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Flashcards in Endocrine II Deck (30):
1

What causes Graves disease?

Autoimmune stimulation of the thyroid

2

What HLA markers are associated with Graves disease?

HLA-DR3
HLA-B8

3

What drugs are used to treat Graves disease?

Propylthiouracil (PTU)
Methimazole

4

What is the MoA of PTU?

Inhibits oxidation of I- (inhibits iodination of thyroglobulin)
Inhibits peripheral conversion of T4 to T3

5

What are the side effects seen with PTU?

Agranulocytosis
Liver dysfunction

6

What is the MoA of methimazole?

Inhibits oxidation of I- (inhibits iodination of thyroglobulin)

7

What are the side effects seen with methimazole?

Agranulocytosis
Fetal aplasia cubis (fatal scalp defect)
Fetal goiter

8

When is PTU used? When is methimazole used?

PTU is used in pregnant women for the first trimester

Methimazole is used any time other than in pregnant women during the first trimester

9

There are "hot nodules" in the thyroid. What is the likely diagnosis? What is the likely cause?

Toxic adenoma and multinodular goiter

D/t mutation in TSH receptor

10

When is iodine induced hyperthyroidism (Jod-Baselow Phenomenon) seen?

Increased iodine...like after contrast dyes are used

11

A patient comes in with a painful goiter and explains a course of hyperthyroid period to now being hypothyroid. What is the likely diagnosis? What causes it? Is it bad?

Subacute thyroiditis (de Quervain) d/t focal destruction of thyroid with granulomatous inflammation

De Quervain is usually self-limited

12

What is de Quervain associated with?

HLA-B35
Viral infection

13

How is a thyroid storm treated?

Beta-blocker
PTU or methimazole

14

Why are all babies screened for congenital hypothyroidism?

Because it can cause impaired physical/mental growth (and an enlarged tongue and enlarged/distended abdomen) and the symptoms can be avoided entirely

15

A patient presents with hypothryoid symptoms and a painless goiter. What should be on the differential?

Hashimoto thyroiditis (lymphocytic inflammation)
B-cell lymphoma

16

What HLA subtypes are seen with Hashimoto thyroiditis?

HLA-DR5
HLA-B5

17

What is the biggest concern about a rock hard goiter?

Riedel's thyroiditis can extend into the airway

18

Thyroid cancer is expected, and the cleared out cells and psammoma bodies are seen on biopsy. What is the likely diagnosis? What are some risk factors?

Thyroid papillary cancer...has a good prognosis

Tobacco use, radiation exposure, genetics (RET gene, BRAF gene)
Activation of a tyrosine kinase

19

Thyroid cancer is expected, and fibrous covered nodules are seen on a biopsy. What is the likely diagnosis? How can it spread? What are some associations?

Follicular carcinoma can spread hematogenously

Follicular carcinoma is associated with RAS mutation, PAX8-PPAR-gamma1 rearrangement

20

What is secreted from a medullary carcinoma? What is this cancer associated with?

Medullary carcinomas secrete calcitonin

MEN2A&B are associated with medullary carcinomas (RET mutation)
Tyrosine kinase activation

21

An old patient comes in with a new rock hard goiter. What is the likely diagnosis? Is this bad?

Anaplastic thyroid carcinoma is bad

22

Diabetes type I is associated with which HLA types?

HLA-DR3-DQ2
HLA-DR4-DQ8

Both on chromosome 6

23

Why are Schwann cells, lens, retina, and kidney most often damaged with diabetes?

These tissues don't have sorbitol hydroxylase...after aldolase B converts glucose to sorbitol, it just stays in the cell...increasing the oncotic gradient

24

What causes DKA?

Various things create a state of excess glucagon, catecholamines and/or corticosteroids

25

What kind of opto/nasal fungi are associated with DKA?

Mucormycosis (mucor or rhizopus)

26

DKA is seen in DMI, what is sometimes seen in DMII?

Hyperosmolar Hyperglycemic State (HHS)...there is some insulin...so no ketones

Ketosis prone DMII also exists...strong genetic component

27

What hypothalamic nuclei are acted on by leptin?

Lateral nuclei...leptin inhibits
Ventromedial nuclei...leptin activates

28

What hypothalamic nuclei regulate food intake outside of leptin's signals?

Paraventricular nuclei
Dorsal medial nuclei
Arcuate nucleus

29

What drugs cause an increased appetite?

Atypical antipsychotics
Mirtazepine
Many diabetes drugs
Some progestins

30

What is orlistat?

A weight loss drug...inhibits fat absorption