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COMLEX > Endo > Flashcards

Endo Flashcards

1
Q

constipation, abdominal pain, polyuria, mentation changes?

A

hypercalcemia

- stones, bones, grones, psychiatric undertones

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2
Q
  • very high PTH
  • Elevated serum calcium
  • Hypophosphatemia
  • Increased urine calcium levels
A

primary hyperPTH

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3
Q
  • mildly high PTH

- very low urine calcium

A

Familial hypocalciuric

hypercalcemia (FHH)

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4
Q

what causes an increase in secretion of calcitonin by the parafollicular cells (C-cells) of the thyroid?

A

elevated calcium levels

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5
Q

inappropriately concentrated urine

A

SIADH

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6
Q

Squamous cell carcinomas of the lung can cause a paraneoplastic syndrome in which the tumor secretes what?

A

parathyroid hormone-related peptide

- has the same physiological action and effect as that of endogenous PTH

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7
Q

what malignancies can cause hypoPTH?

A
  • squamous cell of lung (secretes PTHrP)

* Multiple myeloma (osteoclast activating factor [IL-1] by plasma cells)

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8
Q

what granulomatous diseases can cause hypoPTH?

A
  • Lymphomas
  • Tuberculosis (caseating)
  • Sarcoidosis (NONcaseating)
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9
Q

what is the tx for carcinoid syndrome?

  • neuroendocrine tumor, most of which originate in the GI tract, but symptoms don’t appear until there is metastasis to the liver
  • dx by increased 24-hour urinary excretion of 5-HIAA
A

octreotide

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10
Q

what neuroendocrine tumor?
• High volume watery diarrhea
• Hypokalemia
• Hypochlorhydria

A

VIPoma

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11
Q

what neuroendocrine tumor?
• Dermatitis (necrolytic migratory erythema)
• Diabetes

A

glucagonoma

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12
Q 
what neuroendocrine tumor?
• Abdominal pain
• Weight loss
• Gallstones
• Diabetes
• Diarrhea
A

somatostatinoma

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13
Q

what neuroendocrine tumor?
• Diarrhea
• Esophagitis
• Peptic ulcer disease

A

gastrinoma (ZES)

- look for other MEN type 1 sx

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14
Q

carcinoid syndrome can lead to what vitamin deficiency?

A

niacin

- due to a relative deficiency of tryptophan (precursor of niacin and 5HT)

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15
Q

what are the 4 D’s of niacin deficiency?

A
  1. Dermatitis: Pellagra, which means “raw skin,” is characterized by a photosensitive pigmented dermatitis located in sun-exposed areas.
  2. Diarrhea: Severe diarrhea may lead to hypovolemia, hypotension, and nutritional deficiencies.
  3. Dementia: Lack of niacin leads to neurologic findings including delusions, encephalopathy, and dementia.
  4. Death: Niacin is an essential vitamin, and therefore with prolonged deficiency, death may occur.
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16
Q

reversible syndrome characterized by the triad of encephalopathy, oculomotor dysfunction, and gait ataxia

A

Wernicke encephalopathy

- progresses to Korsakoff (confabulation/memroy impairment) and becomes irreversible

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17
Q

symmetrical peripheral neuropathy with motor and sensory impairment

A

dry Beriberi

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18
Q

cardiomegaly, cardiomyopathy, heart failure, peripheral edema, and tachycardia

A

wet Beriberi

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19
Q

self-limited hypothyroidism that is typically seen following a viral, flu-like illness
- tender, enlarged thyroid gland with referred jaw pain

A

DeQuervian thyroiditis

- tx is supportive: nonsteroidal antiinflammatories, beta blockers, and if severe, steroids

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20
Q

Functional thyroid hormone secreted from ovarian tumor

A

struma ovarii

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21
Q

a fixed, firm, painless goiter

- thyroid gland is replaced with fibrous tissue

A

Reidel thyroiditis (HYPOthyroid)

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22
Q

exophthalmos and pretibial myxedema

A

Graves disease

  • MCC HYPERthyroidism
  • result of autoimmune, thyroid stimulating/TSH receptor antibodies
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23
Q

primary adrenal insufficiency that results in inadequate secretion of various adrenal steroid hormones

  • HYPOnatremia
  • hyperkalemia
  • acidosis and skin hyperpigmentation
A

Addison disease
- caused by adrenal atrophy that affects all 3 layers of the adrenal cortex

NOTE: early Addison’s often presents with uncontrolled hiccups…

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24
Q

lack of ADH?

A

diabetes insipidus

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25
Q
  • high serum osmolality (decreased urinary sodium excretion)
  • high urine output
  • desmopressin corrects osmolality
A

central DI

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26
Q
  • dysfunctional ADH receptors that are unable to recognize ADH
  • high serum osmol (less Na excreted)
  • high urine output
  • no change after desmopressin
A

peripheral DI

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27
Q

hyperexcretion of aldosterone, usually due to an adrenal adenoma or hyperplasia

  • hypernatremia
  • hypokalemia
  • metabolic alkalosis
  • low plasma renin
  • HTN
A

Conn syndrome (primary hyperaldosteronism)

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28
Q

which layer of adrenal medulla produces cortisol?

A

fasciculata

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29
Q

which layer of adrenal medulla produces aldosterone?

A

glomerulosa

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30
Q

which layer of adrenal medulla produces DHEA-S,

DHEA, androstenedione?

A

reticularis

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31
Q

Cushing symptoms, that are suppressed with a HIGH-dose dexamethasone test?

A

ACTH producing pituitary tumor

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32
Q

what stimulates the release of ACTH from the pituitary?

A

corticotropin-releasing hormone (CRH) from the hypothalamus

CRH -> ACTH -> adrenals

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33
Q

what is the MOA of metformin?

A

decreases gluconeogenesis in the liver
- activates adenosine monophosphate-activated protein kinase (AMPK)

NOTE: can lead to B12 deficiency by decreasing absorption

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34
Q

where is B12 normally absorbed?

A

ileum

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35
Q

what stimulates glycogenolysys?

A

epinephrine, cortisol (stress!)

- also glucagon and insulin

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36
Q

HYPERnatremia, HYPOkalemia?

A

hyperaldosteronism

- aldosterone keeps NA IN

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37
Q

autoimmune hyperthyroidism (Graves dz) is what type of immune response?

A

Type 2, non-cytotoxic

- Ab against a TISSUE

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38
Q

SLE, and serum sickness are what type of immune response?

A

Type 3

- Ab-Ag complexes, go on to injur kidneys, joints and small vessels

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39
Q

ABO transfusion reaction is what type of immune response?

A

Type 2, cytotoxic

- Abs react with foreign blood, cause hemolysis (cytotoxic)

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40
Q

palpitations, tremor, exophthalmos, and increased deep tendon reflexes?
- low TSH, high T3/T4

A

HYPERthyroid

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41
Q

abdominal pain and wt loss w/

  1. diabetes/glucose intolerance
  2. cholelithiasis
  3. diarrhea/steatorrhea
A

somatostatinoma

- usually found in the head of the pancreas

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42
Q

what hormone inhibits insulin, glucagon, gastrin, CCK, and growth hormone?

A

somatostatin

- released from delta cells of pancreas

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43
Q

suprasellar adenoma on CT scan?

A 
pituitary tumor
- neg feedback on hypothalamus = low
Thyrotropin-releasing hormone (TRH)
Gonadotropin-releasing hormone (GnRH)
Growth hormone-releasing hormone (GHRH)
Corticotropin-releasing hormone (CRH)
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44
Q

solitary thyroid nodule

- fine-needle aspiration shows uniform follicles invading the thyroid capsule

A

follicular carcinoma

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45
Q

solitary thyroid nodule exhibiting “ground-glass” nuclei (aka large nuclei with a clear center) and psammoma bodies

A

papillary thyroid carcinoma (MC thyroid cancer!)
- look out for past hx of radiation exposure in childhood

Papillary is Popular, has Psammoma bodies

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46
Q

when do you see mucosal neuromas?

- what do they look like?

A

MEN 2B

- look like skin colored warts/vesicles on inside of mouth

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47
Q

what distinguishes primary hyperaldosteronism from secondary?

A

renin levels
- secondary hyperaldosteronism is often caused by hypovolemia or low renal perfusion -> activates RAAS

  • primary will have low renin levels
48
Q

gestational diabetes has what effect on newborns insulin levels?

A

increased insulin levels in utero (due to GDM) will cause hypoglycemia once baby is born

49
Q

when would you see myxedema coma?

- decreased mental status, hypothermia

A

severe HYPOthyroid

50
Q

where does medullary thyroid carcinoma arise from?

A

parafollicular C-cells

- produces calcitonin

51
Q

what b-blocker can be used to treat hyperthyroid?

A

propanolol

- decreases sympathetic stimulation

52
Q

what is the treatment for adrenal hyperplasia?

A

spironolactone

53
Q

what would the BP look like of someone with primary hyperaldosteronism?

A

HTN (due to excess aldosterone -> Na reabs)

54
Q

what is the most common adverse effect of thyroidectomy?

A

hypocalcemia due to (accidental/unavoidable) parathyroid removal
- can see effects in as little as 1 day post-op (hypothyroidism is more gradual onset)

55
Q

what causes parathyroid gland to secrete PTH?

A

low serum calcium

- low Ca -> increases PTH -> activates osteoCLASTS -> increases serum Ca

56
Q

what is a pheochromocytoma?

A

tumor of adrenal medulla

57
Q

Anti-smooth muscle antibodies

A

autoimmune hepatitis

58
Q

Anticentromere antibodies

A

scleroderma

59
Q

Antihistone antibodies

A

drug-induced lupus

60
Q

Antimitochondrial antibodies

A

PBC

- causes severe itching due to excess bile acids!

61
Q

sweating, palpitations, shaking, and nervousness that often accompany a falling or low blood sugar are caused by what?

A

the epinephrine response

62
Q

what is the primary tx for Addison’s disease?

A

corticosteroids

63
Q

what is tetany a sign of?

A

hypocalcemia

64
Q

what effect does PTH have on phosphorus?

A

it inhibits reabsorption

65
Q

what effect does vitamin D have on calcium and phosphorus?

A

it increases the absorption of both phosphorus and calcium from the GI tract

66
Q

what effect does PTH have on calcium levels?

A

it stimulates reabsorption of calcium into the blood

67
Q

what is tamsulosin used for?

A

alpha-1 blocker used specifically for benign prostatic hyperplasia

68
Q

what is phenoxybenzamine used for?

A

pheochromocytoma

- irreversibly blocks both alpha-1 and alpha-2 receptors

69
Q

what should you always think of when you see vanillylmandelic acid?

A

pheochromocytoma

70
Q

what is the treatment for central DI?

A

intranasal desmopressin

71
Q

what is the treatment for nephrogenic DI?

A

low salt diet and diuretic (hydrochlorothiazide or amiloride)

72
Q

normally, depriving someone of water has what effect on on ADH levels?

A

dehydration causes an increase in ADH secretion

73
Q

PTH = Phosphate Trashing Hormone

A

increases phosphate excretion
- for every molecule of calcium that gets reabsorbed a phosphate molecule needs to be excreted into the urine to maintain electrical neutrality

74
Q

what effect does PTH have on the kidneys?

A

it inhibits the sodium/phosphate co-transport allowing for increased calcium reabsorption and increased phosphate excretion

75
Q

masculinization and female pseudohermaphroditism, hypotension, hyperkalemia, increased plasma renin, and volume depletion?

A

21-hydroxylase deficiency

76
Q

externally phenotypic female

  • will have normal internal sex organs
  • lack secondary sex characteristics
A

17-a-hydroxylase deficiency

77
Q

• AMP-activated kinase decreases gluconeogenesis
• Increases glucose uptake in fat and muscle
- GI upset, reduced folate and B12 absorption, lactic acidosis

78
Q 
antidiabetic drugs that block potassium channels to allow depolarization and release of insulin from pancreatic beta cells. Adverse effects:
• Hypoglycemia
• Weight gain
• Rash
• Disulfiram reactions
A

sulfonylureas

  • Glipizide
  • Glyburide
  • Glimepiride
79
Q

antidiabetic drug:
• PPAR gamma agonist to enhance nuclear transcription
• Increase GLUT-4

A

Thiazolidinediones (oral)

  • Pioglitazone
  • Rosiglitazone
80
Q

antidiabetic drugs that inhibits intestinal brush border enzyme, delay starch digestion and decrease glucose absorption
cause flatulence and diarrhea

A

Alpha-glucosidase inhibitors (oral)

  • Acarbose
  • Miglitol
81
Q

cellular aspirate, papillary architecture, nuclear features including pseudonuclear inclusions, nuclear grooves, nuclear clearing

A

papillary thyroid carcinoma

82
Q

dispersed cells that have eccentric nuclei, cytoplasmic tails, and granular cytoplasm

A

medullary thyroid carcinoma

83
Q

marked pleomorphism, with bizarre, markedly enlarged cells, occasionally spindle cells

A

anaplastic carcinoma

84
Q

undifferentiated small blue cells, and many feature Homer Wright rosettes — rings of cells around little clumps of nerve fibers, without lumens

A

neuroblastoma

85
Q

Peak age 3-4 years

  • Mass seldom crosses midline. Intrinsic to kidney on imaging (“claw sign”)
  • Calcifications are rare
  • Rings have true lumens
  • Paraneoplastic effects are rare
A

nephroblastoma (Wilms tumor)

86
Q

Peak age < 2 years

  • Mass often crosses midline (compresses but does not invade)
  • Calcifications are common
  • Rings contain neural filaments
  • Paraneoplastic effects (neurologic) are common
A

neuroblastoma

87
Q

what type of pancreatic tumor causes diabetes mellitus, cholelithiasis, steatorrhea, and hypochlorhydria?

A

delta cell tumor (somatostatinoma)

88
Q

A high calcitonin level is associated with what type of thyroid carcinoma?

A

medullary thyroid carcinoma

  • due to the proliferation of parafollicular C-cells, which secrete calcitonin
  • also associated with the endocrine disorders MEN-2a and MEN-2B*
89
Q

what type of hypersensitivity rxn?

  • ABO mismatch
  • Goodpasture’s syndrome
  • Rh hemolytic disease of the newborn
  • myasthenia gravis
A

type 2 (Ab against tissue/receptors)

90
Q

what is metoclopramide used as a treatment for?

A

increasing gastric motility by sensitizing the gastric mucosa to acetylcholine

91
Q

achalasia, megacolon -> caused by what bug?

A

T. cruzi (Chagas)

92
Q

gastroparesis?

A

diabetes (secondary to autonomic neuropathy)

93
Q

Conn syndrome

A 
adrenal adenoma (unilat) or hyperplasia (bilat)
- excess aldosterone -> increased Na reabs, hypokalemia -> suppresses RAAS
94
Q

what is the medical management of Conn syndrome?

A

spironolactone or eplerenone

- K-sparing aldosterone antags (adrenal hyperplasia causes hypokalemia)

95
Q

adrenal adenomas that may cause virilization or Cushing syndrome
- lipid-rich and is often > 4 cm

A

adrenocortical carcinoma

96
Q

pretibial myxedema is caused by a buildup of what?

A 
hyaluronic acid (HA) from Graves' disease
- HA is a glycosaminoglycan produced by fibroblasts, which are stimulated by both the thyrotropin receptor antibodies and thyrotropin hormone
97
Q

what medication is used for symptomatic tx of Graves disease?

A

B-blockers: metoprolol or propranolol

98
Q

what is the treatment for Hashimoto’s?

A

levothyroxine

99
Q

what are definitive tx options for Graves?

A
  • PTU and methimazole (methimazole less hepatotoxic)
  • NOTE: PTU in first trimester, methimazole 2nd and 3rd
  • radioactive iodine ablation, or thyroidectomy
100
Q

young, otherwise healthy pt with resistant HTN, unexplained hypokalemia, metabolic alkalosis (elevated bicarb)?

A

adrenal hyperplasia

101
Q

10 weeks pregnant w/heat intolerance, palpitations, tremor, diarrhea, proptosis

A

PTU 1st trimester for Graves!

- methimazole 2nd and 3rd

102
Q

what are the most common symptomatic pancreatic tumors?

A

gastrinoma

103
Q

development of bilateral multifocal kidney cancer

  • Dermatologic manifestations include fibrofolliculomas (benign white hamartomatous papules of hair follicles commonly found on the nose and cheeks)
  • most have cysts in the lungs and often develop spontaneous pneumothoraces
A

Birt-Hogg-Dubé syndrome

104
Q

what is another name for MEN 2B?

A

mucosal neuroma syndrome

  • 3 M’s and 1 P
  • mucosal neuroma, medullary thyroid CA, marfanoid body habitus
  • pheochromocytoma
105
Q

rare form of congenital bilateral adrenal hyperplasia

  • abnormal external genitalia
  • hypotension/hypovolemia
  • elevated ACTH with low cortisol levels
A

3β-hydroxysteroid dehydrogenase (3BHSD) deficiency
- causes decreased sex steroids, resulting in incompletely masculinized male infants with a small penis and varying degrees of hypospadias

106
Q

Difficulty rising from a chair or reaching arms overhead in the setting of an increased metabolic state (weight loss, tachycardia, hypocholesterolemia) are consistent with?`

A

hyperthyroidism

- thyrotoxic myopathy in which proximal muscles are more affected than distal

107
Q

weight gain, hyperglycemia, moon facies, truncal obesity, a buffalo hump, and osteoporosis
- what is the dx and what is the tx?

A

Cushings

- dexamethasone suppression test

108
Q

painless thyroid nodule with histology demonstrating clusters of follicular cells; fine, powdery chromatin; nuclear grooves; and pseudonuclear inclusions?

A

papillary thyroid carcinoma

  • BRAF mutation MC in adults
  • RET mutation MC in children
109
Q

biopsy of the thyroid gland showing germinal centers with a lymphocytic infiltrate and follicular destruction characteristic of what?

A

Hashimoto’s thyroiditis

110
Q

what does prolactin have an inhibitory effect on?

A

the release of gonadotropin releasing hormone (GnRH) from the hypothalamus
- less GnRH -> less LH/FSH

111
Q

dopamine agonist used to treat a prolactinoma?

A

cabergoline

112
Q

difference between primary and secondary hypothyroidism?

A

primary: Hashimoto, high TSH, low T4
secondary: central cause (Shehan synd), low TSH, low T4 -> look for other pituitary abnormalities (amenorrhea)

113
Q

ACTH secreting pituitary tumor?

A

Cushing disease

114
Q

thyrotropin receptor Ab vs thyroid peroxidase Ab?

A
  • thyrotropin (TSH) = Graves
  • TPO = Hashimoto, postpartum thyroiditis

NOTE: thyroglobulin is nonspecific, but more common in hypothyroid

115
Q

newborn with normal TSH, normal free T4, low total thyroxine (T4)

A

TBG deficiency

COMLEX (14 decks)

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