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Flashcards in 2nd Endocrine exam Deck (84):
1

Enzyme PTH acts on in kidneys

1alpha-hydroxylase

2

What prevents PTH secretion?

Ca2+ binds receptors
Gq inhibits exocytosis
Gi inhibits PTH secretion

3

Bone cells with PTH receptors

Osteoblasts
Osteophytes

4

Precursor of Vit D in skin

in lower dermis
7-dehydrocholesterol

5

Storage forms of Vit D

lumisterol
tachysterol

6

Calcitonin source and use for marker

C cells of thyroid
marker for medullary carcinoma of thyroid

7

Sx of hypercalcemia

renal stones/bone pain/abd pain/polyuria constipation
short QT interval
decreases neuronal excitability

8

Different b/t hypercalcemia with malignancy and primary hyperparathyroidism

malignancy-high PTHrp, low PTH
hyperparathryoid-low PTHrp, high PTH

9

Tx for severe hypercalcemia

saline
bisphosphonates
loop diuretics
mithramycin

10

Use of mithramycin

RNA inhibitor of osteoclasts
for hypercalcemia
do not use with liver/renal dysfxn or coagulopathy

11

MOA of gallium nitrate

decreases solubility of hydroxyapatite crystals
used for hypercalcemia

12

Use and risk with phosphate

rapid/profound hypercalcemia tx
risk with renal azotemia

13

Effects of PTH depending on administration

1-3hrs daily-builds bone
continuous-bone resorption

14

MOA of teriparatide

active PTH
for osteoporosis

15

Oral phosphate binders

Ca2+ carbonate/acetate- inhibit phosphate absorption
sevelamer-binds intestinal phosphate
used with CKD

16

MOA of cinacalet

calcimimetic
binds Ca2+ receptor on parathyroid
inhibits PTH release

17

Pro and con of bisphosphonates

long t1/2
poor GI absorption

18

Risk with etidronate long term use

osteomalacia

19

Use for calcitonin

osteoporosis
Paget's disease

20

Pros and cons of estrogen/hormone replacement for osteoporosis

pro-decreased LDL, increased HDL and TG's
con-increased endometrial hyperplasia/cancer

21

MOA of raloxifene

estrogen agonist
no endometrial stimulation
decreases LDL and cholesterol

22

Adverse effects of raloxifene

muscle cramps
DVT
peripheral edema

23

MOA of thyroid peroxidase

oxidizes I- to I
adds I to tyrosine
conjugates DIT/MIT

24

Transports of I in thryoid

basal-Na/I symport
apical-pendrin (I uniport)

25

Labs seen with iodine deficiency

decreaseds overall T3 and T4
increased T3/T4 ratio

26

Carriers of thyroid hormones

TBG-affected by heparin
transthyretin-affinity for T4
albumin

27

Types of deiodinase enzymes

type 1-provides T3 from T4
type 2-T3 levels in CNS
type 3-inactivates T3/T4 in placenta/glial cells

28

What extends the t1/2 of TSH?

glycosylation

29

T3 transport in cells

into via MCT8/10 or OATP1C1
binds Zn finger in DNA

30

Molecules decreasing T3/T4 release

dopamine
somatostatin
glucocorticoids

31

MOA of thyroid hormones

increase mitochondrial genes
use MAPK and STAT pathways

32

Actions of T3/T4

CNS-increase excitability/maturity
Bone growth
beta1 receptor upregulation

33

Impact of secondary hyperparathyroidism

renal osteodystrophy
calciphylaxis (vascular calcification)

34

Abs seen with Hashimoto's thyroiditis

anti-microsomal Abs
anti-thyroid peroxidase Abs
anti-thyroglobulin Abs

35

What is seen with Hashimoto's thyroiditis?

Huerthle cells
lymphocyte infiltrate
gradual failure
anti-microsomal/anti-TPO

36

What is seen with De Quervain's thyroiditis?

aka subacute granulomatous thyroiditis
painful goiter
previous coxsackie/echovirus infection
hyper (1-3wks) followed by hypothyroidism

37

Post-partum thyroiditis

anti-TPO
2-10 post birth

38

Cause of proptosis in Grave's disease

hyaluronic acid deposition around the eye

39

What is seen with Grave's disease?

TSI
exophthalmos
pretibial myxedema
onycholysis of 4th/5th digit

40

Risk with antithyroid drugs

agranulocytosis

41

What helps with thyroid nodule dx?

MoAB 47 increases accuracy with needle aspiration

42

When are psammona bodies seen?

papillary carcinoma of thyroid
papillary renal cell carcinoma
papillary serous carcinoma
mesothelioma

43

Medullary thyroid carcinoma asscs

MEN 2A and 2B

44

Cause of subacute granulomatous thyroiditis

in summer
coxsackie/measles/mumps/adenovirus
triggered by URT infection

45

Microscopy of Grave's disease

scalloped margins of colloid

46

Assc with papillary thyroid carcinoma

ionizing radiation
Orphan Anne's eyes
psammona bodies
lymphatic spread

47

Spread of follicular thyroid carcinoma

hematogenous

48

Microscopy of Medullary thyroid carcinoma

amyloid deposits
secretes calcitonin

49

Risk with liothyronine

cardiotoxicity

50

Risk with thyroid agonists

induction by CYP450
cardio problems at higher doses

51

Con of antithyroid drugs

increased relapse

52

MOA of methimazole/propylthiouracil

inhibits TPO

53

Methimazole impact on fetus

fetal scalp defect

54

Adverse effect of methimazole
Adverse effect of propylthiouracil

change taste or smell
liver toxicity

55

Beta blockers used for sx of hyperthyroidism

propanolol
esmolol

56

Role of FOX01 gene

effects of fasting/decreasing beta cells
insulin inhibits it

57

Inhibitors of glucagon release

insulin
somatostatin
Zn2+
GABA

58

Insulin impact on K+

increased transport into cells

59

When is amylin increased?

obesity & HTN
packed with insulin in granules

60

Islet of Langerhans granule types

beta-rectangular matrix with halos
alpha-round with dense center
delta-pale granules (somatostatin)
PP-small dark granules

61

Defect with MODY

insulin-insulin recetpor signal
AD

62

Diabetes and microscopy of kidney

Kimmelstein-Wilson nodules (PAS (+))
sign of sclerosis
hyaline ateriolosclerosis (afferent only)

63

Gastrinoma assc

MEN 1
Zollinger-Ellison syndrome

64

Sx of VIPoma

watery diarrhea
hypokalemia
achlorhydria

65

Rapid acting insulins

aspart
lispro
glulisine

66

Long acting insulins

glargine
detemir

67

Metformin

biguanide
increases insulin sensitivity
decreases gluconeogenesis of liver
no hypoglycemia seen

68

Glipizide/glyburide/glimepiride

sulfonylureas
block K+ channels in beta cells
cause hypoglycemia

69

Rosiglitazone/pioglitazone

thiazolidinediones
same MOA as metformin

70

Acarbose/miglitol

alpha-glucosidase inhibitors
steady Glc uptake
work on brush border enzymes

71

Repaglinide/nateglinide

glinides/meglitinides
closes K+ channels in beta cells
less hypoglycemia

72

Sitagliptan/saxagliptan/linagliptan/alogliptan

dipeptidyl peptidase inhibitor-4
increase Glc mediated insulin production
allows incretins (GLP-1 & GIP) to act

73

DM type 1 asscs

HLA-DR3 and DR4

74

Honeymoon phase of DM1 tx

temporary regain of insulin secretion
goes away within weeks

75

Cause of acanthosis nigrans

ILGF stimulation from insulin
causes keratinocytes to proliferate

76

Risk with metformin

lactic acidosis

77

Exenatide/liraglutide

GLP-1 analogs
increase insuline release via Glc

78

Tx for autonomic impact of DM

midodrine for orthostatic hypotension

79

Tx for peripheral neuropathy of DM

amitryptiline
gabapentin
regabalin
duloxitine

80

Tx for GI neuropathy of DM

erythromycin
metocloperamide (cholinergic)

81

MODY mutation

glucokinase transcription factors
AD

82

Infection with diabetic ketoacidosis

mucor
klebsiella

83

Meds causing DKA

steroids
clozapine
pentamidine

84

Whipple's triad

documented low BG
sx of hypoglycemia
reverasal of sx with Glc