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124 Cards in this Set

  • Front
  • Back
what are antibodies directed against in type I DM?
glutamic acid decarboxylase (GAD)
treatment for pituitary apoplexy?
glucocorticoids and thyroid hormone
most accurate test for hypothyroidism?
serum TSH
metabolic disturbance seen in primary adrenal insufficiency?
what effect do alpha2 agonists have on insulin secretion?
directly inhibit it
what is Laron dwarfism?
congenital absence of growth hormone receptors
classical physical finding in Addison's disease?
how does pregnancy/estrogen affect thyroid-binding globulin?
increases its synthesis
Hashimoto's can be associated with disorders of what other organ?
how do you distinguish nephrogenic DI from neurogenic DI?
water deprivation will fail to increase urine osmolarity in both, but subsequent injeciton of vasopressin will concentrate the urine in the case of neurogenic DI but not nephrogenic DI
what are the secretory products of the zona glomerulosa?
what are the secretory products of the zona fasciculata?
cortisol, sex hormones
what are the secretory products of the zona reticularis?
sex hormones, e.g. androgens
what are the secretory products of the adrenal medulla?
what doe sthe posterior pituitary produce?
vasopressin and oxytocin
what embryonic layer is the posterior pituitary derived from?
what hormones is the alpha subunit common to?
what subunit determines hormone specificity?
in what part of the pancreas are the islets of Langerhans most numerous?
from what do the pancreatic islets arise?
pancreatic buds
what type of pancreatic cells secrete glucagon?
what type of pancreatic cells secrete insulin?
what type of pancreatic cells secrete somatostatin?
how does prolactin influence dopamine synthesis and secretion?
increases it
what effect does dopamine have on prolactin?
inhibits it's secretion
what effect do dopamine agonists (e.g. bromocriptine) have on prolactin secretion?
inhibit (antagonists - e.g. antipsychotics - stimulate
decreased sex hormones, decreased cortisol, increased mineralocorticoids - hypertension, hypokalemia; phenotypically female but no maturation
17alpha hydroxylase deficiency
what is the most common form of congenital adrenal hyperplasia?
21 beta hydroxylase deficiency
decreased cortisol (increased ACTH), decreased mineralocorticoids, increased sex homrones - masculinization, female pseudohermaphroditism, etc.
21 beta hydroxylase deficiency
what is the difference in BP between 17 alpha hydroxylase deficiency and 21 beta hydroxylase deficiency?
17 - hypertension
21 - hypotension
increased plasma renin activity, volume depletion, hyponatremia, hyperkalemia are associated with what congenital adrenal hyperplasia?
21 beta hydroxylase deficiency
decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones, masculinization, hypertension?
11 beta hydroxylase deficiency
what effect does PTH have on phosphate?
decreases serum phosphate, increases urine phosphate
what effect does PTH have on calcium?
increases serum calcium
where does PTH influence calcium resorption?
increases it in distal convuluted tubule
what type of vitamin D comes from sun exposure in skin?
what increases absorption of dietary calcium and phosphate and increases bone resorption of them as well?
vitamin D
levels of calcium, phosphate, alk phos in osteoporosis?
all normal
levels of calcium, phosphate, alk phos in hyperparathyroidism?
increased calcium
decreased phosphate
increased alk phos
levels of calcium, phosphate, alk phos in Paget's disease
normal or increased calcium
normal phosphate
very high alk phos
levels of calcium, phosphate, alk phos in vitamin D intoxication?
all increased (alk phos normal or increased)
levels of calcium, phosphate, alk phos in renal insufficiency?
decreased calcium
increased phosphate
normal alk phos
what is the source of calcitonin?
parafollicular (C cells) of thyroid
waht is the function of calcitonin?
decreases bone resorption of calcium
what causes calcitonin secretion?
increased serum calcium
when is thyroid binding globulin decreased?
hepatic failure
how does thyroid hormone increase BMR?
increases Na/K ATPase activity - increased O2 consumption, RR, body temp
Cushing's disease?
primary pituitary adenoma - increased ACTH and cortisol
ACTH level in primary adrenal hyperplasia/neoplasia?
decreased (cortisol increased)
dexamethasone suppression in healthy person?
decreased cortisol after low does
dexamethasone suppression test in person with ACTH-producing tumor?
increased cortisol after low does
decreased after high dose
dexamethasone suppression in person with cortisone-producing tumor?
increased cortisol after low and high dose
primary hyperaldosteronism/Conn's syndrome?
caused by an aldosterone-secreting tumor
findings in Conn's syndrome?
hypertension, hypokalemia, metabolic alkalosis
renin level in primary aldosteronism? in secondary?
low in primary
high in secondary
this type of hyperaldosteronism is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome
secondary - kidney perception of low intravascular volume results in overactive RAA system - high plasma renin
primary deficiency of aldosterone and cortisol due to adrenal atrophy
Addison's disease
hyponatremic volume contraction and skin hyperpigmentation
Addison's disease
how do you distinguish Addison's disease from secondary deficiency of aldosterone?
no skin hyperpigmentation in secondary (due to decreased pituitary ACTH production)
what is the cause of skin hyperpigmentation in Addison's?
MSH, a byproduct of increased ACTH production from POMC
what cells is a pheochromocytoma derived from?
chromaffin cells (arise from neural crest)
what MEN types is pheochromocytoma associated with? what other disorder is it associated with?
MEN II and III; neurofibromatosis
most common tumor of adrenal medulla in adults? kids?
pheochromocytoma; neuroblastoma (can occur anywhere along the sympathetic chain)
how is pheochromocytoma treated?
alpha antagonists, especially phenoxybenzamine
pancreas (e.g. Zollinger-Ellison syndrome, insulinomas, VIPomas), parathyroid, and pituitary tumors (3 P's)
how does MEN I present?
kindey stones and stomach ulcers
another name for MEN I?
Wermer's syndrome
medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor
another name for MEN II?
Sipple's syndrome
medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromas (mucosal neuromas)
how are MEN syndromes inherited?
what gene are MEN II and III associated with?
what type of hypersensitivity reaction is Grave's?
type II
what is Riedel's thyroiditis?
thyroid replaced by fibrous tissue (hypothyroid)
histologic finding in hashimoto's?
lymphocytic infiltrate with germinal centers
self-limited hypothyroidism often following a flulike illness; elevated ESR, jaw pain, early inflammation, and very tender thyroid?
subacute thyroiditis (de Quervain's)
what is the most common type of thyroid cancer?
papillary carcinoma - excellent prognosis
ground-glass/Orphan Annie nuclei, psammoma bodies
papillary carcinoma of the thyroid
from what does medullary carcinoma of the thyroid arise?
parafollicular C cells
thyroid cancer that produces calcitonin, sheets of cells in amyloid stroma?
medullary carcinoma
type of thyroid cancer seen in older patients, very poor prognosis?
defect in T4 formation or developmental failure in thyroid formation is seen in what?
sporadic cretinism
treatment for acromegaly?
primary hyperparathyroidism is usually caused by what?
findings in primary hyperparathyroidism?
hypercalcemia, hypercalciuria, hypophosphatemia, increased PTH, increased cAMP in urine
symptoms of primary hyperparathyroidism?
often asymptomatic; may present with weakness and constipation
what causes secondary hyperparathyroidism?
secondary hyperplasia due to decreased serum calcium, most often in chronic renal disease
findings in secondary hyperparathyroidism?
hypocalcemia, hyperphosphatemia, increased PTH
what causes hypoparathyroidism?
accidental surgical excision or DiGeorge's
findings in hypoparathyroidism?
hypocalcemia, tetany
what is Chvostek's sign?
hypocalcemia - tap facial nerve and see contraction of facial muscles
what is Trousseau's sign?
hypocalcemia - occlusion of brachial artery with BP cuff leads to carpal spasm
what is pseudohypoparathyroidism?
AR kidney unresponsiveness to PTH; hypocalcemia, shortened 4th/5th digits, short stature
excess of what vitamins can cause hypercalcemia?
vitamins A and D
what is usually the cause of DKA?
increase in insulin requirements from an increase in stress (e.g. infection) - excess fat breakdown and increased ketogenesis from the increase in free fatty acids, which are then made into ketone bodies
what is the metabolic disturbance associated with DKA?
increased H+, decreased HCO3-
anion gap metabolic acidosis; hyperkalemia but depleted intracellular K+
intensive thirst and polyuria with inability to concentrate urine?
diabetes insipidus
causes of central DI?
pituitary tumor, surgery, trauma, histiocytosis X
causes of nephrogenic DI?
hereditary or secondary to hpercalcemia, lithium, demeclocycline
what happens in a water deprivation test in DI?
urine osmolality doesn't increase
urine specific gravity is less than what in DI? osmolality greater that what?
what is the treatment for central DI?
intranasal desmopressin (ADH analog)
what is the treatment for nephrogenic DI (lack of renal resonse to ADH)?
hydrochlorothiazide, indomethacin, or amiloride
excessive water retention, hyponatremia, and urine osmolarity > serum osmolarity
what is a dangerous potential effect of SIADH?
very low serum sodium levels can lead to seizures (correct slowly)
causes of SIADH?
ectopic ADH, CNS disorders/head trauma, pulmonary disease, cyclophosphamide
treatment for SIADH?
demeclocycine or water restriction
diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease?
carcinoid syndrome
carcinoid syndrome?
rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of serotonin - not seen if tumor is limited to GI tract (serotonin undergoes first-pass metabolism in GI tract)
what is the most common tumor of the appendix?
urine finiding in carcinoid syndrome?
increased 5-HIAA
what are carcinoid tumors derived from?
neuroendocrine cells of GI tract
treatment for carcinoid syndrome?
rule of 1/3s for carciniod syndrome?
1/3 metastasize
1/3 present with 2nd pregnancy
1/3 multiple
what fascia encloses the thyroid gland?
pretracheal fascia
surgical resection of ileum causes what levels of calcium, 25-OH vitamin D, phosphate?
all decreased
mechanism of propylthiouracil?
inhibits deiodonation of T4
somatostatin inhibits the release of what 2 hormones?
GH and TSH
thyroid condition preceding lymphoma?
Hashimoto thyroiditis
pentagastrin-stimulated calcitonin secretion is a marker for what?
medullary carcinoma of the thyroid
treatment for DKA?
fluids, insulin, and potassium; glucose if necessary to prevent hypoglycemia
activation of pyruvate dehydrogenase and increased levels of acetyl CoA are associated with what?
type 2 DM
why does glucose taken orally cause a greater increase in insulin than when given IV?
increases duodenal secretion of gastric inhibitory peptide, increasing beta cell release of insulin
thyroid nodule with small 'solid balls' of neoplastic follicular cells containing microscopic blood vessels and fibrous stroma in their centers
papillary carcinoma