Boards - Bbc Session 12

Front 1

Define Prolactinoma

Back 1

pit. tumor that over-produces prolactin

Symptoms = amenorrhea, oligomenorrhea, impotence, galactorrhea, gynecomastia, visual complaints

Front 2

Define Cushing's disease

Back 2

Ant. pit. tumor. Over-production of ACTH --> adrenal gland produces cortisol resulting in Cushing's syndrome

Front 3

Symptoms of Cushing's disease?

Back 3

Buffalo hump, moon facies, violaceous striae, truncal obesity, HTN, hyperglycemia, osteoporosis, poor wound healing

Front 4

Acromegaly is due to what?

Back 4

ant. pit adenoma that over-produces GH


= pts outgrow rings, hats, shoes

Front 5

Gigantism is due to what?

Back 5

ant. pit. adenoma that over=produces GH

=pt becomes tall and large

Front 6

Define PCOS, its symptoms, and labs

Back 6

direct result of LH over-production

=acne, hirsutism, infertility

Labs = high: LH, androstenedione, testosterone, E2
Low: FSH

Front 7

Menopause is what?

Back 7

ovarian failure

= no E2 or progesterone production = neg. feedback on ant. pit.

High FSH and LH

Front 8

What will labs look like for Menopause?

Back 8

= ovarian failure

=High: LH, FSH
Low: P4, E2

Front 9

Define SIADH

Back 9

Excess anti-diuretic hormone secretion from post. pit.
=excess water reabsorption from post. pit
=excess water reabsorption at kidney = hyponatremia and cerebral edema +/- HTN

Front 10

What are the causes of SIADH?

Back 10

Small cell lung cancer

Head trauma resulting in damage to hypothalamus or post. pit.

Front 11

Define panhypopituitarism

Back 11

AKA pituitary cachexia or Simmond's disease

Causes = Pit tumor, post-partum pit. necrosis (Sheehan's syndrome)

Dec. production of TSH, GH, ACTH, LH, FSH

Front 12

Define Pituitary Dwarfism

Back 12

Congenital deficiency of GH

Front 13

Define Diabetes Insipidus (central)

Back 13

Caused by ADH deficiency secondary to decreased secretion by post. pit.

Causes polyuria and polydipsia

Usually due to head trauma wherein the posterior pit or hypothalamus are damaged

Front 14

Whats the cause of nephrogenic Diabetes insipidus?

Back 14

Lack of kidney response to ADH

Front 15

Define Conn's Syndrome

Back 15

Due to adrenal adenoma that over-produces aldosterone

Inc Al --> Inc. Na+ uptake with K+ exchange = Hypernatremia --> inc H2O uptake --> severe hypertenison (w/ Headaches) and Hypokalemia --> muscle weakness

Front 16

What is the cause of Cushing's syndrome?

Back 16

Due to any cause of inc. glucocorticoids:

adrenal adenoma, adrenal carcinoma, Cushing's disease, small cell lung carcinoma, prolonged use of glucocorticoids (steroids)

Front 17

How do we screen for Cushing's?

Back 17

24 hour urinary cortisol

Confirm Dx with Dexamethasone suppression test

Front 18

What does excess cortisol cause?

Back 18

fat redistribution to central body regions --> truncal obesity --> buffalo hump, moon facies.

Inc cortisol --> impaired healing/collagen deposition --> thinning of CT, esp in areas of stress --> purple striae

Inc. cortisol --> bony changes --> osteoporosis

Inc. cortisol --> glucose intolerance (hyperglycemia) and mineralocorticoid-like effects from cortisol precursors --> HTN

Front 19

Whats the cause of a Pheochromocytoma?

Back 19

Tumor of Adrenal Medulla --> Excess NE + or - Epi secretion

Front 20

How does a Pheochromocytoma come about?

Back 20

Sporadically or as a part of MEN II

pts with von Hippel-Lindau are at inc. risk

Front 21

How do we screen for Pheochromocytoma?

Back 21

24 hour urine catecholamines

24 hr. metanephrins and normetanephrins

best = 24 hr. VMA

Front 22

Define Neuroblastoma

Back 22

malignant tumor of adrenal medulla or sympathetic ganglia or both

Produces excess Norepi

Cells of neural crest origin are termed neuroblasts

Presenting sign is usually an enlarging abdomen

Front 23

Whats the cause of Addison's disease?

Back 23

Usually autoimmune but can be due to invasion by Mycobacterium tuberculosis or Histoplasma capsulatum

Front 24

Describe the pathogenesis of Addison's disease

Back 24

Dec. Al --> Excess Na and water loss through kidney --> hypotension and dec. Al--> dec. neg feedback on ant. pit. = excess ant. pit. production of POMC--> excess production of ACTH and MSH (melanocyte stimulating hormone) = excess melanocyte stimulation --> hyperpigmentation (pt will look tan)

Front 25

Primary Hyperthyroidism labs?

Back 25

High T3, Free T4

Low TSH

Front 26

Secondary Hyperthyroidism labs?

Back 26

High T3, Free T4, TSH

Front 27

Primary Hypothyroidism labs?

Back 27

High TSH

Low T3, Free T4

Front 28

Secondary Hypothyroidism labs?

Back 28

Low T3, Free T4, TSH

Front 29

Subacute Thyroiditis labs? (AKA DeQuervain's Thyroiditis)

Back 29

high or low T3, Free T4, and TSH
ie no pattern

Front 30

Whats the most common type of Thyroidism in the US?

Back 30

Grave's disease = diffuse toxic goiter

Front 31

A pt has exopthalmos (eyes bulging out), and hyperthyroid symptoms of diarrhea, palpitations, tachy, diaphoresis, anxiety/irritability, insomnia, fine silky hair, and weight loss. Dx?

Back 31

Grave's disease

Front 32

What drug to we give pts with Graves?

Back 32

Propylthiouracil

Front 33

Define Plummer's disease AKA nodular toxic goiter

Back 33

Occurs in post-menopausal multi-parous females. Risk increases with degree of parity

= a Hyperthyroid state, but often none of these symptoms...pts present with fatigue, malaise.

Front 34

Iodine deficiency pts will present how?

Back 34

With diffuse simple goiter = hypOthyroid signs such as constipation, fatigue, dry skin and course hair, swollen legs, cold intolerance, weight gain

Tx = Iodine

Front 35

Pathogenesis of Hashimoto's thyroiditis?

Back 35

T cell disorder with Abs that gradually and progressively mediate the destruction of the thyroid gland = hypothyroid symptoms

Front 36

Treatment of Hashimoto's Thyroiditis?

Back 36

Levothyroxine

Front 37

Ergot migraine meds can lead to what thyroid pathology?

Back 37

Riedel's Thyroiditis (Fibrous Thyroiditis) = Hypothyroid signs/symptoms

Front 38

Whats the cause of DeQuervain's thyroiditis?

Back 38

viral and usually follows an upper respiratory viral infection

HypERthyroid symptoms

Front 39

Treatment of DeQuervain's Thyroiditis?

Back 39

NSAIDS

Front 40

What can cause sick thyroid syndrome?

Back 40

severe illness, physical trauma, physiological stress

Front 41

Define follicular Adenoma of the thyroid

Back 41

Benign, single palpable thyroid nodule. Often Hyperthyroid

Front 42

T/F: Thyroid carcinomas are usually cold nodules meaning the mass does not produce any thyroid hormone

Back 42

TRUE

Front 43

Define cold nodule

Back 43

A mass in thyroid that doesn't make thyroid hormone. = it doesn't require any iodine, so if radioactively labeled iodine is injected, this mass will show up as "cold"

Front 44

What are the 4 main types of thyroid carcinoma?

Back 44

Papillary, Follicular, Anaplastic, Medullary

Front 45

Which thyroid carcinoma has the best prognosis?

Back 45

Papillary

Front 46

What are all the dif roles of parathyroid hormone?

Back 46

OVERALL = INC. Serum Ca2+

Activate osteoclasts --> inc bone demineralization = inc serum Ca2+
Inc renal tubular reabsorption of Ca2+ --> inc serum Ca2+

Front 47

Whats the overall effect of vit D in the body?

Back 47

active Vit D (1,25-dihydroxy-D3) acts in small intestines to inc serum Ca and P = inc bone mineralization

Front 48

Primary Hyperparathyroidism labs?

Back 48

Hi PTH and Ca2+

Low PO4

Front 49

Secondary Hyperparathyroidism labs?

Back 49

ex = chronic renal failure = kidneys won't respond to PTH

High PTH, PO4

Low Ca2+

Front 50

Hypoparathyroidism labs?

Back 50

High PO4

Low PTH, Ca2+

Front 51

Labs for Pseudohypoparathyroidism?

Back 51

High PTH but no response so low Ca2+, HIGH PO4

Front 52

Symptoms of Diabetes?

Back 52

Hyperglycemia, polyphagia, polyuria, polydipsia, inc. infections, blurred vision

Front 53

PT has HLA-DR3 and HLA-DR4. What type of Diabetes do they have?

Back 53

Type 1

-usually jevenile onset

Front 54

Pt has Diabetes but NO HLA connection and it came about in their 40s. What type of Diabetes do they have?

Back 54

Type 2

Front 55

Pt is lean and has Abs directed against beta-islet cells meaning they have no insulin production. What type of Diabetes do they have?

Back 55

Type 1

Front 56

Describe the pathogenesis of Type 2 Diabetes

Back 56

Chronic/frequent high glucose intake --> chronic and frequent inc. insulin requirement --> inc insulin resistance --> less insulin sensitivity --> more insulin needed --> pancreas burns out

Front 57

What are some CHRONIC complications of Diabetes we can see?

Back 57

neuropathy, atherosclerosis (leading to MI, PVD, stroke, AA, mesenteric ischemia), retinopathy, nephropathy (Kimmelstiel-Wilson, nodular sclerosis)

Front 58

Define Gestational Diabetes

Back 58

beta cell reserve inadequate for demands of pregnancy

Resolves after pregnancy most of the time.

Front 59

Define MODY, mature onset diabetes of the young

Back 59

Due to glucokinase defect, which is the first enzyme glucose encounters when it enters cell

glucokinase defect = cells can't phsophorylate glucose made available to them = glucose released back into serum = hyperglycemia

Front 60

Define MEN, Multiple Endocrine Neoplasia

Back 60

MENs are autosomally dominant inherited disorders in which the individual inherits a LIFE-LONG risk of developing certain neoplasias (benign or malignant) of endocrine glands

Front 61

Define the different types of MEN

Back 61

MEN Type 1 = Wermer's syndrome
MEN Type 2a = Sipple's Syndrome
MEN Type 2b = MEN Type 3

Front 62

Define Seborrheic keratosis

Back 62

Benign round flat coin-like "stuck on" plaques that feel greasy

Front 63

Define keratocanthoma

Back 63

Flesh-colored dome-shaped nodule with keratin-filled plug

Usually on face and dorsum of hand

Front 64

Define actinic keratosis

Back 64

Due to too much sun.

Dysplasia before the malignant cancer

some have cutaneous horn

Front 65

Define Basal Cell Carcinoma

Back 65

pearly gray with telangiectasias

Caused by SUN

Slow growing, rarely metastasizes

Front 66

Define Squamous cell carcinoma

Back 66

Caused by SUN,

Too much UV --> DNA damage --> damages Langerhans cells --> no surveillance --> allows malignant cells to develop/grow

Front 67

Whats the #1 tumor on sun-exposed skin of adults?

Back 67

Squamous cell carcinoma

Front 68

Define Melanoma

Back 68

Caused by SUN
Most are cured by excisional removal

Most important sign = color change
risk factors = sun exposure, pre-existing nevus, genetics, carcinogens

Front 69

Where does Bowen disease occur?

Back 69

genital region of males and females

= Thick gray-white plaque

>90% have HPV
10% transition to become squamous cell cancer

Front 70

Define Bowenoid papulosis

Back 70

multiple, pigmented papules on external genitalia of male

may mimic condyloma acuminatum

rarely transition into squamous cell cancer

Front 71

Define Erythroplasia of Queyrat

Back 71

Single or multiple shiny red plaaque (sometimes velvety) on the glans penis or prepuce

10% transition to squamous cell cancer

Front 72

Define Pemphigus

Back 72

Abs cause loss of attachment between keratinocytes and fluid fills within the spaces, resulting in vesicles

Histologically, acantholysis = lysis of intercellular adhesion sites

Front 73

Define Bullous Pemphigoid

Back 73

Tense bullae with clear fluid

occurs in elderly, and CAN heal without a scar
Abs develop against adhesion sites between basal cells and basement membrane = loss of attachment, fluid fills area, lifting entire cutaneous epi layer from BM

Histologically = sub-epidermal non-acantholytic blister

Front 74

Define Impetigo

Back 74

Due to Strep pyogenes or Staph a.

Vesicles/bullae --> pustules --> rupture --> crusted skin lesions

usually on hands/face

Front 75

Define Pityriasis rosea

Back 75

rash preceded by herald patch

Rash -->oval to round plaques with surrounding scale, most often on trunk (spares palms/soles)

Christmas tree pattern

Front 76

Define Rosacea

Back 76

Chronic dis. of nose/forehead/cheeks

females >>> males but males more severely affected

=erythema, telangiectasia, superficial pustules (without comedones), facial flushing (frequent, common). inc occurence of keratitis, iritis, chalazions --> all may be sight-threatening

Front 77

Define tinea versicolor

Back 77

Hyperpigmented or hypopigmented scaly patches on trunk

Microscopically = mixture of hyphae (long) + spores (round) --> spaghetti and meatballs appearance

cause = pityrosporum orbicularis/pityrosporum ovale/malassezia furfur

Front 78

Define Psroiasis

Back 78

Sharply demarcated, erythematous plaques with thick scale

primarily affects elbows, knees, scalp

Front 79

Define Seborrheic dermatitis

Back 79

Greasy scales over erythematous patches or plaques

#1 location = scalp --> dandruff

If evident in neonate = cradle cap
VERY common in those with Parkinsons

Front 80

Define Eczema

Back 80

Dermatitis

final common expression of atopic dermatitis, contact dermatitis and sebhorrheic dermatitis etc.

Front 81

Define Xanthoma

Back 81

Cholesterol accumulations within the dermis

Front 82

Whats the #1 type of hemangioma

Back 82

Capillary hemangioma
2 Types:
1. aka the ordinary birth mark = salmon patch or stork bite
2. Straberry hemangioma = develops in 1-2 years but regresses by age 7

Front 83

A pt has Sturge-Weber = a congenital disease with faulty mesoderm and ectoderm development resulting in hemangiomas assoc. with meninges --> seizures. What skin condition is assoc. with this?

Back 83

Port wine stain = Cavernous hemangioma

Front 84

Define Cafe au Lait

Back 84

Light brown macules with smooth border over nerve trunks

Front 85

Define vitiligo

Back 85

flat non-pigmented macules due to anti-melanocyte Abs

usually seen in higher assoc with pernicious anemia, Addison's dis. and or autoimmune thyroiditis (Hashimoto's)

Front 86

Define Lentigo

Back 86

Opposite of vitiligo in terms of appearance = ie small oval tan macules

AKA Liver Spots

Front 87

Sources of Cadmium poisoning and Symptoms?

Back 87

sources = welding, paints, pigments

Symptoms = metallic taste, N, V, D, inc. salivation, kidney and liver damage

Front 88

Source and symptoms of Cobalt poisoning?

Back 88

Source = vitamin B12 intoxication, drilling/milling, metals, labs

Symptoms = acute ingestion = stomach lavaged, and a PINK lavage is collected


long term outcome = dilated cardiomyopathy

Front 89

Sources and Symptoms of Lead poisoning?

Back 89

Source = paints, toys, house paint, fishing sinkers, old plumbing

Symptoms =
Chronic exposure = microcytic anemia, irritability, insomnia, dec. IQ, behavioral and attention problems, wine urine, Burton's lines (blue-black ginginvae lines), renal tubular acidosis, lead lines in long bones, lead spots on KUB

Front 90

Sources and Symptoms of Mercury poisoning?

Back 90

Sources = glass thermometers, labs, thimerosal, fish contaminated with methyl mercury

Symptoms = low-level, chronic exposure = insomnia, wine urine, colitis, black feces, grey skin, Burton's lines, proximal tubular necrosis, paresthesias, tremors, ataxia, blindness

Front 91

Sources and Symptoms of Arsenic poisoning?

Back 91

Source = ground water

Symptoms = garlic smell on breath, rash, anxiety, extreme diaphoresis and salivation, colitis, death within a short period of time, skin cancer, lung cancer, kidney cancer, cirrhosis, peripheral vascular dis., microcytic anemia, DM, blindness, mood disorders

Front 92

Source and Symptoms of asbestos?

Back 92

Source = Asbestos mines, exposure to insulation installed before 1980s, work at railroads, shipyards and automotive plants

Symptoms: Chronic exposure may lead to asbestosis, mesothelioma = plural thickening on X-ray before mesothelioma development

Front 93

Source and Symptoms of aromatic amines?

Back 93

Source = red and yellow food dyes, hair dyes, tobacco smoke

Symptoms = bladder cancer with chronic exposure

Front 94

Source Symptoms of Benzene

Back 94

Source = research and chemical manufacturing labs
Symptoms = acute poisoning = oliguria, insomnia, CNS depression
Chronic poisoning = wine urine, severe bone marrow damage

Front 95

Source/Symptoms of Chromium poisoning?

Back 95

Source = incinerators, work in metallurgy/welding, paints, road dust, tattooing, ingestion of the dietary supplement chromium picolinate

Symptoms = acute = anuria and inevitable death
Chronic = lung cancer

Front 96

Source/Symptoms of Vinyl Chloride poisoning?

Back 96

Source = PVC-packaged foods, refrigerants, manufacturing plants

Symptoms = recurrent exposure = portal vein fibrosis
Symptoms = malignant neoplasms arising from endothelium of blood vessels in liver: angiosarcoma

Front 97

Source/Symptoms of Alpha-Amanitin

Back 97

Source = toadstools and poison mushrooms
Symptoms = acute = diarrhea, cramping within 24-48 hrs, then no symptoms until the 4th or 5th day, then there is complete renal and hepatic failure

7-8th day patients die

Front 98

Source/Symptoms of CO poisoning?

Back 98

Source = combustion ie home heaters, car exhaust
Symptoms = cherry red lips, extreme anxiety followed by stupor/death

Front 99

Source/Symptoms of Cyanide poisoning?

Back 99

Source = cherry pits, apricot pits and apple seeds, peach pits, raw cassava, smoke inhalation from rubber or plastic

Symptoms = RAPID weakness, confusion, excessive sleepiness, coma, seizure, death