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what is the most likely explanation for hyperthyroidism in pregnant women?

hCG is homologous to TSH (thyrotropin) and stimulates excess release of TH from thyroid gland


what is hyperemesis gravidarum?

intractable nausea, may be caused by extremely high hCG (also due to hyperthyroidism)


what is a complete VS incomplete/partial hydatidiform mole?

complete: empty ovum is fertilized with an X sperm that duplicated
-proliferates widely as a tumor, isntead of a normal fetus

incomplete: egg was fertilized by 2 sperm or 1 sperm that duplicated, so it becomes 69 or 92 Xm
-usually dies quickly


explain the gravida and para X-X-X-X system?

gravida = how many times one has been pregnant
para = full term - pre-term - abortion - living children
-Floriday Power and Light


what are the three MUST GIVES for OB-GYNs?

1. betamethasone - improve outcomes for neonates that are delivered prematurely
-intramuscular to decrease intra-cranial hemorrhage, necrotizing encephalitis
2. zidovudine - prevent vertical transmission of HIV to baby
3. progesterone supplementation


what is consumptive coagulopathy?

inability to clot following hemorrhage, because so many clotting factors have been used up
-can lead to DIC


what is Sheehan syndrome?

pan-pituitary dysfunction
-susceptible to hypoperfusion in times of shock
-usually anterior pituitary, but can be both


why is the GTT important to perform in PCOS women?

for every year a woman has PCOS, the risk for developing glucose intolerance and/or DMII rises
-GTT is most reliable test to rule out clinically significant glucose intolerance


what are myoepithelial cell markers (normally)?

smooth muscle myosin heavy chain


what is a sclerosing adenosis?

lobulocentric proliferative lesion
-mostly in association with fibrocystic change
-may to detectable upon palpation and X-ray
-usually <2 cm
-often associated with calcifications
-show 1.5 to 2-fold increase in breast cancer risk


what are details on fibroadenomas?

stromal cells express ER-beta, while epithelial cells variably express Er-alpha
-both express PR


what is adenomyoepithelioma of the breast?

uncommon benign lesion composed of proliferating epithelial and myoepithelial cells


explain what "triple negative" and "basal-like" means for breast cancer?

3-: it means it is negative for ER, PR (hormone receptors), and HER2/Neu (about 10-20% of breast cancers)
basal: tumors have cells with features similar to basal cells surrounding mammary (most have p53 mutations)
-most, but not all, triple-negative are basal-like (and vice versa)
-occur in younger and African-American women
-most BRCA1 tumors are both triple-negative and basal-like
-often aggressive with poor prognosis


what are stats on BRCA1/2 mutations?

-increase risk of ovarian cancer from 2% up to 70%
-reduce risk by having prophylactic oophorectomy
-increased risk of pancreatic, prostate, colon, and second primary cancer
-defective tumors have specific patterns of genetic alterations required for tumor genesis
-1:400 to 1:800 people have BRCA1/2 mutation
--1:40 Ashkenazi Jews


relationship between Myb, p53, and BRCA1 mutation?

Myb amplification and p53 mutation with different pattern frequently occur in BRCA1 deficient tumros compared to sporadic ones


what is beer potomania?

hyponatremia/kalemia due to excessive beer
-cause dizziness, muscle weakness, neurological impairment, seizures


is the osmotic force exerted by PRO and phosphates greater in intracellular space or extracellular space? what prevents them from swelling?

intracellular space
-Na/K ATPase prevent lysing


how is extracellular osmolality determined? how is this different from normal serum tonicity?

(Na+ x 2) + (Glu / 18) + (BUN / 2.8) + alcohol (usually 0) = usually 289
-x2 takes Cl- into account
-18 is MW of glucose
-2.8 is MW of N2

NST doesn't include BUN or alcohol (=285)


what are DDx for hypovolemia (low Na, low water)?

increased renal losses (high FENa)
-aldosterone deficiency
-glucocorticoid deficiency
-Barrter's/Gitelman's syndrome
-Fanconi's syndrome
-Diuretics (acutely)

Increasex extrarenal losses (low FENa)
-GI losses
-skin losses


what are DDx for euvolemia (unchanged Na, high water)?

low free water clearance (high Uosm)
-reset osmostat

high water intake (low Uosm)
-primary/psychogenic polydipsia
-beer potomania
-"tea and toast"


what are DDx for hypervolemia (high Na, higher water)

renal issue (high FENa)
-renal failure

extrarenal issue (low FENa)
-congestive heart failure
-nephrotic syndrome
-severe hypothyroidism


what can prevent acute kidney injury (AKI)?

-volume expansion
-phosphate binder


how can intracellular shifts of K+ into extracellular space cause hyperkalemia?

-insulin deficiency (diabetes)
-acidemia (usually metabolic)
-cell lysis (TLS, rhabdomyolysis, hemolysis)


how can decreased excretion from kidney cause hyperkalemia?

-not filtered (AKI, CKD, ESRD)
-insufficient Na+ delivery to distal tubule (pre-renal)
-aldosterone issue (lack of production, resistance problem from medications or cell damage)


what are three types of treatment of hyperkalemia?

1. stabilizers (Ca++ only if EKG changes are noted)
2. shifters (insulin+glucose, beta-2 agonist, sodium bicarbonate)
3. removers (Kayexalate+sorbitol if colon working, kaliuretic or sodium bicarbonate if kidneys working, dialysis)


treatment if hyperkalemia without EKG changes

K+ level is:
5-5.5 --> dietary restriction
5.5-6.5 --> above plus excretion enhancer
6.5-7 --> above plus compartmental shifters
>6.5 --> dialysis if above cannot help


what are causes of anion gap acidosis?

gain of non-HCl
-ethylene glycol
-ethyl alcohol
-isopropyl alcohol
-salicylic acid

-diabetic ketoacidosis
-L-lactic acidosis (shock)
-D-lactic acidosis (gut flora, small bowel loss)


what are causes of hyperchloremic acidosis?

loss of bicarbonate/gain of Cl
GI losses (diarrhea, ureteral-enteric diversions)
renal losses (renal tubular acidosis, excessive saline infusion)


what tests can support carcinoid?

urine 5-HIAA


PCOS patients have high serum levels of what hormones?

LH:FSH ratio