Endocrinology 4 Flashcards

1
Q

Types of Ectopic hormone secretion

  1. SCLC of lung produces?
  2. Squamous lung produces?
  3. HCC produces?
  4. choriocarcinoma/hydatidform mole/testes
  5. Breast cancer
A
  1. SCLC of lung = SIADH ( low Na)
    SCLC of lung = ACTH ( low K)
  2. Squamous cancer of lung = PTH ( hypercalcemia)
  3. HCC = EPA ( Polycythemia)
    HCC = Insulin growth factor ( low BGL)
  4. Choriocarcinoma/hydatidform mole/testes = TSH
  5. Breast cancer = GNRH ( gynecomastia/galatorrhoea)
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2
Q

Schmidt syndrome - what is it?

A

T1DM a/w adrenal insufficiency/autoimmune Thyroid!

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3
Q

White adipocytes - what is it?

Brown adipocytes - what is it?

A

White =Normal adipose tissue

Brown
Uncoupling protein (UCP1) + Iron mitochondria
-convert fat into heat

-found in paravetebral/supraclavicular region

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4
Q

MEN4 - what gene mutation and features?

A

CDNK1B

-Anterior pituitary + Parathyroid tumours

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5
Q

Pagets’ mutation - SQSTM1 causes what?

A

Prevents p62 to bind to ubiquitin

SO RANKL have freedom! and activates osteoclast

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6
Q

Diabetic gastroparesis

  • what causes autonomic neuropathy?
  • what causes enteric neuropathy?
  • what causes iatrogenic neuropathy?
A

Autonomic neuropathy - vagal nerve problem

Enteric neuropathy - Loss Interstitial cells of Cajal!= delay gastric emptying

iatrogenic neuropathy - GLP1-agonist drug = blocks vagal nerve

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7
Q

How does high glucose causes diabetic gastroparesis?

A

Pyloric muscle contractions but antral hypomotility due to acute hyperglycemic state

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8
Q

When do you start thiazides for Diabetes insipidus?

A

Once urine volume > 4L/day

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9
Q

Work up for Pheochromocytoma?

there are 4 lines of work-up

A

1st line = Plasma metanephrine

2nd line = 24 hours urine fractionated catecholamines/metanephrines

3rd line = MRI - hyperintense tumor

4th line = MIBG scan ( metadobenzylguanidine) - resembles norepinephrine taken up by pheochromocytoma

*Use 4th line esp. if CT/MRI can’t detect or multiple tumors

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10
Q

Highest specificity test for pheo?

Lowest accuracy test for pheo?

A

Urinary EPInephrine

Plasma catecholamines

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11
Q

what side effect strongly a/w Dapagliflozin?

A

UTI!!

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12
Q

Majority of thyroid carcinoma - driver mutation comes from what pathway?

A

MAPK pathway

Commonest - BRAF V600E mutations! RAS 2nd

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13
Q

Transgender people
aim hormone estradiol and testosterone at what level?

When is GnRH analogues used?

A

Estradiol - 300 - 600
Testosterone < 0.2

GnRH analogues only in adolescents as puberty blocker

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14
Q

Bariatric surgery

-What mineral deficiency likely with Roux-en-Y bypass and Biliopancreatic diversion?

A

RYGB and BPD = Zinc deficiency

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15
Q

Types of bariatric surgery

Restrictive?
Malabsorption?
Mixed

A

Restrictive = Gastric sleeve/banding

Malabsoprtion = BPD - biliopancreaticodiversion

Mixed - Roux-En-Y bypass

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16
Q

According to Tirads score for thyroid nodules
when suspicious of malignancy?

when to FNA biopsy?

A
Micro-calcifications
Taller than wide
Hypo-echoic
Solid
Irregular/lobulated margin

High suspicious : > 1 cm
Moderate suspicion : > 1.5 cm
Low suspicious : > 2 - 2.5cm

17
Q
PCOS has 4 phenotypes
Which type;
No hyperandrogenism?
No oligomenorrhea?
No PCOS on ultrasound?
Has all features of PCOS - HOPE mneumonic
A

No hyperandrogenism = D phenotype
No oligomenorrhea = C phenotype
No PCOS on US = B phenotype
All features = A phenotype

18
Q

When adrenal tumor is carcinoma - based on contrast washout?

A

< 50% washout in 10 minutes

Tumor hungry - ABSORB contrast

19
Q

FRAX parameters?

FRAS mnemonic

A
Fracture/Fracture in parents
Femoral Neck BMD
RA
Age/Weight/Height etc
Steroids usage/Smoking/Drinking > 3 SD per day
20
Q

High index suspicion of Pheochromocytoma - what test?

IF CT/MRI doesn’t show pheo but still suspect- do what test?

A

Plasma metanephrines - more sensitive and specific

MIBG (metaiodobenzylguanidine) scintigraphy - form of compound like epinephrine which will be taken up by pheochromocytoma

21
Q

AME pathogenesis ( apparent mineralocorticoid excess)?

A

cortisol > aldosterone bcoz deficient of 11-B-HSD2,
So high cortisol, high aldosterone!

11B-HSD2 converts cortisol into cortisone ( inactive form)

22
Q

Liddle syndrome pathogenesis?

A

ENAC mutation - so keep reabsorbing Na ( resistant to degradation by aldosterone)

23
Q

Liquorice pathogenesis?

A

Liquorice inhibits 11B-HSD2

24
Q

Glucocorticoid-remediable aldosteronism (GRA) pathogenesis?

A

11 Beta hydroxlase mutation - so Cortisol and Aldosterone controlled by ACTH

Tx - steroids to suppress ACTH - so reduce aldosterone and cortisol production