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USMLE S1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

granulomatous inflammation of tender thyroid what disease?

A

Subacute (de Quervain’s) granulomatous thyroiditis

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2
Q

bone path 2ary to hyperPTH?

A

osteitis fibrosa cystica -resporption of bone leading to fibrosis and cystic spaces

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3
Q

3 disease associated with phaeochromocytoma

A
  1. MEN 2A/B
  2. VHL disease
  3. NF type 1
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4
Q

what boney cell type does PTH activate?

A

osteoblasts - which then themselves activate osteoclasts and secrete Alk Phos

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5
Q

head trauma precipitating central DI

what is the difference in lesion to hypothalamus and posterior pituitary?

A

hypothalamus - permanent loss of ADHergic neurons, permanent disease

posterior pit - ADHergic neruons will regenerate after some time and disease will remit

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6
Q

what is the receptor implicated in familial hypocalciuric hypercalaemia?

A

GPCR - calcium-sensing receptor (CaSR)

Ca binding CaSR inhibits PTH release

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7
Q

‘scalloping’ of colloid suggests what?

A

graves disease

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8
Q

what is the treatment for post-thyroidectomy hypoPTH?

A

calcitriol

not calcidiol because it requires conversion under control of PTH

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9
Q

what arrhythmia occurs with hyperT4?

A

atrial fib esp in elderly

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10
Q

epidemiology of Reidel fibrosing thyroiditis

A

young female

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11
Q

Rx graves disease

A
  1. beta-blockers 2. thioamide 3. radioiodine ablation
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12
Q

how does cortisol affect the immune system?

A

inhibits phospholipase A2

inhibits IL-2

inhibits mast cell degranulation

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13
Q

what thyroid neoplasm?

A

Follicular adenoma

benign proliferation of follicles surrounded by fibrous capsule

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14
Q

in CAH with 17 hydroxylase deficiency, what hormones are not made?

A

cortisol and sex steroids

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15
Q

natural history of de Quervain thyroiditis?

A

self-limiting rarely (15%) progress to hypothyroidism

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16
Q

metabolic effects of hyperT4?

A

hypocholesterolaemia hyperglycaemia

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17
Q

what is the mechanism and side effects of biguanides?

A

metformin

binds to AMPK to decrease glucose production and insulin resistance

lactic acidosis - so contraindicated in renal insufficiency

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18
Q

chronic inflammation and extensive fibrosis of the thyroid on biopsy what disease?

A

Reidel fibrosing thyroiditis

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19
Q

what is sevelamer?

A

phosphate-binding polymer that reduces absorption of phosphate in the GI tract

used for hyperphosphataemia in CKD

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20
Q

anterior neck mass of thyroid origin?

A

thyroglossal duct cyst

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21
Q

symptoms of phaeochromocytoma? (5)

A

headaches, episodic HTN, palpitations, tachycardia and diaphoresis

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22
Q

phaeochromocytoma rule of 10 (4)

A
  1. 10% extramedullary
  2. 10% malignant
  3. 10% familial
  4. 10% bilateral
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23
Q

what is the major side effect of GLP-1 analogues?

A

pancreatitis

modest weight loss :)

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24
Q

follicular adeoma malignant or benign?

A

benign

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25
Q

common metformin toxicity?

A

lactic acidosis

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26
Q

what is the mechanism for fibrate drugs?

A

fenofibrate, gemfibrozil

activating PPAR-alpha, increases lipoprotein lipase

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27
Q

Rx cushing syndrome

A

surgical resection if tumour

medical - ketokonazole or metyrapone

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28
Q

how does cortisol impact blood pressure?

A

cortisol increases expression of alpha1-adrenoceptors, which are vasoconstrictive

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29
Q

in CAH with 11 hydroxylase deficiency, what hormones are not made?

A

strong mineralocorticoids and cortisol

so you get clitoral enlargement/precocious puberty but HTN with hypokalaemia.

low renin and aldosterone (b/c pregnenolone being shunted to DHEA and DOC)

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30
Q

‘hard as wood’, nontender thyroid suggests what disease?

A

Reidel fibrosing thyroiditis

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31
Q

thyroid biopsy shows chronic inflammation with formation of germinal centres

A

hashimoto thyroiditis

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32
Q

MEN1 neoplasms

A

pancreatic endocrine tumour

parathyroid hyperplasia

pituitary adenoma

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33
Q

which thyroid CA?

A

anaplastic CA

very undifferentiated tumour not really making any structures

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34
Q

1 common and 2 uncommon causes of primary hyperPTH

A

parathyroid adenoma

sporadic parathyroid hyperplasia and parathyroid carcinoma

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35
Q

decreased glucose

increased insulin

increased c-peptide

what pathology?

A

insulinoma

always check for MEN1!

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36
Q

two aetiologies of nephrogenic DI

A

inherited mutations drugs - lithium, demeclocycline (antibiotic)

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37
Q

arrhythmia, hyperthermia, vomiting and hypovolaemic shock … diagnosis?

A

thyroid storm

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38
Q

symptoms of cholinergic crisis?

A
  • salivation
  • lacrimation
  • urination
  • defactation

(SLUD)

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39
Q

what is Winter formula?

when is it used?

A

PaCO2 = (1.5 * HCO3-) + 8 +/- 2

expected compensatory range for PaCO2 in metabolic acidosis

in DKA is PaCO2 is above the range this indicates a degree of respiratory failure (pulmonary oedema, respiratoy fatigue or decreased GCS)

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40
Q

perioral tingling, muscle spasm, Trousseu and Chvostek signs … eventually seizures.

lab findings?

causes? (4)

A
  1. hypocalcaemia

causes - damage to parathyroids (iatrogenic/autoimmune), tumour lysis syndrome, severe vitamin D deficiency, sepsis

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41
Q

mental retardation, short stature, coarse facial features, umbilical hernia, enlarged tongue diagnosis?

A

cretinism

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42
Q

what is the side effect of PTU?

A

agranulocytosis

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43
Q

how to tell the difference between ACTH from pit adenoma or paraneoplastic ACTH?

A

dex suppression test - will reduce ACTH from pit adenoma but not from paraneoplastic source

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44
Q

three layers of adrenal cortex

A

glomerulosa, fasiculata, reticularis

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45
Q

watery diarrhoea

hypokalaemia

achlorhydria

what pathology?

A

VIPoma

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46
Q

what are the classes of antihyperlipidaemic drugs and how do they work?

A
  1. statins - HMG-CoA reducase inhibitor. stop hepatic synthesis of cholesterol
  2. ezetemibe - block intestinal absorption through NPC1L1 transporter, increase hepatic cholesterol production, decease serum LDL
  3. Niacin, fish oil, fibrates - block hepatic production of triglycerides and conversion of VLDL to LDL
  4. PCSK1 inhibitor - block internalisation of LDL receptor, increasing hepatic clearance of LDL
  5. bile acid-binding resins - induce bile acid wasting, increase hepatic comsuption of cholesterol in regeneration of bile acids, decrease serum LDL
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47
Q

what is cinacalcet? indication?

A

‘calcimimetic’ - activates Ca-sensing receptor in parathyroids, decreasing PTH

indicated in 2ary hypercalcaemia (CKD)

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48
Q

walk through - CRF leading to secondary hyperPTH and renal osteodystrophy

A

renal failure, unable to excrete phosphate

increase serum Pi binds free Ca2+

decrease Ca++ stimulates PTH (all four glands)

PTH stimulates boney resorption

Lab findings: ++ PTH, - Ca2+, ++ Alk Phos, ++ Pi

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49
Q

what thyroid neoplasm with ionizing radiation during childhood?

A

papillary carcinoma

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50
Q

prognosis of papillary CA?

A

excellent

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51
Q

serum glucose definition in HONC?

why are ketones absent?

A

>500 mg/dL

small amount of circulating insulin prevents ketogenesis

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52
Q

what changes in FBC when starting steroids?

A

neutrophilia

neutrophil demargination from lung vasculature

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53
Q

increased urine cAMP suggests what pathology?

A

hyperPTH

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54
Q

what thyroid CA? what feature helps distinguish this?

A

medullary CA

local deposition of amyloid (malignant cells in amyloid stroma)

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55
Q

what muscle and nerve can be damaged in thyroidectomy (caudal end)

A

muscles - intrinsic muscles of the larynx, except cricothyroid

nerve - recurrent laryngeal

R laryngeal runs in close proximity to inferior thyroid artery, which must be ligated in total thyroidectomy

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56
Q

what drugs can lead to SIADH (3)?

A

carbamazepine

cyclophosphamide

SSRIs

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57
Q

Rx SIADH?

A

water restriction demeclocycline (blocks effect of ADH)

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58
Q

four thyroid neoplasms?

A
  1. papillary
  2. anaplastic
  3. medullary
  4. follicular
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59
Q

decrease 131-I uptake suggests…

A

adenoma or carcinoma warrants FNA biopsy

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60
Q

association with long standing hashimoto’s & enlarged glad

A

marginal zone B cell lymphoma

61
Q

somatostatin secreted from what cells in the pancreas?

A

delta cells

inhibit the release of GH, secretin, CCK, glucagon (-),

insulin (—-) and gastrin

–> more likely hyperglycaemia

62
Q

what are the different adrenoceptors found on pancreatic beta cells and what are their actions?

A

alpha 2 - inhibits insulin secretion

beta 2 - promotes insulin secretion

overall, adrenaline physiologically will act more on alpha2 and cause supression of insulin release

63
Q

alchlorhydria

cholelithiasis and streatorrhoea

what pathology?

A

somatostatinoma

64
Q

roughly what should be the steady state maximum urine osmolality achieved during a water deprivation test?

A

500 - 520 mOsm/L

65
Q

what is the main side effect fo DPP4 inhibitors?

A

DPP4 = enzyme that breaks down endogenous GLP-1

nasopharyngitis

66
Q

catecholamines, glucagon and glucocorticoids induce insulin resistance by what mechanism?

A

serine and threonine phosphorylation of both IR and IRS-1

67
Q

what is the role of neurophysin?

A

produced in the hypothalamus to facilitate transport of ADH and oxytocin to the neurohypophysis

68
Q

overall action of aldosterone on the collecting ducts

what is the electrolyte imbalance in hyperaldosteronism? resulting symptoms?

A

to resorb Na+ in exchange for K+ and H+

hypokalaemic alkalosis

hypertension, parasthesia and muscle weakness

69
Q

features of Kallman syndrome (3)

pathogenesis

associated mutation (2)

A

delayed puberty (central hypogonadism), anosmia, clef lip/palate

failure of GnRH-stimulating neurons to migrate from origin in olfactory placode

KAL-1 or FGFR-1

70
Q

diagnosis of GH adenoma?

A

elevated GH and IGF-1 lack of GH supression with OGTT

71
Q

considerations of methimazole (carbimazole) in hyperthyroidism (3)

A
  1. teratogenic
  2. cholestasis
  3. agranulocytosis (neutrophils <500 cells/microL)
72
Q

most common thyroid carcinoma

A

papillary (80%)

73
Q

what CA goes to adrenals?

74
Q

Rx central DI

A

recombinant AVP

75
Q

craniopharygnioma is a tumour arising from what?

who gets them?

A

remnant of the Rathke pouch

children (presents between 5 - 10 years old)

76
Q

RET oncogene suggests what disease?

presence indicates what management?

A

MEN2A or MEN2B

prophylactic thyroidectomy

77
Q

what must be monitored in SGLT-2 therapy?

A

kidney function (BUN and creatinine)

78
Q

TSH-independent hyperthyroidism suggests what?

A

multinodular goitre (‘toxic’) from secondary iodine deficiency, though usually euthyroid

79
Q

how are these sulfonylureas different?

glipizide, glyburide, glimepiride

A

glimepiride & glyburide are longer acting (more hypo’s)

glipizide = shorter acting with fewer hypo’s

80
Q

which anti-androgen supresses testosterone secretion from Leydig cells?

A

ketoconazole

81
Q

what is eflornothine? what is it used for and how dose it work?

A

ornithine decarboxylase inhibitor

facial hair removal

ornithine decarboxylase functions as a DNA mismatch repair enzyme. inhibition = decreased cell growth and increase apoptosis. topical application kills hair follicles

82
Q

elevated calcitonin suggests what CA?

what lab finding will you have?

A

medullary thyroid CA

hypocalcaemia

83
Q

Rx for phaeochromocytoma?

A

surgical excision

but must include medical management

  1. phenoxybenzamine (irreversible alpha-blocker)
    * followed by*
  2. beta-blocker
84
Q

associated HLA types with diabetes mellitus type 1

A

HLA-DR3

HLA-DR4

85
Q

what is the mechanism of sulfonylureas and meglitinides?

glipizide, glyburide, glimepirilide

nateglinide, repaglinide

side effects?

A

insulin secretogogues - inihibits beta cell K+ channels, resulting in insulin secretion

hypoglyaemia and weight gain

86
Q

low Ca with high PTH suggests what pathology?

A

pseudohypoparathyroidism

PTH is being appropriately secreted in the absence of Ca++ but there is an autocomal dominant mutation in the PTH-R (a Gs GPCR).

87
Q

what is the major endocrine side effects of amiodarone?

A

amIODarone is 40% iodine by weight

so both hypo-/hyper-thyroidism

check serum TSH for preexisting thyroid disease

88
Q

antimicrosomal antibodies suggest what disease?

A

hashimoto thyroiditis

89
Q

pathogenesis of sheehan syndrome?

A

pituitary doubles in size during pregnancy but the blood supply does not change. if woman loses blood intrapartum will infarct the pituitary gland

90
Q

treatment of GH adenoma?

A

ocreotide (somatostatin analog) GH receptor antagonist surgical removal

91
Q

pathogenesis of sheehan syndrome?

A

pituitary doubles in size during pregnancy but the blood supply does not change. if woman loses blood intrapartum will infarct the pituitary gland

92
Q

what is the boney structure that holds the pituitary gland?

A

sella turcica

93
Q

what is ezetemibe?

A

inhibitor of Niemann-Pick C1-like 1 transporter protein (NPC1L1)

inhibits transport of dietary cholesterol from the GI lumen into intestinal enterocytes

lower dietary choesterol to liver reduces intrahepatocyte concentration, so LDL receptor is upregulated in order to pull cholesterol out of circulation.

94
Q

hypopituitarism - causes (4)?

A
  1. pit adenoma (adults) 2. craniopharyngioma (children) 3. sheenhan syndrome 4. empty sella syndrome (1ary - herniation of arachnoid & CSF into sella , 2ary to trauma)
95
Q

what is the effect of oestrogen on thyroid hormones?

A

oestrogen (pregnancy, OCP, menopause Rx) increases the circulating levels of thyroxine-binding globulin (TBG)

normal HPT axis increases total T3/4 levels to saturate increasing TBG

free T3/4 remains normal (euthyroid) but total levels increase

96
Q

what is the most common cause of male hypogonadism?

A

Klinefelter syndrome (47 XXY)

sertoli and leydig cell dysfunction. low testosterone and low inhibit. high gonadotrophs (LH & FHS). subsequently high aromatase, so high oestrogen

gynaecomastia, testicular atrophy, infertility, intelectual disability.

97
Q

hypotension, hyperpigmentation, low Na+, high K+, N&V…

what disease? aetiologies (4)?

A

adrenal insufficiency

can be acute (WF syndrome) or chronic (autoimmune, TB, metastatic spread)

98
Q

how does hyperthyroidism increase sympathetic nervous system activity?

A

increases beta1-adrenoceptor expression

99
Q

acne, elevated haematocrit, testicular atrophy, aggressivity, gynaecomastia

suggests what?

A

androgen steroid abuse

100
Q

how are newborns screened for CAH?

A

serum 17-hydroyxprogesterone

101
Q

central diabetes insipidus - diagnosis

A

water deprivation test urine osmolality does not increase

102
Q

how to tell the difference between anaplastic thyroid CA and Reidel fibrosing thyroiditis if they both involve the airways?

A

epidemiology anaplastic thyroid CA for old people and Reidel for young women

103
Q

how does hyperthyroidism increase basal metabolic rate?

A

global upregulation of Na+-K+ ATPase

104
Q

what enzyme mediates lens damage in hyperglycaemia?

A

aldose reductase

converts glucose to sorbitol

105
Q

association of growth hormone adenoma?

A

secondary diabetes GH stimulates gluconeogenesis and decreases glucose uptake into cells

106
Q

MEN2A neoplasms

A

medullary carcinoma

pheochromocytoma

parathyroid adenoma

107
Q

cell signalling of glucagon in the liver

A

activate Gs, AC, cAMP, PKA –> gluconeogeneis (pyruvate carboxylase, PEP carboxykinase) and glycolysis (glycogen phosphorylase), inhibit glycolysis (decreasing fructose 2,6-bisphosphate)

108
Q

enlarged tongue and deepening of the voice… what’s happening?

A

myxedema of the soft tissue classic in hypothyroidism of older children and adults

109
Q

galactorrhoea, amennorhoea

A

prolactinoma

…woman breast feeding

110
Q

what is the mechanism of aciton of canagliflozin/dapagliflozin?

main side effects and considerations?

A

inhibit tubular reabsorption of glucose

glucosuria, UTIs - volume depletion and hypotension

must monitor renal function before and during drug treatment

111
Q

4 causes of cushing syndrome

A
  1. iatrogenic (bilateral atrophy)
  2. primary adrenal adenoma, hyperplasia, carcinoma (cushing disease, unilateral)
  3. ACTH-secreting pit adenoma (bilateral hyperplasia)
  4. paraneoplastic ACTH (bilateral hyperplasia)
112
Q

in CAH with 21 hydroxylase, what hormones are not made?

A

any mineralocorticoids and cortisol

113
Q

sheenhan syndrome presentation?

A
  1. poor lactation 2. loss of pubic hair (dependent on androgens, dependent on LH) 3. fatigue
114
Q

what is the mechanism of action of TZDs/glitazones?

A

piloglitazone/rosiglitazone

mechanism = binds PPAR-gamma to increase insulin sensitivity

s/e = weight gain, oedema, heart failure, increase # risk

115
Q

brown tumour of adrenal?

A

pheochromocytoma

116
Q

what cells secrete PTH?

A

chief cells of parathyroid gland

117
Q

SIADH serum Na+ and serum osmolality?

A

Na+ - low osmolality - low

118
Q

MEN2B neoplasms

A

medullary carcinoma

pheochromocytoma

ganglioneuroma of oral mucosa

Marfanoid habitus

119
Q

headache and episodic hypertension associated with urination…

what pathology?

A

phaeochromocytoma found in the bladder wall rather than adrenal medulla

120
Q

what class of drugs are cholestyramine, colestipol and colesevelam?

mechanism

side effects

A

bile acid-binding resins

bind bile in intestine, inhibit enterohepatic circulation –> bile acid wasting
intrahepatic cholesterol needed to synthesis new bile acid, increase LDL receptor recycling, decrease serum LDL

s/e’s: GI upset, malabsroption, hypertriglycerideamia

121
Q

symptoms of male prolactinoma?

A

decreased libido and headache

122
Q

route of metastatic spread for follicular thyroid carcinoma?

A

haematogenous

Four Carcinoma Route Haematogenously

(follicular, choriocarcinoma, RCC, HCC)

123
Q

what muscle and nerve can be damaged during thyroidectomy (cranial end)

A

muscle - cricothyroid (increases voice pitch)

nerve - external superior largyngeal

124
Q

differentials for low bone density (5)

A

vitamin D deficiency

primary hyperPTH

prolactinoma

cushing syndrome

hyperthyroidism

125
Q

monozygtic twin concordance studies show genetic correlation between T1DM and T2DM to be what percentages?

A

50% and 80% respectively

126
Q

symptoms on non-functioning pit adenoma

A
  1. bilateral hemianopsia
  2. headache
  3. hypopituitarism
127
Q

diabetes diagnosis

fasting blood sugar

random blood glucose

GTT (2 hours after load)

A

fasting >126 mg/dL

random >200 mg/dL

glucose tolerance test >200 mg/dL

128
Q

antithyrogolbulin antibodies suggest what disease?

A

hashimoto thyroiditis

129
Q

nephrolithiasis in hypercalcaemia - what stone?

A

calcium oxalate

130
Q

what thyroid neoplasm?

2x pathoG findings here?

A

papillary CA

  1. psammoma body (concentric layers of calcification)
  2. orphan annie eye nuclei
131
Q

considerations of PTU therapy in hyperthyroidism (3)

A
  1. hepatotoxic
  2. ANCA-vasculitis
  3. agranulocytosis (neutrophils <500 cells/microL
132
Q

hypotension, adrenal hyperplasia, salt wasting (hyperkalaemia, hyponatraemia)

precocious puberty, clitoral enlargement

what disease?

A

CAH - 21-hydroxylase deficiency

133
Q

mechanism of action for PTU

A

inhibits thyroid peroxidase

134
Q

base of tongue mass of thyroid origin called?

A

lingual thyroid

135
Q

which thyroid CA has poorest outcome

A

anaplastic - extensive local invasion leading to dysphagia and resp distress

136
Q

HLA subtype associated with hashimoto thyroidis

137
Q

pathology?

A

type 2 diabetes mellitus

deposition of amyloid (hyalinisation) of islets

138
Q

what is the difference between follicular adenoma and carcinoma?

A

invasion of the follicles through the fibrous capsule.

139
Q

central DI serum Na+ serum osmolality urine osmolality

A

serum Na+ - high serum osmolality - high urine osmolality - low

140
Q

eosinophilic metaplasia of cells that line the follicles on thyroid biopsy suggests what disease? what are these cells called?

A

hashimoto thyroiditis Hurthle cells

141
Q

how does metyrapone work in Cushing’s?

A

inhibition of 11beta-hydroxylase, blocking production of cortisol from 11-deoxycortisol

142
Q

4 aetiology of SIADH

A
  1. paraneoplasitc (Small cell lung CA) 2. head trauma 3. pulmonary infection 4. drugs
143
Q

what is the mechaism of action of acarbose or miglitol?

class of drug? main side effects?

A

inihibits intestinal absorbtion of disaccherides

alpha-glucosidase inhibitors

diarrhoea and flatulence

144
Q

causes of cretinism? (4)

A
  1. maternal hypothyroidism in early pregnancy 2. thyroid agenesis 3. thyroid peroxidase deficiency 4. iodine deficiency
145
Q

what cell type is proliferating in medullary thyroid carcinoma?

A

parafollicular C cells

146
Q

Rx thyroid storm

A

beta-blockers, steroids, propylthiouracil

147
Q

examples of dopamine agonist?

A

bromocriptine, cabergoline suppress prolactinoma

148
Q

coalescing painful erythematous plaques, GI symptoms, diabetes.

what pathology?

A

glucagonoma

149
Q

what medications activate PPAR-gamma?

what are the main side effects?

A

TZDs/glitazones

rosiglitazone, piloglitazone

weight gain and oedema; HF; increased risk of fractures

USMLE S1 (16 decks)

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