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endo Flashcards

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0
Q

Thyroid connect to the tough by?

disease?

A

thyroglossal duct.
normally disappears,
presistence as pyramidal lobe of thyroid
foramen cecum is normal remnant of thyroglossal duct

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1
Q

thyroid diverticulum arises from?

A

floor of primitive pharynx

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2
Q

ectopic thyroid tissue most likely in?

A

tongue

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3
Q

Thyroglossal duct cyst?

A

anterior midline neck mass that moves swallowing

contain thyroid tissue

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4
Q

Branchial cysts?

A

lymphoepithelial cysts
persistent cervical sinus in the lateral neck
remnant of branchial arch and salivary gland inclusion in cervical LN
lymphoid tissue

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5
Q

adrenal medulla arises from?

A

neural crest

chromaffin cell

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6
Q

adrenal cortex arises from

A

mesoderm

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7
Q

outer layer of cortex of medulla

A

Zona Glomerulosa
renin-angiotensin regulation
produces aldosterone

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8
Q

middle layer of adrenal cortex

A

Zona Fasiculata
ACTH, hypothalamic CRH regualtion
ropuces cortisol and sex hormones

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9
Q

inner layer of cortex of adrenal

A

Zona reticularis
ACTH and hypothalamic CRH stimulation
produces sex hormones

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10
Q

Medulla of adrenal

A

preganglionic sympathetic fiber stimulation

produces catecholamines, Epi and NE

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11
Q

most common tumor in adrenal gland in adult

A

phenochromocytoma

causes episodic HTN

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12
Q

the most common adrenal tumor in Children

A

neurblastoma

do not cause episodic HTN

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13
Q

left adrenal drainage

A

left adrenal vein–>left renal vein–>IVC

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14
Q

right adrenal drainage

A

right adrenal vein–>IVC

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15
Q

posterior pituitary secret?

A

ADH and oxytocin
derive from neuroectoderm
from supraoptic and paraventricular thalamus, via neurophysins

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16
Q

anterior pituitary derive from?

A

oral ectoderm

Rathke’s pouch

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17
Q

Acidophils in pituitary

A

GH and prolactin

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18
Q

Basophils in pituitary

A 
FSH,
LH, 
ACTH 
TSH
B-FLat
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19
Q

alpha cell of islet?

A

secrete glucagon

peripheral

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20
Q

Beta cell of islet ?

A

secrete insulin

central position

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21
Q

Delta cell of islet

A

secrete somatostatin

interspersed

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22
Q

insulin secretion

A 
Glucose+GLUT-1-->
Glycosis-->
ATP increase-->
closes K+channels and depolarizes beta cells membrane-->
opens Ca2+ channel-->
Ca influx stimulate insulin secretion
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23
Q

Do insulin cross placenta?

A

No

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24
Insulin independent glucose uptake BRICK L Glut-2
``` Brain RBC Intestine Cornea Kidney Liver ```
25
insulin dependent glucose uptake
adipose tissue and skeleton muscle | Glut-4
26
bidircetional uptake
``` Glut-2 islet cell liver kidney small intestine ```
27
``` insulin effect? glucose? glycogen?glucagon? TG? Protein?AA? Na+?K+? ```
increase transport into skeleton muscle and adipose tissue,increase synthesis, decrease release; increase synthesis and storage; increase synthesis; increase cellular uptake increase retention, increase cellular uptake;
28
increase insulin?
``` hyperglycemia beta2-agonist GH GIP Glucagon need insulin to deliver to cell Secretagogues, sulfonylurea and meglitinide binds to K+channel on cell to increase ```
29
decrease insulin
hypoglycemia, somatostatin, alpha-2 agonists stress:NE
30
increase fatty acid will____________insulin resistance
increase
31
glucagon targets?
liver cell, | not muscle!!!!!!
32
``` steroid hormone: speed? Protein bound? half life? action by? exceptions? ```
``` slow speed Yes protein bound long half-life actionby nuclear receptor-->mRNA-->translate protein DHEA-except watersoluble adrenal adrogens not protein bound ```
33
``` Peptide hormones speed? Protein bound? half life? action by? exceptions? ```
fast not protein bound,secreted by urine Gprotein-->messenger--> Protein phospholation-->enzyme regulation short half life except IGF that is protein bound with a protin carrier
34
all hormones are pulsatile except?
thryroid
35
prolactin is inhibited by?
DA | prolactin + DA secretion and DA- prolactin
36
treatment for prolactinoma
Dopamin agonist:bromocriptine
37
prolactin is stimulated by?
TRH, very nonspecific
38
GH is max at
night,2 am | also increase during excercise
39
GH function by stimulation of ?
IGF-1/ somatomedin | result in insulin resistance
40
GH is inhibited by?
Glucose and somatostatin
41
GH level is reflected by?
IGF-1 IGF-1 have a longer half lofe arginine infusion will increase GH
42
fetal hypothyroidism is cuzed by?
increase need for GH | GH need thyroid hormone
43
GH deficiency will cause? resistant will cause?
deficiency: Dwartism resistance: Laron syndrome increase GH and decrease IGF-1, cannot be treat by GH
44
17-alpha hydroxylase deficiency
increase mineralocorticoid: hypertension, hypo K+ decrease cortisol: decrease sex hormone: decrease DHT: 外生殖器不明显，testis未降 女性：缺少第二性征，其余表现皆为女性
45
21－hydroxylase
decrease minerlocorticoid: hyPOtension, hyPER K+,increase renin, volume depletion. decrease cortisol increase sex hormone: masculinization
46
11beta-hydroxylase
1. decrease aldosterone, increase 11-deoxycorticosterone,: hyPERtension 2. decrease cortisol 3. increase sex hormone: masculinization.
47
cortisol______insulin? _____fibroblast? _____bone formation? ______Gluconeo?________lipolysis?____proteolysis?
increase insulin resistant inhibits decrease increase
48
aldosterone function
targets kidney Na+retention, increase secretion of Na+ increase ECF and BP
49
index for all androgen? in urine
17-detosteroid | adrenal and testicular
50
Pth is secreted by?
chief cell of parathyroid
51
PTH function
1. increase Ca and VitD 2. decrease phosphate, increase urine phosph 3. increase M-CSF and RANK-1 in osteoblasts,+osteoclasts * Ca increase via kidney is fast, via bone is slow
52
PTH secretion is ______by increased Mg?
is increased Mg, Ca decrease->PTH increase but if Mg decrease too much-->PTH decrease
53
common cause of lose of Mg
Diarrhea aminoglycoside diurectics: loop alcohol
54
PTHrP is?
produced by tumor, paracine increase Ca , structure homology to PTH and binds to receptor can be treated by calcitonin
55
calcitonin function?
secreted in increase Ca | it will shunt off osteoblasts
56
Vit D formation
D3 from sun and D2 from plants--> 25-OH in liver--> 1,25-(OH)2 in kidney
57
Vit D is increase by?
increased PTH decrease Ca decrease phosph
58
calcitonin is secreted by?
parafollicular cell of thyroid | C cell,from neural crest
59
thyroid follicular cell is from? parafollicular cell? intersititial cell from?
ectoderm neurcrest mesothelium
60
TBG regulation?
increased in pregnancy and OCP use also increase T4,so..... increase in TBG-->normal free hormone, only free the active increase in total T3,T4, normal TSH
61
T3 and T4 which is major in production and major in function
T4 is major in production T3 is major in function T4-->(via 5'-deiodinase)T3 beta blocker blocks conversion
62
function of peroxidase?
oxidation and organification of iodide as well as coupling of MIT and DIT inhibited by propylthiouracil and methimazole. propylthiouracil also inhibits 5'-deiodinase.
63
difference between TRH,TSH,TSI
TRH-->+TSH-->+T3, T4 | TSH and TSI is similiar and TSI stimulate cell in Graves Disease, thyroid stimulating immunoglobins.
64
Wolff-chaikoff effect?
excess iodine temporarily inhibits thyroid peroxidase--> decrease iodine organification--> decrease T3 and T4 production
65
what is rT3
reverse T3: inactive form of thyroid T3 cannot become rT3, but... T4 can become T3 and rT3
66
what inhibits organification of Iodine
Anions perchlorate pertechnetate
67
Thyroid tests
TSH is 1st!!!! for Hypo, changes before T3 and T4 free T4 Ab? TPO Ab(hashimoto and graves); TSI Ab(Graves) Iodine isotype increase in hyperthyroid
68
suppress with high and low dex
normal
69
suppress with high dex but not low
ACTH-pituitary tumor
70
not suppressed by high or low dex
ectopic ACTH-producing tumor | cortisol producing tumor
71
hypertension hypokalemia metabolic alkalosis low plasma renin
conn syndrome adrenal hyperplasia/aldosterone-secreting adrenal adenoma bilateral or unilateral treat:surgery, spironolactone, K sparing diuretic that works by acting an aldosterone antagonist
72
``` high plasma renin Na increase ECF volume increase renal perfusion decrease edema no HTN ```
``` 2ndary hyperaldosteronism due to over reation of renin-ang system: renal artery stenosis,nephrotic syndrome CHF cirrhosis Treat:spironolactone,never scan first.一般都有阳性反应 ```
73
increase cortisl decrease ACTH no hyperpigmentation
primary hypercortisol
74
increase cortisol increase ACTH hyperpigmentation
2ndary hypercortisol | cushing and atopic ACTH
75
decrease cortisol increase ACTH hyperpigmentation
primary adrenal hypocortisol
76
decrease cortisol decrease ACTH no hyperpigmentation
2nd hypocortisol 2nd adrenal insufficiency, from sudden withdrawal of steriod no pigment and no hyper k
77
addison disease
adrenal atrophy and absence of hormone production, involving 3 layer 1.hypotension,hyperK, asidosis 2.skin pigmentation:MSH from POMC increase intracellular fluid but decrease osm, decrease EC fluid and osm rapid ACTH stimulation test: normal cortisol will increase, no change hypo
78
waterhouse-friderichsen syndrome
N. meningitidis septicemia endotoxic shock Acute primary adrenal insufficiency
79
episodic HTN with 5P
phenochromocytoma Pressure,pain, perspiration, palpitation, pallor #1 tumor in adult adrenal medulla, from chromaffin cells,neural crest secrete NE, Epi,DA diagnosis: urine VMA and increase plasma catecholamines associated with neuroblastomasis type1 and MEN 2A 2B treat:alpha and beta bocker-->surgery
80
MIBG scan
metaiodobenaylguanidine uptake by norepi transporter diagnosis metastatic pheoromocytoma
81
Neuroblastoma
``` #1 in children overexpression of N-myc oncogene-->rapid progression less likely for HTN can occur anywhere along the SANS chain increase HVA in urine ```
82
osteitis fibrosa cystica
cystic bone spaces filled with brown fibrous tissue | bone pain
83
stone bone goan
primary hyper PTH with osteitis fibrosa cystica-->bone increase Alka phosph, increase cAMP inurine weakness and constipation-->goan hyperciluria-->stone
84
Renal osteodystrophy
2ndary hyperPTH decrease Ca absorption in gut and increase phosph inchronic renal disease: hypoVitD-->decrease Ca absorption increase alka phosph
85
tertiary hyperPTH
refractory(autonomous) hyper PTH resulting from chronic renal disease very high PTH, increase Ca
86
cause for hypoPTH
``` autoimmune excision by surgery DiGeorge's syndrome Finding:hypoCa and tetany Chvostek and Trousseau's sign ```
87
chvostek's sign
tapping of facial nerve-->contraction | hypo PTH
88
Trousseau's sign
occlusion of brachial artery with BP cuff-->carpal spasm 20mmhg for 3min hypoPTH
89
hypo Ca | shortened 4 and 5 digits short stature
AD Albright's hereditary osteodystrophy pseudohypoparathyroidism
90
common cause for hyper Ca
``` increase PTH and Thyroid Bone destruction Addison Renal filure increase PH and BAR ```
91
bitemporal hemianopia with amenorrhea and galactorrhea
pituitary adenoma prolactinoma decrease GnRH: infertility, low libido, amenorrhea, galactorrhea treat: with DA agonist, bromocriptine or cabergoline decrease GH, LH and FSH, ACTH, TSH, cortisol-->increase ACTH and CRH
92
thyrotropin-secreting pituitary adenoma
hyperthyroidism-->palpitation
93
acromegaly caused by? | diagnosis?
pituitary adenoma, excessive GH increase IGF-1 failure to suppress serum GH following oral glucose tolerance test pituitary mass seen on brain MRI cariomega, colon polyp, carpal tunnel, sleep apnea, odor from sweat treat:somatostatin
94
Hashimoto
most common cause of hypothyroid (maybe hyper at first cuz by thyrotoxicosis) autoimmune: thyroid peroxidase(TPO), antithyrogloblin Ab, HLA-DR5 increase risk for non-hodgkin's lymphoma Histology: hurthle cell, lymphocytic infiltration with germinal centers moderately enlarged, nontender thyroid, increase TSH, decrease T4
95
Cretinism
fetal hypothyroidism, irreversible, unless replacement therapy endemic: occurs when endemic goiter prevalent (lack iodine) sporadic:defect in t4 formation or developmental failure in thyroid Pot-bellied, Pale, Puffy face child, Protruding umbilicus and Protuberant tongue
96
Subacute thyroiditis | de Quervain's
Self-limiting following flu-like syndrome histology: granulomatous inflammation Finding: increase ESR, jaw pain, early inflammation, very tender!!!!!!
97
Riedel's thyroiditis
thyroid replaced by fibrous tissue, hypothyroid Finding: fixed, hard(rock-like), painless goiter manifestation of IgG4-related systemic disease
98
toxic multinodular goiter
focal patches of hyper-functioning follicular cells working independently of TSH due to mutation of TSH receptor increase release of T3,T4 Hot nodules are rarely malignant *Jod-basedow phenomenon
99
Grave's disease
autoimmune hyperthyroidism with TSI, TPO and TSI Ab, ophthalmopathy, proptosis, EOM swelling, treat with steroid pretibial myxedema increase connective tissue deposition diffuse goiter increase I 131 uptake
100
Jod-basedow phenomenon
thyrotoxicosis if a patient with iodine defiency goiter is made iiodine replete
101
thyroid storm
stress-induced catecholamine surge leading to death by arrhythmia serious complication of grave disease and other hyperthyroid disorder increase ALP due to bone turn over
102
thyroid papillary carcinoma
``` most common excellent prognosis empty appearing nuclei, orphan Annie's eye nuclear groove increase risk with childhood irradiation ```
103
thyroid follicular carcinoma
good prognosis uniform follicles Hurthle cell (hashimoto-like) cannot be diagnosed with fine needle
104
thyroid medullary carcinoma
parafollicular c cell, neural crest produce calcitonin sheets of cells in amyloid stroma associated MEN type 2A and 2B, ret
105
thyroid undifferentiate anaplastic
older patients very poor prognosis invade esophagus and trachea
106
thyroid lymphoma
associated with hashimato's thyroiditis
107
inferior artery is near?
recurrent laryngeal nerve
108
superior thyroid artery is near?
superior laryngeal nerve | external innervates cricothyroid muscle
109
urine osm decrease that do not increase with Desmopressin
nephrogenic DI
110
urine osm decrease that increase with desmopressin
central DI
111
hypopituitarism is due to?
``` nonsecreting pituitary adenoma sheehan's syndrome empty sella syndrome brain injury, hemorrhage radiation treat with substitution therapy ```
112
DM is more likely to get AS becuase?
glycosylation of LDL, more likely to be oxidased to be ox-LDL, increase crosslinking and decrease degradation
113
DM also accelerate polyol pathway, which cause?
increase aldose reductanse | increase intracellular sorbitol: osm cell injury: cataracts and neuropathy
114
DM retinopathy
microhemorrhages and vessel proliferation exdates, microaneurysms vessel proliferation
115
Kimmelstiel-Wilson nodule
nephropathy ovoid, hyaline PAS+ in mesangial coreat the edge of glomerulus nodular sclerosis and protinuria and chronic renal failure cuzed by thickening of GBM
116
gestation DM is often seen in______wk? | complication?
24-48wk transposition of great vessel hypoglycemia in fetus by diffuse hyperplasia of islet cells
117
histology of type1 and 2 | beta-cell?
type1: leukocytic infiltration, decrease beta-cell type2: keislet amyloid(AIAPP) deposition
118
ketosis lab work | K?
hyper K, shift from intra to extraincrease ketone, glycemia, H+ decrease HCO3
119
symptoms of hypoglycemia
increase epi adrengic symptoms: sweating, tremor, palpation, hungar nervous CNS symptoms when glu is even lower: behavior change, confusion if using beta blocker at the same time will make the adrenal symptoms, so beta-blocker is not used in these patients
120
MEN 1 Wermer's syndrome 3P
AD parathyroid tumors pituitary tumors, prolactin or GH pancreatic endocrine tumor-zollinger-Ellison syndrome, insulinoma, VIPomas,glucagonomas present with kidney stone and stomach ulcers
121
MEN2A Sipple's syndrome 2P
``` Medullary thyroid carcinoma: secretes calcitonin Pheochromocytoma Parathyroid tumors ret gene AD ```
122
MEN2B | 1P
medullary thyroid carcinoma pheochromocytoma oral/intestinal ganglioneuromatosis: flesh colored nodules, associated with marfanoid habitus ret gene,AD

Pathology (11 decks)

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