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Step 1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

where does the thyroid originate?

what is it derived from

A

pharynx floor

endoderm

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2
Q

remnant of thyroglossal duct

A

foramen cecum

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3
Q

ectopic thyroid tissue

A

tongue

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4
Q

what are the parafollicular cells of the thyroid derived from?

A

neural crest cells

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5
Q

zona glomerulosa
zona fasciculate
zona reticularis
medulla

A

aldosterone
cortisol
sex hormones
catecholamines

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6
Q

posterior pituitary

A

ADH, oxytocin

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7
Q

pituitary derivatives

A

anterior - oral ectoderm

posterior - neuroectoderm

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8
Q

alpha subunit in anterior pituitary

A

subunit common to TSH, LH, FSH, hCG

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9
Q

beta subunit in anterior pituitary

A

determines hormone specificity

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10
Q

POMC –>

A

ACTH + MSH

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11
Q

acidophilic anterior pituitary release

A

GH, PRL

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12
Q

islets of langerhans cells and function

A

a - glucagon
b - insulin
d - somatostatin

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13
Q

where is insulin precursor synthesised?

A

RER

preproinsulin

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14
Q

high insulin low C-peptide

A

exogenous insulin

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15
Q

effects of insulin

A

triglyceride synthesis (+decrease lipolysis)
Na retention
protein synthesis
increase K+ and a.a. uptake

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16
Q 
GLUT
1
2
3
4
5
A

RBC, brain, cornea, placenta
b islet cells, liver, kidney, small intestine
brain, placenta
adipose, striated muscle - insulin dependent
fructose - spermatocytes, GI tract - insulin dependent

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17
Q

better to injest glucose

A

bigger insulin release because GLP-1 is released after meals

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18
Q

glucagon inhibition

A

insulin, hyperglycaemia, somatostatin

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19
Q

somatostatin affect on pituitary

A

decreases GH and TSH

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20
Q

TRH effect on pituitary

A

TSH and prolactin stimulation

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21
Q

Dopamine effect on the pituitary

A

decreases prolactin and TSH

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22
Q

CRH effect on pituitary

A

increases ACTH, MSH, B-endorphin

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23
Q

how does prolactin inhibit itself?

A

increases dopamine

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24
Q

prolactinoma Rx

A

dopamine agonist - bromocriptine

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25
Q

prolactin stimulation

A

dopamine antagonists - antipsychotics

estrogens

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26
Q

GH stimulates

A

IGF-1

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27
Q

when does GH stimulation increase?

A

exercise, deep sleep, puberty, hypoglycaemia

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28
Q

Rx xs GH secretion

A

somatostatin analogs - octreotide

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29
Q

what is GH stimulated by?

A

ghrelin

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30
Q

V1 and V2 receptors

A

1 - serum osm

2 - bp

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31
Q

nephrogenic DI mutation

A

V2 receptor

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32
Q

Rx central DI

A

desmopressin acetate (ADH analog)

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33
Q

17-a hydroxylase

A

pregnenolone/progesterone –>17-hydroxy version

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34
Q

17-a-hydroxylase defeciency

A

more aldosterione, decreased others

raised bp, low K+

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35
Q

decerased androstenedione

A

17a-hydroxylase deficiency

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36
Q

ambiguous genitalia, undescended testes

female version

A

17a-hydroxylase deficiency

lacks secondary sexual development

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37
Q

21-hydroxylase deficiency

A

decreased Aldosterone and cortisone, increased sex hormones

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38
Q

high renin and 17-hydroxy-progesterone

A

21-hydroxylase deficiency

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39
Q

salt wasting, precocious puberty

A

21-hydroxylase deficiency

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40
Q

11-B hydroxylase deficiency

A

increased aldosterone, cortisol
increased sex hormones, bp
decreased renin

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41
Q

what causes striae

A

fibroblast activity increase

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42
Q

cortisol decrease in immune response

A 
inhibits leukotrienes and prostaglandins
inhibits WBC adhesion --> neutrophilia
blocks histamine release form mast cells
reduces eosinophils
blocks IL-2 production
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43
Q

raised pH and calcium

A

higher affinity to albumin –> hypocalcemia

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44
Q

vitamin D2

D3

A

2 - plants, fungi, yeast

3 - sunlight, fish, plants

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45
Q

vitamin D on PTH

A

increases PTH

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46
Q

PTH effects

A

increases Ca reabsorption
increases vitamin D3 production
PO4 from bone, PO4 lost in kidney

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47
Q

How does PTH affect bone?

A

increases RANK-L

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48
Q

raised PO4 on PTH

A

increases PTH

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49
Q

Mg effect on PTH

A

low - raises PTH

very low - decreases PTH

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50
Q

Calcitonin action

A

decreases Ca

opposes PTH

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51
Q

T3 function

A

brain maturation, bone growth, B adrenergic, Basal metabolic rate increase

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52
Q

changes is TBG leevls

A

decreased in hepatic failure, steroid use

increased in pregnancy or OCP use (E increases TBG)

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53
Q

Grave’s disease

A

thyroid stimulating immunoglobulin

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54
Q

wolff-chaikoff effect

A

XS iodine temporarily inhibits thyroid peroxidase decreasing T3/4 production

55
Q

propylthiouracil inhibits

A

thyroid peroxidase + 5’-deiodinase

56
Q

methimazole inhibits, use, s.e

A

thyroid peroxidase
hyperthyroid
rash, agranulocytosis, aplastic anaemia, hepatotoxicity, tetarogenic

57
Q 
function thyroid peroxidase
5'-deiodinase
A

helps thyroid globulin bind T3

releases T3 from thyroid globulin

58
Q

hormones using cGMP

A

BNP, ANP, EDRF (NO)

vasodilators

59
Q

hormones using IP3

A

GnRH, Oxytocin, ADH, TRH, Histamine, Angiotensin II, Gastrin

HAG GOAT

60
Q

intracellular hormone receptors

A

adrenal hormones, T3/4, vitamin D

61
Q

non receptor tyrosine kinase hormones

A

prolactin, immunomodulators, GH, G-CSF, Erythropoeitin, thrombopoeitin
PIGGlET

62
Q

metformin class, mechanism

s.e.

A

biguanides
decreases GNG, increases glycolysis, increases peripheral glucose uptake
weight loss, lactic acidosis

63
Q

1st gen sulfonureas, mechanism, s.e

A

-amide
closes K channel in B cells, increases inc=sulin release
hypoglycaemia, weight gain, disulfiram like effects

64
Q

2nd gen sulfonureas, s.e

A

glimepiride, glipizide, glyburide

hypoglycaemia

65
Q

pioglitazone mechanis, s.e

A

increases insulin sensitivity binds PPAR-y

weight gain, edema, hepatotoxicity, HF, fracture risk

66
Q

meglitinides, mechanism, s.e

A

-glinide, stimulates insulin release

hypoglycaemia, weight gain

67
Q

GLP-1 analogs, mechanism, s.e

A

exenatide, liraglutide (sc)
increases insulin release, decreases gluon release, decreases gastric emptying
nausea/vomiting, pancreatitis, weight loss

68
Q

DPP-4 inhibitors, mechanism, s.e

A

-gliptin, deactivates GLP-1

urinary/resp infections

69
Q

pramlintide

A

amylin analog, SC injection, decreases gastric emptying and glucagon
hypoglycaemia, nausea

70
Q

SGLT-2 inhibitors

A

-gliflozin, blocks glucose reabsorption in kidney, UTI, vaginal yeast infection, hyperkalaemia, dehydration, hOtn

71
Q

acarbose, miglitol

A

a-glucosidase inhibitors
inhibit brush border and glucose absorption
GI disturbance

72
Q

levothyroxine s.e.

A

tachy, heat intolerance, tremors, arrhythmia

73
Q

ADH antagonists e.g, use

A

-vaptan,demelocycline, SIADH

74
Q

GH used for

A

Turner’s

75
Q

octreotide use

A

acromegaly, carcinoid, gastrinoma, glucagonoma, eosophageal varicies

76
Q

fludrocortisone

A

aldosterone analog

77
Q

inhibits NF-kb

A

glucocorticoids

78
Q

cinacalcet use, s.e.

A

hyperparathyroidism, hypocalcemia

sensitises Ca receptors in parathyroid

79
Q

cushing disease

A

ACTH secreting pituitary adenoma

80
Q

weak, tired, muscle aches, weight loss

A

adrenal insufficiency

81
Q

metyrapone stimulation test, does, for

A

blocks cortisol synthesis, adrenal insufficiency

82
Q

skin pigmentation, hypotension, hyperkalaemia

A

adrenal insufficiency

83
Q

causes of Addison’s

A

autoimmune, TB

84
Q

Waterhouse-Freidrichsen syndrome

A

acute primary adrenal insufficiency due to adrenal hemorrhage from septicemia with n.meningitidis, DIC or endotoxic shock

85
Q

difference between primary and secondary adrenal insufficiency

A

2nd - no skin pigmentation or hyperkalaemia

86
Q

Conn syndrome

A

primary hyperaldosteronism

87
Q

Kulchitsky cells

A

neuroendocrine tumours

88
Q

uptake APUD

A

kulchitsky cells

89
Q

adrenal tumour in children

A

neuroblastoma

90
Q

dancing eyes, dancing feet

A

neuroblastoma in children

91
Q

HVA and VMA in urine

A

neuroblastoma

92
Q

Homer-Wright rosettes

A

neuroblastoma, medulloblastima

93
Q

phaeochromocytoma cells, derivative

A

chromaffin cells, neural crest

94
Q

Rule of 10s phaeochromocytoma

A

10%…

malignant, bilateral, extra-adrenal, calcify, kids

95
Q

phaeochromocytoma Rx

A

a-antagonists, B blockers after

phenoxybenzamine

96
Q

thyroid myopathy

A

both - weakness

raised CK in hypothyroidism

97
Q

hashimoto’s causes

A

hypothyroidism

may start hyperthyroid

98
Q

pot-belly, puffy face, protuberant tongue, poor brain development

A

cretinism

congenital hypothyroidism

99
Q

tender thyroid, post flu like illness, hyper–> hypothyroid

A

de Quervians

subacute granulomatous thyroiditis

100
Q

hypersensitivity thyroid

A

Graves - IgG type II

101
Q

scalloped colloid, crowded folicular epithelial cells

A

Grave’s disease

102
Q

thyroid storm

A

hyperthyroid not treated properly, stress then makes situation much worse

103
Q

Jod-Basedown

A

iodine deficient –> hyperthyroid when given iodine

Opposite of Wolff-Chairkoff

104
Q

empty nuclei with central clearing, psammoma bodies, nuclear grooves

A

papillary carcinoma

105
Q

RAS mutation, uniform follicles invading capsule

A

follicular carinoma

106
Q

RET + BRAS

A

papillary

107
Q

RET

A

medullary

MEN 2

108
Q

sheets of cells in amyloid stroma

A

medullary carcinoma

109
Q

pseudohypoparathyroidism type 1A

A

kidney unresponsive to PTH

albright hereditary osteodystropy

110
Q

short 4th and 5th digits

A

pseudohypoparathyroidism type 1A

111
Q

cause pseudohypoparathyroidism type 1A

A

Gs protien a subunit defect

imprinted from mother

112
Q

pseudohypoparathyroidism NOT type 1A

A

no end organ PTH resistance

defective Gs a1 subunit from father

113
Q

defective Ca sensing R

A

familial hypocalciuric hypercalcemia

114
Q

difference between primary and secondary hyperparathyroidism

A

1 - hypercalcemia

2 - hypocalcemia

115
Q

where does pituitary adenoma come from?

A

lactotrophs

116
Q

Nelson syndrome

A

enlargement of ACTH secreting pituitary adenoma after bilateral adrenalectomy for refractory Cushing disease

117
Q

test for acromegaly

A

GH doesn;t decrease following oral glucose tolerance test

118
Q

causes of nephrogenic DI

A

ADH R mutation, secondary to hypercalcemia, hypokalaemia, lithium, demelocycline

119
Q

Rx nephrogenic DI

A

HCTZ, indomethacin, amiloride

120
Q

hyponatermia with Na in urine

A

SIADH

121
Q

kimmelsteil-wilson nodules

A

nodular glomerulosclerosis

122
Q

diabetes progressive proteinuria give

A

ACE inhibitors

123
Q

fasting plasma glucose, 2 hours glucose tolerance

A

126

200

124
Q

complication on DKA

A

mucormycosis (Rhizopus), cerebral edema, arrhythmia, HF

125
Q

dermatitis, diabetes, DVT, declining weight, depression

A

glucagonoma

126
Q

whipple triad

A

low blood glucose, symptoms of hypoglycemia, resolution after normalised glucose levels

127
Q

diabetes, glucose intolerance, steatorrhoea, gallstones

A

somatostatinoma

128
Q

carcinoid secretes

A

5-HT

129
Q

5-HIAA in urine, niacin deficiency

A

carcinoid syndrome

130
Q

xollinger-ellison syndrome

A

gastrin secretin tumour

131
Q

MEN 1

A

Pituitary, Parathyroid, Pancreas

132
Q

MEN 2A

A

Parathyroid, Pheochromocytoma, medullary thyroid carcinoma

133
Q

MEN 2B

A

pheochromocytoma, medullary thyroid carcinoma, mucosal neuroma, marfinoid
P MMM

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