Thyroid/Parathyroid
Patient 1: cold intolerance, weight gain
Patient 2: heat intolerance, weight loss
Patient 3: hypercalcemia, renal stones, constipations, bone pain/weakness, neuropsych problems
What is hypothyroidism?
What is Hyperthyroidism?
What is primary hyperparathyroidism?
1) Main lipid component is cholesterol, B100, delivers cholesterol to peripheral tissues and to liver.
2) Inhibitor of HMG-CoA reductase but doesn't affect p450 activity, lowers serum LDL cholesterol
1) What is LDL?
2) What is Pravastatin?
1) CN III, CN VII, CN X, pelvic splanchnic nerves, long pregaglionic, short postganglionic
2) T1-L2 short preganglionic, long postganglionic
1) What are the levels of the PNS? (OMM techniques to Occiput/Cranium/pelvis/sacrum)
2) What are the levels of the SNS? (any OMM technique on the vertebrae and ribs (plus ganglion inhibition, Chapman point treatment, and mesenteric lift) will affect the SNS)
1) low cortisol, low aldosterone, hyperpigmentation, hyperkalemia, metabolic acidosis, hypotension
2) low ACTH production, no hyperpigmentation, no hyperkalemia
3) metabolite can't bind to mineralocorticoid receptors
1) What is primary adrenal insufficiency? (2 types: acute and chronic)
2) What is secondary adrenal insufficiency? (cancer, exogenous glucocorts= wean off the steroids bro)
3) What is cortisone? (metabolite of cortisol. Cortisol is converted to cortisone by 11-beta-deoxysteroid dehydrogenase, but in excess cortisol production such as cushing syndrome, the enzyme cannot keep up with cortisol production= hyperaldosteronism symptoms)
1) tumor of chromaffin cells of the SNS, hypertension, headaches, hyperhidrosis, forceful heartbeats
2) islet cell tumors of pancreas, hypergastrinemia, severe ulcer disease
1) What is Pheochromocytoma?
2) What is Zollinger Ellison Syndrome? (MEN-1, surgx cures)
antithyroid peroxidase, antithyroglobulin antibodies, Hurthle cells
What is Hasimoto's thyroditis?
1) Avoid concurrent use with statins, best for reducing TG levels.
2) Increases half life of ApoAI= increased HDL, decreases VLDL production= decreased plasma LDL and TG
1) What is a Fibrate? (Gemfibrozil, Fenofibrate) discuss side effx
2) What is Niacin (Vitamin B3)? discuss side effx
1) Short reflex, prevertebral ganglion, same sympathetic nerve for both efferent and afferent signals
2) Long reflex, CNS involvment for input/signal modification, interneurons can stimulate autonomic motor neuron, and somatic alpha motor neuron at same segmental level
3) Long reflex, has CNS involvement for input/signal modification. Dysfxn at a vertebral level causes somatic afferent signal back to spinal cord through posterior root.Efferent neurons synapse with interneuron and communicate with the viscera, traveling through the splanchnic nerves causing dysfxn at organ
1) What is a Viscerovisceral reflex?
2) What is a Viscerosomatic reflex?
3) What is a Somatovisceral reflex?
1) hypotension, hyperkalemia, sexual ambiguity in females, decreased cortisol, increased mineralocorticoids (not necessarily aldosterone)
2) Hypertension, masculinzation, virilization decrease cortisol, decrease aldosterone, increased androgens
3) Hypertension, hypokalemia, phenotypically female but no maturation, decreased androgens, decreased cortisol, increased mineralocorticoids.
1) What is a 21-hydroxylase deficiency? (most common)
2) What is a 11-beta hydroxylase deficiency?
3) What is a 17-alpha hydroxylase deficiency?
Treatment: replace deficient enzymes and glucocorts/mineralocorts, maybe surgx for ambigious gen
1) parathyroid, pituitary, pancreas, deletion/subsitutions of long arm of chromosome 11q13
2) Medullary thyroid cancer, parathyroid, pheo, missense substituitons of RET proto-oncogene
3) Medullary thyroid cancer, marfan habitus, mucosal neuromas, pheo, ganglionuromatosis
4) cafe au lait spots
1) What is MEN-1?
2) What is MEN-2a?
3) What is MEN-2b?
4) What is neurofibromatosis type 1? (chromosome 17 problem)
Used for thyrotoxicosis due to its ability to inhibit peripheral conversion of T4 to T3 but is extremely hepatotoxic. use in 1st trimester
What is propylthiouracil?
1) Intestine, Dietary TGs, ApoB48
2)TGs, phospholipids, cholesterol, ApoB48, ApoE
3)Endogenous TGs, ApoB100, CII, E
4) TG/Cholesterol, ApoB100, E
5) Majority Cholesterol, ApoB100
6) Phospholipids and Cholesterol, ApoAI, CII, E
1) What are Chylomicrons?
2) What are Chylomicron remnants?
3) What is VLDL?
4) What is IDL?
5) What is LDL?
6) What is HDL?
1) Majority of drainage
2) Right side of head, right upper extremity, heart, part of right lung
3)Thoracic Inlet Release, Abdominal Diaphragm Treatment, Pelvic Floor Treatment.
4) prevents edema; removes debris; bacteria, and exudate; lymphocytes/lymph nodes; proteins cholesterol.
1) What is the Left thoracic duct?
2) What is the Right thoracic duct?
3) What is the order of lymph drainage?
4) What are the roles of lymph system? (Fluid balance, waste removal, immunity, nutrition)
1) HTN in childhood to early adulthood. Treated by glucocorticoids.
2) HTN in early to middle adulthood, doesn't improve with glucocorticoids.
3) adrenal glands enlarged, severe HTN in childhood
4) 5' regulatory region of 11b-hydroxylase is fused to coding region of aldosterone synthase, control of aldosterone synthase is under the control of factors that regulate 11b-hydroxylase production.
1) What is Familial hyperaldosteronism Type I= glucocorticoid remediable aldosteronism?
2) What is Familial hyperaldosteronism type II?
3) What is Familial hyperaldosteronism type III?
4) What is the result of abnormal fusion of the CYP11B1 gene (11-b-hydroxylase) and CYP11B2 gene (aldosterone synthase)?
1) Bromocriptine and cabergoline
2) Elevated IGF-1 -> OGTT -> GH greater than 1.0 ng/mL in an adult
3) ACTH secreting pituitary tumor
4) non cancerous, vision changes, fatigue, excessive urination, headaches
1) What is a treatment of a prolactinoma? (Dopamine agonsits inhib prolactin)
2) What is acromegaly? (gigantism in kids)
3) What is Cushing Disease?
4) What is a craniopharyngioma? (vision changes= optic chiasm, fatigue= levels of TSH/ACTH affected, Exs urination= levels of ADH affected, tx= surgery)
glycosaminoglycan deposition and lymphoid infiltrates are responsible for the ophthalmopathy and dermopathy. elevated T3/T4 decreased serum TSH
What is Graves Disease?
1) Adipose Enzyme has high Km/low affinity, allowing TG removal for storage when plasma TG levels are high. ApoCIII inhibits it.
2) Specific for HDL, Chylomicron remnants, and VLDL remnants. hydrolyzes TG to FFA and glycerol
3) Synthesizes intracellular cholesteryl ester
4) Forms cholesterol esters in HDL, activated by apoAI
5) Exchanges cholesterol esters and TG b/w lipoprotein particles
1) What is LPL?
2) What is Hepatic Lipase?
3) What is ACAT?
4) What is LCAT?
5) What is CETP?
1) Supraclavicular space/Thoracic Inlet
2) Posterior Axillary Fold
3) Epigastric Area
4) Inguinal Area
5) Popliteral space6) Achilles Tendon
What are the terminal drainage sites for lymphatics?
1) Head and neck
2) Arm
3) lower ab and chest
4) lower extremity
5) leg
6) ankle and foot1) Male patient with hypernatremia, hypokalemia, bilateral adrenal adenomas asks for treatment with fewer side effects
2) increased plasma renin activity and increased plasma aldosterone concentration
1) What is eplerenone? (no gynecomastia) Spironolactone, amiloride, surgx maybe better for unilateral, but can do bilateral
2) What is secondary hyperaldosteronism? primary has a decreased PRA
1) flushing, diarrhea, asthma/wheezing, CHF, abdominal cramping, peripheral edema, heart palpitations, right sided heart failure
2) most common secretions of carcinoid
3) best initial screenings for carcinoid
1) What are the symptoms of carcinoid tumors?
2) What are serotonin and substance P? (octreotide for tx)
3) What are 5-HIAA and chromogranin A?
1) Pot-bellied, Pale, Puffy faced, Protuberant tongue, poor brain development
2) Very tender thyroid, granulomatous, self limited often follows flu like illness
3) thyroid replaced by fibrous tissue, mimics anaplastic carcinoma, IgG4 related disease, 1/3 are hypothyroid
4) thyroid gland downregulation in response to increased iodine
1) What is congenital hypothryoidism?
2) Subacute granulomatous thyroiditis (de Quervain)
3) Riedel thyroiditis
4) Wolff-Chaikoff effect
Patient was taking this class of drugs and began to experience upper respiratory tract infections.
What are PCSK9 inhibitors? Alirocumab, evolocumab
1) Patient has lower quadrant pain, chapman point discovered at the tip of the 12th rib.
2) Patient has with Barret's esophagus has a notable chapman point at the left medial 5th intercostal space
3) Chapman point location of the thyroid
4) After draining the lymps, the physician diagnoses and treats the pelvis first, with patient supine physician then applies firm pressure and rotatory motion with finger pan for 15-30 seconds, repeats with the pt prone, stops when mass disappears or tx cannot be tolerated.
1) Where is the appendix's anterior chapman point? (posterior point is 11th IC space)
2) Where is the stomach chapman point (acidic component)?
3) What is the IC space b/w 2nd and 3rd ribs close to the sternum?
4) What is the correct sequence in treating chapman points?
1) overproduction of aldosterone leading to suppression of RAAS, HTN
2) KCNJ5, most common underlying cause of primary hyperaldosteronism
1) What is primary hyperaldosteronism? (Conn's syndrome if adrenal adenoma)
2) What is Bilateral idiopathic hyperaldosteronism? (bilateral nodular hyperplasia of adrenals)
1) episodic episodes of spontaneous hypoglycemia; hypoglycemia indued confusion, anxiety, stupor, convulsions, coma; dramatic rapid reversal of CNS abnormalities upon glucose administration
2) 72 hour supervised fast, check for sulfonylureas, Endoscopic ultrasound
3) common, almost always solitary, sestamibi scan, increase PTH
4) very high hypercalcemia, vascular invasion
5) Most common cause of thyroid lymphoma
1) What is the Whipple's triad for diagnosis of Insulinoma?
2) What is the gold standard for diagnosing an insulinoma, and what is the most sensitive way to find insulinoma?
3) What is a parathyroid adenoma?
4) What are some findings of a parathyroid carcinoma?
5) What is Hashimoto Thyroditis?