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Uworld GU plus Preg Flashcards

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1
Q

What effect does a confounding bias have?

A

Exposure disease relatinship may be muffied by the effect of an extranous factors that has correlatsiont o both the exposures and disease.Think alcohol seen to be assoc w/ bladder cancer.But you stratify for smoking, alcohol has no effect.It’s because smoking is tied to bladder cancer, but smoking is assoc w/ alcohol.

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2
Q

What are the 3 factors that cause a positive (Downs) screen in Tripple screen?

A

DEC AFP, DEC Estriol, INC HCG.

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3
Q

What are hormonal signs seen in KlinefeltersTurners?

A

Klinefelers - XXY - INC FSH!!! INC LH, INC Estradiol (cause of other signs) DEC tesosterone.Turners- XO - INC FSH, INC LH, DEC Estrogen (cause of the other findings) IN BOTH CASES, ESTROGEN LEVELS (BASED OFF OF CHROMOSOME) IS THE DRIVER.

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4
Q

Why do you get gonorrhea multiple times?

A

Due to no vaccine - due to rapid antigenic variation of PILUS protein. AKA the surface antigen has high frequency of changes.

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5
Q

16 y.o w/ pain once a month - has secondary sexual characteristics, never had a menstrual period. Palpable mass anterior to rectum.

A

Imeprforated hymen - mucus in the vaginal canal (mucocolpos) may manifest as bulging introitus . Hematocolpos (accumulation of blood in vagina canal) -> marked distention of vagina -> Back pain and dififcultes w/ defecation/urination - may have vaginal bulge or mass palpable anteiror to rectum. Also mullerian duct anomaly is possible.

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6
Q

What recognizes stop codons on mRNA?

A

Releasing factors.

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7
Q

Painless sore on penis? Can be two things?If there are additional swellings and inflam, ulcer around groin?

A

Syphilis, Chalmydia Lymphogranuloma venereumOnly lymphogranuloma venereum (chlamydia_ L1,2,3, (buboes) ALSO SEE INTRACYTOPLASMIC INCLUSION BODIES.Syphilis: One would see treponemes in fluid from chancre. Not intracytoplasmic inclusiosn. Syphilis primary painless lesion can heal without treatmetn ina few weeks.

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8
Q

Two functions of aromatase?

A

Androstenedione ->: estroneTestosterone -> estradiol.

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9
Q

46 XX baby w/ ambiugous genitalia, INC teset, and androstenedioneMaternal virilization

A

Aromatse def.

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10
Q

Where does the proximal 1/3 of ureter get its blood supply from?Where do transplanted renal arteries/veins anastomose to?

A

proximal 1/3 of ureter receives blood from branches of renal artery. This is why it is typically viable during transplantation and taken into the new host.The donor original kidneys are usualyl left in place - therefore the donor kidneys are placed retroperitoneally in RIGHT Iliac Fossa - blood supply via recipients EXTERNAL iliac artery, and EXTERNAL iliac vein.

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11
Q

Lymph drainage (CA drainage) of Scrotum?Glans penisTestis?

A

Scrotum - superficial inguinal nodes (plus rest of cutaneous body inferior to umbilicus minus calf)Glans penis - Deep inguinal (cutaneous calf. First to popliteal, then to Deep inguinal)Testis - para-aortic.

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12
Q

Postauricular LNA in mom + polyarthralgiaWhat is this.What are the 3 things seen in kid?

A

Rubella - Deafness, Cataracts, PDA/cardiac

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13
Q

What can untreated endocervical gonorrhea infection lead to?

A

PID (endometritis, salpingits, tubo-ovarian abscess, pelvic peritonitis) - 8-10%. MOST SERIOUS/PERMANENT DMG = INFERTILITY - DUE TO SCARRING AND BLOCKAGE OF FALLOPIAN TUBES. Infertility is 15-20% of PID, and 50-80% for multiple PID.

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14
Q

What is the cell type of the ovary?

A

Simple bucoidal aka germinal epithelium.

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15
Q

What is the Eosinophil mech of action?

A

Eos regulate T1 HSR. Eos granules contain histaminase (degrades histamine) - reduces severity of atopic symptoms. Also contain leukotrienes and peroxidases which facilitate inflam. Also, w/ parasites - IgE binding to IgE Fc receptor on Eos cell surface. stimulation leads to antibody dependent cellular cytotox (Major basic protein etc) w/ enzymes from cytoplasmic granules M! and NK also rely on ADCC.

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16
Q

What types of agar can E Coli be grown in? What are appearances?What kinds of digestive ability for sugars does it have?

A

Blood - B hemolytic (clear circles)MacConkey - ferments, lactose, glucose, sorbitol (except EHEC no sorbitol fermentation)Eosin methylene blue(EMB) -> green metallic sheen.

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17
Q

What are virulence factors for different types of E Coli Disease?

A

Fibriae - cystis and pyeloneprhitisK1 capsule - meningitis, penumonia ( think japanese fight knock out)Heat lable - cAMGHeat stable - cGMPO - classifies gram negative. Lipid A - compoenent of LPS- similar for all enterobacteira.

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18
Q

Primary HSV-2 - treatment for time during present lesion and treatment preventing recurrence?

A

Acyclovir during episodeEither, Valacyclovir, acyclovir, or famciclovir DAILY ORAL PILLS to prevent recurrence

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19
Q

Small phalus and hypospaida - well devos testes in inguinal area. BP normal, karyotype normalWhat is this?

A

5a reductase DEF. May have ambiguous genitalia until puberty, when INC testosterone causes mauculination. Tesosterone/estrogen norma, LH normal. Intenral genitalia are normal

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20
Q

When is progesteronem, estradiol production by corpus luteum taken over by something else?What is that something else?

A

First trimester.Progetserone - from placentaEstronge - fetal adrenal gland + placenta

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21
Q

Why do women not lactate even though prolactin levels are high until after delivery?

A

estrogen and progesterone downregulate receptors for prolactin

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22
Q

What supplies all nerves, blood, lymph to the ovary?

A

Suspensory ligament (infundibulopelvic ligament) - supplie nserve,s arteries, veins, lymphatics. That means it connects from the aorta and vena cava/left renal vein. Parasympathetic from vagus.

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23
Q

If pt received blood transufsion -> difficulty breathing, dark urine …

A

Complemetn mediated cell lysis - acute hemolytic rxT2 HSR. C3a,5a anaphylatoxins + MAC

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24
Q

Body temp is septic shock?

A

Eiterhe levated or decreased.Early sesis - INC cardiac output via peripheral vasodilation (warm extremities)Progression -> Storke volume DEC - distal hypoperfusion. Advanced - cool/clammy. Delayed cap refil, etc. TNFa! IL1 IL6.

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25
Plasma, urine findings in most pt w/ kdiney stone?
Idiopathic hypercalciuria - NORMOCALCEMIA.
26
What bleeding factor affected in SLE?
INC PTT. Normal PT.
27
Lady parts problem w/ SLE?
repeated miscarriages.
28
What is the chlamydia anomoly?
Chlamydia produces penicillin bidning proteins, and contains genes for peptidoglycn synthesis - HOWEVER, TEHRE IS NO PEPTIDOGLYCAN IN ITS CELL WELL.
29
2 most common cuases of NGU? Characteristics of bugs?
ChlamydiaUreaplasma urealyticumBoth lack peptidoglcan in cell wallChamyldia cant make ATPUU does not even have a cell wall to begin w! UU CAN make ATPBoth tx w/ antirobosomal - macrolides (azithromycin)m tetracyclines.
30
What is the structure of penicillin?>
Structural analog to D-Ala-D-Ala (inhibits transpeptuidase) as a decoy.
31
Transillumination in scrotum - think? Mech? wHERE?
Hydrocele! Not varicocele. Or they would say bag of worms etc.This is due serous fluid collecting within TUNICA VAGINALIS, which is derived from PERITONEUM - CAN REMAIN IN COMMUNICATION W/ PERITONEUM. Spermatic cord and tunica vaginalis are overlied by intenral spermatic fascia (transversalis fascia)
32
2 most common cause of normal development, primary eugonadotropic amenorrhea?
Imperforated hymen or mullerian duct anomalies (agenesis) - may have hsortened vaginal canal and rudimentary uterus.
33
What is indirect inguinal hernia cuased by?DirecT?What layers of fascia are they covered by?
Entering through internal inguinal ring -> lateral to Inf. Epigastric. Caused by persistent processus vaginalis and failure of INTERNAL INGUINAL ring to close - seen in male infants usu.Direct - olrder men - bulges through hesselbachs triangel, medial to epigastric, to reach EXTERNAL inguina ring - caused by weakness in transversalis fascia. Indirect (lateral)- covered by ALL 3 SPERMATIF FASCIA LAYERSDirect (medial) -EXTERNAL spermatic fascia ONLY. Because these do pass through deep inguinal ring - only through superficial inguinal ring.
34
What are these used for?DiethylcarbamazineIvermectinNifurtimoxPraziquantelMebendazole?
Diethylcarbamazine - Loa Loa, Wucheria bancroftiIvermectin - Onchocerca vovulus, StrongyloidesNifurtimox - TrypanosomesPraziquantel - Shicstosoma, Clonorchis, ParagonimusMebendazole - Enterobius
35
46 XY, normal leydig, total absence of SertoliWhat are the phenotypes?
Internal - both female and male (no MIF )External - Male
36
What is missing in breast milk?
D and K. K given as IM injectionD from sun. Dark skinned infants require more sunlight to rpdouce adequate vitD. Dark skinned infants w/o ample sunlight should receive vit D supplementation. DOES prodive enough folic acid, thiamine riboflavin.
37
Treatment of PCOS?For those trying to get pregnant?
PCOS tx - weight loss - OCPMedications needed to induce ovulation (such as clomiphene) - selective estrogen receptor modulator - prevents negative feedback inhibition on hyothalamus by circulating estrogens. -> INC FSH and LH and ovulaiton.
38
What is clomiphene? What are its uses?
Antagonist to Estrogen recpetors in hypothalamus -- inhibits normal feedbakc inhibition - INC LH and FSH -> stimulates ovulation.may lead to mutliple simultaneous pregnancies, hot flashes, ovarian englargement - Tx for PCSO.
39
pathway of schistosoma invasion?
From snails -> skinTravel thru vascular/lymph -> liver.Mature into adults S japonicum and S mansoni -> mesentaryS haematobium -> vasical venous plexus. Remain in blood vessels for life (5-30 years!) - adhering to wall and releasing eggs. Result in TH2 mediated resposne to eggs. Granulomatous inflam and fiborsis -> ucleration of bowels/bladder/ureters. If they settle in the lvier 0-> hepatic schistosomias - can restrict protal venous flow/portal HTN.
40
Impetigo . What are later consequences?
Impetigo -> glomerulonephritisPharyngitis -> glomeruloneprhtiis OR Rheumatic fever SKIN INFECTIOSN DO NOT CAUSE RHEUMATIC FEVER.
41
For what is high dose IL-2 given? What is the mech?
ANTI-TUMOR EEFECT. IL2 (aldesleukin) - immunotherapy for metastatic melanomas and RCC> Works in approx 10% of ott. Enhances activity of NK cells. Produced primary by Th1.
42
What is the most common cuase of fetal hydronephrosis?
Normal fetal devo - ureteres are fully canalzied before metanephros begin producing urine (8-10th week gestation)Inadequate recanalization of URETEROPELVIC JUNCTION is most common cause of fetal hydronephrosis
43
Recent surgery -> renal failure and cyanotic body part? Think?
Embolic event. If undergoing angiograph/plastic/aortic surger y-> cholesterol crystals
44
Non lactose fermenting GN bacilli that can often cause UTI?
Pseudomonas./
45
Most common cause of urinary tract obsturction in older man?
BPH.
46
How tot ell hydronephrosis vs ADPKD?
ADPKD - is very cystic and lumpy on the outside.Hydronephrosis has enlarged kidney but rather smooth surfaces - if cut- would hsould marked atrophy and scarring of renal parenchyma -
47
What are Anti-Rh (D) akak RhoGAM made of?
IgG anti-Rh (D) ab. Very lkittle anti-D IgG is injected - so the anti Ab doesnt go into baby - as such - minimal transplacental fetal hemolysis Also because IgG has greater affinity to Fc receptors on phagocytic cells.
48
What are remannts that = meckels?Urachus?
Meckels - vitelline duct/yolk stalkUrachus - allantois remnanc (connects bladder to yolk sac)
49
What drains tot he superficial inguinal lmyph?
Alls kin umbilicus down - INCLUDING anus (up to petinate line), but exlcuding ;posterior calk (drains to popliteal LM)Also includes the scrotum.Superficial Inguinal - scortumDeef inguinal - penisTestes - para-aotic
50
What causes impaired antibiotic use in Enterococci w/ aminoglyocisdes?
Aminoglycoside modifying enzmyes -> transfer differnet chemical groups (acetly, adenly, Phosphate) t- Aminoglycoside -> impaire Ab binding to ribosomal subunit. SEEN IN ENTEROCOCCI.
51
Method of Vanc resistance in VRE? Mediated by?
Mediated by plasmids or transposons -> proteins are synth act as ligases and alter D-ala D ala.VanA ligase subsitutes D alal D lactate for D ala D ala.
52
Best way to help tx a "calcium stone"
Dont know waht kind of stone it is.. Calcium oxalate - tx w/ baseCalcium Phosphate -> tx w/ acidSO INSTEAD - use hydration and HIGH URINE CITRATE CONC - citrate binds FREE Ca - prevents precipitaiton.
53
histology of chorioCa? When do you see ChorioCA?What are the signs?
Proliferation of byth cytotorphoblasts and syncytiotrophoblasts. NO VILLI ARE PRESENT. Gestational ChorioCa - commonly from evacuated mole, but also can happen after normal pregnancy, or ectopic pregnancy. Aggressive - metastazies mhematogenous - lungs most common sites - can get hemopttysissTumor is aggressive but is highly sensitive to CHEMO.
54
Granulosa theca cells most likley to secrete?
Estrogen (or progesterone) May have histo that shows Call-Exner bodies (resemble primordial follicles) Because they secret lots of estrogen - may see precocious puberty. Mainly in older women tho - can get endometrial hyperplasia in post-menopausal women.
55
In GAS, what prevents phagocytic killing?
M protein - major virulence factor of strep pyogenes - inhibits phagocytosis and activation of complement - also mediates bacterial adherance - is the targe of humoral immunity to strep
56
Intraductal CA of breast - w/ central necrosis?
ComedoCA. Type of DICS
57
What toxin mediate sseptic shock?
Lipid A (componenet of LPS) LPS is not acteively secereted! - actiavtes M! that leads to relase of IL1 and TNF alpha + granulocyte activation. IL1 -> febrile on hypothalamus,
58
What is the culture of Neisseira?
Thayer Martin - Vanc - inhbiits GPPolymyxin - inhibits GN except NeisseriaNystatin - inhibits fungi "To connec to Neisseria, please use your VPN"
59
Severe lower ab pain during menstrual periods - pain during intercourse. Think? Normal sized uterus?
Endometriosis or Adenomyosis if normal uterus - Endometriosis. May be asymptomatic or present w/ severe dysmenorrhea, dyspareunia, and infertility. Adenomyosis has enlaregd uterus. MANY WOMEN ARE DIAGNOSED W/ ENDOMETRIOSIS WHILE BEING EVALUATED FOR INTERFILITY. Due to bluee/hemolysis/local inflam -> adhesions and distorted organ structure.
60
What are the symptoms of malpositioning of uterus?
Retroveriosn is most common type - usu asymptomatic.
61
Mutated sperm motility -what other problems?
Kartageners syndrome - male inferitlity, situs inverus, recurrent sinusitis, BRONCHIECTASIS. AR mutation.
62
Attrition bias is under what global category?How does this differ from sampling bias?
Attrition AND Sampling bias are both under selection bias.Attrition - duhSampling - nonrandom sampling of target population.
63
What is the cellualr mech of toxic shock?
M and T cells.SUperantigen - activates MASSIVE AMOUNTS OF helper T cells - superantigen (TSST1)
64
PCOS pust you at long term risk of?
Endometrial adenoCA and T2 Diabetes, infertility. Risk of atherosclerosis and CAD. Elevated andreon, LH, w/ nromal FSH (LH>FSH ratio is greater than 3)Insulin resistant.
65
What is maternal insulin resistance due to?
Human placental lactogen (hPL) - INC insulin resistance and stimulates proteolysis and lipolysis and inhibits gluconeogenesis.AKA baby wants gluocse and amino acids.Mom uses fatty acids, ketones and glycerol for energy.hPL released from baby's SYNCYTIOTROPHOBLASTS. Similar properties to prolactin and GH. Gestational diabetes occurs when a mom's pancreatic function is not sufficient to overcome pregnancy related INC in insulin resistance. Insulin resistance due to: hPL, placental GH, estrogen, progesterone, glucocorticoids.
66
Single ulcerated mass in HIV pt? Intermittent rectal bleeding.
HPV - anogenital squamous cell CA.
67
What is the relevance of RR=1 (null value) in relative risk? How does this relate to the 95% confidence interval?
RR = 1 means no difference.More than 1 means associated, less than 1 = inversely associated.The way you can tell signifiance is by the RANGE of the confidence interval.If the confidence interval does not overlap w/ 1, it is significant = p less than .05. For example.RR = 1.495% Confidence interval = 1.02 to 1.85This is significant!
68
What is the physiological term for what occurs during sloughing?
Apoptosis - due to withdrawal of progesterone.
69
Normal tx for symptomatic UTI?
3 day course of fluoroquinoline (ciprofloxin prob) and TMP SMX.
70
Mech of oral contraception?
Give estrogen and progesterone - these inhibit levels of FSH and LH meaning no surge. = low levels of GONADOTROPINS (LH, FSH) - duh, since GnRH is (gonadoropin! releasing hormone).
71
When is bHCG detectable in serum?
By around 8th day.in 6 days you have hCG secretion from blastoytes - however, need successful implantation for hCG to be in maternal serum - so usu within 8 days.
72
Abnormal uterine bleeding in 30 year old - not pregnant - endometrial hyperplasia and right sided adnexal mass. Most likely?Histo of this?
Granulosa cell tumor .Lots of estrogen -> endometrial hyperplasia + bleeding.Can also lead to endometrial CA. May see Call Exner bodies - small follicle like structures filled w/ eosinophilic secretions.
73
Twin = 1 boy one girl. What is likey situation of amnio and chorion?
Dichorionic diamniotic = 2 diff oocytes from 2 diff eggs.
74
Monozygotic twins - what are the amnionic, chorionic status? Which days are what?
0-4 day split (25%) - Dichorionic diamniotic 4-8 days (75%) - Monochorionic diamnioticFor the most part, always diamniotic. If the separation happens later (4-8 days) - the chorion/placenta has probably alreaddy attached so they share one.
75
14 year old minor - how do treat pregnancy, birth control, STI, alcohol addiction?
Can get treated for any of these without consent.
76
Vaccine for Gonoccoci vs meningococci?
Gonococci - No vaccine - due to rapid antigenic variation of pilus proteinMeningococci - Vaccine available -but NONE to Type B - because Type B capsule is not immunogenic. Give vaccine to only certain population (military, college, etc)
77
What is the morning after pill composed of/administered w/?
Mifepristone - PROGESTERONE ANTAGONIST (competitive inhibitor of progestins). Aslo ANTI-PROGESTIN - this leads to the cramps, nausea and bleeding. Administered w/ Misoprostol (PGE1) Progestins - bind progestone receptor and DEC growth of endometrium and INC vascularization. Aso sensitize to PROSTAGLANDIN - which INC uterine contractions and INC cervical dilation.
78
What are contraindicators to OCPs? (4)
Smokers >35 due to INC cardiovascular eventsPt w/ history of thormobembolism and stroke History of estrogen dependent tumor. Hypertriglyceridema (can induce glucose intolerance)
79
Where does femoral hernia occur?
Medial to femoral vein.Think NAV_LThat space has the femoral hernia!
80
Most likely cause of missed periods with random spotting in 14 year girl who just started having periods. Or in a 50 year old woman?
Anovulatory cycles - common in women who just began their periods or right before menopaus. This is because in the absence of ovulation (ANOVULATION) ovarian follicle does not degen -> NO corpus lutuem -> NO progesterone produce.Estrogen remains high so endometrium remains in prolif phase. Eventually becomes unstable and sloughs off - irregular periods of breakdown with variable heavy bleeding.
81
Positive VDRL and pleocytosis in CSF means what?
NOT JUST SYPHILIS - BUT TERTIARY SYPHILIS.If you see painless ulceration on vagina in pt w/ 3rd syphilis, it is a GUMMA, not a chancre or condyloma lata.
82
Condyloma lata Condyloma acuminatachancre?
lata - secondary syphilis (late in syph!)condyloma acuminata - HPVChancre = 1' syph
83
Most common cause of candida vaginitis?
Antibiotic use - suppresses normal bacterial flora -> candida overgrowth. Other cuases - contraceptive use, systemic coritcosteroids, DM, immunosuppression
84
Pelvic fracture + inability to void suggestive of?
Urethral injury. As is boggy prostate (hematoma formation below gland), blood at urethral meatus. Placement of foley is contraindicatved in urethral injury.
85
What are 2 Ab that are highly specific to regular Lupus?
Anti-dsDNA. ANti-Smith Ab
86
What drug has the same mechonism as methotrexate?
TMP.Both inhibit DHF reductase to THF.
87
Cause of dysuria and hematuria in childrne in daycare
adenovirus - hemorrhagic cystitis in children
88
Rebound ab tenderness, cervical motion and adnexal tenderness on bimanual exam ?
PID. can cause ectopic pregnacny rates to approach 50% if severe - bloody vaginal discharge in pregnant female.
89
How long do viable sperm last post-vasectomy?
20% of pt still ahve viable sperm in ejacualte after 3 months and at least 20 ejaculations. Stay in proximal vas deferens No change in sexual desire or ability to maintian an erection. Very little effec ton volum eof ejaculate (205% spermatozoa in volume)
90
PID most often cuased by?
GOnorrhea, Chlamydia. If not treated, can lead to scarring of fallopian tubes and infertility/ectopic pregnancy. Must treat for both
91
Most common source of E. COli bacteremia in a male?
UG tract - Risk factors can be BPH, fecal incontinence, neurogenic bladder, frequent catehterizations.
92
Recurrent kidny stones - Sodium cyanide to urine. + SOdium nitroprusside -> red purple. WHat is this?
Cystinuria. DEC resoprtion of AA cystine - pathognomonic hexagonal cystine crystals.
93
4 main causes of papillary necoriss?
SS, Analgesic nephropathy, DM, Acute pyleo/UT obstruction.
94
CEACA19-9CA125
CEA - 70% of colorectal OR pancreaticCA19-9 - PancreaticCA125 - 50-90% depending on severity - Ovarian
95
Nonfusion of urethral folds?Nonfusion of urethral folds in female?
HypospadiaNormal - forms vestibule of vagina
96
Last menstraul period 7 weeks ago - History of PID - presents w/ hypotension and vaginal bleeding Histo of endometrium?
Ectopic pregnancy w/ possible rupture. Endometirum would show decidualized endometrim WITHOUT chorionic villi (due to no implantation)
97
Defect in transported of cystine, ornithine, ariginne, and lysine in the gut? What other presentations would be common?
Cystinue, ornithine, lysine, arginine - all ahve common transproted in kidney and intestinal lumen.WOuld see Kidney stones. due to cystinuria.
98
What blood supply is nearby the lower ureter? WHere is it placed?
Ureter is just lateral to internal iliac artery near the bladder. Higher up on the ureters, the gonadal artery and veins cross over on top of the ureter. Ureters cross OVER common/external iliac.UNDER the gonadal vessels. Pass LATERAL to internal iliac and MEDIAL to gonadal vessels as they enter true pelvis
99
White discharge from nipple. Most likely from? (nonpregnant)
Pituitary adenoma
100
What is the most common renal VASCULAR injury? Histo?
HTN neprhosclerosis - arterial intima fibroplasia and arteriolar hyalinization w/ inerstitial fibrosis. Less common - renal arterial stenosis - marked renal tissue atrophy.
101
WHat is uniparental disomy?
2 copies from one parent and no copies form the other parents. Prader WIlli - 2 coppies of 15 due to deleted OR! unepxressed paternal.Same w/ angelmen.
102
Most common benign tumor of breast?Histo?
Fibroadenoma Well demarcated psherical nodules ranging in size - can have multiple - Cellular often MYXOID stroma that encircles glanduar space.
103
Triad of Pre eclampsia?
HTN, proteinuria, edema. Can be made w/ just HTN and proteinuria though.
104
What was be done to monitor hydatidiform mole?
FOR THE NEXT YEAR - b-hCG to monotor devo of invasive mole or chorioCA

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