HY Arrows

Question 1

Patient has high aldosterone. What are the arrows for serum Na+, K+, pH, bicarb, and CO2?

Answer 1

↑ Na+
↓ K+
↑­ pH
↑ ­Bicarb
↑­ CO2

Question 2

Aldosterone upregulates the ___ on the basolateral membrane of the cortical collecting duct in the kidney.

Answer 2

Na-K ATPase pump

Question 3

Aldosterone upregulation causes Na+ __(secretion/reabsorption) and K+ __(secretion/reabsorption).

Answer 3

Reabsorption; Secretion

Question 4

Decreased aldosterone would mean which metabolic state?

Answer 4

Normal anion gap metabolic acidosis with respiratory compensation

Question 5

Patient is given Lisinopril. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels?

Answer 5

­↑ Renin
↑ Angiotensin I
↓ Angiotensin II
↓ Aldosterone
↑ K+

Question 6

Patient is given Valsartan. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels??

Answer 6

­↑ Renin
↑ Angiotensin I
↑ Angiotensin II
↓ Aldosterone
↑ K+

Question 7

Patient is given Spironolactone. What change will this cause in renin, angiotensin I, angiotensin II, aldosterone, and K+ levels?

Answer 7

­↑ Renin
↑ Angiotensin I
↑ Angiotensin II
↑ Aldosterone
↑ K+

Question 8

Spironolactone MOA?

Answer 8

Aldosterone receptor antagonist

Question 9

Which drug is anti-androgenic and can cause gynecomastia?

Answer 9

Spironolactone

Question 10

If a patient is given enalapril, what will happen to left ventricular afterload, systemic
arteriolar diameter, renal afferent arteriolar diameter, and renal efferent arteriolar diameter?

Answer 10

↓ LV afterload
↑ Systemic arteriolar diameter
⟷ Afferent diameter
↑ Efferent diameter

Question 11

What does AT II do?

Answer 11

1) Increases aldosterone synthase activity in the zona
glomerulosa of the adrenal cortex
2) Constricts peripheral arterioles

Question 12

32F + abdominal bruit + BP of 160/100. Diagnosis?

Answer 12

Fibromuscular Dysplasia (Tunica media proliferation)

Question 13

32F + abdominal bruit + BP of 160/100. What are the arrows for Na+, K+, pH, bicarb, and CO2?

Answer 13

↑ Na+
↓­ K+
↑ pH
↑ Bicarb
↑­ CO2

Question 14

74M + hyperpigmentation of the forearms + eosinophils 23% + 6-month Hx of fatigue + BP 100/60. Diagnosis?

Answer 14

Addison’s disease (Primary hypoadrenalism)

Question 15

Etiology behind Addison’s disease?

Answer 15

Autoantibodies against 21-hydroxylase in the adrenal cortex.

Question 16

74M + hyperpigmentation of the forearms + eosinophils 23% + 6-month Hx of fatigue + BP 100/60. What are the arrows for Na+, K+, pH, bicarb, CO2, aldosterone, and ACTH?

Answer 16

↓ Na+
↑ K+
↓ pH
↓ Bicarb
↓ CO2
↓ Aldosterone
­↑ ACTH

Question 17

___ is common in adrenal insufficiency.

Answer 17

Eosinophilia

Question 18

Low aldosterone =

Answer 18

Less sodium reabsorption
Less potassium and proton secretion

Question 19

39F + 20-year-Hx of rheumatoid arthritis managed with NSAIDs, prednisone, methotrexate, and infliximab. She has Cushingoid appearance. What are the arrows for her ACTH and cortisol levels?

Answer 19

↓ ACTH
↓ Cortisol

Question 20

13M + three days ago treated for meningococcal septicemia + now has BP of 80/50. Diagnosis?

Answer 20

Waterhouse-Friderichsen syndrome (Hemorrhagic necrosis of the adrenal glands
secondary to meningococcal septicemia)

Question 21

13M + three days ago treated for meningococcal septicemia + now has BP of 80/50. What are the arrows for serum aldosterone, cortisol, ACTH, K+, Na+, HCO3-, pH, and CO2?

Answer 21

↓ Aldosterone
↓ Cortisol
↑ ACTH
↑ K+
↓ Na+
↓ HCO3-
↓ pH
↓ CO2

Question 22

Cortisol normally functions to upregulate ___ on arterioles.

Answer 22

a1-receptors

Question 23

Test for Cushing syndrome?

Answer 23

Low-dose dexamethasone

Question 24

Which can maintain upward gaze for 60 seconds? Myasthenia gravis or Lambert-Eaton?

Answer 24

Lambert-Eaton

Question 25

50M + Cushingoid appearance + proximal muscle weakness + successful ability to maintain upward gaze for 60 seconds + serum ACTH levels high + serum cortisol high. Diagnosis?

Answer 25

Both Lambert-Eaton and Cushing syndromes secondary to small cell bronchogenic carcinoma.

Question 26

50M + Cushingoid appearance + proximal muscle weakness + successful ability to maintain upward gaze for 60 seconds + serum ACTH levels high + serum cortisol high; if high-dose dexamethasone is administered, what will happen to his ACTH and cortisol levels?

Answer 26

⟷ ACTH ⟷ Cortisol

Question 27

35F + central obesity with purple striae + adrenal mass visualized on CT of the abdomen. Diagnosis?

Answer 27

Cushing syndrome due to a cortisol-secreting adenoma of the zona fasciculata.

Question 28

35F + central obesity with purple striae + adrenal mass visualized on CT of the abdomen. What are the arrows for this patient’s serum ACTH, cortisol, and urinary potassium?

Answer 28

↓ ACTH ↑­ Cortisol ↑ Urinary potassium

Question 29

28F + gave birth one week ago via C-section in which she lost a lot of blood + now has fatigue + difficulty breastfeeding postpartum. Diagnosis?

Answer 29

Sheehan Syndrome

Question 30

28F + gave birth one week ago via C-section in which she lost a lot of blood + now has fatigue + difficulty breastfeeding postpartum; what are the arrows for serum prolactin, ACTH, TSH, and Aldosterone?

Answer 30

↓ Prolactin ↓ ACTH ↓ TSH ↑ Aldosterone

Question 31

40M + recent weight gain + pituitary mass visualized on MRI + point tenderness over a vertebra at L1 + compression fracture visualized on x-ray + slight muscle weakness. Diagnosis?

Answer 31

Cushing disease

Question 32

40M + recent weight gain + pituitary mass visualized on MRI + point tenderness over a vertebra at L1 + compression fracture visualized on x-ray + slight muscle weakness. What are the arrows for prolactin, ACTH, and serum K+?

Answer 32

⟷ Prolactin ↑ ACTH ↓ K+

Question 33

Cushing disease can present as mere osteoporosis and weight gain in a patient with a ___.

Answer 33

Pituitary adenoma

Question 34

If urinary specific gravity is ­, the urine is ↑, that means:

Answer 34

The urine is concentrated

Question 35

Vasopressin is an:

Answer 35

ADH analog

Question 36

45M + long history of smoking + recent weight loss + confusion. Diagnosis?

Answer 36

SIADH secondary to small cell bronchogenic carcinoma

Question 37

Small cell lung cancer paraneoplastic syndromes:

Answer 37

1) SIADH (ADH secretion) 2) Cushing syndrome (ACTH secretion) 3) Lambert-Eaton syndrome 4) Neurologic/cerebellar dysfunction (Anti-Hu/-Yo antibodies)

Question 38

High Yield squamous cell lung cancer paraneoplastic syndrome:

Answer 38

Hypercalcemia often presenting as urolithiasis (PTH-related peptide; i.e., PTHrp, secretion).

Question 39

24F + bipolar disorder + mildly tremulous + increased urinary output. What are arrows in this patient for tonicity of her proximal convoluted tubule (PCT), juxtaglomerular apparatus (JGA), and medullary collecting duct (MCD) in comparison to her serum tonicity?

Answer 39

⟷ PCT ↓ JGA ↓ MCD

Question 40

The PCT is always ___ no matter what.

Answer 40

Isotonic

Question 41

The JGA is always ___ no matter what.

Answer 41

Hypotonic

Question 42

The MCD will be hypertonic in:

Answer 42

1) SIADH 2) Dehydration

Question 43

The MCD will be hypotonic in:

Answer 43

1) DI (both central and nephrogenic) 2) Psychogenic polydipsia

Question 44

47F + has been taking large doses of ibuprofen the past 25 years. What are the arrows for this patient’s urine volume and urine osmolality in response to exogenous administration of ADH?

Answer 44

⟷ Urine volume ⟷ Urine osmolality

Answer 45

⟷ ↑ ↓