Day 1, 3

Question 1

What are the regulatory factors in the release of TH and where do they act?

Answer 1

T3 and T4 act at the hypothalamus and Pituitary to down regulate TRH and TSH, respectively.

Question 2

What is the most sensitive test for thyroid function?

Answer 2

TSH

Question 3

What are the reasons for hypothyroid signs and symptoms?

Answer 3

Decr. BMR: Decrease in ATPase

Decr. SNS: Decrease in catacholamines

Question 4

What drug class causes hypothyroidism?

Answer 4

Antipsychotics (lithium)

Question 5

What is a concern for maternal iodide deficiency?

Answer 5

Congenital hypothyroidism

Question 6

What is the most common type of hypothyroidism?

Answer 6

Hashimotos

Question 7

What is the classic triad for Graves?

Answer 7

Goiter, Thyrotoxicosis, Opthalmopathy

Question 8

What are the underlying causes of hyperthyroid signs and symptoms?

Answer 8

Incr. BMR from increase ATPase production

Incr. SNS activity from incr. catacholamines

Question 9

What is the pathogenesis of Graves’ disease?

Answer 9

Autoantibodies against TSH receptors –> increase T3 and T4 production and release in the thyroid.

Question 10

What are the effects of T3 and T4 in regards to cholesterol levels?

Answer 10

Reduction by increasing the liver LDL receptors

Question 11

What is the primary enzyme in the production of T3 and T4?

Answer 11

Thyroid peroxidase

Question 12

What is the DoC for hypothyroidism?

Answer 12

Levothyroxine is a T4 sythetic

Question 13

What is the usual demographic for hyperthyroidism?

Answer 13

Older women with a personal or family history of Autoimmune

Question 14

What is the second leading cause of hyperthyroidism?

Answer 14

Toxic nodular adenoma

Question 15

What is the usual morphology of a Graves’ goiter?

Answer 15

Diffuse bilateral hot spots

Question 16

What is the drug class and DoC used for Graves?

Answer 16

Thioamines, Methimazole

Question 17

What is prescribed to pregnant Graves patients?

Answer 17

PTU

Question 18

What is the first drug given in a thyroid storm?

Answer 18

Beta blocker - atenolol or propranolol

Question 19

What are the 3 actions of PTH?

Answer 19

Incr. osteoclast activity via stimulation of blasts
Increase 1, 25 Vit D –> incr. Ca++ absorption
Increase Ca++ reabsorption in kidney

Question 20

What two structures inhibit PTH release?

Answer 20

Ca++ and 1, 25 (OH)2D3

Question 21

What is the pathway for Vit production?

Answer 21

http://ajprenal.physiology.org/content/289/1/F8

Question 22

Where does PTH act in the Vit D pathway?

Answer 22

Increased 1a-hydroxylase in proximal tubules

Question 23

What is the pathology of pseudohypoparathyroidism?

Answer 23

Gs protein deficiency

Question 24

What is the class of drugs and the DoC for treating Paget’s?

Answer 24

Bisphosphonates (Alendronate)

Question 25

What are the two drugs preferred in the treatment of postmenopausal Osteoporosis?

Answer 25

Raloxifene (SERM)

Question 26

What is the suffix for bisphosphonates?

Answer 26

"...dronate"

Question 27

When is PTU used?

Answer 27

1st trimester hyperthyroidism (e.g. Graves')

Question 28

What is the use and MoA of Denosumab?

Answer 28

Postmenopausal Osteoparosis, RANK-L Ab -- downregulates osteoclasts

Question 29

What is the use and MoA of Levothyroxine?

Answer 29

Hypothyroidism, TH analogue

Question 30

What are the embryologic origins of the cortex and medulla of the adrenal gland?

Answer 30

Cortex: Mesenchyme Medulla: Neural crest

Question 31

What supplies the blood to the adrenal gland?

Answer 31

aorta, phenic, and renal arteries

Question 32

What are the three zones of the adrenal cortex and their products?

Answer 32

Zona glomerulosa: aldosterone Zona fasiculata: cortisol Zona reticulata: androgens

Question 33

Where is epi synthesized, what enzyme is used, and what cofactor is required?

Answer 33

Phenolethynolamine N-methyltransferase (PNMT)

Question 34

What is the function of Cortisol?

Answer 34

Glucocorticoid, mobilzes glucose and ffa

Question 35

What is the function of aldosterone?

Answer 35

Mineralcorticoid, stimulates Na reabsorption

Question 36

What is the function of dehydroepiandrosterone sulfate?

Answer 36

Androgen, sex hormones

Question 37

Draw out the synthesis of

Answer 37

http://www.nature.com/nrendo/journal/v5/n9/fig_tab/nrendo.2009.148_F1.html

Question 38

What is the rate limiting and committed step in steroid synthesis in the adrenal cortex?

Answer 38

Desmolase

Question 39

What is the effect of cortisol on the body?

Answer 39

Similar to fasting state

Question 40

What are the 5 pathologies associated with excess cortisol?

Answer 40

``` Primary Cushing's - adrenal Secondary Cushing's - pituitary Tertiary Cushing's - hypothalamus Ectopic ACTH - lung and GI neoplasm Iatrogenic ```

Question 41

What is the "heavy hitter" cortisol-based drug?

Answer 41

Dexamethasone

Question 42

What is the difference between Cushing's Syndrome and Disease?

Answer 42

Syndrome: No negative feedback set point Disease: Set point is too high

Question 43

A normal result of what test will exclude Cushing's?

Answer 43

Low-Dose Dexamethasone Suppression

Question 44

What are the ACTH levels after the dexamethasone test in Cushing's caused by: Adrenal Tumor, Ectopic ACTH Syndrome, and Cushing's Disease?

Answer 44

Undetectable Elevated Normal to elevated

Question 45

What is the physiology of the dexamethasone test?

Answer 45

http://www.webmd.com/a-to-z-guides/overnight-dexamethasone-suppression-test

Question 46

What is the physiology behind hypocortisolemia skin bronzing?

Answer 46

Incr ACTH --> melanocyte activation via melanotropin

Question 47

What is Addison's Disease?

Answer 47

Hypocortisolism (opposite of Cushing's)

Question 48

What are the three types of hypocotisolemia?

Answer 48

Primary: Adrenal destruction (Addison's) Secondary: Pituitary doesn't make ACTH Tertiary: Hypothalamus doesn't produce CRH