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Random Review Part 2 Flashcards

1
Q

Beta hemolytic bacteria

A

GAS, GBS, Staph aureus, listeria

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2
Q

“Lancet shaped gram positive diplococci”

A

Strep pneumo

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3
Q

Infecting heart valves

A

Strep viridans: makes dextrans to bind fibrin-platelet aggregates on damaged heart valves
Staph epidermidis: produces adherent biofilms
Staph aureus: can fuck shit up and make fibrin clots around itself

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4
Q

Weird stuff about GAS

A

Produces CAMP factor: enlarges area of hemolysis by S.aureus.
Hippurate test +
Take your baby camping

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5
Q

Weird stuff about Enterococci (faecalis)

A

Lancefield grouping, based on differences in C carbohydate on bacterial cell wall
Can cause subacute endocarditis after GI/GU procedures
To remember this bacteria, just remember this is where VRE comes from

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6
Q

Diptheriae can cause (dangerous)

A

Myocarditis, arrthmias

Diagnose: Gram + rods with metachromatic granules (blue/green), Elek + for toxin

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7
Q

Gram positive rods

A

Bacillus
Corynebacterium
Listeria
Clostridium

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8
Q

To kill spores:

A

Autoclave by steaming at 121C for 15 minutes

Spore produces: Clostridium, bacillus, coxiella

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9
Q

C. tetani location of action

A

Renshaw cells in spinal cord

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10
Q

Baby with constipation

A

Can be botulism starting out

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11
Q

C. perfringens can also cause

A

late onset food poisoning (watery diarrhea)

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12
Q

Tx c.diff

A

Metronidazole + PO vanc

Recurrent: repeat or fidaxomicin (macrolide)

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13
Q

Medussa head colonies

A

Anthrax

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14
Q

Listeria

A
  • Rocket tails (actin polymerization) in vitro, and tumbling motility which works better in cold temperatures (4C)
  • Only gram + to produce endotoxin
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15
Q

Actinomyces

A
  • Anaerobe, not acid fast, normal oral flora
  • Causes oral/facial abscesses that drain through sinus tracts, yellow sulfur granules. Pronounce “acnemycs” to remember abscesses and that its normal flora.
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16
Q

Nocardia

A
  • Aerobe, partially acid fast, found in soil

- Since its aerobic, causes pulmonary infection in immunocompromised or cutaneous infections s/p trauma in normal people

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17
Q

Treatment of actinomyces/nocardia

A

Treatment is a SNAP

Sulfonamides - Nocardia, Actinomyces - Penicillin

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18
Q

PPD false negative

A

Anergic (steroids, malnutrition, immunocomprimised), or sarcoidosis

If BCG vaccine (false positive), use Interferon-y release assay for fewer false positives

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19
Q

TB special virulence factor

A

Cord factor – inhibits macrophage maturation and induces release of TNF-a.

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20
Q

Leprosy

A

Lepromatous: Th1 compromised, so predominantly Th2 mediated (humoral)
Tuberculoid: Th1 not compromised, so predominantly Th1 mediated (cell mediated), which is preferred
Tx: Dapsone + rifampin for tuberculoid
add clofazimine for lepromatous form

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21
Q

PPx for N. meningitidis

A

Rifampin (also use for h.flu), cipro, ceftriaxone

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22
Q

H.flu tx

A

Amp+/-clav

Meningitis: ceftriaxone

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23
Q

H.flu vacc is against what?

A

PRP (polyribosylribitol phosphate)

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24
Q

Legionella quick facts

A

SIADH (hyponatremia), relative bradycardia
urine antigen
Tx w/macrolides or quinolone (erythromycin)
Pontiac fever is a mild flu like syndrome caused by it
GI symptoms

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25
Q

Pseudomonas drugs

A
  • Extended spectrum B-lactams (piperacillin, ticarcillin, cefepime) FYI: pip and tic are listed as “antipseudomonals” in FA
  • Carbapenems (imipenem, meropenem)
  • Monobactams (aztreonam)
  • Fluoroquinolones (cipro)
  • Aminoglycosides (gentamicin, tobramycin)
  • MDR strains: Colistin, polymyxin B
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26
Q

Erythema gangerenosum

A

necrotic cutaneous lesion, caused by pseudomonas, immunocompromised patients

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27
Q

General pseudomonas

A 
Hot tub foliculitis
Burn victims (aerobic reminder)
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28
Q

EIEC vs EHEC

A

EIEC produces similar manifestions of shigella since it invades, but doesnt produce the shiga like toxin that EHEC does. Remember that Shigella’s key to pathogencitiy is invasion, not toxin production*** EHEC doesnt need to invade to cause dysentery, the toxin alone is enough

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29
Q

How to differentiate EHEC from all other E. Coli?

A

DOES NOT ferment on sorbitol

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30
Q

HUS

A

Caused be EHEC
Anemia, thrombocytopenia, acute renal failure, schistocytes, platelet consumption
Looks like TTP but renal predominant

Since TTP/HUS/DIC can all look similar, pay attention to clinical scenario and lab values

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31
Q

Klebsiella pneumonia

A

Lobar, current jelly sputum

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32
Q

Salmonella typhi

A

H2S, Flagella, Endotoxin + Vi capsule, inactivated by gastric acids, response mediated by monocytes, causes constipation and rose spots on abdomen, followed by diarrhea, oral vaccine is live while IM vaccine is Vi capsular polysaccharide. Carrier state w/gallbladder colonization

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33
Q

Salmonella (non-typhi)

A

Same as typhi except PMN predominant response, bloody diarrhea (no constipation), no vaccine available (no Vi capsule), and doesnt produce rose spots.

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34
Q

Shigella

A

Only spreads cell to cell, no H2S or flagella, PMN predominant response, bloody diarrhea, no vaccine. Invasion = key to pathogenicity, doesnt even need the toxin.

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35
Q

Pseudoappendicitis

A

Yersinia enterocolitica

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36
Q

H plyori triple therapy

A

PPI, clarithromycin, amoxicillin (metronidazole if PCN all.)

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37
Q

3 spirochetes:

A

Borrelia - largest, can be visualized with wright/giemsa stain as a result
Leptospira
Treponema - dark field microscopy

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38
Q

Leptospira can cause 2 diseases:

A

Leptospirosis - flu like, myalgias (CALVES), jaundice, photophobia, conjunctival suffusion. SURFERS in TROPICS

Weil (whale) disease - severe form of jaundice and azotemia from liver/kidney dysfunction, fever, hemorrhage, anemia

Contaminated waters with animal urine

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39
Q

Borrela burdorferi

A

Natural reservoir is mouse, transmitted by Ixodes deer tick

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40
Q

Syphilis lesions

A

Primary = Painless chancre, Secondary = Condylomata lata, Tertiary = Gummas

*Condylomata acumulata = HPV

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41
Q

Neurosyphilis signs

A

Broad based ataxia, + romberg, charcot joint, stroke WITHOUT htn

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42
Q

VDRL false positives

A

Viral infection (mono, hepatitis)
Drugs
Rheumatic fever
Lupus anticoagulant/Leprosy

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43
Q

Gram variable rod

A

Gardnerella vaginalis

Clue cells, not an STD but associated with sexual activity. Tx with metronidazole or clinda

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44
Q

Rash on palms and soles

A

Coxsackie A infection
Rocky mountain spotted fever
Syphillus (secondary)

CARS

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45
Q

Rocky mountain spotted fever

A

Headache, RASH, fever. Tick vector

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46
Q

Typhus vectors

A

Flees (endemic)

Human body louse (epidemic)

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47
Q

Ehrlichiosis presentation

A

RMSF w/o rash. Tick vector.Morulae monocytes (berry like inclusions) To complete this notecard, required to do an internet search for image

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48
Q

Anaplasmosis presentation

A

Tick vector. Same as ehrlichiosis, no rash.

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49
Q

Q fever (coxiella). Its queer, why?

A

No rash, no arthropod vector. Comes from sheep/cattle amniotic fluid aersolized. Most common cause of culture negative endocarditis

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50
Q

2 forms of chlamydiae

A

1) Elementary bodies: Enfectious, enters cell via Endocytosis–> transforms into reticulate body. Analagous to spore, small and dense.
2) Reticulate bodies: Replicates in cell by fission, reorganizes into elementary bodies

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51
Q

Chlamydiae treatment

A

Azithromycin (favored), or doxycycline

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52
Q

Bird related disease, atypical pneumonia

A

Chlamydiae psittaci

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53
Q

Types of chlamydia trachomatis (serotypes)

A

A,B,C: Africa, Blindness (follicular cnjunctivitis), Chronic infection
D-K: “Everything else” Urethritis/PID, neonatal pneumonia (staccato cough) w/eosinophilia, neonatal conjunctivitis
L1, L2, L3: Lymphogranuloma venereum - painless geneital ulcers, painful inguinal lymphadenopathy. tx w/doxycycline

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54
Q

Mycoplasma pneumoniae high yield

A 
Xray looks worse
High cold agglutinins IgM, can lyse RBCs
Grown on Eaton agar (cholesterol)
Military recruits, prisons
Macrolides, doxy, fluoroquinolone
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55
Q

Systemic Mycoses high yield

A

Histo: Hides in macrophages. Bird/bat droppings. Ovoid cells. Smaller than RBC

Blasto: Buds broadly, Granulomatous nodules. Doubly refractile wall. Can disseminate to bone/skin. Same size as RBC.

Coccidio: Spherules. Can disseminate to bone (arthralgias)/skin (erythema nodosum). Larger than RBC.

Paracoccidio: Captain’s wheel. Latin America.

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56
Q

Tinea versicolor

A

NOT a dermatophyte despite being called tinea
Degradation of lipids –> acids –> damage melanocytes
Spaghetti and meatbballs

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57
Q

Opportunistic infection high yield

A

Candida: Budding yeast/pseudohyphae. T cell for superficial protection, neutrophils for hematogenous spread. Can cause endocarditis in IV drug users. Normal inhabitant.

Aspergillus: Acute angles. Septate hyphae. Allergic bronchopulmonary aspergillosis associated with ASTHMA and CYSTIC FIBROSIS. Causes bronchiectasis and eosinophilia. Aspergillomas s/p TB. Can produce aflatoxins (p53 mutation inducing) –> HCC.

Cryptococcus: Yeast, heavily encapsulated. Also in soil/bird poop like histo. Culture on sab, stain with india ink and mucicarmine. Latex agglutination test specific. Soap bubble lesions in brain.

Mucor and Rhizopus: Wide angles, nonseptate hypae. Similar presentation as aspergillus (look at histology). Penedrate bloo vessel walls, enter brain via cribriform plate. Black eschar on face.

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58
Q

Treat/prophylaxis for PCP

A

Bactrim

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59
Q

Sporothrix schenckii

A

Dimorphic, cigar shaped. Roses. Ascending lymphangitis. Tx w/itraconazole or POTassium iodide (plant a rose in a POT)

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60
Q

Protozoa - GI infection high yield

A

Get from cysts in water, or oocysts in water for crypto

Giardia - foul-smelling, fatty diarrhea. Diag: trophozoits or cysts in stool. Tx: metronidazole

Entamoeba histolytica (amebiasis) - DYSENTERY, liver abscess, anchovy paste exudate, RUQ pain, flask shaped ulcer. Diag: serology and/or trophozoits or cysts in stool. Tx: metronidazole. Iodoquinol for asymtpomatic cyst

Cryptosporidium - AIDS causes severe diarrhea, mild watery diarrhea for everyone else. Diag: oocysts on acid fast stain. Tx: nitazoxanide

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61
Q

Toxo treatment

A

Sulfadiazine + pyrimethamine

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62
Q

Naegleria fowleri

A

Rapidly fatal meningoencephalitis. Nalgene filled w/fresh water. Enters via cribriform plate. Amoebas in spinal fluid. Amphotericin B, but rarely works.

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63
Q

Trypanosoma brucei

A

African sleeping sickness: Enlarged lymph nodes, recurring fever, somnolence and coma. get it from Tsetse fly bite (PAINFUL). Tx w/Suramin for blood born disease or melarsoprol for CNS penetration

“It SURe is nice to go to sleep. MELAtonin helps with sleep”

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64
Q

Plasmodium (malara) high yield

A

Anopheles mosquito

For all, use chloroquine (if sensitive), blocks plasmodium’s heme polymerase. If not, use mefloquine or atovaquone/proguanil

Vivax/ovale has hypnozoite –> add primaquine to kill it first. Diagnose with Schuffner stippling (red granules)

Falciparum is deadliest form. Fucks up capillaries in brain, kidneys, and lungs.

65
Q

Babesia high yield

A

Fever + hemolytic anemia (Malaria like illness)
Asplenia increases risk of severe disease
Spread by Ixodes tick –> Lyme can coinfect
Maltese cross [Must look up on google images to complete card]
Tx: atovaquone + azithromycin

66
Q

Trypanosoma cruiz

A 
Reduviid bug (kissing bug, painless bite), feces.
Romana sign (unilateral periorbital swelling of acute stage)
67
Q

Leishmaniasis

A

Can be visceral, or cutaneous. Spiking fevers, hepatosplenomegaly, pancytopenia. Sandfly transmission. Macrophages contain amastigotes.

68
Q

Trichomonas vaginalis

A

Dont confuse with gardnella. Foul smelling, green discharge. Sexual tranmission. Strawberry cervix. Treat with metronidazole for partner and patient.

69
Q

Nematodes (intestinal)

A

Treat all intestinal ones with bendazoles (because worms are bendy, and so is the gut)

3 fecal oral:

  1. Pinworm Ienterobius vermicularis)
    • Tape test
  2. Giant roundworm (ascaris lumbricoides)
    • Possible obstruction of ileocecal valve
  3. Trichinella spiralis
    • Encyst in striated muscle –> trichinoosis = F/N/V, periorbital edema, myalgias (Imagine trying to make a spiral when I flex my biceps)

2 penetrate skin:

  1. Strongyloides
    - Feels like peptic ulcer
  2. Hookworm (Ancylostoma duodenale, necator americanus)
    - Anemia by sucking intestinal walls
70
Q

Nematodes (Tissue)

A

3 from bugs:

  1. Onchocerca volvulus (Female blackfly bite)
    • Hyperpigmented skin
    • River blindness [black fly, black skin, black sight]
    • Tx: ivermectin (Rivermectin)
  2. Loa loa (Deer/horse/mango fly)
    • Swelling in skin, worm in conjunctiva
    • Tx: diethylcarbamazine
  3. Wuchereria bancrofti (female mosquito)
    • ELEPHANTITIS (9mo-1yr s/p bite)
    • Tx: diethylcarbamazine

1 fecal oral:

  1. Toxocara canis
    • Visceal larva migrans
    • Bendazoles
71
Q

Taenia solium

A

Eat larvae in pork – intestinal infection (tx: praziquantel)
Eat eggs – neurocysticercosis (tx: albendazole)

72
Q

Diphllobothrium latum

A

“Jewish housewives disease” Ingestion of larvae from raw freshwater fish –> B12 deficiency. tx: praziquantel

73
Q

Echinoccus granulosis

A

eggs from dog feces, sheep = intermediate host. Hydatid cysts in liver, can cause ANAPHYLAXIS if antigens relased (so inject w/ethanol or hypretonic saline to kill daughter cysts before removal). tx albendazole

74
Q

Schistosoma

A

Shit I stepped on a snail. Portal htn. Chronic infection can lead to SCC of bladder and pulmonary htn. Txl praqiequantel

75
Q

Clonorchis sinesis

A

Undercooked fish. Biliary tract inflammation –> pigmented stones –> cholangiocarcinoma. tx: praziquantel

76
Q

MMR and HIV+

A

Yes, as long as not showing signs of immunodeficiency

77
Q

Virus cellular receptors

A 
CMV - cellular integrins
EBC - CD21
HIV - CD4 and CXCR4 (CCR5)
Rabies - nicotinic ACh receptors
Rhinovirus - iCAM1 (CD54)
78
Q

Tzanck test

A

Detects multinucleated giant cells (HSV1, HSV2, VZV)

79
Q

VIrus memory aids

A

DNA: P P P AHH P (Pee pee pee ahhhhh pee) [box the last 3]
dsRNA: Reo
+RNA: CHP RC TF (California Highway Patrol, Remote Control, TF [box the last 4]
- RNA: ABPOFR (always bring polymerase or fail replication) [box all of them]
Segemented: BOAR (Bunya, orthomyxo, arena, reo) <–can undergo reassortment

ENTERIC VIRUSES DONT HAVE AN ENVELOPE

80
Q

Picornaviruses

A

RNA is translated into 1 large polypeptite that is cleaved by proteases
All except Rhino are fecal-oral spread

81
Q

Yellow fever

A

Black vomit. Councilman bodies in liver (eosinophilic apoptopic globules)

82
Q

Congenital Rubella

A

Extramedullary hematopoises gives the blueberry muffin appearance

83
Q

Paramyxovirus

A

All have surface F (fusion) protein –> causes respiratory epithelium cells to fuse –> forms multinucleated cells. Palvizumab is an Ab against the F protein, used against RSV.

84
Q

Rabies

A

Found in same locations that are susceptible to hypoxia/global ischemia (perkinje of cerebellum and prymads of hippocampus)

85
Q

HBV

A

-Window period is between HBsAg and anti-HBsAg, only thing then is the anti-HBe and Anti-HBc IgGs
-Chronic = expressing HBsAg, no anti-HBsAg
High infectivity with HBeAg, Low infectivity with Anti-HBeAg

86
Q

HIV genes

A

env: gp160 –> gp41 + gp120 (crosses placenta, can cause false positive)
gag: p24 capsid protein
pol: reverse transcriptase, integrase, aspartate protease

Binds CD4 + coreceptor (CCR5 on macrophages earlier, CXCR4 on T cells later)

87
Q

Dominant flora of colon

A

B.fragilis>E.coli

88
Q

Pre surgery antibiotic

A

Cefazolin for s. aureus

89
Q

Cephalosporin use

A

1st gen: PEcK (proteus, e.coli, klebsiella)
2nd gen: HEN PEcKS (h.flu, enterobacter, neisseria,..)
Antipseudo: Cefepime (4th), Ceftazidime (3rd)

90
Q

Imipenem always given with:

A

cilastatin (to make the killin lastin) for renal inactivation prevention

91
Q

Carbapenems toxicity

A

CNS, seizures

92
Q

Allergic to PCN or can’t tolerate aminoglycosides:

A

Aztreonam. ONLY for gram-negative rods

93
Q

Fluoroquinolones

A

hurt attachments to your bones (cartilage/tendon damage). Use for gram (-) rods of urinary and GI tractts

94
Q

Daptomycin

A

Dont use for pneumonia because surfactant inactivates it. Depolarizes cell membrane by disrupting it (gram + cocci). Myopathy, rhabdo

95
Q

Flucytosine converts to:

96
Q

Azoles

A

Inhibit the cytochrome p450 enzyme that converts lanosterol to ergosterol (final step), Also inhibits testosterone synthesis so can get gynecomastia

97
Q

Terbinafine

A

Second to last step of ergosterol synthesis (squalene epoxidase)

Dermatophytes

98
Q

-fungin drugs

A

Inhibit cell wall synthesis (inhibiting synthesis of B-glucan)
Good for aspergillosis and Candida

99
Q

Griseofulvin

A

accumulates in keratin containing tissue, good for dermatophytes (tinea, ring worm). Fucks with microtubule formation

100
Q

Anti-mite/louse therapy (scabies)

A

All are neurotoxic

101
Q

Antivirals not requiring activation by viral kinase:

A

Both good for CMV retinitis. Cidofovir good for acyclovir-resistant HSV found in HIV patients

  • Foscarnet (binds to pyrophosphate binding site on DNA/RNA pol)
  • Cidofovir ( (preferentially DNA pol) [Give probenecid + IV saline]
102
Q

NNRTIs

A

Delavirdine
Efavirenz
Nevirapine

Never delete favorites

Stevens Johnsons, hepatotoxic

103
Q

Raltegravir

A

Integrase inhibitor

I hope the rales have integraty

104
Q

Fusion inhibitors

A

Enfuviridine (no Entry) –> Binds gp41

Maraviroc (Marry me) –> binds CCR5

105
Q

Ribavarin

A

For HCV, and RSV in children

Inhibits synthesis of guanine nucleotides (ribs taste Good)

106
Q

Other HCV treatments:

A 
Same sofa (Simeprevir, sofosbuvir)
protease inhibitor, RNA polymerase inhibitor
107
Q

Embroygenesis genes shortcuts

A

Sonic hedgehog - A/P axis, CNS dev
Wnt-7 - Dorsal-ventral axis
FGF - Lengthening of limbs
Homeobox (hox) - Segments, transcription factors, appendages in appropriate places

108
Q

Early fetal development shortcuts

A

1wk: hCG at 6, blastcyst sticks at 7
2wk: 2 layers
3wk: 3 layers, neural plate forms
3-8wk: Neural tube, organs, teratogens
Wk 4: heart beats (4 chambers), 4 limbs
Wk 6: can see heart beat
Wk 10: Genitalia discernible

109
Q

Twinning

A

Cleavage between:
2 cell stage and morula = didi [Second most common]
morula and blastocyst = monodi [Most common]
blastocyst and formed disc = monomono
after formed disc = monomono conjoined

110
Q

Aortic arches

A 
1 = maximal, maxillary
2 = second, stapedius and hyoid
3 = 3Cs, common carotid, internal carotid
4 = 4 limbs, proximal right subclavian, aortic arch [right recurrent larygneal]
6 = pulm artery, ductus arteriosus  [Left recurrent laryngeal]
111
Q

Branchial arch

A

1 | V2, V3 | Chew (M’s) | Treacher
2 | VII | Smile (S’s) | Fistulas
3 | IX | Swallow stylishly | Tongue post
4 | X (superior laryngeal) | Simply swallow | Tongue post
6 | X (inferior laryngeal) | Speak |

Anterior digastric belly = 1
Posterior digastric belly = 2

112
Q

Branchial pouch

A

1 | Ear
2 | Tonsils
3 | Thymus, I. parathyroids
4 | S. parathyroids

113
Q

Mesonephric duct derivatives

A

Male internal structures except prostate, which comes with DHT exposure to urogenital sinus

114
Q

Gubernaculum

A

Anchors tests within scrotum, becomes ovarian ligament and round ligament of uterus (on fundus) in females

115
Q

Ovarian ligament vs. suspensory ligament of ovary

A

Ovarian ligament anchors to uterus, suspensory ligament actually has the ovarian vessels

116
Q

Histology of female

A

Most of the internal structures are simple columnar, but ovaries are cuboidal

117
Q

Autonomic innervation of male sexual response

A

Pelvic nerve, Parasympathetics, erection
Hypogastric nerve, Sympathetic, emission
Pudendal nerve, (S2,3,4) somatic, ejaculation

118
Q

Inhibin

A

Temperature decreases levels, seen in varicocele and cryptorchidism

119
Q

Estrogen potency

A

17B-estradiol (ovary) > estrone (aromatization) > estriol (placenta)

120
Q

Estrogen vs progesterone, plus select details

A

Increases vs decreases myometrial excitability
Increase vs decreases estrogen receptor expression

Fall in progesterone s/p delivery disinhibits prolactin to allow lactation
Increased progesterone is indicative of ovulation (measure temperature)

121
Q

Oogenesis and ovulation

A

PrOphase I before ovulation
Metaphase II before fertilization

Ovulation: ^ estrogen –> ^ GnRH receptors on ant pituitary –> estrogen surg –> ^LH –>ovulation

122
Q

MIttelschmerz

A

From peritoneal irritation (follicular swelling/rupture, fallopian tube contraction)

123
Q

Purpose of hCG

A

Secreted by syncytiotrophoblast
Acts as LH to maintain corpus leteum –> maintains progesterone
8-10 weeks, then placenta makes its own estriol and progesterone and corpus luteum goes away
Alpha subunit same as LH, FSH, TSH

124
Q

Spermatogenesis

A

Spermatogonium –> primary and secondary spermatocytes –> Spermatid –> spermatozoon (zoomin towards egg)

125
Q

What closes the epiphyseal plate?

A

Estrogen (in males, testosterone converted to estrogen)

126
Q

XYY

A

Nondisjunction @ paternal meiosis II

127
Q

Hydatidiform moles

A

hCG high in complete (46), increased risk for chorio and will get hyperthyroid b/c TSH and hCG share alpha unit

Partial mole has fetal parts
Complete mole is a snowstorm

128
Q

BP control in pregnancy

A

alpha-methyldopa, hydralazine, labetalol, nifedipine

129
Q

HELLP

A

Leads to hepatic subcapsular hematomas –> rupture –> severe hypotension

130
Q

Eclampsia

A

Death due to stroke, intracranial hemorrhage, ARDS

131
Q

Accreta/increta/percreta

A

Accreta - myometrium w/o penetration
Increta - invades myometrium
Percreta - perforates through into uterine serosa, can attach to rectum or bladder

132
Q

Abruption vs previa

A

Bleeding: Abruption is painful, previa is painless

133
Q

Velamentous umbilical cord insertion

A

Cord insersts into chorioamniotic membrane rather than placenta, so fetal vessels travel to placenta unprotrected by Wharton jelly –> predisposes to vasa previa (look for hemorrhage and fetal bradycardia)

134
Q

HPV 16 and 18 gene products

A

E6 - inhibits p53 gene
E7 - inhibits Rb gene

Lateral invasion of cervical SCC can block urters and cause renal failure

135
Q

Theca-lutein cyst

A

Bilateral, Caused by excess B-hCG so will get with choriocarcinoma or molar pregnancy.

136
Q

Coffee been nuclei

A

Brenner Tumor. Urothelium, Looks like bladder.

137
Q

Ascites + pulling sensation in groin

A

Meigs Syndrome – mostly from ovarian fibromas, but can be from other benign ovarian neoplasms. Ascites resolves with removal

138
Q

Thecoma produces

A

Estrogen. Just like granulosa cell tumors (but those are malignant)

139
Q

Immature teratoma is aggresive and contains:

A

neuroectoderm, immature neural tissue, more likely to contain thyroid tissue

140
Q

Granulosa cell tumor histology

A

Call-Exner bodies (looks like primordial follicles w/granulosa cells arranged haphazardly around collections of eosinophilic fluid)

141
Q

Cystadenocarcinoma (2 types)

A

Serous – most common, psammoma bodies, BRCA-1

Mucinous – causes “Pseudomyxoma peritonei”, where mucinus material from ovary fills up the peritoneum

142
Q

Dysgerminoma (male equivalent =?)

A

Seminoma. Sheets of fried egg and hCG, LDH are high

143
Q

Choriocarcinoma

A

NO chorionic villi present. Hemoptysis, hematogenous spread to lungs. high B-hCG

144
Q

Yolk sac tumor (endodermal sinus)

A

Aggressive. Ovaries or tests. Schiller-Duval bodies which resemble glomeruli. AFP are high

145
Q

Adenomyosis

A

caused by hyperplasia of basal layer of endometrium. tx w/GnRH agonists or hysterectomy

146
Q

Most common cause of endometritis (pathogens):

A

Bacteroides. Tx w/ gent+clinda +/- amp

147
Q

Mastitis pathogen

148
Q

Noninvase breast cancer high yield

A

DCIS – Ductal atypia, fills ductal lumen
Comedocarcinoma – central necrosis
Paget disease – paget cells (large cells in epiderms w/clear halo)

149
Q

Invasive breast cancer high yield

A

Invasive ductal –Stellate inflitration, worst, most invasive
Invasive lobular – Indian file, orderly rows, loss of E-cadherin
Medullary – Fleshy, cellular, lymphocytic infiltrate
Inflammatory – Peau d’orange. Dermal lymphatic invasion

150
Q

Biopsies and testicular tumors

A

DONT DO IT

151
Q

Testicular tumors

A

Germ cell (95%)

  • Seminoma: Most common, 30s, fried egg, ALP. Good prognosis. Radiosensitive. Alk Phos
  • Yolk sac (endodermal sinus) tumor): Schiller Duval bodies (glomeruli). AFP. <3y/o
  • Choriocarcinoma: hCG. hematogeouns mets. gynecomastia. hyperthyroidism.
  • Teratoma: mature can be malignant (unlike in women). hCG and/or AFP
  • Embryonal carcinoma: Painful. hCG. AFP when mixed. glandular/papillary.

Non-germ cell (5%)

  • Leydig cell: Reinke cystals (eosinophilic cystoplasmic inclusions), gynecomastia. produces androgens.
  • Sertoli cell: Androblastoma
  • Testicular lymphoma: Older men. Not primary. Usually diffuse large B-cell type.
152
Q

Acute prostatitis pathogen

153
Q

Prostate cancer markres

A

increased PSA, but decreased free PSA. OSTEOBLASTIC as opposed to most bone mets from other tumors which are osteolytic

154
Q

Tamoxifen and Raloxifene

A

Both are antagonists in breast and agonists in bone, but tamoxifen is an agonist in the endometrium and raloxifene is an antagonist there

155
Q

Mifepristone

A

Competitive inhibitor of progestins at progesterone receptor

156
Q

Terbutaline, ritodrine

A

B2-agonists, relax uterus, tocolytics

157
Q

Danazol

A

Synthetic androgen, partial agonist. Causes atrophy of endometrium. Can also be used for hereditary angioedema because it increases production of C1-esterase inhibitor.

158
Q

Side effects of boner drugs

A

Hot and sweaty, then headache heartburn and hypotension. blue tinted vision

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