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Endo Flashcards

1
Q

What does POMC give rise to?

A

ACTH
MSH
b-Endorphins

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2
Q

Explain pathogenesis of high PTH and Calcium deficiency in Celiac.

A

Can’t absorb the Calcium

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3
Q

XX virilization
Salt Wasting
Increased serum 17-hydroxyprogesterone

Diagnosis?

A

CAH, 21-hydroxylase deficiency

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4
Q

Spindle cells on amorphous background with extracellular amyloid
Proliferation of parafollicular, calcitonin secreting C cells

Diagnosis?

A

Medullary thyroid cancer

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5
Q

What syndrome and oncogene is medullary thyroid cancer associated with?

A

MEN 2, RET pro-oncogene (TK)

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6
Q

What is the MOA of Thiazolidinediones (ex. Pioglitazone)?

A

Decrease insulin resistance by binding PPAR-g, a TF of genes in glucose and lipid metabolism

(DM)

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7
Q

What is an adverse effect of the Thiazolidinediones in treating DM?

A

Increase adiponectin >
increase fluid retention >
exacerbate CHF

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8
Q

What is osteitis fibrosa cystica?

A

Skeletal manifestation of primary hyperparathyroidism

  • Cortical bone involvement
  • Subperiosteal erosions, osteolytic cysts in long bones
  • Salt and pepper skull
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9
Q

Lesion to what part of the brain will affect production of ADH and cause permanent central DI?

A

Hypothalamus

- ADH is made int he hypothalamic nuclei

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10
Q

Lesion to what part of the brain will affect release of ADH and cause transient central DI?

A

Posterior Pituitary

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11
Q

What is the effect of glucocorticoids in the periphery?

A

Catabolism

  • Antagonist of insulin in skeletal and adipose tissue
  • Decreased enzymes
  • Provide substrate to the liver instead

(Peripheral wasting with steroid use)

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12
Q

What is the effect of glucocorticoids on the liver?

A

Anabolism

Gluconeogenesis:
- Increase enzymes: PEPCK, G6Phosphatase

Glycogenesis
- Increase enzymes: Glycogen synthase

(Central obesity with steroid use)

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13
Q

What is the Na+ level in primary hyperladosteronism?

A

Normal!

Low K+ and H+

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14
Q

What is the pathogenesis of a normal Na+ level in primary hyperaldosteronism?

A

“Aldosterone Escape”

Aldo retains a lot of water and Na+ >
ANP tries to diurese >
Overall negative charge in lumen pulls out K+ and H+ >
Normal Na, hypoK, alkalosis

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15
Q

What hormones promote gluconeogenesis?

A

Cortisol (through steroid Rs)
GH (through JAK/STAT)
Epi, NE, Glucagon (through GPCRs)

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16
Q

Where are thyroid hormone receptors located?

A

In the nucleus

NOT in the cytoplasm and later translocated to the nucleus

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17
Q

What are the volume and sodium levels in SIADH?

A

Euvolemic Hyponatremia

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18
Q

What is the pathogenesis of euvolemic hyponatremia in SIADH?

A

Increased ADH causes transient fluid overload >
Increased ANP and Decreased aldo in rxn >
Natriuresis (pee out sodium) >
Euvolemia with profound hyponatremia

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19
Q

What is the location and function of chromaffin cells?

A 
Adrenal medulla (stimulated by Ach)
Release catecholamines (NE and Epi)
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20
Q

Exophthalmos in Graves disease is associated with what substance buildup?

A

Glycosaminoglycans

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21
Q

What symptom of Graves disease do glucocorticoids not resolve?

A

Exophthalmos

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22
Q

What is the MOA to Methimazole and Propylthiouracil?

A

Inhibit thyroid peroxidase, thereby inhibiting iodine organification

Rx for Graves disease

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23
Q

What is the adverse effect of both Methimazole and PTU?

A

Agranulocytosis

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24
Q

What is an adverse effect of Methimazole?

A

1st trimester teratogen

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25
What is an adverse effect of PTU?
Hepatic failure, ANCA vasculitis
26
What is an additional effect of PTU, beyond inhibiting thyroid peroxidase?
Decreases peripheral conversion of T4 > T3
27
Describe intracellular effects after insulin binds its receptor.
Insulin > RTK > *protein phosphatase* > enzymes - Activate glycogen synthase to increase glycogen synth - Deactivate fructose 1,6 bis to decrease gluconeogeesis
28
What is the Rx to decrease sympathetic adrenergic symptoms of thyrotoxicosis?
Beta blocker
29
What are 2 effects of beta blockers in thyrotoxicosis?
Decrease sympathetic adrenergic drive | Decrease peripheral conversion of T4 > T3
30
What is the effect of Lithium on the thyroid?
HYPOthyroidism | - Measure TSH periodically
31
What is the MOA of Canagliflozin, Dapgliflozin?
SGLT2 inhibitors Decrease absorption of glucose in the proximal tubule Increased urinary loss of glucose "Floozies lose everything"
32
Anti-androgens: what is the MOA of... Ketoconazole?
Blocks T synthesis at Leydig cells
33
Anti-androgens: what is the MOA of... Spironolactone?
Blocks T synthesis + binding at receptor
34
Anti-androgens: what is the MOA of... Finasteride
Blocks peripheral conversion of T to DHT
35
Anti-androgens: what is the MOA of... Flutamide
Block action at receptor
36
Anti-androgens: what is the MOA of... Cyproterone
Block action at receptor
37
Watery diarrhea Hypokalemia Achlorhydria
VIPoma, pancreatic tumor
38
What is the Rx for a VIPoma?
Octreotide (SST)
39
What is the pathogenesis of poisoning by Amanita Phalloides?
Amatoxins bind to RNA pol II and stop mRNA synthesis Aminata goes by MINA...mRNA PhaLLoides...pol II
40
Most tissues have X as the first enzymes in the glycolytic pathway, but the pancreas has Y.
``` X = hexokinase Y = glucokinase ```
41
Which has a higher Km, hexokinase or glucokinase?
Glucokinase | - It only works when glucose levels are high
42
Which is more sensitive to feedback inhibition by G6P, hexokinase or glucokinase?
Hexokinase | - Glucokinase is not as affected by negative feedback
43
What is the effect of glucokinase in pancreatic beta cells?
Coverts glucose > G6P *rate limiting step* Results in insulin release!
44
What is the result of mutation to glucokinase?
Hyperglycemia and decreased insulin release
45
What are carrier proteins for oxytocin and ADH?
Neurophysins
46
What is the result of mutations to neurophysins, carrier proteins for oxytocin and ADH?
Decreased ADH, diabetes insipidus
47
What is the Rx for a Pheo?
Phenoxybenzamine
48
Increased LFTs with neuro symptoms Slit lamp test indicated Diagnosis?
Wilson's Disease
49
Increased LFTs with > 50% transferrin sat New onset diabetes Diagnosis?
Hemochromatosis
50
What is the cause of Bronze Diabetes?
Hemochromatosis
51
Tall, crowded follicular epithelium Small pseudopapillae project into lumen Graves or Hashimoto?
Graves
52
Lymphocytic infiltrate with lymphoid germ centers Destruction of thyroid follicles Graves or Hashimoto?
Hashimoto
53
What are the functions of Vitamin D?
Increased intestinal absorption of Ca and Phos | Bone resorption and release of Ca and Phos when levels of one or both are low
54
What kind of receptor does glucagon target?
GPCR (> cAMP > PKA)
55
What is the cause of paresthesias and muscle weakness in Conn's Syndrome
HypoK paresis The hyperaldo leads to increased Na+ in and K+ out
56
What is the Rx for Congenital Adrenal Hyperplasia?
Low dose corticosteroids
57
What is the pathogenesis of hypercalcemia in Sarcoidosis?
T cells are activated in inflammatory response > IFN-g > 1-a-hydroxylase in MACROPHAGES > Activates vitamin D > Increased Ca and Phos absorption from gut
58
What is the overall effect of estrogen on thyroid hormone?
Estrogen increases thyroid hormone binding globulin | - Will increase overall thyroid hormone but maintain free
59
What are the levels of neutrophils, lymphocytes, monocytes, basophils, and eosinophils with corticosteroid use?
Neutrophils INCREASE because of demargination of neutros attached to cell walls DECREASED: lymphos, monos, basos, eos
60
Describe the intracellular cascade that releases insulin from pancreatic beta cells, starting with glucose.
``` Glucose enters via GLUT2 > Generates ATP through Kreb's Cycle > ATP binds and closes KATP channel > No more K+ out, so cell depolarizes > Voltage gated Ca channels open > Increase in Ca induces INSULIN RELEASE ```
61
What is the MOA of sulfonylureas and meglitinides in DM?
Increase endogenous insulin secretion ex) Glyburide
62
Thyroid cancer: Finely dispersed chromatin: "ground glass" Intranuclear inclusions + grooves Orphan Annie nuclei Psammoma bodies (calcifications)
Papillary
63
Thyroid cancer: Polygonal spindle shaped cells Cytostain for calcitonin Adjacent amyloid MEN2
Medullary
64
Thyroid cancer: Pleomorphic cells Giant cells Biphasic Spindle cells
Anaplastic
65
What is the Rx for DKA?
Regular insulin, administered IV for aute DKA
66
How does estrogen impact thyroid binding globulin? What are the levels of TSH and T4?
Increases synth of TBG T4 pool increases but free T4 remains normal Euthyroid with normal TSH
67
What is the underlying cause of diabetic mononeuroathy of CN III?
Ischemia
68
External radiation in childhood increases risk of what in adulthood?
Thyroid cancer
69
What is the MOA of Perchlorate + PErtechnate?
Competitive inhibitors of iodide uptake in thyroid at the sodium-iodide transporter

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