First Aid Q&A: Endocrine (Pharm heavy)
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| What is the mechanism of goiter formation in Grave's disease? | TSH receptor stimulation by thyroid stimulating immunoglobulins (TSI's) leads to glandular hyperplasia and enlargement
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| What other autoimmune diseases are associated with Grave's disease? | pernicious anemia and DM type I
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| Idiopathic replacement of thyroid and surrounding tissue with fibrous tissue resulting in dysphagia, stridor, dyspnea, and hypothyroidism. Diagnosis? | Riedel's thyroiditis
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| Are thyroid adenomas usually solitary nodules or multiple nodules and are they hyperfunctioning or nonfunctional? | Usually solitary nonfunctional nodules
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| What is a struma ovarii? | Ovarian teratoma which is capable of producing thyroid hormone
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| Diarrhea, weight loss, and hyperglycemia that does not respond to oral hypoglycemic agents. Also painful, pruritic erythematous papules that blister, erode, and crust over noted around mouth. Diagnosis? | Glucagonoma; associated with necrolytic migratory erythema (skin rash)
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| Hypersecretion of T4 from ectopic gland can result in what menstrual abnormalities? | amenorrhea and oligomenorrhea
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| Accumulations of mesangial matrix in glomeruli. | Kimmelstiel-Wilson nodules; often accompanied by increased basement membrane thickness
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| These sensory receptors are responsible for transducing vibratory, pressure, and tension sensation. | Pacinian corpuscles
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| Sensory receptors are responsible for conveying sensation of light touch. | Meissner's corpuscles
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| Type 2 diabetic complains of vomiting, headache, dizziness, blurry vision, difficulty breathing after attending a cocktail party. Skin is notably flushed. What is the likely medication which caused these symptoms? | Diabetic med that causes Disulfiram-like reaction; First generation sulfonylurea (Tolbutamide, chlorpropamide)
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| What is the blood supply for the pancreas? | Superior pancreaticoduodenal arteries are supplied by gastroduodenal artery off celiac trunk; Inferior pancreaticoduodenal arteries are supplied by superior mesenteric artery
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| What is the treatment for acromegaly? | Octreotide; somatostatin analog that acts anterior pituitary to suppress GH secretion
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| What is the treatment for BPH? | Finasteride; 5alpha reductase inhibitor which suppresses conversion of testosterone to dihydrotestosterone
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| What is the drug used to treat infertility, prostate cancer, and uterine fibroids? | Leuprolide; GnRH analog
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| What is somatrem? | somatotropin, or growth hormone analog
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| What is the effect of hypoglycemia on GH? | GH is critical in stress response and acts to decrease glucose uptake by cells and increase lipolysis to raise blood sugar.
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| What is the mode of inheritance of pseudohypoparathyroidism? | Autosomal dominant with genetic imprinting; maternal is associated with renal involvement whereas paternal is usually just skeletal abnormalities with a PTH responsive kidney
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| What is the mechanism of action of insulin? | insulin binds receptor, receptor autophosphorylates, generation of tyrosine kinase which participates in intracellular signaling cascade
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| This DM drug decreases hydrolysis and absorption of disaccharides and polysaccharides at the intestinal brush border. | Acarbose; alpha glucosidase inhibitor (SE's include cramps, diarrhea, and flatulence)
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| DM drugs that act via stimulation of insulin secretion by the pancreas. | Sulfonylureas (chlorpropamide, tolbutamide, glipizide, glyburide, glimepiride)
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| DM drugs that sensitize peripheral tissues to insulin. | Glitazones (SE hepatotoxic)
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| Defect in fibroblast growth factor receptor 3 results in this condition. | Achondroplasia; short limbs with normal sized head and trunk
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| Defective dihydrotestosterone receptor results in men affected by this syndrome. | Testicular feminization syndrome (XY appearing female)
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| Into what veins do the adrenal glands drain? | Right adrenal --> IVC; Left adrenal --> left renal vein
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| 34 yro african american female presents with cramps that worsen during menstrual cycle, with periods lasting longer than 7 days. Ultrasound shows multiple masses on patients uterus. Diagnosis? | Leiomyoma or fibroids
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| Hyperfunctioning nodular goiter causing hyperthyroidism. Diagnosis? | Plummer's disease
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| A tan man with diabetes. Diagnosis? | Hemochromatosis; micronodular pigment cirrhosis leading to diabetes, hemosiderin deposition leading to skin pigmentation
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| What is the inheritance pattern for MEN? | Autosomal dominant
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| Patient being treated for hypothyroidism complains of sore throat, rashes, metallic taste in mouth, and ulcerations of mucous membranes. What is the drug causing these symptoms? | Oral iodide
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| This hyperthyroid drug inhibits peroxidase. | propylthiouracil
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| Why would a diabetic patient being treated for hypertension be at increased risk for hypoglycemia? | Because the response to hypoglycemia (tachycardia, diaphoresis, tremor, and anxiety) is mediated by sympathetic tone. If the patient is on a beta blocker for HTN, then these symptoms may be masked.
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| What is the major side effect of metformin? | Lactic acidosis, an anion gap metabolic acidosis
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| Competitive inhibitor of testosterone used in the treatment of prostate carcinoma. | Flutamide
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| What HLA's are associated with DM type I? | HLA-DR3 and HLA-DR4
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| Demeclocycline and lithium can effect kidneys resulting in this condition. | Nephrogenic diabetes insipidus
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| What are the two first generation sulfonylureas? | Tolbutamide, chlorpropamide
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| What are the second generation sulfonylureas? | Glyburide, glimepiride, glipizide
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| What is the mechanism of action of sulfonylureas? | Close potassium channel to depolarize cell triggering insulin release via Calcium influx
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| What is believed to be the primary effect of metformin? | Decrease gluconeogenesis
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| What is the mechanism of action of acarbose? | inhibit intestinal brush border alpha-glucosidase
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| This drug inhibits pancreatic lipase. | Orlistat
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| Sympathomimetic serotonin and norepinephrine reuptake inhibitor used to treat obesity. | Sibutramine
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| This drug inhibits organification and coupling of thyroid hormone synthesis. | Propylthiouracil
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