Hyc 15-15.8 Session 11

Front 1

Prolactinoma

Back 1

MOST COMMON tumor of pituitary

amenorrhea/oligomenorrhea, impotence, galactorea, gynocomasteam visual complaints (bc this is a macroadenoma so its so big it pushed on the optic chiasm)

Front 2

Cushing's Dz

Back 2

due to ant. pituitary tumor
overproduce ACTH

over produce cortisol = steroid man

Front 3

Acromegaly

Back 3

due to ant pituitary adenoma that over produced Growth Hormone AFTER adolescence

outgrow shoes, gloves & hats, dev course facial features

Front 4

Gigantism

Back 4

due to ant pituitary adenoma that over produced Growth Hormone PRIOR to puberty

tall and large but proportional

Front 5

PCOS

Back 5

over produced LH!
NOT assoc. w/ pituitary adenoma
acne, hirsutism, infertility

LH:FSH ratio is 2:1 or more

Front 6

Menopause

Back 6

ovarian failure

no estrogen or progesterone = no negative feedback so high FSH

FSH:LH ratio is 2:1

hot flashes and osteoporosis

Front 7

SIADH

Back 7

excess ADH produced by posterior pituitary

excess water reabsorption from the kidney = hyponatremia, cerebral edema with maybe hypertension

Front 8

What else can produce high SIADH?

Back 8

Small cell lung cancer

head trauma-damage to hypothalamus or post. pituitary

Front 9

Panhypopituitarism aka pituitary cachexia or simmonds dz

Back 9

1-pituitary tumor-nonfunctional
2-postpartum pituitary necrosis-Sheehan's Syndrome

decreased TSH, GH, ACTH, LH and FSH

Front 10

Pituitary Dwarfism

Back 10

congenital def in Growth hormone

short and proportionately small

Front 11

Diabetes Insipidus (central)

Back 11

caused by ADH def secondary to decreased secretion by the posterior pituitary-usually head trauma wherein the post. pituitary or hypothalamus are damaged

polyuria & polydipsia

*nephrogenic DI is due to lack of kidney response to ADH but cause similar symptoms

Front 12

Conn's Syndrome

Back 12

adrenal adenoma that overproduces aldosterone

too much aldosterone=hypernatremia=severe HTN (headache) & hypokalemia->muscle weakness

Front 13

Cushing's Syndrome

Back 13

due to ANY cause for increased glucocorticoids

screen: 24 hour urine test bc levels flucuate throughout the day

confirm:dexamethasone suppression test

Front 14

5 caused of Cushings Syndrome

Back 14

1-adrenal adenoma
2-adrenal carcinoma
3-Cushing's Dz-pit ACTH producing adenoma
4-small cell lung cancer-paraneoplastic production of ACTH
5-prolonged use of glucocorticoids-steroids

Front 15

Pheochromocytoma

Back 15

excess NE +/- Epi secretion ( tumo rof the adrenal medulla)

sporadic HTN,paroxysmal hyperhidrosis, and episodic aggressive behavior changes

Best screen:24 hour urinary VMA (also use 24 hr metanephrines and normetanepthrines or 24 hr catacholamines

Front 16

Neuroblastoma

Back 16

malignant tumor of adrenal gland or sympathetic ganglia or both produces excess norepi

neural crest in origin

peak age <3 yo

presenting sign-enlarging abdomen & HTN can occur. later symptoms are due to metastisis

Front 17

Addison's Dz

Back 17

autoimmune but can be bc invasion of mycobacterium tuberculosis or histoplasma capsulatum

decreased aldosterone production=excess Na loss through kidney=hypotension

hyperkalemia=muscles weakness and cardiac arrhythmias

decreased neg feedback on ant pit =over produce POMC=increase ACTH and MSH(why JKF so tan bc excess melanin)

Front 18

Graves Dz (diffuse toxic goiter)

Back 18

young females
MOST COMMON cause of HTN in US

ANTI-TSH antibodies
exopthalmos, dermopathy (pre tibial fat pad)

1st line management: radioablation with sodium iodine

Front 19

Plummers Dz (nodular toxic goiter)

Back 19

post menopausal women, multiparous females-risk increased with degree of parity (aka more kids higher risk)

due to; reactivation of subsequent hyperactivity of isolated nests of cells within the thyroid gland

often no HYPERthyroid symp just recurrent fatigue, tired & malaise-bc rest of the gland is inadequately stimulated due to to resulting low TSH levels

Front 20

Diffuse Simple Goiter (iodine def)

Back 20

any age-in regions of world iwth no iodized salt or with out crustaceans

hypothyroid symptoms

treat:iodine

Front 21

Hashimotos ThryoidItis

Back 21

t cell disorder with ANTI-MICROSOMAL antiboides-gradually and progressively destruct the gland

constipation, fatigue,dry skin, coarse hair, swollen legs, cold intolerence, weight gain

treat: levothyroxine

Front 22

Riedels (FIbrous) Thyroiditis

Back 22

elderly
chronic use of migrain meds -weird
fibrosis and bc nonfunctional
treat:levothyroxine

Front 23

DeQuervain's throiditis

Back 23

probably viral & usually follows a viral URI

Hyperthyroid symptoms followed by hyporthyroid symptoms

transient and temporary

NSAIDS

Front 24

Sick Euthyroid Syndromes

Back 24

due to sever illness, physical trauma, physiologic stress

treat the underlying cause

many variants but all have NORMAL TSH

Front 25

follicular adenoma

Back 25

single, palpable, thyroid nodule

female

>45 y/o

hyperthyroid signs

Front 26

Carcinomas of thyroid

Back 26

females>males

painless mass

euthryoid-NORMAL thyroid levels

cold nodules-radioactive iodine injected and nodule shows no activity

Front 27

4 types of thyroid carcinoma

Back 27

Papillary
Follicular
Ananplastic
Medularry

Front 28

Papillary CA

Back 28

Most common and best pronosis so yay :)

females in their 20's

fingerlike projections & ground glass appearance of nuclei

assoc w/ prior radiotherapy of the neck

Front 29

Follicular CA

Back 29

middle aged
poorer prognosis

Front 30

Anaplastic CA

Back 30

elderly
VERY aggressive & very poor prognosis

Front 31

Medullary CA

Back 31

Late middle aged/ early elderly

tumor of parafollicular C cells (part of the MEDULLA of the thryoid gland)

C cells make calcitonin (encourage Ca deposition in the bone)

tumor makes high calcitonin=hypocalcemia

Front 32

5 roles of Parathyroid hormone

Back 32

1-activate osteoclasts-increasing serum Ca
2-Increase renal tubular re-absorption of Ca=increase serum Ca
3-Increase Vit D conversion to 1,25 dihydroxyvitamin D in kidneys-increase serum calcium & phosphorous
4-increase renal phosphate excretion-DECREASE serum phosphate-lose massive amts by this
5-increase GI absorption of Ca=increase serum Ca

Front 33

Primary hyperparathyroidism

Back 33

due to pathology of the parathyroid gand

hi PTH
hi Ca
lo
PO4

Front 34

Secondary hyperparathyroidism

Back 34

due to low calcium with resulting response of activity by parathyroid gland

ex:Chronic renal failure-so kidneys will not reabsorb CA=loss Ca in urine= PTH increased in response so

hi PTH
lo Ca-bc kidney failed
hi PO4-bc kidney failed

Front 35

Hypoparathyroidism

Back 35

lack of parathryoid activity

ex: accidental parathyroid removal with thyroidectomy

lo PTH--> lo Ca & Hi PO4

Front 36

Pseudohypoparathyroidism

Back 36

PTH receptors are non functional so parathyroids ar enormal but tissues can't respond

inherited rather than acquired

hi PTH but no respone so lo Ca & lo PO4

several types: 1a is also known as Albright's -features: short stature, obesity, and short hand bones

Front 37

Pseudopseudohypoparathryoidism

Back 37

AD but INTERESTING BC-inherit gene from DAD get this but inherit gene from mom and get pseudohypoparathhyroidism type 1A

PTH receptors are fine but 2nd messanger system is defective= response to PTH slow but possible-Ca and PO4 equilibrate slowly

features: short stature, obesity, and short hand bones

Front 38

Primary Diabetes

Back 38

1-Type 1
2-Type 2
3-gestational
4-MODY

Front 39

Secondary Diabetes-

Back 39

hemochromatosis,chronic pancreatitis, pancreatic Ca

Front 40

Hallmarks of all diabetes

Back 40

hyperglycemia, polyphagia, polyuria, polydipsia, increased infections, blurred vision

Front 41

Type 1 DM

Back 41

not common- ANTI ISLET CELL Ab destroy beta islet cells

juvenile onset-lean body-no insulin

KETOACIDOSIS RISK-lack of insulin + stress = extreme over activation of HSL=explosive lipolysis and consequent ketoacidosis

HLA DR3 & DR4

Front 42

Type 11 DM

Back 42

very common & growing in kids

hypoosmolar nonketotic coma risk-glucose levels reach super high levels and pull water into vasculature thereby dessicating (drying out) the brain = coma

women>men

No HLA connection or autoantibodies

OBESE

Front 43

Chronic Complications of DM

Back 43

neuropathy, atheroscleroiss (MI, PVD, stoke, AAA, mesenteric ichemia) retinopathy, nephropathy

Front 44

Gestational Diabetes

Back 44

Beta cell reserve is inadequate for increased demands of preggo

exacerbated by human placental lactogen, product of the placenta which causes mild insuline resistance

screen: Glucola test in 27-28 weeks

Front 45

MODY-maturity onset diabetes of the young

Back 45

glucokinase defect-prevents cells from being able adequately phosphorylate the glucose that is made available to them=glucose cannot be used & released back into serum =HYPERGLYCEMIA

Front 46

MEN's

Back 46

AD
LIFE LONG risk of dev certain neoplasms of certain endocrine glands

Front 47

MEN type 1-Wermer's Syndrome

Back 47

adrenal cortex
pituitary
parathyroid
pancreas

Front 48

MEN type 2a-Sipple's

Back 48

adrenal cortex-pheochromocytoma
thyroid medculla
parathyroid

Front 49

MEN type 2b=MEN type 3

Back 49

adrenal medulla
thryoid medulla
mucosal neuroms
marfanoid features

Front 50

Seborrheic Keratosis

Back 50

at or later than middle age
benign and on the trunk
round, flat , coin like plaques that feel velvety/granular/greasy and often look stuck on

Front 51

Keratoacanthoma

Back 51

50 yo male esp caucasian
flesh colored dome shaped nodule with keratine filled plug
may heal spon

face or dosum of hands

Front 52

Actinic Keratosis

Back 52

SUN
dysplasia b4 malignancy
some have cutaneous horn

Front 53

Basal Cell Carcinoma

Back 53

SUN-esp chronic sun exposure

slow growing and rarely mets

pearly gray with telangiectasias

Front 54

Squamous cell Carcinoma

Back 54

SUN
male>female
too much UV= DNA damage= damage langerhans cells=no surviellance=malig can grow and dev

#1 skin tumor on sun exposed sites in older adults

Front 55

Melanoma

Back 55

SUN
most are cured by excision
most important sign-change in color
may be pruitic
risk factors-sun, preexiting nevus, genetics, carcinogens

Front 56

Bowen Dz

Back 56

genital region
>35 yo
thickened, gray-white plaques
>90% have HPV (16)
possible assoc w/ visceral malignancy

Front 57

Bowenoid Papulosis

Back 57

multiple, pigmented papules on external genitialia of MALES

may mimc condyloma acuminatum

<35 yo
rarely transitions to squamous cell CA

Front 58

Erythroplasia of Queyrat

Back 58

single or multiple, shiny, red plaque on the glans penis or prepuce
>35 yo
10% tranisition to squamous cell CA

Front 59

Pemphigus

Back 59

ANTI KERATINOCYTE Abs
male>female but rare
40-60 yo
the Abs cause a loss of attachement bt keratinocytes and fluid fills within the spaces getting vesicles

Front 60

Pemphigoid

Back 60

ANTI EPIDERMAL BASEMENT MEMBRANE Abs

common
tense bullae filled with clear fluid in elderly

heals with a scar

abs dev agaisnt adhesions sites bt basal cells and basement membrane=loss of attachment=fluid fills the area=lifitng the entire cutaneous epithelial layer from its basement membrane= bullae

Front 61

Impetigo

Back 61

due to Strep pyogenes or Staph aureus

vesicles/bullae=pustules=rupture= crusted skin lesions

hands or face

Front 62

Pityriasis (pityriasis rosea)

Back 62

Rash often preceded by a HERALD PATCH

round to ovale plaques with surrounding scale most often in trunk

CHRISTMAS TREE pattern

self limited-resolves in 2-8 weeks

Front 63

Rosacea

Back 63

Chronic dz of nose, forehead, cheeks
>30 yo
females more but males when do get it have it worse

erythema, telangiectasia, superficial pustules, facial flushing

exacerbated by heat, stress, emotional stimuli, alcohol, hot drinks

long standing=tissue overgrowth of nose

increased occurrence of keratitis, iritis, chalazions which may be sight threatening

Front 64

tinea versicolor

Back 64

hyper/hypo pigmented scaly patches on trunk

promoted by heat and humidiity

"SPEGHETTI & MEATBALLS" bc a mixture of hypea and spores

Front 65

Psoriasis

Back 65

sharply demarkated, erthyematous plaques with thick scale

elbows, knees and scalp

Front 66

Seborrheic dermatitis

Back 66

COMMON
Neonates and adults at risk

greasy scales over erythematous patches or plaques

#1 location-scalp=sever dandrugg
cradle cap in infant

VERY COMMON in those w/ parkinsons, CVA or HIV

Front 67

Eczema

Back 67

final common expression of atopic dermatitis, contact dermatitis, seborrheic dermatitis and related disorders

erythematous apules and macules and vesicles coalesce to form patches and plaques, may progress to weekping, crusting and or thickened scale

Front 68

Xanthoma

Back 68

cholesterol accumulation within the dermis

Front 69

Capillary hemangioma

Back 69

2 types
1-ordinary birthmark-salmon patch or stork bite
closely packed capillaries;regress spontaneously

2-strawberrry-dev 1-3 yo and regress by 7

Front 70

Cavernous Hemangioma-Port Wine stain

Back 70

face
large, dilated vascular channel
assoc w/ Struge Weber-congenital dz with faulty mesoderm and ectoderm dev=hemangiomas assoc/ w/ meninges= SEIZURES

Front 71

Cafe au Lait

Back 71

Light Brown macules with smooth border over ner ve trunks

Front 72

Vitiligo

Back 72

ANTI MELANOCYTE Abs
asymp, flat NON pigmented macules

Front 73

Lentigo

Back 73

opposite of vitiligo
benign
hyperplasia of melanocytes = small oval tan macules
"Liver Spots"