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Flashcards in 3/17 repro Deck (122):
1

renal cell carcinoma
-most common location of metastasis?

lungs

2

Where do primary brain neoplasms often metastasize to?

inside the CNS

3

link btwn hypothyroidism & amenorrhea/galactorrhea

inc. TRH can stimulate PRL prod.

4

Most common cause of spont. nipple discharge?

intraductal papilloma

5

polythelia
-what is it?

accessory nipple

6

ephelide
-what is it?

freckle

7

ANP & BNP
-which messenger system do they use?

inc. cGMP.

8

vitamin D
-wheres its receptor?

cytoplasm

9

AFP:
-what normally produces it?
-marker for which tumors?

-fetal liver & yolk sac = normal
-HCC, nonseminomatous testicular carcinomas, ovarian carcinomas.

10

CA-125
-marker for what?

ovarian cancer
-not good for screening: highly nonspecific.
-use it to monitor progression.

11

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.

12

choriocarcinoma
-most common distant metastasis?

lungs

13

choriocarcinoma
-cancer of which cells?
-villi? cytotropho? syncytiotropho?

-neoplasm of trophoblast = which includes both cyto & syncytio.
-NOT of villi.

14

klinefelters:
-abnormal hormone levels?

-dec. testosterone
-inc. FSH (bc dec inhibin)
-inc. LH => inc. estrogen

*i dont understand why estrogen is inc.

15

CEA
-marker for what?

-colorectal & pancreatic cancer

16

Where do most ovarian malignancies arise from?

90% = surface epithelium derived

17

Case control study
-odds ratio or relative risk?

-odds ratio

18

Cohort study
-odds ratio or relative risk?

-relative risk

19

Most important chemical mediator of sepsis?

TNF-alpha

20

Suckling increases which hormone production?

oxytocin & PRL

21

Risks for child thats not breast-fed:

-Asthma, allergies, diabetes mellitus, and obesity.

22

hPL
-inc or dec. in hypoglycemia?

-elevated to shunt what little glucose there is to the fetus.
*inc. the moms resistance to insulin.

23

Which is a better diagnostic test for menopause, LH or FSH?

FSH.

24

Why do post menopausal woman have inc. risk of CAD?

bc estrogen inc. HDL and dec. LDL.
-and now you have way less estrogen!

25

spermiogenesis

-loss of cytoplasmic contents, gain of acrosomal cap = forms mature spermatozoon.

*dont confuse w/spermatogenesis.

26

Which hormone responsible for growth of penis?

Testosterone

27

Which hormone responsible for differentiation of penis?

DHT

28

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.

29

Genetics of Turners syndrome:

-Can be complete monosomy (45,XO) or mosaicism (e.g., 45,XO/46,XX).

30

Double Y males [male] (XYY)
-Sxs:

Phenotypically normal
-very tall, severe acne.
-antisocial behavior.
-Normal fertility.
-Small % diagnosed with autism spectrum disorders.

31

True hermaphroditism
-genetics?
-aka?

-46,XX or 47,XXY
-ovotesticular disorder
-both ovary and testicular tissue present.

32

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)

33

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).

34

Maternal virilization during pregnancy
-possible cause?

-Aromatase deficiency: fetal androgens cross placenta.

35

Androgen insensitivity syndrome
-genetics?
-presentation?

-46,XY
-testes present, female external genitalia.

36

Androgen insensitivity syndrome (46,XY)
-hormone levels?

-inc. test.
-inc. estrogen
-inc. LH

37

5α-reductase deficiency
-inheritance pattern?
-who gets this disease?

-Autosomal recessive (like most enzyme deficiencies).
-genetic males 46 XY

38

5α-reductase deficiency
-Sxs:

ambiguous genitalia until puberty, then male.

39

"penis at 12" phenomenon
-aka?

5α-reductase deficiency

40

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.

41

hydatidiform mole
-swelling of what?
-proliferation of what?

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

42

hydatidiform mole
-Tx:
-monitor levels of what?

-D&C and methotrexate
-b-HCG

43

Is uterine size inc. in partial mole?

no

44

Genetic components of a complete mole.

-Enucleated egg + single sperm (subsequently duplicates paternal DNA)
-empty egg + 2 sperm is rare

45

Genetic components of a partial mole.

2 sperm + 1 egg

46

Sxs of complete mole?

-vaginal bleeding
-enlarged uterus
-hyperemesis
-pre-eclampsia
-hyperthyroidism

47

Sxs of preeclampsia before 20 wks gestation =

Molar pregnancy!
-most likely complete mole.

48

Mittelschmerz

-transient mid-cycle ovulatory pain
-classically associated with peritoneal irritation (e.g., follicular swelling/rupture, fallopian tube contraction).
-Can mimic appendicitis.

49

potential cause of pre-eclampsia

placental ischemia

50

Time frame for pre-eclampsia

20 wks gestation => 6 weeks post-partum

51

Elevated liver enzymes and thrombocytopenia during pregnancy?

These are potential Sxs of pre-eclampsia.

52

Eclampsia
-maternal death usually due to:

-stroke (intracranial hemorrhage) or ARDS.

53

Eclampsia
-Tx:

-antihypertensives, IV magnesium sulfate, immediate delivery.

54

Anti-HTN meds for pregnancy

α-methyldopa, labetalol, hydralazine, nifedipine

55

Pre-eclampsia
-Tx:

-antihypertensives
-deliver at 34 weeks (severe) or 37 weeks (mild)
-IV magnesium sulfate to prevent seizure.

56

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.

57

Thrombotic microangiopathy in liver during pregnancy?

HELLP syndrome

58

Placental abruption
-painful?
-causes:

-yes
-trauma, smoking, HTN, preeclampsia, cocaine.

*life threatening for mother & fetus.

59

Placenta previa
-painful?

no

60

Placental abruption
-will mother have bleeding?

depends if bleeding is concealed or not.

61

Placenta accreta

-placenta attaches to myometrium without penetrating it
-most common type.

62

Placenta increta

-placenta penetrates into myometrium.

63

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.

64

decidua =

Endometrium under the effects of progesterone.
-aka during a pregnancy

65

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.

66

Placenta accreta/increta/percreta
-risk factors:

prior C-section, inflammation, placenta previa.

67

Placenta previa
-risk factors?
-Sxs:

-prior C-section, multiparity.
-may cause painless bleeding.
-will require C-section to deliver.

68

Ectopic pregnancy
-b-HCG levels:

lower than expected rise in b-HCG
-should be doubling every 2 days up until 7th week.

69

Polyhydramnios
-associated w/what common disease the mother could have?

DM

70

What types of cell does HPV infect?

Squamous cells
-thats why it only causes SCC.

71

HPV 16 & 18
-E6 gene product: inhibits what?

p53

72

HPV 16 & 18
-E7 gene product: inhibits what?

RB

73

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.

74

HPV infected cell histology

koilocytic change
-nucleus looks like a raisin.

75

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.

76

Does pap smear detect adenocarcinoma well?

no

77

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.

78

Endometritis
-Tx:

gentamicin + clindamycin with or without ampicillin.

79

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.

80

endoemetriosis vs adenomyosis
-size of uterus?

endometriosis = normal size uterus
adenomyosis = uniformly enlarged uterus

81

Asherman Syndrome

-Loss of basalis leading to secondary amennorhea.
-Caused by over aggressive D&C.

82

Adenomyosis
-Tx:

hysterectomy

83

Most common gynecologic malignancy?

endometrial carcinoma

84

endometrial carcinoma
-what age does it present?

-55-65, postmenopausal.

85

most common tumor in females?
-what race gets them the most?

leiomyoma
-blacks

86

leiomyoma
-hormone sensitive?
-usually singular or multiple?

-yes, estrogen sensitive
-multiple

87

leiomyoma
-histology?

Whorled pattern of smooth muscle bundles w/well-demarcated borders.

88

leiomyoma
-what age?

20-40, pre-menopausal.

89

Between cervical, endometrial, and ovarian cancer:
-incidence rate?

-endometrial > ovarian > cervical
*USA
-cervical is most common worldwide.

90

Between cervical, endometrial, and ovarian cancer:
-worst prognosis?

Worst prognosis—ovarian > cervical > endometrial.

91

Dermoid cyst
-what is it?

mature teratoma

92

Endometrioid cyst
-where?
-aka?

-endometriosis w/in ovary w/cyst formation.
-chocolate cyst (when filled w/blood)

93

sex cord stroma =

-Granulosa cells + theca cells + fibroblasts

94

tubal ligation
-inc or dec chances of ovarian cancer?

-dec.
-if it increased ur chances then no one would get it.

95

Ovarian neoplasms
-how can they present?
-how do you Dx?

-presents with adnexal mass, abdominal distension, bowel obstruction, pleural effusion.
-diagnose surgically

96

Ovarian neoplasms
-whats one reason why they have a poor prognosis?

They present late.

97

Serous cystadenoma
-unilateral or bilateral?

often bilateral

98

most common ovarian tumor in women 20–30 years old.

mature cystic teratoma
-aka dermoid cyst

99

Mature cystic teratoma (dermoid cyst)
-whats it called if it has functional thyroid tissue?

struma ovarii

100

Ovarian cyst + hyperthyroidism

struma ovarii
-type of mature cystic teratoma (aka dermoid cyst).

101

Brenner tumor
-whats it look like?
-whats its nuclei look like?

-Looks like bladder, looks like transitional epi.
-"coffee bean" nuclei

102

Meigs syndrome

Triad of ovarian fibroma, ascites, and
hydrothorax. Pulling sensation in groin.

103

ovarian fibroma, ascites, and hydrothorax. Pulling sensation in groin.

Meigs syndrome

104

Age 15-30:
-what is the ovarian mass?

germ cell tumor

105

Age 35-40
-what is the ovarian mass?

benign surface epithelial tumor

106

Age 60-70
-what is the ovarian mass?

malignant surface epi tumor.

107

Thecoma
-may produce what hormone?

Estrogen
-My guess would be androgens, but answer is estrogen.

108

BRCA-1: most common ovarian/fallopian tube neoplasm =

serous cystadenocarcinoma

109

gene mutation leading to primary pulm. HTN.

-BMPR2 mutation (normally inhibits vascular smooth muscle prolif.)
-auto dom, variable penetrance

110

Osteoporosis
-serum chemistry?

NORMAL serum chemistry!

111

Osteoporosis
-affects which type of bone?
-example?

Trabecular
-distal radius, vertebral bodies, neck of femur.

112

Mosaic pattern of lamellar and woven bone.
-which disease?

Paget's disease of bone.

113

Spongiosa filling medullary canals
-which bone disease?

Osteopetrosis

114

What exits the jugular foramen?

CN 9, 10, 11 & jugular vein.

115

Negative charges in basement membrane of glomerulus provides by what?

heparan sulfate

116

acanthosis
-what is it?

-inc. thickness of stratum spinosum
-psoriasis has this.

117

Duchenne muscular dystrophy
-what kind of mutation?

frameshift

118

Becker muscular dystrophy
-what kind of mutation?

point
-x-linked

119

Rapid relief for RA - give what?

corticosteroids

120

Vimentin
-found where?
-marker to Dx what?

-Int. filament found in cells of mesenchymal origin.
-used ti Dx sarcomas

121

Where do brain metastases usually occur?

Junction btwn white and grey matter.

122

most commonly injured nerve in leg?
-location?

common peroneal (fibular)
-due to its superficial location around the neck of the fibula.