Test your basic knowledge |

Endocrine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What 3 things does insuline def and glucagon excess lead to...
Dec glucose uptake - inc protein catabolism - inc lipolysis
Inc glucose transport - inc glycogen synthesis and storage - inc triglyceride synthesis and storage - inc Na retention in kidney - inc protein synthesis in muscle - inc cellular uptake of K and amino acids
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
Peripheral tissue

2. What is the common etiology of primary hyperPTH and What are the expected changes in serum and urine - How does it present
Osteitis fibrosa cystica
Small cell lung cancer and bronchial carcinoids
Cushing's diseaes = ACTH secretion from pit ademona - inc ACTH - ectopic ACTH = non pit tissue secreting ACTH - inc ACTH - adrenal production of cortisol = ademona - carcinoma - nodular adrenal hyperplasia - dec ACTH
Adenoma - hypercalcemia - hypercalciuria - hypophosohatemia - inc PTH - inc alk phos - inc cAMP in urine - often asymptomatic present as weakness and contipation - groans

3. What kind of inheritance to MEN syndromes have
Small cell lung cancer and bronchial carcinoids
AD
1 -25 OH2 vitamin D (active form)
Vitamin d

4. What does pheo tumors secrete - What can they cause and what serum and urinary makers are there
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines
Bound to corticosteroid binding globulin - CGB
VMA
Beta - hydroxybutyrate > acetoacetate

5. What kind of cells are in the adrenal medulla and What do they secrete
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test
Inhibits glucagon release
Chromaffin cells - catecholamines
DR5 - antimicrosomal - antithyroglobulin

6. most common thyroid cancer - ground glass nuclei - psammona bodies - nuclear grooves - prognosis and risk
5- HIAA
Excellent prognosis - risk with childhood radiation - papillary carcinoma
Neural crest
Less likely

7. What does the stomach show in Zollinger Ellison
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1
Inc glucose transport - inc glycogen synthesis and storage - inc triglyceride synthesis and storage - inc Na retention in kidney - inc protein synthesis in muscle - inc cellular uptake of K and amino acids

8. What is the TX for DKA
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Urine specific grav < 1.006 - serum osm > 290
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid

9. What is the source of calcitonin and What does it do
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca
Retinopathy (hemorrhage - exudates - microanuerysms - vessel proliferation) - glaucoma - nephropathy (noduclar sclerosis - progressive proteinuria - CRF) - arteriosclerosis leading to HTN - kimmelstiel wilson nodules
Dec in DM1 - variable in DM2 with possible amyloid
Prolactinoma

10. What is the tx for hyperaldosteronism
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Zona reticularis - ACTH hypothalamic CRH - sex hormones - androgens
Surgery to remove tumor - sprinolactone - (K sparing diuretic)
Raises free testosterone and they gey hirsutism

11. Most common tumor of adrenal medulla in adults - cells - and embyronic origin
Inhib
TSH - elevated in hypo - low in hyper
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
Chromaffin cells from NC

12. What are the clinical findings with hashimotos
Chromaffin cells - catecholamines
Moderatly enlarged nontender thyroid
Pheochromocytoma
Rapid/deep breathing (Kussmal's resps) N/V - abdominal pain - psychosis/delirium - dehydration - FRUITY breath odor -

13. What is the fxn of prolactin
Riedel's - fixed hard and painless goiter
Milk production in females and spermatogenesis in males (by inhibiting GnRH synthesis and release
Chvostek's sign
Chromaffin cells - catecholamines

14. How does PTH stimulate Ca relase from bone
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Diffuse thickening of the BM
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K

15. self - limiting hypothyroidism following a flu - like illness - dz - hist - and findings
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid
ANP - NO and EDRF
Nonenzymatic glycosylation

16. Medullary carcinoma forms From what cells and What do they produce - histo and association
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias
1 = juveline - IDDM - 2 = adult - NIDDM
Thyroid hormones T3/T4

17. tapping of the facial nerve leads to contraction of facial muscles

18. All three effects of hyperinsulinemia lead to which two clinical features
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation
Dehydration and acidosis leading to coma and death
AD
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis

19. What causes skin hyperpigmentation in primary adrenal insuff
DM1 = severe - DM2 = mild to moderate
MSH - a by product of inc ACTH production from POMC
Kidney perception of low intravascular volume results in overactive renin - angiotensin system - due to renal artery stenosis - CRF - CHF - cirrhosis or nephrotic syndrome - associated with HIGH plasma renin
Due to dec gut absorption of Ca - inc PO4 due to chronic renal disease (no vit D) hypOcalcemia - hyperphophatemia - inc alk phos - inc PTH

20. What is the pathway of catecholamine production
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
HTN
Riedel's - fixed hard and painless goiter
Surgery to remove tumor - sprinolactone - (K sparing diuretic)

21. What are the 3 endogenous causes of cushing's syndrome and What are the ACTH values for each

22. In what organs/systems do you see the effects of small vessel disease
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple
Zona fasciculata - ACTH - hypothalamic CRH - cortisol/sex hormones
Retinopathy (hemorrhage - exudates - microanuerysms - vessel proliferation) - glaucoma - nephropathy (noduclar sclerosis - progressive proteinuria - CRF) - arteriosclerosis leading to HTN - kimmelstiel wilson nodules
Dec in DM1 - variable in DM2 with possible amyloid

23. What is the rule of 1/3s in carcinoid syndrome
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Growth factors - IGF-1 - FGF - and PDGF all MAP kinase pathway
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple

24. bone lesions due to secondary or tertiary hyperPTH due in turn to renal disease
Caused by aldosterone secreting tumor - resulting in HTN - hypokalemia - metaboolic alkalosis low plasma renin - B/L or unilateral
Less likely
21 hydroxylase - masculinization - hypotension - hyperkalemia - inc plasma renin - volume depletion
Renal osteodystrophy

25. autosomal dominant kidney unresponsive to PTH leading to hypocalcemia - shortened 4th/5th digits and short stature

26. What is the tx for diabetes inspidus - central and nephrogenic
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR
1 = juveline - IDDM - 2 = adult - NIDDM
Dehydration and acidosis leading to coma and death
Medullary thyroid carcinoma - calcitonin

27. What is the effect of GHRH on GH
During stress - childbirth
Prolactin and GH
Pheochromocytoma
Stim

28. Which are the acidophiles
Stim
Prolactin and GH
Kidney stones and stomach ulcers
Inc in serum Ca causes calcitonin secretion

29. dec glucose uptake leads to...
Pheochromocytoma and PTH
Ingested from plants
Somatostatin analog
Hyperglycemia - glucosuria - osmotic diureses - lyte depletion

30. In which DM is there a stronger genetic association
Prolactin and GH
DM2
Inc in ACTH because low levels of cortisol
AD

31. nonenzymatic glycosylation leads to what 3 catageories of defects
HTN - weight gain - moon facies - truncal obesity - buffalo hump - hyperglycemia - skin thinning and striae - osteoporosis - amenorrhea - immune suppression
Small vessel disease - large vessel disease and osmotic drainage
Excessive water retenion - hyponatremia - urine osm > serum osm
Anwhere along the sympathetic chaing - HVA - N- myc

32. When does graves typically present
Surgery to remove tumor - sprinolactone - (K sparing diuretic)
During stress - childbirth
Zona reticularis - ACTH hypothalamic CRH - sex hormones - androgens
Stress induced catecholamine surge leading to death by arrhythmia - graves

33. What are the 3 P's of MEN type 1 (Werners)
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias
Pancreas - pituitary and PTH
Excellent prognosis - risk with childhood radiation - papillary carcinoma
Chromaffin cells from NC

34. What are the 4 fxns of PTH
Milk production in females and spermatogenesis in males (by inhibiting GnRH synthesis and release
DM1 - HLA- DR3 and DR4
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
Inc bone resorption of Ca and PO4 - inc kidney reabsorption of Ca in DIC - dec kidney reabsorption of PO4 - inc calcitriol production by stimulated 1alpha - hydroxylase

35. What are the hormones released from the neurohypophysis and where are they made
ADH - oxytocin - made in the hypothalamus and shipped to posterior pituitary
Neuroblastoma
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
PseudohypoPTH - albright's hereditary osteodystrophy

36. cystic bone spaces filled with brown fibrous tissue causing pain
Type 1
Somatostatin analog
Bound to corticosteroid binding globulin - CGB
Osteitis fibrosa cystica

37. What are the urine and serum findings in diabetes insipidus
DM1
Z- E - insulinomas - VIPomas - glucagonomas are rare
Inc cortisol after low dose and high dose
Urine specific grav < 1.006 - serum osm > 290

38. What are the 4 causes of SIADH
Pancreas - pituitary and PTH
Ectopic ADH in small cell lung cancer - CNS disorder/head trauma - pulmonary diseae - drugs like cyclophosphamide
Islets of langerhans are collections of alpha - beta and delta
Octreotide

39. What are the likely causes of hypoPTH
Chvostek's sign
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple
Due to dec gut absorption of Ca - inc PO4 due to chronic renal disease (no vit D) hypOcalcemia - hyperphophatemia - inc alk phos - inc PTH

40. Where are the beta cells located in the islets
Less likely
Inside
Stim
Undifferentiated/anaplastic

41. How is PTH regulated
FLAT
Dec free serum Ca inc PTH secretion - dec free serum Mg dec PTH secretion
Inc in serum Ca causes calcitonin secretion
Inhib

42. endocrine hormones that use cAMP - FLAT CHAMP - What are they?
TSH - elevated in hypo - low in hyper
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Raises free testosterone and they gey hirsutism

43. intense thirst - polyuria and inability to concentrate urine
Diabetes insipidus - lack of ADH - or lack of response to ADH in kidney
Bromocriptine or cabergoline
Inc cortisol after low dose - dec cortisol after high dose
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut

44. in the congenital bilateral adrenal hyperplasias which enzyme deficiency is characterized by dec in sex hormones - dec in cortisol - and inc in mineralcorticoids - enzyme and sx
Chvostek's sign
TSH - elevated in hypo - low in hyper
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis

45. What diseases can cause primary adrenal insufficiency
Rapid/deep breathing (Kussmal's resps) N/V - abdominal pain - psychosis/delirium - dehydration - FRUITY breath odor -
HTN
Peroxidase
Autoimmune - TB - metastasis

46. Where can neuroblastomas occur - What do you see elevated in the urine and what oncogene is associated
Stress - exercise and hypoglycemia
Adenoma - hypercalcemia - hypercalciuria - hypophosohatemia - inc PTH - inc alk phos - inc cAMP in urine - often asymptomatic present as weakness and contipation - groans
Anwhere along the sympathetic chaing - HVA - N- myc
Follicles of thyroid - most T3 formed in the blood

47. What is secondary hyperPTH due to and What are the expected serum values
Metanephrine
Inhibits glucagon release
Inside
Due to dec gut absorption of Ca - inc PO4 due to chronic renal disease (no vit D) hypOcalcemia - hyperphophatemia - inc alk phos - inc PTH

48. pheochromocytoma rule of 5 P's - What are they
Demeclocycline or H2O restriction
Episodic hyperadrenergic symptoms - pressure - pain (headache) - perspiration - palpitations (tachycardia) - pallor
Undifferentiated/anaplastic
Inhib

49. What is the primary defect in DM1 vs DM2
Octreotide
Follicular carcinoma of thyroid
Rapid/deep breathing (Kussmal's resps) N/V - abdominal pain - psychosis/delirium - dehydration - FRUITY breath odor -
1 = viral/immune destruction beta cells - 2 = insulin resistance

50. What are the two types of diabetes insipidus and What causes them
Kidney stones and stomach ulcers
GH - large tognue - deep furrows - deep voice - large hands/feet - coarse fascial features - impaired glucose tolerance
Central - pituitary tumor - truama - surgery - histiocytosis X and nephrogenic - hereditary - 2ndary to hypoglycemia - lithium - demeclocycline (ADH antagonist)
Hashimotos thyroiditis