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USMLE Step 1 Quick Notes > Endocrine > Flashcards

Endocrine Flashcards

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USMLE® Step 1 flashcards
1
Q

If decreased phosphate and calcium, what should you consider?

A

Vitamin D deficiency

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2
Q

What are the symptoms of glucagonoma?

A

Cheilitis, necrolytic migratory erythema, hypeglycemia

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3
Q

What does necrolytic migratory erythema look like?

A

Pruritic painful plaques/papules with central clearing and bronze induration

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4
Q

Neonatal hyperglycemia from gestational diabetes is permanent or transient?

A

Transient (so is mom’s diabetes)

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5
Q

What do you give if exposed to radioactive iodine?

A

Potassium Iodine because it competitively inhibits radioactive I uptake?

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6
Q

What does propranolol do for the thyroid?

A

Blocks peripheral conversion of T4 to T3 by iodothyronin deiodase?

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7
Q

What does waist to hip ratio indicate?

A

Type 2 DM

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8
Q

What happens if hCG given for anovulation?

A

Stimulates LH surge

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9
Q

What else besides water does vasopressin increase the permeability of?

A

Urea

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10
Q

What is the diagnosis: pot-bellied, protruding tongue, umbilical herniation, coarse facial features, poor brain development (the 6P’s)?

A

Cretinism (congenital hypothyroidism)

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11
Q

What makes beta-endorphin?

A

POMC

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12
Q

What other hormone is beta-endorphin related to?

A

ACTH because they are from the same precursor (POMC)

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13
Q

What happens to pH and bicarbonate in diabetic ketoacidosis?

A

Decreased pH and decreased bicarb

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14
Q

What is Waterhouse-Friederichson?

A

Primary adrenal insufficiency from adrenal hemorrhage associated with Neisseria meningitidis, shock, DIC.

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15
Q

What is the problem if a sublingual mass that when removed causes lethargy, dry skin, feeding problem?

A

Hypothyroid because thyroid gland failed to migrate

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16
Q

What is carcinoid a tumor of?

A

ECL cells in the small bowel

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17
Q

When do you see symptoms of carcinoid?

A

When it has metastasized

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18
Q

What is the normal remnant of the thyroglossal duct?

A

Foramen cecum

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19
Q

What embroyological derivative does the adenohypophysis come from?

A

Surface ectoderm

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20
Q

Where is MSH made?

A

Anterior pituitary

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21
Q

How does insulin cause glucose uptake in skeletal and adipose tissue?

A

Tyrosine phosphorylation –> PI3K pathway –> vesicles with GLUT-4 exocytosed and glycogen/lipid/protein synthesis activated
Tyrosine phosphoryation –> RAS/MAP Kinase Pathway –> cell growth, DNA synthesis

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22
Q

What is the diagnosis? Necrolytic migratory erythema, hyperglycemia, cheilitis

A

Glucagonoma

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23
Q

What is the diagnosis? Painful, pruritic, papules coalesce with central clearing and bronze induration

A

Necrolytic migratory erythema

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24
Q

What stimulates Prolactin production?

A

TRH

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25
Q

How does GH affect insulin?

A

Causes insulin resistance so increased insulin release

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26
Q

What do neurophysins do to oxytocin and AD?

A

Post-translationally modify

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27
Q

How does cortisol increase BP?

A

Upregulates alpha1 receptors on arterioles (increased sensitivity to NE and Epi)

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28
Q

How does cortisol decrease inflammatory/immune response?

A

Decreases histamine release, decreases IL-12 production, reduces eosinophils, inhibits leukocyte adhesion (neutrophilia), inhibits PLA2

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29
Q

What happens to calcium when pH increases?

A

Binds to albumin and you see clinical manifestations of hypocalcemia

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30
Q

Which hormone receptors have intrinsic tyrosine kinase activity?

A

Insulin and the growth factors

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31
Q

Which hormone receptors have receptor associated tyrosine kinase activity?

A

GH, Prolactin, cytokines

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32
Q

Which pathway is used in intrinsic tyrosine kinase receptors?

A

MAP Kinase

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33
Q

Which pathway is used in receptor associated tyrosine kinase things?

A

JAK/STAT

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34
Q

Which hormones use cAMP for signaling?

A

ACTH, FSH, LH, CRH, TSH, hCG, MSH, PTH, GHRH, calcitonin, glucagon

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35
Q

Which hormones using IP3 for signaling?

A

GnRH, TRH, oxyctocin, angiotensin II, gastrin

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36
Q

Where is the thyroid receptor?

A

In the nucleus

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37
Q

How does thyroid increase basal metabolic rate?

A

Increasing Na/K ATPase

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38
Q

What do anions perchlorate ad pertechnetate and thiocynate do?

A

Inhibit iodide uptake in follicular cells of thyroid

39
Q

What is the metyrapone stimulation test?

A

Metyrapone inhibits 11beta hydroxylase –> decreases cortisol –> increases ACTH and 17-OH corticosteroid

40
Q

What do you increased homovanillic acid with?

A

Neuroblastoma

41
Q

How does thyroid affect cholesterol?

A

Hyperthyroidism causes hypocholesterolemia (due to increased LDL receptor expression)

42
Q

What does Hashimoto’s increases the risk for?

A

Non-hodgkin’s lymphoma

43
Q

What do you see on histology for De Quervain?

A

Granulomatous inflammation (giant cells, neutrophils)

44
Q

What are the findings for De Quervain?

A

Increased ESR, jaw pain, early inflammation, very tender thyroid

45
Q

When do you get De Quervain?

A

After a flu like illness

46
Q

What do you see with Riedel thyroiditis?

A

Thyroid replaced by fibrous tissue that may extend to local structures. Mimics anaplastic carcinoma. Rock hard fixed painless goiter

47
Q

What is the cause of death in Grave’s patients?

A

Tachyarrhythmia

48
Q

What is the Jod-basedow phenomenon?

A

Thyrtoxicosis if patient with iodide deficiency goiter made iodide replete

49
Q

What is pegvisomant?

A

GH receptor antagonist used for acromegaly

50
Q

How do you treat diabetes inspidius nephrogenic?

A

HCTZ, amiloride, indomethacin

51
Q

What do you see after post pituitary damage?

A

Transient central DI

52
Q

What do you see after hypothalamic nuclei damage?

A

Permanent central DI

53
Q

What does cyclophosphamide cause?

A

SIADH

54
Q

How do you treat SIADH?

A

Conivaptan, Tolvaptan, Demeclocycline

55
Q

What is empty sella syndrome?

A

Atrophy or compression of pituitary, often idiopathic, seen in obese women

56
Q

What causes peripheral neuropathy in diabetic patients?

A
  1. Ischemia from hyaline arteriosclerosis

2. Sorbitol accumulation causes osmotic damage

57
Q

How do you treat severe hypoglycemia in non medical setting?

A

Intramuscular glucagon

58
Q

What do you see on histology for T1DM?

A

Islet leukocytic infiltrate?

59
Q

What do you see on histology for T2DM?

A

Islet amyloid polypeptide (IAPP) deposits due to amylin deposition in pancreas

60
Q

What are the toxicities of sulfonylureas?

A

1st generation: disulfiram-like effects

2nd generation: hypoglycemia (increased risk in renal failure patients)

61
Q

What is tolbutamide and Chlorpropamide?

A

1st generation sulfonylurea

62
Q

What is canaglifozin?

A

SGTP-2 inhibitor (prevents glucose reabsorption in proximal tubules of kidney)

63
Q

What are the effects of GLP-1 analogs?

A

N/V, pancreatitis

64
Q

What are the side effects of glitazones?

A

Weight gain, edema, hepatotoxicity, HF

65
Q

What is Pramlinitide?

A

Amylin analog that decreases gastric emptying and glucagon

66
Q

What are the side effects of Methimazole and Propylthiouracil?

A

Skin rash, agranulocytosis, aplastic anemia, hepatotoxicity

67
Q

How does cortisol increase epinephrine production?

A

It induces PNMT which converts NE to epinephrine

68
Q

How do FFA and TG affect insulin?

A

Increase insulin resistance

69
Q

How do GC, TNF-alpha, and Glucagon affect insulin?

A

They cause serine phosphorylation of insulin receptor

70
Q

How do glucocorticoids increase neutrophils?

A

Cause dermargination of leukocytes previously attached to vessel wall

71
Q

What are the changes you see with sodium in SIADH?

A

Presents with euvolemic hyponatremia (transient volume increase but suppression of RAAS causes natriuresis and restore volume but worsens hyponatremia)

72
Q

What are the 5P’s of pheochormocytoma (aka symptoms)?

A

Palpitations, pressure (increased BP), pain (headache), perspiraton, pallor

73
Q

What does the CEA tumor marker tell you?

A

If tumor has recurred

74
Q

What happens with acid-base in DKA?

A

High anion gap metabolic acidosis –> compensatory respiratory alkalosis, low bicarb

75
Q

What happens with the bladder in diabetics?

A

Diabetic neuropathy can cause overflow incontinence due to an inability to sense bladder fullness and incomplete emptying. Postvoid residual volume with ultrasound can confirm diagnosis

76
Q

How do you tell complete vs partial DI?

A

Urine osmolarity jumps by >50% after vasopressin administration during water deprivation test.

77
Q

What do perchlorate and pertectinate do?

A

Competitively inhibit radioactive iodine uptake

78
Q

DKA is with T1DM, T2DM, or both?

A

T1DM because there is no insulin at all

79
Q

What do you give for gestational diabetes if lifestyle modifications fail?

A

Give insulin

80
Q

Why do anorexic patients get amenorrhea?

A

Below a certain body fat level, GnRH pulses stop (remember that leptin produced from fat triggers GnRH when puberty starts)

81
Q

How do you treat exophthalmos in Grave’s?

A

Glucocorticoids

82
Q

What are the side effects of canaglifozin?

A

Genital yeast infections, osmotic diuresis

83
Q

What is the treatment for a prolactinoma?

A

D2 agonists: bromocriptine and cabergoline

84
Q

What increases in blood cell counts with high dose glucocorticoids?

A

Neutrophils because GCs demarginate them

85
Q

What does addison’s disease affect?

A

All three layers of the adrenal gland (deficiency of aldosterone and cortisol). Spares medulla

86
Q

How does cortisol affect insulin?

A

Decreases insulin requirement

87
Q

What happens to volume in the body with SIADH?

A

SIADH causes EUVOLEMIC hyponatremia because initial fluid retention suppresses RAAS, activates ANP, and promotes natriuresis

88
Q

What happens with K and renin with pheochromocytoma?

A

Won’t see hypokalemia and therefore won’t have muscle weakness. Renin might actually go up.

89
Q

What has the same molecular origin as a pentapeptide that has a strong affinity for mu and delta receptors?

A

ACTH because it derives from POMC which also makes beta endorphins

90
Q

If someone has low blood glucose but doesn’t show symptoms of hypoglycemia they are likely taking what?

A

Non selective beta blocker. They mask the symptoms of hypoglycemia because normally body would produce Epi/NE (and other hormones) to increase lipolysis, gluconeo etc and also causes palpitations, sweating, hunger, tremor but beta blockers block these effects so you can’t tell that they are hypoglycemic. Avoid in diabetics.

91
Q

Diagnosis: young women who has postprandial hyperglycemia because pancreatic islet cells have a high set point for insulin secretion in response to blood glucose? What is deficient?

A

Glucokinase

Diagnosis is MODY: mutation decreases enzyme’s affinity for gluocose –> not sensing it

92
Q

What is the “glucose sensing device” in pancreatic beta cells?

A

Glucokinase

93
Q

What do you treat acromegaly with?

A

Octreotide and Pegivsomant

USMLE Step 1 Quick Notes (17 decks)

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