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74 Cards in this Set

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endometrium polyps
asympto
estrogen sensitive
benign
Endometrium hyperplasia
pre malingnant
due to high Estrogen or low progesteron (indirect estrogen stimulation)
risks:
PCOS, >40 Year old, early menarche, late menopause, granlosa-theca cell tumor, nulliparity, obesity, DM type 2, HTN
endometrium carcinoma
#1 invasive CA of female genital tracts,
from hyperplasia
cervicitis
inflamation
casues: gardenerella vaginalis, trichomonas vaginlalis, chlamydia trachomatis, CAndida albicans
cervical intraepithelial neoplasia (CIN)
involves squamocolumnar junx
HPV 16, 18, 30, 40, 50
inhibitiion of tumor suppressor genes p53, RB
treat: CIN1: cryotherapy, laser, Loop electric excision procedure
CIN2, 3: cone biopsy

CIN1: mild dyplasia of upper layer of cervical epithelium
CIN2: sever dysplaia of various cells throughout entire epithelial thickness
CIN3: carcinoma in situ, entire epil layer is neoplastic, no invasion beyond BM
invasive cervial carcinoma
neoplstic development of cervical epi wiht invasion through BM
stage 0: CIN3
stage 1: invasive carcinoma confined to cervix
stage 2: beyond cervix
stage3; extended to pelvic wall
stage4: extended beyond pelvic wall
PCOS
chronic anovulation wiht androgen excess + obesity
due to excess LH-->stimulates ovarian theca cells-->produce androgens-->converted to estrone in adipose tissue (increased in obese women)-->inhibit release of FSH-->decreased follicular development-->anovulation-->amenorrhea

estrone also cause endometrial hyperplasia --> increase rish of endometrial cancer
signs: infertility, amenorrhea, acne, hirsutism
Labs: >_ 2:1 LH: FSH, high androgens and estrone
endometriosis
presence and proliferation of non-neoplastic endometrial tissue outside of uterine cavity
#1 site is ovary : called chocolate cysts (collection of old blood)
dysmenorrhea, dyschezia, dyspareunia
Uterine leiomyoma
fibriod, benign smooth muscle tumor
#1 uterine tumor and #1 overall tumor in women
estrogen sensivitve so may regress during menopause
most in blacks
whorled pattern of smooth muscle bundles
Hydatidiform mole
due to abnormal ovum fertilization casue excesive trophoblastic development in the form of GRAPE LIKE CYTS
COMPLETE MOLE: 2 x chromo sperms + 1 ennucleate ovum, higher risk of choriocarcinoma

INCOMPLETE MORE: 1 ovum + 2 or more sperm yeilding
triploidy, tetraploidy, etc

cystic swelling of villi (grape-like cysts) with trophoblastic proliferation cause VERY HIGH BETA-HCG
larger uterus that gestational age
choriocarcinoma
malignant neoplams of trophoblastic cells (placenta)
very high BETA hicg
LATE FINDINGS: irregular spotting of brown, bloody foulsmelling fluid
risk factors: retained hydatidiform mole, retained placenta
fibrocystic breast change
multiple bilat nodules
LUMPY BUMPY BREASH
fluctuate in size and tenderness wiht menstrual cycle
benign
breast cancer
one solitary nodule
unilate
nonternder in early
no fluctuation
fibroadenoma
stromal tumor
single, sharply circumscribed, mobile, marble shaped and sized
<30 years
mild increase riskof breast cancer
phylloided tumor
stromal tumor
> 60 years
benign (called cystosarcoma phylloides tumor if malignant)
grows quickly
huge LOG-SHAPED TUMOR
intraductor papilloma
epithelial tumor
benign
nipple discharge: bloody or serous
ductal carcinoma in situ
non-invasive carcinoma
5 types: comedocarcinom, solid, cribriform, papillary, micropapillary
invasive ductal carcinoma
most common breast CA
scirrhous (hard)
may see: peau d'orange, nipple retration, dimpling, may palpate fixed mass
lobular carcinoma in situ
tumor of lobules/terminal ducts/ductules
NEVER FORM CALCIFICATION OR MASSES
TEND TO BE BILAT
signes-ring cells common
invasive lobulear carcinoma
TEND TO BE BILAT
signes-ring cells
diffusely invasive through breast-detection is hard
HI met rate to CSF, ovary BM, uterus
rubey consistency to breast-->changes shape of breast
Pagets dis of nipple
form of DCIS from nipple ducts inot nipple sckin and areola
plapable mass
fissured ulcerated, oozing hyperemic edematous nipple
medullary carcinoma
young women
assoc: BRCA1 gene mutation
soft fleshy consistency
colloid (mucinous) carcinoma
older women
gelatinous consist
receptor +
tubular carcinoma
10% of mammographically identified tumors
conspicuously spiculated
usally receptor +
EXCELLENT px
SARCOMA
stromal tumor
malignant
bulky and palpable
angiosarcoma, rhabdomyosarcoma, leiomyosarcoma, chondrosarcoma, osteosarcoma
invasive ductal of tubular breast cancer mamography
spiculated density wiht irregular infiltration of surrounding tissue
cyst of fibroadenoma, meudally carcinoma, mucinous carcinmoa mamography
well circumcribed density, smooth borders
calcificaiton on mamography
most commonly DCIS
breast CA metasteses
lungs, bone, liver, adrenal, brain, meninges
estrogen& progesterone receptors
+ in 50-85 % of breast tumros
more common in post menopausal pts
3/4 regress abfter hormonal manipulation
glossitis
inflammation of tongue
B2, B12 def
cheilosis
drying and scaling of lips wiht fissuring at corners of mount
b2 def
smooth beefy red tongue
atropy of papillae and mucosa
b12 def
straberry tonge
scarlet fever
kopliks spots
first sign of measles
c-erb-B2 (HER-2/neu)
oncogene
BRCA1, BRCA2, p53
tumor suppressor genes
zenkers diverticulum
aboer UES
tracton
midpoint of esophagus
epiphrenic
above LES
false diverticulum
on herniation of mucosa
true divertuculm
all layers of esophagus
acute errosive gastritis
focal damage
risks: EtOH, NSAIDS (decr. PG), stress (burns cause CURLING ULCERS, head trauma casue CUSHINGS ULCERS), cancer drugs smoking
cHRONOC TYPE A
AUTOIMMUNE
glandular destrucion and mucosal atrophy
affects FUNDUS-->antibodies against parietal cells, and IF
casue pernicious anemia & achlorhydria
assoc: hachimotos dis, addisons dis, vitiligo
Chronic type B
chronic irritation due to H. PYlori
affects antrum
irrication leads to mucosal atrophy and metaplasia -->carcinoma
Menetriers
mucosa hyperplasia
mucosa becomes thick with concomitatnt atrophy of glands
hyperplastic intestinal polyps
most common colonic polyp
in 50s and 60s
due to decreased epith cell turnover in bowel-->accumulation of mature cells on teh surface
nonmalignanct
Hamartomatous polyps
malformation of glads and stromaof epith-->overgrowht of maturre nature tissue to are
nonmalign
inflammatory polyps
pseudopolyps
inflammed regenerating tissue surrounded by ulcer
asso: ulceraive collitis
adenomatous ployps
NEOPLASTIC TO INVASIVE COLORECTAL CA
3 types:
tubular adenoma: from tubular glands
villious adenoma: when >4 cm in diameter, polyps with highes RISK OF MALIGNANT TRANSFORMATION. most common to RECTUM, SIGMOID COLON-->cause gross rectal bleeding, hypokalemia, hypoproteinemia
tubulovillous adenoma
Peutz-jeghrs syndrome
autosomal dominant hamartomatous polyp
entire bowel
signs: polyps + melanin hyperpigmentaion of lips, palms, and soles
increase risk of colon cancer relative to general population
familial adenomatos polyposis
autosomal dominant
due to loss of tumor suppressor gene APC
100% chance of cancer from polyp
adenomatous polyps
Gardners sndrome
form of FAP
classic FAP colon polyps +benign mandible and skull tumors + epidermal cysts +high risk of abnormal dentition
100% of cancer from polyp
Autosomal dominant
turcots syndrome
form of FAP
classic FAP colon polyps +malignant brain tumors
high risk of cancer from polyp
autosomal dominant
Hereditary nonpolyposis colorectal cancer (HNPCC)
autosomal dominant
due to defective DNA mismatch repair genes associa wiht microsatellites
increase risk of colon cancer + other cancers especially endometrium and ovary
colon cancer
APC gene inactivated-->K-RAS (oncogene) is mutated-->p53 is inactivated
risks: excessive dietary caloric intake, high refined carb diet, intake of red meat, reduced fiber intake
NSAIDS aand aspirin are protective
right colon cancer: IDA (fatigue and weakness), + hemoccult test, no stool changes
Left colon cancer: + hemoccult test, change in bowel habits, cramply LLQ discomfort, tenesmus, pencil stools,
lungs and liver are prefered mets sites
diverticullosis
most commonly at sigmoid colon
where blood vessels penetrate the wall
diverticuli expose blood vessels-->+ hemocult test and bleeding
painless
DX: barium enema and xray or colonoscopy
diverticulitis
inflmamation of diverticuli due to seeds, nuts casue bacteria to be trapped and casue infx
LLQ pain, fever, elevated PMN, diarrhea, but hemoccult (-) because blood vesses are blocked by seeds or nuts
can cause abscess formation, bowel perforation, sepsis, fatal
Dx: Ct scan (never do barium enma)
tx: cipro, metronidazole
irritable bowel syndrome
recurrent, unpredictable bowel habits (diarrha, constipation)
exacerbated by emotional stress
due to dysregulation of the enteric NS
neurological problem, can sleep through the night without symps
crohns dis
rectum is spared
ileaum usually most involved (but can be anywhere in the GI)
skip lesions
transmural
granulomas (non caseating)
crypts abscesses (PMNs in crypt lumen)
strictures (+ string sign), fissures (minor bleeding), fistulas

most common in whites, jews carry highest risk
smoking increase risk
increase colon Ca risk
ulcerative collitis
begins at rectum progresses proximally
continous lesions
mucosa and submucosa only
nongranulomatous lesions only ulcers
crypt absesses
pseudopolyps (inflammed regenrating mucus membrane encircled by ulcer)
Lead pipe colon (due to fibrosis, loss of haustra)

more in whites and jews
females have highest risk
smoking is protective
high risk of colon CA adn toxic megacolon
bleeding >>pain
tx: bowel rest, sulfasalazine (5ASA) +/-immunosuppressives
malabsorttion
casue steatorrhea, diarrhea
sudan 3 stain of tool
determin if increase in stool fat
screening
stool fat analysis
measures amt of fat after being fed a measure quantitsy
high amt in stool indicate malabsorption
GOLD STD TEST
D-XYLOSE absorption test
pt is fed d-xylose (nondigestile sugar)-->measure in pts urine
in malabsorption: small quantity in urine
celiac sprue
affects small intestine
bx od duodenum: flat villi
Labs: antigliadin, antigluten antiendomysial, antireticulum ab
wt loss, steatorrhea, diarrhea, bloating after eating wheat, rye, barley, oat
high in caucaians
dermatitis herpitformis (teate wiht dapsone)
incre. risk of MALT lymphoma
whipples dis
affets any organ but primarily intestine, cns, and joints cause steatorrhea, arthralgia, and fever
BX of small bowel: PAS + macs in mucosa due to gram + Actinomyces
TRPHERYMA WHIPPELI
tx: many agents, Bactam ( 1st line) EVERY ABX GIVEN FOR 4-6 MONTHS ATLEAST PREFER 1 YEAR
Cholesterol stones
due to high chole
most common typ eof stone in US
Higest risk in : fat, female, forty over, fertile
Mixed stones
chole plus bilirubin
most common worldwide
pigment stone
from excess bilirubin
insoluble Ca2+ salts of bilirubin and inorganic calcium
cholelithaisis
gallstone sin GB
usually asymp
all labs norma;
treat surgcially in : porcelain GB (calcium lined GB), or Native Americans becasue incrs. risk of GB CAncer
cholecystitis
GB infx
fever RUQ pain, murphys sign, nausea, vomititng
elevated PMN, ALKALINE PHOSPHATASE
ULTRASOUND FINGING: GB wall thick, perichoecystic fluid, gallstones
choledocholithaisis
obstuction of common bile duct
RUQ pain, jaundice, CLAY-COLORED STOOL, TEA COLORED URINE
elevated ALKALINE PHOSPAHASE AND CONJUGATED BILIRUBIN
Ultrasound: dilated common bile duct
ascending cholangitis
infx of common bile duct
complication of choledocholithiasis
RUQ pain, jaundice, CLAY-COLORED STOOL, TEA COLORED URINE
CHARCOT'S TRIAD: RUQ pain + jaundice + fever
elevated ALKALINE PHOSPAHASE AND CONJUGATED BILIRUBIN, eleveted PMN

can quickly ascend to liver (increase AST and ALT)-->fatal sepsis