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Renal & Repro Review Flashcards

1
Q

Mesonephros becomes

A

WOlffian duct

epididymus

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2
Q

Metanephros becomes

A

uretric bud –> metanephric mesoderm –>

collecting duct
Major/minor calyxces
Renal pelvis

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3
Q

Metanephric blastema becomes

A

Glomeruli, bowman proximal tubule, loop of henle, distal convoluted tubules

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4
Q

Horseshoe kidney associated with what chromosomal syndromes

A

Turner syndrome
Trisomies 13, 18, 21
Rarely renal cancer

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5
Q

Unilateral renal agenesis due to

A

Absence of one kidney due to failure of ureteric bud to develop

No ureteric bud to induce differentaition ofmetanephric mesenchyme

Absence of kidney and ureter

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6
Q

Hydronephros

Dilated or thick walled bladder on ultrasound

A

Posterior urethra valves

Membrane remnant in the posterior urethra in males

Leads to urethra obstruction

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7
Q

What kidney is taken during donor transplantation?

A

Left kidney due to longer renal vein

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8
Q

Renal blood flow (10 steps)

A
  1. Renal artery
  2. Segmental artery
  3. Interlobar artery
  4. Arcuate artery
  5. Interlobular artery
  6. Afferent arteriole
  7. Glomerulus
  8. Efferent arteriole
  9. Vasa recta/ peritubular capillaries
  10. Venous outflow
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9
Q

Course of ureters

- under/over

A

Under uterine artery or vas deferens

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10
Q

Plasma volume can be measured by

A

Radiolabeling albumin

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11
Q 
Percentages Total body water
ICF
ECF
Plasma
Interstitial fluid
A

60% total
40% ICF
20% ECF

Of ECF
25% Plasma
75% Interstitial fluid

% of body weight

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12
Q

Basement membrane of glomerular filtration barrier composed of

A

Type IV collagen chains

Heparan sulfate

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13
Q

Serum creatinine begins to rise when

A

GFR declines to < 60

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14
Q

Renal plasma flow can be estimated using

A

para-aminohippuric acid (PAH) clearance

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15
Q

Filtration Fraction

A

FF= GFR/RPF

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16
Q

Prostaglandins on filtration

A

Prostaglandins Dilate Afferent arteriole (PDA)

Increase GFR
Increase RPF
No change FF

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17
Q

Angiotension II on filtration

A

Angiotensen II constrict efferent arteriole (ACE)

Increase GFR
Decrease RPF
Increase FF

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18
Q

GFR vs RPF

A

GFR: amount filtered

RPF: amount filtered and secreted

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19
Q

Changes in glomerular dynamics (GFR, RPF, FF)

1) Afferent arterole constriction
2) Efferent arterole constriction
3) Increase plasma protein concentration
4) Constriction of ureter
5) Dehydration
6) ACE inhibitors
7) NSAIDS
8) Prostaglandins
9) Angiotensin II

A

1) Afferent arterole constriction
Decrease GFR
Decrease RPF
No change FF

2) Efferent arterole constriction
Increase GFR
Decrease RPF
Increase FF

3) Increase plasma protein concentration
(Fluid stays in arterole) 
Decreased GFR
No change RPF
Decreased FF

4) Constriction of ureter
( High hydrostatic pressure inside bowman capsule –> favor blood staying in capillaries)

Decrease GFR
No change RPF
Decrease FF

5) Dehydration
(Less filtered or secreted)
Decrease GFR
Large Decrease RPF
Increase FF

6) ACE inhibitors
- Dilates efferent
Decrease GFR
Increase RPF
Decrease FF

7) NSAIDS
- Constrict Afferent
- Decrease GFR
- Decrease RPF
- No net change FF

8)Prostaglandins
- Dilate afferent
Increase GFR
Increase RPF
No change FF

9) Angiotensin II
- Constrict efferent
Increase GFR
Decrease RPF
Increase FF

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20
Q

Three stimuli for renin release

A
  1. beta-adrenergic stimulation (beta 1)
  2. Low Na in distal convoluted tubule
  3. Low pressure in afferent arteriole
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21
Q

Ureteric bud comes from

A

Caudal end of mesonephros (closest to feet)

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22
Q

Juxtaglomerular cells located

A

Inbetween afferent arteriole and distal tubule

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23
Q

Pregnancy effect on PCT

A

Decrease ability of PCT to reabsorb glucose and amino acids –> glucosuria and aminoaciduria

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24
Q

Concentration at which glucose spilled

Concentration at which tubular reabsorption of glucose saturated

A

Spilling at 160-200

Saturated at 350 mg/dL

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25
Q

First half proximal convoluted tubule primarily reabsorbs

A

Bicarb

Na

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26
Q

Relative concentrations along proximal tubule

A

Plasma Concentration Increases Unless Cleared by Kidneys

PAH
Creatinine
Inulin
Urea
Chloride
Potassium

Sodium
HCO3
Amino acids
Glucose

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27
Q

Na reabsorbed with

1) Early PCT
2) Late PCT

A

1) Early PCT
- Na/H (Na in/ H out)
- Na/ X (glucose, AA, lactate) (all in)

2) Late PCT
- Na/Cl (all in)
(Driven by Na/K atpase)

3) Thick ascending limb
- Na/K/ 2Cl ( all in)

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28
Q

What class of drugs inhibits the Na/2Cl/K symporter in thick ascending limb

A

Loop diuretics

Causes Isotonic water excretion

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29
Q

Two cell types of collecting duct and last segment of distal tubule

Fxn of cells

A

1) Principal cells
- reabsorb water and Na
- Secrete K

2) Intercalated cells
- secrete H or HCO3
- Reabsorb K

Intercalated cells

  • Alpha: Secrete H
  • Beta: Secrete HCO3
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30
Q

Alpha ketoglutarate in which part of nephron

A

Proximal convoluted tubule

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31
Q

Absorbed in thick ascending limb

A

Na, Cl, K

Ca and Mg sneak in between cells

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32
Q

Nephron impermeable to water

A

Thick ascending limb

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33
Q

ADH works on what receptors

A

V2 vasopressin receptors on principal cells of collecting tubule

Tells cells to insert aquaporins into lumen surface of cells

H20 reabsorption

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34
Q

Drug that works by entering Na channel and blocks aquaporin

A

Lithium

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35
Q

Aldosterone effect on principal cell intercalated cells of collecting duct

A

Acts on mineralocorticoid receptor –> mRNA –> protein synthesis

Principal cells: reabsorption of Na and secretion of K

  • Increase apical K conductance
  • Increase Na/K pump
  • Increase epithelial Na channel activity –> lumen negativity –> K secretion

Intercalated cells: Stimulates secretion of H (alpha cells)
- negative lumen –> Increase H ATPase activity –> increase H secretion –> Increase HCO3/Cl exchanger activity

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36
Q

PTH works on

A

Early PCT- inhibits Na/PO4 3- cotransport
–> PO4 3- (phosphate) excretion

Early DCT
- Increase Ca/Na exchange –> Ca reabsorption

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37
Q

AT II effect on nephron

A

Stimulates Na/ H exchange in early PCT

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38
Q

Acetazolamide

  • MOA
  • Uses
  • Side effects
A

Carbonic anhydrase inhibitor

  • Carbonic anhydrase converts HC02 –> CO2 + H20
  • Cant reabsorb bicarb without
  • Excreted in urine

Minor diuretic effect
Altitude sickness
(over come respiratory alkosis more quickly)
Urine Alkalinization
Glaucoma
(Bicarb production draws water into eye)
Idiopathic intracranial HTN (pseudotumor cerebri)

Adverse

  • Metabolic acidosis
  • Sulfa allergy
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39
Q

First line tx Idiopathic intracranial HTN

A

Acetazolamide

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40
Q

Mannitol

  • MOA
  • Use
  • Adverse
  • Dont use in (2)
A

Osmotic diuretic

  • Causes osmolar load to stay in filtrate
  • Prevent reabsorption of water
  • Excretion of water

Increase serum osmolarity and Na

Shock
Drug overdose
Acute angle-closure glaucoma
Elevated ICP

Adverse
- Dehydration

Dont use

  • Anuric renal failure
  • CHF
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41
Q

Loop Diuretics

  • Examples (4)
  • MOA
  • Use
  • adverse
A

Bumetanide
Ethacrynic acid
Furosemide
Torsemide

Inhibit Na/K/Cl cotransporter

Loops Lose calicum

Use

  • CHF
  • Pulmonary edema
  • Nephrotic syndrome
  • Cirrhosis
Adverse
- sulfa allergy (except ethacrynic acid) 
- Hypokalemia
- Gout
- Ototoxicity **
- Nephrotoxicity **
Muscle weakness **
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42
Q

Tx Altitude sickness

A

Acetazolamide

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43
Q

Thiazide diuretic

  • Examples (3)
  • MOA
  • Feature
  • Use
  • Side effect
A

Chlorthalidone
Hydrochlorothiazide
Metolazone

Inhibit reabsorption of Na and Cl
- reducing diluting capacity of nephron

Retain Calcium
Helps with osteoporosis

HTN (first line)

Side effect

  • Hypokalemia
  • Hyponatremia
  • Hyperglycemia
  • Sulfa allergy
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44
Q

Potassium sparing diuretics

  • examples
  • MOA
  • Use
  • Adverse
A

Aldosterone antagonist

  • Spironolactone
  • Eplerenone

Block Na channels

  • Amiloride
  • Triamterene

CHF

Adverse
- Hyperkalemia
- Arrhythmias
- Gynecomastia (antagonist androgen receptor)
- menstrual irregularities
(Not eplerenone specific to mineralocorticoid receptor)

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45
Q

Diuretic

1) Increases urinary NaCl
2) Acidosis
3) Alkalosis

A

1) Increases urinary NaCl
- All except acetazolamide

2) Acidosis
- Acetazolamide
- K spring diuretics

3) Alkalosis
- Loop diuretics
- Thiazide diuretics

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46
Q

Shifts K into cells –> hypokalemia

A

Insulin
Beta- agonist
Alkalosis
Cell creation/ proliferation

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47
Q

PTH effect on Vit D synthesis

A

Faciliates 1alpha-hydroxylase addinig second hydroxyl group to make 1,25 (OH)2 Vit D

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48
Q

ANP on kidneys

A

Released by heart due to increased atrial volume and atrial pressure

Constricts efferent arterioles and dilates afferent arterioles

Increase GFR
Diuresis

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49
Q

Drug that causes SIADH

A

Cant Concentrate Serum Sodium

Carbamazepine
Cyclophosphamide
SSRI

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50
Q

Locked in syndrome

A

Correct hyponatremia too quickly

Causes lysis of myelin and pons

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51
Q

Diabetes insipidus

  • Due to
  • Central
  • Nephrogenic
A

Too little ADH effect
Cant concentrate urine

Central
- Abnormal ADH production by hypothalamus

Nephrogenic
- Kidneys unresponsive to ADH

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52
Q

Nephrogenic diabetes inspidius can be cause by what drugs

A

Lithium

Demeclocycline (cousin of tetracycline)

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53
Q

First line tx Nephrogenic DI

A

Hydrochlorothiazide
- causes dehydration so PCT will concentrate more

(Indomethacin: decrease renal blood flow)
(Amiloride: lithium induced Nephrogenic DI)
- blocks Na channels Lithium enters through

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54
Q

Tx for Lithium induced Nephrogenic Di

A

Amiloride

- Blocks Na channels LIthium enters thorugh

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55
Q

Depression of reflexes

A

Hypermagnesemia

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56
Q

Tx Central DI

A

Desmopressin

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57
Q

Causes of acidosis with elevated anion gap

A

MUDPILES

Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablet/ Isoniazide
Lactic acidosis
Ethylene glycol
Salicylates
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58
Q

Patient with kidney stones presents with hypokalemia and metabolic acidosis. Anion gap is normal. Urine pH is 5.7. Defect?

A

Renal Tubular acidosis Type I

  • Hypokalemia
  • pH > 5.5

Impaired secretion of H by alpha intercalated cells in the collecting tubule

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59
Q

Hypoventilation causes

A

Respiratory acidosis

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60
Q

Anion gap=

A

[Na] - [Cl]- [HCO3]

10-12 normal

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61
Q

Normal anion gap acidosis

A

HARDASS

Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
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62
Q

Metabolic alkalosis caused by (3)

A

Excessive vomiting
Diuretics
Hyperaldosteronism

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63
Q

Type 1 Renal tubular acidosis

  • due to
  • pH
  • electrolyte
  • Increased risk for
  • causes (3)
  • Location
A

Alpha intercalated cells in collecting tubule unable to secrete H

Urine pH > 5.5
Hypokalemia

Risk for calcium phosphate kidney stones (due to increased pH and increased bone turnover)

Causes

  • Amphotericin B toxicity
  • analgesic nephropathy
  • congenital anomalies (obstruction) of urinary tract

Distal

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64
Q

Type 2 Renal tubular acidosis

  • due to
  • pH
  • electrolytes (2)
  • Location
  • Risk for
  • Causes
A

Proximal tubule defect of HCO3 reabsorption

Urine pH < 5.5
Hypokalemia
Hypophosphatemia

PCT

Risk for hypophosphatemic rickets

Causes

  • Fanconi syndrome
  • Carbonic anhydrase inhibitors
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65
Q

Type 4 Renal tubular acidosis

  • due to
  • pH
  • Electrolytes
  • causes
A

Often due to hypoaldosteronism
If Low not putting potassium into urine

Urine pH < 5.5
Hyperkalemia
(prevents PCT from generating NH4)

Causes

  • decrease aldosterone production (ACE inhibitor, ARB, NSAID, heparin, cyclosporine)
  • Aldosterone resistance (K sparing diuretics, obstruction nephropathy, TMP/SMX)
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66
Q

Henoch-Schonlein Purpura renal problem

A

IgA nephropathy

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67
Q

Increased AA, glucose, bicarb, phosphate in urine.

  • Due to
  • May cause
  • Causes
A

Fanconi syndrome

Generalized reabsorptive defect in PCT

May result in metabolic acidosis (proximal renal tubular acidosis)

Wilson dis
GLycogen storage disease
Ischemia
MM
Drugs (ifosfamide, cisplatin, tenofovir, expired tetracyclines)
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68
Q

Urine pH < 5.5
Hypokalemia

  • type
  • due to
  • other lab
A

Type 2 Renal tubular acidosis

Hypophosphatemia

Proximal tubule defect of HCO3 reabsorption

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69
Q

Serum pH > 7.45
Hypokalemia
No medications

Increased Renin
Increased Aldosterone
Increased urine Ca

A

Bartter syndrome
- AR

Reabsorptive defect in thick ascending loop of Henle
- affects Na/K/2Cl cotransporter

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70
Q

Serum pH > 7.45
Hypokalemia
Hypomagnesemia
Hypocalcuria

Increased Renin
Increased aldosterone

A

Gitelman syndrome
AR

Reabsorptive defect of NaCl in DCT

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71
Q

Serum pH > 7.45
HTN
Hypokalemia
Decreased aldosterone

Decreased Renin

Tx

A

Liddle syndrome
AD

Gain of function mutation
Increase Na reabsorption in collecting tubules

Tx Amiloride

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72
Q

Urine pH < 5.5
Hyperkalemia

  • type
  • due to
  • lab
A

Type 4 Renal tubular acidosis

Due to hypoaldosteronism
Low so not putting potassium into urine

Prevents PCT from generating NH4

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73
Q 
Serum pH > 7.45
HTN
Hypokalemia
Decreased aldosterone
Increased cortisol
  • Acquired from
  • Tx
A

Syndrome of Apparent Mineralocorticoid Excess (SAME)

Hereditary deficiency of 11beta-hydroxysteroid dehydrogenase
- cortisol not converted to cortisone

Can acquire from glycyrrhetinic acid (present in licorice)

Tx: Corticosteriods

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74
Q

Dopamine affect on nephron

  • secreted by
  • promotes
  • affects what parts
  • effect
A

Secreted by PCT cells promotes natriuresis

At lose doses, dilates interlobular arteries, afferent arterioles and efferent arterioles

–> Increase RBF, little to no change GFR

Higher doses= vasoconstrictor

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75
Q

Part of nephron with lowest pH

What happens at low pH

A

Distal tubule
Collecting duct

Uric acid precipitates at low pH

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76
Q

RBC cast

A

Glomerulonephritis

Malignant HTN

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77
Q

WBC cast

A

Tubulointerstitial inflammation
Acute pyelonephritis
Transplant rejection

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78
Q

Fatty casts

A

Nephrotic syndrome

Assoc w/ Maltese Cross sign

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79
Q

Granular (Muddy brown) casts

A

Acute tubular necrosis

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80
Q

Waxy casts

A

End-stage renal disease

Chronic renal failure

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81
Q

Hyaline cats

A

Nonspecific

Concentrated urine samples

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82
Q

Membranous means

A

Thickening of glomerular basement membrane

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83
Q

Nephritic (5) vs Nephrotic (5)

  • due to
  • features
A

Nephritic

  • Due to GBM disruption
  • HTN
  • Increased BUN/Cr
  • Hematuria
  • RBC in urine
  • proteinuria < 3.5
  • Azotemia ( high nitrogen containing compounds, urea, creatinine)
  • Oliguria ( low urine output)
Nephrotic
- Podocyte disruption --> charge barrier impaired
- Proteinuria > 3.5 g/ day
- Hypoalbuminemia
- Hyperlipidemia
- Edema
(Frothy urine with fatty casts)
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84
Q 
URI 2 weeks ago
Child
Periorbital edema
proteinuria <3.5 
Cola-colored urine
HTN
  • Disease
  • LM
  • IF
  • EM
  • Type rxn
  • decrease level
A

Acute poststreptococcal glomerulonephritis

LM
- gomeruli enlarged and hypercellular

IF

  • “starry sky” granular appearance
  • “Lumpy-bumpy” due to IgG, IgM and C3 deposition along GBM and mesangium

EM
- subepithelial immune complex (IC) humps

Type III hypersensitivity rxn

Decrease complement levels (C3) due to consumption

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85
Q

Nephritic syndrome seen in Good pasture syndrome

  • clinical
  • Seen on IF
  • type hypersensitivity
A

Rapidly progressive (crescentic glomerulonephritis)

Hematuria
Hemoptysis

Type II hypersensitivity txn
Antibodies to GBM and alveolar basement membrane
–> Linear IF

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86
Q

Rapidly deteriorating renal function (days to weeks)

LM?
Consist of
Disease associated?

A

Rapidly progressive (crescentic) glomerulonephritis)

LM and IF- crescentmoon shape

Crescents consist of fibrin and plasma protein (C3b) with glomerular parietal cells, monocytes and macrophages

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87
Q

Nephritic syndrome seen with Granulomatosis with polyangiitis (wegener)

A

Rapidly progressive (crescentric) glomerulonephritis

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88
Q

Renal disease associated with SLE

A

Diffuse proliferative glomerulonephritis

Wire loop

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89
Q

Diffuse proliferative glomerulonephritis

  • Due to
  • LM
  • EM
  • IF
A

SLE

LM
- “wire looping” of capillaries

EM
- subendotthelial and sometimes intramembranous IgG based ICs often with C3 deposition

IF
- granular

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90
Q

Episodic gross hematuria that occurs concurrently with respiratory or GI tract infections.

LM
EM
IF

Assoc with

A

IgA nephropathy (Berger disease)

LM
- Mesangial proliferation

EM
- mesangial IC deposition

IF
- IgA based IC deposits in mesangium

Henoch Schonlein purpura

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91
Q

Retinopathy or lens dislocation
Glomerulonephritis
Deafness

  • disease
  • inheritence
  • mutation
  • MOD
  • EM
A

Alport syndrome

X linked dominant

Mutation in type IV collagen

Thinning and splitting of glomerular basement membrnae

Basket weave appearance on EM

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92
Q

Membranoproliferative glomerulonephritis

  • Type I (IF, appearance, Due to, assoc w/)
  • Type II (also called, assoc with
A

Type I

  • subendothelial immune complex (IC) deposits with granular IF
  • Tram track appearance on PAS stain
  • Due to GBM splitting caused by mesangial in growth
  • May be secondary to Hep B or C infection

Type II

  • Also called dense deposit disease
  • Associated with C3 nephritic factor (IgG antibody that stabilizes C3 convertase –> persistent complement activation –> decrease C3 levels)
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93
Q

Nephrotic syndrome in children
Recent infection or immunization

  • Disease
  • LM
  • IF
  • EM
  • Tx
A

Minimal change disease (lipoid nephrosis)

LM
- normal glomeruli (lipid may be seen in PCT cells)

IF
- negative

EM
- effacement of foot processes

Corticosteriods

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94
Q

Nephrotic syndrome associated with HIV, sickle cell

LM
IF
EM
Most common in

A

Focal segmetnal glomerulosclerosis

LM
- segmental sclerosis and hyalinosis

IF
- often negative but may be positive for nonspecific focal deposits of IgM, C3, C1

EM
- Effacement of foot process similar to minimal change disease

African americans and hispanics

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95
Q

Membranous nephopathy (membranous glomerulonephritis)

LM
IF
EM

Common in

Caused by

  • primary
  • secondary
A

LM
- diffuse capillary and GBM thickening

IF
- Granular as a result of immune complex deposition

EM
- Spike and dome with subepithelial deposits

Caucasian adults

Primary
- Ab to phospholipase A2 receptor (PLA2R)

Secondary

  • NSAIDs
  • Infectiosn (HBV, HCV, Syphilis)
  • SLE

Poor responds to steroids

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96
Q

Diabetic glomerulonephropathy

LM
Pathogenesis

A

LM

  • mesangial expansion
  • GBM thickening
  • Eosinophilic nodular glomerulosclerosis ( Kimmelstiel-Wilson lesions)

Nonenzymatic glycosylation of GBM –> increased permeability, thickening

Nonenzymatic glycosylation of efferent arterioles (hyaline arteriosclerosis) –> increase GFR –> mesangial expansion

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97
Q

Uric acid stones where

Xray findings
Crystal formation

A

Collecting duct

RadiolUcent
Rhomboid or rosettes

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98
Q

Cystine crystals

  • xray findings
  • shape
  • test
A

Radiolucent
Hexagonal

Sodium cyanide nitroprusside test

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99
Q

Hydronephrosis due to

A

Distention or dilation of renal pelvis and calyces

Usually caused by urinary tract obstruction (e.g renal stones, sever BPH, cervical cancer)

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100
Q

Renal cell carcinoma

  • originates from
  • cell description
  • color
  • Clinical presentation
  • Invades (may cause)
  • Spreads to
  • Tx
  • Associated gene
  • Assoc paraneoplastic
A

Originates from PCT cells

Polygonal clear cells filled with accumulated lipids and carbohydrates

Golden yellow due to high lipid content

Hematuria
Palpable mass
Secondary polycythemia
Flank pain
Fever
WL

Invades renal vein
(May develop varicocele if left sided)

Spreads to IVC and spreads hematogenously –> lung and bone

Surgery
Immunotherapy (aldesleukin)

Gene deletion chromosome 3
(Sporadically or part of VHL disease)

Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP, renin)
Polycythemia, Anemia, Hypercalcemia

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101
Q

Well circumscribed mass with central scar in kidney

  • is what
  • description
  • seen with
A

Renal oncocytoma
- benign epithelial cell tumor arising from collecting ducts

Large eosinophilic cells with abundant mitochondria without perinuclear clearing

Arranged into nests

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102
Q

Large palpable unilateral flank mass on child
Hematuria
- contains
- mutation

A

Wilms tumor
(Nephroblastoma)

Contains embryonic glomerular structures

Loss of function mutation of tumor suppressor genes WT1 and WT2 on chr 11

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103
Q

Three syndromes that have wilms tumors

A

1) WAGR complex
- Wilms tumor
- Aniridia (absence of iris)
- Genitourinary malformation
- Mental retardation
(WT1 deletion)

2) Denys-Drash
- Wilms tumor
- Early onset nephrotic syndrome
- Male pseudohermaphroditism
(WT1 mutation)

3) Beckwith-Wiedemann
- Wilms tumor
- Macroglossia
- Organomegaly
- Hemihyperplasia (enlargement one side)
(Wt2 mutation)

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104
Q

Tumor of urinary tract system

  • presentation
  • seen in urine
A

Transition cell carcinoma

Painless hematuria
No casts

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105
Q

Squamous cell carcinoma of the bladder risk factor

A

Schistosoma haematobium infection (middle east)

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106
Q

Stress incontinence

A

Outlet incompetence

  • Urethral hypermobility
  • Intrinsic sphincteric deficiency

Leak with increase intra-abdominal pressure

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107
Q

Urgency incontinence

Tx

A

Overactive bladder
- detrusor instability

Leak with urge to void immediately

Tx: Antimuscarinics (oxybutynin)

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108
Q

Urinary incontinence associated with MS

A

Urgency incontinence

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109
Q

Overflow incontience

Tx

A

Incomplete emptying

  • detrusor underactivity
  • Outlet obstruction

Leak with overfilling
Increased post void residual

Tx

  • Catheterization
  • Relieve obstruction (alpha blocker BPH)
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110
Q

Seen in chronic pyelonephritis

A

Coarse, asymmetric corticomedullary scarring blunted calyx

Tubules can contain eosinophilic casts resembling thyroid tissue

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111
Q 
Hypocalcemia
Hyperphosphatemia
Thinning of bones
Bone lesions
Hyperparathyroidism
A

Renal osteodystrophy

Failure of Vit D hydroxylation associated iwth chronic renal disease
- secondary hyperparathyroidism

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112
Q

> 20:1 BUN/CR

A

Prerenal

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113
Q

<15:1 BUN/CR

A

Intrinsic renal

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114
Q

Consequences of renal failure

A

MAD HUNGER

Metabolic acidosis
Dyslipidemia (increased TGs)
Hyperkalemia
Uremia (Increased BUN) 
Na/ H20 retention (HF, pulm edema, HTN)
Growth retardation
Erythropoietin failure (anemia)
Renal ostodystrophy
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115
Q

A patient is recovering at the hospital from a
suspected bacterial pneumonia. Over the
course of a few days he develops fever, rash, dysuria, and urinary urgency. Urinalysis shows a specific gravity of 1.001 with hematuria and mild proteinuria. Renal biopsy shows partial effacement of the tubulointerstitial structures
with pronounced edema and infiltration of the
interstitium with polymorphonuclear leukocytes, eosinophils, and lymphocytes with papillary necrosis. What is most likely to have
caused this condition?
(A) Antibiotics
(B) Chronic hypertension
(C) Lead ingestion
(D) Multiple myeloma
(E) Wegener’s granulomatosis

A

A. Antibiotics

Acute interstitial nephritis

P’s

  • Pee (diuretics)
  • Pain free (NSAIDS)
  • Penicillins and cephalosporins
  • Proton pump inhibitors
  • RifamPin
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116
Q

Part of nephron injured in nephrotoxic acute tubular necrosis

A

PCT

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117
Q

A 64-year-old man with a medical history significant for hypertension, hypercholesterolemia, and coronary artery disease comes to the emergency department because of blood in his urine, nausea, and vomiting. Urinalysis reveals reddish-colored urine with no RBCs, but is positive for granular casts and protein. A basic metabolic panel shows highly elevated BUN and creatinine levels with a BUN:creatinine ratio of 10:1, as well as severe uremia. He is declared to be in acute renal failure and placed on dialysis. This patient has recently started a new drug
prescribed by his family physician. Which of
the following is the most likely cause of this
patient’s renal failure?
(A) A β-blocker
(B) An autoimmune reaction
(C) A statin drug
(D) Trauma

A

C. A statin drug

Statin can cause rhabomyolysis

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118
Q 
A 48-year-old man is hospitalized for shock after massive blood loss in a motor vehicle accident. On the patient’s second day in the hospital, his blood urea nitrogen (BUN) and creatinine levels begin to rise and he develops pitting edema to his knees. A subsequent urinalysis shows numerous
granular casts. Which of the following
is the most appropriate treatment?
(A) Angioplasty
(B) Broad-spectrum antibiotics
(C) Corticosteroids
(D) Fluids and dialysis
(E) Use of ultrasound to remove blockage
A

D. Fluids and dialysis

Acute tubular necrosis secondary to ischemia of the epithelial cells of teh PCT

Granular casts**

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119
Q

Common agents that cause nephrotoxic acute tubular necrosis

A

MARCEL

Myoglobinuria (Crush injury or statin) 
Aminoglycosides
Radiocontrast agents
Cisplatin
Ethylene glycol
Lead
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120
Q

Renal papillary necrosis

  • seen in tubules
  • clinical presentation (2)
  • due to
  • Associated with (4)
A

Sloughing of necrotic renal papillae
- gross hematuria and proteinuria

Recent infection or immune stimulus

SAAD papa with papillary necrosis:

  • Sickle cell disease
  • Acute pyelonephritis
  • Analgesics (NSAIDS)
  • Diabetes mellitus
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121
Q

ADPKD

  • Presentation
  • Mutation
  • Death from
  • Caused by
  • Assoc with (4)
  • Tx
A

Numerous cysts in cortex and medulla causing bilateral enlarged kidneys

PKD1 chr 16
PKD2 chr 4

Death from complications of chronic kidney disease or hypertension
- caused by increased renin production

Associated with

  • Berry aneurysms
  • Mitral valve prolapse
  • Bengin hepatic cysts
  • Diverticulosis

Tx

  • ACE inhibitor
  • ARBs
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122
Q

ARPKD

  • Presentation
  • Assoc with
  • complications
A

Cystic dilation of collecting ducts
Infancy

Associated with congenital hepatic fibrosis
Potter sequence

Complications beyond infancy

  • systemic HTN
  • progressive renal insufficiency
  • portal hypertension due to congenital hepatic fibrosis
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123
Q

ACE inhibitor

  • Use
  • Adverse
  • Caution with
A

HTN
HF (decrease mortality)
Proteinuria
Diabetic nephropathy

In chronic kidney disease (diabetic nephropathy) decrease intraglomerular pressure –> slowing GBM thickening

Adverse (CATCHH)

  • Cough
  • Angioedema
  • Teratogen
  • Creatinine (increase, decrease GFR)
  • Hyperkalemia
  • Hypotension

Caution with patient that have bilateral renal artery stenosis, further decrease GFR

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124
Q

Aliskiren

  • Type
  • MOA
  • Use
  • Adverse
A

Direct renin inhibitor
Blocks conversion of Angtensinogen to angiotensin I

Use: HTN

Adverse

  • Hyperkalemia
  • Hypotension
  • Angioedema
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125
Q

Brown urine
Subepithelial humps
Decrease C3

A

Post streptococcal glomerulonephritis

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126
Q

Red spots on butt and legs
Abdominal pain
Hematuria
Proteinuria <3.5

A

IgA Nephropathy

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127
Q

Which glomerular disease

1) Linear pattern of IgG deposition on IF
2) Lumpy-bumpy deposits of IgG, IgM, C3 in the mesangium
3) Deposits of IgA in teh mesangium
4) Anti-GBM antibodies, hematuria and hemoptysis
5) Crescent formation in the glomeruli
6) Wire loop appearance on LM
7) EM: Effacement of epithelial foot processes
8) Nephrotic syndrome assoc w/ Hep B
9) Nephrotic syndrome assoc with HIV

10 ) EM:Subendothelial humps and tram-track appeance

11) LM: Segmental sclerosis and hyalinosis
12) Purpura on back of arms and legs, abdominal pain, IgA nephropathy
13) Em: Spiking of the GBM due to electron-dense subepithelial deposits

A

1) Linear pattern of IgG deposition on IF
- Good pasture

2) Lumpy-bumpy deposits of IgG, IgM, C3 in the mesangium
- Post-streptococcal glomerulonephritis

3) Deposits of IgA in teh mesangium
- IgA nephropathy

4) Anti-GBM antibodies, hematuria and hemoptysis
- Good pasture

5) Crescent formation in the glomeruli
- Rapidly progressive glomerulonephritis

6) Wire loop appearance on LM
- Lupus nephritis

7) EM: Effacement of epithelial foot processes
- Minimal change disease

8) Nephrotic syndrome assoc w/ Hep B
- Membranous GN > Membranoproliferative

9) Nephrotic syndrome assoc with HIV
- Focal segmental glomerulosclerosis

10 ) EM:Subendothelial humps and tram-track appeance
- Membranoproliferative glomerulonephritis

11) LM: Segmental sclerosis and hyalinosis
- Focal segmental glomerulosclerosis

12) Purpura on back of arms and legs, abdominal pain, IgA nephropathy
- Henoch-Schonlein purpura

13) Em: Spiking of the GBM due to electron-dense subepithelial deposits
- Membranous nephropathy

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128
Q

Thickening of basement membrane

Spike and dome appearance

A

Membranous glomerulonephritis

SLE can cause

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129
Q

Train track

Subendotheial humps

A

Membranoproliferative glomerulonephritis

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130
Q

Glomerulonephritis assoc w/ Hep B and C

A

Membranoproliferative glomerulonephritis

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131
Q

Hematuria and proteinuria
Pulmonary infiltrates
Nasopharyngeal granulomas
c-ANCA

A

Granulomatosis with polyangiitis (wegener’s dis)

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132
Q

Urinary casts are made up of

A

Tamm-Horsfall mucoprotein

Secreted by tubule epithelial cells

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133
Q

Diffuse maculopapular rash
Azotemia
Eosinophilia
Fever

A

Acute interstitial nephritis (AIN)

Allergy induced
Drug induced

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134
Q

Urease producing bacteria

A

Proteus mirabilis
Klebsiella
S. saprophyticus

Struvite stones

Pee CHUNKSS
Proteus mirabilis
Cryptococcus
H. pylori
Ureaplasma
Nocardia
Klebsiella
S. Epidermidis
S. Saprophyticus
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135
Q

Renal tumor with clear cells

A

Renal cell carcinoma

Full of lipids/ carbs

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136
Q

Major risk factors transitional cell carcinoma

A

Smoking**
Aniline dyes
Naphthylamine dyes
Cyclophosphamide

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137
Q

Gene for thickened ectoderm at distal end of each developing limb bud

A

Wnt-7 gene

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138
Q

Gene for lengthening of limbs

A

FGF gene

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139
Q

Mutation in HOX presents as

A

Appendages in wrong locations

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140
Q

What forms week 3

A

Neural tube

141
Q

Disruption vs deformation

A

Disruption
- Secondary breakdown of previously normal tissue or structure

Deformation
- extrinsic disruption; occurs after embryonic period

142
Q

Field defect

A

Initial embryonic disturbance leas to multiple malformations by disrupting the development of adjacent tissues ( holoprocephaly)

143
Q

ACE inhibitors on fetus

A

Renal damage

144
Q

Alkylating agents on fetus

A

Absence of digits

Multiple anomalies

145
Q

MOA in fetal alcohol syndrome

A

Failure of cell migration

146
Q

Twinning

  • Dichorionic diamniotic
  • Monochorionic diamniotic
  • Monochorionic Monoamniotic
  • Conjoined
A

Dichorionic diamniotic (0-4 days)

Monochorionic diamniotic (4-8 days)

Monochorionic Monoamniotic (8-12 days)

Conjoined (> 13 days)

147
Q

How does syncytiotrophoblast avoid attack by maternal immune system

A

Lacks MHC I expression

148
Q

Decidua basalis

- derived from

A

Maternal component of placenta

Derived from endometrium

149
Q

Umbilical arteries return ______ blood from fetal _________ arteries to placenta

A

deoxygenated blood from fetal internal iliac arteries to placenta

150
Q

Umbilical vein drains into IVC via

A

Liver or ductus venosus

151
Q

Urachus formation

A

In the 3rd week the yolk sac forms the allantois

Which extends into urogenital sinus

Allantois becomes the urachus, a duct between fetal bladder and umbilicus

152
Q

Urachal cyst is a risk for

A

Fluid filled cavity lined with uroepithelium between umbilicus and bladder

Risk for Adenocarcinoma

153
Q

Vesicourachal diverticulum

A

Slight failure of urachus to obliterate

Outpouching of bladder

154
Q

What occurs during 7th week

A

Obliteration of vitelline duct (omphalomesenteric duct), which connects yolk sac to midgut lumen

155
Q

Meconium discharge from umbilicus

A

Vitelline fistula

Vitelline duct fails to close

156
Q

Aortic arch derivatives

A

1st Arch: Part of maxillary artery

2nd arch: stapedial artery and hyoid artery

3rd arch: common carotid artery and proximal part of internal carotid artery

4th arch:

  • left: aortic arch
  • right: proximal part of right subclavian artery

5th arch: Proximal part of pulmonary arteries and (on left only) ductus arteriosus

157
Q

Recurrent laryngeal nerves loop around

A

Left loops around: aortic arch distal to ductus arteriosus

Right loops around right subclavian artery

158
Q

Brachial clefts, arches and pouches derived from

A

Clefts: Ectoderm

Arches: Mesoderm

Pouches: Endoderm

159
Q

Branchial cleft cyst

A

Lateral neck
Anterior to sternocleidomastoid muscle
Immobile during swallowing

Cleft= ectoderm derived

Persistent cervical sinus

160
Q

Branchial pouch derivates

A

1st pouch
- middle ear cavity, eustachian tube, mastoid air cells

2nd pouch
- epithelial lining of palatine tonsil

3rd pouch

  • dorsal wings: inferior parathyroids
  • ventral wings: thymus

4th pouch

  • dorsal wings: super parathyroids
  • ventral wings: ultimobranchial body, parafollicular C cells of thyroid
161
Q

Cleft lip failure of

A

fusion of maxillary and medial nasal processes

162
Q

cleft palate failure of

A

fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelves with nasal septum and/or median palatine shelf

163
Q

Male Development

A

SRY gene on Y chromosome
Produces testis-determining factor –> testes development

Sertoli cells secrete Mullerian inhibitory factor (MIF) that suppresses development of paramesonephric ducts

Leydig cells secrete androgens that stimulat development of mesonephric ducts

Leydig Leads to male (internal and external) sex differentiation
Sertoli Shuts down female (internal) sex differentation

164
Q

Mesonephric duct

A

Develops into male internal structures (except prostate)

SEED

  • Seminal vesicles
  • Epididymis
  • Ejaculatory duct
  • Ductus deferens
165
Q

XY with No Sertoli cells

A

Lack of Mullerian inhibitory factor

Develop both male and female internal genitalia

Male external genitalia

166
Q

5alpha reductase deficiency

  • defect
  • internal genitalia
  • external genitalia
  • inheritence
  • Serum levels
A

Inability to convert testosterone to DHT

Male internal genitalia

Ambiguous external genitalia until puberty ( Increase testosterone levels cause masculinization)

Autosomal recessive

Normal testosterone/ estrogen
LH normal or increased

167
Q

Septate uterus due to

  • consequences
A

Incomplete resorption of septum

Thick V shaped

Decreased fertility
Early miscarriage/ pregnancy loss

168
Q

Bicornuate uterus

  • due to
  • consequences
A

Incomplete fusion of Mullerian ducts

Increased risk of complicated pregnancy
Early pregnancy loss
Malpresentation
Prematurity

169
Q

Uterus didelphys

A

Complete failure of fusion

–> double uterus, cervix and vagina

170
Q

Genital tubercle becomes

A

Top bulb towards front of person

Males

1) Glans penis
2) Corpus cavernosum and spongiosum

Female

1) Glans clitoris
2) Vestibular bulbs

171
Q

Urogenital sinus becomes

A

Males

1) Bulbourethral glands (of Cowper)
2) Prostate gland

Female

1) Greater vestibular glands (of Bartholin)
2) Urethral and paraurethral glands (of Skene)

172
Q

Urogenital folds becomes

A

Outside mound surrounding genital groove, just posterior to genital tubercle

Male
- Ventral shaft of penis (penile urethra)

Female
- Labia minora

173
Q

Labioscrotal swelling becomes

A

Large mound outside Urogenital folds

Male
- Scrotum

Female
- Labia Majora

174
Q

Bifid scrotum

A

Malunion of the labioscrotal folds

175
Q

Hypospadias

  • is what
  • due to
  • associated with (2)
A

Abnormal opening of penile urethra on ventral surface of penis

Due to failure of urethral folds to fuse

Associated with

  • Inguinal hernia
  • Cryptochidism

Hypo is below

176
Q

Epispadias

  • is what
  • due to
  • associated with
A

Abnormal opening of penile urethra on dorsal surface of penis

Due to faulty positioning of genital tubercle

Associated with
- Exstrophy of bladder

When you have Epispadias, you hit your Eye when you pEE

177
Q

Anchors testes within scrotum

  • Female remnant
A

Male remnant of Gubernaculum
(band of fibrous tissue)

Female remnant= ovarian ligament and round ligament of uterus

178
Q

Gubernaculum

  • Male remnant
  • Female remnat
A

Band of fibrous tissue

Anchors testes within scrotum

Ovarian ligament + round ligament of uterus

179
Q

Processus vaginalis

A

Evagination of peritoneum

Male remnant
- forms tunica vaginalis

Female remnant
- Obliterated

180
Q

Venous drainage of gonads

A

Left ovary/ testis –> left gonadal vein –> left renal vein –> IVC

Right ovary/ testis –> right gonadal vein –> IVC

Left gonadal vein takes the LONG way around

181
Q

Varicocele more common on

A

More common on left

Left spermatic vein enters the left renal vein at 90 degree angle, flow is less laminar on left than right.

Left venous pressure > Right venous pressure

Varicocele more common on left

182
Q

Lymphatic drainage

1) Glans penis
2) Distal vagina
3) Uterus
4) Ovaries/ testes
5) Vulva/ Scrotum
6) Cervix
7) Prostate
8) Superior bladder
9) Distal anus
10) Corpus cavernosum
11) Proximal vagina

A

1) Glans penis= Deep inguinal nodes
2) Distal vagina= Superficial inguinal nodes
3) Body of Uterus= External iliac nodes
4) Ovaries/ testes= Para-aortic lymph nodes
5) Vulva/ Scrotum= Superficial inguinal nodes
6) Cervix= Internal iliac nodes
7) Prostate= Internal iliac nodes
8) Superior bladder= External iliac nodes
9) Distal anus= Superficial inguinal nodes
10) Corpus cavernosum= Internal iliac nodes
11) Proximal vagina= Internal iliac nodes

183
Q

Ligate what vessels during oophorectomy to avoid bleeding

A 
Infundibulopelvic ligament ( suspensory ligament of ovary) 
- ovarian vessels
184
Q

Ligated in hysterectomy

A

Cardinal ligament

- Uterine vessels

185
Q

Ligament/ vessels involved in ovarian torsion

A 
Infundibulopelvic ligament ( suspensory ligament of ovary) 
- ovarian vessels
186
Q

Maintains anteflex uterus

A

Round ligament of the uterus
- Uterien fundus to labia majora

Derivative of gubernaculum

Travels through round inguinal canal; above artery of sampson

187
Q

Ovarian ligament

A

Derivative of gubernaculum

Ovarian Ligament Latches to Lateral Uterus

188
Q

No vessels in which ligaments

A

Ovarian ligament

Round ligament

189
Q

Female reproductive histology

1) Stratified squamous epithelium, non keratinized
2) Simple columnar epithelium
3) Simple columnar epithelium with long tubular glands in proliferative phase; coiled glands in secretory phase
4) Simple columnar epithelium, ciliated
5) Simple cuboidal epithelium

A

1) Vagina
Ectocervix

2) Endocervix
3) Uterus
4) Fallopian tube
5) Ovary

190
Q

Pathway of sperm ejaculation

A

SEVEN UP

```
Seminiferous tubules
Epididymus
Vas deferens
Ejactulatory duct
Nothing
Urethra
Penis
~~~

191
Q

Urethra prone to injury from pelvic fracture

  • leak where
A

Posterior urethra- membranous urethra prone to injury from pelvic fracture

Cause urine to leak into retropubic space

192
Q

Urethra injured in perineal straddle injury

  • leak where
A

Anterior urethra- bulbar urethra

Urine leaks beneath deep fascia of Buck

If fascia torn, urine escapes into superficial perineal space

193
Q

Emission controlled by

A

Sympathetic nervous system

hypogastric n.

194
Q

Ejaculation controlled by

A

Visceral and somatic nerve

pudendal nerve

195
Q

Proerectile and antierectile

A

Proerectile
- NO –> increase cGMP –> smooth muscle relaxation –> vasodilation –> erection

Antierectile
- NE –> increase Ca –> smooth muscle contraction –> vasoconstriction

196
Q

Cell type that lines seminiferous tubules

A

Spermatogonia (germ cells)
-Produce primary spermatocytes

Sertoli cells

197
Q

Sertoli cells secrete

A

Inhibin B –> inhibit FSH

Androgen binding protein –> maintain local levels of testosterone

MIF

Form blood-testis-barrier

198
Q

Estrogen sources

A

Ovary= estradiol

Placenta= estriol

Adipose tissue= estrone

199
Q

Ovulation steps

A

Increase estrogen
Increase GnRH receptors on anterior pituitary

Estrogen surge stimulates LH release –> ovulation (rupture of follicle)

Increase temp ( progesterone induced)

200
Q

Follicular growth is fastest during what

A

2nd week of follicular phase

201
Q

What stimulates and maintains endometrium

A

Estrogen stimulates endometrial proliferation

Progesterone maintains endometrium to support implantation

202
Q

Fertilization commonly occurs in

when

A

The ampulla

Within 1 day of ovulation

203
Q

Implantation occurs

A

6 days after fertilization

204
Q

What secretes hCG after implantation

  • fxn
  • timing
A

Syncytiotrophoblasts of placenta

Maintains corpus luteum (progesterone) for first 8-10 weeks of pregnancy

205
Q

Placenta at 8-10 weeks

A

Synthesizes its own estriol and progesterone

Syncytiotrophoblasts stop producing hCG
Corpus luteum regresses

206
Q

hCG subunits

A

alpha subunit

  • identical to LH, FSH, TSH
  • Increase hCG can cause hyperthyroidism

Beta subunit

  • unqiue
  • pregnancy test detects
207
Q

Human placental lactogen

  • secreted by
  • fxn
A

Syncytiotrophoblast of placenta

Stimulates insulin production
Increase insulin resistance due to shunting carbohydrate metabolism toward supplying glucose/ amino acids to fetus

Increase lipolysis (due to insulin resistance)

208
Q

APGAR score

- what score requires further evaluation

A 
Appearance
Pulse
Grimace
Activity
Respiration

<7 needs evaluation

209
Q

Prolactin fxn (2)

Oxytocin fxn (2)

A

Prolactin

  • induce and maintain lactation
  • decrease reproductive function

Oxytocin

  • Milk letdown
  • uterine contractions
210
Q

Breast milk contains

- Age for breast feeding

A

< 6 months old

IgA, Macrophages, Lymphocytes

211
Q

Exclusively breast feed infants require

A

Vit D supplementatoin

212
Q

Menopause diagnosed by

  • due to
  • increase in what
A

Amenorrhea for 12 months

Decreased estrogen production due to age-linked decline in number of ovarian follicles

Increase FSH, LH, GnRH

213
Q

Testosterone fxn (5) vs DHT fxn (4)

A

Testosterone

  • Differentiation of internal genitalia (except prostate)
  • Growth spurt (penis, muscles)
  • Deepening of voice
  • Closing epiphyseal plates (via estrogen converted from testosterone)
  • Libido

DHT

  • Early: differentiation of penis, scrotum and prostate
  • Late: prostate growth, balding, sebaceous gland activity
214
Q

Testosterone converted to DHT by

-Inhibited by

A

5alpha-reductase

Inhibited by: finasteride

215
Q

Spermatogenesis

  • takes how long
  • occurs where

Spermiogenesis
- is what

A

2 months
Seminiferous tubules

Spermiogenesis
- Spermatids undergo loss of cytoplasmic contents, gain of acrosomal cap to form mature spermatozoon

216
Q

Spermatogenesis steps (5)

A

“Gonium” is going to be a sperm;
“Zoon” is Zooming to egg

Spermatogonium

  • Diploid, 2N 2C
  • 46 single chromosomes

Primary spermocyte

  • Diploid, 2N, 4C
  • 46 sister chromatids
  • division of X and Y at end of meiosis I

Secondary spermatocyte

  • Haploid, 1N, 2C
  • division of X-X
  • division of Y-Y at meiosis II

Spermatid
- 1N 1C

Spermatozoon

217
Q

47 XXY male, one X chromosome from patients father error occurred at what stage of spermatogenesis?

A

Primary spermatocyte

- division of X and Y occurs at end of meiosis I

218
Q

Spermiogenesis

A

Spermatid Haploid (1N, 1C ) –> Mature spermatozoon (1N, 1C) with acrosome, tail

219
Q

47 XYY male, both Y from father, occur at what stage of spermatogenesis

A

Secondary spermatocyte

220
Q

No sexual hair

Flat appearing chest with raised nipple

A

Tanner stage 1

221
Q

Coarse pubic hair reaching thighs

Aerola flattens

A

Tanner stage 5

222
Q

Pubic hair appears

Formation of breast buds

A

Tanner stage 2

223
Q

Dark thick public hair not touching thighs
Breast enlarges
Raised areola

A

Tanner stage 4

224
Q

Pubic hair darkening and thickening

Breast mound forms

A

Tanner stage 3

225
Q

Testicular enlargement

Pubic hair appears

A

Tanner stage 2

226
Q

Coarse pubic hair not reaching thigh

Penis width and glans increase

A

Tanner stage 4

227
Q

Pubic hair darkening and thickening

Penis size and length increases

A

Tanner stage 3

228
Q

Mullerian duct forms

A

Fallopian tubes, Uterus, Cervix and upper vagina

229
Q

Amenorrhea
Normal ovaries and secondary sexual characteristics
No uterus

A 
Mullerian aplasia (46, XX)
- Vaginal agenesis or Mayer- Rotitansky Kuster houser syndrome

No upper vagina

230
Q

Androgen insensitivity syndrome

  • Chromosomes
  • Clinical feature
  • Internal genitalia
  • External genitalia
  • Serum
A

46, XY
Minimal axillary or pubic hair
Cryptorchid testes
No uterus or ovaries

External female development

Increased testosterone, estrogen, LH

231
Q

Amenorrhea
No secondary sexual characteristics
No sense of smell

A

Kallman syndrome

Due to defect of X linked KAL chain

Defective migration of GnRH releasing neurons and subsequent failure of GnRH-releasing olfactory bulbs to develop

–> decreased synthesis of GnRH in hypothalamus

Decrease GnRH, FSH, LH, testosterone

232
Q

Klinefelter syndrome

  • Chromosomes
  • Clinical feature
  • Internal genitalia
  • External genitalia
  • Feature
  • Pathogenesis
A

47, XXY

Tall stature, long extremities
Developmental delay

Atrophic testes and infertility

Poorly developed secondary characteristics
Male
Gynecomastia

Presence of inactivated X chromosome (Barr body)

Dysgenesis of seminiferous tubules –> decrease in inhibin B –> increase FSH

Abnormal Leydig cell function –> decrease testosterone –> increase LH –> increase estrogen

233
Q

How to tell coarctation of aortic

- assoc with

A

Femoral < brachial pulse

Turner syndrome

234
Q

Turner syndrome associated with (4)

A

Coarctation of aorta
Bicuspid aorta
Cystic hygroma
Horseshoe kidney

235
Q

Barr body seen in

A

Klinefelter syndrome 47 XXY

236
Q

Double Y males (XYY) features

A 
Very tall
Normal fertility
Severe acne
Learning disability
Autism
237
Q

Placental aromatase deficiency

  • due to
  • affect in fetus
  • serum levels
  • affect in mother
A

Inability to synthesize estrogens from androgens

Masculinization of female (46,XX DSD)
- ambiguous genitalia

Increased serum testosterone and androstenedione

Can present with maternal virilization during pregnancy

238
Q

Pregnant female presents to office with development of coarse facial hair

A

Placental aromatase deficiency

- inabilitly to synthesize estrogen fro androgens

239
Q

Hydatidiform mole forms from

Tx
Monitor

A

Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast)

Methrotrexate
Monitor hCG

240
Q

Partial mole

  • Karyotype
  • components
  • fetal parts
  • uterine size
  • hCG
  • risk of malignancy
  • risk of choriocarcinoma
A

69, XXX 69, XXY 69 XYY

2 sperm + 1 egg

Fetal parts

Normal uterine size

Increased hCG

Low risk of malignancy
Rare risk of choriocarcinoma

241
Q

Complete mole

  • Karyotype
  • components
  • fetal parts
  • uterine size
  • hCG
  • imaging
  • risk of malignancy
  • risk of choriocarcinoma
A

46, XX 46,XY

enucleated egg + single sperm (sperm duplicates paternal DNA)

No fetal parts

Increased uterine size

HIGH increased in hCG

Honey combed uterus or clusters of grapes
Snowstorm on ultrasound

Yes risk of malignancy

Risk of choriocarcinoma

242
Q

Choriocarcinoma

  • Is what
  • Occurs when
  • Not seen
  • Increases frequency
  • Presents as (3)
  • Spread
A

Rare

Malignancy of trophoblastic tissue
- Can occur during or after pregnancy

No chorionic villi present

Increase frequency of bilateral/ multiple theca-lutein cysts

Presents

  • elevated hCG
  • SOB
  • hemoptysis
  • bloody brown discharge

Hematogenous spread to lungs (cannonball metastases)

243
Q

Cannon ball metastases

A

Choriocarcinoma

Malignancy of trophoblastic tissue
- Can occur during or after pregnancy

244
Q

Placenta accreta

A

Placenta attaches to myometrium without pentreting it

245
Q

Placenta increta

A

Placenta penetrates into myometrium

246
Q

Placenta percreta

A

Placenta penetrates (perforates) through myometrium and inot uterine serosa

247
Q

Placenta accreta, increta and percreta due to

A

Defective decidual layer

248
Q

Vasa previa

  • is what
  • may result in
  • triad presentation
  • assoc with
A

Fetal vessels run over or in close proximity to cervical os

May result in vessel rupture, exsanguination, fetal death

Presents triad

  • Membrane rupture
  • painless vaginal bleeding
  • fetal bradycardia (< 110 beats/ min)

Assoc with
- Velamentous umbilical cord insertion (cord inserts in chorioamniotic membrane rather than placenta –> fetal vessels travel to placenta unprotected by Wharton jelly)

249
Q

Midline epislotomy

A

Incision made during delivery to widen opening

Posterior vaginal opening to perineal body

250
Q

Preeclampsia

  • is what
  • caused by
A

New onset HTN with proteinuria or end-organ dysfunction after 20th week of gestation

Caused by abnormal placental spiral arteries

251
Q

Pregnant lady
HTN
Proteinuria
Edema

A

Preeclampsia

252
Q

Eclampsia due to

A

Cerebral profusion abnormalities

253
Q

Glomerular ischemia and hyperfiltration

A

Hypertensive neuropathy

254
Q

3 y.o clear grape like projection from vagina

  • is what
  • type
  • affects
  • cells
  • positive for
A

Sarcoma botryoides

Embryonal rhabdomyosarcoma variant

Affects girls <4 y.o

Spindle shaped cells
+ Desmin

255
Q

Amenorrhea
Decreased fertility
Enlarged bilateral cystic ovaries

  • Due to
  • Serum
  • Other features (2)
  • Increased risk of
  • Tx
A

Polycystic ovarian syndrome

Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feed back response

Increase LH: FSH ration (>2:1), Increase LH, Increase androgens (testosterone) –> decrease rate of follicular maturation –> unruptured follicles (cysts)

Hirsutism
Acne

Increased risk endometrial cancer due to unopposed estrogen from repeated anovulatory cycles

OCPs
Clomiphene
Metformin (induce ovulation)

256
Q

Bilateral cysts

  • type
  • due to
  • assoc with (2)
A

Theca-lutein cysts

Due to gonadotropin stimulation

Assoc w/ choriocarcinoma and hydatidiform moles

257
Q

Teratoma can present with

A

Hyperthyroidism

258
Q

Solid yellow tumor in ovary
Looks encapsulated
Contain Cuboidal epithelium

A

Brenner tumor

- urinary tract like epithelium

259
Q

Meigs syndrome

A

Ovarian fibroma
Ascites
Hydrothorax

260
Q

Abnormal uterine bleeding in post menopausal women

Mass in ovary

A

Thecoma

- may produce estrogen

261
Q

Abnormal uterine bleeding in post menopausal women
Mass in ovary
Call Exner bodies

A

Granulosa cell tumor

Produce estrogen and progesterone

Unilateral

262
Q

Tumor male testes
Young child
+AFP
Yellow

A

Yolk sac tumor

263
Q

Layers of penis (4)

A
  1. Outer dermis
  2. Dartos fascia
    - continuous with colles fascia of perineum
    - scarpa’s fascia of abdominal wall
  3. Deep (Buck’s fascia)
    - continuation of deep perineal fascia
    - separates corpus spongiosum from corpus cavernosa
  4. Tunica albuginea
    - surrounds 2 corpora cavernosa dorsolaterally
    - corpus spongiosum ventrally
264
Q

What can be damaged in prostatectomy

A

Cavernous nerves

–> erectile dysfunction

Prostatic plexus gives rise to cavernous nerves, parasymathetic fibers to penis for erection

265
Q

Nerve to muscles at base on penis

A

Pudendal n.

266
Q

Main artery of pelvis

A

Internal iliac A.

267
Q

Tx Prostate cancer

A

Flutamide

Nonsteroidal competitive inhibitor at testosterone receptor

268
Q

Use to tx hirsutism in polycystic ovarian syndrome

A

Ketoconazole
- inhibits steroid synthesis (inhibit desmolase)

Spironolactone
- inhibits steroid binding

269
Q

True hermaphrodite MOA

A

XX or XY

Have ovarian and testicular tissue

Two fertilized ovum that fuse

Cross over of SRY gene from Y chromosome to X chromosome during meiosis

270
Q

Pain of testicles relieved by lifting

Tx

A

Epididymitis

Tx
- GC/Chlamydia= Ceftriaxone IM then doxycycline

> 35 y.o or history of anal intercourse
- Enterobacteriaceae= Fluoroquinolone

271
Q

Painless homogenous testicular enlargement

Large cells and lobules with watery clear cytoplasm

A

Seminoma
- Fried egg appearance

Radiosensitive

272
Q

Painful palpable mass in scrotum

Glandular with papillary morphology

A

Embryonal carcinoma
- malignant

AFP normal
hCG may be elevated

273
Q

Yellow tumor in young male testicle

Increased AFP

A

Yolk Sac tumor

274
Q

Pattern where mesodermal core w/ central capillary lined by flattened layers of parietal and visceral cells
Testicular tumor

A

Yolk Sac tumor

275
Q

Testicular tumor
Brown cut surface tumor
Gynecomastia
Rod-shaped crystaloids

A

Leydig cell tumor

  • Produce androgens
  • May produce estrogens

Reinke crystals

276
Q

Tumor associated with Peutz-Jegher

A

Sertoli cell tumor

277
Q

Hydrocele due to

A

Incomplete fusion of processus vaginalis

278
Q

Spermatocele due to

A

Dilated epididymal duct

279
Q

Varicocele is

A

Dilated veins in pampiniform plexus

280
Q

Gray solitary crusty plaque on penile shaft or scrotum

  • progress to
A

Bowen disease

- invasive squamous cell carcinoma

281
Q

Red velverty plaque on glans of penis

A

Erythroplasia of Queyrat

- Type of Bowen disease

282
Q

Bowen disease associated with

A

Uncircumscribed and HPV

283
Q

Reddish papules of penile shaft

A

Bowenoid papulosis

284
Q

Painful erection

- due to

A

Peyronie disease

Due to inflammation and fibrous tissue formation of the tunica albuginea

285
Q

Priapism

- assoc with

A

Persistent penile erection

sickle cell disease

286
Q

Balanitis

  • organism
  • more common in
A

Inflammation of glans penis

Candida

Uncircumscised and diabetes

287
Q

Prostatitis

  • symptoms
  • organisms
  • tx
A

Dysuria, frequency, uregency, low back pain

< 35= gonorrhea, chlamydia

> 35= E. coli, klebsiella, serratia, enterobacter, proteus

Tx
- fluoroquinolone (levoflxacin)
TMP-SMX

288
Q

Tamsulosin

A

Alpha 1 (A,D) blocker

Fewer sideeffects than nonselectives
No antihypertensive effects

289
Q

Non-selective alpha 1 blockers

A

Doxazosin
Prazosin
Terazosin

Decrease prostate smooth muscle tone –> immediate improvement in urine flow

Postural hypotension

290
Q 
Urinary frequency
Nocturia
Weak stream
60 y.o man
\+ PSA

Tx

A

Prostate adenocarcinoma
- develops in posterior lobe

Metastasize to bone

  • Low back pain
  • increased alk phos

Tx

  • Flutamide (inhibit testosterone receptor)
  • Resection
291
Q

Side effects sildenafil

A 
Flushing 
HA
Dyspepsia
Impaired blue/green color vision
Life threatening hypotension (w/ nitrates)
292
Q

LH in Theca cell induces

A

Induces cholesterol –> androstenedione by desmolase

293
Q

Female reproductive cycle starts with increase in

294
Q

Tumor associated with Combined estrogen-progestin

A

Hepatic adenoma

- Tumor of liver

295
Q

Thinning o fepidermis
Smooth white plaques
Pruritis
Painful intercourse

A

Lichen sclerosus

Risk of squamous cell carcinoma of vulva

296
Q

Enlarged nuclei and perinuclear halo

A

Koilocytosis

HPV

297
Q

Hepatic adenoma associated with

298
Q

HPV MOA

A

E6 binds to p53 –> degradation

E7 product binds and inactivates Rb

299
Q

Post partum endometritis tx

A

Gentamicin + clindamycin

300
Q

Continuous GnRH agonist

A

Leuprolide

301
Q

Danazol

A

Synthetic androgen

Partial agonist at androgen receptor –> inhibits release of FSH and LH via negative feedback

Side effect

  • Acne
  • hirsutism
  • Deepening voice
  • Weight gain
  • Decreased HDL
  • Hepatotoxicity
302
Q

Tender enlarged uterus
Pelvic pain
Dysmenorrhea
Menorrhagia

A

Adenomyosis

303
Q

Nontender, enlarged uterus with irregular contours

  • pattern
A

Leiomyomas (leiomomata uteri)

Whorled pattern

304
Q

Given presurgery for fibroids to shrink

  • MOA
  • adverse effect
A

Leuprolide

Bind GnRH receptors Initially increase LH and FSH –> downregulation of LH and FSH

Amenorrhea
Decreased Libido
Depression
Bone loss **

305
Q

Rapidly enlarging uterus

A

Leiomyosarcoma

306
Q

Characterized by plasma cells in the endometrium

A

Chronic endometritis

307
Q

Used to tx infertility due to anovulation

  • drug
  • type
  • MOA
  • Side effects
A

Clomiphene
- Selective estrogen receptor modulator (SERM)

Agonist or antagonist depending on tissue

Binds estrogen receptors in hypothalamus –> blocks negative feedback of estrogen –> increase release FSH and LH

Side effect

  • visual disturbances
  • hot flashes
  • ovarian enlargement
  • multiple gestations
308
Q

struma ovarii

A

teratoma contains functional thyroid tissue –> hyperthyroidism

309
Q

Ovarian tumor
hCG
LDH
Clear cytoplasm and central nuclei

A

Dysgerminoma

- analogous to seminoma

310
Q

Sertoli- Leydig tumors

A

Can resemble seminiferious tubules

Produce androgens –> virilization

  • Hirsutism
  • Deepening of voice
  • Clitoromegaly

Yellow grossly

311
Q

Bilateral vs unilateral ovarian tumor

A

Bilateral
- Epithelial tumors (serous, mucinous, endometriod, clear cell, brenner)

Unilateral

  • germ cells (teratoma, dysgerminoma, yolk, choriocarcinoma)
  • Sex cord stromal ( granulosa, sertoli-leydig, fibroma, thecoma)
312
Q

Schiller-Duval body

Call Exner

Psammoma body

A

Schiller-Duval body= Yolk sac tumor

Call Exner= Granulosa cell tumor

Psammoma body= serous tumor

313
Q

What physiologic changes are seen in pregnancy that decrease

A

BP

BUN/ CR

314
Q

Big risk factor for placental abruption

A

Cocaine use **

HTN
Prior abruption
Trauma
Smoking

Painful vaginal bleeding

315
Q

Medications for HTN to use in pregnancy

A

HTN Moms Love Nifedipine

Hydralazine

Methyldopa
- central acting alpha 2 receptor agonist

Labetalol
- Combine alpha and beta adrenergic blocker

Nifedipine
- Ca channel blocker

316
Q

Delays preterm labor

A

Terbutaline
- selective beta agonist

Side effect

  • tachycardia
  • hypotension
  • pulmonary edema
317
Q

Misoprostol

A

Prostaglandin E1 analog
Prevent peptic ulcer in people w/ NSAIDs
Keep patent ductus arteriosus open

Cervical dilation and uterine contraction

318
Q

Dinoprostone

A

Prostaglandin E2 analog

319
Q

Tx for hyperstimulation due to prostaglandins

A

Terbutaline

320
Q

Mifepristone

A

RU-486

Competitive antagonist at progesterone receptor

Termination early pregnancy

321
Q

Complications of diabetes in pregnancy

A

Macrosomia

Hypoglycemia

322
Q 
New onset HTN
Proteinuria
Low hemoglobin
Low platelet count
HIgh AST
A

HELLP syndrome

323
Q

Down syndrome nondisjunction during

A

anaphase meiosis I

324
Q

Prenatal US clue that fetus may have down syndrome

A

Nuchal translucency

325
Q

Cafe au lait spots
Neural tumors
Pigmented nodules in eye
Scoliosis

A

Neurofibromatosis type I

AD
Mut Chr 17

326
Q

Tuberous sclerosis mutation of

A

hamartin or tuberin gene

327
Q

Von Hippel lindau disease

  • risk for developing
  • features
  • results in expression of
A

Hemangioblastomas of retina, cerebellum adn medulla
Pheochromocytomas

Risk bilateral RCC

Expression of HIF

328
Q

Staggering gait,
Frequent falling, nystagmus, pes cavus
Hammer toes

  • mutation of
  • inheritence
  • type disorder
A

Freidreich ataxia

  • AR
  • GAA
  • frataxin (mitochondrial protein involved in iron detoxifying and storage)
329
Q

Cystic fibrosis tx

A

N-acetylcysteine

Antibiotics (fluroquinolones)

330
Q 
Painless papules on lower abdomen and butt
Pain
Renal failure
HTN
Cardiomyopathy
Angiokeratomas
A

Fabry disease
- X linked
Def: alpha-galactosidase
Acc: ceramide trihexoside

331
Q 
Hepatosplenomegaly
Painful bony lesions
Anemia
Fatigue
Thrombocytopenia
A

Gaucher disease
AR

Glucocerebrosidase
Acc: glucocerebroside

Prominent blue cytopalasmic fibrils (crumpled tissue paper)

332
Q 
Hepatosplenomegaly
Thrombocytopenia
Ataxia
Dysarthria, dysphagia
Worsening of intellectual function
Cherry red spot
A

Niemann-Pick
AR

Def: spingomyelinase
Acc: Spingomyelin

Foam cells

333
Q

Worsening of intellectual function
Cherry red spot
Worsening of physical abilities

A

Tay-Sach
AR

Def: hexosaminidase A
Acc: GM2 ganglioside

No hepatosplenomegaly

334
Q 
Weakness or numbness in hands
Seizures
Decrease in vision
Weakness
Developmental dealy
A

Krabbe disease
AR
(start at 3-6 months, dead by 2)

Def: galactocerebrosidase
Acc: galactocerebroside

335
Q

Muscle wasting
Weakness
Progressive vision loss
Dementia

A

Metachromatic leukocystrophy
AR

After first year of life

Def: Arylsulfatase
Acc: cerebroside sulfate

336
Q 
Hepatosplenomegaly
Coarse facial features
Intellectual disability
Poor growth (dwarf) 
Corneal clouding
A

Hurler syndrome
AR

Alpha L iduronidase
acc: heparan sulfate/ dermatan sulfate

337
Q

Hepatosplenomegaly
Aggression
Coarse facial features

A

Hunter syndrome
X linked recessive

iduronate sulfatase
acc: heparan sulfate and dermatan sulfate

338
Q

Breast cancer
ER and PR positive
Signet ring cells

A

Lobular carcinoma in situ

339
Q

Mastitis due to

340
Q

Serous or bloody nipple discharge

A

Intraductal papilloma

- in lactiferous duct

341
Q

Large bulky breast tumor

Leaf like projections

A

Phyllodes tumor

342
Q

Tamoxifen

  • type
  • use
  • risk
A

Estrogen antagonist in breast tissue

Tx primary breast cancer

Increased risk of endometrial cancer

343
Q

Raloxifene

  • type
  • use
  • moa
  • risk
A

Estrogen agonist in bone

Used for osteoporosis

Estrogen antagonist in breast

No risk endometrial cancer

344
Q

Anastrozole

  • type
  • moa
  • use
  • risk
A

Aromatase inhibitors

Inhibits production of estrogen by inhibiting aromatase

Postmenopausal women with breast cancer

Increase risk of osteoporosis and fractures

345
Q

Orderly row of cells (single file)
Breast mass

  • due to
A

Invasive lobular carcinoma

Due to decreased expression of E cadherin

346
Q

BPH tx

A

Alpha 1 antagonist

  • terazosin, tamsulosin
  • relaxation of smooth muscle

5alpha reductase inhibitors
- finasteride

PDE-5 inhibitors
- tadalafil

347
Q

Minoxidil

A

Direct arteriolar vasodilator

Androgenetic alopecia (pattern baldness)
Severe refractory hypertension
348
Q

Floppy baby at birth

A

Werdnig Hoffman disease

349
Q

Tx RCC

A

Aldesleukin (IL-2)

AM- STEP1 (20 decks)

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