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Endo > Firecracker Endo II > Flashcards

Firecracker Endo II Flashcards

1
Q

What binds to T3 and T4 in peripheral blood?

A

TBG (thyroxine-binding globulin)

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2
Q

Graves disease is characterized by a triad of which histologic findings?

A

1) Diffuse hypertrophy & hyperplasia of thyroid follicular epithelial cells
2) Pale colloid with scalloped (moth-eaten) margins
3) Lymphocytic infiltrate w/ germinal centers (!)

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3
Q

123I uptake results in a patient w/ Graves disease?

A

Diffusely ↑ 123I uptake in the whole thyroid gland.

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4
Q

123I uptake results in a patient w/ toxic multi nodular goiter?

A

Uneven 123I uptake with occasional autonomous “hot” nodules demonstrating ↑ 123I uptake.

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5
Q

123I uptake results in a patient w/ thyroiditis

A

↓ 123I uptake

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6
Q

123I uptake results in a patient w/ hypothyroidism taking too much levothyroxine

A

↓ 123I uptake

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7
Q

123I uptake results in euthyroid pt taking thyroid hormone for 2ndary gain?

A

↓ 123I uptake

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8
Q

In subacute lymphocytic thyroiditis, is the thyroid tender or nontender?

A

Nontender

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9
Q

What thyroid hormone is devoid of any biological activity?

A

Reverse T3

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10
Q

What are 5 common causes of hypothyroidism?

A
  • Hashimoto thyroiditis (chronic autoimmune thyroiditis)
  • Post ablation: Surgical or I-131 radiation
  • Iodine deficiency
  • Drugs: Lithium, Amiodarone, Sulfonamides
  • Subacute lymphocytic thyroiditis (painless)
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11
Q

Hyperparathyroidism –> what electrolyte disturbance?

A

hypercalcemia

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12
Q

Can you describe some of the cardiac manifestations of hypothyroidism? What happens to HR, SV, PP, and CO?

A

Down
Down
Down
Down

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13
Q

A patient with a thyroid cancer is found to have increased calcitonin levels. Besides treatment of this patient’s thyroid cancer, you recommend evaluation of her:

A

Adrenal gland (think MEN IIa)

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14
Q

What is the typical presentation of subacute granulomatous (DeQuervain’s) thyroiditis?

A

Preceded by flu-like illness with sore throat and fever, jaw pain, tender thyroid, and a markedly elevated ESR. Causes can include mumps or coxsackievirus.

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15
Q

Describe the relationship between free serum Ca2+ levels and PTH secretion.

A

↓ Free serum Ca2+ causes ↑ PTH secretion and vice versa. Ca2+-sensing receptors on chief cells mediate these effects.

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16
Q

In patients with subacute granluomatous (DeQuervain’s) thyroiditis, what does histologic analysis of thyroid parenchyma typically reveal? (Try to name 2 characteristic findings)

A
  • lymphocytic infiltrate

- multinucleate giant cells surrounding fragments of colloid

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17
Q

Treatment of hyperthyroidism

A
  1. Beta blocker
  2. Thioamide
  3. High-dose iodine
  4. High dose-radioactive iodine
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18
Q

The parathyroid gland contains which 2 types of cells?

A

Chief cells (water-clear appearance) & oxyphil cells.

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19
Q

Which cells secrete parathyroid hormone?

A

Chief cells

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20
Q

How does follicular thyroid carcinoma spread?

A

Hematagoneous

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21
Q

Treatment of DeQuervain

A

ASA

22
Q

PTH –> Bone resorption of calcium and phosphate by binding the PTH receptor on osteoblasts → in response, osteoblasts secrete

A

M-CSF and RANK-L, which stimulate osteoclasts to break down bone and release calcium.

23
Q

Medullary CA of thyroid is associated with which two MEN syndromes?

A

MEN 2a and 2b (2b is sometimes called 3)

24
Q
  • ↓ BMR (basal metabolic rate);
  • Positive nitrogen balance (anabolic)
  • ↓ Heat production
  • Growth retardation
A

Metabolic changes in hypothyroidism

25
Q

Cardiac effect of hyperthyroidism

A

Increased synthesis of beta1 receptors –> increased HR, contractility, and SV

26
Q

What are the 2 dietary forms of vitamin D?

A

D2 or ergocalciferol from plants, and D3 or cholecalciferol from fish.

27
Q

Dietary sources of vitamin D

A

egg yolk, fish oil, liver

28
Q

Parathyroid hyperplasia is commonly associated with what 2 MEN syndromes?

A

MEN 1 and MEN 2A

29
Q
  • ↑ BMR (basal metabolic rate);
  • Weight loss despite ↑ appetite
  • Negative nitrogen balance (catabolic) → thyroid myopathy (proximal muscle weakness and ↓ muscle mass)
  • ↑ Heat production and sweating
A

Metabolic manifestations of hyperthroidism

30
Q

2 ways CKD –> hyperparathryoidism

A
  1. Decreased conversion of active vitamin D

2. Inadequate excretion of phosphate

31
Q

What is the main GI side effect of hyperthyroidism?

A

diarrhea

32
Q

What effect does thyroid hormone have on the autonomic nervous system? How does this occur?

A

increases sympathetic activity because it up-regulates β1-adrenergic receptors in the heart.

33
Q

What is the only emergent hypothyroid condition?

A

Myxedema coma

34
Q

What is the most common cause of hyperparathyroidism?

A

Single benign adenoma: 80% of cases

35
Q

How does active vitamin D affect renal handling of calcium and phosphate?

A
  • ↑ Reabsorption of Ca2+

- ↑ Reabsorption of phosphate

36
Q

What is the Wolff-Chaikoff effect?

A

High levels of I- inhibit thyroid hormone synthesis by blocking the organification step.

37
Q

which autoantibody is relatively specific for Graves?

A

TSI

38
Q
  1. Lymphocyte infiltrate
  2. Prominent germinal follicles
  3. Hürthle cell metaplasia
A

histology of hashimoto

39
Q

What effect does thyroid hormone have on bone growth?

A

bone growth, synergism with growth hormone and IGF-1 (insulin-like growth factor-1)

40
Q

What anions inhibit the Na-I transporter of thyroid follicular cells?

A

thiocyanate and perchlorate

41
Q

Clinical presentation of Hashimoto’s

A

Nontender thyroid, which often becomes diffusely enlarged → insidious development of hypothyroidism, most commonly in women age 30-50

42
Q

Graves disease:

  • more common in males or females?
  • age range for peak incidence?
A

F > M (females are 10x more frequently affected than males); peak incidence between 20-40yo

43
Q

In which patients does thyroid storm most commonly occur?

A

underlying Graves disease

44
Q
  • High fever (hyperpyrexia)
  • Tachycardia out of proportion to fever
  • Tachyarrhythmias
  • Shock due to heart failure and/or vomiting-induced volume depletion
  • Coma
A

Thyroid storm

45
Q

Vitamin D causes resorption of bones in the setting of

A

hypocalcemia or too much vitamin D

46
Q

What disorder of the peripheral nervous system can result from hypothyroidism?

A

Carpal tunnel

47
Q

What are the signs and symptoms of acute thyroiditis? (Try to name 3)

A
  • Fever
  • Painful thyroid
  • Painful cervical lymphadenopathy
48
Q

What are 2 important histological findings associated with papillary thyroid carcinoma?

A
  1. orphan annie eye nuclei

2. psammoma bodies

49
Q

Which thyroid carcinoma stains positive for amyloid?

A

Medullary

50
Q

How many types of thyroid carcinoma are there?

A

4 - papillary, follicular, medullary, anaplastic

Endo (12 decks)

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