TTR Flashcards
medullary carcinoma of the breast presentation
(histologic subtype of invasiv ductal carcinoma)
histo: large, high grade cells, lymphocytic infiltrate
gross: well circumscribed mass; can mimic fibroadenoma on mammography
higher incidence in BRCA1 patients
most important prognostic factor affecting the course of breast cancer
involvement of axillary lymph nodes
If there is no spread to axillary nodes, the 10-year survival rate is almost 80%
risk factors for male breast cancer
age(70+)
1st degree relative w/BC
BRCA2 mutations
exposure to ionizing radiation
exogenous estrogen
infertility
obesity
conn syndrome
primary hyperaldosteronism
commonly an fxnl adrenal adenoma in glomerulosa of adrenal cortex
differentiate metastases in papillary vs follicular thyroid carcinoma
papillary - more likely to involve lymph nodes
follicular - more likely to metastatsistze to distant sites(bone, lung, liver)
how do you differentiate these origins of cushings?
pituitary
adrenal
ectopic
pituitary adenoma - suppressed by dexamethasone
adrenal tumor - unilateral enlargement of adrenals
ectopic ACTH - bilateral adrenal enlargement; not suppressed by dexamethasone
how is phosphate used to differentiate between primary and secondary hyperparathyroidism
phosphate is LOW in primary hyperparathyroidism due to excess PTH
phosphate is HIGH in secondary(renal failure) due to retention/broken kidneys
HLAs associated with DM type 1
HLA DR3, DR4
extensive fibrosis and fatty replacement of the pancreas is seen in what disease?
cystic fibrosis
amyloid deposition islet cells of pancreas is seen in what disease
type II DM
how do craniopharyngiomas cause galactorrhea and hypernatremia?
stalk-effect: reduces dopamine inhibition of prolactin – causes galactorrhea
Hypernatremia results from diabetes insipidus caused by lack of ADH – dilute urine
glucokinase vs hexokinase
both are used to trap glucose by creating G6P
glucokinase acts as a glucose sensor in the pancreas
- has a lower affinity for glucose than hexokinase
- is not inhibited by its product G6P
- defective in MODY2(mild hyperglcyemia since threshold for insulin release increases)
hexokinase is found in all tissue and works to trap glucose in tissues
- higher affinity for glucose
- IS inhibited by G6P
HVA is increased in what childhood tumor?
neuroblastoma
what do you screen for in an adult with a suspected pheochromocytoma
urinary free catecholamines, metanephrine, VMA
empty sella syndrome presentation
obese woman
hyperprolactinemia due to stalk effect - galactorrhea, infertility
the compression of the anterior pituitary by the arachnoid herniation(cause of empty sella) usually does not cause hypopituitary(would have to destory 70%)
when is insulitis seen in a type I diabetes patient?
usually insulitis with T-cell infiltrates is seen BEFORE the diabetes is clinically over(aka ketoacidotic incident)
when the disease becomes clinically evident, usually b-islet cells are absent or severely deficient
how does the progesterone component of OCPs contribute to birth control?
thickens cervical mucous to prevent sperm entry
negative feedback on LH, FSH – prevent LH surge
what are the aromatase inhibitors
letrozole
anastrozole
aromasin
flutamide
anti-androgen; completely antagonizes testosterone receptor
used in hirsutism, prostate cancer
finasteride
5a reductase
used for BPH
how do combined oral contraceptives improve acne and potentially decrease libido?
increased exogenous hormones will spurt he body to make more sex-hormone binding globulins
testosterone gets bound up by these globulins, causing decreased libido and improvement in acne
how do calcium levels in blood affect neuron excitability
hypercalcemia - increases threshold for firing
hypocalcemia - decreases threshold for firing; over-excitable
what is the surface molecule osteoblasts upregulate in resposne to PTH?
RANKL
RANK is expressed on osteoclast precursors which can activate once they see RANKL on activated osteoblasts
what signals regulate phosphorus
FGF23 in osteocytes
PTH
both increase phosphate excretion if it gets too high
familial hypocalciuric hypercalcemia
calcium sensing receptor deficiency in parathyroid
cause of secondary hyper-parathyroid
mild hypercalcemia, no urinary calculi or renal failure seen
pseudohypoparathyroidism
body does not respond to PTH; Ca2+ does not increase
hypocalcemia with high (or normal) PTH
one form is albright hereditary osteodystrophy; short 4/5 metacarpal and MR
denosumab
blocks RANKL
osteoclasts cant be activated
prevents bone resorbtion
bone formation marker
alkaline phosphatase
bone resorption marker
n-telopeptide
normal TSH
0.5-4.5
what thyroid disease predisposes the patient to non-hodgkins lymphoma
hashimoto thyroiditis
what is the range of impaired fasting glucose
100-125 mg/dl
what is the range of impaired glucose tolerance
140-199 mg/dl
