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.
Metoclopramide. What is this drug used for and what’s its basic mechanism of action?
D2 dopamine receptor blocker—> increases Ach (pro-motility)
*remember the me-tickle-opramide guy tickling the gymnast on the D2 dope ropes
Used to treat gastroparesis (delayed gastric emptying) due to pro-motility effects, GERD due to its ability to increase LES tone, and (less commonly) used to decrease vomiting (like in chemo patients)
Which embryologic layer is the spleen derived from?
Mesoderm
Most common type of hepatitis to get from unprotected sex?
Hep B
In T1DM, how does destruction of beta cells occur?
It’s autoimmune!
Specifically, it happens through cell-mediated immunity (CD8 T-cells attack and kill pancreatic beta-cells—not humoral, so antibodies actually aren’t thought to be responsible for the destruction of beta-cells). There is leukocyte/ inflammatory infiltration.
Which hormone has a receptor that contains Zinc?
thyroid hormone (intracellular receptors that bind steroids, thyroid hormone, and fat-soluble vitamins act directly as transcription factors and contain zinc-finger binding domains)
When diverticula (outpouchings of the colon) become inflamed, what is the term for it?
Diverticulitis
Why would the uterus be dilated with coiled endometrial glands and edematous stroma in an ectopic pregnancy?
Even though the pregnancy is in the Fallopian tubes (or elsewhere outside the uterus), the hormones in the body are the same as in any normal pregnancy (high PG, high estrogen), telling the uterus to get thick and prepare for a baby.
How do you get hep A?
Fecal-oral. Acquired by travelers. Get it from contaminated food or water (especially shellfish in the US).
The common iliac artery branches into the external and internal iliac. What regions do these arteries supply blood to?
External iliac—> travels down leg to become femoral artery
Internal iliac—> supplies blood to structures within the pelvis
Mass in middle 1/3rd of esophagus in a smoker. What is it? What would be seen on histology?
Squamous cell carcinoma of the esophagus.
Keratin pearls and intracellular bridges.
Metronidazole does what when taken with alcohol?
Causes a disulfiram- like reaction due to accumulation of acetylaldehyde (causes hangover symptoms like headache, vomiting, abdominal cramps)
(In Sketchy: “no drinking on the metro”
In general, how do TZDs work for diabetics?
By decreasing insulin resistance (NOT by stimulating insulin release from pancreatic beta cells)
*Specifically, they activate PPR-gamma to bring glucose into fat cells/ adipocytes and dec glucose hanging around in the blood)
Pyloric stenosis presents with an olive shaped mass in the right upper abdomen. What is this olive shaped mass due to/ made of?
Smooth muscle hypertrophy (pyloric muscularis mucosa)
Vesicular lesions on the vulva after getting a new sexual partner. What is it until proven otherwise?
Herpes (HSV 2)
“dew drop on rose pedal”, patient may get recurrent genital ulcers
Valproate, carbamazepine, phenytoin, and phenobarbital are teratogens. What type and what problem is most likely to occur in a baby exposed to one of these drugs?
Antiepileptic (anti-seizure) drugs. They decrease folic acid—> neural tube defects.
What drug would decrease acid production in the stomach by decreasing all of the following: vagal stimulation, Gastrin, and histamine?
PPIs (proton pump inhibitors)
-because they block the H+/K+ ATPase (active transport) pump that is DIRECTLY responsible for acid production. All those other things that help stimulate acid production by parietal cells (vagal stimulation/ ACh, Gastrin, histamine) all feed into this.
Man comes in for infertility work up. Is found to have immotile sperm. What is the most likely diagnosis and what other 2 findings might you see in this guy if your diagnosis is correct?
Kartagener syndrome aka Primary Ciliary Dyskinesia (PCD)
(Autosomal recessive inherited defect in Dyenin arm of cilia—> cilia have impaired movement)
Besides infertility…
1. Recurrent pulmonary infections (can’t clear mucus) and bronchiectasis (permanent dilation of airways due to chronic inflammation)
2. Sinus invertsus (organs that should be on left are on right due to failure to migrate in development)
What effect does testosterone have on RBC production?
stimulates erythrocytosis (RBC production) *may see this in the form of inc hematocrit in an athlete abusing steroids, for example
Colon cancer on what side of the colon (right or left) is more likely to cause iron-deficiency anemia?
Right sided colon CA/ ascending colon
Why? If you have colon CA on the right side, it’s bleeding out causing anemia but that blood gets added to stool early on so that when you poop you can’t tell there’s blood in it and are less likely to go to the doctor and get treated to know something is wrong. On the other hand, if your colon CA is on the left side/ descending colon you will present with blood in stool and will have it attended to before anemia develops.
Lack of Sertoli cells but normally functioning Leydig cells in a 46,XY male. Will his internal genitalia and external genitalia be male, female, or both?
Internal genitalia—> both male and female
External genitalia—> male
Here’s why: lack of Sertoli cells—> no MIH (Mullerian Inhibitory factor) to block the development of internal female structures (fallopian tubes, uterus, upper vagina). Normal functioning Leydig cells—> making testosterone—> development of internal and external male structures.
What is the inheritance pattern of Primary Cilia Dyskinesia (PCD) (aka Kartagener syndrome)?
Autosomal recessive
Yellow white plaques of inflammatory cells in colonic mucosa. What are you thinking?
C. Diff.
Psudomembrane formation
What enzyme converts the pancreatic zymogen (inactive enzyme) Trypsinogen—> Trypsin (active enzyme) in the duodenum? Why is this conversion so important?
Enteropeptidase (aka enterokinase)
The conversion of Trypsinogen—> Trypsin in the duodenum is important bc Trypsin then activates all other zymogens (proenzymes/ inactive enzymes) in the duodenum (and also cleaves peptide bonds to complete the breakdown of proteins).
Tests drain into what lymph nodes?
Para-aortic
What type of cell (histo) are vaginal cells?
Stratified squamous (non-keratinized)
Lady with Polycythemia Vera (PV) presents with RUQ pain and an enlarged liver. What is a likely diagnosis?
Bud-Chiari syndrome
(Thrombosis or hepatic veins—> hepatomegaly, ascites, abdominal pain. Associated with hypercoagulable states like PV, Coagulation disorder, pregnancy/ postpartum, OCP use, etc!)
Epinephrine acts on what 2 receptors on pancreatic beta cells to do what?
Epi—> acts on alpha 2 and beta 2 sympathetic receptors of pancreatic beta cells.
Epi acting on beta 2 receptors—> inc insulin
Epi acting on alpha 2 receptors—> dec insulin *this has a greater effect, so overall epi decreases insulin release, which makes sense bc you don’t want to dec blood sugar and store up things in a fight or flight situation
What is the abbreviation for Adrenocorticotropic hormone?
ACTH
Guy has loss of peripheral vision, clumsiness, and recurrent renal stones. You want to do brain imaging, but also consider what type of cancer?
Pancreatic cancer
Remember MEN 1 (multiple endocrine neoplasia): pancreas, pituitary, and parathyroid tumors.
Peripheral vision loss could be explained by a pituitary adenoma (compressing the optic chasm). Renal stones from parathyroid tumor—> hyperparathyroidism (stones, groans, psychiatric overtones)—> inc calcium stones. So, considering MEN 1, check for Pancreatic tumors.
The foregut includes what structures?
Esophagus to upper duodenum
What’s the difference between the theca intern and theca externa cells?
Theca externa—> connective tissue support only
Theca interna—> stimulated by LH, takes cholesterol and makes androgens (androstenedione) (by the enzyme desmolase) *the androgens then get converted into estrone—> estradiol by the granulosa cells of the ovaries
Lithium (in psych medications) is a teratogen. It is most likely to cause what heart defect?
Ebstein anomaly (displacement of the tricuspid valve)
Liver tumor associated with arsenic and vinyl chloride.
Angiosarcoma
Why is avoiding fish a good idea during pregnancy?
Some fish (swordfish, shark, etc.) contain high levels of methymercury, which is a teratogen. If you eat a lot of seafood during pregnancy, that could be neurotoxic to baby—> developmental delay and rarely blindness, deafness, or cerebral palsy)
Person ate at a buffet. Now has bloody diarrhea. Most common cause?
Campylobacter jejuni
Inheritance pattern of hemochromatosis?
Autosomal recessive
Constipation that alternates with diarrhea is consistent with what GI pathology?
Irritable bowel syndrome
Guy presents after a car accident that slammed him against his steering wheel on the left side. He is in shock. Has normal heart and lung sounds. Has left shoulder pain and hiccups. What is the most likely diagnosis?
Ruptured spleen
(The spleen is on the left side and is the most likely organ to rupture in trauma. Bleeding out from the spleen would cause shock. Normal heart and lung sounds eliminates diagnoses like pneumothorax. The spleen sits up near the diaphragm and can irritate the sensory fibers in that area—> referred pain via the phrenic nerve to the shoulder and hiccups from diaphragm spasms.)
What does dyspepsia mean?
Abdominal pain
Polyuria, muscle weakness, constipation, and mental status changes. Has been taking vitamin D pills like crazy. What’s going on?
Excess vitamin D consumption—> excess absorption of Ca—> hypercalcemia. Like hyperparathyroidism (inc PTH—> inc Ca), hypercalcemia presents with “stones (renal Ca stones), thrones (polyuria), groans (constipation, muscle weakness, pancreatitis), and psychiatric overtones (mental status changes).”
The obturator artery is a branch off the internal iliac artery and supplies blood to what 3 structures?
The pelvis, bladder, and parts of the femoral head and medial thigh muscles
What mediates fibrosis of the liver in cirrhosis (what cell type, what inflammatory factor)?
TGF-beta from stellate cells
Although congenital Rubella can cause a number of symptoms, what is the main triad of symptoms in a baby?
Congenital deafness, cataracts, and PDA (machine-like murmur)
What are the 5 big risk factors for pancreatic cancer?
- Smoking (tobacco use)
- Chronic pancreatitis (usually due to alcohol, more than 20 years)
- Diabetes
- Age > 50 years
- Jewish and African-American males
Granulosa cell ovarian tumors secrete what? What would you expect to see on histo?
Estrogen. Call Exner bodies.
How do bile acid resins (cholestyrmine, colestripol, colesavelam) work as lipid-lowering drugs?
Bind to bile acids to prevent their reabsorption into the blood/ recycling to the liver, so the liver has to use up more cholesterol (and pulls some of it from the blood) to replenish the bile acids
A pregnant mom continues to smoke. How is this harmful to the baby?
Cigarettes have nicotine and CO (carbon monoxide).
Nicotine—> vasoconstriction—> dec placental blood flow—> placenta problems
CO—> impaired oxygen delivery—> low birth weight, preterm labor, ADHD
*smoking is also associated with SIDS (sudden infant death syndrome)
What is achlorhydria mean?
Decreased acid production by the stomach
Lady comes in with flu-like symptoms, RLQ tenderness, and periappendicial fluid collection. What does she have?
Appendicitis
Patient with peptic ulcer disease undergoes a gastrojejunostomy gastric bypass surgery as a result of a complicated perforated ulcer. What supplement will he have to take long-term following the procedure?
Iron supplements (Bypassing the duodenum and proximal jejunum—> iron-deficiency anemia, since this is where iron is absorbed)
Lactase is an enzyme found/ released where?
Lactase is a brush border enzyme found on the surface of the duodenum/ small intestine. (It is NOT a pancreatic enzyme.)
Why can elevated hCG lead to hyperthyroidism symptoms?
hCG has a similar structure (same alpha subunit) to LH, FSH, and TSH. Since it’s so similar to TSH, it can activate TSH receptors—> stimulates thyroid gland to pump out more TH—> hyperthyroidism.
What is the major blood supply to the ovary?
Ovarian artery
What people are more prone to SIBO (small intestine bacterial overgrowth)?
Gastric bypass surgery patients
(Too many “good bacteria” in small intestine—> overproduction of vitamin K and folate, but deficiency in most other vitamins, can cause bloating, abdominal discomfort, malabsorption)
Small ovaries with connective tissue, no follicles.
Streak ovaries, seen in Turner syndrome
Mom has bipolar disorder and gives birth to a baby with a teratogen-associated defect. What is it most likely to be?
Ebstein anomaly (apical displacement of the tricuspid valve) due to lithium (in psych meds, which are teratogens). “liTHIum messes up TRIcuspid valve”
Severe testicular pain and absent cremasteric reflex (scrotum fails to rise upon scratching of inner thigh). What is it?
Testicular torsion (spermatic cord is twisted on its own blood supply—> ischemia. The nerves are also within the spermatic cord so you don’t get response to the cremasteric reflex. Remember, in testicular torsion blood can get in through thick walled arteries, but blood cannot escape bc veins are thin walled/ collapsible by the twisting)
How can alcohol in large quantities cause hypOglycemia?
Alcohol (ethanol) inhibits gluconeogenesis (stops the liver from making more glucose). So, once you use up your glycogen stores in the liver, your blood sugar will drop down.
Really tall skinny guy. Small, firm testes. Him and his wife cannot get pregnant. What syndrome might he have? Explain.
Klinefelter syndrome
47, XXY (extra X chromosome). Presents in tall skinny guys (can be mistaken for Marfan’s until you read in the Q stem that the guy is infertile or something to that nature). Often have developmental delay.
Dysgenesis of seminiferous tubules—> dec inhibin B—> inc FSH.
Abnormal Leydig cell function—> dec testosterone—> inc LH, inc estrogen.
2 month old girl. Just started eating normal foods, not just baby food. Has diarrhea. Duodenal biopsy shows villous atrophy. What does she have?
Celiac disease
-causes flattening of the villi and crypt hyperplasia and affects the duodenum most (1st place where gluten/ gliaden hits)
What is a cystic hygroma?
Neck mass/ bulge due to poor lymphatic drainage- seen in Turner syndrome girls
Explain why a CF patient may have a vitamin A, D, E, or K (fat-soluble vitamin) deficiency.
Pancreatic insufficiency is a complication of CF.
Pancreatic insufficiency- the pancreas is still making digestive enzymes, but they can’t get out due to thick mucus secretions bc the CFTR gene—> Cl- channels are messed up in the pancreas too. Because pancreatic enzymes are needed for proper absorption of nutrients in the gut, fat malabsorption and deficiencies in fat-soluble vitamins often occur.
How could pregnancy lead to onset of GERD?
Progesterin= smooth muscle relaxant, so relaxes the LES (lower esophageal sphincter) so that it has decreased tone (not as tight as it should be).
This can also occur from the uterus (late in pregnancy) pushing on the stomach, changing the angle of the LES.
How do combined oral contraceptives work?
Inc estrogen and PG (trick body into thinking it’s pregnant)—> negative feedback onto axis will dec GnRH—> dec LH, FSH, preventing ovulation from happening so pregnancy will not happen
Patient has hyperpigmentation and really low BP. What med do you give her?
A glucocorticoid steroid. She has Addison’s disease (low cortisol—> high ACTH, so more MSH= melanin stimulating hormone that causes hyperpigmentation)
What does peptic ulcer disease mean?
You have a gastric or duodenal ulcer
Baby girl is born with ambiguous genitalia and clitoromegaly. Mom experienced facial hair and voice deepening during pregnancy. What happened? Explain.
Placental Aromatase Deficiency
Normally the placenta makes estradiol from testosterone (testosterone—> estradiol) by the enzyme aromatase. If it can’t—> build up of testosterone—> baby girl will have ambiguous genitalia and mom will have virilization during pregnancy.
4 year old boy with pubic hair. what’s likely to be going on?
he’s having precocious puberty likely due to congenital adrenal hyperplasia (deficiency in an adrenal cortex enzyme like 21-OHase–> can’t make aldosterone or cortisol so pathway gets shunted to excess production of androgens)
Guy has loose stools and unexpected weight loss. You want to test for malabsorption disorders. What’s the best 1st test to do?
Stool microscopy with Sudan III stain
-this tests the stool for fat (with Sudan stain) and is the most sensitive strategy for screening for malabsorptive disorders
How do statins decrease cholesterol?
Inhibit HMG CoA reductase (enzyme for making cholesterol)
Patient suffered a retroperitoneal hematoma following a car accident. Her BP is 110/65. Is it more likely that she is bleeding out from her aorta or head of the pancreas?
Head of the pancreas.
BOTH are retroperitoneal structures, but her BP is stable (barely low) so that rules out bleeding from the aorta (if the aorta is ruptured BP will be super low, shock status, and you’re kinda screwed)
Why is it a good idea to combine aluminum hydroxide with magnesium hydroxide antacids?
To reduce adverse side effects
Smaller dose of 2 drugs= less problems that bigger dose of 1 drug
What 2 things inhibit prolactin secretion?
Dopamine and prostaglandin (PG)
What is a choledochal cyst? How does it present?
Congenital dilation of the common bile duct
Presents in childhood as recurrent abdominal pain and jaundice
How do you get monozygotic twins?
(Monozygotic twins= identical twins)
Only 1 oocyte is fertilized by only 1 sperm and the pregnancy “splits in half” to 2 babies. They share things, but depends on how far along the pregnancy it splits.
What are the 3 genetic causes of Down syndrome (trisomy 21)?
- Nondisjunction (95%)- chromosomes fail to separate in meiosis I or II
- Unbalanced Robertsonian translocation (4%)- chromosome 21 and 14 swap pieces so that chromosome 21 has 2 long parts
- Mosaicism/ mitotic error (1%)- meiosis checks out fine but cell with a normal amount of chromosomes undergoes nondisjunction as it replicates in mitosis—> half the body cells are normal and half have a trisomy
Which medication/ teratogen is associated with discoloration of baby’s teeth and inhibition of bone growth?
Tetracyclines
Increase in LES (lower esophageal sphincter) tone means what? Decrease in LES tone means what?
Increase in LES tone- means the LES is too tight/ constricted, which describes Achalasia (failure of LES to relax due to loss of myenteric plexus there which controls GI motility + relaxation of LES—> dilated esophagus with distal stenosis “bird beak” sign)
Decrease in LES tone- means the LES is not as tight as it should be/ loose/ dilated, which describes GERD (reflux of acid from the stomach due to reduced LES tone triggered by alcohol, tobacco, obesity, fat diet, caffeine, or hiatal hernia)
Explain SIBO (small intestine bacterial overgrowth).
Normally, the small intestine is colonized with “good bacteria” that (1) make vitamins K and folate, (2) inhibit “bad bacteria,” and (3) digest malabsorbed dietary sugars and convert them to fatty acids.
SIBO= overproduction of these intestinal bacteria—> overproduction of vitamin K and folate (deficiency of most other vitamins)—> nausea, bloating, abdominal discomfort, malabsorption
*more common in gastric bypass patients
How can you treat nephrogenic DI?
Thiazide diuretics or Indomethacin
(Thiazide diuretics cause mild hypovolumia that increases Na+ and water reabsorption in the proximal tubule)
(Indomethacin decreases prostaglandin synthesis bc prostaglandins inhibit ADH)
What skin finding can be seen in a person with celiac disease?
Dermatitis herpaformis (vesicular herpes-like rash)
What do pale stools indicate in a patient with jaundice?
Conjugated bilirubin (CB) is not making its way to the duodenum and beyond to add the brown color to feces (remember, CB in the duodenum—> urobilinogen by gut microbes and further becomes—> sterobilin, giving feces their brown color). If you have an obstruction like a gallstone, you have CB (the liver is working to conjugate it) but that CB gets stuck in the GI tract and builds up.
Explain the procedure of orchiopexy (how testes that are undescended are brought down).
The undescended testicles are pushed through the superficial inguinal ring (which is an opening in the external abdominal oblique aponeurosis) and fixed into the scrotum.
Patient has hep B, then gets infected with hep E. What is this called? How does hep B help hep E infect?
Superinfection
Hep B coats hep E (“coating of viral particles”) so that it can get into liver cells
Guy has acute pancreatitis due to alcohol abuse. Which finding will support the pancreatitis is in fact due to alcohol abuse? Low serum calcium level or high MCV (mean corpuscular volume)?
High MCV—> this indicates macrocytic anemia from folate deficiency (alcohol causes this)
*note that a low calcium level is consistent with chronic pancreatitis where the inflammation breaks down surrounding fat and that fat gets calcified, but it is NOT suggestive of alcoholic pancreatitis only—this is a finding seen in pancreatitis with any underlying etiology
Guy has had decreased libido and mild headaches for the past few months. Now presents with sudden onset of severe headache, vision problems (like loss of peripheral vision), and hypotension. What is it?
Pituitary apoplexy (acute hemorrhage of the pituitary gland, as a result of having pituitary adenoma) *note: vision loss due to compression of optic chias and dec libido (sex drive) from hyperprolactinemia
What does cryptorchidism mean?
Failure for the testes to descend (they remain up in the abdomen)
What type of cell (histo) are vaginal cells?
Stratified squamous (non-keratinized)
What type of hernia is medial to the inferior epigastric artery and vein?
Direct hernia
SIADH will do what to Na+ levels (cause hyper- or hypo-natremia?) and what to volume levels in the body (cause hyper- hypo- or eu- volemia?)
SIADH—> euvolemic hypOnatremia
Too much ADH—> lots of water ret./ volume in the body—> low [Na+] since it’s diluted out—> body will respond to high volume by decreasing Aldosterone and increasing ANP/ BNP to decrease Na+/ increase Na+ in pee (when you pee out more Na+ you also pee out more water)—> now Na+ is still low, but volume is leveled out
What type of cell (histo) are the Fallopian tube cells?
Simple columnar (have cilia to transport egg/ embryo)
Patient is sexually active w/o condom use. Smoker. Cervix is red. Pap smear shows abnormality. What cells are probably seen on cytology?
Koilocytes (HPV)
Cause of Mallory-Weiss syndrome?
Increased intraabdominal pressure from vomiting (alcoholics, bulimics)—> tearing of mucosa at GE (gastroesophageal) junction—> hematemesis (painful vomiting of blood)
Guy has a gastric ulcer and it’s not due to H.Pylori or NSAIDs. He has enlargement of gastric folds and parietal cell hyperplasia. What is the cause?
ZE syndrome/ gastrinoma
Tumor secreting high levels of Gastrin—> stimulates parietal cells to pump out more acid, so they undergo hyperplasia—> increased acid leads to ulceration
What nerve is at risk for being injured during a thyroidectomy (removal of the thyroid gland)?
The superior laryngeal nerve (external branch), which supplies the cricothyroid muscle
What is the difference between central and nephrogenic diabetes insidious (DI)?
Central- you’re not making ADH (brain- hypothalamus- problem)
Nephrogenic- you’re not responding to ADH (kidney- CD- problem)
Patient has been on steroid (glucocorticoid) therapy for some time (chronically, not acute like you just put them on the med). They undergo surgery (a stressful event). Compared to a patient not on steroids, their hypothalamus- pituitary axis will consist of increased or decreased: cortisol, ACTH, and CRH?
Low cortisol (after taking steroids which inc cortisol for some time, the body adapts and does negative feedback by making less of its own steroids) Low ACTH and CRH (even though the body is producing less cortisol endogenously, it’s getting cortisol-like from the steroid so there will be normal negative feedback onto ACTH and CRH)
Which teratogen is known to cause renal failure and oligohydramnios (dec amniotic fluid)?
ACE inhibitors
(ACE inhibitors block the conversion of angiotensin I—> to angiotensin II. Angiotensin II is needed for proper development of the kidneys (in addition to just acting on the kidneys to increase Na+ reabsorption). So ACE inhibitors will mess up development of a baby’s kidneys—> baby can’t pee as much—> less amniotic fluid—»Potter’s sequence.)
What can Octreotide be used to treat?
Octreotide= somatostatin (“somato-STOP-in”) analog (blocks insulin, glucagon, GH, gastrin, secretin, CCK, GIP, secretin)
Variceal bleeds, acromegaly, VIPoma, and carcinoid tumors
In 2nd trimester pregnancy screening, are AFP (maternal serum alpha-fetoprotein) levels high, low, or normal when an unborn baby has an open neural tube defect (anencephaly, open spina bifida)?
High AFP
Internal hemorrhoids drain into what vein, which drains into what vein? (When we do band ligation to get rid of the hemorrhoids we cut off this blood supply)
Superior mesenteric vein—> inferior mesenteric vein
What does hematochezia mean?
Passage of fresh blood through the anus
High or low levels of: cholesterol, bile salts, phosphatidylcholine in a cholesterol bile stone?
High cholesterol, low bile salts, low phosphatidylcholine
(High cholesterol and low of everything else in proportion which is what allowed
Where is prostate CA most likely to metastasize?
To the bone—> OsteoBlastic lesions in the vertebrae and/ or pelvis.
What neurotransmitter stimulates Chromaffin cells in the adrenal medulla to secrete catecholamines (NE, epi)?
Acetylcholine (ACh)
What are the differences between caseating and non-caseating granulomas?
CASEATING GRANULOMAS- central necrosis, cheesy appearance. Due to infectious causes (like TB, leprosy, syphilis, cat scratch disease) due to cell death (of macrophages + bacteria) and release of cellular contents.
NON-CASEATING GRANULOMAS- no central necrosis. Due to autoimmune condition (like Crohn’s disease, sarcoidosis, common variable immune deficiency).
Guy just traveled somewhere. Most likely type of hepatitis he could have gotten?
Hep A
PTH binds to what receptors?
Calcium sensitive receptors that act via GPCRs
Think of congenital adrenal hyperplasia from 21-OHase deficiency. How might it present in a boy? girl?
Increased androgens–> boy will have precocious puberty. girl will have virilization (male like characteristics like deep voice, hirstuism/ excess facial hair growth, etc.)
Guy has an ulcer in the distal duodenum. No past medical history other than back pain which he takes NSAIDs for. Other finding is that he has elevated gastrin levels that rise with administration of gastrin. What caused his ulcer most likely?
A neoplasm—gastrinoma (ZE syndrome)
*yes, NSAIDs can cause an ulcer (but usually a gastric ulcer, not duodenal). Yes, H.Pylori is the most common cause of ulcers (95% of duodenal ulcers and 75% of gastric ulcers), but the duodenal ulcers it causes are usually in the anterior duodenum (not the distal duodenum). Big hint is SECRETIN (usually lowers gastric acid secretion) is given—> gastrin still rises. Most likely the ulcer is due to a gastrin-secreting tumor.
Most common benign liver tumor?
Cavernous hemangioma
Why do chronic pancreatitis patients present with steatorrhea (oily, foul smelling stools)?
Atrophy and fibrosis of pancreatic acinar cells that secrete digestive enzymes (like lipase)—> insufficient release of these enzymes (can also think of it as inflammation blocking the exit of digestive enzymes from the main pancreatic duct)—> steatorrhea, fat malabsorption
Baby is born to a mom with epilepsy. What complication is the baby most likely to have from teratogen exposure?
Neural tube defects (anti-seizure meds decrease folic acid—> harm baby’s neuro development—> neural tube defects)
A boy has congenital adrenal hyperplasia due to 21-OHase deficiency. To treat this, you can suppress what hormone?
ACTH.
*you might think to suppress Testosterone/ androgens since the deficiency–> excess androgen production. But, this is just like putting a band aid on and won’t fix the problem. You want to suppress ACTH. why? Cortisol is really low/ you don’t have it so the body increases ACTH in an effort to increase Cortisol production. This does no good since you physically can’t make Cortisol from the enzyme deficiency and in fact, makes the problem worse by causing more shunting over to make more androgens. So inhibit ACTH to lessen the shunting over to make more androgens.
Omphalomesenteric duct. What’s another name for it?
Vitelline duct (the connection between the midgut and yolk sac in embryo. Fails to completely go away in a Meckel diverticulum.)
Why is it important that we surgically pull down the testes of a male older than 2 years old with undescended testes?
When testes are not descended, males have increased risk for infertility (sperm is made in the Sertoli cells of the tests and that requires a lower temperature so they need to hang lower than the rest of the body in the scrotal sac) increased risk for testicular cancer.
Thin yellow-green vaginal discharge. Motile organisms on histo. What is it? How to treat?
Trichomonas
Treat with Metronidazole to both partners (it is an STD)
Before an egg ovulates it is arrested in ___________. Before an egg gets fertilized, it is arrested in __________.
Before an egg ovulates it is arrested in PROPHASE I. Before an egg gets fertilized, it is arrested in METAPHASE II (“MEeTs a sperm”).
What is pituitary apoplexy?
Sudden hemorrhage of the pituitary gland (usually due to having a pituitary gland adenoma)
LLQ (left lower quadrant) pain in an elderly patient. What should you think of?
Diverticulosis
Watery diarrhea + hypokalemia + achlordydria. What is it?
VIPoma
(VIP= vasoactive intestinal peptide. Increases intestinal water and electrolyte secretion, increases relaxation of intestinal smooth muscle sphincters, and decreases gastric acid secretion.)
Most common type of kidney stone in Crohn’s patients is??
Calcium oxalate
Man has cirrhosis. Recently had episodes of vomiting bright red blood. Now is coming in with altered mental status. Explain.
GI bleed—> he swallowed some RBCs which contain Hb protein—> that protein is broken down into nitrogenous waste produces—> build up of NH3–> hepatic encephalopathy
*note: cirrhosis—> less detoxification by the liver (bc it’s failing)—> build up of NH3, but something has to precipitate it to build up to the point that it causes hepatic encephalopathy (drugs, hypovolemia, electrolyte changes, GI bleed, infection, eating high protein so that there’s more NH3 waste, etc.)
In what way is primary biliary cholangitis (aka primary biliary cirrhosis) similar to graft-vs.-host disease?
They are both immune processes
Primary biliary cholangitis- autoimmune disorder—> destruction of intrahepatic bile ducts (bile ducts within the liver). Involves infiltrate of lymphocytes + granulomas.
Graft vs. host dz also involves infiltrate of immune cells.
What are problems seen in fetal alcohol syndrome?
Intellectual disability, microcephaly (small heads), facial abnormalities (small eye openings/ short palpebral fissures, smooth philtrum, and thin upper lip/ thin vermilion border), and heart defects (such as ASD, VSD, and Tetrology of Fallot)
How do statins work as lipid-lowering drugs?
They inhibit HMG-CoA reductase (in cholesterol synthesis pathway)
How do sulfonylureas affect C-peptide level?
They increase it (by causing increased secretion of endogenous insulin by pancreatic beta-cells)
What is the basic mechanism of action of Hep C drugs like Sofosbuvir and Ledipasvir?
Inhibits hep C viral replication and assembly (targets hep C specific enzymes)
(*Sofosbuvir is a NS5B inhibitor, Ledipasvir is a NS5A inhibitor to be specific for these examples)
What does oligohydramnios mean? What causes it?
Too little amniotic fluid. Due to problem with baby peeing (bilateral renal agenesis or posterior urethral valves in males)—> lack of production of amniotic fluid (since it’s made of baby pee)—> Potter sequence (smushed in face from dec amniotic fluid and limb deformity and pulmonary hypoplasia bc baby’s need to swallow amniotic fluid to develop lungs)
Woman has telangiectasis on face, ulcers on fingertips, and calcium deposits on elbows. What is it?
CREST syndrome
What does icteric mean?
Jaundiced
Ulcer in the duodenum. What can you assume it was caused from?
H. Pylori
this accounts for 95% of duodenal ulcers. Other 5% is ZE syndrome aka gastrinoma
What is the first line drug for Lyme disease treatment?
Doxycycline
During orchiopexy (surgically descending undescended testicles), the tests are pushed through what structure which is an opening in what (in order to get down into the scrotal sac)?
Testes are pushed through the superficial inguinal ring, which is an opening in the external abdominal oblique aponeurosis
Which acid suppression medication class is stronger: H2 blockers or PPIs (proton pump inhibitors)?
PPIs
Remember, PPIs will block the H+/K+ pump that produces acid in the parietal cells, so practically shuts off acid production. H2 blockers block binding of histamine to H2 receptors—> decreases acid production but not as much (more indirect).
What is primary sclerosis cholangitis? What is primary biliary cholangitis? What is secondary biliary cholangitis?
(*note: “cholangitis” can also be termed “cirrhosis”)
Primary sclerosis cholangitis- inflammation of the intrahepatic and extrahepatic bile ducts (bile ducts in the liver and outside the liver)
Primary biliary cholangitis- autoimmune destruction of intrahepatic bile ducts (just bile ducts in the liver)
Secondary biliary cholangitis- extrahepatic biliary obstruction (bile ducts outside the liver are obstructed and destroyed by inflammation)
What does aplasia cutis mean?
Missing patch of hair/ skin (associated with exposure to the hyperthyroid med and teratogen Methimazole)
If you are pregnant, why shouldn’t you pop in vitamin A pills like water?
Vitamin A excess can lead to spontaneous abortions and birth defects (cardiac, cleft palate)
*this is also why the acne medication Isotretinoin, a vitamin A derivative, is a teratogen and must be given with contraceptives
Vomiting results in what acid-base disturbance?
Metabolic alkalosis (due to loss of H+ bc you lose H+, Cl-, and K+ when vomiting)
What type of drug is Omeprazole?
A PPI, or proton pump inhibitor
Ends in -“prazole”
Deficiency of what vitamin presents with these symptoms: night blindness, corneal deposits, dry, scaly, itchy skin?
Vitamin A deficiency
Gray white vaginal discharge with fishy smell. What is it and what’s its gram stain?
Bacterial vaginosis (likely Gardnerella Vaginalis) gram-variable
How does Wernicke encephalopathy present?
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)
Painless bright red bleeding into toilet. Tc marker localized ectopic gastric mucosa (stomach cells where they shouldn’t be down in the intestines). What is this?
Meckel diverticulum (remember, the yolk sac is connected to the midgut during embryological development by the Vitelline duct. If the Vitelline duct fails to completely go away—> outpouching of the intestines that contains some ectopic gastric mucosa—> produces acid that is damaging to cells—> bleeding).
What is pernicious anemia?
Autoimmune destruction of parietal cells (which make HCl acid and IF, or intrinsic factor)—> lack of IF to absorb vitamin B12–> vitamin B12 deficiency (macrocytic anemia)
Patient is vomiting dark brown (blood) and is found to have a deep ulcer in the duodenum. What artery has most likely been penetrated/ eroded through by the ulcer?
Gastroduodenal artery
Runs posterior to the duodenal bulb, where duodenal ulcers occur
Which cells in the female reproductive tract are simple columnar?
Cells of the ovaries
Elevated tissue transglutaminase IgA. What are you thinking?
Celiac disease
“Loose stools” in a Q stem can mean what?
Watery diarrhea or oily stool like steatorrhea
Guy has blood streaked stool he notices when he wipes. Terrible pain in anus and purplish-blue sacs bulging into the anal canal. What is it? What nerve relays pain signals?
External hemorrhoids (below the pectinate line of the rectum). Inferior rectal nerve (branch off the puedendal nerve).
What 2 cytokines dampen the immune response? (For example, if the questions says a guy has Crohn’s disease and it got better…because symptoms are on/off, what cytokines are responsible for this getting better phase?)
TGF-beta and IL-10
What organ is very likely to be affected in endometriosis?
The ovaries (“chocolate cysts”)
What should you check before starting a diabetic patient on Canagliflozin?
Canagliflozin= SGLT-2 (sodium glucose co-transporter 2) inhibitor (it blocks the Na/ glucose co-transporter in the PCT to prevent glucose from being reabsorbed into the blood—> pee more out).
Check kidney function (BUN & creatinine) before giving it! Why? It decreases GFR as well, so not recommended if kidney function is impaired!
Guy goes into septic shock. Now has a GI bleed. Why?
Stress-related mucosal injury
Since he has sepsis, he is not getting good blood flow to his intestines. Ischemia= decreased mucosal protection= ulcer formation and these ulcers can bleed.
What class of drugs to treat BPH will decrease the size of the prostate (over 6-12 months)?
5-alpha reductase inhibitors (Finasteride, dutasteride)
(They inhibit the conversion of testosterone—> DHT. Less DHT= less growth of the prostate. Note that other BPH drugs like alpha 1 antagonists relieve symptoms but are not as good bc they don’t decrease prostate size. However, alpha 1 antagonists are first line over 5-alpha reductase inhibitors bc their side effects are milder- orthostatic hypotension and dizziness rather than gynecomastia, decreased libido, and ED.)
“Shrunken, fibrotic gallbladder”
Chronic cholecystitis (inflammation of the gallbladder) Occurs after many acute cholecystitis attacks (can be a complication of cholelithiasis aka gallstones)
Why give pancreatic lipase to a CF patient?
CF—> pancreatic insufficiency (thick mucus secretions that result from the CFTR gene/ channel mutation block ducts so that pancreatic enzymes can’t get out into the duodenum)
So giving pancreatic enzyme supplementation will help with their digestion (helps prevent failure to thrive, malabsorption, and steatorrhea)
How are beta-blockers useful in treating hyperthyroidism (like Grave’s disease)?
Treat symptoms of hyperthyroidism and also inhibit peripheral conversion of T4–> T3, so less T3 (less of the active form of thyroid hormone).
Elevated serum alkaline phosphatase. What GI/ exocrine category of issues should you think of?
A problem with the biliary ducts
(Cells that line the bile ducts and gallbladder make alk phos, so when there is damage to the bile ducts, it gets released. Marker just like Troponin is in the heart cells and gets released from dead myocytes and rises in a MI)
“Fluke infection”
A parasitic infection
What is the criteria for having diabetes? Pre-diabetes?
Diabetic criteria (pre-diabetes in parenthesis):
- Hemoglobin A1C > 6.5% (5.7-6.4%)
- Fasting glucose > 126 (100-125)
- 2 hour plasma glucose > 200 (140-199)
Hepatomegaly and dark tan despite avoiding the sun. What liver pathology is this?
Hemochromatosis
(Mutation in HFE gene—> messed up HFE receptors that can’t take up iron in the blood to bring it into hepatocyte sensors to make hepcidin to inhibit more iron release into the blood since it needs to be tightly regulated since we don’t have a way of getting rid of it…so you get way too much iron in blood that can deposit in organs and skin. Classic TRIAD: cirrhosis + DM + skin pigmentation “bronze diabetes”)
What does “high pitched bowel sounds” indicate?
Small bowel obstruction
Does alcohol increase risk for cervical cancer?
No. But it does increase risk for breast cancer.
*smoking increases risk for cervical cancer.
What’s the mechanism of a progestin-only birth control pill?
Thickens cervical mucus, impairing sperm penetration (same thing PG does when you’re pregnant)
Boy has diarrhea, abdominal distention, muscle wasting, and pitting edema. He has an absence in enteropeptidase activity. How does this explain his symptoms?
His symptoms point to protein deficiency (low oncotic pressure in compared to hydrostatic pressure out—> fluid leakage and edema). Lack of enteropeptidase means he’s not converting Trypsinogen—> to Trypsin in the duodenum (and thus, other pancreatic zymogens that just entered the duodenum are not getting activated). So, protein cannot be broken down to be absorbed as amino acids—> protein gets pooped out and not absorbed—> protein deficiency.
What factor prevents a uterus from developing in male babies?
MIH (Mullerian Inhibitory Factor)
Do TZD’s (diabetic med) affect leptin levels?
No. While they do increase fat mass (by bringing glucose into adipose cells), they do not change circulating leptin.
What vessel runs over the 3rd part of the duodenum?
The SMA (superior mesenteric artery)
What are the 2 types of gastric cancer?
- Intestinal (associated with H. Pylori, carcinogens in foods, smoking, inc acid production by stomach, chronic gastritis, looks like an ulcer but is malignant, which is why we have to biopsy gastric ulcers)
- Diffuse (NOT associated with H. Pylori, signet ring cells, stomach wall is thick and leathery “linitis plastica”)
Do NOT give aspirin to kids under age 16 (exception: Kawasaki disease). WHY?
Risk for Reye syndrome (rare, but fatal childhood encephalopathy related to aspirin and mitochondrial damage to hepatocytes. Kids can get steatosis/ fatty liver, hypoglycemia, hepatomegaly/ enlarged liver, coma and encephalopathy)
The internal pudendal artery is a branch off the internal iliac artery. It supplies blood to what 3 structures in men?
Anus, scrotum, and penis (NOT the testes)
In pregnancy or during OC use or during estrogen replacement therapy, what happens to TBG (thyroid binding globulin) levels? How about total and free T4/ T3 thyroid hormone levels?
Inc estrogen—> inc TBG biding up T3/ T4—> dec FREE T3/ T4–> inc TSH by feedback loop (to try to inc free T3/ T4 back)—> inc total T4/ T3.
Take-home: pregnancy (or anything that increases estrogen levels) will increase TBG and total T3/ T4. Free T3/ T4 will go down.
Where does choriocarcinoma most likely spread?
To the lungs
What hormone gives rise to internal male genitalia? External male genitalia?
Testosterone—> INTERNAL male genitalia
DHT (from testosterone)—> EXTERNAL male genitalia
40 year old lady has really painful periods and uniformly enlarged uterus. She is not pregnant. Histology doesn’t show anything out of the ordinary. What is it?
Adenomyosis (endometriosis in the myometrium)
*note that you couldn’t confirm this diagnosis unless you did a hysterectomy and looked at a piece of the uterus under microscope once it’s taken out
Which is a stronger anti-emesis drug: Ondansetron or Metoclopramide? Which receptors do they both act on?
Ondansetron blocks 5-HT3 (serotonin) receptors. Metoclopramide blocks dopamine receptors.
ONDANSETRON is a stronger anti-emesis (anti-vomiting) drug. Metoclopramide can be used as an anti-emesis drug but is more commonly used for its ability to increase gastric mobility in patients with gastroparesis (delayed gastric emptying).
What 3 structures does the hepatoduodenal ligament contain?
Hepatic artery
Portal vein
Common bile duct
(Note: this is where the Pringle maneuver is done to clamp off bleeding when procedures are done like surgery on the liver)
What over the counter drug can help prevent progression of pre-cancerous colon polyps (adenomatous polyps) to colon CA (carcinoma)?
Aspirin (inhibits COX-2, which protects against this sequence)
What congenital problems (there are 6) can a baby have when born to a mother with diabetes?
- Hypoglycemia (mom’s high glc crosses placenta and baby’s pancreatic beta cells hypertrophy to make extra insulin to deal with the extra sugar. Once born, pancreatic beta cells keep producing extra insulin for a bit but the baby isn’t getting extra sugar from mom anymore—> low blood sugar until cells adjust.)
- Macrosomia (fat baby > 9lbs.)
- Heart defects (transposition of the great vessels)
- Polycythemia (inc RBCs)
- Neural tube defects
- Caudal regression syndrome (incomplete development of the sacrum, can include sirenomelia or “mermaid syndrome” in which the legs are fused)
Which class of lipid lowering drugs increase risk for gallstones as a side effect?
Fibrates (Gemfibrozil, Bezafibrate, Fenofibrate)
In 2nd trimester pregnancy screening, are AFP (maternal serum alpha-fetoprotein) levels high, low, or normal when an unborn baby has ventral wall defects (omphalocele, gastroschisis)?
High AFP
What is the tumor marker for colorectal cancer? What is it useful for?
CEA (CarcinoEmbyonic Antigen)
Useful for monitoring reoccurrence of colon CA (NOT useful for screening- not sensitive or specific)
In what population of women do we see increased FSH?
Post-menopausal women (they have inc FSH and LH due to the body trying to compensate for no more estrogen and PG)
60 year old lady has a diet rich in In & Out burgers. She is bleeding bright red blood from her rectum. Colonoscopy shows multiple outpouchings in the sigmoid colon. What does she have?
Diverticulosis
(Many false diverticula of the colon in which just the mucosa layer outpouches the opposite direction of the lumen. Common in people over 60 who are obese and eat a lot of red meat.)
What type of cell (histo) are uterus/ endometrium cells?
Simple columnar (have cilia, mucus-secreting)
Why are CF patients prone to developing pancreatic insufficiency?
Pancreatic insufficiency means the pancreas is capable of making its digestive enzymes, but they are obstructed from getting out into the duodenum. In CF, thick mucus secretions (in lungs and in pancreas) interfere with pancreatic enzyme relaxes—> pancreatitis.
Do you need to biopsy ulcers in the duodenum? Stomach?
Duodenal ulcers—> NO, assume to be H.Pylori (less than 5% of the time due to ZE syndrome/ gastrinoma)
Gastric ulcers—> YES, have to rule out cancer. But still usually due to H. Pylori (75%). 25% of the time due to NSAIDs
Part of the small intestine is winding around a thin vascular stalk. What is it?
Intestinal atresia (Talking about the “apple-peel” atresia that occurs when the SMA is obstructed. Part of the bowel spirals around vessels.)
Most commonly injured organ in blunt-trauma
The spleen
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)
RLQ abdominal pain. Bowel contents draining to surface of skin. Skin rash. What is the diagnosis?
Crohn’s disease
(Most commonly affects the terminal ileum at the RLQ and can lead to fistula formation where the bowel lumen forms a connection with surrounding structures like the bladder—in this case, between the bowel and the skin. Skin rash is consistent with systemic symptoms you see in inflammatory bowel dz).
What is the normal process of how people get colon cancer?
Normal colon—> colon at-risk (by APC mutation)—> adenoma/ pre-cancerous polyp (by KRAS mutation)—> carcinoma/ cancer (by TP53 mutation).
What’s the most common category of ovarian tumor and what marker would you see elevated in serum?
Surface epithelium tumor (note: it is most common bc the epithelial layer of the ovary has to shed off to release an egg at every ovulation cycle and then regenerate itself, so more chance that a mutation will occur)
CA-125 will be elevated (note: this is NOT a screening tool for ovarian cancer, however, bc a lot of other things like endometriosis will also raise this marker)
What cells in the duodenum secrete bicarb? By release of what hormone?
S cells of the duodenum—> secretin—> bicarb
The GI tract receives blood supply from what 3 main arteries?
Celiac trunk, SMA, IMA (all off the abdominal aorta)
When is hCG detected in a serum pregnancy test? How about in a urine pregnancy test?
Serum hCG is detectable in about a week (as soon as the embryo implants in the uterine wall and the syncytiotrophoblast starts making hCG to act in place of LH to tell the corpus luteum in the ovary to keep making PG)
Urine hCG is detectable in about 2 weeks
What does cholelithiasis mean? What does cholecystitis mean?
Cholelithiasis- gallstones
Cholecystitis- inflammation of the gallbladder wall (a complication of gallstones)
What chromosome(s) do Turner syndrome patients have?
X0 (only 1 X chromosome)
Long-standing diabetic neuropathy can lead to what GI condition?
Gastroparesis (delayed gastric emptying)
*Erythromycin (a macrolide) can be used to treat it bc it acts on motilin receptors to improve gastric motility
What is Calcitrol?
The active form of vitamin D into a medication
What is epispadias and what causes it? What is 1 problem it’s associated with?
Urethra opens on top of penis (“if you have Epispadias, you hit your Eye when you pEE”) due to faulty positioning of the genital tubercle. Associated with exstrophy of the bladder (bladder protruding out of the body).
State what these 3 biliary tract diseases are: (1) Primary sclerosing cholangitis, (2) Primary biliary cholangitis, (3) Secondary biliary cholangitis. What lab finding would you expect to see in all these problems?
(1) Primary sclerosing cholangitis- inflammation and fibrosis of the INTRAhepatic and EXTRAhepatic bile ducts (bile ducts inside liver + outside liver).
(2) Primary biliary cholangitis- autoimmune condition (lymphocytes + granulomas)—> destruction of INTRAhepatic bile ducts (just bile ducts inside liver).
(3) Secondary biliary cholangitis- EXTRAhepatic biliary destruction (just bile ducts outside of liver).
Lab finding in all: High Alk Phos (alkaline phosphatase) *gets released by destroyed cells lining bile ducts
What organ is very likely to be affected in endometriosis?
The ovaries (“chocolate cysts”)
What does cholestasis mean?
Reduced bile flow from the liver
(Presents as itching, elevated alkaline phosphatase suggestive of bile duct damage, and dilated clogged bile ducts from the liver)
What class of drugs end in -“glitazone?”
TZDs (diabetic drugs that activate PPR-gamma to promote uptake of glucose into fat cells/ adipocytes)
Where are Brunner glands found?
In the duodenum. They secrete alkaline bicarb.
What is the most common GI anomaly of the GI tract?
Meckel diverticulum
What syndrome can opioid use in a pregnant mom cause in a baby?
Neonatal abstinence syndrome. Opiate use/ abuse is teratogenic—> nervous system and GI problems in the baby. (Baby may present with uncoordinated sucking reflexes, irritability high-pitched crying, tremors, tachypnea, sneezing, diarrhea, and possibly seizures).
What are the 4 risk factors for cholesterol gallstones?
Female
Fat
Fertile (multiparity- you’ve had kids)
Forty
*note: risk factors for billiruben gallstones (far less common) include extravascular hemolysis (more RBC breakdown—> more billibruben that can build up) and biliary tract infection
How does Turner syndrome happen? Be specific about the genetics. What’s the difference between Germline and somatic mosaicism?
Turner syndrome= X0 (girl missing an X chromosome)
Occurs from nondisjunction during meiosis or mitosis.
Germline mosaicism—> the nondisjunction/ chromosomal problem occurs in meiosis/ up at the germline so that most or all of the cells have the wrong number of chromosomes (XO)
Somatic mosaicism—> the nondisjunction/ chromosomal problem occurs later in mitosis so that about half the cells are normal and about half have an abnormal number of chromosomes (half XX or rarely XY, half XO)—> milder disease
Distal duodenal or jejunal ulcer. More likely to be from H.Pylori or a gastrinoma (gastrin-secreting tumor)?
From a gastrinoma
H.Pylori is the most common cause for ulcers, but tends to cause ulcers in the UPPER duodenum (or in the stomach)—not lower down than that.
Mom has gestational diabetes. How does this affect baby?
Glucose crosses the placenta (insulin does not). Since mom has extra glucose, baby gets extra glucose and baby’s pancreatic beta cells produce extra insulin to deal with that extra glucose. when the baby is born and no longer has extra glucose coming from mom, the baby can develop hypOglycemia (pancreatic beta cell hyperplasia–> spit out too much insulin for the smaller amount of glucose)
What other conditions is primary biliary cholangitis associated with?
Primary biliary cholangitis (aka primary biliary cirrhosis) is an autoimmune disorder (lymphocytes + granulomas)—> destruction of bile ducts in the liver (intrahepatic bile ducts). Therefore, it is associated with OTHER AUTOIMMUNE DISORDERS.
What does dark urine indicate in a patient with jaundice?
Elevated conjugated bilirubin (CB)
What is catheter embolization?
When a patient is bleeding out (ex: GI bleed), a catheter can be placed to insert a mesh “clot” to obstruct a vessel and stop bleeding. Of course, this can only be done where there is collateral blood flow (so you won’t get ischemia to an organ).
The obturator artery comes off of what artery?
Internal iliac artery
You get an immuno question. If it’s viral what does that mean you can rule out? If it’s bacterial what does that mean you can rule out?
Viral—> means it’s cell-mediated immunity (viruses live inside cells). Cross out any answer choices related to antibodies.
Bacterial—> means it’s humoral immunity. Cross out any answer choices related to CD8+ cytotoxic destruction.
Children with watery diarrhea should be treated with what type of solution?
Oral rehydration solutions= Sodium- glucose solutions (to prevent dehydration and electrolyte abnormalities)
How does Ezetimibe work as a lipid-lowering agent?
Prevents cholesterol absorption at small intestine brush border
Does viral hepatitis increase risk for hepatocellular carcinoma (liver CA)?
YES
Hepatitis—> liver inflammation and laying down of fibrosis—> overtime, damaged hepatocytes can become dysplastic nodules and can undergo malignant transformation
Why does DiGeorge syndrome lead to hypocalcemia?
Improper development of the 3rd and 4th pharyngeal pouches—> improper development of the thymus and parathyroid glands—> since the parathyroid gland secretes PTH (which inc serum calcium), if this is messed up you get lowered PTH release= dec serum calcium= hypocalcemia
What is hypospadias and what causes it? What are 3 problems it’s associated with?
Urethra opens on bottom of penis due to failure of the urethral folds to fuse. Associated with cryptorchidism (undescended testes), chordee (downward/ upward bending penis), and inguinal hernias.
Would it be better to give pulsatile or continuous GnRH to treat endometriosis?
Continuous. Remember, continuous GnRH—> decreases LH, FSH, estrogen (like a GnRH agonist). In endometriosis, patients have really painful periods (due to endometrial tissue responsive to hormones in locations outside the uterus), so we want to decreases LH, FSH, estrogen so these patients won’t get a period.
What does leukopenia mean?
Low WBC count
Why might it be a good idea for a patient who just had their thyroid gland removed to take oral calcium and vitamin D (Calcitrol) supplements?
The parathyroid glands are tiny behind the thyroid gland, so these are commonly injured in a thyroidectomy. No parathyroid glands—> can’t make PTH—> can’t inc calcium in the blood. These supplements are given to PREVENT HYPOCALCEMIA.
What’s the abbreviation for alanine aminotransferase?
ALT
Is early onset of sexual activity a risk factor for cervical cancer?
Yes. Women who have had sex before 18 years of age have double the risk of developing cervical cancer than women who were abstinent until age 21.
Guy has loose stools and weight loss. Are you suspecting colon cancer?
No, not really. Colon cancer presents with blood in stool, not loose stools (indicates watery diarrhea or fatty, oily stools)
Strong family history of colon cancer and multiple polyps present on the colon. What is it?
Familial adenomatous polyposis (FAP)
ACE inhibitors are a teratogen associated with oligohydramnios. Explain how they can cause this.
(Oligohydramnios= decreased amniotic fluid)
ACE inhibitors block the conversion of angiotensin I—> to angiotensin II. Angiotensin II is needed for proper development of the kidneys (in addition to just acting on the kidneys to increase Na+ reabsorption). So ACE inhibitors will mess up development of a baby’s kidneys—> baby can’t pee as much—> less amniotic fluid—»Potter’s sequence.
Patient has pernicious anemia. Are the following levels high, low, or normal? Gastrin, pH, and parietal cell mass.
Pernicious anemia= autoimmune destruction of parietal cells (make HCl and IF)—> lack of IF to help absorb vitamin B12–> vit B12 deficiency and macrocytic anemia
LOW parietal cell mass (from autoimmune destruction)
HIGH pH (destroyed parietal cells—> less acid production—> more basic/ higher pH)
HIGH Gastrin (tries to compensate by stimulating parietal cells to make more acid)
Why does Meckel diverticulum present with rectal bleeding/ melana (dark stools) in a kid?
Meckel diverticulum= true diverticulum where all layers (mucosa, submucosa, muscular p., and serosa) outpouch from the small intestine. This is from failure of the Vitelline duct (embryo structure that connects midgut to Yolk sac) to go away fully.
ANSWER:
The outpouch contains gastric mucosa (can be seen with Tc scan)—> produces acid—> damages intestinal mucosa (it’s not made for harsh acid like the stomach mucosa)—> bleeding.
*this is the most common congenital anomaly of the GI tract
What helps to down-regulate acid secretion after a meal?
Intestinal influences (Remember, the stomach pumps out acid. The intestines pump out alkaline solution like bicarb to buffer it)
Why do GERD symptoms get worse at night?
When you lay down to go to bed, gravity is not on your side anymore. The acid from stomach can now more easily shoot up into the esophagus, causing symptoms.
Is vitamin B-12 a water or fat soluble vitamin?
Water-soluble vitamin
“Mononuclear cells”
Lymphocytes
Why can shoulder pain and hiccups occur as a result of splenic rupture?
Ruptured spleen (or peritonitis)—> irritation of sensory nerves around the diaphragm (the spleen sits underneath it)—> referred pain via the phrenic nerve to C3, C5 shoulder region—> shoulder pain and hiccups (due to spasms of the phrenic nerve)
What is an ovulation predictor kit?
Pee on a strip that predicts ovulation (LH surge) one day before ovulation (you are fertile)
Gray-white vaginal discharge with fishy smell and clue cells. What is it?
Bacterial vaginosis, probably due to Gardnerella Vaginalis (anaerobic gram-variable rod)
What is Mullerian agenesis?
Short vagina (no upper vagina) and variable uterine development (their uterus is abnormal or not present—> primary Amennorrhea/ don’t get periods) *these patients have normal ovaries and secondary sex characteristics
What structure is lateral to a femoral hernia?
Femoral vein
What 3 specific facial abnormalities are seen in fetal alcohol syndrome?
- Small eye openings/ short palpebral fissures
- Smooth philtrum
- Thin upper lip/ thin vermilion border)
Does sympathetic or parasympathetic nervous system signaling lead to vomiting?
PNS
Think: “rest, digest, and upchuck” (Also can think the stomach contracts to digest food…also contracts to vomit up food. Also can think you don’t have time to vomit when running from a bear, so can’t be sympathetic.)
What is adenomyosis?
Endometriosis in the myometrium (hyperplasia of basal layer of endometrium, characterized by extension of endometrial tissue into the uterine myometrium, painful periods, abnormal uterine bleeding, uniformly enlarged uterus)
Why is the liver less likely to become occluded from a thrombus compared to other organs?
It has a dual blood supply (80% of blood coming into it from the portal vein and 20% of blood coming into it from the hepatic artery)
Where does lymph drainage go above the pectinate line of the rectum? How about below?
Above pectinate line—> internal iliac lymph nodes
Below pectinate line—> superficial inguinal lymph nodes
A transplant patient comes in with ulcerations in the esophagus. What virus is it? What finding would be seen on an esophageal biopsy?
CMV (cytomegalovirus) esophagitis
Intranuclear inclusions
Which class of diabetic drugs have delayed onset of action by several weeks? Why?
TZDs (Glitazones/ Thiazolidinediones)
Delay is due to their mechanism of transcription modulation (activate PPR-gamma, a nuclear receptor, to promote the uptake of glucose by fat cells/ adipocytes)
Is it okay to give Warfarin to a pregnant lady? How about Heparin?
Warfarin NO! It is a teratogen—> fetal hemorrhage and bone deformity, etc.
Heparin is okay bc it does not cross the placenta.
“Do not wage WARFare on the baby, keep it HEPpy with HEParin” (don’t give Warfarin, Heparin is fine)
What teratogens cause renal failure—> oligohydramnios—> Potter’s sequence?
ACE inhbitors (and ARBs)
They interfere with the RAA system (block conversion of angiotensin I—> angiotensin II). This messes up kidney development in the baby—> decreased urine production—> decreased amniotic fluid.
Thin off-white vaginal discharge with fishy odor. Clue cells on histology. What is it and how to treat?
Bacterial vaginosis (often Garderella) Treat with Metronidazole or Clindamycin
Are the following markers high, low, or normal in a Down syndrome (trisomy 21) baby during mom’s pregnancy screening?
1st trimester: beta-hCG, PAPP-A
2nd trimester: beta-hCG, inhibit A, estriol, AFP
1st trimester: HIGH beta-hCG, LOW PAPP-A
2nd trimester: HIGH beta-hCG, HIGH inhibin A, LOW estriol, LOW AFP
Baby (<2 months) presents with dark urine, pale stools, yellow face. Mildly enlarged, firm liver. What’s wrong?
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
(Note: the fact that baby has dark urine means high CB and pale stools indicates obstruction preventing CB from being added to stool…if it were just physiologic jaundice of the newborn due to fast RBC turnover and slowed UGT enzyme activity to conjugate you’d expect increased UCB—> maybe darkish urine from a little elevated CB too, but no pale stools bc there’s no obstruction blocking CB from adding to stool)
Can beta-blockers be helpful in treatment of Grave’s disease?
Yes, they can provide symptomatic relief (for example, can help with HTN, sweating, heat intolerance, anxiety, etc. from the hyperthyroidism), however, beta-blockers will not help with Grave’s exophthalmos (budging eyes).
DiGeorge syndrome results from failure of what to develop properly?
3rd and 4th pharyngeal pouches
What’s the mechanism of a copper IUD in preventing pregnancy?
Creates a chronic cytotoxic inflammatory response in uterus, impairing sperm migration
Lady comes in complaining of fatigue. Her labs show a really high alkaline phosphatase level. What lab should you order to follow-up on that and narrow your ddx?
GGT (gamma-glutamyl transpeptidase)
Both cells lining bile ducts & ostoeoBlasts make alk phos (gets released when the cells are destroyed), so would expect high alk phos in a bile duct problem OR a bone problem. If symptoms don’t point to one or the other, you’d want to order GGT. If GGT levels are high—> bile duct problem. If GGT levels are normal—> bone problem.
Where is ADH made?
In the hypothalamus! (Remember, ADH and oxytocin are made in the hypothalamus, secreted in the posterior pituitary)
Alcoholic. Epigastric pain. Oily stools. What are you thinking?
Chronic pancreatitis
What enzyme converts the pancreatic enzyme Trypsinogen (inactive) —> to Trypsin (active) in the duodenum?
Enteropeptidase
What does agenesis mean?
Failure of an organ to develop
During what time of pregnancy is a baby at greatest risk for harm by a teratogen?
1st trimester
What type of cell (histo) are the ovary cells?
Simple cuboidal
What 3 cytokines are responsible for fever/ acute onset illness?
IL-1, IL-6, and TNF-alpha
Really tall, slim male in special education classes. Presents with breast enlargement. What does he have? Are the following levels low, high, or normal? Inhibin B, FSH, testosterone, LH, and estrogen.
Klinefelter syndrome (47, XXY males- tall, slim, intellectual disability and infertility bc testicles are present but small and not working right) Dysgenesis of seminiferous tubules (Sertoli cells not working right)—> LOW inhibin B—> HIGH FSH (not as much negative feedback onto it) Abnormal Leydig cell function—> LOW testosterone (since they make it)—> HIGH LH (less negative feedback onto it)—> HIGH estrogen (from the high LH, this causes enlarged breasts)
Guy has epigastric abdominal pain after meals. Is a smoker and has a history of coronary artery bypass grafting. What is the likely diagnosis and what other condition is it similar to?
Chronic mesenteric ischemia
“Intestinal angina”- atherosclerosis of the celiac artery, SMA, or IMA (mesenteric arteries). When you eat, the intestines require extra blood flow than when resting to get ATP/ energy to do their digestive work, so lack of blood flow (due to atherosclerosis) will become a problem at this time
This is just like angina in the chest (chest pain comes on when exercising)
Alcoholic is vomiting blood. There are mucosal tears at GE junction. What is it?
Mallory-Weiss syndrome
What does hematemesis mean?
Vomiting blood
What maternal behavior increases risk for SIDS (sudden infant death syndrome) to baby?
Smoking
Baby presents with uncoordinated sucking reflexes, irritability high-pitched crying, tremors, tachypnea, sneezing, diarrhea, and possibly seizures. What teratogen was the baby most likely exposed to in utero?
Opiates.
This is “Neonatal abstinence syndrome.” Opiate use/ abuse is teratogenic—> nervous system and GI problems in the baby.
Can long-term oral contraceptive use lead to infertility?
It shouldn’t. Once off the pill, the cycle should return to normal.
A baby is born with aplasia cutis (missing patch of hair/ skin). What teratogen was the baby likely exposed to in the 1st trimester?
Methimazole (hyperthyroid med)
What are signs of hyperestrinism that can occur in a male patient with liver cirrhosis? Why?
Gynecomastia, spider angioma, and testicular atrophy
The liver normally breaks down estrogen. If the liver is failing (due to end-stage liver disease/ fibrosis from the cirrhosis), it will not be breaking down as much estrogen—> high estrogen levels.
Area of dark latency that parallel the bowel wall lumen in a premature baby. What is it?
Necrotizing enterocolitis
*in pre-mature babies with immature immune systems. Necrosis of intestinal mucosa with possible perforation—> pneumatosis intestinalsis (air in bowel wall, which is why it shows up dark/ can’t see it on x-ray)
How can you diagnose cholecystitis and distinguish calculous cholecystitis from a Acalculous cholecystitis?
- Ultrasound
- Cholescrintigraphy aka HIDA scan (hepatobiliary iminodiacetic acid scan)- a radionuclear biliary scan (when inconclusive)
Failure to visualize the gallbladder on HIDA scan suggests obstruction (calculous cholecystitis where there is a stone obstructing leading to the gallbladder inflammation, NOT Acalculous cholecystitis where there’s gallbladder inflammation due to stasis, hypoperfusion, or infection). Why? Bc if the cystic duct is blocked off by a stone then the gallbladder won’t be able to take up the radiotracer!
What are the 2 layers of the endometrium and what makes them different?
- Stratum basalis (inner layer of endometrium)- the regenerative (stem cell) layer
- Stratum functionalis (outer layer of endometrium)- the layer that gets sloughed off with each period
Infertile guy with absence of vas deferens. Has a history of reoccurring pneumonia. What condition does he have?
Cystic fibrosis
Baby has Ebstein anomaly (displacement of tricuspid valve). What medical condition did mom likely have, assuming baby got this defect from a teratogen?
Bipolar disorder (psych meds for bipolar have lithium, which is the teratogen that causes Ebstein anomaly)
What is “chorionic somatomammotropin” the same thing as?
Human placental lactose
A lady dies and autopsy reveals MULTIPLE tumors with neoplastic cells on her liver. Where was her primary cancer most likely?
Most likely she did NOT have primary liver CA (that would present as a single tumor as opposed to multiple, plus it’s more common to get another type of cancer that mets to the liver rather than a primary liver cancer).
Most common cause of liver metastasis= COLORECTAL CANCER.
Spreads through the blood by portal circulation (up from the portal vein).
Defective calcium receptors on the parathyroid gland and kidneys. Presents with hypocalcuria (low calcium in urine) and hypercalcemia (high calcium in blood) with family history of same lab results. What is it?
Familial hypocalciuria hypercalcemia
What results from failure of the Vitelline duct to fully close?
Meckel diverticulum (remember, the yolk sac is connected to the midgut during embryological development by the Vitelline duct. If the Vitelline duct fails to completely go away—> outpouching of the intestines that contains some ectopic gastric mucosa).
What 3 teratogens cause neural tube defects?
- Timethoprim (in TMP-SMX aka Bactrim)
- Methotrexate (chemo drug)
- Anti-seizure (anti-epileptic) drugs
Why do these drugs lead to neural tube defects in baby? Bc they decrease folic acid levels, which is essential for baby’s neuro development. That is why we tell epileptic pregnant patients to take extra folate supplements during pregnancy.
What does pruitis mean?
Itching
In cell-mediated organ rejection (there can be antibody mediated too), you’d see what on histo?
Lymphocyte infiltrations
Baby is born with Ebstein anomaly. What teratogen was the baby most likely exposed to?
Lithium (in psych medications)
Free fatty acids contribute to what component of T2DM?
insulin resistance
What affect can a cluster of mast cells have on acid secretion by the stomach?
Mast cells—> release histamine—> activate parietal cells to secrete HCl acid
Which nerve can you apply anesthesia to in order to eliminate pain to the perineum (area between the anus and vulva) for a gynecological procedure?
The pudendal nerve
Ovarian tumor with “anaplasia of epithelial cells.” What tumor marker could you track the progression of this cancer with?
CA-125 (this is a type of epithelial ovarian cancer)
Tetracyclines are teratogens (do not give to pregnant women!). What problems would they cause in baby?
Discolored teeth and inhibited bone growth
“Teeth-racyclines”
Anti-mitochondrial antibody is positive. What GI/exocrine condition is it?
Primary biliary cholangitis (aka primary biliary cirrhosis)
-autoimmune reaction (lymphocytes + granulomas)—> destruction of intrahepatic bile ducts (bile ducts within the liver)
Ulcerative colitis, non compliant with treatment. Now presents with bloody diarrhea. What can we do to work him up?
Regular abdominal X-ray to check for toxic megacolon.
Tall boy. Has a learning disability and intellectual disability. Has 47 chromosomes. What syndrome does he probably have? Will he be fertile?
Klinefelter syndrome (47, XXY)
Not fertile due to the extra X chromosome. (Testicles are present but not working. Dysgenesis of seminiferous tubules—> dec inhibin B and abnormal Leydig cell function—> dec testosterone—> inc LH—> inc estrogen)
An expecting mom has Graves’ disease. What medication should we treat her with and what medication should we NOT treat her with during the 1st trimester of her pregnancy?
Treat her with PTU, NOT Methimazole. Although Methimazole is the preferred hyperthyroid medication, it is a teratogen (can cause aplasia cutis, or missing patches of skin/ hair on baby) so PTU is a safer medication to give.
Esophageal cancer in the upper 1/3rd of the esophagus is what type of cancer specifically? What lymph nodes can it spread to?
Squamous cell carcinoma
Drains to cervical lymph nodes
One guy gets a killed Polio vaccine. Other guy gets an oral, live attenuated vaccine. What antibody will differ the most between them?
Mucosal IgA antibodies (Duodenal luminal IgA antibodies)
Note: NOT serum IgA. The live vaccine is taken orally, so passes through the stomach mucosa and IgA is made.
(Remember in Sketchy: “Savin’ A life” for IgA goes with Live vaccine)
The common hepatic artery, which supplies the liver with blood, branches off of what?
The celiac trunk (from the abdominal aorta)
What 2 bacteria are more likely to cause appendicitis?
E. Coil and B. Fragilis
Bud-Chiari syndrome involves thrombosis of what vein?
The hepatic vein (going out of the liver—> so you get hepatomegaly since it backs up)
Personal trainer with acne and decreased testicular volume. What is likely to be going on?
Steroid drug abuse. (when you take testosterone/ steroids exogenously, your body produces less steroids endogenously due to negative feedback/ regulation–> testicular atrophy).
Thick cottage-cheese like vaginal discharge. Pseudohyphae on histology. What is it? How to treat?
Vaginal Cadidiasis (Candida yeast infection) Treat with Fluconazole
What embryologic layer does the spleen derive from?
Mesoderm
What is another name for “suspensory ligament of the ovary?”
Infundibulopelvic ligament
Guy comes in complaining of suddenly not being able to get an erection. He has a recent history of arguments with the wife and he has noticed that he has continued to get morning erections. What is the most likely cause of his ED?
Psychogenic factors (emotional stress) The fact that he is getting morning erections rules out vascular and neurologic disease that may make it to where he could not physically get an erection and his history of marital problems supports psychogenic factors (responsible for 10% of ED cases).
What structure is missing in male CF (cystic fibrosis) patients that makes them infertile?
Vas deferens
Most common virus that causes croup (“barking cough”) and the class of viruses it falls under?
Paraflu (falls under paramyxovirus)
How do you get dizygotic twins?
(Dizygotic twins= fraternal twins)
2 different sperm fertilize 2 different oocytes—> like 2 completely separate pregnancies happening at the same time (baby’s don’t share stuff)
What is the role of human placental lactogen and the tie in to gestational diabetes?
Human placental lactogen (aka chorionic somatomammotropin) is a pregnancy hormone. It is released by the syncytiotrophoblasts of the placenta. Overall, it blocks the effects of insulin (causes insulin resistance)—> to increase blood glucose (to ensure baby gets plenty of glucose). Since it causes insulin resistance, it makes a mom who already has diabetes risk factors more vulnerable to developing diabetes during pregnancy (gestational diabetes).
A direct hernia occurs due to acquired weakness (from straining, etc.) in what??
Transversalis fascia (This is the floor of Hasselbalch’s triangle. Yes, direct hernias are due to weakness in the abdominal wall, but specifically it is the transversalis fascia that weakens- not a muscle, that wouldn’t even make sense for a hernia to push through a tough, thick, bulky muscle).
A pregnant mom does cocaine. How is this dangerous to her developing baby?
Cocaine—> vasoconstriction—> dec placental blood flow—> placenta problems (placental abruption), low birth weight, preterm birth
What vitamin deficiencies can result in a person with a biliary disorder, exocrine pancreatic insufficiency, or intestinal malabsorption?
Fat-soluble vitamin deficiency (since release of bile and pancreatic enzymes is needed to break down fat and proper functioning of the small intestine is needed to absorb nutrients into the blood). That means: vitamin A, K, E, or D.
What is cretinism
HypOthyroidism in baby (can be due to mom having lack or excess of Iodine during pregnancy)
Which embryologic layer do GI structures come from?
Endoderm
“ENdoderm is the ENternal/ internal layer”
What is familial hypocalciuria hypercalcemia?
Defective calcium receptors on the parathyroid gland and kidneys. Presents with hypocalcuria (low calcium in urine) and hypercalcemia (high calcium in blood).
What is Kartagener syndrome (aka Primary Ciliary Dyskinesia) (be specific)? What 3 findings is it associated with?
Inherited (autosomal recessive) defect of the Dyenin arm (specific component of cilia) necessary for cilia movement.
- Recurrent respiratory infections and bronchiectasis (permanent dilation of bronchi/ bronchioles due to inflammation damaging the airway walls)
- Sinus inversus (organs like the heart that are normally on the left side are on the right side due to failure to migrate over in development)
- Infertility (impaired sperm flagella in men, impaired Fallopian tube cilia in women)
Fatty stools, joint pain, PAS + granules in the lamina propria. What is the disease and generic treatment?
Whipple disease (due to infection with T. Whipplei) -macrophages try to eat up the organism but are unable to completely kill it, so it hangs out in the macrophages—> PAS+ foamy macrophages. Affects lamina propria—> compression of lacteals—> malabsorption of fats—> diarrhea/ steatorrhea (also systemic symptoms like joint pain bc it’s a systemic infection. Interference of chylomicrons is just one of the problems it causes related to GI). Treat with antibiotics
When does the trophoblast differentiate into cytotrophoblast (inner) and syncytiotrophoblast (outer)?
During implantation (6-10 days after ovulation/ fertilization of the egg)
How does Sildenafil (Viagra) work (what’s its mechanism)?
It is a Phosphodiesterase 5 Inhibitor.
Inhibits PDE 5–> inc cGMP—> smooth muscle relaxation in artery walls= vasodilation= inc blood flow (through deep artery of penis) to penis (corpus cavernosum)—> erection
What are the 3 differential diagnoses to have in mind when a patient presents with polyuria (peeing all the time)?
- Diabetes mellitus (DM)- pee a lot due to glucose spilling into urine and bringing water along with it
- Diabetes insidious (DI)- not making ADH (if central) or not responding to ADH (if nephrogenic)—> can’t retain water, so pee it out
- Primary (psychogenic) polydipsia (PP)- (polydipsia means excessive thirst) you are drinking water all the time so peeing all the time (it’s a psych issue where these people are like addicted to water)
What’s hepatic encephalopathy? How do you treat it (3 options of meds)?
Cirrhosis (liver is failing)—> decreased detoxification—> build up of NH3 (ammonia) and other toxins—> mental status changes
Treat with LACTULOSE (NH3–> NH4+) or
REFAXIMIN or NEOMYCIN (decrease NH3-producing gut bacteria)
What enzyme converts Trypsinogen—> Trypsin in the duodenum?
Enteropeptidase (a brush border enzyme on the surface of the duodenum)
*once Trypsin is activated, it activates all other pancreatic zymogens that have entered the duodenum
HypOthyroidism will increase or decrease prolactin?
Low T3/ T4–> high TRH (body tries to compensate)—> high prolactin
(Remember, TRH release leads to production of thyroid hormone on one axis, prolactin on another axis)
Lactose intolerance. What would you see on intestinal biopsy.
Nothing—would appear as normal intestinal mucosa.
What is another name for Kartagener Syndrome?
Primary Ciliary Dyskinesia (PCD)
Or Immotile Ciliary Syndrome
Patient has GERD. What can you treat them with and why?
PPI (proton pump inhibitor) or H2 blocker to decrease acid production in the stomach (by the parietal cells).
Antacid (like Tums) to neutralize any remaining acid (possible take a couple before bed to be sure acid is cleared before laying down when gravity is against you and acid would be more likely to shoot up).
Metoclopramide to increase LES (lower esophageal sphincter) tone (make it tighter) to reduce the likelihood acid will shoot up (remember, the problem in GERD is a decreased/ loose LES).
What measures are most indicative of a poor prognosis in a patient with liver failure?
Indicator of liver function— high PT, hypoalbuminemia, high bilirubin (the liver MAKES coagulation factors, albumin protein, and conjugates bilirubin, so testing these things gives us the most information about how well the liver is working)
NOT indicators of liver injury— high ALT and AST, high alk phos, high gamma-glutamyl transpeptidase (these things tell you your liver is failing but don’t necessarily tell you how bad of shape it’s in) or other—low platelets (due to splenic sequesteration, something you see in liver failure but not directly telling you how the liver is doing)
Which is worse: a sessile hyperplastic polyp or a villous adenomatous polyp?
Villous adenomatous polyp
*sessile polyps carry an increased cancer risk and therefore are worse than pedunculated (on a stalk) polyps—but, both are benign
Adenomatous polyps= pre-cancerous polyps (so of course, that’s worse than a benign polyp even if it’s “at-risk” for future cancer). Of the adenomatous polyps, villous is worse (increased progression to cancer) than tubular *remember “villous is the villan”
Diabetic mom gives birth to baby. What is the baby most likely to have: transient hypOglycemia, permanent hypOglycemia, transient hypERglycemia, or permanent hypERglycemia?
Transient hypOglycemia (Mom has extra sugar floating around in her blood that crosses the placenta to baby—> baby’s pancreatic beta cells hypertrophy to pump out more insulin to deal with the excess sugar—> when baby is born and mom is not supplying all that extra sugar, yet the pancreatic beta cells are working in overdrive to pump out insulin, baby is at risk for becoming hypOglycemic. However, this is reversible and will go away 3-7 days later.)
What sign on the neck can be a sign of insulin resistance?
acanthosis nigracans
What artery is contained within the spermatic cord and where does it branch from?
Gonadal artery
Comes off the abdominal aorta
TZD’s (diabetic med) upregulate what 2 genes?
GLUT 4 transporters and adiponectin (a cytokine that fat secretes that increases # of adipocytes/ fat cells that respond to insulin and stimulates fatty acid oxidation).
