Pathology VIII

Question 1

What causes the fruity breath odor of DKA?

Answer 1

Exhaled acetone (p.303)

Question 2

What lab findings point to a diagnosis of DKA?

Answer 2

Hyperglycemia, Increased H+, decreased bicarb, anion gap metabolic acdosis, increased blood ketone levels, leukocytosis, hyperkalemia (but depleted intracellular K+) (p.303)

Question 3

Name five potential complications of DKA.

Answer 3

Life threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrythmias, heart failure (p.303)

Question 4

How is DKA treated?

Answer 4

IV fluids, IV insulin, and Potassium (to replete intracellular stores). Give glucose if necessary to prevent hypoglycemia (p.303)

Question 5

What is carcinoid syndrome?

Answer 5

Rare syndrome caused by carcinoid tumors (p.304)

Question 6

Which type of tumor most commonly causes carcinoid syndrome?

Answer 6

Metastaic small bowel tumors (p.304)

Question 7

From what cells are carcinoid tumors derived?

Answer 7

Neuroendocrine cells (p.304)

Question 8

What is secreted from carcinoid symdrome small bowel tumors?

Answer 8

High levels of serotonin (p.304)

Question 9

When is carcinoid syndrome detected in patients with small bowel tumors?

Answer 9

When tumor metastasises to liver; not seen if tumor is limited to GI tract (serotonin undergoes first pass metabolism in the liver) (p.304)

Question 10

What symptoms are caused by carcinoid syndrome?

Answer 10

Recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease (p.304)

Question 11

What lab findings are characteristic of carcinoid syndrome?

Answer 11

Increased 5-HIAA in urine; niacin deficiency (p.304)

Question 12

How is carcinoid syndrome treated?

Answer 12

Somatostatin analogues (e.g. octreotide) (p.304)

Question 13

What type of drug is octreotide?

Answer 13

A somatostatin analogue (p.304)

Question 14

What is the rule of 1/3s as it pertains to carcinoid tumors?

Answer 14

1/3 metastasize, 1/3 present with second malignancy, 1/3 are multiple tumors (p.304)

Question 15

What is the most common tumor of the appendix?

Answer 15

Carcinoid tumor (p.304)

Question 16

What is Zollinger- Ellison syndrome?

Answer 16

Gastrin secreting tumor of the pancreas or duodenum (p.304)

Question 17

What pathologic changes to the stomach occur with Zollinger Ellison syndrome?

Answer 17

Rugal thickening of the stomach with acid hypersecretion; causes recurrent ulcers (p.304)

Question 18

What conditon is associated with Zollinger Ellison syndrome?

Answer 18

MEN Type I (p.304)

Question 19

What are five characteristic findings in MEN I (Wermer’s syndrome)?

Answer 19

Parathyroid tumors, pituitary tumors (prolactin or GH), pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas), Kidney stones, stomach ulcers (Findings include ‘3 Ps’) (p.304)

Question 20

What are four types of pancreatic endocrine tumors?

Answer 20

Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas (very rare) (p.304)

Question 21

What are three characteristic findings in MEN 2A (Sipple’s syndrome)?

Answer 21

Medullary thyroid carcinoma, pheocromocytoma, parathyroid tumors (findings include ‘2 Ps’) (p.304)

Question 22

What is secreted by medullary thyroid carcinomas seen in MEN 2A and MEN 2B?

Answer 22

Calcitonin (p.304)

Question 23

What are three characteristic findings in MEN 2B?

Answer 23

Medullary thyroid carcinoma, pheocromocytoma, oral/intestinal ganglioneuromatosis (findings include ‘1 P’) (p.304)

Question 24

What is the principle difference in findings in MEN 2A vs MEN2B?

Answer 24

MEN 2A- parathyroid tumors; MEN 2B- oral/intestinal ganglioneuromatosis (p.304)

Question 25

What is associated with oral/intestinal ganglioneuromatosis?

Answer 25

Marfanoid habitus (p.304)

Question 26

How are all MEN syndromes inherited?

Answer 26

Autosomal dominant inheritance (p.304)

Question 27

What gene mutation is associated with MEN types 2A and 2B?

Answer 27

Ret gene mutation (p.304)