Comp (Endocrine and GI) Flashcards by Elizabeth O'Grady

Bromocriptine can treat —- adenoma

pituary

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The classic presenting signs of primary ———– are hypertension and hypokalemia.

aldosteronism

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in aldosterone-secreting adrenal adenoma, ——- will every low

renin

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In Cushing’s disease, secretion of ACTH by a pituitary adenoma causes ————– of the adrenal glands, leading to excess cortisol production.

cortical hyperplasia

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Which of the following laboratory tests is typically used in the diagnosis of diabetes mellitus?

fasting plasma glucose

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”——– is a 54-kd glycoprotein synthesized in the liver that has one binding site for T4. The affinity of —- for T4 is very high, while that for T3 is lower”

”——- receptors mediate most, if not all, of the physiologic actions of thyroid hormone”

TBG

nuclear

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A 35-year-old man has an adenoma of the parathyroid gland, with increased serum concentrations of parathyroid hormone (PTH) and calcium. In this patient, PTH induces which of the following processes to cause hypercalcemia?

Stimulation of osteoclast activity

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—–cells make epi and NE

chromaffin cells in adrenal medulla

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obesity in an older woman is risk factor for endometrial cancer bc

Increased production of estrogen by adiposetissue

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Before a pt starts isotretinoin (accutane) you should order a _______

hcg urine test

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The most reliable method for identifying catecholamine-secreting tumors (such as pheochromacytoma) is measuring fractionated —————- in a 24-hour urine collection.

metanephrines and catecholamines

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————– are the most common form of congenital cyst in the neck. They are epithelial remnants of the thyroglossal tract and present as a midline neck mass at the level of the thyrohyoid membrane. They move up with swallowing or protrusion of the tongue.

Thyroglossal duct cysts

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———- carcinoma is a thyroid cancer composed of parafollicular cells (C cells) that produce calcitonin.

Medullary

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thyroid nodule, histologic sections show sheets of granular cells embedded in a hyaline stroma. Immunohistochemical stains show the presence of cytoplasmic calcitonin. What cancer?

medullary thyroid carcinoma

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The ——– test measures the absorptive capacity of the proximal small intestine and is used to determine whether defects in the intestinal epithelium are responsible for malabsorption. Absorption is usually normal in pancreatic insufficiency since pancreatic enzymes are not required for xylose absorption

D-xylose

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Following radioactive iodine exposure, giving ———— blocks uptake of radioiodine by the thyroid, reducing the risk of thyroid cancer.

potassium iodide

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increased activity of ———enzyme after giving patient with diabetes insulin

glucokinase

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“Polyneuropathy is typically characterized by symmetric distal sensory loss, ——- sensations, or weakness.”

burning

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A 23-year-old man has a 3-month history of mildly depressed mood, decreased energy, and dry skin. His thyroid gland is not palpably enlarged. Serum (T4) and TSH concentrations are decreased. Which of the following is the most likely diagnosis?

Secondary hypothyroidism

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Reason for increased calcium level after overdose of vitamin D:

Increased absorption of calcium in the gastrointestinal tract

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A 51-year-old woman receives the diagnosis of pheochromocytoma. Preoperative treatment with propranolol is prescribed to decrease excessive tachycardia. Which of the following drugs should be administered before starting propranolol therapy in this patient?

Phenoxybenzamine

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A newborn female is diagnosed with hypothyroidism 2 days after birth. Ultrasonography of the neck shows the absence of any thyroid gland tissue. Physical examination shows no abnormalities, including normal root, suck, grasp, and Moro reflexes. Maternal to fetal transfer of which of the following best explains the normal development in this newborn?

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A 59-year-old man undergoes a total thyroidectomy and central lymph node dissection for a 4-cm follicular carcinoma of the thyroid. Twelve hours after the procedure, he has paresthesias of his hands and feet. Vital signs are stable, but carpal spasm is noted on inflation of the blood pressure cuff. Which of the following sets of laboratory findings in serum is most likely in this patient (pth and calcium)?

Parathyroid hormone: decreased, calcium: decreased

Postsurgical hypoparathyroidism can occur after thyroid, parathyroid, or radical neck surgery for head and neck cancer, and it may be transient.
The acute manifestations of hypoparathyroidism are due to acute hypocalcemia.
The hallmark of acute hypocalcemia is tetany, which is a disorder of neuromuscular irritability. The symptoms of tetany may be mild (perioral numbness, paresthesias of the hands and feet, muscle cramps) or severe (carpopedal spasm, laryngospasm, and focal or generalized seizures, which must be distinguished from the generalized tonic muscle contractions that occur in severe tetany). The classic physical findings in patients with neuromuscular irritability due to latent tetany are Trousseau’s and Chvostek’s signs.

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Parotid gland hypertrophy (sialadenosis) is typically bilateral and painless, and occurs in approximately 10 to 25 percent of patients with ————

bulimia nervosa

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measure --- levels for reccurance of medullary thyroid carcinoma

calcitonin

Bilateral thyroid lesions are composed of **_spindle cells_** arranged in small clusters. **Deposits of amyloid** are present between neoplastic cells. **Foci of C-cell hyperplasia** are also present. The lesions are confirmed as malignant. What is it?

medulllary carcinoma

A 28-year-old woman at 18 weeks' gestation has palpitations. Laboratory studies show an **increased serum total thyroxine T3 concentration.** Which of the following tests is best to **confirm a diagnosis of hyperthyroidism** in this patient?

Free T4

A 42-year-old woman comes to the physician because of a 1-month history o**f abdominal pain, especially after eating fatty meals**. BMI is 31 kg/m2. Physical examination shows **jaundice and tenderness of the right upper quadrant of the abdomen**. An **increase in which of the following liver functions** is most likely in this patient?

cholesterol synthesis

A 12-year-old boy is swimming in a mountain stream. He is **immersed up to his neck in 60° F water** for 20 minutes. Which of the following sets of physiologic changes (**blood volume, ADH and ANP**) is most likely to occur in this boy?

blood vol: increase ADH decrease ANP: increase **Water immersion (WI)** to the neck induces prompt **increases in central blood volume, central venous pressure, and atrial distension**. Since **atrial distension is a major stimulus for atrial natriuretic peptide (ANP)** release. The **increase in central blood volume suppresses the release of ADH** (antidiuretic hormone)

A 20-year-old man comes to the physician because of a 3-month history of **progressive thirst and urinary frequency;** the thirst became excessive during the past 3 days. He says that he has been **drinking a lot of fluid.** Physical examination shows no abnormalities. Urinalysis shows a specific gravity of less than 1.006. This patient most likely has **dysfunction of which of the following endocrine structures**?

Posterior pituitary gland He has Central diabetees insipidus

Man given an infusion of **2 g of calcium chloride** over 2 hours. His **serum calcium concentration now is 11.5** mg/dl. Compared with the preinfusion level, the **serum concentration of which of the following substances is most likely to be increased** at this time?

24,25 dihydroxycholecalciferol The renal tubular cells contain two enzymes, 1-alpha-hydroxylase (CYP27B1) and 24-alpha-hydroxylase (CYP24), that can further hydroxylate 25(OH)D, producing **1,25-dihydroxyvitamin D, the most active form** of vitamin D, or **24,25-dihydroxyvitamin D, an inactive metabolite.**

The characteristic biochemical abnormality in patients with **classic 21 Hydroxlase Defeciency** is an **elevated** serum concentration of --------------- the normal substrate for 21-hydroxylase,

17-hydroxyprogesterone (17OHP)

With prolonged, **severe vitamin D deficiency**, there is **reduced** -------------------- and **hypocalcemia** occurs, causing **secondary hyperparathyroidism**, which leads to **phosphaturia, demineralization** of bones, and, when prolonged, **osteomalacia in adults.**

intestinal absorption of calcium and phosphorus

anabolic steriodss cause infertility by

Suppression of gonadotropins

Sheehan syndrome levels of Prolactin, ACTH, TSH; and Aldosterone

Prolactin: decrease, ACTH; decrease, TSH; decrease, Aldosterone; increase

A 10-year-old boy who has had type 1 diabetes mellitus for 1 year is receiving insulin. One hour **after his morning dose of insulin**, he becomes **tremulous and diaphoretic and has tachycardia**. Several hours later, his symptoms resolve. His blood glucose concentration is now increased. Which of the following is the most likely cause of this patient's hyperglycemia?

Activation of hepatic adenylyl cyclase

----------------------are neoplasms that arise from **neural crest chromaffin cells** that are associated with autonomic ganglia and have the ability to **secrete catecholamines**. Paragangliomas are located almost **exclusively in the neck** and skull base, arising most often from the **_carotid body_** and jugulotympanic paraganglia. They are non-functional. Immunohistochemical staining stains positive for:

Paragangliomas neuron-specific enolase, synaptophysin, and/or chromogranin.

Which of the following **diet** is most likely to be effective in **decreasing this patient's risk for type 2 diabetes mellitus?**

low calorie

**Chronic lithium ingestion** in patients with bipolar disorder has been associated with -----------------

nephrogenic diabetes insipidus.

A patient with **nephrogenic DI** will have isotonic **proximal convoluted tubule, hypotonic juxtaglomerular apparatus, and hypotonic medullary collecting duct** (due to the inability of ADH to increase water reabsorption).

isotonic hypotonic hypotonic

pt with foul smelling vaginal discharge and vaginal itching. There is **_frothy, watery-gray discharge_** in the posterior vaginal vault. A wet mount preparation of the discharge shows numerous **_multi-flagellated_** organisms the size of erythrocytes. What is organism?

**Trichomonas vaginalis** Common signs and symptoms of acute infection include a **purulent, malodorous, thin discharge** associated with **burning, pruritus, dysuria, frequency, lower abdominal pain, or dyspareunia.**

A 20-year-old woman comes to the physician because of **severe dysuria and a painful vulvar rash** for 2 days. Examination shows **vesicular lesions** on an erythematous base on the right vulva. Which of the following is the most likely causal organism?

Candida albicans

SCC of cervix, cells from this site will most likely drain first to which of the following lymph nodes in this patient?

internal iliac

The -------- is at risk of injury during ligation of **ovarian vessels in ovariectomy.** Pt will have flank pain

ureter

Congenital anomalies of the uterus are associated with congenital ---------------defects and is frequently discovered after **hysterosalpingography** during a work up of **infertility.**

paramesonephric (mullerian defects)

-------– anchoring placental villi attach to the myometrium

Placenta accreta

The most important risk factor for development of Placenta accreta is placenta -------- after a prior cesarean delivery.

previa

A 55-year-old woman is scheduled to undergo **transvaginal hysterectomy and oophorectomy** for dysfunctional uterine bleeding. During the procedure, the **uterus must be separated from all surrounding pelvic structures**. Identification and incision of which of the following structures that **attaches to the cervical region and extends posteriorly** is most appropriate in this patient?

**uterosacral ligament** The uterosacral and cardinal ligaments are connected at their cervical insertion, and together **suspend the uterus**. The **uterosacral ligament passes posteriorly** and inferiorly to attach to the ischial spine and sacrum. (The **cardinal ligament contains the uterine vessels**).

Nausea, acute sharp **right lower abdominal pain**, Ultrasonography of the pelvis confirms the presence of an **enlarged ovary**, and Doppler ultrasonography shows **decreased adnexal flow**. Which of the following **structures** is most likely affected in this patient?

The **suspensory ligament** connects the ovaries to the lateral pelvic wall and contains ovarian vessels.

A 35-year-old woman has an abnormal Pap smear. Examination of tissue obtained on **cervical biopsy** shows **microinvasive cervical carcinoma**. Which of the following microscopic features led to this diagnosis?

Neoplastic cells in **sub-basement** membrane **connective tissue**

48yr old woman with uterine bleeding and period every 28-38 days. During pelvic examination, the adnexae are non palpable. Endometrial curettage shows **abundant tissue.** Which of the following is the most likely cause of this patient's symptoms?

**Endometrial hyperplasia** is characterized by a **proliferation of endometrial glands resulting in a greater gland-to-stroma ratio** (\>50 percent) than observed in normal proliferative endometrium Endometrial hyperplasia typically presents wit**h abnormal uterine bleeding** and is most common in women who are **perimenopausal or early postmenopausal**

If an operation is required to control **post birth bleeding**, **ligation of a branch** of which of the following **arteries** is most appropriate?

Bilateral ligation of the **internal iliac arteries** (hypogastric arteries) r**educes the pulse pressure of blood** flowing to the uterus

painful urinatation, vaginal itching, odorless curd-like discharge. The pH of the vaginal discharge is 4. The saline slide shows **mature squamous epithelial cells**, and the KOH slide shows multiple **buddingyeasts with pseudohyphae. What is it?**

Candidiasis

**Two hours after vaginal delivery** at term of a 3062-g (6-lb12-oz) newborn, a 32-year-old woman, gravida 3, para 3,has the **onset of heavy vaginal bleeding**. Labor wasaugmented with oxytocin because of a prolonged first stageand required forceps delivery over a midline second-degreeepisiotomy. The abdomen is soft and nontender.Examination shows a **_boggy uterus_** palpated 4 cm above theumbilicus. The perineum is intact. Which of the followingis the **most likely cause of this patient’s hemorrhage**?

uterine atony

**epinephrine** on **beta2-**adrenoreceptors in females cause:

uterine relaxation

A 26-year-old woman comes to the physician because of **vaginal irritation and discharge** for 5 days. She has been sexually active with the same partner for the past 6 months. Pelvic examination shows a **_frothy, yellow-green discharge_** in the vagina. The vaginal wall is markedly erythematous, and there are **two red macular lesions on the cervix (strawberry cervix)**. The pH is 4. There is no foul or fishy odor. Microscopy shows **_motile organisms with flagella_**. What organism and how to treat?

Trichomoniasis is caused by the protozoa **Trichomonas vaginalis.** Give Oral **metronidazole**

A 20-year-old woman comes to the physician because her menstrual period is 1 week late. Menses had occurred at regular 28-day intervals. She had **unprotected sex**ual intercourse with her boyfriend **20 days ago.** A urine **pregnancy test result is positive**. Which of the following best describes the **stage of development of the embryo** at this time?

The neural plate is present, but the neural tube is not yet complete

Increased **concentration of estrogen** and **decreased concentration of progesterone** means a woman is around day ----- of her cycle. Estrogen concentrations hit their peak just before------

ovulation period (Day 14). hit peak judt before ovulation

An otherwise asymptomatic **52-year-old woman** comes to the physician because of **hot flashes**. Her menses have been **irregular for the past 6 months.** Which of the following is the most likely physiologic cause of her symptoms?

Failure of the ovaries to secret **17 beta estradiol**

A 65-year-old woman comes to the physician because of **progressive vulvar itching** over the past 2 months; treatment with miconazole for yeast infections has been ineffective. Examination shows **atrophy of the labia** minora and **_thin, parchment-like skin_** over the vulva and around the anus. Which of the following is the most likely diagnosis?

Lichen sclerosus

17-Hydroxyprogesterone Increased in ----- defeciency

21 hydroxlase

A 30-year-old woman with a **long-standing history of pelvic inflammatory disease** has surgical **resection of a scarred segment** of a fallopian tube. Which of the following inflammatory cells is most likely to be found in the resected specimen?

Macrophages

A sexually active 32-year-old woman has **vaginal pain and pain with urination.** Pelvic examination shows bilateral **_vesiculoulcerative lesions_** of the introitus. Which of the following is the most appropriate antimicrobial therapy?

The nucleoside analogues **acyclovir, valacyclovir,** and **famciclovir** are the preferred antivirals for **_HSV_** infections.

A 22-year-old nulligravid woman comes to the physician for counseling prior to conception. **Menses** have occurred at **irregular** 26- to 32-day intervals since menarche at the age of 14 years. BMI is 32 kg/m2. Her blood pressure is 130/80 mm Hg. Physical examination shows **mild hirsutism** and **velvety brown, thickened skin at the base of the neck and around the axillae**. This patient most likely also has which of the following conditions?

**hyperinsulinimia** **Acanthosis nigricans** is a common, benign disorder that typically presents with velvety, hyperpigmented plaques on the skin. Insulin resistance likely plays a key role in many cases of acanthosis nigricans, including cases linked to obesity, diabetes, and some genetic syndromes.

A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum examination of the vagina and cervix, the **Valsalva maneuver causes a bulge of the anterior vaginal wall.** Which of the following is the most likely cause of this finding?

**Cystocele** Anterior compartment prolapse – Hernia of anterior vaginal wall often associated with descent of the bladder (cystocele)

The **fetus is most vulnerable to major morphologic teratogenesis during organogenesis** in the embryonic period of the ------trimester, between the ----- and -----week of gestation

first trimester between 3-8 weeks

------------contribute to the development of **acne** through stimulating the growth and secretory function of **sebaceous glands.**

Androgens

Formation of ----------- occurs following **C difficile toxin**-induced ulcer formation on the mucosal surface of the intestine, which facilitates release of serum **proteins, mucus, and inflammatory cells.**

pseudomembranes

A **3-week-old infant** is brought to the physician by his mother because of a 1-week history of increasingly **frequent vomiting**. The **_vomitus is nonbilious_** and consists of breast milk. He has had fewer wet diapers during the past 2 days. He was born at term following an uncomplicated pregnancy and initially fed well. He appears lethargic and dehydrated. A 1 × 2-cm, firm, **_mobile, olive-shaped mass_** is palpated immediately to the **left of the epigastrium**. Which of the following is the most likely diagnosis?

pyloric stenosis

A 60-year-old man comes to the emergency department because of the sudden onset of **acute abdominal pain and tenderness, nausea, vomiting, and bloody diarrhea** 2 hours ago. He has a history of cirrhosis and hepatocellular carcinoma. His blood pressure is 99/50 mm Hg. His abdominal wall becomes rigid, with the loss of bowel sounds. During surgical intervention, half of the **_small intestine is found to have a dark purple-red hemorrhagic appearance_**. Which of the following is the most likely cause?

mesenteric venous thrombosis

The --------- nerve **releases gastrin-releasing peptide (GRP)** to stimulate gastrin, which leads to **_increased acid secretion._** The vagus nerve also directly stimulates the **M3 receptor (via Ach) in parietal cells,** which also leads to increased acid secretion. Thus, cutting the ------- trunks **would decrease acid secretion.**

vagus

A 20-year-old man comes to the physician because of a 6-month history of **diarrhea and a 16-kg (35-lb) weight loss.** Physical examination shows pallor and pitting edema of the lower extremities. Laboratory studies show microcytic hypochromic anemia, hypoalbuminemia, and an **increased fat concentration in stool**. Serum **_anti-endomysium lgA and anti-tissue transglutaminase lgA antibodies are positive_**. A biopsy specimen of the small intestine is most likely to show which of the following in this patient? what disease?

**Loss of villi** and increased number of intraepithelial **lymphocytes** ## Footnote **Celiac disease**

The presence of the **carcinoid syndrome** may be suspected when a patient demonstrates **_unexplained diarrhea or flushing._** The most useful initial diagnostic test for the carcinoid syndrome is to measure 24-hour urinary excretion of ---------------- which is the end product of serotonin metabolism. Seventy-five to 80 percent of patients with carcinoid syndrome have tumors located in:

5-hydroxyindoleacetic acid **(5-HIAA)** **small bowel** primary neuroendocrine tumors (NETs)

------------------- is an autosomal dominant syndrome characterized by **_multiple hamartomatous polyps_** in the **gastrointestinal tract**, **_mucocutaneous pigmentation_**, and an increased risk of gastrointestinal and nongastrointestinal cancer. The characteristic mucocutaneous pigmentations (**_melanin spots_**) of ------ are present in more than 95 percent of patients, occurring most commonly on the lips and perioral region, palms of the hands, buccal mucosa, and soles of the feet.

Peutz-Jeghers syndrome (PJS) [https://medicoapps.org/peutz-jeghers-syndrome-2/](https://medicoapps.org/peutz-jeghers-syndrome-2/)

A 68-year-old man comes to the physician because of **difficulty swallowing solids** for 2 months. He has a history of **_dilated cardiomyopathy._** X-rays of the esophagus with barium contrast show **indentation and posterior displacement of the esophagus**. Enlargement of which of the following structures is the most likely cause of the dysphagia?

Left atrium

A 55-year-old man with **_hepatic encephalopathy_** is brought to the physician because of confusion and increased lethargy during the past 24 hours. He has a history of **cirrhosis of the liver** caused by hepatitis C. He is easily arousable despite the lethargy. His temperature is 37°C (98.6° F). Physical examination shows scleral icterus, asterixis, a protuberant abdomen, and ascites. Test of the stool for occult blood is negative. Administration of which of the following **drugs** is most likely to **improve this patient's mental status**?

**Lactulose** **Decreased metabolism of ammonia by the liver can lead to hepatic encephalopathy** (impaired brain function in patients with liver failure). Lactulose is catabolized by colonic bacteria to short chain fatty acids, which lowers colonic pH. The decreased pH leads to formation of nonabsorbable NH4+ from NH3. The nonabsorbable NH4+ is then trapped in the colon and excreted, which reduces plasma ammonia concentrations by creating a gradient for the excretion of NH3.

A **16-month-old** boy is brought to the emergency department because of **_2-to 3-minute episodes of acute abdominal pain_** over the past 6 hours. During the episodes, h**_e turns pale, screams, and draws up his knees._** He has also passed one bloody stool. A **mass is palpated in the right upper quadrant of the abdomen**. What is diagnosis? What is the most appropriate next step in management?

Diagnosis: **Intussusception** refers to the invagination (telescoping) of a part of the intestine into itself. It is the most common abdominal emergency in early childhood, particularly in children younger than two years of age. Next step: **Water-soluble contrast enema** When **_hydrostatic reduction_** is performed under fluoroscopic guidance, a **water-soluble contrast enema** is preferred because of the risk of perforation before or during the procedure. Water-soluble agents reduce the risk of electrolyte disturbances and peritonitis in patients in whom perforation has occurred.