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Flashcards in Pathology Deck (39):

heroin users are at risk of

OD, hepatitis, abscess, hemorrhoids, AIDS, R-sided endocarditis


alcohol incr risk of

alcoholic cirrhosis, hepatitis, pancreatitis, preipheral neuropathy; testicular atrophy


Mallory-Weiss syndrome

longtitudinal partial thickness of gastroesophageal junction caused by vomiting and may lead to lethal bleeding (alcoholics) and hematemesis; pain (vs esophageal varicies)


most common adrenal medulla tumors in kids; in adults

kids- neuroblastoma; adults - pheochromocytoma; medulla - from NC; cortex- from mesoderm



may be treated with somatostatin analog


diabetes insipidus

central - decreased ADH; nephrogenic and primary polydypsia- normal or increased


nephrogenic DI may be caused by

V2 vasopressin receptor mutation (regulation of serum osmolarity)


17-alpha hydroxylase def

bilateral increase in size of adrenal glands due to incr in ACTH secretion (because of low cortisol)
increased Aldo; decr cortisol and sex hormones; HTN, hypokalemia, decreased DHT
XX:lack of secondary sex development


21-hydroxylase def (most common)

bilateral increase in size of adrenal glands due to incr in ACTH secretion (because of low cortisol);
decreased aldo --> hypotension-->increased renin activity; increased 17-hydroxyprogesterone;
infant salt wasting or childhood early puberty; increased sex hormones-->virilization+


11-beta def

no aldosterone--> accumulation of 11-deoxycorticosterone-->HTN (but low renin); decreased cortisol-->bilateral increase in size of adrenal glands due to incr in ACTH secretion; increased sex hormones;
XX- virulization +


exogenous corticosteroids may cause

reactivation of TB and candidiasis- because downregulate IL-2 production



PTH-related peptide functions like PTH and is often increased in malignancies (stimulates pprod of macrophage CSF and RANK-L(activates NFkappa-B)--> (RANK-L binds to RANK on osteoblasts--> osteoclast stimulation and serum Ca increase)


decrease in Mg

diurrhea, aminoglycosides, diuretics, alcohol abuse


increased pH (alkalosis)--> increase in albumin affinity for Ca-->

hypocalcemia--> paresthesisa, cramps, pain, carpopedal spasm)


SHBG changes and free testosterone

Sex-hormone binding globulin; increase in men--> dercreased free testosterone--> gynecomastia;
decrease in women--> increase in free testosterone--> hirsutism;
OCP and pregnancy--> increase in SHBG (no change of free testosterone)


wolff-chaikoff effect

excess iodine inhibits thyroid peroxidase--> decrease in iodine organification--> decrease in T3/T4 production



tyrosine binding protein; decreased in hepatic failure; increased in OCP and pregnancy due to increase in estrogen; T4 - major circulating/secreted hormone; T4--> T3 by 5'-deiodinase (T3 has greater affinity) in preipheral tissue


conn syndrome

primary aldosteronism - aldosterone secreting adrenal adenoma--> HTN, hypokalemia, metabolic alkalosis, low plasma renin; no edema- normal Na due to aldosterone escape (volume and/or pressure natriuresis)


Cushing disease

ACTH secreting pituitary adenoma (optic chiasm above and cavernous carotid arteries on the sides); (ACTH can also be elevated in SC lung cancer; bronchial carcinoids); increased ACTH, bilateral adrenal hyperplasia;
HTN, moon face, truncal obesity, abdominal striae (cortisol elvated), weight gain, buffalo hump, hyperglycemia (due to diabetogenic effect of increased cortisol), skin thinning and striae, osteoporosis, amenorrhea, immune suppression (incr cortisol); measure ACTH (ACTH-dep or indep); if levated >20pg/ml--> ACTH dep--> dexamethasone and CRH stimulation tesst to distinguish from ectopic ACTH



most common kids adrenal medulla tumor (<4yr/o); irregular firm mass that can cross the midline (Wills tumor cannot); arise from neural crest; homovanillic acid (DA metabolism) in creased in the urine; less likely to develop HTN; overexpression of N-myc; micro: bunch of cells with small blue round nuclei arranged in rosettes.



m.c. adrenal medulla tumor in adults; from chromaffin cells- neurocrest; enlarged dysmorphic nuclei, large pale looking cells;
Rule of 10:
10% malignant; bilateral; extra-adrenal; celcify; kids
Ass with VHL disease, MEN 2A and 2B; episodic 5P's:
pressure incr; pain (HA); perspiration; palpitations; pallor; most sectere E, NE, DA;
urinary VMA (NE breakdown) and plasma catacholamines increased; Tx: 1. alpha-antagonsits (phenoxybenzamine); 2. beta-blockers.


Hashimotos throiditis (thyroidotis)

HLA-DR5; increased risk of non-Hodgkins; nontender mass; anti-thyroid peroxidase and anti-thyroglobulin Abs); may be hyperTH early due to follicular rupture; Hurthle cells (enlarged epithelial cells with abundant eosinophilic granular cytoplasm as a result of altered mitochondria.[2] They generally stain pink)



thyroid disgenesis in US- m.c.c.; 6P's:
Pot bellied, pale, puffy face with protruding umbiicus and protruberant tongue; poor brain development


de quervan thyroiditis

subacute, self-limiting; ater flu-like illness; Incr ERS, painful; jaw pain; early inflammation; granulomatous inflammation


Riedel thyroiditis

thyroid--> fibrous tissue; may extend to local structure such as airway mimicking anaplastic carcinoma; ass with IgG4-mediated disease; fixed rock-hard goiter; painless


anaplastic carcinoma

Anplastic carcinoma is a general term for a malignant neoplasm arising from the uncontrolled proliferation of transformed cells of epithelial origin, or showing some epithelial characteristics, but that reveal no cytological or architectural features of associated with more differentiated tumors, such as the glandular formation or special cellular junctions that typical of adenocarcinoma and squamous cell carcinoma, respectively.


toxic multinodular goiter vs Graves disease

mutation in TSH thyroid R--> continuous activation vs IgG that stimulates TSH receptor on the thyroid


osteotitis fibrosa cystica

cystic bone spaces filled with brown fibrous tissue; with primary hyperPTH--> bones, stones, groans, and moans.



albright hereditary osteodytorphy- AD; kidney unresponsive to PTH--> hypocalcemia, shortened 4th and 5th digits, short stature.



Tx: bromocriptine and cabergoline - DA R agonsits


pituitary adenoma secreting GH--> acromegaly or gigantism in kids (long bone growth; die of cardiac failure)

Tx: resection; octreotide (somatostatin analog); pegvisomant (GH R antagonist)


nephrogenic DI

may be caused by ADH R mutation; lithium; demeclocycline (ADH R antagonist)


sheehan syndrome

ischemic infarct of pituitary--> presents with failure to lactate


Empty sella syndrome

atrophy of pituitary; idiopathic; common in obese women


Kimmelsteil-Wilson nodules

in DM: in the kidney affecting small blood vessels; spherical, eosinophilic, with a central acellular area, and they can be surrounded by a ring of cells. They stain blue or green with the trichrome stain and they are positive with PAS and methenamine-silver stains


Whipple triad

seen in insulinoma- tumor of pancreatic beta-cells; includes episodic CNS symptoms: lethargy, syncope, diplopia



niacin def (also in carcionoid syndrome) - diarrhea, dermatitis, dementia, death


carcinoid syndrome

neuroendocrine tumor secreting serotonin; recurrent diarrhea, cutaneous flashing, asthmatic wheezing, R-sided valvular disease; increase in 5-hydroxyindoleacetic acid in urine; niacin def--> pellagra;
1/3 metastize, present with 2nd malignancy, and are multiple
Tx: resection and somatostatin analog (octerotide)


zollinger-Ellison syndrome

gastrin secreting tumor--> increase in acid secretion--> peptic ulcers in distal duodenum and jejunum--> abdominal pain, diarrhea--> malabsorption. may be ass with MEN1