USMLE 1 Path Endo
Terms
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- (4)* functions of T3
-
4 Bs:
Brain maturation,
Bone growth,
Beta-adrenergic effects,
BMR increase -
what is the cause of increased cortisol w/ low ACTH
(aside from Cushings)? - Chronic steroid use
-
(2) steps of Dexamethasone test to determine cause of Increased cortisol
(3 causes) -
1. Give LOW dose
(result: Lower cortisol = Healthy)
(result: Higher cortisol = step 2)
2. Give HIGH dose
(result: Lower cortisol = ACTH-producing tumor)
(result: Higher cortisol = Cortisone producing tumor) -
Dx:
Low cortisol; High ACTH -
Primary Hypocortisol
(Addisons) -
Dx:
Low cortisol; Low ACTH -
Secondary Hypocortisol
(no ACTH; no skin pigmentation) -
Dx:
High cortisol; Low ACTH
(2) -
Primary Hypercortisol
(Cushings; chronic steroids) -
Dx:
High cortisol; High ACTH -
Secondary Hypercortisol
(Tumor) -
Dx:
HTN, hypoK, metabolic alkalosis, low plasma renin -
Primary Hyperaldosteronism
(Conn's syndrome) -
Dx:
HTN, hypoK, metabolic alkalosis, high plasma renin -
Secondary Hyperaldosteronism
(CRF, CHF, renal artery stenosis, cirrhosis; anything that stimulates venous pooling) -
Dx:
low aldosterone, low cortisol, hypotension, skin pigmentation, Adrenal Atrophy, Absence of hormones, All 3 cortical divisions affected -
Addison's Dz
(Primary Hypoaldosteronism and Hypocortisol) - MC tumor of the adrenal medulla in children
- Neuroblastoma
-
Dx:
elevated Pressure, HA Pain, Perspiration, Palpitations, Pallor - Pheochromocytoma
-
Dx:
kidney stones, stomach ulcers, pituitary tumor -
MEN I (Wermer's syndrome)
3P = Pancreas, Pituitary, Parathyroid -
Dx:
medullary CA of thyroid, pheochromocytoma, parathyroid tumor - MEN II - Sipple syndrome
-
Dx:
medullary CA of thyroid, pheochromocytoma, mucosal neuromas - MEN III
-
Dx:
Inc ESR, jaw pain, very tender thyroid; hypothyroidism following flu-like illness -
Subacute Thyroiditis
(de Quervain's Thyroiditis) - MC thyroid anomaly
- Thyroglossal duct cyst
-
Dx:
Increased TSH at thyroid - Goiter
- MCC of hypothyroidism
- Iodine deficiency
-
Dx:
child w/ potbelly, pale, puffy-faced, impaired growth, protruding umbilicus and tongue, mental retardation
what is deficient? -
Cretinism
(Iodine deficiency) -
Dx:
hyperthyroidism, nodular goiter, no exophthalamos - Plummer Dz
-
Dx:
hypothyroidism w/ massive infiltrates of lymphocytes in germinal center - Hashimoto thyroiditis
-
Dx:
previous radiation of neck, "ground-glass" nuclei in thyroid, psammoma bodies -
Papillary carcinoma of thyroid
(MC type of thyroid CA) -
Dx:
Increased Calcium; Decreased Phosphorus -
Primary Hyperparathyroidism
(Inc PTH) -
Dx:
Decreased Calcium; Decreased Phosphorus -
Secondary Hyperparathyroidism
(Dec Vit-D) -
Dx:
Decreased Calcium; Increased Phosphorus -
Primary Hypoparathyroidism
(Dec PTH) -
Dx:
Increased Calcium; Increased Phosphorus -
Secondary Hypoparathyroidism
(Inc Vit-D) -
Dx:
stones, bones (pain) and groans (constipation) - Primary Hyperparathyroidism
-
Definition:
cystic bone spaces filled w/ brown fibrous tissue as a result of the osteoclastic reabsorption in primary hyperparathyroidism
(2 names) -
Osteitis Fibrosa Cystica
(von Recklinghausen's syndrome) -
Definition:
bone lesions due to secondary hypoparathyroidism due to renal Dz - Renal Osteodystrophy
- (2) Physical exam signs of low calcium
-
tapping facial nerve -> contraction of facial muscles
(Chvostek's sign)
occlusion of Brachial artery w/ BP cuff -> carpal spasm
(Trousseau's sign) -
Dx:
Decreased Calcium, Increased Phosphorus, Increased PTH, shortened 4th/5th digits, short stature
what protein is deficient? -
Pseudohypoparathyroidism
(Dec Guanine Nucleotide BP) -
Dx:
kussmaul respirations, hyperthermia, N/V, Abd pain, psychosis, dehydration, fruity breath - Diabetic Ketoacidosis
-
Dx:
adrenal insufficiency due to hemorrhagic necrosis of adrenal cortex, assoc c/ DIC, due to Meningococcemia - Waterhouse-Friderichsen syndrome
-
Dx:
hyperinsulinemia and hypoglycenia, CNS dysfunction, reversal of CSN symptoms w/ glucose administration - Insulinoma
-
Dx:
hypresecretion of HCl in stomach, recurrent peptic ulcer Dz, hypergastrinemia - Zollinger-Ellison syndrome
-
Dx:
rare tumor w/ watery diarrhea, hypokalemia, achlorhydria -
VIPoma
(Inc VIP) -
Dx:
Adrenal hyperplasia, High BP, Low Cortisol, High Androgens - 11-Hydroxylase deficiency
-
Dx:
Adrenal hyperplasia, Low BP, Low Cortisol, High Androgens - 21-Hydroxylase deficiency
-
Dx:
Adrenal hyperplasia, High BP, Low Cortisol, Low Androgens - 17-Hydroxylase deficiency
-
Dx:
Increase in Dilute Urine, Hyposmolar serum - Primary Polydipsia
-
Dx:
Increase in Dilute Urine, Hyperosmolar serum -
Diabetes Insipidus
(ADH deficiency = Neurogenic)
(ADH receptor issue = Nephrogenic) -
Dx:
Increase in concentrated Urine, Hyposmolar serum - SIADH
-
what receptors promote insulin secretion?
inhibit? -
promote: Beta receptors
inhibit: Alpha receptors - what stimulates both insulin and glucagon?
- Amino Acids
- what hormone is needed for GH to function correctly?
- Thyroid hormones
-
Definition:
causes the increased synthesis of cartilage in epiphyseal plates of long bones; is a good measure of GH secretion -
Insulin-like Growth Factor-1
(IGF-1: a somatomedian) -
how is GH similar to glucagon?
insulin? -
glucagon: Inc blood glucose and fat
Insulin: Inc uptake of AA into cells - Calcium change w/ Acidosis
- Increased
- Name bone calcium and phosphate
- Hydroxyapatite
- where is receptor for PTH in bone?
-
Osteoblasts
(which stimulate osteoclasts) -
Which leads to Inadequate Bone Mineralization:
Vit-D deficiency or excess?
How? -
Both
Deficiency: decalcification of bone
(Rickets/Osteomalacia)
Excess: Inc. bone Resorption - what fills the lumen of the thyroid follicle?
- Thyroglobulin