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*First Aid in Brainscape* > AAW - Endo/Repro > Flashcards

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
Q

patient was sick NOS like a week ago, they have tender area around their adams apple and jaw pain

A

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

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26
Q

person comes in because they are having trouble breathing, and have a rockhard painless goiter

A

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

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27
Q

thyroid biopsy shows empty-appearing nuclei

A

“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

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28
Q

Medullary carcinoma of the thyroid

Cells?
histo findings?
ass with what?

A

from parafollicular “C cells”; produces calcitonin, sheets of cells in an amyloid stroma. Associated with MEN 2A and 2B (RET mutations)

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29
Q

hypertension, hypokalemia, metabolic alkalosis

A

Conn syndrome (cortical adenoma, primary hyperaldosteronism)

hypokalemia - get weakness/fatigue/psycosis

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30
Q

secondary hyperaldosteronism vs primary - how can you tell the difference?

A

in secondary, your renin is up (kidneys are underperfused for example)

in primary, the renin is down (aldosterone secreting tumor, for example)

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31
Q

congenital adrenal hyperplasia - what enzyme is most commonly not working

A

21-hydroxylase -

hypotension, hyperkalemia, increased renin, increased 17-hydroxyprogenterone (can’t make aldosterone)

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32
Q

adrenal hemmorhage, hypotention, DIC

A

waterhouse-Friderichsed syndrome (meningococcemia)
caused by neisseria

Sx are from lack of mineralcorticoids

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33
Q

metanephrines in the urine

A

pheo

also see VMA

clusters of cells are called zellballen

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34
Q

diagnostic findings of neuroblastoma

oncogene?

A

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)

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35
Q

MEN assc with medullary carcinoma

what do you do before they get it

A

MEN-2 A and B

take out the thyroid

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36
Q

MEN-1 mneumonic

A

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

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37
Q

MEN-2A mnuemonic

A

2ps

Parathyroids (medullary thyroid carcinoma secreting calcitonin)
pheochromocytoma

remember by drawing a square

assc with ret gene mutations

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38
Q

MEN-2B mneumonic

A

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

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39
Q

give 2 examples of a first gen sulfonylurea, SE too

give 3 examples of a second gen sulfonylurea, SE too

mech?

A

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

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40
Q

Pramlintide

A

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

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41
Q

exanatide

A

GLP-1 analog - makes people feel full

increases insulin, decreases glucagon release, delays gastric emptying

used for type 2

SE: nausea, vom, pancreatitis

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42
Q

liraglutide

A

GLP-1 analog - makes people feel full

increases insulin, decreases glucagon release, delays gastric emptying

used for type 2

SE: nausea, vom, pancreatitis

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43
Q

acarbose

A

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

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44
Q

miglitol

A

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

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45
Q

pioglitazone, rosiglitazone

A

“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

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46
Q

what does activation of PPAR-gamma do

A

increases insulin sensitivity and levels of adiponectin

the glitazones do this

(also the fibrates activate PPAR-alpha to induce HDL synthesis!)

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47
Q

metformin

A

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)

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48
Q

linagliptin
saxagliptin
sitagliptin

A

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

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49
Q

what diabetes medication has an increased risk of hypoglycemia in patients with renal failure

A

sulfonylureas (most common in glipizide)

Close K+ channel in β-cell
membrane Ž cell depolarizes
Ž insulin release via  Ca2+
influx.

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50
Q

Signaling pathways of endocrine hormones:

cAMP

A

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)

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51
Q

Signaling pathways of endocrine hormones:

IP3

A

(Gq receptors)

GOAT HAG

GnRH, Oxytocin, ADH ((qinky) V1 receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin

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52
Q

Signaling pathways of endocrine hormones:

intrinsic tyrosine kinase

A

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

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53
Q

Signaling pathways of endocrine hormones:

Receptor-associated tyrosine kinase

A

Prolactin, Immunomodulators (e.g. cytokines, IL-2, IL-6, IL-8, IFN), GH

JAK/STAT pathway
think acidophiles and cytokines

P.I.G.

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54
Q

what drugs can be used in diabetes that decreases glucose absorption

A

SGLT2 inhibitors decrease reabsorption of glucose in the PCT

also the α-glucosidase inhibitors:
Acarbose
Miglitol

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55
Q

Propylthiouracil

A

Thyroglobulin peroxidase inhibitor - used in graves disease

(block tyrosine iodination (also known as organification)) and coupling

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56
Q

what cells secrete androgens that stimulate the development of mesonephric ducts and testosterone (in the presence of LH)

where are they found

A

leydig cells

testosterone production is unaffected by temp, btw

found in the interstitium between the seminiferous tubules

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57
Q

tunica albuginea

A

thick capsule around the testis that has septa that divide the different lobules

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58
Q

what cells secrete inhibit and what do they do

A

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

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59
Q

main energy source for motile sperm

where is it made

A

fructose

made in the seminal vesicles (seminal fluid is rich in fructose, ascorbic acid, and prostaglandins)

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60
Q

finasteride

A

5-alpha reductase inhibitor, blocks the conversion of testosterone to DHT (the main stimulatory androgen of the prostate, external genitalia, and skin)

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61
Q

what is the difference between hypogonadotropic hypogonadism and primary hypogonadism

A

hypogonadotropic gonadism is a lack of LH and testosterone

primary hypogonadism is a lack of testosterone and an increase in LH

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62
Q

flutamide

A

a nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma

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63
Q

person has failure to complete puberty, decreased GnRH, FSH, LH

also has anosmia (can’t smell)

A

Kallmann syndrome

defective migration of GnRH cells and formation of olfactory bulb.

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64
Q

what do modern pregnancy tests detect and what produces the thing that they detect

A

hCG

syncytiotrophoblasts

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65
Q

testicular tumor most common in young boys

A

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
Q

testicular tumor with large cells in lobules with a watery cytoplasm

elevated alkaline phosphatase

A

seminoma - “fried egg”

malignant, painless, homogenous, no necrosis

most common in third decase

67
Q

malignant, hemorrhagic and painful testicular tumor

type?
morphology?
age?

A

embryonal carcinoma

glandular/papillary morphology

20-30 year age group

68
Q

what cells that are naturally in placentas also show up in seminomas and choriocarcinoma

what symptoms can it produce

A

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
Q

what bugs can cause perihepatitis, when the liver binds to the peritoneum and forms violin string adhesions

A

chlamydia trachomatis

neisseria gonorrhoeae
chlamydia trachomatis

called fitz-hugh-curtis syndrome

comes on after pelvic inflammatory disease

70
Q

clue cells

A

gardonella

i have no clue why it smells like fish in the vagina garden…

71
Q

solitary painless genital lesion

A

syphilis until proven otherwise

72
Q

HPV serotypes assc. with warts

types assc. with cervical cancer

which have a vaccine

A

1,2,6,11 - warts

16,18 - cervical cancer

6,11,16,18 have vaccine

73
Q

eczematous patches on the nipple that are red and itchy

A

paget disease resulting from underlying DCIS or invasive breast cancer.

74
Q

washed out, multi-nucleated squamous cells on a pap smear

what is it

A

herpes

75
Q

tamoxifen and raloxifene

mech
similarities and differences

A

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
Q

bilateral malignant ovarian neoplasm with psammoma bodies

A

serous cystadenocarcinoma

most common malignant ovarian neoplasm

77
Q

psammoma modies are seen in what

A

PSaMMoma

Papillary carcinoma of thyroid (orphan annie eyes)

Serous papillary cystadenocarcinoma of ovary (bilateral, bad prognosis)

Meningioma

Malignant mesothelioma

78
Q

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

A

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
Q

whorled pattern of smooth muscle bundles with well-demarcated borders on biopsy of the endometrium

A

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
Q

testicular tumor
golden brown
eosinophilic cytoplasmic inclusions
gynecomastia in men, precocious puberty in boys

A

Leydig cell tumor

81
Q

androblastoma tumor from sex cord stroma

A

Sertoli cell tumor

82
Q

aggressive tumor in the testicle that is a met

A

testicular lymphoma

83
Q

endometrial stuff that can cause polycythemia

A

leiomyoma causing increased erythropoietin production

84
Q

drugs that can be used for polycystic ovarian syndrome to reduce androgenic symptoms

A

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
Q

amenorrhea/oligomenorrhea, hisrutism, acne, not fertile, obese

Tx

A

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
Q

how do you monitor response of an ovarian neoplasm to therapy

A

CA 125 levels

not good for screening tho

87
Q

55 yo, breast tenderness, bleeding from vagina

in the ovary, ovary granulosa cells arranged haphazardly around collections of eosinophilic fluid

A

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
Q

what is meant by

pseudomyxoma peritonei

A

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
Q

post menopause

tumor that contains immature fetal tissue, neuroectoderm

what tissue in the most common?

A

immature teratoma of the ovary

neuroectoderm is the most common

90
Q

adolescent ovarian mass

fried egg cells

hCG, LDH up

A

dysgerminoma - most common malignant germ cell tumor - clear cytoplasm and central nuclei

equivalent to male seminoma but rarer

91
Q

ovarian tumor that resembles glomeruli

what tumor
what are the glomerulus like structures called
tumor marker?

A

schiller-duval bodies

found in a yolk sac tumor “endodermal sinus tumor”

AFP is tumor marker

92
Q

salpingectomy

A

removal of fallopian tube

93
Q

placenta:

accreta
increta
percreta

A

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
Q

abrupt painful bleeding in third trimester

A

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
Q

causes of postpartum hemorrhage

A

Due to 4 T’s: Tone (uterine atony; most
common), Trauma (lacerations, incisions,
uterine rupture), Thrombin (coagulopathy),
Tissue (retained products of conception).

96
Q

virus type: HPV

A

DNA
DS and circular

family: papillomavirus

97
Q

koilocytes

A

HPV - rasin looking nuclei

98
Q

lichen simplex chronicus

A

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
Q

white vagina

ddx

A

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
Q

how do you differentiate between paget’s disease of the vulva and vulvular melanoma

A

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
Q

decreased androstenedione and not going into puberty

deficiency?
mineralcoticoids?
cortisol?
sex hormones?
PB?
K?
A 
17alpha-hydroxylase def
increased mineralcorticoids
decreased cortisol
decreased sex hormones
increased BP
decreased K
102
Q

salt wasting in infancy and precocious puberty, virilization in females

deficiency?
mineralocorticoids?
cortisol?
sex hormones?
PB?
K?
renin activity?
concentration of 17-hydroxyprogesterone?
A 
21-hydroxylase def
decreased mineralocorticoids
decreased cortisol
increased sex hormones
decreased BP
increased K

increased renin activity
increased 17-hydroxyprogesterone

103
Q

Virilization in a female with increased blood pressure

deficiency?
mineralocorticoids?
cortisol?
sex hormones?
K?
renin activity?
A

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
Q

triiodothyronine resin uptake test results in a person with hypothyroidism

A

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
Q

what causes elevated levels of PTH in people with kidney failure

A

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
Q

watery diarrhea, hypokalemia, increased pH on nasogastric suction fluid

A

WDHA syndrome seen in VIPomas

watery diarrhea, hypokalemia, achlorhydria

107
Q

prolactinoma Sx in men

A

low libido, infertility

108
Q

lab test that would most likely be abnormal in a patient with acromegaly

A

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
Q

where do these come from

17beta-estradiol

estriol

estrone

A

17beta-estradiol - ovary

estriol - placenta

estrone - adipose tissue

potency (greatest to least): estradiol, estrone, estriol

110
Q

what happens to FSH and LH levels in menopause

A

they go up because they are not inhibited by estrogen

111
Q

patient has headache and vom

cannot look up

where is the tumor and why the headache/vom

A

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
Q

drugs that can cause unwanted prolactin secretion

A

dopamine antagonists (most antipsychotics)

113
Q

terbutaline, ritodrine

A

beta2 agonists that relax the uterus; used to decrease contraction frequency in women during labor

114
Q

Treatment for preeclampsia

A

antihypertensives and IV magnesium sulfate to prevent seizure

definitive is delivery

115
Q

what is the difference between heart and smooth muscle with in relation to cAMP levels

A

cAMP increase in cardiac muscle increases contraction

cAMP levels in smooth muscle decrease contraction

116
Q

dinoprostone

A

natural PGE2 analog

increases uterine tone - used as an abortifacient or to induce labor

117
Q

carboprost

A

PGF2alpha analog

increases uterine tone - used as an abortifacient or to induce labor

118
Q

misoprostol

A

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
Q

anastrozole, letrazole, exemestane

A

block aromatase, stop conversion of androstenedione to estrone

AND

block conversion of testosterone to estradiol

120
Q

asherman syndrome

A

someone scrapes away the basalis of the endometrium, causes amenorrhea

121
Q

adenomyosis

A

endometriosis involvement of the uterine myometrium

122
Q

two types of endometrial carcinoma

which is “endometrioid”

which is “serous”

A

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
Q

BRCA1 mutation - female cancer below the waist?

A

serous carcinoma of the ovary and fallopian tube

124
Q

surface ovary tumor that resembles urothelium

A

Brenner tumor

brenner = bladder

coffee Bean nuclei

125
Q

hyperthyroid

mass in the ovary

A

cystic teratoma composed primarily of thyroid tissue

struma ovarii

126
Q

testicular/ovary tumor

pink cells containing crystals

A

leydig cells containing characteristic Reinke crystals

yes, leydig tumors can happen in females too

127
Q

Meigs syndrome

A

fibroma that causes hydrothorax (pleural effusion) and ascites

128
Q

kruckenberg tumor

A

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
Q

fibrinoid necrosis in the vessels of the placenta

A

preeclampsia

130
Q

HELLP syndrome

A

Hemolysis

Elevated Liver enzymes

Low Platelets

Thrombi are being formed in the arteries of the liver of a pregnant woman

131
Q

hypospadias

epispadias

A

failure of the urethral fold to close, opening of urethra on inferior surface of penis

epi - same, but on the top

132
Q

lymphogranuloma venereum

waht causes

A

Chlamydia trachomatis (L1-3)

obligate intracellular (chlamydia = cloaked) because it needs host ATP

133
Q

bowen disease

A

in situ carcinoma precancerous lesion of the shaft of the penis

134
Q

erythroplasia of queyrat

A

cancer of the glans of the penis

135
Q

varicocele

side of the body?
assc with what cancer?

A

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
Q

testicular homogenous mass with no necrosis

A

seminoma

137
Q

male with pain on urination along with fever and chills

what disease

what organisms in
young adults
older adults

A

acute prostatitis: urine shows WBC

young adults - C trachomatis, N gonorrhoeae

older adults - E coli, Pseudomonas

138
Q

prostatic adenocarcinoma histo

A

lots of small glands with enlarged nuclei and darkened nucleoli

139
Q

leuprolide

A

continuous GnRH analogs, used in prostate cancer

when continuous, they wear out and shut down the system

140
Q

mutation in sonic hedgehog gene

A

holoprosencephaly

141
Q

Wnt-7 gene

A

produced at the apical ectodermal ridge (thickened ecoderm at distal end of each developing limb)

necessary for proper organization along dorsal-ventral axis

142
Q

FGF gene

A

produced at apical ectodermal ridge. stimulates mitosis of underlying mesoderm, providing for lengthening of limbs

143
Q

Homeobox (HOX) genes

A

involved in segmental organization of embryo in a craniocaudal diraction. Code for stranscription factors

mutations –> appendages in wrong locations

144
Q

teratogenic effects of:

ACE inhibitors

Alkylating agents

Aminoglycosides

Antiepileptic drugs

Diethylstilbestrol

Folate antagonists

Isotretinoin

Lithium

Methimazole

Tetracyclines

Thalidomide

Warfarin

A

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).

145
Q

mnemonic for branchial pouch derivatives

A 
Ear, tonsils, bottom-to-top:
1 (ear),
2 (tonsils),
3 dorsal (bottom for inferior
parathyroids),
3 ventral (to = thymus),
4 (top = superior
parathyroids).
146
Q

tolbutamide

A

first gen sulfonylurea

closes K channel in beta cell, depolarizes it causing insulin release

SE: disulf

147
Q

chlorpropamide

A

first gen sulfonylurea

closes K channel in beta cell, depolarizes it causing insulin release

148
Q

nateglinide, repaglinide

A

meglitinides

bind to the same K channels that sulfonylureas to, but in a different area

149
Q

majority of normal flora of the Vag

A

lactobacilli - gram-pos faculative anaerobe

maintain a pH of around 3.5-4.2

150
Q

media to culture N. gonorrhoeae

A

Thayer-Martin agar

151
Q

tuberoinfundibular pathway

A

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)

152
Q

elevated alpha fetoprotein with normal estriol and beta-human chorionic gonadotropin

A

probably a neural tube defect

153
Q

what treatment for diabetes can give you a gap acidosis

A

metformin - contraindicated in renal insufficiency

154
Q

phenoxybenzamine

A

irreversible alpha antagonist used prior to tumor resection of pheo

phenoxybenzamine (16 letters) is given for
pheochromocytoma (16 letters)

155
Q

greensih vaginal discharge, a friable cervix, itching and burning

what is it
plated?
Tx?

A

trichomonas

trophozoites (mobile) on wet mount, strawberry cervix

give metronidazole

156
Q

treatment for gestational hypertension

A

Hypertensive Moms Love Nifedipine

Hydralazine, alpha Methyldopa, Labetalol, Nifedipine

157
Q

antihistone antibodies

what disease

A

drug-induced SLE

getting lupus is SHIPP-E

sulfa drugs, hydralazine, isoniazid, phenytoin, procainamide, etanercept

158
Q

hydralazine

what does it do
mech

A

increases cGMP, smooth muscle relaxation, vasodilates arterioles more than veins

usually administered with a beta blocker to reduce reflex tachycardia

159
Q

torches infections

A 
Toxoplasmosis
Rubella
Cytomegalo
Herpes/HIV
Syphilis
160
Q

haemophilus ducreyi

A

causes Chancroid - a painful genital ulcer that is assc. with purulent inguinal adenopathy

gram neg coccobacillus

it’s so painful you “do cry” (ducreyi)

161
Q

most common benign breast tumor in young women

what do you see on histo

A

fibroadenomas

fibrosing stroma around normal glandular tissue

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