Endo Path Clinical Flashcards
Pt presents with abdominal pain and diarrhea. You do a secretin stimulation test. What were you expecting and what disease could it be associated with?
MEN1 with ZE initial suspicion
Pt presents with abdominal pain and diarrhea. You do a secretin stimulation test. What are you suspecting?
Zollinger-Ellison syndrome
Pt comes in to clinic with diarrhea and during the interview had a flushing episode. He also complains of itching. You take a biopsy of his parathyroid and it has multiple cells more than normal. What disease does he have?
MEN2A because of pheochromocytoma and parathyroid hyperplasia.
Pt comes in with symptoms of abdominal flank pain, and weakness. He complains that lately it has been hard to go to the bathroom and things have been a little gloomy for him. What is this disease and most common cause? You run blood work. What findings do you expect? How about in urine analysis? Why does he have back pain? How would you treat him?
Primary hyperparathyroidism mostly from parathyroid adenoma. Back pain caused by acute pancreatitis and nephrolithiasis. Other symptoms are depression, constipation. Lab findings will show increased PTH, increased calcium, increased ALP, decreased phosphate because it acts on the distal convoluted tubule and helps I crease free phosphate. You will find increased urine cAMP. Treat with surgery.
35 yo Pt comes in for his annual checkup and upon running lab work, you find he has increased ALP and CAMP in his urine. When asked if he has any symptoms, he says he is fine except pain in his lower back. He also mentions that he has been taking peptic ac because of reflux he has been having. Upon further probing you find that he has a decreased sex drive and has been considering taking Viagra for occasional erectile dysfunction. What does he have?
MEN1 with symptoms for parathyroid tumor and a Zollinger Ellison pancreatic endocrine tumor and a low testosterone due to prolactin secretion which reduces sex drive and causes ED.
Doing a radioactive uptake study, you see that there is increased uptake of the iodine. What disease are you expecting? What kind of mass is it? What type of hypersensitivity is this disease? What is the classical patient?what are histology and lab findings? Treatment? Cholesterol level?
Graves’ disease or nodular goiter. Graves’ disease has a diffuse goiter and type 2 hypersensitivity. Classically in women of child bearing age. Lab findings are high and total T4 and low TSH. Low cholesterol. Increased serum glucose. Irregular scallop shaped follicles and chronic inflammation. Tx with beta blockers to slow down sympathetic activity, thioamide to block peroxidase, and radio iodine ablation.
Doing a radioactive uptake study, you see that there is decreased uptake of the iodine. What disease are you expecting? What is the next step?
Adenoma or carcinoma. Take a biopsy.
23 yo pt comes in complaining of weight gain eve though her appetite has gone down. Upon physical examination, you notice that her skin is dry and cool, her reflexes are low and she was short of breath when you asked her to move to the other side of the room. When palpating her neck, you find that there is a hard mass that is non tender. What is your dx?
Riedel fibrosing thyroiditis because of hard as wood non tender thyroid gland.
50 yo pt comes in complaining of weight gain eve though her appetite has gone down. Upon physical examination, you notice that her skin is dry and cool, her reflexes are low and she was short of breath when you asked her to move to the other side of the room. When palpating her neck, you find that there is a hard mass that is non tender. What is your dx? What is the prognosis?
Anaplastic carcinoma. Poor prognosis. It invades into neighboring structures leading to dysphagia or respiratory compromise.
You are a pathologist and you see a histological slide that shows cells lined with papillae with clear nuclei and nuclear grooves. The pts chart says that they were from a small town in airway and when she was a little girl, the town had a nuclear plant that had a huge accident and exposed the population to an unhealthy dose of radiation. What type of disease do you think she has? What other histological structure do you expect to see?
Papillary carcinoma due to histology and clear orphan Annie eyes. PSAMOMMA bodies.
You are a pathologist and you see a histological slide that shows cells lined with papillae with clear nuclei and nuclear grooves. The pts chart says that they were from a small town in airway and when she was a little girl, the town had a nuclear plant that had a huge accident and exposed the population to an unhealthy dose of radiation. What type of disease do you think she has? What physical finding do you expect to have?
Papillary carcinoma. Excellent prognosis. Cervical neck lymph node progression.
Patient comes in for routine workup and you notice that she has a high urine calcium output. Suspecting she has a thyroid disorder, you run some blood tests and find high levels of calcitonin. The biopsy you ordered also showed a sheet like appearance of malignant cells in a stroma and stained positive when using congo red. What disease is this? What mutations and gene are associated with it? How would you detect the mutation?
Medullary carcinoma due to proliferation of para follicular c cells. Amyloid stroma. Familial cases associated with MEN 2A and B due to mutations in the Ret oncogene. Detection is via prophylactic thyroidectomy.
70 yo patient comes in with her caretaker. She has been complaining that she has difficulty swallowing food and when she lays down on her bed, she has SOB. What do you think is causing this? How would you make a diagnosis? Can you make a diagnosis by FNA? What other disease looks the same in FNA? Can she have metastasis? How would it metastasize?
Follicular carcinoma seen by malignant proliferation of follicles surrounded by fibrous capsule with invasion through the capsule. Invasion through capsule means not follicular ADENOMA. Entire capsule must be examined microscopically. FNA can’t distinguish between the follicular carcinoma and adenoma. Hematogenous mets.
Patient comes to your pulmonary clinic where she visits you regularly for checkup on her asthma. You were supposed at this visit due to her appearance which shows weight gain, high blood pressure, abdominal striae. You ask her what happened and she said she has been abroad for the past month and the only thing that has changed is her astham medication was lost in her luggage and she has been taking it easy to make sure she doesn’t have an attack. What happened?
She has iatrogenic Cushing syndrome from stopping her asthma steroid medication.
How would you treat SIADH?
Block action at V2 receptors using conivapatan and tolvaptan.
