MOD 4 Flashcards
Sx of coarsening of facial features, glucose intolerance induced neuropathy (numbness/tingling), tunnel vision/bitemporal blindness may indicate?
Acromegaly! Pit tumor (which compresses optic chiasm causing vis issues) secr excess GH, which causes glucose intolerance and DM like sx, larger jaw or rings dont fit, clumsy etc
what might you tx prolactin secreting tumor with?
Bromocriptine
Sx of weight loss with tachycardia/HTN etc, emotional lability?
Grave’s disease! Hyperthyroidism, emotional lability from thyroid storm (too much iodine!), CNS sx (since TH crosses BBB), bulging eyes
What lvl do we test for Graves?
What prevents most ppl from hyperthyroidism?
Test TSH, NOT t3/t4
-Wolff-Chaikoff effect reduces thryoid hormone with consumption of iodine to prevent hyperthyroidism
Which is an example of a drug that can cause hyperthyroidism and why?
Amiodarone bc has high salt content
Sx of velvety black rash (acanthosis nigricans), easy infections, weight gain?
Diabetes! (acanthosis nigricans is insulin-res induced autoimmune issue)
Sx of stooped over, backache, agitation/depr, flank pain w blood in urine?
Hyperparathyroidism! (mild is common), causing Ca2+ issues
- also includes subperiosteal erosions and SHORTENED QT intervals
- in testing for ca, must correct for serum albumen
Sx of sticking in throat feeling, sleeps on pillows, depr, fatigue, hoarseness, but no progressive dysphagia
Primary hypOthyroidism!
from primary glandular failure, low vital signs, thyroid compressing trach and esoph, insidious, high TSH, elderly
young women g0p0, pelvic pain worsens during period, and dysmenorrhea (painful periods), adnexal mass
Endometriosis!
Endometriosis
sx
histo
px
endometrial tissue outside of uterus, common, young women
- cyclic pelvic pain with menses, possible mass, painful intercourse, irreg bleeding, infertility, back/abd/pelvic pain
- histo: epith lining, benign, cyst, hemosiderin (brown spots) and chocolate colored fluid in lining from bleeding that cant evacuate
- malig is rare
Ovarian cancer possible serum marker?
CA-125!
Malignant germ cell tumors that can occur in young women?
immaturte teratoma, dysgerminoma, etc
Diff between endometriosis and adenomyosis?
endo is tissue OTUSIDE uterus, but adenomyosiss is endo tissue in myometrium
Theories of how endometriosis tissue gets outside of uterus>
moves retrograde during menstruation
Displaced during operation
Lymph/vasc spread
Mullerian duct diff, stem cells
Common sites of endometrial tissue?
Anywhere! esp ovaries, uterine ligaments, large/small bowel, mucosa of cervix/vag/tubes, ureter/bladder
Sx of spotting (in postmenopausal woman) with increased endometrial thickness, and adnexal mass?
- spotting pathologic in menopause!
- Endometrial carcinoma! (most common malig in female genital)
Endometrial carcinoma
dx in postmeno women?
risk factors
types
endo biopsy using curettage, but hard in post meno women to sample
- older women, v uncommon under 40
- obesity, estrogen exposure, atypical endo hyperplasia (also DM, genes, HTN, infert etc)
- type I and type II ECC
Type I vs type II endometrial carcinoma
Type I- assoc with microsatellite instability and MMR, various histo
Type II- assoc with endo atrophy in underweight women (serious or clear cell or MMT)
Type II ECC histo
Serious will have psammoma body (roudn calcium collection, may have conc circles), and clear cell will have hobnail cells
What is grading of ECC based on?
Glandular component!
the more it looks like epith, the better the px
What staging sys do we use for ECC?
Figo!
Endometrial hyperplasia
incr gland to stroma ratio, wiht atypia has higher risk of malig (EIN assoc with endo carc)
ENdometrial polyps
pop and main sx?
what drug are they assoc with?
stromal focal hyperplasia of basalis, prolif of glands etc etc
- middle aged pt with bleeding
- giant endometrial polyp assoc with use of TAMOX!
Sx of itching/burning vulva with large red/oozing lesion on genital (ulcerated lesion or solid papillary mass)
Squamous cell carc of the vulva!
-uncommon, 2 types group I and II
2 groups of SCC of vulva?
histo, age, risks, mut, px?
Group I- basaloid or Warty SCC (50s, HPV 16/8, cigs)
Group 2-Keratinizing SCC- lichen sclerosis (PARCHMENT LIKE, NO assoc with hpv/cigs, inv p53, worse px, hsito has round conc circles???)
-both inv VIN etc
What cancer risk is assoc with lichen sclerosis?
atrophy/thinning/white patch of vagina, assoc with SCC risk (esp group II keratinizing)
Paget’s disease of the vulva
carc with prolif of large cells with clear cyto, assoc with other carc, postmeno white women, slowly progressive
Black woman ~30-40, pelvic pain, heavy menstrual bleeding, multiple irreg intrauterine masses, dx?
Leiomyoma! (uterine fibroids)
Leiomyoma aka uterine fibroids
- pop
- sx?
- assoc?
- AA women 30s-40s
- Firm irreg masses (benign smooth muscle tumors of MYOmetrium), may grow during preg and regress after meno, can infarct or cause pain, may have abd pain or uterine bleeding (but most asx)
- lots of variants
Leiomyosarcoma
- uncommon
- INtramural solitary hemorrhagic masses with necrosis, atypia, mitotic figures, invasion
- poor px, high mets, usu de novo
- older women around 50
Stromal tumors
endo stromal nodules with worm like pattern
Malig Mixed Mullerian Tumor (MMMT)
older women in 60s with pelvic radiation, carc, polypoid appearance, poor px
what is endometrial hyperplasia a risk factor for?
dev endometrial carc! (vag bleeding, adenoarc)
what tsg is involved in type I endometriod carc?
PTEN!
type I endometrial carc sx?
uterine bleeding from prior atypical hyperplastic lesions, 55-65 y.o, obes/htn/dm, pten, stay local before spreading to lymph
red lesion or pink/white slightly raised lesion, infiltration by large cells with pale blue (clear) to granular cytoplasm
large cells with clear cyto means PAGET’S! (extramammary)
What is associated with VIN (vulvular itraepithelial neoplasia) and what might the sx be?
HPV 16/18! sx may include pale flat white discolartion area, dysplastic cells occupying full squamous epith
T2DM sx
fatigue, blurry vision, weight gain, acanthosis nigricans (type 1 would be ketones)
-fhx, native american (or AA/hispanic)
Tests for t2DM
dx fasting glucose >125 A1ac (replaced oral glucose) >6.5%, reflects average over a few months (hallmark) (fingerstick just gives us a range) (other stuff >200)
what risk increases when A1c is >7%?
microvascular complications
for every 1 decr in A1c, hwo much does risk of microvasc compl decr?
25%
But what does HbA1c decr do to cardiovascular events?
resutls in more!
Prediabetes A1c value?
5.8-6.5%
What happens to b-cell insulin production on DM graph?
as insulin res incr, B cells respond by producing more (initial curve up) but then get exhausted and prod declines, resulting in blood glucose incr
Best tx for prediabetes?
lifestyle! better than metformin
Best DM2 tx?
metformin plus OTHERS (combo, no mono tx! acc to OKPDS trials) maybe STATIN or ACE/ARB to prevent CV isseus
how does metformin work
decreases glucose production by liver, and increases sensitivity to insulin (also decr glucose uptake and intest abs)
Sulfonurea and statin MOA?
sulf- incr release of insulin into blood
statins reduce risk of CV
TZD (eg pioglitaZONE) and GLP-1 (glucagon peptide) agonists (like liraGLUTIDE) moa
TZD- enhances insulin sensitivity (incr glucose uptake in skm, and decr gluconeo in liver)
GLP-1 agonist-stim insulin secretion and decr A1c levels
