Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/122

Click to flip

122 Cards in this Set

  • Front
  • Back
Where can you find nicotinic ACh receptors in the body?
NM Jn
Autonomic ganglion
What are the function of interleukins 1-5?
IL-1: fever
IL-2: T cell stimulator
IL-3: BM stimulator
IL-4: IgE, IgG
IL-5: IgA, ephils

HOT T BONE STEAK
What changes in sleep patterns sexual anatomy are seen in the elderly?
Dec'd REM
Dec'd slow wave sleep
Inc'd awakenings

-Slower ejaculation/refractory period
-Atrophic vaginitis in females (vaginal shortening, dryness(
What is the main difference between delirium and dementia?

Which is more commonly reversible?
Delerium--reversible, rapid onset

Dementia--irreversible, no alterations of consciousness, long-term onset
What are the layers of the epidermis?
Californians like girls in string bikinis
Corneum
Lucidum
Granulosum
Spinosum
Basalis
What structures arise from the paramesonephric ducts?
Fallopian tubes
Uterus
Upper portion vagina
Which defense mechanism:
Involuntary withholding of a feeling from conscious awareness
Repression
Which defense mechanism:
A veteran that can describe horrific war details without any emotion
Isolation
Which defense mechanism:
A child abuser was himself abused as a child
Identification
Underlies all other defense mechanisms
Repression
Which defense mechanism:
May lead to multiple personalities
Dissociation
Which defense mechanism:
Adult whining, bedwetting, crying
Regression
What is the basic equation for cardiac output?
CO= SV x HR
What is the Fick principle?
CO = Rate of Oxygen consumption/(arterial - venous O2 content)
Describe flow of ions during a pacemaker action potential?
Phase 4--baseline, slow inc in Na+ conductance to Phase 0 (calcium causes depol)
No plateau
Repol = Phase 3 due to K+ permeability
What cellular changes (in ions) can increase contractility?
Catechols--ANX, exercise, stress

Inc intracell Ca, dec in extracell Na--both accomplished by Digoxin
Which pathology:
Smudge cell
CLL
Which pathology:
Port-wine stain in ophthalmic division of trigeminal nerve
Sturge-Weber Syndrome (sp)
Which pathology:
S3 heart sound
Dilated CM (LVH, VSD, PDA, MI, Mitral regurg)
Which pathology:
Adrenal hemorrhage a/w meningococcemia
Waterhouse-Friedrichson
Which pathology:
Ferruginous bodies
Asbestos
Which pathology:
Subepithelial humps on EM
Post-strep GN
Which pathology:
Myocyte disarray
Hypertrophic CM
Which pathology:
Currant jelly stool
Intussusception
Which pathology:
Sacroileitis
Ankylosing spondylitis
Which pathology:
Adverse reaction from mixing succinylcholine with inhaled anesthetics
Malignant hyperthermia
Which HTN drug:
First dose orthostatic hypotension
Alpha-1 blockers (zosins)
Which HTN drug:
Hypertrichosis
Minoxidil
Which HTN drug:
Cyanide toxicity
Nitroprusside
Where would you expect to find B cells and T cells in the spleen?

In the lymph nodes?
B cells in follicles of spleen and LNs

T cells: PALS of spleen, paracortex of LNs
Which HTN drug:
Dry mouth, sedation, severe rebound HTN
Clonidine
Which HTN drug:
Bradycardia, impotence, asthma exacerbation
beta-blockers
Which HTN drug:
Reflex tachycardia
Nitrates, vasodilators
Which HTN drug:
Metabolic alkalosis
Loop diuretics
Which HTN drug:
Elevated anti-histone antibodies
Hydralazine
Which HTN drug:
Hypercalcemia
HCTZ
Which cancer:
PSA
CaP
Which cancer:
AFP
HCC, yolk sac tumors
Which cancer:
CA-125
Ovarian Ca
Which cancer:
Elevated Alk Phos
Bony turnover, Pagets, Mets to Bone--CaP, Testicular Ca, Kidney Ca, Lung, Breast, Thyroid
Which cancer:
CEA
GI cancers--panc, stomach,
Which cancer:
beta-hCG
Choreoca
Hydatidiform mole
Which cancer:
S100
Astrocytome
Melanome
Neuro syx
Study X shows that vitamin C can prevent coronavirus infections, but 10 other studies show no benefit.

What type of error is found in study X?
alpha-error
What structures are at risk for injury with an anterior shoulder dislocation?
Axillary n
Posterior circumflex artery
Supraspinatus tendon
What is the rate-limiting step in purine synthesis?
Glutamine PRPP aminotransferase
What is the rate-limiting step in pyrimidine synthesis?
CPSII
Which anti-cancer drug:
Prevents breast cancer
Tamoxifen
Raloxifene
Which anti-cancer drug:
Treatment for testicular cancer
Cisplatin
Bleomycin
Etoposide
Which anti-cancer drug:
Treatment for childhood tumors (Ewing's, Wilms', rhabdomyosarcoma)
Dactinomycin
Which anti-cancer drug:
Inhibits ribonucleotide reductase
Hydroxyurea
Which anti-cancer drug:
SE: Hemorrhagic cystitis
Cyclophosphimide
Which anti-cancer drug:
Antibody against Philadelphia chromosome
Imatinib
What drugs should not be given to sulfa allergic patients?
Celecoxib
Loops diuretics, thiazide diuretics
Probenecid
Sulfonamides (TMP-SMX)
Sulfonylureas
Describe differences in gonadal venous drainage (L vs R).
Left ovary/testis-->Left gonadal vein-->left renal vein-->IVC

Right ovary/testis-->right gonadal vein-->IVC

(RIGHT IS MORE DIRECT)

Varicocele more common on left.
What do the superficial inguinal nodes drain?
Distal 1/3 of vagina/vulva/scrotum
What do the obturator, external iliac, and hypogastric nodes drain?
Proximal 2/3 of vagina/uterus
What do the para-aortic lymph nodes drain?
Ovaries/testes
Describe the production of estrogen in women.

Begin at the level of the hypothalamus.
Arcuate nucleus of Hthal-->PULSATILE GnRH
-->Pituitary: FSH, LH

FSH-->Granulosa cell-->(+)Aromatase: Androstene dione-->Estrogen (Estradiol)

LH-->Theca cell-->(+) Desmolase (a 17-alpha hyoxylase): Cholesterol-->Androstenedione-->Granulosa Cell
Estrogen:
Source (estradiol vs estriol)
Function
Source: Ovary (estradiol), placenta (estriol), blood (aromatization)

Fn:
1. Dev't genitalia, breast, female fat distribution
2. Growth of follicle, endometrial prolifern, myometrial excitability
3. Upreguln E2, LH, PG receptors; feedback inhibition of FSH, LH
4. STIMULATE PL secretion but BLOCKS action at breast
5. Inc'd transport of SHBG (sex hormone binding globulin), Inc'd HDL, dec'd LDL
Estradiol vs Estriol:
Potency
Levels during Pregnancy
Receptors
Estradiol > estrone > estriol (potency)

Pregnancy:
50-fold inc in estradiol and estrone
1000-fold inc in estriol (indicator of fetal well-being---made by placenta)

Receptors expressed in cytoplasm; translocate to nucleus when bound by ligand
Progesterone:
Source
Function
Source: Corpuse luteum, placenta, adrenal cortex, testes

Fn:
1. Stimulates endometrial glandular secretions, spiral artery dev't

2. Maintenace of prgenancy

3. Dec'd myometrial excitability

4. Production of thick cervical mucus, inhibiting sperm entry into uterus

5. Inc'd temp

6. Inhibits LH, FSH

7. Uterine SM relaxation (prevents contractions)

8. Dec'd estrogen receptor expressivity
Outline the general hormone sequence of the female reproductive cycle.
FSH-->follicle maturation-->production of E2
E2-->LH surge-->ovulation and production of PG with E2
-->inhibit FSH, LH production
-->Decline of corpus luteum-->no production of E2/PG
-->Loss of FSH inhibition
-->Increase in FSH (repeat cycle)
What are the 2 main phases of the menstrual cycle?
How long is each phase?
2 phases (in order): Proliferative (follicular phase), Secretory (luteal) phase

Follicular phase varies
Luteal phase = 14 days (always)
What hormone triggers ovulation?
LH
Which hypothalamic nucleus is involved in ovulation?
Arcuate nucleus
What are the layers of the endometrium?

Which layers are shed during menstruation?
Stratum basalis
Stratum spongiosum--shed
Straum compactum--shed
When does the basal body temperature increase in relation to ovulation?
24hrs prior to ovulation as PG increases
What hormone maintains pregnancy for the first 6-7 weeks?

Source?
Corpus luteum produces progesterone and E2 in luteal phase for 13-14 days (luteal phase)

If beta-hCG from placenta present, lifespan of corpus luteum extends to 6-7 weeks until placenta is able to produce its own PG.
Oogenesis:
Meiosis I vs Meiosis II--
Arrest
Cells involved--haploid, diploid?
Primary oocyte (4N) stuck in Meiosis I prOphase for years until Ovulation

Secondary oocyte (2N) stuck in Meisosis II METaphase until fertilization

(An egg MET a sperm.)
Role of prolactin in pregnancy.
Prolactin induces and maintains lactation
Decreases reproductive function (harder to get pregnant while breastfeeding)
Role of oxytocin in pregnancy.
Helps with milk letdown, may be involved with uterine contractions
hCG:
Source
Function
Syncytiotrophoblast of placenta

-Maintains corpus luteum (and thus progesterone) for first trimester by acting like LH; in 2nd and 3rd trimesters, placenta makes its own estriol and PG and corpus luteum degenerates

-Used to detect pregnancy because it appears early in urine

-Elevated hCG in pathalogic states (hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors)
Premature ovarian failure:
Pathophys
Presentation
Premature atresia of ovarian follicles in women of reproductive age

Patient presents with signs of menopause after puberty but before age 40.

Low E2, high LH/FSH
Hormone replacement therapy:
Indications
AE
Used for prevention of menopausal syx (hot flashes, vaginal atrophy) and osteoporosis (inc'd E2-->dec'd oclast activity)

Unopposed ERT (estrogen replacement tx)-->inc'd risk endometrial ca; so PG is added

Possible inc'd CV risk
Estrogens (ethinyl estradiol, DES< mestranol):
Indications
AE
Contraindications
Bind Estrogen receptors

Used in hypogonadosim or ovarian failure, menstraul abbnlts, HRT in postmenopausal women; in men w/androgen-dependent CaP

AE: risk endometrial ca, bleeding in postmenopasual women, vaginal ca, inc'd risk thrombi

Contraindications--ER poz BrCa, hx of DVTs
Progestin:
Indications
Bind PG-receptor-->reduce growth, inc'd vasc of endometrium

Used in OCPs, in tx of endometrial Ca, abnl uterine bleeding

(Ex: medroxyprogesterone, IUDs)
OCPs:
MOA
Advantages, Disadvantages
MOA: Prevent estrogen surge, thus prevents LH surge-->no ovulation

Advantages:
Reliable (<1% failure)
Dec'd risk endometrial/ovarian ca
Dec'd incidence ectopic pregnancy
Dec'd pelvic infections
Regulation of menses

Disadv:
Taken daily
No protection x STDs
Inc'd TGs
Depression, weight gain, nausea, HTN
Hypercoagulable state**-->DVT, PE
Mifepristone:
MOA
Use
Competitive inhibitor of progesterone receptors

Use: termination of pregnancy; administered with misoprostol (PGE1)
Virus associated with cervical cancer.

Other risk factors.
HPV 16,18

Smoking, multiple sexual partners; intercourse at early age
Endometriosis:
Presentation
Common Sites
Cyclic bleeding from ectopic endometrial tissue resultingin blood-filled CHOCOLATE CYSTS

Manifests are menstrual-related pain; oftein results in infertility. Can be due to retrograde menstrual flow or ascending infection.

Commonly in ovary/peritoneum
Endometrial hyperplasia:
Cause
Risks
Excess Estrogen stimuln; inc'd risk endometrial carcinoma

Risk factors for it: anovulatory cycles, HRT, polycystic ovarian syndrome, granulosa cell tumor
Endometrial carcinoma:
Presentation
Risk factors
Presents with vaginal bleeding; typically preceded by endometrial hyperplasia

Risk factors:
-Prolonged use of estrogen without PG
-Obesity
-DM
-HTN
-Nulliparity
-Late menopause
Leiomyoma vs Leiomyosarcoma:
What are they?
Effects
Leiomyoma = fibroid--most comon of all tumors in females. Benign SM tumor. Malignant transformation rare.

Decrease w/menopause
May lead to Fe-deficiency anemia (inc'd bleeding)

Leiomyosarcoma:
Bulky, irregular shaped tumors with areas of necrosis and hemorrhage, typically arises de novo

May protrude from cervix and bleed. Must be removed!
Leuprolide:
Pulsatile vs Continuous Administration--
Effects
Indications
AE
GnRH analogs
-Stimulatory properties if used in pulsatile fashion--infertility

-Antagonizing properties if used continuously--to induce menopause, tx prostate cancer, tx uterine fibroids

Use in infertility

AE: antiandrogen, nausea, vomiting
What are the most common causes of anovulation?
PCOS, obesity, HPO axis abnlts, premature ovarian failure, hyper-PL
Which pathology:
Excess unopposed estrogen is main risk factor
Endometrial hyperplasia and carcinoma
Which pathology:
Menorrhagia with enlarged uterus, no pelvic pain
Leiomyoma
Which pathology:
Pelvic pain present only during menstruation
Endometriosis
Which pathology:
Diagnosed by endometrial biopsy in clinic
Endometrial hyperplasia/carcinoma
Which pathology:
Definitive diagnosis and treatment is by laporoscopy
Endometriosis
Which pathology:
Menstruating tissue within myometrium
Adenomyosis
Which pathology:
Malignant tumor of uterine smooth muscle
Leiomyosarcoma
Which pathology:
Most common gynecologic malignancy
Endometrial carcinoma
Polycystic ovarian syndrome:
Pathophys
Presentation
Treatment
Inc'd LH production-->anovulation
Hyperadrogenism due to deranged steroid synthesis by theca cells

Leads to enlarged, BILATERAL cystic ovaries manifesting with amenorrhea, infertility, obesity, hirsutism

Inc'd risk endometrial cancer

Tx: weight loss!, OCPs!, Gonadotropin analogs, clomiphene, surgery
Clomophene:
MOA
Indications
AE
Partial agonist at estrogen receptors in hypothalamus

Prevents feedback inhibition and increases release of LH and FSH from pituitary-->stimulates ovulation

Use to tx infertility and PCOS

AE: Inc'd risk multiple simultaneous pregnancies, hot flashes, ovarian enlargement
What are the 4 main categories of ovarian tumors?
Epithelial--65% ovarian tumors, 90% of ovarian cancers
Germ cell
Stromal
Mets (GI, breast, endometrium)
What are the main types of epithelial cell ovarian tumors?
My Med Students Consistently Beat Exams

***Serous
***Mucinous
****Endometroid
Clear Cell
Brenner
Mixed
What are the main types of germ cell ovarian tumors?
Teratoma***
Dysgerminoma***

Endometrial sinus
Choriocarcinoma
Dysgerminoma:
Characteristics
Malignant, equivalent to male seminoma, but rarer
Choriocarcinoma:
Characteristics
Rare, malignant; develop during prengancy in mother or baby

Large, hyperchromatic syncytiotrophoblastic cells.

Inc'd hCG
Yolk sac (endodermal sinus) tumor:
Characteristics
Aggressive malignancy in ovaries (testes in boys)

Yellow, friable, solid masses, Schiller-Duval bodies (resemble glomeruli)

ELEVATED AFP
Teratomas:
Mature vs Immature vs Struma ovarii
Mature: dermoid cyst--most frequent benign ovarian tumor

Immature teratoma: aggressively malignant

Struma ovarii: contains fnal thyroid tissue, can present as hyperthy
Serous cystadenoma vs cystadenocarcinoma:
Characteristics
Serous cystadenoma: benign; lined w/fallopian tube-like epithelium.

Cystadenoca: malignant, bilateral; BRCA-1 risk factor. GENETIC!
Mucinous cystadenoma vs cystadenocarcinoma:
Characteristics
Mucinous Cystadenoma: multilocular lined by mucuse-secreteing epithelium. Benign, intestine-like tissue.

Cystadenoca: Malignant, intraperitoneal accumuln mucinous material from ovarian or appendiceal tumor
Krukenberg tumor:
Characteristics
GI malignancy that mets to ovaries, causing mucin-secreting signet cell adenoca
Which ovarian tumor:
Produces AFP
Yolk sac tumor--AKA endodermal sinus tumor
Which ovarian tumor:
Estrogen secreting-->precocious puberty
Granulosa theca cell tumor
Which ovarian tumor:
Intraperitoneal accumulation of mucin
Mucinous cystadenocarcinoma
Which ovarian tumor:
Testosterone secreting-->virilization
Sertoli-Leydig Cell tumor
Which ovarian tumor:
Psammoma bodies
Serous cystadenocarcinoma
Which ovarian tumor:
Multiple different tissue types
Teratoma
Which ovarian tumor:
Lined with fallopian tube-like epithelium
Serous cystadenoma
Which ovarian tumor:
Ovarian tumor, ascites, pleural effusions
Meig's Syndrome of Brenner tumor fibromas
Which ovarian tumor:
Call-Exner bodies
Granulosa-theca cell tumor
Which ovarian tumor:
Resembles bladder epithelium
Brenner tumor
Which ovarian tumor:
Elevated beta-hCG
Choriocarcinoma
An obese woman presents with amenorrhea and increased serum testosterone.

Diagnosis?
PCOS
A patient with PCOS is most at risk for developing which type of cancer?
Endometrial ca due to high E2
Why is progesterone used in combination with estrogen during estrogen-replacement?
To reduce incidence of endometrial hyperplasia/ca
Under what circumstances would you expect to see an elevated LH?
Menopause
PCOS
Prior to ovulation (LH surge)
Androgen-insensitivity syndrome
What are the risk factors for ovarian cancer?
Lack of ovulation