2nd Endocrine exam

Question 1

Enzyme PTH acts on in kidneys

Answer 1

1alpha-hydroxylase

Question 2

What prevents PTH secretion?

Answer 2

Ca2+ binds receptors
Gq inhibits exocytosis
Gi inhibits PTH secretion

Question 3

Bone cells with PTH receptors

Answer 3

Osteoblasts

Osteophytes

Question 4

Precursor of Vit D in skin

Answer 4

in lower dermis

7-dehydrocholesterol

Question 5

Storage forms of Vit D

Answer 5

lumisterol

tachysterol

Question 6

Calcitonin source and use for marker

Answer 6

C cells of thyroid

marker for medullary carcinoma of thyroid

Question 7

Sx of hypercalcemia

Answer 7

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

Question 8

Different b/t hypercalcemia with malignancy and primary hyperparathyroidism

Answer 8

malignancy-high PTHrp, low PTH

hyperparathryoid-low PTHrp, high PTH

Question 9

Tx for severe hypercalcemia

Answer 9

saline
bisphosphonates
loop diuretics
mithramycin

Question 10

Use of mithramycin

Answer 10

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

Question 11

MOA of gallium nitrate

Answer 11

decreases solubility of hydroxyapatite crystals

used for hypercalcemia

Question 12

Use and risk with phosphate

Answer 12

rapid/profound hypercalcemia tx

risk with renal azotemia

Question 13

Effects of PTH depending on administration

Answer 13

1-3hrs daily-builds bone

continuous-bone resorption

Question 14

MOA of teriparatide

Answer 14

active PTH

for osteoporosis

Question 15

Oral phosphate binders

Answer 15

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

Question 16

MOA of cinacalet

Answer 16

calcimimetic
binds Ca2+ receptor on parathyroid
inhibits PTH release

Question 17

Pro and con of bisphosphonates

Answer 17

long t1/2

poor GI absorption

Question 18

Risk with etidronate long term use

Answer 18

osteomalacia

Question 19

Use for calcitonin

Answer 19

osteoporosis

Paget’s disease

Question 20

Pros and cons of estrogen/hormone replacement for osteoporosis

Answer 20

pro-decreased LDL, increased HDL and TG’s

con-increased endometrial hyperplasia/cancer

Question 21

MOA of raloxifene

Answer 21

estrogen agonist
no endometrial stimulation
decreases LDL and cholesterol

Question 22

Adverse effects of raloxifene

Answer 22

muscle cramps
DVT
peripheral edema

Question 23

MOA of thyroid peroxidase

Answer 23

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

Question 24

Transports of I in thryoid

Answer 24

basal-Na/I symport

apical-pendrin (I uniport)

Question 25

Labs seen with iodine deficiency

Answer 25

decreaseds overall T3 and T4 | increased T3/T4 ratio

Question 26

Carriers of thyroid hormones

Answer 26

TBG-affected by heparin transthyretin-affinity for T4 albumin

Question 27

Types of deiodinase enzymes

Answer 27

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

Question 28

What extends the t1/2 of TSH?

Answer 28

glycosylation

Question 29

T3 transport in cells

Answer 29

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

Question 30

Molecules decreasing T3/T4 release

Answer 30

dopamine somatostatin glucocorticoids

Question 31

MOA of thyroid hormones

Answer 31

increase mitochondrial genes | use MAPK and STAT pathways

Question 32

Actions of T3/T4

Answer 32

CNS-increase excitability/maturity Bone growth beta1 receptor upregulation

Question 33

Impact of secondary hyperparathyroidism

Answer 33

renal osteodystrophy | calciphylaxis (vascular calcification)

Question 34

Abs seen with Hashimoto's thyroiditis

Answer 34

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

Question 35

What is seen with Hashimoto's thyroiditis?

Answer 35

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

Question 36

What is seen with De Quervain's thyroiditis?

Answer 36

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

Question 37

Post-partum thyroiditis

Answer 37

anti-TPO | 2-10 post birth

Question 38

Cause of proptosis in Grave's disease

Answer 38

hyaluronic acid deposition around the eye

Question 39

What is seen with Grave's disease?

Answer 39

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

Question 40

Risk with antithyroid drugs

Answer 40

agranulocytosis

Question 41

What helps with thyroid nodule dx?

Answer 41

MoAB 47 increases accuracy with needle aspiration

Question 42

When are psammona bodies seen?

Answer 42

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

Question 43

Medullary thyroid carcinoma asscs

Answer 43

MEN 2A and 2B

Question 44

Cause of subacute granulomatous thyroiditis

Answer 44

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

Question 45

Microscopy of Grave's disease

Answer 45

scalloped margins of colloid

Question 46

Assc with papillary thyroid carcinoma

Answer 46

ionizing radiation Orphan Anne's eyes psammona bodies lymphatic spread

Question 47

Spread of follicular thyroid carcinoma

Answer 47

hematogenous

Question 48

Microscopy of Medullary thyroid carcinoma

Answer 48

amyloid deposits | secretes calcitonin

Question 49

Risk with liothyronine

Answer 49

cardiotoxicity

Question 50

Risk with thyroid agonists

Answer 50

induction by CYP450 | cardio problems at higher doses

Question 51

Con of antithyroid drugs

Answer 51

increased relapse

Question 52

MOA of methimazole/propylthiouracil

Answer 52

inhibits TPO

Question 53

Methimazole impact on fetus

Answer 53

fetal scalp defect

Question 54

Adverse effect of methimazole | Adverse effect of propylthiouracil

Answer 54

change taste or smell | liver toxicity

Question 55

Beta blockers used for sx of hyperthyroidism

Answer 55

propanolol | esmolol

Question 56

Role of FOX01 gene

Answer 56

effects of fasting/decreasing beta cells | insulin inhibits it

Question 57

Inhibitors of glucagon release

Answer 57

insulin somatostatin Zn2+ GABA

Question 58

Insulin impact on K+

Answer 58

increased transport into cells

Question 59

When is amylin increased?

Answer 59

obesity & HTN | packed with insulin in granules

Question 60

Islet of Langerhans granule types

Answer 60

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

Question 61

Defect with MODY

Answer 61

insulin-insulin recetpor signal | AD

Question 62

Diabetes and microscopy of kidney

Answer 62

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

Question 63

Gastrinoma assc

Answer 63

MEN 1 | Zollinger-Ellison syndrome

Question 64

Sx of VIPoma

Answer 64

watery diarrhea hypokalemia achlorhydria

Question 65

Rapid acting insulins

Answer 65

aspart lispro glulisine

Question 66

Long acting insulins

Answer 66

glargine | detemir

Question 67

Metformin

Answer 67

biguanide increases insulin sensitivity decreases gluconeogenesis of liver no hypoglycemia seen

Question 68

Glipizide/glyburide/glimepiride

Answer 68

sulfonylureas block K+ channels in beta cells cause hypoglycemia

Question 69

Rosiglitazone/pioglitazone

Answer 69

thiazolidinediones | same MOA as metformin

Question 70

Acarbose/miglitol

Answer 70

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

Question 71

Repaglinide/nateglinide

Answer 71

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

Question 72

Sitagliptan/saxagliptan/linagliptan/alogliptan

Answer 72

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

Question 73

DM type 1 asscs

Answer 73

HLA-DR3 and DR4

Question 74

Honeymoon phase of DM1 tx

Answer 74

temporary regain of insulin secretion | goes away within weeks

Question 75

Cause of acanthosis nigrans

Answer 75

ILGF stimulation from insulin | causes keratinocytes to proliferate

Question 76

Risk with metformin

Answer 76

lactic acidosis

Question 77

Exenatide/liraglutide

Answer 77

GLP-1 analogs | increase insuline release via Glc

Question 78

Tx for autonomic impact of DM

Answer 78

midodrine for orthostatic hypotension

Question 79

Tx for peripheral neuropathy of DM

Answer 79

amitryptiline gabapentin regabalin duloxitine

Question 80

Tx for GI neuropathy of DM

Answer 80

erythromycin | metocloperamide (cholinergic)

Question 81

MODY mutation

Answer 81

glucokinase transcription factors | AD

Question 82

Infection with diabetic ketoacidosis

Answer 82

mucor | klebsiella

Question 83

Meds causing DKA

Answer 83

steroids clozapine pentamidine

Question 84

Whipple's triad

Answer 84

documented low BG sx of hypoglycemia reverasal of sx with Glc