renal cell carcinoma
-most common location of metastasis?
lungs
Where do primary brain neoplasms often metastasize to?
inside the CNS
link btwn hypothyroidism & amenorrhea/galactorrhea
inc. TRH can stimulate PRL prod.
Most common cause of spont. nipple discharge?
intraductal papilloma
polythelia
-what is it?
accessory nipple
ephelide
-what is it?
freckle
ANP & BNP
-which messenger system do they use?
inc. cGMP.
vitamin D
-wheres its receptor?
cytoplasm
AFP:
- what normally produces it?
- marker for which tumors?
- fetal liver & yolk sac = normal
- HCC, nonseminomatous testicular carcinomas, ovarian carcinomas.
CA-125
-marker for what?
ovarian cancer
- not good for screening: highly nonspecific.
- use it to monitor progression.
Gross hematuria in a sickle cell pt/DM pt/tylenol abuser
- which disease?
- dont confuse w/what?
renal papillary necrosis
-dont confuse w/acute tubular necrosis which presents in a severely ill hospitalized pt w/oliguria.
choriocarcinoma
-most common distant metastasis?
lungs
choriocarcinoma
- cancer of which cells?
- villi? cytotropho? syncytiotropho?
- neoplasm of trophoblast = which includes both cyto & syncytio.
- NOT of villi.
klinefelters:
-abnormal hormone levels?
- dec. testosterone
- inc. FSH (bc dec inhibin)
- inc. LH => inc. estrogen
*i dont understand why estrogen is inc.
CEA
-marker for what?
-colorectal & pancreatic cancer
Where do most ovarian malignancies arise from?
90% = surface epithelium derived
Case control study
-odds ratio or relative risk?
-odds ratio
Cohort study
-odds ratio or relative risk?
-relative risk
Most important chemical mediator of sepsis?
TNF-alpha
Suckling increases which hormone production?
oxytocin & PRL
Risks for child thats not breast-fed:
-Asthma, allergies, diabetes mellitus, and obesity.
hPL
-inc or dec. in hypoglycemia?
- elevated to shunt what little glucose there is to the fetus.
- inc. the moms resistance to insulin.
Which is a better diagnostic test for menopause, LH or FSH?
FSH.
Why do post menopausal woman have inc. risk of CAD?
bc estrogen inc. HDL and dec. LDL.
-and now you have way less estrogen!
spermiogenesis
- loss of cytoplasmic contents, gain of acrosomal cap = forms mature spermatozoon.
- dont confuse w/spermatogenesis.
Which hormone responsible for growth of penis?
Testosterone
Which hormone responsible for differentiation of penis?
DHT
Klinefelter vs Turner
-which one has a barr body, which one doesn’t?
- Klinefelter (47 XXY) has a barr body
- Turner (45 XO) does NOT.
Genetics of Turners syndrome:
-Can be complete monosomy (45,XO) or mosaicism (e.g., 45,XO/46,XX).
Double Y males [male] (XYY)
-Sxs:
Phenotypically normal
- very tall, severe acne.
- antisocial behavior.
- Normal fertility.
- Small % diagnosed with autism spectrum disorders.
True hermaphroditism
- genetics?
- aka?
- 46,XX or 47,XXY
- ovotesticular disorder
- both ovary and testicular tissue present.
Female pseudo-hermaphrodite
- genetics?
- what is it?
- XX
- Ovaries present, but external genitalia are virilized or ambiguous.
- Due to excessive and inappropriate exposure to androgenic steroids during early gestation (e.g., CAH or exogenous admin. of androgens during pregnancy)
Male pseudo-hermaphrodite
- genetics?
- what is it?
- XY
- Testes present, but external genitalia are female or ambiguous.
- Most common form is androgen insensitivity syndrome (testicular feminization).
Maternal virilization during pregnancy
-possible cause?
-Aromatase deficiency: fetal androgens cross placenta.
Androgen insensitivity syndrome
- genetics?
- presentation?
- 46,XY
- testes present, female external genitalia.
Androgen insensitivity syndrome (46,XY)
-hormone levels?
- inc. test.
- inc. estrogen
- inc. LH
5α-reductase deficiency
- inheritance pattern?
- who gets this disease?
- Autosomal recessive (like most enzyme deficiencies).
- genetic males 46 XY
5α-reductase deficiency
-Sxs:
ambiguous genitalia until puberty, then male.
“penis at 12” phenomenon
-aka?
5α-reductase deficiency
5α-reductase deficiency
-testosterone levels?
normal
- you may think increased bc you’re not converting any to DHT, but thats not the case.
- that is the case if you use 5α-reductase inhibitors.
hydatidiform mole
- swelling of what?
- proliferation of what?
-Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).
hydatidiform mole
- Tx:
- monitor levels of what?
- D&C and methotrexate
- b-HCG
Is uterine size inc. in partial mole?
no
Genetic components of a complete mole.
- Enucleated egg + single sperm (subsequently duplicates paternal DNA)
- empty egg + 2 sperm is rare
Genetic components of a partial mole.
2 sperm + 1 egg
Sxs of complete mole?
- vaginal bleeding
- enlarged uterus
- hyperemesis
- pre-eclampsia
- hyperthyroidism
Sxs of preeclampsia before 20 wks gestation =
Molar pregnancy!
-most likely complete mole.
Mittelschmerz
- transient mid-cycle ovulatory pain
- classically associated with peritoneal irritation (e.g., follicular swelling/rupture, fallopian tube contraction).
- Can mimic appendicitis.
potential cause of pre-eclampsia
placental ischemia
Time frame for pre-eclampsia
20 wks gestation => 6 weeks post-partum
Elevated liver enzymes and thrombocytopenia during pregnancy?
These are potential Sxs of pre-eclampsia.
Eclampsia
-maternal death usually due to:
-stroke (intracranial hemorrhage) or ARDS.
Eclampsia
-Tx:
-antihypertensives, IV magnesium sulfate, immediate delivery.
Anti-HTN meds for pregnancy
α-methyldopa, labetalol, hydralazine, nifedipine
Pre-eclampsia
-Tx:
- antihypertensives
- deliver at 34 weeks (severe) or 37 weeks (mild)
- IV magnesium sulfate to prevent seizure.
HELLP syndrome
- what is it?
- Tx:
Hemolysis, Elevated Liver enzymes, Low Platelets.
- A manifestation of severe preeclampsia, although may occur without hypertension.
-thrombotic microangiopathy in liver
-RBCs get sheared as they pass by these micro-clots
in the liver -> schistocytes.
-some liver tissue will infarct
-platelets being used up to form all these little thrombi.
-Tx: delivery immediately.
Thrombotic microangiopathy in liver during pregnancy?
HELLP syndrome
Placental abruption
- painful?
- causes:
- yes
- trauma, smoking, HTN, preeclampsia, cocaine.
*life threatening for mother & fetus.
Placenta previa
-painful?
no
Placental abruption
-will mother have bleeding?
depends if bleeding is concealed or not.
Placenta accreta
- placenta attaches to myometrium without penetrating it
- most common type.
Placenta increta
-placenta penetrates into myometrium.
Placenta percreta
- placenta penetrates (“perforates”) through the myometrium and into uterine serosa (invades entire uterine wall)
- can result in placental attachment to rectum or bladder.
decidua =
Endometrium under the effects of progesterone.
-aka during a pregnancy
Placenta accreta/increta/percreta
- due to defective what?
- is it serious?
- decidual layer (endometrium during pregnancy)
- life threatening for mother. no separation of placenta following birth => massive bleeding.
Placenta accreta/increta/percreta
-risk factors:
prior C-section, inflammation, placenta previa.
Placenta previa
- risk factors?
- Sxs:
- prior C-section, multiparity.
- may cause painless bleeding.
- will require C-section to deliver.
Ectopic pregnancy
-b-HCG levels:
lower than expected rise in b-HCG
-should be doubling every 2 days up until 7th week.
Polyhydramnios
-associated w/what common disease the mother could have?
DM
What types of cell does HPV infect?
Squamous cells
-thats why it only causes SCC.
HPV 16 & 18
-E6 gene product: inhibits what?
p53
HPV 16 & 18
-E7 gene product: inhibits what?
RB
Invasive cervical SCC
-can it affect kidneys?
-Lateral invasion can block ureters, causing renal
failure.
-may present as hydronephrosis.
-post-renal failure is one of most common causes of death in pt. w/invasive cervical carcinoma.
HPV infected cell histology
koilocytic change
-nucleus looks like a raisin.
What age does cervical SCC present?
Takes about 20-25 years from HPV infection until
cervical carcinoma. So carcinoma usually presents
around 40-50 yr old females.
Does pap smear detect adenocarcinoma well?
no
HPV vaccine protects against which strains of HPV?
HPV 6, 11, 16, 18 (not 31 or 33)
-thats why u still need to get pap smear.
Endometritis
-Tx:
gentamicin + clindamycin with or without ampicillin.
How does endometriosis happen? How does it spread?
-Can be due to retrograde flow, metaplastic
transformation of multipotent cells, or transportation of endometrial tissue via the lymphatic system.
endoemetriosis vs adenomyosis
-size of uterus?
endometriosis = normal size uterus adenomyosis = uniformly enlarged uterus
Asherman Syndrome
- Loss of basalis leading to secondary amennorhea.
- Caused by over aggressive D&C.
Adenomyosis
-Tx:
hysterectomy
Most common gynecologic malignancy?
endometrial carcinoma
endometrial carcinoma
-what age does it present?
-55-65, postmenopausal.
most common tumor in females?
-what race gets them the most?
leiomyoma
-blacks
leiomyoma
- hormone sensitive?
- usually singular or multiple?
- yes, estrogen sensitive
- multiple
leiomyoma
-histology?
Whorled pattern of smooth muscle bundles w/well-demarcated borders.
leiomyoma
-what age?
20-40, pre-menopausal.
Between cervical, endometrial, and ovarian cancer:
-incidence rate?
- endometrial > ovarian > cervical
- USA
- cervical is most common worldwide.
Between cervical, endometrial, and ovarian cancer:
-worst prognosis?
Worst prognosis—ovarian > cervical > endometrial.
Dermoid cyst
-what is it?
mature teratoma
Endometrioid cyst
- where?
- aka?
- endometriosis w/in ovary w/cyst formation.
- chocolate cyst (when filled w/blood)
sex cord stroma =
-Granulosa cells + theca cells + fibroblasts
tubal ligation
-inc or dec chances of ovarian cancer?
- dec.
- if it increased ur chances then no one would get it.
Ovarian neoplasms
- how can they present?
- how do you Dx?
- presents with adnexal mass, abdominal distension, bowel obstruction, pleural effusion.
- diagnose surgically
Ovarian neoplasms
-whats one reason why they have a poor prognosis?
They present late.
Serous cystadenoma
-unilateral or bilateral?
often bilateral
most common ovarian tumor in women 20–30 years old.
mature cystic teratoma
-aka dermoid cyst
Mature cystic teratoma (dermoid cyst)
-whats it called if it has functional thyroid tissue?
struma ovarii
Ovarian cyst + hyperthyroidism
struma ovarii
-type of mature cystic teratoma (aka dermoid cyst).
Brenner tumor
- whats it look like?
- whats its nuclei look like?
- Looks like bladder, looks like transitional epi.
- “coffee bean” nuclei
Meigs syndrome
Triad of ovarian fibroma, ascites, and
hydrothorax. Pulling sensation in groin.
ovarian fibroma, ascites, and hydrothorax. Pulling sensation in groin.
Meigs syndrome
Age 15-30:
-what is the ovarian mass?
germ cell tumor
Age 35-40
-what is the ovarian mass?
benign surface epithelial tumor
Age 60-70
-what is the ovarian mass?
malignant surface epi tumor.
Thecoma
-may produce what hormone?
Estrogen
-My guess would be androgens, but answer is estrogen.
BRCA-1: most common ovarian/fallopian tube neoplasm =
serous cystadenocarcinoma
gene mutation leading to primary pulm. HTN.
- BMPR2 mutation (normally inhibits vascular smooth muscle prolif.)
- auto dom, variable penetrance
Osteoporosis
-serum chemistry?
NORMAL serum chemistry!
Osteoporosis
- affects which type of bone?
- example?
Trabecular
-distal radius, vertebral bodies, neck of femur.
Mosaic pattern of lamellar and woven bone.
-which disease?
Paget’s disease of bone.
Spongiosa filling medullary canals
-which bone disease?
Osteopetrosis
What exits the jugular foramen?
CN 9, 10, 11 & jugular vein.
Negative charges in basement membrane of glomerulus provides by what?
heparan sulfate
acanthosis
-what is it?
- inc. thickness of stratum spinosum
- psoriasis has this.
Duchenne muscular dystrophy
-what kind of mutation?
frameshift
Becker muscular dystrophy
-what kind of mutation?
point
-x-linked
Rapid relief for RA - give what?
corticosteroids
Vimentin
- found where?
- marker to Dx what?
- Int. filament found in cells of mesenchymal origin.
- used ti Dx sarcomas
Where do brain metastases usually occur?
Junction btwn white and grey matter.
most commonly injured nerve in leg?
-location?
common peroneal (fibular) -due to its superficial location around the neck of the fibula.
