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Endocrine: How To Use The Workbook With The Videos
Endocrine: How To Use The Workbook With The Videos
Endocrine
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2014,
watch the corresponding First Aid Express 2014 videos, and then answer the workbook
questions.
Questions
EMBRYOLOGY
1. Which structure connects the thyroid gland with the tongue? (p. 306) ________________________
2. How can you differentiate a thyroglossal duct cyst from a branchial cleft cyst? (p. 306) __________
______________________________________________________________________________
ANATOMY
3. What are the three major zones of the adrenal gland? List the major secretory product of each.
(p. 306) ________________________________________________________________________
______________________________________________________________________________
4. What is the most common adrenal medulla tumor in children? In adults? (p. 306) ______________
______________________________________________________________________________
5. What are the two divisions of the pituitary gland? Which hormones does each secrete? (p. 307) __
______________________________________________________________________________
6. What cells produce the hormones released by the posterior pituitary gland? (p. 307) ____________
7. Name the three major cell types of the Islets of Langerhans. What critical hormone is secreted by
each cell? (p. 307) _______________________________________________________________
______________________________________________________________________________
PHYSIOLOGY
8. Which tissues do not need insulin to facilitate glucose uptake? (p. 308) ______________________
______________________________________________________________________________
9. If you suspect that a hypoglycemic patient with high insulin levels is surreptitiously using exogenous
insulin, what should you test for? (p. 308) _____________________________________________
______________________________________________________________________________
10. Which two molecules control the secretion of prolactin? Are they stimulatory or inhibitory? (p. 310)
______________________________________________________________________________
11. For each of the congenital bilateral adrenal hyperplasias, indicate whether blood pressure and sex
hormone levels are increased or decreased. (p. 312)
12. What enzyme modulates the conversion of testosterone to estradiol? What enzyme modulates the
conversion of testosterone to DHT? (p. 312) ___________________________________________
15. Which kidney enzyme acts on vitamin D to activate it? (p. 314) ____________________________
16. What condition can vitamin D deficiency cause in children? In adults? (p. 315) ________________
______________________________________________________________________________
18. How do T3 and T4 control the body’s metabolic rate? (p. 316) ______________________________
______________________________________________________________________________
PATHOLOGY
19. What is the most common cause of Cushing syndrome? (p. 317) __________________________
20. For a patient who is not taking steroids, what are other potential causes of Cushing syndrome? (p.
317) __________________________________________________________________________
______________________________________________________________________________
21. What are the common clinical manifestations of Cushing syndrome? (p. 317) _________________
______________________________________________________________________________
24. Is hyperkalemia seen in primary or secondary adrenal insufficiency? (p. 318) _________________
25. What are the three common causes of Waterhouse-Friderichsen syndrome? (p. 318) ___________
______________________________________________________________________________
26. What is the “rule of 10s” for pheochromocytoma? What is the cell of origin for this tumor? (p. 319)
______________________________________________________________________________
______________________________________________________________________________
27. What are the signs and symptoms of pheochromocytoma? (p. 319) _________________________
______________________________________________________________________________
28. Compare and contrast the characteristics of hypothyroidism vs. hyperthyroidism. (p. 320)
29. List four diseases characterized primarily by hypothyroidism. (p. 320-321) ____________________
______________________________________________________________________________
30. What is the difference between de Quervain thyroiditis and Riedel thyroiditis? (p. 321) __________
______________________________________________________________________________
31. List some diseases characterized primarily by hyperthyroidism. (p. 322) _____________________
______________________________________________________________________________
32. What are the four types of thyroid cancer? Which is most common? (p. 323) __________________
______________________________________________________________________________
34. What does the mnemonic “stones, bones, groans, and psychiatric overtones” stand for? (p. 323)
______________________________________________________________________________
______________________________________________________________________________
37. What are the symptoms of the most common form of pituitary adenoma? (p. 324) ______________
______________________________________________________________________________
40. What are the differences between DI and SIADH? (p. 325-326) ____________________________
______________________________________________________________________________
41. What are the acute manifestations of diabetes mellitus type 1? (p. 327) ______________________
______________________________________________________________________________
42. What are the chronic manifestations of poorly controlled diabetes? (p. 327) ___________________
______________________________________________________________________________
43. Compare and contrast the characteristics of type 1 vs. type 2 diabetes. (p. 328)
Type 1 Type 2
Associated with obesity
Genetic predisposition
Glucose intolerance
Ketoacidosis
Need for insulin
Primary defect
Sensitivity to insulin
Typical age of onset
44. How can patients with diabetic ketoacidosis be recognized by their breath? (p. 328) ____________
______________________________________________________________________________
45. What are the signs and symptoms of carcinoid syndrome? (p. 329) _________________________
______________________________________________________________________________
46. Check which components are involved in the multiple endocrine neoplasias. (p. 329)
PHARMACOLOGY
47. What eight classes of drugs are used to treat diabetes mellitus? (p. 330) _____________________
______________________________________________________________________________
______________________________________________________________________________
48. What is the most feared complication of metformin? (p. 330) ______________________________
49. Which drugs are used to treat hyperthyroidism? (p. 331) _________________________________
50. Which drugs are used to treat hypothyroidism? (p. 331) __________________________________
51. What is the most feared complication of glucocorticoid overdose? (p. 332) ___________________
Answers
EMBRYOLOGY
1. Thyroglossal duct (a common site of ectopic thyroid tissue).
2. A thyroglossal duct cyst will move with swallowing whereas a branchial cleft cyst will not.
ANATOMY
3. Zona glomerulosa produces aldosterone, zona fasciculata produces cortisol, and zona reticularis
produces sex hormones.
4. Neuroblastoma; pheochromocytoma.
5. Posterior pituitary: ADH (vasopressin), oxytocin. Anterior pituitary: FSH, LH, ACTH, TSH, prolactin,
GH, MSH.
7. β cells produce insulin. α cells produce glucagon, and δ cells produce somatostatin.
PHYSIOLOGY
8. Brain, RBCs, intestine, cornea, kidney, and liver.
9. C-peptide is absent if the source of insulin is exogenous and present in high levels if the patient
has an insulinoma.
11.
13. CRH stimulates release of ACTH in pituitary, which prompts coritsol production in the adrenal zona
fasciculata.
15. 1α-hydroxylase.
PATHOLOGY
19. Iatrogenic steroids.
20. Cushing disease (pituitary adenoma): 70%; ectopic ACTH (e.g., small cell lung cancer): 15%;
adrenal tumor: 15%.
21. Weight gain (truncal obesity), moon facies, buffalo hump, skin thinning, striae, hypertension,
hyperglycemia, osteoporosis, amenorrhea, and immunosuppression.
26. 10% are malignant, 10% are bilateral, 10% are extra-adrenal, 10% calcify, 10% occur in kids, and
10% of cases are familial. Chromaffin cells are the cells of origin for pheochromocytoma.
27. Elevated blood Pressure, Pain (headache), Perspiration, Palpitations (tachycardia), and Pallor.
These “5 P’s” are episodic.
28.
Chest pain,
Bradycardia; dyspnea
Cardiovascular changes palpitations,
on exertion
arrhythmias
T3 uptake ↓ ↑
30. de Quervain (subacute) thyroiditis is a self-limited type of hypothyroidism that follows a flu-like
illness. Riedel thyroiditis involves fibrous replacement of the thyroid.
32. Papillary thyroid carcinoma (most common), follicular, medullary, and anaplastic.
34. Renal calcium stones, osteitis fibrosa cystica of bones, depression, and abdominal complaints
(groans due to constipation).
35. In hypoparathyroid patients, tapping of the facial nerve causes the facial muscles to contract.
36. In hypoparathyroid patients, occlusion of the brachial artery causes carpal spasm.
38. Water deprivation test: urine osmolality doesn’t increase in response to water deprivation.
Response to desmopressin can distinguish between central and nephrogenic DI.
39. Ectopic ADH (e.g., small cell lung cancer), CNS disorder/head trauma, pulmonary disease, and
drugs such as cyclophosphamide.
40. DI denotes lack of ADH; SIADH denotes too much ADH. DI is characterized by intense thirst and
polyuria, with high serum osmolarity and low urine concentration. SIADH is characterized by
excessive water retention, with high urine osmolarity and low serum osmolarity.
41. Polydipsia, polyuria, polyphagia, weight loss, DKA, and exacerbation of hyperglycemia due to
unopposed GH and epinephrine secretion.
43.
Type 1 Type 2
Associated with obesity No Yes
Genetic predisposition Weak Strong
Glucose intolerance Severe Mild to moderate
Ketoacidosis Common Rare
Need for insulin Always Sometimes
Primary defect Destruction of β cells Increased resistance to insulin
Sensitivity to insulin High Low
Typical age of onset <30 years >40 years
44. Increased ketogenesis results in accumulation of acetone and other ketones; when exhaled,
acetone gives breath a fruity odor.
45. Diarrhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease.
46.
PHARMACOLOGY
47. Insulin, biguanides, sulfonylureas, glitazones/thiazolidinediones, α-glucosidase inhibitors, amylin
analogs, GLP-1 analogs, and DPP-4 inhibitors.