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BOARD REVIEW > Endo > Flashcards

Endo Flashcards

1
Q

Percentage of T3 derived from conversion of T4

A

80%

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2
Q

Major thyroid hormone-binding protein

A

Thyronine-binding globulin (TBG)

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3
Q

% of T4 and T3 are bound

A

Greater than 99.5%

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4
Q

Major cause of decreased T3 concentration in patients with a critical illness

A

Impaired peripheral conversion of T4 to T3 secondary to inhibition of deiodination process

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5
Q

Embryonic origin of thyroid gland

A

Median downgrowth of 1st and 2nd pharyngeal pouches in the area of foramen cecum

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6
Q

Embryonic origin of parafollicular cells

A

Ultimobranchial bodies of 4th and 5th branchial pouches
Neuroendocrine cell lineage

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7
Q

Genetic mutation in medullary thyroid cancer

A

RET proto-oncogene

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8
Q

Electrolyte ratio pathognomonic for hyperparathyroidism

A

Serum chloride to phosphate ration >30

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9
Q

Hemodynamics of thyroid storm

A

Tachycardia
Increased CO
Decreased systemic vascular resistance (SVR)

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10
Q

What artery do all parathyroids typically receive their blood supply from?

A

Inferior thyroid

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11
Q

Oncogene of hyperparathyroid

A

Prad oncogene

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12
Q

Bone finding pathognomonic for hyperparathyroidism

A

Osteitis fibrosa cystica

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13
Q

Lab findings in hyperthyroidism

A

Hypercalcemia
Hypokalemia
Hyperglycemia
Hypocholesterolemia
Microcytic anemia
Lymphocytosis
Granulocytopenia
Hyperbilirubinemia
Increase alkaline phosphatase

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14
Q

Initial tx for thyroid storm

A

IV fluids
Hypothermia
Acetaminophen
Propranolol
PTU
Iodine

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15
Q

Single test would allow for differentiation of thyrotoxicosis from acute destruction viral thyroiditis

A

Radioactive iodine uptake (RAIU) test

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16
Q

What inhibits the release of TSH

A

Elevated circulating levels of T3, T4 and somatostatin

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17
Q

45yo
2yr hx of Diffuse, tender thyroid enlargement
Lethargy
20pound weight gain
Dx?

A

Hashimoto’s thyroiditis

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18
Q

Vebous drainage of thyroid gland

A

Superior and middle thyroid vein – Internal Jugular Vein
Inferior thyroid vein – Innominate vein

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19
Q

MC location of recurrent laryngeal nerve

A

Tracheoesophageal groove

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20
Q

Result of bilateral injury to Superior laryngeal nerve

A

Swallowing disorders

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21
Q

Single most important test in the diagnostic work up of patients with solitary thyroid nodule

A

FNA

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22
Q

Which thyroid malignancy does radiation increases the incidence

A

Papillary cell CA

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23
Q

This is a variant of follicular cell ca
SIZE is the only predictor of malignancy
Associated with history of Hashimoto’s thyroiditis

A

Hurthle cell CA

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24
Q

5cm thyroid nodule
FNA - fluid, nodule disappeared, cytology benign
Next step?

A

Total thyroid lobectomy with isthmusectomy
- increased chance of malignancy in large cysts (>3cm)

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25
Q

No risk factor
(+) thyroid jodule
FNA is non diagnostic (follicular cells)
Tx of choice?

A

Thyroid lobectomy with isthmusectomy
If follicular CA, secondary sx for completion total thyroidectomy w postop I-131 is indicated

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26
Q

Factor best correlates w presence of LN metastasis in papillary CA

A

Age

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27
Q

Tx of choice for patients with papilary thyroid ca without clinical evidence of LN metastasis

A

Total thyroidectomy

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28
Q

Pt with very highCalcium
Palpable roch hard neck mass
Dx?

A

Parathyroid carcinoma
Tx
Wide excision with en block resection of adjacent thyroid tissue

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29
Q

Neuroendocrine cell etiology
Can occur throughout GI tract or bronchi
Flushing, diarrhea, R sided heart failure most commonly occurs with metastatic disease and mid-gut tumors

A

Carcinod tumor
Tx: Octreotide
Isolated mets can be resected

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30
Q

Follicular carcinoma metastases occur primarily by?

A

Hematogenoys dissemination to lungs, bones and other peripheral tissues

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31
Q

Confirmation of follicular thyroid CA

A

Indentification of Vascular or Capsular invasion by tumor from histologic section

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32
Q

Surgical tx of medullay thyroid CA

A

Total thyroidectomy w Central node dissection, lateral cervical LN samplinv of palpable nodes and a modified radical neck dissection, if positive

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33
Q

Germline defect in what gene responsible for Multiple Endocrine Neoplasia (MEN2a and 2b) and Familiar Medullary Thyroid CA (FMTC)

A

RET Proto-oncogene
- should undergo prophylactic thyroidectomy before 10yo

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34
Q

Histo caharacteristic of Medullary thyroid CA (MTC)

A

Congo red dye (+)
Apple green birefringence consistent with amyloid
Immunihistochemistry (+) for cytokeratins, CEA and Calcitonin
PARAFOLLICULAR C CELLS are the precursor to tumor cells

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35
Q

(+) Medullary thyroid CA
High urinary Vanillylmandelic acid (VMA)
Enlrged left adrenal gland
Management?

A

Alpha and beta blockers
Then resection of left adrenal gland
–should be performed before thyroid sx

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36
Q

Embryological origin of parathyroid gland

A

Inferior parathyroid - 3rd pharygeal pouch
Superior parathyroid - 4th pharyngeal pouch

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37
Q

Etiologies of hypercalcemia

A

Hyperparathyroidism
Paraneoplastic syndrome
Metastatic CA
Bone metastasis
Milk-alkali syndrome
Sarcoidosis

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38
Q

Effect of PTH on intestinal absorption of calcium

A

PTH stimulates vit D hydroxylation in the kidney and increases intestinal absorption of calcium

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39
Q

Calcitonin is produced in?

A

Parafollicular cells (C cells) of thyroid

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40
Q

Serum Calcium of 13 mg/dL
Serum PTH 400 mEq/mL
Dx?

A

Prinary hyperparathyroidism

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41
Q

Serum Calcium of 8.5 mg/dL
Serum PTH 400 mEq/mL
Serum creatinine 5.6mg/dL
Dx?

A

Secondary hyperparathyroidism

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42
Q

Appropriate management if thr 4th Parathyroid hormone cannot be located by intraoperative utz

A

Terminate the operation for localization studies

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43
Q

Problem if injured external branch of superior laryngeal nerve

A

Loss of High-pitched tone

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44
Q

Components of MEN 1 syndrome

A

Parathyroid hyperplasia (90%)
Islet cell Neoplasms (30-80%)
Pituitary tumors (15-50%)

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45
Q

Tx of choice pt w hyperparathyroidism associated MEN 1 or MEN 2
Also secondary hyperparathyroidism

A

Subtotal (3 ½ gland) parathyroidectomy or total parathyroiderctomy w autotransplantation in the FOREARM

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46
Q

1st line therapy for patients with marked hypercalcemia and/or severe symptoms

A

IV hydration followed by furosemide

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47
Q

Idication of calcium supplement after thyroid or parathyroid sx

A

Circumoral paresthesia, anxiety, positive Chvostek’s or Trousseau’s sign, tetany, ECG changes or serum calcium less than 7.1 mL/dL

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48
Q

In a nonacute setting, what is the max useful amount of calcium supplementation

A

2g calcium/d

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49
Q

Appropriate Calcium suppplementation if max amount of calciun has already been given and patient still hypocalcemic

A

Calcitriol or other vit D preparations

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50
Q

Medullary thyroid carcinoma
Pheochromocytoma
Mucosal neuromas
Ganglioneuromas
MARFANOID habitus
Dx?

A

MEN 2b

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51
Q

Zone of adrenal gland spared in autoimmune adrenal disease

A

Medulla

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52
Q

Secretion of which adrenal hormone NOT impaired by secondary adrenal insufficiency

A

Aldosterone

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53
Q

MC cause of chronic primary adrenal insufficiency (Addison’s disease)

A

Autoimmune disease

54
Q

MC cause of acute secondary adrenal insufficiency

A

Steroid medication withdrawal
Sheehan’s sybdrome (postpartum Pituitary necrosis)
Bleeding into a pituitary macroadenoma
Head trauma

55
Q

Posterior pituitary secrete?

A

ADH and Oxytocin

56
Q

Anterior pituitary secrete?

A

Growth hormone (GH)
Adrenal corticotropin hormone (ACTH)
TSH
LH
FSH
Prolactin

57
Q

Therapy should be istituted to obtaininv the results of ACTH stimulation test in a critically ill patient

A

Empiric stress dose of DEXAMETHASONE

58
Q

Basis of insulin-induced hypoglycemia test for patients with secondary adrenal insufficiency

A

Hypoglycemia induced by 0.1 unit of insulin/kg stimulates the entire hypothalamus-hypophyseal-adrenal axis (HPA) and the sympathetic nervous system
Plasma cortisol level should exceed 20g/dL

59
Q

Decreased SVR
Hypotension with high CO
Normal filling pressure
Hypoglycemia
Dx?

A

Hemodynamic pattern of patient with ADRENAL INSUFFICIENCY

60
Q

Daignostic test best predictor of adrenal adequacy in patients previously receiving steeoids, who are scheduled for surgery

A

Peak corrisol level after administration of corticotropin

61
Q

45yo male
Hypotension and lethargy
Henoglobin 12g/dL
Blood glucose 34mg/dL 24 hrs after colectomy
Hx renal transplant 3 years ago
Dx?

A

Addisonian crisis

62
Q

What inhibits GH secretion

A

Somatostatin

63
Q

Where aldosterone exert its primary effect

A

Distal tubules and collecting Ducts of the kidney

64
Q

Effect of aldosterone in kidney

A

Increases absorption of Sodium from urine in exchange for Potassium, aiding in water retention and restoring intravascular volume

65
Q

Catecholamines in stress

A

Increase
Glycogenolysis
Gluconeogenesis
Lipolysis
Ketogenesis

Inhibit insulin use in peripheral tissue

66
Q

Function of angiotensin II

A

VasoCONSTRICT
Cardiac stimulation
Stimulation of ADH, aldoaterone and thirst

67
Q

Stimuli causes release of ADH (vasopressin)

A

Plasma osmolality greater than 285 mOsm/L
Decrease circulating blood volume, catecholamines, renin-angiotensin system and opiates

68
Q

Inhibits release of LH in male adult

A

Androgens synthesized by testes

69
Q

Function if FSH in adult female

A

Stimulates maturation of the Graafian follicle and production of estradiol

70
Q

Limits secretion of ACTH and corticotropin-releasing factor (CRF)

A

Circulating levels of ACTH

71
Q

GH released in bursts when?

A

3-4 hrs after meals and during stage III and IV sleep

72
Q

Inhibits release of Prolactin

A

Dopamine

73
Q

Main physiological stimulus of prolactin release

A

Suckling of breast

74
Q

Drug interferes with release of dopamine into pituitary portal circulation and enhances prolactin secretion

A

Metaclopramide
Haloperidol
Chlorpromazine
Reserpine

75
Q

Patient with ACTH deficiency
What test will distinguish a hypothalamic CRH deficiency from pituitary ACTH deficiency

A

CRH stimulation test

76
Q

Dx if absent ACTH responsiveness to CRH

A

Pituitary corticotropin deficiency

77
Q

Two test will stimulate the entire HPA

A

Insulin-induced hypoglycemia test
Glucagon test

78
Q

Condition defined by a relative or absolute insuffeciency of vasopressin secretion from posterior pituitary

A

Diabetes insipidus

79
Q

How to diagnose central DI

A

Water deprivation test

80
Q

Tx of choice for central DI

A

Exogenous vasopressin

81
Q

Postpartum failure to lactate
Postpartum amenorrhea
Progressive signs and symptoms of adrenal insufficiency
Dx

A

Sheehan’s syndrome

82
Q

MC type of pitutary adenoma

A

Prolactin-secreting and null-cell (chromophobe adenoma)

83
Q

MC functional pituitary tumor

A

Prolactinoma

84
Q

MC presenting symptom of prolactinoma in females

A

Secondary amenorrhe

85
Q

Pharma agent effective in reducing serum prolactin, tumor mass and inhibit tumor growth

A

Bromocriptine (dopaminergic agonist)

86
Q

Hypersecretion of ACTH by pituitary

A

Cushing disease

87
Q

Hypertension
DM
Goiter
Hyperhidrosis

A

Metabolic manifestation of acromegaly

88
Q

Confirmatory test for acromegaly

A

Glucose suppresion test
Oral 100g of glucose fail to supress the GH level to less than 5ng/mL at 60mins

89
Q

Tx of GH producing pituitary adenoma

A

Surgical excision
Medical - octreotide

90
Q

Surgucal approach to pituitary

A

Transnasal
Trans sphenoidal approach

91
Q

Hormones synthesized and secreted by adrenal CORTEX

A

Cortisol
Aldosterone
Adrenal androgen
Estrogen

92
Q

Hormones synthesized by adrenal MEDULLA

A

Epinephrine
Norepinephrine
Enkephalins
Neuropeptide Y
Corticotropin-releasing hormone

93
Q

Adrenal Corticosteroid hypersecretion

A

Cushing SYNDROME

94
Q

Pt with palpitations
Headache
Emesis
Pounding pulse
Retinitis
Dx?

A

Pheochromocytoma

95
Q

Embryonic origin of adrenal cortex

A

Coelomic mesothelial cells

96
Q

Embryonic origin of adrenal Medulla

A

Ectodermal neural crest cells

97
Q

Primary neurotransmitter of sympathetic postganglionic fibers

A

Norepinephrine

98
Q

Ectopic adrenal medullary cells located lateral to aprta, near origin of inferior mesenteric artery

A

Glands of Zuckerland

99
Q

Arterial supply of adrenal gland

A

Superior suprarenal artery
Inferior suprarenal artery
Branch from Inferior phrenic artery

100
Q

Innervation of adrenal medulla

A

Preganglionic sympathetic neuron from celiac and renal plexus via splanchnic nerves

101
Q

Drainage of Right adrenal vein

A

Posterior Inferior vena cava

102
Q

Most circulating plasma cortisol is bound to this protein

A

Cortisol-biding globulin (CBG) , although small amounts are bound to albumin and other plasma proteins

103
Q

Effect of glucocorticoids on insulin and glucagon

A

Stimulates production of glucagon and inhibit secretion of insulin

104
Q

Aldosterone physiologic action

A

Reabsorb Sodium and excretion of Potassium, Hydrogen, and ammonia from the renal tubules
Stimulates active sodium and potassium transport in epithelial tissue (sweat glands, GU mucosa and saliva)

105
Q

MC cause of Cushing Syndrome

A

Pituitary adenoma

106
Q

MC causes ectopic ACTH secretion

A

Small Cell CA of lung

107
Q

Expected result of Dexamethasone supression test in a pt with ectopic source of ACTH secretion

A

Dexamethasone should fail to supress cortisol secretion

108
Q

Sex steroids produced in?

A

Zona reticulosis of adrenal cortex

109
Q

Initial eval in pt suspected to have Cushing’s syndrome

A

Urinary-free cortisol level (markedly elevated) and a low dose decamethasone supression test (no supresion of cortisol)

110
Q

Elevated cortisol
Elevated plasma ACTH
Persistent elevation of free cortisol after low and high dose dexamethasone administration

A

Ectopic source of ACTH

111
Q

Useful test to differentiate hypercortisolism caused by pituitary source of ACTH vs ectopic source of ACTH

A

Dexamethasone supression test
Metyrapone test

112
Q

MC cause of primary hyperaldosteronism

A

Solitary adrenal adenoma

113
Q

Enzymatic deficiency associated with most cases of adrenogenital syndrome (Congenital Adrenal Hyperplasia)

A

21- hydroxylase

114
Q

Marked hyperpigmentation of skin and visual disturbance
Dx,

A

Nelson syndrome

115
Q

MC cause of acute adrenocortical insufficiency

A

Withdrawal of chronic steroid therapy

116
Q

MC cause of Spontaneous adrenal insufficiency

A

Autoimmune dectruction of adrenal glands (>80%)

117
Q

MC associated disorder in pt with autoimmune adrenocortic insufficiency

A

Hashimoto’s thyroiditis

118
Q

Acute adrenal hemorrhage secondary to sepsis (classically meningococcal)

A

Waterhouse-Freiderichsen syndrome

119
Q

Most useful test to evaluate pt suspected having adrenocortical insufficiency

A

Rapid ACTH stimulation test

120
Q

Test of choice to distinguish hyperplasia from an adenoma as the cause of primary hyperaldosteronism

A

Measure plasma aldosterone concentration after change in posture

** only pt with adenoma experience postural decrease in aldosterone**

121
Q

Serum abnormalities seen in functional cortisone secreting adrenal adenoma

A

High 24hr urine cortisol
Low ACTH level

122
Q

Stimuli causes adrenal secretion of catecholamines

A

Hypoxemka
Hypoglycemia
Change in temp
Pain
Shock
CNS injury
Local wound factors
Endotoxin
Severe respiratory acidosis

123
Q

Dx test to confirm Pheochromocytoma

A

Urine metanephrines

124
Q

MC location of Neuroblastoma

A

Intra abdominal or retroperitoneal (60-70%)

125
Q

Classic electrolyte finding in hyperaldosteronism

A

Hypernatremia
Hypokalemia

126
Q

Syndromes associated with pheochromocytoma

A

MEN2a
MEN2b
Von Recklinghausen disease
Tuberous sclerosis
Sturge-weber disease

127
Q

Stimulates uterine contraction during labor
Elicit milk ejection by myoepithelial cells of the mammary ducts

A

Oxytocin

128
Q

Onlu hypervascular pancreatic neoplasm in angiography

A

Pancreatic Neuroendocrine tumors

129
Q

Fasting glucose <45 and relief of symptoms with glycose
High N and C trrminus of insulin in blood (exogenous insulin with C terminus only)

Most common islet tumor and benign in 90% of cases

A

Insulinoma

130
Q

High malignant potential
Most frequent islet cell tumor in MEN syndromw
High gastrin level
Severe peptic ulcer disease
Most located in gastrinoma triangle between CBD/cystic duct junction, 3rd portion of duodenum and gallbladder

A

Gastrinomas

131
Q

Order of sympathetic blocking medication administration preoperatively for pheochromocytoma

A

Alpha blocking preoperative (PHENOXYBENZAMINE) with PRN periop B blockade as 2ndary measure

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