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USMLE Step 1 Quick Notes > Endocrine > Flashcards

Endocrine Flashcards

(93 cards)

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1
Q

If decreased phosphate and calcium, what should you consider?

A

Vitamin D deficiency

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2
Q

What are the symptoms of glucagonoma?

A

Cheilitis, necrolytic migratory erythema, hypeglycemia

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3
Q

What does necrolytic migratory erythema look like?

A

Pruritic painful plaques/papules with central clearing and bronze induration

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4
Q

Neonatal hyperglycemia from gestational diabetes is permanent or transient?

A

Transient (so is mom’s diabetes)

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5
Q

What do you give if exposed to radioactive iodine?

A

Potassium Iodine because it competitively inhibits radioactive I uptake?

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6
Q

What does propranolol do for the thyroid?

A

Blocks peripheral conversion of T4 to T3 by iodothyronin deiodase?

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7
Q

What does waist to hip ratio indicate?

A

Type 2 DM

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8
Q

What happens if hCG given for anovulation?

A

Stimulates LH surge

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9
Q

What else besides water does vasopressin increase the permeability of?

A

Urea

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10
Q

What is the diagnosis: pot-bellied, protruding tongue, umbilical herniation, coarse facial features, poor brain development (the 6P’s)?

A

Cretinism (congenital hypothyroidism)

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11
Q

What makes beta-endorphin?

A

POMC

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12
Q

What other hormone is beta-endorphin related to?

A

ACTH because they are from the same precursor (POMC)

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13
Q

What happens to pH and bicarbonate in diabetic ketoacidosis?

A

Decreased pH and decreased bicarb

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14
Q

What is Waterhouse-Friederichson?

A

Primary adrenal insufficiency from adrenal hemorrhage associated with Neisseria meningitidis, shock, DIC.

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15
Q

What is the problem if a sublingual mass that when removed causes lethargy, dry skin, feeding problem?

A

Hypothyroid because thyroid gland failed to migrate

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16
Q

What is carcinoid a tumor of?

A

ECL cells in the small bowel

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17
Q

When do you see symptoms of carcinoid?

A

When it has metastasized

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18
Q

What is the normal remnant of the thyroglossal duct?

A

Foramen cecum

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19
Q

What embroyological derivative does the adenohypophysis come from?

A

Surface ectoderm

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20
Q

Where is MSH made?

A

Anterior pituitary

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21
Q

How does insulin cause glucose uptake in skeletal and adipose tissue?

A

Tyrosine phosphorylation –> PI3K pathway –> vesicles with GLUT-4 exocytosed and glycogen/lipid/protein synthesis activated
Tyrosine phosphoryation –> RAS/MAP Kinase Pathway –> cell growth, DNA synthesis

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22
Q

What is the diagnosis? Necrolytic migratory erythema, hyperglycemia, cheilitis

A

Glucagonoma

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23
Q

What is the diagnosis? Painful, pruritic, papules coalesce with central clearing and bronze induration

A

Necrolytic migratory erythema

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24
Q

What stimulates Prolactin production?

A

TRH

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25
How does GH affect insulin?
Causes insulin resistance so increased insulin release
26
What do neurophysins do to oxytocin and AD?
Post-translationally modify
27
How does cortisol increase BP?
Upregulates alpha1 receptors on arterioles (increased sensitivity to NE and Epi)
28
How does cortisol decrease inflammatory/immune response?
Decreases histamine release, decreases IL-12 production, reduces eosinophils, inhibits leukocyte adhesion (neutrophilia), inhibits PLA2
29
What happens to calcium when pH increases?
Binds to albumin and you see clinical manifestations of hypocalcemia
30
Which hormone receptors have intrinsic tyrosine kinase activity?
Insulin and the growth factors
31
Which hormone receptors have receptor associated tyrosine kinase activity?
GH, Prolactin, cytokines
32
Which pathway is used in intrinsic tyrosine kinase receptors?
MAP Kinase
33
Which pathway is used in receptor associated tyrosine kinase things?
JAK/STAT
34
Which hormones use cAMP for signaling?
ACTH, FSH, LH, CRH, TSH, hCG, MSH, PTH, GHRH, calcitonin, glucagon
35
Which hormones using IP3 for signaling?
GnRH, TRH, oxyctocin, angiotensin II, gastrin
36
Where is the thyroid receptor?
In the nucleus
37
How does thyroid increase basal metabolic rate?
Increasing Na/K ATPase
38
What do anions perchlorate ad pertechnetate and thiocynate do?
Inhibit iodide uptake in follicular cells of thyroid
39
What is the metyrapone stimulation test?
Metyrapone inhibits 11beta hydroxylase --> decreases cortisol --> increases ACTH and 17-OH corticosteroid
40
What do you increased homovanillic acid with?
Neuroblastoma
41
How does thyroid affect cholesterol?
Hyperthyroidism causes hypocholesterolemia (due to increased LDL receptor expression)
42
What does Hashimoto's increases the risk for?
Non-hodgkin's lymphoma
43
What do you see on histology for De Quervain?
Granulomatous inflammation (giant cells, neutrophils)
44
What are the findings for De Quervain?
Increased ESR, jaw pain, early inflammation, very tender thyroid
45
When do you get De Quervain?
After a flu like illness
46
What do you see with Riedel thyroiditis?
Thyroid replaced by fibrous tissue that may extend to local structures. Mimics anaplastic carcinoma. Rock hard fixed painless goiter
47
What is the cause of death in Grave's patients?
Tachyarrhythmia
48
What is the Jod-basedow phenomenon?
Thyrtoxicosis if patient with iodide deficiency goiter made iodide replete
49
What is pegvisomant?
GH receptor antagonist used for acromegaly
50
How do you treat diabetes inspidius nephrogenic?
HCTZ, amiloride, indomethacin
51
What do you see after post pituitary damage?
Transient central DI
52
What do you see after hypothalamic nuclei damage?
Permanent central DI
53
What does cyclophosphamide cause?
SIADH
54
How do you treat SIADH?
Conivaptan, Tolvaptan, Demeclocycline
55
What is empty sella syndrome?
Atrophy or compression of pituitary, often idiopathic, seen in obese women
56
What causes peripheral neuropathy in diabetic patients?
1. Ischemia from hyaline arteriosclerosis | 2. Sorbitol accumulation causes osmotic damage
57
How do you treat severe hypoglycemia in non medical setting?
Intramuscular glucagon
58
What do you see on histology for T1DM?
Islet leukocytic infiltrate?
59
What do you see on histology for T2DM?
Islet amyloid polypeptide (IAPP) deposits due to amylin deposition in pancreas
60
What are the toxicities of sulfonylureas?
1st generation: disulfiram-like effects | 2nd generation: hypoglycemia (increased risk in renal failure patients)
61
What is tolbutamide and Chlorpropamide?
1st generation sulfonylurea
62
What is canaglifozin?
SGTP-2 inhibitor (prevents glucose reabsorption in proximal tubules of kidney)
63
What are the effects of GLP-1 analogs?
N/V, pancreatitis
64
What are the side effects of glitazones?
Weight gain, edema, hepatotoxicity, HF
65
What is Pramlinitide?
Amylin analog that decreases gastric emptying and glucagon
66
What are the side effects of Methimazole and Propylthiouracil?
Skin rash, agranulocytosis, aplastic anemia, hepatotoxicity
67
How does cortisol increase epinephrine production?
It induces PNMT which converts NE to epinephrine
68
How do FFA and TG affect insulin?
Increase insulin resistance
69
How do GC, TNF-alpha, and Glucagon affect insulin?
They cause serine phosphorylation of insulin receptor
70
How do glucocorticoids increase neutrophils?
Cause dermargination of leukocytes previously attached to vessel wall
71
What are the changes you see with sodium in SIADH?
Presents with euvolemic hyponatremia (transient volume increase but suppression of RAAS causes natriuresis and restore volume but worsens hyponatremia)
72
What are the 5P's of pheochormocytoma (aka symptoms)?
Palpitations, pressure (increased BP), pain (headache), perspiraton, pallor
73
What does the CEA tumor marker tell you?
If tumor has recurred
74
What happens with acid-base in DKA?
High anion gap metabolic acidosis --> compensatory respiratory alkalosis, low bicarb
75
What happens with the bladder in diabetics?
Diabetic neuropathy can cause overflow incontinence due to an inability to sense bladder fullness and incomplete emptying. Postvoid residual volume with ultrasound can confirm diagnosis
76
How do you tell complete vs partial DI?
Urine osmolarity jumps by >50% after vasopressin administration during water deprivation test.
77
What do perchlorate and pertectinate do?
Competitively inhibit radioactive iodine uptake
78
DKA is with T1DM, T2DM, or both?
T1DM because there is no insulin at all
79
What do you give for gestational diabetes if lifestyle modifications fail?
Give insulin
80
Why do anorexic patients get amenorrhea?
Below a certain body fat level, GnRH pulses stop (remember that leptin produced from fat triggers GnRH when puberty starts)
81
How do you treat exophthalmos in Grave's?
Glucocorticoids
82
What are the side effects of canaglifozin?
Genital yeast infections, osmotic diuresis
83
What is the treatment for a prolactinoma?
D2 agonists: bromocriptine and cabergoline
84
What increases in blood cell counts with high dose glucocorticoids?
Neutrophils because GCs demarginate them
85
What does addison's disease affect?
All three layers of the adrenal gland (deficiency of aldosterone and cortisol). Spares medulla
86
How does cortisol affect insulin?
Decreases insulin requirement
87
What happens to volume in the body with SIADH?
SIADH causes EUVOLEMIC hyponatremia because initial fluid retention suppresses RAAS, activates ANP, and promotes natriuresis
88
What happens with K and renin with pheochromocytoma?
Won't see hypokalemia and therefore won't have muscle weakness. Renin might actually go up.
89
What has the same molecular origin as a pentapeptide that has a strong affinity for mu and delta receptors?
ACTH because it derives from POMC which also makes beta endorphins
90
If someone has low blood glucose but doesn't show symptoms of hypoglycemia they are likely taking what?
Non selective beta blocker. They mask the symptoms of hypoglycemia because normally body would produce Epi/NE (and other hormones) to increase lipolysis, gluconeo etc and also causes palpitations, sweating, hunger, tremor but beta blockers block these effects so you can't tell that they are hypoglycemic. Avoid in diabetics.
91
Diagnosis: young women who has postprandial hyperglycemia because pancreatic islet cells have a high set point for insulin secretion in response to blood glucose? What is deficient?
Glucokinase Diagnosis is MODY: mutation decreases enzyme's affinity for gluocose --> not sensing it
92
What is the "glucose sensing device" in pancreatic beta cells?
Glucokinase
93
What do you treat acromegaly with?
Octreotide and Pegivsomant

USMLE Step 1 Quick Notes (17 decks)

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