AAW - Endo/Repro Flashcards
carcinoid syndrome
Rare syndrome caused by carcinoid tumors
(neuroendocrine cells), especially metastatic
small bowel tumors, which secrete high levels
of serotonin (5-HT). Not seen if tumor is
limited to GI tract (5-HT undergoes first-pass
metabolism in liver). Results in recurrent
diarrhea, cutaneous flushing, asthmatic
wheezing, and right-sided valvular disease.
increased 5-hydroxyindoleacetic acid (5-HIAA) in
urine, niacin deficiency (pellagra).
Treatment: resection, somatostatin analog (e.g.,
octreotide).
Every now and then, I get really flushed for about 5 minutes and then it goes away and I don’t know what it is!
think carcinoid syndrome
carcinoid tumors now called neuroendocrine tumors i guess
diagnostic test for carcinoid syndrome
5-hydroxyindolacetic acid in urine
salt and pepper chromatic pattern with oval nucleus
neuroendocrine tumor
Adrenal hemorrhage, hypotension, DIC
what syndrome
what bacteria
waterhouse-friederichsen syndrome
Acute 1° adrenal insufficiency due to adrenal hemorrhage associated with Neisseria meningitidis
septicemia, DIC, and endotoxic shock.
exophthalmos, weight loss, palpitations
what is it
how do you diagnose
graves disease - type II hypersensitivity
Most common cause of hyperthyroidism. Autoantibodies (IgG) stimulate TSH receptors on thyroid
(hyperthyroidism, diffuse goiter), retro-orbital fibroblasts (exophthalmos: proptosis, extraocular
muscle swelling B ), and dermal fibroblasts (pretibial myxedema). Often presents during stress
(e.g., childbirth).
ELIZA to look for those antibodies
cervical dysplasia and cacinoma in sity assc with what virus
what are the genetic effects of the virus
HPV 16 and 18, which produce both the E6 gene product
(inhibits p53 suppressor gene) and E7 gene
product (inhibits RB suppressor gene)
p53 normally recruits bax, which knocks out BCL-2 (the molecule that normally stabilizes the mitochondrial membrane) - if mit memb is bad, cytochrome C leaks out and the cell dies
destruction of Rb stops its inhibition of E2F, which moves cells into S phase
all hormones produced by the anterior pituitary (adenohypophysis)
FLAT PiG:
FSH LH ACTH TSH ProlactIn GH
bromocriptine
dopamine agonist
can be used to treat prolactinomas
octreotide
long acting somatostatin analog
treats acromegaly, glucagonoma, somatostatinoma (counter intuitive, but its for sx control), carcinoid syndrome, gastrinoma, esophageal varicies
pegvisomant
GH receptor antagonist
makes you short as a peg
main prolactin inhibitory factor
Tx for prolactinoma
Dopamine acting on D2 receptors
dopamine agonists (bromocriptine or cabergoline) are the Tx for prolactin secreting tumors
function of thyroid peroxidase what blocks it (used for what purpose? SE?)
oxidizes iodide to iodine in the thyroid, which eventually iodinates thyroglobulin tyrosine residues
propylthiouracil, methimazole block it (used for hyperthyroidism (PTU blocks Peripheral conversion (iodinase I), used in Pregnancy (otherwise methimazole is preferred))
SE skin rash, agranulocytosis (rare), aplastic anemia, hepatotox (PTU). Methimazole is a possible teratogen
HLA subtype for hashimoto
autoantibodies for it
increased risk of what cancer
histologic finding
btw, it is the most common cause of hypothyroidism in iodine-sufficient regions
DR5
“i got 5 on it” DR5 because self-medication
(on the hash)
Antimicrosomal, antithyroglobulin, anti-thyroid peroxidase
increased risk of non-hodgkin lymphoma
find Hurthle cells, lymphoid aggregates with germinal centers
Jod-Basedow phenomenon
thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
propylthiouracil
antithyroid
used in thyrotoxicosis, graves disease
tx for thyroid storm
three Ps
beta-blockers (Propanolol), Propylthiouracil, corticosteroids (Prednisone)
methimazole
used to treat thyroid hormone hypersecretion due to Graves’ disease or thyroid storm
inhibit thyroid peroxidase
mifepristone
competitive inhibitor of progestins at progesterone receptors. “morning after pill”
Wolff-Chaikoff
excess iodine temporarily inhibits thyroid peroxidase, get decreased iodine organification, decreased T3/4 production
hashimotos antibodies
antithyroid peroxidase (antimicrosomal), antithyroglobulin antibodies
graves antibodies
anti-TSH receptor (it actually stimulates the receptors)
hurthle cells
hashimotos
lymphoid aggregate with germinal centers in the thyroid
HLA type in hashimotos
HLA-DR5
patient was sick NOS like a week ago, they have tender area around their adams apple and jaw pain
subacute thyroiditis (de quervain)
self-limited hypothyroidism
may be hyperthyroid early in course
granulomatous inflammation of the thyroid!
elevated ESR, de quervain is assc with pain
person comes in because they are having trouble breathing, and have a rockhard painless goiter
Reidel thyroiditis
thyroid replaced by fibrous tissue (they become hypothyroid)
fibrosis may extend to local structures, mimicking anaplastic carcinoma
related to IgG4 related systemic disease
thyroid biopsy shows empty-appearing nuclei
“orphan annie” eyes - seen in papillary carcinoma
most common thyroid cancer, excellent prognosis
also see psammoma bodies (little calcification lump - orphan annie’s dog is named sandy), nuclear grooves (looks like coffee beans),
increased risk with RET and BRAF mutations, childhood irradiation
Medullary carcinoma of the thyroid
Cells?
histo findings?
ass with what?
from parafollicular “C cells”; produces calcitonin, sheets of cells in an amyloid stroma. Associated with MEN 2A and 2B (RET mutations)
hypertension, hypokalemia, metabolic alkalosis
Conn syndrome (cortical adenoma, primary hyperaldosteronism)
hypokalemia - get weakness/fatigue/psycosis
secondary hyperaldosteronism vs primary - how can you tell the difference?
in secondary, your renin is up (kidneys are underperfused for example)
in primary, the renin is down (aldosterone secreting tumor, for example)
congenital adrenal hyperplasia - what enzyme is most commonly not working
21-hydroxylase -
hypotension, hyperkalemia, increased renin, increased 17-hydroxyprogenterone (can’t make aldosterone)
adrenal hemmorhage, hypotention, DIC
waterhouse-Friderichsed syndrome (meningococcemia)
caused by neisseria
Sx are from lack of mineralcorticoids
metanephrines in the urine
pheo
also see VMA
clusters of cells are called zellballen
diagnostic findings of neuroblastoma
oncogene?
homer-wright rosettes (circular grouping of dark tumor cells surrounding pale neurofibrils (aka neuropil))
homovanilic acid, a breakdown product of dopamine in urine.
Bombesin positive
(tumor of the adrenal medulla in kids)
N-myc gene copies all floatin around (a transcription factor)
MEN assc with medullary carcinoma
what do you do before they get it
MEN-2 A and B
take out the thyroid
MEN-1 mneumonic
three ps
parathyroid hyperplasia/tumors
pituitary adenoma - prolactin or GH
pancreatic endocrine tumors - ZE syndrome, insulinomas, VIPoma, glucagonoma
remember by drawing a diamond
commonly presents with kidneystones and stomach ulcers
AKA wermer syndrome
MEN-2A mnuemonic
2ps
Parathyroids (medullary thyroid carcinoma secreting calcitonin)
pheochromocytoma
remember by drawing a square
assc with ret gene mutations
MEN-2B mneumonic
1p
pheochromocytoma
(also this can lead to medullary thyroid carcinoma, marfanoid habitus)
remember by drawing a triangle (adrenals and mouth/thyroid)
assc with ret gene mutations
give 2 examples of a first gen sulfonylurea, SE too
give 3 examples of a second gen sulfonylurea, SE too
mech?
First gen: tolbutamide, chlorpropamide. SE: disulfiram-like effects
2nd gen: glipizide, glimepiride, glyburide (rarely used). SE: hypoglycemia
MECH:
binds to the SUR1 subunit of the K channel, closing it. Happens in the beta cell, depolarizes and triggers insulin release via Ca influx SO IT DOESN’T WORK IF THEY HAVE NO ISLETS LEFT
Pramlintide
not common
Amylin analog - makes people feel full - amy and LINT in her pocket - also the TIDE is the fullness feeling
used to decrease gastric emptying, decreases glucagon
used in type 1 and 2
can cause hypoglycemia, nausea, diarrhea
exanatide
GLP-1 analog - makes people feel full
increases insulin, decreases glucagon release, delays gastric emptying
used for type 2
SE: nausea, vom, pancreatitis
liraglutide
GLP-1 analog - makes people feel full
increases insulin, decreases glucagon release, delays gastric emptying
used for type 2
SE: nausea, vom, pancreatitis
acarbose
alpha-glucosidase inhibitor
inhibits intestinal brush-border alpha-glucosidases, causes delayed sugar hydrolysis and glucose absorption, leads to decreased postprandial hyperglycemia
SE: N/V/D
miglitol
alpha-glucosidase inhibitor
inhibits intestinal brush-border alpha-glucosidases, causes delayed sugar hydrolysis and glucose absorption, leads to decreased postprandial hyperglycemia
SE: N/V/D
pioglitazone, rosiglitazone
“glitazones”/thiazolidinediones (“TZDs”)
increase insulin sensitivity in peripheral tissue by binding to PPAR-gamma nuclear transcription regulator
SE: weight gain, edema, hepatotox, heart failure
not used often because of SE
You are in the zone if you are getting a lot of pars
what does activation of PPAR-gamma do
increases insulin sensitivity and levels of adiponectin
the glitazones do this
(also the fibrates activate PPAR-alpha to induce HDL synthesis!)
metformin
exact mech unknown
decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake (insulin sensitivity)
first like in T2DM
most serious SE is lactic acidosis (contraindicated in renal failure)
linagliptin
saxagliptin
sitagliptin
DPP-4 (dipeptidyl peptidase) inhibitors: blocks degradation of incretins (like GLP-1, which works by increasing cAMP in the beta cell, secreting insulin)
increase insulin, decrease glucagon release
used for type 2
can cause significant weight loss in certain patients
what diabetes medication has an increased risk of hypoglycemia in patients with renal failure
sulfonylureas (most common in glipizide)
Close K+ channel in β-cell
membrane cell depolarizes
insulin release via Ca2+
influx.
Signaling pathways of endocrine hormones:
cAMP
FLAT ChAMP
FSH, LH, ACTH, TSH, CRH, hCG, ADH
(V2-receptor), MSH, PTH
I don’t know why these aren’t in the mneumonic in FA, but these too:
calcitonin, GHRH,
glucagon
(i guess champs need to tone their bones, need to have a GROWTH HORMONE RELEASING HORMONE, and need to have sugar in their blood to perform like a champ)
Signaling pathways of endocrine hormones:
IP3
(Gq receptors)
GOAT HAG
GnRH, Oxytocin, ADH ((qinky) V1 receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin
Signaling pathways of endocrine hormones:
intrinsic tyrosine kinase
Insulin, IGF-1 (insulin like growth factor), FGF (fibroblast growth factor), PDGF (platelet derived growth factor - responsible for overgrowth of blood vessels in cancer), EGF
MAP kinase pathway
think growth factors
Signaling pathways of endocrine hormones:
Receptor-associated tyrosine kinase
Prolactin, Immunomodulators (e.g. cytokines, IL-2, IL-6, IL-8, IFN), GH
JAK/STAT pathway
think acidophiles and cytokines
P.I.G.
what drugs can be used in diabetes that decreases glucose absorption
SGLT2 inhibitors decrease reabsorption of glucose in the PCT
also the α-glucosidase inhibitors:
Acarbose
Miglitol
Propylthiouracil
Thyroglobulin peroxidase inhibitor - used in graves disease
(block tyrosine iodination (also known as organification)) and coupling
what cells secrete androgens that stimulate the development of mesonephric ducts and testosterone (in the presence of LH)
where are they found
leydig cells
testosterone production is unaffected by temp, btw
found in the interstitium between the seminiferous tubules
tunica albuginea
thick capsule around the testis that has septa that divide the different lobules
what cells secrete inhibit and what do they do
sertoli cells:
inhibin inhibits FSH directly at the pituitary (the sertoli cells themselves are stimulated by FSH, and increased spermatogenesis when bound by FSH)
also they secrete androgen-binding protein –> maintains local levels of testosterone
tight junctions between adjacent sertoli cells form the blood-testis barrier –> isolate gametes from autoimmune attack
temp sensitive, decrease sperm production and inhibin release when temps go up
main energy source for motile sperm
where is it made
fructose
made in the seminal vesicles (seminal fluid is rich in fructose, ascorbic acid, and prostaglandins)
finasteride
5-alpha reductase inhibitor, blocks the conversion of testosterone to DHT (the main stimulatory androgen of the prostate, external genitalia, and skin)
what is the difference between hypogonadotropic hypogonadism and primary hypogonadism
hypogonadotropic gonadism is a lack of LH and testosterone
primary hypogonadism is a lack of testosterone and an increase in LH
flutamide
a nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma
person has failure to complete puberty, decreased GnRH, FSH, LH
also has anosmia (can’t smell)
Kallmann syndrome
defective migration of GnRH cells and formation of olfactory bulb.
what do modern pregnancy tests detect and what produces the thing that they detect
hCG
syncytiotrophoblasts
testicular tumor most common in young boys
yolk sac (endodermal sinus) tumor
yellow, mucinous. Aggressive malignancy of testes, analogous to ovarian yolk sac
see schiller-duval bodies that resemble primitive glomeruli
alpha fetoprotein is the marker
the other one in young boys is a teratoma
testicular tumor with large cells in lobules with a watery cytoplasm
elevated alkaline phosphatase
seminoma - “fried egg”
malignant, painless, homogenous, no necrosis
most common in third decase
malignant, hemorrhagic and painful testicular tumor
type?
morphology?
age?
embryonal carcinoma
glandular/papillary morphology
20-30 year age group
what cells that are naturally in placentas also show up in seminomas and choriocarcinoma
what symptoms can it produce
syncytiotrophoblasts (without villi) - produce hCG, which can be used as a tumor marker
also see cytotrophoblastic elements (without villi)
may produce gynecomastia, symptoms of hyperthyroidism (hCG is structurally similar to LH, FSH, TSH)
poor response to chemotherapy
what bugs can cause perihepatitis, when the liver binds to the peritoneum and forms violin string adhesions
chlamydia trachomatis
neisseria gonorrhoeae
chlamydia trachomatis
called fitz-hugh-curtis syndrome
comes on after pelvic inflammatory disease
clue cells
gardonella
i have no clue why it smells like fish in the vagina garden…
solitary painless genital lesion
syphilis until proven otherwise
HPV serotypes assc. with warts
types assc. with cervical cancer
which have a vaccine
1,2,6,11 - warts
16,18 - cervical cancer
6,11,16,18 have vaccine
eczematous patches on the nipple that are red and itchy
paget disease resulting from underlying DCIS or invasive breast cancer.
washed out, multi-nucleated squamous cells on a pap smear
what is it
herpes
tamoxifen and raloxifene
mech
similarities and differences
Both: selective estrogen receptor modulator, receptor antagonists in breast and agonists in bone
Tamoxifen: breast cancer treatment, partial agonist in endometreum, increases the risk of endometrial cancer and gives hot flashes risk of endometrial polyps
Raloxifene: osteoporosis prevention , estrogen antagonists in endometrial tissue (does not cause endometrial cancer)
bilateral malignant ovarian neoplasm with psammoma bodies
serous cystadenocarcinoma
most common malignant ovarian neoplasm
psammoma modies are seen in what
PSaMMoma
Papillary carcinoma of thyroid (orphan annie eyes)
Serous papillary cystadenocarcinoma of ovary (bilateral, bad prognosis)
Meningioma
Malignant mesothelioma
surgical wound from c section gets a growth with rubbery white tissue with hemosiderin brown spots
what is it
what drug can you give specific for it
SE of that drug
endometriosis “chocolate
cysts”
Danazol - synthetic androgen that acts as a partial agonist at androgen receptors. stops formation of androstenedione
weight gain, edema, acne, hirsutism, masculinization, decreased HDL, hepatotox
whorled pattern of smooth muscle bundles with well-demarcated borders on biopsy of the endometrium
Leiomyoma (fibroma)
most common tumor in females, usually multiple discrete tumors
african americans
estrogen sensitive - increase size with pregnancy, decreased with menopause
if it is symptomatic, historectomy
testicular tumor
golden brown
eosinophilic cytoplasmic inclusions
gynecomastia in men, precocious puberty in boys
Leydig cell tumor
androblastoma tumor from sex cord stroma
Sertoli cell tumor
aggressive tumor in the testicle that is a met
testicular lymphoma
endometrial stuff that can cause polycythemia
leiomyoma causing increased erythropoietin production
drugs that can be used for polycystic ovarian syndrome to reduce androgenic symptoms
ketoconazole (inhibits 17,20 desmolase) and spironolactone (inhibits steroid binding, 17alpha-hydroxylase, and 17,20 desmolase)
can get addison-like hyperpigmentation from the desmolase inhibition
desmolase is what converts cholesterol into pregnenolone (and then all the androgens are downstream of that)
amenorrhea/oligomenorrhea, hisrutism, acne, not fertile, obese
Tx
polycystic ovarian syndrome
alters hypothalamic hormonal feedback response –> increased LH and FSH, increased androgens from theca interna cells, decreased rate of follicular maturation –> unruptured follicles and anovulation
enlarged bilateral cystic ovar
Treatment: weight reduction, OCPs, clomiphene citrate, ketoconazole, spironolactone.ies
how do you monitor response of an ovarian neoplasm to therapy
CA 125 levels
not good for screening tho
55 yo, breast tenderness, bleeding from vagina
in the ovary, ovary granulosa cells arranged haphazardly around collections of eosinophilic fluid
granulosa cell tumor
most common malignant stromal tumor
Often produces
estrogen and/or progesterone and presents with postmenopausal bleeding, sexual precocity
(in pre-adolescents), breast tenderness. Histology shows Call-Exner bodies
what is meant by
pseudomyxoma peritonei
intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor - usually starts in appendix, mets to ovary
the tumor is called a mucinous cystadenocarcinoma - usually unilateral
post menopause
tumor that contains immature fetal tissue, neuroectoderm
what tissue in the most common?
immature teratoma of the ovary
neuroectoderm is the most common
adolescent ovarian mass
fried egg cells
hCG, LDH up
dysgerminoma - most common malignant germ cell tumor - clear cytoplasm and central nuclei
equivalent to male seminoma but rarer
ovarian tumor that resembles glomeruli
what tumor
what are the glomerulus like structures called
tumor marker?
schiller-duval bodies
found in a yolk sac tumor “endodermal sinus tumor”
AFP is tumor marker
salpingectomy
removal of fallopian tube
placenta:
accreta
increta
percreta
Defective decidual layer abnormal
attachment and separation after delivery.
Risk factors: prior C-section, inflammation,
placenta previa.
Placenta accreta—placenta attaches to
myometrium (not the decidual layer of the ENDOmetrium like it should) without penetrating it; most
common type.
Placenta increta—placenta penetrates into
myometrium.
Placenta percreta—placenta penetrates
(“perforates”) through myometrium and into
uterine serosa (invades entire uterine wall);
can result in placental attachment to rectum
or bladder.
Presentation: often detected on ultrasound prior
to delivery. No separation of placenta after
delivery postpartum bleeding (can cause
Sheehan syndrome)
abrupt painful bleeding in third trimester
placental abruption
premature separation of placenta from uterine wall before delivery
10-20% risk of DIC (placenta is rich in factor III, AKA “tissue factor”)
causes of postpartum hemorrhage
Due to 4 T’s: Tone (uterine atony; most
common), Trauma (lacerations, incisions,
uterine rupture), Thrombin (coagulopathy),
Tissue (retained products of conception).
virus type: HPV
DNA
DS and circular
family: papillomavirus
koilocytes
HPV - rasin looking nuclei
lichen simplex chronicus
hyperplasia of the vulvar squamous epithelium
leukoplakia with thick, leathery vulvar skin
NOOO increased risk of squamous cell
not to be confused with lichen sclerosis, where you get paper-like skin that is white and thin –> slight assc with squamous cell
white vagina
ddx
lichen sclerosis - thin paper like
lichen simplex - think, chronic irritation from scratching
vulvar carcinoma - may be due to HPV (causes vulvar intraepithelial neoplasia or VIN - 40-50 yo) or not (long standing lichen sclerosis - postmenopausal)
how do you differentiate between paget’s disease of the vulva and vulvular melanoma
paget: PAS + (mucus - only epithelial cells make mucus), keratin + (intermediate filament present in epithelial cells - if epithelium is malignant its called carcinoma), s100 neg
* in paget’s of the vulva, there is just malignant cells in the epithelium, not in the underlying tissue, unlike paget’s disease of the breast
Melanoma: s100 +
decreased androstenedione and not going into puberty
deficiency? mineralcoticoids? cortisol? sex hormones? PB? K?
17alpha-hydroxylase def increased mineralcorticoids decreased cortisol decreased sex hormones increased BP decreased K
salt wasting in infancy and precocious puberty, virilization in females
deficiency? mineralocorticoids? cortisol? sex hormones? PB? K? renin activity? concentration of 17-hydroxyprogesterone?
21-hydroxylase def decreased mineralocorticoids decreased cortisol increased sex hormones decreased BP increased K
increased renin activity
increased 17-hydroxyprogesterone
Virilization in a female with increased blood pressure
deficiency? mineralocorticoids? cortisol? sex hormones? K? renin activity?
11-beta hydroxylase def
Mineralocorticoids: decreased aldosterone, but increased 11-deoxycorticosterone (results in increased BP)
decreased cortisol
increased sex hormones
decreased K
decreased renin activity (because of increased BP?)
triiodothyronine resin uptake test results in a person with hypothyroidism
they are hypothyroid, so they don’t have much of their T3 bound to their thyroxine-binding globulin in their serum
so you mix patients serum with radioactive fake T3 and that occupies the empty thyroxine-binding globulin
then put a block of insoluble T3 resin in the serum
you will notice that the resin has a reduced uptake of fake, radiolabeled T3, because it is all taken up by the patients empty thyroxine binding globulin
what causes elevated levels of PTH in people with kidney failure
the elevated levels of phosphate
(you would think think that the decrease in Ca being absorbed from the gut (because the kidney is not producing 1,25 vit d) would also cause the increase in PTH)
watery diarrhea, hypokalemia, increased pH on nasogastric suction fluid
WDHA syndrome seen in VIPomas
watery diarrhea, hypokalemia, achlorhydria
prolactinoma Sx in men
low libido, infertility
lab test that would most likely be abnormal in a patient with acromegaly
glucose tolerance test
diagnosis can be made with high insulin-like growth factor 1 levels, but is confirmed with an oral glucose tolerance test
where do these come from
17beta-estradiol
estriol
estrone
17beta-estradiol - ovary
estriol - placenta
estrone - adipose tissue
potency (greatest to least): estradiol, estrone, estriol
what happens to FSH and LH levels in menopause
they go up because they are not inhibited by estrogen
patient has headache and vom
cannot look up
where is the tumor and why the headache/vom
parinaud syndrome - paralysis of conjugate vertical gaze due to lesion in superior colliculi
Pinealoma
increased pressure in the ventricles causes the headache and vom
drugs that can cause unwanted prolactin secretion
dopamine antagonists (most antipsychotics)
terbutaline, ritodrine
beta2 agonists that relax the uterus; used to decrease contraction frequency in women during labor
Treatment for preeclampsia
antihypertensives and IV magnesium sulfate to prevent seizure
definitive is delivery
what is the difference between heart and smooth muscle with in relation to cAMP levels
cAMP increase in cardiac muscle increases contraction
cAMP levels in smooth muscle decrease contraction
dinoprostone
natural PGE2 analog
increases uterine tone - used as an abortifacient or to induce labor
carboprost
PGF2alpha analog
increases uterine tone - used as an abortifacient or to induce labor
misoprostol
PGE1 analog
increases production and secretion of gastric mucous barrier, decreases acid production. prevention of NSAID-induced peptic ulcers
used as an abortifactant along with MTX
anastrozole, letrazole, exemestane
block aromatase, stop conversion of androstenedione to estrone
AND
block conversion of testosterone to estradiol
asherman syndrome
someone scrapes away the basalis of the endometrium, causes amenorrhea
adenomyosis
endometriosis involvement of the uterine myometrium
two types of endometrial carcinoma
which is “endometrioid”
which is “serous”
hyperplasia due to unopposed estrogen - papillae formation - endometrioid - assc with endometrioid carcinoma of the ovary
serous - atrophic endometrium - sporadic - p53 mutations
see psammoma bodies in both
BRCA1 mutation - female cancer below the waist?
serous carcinoma of the ovary and fallopian tube
surface ovary tumor that resembles urothelium
Brenner tumor
brenner = bladder
coffee Bean nuclei
hyperthyroid
mass in the ovary
cystic teratoma composed primarily of thyroid tissue
struma ovarii
testicular/ovary tumor
pink cells containing crystals
leydig cells containing characteristic Reinke crystals
yes, leydig tumors can happen in females too
Meigs syndrome
fibroma that causes hydrothorax (pleural effusion) and ascites
kruckenberg tumor
met of diffuse gastric carcinoma (or breast or colon if they have signet ring cells) to bilateral ovaries
see signet ring cells (nucleus pushed to the side my mucous)
fibrinoid necrosis in the vessels of the placenta
preeclampsia
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets
Thrombi are being formed in the arteries of the liver of a pregnant woman
hypospadias
epispadias
failure of the urethral fold to close, opening of urethra on inferior surface of penis
epi - same, but on the top
lymphogranuloma venereum
waht causes
Chlamydia trachomatis (L1-3)
obligate intracellular (chlamydia = cloaked) because it needs host ATP
bowen disease
in situ carcinoma precancerous lesion of the shaft of the penis
erythroplasia of queyrat
cancer of the glans of the penis
varicocele
side of the body?
assc with what cancer?
usually left sided (because the left spermatic vein goes to the left renal vein before the IVC), associated with left sided renal cell carcinoma
testicular homogenous mass with no necrosis
seminoma
male with pain on urination along with fever and chills
what disease
what organisms in
young adults
older adults
acute prostatitis: urine shows WBC
young adults - C trachomatis, N gonorrhoeae
older adults - E coli, Pseudomonas
prostatic adenocarcinoma histo
lots of small glands with enlarged nuclei and darkened nucleoli
leuprolide
continuous GnRH analogs, used in prostate cancer
when continuous, they wear out and shut down the system
mutation in sonic hedgehog gene
holoprosencephaly
Wnt-7 gene
produced at the apical ectodermal ridge (thickened ecoderm at distal end of each developing limb)
necessary for proper organization along dorsal-ventral axis
FGF gene
produced at apical ectodermal ridge. stimulates mitosis of underlying mesoderm, providing for lengthening of limbs
Homeobox (HOX) genes
involved in segmental organization of embryo in a craniocaudal diraction. Code for stranscription factors
mutations –> appendages in wrong locations
teratogenic effects of:
ACE inhibitors
Alkylating agents
Aminoglycosides
Antiepileptic drugs
Diethylstilbestrol
Folate antagonists
Isotretinoin
Lithium
Methimazole
Tetracyclines
Thalidomide
Warfarin
ACE inhibitors: Renal damage
Alkylating agents: Absence of digits, multiple anomalies
Aminoglycosides: Ototoxicity A mean guy hit the baby in the ear.
Antiepileptic drugs: Neural tube defects, cardiac defects, cleft
palate, skeletal abnormalities (eg, phalanx/nail
hypoplasia, facial dysmorphism)
High-dose folate supplementation
recommended. Most commonly valproate,
carbamazepine, phenytoin, phenobarbital.
Diethylstilbestrol: Vaginal clear cell adenocarcinoma, congenital Müllerian anomalies
Folate antagonists: Neural tube defects Includes trimethoprim, methotrexate,
antiepileptic drugs.
Isotretinoin: Multiple severe birth defects Contraception mandatory. IsoTERATinoin.
Lithium: Ebstein anomaly (apical displacement of
tricuspid valve)
Methimazole: Aplasia cutis congenita
Tetracyclines: Discolored teeth, inhibited bone growth “Teethracyclines.”
Thalidomide: Limb defects (phocomelia, micromelia—
“flipper” limbs)
Limb defects with “tha-limb-domide.”
Warfarin: Bone deformities, fetal hemorrhage, abortion,
ophthalmologic abnormalities
Do not wage warfare on the baby; keep it heppy
with heparin (does not cross placenta).
mnemonic for branchial pouch derivatives
Ear, tonsils, bottom-to-top: 1 (ear), 2 (tonsils), 3 dorsal (bottom for inferior parathyroids), 3 ventral (to = thymus), 4 (top = superior parathyroids).
tolbutamide
first gen sulfonylurea
closes K channel in beta cell, depolarizes it causing insulin release
SE: disulf
chlorpropamide
first gen sulfonylurea
closes K channel in beta cell, depolarizes it causing insulin release
nateglinide, repaglinide
meglitinides
bind to the same K channels that sulfonylureas to, but in a different area
majority of normal flora of the Vag
lactobacilli - gram-pos faculative anaerobe
maintain a pH of around 3.5-4.2
media to culture N. gonorrhoeae
Thayer-Martin agar
tuberoinfundibular pathway
dopaminergic pathway
when the activity is decreased (by dopaminergic blockers such as antipsychotics), you get increased prolactin, decreased libido, sexual dysfunction, galactorrhea, gynecomastia (in men)
elevated alpha fetoprotein with normal estriol and beta-human chorionic gonadotropin
probably a neural tube defect
what treatment for diabetes can give you a gap acidosis
metformin - contraindicated in renal insufficiency
phenoxybenzamine
irreversible alpha antagonist used prior to tumor resection of pheo
phenoxybenzamine (16 letters) is given for
pheochromocytoma (16 letters)
greensih vaginal discharge, a friable cervix, itching and burning
what is it
plated?
Tx?
trichomonas
trophozoites (mobile) on wet mount, strawberry cervix
give metronidazole
treatment for gestational hypertension
Hypertensive Moms Love Nifedipine
Hydralazine, alpha Methyldopa, Labetalol, Nifedipine
antihistone antibodies
what disease
drug-induced SLE
getting lupus is SHIPP-E
sulfa drugs, hydralazine, isoniazid, phenytoin, procainamide, etanercept
hydralazine
what does it do
mech
increases cGMP, smooth muscle relaxation, vasodilates arterioles more than veins
usually administered with a beta blocker to reduce reflex tachycardia
torches infections
Toxoplasmosis Rubella Cytomegalo Herpes/HIV Syphilis
haemophilus ducreyi
causes Chancroid - a painful genital ulcer that is assc. with purulent inguinal adenopathy
gram neg coccobacillus
it’s so painful you “do cry” (ducreyi)
most common benign breast tumor in young women
what do you see on histo
fibroadenomas
fibrosing stroma around normal glandular tissue
