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Step 1 > PP Endo > Flashcards

PP Endo Flashcards

0
Q

What is a Thyrotrope?

A

TSH

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1
Q

What is a Gonadotrope?

A

LH, FSH

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2
Q

What is a Corticotrope?

A

ACTH

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3
Q

What is a Lactotrope?

A

PRL

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4
Q

What are the steroid hormones?

A 
"PET CAD"
Note: thyroid hormone acts like a steroid
Progesterone 
E2
Testosterone 
Cortisol
Aldo
Vit D
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5
Q

What organs do not require insulin?

A 
"BRICKLE"
Brain
RBC
Intestine
Cardiac, Cornea
Kidney
Liver
Exercising muscle
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6
Q

What does GnRH do?

A

Stimulates LH, FSH

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7
Q

What does GRH do?

A

Stimulates GH

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8
Q

What does CRH do?

A

Stimulates ACTH

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9
Q

What does TRH do?

A

Stimulates TSH

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10
Q

What does PRH?

A

Stimulates PRL

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11
Q

What does oxytocin do?

A

Milk letdown, baby letdown

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12
Q

What does GH do?

A

IGF-1 release from liver

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13
Q

What does TSH do?

A

T3, T4 release from thyroid

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14
Q

What does LH do?

A

Testosterone release from testis, E2 and progesterone release from ovary

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15
Q

What does FSH do?

A

Sperm or egg growth

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16
Q

What does PRL do?

A

Milk production

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17
Q

What does ACTH do?

A

Cortisol release from adrenal gland

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18
Q

What does MSH do?

A

Skin pigmentation

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19
Q

What are the stress hormones?

A 
Epi: immediate
Glucagon: 20min
Insulin:30min
ADH: 30min
Cortisol: 2-4hr
GH:24hr
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20
Q

What is Diabetes Insipidus?

A

Too little ADH=> urinate a lot

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21
Q

What does ADH do?

A

Concentrates urine

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22
Q

What is Central DI?

A

Brain not making ADH

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23
Q

What is nephrogenic DI?

A

Blocks ADH receptors

Can be caused by Li and Domecocucline

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24
Q

What does the water deprivation test tell you?

A

What’re deprivation => DI ( fails to concentrate urine)

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25
Q

What does giving DDAVP tell you?

A

DDAVP => central DI

Concentrates >25%

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26
Q

What is SIADH?

A

To much ADH => expand plasma vol => pee Na

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27
Q

What is the difference b/w DI and SIADH?

A

DI has diluted urine

SIADH has concentrated urine

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28
Q

What is Psychogenic Polydipsia?

A

Pathologic water drinking => low plasma osmolarity

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29
Q

What does Aldosterone do?

A

Reabsorbs Na, secretes H/K

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30
Q

What is neuroblastoma?

A

Adrenal medulla tumor in kids
Dancing eyes / feet
Secretes catecholamines

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31
Q

What is pheochromocytoma?

A

Adrenal medulla tumor in adults, 5 P’s : Pressure, Pain, Perspiration, Palpitation, Pallor
Urinary VMA and plasma Catecholamines are elevated
Treated first with alpha blocker and then the beta blocker

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32
Q

What does the zona Glomerulosa make?

A

Aldosterone “salt”

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33
Q

What does the zona Fasiculata make?

A

Cortisol “sugar”

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34
Q

What does the zona Reticularis?

A

Androgens “ sex”

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35
Q

What is Conn’s syndrome?

A

High Aldo ( tumor )
Decrease renin
Treated with spironolactone

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36
Q

What does ANP do?

A

Inhibits Aldo

Dilates renal artery ( afferent arterioles)

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37
Q

What does Calcitonin do?

A

Inhibits osteoclasts => low serum Ca

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38
Q

What is MEN I?

A

Parathyroid hyperplasia
Pituitary adenomas
Pancreatic islet cell tumors ( gastrinomas { ZES}, insulinoma, VIPomas)

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39
Q

What is MEN 2A?

A

Medullary thyroid cancer
Pheochromocytoma
Parathyroid hyperplasia

A/w Marfanoid habitus, RET gene

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40
Q

What is MEN 2B?

A

Medullary thyroid cancer
Pheochromocytoma
Oral/GI mucosal neuromas

A/w Marfanoid habitus, RET gene

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41
Q

What does CCK do?

A

Gallbladder contraction, bile release

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42
Q

What does cortisol do?

A

“BIG FIB”
Increase: BP, insulina resistance, gluconeogenesis, lipolysis, proteolysis.

Decrease: fribroblast activity, inflammatory & immune response, bone formation.

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43
Q

What is Addison’s syndrome?

A

Autoimmune destruction of adrenal cortex => hyperpigmentatio, increase ACTH, hypotension, hyperkalemia

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44
Q

What is Waterhouse Friderichsen?

A

Adrenal hemorrhage
Commonly seen in children
Associated with Neisseria meningitidis

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45
Q

What is Cushing’s syndrome?

A

High cortisol ( pituitary tumor or adrenal tumor or small cell lung CA)

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46
Q

What is Cushing’s disease?

A

High ACTH ( pituitary tumor)

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47
Q

What is Nelson’s syndrome?

A

Hyperpigmentation after adrenalectomy

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48
Q

If the low-dose dexamethasone test suppresses, what does that tell you?

A

Normal
Obese
Depressed

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49
Q

If the low-dose dexamethasone test does not suppresses, what does that tell you?

A

Cushing’s => do high dose test

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50
Q

If the high-dose dexamethasone test suppresses, what does that tell you?

A

Pituitary tumor => ACTH (call brain surgeon)

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51
Q

If the high-dose dexamethasone test does not suppress, what does that tell you?

A

Adrenal Adenoma => Cortisol (call general surgeon)

Small cell lung cancer => ACTH (call thoracic surgeon)

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52
Q

What are the survival hormones?

A

Cortisol: permissive under stress
TSH: permissive under normal

53
Q

What does Gastrin do?

A

Stimulates parietal cells => IF, H

54
Q

What does GH do?

A

Growth
Sends somatomedin to growth plates
Gluconeogenesis by proteolysis

55
Q

What is Achondroplasia = Laron Dwarf?

A

Abnormal FGF receptor in extremities

56
Q

What is Acromegaly?

A 
Adult bones stretch "my hat doesn't fit"
Coarse facial features
Large furrowed tongue
Deep husky voice
Jaw protrusion
Increase IGF-1 b/c of GH tumor
57
Q

What is Gigantism?

A

Childhood acromegaly

58
Q

What does GIP do?

A

Enhances insulin action => post-prandial hypoglycemia

59
Q

What does Glucagon do?

A

Gluconeogenesis
Glycogenolysis
Lipolysis
Ketogenesis

60
Q

What does Insulin do?

A

Pushes glucose into cells
Increase Gycogen synthesis
Increase TG synthesis
Protein synthesis

61
Q

What is Type I DM?

A 
Anti-islet cell Ab
GAD Ab
Low insulin
DKA
Polyuria
Polydipsia
Polyphagia
Ketoacidosis
62
Q

What is Type II DM?

A

Insulin receptor insensitivity
High insulin
HONK coma
Acanthosis nigricans

63
Q

How does DKA presents?

A

Kussmaul respiration
Fruity breath (acetone)
Altered mental status
Abd pain, vomiting

  • pt severely dehydrated with electrolyte abnormalities
  • Tx: fluids, k, insulin, bicarbonate
64
Q

What is Factitious hypoglycemia?

A

Insulin injection ( increase insulin, decrease C-peptide)

65
Q

What is an insulinoma?

A

Tumor ( increase insulin and C-peptide)

66
Q

What is Erythrasma?

A

Rash in skin folds

Coral-red Wood’s lamp

67
Q

What are foot ulcer risk factor?

A

DM/ glycemic control
Male smoker
Bony abnormalities
Previous ulcer

68
Q

What conditions cause weight gain?

A 
Obesity
Hypothyroidism
Depression
Cushing's 
Anasarca
69
Q

What does PTH do?

A

Chews up bone

70
Q

What does Vit. D do?

A

Builds bone

71
Q

What do stomach chief cell secrete?

72
Q

What is the difference between Norepinephrine and Epinephrine?

A

NE: neurotransmitter
EPi:hormone

73
Q

What is 1 hyperparathyroidism?

A

Parathyroid adenoma

74
Q

What is 2 hyperparathyroidism?

A

Renal failure

75
Q

What is Familial Hypocalciuria Hypercalcemial?

A

Decrease Ca excretion

76
Q

What is both serum Ca and PO4 decrease?

A

Vit D deficiency

77
Q

What if serum Ca and PO4 change in opposite direction?

A

PTH problem

  • High Ca => hyper PTH
  • Low Ca => hypo PTH
78
Q

What is the most common cause of 1 hypoparathyroidism?

A

Thyroidectomia

79
Q

What is Pseudohypoparathyroidism?

A

Bad kidney PTH receptor

Decrease urinary cAMP

80
Q

What is Psedopseudohypoparathyroidism?

A

G-protein defect

No Ca problem

81
Q

What does Secretin do?

A

Secretion of bicarb
Inhibit gastrin
Tighten pyloric sphincter

82
Q

What does Somatostatin do?

A

Inhibits secreting
Motilin
CCK

83
Q

What do T3 and T4 do?

A

Growth

Differentiation

84
Q

What disease has Exophthalmos?

85
Q

What disease has Enophthalmos?

A

Horner’s

86
Q

What is Plummer’s syndrome?

A

Hyperthyroid Adenoma

87
Q

What does Testosterone do?

A

Makes internal male genitalia

88
Q

What does Müllerian Inhibiting Factor do?

A

Makes internal male genitalia

89
Q

What does VIP do?

A

Inhibits secretin
Motilin
CCK

90
Q

How does VIPoma present?

A

Watery diarrhea

91
Q

Which hormones have the same alpha subunits?

A
  • LH, FSH
  • TSH
  • beta-HCG
92
Q

Which is the Triad for Hyperaldosteronismo?

A

HTN
Hypokalmia
Metabolic alkalosis

93
Q

How are the TH levels in a pregnant woman?

A

Increase TBG
Increase Total T3 and T4
Normal free T3 and T4

94
Q

Which are the hypothyroidism disease?

A

Hashimoto’s thyroiditis - painless nodule, most common
Subacute thyroiditis ( de Quervains) - painful nodule, A/ w viral infection
Riedel’s thyroiditis - rock hard nodule, macro and eosino
Cretinism - fetal hypothyroidism

95
Q

Which are the hyperthyroidism disease?

A

Toxic Multinodular Goiter - mutation of TSH receptor
Grave’s disease - autoimmune hyperthyroiditis
Thyroid Storm - surge of catecholamines

96
Q

Which are the hyperthyroidism sings/symptoms?

A 
Heat intolerance
Increase appetite 
Hyperactivity
Diarrhea 
Warm, moist skin; fine hair
Chest pain, palpitation, arrhythmia, increase beta adrenergic receptor
97
Q

Which are the hypothyroidism sings/symptoms?

A 
Cold intolerance
Decrease appetite 
Hypoactive, lethargic, fatigue, weakness
Constipation
Dry cool skin; brittle hair
Bradycardia
98
Q

Primary Hyperparathyroidism disease?

A

Parathyroid adenoma
“ Hyperplasia
Malignancy

99
Q

Secondary Hyperparathyroidism disease?

A 
Chronic hypocalcemia
Chronic renal disease
Values:
Decrease Ca
Increase PTH and PO4
100
Q

Tertiary Hyperparathyroidism disease?

A 
Chronic renal disease
Parathyroid hyperplasia
Hypercalcemia
Values 
Increase Ca and PTH
101
Q

What is a Somatotrope?

102
Q

Next Tx step for pt. With high TSH & high free T3 & T4?

A

MRI of pituitary gland

  • look for a TSH-secreting pituitary adenoma
103
Q

Pt with untreated Hyperthyroid are at risk for?

A
  • increase osteoclasts activity -> increase bone resorption, decrease bone density and increase bone Fx
  • Hypercalcemia & hypercalciuria fue to bone turnover
  • cardiac arrhythmia; A-fin
104
Q

3 types of thyroiditis?

A
  1. Chronic autoimmune thyroiditis “Hashimotos”
    • hypothyroidism features
    • diffuse goiter
  2. Painless thyroiditis ( Silent thyroiditis)
    • mild, brief hyperthyroid phase
    • small, nontender goiter
  3. Subacute thyroiditis “de Quervain”
    • post viral
    • fever & hyperthyroid symptoms
    • painful/ tender goiter
105
Q

What do you test when evaluating Adrenal insuffficiency?

A

8am serum cortisol & plasma ACTH

106
Q

MCC of Congenital hypothyroidism?

A

Thyroid disgenesis

  • increase TSH
  • decrease free T4
  • Tx: Levothyroxine
107
Q

Metabolic abnormalities in hypothyroidism

A

HLD

  • increase cholesterol alone or
  • increase cholesterol and triglyceride

Hyponatremia

A symptomatic elevation of

  • CK
  • serum transaminase AST, ALT
108
Q

Euthyroid sick syndrome

A

“Low T3 syndrome “
- characterized by: decrease total & free T3 with normal T4 & TSH

  • seen in pt with an acute, severe illnesse that may have abnormal thyroid function tests
109
Q

Microangiopathy

A

Microvascular damage due to HYPERGLYCEMIA

  • eyes
  • kidney
  • diabetic microangiopathy due to more than 10 years of DM
110
Q

Acid-base disturbance in Addison’s disease

A

Non-anion gap
Hyponatremic metabolic acidosis
Hypercalemia

111
Q

Hallmark of carcinoid syndrome?

A

Episodic flushing

-others: secretory diarrhea, wheezing, murmur from tricuspid regurgitation

112
Q

Antibodies a/w Hashimoto’s thyroiditis?

A 
Anti thyroglobulin antibodies 
Antimicrosomal antibodies ( anti-TPO)
113
Q

High radioactive iodine uptake suggests?

A

De Novo hormone synthesis due to:

  • Graves’ disease
  • Toxic nodular disease
114
Q

Low radioactive iodine uptake suggests?

A

Release of preformed thyroid hormone ( Thyroiditis)

Exogenous thyroid hormone intake

115
Q

Elevated 17- hydroxyprogesterone level is diagnostic for?

A

CAH, particularly 21-hydroxylase defi

116
Q

2 important causes of hypoglycemia in non-diabetic pt with elevated insulin level?

A

Insulinoma ( B cell tumors)

Surreptitious use of insulin or sulfonylurea

117
Q

Differential do for the Anterior mediastinal mass

A

“4T’s”

  • thymoma
  • teratoma ( other giant cell tumor)
  • thyroid neoplasms
  • terrible lymphoma
  • Middle mediastinum-> Bronchogenic
  • Posterior mediastinum-> Neurogenic tumors
118
Q

DKA abnormalities?

A 
Metabolic acidosis 
Ketonemia & ketonuria
Hyperglycemia 
Hyperkalemia (k)
Hyponatremia
  • decrease of insulin which results in increase lypolysis and increase ketone production
119
Q

Active form of Vit. D?

A

Calcitriol

120
Q

Failure to lactate
Absent menstruation
Cold intolerances
Loss of hair

A

Sheehan syndrome

* ischemic infarcts of pituitary following postpartum bleeding

121
Q

Diagnosis of hyperprolactinemia

A

1st-> prolactin level ( > 200ng/ml)
2nd but mos accurate -> MRI

  • get level of TSH to rule out hypothyroidism as the cause
122
Q

High Urine Na (>20) in a pt with hyponatremia is consistent with?

A

Syndrome of Inappropriate ADH (SIADH)

123
Q 
Dermatitis ( necrolytic migratory erythema)
Diabetes
DVT
Depression 
Diarrhea
A

Glucagonoma

124
Q

Histology of DM type 1 & 2?

A

1-leukocytic infiltrate

2-islet amyloid polypeptide (IAPP) deposits

125
Q

An increase in Estrogen activity ( due to: pregnancy, OCP, post-menopausal hormone replacement therapy) will result in?

A

Increase circulating TBG –> will decrease free T3 & 4 ( by binding to it) —–> which will signal an increase in TRH and TSH ——-» it will end up in the INCREASE OF TOTAL T3 &4

126
Q

Medullary carcinoma

A

From parafollicular “c cell”
Calcitonin production
Amyloid stroma
A/w MEN 2A & 2B ( RET)

127
Q

17 alpha - hydroxylase defi.

A

Hormone: increase ALDO, decrease CORTISOL

  • increase BP, decrease K, decrease sex hormone
  • decreases Androstenedione
128
Q

21-hydroxylase defi?

A

Decrease ALDOSTERONE & CORTISOL

  • decrease PB, increase K, increase sex hormone
129
Q

Oral GTT is the preferred screening method for?

A

Gestational diabetes
1hr> 180
2hr> 155
3hr> 140

CF related diabetes

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