AAW - Endo/Repro Flashcards

1
Q

carcinoid syndrome

A

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).

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2
Q

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!

A

think carcinoid syndrome

carcinoid tumors now called neuroendocrine tumors i guess

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3
Q

diagnostic test for carcinoid syndrome

A

5-hydroxyindolacetic acid in urine

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4
Q

salt and pepper chromatic pattern with oval nucleus

A

neuroendocrine tumor

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5
Q

Adrenal hemorrhage, hypotension, DIC

what syndrome
what bacteria

A

waterhouse-friederichsen syndrome

Acute 1° adrenal insufficiency due to adrenal hemorrhage associated with Neisseria meningitidis
septicemia, DIC, and endotoxic shock.

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6
Q

exophthalmos, weight loss, palpitations

what is it
how do you diagnose

A

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

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7
Q

cervical dysplasia and cacinoma in sity assc with what virus

what are the genetic effects of the virus

A

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

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8
Q

all hormones produced by the anterior pituitary (adenohypophysis)

A

FLAT PiG:

FSH
LH
ACTH
TSH
ProlactIn
GH
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9
Q

bromocriptine

A

dopamine agonist

can be used to treat prolactinomas

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10
Q

octreotide

A

long acting somatostatin analog

treats acromegaly, glucagonoma, somatostatinoma (counter intuitive, but its for sx control), carcinoid syndrome, gastrinoma, esophageal varicies

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11
Q

pegvisomant

A

GH receptor antagonist

makes you short as a peg

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12
Q

main prolactin inhibitory factor

Tx for prolactinoma

A

Dopamine acting on D2 receptors

dopamine agonists (bromocriptine or cabergoline) are the Tx for prolactin secreting tumors

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13
Q
function of thyroid peroxidase
what blocks it (used for what purpose? SE?)
A

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

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14
Q

HLA subtype for hashimoto
autoantibodies for it
increased risk of what cancer
histologic finding

A

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

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15
Q

Jod-Basedow phenomenon

A

thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete

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16
Q

propylthiouracil

A

antithyroid

used in thyrotoxicosis, graves disease

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17
Q

tx for thyroid storm

A

three Ps

beta-blockers (Propanolol), Propylthiouracil, corticosteroids (Prednisone)

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18
Q

methimazole

A

used to treat thyroid hormone hypersecretion due to Graves’ disease or thyroid storm

inhibit thyroid peroxidase

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19
Q

mifepristone

A

competitive inhibitor of progestins at progesterone receptors. “morning after pill”

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20
Q

Wolff-Chaikoff

A

excess iodine temporarily inhibits thyroid peroxidase, get decreased iodine organification, decreased T3/4 production

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21
Q

hashimotos antibodies

A

antithyroid peroxidase (antimicrosomal), antithyroglobulin antibodies

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22
Q

graves antibodies

A

anti-TSH receptor (it actually stimulates the receptors)

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23
Q

hurthle cells

A

hashimotos

lymphoid aggregate with germinal centers in the thyroid

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24
Q

HLA type in hashimotos

A

HLA-DR5

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25
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
26
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
27
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
28
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)
29
hypertension, hypokalemia, metabolic alkalosis
Conn syndrome (cortical adenoma, primary hyperaldosteronism) hypokalemia - get weakness/fatigue/psycosis
30
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)
31
congenital adrenal hyperplasia - what enzyme is most commonly not working
21-hydroxylase - hypotension, hyperkalemia, increased renin, increased 17-hydroxyprogenterone (can't make aldosterone)
32
adrenal hemmorhage, hypotention, DIC
waterhouse-Friderichsed syndrome (meningococcemia) caused by neisseria Sx are from lack of mineralcorticoids
33
metanephrines in the urine
pheo also see VMA clusters of cells are called zellballen
34
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)
35
MEN assc with medullary carcinoma what do you do before they get it
MEN-2 A and B take out the thyroid
36
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
37
MEN-2A mnuemonic
2ps Parathyroids (medullary thyroid carcinoma secreting calcitonin) pheochromocytoma remember by drawing a square assc with ret gene mutations
38
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
39
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
40
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
41
exanatide
GLP-1 analog - makes people feel full increases insulin, decreases glucagon release, delays gastric emptying used for type 2 SE: nausea, vom, pancreatitis
42
liraglutide
GLP-1 analog - makes people feel full increases insulin, decreases glucagon release, delays gastric emptying used for type 2 SE: nausea, vom, pancreatitis
43
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
44
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
45
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
46
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!)
47
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)
48
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
49
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 Ž cell depolarizes Ž insulin release via  Ca2+ influx.
50
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)
51
Signaling pathways of endocrine hormones: IP3
(Gq receptors) GOAT HAG GnRH, Oxytocin, ADH ((qinky) V1 receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin
52
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
53
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.
54
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
55
Propylthiouracil
Thyroglobulin peroxidase inhibitor - used in graves disease (block tyrosine iodination (also known as organification)) and coupling
56
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
57
tunica albuginea
thick capsule around the testis that has septa that divide the different lobules
58
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
59
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)
60
finasteride
5-alpha reductase inhibitor, blocks the conversion of testosterone to DHT (the main stimulatory androgen of the prostate, external genitalia, and skin)
61
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
62
flutamide
a nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma
63
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.
64
what do modern pregnancy tests detect and what produces the thing that they detect
hCG | syncytiotrophoblasts
65
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
66
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
67
malignant, hemorrhagic and painful testicular tumor type? morphology? age?
embryonal carcinoma glandular/papillary morphology 20-30 year age group
68
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
69
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
70
clue cells
gardonella i have no clue why it smells like fish in the vagina garden...
71
solitary painless genital lesion
syphilis until proven otherwise
72
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
73
eczematous patches on the nipple that are red and itchy
paget disease resulting from underlying DCIS or invasive breast cancer.
74
washed out, multi-nucleated squamous cells on a pap smear what is it
herpes
75
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)
76
bilateral malignant ovarian neoplasm with psammoma bodies
serous cystadenocarcinoma most common malignant ovarian neoplasm
77
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
78
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
79
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
80
testicular tumor golden brown eosinophilic cytoplasmic inclusions gynecomastia in men, precocious puberty in boys
Leydig cell tumor
81
androblastoma tumor from sex cord stroma
Sertoli cell tumor
82
aggressive tumor in the testicle that is a met
testicular lymphoma
83
endometrial stuff that can cause polycythemia
leiomyoma causing increased erythropoietin production
84
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)
85
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
86
how do you monitor response of an ovarian neoplasm to therapy
CA 125 levels not good for screening tho
87
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
88
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
89
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
90
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
91
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
92
salpingectomy
removal of fallopian tube
93
placenta: accreta increta percreta
Defective decidual layer Ž 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 Ž postpartum bleeding (can cause Sheehan syndrome)
94
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")
95
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).
96
virus type: HPV
DNA DS and circular family: papillomavirus
97
koilocytes
HPV - rasin looking nuclei
98
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
99
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)
100
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 +
101
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 ```
102
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
103
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?)
104
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
105
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)
106
watery diarrhea, hypokalemia, increased pH on nasogastric suction fluid
WDHA syndrome seen in VIPomas watery diarrhea, hypokalemia, achlorhydria
107
prolactinoma Sx in men
low libido, infertility
108
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
109
where do these come from 17beta-estradiol estriol estrone
17beta-estradiol - ovary estriol - placenta estrone - adipose tissue potency (greatest to least): estradiol, estrone, estriol
110
what happens to FSH and LH levels in menopause
they go up because they are not inhibited by estrogen
111
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
112
drugs that can cause unwanted prolactin secretion
dopamine antagonists (most antipsychotics)
113
terbutaline, ritodrine
beta2 agonists that relax the uterus; used to decrease contraction frequency in women during labor
114
Treatment for preeclampsia
antihypertensives and IV magnesium sulfate to prevent seizure definitive is delivery
115
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
116
dinoprostone
natural PGE2 analog increases uterine tone - used as an abortifacient or to induce labor
117
carboprost
PGF2alpha analog increases uterine tone - used as an abortifacient or to induce labor
118
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
119
anastrozole, letrazole, exemestane
block aromatase, stop conversion of androstenedione to estrone AND block conversion of testosterone to estradiol
120
asherman syndrome
someone scrapes away the basalis of the endometrium, causes amenorrhea
121
adenomyosis
endometriosis involvement of the uterine myometrium
122
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
123
BRCA1 mutation - female cancer below the waist?
serous carcinoma of the ovary and fallopian tube
124
surface ovary tumor that resembles urothelium
Brenner tumor brenner = bladder coffee Bean nuclei
125
hyperthyroid | mass in the ovary
cystic teratoma composed primarily of thyroid tissue struma ovarii
126
testicular/ovary tumor pink cells containing crystals
leydig cells containing characteristic Reinke crystals | yes, leydig tumors can happen in females too
127
Meigs syndrome
fibroma that causes hydrothorax (pleural effusion) and ascites
128
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)
129
fibrinoid necrosis in the vessels of the placenta
preeclampsia
130
HELLP syndrome
Hemolysis Elevated Liver enzymes Low Platelets Thrombi are being formed in the arteries of the liver of a pregnant woman
131
hypospadias epispadias
failure of the urethral fold to close, opening of urethra on inferior surface of penis epi - same, but on the top
132
lymphogranuloma venereum waht causes
Chlamydia trachomatis (L1-3) obligate intracellular (chlamydia = cloaked) because it needs host ATP
133
bowen disease
in situ carcinoma precancerous lesion of the shaft of the penis
134
erythroplasia of queyrat
cancer of the glans of the penis
135
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
136
testicular homogenous mass with no necrosis
seminoma
137
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
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prostatic adenocarcinoma histo
lots of small glands with enlarged nuclei and darkened nucleoli
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leuprolide
continuous GnRH analogs, used in prostate cancer | when continuous, they wear out and shut down the system
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mutation in sonic hedgehog gene
holoprosencephaly
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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
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FGF gene
produced at apical ectodermal ridge. stimulates mitosis of underlying mesoderm, providing for lengthening of limbs
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Homeobox (HOX) genes
involved in segmental organization of embryo in a craniocaudal diraction. Code for stranscription factors mutations --> appendages in wrong locations
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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).
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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). ```
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tolbutamide
first gen sulfonylurea closes K channel in beta cell, depolarizes it causing insulin release SE: disulf
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chlorpropamide
first gen sulfonylurea closes K channel in beta cell, depolarizes it causing insulin release
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nateglinide, repaglinide
meglitinides bind to the same K channels that sulfonylureas to, but in a different area
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majority of normal flora of the Vag
lactobacilli - gram-pos faculative anaerobe maintain a pH of around 3.5-4.2
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media to culture N. gonorrhoeae
Thayer-Martin agar
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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)
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elevated alpha fetoprotein with normal estriol and beta-human chorionic gonadotropin
probably a neural tube defect
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what treatment for diabetes can give you a gap acidosis
metformin - contraindicated in renal insufficiency
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phenoxybenzamine
irreversible alpha antagonist used prior to tumor resection of pheo phenoxybenzamine (16 letters) is given for pheochromocytoma (16 letters)
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greensih vaginal discharge, a friable cervix, itching and burning what is it plated? Tx?
trichomonas trophozoites (mobile) on wet mount, strawberry cervix give metronidazole
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treatment for gestational hypertension
Hypertensive Moms Love Nifedipine Hydralazine, alpha Methyldopa, Labetalol, Nifedipine
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antihistone antibodies what disease
drug-induced SLE getting lupus is SHIPP-E sulfa drugs, hydralazine, isoniazid, phenytoin, procainamide, etanercept
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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
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torches infections
``` Toxoplasmosis Rubella Cytomegalo Herpes/HIV Syphilis ```
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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)
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most common benign breast tumor in young women what do you see on histo
fibroadenomas fibrosing stroma around normal glandular tissue