#usmle endocrine

[mednotecollection]

🧠 MEN SYNDROME Multiple Endocrine Neoplasia MedNote Collection --------------------------------- instagram.com/mednotecollection t.me/MedNoteCollection pinterest.com/MedNoteCollection fb.me/MedNoteCollection --------------------------------- #medicine #medical_student #doctor #mednote_collection #MedNoteCollection #usmle #mrcp #endocrinology #Genetic https://www.instagram.com/p/CqBHR-hs5QK/?igshid=NGJjMDIxMWI=

[zydea]

The usmle step 1 breakdown exam

The usmle step 1 breakdown exam is crucial for students intending to take the test. It offers an outline of the questions’ types, covered subject areas, and what to anticipate during the exam. By comprehending this breakdown, pupils can enhance their preparation for the exam. Improve their odds of succeeding in this significant examination.

The USMLE Step 1 test is a multiple-choice exam that tests the candidate’s understanding of fundamental scientific concepts related to medical practice. The exam is structured around a comprehensive content outline that emphasizes crucial principles and ideas. Throughout various bodily systems and even within a single system, there are connections and interactions taking place.

the beginning of Step 1 to guide examinees on how to approach such questions. The tutorial provides tips and strategies for interpreting the graphic and tabular material that is commonly used in clinical situations.

The first stage is intended to assess how well an individual applies fundamental scientific concepts to practical situations. This portion of the examination contains questions that necessitate understanding graphical and tabular data, distinguishing between normal and abnormal specimens at a macroscopic or microscopic level and troubleshooting problems.

A tutorial accompanies Step 1, which offers helpful suggestions on how to confront these types of inquiries. It also covers techniques for interpreting graphical and tabular materials that are often utilized in clinical settings. At the commencement of the exam, provision is made to acquaint the examinee with the test software.

It is crucial for the test taker to understand how items with audio findings work before their examination day since Step 1 interactive testing involves such items.

The most important topics included in the USMLE Step 1 are:

Anatomy

Physiology

Biochemistry

Pharmacology

Pathology

Microbiology

Behavioral sciences

Various subjects' cross multiple areas of study, such as nutrition, genetics, aging, ethics, and additional topics.

General principles

The human body is composed of various organ systems, including the hematopoietic and lymphoreticular systems, as well as the nervous and special senses systems. The skin and connective tissues form another organ system, while the musculoskeletal system supports movement. The respiratory and cardiovascular systems are responsible for breathing and circulation, respectively. The gastrointestinal system processes food, while the renal/urinary system removes waste from the body. Reproductive organs facilitate reproduction, while the endocrine system produces hormones that regulate bodily functions. Finally, the immune system defends against infectious agents.

References: Brocali.co

[medicosis]

Can you answer today’s question 🙋‍♀️?! Q: Which of the following is the most common cause of a hypersecreting endocrine gland?! 🤷‍♂️ …#physiology #pathology #endocrinologia #endocrinology #nurse #doctor #pharmacist #medical #biology #neet #usmle #nclex https://www.instagram.com/p/CpHJvwRO37n/?igshid=NGJjMDIxMWI=

[gennahas]

First aid usmle step 2 pdf

#First aid usmle step 2 pdf full

įrom the authors who helped you pass Step 1, this is your high-yield review for the USMLE Step 2 CK. Completely revised to cover all core areas on the boards, including information on newly tested patient safety and quality improvement. Bonus material and real-time updates exclusively at įrom the authors who helped you pass Step 1, this is your high-yield review for the USMLE Step 2 CK.Acclaimed recommendations for high-yield print and digital study resources.Rapid Review section for efficient last-minute preparation.Reorganized content in the Pathology, Endocrine, Hematology and Oncology, and Neurology chapters for more intuitive learning.1,200+ color photos and illustrations-200 new or revised-help you visualize processes, disorders, and clinical findings.1300+ must-know topics with mnemonics to focus your study.Written by students who excelled on their Step 1 exam and reviewed by top faculty for accuracy.A complete framework for USMLE® Step 1 preparation, annually updated with crowdsourced contributions from thousands of students.First Aid Cases for the USMLE Step 1 aims to directly address this need.ĮXCEL ON THE USMLE® STEP 1 WITH HELP FROM THE WORLD’S MOST POPULAR MEDICAL REVIEW BOOK! Trust the First AidTM team to help you score your highest on this high-stakes exam INSIDER ADVICE FOR STUDENTS FROM STUDENTS There are two types of review books: those that are stand-alone titles and Charts and diagrams maybe the best those that are part of a series. A completely updated listing of top-rated review sources INSIDER ADVICE FOR STUDENTS FROM STUDENTS.Revised study and test-taking strategies.Hundreds of full-color photographs and illustrations.Updated Rapid Review section facilitates last-minute cramming.Expert coverage of best initial steps in diagnosis and management.Key Facts and mnemonics reinforce must-know concepts.Concise summaries of more than 1,000 commonly tested clinical topics for fast, high-yield study.Co-written by students who excelled on the recent exam and reviewed by top faculty.Included is a host of learning tools, from key facts and mnemonics to full-color illustrations and proven test-taking strategies-everything students need to pass the exam with flying colors. With an easy-to-follow bulleted presentation of must-know diseases and disorders, this one-of-a-kind study companion offers the most current overview of all core areas on the boards. The most comprehensive and up-to-date high-yield review available for the USMLE® Step 2 CK - completely revised and better than ever! The expert author team that guided students to success on the USMLE® Step 1 presents the latest edition of this skill-sharpening review for the USMLE® Step 2 CK. Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product. Publisher: McGraw-Hill Education / Medical With an easy-to-follow bulleted presentation of must-know diseases and. The expert author team that guided students to success on the USMLE® Step 1 presents the latest edition of this skill-sharpening review for the USMLE® Step 2 CK. Completely revised to cover all core areas on the boards, including information on newly tested patient safety and quality improvement topics, First Aid for the USMLE Step 2 CK: Ninth Edition features: High-yield, bulleted presentation of diseases and disorders you need to remember Integrated flash-facts in margins test your knowledge at the point of learning Embedded case vignettes test your application of knowledge Key facts and mnemonics reinforce essential information Rapid-review section for last-minute cramming Includes hundreds of color clinical images and illustrations Market: US medical students (18,500/yr.) and foreign medical graduates (12,500/yr.) preparing for the USMLE Step 2 CK About the Author: Tao Le, MD (Louisville, KY) and Vikas Bhushan, MD

#First aid usmle step 2 pdf full

The ninth edition represents a thorough revision in many ways and includes: □ Full color images designed for .įrom the authors who helped you pass Step 1, this is your high-yield review for the USMLE Step 2 CK. With the ninth edition of First Aid for the USMLE Step 2 CK, we continue our commitment to providing students with the.

[mariesstudycorner]

Diseases of the thyroid gland

------------------------

Chapter 2 : Thyroiditis.

-----------------------

Thyroiditis:

Inflammation of the thyroid gland that it can be:

1. Acute : bacterial infection

2. Subacute : ➡ painful : Viral (De Quervain's )

➡ silent (painless) : postpartum. Autoimmune.

3. Chronic: Hashimoto's & Riedel's

4. Other: Amiodarone and thyroiditis

------------------------------

De Quervain's:

🔮 follows a viral illness.

🔮 also called : subacute granulomatous thyroiditis.

🔮 clinical features:

🎯 prodromal phase lasts few weeks : fever, flu-like illness.

🎯Transiet hyperthyroidism ➡ euthyroid state ➡ hypothyroid state.

The transiet hyperthyroidism is due to the leakage of hormones from the inflamed gland.

🎯 Painful, tender thyroid gland. Maybe enlarged

🎯 ⏬⏬ Radioiodine uptake

🎯 ⏫⏫ ESR

🔮 Treatment.

🚨 Mild symptoms : NSAIDs and Aspirin

🚨 More severe: Corticosteroids

🔮 Recovery:

Most patient have recovery within few months to 1 year.

--------------------------------------

Hashimoto thyroiditis:

🔮 Chronic lymphocytic thyroiditis.

🔮 Most common cause of autoimmune thyroid disorder.

🔮 More common in women

🔮Causes:

🔆 Genetic

🔆 Antithyroid antibodies.

🔮 Clinical manifestation:

🎯 Goiter

🎯 Hypothyroidism often later in the disease.

🔮 Normal thyroid lab works unless hypothyroidism is present.

🔮 Antithyroid antibodies:

Antiperoxidase antibodies (in 90% of patients)

Antithyroglobulin antibodies (in 50% of patients)

🔮Treatment : Thyroid hormone

--------------------------------------------

Reidel thyroiditis:

🔮 Fibrous tissue replaces the thyroid tissue ➡ firm thyroid.

🔮 The fibrosis doesn't stop at the thyroid gland but it can destroy nearby tissue.

🔮 in severe cases the parathyoid, trachea and muscles, nerves fuse together into one solid fibrous mass :(

🔮 Symptoms:

🎯 Goiter (hard like a rock) ➡ pressure on surrounding structures ➡ shortness of breath & Dysphagia.

🎯 Voice hoarseness.

🎯Hypothyroidism symptoms :

Lack of energy

Constipation

Dry skin

Cold intolerance.

🔮 Diagnosis:

⏬ thyroid hormones

Enlarged gland on Ultrasound/ CT-scan / MRI

On tissue biopsy : Fibrous tissue & ⏫ T-cells & IgG 4 antibody-producing plasma cells.

🔮Treatment:

Corticosteroids

Thyroid hormone

Surgery

[drawittoknowitmedical]

Can you show the pathway to Growth Hormone release from the anterior pituitary? Review the flashcard at the link to learn more about growth hormone regulation and effects throughout the body!

By Fall 2020, we'll be releasing hundreds of these exercises on our website!

[physiologyopen]

Biosynthesis of thyroid hormones

Thyroid hormones are iodinated tyrosine which is an amino acid.   Synthesis of thyroid hormones occurs in multiple steps 

 1. Synthesis of thyroglobulin: Thyroglobulin is synthesised by follicular epithelial cells just like any other protein synthesis by cells and is secreted into the colloid by exocytosis. So this protein is stored in the colloid. 

 2. Trapping and transport of iodide: Iodine is present in circulation as iodide ion. This iodide is taken up into the cytoplasm by NaI- symporter which is a secondary active transporter present on the basolateral membrane of thyrocytes. This Iodide then enters into the colloid via the apical membrane through the Cl-/I- exchanger which is also known as ‘pendrin’ 

 3. Organification: So now we got both iodide and thyroglobulin in the colloid. However, the iodide cannot react with tyrosine residues. For that it should be oxidised to iodine. So this process of oxidation of iodide to iodine and iodination of the tyrosine residues of the thyroglobulin is known as organification.  This occurs in presence of the enzyme thyroid peroxidase present on the apical membrane of thyrocytes.  Many tyrosine residues of thyroglobulin are iodinate either at single site forming monoiodotyrosines i.e MIT or two sites forming diiodotyrosines i.e DIT. 

 4. Coupling reaction: MIT and DIT are not thyroid hormones. It is the coupling or combination of these iodinated tyrosines which produces thyroid hormones. One MIT and one DIT couple to form triiodothyronine i.e. T3 and 2 DITS couple to form Tetraiodothyronine i.e T4 or thyroxine in presence of enzyme thyroid peroxidase. This is known as coupling reaction. 

So basically, thyroid hormones form within the thyroglobulin molecule.

When the gland is stimulated by Thyroid stimulating hormone, all these steps of synthesis of thyroid hormones i.e  synthesis of thyroglobulin, uptake of iodide, organification and coupling reaction are stimulated. 

Also, the follicular cells start taking up the stored iodinated thyroglobulin from the colloid by endocytosis. Intracellularly lysosomes fuse with the phagocytosed thyroglobulin and cleave T3 and T4 from thyroglobulin by proteases which are then released from the basolateral side and enter into the circulation. The separated amino acids are reused to produce thyroglobulin. The MIT and DIT which are not coupled are acted upon by the enzyme ‘deiodinase’ which as its name suggests detaches the iodine from the tyrosine both of which are recycled. 

[medicallife0]

Make your learning interesting ❤ . Hit the like button ❤and follow↗️ my page if you like ❤my contant.. .Mention your friends to see this if you like Do Like ❤ Share 👥 Comment Your Thoughts💬 : Love Our Posts? Turn On Post Notifications For New Post Updates🔔 . #usmle #usmlestep1#usmlestep2 #usmleprep #doctor #doctorsofinstagram#likeforlikes #love #medicine #endocrine #followme #surgery #estudiantemedico #futuredoctor#futuremd #medico #mbbs #medstudent #medstudentlife#medschool #nclex #premed #medlife #nurse #nursingschool #cardiology #medicalguidelines #anatomy, https://www.instagram.com/p/B7Szx55hwGd/?igshid=1grz8rjzzmgf7

[lifeofayoungdoctor]

I should be sleeping 😭

It's 1:24am and I have an exam at 9am. Rarely do I stay up this late in general but tonight I am STRESSING! Going to bed now...

[medschooltutors]

You probably haven’t worried this much about hormones since middle school. Luckily, this time it’s much less confusing.

[thebiomics]

Remember WBCs with percentage White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are found throughout the body, including the blood and lymphatic system. These broadest categories can be further divided into the five main types: neutrophils, eosinophils (acidophiles), basophils, lymphocytes, and monocytes.These types are distinguished by their physical and functional characteristics. Monocytes and neutrophils are phagocytic. #usmle #usmlestep1 #usmlestep2 #usmleprep #md #doctor #doctorsofinstagram #hospital #medicine #endocrine #surgeon #followforfollow #clinicals #surgery #medico #mbbs#medstudent#pathology #microbiology #anatomy #physiology #biochemistry #ent #gynaecology #obstetrics https://www.instagram.com/p/CAHHik6jH1e/?igshid=mgvz8yqkx5gn

[emgoesmed]

1/6/2022

My school is insisting we have our exams in person next Friday, but I haven't heard anything about contingency plans for students who test positive... which I think a lot of students will, unfortunately. Everything is a mess and I'm just trying to work on endocrine material and get back on track with step studying.

What is the most important thing that is going to happen to you this year?

I’m going to take USMLE Step 1 in April. I can’t believe it’s happening so soon! The only reason I’m not panicking 24/7 is because it's Pass/Fail haha.

Would you rather live in a world where it is always winter or always summer?

Always summer. I could always have fresh vegetables and fruit, and spend lots of time outside.

What is the weather like during the winter in your country?

There is a lot of variation across the country. Where I live it's typically cold, snowy, and icy, but that's changing somewhat because of climate change.

[medicosis]

Can you answer today’s question? Q: Why does pheochromocytoma cause pallor? 🤔🧐

👉 The answer is on my “tachycardic” website 😉...#medicine #pathology #physiology #anatomy #cardio #nurse #pharmacist #tumor #doctor #usmle #medschool

[mariesstudycorner]

Diseases of the thyroid gland

----------------------------------

Chapter 1 : Hyperthyroidism.

-----------------

We're going to discuss:

What is Hyperthyroidism?

Causes of hyperthyroidism?

Clinical manifestation.

Lab works

Other investigations

Treatment

What is a thyroid storm?

----------------------------------------

What is hyperthyroidism?

It is a state where there is ⏫ synthesis of the thyroid hormones : T4 & T3 ➡ ⏫ levels of these hormones in the blood.

-------------------------------

Causes:

Graves' disease (diffuse toxic goiter)

Plummer disease (multinodular toxic goiter)

Toxic thyroid adenoma (single nodule)

Subacute thyroiditis & Hashimoto thyroiditis. (Transient hyperthyroidism)

Fetal thyrotoxicosis

Other rare causes:

- postpartum thyroiditis (transiet)

- Iodine-induced hyperthyroidism.

- Excessive dose of levothyroxine.

------------------

1. Graves' disease:

Autoimmune disorder.

Thyroid-stimulating immunoglobulin TSI (IgG) binds to the TSH receptors on the thyroid cells ➡ triggers the synthesis of excess thyroid hormones.

Younger women >

Goiter : every thyroid cell is hyperfunctioning so it affects ALL parts of the gland >> diffuse. Non tender

2. Plummer disease:

Starts with chronic lack of dietary Iodine ➡ low levels of T4 ➡ triggers high levels of TSH ➡ Thyroid hypertrophy & hyperplasia.

The growth is uneven >> nodules.

These nodules become toxic when a genetic mutation happens and causes TSH recepters to be constantly ON. >> ⏫⏫⏫ T4/T3.

That elevation acts as a negative feed back to the pituitary gland to secrete less TSH >> the rest of the thyroid is not functioning >> atrophy .

3. Adenoma : 2% of all cases.

4. Thyroiditis:

Inflammation of the thyroid gland >> releasing the previously synthesized thyroid hormones ➡ temporary ⏫⏫ in circulating T4/T3.

A hypothyoid phase may follow.

5. Fetal thyrotoxicosis:

Classically in an infant born to a mother with Graves disease. TSI are IgG and can cross the placenta.

--------------------------------------------

Clinical manifestations : Symptoms

Nervousness.

Irritability

Insomnia.

Fine tremor

Hyperactivity

Heat intolerance & excessive sweating.

Weight loss despite increased appetite.

Proximal muscle weakness.

Palpitations.

Signs:

On the thyroid glad:

Graves' : diffusely enlarged. symmetric . Nontender gland. Bruit may be present.

Subacute thyroiditis: exquisitely tender. Diffusely enlarged (viral illness)

Plummer: bump. Irregular . Asymmetric gland.

Toxic adenoma: single nodule with atrophic gland.

Extrathyroidal:

Eyes: - Edema of the extraocular muscles ➡ proptosis (hallmark of Graves') - lid lag - lid retraction

- corneal exposure ➡ excessive tearing.

Cardiovascular effects: ⏫ Blood pressure.

- Arrhythmias : Sinus tachycardia - Atrial fibrillation

Skin: Warm & moist - pretibial myxedema (specific to Graves')

Neurologic: Hyperreflexia - fine tremor.

-----------------------------------

Lab works:

⏬⏬ TSH

⏫⏫ free T4 & FT3

Other investigations:

1. RAIU:

Radioactive iodine uptake scan.

Useful to differentiate the causes of hyperthyroidisim.

If the uptake is ⏫look for the findings (forms):

Diffuse ( homogeneous) ➡ Graves'

Heterogeneous (multiple nodules of ⏫uptake) ➡ plummer

Focal (one area of ⏫ uptake w/suppression of rest of the gland) ➡ adenoma (hot nodule)

No RAIU findings (⏬⏬uptake) we look at serum thyroglobulin:

⏫ ➡ Thyroiditis /iodine exposure / extraglandular production

⏬ ➡ Exogenous thyroid hormone.

2. Radioactive T3 uptake:

Gives information about the status of TBG

We give resin to the patient + radioactive T3.

Radioactive T3 will bind to resin only when there is no space left on TBG.

SO WHEN THERE IS ⏫T4 ➡ no available seats on TBG ➡ more radioactive T3 will bind to resin ➡ ⏫ radioactive uptake.

The importance of this is to know if there is true hyperthyroidism or increased TBG

High TBG production ➡ low radioactive T3 uptake.

3. Free thyroxine index (FTI) :

Proportional for FREE T4 concentration.

Calculated to correct for the changes in the thyroid binding proteins.

FTI : ( Radioactive T3 uptake × serum total T4) /100

FTI : (patient's radioactive T3 uptake / normal radioactive T3 uptake) × total T4

Normal : 4-11

--------------------------------------------

Treatment :

1. Pharmacologic:

🎐Immediate control of adrenergic symptoms:

B-blockers (propanolol)

🎐 Anti-thyroid drugs: Thionamides

Methimazole:

1- Inhibits thyroid peroxidase ➡ stops the oxidation of Iodide into Iodine

2- Inhibits the coupling of DIT and MIT to form T3 & T4.

PTU (propylthiouracil) :

Shares the same mechanism with Methimazole except that PTU works on the peripheral tissue by

- Inhibiting the converting of T4 into T3.

⚠ Watch for side effects⚠

⚠Agranulocytosis

⚠Skin rash

⚠Arthralgias

Specific ⚠ for PTU is:

Hepatotoxicity.

During pregnancy:

Both can cross the placenta but it is preferred to give:

PTU at the first trimester

Methimazole at the 2nd and 3rd trimester.

Sodium ipodate or iopanoic:

Lowers serum T3 & T4 levels and causes rapid improvement of hyperthyroidism.

Appropriate for acute management of severe hyperthyroidism that's not responding to conventional therapy.

2. RAI ; Radioactive iodine:

Causes destruction of thyroid follicular cells.

Uses IODINE 131

Most common for: Graves' disease & multi-nodular goiter.

If the first dose doesn't control the hyperthyroidism within 6 to 12 months then administer another dose.

✔ Selected pations ✔

✔ Elderly patients w/Graves disease.

✔ Solitary toxic nodule

✔ Patients w/graves disease in whom therapy w/antithyroid drugs fails.

⚠ Warning ⚠

⚠ Hypothyroidism over time in the majority patients. ⚠

Note :

Ophthalmopathy can worsen after RAI prevent that by prophylactic therapy w/prednisone in high-risk patients.

3. Surgery:

Very effective

Only 1% of patients are treated by it.

Often reserved w/patients that have large goiters ; more common in toxic multinodular goiter.

⚠ Side Effects ⚠

⚠ permanent hypothyroidism 30%

⚠Recurrent laryngeal nerve palsy 1%

⚠Permanent hypoparathyroidism 1%

⚠ watch for hypocalcemia (due to inflammation/removal of the parathyroid glands)

------------------------------------------

Treatment plan :

Immediate control of adrenergic symptoms (of any cause) ➡ (beta-blocker) propanolol

Non-pregnant patients w/Graves' disease: beta blocker + Methimazole Taper B-blocker after 4-8 weeks (once methimazole takes effect) give methimazole for 1-2 years then measure TSI at 12 months : ✔ Absent ➡ discontinue therapy. ✔ Relapse ➡ Resume methimazole for 1 more year or radioactive therapy.

Pregnant patients w/Graves' disease : Endocrinology consult is indicated before starting treatment.

Toxic multinodular goiter or Toxic adenoma: RAI or surgery Methimazole pretherapy for surgery and before RAI in selected patients.

------------------------------------

What is a thyroid storm?

Rare, life-threatening complication of thyrotoxicosis.

Characterized by an acute exacerbation of the manifestations of hyperthyroidism.

There's usually a precipitating factor: infection, DKA, stress (Surgery, illness, childbirth)

High mortality rate

Clinical manifestations:

✔ Marked fever

✔ Tachycardia

✔ agitation

✔ Confusion

✔ GI symptoms (nausea , vomiting , diarrhea)

Treatment:

Provide supportive therapy : IV fluids , cooling blankets and glucose

Give antithyroid agents (PTU preferred due to its peripheral effects) followed w/iodine.

B-blockers

Dexamethazone (steroids) to impair peripheral generation of T3 from T4 and to provide adrenal support.

-------------------------

Wow that was a long one XD

I tried to include all the important stuff :)

Resources:

First-aid

Kaplan lecture notes 2019

Medscape

Pocket medicine

Step-up to medicine.