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1
Q

Where is the damage in transient central DI

A

posterior pituitary

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2
Q

where is the damage in permenant central DI

A

hypothalalmus

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3
Q

glyburide (class of drug)

A

sulfonylurea: increases insulin secretion

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4
Q

what class of drug is anastrozole

A

aromatase inhibitor: inhibits synthesis of estrogen from androgenic substrate

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5
Q

mechanism of action for SERMs (tamoxifen)

A

breast: anti-estrogenic used for estrogen positive breast cancer
endometrial: stim effect–> endometrial hyperplasia

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6
Q

how much of a population is within 1 st dev of mean, 2 SD, 3 SD

A

1: 68%
2: 95%
3: 99.7%

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7
Q

Side effects of amiodarone

what test should you order before starting

A 
thyroid dysfunction (order TFT)--> hypothyroid due to excessive iodine  because amiodarone is 40% iodine
corneal microdeposits
blue grey skin discoloration
drug related heptititis
pulmonary fibrosis
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8
Q

What does FSH stim in males

A

sertoli cells to produce inhibin B, this decreases FSH by negative inhibition.
with one testicle–> decreased sertoli cells –> decreased inhibin B–> elevated FSH

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9
Q

In infertility treatment with menotropin and hCG, what does hCG mimic

A

LH surge

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10
Q

symptoms of hypo or hyper thyroid with neck pain and recent viral infection, increased ESR, decreased iodine uptake

A

subacute thyroiditis

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11
Q

histology of subacute thyroiditis

A

mixed cellular infiltration with occasional multinucleate giant cells

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12
Q

MEN 1

A

pituitary, parathyroid, pancreas (diamond)

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13
Q

MEN 2A

A

medullary thyroid carcinoma, parathyroid, pheochromocytoma (square)

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14
Q

MEN 2B

A

medullary thyroid carcinoma, oral/intestinal ganglioneuromatosis (marfans habitus), pheochromocytoma (triangle)

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15
Q

mutation associated with MEN 2A/B

A

ret oncogene

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16
Q

embryonic origin of endocrine organs

A

neural crest

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17
Q

What is neurophysin

A

carrier proteins for oxytocin and ADH and shuttle them from hypothalamus to posterior pituitary
mutation leads to central DI from hypothalamus

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18
Q

what happens to portion of proinsulin cleaved off to form insulin?

A

secreted after it is converted to C protein in golgi

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19
Q

mechanism of action pioglitazone

A

thiazolidinediones decrease insulin resistance by binding transcriptional regulator in glucose and limit metabolism (peroxisome proliferator activated receptor gamma)

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20
Q

mechanism of action thioamide (PTUm methimazole)

A

inhibits thyroid peroxidase –> inhibits thyroid hormone formation

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21
Q

mechanism of action of perchlorate, pertechnetate

A

blocks iodine absorption in thyroid by competitive inhibition

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22
Q

electrolyte changes in addison’s disease

A 
decreased aldosterone:
Na decreases
K increases 
H increases (non anion gap acidosis)
Cl increases
HCO3 decreases
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23
Q

What receptors inhibit insulin secretion?
what receptors stim insulin secretion?
what is predom

A

alpha 2 adrenergic inhibit and is predom

beta 2 adrenergic stim insulin. effects only seen with beta blockers

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24
Q 
Describe the CBC on glucocorticoids
neutrophils
basophils
eosinophils
lymphocytes
monocytes
A

neutrophils increase

all others decrease

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25
Mech of peripheral neuropathy and cataracts in DM
aldose reductase converts glucose to sorbitol which accumulates --> osmotic cellular injury
26
mech of atherosclerosis in DM
glycosylation (sugars stuck to amino acids) products accumulate and crosslink with collagen in blood vessels and interstitial tissues --> atherosclerosis
27
female baby with ambiguous genitalia and maternal virilization
aromatase deficiency leading to build up of androgens (not getting converted to estrogens)
28
labs before starting metformin
renal function (creatinine) because it is contraindicated in renal fail
29
genotypical male with female phenotype
17 alpha hydroxylase def
30
side effect of PTU, methimazole
agranulocytosis | suspect this in patients on meds for hyperthyroid with fever and order CBC with diff
31
what is crossover study
subjects given 2 or more treatments consecutively with washout period in between to limit confounding effects of prior treatment
32
hypothyroid symp with mononuclear paranchymal infiltration with germinal centers
hashimotos | also see Hurthle cells
33
most common cause of congenital adrenal hyperplasia
21 hydroxylase deficiency
34
hypogonadism or delayed puberty with no sense of smell
Kallmann syndrome mutation in KAL 1 gene or FGFR 1 failure of neurons to migrate from olfactory placode to hypothalamus--> no GnRH secretory neurons in the hypothalamus
35
``` Klienfelters: LH FSH testosterone sperm count ```
LH: increased FSH: increased testosterone: decreased sperm count: decreased problem is with destruction of of seminiferous tubules--> low testosterone --> continue to increase LH/FSH
36
causes of AFP elevation
underestimation of gestational age | NT defects, abdominal defects, multigestation
37
ketoacidosisL extracellular K intracellular K total body K
extracellular K increase intracellular K decrease total body K decrease
38
Mechanism of action of pioglitazone
Thiazolidinnedione | decrease insulin resistance by binding PPAR-gamma, nuclear receptor
39
definition of permissive when combining drugs
second drug allows the first to reach it's full potential
40
cushing's syndrome with elevated ACTH | what is the effect on adrenals
hyperplasia of the zona fasciculata and reticularis
41
mechanism of action of finasteride
anti androgen that inhibits the action of 5 alpha reductase | decreases conversion of testosterone---> DHT (more active form)
42
use of finasteride
can decrease size of prostate in BPH and can bring hair back in androgenic alopecia
43
mechanism of action flutamide
non steroid anti androgen competes with testosterone and DHT for receptors on target cells preventing them from binding--> blocks stim effect of testosterone and DHT must give with GnRH agonist or testosterone will increase again due to negative feedback
44
``` in SIADH plasma Na plasma osmolality urine osmilality urine Na total body volume ```
``` plasma Na: decreased plasma osmolality: decreased urine osmolality: increased urine Na: increased total body volume: normal ``` inappropriate ADH--> retention of H2O--> body decreases aldosterone --> dump Na to draw water out of body
45
treatment of hypothyroid with T3 | how are TSH, T3, reverseT3 and T4 affected?
TSH: decrease (negative inhibition) T3: increase reverse T3: decrease T4: decrease
46
What does metyrapone do and what is it used for?
blocks cortisol synthesis by inhibiting 11 beta hydroxylase which converts 11deoxycortisol--> cortisol decrease in cortisol --> increase in ACTH
47
plasma lytes in primary aldosteronism Na K bicarb
Na: normal K: decreased bicarb: high (increased urinary loss of H) also has HTN
48
LH, FSH, estradiol in anorexia
all decreased
49
``` baby boy with: recurrent vomiting, poor feeding dehydrated, hypotensive hyponatremia hyperkalemia ```
21 hydroxylase deficiency
50
hypothyroid symptoms delayed tendon reflexes with myoedema muscle pain, cramps and weakness with proxminal muscles elevated CK
hypothyroid myopathy
51
mechanism of action of Canagliflozin | labs prior to starting?
Na-glucose cotransporter 2 inhibitor--> urinary glucose loss side effects: UTI, genital mycotic infections labs: check renal function
52
histo for papillary thyroid carcinoma
orphan annie eyes: clearing of nuclei nuclear grooves psammoma bodies
53
histo for medullary thyroid carcinoma
sheets of cells in amyloid stroma | increased calcitonin
54
glucocorticoids causes increased protein synthesis in what organ
liver: glucocorticoids stim gluconeogenesis promotes break down and metabolism in muscle and adipose
55
Short acting insulin
aspart | lispro
56
long acting insulin
glargine, detemir
57
intermediate acting insulin
NPH
58
mechanism of action of beta blocker in hyperthyroidism
(1) block symptomatic outflow tract actions--> decrease HR and anxiety (2) decreases peripheral conversion of T4--> T3
59
where is neuriphysin secreted
posterior pituitary
60
mechanism of action of acarbose, miglitol
inhibits intestinal brush order alpha glucosidases (GI surface membrane bound enzymes) decreases sugar hydrolysis--> decreases post prandial hyperglycemia
61
side effects of pioglitazone
weight gain and edema
62
symptoms of conn syndrome (hyperaldosteroneism)
increase aldosterone--> increased renal K and H loss, increased Na reabsorption - -> HTN, hypokal, metabolic alk - -> muscle weakness, paresthesis
63
girl with ambiguous genitalia, clitoral enlargement and parital fusion of labioscrotal folds HTN hypokalemia
11 beta hydroxylase deficiency increased androgens--> females have ambiguous genitalia decreased cortisol increased 11 deoxycorticosterone: has weak mineralcorticoid ability--> produces some aldosterone--> urinary K loss and increased renin--> hypokalemia and HTN
64
``` patient on estrogen supplementation TSH levels total T4 total T3 free T3 ```
``` estrogen increases TBG (because destruction of TBG decreases with estrogen)--> more thyroid bound to more TBG TSH levels: normal total T4: increased total T3: increased free T3: normal ``` overall euthyroid
65
TBG levels in liver failure
decreased
66
TBG in pregnancy
increases--> normal to be hypothyroid in preg
67
glucose level with exercise
decreases
68
glucose level with stress
increases | catecholemines increases glycogenlysis and gluconeogen
69
glucose level with infxn, pain, sleep deprivation
increases
70
drugs for hirsutism
drugs with antiandrogenic properties spironolactone flutamide finasteride
71
``` after stopping long term glucocorticosteroid use CRH ACTH Cortisol levels and symptoms ```
CRH: decreased ACTH: decreased Cortisol levels: decreased and symptomsL hypoten, tachycard
72
diarrhea, weight loss, abdominal pain | duodenal and jejunal ulcers
gastrinoma
73
what mediates hyperthyroidism with testicular tumor
tumor has increased hCG which has similar structure to TSH--> stim TSH receptors--> hyperthyroid
74
why should you not use non selective betablockers in people with DM
exacerbate hypoglycemia and mask adrenergic symptoms (tremor, palpitations)
75
how is glucose transported across membranes
carrier mediated transport
76
erythematous papules/plaques on face perineum, extremities | Lesion enlarge and coalesce, leaving bronze colored central indurated area with peripheral blistering and scaling
Necrolyting migratory erythema found in glucogonoma other symptoms: DM anemia diarrhea, anorexia, abdominal pain

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