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125 Cards in this Set

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friedreich's ataxia
spinal ataxia, AR, a/w hypertrophic cardiomyopathy
digeorge syndrome, cardio involvement
tetralogy of fallot, interrupted aortic arch (truncus arteriosus)
transplant rejection 2 wks after transplant
acute rejection; dense infiltrate of T-cells
shigella vs salmonella
shigella is much higher virulence (?) -- 100 orgs vs 10^6 (for salmonella) are sufficient for infection; c.jejuni (500), entamoeba histolytica, and giardia lamblia (both 1) are also capatable of causing diarrhea with a small inoculum
shigella's toxin vs. c.dyphteria's toxin:
shigella's shiga toxin cause inactivation of 60s ribosomal subunit; c.diphteria has AB-exotoxin which ADB ribosylates EF-2 preventing translation
side effects of statins
myopathy and hepatitis
effects of femfibrozil on statins
ingemfibrozil increases conc of statins --> increased risk of side effects (hepatitis, myopathy)
side effects of fibrates
increased cholesterol in bile --> cholesterol stones; also, myopathy (both direct and by potentiating statins)
ace inhibitors and renal artery stenosis
pts with RAS use ACE to maintain renal perfusion and GFR; ACEi --> block this effect --> reduce renal perfusion --> ARF
angioedema
side effect of ACEi tx; swelling of tongue, lips, eyelids, can cause difficulty breathing; from accumulation of bradykinin
carvedilol
unique beta blocker that nonspecifically antagonizes b1, b2, a1; proven mortality benefit in CHF (along with beta blockers in general)
furosemide and CHF
no mortality benefit (some studies even show mortality increase)
mcc renal failure during pregnancy
eclampsia, hypovolemic shock, ascending infections
inflammatory carcinoma
not a true morphologic subtype, but rather any rapidly growing, infiltrating breast cancer that occludes the dermal lympathics can cause swelling and redness; VERY AGGRESSIVE
deep perineal space
middle (muscle) layer of urogenital diaphragm. Contains two skeletal muscles (SPHINCTER URETHRAE and DEPP TRANSVERSE PERINEAL), along with the BULBOURETHRAL gland (Cowper's gland)
oncogenesis of HPV
viral proteins: E6 --| p53; E7--|p110 (Rb);
SRY gene
located on short arm of Y chromosome, produces TDF (testes-determining factor).
MCC bacterial postatitis
E.Coli (others: SSEEK PP)
apocrine metaplasia of the breast
benign change; breast epithelial cells --> sweat-gland-like cells; often seen in fibrocystic changes, also in normal breast
factors that predispose to ectopic pregnancy
PID and endometriosis
males: complete androgen resistance vs 5a-reductase deficiency
testosterone converted to DHT via 5a-reductase; testosterone necessary for wolffian duct differentiation, DHT for external genitalia; absence of 5a-REDUCTASE --> feminization until puberty, when inc testosterone causes virilization ("penis at 12 syndrome"; with ANDROGEN INSENSITIVITY, no goandal development (entire wolffian system degenerates)
MCC maternal death in pre-eclampsia
cerebral hemorrhage and pulmonary complications (ARDS)
paramesonephric ducts
F: uterine tubes, uterus, cervix, upper vagina; M: appendix of testes
mesonephric ducts
F: duct of gartner; M: epididymis, ductus deferens, seminal vesicle, ejaculatory duct
cause of female pseudointersex (ovaries, no testes, masculinzation of female external genitalia)
congenital adrenal hyperplasia --> excess androgens
cause of male pseudointersex (46 XY, testes, no ovaries, stunted male external genitalia growth)
inadquate prod of testosterone / MIF by testes, or due to 5-alpha reductase deficiency
complete androgen insensitivity (CAIS)
46XY with testes, female external genitalia, rudimentary vagina; MCC is mut in androgen receptor
pouch of douglas
aka rectouterine puch -- between uterus and rectum, collects peritoneal fluid, often a location for endometriosis
processus vaginalis
evagination of parietal peritoneum that descends thru inguinal canal w/ testes; mostly collapses --> tunica vaginalis; if remains patent, get HYDROCELE
contents of spermatic cord
ductus deferens, artery of ductus deferens, testicular artery and veins (2), pampiniform plexus (dilated in varicocele), lymphatics (drain testes to peri-aortic nodes)
what structure contains ovarian vessels
suspensory ligament of ovary
what structure contains uterine vessels
transverse cervical (cardinal) ligament
what structure contains the round ligaments of the ovaries and uterus, along with uterine tubules and vessels?
broad ligament
from what is the acrosome derived, and what does it contain
derived from golgi apparatus; contains hyaluronidase (dissolves corona radiata ECM) and acrosin (facilitates penetration of zona pellucida), both used in the acrosomal reaction
where are a sperm's mitochondria
in the middle piece (neck)
trace path from spermatagonia to spermatid, noting ploidy
spermatagonia (2N, diploid) --mitosis--> primary spermatocyte (4N, diploid) --meiosis--> secondary spermatocyte (2N, haploid) --meiosis--> spermatid(N, haploid)
kartagener's syndrome
defect in dynein; 1) dec mucus clearance --> sinus infections; 2) dec sperm motility --> infertility; 3) impaired dev patternig --> situs inversus; 3) bronchiectasis
name the three steps of fertilization
capacitation, acrosomal rxn, cortical reaction
capacitation
biochemical modification of sperm after it enters the uterus, prepares it for fertilization (?)
acrosomal reaction
as sperm nears corona radiata (layer of granulosa cells around ovum), acrosome release hyaluronidase to dissolve the corona radiata, allowing access to zona pelucida (mucopolysaccharides); acrosin from acrosome facilitates penetration of the zona
cortical reaction
after the first sperm fuses with the plasma membrane of the ovum, calcium-dependent release of granules causes thickened zona so that no more sperm can penetrate
name the androgens in order of potency
DHT (from t'one) > Testosterone (testes) > androstenedione (adrenals)
effects of LH in women
stimulates theca cells to produce androgen; stimulates granulosa cells to convert chol --> progesterone
effects of FSH in women
stimulates granulosa cell to: 1) chol-->progesterone; 2) androgen --aromatase--> estradiol; 3) secrete inhibin
effect of estradiol in regulation of female hormone axis
estradiol, produced by granulosa cells, inhibits FSH and GnRH release, and has variable effect on LH (normally inhibitory, but becomes positive feedback just before LH surge)
effects of estrogen on breast
stimulates stromal development of breast; also stims prolactin (milk production) but prevents milk release (--> builds stores for lactation)
sources of estrogens
1) ovary (estradiol); 2) placenta (estriol); 3) blood (aromatization)
what does granulosa cell make?
progesterone (from cholesterol), estradiol (from androgens from theca cells), and inhibin (for feedback)
changes in theca/granulosa cells after follicular rupture
ruptured follicle becomes corpus luteum; THECA cells begin secreting ESTROGEN, and GRANULA cells begin secreting PROGESTERONE
life of corpus luteum
if fertilized, grows for 3 months (maintained by hCG from embryo), then placenta takes over and corpus luteum degenerates
proliferative phase of uterine cycle
~follicular phase of menstrual cycle; estrogen from granulosa cells causes proliferation of endometrial glands, makes endometrium thicker and contractile
secretory phase of uterine cycle
~luteal phase of menstrual cycle; progesterone from corpus luteum causes cell proliferation and vascularization, but depresses uterine contractility
what triggers menses?
fall in LH --> fall in estrogne, accompanied by fall in progesterone ==> can't maintain endometrium ==> sloughs off
progesterone and estrogen effects on uterine contractility
estrogen INCREASES uterine contractility, progesterone DECREASES contractility
effects of estrogen / progesterone on lactation during pregnancy
both stimulate dev of mammary glands for lactation and stimulate prolactin, while oxytocin is inhibited, preventing milk letdown
changes in prolactin / oxytocin after delivery
internal stimulus for prolactin (estrogen/progesterone) falls, but suckling promotes increased prolactin release; oxytocin also released in response to suckling or crying --> milk letdown
how does epithelium change as you go from vagina to fallopian tube?
squamous at entry (vagina, cervix) --> columnar epithelium (secretory) --> cuboidal ovary; fallopian tubes are ciliated columnar (to move egg/zygote?)
presentation and tx of primary dysmenorrhea
painful menstruation b/c of PG-mediated contractions; ==> give NSAIDs
source of hCG
blastocyst after 8 days and syncytiotrophoblast of placenta --> maintains corpus luteum for first semester
cancer risk in cryptorchidism
increased risk of germ cell tumors, incl seminoma and embyronal carcinoma
germ cell tumors of testes: benign or malignant; treatment options
almost always malignant, tx by orchiectomy (except seminoma -- radiosensitive)
mature teratomas in M/F
M: Malignant; F: benign
histo characteristics of choriocarcinoma
consists of cells resembling syncitiotrophoblasts and cytotrophoblasts (--> inc hCG)
sex cord tumors in males
LEYDIG: like sertoli-leydig of ovary, benign, androgen producing, contain Reinke crystals; differential effects on old (gynecomastia) and young (precocious puberty) owing to different androgen responses; SERTOLI: aka androblastoma; benign, histologically looks resembles tubular and stromal elements
which lobe/zone of prostate is characteristic for carcinoma?
peripheral zone / posterior lobe
cause of BPH
increase in DHT or age-related increase in estrogens (promote DHT receptor expression)
lobes/zones for BPH
periurethral/transitional zones
PSA in adenocarcinoma vs BPH
elevated COMPLEXED PSA with malignancy, elevated FREE PSA with BPH
serum marker of prostate adenocarcinoma invasion
PROSTATIC ACID PHOSPHATASE indicates penetration of adjacent tissue; elevated ALK PHOS indicates bone met
MCC vaginal discharge + clinical features
gardnerella vaginitis, fishy amine odor (esp with KOH), clue cells (epithelial cells coated with bacteria)
cause of lymphogranuloma venereum
chlamydia trachomatis, serotypes L1-3
condyloma lata vs condyloma acuminatum
LATA: syphilis; gray, flattened, wart-like lesions; ACUMINATUM: HPV 6 an 11; multiple wart-like lesions w/ koilocytes
donovan bodies
multiple organisms filling large histiocytes, charcteristic of granuloma inguinale (caused by Donovania granulomatis, a g- rod)
cause of endometritits
s. aureus / strep, usually following intrauterine trauma IUD, pregnancy complications, etc.
chocolate cysts
ENDOMETRIOSIS (menstrual bleeding into ectopic endometrium)
causes of endometrial hyperplasia
excess estrogen secretion, 2' to {anovulatory cycles, PCOS, ovarian tumors like granulosa cell, or estrogen replacement therapy} ==> postmenopausal bleeding, carcinoma risk
hormonal impact on leiomyomas
estrogen-sensitive --> increase during preg, decrease with menopause
cervical vs endometrial carcinoma
CERVICAL: mid-aged women, early sex, lots of partners, smoking, HPV; ENDOMETRIAL: older women, nulliparity, estrogen stim, obesity (estrogen from adipose tissue?), DM, HTN
most frequent site of endometriosis
ovaries
psuedomyxoma peritonei
rupture/met of mucinous cystadenocarcinoma (ovarian epithelial tumor) --> large qauntities of intraperitoneal mucinous material; similar to mucinous release from appendix mucocele rupture or OVARIAN CYST
dermoid cyst
most frequent benign ovarian tumor; "mature teratoma" (but benign, unlike mature teratoma in men); lined by skin, hair, bone, teeth, cartilage, and various glandular tissues
struma ovarii
type of monodermal teratoma consisting entirely of thyroid tissue --> hyperthyroidism
meigs syndrome
triad of: 1) ovarian fibroma; 2) ascities; 3) hydrothorax; resolves upon tumor resection
call-exner bodies
GRANULOSA CELL TUMOR; small follicles filled with eosinophilic secretion;
abrutio placentae vs placenta acrreta
abrutio placentae causes ANTEpartum bleeding, fetal death, and DIC; placenta accreta causes impaired placental separation AFTER delivery --> POSTpartum bleeding (can be massive hemorrhage)
toxemia of pregnancy
tow forms: pre-eclampsia (w/ variant HELLP) and eclapmsia (preeclampsia + convulsions + DIC)
sheehan syndrome
postpartum anterior pituitary necrosis (from hypotension)
blue dome cysts
fluid-filled cysts seen in fibrocystic disease (most common disorder of breat, esp in 25-50yo F; benign, bilateral lumpy breasts w/ midcycle tenderness); only precancerous if demonstrate atypia
fibroadenoma
most common breast tumor in F < 25yo; BENIGN, firm, rubbery, painless, well circumscribed
most common cause of breast mass in post-menopausal women
carcinoma of breast
most common site of breast cancer
upper outer quadrant
estrogen/progesterone involvement in breast cancer
breast cancers that express estrogen/progesterone receptors have better prognosis (predict efficacy of anti-estrogen tx); oral contraceptives are NOT predisposing factors
breast cancer with cells arranged in linear fashion -- "Indian-file"
Invasive Lobular carcinoma
risk factors for breast cancer
Family Hx, inc reproductive yrs (early menarche, late menopause), late 1st pregnancy
seminoma vs embryonal carcinoma (males)
seminoma --> painLESS, elevated hCG, most common; embryonal carcinoma --> painFUL, elevated AFP, second most common
choriocarcinoma
germ cell tumor with elevated hCG; rare, but malignant; devs during preg in mom or baby from syncytiotrophoblastic cells
germ cell tumors with elevated AFP
yolk sac (endodermal sinus) tumors, maybe embryonal carcinoma; YOLK SAC: aggressive malignancy in babies/kids; histo: Schiller-Duval bodies (primative glomeruli)
benign ovarian tumor representing bladder epithelium (transitional)
Brenner
benign breast tumor with serous or bloddy discharge
intraductal papilloma
serous vs mucinous cystadenoma/cystadenocarcinoma of ovary
SEROUS: lined with fallopian tube-like epithelium (ciliated columnar); MUCINOUS: lined by mucus-secreting epithelium (columnar w/ apical mucin, NO CILIA)
bilateral breast lesions with midcycle tenderness
fibrocystic dz, most common in 25-50yo
most common breast tumor < 25 yo
fibroadenoma -- small, mobile, firm mass, estrogen-sensitive size, not premalignant
fibrocystic disease vs tumor
FIBROCYSTIC: b/l, multi-nodular, estrogen-sensitive-cycling of size, pain, engorgement; TUMOR: unilateral, uni-nodular, insensitive
theca interna vs externa
interna produces androgens; externa is fibrous, protective
primary oocytes
cells arrested in prophase of meiosis I (46, 4N) until puberty; at puberty, FSH --> some oocytes complete meiosis I --> secondayr oocytes --> begins meiosis II, halts in metaphase II until fertalization
acute hemolytic transfusion reaction, what type of hypersensitivty, whats the mechanism
type II (Ab-mediated); Anti-ABO antibodies bind erythrocytes --> Ag-Ab complexes activate complement --> anaphyatoxins (--> shock) and MAC ( --> cell lysis)
measles vs rubella
both present with rashes that start at head/neck and spread downward; RUBELLA also has generalized lymphadenopathy, esp postauricular and occiptal, with sequelae including polyarthritis and polyarthralgia
vaginal flora of prepubertal girls
colonic and skin flora (s.epidermidis); lactobacillus, candida, and strep only in women of child-bearing age
complete vs partial mole
complete is diploid, results from androgenesis (sperm fertilizing empty egg), no fetal parts, and 2% progress to choriocarcinoma; PARTIAL: triploid, egg + 2 sperm, fetal parts, rarely progresses to choriocarcinoma
seminoma vs dysgerminoma
age of presentation (men: 30s, women: 20s); frequency (m: 30% of testicular tumors, common; f: 1% of ovarian tumrs, rare)
potential complications of cryptorchidism
testicular carcinoma (unless surgically corrected; if b/l, sterility, infection
diff in presentation b/w placenta previa and placenta abrutptio
both can cause antepartum bleeding; PREVIA: any trimester, painLESS; ABRUPTIO: usu 3rd trimester, painFUL
gestational vs ovarian choriocarcinoma
BOTH: elev hCG, aggressive, malig; GEST: more common, from previous/current pregnancy; OVARIAN: from germ cells
what causes fluctuation in leiomyoma size?
estrogen -- increases in pregnancy, decreases post-menopausally
schiller-duval bodies
primitive glomeruli-like structures found in YOLK-SAC tumors
risk of which tumor with cryptorchidism
seminoma (male germinoma)
name the ovarian epithelial tumors and their associated epithelial types
1) serous (fallopian tube -- ciliated columnar); 2) mucinous (intestinal -- mucin-filled columnar); 3) brenner (bladder-like -- transitional)
most common testicular cancer in older men
testicular lymphoma
name the three benign breast tumors and their defining features
1) FIBROADENOMA (F<25yo, small firm welldemarcated mobile mass, inc size and tenderness during preg); 2) CYSTOSARCOMA PHYLLODES (leaf-like projections); 3) INTRADUCTAL PAPILLOMA (serous/bloody nipple discharge)
what is the source of MIF
sertoli cells
when do spermatocytes / oocytes become haploid?
at first meiotic division --> secondary spermocytes / secondary oocyte (ooctye frozen here until fertilization)
meiosis changes in recruited oocyte during follicular phase
goes from prophase of meiosis I (primary oocyte) to metaphase of meiosis II (secondary oocyte)
from what cells does a gestational choriocarcionoma arise?
trophoblast, usu after hydatidiform mole but also pregnancy
viral cause of acute hemorrhagic cystisitis in kids
adenovirus
first-line drug for hypertension in pregnancy
methyldopa