Shit - Endo Flashcards Preview

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Flashcards in Shit - Endo Deck (85):
1

MSH

from intermediate lobe of AP

2

AP vs PP origins

AP = oral ectoderm
PP = neuroectoderm

3

Increase C-peptide via

Insulinoma
Sulfonyluras (chlorpromazine, tolbutamide, Glimeperide, glipizide, glyburide)

4

insulin effects on the kidney:

increase Na+ resorption

5

Insulin-independent glucose transporters:

1 = brain, RBC, cornea
2 = liver, panc, kidney, GIT
3 = brain, placenta, neurons
5 = fructose @ spermatocytes, GIT

6

Adrenergics on insulin release

a2 = decrease insulin release (stronger)
(b2 = increase insulin release)

7

Effect of drugs that open K+ channels (diazoxide) or cause decreased EC K+ (thiazides)

Can;t close b-cell K+ channels .: can't release insulin .: hyperglycaemia

8

CRH effects

ACTH, MSH, b-endorphins

9

Tesamorelin

GHRH analog to treat lipodystrophy in HIV

10

GnRH regulated by:

prolactin (i.e. breastfeeding stops GnRH release; prolactinoma causes infertility, OP, galactorhea)

11

delta cells in pancreas secrete + function

somatostatin; inhibits GH and TSH release in HPA (also many GIT actions).

12

Somatostatin role in HPA

inhibit GH and TSH release

13

Somatostatin role in GIT

INHIBITS RELEASE OF:
Gastrin
Cholecystokinin (CCK)
Secretin
Motilin
Vasoactive intestinal peptide (VIP)
Gastric inhibitory polypeptide (GIP)
Enteroglucagon
Decrease rate of GE

Panc:
Insulin
GCG
Exocrine function

14

TRH effects

increases TSH and prolactin release.
[so 1' or 2' hypothyroidism would cause hyperprolactinemia]

15

How is prolactin regulated

Increase: TRH
Decrease: DA, Prolactin (increases DA synthesis)

16

Somatomedin C =

IGF-1 (muscle mass, linear growth) [GH = InsResistance]

17

GH: increased and decreased by:

Increased:
GHRH
Sleep
Exercise

Decreased:
somatostatin
glucose
somatomedin negative feedback

18

Ghrelin function:

induce hunger
cause HG release

19

Conditions that increase ghrelin release

Sleep deprivation
Prader-willi

20

Regulation of AHD

1' = osmo-Rs in hypothalamus (most important job is osmolarity)
2' = hypovolemia

21

desmolase: other name, job, regulated by

= side chain cleavage enzyme
Turns cholesterol to pregnenolone
Increased by ACTH
Inhibited by Ketoconazole

22

renin levels in CAHs

21 = high
17 = low
11 = low

23

Hormone in 11-CAH that causes HTN

11-deoxycorticosterone

24

17-CAH presentation wrt sexes

XX = lack secondary sex characteristics
XY = pseudohermaphroditism, cryptorchidism

25

Rx CAH

Exogenous cortisol to inhibit ACTH release
Other supplements i.e. aldosterone

26

Functions of cortisol:

BP: upregulates a1-Rs, acts as aldosterone at high conc
Insulin resistance
Gluconeo, lipolysis, proteolysis
Decrease fibroblast activity (striae)
Decrease immune system (incl. IL-2 production --> candidiasis and reactivation of TB). Neutrophilia
Decreased OBL activity

27

Ca and pH

40% Ca bound by albumin (45% ionized = free)
Increase pH = less H+ = albumin binds more Ca++ = hypocalcemia (tetany, cramps, spasms, paresthesias)

28

Vit D2 vs D3

D2 = plant foods
D3 = skin

29

Vit D regulation

Increased by: low Ca, low PO4, high PTH
Decreased by: high Vit D (inhibits itself and PTH)

30

Ca++ regulation cells

Chief = parathyroid (bone, kidney, vitD)
C-cell = calcitonin (bone)

31

PTH in kidney

PO4 - decrease resorption in PCT
Ca - increase resorption in DCT
Vit D - increase a-1-OHase in PCT

32

PTH in bone

increase Macrophage-CSF and OBL to secrete RANK-L

33

PTH secretion and Mg levels

Low Mg = increased PTH release
VERY low Mg = decreased PTH release

*get low Mg via diarrhea, loops, aminoglycosides, alcohol abuse

34

Increase SHBG via:

pregnancy and OCPs
.: more T bound up .: feminizing

35

5'deiodinase: role and inhibitors

converts T4 to T3 peripherally

Inhibited by:
Propylthiouracil
Glucocorticoids
Amiodarone
Iopanoic acid (contrast agent)
Non-selective b-blockers

36

Wolf-Chaikoff

High Iodine temporarily inhibits TPO

37

Competitive inhibitors of NIS

Perchlorate
Pertechnetate
Thiocyanate

38

S/S of adrenal insufficiency:

Electrolytes: low Na+, high K+, metabolic acidosis (NON-ion gap), high Cl-

weak, fatigue, N/V/D, muscle aches, ORTHOSTATIC HYPOTENSION, weight LOSS, salt/sugar cravings

39

Dx of adrenal insufficiency:

ACTH stimulation test

OR

Metyrapone stimulation test (blocks 11-deoxycortisol to cortisol)
Normal = high 11-deoxy an high ACTH
1' = no 11-deoxy but high ACTH
2' = now 11-deoxy or ACTH

40

Addison underlying disease

Autoimmune, TB, mets

41

When do you see skin pigmentation and when do you see hyperkalemia in adrenal insufficiency

1' = skin and hyperkalemia
2' and 3' = NO skin (no ACTH) and NO hyperkalemia (aldosterone synthesis preserved)

42

Na+ levels in hyperaldosteronism

NORMAL!
Aldosterone increases Na+ and H2O, so increased GFR causes Na+ loss; so HTN with normal Na+ and no edema = "aldosterone escape"

43

Opsoclonus myoclonus: underlying disease and characteristics

NEUROblastoma
irregular abdominal mass, can cross midline
HVA, VMA, bombesin, neuron-spec enolase
N-myc
HOMER-WRIGHT ROSETTES

44

Homer-Wright Rosettes

Neuroblastoma
Medulloblastoma

45

Theo associated with what syndromes:

NF-1
VHL
MEN2A
MEN2B

46

Signs and level sin hyperaldosteronism

NORMAL Na+
Low K+ [muscle weakness and parenthesias]
Metabolic alkalosis (high HCO3-)
low Cl- (for electroneutrality of bicarb)
hypertension (no edema or hyperNa+)
low renin (if primary)

47

Most sensitive measure for hypothyroidism

High TSH

48

Cholesterol levels in hypo and hyper thyroidism

Hypothyroid = hyper cholesterolemia (via decreased LDL-R expression)

hyperthyroid = hypocholesterol
[also hyperglycaemia and hypercalcemia (bone resorption)]

49

Myoedema

Hit muscle, stays bulged for longer because of slow Ca uptake into SR. Seen in hypothyroidism

50

hashimotos ABs

anti-TPO
anti-TG
anti-microsomal

51

Immune gene of hashimotos

HLA-DR5

52

umbilical hernia, tongue sticking out

cretinism

53

DeQuervains

post flu-like
Hyper then hypo
granulomatous inflammation with mixed cell infiltrate and giant cells
High ESR, jaw pain, tender thyroid

54

Reidel Thyroiditis

Fibrosis extending i.e. airway (ddx = anaplastic but thats old ppl) = rock/wood-like
young woman
IgG4 related - autoimmune pancreatitis, retroperitoneal fibrosis, non-infectious aortitis

55

Ab for Graves

IgG

56

Mutation in TSH-R causes:

toxic multinodular goiter - hot nodule, rarely malignant

57

Thyroid storm s/s and rx

Stress-induced
Agitation, delerium, fever, diarrhea, vomiting, coma
COD = tachyarrythmia

Rx = b-blocker, PTU, corticosteroids

58

Jod-Basedow phenomenon

Iodine deficient person made iodine replete presenting with thyrotoxicosis

59

Thyroid artery matched with nerve that can be damaged:

Superior thyroid artery = superior laryngeal nerve
- external = cricothyroid (low-pitched monotone)
- internal = sensation above vocal cords (aspiration)

Inferior thyroid artery = recurrent laryngeal nerve = all laryndeal muscles (less cricothyroid)
- hoarseness and sensation below vocal cords

60

Papillary thyroid cancer:

Orphan annie
RET or BRAF
Psammoma
Nuclear grooves
childhood iradiation

61

Follicular thyroid cancer

Hematogenous mets
RAS
Invasion of thyroid capsule

62

Medullary CA thyroid

Calcitonin
C-cells
Amyloid background
RET

63

Undifferentiated/anaplastic Thyroid CA

old person
Invades local structures (ddx = riedel's thyroiditis)
p53

64

Hematogenous CA mets

Follicular CA thyroid
ChorioCA
HCC
RCC

65

Pseudohypoparathyroidism =

Albright hereditary osteodystrophy

- kidneys unresponsive to PTH so low Ca and high PO4
- short 4th and 5th digits, short, AD

66

Albright hereditary osteodystrophy

Pseudohypoparathyroidism =
- kidneys unresponsive to PTH so low Ca and high PO4
- short 4th and 5th digits, short, AD

67

Familial hypocalciuric hypercalcemia

Defective Ca-sensory on parathyroid
Keep resorbing it from bone = hypercalcemia
Dont excrete it in kidneys = hypocalciuria

68

Kidneys unresponsive to PTH vs. defective Ca-sensor on parathyroid

unresponsive kidneys = pseudohypoparathyroidism/albrights

defective sensor = familial hypocalciuric hypercalcemia

69

increased cAMP in urine

hyperparathyroidism (signalling molecule)

70

2' hyperPTH levels via kidney failure

Low Ca
High PO4

71

Acromegaly s/s, complication, test, rx

Large tongue with deep furrows, insulin resistance
Increased risk of colorectal polyps and cancer
Test = GH not suppressed with OGTT
Rx:
- Octerotide (somatostatin analog)
- Pegvisomant (GH-R antagonist)

72

Causes, urine spec. gravity, and rx of central vs nephrogenic DI

Central:
- pituitary tumour, hypothalamus problem, trauma, surgery, ischemic encephalopathy, idiopathic
-

73

SIADH: complication, causes, rx

Cerebral edema
- fix too quick, get osmotic demyelination syndrome

Via small cell, head trauma, PULMONARY DISEASE, cyclophosphamide, carbamazepine

Rx = IV hypertonic saline (slowly), conivaptan, tolivaptan, demeclocycline

74

Empty sella pt

obese woman

75

pregnancy and pituitary problems

Sheehans = ischemic infarct post-blood loss
Autoimmune hypophysitis = acute HA, visual field changes, cortisol deficiency in late pregnancy or early post-delivery

76

DM: lipolysis and proteolysis

present in TIDM
NOT usually in T2 because some basal insulin to prevent it

Both have increased protein catabolism

77

MCCD DM

MI

78

Osmotic damage: what enzymes

Have aldose reductase
NO or LOW sorbitol dehydrogenase

79

Gestatoinal DM: hormone and s/s in fetus

hPL

Caudal regression syndrome, VSD, transposition of great vessels, neural tube defects, rectal atresia, renal agenesis

80

T1DM HLA link

DR-3 and DR-4

81

DKA complications

life-threatening mucor, cerebral deem, arrythmias, heart failure

82

Glucagonoma s/s

Dermatitis - necrolytic migratory erythema
Depression
Diabetes
DVT
Diarrhea
Normo normo anemia

83

whipples triad

insulinoma

84

carcinoid markers

Neuroendocrine (chromogrannin)
5-HIAA
Niacin deficiency (pellagra)

85

MEN genes

MEN1 = MEN1 = menin tumour supressor
MEN2 = RET = tyrosine kinase