Random Review Part 2 Flashcards
1
Q
Beta hemolytic bacteria
A
GAS, GBS, Staph aureus, listeria
2
Q
“Lancet shaped gram positive diplococci”
A
Strep pneumo
3
Q
Infecting heart valves
A
Strep viridans: makes dextrans to bind fibrin-platelet aggregates on damaged heart valves
Staph epidermidis: produces adherent biofilms
Staph aureus: can fuck shit up and make fibrin clots around itself
4
Q
Weird stuff about GAS
A
Produces CAMP factor: enlarges area of hemolysis by S.aureus.
Hippurate test +
Take your baby camping
5
Q
Weird stuff about Enterococci (faecalis)
A
Lancefield grouping, based on differences in C carbohydate on bacterial cell wall
Can cause subacute endocarditis after GI/GU procedures
To remember this bacteria, just remember this is where VRE comes from
6
Q
Diptheriae can cause (dangerous)
A
Myocarditis, arrthmias
Diagnose: Gram + rods with metachromatic granules (blue/green), Elek + for toxin
7
Q
Gram positive rods
A
Bacillus
Corynebacterium
Listeria
Clostridium
8
Q
To kill spores:
A
Autoclave by steaming at 121C for 15 minutes
Spore produces: Clostridium, bacillus, coxiella
9
Q
C. tetani location of action
A
Renshaw cells in spinal cord
10
Q
Baby with constipation
A
Can be botulism starting out
11
Q
C. perfringens can also cause
A
late onset food poisoning (watery diarrhea)
12
Q
Tx c.diff
A
Metronidazole + PO vanc
Recurrent: repeat or fidaxomicin (macrolide)
13
Q
Medussa head colonies
A
Anthrax
14
Q
Listeria
A
- Rocket tails (actin polymerization) in vitro, and tumbling motility which works better in cold temperatures (4C)
- Only gram + to produce endotoxin
15
Q
Actinomyces
A
- Anaerobe, not acid fast, normal oral flora
- Causes oral/facial abscesses that drain through sinus tracts, yellow sulfur granules. Pronounce “acnemycs” to remember abscesses and that its normal flora.
16
Q
Nocardia
A
- Aerobe, partially acid fast, found in soil
- Since its aerobic, causes pulmonary infection in immunocompromised or cutaneous infections s/p trauma in normal people
17
Q
Treatment of actinomyces/nocardia
A
Treatment is a SNAP
Sulfonamides - Nocardia, Actinomyces - Penicillin
18
Q
PPD false negative
A
Anergic (steroids, malnutrition, immunocomprimised), or sarcoidosis
If BCG vaccine (false positive), use Interferon-y release assay for fewer false positives
19
Q
TB special virulence factor
A
Cord factor – inhibits macrophage maturation and induces release of TNF-a.
20
Q
Leprosy
A
Lepromatous: Th1 compromised, so predominantly Th2 mediated (humoral)
Tuberculoid: Th1 not compromised, so predominantly Th1 mediated (cell mediated), which is preferred
Tx: Dapsone + rifampin for tuberculoid
add clofazimine for lepromatous form
21
Q
PPx for N. meningitidis
A
Rifampin (also use for h.flu), cipro, ceftriaxone
22
Q
H.flu tx
A
Amp+/-clav
Meningitis: ceftriaxone
23
Q
H.flu vacc is against what?
A
PRP (polyribosylribitol phosphate)
24
Q
Legionella quick facts
A
SIADH (hyponatremia), relative bradycardia
urine antigen
Tx w/macrolides or quinolone (erythromycin)
Pontiac fever is a mild flu like syndrome caused by it
GI symptoms
25
Pseudomonas drugs
- Extended spectrum B-lactams (piperacillin, ticarcillin, cefepime) FYI: pip and tic are listed as "antipseudomonals" in FA
- Carbapenems (imipenem, meropenem)
- Monobactams (aztreonam)
- Fluoroquinolones (cipro)
- Aminoglycosides (gentamicin, tobramycin)
- MDR strains: Colistin, polymyxin B
26
Erythema gangerenosum
necrotic cutaneous lesion, caused by pseudomonas, immunocompromised patients
27
General pseudomonas
```
Hot tub foliculitis
Burn victims (aerobic reminder)
```
28
EIEC vs EHEC
EIEC produces similar manifestions of shigella since it invades, but doesnt produce the shiga like toxin that EHEC does. Remember that Shigella's key to pathogencitiy is invasion, not toxin production*** EHEC doesnt need to invade to cause dysentery, the toxin alone is enough
29
How to differentiate EHEC from all other E. Coli?
DOES NOT ferment on sorbitol
30
HUS
Caused be EHEC
Anemia, thrombocytopenia, acute renal failure, schistocytes, platelet consumption
Looks like TTP but renal predominant
*Since TTP/HUS/DIC can all look similar, pay attention to clinical scenario and lab values*
31
Klebsiella pneumonia
Lobar, current jelly sputum
32
Salmonella typhi
H2S, Flagella, Endotoxin + Vi capsule, inactivated by gastric acids, response mediated by monocytes, causes constipation and rose spots on abdomen, followed by diarrhea, oral vaccine is live while IM vaccine is Vi capsular polysaccharide. Carrier state w/gallbladder colonization
33
Salmonella (non-typhi)
Same as typhi except PMN predominant response, bloody diarrhea (no constipation), no vaccine available (no Vi capsule), and doesnt produce rose spots.
34
Shigella
Only spreads cell to cell, no H2S or flagella, PMN predominant response, bloody diarrhea, no vaccine. Invasion = key to pathogenicity, doesnt even need the toxin.
35
Pseudoappendicitis
Yersinia enterocolitica
36
H plyori triple therapy
PPI, clarithromycin, amoxicillin (metronidazole if PCN all.)
37
3 spirochetes:
Borrelia - largest, can be visualized with wright/giemsa stain as a result
Leptospira
Treponema - dark field microscopy
38
Leptospira can cause 2 diseases:
Leptospirosis - flu like, myalgias (CALVES), jaundice, photophobia, conjunctival suffusion. SURFERS in TROPICS
Weil (whale) disease - severe form of jaundice and azotemia from liver/kidney dysfunction, fever, hemorrhage, anemia
Contaminated waters with animal urine
39
Borrela burdorferi
Natural reservoir is mouse, transmitted by Ixodes deer tick
40
Syphilis lesions
Primary = Painless chancre, Secondary = Condylomata lata, Tertiary = Gummas
*Condylomata acumulata = HPV
41
Neurosyphilis signs
Broad based ataxia, + romberg, charcot joint, stroke WITHOUT htn
42
VDRL false positives
Viral infection (mono, hepatitis)
Drugs
Rheumatic fever
Lupus anticoagulant/Leprosy
43
Gram variable rod
Gardnerella vaginalis
Clue cells, not an STD but associated with sexual activity. Tx with metronidazole or clinda
44
Rash on palms and soles
Coxsackie A infection
Rocky mountain spotted fever
Syphillus (secondary)
CARS
45
Rocky mountain spotted fever
Headache, RASH, fever. Tick vector
46
Typhus vectors
Flees (endemic)
| Human body louse (epidemic)
47
Ehrlichiosis presentation
RMSF w/o rash. Tick vector.Morulae monocytes (berry like inclusions) To complete this notecard, required to do an internet search for image
48
Anaplasmosis presentation
Tick vector. Same as ehrlichiosis, no rash.
49
Q fever (coxiella). Its queer, why?
No rash, no arthropod vector. Comes from sheep/cattle amniotic fluid aersolized. Most common cause of culture negative endocarditis
50
2 forms of chlamydiae
1) Elementary bodies: Enfectious, enters cell via Endocytosis--> transforms into reticulate body. Analagous to spore, small and dense.
2) Reticulate bodies: Replicates in cell by fission, reorganizes into elementary bodies
51
Chlamydiae treatment
Azithromycin (favored), or doxycycline
52
Bird related disease, atypical pneumonia
Chlamydiae psittaci
53
Types of chlamydia trachomatis (serotypes)
A,B,C: Africa, Blindness (follicular cnjunctivitis), Chronic infection
D-K: "Everything else" Urethritis/PID, neonatal pneumonia (staccato cough) w/eosinophilia, neonatal conjunctivitis
L1, L2, L3: Lymphogranuloma venereum - painless geneital ulcers, painful inguinal lymphadenopathy. tx w/doxycycline
54
Mycoplasma pneumoniae high yield
```
Xray looks worse
High cold agglutinins IgM, can lyse RBCs
Grown on Eaton agar (cholesterol)
Military recruits, prisons
Macrolides, doxy, fluoroquinolone
```
55
Systemic Mycoses high yield
Histo: Hides in macrophages. Bird/bat droppings. Ovoid cells. Smaller than RBC
Blasto: Buds broadly, Granulomatous nodules. Doubly refractile wall. Can disseminate to bone/skin. Same size as RBC.
Coccidio: Spherules. Can disseminate to bone (arthralgias)/skin (erythema nodosum). Larger than RBC.
Paracoccidio: Captain's wheel. Latin America.
56
Tinea versicolor
NOT a dermatophyte despite being called tinea
Degradation of lipids --> acids --> damage melanocytes
Spaghetti and meatbballs
57
Opportunistic infection high yield
Candida: Budding yeast/pseudohyphae. T cell for superficial protection, neutrophils for hematogenous spread. Can cause endocarditis in IV drug users. Normal inhabitant.
Aspergillus: Acute angles. Septate hyphae. Allergic bronchopulmonary aspergillosis associated with ASTHMA and CYSTIC FIBROSIS. Causes bronchiectasis and eosinophilia. Aspergillomas s/p TB. Can produce aflatoxins (p53 mutation inducing) --> HCC.
Cryptococcus: Yeast, heavily encapsulated. Also in soil/bird poop like histo. Culture on sab, stain with india ink and mucicarmine. Latex agglutination test specific. Soap bubble lesions in brain.
Mucor and Rhizopus: Wide angles, nonseptate hypae. Similar presentation as aspergillus (look at histology). Penedrate bloo vessel walls, enter brain via cribriform plate. Black eschar on face.
58
Treat/prophylaxis for PCP
Bactrim
59
Sporothrix schenckii
Dimorphic, cigar shaped. Roses. Ascending lymphangitis. Tx w/itraconazole or POTassium iodide (plant a rose in a POT)
60
Protozoa - GI infection high yield
Get from cysts in water, or oocysts in water for crypto
Giardia - foul-smelling, fatty diarrhea. Diag: trophozoits or cysts in stool. Tx: metronidazole
Entamoeba histolytica (amebiasis) - DYSENTERY, liver abscess, anchovy paste exudate, RUQ pain, flask shaped ulcer. Diag: serology and/or trophozoits or cysts in stool. Tx: metronidazole. Iodoquinol for asymtpomatic cyst
Cryptosporidium - AIDS causes severe diarrhea, mild watery diarrhea for everyone else. Diag: oocysts on acid fast stain. Tx: nitazoxanide
61
Toxo treatment
Sulfadiazine + pyrimethamine
62
Naegleria fowleri
Rapidly fatal meningoencephalitis. Nalgene filled w/fresh water. Enters via cribriform plate. Amoebas in spinal fluid. Amphotericin B, but rarely works.
63
Trypanosoma brucei
African sleeping sickness: Enlarged lymph nodes, recurring fever, somnolence and coma. get it from Tsetse fly bite (PAINFUL). Tx w/Suramin for blood born disease or melarsoprol for CNS penetration
"It SURe is nice to go to sleep. MELAtonin helps with sleep"
64
Plasmodium (malara) high yield
Anopheles mosquito
For all, use chloroquine (if sensitive), blocks plasmodium's heme polymerase. If not, use mefloquine or atovaquone/proguanil
Vivax/ovale has hypnozoite --> add primaquine to kill it first. Diagnose with Schuffner stippling (red granules)
Falciparum is deadliest form. Fucks up capillaries in brain, kidneys, and lungs.
65
Babesia high yield
Fever + hemolytic anemia (Malaria like illness)
Asplenia increases risk of severe disease
Spread by Ixodes tick --> Lyme can coinfect
Maltese cross [Must look up on google images to complete card]
Tx: atovaquone + azithromycin
66
Trypanosoma cruiz
```
Reduviid bug (kissing bug, painless bite), feces.
Romana sign (unilateral periorbital swelling of acute stage)
```
67
Leishmaniasis
Can be visceral, or cutaneous. Spiking fevers, hepatosplenomegaly, pancytopenia. Sandfly transmission. Macrophages contain amastigotes.
68
Trichomonas vaginalis
Dont confuse with gardnella. Foul smelling, green discharge. Sexual tranmission. Strawberry cervix. Treat with metronidazole for partner and patient.
69
Nematodes (intestinal)
Treat all intestinal ones with bendazoles (because worms are bendy, and so is the gut)
3 fecal oral:
1. Pinworm Ienterobius vermicularis)
- Tape test
2. Giant roundworm (ascaris lumbricoides)
- Possible obstruction of ileocecal valve
3. Trichinella spiralis
- Encyst in striated muscle --> trichinoosis = F/N/V, periorbital edema, myalgias (Imagine trying to make a spiral when I flex my biceps)
2 penetrate skin:
1. Strongyloides
- Feels like peptic ulcer
2. Hookworm (Ancylostoma duodenale, necator americanus)
- Anemia by sucking intestinal walls
70
Nematodes (Tissue)
3 from bugs:
1. Onchocerca volvulus (Female blackfly bite)
- Hyperpigmented skin
- River blindness [black fly, black skin, black sight]
- Tx: ivermectin (Rivermectin)
2. Loa loa (Deer/horse/mango fly)
- Swelling in skin, worm in conjunctiva
- Tx: diethylcarbamazine
3. Wuchereria bancrofti (female mosquito)
- ELEPHANTITIS (9mo-1yr s/p bite)
- Tx: diethylcarbamazine
1 fecal oral:
1. Toxocara canis
- Visceal larva migrans
- Bendazoles
71
Taenia solium
Eat larvae in pork -- intestinal infection (tx: praziquantel)
Eat eggs -- neurocysticercosis (tx: albendazole)
72
Diphllobothrium latum
"Jewish housewives disease" Ingestion of larvae from raw freshwater fish --> B12 deficiency. tx: praziquantel
73
Echinoccus granulosis
eggs from dog feces, sheep = intermediate host. Hydatid cysts in liver, can cause ANAPHYLAXIS if antigens relased (so inject w/ethanol or hypretonic saline to kill daughter cysts before removal). tx albendazole
74
Schistosoma
Shit I stepped on a snail. Portal htn. Chronic infection can lead to SCC of bladder and pulmonary htn. Txl praqiequantel
75
Clonorchis sinesis
Undercooked fish. Biliary tract inflammation --> pigmented stones --> cholangiocarcinoma. tx: praziquantel
76
MMR and HIV+
Yes, as long as not showing signs of immunodeficiency
77
Virus cellular receptors
```
CMV - cellular integrins
EBC - CD21
HIV - CD4 and CXCR4 (CCR5)
Rabies - nicotinic ACh receptors
Rhinovirus - iCAM1 (CD54)
```
78
Tzanck test
Detects multinucleated giant cells (HSV1, HSV2, VZV)
79
VIrus memory aids
DNA: P P P AHH P (Pee pee pee ahhhhh pee) [box the last 3]
dsRNA: Reo
+RNA: CHP RC TF (California Highway Patrol, Remote Control, TF [box the last 4]
- RNA: ABPOFR (always bring polymerase or fail replication) [box all of them]
Segemented: BOAR (Bunya, orthomyxo, arena, reo) <--can undergo reassortment
ENTERIC VIRUSES DONT HAVE AN ENVELOPE
80
Picornaviruses
RNA is translated into 1 large polypeptite that is cleaved by proteases
All except Rhino are fecal-oral spread
81
Yellow fever
Black vomit. Councilman bodies in liver (eosinophilic apoptopic globules)
82
Congenital Rubella
Extramedullary hematopoises gives the blueberry muffin appearance
83
Paramyxovirus
All have surface F (fusion) protein --> causes respiratory epithelium cells to fuse --> forms multinucleated cells. Palvizumab is an Ab against the F protein, used against RSV.
84
Rabies
Found in same locations that are susceptible to hypoxia/global ischemia (perkinje of cerebellum and prymads of hippocampus)
85
HBV
-Window period is between HBsAg and anti-HBsAg, only thing then is the anti-HBe and Anti-HBc IgGs
-Chronic = expressing HBsAg, no anti-HBsAg
High infectivity with HBeAg, Low infectivity with Anti-HBeAg
86
HIV genes
env: gp160 --> gp41 + gp120 (crosses placenta, can cause false positive)
gag: p24 capsid protein
pol: reverse transcriptase, integrase, aspartate protease
Binds CD4 + coreceptor (CCR5 on macrophages earlier, CXCR4 on T cells later)
87
Dominant flora of colon
B.fragilis>E.coli
88
Pre surgery antibiotic
Cefazolin for s. aureus
89
Cephalosporin use
1st gen: PEcK (proteus, e.coli, klebsiella)
2nd gen: HEN PEcKS (h.flu, enterobacter, neisseria,..)
Antipseudo: Cefepime (4th), Ceftazidime (3rd)
90
Imipenem always given with:
cilastatin (to make the killin lastin) for renal inactivation prevention
91
Carbapenems toxicity
CNS, seizures
92
Allergic to PCN or can't tolerate aminoglycosides:
Aztreonam. ONLY for gram-negative rods
93
Fluoroquinolones
hurt attachments to your bones (cartilage/tendon damage). Use for gram (-) rods of urinary and GI tractts
94
Daptomycin
Dont use for pneumonia because surfactant inactivates it. Depolarizes cell membrane by disrupting it (gram + cocci). Myopathy, rhabdo
95
Flucytosine converts to:
5-FU
96
Azoles
Inhibit the cytochrome p450 enzyme that converts lanosterol to ergosterol (final step), Also inhibits testosterone synthesis so can get gynecomastia
97
Terbinafine
Second to last step of ergosterol synthesis (squalene epoxidase)
Dermatophytes
98
-fungin drugs
Inhibit cell wall synthesis (inhibiting synthesis of B-glucan)
Good for aspergillosis and Candida
99
Griseofulvin
accumulates in keratin containing tissue, good for dermatophytes (tinea, ring worm). Fucks with microtubule formation
100
Anti-mite/louse therapy (scabies)
All are neurotoxic
101
Antivirals not requiring activation by viral kinase:
Both good for CMV retinitis. Cidofovir good for acyclovir-resistant HSV found in HIV patients
- Foscarnet (binds to pyrophosphate binding site on DNA/RNA pol)
- Cidofovir ( (preferentially DNA pol) [Give probenecid + IV saline]
102
NNRTIs
Delavirdine
Efavirenz
Nevirapine
Never delete favorites
Stevens Johnsons, hepatotoxic
103
Raltegravir
Integrase inhibitor
| I hope the rales have integraty
104
Fusion inhibitors
Enfuviridine (no Entry) --> Binds gp41
| Maraviroc (Marry me) --> binds CCR5
105
Ribavarin
For HCV, and RSV in children
| Inhibits synthesis of guanine nucleotides (ribs taste Good)
106
Other HCV treatments:
```
Same sofa (Simeprevir, sofosbuvir)
protease inhibitor, RNA polymerase inhibitor
```
107
Embroygenesis genes shortcuts
Sonic hedgehog - A/P axis, CNS dev
Wnt-7 - Dorsal-ventral axis
FGF - Lengthening of limbs
Homeobox (hox) - Segments, transcription factors, appendages in appropriate places
108
Early fetal development shortcuts
1wk: hCG at 6, blastcyst sticks at 7
2wk: 2 layers
3wk: 3 layers, neural plate forms
3-8wk: Neural tube, organs, teratogens
Wk 4: heart beats (4 chambers), 4 limbs
Wk 6: can see heart beat
Wk 10: Genitalia discernible
109
Twinning
Cleavage between:
2 cell stage and morula = didi [Second most common]
morula and blastocyst = monodi [Most common]
blastocyst and formed disc = monomono
after formed disc = monomono conjoined
110
Aortic arches
```
1 = maximal, maxillary
2 = second, stapedius and hyoid
3 = 3Cs, common carotid, internal carotid
4 = 4 limbs, proximal right subclavian, aortic arch [right recurrent larygneal]
6 = pulm artery, ductus arteriosus [Left recurrent laryngeal]
```
111
Branchial arch
1 | V2, V3 | Chew (M's) | Treacher
2 | VII | Smile (S's) | Fistulas
3 | IX | Swallow stylishly | Tongue post
4 | X (superior laryngeal) | Simply swallow | Tongue post
6 | X (inferior laryngeal) | Speak |
Anterior digastric belly = 1
Posterior digastric belly = 2
112
Branchial pouch
1 | Ear
2 | Tonsils
3 | Thymus, I. parathyroids
4 | S. parathyroids
113
Mesonephric duct derivatives
Male internal structures except prostate, which comes with DHT exposure to urogenital sinus
114
Gubernaculum
Anchors tests within scrotum, becomes ovarian ligament and round ligament of uterus (on fundus) in females
115
Ovarian ligament vs. suspensory ligament of ovary
Ovarian ligament anchors to uterus, suspensory ligament actually has the ovarian vessels
116
Histology of female
Most of the internal structures are simple columnar, but ovaries are cuboidal
117
Autonomic innervation of male sexual response
Pelvic nerve, Parasympathetics, erection
Hypogastric nerve, Sympathetic, emission
Pudendal nerve, (S2,3,4) somatic, ejaculation
118
Inhibin
Temperature decreases levels, seen in varicocele and cryptorchidism
119
Estrogen potency
17B-estradiol (ovary) > estrone (aromatization) > estriol (placenta)
120
Estrogen vs progesterone, plus select details
Increases vs decreases myometrial excitability
Increase vs decreases estrogen receptor expression
Fall in progesterone s/p delivery disinhibits prolactin to allow lactation
Increased progesterone is indicative of ovulation (measure temperature)
121
Oogenesis and ovulation
PrOphase I before ovulation
Metaphase II before fertilization
Ovulation: ^ estrogen --> ^ GnRH receptors on ant pituitary --> estrogen surg --> ^LH -->ovulation
122
MIttelschmerz
From peritoneal irritation (follicular swelling/rupture, fallopian tube contraction)
123
Purpose of hCG
Secreted by syncytiotrophoblast
Acts as LH to maintain corpus leteum --> maintains progesterone
8-10 weeks, then placenta makes its own estriol and progesterone and corpus luteum goes away
Alpha subunit same as LH, FSH, TSH
124
Spermatogenesis
Spermatogonium --> primary and secondary spermatocytes --> Spermatid --> spermatozoon (zoomin towards egg)
125
What closes the epiphyseal plate?
Estrogen (in males, testosterone converted to estrogen)
126
XYY
Nondisjunction @ paternal meiosis II
127
Hydatidiform moles
hCG high in complete (46), increased risk for chorio and will get hyperthyroid b/c TSH and hCG share alpha unit
Partial mole has fetal parts
Complete mole is a snowstorm
128
BP control in pregnancy
alpha-methyldopa, hydralazine, labetalol, nifedipine
129
HELLP
Leads to hepatic subcapsular hematomas --> rupture --> severe hypotension
130
Eclampsia
Death due to stroke, intracranial hemorrhage, ARDS
131
Accreta/increta/percreta
Accreta - myometrium w/o penetration
Increta - invades myometrium
Percreta - perforates through into uterine serosa, can attach to rectum or bladder
132
Abruption vs previa
Bleeding: Abruption is painful, previa is painless
133
Velamentous umbilical cord insertion
Cord insersts into chorioamniotic membrane rather than placenta, so fetal vessels travel to placenta unprotrected by Wharton jelly --> predisposes to vasa previa (look for hemorrhage and fetal bradycardia)
134
HPV 16 and 18 gene products
E6 - inhibits p53 gene
E7 - inhibits Rb gene
Lateral invasion of cervical SCC can block urters and cause renal failure
135
Theca-lutein cyst
Bilateral, Caused by excess B-hCG so will get with choriocarcinoma or molar pregnancy.
136
Coffee been nuclei
Brenner Tumor. Urothelium, Looks like bladder.
137
Ascites + pulling sensation in groin
Meigs Syndrome -- mostly from ovarian fibromas, but can be from other benign ovarian neoplasms. Ascites resolves with removal
138
Thecoma produces
Estrogen. Just like granulosa cell tumors (but those are malignant)
139
Immature teratoma is aggresive and contains:
neuroectoderm, immature neural tissue, more likely to contain thyroid tissue
140
Granulosa cell tumor histology
Call-Exner bodies (looks like primordial follicles w/granulosa cells arranged haphazardly around collections of eosinophilic fluid)
141
Cystadenocarcinoma (2 types)
Serous -- most common, psammoma bodies, BRCA-1
| Mucinous -- causes "Pseudomyxoma peritonei", where mucinus material from ovary fills up the peritoneum
142
Dysgerminoma (male equivalent =?)
Seminoma. Sheets of fried egg and hCG, LDH are high
143
Choriocarcinoma
NO chorionic villi present. Hemoptysis, hematogenous spread to lungs. high B-hCG
144
Yolk sac tumor (endodermal sinus)
Aggressive. Ovaries or tests. Schiller-Duval bodies which resemble glomeruli. AFP are high
145
Adenomyosis
caused by hyperplasia of basal layer of endometrium. tx w/GnRH agonists or hysterectomy
146
Most common cause of endometritis (pathogens):
Bacteroides. Tx w/ gent+clinda +/- amp
147
Mastitis pathogen
S. aureus
148
Noninvase breast cancer high yield
DCIS -- Ductal atypia, fills ductal lumen
Comedocarcinoma -- central necrosis
Paget disease -- paget cells (large cells in epiderms w/clear halo)
149
Invasive breast cancer high yield
Invasive ductal --Stellate inflitration, worst, most invasive
Invasive lobular -- Indian file, orderly rows, loss of E-cadherin
Medullary -- Fleshy, cellular, lymphocytic infiltrate
Inflammatory -- Peau d'orange. Dermal lymphatic invasion
150
Biopsies and testicular tumors
DONT DO IT
151
Testicular tumors
Germ cell (95%)
- Seminoma: Most common, 30s, fried egg, ALP. Good prognosis. Radiosensitive. Alk Phos
- Yolk sac (endodermal sinus) tumor): Schiller Duval bodies (glomeruli). AFP. <3y/o
- Choriocarcinoma: hCG. hematogeouns mets. gynecomastia. hyperthyroidism.
- Teratoma: mature can be malignant (unlike in women). hCG and/or AFP
- Embryonal carcinoma: Painful. hCG. AFP when mixed. glandular/papillary.
Non-germ cell (5%)
- Leydig cell: Reinke cystals (eosinophilic cystoplasmic inclusions), gynecomastia. produces androgens.
- Sertoli cell: Androblastoma
- Testicular lymphoma: Older men. Not primary. Usually diffuse large B-cell type.
152
Acute prostatitis pathogen
E. coli
153
Prostate cancer markres
increased PSA, but decreased free PSA. OSTEOBLASTIC as opposed to most bone mets from other tumors which are osteolytic
154
Tamoxifen and Raloxifene
Both are antagonists in breast and agonists in bone, but tamoxifen is an agonist in the endometrium and raloxifene is an antagonist there
155
Mifepristone
Competitive inhibitor of progestins at progesterone receptor
156
Terbutaline, ritodrine
B2-agonists, relax uterus, tocolytics
157
Danazol
Synthetic androgen, partial agonist. Causes atrophy of endometrium. Can also be used for hereditary angioedema because it increases production of C1-esterase inhibitor.
158
Side effects of boner drugs
Hot and sweaty, then headache heartburn and hypotension. blue tinted vision
