Endo/Repro Pathology Flashcards Preview

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Flashcards in Endo/Repro Pathology Deck (279):
1

Conn Syndrome - presentation(5)

Primary Hyperaldosertonism due to hyperplasia or tumor

-hypertension
-hyperkalemia
-metabolic alkalosis
-LOW plasma renin
- transient weakness

2

Unilateral lesion of the lower vulvular vestibule

Bartholin cyst

3

High risk HPV (4)

16 ,18, 31, 33

4

Low risk HPV (2)

Distinguished by ?

6 , 11

DNA testing

5

Condyloma acuminatum

Genital wart

6

Lichen Sclerosis histology and timeline

Risk of cancer?

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

postmenopause

"parchment like vulgar skin" - leukoplakia

Slight risk of squamous cell

7

Lichen Simplex Chronicus histo

Risk of Cancer

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

NO risk

8

2 paths of vulvar cancer

Presentation and age

leukoplakia

HPV - 40-50s, dyspalstic trasnfomeation

long standing Lichen Sclerosis - >70 yrs old

9

Koiliocyte

Histology of HPV

raisin like nucleus

10

Erythematous pruritic ulcerated vulvar skin

Extramammary paget disease

11

Histology of extramammary paget disease

Lab tests?

malignant epithelial cells in the epidermis

Distinguished from melanoma being
keratin +
S100 -
PAS +

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

12

Adenosis
what is it?
higher risk for?

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

13

Diethylstilbestrol associated risks (2)

given in the 60s to help moms with pregnant

leads to in daughters
-adenosis and clear cell carcinoma risk
-Smooth muscle abnormalities (ectopics etc.)

14

Bleeding grapelike mass

Age of presentation?

Embryonal Rhabdomyosarcoma
- protruding from vagina or penis

<5 y.o

15

Cytoplasmic cross striations cell

2 stains associated

Rhabdomyoblast
- characteristic of embryonal rhabdomyosarcoma

desmin- intermediate filament of muscle cell
myogenin- nuclear TF

16

transformation zone

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

Sharp change - all path occurs here

17

High risk HPV characterized by what 2 gene products?

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

18

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

hyperchomatic nuclei

high nuclear to cytoplasmic ratio

19

Confirmatory test w/ abnormal PAP

Colposcopy and biopsy

20

CIN I II and III compared to carcinoma in situ

carcinoma in situ does not regress and is full thickness

21

Cervical Carcinoma risk factors (3)

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

22

Asherman Syndrome
-Path and Cause?

secondary amenorrhea due to loss of basalis and scarring

Due to overaggressive D and C

23

Stem Cell of Endometrium

Basalis

24

Anovulatory cycle complications

Seen around

Cycle w/out ovulation
-> estrogen driven proliferation building up
-> no shedding with progesterone drop phase

Abnormal bleeding around menarche and menopause

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

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Worse tumor of thyroid

Anaplastic carcinoma seen in the elderly

local invasion -> dysphagia and respiratory compromise

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Most common cause of primary parahypothyroidism

other 2?

parathyroid adenoma (benign)

sporadic parathyroid hyperplasia
parathyroid carcinoma

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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

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Nephrolithiasis
Nephrocalcinosis - calcification of renal tubules
CNS disturbances -
Constipation

some complications of hyperparathyroidism


peptic ulcer disease
acute pancreatitis
Ostei fibrosa cystica

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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)

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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)

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Most common cause of secondary hyperparathyroidism?

Mech?

Chronic renal failure

renal insufficeincy -> decreased Phosphate excretion

all 4 gland stimulated to increase PTH release

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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)

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Muscle spasms of the facial nerve or with blood pressure cuff indicative of what

Low serum Ca

Chvostek and Trosseau respectfully

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Periorbital tingling, numbness may indicate?

Low serum Ca

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Causes of hypoparathyrodism (3)

Autoimmune damage
accidental surgical excision
Digeourge syndrome and faille of 3rd and 4th pharyngeal arch

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Low PTH and low Ca in labs indicates

Hypoparathyrodism

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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

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Autosomal dominant disease w/ short stature and chart 4th and 5th digits associated w/

pseudohypoparathyroidism

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Insulin is secreted by ?

Beta cells in the center of the islets of langerhans

GLUT 4

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Glucagon is secreted by

alpha cells of pancreas

-> gycogenolysis and lipolysis

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HLA DR3 and HLA DR4

Associated w/ DM 1

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Chronic inflammation of islets due to

autoimmune destruction of beta cells by T lymphocytes

Type 4 hypersensitivity

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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

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Eliciting factor in diabetic ketoacidosis and pathophys

DM1
Stress -> epinephrine -> glucagon secretion -> lypolysis -> increased FFA -> liver converts to ketone bodies

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ketone bodies(2)

beta hydroxybutyric acid
acetoacetic acid

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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

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Kussmaul respirations

seen in ketoacidosis due to blowing off the acid

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Presentation of Ketoacidosis (6)

Kussmaul respirations
dehydration
nausea
vomiting
mental status change
fruity smelling breath -acetone

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Rx considerations w/ DKA (3)

fluids
insulin
electrolytes (esp K)

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Obesity leads to DMII due to

end organ resistance w/ decreased # of insulin receptors

Strong genetic component

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Histology of DMII

amyloid deposition in the islets

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DMII presentation (3)

often silent but
polyuria, polydipsia, hyperglycemia

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Lab values for DMII

Random Glucose
Fasting Glucose
Glucose tolerance

RG > 200 mg/dL
FG >126 mg/dL
serum > 200 2 hrs after loading

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Rx progession in DMII(3)

1. Weight loss
2. meds (metformin and sulfoylureas)
3. insulin

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life threatening diuresis w/ hypotension and coma

DMII complication called hyperosmolar non-ketotic coma

no ketones dut to limited insulin

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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

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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

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A1C

NEG of hemoglobin -> 120 day measure of sugar average

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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)

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Tumors of islet cells - associated w.

5% of pancreatic tumors
MEN 1 - parathyroid hyperplaia and pituitary adenomas

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Insulinomas present as

episodic hypoglycemia w/ mental status change

C peptide increased

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Zollinger Ellison Syndrome

Rx resistant peptic ulcer disease due to gastrinoma

jejunum can be affected

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Presentation of achlohydia, cholelithias and streatorrhea

Somatostainomas -> somatostatin increase -> decreased gastrin and CCK

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Watery diarrhea w/ hypokalemia and achlohydria

VIPoma - excessive vasoactive intestinal peptide

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3 layers of adrenal cortex and products

Glomerulosa - mineralcorticoids
fasiculata - glucocorticoids
reticularis - sex steroids

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Moon facies, buffalo hump ad truncal obesity characteristic of what and why?

cushing syndrome

gluconeogenesis -> increase insulin -> storage in these areas

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3 Immune mechanisms of cushing syndrome

high cortisol ->
inhibits phopholipase A2
Inhibits IL2
inhibits histamine release from mast cell -> vasodilatation

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hypertension seen in cushing syndrome?

cortisol -> alpha 1 receptors on vessels - increased tone and response to NE effect

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Clinicla features of Cushing (6)

muscle weakness- cortisol breaks down for glconeogen
moon facies and buffalo hump
abdominal striae
HYN
Osteoperosus
Immune suppression

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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

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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

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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)

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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)

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bilateral adrenal hyperplasia w/ salt wasting hyperkalemia and hyponatremia; hypotension w/ lack of cortisol and clitoral enlargement /precocious puberty think?

21 hydroxylase deficiency

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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

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bilateral adrenal hyperplasia w/ NO sex steriods and no cortisol and a lot of mineral corticoid production

17 hydroxylase deficiency

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hemorragic necrosis of adrenals in child due to DIC

Name of disorder?
Causal agent

acute adrenal insufficiency/Waterhouse friderichsen

N meningitidis infection prior

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Cause of death w/ acute adrenal insufficiency

Lack of cortisol -> life threatening hypotension

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Chronic history of hypotension, hyponatremia and hypovolemia, hyperkalemia, and weakness

Giveaway clue?

Addisons - chronic adrenal insufficiency

ACTH overproduction -> hyperpigmentation

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Causes of addisons (3)

autoimmune destruction
TB
metastatic carinoma (LUNG)

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Adrenal medulla derived frome

neural crest cells - > chromaffin

274

Adrenal medulla produces

catecholamines
epinephrine and NE

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Episodic HTN, HA, palpitations, Tachy and sweating think?

Pheochromocytoma

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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

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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