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Step 1 > Lifecycles - Diseases > Flashcards

Lifecycles - Diseases Flashcards

1
Q

Benign Prostatic Hyperplasia (BPH)

A

Common in men > 50; characterized by smooth nodular enlargement of the middle and lateral lobes of the periurethral prostate, causing compression of the urethra

Presents with polyuria, nocturia, dysuria, difficulty starting/stopping urine stream; may cause UTI, distension/hypertrophy of the bladder, hydronephrosis

Treated with alpha-1 adrenergic blockers - Prazosin, Terazosin, Tamsulosin (specific for a-1 receptors on the prostate with fewer vascular side effects)

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2
Q

Candida vulvovaginitis

A

“Yeast infection”

Presents with pruritis, inflammation, and thick, white “cottage cheese” discharge

Lab findings: Gram stain shows pseudo/hyphae and blastospores

Treatment: -azole antifungals

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3
Q

Abruptio Placentae

A

Premature separation (partial or complete) of placenta from uterine wall prior to full term delivery

Risk factors: Trauma, smoking, hypertension, preeclampsia, cocaine

Presents as abrupt, painful bleeding in the 3rd trimester

Complications: DIC, maternal shock, fetal distress; life threatening for mother and fetus

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4
Q

Placenta Previa

A

Abnormal attachment of the placenta to the inferior aspect of the uterine wall, either partially or completely obstructing the cervical os

Risk factors: Multiparity, previous C-section

Presents as copious, painless, bright red vaginal bleeding and cervical dilation after 28 weeks gestation

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5
Q

Bicornuate uterus

A

Two-horned uterus with communicating endometrial cavities, caused by failure of fusion of the two paramesonephric ducts

Associated with recurrent miscarriage; fetal survival rate ~ 60%

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6
Q

Meig’s Syndrome

A

Clinical syndrome of benign ovarian tumor + ascites + pleural effusion / pneumothorax; pleural effusion and ascites resolves following removal of tumor

Presents with small, hard, palpable ovarian mass + abdominal fullness/discomfort

Findings: Hypoactive bowel sounds, abdominal guarding on deep palpation, fluid wave, diminished breath sounds

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7
Q

21 Hydroxylase Deficiency

A

Most common cause of congenital adrenal hyperplasia

Characterized by low cortisol, low aldosterone, and increased sex hormones; presents as salt wasting (in infancy) or precocious puberty (in childhood); XX females have virilization

Labs: Hypotension, hyperkalemia, increased renin, increased 17-hydroxyprogesterone

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8
Q

17 Hydroxylase Deficiency

A

Rare cause of congenital adrenal hyperplasia

Characterized by low cortisol, low sex hormones, and high aldosterone; males present with undescended testes / ambiguous genitalia (under-virilized); females present with lack of secondary sex characteristics

Labs: Hypertension, hypokalemia

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9
Q

11-B-hydroxylase Deficiency

A

Rare cause of congenital adrenal hyperplasia

Characterized by low cortisol, low aldosterone (but high 11-deoxycorticosterone), and low sex hormones

Presents in XX females as virilization

Labs: Low cortisol, low aldosterone, high 11-deoxycorticosterone –> Hypertension

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10
Q

Brenner Tumor

A

Least common of the ovarian epithelial tumors; neoplastic proliferation of cells that resemble transitional epithelium of the bladder

Findings: Biopsy shows nests of cells with “coffee-bean” shaped nucleus in a fibrous stroma

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11
Q

Pre-eclampsia

A

Defined as HTN > 140/90 and proteinuria with or without end-organ damage; usually occurs in 3rd trimester of pregnancy, increased risk with pre-existing HTN, DM, CKD, or autoimmune dz

Pathogenesis is related to formation of abnormally vascularized placenta with maternal endothelial dysfunction, vasoconstriction, and inflammation

Complications: Placental abruption, coagulopathy, renal failure, eclampsia

Treatment: Delivery at 37 (mild) or 34 (severe) weeks, anti-hypertensives, IV Mg to prevent seizures

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12
Q

Eclampsia

A

Pre-eclampsia + maternal seizures

Risk of maternal death due to hemorrhaging stroke

Treated with immediated delivery, anti-hypertensives, IV magnesium

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13
Q

Molar pregnancy

A

Complete mole results from fertilization of anucleate egg with sperm, followed by duplication of paternal DNA; partial mole results from fertilization of normal egg with 2 sperm; results in cystic swelling of chorionic villi

Presents with pre-eclampsia (hypertension, proteinuria, edema) before 20 weeks gestation + vaginal bleeding; may also present with hyperthyroidism

Findings: Elevated hCG, increased uterine size, ultrasound shows “honeycombed” appearance to uterus or “cluster of grapes” structure

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14
Q

Disorders of placental attachment / separation

A
  1. Placenta accreta - abnormal attachment of the placenta to myometrium, without invasion; most common sub-type
  2. Placenta increta - abnormal invasion of the placenta into the myometrium
  3. Placenta percreta - abnormal invasion of the placenta through the myometrial wall and into the uterine serosa; may cause placental attachment to rectum or bladder; risk of massive bleeding, life threatening for mother
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15
Q

Prostatic adenocarcinoma

A

Common in men > 50; accounts for 32% of all cancers in men but only 13% of cancer mortality

Most commonly arises in the posterior lobe (peripheral zone); diagnosed by elevated PSA with needle biopsy showing small, neoplastic glands amidst normal prostatic stroma

Treatment: Androgen antagonists (Flutamide), continuous GnRH analog administration (Leuprolide), estrogens

Metastases to bone may develop late in disease, characterized by low back pain, elevated alk phos, and elevated PSA

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16
Q

Ectopic Pregnancy

A

Most commonly located in the ampulla > isthmus > fimbriae > interstitium of the fallopian tube; risk increased with PID / salpingitis, prior tubal surgery

Suspect based on history of amenorrhea, lower-than-expected hCG levels based on dates

Presents with sudden onset lower abdominal pain +/- hypotension; often mistaken for appendicitis

Dx: Ultrasound

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17
Q

Endometrial carcinoma

A

Most common gynecological neoplasm; peak incidence ~ 60 years. Increased risk associated with prolonged exposure to unopposed estrogen (early menarche / late menopause / nulliparity, estrogen HRT), obesity, HTN, DM

Presents with vaginal bleeding / heavy menstruation

Treated with progestins

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18
Q

Polyhydramnios

A

Amniotic fluid > 1.5-2L

Associated with fetal malformations of the GI tract (esophageal / duodenal atresia) or anencephaly, which impair ability of fetus to swallow amniotic fluid

Complications: Pre-term labor, maternal respiratory distress

19
Q

Oligohydramnios

A

Amniotic fluid < 0.5L; associated with placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males), or other causes which impair renal excretion of urine in utero

Results in Potter Syndrome: 
Pulmonary Hypoplasia 
Oligohydramnios
Twisted face
Twisted skin 
Extremity Defects 
Renal failure (in utero)
20
Q

Potter Syndrome

A

Clinical syndrome of infants seen as a result of oligohydramnios (amniotic fluid < 0.5L); due to fetal compression in utero

Pulmonary hypoplasia
Oligohydramnios 
Twisted skin
Twisted face
Extremity defects 
Renal failure (in utero)
21
Q

Fibroadenoma

A

Benign tumor of the breast; most common breast tumor in women < 35

Characterized by small, firm, mobile mass with sharp edges; may increase in size and tenderness with elevated estrogen (pregnancy, prior to menstruation)

No increased risk of malignant breast cancer

22
Q

Intraductal papilloma

A

Small, benign tumor of the breast which grows within the lactiferous ducts, typically beneath the areola

May present with serous or bloody nipple discharge

Slightly increased risk for carcinoma of breast

23
Q

Phyllodes tumor

A

Benign tumor of breast most often seen in women in their 50s-60s

Characterized by a large, bulky mass of connective tissue and cysts growing within the stroma of the breast

Some may progress to malignancy

24
Q

Ductal Carcinoma In Situ (DCIS)

A

Atypical dysplasia of ductal cells which fill the duct lumen but do not penetrate the basement membrane

Seen early as micro-calcifications on mammogram

25
Q

Comedocarcinoma

A

A subtype of ductal carcinoma in situ causing caseous necrosis of the duct

26
Q

Paget disease

A

Eczematous lesion of the nipple/areola also associated with excoriation, ulceration, crusting, and serosanguinous discharge

Suggests underlying DCIS

*Note: May also be seen on the vulva, where it is NOT associated with underlying malignancy

27
Q

Cervical dysplasia / Carcinoma in situ

A

Disordered epithelial growth of cells at the squamocolumnar junction (transition zone)

Classified as CIN 1, 2, or 3/CIS depending on the degree of dysplasia; risk of progression to invasive carcinoma if left untreated

Associated with HPV 16 and 18

Typically asymptomatic but may present with post-coital vaginal bleeding; detected by Pap smear

Risk factors: Multiple sexual partners, early first sexual intercourse, HIV, smoking

28
Q

Hydrocele

A

Accumulation of serous fluid between the visceral and parietal layers of the tunica vaginalis, causing bilateral, painless swelling of the testicles

Positive transillumination test

29
Q

Neural Tube Defects

A

Failure of neuropore to close ~ 4th week of development

Associated with low folic acid consumption prior to conception and during pregnancy; increased risk with folate antagonists, Carbemazepine, and Valproate

Elevated AFP seen in amniotic fluid and maternal serum

30
Q

Spina Bifida Occulta

A

Most common neural tube defect

Failure of the bony spinal canal to close around the spinal cord; dura is intact, does not involve herniation

Usually presents with a tuft of hair or skin dimple at the level of the defect

31
Q

Meningocele

A

Herniation of the meninges through the bony spinal canal defect leading to protrusion of a CSF-filled sac

32
Q

Meningomyelocele

A

Herniation of meninges and spinal cord through the bony spinal canal defect

33
Q

Krukenberg Tumor

A

Bilateral metastasis of adenocarcinoma of the stomach to the ovaries

Finding: Mucin-producing “signet cells” in the ovaries

34
Q

Mittelschmerz

A

Transient, mid-cycle ovulatory pain due to bleeding from rupture of the mature follicle; blood irritates the peritoneum and can cause TTP and guarding on physical exam

May mimic appendicitis if the R ovary is involved

Differentiated from ruptured ovarian cyst by the absence of an adnexal mass and normal ovaries by ultrasound

35
Q

Polycystic Ovarian Syndrome (PCOS)

A

Most common cause of hyperandrogenism in women (6-8% prevalence)

Overactivity of GnRH pulse generator causes high LH levels with over-production of testosterone; aromatization of testosterone to estrogen inhibits FSH leading to under-development of ovarian follicles

Presents with anovulation, olig/amenorrhea, hirsutism and acne, multiple (8-9) small cysts on the ovaries, and metabolic abnormalities

Increased risk of infertility, metabolic syndrome, and endometrial cancer

Treatment: OCPs to regularize menses, Spironolactone for anti-androgen effects

Clomiphene citrate (hypothalamic SERM - antagonist) and letrozole (aromatase inhibitor) decrease feedback inhibition of hypothalamus by estrogen, increasing pulse generator activity and ovulation

36
Q

IVC Compression

A

Caused by compression of the IVC by the fetus when a pregnant woman lays down; decreased venous return reduces pre-load which decreases CO

Presents as hypotension / dizziness with lying down

Women should lay on their left sides to relieve pressure on the IVC applied by the fetus

37
Q

Leiomyoma

A

AKA “uterine fibroid” - common, benign tumor of uterine smooth muscle

May be asyptomatic or may cause abnormal uterine bleeding; often estrogen sensitive

Treated with GnRH agonists

38
Q

Granulosa Cell Ovarian Tumor

A

Most common sex cord stromal tumor of the ovary

Often produces estrogen and/or progesterone; presents with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness

Histology shows Call-Exner bodies (resemble primordial follicles)

Increased risk of endometrial hyperplasia / carcinoma due to unopposed estrogen

39
Q

Pseudomyxoma peritonei

A

Filling of the intra-abdominal cavity upon rupture of a mucinous appendiceal tumor

40
Q

Hemolysis, Elevated Liver Enzymes, Low Platelet (HELLP) Syndrome

A

Occurs as a complication of severe pre-eclampsia

Treatment is immediate delivery

41
Q

Acute Fatty Liver of Pregnancy (AFLP)

A

Occurs as a complication of pre-eclampsia

Lab findings: Low blood glucose (<50 mg/dL) due to decreased hepatic gluconeogenesis, decreased levels of fibrinogen and antithrombin III due to decreased hepatic protein synthesis

42
Q

Laryngomalacia

A

Congenital defect of the arytenoid cartilages, derived from the 6th pharyngeal arch; leads to development of “bulky” arytenoid cartilages which prolapse anteromedially with inspiration

Presents as noisy breathing without respiratory distress, exacerbated in the supine position

43
Q

Fetal alcohol syndrome

A

Congenital abnormalities include:

Facial abnormalities (small palpebral fissues, thin upper lip, cleft lip) 
Growth restriction 
Microcephaly 
Intellectual Disability
Cardiac anomalies (ASD)
44
Q

Bacterial vaginosis

A

Caused by gram variable rod Gardernella vaginalis +/- overgrowth of other anaerobic bacteria

Presents as a gray/white vaginal discharge with a fishy odor, non-painful

Diagnosed by the presence of Clue cells (vaginal epithelial cells coated in Gardernella) under the microscope

Treated with metronidazole or clindamycin (for anaerobes)

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