Term
| What are hormones that have endocrine organs as their target known as? |
|
Definition
|
|
Term
| Two methods of negative feedback in hormone regulation: |
|
Definition
Hormone later in the pathway -'vely feedsback (e.g. thyroid hormone feedback on TSH)
Non-hormonal signal feeds back (e.g. elevated Ca levels inhibits PTH) |
|
|
Term
| What is the function of PTH? What is its mode of action? |
|
Definition
Increase Ca concentration in the blood
It causes - increased bone resorption, increased reabsorption from kidneys, increased absorption from intestines |
|
|
Term
| What regulates PTH secretion? |
|
Definition
The Ca level in the blood
When low - stimulates release
When high - inhibits release |
|
|
Term
| Different causes of hypercalcemia? |
|
Definition
Excess PTH secretion from PT glands (high PTH levels in blood)
Bone tumor causing bone resorption (low PTH levels in blood b/c -'ve feedback) |
|
|
Term
| Function of Bromocryptine |
|
Definition
Treat for hyperprolactinemia
Suppresses PRL release
Also shrinks size of prolactinoma if present |
|
|
Term
|
Definition
| INADEQUATE insulin production by B-cells of pancreas |
|
|
Term
|
Definition
DM I - autoimmune destruction of B-cells; LOW insulin in blood
DM II - insulin insensitivity; normal or high levels of insulin in blood |
|
|
Term
| What are the various effects of insulin at its different target tissues? |
|
Definition
LIVER - glycogenesis, glycolysis, lipogenesis (ALL ANABOLIC)
Increase glucose uptake by muscle and fat
Increased amino acid absorption |
|
|
Term
| What regulates insulin levels in the body (what controls its release)? |
|
Definition
The levels of glucose in the blood
Low glucose - suppressed
High glucose - stimulate insulin release |
|
|
Term
| Is insulin a catabolic or anabolic hormone? |
|
Definition
ANABOLIC
In liver stimulates, glycolysis, glycogenesis, lipogenesis |
|
|
Term
|
Definition
Increased blood glucose
Glycosuria - glucose in urine b/c exceeding of renal threshold
PPP - polyuria, polydipsia, polyphagia |
|
|
Term
| Which type of DM is more common? |
|
Definition
|
|
Term
| What is the initial pathology of DM? |
|
Definition
Hyperglycemia (elevated blood glucose)
PPP (polyuria, polydipsia, polyphagia)
Weight loss/starvation (reduced metabolism) |
|
|
Term
|
Definition
| Insulin therapy - subcutaneous injection or w/ continuous injection pump |
|
|
Term
|
Definition
Diet - increase complex carb, fiber and protein intake
Exercise - active skeletal muscle can uptake glucose w/o effects of insulin (reduce blood glucose)
Drugs - sulfonylureas, biguanidines |
|
|
Term
| Method of action of Sulfonylureas |
|
Definition
Stimulate B-cells of the pancreas to release insulin
Example - Glyberide |
|
|
Term
| Method of action of Biguanidines |
|
Definition
Increase tissue's insulin sensitivity
Example - Metformin, Glucophage |
|
|
Term
|
Definition
Combination of glyberide (sulfonylurea) and metformin (biguanidine)
Therefore causes increased insulin production and increases insulin sensitivity |
|
|
Term
| What are the two acute complications of DM? |
|
Definition
Insulin shock (insulin induced hypoglycemia)
Diabetic ketoacidosis |
|
|
Term
| Two main symptoms in insulin shock |
|
Definition
CNS depression - slurred speech, staggering, blurred vision (similar to intoxication)
SNS activation - sweating, increased HR, anxiety, vasoconstriction, increased BP |
|
|
Term
| Treatment for Insulin Shock |
|
Definition
If conscious - fruit juice, honey, sugar
If unconscious - IV glucose |
|
|
Term
| Difference in the causes of insulin shock & ketoacidosis |
|
Definition
Insulin shock -> caused by EXCESS insulin (leading to hypoglycemia)
Ketoacidosis -> caused by INADEQUATE insulin (leading to hyperglycemia) |
|
|
Term
| What type of state does the body shift into in ketoacidosis? |
|
Definition
CATABOLIC
In the liver see glycogenolysis, lipolysis, gluconeogenesis, ketogenesis |
|
|
Term
| Why does the body enter a catabolic state in ketoacidosis? |
|
Definition
| B/c cells think that b/c there is low insulin, there is low glucose as well, therefore try to increase concentration of glucose by increasing catabolism |
|
|
Term
| 3 main categories of symptoms in diabetic ketoacidosis: |
|
Definition
Dehydration
Metabolic Acidosis
Electrolyte Imbalance |
|
|
Term
| Dehydration symptoms of ketoacidosis |
|
Definition
|
|
Term
| Metabolic acidosis symptoms of ketoacidosis |
|
Definition
| Rapid respiration (try to lower pCO2), acetone breath, lethargy |
|
|
Term
|
Definition
| Vomiting, cramps, lethargy |
|
|
Term
| Treatment for diabetic ketoacidosis |
|
Definition
Treat for the 3 categories of symptoms
Rehydration & electrolyte replacement
Administer bicarbonate ions to raise pH |
|
|
Term
| How to perform ddx of unconscious diabetic (could be either insulin shock or ketoacidosis) |
|
Definition
Check breath - if sweet, then is ketoacidosis
Check skin turgor - if low turgor = dehydration = ketoacidosis
Check for SNS symptoms - check BP/HR (high BP is shock, low BP is ketoacidosis) |
|
|
Term
| What are some chronic complications of DM? |
|
Definition
| CVD, CVA, retinopathy, ESRD, amputation (PVD), CNS (neurologic effects) |
|
|
Term
| What can PVD as a chronic complication of DM lead to? |
|
Definition
Ischemia & poor healing in extremities
Ischemic environment and glucose in blood nourishes bacteria (prone to infections)
Often see amputation in chronic conditions |
|
|
Term
| Where do some of the microvascular changes occur in the chronic complications of DM? |
|
Definition
| Eye (retinopathy), kidney (nephropathy) |
|
|
Term
| What is the leading cause of ESRD? |
|
Definition
| Chronic complications of DM |
|
|
Term
| Neurologic pathologies seen as a consequence of chronic DM? |
|
Definition
Demyelinationo of peripheral nerves leading to numbness
Autonomic NS dysfunction - incontinence, erectile dysfunction |
|
|
Term
| 3 different types of diabetes insipidus? |
|
Definition
Neurogenic - body does not produce ADH
Nephrogenic - kidney does not respond to ADH (ADH-resistance)
Dipsogenic - behavioral consequence of excessive thirst |
|
|
Term
| Urine differences in DM and DI: |
|
Definition
Mellitus - sweet urine b/c of glycosuria
Insipidus - dilute watery urine b/c of excess water |
|
|
Term
| What is the most common cause of hyperparathyroidism? |
|
Definition
|
|
Term
| Name two different causes of hypercalcemia: |
|
Definition
Hyperparathyroidism caused by an adenoma secreting excess PTH
Bone tumor stimulating excessive bone resorption (increases calcium levels in blood) |
|
|
Term
| Relative PTH levels in bone cancer vs. PT adenoma which both lead to hypercalcemia? |
|
Definition
In cancer -> low PTH levels b/c of negative feedback from high Ca
In PT adenoma -> high PTH levels because of hypersecretion |
|
|
Term
| What can cause HYPOCALCEMIA? |
|
Definition
Renal disease - decreased activation of Vit D to calcitriol = impaired Ca absorption
See HIGH PTH levels, LOW Ca levels |
|
|
Term
| Where is calcitonin synthesized & released? |
|
Definition
| In the parafollicular (C) cells of the thyroid gland |
|
|
Term
| How are the functions of calcitonin and PTH related? |
|
Definition
They are ANTAGONISTIC to each other
PTH - increase Ca levels via bone resorption, increased absorption of Ca
Calcitonin - decrease Ca levels via bone formation, decreased Ca absorption + increased excretion |
|
|
Term
| What can calcitonin be used clinically to treat? |
|
Definition
Osteoporosis & osteopenia
Hypercalcemia |
|
|
Term
| Which pituitary hormones have inhibitory hormones from the hypothalamus? What are these hormones? |
|
Definition
PRL and GH both have inhibitory hormones
PRL -> dopamine inhibits
GH -> GHIH inhibits |
|
|
Term
| Which is the only pituitary hormone which does NOT have a positively stimulating releasing hormone from the hypothalamus? |
|
Definition
PRL
It is controlled solely by dopamine, which inhibits its release |
|
|
Term
| What is the most common pituitary tumor? |
|
Definition
| Prolactinoma causing hypersecretion of PRL |
|
|
Term
| What are two symptoms of a PRL-adenoma causing hyperprolactinemia? |
|
Definition
Galactorrhea - milk from nipples
Amennorhea - cessation of menstruation |
|
|
Term
|
Definition
If have excess GH BEFORE puberty = gigantism
If have excess GH AFTER puberty = acromegaly |
|
|
Term
| Difference between hypopituitarism and panhypopituitarism? |
|
Definition
Hypo = non-specific; decrease in SOME hormones
Panhypo = decrease in ALL pituitary hormones |
|
|
Term
|
Definition
| Hemorrhage in pregnant women causes collapse of vessels; causes PANHYPOPITUITARISM |
|
|
Term
| Pituitary Stalk Transection |
|
Definition
Typically from trauma (car accident)
Severs connection between hypothalamus & pituitary -> see panhypopituitarism EXCEPT for PRL
PRL secretion is UPREGULATED b/c it is no-longer inhibited by dopamine |
|
|
Term
|
Definition
Hashitmoto's - autoimmune destruction; most common
Thyroiditis - inflammation which first presents as hyperthyroid, then shows hypo
Congenital - lack of development
Surgery
Goiter/Cancer |
|
|
Term
| What is a hypothyroid goiter typically caused from? |
|
Definition
Iodine deficiency
Because of less negative feedback have HIGH TSH levels -> stimulate TSH receptors on thyroid to form goiter |
|
|
Term
| What type of goiter is seen in HYPOTHYROIDISM? |
|
Definition
| ENDEMIC GOITER (non-functional goiter) |
|
|
Term
| Symptoms of HYPOTHYROIDISM |
|
Definition
Reduced metabolism - cold intolerant, slow HR, lethargic
Decreased appetite w/ weight gain (b/c of low metabolism)
ENDEMIC Goiter = from excess TSH levels |
|
|
Term
| Which is more common, hypothyroidism or hyperthyroidism? |
|
Definition
| Hypothyroidism (5% prevalence) |
|
|
Term
| Causes of HYPERTHYROIDISM |
|
Definition
Grave's disease - Ig's stimulate TSH receptors on thyroid to stimulate hormone production; forms goiter
Nodules - adenomas of the thyroid
Iatrogenic - overmedication of hypothyroid
Pituitary adenoma (rare; secondary) |
|
|
Term
| Goiter formation in hypo vs. hyperthyroidism? |
|
Definition
Hypo - iodine deficiency leads to high TSH levels which stimulate TSH receptors on thyroid, causing goiter
Hyper - Grave's antibodies stimulate TSH receptors of thyroid and cause goiter formation |
|
|
Term
| TSH levels in primary hypo vs. hyperthyroidism? |
|
Definition
Hypo - if primary, then will have HIGH TSH levels because of lack of negative feedback
Hyper - if primary, have LOW TSH levels because of excessive negative feedback |
|
|
Term
| Symptoms of Hyperthyroidism |
|
Definition
Goiter formation by TSH receptor stimulation by Grave's antibodies
Increased metabolism - high HR, heat intolerant
Weight loss w/o loss of appetite
SNS activation - sweating, vasoconstriction
Exopthalamus - from SNS & antibodies |
|
|
Term
| Treatment for Hyperthyroid |
|
Definition
Radioactive iodine
Surgery
Medications - B-blocker for SNS, propylthiouracil (interfere with thyroid hormone formation) |
|
|
Term
| What is propothiouracil used to treat? |
|
Definition
| Hyperthyroidism; inhibits incorporation of I into thyroid hormone |
|
|
Term
| What are pathologies of the adrenal medulla and cortex? |
|
Definition
Medulla - pheochromocytoma
Cortex - Cushing's (hypercortisolemia) & Addison's (adrenal insufficiency) |
|
|
Term
|
Definition
Benign tumor in medulla of adrenal gland
Secretes excess E and NE (symptoms all have to due from HTN from excess SNS activation)
Need surgery to remove |
|
|
Term
| Differences in ACTH levels in primary and secondary Cushing's: |
|
Definition
Primary (adrenal tumor) -> low ACTH
Secondary (paraneoplastic or pituitary) -> high ACTH |
|
|
Term
| What are the various "Cushingoid" features? |
|
Definition
Cushingoid features - truncal obesity, buffalo hump, moon face
Reduced muscle mass in limbs
Stria from collagen breakdown |
|
|
Term
| Non-"cushingoid" symptoms of Cushing's: |
|
Definition
Insulin resistance (DM II) -> since cortisol is gluconeogenic, increases blood glucose
Delayed healing/increased infection -> combination of immune suppression and DM II
Reduced stress response b/c of cortisol over-production |
|
|
Term
| How can you determine the location of the pathology in Addison's based on the levels of the hormones produced by the adrenal cortex? |
|
Definition
If you see low levels of all 3 -> then it has to be primary
If you only see low glucocorticoids (cortisol) -> then it is a secondary pathology (b/c decreased ACTH ONLY affects cortisol) |
|
|
Term
| Primary Addison's can be caused by... |
|
Definition
| Autoimmune destruction, tumors, infection from TB |
|
|
Term
| What is one symptom common to both Cushing's & Addison's? |
|
Definition
| Reduced (poor) stress response |
|
|
Term
|
Definition
Increased risk of infection
Poor stress response
Hypotension (from lack of aldosterone; only seen if primary)
Hyperpigmentation, weight loss, anorexia |
|
|
Term
| Relationship between hyperpigmentation, weight loss and anorexia in Addison's |
|
Definition
Due to HIGH LEVELS OF ACTH
Excess ACTH is cleaved into a-MSH; causes hyperpigmentation of skin, also inhibits appetite in the brain |
|
|
Term
| Why are the testes kept at a temperature lower than the core body temperature? |
|
Definition
Needed for SPERMATOGENESIS - sperm development
In contrast, STEROIDOGENESIS (testosterone production) is temperature independent |
|
|
Term
| Intratesticular structures |
|
Definition
| Seminiferous tubules, efferent ducts, epididymis |
|
|
Term
| Extratesticular structures |
|
Definition
| Seminal vesicles, prostate, ampulla, vas deferens |
|
|
Term
| Function of seminal vesicles & prostate is sperm modification? |
|
Definition
Seminal vesicles = produce 95% of seminal fluid; energy for sperm (fructose)
Prostate = alkaline secretion to increase pH |
|
|
Term
|
Definition
No conception after 1 year of regular, unprotected intercourse
40% associated with father - 20% alone, 20% mixed male & female |
|
|
Term
|
Definition
2-4 mL
> 20 million/mL; average = 100 million/mL
> 40% motile
<60% abnormal is normal (only need 40% or more to be normal) |
|
|
Term
| What causes the majority of male infertility? |
|
Definition
|
|
Term
| Intrauterine insemination |
|
Definition
| Centrifuge semen sample & concentrate sperm then inject into uterus |
|
|
Term
|
Definition
Collect oocyte & fertilize in vitro, then transfer into uterus
To increase odds, stimulate and collect multiple oocytes; 30-40% success rate |
|
|
Term
| Intracytoplasmic sperm injection |
|
Definition
Take SINGLE sperm and directly inject into cytoplasm of oocyte
Can be done even if man has 0 sperm count (can inject immature sperm) |
|
|
Term
| Causes of female infertility |
|
Definition
Anovulation from amenorrhea
Structural defects to internal structures
Immunologic - antibody production against sperm; immune response to fetus |
|
|
Term
|
Definition
Menarche never has occurred (no onset)
From genetic disorder (Turner's = XO); congenital disorder of brain/pituitary
May have a cause of secondary amenorrhea occurring before puberty/menarche (exercise, stress, etc.) |
|
|
Term
|
Definition
| Cessation of menstrual cycles after regular cycles |
|
|
Term
| Causes of secondary amenorrhea? |
|
Definition
CNS or pituitary tumor - hyperPRL most common
Inhibition of GnRH - hyperPRL, stress, exercise, anorexia
Obstruction of outflow (blockage; leiomyoma or Asherman's syndrome = scarring of uterine tissue) |
|
|
Term
|
Definition
Resection of tumors
Oral contraceptive therapy - increase estrogen
Bromocryptine - if hyperPRL
Stimulate FSH/LH secretion from pituitary |
|
|
Term
|
Definition
ECTOPIC endometrium (somewhere outside of uterine cavity)
Leads to scarring & distortion of fallopian tubes
Dysmenorrhea & dyspareunia (pain during sex) |
|
|
Term
| What can cause endometriosis? |
|
Definition
Blocked fallopian tubes from:
STI or ruptured appendix - both are pelvic inflammatory conditions |
|
|
Term
| Treatment of endometriosis: |
|
Definition
Inhibit OVULATION w/ GnRH AGONIST - functions to downregulate GnRH receptors to reduce gonadotrophin levels
Danazol = androgenic steroid; increase negative feedback to GnRH |
|
|
Term
| What is the most common tumor in young men? |
|
Definition
|
|
Term
| What is the etiology of testicular cancer? |
|
Definition
Genetic component
More likely with undescended testes
NOT ASSOCIATED with trauma/infection |
|
|
Term
| Diagnosis of testicular cancer? |
|
Definition
Often by self-diagnosis - hard, unilateral painless mass
Use tumor markers - hCG, AFP |
|
|
Term
| What is the effect of an ochiectomy? |
|
Definition
Removal of one testis affected by testicular cancer
NO EFFECT on fertility (other testis produces adequate sperm) |
|
|
Term
| Difference in enlargement site in BPH vs. prostate cancer? |
|
Definition
BPH = central enlargement
Prostate Cancer = carcinoma in SURFACE epithelium |
|
|
Term
|
Definition
Reduced urinary stream (hypertrophy impinges in urethra)
Urinary retention can cause cystits or UTI |
|
|
Term
|
Definition
Surgery is RARE
Drugs - anti-androgen (reduce stimulation), a-adrenergic blocker |
|
|
Term
| Main difference, besides enlargement site, of prostate ca and BPH? |
|
Definition
| Cancer metastasizes, BPH never does so |
|
|
Term
| What type of tumor is seen in prostate cancer and where is it seen? |
|
Definition
| Adenocarcinoma on the surface epithelium of the prostate |
|
|
Term
| How can you get an early diagnosis of prostate cancer? |
|
Definition
PSA level elevation
However and elevation in PSA is not specific to prostate cancer (also seen in BPH and infection)
Use rectal exams to check
Ultrasound & biopsy |
|
|
Term
| What does cervical cancer begin as? |
|
Definition
| DYSPLASIA of squamous epithelium of external os |
|
|
Term
| Early signs of cervical cancer? |
|
Definition
Spotty and watery discharge
More severe later on, anemia & weight loss |
|
|
Term
| What do the different stages of cervical cancer indicate? |
|
Definition
In situ carcinoma = asymptomatic
Pap smear detects dysplasia @ columnar junction
Spotting shows invasive carcinoma |
|
|
Term
| Treatment of cervical cancer |
|
Definition
Surgery/radiation; 5 yr survival is 100% w/ early detection
Vaccines - protection against 2 strains HPV and 2 strains which cause genital warts |
|
|
Term
| When is uterine cancer most common? |
|
Definition
| In post menopausal women (55-65 yo) |
|
|
Term
| 1st sign of carcinoma of the uterus? |
|
Definition
Unusual spotting
Because it is seen primarily in post-menopausal women, any spotting is unusual
Look for biopsy and uterine dysplasia |
|
|
Term
| What is seen in the endometrium in uterine cancer? |
|
Definition
Hyperplasia of endometrium leading into dysplasia
Hyperplasia stimulates bleeding (unexpected spotting) |
|
|
Term
| Treatment of carcinoma of the uterus |
|
Definition
| Hysterectomy w/ radiation (no metastasis gives 90% 5 yr survival) |
|
|
Term
| Which female reproductive cancer has the highest mortality rate? |
|
Definition
|
|
Term
| Risk factors for ovarian cancer |
|
Definition
Genetic component - history of breast, ovarian, endometrial, prostate Ca in family
BRCA1/2 gene mutation
Increased risk w/ ovulation (see reduced ovarian Ca in OC users and women w/ multiple pregnancies) |
|
|
Term
| Mechanism for increased ovarian cancer risk with ovulation... |
|
Definition
| Mutation of ovarian epithelium at site of ovulation (estrogen may stimulate proliferation of oncogenes and decrease apoptosis) |
|
|
Term
| Is there a prophylaxis for ovarian cancer? |
|
Definition
| Prophylactic oophorectomy in those with BRCA1/2 gene mutation |
|
|
Term
|
Definition
Tamoxifen (estrogen antagonist)
Aromatase inhibitor (prevent testosterone to estrogen conversion) |
|
|
Term
| What acts as negative feedback for insulin? |
|
Definition
| [glucose] - as it decreases, B-cells release less insulin |
|
|
Term
| Types of hypoglycemics taken in DM I vs. II |
|
Definition
DM I = injected insulin (injection of hypoglycemic)
DM II = oral hypoglycemics (Glyberide, Glucophage, Metformin) |
|
|
Term
| PTH levels in hypercalcemia vs. hypocalcemia? |
|
Definition
If hypercalcemia caused by bone tumor, get negative feedback to get low PTH
If hypocalcemia due to renal disease, get no negative feedback and thus high PTH |
|
|
Term
| Antagonistic hormone to PTH and where is it released from? |
|
Definition
Calcitonin, released from parafollicular/C cells in thyroid gland
Increase osteoblast function, decrease Ca absorption - wants to lower Ca levels in the blood |
|
|
Term
|
Definition
Hemorrhage in pregnant woman = ischemia to pituitary
Get complete panhypopituitarism |
|
|
Term
| Another name for autoimmune destruction of thyroid? |
|
Definition
| Hashimoto's - main cause of hypothyroidism |
|
|
Term
| What is a hypothyroid goiter usually formed due to? What is another name for this goiter? |
|
Definition
Usually formed due to iodine deficiency - lack of negative feedback stimulates TSH production which constantly stimulates thyroid as it enlarges
Also called ENDEMIC (non-functional) goiter |
|
|
Term
|
Definition
| Primarily peri or post menopausal |
|
|
Term
|
Definition
|
|
Term
| What bariatric surgery is ideal for those with DM II? |
|
Definition
| Roux-en-Y - best surgery for co-morbidities |
|
|
Term
| What is the 1st recipient of nutrients & absorbed blood-borne factors? |
|
Definition
|
|
Term
| Which form of hepatitis has an associated cancer risk? |
|
Definition
|
|
Term
| Which forms of Hepatitis are acute/chronic? |
|
Definition
Acute = A, D, E
Chronic = B, C |
|
|
Term
| What type of immune response is IgA responsible for? |
|
Definition
|
|
Term
| Why can chronic ingestion of gluten in someone with Celiac disease lead to anemia? |
|
Definition
| Because of flattened villi get malabsorption of Fe - low iron intake = anemia over time |
|
|
Term
| What does increased fluid volume in the intestinal lumen do in respect to motility? |
|
Definition
| Increased fluid volume = increased motility (what is seen in diarrhea) |
|
|
Term
| How can intussusception lead to peritonitis? |
|
Definition
Telescoping of intestine into upstream segment is due to loose mucosa
As the segment is telescoped, get compression of BV's and nerves in mesentery - leads to ischemia, necrosis, and perforation |
|
|
Term
| When is intussusception most common> |
|
Definition
| In young bowel (<2 yrs of age) |
|
|
Term
| Guarding reflex is most commonly seen in what pathology? |
|
Definition
|
|
Term
| 4 different pathologies in which pain is unremitting |
|
Definition
Peritonitis
Appendix if ruptured
Diverticulitis
Pancreatitis |
|
|
