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Step 1 2019 First Aid Flashcards > Endo - FA Anat/Phys p322 - 332 > Flashcards

Endo - FA Anat/Phys p322 - 332 Flashcards

1
Q

Most common ectopic thyroid tissue site?

A

thyroid tissue at base of tongue

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2
Q

Thyroglossal duct could persist as what structure?

A

as cysts or pyrimidal lobe of thyroid

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3
Q

normal remnant of thyroglossal duct?

A

foramen cecum

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4
Q

What is thyroglossal duct cyst? You must diff dx from?

A

anterior midline neck mass that moves with swallowing or protrusion of the tongue - (cystic dilation of of thyroglossal duct remnant)

Diff dx w. a lateral neck mass would be a persistent cervical sinus leading to pharyngeal cleft cyst

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5
Q

Thyroid follicular and parafollicular cells derived from?

A

endoderm

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6
Q

Layers of Adrenal Cortex? embryo origin

A

Glomerulosa, Fasciculata, Reticularis, from mesoderm

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7
Q

Cell type of adrenal medulla? origin?

A

chromaffin cells; neural crest

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8
Q

Primary regulatory control of Glomerulosa?

A

RAAS (not pituitary!!)

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9
Q

Secretory product of Glomerulosa?

A

Aldosterone (Mineralocorticoids) “Zona Aldosterona”

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10
Q

Primary regulatory control of Fasiculata and Reticularis?

A

ACTH, CRH

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11
Q

Secretory product of Fasiculata?

A

Cortisol (Glucocorticoids)

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12
Q

Secretory product of Reticularis?

A

Androgens

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13
Q

Adenohypophysis is of what embryo origin?

A

oral ectoderm

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14
Q

Neurohypophysis is of what embro origin?

A

Neuro ectoderm

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15
Q

Most common tumor of adrenal medulla in adults?

A

Pheochromocytomas

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16
Q

Most common adrenal medulla tumor in children?

A

Neuroblastoma

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17
Q

Pancreas cell types and products?

A

ƒ α = glucαgon (peripheral) ƒ β = insulin (central) ƒ δ = somatostatin (interspersed)

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18
Q

INC hCG seen in what disease?

A

Choriocarcinoma

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19
Q

Why do we see hyperpigmentation in tumors that produce inc ACTH?

A

ACTH and MSH are both from POMC, so with over production of ACTH, once also sees an increase of MSH, leading to inc melanin deposition

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20
Q

Alpha subunit of hormones in ant pit is common in which hormones?

A

TSH LH FSH, hCG - why with inc hCG we can see thyroid sx, it can act like TSH.

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21
Q

If trauma cuts stalk between hypothal and pit - which hormone will increase? why?

A

PRL - bc normally inhibited by Dopamine

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22
Q

If we always produce oxytocin, then why does oxytocin only cause uterine contraction and milk letdown at the end of pregnancy?

A

In fetal development, oxytocin of mother stays constant. Later in gestation, INC EXPRESSION of Oxytocin RECEPTORS of myometrium, inc sensitivity to oxytocin.

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23
Q

Give an example of permissive action of endocrine hormones?

A

Cortisol release leads to inc catecholamines and glucagon (glycogenolysis)

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24
Q

3 Migration failures of Endocrine? - explain

A
  1. Lingual Thyroid - failure of migration of thyroid tissue to its final location, thyroid can form at any part of thyroglossal duct 2. Kallman syndrome - failure of GnRH secreting hormomes to migrate from olfactory lobes –> HT 3. Cryptorchidism - failure of testes to migrate to scrotum
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25
Q

Failure of apoptosis leading to endocrine disorder?

A

T1DB, inappropriate apoptosis of pancreatic Beta cells

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26
Q

Beta subunit of ant pituitary determines what?

A

hormone Specificity

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27
Q

Vasopressin made in what part of the brain? (which nucleus)

A

SupraOptic nuclei (some Paraventricular)

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28
Q

Oxytocin is made in what part of the brain?

A

Paraventricular nuclei (some Supraoptic)

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29
Q

Synthesis of Insulin occurs where?

A

rER

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30
Q

What transporter is needed to take glucose into insulin dependent cells?

A

GLUT 4

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31
Q

List all functions of insulin

A

Dec lipolysis in adipose tissue
Inc glucose transport in sk musc and adipose tissue
inc glycogen synthesis and storage
inc TAG synthesis
Inc Na retention - kidney
Inc protein synthesis
Inc cellular uptake of K and amino acids
Dec glucagon release

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32
Q

Does Insulin cross the placenta?

A

No, only Glucose does

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33
Q

List all glucose transporters and where they are? Which is insulin dependent and independent?

A

Dependent GLUT 4 - adipose, sk musc

Independent

GLUT 1 - RBC, brain, cornea, placenta

GLUT 2 - bidirectional - B islet cells, liver, kidney, small intestine. —- NOTE REGULATORS OF INSULIN

GLUT 3 - brain, placenta

GLUT 5 (fructose) - spermatocytes, GI tract

SGLT1/2 - Na/glucose transporters - kidney, SI

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34
Q

Can RBC use ketones for energy ?

A

No, they can only do anaerobic glycolysis, since they lack mitochondria. Therefore, can only use glucose

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35
Q

Why is there an increased response to oral glucose over IV

A

Due to incretins like GLP2 and GIP, which are released in response to meals and inc B cell sensitivity to glucose

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36
Q

Autonomic receptor regulation of insulin

A

. Release dec by α2, inc by β2 stimulation (2 = regulates insulin)

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37
Q

MOA of sulfonylureas?

A

block K channel, leading to depol of B cells membran –> causing influx Ca2+ thru voltage gated calcium channels, inc Insulin release

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38
Q

What is increased before closing of K+ channels in beta cells of pancreas due to the entrance of glucose?

A

Inc ATP/ADP ratio

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39
Q

Fxn of Glucagon?

A

(+) glycogenolysis, gluconeogenesis, lipolysis and ketone production

increase blood sugar levels - When your glucose is gone…Glucagon

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40
Q

What 3 things inhibit glucagon?

A

Insulin, Hyperglycemia, Somatostatin

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41
Q

Fxn of ADH

A

Inc water permeability of DCT and coll duct, to inc water resorption

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42
Q

What stimulates ADH release - except when?

A

inc plasma osmolality, except in SIADH, where osmo is low, and ADH is still secreted.

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43
Q

CRH (+) release of?

A

ACTH, MSH, β-endorphin

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44
Q

Dopamine antagonists, like antipsychotics, cause _______ bc of inc PRL?

A

Galactorrhea

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45
Q

What GHRH analogue drug used to treat HIV assoc lipodystrophy?

A

Tesamorelin

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46
Q

High levels of prolactin suppresses what?

A

GnRH

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47
Q

Pulsatile GnRH leads to?

A

puberty, fertility

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48
Q

4 symptoms of pituitary Prolactinoma?

A

Amenorrhea, Osteoporosis, Hypogonadism, Galactorrhea

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49
Q

Analogue of somatostatin used to treat acromegaly and esoph varices?

A

Octreotide

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50
Q

Two GLP analogues?

A

Exenatide, Liraglutide

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51
Q

Fxn of PRL?

A

Stimulates milk production in breast, Inhibits ovulation in females and spermatogenesis in males by (-) GnRH synthesis and release

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52
Q

How does PRL inhibit its own secretion?

A

PRL (-) its own secretion by inc dopamine synthesis and secretion from HT

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53
Q

Rx for PRL-oma?

A

Dopamine agonists like Bromocriptine, Pergolide (-) PRL secretion

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54
Q

Which Rx stimulate PRL secretion?

A

Dopamine antagonists (most antipsychotics) and estrogens (OCPs, pregnancy) stimulate PRL secretion

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55
Q

Most common cause of gastroenteritis in developed countries?

A

Norovirus (single stranded RNA virus)

56
Q

What are the functions of growth hormone?

A

Stimulates linear growth Stimulates muscle mass
Increases insulin resistance (diabetogenic)

57
Q

Growth hormone stimulates muscle mass through

A

IGF-1 (Somatomedin C)

58
Q

Secretion of GH inc/dec when?

A

Secretion INC during exercise, deep sleep, puberty, hypoglycemia.

Secretion inhibited by glucose, somatostatin, and somatomedin

59
Q

function of ghrelin

A

Stimulates hunger (orexigenic effect) release of GH via GH secretagog receptor

60
Q

ghrelin is released by

A

the stomach

61
Q

ghrelin is increased in what two conditions

A

increased with sleep deprivation & prader willi syndrome

62
Q

leptin is

A

satiety hormone

63
Q

leptin is secreted by

A

adipose tissue

64
Q

mutation in what gene causes congenital obesity

A

Mutation in leptin gene

65
Q

Endocannabinoid receptors are in what part of the brain?

A

hypothalamus, nucleus accumbens

66
Q

what stimulates cortical reward center and increase desire for high fat foods

A

endocannabinoids

67
Q

Which receptors sense/regulates serum osmolarity and blood pressure

A

V1 recp - BP

V2 - serum osmolality

68
Q

ADH is synthesized in the

A

supraoptic nucleus of the hypothalamus

69
Q

ADH levels in central DBI or nephrogenic DI

A

dec in central diabetes insipidus
normal/Inc nephrogenic DI

70
Q

Calcitonin opposes the action of

A

PTH

71
Q

Calcitonin blocks what type of bone cell

A

osteoclast

72
Q

Zona fasciculata produces

A

glucocorticoids

73
Q

zona reticularis produces

A

androgens

74
Q

zona glomerulosa produces

A

mineralocorticoids

75
Q

ACTH stimulates what enzyme

A

cholesterol desmolase

76
Q

cholesterol desmolase is inhibited by

A

ketoconazole

77
Q

cholesterol desmolase converts cholesterol to

A

pregnenolone

78
Q

what are the 2 roles of 17 alpha hydroxylase

A

converting pregnenolone to 17-hydroxypregnenolone and then to DHEA (Dehydroepiandrosterone)

converting prosgesterone to 17-hyrdroxyprogesterone and then to Androstenedione

79
Q

2 drugs that block aromatase

A

Anastrozole and exemestane letrozole

80
Q

what block 5 alpha reductase

A

finasteride

81
Q

symptoms of 17 alpha hydroxylase in XY/XX

A

XY - ambiguous genitalia, undescended testes XX - lacks secondary sexual development

82
Q

what blocks conversion of cortisol to cortisone?

A

Glycyrrhetininc Acid (AKA Enoxolone)

83
Q

What stimulates aldosterone synthase?

A

Angiotensin II

84
Q

what enzyme deficiency is associated with decreased renin?

A

11 Beta Hydroxylase

85
Q

what enzyme deficiency is associated with increased renin and increased levels of 17-hydroxy-progesterone

A

21-hydroxylase

86
Q

what is the level of renin and aldosterone in 17 alpha hydroxylase def?

A

low renin, high aldo

87
Q

is the potassium level high or low in in 17 alpha hydroxylase def

A

low

88
Q

what explains low serum K+ in 17 alpha hydroxylase def?

A

11 deoxycorticosterone acts similiar to aldosterone leading to hypokalemia and metabolic acidosis

89
Q

which congenital adrenal enzyme def mimics Addison’s disease?

A

21 hydroxylase deficiency (b/c of high ACTH and low cortisol, hyperkalemia)

90
Q

Which congenital adrenal hyperplasia has higher levels of sex hormones?

A

11β-hydroxylase def and 21 hydroxylase

91
Q

which congenital adrenal enzyme def mimics Conn’s syndrome?

A

both 17 alpha hydroxylase and 11 beta hydroxylase def (b/c of low renin activity, hypokalemia due to high 11 DOC)

92
Q

how is cortisol regulated?

A

CRH from the hypothalamus stimulates ACTH release from the pituitary that stimulates cortical production in the adrenal zona fasciculata

93
Q

Actions of Cortisol

A

Inc appetite
Inc blood pressure
Inc insulin resistance & with that, dec glucose utilization (Inc gluconeogenesis, lipolysis, proteolysis)
dec fibroblast activity
dec bone formation (dec osteoblast activity)
Dec inflammatory and immune response

94
Q

How does cortisol dec inflammatory/ immune response?

A

ƒ Inhibits production of leukotrienes and prostaglandins
ƒ Inhibits WBC adhesion
Ž neutrophilia
ƒ Blocks histamine release from mast cells
ƒ Eosinopenia, lymphopenia
ƒ Blocks IL-2 production

95
Q

describe the effect of excess cortisol on CRH, ACTH

A

decrease CRH, decrease ACTH

96
Q

what property of cortisol can lead to purple striae

A

decreased fibroblast activity

97
Q

`Exogenous corticosteroids can lead to what infection and why?

A

Exogenous corticosteroids can cause reactivation of TB and candidiasis (blocks IL-2 production).

98
Q

2 reasons cortisol increases blood pressure

A

upregulates alpha 1 receptors on arterioles -> increased sensitivity to norepi and epi at high concentration, can bind to aldosterone receptor

99
Q

cortisol decreases bone formation by decreasing what cell activity?

A

osteoblast

100
Q

what acid/base disturbance can lead to hypocalcemia?

A

alkalosis (inc pH) –> inc affinity of albumin to bind Ca2+, leading to hypocalcemia

101
Q

symptoms of hypocalcemia?

A

cramps, pains, paresthesias, carpopedal spasm

102
Q

pH effect on PTH

A

Inc pH –> Inc PTH
dec pH –> albumin binds less Ca2+ –> Inc ionized Ca2+ –> dec PTH

103
Q

How does Ca levels, pH, and albumin affect PTH?

A

Ionized/free Ca2+ is 1° regulator of PTH; changes in pH alter PTH secretion, whereas changes in albumin concentration do not.

104
Q

name 4 functions of parathyroid hormone

A
  1. inc bone resorption of Ca2+ and PO43-
  2. inc kidney reabsorption of Ca2+ in distal convoluted tubule
  3. dec reabsorption of PO43- in proximal convoluted tubule
  4. inc 1, 25 (OH)2D3 (calcitriol) production by stimulating kidney 1 alpha hydroxylase in proximal convoluted tubule
105
Q

explain how PTH leads to the activation of osteoclast which leads to inc serum Ca2+

A

inc production of macrophage colony-stimulating factor and RANK-L (receptor activator of NF-KB ligand)

106
Q

RANK-L (ligand) is secreted by

A

osteoblast and osteocytes

107
Q

RANK receptor is on what cell

A

osteoclasts and their precursors

108
Q

how does RANK-L and RANK interact to stimulate Ca2+ release?

A

RANK-L (ligand) secreted by osteoblasts and osteocytes binds RANK (receptor) on osteoclasts and their precursors to stimulate osteoclasts and inc Ca2+ –> bone resorption

109
Q

will low serum Mg2+ stimulate or inhibit PTH secretion? what about very low serum Mg2+?

A

low serum Mg2+ will stimulate, however very low Mg2+ will lower PTH

110
Q

name 4 common causes of low serum Mg2+, thus can cause hyperparathyroidism

A

1)diarrhea 2)aminoglycosides 3)diuretics 4)alcohol

111
Q

`Calcitonin action

A

Calcitonin opposes actions of PTH. Not important in normal Ca2+ homeostasis.
Calcitonin tones down serum Ca2+ levels and keeps it in bones

112
Q

Fxn of Calcitonin and regulation

A

dec bone resorption of Ca2+
inc serum Ca2+ –> calcitonin secretion

113
Q

T3 functions

A

Brain maturation
Bone growth
β-adrenergic effects
Basal metabolic rate
Blood sugar
Break down lipids

114
Q

When are levels of TBG dec?

A

In hepatic failure, steroid usage, nephrotic syndrome

115
Q

How does T3 T4 inc BMR?

A

via inc Na+/K+-ATPase activity –> incr O2 consumption, RR, body temperature

116
Q

When are the TBG levels inc?

A

in pregnancy or OCP use (estrogen inc TBG)

117
Q

Which adrenergic receptors does T3/T4 affect?

A

incr β1 receptors in heart = incr CO, HR, SV, contractility

118
Q

What effect does T3/T4 have on glycogen and lipids?

A

inc glycogenolysis, gluconeogenesis, lipolysis

119
Q

T4 is converted to T3 in peripheral tissue by which enzyme?

A

5’ deiodinase

120
Q

T or F? Propylthiouracil inhibits only peroxidase.

A

F. inhibits both peroxidase and 5’-deiodinase

121
Q

Explain the Wolff-Chaikoff effect

A

excess iodine temporarily inhibits thyroid peroxidase–> Ž decr iodine organification–> decr T3/T4 production.

122
Q

Methimazole inhibits?

A

thyroid peroxidase

123
Q

coupling of monoiodotyrosine and di-iodotyrosine happens via which enzyme?

A

thyroid peroxidase

124
Q

Which Anions inhibit iodine oxidation?

A

perchlorate, pertechnetate, thiocyanate, iodide

125
Q

name all the hormones that use cAMP

A

FLAT ChAMP FSH LH ACTH TSH CRH hCG ADH (V2 receptor) MSH PTH calcitonin GHRH glucagon

126
Q

name all the hormones that use cGMP

A

ANP, BNP, NO

127
Q

name all the hormones that use IP3

A

GOAT HAG GnRH Oxytocin ADH TRH Histamine Angiotensin II Gastrin

128
Q

Which hormones use intracellular receptor?

A

Progesterone, Estrogen, Testosterone, Cortisol, Aldosterone, T3/T4, Vitamin D

129
Q

name all the hormones that use non Receptor-associated tyrosine kinase

which pathway?

A

Prolactin, Immunomodulators (eg, cytokines IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoietin

JAK/STAT pathway - think acidophils, cytokines

130
Q

name all the hormones that use Receptor-associated tyrosine kinase - which pathway?

A

Insulin, IGF-1, FGF, PDGF, EGF

MAP kinase pathway

131
Q

what 2 conditions increase SHBG in women?

A

OCPs, pregnancy (b/c estrogen inc SHBG synthesis)

132
Q

What form of vitamin D is from plants?

A

vitamin D2

133
Q

What form of vitamin D is from sun exposure?

A

vitamin d3

134
Q

2 functions of Vitamin D

A
  1. inc absorption of dietary Ca2+ and PO43- 2. inc bone resorption –> inc Ca2+ and PO43- absorption
135
Q

what 2 conditions increase SHBG in women?

A

OCPs, pregnancy (b/c estrogen inc SHBG synthesis)

Step 1 2019 First Aid Flashcards (63 decks)

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