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USMLE Endocrine

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poxidicu's version from 2016-04-10 16:09

Nodal

Question Answer
Atria electric patternWave
Phase 0Large increase in calcium influx (Na channels are permanently inactivated d/t less negative resting voltage of these cells)
Phase 2NONE
Phase 3inactivation of Ca channels and ↑ activation of K channels → ↑ K efflux
Phase 4slow diastolic depolarization with inward sodium flow
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Ventricles

Question Answer
Ventricle electric patternMountain
Phase 0Depolarization - Rapid Na influxINa
Phase 1inactivation of Na channels, K channels begin to open and increased outflow of K
Phase 2plateau Ca inward equal to K outward - ICa & EK; Ca release from sarcoplasmic reticulum → myocyte contraction
Phase 3Repolarization - massive EK through slow channels and closure of Ca channels. Inward calcium current & K rushes out
Phase 4Resting potential - high K permeability through K channels
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Glut Transporters

Question Answer Column 3
Glut 1Erythrocytes, Blood brain barrierBasal Glucose Transport
Glut 2B pancreatic cells/Renal tubular cells/hepatocytesRegulation of insulin release
Glut 3Placenta, NeuronsPlacental & Neuronal Glucose transport
Glut 4Skeletal Muscle, AdipocytesInsulin only responsive to mediate glucose uptake
Glut 5Spermocytes, Gi TractFructose Transport
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Brain

Question Answer
Pure motorPosterior limb of Internal Capsule
Pure SensoryVentroposterolateral or Ventroposteromedial thalamus
AtaxiaBase of pons
Dysarthria - clumsy hand syndromeBase of pons or genu of internal capsule
Hypoxic EncephalopathyCardiac arrest/shock
Hypoxic Encephalopathy affectsPyrimadal cells of hippocampus/ Purkinjee cells/ Anterior & Middle Cerebral Arteries
Hypertensive EncephalopathyCerebral Edema, headaches, nausea/vomiting
Charcout Bouchard<1mm, Long standing Hypertension
Lacnuar infarcts/ Hypertensive arteriolar sclerosis<15mm, later ct scan shows Cavity, Sudden weakness, CT scan normal
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Colon

Question Answer
APCInitial growth of polyp from normal colonic mucosa
DCCFinal step of adenomatous polyps into adenocarcinoma
K-rasResponsible for unregulated growth and size in polyps
p53Mutation triggers the final step of adeno - carcinoma sequence
MSH2Mismatch repair HNPCC/Lynch Syndrome
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Inducer vs Inhibitor

Question Answer
FluconazoleInhibitor
OmeprazoleInhibitor
CimetidineInhibitor
AzithromycinInhibitor
MacrolidesInhibitor
Grapefruit JuiceInhibitor
IsoniazidInhibitor
BarbituatesInducer
RifAMPinInducer
GriseofulvinInducer
CarbamazepineInducer
Chronic AlcoholInducer
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Sexual

Question Answer Column 3
H.DucreyiMultiple and deep ulcers, Base has gray to yellow exudate, clump in long parallelPainful
HSV1&2Multiple small grouped ulcers, Shallow erythematous base, Multinucleate giant cells and intranuclear lesionsPainful
Klebsiela inguinaleIntracytoplasmiccysts, base with granulation tissuePainless
Treponema pallidumclean base, single indurated well circumcised ulcer, corkscrew shaped thinPainless
Chlamydia TrachomatisSmall shallow ulcers, heal rapidly, intracytoplasmic chlamydial inclusion bodies present in epithelial cellsPainless
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DNA

Question Answer
HelicaseUnwinding of double helix
Topoisomerase IIRemoval ofsupercoils
Single-strandedDNA- binding proteinStabilization of unwound template strands
Primase(RNA polymerase)Synthesis of RNA primer
DNA polymerase III5' TO 3' DNA synthesis & 3' to 5' exonuclease activity) & replaces it with DNA
DNA polymerase ISame as DNA polymerase III, also removes RNA primer & replaces it with DNA
DNA ligaseJoining of Okazaki ligaments(lagging strand)
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E.coli

Question Answer Column 3
LipopOlysaccharideMacrophage activation causes widespread release of IL-1, IL-6, TNF-aBacteriemia & septic schock
K1 capsular polysaccharidePrevents phagocytosis & complement mediated lysisNeonatal meningitis
Verotoxin(Shiga like)Inactivates 60s ribosomal halting protein synthesis & cell deathGastroenteritis(BLOODY)
Heat stable/Heat labilePromotes fluid & electrolytes secretion from intestinal epitheliumGastroenteritis(WATERY)
P.FimbriaeAllows adhesion to uroepitheliumUrinary tract infections
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Portacaval

ClinicalPortal ciruclationSystemic circulation
Esophageal varicesLeft gastric veinEsophageal vein
HemorrhoidsSuperior rectal veinMiddle & inferior rectal veins
Caput medusaeParaumblical veinsSuperficial & inferior epigastric veins
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MEN

QuestionAnswerMnemonic
MEN1Pituitary/parathyroid/pancreatic (ZE/insulinoma/VIP/glucagonomas/kidney stones/stomac ulcers)Diamond
MEN2AMTC/pheochromocytomas/parathyroidSquare
MEN2BMTC/pheochromocytomas/oral/intestinal ganglioneuromatosis (w/Marfoid habitus)Triangle
MEN inheritanceADN/A
MEN2A/B mutationretN/A
Parathyroid tumors inMEN1/2AN/A
Pituitary tumors inMEN1N/A
Pheochromocytomas inMEN2A/BN/A
MTC inMEN2A/BN/A
Oral/intestinal ganglioneuromas inMEN2BN/A
Sipple's syndrome isMEN2AN/A
Wermer's syndrome isMEN1N/A
Zollinger Ellinger syndromeGastrinoma of pancreas/duodenumN/A
Carcinoid pathophysiologyNeuroendocrine cell tumors/usually small bowel/5-HT secretion3
Carcinoid presentationRecurrent diarrhea/cutaneous flushing/asthmatic wheezing/right sided valvular disease/5HIAA in urine/Niacin deficiency6
NeuroblastomaAdrenal medulla/sympathetic chain2
Neuroblastoma geneN-mycN/A
Neuroblastoma testHVA (dopamine metabolite) elevated in urineN/A
PPPMEN1a
MPPMEN2a
MMPMEN2b
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Thyroid Pathophysiology

ConditionDetailsNumberMnemonic
Thyroid stormMost common in Grave's1Epidemiology
Thyroid stormFever/tachycardia/arrythmias (fibs)/shock/coma5Sx
Primary hypothyroidismHashimoto/post ablation/I deficiency/drugs/subacute lymphocytic thyroidits5Differential
Drugs causing primary hypothyroidismLithium/amiodarone/sulfonamides3Differential
Secondary hypothyroidism differentialPituitary hypofunction1Definition
Tertiary hypothyroidismHypothalamic hypofunction1Definition
HypothyroidismCoarse brittle hair and nails/yellow orange skin/myxedema (non pitting edema from mucopolysaccharides3Derm Sx
HypothyroidismConstipation from low motility1GI Sx
HypothyroidismCarpal tunnel1MSK Sx
Hashimoto'sLymphocytic infiltrate/prominent germinal follicles/atrophic follicles lined w/Hurthle cells (eosinic cytoplasm epithelia)3Histology
Grave'sHyperthyroidism/opthalmopathy (exopthalmos/muscle weakness)/infiltrative dermopathy (pretibial myxedema/scaly thickening)3Sx
DeQuervain'sPreceded by flu-like (mumps/coxsackie)/early hyperthyroidism/resolving after weeks3Presentation
Grave'sDiffuse/symmetrical/nontender enlargement3Thyroid PE
DeQuervain'sJaw pain/tender thyroid/fever/no lymphadenopathy4Thyroid PE
DeQuervain'sLymphocytic infiltrate/multinucleat giant cells surrounding fragments of colloid/granulomatous3Histology
Subacute lymphocytic thyroiditisNontender thyroid1PE
Subacute lymphocytic thyroiditisLymphocytic infiltrate/prominent germinal follicles/No Hurtle cells3Histology
Subacute lymphocytic thyroiditisPostpartum women/1/3 will become hypothyroid w/in 10 years2Epidemiology
Papillary carcinomaMost common (85%)1Prevalence
Papillary carcinomaWomen/20s-30s2Epidemiology
Follicular carcinomaSecond most common (10%)1Prevalence
Papillary carcinomaLymphatic metastases1Spread
Follicular carcinomaHematologic spread1Spread
MTCSheets of cells in amyloid stroma1Histology
Papillary carcinomaEmpty appearing nuclei (Orphan Annie's eyes)/psammoma bodies (calcium collection)/nuclear grooves1Histology
MTC~5%1Prevalence
MTCRET protooncogen/70% sporadic1Genetics
Anaplastic>65 y/o1Epidemiology
Follicular carcinomaRAS/PPARg/Pax8 rearrangements3Genetics
Papillary carcinomaBRAF in non-radiation/RET/PTC in pediatric or radiation3Genetics
Papillary carcinomaChildhood radiation1Predisposition
Follicular carcinomaIodine deficiency1Predisposition
Papillary carcinomaFine needle aspiration1Diagnosis
Follicular carcinomaNot fine needle aspiration (looks like normal thyroid)1Diagnosis
Myxedema comaHypothermic stupor/coma/hypoventilation with CO2 retention/hypotension4Sx
Grave'sWomen/20s-30s2Epidemiology
Congenital hypothyroidismRespiratory (hoarse cry/weak cough/slow respiration)/abdominal distention/prolonged neonatal jaundice/poor feeding-hypotonia/macroglossia/bones (enlarged fontanelles/delayed dentition/retarded bone age)/facies (coarse/wides set eyes/broad flat nose/dry skin/pale with mottled extremities)7Sx
Thyroid adenomaFollicular epithelium derived1Pathology
Thyroid adenomaLike follicular carcinoma/difficult to distinguish2Histology
Hashimoto'sTg/TPO2Ig
Hashimoto'sCD8 cytotoxic/cytokines activate macrophages/ADCC3Mechanisms of cell death
Reidel'sFibrous tissue replaces parenchyma/fibrosis into surrounding tissue2Histology
Reidel'sPossible hypothyroidism/fixed/rock hard/painless goiter4Presentation
Grave'sLymphocytic infiltrate with germinal centers/diffuse hypertrophy and hyperplasia/coloid pale and scalloped/3Histology
Grave'sHLA-DR3/B82HLA
Grave'sDiffusely increased1I123 uptake
Toxic multinodular goiterUneven increased (hot nodules)1I123 uptake
ThyroiditisDecreased1I123 uptake
Exogenous thyroid hormone intakeDecreased1I123 uptake
Acute thyroiditisFever/painful thyroid/painful cervical lymphadenopathy3Sx
Grave'sPretibial myxedema (nonpitting edema of shins)/exopthalmos only seen in one hyperthyroid state2Specific Sx
Hashimoto'sWomen/30s/40s2Epidemiology
Wolff Chaikoff effectLarge Iodine ingestion causes organification/oxidation of iodine2Physiology
Hashimoto'sHLA-DR51HLA
Jod-Basedow phenomenonThyrotoxicosis when iodine deficiency goiter receives iodine1Physiology
DM1HLA-DR3/42HLA
Reed steen bergAmple cytoplasm, bilobed or double nuclei, inclusion like eosinophil nuclei stained in hematoxylin and eosin stain in the background of lymphocytes
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Misc Pathophysiology

ConditionDetailsMnemonic
Primary HyperalosteronismConns - Aldosterone adrenal adenomaHypertension, HypoKalemia(H+ & K excreted), Hypernatremia, High Bicarb(Metabolic alkalosis), LOW plasma RENIN
Secondary HyperaldosteronismKidney ->low blood volume-> Renin Angiotensin system ON (Renal artery stenosis, chronic renal failure, CHF, Cirrhosis)HIGH plasma RENIN
Cushing syndromeIncreased cortisolHypertension, moon facies, truncal obesity, buffalo hump, hyperglycemia, skin changes(striae)
Cushing syndrome - Cushings disease↑ACTHHigh ACTH release due to pituatry adenoma
Cushings Syndrome - Ectopic ACTH↑ACTHNon-pituitary ACTH production(Small cell lungcancer)
Cushing syndrome - Adrenal adenoma↓ACTHadenoma, carcinoma, nodular adrenal hyperplasia
Addisons diseaseLack of aldosterone & cortisolHypotension. Hyponateremia, hyperkalemia, acidosis
Addisons disease - PrimaryAdrenal atrophy or destructionConstant production of ACTH from pituatry but no EFFECT On adrenals(Skin Hyperpigmentation)
Addisons disease - Secondary↓pituitar ACTH productionNo skin hyperpigmentation and no hyperkalemia
SIADHChlropropamide/carbamazepine/cyclophosphamideDrug causes
SIADHMedications/ectopic tumor production (lung/SCC)/pumonary infection3 differential
Waterhouse Friderichsen syndromeAcute primary adrenal insufficiency/N meningitidis septicemia/DIC/endotoxic shock4
Chvostek's signTapping facial nerves elicits facial muscle contraction1
Trousseau's signOcclusion of brachial artery w/BP cuff induces carpal spasm1
Sheehan's syndromeIschemia of pituitary/postpartum bleeding/failure to lactateN/A
Empty sell syndromeAtrophy/compression of pituitary/often idiopathic/in obese womenN/A
DM1Islet leukocytic infiltrateHistology
DM2Islet amyloid (AIAPP) depositHistology
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Hip Muscles

Question Answer
Psoas MajFlexion
Psoas MinFlexion
IliacusFlexion
Rectus FemorisFlexion
Tensor Fascia LataFlexion
Gluteus MaxExtension
SemitendonusExtension
SemimembranousExtension
Biceps femorisExtension
GlutesMediusAbduction
Glutes MinimusAbduction
Adductor brevisAdduction
Adductor longusAdduction
Adductor magnusAdduction
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Immuno

Question Answer
Ataxia TelangxtasiaAtaxia, Telangactesia, Sinopulmonary Infections
Chediak HigashiOculataneous Albinism, Pyogenic infections, Progressive Neurologic Problem
Chronic GranulamatousBacterial and fungal with granulomas
Digeorge SyndromeHypocalcemia, Dysmorphic face, Congenital Heart disease
SCIDBacterial and viral infections, chronic diarrhea, Mucocutaneous candidasis
WASEasy bleeding, eczema, recurrent infections
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: Hepatocyte
Question Answer
Hepatocyte bridging necrosis/Inflammatory cell infiltrationHepatitis
Prolonged pruritius/fatiguePrimary sclerosing cholangitis
Skin pigmentation & DMHemochromatosis
Upper GI bleeding/AscitesLiver Cirrhosis
Acholic stools/Bone painPrimary Biliary Cirrhosis
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