Pathology

Question 0

Acute Primary adrenal insufficiency from adrenal hemorrhage associated with Neisseria Meningitidis septicemia, DIC, and endotoxic shock

Answer 0

Waterhouse-Friderichsen Syndrome

Question 1

Pituitary change from normal granular, basophilic ACTH-producing cell cytoplasm to pale and homogenous cytoplasm from Keratin filament deposition

Answer 1

Crooke Hyaline Change

Question 2

Episodic Hyperadrenergic Symptoms associated with Pheochromocytoma

Answer 2

Pressure (increased BP), Pain (Headache), Perspiration, Palpitations (tachycardia), Pallor

Question 3

Pheochromocytoma Cells Derived From

Answer 3

Chromaffin Cells of the Neural Crest

Question 4

Rule of 10’s with Pheochromocytoma

Answer 4

10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids

Question 5

Arrhythmia associated with hyperthyroidism

Answer 5

Atrial Fibrillation

Question 6

Most common cause of hypothyroidism in iodine sufficient areas due to autoimmune disorder associated with HLA-DR5.

Answer 6

Hashimoto’s Thyroiditis

Question 7

Atrophic Thyroid Follicles with eosinophilic granular cytoplasm in residual follicular cells

Answer 7

Hurthle Cells

Question 8

Histology includes Hurthle Cells and lymphocytic infiltrate with germinal centers.

Answer 8

Hashimoto’s Thyroiditis

Question 9

Findings include moderately enlarged, nontender thyroid with antithyroglobulin and/or antimicrosomal antibodies

Answer 9

Hashimoto’s Thyroiditis

Question 10

• Pot-bellied, Pale, Puffy-faced child with Protruding Umbilicus and Protuberant Tongue.
• Findings also include mental retardation, short stature, and coarse facial features

Answer 10

Cretinism

Question 11

Due to severe fetal hypothyroidism.

Answer 11

Cretinism

Question 12

Self-limited hypothyroidism often following a flu-like illness with granulomatous inflammation (Multinucleate Giant Cells).

Answer 12

Subacute Thyroiditis (de Quervain’s or Granulomatous)

Question 13

Findings include increased ESR, jaw pain and very TENDER thyroid

Answer 13

Subacute thyroiditis (de Quervain’s or Granulomatous)

Question 14

Thyroid replaced by fibrous tissue with fixed, rock hard, painless goiter. Thought to be a manifestation of IgG4 related systemic disease.

Answer 14

Riedel’s Thyroiditis (young females)

Question 15

Findings include Hypercalcemia, hypercalciuria (renal stones), hypophosphatemia, increased PTH, increased ALP, increased cAMP in urine. May present with weakness and constipation.

Answer 15

Primary Hyperparathyroidism (Stones, Bones, and Groans!)
- Usually due to adenoma!

Question 16

Findings include Hypocalcemia, hyperphosphatemia in chronic renal failure, increased ALP, and increased PTH.

Answer 16

Secondary Hyperparathyroidism

Question 17

Secondary Hyperparathyroidism presents with hyperplasia, why?

Answer 17

Renal Disease –> decreased Vit D –> decreased Ca 2+ –> increased phosphate –> increased PTH (and subsequent hyperplasia) –> increased ALP

Question 18

Cystic bone spaces filled with brown fibrous tissue (lotsa pain!)

Answer 18

Osteitis Fibrosa Cystica (associated with primary hyperparathyroidism)

Question 19

Tapping of Facial Nerve leads to contraction of facial muscles

Answer 19

Chvostek’s Sign

Question 20

Occlusion of brachial artery with BP cuff leads to carpal spasm

Answer 20

Trousseau’s Sign

Question 21

Autosomal dominant kidney unresponsiveness to PTH results in hypocalcemia, shortened 4th/5th digits, short stature, and increased PTH due to a defect in the Gs protein

Answer 21

Albright’s Hereditary Osteodystrophy

Question 22

Presents with Parathyroid Tumors, Pituitary Tumors (Prolactin or GH), and Pancreatic Endocrine Tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, or glucagonomas) and commonly presents with kidney stones and stomach ulcers.

Answer 22

Multiple Endocrine Neoplasia 1 (MEN-1, Wermer’s Syndrome)

- Remember to draw a diamond connecting the Pituitary, the two Parathyroids, and the Pancreas.

Question 23

Presents with medullary thyroid carcinoma (secretes calcitonin), Pheochromocytoma, and Parathyroid Tumors

Answer 23

MEN-2A, remember to draw a square (2 P’s)

Question 24

Presents with Medullary Thyroid Carcinoma (secretes calcitonin), Pheochromocytoma and Oral/Intestinal ganglioneuromatosis (associated with marfanoid habitus).

Answer 24

MEN-2B (remember to draw a triangle)

Question 25

All MEN syndromes have what inheritance pattern? What gene mutation is associated with MEN 2A and 2B?

Answer 25

• Autosomal Dominant

- RET gene mutation