Comp (Endocrine and GI) Flashcards
Bromocriptine can treat —- adenoma
pituary
The classic presenting signs of primary ———– are hypertension and hypokalemia.
aldosteronism
in aldosterone-secreting adrenal adenoma, ——- will every low
renin
In Cushing’s disease, secretion of ACTH by a pituitary adenoma causes ————– of the adrenal glands, leading to excess cortisol production.
cortical hyperplasia
Which of the following laboratory tests is typically used in the diagnosis of diabetes mellitus?
fasting plasma glucose
”——– 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
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
—–cells make epi and NE
chromaffin cells in adrenal medulla
obesity in an older woman is risk factor for endometrial cancer bc
Increased production of estrogen by adiposetissue
Before a pt starts isotretinoin (accutane) you should order a _______
hcg urine test
The most reliable method for identifying catecholamine-secreting tumors (such as pheochromacytoma) is measuring fractionated —————- in a 24-hour urine collection.
metanephrines and catecholamines
————– 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
———- carcinoma is a thyroid cancer composed of parafollicular cells (C cells) that produce calcitonin.
Medullary
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
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
Following radioactive iodine exposure, giving ———— blocks uptake of radioiodine by the thyroid, reducing the risk of thyroid cancer.
potassium iodide
increased activity of ———enzyme after giving patient with diabetes insulin
glucokinase
“Polyneuropathy is typically characterized by symmetric distal sensory loss, ——- sensations, or weakness.”
burning
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
Reason for increased calcium level after overdose of vitamin D:
Increased absorption of calcium in the gastrointestinal tract
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
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?
T4
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.
Parotid gland hypertrophy (sialadenosis) is typically bilateral and painless, and occurs in approximately 10 to 25 percent of patients with ————
bulimia nervosa
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 of 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 with 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) reduces 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 sexual 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
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)
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, he 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.
