Clinical Correlates Flashcards
(201 cards)
1
Q
MOST common 2nd messenger system
A
cAMP system
2
Q
2nd messenger system for INSULIN
A
Tyrosin Kinase (also used by IGF-1, EPO)
3
Q
2nd meseenger for THYROID HORMONE
A
None (acts like a steriod; does not need 2nd messenger)
4
Q
Hormones derived from Proopiomelanocortin (POMC)
A
MSH, ACTH, B-Lipoprotein, B-Endorphin
5
Q
Other name for Growth Hormone
A
Somatotropin
6
Q
Other name for Insluin-like Growth Factor 1 (IGF-1)
A
Somatomedin
7
Q
ANTAGONIZES Prolactin
A
Dopamine (and dopamine analogs like Bromocriptine)
8
Q
Main site of ADH/Vasopressin sytnehsis
A
Supraoptic nuclei of the anterior hypothalamus
9
Q
Main site of Oxytocin synthesis
A
Paraventricular Nuclei of the Anterior Hypothalamus (Mnemonic: PARA sa Voovs!)
10
Q
Site of Oxytocin and ADH/Vasopressin storage and secretion
A
Posterior Pituitary
11
Q
Predominant form of thyroid hormone in the blood
A
T4
12
Q
Active form of thyroid homone
A
T3
13
Q
3 Parts of the Adrenal Cortex
A
From outer to inner: G-F-R (salt, sugar, sex)
- Zona Glomerulosa (Aldosterone Secretion)
- Zona Fasciulatata (Cortisol secretion)
- Zona Reticularis (Weak Androgens)
14
Q
2 Products of the Adrenal Medulla
A
Epinephrine (80%), NE (20%)
15
Q
Increased adrenal androgens, decreased aldosterone, decreased cortisol
A
21-Beta Hydroxylase Deficiency (virilizing)
16
Q
Increased aldosterone, decreased adrenal androgens, decreased cortisol
A
17-Alpha Hydroxylase Deficiency (non-virilizing)
17
Q
Effect of insulin on potassium
A
Increased potassium uptake in muscles and adipose tissue (decreases plasma K+)
18
Q
Marker for endogenously produced insulin
A
C-peptide
19
Q
Responsible for TENSILE strength of bone
A
Collagen ibers (make up 95% of the organic matrix)
20
Q
Responsible for the Compressional strength of the bone
A
Bone salts
21
Q
Decreases calcium and phosphate excretion but increases urinary calcium, Increases intestinal calcium absorption
A
Vitamin D
22
Q
Decreases calcium excretion, increases phosphate excretion increases 1-alpha hydroxylase, increases bone resorption
A
PTH
23
Q
Stiulated by LH, releases the “libido” hormone testosterone
A
Leydig Cells (Mnemonic: LLL, LH, Leydig Cells, Libido)
24
Q
Stimulated by FSH, nurse cell for sperm
A
Sertoli Cells (Mnemonic: SSS: FSH, Sertoli Cells, Sperm)
25
Sperm formation
Seminiferous Tubutles
26
Sperm motility
Epididymis
27
Sperm Storage
Vas Deferens
28
Production of fructose, prostaglandins
Seminal Vesicle
29
Contributes to semen alkalinity
Prostate Gland
30
Supplies mucus to semen for lubrication
Bulbourethral Glands (Cowper's glands)
31
Main hormone of the follicular phase
Estrogen
32
Main hormone of the luteal phase
Progesterone
33
Causes ovulation
LH surge
34
Cells of the blastocyst that digests and liquefies the endometrium for invasion
Trophoblast
35
Beta-HCG is produced by
Syncytiotrophoblast
36
Promotes growth of the fetus, insulin resistance in the mom, lipolysis in the mother, index of fetal well-being
Human Chorionic Somatomammatropin (HCS) formerly known as HPL (Human Placental Lactogen)
37
Prevens pregnancy during breastfeeding
Inhibition of GnRH by prolactin
38
Adult Growth Hormone Deficiency
Peak GH response to hypoglycemia of
39
Acromegaly
Confirmed by demonstrating the failure of GH suppression to
40
Pegvisomant
GH-receptor antagonist that antagonizes endogenous GH action by blocking peripheral GH binding to its receptor
41
Cushing's Disease
Refers specifically to Cushing's syndrome caused by a pituitary corticotrope adenoma (increased ratio (>2) of inferior petrosal:peripheral vein ACTH)
42
Diabetes Insipidus
Syndrome characterized by the production of abnormally LARGE volumes of dilute urine
- 24 hour urine volume: >50mL/kg body weight
- urine osmolarity:
43
Pemberton's Sign
Venous distension over the neck and difficulty breathing especially when the arms are raised (in large retrosternal goiters)
44
Glucocorticoid EQUIPOTENCY can be assumed for
1mg hydrocortisone
1. 6mg cortisone acetate
0. 2mg prednisolone
0. 25mg prednisone
0. 025mg dexamethasone
45
"Rule of 10's" in Pheochromocyoma
```
10% are bilateral
10% are extraadrenal
10% are malignant
10% calcify
10% in children
10% familial
```
46
Rule of 1/3 in Carcinoid Syndrome
1/3 metastasize
1/3 present with 2nd malignancy
1/3 multiple
47
Screening for DM
- All individuals >45 years every 3 years
| - Screening at an EARLIER age if overweight (BMI>25) and have one additional risk factor for diabetes
48
C peptide
- Useful MARKER of insulin secretion
| - Allows discrimination of endogenous and exogenous sources of insulin in the evaluation of hypoglycemia
49
Honeymoon phase
Time when glycemic control is achieved with modest doses of insulin
50
Protypical patient of hyperglycemic hyperosmolar state
- Elderly with type 2 DM, with several week history of polyuria, weight loss, and diminished oral intake
- Culminates in mental confusion, lethargy or coma
51
Correlated serum sodium
Add 1.6meq for each 100mg/dL rise in serum glucose
52
Microvascular manifestations of DM
Retinopathy, Neuropathy, Nephropathy
53
Macrovascular manifestations of DM
Coronary heart disease, Peripheral Arterial Disease, Cerebrovascular Disease
54
Proliferative retinopathy
Treated with panretinal laser photocoagulation
55
Macular edema
Treated with focal laser photocoagulation
56
Microalbuminuria
30-299mg/day in a 24-h collection or 30-299 ug/mg creatinine in a spot collection (PREFERRED)
57
Diabetic Dermatopathy
Pigmented pretibial papules or diabetic skin spots
58
Fructosamine Assay
Reflects the glycemic status over the prior 2 week
59
Normal ejaculate
Volume of 2-6mL
Sperm counts >20million/mL
Motility of >50%
>15% normal morphology
60
True gynecomastia
Glandular breast tissue that is >4cm in diameter and often tender
61
Mittelschmerz
Midcycle pelvic discomfort that is thought to be caused by the rapid expansion of the dominant follicle at the time of ovulation
62
Infertility
Defined as the inability to conceive after 12 months of unprotected sexual intercourse
63
Fecundability
Probability of achieving pregnancy in one menstrual cycle
64
Precocious puberty in boys
Development of secondary sexual characteristics before the age of 9
65
Delayed puberty in boys
Development of secondary sexual characteristics after the age of 14
66
Precocious puberty in girls
Development of secondary sexual characteristics before the age of 8
67
Delayed Puberty in Girls
Absence of secondary sexual characteristics by age 13
68
Humoral Hypercalcemia of Malignancy
Due to the overproduction of the parathyroid hormone related peptide (PTHrP) by cancer cells
69
FGF-23
POTENT inhibitor of renal 1A-hydroxylase
70
WHO definition of osteoporosis
Bone density that falls 2.5 standard deviations (SD) BELOW the mean for young healthy adults of the same sex (also referred to as a T score of -2.5)
71
T Scores
Compare individual results to those in a YOUNG population that is matched for RACE AND SEX
72
Z-Scores
Compare individual results to those of an AGE-MATCHED population that also is matched for RACE and SEX
73
Diagnosis of osteoporosis
T-score below -2.5 in lumbar spine, femoral neck, or total hip
74
Denosumab
Fully human monoclonal antibody to RANKL
75
Teriparatide (1-34hPTH)
An exogenous PTH analogue
76
Increased ACTH secretion by pituitary gland
Cushing's Disease
77
Hypercortisolism due to other causes
Cushing Syndrome
78
Excessive urination secondary to insensitivity of the renal tubules to aDH
Nephrogenic Diabetic Insipidus
79
Excessive urination secondary to lack of ADH
Central Diabetes Insipidus
80
Excess ADH causing excessive resorption of water in hyponatremia
SIADH
81
MOST common cause of hypopituitarism in children associated with WNT signaling pathway
Craniopharyngioma
82
Hypothyroidism in infancy or early childhood
Cretinism
83
Taping along facial nerve induces contractions of the muscles of the eye, mouth or nose
Chvostek sign
84
Carpal spasms produced by occlusion of the circulation to the forearm
Trousseau sign
85
Most common functioning pituitary adenoma
Prolactinoma
86
Second MOST common pituitary adenoma
Somatotroph adenoma
87
Postpartum necrosis of anterior pituitary gland which clinically presents as sudden cessation of lactation
Sheehan syndrome
88
Presents with headache, diplopia, hypopituitarism
Pituitary apoplexy
89
Papillary Thyroid CA
Orphan Annie eye nuclei
90
Follicular Thyroid CA
Hurthle cells, invades blood vessels
91
Medullary Thyroid CA
Derived from C cells, MEN-associated
92
Anaplastic ThyroidCA
Giant cells, spindle cells
93
MOST COMMON cause of hypthyroidism in iodine sufficient areas
Hashimoto Thyroiditis
94
MOST COMMON cause of hypothyroidism worldwide
Iodine deficiency
95
Chronic inflammatory infiltrate of the thyroid gland with multinucleate giant cells
Subacute thyroiditis
96
Most common cause of PAINFUL thyroid gland; associated with viral infection (Coxsackie)
Subacute, granulomatous, De Quervain
97
Lymphocytic infiltration of the thyroid gland with hyperplastic germinal centers; patchy disruption and collapse of thyroid follicles; no fibrosis and Hurthle cell metaplasia
Lymphocytic thyroiditis
98
Condition where normal thyroid tissues are replaced by fibrous tissue; usually associated with sclerosing mediastinitis
Reidel thyroiditis
99
Presents with hyperthyroidism, ophthalmopathy, dermopathy
Graves Disease
100
MOST common primary thyroid cancer in adults and children
Papillary Thyroid Cancer
101
Diseases associated with PSaMMoma Bodies
Papillary Thyroid CA
Serous Cystadenoma of the ovaries
Meothelioma
Meningioma
102
Most common cause of primary hyperparathyroidism
Parathyroid adenoma
103
Elevated PTH, Normal Calcium levels
PseudoPseduoHypoparathyroidism/Tertiary Hyperparathyroidism
104
Elevated PTH occuring in CKD patients
Secondary Hyperparathyroidism
105
Osteoporosis
```
Ca2+ --
Phosphate--
ALP--
PTH--
Notes: Bone mass decreases
```
106
Osteopetrosis
```
Ca2+ --
Phosphate--
ALP--
PTH--
Notes: Thickened dense bones
```
107
Osteomalacia/rickets
```
Ca2+ decrease
Phosphate decrease
ALP --
PTH Increase
Notes: Soft Bone
```
108
Osteitis Fibrosa Cystica
```
Ca2+ Increase
Phosphate Decrease
ALP Increase
PTH Increase
Notes: "Brown Tumors"
```
109
Paget's Disease
```
Ca2+ --
Phosphate--
ALP Increase
PTH--
Notes: Abnormal Bone architecture
```
110
Type 1 DM
Usually Occurs at age
111
Type 2 DM
Strong, polygenic genetic predisposition
| Islet amyloid deposit
112
Hypertension associated with hypokalemia treated which cannot be controlled by monotherapy
Hyperaldosteronism
113
Most common cause of primary hyperaldosteronism
Idiopathic Hyperaldosternosim
114
Adrenals are converted to sacs of clotted blood, which virtually obscures all underlying detail
Waterhouse-Friderichsen Syndrome (causes Acute Adrenal Insufficiency)
115
Neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones
Pheochromocytoma
116
Serum Cortisol
Pituitary CS: Increased
Adrenal CS: Increased
Ectopic Cs: Increased
117
Urine free cortisol
Pituitary CS: Increased
Adrenal CS: Increased
Ectopic Cs: Increased
118
Low-dose dexamethasone
Pituitary CS: Cortisol not suppressed
Adrenal CS: Cortisol not suppressed
Ectopic Cs: Cortisol not suppressed
119
High dose dexamethasone
Pituitary CS: Cortisol suppressed
Adrenal CS: Cortisol not suppressed
Ectopic Cs: Cortisol not suppressed
120
Plasma ACTH
Pituitary CS: Normal to elevated
Adrenal CS: Decreased
Ectopic Cs: Markedly Increased
121
Tropic hormone failure associated with pituitary compression or destruction usually occurs SEQUENTIALLY
GH>FSH>LH>TSH>ACTH
- during childhod: growth retardation is often the presenting feature
- In adults: HYPOGONADISM is the earliest symptom
122
ACTH reserve most reliably assessed by
Measuring ACTH and cortisol levels during insulin-induced hypoglycemia
123
Size of Microadenoma
124
Presents the LEAST resistance to soft tissue expansion from the sella; consequently, pituitary adenomas frequently exend in a SUPRASELLAR direction
Dorsal sellar diaphragm
125
MOST common MECHANISM by which suprasellar extension can lead to a bitemporal heianopsia
Compression of the Optic Chiasm
126
EARLY sign of optic tract pressure
Loss of red perception
127
DESIRED surgical approach for pituitary tumors (EXCEPT for the rare invasive suprasellar mass surrounding the frontal or middle fossa or the optic nerves or invading posteriorly behind the clivus)
Transsphenoidal Surgery
128
MOST common pituitary hormone hypersecretion syndrome in both men and women
Hyperprolactinemia
129
Hallmarks of hyperprolactinemia
- Amenorrhea
- Galactorrhea
- Infertility
130
Mainstay of therapy for patients with micro- or macroprolactinomas
Dopamine agonists (Cabergoline and Bromocriptine)
131
Most abundant anterior pituitary hormone
GH (cells are acidophilic along with those producing prolactin)
132
Major source of circulating IGG-1
Liver
133
Major determinant of hepatic IGF-1 synthesis
Growth Hormone
134
Most validated test to distinguish pituitary-sufficient patients from AGHD
Insulin-induced hypoglycemia
135
Most common cause of GHRH-mediated
Chest or abdominal Carcinoid tumor
136
MOST significant clinical impact of GH exess occurs with respect to
Cardiovascular system
137
Overall MORTALITY in acromegaly is increased about threefold and is due PRIMARILY to
Cardiovascular and cerebrovascular disorders and respiratory disease
138
Provides a useful laboratory SCREENING measure when clinical feature raise the possibility of acromegaly
IGF-1 level
139
INITIAL treatment for MOST patients with acromegaly
Surgical resection of GH-secreting adenomas
140
Side effect of somatostatin analogues in acromegaly
Drug-induced suppression of gastrointestinal motility and secretion
141
Account for 70% of patients with ENDOGENOUS causes of Cushing's syndrome
Pituitary Adenomas
142
MOST common cause of Cushingoid features
latrogenic hypercortisolism
143
Certain features make PATHOLOGIC causes of Hypercortisolism more likely
- Central redistribution of fat
- Thin skin with striae and bruising
- Proximal Muscle weakness
144
Primary cause of DEATH in Cushing's
Cardiovascular Disease
145
Precise and cost-effective screening test for Cushing's syndrome
Measurement of 24-h urine free cortisol
146
DISTINGUISH patients with ACTH-independent (adrenal or exogenous glucocorticoid) from those with ACTH dependent (pituitary, ectopic ACTH) Cushing's syndrome
Basal plasma ACTH levels
147
Most ACTH-secreting pituitary tumors
148
May be required to DISTINGUISH these lesions from ectopic ACTH-secreting tumors
Bilateral inferior petrosal sinus ACTH sampling before and after CRH administration
149
MOST common PRESENTING feature of adult hypopituitarinism, even when other pituitary hormones are also deficient
Hypogonadism
150
HARBINGER of hypothalamic or pituitary lesions that impair GnRH production or delivery through the pituitary stalk
Hypogonadism
151
MOST COMMON type of pituitary adenoma
Nonfunctioning and gonadotropin-producing pituitary adenomas
152
Most clinically nonfunctioning adenomas
Originate from gonadotrope cells
153
Most important, if NOT the only, physiologicaction of Arginine Vasopresin (AVP)
Reabsorbs water, promotes concentrated urine
154
Differentiates Central vs. Peripheral Diabetes Insipidus (DI)
Fluid Deprivation test
155
Thyroid hormone synthesis normally begins
11 weeks gestation
156
Subunit unique to TSH
Beta subunit (alpha subunit is common to LH, FSH, hCG)
157
Critical FIRST step in thyroid hormone synthesis
Iodid uptake
158
MOST common cause of preventable mental deficiency
Iodide deficiency
159
Importance in diagnosis of Thyroid Hormone Resistance
To avoid inappropriate treatment of mistaken hyperthyroidism and to provide genetic counseling
160
Method of CHOICE when it is important to determine thyroid size accurately
Ultrasound
161
Logical approach to thyroid testing is to FIRST determine
TSH levels
162
Detected MOST easily by measuring circulating antibodies against thyroid peroxidase and thyroglobulin
Autoimmune thyroid disease
163
Main use of thyroid-stimulating antibodies (TSI)
Predict neonatal thyrotoxicosis caused by high maternal levels of TSI in the LAST trimester of pregnancy
164
MOST common SYMPTOM of hypothyroidism
Tiredness, Weakness
165
MOST common SIGN of hypothyroidism
Dry coarse skin, cool peripheral extremities
166
Least common SYMPTOM of hypothyroidism
Impaired hearing
167
Least common SIGN of hypothyroidism
Serous cavity effusions
168
BEST documented risk factors for autoimmune hypothyroidism
HLA-DR polymorphisms (especially HLA-DR3, -DR4 and -DR5)
169
There is NO convincing evidence for a role in infection in autoimmune hypothyroidism EXCEPT FOR
Congenital rubella syndrome
170
Thyroid cell destruction in autoimmune thyroiditis is PRIMARILY mediated by
CD8+ cytotoxic T cells
171
Normal TSH level excludes
Primary (but NOT secondary) hypothyroidism
172
MAJOR role in pathogenesis of MYXEDEMA COMA, leading to hypoxia and hypercapnia
Hypoventilation
173
External warming in hypothermia if myxedema is indicated only if
Temperature is
174
MAJOR etiologies of thyrotoxicosis are hyperthyroidism are caused by
- Graves' disease
- Toxic multinodular goiter
- Toxic adenoma
175
Most common SYMPTOM of hyperthyroidism
Hyperactivity, irritability, dysphoria
176
Most common SIGN of hyperthyroidism
Tachycardia, atrial fibrillation in the elderly
177
Least common SYMPTOM of hyperthyroidism
Oligomenorrhea, loss of libido
178
Least common SIGN of hyperthyroidism
Gynecomastia
179
Minor risk factor for Grave's disease
Smoking
180
MAJOR risk factor for the development of ophthalmopathy
Smoking
181
Apathetic thyrotoxicosis in the elderly present mainly with
Fatigue and weight loss
182
Most common cardiovascular manifestation of hyperthyroidism
Sinus tachycardia (often associated with palpitations)
183
EARLIEST manifestations of Grave's opthalmopathy
Sensation of grittiness, eye discomfort and excess tearing
184
Grave's ophthalmopathy: in 5-10%, muscle swelling is so severe that diplopia results, typically, but not exclusively, when patient looks
Up and laterally
185
Most serious manifestation of Grave's ophthalmoscopy
Compression of optic nerve at apex of the orbit
186
Most frequent site of Thyroid Dermopathy
Anterior and lateral aspects of the lower leg (pretibial myxedema)
187
Time of MAJOR risk for relapse in Graves' disease in pregnancy
Post-partum period
188
Prior to radioiodine therapy, carbimazole or methimazole must be stopped
At least 2 days before
189
Prior to radioiodine therapy, PTU should be stopped
Several weeks before
190
ABSOLUTE contraindications to radioiodine
Pregnancy and breast-feeding
191
Most common cause of acute thyroiditis in children and young adult
Presence of a piriform sinus (Predominantly Left-sided)
192
MOST common clinically apparent cause of chronic thyroiditis
Hashimoto's Thyroiditis
193
MAJOR cause of sick euthyroid syndrome
Release of CYTOKINES
194
MOST common pattern of sick euthyroid syndrome
DECREASE in total and unbound T3 levels (low T3 syndrome) with NORMAL levels of T4 and TSH
195
Clinical manifestations of MOST goiters
Asymptomatic
196
Sonographic characteristics of thyroid nodules suggestive of malignancy
- Microcalcifications
- Hypoechogenicity
- Increased vascularity
197
In benign thyroid neoplasms, risk of Malignancy is Very LOW
- macrfollicular (colloid)
| - Normofollicular (simple)
198
In benign thyroid neoplasms, risk of malignancy raise greater concern and histology is more difficult to interpret
- microfollicular (fetal)
- trabecular (embryonal)
- Hurthle cell variant (oncocytic)
199
MOST common malignancy of the ENDOCRINE system
Thyroid CA
200
Most common type of THYROID CANCER
Papillary Thyroid Carcinoma
201
More common in iodine-deficient regions
Follicular Thyroid Carcinoma
