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Renal & Repro Review Flashcards

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1
Q

Mesonephros becomes

A

WOlffian duct

epididymus

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2
Q

Metanephros becomes

A

uretric bud –> metanephric mesoderm –>

collecting duct
Major/minor calyxces
Renal pelvis

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3
Q

Metanephric blastema becomes

A

Glomeruli, bowman proximal tubule, loop of henle, distal convoluted tubules

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4
Q

Horseshoe kidney associated with what chromosomal syndromes

A

Turner syndrome
Trisomies 13, 18, 21
Rarely renal cancer

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5
Q

Unilateral renal agenesis due to

A

Absence of one kidney due to failure of ureteric bud to develop

No ureteric bud to induce differentaition ofmetanephric mesenchyme

Absence of kidney and ureter

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6
Q

Hydronephros

Dilated or thick walled bladder on ultrasound

A

Posterior urethra valves

Membrane remnant in the posterior urethra in males

Leads to urethra obstruction

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7
Q

What kidney is taken during donor transplantation?

A

Left kidney due to longer renal vein

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8
Q

Renal blood flow (10 steps)

A
  1. Renal artery
  2. Segmental artery
  3. Interlobar artery
  4. Arcuate artery
  5. Interlobular artery
  6. Afferent arteriole
  7. Glomerulus
  8. Efferent arteriole
  9. Vasa recta/ peritubular capillaries
  10. Venous outflow
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9
Q

Course of ureters

- under/over

A

Under uterine artery or vas deferens

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10
Q

Plasma volume can be measured by

A

Radiolabeling albumin

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11
Q 
Percentages Total body water
ICF
ECF
Plasma
Interstitial fluid
A

60% total
40% ICF
20% ECF

Of ECF
25% Plasma
75% Interstitial fluid

% of body weight

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12
Q

Basement membrane of glomerular filtration barrier composed of

A

Type IV collagen chains

Heparan sulfate

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13
Q

Serum creatinine begins to rise when

A

GFR declines to < 60

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14
Q

Renal plasma flow can be estimated using

A

para-aminohippuric acid (PAH) clearance

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15
Q

Filtration Fraction

A

FF= GFR/RPF

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16
Q

Prostaglandins on filtration

A

Prostaglandins Dilate Afferent arteriole (PDA)

Increase GFR
Increase RPF
No change FF

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17
Q

Angiotension II on filtration

A

Angiotensen II constrict efferent arteriole (ACE)

Increase GFR
Decrease RPF
Increase FF

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18
Q

GFR vs RPF

A

GFR: amount filtered

RPF: amount filtered and secreted

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19
Q

Changes in glomerular dynamics (GFR, RPF, FF)

1) Afferent arterole constriction
2) Efferent arterole constriction
3) Increase plasma protein concentration
4) Constriction of ureter
5) Dehydration
6) ACE inhibitors
7) NSAIDS
8) Prostaglandins
9) Angiotensin II

A

1) Afferent arterole constriction
Decrease GFR
Decrease RPF
No change FF

2) Efferent arterole constriction
Increase GFR
Decrease RPF
Increase FF

3) Increase plasma protein concentration
(Fluid stays in arterole) 
Decreased GFR
No change RPF
Decreased FF

4) Constriction of ureter
( High hydrostatic pressure inside bowman capsule –> favor blood staying in capillaries)

Decrease GFR
No change RPF
Decrease FF

5) Dehydration
(Less filtered or secreted)
Decrease GFR
Large Decrease RPF
Increase FF

6) ACE inhibitors
- Dilates efferent
Decrease GFR
Increase RPF
Decrease FF

7) NSAIDS
- Constrict Afferent
- Decrease GFR
- Decrease RPF
- No net change FF

8)Prostaglandins
- Dilate afferent
Increase GFR
Increase RPF
No change FF

9) Angiotensin II
- Constrict efferent
Increase GFR
Decrease RPF
Increase FF

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20
Q

Three stimuli for renin release

A
  1. beta-adrenergic stimulation (beta 1)
  2. Low Na in distal convoluted tubule
  3. Low pressure in afferent arteriole
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21
Q

Ureteric bud comes from

A

Caudal end of mesonephros (closest to feet)

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22
Q

Juxtaglomerular cells located

A

Inbetween afferent arteriole and distal tubule

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23
Q

Pregnancy effect on PCT

A

Decrease ability of PCT to reabsorb glucose and amino acids –> glucosuria and aminoaciduria

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24
Q

Concentration at which glucose spilled

Concentration at which tubular reabsorption of glucose saturated

A

Spilling at 160-200

Saturated at 350 mg/dL

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25
First half proximal convoluted tubule primarily reabsorbs
Bicarb | Na
26
Relative concentrations along proximal tubule
Plasma Concentration Increases Unless Cleared by Kidneys ``` PAH Creatinine Inulin Urea Chloride Potassium ``` Sodium HCO3 Amino acids Glucose
27
Na reabsorbed with 1) Early PCT 2) Late PCT
1) Early PCT - Na/H (Na in/ H out) - Na/ X (glucose, AA, lactate) (all in) 2) Late PCT - Na/Cl (all in) (Driven by Na/K atpase) 3) Thick ascending limb - Na/K/ 2Cl ( all in)
28
What class of drugs inhibits the Na/2Cl/K symporter in thick ascending limb
Loop diuretics Causes Isotonic water excretion
29
Two cell types of collecting duct and last segment of distal tubule Fxn of cells
1) Principal cells - reabsorb water and Na - Secrete K 2) Intercalated cells - secrete H or HCO3 - Reabsorb K Intercalated cells - Alpha: Secrete H - Beta: Secrete HCO3
30
Alpha ketoglutarate in which part of nephron
Proximal convoluted tubule
31
Absorbed in thick ascending limb
Na, Cl, K Ca and Mg sneak in between cells
32
Nephron impermeable to water
Thick ascending limb
33
ADH works on what receptors
V2 vasopressin receptors on principal cells of collecting tubule Tells cells to insert aquaporins into lumen surface of cells H20 reabsorption
34
Drug that works by entering Na channel and blocks aquaporin
Lithium
35
Aldosterone effect on principal cell intercalated cells of collecting duct
Acts on mineralocorticoid receptor --> mRNA --> protein synthesis Principal cells: reabsorption of Na and secretion of K - Increase apical K conductance - Increase Na/K pump - Increase epithelial Na channel activity --> lumen negativity --> K secretion Intercalated cells: Stimulates secretion of H (alpha cells) - negative lumen --> Increase H ATPase activity --> increase H secretion --> Increase HCO3/Cl exchanger activity
36
PTH works on
Early PCT- inhibits Na/PO4 3- cotransport --> PO4 3- (phosphate) excretion Early DCT - Increase Ca/Na exchange --> Ca reabsorption
37
AT II effect on nephron
Stimulates Na/ H exchange in early PCT
38
Acetazolamide - MOA - Uses - Side effects
Carbonic anhydrase inhibitor - Carbonic anhydrase converts HC02 --> CO2 + H20 - Cant reabsorb bicarb without - Excreted in urine Minor diuretic effect Altitude sickness (over come respiratory alkosis more quickly) Urine Alkalinization Glaucoma (Bicarb production draws water into eye) Idiopathic intracranial HTN (pseudotumor cerebri) Adverse - Metabolic acidosis - Sulfa allergy
39
First line tx Idiopathic intracranial HTN
Acetazolamide
40
Mannitol - MOA - Use - Adverse - Dont use in (2)
Osmotic diuretic - Causes osmolar load to stay in filtrate - Prevent reabsorption of water - Excretion of water Increase serum osmolarity and Na Shock Drug overdose Acute angle-closure glaucoma Elevated ICP Adverse - Dehydration Dont use - Anuric renal failure - CHF
41
Loop Diuretics - Examples (4) - MOA - Use - adverse
Bumetanide Ethacrynic acid Furosemide Torsemide Inhibit Na/K/Cl cotransporter Loops Lose calicum Use - CHF - Pulmonary edema - Nephrotic syndrome - Cirrhosis ``` Adverse - sulfa allergy (except ethacrynic acid) - Hypokalemia - Gout - Ototoxicity ** - Nephrotoxicity ** Muscle weakness ** ```
42
Tx Altitude sickness
Acetazolamide
43
Thiazide diuretic - Examples (3) - MOA - Feature - Use - Side effect
Chlorthalidone Hydrochlorothiazide Metolazone Inhibit reabsorption of Na and Cl - reducing diluting capacity of nephron Retain Calcium Helps with osteoporosis HTN (first line) Side effect - Hypokalemia - Hyponatremia - Hyperglycemia - Sulfa allergy
44
Potassium sparing diuretics - examples - MOA - Use - Adverse
Aldosterone antagonist - Spironolactone - Eplerenone Block Na channels - Amiloride - Triamterene CHF Adverse - Hyperkalemia - Arrhythmias - Gynecomastia (antagonist androgen receptor) - menstrual irregularities (Not eplerenone specific to mineralocorticoid receptor)
45
Diuretic 1) Increases urinary NaCl 2) Acidosis 3) Alkalosis
1) Increases urinary NaCl - All except acetazolamide 2) Acidosis - Acetazolamide - K spring diuretics 3) Alkalosis - Loop diuretics - Thiazide diuretics
46
Shifts K into cells --> hypokalemia
Insulin Beta- agonist Alkalosis Cell creation/ proliferation
47
PTH effect on Vit D synthesis
Faciliates 1alpha-hydroxylase addinig second hydroxyl group to make 1,25 (OH)2 Vit D
48
ANP on kidneys
Released by heart due to increased atrial volume and atrial pressure Constricts efferent arterioles and dilates afferent arterioles Increase GFR Diuresis
49
Drug that causes SIADH
Cant Concentrate Serum Sodium Carbamazepine Cyclophosphamide SSRI
50
Locked in syndrome
Correct hyponatremia too quickly Causes lysis of myelin and pons
51
Diabetes insipidus - Due to - Central - Nephrogenic
Too little ADH effect Cant concentrate urine Central - Abnormal ADH production by hypothalamus Nephrogenic - Kidneys unresponsive to ADH
52
Nephrogenic diabetes inspidius can be cause by what drugs
Lithium | Demeclocycline (cousin of tetracycline)
53
First line tx Nephrogenic DI
Hydrochlorothiazide - causes dehydration so PCT will concentrate more (Indomethacin: decrease renal blood flow) (Amiloride: lithium induced Nephrogenic DI) - blocks Na channels Lithium enters through
54
Tx for Lithium induced Nephrogenic Di
Amiloride | - Blocks Na channels LIthium enters thorugh
55
Depression of reflexes
Hypermagnesemia
56
Tx Central DI
Desmopressin
57
Causes of acidosis with elevated anion gap
MUDPILES ``` Methanol Uremia Diabetic ketoacidosis Propylene glycol Iron tablet/ Isoniazide Lactic acidosis Ethylene glycol Salicylates ```
58
Patient with kidney stones presents with hypokalemia and metabolic acidosis. Anion gap is normal. Urine pH is 5.7. Defect?
Renal Tubular acidosis Type I - Hypokalemia - pH > 5.5 Impaired secretion of H by alpha intercalated cells in the collecting tubule
59
Hypoventilation causes
Respiratory acidosis
60
Anion gap=
[Na] - [Cl]- [HCO3] 10-12 normal
61
Normal anion gap acidosis
HARDASS ``` Hyperalimentation Addison disease Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```
62
Metabolic alkalosis caused by (3)
Excessive vomiting Diuretics Hyperaldosteronism
63
Type 1 Renal tubular acidosis - due to - pH - electrolyte - Increased risk for - causes (3) - Location
Alpha intercalated cells in collecting tubule unable to secrete H Urine pH > 5.5 Hypokalemia Risk for calcium phosphate kidney stones (due to increased pH and increased bone turnover) Causes - Amphotericin B toxicity - analgesic nephropathy - congenital anomalies (obstruction) of urinary tract Distal
64
Type 2 Renal tubular acidosis - due to - pH - electrolytes (2) - Location - Risk for - Causes
Proximal tubule defect of HCO3 reabsorption Urine pH < 5.5 Hypokalemia Hypophosphatemia PCT Risk for hypophosphatemic rickets Causes - Fanconi syndrome - Carbonic anhydrase inhibitors
65
Type 4 Renal tubular acidosis - due to - pH - Electrolytes - causes
Often due to hypoaldosteronism If Low not putting potassium into urine Urine pH < 5.5 Hyperkalemia (prevents PCT from generating NH4) Causes - decrease aldosterone production (ACE inhibitor, ARB, NSAID, heparin, cyclosporine) - Aldosterone resistance (K sparing diuretics, obstruction nephropathy, TMP/SMX)
66
Henoch-Schonlein Purpura renal problem
IgA nephropathy
67
Increased AA, glucose, bicarb, phosphate in urine. - Due to - May cause - Causes
Fanconi syndrome Generalized reabsorptive defect in PCT May result in metabolic acidosis (proximal renal tubular acidosis) ``` Wilson dis GLycogen storage disease Ischemia MM Drugs (ifosfamide, cisplatin, tenofovir, expired tetracyclines) ```
68
Urine pH < 5.5 Hypokalemia - type - due to - other lab
Type 2 Renal tubular acidosis Hypophosphatemia Proximal tubule defect of HCO3 reabsorption
69
Serum pH > 7.45 Hypokalemia No medications Increased Renin Increased Aldosterone Increased urine Ca
Bartter syndrome - AR Reabsorptive defect in thick ascending loop of Henle - affects Na/K/2Cl cotransporter
70
Serum pH > 7.45 Hypokalemia Hypomagnesemia Hypocalcuria Increased Renin Increased aldosterone
Gitelman syndrome AR Reabsorptive defect of NaCl in DCT
71
Serum pH > 7.45 HTN Hypokalemia Decreased aldosterone Decreased Renin Tx
Liddle syndrome AD Gain of function mutation Increase Na reabsorption in collecting tubules Tx Amiloride
72
Urine pH < 5.5 Hyperkalemia - type - due to - lab
Type 4 Renal tubular acidosis Due to hypoaldosteronism Low so not putting potassium into urine Prevents PCT from generating NH4
73
``` Serum pH > 7.45 HTN Hypokalemia Decreased aldosterone Increased cortisol ``` - Acquired from - Tx
Syndrome of Apparent Mineralocorticoid Excess (SAME) Hereditary deficiency of 11beta-hydroxysteroid dehydrogenase - cortisol not converted to cortisone Can acquire from glycyrrhetinic acid (present in licorice) Tx: Corticosteriods
74
Dopamine affect on nephron - secreted by - promotes - affects what parts - effect
Secreted by PCT cells promotes natriuresis At lose doses, dilates interlobular arteries, afferent arterioles and efferent arterioles --> Increase RBF, little to no change GFR Higher doses= vasoconstrictor
75
Part of nephron with lowest pH What happens at low pH
Distal tubule Collecting duct Uric acid precipitates at low pH
76
RBC cast
Glomerulonephritis | Malignant HTN
77
WBC cast
Tubulointerstitial inflammation Acute pyelonephritis Transplant rejection
78
Fatty casts
Nephrotic syndrome | Assoc w/ Maltese Cross sign
79
Granular (Muddy brown) casts
Acute tubular necrosis
80
Waxy casts
End-stage renal disease | Chronic renal failure
81
Hyaline cats
Nonspecific | Concentrated urine samples
82
Membranous means
Thickening of glomerular basement membrane
83
Nephritic (5) vs Nephrotic (5) - due to - features
Nephritic - Due to GBM disruption - HTN - Increased BUN/Cr - Hematuria - RBC in urine - proteinuria < 3.5 - Azotemia ( high nitrogen containing compounds, urea, creatinine) - Oliguria ( low urine output) ``` Nephrotic - Podocyte disruption --> charge barrier impaired - Proteinuria > 3.5 g/ day - Hypoalbuminemia - Hyperlipidemia - Edema (Frothy urine with fatty casts) ```
84
``` URI 2 weeks ago Child Periorbital edema proteinuria <3.5 Cola-colored urine HTN ``` - Disease - LM - IF - EM - Type rxn - decrease level
Acute poststreptococcal glomerulonephritis LM - gomeruli enlarged and hypercellular IF - "starry sky" granular appearance - "Lumpy-bumpy" due to IgG, IgM and C3 deposition along GBM and mesangium EM - subepithelial immune complex (IC) humps Type III hypersensitivity rxn Decrease complement levels (C3) due to consumption
85
Nephritic syndrome seen in Good pasture syndrome - clinical - Seen on IF - type hypersensitivity
Rapidly progressive (crescentic glomerulonephritis) Hematuria Hemoptysis Type II hypersensitivity txn Antibodies to GBM and alveolar basement membrane --> Linear IF
86
Rapidly deteriorating renal function (days to weeks) LM? Consist of Disease associated?
Rapidly progressive (crescentic) glomerulonephritis) LM and IF- crescentmoon shape Crescents consist of fibrin and plasma protein (C3b) with glomerular parietal cells, monocytes and macrophages
87
Nephritic syndrome seen with Granulomatosis with polyangiitis (wegener)
Rapidly progressive (crescentric) glomerulonephritis
88
Renal disease associated with SLE
Diffuse proliferative glomerulonephritis Wire loop
89
Diffuse proliferative glomerulonephritis - Due to - LM - EM - IF
SLE LM - "wire looping" of capillaries EM - subendotthelial and sometimes intramembranous IgG based ICs often with C3 deposition IF - granular
90
Episodic gross hematuria that occurs concurrently with respiratory or GI tract infections. LM EM IF Assoc with
IgA nephropathy (Berger disease) LM - Mesangial proliferation EM - mesangial IC deposition IF - IgA based IC deposits in mesangium Henoch Schonlein purpura
91
Retinopathy or lens dislocation Glomerulonephritis Deafness - disease - inheritence - mutation - MOD - EM
Alport syndrome X linked dominant Mutation in type IV collagen Thinning and splitting of glomerular basement membrnae Basket weave appearance on EM
92
Membranoproliferative glomerulonephritis - Type I (IF, appearance, Due to, assoc w/) - Type II (also called, assoc with
Type I - subendothelial immune complex (IC) deposits with granular IF - Tram track appearance on PAS stain - Due to GBM splitting caused by mesangial in growth - May be secondary to Hep B or C infection Type II - Also called dense deposit disease - Associated with C3 nephritic factor (IgG antibody that stabilizes C3 convertase --> persistent complement activation --> decrease C3 levels)
93
Nephrotic syndrome in children Recent infection or immunization - Disease - LM - IF - EM - Tx
Minimal change disease (lipoid nephrosis) LM - normal glomeruli (lipid may be seen in PCT cells) IF - negative EM - effacement of foot processes Corticosteriods
94
Nephrotic syndrome associated with HIV, sickle cell LM IF EM Most common in
Focal segmetnal glomerulosclerosis LM - segmental sclerosis and hyalinosis IF - often negative but may be positive for nonspecific focal deposits of IgM, C3, C1 EM - Effacement of foot process similar to minimal change disease African americans and hispanics
95
Membranous nephopathy (membranous glomerulonephritis) LM IF EM Common in Caused by - primary - secondary
LM - diffuse capillary and GBM thickening IF - Granular as a result of immune complex deposition EM - Spike and dome with subepithelial deposits Caucasian adults Primary - Ab to phospholipase A2 receptor (PLA2R) Secondary - NSAIDs - Infectiosn (HBV, HCV, Syphilis) - SLE Poor responds to steroids
96
Diabetic glomerulonephropathy LM Pathogenesis
LM - mesangial expansion - GBM thickening - Eosinophilic nodular glomerulosclerosis ( Kimmelstiel-Wilson lesions) Nonenzymatic glycosylation of GBM --> increased permeability, thickening Nonenzymatic glycosylation of efferent arterioles (hyaline arteriosclerosis) --> increase GFR --> mesangial expansion
97
Uric acid stones where Xray findings Crystal formation
Collecting duct RadiolUcent Rhomboid or rosettes
98
Cystine crystals - xray findings - shape - test
Radiolucent Hexagonal Sodium cyanide nitroprusside test
99
Hydronephrosis due to
Distention or dilation of renal pelvis and calyces Usually caused by urinary tract obstruction (e.g renal stones, sever BPH, cervical cancer)
100
Renal cell carcinoma - originates from - cell description - color - Clinical presentation - Invades (may cause) - Spreads to - Tx - Associated gene - Assoc paraneoplastic
Originates from PCT cells Polygonal clear cells filled with accumulated lipids and carbohydrates Golden yellow due to high lipid content ``` Hematuria Palpable mass Secondary polycythemia Flank pain Fever WL ``` Invades renal vein (May develop varicocele if left sided) Spreads to IVC and spreads hematogenously --> lung and bone Surgery Immunotherapy (aldesleukin) Gene deletion chromosome 3 (Sporadically or part of VHL disease) Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP, renin) Polycythemia, Anemia, Hypercalcemia
101
Well circumscribed mass with central scar in kidney - is what - description - seen with
Renal oncocytoma - benign epithelial cell tumor arising from collecting ducts Large eosinophilic cells with abundant mitochondria without perinuclear clearing Arranged into nests
102
Large palpable unilateral flank mass on child Hematuria - contains - mutation
Wilms tumor (Nephroblastoma) Contains embryonic glomerular structures Loss of function mutation of tumor suppressor genes WT1 and WT2 on chr 11
103
Three syndromes that have wilms tumors
1) WAGR complex - Wilms tumor - Aniridia (absence of iris) - Genitourinary malformation - Mental retardation (WT1 deletion) 2) Denys-Drash - Wilms tumor - Early onset nephrotic syndrome - Male pseudohermaphroditism (WT1 mutation) 3) Beckwith-Wiedemann - Wilms tumor - Macroglossia - Organomegaly - Hemihyperplasia (enlargement one side) (Wt2 mutation)
104
Tumor of urinary tract system - presentation - seen in urine
Transition cell carcinoma Painless hematuria No casts
105
Squamous cell carcinoma of the bladder risk factor
Schistosoma haematobium infection (middle east)
106
Stress incontinence
Outlet incompetence - Urethral hypermobility - Intrinsic sphincteric deficiency Leak with increase intra-abdominal pressure
107
Urgency incontinence Tx
Overactive bladder - detrusor instability Leak with urge to void immediately Tx: Antimuscarinics (oxybutynin)
108
Urinary incontinence associated with MS
Urgency incontinence
109
Overflow incontience Tx
Incomplete emptying - detrusor underactivity - Outlet obstruction Leak with overfilling Increased post void residual Tx - Catheterization - Relieve obstruction (alpha blocker BPH)
110
Seen in chronic pyelonephritis
Coarse, asymmetric corticomedullary scarring blunted calyx Tubules can contain eosinophilic casts resembling thyroid tissue
111
``` Hypocalcemia Hyperphosphatemia Thinning of bones Bone lesions Hyperparathyroidism ```
Renal osteodystrophy Failure of Vit D hydroxylation associated iwth chronic renal disease - secondary hyperparathyroidism
112
>20:1 BUN/CR
Prerenal
113
<15:1 BUN/CR
Intrinsic renal
114
Consequences of renal failure
MAD HUNGER ``` Metabolic acidosis Dyslipidemia (increased TGs) Hyperkalemia Uremia (Increased BUN) Na/ H20 retention (HF, pulm edema, HTN) Growth retardation Erythropoietin failure (anemia) Renal ostodystrophy ```
115
A patient is recovering at the hospital from a suspected bacterial pneumonia. Over the course of a few days he develops fever, rash, dysuria, and urinary urgency. Urinalysis shows a specific gravity of 1.001 with hematuria and mild proteinuria. Renal biopsy shows partial effacement of the tubulointerstitial structures with pronounced edema and infiltration of the interstitium with polymorphonuclear leukocytes, eosinophils, and lymphocytes with papillary necrosis. What is most likely to have caused this condition? (A) Antibiotics (B) Chronic hypertension (C) Lead ingestion (D) Multiple myeloma (E) Wegener’s granulomatosis
A. Antibiotics Acute interstitial nephritis P's - Pee (diuretics) - Pain free (NSAIDS) - Penicillins and cephalosporins - Proton pump inhibitors - RifamPin
116
Part of nephron injured in nephrotoxic acute tubular necrosis
PCT
117
A 64-year-old man with a medical history significant for hypertension, hypercholesterolemia, and coronary artery disease comes to the emergency department because of blood in his urine, nausea, and vomiting. Urinalysis reveals reddish-colored urine with no RBCs, but is positive for granular casts and protein. A basic metabolic panel shows highly elevated BUN and creatinine levels with a BUN:creatinine ratio of 10:1, as well as severe uremia. He is declared to be in acute renal failure and placed on dialysis. This patient has recently started a new drug prescribed by his family physician. Which of the following is the most likely cause of this patient’s renal failure? (A) A β-blocker (B) An autoimmune reaction (C) A statin drug (D) Trauma
C. A statin drug Statin can cause rhabomyolysis
118
``` A 48-year-old man is hospitalized for shock after massive blood loss in a motor vehicle accident. On the patient’s second day in the hospital, his blood urea nitrogen (BUN) and creatinine levels begin to rise and he develops pitting edema to his knees. A subsequent urinalysis shows numerous granular casts. Which of the following is the most appropriate treatment? (A) Angioplasty (B) Broad-spectrum antibiotics (C) Corticosteroids (D) Fluids and dialysis (E) Use of ultrasound to remove blockage ```
D. Fluids and dialysis Acute tubular necrosis secondary to ischemia of the epithelial cells of teh PCT Granular casts**
119
Common agents that cause nephrotoxic acute tubular necrosis
MARCEL ``` Myoglobinuria (Crush injury or statin) Aminoglycosides Radiocontrast agents Cisplatin Ethylene glycol Lead ```
120
Renal papillary necrosis - seen in tubules - clinical presentation (2) - due to - Associated with (4)
Sloughing of necrotic renal papillae - gross hematuria and proteinuria Recent infection or immune stimulus SAAD papa with papillary necrosis: - Sickle cell disease - Acute pyelonephritis - Analgesics (NSAIDS) - Diabetes mellitus
121
ADPKD - Presentation - Mutation - Death from - Caused by - Assoc with (4) - Tx
Numerous cysts in cortex and medulla causing bilateral enlarged kidneys PKD1 chr 16 PKD2 chr 4 Death from complications of chronic kidney disease or hypertension - caused by increased renin production Associated with - Berry aneurysms - Mitral valve prolapse - Bengin hepatic cysts - Diverticulosis Tx - ACE inhibitor - ARBs
122
ARPKD - Presentation - Assoc with - complications
Cystic dilation of collecting ducts Infancy Associated with congenital hepatic fibrosis Potter sequence Complications beyond infancy - systemic HTN - progressive renal insufficiency - portal hypertension due to congenital hepatic fibrosis
123
ACE inhibitor - Use - Adverse - Caution with
HTN HF (decrease mortality) Proteinuria Diabetic nephropathy In chronic kidney disease (diabetic nephropathy) decrease intraglomerular pressure --> slowing GBM thickening Adverse (CATCHH) - Cough - Angioedema - Teratogen - Creatinine (increase, decrease GFR) - Hyperkalemia - Hypotension Caution with patient that have bilateral renal artery stenosis, further decrease GFR
124
Aliskiren - Type - MOA - Use - Adverse
Direct renin inhibitor Blocks conversion of Angtensinogen to angiotensin I Use: HTN Adverse - Hyperkalemia - Hypotension - Angioedema
125
Brown urine Subepithelial humps Decrease C3
Post streptococcal glomerulonephritis
126
Red spots on butt and legs Abdominal pain Hematuria Proteinuria <3.5
IgA Nephropathy
127
Which glomerular disease 1) Linear pattern of IgG deposition on IF 2) Lumpy-bumpy deposits of IgG, IgM, C3 in the mesangium 3) Deposits of IgA in teh mesangium 4) Anti-GBM antibodies, hematuria and hemoptysis 5) Crescent formation in the glomeruli 6) Wire loop appearance on LM 7) EM: Effacement of epithelial foot processes 8) Nephrotic syndrome assoc w/ Hep B 9) Nephrotic syndrome assoc with HIV 10 ) EM:Subendothelial humps and tram-track appeance 11) LM: Segmental sclerosis and hyalinosis 12) Purpura on back of arms and legs, abdominal pain, IgA nephropathy 13) Em: Spiking of the GBM due to electron-dense subepithelial deposits
1) Linear pattern of IgG deposition on IF - Good pasture 2) Lumpy-bumpy deposits of IgG, IgM, C3 in the mesangium - Post-streptococcal glomerulonephritis 3) Deposits of IgA in teh mesangium - IgA nephropathy 4) Anti-GBM antibodies, hematuria and hemoptysis - Good pasture 5) Crescent formation in the glomeruli - Rapidly progressive glomerulonephritis 6) Wire loop appearance on LM - Lupus nephritis 7) EM: Effacement of epithelial foot processes - Minimal change disease 8) Nephrotic syndrome assoc w/ Hep B - Membranous GN > Membranoproliferative 9) Nephrotic syndrome assoc with HIV - Focal segmental glomerulosclerosis 10 ) EM:Subendothelial humps and tram-track appeance - Membranoproliferative glomerulonephritis 11) LM: Segmental sclerosis and hyalinosis - Focal segmental glomerulosclerosis 12) Purpura on back of arms and legs, abdominal pain, IgA nephropathy - Henoch-Schonlein purpura 13) Em: Spiking of the GBM due to electron-dense subepithelial deposits - Membranous nephropathy
128
Thickening of basement membrane | Spike and dome appearance
Membranous glomerulonephritis SLE can cause
129
Train track | Subendotheial humps
Membranoproliferative glomerulonephritis
130
Glomerulonephritis assoc w/ Hep B and C
Membranoproliferative glomerulonephritis
131
Hematuria and proteinuria Pulmonary infiltrates Nasopharyngeal granulomas c-ANCA
Granulomatosis with polyangiitis (wegener's dis)
132
Urinary casts are made up of
Tamm-Horsfall mucoprotein Secreted by tubule epithelial cells
133
Diffuse maculopapular rash Azotemia Eosinophilia Fever
Acute interstitial nephritis (AIN) Allergy induced Drug induced
134
Urease producing bacteria
Proteus mirabilis Klebsiella S. saprophyticus Struvite stones ``` Pee CHUNKSS Proteus mirabilis Cryptococcus H. pylori Ureaplasma Nocardia Klebsiella S. Epidermidis S. Saprophyticus ```
135
Renal tumor with clear cells
Renal cell carcinoma Full of lipids/ carbs
136
Major risk factors transitional cell carcinoma
Smoking** Aniline dyes Naphthylamine dyes Cyclophosphamide
137
Gene for thickened ectoderm at distal end of each developing limb bud
Wnt-7 gene
138
Gene for lengthening of limbs
FGF gene
139
Mutation in HOX presents as
Appendages in wrong locations
140
What forms week 3
Neural tube
141
Disruption vs deformation
Disruption - Secondary breakdown of previously normal tissue or structure Deformation - extrinsic disruption; occurs after embryonic period
142
Field defect
Initial embryonic disturbance leas to multiple malformations by disrupting the development of adjacent tissues ( holoprocephaly)
143
ACE inhibitors on fetus
Renal damage
144
Alkylating agents on fetus
Absence of digits | Multiple anomalies
145
MOA in fetal alcohol syndrome
Failure of cell migration
146
Twinning - Dichorionic diamniotic - Monochorionic diamniotic - Monochorionic Monoamniotic - Conjoined
Dichorionic diamniotic (0-4 days) Monochorionic diamniotic (4-8 days) Monochorionic Monoamniotic (8-12 days) Conjoined (> 13 days)
147
How does syncytiotrophoblast avoid attack by maternal immune system
Lacks MHC I expression
148
Decidua basalis | - derived from
Maternal component of placenta Derived from endometrium
149
Umbilical arteries return ______ blood from fetal _________ arteries to placenta
deoxygenated blood from fetal internal iliac arteries to placenta
150
Umbilical vein drains into IVC via
Liver or ductus venosus
151
Urachus formation
In the 3rd week the yolk sac forms the allantois Which extends into urogenital sinus Allantois becomes the urachus, a duct between fetal bladder and umbilicus
152
Urachal cyst is a risk for
Fluid filled cavity lined with uroepithelium between umbilicus and bladder Risk for Adenocarcinoma
153
Vesicourachal diverticulum
Slight failure of urachus to obliterate Outpouching of bladder
154
What occurs during 7th week
Obliteration of vitelline duct (omphalomesenteric duct), which connects yolk sac to midgut lumen
155
Meconium discharge from umbilicus
Vitelline fistula Vitelline duct fails to close
156
Aortic arch derivatives
1st Arch: Part of maxillary artery 2nd arch: stapedial artery and hyoid artery 3rd arch: common carotid artery and proximal part of internal carotid artery 4th arch: - left: aortic arch - right: proximal part of right subclavian artery 5th arch: Proximal part of pulmonary arteries and (on left only) ductus arteriosus
157
Recurrent laryngeal nerves loop around
Left loops around: aortic arch distal to ductus arteriosus Right loops around right subclavian artery
158
Brachial clefts, arches and pouches derived from
Clefts: Ectoderm Arches: Mesoderm Pouches: Endoderm
159
Branchial cleft cyst
Lateral neck Anterior to sternocleidomastoid muscle Immobile during swallowing Cleft= ectoderm derived Persistent cervical sinus
160
Branchial pouch derivates
1st pouch - middle ear cavity, eustachian tube, mastoid air cells 2nd pouch - epithelial lining of palatine tonsil 3rd pouch - dorsal wings: inferior parathyroids - ventral wings: thymus 4th pouch - dorsal wings: super parathyroids - ventral wings: ultimobranchial body, parafollicular C cells of thyroid
161
Cleft lip failure of
fusion of maxillary and medial nasal processes
162
cleft palate failure of
fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelves with nasal septum and/or median palatine shelf
163
Male Development
SRY gene on Y chromosome Produces testis-determining factor --> testes development Sertoli cells secrete Mullerian inhibitory factor (MIF) that suppresses development of paramesonephric ducts Leydig cells secrete androgens that stimulat development of mesonephric ducts Leydig Leads to male (internal and external) sex differentiation Sertoli Shuts down female (internal) sex differentation
164
Mesonephric duct
Develops into male internal structures (except prostate) SEED - Seminal vesicles - Epididymis - Ejaculatory duct - Ductus deferens
165
XY with No Sertoli cells
Lack of Mullerian inhibitory factor Develop both male and female internal genitalia Male external genitalia
166
5alpha reductase deficiency - defect - internal genitalia - external genitalia - inheritence - Serum levels
Inability to convert testosterone to DHT Male internal genitalia Ambiguous external genitalia until puberty ( Increase testosterone levels cause masculinization) Autosomal recessive Normal testosterone/ estrogen LH normal or increased
167
Septate uterus due to - consequences
Incomplete resorption of septum Thick V shaped Decreased fertility Early miscarriage/ pregnancy loss
168
Bicornuate uterus - due to - consequences
Incomplete fusion of Mullerian ducts Increased risk of complicated pregnancy Early pregnancy loss Malpresentation Prematurity
169
Uterus didelphys
Complete failure of fusion | --> double uterus, cervix and vagina
170
Genital tubercle becomes
Top bulb towards front of person Males 1) Glans penis 2) Corpus cavernosum and spongiosum Female 1) Glans clitoris 2) Vestibular bulbs
171
Urogenital sinus becomes
Males 1) Bulbourethral glands (of Cowper) 2) Prostate gland Female 1) Greater vestibular glands (of Bartholin) 2) Urethral and paraurethral glands (of Skene)
172
Urogenital folds becomes
Outside mound surrounding genital groove, just posterior to genital tubercle Male - Ventral shaft of penis (penile urethra) Female - Labia minora
173
Labioscrotal swelling becomes
Large mound outside Urogenital folds Male - Scrotum Female - Labia Majora
174
Bifid scrotum
Malunion of the labioscrotal folds
175
Hypospadias - is what - due to - associated with (2)
Abnormal opening of penile urethra on ventral surface of penis Due to failure of urethral folds to fuse Associated with - Inguinal hernia - Cryptochidism Hypo is below
176
Epispadias - is what - due to - associated with
Abnormal opening of penile urethra on dorsal surface of penis Due to faulty positioning of genital tubercle Associated with - Exstrophy of bladder When you have Epispadias, you hit your Eye when you pEE
177
Anchors testes within scrotum - Female remnant
Male remnant of Gubernaculum (band of fibrous tissue) Female remnant= ovarian ligament and round ligament of uterus
178
Gubernaculum - Male remnant - Female remnat
Band of fibrous tissue Anchors testes within scrotum Ovarian ligament + round ligament of uterus
179
Processus vaginalis
Evagination of peritoneum Male remnant - forms tunica vaginalis Female remnant - Obliterated
180
Venous drainage of gonads
Left ovary/ testis --> left gonadal vein --> left renal vein --> IVC Right ovary/ testis --> right gonadal vein --> IVC Left gonadal vein takes the LONG way around
181
Varicocele more common on
More common on left Left spermatic vein enters the left renal vein at 90 degree angle, flow is less laminar on left than right. Left venous pressure > Right venous pressure Varicocele more common on left
182
Lymphatic drainage 1) Glans penis 2) Distal vagina 3) Uterus 4) Ovaries/ testes 5) Vulva/ Scrotum 6) Cervix 7) Prostate 8) Superior bladder 9) Distal anus 10) Corpus cavernosum 11) Proximal vagina
1) Glans penis= Deep inguinal nodes 2) Distal vagina= Superficial inguinal nodes 3) Body of Uterus= External iliac nodes 4) Ovaries/ testes= Para-aortic lymph nodes 5) Vulva/ Scrotum= Superficial inguinal nodes 6) Cervix= Internal iliac nodes 7) Prostate= Internal iliac nodes 8) Superior bladder= External iliac nodes 9) Distal anus= Superficial inguinal nodes 10) Corpus cavernosum= Internal iliac nodes 11) Proximal vagina= Internal iliac nodes
183
Ligate what vessels during oophorectomy to avoid bleeding
``` Infundibulopelvic ligament ( suspensory ligament of ovary) - ovarian vessels ```
184
Ligated in hysterectomy
Cardinal ligament | - Uterine vessels
185
Ligament/ vessels involved in ovarian torsion
``` Infundibulopelvic ligament ( suspensory ligament of ovary) - ovarian vessels ```
186
Maintains anteflex uterus
Round ligament of the uterus - Uterien fundus to labia majora Derivative of gubernaculum Travels through round inguinal canal; above artery of sampson
187
Ovarian ligament
Derivative of gubernaculum Ovarian Ligament Latches to Lateral Uterus
188
No vessels in which ligaments
Ovarian ligament | Round ligament
189
Female reproductive histology 1) Stratified squamous epithelium, non keratinized 2) Simple columnar epithelium 3) Simple columnar epithelium with long tubular glands in proliferative phase; coiled glands in secretory phase 4) Simple columnar epithelium, ciliated 5) Simple cuboidal epithelium
1) Vagina Ectocervix 2) Endocervix 3) Uterus 4) Fallopian tube 5) Ovary
190
Pathway of sperm ejaculation
SEVEN UP | ``` Seminiferous tubules Epididymus Vas deferens Ejactulatory duct Nothing Urethra Penis ```
191
Urethra prone to injury from pelvic fracture - leak where
Posterior urethra- membranous urethra prone to injury from pelvic fracture Cause urine to leak into retropubic space
192
Urethra injured in perineal straddle injury - leak where
Anterior urethra- bulbar urethra Urine leaks beneath deep fascia of Buck If fascia torn, urine escapes into superficial perineal space
193
Emission controlled by
Sympathetic nervous system | hypogastric n.
194
Ejaculation controlled by
Visceral and somatic nerve | pudendal nerve
195
Proerectile and antierectile
Proerectile - NO --> increase cGMP --> smooth muscle relaxation --> vasodilation --> erection Antierectile - NE --> increase Ca --> smooth muscle contraction --> vasoconstriction
196
Cell type that lines seminiferous tubules
Spermatogonia (germ cells) -Produce primary spermatocytes Sertoli cells
197
Sertoli cells secrete
Inhibin B --> inhibit FSH Androgen binding protein --> maintain local levels of testosterone MIF Form blood-testis-barrier
198
Estrogen sources
Ovary= estradiol Placenta= estriol Adipose tissue= estrone
199
Ovulation steps
Increase estrogen Increase GnRH receptors on anterior pituitary Estrogen surge stimulates LH release --> ovulation (rupture of follicle) Increase temp ( progesterone induced)
200
Follicular growth is fastest during what
2nd week of follicular phase
201
What stimulates and maintains endometrium
Estrogen stimulates endometrial proliferation Progesterone maintains endometrium to support implantation
202
Fertilization commonly occurs in when
The ampulla Within 1 day of ovulation
203
Implantation occurs
6 days after fertilization
204
What secretes hCG after implantation - fxn - timing
Syncytiotrophoblasts of placenta Maintains corpus luteum (progesterone) for first 8-10 weeks of pregnancy
205
Placenta at 8-10 weeks
Synthesizes its own estriol and progesterone Syncytiotrophoblasts stop producing hCG Corpus luteum regresses
206
hCG subunits
alpha subunit - identical to LH, FSH, TSH - Increase hCG can cause hyperthyroidism Beta subunit - unqiue - pregnancy test detects
207
Human placental lactogen - secreted by - fxn
Syncytiotrophoblast of placenta Stimulates insulin production Increase insulin resistance due to shunting carbohydrate metabolism toward supplying glucose/ amino acids to fetus Increase lipolysis (due to insulin resistance)
208
APGAR score | - what score requires further evaluation
``` Appearance Pulse Grimace Activity Respiration ``` <7 needs evaluation
209
Prolactin fxn (2) Oxytocin fxn (2)
Prolactin - induce and maintain lactation - decrease reproductive function Oxytocin - Milk letdown - uterine contractions
210
Breast milk contains | - Age for breast feeding
< 6 months old | IgA, Macrophages, Lymphocytes
211
Exclusively breast feed infants require
Vit D supplementatoin
212
Menopause diagnosed by - due to - increase in what
Amenorrhea for 12 months Decreased estrogen production due to age-linked decline in number of ovarian follicles Increase FSH, LH, GnRH
213
Testosterone fxn (5) vs DHT fxn (4)
Testosterone - Differentiation of internal genitalia (except prostate) - Growth spurt (penis, muscles) - Deepening of voice - Closing epiphyseal plates (via estrogen converted from testosterone) - Libido DHT - Early: differentiation of penis, scrotum and prostate - Late: prostate growth, balding, sebaceous gland activity
214
Testosterone converted to DHT by -Inhibited by
5alpha-reductase Inhibited by: finasteride
215
Spermatogenesis - takes how long - occurs where Spermiogenesis - is what
2 months Seminiferous tubules Spermiogenesis - Spermatids undergo loss of cytoplasmic contents, gain of acrosomal cap to form mature spermatozoon
216
Spermatogenesis steps (5)
"Gonium" is going to be a sperm; "Zoon" is Zooming to egg Spermatogonium - Diploid, 2N 2C - 46 single chromosomes Primary spermocyte - Diploid, 2N, 4C - 46 sister chromatids - division of X and Y at end of meiosis I Secondary spermatocyte - Haploid, 1N, 2C - division of X-X - division of Y-Y at meiosis II Spermatid - 1N 1C Spermatozoon
217
47 XXY male, one X chromosome from patients father error occurred at what stage of spermatogenesis?
Primary spermatocyte | - division of X and Y occurs at end of meiosis I
218
Spermiogenesis
Spermatid Haploid (1N, 1C ) --> Mature spermatozoon (1N, 1C) with acrosome, tail
219
47 XYY male, both Y from father, occur at what stage of spermatogenesis
Secondary spermatocyte
220
No sexual hair | Flat appearing chest with raised nipple
Tanner stage 1
221
Coarse pubic hair reaching thighs | Aerola flattens
Tanner stage 5
222
Pubic hair appears | Formation of breast buds
Tanner stage 2
223
Dark thick public hair not touching thighs Breast enlarges Raised areola
Tanner stage 4
224
Pubic hair darkening and thickening | Breast mound forms
Tanner stage 3
225
Testicular enlargement | Pubic hair appears
Tanner stage 2
226
Coarse pubic hair not reaching thigh | Penis width and glans increase
Tanner stage 4
227
Pubic hair darkening and thickening | Penis size and length increases
Tanner stage 3
228
Mullerian duct forms
Fallopian tubes, Uterus, Cervix and upper vagina
229
Amenorrhea Normal ovaries and secondary sexual characteristics No uterus
``` Mullerian aplasia (46, XX) - Vaginal agenesis or Mayer- Rotitansky Kuster houser syndrome ``` No upper vagina
230
Androgen insensitivity syndrome - Chromosomes - Clinical feature - Internal genitalia - External genitalia - Serum
46, XY Minimal axillary or pubic hair Cryptorchid testes No uterus or ovaries External female development Increased testosterone, estrogen, LH
231
Amenorrhea No secondary sexual characteristics No sense of smell
Kallman syndrome Due to defect of X linked KAL chain Defective migration of GnRH releasing neurons and subsequent failure of GnRH-releasing olfactory bulbs to develop --> decreased synthesis of GnRH in hypothalamus Decrease GnRH, FSH, LH, testosterone
232
Klinefelter syndrome - Chromosomes - Clinical feature - Internal genitalia - External genitalia - Feature - Pathogenesis
47, XXY Tall stature, long extremities Developmental delay Atrophic testes and infertility Poorly developed secondary characteristics Male Gynecomastia Presence of inactivated X chromosome (Barr body) Dysgenesis of seminiferous tubules --> decrease in inhibin B --> increase FSH Abnormal Leydig cell function --> decrease testosterone --> increase LH --> increase estrogen
233
How to tell coarctation of aortic | - assoc with
Femoral < brachial pulse Turner syndrome
234
Turner syndrome associated with (4)
Coarctation of aorta Bicuspid aorta Cystic hygroma Horseshoe kidney
235
Barr body seen in
Klinefelter syndrome 47 XXY
236
Double Y males (XYY) features
``` Very tall Normal fertility Severe acne Learning disability Autism ```
237
Placental aromatase deficiency - due to - affect in fetus - serum levels - affect in mother
Inability to synthesize estrogens from androgens Masculinization of female (46,XX DSD) - ambiguous genitalia Increased serum testosterone and androstenedione Can present with maternal virilization during pregnancy
238
Pregnant female presents to office with development of coarse facial hair
Placental aromatase deficiency | - inabilitly to synthesize estrogen fro androgens
239
Hydatidiform mole forms from Tx Monitor
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast) Methrotrexate Monitor hCG
240
Partial mole - Karyotype - components - fetal parts - uterine size - hCG - risk of malignancy - risk of choriocarcinoma
69, XXX 69, XXY 69 XYY 2 sperm + 1 egg Fetal parts Normal uterine size Increased hCG Low risk of malignancy Rare risk of choriocarcinoma
241
Complete mole - Karyotype - components - fetal parts - uterine size - hCG - imaging - risk of malignancy - risk of choriocarcinoma
46, XX 46,XY enucleated egg + single sperm (sperm duplicates paternal DNA) No fetal parts Increased uterine size HIGH increased in hCG Honey combed uterus or clusters of grapes Snowstorm on ultrasound Yes risk of malignancy Risk of choriocarcinoma
242
Choriocarcinoma - Is what - Occurs when - Not seen - Increases frequency - Presents as (3) - Spread
Rare Malignancy of trophoblastic tissue - Can occur during or after pregnancy No chorionic villi present Increase frequency of bilateral/ multiple theca-lutein cysts Presents - elevated hCG - SOB - hemoptysis - bloody brown discharge Hematogenous spread to lungs (cannonball metastases)
243
Cannon ball metastases
Choriocarcinoma Malignancy of trophoblastic tissue - Can occur during or after pregnancy
244
Placenta accreta
Placenta attaches to myometrium without pentreting it
245
Placenta increta
Placenta penetrates into myometrium
246
Placenta percreta
Placenta penetrates (perforates) through myometrium and inot uterine serosa
247
Placenta accreta, increta and percreta due to
Defective decidual layer
248
Vasa previa - is what - may result in - triad presentation - assoc with
Fetal vessels run over or in close proximity to cervical os May result in vessel rupture, exsanguination, fetal death Presents triad - Membrane rupture - painless vaginal bleeding - fetal bradycardia (< 110 beats/ min) Assoc with - Velamentous umbilical cord insertion (cord inserts in chorioamniotic membrane rather than placenta --> fetal vessels travel to placenta unprotected by Wharton jelly)
249
Midline epislotomy
Incision made during delivery to widen opening Posterior vaginal opening to perineal body
250
Preeclampsia - is what - caused by
New onset HTN with proteinuria or end-organ dysfunction after 20th week of gestation Caused by abnormal placental spiral arteries
251
Pregnant lady HTN Proteinuria Edema
Preeclampsia
252
Eclampsia due to
Cerebral profusion abnormalities
253
Glomerular ischemia and hyperfiltration
Hypertensive neuropathy
254
3 y.o clear grape like projection from vagina - is what - type - affects - cells - positive for
Sarcoma botryoides Embryonal rhabdomyosarcoma variant Affects girls <4 y.o Spindle shaped cells + Desmin
255
Amenorrhea Decreased fertility Enlarged bilateral cystic ovaries - Due to - Serum - Other features (2) - Increased risk of - Tx
Polycystic ovarian syndrome Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feed back response Increase LH: FSH ration (>2:1), Increase LH, Increase androgens (testosterone) --> decrease rate of follicular maturation --> unruptured follicles (cysts) Hirsutism Acne Increased risk endometrial cancer due to unopposed estrogen from repeated anovulatory cycles OCPs Clomiphene Metformin (induce ovulation)
256
Bilateral cysts - type - due to - assoc with (2)
Theca-lutein cysts Due to gonadotropin stimulation Assoc w/ choriocarcinoma and hydatidiform moles
257
Teratoma can present with
Hyperthyroidism
258
Solid yellow tumor in ovary Looks encapsulated Contain Cuboidal epithelium
Brenner tumor | - urinary tract like epithelium
259
Meigs syndrome
Ovarian fibroma Ascites Hydrothorax
260
Abnormal uterine bleeding in post menopausal women | Mass in ovary
Thecoma | - may produce estrogen
261
Abnormal uterine bleeding in post menopausal women Mass in ovary Call Exner bodies
Granulosa cell tumor Produce estrogen and progesterone Unilateral
262
Tumor male testes Young child +AFP Yellow
Yolk sac tumor
263
Layers of penis (4)
1. Outer dermis 2. Dartos fascia - continuous with colles fascia of perineum - scarpa's fascia of abdominal wall 3. Deep (Buck's fascia) - continuation of deep perineal fascia - separates corpus spongiosum from corpus cavernosa 4. Tunica albuginea - surrounds 2 corpora cavernosa dorsolaterally - corpus spongiosum ventrally
264
What can be damaged in prostatectomy
Cavernous nerves --> erectile dysfunction Prostatic plexus gives rise to cavernous nerves, parasymathetic fibers to penis for erection
265
Nerve to muscles at base on penis
Pudendal n.
266
Main artery of pelvis
Internal iliac A.
267
Tx Prostate cancer
Flutamide Nonsteroidal competitive inhibitor at testosterone receptor
268
Use to tx hirsutism in polycystic ovarian syndrome
Ketoconazole - inhibits steroid synthesis (inhibit desmolase) Spironolactone - inhibits steroid binding
269
True hermaphrodite MOA
XX or XY Have ovarian and testicular tissue Two fertilized ovum that fuse Cross over of SRY gene from Y chromosome to X chromosome during meiosis
270
Pain of testicles relieved by lifting Tx
Epididymitis Tx - GC/Chlamydia= Ceftriaxone IM then doxycycline > 35 y.o or history of anal intercourse - Enterobacteriaceae= Fluoroquinolone
271
Painless homogenous testicular enlargement | Large cells and lobules with watery clear cytoplasm
Seminoma - Fried egg appearance Radiosensitive
272
Painful palpable mass in scrotum | Glandular with papillary morphology
Embryonal carcinoma - malignant AFP normal hCG may be elevated
273
Yellow tumor in young male testicle | Increased AFP
Yolk Sac tumor
274
Pattern where mesodermal core w/ central capillary lined by flattened layers of parietal and visceral cells Testicular tumor
Yolk Sac tumor
275
Testicular tumor Brown cut surface tumor Gynecomastia Rod-shaped crystaloids
Leydig cell tumor - Produce androgens - May produce estrogens Reinke crystals
276
Tumor associated with Peutz-Jegher
Sertoli cell tumor
277
Hydrocele due to
Incomplete fusion of processus vaginalis
278
Spermatocele due to
Dilated epididymal duct
279
Varicocele is
Dilated veins in pampiniform plexus
280
Gray solitary crusty plaque on penile shaft or scrotum - progress to
Bowen disease | - invasive squamous cell carcinoma
281
Red velverty plaque on glans of penis
Erythroplasia of Queyrat | - Type of Bowen disease
282
Bowen disease associated with
Uncircumscribed and HPV
283
Reddish papules of penile shaft
Bowenoid papulosis
284
Painful erection | - due to
Peyronie disease Due to inflammation and fibrous tissue formation of the tunica albuginea
285
Priapism | - assoc with
Persistent penile erection sickle cell disease
286
Balanitis - organism - more common in
Inflammation of glans penis Candida Uncircumscised and diabetes
287
Prostatitis - symptoms - organisms - tx
Dysuria, frequency, uregency, low back pain < 35= gonorrhea, chlamydia >35= E. coli, klebsiella, serratia, enterobacter, proteus Tx - fluoroquinolone (levoflxacin) TMP-SMX
288
Tamsulosin
Alpha 1 (A,D) blocker Fewer sideeffects than nonselectives No antihypertensive effects
289
Non-selective alpha 1 blockers
Doxazosin Prazosin Terazosin Decrease prostate smooth muscle tone --> immediate improvement in urine flow Postural hypotension
290
``` Urinary frequency Nocturia Weak stream 60 y.o man + PSA ``` Tx
Prostate adenocarcinoma - develops in posterior lobe Metastasize to bone - Low back pain - increased alk phos Tx - Flutamide (inhibit testosterone receptor) - Resection
291
Side effects sildenafil
``` Flushing HA Dyspepsia Impaired blue/green color vision Life threatening hypotension (w/ nitrates) ```
292
LH in Theca cell induces
Induces cholesterol --> androstenedione by desmolase
293
Female reproductive cycle starts with increase in
FSH
294
Tumor associated with Combined estrogen-progestin
Hepatic adenoma | - Tumor of liver
295
Thinning o fepidermis Smooth white plaques Pruritis Painful intercourse
Lichen sclerosus Risk of squamous cell carcinoma of vulva
296
Enlarged nuclei and perinuclear halo
Koilocytosis HPV
297
Hepatic adenoma associated with
OCP use
298
HPV MOA
E6 binds to p53 --> degradation | E7 product binds and inactivates Rb
299
Post partum endometritis tx
Gentamicin + clindamycin
300
Continuous GnRH agonist
Leuprolide
301
Danazol
Synthetic androgen Partial agonist at androgen receptor --> inhibits release of FSH and LH via negative feedback Side effect - Acne - hirsutism - Deepening voice - Weight gain - Decreased HDL - Hepatotoxicity
302
Tender enlarged uterus Pelvic pain Dysmenorrhea Menorrhagia
Adenomyosis
303
Nontender, enlarged uterus with irregular contours - pattern
Leiomyomas (leiomomata uteri) Whorled pattern
304
Given presurgery for fibroids to shrink - MOA - adverse effect
Leuprolide Bind GnRH receptors Initially increase LH and FSH --> downregulation of LH and FSH Amenorrhea Decreased Libido Depression Bone loss **
305
Rapidly enlarging uterus
Leiomyosarcoma
306
Characterized by plasma cells in the endometrium
Chronic endometritis
307
Used to tx infertility due to anovulation - drug - type - MOA - Side effects
Clomiphene - Selective estrogen receptor modulator (SERM) Agonist or antagonist depending on tissue Binds estrogen receptors in hypothalamus --> blocks negative feedback of estrogen --> increase release FSH and LH Side effect - visual disturbances - hot flashes - ovarian enlargement - multiple gestations
308
struma ovarii
teratoma contains functional thyroid tissue --> hyperthyroidism
309
Ovarian tumor hCG LDH Clear cytoplasm and central nuclei
Dysgerminoma | - analogous to seminoma
310
Sertoli- Leydig tumors
Can resemble seminiferious tubules Produce androgens --> virilization - Hirsutism - Deepening of voice - Clitoromegaly Yellow grossly
311
Bilateral vs unilateral ovarian tumor
Bilateral - Epithelial tumors (serous, mucinous, endometriod, clear cell, brenner) Unilateral - germ cells (teratoma, dysgerminoma, yolk, choriocarcinoma) - Sex cord stromal ( granulosa, sertoli-leydig, fibroma, thecoma)
312
Schiller-Duval body Call Exner Psammoma body
Schiller-Duval body= Yolk sac tumor Call Exner= Granulosa cell tumor Psammoma body= serous tumor
313
What physiologic changes are seen in pregnancy that decrease
BP | BUN/ CR
314
Big risk factor for placental abruption
Cocaine use ** HTN Prior abruption Trauma Smoking Painful vaginal bleeding
315
Medications for HTN to use in pregnancy
HTN Moms Love Nifedipine Hydralazine Methyldopa - central acting alpha 2 receptor agonist Labetalol - Combine alpha and beta adrenergic blocker Nifedipine - Ca channel blocker
316
Delays preterm labor
Terbutaline - selective beta agonist Side effect - tachycardia - hypotension - pulmonary edema
317
Misoprostol
Prostaglandin E1 analog Prevent peptic ulcer in people w/ NSAIDs Keep patent ductus arteriosus open Cervical dilation and uterine contraction
318
Dinoprostone
Prostaglandin E2 analog
319
Tx for hyperstimulation due to prostaglandins
Terbutaline
320
Mifepristone
RU-486 Competitive antagonist at progesterone receptor Termination early pregnancy
321
Complications of diabetes in pregnancy
Macrosomia | Hypoglycemia
322
``` New onset HTN Proteinuria Low hemoglobin Low platelet count HIgh AST ```
HELLP syndrome
323
Down syndrome nondisjunction during
anaphase meiosis I
324
Prenatal US clue that fetus may have down syndrome
Nuchal translucency
325
Cafe au lait spots Neural tumors Pigmented nodules in eye Scoliosis
Neurofibromatosis type I AD Mut Chr 17
326
Tuberous sclerosis mutation of
hamartin or tuberin gene
327
Von Hippel lindau disease - risk for developing - features - results in expression of
Hemangioblastomas of retina, cerebellum adn medulla Pheochromocytomas Risk bilateral RCC Expression of HIF
328
Staggering gait, Frequent falling, nystagmus, pes cavus Hammer toes - mutation of - inheritence - type disorder
Freidreich ataxia - AR - GAA - frataxin (mitochondrial protein involved in iron detoxifying and storage)
329
Cystic fibrosis tx
N-acetylcysteine | Antibiotics (fluroquinolones)
330
``` Painless papules on lower abdomen and butt Pain Renal failure HTN Cardiomyopathy Angiokeratomas ```
Fabry disease - X linked Def: alpha-galactosidase Acc: ceramide trihexoside
331
``` Hepatosplenomegaly Painful bony lesions Anemia Fatigue Thrombocytopenia ```
Gaucher disease AR Glucocerebrosidase Acc: glucocerebroside Prominent blue cytopalasmic fibrils (crumpled tissue paper)
332
``` Hepatosplenomegaly Thrombocytopenia Ataxia Dysarthria, dysphagia Worsening of intellectual function Cherry red spot ```
Niemann-Pick AR Def: spingomyelinase Acc: Spingomyelin Foam cells
333
Worsening of intellectual function Cherry red spot Worsening of physical abilities
Tay-Sach AR Def: hexosaminidase A Acc: GM2 ganglioside No hepatosplenomegaly
334
``` Weakness or numbness in hands Seizures Decrease in vision Weakness Developmental dealy ```
Krabbe disease AR (start at 3-6 months, dead by 2) Def: galactocerebrosidase Acc: galactocerebroside
335
Muscle wasting Weakness Progressive vision loss Dementia
Metachromatic leukocystrophy AR After first year of life Def: Arylsulfatase Acc: cerebroside sulfate
336
``` Hepatosplenomegaly Coarse facial features Intellectual disability Poor growth (dwarf) Corneal clouding ```
Hurler syndrome AR Alpha L iduronidase acc: heparan sulfate/ dermatan sulfate
337
Hepatosplenomegaly Aggression Coarse facial features
Hunter syndrome X linked recessive iduronate sulfatase acc: heparan sulfate and dermatan sulfate
338
Breast cancer ER and PR positive Signet ring cells
Lobular carcinoma in situ
339
Mastitis due to
S. aureus
340
Serous or bloody nipple discharge
Intraductal papilloma | - in lactiferous duct
341
Large bulky breast tumor | Leaf like projections
Phyllodes tumor
342
Tamoxifen - type - use - risk
Estrogen antagonist in breast tissue Tx primary breast cancer Increased risk of endometrial cancer
343
Raloxifene - type - use - moa - risk
Estrogen agonist in bone Used for osteoporosis Estrogen antagonist in breast No risk endometrial cancer
344
Anastrozole - type - moa - use - risk
Aromatase inhibitors Inhibits production of estrogen by inhibiting aromatase Postmenopausal women with breast cancer Increase risk of osteoporosis and fractures
345
Orderly row of cells (single file) Breast mass - due to
Invasive lobular carcinoma Due to decreased expression of E cadherin
346
BPH tx
Alpha 1 antagonist - terazosin, tamsulosin - relaxation of smooth muscle 5alpha reductase inhibitors - finasteride PDE-5 inhibitors - tadalafil
347
Minoxidil
Direct arteriolar vasodilator ``` Androgenetic alopecia (pattern baldness) Severe refractory hypertension ```
348
Floppy baby at birth
Werdnig Hoffman disease
349
Tx RCC
Aldesleukin (IL-2)

AM- STEP1 (20 decks)

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