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USMLE Step 1: Things I Cannot Remember > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Appetite Regulation:

  • Ghrelin ⇒
  • Leptin ⇒
  • Endocannabinoids ⇒
A
  • Ghrelin ⇒ stimulates hunger
    • produced by the stomach
    • inc w/ sleep and Prader-Willi Syndrome
  • Leptin ⇒ satiety hormone
    • ​produced by adipose tissue
    • mutation of leptin gene ⇒ congenital obesity
    • dec w/ sleep deprivation
  • Endocannabinoids ⇒ stimulate cortical reward centers
    • inc desire for high fat foods (munchies)
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2
Q

What hormones use the cAMP signaling pathway?

A

FLAT ChAMP

  • FSH
  • LH
  • ACTH
  • TSH
  • C​RH
  • hCG
  • ADH
  • MSH
  • PTH, calcitonin, GHRH, glucagon
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3
Q

What hormones use the cGMP signaling pathway?

A

Vasodilators

  • ANP
  • BNP
  • NO (EDRF)
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4
Q

What hormones use the IP3 signaling pathway?

A

GOAT HAG

  • GnRH
  • Oxytocin
  • ADH (V1 - receptor)
  • TRH
  • Histamine (H1 - receptor)
  • Angiotensin II
  • Gastrin
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5
Q

What hormones use an intracellular receptor signaling pathway?

A

VETTT CAP

*Vitamin D, sex hormones, adrenal steroids, thyroid hormones

  • Vitamin D
  • Estrogen
  • Testosterone
  • T3/T4
  • Cortisol
  • Aldosterone
  • Progesterone
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6
Q

What hormones use an intrinsic tyrosine kinase signaling pathway?

A

Growth factors (and MAP kinase pathway)

  • Insulin
  • IGF-1
  • FGF
  • PDGF
  • EGF
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7
Q

What hormones use a receptor-associated tyrosine kinase signaling pathway?

A

PIGGLET

*JAK/STAT pathway, acidophils, cytokines

  • Prolactin
  • Immunomodulators (cytokines)
  • GH
  • G-CSF
  • Erythropoietin
  • Thrombopoietin
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8
Q

What are the characteristics of MEN1?

(remember the diamond)

A

3 P’s:

  1. Pituitary tumors
    • prolactin and GH
  2. Parathyroid tumors
  3. Pancreatic endocrine tumors
    • ZE syndrome, VIPomas, glucagonomas (rare)
  • mutation of MEN1 gene (menin, tumor suppressor)
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9
Q

What are the characteristics of MEN2A?

(remember the square)

A

2 P’s:

  1. Parathyroid hyperplasia
  2. Pheochromocytoma
  3. Medullary thyroid carcinoma (secretes calcitonin)
  • marfinoid habitus
  • mutation in RET gene (codes for receptor tyrosine kinase)
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10
Q

What are the characteristics of MEN2B?

(remember the triangle)

A

1 P:

  1. Pheochromocytoma
  2. Oral/intestinal ganglioneuromatosis (mucosal neuromas)
  3. Medullary thyroid carcinoma (secretes calcitonin)
  • marfinoid habitus
  • mutation in RET gene (codes for receptor tyrosine kinase)
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11
Q

What are the rapid acting insulins?

A
  1. Aspart
  2. Glulisine
  3. Lispro
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12
Q

What are the short acting insulins?

A

Regular insulin

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13
Q

What are the intermediate acting insulins?

A

NPH

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14
Q

What are the long acting insulins?

A
  1. Detemir
  2. Glargine
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15
Q

Where is the most common thyroid ectopic tissue site?

A

tongue

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16
Q

Thyroglossal duct cyst vs. Branchial cleft cyst

A
  • Thyroglossal duct cyst ⇒ anterior midline neck mass that moves when swallowing
  • Branchial cleft cyst ⇒ cyst in the lateral neck (due to a persistent cervical sinus
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17
Q

The most common tumor of the adrenal medulla in adults:

A

Pheochromocytoma — episodic hypertension

18
Q

The most common tumor of the adrenal medulla in children:

A

Neuroblastoma — rarely causes hypertension

19
Q

Anterior pituitary is derived from the ____ _______

A

Anterior pituitary is derived from the oral ectoderm (Rathke pouch)

20
Q

List the Anterior Pituitary Hormones:

A

FLAT PiG

  • FSH
  • LH
  • ACTH
  • TSH
  • Prolactin
  • GH
21
Q

Anterior Pituitary Hormones - Acidophils

A

GH and prolactin

22
Q

Anterior Pituitary Hormones - Basophils

A

B-FLAT

Basophils -

  • FSH
  • LH
  • ACTH
  • TSH
23
Q
  • Which pituitary hormones share the same α-subunit?
  • How are they different?
A
  • FSH, LH, TSH and β-HCG share the same α-subunit
  • Hormone specificity is determined by the β-subunit
24
Q

What are the insulin-dependent tissues?

A

BRICK L

  • Brain
  • RBCs
  • Intestines
  • Cornea
  • Kidneys
  • Liver
25
Insulin-dependent glucose transporters:
**GLUT-4** * adipose tissue, striated muscle * excercise can increase GLUT-4 expression
26
Insulin-independent glucose transporters:
* **GLUT-1:** * RBCs, brain, cornea * **GLUT-2** (_bidirectional_): * ß-islet cells, liver, kidneys, small intestine * **GLUT-3:** * brain * **GLUT-5** (_fructose_): * spermatocytes, GI tract
27
How is insulin regulated?
* **Glucose** is the _major regulator_ * **ß2-agonists** ⇒ ↑ insulin release * **GH** ⇒ ↑ insulin resistance ⇒ ↑ insulin release * **Glucose enters cell** ⇒ **↑ ATP generated** from glucose metabolism ⇒ **K+ channels close** ⇒ ß cell membrane **depolarizes** ⇒ Voltage-gated Ca2+ channels open → **Ca2+ influx** ⇒ stimulation of **insulin exocytosis**
28
What are the physiologic effects of insulin?
**Anabolic** effects: * **↑ glucose uptake** into _skeletal muscle and adipose tissue_ (insulin-dependent - GLUT4) * ↑ glycogen synthesis and storage * ↑ trig synthesis * ↑ Na+ retention (kidneys) * ↑ protein synthesis (muscles) * ↑ cellular **uptake K+ and amino acids** * **↓ glucagon release**
29
What is the most common congenital adrenal hyperplasia?
**21-hydroxylase deficiency** * **Infancy** ⇒ salt wasting * **Childhood** ⇒ precocious puberty * **XX ⇒** virilization
30
Effects of **17**α**-hydroxylase deficiency:** * Mineralocorticoids: * Cortisol: * Sex Hormones: * BP: * [K+]: * Labs: * Presentation:
* Mineralocorticoids: ↑ * Cortisol: ↓ * Sex Hormones: ↓ * BP: ↑ * [K+]: ↓ * Labs: ↓ androstenedione * Presentation: * XY: pseudo-hermaphroditism (ambiguous genitalia, undescended testes) * XX: lack of secondary sexual development
31
Effects of **21-hydroxylase deficiency:** * Mineralocorticoids: * Cortisol: * Sex Hormones: * BP: * [K+]: * Labs: * Presentation:
* Mineralocorticoids: ↓ * Cortisol: ↓ * Sex Hormones: ↑ * BP: ↓ * [K+]: ↑ * Labs: **↑ renin, ↑ 17-hydroxyprogesterone** * Presentation: * **Infancy:** salt wasting * **Childhood:** precocious puberty * **XX:** virilization
32
Effects of **11**β**-hydroxylase deficiency:** * Mineralocorticoids: * Cortisol: * Sex Hormones: * BP: * [K+]: * Labs: * Presentation:
* Mineralocorticoids: ↓ * Cortisol: ↓ * Sex Hormones: ↑ * BP: ↑ * [K+]: ↓ * Labs: **↓ renin activity** * Presentation: * **XX:** virilization
33
What are the functions of cortisol?
Cortisol is a **BIG FIB:** * **↑ B**lood pressure * upregulates α1-receptor activity ⇒ **↑** sensitivity to NE and epi * With high levels, can bind to aldosterone receptor * **↑ I**nsulin resistance (_diabetogenic_) * **↑** **G**luconeogenesis, lipolysis, proteolysis * **↓ F**ibroblast activity ⇒ causes striae * ↓ **I**nflammatory and **I**mmune response * ↓ **B**one formation (↓ osteoblast activity)
34
How does cortisol supress the Inflammatory/Immune response?
* Inhibits production of leukotrienes and prostaglandins * _Inhibits WBC adhesions_ ⇒ **neutrophilia** * **Blocks histamine release** from mast cells * ↓ eosinophils * **Blocks IL-2 production** * Exogenous cortisol ⇒ can lead to reactivation of TB and candidiasis
35
Which oral hypoglycemic agents can cause **hypoglycemia**?
* **Sulfonylureas** * Chlorpropamide, Tolbutamide - 1st generation * Glimpepiride, Glipizide, Glyburide - 2nd generation * **Amylin analogs** * Pramlitinide
36
What oral hypoglycemic agents can cause **hepatotoxicity**?
**Glitazones/thiaglitazones** * Pioglitazone * Rosiglitazone
37
Which oral hypoglycemic agents cause UTIs and vaginal yeast infections?
**SGLT-2 inhibitors** * Canaglifozin * can also cause glucosuria
38
What is the most serious adverse effect of biguanides (metformin)?
**lactic acidosis**
39
What oral hypoglycemic drugs **↑ insulin sensitivity**?
* **Biguanides** (Metformin) * exaxt mechanism unknown: ↑ peripheral glucose upake, ↑ glycolysis, ↓ gluconeogenesis * **Glitazones/Thiaglitazones** (Pioglitazone, Rosiglitazone) * ↑ insulin sensitivity in peripheral tissue * Binds to PPAR-γ nuclear transcription regulator
40
What are the side effects of Glitazones/Thiaglitazones?
* **Hepatotoxicity** * _Weight gain_ * _HF_ * Edema * ↑ risk of fractures
41
Which oral hypoglycemic agents can cause **pancreatitis**?
**GLP-1 receptors** * Exenatide * Liraglutide

USMLE Step 1: Things I Cannot Remember (16 decks)

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