Endo (Path/Ques/First Aid) Flashcards
death in acromegaly
cardiac failure
treatment of prolactinoma
dopamine agonists: bromocriptine, cabergoline
drugs that cause DI
lithium
demeclocycline
SIADH treatment
free water restriction or demeclocycline
DI treatment
desmopressin
drugs that cause SIADH
cyclophosphamide
thyroglossal duct cyst
anterior neck mass
lingual thyroid
base of tongue mass
hyperthyroid increased BMR
increased synthesis of NaK ATPase
hyperthyroid increased SNS activity
increased expression of B1 adrenergic receptors
cause of exophthalmos
fibroblasts behind orbit express the TSH receptor
results in glycosaminoglycan buildup
scalloped colloid
Graves Disease
Graves Disease Treatment
B blockers
thioamide
radioiodine ablation
thyroid storm
due to elevated catecholamines
thyroid storm treatment
PTU, B blockers, Steroids
PTU mofa
inhibits peroxidase-mediated oxidation, organification and coupling
peripheral conversion of t4 to t3
multinodular goiter
due to relative iodine def
usually nontoxic
hashimoto path findings
chronic inflamm with germinal centers, Hurthle cells
hashimoto complications
increased risk for B cell marginal zone lymphoma
subacute granulomatous/de quervain thyroiditis
after viral infection
tender thyroid
transient hyperthyroidism
reidel fibrosing thyroiditis
hard non tender thyroid
fibrosis can involve local structures (airway)
increased uptake of I
graves dz
nodular goiter
decreased uptake of I
adenoma, carcinoma
follicular adenoma of thyroid
surrounded by fibrous capsule
anaplastic carcinoma
undifferentiated, elderly
invades local structures – dysphagia/resp compromise
PTH functions
increase bone osteoclasts (release Ca and Phos)
increase small bowel absorption of C and P by Activating Vitamin D
increases renal calcium reabsorption (DT)
decreased phosphate reabsorption (PT)
Paratyhroid cells
chief cells - PTH
primary hyperparathyroidism causes
adenoma > hyperplasia > carcinoma
osteitis fibrosa cystica
reabsorption of bone leading to fibrosis and cystic spaces
hyperparathyroidism
weird hyperparathyroidism stuff
acute pancreatitis
hyperparathyroidism labs
increased PTH, ca
decreased phosphate
increased urinary cAMP
increased ALKPHOS
PTH receptor
Gs (adenylate cyclase)
cause of secondary hyperparathyroidism
chronic renal failure (decreased phosphate excretion)
secondary hyperparathyroidism labs
increased PTH
decreased ca, increased phosphate
increased alkphos
pseudohypoparathyroidism
AD, short stature
defective Gs protein
DMT1 HLA
DR 3 and 4
amyloid deposition in pancreas islets
T2DM
T2DM nonenzymatic glycosylation of basement membranes: large and medium sized vessels
atherosclerosis:
- cv disease
- non traumatic amputations
NEG of small vessels
hyaline arteriosclerosis
- glumerulosclerosis
- efferent arterioles (Kimmelsteil-Wilson nodules)
NEG of hemoglobin
increase HbA1c
aldose reductase
glucose to sorbitol
glucose freely enters
Schwann cells
pericytes of retinal BVs
somatostatinomas
achlorhydria (inhib of gastrin)
choleithiasis with steatorrhea (inhibition of CCK)
VIPomas
watery diarrhea, hypokalemia, achlorhydria
abdominal striae
impaired synthesis of collagen
high dose dexamethasone
suppress ACTH production by pituitary adenoma (but not ectopic)
Hyperaldosteronism labs
hypernatremia
hypokalemia
metabolic alkalosis
Primary hyperaldosteronism
adrenal adenoma
high aldosterone
low renin
Seconary hyperaldosteronism
activate RAS
high aldosterone and renin
FMD, atherosclerosis
salt wasting/loss of aldosterone
hyponatremia
hyperkalemia
hypovolemia
causes of adrenal insufficiency
autoimmune TB metastatic carcinoma (lung cancer)
diagnosis of pheochromocytoma
increased serum metanephrine
inscreased urine metanephrines and vanillylmadelic acid
heavily methylated DNA
low transcription activity
hCG stimulates
LH surger
LH
testosterone from leydig sells
FSH
release of inhibin from sertoli cells
inhibin suppresses
FSH
testosterone inhibits
LH, GnRH
gestational DM treatment
insulin
Glucocorticoids
increase neutrophils
decrease lymphocytes
treatment of severe hypoglycemia
IM glucagon
chromaffin cells activated by
Ach
pretreatment for iodine ablation
perchlorate
5’ deiodinase
t4 –> t3
5 alpha reductase
testosterone –> DHT in peripheral tissues
CVD risk factors
atherosclerotic dz, CKD, DM
TZD specific mechanism
bind to PPAR gamma
increase adiponectin to decrease insulin resistance
proinsulin
C peptide and insulin
med for radioactive material exposure
potassium iodide
21 hydroxylase rxn
(prog) –> (11deoxy)
teratomas
increased HCG
best test for hypothyroidism
TSH
estrogen relationship to thyroid
increases T4
potassium shift in diabetic ketoacidosis
shift out
increase extracellular, decrease intracellular
GnRH treats
infertility
necrolytic migratory erythema
glucagonoma
propanol mofa in hyperthyroidism
decreases t4-t3 conversion
long acting insulin
NPH, glargine, determir
postprandial short acting insulin
lispro, aspart, glisine, regular
tamoxifen SE
endometrial hyperplasia
risperidone SE
hyperprolactinoma
subacute thyroiditis histo
mixed cellular infiltrate
multinuclear giant cells
T1DM path
luekocyte infiltrate
leuprolide for infertility
increases then decreases T and DHT
Beta blockers for hypoglycemia
inhibit Epi and NE medidated rxns/symptoms
neuroblastoma
adrenal medulla tumor in children
adrenal drainage
left adrenal – left renal vein – IVC
right adrenal – IVC
dopamine inhibits
prolactin
somatostatin inhibits
GH, TSH
prolactin inhibits
GnRH
dopamine antagonists
stimulate prolactin secretion
antipsychotics and OCPs
21 hydroxylase dysfunction
decreased mc
decreased cortisol
increased sex steroids
17 alpha hydroxylase dysfunction
increased mc
decreased cortisol
decreased sex steroids
11B hydroxylase dysfunction
decreased aldosterone, increased 11 deoxy
decreased cortisol
increased sex steroids
receptor associated tyrosine kinases
prolactin
immunomodulartors
GH
elevated homovanillic acid (HVA)
neuroblastoma
carcinoid
high 5-HT
5-HIAA in urine
niacin def
carcinoid treatment
octreotide
demeclocycline
ADH antagonist
condyloma acuminatum
HPV 6 or 11
lymphogranuloma venerum
chlamydia trachomatis
perianal involvement
Squamous cell carcinoma of penis risk factors
HPV
lack of circumsicion
bowen disease
shaft, scrotum
leukoplakia
erythroplasia of Queyrat
glans
Bowenoid papulosis
reddish papules
cryptochordism complications
testicular atrophy with infertility
increased risk for seminoma
Orchitis in young aduls
chlamydia
neisseria
mumps
orchitis in older adults
e coli
pseudomonas
testicular torsion
congenital failure of testes to attach to inner lining of scrotum via processus vaginalis
Varicocele
dilation of spermatic cord
bag of worms
left sided
associated with left sided RCC
hydrocele
fluid collection within tunica vaginalis
incomplete closure of processus vaginalis
transilluminates
prostate adenocarcinoma risk factors
african americans
diets high in saturated fats
location of prostate adenocarcinoma
posterior periphery
prostate adenocarcinoma spreading to bone - labs
increased alk phosph
increased PAP
treatment for prostate adenocarcinoma
prostatectomy
leuprolide (supress LH and FSH)
flutamide
flutamide
competitive inhibitor of androgen receptor
cause of BPH
DHT acts on androgen receptor –> hyperplastic nodules
histo for prostate adenocarcinoma
prominent/dark nucleoli
testicular germ cell tumor risk factors
15-40
cryptochordism
klinefelter syndrome
seminoma
good prognosis
large cells with clear cytoplasm
homogenous
BHCg
embryonal carcinoma
immature primitive cells
may produce glands
hemorragic mass with necrosis
AFP or BhCG
yolk sac tumor
children
schiller duval bodies
AFP elevated
choricarcinoma
tumor trophoblasts
B hcg
hyperthyroidism/gynecomastia
terotoma
malignant in famles
AFP or Bhcg
sertoli cell tumor
tubules
silent
lymphoma of testicles
> 60
diffuse large B cell type
vulva histo
sqaumous epithelium
lichen sclerosis
thining of epidermis, fibrosis of dermis leukoplakia paper-like postmenopausal women benign, slight risk of SCC
lichen simplex chronicus
hyperplasia
luekoplakia, thick skin
chronic irritation
benign, no risk
vulvar carcinoma
Squamous, leukoplakia
HPV or Non HPV
non HPV vulvar carcinoma
from long standing lichen sclerosis
>70 years
extramammary paget disease
malightant epithelial cells in epidermis of vulva
CIS
paget cells
PAS+, Keratin +
S100-
melanoma
PAS-, keratin -
S100+
vagina histo
non-keratinizaing squamous epithelium
adenosis
persistance of columar epitherlium in vagina
DES
upper 2/3 of vagina
mullerian ducts (originally columnar epithelium) drains to regional iliac nodes
lower 2/3 of vagina
urogential sinus (squamous epithelium) drains to inguinal nodes
clear cell adenocarcinoma of vagaina
DES associated vaginal adenosis
Emrbyonal Rhabdomyosarcoma
maligant immature skeletal muscle
bleeding, grape like mass
<5 yrs
rhabdomyoblast stain
desmin and myogenin
vaginal carcinoma
SCC, high risk HPV, VAIN
exocervix
nonkeratinizing squamous
endocervix
single layer of columnar cells
HPV
DNA virus
E7
knocks out Rb
E6
knocks out p53
CIN I
<1/3
CIN II
<2/3
CIN III
<thickness
Cervical Carcinoma
middle aged women, 40-50
squamous > adenocarcinoma
cervical carcinoma risk factors
HPV
smoking, immunodef
invasive cervical carcinoma
hydronephrosis with postrenal failure
proliferative phase of uterus
estrogen driven
growth of endometrium
secretory phase of uterus
progesterone driven
preparation for implantation
menstrual phase of uterus
loss of progesteron e–> shedding
asherman syndrome
secondary amenorrhea from excess d and c
anovulatory cycle
proliferative phase without secretory phase
acute endometriosis
retained products of conception
chronic endometriosis
lymphocytes and plasma cells
retained products of conception, PID, TB, IUD
tamoxifen
anti-e on breast
weak pro-e on endometrium
polyps!
endometriosis increases risk for
carcinoma at side
endometrial hyperplasia
hyperplasia of glands
unopposed estrogen
cellular atypia increaes progression
endometrial carcinoma
prolif of glands
hyperplasia vs sporadic pathway
endometrial carcinoma - hyperplasia pathway
estrogen exposure
60 years
endometrioid histo
endometrial carcinoma - sporadic pathway
70 years
serous papillary
psammoma bodies
p53
leiomyoma
benign, multiple, e exposure,
well-defined white whorled masses
leiomyosarcoma
postmenopausal women
single lesion - necrosis and hemorrhage
follicleq
oocyte
granulosa
theca cells
theca cells
LH, androgens
granulosa cells
FSH
androgen to estradiol
estradiol surger
LH surge –> ovulation
corpus luteum
produces progesteron
follicular cysts
no significance
PCOD
increased LH (lots of andorgens) androgen --> estrone, inhibits FSH increased risk for endometrial carcinoma
BRCA1 mutation
increased risk for serous carcinoma of ovary and fallopian tube
endometroid tumor
malignant
arise from endometriosis
brenner tumors
bladder-like epithelium
usually benign
CA-125
serum marker for treatment/recurrence of surface epithelial tumors
cystic teratoma - female
fetal tissue (skin, hair, bone etc) benign (unless SCC or neural immature tissue)
struma ovarii
teratoma composed of thyroid tissue
dysgerminoma - female
large cells with clear cytoplasma
malignant
elevated LDH
responds to radiotherapy/good prognosis
schiller duval bodies
gluomerous like structures
Choriocarcinoma - female
hemorrhagic tumor
high beta-hcg
may lead to thecal cysts
poor response to chemo
embryonal carcinoma - female
malignant
large primitive cells
early metastasis
krukenberg tumor
metastatic mucinous tumor
both ovaries
due to metastatic gastric carcinoma
pseudomyoxma peritonei
mucinous tumor of appendix
ectopic pregnancy risk factors
scarring
teratogens - first two weeks
sponatneous abortion
teratogens weeks 3-8
risk of organ malformation
teratogens months 3-9
organ hypoplasia
SIDS risk factors
sleeping on stomach
exposure to cig smoke
prematurily
phenytoin
digit hypoplasia and cleft palate
thalidomide
limb defects
partial mole
69 chromosomes
fetal tissue
complete mole
46 chromosomes
no fetal tissue
hydropic villi
risk of choriocarcinoma
sertoli cells - embryo
MIF – involute female stuff
test in males and development
test - male intenal gen (wolf duct)
dht - male extern gen (UGS/GT)
shortened vaginal canal
mullerian agenesis
para-aortic nodes
testses
deep inguinal nodes
glans penis, superficial nodes
superficial inguinal nodeds
scrotum
oocyte arrested at
prophase 1
metaphase ii
ovary histo
simple cuboidal
fallopian tube histo
simple columnar
B-hcg detected
6-11 d after ovulation
nondisjunction occurs during
meiosis 1