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usmle - endorepro


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this type of proliferative fibrocystic disease is associated with an increased risk of invasive breast cancer
sclerosing adenosis
transformation of ductal epithelial cells to eosinophilic cells resembline apocrine sweat gland epithelium; not associated with increased CA risk
apocrine metaplasia
testicular enlargement with obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells
child infected in utero with DS DNA virus - petechiae, hepatosplenomegaly, jaundice; brain calcifications
what marker do leiomyomas express?
smooth muscle actin
organism that lacks muramic acid?
most common bacterial STD in U.S.?
what complications account for the most maternal deaths in preeclampsia?
cerebral hemorrhage and ARDS
solitary, thickened, whitish plaque on penis - dysplastic epithelial cells with many mitoses, no stromal invasion
Bowen's disease
what is the posterior fornix in contact with - space that is the lowest part of the peritoneal cavity in the female pelvis
dermal lymphatic invasion by cancer cells?
inflammatory breast cancer
what maintains the corpus luteum during pregnancy?
tumor marker for serous papillary cystadenocarcinomas?
initial event in pathogenesis of preeclampsia?
placental ischemia
bacteria causing amnionitis?
listeria monocytogenes
drainage of left ovary/testis?
left gonadal vein - left renal ven - IVC
drainage of right ovary/testis?
right gonadal ven - IVC
what does the suspensory ligament of the ovaries contain?
ovarian vessels
what does the transverse cervical/cardinal ligament contain?
uterine vessels
what does the round ligament of the uterus contain?
no important structures
what does the broad ligament of the uterus contain?
round ligaments of uterus and ovaries and uterine tubules and vessels
what is the acrosome derived from?
what is the flagellum (tail) of sperm derived from?
one of the centrioles
what is the sperm food supply?
what does spermatogenesis begin with?
spermatogonia (type A and B)
where does spermatogenesis occur?
seminiferous tubules
what does type A spermatogonia form?
both type A and type B
what forms the blood-testis barrier?
junctional complex (tight junction) between Sertoli cells
what stimulates testosterone release from Leydig cells?
FSH stimulates sertoli cells to produce what?
androgen binding protein & inhibin (inhibits FSH)
what converts testosterone and androstenedione to estrogen in adipose tissue?
list the forms of estrogen in order of potency
estradiol > estrone > estriol
what enzyme converts cholesterol to androstenedione in the theca cell? what stimulates it?
desmolase; LH
what converts androstenedione to estrogen in the granulosa cell? what stimulates it?
aromatase; FSH
what is elevation of progesterone indicative of?
what does unopposed estrogen therapy increase the risk of? what can be added to decrease this risk?
endometrial cancer; progesterone decreases the risk
this hormone is responsible for stimulation of endometrial glandular secretions and spiral artery development
what does progesterone do to myometrial excitability?
decreases it
what influence does progesterone have on uterine smooth muscle?
relaxes it
when is follicular growth the fastest?
during 2nd week of proliferative phase
what stimulates endometrial proliferation?
what maintains the endometrium to support implantation?
when does the estrogen surge occur?
day before ovulation - stimulates LH, inhibits FSH
what effect does progesterone have on temperature?
increases it
what is the role of OCPs?
prevent estrogen surge, LH surge so ovulation does not occur
what maintains the corpus luteum for the 1st trimester?
when does hCG appear in urine after fertilization?
8 days
what is the average age of onset of menopause?
51 - earlier in smokers
what happens to estrogen levels after menopause?
what happens to levels of FSH, LH, GnRH at menopause?
increase (FSH increases the most; no LH surge)
what does a bicornuate uterus result from?
incomplete fusion of the paramesonephric ducts; associated with UT abnormalities and infertility
what does hypospadias result from?
failure of urethral folds to close - opening on inferior/ ventral side
what does epispadias result from?
faulty positioning of genital tubercle - on superior/dorsal side
what is hypospadias associated with?
UTIs - more common than epispadias
what is epispadias associated with?
exstrophy of the bladder
what stage is an oocyte in prior to ovulation?
prOphase of meiosis I
what stage is a follicle in until fertilization?
METaphase of meiosis II
what is Mittelschmerz
blood from ruptured follicle causes peritoneal irritation - can mimic appendcitis
ovaries present, but external genitalia are virilized or ambiguous - due to exposure to androgenic steroids during early gestation
female pseudohermaphrodite (XX)
testes present, but external genitalia are female or ambiguous
male pseudohermaphrodite
what is the phenotype in androgen insensitivity syndrome (46, XY)?
female - female external genitalia with rudimentary vagina, uterus and uterine tubes generally absent; develops testes
in androgen insensitivity, what levels of testosterone, estrogen, LH are seen?
all high
cryptorchidism is associated with an increased risk for what?
germ cell tumors, especially seminoma and embryonal carcinoma
what happens in 5-alpha reductase deficiency?
unable to convert T-DHT; ambiguous genitalia until puberty, when increased testosterone causes masculinization of genitalia
what levels of testosterone, estrogen, and LH are associated with 5-alpha reductase deficiency?
normal; LH normal or increased
in what location is nodular enlargement seen in BPH?
periuretheral (lateral and middle) lobes
from where does prostatic adenocarcinoma most often arise?
posterior lobe (peripheral zone)
what is the genotype of a complete hyatidiform mole? what is the origin?
46, XX- completely paternal in origin
what is HELLP syndrome?
Hemolysis, Elevated LFTs, Low Platelets
what is the treatment for eclampsia?
IV magnesium sulfate and diazepam
increased risk of abruptio placentae with what?
smoking, hypertension, cocaine use
painful uterine bleeding usually during 3rd trimester
abruptio placentae - premature separatino of placenta (may be associated with DIC)
defective decidual layer allows placenta to attach directly to myometrium
plaenta accreta
what stimulates theca cells to secrete androstenedione and testosterone?
what stimulates aromatase activity in granulosa cells?
where is the deep inguinal ring?
about 1/2 inch above the midpoint of the inguinal ligament
how do indirect inguinal hernias enter the inguinal canal?
through the deep inguinal ring
in many cases of Paget disease of the breast, what else is present?
underlying adenocarcinoma
lump in breast with prominent multinucleated giant cell reaction?
fat necrosis
three types of ovarian tumors that can produce large amounts of steroid hormones?
sertoli-leydig cell tumors, fibroma-thecomas, granulosa cell tumors
what is the most likely condition predisposing to breast abscess/mastitis?
breast feeding
what predisposes to placenta accreta?
prior C-section or inflammation; may have massive hemorrhage after delivery
placenta previa?
attachment of placenta to lower uterine segement; may occlude cervical os
painless bleeding in any trimester
placenta previa
what is polyhydraminos (>1.5-2L) associated with?
esophageal/duodenal atresia; anencephaly
what is oligohydraminos (<0.5L) associated with?
bilateral renal agenesis or posteror urethral valves (in males)
cervical dysplasia - HPV
what types of HPV are associated with CIN?
16, 18
how does HPV cause CIN?
HPV viral proteins E6 & E7 bind and inactivate gene products of p53 & Rb
endometrial hyperplasia puts one at an increased risk for what?
endometrial CA
abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
endometrial hyperplasia
what is the most common gynecological malignancy?
endometrial carcinoma
what is the peak age for endometrial carcinoma? how does it typically present?
55-65; vaginal bleeding
risk factors for endometrial cancer?
prolonged estrogen use, obesity, diabetes, and hypertension
leiomyomas are sensitive to what?
estrogen - increased sized with pregnancy and decreased with menopause
amenorrhea, infertility, obesity, hirsutism
polycystic ovarian syndrome
increased LH production leads to anovulation, hyperandrogensim due to deranged steroid synthesis
treatment for polycystic ovarian syndrome?
ketoconazole, spironolactone
what are antibodies directed against in type I DM?
glutamic acid decarboxylase (GAD)
treatment for pituitary apoplexy?
glucocorticoids and thyroid hormone
most accurate test for hypothyroidism?
serum TSH
metabolic disturbance seen in primary adrenal insufficiency?
what effect do alpha2 agonists have on insulin secretion?
directly inhibit it
what is Laron dwarfism?
congenital absence of growth hormone receptors
classical physical finding in Addison's disease?
how does pregnancy/estrogen affect thyroid-binding globulin?
increases its synthesis
Hashimoto's can be associated with disorders of what other organ?
how do you distinguish nephrogenic DI from neurogenic DI?
water deprivation will fail to increase urine osmolarity in both, but subsequent injeciton of vasopressin will concentrate the urine in the case of neurogenic DI but not nephrogenic DI
what are the secretory products of the zona glomerulosa?
what are the secretory products of the zona fasciculata?
cortisol, sex hormones
what are the secretory products of the zona reticularis?
sex hormones, e.g. androgens
what are the secretory products of the adrenal medulla?
what doe sthe posterior pituitary produce?
vasopressin and oxytocin
what embryonic layer is the posterior pituitary derived from?
what hormones is the alpha subunit common to?
what subunit determines hormone specificity?
in what part of the pancreas are the islets of Langerhans most numerous?
from what do the pancreatic islets arise?
pancreatic buds
what type of pancreatic cells secrete glucagon?
what type of pancreatic cells secrete insulin?
what type of pancreatic cells secrete somatostatin?
how does prolactin influence dopamine synthesis and secretion?
increases it
what effect does dopamine have on prolactin?
inhibits it's secretion
what effect do dopamine agonists (e.g. bromocriptine) have on prolactin secretion?
inhibit (antagonists - e.g. antipsychotics - stimulate
decreased sex hormones, decreased cortisol, increased mineralocorticoids - hypertension, hypokalemia; phenotypically female but no maturation
17alpha hydroxylase deficiency
what is the most common form of congenital adrenal hyperplasia?
21 beta hydroxylase deficiency
decreased cortisol (increased ACTH), decreased mineralocorticoids, increased sex homrones - masculinization, female pseudohermaphroditism, etc.
21 beta hydroxylase deficiency
what is the difference in BP between 17 alpha hydroxylase deficiency and 21 beta hydroxylase deficiency?
17=hyPERtension and 21=hyPOtension
increased plasma renin activity, volume depletion, hyponatremia, hyperkalemia are associated with what congenital adrenal hyperplasia?
21 beta hydroxylase deficiency
decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones, masculinization, hypertension?
11 beta hydroxylase deficiency
what effect does PTH have on phosphate?
decreases serum phosphate, increases urine phosphate
what effect does PTH have on calcium?
increases serum calcium
where does PTH influence calcium resorption?
increases it in distal convuluted tubule
what type of vitamin D comes from sun exposure in skin?
what increases absorption of dietary calcium and phosphate and increases bone resorption of them as well?
vitamin D
levels of calcium, phosphate, alk phos in osteoporosis?
all normal
levels of calcium, phosphate, alk phos in hyperparathyroidism?
increased calcium, decreased phosphate, increased alkphos
levels of calcium, phosphate, alk phos in Paget's disease
normal to increased calcium, normal phosphate, very high alk phos
levels of calcium, phosphate, alk phos in vitamin D intoxication?
all increased (alk phos normal or increased)
levels of calcium, phosphate, alk phos in renal insufficiency?
decreased calcium, increased phosphate, normal alk phos
what is the source of calcitonin?
parafollicular (C cells) of thyroid
waht is the function of calcitonin?
decreases bone resorption of calcium
what causes calcitonin secretion?
increased serum calcium
when is thyroid binding globulin decreased?
hepatic failure
how does thyroid hormone increase BMR?
increases Na/K ATPase activity - increased O2 consumption, RR, body temp
Cushing's disease?
primary pituitary adenoma - increased ACTH and cortisol
ACTH level in primary adrenal hyperplasia/neoplasia?
decreased (cortisol increased)
dexamethasone suppression in healthy person?
decreased cortisol after low does
dexamethasone suppression test in person with ACTH-producing tumor?
increased cortisol after low dose, decreased cortisol after high dose
dexamethasone suppression in person with cortisone-producing tumor?
increased cortisol after low and high dose
primary hyperaldosteronism/Conn's syndrome?
caused by an aldosterone-secreting tumor
findings in Conn's syndrome?
hypertension, hypokalemia, metabolic alkalosis
renin level in primary aldosteronism? in secondary?
low renin in primary, high renin in secondary
this type of hyperaldosteronism is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome
secondary - kidney perception of low intravascular volume results in overactive RAA system - high plasma renin
primary deficiency of aldosterone and cortisol due to adrenal atrophy
Addison's disease
hyponatremic volume contraction and skin hyperpigmentation
Addison's disease
how do you distinguish Addison's disease from secondary deficiency of aldosterone?
no skin hyperpigmentation in secondary (due to decreased pituitary ACTH production)
what is the cause of skin hyperpigmentation in Addison's?
MSH, a byproduct of increased ACTH production from POMC
what cells is a pheochromocytoma derived from?
chromaffin cells (arise from neural crest)
what MEN types is pheochromocytoma associated with? what other disorder is it associated with?
MEN II and III; neurofibromatosis
most common tumor of adrenal medulla in adults? kids?
pheochromocytoma; neuroblastoma (can occur anywhere along the sympathetic chain)
how is pheochromocytoma treated?
alpha antagonists, especially phenoxybenzamine
pancreas (e.g. Zollinger-Ellison syndrome, insulinomas, VIPomas), parathyroid, and pituitary tumors (3 P's)
how does MEN I present?
kindey stones and stomach ulcers
another name for MEN I?
Wermer's syndrome
medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor
another name for MEN II?
Sipple's syndrome
medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromas (mucosal neuromas)
how are MEN syndromes inherited?
what gene are MEN II and III associated with?
what type of hypersensitivity reaction is Grave's?
type II
what is Riedel's thyroiditis?
thyroid replaced by fibrous tissue (hypothyroid)
histologic finding in hashimoto's?
lymphocytic infiltrate with germinal centers
self-limited hypothyroidism often following a flulike illness; elevated ESR, jaw pain, early inflammation, and very tender thyroid?
subacute thyroiditis (de Quervain's)
what is the most common type of thyroid cancer?
papillary carcinoma - excellent prognosis
ground-glass/Orphan Annie nuclei, psammoma bodies
papillary carcinoma of the thyroid
from what does medullary carcinoma of the thyroid arise?
parafollicular C cells
thyroid cancer that produces calcitonin, sheets of cells in amyloid stroma?
medullary carcinoma
type of thyroid cancer seen in older patients, very poor prognosis?
defect in T4 formation or developmental failure in thyroid formation is seen in what?
sporadic cretinism
treatment for acromegaly?
primary hyperparathyroidism is usually caused by what?
findings in primary hyperparathyroidism?
hypercalcemia, hypercalciuria, hypophosphatemia, increased PTH, increased cAMP in urine
symptoms of primary hyperparathyroidism?
often asymptomatic; may present with weakness and constipation
what causes secondary hyperparathyroidism?
secondary hyperplasia due to decreased serum calcium, most often in chronic renal disease
findings in secondary hyperparathyroidism?
hypocalcemia, hyperphosphatemia, increased PTH
what causes hypoparathyroidism?
accidental surgical excision or DiGeorge's
findings in hypoparathyroidism?
hypocalcemia, tetany
what is Chvostek's sign?
hypocalcemia - tap facial nerve and see contraction of facial muscles
what is Trousseau's sign?
hypocalcemia - occlusion of brachial artery with BP cuff leads to carpal spasm
what is pseudohypoparathyroidism?
AR kidney unresponsiveness to PTH; hypocalcemia, shortened 4th/5th digits, short stature
excess of what vitamins can cause hypercalcemia?
vitamins A and D
what is usually the cause of DKA?
increase in insulin requirements from an increase in stress (e.g. infection) - excess fat breakdown and increased ketogenesis from the increase in free fatty acids, which are then made into ketone bodies
what is the metabolic disturbance associated with DKA?
increased H+, decreased HCO3-
anion gap metabolic acidosis; hyperkalemia but depleted intracellular K+
intensive thirst and polyuria with inability to concentrate urine?
diabetes insipidus
causes of central DI?
pituitary tumor, surgery, trauma, histiocytosis X
causes of nephrogenic DI?
hereditary or secondary to hpercalcemia, lithium, demeclocycline
what happens in a water deprivation test in DI?
urine osmolality doesn't increase
urine specific gravity is less than what in DI? osmolality greater that what?
<1.006, >290
what is the treatment for central DI?
intranasal desmopressin (ADH analog)
what is the treatment for nephrogenic DI (lack of renal resonse to ADH)?
hydrochlorothiazide, indomethacin, or amiloride
excessive water retention, hyponatremia, and urine osmolarity > serum osmolarity
what is a dangerous potential effect of SIADH?
very low serum sodium levels can lead to seizures (correct slowly)
causes of SIADH?
ectopic ADH, CNS disorders/head trauma, pulmonary disease, cyclophosphamide
treatment for SIADH?
demeclocycine or water restriction
diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease?
carcinoid syndrome
carcinoid syndrome?
rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of serotonin - not seen if tumor is limited to GI tract (serotonin undergoes first-pass metabolism in GI tract)
what is the most common tumor of the appendix?
urine finiding in carcinoid syndrome?
increased 5-HIAA
what are carcinoid tumors derived from?
neuroendocrine cells of GI tract
treatment for carcinoid syndrome?
rule of 1/3s for carciniod syndrome?
1/3 metastasize, 1/3 with 2nd pregnancy, 1/3 mutiple
what fascia encloses the thyroid gland?
pretracheal fascia
surgical resection of ileum causes what levels of calcium, 25-OH vitamin D, phosphate?
all decreased
mechanism of propylthiouracil?
inhibits deiodonation of T4
somatostatin inhibits the release of what 2 hormones?
GH and TSH
thyroid condition preceding lymphoma?
Hashimoto thyroiditis
pentagastrin-stimulated calcitonin secretion is a marker for what?
medullary carcinoma of the thyroid
treatment for DKA?
fluids, insulin, and potassium; glucose if necessary to prevent hypoglycemia
activation of pyruvate dehydrogenase and increased levels of acetyl CoA are associated with what?
type 2 DM
why does glucose taken orally cause a greater increase in insulin than when given IV?
increases duodenal secretion of gastric inhibitory peptide, increasing beta cell release of insulin
thyroid nodule with small 'solid balls' of neoplastic follicular cells containing microscopic blood vessels and fibrous stroma in their centers
papillary carcinoma
actions of insulin/insulin-like drugs?
TK activity: liver (increase glucose stored as glycogen), muscle (increased glycogen and protein synthesis, K+uptake), fat (aids TG storage)
what type of drug: tolbutamide & chlorpropamide?
first generation sulfonylureas
what type of drug: glyburide, glimepiride, glipizide?
second generation sulfonylureas
mechanism of action of sulfonylureas?
close K+ channel in beta cell membrane so cell depolarizes, triggering of insulin release via Ca2+ influx
what are sulfonylureas used for?
stimulate release of endogenous insulin in type 2 DM; require some islet function so useless in type 1
side effects of first generation sulfonylureas?
disulfiram-like reactions
side effect of second generation sulfonylureas?
what is the most grave side effect of metformin?
lacti acidosis
can metformin be used in patients without islet function?
action of pioglitazone and rosiglitazone?
increase target cell response to insulin
action of acarbose and miglitol?
alpha glucosidase inhibitors - inhibit intestinal brush border alpha glucosidases; delayed sugar hydrolysis and glucose and glucose absorption lead to decreased postprandial hyperglycemia
mechanism of propylthiouracil, methimazaole?
inhibit organification and coupling of thyroid hormone synthesis - used for hyperthyroidism
toxicity of propylthiouracil, methimazole?
skin rash, agranulocytosis (rare), aplastic anemia
what are orlistat and dsibutramine used for?
obesity management (orlistat is long-term)
use of glucocorticoids?
Addison's disease, inflammation, immune suppression, asthma
mechanism of finasteride?
5 alpha reductase inhibitor
mechanism of flutamide?
nonsteroidal competitive inhibitor of androgens at the testosterone receptor
mechanism of leuprolide?
GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when used in continuous fashion
mechanism of clomephine?
partial agonist at estrogen receptors in hte pituitary - prevents normal feedback inhibition and increases release of LH and FSH from the pituitary, which stimulates ovulation
drug of choice for women with estrogen receptor + breast cancer?
tamoxifen - competitively inhibits estradiol at estrogen receptors

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