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Endocrinology: 4/3- 4/6 > Endo- FA > Flashcards

Endo- FA Flashcards

1
Q

Medications (2) prior to surgery for pheochromocytoma?

A

phenoxybenzamine (irreversible alpha antagonist) followed by B-blocker (to repress reflex tachycardia)

*PHEnOxybenzamine for PHEO

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2
Q

Eye finding in insulinoma?

A

diplopia

diplopia is one of symptoms of hypoglycemia
( other symptoms include lethargy, syncope)

  • Whipple triad: diplopia, lethargy (lack of energy), syncope (sudden loss of consciousness)
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3
Q

SHBG (Sex Hormone Binding Globulin)

  • what condition is associated with increased SHBG?
  • what condition is associated with decreased SHBG?
A
  • high SHBG -> low free testosterone
  • > gyenocomastia in men
  • low SHBG -> high free testosterone-> hirschitism in women
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4
Q

Explain TBG, total T3/T4, free T3/T4 in pregnant women.

A
  • TBG: increased by estrogen
  • total T3/T4: increased
  • free T3/T4: no change
  • euthyroid state. synthesis of T3/T4 does increase in response to increased TBG, but free T3/T4 stays same
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5
Q

Sheehan syndrome vs. pituitary apoplexy

: compare the similarity and difference

A

Both are hemorrhage induced hypopituitarism

  • Sheehan syndrome: ischemic infract of pituitary in POSTPARTUM BLEEDING
  • pituitary apoplexy: hemorrhage at pituitary
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6
Q

Diabetes, biliary colics, steatorrhea : what cancer should be in differential diagnosis?

A

somatostatinoma (pancreatic delta cells)

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7
Q

Why diabetic patients are dehydrated?

A

osmotic polyuria

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8
Q

Ant.pituitary vs. Post. pituitary: embryological origin?

A

Ant: oral ecdoterm (Rathkes pouch)

Post: neuroectoderm (neuroectoderm gives rise to majority of CNS structures)

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9
Q

Three hormones that act as insulin counter-regulatory hormones?

A

GH, T3, Cortisol

*GTC

lipolysis, gluconeogensis, glycogenolysis

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10
Q

What structure is comprised of chromaffin cells?
What cancer is originated from this cell?
What embryological structure gives rise to this cell?

A
  • adrenal medulla
  • neuroendocrine tumors (pheo, neuroblastoma)
  • neural crest cell A in motelpass, Adrenal medulla, which is comprised of chromaffin cells)
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11
Q

hypothyroidism vs. hyperthyroidism: compare dyslipidmia

A

hypothyroidism
: low LDL receptor expression-> hypercholesterolemia

hyperthyroidism
: high LDL receptor expression-> hypocholesterolemia

LDL receptor goes with same (hypo: low, hyper: high)
cholesterolemia goes with opposite

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12
Q

Thyroid: Jod-Basedow phenomenon vs. Wolff-Chaikoff effect

A

Jod-Basedow phenomenon
: Iodine DEFICIENCY -> thyrotoxicosis from partially hot nodule when iodine is REPLETED
* This is one type of hyperthyroidism

Wolff-Chaikff effect
: high Iodine -> temporarily inhibit thyroid peroxidase
-> reduced T3/T4 synthesis

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13
Q

Iodine deficiency: hyper or hyperthyroidism?

A

EITHER

  • Iodine deficiency with partially hot nodule
  • > hyperthyroidism due to Jod-Basedow phenomenon
  • Iodine deficiency without hot nodule
  • > hypothyroidism due to impaired T3/T4 synthesis
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14
Q

Physical exam findings of palpation on thyroid in hypothyrodisms

  • Hashimotto
  • subacute (deQuervain)
  • Riedel thyroiditis
A
  • Hashimotto: non-tender
  • subacute (deQuervain): very tender
  • deQuervain is the only tender thyroid. Whenever tender thyroid shows up, pick this one.
  • Riedel thyroiditis: hard (like rock), non-tender
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15
Q

Histologic findings in hypothyroidisms

  • Hashimotto
  • subacute (deQuervain)
  • Ridel thyroiditis
A
  • Hashimotto: germinal centers
  • subacute (deQuervain): granuloma
  • Riedel thyroiditis: fibrosis (why feel hard on palpation) with inflammatory infiltrates
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16
Q

Autoimmune antibody in type 1 DM? What about HLA?

A

GAD-65 (Glutamic Acid Decarboxylase)

HLA-DR3 and DR4

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17
Q

MEN2A and MEN2A: what gene is mutated? what chromosome? what does it code for?

A

RET
chromosome 10 (MEN TEN)
encodes receptor tyrosine kinase

18
Q

How come PTH can be used for osteoporosis? In what fashion should PTH be given?

A

intermittent PTH can also stimulate bone formation

19
Q

Two drugs that cause hypothyroidism?

A

lithium

Amiadarone

20
Q

Lithium side effects

  • 2 endocrinology
  • 1 heart
  • 1 GI
A

endocrinology

  • nephrogenic DI
  • hypothyroidism (snowboard with penguin in bowtie)

heart
- congenital Ebstein anomaly

GI
- GI disturbance: vomiting, nausea, diarrhea

21
Q

Type 1 DM pregnant. If insulin is given, what happens to fetus?

A

insulin does NOT cross placenta.
However, it will lower mom’s blood sugar, which also lowers babies blood sugar (and baby’s insulin)

  • ONLY GLUCOSE can cross placenta. NOT for insulin
22
Q

Which two malignancies secrete PTHrP?

A
  • squamous cell carcinoma of lung

- renal cell carcinoma

23
Q

Skin manifestation of glucagonoma? What is 5 Ds of glucagonoma?

A

necrolytic migratory erythema
= PAINFUL PRURITIC skin rash

  • 5Ds
  • Dermatitis (necrolytic migratory erythema)
  • Depression
  • Declining weight (lipolysis)
  • DVT
  • Diabetes (hyperglycemia)
24
Q

Person with Graves disease received medications. Later pt develops fever and sore throat. What is going on?

A

agranulocytosis by PTU or methimazole

-> infection

25
Q

How does level of Mg2+ affect PTH secretion? List 3 causes that lower Mg2+

A

low Mg2+ -> increase PTH
really low Mg2+ -> decrease PTH

Mg2+ can be lowered by

  • diuretics (both thiazide and loop diuretics)
  • chronic alcohol
  • aminoglycosides
26
Q

Most common cause of death in diabtetes

A

MI ( diabetes increase risk for CAD due to hyperlipidemia and hyaline arteriolosclerosis)

27
Q

ALP level in hyperparathyroidism?

A

increased

high PTH -> high born degradation
-> more need to make bone -> elevated ALP (indication of increased bone synthesis)

28
Q

Name of two dopamine agonists that can be used for prolactinoma

A
  • bromocriptine

- cabergoline

29
Q

Germline mutation in which three genes are associated with pheocytochroma?

A
  • NF1
  • RET (MEN2A and MEN2B)
  • VHL
30
Q

Etiology of Addison

  • US
  • developing countries
A

US: autoimmune

Developing countries: TB

31
Q

DKA: plasma level of each

  • glucose
  • potassium
  • WBC
A
  • hyperglycemia: cells can’t take it due to absence of insulin
  • FALSE hyperkalemia
    : acidosis -> K+ moves to extracellular space via K+/H+ exchanger. This is false hyperkalemia becuase intracellular K+ level is low. Patient still needs to be treated with potassium even with normal to high potassium level
  • increased WBC: DKA leads to leukocytosis (don’t know why)
32
Q

How glucocorticoids lead to hyperglycemia?

A

it increases insulin resistance

33
Q

Pregnant woman with hypothyroidism give a birth. Baby does not have a layer of epidermis on scalp. What happened? How could she prevent this?

A

methimzaole is teratogen.
it causes aplasia cutis

methimazole can be replaced with PTU (PTU is not teratogen)

34
Q

Thyroid hormone- increased HR/contractility
cortisol - increased blood pressure

Describe the mechanism

A

thyroid hormone -> increased beta1 adrenergic receptor

cortisol -> increased alpha1 adrenergic receptor

35
Q

serum calcium level in secondary hyperparathyroidism?

A

low

low calcium level as a cause for secondary hyperparathyroidism

  • Don’t confuse that high calcium level as a product of secondary hyperparathyroidism. It is “low calcium” that derives increased PTH. As calcium level gets normalized, PTH will also be normalized
36
Q

Which molecule is used for diagnostic accumulant in 21-hydroxylase deficiency?

A

17-hydroxyprogesterone

  • part of cortisol pathway
37
Q

Why predinosone is contraindicated to patient with liver failure?

A

prednisone is prodrug. It is metabolized to active form, prednisolone, in liver

38
Q

POMC is precursor for what three molecules?

A

ACTH
MSH (melanotrophin)
beta-endorphin (binds to u opioid receptor)

39
Q

What is oncogene is associated with neuroblastoma?

A

N-myc

Neuroblastoma, N-myc

40
Q

Prolactin directly inhibits what hormone?

A

GnRH

  • I thought FSH/LH, but no. It directly inhibits GnRH, resulting in low LH/FSH
    => decreased libido and secondary amenorrhea with pituitary adenoma (most commonly prolactinoma)
41
Q

histologic finding of type 2 diabetes?

A

amylin (amyloid) deposition in islet cells

42
Q

What two hormones are secreted from acidophils of anterior pituitary?

A

Growth hormone and prolactin

*GPA= Growth hormone, Prolactin, Acidophil

Endocrinology: 4/3- 4/6 (6 decks)

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