Endocrine

Question 1

40 or 50yo with thyroid cancer, palpatations, HTN, anxiety, sweating and other sympathetic symptoms. W/U shows adrenal mass (pheochromocytoma, should be thinking of MEN syndrome at this point). What is pre-op treatment?

Answer 1

Alpha and beta blockade

Question 2

Research lab studying insulin resistant DM: what biochemical assay would they be working on? Inhibition of which biochemical agent would be associated with insulin-resistance in DM?

Answer 2

Tyrosine kinases

Question 3

Patient in 60s, smoker, shows up to ER with vomiting, HA, and malaise. CT shows nodule in lung (lung cancer) and labs show high Ca2+, low ALP, low phosphorous. Where is the primary function for these lab studies?

Answer 3

Small cell lung cancer most likely; none of the endocrine organs effected but bones and tubules are affected

Question 4

54yo woman with DM, osteoporosis, and HTN who gains a bunch of weight and gets ascites. Imaging studies show mass adjacent to right kidney. Neither low or high dose dexamethasone changes cortisol levels (dexamethasone suppression test). What does she have?

Answer 4

Adrenal adenoma

Question 5

Woman in 50s has no real physical findings except exophthalmos. She receives drug treatment but develops GI issues, fever and infection. What medication was she given?

Answer 5

Propothouracil for Grave’s disease

Question 6

A patient with chronic renal disease and osteodystrophy (hyperactive osteoclast activity). Which of the following hormones plays a role?

Answer 6

PTH

Question 7

A 65yo male with SCLC is given democycline to treat ectopic ADH production which leads to large amounts of dilute urine production. Patient is told to hold all fluids for 12 hours. However the patient continues to produce dilute urine, ADH levels are markedly elevated, serum hyperosmolality and serum hyponatremia are prominent. Which of the following is most likely?

Answer 7

a. Not DM, not SIADH, not primary hyperaldosteronism

b. Medication-induced diabetes insipidus

Question 8

19yo college student is vomiting, photophobia, fever, malaise, leg pain rash (basically septic). Gram stain shows G- diplococci. He then develops vomiting, flank pain, and abdominal pain. What is causing this?

Answer 8

Hemorragic change in adrenal glands (Waterhouse-Friedrich syndrome)

Question 9

Kid born with organomegaly, large tongue, Wilm’s tumor, omphalocele, pits in back of ear. What does she have?

Answer 9

Beckman-Wiedmann syndrome

Question 10

5yo kid with excessive hunger, thirst, high levels of glucose/ketones in urine (he’s in DKA). What’s the association?

Answer 10

HLA-DR: autoimmune

Question 11

How do steroid hormones work?

Answer 11

Generally transform hormone receptor complex, generally located in nucleus

Question 12

Older guy with DM symptoms and symptoms of BPH (stream issues, trouble starting and stopping, enlarged prostate on DRE etc.

Answer 12

Glandular and stromal hyperplasia of prostate (not an endocrine disorder)

Question 13

Patient with thyroidectomy for Grave’s disease. She has facial spasm with tap on cheek, QT prolongation, low calcium, low PTH, high phosphorous. What happened?

Answer 13

Hypocalcemia secondary to hypoparathyroidism from removal of PTH glands during surgery

Question 14

Patient is a diabetic and loses vision in both eyes (DM shouldn’t lose simultaneous, acute vision in both eyes). Mass identified in brain; biopsy reveals GH-producing adenoma. What type of cell composes this mass?

Answer 14

Acidophilic cells

Question 15

Patient with DM and HTN shows up with a HbA1c of 8.5%, SOB, dizziness, and chest pain. What drug were they most likely given that induced these symptoms?

Answer 15

Beta-blocker (propranolol)

Question 16

Patient with intracranial tumor, plasma ADH is normal, urine flow is 10ml/min, and serum osmolality is 290 (Nephrogenic DI). Which of the following osmolarity values should resemble condition?

Answer 16

Either 100 or 1000

Question 17

28yo patient with hypothyroidism, diarrhea, palpatations, tachycardia and fatigue. Hypothyroidism presents with lethargy, hyperthyroidism causes BMR to become fast than it should –> fatigue.

Answer 17

Cause = overmedication for hypothyroidism (levothyroxine)

Question 18

25yo female with galactorrhea, visual changes, loss of libido and mass in sella turcica. Which of the following functions is most likely to be preserved?

Answer 18

Salt retention

She likely has a prolactinoma)

Question 19

24yo with galactorrhea; PMH of duodenal ulcers and hypercalcemia; FHx has wide variety of tumors in pancrease, pituitary, etc. Which of the following inheritance patterns is most likely?

Answer 19

Autosomal dominant (MEN syndrome)

Question 20

Researcher wants to know how thyroid hormone works

Answer 20

TSH tends to access Na/K/ATPase

Question 21

History of pheochromocytome (chromaffin cells in adrenal medulla)

Answer 21

Will secrete NE

Question 22

Young woman who stops menstruating, has N/V/weakness, 160/100 BP, low serum potassium of 2. Condition affects 2 adrenal hormones and leaves 1 hormone intact. Which are/hormone is intact?

Amenorrhea –> anti-androgenic effects
Low serum K –> aldosterone affected

Answer 22

Cortisol is intact so glomerulosa is intact

Question 23

Autoimmune disorder of adrenal gland: given symptoms we must recognize, given patient with multiple masses in uterus and adrenal gland. She does not have leiomyomas. Clinical manifestation of adrenocortical carcinoma

Answer 23

Adenocortical mass: stain with inhibin

Sort of a trick question because adrenal cortical tumors, especially carcinomas, share inhibin positivity just like granulosa cells.

Question 24

Patient with hyperthyroidism (basically has Hashimoto), anxiety, weight loss, pretibial myxedema. Given series of etiologies for this (radiation, auto-antibodies, etc)

Answer 24

Test of choice is anti-TSH (auto AB for TSH)

Question 25

Hypercalcemia: always look at PTH or kidney.

Patient with hypercalcemia, dry mouth and thyroid nodule (MEN-type presentation); outside of conventional parayhtoid PTH hormone, the only ting that will cause hypercalcemia is valcitonin vs amyloid deposition

Answer 25

Medullary cancer of thyroid

Question 26

Where do adrenal veins drain into?

Answer 26

IVC

Question 27

EKG: endocrine pathology associated with a couple different manifestations

Answer 27

Prologed QT with hypercalcemia

u wave associated with long-standing steroid use (cortisol)

Question 28

Papillary cancer of thyroid

Answer 28

Know linkage to radiation (radiology techs prior to protective measures, treatment of ance with radiation)

Question 29

DM type II: remember that there are certain drugs which can cause hydrolysis of sugars at the brush border, know drugs, their actions, their symptoms

Answer 29

Acarbose

Question 30

Recognize different tumors in pituitary gland and their different manifestations; GH overproduction and gigantism

Answer 30

GH-producing adenoma

Question 31

Patient with chronic fracture, weight gain, compression fractures, polyuria, polydipsia.

Answer 31

Cortisol causes these diabetes like S/S fractures, etc (reason for hesitancy in treating elderly with long-term steroids)

Question 32

Patients with a bunch of autoimmune disorders, DM etc

Answer 32

If GI symptoms also, celiac disease; linkage between celiac and DM

Question 33

High TSH, low total and free T4: probably older patient with fatigue, weakness, weight gain, constipation, cold-insensitivity, etc

Answer 33

Has hypothyroidism

Question 34

MEN

Answer 34

Autosomal dominant

Question 35

End terminal PTH produced where?

May have patient with high PTH and high calcium (either symptoms or lab values) –where is hormone produced?

Answer 35

End terminal PTH is mostly produced by chief cells > oxaphilic cells

Question 36

How do you treat GH tumors?

Answer 36

Somatostatin therapy

Question 37

Pancreatic vascular blood distribution; islet cell tumors

Answer 37

Gastroduodenal and SMA could be problematic in surgery

Question 38

DM: diabetic nerve pain has lots of new drugs; what is the abnormality in the peripheral neuropathy?

Answer 38

Pacinian corpuscle

Question 39

How does PTH work in the kidney?

Answer 39

Decreased reabsorption of sodium, increased excretion of phosphate

Question 40

Guy with UC on chronic steroid therapy and suddenly develops what symptoms of steroid use?

Answer 40

Can develop DM

Question 41

Know Kimmelstiel-Wilson histology and DM

Answer 41

Nodular glomerulosclerosis in kidney