Path

Question 1

What cells are seen in the parathyroid?

Answer 1

Chief cells

Oxyphil cells

Question 2

Which cells of the parathyroid contain PTH?

Answer 2

Chief cells

Question 3

What can be seen in a normal parathyroid tissue stain?

Answer 3

Fat globules

Question 4

What is the most important cause of hypercalcemia?

Answer 4

Primary hyperparathyroidism

Question 5

Most frequent parathyroid lesion

Answer 5

Adenoma

Question 6

Primary hyperparathyroidism

Answer 6

Adults, 50's or later
Women more common
Solitary adenoma, 0.5 to 5.0 grams
Soft nodule, well circumscribed
Squash surrounding tissue
Inconspicuous adipose tissue
MEN-1, MEN-2, Familial hypocalciuric hypercalcemia

Question 7

Primary hyperplasia

Answer 7

All four glands
Component of MEN syndrome
Combined weight rarely over 1 gram
Water clear cells, islands of oxyphils

Question 8

Parathyroid carcinomas

Answer 8

Circumscribed lesions
One gland
Can exceed 10 grams in weight
Invasion of surrounding tissues
Nephrolithiasis, nephrocalcinosis, metastatic calcification secondary to hypercalcemia

Question 9

Symptoms of primary hyperparathyroidism

Answer 9

Painful bones
Renal stones
Abdominal groans
Psychic moans

Question 10

Most common cause of secondary hyperparathyroidsism

Answer 10

Renal failure

Question 11

Symptoms of secondary hyperparathyroidism

Answer 11

Symptoms of chronic renal failure

Calciphylaxis - vascular calcification, significant ischemic damage to skin and other organs

Question 12

Causes of hypoparathyroidism

Answer 12

Acquired - inadvertent consequence of surgery
Autoimmune - LYMPHOCYTES
Congenital absence - DiGeorge syndrome

Question 13

Hallmark of hypocalcemia

Answer 13

Tetany

Question 14

Major clinical manifestations of hypoparathyroidism

Answer 14

Hypocalcemia - tetany
Mental status changes
Intracranial manifestations
Ocular dz
Cardio manifestations
Dental abnormalitites

Question 15

Pseudohypoparathyroidism

Answer 15

Resistance to PTH
Serum PTH lvls normal or elevated
Hypocalcemia
Hyperphosphatemia

Question 16

Causes of hyperthyroidism

Answer 16

Diffuse hyperplasia associated with Graves disease
Hyperfunctional multinodular goiter
Hyperfunctional adenoma

Question 17

Clinical manifestations of hyperthyroidism

Answer 17

Excessive lvls of thyroid hormone
Increase in BMR
Flushed, thin
Heat intolerance
Sweating
Tachy, palpitation, cardiomegaly (first signs)

Question 18

Dx of hyperthyroidism

Answer 18

Low TSH

Increased free T4

Question 19

Congenital hypothyroidism

Answer 19

Endemic iodine deficiency in diet

Question 20

Causes of acquired hypothyroidism

Answer 20

Sugical removal
Radiation induced ablation
Drugs like methimazole, propylthiouracil, lithium

Question 21

Circulating autoantibodies in autoimmune hypothyroidism

Answer 21

Antimicrosomal
Antithyroid peroxidase
Antithyroglobulin antibodies

Question 22

Hashimoto Thyroiditis

Answer 22

Most common cause of hypothyroidism where iodine lvls are sufficient
Intense LYMPHOCYTIC INFILTRATE
More common in women
45-65 y/o
Atrophic follicles 
Hurthle cells

Question 23

Subacute Granulomatous De Quervain Thyroiditis

Answer 23

Women more than men
40-50 y/o
Most common cause of thyroid pain
Triggered by viral infection - coxsackievirus, mumps, measles, adenovirus
Seasonal incidence peaking in summer
Multinucleate giant cells

Question 24

Subacute Lymphocytic Thyroiditis

Answer 24

PAINLESS

Circulating anti-thyroid peroxidase antibodies

Question 25

Graves Disease

Answer 25

``` Most common cause endogenous hyperthyroidism Exophthalmos Pretibial myxedema Colloid is pale with scalloped margins Women more than men 20-40 y/o Over 80 grams ```

Question 26

Cause of diffuse goiters

Answer 26

Dietary iodine deficiency

Question 27

Endemic goiter

Answer 27

Where there is low levels of iodine | Andes and Himalayas

Question 28

Multinodular goiter

Answer 28

All long standing simple goiters convert to this Weights of more than 200 grams Intrathoracic or plunging goiter

Question 29

Hallmark of all follicular adenomas

Answer 29

Presence of intact, well formed capsule encircling the tumor

Question 30

Most prominent subtype of thyroid carcinoma

Answer 30

Papillary carcinoma

Question 31

Papillary carcinoma

Answer 31

Associated with previous exposure to ionizing radiation Fibrovascular stalk Psammoma bodies Optically clear or empty nuclei - Orphan Annie eye nuclei Intranuclear inclusion/intranuclear grooves Vascular invasion uncommon Mets to lymph nodes

Question 32

Follicular Carcinoma

Answer 32

More frequent in areas with dietary iodine deficiency Psammoma bodies not present Lymphatic spread uncommon Vascular dissemination common

Question 33

Anaplastic carcinoma

Answer 33

Aggressive | Undifferentiated

Question 34

Medullary Carcinoma

Answer 34

Derived from parafollicular cells, or C cells, of thyroid Secrete calcitonin Amyloid deposits

Question 35

Most consistent morphologic feature of diabetes

Answer 35

Diabetic microangiopathy

Question 36

Diabetic nephropathy

Answer 36

THREE LESIONS - Glomerular lesions Renal vascular lesions Pyelonephritis (including necrotizing papillitis)

Question 37

Nodular glomerulosclerosis

Answer 37

Kimmelstiel-Wilson Ovoid or spherical, laminated, nodules of matrix Periphery of glomerulus PAS positive Consequences - ischemia, tubular atrophy, interstitial fibrosis

Question 38

Insulinoma

Answer 38

Beta cell tumor Most common pancreatic endocrine neoplasm Excess insulin Induces clinically significant hypoglycemia Precipitated by fasting or exercise High circulating insulin lvls High insulin to glucose ratio

Question 39

Gastrinoma

Answer 39

Marked hypersecretion of gastrin Diarrhea ZE syndrome - pancreatic islet cell lesions, hypersecretion of gastric acid, severe peptic ulceration Intractable jejunal ulcers = ZE syndrome