Term
| T or f: Polypeptides are digested when taken orally and steroids are absorbed. |
|
Definition
|
|
Term
| The body controls _________ with water, and _____ with salt. |
|
Definition
|
|
Term
| With low vasopressin (______ _________) absence stimulation of V2 receptors causes polyuria of water. This should cause hypernatremia but stimulation of thirst keeps serum sodium near-normal. |
|
Definition
|
|
Term
| With high vasopressin (__________) increase stimulation of V2 receptors causes water retention. Thirst is NOT decreased so there is volume expansion and hyponatremia. The volume expansion causes sodium excretion, aggravating the hyponatremia. |
|
Definition
|
|
Term
| Damage of theOsmoreceptor System causes decreased AVP stimulation of the V2 receptors and produces ____. |
|
Definition
|
|
Term
| Osmoreceptor controls _________ and is more important physiologically. |
|
Definition
|
|
Term
| Thirst is stimulated at ________ osmolality and is not turned off at ______ osmolal. |
|
Definition
|
|
Term
| What is the differential of DI? |
|
Definition
| Polyuria of hypotonic urine and polydipsia. |
|
|
Term
| T or F: DI can be caused by excess intake such as from primary polydup, dipsogenic DI, iatrogen admin of fluids. |
|
Definition
|
|
Term
| In people with abnormal auto rece gene for AVP why do they have DI? |
|
Definition
| Because mutant precursors gum up the ER where made |
|
|
Term
| In pregnancy ________ metab of vasopressin is normal, but can cause DI. |
|
Definition
| Increased; causing decerased Na and Osm |
|
|
Term
| Hereditary nephro DI ahs defective AVP receptor and congenital version has defective aquaporins, name gene transmission for each. |
|
Definition
| X-link rece, auto rece; all aquired version of nephro DI have bad aquaporins |
|
|
Term
|
Definition
| Water, ADH, chlorpropamide, thiazides |
|
|
Term
| Damage to what system causes increased AVP stim of V2 receptors cqausing water retention. |
|
Definition
|
|
Term
| What is the differ dx of SIADH? |
|
Definition
| Hyponature, with inappropriate natriuesis |
|
|
Term
| Genetic SIADH is due to what causes of abnormal syn of AVP? |
|
Definition
| Bronchogenic CA, other cancers |
|
|
Term
| T or f: SIADH due to consitutuively active V2 recptor |
|
Definition
|
|
Term
| Which of the following are treatments for hypo Na - fluid restriction, 3% saline, vasopressin antags. |
|
Definition
|
|
Term
| Therapy of hypo Na is whether acute or chronic which is greater or less than _______ hours. |
|
Definition
|
|
Term
| Osmotic demylination syndrome. |
|
Definition
| Pontine demylineation due to hypercorrection of hyponaturemia |
|
|
Term
| The hormones of the post pituit are made in the ______. |
|
Definition
| Hypothal - SO and PV nuclei |
|
|
Term
| Which of the following meds cause hyper prolactin - SSRI, phenothiazines, metoclopromide, TCA, H2 antags. |
|
Definition
|
|
Term
| What is the treatment of choice for hyperprolactin using dopamine? |
|
Definition
|
|
Term
| What is the treatment for acromegaly? |
|
Definition
| Transphenoid surgery first, dopamine and somato ags (octreotide which has side effects of ab discomfort, loose stools, nausea, gall stones) |
|
|
Term
|
Definition
|
|
Term
| What level of prolactin indicates a prolactinoma? |
|
Definition
|
|
Term
| How do you establish cortisol excess? |
|
Definition
| 24 urinary free cortisol over 250, and dexamethsone suppression test where cortisol doesn |
|
|
Term
| How does localizing the source of excess hormone in cushings via plasma ACTH work? |
|
Definition
| ACTH less than 5 its acth indep from adrenal source, greater than 10 is depend and is ectopic or pituit |
|
|
Term
| What is the treatment for cushings? |
|
Definition
| Transpehnoid surgery, if fails radio therapy, meds never primary |
|
|
Term
| Which of the following inhibit adrenal steroids - ketoconozole, metyrapone. |
|
Definition
|
|
Term
| Non-functioning pituitary adenomas arise from what cells and what is treatment? |
|
Definition
|
|
Term
| What is the diff btw auto dom MEN-1/2A/2B when describing genetic pituitary tumors? |
|
Definition
| MEN 1 - pancreas, pituit, parathy; MEN2A med thyroid carcinoma, pheochromo, para; MEN2b - med thyroid carcin, pheochromo |
|
|
Term
| What is the disease that is postpartum hypopituit disease due to infarct from obstetric hemorrhage? |
|
Definition
|
|
Term
| In association with pregger lymphocytic invasion of pituitcytes and detruction of cells. |
|
Definition
|
|
Term
| Name disease auto dom with GnRH defici, anosmia, eunuchoidal body with long arms and legs. |
|
Definition
|
|
Term
| How do you asses pituitary function of GH and Cortisol? |
|
Definition
|
|
Term
| What is the diff btw acute and subacute thyroiditis? |
|
Definition
| Suppurative thyroiditis: very rare, caused by bacteria or fungi; Subacute Thyroiditis -non-suppurative, granulomatous, giant cell, pseudotuberculous, de Quervain |
|
|
Term
|
Definition
| chronic sclerosing thyroiditis. It leads to complete destruction of the thyroid gland and also involves the surrounding neck tissues by a progressive proliferating fibrosis. |
|
|
Term
| Describe diffuse hyperplasia of the thyroid. |
|
Definition
| Diffuse hyperplasia is the common underlying lesion of thyrotoxicosis, Graves |
|
|
Term
|
Definition
| Nodular hyperplasia may also be |
|
|
Term
| Name this malignant thyroid carcinoma - 60-70% of thyroid carcinomas. Radiation exposure to the neck is a known etiologic factor. Solitary cold nodule. Locally invasive and may be multicentric. Papillary pattern variable in extent (0-100%), remainder follicular. Even with mixed pattern |
|
Definition
|
|
Term
| Low-grade lesions have same histologic patterns as follicular adenoma, but demonstrate capsular and/or vascular invasion. Higher grade lesions incompletely encapsulated or diffusely invasive. Lymph nodal metastasis much less common than with papillary carcinoma. Blood borne metastasis to lungs and bone most frequent. |
|
Definition
|
|
Term
| Name this malignant thyroid carcinoma - derived from parafollicular C-cells, A neuro-endocrine tumor capable of producing calcitonin and ACTH. rather solid, trabecular or islet patterns. Frequently produces stromal amyloid. Metastasis to the regional lymph modes occurs early in the course of the disease. |
|
Definition
|
|
Term
| How do you assess thyroid function with what tset? |
|
Definition
|
|
Term
| Name three conditions which affect the whole thyuroid and 3 that are localized. |
|
Definition
| Graves, hashi, subacute thyroid; solitary nodule, multiple, toxic nuodule |
|
|
Term
| In what tissues does D1 deoiodinase and D2 live? |
|
Definition
| D1 is thyroid, lung and kidney, D2 is thyroid, skeletal/cardiac |
|
|
Term
| Where does D3 that inactivates thyroxine live? |
|
Definition
| Placenta, skin , brain, liver |
|
|
Term
| In what disease are anti-TPO and anti-TSHr found? |
|
Definition
|
|
Term
| T or f, Hypothyroidism and TSH increase with age. |
|
Definition
|
|
Term
| Why would you increase or decrease levothyroxine treatment? |
|
Definition
| Up - pregnant, poor absorp, up clearance; down - old, weight loss, androgen use |
|
|
Term
| Treatment for graves is drugs for mild, if no work then radio is Tx of choice, then surgery - list two drugs used. |
|
Definition
| Methimazole is DOC and Propylthiouracil is second with liver toxic |
|
|
Term
| T or f, Beta-blockers are used only for symptomatic relief of thyrotoxicoses. |
|
Definition
|
|
Term
| What are the contraindic for radioiodine for graves? |
|
Definition
| Preggers, worsens eye disease |
|
|
Term
| Low iodine uptake is characterisitic of _________? |
|
Definition
| Thyroiditis - hasi, sporadic, post-partum |
|
|
Term
| What are the treatment options for a non-toxic multinodular goiter? |
|
Definition
| Surgery first, radioiodine with recombinant TSH |
|
|
Term
| 90% of nodules are hypofuncitoning and need to be aspirated. |
|
Definition
|
|
Term
| Thryroid nodules increase with age and female, and with thry function test showing low TSH suggests a _____ nodule, and high TSH suggests __________. |
|
Definition
|
|
Term
| Define which list of features is a malignant or benign thyroid nodule from ultrasound. 1 - hypoechogenic, no halo sign, irregular margins, microcalcifications. 2. - anecho or hyperecho, uniform, thin halo, regular margins, egg-shell calcifications. |
|
Definition
|
|
Term
| Thyroid incedentalomas should be watched for what 3 things? |
|
Definition
| Microcalicifications, >1.5cm, irregular capsule or flow |
|
|
Term
| Sudden growths found in thyroid are most likely cysts or _______ ________ nodules. |
|
Definition
|
|
Term
| T or f, Most hot nodules in thyroid are benign and need to be aspirated and treated with radioiodine. |
|
Definition
| False, no aspiration needed. |
|
|
Term
| What are the two ways to monitor thyroid cancer? |
|
Definition
| Serum Tg after normal cells ablated, and whole body iodine scan with stimulated TSH because cancer concentrates iodine poorly |
|
|
Term
| What two hormones are created from the POMC gene? |
|
Definition
|
|
Term
| Cortisol has marked circadian rythyms and what are its affects. |
|
Definition
| Carb/lipid metab and catab, bone reformation, up vascular tone, down immune, down GH/thyroid |
|
|
Term
| Excess licorice prevents conversion of what hormone to its inactive state via 11b-HSD2? |
|
Definition
| Cortisol->cortisone, and cortisol binds mineralocorticoid and gluco receptor |
|
|
Term
| What happens to men and women with excessive adrenal androgen precursors? |
|
Definition
| Men - nothing, women- hirsuitism, acne, virilization |
|
|
Term
| Diff btw primary, seconday, gluco withdrawal adrenal insuff. |
|
Definition
| Primary is adrenal destruction, second is acth insuff due to pituit, gluco is from ACTH suppression due to exogenous glucose |
|
|
Term
| What is the cosyntropin test used for? |
|
Definition
| Test adrenal insufficiency in morning with syn ACTH and measure cortisol response to R/O primary or secondary causes if prolonged ACTH suppression |
|
|
Term
| If aldosterone is low how do you check body response? |
|
Definition
| Cosyntropin or salt restriction for 3-5 days |
|
|
Term
| If testing ACTH when should you perform any necessary gluco therapy? |
|
Definition
| Draw labs before therapy or 24 hours after therapy |
|
|
Term
| T or f, Cortisol rises during surgery, sepsis. |
|
Definition
|
|
Term
| What is the treatment of adrenal crisis (injury with adrenal insufficiency) that causes hypotension, shock, acidosis, hyponatremia. |
|
Definition
| Labs, fluids, hydrocortisone, test for insufficiency insufficiency |
|
|
Term
| What two drugs are therapy for primary insufficiency? |
|
Definition
| Hydrocortisone for glucose and fludrocortisone for mineralos, |
|
|
Term
| What are these changes acharacterisitc of - change in weight, poor sleep, depression, fatigue, decreased libido? |
|
Definition
|
|
Term
| Name 4 of types of cushings etiologies. |
|
Definition
| ACTH-dep pituitary tumor, ACTH-indep adrenal adenoma, small cell carcinoma ups ACTH, pancreatic ups CRH |
|
|
Term
| What are some causes of pseudo-cushings? |
|
Definition
| Obesity, alcohol, depression, stress, preggers, anorexia |
|
|
Term
| How do you diagnose hypercortisolism? |
|
Definition
| Urinary free cortisol (measures free not bound) and Overnight dexamethasone (gluco) treatment should cause a drop in cortisol in morning |
|
|
Term
| Why does a midnight cortisol test differ for cushings and pseudo cushings patients? |
|
Definition
| Cushings patients lack diurnal coritsol variation, while psuedos still havbe it. |
|
|
Term
| Low and high dose dexamethasone will suppress cortisol in what two types of cushings? |
|
Definition
| Pseudo and ACTH-dep pituit |
|
|
Term
| What types of drugs can you use for cortisol excess starting with best? |
|
Definition
| Mifeprestone, metyrapone, mitotane |
|
|
Term
| Why is a inferior petrosal sinus sampling done? |
|
Definition
| To confirm pituitary source of ACTH |
|
|
Term
| What is the difference in origfin of primary or secondary hyp-eraldosteronism? |
|
Definition
| Primary is from adenomas or hyhperplasia, secondary is due to rennin system and may or may not have hypertension and hypokalemia |
|
|
Term
| What is the workup for mineralo excess? |
|
Definition
| Test K, if low then test aldos and rennin; after diag, use CT to determine if primary adenoma (surgical treat) or hyperplasia (med treat) |
|
|
Term
|
Definition
| Hypersecretion of catecholamines most of which are in adenomas in the adrenal medulla or ectopic tumors in mediastinum or abdomen; findings are hypertension, variations in blood pressure, flushing axiety, headache, palpitations and sweating |
|
|
Term
| Plasma free metaneprhine or clonidine suppresion tests for what disease? |
|
Definition
| Pheochromocytoma, because meta is metab of catechole |
|
|
Term
| What is the treatment for pheocromocytoma? |
|
Definition
| Surgery, plus alpha and B antags prior to suregery (phenooxybenzamie is a tyrosine ihibi) |
|
|
Term
| What are the criteria for fasting glucose and 2 hour oral glucose test for DM? |
|
Definition
| >125 on two occasions, or >200 |
|
|
Term
| T or f, All type 1 DM is immune mediated. |
|
Definition
| Flase, type 1 B is non-immune based |
|
|
Term
| What are the genetic risk factors for T1DM? |
|
Definition
| Not dom or recessive, 50% of genes on short arm chrom 6 of MHC called IDDM1, MHC2 DR3 and DR4 and DQ genes high risk |
|
|
Term
| T or f, Most cases of T1DM are familial. |
|
Definition
| F, most are sporadic with 10-15% having familial link, auto immune links, immunological and environmental trigger are part of it |
|
|
Term
| T1DM have immunological markers like autoantibodies until islet cells gone, what else is deficient in these patients? |
|
Definition
| Amylin that is cosecreted with insulin |
|
|
Term
| What is the genetic and famlial link of T2DM? |
|
Definition
| genetic is uncertain and multifactorial, familial is direct concordance and increased risk |
|
|
Term
| High fat foods reduce expression of what sensor in beta cells? |
|
Definition
|
|
Term
| Deficiency in incretin, gut peptides GIP and GLP-1 are more prevalent in what disease? |
|
Definition
| T2DM, they increase beta cell productivity from oral glucose ingestion |
|
|
Term
| Normal preggers has increased insulin resist but which passes the placenta glucose or insulin? |
|
Definition
| Glucose, not insulin - can contribute to fetal hyperinsulinism |
|
|
Term
| What can prevent T1DM and T2DM? |
|
Definition
|
|
Term
| What are the two most serious complication of diabetes? |
|
Definition
| Diabetic ketoacidosis and hyperglycemic hyperosmolas state most commonly precitptated by infection or lack of insulin |
|
|
Term
| What is the key difference btw DKA and HHS in timing, history, and exam. |
|
Definition
| DKA - rapid, vomiting ab pain, kussmaul respirations; HHS - over weeks, drowsiness, confusion, lethargy |
|
|
Term
| What is the patho or diabetic retino? |
|
Definition
| Accum or sorbitol, glycosylation end products, impaired autoregulatino of blood flow, leading to vascular leak, ischemia, and VEGF induced neovascularization |
|
|
Term
| What is the difference between non-proliferative and prolif diabetic retino? |
|
Definition
| Non-prolifer appears late in first decade of disease and has cotton wool spots and microanuerysms, Prolifer has leaky neovascularization due to hypoxia resulting in fibrosis and retinal detachment |
|
|
Term
| The patho of end stage renal disease is caused by soluble factors (growth, angio2), changes in microcirculation, structural changes in the glomer, all caused by what? |
|
Definition
|
|
Term
| What is the screening for diabetic nephropathy? |
|
Definition
| Albuminuria 30-300 and GFR via creatininie |
|
|
Term
| T or f, Mesangial expansion and glomer sclerosing can be seen in nephropathy. |
|
Definition
|
|
Term
| What is the patho of diab neuro? |
|
Definition
| Accumulation of glycol end products and sorbitol, as well as increased oxidative stress |
|
|
Term
| Autonomic neuropathy from diabetes can affect what organs? |
|
Definition
|
|
Term
| T or f, Risk of CHD and poor hemostasis increases before diabetes DX is establied. |
|
Definition
|
|
Term
| T or f, In patients with CAD, tight glycemic control decreases macrovascular outcomes. |
|
Definition
| Flase, no correlation; however, statins help reduce CAD in diabetics |
|
|
