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Clinical Medicine LAB - Professor Sample > Endo #1 > Flashcards

Endo #1 Flashcards

1
Q

hGH- Human Growth Hormone secreted by ?

A

acidophil cells

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2
Q

hGH- Human Growth Hormone modulates ?

A

Modulates growth from birth until the end of puberty

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3
Q

hGH- Human Growth Hormone when is it secreted ?

A

Secreted in response to sleep, exercise, ingestion of protein, and response to hypoglycemia

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4
Q

hGH- Human Growth Hormone

own notes ?

A

fluctuates with sleeep, glucose levels in the blood stream or types of meals that we are eating

need to remember that Gh fluctuate in the serum

to much GH from childhood is giantism

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5
Q

GH assay: Increased ?

A

Gigantism - starts in childhood

Acromegaly - excess growth hormone starting in adult hood

  • *Arcomegaly - large extremities and head circumference gets bigger
  • *
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6
Q

GH assay: Decreased ?

A

Dwarfism - decrease at childhood ( achondroplasia)

Pituitary insufficiency -

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7
Q

GH Hormone Stimulation Test use ________ or ___________ hypoglycemia to stimulate GH secretion

A

Arginine

insulin-induced

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8
Q

GH Hormone Stimulation Test: decreased ?

A

Pituitary deficiency

GH deficiency

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9
Q

GH Hormone Stimulation Test own notes ?

A

lower the BG then more GH will be secreted

we used insulin or arginine ( to stimulate hyperglycemia) to stimulate GH secretion - if they can secret cause they are deficit

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10
Q

GH Suppression Test aka ?

A

Oral glucose tolerance test

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11
Q

Oral glucose tolerance test: GH will not be suppressed in patients with ?

A

acromegaly or gigantism

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12
Q

Oral glucose tolerance test own notes ?

A

give them a big oral glucose load, it should surpass GH secretion ( if you cant suppress it , like acromegaly and giantism )

given to prig patients to see if gestational diabetes

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13
Q

Insulin-like Growth Factor (Somatomedin C) reflects ?

A

More accurately reflects GH activity

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14
Q

Insulin-like Growth Factor (Somatomedin C) increased ?

A

Acromegaly

Gigantism

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15
Q

Insulin-like Growth Factor (Somatomedin C) decreased ?

A

Dwarfism

GH deficiency

Pituitary deficiency

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16
Q

Insulin-like Growth Factor (Somatomedin C) own notes ?

A

GH are all somatomedin

Insulin like Growth factors is one of them

when they are circulating, you can check for these instead of the GH cause it does not fluctuate like the GH does = get a better average of what the GH activity look like

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17
Q

ADH aka ?

A

Anti-diuretic hormone, Vasopressin

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18
Q

ADH own notes ?

A

it lines the tubules and sucks water back into the tissue tr into the bodty = helps retain water

concentrates the urine bay acting on the tubules to retain water

taking free water out

less aADH - more dilute urine - water is not being reabsorbed

bug part in osmotic homeostasis and helps maintain BP

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19
Q

ADH: Osmotic homeostasis ?

A

Concentrates the urine by acting on the collecting tubules to reabsorb the water

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20
Q

ADH: Volume homeostasis ?

A

↑ water reabsorption : maintains BP

vasoconstrictor

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21
Q

ADH is secreted in response to ?

A

Hypernatremia

Dehydration

Hypotension

Stress/ anxiety - retain water

anywhere where our body wants to retain water

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22
Q

ADH is surpassed by ?

A

Hyponatremia
CHF
Vasoconstrictors

when our body want to get rid of free water 9 less ADH lining tubules so we dont retain the water

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23
Q

Abnormal ADH: DI ?

A

ADH secretion is inadequate

Nephrogenic

Central (Neurogenic)

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24
Q

Abnormal ADH: SIADH ?

A

Carcinoma of thymus or lung (SCLC)

Severe stress

CNS tumor/ CVA ( stroke)

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25
Q

ADH testing: Serum ADH increased ?

A

SIADH

Nephrogenic DI
because if we have ADH that is trying to stimulate the K to retain water and the K can respond and it is still release water - High ADH levels but still going to have volume depletion ( K cannot concentrate urine)

CNS tumors/ infection

Ectopic ADH secretion (paraneoplastic syndrome)

Dehydration

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26
Q

ADH testing: Serum ADH decreased ?

A

Neurogenic DI
lack of ADH coming from central area

Ablation of pituitary
pituitary problems

Hypervolemia

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27
Q

ADH Suppression Test purpose ?

A

Differentiate between SIADH and other edematous conditions

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28
Q

ADH Suppression Test procedure ?

A

Administer water (20 mL/kg up to 1500 mL) in 10-20 minutes

Collect urine every hour for 6 hours and send for SG ( specific gravity) and urine osmolality measurements

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29
Q

ADH Suppression Test: results - SIADH ?

A

Water excretion: little

Urine osmolality: ↑

Urine SG: ↑

U/S ratio: ↑

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30
Q

ADH Suppression Test: results - other edematous states ?

A

Begin excreting up ~80% of water load = NL

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31
Q

ADH Suppression Test own notes ?

A

NL alot of water they will just pee it out

SIADH the more water we give them they still can get it out and they continue to be more and more volume overloaded ( no free water secretion into urine)

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32
Q

Water Deprivation Test: ADH Stimulation Test

purpose ?

A

Differentiate between causes of polyuria including neurogenic/ nephrogenic DI = peeing alot of free water

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33
Q

ADH Stimulation Test: procedure ?

A

Pt is deprived of fluids

Serum osmolality rises above 288 mOsm/kg to consider pt adequately dehydrated

Administer Vasopressin SQ

Obtain urine osmolality

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34
Q

ADH Stimulation Test

own notes ?

A

we dehydrate them even further

kidney problem or neurologic problem

Neurogenic Problem - and we give them vasopressin - then we will see a rise in urine osmolality - cause it is from a central place ( when give the V you should see a rise in UOsmolality if neurogenic )

Kidney Problem - and kidney is not responding and you give them the V - the kidneys still cannot concentrate the urine

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35
Q

Water Deprivation Test: results - Rise in Urine Osmolality of > 9% ?

A

Neurogenic DI

36
Q

Water Deprivation Test: results - Little to No increase in Urine Osmolality ?

A

Nephrogenic DI

37
Q

_________- - Ca balance and homeostasis ( calcitonin, calcitriol, regulateds)

A

parathyroid

Thyroid and Parathyroid

38
Q

Calcium homeostasis is regulated by ?

A

Parathyroid hormone (PTH)

Calcitriol

Calcitonin

39
Q

Calcium Balance own notes ?

A

decrease loss of Ca from the urine

pulls Ca from the bone

PTH - is supposed to increase Ca

we need healthy liver ( for VD) and precusrose to make calcitriol ( active VD) which we need to get Ca increase

PTH leaks Ca out of bone

calcitonin - deposits it back to the bone

they do the opposite

40
Q

Calcium: NL physiology ?

A

PTH,

↓Phosphate,

↓1,25 (OH)2 Vit D ( cause it needs it for the Ca) ,

↑ Calcitonin ( decrease serum Ca)

41
Q

Calcium Increased: in blood stream ?

A

Malignancy - bone mets, neruoendorcine acts

Hyperparathyroidism (Primary) - uncheck PTH release that increase serum Ca

42
Q

Calcium decreased ?

A

Hypoparathryoidism

Liver disease (malabsorption of vitamin D)

43
Q

Calcium Balance own notes ?

A

Ca is inverse P ( not Mg)

just know it is related between these tings

dont worry about the arrows

need VD to absorb the Ca

44
Q

PTH NL physiology ?

A

↑ Ca,

↓ Phosphate

45
Q

PTH increased ?

A

Hyperparathyroidism

46
Q

PTH decreased ?

A

Malignancy ( because of negative feedback mechanism)

Hypoparathyroidism

47
Q

Calcitonin NL physiology ?

A

↓ Ca

48
Q

Calcitonin increased ?

A

Tumor marker for medullary carcinoma (thyroid CA) - highly likely

used all the time to monitor this CA

49
Q

1,25- (OH)2 Vit D Calcitriol aka ?

A

Calcitriol

50
Q

Calcitriol NL physiology ?

A

↓PTH

↑Ca

51
Q

Calcitriol decreased ?

A

Renal failure

Liver failure

**rickets

osteomalacia **

52
Q

Intact PTH range ?

A

(10-65)

53
Q

Serum Calcium range ?

A

(9-10.5)

54
Q

Intact PTH = 75.2

Serum Calcium = 11.2

condition ?

A

Hyperparathyroidism ( primary - coming from the gland itself - something wrong with the gland

55
Q

Intact PTH = 23.8

Serum Calcium = 9.2

condition ?

A

NL

56
Q

Intact PTH = 8

Serum Calcium = 11.6

condition ?

A

Malignancy ( PTH is low cause it is trying to lower Ca) think CA first before anything else

57
Q

Intact PTH = 124

Serum Calcium = 9.1

condition ?

A

Secondary Hyperparathyroidism ( just barely bring Ca into NL range - maybe secondary to kidney disease )

58
Q

Intact PTH = 6.4

Serum Calcium = 8.0

condition ?

A

Hypoparathyroidism

59
Q

remember the Ca levels are very sensitive ?

A

a little change? then follow up and investigate it

60
Q

Thyroid own notes ?

A

like gas petal in car

hyperthyroid - sweating , palpatations, anoxiat7 attacks, diarrhea

hypothyroid - cold all the time, sluggish , tired, gained wiehgt, constipation

TRH from Hypothalamus then goes to the Pituitary to release TSH and then it goes to the thyroid to release T3 and T4

61
Q

Thyroid stimulating hormone (TSH) aka ?

A

Thyrotropin

62
Q

Thyroid stimulating hormone (TSH) stimulates ?

A

Stimulates thyroid to secrete T3 and T4

63
Q

Thyroid stimulating hormone (TSH) increased ?

A

Primary hypothyroidism

64
Q

Thyroid stimulating hormone (TSH) decreased ?

A

Hyperthyroidism ( primary)
trying to put break on thyroid but it keeps release T3 and T4 but the TSH decline and the T keeps pumping it out ( TSH levels dont matter)

Secondary hypothyroidism
P is failing to put out TSH , decreased TSH levels , something wrong with the producer

65
Q

T4/ Thyroxine: 90% total = ?

A

Bound + Unbound

**free T4 is more metabolically active **

66
Q

T4/ Thyroxine free: increased ?

A

Hyperthyroidism

67
Q

T4/ Thyroxine free: decreased ?

A

Hypothyroidism

68
Q

T3/ Triiodothyronine

free: increased ?

A

Hyperthyroidism

69
Q

T3 aka ?

A

Triiodothyronine

70
Q

T4 aka ?

A

Thyroxine

71
Q

Antithyroglobulin antibody (Anti-TG Ab) increased in ?

A

Hashimoto’s

Grave’s disease

72
Q

Antithyroglobulin antibody (Anti-TG Ab) bates page ?

A

Mosby’s pg. 103, Table 2-7

73
Q 
Antithyroglobulin antibody (Anti-TG Ab)
 own notes ?
A

Thyroid disease is often from a autoimmune problem

H ( AI hypo) and GD ( AI hyper)

ABS toward the thyroid and you can test for the ABS

Thyroid globulin is normally in the thyroid and with damage it can be in the serum and it acts like a antigen and the body attacks

more likely to be found in H (70%) then GD ( 55%)

74
Q

Antithyroglobulin antibody (Anti-TG Ab) is more sensitive to ?

A

more likely to be found in H (70%) then GD ( 55%)

75
Q

Antithyroid peroxidase antibody (Anti-TPO Ab)

increased in ?

A

Hashimoto’s

Grave’s disease

76
Q

Antithyroid peroxidase antibody (Anti-TPO Ab)

own notes ?

A

only found in the microsomes in the epithelial cells inside the T and NL not in the serum

if tissue destruction - some escape the microsomes and our body sees it as an FB antigen

90% H have this ABS

70% with GD have this ABS

GD - inflammation of the T and stimulates the T cells that relate the Hormones

77
Q

Antithyroid peroxidase antibody (Anti-TPO Ab) is more sensitive to ?

A

90% H have this ABS

70% with GD have this ABS

78
Q

Thyroid Stimulating Immunoglobulin (TSI)

supports what dx ?

A

Grave’s disease

  • *This is more for GD dx the other two are more for H
  • *
79
Q

TSH NL range ?

A

0.3-5

80
Q

Free T4 ?

A

0.8-2.8

81
Q

TSH = 0.1

Free T4 = 3.6

Diagnosis ?

A

Hyperthyoridism ( GD)

82
Q

TSH = 10.2

Free T4 = 0.6

Diagnosis ?

A

Hypothyroidism ( primary)

83
Q

TSH = 3.2

Free T4 = 2.6

Diagnosis ?

A

NL

84
Q

TSH = 0.03

Free T4 = 0.4

Diagnosis ?

A

secondary hypothyroidism( pituitary is failing)

85
Q

TSH = 0.12

Free T4 = 6.5

Diagnosis ?

A

Hyperthyroidism ( could be GD but you need ABS)

Clinical Medicine LAB - Professor Sample (36 decks)

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