Endocrine Flashcards
1
Q
Do endocrine glands have ducts
A
No
2
Q
2 Hormones released from the posterior pituitary
A
- oxytocin
2. ADH
3
Q
what are the 6 hormones released from the anterior pituitary
A
- TSH (thyroid stimulating)
- ACTH
- FSH,LH
- GH growth hormone
- PRL proctin
- Dopamine
4
Q
Where is the parathyrid gland
A
posterior side of the thyroid
5
Q
effect of Parathyroid hormone
A
Increases Ca in the blood
6
Q
ACTH causes what to be released from the adrenal cortex
A
glucocorticoids
7
Q
what is an example of a positive feedback loop
A
Oxycontin and child birth
8
Q
what ways do hormones circulate
A
- free
2. bound to plasma proteins
9
Q
effect of binding to plasma
A
increased 1/2 life
10
Q
benefit of having hormones bond to plasma
A
they can serve as a resivore
11
Q
which hormone is bound to a protein T3 or T4
A
T4
12
Q
what hormone correlates best with clinical findings (free or bound)
A
free
13
Q
The secretion of most hormones have what nature
A
pulsatile
14
Q
Circhoal
A
released every hour
15
Q
Ultradian
A
-released
> 1 hr
<24 hours
16
Q
circadian
A
released every 24 hours
17
Q
Diurnal
A
episodic activity is expressed at defined periods of the day
18
Q
involves the organ(s) that produce the hormone
what order disease
A
Primary Disease
19
Q
related to the pituitary which produces trophic hormones
what order disease
A
Secondary Disease
20
Q
hypothalamic problems what order disease
A
hypothalamic problems
Tertiary Disease
21
Q
- Hashimoto’s thyroiditis
- Addison’s disease
- Type 1 DM
are all examples or what order diseases
A
Primary Deficiency Disorder
22
Q
feeling cold all the time could be what kind of issue
A
hypothyroid
23
Q
Secondary hypothyroidism
Secondary adrenal insufficiency
(where is the issue)
A
pituitary
24
Q
Tertiary hypothyroidism
where is the issue
A
issue is in the hypothalamus
25
Hyperthyroid is also called
Graves disease
26
The primary focus of endocrine testing is
hormone measurement
27
(blank) test to assess hypofunctioning
stimulation
28
(blank) test to assess hyperfunctioning
suppression
29
4 sources for endocrine testing
1. Blood
2. Urine
3. Imagine
4. Tissue
30
what is more common blood from an artery or vein
Vein
31
where does the blood for an ABG come from
artery
32
capillary puncture gives you what
glucose
33
what gets glocose into the cell
Insulin
34
what organ is the most sensitive to a change in glucose
brain
35
Insulin is made by what organ
pancreas
36
insulin has what effect on blood glucose
lowers
37
what is the opposite of insulin
glucagon
38
Fatty acids packaged for future use
Triglycerides (TG)
39
Source of fuel that is the product of protein breakdown
Amino Acids (AA)
40
Breakdown of glucose to make energy (ATP) for the cell
Glycolysis
41
Generation of glucose from non-carbohydrate substances (such as glycerol from pyruvate, lipids, amino acids, and lactic acid).
Gluconeogenesis
42
Long term storage molecule of glucose which is stored and synthesized mainly in the liver and muscles
glycogen
43
where is glycogen stored (2)
1. Liver
| 2. Muscle
44
Formation of glycogen from glucose
Glycogenesis
45
Glycogenolysis
Breakdown of glycogen into glucose for use as fuel
46
Breakdown of triglycerides to fatty acids and further degradation which leads to production of ketones and energy
Lypolysis
47
Islets of Langerhans make up what percent of the pancreas
2%
48
98% of the pancreas is what
digestive enzymes (exocrine glands)
49
Insulin secreted by what cells
beta cells
50
RBCs absorb glucose without insulin,
1. Brain
2. Liver
3. Kidney
3. RBCs
51
glucagon secreted by what cells
alpha
52
released in response to rising amino acid levels in blood
Glucagon
53
The body wants to keeo blood glucose at what level
90-100 (mg/DL)
54
glucose > 100 mg, Dl
HYPERGLYCEMIA
55
gluclose 70-100 Mg/Dl
NORMOGLYCEMIA (Euglycemia)
56
LOW Blood Glucose (< 70 mg/dL)
HYPOGLYCEMIA
57
Immune system sees its own cells as foreign and attacks and destroys β-cells of the pancreas
DM type I
58
Cannot use insulin effectively (insulin resistance) so glucose builds up in the blood
DM type II
59
If there is urine in the blood what must blood glucose be
180 mg/Dl
60
bed wetting could be a sign of what condition
DM type I
61
Blood test that represents the amount of glycosylated hemoglobin – the average blood sugar level for the 120 day period before the test
Hemoglobin A1c
62
Hemoglobin A1c works because its involved with what type of cell
RBC
63
How long does A1C look back
120 days
64
Pre-diabetes qualification
100 to 126 mg/dl on the FBG test, OR
140-199 mg/dl on the OGTT, OR
Hemoglobin A1c between 5.7 – 6.4%
65
overweight is what BMI
25
66
In the absence of criteria (risk factors), testing for diabetes should begin at age
45 years old
67
If results are normal, testing should be repeated at least at (?) intervals
3 year
68
Sweet taste of the urine, distinguished diabetes mellitus from diabetes insipidus (what is this)
(frequent urination due to ADH)
69
Cut off for DM A1C
6.5% (pre: 5.7-6.4)
70
Fasting plasma glucose for DM
>126 mg/ Dl (pre: 100-126)
71
2 hour plasma glucose for DM
> 200 mg/DL (pre: 140-199)
72
random glucose for DM
> 200 mg/ DL
73
A positive result (ketonuria) is associated with
diabetic ketoacidosis
74
Horseness can be a symptome of what
enlarges thyroid
75
what percent of T3 and T4 are bound to a protein
> 99%
76
TSH is released by the
puititary
77
In the early phases of developing thyroid disease, (what)is the first marker to reflect the disorder
TSH
78
Low TSH =
hyperfunctioning
79
High TSH =
hypofunctioning
80
what does ordering a "TSH with reflex" mean
They check the TSH if that is abnormal they will check T4
81
Total T4 or T3 is an (inadequate OR adequate) indicator of thyroid status
inadequate
82
What can effect levels of T3 T4 (another hormone)
estrogen therapy
83
what is a better indicator T3 or T4
T4
84
Acute thyroiditis
Graves’ disease
Thyroid cancer
(these conditions will cause you to look into what)
Thyroglobulin (Tg)
85
Monitoring of Tg levels is frequently used to evaluate the effectiveness of treatment for (what)
thyroid cancer
86
Thyrotropin Receptor Blocking Antibodies elevated in what condition
Hashimoto’s disease
87
TSH Receptor Antibodies elevated in what condition
Graves disease
88
Very good modality for evaluating nodule activity
Thyroid Nuclear Medicine Scan
89
Hypothyroidism – causes what kind of uptake in the Thyroid Nuclear Medicine Scan
decreased uptake
90
Non-specific term for enlargement of the thyroid.
Goiter
91
Discrete area that is clearly different from the surrounding thyroid tissue.
Nodule
92
Hyperfunctioning (hot) nodules are (unlikely or likely) to be cancerous.
unlikely
93
Cold nodule shows up what on the thyroid scan
white
94
It tells if a nodule is "solid" or a fluid-filled cyst, but it will not tell if a nodule is benign or malignant. (What is)
Thyroid ultrasound
95
It is the most reliable test to differentiate the "cold" nodule that is cancerous from the "cold" nodule that is benign. (what is)
FNA (fine needle aspiration)
96
Do not let the term “follicular” mislead you. Follicular cells are (what) until proven other wise
malignant
97
~75% will be benign with “high confidence”
~20% will be “indeterminate” (~20-40% of these will be cancer)
~5% will diagnose a malignant lesion
75% benign
20% unsure (20-40% malignant)
5% malignant
98
PTH does what to blood calcium
increases
99
```
Muscle contraction
Exocytosis
Blood clotting
Formation of cardiac action potentials
Enzyme activation
Cell signaling
Bone & tooth structure
(what hormone)
```
calcium
100
PTH has (what effects) on intestinal absorption of Ca+2
no directs effect
101
PTH stimulates osteoclast or osteoblast
osteoclast
102
does PTH involve the hypothalmus
no
103
Secreted by thyroid C cells (parafollicular cells)
Calcitonin
104
medullary thyroid cancer marker
Calcitonin
105
Hyperparathyroidism
Bone malignancies
Prolonged immobilization
Excess vitamin D and calcium in the diet
causes of Hypercalcemia
106
Bones, stones, abdominal groans, psychic moans, with fatigue overtones"
Hypercalcemia
107
```
PTH
Total Calcium
Phosphate
Vitamin D
(what gland is this testing)
```
patathyroid
108
Only about (?)% of total body phosphate is present in the blood
1%
109
The main role of vitamin D is to help regulate blood levels of (3)
1. Calcium
2. Phosphorous
3. Magnesium
110
Active vitamin D levels (should or should not) be used to DX Vit-D deficiency
Not
111
Sestamibi is used to examine what gland
parathyroid
112
what is the primary Glucocorticoid
cortisol
113
Cortisol secretion is pulsatile, diurnal and under the control of
ACTH
114
long term cortisol production will have what effect on the adrenal
atrophy
115
when do you want to perform your blood draw to test for cortisol
Blood drawn between 8 a.m. and 9 a.m.*
116
Cortisol
1. >10
2. 3-10
3. < 3
1. Good
2. unknown
3. adrenal insufficiency
117
Ideal for suspected hypercortisolism
24 Hour UA
118
what do you do with the morning void for a 24 hr UA
disregard
119
Differentiate source of adrenal insufficiency (cortisol deficiency)
ACTH Stimulation Test
- 250 mcg cosyntropin administered via IV
- Measure plasma cortisol levels at 30 and 60 minutes
120
Dexamethasone Suppression Test
Confirm abnormal excess production
| cortisol
121
How many para thyroid glands do we have
2-6 (normal is 4)
122
primary Goal of parathyroid hormone
increase blood calcium
123
where is parathyroid hormone released
parathyroid gland
124
What does reabsorb mean
Body takes it back. for example bone Calcium absorption means the body takes it from the bone into the blood stream
125
Does PTH directly or indirectly effect bone absorption
directly
126
Does PTH directly or indirectly effect ca absorption from intestine
indirectly (via the effect if Vit- D) this has the largest effect on Ca levels
127
Parathyroid hormones effect on phosphate plasma
decrease
128
what is more powerful parathyroid of calcitonin
parathyroid
129
4 things to test for with parathyroid
1. PTH
2. blood calcium
3. Phosphate
4. Vit D
130
when testing for Vit D what do you test for
Vit D 25
131
Nuclear medicine scan for parathyroid issue uses what chemical
sestamibi
132
sestamibi is absorbed by what 4 locations
1. heart
2. thyroid
3. salavaery
4. Para thyroid
133
order of exams when you suspect an issue with the thyroid
1. Blood tests
2. Nuclear medicine scan
3. biopsy
134
2 hormones you would use to monitor the effectiveness of thyroid cancer after thyroid removal
1. TG
| 2. Calcitonin
135
primary cause of hyperparathroidsim
hyper functioning ademoma
136
age for hyper functioning adenoma
>40
137
how are most hyper functioning adenoma detected
hyper calcemia
138
4 primary reasons for hyper calcemia
1. hyperparathyroid
2. Bone malignancy
3. Prolonged immobilization
4. excessive Vit D supplements
139
3 clinical findings of hyper calcemia
1. hyporeflexive
2. kidney stones
3. hypertension
140
primary cause of hypo parathyroidism
thyroid ectomy
141
Chvosstek's sign
trousseus sign
hyperreflexia
are indications of what
hypo calcemia
142
with hypocalcemia why do muscles become more exited
at the level of the nerve
143
Primary hormone of the glucocorticoid class
cortisol
144
cortisol is released in a response to
stress
145
what hormone from the pituitary causes cortisol to be released
ACTH
146
what hormone cause ACTH to be released
CRH from anterior hypothamus
147
fight or flight stimulates what hormone
cortisol
148
if you are on a steroid for > 7 days what can happen
your body stops producing its own cortisol
| adrenal insufficiency
149
5 Lab tests that look into how the cortisol system is doing
1. serum total cortisol
2. 24 hr UA free cortisol level
3. Plasma ACTH
4. ACTH stimulation
3. dexamethasone suppression
150
what is the initial study if you suspect an issue with the cortisol
serum total cortisol levels
151
serum total cortisol levels what do you adjust for
albumin
152
what time of day do you draw for serum total cortisol levels
8-9 am
153
3 words to describe the release of cortisol
1. pulsitile
2. diurnal
3. under control of ACTH
154
what are the 3 ranges for serum total cortisol levels
> 10 (no adrenal insufficiency)
3-10 (unsure)
< 3 adrenal insufficiency
155
what do you do with your UA during collection
must refriderate
156
what is the 24HR UA test good for
hypercortisol ism
157
what is the pattern of ACTH
diurnal
158
Plasma ACTH helps distinguish what
if the issue is pituitary or adrenal
159
ACTH stimulation tests done if you suspect
hypo adrenal
160
describe ACTH stimulation tests
1. inject 250mg/dl syntheric ACTH
| 2. measure 30-60 min
161
Results of ACTH stimulation
1. if cortisol doubles adrenal is good
| 2. If cortisol does NOT double: adrenal insufficiency
162
Describe dexamethasne suppression test
1. 1mg dexamethasone at 11pm
| 2. Draw blood at 8 am
163
Describe dexamethasne suppression test response
decrease in cortisol: adrenal is good
| no change in cortisol: adrenal is hyper functioning
