bananas's version from 2015-07-16 00:42

Thyroid Cancer

Question Answer
MC Thyroid cancer?Papillary carcinoma
Papillary carcinoma: Orphan Annie nuclei
- Empty nuclei with central clearing

[ Papi like Daddy Warbucks ]
Papillary carcinoma: Psamomma bodies

[Momma and Papi]
RET and BRAF mutationsPapillary carcinoma
What is the treatment for Papillary carcinoma?Sorafenib: Kinase inhibitor
2nd MC thyroid cancer?Follicular carcinoma
How does Follicular carcinoma invade?Through the thyroid capsule
How does Follicular carcinoma metastasize?Hematogenously!!
RAS and PAX8-PPAR1Follicular carcinoma
Associated with MEN2A and MEN 2B RET mutationsMedullary carcinoma
Medullary carcinoma is derived from which cells?Parafollicular c cells: secrete Calcitonin
Calcitonin: causes HypocalcemiaMedullary carcinoma: proliferation of parafollicular C cells
Medullary Carcinoma: Sheets of cells in aMyloid stroma
What type of thyroid cancer has the worst prognosis?Undifferentiated / Anaplastic carcinoma
Rock hard thyroid in older patientsUndifferentiated / Anaplastic carcinoma
Which type of cancer is associated with Hashimoto thyroiditis?B Cell Lymphoma
What are common complications of thyroidectomy?1. Hypocalcemia: remove parathyroid glands
2. Hoarseness: damage laryngeal nerves
Activation of receptor tyrosine kinase?Papillary and Medullary
MEN 2AMedullary thyroid carcinoma
Parathyroid adenoma
MEN 2BMedullary thyroid carcinoma
Mucosal neuromas
+ Marfenoid


Question Answer
What are common causes of Primary Hyperparathyroid?Parathyroid Adenoma (MC... MEN1 and MEN2a)
↑Ca++ ↑PTH ↑ALP ↑cAMP in urinePrimary hyperparathyroid
Why is cAMP high in the urine with primary hyperparathyroid?PTH stimulates Gs → AC: ATP→cAMP
What are the key findings of Primary hyperparathyroid?Hypercalcemia:
Psychiatric overtones
What kind of renal stones develop in Primary hyperparathyroid?Calcium oxalate (due to ↑Ca++ in the urine
What bone deformities develop in Primary hyperparathyroid?Osteitis fibrosa cystica
- Cystic bone space filled with brown fibrous tissue
↓Ca++ ↑PO4- ↑PTH ↑ALPSecondary Hyperparathyroid
What is the cause of Secondary Hyperparathyroidism?Chronic Renal Insufficiency
- No vitamin D: ↓Ca++
- Can't excrete PO4 → PO4- binds free Ca++
Acute pancreatitisHyperparathyroidism: ↑Ca++ stimulates pancreatic enzymes
What is the most common congenital cause of Hypoparathyroid?DiGeorge
- Failure to form the 3rd and 4th pharyngeal pouch!
What are common causes of Hypoparathyroid?Surgical excision
↓Ca++ ↓PTHHypoparathyroidism
What are signs of Hypoparathyroid?Tingling and Numbness
↓Ca++ ↑PTHPseudo-Hypoparathyroid
Contraction when tapping facial nerveChvostek Sign: Hypoparathyroidism
Carpal spasm when brachial artery is occludedTrousseau sign: Hypoparathyroidism
Cause of PseudohypoparathyroidAlbright osteodystrophy:
- Kidney is unresponsive to PTH due to defective Gs protein
Short 4th and 5th fingersAlbright Osteodystrophy (Pseudohypoparathyroidism)

DM Drugs

Question Answer
lisprorapid acting insulin
aspartrapid acting insulin
regular insulinquick (but not rapid) acting insulin
NPHintermediate insulin
glarginelong-acting insulin
detemirlong-acting insulin
tolbutamide1st generation sulfonylurea
chlorpropramide1st generation SU
1st generation SU SE?disulfiram rxn
mechanism of SU?closes K channels > cell membrane depolarizes > ca influx > release of insulin
metforminbiguinide; decreased gluconeogenesis, increased glucose uptake
SE of metforminlactic acidosis ∴ contraindicated in renal failure
glitazones mech↑ insulin sensitivity via PPAR-γ receptor (transcription factor)
glitazones SEweight gain, edema, hepatotox, CV tox
acarboseα-glucosidase inhibitor
miglitolα-glucosidase inhibitor
pramlintideamylin analog > ↓ glucagon
exenatideGLP-1 analog > ↑ insulin and ↓ glucagon
exenatide SEpancreatitis
propylthiouracilinhibits thyroperoxidase; also decreases peripheral conversion of T4 to T3!; use propylthiouracil if pregnant
SE of hyperthyroid drugsskin rash, agranulocytosis, aplastic anemia
methimazoleinhibits thyroperoxidase; safer but teratogen
demeclocyclineADH blocker; used for SIADH; can cause DI; member of tetracycline family > photosensitivity, bone and teeth abnormalities
glucocorticoid mechinhibits phospholipase A2 > less of all inflammatory molecules