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Clinical Medicine LAB - Professor Sample > Endo #1 > Flashcards

Endo #1 Flashcards

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1
Q

hGH- Human Growth Hormone secreted by ?

A

acidophil cells

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2
Q

hGH- Human Growth Hormone modulates ?

A

Modulates growth from birth until the end of puberty

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3
Q

hGH- Human Growth Hormone when is it secreted ?

A

Secreted in response to sleep, exercise, ingestion of protein, and response to hypoglycemia

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4
Q

hGH- Human Growth Hormone

own notes ?

A

fluctuates with sleeep, glucose levels in the blood stream or types of meals that we are eating

need to remember that Gh fluctuate in the serum

to much GH from childhood is giantism

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5
Q

GH assay: Increased ?

A

Gigantism - starts in childhood

Acromegaly - excess growth hormone starting in adult hood

  • *Arcomegaly - large extremities and head circumference gets bigger
  • *
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6
Q

GH assay: Decreased ?

A

Dwarfism - decrease at childhood ( achondroplasia)

Pituitary insufficiency -

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7
Q

GH Hormone Stimulation Test use ________ or ___________ hypoglycemia to stimulate GH secretion

A

Arginine

insulin-induced

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8
Q

GH Hormone Stimulation Test: decreased ?

A

Pituitary deficiency

GH deficiency

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9
Q

GH Hormone Stimulation Test own notes ?

A

lower the BG then more GH will be secreted

we used insulin or arginine ( to stimulate hyperglycemia) to stimulate GH secretion - if they can secret cause they are deficit

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10
Q

GH Suppression Test aka ?

A

Oral glucose tolerance test

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11
Q

Oral glucose tolerance test: GH will not be suppressed in patients with ?

A

acromegaly or gigantism

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12
Q

Oral glucose tolerance test own notes ?

A

give them a big oral glucose load, it should surpass GH secretion ( if you cant suppress it , like acromegaly and giantism )

given to prig patients to see if gestational diabetes

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13
Q

Insulin-like Growth Factor (Somatomedin C) reflects ?

A

More accurately reflects GH activity

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14
Q

Insulin-like Growth Factor (Somatomedin C) increased ?

A

Acromegaly

Gigantism

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15
Q

Insulin-like Growth Factor (Somatomedin C) decreased ?

A

Dwarfism

GH deficiency

Pituitary deficiency

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16
Q

Insulin-like Growth Factor (Somatomedin C) own notes ?

A

GH are all somatomedin

Insulin like Growth factors is one of them

when they are circulating, you can check for these instead of the GH cause it does not fluctuate like the GH does = get a better average of what the GH activity look like

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17
Q

ADH aka ?

A

Anti-diuretic hormone, Vasopressin

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18
Q

ADH own notes ?

A

it lines the tubules and sucks water back into the tissue tr into the bodty = helps retain water

concentrates the urine bay acting on the tubules to retain water

taking free water out

less aADH - more dilute urine - water is not being reabsorbed

bug part in osmotic homeostasis and helps maintain BP

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19
Q

ADH: Osmotic homeostasis ?

A

Concentrates the urine by acting on the collecting tubules to reabsorb the water

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20
Q

ADH: Volume homeostasis ?

A

↑ water reabsorption : maintains BP

vasoconstrictor

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21
Q

ADH is secreted in response to ?

A

Hypernatremia

Dehydration

Hypotension

Stress/ anxiety - retain water

anywhere where our body wants to retain water

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22
Q

ADH is surpassed by ?

A

Hyponatremia
CHF
Vasoconstrictors

when our body want to get rid of free water 9 less ADH lining tubules so we dont retain the water

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23
Q

Abnormal ADH: DI ?

A

ADH secretion is inadequate

Nephrogenic

Central (Neurogenic)

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24
Q

Abnormal ADH: SIADH ?

A

Carcinoma of thymus or lung (SCLC)

Severe stress

CNS tumor/ CVA ( stroke)

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25
ADH testing: Serum ADH increased ?
SIADH Nephrogenic DI because if we have ADH that is trying to stimulate the K to retain water and the K can respond and it is still release water - High ADH levels but still going to have volume depletion ( K cannot concentrate urine) CNS tumors/ infection Ectopic ADH secretion (paraneoplastic syndrome) Dehydration
26
ADH testing: Serum ADH decreased ?
Neurogenic DI lack of ADH coming from central area Ablation of pituitary pituitary problems Hypervolemia
27
ADH Suppression Test purpose ?
Differentiate between SIADH and other edematous conditions
28
ADH Suppression Test procedure ?
Administer water (20 mL/kg up to 1500 mL) in 10-20 minutes Collect urine every hour for 6 hours and send for SG ( specific gravity) and urine osmolality measurements
29
ADH Suppression Test: results - SIADH ?
Water excretion: little Urine osmolality: ↑ Urine SG: ↑ U/S ratio: ↑
30
ADH Suppression Test: results - other edematous states ?
Begin excreting up ~80% of water load = NL
31
ADH Suppression Test own notes ?
NL alot of water they will just pee it out SIADH the more water we give them they still can get it out and they continue to be more and more volume overloaded ( no free water secretion into urine)
32
Water Deprivation Test: ADH Stimulation Test | purpose ?
Differentiate between causes of polyuria including neurogenic/ nephrogenic DI = peeing alot of free water
33
ADH Stimulation Test: procedure ?
Pt is deprived of fluids Serum osmolality rises above 288 mOsm/kg to consider pt adequately dehydrated Administer Vasopressin SQ Obtain urine osmolality
34
ADH Stimulation Test | own notes ?
we dehydrate them even further kidney problem or neurologic problem Neurogenic Problem - and we give them vasopressin - then we will see a rise in urine osmolality - cause it is from a central place ( when give the V you should see a rise in UOsmolality if neurogenic ) Kidney Problem - and kidney is not responding and you give them the V - the kidneys still cannot concentrate the urine
35
Water Deprivation Test: results - Rise in Urine Osmolality of > 9% ?
Neurogenic DI
36
Water Deprivation Test: results - Little to No increase in Urine Osmolality ?
Nephrogenic DI
37
_________- - Ca balance and homeostasis ( calcitonin, calcitriol, regulateds)
parathyroid Thyroid and Parathyroid
38
Calcium homeostasis is regulated by ?
Parathyroid hormone (PTH) Calcitriol Calcitonin
39
Calcium Balance own notes ?
decrease loss of Ca from the urine pulls Ca from the bone PTH - is supposed to increase Ca we need healthy liver ( for VD) and precusrose to make calcitriol ( active VD) which we need to get Ca increase PTH leaks Ca out of bone calcitonin - deposits it back to the bone they do the opposite
40
Calcium: NL physiology ?
PTH, ↓Phosphate, ↓1,25 (OH)2 Vit D ( cause it needs it for the Ca) , ↑ Calcitonin ( decrease serum Ca)
41
Calcium Increased: in blood stream ?
Malignancy - bone mets, neruoendorcine acts Hyperparathyroidism (Primary) - uncheck PTH release that increase serum Ca
42
Calcium decreased ?
Hypoparathryoidism Liver disease (malabsorption of vitamin D)
43
Calcium Balance own notes ?
Ca is inverse P ( not Mg) just know it is related between these tings dont worry about the arrows need VD to absorb the Ca
44
PTH NL physiology ?
↑ Ca, ↓ Phosphate
45
PTH increased ?
Hyperparathyroidism
46
PTH decreased ?
Malignancy ( because of negative feedback mechanism) Hypoparathyroidism
47
Calcitonin NL physiology ?
↓ Ca
48
Calcitonin increased ?
Tumor marker for medullary carcinoma (thyroid CA) - highly likely used all the time to monitor this CA
49
1,25- (OH)2 Vit D Calcitriol aka ?
Calcitriol
50
Calcitriol NL physiology ?
↓PTH ↑Ca
51
Calcitriol decreased ?
Renal failure Liver failure **rickets osteomalacia **
52
Intact PTH range ?
(10-65)
53
Serum Calcium range ?
(9-10.5)
54
Intact PTH = 75.2 Serum Calcium = 11.2 condition ?
Hyperparathyroidism ( primary - coming from the gland itself - something wrong with the gland
55
Intact PTH = 23.8 Serum Calcium = 9.2 condition ?
NL
56
Intact PTH = 8 Serum Calcium = 11.6 condition ?
Malignancy ( PTH is low cause it is trying to lower Ca) think CA first before anything else
57
Intact PTH = 124 Serum Calcium = 9.1 condition ?
Secondary Hyperparathyroidism ( just barely bring Ca into NL range - maybe secondary to kidney disease )
58
Intact PTH = 6.4 Serum Calcium = 8.0 condition ?
Hypoparathyroidism
59
remember the Ca levels are very sensitive ?
a little change? then follow up and investigate it
60
Thyroid own notes ?
like gas petal in car hyperthyroid - sweating , palpatations, anoxiat7 attacks, diarrhea hypothyroid - cold all the time, sluggish , tired, gained wiehgt, constipation TRH from Hypothalamus then goes to the Pituitary to release TSH and then it goes to the thyroid to release T3 and T4
61
Thyroid stimulating hormone (TSH) aka ?
Thyrotropin
62
Thyroid stimulating hormone (TSH) stimulates ?
Stimulates thyroid to secrete T3 and T4
63
Thyroid stimulating hormone (TSH) increased ?
Primary hypothyroidism
64
Thyroid stimulating hormone (TSH) decreased ?
Hyperthyroidism ( primary) trying to put break on thyroid but it keeps release T3 and T4 but the TSH decline and the T keeps pumping it out ( TSH levels dont matter) Secondary hypothyroidism P is failing to put out TSH , decreased TSH levels , something wrong with the producer
65
T4/ Thyroxine: 90% total = ?
Bound + Unbound **free T4 is more metabolically active **
66
T4/ Thyroxine free: increased ?
Hyperthyroidism
67
T4/ Thyroxine free: decreased ?
Hypothyroidism
68
T3/ Triiodothyronine | free: increased ?
Hyperthyroidism
69
T3 aka ?
Triiodothyronine
70
T4 aka ?
Thyroxine
71
Antithyroglobulin antibody (Anti-TG Ab) increased in ?
Hashimoto’s Grave’s disease
72
Antithyroglobulin antibody (Anti-TG Ab) bates page ?
Mosby’s pg. 103, Table 2-7
73
``` Antithyroglobulin antibody (Anti-TG Ab) own notes ? ```
Thyroid disease is often from a autoimmune problem H ( AI hypo) and GD ( AI hyper) ABS toward the thyroid and you can test for the ABS Thyroid globulin is normally in the thyroid and with damage it can be in the serum and it acts like a antigen and the body attacks more likely to be found in H (70%) then GD ( 55%)
74
Antithyroglobulin antibody (Anti-TG Ab) is more sensitive to ?
more likely to be found in H (70%) then GD ( 55%)
75
Antithyroid peroxidase antibody (Anti-TPO Ab) | increased in ?
Hashimoto’s Grave’s disease
76
Antithyroid peroxidase antibody (Anti-TPO Ab) | own notes ?
only found in the microsomes in the epithelial cells inside the T and NL not in the serum if tissue destruction - some escape the microsomes and our body sees it as an FB antigen 90% H have this ABS 70% with GD have this ABS GD - inflammation of the T and stimulates the T cells that relate the Hormones
77
Antithyroid peroxidase antibody (Anti-TPO Ab) is more sensitive to ?
90% H have this ABS 70% with GD have this ABS
78
Thyroid Stimulating Immunoglobulin (TSI) | supports what dx ?
Grave’s disease * *This is more for GD dx the other two are more for H * *
79
TSH NL range ?
0.3-5
80
Free T4 ?
0.8-2.8
81
TSH = 0.1 Free T4 = 3.6 Diagnosis ?
Hyperthyoridism ( GD)
82
TSH = 10.2 Free T4 = 0.6 Diagnosis ?
Hypothyroidism ( primary)
83
TSH = 3.2 Free T4 = 2.6 Diagnosis ?
NL
84
TSH = 0.03 Free T4 = 0.4 Diagnosis ?
secondary hypothyroidism( pituitary is failing)
85
TSH = 0.12 Free T4 = 6.5 Diagnosis ?
Hyperthyroidism ( could be GD but you need ABS)

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