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227 Cards in this Set
- Front
- Back
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Which virus is responsible for most new annual incidences of STD in the US?
Which virus is responsible for most permanent STD infections in the US? |
Papilloma virus is responsible for the most new cases of STD.
Herpes Simplex virus is responsible for the most ongoing cases of STD. |
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Which strains of HSV are responsible for genital herpes?
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60-70% of infections are d/t HSV-2
30-40% of infections are d/t HSV-1 |
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From initial infection to recurrent infection, please give the pathogenesis of HSV.
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Epithelial cells are initially infected with HSV. After the initial infection, HSV lays dormant in peripheral nerve ganglions (S2-S5) attached to chromosomal DNA. Its reactivation is determined by the metabolic activity of the neuron, if the neuron becomes active, the virus will become active.
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What is the impact of HSV viral miRNA and siRNA?
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miRNA and siRNA are produced by the virus to protect the neuron from apoptosis so it can foster the virus.
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What is the average duration of symptoms and virus shedding an inital infection? What about a recurrent infection?
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In an initial infection, the symptoms will last approximately 12-20 days, but will shed the virus for 12 days.
In a recurrent infection, symptoms will last about 8-12 days, but the virus will shed for 8 days. Second response is shorter because the epithelial cell can fight off the infection faster. |
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What are the TORCH infections?
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Toxoplasma Gondii
Other (whack) Rubella CMV Herpes |
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How can neonates acquire herpes? What are the clinical patterns they present with?
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90% of neonates infected with HSV get it in the birth canal.
Patterns: 1. SEM- skin, eyes, mouth (33% mortality) 2. CNS- encephalitis (50% mortality) 3. Disseminated (85% mortality) |
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What is the gold standard of HSV2 diagnosis?
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Viral culture
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What are the preventative and treatment techniques for HSV?
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Inform partner
Abstinence during an outbreak Condom use Acyclovir- continuous use reduces frequency and duration of symptomatic recurrence of shedding time |
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Why is papillomavirus such a large concern?
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Papilloma viruses are responsible for 95% of malignant cervical (and 70% of anal) carcinomas
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Of the mucocutaneous subtype of HPV, which strains are benign and which are malignant?
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Types 6 and 11 are benign
Types 16 and 18 are malignant |
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What genes in HPV type 16 are responsible for it's malignant potential?
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E6- stimulates telomerase (immortalize cells), inactivates p53 to stop degredation
E7- blocks action of Rb (to keep cell cycle going) |
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What is the significance of HPV gene E2?
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E2 controls the expression of E6 and E7
E2 is disrupted or lost upon integration in the high risk types of HPV(16, 18) so it cannot keep E6 and E7 in check, so they will end up being constitutively expressed |
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How does polymorphic p53 play a role in the oncogeniticy of some HPV strains?
At what stage in the cell cycle does p53 normally act? |
If p53 expresses pro or arg at codon 72, it is 77% more susceptible to type 16/18 E6 induced degradation.
p53 normally inhibits the cell cycle from progressing to S from G1 |
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How do physicians diagnose HPV?
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Cytology- pap smear (microscopic ID of koilocytes)
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What is Gardasil?
What is Cervarix? |
Gardasil is a vaccine against type 6, 11, 16 and 18 of HPV
Cervarix is a vaccine against type 16 and 18 of HPV CDC recommends vaccination of girls 11-12 *** |
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What are the general characteristics of Neisseria gonorrhea?
ie. morphology, oxidase |
Gran negative diplococci, fastideous, oxidase positive
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Gonococcal infections include:
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urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis, epididymitis, PID, arthritis
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Why is Neisseria gonorrhea so virulent?
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Antigenic variation of PILI allows for attachment to specific sites on mucosal surfaces
Lipooligosaccharide (LOS) causes inflammation and tissue damage Outermembrane proteins (OMP) have lots of antigenic variation: OMP I --> porins OMP II --> systemic affects OMP III --> prevents Ab killing of bacteria |
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Does Neisseria gonorrhea have a capsule? Neisseria meningitis?
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Neisseria gonorrhea does NOT have a capsule
Neisseria meningitis DOES have a capsule |
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What broad class of drug treats Neisseria gonorrhea infection?
Is this drug bacteriostatic or bacteriacidal? What is the mechanism of action of these drugs? |
3rd generation cephalosporin (sp Ceftriaxone)
Bacteriacidal B lactams inhibit cell wall synthesis by inhibition of peptidoglycan crosslinking |
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What symptoms would tip a physician off that the patient was infected with Neisseria gonorrhea?
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purulent discharge
dysuria frequency |
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What are the general characteristics of chlamydia?
Please give its life cycle. |
Obligate intracellular parasite
Chlamydia attaches to cells and becomes phagocytized --> avoid lysosomal fusion --> change from nonreplicating elementary bodies to metabolically active reticulate bodies (non infectious) --> replicate and develop into elementary bodies (infectious) --> lyse host cell and initiate new infection life cycle takes 24-48 hours |
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What serotypes of chlamydia trachomatis are responsible for urethritis, reiters syndrome, neonatal conjunctivitis and infant pneumonia?
Which serotypes are responsible for blinding trachoma? Which serotypes are responsible for lymphpgranuloma venereum? |
Serotypes D-K for general STD--> these are the most common serotypes
Serotypes A-C for blinding trachoma Serotypes L1-3 for lymphogranuloma vernerum --> endemic in Caribbean |
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One of the most debilitating outcomes of chlamydia trachomatis is blinding trachoma. How do physicians make this clinical diagnosis?
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Chronic keratoconjunctivitis develops that progresses to conjunctival and corneal scarring and eventual blindness
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What are the DOC for chlamydia?
What are the mechanisms of these drugs? |
Tetracyclines- 30s inhibitors; DO NOT take with milk, antacids or iron containing preparations because divalen cations inhibit absorption in the gut; also remember inhibition of bone growtn , discoloration of teeth and GI distress; photosensitivity; contraindicated in pregnancy
Sulfonamides- PABA antimetabolites inhibit dihydropteroate synthases from making dihydrofolic acid |
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A common complication of chlamydia and gonorrhea infection is PID. Why does this happen?
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Pelvic inflammatory disease occurs in 10-40% of owmen with untreated chlamydial or gonococcal cervicitis due to ECTOPY.
Cervical ectopy is the growth of cervical tissue into the vagina As the woman matures, the ectopy will go away |
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What is lymphogranuloma venereum?
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Disease of chlamydia trachomatis
Ulcer on genitalia --> suppurative inguinal adenitis --> lymphatic obstruction and rectal strictures Commonly presents with buboes Endemic in Carribbean |
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What is the diagnostic criteria for bacterial vaginosis?
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vaginal pH >5: normally pH is <5 and colonized with lactobacilli
thin homogenous vaginal discharge release of amine odor when the vaginal discharge is mixed with 10% KOH Clue cells in gram stain |
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A 34 year old woman presents with malodorous, frothy discharge associated with burning. On microscopy, the discharge is full of flagellated organisms. What is going on?
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Trichomonas vaginalis
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What is the causative agent of syphilis? What are it's characteristics? Which sex is more likely to get syphilis?
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Treponema pallidum
long, thin, helical bacteria rototary motility gran negative wall lack endotoxin MEN are more likely to get syphilis (esp MSM) |
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What are the stages of syphilis?
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Primary- single, painless chancre with a raised border develops 3 weeks after infection at the site where Treponema entered the body; chancre lasts about one month
Secondary- skin rash, skin lesions; 1/3 will cure spontaneously; 2/3 will develop latent syphilis Tertiary- develops in about 15% of latent cases; gummas develop in skin or other tissues, characterized by granuloma formation |
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Patient presents with a soft chancre with purulent edges on his penis. It bleeds easily. Most likely is it a cancroid. What is the causitive agent?
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Haemophilus ducreyi
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Patient presents with a purulent rash oh his stomach, buttocks, armpits and in the webs of his fingers. What is going on? How do you diagnose this?
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Ectoparasites!
Scabies or pubic lice examint hair follicles for nits or adults lice in crabs skin scraping with KOH wet mount for scabies |
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What group of individuals is most frequently poisoned accidently?
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Children 1-2 typically have the highest incidence of accidental poisonings
Majority of cases occur in the home, are unintentional and are managed in non health care settings |
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Patients in altered consciousness are administered a 'coma cocktail'. What is in it and why is each part important?
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1. dextrose- recommended if cause of coma is UNKNOWN, hypoglycemic patients may appear intoxicated
2. thiamine- to treat/prevent precipitating acute Wernicke's encephalopathy; long term alcohol abulse or malnutrition 3. nalOxOne- given when signs, symptoms or history are suggestive of Opiate OD 4. flumaZenil- benZodiazepine antagonist Danielle's Favorite Nightly Treat (Dextrose, Flumazenil, Naloxone, Thiamine) is a cocktail. |
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What is the mechanism of action of syrup of ipecac***? How do ipecac and gastric lavage compare?
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Irritates GI tract and stimulates the chemoreceptor trigger zone --> will normally have 3 vomiting episodes in an hour; the onset of emesis is slow, 20-30 minutes for first episode
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When would you use syrup of ipecac?
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Used most frequently outside of health care facilities.
Used to treat ingestions at home under telephone supervision or physician or poison control center personel Use in alert patients that won't be in a health care facility for an hour or more Ingestion of toxic plants or tablets that won't pass through a large lavage tube Pediatric patients who are too small to have effective lavage Injestion of dangerous compounds such as pesticides |
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What is the efficacy of using activated charcoal for:
caustics and corrosives heavy metals alcohols cyanide aliphatic hydrocarbons laxatives |
Activated charcoal does NOT absorb:
Caustics/corrosives Heavy metals Alcohols and glycols Rapidly absorbed substances Cyanide, chlorine Other insoluble drugs Aliphatic hydrocarbons Laxatives Pesticides, potassium Acids, alkalai, alcohols Iron Lithium Solvents |
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what are some of the complications of induced emesis?
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aspiration
prolonged vomiting (MOST COMMON) vagal induced bradycardia esophageal tearins |
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Emesis or gastric lavage should NOT be used in which situations?
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Vomiting should not be induced in patients:
with altered mental status <6mos old inability to protect airway ingestion of agents causing a rapid change in mental status, convulsants, TCA, CNS stimulants ingestion of acide, alkali, petroleum or sharp objects |
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What substance is most frequently involved in human poisoning? Child poisoning? Most fatalities?
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Most common human poisoning? Analgesics
Child poisoning? Cosmetics/personal care products Most fatalities? Sedatives |
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In the management of an acute poisoning, what are the ABCs?
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Airway- free of vomitus and intubate if necessary to protect airways
Breathing- observation and oxemetery, intubate and mechanically ventilate if not sufficient Circulation- continuously monitor pulse rate, BP, urinary output, peripheral perfusion; start an IV and draw blood for glucose |
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When is emptying the stomach most effective in a poisoning? Why?
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Most effective if done in the first hour after ingestion!!!
Most of the drugs will hit and go beyong the Cmax after an hour |
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What are some of the problems with gastric lavage?
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ASPIRATION
ESOPHAGEAL PERFORATION INTRATRACHEAL INSERTION |
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When is hemodialysis indicated for the management of acute poisoning?
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Use hemodialysis to hasten elimination --> used for SEVERE poisoning
Not useful for drugs with a large Vd Useful for methanol, salicylates, ethylene glycol and lithium |
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When is peritoneal dialysis indicated for the management of acute poisoning?
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Phenobarbital
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What are some major risk factors for breast cancer?
*these deal with periods* |
Early menarche (before 12)
Late menopause (after 55) No pregnancies or first pregnancy after 30 All three give a string of uninterrupted menstrual cycles |
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Only 10% of breast cancers are associated with family history. Which relative gives the greatest risk?
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Sister with positive breast cancer --> 2.5x more likely
Mother with positive breast cancer --> 1.8x more likely Mother and sister positive for breast cancer --> 5.6x more likely |
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What is the most common type of breast mass?
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Benign cysts- cyclic hormonal stimulation, round to elliptical, freely mobile, no dimpling or retraction, may be tender premenstrual
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Woman presents because she has felt a mass in her breast. She tells you that her husband thinks it is all in her head because two months ago, she felt the mass and then it disappeared once she finished her cycle. The same thing happened this month. What is going on?
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Benign cyst- cyclic hormonal stimulation
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Woman presents with a nontender, freely mobile, round breast mass. You note no dimpling or fixation. What most likely is your diagnosis?
What if the mass was tender? |
Fibroadenoma- usually nontender
Benign cyst- may be tender with premenstrually |
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What are the classic physical signs of breast cancer?
Where are most breast cancers found? |
irregular in contour
firm to hard consistency not well delineated from surrounding tissue nontender fixation (infiltration into posterior chest wall) retraction dimpling 50% of breast cancers are found in lateral upper breast quadrant (tail of spence) |
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Where does most of the lymph drain in the breast?
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Drains into axilla
Half drains into axillary lymph nodes, half drains into sentinel lymph nodes |
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What is TNM? Why is it important?
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T: size of primary tumor
N: involvement of lymph nodes M: metastasis |
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Some women may opt to conserve their breast as much as possible an just get a lumpectomy. What are some contraindications to breast conservaiton therapy?
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pregnancy
skin connective tissue disorder previous XRT to breast breast is too small or large multicentric disease * |
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Generally describe the following breast cancer treatments:
Surgery Radiation Chemotherapy Hormone therapy Biologic therapy |
Surgery: remove/debulk
Radiation: target cell DNA (daily therapy for 6-7 weeks, all women with breast preservation therapy must get this) Chemo: toxins to kill rapidly dividing cells Hormone therapy: interfering with the tumor's access to hormones needed to grow and thrive Biologic therapies: specific targeted antibodies |
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What are the uses of Tamoxifen and Raloxifene?
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Tamoxifen is a SERM used to treat breast cancer. Comes with significant increase in risk of endometrial cancer. Breast antagonist, Bone agonist, Endometrial agonist
Raloxifene- breast antagonist, endometrial antagonist, bone agonist |
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A recent breast cancer survivor presents to your office asking about the risk of the disease recurring. What do you tell her?
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Recurrence risk is related to extent of disease, tumor size and nodal involvement. May recur 20-40 years after initial diagnosis.
Risk of second primary malignancy: 7-8% chance in contralateral breast, slight increased risk of colon and ovarian cancer risk |
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Breast cancer survivors must follow a strict regimen of followup care. Please describe it?
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H&P every three months for three years
H&P every 6-12 months for 2 years Yearly Mammogram yearly |
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What is the breast cancer risk associated with BRCA1 and 2?
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BRCA1: 50% risk by 70
BRCA2: 37% risk by 70 |
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What is meant by posterior acoustic shadowing?
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Sound beam is stopped, forming a shadow
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Know the densities in an US:
Bone/calcium Water Soft Tissue Fat Air |
Bone/calcium- white (echogenic)
Water- black (sonolucent) Soft Tissues- shades of gray Fat- white (echogenic) Air- very poor conductor of US waves, limiting factor |
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What is the most accurate measurement of fetal age up to 12 weeks?
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Crown Rump Length
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Nuchal translucency on a fetal ultrasound is indicative of what?
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Potential congenital anomaly
Should be less than 3mm, if it is too thick --> think Down's Nuchal translucency is the first indicator of a congenital abnormality |
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What is the most common uterine mass? How would the patient present? What population are you most likely to see it in?
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Myoma (fibroids)- may be solitary or multiple
Patients present with vaginal bleeding, pelvic pain or pelvic fullness More common in African American women |
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What is the most common ovarian tumor?
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DERMOID cyst
(mature teratomas) |
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What are the houndsfield units of:
bone air fluid |
Bone is 1000
Air is -1000 Fluid is 1-20 |
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The double decidual sac sign/'pseudo-sac' is indicative of...
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Ectopic pregnancy
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What are the signs of an ectopic pregnancy in both the lab and radiologically?
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intrauterine 'pseudo-sac'
adnexal mass cul de sac or adnexal blood or fluid bHCG increase more than normal |
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Nuchal translucency seen at 12-14 weeks is a marker for:
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Downs, Edwards, Patau, Turners, various cardiac defects
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At what week is the gestational sac identified?
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as early as 4.5 weeks
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What is meant by a marginal placenta previa?
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Placenta partially overlaps the internal cervical os
A cause for antepartem hemorrhage (before birth) May necessitate a C-section |
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How will a benign and malignant breast lesion on an ultrasound compare?
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Malignant will be taller than wide, dense, shadowing and irregular borders
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Computer Aided Detection (CAD) can improve accuracy of breast imaging 10-15%. What is it detecting?
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Asymmetric densities and calcifications
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Oligomenorrhea is defined as:
Hypermenorrhea is defined as: |
Oligomenorrhea is a cycle lasting more than 35 days
Hypermenorrhea is a cycle lasting less than 21 days |
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What is the number one cause of oligomenorrhea? What is oligomenorrhea?
What are some other causes? |
Oligomenorrhea is a cycle lasting more than 35 days
The number one cause of oligomenorrhea is anovulation Can also be caused by hypothyroidism, prolactinoma, obesity, PCOS, anorexia |
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What is polycystic ovarian syndrome (levels of LH, FSH, testosterone and estrogen)? Will it cause hypermoenorrhea or oligomenorrhea?
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While the exact cause of PCOS is unknown, it presents with high LH, low FSH, high testosterone and high estrogen causing the following symptomatology:
obesity, acne, INSULIN RESISTANCE, hirsuitism, anovulation (resulting in irregular menstruation) or amenorrhea/oligomenorrhea, , and excessive amounts or effects of androgenic (masculinizing) hormones. A typical patient with PCOS will present with infertility, will be obese, have hirsuitism and complain of irregular periods. |
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A woman comes in complaining of irregular menstrual cycles. On ultrasound you notice a rosary bead pattern on the surface of her ovaries. What is going on?
What other symptoms would you expect her to have? How would we treat her? |
PCOS- follicles become arrested at the ovarian surface
PCOS patients typically present with obesity, acne, hirsuitism, insuling resistance and infertility. 1. oral contraceptives- increase SHBG to decrease the amount of free testosterone and improve acne, hair growth; also causes normalization of periods --> uterus is emptied monthly and the risk of endometrial cancer is reduced |
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What is the most concerning sequelae of polycystic ovarian syndrome?
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If the patient is not having menstrual cycles, the endrometrium can overgrow --> increased risk of endometrial cancer
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What is the difference between dysfunctional uterine bleeding and abnormal uterine bleeding?
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Dysfunctional uterine bleeding is due to a physiological dysfunction, like anovulation
Abnormal uterine bleeding is due to an anatomical abnormality, like fibroids (this is the most common reason) |
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Is hypermenorrhea due to an anatomical abnormality or a physiological dysfunction?
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Hypermenorrhea (cycles shorter than 21 days) is usually due to an anatomical abnormality
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What are the treatment options for abnormal and dysfunctional uterine bleeding?
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oral contraceptives, cyclic progestins, continuous progesting (depo, mirena)
**If the bleeding is due to an anatomic cause (ie ABNORMAL uterine bleeding), it won't respond |
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What is Asherman's syndrome?
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Amenorrhea, uterine synechiae (scarring) and infertility
Occurs most frequently after a D&C is performed on a recently pregnant uterus, following a missed or incomplete miscarriage, birth, or elective termination (abortion) to remove retained products of conception |
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What is the definition of an ectopic pregnancy?
How often does it occur? Where is the most common location? |
Pregnancy outside the uterine corpus
Occurs in 20 per 1000 pregnancies Most common site of implantation is in the ampulla of the fallopian tube (80%) |
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What surgical routes can be used to treat an ectopic pregnancy in a hemodynamically stable patient? An unstable patient?
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Stable patient- laparoscopy
Unstable patient- laparotomy |
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What are some of the criteria that must be met to safely administer methotrexate? What is methotrexate used for?
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Methotrexate is the only medical management for an ectopic pregnancy
Used in healthy, hemodynamically stable, compliant patients; no evidence of rupture; no fetal cardiac activity; high bHCG; D and C fail to show chorionic vili |
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What are some of the risk factors of ectopic pregnancy?
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PRIOR ECTOPIC PREGNANCY
PID tubal ligation IUD |
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Which labs would indicate a possible ectopic pregnancy?
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hCG would double every two days up to 10 weeks!
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What is the pharmacological management of an ectopic pregnancy? What is the mechanism of action of this drug?
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METHOTREXAXTE: folic acid inhibitor --> interferes with DNA synthesis
Methotrexate stops progression of the pregnancy, allows the body to resorb it and preserves teh tubes |
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At what time would you consider performing a salpingectomy on a patient with an ectopic pregnancy?
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If the woman has a second ectopic pregnancy in the same tube, the tube must come out. After 1 ectopic, there is a 12% risk of a subsequent ectopic and a 10 fold increase after 2 ectopics.
Also consider if childbearing is completed, there is uncontrolled bleeding or there is severe tubal damage |
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What is the definition of endometriosis?
How would a patient with endometriosis present typically? |
Endometriosis is misplaced endometrial tissue.
Patient would present with dysmenorrhea (pain is worse with cycles), menorrhagia (abnormally heavy or prolonged menstrual cycles at regular intervals), dyspareunia (esp with a deep thrust), infertility |
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What is the overall goal of treatment of endometriosis?
What is the absolute curative treatment of endometriosis? |
Anovulation --> if nothing ovulates the uterus will not need to keep up a lining
Total hysterectomy with bilateral salpingoophorectomy cures |
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Which diagnostic modalities can rule out endometriosis?
** |
Laparoscopic proven with or without biopsies
Will also respond to depo lupron |
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What are leiomyomata?
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Commonly known as fibroids, they are smooth muscle tumors
Most common female tumor |
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If radiological studies showed 'powder burns' or a 'ground glass' appearance, what disease process is at the top of your differential?
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ENDOMETRIOSIS
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What is Depo lupron? What can it be used for?
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GnRH antagonist when used in a continuous fashion--> therefore no stimulation of FSH so no endometrium proliferation --> used for endometriosis
GnRH agonist when used in a pulsatile fashion --> tx infertility |
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What laparoscopic findings would you expect in a patient with endometriosis?
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Chocolate cysts
Powder burns Ground glass appearance Adhesions |
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How would a woman with uterine fibroids typically present?
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Dysmenorrhea
Back pain Urinary frequency Heavy menses |
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There are several treatments for uterine fibroids including:
Myomectomy Uterine Artery Embolization Hysterectomy Depo lupron Please describe |
Myomectomy: removal of fibroid only; good for those who want to continue child bearing --> THESE PATIENTS MUST HAVE C-SECTIONS FROM THEN ON *****
Uterine Artery Embolization: find the vessel that feeds the fibroid and plug it up! (not good for those who still want to get pregnant --> essentially cutting off the blood supply to the uterus) Hysterectomy: fibroids are the most common cause of hysterectomy Depo lupron- GnRH agonist, estrogen feeds fibroids and causes growth; this shrinks them (remember** leuprolide is a GnRH agonist when used in a pulsatile fashion) |
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What is the most common indication for a hysterectomy?
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The most common indication for a hysterectomy is a symptomatic fibroid uterus.
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Define:
Total hysterectomy Subtotal hysterectomy Radical hysterectomy Bilateral salpingoopherectomy |
Total hysterectomy: removal of the uterus and cervix
Subtotal hysterectomy: removal of the uterus Radical hysterectomy: removal of uterus, cervix, parametrium and uterosacral ligaments Bilateral salpingoopherectomy: removal of both tubes and both ovaries |
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What are some complications of a hysterectomy?
What type of hysterectomy minimizes these complications? |
Bleeding
Infection Damage to bowel, bladder, ureter, blood vessels Death All of these risks are much greater with TAH than TVH |
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What is a radical hysterectomy and when would it be performed?
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A radical hysterectomy is the removal of the uterus, cervix, parametrium and uterosacral ligaments
Common with cervical cancer and stage IIB parametrial involvement (IIB needs to be irradiated) |
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A woman with a large, LARGE uterus come in with symptomatic fibroids. What do you need to do?
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Fibroids are the most common indication for a hysterectomy.
Consider Depo Lupron preoperatively for three months to shrink the uterus |
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What is the difference between true menopause and perimenopause?
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True menopause is the cessation of menses for one year
Perimenopause is the period immediately before and after true menopause |
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What symptoms usually accompany menopause?
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Vasomotor instability- hot flashes
Atrophy- dyspareunia, pruitis, urinary difficulties, incontinence Psychological issues |
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Hormone replacement therapy is frequently utilized in menopause. What are the risks and benefits of HRT (specifically estrogen and progesterone)?
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Estrogen- shown to decrease weight gain, prevents loss of collagen, treats GU atrophy, treats hot flashes and hypothesized to inhibit PTH (stop osteoporosis)
Progesterone- prevents endometrial hyperplasia --> helps prevent endometrial cancer |
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At what age does the average woman start menopause?
How does smoking factor into the onset of menopause? |
The mean age is 51-52 years old
Smoking decreases the age of onset by 2 years |
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What physiologic alterations accompany menopause?
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Body mass increases after menopause (most women gain 2.2 pounds/year after menopause)
Skin- decreased collagen leading to thinning and wrinkling GI Tract- decreased collagen in the uterosacral and cardinal ligmants leading to pelvic organ prolapse Osteoporosis- bone loss at a rate of 1-2%/year (bone resorption increases while rate of formation is unchanged) |
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Beth is a 23 year old woman who presents to your office because she is concerned about her family history of breast cancer. Her mother was diagnosed with breast cancer at age 37. When should Beth start getting mammograms?
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Age 27
You want to start giving her mammograms ten years earlier than the age at diagnosis or ag age 25, whichever is older Note- most women get yearly mammograms after 40 |
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What test is used to determine bone density? At what age should this test begin? How is this test run?
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DEXA
Begin at age 65 for women with no risk factors Begin at age 60 for women with risk factors Measured at the spine and femoral neck Score between -1 and -2.5 indicates osteopenia Score less than -2.5 indicates osteoporosis |
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What is a laparoscopy? What is it indicated in?
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Laparoscopy is an operation preformed in the abdomen or pelvis through small incisions with the aid of a camera. It can be used to diagnose uterine pathology or to perform surgery.
Used in: Sterilization Endometriosis Hysterectomy Ectopic pregnancy |
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What is a hysteroscopy? What is it indicated in?
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A hysteroscopy is the direct visualization of the endometrial cavity using an endoscope and a light (access through the cervix). It can be used to diagnose uterine pathology or to perform surgery.
Indicated in: repetitive abnormal bleeding recurrent pregnancy loss removal of IUD sterilization |
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What is the difference between an open and closed laparoscopy?
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Open laparoscopy is an open dissection and Hassan trocar (guide funnel)
Closed laparoscopy is using a veres needle and optical ports Neither is superior over the other |
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What distention media is normally used in a hysteroscopy?
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Crystalloids
D5 water Hyskon (dextran) Mannitol CO2 I think if he asks one, it will be CO2 |
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What sterilization options are available for laproscopy?
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YOON
Filshie clips Cautery These are all pretty similar to Essure |
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What sterilization options are available for hysteroscopy?
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Essure
Inserts are placed into the fallopian tubes by a catheter passed from the vagina through the cervix and uterus. The insert contains inner polyethylene terephthalate fibers to induce benign fibrotic reaction and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil (1). Once in place, the device is designed to elicit tissue growth in and around the insert to form over a period of three months an occlusion or blockage in the fallopian tubes; the tissue barrier formed prevents sperm from reaching an egg. |
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When must a hysterosalpingogram be performed after an Essure?
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FDA requires 3 month post op HSG to confirm tubal blockage
Patients must use another method of birth control as back up contraception for three months |
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What are some risk factors for pelvic floor collapse?
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Multiparity and birth trauma
advanced age estrogen deficiency |
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Which muscles/ligaments support the pelvic floor?
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Uterosacral ligaments
Cardinal ligaments Levator Ani muscles Endopelvic fascia |
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A 57 year old G3P3003 female comes into your office complaining of urinary incontinence, pelvic fullness and the feeling of 'sitting on a lump'. She states that the only time she does not have these symptoms is when she is laying down. She wants to find out what is going on because she and her husband have a half marathon coming up and the pelvic pressure is making it difficult for her to run. What is going on and how would you treat this?
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Uterine prolapse: descent of the uterus and cervix down the vaginal canal; usually d/t injury to the endopelvic fascia and relaxation of the musculature of the pelvic floor
Menopause, mulitparity and loss or estrogen increase intra abdominal pressure Symptom relief when lying down Surgical treatments include mesh augumentation, sacrospinous ligament fixation and abdominal sacrocolpopexy Abdominal sacrocolpopexy is attaching the vagina to the sacrum --> REMEMBER: if a patient has severe prolapse and they are active, this is the best long term treatment *** |
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A 58 year old woman comes in because she has noticed that when she laughs or sneezes, she sometimes urinates. What type of incontinence is this? How would you work it up?
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Stress incontinence
Q tip test- elevation more than 30 degrees is indicative of a hypermobile urethra --> incontinence |
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Please define:
Cystocele Cystourethrocele Uterine prolapse Rectocele Enterocele |
Cystocele- downward displacement of bladder
Cystourethrocele- cystocele that includes the urethra Uterine prolapse- descent of the uterus and cervix into the vaginal canal toward the vaginal introitus Rectocele- protrusion of the rectum into the posterior vaginal lumen Enterocele- herniation of the small bowel into the vaginal lumen |
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What is the most common presentation of uterine prolapse?
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feeling of PRESSURE
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At what trimester is miscarriage the greatest risk?
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First Trimester
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When should nuchal translucency be measured and what does it indicate?
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Nuchal translucency should be measured at 10-13 weeks
Back of babies neck should be a certain thickness, if it is too thick --> increased risk of Down's Syndrome |
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What is chorionic villus sampling?
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Best done after 10 weeks
Transvaginal approach using spiral needle and ultrasound Samples developing placenta rather than penetrating amniotic membrane |
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What is the triple screen? When is it collected? What is its rate of Down's detection?
How does this differ from the quadruple screen? |
AFP, bHCG, estriol
60-70% detection of Downs Collection at 15-22 weeks The quadruple screen adds inhibin A --> improves detection rate of Down's to 82% |
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Elevated HCG indicates...
Elevated AFP indicates... Low HCG indicates... Low AFP indicates... Low estriol indicates... *** |
Elevated HCG indicates DOWNS
Elevated AFP indicates ONTD Low HCG indicates TRISOMY 18 Low AFP indicates TRISOMY 18 OR DOWNS Low estriol indicates TRISOMY 18 |
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What is an amniocentesis? What risks are involved?
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An amniocentesis is a transabdominal sampling of amniotic fluid using a spinal needle and and ultrasound
1:270 risk of abortion limb deformities |
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What is the most common defect in Down's syndrome?
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Cardiac defects --> particularly VSD
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The buzzwords: growth restriction, cardiac defects, double bubble, are indicative of what anomaly?
The buzzwords: lemon sign, banana sign, are indicative of what anomaly? |
Down's
ONTD |
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Prenatal diabetes screens are typically down at 24-28 weeks. Why?
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At this point, the placenta is at its peak mass and human placental lactogens are secreted at a maximal rate.
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What is the mechanism of carbon monoxide poisoning?
How would the patient typically present? What is the treatment? |
Carbon monoxide reversibly binds to Fe2+ of heme with an affinity 200x greater than that of oxygen --> direct myoglobin binding and muscle cell toxicity, cerebral dilation causing syncope, increased NO activity causing syncope
CNS and heart are most sensitive, fainting is most common because the tissue hypoxia causes vasodilation and the heart can't adequately compensate Treatment is to give 100% O2 |
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What is the mechanism of cyanide poisoning?
How would the patient typically present? What is the treatment? |
CN affects virtually all body tissues by binding to Fe3+ --> prevents reduction fo Fe2+ involved in cytochrome oxdase ETC (specifically complex IV) --> the tissues can't generate ATP even though there is plenty of O2 available in the blood --> cells must use anaerobic metabolism for energy --> metabolic acidosis
The patient would present in METABOLIC ACIDOSIS (d/t anaerobic), histotoxic hypoxia (tissue O2 is normal), hyperpnea, gasping, collape, convuslsions **inhalation kills you within minutes Standard treatment is immediate: 1. Sodium nitrite (IV) to pull CN out of the cells and promotes the formation of methemoglobin to detox CN to cyanmethemoglobin (which acts as a CN competitor) 2. Sodium thiosulfate (IV) to facilitate the natural rhodanase catalyzed conversion of cyanide to thiocyanate (which can be excreted) |
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Why would you expect to see hypernea with cyanide poisoning, but not with carbon monoxide poisoning?
What does CO bind to? CN? |
Carbon monoxide does NOT cause hyperpnea because the chemoreceptors are not activated until pO2 decreases to 1/2 normal; CO is potent and produces its effects before pO2 has a chance to decrease
CN causes hyperpnea due to its direct stimulation of AORTIC and CAROTID chemoreceptors CO binds to Fe2+ CN binds to Fe3+ |
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What is the relationship between O2 and CO?
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O2 is a competitive antagonist to CO
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Organophosphates and Carbamates are both toxic to humans. What are their mechanisms? Of the two, which is more toxic?
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OP: poisoning is common, but death is rare; well absorbed through skin, GI and respiratory tract; Cholinesterase inhibitors
Carbamate inhibits acetylcholinesterase by carbamoylation --> similar effects to OP, but effects are less severe because carbamoylation is rapidly reversible **remember, praladoxime works for OP, but NOT for carbamates |
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How would a patient with acute organophosphate posoning present? How would you treat them?
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DUMBBELSS
Diarrhea, urination, miosis, bradycardia, bronchospasm, excitation of skeletal muscle, lacrimation, sweating, salivation Atropine to block muscarinic effects... you give this til their respiratory secretions are controlled Pralidoxime (2PAM)- reactivates acetylcholine esterase before aging process occurs (aging refers to a further chemical reaction of the inhibited enzymes) |
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Please describe the delayed toxicity associated with paraquat ingestion. What is the mechanism? Why is prompt GI removal essential?
** |
Paraquat is one of the most widely used herbicides in the world. Poisoning is uncommon, but death is likely --> once paraquat is absorbed, 50% chance of death ***
Accumulates slowly in lungs (regardless of route of exposure); after oral exposure --> GI irritation Later, there is delayed toxicity (weeks) of respiratory distress --> fibrosis of lungs, pulmonary hemorrhage There is no specific treatment. Prompt removal from GI tract is CRITICAL --> gastric lavage is life saving |
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What is a common additive of rodenticides? How would you treat human intoxication?
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Warfarin
Antagonizes action of vitamin K --> induces bleeding Treat with vitamin K |
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This rodenticide completitively blocks glycine inhibition of neurons --> continuous excitation of CNS neurons
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Strychnine
Opisthotinus --> spasm in which head and heels arch backward in extreme hyperextension |
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What is the major risk associated with the ingestion of kerosene? Why do we need to used an endotracheal tube in the gastric lavage of kerosene?
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Exposure is usually associated with pulmonary aspiration, so we must protect the airway! Lungs have a large surface area --> oil floats and will coat the surface of the lungs, mess up surfactant and prevent proper O2 exchange --> pulmonary aspiration can result in chemical pneumonitis
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What are the primary symptoms associated with lead poisoning? How do the symptoms differ in a child and adult?
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Lead encephalophaty (more seen in kids) --> clumsiness, vertigo, ataxia, progressive central neuropathy
GI effects (more seen in adults) --> constipation, gingival lead lines, colic Hematological--> basophilic stippling, inhibits heme formation by inhibiting ALA CNS effects of children are more pronounced because lead can cross their BBB |
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How do we diagnose lead poisoning? What is the treatment?
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The main diagnostic test is the elevation of ALA (aminolevulinic acid dehydratase) in the urine --> inhibits heme formation --> RBCs will be more fragile --> basophilic stippling and anemia
Blood lead level used to diagnose lead tox and it determines the actions to be taken Treatment is chelation therapy with EDTA!! |
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How does lead poisoning result in anemia?
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Lead binds to hemoglobin in erythrocytes --> inhibits heme formation by inhibiting aminolevulnic acid dehydratase (ALA) and inhibiting ferrochelatase --> RBC more fragile --> HYPOCHROMIC MICROCYTIC anemia
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Which symptoms are associated with acute and chronic arsenic toxicity?
Where does the most arsenic concentrate? How would you treat this? |
Arsenic is widely distributed, but concentrates highest in hair and nails
Acute- NV (projectile), capillary leakage, rice water stools (what else does this?!), CV effects, BMD, convulsions Chronic- less pronounced GI effects, hyperpigmentation of palms and soles***, Mee's lines***, stocking and glove peripheral neuropathy *** Inorganic arsenic poisoning is treated by emptying the stomach and chelation therapy (dimercaprol) Organic arsenic poisoning, no specific antidotes. zoos zoos. |
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Which symptoms are associated with acute and chronic inorganic and organic mercury toxicity?
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Acute organic mercury poisoning- pulmonary toxicity, NV, gingivostomatitis, twitching
Chronic organic mercury vapor poisoning --> CLASSIC TRIAD --> neuropsychiatric disorders, tremors, gingivostomatitis (think of Mad Hatter syndrome) Acute inorganic mercury- ashen gray mucous membranes secondary to precipitation of mercuric salts, hemorrhagic gastroenteritis Chronic inorganic mercury- ACRODYNIA |
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Which symptoms are associated with acute and chronic iron toxicity?
List the four stages. How would you treat this? |
One of the leading causes of fatality in children --> cell death d/t peroxidation of membrane lipids
Acute- gastric bleeding Chronic- metabolic acidosis, scarring leading to GI obstruction I- GI irritation, NV, drowsiness II- apparent recovery III- multiorgan failure, metabolic acidosis, hepatic necrosis, ATN, CV collapse IV- delayed effects of obstruction and scarring Tx- empty the stomach and chelate with DEFEROXAMINE |
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How does EDTA work? What is it used to treat?
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Lead displaces calcium from EDTA --> removes ions from solution --> prevents tox and enhances secretion
Primarily used to treat LEAD poisoning |
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How does dimercaprol work? What is it used to treat?
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Metal complexes with the toxin --> removes ion from solution --> prevents tox and enhances excretion
Primarily used to treat LEAD, ARSENIC or MERCURY (**succimer treats these too) |
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How does Succimer work?
What is it used to treat? |
Orally effective chelator
Approved for use in children Primarily used to treat LEAD, ARSENIC or MERCURY (**dimercaprol treats these too) |
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How does penicillamine work? What is it used to treat?
|
Orally effective chelator
Primarily used to treat COPPER and MERCURY, Wilsons disease |
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What is deferoxaimne used to treat?
|
specific iron chelating agent
adverse effect? turns your pee pee red :( |
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What are the indications and contraindications of OMT during pregnancy?
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Indications: gravitational stresses (increased lumbar lordosis), lymphatic congestion, venous congestion (headaches), viscerosomatic reflex
Contraindications: labor |
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At what spinal levels would you expect to palpate a tissue texture change for an ovarian problem?
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T9-T10
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At what spinal levels would you expect to palpate a tissue texture change for a uterine problem?
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T10-T11
Sympathetics carried by lumbar splanchnics Parasympathetics carried by pelvic splanchnics |
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What normal curvature is exacerbated in pregnancy?
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Carrying an anterior load increases lumbar lordosis --> puts tension on the ligaments, especially the ligaments around the lumbar facets
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How does the anterior carry of pregnancy affect the lymphatic and venous drainage?
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Vascular elements are passing through the diaphragm --> impairment of flow --> slow down the return of lymph or blood back to the heart --> pedal edema
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Why might a pregnant woman present with 'bumps or potholes' on a rib examination?
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big ol boobies floppin around --> pull on thoracic cate --> thoracic somatic dysfunction and rib problems
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If a woman is post menopausal, where would we expect to palpate the uterus?
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Below the level of the pubes
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Which phase of the menstrual cycle is responsible for the variability in time?
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The follicular phase
**remember, estrogen dominates the follicular phase --> stimlates endometrium to grow |
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What is an ASCUS report? What would be your next move?
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Atypical Squamous Cells of Undetermined Significance
Abnormal PAP Test to determine HPV status |
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A woman recieves a pathology report of Bi-Rads Category Four. What do you recommend?
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Bi-Rads Category IV
Mammogram results are often expressed in terms of the BI-RADS Assessment Category, often called a "BI-RADS score." The categories range from 0 (Incomplete) to 6 (Known biopsy – proven malignancy). Mammograms are scored on a scale from 1-5 (1 = normal, 2 = benign, 3 = indeterminate, 4 = suspicious of malignancy, 5 = malignant) Stereotactic biopsy is recommended ** in the absence of a palpable mass, get a radiographic localization of the lesion |
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What are the five common causes of dysmenorrhea?
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endometriosis
PCOS cervicitis adenomyosis fibroids |
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23 year old female presents to the clinic with vaginal discharge, burning and itching. The exudate is green and bubbly. The vaginal mucosa is hyperemic. Microbiology shows parasites with jerky motility.
What is the infective organism? How would you treat it? |
Trichomonas vaginalis
Treat wtih oral metronidazole WITH SIMULTANEOUS TREATMENT OF SEXUAL PARTNERS |
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What type of organism is trichomonas vaginalis?
|
Parasites wtih 3-5 flagella on the side, an undulating membrane and a single nucleus.
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What are the clinical manifestations of Trichomonas vaginalis in women?
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yellow/green discharge
vulvar itching and burning dyspareunia solpitis macularis (STRAWBERRY CERVIX) |
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Why is accessory axillary breast tissue a concern?
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Accessory axillary breast tissue is the expansion of the normal ductal system into the subcutaneous tissue of the chest wall or the axillary tail of Spence --> the expansion can give rise to carcinomas outside the breast proper
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What is acute mastitis? What pathogen is normally responsible?
|
Acute mastitis is inflammation of the breast related to nursing and lactation
S.aureus is the most common pathogen |
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A 34 year old woman presents to your office with an areolar mass. She has a history positive for smoking.
A 34 year old woman presents to your office with an areolar mass. She does NOT have a history of smoking. |
Areolar mass --> periductal mastitis or mammary duct ectasia
Positive smoking history --> most likely periductal mastitis Negative smoking history --> mammary duct ectasia Think Mammary: Mom wouldn't want you to smoke, so you don't!! |
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What is fat necrosis of the breast? What is the major clinical significance?
|
Painless palpable mass with skin thickening and retraction
Usually d/t trauma Biggest problem is that it looks a lot like CA |
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Cystic change, fibrosis and adenosis are the three principle morphologies associated with fibrocystic changes of the breast. Where do these changes usually occur and in what population?
|
common in 20-50 year olds
usually in the upper outer quadrant often bilateral, multiple nodes, menstrual variation, cyclic pain and engorgement |
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What is the most common benign breast tumor? Please describe it.
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Fibroadenoma- normally in women around 35 (FA says less than 25, oh well); increase size and tenderness with estrogen
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Patient presents with a 3 week history of bloody nipple discharge. What are you thinking? Is she at a higher risk of breast carcinoma?
|
Intraductal papilloma
slight (1.5-2x) increase risk for breast cancer |
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What is a phyllodes tumor?
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Large, bulky mass of CT and cysts in 'leaf like' projections --> normally in women over 50
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Mammograms are sometimes helpful in detecting breast cancers. Which breast cancer is it NOT helpful in detecting: DCIS or LCIS?
|
Lobar Carcinoma in situ is always an incidental biopsy finding since it is not associated with calcifications or stroma reactions that produce mammographic densities
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What are the risks of cervical intraepithelial neoplasia?
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Early sexual intercourse, multiple partners, smoking, STD, HPV types 16, 18
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What are the differences between CIN I, II, III?
|
Cervical Intraepithelial Neoplasia I: kiolocytotic atypia, pronounced in the basal 1/3
CIN II: pronounced in lower 2/3 of epithelium (although cytodifferentiation occurs in the upper third of the epithelium, it is less pronounced than in CIN I CIN III: diffuse atypia with loss of maturation, neoplastic cells are present throughout entire epithelium |
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What is the most common pattern of Invasive Squamous Cell Cervical Carcinoma?
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FUNGATING
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Adenocarcinoma only accounts for 5-15% of invasive cervical carcionomas. What population is it most prevalent in and what is the prognosis?
|
Higher percentage in Jewish women
Overall prognosis is less favorable than SCC |
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What is the normal causative agent of suppurative salpingitis? What is the morphology of this agent?
|
Gonococcus (Neisseria gonorrhea)
Gram negative diplococci |
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What is tuberculous salpingitis? What population would you expect to find this in?
|
Infection of the fallopian tubes caused by TB
Not seen in US, but common cause of infertility in areas of the world where TB is prevalent |
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What tumor marker is associated with ovarian carcinomas?
|
CA 125
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How would a granulosa thecal cell tumor present in a:
child woman of reproductive age post menopausal woman |
Granulosa theca cell tumors are estrogen producing tumors
child --> precocious puberty reproductive age --> irregular menses post menopausal --> vaginal bleeding |
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What is a Bartholin Cyst?
|
Secondary with obstruction of the duct --> treat with excision
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What is a Gartner Duct Cyst?
|
Common lesions along lateral walls of vagina and derived from wolffian (mesonephric) duct rests
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What virus is associated wtih condyloma acuminatus? How would this present?
|
HPV types 6, 11
Warts on perineal, vulvular and perianal regions Microscopically- would see proliferation of stratified squamous epithelium, acanthosis, hyperkeratosis, nuclear atypia in surface cells ** |
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How does bacterial vaginosis present? Most common causative organism?
|
Gardnerella vaginalis
Patient presents with thin, green/gray malodorous discharge |
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How would candidiasis present?
|
Yeasts are part of many women's normal flora and the development of candidiasis is typically a result of a disturbance in the vaginal microbial ecosystem
Diabetes, ABX, pregnancy and compromised immunity are permissive to infection Marked by pruritus, erythma, swelling and curdlike vaginal discharge |
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Please explain the multi hit model of cancer?
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In the multi hit model, multiple genes must be mutated.
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What is the difference between oncogenes and tumor suppressors? Please give some examples of each?
|
Oncogenes --> gain of function mutation --> promotes cell cycle; Ras, Raf...
Tumor suppressor --> loss of function mutation --> cannot inhibit cell cycle; p53, Retinoblastoma |
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Which model is specific for Retinoblastoma. Please explain the model.
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The two hit model --> both Rb alleles must be mutated
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Where do p53 and Retinoblastoma regulate?
|
Both control G1 --> S transition
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What protein is directly involved in detachment in metastasis?
|
E cadherin loss of function mutations are very common in metastatic cells
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What translocation is seen in chronic myelogenous leukemia?
|
9;22 Philadelphia chromosome
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What translocation is seen in Burkitts Lymphoma?
|
8;14
myc gene |
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What is chromosomal instability syndrome?
|
Chromosome instability syndromes are a group of inherited conditions associated with chromosomal instability and breakage. They often lead to an increased tendency to develop certain types of malignancies.
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What is the mutation in PKU? This will cause a build up and deficiency of what?
|
Loss of function mutation in phenylalanine hydroxylase (PAH)
Phenylalanine --PAH--> Tyrosine Build up of toxic phenylalanine by products and a deficiency in tyrosine (** problem because tyrosine makes tons of the neurotransmitters --> mental retardation) |
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How is PKU inherited?
|
Autosomal recessive
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How does one test for PKU?
|
Guthrie test
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A child with diagnosed PKU should be on what type of diet?
|
Restriction in meat, chicken, fish, nuts, cheese, dairy products, potatoes, bread, pasta, corn, diet foods with sweetener aspartame
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What would you expect the values on a triple screen to show in a fetus with Edwards Syndrome?
|
Low hCG
Low AFP Low estriol |
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|
The most common location for invasive SCC of the vagina is...
|
Labia Majora
|
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What imaging modality is used to evaluate a testicular torsion?
|
US
If it does not show a torsion, start thinking epididymitis |
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What is the significance of taking an abdominal circumference in late pregnancy?
|
Reflects fetal size over age
|
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|
How many women will have to come back in post mammography to get additional views?
|
10%, this is a concern for women because they will think they have cancer, when in reality, they just need more pictures.
1% of those who come back will need a biopsy Only 25% of those biopsied will actually have cancer |
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A 48 year old woman presents to you office because she noticed a lump on her regular self breast exam. What is your next step?
|
Imaging
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To prophylactically treat breast cancer, the best choice is...
|
Raloxifene
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On bimanual exam, at what level would you expect to palpate a post menopausal uterus?
|
Below the level of the pubes
|
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|
At what endometrial thickness would you need to get a biopsy?
|
If it is very thin, like less than 3mm
|
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|
Retinoblastoma has two forms. What are they? Which form is bilateral? Which presents at a young age?
|
Inherited (familial)- bilateral, multiple foci, early age of onset, AD; much more common, because every retinoblast begins with a mutated Rb allele, every mutation of the other allele results in a tumor
Sporadic- asymmetric, presents later in life |
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|
Where are embryonic stem cells isolated from?
Adult stem cells? |
Isolated from inner cell mass of the morula
Embryonic stem cells are even less differentiated that adult stem cells Adult stem cells from mesenchymal cells |
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What is the difference between in vivo and ex vivo gene therapy?
|
In vivo- transformation of cells within the body
Ex vivo- transformation of extracted cells, which are then reimplanted back into the body |
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|
Some of the dangers of gene therapy include: immunologic reaction, horizontal transformation, pathogenesis of vector and insertional mutagenesis. Just read this.
|
Horizontal transformation- somatic to germ cell line
Pathogenesis of vector- reversion of replication via incompetent vector Insertional mutagenesis- XSCIDS cases |
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|
What virus is most commonly used in gene therapy clinical trials?
|
Adenovirus
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Why would a patient with PKU present with albinism?
|
No tyrosine can be synthesized --> no melanin
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|
Poisoning with a volative hydrocarbon is most often treated with:
|
osmotic cathartics (laxatives)
|
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|
The first line treatment in moderate salicylate poisoning is:
|
urine alkalation
|
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|
What is the unhappy triad?
|
Force is recieved to the lateral knee --> damage of MCL, ACL and lateral meniscus
|
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|
See Codman's triangle on x ray. What does this mean? Who is our patient? Where do you see this?
|
Osteosarcoma
Probably a male 10-20 years old Commonly found in the metaphysis of long bones |
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Koplik spots are pathognomonic for...
|
measles
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|
Branchial arch innervation for:
Arch 1 Arch 2 Arch 3 Arch 4 Arch 6 |
Arch 1: CN V --> muscles of mastication
Arch 2: CN VII --> facial expression Arch 3: IX --> muscles of pharynx Arch 4: X --> muscles of palate Arch 6: X --> muscles of phonation |
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What bug is most commonly responsbile for UTI? What is it's morphology? Lactose?
|
E.coli
G- rod Lactose + (fermenter) |
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|
What drug is most commonly used to treat hirtuitism in PCOS?
|
Spironolactone --> androgen inhibition
|
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|
Delayed bowel injury is an important complication post surgical intervention. When would this most likely present and how?
|
4-5 days after surgery
ileus |
