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From Flashcardlet > 5/30 > Flashcards

5/30 Flashcards

1
Q

What structures are underneath the left 12th rib, and the 9th, 10th, and 11th ribs?

A

12 (a floating rib) = left kidney

9th, 10th, 11th = spleen

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2
Q

Cause of lacunar infarcts

A

Hypertensive arteriolar sclerosis (less than <1mm)

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3
Q

First enzyme of glycolysis, induced by insulin

A

Glucokinase (found in liver and B-cells of pancreas

Hexokinase is ubiquitous and is uninduced by insulin

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4
Q

What stain do you use for a liver of an a1-antitrypsin def

A

PaS stain

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5
Q

What are the pleural boarders on the right and left lung? Where does the lung lie in relation to these boarders?

A

These are the locations of the pleura, the actual lung runs 2 ribs above these landmarks. To not puncture the lungs, aim between these two

Right =

  • *Midclavicular = 7th
  • *Midaxillary = upper boarder of 10
  • *Paravertebral = 12

Left =

  • *Midclavicular = 7th
  • *Midaxillary = lower boarder of 10
  • *Paravertebral = 12
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6
Q

Head Bobbing murmur

A

Aortic Regurg –> widening of pulse pressure

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7
Q

Macrocytic megaloblastic anemia seen in alcoholics

A

Folic acid def

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8
Q

What cell type is involved in the final stage of an atherosclerotic brain emboli lesion?

A

Astrocytes (gliosis)

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9
Q

Differential Cyanosis

A

Clubbing/blueing of toes but not fingers

Due to a PDA that has reversed its flow (from left –> right shunt originally to right –> left shunt due to pulmonary hypertension and vascular sclerosis)

THe upper extremities are perfused fine, but the lower are not

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10
Q

What causes keloids

What causes contracture?

A

keloids - excessive collagen deposition (usually in upper extremity/neck/shoulder

contracture - excessive MMP activity (usually on palms, feet, or burns

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11
Q

Which vagina discharge has basic ph and acidic ph?

A

basic = Trichi and Gardinella

acid = normal and Candida

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12
Q

What is the function and location of bartholin glands?

A

Primary lubricators of the vagina

Found at 4 and 8 o clock

test of gonnorrhea or chlamydia

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13
Q

Where are skenes glands?

A

Periurethral

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14
Q

How are VIN and VAIN seperated into grades?

A

3 grades, dependent on number of mitotic figures and depth of penetration

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15
Q

HPV 16 and 18 effects are caused by what gene products and tumor suppressors?

A

HPV 16 = E6, p53

HPV 18 = E7, Rb

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16
Q

Cancer associated with DES exposure

A

Clear cell carcinoma of the vagina

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17
Q

Grape-like polyploid mass sticking out of the vagina (8-10yo)

A

Embryonal Rhabdomyosarcoma

Will also see invasion into muscle (desmin or myoglobin +)

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18
Q

What occurs to the squamo-columnar junction of the cervix with age?

A

columnar expansion with reaching of adulthood/estrogen secretion

columnar regression as you age

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19
Q

Endometriosis vs Adenomyosis

A

Both can cause painful intercourse or infertility

endometriosis = glands outside the uterus. Can result in severe pain a week before/during period and CHOCOLATE CYST FORMATION. Often due to retrograde flow. Uterus is NORMAL SIZE

Tx: OCPs, Leuprolode, Danazol

Adenomyosis = glands inside the myometrium –> enlarged uterus. Same bleeding etc as above

Tx: hysterectomy

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20
Q

Danazol

A

Idx: Endometriosis

A testosterone w/ mild androgenic effects that will cause masculinization of mom and fetus NOT USED ANYMORE

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21
Q

What are risk factors for endometrial hyperplasia?

What gene mutation is associated with it?

A

PTEN gene

Risks = anything that will increase estrogen (anovulatory cycles, fat, PCOS, HRT etc

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22
Q

What is the incidence and worst prognosis lists for gyn tumors?

A

Incidence: endo > Ovarian > Cervical

Worst Prognosis = Ovarian > Cervical > Endometrial

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23
Q

What bugs cause cat scratch fever?

animal urine in water making you sick?

A

cat scratch = bartonella henselae

animal urine = leptospira

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24
Q

What are the clinical findings of PCOS?

Hormonal findings?

A

exam = acne, darkening hair, amenorrhea or infertile, fat

hormones = VERY high LH in comparison to FSH. Elevated E2, Insulin. Decreased SHBG

All these factors combine to produce a very high level of LH and estrogen which has stopped ovulation

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25
Q

Tx for PCOS?

A

Weight loss, OCPs, Spironolactone

Clomiphene (SERM) used to partially agonize R’s in the hypothalamus and stop LH secretion

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26
Q

What are the characteristics of:

Follicular Cyst
Corpus Leteum Cyst
Theca-lutein Cyst
Hemorrhagic Cyst

A

Follicular Cyst = distention of unruptured graafian follicle, associated with hyperestrinism and endometrial hyperplasia

Corpus Leteum Cyst = hemorrage of persistent CL. Often regress spontaneously

Theca-lutein Cyst = associated with elevated hCG levels (mole or choriocarcinoma). Can be multiple.

Hemorrhagic Cyst = Blood vessel rupture in cyst wall. Cyst grows with increased blood retention

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27
Q

Tamoxifen

Raloxifene

A

Tam = antagonist on breasts, used to treat ER+ breast CA

Ral = Agonist on bone, treats osteoporosis by increasing E2 influence on bone

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28
Q

What is the most common metastatic tumor that has spread to ovary?

A

GI

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29
Q

Epithelial Cell Ovarian Tumors:

Serous
Mucinous
Brenner

A

INCREASED CA-125 PRESENT

Serous:

  • *Cystadenoma = fallopean tube-like
  • *Cystadenocarcinoma = psammoma bodies

Mucinous:

  • *Cystadenoma = mucous secreting, intestine like
  • *Cystadenocarcinoma = pseudomyxoma peritonei (puss everywhere in stomach)

Brenner = looks like a bladder, pale, yellow color, coffee bean nuclei

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30
Q

Germ-Cell Tumors:

Dysgerminoma
Choriocarcinoma
Yolk Sac
Teratoma

A

Dysgerminoma = equiv to male seminoma. sheets of uniform cells. associated with turners syndrome. hCG and LDH (+)

Choriocarcinoma = trophoblastic tissue, but no chorionic villi. hCG(+), can spread hematogenously to lungs. Only radiosens if it came from a MOLE.

Yolk Sac = young ppl, sacrococcygeal area. Friable, solid masses w/ Schiller Duval (glomeruli-esque) bodies. AFP(+)

Teratoma = mature - benign, immature - malignant.
**Struma ovarii = thyroid tissue involved

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31
Q

What is Meigs syndrome?

A

Classic triad of ovarian fibroma, ascites, and hydrothorax (pleural effusion)

Micro = fibroblasts with spindle cells and lipid droplets

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32
Q

Granulosa cell tumors

A

Secrete estrogens, can cause precocious puberty in kids or endo hyperplasia in adults

Call - Exnar bodies (eosinophilic) seen

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33
Q

Leydig Cell tumors

A

Virulizing tumor (secretes androgens) in perimenopausal women

Will see reinke crystals w/ sertoli cell tubules

34
Q

What increases your risks for ovarian cancers?

A

Lots of pregnancies and , late menopause, early menarche

REDUCED RISK = OCPs, younger in life, dont get pregnant earlier in life

35
Q

Thyroid cells with optically clear nuclei

A

Papillary CA - these are orphan annie eyes

36
Q

Which primary bone tumor fits the following description?

Most common malignant primary bone tumor in kids
MCC benign bone tumor
11;22 translocation
soap bubble appearance on x-ray
onion-skin appearance of bone
codmans triangle on xray
A

Most common malignant primary bone tumor in kids = osteosarcoma

MCC benign bone tumor = osteochondroma

11;22 translocation = ewings sarcoma

soap bubble appearance on x-ray = giant cell

onion-skin appearance of bone = ewings sarcoma

codmans triangle on xray = osteosarcoma

37
Q

Paritiy numbers:

A

TPAL

Total term delivers
preterm deliveries
abortions
living children

38
Q

Common causes of recurrent miscarriages

A

decreased progesterone

decreased b-hCG

Chromosomal abnormalities (robertsonian translocations)

hypercoagulopathy

39
Q

Dizygotic vs Monozygotic twins

A

Di = 2 eggs, 2 sperm, 2 seperate placentas (chorions) and 2 seperate amniotic sacs

Mono = 1 egg, 1 sperm produce one fertilized structure that splits into 2 zygotes early in pregnancy. Timing of split counts…

***0-4 days split = Di Di (the chorion and amnion have not developed, so when they do, they surround seperate structures)

**4-8 days split (most common mono) = Mono Di (1 chorion [which developed on day 3-4] and 2 amnions

**8-12 days split = Mono mono (Amnion develops on day 8)

**>13 day split = mono mono CONJOINED

40
Q

Cytotrophoblast vs Syncytiotrophoblast

A

Cyto = inner layer of chorionic villi - makes the cells

Sync = outer layer, secretes hCG that stimulates the corpus leuteum to secrete progesterone during 1st trimester)

41
Q

What are umbilical arteries and veins derived from>?

A

Allantois

THere are typically 2 umbilical arteries and 1 umbilical vein.

If there is only 1 umb artery, this is associated with congenital and chromosomal abnormalities

42
Q

What is the urachal duct? What is it derived from?

A

Yolk sac –> allantois –> Urachal duct (between bladder and yolk sac)

If this doesnt obliterate, you get a PATENT URACHUS (pee out your belly button)

Vesicourachal diverticulum = outpouching of bladder

43
Q

What is the function of the vitelline duct?

A

Connects yolk sac to midgut lumen, closes at 7 weeks

If it doesnt close =

Vitelline fistula (meconium poo dicharge thru belly button)

Meckels Diverticulim = partial closure, patent portion attached to ileum. (ectopic gastric mucosa, melena, periumb pain, ulcer

44
Q

What are some changes to body during pregnancy?

A

increased CO

increased plasma volume > increased RBC volume (ANEMIA OF PREGNANCY)

Increased GFR, decreased BUN and Cr

Resistance to Insulin (due to Human Placental Lactogen

45
Q

Complete vs Partial Mole

A

Complete - all dad, empty egg. XX, big increase in hCG, chance to progress to CA. Snowstorm appearance

Partial - shared parents, XXX, fetal parts present, low risk for malignancy

BOTH TYPES WILL PRESENT WITH CLUSTER OF GRAPES HISTO AND MAYBE PRE-ECLAMPSIA AT < 20 WEEKS

46
Q

Pre-eclampsia vs eclampsia vs HELLP

Tx?

A

Pre = proteinuria, HTN, edema. Caused by placental ischemia due to impaired vasodilation of spiral arteries.

Eclampsia = pre-eclampsia + seizures

HELLP = hemolysis, elevated liver enzymes, low platelets

Tx: deliver fetus asap. Tx with magnesium sulfate to prevent seizures and treat them (side effects could cause pulmonary edema or decreased deep tendon reflexes)

47
Q

Abroptio placentae

Placenta accreta

Placenta Previa

A

Abroptio placentae = due to increased vasoconstriction (coke, smoking, HTN) causing a retroplacental clot and detaching placenta from implantation site. PAINFUL BLEEDS @ 3RD TRIMESTER

Placenta accreta = decidual layer allows placenta to attach to myometrium (inside the muscle.) Placenta does not seperate after birth and can cause massive bleeding after delivery. May need a hysterectomy

Placenta Previa = PAINLESS BLEEDING WHILE PREGZ (3RD TRI). Placenta attaches to lower uterine segment over the Os. ULTRASOUND BEFORE YOU EXAMINE, and MUST get an ultrasound

48
Q

What are some risk factors for an ectopic pregnancy?

A

PID
Infertility Hx
Ruptured appendix
Tubal surgeries

49
Q

Terbutaline

A

B2 agonist – reduces premature uterine contractions and relaxes uterus

50
Q

FMR1 gene mutation (found in testes and brain)

A

Fragile X

involved in mRNA translation in dendrites –> results in CGG trinucleotide repeat disorder

51
Q

What are the quad screen findings for Trisomy 21?

A

decreased AFP
decreased estriol
increased bHCG
increased inhibin A

1st trimester ultrasound will also so increased nuchal translucency (CAN ALSO BE TURNERS)

52
Q

What does the quad screen look like for Trisomy 18?

A

decreased AFP
decreased estriol
decreased bHCG
normal inhibin A

53
Q

What is a barr body?

What males is this seen in?

A

barr body = inactive X chromosome

Klinefelters (since they are XXY)

54
Q

What is the hormone levels in Klinefelters?

A

Semi tubules are messed up, so decreased inhibin, increased FSH,

Leydig cells messed up so decreased testosterone, and increased LH and estrogen

55
Q

What is velocardiofacial Syndrome?

A

It is a 22q11 deletion syndrome similar to DiGeorge but with a different presentation:

Palate, Facial, and Cardiac defects

56
Q
  1. Berry aneurysms, MVP, polycystic liver
  2. Berry aneurysms, subluxation of lens, floppy mitral valve, dissecting aortic aneurysm
  3. Recurrent nose bleeds, skin discoloration
A

all AD!!!!!!!

  1. ADPKD
  2. Marfans
  3. Osler-Weber-Rendu
57
Q
  1. Facial lesions, seizure disorder, cancer(s) risk
  2. Pigmented iris hamartomas, neural tumors, scoliosis, cafe au lait
  3. juvenile cateracts, bilateral acoustic schwannomas
  4. bilateral renal cell carcinomas, hemangioblastomas
A

all AD!!!!

  1. Tuburous Sclerosis
  2. NF-1
  3. NF-2
  4. VHL
58
Q

Rash on Palms and Soles

A

Coxsackie A
Rocky Mountain spotted fever
2* Syphilis

59
Q

Toxicities of TCA’s

A 
Convulsions
Coma
Cardiotoxxx
Hyperpyrexia
Respiratory Depression
60
Q
  1. Bilateral absence of vas deferens, meconium ileus, pseudomonas
A
  1. CF
61
Q

Lysosomal storage diseases!!!

Renal failure:
X-linked Recessives:
Death by age 3:
Demyelinating Dz:
Accumulation of G2 ganglioside
Accum of Dermatin sulfate
Cherry Spot
A

Renal failure: Fabrys

X-linked Recessives: Hunters, Fabrys

Death by age 3: Tay Sacks, Neimann Pick, Krabbe

Demyelinating Dz: Metachromatic Leukodystrophy

Accumulation of G2 ganglioside: Tay Sacks

Accum of Dermatin sulfate: Hurlers, Hunters, Sheie’s

Cherry Spot: Tay Sacks, Niemann Pick

62
Q

Corneal Clouding vs MR:

Hurlers
Hunters
Scheie
I-Cell

A 
Hurlers = MR and clouding
Hunters = MR
Scheie = clouding
I-Cell = clouding +/- MR
63
Q

Defect in:

aL iduronidase
Iduronate Sulfatase
Arylsulfatase A
a-galactosidase A
Galactocerebrosidase
B-glucocerebrosidase
Hexasaminidase
Sphingomyelinase
A

aL iduronidase = Hurler/Sheie

Iduronate Sulfatase = Hunter

Arylsulfatase A = Meta Leuko

a-galactosidase A = Fabrys

Galactocerebrosidase = Krabbes

B-glucocerebrosidase = Gauchers

Hexasaminidase = Tay Sacks

Sphingomyelinase = Neimann Pick

64
Q

X-linked recessive disorders

A

Be Wise, Fools GOLD Heeds Silly HOpes

Brutons Agamma
Wiskot Aldridge
Fabrys
G6PD
Ocular albinism (NORMAL ALBINISM IS AR)
Lysch Nyhan
Duchenes/Becker MD
Hunters Syndrome
Hemophilia A and B
OTC def
65
Q

Which portions of the sarcomere shrink during contraction? Which do not?

A

H and I bands shorten, bringing the Z bands closer together

M and A bands do not shorten

66
Q

Two time you see cafe-au lait spots

A
  1. NF-1 (along with retinal hamartommas, neurofibromas)

2. McCune-Albright syndrome (along with precocious puberty/endocrine abnormalities, and unilateral bone lesions)

67
Q

Lymphocytic infiltration of exocrine glands

Especially salivary and lacrimal

Triad of dry eyes, dry mouth, and arthritis

A

Sjogrens

Triad of dry eyes, dry mouth, and arthritis

Parotid enlargement and a risk of B-cell lymphoma

68
Q

fusion of spine joints, uveitis, aortic regurg

A

ankylosing spondylitis (seronegative arthropathy associated with B27)

69
Q

What dz features Acantholysis

A

Pemphigus vulgaris

70
Q

Papular nevi vs flat nevi

A 
papular = interdermal
flat = junctional
71
Q

What is the mechanism of action of Celecoxib?

A

Blocks Cox-2, thus decreasing inflammation and pain

It spares Cox 1 which is good for gastic mucosa. It also doesnt effect platelet aggregation b/c TXA relies on Cox1

72
Q

What is the predominant activity in the heart 12 days post-MI?

A

granulation tissue and neovascularization

macrophage phagocytosis occurs 5-10 days

73
Q

Henoch-Scholffen Purpura

A

IgA hypersensitivity causing hematuria, ab pain, joint pain, and purpura on butt

74
Q

Children with a Predisposition to Giardia

A

Common Variable Immuno Def or X linked agammaglobulinemia (a def in IgA is what is the cause)

75
Q

Coca cola urine with mesangial deposits

A

IgA Nephropathy

76
Q

What is the MOA of ethosuximide?

A

Blocks thalamic T-type Ca channels

This is the FIRST LINE tx for absence seizures

77
Q

What is the mechanism of esophageal dysmotility in CREST?

A

atrophy and fibrous displacement of the esophageal muscles

78
Q

Histology of Halothane poisoning

A

Identical to viral hepititis

Eosinophilia, increased ALT levels, and prolonged prothrombin time

MASSIVE HEPATIC NECROSIS as a direct result of halothane metabolites and autoantibodies to liver proteins

79
Q

Drug used to decrease toxicity of Cisplatine

Drug used to decrease toxicity if Doxorubicin

A

Amifostine

Dexrazoxane

80
Q

Cancer MOST common in asbestos exposure

A

Bronchogenic carcinoma

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