final exam Flashcards
(241 cards)
1
Q
different pancreatic cell types: alpha cell
A
stimulate release of glucagon and glycogen stores and promote gluconeogenesis
2
Q
different pancreatic cell types: beta cell
A
stimulate release of insulin and lower blood glucose level
3
Q
different pancreatic cell types: delta cell
A
inhibit glucagon and insulin secretion
4
Q
acute pancreatitis
pathogenesis
causes
A
inflammation and hemorrhage of pancreas (premature activation of trypsin –> pancreatic enzymes autodigest pancreatic parenchyma
alcohol, gallstones, trauma
pancreatic pseudocysts (liquefactive necrosis), pancreatic abscess (E. coli)
5
Q
chronic pancreatitis
pathogenesis
causes
symptoms
signs
risks
A
fibrosis of pancreatic parenchyma secondary to recurrent acute pancreatitis
alcohol, CF, idiopathic
epigastric pain radiating to back, pancreatic insufficiency
dystrophic calcification on xray (“chain of lakes” pattern)
may inc. risk of pancreatic carcinoma
6
Q
T1D
pathogenesis
classification
risks
symptoms
treatment
A
insulin deficiency (hyperglycemia) due to autoimmune destruction of beta cells by T lymphocytes, inflammation of islets
HLA-DR3 and DR4, autoantibodies against insulin
untreated –> ketosis and diabetic ketoacidosis
weight loss, polydipsia, polyphagia, weakness
need lifelong insulin
7
Q
T2D
pathogenesis
side effects
diagnosis (levels)
A
non-insulin dependent, insulin resistance and inadequate insulin secretion, resistance linked with inc. levels of free fatty acids and pro-inflammatory cytokines
lipotoxicity (toxic effects of excess free fatty acids), unregulated secretion on cytokines
amyloid deposits
dx: (normal 70-120 ug/dL) random > 200, fasting > 126, gestational > 200
8
Q
T1D emergency: diabetic ketoacidosis
pathogenesis
symptoms
treatment
A
bodys change to fat metabolism and build up of ketones (acidosis)
hyperglycemia (>300), hypercalcemia, Keussmaul respirations, dehydration, fruity breath
tx with fluids, insulin, electrolytes
9
Q
T2D emergency: hyperglycemic hyperosmolar non-ketotic coma (HHNC)
pathogenesis
sign
treatment
A
(>500 mg/dL) —> diuresis with hypotension and coma
absent ketones due to dec. insulin, hyperglycemia
tx with fluids and insulin
10
Q
hypoglycemia: insulin shock
levels
treatment
A
< 60 mg/dL, medical emergency
tx with oral glucose (if awake and able, 15-30 gram or food/drink, slower activation), IV glucose (dextrose 50% D50 for adult, D25 for children, D10 for infants)
11
Q
pituitary tumors
sizing
pathogenesis
A
macro > 1 cm or micro < 1 cm adenoma
lesion causing compression of optic chiasm or basal portion of brain
12
Q
pituitary tumors: prolactinoma
pathogenesis, male/female
commonality
treatment
A
inc. prolactin, female: galactorrhoea and amenorrhea, male: dec libido and headache
most common type of pituitary adenoma
tx with dopamine antagonists or sx
13
Q
pituitary tumors: GH cell adenoma
levels
symptoms
treatment
A
inc. GH
gigantism if before epiphyseal closure (F: 12-16, M: 14-19)
acromegaly if after epiphyseal closure (jaw, hands, feet, face)
treat with GH receptor agonist
14
Q
pituitary tumors: ACTH
causes…
A
Cushing’s Sydnrome
15
Q
hypopituitarism
definition
cause
A
deficient secretion of only one or a few pituitary hormones
caused by tumor
16
Q
panhypopituitarism
definition
A
total failure of pituitary function
17
Q
Sheehan syndrome
definition
pathogenesis
cause
cause of symptoms
A
pregnancy related infarct of pituitary gland
2x in size but blood supply does not inc.
infarct caused by blood loss and shock during childbirth
symptoms due to loss of gonadatropins, then TSH and ACTH
18
Q
empty sella syndrome
pathogenesis
disturbance
A
thin, flat pit. gland secondary to congenital defect or absented diaphragma sella, CSF pressure into sella
minor endocrine disturbance
19
Q
diseases of posterior pituitary: syndrome of inappropriate ADH (SIADH) secretion
definition
symptom
treatment
A
ectopic production of ADH by various tumor
water retention with hyponatremia
treat with water restriction
20
Q
diseases of posterior pituitary: ADH deficiency
results in
symptoms
treatment
A
results in diabetes insipidus
dehydration, insatiable thirst
treat with ADH analog
21
Q
Marfan syndrome
A
connective tissue
22
Q
thyroid hormone: hypo-
levels
symptoms
A
dec free T4 inc TSH
cretinism (iodine deficiency), mental retardation, growth impairment, large tongue, big abdomen
23
Q
thyroid hormone: hypo- … myxedema
who does it affect
symptoms
A
women
weight gain (dec BMR), lower voice, constipation, physical/mental slowness, puffy, dry skin, brittle hair, hair loss, inc. relaxation stage of deep tendon reflexes
24
Q
thyroid hormone: hypo- … hashimoto’s
classification
main symptom
A
HLA-DR5, anti-thyroglobulin and anti-microsomal antibodies
chronic inflammation
25
thyroid hormone: hyper- ... grave's disease
pathogenesis
who does it affect, classification
symptom
treatment
autoantibody (IgG) that stimulates TSH receptor (type II hypersensitivity); TSI reacts with TSH receptors = glandular hyperplasia and enlargement, stimulates thyroid hormones production
women, inc. in HLA-DR3
exophthalmos
treat with anti-thyroid drugs, thyroidectomy, radioactive iodine
26
thyroid hormone: hyper- ... plummer's disease
less severe symptoms than graves and never develop exophthalmos
27
thyroid hormone: goiter
thyroid enlargement
28
thyroid hormone: goiter - simple (nontoxic)
without thyroid hormone dysfunction
29
thyroid hormone: goiter - toxic
hyperthyroidism
30
thyroid hormone: goiter - endemic
high frequency in iodine-deficient geographic area
31
thyroid hormone: goiter - sporadic
non-iodine deficient area
32
thyroid hormone: goiter - nodular
irregular thyroid enlargement = nodule formation
33
thyroid hormone: goiter - nodular colloid
late stage simple goiter, looks nodular
34
thyroid cancer: papillary carcinoma
definition
malignancy
incidence
survival
papillae lined by cuboidal cells with clear nuclei
low grade malignancy
incidence 70%
survival 85% @ 20 years
35
thyroid cancer: follicular carcinoma
cells affected
who is affected
incidence
thyroid follicular cells
women, aggressive
incidence 20%
36
thyroid cancer: medullary carcinoma
definition
survival
incidence
amyloid deposits in tumor and inc. calcification
aggressive
survival 50% @ 5 years
incidence 5%
37
thyroid cancer: anaplastic carcinoma
malignancy
survival
incidence
highly malignant, rapid growth
most patients die within 1 year
incidence 1%
38
parathyroid diseases: hyper-
Ca2+ inc.
39
parathyroid diseases: hypo-
levels
causes
symptoms
treatment
Ca2+ dec.
accidental surgical excision, DiGeorge
hypocalcemia, neuromuscular excitability and tetany
treat with high Ca2+ diet and vitamin D supplement
40
parathyroid diseases: primary hyperparathyroidism
pathogenesis
treatment
associated disease
excess PTH, parathyroid adenoma (> 80% causes)
treat with sx
von Recklinghausen disease
41
parathyroid diseases: secondary hyperparathyroidism
definition
levels
compensatory parathyroid hyperplasia in response to hypocalcemia due to chronic renal disease
inc. PTH
42
parathyroid diseases: pseudohypo-
levels
pathogenesis
dec. Ca2+, inc. phosphate, inc. PTH
multihormone resistance (PTH, LSH, LH, FSH)
43
adrenal cortex: hyper- ... Cushing's
signs
causes
dx
symptoms
treatment
inc. glucocorticoids
exogenous corticosteroid medication, hyperproduction of ACTH, adrenal cortical adenoma or adrenal carcinoma, ectopic production of ACTH by non-pit. carcinomas
dx with 24 hour inc. cortisol (blood or urine)
moon face, buffalo hump
treat with cortisol inhibition and sx
44
adrenal cortex: hyper- ... Conn's
inc. aldosterone, secreting adenoma
45
adrenal cortex: hyper- ... congenital adrenal hyperplasia
definition
treatment
absent sex steroid with hyperplasia of both adrenal glands
treat with HRT
46
adrenal cortex: hypo - ... Addison's
cause
sign
treatment
due to idiopathic adrenal atrophy, autoimmune, TB
hyperpigmentation (inc. ACTH)
treat with corticosteroids
47
tumors of the adrenal medulla: neuroblastoma
definition
cell signs
treatment
highly malignant catecholamine-producing tumor in early childhood
small round blue cells with rosette like structures
rarely causes hypertension
treat with sx and chemo
48
TORCH
definition
fetal symptoms
stands for
intrauterine infection from mom to fetus
microcephaly, CNS calcification, rash, hepatosplenomegaly, thrombocytopenia
Toxoplasma
Other
Rubella
Cytomegalo virus
Herpes simplex virus 1&2
49
neural tube defects
caused by
maternal folic acid deficiency
50
neural tube defects: spina bifida
failure to lose posterior vertebral arches
51
neural tube defects: spina bifida occulta
no apparent abnormalities, patch of hair over vertebral defect
52
neural tube defects: spina bifida cystica
herniation of meninges through a defect
meningocele: meninges only
meningomyelocele: protrusion of meninges and spinal cord
53
Tay-Sachs
who does it affect
symptoms
pathogenesis
Jewish kids
fixed gaze, distinctive cherry red spot
hexosaminidase A is a lysosomal enzyme involved in breakdown of gangliosides (type of phospholipid), accumulation of GM2 gangliosides
54
anencephaly
absence of fetal brain tissue and overlying skull, frog like looking
55
Down's syndrome
cause
signs
dx
trisomy 21
gaping mouth, large tongue, heart and GI defects
dx with inc. alpha protein or inc. estriol in blood or amniotic fluid of mother
56
Arnold-Chiari malformation
definition
results in
causes...
downward displacement of cerebellar tonsils and medulla through foramen magnum
results in pressure atrophy of displaced brain tissue
causes hydrocephalus due to CSF outflow obstruction
57
dandy-walker malformation
pathogenesis
dx
prevention
failed development of cerebellar vermis, massively dilated 4th ventricle with absent cerebellum and hydrocephalus
dx with ultrasound or inc. acetylcholine esterase
prevent with supplementary folic acid over 1,000 ug/day
58
hydrocephalus
pathogenesis
inc. volume of CSF due to obstruction of CSF circulation by congenital malformation, inflammation, tumors, or dec. cerebral mass (ex: Alzheimer's)
59
chronic traumatic encephalopathy (CTE)
cause
pathogenesis
when does it happen
symptoms
history of repeated TBI
progressive degeneration of brain tissue, buildup of protein tau
months to years after TBI
memory loss, confusion, impaired judgement, impulse control issues, aggression, depression, progressive dementia
60
bullet wounds to the head: high velocity vs low velocity
high: immediate inc. supratentorial pressure and clean thru to death, like a sniper
low: inc. pressure at gradual rate, hemorrhagic, edema, can do more internal damage
61
hemorrhages: epidural hematoma
flow
definition
urgency
arterial
laceration of branches of middle meningeal artery, skull fx
immediate emergency, lens shape lesion on CT
62
hemorrhages: subdural hematoma
flow
definition
when does it happen
venous
collection of blood under dura, crescent shape lesion on CT, inc. ICP
hours, days, weeks later
63
hemorrhages: subarachnoid hemorrhage
definition
cause
mortality
berry aneurysm of circle of Willis
by traumatic brain contusion or rupture of berry aneurysm
high mortality, blood in CSF
64
Cushing's reflex for ICP
INC BP (dec with shock)
dec pulse
dec respiration
dec consciousness
65
trauma of CNS: coup
impact site = injury site
66
trauma of CNS: contrecoup
injury site opposite of impact site, head stops and brain collides into skull
67
diffuse axonal injury (DAI)
result from TBI, neuro deficit and coma, researched by military
68
coma scoring
13 or lower: mild BI
9-12: moderate BI
8 or lower: severe BI
69
spinal injury: anterior cord syndrome
definition
bony fragments put pressure on anterior cord = loss of motor movements and pain below injury
70
spinal injury: central cord syndrome
definition
hyperextension of c-spine = loss of motor movements in UE and disruption
71
spinal injury: brown-sequard syndrome
definition
cause
injury to one side of spinal cord = sensory and motor loss on same side, pain and temperature loss on the other side
penetrating injury is cause
72
stroke
definition
types
causes
cerebrovascular compromise
ischemia (85%), hemorrhage (15%)
cerebral thrombosis, cerebral embolus, cerebral hemorrhage, carotid artery ateriosclerosis
73
stroke: transient ischemic attack
definition
duration/damage
indicative of...
temporary disturbance of cerebral circulation, damage is not permanent, indicative of carotid artery disease, symptoms resolve in minutes
74
SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS
Embolic Stroke
embolus from another location
caused by atrial fibrillation
clots form in heart and go to the brain
75
SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS
Thrombolytic stroke
thrombus developed at clogged part of vessel
happens at nighttime
76
SHORT ANSWER
ISCHEMIC OR OCCLUSIVE STROKE PATHOGENESIS
Lacunar (cryptogenic) stroke
blockage of cerebral artery
brain cells in a small area are damaged or killed by lack of O2, causes significant disability
hypertension and plaque in carotid arteries are contributing factors
77
stroke: hemorrhagic stroke
definition
location
bleeding interferes with brain function
can be within brain or between brain and skull
78
stroke: hemorrhagic stroke - intracerebral bleeding
causes
due to berry aneurysm or hypertension
79
stroke: hemorrhagic stroke - subarachnoid hemorrhage
pathogenesis
cause
damaged blood vessels = blood accumulates at brain surface, blood into CSF, inc. pressure = immediate headache, artery spasms
leaking sacular aneurysm or arteriovenous malformation (AVM)
80
stroke symptoms
facial drooping, difficulty speaking, headache, weakness/paralysis on one side, numbness, incontinence
HYPOGLYCEMIC PATIENTS MIMIC STROKE SYMPTOMS
81
stroke symptoms: FAST
Face
Arm
Speech
Time
82
stroke dx
CT
MIR
depends on location and size
83
stroke treatment: ischemic stroke
TPA within 3 hours, try not to damage penumbra
within 6-7 hours = endovascular thrombolectomy
84
stroke treatment: hemorrhagic stroke
catheter with coil endovascular removal
85
meningitis
inflammation of leptomeninges (pia and arachnoid mater)
86
pyogenic meningitis
causes
signs
tx
group B strep, e. coli, listeria monocytogenes (infant), neisseria meningitis (children, teenager), strep pneumoniae (children, teenagers) , H. influenza (non vaxxed infants)
purulent exudate, dilated meningeal vessels, cloudy CSF with neutrophils, inc. protein and dec. CSF glucose
tx with antibiotic and steroid
87
viral meningitis
causes
sign
tx
HBV, coxsackievirus (children, oral-fecal), echovirus; low incidence
lymphocytes with normal CSF glucose
tx with antiviral
88
fungal meningitis
sign
tx
rare
lymphocytes with dec. CSF glucose
tx with antifungal and steroid
89
meningitis symptoms
triad
bacterial complications
triad: headache, neck stiffness, fever
photophobia, vomiting, altered mental status,
complications with bacterial: death, herniation, hydrocephalus, seizures, hearing loss
90
Crutzfeld-Jacob disease (mad cow)
cause
transmission
sign
treat
caused by small protein "bad prion" (PrPsc)
transmission by exposure to prion-containing animal tissue (usually brain)
find spongiform encephalopathy with small cysts in CNS gray matter
inactivate with 1M NaOH for 1 hour
91
SHORT ANSWER: pathogenesis of MS
1. demyelination of white matter of CNS, shows gray appearing plaque in white matter; helper CD4+ and cytotoxic CD8+ T lymphocytes and macrophages infiltrate plaques
2. women 2x as likely as men
3. HLA-DR2
4. depletion of myelin-producing oligodendrocytes
92
multiple sclerosis
definition
Charcot's triad
symptoms
dx
relapsing neuro deficits with periods of remission
Charcot's triad: nystagmus, scanning speech, tremor
loss of sensitization of touch, muscle weakness, dysfunction of bowel, bladder, sexual (autonomic NS)
dx: MRI reveals plaque, spinal tap shows inc. lymphocytes, immunoglobulin, and myelin basic protein
93
SHORT ANSWER: pathogenesis of Alzheimer's disease
1. brain appears atrophic, narrowing of gyri, widening of sulci
2. neuritic plaque: cluster AB amyloid derived from amyloid precursor protein (APP) coded on chromosome 21. APP undergoes alpha and beta cleavage, resulting in AB amyloid, which may deposit around vessels, inc. risk of hemorrhage
3. neurofibrillary tangles: Tau proteins (defective)
94
Alzheimer's disease
definition
physiological sign
risk factors
dx
tx
most important cause of dementia
atrophy of cortical parts of frontal and temporal lobes
70+ years old, become mute and bedridden, infection is common cause of death
ApoE4 inc. risk, ApoE2 dec. risk
dx with PET, MRI
tx with acetylcholinerase inhibitors to slow progression, no cure
95
Pick disease
what does it cause
who does it affect
signs
tx
cause dementia
affect more women
cortical atrophy and accumulation of Pick bodies
tx behavioral and language symptoms, no cure
96
Parkinson's disease
causes
symptoms
tx
tremor at rest that goes away with movement, rigidity, ankinesia/bradykinesia
tx with LDOPA, dopamine agonist, deep brain stimulation
causes: idiopathic, trauma, dopamine antagonists, contaminated street drugs
97
SHORT ANSWER: Parkinson's disease
1, subcortical neurodegenerative disorder
2. dec. number of dopaminergic neurons in substantia nigra; depigmentation of substantia nigra, damaged cells contain Lewy bodies
3. idiopathi PD damages neuronal oathways from substantia nigra to corpus striatum, leading to dopamine depletion
98
chronic alcoholism: Wernicke's syndrome
definition
cause
reversible?
loss of memory and disorientation from chronic alcoholism and deficiency or thiamine (vitamin B1)
reversible
99
chronic alcoholism: Korsakoff syndrome
symptoms
reversible?
disorientation, delusion, insomnia, painful extremities, nerve pain
may be irreversible
100
Guillain-Barre syndrome
cause
symptoms
reversible?
dx
tx
follows viral infection
(demyelination of neurons)
weakness/tingling in legs, ascending muscle weakness, rapidly progressing paralysis
reversible, may affect CNS or cognitive properties
dx with spinal tap, CSF with large protein count with mild cell count increased
tx with supportive/resuscitative interventions, IV IgG
101
Huntington's disease
cause
symptoms
signs
autosomal dominant on chromosome 4 (CAG repeat)
involuntary movements, progressive dementia, depression (around age 40)
atrophy of cortex and subcortical nuclei, degeneration of GABA generating neurons
102
ALS
onset
definition
symptoms
40+ years old, early middle age onset with rapid progression to death in 1-6 years due to respiratory failure
degeneration and atrophy of lateral corticospinal tractsand anterior neurons of cord
motor weakness, progressive muscle wasting in extremities, involuntary twitching, slurred speech
103
brain tumors
mortality
who does it affect
metastasis
high mortality, any age, 505 primary neoplasms, benign or malignant, does no metatstasize
104
brain tumors: astrocytoma
most common primary, well differentiated astrocytes
low grade fibrillary astrocytomas are WHO grade II, anaplastic is WHO grade III
105
brain tumors: glioblastoma multiforme
astrocytes, most common primary malignant in adults
cerebral hemisphere, crosses corpus callosum, butterfly lesion
vascular changes, dead in a year
106
brain tumors: oligodendroglioma
slow growing, middle age, cerebral hemispheres, oligodendrocytes
calcified tumor in white matter of frontal lobe, present with seizures
cells look like a fried egg
107
brain tumor: meningioma
meninges, mostly benign, WHO grade !
most common in women, rare in children
seizures with the tumor suppressing the cortex
psammoma bodies
round mass attached to dura
108
42 year old man in ED with severe epigastric and LUQ abdominal pain radiating to his back. Nausea and vomiting for 24 hours, binge drinking for 2 days prior to onset, not first instance of action followed by these symptoms. Chronic alcohol use. Diaphoretic, fever of 102.8, distended abdomen and tender to palpitation of epigastric and LUQ region. Serum studies show leukocytosis and elevated lipase and amylase. IV fluids and demerol for pain
acute ad chronic pancreatitis
109
65 year old man with generalized malaise and weakness, 15 lb weight loss in 8 weeks, anorexia. Jaundiced, redness and tenderness with palpation of extremities (consistent with migratory thrombophlebitis). Labs for inc. direct bilirubin, ALP, positive CA 19-9. Get CT, bad prognosis
pancreatic carcinoma
110
28 year old woman with amenorrhea and fatigue over 3-4 months. Not pregnant, she has a 6 month old whose birth was complicated by severe hemorrhage. Loss of pubic hair, delayed deep tendon reflexes, BP 90/50 mmHg. Labs show dec FSH, LH, TSH, ACTH, Need HRT
pituitary cachexia
111
32 year old woman with milky discharge from both nipples. Period has become extremely irregular and last was over 7 months ago. Not pregnant, inc. prolactin, dec. LH and FSH. Get MRI of brain
prolactinoma
112
47 year old man with occasional vision loss in lateral visual fields. Needs larger gloves and shoes and gained 25 lbs over 3 months. Labs show hyperglycemia and inc. GH. May need sx
acromegaly and gigantism
113
65 year old man in ED by daughter due to confusion. Recent dx of small cell broncogenic carcinoma and planned to begin chemo soon. Labs show significantly dec. serum sodium, serum osmolality, inc. urine osmolality
syndrome of inappropriate ADH (SIADH)
114
42 year old woman with headaches. Extremely thirsty lately and urinating frequently. Neuro exam unremarkable, labs show inc. osmolality and hypernatremia. Send to endo
diabetes inspidus
115
37 year old woman with fatigue and thinning hair. gained 20 lbs over 6 months no change in diet or exs. Mildly enlarged thyroid and dry skin
cretinism and myxedema
116
42 year old woman with fatigue, thinning hair, weight gain of 15 lbs over a month with no eating habit change. Pulse 52 bpm, delayed deep tendon reflexes, puffy face and eyelids, enlarged thyroid gland. Labs show antibodies against TG and TSH
Hashimoto thyroiditis
117
35 year old woman with palpitations and heat intolerance. Inc appetite and is very irritable lately. Exophthalmos, moist skin, pulse 110 bpm, diffusely enlarged thyroid
Graves disease
118
58 year old woman with several little lumps in her neck. HX of long standing diffuse goiters, but otherwise unremarkable. Irreg enlargement of thyroid, no cervical lymphadenopathy. Check TH and TSH, ultrasound, biopsy
multinodular goiter
119
52 year old man with lump in neck that has slowly enlarged. No hyper or hypothyroidism symptoms, had radiation of thymus when he was a child. Nontender nodule in anterior neck and cervical lymphadenopathy. Check TSH, thyroid scan, and biopsy
thyroid carcinoma
120
63 year old woman with generalized bone pain. Polyuria, constipation, muscular weakness. Sig. loss of cortical bone. Labs show inc. calcium, inc. PTH, inc. alkaline phosphatase, dec. phosphate. Parathyroid biopsy will reveal polygonal chief cells and larger oxyphil cells, bone biopsy would show brown tumors
primary hyperparathyroidism
121
58 year old man to nephrology with chronic renal insufficiency. Generalized bone pain. Labs show dec. calcium, inc. serum phosphate. Check PTH, possible elevation, and recommend calcium and vitamin D and phosphate binders
secondary hyperparathyroidism
122
45 year old woman for follow up for thyroidectomy. Wrist spasms. Carpal spasm with mins after inflation of BP cuff and facial twitching when you tap facial nerve. Check calcium, phosphate, PTH
hypoparathyroidism
123
37 year old for annual. BP 160/100. Felt weak lately and frequent urination. Hx is insignificant. Labs show low serum potassium, inc. serum bicarbonate, inc. blood pH, inc. CO2. Abdominal/pelvic CT needed
primary hyperaldosteronism (Conn's syndrome
)
124
45 year old woman with inc. urination over past several months. Gained 35 lbs over past year, bruises easily, hair on chin. Moon face and inc. fat pads on back of neck. Labs show hyperglycemia, inc. cortisol, inc. serum ACTH. Dexamethasone suppression test
Cushing syndrome
125
47 year old woman with nausea and fatigue. Hyperpigmented skin over knuckles, knees, elbows. BP 90/60. Labs show hypoglycemia, hyperkalemia, hyponatremia. May be autoimmune and need HRT
primary andrenocortical insufficiency (Addison's disease)
126
16 year old girl with delayed menarche. Denies sexual activity, home pregnancy test neg. Absence of breast tissue, hair on upper lip, chin, axillary, and hypertension. Labs show dec. cortisol and aldosterone. Rare autosomal recessive enzyme deficiency
congenital adrenal hyperplasias
127
29 year old man in ED with crushing headache and palpitations. Similar episodes in the past. Pulse 140 bpm and BP 200/110. 24 hour urin shows inc. VMA and metanephrine levels. blood tests show inc. plasma catecholamine. Prescribe phenoxybenzamine, likely need sx
pheochromocytoma
128
10 year old girl in ED with confusion, hypotensive, rapid and deep respirations. Fruity breath. Lost some weight, inc. appetite. Drinking and urinating more frequently. Labs show hyperglycemia, ketonemia, anion gap metabolic acidosis. Give insulin, fluids, electrolytes
diabetes mellitus
129
58 year old obese man with generalized weakness. Urinating more frequently. Past hx of hyperlipedema and hypertension. Physical exam unremarkable. Labs show fasting hyperglycemia and glycosuria
diabetes mellitus
130
baby boy delivered via uncomplicated vaginal delivery. Large birthmark associates with dimples and hairy tufts at base of back. No prenatal vitamins or receive prenatal care
congenital CNS abonormalities (spina bifida occulta)
131
POSSIBLE SHORT ANSWER
27 year old caucasian woman with visual disturbances. Lateral gaze, one eye does not adduct and the other has nystagmus on abduction. Cerebellar function test shows intention tremor and dec. sensation on both legs. CSF obtained from lumbar puncture and find multiple oligoclonal bands of IgG on electrophoresis. Brain MRI needed
multiple sclerosis
132
29 year old man to ED with muscle weakness beginning in calves but now involves thighs, hips, torse, and arms. Recently recovered from flu. Symmetrical muscle weakness in all limbs and absent deep tendon reflexes. Lumbar puncture shows albuminocytologic dissociation of CSF. Admit to ICU
Guillan-Barre syndrome
133
POSSIBLE SHORT ANSWER
82 year old woman brought in by children. Very forgetful and has twice wandered out of her house and gotten lost, requiring police. Short term memory compromised and struggles to find words to express what she wants to say. Brain MRI no evidence of stroke. Biopsy may reveal neuritic plaque and neurofibrillary tangles
Alzheimer disease
134
62 year old woman brought in by husband. Has been irritable and aggressive. Caught shoplifting twice in the last month and misnames common household objects. Impatient and socially inappropriate. Form of dementia with round, silver staining, neurofilamentous bodies within neuronal cytoplasm. refer out to neuro
Pick disease
135
48 year old man with involuntary movements of arms and legs. Mother had similar symptoms that progressed to dementia. Involuntary jerky movements, flattened affect, poor concentration. Brain MRI shows atrophy of caudate nucleus and putamen, dilation of ventricles
Huntington disease
136
POSSIBLE SHORT ANSWER
74 year old man at neuro with unsteadiness. Expressionless faces and pill-rolling tremor at rest. Shuffling gait, reigidity in response to passive movement and bradykinesia. Neurons of substantia nigra may contain Lewy bodies and prescribe levodopa
Parkinson's disease
137
47 year old man with hand weakness. Frequently dropping objects and cannot perform fine motor tasks. Positive Babinski sign, hyperreflexia, and diminished strength in muscles of hands and calves as well as fasciculations and atrophy in these muscle groups. Death by respiratory failure
amyotrophic lateral sclerosis (ALS)
138
POSSIBLE SHORT ANSWER
68 year old woman in ED after developing left side paralysis one hour ago. L side sensory and motor paralysis, L side hyperreflexia, L side Babinski reflex, and bilateral symmetric loss of vision in half of her visual fields. Hx of tobacco use, hypertension, and hyperlipidemia. CT of head to confirm no bleed, administer thrombolytic therapy
ischemic stroke
139
POSSIBLE SHORT ANSWER
67 year old man in ED with severe headache and nausea. Hx significant for long standing hypertension. R sided hemiparesis and altered mental status. May be related to hypertension, which caused formation of Charcot-Bouchard microaneurysms. CT of head
Hemorrhagic stroke
140
44 year old woman in ED with nausea and worst headache of her life. Heavy smoker and hx of poorly controlled hypertension. Lumbar puncture shows blood in CSF. Head CT shows blood in basal cisterns. Immediate neurosx consult
berry aneurysm and subarachnoid hemorrhage
141
78 year old woman in ED by son due to headache and altered mental status for 3 days. Fall down stairs two weeks ago, but was fine. Bilateral papilledema. Head CT shows 3 cm crescent shapes collection of fluid on R side that crosses suture lines with a 7 mm midline shift. Related to tearing of bridging veins between cerebrum and venous sinuses in dura. Immediate sx drainage of blood
epidural and subdural hematoma
142
43 year old woman in ED with episodic loss of vision. Severe headaches with nausea and vomiting over past month. Bilateral papilledema and CT of head shows dilation of ventricles. May need ventriculoperitoneal shunt
hydrocephalus
143
21 year old man in ED with severe headache. Fever of 102, nuchal rigidity, photophobia. lumbar puncture shows purulent CSF infiltrated with neutrophils, inc. protein content, dec. glucose content. broad spectrum antibiotics while waiting for cultures
pyogenic and viral meningitis
144
59 year old man with severe headaches for last week. Often associated with projectile vomiting. Bilateral papilledema and head CT shows irregular mass in L cerebral hemisphere. Biopsy shows pseudopalisading malignant cells around areas of necrosis. poor prognosis
glioblastima multiforme
145
42 year old woman with headaches and vomiting over the past four months. Trips a lot when walking, trouble remembering things. Bilateral papilledema and reduced strength and hyperreflexia in both legs. CT shows parasagittal mass compressing brain. Biopsy shows whorled pattern of tumor cells with psammoma bodies. need sx
meningioma
146
49 year old man in ED with seizure. Severe headaches over last few months. CT of head shows large mass in frontal lobe with areas of calcification. Need sx
oligodendroglioma
147
8 year old girl with blurry vision. Bilateraly papilledema. Head CT shows mass extending from flood of 4th ventricle and dilated lateral and third ventricles. Biopsy may show cells with blepharoplasts in a perivascular pseudorosette arrangement
ependymoma
148
25 year old white man at pcp for follow up after detached retina week before. Hx multiple shoulder dislocations as a teen. Tall, long arms, legs, and digits. Double jointed and displays flexibility, father was same build and flexibility. Father passed away due to cardiovascular accident. Heart murmur consistent with mitral valve prolapse. Risk of developing aortic dissection
Marfan syndrome
149
40 year old white woman with hx of lupus at nephrology with inc. swelling in legs. Labs show proteinuria, hypoalbuminemia, hyperlipidemia. Renal biopsy may show immune complex deposition on electron microscopy as well as spike and dome appearance on silver methanamine stain
membranous neuropathy
150
40 year old HIV+ man in hospital with generalized edema and fatigue. Hx shows habitual IV drug user. Labs show hypoalbuminemia, hyperlipidemia, proteinuria, microscopic hematuria. Need renal biopsy
focal segmental glomerulosclerosis
151
60 year old african amerixan man with 30 year hx of hypertension with episodic headaches and LE swelling from time to time. BP 174/106. ECG shows L ventricle hypertrophy. Labs show elevated BUN and creatinine. At risk for ESRD if hypertension is not controlled
hypertensive nephrosclerosis
152
10 year old girl with eye swelling, seen 3 weeks ago for sore throat. Pronounced periorbital edema, very little urination despite adequate fluid intake. BP 150/90. Labs show azotemia, hematuria, red cell casts in urine, elevated ASO antibody titer. Resolve on its own
poststreptococcal glomerulonephritis (acute proliferative glomeruloneohritis)
153
40 year old white man in hospital with bloody sputum and urine. Fever, malaise, 10 lb lost over month. BP 160/95, several abnormal lung sounds. Urine dipstick shows hematuria. CXR shows several nodular lesions, blood shows elevated BUN and creatinine, presence of c-ANCA, elevated ESR. High dose of corticosteroids. Renal biopsy may show crescent shaped between Bowman capsule and glomerular tuft
rapidly progressive (crescentic) glomerulonephritis
154
10 year old boy with red tinge to urine. DX with mild nerve deafness 2 years ago and also developed posterior cataracts 1 year ago. Labs confirm hematuria and presence of erythrocyte casts. Genetic
Alport syndrome
155
15 year old asian american in ED with blood in urine. Fevers, myalgias, arthralgias for 2 days. Labs show presence of RBCs in urine and inc. serum IgA and normal serum complement levels. Begin prednisone. Most common form of acute glomerulonephritis in US.
IgA Nephropathy (Berger Disease)
156
25 year old woman in ED with fever, vomiting, severe R side flank pain. Sexually active and has one week hx of burning pain while urinating and inc. urinary frequency. Urinanalysis reveals white cell casts in urine and sample is sent for culture. Start on broad spectrum antibiotics
acute and chronic pylonephritis
157
60 year old man in ICU with hypotension and severe sepsis. Hypotension gradually resolves with aggressive fluid resuscitation and pressor support. Next few days he becomes progressively oliguric. Labs show worsening renal failure and hyperkalemia. Urine sediment shows muddy brown clasts. May need dialysis
acute tubular necrosis
158
25 year old man with blood in urine. Father died of kidney failure in late 30s. BP 170/110 and bilateral, palpable renal masses. Midsystolic click heard on cardiac exam that is consistent with mitral valve prolapse. Need abdominal CT
adult and infantile polycystic kidney disease
159
40 year old woman in ED with colicky abdominal pain and flank pain radiating toward groin. Blood in urine in recent weeks and hx of recurrent UTIs. Plain abdominal film shows large staghorn calculus
urolithiasis (kidney stones)
160
72 year old man at nephro for kidney disease follow up. Hx sig. for coronary artery disease, T2D takes insulin, hypertension. Bilateral crackles in lung field as well as 2+ pitting edema in both LE. Labs show potassium level of 6.2 mmol/L and creatinine of 5.3 mg/dL. Need dialysis
chronic kidney disease
161
60 year old man with cola colored urine and flank pain. Low grade fever over last few weeks and lost 10 lbs over the last month. Chronic smoker (pack a day for 30 yrs). Large mass in left flank area. Labs show secondary polycythemia. abdominal CT may show solid renal mass and possible metastasis to regional lymph nodes
renal cell carcinoma
162
3 year old boy in ED with abdominal pain after falling onto a toy truck that hit his abdomen. Huge, palpable flank mass on L side. Urinanalysis shows microscopic hematuria. CT shows large enhancing mass originating from kidney. Gene deletion on chrom. 11, not related to fall
Wilms tumor
163
33 year old woman with vague abdominal pain for 4 days. Pelvic pressure generalized bilaterally. Last period was 2.5 weeks ago and are regular, not pregnant. No digestive changes and denies nausea, vomiting, constipation, diarrhea. No family hx of ovarian cancer. Put on oral contraceptive, symptoms will be gone in two months, need f/u ultrasound
ovarian cysts
164
30 year old white woman at fertility clinic with husband, inability to conceive. Not menstruated for 4 months and always has had irregular and sporadic cycle. Obese with inordinate amount of facial hair. No abnormal uterine bleeding. Labs show inc. plasma LH and testosterone and dec. FSH
polycystic ovarian syndrome (Stein-Leventhal syndrome) PCOS
165
48 year old woman in ED with generalized abdominal pain and pelvic pressure. Not passed stool for 3 days and vomited this morning. Pain steady for a week. Abdominal/pelvic CT is clear, but shows bilateral enlargement of ovaries. Exploratory laparotomy shows mucinous ascites, cystic epithelial implants on peritoneal surface, and several adhesions.
ovarian tumors of surface epithelium origin
166
31 year old woman with abnormal vaginal bleeding and mild abdominal pain. Last period 1 week ago and has not experienced abnormal bleeding before. Hx of two prior episodes of pelvic inflammatory disease in last year. Trying to conceive for last year with no success. Pelvic exam shows redness and inflammation of cervix, but no discharge. Endometrial biopsy may show plasma cells along with macrophages and leukocytes in glandular lumen. Empiric antibiotic therapy
endometritis
167
24 year old woman with inc pain and bleeding during menstruation. Last 3 periods have had inc. intensity of cramping and larger amounts of blood. Irregular cycle for last 6 months. Inc. pelvic pain with sex. Pelvic exam shows fixed bilateraly ovarian masses and MRI shows chocolate cysts in ovary. Begin oral contraceptives and suggested sx removal of cysts
endometriosis
168
60 year old woman with postmenopausal bleeding. Nulliparous and T2D, controlled with diet and insulin. Obese and BP of 150/96. Pap smear and endometrial biopsy. May find well defined gland patterns lined by malignant stratified columnar epithelial cells on biopsy
endometrial carcinoma
169
22 year old woman in ED with lower abdominal pain, chilld, fever, purulent vaginal discharge. Multiple sex partners over last year and does not protect. Pain started 3 days ago with subsequent fever, chills, night sweats. Febrile and temp of 102.4. Pelvic exam shows cervical motion tenderness with foul-smelling, purulent, cervical discharge. Neg. pregnancy test. Admit and begin on IV cefoxitin plus doxycycline while awaiting results of culture.
pelvic inflammatory disease
170
32 year old woman vaginally delivers a baby boy, she is hemorrhaging and abnormally large amount of bloof. One previous c section and extensive scarring. Pregnancy complicated by a defective decidual layer that allowed the placenta to attach directly to he myometrium. Emergency hysterectomy
placental attachment abnormalities (abruptio placentae, placenta previa, placenta accreta)
171
31 year old pregnant woman in ED with headaches and blurred vision for one week. 32 weeks into first pregnancy. LE edema, BP 180/100, no hx of hypertension. Labs show mild thrombocyotpenia, elevated AST and ALT, sig. proteinuria. Immediate bedrest, close monitoring, BP control, May need to deliver early
preeclampsia and eclampsia
172
23 year old woman in 13th week of pregnancy in ED for excessive nausea and vomiting as well as vaginal bleeding. Vomits 10x per day for 3 days and is constantly nauseous. Ultrasound shows classic snowstorm appearance with multiple echoes, indicating edematous villi within an enlarged uterus and absense of fetus or placenta. Labs show hCG above 50,000 mIU/mL. Immediate uterine suction and emptying
hydatidiform mole and gestational choriocarcinoma
173
19 year old male with localized scrotal swelling. Nontender mass on side of R testicle, denies any trauma. Nontender fullness on lateral and anterior aspect of R testicle, translucent with flashlight. Benign fluid collection related to persistent connection of processus vaginalis between peritoneal cavity and scrotum
cystic masses of scrotum
174
27 year old white man with R testicular enlargement over 3 months. No trauma or pain and no problems urinating. Low grade fevers, night sweats, fatigue, malaise, 15 lb weight loss over 3 months. R testicle 2x sixe of L and mass does not transilluminate with flashlight. Serum labs show elevated hCG, regular AFP. biopsy may show sheets of uniform cells with distinct cell membranes, clear cytoplasm, and large nuclei
testicular germ cell tumors
175
72 year old man who cannot completely empty his bladder when urinating. Inc. frequenct of urination and nocturia, difficulty starting and stopping stream. Rectal exam shows smooth, enlarged, prostate. Labs show inc. total PSA with proportionate inc in fraction of free PSA. Put on finasteride and is predisposed to UTIs
benign prostatic hyperplasia
176
81 year old man with pain with urination. Difficulty starting and stopping stream for 4 months and recently been suffering from severe back pain. Recal exam shows large palpable postate nodule, firm and irregularly shaped. Labs may show inc. serum alkaline phophatase. Refer out to urologist for prostatic biopsy
prostate carcinoma
177
4 year old South African boy with inability to pass urine, hasnt in two days and has always had an issue with this. Abnormal urethral opening on ventral surface of penis. testes not palpable in child's scrotum. Urethral defect is a common congenital one, sx to help
penile diseases
178
45 year old kenyan man who just immigrated to US with long standing lesion on penis that has started to bleed. Growth has been there over a year and just began to ulcerate. Penile lesion appears on inner surface of prepuce near the coronal sulcus. Papillary lesions look like condylomata acuminata, producing a cauliflower like fungating mass. Bleeding ulceration on lesion. No pain, fever, or urinary symptoms. Biopsy needed
penile cancers
179
crytpochidism
definition
risks
tx
testes do not descend into the scrotum
more prone to testicular cancer
need sx to fix right away
180
hypospadias
urethral opening is on the ventral surface of the penis
181
epispadias
urethral opening is on the dorsal surface of the penis
182
Klinefelter's syndrome
definition
symptoms
commonality
tx
chromosomes disorder, extra sex chromosome 47, XXY (1 in 600)
speech and language delay, gynecomastia, azoospermia, smaller gonads
more common than Down's and CF
tx with HRT testosterone
183
testicular tortion
definition
symptoms
attachment of testes in scrotum, twisting of testes and spermatic cord, compromises blood flow
pain, swelling, hemorrhagic infarction
184
hydrocele
definition
tx
excess fluid in tunica vaginalis
tx with aspiration or resection
185
varicocele
definition
tx
varicose veins in spermatic cord, usually L side, may impair fertility, no tx
186
erectile dysfunction or impotence
definition
causes
failure to erect (by vasodilation of penile arteries), parasympathetic nervous system
beta blockers, psychological problems, distortion of penile arteries and tissue, alcohol related liver damage, diabetes, smoking
187
priapism
painful erection by fibrosis of tissue lasting 4+ hours
188
chancroid
bacteria
definition
hemophilus ducrey
soft, painful ulcer, prone to infection
189
syphillus
bacteria
stages
dx
tx
treponema pallidum
primary: painless, ulcer, may not know
secondary: largest # of organisms in body, diffuse rash of small red macules on palms, soles, and membranes
tertiary: gummas form; left untreated, may infect heart and nervous system, 2-20 years later
dx by treponemas/spirochetes in chancre, serologic tests
tx with antibiotics
190
gonorrhea
causes...
symptoms
dx
tx
causes PID
urethritis, cervicitis, pharyngitis, proctitis
dx by cultures
tx with antibiotics
191
herpes
type, spread
symptoms
cell type
signs
viral, T2 for most oral cases, spread by sex
vesicles and ulcers in cervix, vagina, clitoris, vulva, urethra, perianal skin
multinucleated giant cells with viral inclusions in cytologic smears from lesions
3 m's: multinucleation, nuclear molding, margination of chromatin
192
tumors of testes
characteristics
ages
tx
rare, malignant, more than 90% survive
25-45
tx with sx, chemo, radiation
193
tumors of testes: seminomas
commonality
who is affected
cell type
prognosis
symptoms
signs
most common of germ cells (50%)
men in 30s
single cell
better prognosis than NSGCT
10x size of normal testicle
do not secrete markers, not transilluminate on flashlight
194
tumors of testes: nonseminomatous germ cell tumor (NSGCT)
malignant or beingn
physiological/endocrinological characteristic
tx
more malignant than seminomas, metastases in early stages
secretes AFP & hCG
tx with sx, abdominal lymph node dissection, chemo
195
tumors of testes: NSGCT - embryonal carcinoma
more aggressive than seminomas, 20-30 year olds
196
tumors of testes: NSGCT - choriocarcinoma
malignant or benign
characteristics
how to find
symptoms
highly malignant, most aggressive NSGCT
mixed germ cell tumor, small
found by palpation of a small testicular nodule
enlargement rare, necrosis and hemorrhage common
197
tumors of testes: teratoma
random arrangement of mesodermal, ectodermal, and endodermal tissue
198
benign prostate hyperplasia
definition
physiological causes
physical sign
dx
tx
most frequent cause of urinary tract obstruction, extremely common in older men
dihydrotestosterone (DHT), age related inc. in estrogen
rubbery, nodular gland enlargement, affecting inner groupings of glands
dx by inc. total PSA with proportional inc in free PSA
tx with finasteride or cialis, alpha-blocker, TURP
199
prostate carcinoma
most common cancer of internal organs in males with +100,000 new cases per year
3rd most common cause of cancer related death in males, old age
no effective tx
idiopathic, old age, no major risk factors, testosterone involved
african > european > east asian
peripheral group of glands
dx with rectal exam
tx with prostatectomy, radiotherapy, anti-androgens, chemo
200
developmental disorders of urinary: renal agenesis
bilateral vs unilateral
bilateral (Potter syndrome) is deadly
unilateral causes kidney hypertrophy and hyperfiltration inc. risk of renal failure
201
developmental disorders of urinary: horseshoe kidney
fusion of kidneys at lower pole
202
developmental disorders of urinary: multicystic renal dysplasia
unilateral, cysts in connective tissue
203
polycystic kidney disease: ADPKD (autosomal dominant)
pathogenesis
signs
symptoms
2 abnormal genes, mutation in APDK-1 and 2
water filled hepatic cysts, berry aneurysm, mitral valve prolapse
young adults, hypertension, hematuria, renal failure
204
polycystic kidney disease: ARPKD (recessive)
very rare, infants with kidney enlargement and renal failure
205
Berger's disease
definition
cause
symptom
tx
deposit of IgA over cortex, most common neuropathy
bacterial or viral
hematuria and proteinuria
tx with ACE inhibitor or steroid
206
goodpasture syndrome
pathogenesis
causes...
autoimmune - anti-glomerular basement membrane, IgG
cause pulmonary hemorrhage and glomerulonephritis
207
Alport syndrome
defintion
symptom
cause
pathogenesis
hereditary nephritis with nerve damage and ocular disorders (cataracts, lens dislocation)
symptom is nephritic syndrome (proteinuria and hypoalbuminemia) ---> end stage renal disease by 30
caused by gene mutation of alpha 5 chain of type IV collagen
thinning/splitting of glomerular basement membrane
208
poststreptococcal glomerulonephritis
pathogenesis
symptoms
immune complex disease with strep antigen, 2-3 weeks after group A beta-hemolytic strep or skin infection
hematuria, oliguria, hypertension, periorbital edema
209
urinary stones
kinds and %
calcium phosphate or oxalate (inc. Ca2+ concentration) - 75%
struvite: magnesium phosphate, in alkaline urine, persistent UTI - 15%
uric acid: gout - 5%
cystine: cystinosis - 1%
210
urolithiasis
definition
causes
symptom
tx
kidney stone formation
due to increased salts in urine (gout increases uric acid, inc. Ca2+ by hyperparathyroidism) or UTI (dec.solubility of salts, bacteria)
pain in back ---> R shoulder
tx with sx/wave therapy, drugs, pass stone
211
UTI
pathogenesis
bacteria
causes
dx
symptoms
infection of urinary tract and kidney, women more often (shorter urethra), inc. during pregnancy
e. coli, staph. saprophyticus
impaired urine drainage, injury to mucosa by kidney stone, catheter with bacteria
dx with urinalaysis (> 10 hpf), dipstick + for leukocyte enterase and nitrites, culture > 100k colony forming units (gold standard)
symptoms: frequency, dysuria, pyuria, hematuria, bacteriuria, cystitis, pyelonephritis
212
cystitis
only affects bladder, sexually active young women and old men with BPH
213
acute tubular necrosis
definition
pathogenesis
dx levels
ischemia
nephrotic
tx
injury/necrosis of tubular epithelial cells cause acute renal failure
necrotic cells plug tubule ---> obstruction dec. GFR ---> brown granular casts in urine
BUN:creatinine < 15, osmolarity < 500
ischemia: dec. blood supply = tubule necrosis
nephrotic: toxic agents = tubule necrosis (NSAIDs, lead, chemo)
hemodialysis: more common; eliminate water and waste from body; connect via fistula, access port, or shunt
peritoneal: less common; cleansing fluid thru catheter into abdomen and filters waste from blood; higher infection risk
214
WIlm's tumor
pathogenesis
prognosis
sign
2-4 years old, immature cells resembling renal blastoma, deletion of short arm of chromosome 11, genes WT-1 and WT-2 are cancer suppressor genes
good prognosis with sx + chemo
palpable flank mass
215
renal cell carcinoma
pathogenesis
symptoms
men 50-70, smokers, gene deletion on chromosome 3
flank pain, palpable mass, hematuria, secondary polycythemia, hypercalcemia
most common form
216
transitional cell carcinoma
area
symptom
cause
renal pelvis, ureter, bladder
likely to recur, likely to spread by local extension
hematuria
industrial exposure, smoking
217
pelvic inflammatory disease
definition
cause
predisposes to..
inflammation of fallopian tubes and ovaries
by gonorrheal and chlamydial infection
predisposes to ectopic pregnancy
218
ectopic pregnancy
definition
predisposing factors
signs
outside uterus - 95% fallopian tubes, 1 in 200
predisposing: tubal infection, PID, IUD, previous ectopic preg.
missed period, excessive bleeding, low abdominal pain
219
diethylstilbestrol (DES)
super estrogen
1946-70 non steroidal estrogen used for women with spontaneous abortion
precocious puberty in daughters, clear cell adenocarcinoma of cervix and vaginal adenosis
220
placental abnormalities: placenta accreta
definition
tx
placental villi into uterus wall, predisposed by C-section
tx with sx to stop bleeding
221
placental abnormalities: placenta previa
zygote implants in lower section of uterus, painless bleeding
tx with c-section
222
placental abnormalities: abruptio placentae
partial/complete premature separation of placenta; emergency
abdominal pain and painful bleeding
tx with delivery and bleeding control
223
abortion
definition
symptoms
pathogenesis
termination of pregnancy before week 22 of gestation
cramping, abdominal pain, backache, vaginal bleeding
induced by DR or RU-486 or mifeprex or mifepristine: competes for progesterone receptors, opens cervix and influence contractions to expel embryo within first 9 weeks
224
gestational trophoblastic disease
definition
signs
moles: complete and incomplete
swelling of chorionic villi
B-hCG higher, grape like masses in vaginal canal (2nd trimester)
mole in 1st trimester = absent fetal heartbeat, 'snowstorm' on ultrasound
complete mole: fetus cannot be identified due to androgen production, only paternal chromosome
incomplete mole: some fetal parts present, ovum fertilized by 2+ sperm, tx with spontaneous abortion usually or dilatation and curettege, chemical pregnancy
225
preeclampsia
symptoms
tx
hypertension, edema, proteinuria in 3rd trimester, hemolysis, elevated liver enzymes, low platelets
tx hypertension, deliver fetus, bed rest
226
eclampsia
definition
tx
preeclampsia + seizures, emergency
tx with magnesium sulfate and diazepam (anti-epileptics)
227
Turner syndrome
definition
symptoms
tx
pubertal delay due to low estrogen, absent second functional X chromosome due to primary gonadal failure = inc. FSH and LH
short, webbed neck, primary amenorrhea
tx with estrogen and progesterone
228
endometriosis
definition
signs
dx
tx
deposits of endometrium outside its normal location (on ovary, pelvic peritoneum)
responsive to hormone variation of menstrual cycle
blood filled cysts, dysmenorrhea, infertility
dx with laparoscope, ultrasound, CT
tx with birth control (OCP)
229
polycystic ovary syndrome
enlarged ovaries, cysts, inc. androgens affect development and release of eggs during ovulation
excess insulin inc. production of androgens
dx with blood LH, androgens, ultrasound of ovaries
no ideal tx, OCP, metformin (T2D med, not FDA approved for PCOS), ovulation meds, IVF, ovarian drilling sx
230
complete abortion
spontaneous expulsion of all fetal and placental tissue from uterus prior to 20 weeks gestation . Cervix closed on exam
231
incomplete abortion
passage of some fetal or placental tissue, but not all, from uterus prior to 20 weeks. Cervix dilated on exam
232
threatened abortion
uterine bleeding prior to 20 weeks without any cervical dilation or effacement
233
inevitable abortion
uterine bleeding prior to 20 weeks, accompanied by cervical dilation, but no expulsion of any fetal or placental tissue through cervical os
234
missed abortion
fetal death before 20 weeks without expulsion of any fetal or maternal tissue for at least 8 weeks thereafter
235
septic abortion
any of the mentioned abortions + uterine infection
236
menorrhagia
> 7 days or > 80 mL at regular intervals
237
metrorrhagia
irregular but frequent intervals
238
polymenorrhea
< 21 days between periods
239
oligomenorrhea
> 35 days between periods
240
dysmenorrhea
pain with menstruation
241
amenorrhea
primary
secondary
psychogenic
lactational
anorexia nervosa
exercise
runner's
tx
primary: period failure during puberty
secondary: 6 months or longer w out period
psychogenic: college freshman, opiates
lactational: inc. PRL
anorexia nervosa: dec. BW, FSH, LH, estrogen
exercise: female athlete triad (dec. FSH and LH)
runner's: beta endorphins inhibit GnRH production
tx diet, dec. exs., OCP
