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
- syphilis
- child infected in utero with DS DNA virus - petechiae, hepatosplenomegaly, jaundice; brain calcifications
- CMV
- what marker do leiomyomas express?
- smooth muscle actin
- organism that lacks muramic acid?
- chlamydia
- most common bacterial STD in U.S.?
- chlamydia
- 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
- rectouterine
- dermal lymphatic invasion by cancer cells?
- inflammatory breast cancer
- what maintains the corpus luteum during pregnancy?
- hCG
- tumor marker for serous papillary cystadenocarcinomas?
- CA-125
- 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?
- golgi
- what is the flagellum (tail) of sperm derived from?
- one of the centrioles
- what is the sperm food supply?
- fructose
- 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?
- LH
- FSH stimulates sertoli cells to produce what?
- androgen binding protein & inhibin (inhibits FSH)
- what converts testosterone and androstenedione to estrogen in adipose tissue?
- aromatase
- 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?
- ovulation
- 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
- progesterone
- 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?
- estrogen
- what maintains the endometrium to support implantation?
- progesterone
- 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?
- hCG
- 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?
- decrease
- 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?
- LH
- what stimulates aromatase activity in granulosa cells?
- FSH
- 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)
- koilocytes?
- 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
- PCOS
- 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?
- hypokalemia
- 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?
- hyperpigmentation
- how does pregnancy/estrogen affect thyroid-binding globulin?
- increases its synthesis
- Hashimoto's can be associated with disorders of what other organ?
- thymus
- 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?
- aldosterone
- 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?
- catecholamines
- what doe sthe posterior pituitary produce?
- vasopressin and oxytocin
- what embryonic layer is the posterior pituitary derived from?
- neuroectoderm
- what hormones is the alpha subunit common to?
- TSH, LH, FSH, hCG
- what subunit determines hormone specificity?
- beta
- in what part of the pancreas are the islets of Langerhans most numerous?
- tail
- from what do the pancreatic islets arise?
- pancreatic buds
- what type of pancreatic cells secrete glucagon?
- alpha
- what type of pancreatic cells secrete insulin?
- beta
- what type of pancreatic cells secrete somatostatin?
- delta
- 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?
- D3
- 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
- MEN I?
- 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
- MEN II?
- medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor
- another name for MEN II?
- Sipple's syndrome
- MEN III?
- medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromas (mucosal neuromas)
- how are MEN syndromes inherited?
- AD
- what gene are MEN II and III associated with?
- ret
- 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?
- undifferentiated/anaplastic
- defect in T4 formation or developmental failure in thyroid formation is seen in what?
- sporadic cretinism
- treatment for acromegaly?
- octreotide
- primary hyperparathyroidism is usually caused by what?
- adenoma
- 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
- SIADH
- 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?
- carcinoid
- urine finiding in carcinoid syndrome?
- increased 5-HIAA
- what are carcinoid tumors derived from?
- neuroendocrine cells of GI tract
- treatment for carcinoid syndrome?
- octreotide
- 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?
- hypoglycemia
- what is the most grave side effect of metformin?
- lacti acidosis
- can metformin be used in patients without islet function?
- yes
- 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