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Elliot Step 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Signaling pathway for GH?

A

receptor associated tyrosine kinase (PIG)

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2
Q

Low magnesium concentration does what to PTH?

A

Increases PTH

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3
Q

Thyroid storm pathophys? Explain! Don’t cheat!

A

Increased production of thyroid hormone due to stress leads to an increase in catecholamines which can lead to death by arrhythmias (may see increased alk phosp)

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3
Q

Inc IGF1; failure to suppress serum GH when given oral glucose tolerance test?

A

Acromegaly

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4
Q

FSH stimulates?

A

sertoli cells (in seminiferous tubules)– inhibin B

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4
Q

Orpahn annie nuclei? (ground glass)

A

Papillary carcinoma– increased risk with childhood irradiation

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4
Q

Psammomma bodies?

A

Papillary carcinoma

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5
Q

Cortisol levels are highest?

A

in the morning

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5
Q

Alpha subunit is common to ?

A

TSH, LH, FSH, and hCG — each have Beta specific units

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5
Q

Cutaneous flushing, asthmatic wheezing, diarrhea and Right sided valvular disease? inc?

A

Carcinoid syndrome–> inc 5 HIAA in urine and niacine deficiency

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6
Q

End organ resistance to PTH? Labs?

A

Alrbrights hereditary osteodystrophy– defective Gs protein in kidney and bone Hypocalcemia and hyperparathyroidism

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6
Q

Why do RBC always depend on glucose ?

A

Because they do not have mitochondria for aerobic metabolism

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6
Q

Associations of MEN2b?

A

Medullary thyroid cancer and Marfanoid habitus

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6
Q

Where do you see decrease in GAGs?

A

Lysosomal storage diseases– Hurlers, Hunters

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7
Q

Cardiac drug that can stimulate prolactin synthesis?

A

Hydralazine

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8
Q

Signaling pathway for insulin involves?

A

Tyrosine kinase receptor

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8
Q

Signaling pathway for ADH?

A

IP3 and cAMP

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8
Q

Facial and periorbital myxedema?

A

Hypothyroidism

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8
Q

MEN1?

A

Pituitary; parathyroids; pancreas (ZE; insulinomas, VIPomas, glucagonomas)

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9
Q

Peroxidase enzyme?

A

Catalyzes I- to I2

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10
Q

Don’t forget this detail about acromegaly?

A

Patients have impaired glucose tolerance (insulin resistance)

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10
Q

Treatment of acromegaly?

A

Octreotide

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11
Q

Jod Basedow phenomenon?

A

Pt. with hypothyroidism can get thyrotoxicosis if patient with iodine deficiency goiter is made iodine replete too quickly (only occurs in people with abnormal thyroid glands)

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11
Q

Ketoacidosis

A

common in type 1

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12
Q

ZE tumors come from where?

A

Duodenum or pancreas

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13
Q

Which thyroid cancer spread hematogenously?

A

Follicular carcinoma

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14
Q

Secondary hyperaldosteronism causes?

A

CHF; Renal failure; renal artery stenosis– renal perception of low intravascular volume!

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15
Q

Adrenal cortex derived from?

A

mesoderm

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15
Q

cGMP signaling pathway?

A

ANP; NO– vasodilators

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15
Q

Treatment of SIADH 3

A

Conivaptan, tolvaptan, demeclocycline (vaptans treat siadh)

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16
Q

Decreased Ca; increased PTH; decreased phosphate?

A

Vit D deficiency

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17
Q

LH stimulates?

A

Leydig cells–>testosterone

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17
Q

Angiotensin II acts on which enzyme?

A

Aldosterone synthase (Corticosterone to aldosterone)

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19
Q

Where are CRH neurons located?

A

Paraventricular nuclei of hypothalamus

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20
Q

Insulin increased production of what two enzymes?

A

2,6 bisphosphate and phophofructokinase

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20
Q

MEN2b?

A

Oral and pheos

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21
Q

What must we rule out in pt with excess prolactin?

A

Hypothyroidism–>increased TRH–>increased prolactin

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22
Q

Shortened 4th and 5th digit, hypocalcemia?

A

Pseudohypoparathyroidism (Albrights hereditary osteodystrophy)

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22
Q

Secondary causes of nephrogenic DI?

A

Lithium, hypercalcemia, demeclocycline (ADH antagonist)

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23
Q

Chronic elevation of TSH causes?

A

Hypertrophy of pituitary gland

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25
Q

Treatment for Cushings disease?

A

Ketoconazole

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26
Q

Does insulin cross placenta?

A

No

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27
Q

What blocks peroxidase?

A

Propylthiouracil

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28
Q

Pheos derive from where?

A

Chromaffin cells in neural crest

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29
Q

Antithyroglobulin antibodies and antimicrosomal antibodies associated with which HLA?

A

DR5– hashimotos thyroiditis– at increased risk for non hodgkins lymphoma

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30
Q

Thyroid issue that leads to increased risk of non hodgkins?

A

Hashimotos

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32
Q

What happens to thyroid levels in hepatic failure

A

TBG levels decrease leading to decrease in total thyroid hormone, BUT NORMAL LEVELS OF FREE HORMONE

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32
Q

What occurs in testes with regard to testosterone?

A

Androstenedione is converted to testosterone

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33
Q

Neonatal hypothyroidism?

A

Cretinism– short stature and low IQ

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35
Q

Deficiency in 21Beta hydroxylase?

A

Cannot make aldosterone or cortisol

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36
Q

Causes of SIADH?

A

Ectopic ADH (small cell lung cancer) CNS disorers Pulmonary disease Cyclophosphamide

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37
Q

What does aldosterone do to K+ and H+?

A

Increases renal secretion of both

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38
Q

Signaling pathway for Aldosterone?

A

Steroid

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38
Q

Cortisol increased which two enzymes?

A

PEP carboxykinase and Glucose 6 phosphatase

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39
Q

Excess ingestion of iodide can lead to?

A

Decrease levels of t4 and t3 by temporarily inhibiting thyroid peroxidase–>decreased iodine organification

AKA Wolff Chaikoff effect– the wolff shuts everything down

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39
Q

Tolvaptan and conivaptan?

A

Used for treatment of SIADH

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40
Q

HLA association of type 1?

A

DR3 or DR4 (DR4 is also seen in RA)

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42
Q

Hypothyroidism in perinatal period–>?

A

Mental retardation

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42
Q

right adrenal vein drains?

A

directly into IVC

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42
Q

MCC of addisons?

A

Autoimmune

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43
Q

What happens when thyroid cells are stimulated?

A

iodinated thryoglobulin is taken back into follicular cells by endocytosis. Lysosomal enzymes then digest thryoglobulin releasing t4 and t3

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43
Q

TRH stimulates?

A

TSH and Prolactin

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44
Q

Common causes of low magnesium?

A

diarrhea, aminoglycosides, diuretics, and alcohol abuse

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45
Q

Signaling pathway for T4?

A

Steroid (thyroid and steroid hormon have similar mechanism)

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45
Q

Catecholamines are cousins with?

A

Thyroid hormone

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45
Q

Most common cause of goiter?

A

Iodine deficiency

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46
Q

Mutation in which gene requires prophylactic thyroidectomy?

A

RET gene

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47
Q

Perchlorate blocks?

A

Oxidation step (prevents I- from entering cell)

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48
Q

Small cell lung cancer can cause what disease?

A

SIADH

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49
Q

Pt. presents with tender thyroid and jaw pain. Coughing and fever two weeks ago?

A

Subacute thyroiditis– may be hyperthyroid early

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50
Q

Blocks 11 Beta hydroxylase?

A

Metyrapone

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52
Q

Vit D acts through what signaling pathway?

A

Steroid receptor

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53
Q

11 Beta hydroxylase deficiency?

A

Same as 21 hydroxylase deficiency except have increased 11 deoxycorticosterone SO pt has HYPERTENSION as opposed to hypotension

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53
Q

Lidlag– stare?

A

Hyperthyroidism

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54
Q

Cystic bone spaces with brown fibrous tissue?

A

Primary hyperparathyroidism– soft and PAINFUL bones

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56
Q

Beta and alpha agonists on insulin?

A

Beta agonist INC insulin secretion Alpha agonist DEC insulin secretion (Stop GO alpha beta)

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58
Q

Beta endorphin stimulated by?

A

CRH

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60
Q

Bone maturation is stimulated by?

A

Thyroid hormone

61
Q

TBG in pregnancy?

A

Increased– amount of free is normal

61
Q

Iselt amyloid deposits?

A

dm2

63
Q

Adrenal medulla derived from ?

A

Neural crest

64
Q

Signaling pathway for progesterone?

A

Steroid

65
Q

Signaling pathway of prolactin?

A

Receptor associated tyrosine kinase (PIG)

66
Q

Shock, coagulopathy, and petechial rash, adrenals?

A

Waterhouse Friderichsen syndrome– acute adrenal crisis– Neisseria

66
Q

Trousseaus sign?

A

Occlusion of brachial artery with BP cuff–>carpal spasm

68
Q

TBG levels in pregnancy?

A

Increase, leading to increase in total but NORMAL free horomone

69
Q

Inc in GAG deposition may lead to?

A

Mitral valve prolapse– inc in dermatan sulfatate

70
Q

Most common tumor of appendix?

A

Carcinoid

70
Q

Man with low T4 and normal TSH?

A

Anabolic steroids

71
Q

Norepi to Epi only occurs in the medulla– why?

A

Requires PNMT enzymes which is only expressed in medulla

72
Q

CRH stimulates?

A

ACTH and Beta endorphin!

72
Q

Sheets of cells in amyloid stroma; associated with MEN 2a?

A

Medullary carcinoma

74
Q

17 hydroxylase deficiency?

A

Dec androgen and cortisol levels

75
Q

Renal perception of low intravascular volume–>

A

Secondary hyperaldosteronism– treat with spironolactone

76
Q

Side effect of demeclocyline?

A

DI– cannot concentrate urine and have high mOSMs >290

77
Q

Where is calcium absorbed in kidney?

A

distal convoluted tubule

78
Q

Hurthle cells?

A

Hashimotos– may be hyperthyroid early in course (thyrotoxicosis during follicular rupture)

78
Q

increase in estrogen does what to TBG?

A

Increases TBG

79
Q

D2 comes from?

A

Plants

80
Q

I- minus (iodine) transport into follicular cells is inhibited by?

A

Thiocyanate an perchlorate anions

81
Q

Drug used to treat Pheo initially?

A

Phenoxybenzamine– nonselective alpha antagonist– avoid hypertensive crisis and then B blockers are given to slow heart rate

82
Q

binding protein for iron?

A

Transferretin

84
Q

Neither low nor high dose dexamehtasone inhibits cortisol secretion in?

A

Adrenal cortical tumors

85
Q

TH on ANS?

A

Increases B-1 receptors in heart– give propranolol

87
Q

Propylthiouracil inhibits?

A

Peroxidase enzyme (which cataylyzes I minutes to I2

88
Q

Pretibial myxedema?

A

Graves

89
Q

Treatment for prolactinoma?

A

Cabergoline and bromocriptine (dopamine agonists)

90
Q

AA that stimulate growth hormone?

A

Arginine and histidine– basic amino acids

92
Q

Cortisol up regulated which receptors?

A

Alpha 1 receptors on arterioles–>inc arterial pressure

93
Q

Peroxidase is inhibited by?

A

Propylthiouracil

94
Q

Testosterone to Estradiol?

A

Aromatase (or if 5 alpha reductase acts on it, testosterone goes to DHT)

95
Q

Converts cholesterol to pregnenolone?

A

Cholesterol desmolase (secreted by ACTH0

95
Q

Anterior pituitary derived from?

A

Oral ectoderm (Rathke’s pouch)

97
Q

Insulin on SHBG?

A

Insulin suppresses production of sex hormone binding globulin

97
Q

Hyperparathyroidism usually caused by?

A

Adenoma

98
Q

Cyst in anterolateral portion of neck?

A

Branchial cleft cyst

100
Q

Receptor associated tyrosine kinase?

A

Prolactin, Immunomodulators, and GH (PIG)

101
Q

Hypercalcemia may lead to?

A

Polyurea

103
Q

Posterior pituitary derived from?

A

Neuroectoderm– extension of hypothalamus– true neural structure– blood brain barrier is absent here

103
Q

GH involved in?

A

Gluconeogenesis and AA uptake

104
Q

Test to perform in suspected DI?

A

Water deprivation test– urine osmolality doesn’t increase; response to desmopressin distinguished btw central and nephrogenic

105
Q

C peptide of insulin is cleaved where?

A

Within storage granules– the peptide is packaged and secreted along with the insulin

106
Q

Pt. presents with hypocalcemia with sheets of malignant cells in stroma?

A

Medullary Ca– associated with MEN 2a and 2b

108
Q

Increase in SHBG in men leads to?

A

lower free testosterone

109
Q

Mechanism of insulin release from beta cells?

A

ATP generation via glucose metabolism closes K+ channels–>depolarizes Beta cell membrane–> opening of Ca2+ channels. Ca2+ influx stimulates insulin secretion

110
Q

21 Hydroxylase deficiency results in?

A

decreased cortisol and aldosterone production; see an increase in 17 hydroxyprogesterone; virilization in women

112
Q

High levels of what inhibit organification?

A

I minus (organification is the phase in which tyrosine residues of thryoglobulin react with I2 to form mono or di iodotryosine)

114
Q

Second messenger for PTH?

A

cAMP

114
Q

Growth hormone does what to insulin?

A

Increases insulin resistance

116
Q

Pt. presents with hard, non tender thyroid gland– pathophys?

A

Thyroid is replaced by fibrous tissue due to IgG related systemic disease– Reidels thyroiditis

117
Q

Difference between neuroblastoma and Wilm’s tumor?

A

Wilm’s is unilateral and does not cross midline

118
Q

EXtremely low magnesium concentration does what to PTH?

A

Decreases PTH

119
Q

Infection in diabetic ketoacidosis?

A

Rhizopus

121
Q

Renal osteodystrophy?

A

Renal failure– kidney unable to make 1,25 dihydroxycholecalciferol– decreased Ca leads to secondary hyperparathyroidism

123
Q

Medulla secretes?

A

Catacholamines

124
Q

4 Bs of thyroid?

A

Bone maturation; bone growth; beta adrenergic; BMR

125
Q

Graves due to ???immuno?

A

IgG antibody against receptor (type 2– also see type 2 in MG)

126
Q

Glut1

A

Insulin independent (RBC, Brain)

127
Q

Osmotic damage of DM can lead to?

A

Neuropathy and cataracts

128
Q

Exopthalmos path?

A

GAG deposited in orbital fat and pushing the eye out

129
Q

Potassium in diabetic ketoacidosis?

A

Hyperkalemia even though low potassium in body (K+ leaves intracellular space and swaps with H+)

130
Q

Petechial lesions meningitis?

A

Neisseria

132
Q

VMA?

A

Breakdown of norepi and epi

133
Q

Steroid receptor pathway?

A

VETTT CAP; Vitamin D; Estrogen; Testosterone, T4/T3, Cortisol, aldosterone, progesterone

134
Q

17 hydroxylase def in XY?

A

pseudohermaphdroditism due to decrease in DHT

135
Q

T4–>T3 via?

A

5’ iodinase

137
Q

Decreases in SHBG in women leads to?

A

Higher free testosterone–>hirsutism SHBG levels INCREASE during pregnancy

138
Q

Path of DM small vessel?

A

Nonezymatic glycosylation of basement membrane leading to hyaline arteriolesclerosis–>eventually progresses to nephrotic syndrome characterized by sclerosis of the mesangium forming kimmelstiel wilson nodules

139
Q

Acidic amino acids?

A

Glutamate and aspartate (COOH groups)

141
Q

Glut 2

A

bidirectional: beta islet cells, liver, kidney, small intestine

142
Q

Virilization of women, hypertension, Striae, osteoporosis, hyperglycemia?

A

Cushing’s syndrome (disease if at level of pituitary)

142
Q

Islet leukocytic infiltrate?

A

DM1

143
Q

MEN2a?

A

Parathyroids and pheos

144
Q

Prolactin is stimulated by?

A

TRH

146
Q

D3 comes from?

A

sun exposure

148
Q

Most common tumor of adrenal medulla?

A

Neuroblastoma

150
Q

Patient presents with abdominal distention and firm irregular mass– condition associated with over expression of N-myc oncogene?

A

Neuroblastoma– see increased Homovanillic acid– breakdown of dopamine

151
Q

Sigs and sx of VIPoma?

A

WDHA; Watery diarrhea; hypokalemia; and achlorhydria

153
Q

Mom presents with failure to lactate after giving birth?

A

Sheehans syndrome– ischemic infarct of pituitary following postpartum bleeding

155
Q

High urine Homovanillic acid?– gene associated with this condition?

A

Neuroblastoma– associated with N-myc; unusual growth in abdomen; pseudorossettes; occurs anywhere along sympathetic chain

156
Q

Moderately enlarged non tender thyroid; HLA DR5?

A

Hashimotos

157
Q

Mechanism by which cortisol produces striae?

A

Inhibits fibroblasts

158
Q

I minus –>I2 catalyzed by?

A

Peroxidase enzyme in follicular cell membrane

158
Q

ADH and oxytocin are shipped to poster pituitary via?

A

Neurophysins

159
Q

Negative Ca2+ balance is seen in women during?

A

Pregnancy and lactation

160
Q

What kind of immune reaction is hashimotos?

A

Type 4

162
Q

3yo presents with beer belly, pale and puffy eyes with a protubertant tongue?

A

Cretinism

163
Q

Malignant proliferation of follicles surrounded by a capsule

A

Follicular carcinoma

164
Q

Left adrenal vein drains?

A

Into left renal vein

165
Q

MC cause of death in acromegaly?

A

cardiomyopathy

166
Q

17 hydroxylase def in XX

A

Externally phenotypic female with normal internal sex organs; lacks secondary sex characteristics

167
Q

Focal patches of hyperfunctioning follicular cells?

A

Toxic multinodular goiter– mutation in thyroid receptor

168
Q

Graves is what type of immune disease?

A

Type 2 hypersensitivity– can see clubbing of fingers

170
Q

Increased TSI?

A

Grave’s disease

171
Q

Must get what test with patient with atrial fib?

A

TSH– for Grave’s disease

173
Q

Cortisol maintains BP how?

A

upregulates alpha 1 receptors on arterioles–> increased sensitivity to NE

174
Q

IP3 signaling pathway?

A

GGOAT GnRH GHRH Oxytocin ADH TRH histamine; AII, gastrin

175
Q

Nonezymatic glyosylation

A

Inappropriate addition of glucose onto proteins

177
Q

Treatment of DKA?

A

Bolus of K+, IV insulin, IV fluids, gluocose to prevent hypoglycemia (administration of insulin without K+ might cause hypokalemia)

178
Q

Glut 4

A

Insulin DEPENDENT: Adipose tissue and skeletal muscle!

179
Q

Treatment of nephrogenic DI?

A

HCTZ (gets rid of water and sodium in distal regions of nephron–>making body respond by increasing uptake of water), indomethacin, amiloride

181
Q

Blocks 5 alpha reductase in BPH?

A

Finasteride

182
Q

Somatomedin?

A

IGF-1

183
Q

Stain Medullary carcinoma with?

A

congo red– apple green birefringence= amyloid A (which come from calcitonin)

185
Q

Thyroid peroxidase?

A

Oxidation of iodine and Adding iodine onto tyrosine residues of TG and coupling of MIT and DIT

186
Q

Metabolic acidosis, hyperkalemia, hypotension?

A

Addisons (or CAH i.e. 21hydroxylase)

187
Q

Associatoins of MEN2?

A

Medullary thyroid cancer

188
Q

High T4 with normal TSH woman?

A

Estrogen

189
Q

Only two tissues that are insulin sensitive?

A

Skeletal muscle and adipose tissue

190
Q

Deficiency in 17 hydroxylase?

A

Can only make Aldosterone

191
Q

Androstenedione to estrone?

A

Aromatase

192
Q

Blocks desmolase?

A

Ketoconazole (antifungal)

193
Q

PNMT is under the control of? What does it do?

A

Under control of cortisol– converts NE to epi

194
Q
A

Elliot Step 1 (32 decks)

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