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124 Cards in this Set
- Front
- Back
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what are antibodies directed against in type I DM?
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glutamic acid decarboxylase (GAD)
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treatment for pituitary apoplexy?
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glucocorticoids and thyroid hormone
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most accurate test for hypothyroidism?
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serum TSH
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metabolic disturbance seen in primary adrenal insufficiency?
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hypokalemia
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what effect do alpha2 agonists have on insulin secretion?
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directly inhibit it
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what is Laron dwarfism?
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congenital absence of growth hormone receptors
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classical physical finding in Addison's disease?
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hyperpigmentation
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how does pregnancy/estrogen affect thyroid-binding globulin?
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increases its synthesis
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Hashimoto's can be associated with disorders of what other organ?
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thymus
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how do you distinguish nephrogenic DI from neurogenic DI?
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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
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what are the secretory products of the zona glomerulosa?
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aldosterone
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what are the secretory products of the zona fasciculata?
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cortisol, sex hormones
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what are the secretory products of the zona reticularis?
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sex hormones, e.g. androgens
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what are the secretory products of the adrenal medulla?
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catecholamines
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what doe sthe posterior pituitary produce?
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vasopressin and oxytocin
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what embryonic layer is the posterior pituitary derived from?
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neuroectoderm
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what hormones is the alpha subunit common to?
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TSH, LH, FSH, hCG
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what subunit determines hormone specificity?
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beta
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in what part of the pancreas are the islets of Langerhans most numerous?
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tail
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from what do the pancreatic islets arise?
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pancreatic buds
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what type of pancreatic cells secrete glucagon?
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alpha
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what type of pancreatic cells secrete insulin?
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beta
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what type of pancreatic cells secrete somatostatin?
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delta
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how does prolactin influence dopamine synthesis and secretion?
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increases it
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what effect does dopamine have on prolactin?
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inhibits it's secretion
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what effect do dopamine agonists (e.g. bromocriptine) have on prolactin secretion?
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inhibit (antagonists - e.g. antipsychotics - stimulate
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decreased sex hormones, decreased cortisol, increased mineralocorticoids - hypertension, hypokalemia; phenotypically female but no maturation
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17alpha hydroxylase deficiency
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what is the most common form of congenital adrenal hyperplasia?
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21 beta hydroxylase deficiency
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decreased cortisol (increased ACTH), decreased mineralocorticoids, increased sex homrones - masculinization, female pseudohermaphroditism, etc.
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21 beta hydroxylase deficiency
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what is the difference in BP between 17 alpha hydroxylase deficiency and 21 beta hydroxylase deficiency?
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17 - hypertension
21 - hypotension |
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increased plasma renin activity, volume depletion, hyponatremia, hyperkalemia are associated with what congenital adrenal hyperplasia?
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21 beta hydroxylase deficiency
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decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones, masculinization, hypertension?
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11 beta hydroxylase deficiency
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what effect does PTH have on phosphate?
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decreases serum phosphate, increases urine phosphate
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what effect does PTH have on calcium?
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increases serum calcium
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where does PTH influence calcium resorption?
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increases it in distal convuluted tubule
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what type of vitamin D comes from sun exposure in skin?
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D3
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what increases absorption of dietary calcium and phosphate and increases bone resorption of them as well?
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vitamin D
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levels of calcium, phosphate, alk phos in osteoporosis?
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all normal
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levels of calcium, phosphate, alk phos in hyperparathyroidism?
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increased calcium
decreased phosphate increased alk phos |
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levels of calcium, phosphate, alk phos in Paget's disease
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normal or increased calcium
normal phosphate very high alk phos |
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levels of calcium, phosphate, alk phos in vitamin D intoxication?
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all increased (alk phos normal or increased)
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levels of calcium, phosphate, alk phos in renal insufficiency?
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decreased calcium
increased phosphate normal alk phos |
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what is the source of calcitonin?
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parafollicular (C cells) of thyroid
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waht is the function of calcitonin?
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decreases bone resorption of calcium
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what causes calcitonin secretion?
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increased serum calcium
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when is thyroid binding globulin decreased?
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hepatic failure
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how does thyroid hormone increase BMR?
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increases Na/K ATPase activity - increased O2 consumption, RR, body temp
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Cushing's disease?
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primary pituitary adenoma - increased ACTH and cortisol
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ACTH level in primary adrenal hyperplasia/neoplasia?
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decreased (cortisol increased)
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dexamethasone suppression in healthy person?
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decreased cortisol after low does
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dexamethasone suppression test in person with ACTH-producing tumor?
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increased cortisol after low does
decreased after high dose |
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dexamethasone suppression in person with cortisone-producing tumor?
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increased cortisol after low and high dose
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primary hyperaldosteronism/Conn's syndrome?
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caused by an aldosterone-secreting tumor
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findings in Conn's syndrome?
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hypertension, hypokalemia, metabolic alkalosis
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renin level in primary aldosteronism? in secondary?
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low in primary
high in secondary |
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this type of hyperaldosteronism is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome
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secondary - kidney perception of low intravascular volume results in overactive RAA system - high plasma renin
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primary deficiency of aldosterone and cortisol due to adrenal atrophy
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Addison's disease
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hyponatremic volume contraction and skin hyperpigmentation
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Addison's disease
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how do you distinguish Addison's disease from secondary deficiency of aldosterone?
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no skin hyperpigmentation in secondary (due to decreased pituitary ACTH production)
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what is the cause of skin hyperpigmentation in Addison's?
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MSH, a byproduct of increased ACTH production from POMC
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what cells is a pheochromocytoma derived from?
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chromaffin cells (arise from neural crest)
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what MEN types is pheochromocytoma associated with? what other disorder is it associated with?
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MEN II and III; neurofibromatosis
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most common tumor of adrenal medulla in adults? kids?
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pheochromocytoma; neuroblastoma (can occur anywhere along the sympathetic chain)
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how is pheochromocytoma treated?
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alpha antagonists, especially phenoxybenzamine
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MEN I?
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pancreas (e.g. Zollinger-Ellison syndrome, insulinomas, VIPomas), parathyroid, and pituitary tumors (3 P's)
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how does MEN I present?
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kindey stones and stomach ulcers
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another name for MEN I?
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Wermer's syndrome
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MEN II?
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medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor
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another name for MEN II?
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Sipple's syndrome
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MEN III?
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medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromas (mucosal neuromas)
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how are MEN syndromes inherited?
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AD
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what gene are MEN II and III associated with?
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ret
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what type of hypersensitivity reaction is Grave's?
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type II
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what is Riedel's thyroiditis?
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thyroid replaced by fibrous tissue (hypothyroid)
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histologic finding in hashimoto's?
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lymphocytic infiltrate with germinal centers
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self-limited hypothyroidism often following a flulike illness; elevated ESR, jaw pain, early inflammation, and very tender thyroid?
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subacute thyroiditis (de Quervain's)
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what is the most common type of thyroid cancer?
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papillary carcinoma - excellent prognosis
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ground-glass/Orphan Annie nuclei, psammoma bodies
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papillary carcinoma of the thyroid
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from what does medullary carcinoma of the thyroid arise?
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parafollicular C cells
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thyroid cancer that produces calcitonin, sheets of cells in amyloid stroma?
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medullary carcinoma
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type of thyroid cancer seen in older patients, very poor prognosis?
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undifferentiated/anaplastic
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defect in T4 formation or developmental failure in thyroid formation is seen in what?
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sporadic cretinism
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treatment for acromegaly?
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octreotide
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primary hyperparathyroidism is usually caused by what?
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adenoma
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findings in primary hyperparathyroidism?
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hypercalcemia, hypercalciuria, hypophosphatemia, increased PTH, increased cAMP in urine
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symptoms of primary hyperparathyroidism?
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often asymptomatic; may present with weakness and constipation
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what causes secondary hyperparathyroidism?
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secondary hyperplasia due to decreased serum calcium, most often in chronic renal disease
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findings in secondary hyperparathyroidism?
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hypocalcemia, hyperphosphatemia, increased PTH
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what causes hypoparathyroidism?
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accidental surgical excision or DiGeorge's
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findings in hypoparathyroidism?
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hypocalcemia, tetany
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what is Chvostek's sign?
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hypocalcemia - tap facial nerve and see contraction of facial muscles
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what is Trousseau's sign?
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hypocalcemia - occlusion of brachial artery with BP cuff leads to carpal spasm
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what is pseudohypoparathyroidism?
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AR kidney unresponsiveness to PTH; hypocalcemia, shortened 4th/5th digits, short stature
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excess of what vitamins can cause hypercalcemia?
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vitamins A and D
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what is usually the cause of DKA?
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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
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what is the metabolic disturbance associated with DKA?
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increased H+, decreased HCO3-
anion gap metabolic acidosis; hyperkalemia but depleted intracellular K+ |
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intensive thirst and polyuria with inability to concentrate urine?
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diabetes insipidus
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causes of central DI?
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pituitary tumor, surgery, trauma, histiocytosis X
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causes of nephrogenic DI?
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hereditary or secondary to hpercalcemia, lithium, demeclocycline
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what happens in a water deprivation test in DI?
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urine osmolality doesn't increase
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urine specific gravity is less than what in DI? osmolality greater that what?
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<1.006
>290 |
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what is the treatment for central DI?
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intranasal desmopressin (ADH analog)
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what is the treatment for nephrogenic DI (lack of renal resonse to ADH)?
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hydrochlorothiazide, indomethacin, or amiloride
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excessive water retention, hyponatremia, and urine osmolarity > serum osmolarity
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SIADH
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what is a dangerous potential effect of SIADH?
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very low serum sodium levels can lead to seizures (correct slowly)
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causes of SIADH?
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ectopic ADH, CNS disorders/head trauma, pulmonary disease, cyclophosphamide
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treatment for SIADH?
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demeclocycine or water restriction
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diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease?
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carcinoid syndrome
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carcinoid syndrome?
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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)
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what is the most common tumor of the appendix?
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carcinoid
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urine finiding in carcinoid syndrome?
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increased 5-HIAA
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what are carcinoid tumors derived from?
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neuroendocrine cells of GI tract
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treatment for carcinoid syndrome?
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octreotide
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rule of 1/3s for carciniod syndrome?
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1/3 metastasize
1/3 present with 2nd pregnancy 1/3 multiple |
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what fascia encloses the thyroid gland?
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pretracheal fascia
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surgical resection of ileum causes what levels of calcium, 25-OH vitamin D, phosphate?
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all decreased
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mechanism of propylthiouracil?
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inhibits deiodonation of T4
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somatostatin inhibits the release of what 2 hormones?
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GH and TSH
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thyroid condition preceding lymphoma?
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Hashimoto thyroiditis
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pentagastrin-stimulated calcitonin secretion is a marker for what?
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medullary carcinoma of the thyroid
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treatment for DKA?
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fluids, insulin, and potassium; glucose if necessary to prevent hypoglycemia
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activation of pyruvate dehydrogenase and increased levels of acetyl CoA are associated with what?
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type 2 DM
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why does glucose taken orally cause a greater increase in insulin than when given IV?
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increases duodenal secretion of gastric inhibitory peptide, increasing beta cell release of insulin
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thyroid nodule with small 'solid balls' of neoplastic follicular cells containing microscopic blood vessels and fibrous stroma in their centers
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papillary carcinoma
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