Goljan Pathology Synopsis - Systemic 2 - Renal To Endocrine

Front 1

First sign tubule cell dysfunction

Back 1

inability to concentrate urine

Front 2

Fixed specific gravity

Back 2

chronic renal failure; cannot concentrate or dilute urine

Front 3

Negative urine bilirubin + trace urobilinogen

Back 3

normal urine

Front 4

Positive urine bilirubin, absent urobilinogen

Back 4

obstructive jaundice

Front 5

Positive urine bilirubin + increased urobilinogen

Back 5

hepatitis

Front 6

Negative urine bilirubin + increased urobilinogen

Back 6

extravascular hemolytic anemia

Front 7

Positive urine nitrite + positive urine leukocyte esterase

Back 7

urinary tract infection

Front 8

Sterile pyuria

Back 8

positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis

Front 9

Prerenal azotemia

Back 9

↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)

Front 10

Renal azotemia

Back 10

↑ BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)

Front 11

Postrenal azotemia

Back 11

↑ BUN and creatinine due to obstruction to urine flow

Front 12

Serum BUN:creatinine ratio

Back 12

<15:1 (renal failure); >15:1 (prerenal or postrenal azotemia)

Front 13

BUN 80 mg/dL:creatinine 8 mg/dL

Back 13

ratio 10/1 - renal failure

Front 14

BUN 80 mg/dL:creatinine 2 mg/dL

Back 14

ratio 40/1 - prerenal azotemia or postrenal azotemia

Front 15

Creatinine clearance

Back 15

measures GFR

Front 16

Proteinuria

Back 16

important sign of renal dysfunction

Front 17

RBC casts

Back 17

nephritic type of glomerulonephritis

Front 18

WBC casts

Back 18

acute pyelonephritis, acute tubulointerstitial nephritis

Front 19

Fatty casts with Maltese crosses

Back 19

nephrotic syndrome

Front 20

Hyaline casts

Back 20

normal unless associated with proteinuria

Front 21

Renal tubular cell casts

Back 21

acute tubular necrosis

Front 22

Waxy or broad casts

Back 22

chronic renal failure

Front 23

Cystinuria

Back 23

hexagonal crystals

Front 24

Horseshoe kidney

Back 24

Turner’s syndrome; lower poles fused

Front 25

Renal dysplasia

Back 25

MC childhood cystic disease; abnormal development; flank mass

Front 26

Maternal oligohydramnios

Back 26

fetal juvenile polycystic kidney disease; Potter’s facies in newborn

Front 27

Adult polycystic kidney disease

Back 27

AD; hypertension MC sign; cerebral berry aneurysms

Front 28

Visceral epithelial cells

Back 28

synthesize basement membrane

Front 29

Glomerular BM

Back 29

negative charge due to heparan sulfate

Front 30

Nephritic syndrome

Back 30

oliguria; RBC casts; hypertension; mild to moderate proteinuria

Front 31

Nephrotic syndrome

Back 31

proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes

Front 32

Immunofluorescence

Back 32

linear (anti-glomerular BM antibodies); granular (IC deposition)

Front 33

IgA GN

Back 33

MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits

Front 34

Post-streptococcal GN

Back 34

nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B

Front 35

SLE type IV GN

Back 35

nephritic; subendothelial deposits; anti-DNA antibodies

Front 36

Crescentic GN

Back 36

crescents from parietal cell proliferation; worst GN; Goodpasture’s, Wegener’s

Front 37

Goodpasture’s

Back 37

nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN

Front 38

S/S

Back 38

young male with hemoptysis progressing to renal failure

Front 39

Minimal change disease (lipoid nephrosis)

Back 39

MCC childhood nephrotic syndrome

Front 40

Lipoid nephrosis

Back 40

podocyte fusion; loss of negative charge in glomerular BM

Front 41

Focal segmental glomerulosclerosis

Back 41

nephrotic syndrome; AIDS and IV heroin abuse

Front 42

Membranous GN

Back 42

MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes

Front 43

Causes membranous GN

Back 43

HBV, ACE inhibitors, cancer

Front 44

Type I MPGN

Back 44

nephrotic; subepithelial deposits; HCV association; tram tracks

Front 45

Type II MPGN

Back 45

nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)

Front 46

DM nodular glomerulosclerosis

Back 46

microalbuminuria first sign

Front 47

DM glomerulosclerosis

Back 47

nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles

Front 48

ACE inhibitors

Back 48

inhibit angiotensin II vasoconstriction of efferent arterioles

Front 49

Alport’s syndrome

Back 49

XD hereditary nephritis with sensorineural hearing loss

Front 50

Ischemic ATN

Back 50

prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1

Front 51

Ischemic ATN

Back 51

disruption of BM in proximal tubule and thick ascending limb

Front 52

Nephrotoxic ATN

Back 52

aminoglycosides, IVP dye, Pb/mercury poisoning

Front 53

Nephrotoxic ATN

Back 53

proximal tubule dysfunction; intact BM

Front 54

Oliguria

Back 54

prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia

Front 55

Acute pyelonephritis

Back 55

vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain

Front 56

Chronic pyelonephritis

Back 56

U-shaped scars overlying blunt calyces

Front 57

Drug-induced tubulointerstitial nephritis

Back 57

type I/IV reaction; e.g., penicillin

Front 58

S/S

Back 58

ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts

Front 59

Analgesic nephropathy

Back 59

aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect

Front 60

Myeloma kidney

Back 60

BJ protein produces foreign body reaction in tubules

Front 61

Urate nephropathy

Back 61

prevent by giving allopurinol prior to chemotherapy

Front 62

CRF

Back 62

fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts

Front 63

Renal osteodystrophy CRF

Back 63

hypovitaminosis D (no 1-α-hydroxylase); produces osteomalacia

Front 64

Renal osteodystrophy CRF

Back 64

osteoporosis from metabolic acidosis

Front 65

Renal osteodystrophy CRF

Back 65

secondary HPTH with increased osteoclastic activity

Front 66

S/S CRF

Back 66

pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures

Front 67

Benign nephrosclerosis

Back 67

kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis

Front 68

Malignant hypertension

Back 68

renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside

Front 69

Renal findings

Back 69

necrotizing arteriolitis; “flea bitten” kidney; hyperplastic arteriolosclerosis

Front 70

Renal infarction

Back 70

pale infarcts; hematuria; common in polyarteritis nodosa

Front 71

Hydronephrosis

Back 71

renal stone MCC; atrophy of cortex/medulla; postrenal azotemia

Front 72

Renal stones

Back 72

most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor

Front 73

S/S

Back 73

colicky pain radiating into groin, hematuria; x-ray usually shows stone

Front 74

Staghorn calculus

Back 74

due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell

Front 75

Angiomyolipoma

Back 75

hamartoma; associated with tuberous sclerosis

Front 76

Renal cell carcinoma

Back 76

smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored

Front 77

S/S

Back 77

flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele

Front 78

Renal pelvis transitional cell carcinoma

Back 78

smoking MCC, phenacetin, aniline dyes, cyclophosphamide

Front 79

Wilm’s tumor

Back 79

hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types

Front 80

Urine draining from umbilicus

Back 80

persistent urachus

Front 81

Retroperitoneal fibrosis

Back 81

produces hydronephrosis

Front 82

Bladder extrophy

Back 82

abdominal wall defect + epispadias

Front 83

Bladder diverticula

Back 83

most commonly due to prostatic hyperplasia with urethral obstruction

Front 84

Acute cystitis

Back 84

E. coli; females > males; no fever, flank pain, or WBC casts

Front 85

Bladder transitional cell carcinoma

Back 85

smoking MCC, aniline dyes, cyclophosphamide; papillary

Front 86

S/S

Back 86

hematuria; hydronephrosis

Front 87

Bladder adenocarcinoma

Back 87

risk factors persistent urachus, extrophy

Front 88

Bladder squamous cell carcinoma

Back 88

Schistosoma hematobium infection

Front 89

Hypospadias

Back 89

ventral opening on penis due to failure closure of urethral folds

Front 90

Epispadias

Back 90

dorsal opening on penis due to defect in genital tubercle

Front 91

Peyronie’s disease

Back 91

painful curvature penis due to fibromatosis

Front 92

Priapism

Back 92

persistent/painful erection; HbSS

Front 93

Squamous cell carcinoma penis

Back 93

HPV and lack of circumcision most important risk factors

Front 94

Cryptorchidism

Back 94

undescended testis; risk for seminoma applies to cryptorchid testis and normal testis

Front 95

Orchitis

Back 95

mumps usually unilateral (infertility uncommon)

Front 96

Epididymitis

Back 96

<35 - N. gonorrhoeae, C. trachomatis; >35 - E. coli, P. aeruginosa

Front 97

S/S

Back 97

scrotal pain relieved by elevation of scrotum (Prehn’s sign)

Front 98

Varicocele

Back 98

left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common

Front 99

Varicocele

Back 99

may be due to invasion of left renal vein by renal cell carcinoma

Front 100

Hydrocele

Back 100

persistent tunica vaginalis; scrotum transilluminates

Front 101

Torsion of testicle

Back 101

testicle high in canal; absent cremasteric reflex

Front 102

Testicular cancer

Back 102

unilateral painless mass that does not transilluminate

Front 103

Risk factors

Back 103

cryptorchid testis, Klinefelter’s, testicular feminization

Front 104

Seminoma

Back 104

MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ↑hCG

Front 105

Spermatocytic variant

Back 105

>65 yrs of age

Front 106

Embryonal carcinoma

Back 106

hemorrhage/necrosis; hematogenous spread before lymphatic; ↑AFP, hCG

Front 107

Yolk sac tumor

Back 107

MC testicular cancer in boys; ↑AFP

Front 108

Choriocarcinoma

Back 108

most aggressive testicle cancer; ↑hCG

Front 109

Teratoma

Back 109

more often benign in children than adult

Front 110

Teratocarcinoma

Back 110

teratoma + embryonal carcinoma

Front 111

Malignant lymphoma

Back 111

MC type in elderly; metastasis not primary cancer

Front 112

Prostate

Back 112

DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer

Front 113

Prostatitis

Back 113

perineal pain, fever; WBCs at end of voiding

Front 114

Benign prostatic hyperplasia

Back 114

DHT/estrogen-mediated; glandular/smooth muscle hyperplasia

Front 115

S/S

Back 115

all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx

Front 116

Prostate cancer

Back 116

DHT-mediated; palpable with rectal exam; osteoblastic metastasis (↑ AP)

Front 117

PSA

Back 117

sensitive but not specific for prostate cancer; ↑ in hyperplasia

Front 118

Kallmann’s syndrome

Back 118

absent GnRH, anosmia, absence of taste

Front 119

Impotence

Back 119

failure to sustain an erection; psychogenic in most cases (erections present at night)

Front 120

Erection

Back 120

parasympathetic response

Front 121

Ejaculation

Back 121

sympathetic response

Front 122

Leydig cell failure

Back 122

↑ LH; ↓ testosterone, sperm count; normal FSH

Front 123

Seminiferous tubule failure

Back 123

↑ FSH (↓inhibin); ↓ sperm count; normal LH and testosterone

Front 124

Leydig and seminiferous tubule failure

Back 124

↑ FSH and LH; ↓ testosterone and sperm count

Front 125

Y chromosome

Back 125

determines genetic sex

Front 126

Testosterone

Back 126

develops seminal vesicles, epididymis, vas deferens

Front 127

Dihydrotestosterone (DHT)

Back 127

develops prostate and male external genitalia

Front 128

Male pseudohermaphrodite

Back 128

genetic male; phenotypically female

Front 129

Testicular feminization

Back 129

XR; deficient androgen receptors; MCC male pseudohermaphrodite

Front 130

Klinefelter’s syndrome

Back 130

XXY; 1 Barr body; female secondary sex characteristics

Front 131

Herpes genitalis

Back 131

recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions

Front 132

Human papilloma virus

Back 132

condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo)

Front 133

Chlamydia trachomatis

Back 133

metaplastic squamous cells with vacuoles containing elementary bodies

Front 134

S/S

Back 134

non-specific urethritis, cervicitis, PID, ophthalmia neonatorum

Front 135

Neisseria gonorhoeae

Back 135

urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus

Front 136

Ophthalmia neonatorum first week

Back 136

N gonorrhoeae

Front 137

Ophthalmia neonatorum second week

Back 137

C. trachomatis

Front 138

Lymphogranuloma venereum

Back 138

C. trachomatis subtype

Front 139

S/S

Back 139

scrotal/vulva lymphedema; granulomatous microabscesses; rectal strictures in females

Front 140

Chancroid

Back 140

painful ulcer, adenopathy, Hemophilus ducreyi

Front 141

Granuloma inguinale

Back 141

Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy

Front 142

Treponema pallidum

Back 142

spirochete; produces vasculitis of arterioles (plasma cell infiltrate)

Front 143

Primary syphilis

Back 143

painless chancre

Front 144

Secondary syphilis

Back 144

rash on palms/soles; condyloma lata; generalized adenopathy

Front 145

Tertiary syphilis

Back 145

neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas

Front 146

RPR/VDRL

Back 146

reagin antibodies against cardiolipin; ↓ titer with Rx of syphilis

Front 147

RPR/VDRL

Back 147

false positive with anticardiolipin antibodies (common in SLE)

Front 148

FTA-ABS

Back 148

confirmatory test for syphilis; not distinguish active from treated disease

Front 149

FTA-ABS

Back 149

remains positive after Rx

Front 150

Trichomonas vaginalis

Back 150

flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners

Front 151

Gardnerella vaginalis

Back 151

vaginal pH >5; bacterial vaginosis; clue cells; Rx metronidazole

Front 152

Candida vaginitis

Back 152

white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole

Front 153

Vulvar squamous cancer

Back 153

MC vulvar cancer; HPV association

Front 154

Vulvar leukoplakia

Back 154

biopsy to R/O squamous dysplasia/cancer

Front 155

Lichen sclerosis vulva

Back 155

epidermal atrophy; slight risk for squamous cancer

Front 156

Squamous hyperplasia vulva

Back 156

leukoplakia; no cancer risk

Front 157

Paget’s disease

Back 157

intraepithelial adenocarcinoma (mucin production) of vulva

Front 158

Malignant melanoma

Back 158

vulva location; similar to Paget cells but not mucin positive

Front 159

Gartner’s duct cyst

Back 159

lateral wall vagina; persistent mesonephric duct

Front 160

Embryonal rhabdomyosarcoma

Back 160

bloody, grape-like vaginal mass young girl

Front 161

Vaginal adenosis

Back 161

maternal exposure to DES; precursor clear cell adenocarcinoma vagina

Front 162

Vaginal squamous cancer

Back 162

usually extension of cervical cancer

Front 163

Rokitansky-Kiister-Hauser

Back 163

absence of vagina and uterus

Front 164

Nabothian cysts

Back 164

endocervical glands covered by metaplastic squamous epithelium

Front 165

Pathologic cervicitis

Back 165

trichomonas, HSV-2, C. trachomatis (follicular cervicitis)

Front 166

Cervical Pap

Back 166

superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone)

Front 167

Normal

Back 167

70% superficial, 30% intermediate

Front 168

Atrophic

Back 168

100% parabasal cells

Front 169

Hyperestrinism

Back 169

100% superficial cells

Front 170

Pregnancy

Back 170

100% intermediate cells

Front 171

Endocervical cells

Back 171

sign of adequately performed Pap smear

Front 172

Cervical polyp

Back 172

bleeding after intercourse; non-neoplastic

Front 173

Cervical dysplasia

Back 173

begins in transformation zone; associated with low and high risk HPV

Front 174

Risk factors cervical dysplasia/cancer

Back 174

early onset sexual activity; multiple partners; smoking; OC

Front 175

CIN

Back 175

cervical intraepithelial dysplasia; mild, moderate, severe (in-situ)

Front 176

Cervical cancer

Back 176

↓ incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters

Front 177

S/S

Back 177

cervical discharge; bleeding after intercourse

Front 178

Sequence to menarche

Back 178

breast budding, growth spurt, pubic hair, axillary hair, menarche

Front 179

Proliferative phase cycle

Back 179

estrogen-dependent; ↑estrogen inhibits FSH and stimulates LH

Front 180

Ovulation

Back 180

day 14-I6; LH surge; subnuclear vacuoles; ↑body temperature

Front 181

Secretory phase cycle

Back 181

progesterone-dependent

Front 182

Menses

Back 182

drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting

Front 183

FSH

Back 183

stimulates follicle and aromatase synthesis in granulosa cells

Front 184

LH

Back 184

stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase

Front 185

Day 21

Back 185

day of implantation of fertilized egg

Front 186

Pregnancy

Back 186

↑plasma volume > RBC mass; ↑GFR; ↑thyroxine/cortisol (increased binding proteins)

Front 187

hCG

Back 187

LH analogue produced by syncytiotrophoblast

Front 188

hCG

Back 188

stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks

Front 189

Estrone

Back 189

estrogen of postmenopausal woman; aromatization of adrenal androstenedione

Front 190

Estradiol

Back 190

estrogen of non-pregnant woman in reproductive life; aromatization of testosterone

Front 191

Estriol

Back 191

estrogen of pregnancy

Front 192

Menopause

Back 192

↑ FSH (best screen; due to ↓estrogen), ↑LH

Front 193

S/S

Back 193

secondary amenorrhea, hot flushes

Front 194

Hirsutism

Back 194

↑ hair in normal areas

Front 195

Virilization

Back 195

hirsutism + male secondary sex characteristics (clitoromegaly)

Front 196

Test for hirsutism/virilization

Back 196

↑ testosterone - ovarian source; ↑DHEA-sulfate - adrenal source

Front 197

Polycystic ovarian syndrome (POS)

Back 197

↑ LH; ↓ FSH; ↑ estrogen and androgens

Front 198

S/S

Back 198

hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH >2:1

Front 199

Menorrhagia

Back 199

excess menstrual flow; MCC iron deficiency in women

Front 200

Dysmenorrhea

Back 200

painful menses; 1° PGF2α, 2° endometriosis

Front 201

DUB

Back 201

bleeding related to hormone rather than anatomic causes

Front 202

Anovulatory DUB

Back 202

menarche and perimenopause; estrogen excess without progesterone

Front 203

Ovulatory DUB

Back 203

irregular shedding, inadequate luteal phase

Front 204

Primary amenorrhea

Back 204

no menses by 16 years old

Front 205

Secondary amenorrhea

Back 205

no menses for 3 months

Front 206

Amenorrhea-hypothalamic/pituitary dysfunction

Back 206

↓ FSH/LH; e.g., hypopituitarism

Front 207

Amenorrhea-ovarian dysfunction

Back 207

↑FSH/LH; e.g., Turner’s syndrome

Front 208

Amenorrhea-end-organ disease

Back 208

normal FSH/LH; e.g., imperforate hymen

Front 209

Asherman syndrome

Back 209

surgical removal of stratum basalis

Front 210

Primary amenorrhea-normal secondary sex characteristics

Back 210

constitutional delay MCC

Front 211

Primary amenorrhea-lack secondary sex characteristics

Back 211

Turner’s

Front 212

Turner’s syndrome

Back 212

XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs)

Front 213

S/S

Back 213

newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; 1° amenorrhea

Front 214

Secondary amenorrhea

Back 214

pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma

Front 215

Asherman syndrome

Back 215

removal of stratum basalis causing scarring; secondary amenorrhea

Front 216

Endometritis

Back 216

group B streptococcus; intrauterine device (Actinomyces); chronic - plasma cells

Front 217

Endometrial polyp

Back 217

menorrhagia; not a precursor for endometrial cancer

Front 218

Adenomyosis

Back 218

functioning endometrial glands and stroma in myometrium; enlarged uterus

Front 219

Endometriosis

Back 219

functioning glands and stroma outside uterus; reverse menses; ovary MC site

Front 220

S/S

Back 220

dysmenorrhea, painful stooling, bowel obstruction; “powder burn” appearance

Front 221

Endometrial hyperplasia

Back 221

unopposed estrogen; simple/complex types; precursor endometrial cancer

Front 222

Causes

Back 222

obesity, estrogen Rx, polycystic ovarian syndrome

Front 223

Endometrial cancer

Back 223

obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective

Front 224

S/S

Back 224

bleeding in postmenopausal woman

Front 225

Leiomyoma uterus

Back 225

menorrhagia, obstructive delivery; not a precursor for leiomyosarcoma

Front 226

Leiomyosarcoma

Back 226

MC sarcoma

Front 227

Ectopic pregnancy

Back 227

PID MC risk factor; intraperitoneal hemorrhage; screen with ß-hCG

Front 228

Follicular cyst

Back 228

MC ovarian mass in young woman

Front 229

Risk factors ovarian tumors

Back 229

nulliparity and genetic factors; OC protective

Front 230

Serous ovarian tumors

Back 230

surface-derived; ↑ bilaterality; psammoma bodies in malignant type

Front 231

Mucinous ovarian tumors

Back 231

surface-derived; pseudomyxoma peritonei in malignant type

Front 232

Endometrioid carcinoma

Back 232

resembles endometrial cancer; association with endometriosis

Front 233

Cystic teratoma

Back 233

MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications

Front 234

Dysgerminoma

Back 234

MC malignant germ cell tumor; associated with streak gonads of Turners

Front 235

Yolk sac tumor

Back 235

MC germ cell tumor young girl; ↑AFP; Schiller-Duval bodies

Front 236

Meigs syndrome

Back 236

ovarian fibroma, ascites, right-sided pleural effusion

Front 237

Granulosa tumor

Back 237

low grade malignant; hyperestrinism, Call Exner bodies

Front 238

Thecoma

Back 238

benign; yellow color; hyperestrinism

Front 239

Leydig cell and Sertoli cell tumors

Back 239

hyperandrogenism

Front 240

Gonadoblastoma

Back 240

XY phenotype of Turner’s

Front 241

Krukenberg tumors

Back 241

metastatic stomach cancer; signet ring cells

Front 242

Single umbilical artery

Back 242

↑ incidence congenital defects

Front 243

Syncytiotrophoblast

Back 243

lining of villi; produces hCG and human placental lactogen

Front 244

Human placental lactogen

Back 244

responsible for mild glucose intolerance in pregnancy

Front 245

Abruptio placenta

Back 245

retroplacental clot; painful bleeding; hypertension, cocaine, smoking

Front 246

Placenta previa

Back 246

placenta implanted over cervical os; painless bleeding

Front 247

Placenta accreta

Back 247

direct implantation into myometrium without intervening decidua; hysterectomy

Front 248

Twin placenta

Back 248

monochorionic always identical twins; dichorionic may be identical or fraternal

Front 249

Siamese twins

Back 249

monoamniotic monochorionic twin placenta

Front 250

Enlarged placenta

Back 250

DM, Rh HDN, syphilis

Front 251

Complete mole

Back 251

benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male)

Front 252

S/S

Back 252

preeclampsia in first trimester; ↑ incidence choriocarcinoma

Front 253

Partial mole

Back 253

embryo present; 68 XXY; no transformation into choriocarcinoma

Front 254

Choriocarcinoma

Back 254

malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast)

Front 255

Risk factors

Back 255

complete mole (MC), spontaneous abortion, normal pregnancy

Front 256

S/S

Back 256

↑hCG; lung metastasis; good prognosis

Front 257

Chorioamnionitis

Back 257

group B streptococcus (S. agalactiae) infection

Front 258

Preeclampsia

Back 258

abnormal placentation causing placental ischemia; ↑ in vasoconstrictors (ATII)

Front 259

S/S

Back 259

hypertension, proteinuria, pitting edema; begins in third trimester

Front 260

Spontaneous abortion

Back 260

50% have karyotype deformity (trisomy 16)

Front 261

Amniotic fluid

Back 261

fetal urine

Front 262

Polyhydramnios

Back 262

TE fistula, duodenal atresia, open neural tube defects

Front 263

Oligohydramnios

Back 263

infantile polycystic disease

Front 264

↑ Serum AFP

Back 264

open neural tube defect

Front 265

↓ Serum AFP

Back 265

Down syndrome

Front 266

Urine estriol

Back 266

fetal adrenal, placental, maternal liver involved in its production

Front 267

Down syndrome triad

Back 267

↑ ß-hCG, ↓ serum AFP, ↓ urine estriol

Front 268

Fibrocystic change

Back 268

MC breast mass <50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts

Front 269

Sclerosing adenosis

Back 269

component of FCC; involves terminal lobules often has microcalcifications

Front 270

Fibroadenoma

Back 270

benign stromal tumor; MC movable mass in women <35-yrs-old

Front 271

Intraductal papilloma

Back 271

benign tumor lactiferous duct/sinus; MCC bloody nipple discharge <50-yr-old

Front 272

Invasive ductal cancer

Back 272

MCC breast mass in woman >50-yrs-old

Front 273

Breast cancer risk

Back 273

unopposed estrogen; family history first-degree relatives

Front 274

Breast cancer

Back 274

painless mass upper outer quadrant in woman >50-yrs-old

Front 275

Mammography

Back 275

screening test to detect non-palpable masses

Front 276

Palpable breast mass

Back 276

order fine needle aspiration (not a mammogram)

Front 277

Ductal carcinoma in situ

Back 277

necrotic centers (comedo); microcalcifications common

Front 278

Paget’s disease of breast

Back 278

invasive ductal cancer into nipple; Paget’s cells similar to vulvar Paget’s

Front 279

Medullary carcinoma

Back 279

bulky tumor with large cells and lymphoid infiltrate; more common in Pt with BRCA 1 mutation

Front 280

Inflammatory carcinoma

Back 280

orange peel appearance; lymphatics blocked by tumor (lymphedema)

Front 281

Lobular cancer

Back 281

MC cancer of terminal lobule; ↑ bilaterality

Front 282

Phyllodes tumor

Back 282

low grade malignant tumor of stroma

Front 283

ER-PR positive tumors

Back 283

tumors responding to hormones; candidate for tamoxifen (anti-estrogen)

Front 284

ERB-B2 oncogene positive breast cancer

Back 284

aggressive breast cancer

Front 285

Gynecomastia

Back 285

estrogen stimulation of male breast

Front 286

Gynecomastia

Back 286

normal in newborn, puberty (no surgery), old age; (micronodular) cirrhosis MC pathologic cause

Front 287

Overactive endocrine syndrome

Back 287

most often adenomas; use suppression tests (most do not suppress)

Front 288

Tumors that suppress

Back 288

prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)

Front 289

Underactive endocrine syndrome

Back 289

autoimmune destruction MCC; stimulation tests

Front 290

Hypopituitarism adults

Back 290

non-functioning adenoma MCC, Sheehan’s postpartum necrosis (stop lactation)

Front 291

Hypopituitarism in children

Back 291

craniopharyngioma (Rathke’s pouch remnant) MCC; visual field defects

Front 292

S/S ↓ FSH and LH

Back 292

amenorrhea, ↓ testosterone in male

Front 293

Growth hormone functions

Back 293

muscle growth, gluconeogenesis; release of insulin growth factor (IGF)

Front 294

IGF

Back 294

synthesized in liver; bone and cartilage growth

Front 295

S/S ↓ GH/IGF in children

Back 295

growth retardation; ↓ height and weight

Front 296

Sleep and arginine infusion

Back 296

stimulation tests for GH and IGF

Front 297

S/S ↓ GH/IGF in adults

Back 297

hypoglycemia

Front 298

S/S ↓ TSH

Back 298

secondary hypothyroidism; ↓ T4, ↓ TSH; muscle weakness, dry skin

Front 299

S/S ↓ ACTH

Back 299

secondary hypocortisolism; ↓ cortisol, ↓ ACTH; fatigue; hypoglycemia

Front 300

Metyrapone

Back 300

stimulation test for ACTH reserve

Front 301

Metyrapone

Back 301

blocks adrenal 11-hydroxylase → ↑ ACTH and 11-deoxycortisol (proximal to block)

Front 302

Metyrapone test ↓ ACTH and 11-deoxycortisol

Back 302

pituitary/hypothalamic dysfunction

Front 303

Metyrapone test ↑ ACTH and 11-deoxycortisol

Back 303

Addison's disease

Front 304

Diabetes insipidus

Back 304

loss ADH (central), refractory to ADH (nephrogenic); always diluting urine

Front 305

Central diabetes insipidus (CDI)

Back 305

↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm > 50%

Front 306

Causes CDI

Back 306

pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)

Front 307

Nephrogenic diabetes insipidus (NDI)

Back 307

↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm < 50%

Front 308

Causes NDI

Back 308

lithium, demeclocycline, nephrocalcinosis, severe hypokalemia

Front 309

Gigantism

Back 309

GH secreting pituitary adenoma before epiphyses have fused

Front 310

Acromegaly

Back 310

GH secreting pituitary adenoma after epiphyses have fused

Front 311

S/S acromegaly

Back 311

cardiomyopathy; large hands, feet, jaw; hyperglycemia

Front 312

Prolactin

Back 312

inhibited by dopamine

Front 313

Prolactinoma

Back 313

MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH

Front 314

Rx

Back 314

surgery or bromocriptine (dopamine analog)

Front 315

Other causes hyperprolactinemia

Back 315

primary hypothyroidism, drugs

Front 316

Inappropriate ADH syndrome

Back 316

hyponatremia <120 mEq/L; ↑ UOsm (always concentrating urine)

Front 317

Causes

Back 317

small cell carcinoma lung, CNS injury, chlorpropamide

Front 318

Rx

Back 318

restrict water; demeclocycline in small cell carcinoma

Front 319

Serum T4

Back 319

↑ or ↓ in free hormone or thyroid binding globulin (TBG)

Front 320

↑ Serum T4 and normal TSH

Back 320

↑ TBG; due to ↑ in estrogen

Front 321

↑ Serum T4 and ↓ TSH

Back 321

thyrotoxicosis

Front 322

↓ Serum T4 and normal TSH

Back 322

↓ TBG; due to anabolic steroids

Front 323

↓ Serum T4 and ↑ TSH

Back 323

primary hypothyroidism

Front 324

↓ Serum T4 and ↓ TSH

Back 324

secondary hypothyroidism

Front 325

TSH

Back 325

negative feedback with T4 and T3; best screening test

Front 326

I131 uptake

Back 326

↑ in Graves; ↓ in thyroiditis, patient taking excess thyroid, hypothyroidism

Front 327

Cold nodule

Back 327

non-functioning nodule; no uptake I131

Front 328

Hot nodule

Back 328

functioning nodule; ↑ uptake I131

Front 329

Thyroglossal duct cyst

Back 329

midline cystic mass

Front 330

Branchial cleft cyst

Back 330

cyst in anterolateral neck

Front 331

Acute/subacute thyroiditis

Back 331

painful thyroid; early thyrotoxicosis; ↓ I131 uptake

Front 332

Hashimoto’s thyroiditis

Back 332

MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody

Front 333

Hashimoto’s thyroiditis

Back 333

↑ anti microsomal and thyroglobulin antibodies

Front 334

S/S

Back 334

muscle weakness, periorbital puffiness, ↓ reflexes, diastolic hypertension, constipation, dry skin

Front 335

Lab

Back 335

↓ T4, ↑ TSH

Front 336

Cretinism

Back 336

maternal hypothyroidism before fetal thyroid developed, genetic disorder

Front 337

S/S

Back 337

mental retardation; short stature and increased weight; coarse skin

Front 338

Thyrotoxicosis

Back 338

any cause ↑ thyroid hormone activity; Graves disease, excess hormone, thyroiditis

Front 339

Hyperthyroidism

Back 339

↑ synthesis thyroid hormone; Graves disease and toxic nodular goiter

Front 340

Graves disease

Back 340

autoantibody against TSH receptor (type II reaction); HLA Dr3

Front 341

S/S unique to Graves

Back 341

exophthalmos, pretibial myxedema

Front 342

S/S thyrotoxicosis

Back 342

tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes

Front 343

Lab thyrotoxicosis

Back 343

↑ T4, ↓ TSH, ↑ glucose, ↑ calcium

Front 344

I131 uptake

Back 344

↑ Graves, toxic nodular goiter; ↓ thyroiditis, excess hormone, hypothyroidism

Front 345

Rx Graves disease

Back 345

ß-blocker; drug to decrease hormone synthesis (propylthiouracil)

Front 346

Toxic nodular goiter

Back 346

hyperthyroidism; develops out of a multinodular goiter; no exophthalmos

Front 347

Goiter

Back 347

enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency

Front 348

S/S

Back 348

rapid enlargement due to hemorrhage into cyst; Rx thyroxine

Front 349

Solitary thyroid nodule woman

Back 349

most often benign (cyst)

Front 350

Solitary thyroid nodule man or child

Back 350

often malignant

Front 351

Papillary carcinoma thyroid

Back 351

MC thyroid cancer; radiation exposure; psammoma bodies

Front 352

Follicular carcinoma thyroid

Back 352

invades blood vessels

Front 353

Medullary carcinoma thyroid

Back 353

parafollicular cells; calcitonin; amyloid (calcitonin conversion)

Front 354

MEN I syndrome

Back 354

3 P's; pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or ß-islet cell tumor)

Front 355

MEN IIa syndrome

Back 355

2 P's; medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma

Front 356

MEN IIb syndrome

Back 356

1 P; medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas

Front 357

Alkalotic pH

Back 357

tetany with normal total calcium, ↓ ionized calcium and ↑ PTH

Front 358

Hypoalbuminemia

Back 358

↓ total calcium, normal ionized calcium and PTH

Front 359

Tetany

Back 359

↓ ionized calcium level; threshold potential comes closer to resting potential

Front 360

S/S

Back 360

thumb adducts into palm, twitching after tapping of facial nerve

Front 361

PTH

Back 361

maintains ionized Ca2+; ↑ Ca2+ renal reabsorption; ↓ phosphate/bicarbonate reabsorption in kidneys

Front 362

Primary HPTH

Back 362

↑ Ca2+, hypophosphatemia, ↑ PTH

Front 363

Cause

Back 363

adenoma MCC, hyperplasia, cancer

Front 364

S/S

Back 364

renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification

Front 365

Secondary HPTH

Back 365

↓ Ca2+, ↑ PTH; hypovitaminosis D from renal failure MCC

Front 366

Malignancy-induced hypercalcemia

Back 366

↑ Ca2+, ↓ PTH; all other non-parathyroid causes same results

Front 367

Causes hypercalcemia

Back 367

osteolytic lesions, sarcoidosis, ↑ vitamin D, PTH-related peptide, myeloma

Front 368

Tertiary HPTH

Back 368

hypercalcemia developing from secondary HPTH

Front 369

Primary hypoparathyroidism

Back 369

↓ Ca2+ and ↓ PTH

Front 370

Causes

Back 370

previous thyroid surgery, autoimmune, DiGeorge syndrome

Front 371

S/S

Back 371

tetany; calcification basal ganglia

Front 372

Pseudohypoparathyroidism

Back 372

↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH

Front 373

Other causes ↓ Ca2+

Back 373

hypomagnesemia (↓ PTH), ↓ vitamin D, DiGeorge

Front 374

↓ Ca2+ and ↓ PTH

Back 374

primary hypoparathyroidism

Front 375

↓ Ca2+ and ↑ PTH

Back 375

secondary hyperparathyroidism

Front 376

↑ Ca2+ and ↑ PTH

Back 376

primary hyperparathyroidism

Front 377

↑ Ca2+ and ↓ PTH

Back 377

malignancy induced hypercalcemia; other causes hypercalcemia

Front 378

Waterhouse-Friderichsen syndrome

Back 378

meningococcemia with bilateral adrenal hemorrhage due to DIC

Front 379

Addison’s disease

Back 379

autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis

Front 380

S/S

Back 380

hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia

Front 381

Lab

Back 381

↓ sodium, ↓ cortisol, ↑ potassium, ↑ ACTH

Front 382

Adrenogenital syndrome

Back 382

AR; enzyme deficiency; hypocortisolism; hyperpigmentation from ↑ ACTH

Front 383

21-Hydroxylase deficiency

Back 383

↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite

Front 384

11-Hydroxylase deficiency

Back 384

↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite

Front 385

17-Hydroxylase deficiency

Back 385

↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite

Front 386

MCC Cushings

Back 386

long-term corticosteroid therapy

Front 387

Tests Cushings syndrome

Back 387

low/high dose dexamethasone suppression; urine free cortisol (best test)

Front 388

Normal dexamethasone suppression

Back 388

cortisol analogue; ↓ ACTH and ↑ cortisol

Front 389

Pituitary Cushings

Back 389

MCC Cushing’s; ACTH secreting pituitary tumor

Front 390

Lab

Back 390

low dose dexamethasone not suppress cortisol; high dose suppresses

Front 391

Adrenal Cushings

Back 391

adrenal adenoma secreting cortisol; suppressed ACTH

Front 392

Lab

Back 392

no suppression with low/high dose dexamethasone

Front 393

Ectopic Cushings

Back 393

ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels

Front 394

Lab

Back 394

no suppression with low/high dose dexamethasone

Front 395

S/S Cushings

Back 395

purple stria, truncal obesity, hypertension, DM

Front 396

Primary aldosteronism

Back 396

benign adenoma in zona glomerulosa

Front 397

S/S

Back 397

hypertension and muscle weakness (hypokalemia), no pitting edema

Front 398

Lab

Back 398

hypernatremia, hypokalemia, metabolic alkalosis, ↑ urine K+ and Na+

Front 399

Pheochromocytoma

Back 399

benign tumor in adrenal medulla in adults

Front 400

Associations

Back 400

von Hippel Lindau, neurofibromatosis, MEN IIa and IIb

Front 401

S/S

Back 401

labile hypertension, anxiety, sweating, headache

Front 402

Lab

Back 402

↑ 24 hr urine for VMA and metanephrines

Front 403

Neuroblastoma

Back 403

malignant tumor adrenal medulla child; widespread metastasis; hypertension

Front 404

ß-islet cell tumor (insulinoma)

Back 404

benign tumor; hypoglycemia, ↑ insulin and C-peptide

Front 405

Patient taking excess insulin

Back 405

hypoglycemia, ↑ insulin, ↓ C-peptide

Front 406

Glucagonoma

Back 406

malignant α-islet cell tumor; hyperglycemia and rash

Front 407

Zollinger Ellison syndrome

Back 407

malignant islet cell tumor secreting gastrin; peptic ulcers

Front 408

Somatostatinoma

Back 408

malignant δ islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria

Front 409

VIPoma

Back 409

malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria

Front 410

DM

Back 410

organ damage correlates with glycemic control

Front 411

Type 1

Back 411

young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis

Front 412

Type 2

Back 412

older person; obese; relative insulin deficiency (↓ insulin receptors, postreceptor problems)

Front 413

Type 2

Back 413

family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma

Front 414

↑ Non-enzymatic glycosylation

Back 414

glucose attaches to amino acids in basement membranes

Front 415

Non-enzymatic glycosylation

Back 415

↑ vessel permeability producing hyaline arteriolosclerosis

Front 416

Osmotic damage

Back 416

glucose converted into sorbitol by aldose reductase

Front 417

Osmotic damage

Back 417

lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)

Front 418

Pathogenesis hyperglycemia

Back 418

↑ gluconeogenesis (most important), glycogenolysis

Front 419

Pathogenesis hyperlipidemia

Back 419

no insulin to stimulate capillary lipoprotein lipase; ↑ chylomicrons/VLDL

Front 420

Pathogenesis ketoacidosis

Back 420

↑ oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies

Front 421

Most commons due to DM

Back 421

neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation

Front 422

Glycosylated HbA1c

Back 422

measure of long term glycemic control (8-12 weeks)

Front 423

Gestational DM

Back 423

↑ placental size, human placental lactogen

Front 424

Complications

Back 424

macrosomia (↑ muscle/fat from insulin), RDS, newborn hypoglycemia (↑ insulin)

Front 425

Hypoglycemia

Back 425

insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency

Front 426

Carnitine deficiency

Back 426

no ß-oxidation of fatty acids; all cells compete for glucose