Endo-PATOHMA Flashcards
Sheehan syndrome
- etiology
- presentations (4)
- ischemic infarct of pituitary due to postpartum heavy bleeding => hypopituitarism
- presentations
1. lack of lactation (PRL)
2. loss of pubic hair (LH)
3. absent mensturation (FSH/LH)
4. cold intolerance (TSH)
Physical exam finding in thyroglossal duct cyst?
anterior neck mass
How does T3/T4 increases basal metabolic rate? what about increasing heart rate/contractility?
- BMR: increased activity of Na+/K+ ATPase
- > increased O2 consumption
- HR: increased level of beta 1 adrenergic receptors
Describe histologic finding of Graves disease
scalloped colloid
: white dots on the periphery of colloid
- PATHOMA p. 161
Multinodular goiter: nontoxic vs. toxic
- compare each
- which one is more common?
- nontoxic: cold nodule (euthyroid)
- toxic: hot nodule (hyperthyroidism)
- nontoxic is more common
HLA in Hashimotto?
HLA-DR 3 and 5
Hashimotto is associated with increased risk for development of what cancer?
non-hodgkin B cell lymphoma
Reidel fibrosing thyroiditis vs. Anaplastic thyroid carcinoma: similarity and difference?
- they both show fibrosis that may involve other structures ( airway for example)
- Riedel thyroiditis presents in young patients, IgG4 related systemic diseases (acute pancreatitis for example)
- Anaplastic thyroid carcinoma presents in old patients, no association with IgG4
Follicular adenoma vs. Follicular carcinoma
- key histologic finding for both?
- Difference between two? can FNA do it?
- follicles within fibrous capsule
- follicles not invading fibrous capsule in adenoma, while invasion is seen in carcinoma.
- FNA is taking small malignant cells, so FNA alone will not be sufficient to visualize invasion. Gross examination is required.
ionizing radiation in childhood: what thyroid cancer may develop?
papillary thyroid carcinoma
RET mutation detection warrants what procedure for prevention of familial MEN2A/MEN2B cancer?
Detection of RET mutation pretty much guarantees development of medullary thyroid carcinoma (which makes sense as it presents in BOTH MEN2A and MEN2B)
=> prophylactic thyroidectomy is indicated
hyperparathyroidism: How does it change the level of
- urinary cAMP
- serum ALP
Explain physiology
- increased urinary cAMP
: PTH binds to its receptor -> Gs -> cAMP pathway - increased ALP
: PTH promotes osteoblast (which subsequently releases RANK-L, which activates osteoclast)
=> bone destruction and bone synthesis occurs
=> increased ALP (marker for bone synthesis)
What is the most common cause of secondary hyperparathyroidism
chronic renal failure
=> hyperphosphatemia and hypocalcemia (excess phosphate binds to Ca2+, reducing free Ca2+)
pseudohypoparathyroidism
- inheritance pattern
- PTH level? serum Ca2+ level?
- molecular mechanism
- physical exam finding
- autosomal dominant
- high PTH (why it is pseudo), low Ca2+
- Gs mutation (remember PTH utilizes Gs pathway)
- > peripheral tissues are PTH resistance
- short statue, short 4th/5th digits
Where beta cells are located in pancreatic islets?
center
Type 1 DM vs. Type 2 DM: genetic predisposition?
Type 2 DM has higher genetic predisposition than type 1
Type 1 DM vs. Type 1 DM: islet histology?
Type 1 DM: inflammatory infiltrates (autoimmune destruction)
Type 2 DM: amyloid (amylin) deposition
Three tissue types that are vulnerable to osmotic damage in diabetes? why?
- kidney
- retina-> cataracts
- schawann cells-> peripheral neurophathy
- These three cell types lack sorbitol dehydrogenase, leading to accumulation of sorbitol -> osmotic damage
glucose -> sorbitol -> fructose
- first rxn: aldose reductase (NADPH dependent)
- second rxn: sortibol dehydrogenase
Waterhouse-Friderichsen syndrome: gross appearance of adrenal glands?
hemorrhagic necrosis
What primary cancer can goes to adrenal gland as metastasis? what is consequence of this metastasis?
lung cancer
can cause adrenal insufficiency (it is just chunk of tumor cells with no adrenal gland function)
Embryological origin of chromaffin cells of adrenal medulla?
neural crest
MOTEL PASS, E- Enterochormaffin, which is not exactly same as chormaffin cells, but whatever. chromaffin,
Patient develops tachycardia, diaphoresis, headache during urination? what is going on?
pheochromocytoma located in bladder wall (10% of pheo indeed is located outside of adrenal medulla, bladder wall is the most common site)
