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Step I > endo path > Flashcards

endo path Flashcards

1
Q

cushings etiology

A

increased cortisol d/t

  • endogenous corticosteroids
  • primary adrenal adenoma, hyperplasia, or carcinoma
  • ACTH-secreting pit adenoma (Cushings disease) or pareneoplasitc ACTH secretion
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2
Q

endogenous corticosteroids

A

decreased ACTH
b/l adrenal atrophy
MCC

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3
Q

primary adrenal adenoma, hyperplasia, or carcinoma

A

decreased ACTH
atrophy of uninvolved adrenal gland
can also present w/pseudohyperaldosteronism

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4
Q

ACTH secreting adenoma or paraneoplastic ACTH secretion

A

results in increased ACTH

b/l adrenal hyperplasia

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5
Q

cushings findings

A 
HTN
weight gain
moon facies
truncal obestiy
buffalo hump
skin changes
osteoporosis
hyperglycemia
amenorrhea 
immunosupression
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6
Q

Dexamethasone suppression test

A

cushings disease will suppress

ectopic ACTH secretion will not supress

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7
Q

CRH stimulation test

A

cushings dis-> increase in ACTH and cortisol

ectopic ACTH secretion -> no increase

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8
Q

symptoms of adrenal insufficiency

A 
weakness
fatigue
orthostatic hypotension
mm aches
weight loss
GI 
sugar and/or salt cravings
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9
Q

Dx of adrenal insufficiency

A 
measurement of serum electrocluces
am cortisol
ACTH
ACTH stimulation test 
metyrapone stimulation test
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10
Q

metyrapone stimulation test

A

blocks last step of cortisol synthesis
normal response in decreased cortisol and increased ACTH
in adrenal insufficiency ACTH does not increase

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11
Q

primary adrenal insufficiency

A 
hypotension
hyperkalemia
metaboic acidosis
skin and mucosal hyperpigmentation 
chronic -> addisons disease
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12
Q

causes of addisons

A

autoimmune (MC)
TB
mets

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13
Q

Waterhouse-friderichsen syndomre

A

N. menigitidis

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14
Q

secondary adrenal insufficiency

A

decreased ACTH
no hyperpigmentation
no hyperkalemia

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15
Q

tertiary adrenal insufficiency

A

pt w/chronic exogenous steroid use precipitated by abrupt withdrawal
aldosterone unaffected

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16
Q

neuroblastoma

A

MC tumor of adrenal medulla in kids

usually

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17
Q

neuroblastoma presentation

A 
distended abdomen 
firm irregular mass that can cross midline (wilms-tumor)
opsoclonus-myoclonus sundroem
HVA and VMA increased in urine
bombesin and neuron-specific enolase _
rarely causes HTN 
N-myc
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18
Q

pheo etiology

A

MC tumor of adrenal medulla in adults

derived from chromaffin cells from neural crest

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19
Q

pheo rule of 10’s

A 
10% malignant
10% b/l
10% extra-adrenal
10% calcify
10% kids
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20
Q

pheo symptoms

A 
5 Ps
pressure (increased BP)
pain (HA)
perspiration 
palpitations
pallor
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21
Q

pheo associations

A

NF1
VHL
MEN2A and 2B

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22
Q

pheo findings

A

increased catecholamines and metanephrines in urine and plasma

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23
Q

Tx of pheo

A

irreversilbe alpha antagonists (phenoxybenzamine)
followed by BB prior to tumor resection
if BB first -> HTN crisis

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24
Q

hypothyroidism symptoms

A 
cold intolerance
weight gain, decreased appetite
hypoactivity, lethargy, fatigue, weakness
constipation
decreased reflexes
myxedema (facial/periorbital)
dry, cool skin, coarse brittle hair
bradycardia, dyspnea on exertion
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25
Q

hypothyroidism labs

A

increased TSH (best test)
decreased free T3/4
hypercholesterolemia (d/t decreased LDL R)

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26
Q

hyperthyroidism symptoms

A 
heat intolerance 
weight loss, increased appetite
hyperactivity
diarrhea
increased reflexes
pretibial myxedema 
periorbital edema
warm moist skin, fine hair
chest pain, palpitations, arrhythmias (increased number and sensitivity of betaRs)
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27
Q

hyperthyroidism labs

A

decreased TSH if primary
increased free or total T3/4
hypocholesterolemia (d/t increased LDL R)

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28
Q

hashimotos

A 
MCC of hypothyroidism in iodine sufficient regions
anti-thyroid peroxidase
anti-microsomal
anti-thyroglobulin 
HLA-DR5
increased risk of Hodgkin lymphoma
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29
Q

hashimotos presentation

A

may have transient hyperthyroid stage d/t thyrotoxicosis during follicular rupture
moderately enlarged, non-tender thyroid

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30
Q

hashitmotos histo

A

Hurthle cells

lymphoid aggregate w/germinal centers

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31
Q

congenital hypothyroidism/cretinism

A

severe fetal hypothyroidism

thyroid dsygenesis MCC in US

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32
Q

findings of congenital hypothyroidism

A 
6Ps
pot-bellied
pale
puffy face w/protruding umbilicus
protuberant tongue
poor brain development
33
Q

subacute thyroiditis

A

aka de Quervain
self-limited, often follows flu-like illness
may be hyperthyroid early then hypo

34
Q

subacute thyroiditis histo

A

granulomatous inflammation

35
Q

subacute thyroiditis findings

A

increased ESR
jaw pain
early inflammation
very tender thyroid

36
Q

riedel thyroiditis

A

thyroid replaced by fibrous tissue
mimics anaplastic carcinoma
may be manifestation of IgG4 related systemic disease
fixed, hard, painless goiter

37
Q

IgG4 systemic diseases

A

autoimmune pancreatitis
retroperitoneal fibrosis
noninfectious aortitis

38
Q

graves

A 
MCC of hyperthyroidism 
autoAbs stim TSH R
hyperthyroid, diffuse goiter
retro-orbital fibroblasts
dermal fibroblasts (pre-tibial myxedema)
39
Q

toxic multinodular goiter

A

focal patches of hyperfnxing follicular cells, working independently of TSH d/t mutation in TSH R
increased release of T3/4
hot nodules are rarely malignant

40
Q

thyroid storm

A

stress-induced catecholamine surge
serious complication of thyrotoxicosis
agitation, delirium, fever, diarrhea, coma, tacharrythmia (COD)
increased ALP d/t bone turnover

41
Q

Tx of thyroid storm

A

3 Ps
Propanolol (or other BB)
PTU
Prednisolone (or other corticosteroids)

42
Q

Jod-Basedow phenomenon

A

thyrotoxicosis after iodine deficient goiter given iodine

43
Q

papillary carcinoma

A 
MC thyroid CA
excellent prognosis
orphan annie eyes
psammoma bodies
nuclear grooves
lymphatic invasion common
44
Q

orphan annie eyes

A

empty appearing nuclei w/central celaring

diagnostic of papillary carcinoma

45
Q

papillary carcinoma risks

A

childhood radiation
RET
BRAF

46
Q

follicular carcinoma

A

good prognosis
invases thyroid capsule (unlike follicular adenoma)
uniform follicles

47
Q

medullary carcinoma

A

parafollicular C-cells
produces calcitonin
sheets of cells in amyloid stroma
hematogeneous spread

48
Q

medullary carcinoma assocaitions

A

MEN 2A, 2B -> RET mutations

49
Q

undifferentiated anaplastic carcinoma

A

older pts
invades local structures
poor prognosis

50
Q

lymphoma

A

associated w/hashimotos

hodgkin type

51
Q

hypoparathyroidism signs

A

chvostek sign- tapping of cheek (facial nn) -> contractions of facial mm
trousseau sign- occulusion of brachial a w/BP cuff -> carpal spasm

52
Q

psudohyperparathyroidism

A 
albright hereditary osteodystophy
unresponsiveness of kidney to PTH
hypocalcemia
shortened 4th and 5th digits
short stature
AD
53
Q

familial hypocalciuric hypercalcemia

A

defective Ca sensingR on parathyroid

PTH cannot be suppressed by increased Ca -> mild hypercalcemia w/normal to increased PTH

54
Q

primary hyperparathyroidism

A

stones, bones, groans, and psychiatric overtones
usually d/t parathyroid adenoma or hyperplasia
hypercalcemia, hypercalciuria (stones)
hypophosphatemia
increased PTH
increased ALP, cAMP, in urine
asymptomatic
may present w/constipation and/or derpession

55
Q

osteitis fibrosa cystica

A

cystic bone spaces filled w/brown fibrous tissue and hemosiderin (brown tumor)
painful
complication of primary hyperparathyroidism

56
Q

secondary hyperparathyroidism

A

d/t decreased Ca and/or increased phos
MCC chronic renal disease
hypocalcemia, hyperphosphatemia
increased ALP, PTH

57
Q

renal osteodystrophy

A

bone lesions d/t a secondary or tertiary hyperparathyroidsim that is d/t renal disease

58
Q

tertiary hyperparathyroidism

A

refractory/autonomous hyperparathyroidism from chronic renal disease
very increased PTH
increased Ca

59
Q

pituitary adenoma

A

MC is prolactinoma (bengin)

Tx bromocriptine or cabergoline

60
Q

acromegaly

A

excessive GH in adults, usually d/t pit adenoma
large tongue w/deep furrows
imparied glucose tolerance
increased risk of colorectal polyps and CA

61
Q

acromegaly Dx

A

increased serum IGF-1
failure to suppress serum GH with oral glucose tolerance test
pit mass on MRI

62
Q

acromegaly Tx

A

surgery
octreotide (somatostatin analog)
pegvisomant (GHR antagonist)

63
Q

SIADH

A

euvolemic hyponatremia (d/t decreased aldosterone)
urine osm>blood
very low Na -> cerebral edema and seizures
correct slowly

64
Q

what happenes if you correct hyponatremia too quickly

A

osmotic demyelination syndrome/central pontine meylinolysis

65
Q

causes of SIADH

A

ectopic ADH (small cell lung CA)
CNS disorders/head trauma
pulmonary disease
drugs (cyclophosphamide)

66
Q

Tx of SIADH

A 
fluid restriction
IV hypertonic saline
conivaptan 
tolvaptan
demeclocycline
67
Q

hypopituitarism causes

A 
nonsecreting pit adenoma
craniopharyngioma
sheehan syndrome
empty sella syndroem
pit apoplexy
brain injury
radiation
68
Q

glucagonoma

A 
alpha cell tumor 
dermatitis (necrolytic migratory erythema)
DM
DVT
depression
69
Q

insulinoma

A

beta cell tumor
hypoglycemia
whipple triad

70
Q

whipple triad

A

low blood glucose
hypoglycemia
resolution of symptoms w/glucose

71
Q

carcinoid syndroem

A

rare, but MCC malignancy of small intestine
usually small bowel tumors secreting 5-HT
non seen if tumor limited to GI
recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right valvular disease
increased 5-HIAA in urine
niacin deficiency

72
Q

carcinoid Tx

A

surgery

somatostatin analog- octreotide

73
Q

carcinoid rule of thirds

A

1/3 mets
1/3 present w/secondary malignancy
1/3 are multiple

74
Q

zollinger-ellison syndrome

A 
Gastrin-secreting tumor of pancreas or duodenum 
acid hypersecretion -> recurrent ulcers 
pain, diarrhea
\+ secretin stimulation test 
MEN1
75
Q

secretin stimulation test

A

gastrin levels remain elevated after administration of secretin

76
Q

MEN1

A 
Parathyroid
Pituitary tumors (prolactin or GH)
Pancreatic endocrine (ZE, insulinomas, VIPomas, glucagonomas)
MEN1 gene (tumor supressor)
77
Q

MEN 2A

A 
Parathyroid
Pheo
Medullary thyroid carcinoma (secretes calcitonin)
Marfanoid 
RET gene (TKR)
78
Q

MEN 2B

A 
Pheo
medullary thyroid carcinoma (secretes calcitonin)
oral/intestinal ganglioneuromatosis
marfanoid 
mutation in RET

Step I (22 decks)

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