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endo Flashcards

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
Q

Mech of peripheral neuropathy and cataracts in DM

A

aldose reductase converts glucose to sorbitol which accumulates –> osmotic cellular injury

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26
Q

mech of atherosclerosis in DM

A

glycosylation (sugars stuck to amino acids) products accumulate and crosslink with collagen in blood vessels and interstitial tissues –> atherosclerosis

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27
Q

female baby with ambiguous genitalia and maternal virilization

A

aromatase deficiency leading to build up of androgens (not getting converted to estrogens)

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28
Q

labs before starting metformin

A

renal function (creatinine) because it is contraindicated in renal fail

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29
Q

genotypical male with female phenotype

A

17 alpha hydroxylase def

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30
Q

side effect of PTU, methimazole

A

agranulocytosis

suspect this in patients on meds for hyperthyroid with fever and order CBC with diff

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31
Q

what is crossover study

A

subjects given 2 or more treatments consecutively with washout period in between to limit confounding effects of prior treatment

32
Q

hypothyroid symp with mononuclear paranchymal infiltration with germinal centers

A

hashimotos

also see Hurthle cells

33
Q

most common cause of congenital adrenal hyperplasia

A

21 hydroxylase deficiency

34
Q

hypogonadism or delayed puberty with no sense of smell

A

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
Q 
Klienfelters:
LH
FSH
testosterone 
sperm count
A

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
Q

causes of AFP elevation

A

underestimation of gestational age

NT defects, abdominal defects, multigestation

37
Q

ketoacidosisL
extracellular K
intracellular K
total body K

A

extracellular K increase
intracellular K decrease
total body K decrease

38
Q

Mechanism of action of pioglitazone

A

Thiazolidinnedione

decrease insulin resistance by binding PPAR-gamma, nuclear receptor

39
Q

definition of permissive when combining drugs

A

second drug allows the first to reach it’s full potential

40
Q

cushing’s syndrome with elevated ACTH

what is the effect on adrenals

A

hyperplasia of the zona fasciculata and reticularis

41
Q

mechanism of action of finasteride

A

anti androgen that inhibits the action of 5 alpha reductase

decreases conversion of testosterone—> DHT (more active form)

42
Q

use of finasteride

A

can decrease size of prostate in BPH and can bring hair back in androgenic alopecia

43
Q

mechanism of action flutamide

A

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
Q 
in SIADH
plasma Na
plasma osmolality
urine osmilality
urine Na
total body volume
A 
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
Q

treatment of hypothyroid with T3

how are TSH, T3, reverseT3 and T4 affected?

A

TSH: decrease (negative inhibition)
T3: increase
reverse T3: decrease
T4: decrease

46
Q

What does metyrapone do and what is it used for?

A

blocks cortisol synthesis by inhibiting 11 beta hydroxylase which converts 11deoxycortisol–> cortisol

decrease in cortisol –> increase in ACTH

47
Q

plasma lytes in primary aldosteronism
Na
K
bicarb

A

Na: normal
K: decreased
bicarb: high (increased urinary loss of H)
also has HTN

48
Q

LH, FSH, estradiol in anorexia

A

all decreased

49
Q 
baby boy with:
recurrent vomiting, poor feeding
dehydrated, hypotensive
hyponatremia
hyperkalemia
A

21 hydroxylase deficiency

50
Q

hypothyroid symptoms
delayed tendon reflexes with myoedema
muscle pain, cramps and weakness with proxminal muscles
elevated CK

A

hypothyroid myopathy

51
Q

mechanism of action of Canagliflozin

labs prior to starting?

A

Na-glucose cotransporter 2 inhibitor–> urinary glucose loss
side effects: UTI, genital mycotic infections

labs: check renal function

52
Q

histo for papillary thyroid carcinoma

A

orphan annie eyes: clearing of nuclei
nuclear grooves
psammoma bodies

53
Q

histo for medullary thyroid carcinoma

A

sheets of cells in amyloid stroma

increased calcitonin

54
Q

glucocorticoids causes increased protein synthesis in what organ

A

liver: glucocorticoids stim gluconeogenesis

promotes break down and metabolism in muscle and adipose

55
Q

Short acting insulin

A

aspart

lispro

56
Q

long acting insulin

A

glargine, detemir

57
Q

intermediate acting insulin

A

NPH

58
Q

mechanism of action of beta blocker in hyperthyroidism

A

(1) block symptomatic outflow tract actions–> decrease HR and anxiety
(2) decreases peripheral conversion of T4–> T3

59
Q

where is neuriphysin secreted

A

posterior pituitary

60
Q

mechanism of action of acarbose, miglitol

A

inhibits intestinal brush order alpha glucosidases (GI surface membrane bound enzymes)
decreases sugar hydrolysis–> decreases post prandial hyperglycemia

61
Q

side effects of pioglitazone

A

weight gain and edema

62
Q

symptoms of conn syndrome (hyperaldosteroneism)

A

increase aldosterone–> increased renal K and H loss, increased Na reabsorption

  • -> HTN, hypokal, metabolic alk
  • -> muscle weakness, paresthesis
63
Q

girl with ambiguous genitalia, clitoral enlargement and parital fusion of labioscrotal folds
HTN
hypokalemia

A

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
Q 
patient on estrogen supplementation
TSH levels
total T4
total T3
free T3
A 
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
Q

TBG levels in liver failure

A

decreased

66
Q

TBG in pregnancy

A

increases–> normal to be hypothyroid in preg

67
Q

glucose level with exercise

A

decreases

68
Q

glucose level with stress

A

increases

catecholemines increases glycogenlysis and gluconeogen

69
Q

glucose level with infxn, pain, sleep deprivation

A

increases

70
Q

drugs for hirsutism

A

drugs with antiandrogenic properties
spironolactone
flutamide
finasteride

71
Q 
after stopping long term glucocorticosteroid use
CRH
ACTH
Cortisol levels
and symptoms
A

CRH: decreased
ACTH: decreased
Cortisol levels: decreased
and symptomsL hypoten, tachycard

72
Q

diarrhea, weight loss, abdominal pain

duodenal and jejunal ulcers

A

gastrinoma

73
Q

what mediates hyperthyroidism with testicular tumor

A

tumor has increased hCG which has similar structure to TSH–> stim TSH receptors–> hyperthyroid

74
Q

why should you not use non selective betablockers in people with DM

A

exacerbate hypoglycemia and mask adrenergic symptoms (tremor, palpitations)

75
Q

how is glucose transported across membranes

A

carrier mediated transport

76
Q

erythematous papules/plaques on face perineum, extremities

Lesion enlarge and coalesce, leaving bronze colored central indurated area with peripheral blistering and scaling

A

Necrolyting migratory erythema
found in glucogonoma

other symptoms:
DM
anemia
diarrhea, anorexia, abdominal pain

remember (16 decks)

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