Endocrine (U.W.)

Question 1

what nerve runs with the superior thyroid A? What does it supply

Answer 1

External Br of Superior Laryngeal N

Cricothyroid

Question 2

list the cells that originate from NCC

Answer 2

MOTEL PASS
melanocytes
Odontoblasts
tracheal cartilage
enterochromaffin cells 
laryngeal cartilage 
parafollicular cells of thyoid 
adrenal medulla and all ganglia 
schwann 
spiral membrane

Question 3

central ADH is most likely due to damage of which stucture?

Answer 3

HYPOTHALAMUS (SVN, PVN)
(note post pit injury may cause transeint Central DI but not permanent bc its just a storage and release spot, the hypothalamus can undergo wallerian regen and get its ADH out there again)

Question 4

how does estrogen affect thyroid levels

Answer 4

it increases TBG levels.. less free thyroid hormone will feed back to pituitary and increase TSH which will increase thyroid hormone production. All in all, TOTAL thyroid hormone will increase but FREE thyroid hormone will stay normal

Question 5

anosmia + hypogonadism

Answer 5

Kallman’s

Question 6

how does insulin allow for glycogen synthesis?

Answer 6

through the tyrosin kinase pathway, through PIP3 which activates PROTEIN PHOSPHATASE and this activates GLYCOGEN SYNTHASE

Question 7

whats needed for the cell to shift to gluconeogenesis

Answer 7

It must get Pyruvate (usually from Alanine) and this Pyruvate must undergo Pyruvate Carboxylase to go towards Gluconeogenesis ( not pyruvate dehydrogenase which is in glycolysis) for pyruvate carboxylase to happen, there needs to be INCREASED acetyl COa

Question 8

Sheehan Syndrome

Answer 8

Panhypopituitarism (low prolactin, low TSH etc) post delivery of baby.Cause: ischemia
during pregnancy pituitary undergoes hypertrophy. During birthing if there is hemorrhage, the blood supply may not be enough for pituitary

Question 9

thyroid imbalance following viral infection with painful thyroid to palpation

Answer 9

deQuervain’s aka subacute granulomatous

note while this is hypothyroid, there can be transient hyperthyroid

Question 10

electrolyte results of primary adrenal insufficiency

Answer 10

hyponatremia
hyperkalemia
hyperchloremia
non-anion gap metabolic acidosis

Question 11

what diabetes medication has high risk of hypoglycemia? why?

Answer 11

Sulfyureas (espcially long acting ones like Glyburide) because of their ability to close K+ channels independent to glucose concentration, causing insulin release from B cell independent of glucose level

Question 12

how do glucocorticoids,glucagon, tnfalpha, etc cause insulin resistance

Answer 12

they phosphorylate the intracellular ser or threonine of membrane tyrosine receptor (insulin receptor) blocking insulin’s downstream effects

Question 13

HAART can cause which undesired side effect physically?

Answer 13

lipdystrophy
thinning of arms and legs
fat on central

Question 14

in a normal metyrapone test what is likely to be seen?

Answer 14

increase in ACTH
increase in 11 OHcortisol
increase in urinary 17 hydroxycorticosteroid levels

Question 15

what enzyme is necessary to use glycerol to make glucose

Answer 15

glycerol kinase

Question 16

why would a pituitary resection affect epineprhine levels???

Answer 16

The final step of Epinephrine synthesis is NE–> Epi via PNMT in adrenal medulla. PNMT requires cortisol to be active. If pituitary is resected, ACTH is low and thus cortisol is low

Question 17

what reaction makes DOPA

Answer 17

Tyrosine Hydroxylase with THB as cofactor

Question 18

which thyroid cancer: nest/sheet of polygonal cells derviced from parafollicular C cells? Stains for Congo Red

Answer 18

Medullary Thyroid Ca

Question 19

Kleinfelter’s, what going on with LH/FSH?

Answer 19

Kleinfelters XXY, cause of long extremeties, gynecomastia and small testes. Problem is destruction of the Leydig and Sertoli Cells. These cells are no longer able to make T and sperm respectively. Lack of neg feedback leads to elevated LH and FSH

Question 20

mononuclear infiltrate, dense with lymphocytes making follicular centers, Hurthle cells might be seen

Answer 20

Hashimoto’s

Question 21

what amino acids are best for a pt with PDH def?

Answer 21

Lysine and Leucine. They are both AA that are only ketogenic, not glucogenic. So there is no chance they will go down the glycolysis pathway and encounter the defective PDH

Question 22

corticosteroid reduce levels of all types of WBC except one type? which one and why?

Answer 22

corticosteroid actually INCREASE neutrophil count in the blood. This is because it causes the neutrophils to detatch from blood vessel walls reducing its ability to fight an infection

Question 23

how does the sympathetic nervous system affect insulin release?

Answer 23

alpha 2- inhibits insulin release
beta 2- stimulates insulin release
note that alpha 2 predominates, so when epinephrine binds although it binds to both, inhibition overrides

Question 24

vol status of SAIDH pt? why

Answer 24

EUvolemic

even though Na+ levels are low, compensatory increase in natureitic peptides and decrease in RAAS keeps euvolemia

Question 25

Conn’s syndrome electrolytes?

Answer 25

Na+ - normal, would expect to be high but ALDOSTERONE escape
K+ - low
HCO3- - increased b/c H+ is being excreted more, HCO3- is being reabsorbed more due to exchanger (H+/HCO3- exchanger)
H+- low, aldosterone increase H+ excretion (met alk)

Question 26

which GI drug leads to hypertriglyceridemia?

Answer 26

Bile Acid binding resins (chloestyramine)

Question 27

which enzyme is needed to make glycerol go to gluconeogenesis after fat breakdown

Answer 27

glycerol kinase

Question 28

Familial Hypocalcuric Hypercalcemia

Answer 28

AD disorder of Ca sensing receptors in parathyroid. This increases the setpoint, HIGHER Ca2+ levels are required to stop PTH production. So even at moderately high Ca2+ levels, PTH will be increased. Note the CaSR is a transmembrane G-coupled metabotropic

Question 29

impaired beta oxidation what might be responsible?

Answer 29

defect in Acyl CoA dehydrogenase

defect in carnitine transport

Question 30

thiamine is needed for?

Answer 30

pyruvate dehydrogenase
alpha ketoglutarate dehydrogenase
transketolase

Question 31

pyruvate –> OAA what is the cofactor?

Answer 31

biotin

Question 32

Leuprolide

Answer 32

GnRH analog

Question 33

which thyroid cancer: large cells, overlapping nuclei, fine and sparse chromatin, ground glass appearance, grooves in nucleus

Answer 33

Papillary Carcinoma (thyroid)

Question 34

how do adipocytes respond to insulin resistance?

Answer 34

with insulin resistance, lipolysis occurs more (remember, insulin inhibited lipolysis). this causes an increase in FFA, which WORSENS insulin resistance by increasing hepatic gluconeogenesis (even high blood sugars) and impairing glucose transport into cells

Question 35

symptoms of Niacin deficiency+ neutral AA in urine?

Answer 35

Hartnup Disease

Question 36

what does PPP do?

Answer 36

(1) make bases
(2) generate NADPH which is needed for
(a) glutathione- RBC stability
(b) bioSYNTHESIS of fats and cholesterols

Question 37

maturity onset diabetes in the young (ex: gestational) is caused by?

Answer 37

mutations in glucokinase

which is to do glycolysis in the pancreatic B cells producing insulin

Question 38

what happens to a fetus that has a hyperglycemic mom

Answer 38

B cells hypertrophy (note insulin does not cross the placenta)

Question 39

in alcoholism and DKA how are ketone ratios different than normal

Answer 39

normally- acetoacetate and 3-hydroxybutyrate are somewhat equal. In DKA and alcoholism, there is way more 3-hydroxybutyrate than acetoacetate due to high NADH levels

Question 40

Hashimoto’s has what unexplained clinical abnormality

Answer 40

amenorrhea