Hi Yield 10.1 - 11.2

mhewett's version from 2016-06-24 15:56

Section 10.1 Venereal Diseases

Question Answer
DOC for gonorrheaceftriaxone
What additional drug do you use to treat gonorrhea and why?doxycycline to cover undiagnosed chlamydia
what do you see clinically with gonorrhea?purulent discharge at area of infection (vagina, urethra, rectum, pharynx)
what can gonorrhea cause in females if left untreated?PID and salpingitis
what organism is carried asx in the rectum?trichomoniasis
what is the clinical presentation of trichomoniasis?extreme pruritis; strawberry cervix
DOC for trichomoniasis?metronidazole
what is non-gonococcal urethritis (NGU)?infectious urethritis in the male d/t anything but gonorrhea
what is usually the causative agent of nongonococcal urethritis?chlamydia trachomatis
DOC for chlamydiadoxycycline (+ ceftriaxone for empiric tx of gonorrhea)
lymphogranuloma venereumlarge palpable granulomas develop in the inguinal lymph nodes; caused by chlamydia trachomatis (serotypes L1,2,3)
DOC for lymphogranuloma venereumdoxycycline
what organism causes granuloma inguinale?granuloma inguinale = klebsiella granulomatis
what is the visualized etiologic bacterium in a macrophage for granuloma inguinale?donovan body
painful chancre characterized by "school of fish" on microscopic exam is indicative of what disease? what is the causative agent?Chancroid; hemophilus ducreyi
DOC for chancroidceftriaxone
painless hard chancre is indicative of what disease?syphilis
what do you treat syphilis with?penicillin G
syphilis is d/t what organism?treponema pallidum
what are the 3 stages of syphilis?1st stage: PAINLESS hard chancre
2nd stage: maculopapular red rash on palms, condyloma lata on genitals
3rd stage: gummas, tabes dorsalis, psychosis, dementia, luetic aneurysm, aortitis, aortic regurge
what is condyloma acuminatum?genital warts; painless
what do you see on biopsy with condyloma acuminatum?koilocytes
condyloma accuminatum is usually what types of HPV?6 & 11
HPV genes E6 and E7 interfere with normal function of what tumor suppressor genes allowing for overgrowth of epithelial cells?p53 and RB
latent HSV-1 resides in what ganglia?trigeminal ganglion (oral)
latent HSV-2 resides in what ganglia?lumbar and sacral (genital)
+Tzanck test on vesicular fluid is indicative of what disease?Genital herpes
what organism causes chlamydial cervicitis?chlamydia trachomatis
untreated chlamydia cervicitis causes?PID, salpingitis
DOC for chlamydia cervicitis?doxycycline (+ceftriaxone for GC if it hasn't been ruled out by NAAT)

Section 10.2 Testicular Tumors

Question Answer
what is a germ cell tumor?tumors formed from cells that would ordinarily have become sperm
#1 MC testicular germ cell tumor that is always malignant and analogous to ovarian dysgerminomaSeminoma
which testicular germ cell tumor is characterized by elevated hCG, is the #2 MC germ cell tumor and has a poor prognosis Embryonal
rare germ cell tumor that is malignant with significantly elevated hCG and occurs in teens-20schoriocarcinoma
elevated serum alpha-fetoprotein and more common in kids is what kind of germ cell tumor?yolk sac
teratoma needs to be comprised of at least how many germ cell layers?2
what are the 2 types of non-germ cell testicular tumors?stromal sex cord (leydig, sertoli) and non-stromal sex cord (lymphoma)
stromal sex cord tumor with intracytoplasmic reinke crystalsleydig cell tumor
sertoli cell tumorandroblastoma; usually benign and endocrinologically asymptomatic
lymphoma is more frequently associated in what population?elderly and AIDS patients

Section 10.3 Ovarian Tumors

vague lower abdominal discomfort and mild digestive complaints in a female can be indicative of what? and why does this happen? ovarian tumors, from activation of sympathetics
serous, mucinous, endometrioid, clear cell and brenner tumors are all categorized as what type of tumor surface epitherlium tumors of the ovary
which tumor is lined with fallopian tube epithelium and produces a watery secretion serous
what is a potential complication of a ruptured mucinous ovarian tumor? pseudomyxoma peritonei
tumor comprised of glandular tissue that is usually malignant endometrioid
which tumor has contractile ability and is also known as a celioblastoma? brenner
what are the 4 germ cell tumors of the ovary teratoma, dysgerminoma, endodermal sinus tumor and choriocarcinoma
what is another term for a mature teratoma dermoid cyst
what is a struma ovarii, and what physiological response can it cause unusual variant of dermoid cysts that only has 1 tissue element and can produce hyperthryoidim
which ovarian germ cell tumor has elevated AFP levels? elevated hCG levels? endodermal sinus tumor; choriocarcinoma
which stromal sex cord tumor is associated with + call exner bodies and causes secondary endometrial hyperplasia/CA granulosa-theca cell
which ovarian stromal sex cord tumor produces large amounts of testosterone sertoli-leydig cell
what is Meig's syndrome, and what tumor is it associated with? ascites, pleural effusion and ovarian tumor
mucin produced signet ring cells are indicative of what tumor of metastatic tumor of the ovary? krukenberg tumor
what is the primary location of krukenberg tumors stomach

Section 10.4 Endometrial and Cervical Disorders

Question Answer
What creates the risk in endometrial hyperplasia?Excess estrogen
What are the risk factors of endometrial hyperplasia?PCOS, >40 yoa, early menarche (<12.5yoa), late menopause (>52 yoa), Estrogen tx , Granulosa-Theca cell tumor (Thecas make excess E), Nulliparity, Obesity, DM Type II, HTN
What does CIN mean?Cervical intraepithelial neoplasia; precancerous
What major HPV types are assoc with CIN?HPV 16, 18, 30's, 40's, and 50's
How does HPV cause cancer?Inhibition of tumor suppressor genes p53 and RB
How is CIN I treated? What about CIN II/III?CIN I: cryo or laser or loop electric excision procedure (LEEP)
CIN II/III: Cone biopsy
What's the difference between CIN III and Invasive carcinoma?CIN III: hasn't invaded past the basement membrane but is full epithelial thickness neoplasia
Invasive: has moved through the basement membrane
CIN usually involves what area of the cervix?squamocolumnar junction

Section 10.5 Benign Uterine Disorders

Question Answer
How does PCOS occur?1. Excess LH production from the ant. pituitary stimulates ovarian theca cells to produce androstenedione (causing acne and hirsutism).
2. Fat cells' aromatase converts the androgens to estrone resulting in negative feedback on the ant. pituitary and decreasing FSH production.
3. This decrease in FSH results in decreased follicular development and thus prevents ovum from being ready for ovulation, making her anovulatory. (and therefore infertile)
What lab results would you expect for a woman with PCOS?LH:FSH ration >2:1; Hi androstenedione; Hi testosterone; Hi estrone
What causes endometriosis?Retrograde flow of menses into the abdominal canal where nests of endometrial cells adhere to structures of the peritoneum (#1 site is ovary)
What are the 3 D's of endometriosis?Dyschezia, Dysmenorrhea, Dyspareunia
What is the #1 uterine tumor and the overall #1 tumor in women?Uterine Leiomyoma (smooth muscle tumor of the uterus)
What group of women is most likely to develop uterine leiomyomas?Black women of reproductive age
What is the characteristic finding of uterine leiomyoma on pathologic exam?Whorled pattern of smooth mm bundles
What is the most common complaint with uterine leiomyomas?Abnormal menstrual bleeding (other symptoms include urinary frequency, impaired fertility, increased risk abortion/fetal malpresentation, and postpartum hemorrhage)

Section 10.6 Placenta

Question Answer
What is a complete mole?2 X sperms + 1 enucleated ovum
What is an incomplete mole?>1 sperm + 1 ovum
What lab values would you expect with a mole?Very high beta-HCG
What physical findings would you expect for a pt with a mole?Uterus larger than expected for gestational age d/t growth of villi (grape-like cysts) and trophoblastic proliferation
What is a choriocarcinoma?Malignant neoplasm of trophoblastic cells (placental cells)
Who is at risk for choriocarcinoma?Women with retained placenta or retained GTN; May form spontaneously as a type of germ cell tumor
What is placenta previa?Implantation of the placenta over or near the cervical os
What is placenta accreta?Implantation of the placenta more deeply than is usual (may require hysterectomy)
What is placental abruption?Premature separation of the placenta from the uterus (may be d/t maternal age <20 or advanced age, cocaine use, maternal HTN, smoking, EtOH, fibroids, or trauma)
What lab value would you expect in an ectopic pregnancy?Low beta-HCG

Section 10.7 Breast

Question Answer
What type of changes are occurring in a "lumpy, bumpy" breast and what happens during the menstrual cycle?Fibrocystic changes; fluctuate with menstrual cycle

Section 10.7.1 Benign Breast Tumors

Question Answer
If a young patient (<30 yoa) comes to you complaining of a mobile, marble like knot in her breast, what would be her most likely diagnosis?Fibroadenoma (women <30 yoa with marble like, mobile knots)
A 70yo woman presents to your office with the complaints that she has a huge, log-shaped knot in her breast. What is her most likely diagnosis?Phyllodes tumor
What type of cancer is commonly associated with bloody or serous nipple discharge?Intraductal papilloma

Section 10.7.2 Malignant Breast Tumors

Question Answer
What type of Ductal Carcinoma In Situ is most likely to produce microcalcifications?Comedocarcinoma (microcalcifications form at points of central necrosis)
What type of breast cancer is associated with scirrhous mass(es), nipple retraction, peau d'orange, and dimpling?Invasive ductal carcinoma
Why is lobular carcinoma so hard to see on mammography and what is the recommendation during treatment?Doesn't create calcifications or masses d/t its single file arrangement of cells; B/L mastectomy is recommended d/t likelihood that it will emerge in other breast
What type of consistency does invasive lobular carcinoma cause in the breast?Rubbery consistency
What is Paget's dz of the nipple? involvement of epidermis by malignant cells that have marched out of the nipple ducts; Resembles severely chapped lips with oozing and ulcers and fissures
What type of patient is most likely to get medullary carcinoma?Young women with a BRCA1 gene mutation causes a soft, fleshy consistency of the breast
What type of patient is most likely to get colloid (mucinous) carcinoma? Older women (esp 70-80s) causing a gelatinous consistency and is receptor positive
When performing mammography, what is a tubular carcinoma going to look like?Conspicuously spiculated multifocal mass that is either U/L or B/L in a woman in her late 40s
What is usually seen in lobular carcinoma with regard to changes in breast tissue?Architectural distortion
Do + estrogen/progesterone receptors convey a better or worse prognosis in breast cancer?Slightly better

Section 11.0 Mouth

Question Answer
glossitisinflammation of tongue
associated with B2, B12 deficiency
cheilosisdrying and scaling of lips with fissuring at corners of mouth
associated with B2 deficiency
smooth beefy red tongueatrophy of papillae & mucosa, exposing underlying vasculature
associated with B12 deficiency
strawberry tonguewhite coated tongue with hyperemic papillae
associated with scarlet fever
Koplik's spotsulceration on buccal mucosa
associated with measles

Section 11.1 Esophageal Diverticula

Question Answer
Zenker'sabove upper esophageal sphincter
Tractionmidpoint of esophagus
Epiphrenicabove the lower esophageal sphincter
Pulsionherniation of mucosa only; "false" diverticulum
Trueall layers of esophagus

Section 11.2 Gastritis

Question Answer
What are the 4 types of gastritis?acute erosive, chronic type A, chronic type B, Menetrier's
acute erosivefocal damage
risks: EtOH, NSAIDS, stress, cancer drugs, smoking
chronic type Aglandular destruction & mucosal atrophy
affects fundus
autoimmune: Ab against gastric glands, parietal cells, & intrinsic factor
results in: pernicious anemia (d/t loss of intrinsic factor) & achlorhydria (no HCl) d/t parietal cell loss
usually associated with: Hashimoto's disease, Addison's, vitiligo
chronic type Bchronic irritation d/t H pylori
affects antrum
chronic irritation leads to eventual mucosal atrophy & metaplasia, & then eventual carcinoma
menetrier'smucosal hyperplasia
mucosa becomes thickened with concomitant atrophy of glands
hashimoto'sautoimmune destruction of thyroid gland (causing hypothyroidism)
addison'sautoimmune destruction of adrenal gland (can't produce aldosterone)
vitiligoautoimmune destruction of melanocytes