Random - Quizzes Flashcards
(109 cards)
1
Q
thyroid hormone receptor type
A
part of the nuclear receptor superfamily which are INTRACELLULAR
2
Q
ADH receptor type
A
Gs protein –> adenylyl cyclase –> cAMP
3
Q
most common pituitary adenoma
A
prolactinoma
4
Q
suspect Cushing syndrome, get
A
Midnight salivary cortisol
highly sensitive for the dx of Cushing’s syndrome if the level is over 7.5 mcg/dl
5
Q
acromegaly pt has inc risk of ___ cancer
A
colon
6
Q
Rathke’s pouch
A
ciliated and goblet cells and metaplastic squamous cellls
7
Q
suprasellar mass
A
craniopharyngioma
benign
8
Q
craniopharyngioma biopsy
A
calcification
benign
9
Q
the majority of cases of GH xs are caused by
A
pituitary somatotroph adenoma
10
Q
primary prolactinoma tx
A
dopamine agonists like cabergoline
11
Q
most helpful physical finding in suggesting that a patient may have Cushing’s syndrome
A
supraclavicular fat pad
12
Q
_____ is the most common cause of endogenous Cushing’s syndrome
A
A pituitary tumor producing ACTH
13
Q
necrolytic migratory erythema
A
Glucagonoma
14
Q
flushing, recurrent diarrhea, wheezing
A
carcinoid syndrome
15
Q
dx of carcinoid syndrome
A
24 hour urine collection for 5-HIAA
16
Q
T/F
Steroid hormones are packaged or stored in steroid hormone-producing cells
A
F
17
Q
Steroid hormones target ____ receptors
A
intracellular
18
Q
how does cortisol inc BP
A
increases tissue sensitivity to catecholamines which can contribute to a rise in blood pressure through action at adrenergic receptors
19
Q
rate limiting enz in catecholamine synthesis
A
tyrosine hydroxylase
20
Q
glucocorticoids effect on muscle
A
stim protein degradation in m.
21
Q
elevated plasma cortisol at midnight has a very high specificity (low false positive) for
A
pathologic hypercortisolism (Cushing’s syndrome)
22
Q
highest cortisol levels
A
6-8am
23
Q
pituitary adenoma
A
xs cortisol
24
Q
Asymptomatic nodules in the adrenal are common, and the most frequent diagnosis is
A
cortical adenoma
25
Most adrenal masses at __ cm or higher would be recommended for surgery.
6 cm
risk for adrenal carcinoma rises as adrenal masses grow (even non-func)
26
3 genetic conditions assoc w/ pheochromocytoma
MEN 2
Von Hippel Lindau
Neurofibromatosis
27
plasma DHEAS in primary hypERaldosteronism
normal
28
Conn syndrome
adrenal adenoma
| can lead to primary hyERaldo
29
tx of primary hypERaldo if surgery not indicated
spironolactone
30
pheochromocytoma dx
24-hour urine collection of catecholamines and metanephrines (HVA, MVA)
31
when to perform imaging when suspect pheochromocytoma
AFTER biochemical dx, can do MRI, MIBG, or PET
32
Germline mutations of ___ account for a substantial percentage of familial cases of pheochromocytoma
succinate dehydrogenase (Kreb's)
33
Malignancy can only be diagnosed definitively by the development of _______.
metastases
34
The best predictor of pheochromocytoma metastasis is mutation of the __ gene.
SDHB
35
bilateral adrenal hyperplasia med therapy
spironolactone
36
primary hypERaldo dx
1. inc Aldo:renin ratio
2. Na load test (should suppress aldo)
3. image for adrenal mass
4. adrenal v. sample (could be sec hypERaldo due to renal a. stenosis, CHF, low vol)
37
unilateral adrenal mass producing aldo, tx
Right laparoscopic adrenalectomy
38
primary hyperaldosteronism, Na levels
normal to occasionally high at presentation
39
Metyrapone
causing dec cortisol
| inhibits last step in cortisol synth (11-beta hydroxylase) --> should inc ACTH from pituitary
40
C-cell hyperplasia
MEN2
| calcitonin
41
Iodine is oxidized by thyroid peroxidase to a free radical form which then covalently links to ___ residues within thyroglobulin.
tyrosine
42
Upon stimulation, the thyroglobulin is digested within ____ to form thyroxine.
lysosomes
43
Which is the preferred thyroid replacement tx?
Levothyroxine (T4) over Liothyronine (T3)
| Liothyronine is more rapidly absorbed from the intestines and also mildly induces hypERthyroid sx
44
high normal to elevated radioactive iodine uptake
Graves' disease (AI hyperthyroidism)
toxic nodular goiter
toxic adenoma
45
low to absent radioactive iodine uptake
subacute thyroiditis
| exogenous thyroid hormone
46
High radioactive uptake; Scan with enlarged gland with homogeneous appearance
Graves
47
anti-TPO
Hashimotos`
48
toxic adenoma radioactive iodine uptake
only localized elevation in uptake while the remainder of the gland is suppressed
49
T/F
Subacute thyroiditis may be reversible.
T
| self-limited
50
___ cancer is the most common form of thyroid cancer
Papillary
51
The diagnostic procedure of choice to determine if a nodule contains cancer is
fine needle aspiration
52
T/F
Ultrasound can differentiate between benign and malignant thyroid nodules
F
53
Papillary thyroid cancer recurrence is monitored using
thyroglobulin levels and imaging such as thyroid ultrasound and I-123 body scans
54
RAS point mutations
follicular carcinoma
55
PAX8-PPARgamma1 expressions
follicular carcinoma
56
calcitonin malignancy
medullary thyroid CA
57
amyloid stroma
medullary thyroid CA
58
The majority of thyroid nodules (85-90%) are
benign nodules within a goiter
59
__ and __ are recommended first in the evaluation of a suspected thyroid nodule
TSH level and thyroid US
60
A "warm" thyroid nodule has a __% risk of malignancy
5-15% (sim to a cold nodule)
consider FNA after US results
61
PTH acts at osteoblasts or osteoclasts?
osteoblasts
| inc alk phos
62
High serum calcium and phosphorus can be seen with an excess of
vitamin D
63
low Ca
low Phosphate
nml albumin
tx could target which receptor type
nuclear hormone receptor (vit D receptor)
64
suspect lung cancer causing hypERCa, confirm with
PTHrP
65
In the context of hypercalcemia, a normal ___ is an abnormal finding.
PTH
66
markedly elevated vitD3 intake
1,25-Vit D3 / Calcium / PTH
| all will be essentially normal
67
familial hypOcalciuric hypERcalcemia
AD, point mut in parathyroid Ca sensing proteins --> higher set point of Ca for PTH release to stop
-benign, no tx req
68
nml PTH
mildly elevated Ca
dec urinary Ca
familial hypOcalciuric hypERcalcemia
69
PTH-rP leads to ____ 1,25-vitamin D3
paradoxical suppression of 1,25-D3
70
celiac disease
osteoporosis (Ca and vit D deficiency)
71
bone mineral density T score
< -2.5
72
bone mineral density T score
2.5
73
osteopenia is defined as a BMD between
-1 and -2.5
74
In all pt, ___ takes priority in dx of osteoporosis
fragility fracture
75
labs in osteoporosis
Ca/PTH/alk phos
Ca/PTH/alk phos
WNL
76
insulin action in adipocytes
stimulates lipogenesis and release of free fatty acids from lipoproteins and chylomicrons by lipoprotein lipase
77
___ is an incretin hormone which is released during enteral feeding
GLP-1
potentiates insulin release from the beta cells of the islet
inhibits glucagon release leading to better blood sugars during enteral feeding
78
necrolytic migratory erythema
glucagonoma
79
Insulin and C-peptide are elevated in 2 scenarios:
insulinoma and sulfonylurea use
80
formal dx of hypOglycemic state
triad of a low blood glucose (under 50-55 mg/dl), sx (sweating/tremor) and improvement in sx with administration of glucose
(Whipple's triad)
81
effects of gestational diabetes on newborn
increased birth weight, increased risk of dystonia and increased fetal mortality
may also have hyperplasia of pancreatic islets and accompanying hypoglycemia.
82
Normal HbA1C is under___% at Tufts Medical Center.
5.7
83
goal for fasting and premeal blood sugars is ____ mg/dl
80-130
84
postprandial blood sugar goal is
under 160-180 mg/dl (normal under 140)
85
Antibodies to ______ antigen on beta-cell may be a marker for type 1 DM.
glutamic acid decarboxylase
86
DM type 1 --> __% concordance in twin studies
30-50%
87
Insulin / Glucagon / Cortisol
| in DKA
low / high / high
88
hyperglycemic, hyperosmolar nonketonic state (HHNS) tx
fluid replacement
| ^often will dramatically lower their blood sugar concentration
89
plasminogen activator inhibitor-1 (PAI-1) in type II DM
PAI-1 levels are increased in response to a cascade starting with intracellular hyperglycemia and activation of protein kinase C
--> vascular occlusive episodes
90
In type II DM, exercise improves glucose tolerance by
increasing the number of insulin receptors in the body and increasing the receptor affinity for insulin along with increasing the number of GLUT4 transporters at the cell membrane
91
type II DM starting regimen
start all patients on lifestyle management and metformin at the time of dx
92
BP goals in type II DM are under
140/90 (under 130/80 if it can be safely achieved in a younger patient)
93
lipid levels in type II DM
Triglycerides under 150 mg/dl
| HDL over 50 mg/dl in a woman or over 40 mg/dl in a man.
94
Bariatric surgery is very effective for weight loss and glycemic control in patients with diabetes and BMI over __ kg/m2.
35
95
Cabergoline
DA agonist
| prolactinoma tx
96
acromegaly confirmatory test
glucose challenge
97
Cortrosyn
synthetic ACTH
tests for adrenal insufficiency
cortisol should rise after admin
if rise but pituitary was removed, still need to admin glucocorticoids bc adrenals may have just not yet atrophied
98
Cushing dx
```
1 mg (low dose) dexamethasone suppression test
24 hour urine cortisol
late night salivary cortisol (should be low at night)
```
99
low dose dexamethasone test
```
to establish Cushing's
give at bedtime
suppresses nml pituitary release
blood test in AM
if cortisol low --> nml
if high --> Cushing's
```
100
high dose dexamethasone test
to differentiate cause of Cushing's
give high dose
if cortisol falls --> adequate suppression (normal or pituitary adenoma secreting ACTH)
if cortisol high --> ectopic ACTH secretion (malignant tumor like small cell lung cancer)
101
first choice of tx for pheo while a workup proceeds
alpha antagonist
102
______ by itself should not be used as therapy when there is suspicion of pheo as
Beta adrenergic antagonist (unopposed alpha agonism can cause a hypertensive crisis)
103
small round blue cells
neuroblastoma
104
rosettes
neuroblastoma
105
type 1 diabetes with diabetic ketoacidosis first tx
IV normal saline for overall volume (salt and water) repletion
106
Parathyroid adenoma is the most likely pathology of _______ followed by parathyroid hyperplasia.
hyperparathyroid
107
small cell lung cancer
inc ACTH
| siADH
108
test to assess adequate GH prod
insulin tolerance test
bolus of insulin is given to induce hypoglycemia
in response to the hypoglycemia, growth hormone levels should rise and this rise would show adequate growth hormone reserves.
109
Cortrosyn results: initially low cortisol level which rises with administration of Cortrosyn, but does not surpass 18 mcg/dl at 60 minutes as would be expected in a normal response
secondary adrenal insufficiency such as ACTH deficiency
