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Endocrine

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. occlusion of brachial artery with BP cuff leads to carpal spasm

2. where do you see GLUT 4 transporter
Rapid/deep breathing (Kussmal's resps) N/V - abdominal pain - psychosis/delirium - dehydration - FRUITY breath odor -
Most antipsychotics and all OCPs - estrogen in pregs
Insulin responsive - adipose and skeletal muscle
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test

3. How does PTH stimulate Ca relase from bone
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Free hormone is active T3 bind more than T4
DM1 = severe - DM2 = mild to moderate
Left adrenal - left adrenal vein - left renal vein - IVC

4. What is the effect of CRH on ACTH
Stim
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
Inhib
Pheochromocytoma

5. What are the common causes of dec Mg
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B
Stress induced catecholamine surge leading to death by arrhythmia - graves
Diarrhea - aminoglycosides - diuretics - and EtOH
All 3 - spares medulla

6. How is PTH regulated
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Ingested from plants
Riedel's - fixed hard and painless goiter
Dec free serum Ca inc PTH secretion - dec free serum Mg dec PTH secretion

7. Is there an association with obesity in DM1 or DM2
Retinopathy (hemorrhage - exudates - microanuerysms - vessel proliferation) - glaucoma - nephropathy (noduclar sclerosis - progressive proteinuria - CRF) - arteriosclerosis leading to HTN - kimmelstiel wilson nodules
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
DM2

8. Medullary carcinoma forms From what cells and What do they produce - histo and association
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
GnRH - Oxytocin - ADH (V1) - TRH
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome

9. How does the body respond to SIADH and What does that cause
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
DM2
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
Dec aldosterone causing hyponatremia which can lead to seizures

10. What vitamin D conversion takes place in the kidney
1 -25 OH2 vitamin D (active form)
Episodic hyperadrenergic symptoms - pressure - pain (headache) - perspiration - palpitations (tachycardia) - pallor
Nonenzymatic glycosylation
T3/T4 - cytosol

11. What are the endocrine cells of the pancrea
DM1 = severe - DM2 = mild to moderate
DM1 - HLA- DR3 and DR4
Islets of langerhans are collections of alpha - beta and delta
GH - prolactin also IL-2

12. What is the serum insulin level of DM1 vs DM2
Urine osm doesn't inc - and desmopressin admin distinguishes
DM1 = dec - DM2 = variable
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Milk production in females and spermatogenesis in males (by inhibiting GnRH synthesis and release

13. What does the stomach show in Zollinger Ellison
Correct is slowly
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Waterhouse friderichsen - n meningitidis septicemia

14. In which DM is polyuria - polydipsia - thirst and weight loss more common
Bidirectional - beta cells - liver kidney - small intestine
Peripheral tissue
Kidney - 1 -25 OH2 vit d
DM1

15. What other conditions are associated with MEN 2B
Small (metastatic) bowel tumors - 5HT goes to liver for first pass -
TGB - dec in hepatic failure - inc in pregnancy via estrogen
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Surgery to remove tumor - sprinolactone - (K sparing diuretic)

16. What kind of cells are in the adrenal medulla and What do they secrete
Polydipsia - polyuria - polyphagia - weight loss - DKA (type1) - hyperosmolor coma (type2) unopposed secretion of GH and epi (exacerbating hyperglycemia
Inhib
Chromaffin cells - catecholamines
Medullary thyroid carcinoma - calcitonin

17. What is the source of calcitonin and What does it do
Gigantism - linear bone growth
DM1 = dec - DM2 = variable
Pheochromocytoma
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca

18. GOAT goes IP3
2A and 2B
DM1 - HLA- DR3 and DR4
GnRH - Oxytocin - ADH (V1) - TRH
25- OH vitamin D

19. What other diseases or syndromes are associated with pheochromocytoma
Neurofibramtosis - MEN types 2A and 2B
Hashimotos thyroiditis
HTN
Stim

20. Carcoid tumors are derived From what cells
GnRH - Oxytocin - ADH (V1) - TRH
Beta - hydroxybutyrate > acetoacetate
Neuroendocrine cells of GI tract
25- OH vitamin D

21. What are the labs for free T4 - total T4 and T3 uptake for hypo/hyperthyroidism
Ingested from plants
Hypo is low - hyper is high on all
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Autoimmune - TB - metastasis

22. What drugs cause shrinkage of prolactinoma
DM1 - HLA- DR3 and DR4
Bromocriptine or cabergoline
5- HIAA
Correct is slowly

23. What are the clinical findings in cretinism
Mesoderm
Excessive water retenion - hyponatremia - urine osm > serum osm
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
Removal of pituitary adenoma and octreotide

24. What are the clinical findings with hashimotos
T3/T4 - cytosol
Moderatly enlarged nontender thyroid
21 hydroxylase - masculinization - hypotension - hyperkalemia - inc plasma renin - volume depletion
Autoimmune - TB - metastasis

25. What is the effect of DA on prolactin
Inhib
Neuroendocrine cells of GI tract
Alpha = glucagon - beta = insulin - delta = somatostatin
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

26. Neuroblastoma does not come with...
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
HTN
GnRH - Oxytocin - ADH (V1) - TRH
Diffuse thickening of the BM

27. thyroid cancer in older patients with poor prognosis
Riedel's - fixed hard and painless goiter
Undifferentiated/anaplastic
Free hormone is active T3 bind more than T4
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B

28. What are two examples of ectopic ACTH producing tumors
Small cell lung cancer and bronchial carcinoids
Tonic DA from hypothalamus inhibits - prolactin causes DA synthesis and increases own inhibition - TRH stimulates prolactin
Peroxidase
Toxic multinodular goiter

29. What are the clinical findings of cushing's
Hashimotos thyroiditis
HTN - weight gain - moon facies - truncal obesity - buffalo hump - hyperglycemia - skin thinning and striae - osteoporosis - amenorrhea - immune suppression
HVA
21 hydroxylase - masculinization - hypotension - hyperkalemia - inc plasma renin - volume depletion

30. What regulates vit D
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Dehydration and acidosis leading to coma and death
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
Inc cortisol after low dose and high dose

31. What is the source of thyroid hormone
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
Follicles of thyroid - most T3 formed in the blood
Pheochromocytoma
5- HIAA

32. What are the labs of DKA
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
Inc cortisol after low dose and high dose
Chvostek's sign
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis

33. In which DM is there a stronger genetic association
DM2
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
RBC brain
Bromocriptine or cabergoline

34. What happens in the dexamethasone suppression test in somoeone with an ectopic ACTH producing tumor
Toxic multinodular goiter
1 = juveline - IDDM - 2 = adult - NIDDM
Small vessel disease - large vessel disease and osmotic drainage
Inc cortisol after low dose and high dose

35. What is the tx for pheochromocytoma
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
Hyperglycemia - glucosuria - osmotic diureses - lyte depletion
All 3 - spares medulla
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis

36. In which DM is there an islet cell leukocytic infiltrate and what kind of infiltrate does the other have
Waterhouse friderichsen - n meningitidis septicemia
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
DM1 - DM2 has islet amyloid deposit

37. What is the effect of TRH on TSH and prolactin
Zona reticularis - ACTH hypothalamic CRH - sex hormones - androgens
DM1 = severe - DM2 = mild to moderate
Demeclocycline or H2O restriction
Stim

38. What are neurophysins
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Tonic DA from hypothalamus inhibits - prolactin causes DA synthesis and increases own inhibition - TRH stimulates prolactin
25- OH vitamin D

39. What are the findings of hypoPTH
Neuroendocrine cells of GI tract
Hypocalcemia and tetany
Renal osteodystrophy
Stim

40. What is the common etiology of primary hyperPTH and What are the expected changes in serum and urine - How does it present
Type 1
FLT - hCG
Adenoma - hypercalcemia - hypercalciuria - hypophosohatemia - inc PTH - inc alk phos - inc cAMP in urine - often asymptomatic present as weakness and contipation - groans
Diffuse thickening of the BM

41. What is the histology with hashimotos thyroiditis
Hurthle cells - lymphocytic infiltrate with germinal centers
Somatostatin analog
1 = viral/immune destruction beta cells - 2 = insulin resistance
DM1 = dec - DM2 = variable

42. What is the most common tumor of the adrenal medulla in adults
Pheochromocytoma
Dec in DM1 - variable in DM2 with possible amyloid
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
Sun exposure in skin

43. When is the onset of DM1 vs DM2 causing what kind of DM
Toxic multinodular goiter
Inhib
1 = juveline - IDDM - 2 = adult - NIDDM
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi

44. hyperthyroidism signs/symptoms
Zona reticularis - ACTH hypothalamic CRH - sex hormones - androgens
BRICK L - brain - RBC - intestine - cornea - kidney - liver
DM2
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias

45. What is the source of D3
Urine osm doesn't inc - and desmopressin admin distinguishes
Sun exposure in skin
Inhibits glucagon release
Follicular carcinoma of thyroid

46. The adrenal cortex derives From What embryonic tissue
Mesoderm
Left adrenal - left adrenal vein - left renal vein - IVC
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
No - proinsulin to insulin + C peptide

47. In what instances in an inc in GH normal
Stress - exercise and hypoglycemia
Chief cells of parathyroid
Diarrhea - aminoglycosides - diuretics - and EtOH
Retinopathy (hemorrhage - exudates - microanuerysms - vessel proliferation) - glaucoma - nephropathy (noduclar sclerosis - progressive proteinuria - CRF) - arteriosclerosis leading to HTN - kimmelstiel wilson nodules

48. Where is the defect in toxic multinodular goiter
Right adrenal - right adrenal vein - IVC
Zona fasiculata
TSH receptor leading to inc release of T3 and T4 - hot nodules are rarely malignant
Dec aldosterone causing hyponatremia which can lead to seizures

49. What vasodilators use the cGMP pathway
Ketone bodies
ANP - NO and EDRF
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K

50. What is the rule of 10s in pheochromocytoma
DM1 = severe - DM2 = mild to moderate
Transcellular shif from dec insulin
10% malignant - 10% bilateral - 10% extra - adrenal - 10% calcify - 10% kids - 10% familial
Prolactin and GH