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USMLE Step 1 > Endo - Stuff Missed > Flashcards

Endo - Stuff Missed Flashcards

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USMLE® Step 1 flashcards
1
Q

Side effect of thialidozines

A

Fluid retention, weight gain and edema

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2
Q

Side effect of metformin therapy

A

Lactic acidosis -

** don’t use in patients with abnormal renal function, liver function, CHF, alcoholism, and sepsis

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3
Q

Thialidozines

A

bind to PPAR-gamma to improve insulin resistance

- may take days to weeks to work

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4
Q

Congenital hypothyroidism

A

presents soon after birth with hypotonia, poor feeding, jaundice, macroglossia, constipation and umbilical hernia

  • diagnosis early to prevent mental retardation
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5
Q

Pulsatile administration of GnRH analogs has what effect?

A

It has an AGONIST effect and stimulates LH and FSH release

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6
Q

Continuous adminsitration of GnRH analogs have what effect?

A

It has an ANTAGONIST effect and suppresses LH and FSH release

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7
Q

Anovulation

A
  • common cause of infertility
  • can be treated by administering menotropin (human menopausal gonadotropin analog) that acts like FSH and leads to formation of dominant follicle
  • Ovulation is induced by large dose of hCG which stimulates LH surge
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8
Q

FSH

A
  • stimulates dominant follicle to form in one of ocaries
  • stimulates estrogen production from ovaries
  • as follicle expands, there is a rise in estrogen
  • In follicular phase, estrogen has positive feedback on LH leading to LH surge which eventually causes rupture of follicle
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9
Q

Anastrozole

A

selective aromatase inhibitor

  • thus less conversion of androgens into estrogens
  • suppress estrogen to postmenopausal levels
  • in treatment of metastatic breast cancer, aromatase inhibitors are equivalent or superior to tamoxifen
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10
Q

Ketoconazole

A
  • selective aromatase inhibitor

- antifungal agent that decreases androgen synthesis

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11
Q 
2 y.o. girl has ambiguous genetailia. Has clitoral enlargement and partial fusion of labioscrotal folds
- has high BO
- hypokalemic
- is 46, XX
Likely diagnosis?
A

11-B hydroxylase deficiency
- less cortisol production
- less aldosterone production (hypertension and hypokalemia)
- more testosterone production (virilization of female)
-

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12
Q

11-B hydroxylase deficiency

A
  • results in excessive adrenal androgen and mineralcorticoids (but NO ALDOSTERONE)
  • females are born with ambiguous genitalia
  • develop hypertension because of weak mineralcorticoid excess (not as good as aldosterone but good enough)
  • hypokalemia
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13
Q

17-alpha hydroxylase deficiency

A
  • results in:
  • less cortisol
  • less teststerone
  • Females are born with normal genitalia
  • Males are born UNDERVIRILIZED (less testosterone)
  • affected don’t undergo puberty (no sex hormones)
  • develop HYPERtension and hypokalemia (mineralcorticoid excess)
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14
Q

21 hydroxylase defiency

A
  • most common cause of adrenal hyperplasia
  • less cortisol
  • less mineralcorticoids
  • more testosterone
  • Females have ambiguous genitalia (due to testosterone excess)
  • HYPOtension and HYPERkalemia
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15
Q

Finasteride

A

5-alpha reductase inhibitor

  • suppresses peripheral conversion of testosterone to DHT
  • used in BPH and androgenetic alopecia
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16
Q

Nephrogenic DI

A

caused by lack of response to ADH

- can be treated by hydrochlorothiazide

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17
Q

Primary polydipsia

A
  • excessive pathological water drinking
  • psych disorder no underlying medical etiology
  • water deprivation test will show increase in urine osmolality
  • low serum sodium levels
  • restriction of water normalizes urine osmolality
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18
Q

Neurogenic DI

A
  • due to decreased production of ADH in posterior pituitary
  • decreased urine osmolality with dehydration
  • increased urine osmolality with ADH
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19
Q

Nephrogenic DI

A
  • due to decreased responsiveness of collecting tubules to ADH
  • decreased urine osmolality with dehydration
  • decreased urine osmolality with ADH
20
Q

Thiazolidinediones (TZDs)`

A
  • bind to peroxisome proliferator activated receptor-gamma (PPAR-gamma) - a transcript regulator involved in glucose and lipid metabolism
  • takes days to work
  • lowers glucose by decreasing insulin resistance
  • increaeses expression of adiponectin gene
21
Q

Leptin

A
  • secreted by fat cells

- responsible for appetitie suppression and decreased insulin resistance

22
Q

How do prolactinomas leads to osteoporosis?

A
  • High levels of prolactin decrease GnRH
  • Less GnRH leads to less estrogen
  • Less estrogen means loss in bone density as estrogen is protective against osteoporosis
23
Q

MEN1

A

3Ps

  • Parathyroidism
  • Peptic ulcer
  • Pituitary adenoma
24
Q

Men2A

A

2s

  • Pheochromocytomas
  • Pituitary adenoma
  • Medullary thyroid carcinomas
25
Q

Men 2B

A
  • Medullary thyroid Carcinoma
  • Pheochromocytoma
  • Oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
26
Q

Medullary Thyroid Carcinoma

A
  • usally from parafollicular C cells
  • produce calcitonin, sheets of cells in amyloid strom
  • associated with MEN2A and MEN 2B
27
Q

Carcinoid syndrome

A

caused by neuroendocrine cells esp. metastatic bowel caner tumors

  • secrete high levels of 5-HT
  • not seen if tumor is limited to GI tract because liver processes
  • presents with recurrent flushing, asthmatic wheezing, and right side valvular disease
28
Q

Carcinoid syndrome Findings and Treatment

A
  • Recurrent flushing, asthmastic wheezing, right-sided valvular disease
  • 5-HIAA inurine
  • Niacin deficiency

Tx: Somatostain analog (e.g. octreotide)

29
Q

Conditions associated with excess growth hormone. In children? in adults?

A

In children: Gigantism - excess growth hormone before closure of epiphyses
In adults: Acromegaly - excess growth hormone after closure of epiphyses

30
Q

Growth hormone

A
  • increases linear growth by stimulating production of IGF-1 from liver
  • defective growth hormone receptors leads to decrease in linear growth
31
Q

Laron dwarfism

A
  • due to decrease in linear growth

- characterized by high serum growth hormone levels with low IGF-1

32
Q

Acute effects of corticosteroids

A
  • Increased neutrophil count
  • Decreased lymphocyte, monocyte, basophil, and eosinophil counts
  • Increase in neutrophil due to demargination of neutrophils previously attached to vessel walls
33
Q

Which hormone needs to be monitored in amiodarone therapy?

A

TSH

  • Amiodarone (40% iodine) can lead to hypothyroidism
  • Amiodarone induced hypothyroidism is treated with levothyroxine
34
Q

Amiodarone

A 
class III anti-arrhythmic used to suppress cardiac conduction
-
35
Q

Amiodarone side effects

A
  • Thyroid dysfunction
  • Corneal microdepsots
  • Blue-gray skin discoloration
  • Drug related hepatitis
  • Pulmonary fibrosis (rare but life threatening)
36
Q

Glucocorticoiids

A
  • predominatwly carabolic, causing muscle weakness, skin thinning, impaired wound healing, osteoporosis, and immunosuppression
  • increase liver protein synthesis, specifically ones involved in gluconeogenesis and glyconegenesis
37
Q

Hydrochlorothiazide

A
  • acts on distal tubules (blocks Na/Cl)
  • causes HYPERgluc -
  • Hyperglycemia
  • Hyperlipidemia
  • Hyperuricemia
  • Hypercalcemia
38
Q

Risperodine and amenorrhea

A
  • Risperidone (atypical anti-psychotic) is associated with hyperprolactinemia
  • Riperiodone suppresses dopamine. Dopamine suppresses prolactin
  • More prolactin means less GnRH which means less FSH and less LH thus no menstruation
39
Q

Mechanism of B-blockers in thyrotoxicosis

A
  • Decrease in effect of sympathetic adrenegic impulses reaching target orens
  • Decrease in peripheral conversion of T4 to T3
40
Q

teen girl presents as thin with downy hair
- presents with inadequate diet and regular excercises
- asks about weight loss advice
Likely diagnosis?

A

Anorexia nervosa - often presents as decreased LH, FSH, estriadiol, and estrone

  • hypogonadotropic amenorrhea
  • often presents with downy
41
Q

Long term use of glucocorticoids leads to what effect on adrenal glands

A

Long term glucocorticoids suppress HPA axis (by decreasing ACTH release)
- Leads to bilateral adrenocortical atrohy

42
Q

What occurs if patient suddenly stops taking doses of corticosteroids?

A

Adrenal crisis

43
Q

Glucagon

A
  • increases serum glucose by increased production of glucose from liver
  • stimulates insulin secretion from pancreas
  • has little effect on skeletal muscle
44
Q

Addison’s disease

A

Chronic primary adrenal insufficiency due to adrenal atrophy OR
destruction by disease (e.g. autoimmune, TB, metasstasis)
- aldosterone deficiency and cortisol
- HYPOtension
- HYPERkalemia
- skin HYPOpigmentation

45
Q

Epinepherine (and glucose)

A

epinepherine increases glucose by various mechanisms

  • increased glycogenolysis and gluconeogenesis
  • decreases glucose uptake in skeletal muscle
  • increases alanine release from skeletal muscle for gluconeogenesis in liver
  • increases TG breakdown in fat tissue
46
Q

Propylthiouracil

A

thionamide medication used for treatment of hyperthyroidism

- decreases formation of thyroid hormone by inhibiting thyroid peroxidase

47
Q

Potassium iodide

A
  • may prevent thyroid absorption of radioactive iodine isotopes by competitive inhibition

USMLE Step 1 (34 decks)

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