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Endocrine

Pathology: Endocrine

QuestionAnswer
1. Most common hormone secreted by pituitary adenoma 2. Central diabetes insipidus vs Nephrogenic diabetes insipidus 1. prolactin 2. ADH deficiency vs impaired renal response to ADH
1. Poor lactation, loss of pubic hair and fatigue following pregnancy. 2. What is the pathologenesis of this disorder? 1. Sheehan syndrome 2. pituitary doubles in size during pregnancy, but blood supply does not → infarction
Treatment of: 1. central diabetes insipidus 2. prolactinoma 1. desmopressin (ADH analog) 2. bromocriptine (dopamine agonist)
Drug related to: 1. SIADH 2. Nephrogenic diabetes insipidus 1. Cyclophosphamide 2. Lithium
What is responsible for the following findings in hyperthyroidism? 1. increased basal metabolic rate 2. increased sympathetic nervous system activity 3. hypocholesterolemia 4. finger clubbing 1. increased synthesis of Na+-K+ ATPase 2. increased expression of β1 adrenergic receptors 3. increased LDL receptor synthesis 4. (acropachy) subperiosteal new bone formation
Which type of hypersensitivity reaction: 1. Graves disease 2. Type 1 diabetes 1. type II - autoantibody stimulates TSH receptor 2. type IV
What is the cause of exophthalmos and pretibial myxedema seen in Graves disease? 1. TSH binds fibroblast TSH receptors → glycosaminoglycans buildup 2. immune reaction → inflammation, edema, and fibrosis
What are the lab levels of T4 and TSH in: 1. primary hypothyroidism 2. secondary hypothyroidism 3. hyperthyroidism 1. ↓ T4, ↑ TSH (thyroid gland problem) 2. ↓ T4, ↓ TSH (pituitary problem) 3. ↑ T4, ↓ TSH
Patient with long-standing Hashimoto thyroiditis now presents with an enlarging thyroid. What is the most likely diagnosis? B-cell (marginal zone) lymphoma
Hypothyroidism in: 1. neonates and infants 2. children or adults 1. Cretinism 2. Myxedema
Patient with hyperthyroidism, tender thyroid following a viral infection. What is the cause of thyrotoxicosis? Subacute (De Quervain) Thyroiditis. increased T4 release after gland destruction
What is the most likely diagnosis when investigating a thyroid nodule with radioactive iodine uptake: 1. Increased uptake 2. Decreased uptake 1. Graves disease or nodular goiter 2. Adenoma and carcinoma
1. Genetic mutation associated with multiple endocrine neoplasia 2. 1. What is the outcome of a water deprivation test administered to a patient with diabetes insipidus? 1. RET oncogene 2. no increase in urine osmolality
Pathogenesis of renal osteodystrophy 1. kidney failure → ↓ phosphate secretion and ↓ vitamin D activation 2. ↑ phosphate binds free calcium → ↓ ionized calcium 3. ↓ free calcium stimulates PTH secretion 4. ↑ PTH leads to bone resorption
1. ↑ serum PTH, ↑ serum calcium, ↓ serum phosphate. Diagnosis? 2. Most likely cause? 1. Primary hyperparathyroidism 2. Parathyroid adenoma
1. Trousseau sign 2. Chvostek sign 1. hand spasm after inflation of BP cuff during hypocalcemia 2. contraction of facial muscle after tapping on masseter during hypocalcemia
1. What is the differential for: ↑ serum PTH, ↓ serum calcium, ↑ serum phosphate 2. What is the most likely cause of each differential? 1. Secondary hyperparathyroidism - chronic renal failure 2. pseudohypoparathyroidism - defective Gs protein at PTH receptor
Which major histocompatability complex is associated with: 1. Type 1 diabetes 2. Hashimoto thyroiditis 1. HLA-DR3 and HLA-DR4 2. HLA-DR5
Why are ketones absent in type 2 diabetes mellitus insulin is present in DM2 (as opposed to DM1) and counteracts glucagon mediated lipolysis
1. Abdominal mass with episodic hypoglycemia and mental status changes 2. What is a gastrinoma? 3. Where is gastrin produced? 1. insulinoma 2. tumor secreting excess gastrin 3. G cells in the antrum of the stomach, duodenum, and the pancreas
What is the pathogenesis of diabetic retinopathy? 1. pericytes lining retinal blood vessels take up glucose and incur osmotic damage 2. pericytes die and blood vessels weaken leading to aneurysm, hemorrhage and blindness
1. Most common cause of primary hyperaldosteronism (Conn's syndrome) 2. Common cause of secondary hyperaldosteronism 1. adrenal adenoma 2. renovascular hypertension leading to activation of RAAS (e.g. fibromuscular dysplasia)
1. In congential adrenal hyperplasia (CAH), what is the cause of adrenal hyperplasia? 2. Most common cause of CAH? 1. increased ACTH secretion 2. 21-hydroxylase deficiency
Which adrenal cortex hormones are able to be produced in the following enzyme deficiencies: 1. 21-hydroxylase 2. 17-hydroxylase 3. 11-hydroxylase 1. sex steroids 2. mineralocorticoids 3. sex steroids and a metabolite with mineralocorticoid activity
Which mineralocorticoid like metabolite is produced in 11-hydroxylase deficiency? 11-deoxycorticosterone
Exacerbation of hypotension is children with N meningitidis infection Waterhouse-Friderichsen syndrome - hemorrhagic necrosis of adrenal glands due to DIC from N meningitidis - leads to lack of cortisol
1. What is the cause of Addison disease? 2. Embryologic origin of adrenal medulla 1. progressive autoimmune destruction of the adrenal glands 2. neural crest
1. Anosmia and hypogonadism 2. What is the defect? 1. Kallmann syndrome 2. Failure of GnRH neurons to migrate from the olfactory placode to the hypothalamus; failure of olfactory bulb to form
1. Embryologic origin of the majority of pineal gland tumors 2. Craniopharyngioma is derived from: 1. germ cell (germinoma) 2. Rathke's pouch remnants
What are the symptoms of a prolactinoma and why are these symptoms seen? 1. galactorrhea (overproduction of breast milk) 2. inhibition of ovulation and spermatogenesis by inhibiting GnRH
1. usual cause of death from acromegaly 2. Best screening test for thyroid dysfunction 1. cardiomyopathy 2. TSH
How does estrogen increase serum T4 but there is no thyrotoxicosis? 1. estrogen ↑ thyroid binding globulin (TBG) 2. free T4 (FT4) binds TBG and the thyroid replaces FT4 3. total T4 (bound and free) is ↑ but FT4 remains normal
Extensive fibrosis of the thyroid gland presenting as a 'hard as wood'gland in young female. Reidel fibrosing thyroiditis
Autoimmune thyroiditis that develops post partum Subacute painless lymphocytic thyroiditis
1. How does growth hormone excess lead to hyperglycemia? 2. Thyroid neoplasm associated with empty-appearing nuclei (Orphan Annie nuclei) 1. GH increased gluconeogenesis 2. papillary adenocarcinoma
1. How is toxic multinodular goiter differentiated from Grave's disease on physical exam? 2. Why is this distinction seen? 1. lack exophthalmos and pretibial myxedema 2. while both have ↑ T4 therefore ↓ TSH, Grave's has autoantibody stimulation of fibroblast TSH receptors and inflammation
What are glucose and cholesterol levels in hypothyroidism 1. hypoglycemia (decreased glycogenolysis) 2. hypercholesterolemia (decreased LDL receptor synthesis)
What is the cause of a nontoxic goiter? ↓ thyroid hormone → ↑ TSH → hyperplasia/hypertrophy of gland
How does metabolic alkalosis effect free and total serum calcium and PTH? due to few H+ ions, the COOH group of albumin is mostly COO- and binds more ionized Ca2+ 1. free, ionized calcium decreased 2. total serum calcium normal 3. PTH increased
How does liver cirrhosis effect free and total serum calcium and PTH? liver cirrhosis leads to ↓ albumin production and less calcium binding 1. free, ionized calcium normal 2. total serum calcium decreased 3. PTH normal
What is DiGeorge's syndrome failure of descent of 3rd/4th pharyngeal pouches leading to absent thymus and parathyroid
1. cystic and hemorrhagic bone lesion seen with ↑ PTH 2. Why is metabolic acidosis seen with hyperparathyroidism? 1. osteitis fibrosa cystica (caused by ↑ osteoclast activity) 2. decreased proximal tubule reclamation of bicarbonate
How does sarcoidosis lead to hypercalcemia? macrophages in granulomas synthesize 1α-hydroxylase, causing hypervitaminosis D
How does respiratory/metabolic alkalosis lead to hypophosphatemia 1. ↑ intracellular pH activates phosphofructokinase 3. ↑ phosphate uptake into cells to create ATP 2. ↑ Glycolysis leads to phosphate consumption as glucose phosphorylation increases
1. Most common cause of hyperphosphatemia 2. What is the likely cause of ectopic Cushing syndrome? 1. renal failure 2. ACTH production by a small cell carcinoma
1. What disorder is the Metyrapone test used to diagnose? 2. What does it do? 1. adrenal insufficiency (Addison's disease) 2. blocks cortisol synthesis by inhibitng 11β-hydroxylase thus stimulating ACTH secretion by pituitary
What is the cause of weight gain in Cushing syndrome? 1. cortisol causes gluconeogenesis → hyperglycemia 2. insulin increases storage of fat in adipose
What is the cause of the following clinical findings in Cushing syndrome: 1. muscle weakness 2. purple abdominal striae 3. hirsutism 1. gluconeogenesis leads to breakdown of type II (fast twitch) muscles 2. cortisol weakens collagen, causing blood vessel rupture and stretch marks 3.↑ DHEA and androstenedione
Patient with palpitations, sweats, anxiety and headache. Pheochromocytoma (half have sustained or paroxysmal hypertension)
Most common tumor of the adrenal medulla 1. adults 2. children 1. pheochromocytoma 2. neuroblastoma
What urine epinephrine metabolites are used to diagnose pheochromocytoma and neuroblastoma? 1. vanillylmandelic acid (VMA) 2. homovanillic acid (HVA)
1. Which type of diabetes is hereditary and manifests when patients are < 25? 2. What is the inheritance patter? 1. Maturity onset diabetes of the young (MODY) 2. autosomal dominant
1. How does obesity effect insulin resistance? 2. Why are triglyceride levels high in type 2 DM? 3. Why are triglyceride levels high in type 1 DM? 1. increased adipose downregulates insulin receptor synthesis 2. hyperinsulinemia increases synthesis of VLDL 3. decreased insulin → ↓ action of lipoprotein lipase; fatty acids cannot be hydrolyzed off of VLDL
Pathogenesis for diabetic nodular glomerulosclerosis 1. hyaline arteriosclerosis of efferent arterioles ↑ GFR 2. leads to hyperfiltration damage to mesangium 3. ↑ deposition of type IV collagen
Mechanism for gestational diabetes most likely human placental lactogen (HPL), cortisol and progesterone have anti-insulin effects
1. Do newborns of mothers with gestational diabetes experience hypoglycemia or hyperglycemia? 2. How does respiratory distress syndrome occur following gestational diabetes? 1. hypoglycemia; high levels of insulin at birth drives glucose into hypoglycemic range 2. insulin inhibits fetal surfactant production
How does diabetic ketoacidosis (DKA) lead to hyperkalemia? 1. DKA is an increase in ketone bodies and lactic acid leading to metabolic acidosis 2. the body ↑ H+ uptake in exchange for K+ in attempt to raise pH 3. leads to hyperkalemia
For the clinical diagnosis of hypoglycemia, what triad of findings must be present? Whipple triad: 1. symptoms consistent with hypoglycemia 2. low plasma glucose concentration (<50mg/dL) 3. relief of symptoms after plasma glucose is normalized
What is postprandial (reactive) hypoglycemia? (postprandial means after a meal) exaggerated insulin secretion after a meal leading to transient hypoglycemia
What is required for a diagnosis of metabolic syndrome? Three of the following: 1. ↑ waist circumference 2. ↑ triglycerides 3. ↑ LDL 4. ↑ blood pressure 5. ↑ fasting glucose
What is the cause of hypotension seen in patients with Addison's disease? 1. ↓ cortisol → ↓ α1 receptors in vasculature 2. ↓ aldosterone → hypovolemia
Which type of acidosis is associated with hypoaldosteronism (Addison's disease)? Type IV renal tubular acidosis - ↓ aldosterone → ↑ K+ → inhibits NH3 secretion - NH3 combined with the H+ that is also not secreted (from ↓ aldosterone) - NH4+ accumulates → metabolic acidosis
What would glucose levels be expected to be in Congenital Adrenal Hyperplasia? ↓ cortisol → ↓ in gluconeogenesis and hypoglycemia
Cause for pathology in diabetes type 2 1. resistance of peripheral tissues to the action of insulin 2. peripheral neuropathy 3. cataracts 1. high free fatty acids 2. uptake of glucose by Schwann cells, conversion to sorbitol and osmotic injury 3. same as neuropathy but uptake of glucose by lens of eye
1. Most common cause of hypocalcemia? 2. Tetany with normal calcium level 1. hypoalbuminemia (cirrhosis, nephrosis, burns) 2. metabolic alkalosis or ↑ albumin
1. Which diuretic drug can cause hypercalcemia? 2. Which hypertensive drug can cause hypocalcemia? 1. thiazide 2. furosemide
What are some causes of hyperprolactinemia? 1. oral contraceptives 2. prolactinoma 3. hypothyroidism 4. breast feeding (suckling stimulus) 5. severing hypothalamic-hypophysial tract from injury (loss of dopamine connection)
How does Cushing's disease lead to hypertension? 1. ↑ ACTH → ↑cortisol and aldosterone 2. ↑ cortisol → ↑α1 adrenergic receptors in vasculature 3. ↑ aldosterone → Na and water retention
What is the effect of a dexamethasone suppression test on cortisol (low dose/high dose): 1. ACTH-producing pituitary adenoma 2. Ectopic ACTH-producing tumor 3. Adrenal adenoma (low/high) 1. no change/↓ cortisol 2. no change/no change 3. no change/no change
Why are sodium levels normal with hyperaldosteronism? 1. initially ↑ aldosterone leads to Na retention followed by ↑ osmolality 2. ADH release and water reabsorption to compensate 3. osmolality back to normal
Treatment for pheochromocytoma phenoxybenzamine, a nonselective α-blocker, followed by surgery to remove tumor
Which antibodies are present in Hashimoto's thyroiditis? antimirosomal and antithyroglobulin
Thyroid neoplasms: 1. proliferation of follicles surrounded by fibrous capsule 2. ↑ risk with childhood irradiation 3. proliferation of follicles with invasion through capsule 4. proliferation of parafollicular cells 1. follicular adenoma 2. papillary carcinoma 3. follicular carcinoma 4. medullary carcinoma (secrete calcitonin)
Thyroid neoplasms: 1. seen in elderly 2. amyloid tumor marker 3. associated with Hashimoto's thyroiditis 4. psamomma bodies 1. anaplastic carcinoma 2. medullary carcinoma 3. Lymphoma 4. papillary carcinoma
1. Primary hyperparathyroidism 2. Secondary hyperparathyroidism 1. parathyroid gland adenoma 2. ↓ Ca2+ → ↑PTH (most often from chronic renal disease → ↓ vitamin D activation)
Characteristics of MEN 1 3P's 1. Parathyroid tumor 2. Pancreatic tumor (gastrin) 3. Pituitary adenoma
Characteristics of MEN 2A MPM 1. Medullary carcinoma of thyroid 2. Pheochromocytoma 3. Parathyroid tumor
Characteristics of MEN 2B MPM 1. Medullary carcinoma of thyroid 2. Pheochromocytoma 3. Marfanoid habitus/Mucosal neuromas
Cardiovascular drug associated with hypothyroidism Amiodarone
How does SIADH effect sodium levels? ↑ ADH → hypervolemia → ↓ aldosterone and hyponatremia
How does ethanol lead to hypoglycemia? inhibition of gluconeogenesis during fasting
How do the following effect glucose levels: 1. Cortisol 2. Growth hormone 3. T4 1. ↑ gluconeogenesis 2. ↑ gluconeogenesis 3. ↑ glycogenolysis
Created by: amichael87