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111 Cards in this Set
- Front
- Back
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In an AIDS patient, what do you use ganciclovir for?
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CMV reitinitis tx
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In an AIDS patient, what do you use, what do you use Amp B for? plus what other drug?
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Cryptomeningitis, plus flucytosine
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In an AIDS patient, what is DOC for MAC? CD4 count?
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Clarithromycin and Ethambutol
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Describe Folate in bacteria, and how we target?
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Folate is produced by bacterial dihydropteroate synthetase - blocked by SMX, sulfadiazine, dapsone
Eukaryotes and bacteria - use folate via enzyme dihydrofolate reductase - to form tetrahydrofolate. Block this with TMP or pyrimethamine |
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what is alternative to Bactrim in pneumocystis jiroveci prophylaxis
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dapsone + pyrimethamine + leucoverin
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what are the two most common germinal testicular tumors
Sx's? Age? |
seminoma - peak at 35, painless enlargement of testicle, always malig and radiosensitive
Embryonal - peak <35, painful with early met ELEVATED hcg, poor prog |
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what are the germ cell testicular tumors that occur at younger ages
sx? signs? |
choriocarcinoma - peak around 20 - malignant, significant elevated hCG
yolk sac (aka infantile type embryonal) - peaks in infancy, elevated AFP |
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what are the stromal sex cord testicular tumors
Cell types? sx? |
leydig cell tumor - precocious puberty, or gynecomastia depending on age, (+) REinke crystals
Sertoli cell - usually benign and asymptomatic |
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what are the major categories of ovarian tumors and how are they related to age
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surface epithelium >20
Germ cell <20 Sex cord stromal cell tumors - variable |
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what are the two kinds of cystadenoma/cystadenocarcinoma
sx? Morphology?? |
serous - mass is always cystic(fluid filled epithelial sac), tumor line with fallopian tube epithelium (ciliated and watery secretion)
Mucinous - also always cystic mass, Line with columnar cells that produce mucus May lead to pseudomyxoma peritonei |
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what female ovarian tumor looks like bladder tissue?
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brenner - aka celioblastoma
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what is the most common germ line ovarian tumor in women? sx?
what are the variants and describe |
Teratoma - 2 orgerm layers
mature - more frequent benign ovarian tumor Immature - aggressively malignant strum ovarii - contains THYROID tissue - can have hyperthyroidism! |
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what are all the types of ovarian germ line tumors
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Teratoma
dysgerminoma -malignant choriocarcinoma - increased hCG and AGGRESSIVE endodermal sinus(yolk sac) - AFP elevated |
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what is an ovarian tumor + asciteis and pleural effusions
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Meigs syndrome
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what do you see in krukenbergs syndrome?
commone source? Morphology? |
Ovarian metastitic cancer - bilateral replacement of ovaries with MUCIN producing signet ring cells!!!!
Source is usually stomach |
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what are they stromal sex cord tumorstestosterone
Type? Lab? Morphology? |
Granulosa the cal cell - secrete LOTs of estrogen - "call-exner bodies"(follicle with eosinophilic secretion) - can cause 2ndary endometrial hyperplasia or CA. Also may cause precocious puberty in kids
Sertoli-leydig cell tumor - Androblastoma - virilization in female. lots of testosterone |
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Endometrial hyperplasia and carcinoma
sx? causes? risk factors Incidence? |
Hyperplasia - due to excess estrogen stim, sx - postmenopausal bleeding. Risk - PCOS, Annovulation, hormone replacement
Carcinoma - MOST COMMON gyne malignancy - sx- present with vaginal bleeing. RISK - prolonged estrogen use without progestins, obesity, DM, HTN, late menopause |
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common causes of cervicitis
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gardnerella vaginalis
trichomonas vaginalis candida albicans Chlamydia trachoma tis |
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Describe how PCOS works
Labs? |
1. Excess LH production - increased androgen production by theca cells- androgen leads to acne and hirsutism
2. androgen converted via aromatase to in adipose (worse in fat asses) 3. 2ndary estrogen increase - inhibits pituitary release of FSH - so they become annovulatory and have amenorrhea 4. - high estrogen leads to endometrial hyperplasia also LABS - 2:1 LH:FSH, high test, high androstenedione, high estrone |
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what is the most common uterine tumor
morphology? sxs? |
leiomyoma (fibroids) -
whorled pattern of smooth muscle present with abnormal menstrual bleeding, urinary frequency BENIGN |
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what are the placental tumors?
sx, labs? |
Hydatidiform mole - abnormal ovum fertilization
complete mole - two sperm onto a egg w/o a nucleus - diploid - VERY high HCG, high malig risk partial mole - triploid! 2 sperm and egg. see fetal parts! and low malig risk Choriocarcinoma - trophoblast tumor - frequent and early mets!!!, very high beta hCG Sx= irregular spotting, BROWN BLODDY FOUL SMELLING |
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Px presents with rock hard mass with sharp margins in her tit. What kind? what other sign may we see?
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Invasive ductal carcinoma
Peau d'orange - nipple retraction due to lymphatic invasion and blockage. Inflammatory cells |
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px. presents with mass in her tit that has a orderly row of cells?
what cell type is common, and what would u expect to see? what would u expect NOT to see? |
Invasive lobular, signet cells!!!!
High MET rate! and rubbery Also NO CALCIFACTIONS Bilateral, look at other tit |
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what is comedocarcinoma
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subtype of DCIS - central areas of NECROSIS and become calcified.
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what can cause restrictive lung dz
see what CXR with one subtype? |
Parenchymal dz's -
collagen vascular dz- RA, SLE, scleroderma hereditary - familial idiopathic pulm fibrosis drugs infections - TB, histo, coccidio, CMV, PJ inflam - wegners, goodpastures, churg struas OR Interstitial fibrosis due to chronic inflammatory process HONEYCOMB LUNG! |
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What does a pulmonary wedge pressure tell us? what is the line?
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>12 - pleural edema - cardiogenic
<12 - pleural edema is NOT cardiogenic - IE ARDS |
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what are the 2 major stages of ARDS
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Exudative vs. proliferative
exudative - endothelial injury leads to hyaline membrane, type 2 pneumocyte prolif Proliferative - interstitial fibrosis, alveolar destruction |
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what abx's are inhibitors of translation
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CEC-50
TA-30 Chloramphenicol, Erythromycin, Clindamycin Tetracyclines, Aminoglycosides |
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what are the inhibitors of DNA replication?
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Anti folates - TMP, sulfonamides, pyrimethamine, dapsone.
Purine analog - 6MP via HGPRT pyrimidine analog - 5FU, cytarabine ABX cytotoxins - actinomycin, doxorubicin, bleomycin FQs |
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MOA cisplatin
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cross links DNA
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MOA actinomycin D
Indications? AEs? |
sits in small groove of DNA and intercalates DNA
Wilms tumor, eqing, rhabdomyosarcoma Child tumors! Ae- BM |
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MOA cyclophosphamide
PKs Indications AEs |
most widely used Alkylating agent, covalent X link DNA at guanine n7
needs bioactivation by P450 Used for NH lymphoma, breast, ovary. also to immune suppress AE = hemorrhagic cystitis and bladder fibrosis!! |
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what is special about vincristine?
Uses? moa? |
inhibits microtubule polymerization in M phase
used for hodgkin, leukemias, and Wilms SPECIAL - NO BONE MARROW TOX |
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what are psammoma bodies and where do we see them?
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Laminated concentric calcific spherules
Papillary carcinoma of the thyroid Serous cystadenocarcinoma of the ovary Meningioma Mesothelioma PSMM |
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what is most common lung cancer in Non smokers
presents? how do we follow? |
adenocarcinoma - in periphery
presents in pre existing scars + CEA - carcinoembryonic antigen - used to follow |
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what paraneoplastic syndrome related to squamous cell carcinoma
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PTH - Hypercalcemia!
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Px arrives with Hypercalcemia, hypoglycemia
what other lab finding might you find? |
Pituitary adenoma - GH, or others
This is MEN1 hyper calcemia from PTH, hypoglycemia fromhypoglycemia tumor - CAN BE OTHERS TOO - ZES, or VIPoma, rarely glucagon |
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SSx in lyphogranuloma venereum
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LYMPHogranuloma hits the lymph nodes with granulomas
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Tx for lymphogranuloma venereum?
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doxycyline....bc this is Chlamydia and all chlamydia treated w doxy
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granuloma inguinale....SSx
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GRanuloma INGUINALE hits the GROIN then blocks the inguinal area (granulomas hit the genitals then the organism blocks lymphatics)
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granuloma inguinale....cause and tx?
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klebsiella granulomatis
tx w TETRACYCLINE |
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Pt presents w a soft painful chancre on his penis....you take a look at it under the scope and see "school of fish" organization of organisms...you tell the Pt he has Dz X and Rx him drug X.
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this is chancroid caused by hemophilus ducreyi and treated w CEFTRIAXONE
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what cells are the hallmark of an HPV infection
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koilocytes...epithelial cells with perinuclear clearing
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what two HPV viral genes interfere with the nl fxn of p53 and Rb tumor suppressor genes
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E6 and E7
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what is the #1 most common germ cell testicular tumor in males
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seminoma
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germ cell testicular seminoma in males is analagous to what germ cell tumor in women
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ovarian dysgerminoma
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pt presents w painless enlargement of the testes...if you suspect a germ cell tumor...what should be top of the list
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seminoma
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#2 most common germ cell testicular tumor in males
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embryonal
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testicular choriocarcinoma in males is analgous to what germ cell tumor in females
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ovarian choriocarcinoma
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male yolk sac tumor is analagous to what germ cell tumor in females
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endodermal sinus tumor (both have elevated AFP)
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Pt presents w a Leydig cell tumor....what would you expect on micro?
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+ intracytoplasmic Reinke crystals
you get a leydig cell tumor from doing the reinke panky |
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list the 5 germ cell tumors in males
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seminoma
embryonal choriocarinoma yolk sac teratoma |
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what are the two stromal sex cord tumors in males
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leydig cell and sertoli cell tumor
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another name for sertoli cell tumor is
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androblastoma
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what are the 5 surface epithelium tumors of the ovary
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serous
mucinous clear cell endometrioid brenner |
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rupture of an ovarian mucinous cystadenocarcinoma leads to multiple intraperitoneal tumor implants....this is caleld what
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pseudomyxoma peritonei
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Brenner tumor is composed of what
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bladder epithelial cells
bladder - brenner |
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what are the 4 major germ cell turmors in females
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choriocarcinoa
endodermal sinus teratoma dysgerminoma |
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another name for an ovarian teratoma is
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dermoid cyst
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what is a struma ovarii
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an ovarian teratoma with only 1 tissue element - thyroid. can lead to hyperthyroidism
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what are the 3 stromal sex cord tumors in females
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granulosa-theca cell tumor
sertoli-leydig cell tumor fibroma |
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Pt presents with a granulosa theca cell tumor of ovary...what labs and micro findings to expect
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tumor secretes high estrogen
+ Call-Exner bodies (follicle full of eosinophilic material) if you get a granulosa theca cell tumor you better call your ex (ner) |
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sertoli leydig cell tumor....Pt presents with...
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sertoli leydig cell tumor aka androblastoma...secretes TEsTOSTERONE
irreversible virilization of female |
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ovary Bx shows a solid tumor of spindle shaped fibroblasts. you Dx what
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ovarian fibroma (benign)
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what is meig's syndrome
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ovarian fibroma + ascites + pleural effusion
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ovary Bx shows signet ring cells...you Dx
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Krukenberg tumor
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what is a Krukenberg tumor
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ovarian tumor metastasized from elsewhere (usually stomach), that bilaterally replaced overaies with mucin-producing signet ring cells
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describe a signet ring cell
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cell of Krukenberg tumor that makes large amounts of mucin intracytoplasmically so the ells nucleus is displaced to the periphery = looks like a class ring
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#1 invasive CA of female genital tract
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endometrial carcinoma
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Pt presents with stage 1 invasive cervical carcinoma ...this tells you what about the carcinoma
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the invasive carcinoma is confined to the cervix
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Pt presents with stage 2 invasive cervical carcinoma .this tells you what about the carcinoma
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invasive carcinoma extends beyond cervix but not onto pelvic wall and if it involves vagina...not the lower 1/3
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Pt presents with stage 3 nvasive cervical carcinoma .this tells you what about the carcinoma
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invasive carcinoma has extended to pelvic wall
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Pt presents with stage 4 invasive cervical carcinoma ...this tells you what about the carcinoma
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invasive carcinoma has extended beyond pelvic wall or has involved bladder or rectal mucosa +/- mets
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SSx of PCOS
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infertile, amenorrhea or oligomenorrhea, acne, hirsutism, obesity.
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what do we think is cause of PCOS.....initial cause
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excess LH production
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labs in PCOS
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> or = to 2:1 LH:FSH ratio.....high androstenedione, testosterone, and estrone
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what is the number 1 site of endometriosis
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ovary
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what is a chocolate cyst
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collection of old blood that develops on ovary when ectopic endometrial tissue of endometrisosis bleeds
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#1 tumor in women
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uterine leiomyoma.....also happens to be the #1 uterine tumor
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what causes a complete mole
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2 sperms get into an enucleate ovum
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what causes an incomplete mole
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2 or more sperm get into an ovum and cause triploidy or tetraploidy or something else weird
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get a radiology report back from your worst radiologist...he wasnt able to classify what he was seeing....the only helpful thing was "uterus larger than expected for gestational age"....this rings your bell for What Dx??
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hydatidiform mole
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choriocarcinoma is composed of what
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malignant neoplasm of trophoblastic cells (placenta....your baby is trying to kill you..not really but think about it like that)
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old lady presents w a single, sharply circumscribed mobile and marble shape/sized mass of the breast. you Dx
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fibroadenoma
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whats the most common breast CA
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invasive ductal Carcinoma
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mammogram shows calcifications of the breast....you know you can exclude WHAT Dx since you know it never presents w calcifications
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lobular carcinomas
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mammography of breast shows a spiculated mass....that makes you think of 2 Dxs.....what are they
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tubular carcinoma and DCIS
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important oncogene in breast cancer (gain fxn)
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c-erb-b2 (her 2 neu)
onco - ERB UNCLE ERB |
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important tumor suppressor genes in breast cancer
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BRCA1, 2, and p53 (loss fxn)
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Pt presents with pulsus paradoxus (greater than or equal to 10mmHg fall in BP during inspiration) and electrical alternanas on ECG (beat to beat alternating height of QRS complex). you Dx...
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cardiac tamponade
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Pt presents with a pleural friction rub and you see ST elevation in all leads on ECG. you Dx...
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pericarditis
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Pt presents with a widened mediastinum on xray and describes abrupt onset severe teraring anterior chest pain radiating to back...you Dx...
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aortic dissection
NOT DISSECTING AORTIC ANEURYSM |
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what is a paradoxical emboli
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venous emboli that bypass the lung via a heart shunt and enter the systemic arterial circulation
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Pt presents with transposition of the great arteries. you expect to see what on CXR
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enlarged EGG SHAPE heart
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Pt presents with coarctation of the aorta...you expect what on CXR
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rib notching
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the gene associated with alpha 1 antitrypsin deficiency is on what chromosome
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chromosome 14
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two chemo cancer drugs that start w B that are well known to cause restrictive lung dz
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busulfan, bleomycin
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transufate vs exudate...compare the protein content and LDH content of the fluid
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exudate has high LDH and high protein
transudate not as high |
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A p ANCA positive patient with recurrent asthma attacks comes in and you suspect Churg Strauss. what other finding would help you rule in this allergic angiitis?
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massive eosinophi invasion of lung and blood.
do not forget to assocaite churg strauss with ALLERGY ..thus eosinophilia |
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a young adult smoker presents with spontaneous pneumothorax. you should be considering
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histiocytosis X (eosinophilic granuloma)
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what is a classic xray finding w silicosis
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EGG SHELL calcifications in hilar lymph nodes
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hypersensitivity pneumonitis....this is an allergic problem. strikingly, what do we see on labs
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NO eosinophilia
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both hypersensitivity pneumonitis and sarcoid present with noncaseating granulomas...how can we distinguish from labs?
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sarcoid CD4: CD8 ratio = 2:1-10:1
hypersensitivity pneumonitis CD4:CD8 ratio = <1:2 |
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patient presents with eosinophilic pneumonia...apart from the peripheral eosinophilia and high IGE....you should suspect what on Cxr
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reverse butterfly peripheral infiltrates
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Bx comes back that says "lines of Zahn....alternating red and white stripes" you Dx ....
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DVT
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classic CXR finding in a PE
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hamptons hump - wedge shaped opacification of distal edges of lung fields
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what are kulchitsky cells
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neuroendocrine tumor cells...small, dark blue nests of cells resembling lymphocytes....seen in small cell and bronchial carcinoid tumors
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menstruating woman presents with dyspnea, hemoptysis, and PNEUMOthoraxxx....suspect what
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lymphangioleiomyomatosis
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what are the 4 anterior mediastinal tumors
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thymoma
teratoma terrible lymphoma thyroid tumor |
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pickwickian sydrome
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fat person w daytime sleepiness, probably bc he has sleep apnea.
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cobalt exposure in lungs will show what on micro
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giant cell pneumonitis....giant cells virtually pathonogmonic
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