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167 Cards in this Set
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pt taking excess hormone will have what changes in T4, free T4, TSH and I123?
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T4, free T4, TSH, I123
increased, increased, decreased (negative feedback), decreased (not producing this excess hormone) |
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pt taking OCP will have what changes in T4, free T4, TSH and I123?
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T4, free T4, TSH, I123
increased, normal, normal, not indicated pt has estrogen effect with an increase in TBG (compare to steroid use which has decrease in TBG) pregnant pts have estrogen effects, and can have an increased thyroid. thyromegaly is NORMAL in pregnancy |
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pt with primary hypothyroidism will have what changes in T4, free T4, TSH and I123?
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T4, free T4, TSH, I123
decreased, decreased, increased (feedback), not indicated primary hypothyroid due to hashimoto's thyroiditis chronic constipation, wt gain, pale, dry, yellow-colored skin, periorbital pufiness, NORMAL SCLERA, prox m. weakness also- hypothyroidism following a thyroidectomy. ex: papillary carcinoma following Chernobyl |
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pt. taking anabolic steroids will have what changes in T4, free T4, TSH and I123?
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T4, free T4, TSH, I123
decreased, normal, normal, not indicated steroids = decrease TBG (estrogen = increase TBG) |
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what are 3 biochemical rxns expected in pt with DKA who is vol. depleted & hypotensive?
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1. beta- oxidation of fatty acids
no malonyl CoA to inhibit carnitine acyltransferase 2. increased fatty acids increased lipolysis due to low insulin (insulin inhibits hormone sensitive lipase in adipose cells) 3. gluconeogenesis (most important) TQ!! initiated by glucagon alanine --> puruvate aspartate --> OAA |
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how do POsm & UOsm change in central diabetes insipidus?
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POsm & UOsm
increased, decreased transected pituitary stalk always diluting, never concentrating urine central diabetes insipidus head trauma, polyuria, increased thirst, galactorrhea |
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how do POsm & UOsm change in SiADH
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POsm & UOsm
decreased, increased always concentrating urine SiADH smoker w centrally located mass (small cell), mental status abnormalities, Na of 110 |
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how do POsm & UOsm change who is volume depleted?
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POsm & UOsm
both increased volume depletion out in desert wout water, dry m.membranes & poor skin turgor concentration |
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how do POsm & UOsm change who has been drinking excess amounts of water?
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POsm & UOsm
both decreased pt is diluting |
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how do you tx CDI vs. NDI?
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diabetes insipidus = always diluting, never concentrating
CDI CNS trauma, tumors tx: desmopressin acetate dx: increase in Uosm post-vasopressin injection NDI drugs (demeclocyclin, lithium), hypokalemia rx: thiazides (by increasing prox reabs. of Na & H2O |
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truncal obesity, purple stiae, & thin extremities in Cushings are BEST explained by an increase in __ & __?
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insulin & cortisol
insulin increases fat deposistion (moon face, truncal obesity) cortisol breaks down m. in extremities to get alanine --> gluconeogenesis. also causes weakening of collagen --> hemorrhage in stretch marks also- HTN, hirsutism, virilization |
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what test can suppress pituitary Cushings?
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high dose DXM
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secondary HPTH will change PTH and Ca how?
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PTH & Ca
increased, decreased end-stage diabetic nephropathy hypovitaminosis D from loss of 1-a-hydroxylast --> hypocalcemia --> secondary HPTH |
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DiGeorge syndrome will change PTH and Ca how?
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PTH & Ca
both decreased failure of the developement of the 3rd & 4th pharyngeal pouches (missing thymus & parathyroid) often have cyanotic congenital heart disease, too |
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malignancy-induced hypercalcemia will change PTH and Ca how?
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PTH & Ca
decreased, increased PTH is suppressed by the hypercalcemia |
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how is QT interval affected by Ca++ levels?
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shortened QT = hypercalcemia
prolonged QT = hypocalcemia |
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primary HPTH will change PTH and Ca how?
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PTH & Ca
both increased calcium oxalate stones, PUD, constipation, diastolic HTN |
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positive family hx, hyperosmolar non-ketotic coma, & down-reg of insulin rec. synthesis are all characteristics of which type of diabetes?
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DM II
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what pituitary disease causes secondary amenorrhea, decreased urine 17-hydroxycoticoids, and decreased plasma ACTH & deoxycortisol after metyrapone testing?
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hypopituitarism from a non-fxn pituitary adenoma
secondary amemorrhea due to decreased serum gonadotripins, males have impotence due to decreased libido from decreased testosterone decreased urine for 17-hydroxycorticoids due to decreased ACTH decreased plasma ACTH & deoxycortisol after metyrapone test also- decreased TSH |
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what does the metyrapone test differentiate?
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metyrapone test:
hypopituitarism vs. adrenal disease hypopituitarism = neither increase adrenal disease = ACTH increases, but 11-deoxycortisol is decreased metyrapone inhibits adrenal 11-hydroxylase, which causes decrease in cortisol and corresponding increase in plasma ACTH (pit) and 11-deoxycortisol (adrenal), which is proximal to the enzyme block |
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bitemporal hemianopsia can be seen in __?
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hypopituitarism
child = craniopharyngioma adult = pituitary adenoma |
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what lab finding would you expect in pt with hypopituitarism from non-fxn (null) pituitary adenoma?
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secondary amenorrhea
-- due to decreased serum gonadotropins decreased urine 17-hydroxycorticoid -- due to decreased ACTH decreased plasma ACTH and decreased serum deoxycortisol after metyrapone test |
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pituitarty adenoma is associated with which MEN syndrome?
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MEN I
"diamond" 3Ps Pituitary adenoma hyperParathyroidism xollinger-ellison / insulinoma Pancreatic tumor |
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end-stage renal disease will change total serum Ca++ & ionized serum Ca++ how?
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total serum Ca++ & ionized serum Ca++
both decreased hypovitaminosis D from loss of 1-a-hydroxylase --> hypocalcemia --> secondary HPTH (increased PTH / decreased ionized Ca++) |
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lipoid nephrosis (minimal change disease) will change total serum Ca++ & ionized serum Ca++ how?
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nephrotic syndrome with loss of ALBUMIN
hypoalbuminemia lowers total Ca++ but no effect on ionized |
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alcoholic will change total serum Ca++ & ionized serum Ca++ how?
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total serum Ca++ & ionized serum Ca++
hypomagnesemia --> acquired hypoparathyroidism both decrease |
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what is an acquired cause of primary hypoparathyroidsism?
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decreased Mg
cofactor for adenylate cyclase with produces cAMP for activation and release of PTH |
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hysterical rxn how do total serum Ca++ and ionized serum Ca++ change?
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respiratory alkalosis
due to hyperventilation low ionized, normal total |
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MENS IIa & passed Ca++ stone
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primary hyperparathyroidism
increase BOTH MEN IIa "square" 2 Ps Parathyroid tumors Medullary thyroid carcinomas (secretes calcitonin) Pheochromocytoma |
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diastolic HTN, extreme m weakness, U wave, + Chvostek sign
increased Na increased Cl decreased K increased bicarb |
primary aldosteronism
increased 24 h urine for K+ (exchange for Na) increased 24 h urine for Na+ (lost in urine due to increase hydrostatic pressure) decreased plasma renin activity |
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present in BOTH neuroblastoma and pheochromocytoma
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diastolic hypertension
increased 24 h urine for catecholamines neuroal crest origin neuroblastoma = malignant --> bone pheochromocytoma = benign |
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Homer- Wright rosettes
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neuroblastoma
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association with MEN IIa/b
drenching sweats hyperglycemia |
pheochromocytoma
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both addison's and hypopituitarism
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decreased 24 h urine for 17-hydroxycorticoids
decreased 24 h urine for 17-ketosteroids |
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addison's disease has __ ACTH after metyrapone, while hypopituitarism has __ ACTH
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addison's = increased
hypopit = decreased |
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what happens to K+ in addisons
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hyper K+
from mineralocorticoid deficiency |
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endemic goiter
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iodide deficiency
decreased synthesis of thyroid hormone |
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sever hypoglycemia in young pt who is comatose
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DM I
insulin rx is MCC reactive hypoglycemia |
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ulcer over metatarsal head in diabetic
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due to peripheral neuropathy
osmotic damage of schwann cells |
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child w nuchal rigidity, petechia, hypovolemic shock
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Neisseria meningitidis
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waterhouse-friderichsen syndrome
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hypovolemic shock indicates hemorrhagic infarction of adrenal glands due to DIC
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sudden cessation of lactation in woman w difficult delivery
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sheehan's postpartum necrosis
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hemorrhage or infarction of pituitary adenoma
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pituitarty apoplexy
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neurofibromatosis pt w diastolic HTN, anxiety, sweating
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pheochromocytoma
association with neurofibromatosis |
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pt w HTN, normocalcemia, increased serum calcitonin
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MEN IIb
"triangle" 1 P mucosal neuromas medullary thyroid carcinoma (secretes calcitonin) pheochromocytoma |
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truncal obesity, purple stria, decreased cortisol post high dose dexamethasone
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dx of pituitary cushings
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pharmacist w hypoglycemia, increased serum insulin, decreased serum C-peptide
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taking insulin
suppressionof B-islet cells |
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man with cold throid nodule and palpable cervical lymph nodes
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papillary adenocarcinoma
thyroid cancer with psammoma bodies |
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what happens to serum FSH, serum LH, serum testosterone in:
pure seminiferous tubule failure |
serum FSH, serum LH, serum testosterone
increased, normal, normal loss of inhibin increases FSH |
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what happens to serum FSH, serum LH, serum testosterone in:
pure leydig cell failure |
serum FSH, serum LH, serum testosterone
increased, increased, decreased testosterone is increased, hence LH is increased |
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what happens to serum FSH, serum LH, serum testosterone in:
XXY genotype (Klinefelter's) |
serum FSH, serum LH, serum testosterone
increased, increased, decreased inhibin decreased causing increase in FSH testosterone is decreased and LH increased, testosterone --> aromatized into estrogens |
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turbid plasma supranate and infranate
increased glucagon/insulin ratio increased production of acetyl coA |
DKA with signs of vol depletion
capillary lipoprotein lipase is inactive supranate - chylomicrons infranate - VLDL |
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small child for age has frontal HA and bitem hemi.
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hypopituitarism due to craniopharyngioma
Rathke's pouch remnants increased 17-hydroxycorticois with prolonged ACTH stimulation |
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hypopituitarism:
after infusion of GnRH? after sleep and arginine infustion? |
after infusion of GnRH?
FSH/LH remain decreased (increase = hypothalamic) after sleep and arginine infustion? ILGF remains decreased |
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cardiomegaly, big forehead, space btw teech, macroglassia, frontal HA
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acromegaly
enlarged sella turcica enlarged hands and feet |
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can GH be suppressed with glucose infusion in acromegaly?
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no
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pituitary tumors have association with which MEN?
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MEN I
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amenorrhea, neg preg test, normal TSH, milky discharge from nipples
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prolactinoma
increased serum prolactin decreased serum gonadotropins (prolactin inhibits release of GnRH |
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prolactinoma is behign adenoma and MC pituitary tumor
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true
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tx prolactinoma
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cabergoline = dopamine analog
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osmotic damage in diabetics
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cataracts
peripheral neuropathy microaneurysm in retinal vessels** lens, schwann cells, pericytes |
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insulin receptor deficiency is associated with
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acanthosis nigricans
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hyaline arteriolosclerosis is due to
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non-enxymatic glycosylation
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pituitary cushing vs other cushing's
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pituitarty:
suppression of cortisol with high dose dexamethason & MC primary cause of cushings |
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all cushing's have
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increased urine for 17-ketosteroids
lack of cortisol suppression with low dose dexamethasone |
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adrenal cushings has __ ACTH
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decreased
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enzyme in both zona g and f/r?
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11-hydroxylase
21-hydroxylase |
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17-hydroxylase is only present in _?
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R/F
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18-hydroxylase is only present in _?
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G
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DKA have __ b-oxidation of fatty acids
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increased
no malonly CoA s present to inhibit carnitine acyltransferase |
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DKA have __ production of acetyl coA
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decreased
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polyuria and galactorrhea after car accident
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central DI
UOsm increased >50% after vasopressin |
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primary aldosteronism and polyuria
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nephrogenic DI
due to vacuolar nephropathy secondery to severe hypokalemia UOsm increased <50% after vasoprssin |
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what should i order in woman with secondary amenorrhea and galactorrhea?
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serum prolactin
serum TSH (to r/o primary hypothyroidism, decreased T4 --> increased TSH --> prolactin) pregnacy test |
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when would i expect increased T4 and suppressed TSH?
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toxic nodular goiter
graves hot nocule subacture painful thyroidits |
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HTN, adenomas, and adrenal origin are all features of
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cushings
primary aldosteronism pheochromacytoma |
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tyrosine kinase and GLUT 4 transport post-receptor defects
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DM II
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HLA Dr3/Dr4 associatoin
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DM I
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DKA
__renal azotemia __kalemia before insulin __kalemia after insulin __natremia metabolic __ __phosphatemia |
prerenal azotemia
hyperkalemia before insulin hypokalemia after insulin hyponatremia increased AG metabolic acidosis hypophosphatemia |
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addison's is __ hypocortisonlism
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primary
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MCC of secondary HPTH due to hypocalcemia
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hypovitaminosis D
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hypogonadism with decrease in gonadotropins
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kallmann's syndrome
also-anosmia and color blindness |
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MCC hyperfxn endocrine gland
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adenoma
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MCC hypofxn endocrine gland
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autoimmine disease
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GnRH stimulation stimulates and FSH/LH response
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hypothalamic disorder
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TRH stimulation with no TSH response
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secondary hypothyroidism
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no response of GH and IGF1 to sleep and arginine infusion
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pituitary dwarfism
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stimulates GH release
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arinine stimulation + sleep
also-- hypoglycemia after giving insulin + sleep |
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primary and secondary hypocortisolism both show __ in cortison after short ACTH stimulation test
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both show no increase
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does oral glc tolerance teset suppress GH/ IGF1 in acromegaly
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no
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MCC overall cause is steroids
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cushings
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high dose dexamethasone distinguishes __ from __
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pituitary from other cushins
suppression of cortisol in pituitary |
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produces granulomatous destruction of hypothalamus and may interfere with fxn
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sarcoidosis
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MCC primary precocious puberty in boys
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midline hamartoma in hypothalamus
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MCC pseudoprecocous puberty
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adrenogenital syndrome
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MCC true precocious puberty in girls
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idiopathis
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pineal calcification
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dystrophic
great marker for mass lesions in brain - displaced to contralateral side of mass |
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fibrous dysplasia + cafe au lait spots + precocious puberty
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albright syndrome
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paralysis of upward gaze
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parinaud's syndrome
pineal gland tumors |
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most pituitarty tumors...
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are hyperfxning
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MC pituitary tumor
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prolactinoma
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is craniopharyngioma a primary pituitary tumor?
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no
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leydig cell failure is example of __ hypogonadism in males
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primary
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impotence
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decrease in testosterone decreases libido
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what hormones increase aa uptake into m?
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GH & insulin
(macrosomia in newborns of DM moms) |
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cause of hypoglycemia in hypopituitarism
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GH deficiency
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GF / IGF1 deficiency in adults
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loss of m mass
loss of stature and m mass in children = pituitarty dwarfism |
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hyperCH is a feature of
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hypothyroidism
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hyperthyroidism has __ in CH
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decrease
due to increase in LDL receptor synthesis by thyroid hormone |
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detection of hypothyroidism is importanct to prevent
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cretinism
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primary hormone responsible for matureation of brain
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thyroxine
T4 or TSH screen |
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best screening test for any thyroid
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TSH
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hypocortisolism / hypothyroidism predispose to
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SiADH
normally they have inhibitory effect on ADH |
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mild __natrremia associated w hypopituitarism
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hypo
(not mineralocorticoid deficiency) |
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what features of acromegaly are IGF1 related
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bone, cartilage, soft tissue growth, organomegaly
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MCC death in acromegaly
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heart failure from cardiomyopathy
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secondary amenorrhea in prolactinoma
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prolactin inhibits GnRH
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TSH- mediated events
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trapping, organification, proteolysis
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cabergoline
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dopamine analogue
inhibits prolactin |
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metabolically active thyroid hormone is T4
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NO
T3 T4 --> T3 outer ring deiodinase |
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T/F thyrotoxicosis includes all causes of increased hormone activity whether from gland synthesis or gland destruction / taking excess / struma ovarii
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true
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graves TSI-IgG are directed against
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TSH receptors
stimulates increased synthesis |
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graves = type __ hrs
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type II
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IgG antibodies in hashimoto's thyroididtis inhibit
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thyroid hormone synthesis
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TSH is best test to distinguish hashimoto's from graves
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anti-microsomal antibodes are INCREASED in both
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thyroglobulin
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tumor marker for thyroid cancer
identifying subacute painless lymphocytic thyroiditis |
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midline cystic mass
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thyroglossal duct cyst
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anterolateral cystic mass
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branchial cleft cyst
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painful thyroid associated thyrotoxicosis from gland destructions
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acute / subacute thyroiditis (de Quevain)
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subacute painless lymphocytic thyroiditis
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commonly progress to hashimoto's
do not yet have follicles in the gland. relationship with postpartum state. painless |
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mimics cancer owing to fibrous infiltration of m
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reidel's thyroiditis
may also progress to hypothyroidism and is associated w other types of infiltrative diseases |
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MCC hyperthyroidism and thyrotoxicosis
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graves
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graves decreased colloid from
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increased proteolysis
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common cause of a fib
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graves
always order a TSH in any pt with A FIB!! |
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exophthalmos pathognomonic for
|
graves
lid stare is seen in any thryotoxicosis |
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block synthesis of thyroid hormone
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thioamides
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decrease adrenergic symptoms related to excess catecholamines
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b blockers
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toxic nodular goiter
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NOT autoimmune
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MC symptom is m weakness
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hashimoto's thyroiditis
cause elevated CK related to myopathy in proximal mm of thigh |
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produces diastolic HTN
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hashimotos
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produces systolic HTN
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graves
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hashimotos and graves are both associated with
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myxedema due to GAG deposition (hyaluronic acid) in the dermis
graves = pretibial hash = periorbital |
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tx for goiter is
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thyroid hormone suppression to decrease TSH
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solitary cold nodule in men
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malignancy
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solitary cold nodule in women
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benign cyst
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papillary cancer thyroid
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MC varieant associated with radiation, orphan annie nuclei
has psammoma bodies |
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calcitonin synthesized by
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C cells in thyroid gland
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precursor for medullary carcinoma in familial type of cancer
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C cell hyperplasia
pentagastrin stimulation test |
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MC arises out of hashimoto's thyroiditis
b cell type of lymphoma |
primary malignant lymphoma
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hypocalcemia __ threshold closer to resting membrane potential to incraese excitability of m and n
|
lowers
hyper = raises threshold |
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MC presentatoin of primary hyperparathyroidism
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renal stones, usually pts are asymptomatic
|
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__ is best test to differ primary from malignacy hypercalcemia
|
yes
increased in primary HPTH and decreased in all other causes of hypercalc |
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hypercalcemia in sarvcoidosis due to
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granuloma synthesis of 1 a hydroxylase causeing hypervitaminosis D
thiazides |
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hypercalcemia in graves due to
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increased bone resorption
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MCC primary hypoPTH
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previous thyroid surgery
second - autoimmune |
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similar to primary hypoPTH excest PTH is normal and it's genetic
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pseudohypoPTH
AD |
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MCC pathology hypocalcemia in hospitalized pt
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hypomagnesemia
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MC overall cause of hypocalcemia
|
hypoalbuminemia
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MCC hyperphosphatemia
|
renal failure
insulin decreases |
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Vitamin D rickets
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inability to reabsorb phosphate in GI
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lowest ACTH levels or all cushings
|
adrenal
ectopic = highest |
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enlargement of sella turcica post bilateral adrenalectomy owing to hypocortisolism further stimulating ACTH synthesis in pituitarty adenoma
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nelson's syndrome
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clid with hypertension and adrenal mass
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homer-wright rosettes
neuroblastoma |
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MCC actue adrenal insufficiency
|
abrupt withdrawal from steroids
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MCC addison's in children
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adrenogenital syndrome
|
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neutrophilic leukocytosis
eosinopenia lymphocytosis |
hypercortisolism or someone taking corticosteroids
|
|
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addisons hypocortisolism
|
neutropenia
eosenophilia lymphocytosid |
