Endo - Stuff Missed Flashcards Preview

USMLE Step 1 > Endo - Stuff Missed > Flashcards

Flashcards in Endo - Stuff Missed Deck (47):
1

Side effect of thialidozines

Fluid retention, weight gain and edema

2

Side effect of metformin therapy

Lactic acidosis -

** don't use in patients with abnormal renal function, liver function, CHF, alcoholism, and sepsis

3

Thialidozines

bind to PPAR-gamma to improve insulin resistance
- may take days to weeks to work

4

Congenital hypothyroidism

presents soon after birth with hypotonia, poor feeding, jaundice, macroglossia, constipation and umbilical hernia

- diagnosis early to prevent mental retardation

5

Pulsatile administration of GnRH analogs has what effect?

It has an AGONIST effect and stimulates LH and FSH release

6

Continuous adminsitration of GnRH analogs have what effect?

It has an ANTAGONIST effect and suppresses LH and FSH release

7

Anovulation

- common cause of infertility
- can be treated by administering menotropin (human menopausal gonadotropin analog) that acts like FSH and leads to formation of dominant follicle
- Ovulation is induced by large dose of hCG which stimulates LH surge

8

FSH

- stimulates dominant follicle to form in one of ocaries
- stimulates estrogen production from ovaries
- as follicle expands, there is a rise in estrogen
- In follicular phase, estrogen has positive feedback on LH leading to LH surge which eventually causes rupture of follicle

9

Anastrozole

selective aromatase inhibitor
- thus less conversion of androgens into estrogens
- suppress estrogen to postmenopausal levels
- in treatment of metastatic breast cancer, aromatase inhibitors are equivalent or superior to tamoxifen

10

Ketoconazole

- selective aromatase inhibitor
- antifungal agent that decreases androgen synthesis

11

2 y.o. girl has ambiguous genetailia. Has clitoral enlargement and partial fusion of labioscrotal folds
- has high BO
- hypokalemic
- is 46, XX
Likely diagnosis?

11-B hydroxylase deficiency
- less cortisol production
- less aldosterone production (hypertension and hypokalemia)
- more testosterone production (virilization of female)
-

12

11-B hydroxylase deficiency

- results in excessive adrenal androgen and mineralcorticoids (but NO ALDOSTERONE)
- females are born with ambiguous genitalia
- develop hypertension because of weak mineralcorticoid excess (not as good as aldosterone but good enough)
- hypokalemia

13

17-alpha hydroxylase deficiency

- results in:
- less cortisol
- less teststerone
- Females are born with normal genitalia
- Males are born UNDERVIRILIZED (less testosterone)
- affected don't undergo puberty (no sex hormones)
- develop HYPERtension and hypokalemia (mineralcorticoid excess)

14

21 hydroxylase defiency

- most common cause of adrenal hyperplasia
- less cortisol
- less mineralcorticoids
- more testosterone
- Females have ambiguous genitalia (due to testosterone excess)
- HYPOtension and HYPERkalemia

15

Finasteride

5-alpha reductase inhibitor
- suppresses peripheral conversion of testosterone to DHT
- used in BPH and androgenetic alopecia

16

Nephrogenic DI

caused by lack of response to ADH
- can be treated by hydrochlorothiazide

17

Primary polydipsia

- excessive pathological water drinking
- psych disorder no underlying medical etiology
- water deprivation test will show increase in urine osmolality
- low serum sodium levels
- restriction of water normalizes urine osmolality

18

Neurogenic DI

- due to decreased production of ADH in posterior pituitary
- decreased urine osmolality with dehydration
- increased urine osmolality with ADH

19

Nephrogenic DI

- due to decreased responsiveness of collecting tubules to ADH
- decreased urine osmolality with dehydration
- decreased urine osmolality with ADH

20

Thiazolidinediones (TZDs)`

- bind to peroxisome proliferator activated receptor-gamma (PPAR-gamma) - a transcript regulator involved in glucose and lipid metabolism
- takes days to work
- lowers glucose by decreasing insulin resistance
- increaeses expression of adiponectin gene

21

Leptin

- secreted by fat cells
- responsible for appetitie suppression and decreased insulin resistance

22

How do prolactinomas leads to osteoporosis?

- High levels of prolactin decrease GnRH
- Less GnRH leads to less estrogen
- Less estrogen means loss in bone density as estrogen is protective against osteoporosis

23

MEN1

3Ps
- Parathyroidism
- Peptic ulcer
- Pituitary adenoma

24

Men2A

2s
- Pheochromocytomas
- Pituitary adenoma
- Medullary thyroid carcinomas

25

Men 2B

- Medullary thyroid Carcinoma
- Pheochromocytoma
-Oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)

26

Medullary Thyroid Carcinoma

- usally from parafollicular C cells
- produce calcitonin, sheets of cells in amyloid strom
- associated with MEN2A and MEN 2B

27

Carcinoid syndrome

caused by neuroendocrine cells esp. metastatic bowel caner tumors
- secrete high levels of 5-HT
- not seen if tumor is limited to GI tract because liver processes
- presents with recurrent flushing, asthmatic wheezing, and right side valvular disease

28

Carcinoid syndrome Findings and Treatment

- Recurrent flushing, asthmastic wheezing, right-sided valvular disease
- 5-HIAA inurine
- Niacin deficiency

Tx: Somatostain analog (e.g. octreotide)

29

Conditions associated with excess growth hormone. In children? in adults?

In children: Gigantism - excess growth hormone before closure of epiphyses
In adults: Acromegaly - excess growth hormone after closure of epiphyses

30

Growth hormone

- increases linear growth by stimulating production of IGF-1 from liver
- defective growth hormone receptors leads to decrease in linear growth

31

Laron dwarfism

- due to decrease in linear growth
- characterized by high serum growth hormone levels with low IGF-1

32

Acute effects of corticosteroids

- Increased neutrophil count
- Decreased lymphocyte, monocyte, basophil, and eosinophil counts
-Increase in neutrophil due to demargination of neutrophils previously attached to vessel walls

33

Which hormone needs to be monitored in amiodarone therapy?

TSH
- Amiodarone (40% iodine) can lead to hypothyroidism
- Amiodarone induced hypothyroidism is treated with levothyroxine

34

Amiodarone

class III anti-arrhythmic used to suppress cardiac conduction
-

35

Amiodarone side effects

- Thyroid dysfunction
- Corneal microdepsots
- Blue-gray skin discoloration
- Drug related hepatitis
- Pulmonary fibrosis (rare but life threatening)

36

Glucocorticoiids

- predominatwly carabolic, causing muscle weakness, skin thinning, impaired wound healing, osteoporosis, and immunosuppression
- increase liver protein synthesis, specifically ones involved in gluconeogenesis and glyconegenesis

37

Hydrochlorothiazide

- acts on distal tubules (blocks Na/Cl)
- causes HYPERgluc -
- Hyperglycemia
- Hyperlipidemia
- Hyperuricemia
- Hypercalcemia

38

Risperodine and amenorrhea

- Risperidone (atypical anti-psychotic) is associated with hyperprolactinemia
- Riperiodone suppresses dopamine. Dopamine suppresses prolactin
- More prolactin means less GnRH which means less FSH and less LH thus no menstruation

39

Mechanism of B-blockers in thyrotoxicosis

- Decrease in effect of sympathetic adrenegic impulses reaching target orens
- Decrease in peripheral conversion of T4 to T3

40

teen girl presents as thin with downy hair
- presents with inadequate diet and regular excercises
- asks about weight loss advice
Likely diagnosis?

Anorexia nervosa - often presents as decreased LH, FSH, estriadiol, and estrone
- hypogonadotropic amenorrhea
- often presents with downy

41

Long term use of glucocorticoids leads to what effect on adrenal glands

Long term glucocorticoids suppress HPA axis (by decreasing ACTH release)
- Leads to bilateral adrenocortical atrohy

42

What occurs if patient suddenly stops taking doses of corticosteroids?

Adrenal crisis

43

Glucagon

- increases serum glucose by increased production of glucose from liver
- stimulates insulin secretion from pancreas
- has little effect on skeletal muscle

44

Addison's disease

Chronic primary adrenal insufficiency due to adrenal atrophy OR
destruction by disease (e.g. autoimmune, TB, metasstasis)
- aldosterone deficiency and cortisol
- HYPOtension
- HYPERkalemia
- skin HYPOpigmentation

45

Epinepherine (and glucose)

epinepherine increases glucose by various mechanisms
- increased glycogenolysis and gluconeogenesis
- decreases glucose uptake in skeletal muscle
- increases alanine release from skeletal muscle for gluconeogenesis in liver
- increases TG breakdown in fat tissue

46

Propylthiouracil

thionamide medication used for treatment of hyperthyroidism
- decreases formation of thyroid hormone by inhibiting thyroid peroxidase

47

Potassium iodide

- may prevent thyroid absorption of radioactive iodine isotopes by competitive inhibition