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Patho > final exam > Flashcards

final exam Flashcards

1
Q

different pancreatic cell types: alpha cell

A

stimulate release of glucagon and glycogen stores and promote gluconeogenesis

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2
Q

different pancreatic cell types: beta cell

A

stimulate release of insulin and lower blood glucose level

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3
Q

different pancreatic cell types: delta cell

A

inhibit glucagon and insulin secretion

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4
Q

acute pancreatitis

pathogenesis
causes

A

inflammation and hemorrhage of pancreas (premature activation of trypsin –> pancreatic enzymes autodigest pancreatic parenchyma

alcohol, gallstones, trauma

pancreatic pseudocysts (liquefactive necrosis), pancreatic abscess (E. coli)

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5
Q

chronic pancreatitis

pathogenesis
causes
symptoms
signs
risks

A

fibrosis of pancreatic parenchyma secondary to recurrent acute pancreatitis

alcohol, CF, idiopathic

epigastric pain radiating to back, pancreatic insufficiency

dystrophic calcification on xray (“chain of lakes” pattern)

may inc. risk of pancreatic carcinoma

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6
Q

T1D

pathogenesis
classification
risks
symptoms
treatment

A

insulin deficiency (hyperglycemia) due to autoimmune destruction of beta cells by T lymphocytes, inflammation of islets

HLA-DR3 and DR4, autoantibodies against insulin

untreated –> ketosis and diabetic ketoacidosis

weight loss, polydipsia, polyphagia, weakness

need lifelong insulin

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7
Q

T2D

pathogenesis
side effects
diagnosis (levels)

A

non-insulin dependent, insulin resistance and inadequate insulin secretion, resistance linked with inc. levels of free fatty acids and pro-inflammatory cytokines

lipotoxicity (toxic effects of excess free fatty acids), unregulated secretion on cytokines

amyloid deposits

dx: (normal 70-120 ug/dL) random > 200, fasting > 126, gestational > 200

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8
Q

T1D emergency: diabetic ketoacidosis

pathogenesis
symptoms
treatment

A

bodys change to fat metabolism and build up of ketones (acidosis)

hyperglycemia (>300), hypercalcemia, Keussmaul respirations, dehydration, fruity breath

tx with fluids, insulin, electrolytes

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9
Q

T2D emergency: hyperglycemic hyperosmolar non-ketotic coma (HHNC)

pathogenesis
sign
treatment

A

(>500 mg/dL) —> diuresis with hypotension and coma

absent ketones due to dec. insulin, hyperglycemia

tx with fluids and insulin

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10
Q

hypoglycemia: insulin shock

levels
treatment

A

< 60 mg/dL, medical emergency

tx with oral glucose (if awake and able, 15-30 gram or food/drink, slower activation), IV glucose (dextrose 50% D50 for adult, D25 for children, D10 for infants)

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11
Q

pituitary tumors

sizing
pathogenesis

A

macro > 1 cm or micro < 1 cm adenoma

lesion causing compression of optic chiasm or basal portion of brain

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12
Q

pituitary tumors: prolactinoma

pathogenesis, male/female
commonality
treatment

A

inc. prolactin, female: galactorrhoea and amenorrhea, male: dec libido and headache

most common type of pituitary adenoma

tx with dopamine antagonists or sx

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13
Q

pituitary tumors: GH cell adenoma

levels
symptoms
treatment

A

inc. GH

gigantism if before epiphyseal closure (F: 12-16, M: 14-19)
acromegaly if after epiphyseal closure (jaw, hands, feet, face)

treat with GH receptor agonist

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14
Q

pituitary tumors: ACTH

causes…

A

Cushing’s Sydnrome

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15
Q

hypopituitarism

definition
cause

A

deficient secretion of only one or a few pituitary hormones

caused by tumor

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16
Q

panhypopituitarism

definition

A

total failure of pituitary function

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17
Q

Sheehan syndrome

definition
pathogenesis
cause
cause of symptoms

A

pregnancy related infarct of pituitary gland

2x in size but blood supply does not inc.

infarct caused by blood loss and shock during childbirth

symptoms due to loss of gonadatropins, then TSH and ACTH

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18
Q

empty sella syndrome

pathogenesis
disturbance

A

thin, flat pit. gland secondary to congenital defect or absented diaphragma sella, CSF pressure into sella

minor endocrine disturbance

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19
Q

diseases of posterior pituitary: syndrome of inappropriate ADH (SIADH) secretion

definition
symptom
treatment

A

ectopic production of ADH by various tumor

water retention with hyponatremia

treat with water restriction

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20
Q

diseases of posterior pituitary: ADH deficiency

results in
symptoms
treatment

A

results in diabetes insipidus

dehydration, insatiable thirst

treat with ADH analog

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21
Q

Marfan syndrome

A

connective tissue

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22
Q

thyroid hormone: hypo-

levels
symptoms

A

dec free T4 inc TSH

cretinism (iodine deficiency), mental retardation, growth impairment, large tongue, big abdomen

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23
Q

thyroid hormone: hypo- … myxedema

who does it affect
symptoms

A

women

weight gain (dec BMR), lower voice, constipation, physical/mental slowness, puffy, dry skin, brittle hair, hair loss, inc. relaxation stage of deep tendon reflexes

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24
Q

thyroid hormone: hypo- … hashimoto’s

classification
main symptom

A

HLA-DR5, anti-thyroglobulin and anti-microsomal antibodies

chronic inflammation

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25
Q

thyroid hormone: hyper- … grave’s disease

pathogenesis
who does it affect, classification
symptom
treatment

A

autoantibody (IgG) that stimulates TSH receptor (type II hypersensitivity); TSI reacts with TSH receptors = glandular hyperplasia and enlargement, stimulates thyroid hormones production

women, inc. in HLA-DR3

exophthalmos

treat with anti-thyroid drugs, thyroidectomy, radioactive iodine

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26
Q

thyroid hormone: hyper- … plummer’s disease

A

less severe symptoms than graves and never develop exophthalmos

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27
Q

thyroid hormone: goiter

A

thyroid enlargement

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28
Q

thyroid hormone: goiter - simple (nontoxic)

A

without thyroid hormone dysfunction

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29
Q

thyroid hormone: goiter - toxic

A

hyperthyroidism

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30
Q

thyroid hormone: goiter - endemic

A

high frequency in iodine-deficient geographic area

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31
Q

thyroid hormone: goiter - sporadic

A

non-iodine deficient area

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32
Q

thyroid hormone: goiter - nodular

A

irregular thyroid enlargement = nodule formation

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33
Q

thyroid hormone: goiter - nodular colloid

A

late stage simple goiter, looks nodular

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34
Q

thyroid cancer: papillary carcinoma

definition
malignancy
incidence
survival

A

papillae lined by cuboidal cells with clear nuclei

low grade malignancy

incidence 70%

survival 85% @ 20 years

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35
Q

thyroid cancer: follicular carcinoma

cells affected
who is affected
incidence

A

thyroid follicular cells

women, aggressive

incidence 20%

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36
Q

thyroid cancer: medullary carcinoma

definition
survival
incidence

A

amyloid deposits in tumor and inc. calcification

aggressive

survival 50% @ 5 years

incidence 5%

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37
Q

thyroid cancer: anaplastic carcinoma

malignancy
survival
incidence

A

highly malignant, rapid growth

most patients die within 1 year

incidence 1%

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38
Q

parathyroid diseases: hyper-

A

Ca2+ inc.

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39
Q

parathyroid diseases: hypo-

levels
causes
symptoms
treatment

A

Ca2+ dec.

accidental surgical excision, DiGeorge

hypocalcemia, neuromuscular excitability and tetany

treat with high Ca2+ diet and vitamin D supplement

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40
Q

parathyroid diseases: primary hyperparathyroidism

pathogenesis
treatment
associated disease

A

excess PTH, parathyroid adenoma (> 80% causes)

treat with sx

von Recklinghausen disease

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41
Q

parathyroid diseases: secondary hyperparathyroidism

definition
levels

A

compensatory parathyroid hyperplasia in response to hypocalcemia due to chronic renal disease

inc. PTH

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42
Q

parathyroid diseases: pseudohypo-

levels
pathogenesis

A

dec. Ca2+, inc. phosphate, inc. PTH

multihormone resistance (PTH, LSH, LH, FSH)

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43
Q

adrenal cortex: hyper- … Cushing’s

signs
causes
dx
symptoms
treatment

A

inc. glucocorticoids

exogenous corticosteroid medication, hyperproduction of ACTH, adrenal cortical adenoma or adrenal carcinoma, ectopic production of ACTH by non-pit. carcinomas

dx with 24 hour inc. cortisol (blood or urine)

moon face, buffalo hump

treat with cortisol inhibition and sx

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44
Q

adrenal cortex: hyper- … Conn’s

A

inc. aldosterone, secreting adenoma

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45
Q

adrenal cortex: hyper- … congenital adrenal hyperplasia

definition
treatment

A

absent sex steroid with hyperplasia of both adrenal glands

treat with HRT

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46
Q

adrenal cortex: hypo - … Addison’s

cause
sign
treatment

A

due to idiopathic adrenal atrophy, autoimmune, TB

hyperpigmentation (inc. ACTH)

treat with corticosteroids

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47
Q

tumors of the adrenal medulla: neuroblastoma

definition
cell signs
treatment

A

highly malignant catecholamine-producing tumor in early childhood

small round blue cells with rosette like structures

rarely causes hypertension

treat with sx and chemo

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48
Q

TORCH

definition
fetal symptoms
stands for

A

intrauterine infection from mom to fetus

microcephaly, CNS calcification, rash, hepatosplenomegaly, thrombocytopenia

Toxoplasma
Other
Rubella
Cytomegalo virus
Herpes simplex virus 1&2

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49
Q

neural tube defects

caused by

A

maternal folic acid deficiency

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50
Q

neural tube defects: spina bifida

A

failure to lose posterior vertebral arches

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51
Q

neural tube defects: spina bifida occulta

A

no apparent abnormalities, patch of hair over vertebral defect

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52
Q

neural tube defects: spina bifida cystica

A

herniation of meninges through a defect

meningocele: meninges only
meningomyelocele: protrusion of meninges and spinal cord

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53
Q

Tay-Sachs

who does it affect
symptoms
pathogenesis

A

Jewish kids

fixed gaze, distinctive cherry red spot

hexosaminidase A is a lysosomal enzyme involved in breakdown of gangliosides (type of phospholipid), accumulation of GM2 gangliosides

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54
Q

anencephaly

A

absence of fetal brain tissue and overlying skull, frog like looking

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55
Q

Down’s syndrome

cause
signs
dx

A

trisomy 21

gaping mouth, large tongue, heart and GI defects

dx with inc. alpha protein or inc. estriol in blood or amniotic fluid of mother

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56
Q

Arnold-Chiari malformation

definition
results in
causes…

A

downward displacement of cerebellar tonsils and medulla through foramen magnum

results in pressure atrophy of displaced brain tissue

causes hydrocephalus due to CSF outflow obstruction

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57
Q

dandy-walker malformation

pathogenesis
dx
prevention

A

failed development of cerebellar vermis, massively dilated 4th ventricle with absent cerebellum and hydrocephalus

dx with ultrasound or inc. acetylcholine esterase

prevent with supplementary folic acid over 1,000 ug/day

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58
Q

hydrocephalus

pathogenesis

A

inc. volume of CSF due to obstruction of CSF circulation by congenital malformation, inflammation, tumors, or dec. cerebral mass (ex: Alzheimer’s)

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59
Q

chronic traumatic encephalopathy (CTE)

cause
pathogenesis
when does it happen
symptoms

A

history of repeated TBI

progressive degeneration of brain tissue, buildup of protein tau

months to years after TBI

memory loss, confusion, impaired judgement, impulse control issues, aggression, depression, progressive dementia

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60
Q

bullet wounds to the head: high velocity vs low velocity

A

high: immediate inc. supratentorial pressure and clean thru to death, like a sniper

low: inc. pressure at gradual rate, hemorrhagic, edema, can do more internal damage

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61
Q

hemorrhages: epidural hematoma

flow
definition
urgency

A

arterial

laceration of branches of middle meningeal artery, skull fx

immediate emergency, lens shape lesion on CT

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62
Q

hemorrhages: subdural hematoma

flow
definition
when does it happen

A

venous

collection of blood under dura, crescent shape lesion on CT, inc. ICP

hours, days, weeks later

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63
Q

hemorrhages: subarachnoid hemorrhage

definition
cause
mortality

A

berry aneurysm of circle of Willis

by traumatic brain contusion or rupture of berry aneurysm

high mortality, blood in CSF

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64
Q

Cushing’s reflex for ICP

A

INC BP (dec with shock)
dec pulse
dec respiration
dec consciousness

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65
Q

trauma of CNS: coup

A

impact site = injury site

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66
Q

trauma of CNS: contrecoup

A

injury site opposite of impact site, head stops and brain collides into skull

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67
Q

diffuse axonal injury (DAI)

A

result from TBI, neuro deficit and coma, researched by military

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68
Q

coma scoring

A

13 or lower: mild BI
9-12: moderate BI
8 or lower: severe BI

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69
Q

spinal injury: anterior cord syndrome

definition

A

bony fragments put pressure on anterior cord = loss of motor movements and pain below injury

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70
Q

spinal injury: central cord syndrome

definition

A

hyperextension of c-spine = loss of motor movements in UE and disruption

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71
Q

spinal injury: brown-sequard syndrome

definition
cause

A

injury to one side of spinal cord = sensory and motor loss on same side, pain and temperature loss on the other side

penetrating injury is cause

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72
Q

stroke

definition
types
causes

A

cerebrovascular compromise

ischemia (85%), hemorrhage (15%)

cerebral thrombosis, cerebral embolus, cerebral hemorrhage, carotid artery ateriosclerosis

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73
Q

stroke: transient ischemic attack

definition
duration/damage
indicative of…

A

temporary disturbance of cerebral circulation, damage is not permanent, indicative of carotid artery disease, symptoms resolve in minutes

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74
Q

SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS

Embolic Stroke

A

embolus from another location

caused by atrial fibrillation

clots form in heart and go to the brain

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75
Q

SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS

Thrombolytic stroke

A

thrombus developed at clogged part of vessel

happens at nighttime

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76
Q

SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS

Lacunar (cryptogenic) stroke

A

blockage of cerebral artery

brain cells in a small area are damaged or killed by lack of O2, causes significant disability

hypertension and plaque in carotid arteries are contributing factors

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77
Q

stroke: hemorrhagic stroke

definition
location

A

bleeding interferes with brain function

can be within brain or between brain and skull

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78
Q

stroke: hemorrhagic stroke - intracerebral bleeding

causes

A

due to berry aneurysm or hypertension

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79
Q

stroke: hemorrhagic stroke - subarachnoid hemorrhage

pathogenesis
cause

A

damaged blood vessels = blood accumulates at brain surface, blood into CSF, inc. pressure = immediate headache, artery spasms

leaking sacular aneurysm or arteriovenous malformation (AVM)

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80
Q

stroke symptoms

A

facial drooping, difficulty speaking, headache, weakness/paralysis on one side, numbness, incontinence

HYPOGLYCEMIC PATIENTS MIMIC STROKE SYMPTOMS

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81
Q

stroke symptoms: FAST

A

Face
Arm
Speech
Time

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82
Q

stroke dx

A

CT
MIR
depends on location and size

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83
Q

stroke treatment: ischemic stroke

A

TPA within 3 hours, try not to damage penumbra

within 6-7 hours = endovascular thrombolectomy

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84
Q

stroke treatment: hemorrhagic stroke

A

catheter with coil endovascular removal

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85
Q

meningitis

A

inflammation of leptomeninges (pia and arachnoid mater)

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86
Q

pyogenic meningitis

causes
signs
tx

A

group B strep, e. coli, listeria monocytogenes (infant), neisseria meningitis (children, teenager), strep pneumoniae (children, teenagers) , H. influenza (non vaxxed infants)

purulent exudate, dilated meningeal vessels, cloudy CSF with neutrophils, inc. protein and dec. CSF glucose

tx with antibiotic and steroid

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87
Q

viral meningitis

causes
sign
tx

A

HBV, coxsackievirus (children, oral-fecal), echovirus; low incidence

lymphocytes with normal CSF glucose

tx with antiviral

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88
Q

fungal meningitis

sign
tx

A

rare

lymphocytes with dec. CSF glucose

tx with antifungal and steroid

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89
Q

meningitis symptoms

triad
bacterial complications

A

triad: headache, neck stiffness, fever

photophobia, vomiting, altered mental status,

complications with bacterial: death, herniation, hydrocephalus, seizures, hearing loss

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90
Q

Crutzfeld-Jacob disease (mad cow)

cause
transmission
sign
treat

A

caused by small protein “bad prion” (PrPsc)

transmission by exposure to prion-containing animal tissue (usually brain)

find spongiform encephalopathy with small cysts in CNS gray matter

inactivate with 1M NaOH for 1 hour

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91
Q

SHORT ANSWER: pathogenesis of MS

A
  1. demyelination of white matter of CNS, shows gray appearing plaque in white matter; helper CD4+ and cytotoxic CD8+ T lymphocytes and macrophages infiltrate plaques
  2. women 2x as likely as men
  3. HLA-DR2
  4. depletion of myelin-producing oligodendrocytes
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92
Q

multiple sclerosis

definition
Charcot’s triad
symptoms
dx

A

relapsing neuro deficits with periods of remission

Charcot’s triad: nystagmus, scanning speech, tremor

loss of sensitization of touch, muscle weakness, dysfunction of bowel, bladder, sexual (autonomic NS)

dx: MRI reveals plaque, spinal tap shows inc. lymphocytes, immunoglobulin, and myelin basic protein

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93
Q

SHORT ANSWER: pathogenesis of Alzheimer’s disease

A
  1. brain appears atrophic, narrowing of gyri, widening of sulci
  2. neuritic plaque: cluster AB amyloid derived from amyloid precursor protein (APP) coded on chromosome 21. APP undergoes alpha and beta cleavage, resulting in AB amyloid, which may deposit around vessels, inc. risk of hemorrhage
  3. neurofibrillary tangles: Tau proteins (defective)
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94
Q

Alzheimer’s disease

definition
physiological sign
risk factors
dx
tx

A

most important cause of dementia

atrophy of cortical parts of frontal and temporal lobes

70+ years old, become mute and bedridden, infection is common cause of death

ApoE4 inc. risk, ApoE2 dec. risk

dx with PET, MRI

tx with acetylcholinerase inhibitors to slow progression, no cure

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95
Q

Pick disease

what does it cause
who does it affect
signs
tx

A

cause dementia

affect more women

cortical atrophy and accumulation of Pick bodies

tx behavioral and language symptoms, no cure

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96
Q

Parkinson’s disease

causes
symptoms
tx

A

tremor at rest that goes away with movement, rigidity, ankinesia/bradykinesia

tx with LDOPA, dopamine agonist, deep brain stimulation

causes: idiopathic, trauma, dopamine antagonists, contaminated street drugs

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97
Q

SHORT ANSWER: Parkinson’s disease

A

1, subcortical neurodegenerative disorder

  1. dec. number of dopaminergic neurons in substantia nigra; depigmentation of substantia nigra, damaged cells contain Lewy bodies
  2. idiopathi PD damages neuronal oathways from substantia nigra to corpus striatum, leading to dopamine depletion
98
Q

chronic alcoholism: Wernicke’s syndrome

definition
cause
reversible?

A

loss of memory and disorientation from chronic alcoholism and deficiency or thiamine (vitamin B1)

reversible

99
Q

chronic alcoholism: Korsakoff syndrome

symptoms
reversible?

A

disorientation, delusion, insomnia, painful extremities, nerve pain

may be irreversible

100
Q

Guillain-Barre syndrome

cause
symptoms
reversible?
dx
tx

A

follows viral infection
(demyelination of neurons)

weakness/tingling in legs, ascending muscle weakness, rapidly progressing paralysis

reversible, may affect CNS or cognitive properties

dx with spinal tap, CSF with large protein count with mild cell count increased

tx with supportive/resuscitative interventions, IV IgG

101
Q

Huntington’s disease

cause
symptoms
signs

A

autosomal dominant on chromosome 4 (CAG repeat)

involuntary movements, progressive dementia, depression (around age 40)

atrophy of cortex and subcortical nuclei, degeneration of GABA generating neurons

102
Q

ALS

onset
definition
symptoms

A

40+ years old, early middle age onset with rapid progression to death in 1-6 years due to respiratory failure

degeneration and atrophy of lateral corticospinal tractsand anterior neurons of cord

motor weakness, progressive muscle wasting in extremities, involuntary twitching, slurred speech

103
Q

brain tumors

mortality
who does it affect
metastasis

A

high mortality, any age, 505 primary neoplasms, benign or malignant, does no metatstasize

104
Q

brain tumors: astrocytoma

A

most common primary, well differentiated astrocytes

low grade fibrillary astrocytomas are WHO grade II, anaplastic is WHO grade III

105
Q

brain tumors: glioblastoma multiforme

A

astrocytes, most common primary malignant in adults

cerebral hemisphere, crosses corpus callosum, butterfly lesion

vascular changes, dead in a year

106
Q

brain tumors: oligodendroglioma

A

slow growing, middle age, cerebral hemispheres, oligodendrocytes

calcified tumor in white matter of frontal lobe, present with seizures

cells look like a fried egg

107
Q

brain tumor: meningioma

A

meninges, mostly benign, WHO grade !

most common in women, rare in children

seizures with the tumor suppressing the cortex

psammoma bodies

round mass attached to dura

108
Q

42 year old man in ED with severe epigastric and LUQ abdominal pain radiating to his back. Nausea and vomiting for 24 hours, binge drinking for 2 days prior to onset, not first instance of action followed by these symptoms. Chronic alcohol use. Diaphoretic, fever of 102.8, distended abdomen and tender to palpitation of epigastric and LUQ region. Serum studies show leukocytosis and elevated lipase and amylase. IV fluids and demerol for pain

A

acute ad chronic pancreatitis

109
Q

65 year old man with generalized malaise and weakness, 15 lb weight loss in 8 weeks, anorexia. Jaundiced, redness and tenderness with palpation of extremities (consistent with migratory thrombophlebitis). Labs for inc. direct bilirubin, ALP, positive CA 19-9. Get CT, bad prognosis

A

pancreatic carcinoma

110
Q

28 year old woman with amenorrhea and fatigue over 3-4 months. Not pregnant, she has a 6 month old whose birth was complicated by severe hemorrhage. Loss of pubic hair, delayed deep tendon reflexes, BP 90/50 mmHg. Labs show dec FSH, LH, TSH, ACTH, Need HRT

A

pituitary cachexia

111
Q

32 year old woman with milky discharge from both nipples. Period has become extremely irregular and last was over 7 months ago. Not pregnant, inc. prolactin, dec. LH and FSH. Get MRI of brain

A

prolactinoma

112
Q

47 year old man with occasional vision loss in lateral visual fields. Needs larger gloves and shoes and gained 25 lbs over 3 months. Labs show hyperglycemia and inc. GH. May need sx

A

acromegaly and gigantism

113
Q

65 year old man in ED by daughter due to confusion. Recent dx of small cell broncogenic carcinoma and planned to begin chemo soon. Labs show significantly dec. serum sodium, serum osmolality, inc. urine osmolality

A

syndrome of inappropriate ADH (SIADH)

114
Q

42 year old woman with headaches. Extremely thirsty lately and urinating frequently. Neuro exam unremarkable, labs show inc. osmolality and hypernatremia. Send to endo

A

diabetes inspidus

115
Q

37 year old woman with fatigue and thinning hair. gained 20 lbs over 6 months no change in diet or exs. Mildly enlarged thyroid and dry skin

A

cretinism and myxedema

116
Q

42 year old woman with fatigue, thinning hair, weight gain of 15 lbs over a month with no eating habit change. Pulse 52 bpm, delayed deep tendon reflexes, puffy face and eyelids, enlarged thyroid gland. Labs show antibodies against TG and TSH

A

Hashimoto thyroiditis

117
Q

35 year old woman with palpitations and heat intolerance. Inc appetite and is very irritable lately. Exophthalmos, moist skin, pulse 110 bpm, diffusely enlarged thyroid

A

Graves disease

118
Q

58 year old woman with several little lumps in her neck. HX of long standing diffuse goiters, but otherwise unremarkable. Irreg enlargement of thyroid, no cervical lymphadenopathy. Check TH and TSH, ultrasound, biopsy

A

multinodular goiter

119
Q

52 year old man with lump in neck that has slowly enlarged. No hyper or hypothyroidism symptoms, had radiation of thymus when he was a child. Nontender nodule in anterior neck and cervical lymphadenopathy. Check TSH, thyroid scan, and biopsy

A

thyroid carcinoma

120
Q

63 year old woman with generalized bone pain. Polyuria, constipation, muscular weakness. Sig. loss of cortical bone. Labs show inc. calcium, inc. PTH, inc. alkaline phosphatase, dec. phosphate. Parathyroid biopsy will reveal polygonal chief cells and larger oxyphil cells, bone biopsy would show brown tumors

A

primary hyperparathyroidism

121
Q

58 year old man to nephrology with chronic renal insufficiency. Generalized bone pain. Labs show dec. calcium, inc. serum phosphate. Check PTH, possible elevation, and recommend calcium and vitamin D and phosphate binders

A

secondary hyperparathyroidism

122
Q

45 year old woman for follow up for thyroidectomy. Wrist spasms. Carpal spasm with mins after inflation of BP cuff and facial twitching when you tap facial nerve. Check calcium, phosphate, PTH

A

hypoparathyroidism

123
Q

37 year old for annual. BP 160/100. Felt weak lately and frequent urination. Hx is insignificant. Labs show low serum potassium, inc. serum bicarbonate, inc. blood pH, inc. CO2. Abdominal/pelvic CT needed

A

primary hyperaldosteronism (Conn’s syndrome
)

124
Q

45 year old woman with inc. urination over past several months. Gained 35 lbs over past year, bruises easily, hair on chin. Moon face and inc. fat pads on back of neck. Labs show hyperglycemia, inc. cortisol, inc. serum ACTH. Dexamethasone suppression test

A

Cushing syndrome

125
Q

47 year old woman with nausea and fatigue. Hyperpigmented skin over knuckles, knees, elbows. BP 90/60. Labs show hypoglycemia, hyperkalemia, hyponatremia. May be autoimmune and need HRT

A

primary andrenocortical insufficiency (Addison’s disease)

126
Q

16 year old girl with delayed menarche. Denies sexual activity, home pregnancy test neg. Absence of breast tissue, hair on upper lip, chin, axillary, and hypertension. Labs show dec. cortisol and aldosterone. Rare autosomal recessive enzyme deficiency

A

congenital adrenal hyperplasias

127
Q

29 year old man in ED with crushing headache and palpitations. Similar episodes in the past. Pulse 140 bpm and BP 200/110. 24 hour urin shows inc. VMA and metanephrine levels. blood tests show inc. plasma catecholamine. Prescribe phenoxybenzamine, likely need sx

A

pheochromocytoma

128
Q

10 year old girl in ED with confusion, hypotensive, rapid and deep respirations. Fruity breath. Lost some weight, inc. appetite. Drinking and urinating more frequently. Labs show hyperglycemia, ketonemia, anion gap metabolic acidosis. Give insulin, fluids, electrolytes

A

diabetes mellitus

129
Q

58 year old obese man with generalized weakness. Urinating more frequently. Past hx of hyperlipedema and hypertension. Physical exam unremarkable. Labs show fasting hyperglycemia and glycosuria

A

diabetes mellitus

130
Q

baby boy delivered via uncomplicated vaginal delivery. Large birthmark associates with dimples and hairy tufts at base of back. No prenatal vitamins or receive prenatal care

A

congenital CNS abonormalities (spina bifida occulta)

131
Q

POSSIBLE SHORT ANSWER

27 year old caucasian woman with visual disturbances. Lateral gaze, one eye does not adduct and the other has nystagmus on abduction. Cerebellar function test shows intention tremor and dec. sensation on both legs. CSF obtained from lumbar puncture and find multiple oligoclonal bands of IgG on electrophoresis. Brain MRI needed

A

multiple sclerosis

132
Q

29 year old man to ED with muscle weakness beginning in calves but now involves thighs, hips, torse, and arms. Recently recovered from flu. Symmetrical muscle weakness in all limbs and absent deep tendon reflexes. Lumbar puncture shows albuminocytologic dissociation of CSF. Admit to ICU

A

Guillan-Barre syndrome

133
Q

POSSIBLE SHORT ANSWER

82 year old woman brought in by children. Very forgetful and has twice wandered out of her house and gotten lost, requiring police. Short term memory compromised and struggles to find words to express what she wants to say. Brain MRI no evidence of stroke. Biopsy may reveal neuritic plaque and neurofibrillary tangles

A

Alzheimer disease

134
Q

62 year old woman brought in by husband. Has been irritable and aggressive. Caught shoplifting twice in the last month and misnames common household objects. Impatient and socially inappropriate. Form of dementia with round, silver staining, neurofilamentous bodies within neuronal cytoplasm. refer out to neuro

A

Pick disease

135
Q

48 year old man with involuntary movements of arms and legs. Mother had similar symptoms that progressed to dementia. Involuntary jerky movements, flattened affect, poor concentration. Brain MRI shows atrophy of caudate nucleus and putamen, dilation of ventricles

A

Huntington disease

136
Q

POSSIBLE SHORT ANSWER

74 year old man at neuro with unsteadiness. Expressionless faces and pill-rolling tremor at rest. Shuffling gait, reigidity in response to passive movement and bradykinesia. Neurons of substantia nigra may contain Lewy bodies and prescribe levodopa

A

Parkinson’s disease

137
Q

47 year old man with hand weakness. Frequently dropping objects and cannot perform fine motor tasks. Positive Babinski sign, hyperreflexia, and diminished strength in muscles of hands and calves as well as fasciculations and atrophy in these muscle groups. Death by respiratory failure

A

amyotrophic lateral sclerosis (ALS)

138
Q

POSSIBLE SHORT ANSWER

68 year old woman in ED after developing left side paralysis one hour ago. L side sensory and motor paralysis, L side hyperreflexia, L side Babinski reflex, and bilateral symmetric loss of vision in half of her visual fields. Hx of tobacco use, hypertension, and hyperlipidemia. CT of head to confirm no bleed, administer thrombolytic therapy

A

ischemic stroke

139
Q

POSSIBLE SHORT ANSWER

67 year old man in ED with severe headache and nausea. Hx significant for long standing hypertension. R sided hemiparesis and altered mental status. May be related to hypertension, which caused formation of Charcot-Bouchard microaneurysms. CT of head

A

Hemorrhagic stroke

140
Q

44 year old woman in ED with nausea and worst headache of her life. Heavy smoker and hx of poorly controlled hypertension. Lumbar puncture shows blood in CSF. Head CT shows blood in basal cisterns. Immediate neurosx consult

A

berry aneurysm and subarachnoid hemorrhage

141
Q

78 year old woman in ED by son due to headache and altered mental status for 3 days. Fall down stairs two weeks ago, but was fine. Bilateral papilledema. Head CT shows 3 cm crescent shapes collection of fluid on R side that crosses suture lines with a 7 mm midline shift. Related to tearing of bridging veins between cerebrum and venous sinuses in dura. Immediate sx drainage of blood

A

epidural and subdural hematoma

142
Q

43 year old woman in ED with episodic loss of vision. Severe headaches with nausea and vomiting over past month. Bilateral papilledema and CT of head shows dilation of ventricles. May need ventriculoperitoneal shunt

A

hydrocephalus

143
Q

21 year old man in ED with severe headache. Fever of 102, nuchal rigidity, photophobia. lumbar puncture shows purulent CSF infiltrated with neutrophils, inc. protein content, dec. glucose content. broad spectrum antibiotics while waiting for cultures

A

pyogenic and viral meningitis

144
Q

59 year old man with severe headaches for last week. Often associated with projectile vomiting. Bilateral papilledema and head CT shows irregular mass in L cerebral hemisphere. Biopsy shows pseudopalisading malignant cells around areas of necrosis. poor prognosis

A

glioblastima multiforme

145
Q

42 year old woman with headaches and vomiting over the past four months. Trips a lot when walking, trouble remembering things. Bilateral papilledema and reduced strength and hyperreflexia in both legs. CT shows parasagittal mass compressing brain. Biopsy shows whorled pattern of tumor cells with psammoma bodies. need sx

A

meningioma

146
Q

49 year old man in ED with seizure. Severe headaches over last few months. CT of head shows large mass in frontal lobe with areas of calcification. Need sx

A

oligodendroglioma

147
Q

8 year old girl with blurry vision. Bilateraly papilledema. Head CT shows mass extending from flood of 4th ventricle and dilated lateral and third ventricles. Biopsy may show cells with blepharoplasts in a perivascular pseudorosette arrangement

A

ependymoma

148
Q

25 year old white man at pcp for follow up after detached retina week before. Hx multiple shoulder dislocations as a teen. Tall, long arms, legs, and digits. Double jointed and displays flexibility, father was same build and flexibility. Father passed away due to cardiovascular accident. Heart murmur consistent with mitral valve prolapse. Risk of developing aortic dissection

A

Marfan syndrome

149
Q

40 year old white woman with hx of lupus at nephrology with inc. swelling in legs. Labs show proteinuria, hypoalbuminemia, hyperlipidemia. Renal biopsy may show immune complex deposition on electron microscopy as well as spike and dome appearance on silver methanamine stain

A

membranous neuropathy

150
Q

40 year old HIV+ man in hospital with generalized edema and fatigue. Hx shows habitual IV drug user. Labs show hypoalbuminemia, hyperlipidemia, proteinuria, microscopic hematuria. Need renal biopsy

A

focal segmental glomerulosclerosis

151
Q

60 year old african amerixan man with 30 year hx of hypertension with episodic headaches and LE swelling from time to time. BP 174/106. ECG shows L ventricle hypertrophy. Labs show elevated BUN and creatinine. At risk for ESRD if hypertension is not controlled

A

hypertensive nephrosclerosis

152
Q

10 year old girl with eye swelling, seen 3 weeks ago for sore throat. Pronounced periorbital edema, very little urination despite adequate fluid intake. BP 150/90. Labs show azotemia, hematuria, red cell casts in urine, elevated ASO antibody titer. Resolve on its own

A

poststreptococcal glomerulonephritis (acute proliferative glomeruloneohritis)

153
Q

40 year old white man in hospital with bloody sputum and urine. Fever, malaise, 10 lb lost over month. BP 160/95, several abnormal lung sounds. Urine dipstick shows hematuria. CXR shows several nodular lesions, blood shows elevated BUN and creatinine, presence of c-ANCA, elevated ESR. High dose of corticosteroids. Renal biopsy may show crescent shaped between Bowman capsule and glomerular tuft

A

rapidly progressive (crescentic) glomerulonephritis

154
Q

10 year old boy with red tinge to urine. DX with mild nerve deafness 2 years ago and also developed posterior cataracts 1 year ago. Labs confirm hematuria and presence of erythrocyte casts. Genetic

A

Alport syndrome

155
Q

15 year old asian american in ED with blood in urine. Fevers, myalgias, arthralgias for 2 days. Labs show presence of RBCs in urine and inc. serum IgA and normal serum complement levels. Begin prednisone. Most common form of acute glomerulonephritis in US.

A

IgA Nephropathy (Berger Disease)

156
Q

25 year old woman in ED with fever, vomiting, severe R side flank pain. Sexually active and has one week hx of burning pain while urinating and inc. urinary frequency. Urinanalysis reveals white cell casts in urine and sample is sent for culture. Start on broad spectrum antibiotics

A

acute and chronic pylonephritis

157
Q

60 year old man in ICU with hypotension and severe sepsis. Hypotension gradually resolves with aggressive fluid resuscitation and pressor support. Next few days he becomes progressively oliguric. Labs show worsening renal failure and hyperkalemia. Urine sediment shows muddy brown clasts. May need dialysis

A

acute tubular necrosis

158
Q

25 year old man with blood in urine. Father died of kidney failure in late 30s. BP 170/110 and bilateral, palpable renal masses. Midsystolic click heard on cardiac exam that is consistent with mitral valve prolapse. Need abdominal CT

A

adult and infantile polycystic kidney disease

159
Q

40 year old woman in ED with colicky abdominal pain and flank pain radiating toward groin. Blood in urine in recent weeks and hx of recurrent UTIs. Plain abdominal film shows large staghorn calculus

A

urolithiasis (kidney stones)

160
Q

72 year old man at nephro for kidney disease follow up. Hx sig. for coronary artery disease, T2D takes insulin, hypertension. Bilateral crackles in lung field as well as 2+ pitting edema in both LE. Labs show potassium level of 6.2 mmol/L and creatinine of 5.3 mg/dL. Need dialysis

A

chronic kidney disease

161
Q

60 year old man with cola colored urine and flank pain. Low grade fever over last few weeks and lost 10 lbs over the last month. Chronic smoker (pack a day for 30 yrs). Large mass in left flank area. Labs show secondary polycythemia. abdominal CT may show solid renal mass and possible metastasis to regional lymph nodes

A

renal cell carcinoma

162
Q

3 year old boy in ED with abdominal pain after falling onto a toy truck that hit his abdomen. Huge, palpable flank mass on L side. Urinanalysis shows microscopic hematuria. CT shows large enhancing mass originating from kidney. Gene deletion on chrom. 11, not related to fall

A

Wilms tumor

163
Q

33 year old woman with vague abdominal pain for 4 days. Pelvic pressure generalized bilaterally. Last period was 2.5 weeks ago and are regular, not pregnant. No digestive changes and denies nausea, vomiting, constipation, diarrhea. No family hx of ovarian cancer. Put on oral contraceptive, symptoms will be gone in two months, need f/u ultrasound

A

ovarian cysts

164
Q

30 year old white woman at fertility clinic with husband, inability to conceive. Not menstruated for 4 months and always has had irregular and sporadic cycle. Obese with inordinate amount of facial hair. No abnormal uterine bleeding. Labs show inc. plasma LH and testosterone and dec. FSH

A

polycystic ovarian syndrome (Stein-Leventhal syndrome) PCOS

165
Q

48 year old woman in ED with generalized abdominal pain and pelvic pressure. Not passed stool for 3 days and vomited this morning. Pain steady for a week. Abdominal/pelvic CT is clear, but shows bilateral enlargement of ovaries. Exploratory laparotomy shows mucinous ascites, cystic epithelial implants on peritoneal surface, and several adhesions.

A

ovarian tumors of surface epithelium origin

166
Q

31 year old woman with abnormal vaginal bleeding and mild abdominal pain. Last period 1 week ago and has not experienced abnormal bleeding before. Hx of two prior episodes of pelvic inflammatory disease in last year. Trying to conceive for last year with no success. Pelvic exam shows redness and inflammation of cervix, but no discharge. Endometrial biopsy may show plasma cells along with macrophages and leukocytes in glandular lumen. Empiric antibiotic therapy

A

endometritis

167
Q

24 year old woman with inc pain and bleeding during menstruation. Last 3 periods have had inc. intensity of cramping and larger amounts of blood. Irregular cycle for last 6 months. Inc. pelvic pain with sex. Pelvic exam shows fixed bilateraly ovarian masses and MRI shows chocolate cysts in ovary. Begin oral contraceptives and suggested sx removal of cysts

A

endometriosis

168
Q

60 year old woman with postmenopausal bleeding. Nulliparous and T2D, controlled with diet and insulin. Obese and BP of 150/96. Pap smear and endometrial biopsy. May find well defined gland patterns lined by malignant stratified columnar epithelial cells on biopsy

A

endometrial carcinoma

169
Q

22 year old woman in ED with lower abdominal pain, chilld, fever, purulent vaginal discharge. Multiple sex partners over last year and does not protect. Pain started 3 days ago with subsequent fever, chills, night sweats. Febrile and temp of 102.4. Pelvic exam shows cervical motion tenderness with foul-smelling, purulent, cervical discharge. Neg. pregnancy test. Admit and begin on IV cefoxitin plus doxycycline while awaiting results of culture.

A

pelvic inflammatory disease

170
Q

32 year old woman vaginally delivers a baby boy, she is hemorrhaging and abnormally large amount of bloof. One previous c section and extensive scarring. Pregnancy complicated by a defective decidual layer that allowed the placenta to attach directly to he myometrium. Emergency hysterectomy

A

placental attachment abnormalities (abruptio placentae, placenta previa, placenta accreta)

171
Q

31 year old pregnant woman in ED with headaches and blurred vision for one week. 32 weeks into first pregnancy. LE edema, BP 180/100, no hx of hypertension. Labs show mild thrombocyotpenia, elevated AST and ALT, sig. proteinuria. Immediate bedrest, close monitoring, BP control, May need to deliver early

A

preeclampsia and eclampsia

172
Q

23 year old woman in 13th week of pregnancy in ED for excessive nausea and vomiting as well as vaginal bleeding. Vomits 10x per day for 3 days and is constantly nauseous. Ultrasound shows classic snowstorm appearance with multiple echoes, indicating edematous villi within an enlarged uterus and absense of fetus or placenta. Labs show hCG above 50,000 mIU/mL. Immediate uterine suction and emptying

A

hydatidiform mole and gestational choriocarcinoma

173
Q

19 year old male with localized scrotal swelling. Nontender mass on side of R testicle, denies any trauma. Nontender fullness on lateral and anterior aspect of R testicle, translucent with flashlight. Benign fluid collection related to persistent connection of processus vaginalis between peritoneal cavity and scrotum

A

cystic masses of scrotum

174
Q

27 year old white man with R testicular enlargement over 3 months. No trauma or pain and no problems urinating. Low grade fevers, night sweats, fatigue, malaise, 15 lb weight loss over 3 months. R testicle 2x sixe of L and mass does not transilluminate with flashlight. Serum labs show elevated hCG, regular AFP. biopsy may show sheets of uniform cells with distinct cell membranes, clear cytoplasm, and large nuclei

A

testicular germ cell tumors

175
Q

72 year old man who cannot completely empty his bladder when urinating. Inc. frequenct of urination and nocturia, difficulty starting and stopping stream. Rectal exam shows smooth, enlarged, prostate. Labs show inc. total PSA with proportionate inc in fraction of free PSA. Put on finasteride and is predisposed to UTIs

A

benign prostatic hyperplasia

176
Q

81 year old man with pain with urination. Difficulty starting and stopping stream for 4 months and recently been suffering from severe back pain. Recal exam shows large palpable postate nodule, firm and irregularly shaped. Labs may show inc. serum alkaline phophatase. Refer out to urologist for prostatic biopsy

A

prostate carcinoma

177
Q

4 year old South African boy with inability to pass urine, hasnt in two days and has always had an issue with this. Abnormal urethral opening on ventral surface of penis. testes not palpable in child’s scrotum. Urethral defect is a common congenital one, sx to help

A

penile diseases

178
Q

45 year old kenyan man who just immigrated to US with long standing lesion on penis that has started to bleed. Growth has been there over a year and just began to ulcerate. Penile lesion appears on inner surface of prepuce near the coronal sulcus. Papillary lesions look like condylomata acuminata, producing a cauliflower like fungating mass. Bleeding ulceration on lesion. No pain, fever, or urinary symptoms. Biopsy needed

A

penile cancers

179
Q

crytpochidism

definition
risks
tx

A

testes do not descend into the scrotum

more prone to testicular cancer

need sx to fix right away

180
Q

hypospadias

A

urethral opening is on the ventral surface of the penis

181
Q

epispadias

A

urethral opening is on the dorsal surface of the penis

182
Q

Klinefelter’s syndrome

definition
symptoms
commonality
tx

A

chromosomes disorder, extra sex chromosome 47, XXY (1 in 600)

speech and language delay, gynecomastia, azoospermia, smaller gonads

more common than Down’s and CF

tx with HRT testosterone

183
Q

testicular tortion

definition
symptoms

A

attachment of testes in scrotum, twisting of testes and spermatic cord, compromises blood flow

pain, swelling, hemorrhagic infarction

184
Q

hydrocele

definition
tx

A

excess fluid in tunica vaginalis

tx with aspiration or resection

185
Q

varicocele

definition
tx

A

varicose veins in spermatic cord, usually L side, may impair fertility, no tx

186
Q

erectile dysfunction or impotence

definition
causes

A

failure to erect (by vasodilation of penile arteries), parasympathetic nervous system

beta blockers, psychological problems, distortion of penile arteries and tissue, alcohol related liver damage, diabetes, smoking

187
Q

priapism

A

painful erection by fibrosis of tissue lasting 4+ hours

188
Q

chancroid

bacteria
definition

A

hemophilus ducrey

soft, painful ulcer, prone to infection

189
Q

syphillus

bacteria
stages
dx
tx

A

treponema pallidum

primary: painless, ulcer, may not know

secondary: largest # of organisms in body, diffuse rash of small red macules on palms, soles, and membranes

tertiary: gummas form; left untreated, may infect heart and nervous system, 2-20 years later

dx by treponemas/spirochetes in chancre, serologic tests

tx with antibiotics

190
Q

gonorrhea

causes…
symptoms
dx
tx

A

causes PID

urethritis, cervicitis, pharyngitis, proctitis

dx by cultures

tx with antibiotics

191
Q

herpes

type, spread
symptoms
cell type
signs

A

viral, T2 for most oral cases, spread by sex

vesicles and ulcers in cervix, vagina, clitoris, vulva, urethra, perianal skin

multinucleated giant cells with viral inclusions in cytologic smears from lesions

3 m’s: multinucleation, nuclear molding, margination of chromatin

192
Q

tumors of testes

characteristics
ages
tx

A

rare, malignant, more than 90% survive

25-45

tx with sx, chemo, radiation

193
Q

tumors of testes: seminomas

commonality
who is affected
cell type
prognosis
symptoms
signs

A

most common of germ cells (50%)

men in 30s

single cell

better prognosis than NSGCT

10x size of normal testicle

do not secrete markers, not transilluminate on flashlight

194
Q

tumors of testes: nonseminomatous germ cell tumor (NSGCT)

malignant or beingn
physiological/endocrinological characteristic
tx

A

more malignant than seminomas, metastases in early stages

secretes AFP & hCG

tx with sx, abdominal lymph node dissection, chemo

195
Q

tumors of testes: NSGCT - embryonal carcinoma

A

more aggressive than seminomas, 20-30 year olds

196
Q

tumors of testes: NSGCT - choriocarcinoma

malignant or benign
characteristics
how to find
symptoms

A

highly malignant, most aggressive NSGCT

mixed germ cell tumor, small

found by palpation of a small testicular nodule

enlargement rare, necrosis and hemorrhage common

197
Q

tumors of testes: teratoma

A

random arrangement of mesodermal, ectodermal, and endodermal tissue

198
Q

benign prostate hyperplasia

definition
physiological causes
physical sign
dx
tx

A

most frequent cause of urinary tract obstruction, extremely common in older men

dihydrotestosterone (DHT), age related inc. in estrogen

rubbery, nodular gland enlargement, affecting inner groupings of glands

dx by inc. total PSA with proportional inc in free PSA

tx with finasteride or cialis, alpha-blocker, TURP

199
Q

prostate carcinoma

A

most common cancer of internal organs in males with +100,000 new cases per year

3rd most common cause of cancer related death in males, old age

no effective tx

idiopathic, old age, no major risk factors, testosterone involved

african > european > east asian

peripheral group of glands

dx with rectal exam

tx with prostatectomy, radiotherapy, anti-androgens, chemo

200
Q

developmental disorders of urinary: renal agenesis

bilateral vs unilateral

A

bilateral (Potter syndrome) is deadly

unilateral causes kidney hypertrophy and hyperfiltration inc. risk of renal failure

201
Q

developmental disorders of urinary: horseshoe kidney

A

fusion of kidneys at lower pole

202
Q

developmental disorders of urinary: multicystic renal dysplasia

A

unilateral, cysts in connective tissue

203
Q

polycystic kidney disease: ADPKD (autosomal dominant)

pathogenesis
signs
symptoms

A

2 abnormal genes, mutation in APDK-1 and 2

water filled hepatic cysts, berry aneurysm, mitral valve prolapse

young adults, hypertension, hematuria, renal failure

204
Q

polycystic kidney disease: ARPKD (recessive)

A

very rare, infants with kidney enlargement and renal failure

205
Q

Berger’s disease

definition
cause
symptom
tx

A

deposit of IgA over cortex, most common neuropathy

bacterial or viral

hematuria and proteinuria

tx with ACE inhibitor or steroid

206
Q

goodpasture syndrome

pathogenesis
causes…

A

autoimmune - anti-glomerular basement membrane, IgG

cause pulmonary hemorrhage and glomerulonephritis

207
Q

Alport syndrome

defintion
symptom
cause
pathogenesis

A

hereditary nephritis with nerve damage and ocular disorders (cataracts, lens dislocation)

symptom is nephritic syndrome (proteinuria and hypoalbuminemia) —> end stage renal disease by 30

caused by gene mutation of alpha 5 chain of type IV collagen

thinning/splitting of glomerular basement membrane

208
Q

poststreptococcal glomerulonephritis

pathogenesis
symptoms

A

immune complex disease with strep antigen, 2-3 weeks after group A beta-hemolytic strep or skin infection

hematuria, oliguria, hypertension, periorbital edema

209
Q

urinary stones

kinds and %

A

calcium phosphate or oxalate (inc. Ca2+ concentration) - 75%

struvite: magnesium phosphate, in alkaline urine, persistent UTI - 15%

uric acid: gout - 5%

cystine: cystinosis - 1%

210
Q

urolithiasis

definition
causes
symptom
tx

A

kidney stone formation

due to increased salts in urine (gout increases uric acid, inc. Ca2+ by hyperparathyroidism) or UTI (dec.solubility of salts, bacteria)

pain in back —> R shoulder

tx with sx/wave therapy, drugs, pass stone

211
Q

UTI

pathogenesis
bacteria
causes
dx
symptoms

A

infection of urinary tract and kidney, women more often (shorter urethra), inc. during pregnancy

e. coli, staph. saprophyticus

impaired urine drainage, injury to mucosa by kidney stone, catheter with bacteria

dx with urinalaysis (> 10 hpf), dipstick + for leukocyte enterase and nitrites, culture > 100k colony forming units (gold standard)

symptoms: frequency, dysuria, pyuria, hematuria, bacteriuria, cystitis, pyelonephritis

212
Q

cystitis

A

only affects bladder, sexually active young women and old men with BPH

213
Q

acute tubular necrosis

definition
pathogenesis
dx levels
ischemia
nephrotic
tx

A

injury/necrosis of tubular epithelial cells cause acute renal failure

necrotic cells plug tubule —> obstruction dec. GFR —> brown granular casts in urine

BUN:creatinine < 15, osmolarity < 500

ischemia: dec. blood supply = tubule necrosis
nephrotic: toxic agents = tubule necrosis (NSAIDs, lead, chemo)

hemodialysis: more common; eliminate water and waste from body; connect via fistula, access port, or shunt
peritoneal: less common; cleansing fluid thru catheter into abdomen and filters waste from blood; higher infection risk

214
Q

WIlm’s tumor

pathogenesis
prognosis
sign

A

2-4 years old, immature cells resembling renal blastoma, deletion of short arm of chromosome 11, genes WT-1 and WT-2 are cancer suppressor genes

good prognosis with sx + chemo

palpable flank mass

215
Q

renal cell carcinoma

pathogenesis
symptoms

A

men 50-70, smokers, gene deletion on chromosome 3

flank pain, palpable mass, hematuria, secondary polycythemia, hypercalcemia

most common form

216
Q

transitional cell carcinoma

area
symptom
cause

A

renal pelvis, ureter, bladder

likely to recur, likely to spread by local extension

hematuria

industrial exposure, smoking

217
Q

pelvic inflammatory disease

definition
cause
predisposes to..

A

inflammation of fallopian tubes and ovaries

by gonorrheal and chlamydial infection

predisposes to ectopic pregnancy

218
Q

ectopic pregnancy

definition
predisposing factors
signs

A

outside uterus - 95% fallopian tubes, 1 in 200

predisposing: tubal infection, PID, IUD, previous ectopic preg.

missed period, excessive bleeding, low abdominal pain

219
Q

diethylstilbestrol (DES)

A

super estrogen

1946-70 non steroidal estrogen used for women with spontaneous abortion

precocious puberty in daughters, clear cell adenocarcinoma of cervix and vaginal adenosis

220
Q

placental abnormalities: placenta accreta

definition
tx

A

placental villi into uterus wall, predisposed by C-section

tx with sx to stop bleeding

221
Q

placental abnormalities: placenta previa

A

zygote implants in lower section of uterus, painless bleeding

tx with c-section

222
Q

placental abnormalities: abruptio placentae

A

partial/complete premature separation of placenta; emergency

abdominal pain and painful bleeding

tx with delivery and bleeding control

223
Q

abortion

definition
symptoms
pathogenesis

A

termination of pregnancy before week 22 of gestation

cramping, abdominal pain, backache, vaginal bleeding

induced by DR or RU-486 or mifeprex or mifepristine: competes for progesterone receptors, opens cervix and influence contractions to expel embryo within first 9 weeks

224
Q

gestational trophoblastic disease

definition
signs
moles: complete and incomplete

A

swelling of chorionic villi

B-hCG higher, grape like masses in vaginal canal (2nd trimester)

mole in 1st trimester = absent fetal heartbeat, ‘snowstorm’ on ultrasound

complete mole: fetus cannot be identified due to androgen production, only paternal chromosome

incomplete mole: some fetal parts present, ovum fertilized by 2+ sperm, tx with spontaneous abortion usually or dilatation and curettege, chemical pregnancy

225
Q

preeclampsia

symptoms
tx

A

hypertension, edema, proteinuria in 3rd trimester, hemolysis, elevated liver enzymes, low platelets

tx hypertension, deliver fetus, bed rest

226
Q

eclampsia

definition
tx

A

preeclampsia + seizures, emergency

tx with magnesium sulfate and diazepam (anti-epileptics)

227
Q

Turner syndrome

definition
symptoms
tx

A

pubertal delay due to low estrogen, absent second functional X chromosome due to primary gonadal failure = inc. FSH and LH

short, webbed neck, primary amenorrhea

tx with estrogen and progesterone

228
Q

endometriosis

definition
signs
dx
tx

A

deposits of endometrium outside its normal location (on ovary, pelvic peritoneum)

responsive to hormone variation of menstrual cycle

blood filled cysts, dysmenorrhea, infertility

dx with laparoscope, ultrasound, CT

tx with birth control (OCP)

229
Q

polycystic ovary syndrome

A

enlarged ovaries, cysts, inc. androgens affect development and release of eggs during ovulation

excess insulin inc. production of androgens

dx with blood LH, androgens, ultrasound of ovaries

no ideal tx, OCP, metformin (T2D med, not FDA approved for PCOS), ovulation meds, IVF, ovarian drilling sx

230
Q

complete abortion

A

spontaneous expulsion of all fetal and placental tissue from uterus prior to 20 weeks gestation . Cervix closed on exam

231
Q

incomplete abortion

A

passage of some fetal or placental tissue, but not all, from uterus prior to 20 weeks. Cervix dilated on exam

232
Q

threatened abortion

A

uterine bleeding prior to 20 weeks without any cervical dilation or effacement

233
Q

inevitable abortion

A

uterine bleeding prior to 20 weeks, accompanied by cervical dilation, but no expulsion of any fetal or placental tissue through cervical os

234
Q

missed abortion

A

fetal death before 20 weeks without expulsion of any fetal or maternal tissue for at least 8 weeks thereafter

235
Q

septic abortion

A

any of the mentioned abortions + uterine infection

236
Q

menorrhagia

A

> 7 days or > 80 mL at regular intervals

237
Q

metrorrhagia

A

irregular but frequent intervals

238
Q

polymenorrhea

A

< 21 days between periods

239
Q

oligomenorrhea

A

> 35 days between periods

240
Q

dysmenorrhea

A

pain with menstruation

241
Q

amenorrhea

primary
secondary
psychogenic
lactational
anorexia nervosa
exercise
runner’s
tx

A

primary: period failure during puberty

secondary: 6 months or longer w out period

psychogenic: college freshman, opiates

lactational: inc. PRL

anorexia nervosa: dec. BW, FSH, LH, estrogen

exercise: female athlete triad (dec. FSH and LH)

runner’s: beta endorphins inhibit GnRH production

tx diet, dec. exs., OCP

Patho (3 decks)

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