UWorld Endocrine Flashcards
In Graves, what does B blocker NOT fix?
Exopthalmos. B blockers may fix mood lability and fatigue - stemming from symapthetic overactivation. B BLOCKER ALSO BLOCKS PERIPHERAL CONVERSION OF T4 TO T3.
What is one of the most common reasons for elevated alpha fetal protein?
AFP synthesized by fetal liver, GI tract, and yolk sac.And thus AFP INC w/ gestational ageMost common reason for INC/DEC AFP levels is gestational age.
Klinefelters - What are…LH, FSH, Estrogen, Testosterone, Sperm count?Turners?
LH, FSH, Estrogen are INC, Test, Sperm DEC.Turners, Estrogen DEC (streak ovaries), which leads to LH and FSH INC.
Thiazolidinediones mech of action? Aka pioglitazone (glitazone)
Bind to peroxisome proliferator actiavted receptor gamma (PPAR) , a receptor that belongs to steroid/thyroid superfamily of NUCLEAR RECEPTORS - Basically skips the external insulin binding and DECREASES insulin resistance and INCREASE INSULIN SENSITIVITY IN PERIPHERAL TISSUES!!PPAR gamma codes for adiponectin - cytokine secreted by fat. Low in DM2. TZD INC levels. DEC insulin resistance.
In septic shock - what plasma findings are different?
Lactic acidosis - INC anion gap - due to tissue hypoxia - results in impaired oxidative phosphrylation. pyruvate shunted to lactate -> hepatic hypoperfusion also contributes to buildup of lactic acid, as liver is priamry site of lactate clearance.
exposure to radioactive heavy isotopes disposal - what to do?
Give Potassium Iodide.May prevent thyroid absorption of radioactive iodine by competitive inhibition
Medication of choice for Gestational DM?
Insulin
Mech of action of finasteride?
5 alpha reducdtase - knocks out peripheral converison of T to DHT. Finasteride - used to treat BPH - also can tx andorgenetic alopecia. (Can give you hair)
How is fructose metabolized in essnetial fructosuira?
Essential - fructokinase deficiency - In this case, fructose is metabozlied by hexokinase to F6P. This pathway is not significant in omral individuals
Mech of menopause? Most reliable test way to confirm?
Estrogen (estradiol, NOT estrone - remains normal from fat), DEC leading to INC FSh and LH. INC FSH are the gold standard for determining menopause
Transmembrane domains are composed of?
Hydrophobic amino acids. (valine, alaniem, isoleucine, methionine, phenylalanine. AKA inside, they are shielded from direct contant w/ water.
Kallmann syndrome - where is the defect? What is the presentation?
Abscence of GnRH. Delayed puberty+ anosmia. Failure of GnRH secereting neurons to migrate from origin in olfactory placode - to normal often due to KAL1 mutation or fibroblast grotwh factor receptor 1 gene. location in hypotahalmus.
What is a crossover study? What is a wash out period?
Crossover - give A then B to one group.Give B then A to another.In between A and B have a no treatment period to “wash out” any effects.
Where are thyroid hormone receptors?
Inside nucleus.
Tx for adrenal crisis?
Corticosteroids
Histo of bone in hyperparathyrroidism?Caused by? Presentation?
Subperiosteal thinning w/ cystic degeneration. ESP on medial side of second and 3rd phalagnes of the hand. Cuased by a parathyroid adnemoa in 85% of pt. Parathyroid CA is VERY uncommon. Often see bones, stones (RENAL COLIC) groans, psychic moans, + GI upset (ULCERS)
Histo of hashimotos?
Mononucelar parenchymal inifiltration w/ WELL DEVEOD GERMINAL CENTERS - classic Hahsimotos.
How can you tell where damage in central diabetes insipidus is at?
Give ADH and see response over time. If damage is to posterior pit - transient Central DIPermanent central DI - dmg to hypothalamic nuclei or pituitary stalk.
Best diabetes t2 tx for post-meal?
Any rapid acting.Lispro, aspart, glulisine.However, Lispro is IV so probably others.
What is the pharm remediation for anovulation?What are the two drugs used - for what reasons?
Menotropin (acts like FSH) - leads to formation of dominant ovarian folliclehCG (simulates LH surge) - leads to ovulation.
Removal of mass in infants neck leads to lethargy, feeding problems, constipation, dry skin.Why?
Removal of lingual thyroid - sometimes this may be the ONLY thyroid that the child has - leads to hypothyroidism. See all these in infants + umbilical hernia macroglossia etc.
Where are NADH, GTP, and FADH synth in TCA cycle?What is the GTP used for?
NADH - isocitrate to akGNADH - akG to succinyCoAGTP - Succinyl Coa to SuccinateFADH - Succinate to FumarateGTP is used in glucoNEOgenesis for the phosphorylation and decarboxylation of oxaloacetate to PEP by PEP carboxykinase.
What 2 things stimulate the pancreas to release enzymes and bicarb? Which cells do these affect?
CCK -> Acinar -> EnzymesSecretin -> Ductal -> BicarbCAESDB
How does glucose get from lumen into cell.
NaK pump establishes gradientNa/Glucose flow into the cell togetherGlucose flows out of basal side via facilitated diffucsion.
Another name for facilitated diffusion?
Carrier mediated transport. These are transmembrane carrier proteins.
Other than Agranlocytosis, Aplastic anemia, hepatotoxicity, teratogenesis, Steven Johnson and p450 induction, what can this drug lead to (endocrine)?
SIADH - by exaggerated response to ADH. Carbamazepine - Na inativation.
Where does ADH synthesis occur? Oxytocin synthesis?Where is this all secreted into?
Supraoptic nucleus. Perhaps tie this in with seizures/carbamazepine, which can cause SIADH and seizures, which can? cause you to see shit. Paraventricular nucleus Secreted into hypophysial vein - ultimately enterse systemic circulation. Hypophysial vein is in between psoterior and anterior pit.
What is the DOC for DKA?
regular
What ist he most common cause of death in pt w/ DM?
Cornoary heart disease/MI.Studies show that DM is one of the strongest risk factors for CHD. Approx 40% of pt die secondary to CHD. Exceeds risk of dying to renal failure, stroke, hyperosmolar nonketotic coma.
Hyperthyroid pt w/ fever. Must?
Get WBC.Fever - concern for agranulocytosis (absolutle N count less than 500/mL.)Also may present w/ fever + THROAT PAIN/SOARE THROAT.
Antithyroid drugs.3 types:Anion inhibitorsThianamidesRadioablationIodide Salts
Anion inhibitors - perchlorate, pertechnetate (comeptitive inhibition)Thionamides (methimazole, PTU - inhibit thyroid peroxidase)RadioablationIodide Salts - potassium idodie -0 inhibit synth and release
What have Glut 2 receptors?Glut 3 receptors?
G2 - Liver, pancreatic b cells, intestine, kidneysG3- placenta, brain, neuron
Where are cortisol receptors located?
Within cytoplasm - translocate to nucleus after binding to cortisol.
What can induce insulin resistance?What is the mech of this?
TNFa - Catecholamines, glucocoritcoids, glucagon - INC serine kinase activity - lead to phosphorylation of IRS-1 (insulin receptor sbustrate) - this inhibits IRS1 tyrosine phosphorylation of insulin.
Why does prolactinoma lead to other signs other than bitemporal hemianopsia?
Inhibits GnRHMales - low LH, T - impotence, usu no galactorrhea or amenorrheaFemales - low LH, estrogen - galactorrhea, amenorrhea - may lead to osteoporosis due to low E.
ACTH - hyperplasia of what?
Fasciulate (cortisol!)ACTH IS NOT ALDOSTERONE, IT IS CORTISOL! DUHHHHHHH
SIADH plasma findings, fluid levels?
Low sodium and osmolality - inappropriate concentrated urine - INC urinary sodium - CLINICALLY NORMAL BODY FLUID - NO edema - no lung fluid build up, JVD etc. No fluid problems because ADH is corrected as extracellular fluid SUPPRESSES renin-aldosterone - and stimulates Natriuretic peptides - leading to excretion of sodium in urine - EUVOLEMIC HYPONATREMIA.
Glucose, Galactose, Fructose - fastest rates of gylcolytic metabolism?
Fructose - it bypasses regulatory step of PFK1. And goes directly to Aldolase B
B blockers concern w/ diabetes?
Nonselective B blcokers exacerbate hypoglycemia and MASK ITS ADRENERGIC SYMPTOMS - should not be use din pt w/ DM unless benefits outweight concenrs.Selective B1 antagonists hsould be used isntead if necessary. Block of B2 inhibits hepatic gluconeogensis and peripheral glycogenolysis/lipolysis. B1 blockers are given because they do not block metabolic sympathetic effects.
In MEN 2a syndrome - which cells of the thyroid are affected? Which cells of the adrenals?
Parathyroid - Medullary thyroid CA - PARAFOLLICULAR cells (C cells!) - which release Calcitonin. PheoBoth parafolliclular and Pheos (adrenal medullary - aka chromafin, whiy you have catecholamine release) are neural crest derivatives.
What are the two a-glucosidase inhibitors. When are they taken?
Acarbose, MiglitolTkane with meals for maximal effect - side effects - GI upset. Dont use in pt w/ malabsoprtion.
What effect would giving T3 have on T4 and rT3?
Giving T3 would DEC TSH, which would DEC T4, which would DEC rT3REMEMBER - rT3 is made from T4! not from T3.
Why does the zona glomerulosa only may mineralocorticoids (aldosterone)
Because it does not have 17a hydroxylase. Cannot make cortisol or androgens.
Describe the polyol pathway.Why do you get cataracts, retinopathy, neuropathy in DM and other sugar disease?
Glucose - aldose reductase -> SorbitolSorbitol -> sorbitol dehydrogenase -> Fructose.Retina, Schwann cells, Kidney have aldolase reductase, but DONT have sorbitol dehydrogenase.Lens DO have sorbitol dehydrogenase, but after a while in DM this can get oversaturateed. Think - “lens is most protected (has both enzymes) since it needs to be clear, but eventually even this goes” So probably have retinopathy before lens problem.