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Endocrinology Board Review > Clinical Correlates > Flashcards

Clinical Correlates Flashcards

1
Q

MOST common 2nd messenger system

A

cAMP system

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2
Q

2nd messenger system for INSULIN

A

Tyrosin Kinase (also used by IGF-1, EPO)

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3
Q

2nd meseenger for THYROID HORMONE

A

None (acts like a steriod; does not need 2nd messenger)

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4
Q

Hormones derived from Proopiomelanocortin (POMC)

A

MSH, ACTH, B-Lipoprotein, B-Endorphin

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5
Q

Other name for Growth Hormone

A

Somatotropin

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6
Q

Other name for Insluin-like Growth Factor 1 (IGF-1)

A

Somatomedin

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7
Q

ANTAGONIZES Prolactin

A

Dopamine (and dopamine analogs like Bromocriptine)

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8
Q

Main site of ADH/Vasopressin sytnehsis

A

Supraoptic nuclei of the anterior hypothalamus

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9
Q

Main site of Oxytocin synthesis

A

Paraventricular Nuclei of the Anterior Hypothalamus (Mnemonic: PARA sa Voovs!)

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10
Q

Site of Oxytocin and ADH/Vasopressin storage and secretion

A

Posterior Pituitary

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11
Q

Predominant form of thyroid hormone in the blood

A

T4

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12
Q

Active form of thyroid homone

A

T3

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13
Q

3 Parts of the Adrenal Cortex

A

From outer to inner: G-F-R (salt, sugar, sex)

  • Zona Glomerulosa (Aldosterone Secretion)
  • Zona Fasciulatata (Cortisol secretion)
  • Zona Reticularis (Weak Androgens)
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14
Q

2 Products of the Adrenal Medulla

A

Epinephrine (80%), NE (20%)

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15
Q

Increased adrenal androgens, decreased aldosterone, decreased cortisol

A

21-Beta Hydroxylase Deficiency (virilizing)

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16
Q

Increased aldosterone, decreased adrenal androgens, decreased cortisol

A

17-Alpha Hydroxylase Deficiency (non-virilizing)

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17
Q

Effect of insulin on potassium

A

Increased potassium uptake in muscles and adipose tissue (decreases plasma K+)

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18
Q

Marker for endogenously produced insulin

A

C-peptide

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19
Q

Responsible for TENSILE strength of bone

A

Collagen ibers (make up 95% of the organic matrix)

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20
Q

Responsible for the Compressional strength of the bone

A

Bone salts

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21
Q

Decreases calcium and phosphate excretion but increases urinary calcium, Increases intestinal calcium absorption

A

Vitamin D

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22
Q

Decreases calcium excretion, increases phosphate excretion increases 1-alpha hydroxylase, increases bone resorption

A

PTH

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23
Q

Stiulated by LH, releases the “libido” hormone testosterone

A

Leydig Cells (Mnemonic: LLL, LH, Leydig Cells, Libido)

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24
Q

Stimulated by FSH, nurse cell for sperm

A

Sertoli Cells (Mnemonic: SSS: FSH, Sertoli Cells, Sperm)

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25
Q

Sperm formation

A

Seminiferous Tubutles

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26
Q

Sperm motility

A

Epididymis

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27
Q

Sperm Storage

A

Vas Deferens

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28
Q

Production of fructose, prostaglandins

A

Seminal Vesicle

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29
Q

Contributes to semen alkalinity

A

Prostate Gland

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30
Q

Supplies mucus to semen for lubrication

A

Bulbourethral Glands (Cowper’s glands)

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31
Q

Main hormone of the follicular phase

A

Estrogen

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32
Q

Main hormone of the luteal phase

A

Progesterone

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33
Q

Causes ovulation

A

LH surge

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34
Q

Cells of the blastocyst that digests and liquefies the endometrium for invasion

A

Trophoblast

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35
Q

Beta-HCG is produced by

A

Syncytiotrophoblast

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36
Q

Promotes growth of the fetus, insulin resistance in the mom, lipolysis in the mother, index of fetal well-being

A

Human Chorionic Somatomammatropin (HCS) formerly known as HPL (Human Placental Lactogen)

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37
Q

Prevens pregnancy during breastfeeding

A

Inhibition of GnRH by prolactin

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38
Q

Adult Growth Hormone Deficiency

A

Peak GH response to hypoglycemia of

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39
Q

Acromegaly

A

Confirmed by demonstrating the failure of GH suppression to

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40
Q

Pegvisomant

A

GH-receptor antagonist that antagonizes endogenous GH action by blocking peripheral GH binding to its receptor

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41
Q

Cushing’s Disease

A

Refers specifically to Cushing’s syndrome caused by a pituitary corticotrope adenoma (increased ratio (>2) of inferior petrosal:peripheral vein ACTH)

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42
Q

Diabetes Insipidus

A

Syndrome characterized by the production of abnormally LARGE volumes of dilute urine

  • 24 hour urine volume: >50mL/kg body weight
  • urine osmolarity:
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43
Q

Pemberton’s Sign

A

Venous distension over the neck and difficulty breathing especially when the arms are raised (in large retrosternal goiters)

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44
Q

Glucocorticoid EQUIPOTENCY can be assumed for

A

1mg hydrocortisone

  1. 6mg cortisone acetate
  2. 2mg prednisolone
  3. 25mg prednisone
  4. 025mg dexamethasone
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45
Q

“Rule of 10’s” in Pheochromocyoma

A 
10% are bilateral
10% are extraadrenal
10% are malignant
10% calcify
10% in children
10% familial
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46
Q

Rule of 1/3 in Carcinoid Syndrome

A

1/3 metastasize
1/3 present with 2nd malignancy
1/3 multiple

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47
Q

Screening for DM

A
  • All individuals >45 years every 3 years

- Screening at an EARLIER age if overweight (BMI>25) and have one additional risk factor for diabetes

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48
Q

C peptide

A
  • Useful MARKER of insulin secretion

- Allows discrimination of endogenous and exogenous sources of insulin in the evaluation of hypoglycemia

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49
Q

Honeymoon phase

A

Time when glycemic control is achieved with modest doses of insulin

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50
Q

Protypical patient of hyperglycemic hyperosmolar state

A
  • Elderly with type 2 DM, with several week history of polyuria, weight loss, and diminished oral intake
  • Culminates in mental confusion, lethargy or coma
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51
Q

Correlated serum sodium

A

Add 1.6meq for each 100mg/dL rise in serum glucose

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52
Q

Microvascular manifestations of DM

A

Retinopathy, Neuropathy, Nephropathy

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53
Q

Macrovascular manifestations of DM

A

Coronary heart disease, Peripheral Arterial Disease, Cerebrovascular Disease

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54
Q

Proliferative retinopathy

A

Treated with panretinal laser photocoagulation

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55
Q

Macular edema

A

Treated with focal laser photocoagulation

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56
Q

Microalbuminuria

A

30-299mg/day in a 24-h collection or 30-299 ug/mg creatinine in a spot collection (PREFERRED)

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57
Q

Diabetic Dermatopathy

A

Pigmented pretibial papules or diabetic skin spots

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58
Q

Fructosamine Assay

A

Reflects the glycemic status over the prior 2 week

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59
Q

Normal ejaculate

A

Volume of 2-6mL
Sperm counts >20million/mL
Motility of >50%
>15% normal morphology

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60
Q

True gynecomastia

A

Glandular breast tissue that is >4cm in diameter and often tender

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61
Q

Mittelschmerz

A

Midcycle pelvic discomfort that is thought to be caused by the rapid expansion of the dominant follicle at the time of ovulation

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62
Q

Infertility

A

Defined as the inability to conceive after 12 months of unprotected sexual intercourse

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63
Q

Fecundability

A

Probability of achieving pregnancy in one menstrual cycle

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64
Q

Precocious puberty in boys

A

Development of secondary sexual characteristics before the age of 9

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65
Q

Delayed puberty in boys

A

Development of secondary sexual characteristics after the age of 14

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66
Q

Precocious puberty in girls

A

Development of secondary sexual characteristics before the age of 8

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67
Q

Delayed Puberty in Girls

A

Absence of secondary sexual characteristics by age 13

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68
Q

Humoral Hypercalcemia of Malignancy

A

Due to the overproduction of the parathyroid hormone related peptide (PTHrP) by cancer cells

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69
Q

FGF-23

A

POTENT inhibitor of renal 1A-hydroxylase

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70
Q

WHO definition of osteoporosis

A

Bone density that falls 2.5 standard deviations (SD) BELOW the mean for young healthy adults of the same sex (also referred to as a T score of -2.5)

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71
Q

T Scores

A

Compare individual results to those in a YOUNG population that is matched for RACE AND SEX

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72
Q

Z-Scores

A

Compare individual results to those of an AGE-MATCHED population that also is matched for RACE and SEX

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73
Q

Diagnosis of osteoporosis

A

T-score below -2.5 in lumbar spine, femoral neck, or total hip

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74
Q

Denosumab

A

Fully human monoclonal antibody to RANKL

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75
Q

Teriparatide (1-34hPTH)

A

An exogenous PTH analogue

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76
Q

Increased ACTH secretion by pituitary gland

A

Cushing’s Disease

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77
Q

Hypercortisolism due to other causes

A

Cushing Syndrome

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78
Q

Excessive urination secondary to insensitivity of the renal tubules to aDH

A

Nephrogenic Diabetic Insipidus

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79
Q

Excessive urination secondary to lack of ADH

A

Central Diabetes Insipidus

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80
Q

Excess ADH causing excessive resorption of water in hyponatremia

A

SIADH

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81
Q

MOST common cause of hypopituitarism in children associated with WNT signaling pathway

A

Craniopharyngioma

82
Q

Hypothyroidism in infancy or early childhood

A

Cretinism

83
Q

Taping along facial nerve induces contractions of the muscles of the eye, mouth or nose

A

Chvostek sign

84
Q

Carpal spasms produced by occlusion of the circulation to the forearm

A

Trousseau sign

85
Q

Most common functioning pituitary adenoma

A

Prolactinoma

86
Q

Second MOST common pituitary adenoma

A

Somatotroph adenoma

87
Q

Postpartum necrosis of anterior pituitary gland which clinically presents as sudden cessation of lactation

A

Sheehan syndrome

88
Q

Presents with headache, diplopia, hypopituitarism

A

Pituitary apoplexy

89
Q

Papillary Thyroid CA

A

Orphan Annie eye nuclei

90
Q

Follicular Thyroid CA

A

Hurthle cells, invades blood vessels

91
Q

Medullary Thyroid CA

A

Derived from C cells, MEN-associated

92
Q

Anaplastic ThyroidCA

A

Giant cells, spindle cells

93
Q

MOST COMMON cause of hypthyroidism in iodine sufficient areas

A

Hashimoto Thyroiditis

94
Q

MOST COMMON cause of hypothyroidism worldwide

A

Iodine deficiency

95
Q

Chronic inflammatory infiltrate of the thyroid gland with multinucleate giant cells

A

Subacute thyroiditis

96
Q

Most common cause of PAINFUL thyroid gland; associated with viral infection (Coxsackie)

A

Subacute, granulomatous, De Quervain

97
Q

Lymphocytic infiltration of the thyroid gland with hyperplastic germinal centers; patchy disruption and collapse of thyroid follicles; no fibrosis and Hurthle cell metaplasia

A

Lymphocytic thyroiditis

98
Q

Condition where normal thyroid tissues are replaced by fibrous tissue; usually associated with sclerosing mediastinitis

A

Reidel thyroiditis

99
Q

Presents with hyperthyroidism, ophthalmopathy, dermopathy

A

Graves Disease

100
Q

MOST common primary thyroid cancer in adults and children

A

Papillary Thyroid Cancer

101
Q

Diseases associated with PSaMMoma Bodies

A

Papillary Thyroid CA
Serous Cystadenoma of the ovaries
Meothelioma
Meningioma

102
Q

Most common cause of primary hyperparathyroidism

A

Parathyroid adenoma

103
Q

Elevated PTH, Normal Calcium levels

A

PseudoPseduoHypoparathyroidism/Tertiary Hyperparathyroidism

104
Q

Elevated PTH occuring in CKD patients

A

Secondary Hyperparathyroidism

105
Q

Osteoporosis

A 
Ca2+ --
Phosphate--
ALP--
PTH--
Notes: Bone mass decreases
106
Q

Osteopetrosis

A 
Ca2+ --
Phosphate--
ALP--
PTH--
Notes: Thickened dense bones
107
Q

Osteomalacia/rickets

A 
Ca2+ decrease
Phosphate decrease
ALP --
PTH Increase
Notes: Soft Bone
108
Q

Osteitis Fibrosa Cystica

A 
Ca2+ Increase
Phosphate Decrease
ALP Increase
PTH Increase
Notes: "Brown Tumors"
109
Q

Paget’s Disease

A 
Ca2+ --
Phosphate--
ALP Increase
PTH--
Notes: Abnormal Bone architecture
110
Q

Type 1 DM

A

Usually Occurs at age

111
Q

Type 2 DM

A

Strong, polygenic genetic predisposition

Islet amyloid deposit

112
Q

Hypertension associated with hypokalemia treated which cannot be controlled by monotherapy

A

Hyperaldosteronism

113
Q

Most common cause of primary hyperaldosteronism

A

Idiopathic Hyperaldosternosim

114
Q

Adrenals are converted to sacs of clotted blood, which virtually obscures all underlying detail

A

Waterhouse-Friderichsen Syndrome (causes Acute Adrenal Insufficiency)

115
Q

Neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones

A

Pheochromocytoma

116
Q

Serum Cortisol

A

Pituitary CS: Increased
Adrenal CS: Increased
Ectopic Cs: Increased

117
Q

Urine free cortisol

A

Pituitary CS: Increased
Adrenal CS: Increased
Ectopic Cs: Increased

118
Q

Low-dose dexamethasone

A

Pituitary CS: Cortisol not suppressed
Adrenal CS: Cortisol not suppressed
Ectopic Cs: Cortisol not suppressed

119
Q

High dose dexamethasone

A

Pituitary CS: Cortisol suppressed
Adrenal CS: Cortisol not suppressed
Ectopic Cs: Cortisol not suppressed

120
Q

Plasma ACTH

A

Pituitary CS: Normal to elevated
Adrenal CS: Decreased
Ectopic Cs: Markedly Increased

121
Q

Tropic hormone failure associated with pituitary compression or destruction usually occurs SEQUENTIALLY

A

GH>FSH>LH>TSH>ACTH

  • during childhod: growth retardation is often the presenting feature
  • In adults: HYPOGONADISM is the earliest symptom
122
Q

ACTH reserve most reliably assessed by

A

Measuring ACTH and cortisol levels during insulin-induced hypoglycemia

123
Q

Size of Microadenoma

A
124
Q

Presents the LEAST resistance to soft tissue expansion from the sella; consequently, pituitary adenomas frequently exend in a SUPRASELLAR direction

A

Dorsal sellar diaphragm

125
Q

MOST common MECHANISM by which suprasellar extension can lead to a bitemporal heianopsia

A

Compression of the Optic Chiasm

126
Q

EARLY sign of optic tract pressure

A

Loss of red perception

127
Q

DESIRED surgical approach for pituitary tumors (EXCEPT for the rare invasive suprasellar mass surrounding the frontal or middle fossa or the optic nerves or invading posteriorly behind the clivus)

A

Transsphenoidal Surgery

128
Q

MOST common pituitary hormone hypersecretion syndrome in both men and women

A

Hyperprolactinemia

129
Q

Hallmarks of hyperprolactinemia

A
  • Amenorrhea
  • Galactorrhea
  • Infertility
130
Q

Mainstay of therapy for patients with micro- or macroprolactinomas

A

Dopamine agonists (Cabergoline and Bromocriptine)

131
Q

Most abundant anterior pituitary hormone

A

GH (cells are acidophilic along with those producing prolactin)

132
Q

Major source of circulating IGG-1

A

Liver

133
Q

Major determinant of hepatic IGF-1 synthesis

A

Growth Hormone

134
Q

Most validated test to distinguish pituitary-sufficient patients from AGHD

A

Insulin-induced hypoglycemia

135
Q

Most common cause of GHRH-mediated

A

Chest or abdominal Carcinoid tumor

136
Q

MOST significant clinical impact of GH exess occurs with respect to

A

Cardiovascular system

137
Q

Overall MORTALITY in acromegaly is increased about threefold and is due PRIMARILY to

A

Cardiovascular and cerebrovascular disorders and respiratory disease

138
Q

Provides a useful laboratory SCREENING measure when clinical feature raise the possibility of acromegaly

A

IGF-1 level

139
Q

INITIAL treatment for MOST patients with acromegaly

A

Surgical resection of GH-secreting adenomas

140
Q

Side effect of somatostatin analogues in acromegaly

A

Drug-induced suppression of gastrointestinal motility and secretion

141
Q

Account for 70% of patients with ENDOGENOUS causes of Cushing’s syndrome

A

Pituitary Adenomas

142
Q

MOST common cause of Cushingoid features

A

latrogenic hypercortisolism

143
Q

Certain features make PATHOLOGIC causes of Hypercortisolism more likely

A
  • Central redistribution of fat
  • Thin skin with striae and bruising
  • Proximal Muscle weakness
144
Q

Primary cause of DEATH in Cushing’s

A

Cardiovascular Disease

145
Q

Precise and cost-effective screening test for Cushing’s syndrome

A

Measurement of 24-h urine free cortisol

146
Q

DISTINGUISH patients with ACTH-independent (adrenal or exogenous glucocorticoid) from those with ACTH dependent (pituitary, ectopic ACTH) Cushing’s syndrome

A

Basal plasma ACTH levels

147
Q

Most ACTH-secreting pituitary tumors

A
148
Q

May be required to DISTINGUISH these lesions from ectopic ACTH-secreting tumors

A

Bilateral inferior petrosal sinus ACTH sampling before and after CRH administration

149
Q

MOST common PRESENTING feature of adult hypopituitarinism, even when other pituitary hormones are also deficient

A

Hypogonadism

150
Q

HARBINGER of hypothalamic or pituitary lesions that impair GnRH production or delivery through the pituitary stalk

A

Hypogonadism

151
Q

MOST COMMON type of pituitary adenoma

A

Nonfunctioning and gonadotropin-producing pituitary adenomas

152
Q

Most clinically nonfunctioning adenomas

A

Originate from gonadotrope cells

153
Q

Most important, if NOT the only, physiologicaction of Arginine Vasopresin (AVP)

A

Reabsorbs water, promotes concentrated urine

154
Q

Differentiates Central vs. Peripheral Diabetes Insipidus (DI)

A

Fluid Deprivation test

155
Q

Thyroid hormone synthesis normally begins

A

11 weeks gestation

156
Q

Subunit unique to TSH

A

Beta subunit (alpha subunit is common to LH, FSH, hCG)

157
Q

Critical FIRST step in thyroid hormone synthesis

A

Iodid uptake

158
Q

MOST common cause of preventable mental deficiency

A

Iodide deficiency

159
Q

Importance in diagnosis of Thyroid Hormone Resistance

A

To avoid inappropriate treatment of mistaken hyperthyroidism and to provide genetic counseling

160
Q

Method of CHOICE when it is important to determine thyroid size accurately

A

Ultrasound

161
Q

Logical approach to thyroid testing is to FIRST determine

A

TSH levels

162
Q

Detected MOST easily by measuring circulating antibodies against thyroid peroxidase and thyroglobulin

A

Autoimmune thyroid disease

163
Q

Main use of thyroid-stimulating antibodies (TSI)

A

Predict neonatal thyrotoxicosis caused by high maternal levels of TSI in the LAST trimester of pregnancy

164
Q

MOST common SYMPTOM of hypothyroidism

A

Tiredness, Weakness

165
Q

MOST common SIGN of hypothyroidism

A

Dry coarse skin, cool peripheral extremities

166
Q

Least common SYMPTOM of hypothyroidism

A

Impaired hearing

167
Q

Least common SIGN of hypothyroidism

A

Serous cavity effusions

168
Q

BEST documented risk factors for autoimmune hypothyroidism

A

HLA-DR polymorphisms (especially HLA-DR3, -DR4 and -DR5)

169
Q

There is NO convincing evidence for a role in infection in autoimmune hypothyroidism EXCEPT FOR

A

Congenital rubella syndrome

170
Q

Thyroid cell destruction in autoimmune thyroiditis is PRIMARILY mediated by

A

CD8+ cytotoxic T cells

171
Q

Normal TSH level excludes

A

Primary (but NOT secondary) hypothyroidism

172
Q

MAJOR role in pathogenesis of MYXEDEMA COMA, leading to hypoxia and hypercapnia

A

Hypoventilation

173
Q

External warming in hypothermia if myxedema is indicated only if

A

Temperature is

174
Q

MAJOR etiologies of thyrotoxicosis are hyperthyroidism are caused by

A
  • Graves’ disease
  • Toxic multinodular goiter
  • Toxic adenoma
175
Q

Most common SYMPTOM of hyperthyroidism

A

Hyperactivity, irritability, dysphoria

176
Q

Most common SIGN of hyperthyroidism

A

Tachycardia, atrial fibrillation in the elderly

177
Q

Least common SYMPTOM of hyperthyroidism

A

Oligomenorrhea, loss of libido

178
Q

Least common SIGN of hyperthyroidism

A

Gynecomastia

179
Q

Minor risk factor for Grave’s disease

A

Smoking

180
Q

MAJOR risk factor for the development of ophthalmopathy

A

Smoking

181
Q

Apathetic thyrotoxicosis in the elderly present mainly with

A

Fatigue and weight loss

182
Q

Most common cardiovascular manifestation of hyperthyroidism

A

Sinus tachycardia (often associated with palpitations)

183
Q

EARLIEST manifestations of Grave’s opthalmopathy

A

Sensation of grittiness, eye discomfort and excess tearing

184
Q

Grave’s ophthalmopathy: in 5-10%, muscle swelling is so severe that diplopia results, typically, but not exclusively, when patient looks

A

Up and laterally

185
Q

Most serious manifestation of Grave’s ophthalmoscopy

A

Compression of optic nerve at apex of the orbit

186
Q

Most frequent site of Thyroid Dermopathy

A

Anterior and lateral aspects of the lower leg (pretibial myxedema)

187
Q

Time of MAJOR risk for relapse in Graves’ disease in pregnancy

A

Post-partum period

188
Q

Prior to radioiodine therapy, carbimazole or methimazole must be stopped

A

At least 2 days before

189
Q

Prior to radioiodine therapy, PTU should be stopped

A

Several weeks before

190
Q

ABSOLUTE contraindications to radioiodine

A

Pregnancy and breast-feeding

191
Q

Most common cause of acute thyroiditis in children and young adult

A

Presence of a piriform sinus (Predominantly Left-sided)

192
Q

MOST common clinically apparent cause of chronic thyroiditis

A

Hashimoto’s Thyroiditis

193
Q

MAJOR cause of sick euthyroid syndrome

A

Release of CYTOKINES

194
Q

MOST common pattern of sick euthyroid syndrome

A

DECREASE in total and unbound T3 levels (low T3 syndrome) with NORMAL levels of T4 and TSH

195
Q

Clinical manifestations of MOST goiters

A

Asymptomatic

196
Q

Sonographic characteristics of thyroid nodules suggestive of malignancy

A
  • Microcalcifications
  • Hypoechogenicity
  • Increased vascularity
197
Q

In benign thyroid neoplasms, risk of Malignancy is Very LOW

A
  • macrfollicular (colloid)

- Normofollicular (simple)

198
Q

In benign thyroid neoplasms, risk of malignancy raise greater concern and histology is more difficult to interpret

A
  • microfollicular (fetal)
  • trabecular (embryonal)
  • Hurthle cell variant (oncocytic)
199
Q

MOST common malignancy of the ENDOCRINE system

A

Thyroid CA

200
Q

Most common type of THYROID CANCER

A

Papillary Thyroid Carcinoma

201
Q

More common in iodine-deficient regions

A

Follicular Thyroid Carcinoma

Endocrinology Board Review (1 decks)

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