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UWORLD QuestionQuestions > Endo/Repro > Flashcards

Endo/Repro Flashcards

1
Q

MEN 1

A

Tumors in 3Ps
Parathyroid - where is this also seen?
PANCREAS
PITUITARY

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2
Q

MEN 2A

A

medullary carcinoma thyroid- MEN 2
Pheochromocytoma- MEN 2

Parathyroid Tumor- also seen in?

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3
Q

MEN 2B

A

medullary carcinoma of thyroid- MEN 2
pheochromocytoma- MEN 2

MUCOSAL NEUROMA- 2B ONLY

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4
Q

Pheochromocytomas? Seen in which disease? act where and do what?

A

MEN 2 A & B

adrenal medulla and secrete catecholamines

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5
Q

Symptoms of Graves Disease? (2 unique + many others)

which ones are NOT alleviated by b-blocker therapy?

A

1) Pretibial myxedema - orangepeel/scaly skin

2) Opthalmia is NOT ALLEVIATED =(exopthalmos,
periorbital edema, eye movement limitations)

Palpations,nervousness,easy fatigability, fine tremor, diarrhea, hyperhidrosis, heat intolerance, weight loss, hyperreflexia

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6
Q

PPAR-Y regulates which 4 genes?

A 
INCREASES
Adiponectin
Fatty Acid Transport protein
Insulin receptor substrate
GLUT-4 Transporter
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7
Q

PERMISSIVE=
ADDITIVE=
SYNERGYSTIC=

A

P=administration of cortisol allows epinephrine to achieve its full vasoconstrictive potential

A= combined effects equal the sum

S= combined effects EXCEEDS the sum of the individual drug effects

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8
Q

Subperiosteal thinning is characteristic of?

how does this manifest clinically?

A

Hyperparathyroidism

subperiosteal erosions of medial phalanges
SALT & PEPPER appearance of calvarium

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9
Q

What prevents lactation during pregnancy?

A

high levels of circulationg estrogen and progesterone

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10
Q

What would be seen in primary amenorrhea in Mullerian agenesis v Turners Syndrome?

A

Mullerian agenesis = FULLY DEVELOPED SECONDARY SEXUAL CHARACTERISTICS

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11
Q

INCREASED AFP

v

DECREASED AFP

A

DATING ERROR; NTDefects, Anterior wall defects (Ophalocele, gastroschsis) multiple gestation

DOWN Syndrom

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12
Q

Decreased Estriol levels in pregnancy are a sign of what?

A

placental insufficiency

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13
Q

hCG is increased in what? (3)

A

trophoblastic issues-

multiple gestation
hydatiform mole
choriocarcinoma

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14
Q

What inhibits GnRH?

Inhibiting GnRH decreases which hormones? (2)

These 2 hormones affect which cells and have what feedback inhibition?

A

TESTOSTERONE

FSH=> SERTOLI => Inhibin B feedback inhibition

LH=> LEYDIG CELLS=> Testosterone => feeback inhibition of LH & GnRH

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15
Q

GIGANTISM v Acromegaly

A

excess GH before closure of epiphysis V. after closure of epiphysis

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16
Q

IGF-1 from where affects linear growth?

A

Liver (not hypothalamus= central nervous activity

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17
Q

Diagnose a Pt. with high Serum GH but low IGF-1 levels? MOA?

A

Laron DWARFISM.

Defective GH Receptors

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18
Q

Glucocorticoids are catabolic causing what? (5)

What do they increase?

A 
muscle weakness
skin thinning
impaired wound healing
osteoporosis 
immunosuppression

Liver protein synthesis = INCR. Gluconeogenesis & glycogenolysis => hyperglycemia (+peripheral antagonism of insulin)

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19
Q

Long Term Glucocorticoid Therapy (>3weeks) can cause what?

Under stressful conditions what can happen during this therapy regimen and how do you prevent this?

A

HPA (hypothalamic-pituitary-adrenal) axis supression = DECR. CRH ACTH & Cortisol

Adrenal crisis may occur under stress (infxns/surgery) if an appropriate increase in Glucocorticoids is not given.

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20
Q

Adenexal mass in elderly female?

serum marker for this?

A

Ovarian Cancer

CA-125

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21
Q

Within the cell where would ACTH biosynthesis occur?

Which cells of the body would have this portion well developed

A

steroids are synthesized in the SER

Adrenals, gonads, liver (steroid producers)

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22
Q

What type of anion gap change would you expect in Septic shock and why?

what other condition my cause a similar anion gap change and why?

A

Lactic Acid Metabolic Acidosis Increases Anion Gap in Septic shock
due to impaired tissue oxygenation => Decr. Ox.Phos. => shunt pyruvate to lactate after glycolysis

Hepatic Hypoperfusion/Failure => lactic acid buildup (liver = site of lactate clearance)

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23
Q

Aspiration Pneumonia risk factors?

A

Altered consciousness (cough reflex& glottis fxn impairment) = dementia.
Dysphagia (neurological complications)
GERD
Mechanical Comprimise (NG/Endotracheal Tubes)
Protracted vomiting

Think of an OLD man with GERD/Strokes/Dementia/and Tubes that give him Pneumonia

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24
Q

Hyperprolactinemia in women can cause?

A

Estrogen Deficiency => (hypogonadism SE)

Galactorrhea
Amenorrhea
Decr. Bone densitiy
Vaginal Dryness

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25
Q

What are the Endocrine Side effects of SPIRINOLACTONE?

A

Anti-androgenic

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26
Q

Drugs used to treat hirsutism?

A

Antiandrogens flutamide (inhibits binding to testosterone receptors)

Finasteride (5-alpha-reductase inhibitor)

Spirinolactone (anti-androgenic)

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27
Q

Rare life threatening complication of antithyroid medications? What test is used to determine if present?

A

Agranulocytosis (absolute neutrophil count of less than 500/mL)

WBC count with a differential

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28
Q

Maternal rubella infection (symptoms in mom?) and sympotms in child

A 
fever
maculopapular rash
post. auricular and suboccipital lymphadenopathy
rash from Trunk to periphery (feet)
polyarthritis/arthralgia

CHILD:
Sensorineural deafness
cataracts
PDA (cardiac)

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29
Q

What types of receptors utilize MAP-Kinase signaling pathway? describe this pathway?

A

Growth Factors (EGF PDGF FGF)

Receptor auto phosphorylates and triggers phosphorylation of Ras protein

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30
Q

What type of receptor utilize JAK/STAT signaling pathway?

A

Cytokines
Growth Hormone (NOT GF=mapkinase)
Prolactin
IL-2

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31
Q

MCC Congenital Adrenal Hyperplasia?

What causes CAH with hypokalemia (<-why is this?)

A

21- Hydroxylase Deficiency

11 B-hydroxylase Deficiency (hypokalemia is due to production of the weak mineralocorticoid (aka aldosterone like activity) of 11-deoxycorticosterone

assoc. w/ ambiguous genitalia, hypertension, hypokalemia in early life

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32
Q

MCC of female infertility? Treatment(2)/how it works?

A

anovulation

Rx: menotropin (acts like FSH=> forms dominant ovarian follicle) then induce ovulation with hCG (large dose) to stimulate LH surge.

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33
Q

Human Placental Lactogen does what? to whom?

A

In mother due to Increased insulin resistance
Stimulates proteolysis
stimulates lipolysis
inhibits gluconeogenesis

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34
Q

glucagonoma clinical findings? 3

A

DM
necrolytic erythema
anemia

hyperglycemia, stomatitis, cheilosis, abdominal pain.

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35
Q

Actopic ACTH production = clinical findings?

A

rapid onset:

Hyperpigmentation
Proximal muscle weakness, 
hypokalemia, 
hyperglycemia, 
markedly elevated levels of serum ACTH
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36
Q

PNMT catalyzes which step of catecholamine production? what is it? What Controls its activity transcriptionally?

A

NE–> Epi; Phenylethanolamin-N-methyltransferase (PMNT)

Cortisol INCR. Transcription of PMNT

4:1 (80% v 20%) EPI: NE ratio due to upreg of NE–> EPI by Cortisol/PMNT

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37
Q

Catecholamine synthesis Pathway?

A

Phenylalanine

-Phenylalanine Hydroxylase->

Tyrosine (from K synthesis in liver or diet)

-Tyrosine Hydroxylase->

DOPA

-DOPA Decarboxylase->

Dopamine

-Dopamine B-Hydroxylase->

NE

-PNMT->

Epi

EPI=> degraded by MAO & COMT (monoamine oxidase & catechol-O-methyltransferase)

38
Q

Tap to hide keyboard in DKA what happens to potassium (intra & extracellularly) and why?

A

potassium loss occurs via osmotic diuresis induced by glycosuria.

intracellular potassium decreases
extracellular potassium increases or doesn’t change

39
Q

what happens to urine osmolality in nephrogenic diabetes insipidus when vasopressin is administered?

A

urine osmolality will not change due to kidney not responding properly to the hormone.

40
Q

when vasopressin is administered in central diabetes insipidus what happens to the urine osmolality?

A

urine osmolality will increase, because production of vasopressin is decr./nonexistant ( but the kidneys will respond when it is injected).

> 50% increase indicates complete Central DI

41
Q

when is anovulation commonly seen and how?

A

The first 5 to 7 years after menarche and the last 10 years before menopause it manifests with menstrual cycle variability

42
Q

MCC of DM type I?

A

autoimmune insulinitis,

43
Q

SIADH can be secondary to which cancer

and what are its findings?

A

SCC of the lung; paraneoplastic

low plasma sodium
low plasma osmolality
concentrated urine
incresed urinary sodium

44
Q

5 possibilites with PCOS?

A 
Hyperandrogenism
chronic anovulation
oligomenorrhea
multiple ovarian cysts
=> ALSO Obesitiy / insulin resistance / dysllipidemia
45
Q

Clomiphene MOA?

A

Estrogen receptor modulator => prevents negative feedback leadig to increase FSH & LH (gonadotropins)

=> ovulation- used in infertility (in PCOS)

46
Q

Which bacteria might cause hemorrhagic destruction of bilateral adrenal glands?

A

Meningococcal sepsis.

ALSO +DIC= Waterhous-Friderichsen syndrome

47
Q

Which cells secrete Mullerian Inhibiing Factor? What does MIF do specifically?

A

Sertoli cells

Involution of paramesonephric ducts (blocks their maturation)

48
Q

what causes herediary fructose intolerance? symptoms?

A

Aldose B deficiency

failure to thrive
jaundice
hepatomegaly

49
Q

Embryologic origin of anterior v posterior pituitary

A

anterior= rathke’s pouch ( outpouching of pharyngeal roof)

posterior= extension of Hypothalamus

50
Q

Craniopharyngioma is seen most commonly in which patients? What is it derived from? 3 components commonly seen?

A

Rathkes pouch remnants in anterior pituitary

MC childhood brain tumor

Solid, Cystic, Calcified

51
Q

IP3 messenger system.

A

Epi activates 2nd Messenger=>

activates PhosphoLipase-C to break Membrane phospholipiids into:

1) IP3 => activates SR to rls Ca2+
2) DAG => activates PK-C

ProteinKinase-C is activated by DAG and Ca2+ rlsd from Sarcoplasmic reticulum.

52
Q

Which days are the Secretory phase of the Menstrual Cycle?

Describe how Progesterone effects this phase and what occurs to the endometrium.

A

days 15-28

Progesterone rls by corpus luteum => uterine glad coils and secretes glcogen-rich mucus

Endometrial stroma => edmatous and traversed by tortuous spiral arteries from deep layer-> uterine lumen.

53
Q

When is metformin contraindicated?

A

Conditions that predispose to Lactic Acidosis:
b/c it can cause LA buildup

Renal failure
liver dysfunction
CHF
Alchoholism
sepsis
54
Q

Side effects of Amiodarone (5)

A

thyroid dysfunction )(40% iodine by weight)
corneal micro-deposits
blue-gray skin discoloration
drug related hepatitis
pulmonary fibrosis-rare &life threatening

55
Q

Biotin is a necessary cofactor for which enzymatic processes and how does it act?

what can lead to its deficiency

A

Carboxylase enzymes

CO2 carrier on the surface of the enzyme

Excessive ingestion of egg whites (avidin)

56
Q

Main side effects of Thiazolidinediones? what if Insulin is used concurrently?

A

Improve insulin resistance (less resistant via PPAR-y)

fluid retention => weight gain + edema from fluid as well as CHF precipitation?

fluid retention is worsened

57
Q

which form of Cushing syndrome has a decrease in ACTH and cortisol levels after high does dexamethasone suppression testing?

which does not?

A

Pituitary adenoma

Ectopic ACTH Secretion (SCC carcinoma)

58
Q

MC cell type in the normal pituitary?

A

Somatotrophs (growth hormone)

59
Q

Glucocorticoid effects on the CBC?

A

Increase neutrophil count- why? below
decreased lymphocyte, Monocyte, basophil, eosinophil counts

Demargination of neutrophils previously attached to the vessel wall

60
Q

What do anion inhibitors like perchlorate and pertechnetate do?

A

Block iodide absorption by the thyroid gland via competitive inhibition

61
Q

Thionamides (name 2) MOA?

A

Decrease the formation of thyroid hormones by inhibiting thyroid peroxidase

methimazole/carbimazole & propylthiouricil

62
Q

How do Iodide salts treat thyroid disorders?

A

inhibit synthesis as well as release of thyroid hormones

63
Q

Causes for hyperthyroidism? 4

A

Graves (MC)
toxic adenoma
toxic multinodular goiter
thyroiditis

64
Q

5 Metabolic processes Glucagon stimulates? (one is under special circumstances)

A 
glycogenolysis
gng
lipolysis
UREA PRODUCTION
KETOACID Synthesis (when glucose is unavailable to cells)
65
Q

What results from a deficiency of insulin and an excess of glucagon coupled with adrenergic activation and increased levels of cortisol and growth hormone?

A

DKA

66
Q

Metabolic syndrome risk factors

A

hypertension
abdominal obesity
atherogenic dyslipidemia
insulin resistance

67
Q

Which medications decrease peripheral conversion of T4 to T3?

A 
propythiouracil
glucocorticoids
amiodarone
iopanic acid
non-selective b-blockers
68
Q

why is dieteary fructose RAPIDLY metabolized?

A

it bypasses PFK-1 the rate limiting enzyme of glycolysis.

69
Q

Activation of Ret? (what type of gene regulator is RET?)

A

proto-oncogene=> Medullary Thyroid cancer

70
Q

OverExpression of RAS causes which cancers?

A

follicular thyroid cancer and some follicular adenomas

71
Q

Anaplastic thyroid cancer is caused by what action on what gene regulator?

A

Inactivating mutations of p53

72
Q

What tye of gene regulator is bcl-2? What change to it causes which specific cancers?

A

BCL-2 mutations => upregulated in follicular lymphomas (anti-apoptotic)

73
Q

Characteristic histiologic findings of thyroiditis (subacute/granulomatous)?

A

mixed cellular infiltration with occasional multinucleated giant cells

74
Q

Granulomatous thyroiditis diagnostic findings- 4?

another name for this

A 
Thyrotoxicosis features
tenderness over the thyroid gland
increased ESR
markedly-reduced radioactive iodine uptake 
POST-FLU

subactue

75
Q

Abberant serine and threonine residue phosphorylation by serine kinase can lead to what? and can occur due to which 4 things?

A

insulin resistance.

TNF-alpha
catecholamines
glucocorticoids
glucagon

76
Q

What patients might experience amenorrhea due to loss of pulsatile secretion of GnRH from the hypothalamus?

A

Anorexia Nervosa

77
Q

MEN1 pancreatic tumors are also known as?

A

gastrinoma

MENIN gene on the chromosome 11

78
Q

Where is Vasopressin synthesized

where is it released?

A

Hypothalamus

Post. Pituitary

79
Q

Hyperthyroid signs NOT improved by B-blocker = (4)?

A

increased tissue oxygen consumption
circulating thyroxine levels
weight loss
exopthalmos-graves

80
Q

What hormone therapy is used for treatment of infertility?

A

Pulsatile administration of GnRH agonist stimulate FSH and LH release

81
Q

Non-pulsatile/constant infusion of GnRH or longer-lasting analogs suppress FSH and LH release and treat which diseases?

A

Precocious puberty
Endometriosis
Dysfunctional uterine bleeding

82
Q

Which drug is used to treat against a.k.a. prophylaxis against Mycobacterium AViuM?

What type of patients is the seen in?

A

Azithromycin

HIV-positive patients with CD4 count less than 50 cells per milliliter

83
Q

Very long chain fatty acids and phytanic acid are metabolized by which organelle? What type of disease is seen with this with what symptoms?

A

Peroxisome’s

Neurological defects from improper CNS myelination

84
Q

What causes wet age-related macular degeneration?

A

Increased vascular endothelial growth factor

Treat with anti-vegf herapy

85
Q

(3) symptoms associated with vitamin A overuse?

A

Intracranial hypertension = >papilledema
Skin changes
Hepatosplenomegaly

86
Q

Vitamin D overdose symptom?

A

Necrotizing enterocolitis and infants

hemorrhagic stroke in adults

87
Q

Teratogenic effects of excessive vitamin a ingestion are?

A

Microcephaly
Cardiac anomalies
Fetal death

88
Q

Vitamin B2 (riboflavin) deficiency is characterized by which six traits?

A 
Cheilosis
Stomatitis
Glossitis
Dermatitis
Corneal vascularization
ariboflavinosis
89
Q

C-peptide, how is it used and what leads to its secretion it?

What would decrease it’s secretion?

A

Marker of the total rate of endogenous beta cell insulin secretion under steady-state conditions

Sulfonylureas (glyburide) increase the rate of insulin secretion and C-peptide levels in DM 2

Acarbose inhibits alpha glucoside ace reducing postprandial hyperglycemia decreasing insulin secretion

90
Q

Findings of neuroblastoma?

A

Opsoclonus – myoclonis paraneoplastic syndrome
Increase copies of N-myc gene
Most common extracranial neoplasm and children
Two years old
Small blue round cells
Retroperitoneal mass hypertension anorexia
Dumbbell tumor
Pancytopenia, hepatomegaly, proptosis,. Orbital ecchymosis,
Increase catecholamines in urine
Better with younger (<1) age
Worsens with more copies of N-myc

91
Q 
Cryptococcus neoformans morphology?
Virulence factor
Epidemiology
Infection
Diagnosis
Treatment
A

M- Oval encapsulated cells with narrow-based buds
V- polysaccharides capsule
E – soil/pigeon droppings opportunistic respiratory
I – long, meningeal encephalitis, disseminated
D – India ink stain/ latex agglutination of CSF, Sabouraud’s agar, GMS stain tissue
Rx- IV Amphotericin B +oral Flucytosine for meningitis
Fluconazole for not meningitis

92
Q

what is absolutely necessary for acute pyelonephritis

A

vesicouretral reflux

retrograde flow

UWORLD QuestionQuestions (12 decks)

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