HY Arrows Flashcards
Patient has high aldosterone. What are the arrows for serum Na+, K+, pH, bicarb, and CO2?
↑ Na+
↓ K+
↑ pH
↑ Bicarb
↑ CO2
Aldosterone upregulates the ___ on the basolateral membrane of the cortical collecting duct in the kidney.
Na-K ATPase pump
Aldosterone upregulation causes Na+ __(secretion/reabsorption) and K+ __(secretion/reabsorption).
Reabsorption; Secretion
Decreased aldosterone would mean which metabolic state?
Normal anion gap metabolic acidosis with respiratory compensation
Patient is given Lisinopril. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels?
↑ Renin
↑ Angiotensin I
↓ Angiotensin II
↓ Aldosterone
↑ K+
Patient is given Valsartan. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels??
↑ Renin
↑ Angiotensin I
↑ Angiotensin II
↓ Aldosterone
↑ K+
Patient is given Spironolactone. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels?
↑ Renin
↑ Angiotensin I
↑ Angiotensin II
↑ Aldosterone
↑ K+
Spironolactone MOA?
Aldosterone receptor antagonist
Which drug is anti-androgenic and can cause gynecomastia?
Spironolactone
If a patient is given enalapril, what will happen to left ventricular afterload, systemic
arteriolar diameter, renal afferent arteriolar diameter, and renal efferent arteriolar diameter?
↓ LV afterload
↑ Systemic arteriolar diameter
⟷ Afferent diameter
↑ Efferent diameter
What does AT II do?
1) Increases aldosterone synthase activity in the zona
glomerulosa of the adrenal cortex
2) Constricts peripheral arterioles
32F + abdominal bruit + BP of 160/100. Diagnosis?
Fibromuscular Dysplasia (Tunica media proliferation)
32F + abdominal bruit + BP of 160/100. What are the arrows for Na+, K+, pH, bicarb, and CO2?
↑ Na+
↓ K+
↑ pH
↑ Bicarb
↑ CO2
74M + hyperpigmentation of the forearms + eosinophils 23% + 6-month Hx of fatigue + BP 100/60. Diagnosis?
Addison’s disease (Primary hypoadrenalism)
Etiology behind Addison’s disease?
Autoantibodies against 21-hydroxylase in the adrenal cortex.
74M + hyperpigmentation of the forearms + eosinophils 23% + 6-month Hx of fatigue + BP 100/60. What are the arrows for Na+, K+, pH, bicarb, CO2, aldosterone, and ACTH?
↓ Na+
↑ K+
↓ pH
↓ Bicarb
↓ CO2
↓ Aldosterone
↑ ACTH
___ is common in adrenal insufficiency.
Eosinophilia
Low aldosterone =
Less sodium reabsorption
Less potassium and proton secretion
39F + 20-year-Hx of rheumatoid arthritis managed with NSAIDs, prednisone, methotrexate, and infliximab. She has Cushingoid appearance. What are the arrows for her ACTH and cortisol levels?
↓ ACTH
↓ Cortisol
13M + three days ago treated for meningococcal septicemia + now has BP of 80/50. Diagnosis?
Waterhouse-Friderichsen syndrome (Hemorrhagic necrosis of the adrenal glands
secondary to meningococcal septicemia)
13M + three days ago treated for meningococcal septicemia + now has BP of 80/50. What are the arrows for serum aldosterone, cortisol, ACTH, K+, Na+, HCO3-, pH, and CO2?
↓ Aldosterone
↓ Cortisol
↑ ACTH
↑ K+
↓ Na+
↓ HCO3-
↓ pH
↓ CO2
Cortisol normally functions to upregulate ___ on arterioles.
a1-receptors
Test for Cushing syndrome?
Low-dose dexamethasone
Which can maintain upward gaze for 60 seconds? Myasthenia gravis or Lambert-Eaton?
Lambert-Eaton
50M + Cushingoid appearance + proximal muscle weakness + successful ability to maintain upward gaze for 60 seconds + serum ACTH levels high + serum cortisol high. Diagnosis?
Both Lambert-Eaton and Cushing syndromes secondary to small cell bronchogenic carcinoma.
50M + Cushingoid appearance + proximal muscle weakness + successful ability to maintain upward gaze for 60 seconds + serum ACTH levels high + serum cortisol high; if high-dose dexamethasone is
administered, what will happen to his ACTH and cortisol levels?
⟷ ACTH
⟷ Cortisol
35F + central obesity with purple striae + adrenal mass visualized on CT of the abdomen. Diagnosis?
Cushing syndrome due to a cortisol-secreting adenoma of the zona fasciculata.
35F + central obesity with purple striae + adrenal mass visualized on CT of the abdomen. What are the arrows for this patient’s serum ACTH, cortisol, and urinary potassium?
↓ ACTH
↑ Cortisol
↑ Urinary potassium
28F + gave birth one week ago via C-section in which she lost a lot of blood + now has fatigue + difficulty breastfeeding postpartum. Diagnosis?
Sheehan Syndrome
28F + gave birth one week ago via C-section in which she lost a lot of blood + now has fatigue + difficulty breastfeeding postpartum; what are the arrows for serum prolactin, ACTH, TSH, and Aldosterone?
↓ Prolactin
↓ ACTH
↓ TSH
↑ Aldosterone
40M + recent weight gain + pituitary mass visualized on MRI + point tenderness over a vertebra at L1 + compression fracture visualized on x-ray + slight muscle weakness. Diagnosis?
Cushing disease
40M + recent weight gain + pituitary mass visualized on MRI + point tenderness over a vertebra at L1 + compression fracture visualized on x-ray + slight muscle weakness. What are the arrows for prolactin, ACTH, and serum K+?
⟷ Prolactin
↑ ACTH
↓ K+
Cushing disease can present as mere osteoporosis and weight gain in a patient with a ___.
Pituitary adenoma
If urinary specific gravity is , the urine is ↑, that means:
The urine is concentrated
Vasopressin is an:
ADH analog
45M + long history of smoking + recent weight loss + confusion. Diagnosis?
SIADH secondary to small cell bronchogenic carcinoma
Small cell lung cancer paraneoplastic syndromes:
1) SIADH (ADH secretion)
2) Cushing syndrome (ACTH secretion)
3) Lambert-Eaton syndrome
4) Neurologic/cerebellar dysfunction (Anti-Hu/-Yo antibodies)
High Yield squamous cell lung cancer paraneoplastic syndrome:
Hypercalcemia often presenting as urolithiasis (PTH-related peptide; i.e., PTHrp, secretion).
24F + bipolar disorder + mildly tremulous + increased urinary output. What are arrows in
this patient for tonicity of her proximal convoluted tubule (PCT), juxtaglomerular apparatus (JGA), and medullary collecting duct (MCD) in comparison to her serum tonicity?
⟷ PCT
↓ JGA
↓ MCD
The PCT is always ___ no matter what.
Isotonic
The JGA is always ___ no matter what.
Hypotonic
The MCD will be hypertonic in:
1) SIADH
2) Dehydration
The MCD will be hypotonic in:
1) DI (both central and nephrogenic)
2) Psychogenic polydipsia
47F + has been taking large doses of ibuprofen the past 25 years. What are the arrows for this patient’s urine volume and urine osmolality in response to exogenous administration of ADH?
⟷ Urine volume
⟷ Urine osmolality
⟷
↑
↓
