Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
426 Cards in this Set
- Front
- Back
First sign tubule cell dysfunction
|
inability to concentrate urine
|
|
Fixed specific gravity
|
chronic renal failure; cannot concentrate or dilute urine
|
|
Negative urine bilirubin + trace urobilinogen
|
normal urine
|
|
Positive urine bilirubin, absent urobilinogen
|
obstructive jaundice
|
|
Positive urine bilirubin + increased urobilinogen
|
hepatitis
|
|
Negative urine bilirubin + increased urobilinogen
|
extravascular hemolytic anemia
|
|
Positive urine nitrite + positive urine leukocyte esterase
|
urinary tract infection
|
|
Sterile pyuria
|
positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
|
|
Prerenal azotemia
|
↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)
|
|
Renal azotemia
|
↑ BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
|
|
Postrenal azotemia
|
↑ BUN and creatinine due to obstruction to urine flow
|
|
Serum BUN:creatinine ratio
|
<15:1 (renal failure); >15:1 (prerenal or postrenal azotemia)
|
|
BUN 80 mg/dL:creatinine 8 mg/dL
|
ratio 10/1 - renal failure
|
|
BUN 80 mg/dL:creatinine 2 mg/dL
|
ratio 40/1 - prerenal azotemia or postrenal azotemia
|
|
Creatinine clearance
|
measures GFR
|
|
Proteinuria
|
important sign of renal dysfunction
|
|
RBC casts
|
nephritic type of glomerulonephritis
|
|
WBC casts
|
acute pyelonephritis, acute tubulointerstitial nephritis
|
|
Fatty casts with Maltese crosses
|
nephrotic syndrome
|
|
Hyaline casts
|
normal unless associated with proteinuria
|
|
Renal tubular cell casts
|
acute tubular necrosis
|
|
Waxy or broad casts
|
chronic renal failure
|
|
Cystinuria
|
hexagonal crystals
|
|
Horseshoe kidney
|
Turner’s syndrome; lower poles fused
|
|
Renal dysplasia
|
MC childhood cystic disease; abnormal development; flank mass
|
|
Maternal oligohydramnios
|
fetal juvenile polycystic kidney disease; Potter’s facies in newborn
|
|
Adult polycystic kidney disease
|
AD; hypertension MC sign; cerebral berry aneurysms
|
|
Visceral epithelial cells
|
synthesize basement membrane
|
|
Glomerular BM
|
negative charge due to heparan sulfate
|
|
Nephritic syndrome
|
oliguria; RBC casts; hypertension; mild to moderate proteinuria
|
|
Nephrotic syndrome
|
proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
|
|
Immunofluorescence
|
linear (anti-glomerular BM antibodies); granular (IC deposition)
|
|
IgA GN
|
MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits
|
|
Post-streptococcal GN
|
nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B
|
|
SLE type IV GN
|
nephritic; subendothelial deposits; anti-DNA antibodies
|
|
Crescentic GN
|
crescents from parietal cell proliferation; worst GN; Goodpasture’s, Wegener’s
|
|
Goodpasture’s
|
nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
|
|
S/S
|
young male with hemoptysis progressing to renal failure
|
|
Minimal change disease (lipoid nephrosis)
|
MCC childhood nephrotic syndrome
|
|
Lipoid nephrosis
|
podocyte fusion; loss of negative charge in glomerular BM
|
|
Focal segmental glomerulosclerosis
|
nephrotic syndrome; AIDS and IV heroin abuse
|
|
Membranous GN
|
MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
|
|
Causes membranous GN
|
HBV, ACE inhibitors, cancer
|
|
Type I MPGN
|
nephrotic; subepithelial deposits; HCV association; tram tracks
|
|
Type II MPGN
|
nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
|
|
DM nodular glomerulosclerosis
|
microalbuminuria first sign
|
|
DM glomerulosclerosis
|
nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
|
|
ACE inhibitors
|
inhibit angiotensin II vasoconstriction of efferent arterioles
|
|
Alport’s syndrome
|
XD hereditary nephritis with sensorineural hearing loss
|
|
Ischemic ATN
|
prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1
|
|
Ischemic ATN
|
disruption of BM in proximal tubule and thick ascending limb
|
|
Nephrotoxic ATN
|
aminoglycosides, IVP dye, Pb/mercury poisoning
|
|
Nephrotoxic ATN
|
proximal tubule dysfunction; intact BM
|
|
Oliguria
|
prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
|
|
Acute pyelonephritis
|
vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
|
|
Chronic pyelonephritis
|
U-shaped scars overlying blunt calyces
|
|
Drug-induced tubulointerstitial nephritis
|
type I/IV reaction; e.g., penicillin
|
|
S/S
|
ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
|
|
Analgesic nephropathy
|
aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
|
|
Myeloma kidney
|
BJ protein produces foreign body reaction in tubules
|
|
Urate nephropathy
|
prevent by giving allopurinol prior to chemotherapy
|
|
CRF
|
fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts
|
|
Renal osteodystrophy CRF
|
hypovitaminosis D (no 1-α-hydroxylase); produces osteomalacia
|
|
Renal osteodystrophy CRF
|
osteoporosis from metabolic acidosis
|
|
Renal osteodystrophy CRF
|
secondary HPTH with increased osteoclastic activity
|
|
S/S CRF
|
pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
|
|
Benign nephrosclerosis
|
kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
|
|
Malignant hypertension
|
renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside
|
|
Renal findings
|
necrotizing arteriolitis; “flea bitten” kidney; hyperplastic arteriolosclerosis
|
|
Renal infarction
|
pale infarcts; hematuria; common in polyarteritis nodosa
|
|
Hydronephrosis
|
renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
|
|
Renal stones
|
most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
|
|
S/S
|
colicky pain radiating into groin, hematuria; x-ray usually shows stone
|
|
Staghorn calculus
|
due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
|
|
Angiomyolipoma
|
hamartoma; associated with tuberous sclerosis
|
|
Renal cell carcinoma
|
smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
|
|
S/S
|
flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
|
|
Renal pelvis transitional cell carcinoma
|
smoking MCC, phenacetin, aniline dyes, cyclophosphamide
|
|
Wilm’s tumor
|
hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
|
|
Urine draining from umbilicus
|
persistent urachus
|
|
Retroperitoneal fibrosis
|
produces hydronephrosis
|
|
Bladder extrophy
|
abdominal wall defect + epispadias
|
|
Bladder diverticula
|
most commonly due to prostatic hyperplasia with urethral obstruction
|
|
Acute cystitis
|
E. coli; females > males; no fever, flank pain, or WBC casts
|
|
Bladder transitional cell carcinoma
|
smoking MCC, aniline dyes, cyclophosphamide; papillary
|
|
S/S
|
hematuria; hydronephrosis
|
|
Bladder adenocarcinoma
|
risk factors persistent urachus, extrophy
|
|
Bladder squamous cell carcinoma
|
Schistosoma hematobium infection
|
|
Hypospadias
|
ventral opening on penis due to failure closure of urethral folds
|
|
Epispadias
|
dorsal opening on penis due to defect in genital tubercle
|
|
Peyronie’s disease
|
painful curvature penis due to fibromatosis
|
|
Priapism
|
persistent/painful erection; HbSS
|
|
Squamous cell carcinoma penis
|
HPV and lack of circumcision most important risk factors
|
|
Cryptorchidism
|
undescended testis; risk for seminoma applies to cryptorchid testis and normal testis
|
|
Orchitis
|
mumps usually unilateral (infertility uncommon)
|
|
Epididymitis
|
<35 - N. gonorrhoeae, C. trachomatis; >35 - E. coli, P. aeruginosa
|
|
S/S
|
scrotal pain relieved by elevation of scrotum (Prehn’s sign)
|
|
Varicocele
|
left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common
|
|
Varicocele
|
may be due to invasion of left renal vein by renal cell carcinoma
|
|
Hydrocele
|
persistent tunica vaginalis; scrotum transilluminates
|
|
Torsion of testicle
|
testicle high in canal; absent cremasteric reflex
|
|
Testicular cancer
|
unilateral painless mass that does not transilluminate
|
|
Risk factors
|
cryptorchid testis, Klinefelter’s, testicular feminization
|
|
Seminoma
|
MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ↑hCG
|
|
Spermatocytic variant
|
>65 yrs of age
|
|
Embryonal carcinoma
|
hemorrhage/necrosis; hematogenous spread before lymphatic; ↑AFP, hCG
|
|
Yolk sac tumor
|
MC testicular cancer in boys; ↑AFP
|
|
Choriocarcinoma
|
most aggressive testicle cancer; ↑hCG
|
|
Teratoma
|
more often benign in children than adult
|
|
Teratocarcinoma
|
teratoma + embryonal carcinoma
|
|
Malignant lymphoma
|
MC type in elderly; metastasis not primary cancer
|
|
Prostate
|
DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer
|
|
Prostatitis
|
perineal pain, fever; WBCs at end of voiding
|
|
Benign prostatic hyperplasia
|
DHT/estrogen-mediated; glandular/smooth muscle hyperplasia
|
|
S/S
|
all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx
|
|
Prostate cancer
|
DHT-mediated; palpable with rectal exam; osteoblastic metastasis (↑ AP)
|
|
PSA
|
sensitive but not specific for prostate cancer; ↑ in hyperplasia
|
|
Kallmann’s syndrome
|
absent GnRH, anosmia, absence of taste
|
|
Impotence
|
failure to sustain an erection; psychogenic in most cases (erections present at night)
|
|
Erection
|
parasympathetic response
|
|
Ejaculation
|
sympathetic response
|
|
Leydig cell failure
|
↑ LH; ↓ testosterone, sperm count; normal FSH
|
|
Seminiferous tubule failure
|
↑ FSH (↓inhibin); ↓ sperm count; normal LH and testosterone
|
|
Leydig and seminiferous tubule failure
|
↑ FSH and LH; ↓ testosterone and sperm count
|
|
Y chromosome
|
determines genetic sex
|
|
Testosterone
|
develops seminal vesicles, epididymis, vas deferens
|
|
Dihydrotestosterone (DHT)
|
develops prostate and male external genitalia
|
|
Male pseudohermaphrodite
|
genetic male; phenotypically female
|
|
Testicular feminization
|
XR; deficient androgen receptors; MCC male pseudohermaphrodite
|
|
Klinefelter’s syndrome
|
XXY; 1 Barr body; female secondary sex characteristics
|
|
Herpes genitalis
|
recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions
|
|
Human papilloma virus
|
condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo)
|
|
Chlamydia trachomatis
|
metaplastic squamous cells with vacuoles containing elementary bodies
|
|
S/S
|
non-specific urethritis, cervicitis, PID, ophthalmia neonatorum
|
|
Neisseria gonorhoeae
|
urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus
|
|
Ophthalmia neonatorum first week
|
N gonorrhoeae
|
|
Ophthalmia neonatorum second week
|
C. trachomatis
|
|
Lymphogranuloma venereum
|
C. trachomatis subtype
|
|
S/S
|
scrotal/vulva lymphedema; granulomatous microabscesses; rectal strictures in females
|
|
Chancroid
|
painful ulcer, adenopathy, Hemophilus ducreyi
|
|
Granuloma inguinale
|
Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy
|
|
Treponema pallidum
|
spirochete; produces vasculitis of arterioles (plasma cell infiltrate)
|
|
Primary syphilis
|
painless chancre
|
|
Secondary syphilis
|
rash on palms/soles; condyloma lata; generalized adenopathy
|
|
Tertiary syphilis
|
neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas
|
|
RPR/VDRL
|
reagin antibodies against cardiolipin; ↓ titer with Rx of syphilis
|
|
RPR/VDRL
|
false positive with anticardiolipin antibodies (common in SLE)
|
|
FTA-ABS
|
confirmatory test for syphilis; not distinguish active from treated disease
|
|
FTA-ABS
|
remains positive after Rx
|
|
Trichomonas vaginalis
|
flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners
|
|
Gardnerella vaginalis
|
vaginal pH >5; bacterial vaginosis; clue cells; Rx metronidazole
|
|
Candida vaginitis
|
white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole
|
|
Vulvar squamous cancer
|
MC vulvar cancer; HPV association
|
|
Vulvar leukoplakia
|
biopsy to R/O squamous dysplasia/cancer
|
|
Lichen sclerosis vulva
|
epidermal atrophy; slight risk for squamous cancer
|
|
Squamous hyperplasia vulva
|
leukoplakia; no cancer risk
|
|
Paget’s disease
|
intraepithelial adenocarcinoma (mucin production) of vulva
|
|
Malignant melanoma
|
vulva location; similar to Paget cells but not mucin positive
|
|
Gartner’s duct cyst
|
lateral wall vagina; persistent mesonephric duct
|
|
Embryonal rhabdomyosarcoma
|
bloody, grape-like vaginal mass young girl
|
|
Vaginal adenosis
|
maternal exposure to DES; precursor clear cell adenocarcinoma vagina
|
|
Vaginal squamous cancer
|
usually extension of cervical cancer
|
|
Rokitansky-Kiister-Hauser
|
absence of vagina and uterus
|
|
Nabothian cysts
|
endocervical glands covered by metaplastic squamous epithelium
|
|
Pathologic cervicitis
|
trichomonas, HSV-2, C. trachomatis (follicular cervicitis)
|
|
Cervical Pap
|
superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone)
|
|
Normal
|
70% superficial, 30% intermediate
|
|
Atrophic
|
100% parabasal cells
|
|
Hyperestrinism
|
100% superficial cells
|
|
Pregnancy
|
100% intermediate cells
|
|
Endocervical cells
|
sign of adequately performed Pap smear
|
|
Cervical polyp
|
bleeding after intercourse; non-neoplastic
|
|
Cervical dysplasia
|
begins in transformation zone; associated with low and high risk HPV
|
|
Risk factors cervical dysplasia/cancer
|
early onset sexual activity; multiple partners; smoking; OC
|
|
CIN
|
cervical intraepithelial dysplasia; mild, moderate, severe (in-situ)
|
|
Cervical cancer
|
↓ incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters
|
|
S/S
|
cervical discharge; bleeding after intercourse
|
|
Sequence to menarche
|
breast budding, growth spurt, pubic hair, axillary hair, menarche
|
|
Proliferative phase cycle
|
estrogen-dependent; ↑estrogen inhibits FSH and stimulates LH
|
|
Ovulation
|
day 14-I6; LH surge; subnuclear vacuoles; ↑body temperature
|
|
Secretory phase cycle
|
progesterone-dependent
|
|
Menses
|
drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting
|
|
FSH
|
stimulates follicle and aromatase synthesis in granulosa cells
|
|
LH
|
stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase
|
|
Day 21
|
day of implantation of fertilized egg
|
|
Pregnancy
|
↑plasma volume > RBC mass; ↑GFR; ↑thyroxine/cortisol (increased binding proteins)
|
|
hCG
|
LH analogue produced by syncytiotrophoblast
|
|
hCG
|
stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks
|
|
Estrone
|
estrogen of postmenopausal woman; aromatization of adrenal androstenedione
|
|
Estradiol
|
estrogen of non-pregnant woman in reproductive life; aromatization of testosterone
|
|
Estriol
|
estrogen of pregnancy
|
|
Menopause
|
↑ FSH (best screen; due to ↓estrogen), ↑LH
|
|
S/S
|
secondary amenorrhea, hot flushes
|
|
Hirsutism
|
↑ hair in normal areas
|
|
Virilization
|
hirsutism + male secondary sex characteristics (clitoromegaly)
|
|
Test for hirsutism/virilization
|
↑ testosterone - ovarian source; ↑DHEA-sulfate - adrenal source
|
|
Polycystic ovarian syndrome (POS)
|
↑ LH; ↓ FSH; ↑ estrogen and androgens
|
|
S/S
|
hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH >2:1
|
|
Menorrhagia
|
excess menstrual flow; MCC iron deficiency in women
|
|
Dysmenorrhea
|
painful menses; 1° PGF2α, 2° endometriosis
|
|
DUB
|
bleeding related to hormone rather than anatomic causes
|
|
Anovulatory DUB
|
menarche and perimenopause; estrogen excess without progesterone
|
|
Ovulatory DUB
|
irregular shedding, inadequate luteal phase
|
|
Primary amenorrhea
|
no menses by 16 years old
|
|
Secondary amenorrhea
|
no menses for 3 months
|
|
Amenorrhea-hypothalamic/pituitary dysfunction
|
↓ FSH/LH; e.g., hypopituitarism
|
|
Amenorrhea-ovarian dysfunction
|
↑FSH/LH; e.g., Turner’s syndrome
|
|
Amenorrhea-end-organ disease
|
normal FSH/LH; e.g., imperforate hymen
|
|
Asherman syndrome
|
surgical removal of stratum basalis
|
|
Primary amenorrhea-normal secondary sex characteristics
|
constitutional delay MCC
|
|
Primary amenorrhea-lack secondary sex characteristics
|
Turner’s
|
|
Turner’s syndrome
|
XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs)
|
|
S/S
|
newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; 1° amenorrhea
|
|
Secondary amenorrhea
|
pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma
|
|
Asherman syndrome
|
removal of stratum basalis causing scarring; secondary amenorrhea
|
|
Endometritis
|
group B streptococcus; intrauterine device (Actinomyces); chronic - plasma cells
|
|
Endometrial polyp
|
menorrhagia; not a precursor for endometrial cancer
|
|
Adenomyosis
|
functioning endometrial glands and stroma in myometrium; enlarged uterus
|
|
Endometriosis
|
functioning glands and stroma outside uterus; reverse menses; ovary MC site
|
|
S/S
|
dysmenorrhea, painful stooling, bowel obstruction; “powder burn” appearance
|
|
Endometrial hyperplasia
|
unopposed estrogen; simple/complex types; precursor endometrial cancer
|
|
Causes
|
obesity, estrogen Rx, polycystic ovarian syndrome
|
|
Endometrial cancer
|
obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective
|
|
S/S
|
bleeding in postmenopausal woman
|
|
Leiomyoma uterus
|
menorrhagia, obstructive delivery; not a precursor for leiomyosarcoma
|
|
Leiomyosarcoma
|
MC sarcoma
|
|
Ectopic pregnancy
|
PID MC risk factor; intraperitoneal hemorrhage; screen with ß-hCG
|
|
Follicular cyst
|
MC ovarian mass in young woman
|
|
Risk factors ovarian tumors
|
nulliparity and genetic factors; OC protective
|
|
Serous ovarian tumors
|
surface-derived; ↑ bilaterality; psammoma bodies in malignant type
|
|
Mucinous ovarian tumors
|
surface-derived; pseudomyxoma peritonei in malignant type
|
|
Endometrioid carcinoma
|
resembles endometrial cancer; association with endometriosis
|
|
Cystic teratoma
|
MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications
|
|
Dysgerminoma
|
MC malignant germ cell tumor; associated with streak gonads of Turners
|
|
Yolk sac tumor
|
MC germ cell tumor young girl; ↑AFP; Schiller-Duval bodies
|
|
Meigs syndrome
|
ovarian fibroma, ascites, right-sided pleural effusion
|
|
Granulosa tumor
|
low grade malignant; hyperestrinism, Call Exner bodies
|
|
Thecoma
|
benign; yellow color; hyperestrinism
|
|
Leydig cell and Sertoli cell tumors
|
hyperandrogenism
|
|
Gonadoblastoma
|
XY phenotype of Turner’s
|
|
Krukenberg tumors
|
metastatic stomach cancer; signet ring cells
|
|
Single umbilical artery
|
↑ incidence congenital defects
|
|
Syncytiotrophoblast
|
lining of villi; produces hCG and human placental lactogen
|
|
Human placental lactogen
|
responsible for mild glucose intolerance in pregnancy
|
|
Abruptio placenta
|
retroplacental clot; painful bleeding; hypertension, cocaine, smoking
|
|
Placenta previa
|
placenta implanted over cervical os; painless bleeding
|
|
Placenta accreta
|
direct implantation into myometrium without intervening decidua; hysterectomy
|
|
Twin placenta
|
monochorionic always identical twins; dichorionic may be identical or fraternal
|
|
Siamese twins
|
monoamniotic monochorionic twin placenta
|
|
Enlarged placenta
|
DM, Rh HDN, syphilis
|
|
Complete mole
|
benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male)
|
|
S/S
|
preeclampsia in first trimester; ↑ incidence choriocarcinoma
|
|
Partial mole
|
embryo present; 68 XXY; no transformation into choriocarcinoma
|
|
Choriocarcinoma
|
malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast)
|
|
Risk factors
|
complete mole (MC), spontaneous abortion, normal pregnancy
|
|
S/S
|
↑hCG; lung metastasis; good prognosis
|
|
Chorioamnionitis
|
group B streptococcus (S. agalactiae) infection
|
|
Preeclampsia
|
abnormal placentation causing placental ischemia; ↑ in vasoconstrictors (ATII)
|
|
S/S
|
hypertension, proteinuria, pitting edema; begins in third trimester
|
|
Spontaneous abortion
|
50% have karyotype deformity (trisomy 16)
|
|
Amniotic fluid
|
fetal urine
|
|
Polyhydramnios
|
TE fistula, duodenal atresia, open neural tube defects
|
|
Oligohydramnios
|
infantile polycystic disease
|
|
↑ Serum AFP
|
open neural tube defect
|
|
↓ Serum AFP
|
Down syndrome
|
|
Urine estriol
|
fetal adrenal, placental, maternal liver involved in its production
|
|
Down syndrome triad
|
↑ ß-hCG, ↓ serum AFP, ↓ urine estriol
|
|
Fibrocystic change
|
MC breast mass <50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts
|
|
Sclerosing adenosis
|
component of FCC; involves terminal lobules often has microcalcifications
|
|
Fibroadenoma
|
benign stromal tumor; MC movable mass in women <35-yrs-old
|
|
Intraductal papilloma
|
benign tumor lactiferous duct/sinus; MCC bloody nipple discharge <50-yr-old
|
|
Invasive ductal cancer
|
MCC breast mass in woman >50-yrs-old
|
|
Breast cancer risk
|
unopposed estrogen; family history first-degree relatives
|
|
Breast cancer
|
painless mass upper outer quadrant in woman >50-yrs-old
|
|
Mammography
|
screening test to detect non-palpable masses
|
|
Palpable breast mass
|
order fine needle aspiration (not a mammogram)
|
|
Ductal carcinoma in situ
|
necrotic centers (comedo); microcalcifications common
|
|
Paget’s disease of breast
|
invasive ductal cancer into nipple; Paget’s cells similar to vulvar Paget’s
|
|
Medullary carcinoma
|
bulky tumor with large cells and lymphoid infiltrate; more common in Pt with BRCA 1 mutation
|
|
Inflammatory carcinoma
|
orange peel appearance; lymphatics blocked by tumor (lymphedema)
|
|
Lobular cancer
|
MC cancer of terminal lobule; ↑ bilaterality
|
|
Phyllodes tumor
|
low grade malignant tumor of stroma
|
|
ER-PR positive tumors
|
tumors responding to hormones; candidate for tamoxifen (anti-estrogen)
|
|
ERB-B2 oncogene positive breast cancer
|
aggressive breast cancer
|
|
Gynecomastia
|
estrogen stimulation of male breast
|
|
Gynecomastia
|
normal in newborn, puberty (no surgery), old age; (micronodular) cirrhosis MC pathologic cause
|
|
Overactive endocrine syndrome
|
most often adenomas; use suppression tests (most do not suppress)
|
|
Tumors that suppress
|
prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)
|
|
Underactive endocrine syndrome
|
autoimmune destruction MCC; stimulation tests
|
|
Hypopituitarism adults
|
non-functioning adenoma MCC, Sheehan’s postpartum necrosis (stop lactation)
|
|
Hypopituitarism in children
|
craniopharyngioma (Rathke’s pouch remnant) MCC; visual field defects
|
|
S/S ↓ FSH and LH
|
amenorrhea, ↓ testosterone in male
|
|
Growth hormone functions
|
muscle growth, gluconeogenesis; release of insulin growth factor (IGF)
|
|
IGF
|
synthesized in liver; bone and cartilage growth
|
|
S/S ↓ GH/IGF in children
|
growth retardation; ↓ height and weight
|
|
Sleep and arginine infusion
|
stimulation tests for GH and IGF
|
|
S/S ↓ GH/IGF in adults
|
hypoglycemia
|
|
S/S ↓ TSH
|
secondary hypothyroidism; ↓ T4, ↓ TSH; muscle weakness, dry skin
|
|
S/S ↓ ACTH
|
secondary hypocortisolism; ↓ cortisol, ↓ ACTH; fatigue; hypoglycemia
|
|
Metyrapone
|
stimulation test for ACTH reserve
|
|
Metyrapone
|
blocks adrenal 11-hydroxylase → ↑ ACTH and 11-deoxycortisol (proximal to block)
|
|
Metyrapone test ↓ ACTH and 11-deoxycortisol
|
pituitary/hypothalamic dysfunction
|
|
Metyrapone test ↑ ACTH and 11-deoxycortisol
|
Addison's disease
|
|
Diabetes insipidus
|
loss ADH (central), refractory to ADH (nephrogenic); always diluting urine
|
|
Central diabetes insipidus (CDI)
|
↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm > 50%
|
|
Causes CDI
|
pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)
|
|
Nephrogenic diabetes insipidus (NDI)
|
↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm < 50%
|
|
Causes NDI
|
lithium, demeclocycline, nephrocalcinosis, severe hypokalemia
|
|
Gigantism
|
GH secreting pituitary adenoma before epiphyses have fused
|
|
Acromegaly
|
GH secreting pituitary adenoma after epiphyses have fused
|
|
S/S acromegaly
|
cardiomyopathy; large hands, feet, jaw; hyperglycemia
|
|
Prolactin
|
inhibited by dopamine
|
|
Prolactinoma
|
MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH
|
|
Rx
|
surgery or bromocriptine (dopamine analog)
|
|
Other causes hyperprolactinemia
|
primary hypothyroidism, drugs
|
|
Inappropriate ADH syndrome
|
hyponatremia <120 mEq/L; ↑ UOsm (always concentrating urine)
|
|
Causes
|
small cell carcinoma lung, CNS injury, chlorpropamide
|
|
Rx
|
restrict water; demeclocycline in small cell carcinoma
|
|
Serum T4
|
↑ or ↓ in free hormone or thyroid binding globulin (TBG)
|
|
↑ Serum T4 and normal TSH
|
↑ TBG; due to ↑ in estrogen
|
|
↑ Serum T4 and ↓ TSH
|
thyrotoxicosis
|
|
↓ Serum T4 and normal TSH
|
↓ TBG; due to anabolic steroids
|
|
↓ Serum T4 and ↑ TSH
|
primary hypothyroidism
|
|
↓ Serum T4 and ↓ TSH
|
secondary hypothyroidism
|
|
TSH
|
negative feedback with T4 and T3; best screening test
|
|
I131 uptake
|
↑ in Graves; ↓ in thyroiditis, patient taking excess thyroid, hypothyroidism
|
|
Cold nodule
|
non-functioning nodule; no uptake I131
|
|
Hot nodule
|
functioning nodule; ↑ uptake I131
|
|
Thyroglossal duct cyst
|
midline cystic mass
|
|
Branchial cleft cyst
|
cyst in anterolateral neck
|
|
Acute/subacute thyroiditis
|
painful thyroid; early thyrotoxicosis; ↓ I131 uptake
|
|
Hashimoto’s thyroiditis
|
MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody
|
|
Hashimoto’s thyroiditis
|
↑ anti microsomal and thyroglobulin antibodies
|
|
S/S
|
muscle weakness, periorbital puffiness, ↓ reflexes, diastolic hypertension, constipation, dry skin
|
|
Lab
|
↓ T4, ↑ TSH
|
|
Cretinism
|
maternal hypothyroidism before fetal thyroid developed, genetic disorder
|
|
S/S
|
mental retardation; short stature and increased weight; coarse skin
|
|
Thyrotoxicosis
|
any cause ↑ thyroid hormone activity; Graves disease, excess hormone, thyroiditis
|
|
Hyperthyroidism
|
↑ synthesis thyroid hormone; Graves disease and toxic nodular goiter
|
|
Graves disease
|
autoantibody against TSH receptor (type II reaction); HLA Dr3
|
|
S/S unique to Graves
|
exophthalmos, pretibial myxedema
|
|
S/S thyrotoxicosis
|
tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes
|
|
Lab thyrotoxicosis
|
↑ T4, ↓ TSH, ↑ glucose, ↑ calcium
|
|
I131 uptake
|
↑ Graves, toxic nodular goiter; ↓ thyroiditis, excess hormone, hypothyroidism
|
|
Rx Graves disease
|
ß-blocker; drug to decrease hormone synthesis (propylthiouracil)
|
|
Toxic nodular goiter
|
hyperthyroidism; develops out of a multinodular goiter; no exophthalmos
|
|
Goiter
|
enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency
|
|
S/S
|
rapid enlargement due to hemorrhage into cyst; Rx thyroxine
|
|
Solitary thyroid nodule woman
|
most often benign (cyst)
|
|
Solitary thyroid nodule man or child
|
often malignant
|
|
Papillary carcinoma thyroid
|
MC thyroid cancer; radiation exposure; psammoma bodies
|
|
Follicular carcinoma thyroid
|
invades blood vessels
|
|
Medullary carcinoma thyroid
|
parafollicular cells; calcitonin; amyloid (calcitonin conversion)
|
|
MEN I syndrome
|
3 P's; pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or ß-islet cell tumor)
|
|
MEN IIa syndrome
|
2 P's; medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma
|
|
MEN IIb syndrome
|
1 P; medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas
|
|
Alkalotic pH
|
tetany with normal total calcium, ↓ ionized calcium and ↑ PTH
|
|
Hypoalbuminemia
|
↓ total calcium, normal ionized calcium and PTH
|
|
Tetany
|
↓ ionized calcium level; threshold potential comes closer to resting potential
|
|
S/S
|
thumb adducts into palm, twitching after tapping of facial nerve
|
|
PTH
|
maintains ionized Ca2+; ↑ Ca2+ renal reabsorption; ↓ phosphate/bicarbonate reabsorption in kidneys
|
|
Primary HPTH
|
↑ Ca2+, hypophosphatemia, ↑ PTH
|
|
Cause
|
adenoma MCC, hyperplasia, cancer
|
|
S/S
|
renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification
|
|
Secondary HPTH
|
↓ Ca2+, ↑ PTH; hypovitaminosis D from renal failure MCC
|
|
Malignancy-induced hypercalcemia
|
↑ Ca2+, ↓ PTH; all other non-parathyroid causes same results
|
|
Causes hypercalcemia
|
osteolytic lesions, sarcoidosis, ↑ vitamin D, PTH-related peptide, myeloma
|
|
Tertiary HPTH
|
hypercalcemia developing from secondary HPTH
|
|
Primary hypoparathyroidism
|
↓ Ca2+ and ↓ PTH
|
|
Causes
|
previous thyroid surgery, autoimmune, DiGeorge syndrome
|
|
S/S
|
tetany; calcification basal ganglia
|
|
Pseudohypoparathyroidism
|
↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH
|
|
Other causes ↓ Ca2+
|
hypomagnesemia (↓ PTH), ↓ vitamin D, DiGeorge
|
|
↓ Ca2+ and ↓ PTH
|
primary hypoparathyroidism
|
|
↓ Ca2+ and ↑ PTH
|
secondary hyperparathyroidism
|
|
↑ Ca2+ and ↑ PTH
|
primary hyperparathyroidism
|
|
↑ Ca2+ and ↓ PTH
|
malignancy induced hypercalcemia; other causes hypercalcemia
|
|
Waterhouse-Friderichsen syndrome
|
meningococcemia with bilateral adrenal hemorrhage due to DIC
|
|
Addison’s disease
|
autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis
|
|
S/S
|
hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia
|
|
Lab
|
↓ sodium, ↓ cortisol, ↑ potassium, ↑ ACTH
|
|
Adrenogenital syndrome
|
AR; enzyme deficiency; hypocortisolism; hyperpigmentation from ↑ ACTH
|
|
21-Hydroxylase deficiency
|
↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite
|
|
11-Hydroxylase deficiency
|
↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite
|
|
17-Hydroxylase deficiency
|
↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
|
|
MCC Cushings
|
long-term corticosteroid therapy
|
|
Tests Cushings syndrome
|
low/high dose dexamethasone suppression; urine free cortisol (best test)
|
|
Normal dexamethasone suppression
|
cortisol analogue; ↓ ACTH and ↑ cortisol
|
|
Pituitary Cushings
|
MCC Cushing’s; ACTH secreting pituitary tumor
|
|
Lab
|
low dose dexamethasone not suppress cortisol; high dose suppresses
|
|
Adrenal Cushings
|
adrenal adenoma secreting cortisol; suppressed ACTH
|
|
Lab
|
no suppression with low/high dose dexamethasone
|
|
Ectopic Cushings
|
ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels
|
|
Lab
|
no suppression with low/high dose dexamethasone
|
|
S/S Cushings
|
purple stria, truncal obesity, hypertension, DM
|
|
Primary aldosteronism
|
benign adenoma in zona glomerulosa
|
|
S/S
|
hypertension and muscle weakness (hypokalemia), no pitting edema
|
|
Lab
|
hypernatremia, hypokalemia, metabolic alkalosis, ↑ urine K+ and Na+
|
|
Pheochromocytoma
|
benign tumor in adrenal medulla in adults
|
|
Associations
|
von Hippel Lindau, neurofibromatosis, MEN IIa and IIb
|
|
S/S
|
labile hypertension, anxiety, sweating, headache
|
|
Lab
|
↑ 24 hr urine for VMA and metanephrines
|
|
Neuroblastoma
|
malignant tumor adrenal medulla child; widespread metastasis; hypertension
|
|
ß-islet cell tumor (insulinoma)
|
benign tumor; hypoglycemia, ↑ insulin and C-peptide
|
|
Patient taking excess insulin
|
hypoglycemia, ↑ insulin, ↓ C-peptide
|
|
Glucagonoma
|
malignant α-islet cell tumor; hyperglycemia and rash
|
|
Zollinger Ellison syndrome
|
malignant islet cell tumor secreting gastrin; peptic ulcers
|
|
Somatostatinoma
|
malignant δ islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria
|
|
VIPoma
|
malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria
|
|
DM
|
organ damage correlates with glycemic control
|
|
Type 1
|
young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis
|
|
Type 2
|
older person; obese; relative insulin deficiency (↓ insulin receptors, postreceptor problems)
|
|
Type 2
|
family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma
|
|
↑ Non-enzymatic glycosylation
|
glucose attaches to amino acids in basement membranes
|
|
Non-enzymatic glycosylation
|
↑ vessel permeability producing hyaline arteriolosclerosis
|
|
Osmotic damage
|
glucose converted into sorbitol by aldose reductase
|
|
Osmotic damage
|
lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)
|
|
Pathogenesis hyperglycemia
|
↑ gluconeogenesis (most important), glycogenolysis
|
|
Pathogenesis hyperlipidemia
|
no insulin to stimulate capillary lipoprotein lipase; ↑ chylomicrons/VLDL
|
|
Pathogenesis ketoacidosis
|
↑ oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies
|
|
Most commons due to DM
|
neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation
|
|
Glycosylated HbA1c
|
measure of long term glycemic control (8-12 weeks)
|
|
Gestational DM
|
↑ placental size, human placental lactogen
|
|
Complications
|
macrosomia (↑ muscle/fat from insulin), RDS, newborn hypoglycemia (↑ insulin)
|
|
Hypoglycemia
|
insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency
|
|
Carnitine deficiency
|
no ß-oxidation of fatty acids; all cells compete for glucose
|