Endocrine Path Flashcards Preview

USMLE Step 1 > Endocrine Path > Flashcards

Flashcards in Endocrine Path Deck (60):
1

Pseudohyperaldosteronism

- Licorice (inhibits 11-beta-HSD type II)
- Liddle's syndrome (increase Na and decrease K)

2

Secondary Hyperaldosteronism causes

Fibromuscular dysplasia (young women)
Atherosclerosis (men)

3

Hyperaldosteronism doesnt show hypernatremia or edema b/c...

Aldosterone escape via ANP

4

Addison's disease causes

- Autoimmune (developed countries)
- TB (developing countries)
- Malignancy (esp lung)

5

Tertiary adrenal insufficiency cause

Exogenous steroid use and immediate withdraw

6

Decrease glucocorticoids on insulin requirements

Decreased

7

Neuroblastoma

- Homer-Wright rosettes
- anywhere on sympathetic chain
- firm, irregular mass, crosses midline
- Opsoclonus-myoclonus syndrome ("dancing-eyes-dancing feet")
- HVA, VMA
- Bombesin and neuron-specific enolase +ve
- Over-express N-myc oncogene

8

Pheochromocytoma rule of 10

10% - malignant, bilateral, extra-adrenal, calcify, kids

9

Pheochromocytoma associated conditions

neurofibromatosis type 1, von Hippel-Lindau disease, MEN 2A and 2B

10

Pheochromocytoma Rx

Phenoxybenzamine ..THEN... B-blocker prior to ressection

11

Hypothyroid heart effect

Mucopolysaccharides deposited b/t fibers causing cardiomyopathy and low voltage EKG

12

Cholesterol levels in hyper-/hypothyroidism

Hyperthyroidism - increased LDL receptor (hypocholesterolemia)
Hypothyroidism - decreased LDL receptor (hypercholesterolemia)

13

Pretibial myxedema

Graves disease

14

Hashimoto thyroiditis

- anti-thyroid peroxidase (anti-microsomal), anti-thyroglobulin
- Risk: non-Hodgkin lymphoma (marginal/B-cell)
- Hurthle Cells
- Non-tender
- germinal centers

15

Congenital hypothyroidism (cretinism)

The 6 P's (also short w/ coarse facial features)
- Pot-bellied
- Pale
- Puffy-faced child
- Protruding umbilicus
- Protuberant tongue
- Poor brain development

16

Subacute granulomatous thyroiditis (de Quervain)

- High ESR, jaw pain, TENDER thyroid
- often post viral

17

Riedel thyroiditis

- Fibrous replacement of thyroid
- manifestation of IgG4-related systemic disease (autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis)
- fixed, hard (rock-like) painless goiter

18

Lithium on thyroid

hypothyroidism

19

Graves Rx

B-blockers, Thiomide (blocks peroxidase), Radioiodine ablation

20

Toxic multinodular

Focal patches of hyperfunctioning follicular cells working independently of TSH d/t receptor mutation

21

Thyroid storm: COD, Lab, Rx

- tachyarrhythmia
- increased ALP
- 3 P's: Propanolol, Propylthiouracil, Prednisolone

22

Jod-Basedow phenomenon

thyrotoxicosis if a patient w/ iodine deficiency goiter is made iodine replete

23

Myoedema

found w/ hypothyroid myopathy and d/t slow resorption of Ca by SR (causes focal mounding of muscle following percussion) - also has increased CK

24

Non-toxic multinodular goiter

- d/t relative iodine def
- euthyroid

25

Hyperthyroidism OGTT

rapid rise and rapid fall

26

Papillary carcinoma (thyroid)

- Orphan annie eye nucleus (central clearing)
- psammoma bodies
- nuclear grooves
- Risk w/ RET and BRAF mutations or childhood radiation
- Lymphatic invasion common

27

Follicular carcinoma vs follicular adenoma

- Invasion of capsule
- FNA doesnt distinguish!! (no biopsy b/c high blood supply)

28

Spread of follicular carcinoma

hematogenous

29

Medullary carcinoma

- amyloid stroma (calcitonin)
- associated with MEN2A, 2B (RET)
- hypocalcemia

30

Undifferentiated/anaplastic carcinoma vs Reidel thyroiditis

old vs. young

31

Lymphoma of thyroid?

Hashimoto's

32

Albright hereditary osteodystrophy

Pseudohypoparathyroidism
- unresponsiveness of kidney to PTH
- shortened 4th/5th digits, short stature
- Gs prot mutation (GNAS1) - AD
- Diagnose w/ PTH --> no increase in urinary cAMP or PO4
- Cafe-late spots, endocrine abnorm (precocious puberty)

33

Familial hypocalciuric hypercalcemia

- Defective CaSR on parathyroid cells
- mild hypercalcemia w/ normal/increased PTH

34

Factitious hypercalcemia

Hypergammablobinemia (increased Ca binding)

35

QT interval: hyercalcemia/hypocalcemia

shortened QT (hyper)
prolonged QT (hypo)

36

Primary hyperparathyroism

Stones, Bones, Groans and psychiatric overtones

37

Cystic bone spaces filled with brown fibrous tissue (deposited hemosiderin from hemmorages)

Osteitis fibrosa cystica

38

Bone lesions from 2 * or 3* hyperparathyroidism due to renal disease

Renal osteodystrophy

39

Pituitary apoplexy

hemmorage into preexisting pituitary adenoma

40

Acromegaly Rx (alt. to surgery)

Octreotide (somatostatin analog)
Pegvisomant (GH-R antagonist)

41

urine specific gravity of DI

42

Hyperosmotic volume contraction

DI or proffuse sweating

43

Nephrogenic DI causes

Hereditary, hypercalcemia, lithium, demeclocycline (ADH antagonist)

44

Nephrogenic DI Rx

Hydrochlorothiazide
indomethacin - PG's inhibit vassopressin action on kidney
amiloride
hydration

45

SIADH

- euvolemic hyponatremia with continued Na excretion (d/t decreased aldosterone levels)
- urine osmolarity > plasma
- cerebral edema and seizures

46

SIADH Rx

- Fluid restriction
- IV hypertonic saline
- Conivapton
- Tolvaptan
- Demeclocycline

47

Most common COD in diabetics

MI

48

Requirements for sorbitol accumulation

- Aldose reductase and decreased/absent sorbitol dehydrogenase
- Schwann cells, retina, kidneys, lens

49

DKA K+ status

Hyperkalemia but decreased total body stores

50

Best glucose test for diabetes

1 - FBG
2 - GTT (for Gestational or cystic fibrosis related diabetes or those with Sx but normal FBG)

51

Glucagonoma

- Dermatitis (necrolytic migratory erythema)
- Diabetes
- DVT
- Depression

52

Somogyi effect

rebound hyperglycemia d/t counter reg hormones in response to hypoglycemia

53

Whipple triad

low blood glucose, hypoglycemia Sx's, improvement with glucose
- seen in Insulinoma

54

Carcinoid rule of 1/3's

1/3 metastasize
1/3 present w/ 2nd malignancy
1/3 are multiple
(most common malignancy of small intestine)

55

Positive secretin stimulation test?
- associations?
- hints?

Zollinger-Ellison syndrome (gastrinoma) = gastrin levels remain raised
- MEN1
- Distal (eg. jeujenal ulcers)

56

Somatostatinoma

- Achlorhydria (inhibits gastrin)
- Cholelithiasis and steatorrhea (inhibits CCK)

57

VIPoma

WDHA synd (watery diarrhea, hypokalemia, achlorhydria)
- Rx. somatostatin

58

MEN1 (AD)

Pituitary (prolactin, GH)
Parathyroid
Pancreatic endocrine tumors (ZE, insulinoma, VIPoma, glucagonoma)
[MEN1 gene - menin=tumor supressor]

59

MEN2A (AD)

Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma (calcitonin)
[RET gene - receptor tyrosine kinase]

60

MEN2B (AD)

Pheochromocytoma
Medullary thyroid carcinoma
Oral/intestinal ganglioneuromatosis (mucosal neuromas)
[RET gene - receptor tyrosine kinase]
marfanoid habitus