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From Flashcardlet > 13.6.2013(endocrinology,bone metabolism) 36 > Flashcards

13.6.2013(endocrinology,bone metabolism) 36 Flashcards

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0
Q

Adenomas are commonly located in

A

Inferior parathyroid gland

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1
Q

Most common cause for hyperparathyroidism

A

Solitary Parathyroid adenoma

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2
Q

Defect in familial hypocalciuric hypercalcemia

A

CASR gene mutated
Both kidney and parathyroid are ignorant of ca levels
Hence kidney cannot excrete excess ca+

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3
Q

Causes of ectopic PTH secretion

A

SCC lung

Adenocarcinoma of kidney

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4
Q

Causes of secondary hyperparathyroidism

A 
CRF
malabsorption syndrome
VitD deficiency(rickets,osteomalacia)
Medullary Ca of thyroid(calcitonin)
Acute pancreatitis
Rhabdomyolysis
Hungry bone syndrome
Osteoblastic metastasis with marked stimulation of bone formation (prostate cancer)
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5
Q

Drugs causing secondary hyperparathyroidism

A

Bisphosphonates,Plicamycin(inhibitors of bone resorption)
Calcium chelators
Altered vit D metabolism(phenytoin,ketoconazole)

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6
Q

Rugger jersey spine is seen in

A

Osteosclerosis of superior and inferior margin of vertebral body
Secondary hyperparathyroidism in renal failure

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7
Q

Bone changes in hyperparathyroidism

A

Osteitis fibrosa cystica(healing response)
Absence of lamina dura(mandible)
Pinhead stippling of skull(salt and pepper or pepper pot skull)
Sub periosteal resorption
Tufting of terminal phalanges

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8
Q

Types of pseudohypoparathyroidism

A

Type1a
Type1b
Type2

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9
Q

Albert hereditary osteodystrophy

A 
Type1A pseudohypoparathyroidism (paternal imprinting)
Pseudopseudohypoparathyroidism(maternal imprinting)
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10
Q

Albert hereditary osteodystrophy is due to

A

Gsalpha mutation

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11
Q

Unique feature of AHO

A

Heterotopic calcification

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12
Q

Defect in type 1B pseudohypoparathyroidism

A 
Upstream of Gsalpha
No bone changes
PTH elevated
Ca+ low
Phosphate elevated
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13
Q

Defect in type 2 pseudohypoparathyroidism

A

Downstream of Gsalpha

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14
Q

Urine cAMP increases in response to PTH in

A

Pseudo pseudohypoparathyroidism

Pseudohypoparathyroidism type 2

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15
Q

Only bone affected in

A

Pseudo pseudohypoparathyroidism

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16
Q

AHO

A 
Short sature
Round Facies 
Anosmia
Ageusia
Short 4th and 5th metacarpal
Basal ganglia calcification(Heterotopic calcification)
Radial curves 
Exostosis
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17
Q

Most common type of pseudohypoparathyroidism

A

Type 1A

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18
Q

Gsalpha activating mutation diseases

A 
Acromegaly
Pitutary corticotroph adenoma
Hyperfunctioning thyroid adenoma
Endocrine ovarian neoplasms 
Mc cune Albright syndrome
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19
Q

Hormone that acts by opening K+ channel

A

Somatostatin

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20
Q

Hormone that acts by decreasing cAMP

A

Dopamine

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21
Q

Hormones that act via IP3/DAG

A 
GnRH
TRH
oxytocin
Vasopressin 
Angiotensin II
Alpha1 adrenergic stimulation
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22
Q

High PTH
High phosphorus
Low Ca++

A

Renal failure
Pseudohypoparathyroidism
Rhabdomyolysis
Tumor lysis syndrome

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23
Q

Low PTH
Low ca++
High phosphorus

A

Hypoparathyroidism(Thyroid Sx,AIPS)
Hypomagnesimia
HYPOTHYROIDISM

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24
Effect of bisphosphonate on mineral metabolism
Low Ca+ Low phosphorus High PTH (blood transfusion produces a similar picture)
25
Parathyroid causes of hypercalcemia
Hyperparathyroidism Li Familial hypocalciuric hypercalcemia
26
Hypercalcemia associated with increased bone turnover
``` Paget Hyperthyroidism Thiazides Vit A intoxication Immobilisation ``` PATHI
27
Hypercalcemia caused due to malignancies
``` Breast metastasis Paraneoplastic syndrome ass with breast,kidney,bladder,SCC(lung,head and neck,cervix,esophagus,vulva,skin) Multiple myeloma Lymphoma/leukemia Pheochromocytoma MEN ```
28
Metal causing hypercalcemia
Aluminium
29
Sarcoidosis serum and urine calcium
Hypercalciuria with or without hypercalcemia
30
Most common cause of hypercalcemic crisis is
malignancy
31
Hypercalcemic crisis
Total calcium>14mg/dl
32
Activating mutations of CaSR leads to
Familial hypocalcemic hypercalciuria(AD)
33
GIT manifestations of hypercalcemia
Vomiting Peptic ulcer disease Constipation
34
Renal manifestations of hypercalcemia
Polyuria Nocturia Nephrolithiasis
35
Rx of hypercalcemia complicating malignancies
Glucocorticoids
36
Drugs with slower onset of action in correcting hypercalcemia
Bisphosphonate(1 to 2days) Glucocorticoids Gallium nitrate(3-4days)
37
Ph and phosphate levels
Hyperphosphatemia is seen in metabolic and respiratory acidosis
38
Causes of hyperphosphatemia
Severe hypermagnesimia Hypomagnesimia Acromegaly Heparin therapy
39
Phosphate levels Leukemic blast crisis
Hypophosphatemia Also seen in intensive erythropoietin or CSF therapy
40
Phosphate levels following parathyroidectomy
If after thyroid Sx,hyperphosphatemia | If Sx done for primary hyperparathyroidism,hypophosphatemia(hungry bone disease)
41
Tumoral calcinosis
Calcium deposition in peri articular location following hemodialysis Normal calcium and elevated phosphate levels
42
PTH/PTHrP Independant genetic causes of hypophosphatemia
``` X linked hypophosphatemic rickets Dent disease AD hypophosphatemic rickets Cystinosis Fanconi Wilson Mc cune Albright Idiopathic hypercalciuria ```
43
Systemic disorders associated with hypophosphatemia
``` Poorly controlled DM Alcoholism Aldosterone excess Hypomagnesimia Amyloidosis HUS renal transplantation or partial liver resection Rewarding or induced hyperthermia ```
44
Drugs or toxins associated with hypophosphatemia
``` Alcohol Diuretics High dose estrogen and glucocorticoids Lead,cadmium Cisplatin,foscarnet,ifosfamide,rapamycin Calcitonin,pamidronate ```
45
Drug causing hyperphosphatemia
Heparin
46
Bone metabolism in lytic bone lesions
Calcium is normal or increased Phosphate is normal or increased Alk.p is normal or increased PTH is normal
47
Tetany causes
Hypocalcemia | Hypomagnesimia
48
Earliest manifestation of rickets
Craniotabes
49
Zones in epiphysis
``` Moving from epiphysis to metaphysis Resting Proliferation Maturation Hypertrophy Provisional calcification ```
50
Bone changes in rickets
``` Thickening of growth plate Widening of growth plate Cupping/flaring of metaphysis Fraying of metaphysis Softening and deformity of long bones ```
51
Capillaries growing from metaphysis to epiphysis go via
Tunnels in zone of provisional calcification
52
Growth of epiphyseal plate is limited by
Ingrowth of capillaries into metaphysis which destroy the cartilaginous cells in zone of hypertrophy
53
Difference in growth plate of rickets
Tunnels are not formed in zone of provisional calcification and capillaries cannot reach zone of hypertrophy
54
Skull changes in rickets
Frontal bossing Craniotabes Caput quadratum
55
Most common manifestation of osteoporosis
Compression # of vertebra
56
Drugs causing osteoporosis
``` Heparin Glucocorticoids Excessive thyroxine GnRH agonists Excessive alcohol Aluminium Li Anticonvulsants Cytotoxic drugs Cyclosporine ```
57
Haematological disorders associated with osteoporosis
Pernicious Anemia Mastocytosis Thalassemia Haemophilia
58
Endocrine disorders associated with osteoporosis
``` Cushing Addison DM1 Thyrotoxicosis Acromegaly Hyperparathyroidism ```
59
Bone disorder associated with turner syndrome
Osteoporosis(all hypogonadal states are associated with osteoporosis)
60
Rheumatologic conditions associated with osteoporosis
AS | RA
61
Inherited disorders associated with osteoporosis
``` Collagen disorders Marfan Ehlers danlos Homocystinuria Epidermolysis bullosa Menkes Hemochromatosis Glycogen storage disease Porphyria Hypophosphatasia ```
62
NSSA mechanism
Norepinephrine and selective serotonin reuptake inhibitors Alpha 2 blocker 5HT2 and 5HT3 blocker
63
NSSA drugs
Mirtazapine
64
Most selective SSRI
Escitalopram
65
Least drug interaction with which SSRI
Sertraline | Citalopram
66
Longest acting SSRI
Fluoxetine
67
Shortest acting SSRI
Fluoxamine
68
Most common adverse effect of SSRI
Gastritis
69
Activating mutations of PTH receptor
Jansen metaphyseal chondrodysplasia
70
Causes of osteoporosis
``` Sarcoidosis Amyloidosis Prolonged immobilisation Pregnancy and lactation Alcohol COPD scoliosis Multiple sclerosis ```
71
Thyroid status in Mc cune Albright syndrome
Hyperthyroid
72
Drugs causing hypothyroidism
``` Iodine excess(iodine containing contrast media and Amiodarone) Li Para aminosalicylic acid Interferon alpha Aminoglutethimide ```
73
Causes of hypothyroidism(infiltrating diseases)
``` Amyloidosis Sarcoidosis Hemochromatosis Cystinosis Scleroderma Reidel thyroiditis ```
74
Most common cardiac manifestation of thyrotoxicosis
Sinus tachycardia
75
Means lerman scratch
Systolic scratch sound best heard in lt second ICS
76
Causes of dancing carotids
AR | thyrotoxicosis
77
Venlafaxine,useful effects
Faster onset of action | No sedation
78
Amiodarone associated thyroiditis is more common among
Women | Positive TPO antibodies
79
Underlying thyroid abnormality is associated with which AIT
Type 1 | Preclinical graves or MNG
80
Mechanism of thyrotoxicosis in AIT2
Drug induced lysosomal activation leading to destructive thyroiditis
81
Increased vascularity in color Doppler is seen in which AIT
AIT1
82
IL-6 levels are markedly raised in which AIT
AIT-II
83
Amiodarone inhibits
De iodinase activity
84
Most common form of thyroiditis
Hashimoto thyroiditis(chronic lymphocytic thyroiditis)
85
De quervain thyroiditis
Subacute Granulomatous thyroiditis | Giant cell thyroiditis
86
RAIU in giant cell thyroiditis
Depressed
87
Cause of dequervain thyroiditis
Viral | Follows an upper respiratory tract infection
88
Hurthle cells are found in
Hashimoto Follicular carcinoma Hurthle cell thyroid adenoma
89
Lymphnode metastasis in medullary carcinoma thyroid
Early
90
Site of organ of zuckerkandl
Origin of IMA
91
10% manifestations in pheochromocytoma
``` Bilateral Extraadrenal Familial Occur in children Multiple Malignant ```
92
Orthostatic hypotension in pheochromocytoma
Diminished plasma volume | Blunted sympathetic reflexes
93
Whipple triad
Hypoglycemic symptoms Low plasma glucose Symptoms relieved after I.v glucose administration
94
Second most common hormone to be secreted by gastrinoma
ACTH
95
Most common site of peptic ulcers in gastrinoma
1st part of duodenum
96
Most valuable provocative test in ZES pts
Secretin injection tests
97
BAO and MAO in ZES
BAO>MAO | 60% greater
98
Highest level of alkaline phosphatase is found in
Hereditary hypophosphatemic rickets | Pagets disease
99
Serum insulin and glucose levels in insulinoma
Insulin more than 6microU/ml | Glucose less than 40mg/dl
100
Gold standard test for diagnosis of insulinoma
72 hour fast test
101
Highest level of alkaline phosphatase is found in
Hereditary hypophosphatemic rickets | Pagets disease

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