Endocrine Neoplasia
Name the three conditions associated with MEN2B.
BONUS! Name the organs that are associated with MEN2A
What are pheochromocytoma, medullary thyroid carcinoma, and marfanoid/mucosal Neuromas? These are the 2M's and 1P. MEN 1 has the 3 P's which are parathyroid, pancreas, and pituitary. MEN 1 is a result of a mutation in the tumor suppressor Menin gene. MEN2A and MEN2B result in the mutation of the RET proto-oncogene which is a gene encoding for a tyrosine kinase receptor.
BONUS! Medullary thyroid carcinoma, pheochromocytoma, and parathyroid
Obj. 7461
Name the Lipoproteins mostly involved with the pathogenesis of atherosclerosis.
What are LDL and VLDL?
Obj. 7217
Identify the Chapman point for the Adrenal glands.
What are 2 1/2 inches above and 1 inch lateral to the belly button bilaterally?
Obj. 7445
In Glucocorticoid Remediable Aldosteronism, the secretion of Aldosterone is under the control of ______
What is ACTH? This can be corrected by... you guessed it... Glucocorticoids by eliciting a negative feedback response. This is an autosomal dominant trait and is very rare. Pt will present typical signs and symptoms of Hyperaldosteronism.
Obj. 7435
Name the first test in determining if a pt has a hyper/hypothyroid.
BONUS! Describe the thyroid lab findings in a pt with Hashimoto's thyroiditis.
What is a TSH level?
BONUS! High TSH, low T3/T4
iLAB
Name the 3 H's in Pheochromocytoma and the tx of this neoplasm.
What are HTN, Headaches, and Hyperhidrosis?
Obj. 7465
Name the plasma lipoprotein that only carries a B100 apoprotein and its main function(s).
BONUS! Name the most effective medication in reducing their levels.
What dare LDL which carries mostly cholesterol esters and provides peripheral tissues with cholesterol, as well as brings cholesterol back to the liver?
BONUS! Statins are the most effective, although other medications can also decrease their levels.
OBJ. 7215
The SNS has _____ postganglionic fibers whereas the PSNS has _____ postganglionic fibers.
BONUS! Identify the organ that directly synapses with the preganglionic SNS neurons.
What is long and short? The SNS preganglionic neurons will synapse with the postganglionic neurons in the sympathetic chain and travel to the innervated organ whereas the PSNS preganglionic neurons synapse directly with the postganglionic neurons in the wall of the innervatedorgan.
BONUS! Chromaffin cells in the adrenal medulla act as modified postganglionic neurons without axons or dendrites to directly stimulate the production of catecholamines.
Obj. 7452
Define Adrenal Incidentaloma.
What is a mass found on the adrenal gland, generally when imaging of the abdomen is done for another reason? Usually, these pts are asymptomatic and are about 1cm in size and are removed when they are >5cm unless chemically active(removed sooner).
Obj. 7430 iLAB
Name the characteristic cells seen in Hashimoto's Thyroiditis.
What is Hurthle cells?
iLAB
Male pt presents to the office with c/o erectile dysfunction, headaches, nipple discharge, and lowered peripheral vision. Identify the most likely increased hormone in this pt.
BONUS! Identify the most likely neoplasm and the cause of the vision defect.
What is an increase in prolactin? These are all acts of prolactin.
BONUS! It is most likely a pituitary adenoma which causes vision defects due to the compression of the optic chiasm. Prolactinomas are the most common pituitary adenoma.
Obj. 7460
Within the body is a Lipoprotein that is in charge of taking free cholesterol and converting it into cholesterol esters(enzyme?) for transport into the liver either by placing it on another lipoprotein(enzyme?) or being uptaken by the liver. Identify this lipoprotein and the enzymes that help complete its task.
BONUS! Name the drug that is the most useful in raising these levels
What is HDL with the help of LCAT(cholesterol conversion) and CETP(cholesterol transfer protein)? HDLs are released from the liver with the aim of decreasing cholesterol in the periphery(scavengers). These lipoproteins have all of the apolipoproteins except for B, but the most important ones are A-1 and C-II which are used for LCAT and LPL respectively.
BONUS! Niacin
Objs. 7215, 7216, and 7221
Describe Pelvic-Thyroid-Adrenal Syndrome and the location of the Thyroid Chapman's Point.
What is that there is some increase in the production of T3/T4 which increases adrenergic tone, cortisol, and increased SNS; Thyroid Chapman's Point is located at the right 2nd intercostal space near the sternal border?
Objs. 7448 and 7445
The most common cause of primary hyperaldosteronism is an idiopathic cause. In these pts, there is HTN, hypernatremia, hypokalemia, and alkalosis. Describe what is seen in relation to the renin levels and how it is treated.
BONUS! Describe the renin level if it was secondary hyperaldosteronism
What is low renin, and normal ACTH, and is treated with spironolactone? Since the cause is idiopathic, the tx is solely medical and focuses on the normalization of BP and electrolytes. Spironolactone is an ALD antagonist which is why it is a common medication used in the tx. If this condition was due to a unilateral adrenal adenoma, the tx would be surgical removal.
BONUS! If this was a secondary cause, the renin level would be high.
Obj. 7434
Pt presents to the office with c/o weight loss despite increased appetite, fatigue, and "seems to get hot really easily". After taking tests, it is determined that the pt has a low TSH and high T3/T4. Name the most like cause of this pt's condition and medications used in its tx.
What is Grave's Disease which can be treated using thioamides? This condition is an autoimmune disease with Thyroid-stimulating immunoglobulins, a TSH agonist that works to activate the production and release of T4/T3. Thioamides are PTU (Propylthiouracil) and Methimazole, which both inhibit TPO, but only PTU inhibits 5'-deiodinase to prevent the peripheral conversion of T4 to T3.
Objs. 7422, 7421, 7418, 7417
iLAB
Pt presents to the office for a check-up on their GERD. Pt states that they recently experienced severe diarrhea, weight loss, and weakness. Upon endoscopy, multiple ulcers were found in the duodenum and jejunum. Identify the gene mutation that is common in this syndrome.
What is the tumor suppressor Menin 1? This pt describes Zollinger Ellison Syndrome which is a gastrin-secreting tumor. To dx this condition, you would have to find an elevated fasting gastrin level (>150pg/mL), elevated overall gastrin level (>1,000pg/mL), and a Gastric pH under 3.0
Obj. 7463
Pt presents to the office for a check-up. PMHx indicates that the pt is taking a Hyperlipidemia drug that works by activating the PPAR-alpha receptor. Name the medication that is greatly discouraged from being prescribed due to the increased risk of rhabdomyolysis.
What are Statins?
Obj. 7221
Pt presents to the office with c/o GERD. Pt states that they are currently on medication to treat this condition, but still feel tense and wish to try some OMM. Being an expert on OMM, name the location where you would look for a Chapman's point on this pt.
What is the 5th intercostal space on the left? This is the location of the stomach that is in charge of acidity.
OBJ. 7445
Pt presents to the office with c/o syncope, fatigue, weight loss, and increased Lays potato chip ingestion. Upon examination, you find the pt to have a BP of 90/70, and "dark spots" on their lips and elbows. Describe the pathogenesis of the most common cause of this disease.
BONUS! Name the common HLA association
What is autoimmune destruction of the zona glomerulosa and fasciculata through auto-Abs(Addison's Disease)? This condition will cause hyperpigmentation due to the increase of ACTH(increase in MSH), volume loss, irregular menses, fatigue, etc.
BONUS! HLA B8, DR3, and DR4
Obj. 7431
Pt presents to the ED via Ambulance. EMTs state that the family called 911 because the pt passed out during the family dinner. Upon examination, the pt is unconscious, has swelling in the face, +2 non-pitting edema BLE, bradycardia, bradypnea, and a scar is found on the front of the pt's neck under the laryngeal prominence. Identify the cause of this pt's life-threatening condition and the tx.
What is myxedema coma which is treated with correcting conditions in the pt(IV fluids, blankets, intubation, etc) as well as TH replacement? The opinions differ with myxedema coma and the initial dosing, but overall there is an initial dose of Levothyroxine(T4) and then if needed, Liothyronine(T3).
Pt presents to the office with a c/o dysphagia. Pt states that have been having fatigue, bone pain, muscle spasms, and diarrhea. Upon examination, a lump was found on their thyroid, when tapping the cheek the muscle twitches, and they have QRS prolongation. Identify the neoplasm found in this pt and the hormone elevated in serum.
What is Medullary Carcinoma and you would see an increase in serum Calcitonin? This pt is showing signs of hypocalcemia which can be caused by an overabundance of Calcitonin. This neoplasm is of the parafollicular cells which produce Calcitonin. If the pt had hyperPTH, then they would show kidney stones, polyuria, bone pain, abdominal pain, and muscle weakness(symptoms of hypercalcemia).
Obj. 7467
Pt presents to the office with the c/o flushing and heating in the past. Pt states that they started a new medication that increases their HDL and lowers their LDL levels. PMHx indicates that they have T2DM. Identify the medication that this individual is taking and whether they should continue taking it.
What is Niacin which they should discontinue due to having T2DM? Niacin can cause hyperglycemia and hyperuricemia which means that those with gout and/or DM should avoid this drug due to the increased risk of severe adverse effects.
Obj. 7221
Pt has been diagnosed with acute cholecystitis. During the visit, the pt confirms that they have RUQ pain that radiates to their shoulder. Explain the reflex pathway of this phenomenon.
What are afferent signals from the visceral organ moving into the dorsal horn, synapsing, and sending efferent signals to the somatic structure and musculature of the right shoulder which will exhibit pain?
Obj. 7449
Newborn pt presents with FTT. Labs indicate, decreased renin levels, hyponatremia, hyperkalemia, and Type IV Renal Tubular Acidosis. Identify the additional characteristics of this pt if they were female.
BONUS! There is a buildup of _______ in this pt (intermediate in steroid hormone genesis)
What are ambiguous genitalia and clitoromegaly? If this was a milder case, the pt would exhibit in their adolescence with hirsutism, irregular menses, and precocious puberty. Males will have normal genitalia but have precocious puberty. Tx includes corticosteroid and mineralocorticoid replacement
Bonus! There is a buildup of 17-hydroxyprogesterone due to the 21-beta hydroxylase deficiency.
Obj. 7432
Pt presents to the office with c/o nervousness, palpitations, tremor, and weight loss. Pt states that this has started recently and there have been so FMHx of any of these symptoms. Upon further examination, it was found that this pt has been a nuclear scientist at a plant for 10 years, with a recent accident with radioactive iodine. Labs show low TSH, elevated T3, and minimally increased free T4, so it is decided to order a radioactive I131 thyroid scan. Describe the findings in this scan and tx.
What is heterogeneous uptake on thyroid scan showing some areas of increased uptake and others with decreased uptake with the tx being antithyroid medications? The presentation and labs indicated a pt with toxic multinodular goiter since it is a pt with recent exposure to radioactive iodine. Moreover, since it is multinodular, it will have different areas of TH production so that is why there is an heterogeneous pattern on the thyroid scan.
Obj. 7420