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78 Cards in this Set

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What are some risk factors for endometrial hyperplasia?
PCOS, > 40 years old, estrogen treatment, increased exposure (early menarche, granulosa theca cell, late menopause), nulliparity, obesity, DM (type 2), hypertension
What does estrogen stimulate?
endometrial lining and hyperplasia
What are the causes of cervicitis?
gardnella vaginalis, trichomonas vaginalis, candida albicans, and chlamydia trichomatis
What is associated with HPV?
inhibition of tumor suppressor genes p53 and RB
What is the treatment for low grade CIN (CIN 1)?
mild dysplasia. cryotherapy, laser, loop electric excision procedure
What is the treatment for high grade CIN (CIN 2 and CIN 3)?
cone biopsy
What are the stages of invasive cervical carcinoma?
stage 0 = CIS
stage 1 = invasive carcinoma (cervix)
stage 2 = cervix + upper vagina
stage 3 = pelvic wall
stage 4 = pelvic wall + bladder
What are the benign uterine disorders?
endometrial polyps, PCOS (polycystic ovarian syndrome), endometriosis, uterine leiomyoma,
What is the cause of polycystic ovarian syndrome?
EXCESS LH
-->stimulates ovarian theca cells (produce androgen)
-->androgen causes acne and hirtuism & estrogen
-->estrogen inhibits ant pituitary ( decreased FSH)
What are some causes of anovulatory periods?
pregnancy and polycystic ovarian syndrome
Patient presents w/ infertility, amenorrhea, oligomenorrhea, acne, and hirstuism, obesity, and diabetes. What does the patient have?
polycystic ovarian syndrome
Patient has dysmenorrhea, dyschezia (difficulty in defecating), and dyspareunia. What does the patient have?
endometriosis (chocolate cysts may also be present)
Black patient has a biopsy and shows "whorled pattern of smooth muscle bundles" and abnormal menstrual bleeding. What is the cause?
uterine leiomyoma ie fibroma (benign, estrogen sensitive masses). In reproductive females
What are some side effects of having uterine leiomyoma?
urinary frequency, impaired infertility, increased risk of spontaneous abortion, postpartum hemorrage
What is the genetic component for a "complete mole"?
completely paternal
2 "X" chromosome, containing sperm that have fertilized one ENUCLATE ovum

**higher risk for malignancy than incomplete mole (immature)
What is the genetic components of an incomplete mole?
ovum with 2 or more sperm. paternal and maternal genetic material. Yielding-->triploidy, tetraploidy

**lower risk for malignancy (than complete mole)
Patient has cystic swelling of villi (grape like cysts) with trophoblastic proliferation with VERY high levels of beta-HcG. What is the dz?
hydatidiform mole
What is choriocarcinoma?
malignant neoplasm of trophoblastic cells (placenta) in ovary or testes
What are some causes of choriocarcinoma?
retained gestational trophoblast, retained placenta from deliver or placenta, spontaneous
What are the 3 benign breast cancers
fibroadenoma (most common)
phyloiddes tumor (+ 60 yo)
intraductal papilloma (nipple discharge)
What are the most common malignant breast cancers?
ductal carcinoma, lobular carcinoma, paget's dz of the nipple
What are the 5 types of ductal carcinoma in situ?
comedocarcinoma (solid sheets of malignant cells)
solid
cribriform (nests)
papillary
micropapillary
Patient has "scirrhous" (hard) mass that is fixed. The skin is peau d'orange with nipple retraction, dimpling. What is the dz?
invasive ductal carcinoma
Patient has bilateral masses in the breast with signet ring cells.
Lobular Carcinoma
What breast cancer is associated with BRCA 1 mutation?
medullary carcinoma
What breast cancer has a gelatinous consistency?
colloid (mucinous) carcinoma
What is the MC mass in the breast associated with calcifications?
ductal carcinoma in situ
What are the oncogenes associated with breast cancer?
c-erb-B2 (HER-2/neu)
What are the tumor suppressor genes associated with breast cancer?
BRCA-1, BRCA-2, p53
Glossitis
B2 or B12 deficiency
Cheilosis
drying and scaling of the lips
B2 deficiency
Smooth beefy red tongue
B12 deficiency
Strawberry tongue--white coated tongue with bumps
scarlet fever (due to strep pyogenes),
What are the three locations of esophageal diverticula?
above UES--ZENKER
midpoint--TRACTION
above LES--EPIPHRENIC
Where does chronic gastritis type A due to autommune response and glandular atrophy normally occur?
fundus (top part of the stomach),
Where does chronic gastritis type B due to H pylori normally occur?
antrum (bottom)
What disorders are associated with chronic gastritis A?
autoimmune-->hashimotos disease, addisons, vitiligo
What are the major types of intestinal polyps?
hyperplastic
hamartomatous
inflammatory
lymphoid
adenomatous (malignant)
What type of polyps form with hamartomaous polyps (overgrowth in natural area)?
Peutz Jeghers syndrome (autosomal dominant)
What are the three types adenomatous polyps (neoplastic)?
tubular
villous (worst)
tubulovillous
Hyperpigmentation of lips, palms and soles. Polyps with risk of colon cancer.
Peutz Jeghers Syndrome
What is the cause of familial polyposis syndrome of the colon (autosomal dominant)?
loss of tumor suppressor gene, APC
classic familial polyposis syndrome colon polyps + benign mandible and skull tumors + epidermal cysts + high risk abnormal dentition
Gardner's Syndrome (autosomal dominant)
classic FAP colon polyps + malignant brain tumors
Turcot's syndrome (autosomal dominant)
colon malignancies in multiple sites, NO polyps, no association with adenomas
hereditary non-polyposis colorectal cancer syndrome (defective DNA mismatch repair)
What are the two molecular mechanisms in which colon cancer develops?
1. APC/Beta-catenin pathway
-->APC becomes inactivated

2. k-RAS (oncogene)
-->k-RAS mutated and p53 is inactivated
What medications are colon cancer protective?
NSAIDS and aspirin
What are some S/S of right colonic cancer?
INCREASED bleeding
hemorrage, hemoccult stool, iron-deficiency anemia
>50 yo with iron deficiency anemia
colon cancer (MUST do the work up)
What are the S/S of left colon cancer?
crampy, discomfort, tenesmus (spasm, feels like they need to use the restroom)
MC mets from the colon
liver and lungs
What is the MC site for diverticulums (outpouchings)?
sigmoid colon
-due to high pressure
Painless + hemooccult stool
diverticulosis
How do you diagnose a diverticulosis?
barium enema, xray or colonscopy
LLQ pain, (-) hemoocult stool, inflammation present
Diverticulitis
What is the dx and trmnt of diverticulitis?
Dx-CT
Trmnt-ciprofloxacin, metronidazole
What do we use fluorquinolones for?
G+/G- bacteria, cancer
recurrent, unpredictable bowel habits (diarrhea an/or constipation), plus abdominal cramping, worse with stress
irritable bowel syndrome
What is the treatment for Crohn's dz?
anti-inflamm-->sulfsalazine, 5-ASA
vit B12
metroniadazole plus corticosteroids
What is the treatment for ulcerative colitis?
anti-inflamm-->sulfsalazine or 5-ASA +/- immunsuppresives (6-MP, methotrexate, azathioprine)
bowel rest
Patient has transmural skip lesions (rectum spared) with granulomas (non-caseating), ulcers, strictures/fistulas/fissurs
+ string sign. Painful.
Crohn's dz
Patient has mucosa/submucosal continous lesions with pseudopolyps. Lead pipe colon (xray). Bleeding.
Ulcerative Colitis
What is the gold standard stool test?
stool fat analysis (qualitative)
What does the schilling test show us?
patient has vit B12 deficiency (no B12 in urine)
improves with instrinsic factor-->pernicous anemia (B12 in urine)

doesn't improve (B12 in urine)-->pancreatitis, bacteria, dz of ileum
chronic diarrhea, steatorrhea, and weight loss in tropical population
tropical sprue
anti-gliadin lab with dermatitis herpetiformis. What cancer is the patient is at risk for?
MALT mucosa-associated lymphoid tissue lymphoma (celiac dz)
Steatorrhea, arthralgia, fever, PAS +macrophages.
Whipple's Dz
What is the trmnt for Whipple's Dz?
any antibiotic therapy (TMP-SMZ or penicillin) for at least 4-6 months
What is the most common type of galllstone?
cholesterol
What are the risk factors for cholesterol gallstones?
female, fertile, fat, fourty
What is a lab that is elevated with biliary disorders?
alkaline phosphatase (bile duct injury)
porcelain gallbaldder, asymptomatic
cholelithiasis
fever, RUQ pain, murphy's sign
cholecystitis
RUQ pain, jaundice, clay-colored stool, tea-colored urine, elevated alk phos, conjugated bilirubin
choledo-cholithiasis (common bile duct blockage)
-->choledo: common bile duct
RUQ pain + jaundice + fever
charcot's triad, ascending cholangitis
High levels of unconjugated bilirubin + brain damage in an infant.
Crigler Najjar: inherited non-hemolytic jaundice, affects metabolism of bilirubin
Pruiritis + RUQ pain, jaundice, cirrhosis. Labs-elevated conjugated bilirubin and alk phosphatase.
Primary Sclerosing Cholangitis (intra and extrahepatic ducts affected)
Pruiritis, jaundice, steatorrhea, xanthelasmas, anti-mitochondrial antibody
Primary Biliary Cirrhosis (autoimmune destruction intrahepatic ducts)