Path 3 Flashcards
Nodules can suggest malig by rads, cerv LAD, vocal cord paralysis, obstruction, hard/immobile. Do FNA to r/o malig. Nml or high TSH can mean malig, low TSH can mean hyperfxning vs 3 features as multinodular goiter, cold nodules/hypofxning unless toxic. 5 subtypes vs minimally or widely invasive, cold nodules usually. 2 prominent subtypes
Solitary nodules vs follicle thyroid adenoma vs follicle thyroid carcinoma
Aggressive, high mitosis, hemorrhagic/nec. 3 subtypes. Tx palliative vs for C cells/parathyroid -> high calcitonin. Sporadic or hereditary -> bil, c cell hyperplasia -> CIS. DX by PCR, tx w/ sunitib
Anaplastic thyroid carcinoma vs medullary thyroid carcinoma
Diffuse nontoxic sporadic vs multinodular vs toxic multinodular goiter vs dyshormonigenic goiter
Incidence dec w/ age, euthyroid, symmetric enlgment w/ hyperplastic epith & abundant colloid vs incidence inc w/ age, calc/fib/hem w/ hyperplastic epith & smaller follicles; variegated; Sanderson polster vs long standing multinodular goiter-> acq somatic mutation in TSHR -> cAMP -> high T4/3 -> hot & cold nodules -> FNA to r/o malig vs AR defect in TH synthesis -> compact slit-like follicles, high n:c ratio, high mitosis, fibrous bands b/w nodules -> hypothyroidism
1o vs 2o hypoPTHism. PseudohypoPTH? What dz can it cause? General sxs?
AIRE autoimmune, AD CaSR -> no Ca sensitivity, AD/R PTH -> truncated PTH protein w/o fxn, diGeorge vs para/thyroid surgery or removal. HypoPTH sxs despite high PTH, even exog PTH doesn’t fix the problem. Albright osteodystrophy -> short, no 2o sex characteristics, amenorrhea. QT prolong, sz, Trousseau & Chstivek sign
1o vs 2o vs 3o hyper PTHism. General sxs?
4 genes; hyperplasia -> nodular or diffuse, adenoma -> tightly packed chief & oxyphil cells, ca -> bland, fibrous bands, invasion or LN mets; crisis -> high serum Ca2+ w/ deteriorating CNS, GÌ, heart, renal -> emergent parathyroidectomy vs chronic renal failure-> osteo fib cystica, vit D defic -> malacia vs autonomous PTH. PTH bone dz, osteo fib cystica, brown tumors (multinuc giant cells w/ hemosiderin), stones, nephrocalcinosis, Mets calc
MEN1 vs MEN2. Dx?
AD RET. multinodular PTH hyperplasia, gastrinoma or insulinoma-> hypoglycemia, ant pit tumors like PRLoma vs AD RET gene, medullary thyroid ca for all; hyperplasia & phèo for 2A, marfanoid & phèo for 2B. genetic screen for RET
Genetic vs environ factors for DM1. Targets for DM1A? Complication of DM1?
HLA DR3/4 vs mimic, by, viral like coxsackie. Beta islet cells, GAD -> ribbon like cords islets. DKA
Genetic factors for DM2. Complications?
TCF7L2. Dec flu uptake, inc gluconeo, overwhelm FA -> DAG & ceramide; amyloid replacing islets. Hyperosmolar hyperglycemic state -> hyperglycemia & osmolar diuresis -> dehydrate & inc serum osmolarity
Dx DM. Acute vs chronic complications
2 separate Fasting flu > 125, hba1c > 6.4%, 2hr gtt > 199, random plasma glucose > 199. DKA -> hyperglycemia, Kussmaul -> IV Insulin & fluids vs macrovasc -> athero, ischemic heart dz, periph aa dz; microvasc -> neuropathy, nephropathy (thick BM -> inc mesangium -> nodular glomerulosclerosis/fibrin & capsular drops), retinopathy (non/proliferative)
Lact vs nonlact mastitis
1st mo BF, by staph, clogged duct, warm/tender to touch vs sq metaplasia-> blocked keratin-> can rupture, abscess, fistula; by staphylococcus, enterococcus, strep
Dil of lact ducts with fluid/secretions & cellular debris, milky nipple d/c, mimic ca on mammo vs central nec, oily cysts w/ calcified rim; giant cells, calc, hemosiderin vs autoimmune, keloid fib around atrophic ducts, isodense mass w/ calc vs immuno compromised, foreign objects; sarcoidosis & TB
Ducts ectasia vs br fat nec vs lymphatic mastopathy vs granulomatous mastitis
4 types of nonprolif br dz. Cause?
Cystic-> filling w/ turbid blue/brown color; apocrine metaplasia resembling sweat glands; adenosis -> inc # of terminal ducts; fib -> ruptured cyst secreting material. Cyclic inc E/P (hyperestrogen)
4 types of prolif br dz w/o atypia vs 2 types of prolif br dz w/ atypia
UDH -> myo/epith prolif, florid hyperplasia, irreg fenestrae; sclerosing adenitis-> inc # of terminal ducts but center compressed & dil periph, myoepith prominent; complex sclerosing adenitis-> same but w/ epith -> Stellate; intraductal papilloma -> polyploid growing in duct lumen -> obstruct or distend, nipple d/c, lg in lact sinus & small in deeper ducts vs ADH -> epith prolif but <2mm, cribiform or micropapillary; ALH -> filling/distending <50% of acini. Both inc risk of brca
FIRS can lead to? General sxs of placental infxn?
PPROM @ 31 wks, leukocytosis, inc IL6. Pain/tender, fever, purulent d/c; yellow/white plaques funisitis, yellow/green discolor chorioamniotic membranes
Pathophys of preeclampsia. Hemolysis for HELLP shows?
Remodeling spiral aa, soluble VEGF receptors, syncytial knots, athero; cerebral edema (IN ECL), liver (fibrin thrombus), renal (enlged glom). Schistocytes, polychromatic RBC, burr cells (ctxed RBC w/ spicules)
