Professional Documents
Culture Documents
A003.- Most commonly bromocriptine: a dopamine receptor agonist that causes the
lesion to shrink- Surgery
A005.- Second most common pituitary tumor- Acidophilic staining- Causes release
of somatomedins by liver (IGF-I, somatomedin C)- Causes gigantism if during chil
dhood, acromegaly during adulthood.- Causes local compression in sela turcica.
A009.- Ischemic necrosis of the pituitary during child birth, due to hypoperfusi
on.- The pituitary enlarges during pregancy but its blood supply does not... hen
A014.- Induces uterine contraction during labor, ejection of milk from mammary a
lveoli
A015.- Small cell carcinoma of lung.- Other tumors can also produce ectopic ADH.
A018.- Large pituitary adenomas that develop after bilateral adrenalectomy: due
to a loss of feedback inhibition on preexisting pituitary microadenomas.
A021.- Benign childhood tumor from remnants of Rathke pouch.- Often cystic or ca
lcified.- Not a true pituitary tumor, but can have mass effects that cause pitui
tary hypofunction.
A023.- thyroglossal duct cyst; it does not lead to alterations in thyroid functi
on.- Ectopic thyroid tissue may also be found anywhere along the course of the t
hyroglossal duct. - (If removing these, be sure they are not the ONLY thyroid ti
ssue!)
A024.- physiologic enlargement during puberty and pregnancy- iodine deficiencyHashimoto thyroiditis- goitrogens: substances that suppress synthesis of thyroid
hormones- dyshormonogenesis: failure of hormone synthesis due to enzyme defects
A025.- most nodules are hypoplastic and do not take up radioactive iodine (cold)
- Some nodules are hyperplastic and actively produce thyroid hormone, and take u
p radioactive iodine (hot)- Nonfunctional (cold) nodules are more likely to be m
alignant compared to functional (hot) nodules.
A033.- Idiopathic replacement of the thyroid by fibrous tissue, can mimic carcin
oma.
A034.- the most common thyroid cancer- Histologically: papillary projection into
gland-like spaces, empty "orphan Annie" nuclei, calcified spheres- excellent pr
ognosis, even when the adjacent lymph nodes are involved- can be caused by longterm radiotherapy to the neck, or RET-PTC fusion gene
Q035.- List the four types of malignant thyroid tumors. Which has the best progn
osis and which has the worst?
A039.- The most common cause is accidental surgical excision during thyroidectom
y. - Sometimes associated with congenital thymic hypoplasia (DiGeorge syndrome).
- Resulting in severe hypocalcemia, manifested as increased neuromuscular excita
bility and tetany.
A040.- Multi-hormone resistance including PTH, and the pituitary hormones TSH, L
H, and FSH.- Clinical characteristics include unresponsiveness of the kidney to
PTH, shortened fourth and fifth metacarpal and metatarsals, short stature, and o
ther skeletal abnormalities.
A044.- Congenital enzyme defects that lead to diminished cortisol production and
compensatory increased ACTH. - This leads to adrenal hyperplasia and androgenic
steroid production.- Deficiencies include 21-hydroxylase deficiency and 11-hydr
oxylase deficiency.- Clinical characteristics include precocious puberty in male
s and virilism in females.
A049.- Usually early in life, less common than type 2 disease. - The disease is
due to failure of insulin synthesis by beta cells of the pancreatic islets. - Ca
use may be due to genetic predisposition or autoimmune inflammation of the islet
s. - Incidences significantly higher in individuals with a mutation in HLA DQ, a
nd in HLA DR3/HLA DR4 positive individuals.
etone bodies".
A051.- Type 2 is much more common than type 1, and tends to begin in middle age.
Positive family history is often present. - Type 2 disease is due to increased
insulin resistance, and is associated with obesity.- Type 2 can also occur as a
secondary phenomenon in certain conditions including:- pancreatic disease -- hem
ochromatosis, pancreatitis, pancreas carcinoma- other endocrine -- Cushing's, ac
romegaly, glucagon hypersecretion, pheochromocytoma, hyperthyroidism- pregnancy
-- gestational diabetes, hyperglycemic mother leads to infants with hyperplastic
islets
A053.- A beta cell tumor, the most common islet tumor. - Characterized by insuli
n secretion with high levels of C-peptide. - Symptoms include Whipple's triad: p
aroxysmal hypoglycemia, CNS dysfunction (confusion, anxiety, coma, convulsions),
immediate recovery with glucose administration
A054.- Gastrin secreting tumor, often malignant and sometimes found outside the
pancreas.- Causes gastrin hypersecretion and hypergastrinemia.- Causes Zollinger
-Ellison syndrome (high gastric HCl, PUD, hypergastrinemia)
A055.- A glucagon secreting alpha cell tumor that causes secondary diabetes mell
itus. - Also causes a skin lesion called necrolytic migratory erythema in 80% of
cases, a spread of erythematous blisters and swelling across areas subject to g
reater friction and pressure, including the lower abdomen, buttocks, perineum, a
nd groin.
A061.- Insulin Independent- Not ketosis prone- Children with sedentary life- Str
ong genetic predisposition- Controlled mainly with oral agents
A062.- Achieve and maintain normal blood glucose levels- BG monitoring- Drug the
rapy- Diet - Exercise- Rest and reduce stress
A068.- Damaged blood vessels, nerves and decreased ability to fight infectionsAffects kidneys, eyes, skin, feet, heart
Q069.- Classifications of DM
A069.- Type 1 - Type 2- Gestational Diabetes- Diabetes due to drugs that raise B
G- Chronic pancreatitis- Removal of pancrease- Cushings disease- Acromegaly- Phe
ochromocytoma (tumor in adrenal gland)
A073.- Polyuria- Polyphagia- Polydipsia- Fatigue- Blurred vision- Older- ObeseNo obvious signs, found at routine MD visit
A074.- Can occur up to 24 hours after exercising- Test before exercising and eat
a snack if necessary- Eat good diet after
Q075.- Sulfonylureas
Q076.- Meglitinides
Q077.- Biguanides
A078.- Mechanism of action: Increase tissue sensitivity to insulin - Timing: QDBID, duration: long half life, can cause liver toxicity- Medications:- *Pioglita
zone: Actos (major ankle swelling)- *Rosiglitazone: Avandia- *Regal- Risks: Weig
ht gain, edema, several weeks to be effective
A079.- Inject air into long acting insulin (cloudy)- Inject air into the short a
cting insulin (clear)- Draw up short acting insulin- Draw up long acting insulin
(mixing vile first)- Make sure to have two licensed RNs confirm both draws of i
nsulin
A081.- Damage to the renal vessels can lead to kidney failure- 1/3 of new ESRD p
atients are diabetic- Leading cause of kidney failure
A084.- Sever osmotic diuresis loss of water, - glucose and electrolytes causes d
ehydration and high serum Na, - decreased intervascular volume, - all leading to
more stress thus causing more glucose to enter the blood stream
A086.- Hyperglycemia, - dehydration (HR up, BP down), - neuro sx, - coma (no ket
osis, acidosis as some insulin present)
A088.- DM Type 1- Failure to take insulin, not enough insulin, infection, stress
- Potassium is outside the cells
A090.- BG > 300-800- 3Ps- Weak, lethargic- Kussmaul resp- N/V, anorexia- Headach
e- Abdominal pain- Fruit breath
A091.- Normalize BG (regulare insulin given IV)- Replace fluids- Replace Potassi
um (unless hyperkalemia or no urine output)
A092.- Keep it continuous and monitor BG often- Only use Regular insulin- If ir
is add to IV bag, it can adhere to tubing, so flush insulin through new tubing
A097.- Lifelong cortisol replacement therapy- Dose needs to be increased for phy
sical and emotional stessors- High Na intake
A100.- May raise Na and lower K- Increase fluid volume- Indications: suppress in
flammatory and immune response (COPD, arthritis, lupus)- Treat addison's - Treat
allergic reactions
A101.- Increase BG levels- Elderly: raises Na and BP, lowers K- Always give (ora
lly) with food(raises HCL production in stomach)- Never abruptly D/C: need to ta
per off (check meds in patients transferred from ICU or CCU)- Wear Medic-alert I
D bracelet
A102.- PVD- Steroid induced DM- Decreased immune response- Inflammation- Osteopo
rosis- HTN, edema- Buffalo hump & moon face- Acne- Bruising- Mood changes- Hirsu
tism (extra hair)- amenorrhea (no period)
A104.- Tumor %80 benign/Malifnant 10%- Tumors located in other sites of adrenal
tissue (aorta, ovaries, spleen)- Genetic predisposition- Secretes excessive cate
cholemines (epi and nor)
A105.- Flight or Fight - Increase HR- HTN- Na and fluid retention- Increased glu
cose during stress
Q108.- Vasopressin
A110.- Lack of ADH- Increased urine output (polyuria) - Increased thirst- Dilute
urine- Urine Specific Gravity < 1.005- Tx: nasal spray: desmopresin
A111.- ACTH: acts on the adrenals- TSH: acts on the thyroid- FSH: acts on the ov
aries and testes- GH: Somatotropin
Q113.- Dwarfism
Q114.- Simmond's
Q115.- Gigantism
Q116.- Acromegaly
Q117.- Thyroid
A117.- T3 & T4 secretion is controlled by TSH from the ant pit.- T3 and T4 regul
A119.- Thyrotoxicosis
Q120.- Hypothyroidism
A120.- Insufficient thyroid hormone due to: - *Primary: thyroid dysfunction (low
T3 & T4, high TSH0- *Secondary: anterior pituitary / hypothalmic dysfunction (l
ow T3 & T4, low TSH)- Causes: tx for hyperthyroidism- S/S: - *weakness and letha
rgy- *slowed speech, thick tongue- *flat affect- *memory loss- *decreased heart
rate- *poor appetite- *intolerance to cold - hypothermia- *dry skin, brittle nai
ls- *weight gain- *myxedema- Tx: leve-thyroxine = synthroid, Levoxyl
A122.- May takes weeks to feel better- Take medications daily- Tx can speed up b
ody functions causing problems for patients with:- *Corinary Artery Disease- *DM
- *Adrenal insufficiency
A123.- Destruction of all or part of the gland- Given orally 3-5mos for effectMay cause hypothyroidism- Can damage parathyroid
Q124.- Tyroidetomy
A124.- Post-op care: monitor for airway obstruction, sauna mask- Keep intubation
/tracheostomy equip at bedside
A125.- High temp 102-106- Severe tachycardia, high CHF hypoxia- Manic/psychotic
behavior- Extreme diaphoresis, vomiting, diarrhea- Coma
A127.- Acts on bone, intestine, kidney, to regulate calcium and phosphate metabo
lism- Fosters normal excitability of nerves and muscles
Q128.- Hypoparathyroidism
Q130.- Tx Hypoparathyroidism
A130.- Sever Case:- IV Calcium gluconate (not given IM, can damage tissue)- Mild
Case:- PO calcium and vitamin D - Amphogel (binds phosphorus)
Q131.- Hyperparathyroidism
Q134.- Incidence of DM
Q135.- Glycogenesis
A135.- Liver converts glucose to glycogen- Glycogen stored in liver and muscle c
ells
Q136.- Glycogenolysis
Q137.- Gluconeogenesis
Q138.- Glucose
A139.- CHO to triglycerides (via liver) -> fatty acids (via lipase) -> Ketones (
via liver) this occurs when large amounts of fatty acids are used for energy sou
rce, causes ketoacidosis/ metabolic acidosis
A141.- Glucose almost totally reabsorbed by renal tubules - However, when plasma
glucose is > 180 mg/dl, glucose spills in urine (glycosuria)
A142.- Can only use glucose as energy source- Only stores enough glucose to last
few minutes- Prolonged & severe hypoglycemia can result in brain death
A143.- Uses either glucose or fatty acids - At rest -> fatty acids- Exercise ->
glucose- Muscle fibers more permeable to glucose during exercise due to contract
ion process even in absence of insulin.
A144.- Secretes Glucagon: BS- Glucagon: Regulated by blood sugar level - BS= Glu
cagon = BS- Maintains BS between meals & fasting/starvation states- BS by hepati
c glucose production
A145.- Secretes Insulin= BS- Insulin: Regulated by blood sugar level- BS = Insul
in = BS- Insulin receptors on cells of the body recognize insulin and allow gluc
ose to be transported into the cell where glucose is converted to energy
A146.- Promotes glucose uptake by target cells, - Promotes storage of excess glu
cose in fat cells, - Increases protein synthesis by increasing transport of amin
o acids into body cells- Inhibits protein breakdown
Q147.- Glucagon
Q148.- Catecholamines
Q149.- Glucocorticoid
A151.- accounts for 10% of cases, occurs at any age, Genetics and autoimmune res
ponses plays a role,
A152.- thin, Peak age = 12 (althoughSudden onset,Body type may occur any age)- F
atigue / Listlessness, Polyuria, Polydipsia, Polyphagia, Weight Loss, Glucosuria
, Ketoacidosis
A153.- Accounts for 90% of all cases of diabetes characterized by - Insulin Resi
stance - Insulin Secretion- Hepatic Glucose Production
Q154.- DM I etiology
Q155.- Etiology of DM II
A155.- Insulin Resistance:- Fewer insulin receptor sites on* cell membrane- Insu
lin receptor abnormality*- Abnormality in glucose* transporter- Function only af
ter insulin binds to receptor site- Insulin Secretion: - Hyprinsulinemia leads t
o beta cell exhaustion- Beta cells poop out- Cells unable Hepatic Glucoseroductio
n: Insulin Deficiency to use glucose as energy source - Cells starving- Liver c
onverts glycogen to glucose - Worsens hyperglycemia
A156.- Age >20,- obesity (85% obese), - Genetics (20-50%.. greater than type 1),
- Race (Black, Native Americans, Hispanics) - Impaired Fasting Glucose (pre dia
betes 110-125mg/dl), - Gestational Diabetes (hyperglycemia in pregnancy 5-10yrs
later), - Insulin Resistance Syndrome (Metabolic Syndrome, Syndrome X, Presence
of Four atherosclerotic risk factors: Insulin resistance, Hypertension, Hyperlip
idemia, Central obesity)
A157.- DM II onset age <25yo,- Often Obese- Genetic Defect ==> Autosomal Dominan
t
Q158.- S/S DM II
A159.- Normal; 70-100mg/dl, - IFG Pre diabetes: 110-125 mg/dl, - DM:> 126 mg/dl confirmed with 2 FPG
A160.- Non fasting test- DM= > 200 mg/dl PLUS the presence of classic sx
A161.- Used to detect gestational DM or to detect DM-2 in person who has a norma
l FPG- DM= > 200 mg/dl after 2 hours
A162.- Normal = 4-6%- Goal for DM = <7%- Determines how well DM is being managed
- Reflects average glucose for the preceding 6-12 week period- Not affected by f
ood intake, stress or exercise
A163.- acute complication in DM-1- When Does it Occur?- Onset of disease (before
dx)*- Omit insulin or insufficient* dose- Illness or Physical-Emotional Stress
==*> BS 2nd to Counter Regulatory Hormones
A164.- pH (< 7.35)- BS (often 600-700)- HCO3 (< 15 mE/L)- Ketones in blood and u
rine- Glucose in urine- Compensate = Kussmauls respirations
A165.- Acute complication of DM 2- Lab Findings- BS > 600 mg/dl- Serum osmolarit
y > 310 mOs/L- No ketoacidosis
A168.- Occurs with DM-1- Morning hyperglycemia 2nd nocturnal hypoglycemia- Noctu
rnal hypoglycemia - Occurs because evening dose of* insulin too high- Morning Hy
perglycemia = Compensatory response- counter* regulatory hormones - Hepatic gluc
ose production- Confirm Somogyi effect by measuring BS 2-3 am- Tx: Decrease even
ing insulin dose
Q170.- Retinopathy
Q171.- Nephropathy
Q172.- Neuropathy
A173.- DM-2: present at time of dx - DM-1: onset depends on age & duration of DM
- CAD (agina, MI), CVA(stroke), PAD (pain/intermittent claudication)
A174.- Takes iodine and converts it to thyroid hormones - T3 & T4- Iodine Necess
ary for synthesis of thyroid hormones
A175.- Functional unit of thyroid gland; - Tiny sac-like structures that absorb
iodine; - Combine iodine and tyrosine (amino acid) to make T3 and T4.- Have appr
oximately 2-3 months supply of thyroid hormone stored in gland
Q176.- Hypothyroid
A176.- Insufficient thyroid hormone- BMR- Slows down all body activity- Classifi
cation- Congenital- Acquired
A177.- Affects approx 1 of 4000 births - Caused by- Absent thyroid gland- Inadeq
uate hormone production- Deficient TSH- Cretinism=manifestations of untx congeni
tal hypothyroidism- Growth retardation- Mental retardation- Tx: Hormone replacem
ent
A180.- Most common- Primarily affects women (5:1 ratio)- form autoantibodies whi
ch react with t Autoimmune disorder hyroid destroys glandantigens - May produce
transient hyperthyroid state = leakage of preformed thyroid hormone from damaged
cells
A183.- Sx Vary ==> May be subtle or overt- Gradual onset, weakness and fatigue,
skin dry and course- Hair course and brittle, Accumulation of hydrophilic mucopo
lysaccharide substance, Puffy appearance especially around eyes, Bradycardia, De
creased RR, Decreased appetite, Menorrhagia, Easy fatigueabiity, Physically/ment
ally sluggish, Severely hypothyroid, unable to metabolizes sedatives, analgesics
and anesthetic drugs, T3, T4, TSH, Cholesterol
Q184.- Hyperthyroidism
A187.- Graves Disease (most common cause)- other causes not discussed
A188.- Presentation may be subtle or dramatic ==> Depends on hormone level, Onse
t: Insidious, heat intolerance, smooth velvety skin, thin fine silky hair, break
able nails, Graves Dermopathy (Rare occurs after many years), Exophthalmos (occu
rs in 1/3 pts), Goiter (2-3x normal size), Increased CO, Tachycardia, Angina, SO
B with exertion, increased appetite, Amenorrhea, muscle protein breakdown= used
as fuel, Restless, anxious, nervous, insomnia, difficulty concentrating, Increas
ed sensitivity to catecholamines (epi/norepi)- T3, T4- TSH- Cholesterol
Q189.- Chatecolamines
A189.- Epi and Norepi. Hormones of Adrenal Medulla. - Increase BP, HR, Respirati
Q190.- Aldosterone
A190.- Hormone of Adrenal Cortex:- Regulates Na+, K+, & Water levels
A191.- Adrenal cortex produces small amounts of sex hormone in both males and fe
males
A192.- Pituitary Tumor -> Increased ACTH- Adrenal Tumor -> Increased Cortisol- L
ung Cancer -> Increased ACTH- Long term prednisone therapy -> Suppresses ACTH
A195.- Gradual onset, Sx appear when 90% of gland destroyed, ( Cortisol) Hypoglyc
emia- Poor tolerance to stress, infection, trauma, ( Aldosterone): Excrete Na/Wat
er; Retain K+, Hypovolemia, Hyponatremia, Hyperkalemia, Hypotension, Weight loss
- ACTH: Melenocyte stimulating activity- Androgen: Females = sparse axillary/pub
ic hair
A196.- nervousness, - anxiety, - irritability, - insomnia, - heat intolerance, sweating, - palpitations, - weight loss with increased appetite, - fatigue, - w
eakness, - emotional lability, - diarrhea
A197.- enlarged thyroid gland, - warm skin, - thyroid stare , - lid lag, - exop
hthalmos, - proptosis, - tremor, - tachycardia, - AFib
Q198.- what disease presents in part with ophthalmoplegia and pretibial myxedema
?
Q199.- what endocrine check should you do when patient present with new-onset AF
ib?
A201.- Graves
disease
A202.- toxic multinodular goiter- individual lumps, not a diffusely enlarged gla
nd
A206.- beta-blockers
A209.- hypothyroidism
Q210.- bradycardia; dry, coarse, cold, pale skin; periorbital and peripheral ede
ma; thick tongue; slow speech; slow reflexes. signs of what endocrine abnormalit
y?
A210.- hypothyroidism
Q211.- what is the most common cause of hypothyroidism? most common type of pati
ent?
A213.- high TSH (unless due to 2* issues); low T3, low T4; hypercholesterolemia
A215.- free T4 measures the active form of thyroid hormone; - many conditions ca
use changes in the amount of thyroid-binding globulin, which change total values
in the absence of hypo- or hyperthyroidism
A217.- a patient with any illness may present with derangements in TFT s that re
semble hypothyroidism
Q218.- what are typical sx of patients with Cushing s syndrome? (increased corti
costeroids)
Q219.- what are typical signs of patients with Cushing s (incr. corticosteroids)
?
A219.- buffalo hump, truncal and central obesity with wasting of extremities, round plethoric faces, - purplish skin striae, - proximal muscle weakness
A222.- 1. 24hr measurement of free cortisol in urine (look for abnormal elevatio
n) or- 2. dexamethasone suppression test (cortisol levels aren t appropriately s
uppressed several hours after administration of dexamethasone)
Q224.- what is most common cause of hirsutism? what causes are important for boa
rds?
Q228.- what do you think about in a patient presenting with both hirsutism AND v
irilization?
Q229.- woman presents with diffuse goiter and hyperthyroidism. What are the expe
cted values of TSH and thyroid hormones?
Q230.- 48y/o female presents with progressive lethargy and extreme sensitivity t
o cold temperatures. What is the diagnosis
A230.- hypothyroidism
Q231.- pt with elevated serum cortisol levels undergoes a dexamethasone does not
decrease cortisol levels, but 8 mg does. What is the disease?
Q232.- 50y/o man complains of diarrhea. On physical exam his face is plethoric a
nd a heart murmur is detected. What is the dx?
Q233.- woman of short stature presents with shortened 4th and 5th metacarpals. W
hat endocrine d/o comes to mind?
Q234.- Nondiabetic patient presents with hypoglycemia but low levels of C peptid
e. What is the dx?
Q235.- cortex of the adrenal glands comes from what embryologic source?
A235.- mesoderm
Q236.- medulla of the adrenal glands comes from what embryologic source?
A237.- Salt (Na+)- Sugar (glucocorticoids) and- Sex (androgens)- mneu: the deepr
you go the sweeter it gets
A239.- aldosterone
A240.- renin-angiotensin
Q247.- what is the most common tumor of the adrenal medulla in adults
A247.- pheochromocytoma
Q248.- what is the most common tumor of the adrenal medulla in children
A248.- neuroblastoma
Q249.- out of pheochromocytoma and neuroblastoma which one causes episodic hyper
tension
A249.- pheochromocytoma
A250.- left adrenal ->left adrenal vein -> left renal vv -> IVC
A252.- neuroectoderm
A254.- hypothalamus
A255.- pituitary
A257.- FLAT Pig- FSH- LSH- ACTH, Melanotropin (MSH)- TSH- Prolactin- GH
Q261.- what part of the pancreas are the alpha, beta, & delta cells most numerou
s
A261.- tail
A263.- glucagon
A264.- insulin
A265.- somatostatin
Q266.- prolactin ____ dopamine synthesis and secretion from the hypothalamus.
A266.- increases
A267.- decreases
A269.- GnRH
A270.- amenorrhea
Q271.- what is the congenital adrenal hyperplasia: Female that is not maturing p
resents with HYPERTENSION, hypokalemia, she has decreased sex hormones, decrease
cortisol, increased mineralocorticoids
Q272.- this congenital adrenal hyperplasia is the most common form. It results i
n decreased cortisol (increased ACTH), decreased mineralocorticoids, increased s
ex hormones. Complications include masculinization, female psuedohermaphroditism
, Hypotension, hyponatremia, hyperkalemia, increased plasma renin activity, and
volume depletion. Salt wasting can need to hypovolemic shock in the newborn
Q273.- this congenital adrenal hyperplasia results in low cortisol, low aldoster
one and corticosterone and high sex hormones. Complications include masculinizat
ion and (Hypertension (11-deoxycorticosterone acts as a weak mineralocorticoid)
A275.- 1) increased bone resorption of Ca++ & phosphate- 2) increased kidney res
orption of Ca++ in the distal convoluted tubule- 3) decreased kidney resorption
of phosphate- 4) increased 1,25 (OH)2 vitamin D (cholecalciferol) production by
stimulating kidney 1 alpha hydroxilase- mneu: PTH increases serum CA, decreases
serum PO, increases urine PO4, and stimulates both osteoclasts and osteoblastsPTH: phosphate trashing hormone
Q277.- image p. 250 actions of PTH and 1,25 OH D in maitenence of Ca++ & phospha
te homeostasis
A277.- shown are the main actions of PTH & 1,25 (OH)2 D in the maintenance of Ca
++ and phosphate homeostasis
Q279.- source of D2
A279.- plants
A280.- liver
A281.- kidney
Q283.- what disease do you get if you don t get enough vit D (kids and adults)
Q287.- in the regulation of vit D, what does increased 1,25-(OH)2 vit D cause
A288.- hyperparathyroidism
A291.- osteoporosis
A295.- PTH
Q297.- the need for gene transcription and protein synthesis delays the onset of
action of these steroid/thyroid hormones
Q298.- these hormones are lipophilic and insoluble in plasma; therfore, they mus
t circulate bound to specific binding globulins, which increase solubility and a
llows for increased delivery of steroid to the target organ.
A298.- steroid
A299.- gynecomastia
A300.- hirsutism
Q301.- these are iodine containing hormones that control the body s metabolic ra
te
A303.- 1) bone growth (synergism w/ GH- 2)CNS maturation- 3) beta adrenergic eff
ects (increased CO,HR,SV, contractility- 4) increase BMR via increased Na+/K+ AT
Pase activity -> increased O2 consumption, RR, increased body temp- 5) increased
glycogenolysis, gluconeogenesis, lipolysis- mneu: T3 fx--4Bs- Brain maturationBone growth- Beta adrenergic effects- BMR incrase
A305.- free
A307.- pregnancy
Q310.- negative feedback by this hormone to the anterior pituitary decreases sen
sitivity to TRH.
A310.- T3
Q311.- in Graves disease it is this TSH analog that stimulates follicular cells
A311.- TSI
A312.- --
Q316.- this syndrome refers to increased cortisol levels due to a variety of cau
ses. The clinical picture includes hypertension, weight gain, moon faces, trunca
l obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinn
ing, striae), osteoporosis, amenorrhea, and immune suppression
Q317.- If your patient presents with Cushings syndrome you have to identify the s
ource, if the patient has increased ACTH levels because of a pituitary adenoma t
he patient has
Q318.- If your patient presents with Cushings syndrome you have to identify the s
ource, if the patient has decreased ACTH levels due to causes that are not iatro
genic, the patient has
Q319.- If your patient presents with Cushings syndrome you have to identify the s
ource, if the patient has decreased ACTH levels due to iatrogenic causes, the pa
tient may be taking
A321.- high cortisol after low dose; low cortisol after high dose
Q324.- this disease is due to renal artery stenosis, chronic renal failure, cHF,
cirrhosis, or nephrotic syndrome. Kidney perception of low intravascular volume
Q328.- this is the most common tumor of the adrenal medulla in adults. It is der
ived from chromaffin cells which arise from the neural crest
A328.- pheochromocytoma
A329.- neurofibromatosis
Q330.- this is the most common tumor of the adrenal medulla in children, but it
can occur anywhere along the sympathetic chain
A330.- neuroblastoma
Q335.- symptoms of pheos occur in "spells"--meaning they often relapse and remit
. What are the 5 "P"s of a pheo
A336.- 10% malignant- 10% bilateral- 10% extraadrena- 10% calcify- 10% kids- 10%
familial
Q337.- this MEN type involves the 1) PANCREAS (e.g., Zollinger-Ellison syndrome,
insulinomas, VIPomas) 2)PARATHYROID 3) PITUITARY TUMORS. It often presents with
kidney stones and stomach ulcers
A337.- MEN I (Wermer s syndrome)= 3 "P" organs - (Pancreas, Pituitary, and Parat
hyroidism)
Q338.- this MEN type involves 1) MEDULLARY CARCINOMA OF THE THYROID 2)PHEOCHROMO
CYTOMA 3) PARATHYROID TUMOR.
Q339.- this MEN type involves 1) MEDULLARY CARCINOMA OF THE THYROID 2)PHEOCHROMO
CYTOMA 3) ORAL AND INTESTINAL GANGLIONEUROMATOSIS (MUCOSAL NEUROMAS).
Q341.- what gene are MEN type II & III associated with
Q342.- this d/o often manifests itself with cold intolerance, hypoactivity, weig
ht gain, fatigue, lethargy, decreased appetite, constipation, weakness, decrease
d reflexes, facial/periorbital myxedema, dry, cool skin, and coarse, brittle hai
r
A342.- hypothyroidism
A343.- increased TSH (most sensitive test for primary hypothyroidism)- decreased
total T4- decreased free T4- decreased T3 uptake
Q344.- in this disease the patient presents hypothyroid. It results because thyr
oid is replaced by fibrous tissue
Q345.- this d/o manifests itself with heat intolerance, hyperactivity, weight lo
ss, chest pain/palpitations, arrhythmias, diarrhea, increased reflexes, warm moi
st skin, and fine hair
A345.- hyperthyroidism
A347.- type II
A348.- decreased TSH (if primary)- increased total T4- increased free T4- increa
sed T3 uptake
Q351.- this is the most common thyroid cancer. It has an excellent prognosis. Mi
croscopically you will see "ground glass" nuclei and psammoma bodies
Q352.- this thyroid cancer has a good prognosis. microscopically you will see un
iform follicules
Q353.- this thyroid cancer arises from parafollicular "C cells". It produces cal
citonin. Microscopicallly you may see sheets of cells in amyloid stroma. It is s
een in MEN types II & III
Q354.- this thyroid cancer occurs in older pts. It carries a very poor prognosis
A354.- undifferentiated/anaplastic
Q355.- this occurs wherever endemic goiter is prevalent (lack of dietary iodine)
. It is common in china. It can also be caused by a defect in T4 formation or de
velopmental failure in thyroid formation. You may see a pot-bellied, pale, puffy
-faced child with protruding umbilicus and protuberant tongue
A355.- cretinism
Q356.- adult patient presents with large tongue, deep furrows, deep voice, large
hands and feet, coarse facial features, impaired glucose tolerance (insulin res
istance). What is the d/o and what hormone is in excess
A357.- gigantism
A358.- octreotide
Q359.- give some natural states in which you might have increased GH
Q360.- this is usually caused by an adenoma. labs will show hypercalemia, hyperc
alciuria (RENAL STONES), hypophosphatemia, increased, PTH & cAMP in urine. While
it is often asymptomatic it may present with weakness and constipation ("GROANS
")
Q361.- this d/o is due to decreased serum Ca++, most often due to chronic renal
disease. Labs will show hypocalcemia, hyperphosphatemia, and increased PTH
A365.- hypoparathyroidism.
Q369.- pt presents w/ hypocalcemia, shortened stature and shortened 4th & 5th di
gits.
A369.- pseudohypoparathyroidism
A371.- autosomal-recessive
A379.- always
A380.- sometimes
Q381.- at what age does type 1--juvenile onset (IDDM)usually strike [many except
ions]
A381.- <30
Q382.- at what age does type 2--adult onset (NIDDM)usually strike [many exceptio
ns]
A382.- >40
A383.- no
A384.- yes
A388.- no
Q389.- describe the glucose intolerance associated with type 1--juvenile onset (
IDDM)
A389.- severe
Q390.- describe the glucose intolerance associated with type 2--adult onset (NID
DM)
A390.- mild-moderate
A391.- commonly
A392.- rarely
Q393.- describe the beta cell numbers in the islets associated with type 1--juve
nile onset (IDDM)
A393.- low
Q394.- describe the beta cell numbers in the islets associated with type 2--adul
t onset (NIDDM)
A394.- variable
Q395.- describe the serum insulin associated with type 1--juvenile onset (IDDM)
A395.- low
Q396.- describe the serum insulin associated with type 2--adult onset (NIDDM)
A396.- variable
Q397.- are the classic symptoms of polyuria, polydipsia, thirst, and weight loss
associated with type 1--juvenile onset (IDDM)
A397.- commonly
Q398.- are the classic symptoms of polyuria, polydipsia, thirst, and weight loss
associated with type 2--adult onset (NIDDM)
A398.- sometimes
A399.- excess fat breakdown and increased ketogenesis from increase in free fatt
y acids, which are then made into ketone bodies.
A402.- hyperglycemia, - increase H+, - decreased HCO3-, (anion gap metabolic aci
dosis, - increased blood ketone levels, - leukocytosis. - Hyperkalemia, but depl
eted intracellular K+
A403.- life-threatening mucormycosis, - rhizopus infection, - cerebral edema, cardiac arrhythmias, - heart failure
Q405.- this d/o is characterized by intensive thirst and polyuria together with
an inability to concentrate urine owing to lack of ADH
Q406.- this type of diabetes insipidus may be caused by a pituitary tumor, traum
a, surgery, histiocytosis
A406.- central DI
Q407.- this type of diabetes insipidus may be caused by hereditary factors, hype
rcalcemia, lithium, demeclocycline
A408.- water deprivation test --urine specific gravity <1.006- serum osmo >290mO
sm/L
Q410.- this d/o results in- 1)excessive water retention- 2)hyponatremia- 3)urine
osmolarity>serum osmolarity
Q412.- in SIADH very low serum sodium levels can lead to this
A412.- seizures
A413.- 1) ectopic ADH (small cell lung CA)- 2) CNS disorders/head trauma- 3) pul
monary disease- 4) Drugs (e.g., cyclophosphamide)
Q414.- this is a rare syndrome that results in recurrent diarrhea, cutaneous flu
shing, asthmatic wheezing, and right sided valvular disease.
Q415.- what will you find in the urine of a patient with carcinoid syndrome
Q416.- carcinoid tumor is the most common tumor in this part of large intestine
A416.- appendix
A422.- octreotide
A426.- dietary modification, exercise for weight loss, and oral hypoglycemics
Q429.- In what cases of Cushing s syndrome would you expect to see increased ACT
H? decreased ACTH?
A429.- Increased ACTH - pituitary adenoma, nonpituitary tissue making ACTH (smal
l cell lung cancer)- Decreased ACTH - exogenous steroids, adrenal adenoma produc
ing cortisol; these are due to negative feedback
A431.- Dexamethasone
Q432.- What is the difference between Addison s disease and secondary adrenal in
sufficiency?
A441.- Insulin, IGF-1, FGF, PDGF, Prolactin, and GH- Think all the growth stuff.
.. and prolactin.
A442.- Glucose enters beta cells of the pancreas through GLUT-2 receptor. - ATP
from glucose metabolism closes K+ channels and depolarizes cell. - Ca2+ channels
open, and insulin is released.
Q443.- Diazoxide
A443.- Keeps Ca2+ channels open and inhibits insulin release. - Used to treat in
sulinomas.
Q444.- What affect does TRH (Thyotropin releasing hormone) have on the anterior
pituitary?
Q447.- Calcitonin
Q450.- What are common causes of decreased magnesium secretion? What effect does
low serum magnesium have on PTH?
A455.- GnRH, GHRH, Oxytocin, ADH, TRH- Anything made in the hypothalamus, not th
e pituitary.
A456.- IGF-1, FGF, PDGF, Insulin - MAP kinase- Prolactin and GH - JAK/STAT- cyto
kines and IL-2 also use JAK/STAT pathway
Q457.- What effect does an increase in sex hormone binding globulin have in men?
A457.- Gynecomastia - due to lower levels of free testosterone; - only free test
osterone has an effect.
A458.- Brain maturation, Bone growth, Beta-adrenergic effects, and increased Bas
al metabolic rate.- Think the 4 Bs!
A460.- Peroxidase
A461.- Conn s syndrome with have low renin, - while secondary hyperaldosteronism
will have high renin (due to lack of blood flow to kidney).
A462.- VMA
A463.- Neurofibromatosis, MEN 2A, MEN 2B, diabetes mellitus- Can also cause poly
cythemia due to excess erythropoiten being produced.
Q464.- Neuroblastoma
A464.- Most common tumor of the adrenal medulla in children. - Can occur anywher
e along the sympathetic chain. HVA is urine. - Less likely to develop hypertensi
on.- Accociated with N-myc oncogene. - Tumor marker is bombasin. - Stain is neur
ofilament stain. - Histology would show Homer-wright pseudorosettes.
A466.- Pot-bellied, pale, puffy faced child with protruding umbilicus and protub
erant tongue.
A467.- Flu-like illness- Associated with elevated ESR, jaw pain, early inflammat
ion, and VERY TENDER thyroid gland. - Histology shows granulomatous inflammation
.
A469.- Most common, - excellent prognosis, - "ground glass" nuclei (Orphan Annie
), - psammoma bodies, - nuclear grooves. - Increased risk with childhood irradat
ion.
Q472.- What drug when given in a case of diabetes insipidus, can distinguish bet
ween cental and nephrogenic?
A476.- Life-threatening mucormycosis, - Rhizopus infection, - cerebral edema, cardiac arrhythmias, - and heart failure
A479.- Octreotide
Q480.- MEN 1
Q481.- MEN 2A
Q482.- MEN 2B
A483.- Most common thyroid malignancy; - excellent prognosis, "ground glass" nuc
lei (Orphan Annie), psammoma bodies, nuclear grooves. - Increased risk with chil
dhood irradiation.
Q486.- Low serum calcium and phosphate and elevated alkaline phosphatase suggest
the diagnosis of...
A486.- osteomalacia (low levels of vitamin D results in low calcium and phosphat
e, and the elevated alk phos is a reflection of increased osteoblast activity)
A488.- Normal calcium and phosphate levels, and alkaline phosphatase increases a
fter a fracture
A491.- Serum levels of the oral hypoglycemic may increase, requiring a lower dos
e of the agent
A496.- Myxedema coma - (decreased mental status, hypothermia, and other parasymp
athetic symptoms. Mortality is 30-60%)
A497.- Graves
disease
A504.- Elevated T4, free T4, and T3, - and low TSH
, or death
A505.- Thyroid storm. - Commonly occurs after surgery, radioactive iodine therap
y, or during a severe illness such as uncontrolled diabetes, trauma, acute infec
tion, severe drug reaction, or MI
A506.- Pituitary TSH deficit. - Characterized by normal or low TSH and low T4
Q507.- Elevated TSH, decreased free T4, and elevated thyroid peroxidase antibodi
es (TPO) and microsomal thyroid antibodies
A508.- Use lower starting dose in cardiac disease as it may exacerbate angina. Concomitant administration of cholestyramine, antacids, and iron supplements ma
y interfere with absorption.
A513.- IV hydration with normal saline, diuresis with IV furosemide, monitor and
replace potassium and magnesium.
A516.- Fasting blood sugar >126 on 2 occasions, 2-hour postprandial glucose >200
after 75g oral glucose, or random glucose >200 on 2 occasions with sxs of diabe
tes.
A517.- Stimulates pancreatic beta cells to secrete insulin and may increase numb
er of insulin receptors on hepatocytes, improving glucose uptake. - (Reduce bloo
d glucose by 70-80)
A518.- Pregnancy.
A519.- Hypoglycemia
A522.- Improve insulin sensitivity in muscle and fat cells and may inhibit hepat
ic glucose output
A524.- Flatulence
A526.- Low
Q527.- Purpose of measuring c-peptide levels in patients who are injecting insul
in
A527.- Determine how much of their own insulin they are producing
Q530.- 2 fundamental pathogenic defects that are the hallmarks of type 2 diabete
s
A531.- Increased glucose production. - (The loss of the insulin inhibitory effec
t on the liver causes an increase in hepatic glucose output)
Q532.- The first step and cornerstone in the management of type 2 diabetes
Q533.- Name the classes of oral antidiabetic agents that are considered insulin
secretagogues
Q535.- Low HDL, high triglycerides, high uric acid levels, central obesity, fast
ing hyperglycemia, and high blood pressure
A536.- <7.0
Q538.- Most common complication and cause of death in patients with type 2 diabe
tes
Q539.- ADA recommendations for HDL level in female patients with type 2 diabetes
.
A539.- >50
A540.- Dilated eye exam, - urinary albumin measurement, - and comprehensive foot
exam
A541.- Onset: 30-60 mins- Peak: 2-4 hours- Duration: 5-8 hours
A542.- Onset: 5-10 minutes- Peak: 0.5-1.5 hours- Duration: 6-8 hours
A543.- Onset: 10-20 minutes- Peak: 1-3 hours- Duration: 3-5 hours
A544.- Onset: 5-15 minutes- Peak: 1-1.5 hours- Duration: 1-2.5 hours
A545.- Onset: 2-4 hours- Peak: 6-10 minutes- Duration: 18-28 hours
A547.- Onset: 1-4 hours- Peak: Not discernible- Duration: 20-24 hours
A548.- ACTH stimulation test: shows decreased morning serum cortisol and increas
ed ACTH
Q556.- 5 P s of Pheochromocytoma
A559.- Lap or open adrenalectomy for adrenal tumors after correcting BP and pota
ssium. - Treat with spironolactone for bilateral adrenal hyperplasia.
Q561.- Thyroid disease that presents with decreased cognitive functioning (memor
y) and depression
A561.- Hypothyroidism
A563.- Renal failure, metastatic bone disease, osteomalacia, and multiple myelom
a
A564.- "moans, groans, stones, bones, and psychiatric overtones"- Moans: not fee
ling well- groans: abdominal pain, constipation- stones: kidney stones- bones: b
one pain and arthralgias- psychiatric overtones: lethargy, fatigue, depression,
memory problems
Q565.- Lab values show hypercalcemia and hypophosphatemia. What should be ruled
out?
A565.- Hyperparathyroidism
A566.- Thyroidectomy
Q567.- Labs reveal increased T3 and Free T4, decreased TSH, and elevated antimic
rosomal and antithyroglobulin antibody titers. Diagnosis?
Q568.- What medication is used to treat the symptoms of Graves disease until th
e hyperthyroidism is resolved?
A568.- Propanolol
Q571.- Labs reveal low free T4, increased TSH, and high titers for antibodies to
thyroperoxidase and thyroglobulin. Diagnosis?
Q572.- What type of thyroiditis will present with a very painful, tender, red th
yroid gland?
A573.- Cold
Q574.- What hormone that is released from the zona glomerulosa of the adrenal co
rtex helps to regulate sodium balance?
A574.- Aldosterone
A575.- Renin
Q576.- What hormone that is released from the zona fasciculata of the adrenal co
rtex helps to maintain physiologic integrity?
A576.- Cortisol
A577.- ACTH
A580.- ACTH-secreting pituitary tumor, - small cell carcinoma of the lung (secre
tes ACTH), - endocrine tumors of foregut origin, - pheochromocytoma, - and ovari
an tumors
A582.- Autoimmune. - Other causes include tuberculosis and bilateral adrenal hem
orrhage
A583.- C. Dexamethasone
Q584.- Testing reveals a low plasma renin activity and elevated 24-hour urine al
dosterone level. Diagnosis?
Q586.- What are the 2 primary hormones released from the posterior pituitary gla
nd?
A587.- Gigantism occurs during childhood, before closure of the epiphyses. - Acr
omegaly occurs after closure of the epiphyses.
Q590.- Low blood pressure, weight loss, and abdominal pain associated with hypog
lycemia, hyponatremia, and hyperkalemia. Diagnosis?
A595.- Autoimmune disorder in which autoantibodies attach to TSH receptors & sti
mulate thyroid hyperfunctioning.
Q596.- A 30 yr old female presents with high fever, vomiting, diarrhea, tachycar
dia, restlessness and confusion. Labs: TSH - low, T3 and T4 are elevated. What i
s the condition? What is the initial treatment of choice?
Q597.- What is the drug of choice for pregnant/breast feeding women with hyperth
yroidism?
A597.- Propylthiouracil
Q598.- Which lab tests are used to confirm the dx of Hashimoto s Thyroiditis?
Q600.- A 25 yr old female presents with painful glandular enlargement with pain
radiating to the ears, dysphagia, low-grade fever and malaise. Which type of thy
roiditis does she have & what is the treatment?
Q601.- Fever, pain, redness & a neck mass are present in _______ thyroiditis. Wh
at is the treatment?
A602.- 0.05
Q607.- What are the diagnostic lab values associated with DM I and II
A607.- Random plasma glucose >200 with classic sx; - or Fasting levels of 126 or
greater on more than one occasion
Q609.- A glucose of 140-199 two hrs after 75g oral glucose indicates __________-
A611.- 70-100 before meals & after overnight fast- <180 at 1 hr postprandial- <1
50 at 2 hrs postprandial
Q612.- What are the LDL and HDL goals for DM patients?
A613.- Hx of hypoglycemic sx- Fasting blood glucose <40- Immediate recovery with
administration of glucose
A614.- 1.) 8:00am plasma cortisol <3 ug/dL with elevated ACTH >200 pg/mL- 2.)Cos
yntropin stimulation test: serum cortisol increase <20 ug/dL after administratio
n of cosyntropin
A615.- excludes
Q616.- Buffalo hump, moon faces and supraclavicular pads are associated with ___
________
Q617.- Excretion of free cortisol in the urine _______ in 24 hrs or greater than
_______ of cortisol per gram of creatinine is diagnostic of Cushing s
A617.- >125 mg/dL (free cortisol in urine)- 95 mcg (cortisol per gram of creatin
ine)
Q619.- Which drugs can cause false postives in cortisol excretion & plasma corti
sol tests?
Q621.- What is the treatment of choice for central DI and DI assoc with pregnanc
y?
A623.- Osteomalacia
A624.- Phenytoin
Q626.- Dietary cholesterol intake should not exceed ________ for patients with D
yslipidemia