Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

USLME Kiss my ass and pray > Endo/Repro Pathology > Flashcards

Endo/Repro Pathology Flashcards

(279 cards)

Start Studying
1
Q

Conn Syndrome - presentation(5)

A

Primary Hyperaldosertonism due to hyperplasia or tumor

  • hypertension
  • hyperkalemia
  • metabolic alkalosis
  • LOW plasma renin
  • transient weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Unilateral lesion of the lower vulvular vestibule

A

Bartholin cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

High risk HPV (4)

A

16 ,18, 31, 33

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Low risk HPV (2)

Distinguished by ?

A

6 , 11

DNA testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Condyloma acuminatum

A

Genital wart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lichen Sclerosis histology and timeline

Risk of cancer?

A

thinning of the epidermis and fibrosis(sclerosis) of the dermis -

postmenopause

“parchment like vulgar skin” - leukoplakia

Slight risk of squamous cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lichen Simplex Chronicus histo

Risk of Cancer

A

hyperplasia of vulval squamous epithelium
thick leathery vulva due to chronic itching and scratching

NO risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2 paths of vulvar cancer

Presentation and age

A

leukoplakia

HPV - 40-50s, dyspalstic trasnfomeation

long standing Lichen Sclerosis - >70 yrs old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Koiliocyte

A

Histology of HPV

raisin like nucleus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Erythematous pruritic ulcerated vulvar skin

A

Extramammary paget disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Histology of extramammary paget disease

Lab tests?

A

malignant epithelial cells in the epidermis

Distinguished from melanoma being
keratin +
S100 -
PAS +

NO underling carcinoma - not so w/ pagets of the breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adenosis
what is it?
higher risk for?

A

focal persistance columnar epithelium in the upper vagina (mullerin duct derived)

-normally taken over by nonketitinizing squamous epithelium of lower (1/3)
(urogenital duct derived)

Clear Cell Carcinoma risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diethylstilbestrol associated risks (2)

A

given in the 60s to help moms with pregnant

leads to in daughters

  • adenosis and clear cell carcinoma risk
  • Smooth muscle abnormalities (ectopics etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bleeding grapelike mass

Age of presentation?

A

Embryonal Rhabdomyosarcoma
- protruding from vagina or penis

<5 y.o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cytoplasmic cross striations cell

2 stains associated

A

Rhabdomyoblast
- characteristic of embryonal rhabdomyosarcoma

desmin- intermediate filament of muscle cell
myogenin- nuclear TF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

transformation zone

A

Junction in the cervix where nonkeritinizing squamous epithelium meets the single layer of columnar

Sharp change - all path occurs here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

High risk HPV characterized by what 2 gene products?

A

E6 - destroys p53
- loss of G1-> S regulation, no DNA check
E7 - destroys Rb
- free floating E2F results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

High grade dysplasia in CIN characterized by(2) - histo

A

hyperchomatic nuclei

high nuclear to cytoplasmic ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Confirmatory test w/ abnormal PAP

A

Colposcopy and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CIN I II and III compared to carcinoma in situ

A

carcinoma in situ does not regress and is full thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cervical Carcinoma risk factors (3)

A

High risk HPV
smoking (odd alone w. prostrate)
immunodeficiency - AIDS defining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Asherman Syndrome

-Path and Cause?

A

secondary amenorrhea due to loss of basalis and scarring

Due to overaggressive D and C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stem Cell of Endometrium

A

Basalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anovulatory cycle complications

Seen around

A

Cycle w/out ovulation

  • > estrogen driven proliferation building up
  • > no shedding with progesterone drop phase

Abnormal bleeding around menarche and menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cause of acute endometritis
retained products of conception
26
Presentation of acute endometritis (3
fever ab uterine bleeding pelvic pain
27
Characteristic cell looked for in chronic over acute endometritis
Plasma cell
28
Chronic endometritis caused by One additional risk of chronic over acute
retained products of conception, IUD, PID and TB Infertility
29
Endometriosis Presentation and location 1 most common 5 others
Ovary most common - dysmenorrhea and pelvic pain ``` uterine ligaments- pelvic pain pouch of douglas - pain w/ dedication bladder wall - pain w/ urination bowel serosa - ab pain and adhesions fallopian tube mucosa - scarring and ectopic risk ```
30
gun powder nodules
yellow brown endometrial tissue in soft organs
31
chocolate cyst
endometriosis in the ovary
32
Adnomyosis
endometriosis in the myometrium
33
Hyperplasia of endometrial glands relative to stroma called______ Due to
endometrial hyperplasia unopposed estrogen - no progesterone phase ->postmenopausal bleeding
34
Most important predictor for hyperplasia progression to carcinoma is
presence of cellular atypic
35
2 pathways of endometrial carcinoma
Hyperplasia- 75% Sporadic -25%
36
Histology of hyperplasia derived endometrial carcinoma Age
endometrioid 50-60s
37
Histology of sporadic pathway derived endometrial carcinoma
serous papillary structure - necrotic and concentric calcification Psammoma body formation Note: p53 associated
38
Benign neoplastic proliferation of smooth muscle arising from myometrium called what? Increased risk?
leiomyoma Estrogen exposure premenopausal women
39
Multiple well defined white whirled mass of uterus
Leiomyoma
40
Most common tumor in females
leiomyoma
41
Leiomyosarcoma only arises?
de novo - not leiomyoma derived
42
Leiomyosarcoma differs from leiomyoma due to (4)
Malignant - postmenopausal single lesion necrosis and hemorrhage (vs white whirled look)
43
functional unit of ovary
follicle
44
LH acts on what cell in the ovary to make what?
thecal androgen
45
FSH acts on what cell in the ovary to make what?
granulosa aromatase -> estrodiol
46
Polycystic Kidney Disease classic presentation
young obese woman w/ infertility oligomenorrhea infertility
47
polycystic kidney disease associated w/ what endocrine disorder? Also at risk for?
Diabetes type II 10-15 yrs later on - due to some insulin resistance seen endometrial carcinoma -high estrone levels
48
High LH and low FSH seen in ? | LH:FSH> 2
Polycystic kidney disease Systemic androgen release from LF is converted in peripheral fat to estrone instead of glomerulosa cell -> disorder leading to multiple ovarian follicular cysts
49
Coelomic epithelium
surface epithelial lining that can become cancerous
50
2 most common subtypes of surface epithelial tumors
serous mucinous most common ovarian cancer Rare: endometroid, Brenner of which they can either be benign, malignant or borderline
51
Cystadenoma - pathology - seen in
benign surface epithelial tumor -either mucinous or serous Single cyst w/ simple flat lining premenopausal
52
Cystadenocarcinomas - pathology - seen in
malignant surface epithelial tissue -either mucinous or serous Complex cysts w/ thick shaggy liines postmenopausal
53
BRACA1 mutation more commonly associated w/ this surface epithelial tumor
Serous carcinoma of ovary and breast in addition to breast cancer risk
54
Endometroid tumor -pathogenesis
less common surface epithelial tumor endometrial-like glands that are malignant, may arise from endometriosis -may be found w/ endometrial carcinoma as well
55
Brenner Tumor - pathogenesis
less common surface epithelial tumor bladder like epithelium (urothelium) that are benign
56
Prognosis of surface epithelial tumors spreads?
poor due to late presentations Spreads locally -> peritoneum -vague ab complaint and signs of compression
57
CA-125
Surface epithelial tumor marker -Rx response and recurrence screening
58
Germ cell Tumors usually occur in what population
reproductive age (15-30) second to surface epithelial tumors in prevalence at 15%
59
Cystic Teratoma weird presentation?
benign tumor derived drom 2 or 3 embryogenic layers - most common germ cell tumor 10% bilateral
60
2 instances when cystic teratoma is malignant
Immature tissue present - usually neuro somatic malignancy - squamous cell carcinoma of skin (cancer has cancer)
61
Struma Ovarii presentation
Teratoma w/ mostly thyroid tissue - hyperthyoirdism
62
Dysgerminoma male counterpart?
large cell w/ clear cytoplasm and central nuclei - looks like oocyte - most common malignant germ cell tumor seminoma
63
LDH is elevated in this germ cell tumor
Dysgerminoma
64
Endodermal Sinus tumor produces? Commonly seen in ?
mimics the yolk sac kids AFP - alpha fetoprotein made
65
glomerous like structures seen in biopsy is what germ cell tumor?
endodermal sinus tumor
66
tumor w/ cytotrophoblasts and syncytiotrophoblasts but villi are absent
Choriocarcinoma - due to normally finding blood vessels, small hemorragic tumor spreads easily
67
Choriocacinoma produces
High beta hCG -> thecal cysts
68
Embryonal Carcinoma
Malignant tumor of large primitive cells - germ cell aggressive
69
Tumor producing estrogen Presentation?(3)
Granulosa-theca cell tumor -> a sex cord stromal tumor Depends on age - precocious puberty - menoohagia/metrorrhagia - postmenopause bleeding (most common setting for this tumor)
70
menorrhagia def
heavy prolonged bleeding
71
metrorrhagia def
outside of normal cycle bleeding
72
Reinke Crystals seen in? What presentation associated w/ finding?
Seen in Sertoli Leydig cell tumors -> a sex cord-stromal tumor Produces androgen (hirsutism and virilization in females)
73
A solid Benign tumor of fibroblasts
fibroma | -> a sex cord stromal tumor
74
Pleural effusion and ascots associated w/ this sex cord stromal tumor
Fibroma Meigs syndrome
75
Psudeomyxoma peritonei presents as? - METS from where?
massive amounts of mucus in the peritoneum from the appendix
76
bilateral ovarian tumor called? Often due to?
Krukenberg tumor METS from diffuse metastatic gastric carcinoma
77
Key risk factor for ectopic pregnancy
Scarring | -PID Hx or endometriosis
78
Classic presentation of ectopic
Lower quadrant abdominal pain a few weeks post missed period
79
Spontaneous abortion is? Often due to ?
miscarriage of fetus before 20 weeks Often due to chromosomal anomalies (trisomy 16)
80
Autoimmune disorder associated w/ recurrent spontaneous abortions
SLE - due to hypercoaguable state
81
Teratogen effects w/in 1st 2 weeks
spontaneous abortion
82
time of highest incidence of organ malformation with teratogen exposure during
weeks 3-8
83
Placenta Previa? presentation-
preview of placenta -implants lower in the uterus, over the os? presents as 3rd trimester bleeding
84
Placental abruption Complication?
Abrupt separation Separation of placenta from decidua prior to delivery - common for still births
85
Placenta accreta Complication?
implantation of placenta into myometrium - difficult delivery of the placenta post partum bleeding worry -> hysterectomy?
86
Thalidomide teratogen causes?
Teratogen | Limb defects
87
Isotertinoin teratogen causes
Spontataneous abortion, hearing and visual impairment Acne
88
Tetracycline teratogen
Causes discolored teeth
89
Warfarin teratogen
fetal bleeding
90
Phenytoin teratogen
digit hypoplasia and cleft lip
91
Preeclampsia defined by(3) Seen when?
hypertension proterinuria edema 3rd trimester
92
What separates preeclampsia from eclampsia
siezures -> immediate delivery
93
HELLP Syndrome
Hemolysis Elevated Liver enzymes Low Platelets Preeclampsia w/ thrombotic microangiopathic liver dysfunction Warning signs -> immediate delivery
94
Complete mole risk of choricarcinoma
2-3% Vs minimal in partial mole
95
46 chromosomes in a an empty ovum
Complete mole vs Partial mole -69 chromosomes (2 sperm and regular egg)
96
Fetal tissue is present in which abnormal conception and proliferation of trophoblasts
Partial mole NONE in complete
97
most Villous edema and diffuse Trophoblast proliferation
Complete mole Partial is focal proliferation and some villus edema
98
Suspect mole if (2)
uterus is larger than dates | beta hCG is higher
99
Passage of grape like masses in the vaginal canal w/ snowstorm appearance on US
mole pregnancy
100
how does choriocarcinoma arising from complete mole conceptions respond to chemo?
Respond well Vs. germ cell pathway do not
101
dysmenorrhea
painful menstration
102
Hypospadius pathologenisis? - see?
failure of urethral folds to close | - opening of urethrea in inferior surface
103
Epispadius primary cause see?
abnormal positioning of the genital tubercle (glans) urethra on superior surface of penis
104
bladder extrophy associated w/ what in males?
epispadias
105
necrotizing granulomatous inflame of the inguinal lymphatics and lymph nodes is called? -Associated w?
lymphogranuloma venereum Chlamydia trachomatis serotype L1-L3 - rectal stricture may be long term comp
106
Precursor in situ lesions of squamous cell carcinoma of penis (2)
Bowen disease - leukoplakia on shaft | Erythroplasia of Queyrat - erythroplakia on glans
107
Bowenoid papulosis is
an In situ lesions of the penis multiple reddish papules (younger 40s's and NO invasive carcinoma risk)
108
Penile squamous cell carcinoma risk (2)
High risk HPV (2/3) | Lack of circumcision
109
Cryptorchidism what is it and how common is it?
failure of testicle decent 1% of population (most common congenital male issue)
110
Orchioplexy
taching down testicles to scrotum - done at 2yrs of age w/ crytorchidism - to prevent testicular atrophy and infertility
111
Causes of orchitis by age group (6)
``` young men - Chlamydia (D-K) and nessiera gonorrhoeae old men -E coli and Pseudomonas teen males -mumps Any -Autoimmune - > granulomas involving seminiferous tubules ```
112
Sudden onset of testicular pain and absent cremaster reflex
testicular torsion | - twisting and compression of vein -> congestion and hemorrhagic infarction
113
Which side does a varicocele affect and what is a common cause?
dilation of spermatic vein due to impaired drainage Left side - spermatic vein drains into renal vein vs direct Often due to L sided renal cell carcinoma
114
Fluid collection w/in the tunica vaginallis that transilluminates infants due to? Adults due to?
Hydrocele persistent processus vaginalis in infants lymphatic blockage in adults
115
Seeding of scrotum and and malignancy complications is the reason why we don't do this?
Biopsy testicular tumors 95% germ cell anyway vs. sex cord
116
Risk factors for germ cell tumors in males? (2)
cryptochidism (seminoma) | Klinefelter syndrome
117
Seminoma ~ ? female tumor | -histo
dysgerminoma | - large cells w/ clear cytoplasm and central nuclei
118
Seminomas response to therapy vs nonseminomas
highly responsive and metastasize late - NOTE: rarely make b hCG (think chorio normally)
119
Germ cell tumors in males vs females
All 5 malignant | -even teratoma which is benign in female
120
Homogenous mass w/ NO hemorrhage and NO necrosis found in the testicle
seminoma - ex:embryonal carcinoma is hemorrhagic and necrotic
121
Chemotherapy leads to differentiation of tumor in a testicular cancer
Embryonal carcinoma See increased AFP or b hCG
122
Most common testicular tumor in kids - see what on histology
yolk sac tumor - a germ cell tumor Schiller duval bodies (glomerular looking structures) AFP is HIGH
123
beta hCG is traditionally seen elevated in this germ cell tumor and has the following complication (2)
Choriocarcinoma Hyperthyroidism and gynectomasia due to similar alpha subunit
124
Most germ cell tumors are of this type in males
mixed germ cell
125
Age >60 year old male and has bilateral testicular cancer
lymphoma 15-40 think germ cell tumor (5 of them)
126
Sex cord stromal tumors in males (2) problems seen?
Benign Leydig cell - precocious puberty and gynectomastia w/ androgen production -- Reinke crystals Sertoli cell - clinically silent
127
tender boggy prostate in digital exam caused by
Acure prostatitis chlamydia, N gonnorrheae E Coli, Psudomonas
128
Differences between acute and chronic prostatitis (2)
Chronic has negative culture pelvic and low back pain
129
Central periurethal change w/ hyperplasia of the prostatic gland and stroma due to _____ made by____
BPH dihydrotestosterone 5 alpha reductase
130
What is a worrisome level in prostate cancer
>10ng/mL PSA | -especially if african american, older and high saturated fat diet
131
Why is prostate cancer clinically silent till late
located in the peripheral, posterior region and no urinary issue till late noticed on DRE
132
Biopsy showing small invasive glands w/ prominent nucleoli in the nucleus
prostate cancer
133
Gleason scale measures what and is based on
Based on architecture- not nuclear atypic 2 biopsies ranked 1-5. higher being bad
134
Common METS of prostate cancer and associated serum results
Lumbar spine or pelvis increased alkaline phosphatase w/ sclerotic change (build up) increased prostatic acid phosphatase as well
135
Lobules and ducts of breast tissue are lined by...
2 layers of epithelium - luminal layer - myoepithelial layer
136
area where most great tissue by density
upper outer quadrent
137
Common causes of galactorrhea(3)
NOT cancer - nipple stim - prolactinoma - drugs
138
erythematous breast w/ purulent nipple discharge common cause? Rx?
mastitis Staph aureus dicloxacillin
139
Periductal mastitis more common in? Why?
Smokers Vitamin A deficiency can't maintained specialized epithelium of the duct
140
Subareular mass and nipple retraction due to squamous metaplasia of lactiferous duct
periductal mastitis pain w/ duct blockage and inflammation - nipples contract w/ myofibroblasts and fibrosis w/ healing
141
green-brown nipple discharge
mammary duct ectasia
142
Biopsy of mammary duct ectasia see?(2)
Dialation chronic inflammatiion plasma cells
143
What else can present as a mass other than breast cancer in a post menopausal female? (5)
mammary duct ectasia Phyllodes tumor Fibrocystic change papillary carcinoma fat necrosis
144
Fat necrosis in a breast is often due to
trauma - mass on physical exam - abnormal calcification on mammography
145
Most common change in premenopausal breast is? Due to ?
fibrocystic change horomone mediated stretching
146
Fibrocystic change has the associated risk with breast cancer
NONE -see blue dome appearance on gross exam
147
Sclerosing adenosis
to many glands w/ fibrosis in-between 2x the risk of invasive breast cancer (both) - Calcified
148
ductal hyperplasia
2 layers of duct abnormally proliferating w/ fibrocystic change -2x risk of invasive breast cancer (both)
149
apocrine metaplasia
w/ fibrosis and cysts - seen in fibrocystic change - NO increased risk
150
Atypical ductal or lobulal hyperplasia seen has what CA risk
5x bilateral invasive CA
151
Bloody nipple discharge in a PREmenopausal women Malignant?
intraductal Papilloma | -NO malignant potential
152
Bloody discharge in a POSTmenopausal woman Malignant?
Papillary carcinoma | -malignant potential
153
Fibrovascular projections lined by luminal cells in a breast
papillary carcinoma -missing the epithelial cell seen normally in intraductal papilloma
154
well circumscribed mobile marble mass in breast associated symptoms (2)
Fibroadenoma - benign grows w/ pregnancy painful w/ menstration
155
leaf like projections seen on biopsy commonly seen in?
phyllodes tumor -fibroadenoma w/ fibrous overgrowth postmenopausal
156
Calcified mass on mammography (3)
Fat necrosis (salponification) sclerosing adenosis Ductal carcinoma in-situ (dystrophic calcification)
157
DCIS usually presents as
calcification, no mass
158
Comedo type DCIS is characterized by (3)
high grade cells w/ necrosis dystrophic calcification
159
Paget's Disease is what differs from extramammary Paget's disease how?
DCIS that extends up the ducts to involve skin and nipple - Differs in that there is cancer underneath (none in extrammamry Pagets)
160
Most common invasive carcinoma Presenting as?
Duct type Presenting as a mass w. dimpling of skin or retraction of nipple late
161
Duct like structures in a desoplastic stroma on biopsy indicates
invasive ductal carcinoma 4 types (3 good prog, 1 bad - inflammatory)
162
Abundent extracellular mucin w. carcinoma Seen in which population
mucinous carcinoma - type of invasive ductal old ladies (>70)
163
well differentiates tubules w/out myoepithela cells
tubular carcinoma | -type of invasive ductal
164
an inflammed swollen breast that does not resolve w/ Abx
Inflammatory Carcinoma | -type of invasive ductal
165
Inflammmatory carcinoma needs 2 things
- tumor cells in lymphatic ducts (swelling) - inflammatory response poor prognosis
166
Type of tumor associated w/ BRCA1
Medullary carcinoma | -type of invasive ductal
167
Breast cancer found by accident called? Why?
Lobular carcinoma in Situ mulitfocal and bilateral w. no mass or calcifications
168
Dyscohesive cells lacking in Lubular carcinoma due to lack of?
E Cadherin
169
Single file pattern w/ no duct formation found on biopsy
invasive lobular carcinoma | -lack E cadherin and line up
170
BRCA1 associated w/ 2 CA
Breast (medullary CA) and Ovarian
171
BRCA2 is associated w/
Male breast CA - (invasive ductal CA) - Sub areolar - also seen in Klinefelter
172
pulling sensation in the groin associated w. as acities and hydrothorax in a female
Meigs syndrome(3) ovarian fibroma ascities hydrothorax - often R pleural effusion
173
Nonfunctional pituitary adenomas present as (3)
Mass effect - bitemporal hemianppsia - hypopituitarism - HA Can also be functional
174
Glactorrhea and Amenorrhea associated neoplasia in males see?
Prolactinoma - most common functional low labido and HA (Prolactin -> decrease in GnRH and associated LH and FSH)
175
Growth hormone cell presentation in kids (1) | compared to adults -3
Gigantism - epiphyses not fused yet Acromegaly in adults - enlarged bones of hands, face, jaw - enlarged visceral organs -> heart - enlarged tounge
176
Associated endocrine problem w/ GH tumor
Secondary DM due to decreased glucose uptake of glucose into cells w/ GH around inceased gluconeogenesis
177
Insulin growth factor 1
liver responds to GH to make
178
Hypopituitarism in Kids vs adults
Kids - craniopharyngioma - stella tucuica compression Adults - pituitary adenoma - compression - als pituitary apoplexy - derranged bleeding in adenoma and compression
179
PRegnancy and hypopituiary | -Cause
Sheehan syndrome Gland doubles in size w/ pregnancy and blood supply can't keep up, susceptible to infarct - parturition
180
Poor lactation loss of pubic hair and fatigue post giving birth
Sheehan Syndrome
181
Empty Stella Syndrome(2)
Congenetal defect leading to herniation of arachnid and CSF or can have trauma
182
Poly uria and polydipsia w/ response to demopressin
Central Diabetes insipities | - ADH deficiency
183
ADH deficiency and associated Na serum levels Test for it?
Hypernatremia and high serum osmolarity due to lack of ability to keep in water Water deprivation test fails to increase urine osmolarity
184
Nephrogenic Diabetes insipid us looks like central except
It does not respond to desmopressin
185
SIADH is? Due to(4)?
Excessive ADH secretion extopic production - small cell carcinoma of lung CNS truama pulmonary infection Drugs - cyclophophamide
186
Hyponatremia and low serum osmolarity and associated mental changes? seen w/ what could be a paraneoplastic caused condition
SIADH -ADH from small cell carcinoma Mental changes due to neuronal swelling and cerebral edema
187
Hyperthyroidism characterized by what 2 pathologic processes
increased basal metabolic rate - increased synthesis of Na/K ATPase Increased sympathetic nervous system - increased beta 1 adrenergic receptors
188
Hyperthyroidsm clinical features especially ____cholesterolemia _______glycemia
``` weight loss heat intolerance tachy Arrythmia Staring gaze w/ lid lag diarrhea Oligomenorrhea decreased muscle mass ``` HYPOcholesterolemia HYPERglycemia - gluconeogenesis and glycogenolysis
189
Autoantibody IgG seen in ?
Graves disease | Acts on TSH receptor of the thyroid -> increased synth and release
190
Scalloped colloid of the follicules
Graves disease
191
Exophalthalos and pretrial myxedema due to
TSH receptors behind the orbits and under the shin -> glycosaminoglycan buildup, fibrosis and edema NOT hyperthyroidism
192
Lab values is Graves (4) T4? TSH? Sugars? Cholesterol?
Increased T4 Decreased endogenous TSH - > less due to response of free T4 hyperglycemia Hypocholesterol
193
Feared complication of hyperthyroidism See (2) due to ? Presents as (4)
Thyroid Storm elevated catecholamines and massive hormone excess Due to Stress arrythmia hyperthermia vomiting hypovolemic shock
194
Mulinodular goider caused by
relative iodide immune deficiency Usually nontoxic
195
When is a multi nodular goider worrisome
when some regions become TSH independent leading to T4 release w/out control
196
Mental retardation, short stature and coarse facial features Maye enlarged tounge and umbilical hernia
Cretinism Hypothyroidism in neonates
197
Causes of Cretinism(4)
Maternal hypothyroidism thyroid agenesis dyshormonogenetic goiter (peroxidase lacking) iodine deficiency
198
Myxedema Associated clinical features (9)
Hypothyroidism in older children or adults ``` myexedema weight gain slowing of mental activity cold intolerance Bradycardia oligomennorhea (both) HYPERcholesterol Constipation ```
199
Common causes of hypothyroidsm(4)
iodine deficiency Hashimoto thyroiditis drugs - Li surgical removal/radioablation
200
HLA-DR5
Autoimmune destruction -> Hashimoto thryoditis initially hyperthyroid
201
Labs in hashimoto T4? TSH?
decreased T4 | increased TSH
202
Antithroglobulin Ab
hashimoto marker, not pathologic cause though
203
antithyroid peroxidase Ab
hashimoto marker, | not pathological cause though
204
Chronic inflammation w/ geminal centers and Hurthle cells
Hashimoto histology Hurthle cells - eosinophilic metaplasia of cells that line the follicle (pink)
205
Hashimoto s/ enlarging thyroid gland be concerned w/
B cell marginal zone lymphoma
206
Painful thyroid w/ transient hyperthyroidism
Subacute granulomatous de quervain thyroiditis
207
Dequervian progression?
Self limited and may progress to hypothyroidism Granulomatous thyrodiditis
208
Chronic inflammation w/ extensive fibrosis of thyroid Presenting concern
Reidel fibrosing thyroiditis Concern w/ mass effect and local structure - airway involvement Mimics anaplastic carcinoma except patients are younger
209
Iodine 131
Useful for imaging thyroid | Usually cold for adenoma and carcinoma
210
Biopsy of a thyroid done w/ Useless in?
Fine needle aspiration Differentiating between follicular adenoma and follicular carcinoma
211
Defining feature of Follicular adenoma
Benign proliferation of follicle W/IN a fibrous capsule
212
Orphan annie eyes and nuclear groves seen in? also may see?
Papillary carcinoma Most common carcinoma (80%) - aslo pasmmona bodies
213
Invasion of the fibrous capsule w/ proliferating follicles
Follicular carcinoma METS hematogenously, worse prognosis
214
Medullary Carcinoma proliferation Secrete?
malignant proliferation of parafollicular C Cells Calcitonin -> hypocalcemia Calcitonin deposits as amyloid
215
Medullary carcinoma associated w/
MEN 2A - p53 mutation - pheochromocytoma and parathyroid adenomas MEN 2B - RET mutation - ganglioneuronomas and pheochromocytoma
216
Worse tumor of thyroid
Anaplastic carcinoma seen in the elderly local invasion -> dysphagia and respiratory compromise
217
Most common cause of primary parahypothyroidism other 2?
parathyroid adenoma (benign) sporadic parathyroid hyperplasia parathyroid carcinoma
218
peptic ulcer disease acute pancreatitis Ostei fibrosa cystica associated w?
some complications of hyperparathyroidism Pancreatitis think high enzyme function ``` Others- Nephrolithiasis Nephrocalcinosis - calcification of renal tubules CNS disturbances - Constipation ```
219
Nephrolithiasis Nephrocalcinosis - calcification of renal tubules CNS disturbances - Constipation
some complications of hyperparathyroidism peptic ulcer disease acute pancreatitis Ostei fibrosa cystica
220
Labs in hyperparathyroidism ``` PTH serum Ca serum phosphate urinary cAMP Serum alkaline phosphatase ```
``` PTH - increased serum Ca - Increased serum phosphate - decreased urinary cAMP - increased (Gs signal) Serum alkaline phosphatase - increased (osteoblasts turned on 1st to activate osteoclasts) ```
221
Principles of too much parathyridism (3)
Want increased free serum Ca increased osteoclast activity (via osteoblast activation) increased small bowel absorption of Ca and phosphate (Vit D activation) Increased renal Ca reabsorption and decreased phosphate reabsorbtion(dumping)
222
Most common cause of secondary hyperparathyroidism? Mech?
Chronic renal failure renal insufficeincy -> decreased Phosphate excretion all 4 gland stimulated to increase PTH release
223
Labs? in secondary hyperparathyroidism PTH Serum Ca Serum Phosphate alkaline phosphate
PTH increased Cerum Ca is decreased (due to increased Phos) Serum Phosphate increased alakine phosphatase increased (PTH activates osteoblasts -> alkaline env; osteoclasts later)
224
Muscle spasms of the facial nerve or with blood pressure cuff indicative of what
Low serum Ca Chvostek and Trosseau respectfully
225
Periorbital tingling, numbness may indicate?
Low serum Ca
226
Causes of hypoparathyrodism (3)
Autoimmune damage accidental surgical excision Digeourge syndrome and faille of 3rd and 4th pharyngeal arch
227
Low PTH and low Ca in labs indicates
Hypoparathyrodism
228
Pseudohypoparathyroidism is due to PTH labs?
end organ resistance to PTH Gs is not working like it should w/ decreased adenylate cyclase activity and ultimately less cAMP Increased PTH
229
Autosomal dominant disease w/ short stature and chart 4th and 5th digits associated w/
pseudohypoparathyroidism
230
Insulin is secreted by ?
Beta cells in the center of the islets of langerhans GLUT 4
231
Glucagon is secreted by
alpha cells of pancreas -> gycogenolysis and lipolysis
232
HLA DR3 and HLA DR4
Associated w/ DM 1
233
Chronic inflammation of islets due to
autoimmune destruction of beta cells by T lymphocytes Type 4 hypersensitivity
234
Presentation of DM1 (3)
childhood seeing - high serum glucose - weight loss, low muscle mass, polyphagia -unopposed glucagon (no stores w/ gycogenolysis and lipolysis) - polyuria -> polydipsia and glycosuria
235
Eliciting factor in diabetic ketoacidosis and pathophys
DM1 | Stress -> epinephrine -> glucagon secretion -> lypolysis -> increased FFA -> liver converts to ketone bodies
236
ketone bodies(2)
beta hydroxybutyric acid | acetoacetic acid
237
Hyperkalemia seen in diabetic ketoacidosis due to?
lack of insulin driving K into cells K is exchanged for H in attempt to put protons into cells NET LOSS of K though in urine - correct w/ Rx
238
Kussmaul respirations
seen in ketoacidosis due to blowing off the acid
239
Presentation of Ketoacidosis (6)
``` Kussmaul respirations dehydration nausea vomiting mental status change fruity smelling breath -acetone ```
240
Rx considerations w/ DKA (3)
fluids insulin electrolytes (esp K)
241
Obesity leads to DMII due to
end organ resistance w/ decreased # of insulin receptors Strong genetic component
242
Histology of DMII
amyloid deposition in the islets
243
DMII presentation (3)
often silent but | polyuria, polydipsia, hyperglycemia
244
Lab values for DMII Random Glucose Fasting Glucose Glucose tolerance
RG > 200 mg/dL FG >126 mg/dL serum > 200 2 hrs after loading
245
Rx progession in DMII(3)
1. Weight loss 2. meds (metformin and sulfoylureas) 3. insulin
246
life threatening diuresis w/ hypotension and coma
DMII complication called hyperosmolar non-ketotic coma no ketones dut to limited insulin
247
Atherosclerosis seen in DMII due to? Causes?
nonezymativ glycosylation of vascular BM of large and medium vessels CV disease - leading cause of death Peripheral vascular disaes - non trauma amputations
248
NEG of small vessels leads to ? Which organ? and complications?
nyaline ateriolosclerosis Kidney renal arterioles 1. efferent -> hyperfiltration injury, micoalbuminuria -> nephrotic syndrome (kimmelstiel-Wilson dodules) 2. Afferent -> diffuse low blood flow and sclerosis -> chronic renal failure
249
A1C
NEG of hemoglobin -> 120 day measure of sugar average
250
Peripheral neuropathy in DMII due to Same mech seen in?(2)
Schwann cells have glucose freely enter and covered to sorbitol by Aldose reductase -> osmotic damage See also in pericytes of retinal blood vessels(aneurism and blindness) and lens (cataracts)
251
Tumors of islet cells - associated w.
5% of pancreatic tumors | MEN 1 - parathyroid hyperplaia and pituitary adenomas
252
Insulinomas present as
episodic hypoglycemia w/ mental status change C peptide increased
253
Zollinger Ellison Syndrome
Rx resistant peptic ulcer disease due to gastrinoma jejunum can be affected
254
Presentation of achlohydia, cholelithias and streatorrhea
Somatostainomas -> somatostatin increase -> decreased gastrin and CCK
255
Watery diarrhea w/ hypokalemia and achlohydria
VIPoma - excessive vasoactive intestinal peptide
256
3 layers of adrenal cortex and products
Glomerulosa - mineralcorticoids fasiculata - glucocorticoids reticularis - sex steroids
257
Moon facies, buffalo hump ad truncal obesity characteristic of what and why?
cushing syndrome gluconeogenesis -> increase insulin -> storage in these areas
258
3 Immune mechanisms of cushing syndrome
high cortisol -> inhibits phopholipase A2 Inhibits IL2 inhibits histamine release from mast cell -> vasodilatation
259
hypertension seen in cushing syndrome?
cortisol -> alpha 1 receptors on vessels - increased tone and response to NE effect
260
Clinicla features of Cushing (6)
``` muscle weakness- cortisol breaks down for glconeogen moon facies and buffalo hump abdominal striae HYN Osteoperosus Immune suppression ```
261
Causes of Cushing (4) and resulting adrenal gross look
``` exogenous corticosteriods -bilateral atrophic primary adrenal adenoma -unlateral atrophy ACTH secreting pituitary adenoma -bilateral hypertrophy Paraneoplastic ACTH secretion -pilateral hypertrophy ```
262
Dexamethasone use in Cushings?
Use to suppress ACTH from pituitary adenoma but fails to suppress ACTH paraneoplastic - like a small cell lung carcinoma Measure endogenous cortisol response
263
Aldosterone acts where
late distal tubule collecting duct
264
High aldosesterone levels effect on pH Na K
metabolic alkalosis - (H excreted from alpha intercalated cells) hypernatremia - chief cell (exchanged) -> HTN hypokalemia - chief cell (exchanged)
265
Primary hyperaldoseronism causes vs secondary Renin?
Primary - sporadic adrenal hyperplasia, adrenal adenoma, adrenal carcinoma high aldosterone, low renin (negative feedback) Secondary - activation of renin angiotensin system - renal vascular hypertension, CHF, fibromuscula dysplasi etc... high aldosterone, high renin (cause)
266
bilateral adrenal hyperplasia w/ salt wasting hyperkalemia and hyponatremia; hypotension w/ lack of cortisol and clitoral enlargement /precocious puberty think?
21 hydroxylase deficiency
267
bilateral adrenal hyperplasia, NO salt wasting, life threatening hypotension w/ lack of cortisol and clitoral enlargement/precosious puberty
11 hydroxylase deficiency Get some weak adosterone metabolites due to the presence of 21 hydroxylase but do not get mature aldosterone Still no cortisol and shift to sex steroids
268
bilateral adrenal hyperplasia w/ NO sex steriods and no cortisol and a lot of mineral corticoid production
17 hydroxylase deficiency
269
hemorragic necrosis of adrenals in child due to DIC Name of disorder? Causal agent
acute adrenal insufficiency/Waterhouse friderichsen N meningitidis infection prior
270
Cause of death w/ acute adrenal insufficiency
Lack of cortisol -> life threatening hypotension
271
Chronic history of hypotension, hyponatremia and hypovolemia, hyperkalemia, and weakness Giveaway clue?
Addisons - chronic adrenal insufficiency ACTH overproduction -> hyperpigmentation
272
Causes of addisons (3)
``` autoimmune destruction TB metastatic carinoma (LUNG) ```
273
Adrenal medulla derived frome
neural crest cells - > chromaffin
274
Adrenal medulla produces
catecholamines | epinephrine and NE
275
Episodic HTN, HA, palpitations, Tachy and sweating think?
Pheochromocytoma
276
Diagnose pheo by what?
increased serum netanephrines, increased urine metanephrins and vanillymandelic acids
277
Prior to surgical excision of pheo give? Why?
phenoxybenzamine give to prevent hypertensive crisis due to leakage of catecholamines squeezed out
278
Rule of 10s in pheo (4)
``` 10% bilateral 10% familial 10% malignant 10% located outside of adrenal medulla -bladder wall or inferior mesenteric artery root ```
279
Pheochromocytoma are a part of 4 syndromes
MEN2a MEN2b von hippel Lindau neurofibromatosis type 1

USLME Kiss my ass and pray (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions