonists

A

induction by CYP450

cardio problems at higher doses

51
Q

Con of antithyroid drugs

A

increased relapse

52
Q

MOA of methimazole/propylthiouracil

A

inhibits TPO

53
Q

Methimazole impact on fetus

A

fetal scalp defect

54
Q

Adverse effect of methimazole

Adverse effect of propylthiouracil

A

change taste or smell

liver toxicity

55
Q

Beta blockers used for sx of hyperthyroidism

A

propanolol

esmolol

56
Q

Role of FOX01 gene

A

effects of fasting/decreasing beta cells

insulin inhibits it

57
Q

Inhibitors of glucagon release

A

insulin
somatostatin
Zn2+
GABA

58
Q

Insulin impact on K+

A

increased transport into cells

59
Q

When is amylin increased?

A

obesity & HTN

packed with insulin in granules

60
Q

Islet of Langerhans granule types

A

beta-rectangular matrix with halos
alpha-round with dense center
delta-pale granules (somatostatin)
PP-small dark granules

61
Q

Defect with MODY

A

insulin-insulin recetpor signal

AD

62
Q

Diabetes and microscopy of kidney

A

Kimmelstein-Wilson nodules (PAS (+))
sign of sclerosis
hyaline ateriolosclerosis (afferent only)

63
Q

Gastrinoma assc

A

MEN 1

Zollinger-Ellison syndrome

64
Q

Sx of VIPoma

A

watery diarrhea
hypokalemia
achlorhydria

65
Q

Rapid acting insulins

A

aspart
lispro
glulisine

66
Q

Long acting insulins

A

glargine

detemir

67
Q

Metformin

A

biguanide
increases insulin sensitivity
decreases gluconeogenesis of liver
no hypoglycemia seen

68
Q

Glipizide/glyburide/glimepiride

A

sulfonylureas
block K+ channels in beta cells
cause hypoglycemia

69
Q

Rosiglitazone/pioglitazone

A

thiazolidinediones

same MOA as metformin

70
Q

Acarbose/miglitol

A

alpha-glucosidase inhibitors
steady Glc uptake
work on brush border enzymes

71
Q

Repaglinide/nateglinide

A

glinides/meglitinides
closes K+ channels in beta cells
less hypoglycemia

72
Q

Sitagliptan/saxagliptan/linagliptan/alogliptan

A

dipeptidyl peptidase inhibitor-4
increase Glc mediated insulin production
allows incretins (GLP-1 & GIP) to act

73
Q

DM type 1 asscs

A

HLA-DR3 and DR4

74
Q

Honeymoon phase of DM1 tx

A

temporary regain of insulin secretion

goes away within weeks

75
Q

Cause of acanthosis nigrans

A

ILGF stimulation from insulin

causes keratinocytes to proliferate

76
Q

Risk with metformin

A

lactic acidosis

77
Q

Exenatide/liraglutide

A

GLP-1 analogs

increase insuline release via Glc

78
Q

Tx for autonomic impact of DM

A

midodrine for orthostatic hypotension

79
Q

Tx for peripheral neuropathy of DM

A

amitryptiline
gabapentin
regabalin
duloxitine

80
Q

Tx for GI neuropathy of DM

A

erythromycin

metocloperamide (cholinergic)

81
Q

MODY mutation

A

glucokinase transcription factors

AD

82
Q

Infection with diabetic ketoacidosis

A

mucor

klebsiella

83
Q

Meds causing DKA

A

steroids
clozapine
pentamidine

84
Q

Whipple’s triad

A

documented low BG
sx of hypoglycemia
reverasal of sx with Glc

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