U-World: Block 8 (GI, Endocrine, Repro) Flashcards
Mom takes DES (Diethylstibestrol) while pregnant to a baby girl. When the baby girl is born, what defect is she likely to have due to teratogen exposure?
Reproductive tract abnormalities (vaginal clear cell adenocarcinoma, congenital Mullerian anomalies like abnormally shaped uterus)
Why should non-selective beta-blockers be used WITH CAUTION in diabetics?
Non-selective beta blockers block both beta 1 and beta 2 receptors and mask sympathetic symptoms (anxiety, tremor, palpitations) that would normally occur in hypOglycemia. So if a diabetic on one of these drugs takes too much insulin and becomes hypOglycemic, he/she may not realize it, won’t eat to restore glucose levels, and this can be dangerous!
First-born baby boy. Has visible peristalsis in the epigastrium and olive shaped mass in right upper abdomen. He vomits (non-bilious) every time he eats. Diagnosis?
Pyloric stenosis
Mild jaundice from high UCB after stress like a hiking trip or fasting. What is the diagnosis most likely?
Gilbert syndrome (reduced UGT activity, which is the enzyme in the liver hepatocytes that conjugates bilirubin…so in stress, this leads to build up of UCB, which backs up to liver—> blood)
What determines poor prognosis for colorectal cancer?
Tumor has spread to regional lymph nodes
Esophageal cancer in the middle 1/3rd of the esophagus is what type of cancer specifically? What lymph nodes can it spread to?
Squamous cell carcinoma
Drains to mediastinal (or trancheobronchial) lymph nodes
Scrotum drains into what lymph nodes?
Superficial inguinal
Abdominal pain and white lesions in the mesenteric with fat destruction and calcium deposition. What is the diagnosis?
Pancreatitis
(Premature activation of pancreatic enzymes—> auto-digestion of the pancreas—> also of the surrounding fat and that fat gets calcified)
What is the most common organ to rupture in a car accident/ trauma?
The spleen
Esophageal cancer in the lower 1/3rd of the esophagus is what type of cancer specifically? What lymph nodes can it spread to?
Adenocarcinoma (from Barrett esophagus—> dysplasia—> adenocarcinoma)
Drains to celiac and gastric lymph nodes
What hormones does somatostatin decrease/ suppress/ inhibit?
Somatostatin released by the hypothalamus inhibits GH (growth hormone).
Somatostatin released by pancreatic delta cells inhibits glucagon, insulin (insulin more so than glucagon—> hyperglycemia), secretin, CCK, and gastrin.
Thyroid carcinoma that has nuclei with finely dispersed chromatin and intracellular grooves. What is it?
Papillary carcinoma. This is describing the Orphan Annie nuclei (cleared centers) and the Psomomma bodies (calcium layering).
“Papa (papillary) and mamma (psomomma bodies) adopted Orphan Annie (Annie eye nuclei).”
How can congenital rubella present in an infant?
Mental retardation, microcephalic, deafness, blindness, cataracts, jaundice, PDA, pulmonic stenosis, and blueberry muffin rash.
What ligament in the female pelvis is most likely to be involved in ovarian torsion?
The inundibulopelvic ligament aka suspensory ligament of the ovary
What parts of the pancreas are formed by the ventral bud of the pancreas? Dorsal bud?
Ventral bud (smaller one)—> uncinate process & main pancreatic duct Dorsal bud (larger one)—> all other parts of the pancreas (body, tail, isthmus, accessory pancreatic duct) *both buds together form the head of the pancreas
What would be seen in the uterus of a patient with elevated hCG and lung masses (not pregnant)?
Proliferated cytotrophoblasts and syncitiotrophoblasts. This is choriocarcinoma.
Guy has GERD. But now presents with worsening substernal chest pain especially at night and antacids aren’t helping much at all. What is probably going on?
Esophageal ulcer
This is NOT Barrett esophagus (pre-cancer metaplasia)—that means the cells have transitioned from squamous—> columnar to cope with the excess acid, but would not cause a sudden increase in pain from acid
(Note: ulcers are not limited to the duodenum and lesser curvature of the stomach. esophageal ulcers can form from acid overtime or even from a pill you are taking)
What does “small phallus” mean?
Small penis (not fully formed)
What is vasopressin?
Another name for ADH (anti-diuretic hormone), which retains water via aquaporin channels in the collecting duct
Exposure to what teratogen may result in a baby girl being born with reproductive tract abnormalities like vaginal clear cell adenocarcinoma or an abnormal uterus?
DES (Diethylstibesterol)
*this drug used to be used to prevent miscarriage before the harm was realized. Now it has been removed from the market.
What are the 3 antibiotics that can treat C. Diff?
- Oral vancomycin
- Metronidazole
- Fidaxomicin
What is biliary atresia?
Failure to form (or early destruction of) extrahepatic biliary ducts (bile ducts outside of the liver)—> biliary obstruction within first 2 months of life
Presents with jaundice, progresses to cirrhosis
What type of cell (histo) are cervix cells?
Ectocervix (outer)—> stratified squamous (non-keratized) (like the vagina)
——-transformation zone——-
Endocervix (inner)—> simple columnar (like the uterus) (have cilia and secrete thin and watery mucus in ovulation, mucus plug in pregnancy)
Mutation in what gene would cause an early colonic adenoma to progress to a late adenoma?
KRAS mutation
(Talking about the adenoma-carcinoma sequence for colon CA development)
normal colon—> at risk colon by APC
At risk colon—> pre-cancer adenocarcinoma polyp by KRAS
Adenocarcinoma polyp—> Colon CA by TP53
What would cause a person with high levels of somatostatin in their blood to develop biliary stones?
Suppression of CCK by somatostatin
What does odynophagia mean?
Pain with swallowing
Abdominal pain, vaginal bleeding, and orthostatic hypOtension. Positive pregnancy test. Past medical history of Chlamydia. What is probably going on?
Ectopic pregnancy that ruptured the Fallopian tube—> internal bleeding
(Chlamydia and Gonorrhea inc risk for ectopic pregnancies due to PID—> tubal scarring)
What is the mechanism of action of sulfonylureas (1st gen end in -“amide,” 2nd gen end in -“ride” or -“zide”) and meglitinides (end in -“glinide”)?
Bind to K+ channels on pancreatic beta cells and close them. This leads to—> depolarization—> calcium influx—> docking of insulin-containing vesicles to cell and exocytosis—> release of endogenous insulin (+ c-peptide). These are helpful diabetic drugs bc they are promoting faster release of insulin.
Esophageal varices is due to backing up of blood through what veins?
Portal vein (portal HTN)—> LEFT GASTRIC VEIN—> esophageal veins (when they are dilated, that is esophageal varices)
Girl is on the cross country team and runs 10 miles a day. She had normal periods but stopped having them. What is probably going on?
Secondary amenorrhea (stop having periods) due to being an athlete/ really thin—> brain recognizes you’re body couldn’t support a pregnancy so decreases GnRH (which decreases LH and FSH—> no period).
What’s the abbreviation for aspartate aminotransferase?
AST
What type of cell (histo) are uterus/ endometrium cells?
Simple columnar (have cilia, mucus-secreting)
PAS+ stain stains what?
Glycoproteins
What’s the most common cardiac problem with Turner syndrome patients?
Bicuspid aortic valve (coarctation of the aorta is 2nd most common)
“Extensive fibrosis that extends beyond the thyroid capsule”
Riedel Fibrosing Thyroiditis
(Chronic inflammation with extensive fibrosis of the thyroid gland—> “hard as wood” non-tender thyroid. This is NOT describing follicular carcinoma bc even though that cancer extends beyond the capsule vs follicular adenoma which does not, it is not characterized by massive fibrosis)
What is necrotizing enterocolitis?
Premature baby with immature immune system—> necrosis of intestinal mucosa with possible perforation—> penumatosis intestinalis (air in bowel wall)
Pre-teen boy is showing no signs of “masculinity.” Has poorly developed sexual characteristics and no sense of smell. What is it and where is the source of the problem?
Kallman syndrome
Problem is at the level of the hypothalamus—> not making enough GnRH (—> dec LH, FSH—> dec testosterone. Infertility. Also, olfactory bulb fails to develop—> lack of smell)
Reye’s syndrome results in what liver finding? What neurological problem?
Microvasicular steatosis (fatty liver) (Remember the sunshine rays on the bottle in sketchy with the FAT cow and liver shaped spot= fatty liver)
Encephalopathy/ coma
Hematemesis means what?
Blood in vomit
Breast milk is the gold standard for baby nutrition. However, it lacks (or has little of) 3 vitamins/ nutrients. What are they?
- Vitamin K (this is given to babies through an injection at birth to prevent hemorrhagic disease of the newborn)
- Vitamin D (this should be given to all exclusively breastfed babies, especially African American babies, to prevent Rickets)
- Iron (breast milk contains sufficient iron for the baby < 4 months, but not enough iron for baby > 4 months, so supplementation is recommended at that point)
Why does hemochromatosis present later in women as compared to men?
Women have menstrual cycles so they are able to lose a little iron each month, making the problem a little better and onset of symptoms a little later
(Remember, hemochromatosis is a problem of iron accumulation due to mutation in the HFE gene—the treatment is phlebotomy or an iron cheating agent when phlebotomy is not possible)
What are the 3 complications from GERD? State their presentations.
- Barrett esophagus (squamous—> columnar). This is asymptomatic (no changes with usual GERD symptoms), but is pre-cancer—> adenocarcinoma (cancer of lower 1/3rd of esophagus).
- Erosive esophagitis with esophageal ulcers. This presents with WORSENING GERD symptoms, including heartburn and odynophagia (painful swallowing).
- Esophageal stricture (happens in the setting of a healing esophageal ulcer, collagen fibers contract—> narrowing of lumen). Presents with dysphasia (difficulty swallowing) and a feeling like food is getting stuck in the throat.
Abdominal protrusion in a baby that is more pronounced in a baby when the baby cries. What is it?
Umbilical hernia
Deficiency of what enzyme leads to the following symptoms: hemolytic anemia, muscle weakness, and decreased sensation?
Vitamin E
What type of diarrhea do you get with lactose intolerance?
Osmotic diarrhea (Since the lactase is not doing its job of breaking down lactose—> glucose + galactose, the lactose hangs out in the intestines and draws water in, leading to diarrhea and bloating)
What are the 2 big anti-thyroid drugs (help treat hyperthyroidism)? What are the 3 big adverse effects associated with these drugs?
Methimazole and PTU
Methimazole—> 1st trimester teratogen (slightly better drug, but not for pregnancy!!)
PTU—> hepatic failure
Both—> agranulocytosis (Neutropenia/ decreased neutrophils. Patients can develop fever, cough, mouth ulcerations. This is serious and drug should be discontinued!)
Is Gardnerella Vaginalis gram (-), (+), what?
It is gram-variable (could be + or -)
*this is the one with gray-white vaginal discharge from bacterial overgrowth that produces a ‘fishy’ odor
During an oophorectomy (surgical removal of the ovaries), what vessel must be lighted to avoid major bleeding and in what structure (ligament) are these vessels contained?
Ovarian arteries (the major blood supply to the ovaries) in the suspensory ligament of the ovaries aka infundibulopelvic ligament
What are all the retroperitoneal structures?
“SAD PUCKER” Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd-4th parts) Pancreas (except not the tail) Ureters Colon (descending and ascending) Kidneys Esophagus (thoracic portion) Rectum
What side is the spleen on?
Patient’s left side
How can you tell the difference between endometriosis and adenomyosis?
In both there is endometrial tissue where it shouldn’t be, painful periods, pain with sex, and infertility due to scar tissue. However, the uterus is normal size in regular endometriosis. In Adenomyosis (endometriosis of the myometrium), the uterus is regularly ENLARGED (*regularly is also important bc if the uterus had humps/ just enlarged in parts, you’d think of fibroids/ lyomyeoma)
Which teratogen is associated with limb defects?
Thalidomide
“Tha-LIMB-domide”
What kind of urinary incontinence is often seen after childbirth?
Stress incontinence (pee with coughing/ sneezing/ increasing inter-abdominal pressure bc of weakened pelvic floor muscles/ damage to pedundal nerves)
Aprepitant. What is this drug used for and what’s its basic mechanism of action?
NK1 receptor blocker and blocks substance P *remember a preppy aunt and the athletes lining up to get their pee checked for drugs
Used to decrease chemotherapy-induced vomiting
Baby boy has normal BP, normal testosterone levels, but undescended testicles, small phallus (penis), and hypospadias (opening of the penis is on the bottom/ ventral side). What enzyme deficiency does he likely have?
5alpha-reductase (the enzyme that converts testosterone to the more potent DHT)
*boys with this often get descended testicles with puberty (it ranges, but their genitalia can appear like that of a female until puberty)
Where does H.Pylori tend to affect? Where does it most commonly cause ulcers?
H. Pylori affects the antrum of the stomach.
Causes ulcers most commonly in the duodenum.
Explain how the D-xylose test can be used to distinguish pancreatic insufficiency from mucosal causes of malabsorption (Celiac disease, bacterial overgrowth, etc.).
D-xylose is a monosaccharide and gets fully absorbed into the blood. So, in a normal individual, if you gave them 40 mg to eat, you’d expect to see 40 mg of it in the blood.
Celiac disease (or other mucosal malabsorption problem)—> flattened villi/ problem at the small intestine level with pushing nutrients into the blood (reabsorption). So, if you give 40 mg of D-xylose, might only see 10 mg that got reabsorbed into the blood (decreased blood and urine levels).
Pancreatic insufficiency—> not getting pancreatic digestive enzymes out into the duodenum to help break down polysaccharides into monosaccharides for absorption. But that won’t be a problem with absorption of D-xylose since it’s already a monosaccharide (doesn’t need pancreatic enzymes to help break it down into absorbable units). So, if you give 40 mg of D-xylose, you’d see 40 mg in the blood like normal.
The superficial inguinal ring is an opening in the _______________. The deep inguinal ring is an opening in the _______________.
The superficial inguinal ring is an opening in the EXTERNAL ABDOMINAL OBLIQUE APONEUROSIS. The deep inguinal ring is an opening in the TRANSVERSALIS FASCIA.
Is inflammatory bowel disease (Crohn’s and ulcerative colitis) a risk factor for colon cancer?
Yes!
Old guy who is a long-time smoker comes in complaining of unexpected weight loss over the last 3 months. He is jaundiced and tells you his urine has been dark and stools have been pale. His gallbladder is palpable (enlarged) on physical exam. Diagnosis?
Pancreatic adenocarcinoma (Smoking is a risk factor for pancreatic cancer, weight loss is consistent with cancer, jaundice/ dark urine/ pale stools is consistent with jaundice due to pancreatic duct obstruction by the mass—> inc conjugated bilirubin that backs up from the liver into the bloodstream, and palpable non-tender gallbladder can be seen in pancreatic cancer, known as Courvoisier sign)
What is vaginal adenosine?
A benign abnormality of the vagina.
Defects in what immuno cytokine can result in disseminated mycobacterium TB during infancy or early childhood?
INF-gamma
What is usually the cause of acromegaly?
A pituitary adenoma—> too much release of GH (growth hormone)—> too much release of IGF-1 (insulin like growth factor) by the liver—> overgrowth of tissues/ organs/ bone/ cartilage
A patient has a gallstone and is jaundiced. Why would they have dark urine and pale stool?
Hepatocytes in the liver conjugate the bilirubin—> CB. Normally, it gets into the duodenum and goes on through the GI tract and is responsible for making feces brown. But with a gallstone blocking the way, CB gets stuck and can’t give stool its color—> pale stool. CB builds up and is water soluble, so gets into urine (backs up to liver—> bloodstream—> filtered through kidneys and excreted as urine—> dark urine).
How do resins increase cholesterol synthesis by the liver, yet decrease cholesterol in the blood overall?
Resins bind to bile acids—> now, bile acids can’t be recycled back to liver—> decreased bile acids so liver uses cholesterol to make more bile acids—> now, cholesterol is low in the liver so it will increase it’s cholesterol synthesis plus pull in more LDL cholesterol from the blood—> this means inc cholesterol synthesis in liver, but decreased cholesterol now in the blood!
Fluoroquinolones are teratogens. What defect can they cause in baby’s if they are exposed to these drugs in utero?
Fetal cartilage damage
Why can cirrhosis patients get ascites?
Cirrhosis—> increased hydrostatic pressure in the portal vein—> fluid leakage and ascites (fluid in peritoneum)
Baby is having trouble feeding. Is vomiting green. Imaging reveals fibrous bands extending from the colon to the retroperitoneum. What congenital problem occurred?
Malrotation of the gut (midgut failed to rotate around the SMA and position itself correctly—> duodenal obstruction—> bilious vomiting due to the obstruction downstream of the Ampulla of Vater where bile enters the duodenum).
Guy has sepsis. Now has a gallbladder issue. What’s the issue?
Inflammed and enlarged gallbladder (due to inflammation from the sepsis infection)
Alcoholics are deficient in what cofactor?
Thiamine, or vitamin B1
When will monozygotic (identical) twins share a chorion? Amnion? Explain based on the days the splitting of the embryo occurs…
Splits 0-4 days—> 2 chorion/ 2 amnion
Splits 4-8 days—> 1 chorion/ 2 amnion
Splits 8-12 days—> 1 chorion/ 1 amnion
Splits >13 days—> 1 chorion/ 1 amnion + conjoined twins
(2 means the babies have their own, 1 means they are sharing)
Female has positive hCG pregnancy test, despite bilateral tubal ligation. Ultrasound shows mass in the left adnexa adjacent to the ovary and thickened endometrial stripe. What’s going on?
Ectopic pregnancy (even though she had tubes tied- it’s rare).
- Positive hCG means pregnancy or choriocarcinoma (which we’d expect to occur during or after a pregnancy).
- Mass in left adnexa (parts adjoining an organ) adjacent to ovary is talking about the Fallopian tubes. The mass is a baby implanted in there (ectopic).
- Endometrial stripe means the endometrium has thickened, which you’d expect in any pregnancy- normal or ectopic- due to increases levels of PG and estrogen.
What does pancreatitis mean? What does pancreatic insufficiency mean?
Pancreatitis- pancreatic digestive enzymes (zymogens) get activated too fast, in the pancreas instead of the duodenum—> self-digestion of the pancreas and inflammation
Pancreatic insufficiency- the pancreas is capable of making its enzymes, but they are not able to get out into the duodenum (for example, in CF patients this is due to thick mucus excretions obstructing the exit)
What does calculous cholecystitis mean?
Gallstones (note that cholecystitis means inflammation of the liver. Calculous means that inflammation is due to a stone.)
What type of cell (histo) are the Fallopian tube cells?
Simple columnar (have cilia to transport egg/ embryo)
If a female patient has a kidney anomaly, what other anomaly is she likely to have?
Uterus anomaly
How does ascites (collection of fluid in abdomen) and edema occur secondary to liver cirrhosis?
Cirrhosis—> portal HTN/ backing up of fluid into portal vein. There is increased hydrostatic pressure (going out) of portal vein, which plays into the ascites. Also, since the liver is failing, it is making less albumin/ proteins—> decreased oncotic pressure holding fluid in other vessels of the body. This also plays into the ascites and edema.
Moldy grains that cause mutation in p53 increase risk for what type of cancer?
Hepatocellular carcinoma (liver CA)
This is talking about Aflatoxins from Aspergillus found in grains
Chromaffin cells in the adrenal medulla are derived from what embryo cells?
Neural crest cells (NCCs)
Guy is vomiting blood and in shock. He is found to have a gastric ulcer along the lesser curvature of the stomach. What’s going on?
The ulcer ruptured/ eroded through the left gastric artery (runs along lesser curvature of the stomach)
Why do we avoid tetracyclines in women who are pregnant?
They are teratogens that can lodge in bone—> discolored teeth and inhibited bone growth in baby.
What type of fat contributes to insulin resistance in T2DM?
Visceral fat (measured by waist size- the fat in the abdomen, not in thighs/ butt)
Where are the 3 main catecholamines (epi, NE, and dopamine) synthesized in the body?
Dopamine and NE are produced in the CNS and PNS. Epi is produced (from NE) in the adrenal medulla (cortisol in the adrenal gland helps promote the conversion of NE—> epi).
What does polyhydramnios mean? What causes it?
Too much amniotic fluid. Due to baby not swallowing enough of it bc baby has esophageal/ duodenal atresia or anencephaly.
(Esophageal/ duodenal atresia means malformation. For example, the upper esophagus doesn’t connect with the lower esophagus and stomach. Anencephaly means underdeveloped brain.)
What is the most common side effect of Pioglitazone?
Pioglitazone is a TZD (thiazolidinedione). Most common side effect= weight gain and edema (bc TZD’s activate PPAR-gamma, and in doing so, push glucose from the blood into adipocytes. Basically, they feed fat cells.)
Lady gets surgery in Mexico and a week later suddenly develops acute liver failure and dies. What probably happened?
In Mexico, they use an inhaled anesthetic that is hepatotoxic called halothane (not used in US)—> can lead to fulminant liver failure
Explain ovarian torsion. What is the risk factor for causing it? What’s the concern with it?
An ovarian mass can lead to—> ovarian torsion in which the blood supply of the ovary gets twisted up—> concern is this can lead to ischemia to the ovary and it can atrophy (die) if not surgical taken care of (also causes severe pelvic pain to the woman)
Do PPIs (proton pump inhibitors) inhibit passive transport or active transport?
Active transport
They inhibit the H+/K+ ATPase channel on parietal cells to block production of acid. Given that this is an ATPase channel, that means it acts by active transport.
What is vaginal adenosine?
A benign abnormality of the vagina.
What’s the most common cause of bloody diarrhea and how do you get this infection?
Campylobacter jejuni
Get it from meat/ poultry or domesticated animals like dogs.
Patient gets a total gastrectomy. What supplement will he need his entire life thereafter?
(His whole stomach was taken out). He will need vitamin B12 supplements bc no stomach= no parietal cells to make IF= no absorption of vitamin B12, which is a vital cofactor.
*Supplementing with acid and gastric enzymes can help, but this is not a requirement bc pancreatic enzymes are sufficient to break down proteins/ food that pass by the GI tract.
Baby is drooling excessively. Seems normal, but when you breastfeed, baby starts choking, coughing, becomes cyanotic. What congenital defect is most likely?
Tracheoesophageal fistula (TEF), meaning there’s esophageal atresia (esophagus dead ends) and the distal esophagus plugs into the trachea (forms a fistula). (Failure of primitive gut to separate from airway)
How does menstrual bleeding occur?
PG withdraw causes endometrial cells to undergo apoptosis—> menstrual bleeding
hCG mimics what hormone to maintain the corpus luteum in early pregnancy?
LH
Where are the following vitamin/ minerals absorbed in the GI tract? Iron, folate, vitamin B12?
Iron- absorbed as Fe2+ in the duodenum (and proximal duodenum)
Folate- absorbed in the small bowel
Vitamin B12- absorbed in the terminal ileum along with bile salts (requires IF, or intrinsic factor)
“Iron Fist Bro”
How does prostate CA spread to the vertebrae? (What route does it take specifically to get there?)
Prostatic venous plexus—> vertebral venous plexus
(Spreads by blood, not lymphatics. Veins, not arteries, bc veins are going up toward the heart and for cancer to get from the prostate to the vertebrae it has to go up.)
Guy has thyroidectomy (removal of thyroid gland). Now is presenting with muscle cramps, twitching of lower facial muscles on percussion, and other signs of hypOcalcemia. What’s going on?
The parathyroid glands (on the backside of the thyroid gland) were also removed in the surgery. No parathyroid—> no PTH to increase calcium in the blood—> dec calcium.
Explain how H. Pylori causes ulcers.
*also, how can H. Pylori spread and lead to iron-deficiency anemia?
H. Pylori infects the antrum of the stomach first—> causes inflammation—> destroys D-cells in the antrum that produce somatostatin—> decreased somatostatin= decreased inhibition on Gastrin= gastrin is free to stimulate more acid production—> ulcers
*if H. Pylori spreads, will move up to body of stomach—> destroys G-cells in the body of the stomach that produce gastrin to stimulate acid secretion by parietal cells—> less acid production (hypochlorydia)—> iron deficiency anemia (iron and some other minerals require acid to be absorbed properly)
What does multifactorial inheritance mean?
Lots of things determine the phenotype…genetics play a role and environmental factors play a role too…(example: HTN- there isn’t an inheritance pattern like autosomal dominant or recessive assigned to that)
What does a “thickened endometrial stripe” tell you?
There’s thickening of the uterine lining (such as in pregnancy)
Vaginal bleeding in a post-menopausal woman is __________ until proven otherwise.
Endometrial cancer
What meds do we use with caution in diabetic patients because they could mask sympathetic symptoms (anxiety, palpitations, etc.) they would get if they were to take too much insulin/ become hypOglycemic?
Non-selective beta blockers (nadolol, pindolol, propranolol, timolol)
*remember selective beta blockers start with letters A-M. Non-selective beta blockers start with letters N-Z.
What does the enzyme 5alpha-reductase do in the adrenal glands?
Converts testosterone—> DHT (dihydrotestosterone)
What bug has a particularly low infectious dose? Which one has a particularly high infectious dose?
Low infectious dose (just a little of it will make you sick)—> Shigella
High infectious dose (you need a lot to make you sick)—> Salmonella
*other organisms like E. Coil and cholera are middle-ground/ in between these
What is a gallstone ileus? Where does the stone usually lodge?
A complication of a gallstone. The gallbladder becomes inflamed to the point that it ruptures/ inflammation eats away at the gallbladder and it forms a connection/ fistula with the duodenum—> gallstone moves from the gallbladder into the duodenum—> most commonly moves further through the bowel till it lodges in the ilium (ILIOCECAL VALVE)
Is the pH of stool higher or lower for people with lactose intolerance compared to normal?
Lactose intolerance (lactase enzyme deficiency, which means lactose can’t be broken down into glucose + galactose, but stays as lactose and draws in water causing osmotic diarrhea)—> fermentation of un-digested lactose by gut bacteria—> inc production of short chain FA’s that acidify stool—> LOWER STOOL pH (more acidic)
Also can think of it like this: for lactose intolerance, we do a lactose hydrogen breath test. The test is positive in these folks, meaning they got more H+ down there that they breath up through esophagus= more acidic= lower stool pH
What does tachypnea mean?
Fast breathing
Which cells in the female reproductive tract are simple cuboidal?
Cells of the ovaries
Guy has chronic viral hepatitis. Now has a liver mass with fibrotic bands. What does he have and what serum marker could be used to monitor for disease reoccurrence?
Hepatocellular carcinoma (liver cancer) Alpha-fetoprotein
What is Leuprolide? What effect does it have when given pulsatile vs. continuous?
GnRH agonist
Given pulsatile—> GnRH agonist (*pulsatile GnRH release is what happens in puberty)
Give continuous—> will act like a GnRH antagonist (*note that when you first start giving it it will act like the GnRH agonist that it is, but then as you continuously give it, it antagonizes)
Mifepristone and Misoprostol. What type of drugs are they? What are their basic mechanisms of action?
Abortion medications.
Mifepristone—> antiprogestin that inhibits PG receptors (kills the baby)
Misoprostol—> PGE1 analog that induces contractions (gets the baby out of the uterus)
What type of ovarian tumor can produce androgens, causing hirsutism and virilization?
Sertoli-Leydig cell tumors
Neonatal abstinence syndrome means mom was taking _____ during pregnancy and now baby is addicted to _____.
Opioids
What does hematemesis mean?
Vomiting blood
What does sarcoidosis do to calcium levels?
Increases calcium in the blood because granulomas promote production of vitamin D (which increases absorption of calcium).
Guy comes in with diarrhea. You see granulomas on histology following a colonoscopy. What does he have?
Crohn’s disease
Vitamin ??? supplementation should be given to all babies exclusively breastfed
Vitamin D
(especially for African American babies bc they need more sunlight in comparison to a fair skinned person to make the same amount of vitamin D)
Jaundice. Defective hepatocellular excretion of bilirubin glucuronides.
Dubin-Johnson syndrome (if black/ dark pigmented liver) or Rotor syndrome (if no change to liver pigmentation)
(CB builds up bc it cannot get transferred properly to bile caniculi)
What hormones does somatostatin decrease/ suppress/ inhibit?
Somatostatin released by the hypothalamus inhibits GH (growth hormone).
Somatostatin released by pancreatic delta cells inhibits glucagon, insulin (insulin more so than glucagon—> hyperglycemia), secretin, CCK, and gastrin.
What hormone released by the syncitiotrophoblast of the placenta in pregnancy contributes to gestational diabetes?
Human placental lactogen
What does leukocytosis mean?
High WBC count
A woman took ceftriaxone in the past. Now can’t get pregnant. What may be the reason?
PID (pelvic inflammatory disease)—> scarring of the Fallopian tubes due to insufficient antibiotic coverage.
Remember, Chlamydia—> Macrolides (Azithromycin) or Tetracyclines (Doxycycline) + Gonorrhea—> 3rd gen cephalosporin (Ceftriaxone). TREAT FOR BOTH! There’s often a co-infection.
Most common cause of bloody nipple discharge is what?
Intraductal papilloma (proliferation of papillary cells in a duct wall) *the bleeding is due to twisting of the vascular stalk of the papilloma in the duct
Why can a 5-alpha reductase inhibitor be used as BPH treatment? What effect does it have on the hair?
5-alpha reductase inhibitors block the conversion of testosterone—> DHT. This prevents growth of the prostate and prevents hair loss.
Psudocysts can be found on CT in what condition? What are these “fake cysts” lined by?
Acute or chronic pancreatitis (the pancreatic enzymes are activated early, in the pancreas rather than the duodenum—> auto-digestion of the pancreas—> inflammation and laying down of granulation tissue around fluid that forms a cyst-like mass)
Lined by granulation tissue (NOT epithelium)
Shigella invades what cells?
M cells in Peyer’s patches
Sketchy: cannon shooting a gorilla that lands on/ invades the pad with “M” on it
Baby presents with poor feeding and muscle weakness. Diet consists of baby food with occasional honey and fruit juice. What should you do next: check stool for bacterial toxins, check blood for liver enzymes, check blood for viral titers, or check the urine for glucose and ketones? Explain.
Check stool for bacterial toxins, this baby likely has botulism! Anytime a baby consumes honey be suspicious of this. Remember that it causes “floppy baby syndrome,” or a flaccid descending paralysis.
How could a Turner syndrome patient get pregnant?
In vitro fertilization (bypasses streaked ovaries)
Women who just had a hysterectomy presents with fever and right sided flank pain, no trouble urinating. What surgical complication are you thinking of as a possibility?
Damage to the ureter (runs below the uterine artery, which gets cut in a hysterectomy- “water under the bridge”)
What does inhibin B do (male hormonal effect)?
inhibin B inhibits FSH in guys
Polyethylene glycol is what type of drug?
Osmotic laxative (draws more water into the colon to soften stool to relieve constipation)
What is the presentation of right sided/ ascending colon CA vs. left sided/ descending colon CA?
Right sided/ ascending colon CA—> mass/ raised lesion, iron deficiency anemia, weight loss
Left sided/ descending colon CA—> infiltrating mass, partial obstruction, colicky pain, hematochezia (bleeding out in stool)
After fertilization occurs, how long does it take (# of days) for implantation to occur?
6-10 days after ovulation the fertilized egg with implant into the uterine wall
What is the difference between giving continuous vs pulsatile GnRH?
Pulsatile GnRH—> will inc GnRH, LH, FSH, estrogen (like a GnRH agonist)
Continuous GnRH—> too much GnRH overwhelms the system and will dec GnRH, LH, FSH, estrogen (like a GnRH antagonist)
What test can be done to confirm celiac disease?
Duodenal biopsy (remember, celiac disease affects the duodenum most commonly bc it gets the most exposure to gliaden from gluten and a biopsy will show flattening of the villi and crypt hyperplasia)
Do dizygotic twins share aminons? Chorions?
No! 2 eggs, 2 sperm (dizygotic twins= fraternal twins= like 2 completely separate pregnancies occurring at the same time)—> 2 amnion, 2 chorion (baby’s don’t share)
Destruction of the intralobular bile ducts. What condition is it? What’s the typical presentation?
Primary biliary cholangitis (aka primary biliary cirrhosis)
(This is an autoimmune reaction—> lymphocyte infiltrate + granulomas—> destruction of bile ducts in the liver)
Middle aged woman with pruitis (itching) and obstructive jaundice symptoms (jaundice, dark urine, pale stools, high cholesterol like xanthelasma deposits near eyes)
Pregnant lady loses a lot of blood during delivery and uterine massage isn’t helping…the placenta was delivered in pieces. What happened?
Placenta accreta (placenta implanted into the myometrium of the uterus, so delivery of the placenta was tough and when it did come out, came out in pieces and resulted in hemorrhage)
In general, what effects do teratogens have on babies before week 3 of pregnancy? During week 3-8? After week 8?
Before week 3–> “all or nothing” (the teratogen will cause spontaneous abortion or do no harm at all)
Week 3-8 (embryonic period)—> damage is likely
After week 8–> growth and function affected (but don’t have to be quite as caution with meds)
Guy comes in complaining of inability to get an erection. How can you distinguish between ED due to psychogenic factors or ED due to another underlying medical problem?
Take a good history…
Sudden onset ED (+ history like marital problems and still getting morning erections)—> psychogenic
ED intermittently and later became more persistent—> other medical cause (DM, vascular disease, neurologic disease, depression, GU trauma, medication side effect, etc.)
What is the role of sinuses of the breast?
They are collecting reservoirs for milk during lactation.
What complete mole type is more common- XX or XY?
XX.
It is more common for a single sperm (X) to fertilize an empty egg and duplicate itself than for two sperm (X and Y) to fertilize an empty egg.
What class of drugs is used in prevention of motion sickness. What is a main side effect of this drug class?
Antimuscurinics (inhibit PNS, act as anti-emesis drug to stop vomiting which is under PNS control/ from vagal stimulation)
Dry mouth
What is familial hypercholesterolemia?
Autosomal dominant disorder in which hepatocytes under-express LDL receptors—> early onset atherosclerosis
Are the following markers high, low, or normal in a trisomy 18 baby during mom’s pregnancy screening?
1st trimester: beta-hCG, PAPP-A
2nd trimester: beta-hCG, inhibit A, estriol, AFP
1st trimester: LOW beta-hCG, LOW PAPP-A
2nd trimester: LOW beta-hCG, normal or LOW inhibit A, LOW estriol, LOW AFP
What would cause a person with high levels of somatostatin in their blood to develop biliary stones?
Suppression of CCK by somatostatin
What are the 2 most common causes of acute pancreatitis?
Gallstones and alcoholism
What medication is a vitamin A derivative, used to treat severe acne, and a teratogen?
Isotretinoin
“IsoTERATinoin” is a teratogen that causes severe birth defects. Prescribe along with contraceptives.
What’s Budd-Chiari syndrome?
Thrombosis or compression of hepatic veins (coming out of the liver)
- centralobular congestion and necrosis (since central veins in the middle of lobules join to form hepatic vein)
- leads to congestive liver dz (hepatomegaly, ascites, varices, abdominal pain, liver failure), “nutmeg liver”
How does rubella present in an adult?
Lymphadenopathy and seizures and knee pain, arthritis
Male patient has heat intolerance, tachycardia, and unintentional weight loss. He also noticed a mass on his left testicle that you palpate on physical exam. What may explain these findings?
Testicular tumor producing elevated hCG (most likely choriocarcinoma, but could rarely be seminoma, embryonal carcinoma, or teratoma). Remember, hCG has a similar structure to FSH, LH, and TSH. It can activate the TSH receptor, leading to hyperthyroidism!
In 2nd trimester pregnancy screening, are AFP (maternal serum alpha-fetoprotein) levels high, low, or normal when an unborn baby has an aneuploidy (abnormal # of chromosomes)- trisomy 18 or 21?
Low AFP
What is another name for “infundibulopelvic ligament?”
Suspensory ligament of the ovary
Large hepatocytes filled with granular hemogenous pale pink cytoplasm. What is this describing?
Hepatitis
What hormone or hormones released by the anterior pituitary gland promote secretion of testosterone by the testes?
LH (not FSH! Both LH and FSH promote estrogen production in females, but guys are simpler- just LH. Their FSH does other stuff)
What does dysphasia mean?
Difficulty swallowing
Took antibiotics 2 weeks ago. Now has thick white vaginal discharge. Budding cells are seen. What is it?
Candida vaginitis (the antibiotic use killed bacteria and altered the normal vaginal flora, allowing for colonization of the Candida fungi).
Can Warfarin cross the placenta? Heparin?
Warfarin can cross the placenta, Heparin cannot.
“Do not wage WARFare on the baby, keep it HEPpy with HEParin” (don’t give Warfarin bc it’s a teratogen, Heparin is fine)
What hormones are produced in each of the different parts of the adrenal medulla (hint: there are 4 parts)?
CORTEX:
1. Zona Glomerulosa (outermost)—> Aldosterone/ mineralocorticoids (“salt”)
2. Zona Fasiculata (middle)—> Cortisol/ glucocorticoids (“sugar”)
3. Zona Reticularis (innermost)—> Androgens/ sex hormones (“sex”)
“It gets sweeter on the inside (the deeper you go the sweeter it gets)”
4. MEDULLA (Chromaffin cells)—> Catecholamines (NE, epi)
You pump up a BP cuff and see the patient’s hands curling, indicating a positive trousseau sign. What does this tell you?
Patient has hypocalcemia
Woman had irregular periods before she got pregnant. Now she just got her 2nd trimester pregnancy screening done and it showed decreased AFP. Most likely why is this??
Dating error.
(While AFP can detect congenital anomalies in the developing baby, most likely the low AFP being picked up is not due to a problem like Down syndrome, but due to incorrect dating of her pregnancy since her cycles were irregular and we base the baby’s gestational age and expected lab values off the last menstrual cycle before pregnancy.)
What does melana mean?
Dark stool
If you find a uterus anomaly in a female patient, what other type of anomaly should you check for?
A renal anomaly
What side effect do opioid analgesics have on the gallbladder?
Can cause contraction of SMOOTH MUSCLE CELLS in the SPHINCTER OF ODDI—> increased pressure in the common bile duct and gallbladder—> abdominal cramping (and really rarely, biliary colic)
Diarrhea, flushed face, wheezing and liver metastasis. Think of what?
Carcinoid syndrome
Kid in the hospital. Started on antibiotics. Gets watery diarrhea a week later. What should you think of? What is the best test to do in order to confirm the diagnosis?
C. Diff.
PCR (bacterial gene amplification) for bacterial gene encoding a toxin
What parasite can cause megaesophagus and megacolon (smooth muscle becomes paralyzed, lack of peristalsis, thin and dilated)?
Trypanosoma Cruzi (Chagas disease)
How does the body eliminate copper?
Copper is transported through the blood on ceruloplasmin and added to bile or directly added to bile—> excreted through feces.
EHEC has a toxin most like what other bug?
Shigella
EHEC has a Shiga-like toxin that blocks protein synthesis by inhibiting 60s ribosomal subunit
What type of hernia is lateral to the inferior epigastric artery and vein?
Indirect hernia
What does eosinophilic mean?
Stains pink (does NOT mean full of eosinophils)
How does Methotrexate work as an abortion medication?
It is also a chemotherapy drug and inhibits folic acid. Since this is needed for a baby to develop, blocking folic acid will kill the baby.
Tamoxifen is used to treat estrogen positive breast CA. What’s its big side effect?
Endometrial hyperplasia (it acts as an antagonist at breast—> good bc estrogen positive breast CA is hormone sensitive, acts as agonist to bone—> can inc bone mineral density, acts as agonist to uterus—> bad, can lead to endometrial hyperplasia which inc risk for endometrial cancer.)
What consolation of symptoms is seen in CREST syndrome? What type of disorder is it in general?
It is an autoimmune condition that involves systemic sclerosis (laying down of fibrosis).
Calcinosis cutis and anti-Centromere antibody Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
What would be the best indicator of acute liver failure?
Prolonged prothrombin time (PT)
Shows up first as opposed to other markers like AST and ALT and albumin that show up later, more chronic
Infertile. Pain with sex. Pain with menstrual periods in lower abdomen. Uterus is regularly sized. What is it probably?
Endometriosis
Due to the scar tissue, patients have pain with penetration in sex and infertility. Since there’s endometrial tissue in ectopic sites that respond to hormonal changes, periods are painful.
*note this is regular endometriosis, not adenomyosis (endometriosis in the myometrium) bc the uterus is normally sized, not enlarged
Inflammation of terminal ilium with granuloma formation. Diagnosis? Th1 or Th2 driven process??
Crohn’s disease
Th1 mediated non-caseating granulomas
Hyperthyroidism will increase or decrease prolactin levels?
High T3/ T4–> low TRH (due to negative feedback)—> low prolactin
(Remember, TRH release leads to production of thyroid hormone on one axis, prolactin on another axis)
What the the order of most common—> least common hepatitis?
Hep A is most common—> hep B—> hep C—> hep D—> hep E is least common
(In the convenient order!)
Ondansetron. What is this drug used for and what’s its basic mechanism of action?
5-HT3 serotonin receptor blocker *remember the tiny dancer in Sketchy
Used to decrease chemotherapy-induced vomiting
What teratogen causes absence of digits (missing fingers/ toes)?
Alkylating agents
Teen girl is sexually active with her new boyfriend. She was prescribed an antibiotic a week ago for something she cannot recall and has been taking it. She drank some alcohol and now feels awful and comes in with a headache, vomiting, and stomach ache. What medication was likely prescribed to her a week ago?
Metronidazole to treat Trichemonas vaginitis (STD). Metronidazole should NOT be taken with alcohol (In Sketchy: “no drinking on the metro”) bc it causes accumulation of acetylaldehyde and a disulfiram like reaction—> hangover symptoms.
Guy comes in with intense scrotal pain after a hard core workout. Doppler imaging reveals no blood flow to testes. What is going on?
Testicular torsion (spermatic cord is twisted on its blood supply—> ischemia)
To prevent congenital rubella, what vaccine can be given to females and kids?
Live, attenuated (MMR vaccine)
*note: since it’s live, don’t give to pregnant women or immunocompromised
Why should pregnant moms who have epilepsy (taking antiepileptic drugs) take extra folate supplements during their pregnancy?
Antieplileptic (anti-seizure) medications are known to decrease folic acid levels (baby needs folate for neuro development)—> neural tube defects. Additional folate supplements can decrease risk of neural tube defects in the baby born to a mom with epilepsy.
2nd trimester screening shows high hCG and inhibin A, low estriol and AFP. What is the most likely anomaly the baby will have?
Trisomy 21 (Downs Syndrome)
Secretin has what effect on pancreatic enzyme secretion?
Increases pancreatic bicarb secretion
Note that Cl- content from pancreatic secretions goes down as bicarb goes up
most common pituitary adenoma?
prolactinoma (prolactin secreting tumor of the pituitary)
What type of cell (histo) are vaginal cells?
Stratified squamous (non-keratinized)
The gonadal (testicular) arteries branch off of what?
The abdominal aorta
Why might there be air in the gallbladder (pneumobilia) in a gallstone ileus?
Air from the intestines travels into the gallbladder since they are connected in this pathology.
Remember: gallstone ileus is a complication of a gallstone. The gallbladder becomes inflamed to the point that it ruptures/ inflammation eats away at the gallbladder and it forms a connection/ fistula with the duodenum—> gallstone moves from the gallbladder into the duodenum—> most commonly moves further through the bowel till it lodges in the ilium (ILIOCECAL VALVE)
What kind of drug is Diphenoxylate? What’s its primary target?
Diphenoxylate is an opioid anti-diarrheal drug that binds mu opioid receptors in the gut to SLOW MOTILITY.
Which antibiotic given to treat C. Diff. is a macrocyclic antibiotic that inhibits RNA polymerase?
Fidaxomicin
Thalidomide is a teratogen associated with what problem in baby?
Limb defects (“Tha-LIMB-domide”)
Congenital hypothyroidism, or cretinism, (can be caused be too little or excess Iodine in mom during pregnancy) leads to a clinical presentation in the baby known by the mnemonic “the 6 P’s.” What are the 6 P’s?
- Pot-bellied
- Pale
- Puffy-faced
- Protruding umbilicus
- Protuberant tongue
- Poor brain development
What is the name of the autosomal recessive condition in which hepatocyte copper transport is defective—> build up of copper within tissues?
Wilson disease
What type of cell (histo) are the ovary cells?
Simple cuboidal
Why do celiac disease patients present with malabsorption and weight loss?
The autoimmune pathophysiology—> flattening of the villi—> malabsorption.
What hernia type is most common in women? Baby boys? Older men?
Women—> femoral
Baby boy—> indirect
Old man—> direct
A sexually active teen girl asks for Isotretinoin to treat her severe acne. What must you also prescribe if you give Isotretinoin to her?
Contraception. Isotretinoin is a teratogen that can lead to severe birth defects! “IsoTERATinoin” is a teratogen.
Guy has loose stools. Intestinal biopsy is performed. PAS positive staining. What is the diagnosis?
Whipple Disease (Infection with T. Whipplelii organism. Macrophages consume it but are not capable of fully killing it so the infection stays within macrophage lysosomes. Site of GI involvement= lamina propria. Compresses lacteals—> fat malabsorption. Also can get other systemic symptoms from the infection such as arthritis and infection of cardiac valves.)
What is desmopressin?
Synthetically made ADH (give to central DI patients who lack the ability to make their own ADH to retain water)
What lipid lowering drug acts by decreasing cholesterol absorption at the small intestine brush border?
Ezetimibe
How can you tell the difference between a non-selective and selective beta blocker on a test?
Selective beta blocker—> begins with letter A-M
Non-selective beta blocker—> begins with letter N-Z
What are 3 drugs we can give to chemo patients to reduce vomiting (anti-emetic drugs for chemotherapy-induced vomiting)?
- Ondansetron (5-HT3 serotonin receptor blocker *remember the tiny dancer in Sketchy)
- Aprepitant (NK1 receptor blocker and blocks substance P *remember a preppy aunt and the athletes lining up to get their pee checked for drugs)
- Metoclopramide (D2 dopamine receptor blocker **though more commonly used in gastroparesis and GERD due to its pro-motility and inc LES tone effects *remember the me-tickle-opramide guy tickling the gymnast on the D2 dope ropes)
*note that 5-HT3, NK1, and D2 receptors are all involved in the vomiting reflex center
What teratogen causes ototoxicity?
Aminoglycosides (remember the picture of the aminoglycoside boxers, which are ears and kidneys bc it is toxic to both ears and kidneys)
Administration of glucose to thiamine-deficient patients (alcoholics) can result in what?
Wernicke encephalopathy (due to increased thiamine demand, whatever that means) *presents with confusion, ophthalmoplegia (weak eye muscles), and ataxia (problems with balance) + confabulation (they have memory loss and start lying/ making up stories to fill in that memory loss)
The internal pudendal artery is a branch off what artery?
The internal iliac artery
What type of cell (histo) are vaginal cells?
Stratified squamous (non-keratinized)
Are the following markers high, low, or normal in a trisomy 13 baby during mom’s pregnancy screening?
1st trimester: beta-hCG, PAPP-A
2nd trimester: beta-hCG, inhibit A, estriol, AFP
1st trimester: LOW beta-hCG, LOW PAPP-A
2nd trimester: normal beta-hCG, normal inhibit A, normal estriol, normal AFP
Explain how galactorrhea can occur in patients who have primary hypothyroidism.
Primary hypothyroidism (low T3, T4)—> high TSH (from anterior pituitary) and high TRH (from hypothalamus) due to feedback/ body trying to compensate by producing more thyroid hormone. High TRH—> high prolactin (bc remember, TRH release leads to production of thyroid hormone on one axis, prolactin on another axis). High prolactin—> galactorrhea (milk discharge from nipples).
“Cells with perinuclear vacuolizaton”
Koilocytes in HPV (nucleus is displaced by large perinuclear vacuole)
Lymphocytic inflammation. Ballooning degeneration of hepatocytes. Cytotoxic CD8+ T-cell mediated apoptosis. What is this describing?
Viral hepatitis
Spotting after vaginal intercourse and yellow purulent discharge from the cervical os. What is it? What do you have to be concerned about if left untreated?
Cervicitis—infection of the cervix most often caused by Gonorrhea or Chlamydia. If left untreated, you have to be concerned about PID—> infertility.
16 year old girl, never had a period, never had intercourse. Experiences cramping once a month in lower abdomen. What might be the reason for her primary amenorrhea?
Imperforate hymen (she is having periods, but there is no escape for the blood, so it has collected inside).
Guy has postbulbular duodenal and jejunal ulcers. He most likely got these ulcers from a tumor secreting what hormone?
Gastrin
This is describing ZE (Zollinger-Ellison) Syndrome which is a gastrinoma (gastrin-secreting tumor). Since gastrin promotes parietal cells to secrete HCl acid, makes sense that crazy high levels of gastrin would lead to ulcers. Note, ulcers are usually caused by H.Pylori, but these are in the upper duodenum or in the stomach, NOT typically lower than that!
What 2 hormones inhibit prolactin?
Dopamine and progesterone (PG)
Old woman has painless rectal bleeding, multiple mucosal outpouchings in sigmoid colon. What is this?
Diverticulosis— many false diverticula (outpouchings) of the colon
- these outpouchings consist of mucosa and submucosa
- these outpouchings can be due to straining and poor diet (red meat) and can lead to painless rectal bleeding and/ or diverticulitis (inflammation)
How can you treat central DI?
Give ADH (desmopressin= synthetically made ADH)
After a molar pregnancy is removed, what hormone should be monitored in a patient?
hCG (due to increased risk for choriocarcinoma, which would secrete hCG).
Woman had an abortion 2 weeks ago. She now presents with fever, abdominal pain, uterine tenderness, and foul-smelling vaginal discharge. What’s going on? What’s the cause?
Septic abortion (absorption—> retained products of conception/ baby parts that get left behind get infected) Caused by Staph Aureus or E. Coli usually
How can bile acid supplementation help a person with gallstones who does not want to undergo gallbladder removal surgery?
Gallstones are almost always clumps of CHOLESTEROL. The cholesterol has precipitated out bc there was too much of it (out of proportion with bile acids). If you give bile acids, it will help even out the proportions so that cholesterol stones are less likely to form.
*note that bile acids are almost never given in real practice bc stone are hard to dissolve, so we do surgery. Giving bile salts may help prevent additional stones from forming, but probably won’t help dissolve the existing ones.
