patho section 2

what is the primary cause of hyperthyroidism

graves disease

what is the primary cause of hypothyroidism

hashimoto's

what does the majority of thyroid hormone bind to

thyroxine binding globulin

what is the negative feedback system involved in thyroid hormone regulation (hypothalamus, AP, thyroid)

T3/T4 has negative feedback on AP and hypothalamus

TSH has negative feedback on hypothalamus

what are the actions of thyroid hormones

muscle catabolism, accelerates bone turnover, stimulates lipolysis, increases metabolic rate, brain development in children

what is the cause of graves disease

TSH-like antibodies act on TSH receptor and lack negative feedback

what causes goiter

high TSH

which gender is more likely to get graves disease

women

what are the metabolic presentations of hyperthyroid

weight loss, sweating, increased appetite, heat intolerance

what are the SNS presentations of hyperthyroid

nervousness, irritability

what are the cardiovascular presentations of hyperthyroid

tachycardia, palpitations

what are the GI presentations of hyperthyroid

diarrhea

what are the neuromuscular presentations of hyperthyroid

muscle weakness, tremor

what causes the SNS/cardiovascular effects of hyperthyroidism

increased beta-adrenergic receptor activation and amplification of catecholamine actions

what causes the muscle weakness seen in hyperthyroidism

increased protein catabolism

what causes the diarrhea seen in hyperthyroidsism

decreased gut transit time

what leads to the reproductive changes seen in hyperthyroidism

increased SHBG lowers free estradiol

what is proptosis

abnormal protrusion of the eye

what are the common lab results in hyperthyroidism

low TSH

high free T4, T3, T4

what is the downside of treating hyperthyroidism

it usually leads to hypothyroidism

when should you follow up for hyperthyroidism

2-4 weeks initially

then 6-8 weeks until normalized

then follow hypothyroid monitoring

what are some drugs that can increase risk of hypothyroidism

lithium and amiodarone

what are the risk factors for hypothyroidism

women, older age, white/asian, family history, pregnancy, radiation

what are the metabolic presentations of hypothyroid

weight gain, fatigue, decreased appetite, cold intolerance

what are the integumentary presentations of hypothyroidism

dry/brittle/thin hair and nails

myxedema

what are the CV presentations of hypothyroidism

bradycardia

what are the muscular presentations of hypothyroidism

muscle weakness, cramps

what are the GI presentations of hypothyroidism

constipation

what causes myxedema

accumulation of protein complexes due to decreased protein catabolism

what causes bradycardia seen in hypothyroidism

decreased SNS activity

what causes constipation seen in hypothyroidism

increased gut transit time

what labs are seen in hypothyroidism

increased TSH

decreased free T4, T3, T4

what is hypothyroidism usually treated with

T4 supplementation

occasionally T3 supplementation

what is an important counseling point for T4 supplementation

don't switch brands

how should you monitor for hypothyroidism

monitor TSH every 4-8 weeks until normal

after large dose changes, monitor in 4 weeks

after small dose changes, monitor in 8 weeks

maintenance: every 6-12 months

what are complications with myxedema coma

respiratory suppression (high CO2)

what is the most common cause of goiter

iodine deficiency

what changes occur in thyroid levels during pregnancy

increases in TBG decrease free thyroid

hCG increased thyroid hormone production

what is the major functioning cell of the prostate, also responsible for PSA production

luminal secretory

what zone are the majority of prostate cancers found

peripheral

what zone is BPH most common in

transitional

what is the main energy source for sperm

citrate

what is cholesterols role in sperm

sperm stability

what role do prostaglandins have in the prostate

sperm stability

what role does spermine have have in the prostate

sperm mobility

what is the function of zinc in the prostate

citrate accumulation and tumor suppression

what is testosterone converted to in the prostate

DHT

what secretes testosterone

leydig cells

what is BPH

androgen-driven growth in size of prostate

what are risk factors for BPH

age >40, family history, circulatory disease, sedentary lifestyle, diabetes, smoking, alcohol

what type of alpha reductase is found in the prostate

type 2

what causes stromal proliferation

FGF

what inhibits stromal proliferation

TGF-b

what are the early symptoms of BPH

obstructive: decreased force of urine stream, straining, dribbling, incomplete emptying

what are the late symptoms of BPH

irritative: increased frequency and urgency, nocturia

what are LUTS

lower urinary tract symptoms

what are some concerning medications for possible BPH

testosterone, diuretics, SGLT2, anti-cholinergics

what are the AUA-SI ratings

0-7: mild

8-19: moderate

20-35: severe

what labs are taken to diagnose BPH

urinalysis to screen for cancer, stones, and infection

maybe PSA

what diagnostic tests are taken to diagnose BPH

uroflowmeter: for low flow rate

ultrasound

PVR

how do you differentiate between BPH and prostate cancer

BPH is enlarged and symmetrical

prostate cancer is nodular

what are the most common bacteria that causes acute bacterial prostatitis

e.coli

what is the timeline/cause for chronic bacterial prostatitis

recurrent UTI for at least 3 months

what are some non-infectious stimuli that can cause prostatisi

bicycle use, biopsy

what are the common causes of chronic bacterial prostatitis

chlamydia and gonorrhea

what are risk factors for prostatitis

age <50, bladder outlet obstruction, diabetes, STI

when should you follow up for prostatitis

2-6 weeks depending on severity, longer if chronic

what race is most likely to get prostate cancer

black

what is the most common type of prostate cancer

adenocarcinoma (in peripheral zone)

what are the three main causes of prostate cancer

androgen excess, chronic inflammation, and genetics

what are the risk factors for prostate cancer

family history, african ancestry, age, genes, smoking

what objective tests are used to diagnose prostate cancer

PSA, DRE

what does the ACS recommend for prostate cancer screening

high-risk men <50

average risk men at 50

with or without PSA

what does the AUA recommend for cancer screening

high risk men 40-45

average risk men between 45-50

screening every 2-4 years b/w 50-69 with or without PSA

what does the USPSTF recommend for cancer screening

start screening PSA b/w 55-69

dont screen above 70

don't do DRE

what is the gleason score

correlates tissue sample with tumor aggressiveness

how do you diagnose prostate cancer

PSA, biopsy, ultrasound, MRI

what is allodynia

pain produced by stimuli that do not normally cause pain

what is analgesia

the absence of pain

what is hyperalgesia

increased sensitivity to pain

what is hypoalgesia

decreased sensitivity to painful stimuli

what is hyperpathia

an exaggerated, unpleasant, and prolonged response to pain

what is hyperesthesia

abnormal increase in sensitivity to sensation

what is hypoesthesia

abnormal decrease in sensitivity to sensation

what is paresthesia

abnormal touch sensation such as tingling or "pins and needles" in the absence of external stimuli

what is pain threshold

point at which stimuli is perceived as painful

what is pain tolerance

maximum intensity or duration of pain that a person is willing to endure before seeking relief

what is the discriminative pathway used for

sense of touch

what is the nociceptive pathway used for

sense of pain

what differs between the discriminative and nociceptive pathways

discriminative vs ipsilateral (doesn't cross over in spinal cord)

nociceptive is contralateral (crosses over in spinal cord)

where is pain registered in the brain

primary somatosensory cortex

what is the anterolateral pathway also known as

spinothalamic pathway or nociceptive pathway

what are the 3 orders of nerve transmission

first: from periphery to spinal cord

second: spinal cord to thalamus

third: thalamus to primary somatosensory cortex

which fiber has higher velocity of transmission (AD or C)

AD

which type of fiber is myelinated

AD

what type of feelings are transmitted through AD neurons

pain, cold temperature

what type of feelings are transmitted through C neurons

pain, warm temperature, itch

what are AB fibers for

touch receptor

which has a higher threshold for activation: discriminative or nociceptive

nociceptive

what is the difference between how AD and C fibers discriminate different types of stimuli

AD fibers specify between mechanical, thermal, and chemical stimulation

C fibers are polymodal and respond to all 3 as 1