Endo

Question 1

Pretibial myxedema vs generalized myxedema

Answer 1

pretibial = Graves (hyper) vs generalized (face, arms, periorbital, etcs) = hypothyroidism

Question 2

Scalloped colloid

Answer 2

Graves–> grabbing at edges to make t3/t4

Question 3

auto-IgG to TSH (stimulating)

Answer 3

Graves. This auto-Ab is called THYROID STIMULATING IMMUNOGLOBULIN. OFTEN PRESENTS DURING STRESS (Pregnancy)

Question 4

Exopthalmos

Answer 4

Graves

Question 5

Most sensitive test for Graves:

Answer 5

TSH. Should be decreased because neg feedback from increased T3/T4

Question 6

hypothyroid conditions that initially are transiently hyperthyroid

Answer 6

Hashimotos and Subacute de quervian granulomatous thyroiditis

Question 7

Primary hypothyroidism

Answer 7

increased TSH

Question 8

Secondary/Tertiary hypothyroidism

Answer 8

decreased TSH

Question 9

Kid with mental retardation, short stature or dwarfism, failure to thrive, goiter

Answer 9

Cretinism (congenital hypothyroid)

Question 10

Thyroid condition associated with a non hodgkin lymphoma (diffuse b cell)

Answer 10

Hashimoto

Question 11

Hurthle cells: appearance and dx

Answer 11

large pink staining eosinophilic cells seen in Hashimoto

Question 12

thyroid condition with lymphoid aggregate and germinal centers

Answer 12

Hashimoto

Question 13

viral illness/flu that leads to thyroid condition

Answer 13

Subacute (de quervain). GRANULOMAS = pathology.

Question 14

very tender thyroid, increased ESR, and jaw pain

Answer 14

Subacute (de quervain) –> de querpain”

Question 15

thyroid replaced by fibrous tissue

Answer 15

Reidel thyroiditis. can extend into local structures i.e. cause hoarseness

Question 16

Polyuria with high serum Na

Answer 16

Diabetes Insipidus (both central and nephrogenic)

Question 17

Polyuria with low serum Na

Answer 17

Primary (polygenic) polydipsia

Question 18

Change in urine osmolality after water deprivation in Diabetes Insipidus

Answer 18

No change (or mild increase)

Question 19

Change in urine osmolality after water deprivation in normal pt

Answer 19

increased

Question 20

change in urine osmolality after water deprivation in primary polydipsia

Answer 20

increased

Question 21

Change in urine osmolality after water deprivation test followed by ADH: Primary Polydipsia

Answer 21

No additional change in osmolality. Since primary polydipsia there is no problem with endogenous ADH/receptor, water deprivation test = maximal endogenous ADH

Question 22

Tx for central DI

Answer 22

Desmopessin (ADH analog)

Question 23

Tx for nephrogenic DI

Answer 23

1. Thiazide ( induce mild hypovolemia = increased na and h20 reabsorption at PCT) 2. Indomethacin (decrease synth of PG)
2. Amiloride (decrease Li)

Question 24

dexamethasone suppression test

Answer 24

Cushings (excess ACTH –> excess cortisol). If pituitary adenoma, will show decreased ACTH and cortisol in response.

Question 25

ACTH stimulation test

Answer 25

adrenocorticoid insufficiency

Question 26

normal pt: cortisol fluctuation by time of day

Answer 26

highest in morning, lowest at night

Question 27

cushings pt: cortisol fluctuation by time of day

Answer 27

loss of circadian cortisol fluctation. thus, measure cortisol levels at night (because will be high, vs normal pt will have low cortisol at night)

Question 28

anti-TPO and anti-thyroglobulin

Answer 28

Hashimoto

Question 29

diffuse lymphocytic infiltrate of thyroid + germinal centers

Answer 29

Hashimoto

Question 30

pancreatic islet infiltrate in Diabetes

Answer 30

Type 1: Leukocytic | Type 2: Amyloid Peptide

Question 31

Diabetes: HLA linkage vs genetic predisposition

Answer 31

T1: HLA linkage (HLA-DR3/4) T2: Strong genetic predisposition

Question 32

Diabetes: autoimmune vs genetic predisposition

Answer 32

T1: autoimmune destruction of B cells T2: resistance to insulin, genetically predisposed

Question 33

Pathophys of amenorrhea in anoxerix

Answer 33

decreased Leptin (dec adipose tissue stores) inhibits pulsatile GnRH = dec LH and FSH = low estrogen

Question 34

failure to lactate after birth

Answer 34

Sheehan syndrome: ischemic necrosis of pituitary

Question 35

episodic headaches

Answer 35

pheochromocytoma

Question 36

which cells pheo come from

Answer 36

Chromaffin cells of adrenal medulla

Question 37

genes implicated in pheo

Answer 37

RET, VHL, NF1

Question 38

Medullary thyroid carcinoma path:

Answer 38

sheets of polygonal/spindle shaped extracellular AMYLOID deposits (derived from calcitonin) Neuroendocrine tumor that arises from parafollicular calcitonin-secreting C cells

Question 39

tx of PCOS

Answer 39

no desire pregnancy: OCP (minimize endometrial prolif), wt loss desire to be pregnant: Clomiphene --> SERM that prevents neg feedback inhibition on hypothal and AP by circulating estrogen

Question 40

Sx of Carcinoid (usually a GI tract mass)

Answer 40

``` Flushing Recurrent Diarrhea Wheezing (asthmatic) Right sided valvular lesions (goes to IVC) Increase 5-HIAA in urine ```

Question 41

What tumor can give you Pellagra/niacin def?

Answer 41

Carcinoid, because uses up tryptophan

Question 42

Tx of Carcinoid

Answer 42

Somatostatin analog --> Ocreotide

Question 43

Recurrent ulcers in duodenum/jejunum | Peptic ulcer disease, abdominal pain, diarrhea

Answer 43

Gastrinoma (Z-E syndrome)

Question 44

Positive secretin stimulation test

Answer 44

Gastrin remains high after secretin (normally inhibits it) = Gastrinoma (Z-E syndrome) can be ass. with Men 1 (pancreas)

Question 45

Histo of T1dm vs T2dm

Answer 45

T1: Leukocytes infiltrate in islet T2: Amyloid infiltrate in inslet

Question 46

Amylin

Answer 46

Released with insulin, so will see in t2dm but not t1

Question 47

Glucagonoma (this is NOT z-e)

Answer 47

Dermatitis (necrolytic migratory erythema) Diabetes (hyperglycemia) DVT Depression

Question 48

failure to lactate cold intolerance absent menstruation (postpartum)

Answer 48

Sheehans: ischemic infarct of pituitary

Question 49

Euvolemic hyponatremia | can be caused by small cell lung cancer or cyclophosphamide

Answer 49

SIADH: Excessive free water retention, but clinically normal volume. Urine osmolality>serum osmolality body decreases water retention with decreased aldosterone aka hyponatremia--? correct slowly

Question 50

What are you going to see in hyperparathyroidism?

Answer 50

FIRST THING YOU THINK WHEN YOU SEE HYPERPARATHYROID: STONES BONES GROANS(constipation) PSYC OVERTONES BITCH

Question 51

Primary vs Secondary Hyperparathyroidism

Answer 51

Primary: Increased Ca, low PO4. Increased ALP, Increased cAMP Secondary: low Ca (chronic renal disease --> no vit D), increased PO4, increased ALP.

Question 52

Treatment for prolactinoma

Answer 52

Bromocriptine or cabergoline (dopamine agonists)