Endocrine

Question 1

PPAR-y

Answer 1

Nuclear receptor that is bound by –glitazones (TZD’s)

• Transcriptional Regulator
• Increases GLUT4 gene expression (adipocytes)
• Weight gain and edema are a side effect

Question 2

Sulfonureas

Answer 2

Bind regulatory subunit of Katp channel on pancreatic Beta cells to close them (calcium influx → insulin release)

Question 3

Aldosterone in Addison’s (Primary Adrenal Insufficiency):

Answer 3

• Low aldosterone: Decreased serum Na and Bicarb

Decreased Na reabsorption) & Increased serum K and Cl (Decreased H+ and K+ excretion

Question 4

Decreased Deep Tendon Reflexes with _______

Answer 4

Hypothyroidism

Question 5

Reverse T3

Answer 5

Inactive form of thyroid hormone that is generated with peripheral conversion of T3 to T4

Question 6

Diabetics should _______

Answer 6

Inspect feet daily because risk of infections

- May have peripheral arterial disease (due to atherosclerotic femoral arteries)

Question 7

Pseudohypoparathyroidism

Answer 7

High PTH, low Ca due to resistant PTH receptors

Question 8

Hashimoto’s Thyroiditis

Answer 8

Looks like germinal centers on histology

Question 9

High levels of vitamin D

Answer 9

Increase both Ca and PO4, and decrease PTH

Question 10

Craniopharyngioma

Answer 10

• Bitemporal hemianopsia
• Calcified, resembles tooth enamel
• Solid, cystic, and calcified; filled with machinery oil liquid

Question 11

Kallman’s Syndrome

Answer 11

No GnRH because failed to migrates from olfactory placode, anosomia

Question 12

Waterhouse-Friedrichsen

Answer 12

Acute primary adrenal insufficiency due to n. meningitides

Question 13

Neurophysins

Answer 13

Carrier proteins for oxytocin and ADH

- Produced by hypothalamus

Question 14

Alpha2 and Somatostatin: Effect on Insulin

Answer 14

Decrease insulin release

Question 15

TZD’s (glitazones)

Answer 15

PPARgamma → decreases insulin resistance

- Transcriptional regulation

Question 16

DPP4 inhibitors

Answer 16

-gliptins

Question 17

Increased secretion of insulin:

Answer 17

Sulfonureas and DPP4

Question 18

Increased sensitivity of insulin

Answer 18

Metformin and TZDs (glitazones)

Question 19

Ophthalmopathy in Grave’s treated w/

Answer 19

Glucocorticoids

Question 20

JAK/STAT receptor signaling pathway used by:

Answer 20

Growth Hormone and Prolactin

Question 21

Osteitis fibrosa cystica

Answer 21

(resorption of subperiosteum)

• Seen with Primary hyperparathyroidism
• Stones, bones, groans, psychiatric overtones

Question 22

Neuroblastoma

Answer 22

• Tumor of adrenal medulla in young children

- Non-rhythmic conjugate eye movements and myoclonus aw/ paraneoplastic syndrome

Question 23

Pregnancy, Hormone replacement therapy, and OCPs effect on Thyroid Hormones

Answer 23

Increased TBG (thyroid binding globulin) so total T3 and T4 are increased but free is normal

Question 24

Hypothyroidism

Answer 24

May have myopathy with myoedema (bump rises when muscle tapped with a reflex hammer), will have elevated CK

Question 25

DKA

Answer 25

HYPERkalemia because potassium inside cells is low (K+ normally taken up with glucose) and potassium outside is normal or increased (potassium sent out of cells), total potassium is low because of lose K+ in urine; sodium is low - Tx: must replace potassium

Question 26

Complete androgen insensitivity syndrome

Answer 26

X linked mutation, breast development and bind pouch vagina, cryporchid testes (karyotype is XY)

Question 27

Papillary Thyroid Cancer

Answer 27

MC; orphan annie eyes, psamomma bodies, internuclear grooves and inclusions - Don't confused with Follicular Adenoma or Carcinoma

Question 28

Anorexia and GnRH

Answer 28

Lose pulsatile secretion of GnRH → amenorrhea and osteoporosis (if long-term)

Question 29

Transient vs Permanent Central DI

Answer 29

- Isolated damage to posterior pituitary → transient central DI - Damage to the hypothalamic nuclei will be permanent

Question 30

Intrinsic Tyrosine Kinase

Answer 30

insulin and growth factors (eg. FGF, EDGF, etc) | - MAP kinase

Question 31

Receptor- Associated Tyrosine Kinase

Answer 31

growth hormone, prolactin, cytokines | - JAK/STAT

Question 32

C-peptide

Answer 32

Formed from pro-insulin (cleaved off) and packed into a secretory granule with insulin (equimolar concentration) - Not present with exogenous insulin

Question 33

IGF-1

Answer 33

Produced by liver due to GH stimulation

Question 34

Insulin Activates:

Answer 34

- Directly activates glycogen synthase | - Indirectly inactivates glycogen phosphorylase (via protein phosphatase 1)

Question 35

Thyroid Hormone increases ________ in Heart

Answer 35

B1 receptors

Question 36

Thyroid Receptors in _______

Answer 36

Nucleus (unlike most steroid hormone receptors which are cytoplasmic)

Question 37

Hypothyroidism

Answer 37

- Hypercholesterolemia (due to downregulation of LDL receptors) - Also an increased risk of non-hodgkins - Hurthle cells; follicles (germinal centers)

Question 38

DeQuervain vs Reidel

Answer 38

- DeQuervain: post-viral hypothyroidism (painful), jaw pain | - Reidel (fibrosing) is not painful

Question 39

Jod Basedow Phenomenon

Answer 39

Thyrotoxicosis if patient with iodine deficiency is given iodine

Question 40

Tx for Growth Hormone excess

Answer 40

If it is not cured by resection: | - Pegvisomant (GH receptor antagonist) or octreotide (somatostatin analog)

Question 41

__________ is given intravenously to treat DKA

Answer 41

Regular insulin - onset 30 min - peaks at 2-4 hours - lasts 5-8

Question 42

HPA Axis Suppression by Exogenous Steroids

Answer 42

All 3 parts are suppressed (hypothal, pituitary, and adrenals) which means that CRH, ACTH, and cortisol will be low in an adrenal crisis if steroids are stopped abruptly

Question 43

Klinefelters: Gonadotropins and Hormones

Answer 43

High LH and FSH Low testosterone Azoospermia Hyalinized semeniferous tubules

Question 44

hCG and TSH

Answer 44

similar in structure so patients with testicular germ cell tumors or gestational trophoblastic disease may develop high hCG that can stimulate TSH receptors and cause hyperthyroidism

Question 45

Proptosis w/ Graves

Answer 45

Due to increased GAGs (glycosaminoglycan) depositing by orbital fibroblasts --> edema and enlargement of extraocular muscles

Question 46

Metryapone

Answer 46

Inhibits 11 B hydroxylase | - Decreases cortisol synthesis and if HPA axis is intact ACTH should increase

Question 47

Uniform polygonal or spindle-shaped cells w/ extracellular amyloid deposits (stains with Congo red)

Answer 47

Medullary Thyroid cancer | - extracellular amyloid deposits formed by calcitonin released from neoplastic parafollicular C-cells

Question 48

Beta-blocker use with Thyrotoxicosis

Answer 48

Decreases Sympathetics | Also decreases rate of peripheral T4 conversion to T3

Question 49

TNFa induced insulin resistance

Answer 49

due to activation of serine kinase (which phosphorylates insulin receptor)