Endo III

Question 1

thyroid hormone synthesis

Answer 1

in follicles
-produce T4

T3 - in peripheral tissues - more active

Question 2

action of thyroid hormones

Answer 2

bone growth
CNS maturation
more B1 on heart
increased basal metabolic rate - more Na/K-ATPase

Question 3

thyroxine binding globulin

Answer 3

binds most T3/T4 in blood
-only free hormone active

decreased TBG - liver failure, steroid
increased TBG - pregnancy or OCP use

Question 4

5’deiodinase

Answer 4

convert T4 > T3 peripherally

Question 5

thyroid peroxidase

Answer 5

oxidation and organification of iodine

also coupling of MIT and DIT

Question 6

PTU

Answer 6

inhibit thyroid peroxidase and 5’deiodinase

Question 7

methimazole

Answer 7

inhibit only thyroid peroxidase

Question 8

wolff chaikoff effect

Answer 8

excess iodine - inhibit thyroid peroxidse

decreased T3 and T4 production

Question 9

cushings

Answer 9

excess cortisol

MCC - exogenous corticosteroids

Question 10

screening test cushings

Answer 10

24 hour free cortisol in urine

Question 11

high cortisol and low ACTH

Answer 11

adrenal tumor - MRI confirm

Question 12

high cortisol and high ACTH

Answer 12

test further
dexamethasone suppression test
CRH stimulation test

Question 13

cushing disease

Answer 13

ACTH secreting pituitary adenoma

will be suppressed with high dose dexamethasone

Question 14

ectopic secretion of ACTH

Answer 14

paraneoplastic

-will not respond to high dose dexamethasone

Question 15

cushing disease results

Answer 15

1 suppression with high dose dexamethasone

2 increased ACTH and cortisol with CRH

Question 16

ectopic secretion of ACTH

Answer 16

1 no suppression high dose dexamethasone

2 no increase ACTH/cortisol with CRH

Question 17

adrenal insufficiency

Answer 17

low secretion of glucocorticoids and aldosterone

weak, fatigue, orthostatic hypotension, muscle ache, weight loss, sugar and salt craving

Question 18

acute primary adrenal insufficiency

Answer 18

waterhouse friedrichsen

-adrenal hemorrhage with septicemia or shock

Question 19

chronic primary adrenal insufficiency

Answer 19

addison disease

arophy or destruction by disease

Question 20

metyrapone test

Answer 20

metyrapone - block convestion 11-deoxycortisol > cortisol

normal response - low cortisol and high ACTH

with adrenal insufficiency - see no rise in ACTH

Question 21

primary adrenal insufficiency

Answer 21

hypotension
hyperK
metabolic acidosis
skin and mucosa hyperpigment - MSH - byproduct of increased ACTH production from POMC

Question 22

secondary adrenal insufficiency

Answer 22

decreased pituitary ACTH production

no hyperpigmentation
no hyperK - aldosterone synthesis preserved

Question 23

tertiary adrenal insufficiency

Answer 23

chronic steroid use

-aldosterone ok

Question 24

neuroblastoma

Answer 24

adrenal medulla tumor in children
-from neural crest

has homer wright rosette

abdomnal mass - cross midline

HVA and VMA elevated

bombesin and neuron specific enolase positive

Question 25

neuroblastoma genetic

Answer 25

associated with overexpression N-myc

Question 26

pheochromocytoma

Answer 26

MC tumor adrenal medulla in adults from chromaffin cells - neural crest see catecholamines and metanephrines in urine

Question 27

rule of 10s

Answer 27

with pheochromocytoma | -10 % malignant, B/L, extra-adrenal, calcify, kids

Question 28

episodic HTN

Answer 28

pheochromocytoma

Question 29

associations with pheochromocytoma

Answer 29

NF1 VHL MEN 2A MEN 2B

Question 30

tx pheochromocytoma

Answer 30

irreversibla a-antagonist -phenoxybenzamine followed by B-blocker a-blockade first - avoid HTN crisis

Question 31

hypothyroid

Answer 31

less reflexes hypercholesterol - decreased LDL receptors

Question 32

hyperthyroid

Answer 32

more reflexes hypocholesterol - increased LDL receptors

Question 33

hashimotos

Answer 33

autoimmune - anti-thyroid peroxidase Abs -also - antimicrosomal and anti-thyroglobulin Abs with HLA-DR5 enlarged nontender thyroid

Question 34

risk with hashimotos

Answer 34

non-hodgkin lymphoma

Question 35

early hyperthyroid in hashimotos

Answer 35

due to follicular rupture - thyrotoxicosis

Question 36

hurthle cells

Answer 36

hashimotos - lymphoid aggregate - germinal centers

Question 37

cretinism

Answer 37

congenital hypothyroid pot belly, pale, puffy face, protruding umbilicus, protuberant tongue, poor brain development

Question 38

de quervain thyroiditis

Answer 38

subacute follow flu-like illness granuloma inflammation jaw pain - very tender thyroid

Question 39

riedel thyroiditis

Answer 39

thyroid - replace with fibrous tissue manifestation of IgG4 systemic disease fixed hard painless goiter