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USMLE Step 1 > Endocrine Path > Flashcards

Endocrine Path Flashcards

1
Q

Pseudohyperaldosteronism

A
  • Licorice (inhibits 11-beta-HSD type II)

- Liddle’s syndrome (increase Na and decrease K)

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2
Q

Secondary Hyperaldosteronism causes

A 
Fibromuscular dysplasia (young women)
Atherosclerosis (men)
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3
Q

Hyperaldosteronism doesnt show hypernatremia or edema b/c…

A

Aldosterone escape via ANP

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4
Q

Addison’s disease causes

A
  • Autoimmune (developed countries)
  • TB (developing countries)
  • Malignancy (esp lung)
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5
Q

Tertiary adrenal insufficiency cause

A

Exogenous steroid use and immediate withdraw

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6
Q

Decrease glucocorticoids on insulin requirements

A

Decreased

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7
Q

Neuroblastoma

A
  • Homer-Wright rosettes
  • anywhere on sympathetic chain
  • firm, irregular mass, crosses midline
  • Opsoclonus-myoclonus syndrome (“dancing-eyes-dancing feet”)
  • HVA, VMA
  • Bombesin and neuron-specific enolase +ve
  • Over-express N-myc oncogene
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8
Q

Pheochromocytoma rule of 10

A

10% - malignant, bilateral, extra-adrenal, calcify, kids

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9
Q

Pheochromocytoma associated conditions

A

neurofibromatosis type 1, von Hippel-Lindau disease, MEN 2A and 2B

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10
Q

Pheochromocytoma Rx

A

Phenoxybenzamine ..THEN… B-blocker prior to ressection

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11
Q

Hypothyroid heart effect

A

Mucopolysaccharides deposited b/t fibers causing cardiomyopathy and low voltage EKG

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12
Q

Cholesterol levels in hyper-/hypothyroidism

A

Hyperthyroidism - increased LDL receptor (hypocholesterolemia)
Hypothyroidism - decreased LDL receptor (hypercholesterolemia)

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13
Q

Pretibial myxedema

A

Graves disease

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14
Q

Hashimoto thyroiditis

A
  • anti-thyroid peroxidase (anti-microsomal), anti-thyroglobulin
  • Risk: non-Hodgkin lymphoma (marginal/B-cell)
  • Hurthle Cells
  • Non-tender
  • germinal centers
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15
Q

Congenital hypothyroidism (cretinism)

A

The 6 P’s (also short w/ coarse facial features)

  • Pot-bellied
  • Pale
  • Puffy-faced child
  • Protruding umbilicus
  • Protuberant tongue
  • Poor brain development
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16
Q

Subacute granulomatous thyroiditis (de Quervain)

A
  • High ESR, jaw pain, TENDER thyroid

- often post viral

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17
Q

Riedel thyroiditis

A
  • Fibrous replacement of thyroid
  • manifestation of IgG4-related systemic disease (autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis)
  • fixed, hard (rock-like) painless goiter
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18
Q

Lithium on thyroid

A

hypothyroidism

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19
Q

Graves Rx

A

B-blockers, Thiomide (blocks peroxidase), Radioiodine ablation

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20
Q

Toxic multinodular

A

Focal patches of hyperfunctioning follicular cells working independently of TSH d/t receptor mutation

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21
Q

Thyroid storm: COD, Lab, Rx

A
  • tachyarrhythmia
  • increased ALP
  • 3 P’s: Propanolol, Propylthiouracil, Prednisolone
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22
Q

Jod-Basedow phenomenon

A

thyrotoxicosis if a patient w/ iodine deficiency goiter is made iodine replete

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23
Q

Myoedema

A

found w/ hypothyroid myopathy and d/t slow resorption of Ca by SR (causes focal mounding of muscle following percussion) - also has increased CK

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24
Q

Non-toxic multinodular goiter

A
  • d/t relative iodine def

- euthyroid

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25
Q

Hyperthyroidism OGTT

A

rapid rise and rapid fall

26
Q

Papillary carcinoma (thyroid)

A
  • Orphan annie eye nucleus (central clearing)
  • psammoma bodies
  • nuclear grooves
  • Risk w/ RET and BRAF mutations or childhood radiation
  • Lymphatic invasion common
27
Q

Follicular carcinoma vs follicular adenoma

A
  • Invasion of capsule

- FNA doesnt distinguish!! (no biopsy b/c high blood supply)

28
Q

Spread of follicular carcinoma

A

hematogenous

29
Q

Medullary carcinoma

A
  • amyloid stroma (calcitonin)
  • associated with MEN2A, 2B (RET)
  • hypocalcemia
30
Q

Undifferentiated/anaplastic carcinoma vs Reidel thyroiditis

A

old vs. young

31
Q

Lymphoma of thyroid?

A

Hashimoto’s

32
Q

Albright hereditary osteodystrophy

A

Pseudohypoparathyroidism

  • unresponsiveness of kidney to PTH
  • shortened 4th/5th digits, short stature
  • Gs prot mutation (GNAS1) - AD
  • Diagnose w/ PTH –> no increase in urinary cAMP or PO4
  • Cafe-late spots, endocrine abnorm (precocious puberty)
33
Q

Familial hypocalciuric hypercalcemia

A
  • Defective CaSR on parathyroid cells

- mild hypercalcemia w/ normal/increased PTH

34
Q

Factitious hypercalcemia

A

Hypergammablobinemia (increased Ca binding)

35
Q

QT interval: hyercalcemia/hypocalcemia

A 
shortened QT (hyper)
prolonged QT (hypo)
36
Q

Primary hyperparathyroism

A

Stones, Bones, Groans and psychiatric overtones

37
Q

Cystic bone spaces filled with brown fibrous tissue (deposited hemosiderin from hemmorages)

A

Osteitis fibrosa cystica

38
Q

Bone lesions from 2 * or 3* hyperparathyroidism due to renal disease

A

Renal osteodystrophy

39
Q

Pituitary apoplexy

A

hemmorage into preexisting pituitary adenoma

40
Q

Acromegaly Rx (alt. to surgery)

A

Octreotide (somatostatin analog)

Pegvisomant (GH-R antagonist)

41
Q

urine specific gravity of DI

42
Q

Hyperosmotic volume contraction

A

DI or proffuse sweating

43
Q

Nephrogenic DI causes

A

Hereditary, hypercalcemia, lithium, demeclocycline (ADH antagonist)

44
Q

Nephrogenic DI Rx

A

Hydrochlorothiazide
indomethacin - PG’s inhibit vassopressin action on kidney
amiloride
hydration

45
Q

SIADH

A
  • euvolemic hyponatremia with continued Na excretion (d/t decreased aldosterone levels)
  • urine osmolarity > plasma
  • cerebral edema and seizures
46
Q

SIADH Rx

A
  • Fluid restriction
  • IV hypertonic saline
  • Conivapton
  • Tolvaptan
  • Demeclocycline
47
Q

Most common COD in diabetics

48
Q

Requirements for sorbitol accumulation

A
  • Aldose reductase and decreased/absent sorbitol dehydrogenase
  • Schwann cells, retina, kidneys, lens
49
Q

DKA K+ status

A

Hyperkalemia but decreased total body stores

50
Q

Best glucose test for diabetes

A

1 - FBG

2 - GTT (for Gestational or cystic fibrosis related diabetes or those with Sx but normal FBG)

51
Q

Glucagonoma

A
  • Dermatitis (necrolytic migratory erythema)
  • Diabetes
  • DVT
  • Depression
52
Q

Somogyi effect

A

rebound hyperglycemia d/t counter reg hormones in response to hypoglycemia

53
Q

Whipple triad

A

low blood glucose, hypoglycemia Sx’s, improvement with glucose
- seen in Insulinoma

54
Q

Carcinoid rule of 1/3’s

A

1/3 metastasize
1/3 present w/ 2nd malignancy
1/3 are multiple
(most common malignancy of small intestine)

55
Q

Positive secretin stimulation test?

  • associations?
  • hints?
A

Zollinger-Ellison syndrome (gastrinoma) = gastrin levels remain raised

  • MEN1
  • Distal (eg. jeujenal ulcers)
56
Q

Somatostatinoma

A
  • Achlorhydria (inhibits gastrin)

- Cholelithiasis and steatorrhea (inhibits CCK)

57
Q

VIPoma

A 
WDHA synd (watery diarrhea, hypokalemia, achlorhydria)
- Rx. somatostatin
58
Q

MEN1 (AD)

A

Pituitary (prolactin, GH)
Parathyroid
Pancreatic endocrine tumors (ZE, insulinoma, VIPoma, glucagonoma)
[MEN1 gene - menin=tumor supressor]

59
Q

MEN2A (AD)

A

Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma (calcitonin)
[RET gene - receptor tyrosine kinase]

60
Q

MEN2B (AD)

A 
Pheochromocytoma 
Medullary thyroid carcinoma
Oral/intestinal ganglioneuromatosis (mucosal neuromas)
[RET gene - receptor tyrosine kinase]
marfanoid habitus

USMLE Step 1 (26 decks)

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