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Flashcards in 02/17/15 - Endocrine Deck (40)
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1

A 40yo female presents with a 3mo history of weight gain, constipation, depressed mood, fatigue and cold intolerance. Thyroid biopsy reveals lymphocytic infiltrate with germinal cell formation. If she has the DR5 subtype, what other disease is she also at risk for?

A. Multiple sclerosis
B. Pernicious anemia
C. Psoriasis
D. Steroid-responsive nephrotic syndrome

B. Pernicious Anemia

DR5 is associated with pernicious anemia and Hashimoto thyroiditis. Multiple sclerosis is seen in the DR2 subtype, Psoriasis with B27.

2

The liver can convert glucose into G6P and minimize postprandial blood sugar increases. What is the best explanation for this ability?

A. Hepatocyte cell membrane permeability for G6P
B. High maximum reaction rate of glucokinase
C. Inhibition of glucokinase by G6P
D. Lack of glucokinase regulation by insulin
E. Low michaelis-menten constant of glucokinase

B. High maximum reaction rate of glucokinase

The membrane G6P permeability would be bad. Inhibition by G6P would reduce the liver's capacity to store. Insulin does actually increase glucokinase. Michaelis-menten constant relates to affinity, and is actually high in this reaction.

3

A genetic mouse knockout's F2 progeny express low TSH, low FSH, low LH, but normal ACTH and exhibit dwarfism. Female mice have impaired milk secretion. What is the impaired second messenger molecule?

A. cAMP
B. cGMP
C. Inositol triphosphate
D. Steroid nuclear hormone receptor
E. Tyrosine kinase

C. Inositol triphosphate

Note that Gq is the second messenger for all hypothalamic hormones except CRH. 

4

A woman has thyroid cancer and is scheduled for a total thyroidectomy. Which complication should she be warned of?

A. Acromegaly
B. Cretinism
C. Hypertension
D. Hypoparathyroidism
E. Renal osteodystrophy

D. Hypoparathyroidism

Due to removal of the parathyroid glands during surgery. Note that renal osteodystrophy results in hypocalcemia resembling hypoparathyroidism, but it is secondary to a renal wasting disorder.

5

A 5yo patient presents with a painless but growing mass in her neck. It is on the midline, below the hyoid bone. Hormones are normal but surgery is recommended. What is the diagnosis?

A. Branchial cleft cyst
B. Dermoid cyst
C. Ectopic thyroid gland
D. Enlarged pyramidal lobe
E. Thyroglossal duct cyst

E. Thyroglossal duct cyst

Hormone levels are normal, so ectopic gland or enlarged lobe is unlikely. Branchial cleft cysts are generally not midline, and dermoid cysts are more superficial?

6

Which of the following is standard treatment for thyrotoxicosis?

A. Aspirin
B. Dobutamine
C. Iodine
D. Levothyroxine
E. Propylthiouracil

E. Propylthiouracil

Methimazole would also be an option. Iodine is generally not used alone? Levothyroxine and aspirin would both worsen thyroid hormone levels. Dobutamine will worsen heart failure.

7

A patient with T1DM develops renal insufficiency. A biopsy shows Kimmelstiel-Wilson nodules. Which medication is effective in delaying this disease's progression?

A. ACE inhibitors
B. Beta blockers
C. Cyclophosphamide
D. Gold therapy
E. Prednisone

A. ACE Inhibitors

Also works for T2DM, and should be given to all diabetics with microalbuminuriaC/D are completely inappropriate, prednisone will worsen hyperglycemia, and beta-blockers can mask hypoglycemia

8

A patient presents with a 4mo history of anxiety, palpitations, weight loss, frequent stools, missed menses, and heat intolerance. She has a thyroid bruit and mild exophthalmos. Labs reveal undetectable TSH and elevated T3/T4. What is the etiology of her condition?

A. Autoimmune stimulation of hormone receptors
B. Idiopathic replacement of thyroid tissue with fibrous tissue
C. Thyroid adenoma
D. Thyroid hormone producing ovarian teratoma
E. Viral infection with destruction of thyroid gland

A. Autoimmune stimulation of hormone receptors

IgG receptors stimulate the thyroid (and pretibial tissue, and extraocular muscles). B describes Riedel's thyroiditis. Adenomas are usually nonfunctional. Ectopic thyroid production does not explain exophthalmos. E is backwards.

9

A patient presents with HTN, hypokalemia, sodium and water retention and decreased renin activity. Diagnosis?

A. Addison's disease
B. Hyperthyroidism
C. Pheochromocytoma
D. Primary hyperaldosteronism
E. Secondary hyperaldosteronism

D. Primary hyperaldosteronism

Potassium wasting water & salt retention bespeaks hyperaldosteronism. Low renin activity indicates primary rather than secondary.

10

A patient presents with hyperglycemia, diarrhea, and weight loss. Metformin hasn't lowered his blood sugars. Abdominal exam reveals pancreatic mass and a migratory necrolytic erythema. Diagnosis?

A. Prednisone use
B. Glucagonoma
C. Insulinoma
D. T1DM
E. VIPoma

B. Glucagonoma

Glucagonoma is the only cause given which can cause the painful, itchy rash.

11

A 12yo girl presents with a soft, nontender mass under her tongue. This congenital anomaly does not affect hormone levels, but if it did, the patient might experience which of the following?

A. Amenorrhea
B. Cold intolerance
C. Constipation
D. Hyperlipidemia
E. Weight gain

A. Amenorrhea

The anomaly is a thyroid remnant; amenorrhea can be seen in thyrotoxicosis due to the increase in metabolic rate. All other answers given are symptoms of hypothyroidism.

12

A patient with ulcerative colitis has been treated for 6mo with prednisone. The treatment has caused him to develop another condition. Which is the most likely adverse effect of the drug?

A. Diabetes insipidus
B. Diabetes mellitus
C. Hyperpigmented skin
D. Hypotension
E. Muscle hypertropy

B. Diabetes mellitus

Steroids elevated blood glucose levels. Hyperpigmented skin is seen in primary Addison's disease. Steroids promote hypertension and muscle atrophy.

13

The physical exam of a diabetic patient yields a loss of vibrational sense on the great toe. Which receptor is most likely affected?

A. Krause end bulb
B. Meissner's corpuscle
C. Merkel disc
D. Pacinian corpuscle
E. Ruffini corpuscle

D. Pacinian corpuscle

Pacinian corpuscles are deep and detect vibration. Merkel discs are superficial for fine touch. Ruffini corpuscles transduce pressure, and Meissner's corpuscles convey light touch & discrimination.

14

A patient presents with symptoms of hypoglycemia and is found to have a blood glucose of 50. Abdominal CT yields an insulinoma in the head of the pancreas. Which vascular structures must be ligated during the resection?

A. Gastroduodenal + IMA
B. Gastroduodenal + SMA
C. L-Gastric + IMA
D. L-Gastric + SMA
E. Proper Hepatic + IMA
F. Proper Hepatic + SMA

B. Gastroduodenal + SMA

The pancreas is supplied dually by the celiac and SMA. Of the celiac, L-Gastric supplies the lesser curvature of the stomach, the hepatics supply the liver & biliary tree, and the gastroduodenal gives rise to the pancreaticoduodenal arteries.

15

A 35yo woman presents with amenorrhea and enlargement of the hands and feet. She has hypertension, coarse facial features, and mild macroglossia. What treatment is appropriate?

A. Finasteride
B. Leuprolide
C. Octreotide
D. Recombinant growth hormone

C. Octreotide

This is acromegaly; finasteride blocks 5a-reductase, leuprolide is a GnRH analog, and rGH is for deficiency, not excess.

16

A 25yo man has intermittent headaches, anxiety and palpitations. His uncle had similar complaints, and his mother & two cousins have all had thyroidectomies. What condition does your patient most likely have?

A. Acromegaly
B. ACTH-secreting pituitary adenoma
C. Hyperparathyroidism
D. A nonfunctioning pituitary adenoma
E. Pheochromocytoma

E. Pheochromocytoma

This is MEN2, of which the triad includes pheochromocytoma, medullary thyroid carcinoma, and parathyroid adenoma. The symptoms of headache and SNS dysregulation further support the presence of a pheochromocytoma.

17

Growth hormone secretion is tightly regulated via a feedback control system. Which of the following is a stimulus for the secretion of GH?

A. Hypoglycemia
B. Obesity
C. Pregnancy
D. Somatomedin excess
E. Somatostatin therapy

A. Hypoglycemia

GH is released as part of the starvation stress response. Note also its suppression with oral sugars. All other listed answers suppress GH secretion.

18

A 70yo male smoker presents with cough, weight loss, fatigue and hemoptysis. His serum sodium is 120 and he experiences seizures. Which of the following is most likely to be elevated?

A. ACTH
B. ADH
C. Parathyroid hormone
D. Renin
E. TNFa

B. ADH

This patient is hyponatremic from ADH secretion due to his lung cancer (Small cell lung cancer causes an ADH-secreting paraneoplastic syndrome). Renin would increase sodium retention, while all other answers do not directly affect sodium.

19

A patient presents with cold intolerance, fatigue, and weight gain. Goiter is presents, as is lymphocytic infiltrate on thyroid biopsy. What is your thyroid hormone pattern?

A. +TSH, +total-T4, +free-T4
B. +TSH, -total-T4, +free-T4
C. +TSH, -total-T4, -free-T4
D. -TSH, -total-T4, +free-T4
E. -TSH, -total-T4, -free-T4
 

C. +TSH, -total-T4, -free-T4

This is Hashimoto thyroiditis, in which the thyroid is attacked and impaired by the immune system, decreasing total and free T4. TSH would be elevated as feedback inhibition on the pituitary is lost.

20

A 27yo female presents with muscle cramps & spasms. She has short stature, round face, abnormal teeth, short 4th & 5th metacarpals/metatarsals, and hypocalcemia despite hyperparathyroidism. There is no evidence of kidney disease. What is the inheritance of this disease?

A. AutDom
B. AutRec
C. Mitochondrial
D. X-Dom
E. X-Rec

A. AutDom

This is pseudohypoparathyroidism (eg Albright's Hereditary Osteodystrophy), in which a single copy of GNAS (signaling molecule) is mutated.

21

A 42yo female presents with weight gain, cold intolerance, dry skin, and bradycardia. Antithyroglobulin and ANA are negative, but TPO antibody is positive. What other autoimmune diseases does she most likely have?

A. Grave's disease & pernicious anemia
B. Osteoarthritis & Addison's disease
C. Rheumatoid arthritis & vitiligo
D. T1DM & celiac disease
E. Whipple's disease & T1DM

D. T1DM & celiac disease

Apparently these two have a high association with Hashimoto's thyroiditis.

22

A 48yo man presents with back pain, polyuria, polydipsia, hypertension & weight gain. X-ray shows lumbar compression fracture. What is most likely elevated?

A. Cortisol
B. Glucagon
C. Growth hormone
D. Insulin
E. Thyroid hormone

A. Cortisol

This is Cushing's disease; note the weight gain, hypertension, and bone turnover. 

23

A middle-aged T2DM woman has started a new treatment for glycemic control. She develops abdominal cramping, diarrhea, and flatulence What agent causes these effects?

A. Acarbose
B. Glipizide
C. Orlistat
D. Metformin
E. Insulin

A. Acarbose

Acarbose is an a-glucosidase inhibitor. Fewer disaccharides and polysaccharides are absorbed in the small intestine, meaning more fuel is available for consumption by lower GI flora, hence the GI symptoms.

24

A 44yo patient has a painlessly enlarged thyroid. Biopsy shows psammoma bodies and thin projections of epithelium surrounding a fibrovascular core. The nuclei of many cells are clear. Which of the following risk factors is most strongly associated with her diagnosis?

A. Smoking
B. History of Graves' disease
C. HLA-DR5 receptors
D. Prior head/neck radiotherapy
E. Recent pregnancy

D. Prior head/neck radiotherapy

This is papillary thyroid cancer (note the Orphan Annie nuclei); for which the only known risk factor is radiation.

25

A patient is undergoing a surgical resection to remove a right-adrenal adenoma. The surgeon must first ligate the primary venous drainage of the tumor. That drainage flows directly in to which of the following structures?

A. Abdominal aorta
B. Inferior vena cava
C. Portal vein
D. R-Gonadal vein
E. R-Renal vein

B. Inferior vena cava

The right adrenal vein empty directly into the IVC, while the left adrenal vein empties into the left renal vein.

26

A 60yo smoker with lung cancer with hypercalcemia is administered an experimental drug. He develops perioral paresthesias, and Chvostek's/Trousseau's signs are present. What was he given?

A. Calcitonin
B. Parathyroid hormone
C. PTHrP
D. Thyroxine
E. Vitamin D

A. Calcitonin

He is now hypocalcemic (Chvostek's/Trousseau's indicate hypocalcemic tetany). Only calcitonin would lower calcium among the drugs listed.

27

A 17yo female presents with amenorrhea, nausea, vomiting, and weakness. She is hypokalemic. Her condition affects the production of 2 out of 3 adrenal hormones. Where is the functional hormone still being produced?

A. Capsule
B. Medulla
C. Zona fasciculata
D. Zona glomerulosa
E. Zona reticularis

D. Zona glomerulosa

This is CAH, 17-OH subtype. Note the hypokalemia, an indication that the RAS axis is still functional. The functioning aldosterone is produced in the zona glomerulosa.

28

A 55yo patient presents with weight loss, hypotension, and hyperpigmented skin. Serum cortisol & sodium are low but potassium & ACTH are high. Urine 17-hydroxypregnenolone is increased. Diagnosis?

A. Autoimmune destruction of adrenal glands
B. Cortisol secreting adrenal adenoma
C. Ectopic ACTH production
D. Hemochromatosis
E. Pituitary corticotropin insufficiency

A. Autoimmune destruction of adrenal glands

This is Addison's disease; note the triad of symptoms including hyperpigmented skin (from a-MSH secretion from pituitary). Cortisol would be high to normal in B/C/D, and skin hyperpigmentation would not be seen in E.

29

Which of the following strategies would be the most effective means by which to determine the level of thyroid hormone activity?

A. Assessing cAMP levels
B. Assessing intracellular calcium levels
C. Assessing Na/K ATPase mRNA levels
D. Assessing phospholipase C activity
E. Assessing phosphorylation of IRS-1

 

C. Assessing Na/K ATPase mRNA levels

Thyroid hormone increases net metabolism. Recall that virtually all cells produce Na/K ATPase and use the gradients it establishes to fuel various cellular processes. Thyroid hormone acts via nuclear hormone receptors to increase transcription of this protein.

30

A 22yo nulliparous female develops galactorrhea. She has a history of hypercalcemia and duodenal ulcers, and reports maternal relatives with "tumors". What is the inheritance pattern of this disorder?

A. AutDom
B. AutRec
C. Mitochondrial
D. X-Dom
E. X-Rec

A. AutDom

This is MEN1; note the 3 "P"s (parathyroid, pancreatic, and pituitary). In this disease, "menin" is mutated leading to a hereditary polyendocrinopathy with high penetrance.