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Step 1 Review > Endocrine High Yield > Flashcards

Endocrine High Yield Flashcards

1
Q

What connects the thyroid to the tongue?

A

Thyroglossal duct

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2
Q

What is the remnant of the thyroglossal duct?

A

Foramen cecum

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3
Q

What makes up the pharyngeal arches (1, 2, 3, 4, 6)?

A

Mesoderm and NCC

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4
Q

What makes up the pharyngeal pouches?

A

Endoderm

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5
Q

What makes up the pharyngeal grooves or clefts?

A

Ectoderm

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6
Q

most common tumor in adult adrenal medulla?

A

Pheochromocytoma

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7
Q

Most common tumor in child adrenal medulla?

A

Neuroblastoma

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8
Q

Name the cells of the adrenal medulla?

A

Chromaffin cells (NCC origin)

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9
Q

What is the anterior pituitary derived form?

A

Oral ectoderm (Rathke’s ouch)

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10
Q

Name the basophilic cell types in the Anterior Pituitary?

A

B- FLAT

Basophils: FSH, LH, ACTH, TSH

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11
Q

Which anterior pituitary hormones have a common alpha subunit?

A

TSH

LH

FSH

(hCG too)

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12
Q

What hypothamaic nuclei is vasopressin made in?

A

Supraoptic nuclei

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13
Q

What hypothamaic nuclei is oxytocin made in?

A

paraventricular nuclei

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14
Q

Where is preproinsulin synthesized?

A

RER of beta cells

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15
Q

When is proinsulin cleaved?

A

Just prior to exocytosis while in the secretory granule

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16
Q

What type of activity do insulin receptors have in insulin dependent cells?

A

Tyrosine kinase

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17
Q

What pathways does insulin receptor activate in insulin dependent cells?

A

RAS/ MAPk pathway–> cell growth and DNA synthesis

PI3k pathway–> glycogen, lipid, protein synthesis and increased GLUT 4 transporters

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18
Q

Does insulin increase or decrease intracellular K+?

A

Increase

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19
Q

Direction of GLUT 2 transporters?

A

Bidirectional

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20
Q

What causes the release of insulin from beta cells?

A

glucose enters–> ATP production–> closure of ATP dependent K+ channel–> cell depolarized–> activation of volt gated Ca2+ channel–> increased intracellular Ca leads to exocytosis

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21
Q

When dopamine increases, what happens to the levels of prolactin?

A

Prolactin decreases

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22
Q

What hormone regulates the release of GnRH from the hypothalamus?

A

Prolactin

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23
Q

What hormone regulates the release of GnRH from the hypothalamus?

A

Prolactin

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24
Q

What is the function of somatostain?

A

Decrease GH, decrease TSH and Decrease Glucagon

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25
Q

How does prolactin inhibit its own secretion?

A

It increases dopamine synthesis and secretion from the hypothalamus

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26
Q

Which hormone can lead to a increase in prolactin levels?

A

TRH (as seen in hypothyroidism)

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27
Q

What Tx is used for prolactinemia?

A

Bromocriptine (DA agonist)

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28
Q

How doe GH stimulate linear growth and muscle mass?

A

through IGF-1 secretion

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29
Q

Describe the release of GH? and GHRH?

A

Pulsatile!

Secretion is increased by exercise and sleep

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30
Q

What organ produces Ghrelin?

A

Stomach

It stimulates hunger

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31
Q

What tissue produces leptin?

A

Adipose tissue

Satiety hormone

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32
Q

Which hormone increases with sleep loss: leptin or ghrelin?

A

Ghrelin

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33
Q

Through which receptors does ADH regulate:

1- osmolarity
2- Blood pressure

A

Osmolarity–> V2 receptor

Blood pressure–> V1 receptor

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34
Q

Name a ADH analog?

A

Desmopressin

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35
Q

Order of enzymes in adrenals?

A 
Cholesterol desmolase--> 12
3--> 17
21
11
Aldosterone synthase
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36
Q

What type of hormone is increased in 17 alpha hydroxylase deficeicny?

A

Mineralcorticods (Aldosterone)

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37
Q

How do 17 alpha hydroxylase patients present?

A

ambguous genitalia (XY)

lack of secondary development (XX)

Salt wasting

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38
Q

What hormones are increased in both 21 hydroxylase and 11beta hydroxylase deficiency?

A

Androgens!

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39
Q

Which has an increased BP…21 hydroxylase and 11beta hydroxylase deficiency? Why?

A

11beta hydroxylase…due to increased 11 deoxycorticosterone

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40
Q

“presents in infancy with salt wasting or childhood with precocious puberty”

A

21 hydroxyase deficiency

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41
Q

How does cortisol increase BP?

A

Upregulates alpha 1 receptors on arterioles–> increased insitivity to NE and Epi

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42
Q

Why do striae form in excess cortisol?

A

decreased fibroblast activity

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43
Q

4 ways that cortisol is an antiinflammatory?

A

1- inhibit production of leukotrienes and prostaglandings

2- Blocks histamine release from mast cells

3- reduces eos

4- blocks IL-2

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44
Q

How does increase in pH affect Ca binding to albumin?

A

Increases Ca affinity for albumin–> Hypocalcemia

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45
Q

3 forms of plasma Ca2+ form?

A

Ionized (45%)

Bound to albumin (40%)

Bound to anions (15%)

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46
Q

4 factors that increase active vit D production?

A

Increased PTH

Decreased Ca2+

Decreased PO4

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47
Q

What cells produce PTH?

A

Chief cells of parathyroid

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48
Q

Where does PTH act in the kidney?

A

Distall tubule to increase Ca reab

In the PCT to decrease PO4 reabsorption

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49
Q

What hormone leads to increased 1 alpha hydroxylase activity in the kidney?

A

PTH…it works in the PCT

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50
Q

How does PTH increase bone resporption?

A

increase production of RANK-L (which then bonds RANK on osteoclasts

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51
Q

Does increased or decreased serum Mg2+ lead to increased PTH secretion?

A

decreased Mg2+ levels

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52
Q

What leads to increased calcitonin levels?

A

increased serum Ca2+

it works to decrease bone reab

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53
Q

Which endocrine hormone signal through cAMP?

FLAT ChAMP

A

FSH
LH
ACTH
TSH

CRH
hCG
ADH (v2)
MSH
PTH

calcitonin
GHRH
Glucagon

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54
Q

Endocrone hormone that act through cGMp? (3)

A

ANO, BNP, NO

55
Q

Endocrone hormones that work through IP3?

GOAT HAG

A

GnRH
Oxytocin
ADH (v1)
TRH

Histamine (H1)
Angiotensin II
Gastrin

56
Q

When endocrine hormones have an intracellular receptor?

VETTT CAP

A 
Vit D
Estrogen
Testosterone
T3
T4

Cortisol
Aldosterone
Progesterone

57
Q

Hormones that have receptors with intrinsic tyrosine kinase activity?

A 
Insulin
IGF-1
FGF
PDGF
EGF
58
Q

Hormones with receptor associated tyrosine kinase?

PIGG(L)ET

A 
Prolactin
Immunomodulators
GH
G-CSF
Erythropoietin
Thrombopoietin
59
Q

Hormones with receptor associated tyrosine kinase?

PIGG(L)ET

A 
Prolactin
Immunomodulators
GH
G-CSF
Erythropoietin
Thrombopoietin
60
Q

How does T3/ T4 increase CO/ HR/ SV?

A

By increasing beta 1 receptors in the heart

61
Q

What are the 4 functions of T3?

A

Brain maturation
Bone growth
Beta adrenergic effects
basal metaboic rate increase

62
Q

Functions of thyroid peroxidase?

A

oxidation and organification of iodide

Coupling of MIT and DIT

63
Q

Most common cause of cushing syndrome?

A

exogenous corticosteroids

64
Q

“ACTH secreting pituitary adenoma”

A

Cushing DISEASE

65
Q

Which will suppress high dose dexamethasone…Cushing disease or Ectopic ACTH?

A

Cushing disease

66
Q

“weakness, fatigue, orthostatic hypotension, muscle aches, weight loss GI disturbances, sugar and or salt cravings”

A

Adrenal insifficiency

67
Q

What is th metyrapone stimulation test used for?

A

Dx adrenal insufficiency

blocks last step in cortisol synthesis..so normal response is to decrease cortisol and increase ACTH

in adrenal insufficiency–> ACTH remains decreased

68
Q

Most common cause of primary chronic adrenal insufficiency?

A

autoimmunity

69
Q

How do you differentiate between primary and secondary adrenal insufficiency?

A

Hyperkalemia and Skin pigmentation in primary

70
Q

Histological finding of neuroblastoma?

A

Homer- Write Rosettes

71
Q

What is different in the presentation of neuroblastoma and Wilms tumor?

A

Neuroblastoma: firm, irregular mass that can cross the midline

Wilms tumor: smooth and unilateral

72
Q

Oncogene associated with neuroblastoma?

A

N-myc

73
Q

Rule of 10’s in pheochromytoma?

A 
10% malignant
10% bilateral
10% extra adrenal
10% calcify
10% kids
74
Q

4 conditions that pheochromocytoma is associated with?

A

NF-1
von Hippel- Lindau Diseae
MEN 2A/ 2B

75
Q

“increased HVA (DA product) and VMA (NE product) in urine”

A

Neuroblastoma

76
Q

“increased catecholamines and metanephrines in urine and plasma”

A

pheochromocytoma

77
Q

Myxedema types seen in hypothyroidism and hyperthyroidism?

A

Hypo–> facial and periorbital myxedema

Hyper–> predibial (Graves) and periorbital

78
Q

is hypercholesterolemia seen in hypo or hyperthyroidism?

A

hypothyroidism

79
Q

HLA type of Hashimoto thyroditis?

A

HLA- DR5

80
Q

3 histologic features of hashimoto?

A

Hurthle cells

Lymphoid aggregate

germinal centers

81
Q

What type of cancer is associated with hashimoto?

A

Marginal zone lymphoma

82
Q

“pot bellied. pale. puffy faced, protruding umbilicus, protuberant tongue, poor brain development”

A

cretinism (congenital hypothyroidism)

83
Q

“granulomatous inflammation of the thyroid, painful goiter”

A

Subacute thyroiditis (de Quervain)

84
Q

“fibrous tissue that replaces thyroid tissue, painless goiter”

A

Riedel thyroiditis

85
Q

“thyroid gland downregulation in reponse to increased iodide”

A

Wolf- Chaikoff effect

86
Q

“thyroid gland downregulation in reponse to increased iodide”

A

Wolf- Chaikoff effect

87
Q

Most common cause of hyperthyroidism?

A

Graves

88
Q

What is the cause of exophthalmos in Graves?

A

retroorbital fibroblast targeting

89
Q

What is the cause of pretibial myxedema in graves?

A

dermal fibroblast targeting

90
Q

Are malignant thyroid nodules hot or cold?

A

Generally cold

91
Q

“thyrotoxicosis that results if a patient with iodine deficiency is made iodine repeate”

A

Jod- Basedow phenomenon

92
Q

What nerve can be damaged in thyroid surgery?

A

recurrent laryngeal nerve (6th pharyngeal arch)

93
Q

Most common form of thyroid cancer?

A

papillary carcinoma

94
Q

Histologic finding in paillary thyroid cancer?

A

“orphan annie” cells and psammoma bodies

95
Q

Mutations associated with papillary carcinoma?

A

RET and BRAF gene mutations

96
Q

Thyroid cancer associated with sheets of amyloid stroma?

A

medullary carcinoma

97
Q

What type of thyroid cancer is seen in older patients?

A

undifferentiated/ anaplastic carcinoma

98
Q

What is Chvostek sign?

A

tapping of facial nerve leads to contraction of facial nerve

seen in hypoparathyroidisim

99
Q

What is trousseau sign?

A

Occlusion of brachial arteru with BP cuff leads to carpal spasm

100
Q

“unresponsiveness of kidney to PTH, hypocalcemia, shortened 4th/5th digits and short stature that is AD inherited”

A

Pseudohypoparathyroidism

101
Q

“defective Ca2+ sensing receptor on parathyroid cells”

A

Familial hypocalciuric hypercalcemia

102
Q

Symptoms of hyperparathyroidism?

A

Stones, bones, groans, psychiatric overtones

103
Q

Bone findings of primary hyperparathyroidism?

A

osteitis fibrosa cystica (cystic bone spaces filled with brown fibrous tissue–> brown tumor)

104
Q

Most common cause of secondary hyperparathyroidism?

A

chronic renal disease

105
Q

Vitamin D level in secondary hyperparathyroidism?

A

Decreased (because decreased action of 1 apha hydroxylase)

106
Q

Vitamin D level in secondary hyperparathyroidism?

A

Decreased (because decreased action of 1 apha hydroxylase)

107
Q

Tx for acromegaly and gigantism?

A

Octreotide (somatostatin analog)

pegvisomat (GH receptor antagonist)

108
Q

Serum osmolarity seen in diabetes insipidus?

A

> 290

109
Q

“hypernatremia with high serum osmolarity”

A

diabetes inspidus

110
Q

“euvolemic hyponatremic with coninued urinary Na+ exretion”

A

SIADH

111
Q

Why does hyponatremia develop in SIADH?

A

because body responds to ADH driven water retention by decreasing aldosterone to maintain near normal volume status

112
Q

What can occur if SIADH imbalances are corrected too quickly?

A

osmotic demyelination syndrome (AKA central pontine myelinolysis)

113
Q

“sdeen hemorrhage of pituitary gland, often in the presence of an existing pituitary adenoma”

A

pituitary apoplexy

114
Q

HLA type associated withT1DM?

A

HLA DR3/4

115
Q

Is the genetic predisposition to develop diabetes stronger in type 1 or type 2?

A

T2DM

116
Q

Describe insulin sensitivity in T1DM?

A

HIGH

117
Q

Histology of pancreas in T1DM?

A

Islet leukocytic infiltrate

118
Q

Histology of pancreas in T2DM?

A

Islet amyloid polypeptide deposits

119
Q

What are ketone bodies made of?

A

Fat (from increased lipolysis)

120
Q

“necrolytic megratory erythema, hyperglycemia, DVT, depression”

A

glucagonoma

121
Q

“necrolytic megratory erythema, hyperglycemia, DVT, depression”

A

glucagonoma

122
Q

When are symptoms of carcinoid syndrome seen?

A

if there are metastatic tumors… if it is limited to the GI tract then 5-HT undergoes 1st pass metabolism and does not exert effects

123
Q

“recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease”

A

Carcinoid syndrome

124
Q

Test used to diagnose zollinger- Ellison Syndrome?

A

secretin stimulation test–> gastrin levels remain elevated after administration of secretin (which normally inhibits gastrin release)

125
Q

Elevated hormone in zollinger Ellison?

A

Gastrin

126
Q

“achlorhydria, cholelithiasis with steatorrhea”

A

somatostatinoma–> inhibition of gastrin and CCK

127
Q

“watery diarrhea, hypokalemia and achlorhydria”

A

VIPomas

128
Q

“watery diarrhea, hypokalemia and achlorhydria”

A

VIPomas

129
Q

MEN 1?

A

Parathyroid tumor
Pituitary tumor
Pancreatic endocrine tumors

130
Q

Gene associated with MEN1?

A

MEN1 gene…Tumor suppressor gene

131
Q

Gene associated with MEN 2A/ 2B?

A

RET

132
Q

MEN 2A?

A

Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma
Marfinoid habitus

133
Q

MEN 2B?

A

Pheochromocytoma
Medullary thyroid carcinoma
Mucosal neuromas
Marfanoid habitus

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