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Endocrine 2
| Question | Answer |
|---|---|
| Autoimmune disorder resulting in hypothyroidism. Autoimmune disorder resulting in hyperthyroidism | Hashimoto, Graves |
| Painful thyroid | Subacute thyroiditis, Graves, |
| Painless thyroid | Hashimoto, Riedel's thyroiditis, Lymphocytic subacute thyroiditis |
| Fixed, hard, painless goiter. what is it? cause? presents as hypo/hyperthyroidism | Riedel's thyroiditis. Caused by thyroid tissue being replaced by fibrous tissue |
| Multinodular goiter is caused by ____. What does it cause release of? | Iodine deprivation followed by iodine restoration. Causes release of T3, T4 |
| Hypothyroidism causes and increase/decrease in cholesterol? If its a primary hypothyroidism, will TSH be high or low? | increase cholesterol. TSH will be high |
| What are Hurthle cells? What disease is associated with them? | Epithelial cells with eosinophilic granules. Associated with hashiomoto's disease |
| What other diseases are associated with Hashimoto's hypothyroidism? | Pernicious anemia, DMM, Sjogrens, |
| Antibodies against Hashimotos? HLA markers? | Anti I-,TSH, thyroglobulin, microsomal. DR5, B5 |
| Lymphoid infiltration with germinal center formation/atrophy follicles | Hashimoto's |
| Autoimmune disorder with hypothyroidism. Slow course that may have thyrotoxicosis due to follicular rupture. | Hashimoto |
| Self-limited hypothyroidism often following flu-like illness. Elevated ESR, jaw pain, early inflammation, tender thyroid. Can be hyperthyroid early in course. | Subacute thyroiditis. de Quervains |
| Granulomatous inflammation in thyroid. | Subacute thyroiditis. de Quervain's |
| Thyroid replaced by fibrous tissue (hypothyroid). Presents with fixed, hard, painless goiter | riedel's thyroiditis |
| HLA and antibodies associated with Grave's | DR3, B8, Anti TSH/TSHr atnibodies |
| Opthalmopathy, pretibial myxedema, diffuse goiter. Presents during stress (eg ___) | Grave's. Childbirth. |
| TSH antibodies to Grave's are what type of antibody. What type of hypersensitivty is presetn? | II; IgG |
| How is death caused in Grave's/hyperthyroidism? | Stress-induced catecholamine surge leading to death by arrythmia. |
| Glandular hyperplasia with papillary infoldings, scalloped colloid, lymphocytic infiltrate | grave's |
| Rule of 10s for pheochromoctyoma | malignant, calcified, bilateral, kids, familial, extra-adrenal |
| Jod-Basedow phenomenon | Thyrotoxicosis if a patient with iodine deficiency gioter is made iodide replete |
| Thyroid cancer:Most common, excellent prognosis, ground glass nuclei (orphan annie), psammoma bodies, nuclear grooves. What puts you at an increased risk? | Papillary carcinoma of the thyroid. risk with childhood iradiation |
| Thyroid cancer:good prognosis, uniform follicles | Follicular carcinoma |
| Thyroid cancer:parafollicular "C" cells; produce calcitonin, sheets of amyloid stroma. Associated with what diseases? | Medullary carcinoma. MEN types 2A/B |
| Thyroid cancer:older patients, poor prognosis | Undifferentiated/anaplastic |
| Thyroid cancer: associated with hashimoto's hypothyroidism | Lymphoma |
| Nodular goiter, hyperthyroidism, no exopthalmos | Plummer disease |
| Fetal hypothyroidism. What causes it? | Cretinism. Endemic (lack of iodine), sporadic (deffect in T4 formation/development of thyroid) |
| Cretinism presentation | pot-bellied, pale, puffy-faced child, with protruding umbilicus and tongue |
| Acromegaly presentation | large tongue with deep furrows, deep voice, large hands/feet, coarse facial features, impaired glucose tolerance, |
| Treatment for increased GH | pituitary adenoma resection/octreotide administration |
| Diagnosis of acromegaly/gigantism | Increased IGF-I; failure to suppress serum GH following oral glucose test |
| Hyperparathyroidism is usually caused by ____ | adenoma |
| Hyperparathyroidism Symptoms | "Stones, bones, groans": hypercalcemia, hypercalciuria (renal stones), hypophosphatemia. may present with wiakenss, constipation, osteitis fibrosa cystica |
| Increased PTH, alkaline phosphatase, increased cAMP in urine | hyperparathyroidism |
| What is osteitis fibrosa cystica (aka ____). What is it caused by? | von Recklinghousen's syndrome = cystic bone spaces filled with brown fibrous tissue (bone pain). (hyperPTh --> osteoclastic activity) |
| Renal osteodystrophy | Bone lesions due to secodnary hyperparathyroidsim (renal disease) |
| Secondary hyperparathyroidism is caused by | decreased Calcium absorption in gut and increased phosphorous; most often due to chronic renal disease and failure to produce vitamine D. will have increased alakline phosphatase, hyperphosphatemia, hypocalcemia |
| Causes of hypoparathyroidism | accidental surgical excision, autoimmune destruction, DiGeorge syndrome. |
| Findings in hypoparathyroidism | hypocalcemia, tetany |
| what is Chvostek's sign? when is it used? | Hypoparathyroidism; tapping of facial nerve--> contraction of facial muscles (tetany) |
| Trousseau's sign? when is it used? | Hypoparathyroidism; occlusion of brachial artery with BP cuff --> carpal spasm (tetany) |
| Autosomal-dominant kidney unresponsibe to PTH. Presents with | pseudohypoparathyroidism; presents with hypocalcemia, shortened 4/5th digits, short stature. |
| Pseudohypoparathyroidism is due to what gene defect? | GNASE1 = g protein that emdiates tissue response to hormones; only mom allele expressed (Father imprinted) |
| Hypercalcemia causes | CHIMPANZEE = calcium ingestion (milk-alkali syndrome), Hyperparathyroid, Hyperthyroid, Iastrogenic (thiazides), Multiple myeloma, Paget's disease, Addison's disease, Neoplasm, Zollinger Ellison, Excess vitamin D, Excess vitamin A, Sarcoidosis |
| What hormones are unopposed during insulin absence? | GH, epinephrin (exacerbate hyperglycemia) |
| Diabetes HLA for type 1 | HLA DR3, DR5 = type 1 |
| Beta cells with amyloid deposits- 1 or 2? | 2 |
| Anatomic changes in type 1 | insulitis = lymphocytic infiltration |
| Anatomic changes in type 2 | focal islet fibrosis, hyalinization (amyloid deposits) |
| Osmotic damage in diabetes causes what two problems? | 1. neuropathy, 2. Cataracts (sorbital accumulation) |
| Hyperglycemia in ketoacidosis in DKA | decreased glucose uptake, decreased glycogenolysis, increased aa, increased FFA, ketoacids |
| Hypotension in DKA | High blood glucose --> osmotic diuretic |
| Metabolic acidosis in DKA | overproduction of keto acids |
| Ketoacidosis in DKA | increased catabolism of fat |
| What are secondary causes of DMM2? | Pancreatic disease (hereditary hemochromatosis -bronze diabetes, pancreatitis, pancreatic carcinoma), Cushing syndrome, acromegaly, Pheyochromocytoma) |
| 5 changes of kidney in diabetes | increased width of glomerula BM, glomerulosclerosis (kmmelsteil-wilson disease), pyelonephritis with renal papillary necrosis |
| Armannin-Ebstein lesion what is it? when does it happen? | tubular deposition of glycogen (diabetes) |
| What is the Whipple triad? | Episodic hyperinsulinoma, hypoglycemia, CNS dysfunction, reversal of CNS with insulin (think insulinoma) |
| Gastrinoma: what disease is it associated with? | Zollinger ellis |
| VIPoma- what is it? | (vasoactive intestinal peptide: Pancreatic cholera (WDHA) watery diarrhea, hypokalemia, achloryida |
| What is MODY? | Autosomal dominant; no loss of Beta cells, mild hyperglycemia. Single gene defect |
| Intense thirst, polyuria, with inability to concentrate urine | Diabetes insipidus (ADH isn't working) |
| What are the 2 causes of diabetes insipidus | Central: pituitary tumor, trauma, surgery; Nephrogenic: lack of renal response: secondary to hypercalcemia, lithium, demeclocycline) |
| Tests for ADH problems | Water deprivation test; no increase in urine osmolarity |
| Response to desmopressin indicates that ___ diabetes insipidue is occuring | central |
| Treatment for central DI | intranasal desmopressin |
| Treatment for nephrogenic DI | hydrochlorthiazide, indomethicin, amiloride |
| SIADH triad | 1. excessive water retention, hyponatriemia, urine osmolarity> serum concentration |
| What happens in hyponatremia? | seizures (correct slowly) |
| Treatment for SIADH | demeclocycline/H20 restriction |
| Causes of SIADH (4) | 1. ectopic ADH (small cell lung cancer), CNS disorders, pulmonary disease, Drugs (cyclophosphamide) |
| what are carcinoid tumors? where are they found? what do they produce? | neuroendocrine cells that usuall smallw bowel, secrete 5HT. (5HT not seen if tumor is in GI since 5HT is easily degraded). |
| symptoms of carcinoid | Diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease |
| Most common tumor of appendix | Carcinoid syndrome |
| Diagnosis of carcinoid syndrome | 5-H1AA in urine |
| rule of 1/3 for carcinoid syndrome | 1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 multiple |
| Treatment for carcinoid | octreotide |
| Gastrin secreting tumor of ___ or ____ | pancreas/duodenum; Zollinger-Ellison |
| Zollinger ellison secretes ___ and causes ____. Maybe associatd with what disease? | gastrin, recurrent ulcers. associated with MEN1a |
Created by:
ddecampo
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