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165 Cards in this Set
- Front
- Back
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an obese woman has a history of palpitations that keep her up at night. She states that she has lost weight over the last few months while attending a weight loss clinic. Physical exam shows non-palpable thyroid gland, sinus tachycardia, lid stare, no exophthalmos, brisk deep tendon reflexes. what will thyroid studies show?
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Increased T4
Increased Free T4 Decreased TSH Decreased I123 the patient is taking excess hormone lead to thyrotoxicosis. This suppresses the thyroid gland so it becomes non-palpable, and the radioactive test shows decreased uptake. Also note the absence of signs of Graves disease |
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A 22 year old woman complains of intermittent fluttering in her chest. PE demonstrates a normal thyroid, no lid stare or exophthalmos, a regular heart rate of 108 bpm, normal DTR, a BP 100/80. A mid-systolic click and murmur is heard at the apex that increases with expiration. She is currently taking OCPs. Thyroid studies reveal?
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This is an estrogen effect with an increase in TBG but not an increase in free hormone. MVP is an incidental finding
Increased T4 Increased Free T4 Decreased TSH |
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a 28 year old woman has complaints of chronic constipation and progressive weight gain over the last 6 months in spite of a pure vegan diet. She is currently on no prescription or OTC meds. PE exhibits a pale young woman with periorbital puffiness, dry yellow colored skin, normal sclera, normal CV and respiratory exam, delayed DTR, proximal muscle weakness. Thyroid studies reveal?
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The patient has primary HYPOthyroidism. Most likely due to Hashimotos thyroiditis
Decreased T4 Decreased Free T4 INcreased TSH |
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a clinic physician at OSU refers a 24 year old OSU wrestler with h/o fatigue to you. PE reveals muscular individual with cystic acne. The thyroid gland and DTR are normal. Thyroid studies?
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the patient is most likely on anabolic steroids, which cause a decreased TBG.
Decreased T4 Normal Free T4 Normal TSH |
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A pregnant woman complains of fatigue. PE demonstrates a slightly enlarged non-tender thyroid gland, normal heart rate, and normal DTRs. Thyroid studies?
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the estrogen has increased TBG and total serum T4. thyromegaly is normal in pregnancy
Increased T4 Normal Free T4 Normal TSH |
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a 32 year old Russian student has a h/o total thyroidectomy for papillary carcinoma of the thyroid gland due to radiation exposure at Chernobyl. She now complains of fatigue, muscle weakness, dry skin. PE demonstates delayed DTRs. Thyroid studies?
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The patient has hypothyroidism. Note the relationship to papillary cancer
Decreased T4 Decreased Free T4 Increased TSH |
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What reactions characterize biochemical reactions expected in DKA who is volume depleted and hypotensive?
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B-oxidation of fatty acids: no malonyl CoA to inhibit carnitine acyltransferase
Increased FA synthesis: increased lipolysis Gluconeogenesis: initiated by glucagon |
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A 25 year old woman with a previous h/o head trauma now has polyuria, increased thirst, and galactorrhea. Osmolarity?
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The patient has central diabetes insipidus where one would expect an increased POsm and a decreased UOsm.
Always diluting Never concentrating urine |
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Iodide deficiency
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Endemic goiter
- decreased synthesis of thyroid hormone |
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Severe hypoglycemia in young patient who is comatose
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probable type I DM
insulin Rx is the MCC of reactive hypoglycemia |
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Ulcer overlying a metatarsal head in a diabetic
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due to peripheral neuropathy
- patient cannot feel the bottom of the foot Osmotic damage of Schwann cells |
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child with nuchal rigidity, petechia, and hypovolemic shock
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Neisseria meningitidis
- hypovolemic shock indicates hemorrhagic infarction of the adrenal glands due to DIC |
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Sudden cessation of lactation in woman with a difficult delivery
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Sheehan's postpartum necrosis
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Pituitary apoplexy
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hemorrhage or infarction of a pituitary adenoma
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Neurofibromatosis patient with diastolic HTN, anxiety, sweating
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Pheochromocytoma
there is an association with Neurofibromatosis |
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Patient with hypertension, normocalcemia, increased serum calcitonin
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MEN IIb
- medullary carcinoma - pheochromocytoma - mucosal neuromas |
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MEN IIa
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medullary carcinoma
pheochromocytoma primary hyperparathyroidism |
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Truncal obesity, purple stria, decreased cortisol post high dose dexamethasone
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suppression by high dose dexamethasone is diagnostic for pituitary Cushing's
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Pharmacist with hypoglycemia, increased serum insulin, decreased C-peptide.
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suppression of b-islet cells
- patient is taking insulin causing suppression of b-islet cells and decreased endogenous synthesis of insulin and release C-peptide. |
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man with a cold thyroid nodule and palpable cervical lymph nodes
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thyroid cancer with psammoma bodies
papillary adenocarcinoma |
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Pure seminiferous tubule failure
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increased serum FSH
Normal serum LH Normal serum testosterone - |
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pure Leydig failure
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decreased testosterone
LH increased FSH normal |
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XXY genotype
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increased serum FSH
increased serum LH decreased serum testosterone - Klinefelter's. Inhibin is decreased causing increased FSH. Testosterone is decreased and LH is increased. Testosterone is aromatized to estrogens |
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Impotence secondary to anxiety
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Normal FSH
Normal LH Normal testosterone - common cause of loss of libido causing erectile dysfunction. Hormones are normal. Nocturnal penile tumescence is present |
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addison's disease
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primary hypocortisolism
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hypovitaminosis D
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is the MCC of 2' HPTH due to hypocalcemia
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Kallmann's syndrome
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produces hypogonadism with a decrease in gonadotropins
- since GnRH is deficient in the syndrome, gonadotropins are decreased anosmia and color blindness are also present |
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Adenoma
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MCC HYPERfunctioning endocrine gland
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Autoimmune disease
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MCC of HYPOfunctioning endocrine gland
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GnRH stimulation stimulates an FSH/LH response
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hypothalamic disorder
- since the pituitary is hypofunctioning and can recover its function with appropriate stimulation |
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TRH stimulation: no TSH response
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Secondary hypothyroidism
hypothalamic disorder would have responded |
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Pituitary dwarfism
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no response to GH and IGF-1 to sleep and arginine infusion
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Arginine stimulation
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stimulates GH release
- so does hypoglycemia after giving insulin and sleep |
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Short ACTH stimulation test
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does not distinguish between 1' and 2' hypocortisolism
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Cushing's syndrome
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MCC overall cause is steroids
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MC pathological cause of Cushing's syndrome
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pituitary Cushing's
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high dose dexamethasone
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distinguishes pituitary from other types of Cushing's
pituitary Cushing's shows suppression of cortisol |
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Sarcoidosis
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may interfere with hypothalamic function
- it produces granulomatous destruction of the hypothalamus |
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primary precocious puberty in boys
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MCC is midline hamartoma in the hypothalamus
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MCC of primary precocious puberty in girls
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idiopathic
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Pineal calcification
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dystrophic calcification
great marker for mass lesion in brain displaced to contralateral side of mass |
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Albright syndrome
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Fibrous dysplasia + cafe au lait spots + precocious puberty
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Paralysis of upward gaze
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Parinaud's syndrome
- common problem with pineal gland tumors |
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Pituitary tumors
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most are HYPERfunctioning
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Prolactinoma
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MC pituitary tumor
not large enough to produce hypopituitarism |
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Bitemporal hemianopia
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compression of optic chiasm
usually an expanding pituitary or suprasellar mass |
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craniopharyngioma
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MCC of hypopituitarism in children
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Sheehan's postpartum necrosis
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MC sign is cessation of lactation
since prolactin is lost most of the increase in size of pituitary in pregnancy is due to synthesis of prolactin |
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craniopharyngioma
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MC site is suprasellar
it is not a primary pituitary tumor |
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primary hypogonadism
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Leydig cell failure is an example of primary hypogonadism in males
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impotence
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decreased testosterone decreased libido
testosterone has no effect on the parasympathetic system which is involved in erection |
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hormone that increases amino acid uptake in muscle
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Growth hormone and insulin
- one reason for macrosomia in newborn of diabetic mothers |
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GH deficiency
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cause of hypoglycemia in hypopituitarism
GH is a gluconeogenic hormone |
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GF/IGF-1 deficiency in adults
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loss of muscle mass
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loss of stature and muscle mass in children
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pituitary dwarfism occurs in children since the epiphysis have not fused
- GF/IGF-1 deficiency |
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Hypercholesterolemia
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feature of hypothyroidsm since LDL receptor synthesis is reduced
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importance of screening newborns for T4 or TSH
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detect hypothyroidism to prevent cretinism
after birth thyroxine is the primary hormone responsible for maturation of the brain which is finished by 2 years of age |
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Serum TSH
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best screening test for any thyroid hypo or hyperfunctioning state
it is also the most useful test in deciding if a decreased or increased T4 is related to a functional disorder or a problem with TBG |
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Hypocortisolism/hypothyroidism
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predisoposes to inappropriate ADH syndrome
- they normally have an inhibitory effect on ADH. this explains the mild hyponatremia associated with hypopituitarism |
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gigantism
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MC manifestation of GH/IGF-1 excess in children
- their epiphysis have not fused yet so linear bone growth may occur |
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IGF-1 related findings in acromegaly
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macroglossia, enlarged hands, prominent jaw, cardiomegaly
- bone, cartilage, soft tissue growth, and organomegaly are related to IGF-1 |
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MCC of death in acromegaly
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heart failure due to cardiomyopathy
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MCC of galactorrhea + secondary amenorrhea
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prolactinoma is most often responsible for combination of galactorrhea and secondary amenorrhea
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secondary amenorrhea in a prolactinoma
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prolactin inhibits GnRH
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trapping, organification, proteolysis
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TSH-mediated events
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Estrogen
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the TSH is normal since the free hormone level is normal
increased T4 normal TSH increased TBG |
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Cabergoline
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dopamine analogue
inhibits prolactin - prolactinomas are not fully autonomous and can be suppressed |
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T3
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the metabolically active form of T4 is converted to T3 by an outer ring deiodinase
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anabolic steroids
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decreased T4
normal TSH decreased TBG |
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Thyrotoxicosis
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includes causes of HYPERthyroidism
thyrotoxicosis includes all causes of increased hormone activity whether from gland synthesis or gland destruction/taking excess hormone/struma ovarii |
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TSI-IgG in Graves disease
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directed against TSH receptors
stimulates increased synthesis Type II HSR IgG antibody in Hashimoto's thyroiditis inhibits thyroid hormone synthesis |
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Serum Thyroglobulin
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TBG is increased with estrogen and decreased with anabolics.
Thyroglobulin is a tumor marker for thyroid cancer and in identifying subacute painless lymphocytic thyroiditis |
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thyroglossal duct cyst
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midline cystic mass
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branchial cleft cyst
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anterolateral cystic neck mass
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subacute painless lymphocytic thyroidiits
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commonly progresses to Hashimoto's thyroiditis
follicles are not present in the gland, it has a relationship with postpartum state and it is painless to palpation |
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Reidel's thyroiditis
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mimics cancer owing to fibrous infiltration of muscles
it may also progress to hypothyroidism and is associated with other types of infiltrative disease |
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Graves disease
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MCC of HYPERthyroidism and thyrotoxicosis
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Graves disease
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decreased colloid from increased proteolysis
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Lid Stare
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seen in any cause of thyrotoxicosis
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exophthalmos is pathognomonic for what disease?
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Graves disease
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Graves
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common cause of atrial fibrillation
always order a TSH in any patient with AF |
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B-blockers
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b-blockers decrease the adrenergic symptoms related to excess catecholamines
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toxic nodular goiter
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autoimmune disease and does not have the signs unique to Graves
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Hashimoto's thyroiditis
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MC symptom is muscle weakness
it is caused by elevated serum CK related to a myopathy in the proximal muscles of the thigh |
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Hashimoto's thyroiditis
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unlike Graves it produces diastolic HTN.
due to salt retention |
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Hashimoto's thyroiditis and Graves associated with myxedema
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both have myxedema due to GAG deposition in the dermis
in Graves it is pretibial Hashimoto's it is periorbital |
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Goiter
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Rx is thyroid hormone suppression
it decreases TSH which is responsible for stimulating the gland and causing the goiter to enlarge |
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Solitary cold nodule
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indicates malignancy in men
indicates cysts in women |
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papillary cancer of thyroid
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MC variant associated with radiation, Orphan Annie nuclei,
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calcitonin
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synthesized by C-cell in the thyroid gland
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C cell hyperplasia
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precursor for medullary carcinoma in the familial types of cancers
this is why family members are screened with the pentagstric stimulation test |
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primary malignant lymphoma
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MC arises out of Hashimoto's thyroiditis
B cell type of lymphoma |
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Hypocalcemia
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lowers Et closer to the resting membrane potential to increase excitability of muscle and nerves.
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Hypercalcemia
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raises the threshold potential of cells
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Primary HPTH
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MC presentation is renal stones
usually patients are asymptomatic |
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Hypercalcemia
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serum PTH is the best test to differentiate 1' HTPH from malignancy induced hypercalcemia
it is increased in primary HPTH and decreased in all other causes of hypercalcemia |
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hypercalcemia in sarcoidosis
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due to granuloma synthesis of 1-a-hydroxylase causing hypervitaminosis D.
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hypercalcemia with thiazide diuretics
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increased absorption in the Na/Cl pump in the kidneys
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Hypercalcemia in Graves
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due to increased bone resorption
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primary hypoPTH
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MCC is previous thyroid surgery
autoimmune disease is 2nd MCC |
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pseudohypoPTH
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similar to primary HypoPTH except the PTH is normal to increased and it is a genetic disease
autosomal dominant disease |
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HYPOmagnesemia
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MCC of pathological hypocalcemia in a hospitalized patient
prevents synthesis of and release of PTH producing hypoPTH |
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hypoalbuminemia
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MC overal cause of hypocalcemia
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HYPERphosphatemia
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MCC chronic renal failure
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Hypophosphatemia in DKA
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insulin Rx of DKA
drives phosphate into the cell along with glucose |
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decreased 1-a-hydroxylase
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occurs in renal failure and produces hypovitaminosis D
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Vitamin D resistant rickets
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due to the inability to reabsorb phosphate in the GI and kidneys
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ADrenal cushing's
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lowest ACTH of all types of Cushins excluding exogenous steroids
due to increased cortisol levels |
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Nelson's syndrome
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enlargement of sella turcica post bilateral adrenalectomy owing to hypocortisolism further stimulating ACTH synthesis in pituitary adenoma
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Pheochromocytoma
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absence of epinephrine manes it originated in the medulla since it has N-methyltransferase and other sites do not, excluding the organ of Zuckerkandl
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Homer-Wright rosetts
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child with HTN and an adrenal mss
histological finding that describes neuroblastoma |
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Acute adrenal insufficiency
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MCC is abrupt withdrawal from steroids
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Addison's in children
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MCC is adrenogential syndrome
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what does hypocortisolism lead to?
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neutropenia
eosinophilia lymphocytosis |
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MEN IIb
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mucosal neuromas
medullary carcinoma pheochromocytoma |
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MEN IIa
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hyperparathyroidism
medullary carcinoma pheochromocytoma |
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Facticious hypoglycemia
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decreased C-peptide
increased serum insulin |
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insulinoma
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increased C-peptide
increased serum insulin |
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Zollinger-Ellison syndrome
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associated with MEN I
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Glucagonoma
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rash of glucagonoma is necrolytic migratory erythema
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Islet cell tumors with HYPERglycemia
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somatistatinoma
glucagonoma |
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islet cell tumor associated with diarrhea
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VIPoma
SE somatostatinoma |
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islet cell tumor associated with achlorhydria
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somatistatinoma
VIPoma |
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MODY
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AD
problem with actual stimulation of insulin release from b-islet cells by glucose NOT obese may progress to type 2 DM |
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metabolic syndrome
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associated with increased VLDL, HTN, resistance to insulin because of obesity and decreased receptor synthesis
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insulinitis
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characteristic of type 1 and represents the autoimmune and cytotoxic T-cell nature of the insulin deficiency
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Type 2 DM
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inability to release GLUT 4 from the golgi apparatus
this is an example of post receptor defect |
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recurrent blurry vision in diabetes
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due to sorbitol absorbing water into the lens and altering refraction o the lens
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malignant external otitis
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complication of diabetes
infection with Pseudomonas aeriginosa |
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Rhinocerreal mucormycosis
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complication of poorly controlled DM
due to Mucor invading frontal lobes in DKA |
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Hb A1C
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best measure of long term glycemic control
evaluates 8-12 weeks |
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most commons in diabetes
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peripheral neuropathy
non-traumatic leg amputation blindness chronic renal failure multiple cranial nerve palsies |
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Fasting glucose > 126 mg/dL
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increased sensitivity
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impaired glucose tolerance
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only 30% develop DM
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Gestational DM
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50 gram glucose challenge between 24-28 weeks is set for highest sensitivity owing to the many newborn and maternal complications associated with hyperglycemia during pregnancy. GDM only refers to diabetes that develops during pregnancy and goes away after delivery
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newborn complications of maternal diabetes
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macrosomia
Respiratory distress syndrome open neural tube defect neonatal hypoglycemia must infuse glucose at birth |
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fasting hypoglycemia
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s/s related to neuroglycopenia: the brain requires glucose in the fasting state.
S/S related to tiredness and mental status abnormalities rather than adrenergic symptoms like those seen in reactive hypoglycemia |
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alcohol induced hypoglycemia
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decreased gluconeogenesis, decreased glycogen stores
increased NADH and conversion of pyruvate to lactate |
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Carnitine deficiency
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all tissue are dependent on carnitine acyltransferase, b-oxidation of FAs is diminished as a fuel source, hence leaving glucose as the only fuel source for all tissues. NO ketone bodies are present since there is no acetyl CoA, the product of b-oxidation of FAs
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ketotic hypoglycemia
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MCC of hypoglycemia in young children
a lot of inborn errors of metabolism are in this category |
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Idiopathic postprandial syndrome
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it is a reactive hypoglycemia that is commonly overdiagnosed since it does not usually demonstrate hypoglycemia when symptoms occur
Frequent protein feeds are recommended |
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insulin induced hypoglycemia
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MCC of reactive hypoglycemia
dangerous bc it damages neurons |
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testing for fasting hypoglycemia
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prolonged fasting is the best etst since symptoms are more likely to occur and blood levels are more likely to show the hypoglycemia. Must satisfy Whipple's triad symptoms: hypoglycemia and symptoms reversed with glucose
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nocturnal penile tumescence
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it rules out an organic cause of male impotence since it is normal for a man to have an erection while sleeping at night
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Viagra
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inhibits the breakdown of cGMP by type 5-phosphodiesterase causing an increase in cGMP
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Vascular insufficiency
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MCC of erectile dysfunction in men > 50 years of age
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Seminiferous tubule dysfunction
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MCC of infertility in males
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this enzyme is only located in the zona glomerulosa and not the fasciulata/reticularis. It is activated by ANG II
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18 hydroxylase
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this hydroxylase enzyme is located in the fasciculata/reticularis and not the zona glomerulosa.
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17 hydroxylase
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this is the strongest sex hormone in women in the reproductive period of their life
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EStradiol
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These compounds are 17-ketosteroids
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DHEA
Androstenedione |
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this enzyme converts a 17-ketosteroid into a non-17-KS male sex hormone
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oxidoreductase converts androstenedione into testosterone
this is NOT aromatization |
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this compound is responsible for the development of the penis and prostate gland in the male fetus
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DHT
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this compound is responsible for the development of the epididymis, seminal vesciles, and vas deferns
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testosterone
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pregnanetriol is the metabolic end product of this compound, which is increased in both 21- and 11- hydroxylase deficiency but decreased in 17-hydroxylase deficiency
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17-hydroxyprogesterone
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this compound is decreased if angiotensin II is inhibited or if the JG apparatus is destroyed
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aldosterone
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these compounds are called 17-hydroxycorticoids
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11-deoxycortisol
cortisol |
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this compound when decreased causes increased production of ACTH and hyperpigmentation in children with adrenogential syndrome
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cortisol
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a deficiency of this enzyme results in newborn with HTN and male pseudohermaphroditis in male infants, owing to an absence of 17-KS, testosterone, and DHT
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17 hydroxylase deficiency
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a deficiency of this enzyme results in ambigious genitalia in a female newborn as well as hypotension, a decreased 17-hydroxycorticoids, and increase in 17-KS
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21-hydroxylase deficiency
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a deficiency of this enzyme results in ambigious genitalia in a newborn female as well as hypertension, an increase in 17-KS, and an increase in 17-OH-corticoids
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11 hydroxylase
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this compound is responsible for hypertension in a patient with 11-hydroxylase deficiency
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11- deoxycorticosterone
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this compound is responsible for the increase in 17-OH-cortocoids in 11 hydroxylase deficiency
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11-deoxycortisol
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this hydroxylase enzyme is present in the adrenal cortex as well as in the ovary and testis
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17-hydroxylase
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these hydroxylase enzyme deficiencies result in precocious puberty in males
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21 hydroxylase
11 hydroxylase |
