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109 Cards in this Set

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  • Back
Cushing's syndrome: What are etiologies of Cushing’s syndrome? Is ACTH always elevated?
increased cortisol due to:, 1. Cushing’s disease (primary pituitary adenoma) increased ACTH, 2. Primary adrenal (hyperplasia/neoplasia) decreased ACTH, 3. Ectopic ACTH production (ie- small cell lung ca) increased ACTH, 4. Iatrogenic, decreased ACTH
Cushing's syndrome: Describe the clinical picture of Cushings.
HTN, wt gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin change (thinning, striae), osteoporosis, immune supression
Hyperaldosteronism: T/F Conn’s syndrome is secondary hyperaldosteronism.
False. Conn’s syndrome is primary hyperaldosteronism, caused by an aldosterone-secreting tumor. Results in HTN, hypokalemia, metabolic alkalosis, low plasma renin.
Hyperaldosteronism: Which hyperaldosteronism is associated with high plasma renin?
Secondary hyperaldosteronism. It is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome. Kidney perception of low intravascular volume results in an overactive renin-angiotensin sysem.
Hyperaldosteronism: What is the tx for hyperaldosteronism?
Spironolactone, a diuretic that works by acting as a aldosterone antagonist.
Addison's Disease: What characterizes addison’s disease? (which hormones are elevated or deficient)? Is it associated with HTN or hypotension?
Primary deficiency of aldosterone and cortisol due to adrenal atrophy, causing hypotension and skin hyperpigmentation. Adrenal atrophy, absence of hormone production, involves all 3 cortical divisions.
Addison's Disease: T/F In primary insufficiency decreased pituitary ACTH production is characterized by skin hyperpigmentation.
False: increased ACTH causes MSH activity & hyperpigmentation
Tumors of adrenal medulla: T/F Neuroblastoma is the most common tumor of adrenal medulla in adults.
False. Pheochromocytoma is the most common tumor of adrenal medulla in adults. It is derived from chromaffin cells (arise from neural crest). It is associated with neurofibromatosis MEN types II and III.
Tumors of adrenal medulla: Where does neuroblastoma occur?
Neuroblastoma is the most common tumor of adrenal medulla in children. It can occur anywhere along the sympathetic chain.
Tumors of adrenal medulla: AUTHOR
Jason Lee
Pheochromocytoma: secrete combination of two molecules
epinephrine and norepinephrine
Pheochromocytoma: epidemiology (rule of 10's)
10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids, 10% familial
Pheochromocytoma: symptoms - 5 P's
(elevated blood) Pressure, Pain (headache), Perspiration, Palpitations, Pallor/diaphoresis --> relapsing and remittant
Pheochromocytoma: elevations in two lab values
urinary VMA and serum catecholamines
Pheochromocytoma: association with two other endocrine diseases
Pheochromocytoma: treatment
Multiple Endocrine Neoplasia: type I (Wermer's syndrome) - 3 P's
Pancreas, Pituitary, and Parathyroid tumors
Multiple Endocrine Neoplasia: type II (Sipple's syndrome)
medullary carcinoma of thyroid, pheochromocytoma, parathyroid tumor, or adenoma
Multiple Endocrine Neoplasia: type III
medullary carcinoma of thyroid, pheochromocytoma, oral/intestinal ganglioneuromatosis
Hypothyroidism and hyperthyroidism: myxedema is prominent in which one
Hypothyroidism and hyperthyroidism: chest pain, palpitations, arrhythmias
Hypothyroidism and hyperthyroidism: TSH is (increased/decreased) in primary hyperthyroidism? In primary hypothyroidism?
hyper - decreased, hypo - increased
Hypothyroidism and hyperthyroidism: Graves' disease involves autoantibodies with what mechanism of action?
stimulation of TSH receptors
Hypothyroidism and hyperthyroidism: three symptoms of Graves'
ophthalmopathy, pretibial myxedema, diffuse goiter
Hypothyroidism and hyperthyroidism: Graves' is a type __ hypersensitivity
type II
Hashimoto's thyroiditis: thyroid is (enlarged/not enlarged) and (tender/nontender)
enlarged, nontender
Hashimoto's thyroiditis: autoimmune antibodies directed against ---
Hashimoto's thyroiditis: histology shows (type of cell) infiltrate
lymphocytes (with germinal centers)
Subacute thyroiditis (de Quervain's): self-limited (hyper/hypo)thyroidism following ---
hypothyroidism following flu-like illness
Subacute thyroiditis (de Quervain's): symptoms include
jaw pain, tender thyroid gland, early hyperthyroidism
Thyroid cancer: most common, good prognosis, "ground glass" nuclei, psammoma bodies
papillary carcinoma
Thyroid cancer: poor prognosis, uniform follicles
follicular carcinoma
Thyroid cancer: calcitonin producing (C cells), sheets of cells
medullary carcinoma (MEN II and III)
Thyroid cancer: older patients, horrible prognosis
Cretinism: caused by a lack of dietary --- or defect in --- formation
iodine (endemic), T4 (sporadic)
Cretinism: symptoms include
pot-belly, paleness, puffy face, protuberant tongue, protruding umbilicus
Acromegaly: caused by excess --- in adults
growth hormone
Acromegaly: symptoms include
large furrowed tongue, deep voice, large hands and feet, coarse facial features
Acromegaly: in children, leads to ---
Diabetes mellitus: acute symptoms common to both types
polydipsia, polyuria, polyphagia, weight loss
Diabetes mellitus: match: (DKA/hyperosmolar coma) with (type I/type II)
DKA=type I, hyperosmolar coma=type II
Diabetes mellitus: effects (increased/decreased) of insulin deficiency and glucagon excess on 1) glucose uptake, 2) protein catabolism, 3) lipolysis
1) decreased, 2) increased, 3) increased
Diabetes mellitus: increased plasma free fatty acids leads to
Diabetes mellitus: hyperglycemia has what effect on blood volume and electrolytes
decreased volume (osmotic diuresis), electrolyte depletion
Diabetes mellitus: three chronic manifestations
retinopathy (hemorrhage, exudate, microaneurysm), nephropathy (nodular sclerosis), neuropathy (sensory, motor, autonomic)
Diabetes mellitus: sorbitol accumulation leads to what sequelae in the eye
cataracts, glaucoma
Diabetes mellitus: three tests - what are they? which one measures long-term glucose control?
fasting glucose, glucose tolerance test, HbA1c
Diabetes mellitus: AUTHOR
Jacob Pugsley
Type 1 - juvenile onset: % of diabetes
Type 1 - juvenile onset: Insulin necessary in treatment
Type 1 - juvenile onset: Age
Type 1 - juvenile onset: Association with obesity
Type 1 - juvenile onset: Genetic predisposition
weak, polygenic
Type 1 - juvenile onset: Association with HLA system
Yes (HLA-DR3 & 4)
Type 1 - juvenile onset: Glucose intolerance
Type 1 - juvenile onset: Ketoacidosis
Type 1 - juvenile onset: B-cell numbers in the islets
Type 1 - juvenile onset: Serum insulin levels
Type 1 - juvenile onset: Classic symptoms of polyuria, polydipsia, thirst, weight loss
Type 1 - juvenile onset: Theorized cause
viral or immune destruction of B cells
Type 2 - adult onset: % of diabetes
Type 2 - adult onset: Insulin necessary in treatment
Type 2 - adult onset: Age
Type 2 - adult onset: Association with obesity
Type 2 - adult onset: Genetic predisposition
Strong, polygenic
Type 2 - adult onset: Association with HLA system
Type 2 - adult onset: Glucose intolerance
mild to moderate
Type 2 - adult onset: Ketoacidosis
Type 2 - adult onset: B-cell numbers in the islets
Type 2 - adult onset: Serum insulin levels
Type 2 - adult onset: Classic symptoms of polyuria, polydipsia, thirst, weight loss
Type 2 - adult onset: Theorized cause
increased resistance to insulin
Diabetic Ketoacidosis (type 1): What precipitates this
Increase in insulin requirements from increase in stress (e.g. infection)
Diabetic Ketoacidosis (type 1): Ketone bodies from where
Excess fat breakdown, increase ketogenesis from increased free fatty acids which are made into ketone bodies
Diabetic Ketoacidosis (type 1): Signs/Symptoms
Kussmaul respirations (rapid/deep breathing), hyperthermia, nausea/vomiting, abdominal pain, psychosis/dementia, dehydration, fruity breath odor
Diabetic Ketoacidosis (type 1): Labs
Hyperglycemia, high H+, low HCO3- (anion gap metabolic acidosis), high blood ketone levels, leukocytosis
Diabetic Ketoacidosis (type 1): Complications
Life threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrhythimias, heart failure
Diabetic Ketoacidosis (type 1): Treatment
Fluids, insulin, and potassium; glucose if necessary to prevent hypoglycemia.
Diabetes insipidus: summary
intensive thirst, polyuria, inability to concentrate urine with fluid constriction owing to lack of ADH (central DI) or to lack of renal response to ADH (nephrogenic DI). Caused by lithium or demeclocycline
Diabetes insipidus: Findings
Urine specific gravity < 1.006; serum osmolality > 290 mOsm/L
Diabetes insipidus: Treatment
adequate fluid intake; Central DI - intranasal desmopressin (ADH analog); nephrogenic DI - hydrochlorothiazide, indomethacin, or amiloride
SIADH: what does it stand for
Syndrome of inapropriate ADH
SIADH: finds
1) excess water retention 2) hyponatremia [may lead to seizures - correct slowly] 3) urine osmolarity > serum osmolarity
SIADH: causes
1) Ectopic ADH [small cell lung cancer] 2) CNS disorders/head trauma 3) pulmonary disease 4) Drugs
Hyperparathyroidism: What causes primary hyperparathyroidism?
Usually an adenoma
Hyperparathyroidism: What are the findings of primary disease?
hypercalcemia, hypercalciuria, hypophosphatemia, high parathyroid hormone, high cAMP in urine; often asymptomatic, may present with weakness and constipation
Hyperparathyroidism: what is osteitis fibrosa cystica? (von Recklinghausen's syndrome)
cystic bone spaces filled with non-neoplastic fibrous tissue
Hyperparathyroidism: What causes secondary hyperparathyroidism?
low serum Ca++, most often chronic renal disease.
Hyperparathyroidism: What are the findings of secondary hyperparathyroidism?
hypocalcemia, hyperphosphatemia, high parathyroid hormone
Hypoparathyroidism: findings
hypocalcemia, tetany.
Hypoparathyroidism: causes
accidental surgical excision (thyroid surgery) or DiGeorge syndrome
Hypoparathyroidism: note: pseudohypoparathyroidism
autosomal recessive kidney unresponsiveness to PTH. Hypocalcemia, shortened 4th/5th digits, short stature
Carcinoid syndrome: frequency
Carcinoid syndrome: cause
carcinoid tumors (neuroendocrine cells), especially those of the small bowel; they secrete high levels of serotonin (5-HT) that does not get metabolized by the liver due to liver metastases.
Carcinoid syndrome: symptoms
recurrent diarhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease.
Carcinoid syndrome: most common tumor of what?
Carcinoid syndrome: lab
high 5-HIAA in urine
Carcinoid syndrome: Rule of 1/3s:
1/3 metastasize; 1/3 present with second malignancy; 1/3 multiple
Carcinoid syndrome: Treatment?
Carcinoid syndrome: What is this medication?
synthetic octapeptide analog of somatostatin (growth hormone-inhibiting hormone)
Zollinger-Ellison syndrome: What kind of tumor causes this?
Gastrin secreting tumor (usually) of the pancreas
Zollinger-Ellison syndrome: what does it cause?
recurrent ulcers
Zollinger-Ellison syndrome: may be associated with what?
MEN type I
Osteoporosis: what is this?
reduction in bone mass in spite of normal bone mineralization
Osteoporosis: what characterizes type 1?
Postmenopausal (10-15 years after menopause); increased bone reabsorption due to low estrogen levels. Treated with estrogen replacement
Osteoporosis: what characterizes type 2?
Senile osteoporosis - affects men and women > 70 y/o
Osteoporosis: what races are affected most?
Osteoporosis: symptoms of vertebral crush fractures
acute back pain, loss of height, kyphosis
Osteoporosis: other
distal radius (Colles') fracures, vertebral wedge fracures.