Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Bud Notes > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

What histologic features distinguish a pituitary adenoma from normal pituitary gland?

A
  1. Cellular monomorphism

2. Absence of a significant reticulin network

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common cause of hyperpituitarism

A

Anterior lobe pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Characteristic mutation in pituitary adenomas

A

Mutation of the GNAS1 gene which results in constitutive activation of Gs protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common type of hyperfunctioning pituitary adenoma

A

Prolactinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of hyperprolactinemia

A 
Prolactinoma
Pregnancy
High dose estrogen
Renal failure
Hypothyroidism
Hypothalamic lesions
Dopamine inhibiting drugs (reserpine
Suprasellar mass (stalk effect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

This pituirary adenoma stain positively with PAS due to accumulation of this protein

A

Corticotroph cell adenoma

Glycosylated ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Many tumors previously classified as “null cell adenomas” were in fact ___.

A 
Gonadotroph adenomas
(These are essentially nonfunctioning tumors.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many % of pituitary adenomas are nonfunctioning?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hypofunctioning of the pituitary occurs with loss of ___% or more of the anterior pituitary parenchyma.

A

75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sheehan syndrome does NOT usually affect the posterior pituitary. Why?

A

The posterior pituitary receives its blood directly from arterial branches and are less susceptible to ischemic injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hypothalamic nuclei that send axons into the posterior pituitary

A

Paraventricular

Supraoptic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Are the actions of thyroid hormone catabolic or anabolic?

A

Both.
Catabolic due to upregulation of carbohydrate and lipid catabolism.
Anabolic due to stimulation of protein synthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of thyrotoxicosis but not hyperthyroidism

A

Subacute granulomatous thyroidits (painful)
Subacute lymphocytic thyroiditis (painless)
Struma ovarii
Factitious thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common cause of hypothyroidism in areas where iodine levels are sufficient

A

Hashimoto’s thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In Hashimoto’s thyroditis, is the thyroid gland enlarged or atrophic?

A

Both!

Usually it is diffusely and symmetrically enlarged; but it may be small in the fibrosing variant of this condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Middle aged woman comes in with painless enlargement of the thyroid with hypothyroid symptoms. This is most probably?

A

Hashimoto’s thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Patients with Hashimoto’s thyroiditis are at higher risk of developing this malignancy.

A

B cell non-Hodgkin lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Histology of thyroid gland reveals disruption of thyroid follicles with extravasation of colloid leading to a polymophonuclear infiltrate. Granulomatous reaction may be seen. What is the cause of this condiiton?

A

DeQuervain thyroiditis

Probably viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Postpartal woman comes in with painless mass and signs of thyrotoxicosis. What is this condition? Histologic features?

A

Subacute lymphocytic thyroiditis

Lymphocytic infiltration and hyperplastic germinal centers (This is an autoimmune condition like Hashimoto’s; absence of Hurthle cell changes and follicular atrophy differentiates this condition from Hashimoto’s.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common cause of endogenous hyperthyroidism

A

Grave’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HLA haplotypes associated with Grave’s disease

A

HLA-B8

HLA-DR3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Thyroid antibodies found in Grave’s disese

A
  1. Antibodies to the TSH receptor
  2. Antibodies to thyroglobulin
  3. Antibodies to thyroid peroxisomes

Antibodies to TSH-R include:

  1. Thyroid stimulating immunoglobulin (specific for Grave’s)
  2. Thyroid growth-stimulating Ig
  3. TSH-binding inhibitor Ig
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is there ophthalmopathy in Grave’s disease?

A
  1. Marked infiltration of the retro-orbital space by mononuclear cells
  2. Inflammatory edema of EOMs
  3. Accumulation of ECM components (GAGs)
  4. Fatty infiltration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Follicular cells are tall, columnar and crowded resulting in the formation of papillae projecting into the lumen; papillae lack fibrovascular cores (vs papillary CA).

A

Grave’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Endemic is used when goiters are present in more than >___% of the population.

A

10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Goitrogenic foods

A

Brassicaceae (cabbage, cauliflower, Brussel sprouts, turnips)
Excess calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does a colloid goiter form?

A

TSH induces hypertrophy and hyperplasia of thyroid follicular cells; causing crowded columnar cells which form projections. If the dietary iodine subsequently increases of it the demand for thyroid hormones decrease, the stimulated epithelium involutes to form an enlarged, colloid-rich gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Adenomas are characterized by which mutations.

A

Gain of function mutations in TSH receptor signaling pathways (a-subunit of Gs; or on the TSH-receptor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hallmark of all follicular adenoma

A

Presence of an intact well-formed capsule encircling the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does one differentiate follicular adenoma from MCAG?

A
  1. Well-defined intact capsule
  2. Single nodule
  3. Compression of adjacent thyroid parenchyma
  4. Papillary change NOT a typical feature (presence of papillary change should raise suspicion for CA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How many percent of cold nodules are malignant?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T/F. An excision biopsy is sufficient for a diagnosis of thyroid CA.

A

False!
The definitive diagnosis of thyroid adenoma can only be made after careful histologic examination of the resected specimen (check for capsular integrity.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q 
What is the cell of origin of the following types of thyroid Ca?
A. Papillary
B. Follicular
C. Medullary
D. Anaplastic
A

All derived from follicular epithelium, except for medullary which is derived from parafollicular or C cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q 
What genetic alterations are common in:
A. Papillary thyroid CA
B. Follicular
C. Medullary
D. Anaplastic
A

A. Formation of ret/PTC fusion genes which constitutively activate RET
B. RAS and PAX8-PPARY1 fusion
C. RET (but NOT via ret/PTC fusion)
D. p53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Thyroid CA Quiz!

Most common type after exposure to ionizing radiation

A

Papillary CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Thyroid CA Quiz!

T/F. The diagnosis of papillary CA requires demonstration of a papillary architecture.

A

False! Diagnosis is based on nuclear features.

Nuclei with very finely dispersed chromatin
“ground glass / Orphan Annie nuclei”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Thyroid CA Quiz!

Histology reveals tumor composed predominantly or exclusively of follicles. The nuclei of cells contain very finely dispersed chromatin; invaginations of the cytoplasm in cells lead to formation of “pseudoinclusions.”

A

Papillary!

Although growth pattern is follicular, what matters in the diagnosis is the nuclear features! What was describes was characteristic of papillary CA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Thyroid CA Quiz!

Concentrically calcified structures present within papillae with dense fibrovascular cores

A

Papillary

Psammoma bodies were described.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Thyroid CA Quiz!

Hematogenous spread is more common than lymphatic spread

A

Follicular CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Thyroid CA Quiz!

Histology reveals fairly uniform cells forming small follicles, reminiscent of normal thyroid.

A

Follicular CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Thyroid CA Quiz!

Medullary CA secrete this peptide

A

Calcitonin

also, somatostatin, serotonin, vasoactive intestinal peptide (may cause diarrhea)

42
Q

Thyroid CA Quiz!

How many % of medullary CA is associated with familial syndromes

A

20%

43
Q

Thyroid CA Quiz!

Necrotic and hemorrhagic mass. Polygonal to spindle-shaped cells forming nests, trabeculae and follicles. Acellular amyloid deposits present in adjacent stroma.

A

Medullary CA

44
Q

Thyroid CA Quiz!

What is one histologic feature of familial medullary thyroid CA that differentiates it from sporadic?

A

Multicentric C cell hyperplasia

45
Q

Thyroid CA Quiz!

Because of the propensity of medullary thyroid CA to secrete calcinotin, hypocalcemia is a common feature. T/F.

A

False!

46
Q

Thyroid CA Quiz!

Elderly patient with long-standing goiter notes rapid growth of the mass.

A

Anaplastic CA

47
Q

Thyroid CA Quiz!

T/F. In most cases, medullary CA causes death within one year due to distant metastasis.

A

False!

Metastases to distant sites are common, but in most cases death occurs in less than 1 year as a result of aggressive local growth and compromise of vital structures in the neck.

48
Q

How many % of thyroid nodules are neoplastic?

A

ONE

49
Q

Most common cause of primary hyperparathyroidism

A

Adenoma (75 - 80%)

Primary hyperplasia (10 - 15%)
Parathyroid carcinoma (<5%)
50
Q

Primary hyperparathyroidism is seen in:

A

MEN1

MEN2A

51
Q

Inactivating mutations in the Ca-sensing receptor on parathyroid cells leading to constitutive PTH secretion

A

Familial hypocalciuric hypercalcemia

52
Q

Two common genetic alterations in parathyroid adenoma

A
  1. PRAD1 (parathyroid adenoma gene 1) - overexpresses cyclin D1 in PTH gland
  2. MEN1 (tumor suppressor gene)
53
Q

T/F. Presence of bizarre and pleomorphic nuclei in parathyroid samples clinch a diagnosis of parathyroid CA.

A

False. These are common even in adenomas. Mitotic figures are rare in the latter.

54
Q

Only 2 valid criteria for malignancy of parathyroid glands

A
  1. Metastatic dissemination

2. Invasion of surrounding structures

55
Q

Which of the parathyroid pathologies affect a single gland only? which affects >1 gland?

A

Parathyroid adenoma and Ca affect only a single gland.

Parathyroid hyperplasia affects > 1 gland.

56
Q

MOST COMMON CAUSE OF:

  1. Clinically silent hypercalcemia
  2. Clinically apparent hypercalcemia in adults
A
  1. Primary hyperparathyroidism

2. Malignancy

57
Q

Most common cause of secondary hyperparathyroidism

A

Renal failure

58
Q

Neurologic features of hypocalcemia

A

Increased ICP

Seizures

59
Q

Drugs which can cause DM

A

Glucocorticoids
Thyroid hormone
B-agonists

60
Q

Infections associated with DM

A

CMV

Coxsackie B

61
Q

Genetic syndromes associated with DM

A

Down syndrome
Klinefelter syndrome
Turner syndrome

62
Q

Amino acids which stimulate insulin release but not its synthesis

A

Arginine

Leucine

63
Q

Clinical features of thyroid nodules that increase likelihood that the lesion is neoplastic

A
  1. Solitary
  2. Young patients
  3. Males
  4. History of radiation treatment
  5. Hot nodules more commonly benign than malignant
64
Q

Principal susceptibility locus for type 1 DM resides in the region that encodes ___

A 
Class II MHC molecules
Chromosome 6p21 (HLA-D)
65
Q

Risk of developing DM in the population at large

A

5 - 7%

66
Q

Best predictor for subsequent progression to diabetes

A

Insulin resistance

67
Q

Name three adipocytokines.

Which contributes to insulin sensitivity? which contributes to insulin resistance?

A

Leptin
Adiponectin
Resistin

RESISTIN = RESISTANCE;
The other two are good guys and increase insulin sensitivity.

68
Q

How do TZDs (hypoglycemic agents) work?

A

They act on the nuclear receptor and transcription factor PPAR-Y highly expressed in adipocytes.

  1. Modulate expression of adipocytokines with the net effect of decreasing insulin resistance
  2. Decreases concentration of FFAs
69
Q

How does DM accelerate atherosclerosis?

A

AGE formation on collagen causes cross-links between polypeptides which may trap plasma proteins. In large vessels, LDL is trapped retarding its efflux from the vessel wall and enhances deposition in the intima.

70
Q

How does DM cause nephropathy?

A

Basement membrane is glycated; binding plasma proteins such as albumin; causing basement membrane thickening.

71
Q

De novo synthesis of this ___ from glycolytic intermediates is stimulated by intracellular hyperglycemia in DM.

A

Diacylglycerol. This then leads to activation of DAG signal transduction pathway leading to production of:

  1. Pro-angiogenic proteins (VEGF in neovascularization of DM retinopathy)
  2. Pro-fibrogenic molecules (TGF-B)
72
Q

These tissues are insulin-independent in their intracellular uptake of glucose.

A

Nerves
Lens
Kidneys
Blood vessels

73
Q

Most common form of monogenic DM is characterized by a mutation in:

A

HNF-1a (MODY3)

74
Q

Most common cause of death in DM

A

MI caused by atherosclerosis of coronary artries

75
Q

Special pattern of acute pyelonephritis more prevalent in diabetics

A

Necrotizing papillitis

76
Q

Most common of the pancreatic endocrine neoplasms

A

Insulinoma

77
Q

Boundaries of the gastrinoma triangle

A
  1. Junction of cystic and common bile ducts
  2. Junction of the 2nd and 3rd parts of the duodenum
  3. Junction of the neck and body of the pancreas
78
Q

Syndrome consisting of mild diabetes mellitus, necrolytic migratory erythema, and anemia

A

Glucagonoma

79
Q

Diabetes mellitus, cholelithiasis, steatorrhea, and hypochloridia

A

Somatostatinoma

80
Q

Watery diarrhea, hypokalemia, achlorydia, or WDHA syndrome

A

VIPoma

81
Q

Biochemical sine qua non of adrenal Cushing syndrome is:

A

Elevated cortisol

Low ACTH

82
Q

Tumor most commonly causing ectopic ACTH secretion

A

Small cell lung CA

Other (carcinoid tumor, medullary CA, islet cell tumors of the pancreas)

83
Q

Eosinophilic, laminated cytoplasmic inclusions in cells of the adrenal gland, suggests intake of this drug.

A

Spironolactone

84
Q

Treatment of choice for primary adrenal hyperplasia

A

Medical management with spironolactone. Adrenalectomy no very beenficial

85
Q

The adrenal cortex secretes the two adrenal hormones.

A
  1. Dehydroepiandrosterone

2. Androstenedione

86
Q

Most common congenital adrenal hyperplasia

A

21-hydroxylase deficiency (encoded by CYP21B gene)

87
Q

Patients with congenital adrenal hyperplasia are given:

A

Glucocorticoids

  1. Provide adequate glucocorticoid levels
  2. Suppress ACTH levels
88
Q

Waterhouse-Friderichsen syndrome is seen in septicemia with ___.

A

Neisseria meningitidis
Pseudomonas sp
Streptococcus pneumoniae
Haemophilus influenzae

89
Q

Most common cause of primary adrenal insufficiency in developed counties

A

Autoimmune adrenalitis

90
Q

Disseminated infections with these two fungi result in chronic adrenocortical insufficiency.

A
  1. Histoplasma capsulatum

2. Coccidioides immitis

91
Q

Causes of adrenal insufficiency in AIDS patients

A
  1. CMV
  2. MAC
  3. Kaposi sarcoma
92
Q

Most metastatic cancers to the adrenals arise from the:

A

Lung

Breast

93
Q

How does one differentiate Addison disease from secondary adrenocortical insufficiency?

A

With secondary disease (parathyroid does not secrete ACTH), there is no hyperpigmentation because melanotropic hormone levels are low.

94
Q

Two rare causes of adrenal cortical carcinoma

A

Li-Fraumeni

Beckwith-Wiedemann

95
Q

Rule of 10s in pheochromocytoma

A

10% associated with familial syndromes
10% bilateral
10% malignant
10% extra-adrenal

96
Q

Pheochromocytomas may occur outside of the medulla in these two sites; in these sites, they are called paragangliomas

A

Organ of Zuckerkandl

Carotid body

97
Q

Definitive diagnosis of malignancy in pheochromocytomas is based exclusively on:

A

Presence of mets. Both capsular, vascular invasion, mitotic figures may be present in benign pheochromocytoma.

98
Q

MEN1 is characterized by lesions in the:

A

3 P’s
Parathyroid (hyperplasia)
Pancreas (endocrine tumors, e.g. gastrinoma)
Pituitary (most frequently, prolactinoma)

99
Q

Which MEN is AR? AD?

What are the underlying genetic abnormalities

A

MEN1: AR. MEN2: AD.
MEN1: MEN1 gene, tumor suppressor (11q13)
MEN2: RET, protooncogene (10q11.2)

100
Q

Involvement of these two organs is seen in both subtypes of MEN2.

A

Thyroid: Medullary CA

Adrenal medulla: 50% with pheochromocytomas

101
Q

Which is unique to MEN2A? MEN2B?

A

MEN2A: Parathyroid gland hyperplasia
MEN2B: Extraendocrine manifestations
(ganglioneuromas of mucosal sites, marfanoid habitus)

Bud Notes (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions