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Step 1 AB > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Causes of decreased Mg

A

Diarrhea, Aminoglycosides, Diuretics, Alcohol abuse

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2
Q

Control of blood flow to parathyroids?

A

Cervical sympathetic ganglia control blood flow to parathyroids

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3
Q

How does PTH activate osteoclasts?

A

PTH binds osteoblasts and causes increased production of macrophage colony stimulating factor and RANK-L –> RANK-L binds RANK receptor on osteoclasts to stimulate them and increase Ca

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4
Q

Where are parafollicular cells derived from?

A

Neural crest

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5
Q

Which endocrine hormones signal through cAMP?

FLATChAMP

A

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon

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6
Q

Which endocrine hormones signal through cGMP?

Vasodilators

A

ANP, BNP, NO (EDRF)

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7
Q

Which endocrine hormones signal through IP3?

GOAT HAG

A

GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin

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8
Q

Which endocrine hormones signal through intracellular receptors? VETTT CAP

A

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

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9
Q

Which endocrine hormones signal though intrinsic tyrosine kinase?

A

Insulin, IGF-1, FGF, PDFG, EGF (think growth factors)

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10
Q

Which endocrine hormones signal through receptor-associated tyrosine kinase?
PIGG(L)ET

A

Prolactin, Immunomodulators (IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoietin

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11
Q

Functions of T3 hormone (4 B’s)

A

Brain maturation
Bone growth (synergism with GH)
B-adrenergic effects (increased B1 receptors in heart = CO, HR, SV, contractility)
Basal metabolic rate increases (via increased Na/K ATPase activity –> increases O2 consumption, RR, body temp)

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12
Q

Mechanism of Propylthiouracil

Mechanism of Methimazole

A

Propylthiouracil inhibits peroxidase (oxidation and organification of iodide, coupling of MIT and DIT) and 5-deiodinase (converts T3 to T4)
Methimazole inhibits peroxidase only

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13
Q

What is the Wolff-Chaikoff effect?

A

Excess iodine temporarily inhibits thyroid peroxidase –> decreases iodine organification and T3/T4 production
-The reason Iodine can be used to treat hyperthyroidism

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14
Q

What is metyrapone stimulation used for?

A

Metyrapone blocks the last step of cortisol synthesis (11 deoxycortisol –> cortisol)
Normal response is a decrease in cortisol and compensatory increase in ACTH but in adrenal insufficiency ACTH remains decreased after test

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15
Q

What do you see in urine of patient with neuroblastoma?

A 
Homovanillic acid (HVA) - breakdown product of dopamine
Vainllylmandelic acid (VMA) - breakdown product of NE
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16
Q

Stains for neuroblastoma

A

Bombesin and neuron-specific enolase positive

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17
Q

EPO secreting tumors

A

Renal cell carcinoma
Hepatocellular carcinoma
Pheochromocytoma
Hemangioblastoma

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18
Q

Rule of 10s for pheochromocytoma

A 
10% malignant
10% bilateral
10% extra-renal (bladder wall)
10% calcify
10% kids
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19
Q

Associations of pheochromocytoma

A

Neurofibromatosis type 1
Von Hippel Lindau
MEN 2A and 2B

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20
Q

Urine of patient with Pheochromocytoma

A

Increased catecholamines and metanephrines in urine and plasma (vanillylmandelic acid)

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21
Q

Treatment for pheochromocytoma

A

IRREVERSIBLE alpha antagonist - Phenoxybenzamine followed by beta blocker prior to tumor resection

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22
Q

Increased CK from myopathy (w/o myoedema)

A

Hypothyroidism

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23
Q

Lab findings in hypothyroidism

A

Increased TSH
Decreased free T3 and T4
Hypercholesterolemia (from decreased LDL receptor expression)

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24
Q

Granulomatous inflammation of thyroid

A

Subacute thyroiditis (de Quervain)

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25
Q

Tender thyroid

A

Subacute thyroiditis (de Quervain)

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26
Q

Thyroid replaced by fibrous tissue

A

Riedel thyroiditis

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27
Q

IgG4 related systemic disease manifestations

A

Autoimmune pancreatitis
Retroperitoneal fibrosis
Non-infectious atrocities
Riedel thyroiditis

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28
Q

Rock like painless goiter

A

Riedel thyroiditis

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29
Q

Treatment for Thyroid storm

A

Propranolol
Propylthiouracil
Prednisolone

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30
Q

Ovarian tumor that presents as hyperthyroidism

A

Struma ovarii teratoma

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31
Q

How do beta blockers treat thyrotoxicosis?

A

Decreased peripheral conversion of T4 –> T3 by inhibiting iodithyronine deiodinase and block beta adrenergic receptors –> decrease HR and agitation

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32
Q

Complications of thyroid surgery

A

Hoarseness (recurrent laryngeal nerve damaged)
Hypocalcemia (removal of parathyroid glands)
Transection of recurrent and superior laryngeal nerves (during ligation of inferior thyroid artery and superior laryngeal artery)

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33
Q

Large cells with overlapping nuclei containing finely dispersed chromatin (empty nuclei with central clearing)

A

Orphan annie nuclei

34
Q

Orphan annie nuclei and psammoma bodies

A

Papillary carcinoma of thyroid

35
Q

Difference between follicular adenoma and follicular carcinoma

A

Carcinoma invades thyroid capsule

FNA can’t distinguish

36
Q

Tumor that produces Calcitonin

A

Medullary carcinoma of thyroid

37
Q

How does medullary carcinoma of thyroid spread?

A

Hematogenous spread

38
Q

Cancer associated with Hashimoto thyroiditis

A

Lymphoma (rapidly enlarging neck mass)

39
Q

Albright hereditary osteodystrophy

A

Pseudohypoparathyroidism = unresponsiveness of kidney to PTH
Hypocalcemia, shortened 4th/5th digits, short stature
PTH levels are high

40
Q

Familial hypocalciuric hypercalcemia

A

Defective Ca sensing receptor on parathyroid cells

PTH cannot be suppressed by increased Ca level –> mild hypercalcemia with normal to increased PTH levels

41
Q

Calcium levels in acute pancreatitis

A

Hypocalcemia - Ca precipitates out of abdomen

42
Q

Lab findings in primary hyperparathyroidism

A 
Increased PTH
Hypercalcemia
Hypercalciuria
Hypophosphatemia
Increased ALP (sign of osteoblast activity)
Increased cAMP in urine
43
Q

Chronic renal failure labs

A

Hypocalcemia
Hyperphosphatemia (can’t excrete it)
Increased PTH

44
Q

Lamellar bone structure resembling mosaic pattern

A

Pagets

45
Q

Osteoid matrix accumulation around trabeculae

A

Vit D deficiency

46
Q

Spongiosa filling medullary canals with no mature trabeculae

A

Osteopetrosis

47
Q

Trabecular thinning with few connections

A

Osteoporosis

48
Q

Treatment for prolactinoma

A

(Dopamine agonists)
Bromocriptine
Cabergoline

49
Q

GH effects on glucose

A

GH decreases glucose uptake

Can cause secondary diabetes

50
Q

Most common cause of death in Acromegaly

A

Heart failure

51
Q

Treatment for Acromegaly

A

Removal of pituitary adenoma
Octreotide (somatostatin analog)
Pegvisomant (growth hormone receptor antagonist)

52
Q

Diagnosis of Diabetes Insipidus

A

Urine specific gravity 290 mOsm/kg

Hyperosomotic volume contraction

53
Q

Treatment of Central DI

A

Intranasal desmopressin acetate

Hydration

54
Q

Treatment of Nephrogenic DI

A

HCTZ, Indomethacin, Amiloride

Hydration

55
Q

How does body respond to water retention in SIADH?

A

Body responds with decreased aldosterone (hyponatremia) to maintain near-normal volume status

56
Q

Causes of SIADH

A

Trauma to head/CNS disorders
Ectopic ADH (small cell lung cancer)
Pulmonary disease
Drugs (Cyclophosphamide)

57
Q

Treatment of SIADH

A 
Fluid restriction
IV hypertonic saline
Conivaptan - ADH antagonist 
Tolvaptan - ADH antagonist 
Demeclocycline - ADH antagonist
58
Q

What is pituitary apoplexy?

A

Sudden hemorrhage of pituitary gland - often in presence of existing pituitary adenoma

59
Q

Secondary diabetes

A

Due to unopposed secretion of GH and epinephrine

60
Q

Complications of diabetes mellitus

A
  1. Nonenzymatic glycation: a. small vessel disease causes retinopathy, glaucoma, neuropathy, nephropathy and b. large vessel disease atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene
  2. Osmotic damage: sorbitol accumulation in organs with aldose reductase and absent orbital dehydrogenase –> neuropathy and cataracts
61
Q

What is Kussmaul breathing?

A

The body’s way of compensation for metabolic acidosis; trying to breathe off CO2 - happens in Diabetic ketoacidosis; rapid deep breathing

62
Q

Why is there hyperkalemia in DKA?

A

H+/K+ exchanger is trying to pull H+ into cells because of metabolic acidosis –> then Kidney compensates and gets rid of K+ so total body K+ will be low

63
Q

Why does hyperosmolar coma happen in type 2 DM instead of DKA?

A

There is some insulin in Type 2 so the insulin prevent lipolysis, B oxidation and ketone production

64
Q

a. Histology of Type 1 DM

b. Histology of Type 2 DM

A

a. Islet leukocytic infiltrate

b. Islet amyloid polypeptide (IAPP) deposits

65
Q

Precipitating factors of DKA

A

Increased insulin requirements due to stress (infection)

66
Q

Complications of DKA

A

Mucormycosis
Cerebral edema
Cardiac arrhythmias
Heart failure

67
Q

Dermatitis, Diabetes, DVT, Depression and Anemia

A

Glucagonoma

68
Q

Treatment of hypoglycemia

A

In medical setting - IV glucose

In emergency non-medical setting - IM glucagon

69
Q

Necrolytic Migratory Erythema

A

Seen in Glucagonoma
Erythematous papules, plaques on face/perineum/extremities
Lesions enlarge and coalesce leaving a bronze colored, central indurated area with blistering/scaling

70
Q

5-Hydroxyindoleacetic acid (5-HIAA) in urine

A

Carcinoid syndrome

71
Q

MEN 1

A 
Parathyroid tumors (100%)
Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors (ZE, insulinoma, VIPomas, glucagonomas)
72
Q

MEN 2A

A

Parathyroid hyperplasia (20%)
Pheochromocytoma (45%)
Medullary thyroid carcinoma (secretes calcitonin)
Associated with marfanoid habitus (mutation in RET gene)

73
Q

MEN 2B

A

Pheochromocytoma
Medullary thyroid carcinoma
Oral/intestinal ganglioneuromatosis (Mucosal neuromas)
Associated with Marfanoid habits (mutation in RET gene)

74
Q

Septicemia, DIC, adrenal hemorrhage, petechial rash

A

Waterhouse-Friderichsen syndrome from N. meningitidis

75
Q

Derivatives of neural crest cells

A 
Chromatin cells
Parafollicular cells of thyroid 
Schwann cells
Autonomic nervous system
Dorsal root and celiac ganglia
Melanocytes
Cranial nerves
Pia and arachnoid
Odontoblasts
Skull bones
Aorticopulmonary septum
76
Q

N-myc oncogene overexpression and homer-wright rosettes

A

Neuroblastoma

77
Q

Drugs that cause hypothyroidism

A

Lithium - inhibits uptake and organification of iodine by thyroid gland and inhibits peripheral conversion of T4 to T3
Amiodarone

78
Q

Plasma antimicrosomal (antiperoxidase) antibodies and lymphocytic infiltrate

A

Hashimoto’s thyroiditis

79
Q

Gestational diabetes predisposes newborns to what?

A

Macrosomia
Hypoglycemia
Respiratory distress syndrome (Insulin inhibits surfactant synthesis)

80
Q

What is Whipple’s triad?

A

Hypoglycemia
Symptoms that are attributed to hypoglycemia
Resolution of symptoms with eating

Step 1 AB (29 decks)

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