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USMLE Step 1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the most common ectopic thyroid?

A

lingual (tongue)

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2
Q

Which neck mass is anterior and which is lateral?

A

thyroglossal cyst is anterior (moving with swallowing and tongue movement) and brachial cleft cyst is lateral

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3
Q

Where are follicular and parafollicular cells derived from?

A

follicular- endoderm

parafollicular-neural crest (secrete calcitonin)

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4
Q

What is the adrenal cortex derived from? what about the adrenal medulla?

A

cortex=mesoderm (GFR- aldosterone, cortisol, DHEA)

medulla=neural crest (chromaffin cells-catecholamines-epi/NE)

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5
Q

Does glucose or insulin cross the placenta?

A

glucose does and insulin does not

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6
Q

What happens to GnRH if you get hyperprolactinemia?

A

decrease it and thus decrease LH and FSH

Note you want pulsatile GnRH for puberty

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7
Q

What is somatostatin used to treat?

A

acromegaly, decreases GH and TSH

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8
Q

What does calcitonin do?

A

Decreases the levels of serum calcium (opposite of PTH)

Secreted by parafollicular cells (C cells of thyroid)

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9
Q

What inhibits T4/T3?

A

PTU (propylthiouracil) and methimazole

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10
Q

What are the functions of T3?

A

6 B’s brain maturation, bone growth, B-adrenergic, basal metabolic rate, blood sugar, break down lipids

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11
Q

What can cause pathogenic high ACTH? What will cause high cortisol, but low ACTH?

A
  1. ACTH secreting pituitary adenoma
  2. paraneoplastic syndromes (SCLC, bronchoid carcinoids)

High cortisol, low ACTH

  1. Bilateral adrenal hyperplasia
  2. Adrenal adenoma
  3. Adrenal carcinoma
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12
Q

What are the symptoms of adrenal insufficiency?

A

can’t make enough mineralocorticoids, glucocorticoids to sustain body’s needs so you get fatigue, orthostatic hypotension, weakness, muscle aches, salt and sugar cravings

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13
Q

What increases in primary adrenal insufficiency?

A

MSH (hyperpigmentation) in response to elevated ACTH

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14
Q

What is Waterhouse-Friderichsen syndrome?

A

massive adrenal hemorrhage (neisseria meningitidis) causing primary adrenal insuff

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15
Q

what is the difference between secondary adrenal insuff and primary?

A

with secondary you have low ACTH, so you don’t get hyperpigmentation with elevated MSH and you don’t get hyperkalemia because you still have an intact renin-angiotensin-aldosterone axis

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16
Q

what is teritary adrenal insuff caused by?

A

exogenous steroids

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17
Q

what are the causes of secondary hyperaldosteronism?

A

renovascular disease, juxtaglomerular cell tumours (renin producing tumour)

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18
Q

what is the difference between neuroblastoma and wilms tumour?

A

wilms tumour is smooth and unilateral, neuroblastoma is irregular and can cross the midline. Neuoblastoma looks for HVA and VMA elevated in urine, Get homer-wright rossetes. Neuroblastoma is a tumour of the adrenal medulla. Arises from neural crest cells.

19
Q

Pheochromocytoma?

A

most common adrenal medulla tumour in adults- neural crest cells (chromaffin cells)

  • rule of 10’s-10% malignant, bilateral, extra adrenal, kids, calcify
  • 5 P’s of symptoms,- pressure, pain, palpitations, perspiration, pallor
  • give phenoxybezamine
20
Q

Whats a VIPoma?

A

secretes vasoactive intestinal peptide- watery diarrhea, hypokalemia, achlorhydria, associated with MEN-1

21
Q

What antibodies cause Hashimoto’s hypothryoiditis? What kind of cells do you see on pathology?

A

antithyroid peroxidase and antithyroglobulin antibodies. Hurthle cells on pathology (lymphoid aggregates with germinal centers)

22
Q

What are the 6 P’s of congenital hypothyroidism?

A

pot-bellied, pale, protruding umbilicus, protuberant tongue, poo brain development
-caused by maternal antibodies

23
Q

What is de Quervain thyroiditis?

A

post viral illness, subacute granulomatous thyroiditis, very tender, usually after viral illness, high ESR, jaw pain

24
Q

What is Graves disease?

A

caused by thyroid stimulating immunoglobulins, HLA DR3 and HLA B8, get tall crowded follicular epithelial cells, scalloped colloid

25
Q

What is a toxic multinodular goiter?

A

Independent of TSH, releases T3/T4 from hot nodules (rarely malignant), the receptors don’t work. On pathology get hyperfunctioning follicular cells with distended colloid

26
Q

What are the 4 tx for thyroid storm?

A

propanolol (beta blocker), prednisone, propylthiouracil and potassium iodide

27
Q

What are the complications from thyroidectomy?

A

hoarseness (injury to recurrent and superior laryngeal nerves), hypocalcemia (removing parathyroid glands), dysphagia, dysphonia

28
Q

What is the most common thyroid cancer and what is the pathology?

A

papillary-orphan annie eyes (empty nuclear with central clearing), psammoma bodies, inc RET/PTC and BRAF arrangements

29
Q

Medullary thyroid carcinoma

A

parafollicular cells- secrete calcitonin, associated with RET mutations, congo red stain, sheets of cells in amyloid stroma

30
Q

What are the signs of hypoparathyroidism?

A

tetany, hypocalcemia, hyperphosphatemia. Can cause Chvostek sign (tap facial nerve and get contraction facial muscles) and/or Trousseau’s sign (BP cuff over brachial nerve causes carpal spasm).

31
Q

McAlbright hereditary osteodystrophy?

A

Kidney doesn’t respond to PTH, shortened 4th/5th digits, short stature, dev delay, AD but must be given by mother because of imprinting

32
Q

What is Osteitis fibrosa cystica?

A

cystic bone spaces filled with fibrous brown tissue (osteoclasts, hemosiderin from hemorrhages) inc PTH (usually from primary which would be parathyroid adenoma or hyperplasia

33
Q

What is familial hypocalciuric hypercalcemia?

A

High Ca, but low Ca in urine, G coupled receptors are less responsive to PTH

34
Q

What is Nelson syndrome?

A

bigger ACTH pituitary adenoma after removal of adrenal glands for Cushings- get headaches, bitemporal hemianopsia and hyperpigmentation

35
Q

How do you treat nephrogenic DI?

A

HCTZ, indomethacin, amiloride, don’t take offending agent, hydration, dietary restriction of salt

36
Q

What is SIADH- what are the causes?

A

caused by CNS injury, SCLC, pulmonary diseases, drugs (cyclophosphamide)- tx is water restriction, diuretics, hypertonic saline. Don’t want to correct too fast because of risk of cerebral edema

37
Q

What is renal path finding of diabetes?

A

Kimmelstiel-Wilson nodules

38
Q

What are the testing parameters for diabetes?

A

fasting >126, oral glucose tolerance >200, HgbA1c >6.5

39
Q

what are the antibodies that cause T1DM?

A

glutamic acid decarboxylase antibodies destroy the B cells

40
Q

What are the symptoms of glucagonoma?

A

DVT, delirium, declining weight, diabetes, depression, necrolytic migratory dermatitis- tx is surgery and ocetrotide

41
Q

What are the symptoms and cause of insulinoma?

A

beta cell tumour- whipple triad-hypoglycemia symptoms, low glucose and resolution of symptoms when you correct glucose-high C peptide- associated with MEN1

42
Q

Whats a somatostatinoma?

A

gamma cells- can cause diabetes/glucose intolerance, gallstones, steatorrhea, achlorhydria- decrease secretion of secretin, cholecystokinin, glucagon, insulin- tx with octreotide or surgery

43
Q

Are MEN syndromes genetically inherited?

A

AD
MEN 1 3P’s: Pituitary, Parathyroid, Pancreas
MEN 2A 2P’s: Parathyroid and pheochromocytoma
MEN 2B 1P: Pheochromocytoma

44
Q

How propylthiouracil and methimazole work?

A

inhibit thyroid perioxidase, inhibit oxidation of iodide, use PTU in 1st trimester then methimazole in 2nd two trimesters

USMLE Step 1 (20 decks)

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