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244 Cards in this Set
- Front
- Back
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this type of proliferative fibrocystic disease is associated with an increased risk of invasive breast cancer
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sclerosing adenosis
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transformation of ductal epithelial cells to eosinophilic cells resembline apocrine sweat gland epithelium; not associated with increased CA risk
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apocrine metaplasia
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testicular enlargement with obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells
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syphilis
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child infected in utero with DS DNA virus - petechiae, hepatosplenomegaly, jaundice; brain calcifications
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CMV
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what marker do leiomyomas express?
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smooth muscle actin
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organism that lacks muramic acid?
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chlamydia
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most common bacterial STD in U.S.?
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chlamydia
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what complications account for the most maternal deaths in preeclampsia?
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cerebral hemorrhage and ARDS
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solitary, thickened, whitish plaque on penis - dysplastic epithelial cells with many mitoses, no stromal invasion
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Bowen's disease
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what is the posterior fornix in contact with - space that is the lowest part of the peritoneal cavity in the female pelvis
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rectouterine
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dermal lymphatic invasion by cancer cells?
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inflammatory breast cancer
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what maintains the corpus luteum during pregnancy?
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hCG
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tumor marker for serous papillary cystadenocarcinomas?
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CA-125
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initial event in pathogenesis of preeclampsia?
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placental ischemia
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bacteria causing amnionitis?
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listeria monocytogenes
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drainage of left ovary/testis?
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left gonadal vein - left renal ven - IVC
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drainage of right ovary/testis?
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right gonadal ven - IVC
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what does the suspensory ligament of the ovaries contain?
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ovarian vessels
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what does the transverse cervical/cardinal ligament contain?
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uterine vessels
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what does the round ligament of the uterus contain?
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no important structures
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what does the broad ligament of the uterus contain?
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round ligaments of uterus and ovaries and uterine tubules and vessels
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what is the acrosome derived from?
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golgi
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what is the flagellum (tail) of sperm derived from?
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one of the centrioles
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what is the sperm food supply?
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fructose
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what does spermatogenesis begin with?
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spermatogonia (type A and B)
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where does spermatogenesis occur?
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seminiferous tubules
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what does type A spermatogonia form?
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both type A and type B
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what forms the blood-testis barrier?
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junctional complex (tight junction) between Sertoli cells
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what stimulates testosterone release from Leydig cells?
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LH
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FSH stimulates sertoli cells to produce what?
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androgen binding protein & inhibin (inhibits FSH)
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what converts testosterone and androstenedione to estrogen in adipose tissue?
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aromatase
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list the forms of estrogen in order of potency
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estradiol > estrone > estriol
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what enzyme converts cholesterol to androstenedione in the theca cell? what stimulates it?
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desmolase; LH
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what converts androstenedione to estrogen in the granulosa cell? what stimulates it?
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aromatase; FSH
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what is elevation of progesterone indicative of?
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ovulation
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what does unopposed estrogen therapy increase the risk of? what can be added to decrease this risk?
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endometrial cancer; progesterone decreases the risk
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this hormone is responsible for stimulation of endometrial glandular secretions and spiral artery development
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progesterone
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what does progesterone do to myometrial excitability?
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decreases it
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what influence does progesterone have on uterine smooth muscle?
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relaxes it
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when is follicular growth the fastest?
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during 2nd week of proliferative phase
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what stimulates endometrial proliferation?
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estrogen
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what maintains the endometrium to support implantation?
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progesterone
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when does the estrogen surge occur?
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day before ovulation - stimulates LH, inhibits FSH
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what effect does progesterone have on temperature?
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increases it
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what is the role of OCPs?
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prevent estrogen surge, LH surge so ovulation does not occur
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what maintains the corpus luteum for the 1st trimester?
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hCG
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when does hCG appear in urine after fertilization?
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8 days
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what is the average age of onset of menopause?
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51 - earlier in smokers
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what happens to estrogen levels after menopause?
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decrease
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what happens to levels of FSH, LH, GnRH at menopause?
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increase (FSH increases the most; no LH surge)
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what does a bicornuate uterus result from?
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incomplete fusion of the paramesonephric ducts; associated with UT abnormalities and infertility
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what does hypospadias result from?
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failure of urethral folds to close - opening on inferior/ ventral side
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what does epispadias result from?
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faulty positioning of genital tubercle - on superior/dorsal side
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what is hypospadias associated with?
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UTIs - more common than epispadias
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what is epispadias associated with?
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exstrophy of the bladder
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what stage is an oocyte in prior to ovulation?
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prOphase of meiosis I
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what stage is a follicle in until fertilization?
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METaphase of meiosis II
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what is Mittelschmerz
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blood from ruptured follicle causes peritoneal irritation - can mimic appendcitis
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ovaries present, but external genitalia are virilized or ambiguous - due to exposure to androgenic steroids during early gestation
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female pseudohermaphrodite (XX)
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testes present, but external genitalia are female or ambiguous
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male pseudohermaphrodite
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what is the phenotype in androgen insensitivity syndrome (46, XY)?
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female - female external genitalia with rudimentary vagina, uterus and uterine tubes generally absent; develops testes
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in androgen insensitivity, what levels of testosterone, estrogen, LH are seen?
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all high
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cryptorchidism is associated with an increased risk for what?
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germ cell tumors, especially seminoma and embryonal carcinoma
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what happens in 5-alpha reductase deficiency?
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unable to convert T-DHT; ambiguous genitalia until puberty, when increased testosterone causes masculinization of genitalia
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what levels of testosterone, estrogen, and LH are associated with 5-alpha reductase deficiency?
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normal; LH normal or increased
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in what location is nodular enlargement seen in BPH?
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periuretheral (lateral and middle) lobes
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from where does prostatic adenocarcinoma most often arise?
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posterior lobe (peripheral zone)
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what is the genotype of a complete hyatidiform mole? what is the origin?
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46, XX- completely paternal in origin
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what is HELLP syndrome?
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Hemolysis, Elevated LFTs, Low Platelets
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what is the treatment for eclampsia?
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IV magnesium sulfate and diazepam
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increased risk of abruptio placentae with what?
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smoking, hypertension, cocaine use
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painful uterine bleeding usually during 3rd trimester
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abruptio placentae - premature separatino of placenta (may be associated with DIC)
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defective decidual layer allows placenta to attach directly to myometrium
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plaenta accreta
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what stimulates theca cells to secrete androstenedione and testosterone?
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LH
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what stimulates aromatase activity in granulosa cells?
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FSH
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where is the deep inguinal ring?
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about 1/2 inch above the midpoint of the inguinal ligament
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how do indirect inguinal hernias enter the inguinal canal?
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through the deep inguinal ring
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in many cases of Paget disease of the breast, what else is present?
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underlying adenocarcinoma
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lump in breast with prominent multinucleated giant cell reaction?
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fat necrosis
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three types of ovarian tumors that can produce large amounts of steroid hormones?
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sertoli-leydig cell tumors, fibroma-thecomas, granulosa cell tumors
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what is the most likely condition predisposing to breast abscess/mastitis?
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breast feeding
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what predisposes to placenta accreta?
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prior C-section or inflammation; may have massive hemorrhage after delivery
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placenta previa?
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attachment of placenta to lower uterine segement; may occlude cervical os
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painless bleeding in any trimester
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placenta previa
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what is polyhydraminos (>1.5-2L) associated with?
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esophageal/duodenal atresia; anencephaly
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what is oligohydraminos (<0.5L) associated with?
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bilateral renal agenesis or posteror urethral valves (in males)
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koilocytes?
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cervical dysplasia - HPV
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what types of HPV are associated with CIN?
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16, 18
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how does HPV cause CIN?
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HPV viral proteins E6 & E7 bind and inactivate gene products of p53 & Rb
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endometrial hyperplasia puts one at an increased risk for what?
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endometrial CA
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abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
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endometrial hyperplasia
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what is the most common gynecological malignancy?
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endometrial carcinoma
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what is the peak age for endometrial carcinoma? how does it typically present?
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55-65; vaginal bleeding
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risk factors for endometrial cancer?
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prolonged estrogen use, obesity, diabetes, and hypertension
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leiomyomas are sensitive to what?
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estrogen - increased sized with pregnancy and decreased with menopause
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amenorrhea, infertility, obesity, hirsutism
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polycystic ovarian syndrome
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increased LH production leads to anovulation, hyperandrogensim due to deranged steroid synthesis
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PCOS
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treatment for polycystic ovarian syndrome?
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weight loss, OCPs, gonadotropin analogs, or surgery
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what are antibodies directed against in type I DM?
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glutamic acid decarboxylase (GAD)
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treatment for pituitary apoplexy?
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glucocorticoids and thyroid hormone
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most accurate test for hypothyroidism?
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serum TSH
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metabolic disturbance seen in primary adrenal insufficiency?
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hypokalemia
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what effect do alpha2 agonists have on insulin secretion?
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directly inhibit it
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what is Laron dwarfism?
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congenital absence of growth hormone receptors
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classical physical finding in Addison's disease?
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hyperpigmentation
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how does pregnancy/estrogen affect thyroid-binding globulin?
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increases its synthesis
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Hashimoto's can be associated with disorders of what other organ?
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thymus
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how do you distinguish nephrogenic DI from neurogenic DI?
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water deprivation will fail to increase urine osmolarity in both, but subsequent injeciton of vasopressin will concentrate the urine in the case of neurogenic DI but not nephrogenic DI
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what are the secretory products of the zona glomerulosa?
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aldosterone
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what are the secretory products of the zona fasciculata?
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cortisol, sex hormones
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what are the secretory products of the zona reticularis?
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sex hormones, e.g. androgens
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what are the secretory products of the adrenal medulla?
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catecholamines
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what doe sthe posterior pituitary produce?
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vasopressin and oxytocin
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what embryonic layer is the posterior pituitary derived from?
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neuroectoderm
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what hormones is the alpha subunit common to?
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TSH, LH, FSH, hCG
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what subunit determines hormone specificity?
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beta
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in what part of the pancreas are the islets of Langerhans most numerous?
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tail
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from what do the pancreatic islets arise?
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pancreatic buds
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what type of pancreatic cells secrete glucagon?
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alpha
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what type of pancreatic cells secrete insulin?
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beta
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what type of pancreatic cells secrete somatostatin?
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delta
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how does prolactin influence dopamine synthesis and secretion?
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increases it
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what effect does dopamine have on prolactin?
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inhibits it's secretion
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what effect do dopamine agonists (e.g. bromocriptine) have on prolactin secretion?
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inhibit (antagonists - e.g. antipsychotics - stimulate
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decreased sex hormones, decreased cortisol, increased mineralocorticoids - hypertension, hypokalemia; phenotypically female but no maturation
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17alpha hydroxylase deficiency
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what is the most common form of congenital adrenal hyperplasia?
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21 beta hydroxylase deficiency
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decreased cortisol (increased ACTH), decreased mineralocorticoids, increased sex homrones - masculinization, female pseudohermaphroditism, etc.
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21 beta hydroxylase deficiency
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what is the difference in BP between 17 alpha hydroxylase deficiency and 21 beta hydroxylase deficiency?
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17=hyPERtension and 21=hyPOtension
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increased plasma renin activity, volume depletion, hyponatremia, hyperkalemia are associated with what congenital adrenal hyperplasia?
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21 beta hydroxylase deficiency
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decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones, masculinization, hypertension?
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11 beta hydroxylase deficiency
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what effect does PTH have on phosphate?
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decreases serum phosphate, increases urine phosphate
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what effect does PTH have on calcium?
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increases serum calcium
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where does PTH influence calcium resorption?
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increases it in distal convuluted tubule
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what type of vitamin D comes from sun exposure in skin?
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D3
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what increases absorption of dietary calcium and phosphate and increases bone resorption of them as well?
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vitamin D
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levels of calcium, phosphate, alk phos in osteoporosis?
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all normal
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levels of calcium, phosphate, alk phos in hyperparathyroidism?
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increased calcium, decreased phosphate, increased alkphos
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levels of calcium, phosphate, alk phos in Paget's disease
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normal to increased calcium, normal phosphate, very high alk phos
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levels of calcium, phosphate, alk phos in vitamin D intoxication?
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all increased (alk phos normal or increased)
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levels of calcium, phosphate, alk phos in renal insufficiency?
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decreased calcium, increased phosphate, normal alk phos
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what is the source of calcitonin?
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parafollicular (C cells) of thyroid
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waht is the function of calcitonin?
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decreases bone resorption of calcium
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what causes calcitonin secretion?
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increased serum calcium
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when is thyroid binding globulin decreased?
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hepatic failure
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how does thyroid hormone increase BMR?
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increases Na/K ATPase activity - increased O2 consumption, RR, body temp
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Cushing's disease?
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primary pituitary adenoma - increased ACTH and cortisol
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ACTH level in primary adrenal hyperplasia/neoplasia?
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decreased (cortisol increased)
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dexamethasone suppression in healthy person?
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decreased cortisol after low does
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dexamethasone suppression test in person with ACTH-producing tumor?
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increased cortisol after low dose, decreased cortisol after high dose
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dexamethasone suppression in person with cortisone-producing tumor?
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increased cortisol after low and high dose
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primary hyperaldosteronism/Conn's syndrome?
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caused by an aldosterone-secreting tumor
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findings in Conn's syndrome?
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hypertension, hypokalemia, metabolic alkalosis
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renin level in primary aldosteronism? in secondary?
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low renin in primary, high renin in secondary
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this type of hyperaldosteronism is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome
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secondary - kidney perception of low intravascular volume results in overactive RAA system - high plasma renin
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primary deficiency of aldosterone and cortisol due to adrenal atrophy
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Addison's disease
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hyponatremic volume contraction and skin hyperpigmentation
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Addison's disease
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how do you distinguish Addison's disease from secondary deficiency of aldosterone?
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no skin hyperpigmentation in secondary (due to decreased pituitary ACTH production)
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what is the cause of skin hyperpigmentation in Addison's?
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MSH, a byproduct of increased ACTH production from POMC
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what cells is a pheochromocytoma derived from?
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chromaffin cells (arise from neural crest)
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what MEN types is pheochromocytoma associated with? what other disorder is it associated with?
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MEN II and III; neurofibromatosis
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most common tumor of adrenal medulla in adults? kids?
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pheochromocytoma; neuroblastoma (can occur anywhere along the sympathetic chain)
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how is pheochromocytoma treated?
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alpha antagonists, especially phenoxybenzamine
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MEN I?
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pancreas (e.g. Zollinger-Ellison syndrome, insulinomas, VIPomas), parathyroid, and pituitary tumors (3 P's)
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how does MEN I present?
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kindey stones and stomach ulcers
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another name for MEN I?
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Wermer's syndrome
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MEN II?
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medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor
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another name for MEN II?
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Sipple's syndrome
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MEN III?
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medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromas (mucosal neuromas)
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how are MEN syndromes inherited?
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AD
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what gene are MEN II and III associated with?
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ret
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what type of hypersensitivity reaction is Grave's?
|
type II
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what is Riedel's thyroiditis?
|
thyroid replaced by fibrous tissue (hypothyroid)
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histologic finding in hashimoto's?
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lymphocytic infiltrate with germinal centers
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self-limited hypothyroidism often following a flulike illness; elevated ESR, jaw pain, early inflammation, and very tender thyroid?
|
subacute thyroiditis (de Quervain's)
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what is the most common type of thyroid cancer?
|
papillary carcinoma - excellent prognosis
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ground-glass/Orphan Annie nuclei, psammoma bodies
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papillary carcinoma of the thyroid
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from what does medullary carcinoma of the thyroid arise?
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parafollicular C cells
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thyroid cancer that produces calcitonin, sheets of cells in amyloid stroma?
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medullary carcinoma
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type of thyroid cancer seen in older patients, very poor prognosis?
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undifferentiated/anaplastic
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defect in T4 formation or developmental failure in thyroid formation is seen in what?
|
sporadic cretinism
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treatment for acromegaly?
|
octreotide
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primary hyperparathyroidism is usually caused by what?
|
adenoma
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findings in primary hyperparathyroidism?
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hypercalcemia, hypercalciuria, hypophosphatemia, increased PTH, increased cAMP in urine
|
|
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symptoms of primary hyperparathyroidism?
|
often asymptomatic; may present with weakness and constipation
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what causes secondary hyperparathyroidism?
|
secondary hyperplasia due to decreased serum calcium, most often in chronic renal disease
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findings in secondary hyperparathyroidism?
|
hypocalcemia, hyperphosphatemia, increased PTH
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what causes hypoparathyroidism?
|
accidental surgical excision or DiGeorge's
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findings in hypoparathyroidism?
|
hypocalcemia, tetany
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what is Chvostek's sign?
|
hypocalcemia - tap facial nerve and see contraction of facial muscles
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what is Trousseau's sign?
|
hypocalcemia - occlusion of brachial artery with BP cuff leads to carpal spasm
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what is pseudohypoparathyroidism?
|
AR kidney unresponsiveness to PTH; hypocalcemia, shortened 4th/5th digits, short stature
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excess of what vitamins can cause hypercalcemia?
|
vitamins A and D
|
|
|
what is usually the cause of DKA?
|
increase in insulin requirements from an increase in stress (e.g. infection) - excess fat breakdown and increased ketogenesis from the increase in free fatty acids, which are then made into ketone bodies
|
|
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what is the metabolic disturbance associated with DKA?
|
increased H+, decreased HCO3-
|
|
|
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anion gap metabolic acidosis; hyperkalemia but depleted intracellular K+
|
|
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intensive thirst and polyuria with inability to concentrate urine?
|
diabetes insipidus
|
|
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causes of central DI?
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pituitary tumor, surgery, trauma, histiocytosis X
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|
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causes of nephrogenic DI?
|
hereditary or secondary to hpercalcemia, lithium, demeclocycline
|
|
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what happens in a water deprivation test in DI?
|
urine osmolality doesn't increase
|
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urine specific gravity is less than what in DI? osmolality greater that what?
|
<1.006, >290
|
|
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what is the treatment for central DI?
|
intranasal desmopressin (ADH analog)
|
|
|
what is the treatment for nephrogenic DI (lack of renal resonse to ADH)?
|
hydrochlorothiazide, indomethacin, or amiloride
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|
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excessive water retention, hyponatremia, and urine osmolarity > serum osmolarity
|
SIADH
|
|
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what is a dangerous potential effect of SIADH?
|
very low serum sodium levels can lead to seizures (correct slowly)
|
|
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causes of SIADH?
|
ectopic ADH, CNS disorders/head trauma, pulmonary disease, cyclophosphamide
|
|
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treatment for SIADH?
|
demeclocycine or water restriction
|
|
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diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease?
|
carcinoid syndrome
|
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|
carcinoid syndrome?
|
rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of serotonin - not seen if tumor is limited to GI tract (serotonin undergoes first-pass metabolism in GI tract)
|
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what is the most common tumor of the appendix?
|
carcinoid
|
|
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urine finiding in carcinoid syndrome?
|
increased 5-HIAA
|
|
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what are carcinoid tumors derived from?
|
neuroendocrine cells of GI tract
|
|
|
treatment for carcinoid syndrome?
|
octreotide
|
|
|
rule of 1/3s for carciniod syndrome?
|
1/3 metastasize, 1/3 with 2nd pregnancy, 1/3 mutiple
|
|
|
what fascia encloses the thyroid gland?
|
pretracheal fascia
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|
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surgical resection of ileum causes what levels of calcium, 25-OH vitamin D, phosphate?
|
all decreased
|
|
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mechanism of propylthiouracil?
|
inhibits deiodonation of T4
|
|
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somatostatin inhibits the release of what 2 hormones?
|
GH and TSH
|
|
|
thyroid condition preceding lymphoma?
|
Hashimoto thyroiditis
|
|
|
pentagastrin-stimulated calcitonin secretion is a marker for what?
|
medullary carcinoma of the thyroid
|
|
|
treatment for DKA?
|
fluids, insulin, and potassium; glucose if necessary to prevent hypoglycemia
|
|
|
activation of pyruvate dehydrogenase and increased levels of acetyl CoA are associated with what?
|
type 2 DM
|
|
|
why does glucose taken orally cause a greater increase in insulin than when given IV?
|
increases duodenal secretion of gastric inhibitory peptide, increasing beta cell release of insulin
|
|
|
thyroid nodule with small 'solid balls' of neoplastic follicular cells containing microscopic blood vessels and fibrous stroma in their centers
|
papillary carcinoma
|
|
|
actions of insulin/insulin-like drugs?
|
TK activity: liver (increase glucose stored as glycogen), muscle (increased glycogen and protein synthesis, K+uptake), fat (aids TG storage)
|
|
|
what type of drug: tolbutamide & chlorpropamide?
|
first generation sulfonylureas
|
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what type of drug: glyburide, glimepiride, glipizide?
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second generation sulfonylureas
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mechanism of action of sulfonylureas?
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close K+ channel in beta cell membrane so cell depolarizes, triggering of insulin release via Ca2+ influx
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what are sulfonylureas used for?
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stimulate release of endogenous insulin in type 2 DM; require some islet function so useless in type 1
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side effects of first generation sulfonylureas?
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disulfiram-like reactions
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side effect of second generation sulfonylureas?
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hypoglycemia
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what is the most grave side effect of metformin?
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lacti acidosis
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can metformin be used in patients without islet function?
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yes
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action of pioglitazone and rosiglitazone?
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increase target cell response to insulin
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action of acarbose and miglitol?
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alpha glucosidase inhibitors - inhibit intestinal brush border alpha glucosidases; delayed sugar hydrolysis and glucose and glucose absorption lead to decreased postprandial hyperglycemia
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mechanism of propylthiouracil, methimazaole?
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inhibit organification and coupling of thyroid hormone synthesis - used for hyperthyroidism
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toxicity of propylthiouracil, methimazole?
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skin rash, agranulocytosis (rare), aplastic anemia
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what are orlistat and dsibutramine used for?
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obesity management (orlistat is long-term)
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use of glucocorticoids?
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Addison's disease, inflammation, immune suppression, asthma
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mechanism of finasteride?
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5 alpha reductase inhibitor
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mechanism of flutamide?
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nonsteroidal competitive inhibitor of androgens at the testosterone receptor
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mechanism of leuprolide?
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GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when used in continuous fashion
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mechanism of clomephine?
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partial agonist at estrogen receptors in hte pituitary - prevents normal feedback inhibition and increases release of LH and FSH from the pituitary, which stimulates ovulation
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drug of choice for women with estrogen receptor + breast cancer?
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tamoxifen - competitively inhibits estradiol at estrogen receptors
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treatment for polycystic ovarian syndrome?
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ketoconazole, spironolactone
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