Pathology

Question 0

Prevents unbalanced bone resorption by being a decoy receptor for RANKL

Answer 0

Osteoprotegrin

Question 1

Common complication of malignancy

Answer 1

Hypercalcemia
Malignancy is the most common cause of clinically apparent hypercalcemia. It is the result of bone resorption.
Hyperparathyroidism is the most common cause of a symptomatic elevated blood calcium (incidental hypercalcemia).

Question 2

Causes hypercalcemia in cancers that have not mets

Answer 2

PTHrP

Promotes expression of RANKL which binds to RANK on osteoclasts

Question 3

Symptoms of hypercalcemia

Answer 3

Fatigue, weakness, constipation

Question 4

Symptoms of hyperparathyroidism

Answer 4

Nephrolithiasis

Bone disease

Question 5

Most common cause of secondary hyperparathyroidism

Answer 5

Renal failure (causes hypocalcemia)

Question 6

responsible for narrowed arteriolar lumen and loss of normal medial function in type 2 DM

Answer 6

deposition of extracellular matrix = hyaline arteriolosclerosis

Question 7

enlargement of the lower jaw

Answer 7

prognathism

Question 8

palpable nodule in a normal size thyroid
euthyroid
“cold” or nonfunctional on scintiscan
Orphan Annie nuclei; psammoma bodies

Answer 8

papillary carcinoma of thyroid

Question 9

bilateral asymetrical enlargement of the thyroid
irregularly nodular to palpation
euthyroid

Answer 9

multinodular goiter

Question 11

• granular eosinophilic cytoplasm = Hurthle cells
• heavy infiltration by lymphocytes (breakdown in self-tolerance) & germinal center formation
• diffuse hyperplasia of follicular cells
• autoimmune disorder with increased susceptibility to other autoimmune disorders
• low T4
• elevated TSH
• painless enlargement of thyroid (diffuse & symmetric)

Answer 11

Hashimoto thyroiditis

Question 11

thyroid nodule that is “cold” on scintiscan is likely to be benign or malignant?

Answer 11

malignant (occurs in only 5% of cold nodules but still must be addressed)
“hot” nodules are more likely to be benign

Question 12

enlargement of part of the thyroid gland with PAIN
inflammatory infiltrate is accompanied by giant cells that surround pre-existing follicles.
age 40-50
likely triggered by a viral infection
multinucleate giant cells

Answer 12

DeQuervain thryoiditis (granulomatous)

Question 13

exposure to this in utero can cause clear cell carcinoma of the vagina and uterine cervix

Answer 13

diethylstilbestrol = synthetic estrogen given to women with high risk pregnancies

Question 14

less aggressive breast carcinoma with islands of cells floating in basophilic mucous

Answer 14

colloid carcinoma

usually ER+, PR+, HER2 -

Question 15

large, polyhedral cells with distinct cell membranes
clear cytoplasm
prominent nucleoli
testicular

Answer 15

seminoma

Question 16

acute adrenal insufficiency with fulminant sepsis and DIC associated most frequently with Neisseria meningitidis

Answer 16

Waterhouse-Friderichsen syndrome

Question 17

tumors composed of two or more derivatives of the three primary germ cell layers

Answer 17

teratoma

Question 18

mass containing hair, sebum & teeth, commonly found in the ovary but rarely in the testis

Answer 18

dermoid cyst = mature cystic teratoma

Question 19

Mass consisting of small, uniform, tightly crowded tubules lined by Sertoli cells. The Sertoli cells have abundant pale cytoplasm and regular, uniform nuclei without atypia or mitotic activity. Inguinal hernia. Commonly associated with what?

Answer 19

complete androgen insensitivity syndrome

female with congenital absence of uterus and karyotype XY

Question 20

most common cause of amenorrhea in women in reproductive years

Answer 20

pregnancy

Question 21

Why are high levels of androgens observed in PCO?

Answer 21

high levels of insulin inhibit synthesis of sex hormone binding globulin
Typical labs: low FSH, high LH, low estradiol, high DHEA & testosterone

Question 22

clinical syndrome of (usually unilateral) pain and inflammation of the epididymis and often teste that lasts less than six weeks

Answer 22

acute epididymitis

Question 23

metabolic bone disease that occurs as a complication (one of the causes for bone pain) of primary hyperparathyroidism

Answer 23

Osteitis fibrosa cystica

Question 24

postpartum pituitary ischemic necrosis associated with hemorrhage and shock during childbirth

Answer 24

Sheehan syndrome Pituitary enlarges during pregnancy, but it's blood supply doesn't enlarge proportionally. Posterior pituitary gets blood supply from arterial branches so is less susceptible to ischemia

Question 25

surgically treatable HTN from aldosterone-secreting adenoma

Answer 25

Conn syndrome = adrenal cortical adenoma

Question 26

deletion of chromosome 22q produces abnormalites in the 3rd and 4th pharyngeal pouches, which form thymus and parathyroids. Absence of parathyroids leading to hypocalcemia and hypoparathyroidism

Answer 26

DiGeorge syndrome

Question 27

``` tumor that originates from the remnant of the Rathke pouch Most are suprasellar dystrophic calcification; cyst formation Bimodal distribution Adult: headaches, visual disturbances Child: growth retardation ```

Answer 27

craniopharyngioma

Question 28

enzyme deficiency in congenital adrenal hyperplasia

Answer 28

21 alpha hydroxylase

Question 29

carcinomas of thyroid first present as a lymph node metastasis

Answer 29

papillary

Question 30

causes cretinism

Answer 30

absence of thyroid gland

Question 31

pheochromocytoma, medullary carcinoma of the thyroid, and parathyroid hyperplasia Associated with RET germline gain of function mutation

Answer 31

MEN2A = Sipple syndrome

Question 32

associated with poor outcome of neuroblastoma

Answer 32

N-MYC

Question 33

local deposition of amyloid is associated with what type of thyroid tumor?

Answer 33

medullary carcinoma | Medullary carcinoma of the thyroid originates in C cells

Question 34

Causes bacterial vaginosis

Answer 34

Gardnerella | Tx: metronidazole

Question 35

Rashes that involve the palms and soles of feet

Answer 35

1. Rocky Mtn Spotted Fever 2. Secondary syphilis 3. Hand, foot, mouth disease (Coxsackie virus)

Question 36

What type of condyloma is associated with syphilis?

Answer 36

condyloma lata

Question 37

cell clearing associated with HPV

Answer 37

koilocytosis | This is not associated with malignant neoplasms

Question 38

tumor in young children that resembles grapes

Answer 38

embryonal rhabdomyosarcoma

Question 39

Is the finding of superficial cells in an 80 yr old female a normal finding?

Answer 39

no. Basal cell maturation in the vagina to superficial cells is under the influence of estrogen.

Question 40

Where are cervical neoplasms most likely?

Answer 40

Transformation zone of the endocervix

Question 41

most frequent cause of death in squamous cell carcinoma of the cervix

Answer 41

renal failure (uremia) from obstructed ureter

Question 42

large amount of bleeding at time other than menstruation

Answer 42

metrorrhagia

Question 43

bleeding at time of menstruation

Answer 43

menorrhagia

Question 44

large amount of bleeding at menstruation and other times

Answer 44

menometrorrhagia

Question 45

inactivation of this tumor suppressor gene is associated with what uterine condition?

Answer 45

endometrial hyperplasia | Not a problem until unopposed estrogen present

Question 47

benign uterine neoplasms of the smooth muscle; very common (1 in 4) and responsive to the hormones of pregnancy

Answer 47

leiomyomata = fibroids | Note: leiomyosarcomas ARE malignant

Question 48

1. Primary hyperParathyroidism 2. tumors of endocrine Pancreas (gastrinoma, insulinomas) 3. Prolactinoma in anterior pituitary "3 P's"

Answer 48

MEN-1 = Wermer syndrome | germline mutations in MEN1 tumor suppressor gene

Question 49

1. medullary thyroid carcinoma 2. pheochromocytoma 3. neuroma or ganglioneuroma (skin, eyes, GI tract, resp tract) long axial skeleton (like marfan) constitutive activation of RET

Answer 49

MEN-2B

Question 50

What is the therapeutic recommendation for all germline mutations of RET?

Answer 50

prophylactic thyroidectomy to avoid medullary carcinoma

Question 51

hallmark of hypocalemia

Answer 51

tetany

Question 52

cell type that is the source of pancreatic tumors that cause carcinoid syndrome

Answer 52

enterochromaffin cells | These synthesize serotonin.

Question 53

blood glucose

Answer 53

insulinoma (pancreatic tumor -> usually benign)

Question 54

tumor of the endocrine cells of the gut or pancreas severe peptic ulceration** some seen with MEN-1

Answer 54

Zollinger-Ellison syndrome (gastrinoma)

Question 55

typical presentation for nonfunctioning pituitary adenoma

Answer 55

mass effects

Question 56

typically presentation: obese female with history of multiple pregnancies visual defects OR hx of radiation or surgery to pituitary

Answer 56

empty sella syndrome

Question 57

most common causes of thyrotoxicosis

Answer 57

1. diffuse hyperplasia associated with Graves disease 2. hyperfunctional multinodular goiter 3. hyperfunctional adenoma of thyroid

Question 58

What causes the symptoms of thyrotoxicosis?

Answer 58

increased metabolic rate | overactivity of the sympathetic nervous system

Question 59

cause of congenital hypothyroidism

Answer 59

endemic iodine deficiency

Question 60

most common cause of hypothyroidism in iodine-sufficient areas of the world

Answer 60

autoimmune, most of which are Hashimoto thyroiditis

Question 61

``` severe mental retardation short stature coarse facial features protruding tongue umbilical hernia ```

Answer 61

cretinism | degree depends on if there was maternal thyroid deficiency before development of fetal thyroid

Question 62

extensive fibrosis of the thyroid & contiguous neck structures

Answer 62

Reidel thyroiditis

Question 63

What causes acute endometritis?

Answer 63

retained products of conception | Group A strep, staph

Question 64

pruritus, labial atrophy, introitus narrows, skin has a thinned whitish appearance

Answer 64

Lichen sclerosis et atrophicus | Increased risk of vulvar squamous carcinoma