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endo Flashcards

1
Q

increased cortisol, decreased ACTH and B/L adrenal atrophy?

A

exogenous steroid use –> Cushing syndrome

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2
Q

increased cortisol, decreased ACTH, unilateral adrenal atrophy?

A

1ary adrenal adenoma, hyperplasia, or carcinoma

** can also present with pseudohyperaldo

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3
Q

increased cortisol, increased ACTH, B/L adrenal hyperplasia?

A

ACTH-secreting adenoma = Cushing disease

or ectopic ACTH - e.g. paraneoplastic

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4
Q

diagnostic method for hypercortisolism?

A

1) serum ACTH - if low, adrenal tumor –> MRI
2) if high –> high dose dex suppression and CRH stim tests

    • adequate dex suppression and increase in ACTH/cortisol with CRH –> Cushing disease
    • no suppression and no change in ACTH/cortisol with CRH –> ectopic ACTH
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5
Q

weakness, fatigue, orthostasis, muscle aches, weight loss, GI disturbances, sugar/salt cravings?

A

adrenal insufficiency

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6
Q

dx of adrenal insufficiency?

A

serum electrolytes, serum cortisol and ACHT, ACTH stim test

** metyrapone stim test (blocks 11deoxycortisol –> cortisol) - normal response = decreased cortisol and increased ACTH; if ACTH remains low then dx = adrenal insuff

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7
Q

hypotension, hyperkalemia, metabolic acidosis, skin and mucosal hyperpigmentation?

A

primary adrenal insufficiency
(MCC in West = autoimmune)

** hyperpigmentation 2/2 MSH = byproduct of increased ACTH production

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8
Q

Waterhouse Friedrichsen?

A

acute 1ary adrenal insufficiency from adrenal hemorrhage

2/2 septicemia (usually N meningitidis), DIC, endotoxic shock

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9
Q

adrenal insufficiency w/o hyperpigmentation or hyperkalemia?

A

secondary adrenal insufficiency
from decreased pituitary ACTH secretion
aldosterone preserved

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10
Q

kid with abdominal distension and firm irregular mass that crosses midline?

A

neuroblastoma - adrenal medulla (from neural crest cells)
HVA and MVA in urine
bombesin and neuron specific enolase +
overexpression of N-myc oncogene

** Homer-Wright rosettes on biopsy

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11
Q

dancing eyes, dancing feet?

A

opsoclonus-myoclonus

seen in neuroblastoma

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12
Q

rule of 10s in pheo?

A 
10% malignant
10% B/L
10% extra adrenal
10% calcify
10% kids
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13
Q

what cells do pheos come from?

A

chromaffin cells - neural crest origin

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14
Q

changes in cholesterol in thyroid dz?

A

hypothyroid –> increased cholesterol 2/2 decreased LDL receptor expression
hyperthyroid –> decreased cholesterol 2/2 increased LDL receptor expression

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15
Q

thyroid biopsy: Hurthle cells, lymphoid aggregate with germinal centers?

A

Hashimoto
HLA DR5 assoc
thyroid non-tender

** increased risk of NHL

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16
Q

pot bellied baby with pale skin, puffy face, protruding umbilicus and tongue?

A

congenital hypothyroidism = cretinism

2/2 maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis, iodine deficiency, dyshormogenetic goiter
MCC in US = thyroid dysgenesis

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17
Q

tender thyroid, jaw pain following flu-like illness?

A

subacute thyroiditis = de Quervain
increased ESR

** biopsy: granulomatous inflammation

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18
Q

fixed, rock hard, painless goiter?

A

Riedel thyroiditis
replacement of thyroid by fibrous tissue; may extend to local structures

** 2/2 IgG4-related dz - e.g. autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis

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19
Q

Wolff-Chaikoff effect?

A

downregulation of thyroid gland in response to increased iodide

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20
Q

pathogenesis of toxic multinodular goiter?

A

mutation of TSH receptor –> hyperfunctioning follicular cells

21
Q

cause of death in thyroid storm?

A

tachyarrhythmia

22
Q

tx of thyroid storm?

A

BBs
PTU
steroids

23
Q

Jod Basedow phenomenon?

A

thyrotoxicosis following iodine repletion in pt with iodine-deficiency goiter

24
Q

thyroid biopsy: Orphan Annie eyes, psammoma bodies, nuclear grooves?

A

papillary thyroid carcinoma - MC, good prog
increased risk with RET and BRAF mutations, hx of childhood irradiation

** lymphatic invasion common

25
Q

thyroid biopsy: uniform follicles, thyroid capsule invasion?

A

follicular carcinoma

good prognosis

26
Q

thyroid biopsy: sheets of cells in amyloid stroma?

A

medullary carcinoma - from parafollicular “C cells”
assoc with MEN2A and 2B
produces calcitonin

** hematogenous spread common

27
Q

thyroid cancer in older patients?

A

undifferentiated/anaplastic

** invades local structures

28
Q

hypocalcemia, shortened 4th/5th digits, short stature?

A

pseudohypoparathyroidism = Albright hereditary osteodystrophy
AD
kidney unresponsive to PTH

29
Q

familial hypocalciuric hypercalcemia?

A

defective Ca-sensing rcptr on parathyroid cells

–> mild hypercalcemia, normal to increased PTH levels

30
Q

MCC of 1ary hyperparathyroidism?

A

parathyroid adenoma or hyperplasia

31
Q

findings in 1ary hyperparathyroidism?

A 
hyperCa
hypercalciuria --> stones
hypoPh
increased PTH
increased ALP
increased cAMP in urine
32
Q

findings in 2ary hyperparathyroidism?

A

hypoCa
hyperPh
increased PTH
increased ALP

33
Q

cancer risk in acromegaly?

A

increased risk of colorectal polyps/cancer

34
Q

MCC of death in acromegaly?

A

HF

35
Q

causes of nephrogenic DI?

A

hereditary - ADH receptor mutation
hypercalcemia
lithium
demeclocycline (ADH antag)

36
Q

tx of central DI?

A

intranasal desmopressin acetate

37
Q

tx of nephrogenic DI?

A

HCTZ
indomethacin
amiloride

38
Q

causes of SIADH?

A

paraneoplastic - SCLC
CNS/trauma
pulmonary disease
cyclophosphamide

39
Q

tx of SIADH?

A 
fluid restriction
IV hypertonic saline (be caaaaareful!)
ADH antag (conivaptan, tolvaptan, demeclocyline)
40
Q

empty sella syndrome?

A

atrophy or compression of pituitary

common in obese women

41
Q

MCC of death in diabetes?

A

MI

42
Q

DM1 vs DM2: genetic predisposition?

A

DM1 - weaker

DM2 - stronger

43
Q

why don’t type 2 DM pts usually get DKA?

A

endogenous insulin usually prevents lipolysis

44
Q

dermatitis, hyperglycemia, DVTs, depression?

A

glucagonoma

- necrolytic migratory erythema

45
Q

recurrent diarrhea, cutaneous flushing, asthmatic wheezing?

A

carcinoid syndrome - MC malignancy in SI
only get sx if mets - if in GI tract, 5HT metabolized in liver
dx: 5HIAA in urine, niacin deficiency

** causes R sided valvular heart disease

46
Q

MEN 1?

A

MEN1 mutation - menin = tumor suppressor

parathyroid tumors
pituitary tumors
pancreatic endocrine tumors (Zollinger Ellison, insulinoma, VIPoma, glucagonoma)

47
Q

MEN 2A?

A

RET mutation (tyr kinase)

parathyroid hyperplasia
pheo
medullary thyroid carcinoma

48
Q

MEN 2B?

A

RET mutation (tyr kinase)

pheo
medullary thyroid carcinoma
marfanoid habitus
mucosal neuromas - oral/intestinal

step 1 - path (12 decks)

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