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ClinMed exam III > Pituitary II > Flashcards

Pituitary II Flashcards

1
Q

What hormones come from the anterior pituitary

A
  • growth hormone
  • prolactin
  • adrenocorticotropic hormone
  • thyroid stimulating hormone
  • luteinizing hormone
  • follicle stimulating hormone
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2
Q

What hormones come from the posterior pituitary

A
  • antidiuretic hormone

- oxytocin

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3
Q

What is diabetes insipidus

A

deficiency in vasopressin (ADH) from the posterior pituitary

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4
Q

What does ADH do in the body

A

water preservation by the kidneys

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5
Q

What happen in the body when the water content in the blood is low

A

the brain produces more ADH–> high volume of water reabsorbed by the kidney–>low urine output–> normal water content in the blood

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6
Q

What happens in the body when the water content in the blood is high

A

brain produces less ADH–>low volume of water absorbed by the kidney–>high output of urine–>normal water content in the blood

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7
Q

Where is ADH created

A

hypothalamus

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8
Q

Where does ADH act in the kidney

A

distal renal tubules

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9
Q

What happens in diabetes insipidus

A

passage of large volumes of dilute urine (>3L/24 hrs and <300 mOsm/kg)

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10
Q

What are the two major causes of diabetes insipidus

A
  • cantral: decrease secretion of ADH

- nephrogenic: the kidneys do not response to normal amounts of ADH

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11
Q

Two subcategories of central diabetes insipidus

A
  • primary: no identifiable lesion on MRI or pituitary or hypothalamus
  • secondary: some type of damage to hypothalamus or pituitary stalk by trauma, infection, bleed, tumor, infarction
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12
Q

What are the most common causes of central diabetes insipidus

A
  • iodiopathic
  • tumor on the pituitary
  • cranial surgery
  • head trauma
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13
Q

What are some causes of nephrogenic diabetes insipidus

A
  • lithium toxicity
  • hypercalcemia
  • demeclocycline
  • steriods
  • abx
  • pregnancy
  • renal disease
  • congenital
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14
Q

Signs and symtpoms of diabetes insipidus

A
  • caused by absence of ADH*
  • polyuria
  • polydipsia
  • nocturia
  • dehydration
  • hypotension
  • hypernatremia
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15
Q

What will the serum glucose and serum electrolytes look like in diabetes insipidus

A
  • high serum NA

- normal serum glucose

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16
Q

What will the plasma osmolality be in diabetes insipidus

A

high

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17
Q

What will the urine osmolality be in diabetes insipidus

A

low

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18
Q

ADH level in central diabetes insipidus

A

low

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19
Q

ADH level in nephrogenic diabetes insipidus

A

high

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20
Q

What will the water deprivation test show in central DI

A

increase of urine osmolality

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21
Q

How do you treat DI

central?
nephrogenic?

A

-hypotonic saline for all

central: desmopressin
nephrogenic: HCTZ

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22
Q

How fast do you want to decrease serum sodium in DI

A

0.5 mEq/hr

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23
Q

SIADH

A

excessive release of antidiuretic hormone from the posterior pituitary

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24
Q

What is the result of SIADH

A

dultional hyponatremia and low serum osmolality

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25
Q

What are some of the etiologies of SIADH

A
  • head trauma
  • malignancy
  • meningitis
  • drugs
  • post pituitary surg
  • neurologic disorders
  • psychiatric disorders
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26
Q

What two malignancies most commonly cause SIADH

A
  • small cell lung cancer

- pancreatic cancer

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27
Q

What are the signs and symptoms in SIADH due to

A

hyponatremia due to water intoxication

28
Q

What are the signs and symptoms of SIADH

A
  • headache
  • N/V
  • seizures
  • altered mental status
  • loss of consciousness
29
Q

What is serum sodium in SIADH? urine sodium?

A

serum sodium is low

urine sodium is high

30
Q

Urine osmolality is SIADH

A

high

31
Q

Why would you do a CT of the abn or pelvis for a patient with SIADH

A

to check for malignancy

32
Q

Treatment of a patient with asymptomatic SIADH

A
  • restrict fluid (<1.5 L/day)
  • discontinue any offending medications
  • Deomeclocycline
33
Q

Treatment of a symptomatic patient with SIADH

A

-hypertonic solution (NaCl)

34
Q

What is psychogenic polydipsia

A

clinical disorder characterized by polyuria and polydipsia

35
Q

Who does psychogenic polydipsia occur in

A

inpatients with psychiatric disorders

36
Q

What are the two most common causes of dwarfism

A
  • familial

- delayed constitutional growth

37
Q

Definition of dwarfism

A

height that is 2 standard deviations below the mean for children of sex and age

height below teh 2.3rd percentile

38
Q

What is the most common cause of bone dysplasia in humans

A

achondroplasia

39
Q

What are the two main categories of dwarfism

A
  • proportionate

- disproportionate

40
Q

What causes proportionate dwarfism

A
  • metabolic/hormonal syndromes
  • GH hormone deficiency syndromes
  • laron syndrome
41
Q

What casues disproportionate dwarfism

A
  • achondroplasia
  • sphnydyloepiphyseal dysplasia
  • diastrophic dysplasia
42
Q

What mutation causes achondroplasia? autosomal dominant or recessive?

A

autosomal dominant

mutation in FGFR3

43
Q

Features of achondroplasia

A
  • normal torso
  • short limbs
  • hydrocephalus
44
Q

Features of spondyloepiphyseal dysplasia

A
  • shortened trunk
  • barrel chest
  • club feet
  • cleft palate
  • severe osteoarthritis
45
Q

Features of diastrophic dysplasia

A
  • shortened forearms and calves
  • limited ROM
  • cleft palate
  • deformed hand/feet
  • swelling of ear at birth
46
Q

Signs of disproportionate dwarfism found in the eyes

A
  • congenital cataracts

- myopia

47
Q

Signs of disproportionate dwarfism found in the mouth

A
  • bifid uvula

- high arched or cleft palate

48
Q

Signs of disproportionate dwarfism found on the hands and feet

A
  • polydactyly
  • hitch hikers thumb
  • clubfoot
49
Q

Signs of disproportionate dwarfism in the heart

A
  • ASD
  • single atrium
  • patent ductus arteriosum
  • transposition of great vessels
50
Q

Treatment of disproportionate dwarfism

A
  • symptomatic relief*
  • tracheotomy
  • cleft palate repair
  • leg braces
  • back braces
  • club foot surgery
51
Q

What causes pituitary dwarfism

A

deficiency in GHRH–>GH deficiency

52
Q

Signs and symptoms of pituitary dwarfism

A
  • severe postnatal growth failure
  • delayed bone age
  • hypoglycemia
  • prolonged jaundice
  • micropenis, high pitched voice, increase body fat
53
Q

What should you do first when diagnosing GHD? what comes after?

A

-evaluate for other causes of growth failure

-if no other evidence order
IGF-1
IGFBP-3
bone age

54
Q

What is required to confirm GHD diagnosis

A

-provocative testing
an agent that prokes the pituitart to release a burst of GH is given–>blood draws are done

if GH,IGF-1 and IGFBP-3 remain low than GH diagnosis is confirmed

55
Q

What is the most common cause cause of genetically mediated growth hormone insensitivity

A

Laron syndrome

56
Q

What causes Laron syndrome

A

mutation in the GH receptor gene that does not allow GH to bind

57
Q

What are the GH levels in a patient with Laron syndrome

A

normal or high

58
Q

Clinical features of Laron syndrome

A
  • small head circumference
  • characteristic facies w/ saddle nose and prominent forehead
  • delayed skeletal maturation
  • abnormal body composition
  • osteopenia
  • obesity
59
Q

What is Turner syndrome

A

missing X chromosome in females

60
Q

What may the only presenting feature in Turner syndrome be

A

short stature

61
Q

What are the signs of Turner syndrome

A
  • webbed neck
  • cubitus valgus
  • genu valgum
  • shortened 4th metacarpals
  • Madelung deformity of the forearm
62
Q

Treatment of pituitary dwarfism

A

growth hormone administered SQ

63
Q

Treatment of Laron syndrome

A

IGF-1

64
Q

What is Sheehan syndrome

A

infarction of the pituitary after postpartum hemorrhage

65
Q

What do you look for immediately in Sheehan syndrom

A

adrenal insufficiency

66
Q

What do you treat ACTH deficiency with

A

hydrocortisone of glucocorticoid

67
Q

What do you treat a TSH deficiency with

A

levothyroxine

ClinMed exam III (7 decks)

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