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Prenatal Development, Birth, and the Newborn Baby – Flashcards 15 terms

Jose Escobar

15 terms

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Prenatal Development, Birth, and the Newborn Baby – Flashcards

question

1. When does the first cell division occur after conception?

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12- 24 hours

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2. Name the three stages of prenatal development and when they occur.

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Germinal Period (Conception- 2 weeks), Embryonic period (2-8 weeks), Fetal Period (9-38 weeks)

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3. What is a blastocyst?

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hollow ball of cells that impants in the uterus lining

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4. What are the major developments that occur during the period of the zygote?

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7th - 9th day: implantation into uterine lining Woman's immune system is weakened Early miscarriage due to defective sperm Amnion, umbilical cord, & placenta develop

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5. What are the major developments during the period of the embryo?

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Major organs begin to form and the heartbeat at the 18th day.

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6. Name the three layers of the embryo and the body parts that develop from them.

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Ectoderm: Develop skin, teeth, hair, nails, and nervous system. Mesoderm: Muscles, skeleton, circulatory system. Endoderm: digestive and respiratory system

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7. What is vernix?

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cottage cheese like substance that covers the skin to protect the skin from fluid

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8. What is lanugo?

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fine hairs that keep the vernix stuck to the body

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9. What is meant by the term age of viability?

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age the fetus can have a chance of surviving outside the womb.

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10. What is a teratogen?

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Any environmental factor that can get into a woman's system and harm the baby

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11. Teratogens pose the greatest risk during which period of prenatal development?

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The embryo, that's when the organs develop

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12. What is fetal alcohol syndrome?

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A series of characteristics in a child from whose mother drank during pregnancy. Ex. Mental retardation, down syndrome

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13. What are fetal alcohol effects?

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Show some facial features, and limited characterics as well. Ex. Flat face, thin lips

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14. Name five other factors that influence prenatal development.

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Diet: folic acid, prenatal vitamins, Age: The older the mother the higher the risk of prematurity and baby's weight, this also can happen when women are too young. Stress: We produce hormones that can damage the baby's body's, when our bodies are stressed we send blood to different parts of the body that can take away from the baby's supply SES: (Socio economic status) those who have lower incomes my have more birth defects Illness (e.g., Aids): chicken pox, measles, syphilis, aids

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15. What was demonstrated using the DeCasper Paradigm and The Cat in the Hat Study?

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DE Casper's Paradigm: Had mothers talk to their babies or read to them while they were pregnant. A couple days after the babies birth the baby was given the option of sucking on two different nipples. On one nipple the baby could hear its mothers voice and on the other the baby would hear another womans voice. The baby almost always chose the nipple in which the could hear their mothers voice. Cat in the Hat Study (DeCasper & Spence, 1986) Had the mother read the baby the cat in the hat while pregnant. Put in same sequence as above and babies preferred to suck on the nipple in which they heard the cat in the hat. This shows babies can remember things prenatally.

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Developmental Biology Developmental Psychology Introductory Psychology Psychology

AP Psych Chapter 4 Development Exam – Flashcards 48 terms

Ruth Jones

48 terms

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AP Psych Chapter 4 Development Exam – Flashcards

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Substances from the environment, including viruses, drugs, and other chemicals that can damage the developing organism during the prenatal environment is called?

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teratogens

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The innate predisposition of some species -- especially birds -- to form attachment to a figure observed at birth is termed?

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Imprinting

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Which of the following explains why avoidant children act unconcerned when they are separated from their mother in a strange situation?

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They no longer seek attachment because their efforts have been met with rejection in the past.

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Cognitive development refers to the study of the changing process....

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for thinking, perceiving, and remembering.

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Because Michelle has an idea that when she sees a dog it will eventually bark and chase a cat, Piaget would say that Michelle has

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developed a schema for dogs

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Assimilation is said to occur when a child...?

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modifies new information to fit what is already known

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Layla has been taken to the ocean for the first time. Upon initially seeing the ocean, she declares "pool". Eventually she is able to understand that these are not the same, and she can distinguish between a pool and an ocean. After this insight occurs, Layla could be said to have demonstrated...?

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accommodation

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The correct sequence of Piaget's stages of cognitive development is...?

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sensorimotor, preoperational, concrete operational, formal operational

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Which of the following is an example of sensorimotor intelligence?

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clinging, crying, and smiling.

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_______ is a term used by Piaget to refer to a child who is unable to take another's perspective and who sees the world only in terms of themselves

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Egocentrism

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An individual who is able to understand the concepts of philosophy and calculus would be found in which of Piaget's stages of cognitive development?

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formal operational

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The zone of proximal development explains...?

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the difference between what a child can do with help and what the child can do without help or guidance.

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Research on parenting styles suggests that authoritative parents produce children that are...?

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confident and self-reliant

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The first stage of Erikson's psychosocial theory involves an infant's need to...?

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develop a basic sense of trust in the environment

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Inadequate resolution of the _______ stage would result in a lack of self-confidence and a feeling of failure

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generativity Vs stagnation

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A child who refuses to steal candy because of a fear of being caught is most likely demonstrating...?

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preconventional moralty

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Kohlbery suggests that the highest stage of moral reasoning is evident when an individual acts in order to...?

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promote the welfare of her society

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Intimacy was defined by Erikson as the...?

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exploration of one's integrated identity

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Psychologists have resolved the nature-nurture controversy by saying that we are the products of...?

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both heredity and environment

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Adjusting current schemas to make sense of new information is called:

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accoommodation

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In regard to the nature-nurture controversy, most researchers...

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are most interested in the interaction of nature and nurture

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Habituation refers to the:

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biological growth processes that are relatively uninfluenced by experience

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The correct order of the three stages of human prenatal development is...?

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zygote, embryo, and fetus

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In synaptic pruning....

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some neural networks are destroyed to ensure that others are working as efficiently as possible.

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Compared with adults from Western Cultures that favor individualism, those from communal societies are less likely to develop _____ morality

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preconventional

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Identical twins typically being to walk on the same day. This best illustrates the importance of ______ to motor skills.

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maturation

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An impaired theory of mind is most closely associated with:

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autism

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Preschoolers acquisition of a theory of mind suggests that Piaget overestimated young children's:

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egocentrism

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Questions about the extent to which maladaptive habits learned in childhood can be overcome in adulthood are most directly relevant to the issue of:

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stability or change

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Crystallized intelligence refers most directly to a person's:

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accumulated knowledge

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A principle difference between a longitudinal study and a cross-section study is...?

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the time span of the study

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Harlow's experiments with substitute mothers made of wire demonstrated the importance of what aspects of nurturing?

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touch

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Which of the following explains why avoidant children act unconcerned when they are separated from their mother's in strange situations?

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they no longer seek attachment because their efforts have met with rejection in the past

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Thor is playing in his crib when his beloved hammer falls under his crib.....

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object permanence

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which of the following is a serious problem in the practical application of Kohlberg's theory of moral development?

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Moral reasoning does not predict actual behavior

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A child's realization that others may have beliefs which the child knows to be false illustrates the development of..?

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a theory of mind

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A researcher who administrates a personality test to the same child every 3 years as they progress through school is conducting a ______ experiment?

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longitudinal

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People's style of romantic love in adulthood are most likely to reflect their childhood:

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attachment experiences

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The fact that many people are happy and well adjusted adults were once rebellious...

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stability or change

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Stage theories of adult development are most likely to be criticized for exaggerating....

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stability of personality

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There is very little relationship between the age of an adult and his or her:

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level of life staisfaction

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Marriage bonds are especially likely to....

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engage in more positive than negative interactions with eachother

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Those who criticize theories of age linked...

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the social clock

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Explaining why the best work of scientists...

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fluid and crystallized intelligence

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Killing one person in order to save 5...

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gut-level intuitions

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Foster care the moves a young child...

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attatchment

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Professor carter observes....

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experimentation

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A correlation coefficient is

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direction of strength of the relationship between two variables

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Alternative Rna Splicing AP Biology Biology Developmental Biology Prokaryotic And Eukaryotic Cells

Biology Chapter 11 – Flashcards 57 terms

James Hopper

57 terms

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Biology Chapter 11 – Flashcards

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1) The term "gene expression" refers to the

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D) process by which genetic information flows from genes to proteins.

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2) A gene operon consists of

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D) transcribed genes, an operator, and a promoter.

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3) In a prokaryote, a group of genes with related functions, along with their associated control sequences, defines

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A) an operon.

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4) The lac operon in E. coli

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C) prevents lactose-utilizing enzymes from being expressed when lactose is absent from the environment.

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5) Proteins that bind to DNA and turn on operons by making it easier for RNA polymerase to bind to a promoter are called

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D) activators.

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6) The lac operon of E. coli is ________ when the repressor is bound to lactose.

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A) active

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7) The expression of the tryptophan operon is controlled by

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D) a repressor that is active when it binds to tryptophan.

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8) Which of the following is likely to occur in E. coli cells that are grown in skim milk?

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D) The trp repressor is activated and the cells will produce lactose-utilizing enzymes.

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9) A single cell, the zygote, can develop into an entirely new organism with many different specialized cells. Which of the following statements about this process is false?

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B) Additional genetic information for the formation of specialized cells is passed on to the developing embryo via the placenta.

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10) The basis of cellular differentiation is

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A) selective gene expression.

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11) The genes for the enzymes of glycolysis

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A) are active in all metabolizing cells, but the genes for specialized proteins are expressed only in particular cell types.

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12) Which of the following statements regarding DNA packing is false?

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C) DNA packing tends to promote gene expression.

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13) The relationship between DNA and chromosomes is most like

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B) thread wrapped around a spool.

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14) In female mammals, the inactive X chromosome in each cell

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B) becomes a Barr body.

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15) The tortoiseshell pattern on a cat

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B) results from X chromosome inactivation.

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16) Both prokaryotic and eukaryotic cells use ________ to turn certain genes on or off.

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D) proteins

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17) Enhancers are

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A) DNA sequences to which activator proteins bind.

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18) Silencers

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C) bind to DNA sequences and inhibit the start of transcription.

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19) RNA splicing involves the

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A) removal of introns from the molecule.

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20) The coding regions of a gene (the portions that are expressed as polypeptide sequences) are called

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B) exons.

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21) Which of the following permits a single gene to code for more than one polypeptide?

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C) alternative RNA splicing

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22) Small pieces of RNA that can regulate translation of mRNA are called

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B) microRNA.

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23) miRNA can be used by

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B) cells to prevent infections from double-stranded RNA viruses.

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24) All of the following mechanisms are used to regulate protein production except

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C) DNA editing.

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25) Which of the following mechanisms of controlling gene expression occurs outside of the nucleus?

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D) translation

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26) Which of the following statements about fruit fly development is false?

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D) The location of the head and tail ends of the egg is primarily determined by the location of sperm entry during fertilization.

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27) A homeotic gene

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A) serves as a master control gene that functions during embryonic development by controlling the developmental fate of groups of cells.

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28) Which of the following statements about microarrays is false?

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A) Microarrays use tiny portions of double-stranded RNA fragments from a large number of genes.

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29) In multicellular organisms, the coordination of cellular activities relies on

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A) cell-to-cell signaling and signal transduction pathways.

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30) To initiate a signal transduction pathway, a signal binds to a receptor protein usually located in the

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C) plasma membrane.

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31) Transcription factors attach to

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D) DNA.

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32) A signal outside a cell triggers changes in the transcription and translation inside the cell through

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B) signal transduction pathways.

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33) Yeast are able to communicate with each other

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B) through chemical signaling.

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34) Signal transduction pathways

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A) are mechanisms of communication that probably evolved in ancient prokaryotes.

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35) In plants, most differentiated cells retain

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C) a complete set of their genes, and retain the ability to express those genes under certain circumstances.

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36) Why can some plants be cloned from a single cell?

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D) Plant cells can dedifferentiate and give rise to all of the specialized cells required to produce an entire plant.

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37) Which of the following processes occurs when a salamander regenerates a lost limb?

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A) Certain cells in the limb dedifferentiate, divide, and then redifferentiate to form a new limb.

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38) The cloning of Dolly the sheep

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D) demonstrated that the nuclei from differentiated mammalian cells can retain their full genetic potential.

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39) The use of cloning to produce special embryonic stem cells is called

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B) therapeutic cloning.

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40) Which of the following mammals has not yet been cloned and brought through the complete gestation cycle?

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A) human

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41) Which of the following possible uses of reproductive cloning is still considered by most to be an unresolved ethical issue?

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A) the reproductive cloning of humans

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42) Which of the following statements regarding stem cells is false?

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B) Adult, but not embryonic, stem cells can be grown in laboratory culture.

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43) Adult stem cells have limited therapeutic potential

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B) because their developmental potential is limited to certain tissues.

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44) A gene that can cause cancer when present in a single copy in a cell is called a(n)

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A) oncogene.

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45) Which of the following statements about proto-oncogenes is false?

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B) A mutation in a tumor-suppressor gene can stop cell division immediately.

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46) Which of the following is not a factor that contributes to normal cells becoming cancerous?

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D) one or more of the cell's genes being removed by a virus

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47) Cancer of the colon is caused by

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D) several somatic cell mutations.

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48) The development of colon cancer occurs slowly, and colon cancer is more frequently seen in the elderly than the young. This is most likely because

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C) four or more somatic mutations must occur to give rise to the cancer, which takes time.

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49) Mutations in the proto-oncogene ras and the tumor suppressor gene p53

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B) disrupt normal regulation of the cell cycle.

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50) Mutations in the p53 gene can lead to cancer by

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A) causing the production of a faulty protein that is no longer able to inhibit cell division.

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51) The carcinogen known to cause the most cases and types of cancer is

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A) tobacco.

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52) Which of the following statements regarding cancer risk factors is false?

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D) Mutagens are usually not carcinogens.

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53) In this drawing of the lac operon, which molecule is an inactive repressor?

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D) molecule D

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54) Which structure in this figure shows one complete nucleosome?

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D) structure D

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55) Why don't the grafted hybrids produce apples with a blend of traits from the scion and the rootstock?

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D) The rootstock regulates gene expression in the scion, but contributes no genetic information for fruit production.

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56) Half the trees in an orchard were derived from rootstock "A" and half from rootstock "B," but all the trees had the same scion. If the trees grafted onto rootstock "A" were infected by a parasite that causes blossom rot, the trees grafted onto rootstock B

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A) would be very likely to become infected, because the remaining scions are genetically identical to those that are already infected.

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mRNA can be used by

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Cells to prevent infections from double-stranded RNA viruses.

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Adult Stem Cells AP Biology Bacterial Rna Polymerase Biology Developmental Biology Embryonic Stem Cells Non Coding Dna

BIO CH 11 – Flashcard 59 terms

Jason Westley

59 terms

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BIO CH 11 – Flashcard

question

The process by which genotype becomes expressed as phenotype

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is gene expression.

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Homeoboxes are evidence of

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the common ancestry of eukaryotic organisms.

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Cloning provides evidence that each of the different types of cells (e.g., liver cells, intestinal cells) of an individual,

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while having different functions, retains a complete genome.

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DNA microassay is a technique that

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could tell you how gene activity differs between individuals with and without cystic fibrosis.

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Regulatory genes code for

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repressors.

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Developmental similarities among very different animals can be attributed

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to shared homeoboxes.

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Repressors bind to

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operators.

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Male tortoiseshell cats are likely to be exceedingly rare and

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very likely to be sterile since normal male cats are XY.

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Transcription factors attach to

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DNA

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Data suggest that the normal version of BRCA1 functions as a

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tumor-suppressor gene.

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Examining a human cell that functions normally, you determine that it has 45 functional chromosomes and one chromosome that is almost completely inactive. You immediately decide that it is very likely that this cell

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came from a normal human female.

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The operator acts as an

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an on off switch

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In an operon, the ______ acts as an on/off switch.

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operator

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Which of the following turns off transcription by binding to the operator?

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repressor

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Repressors act by blocking the binding of _____ to the operator.

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RNA polymerase

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How can a single RNA transcript be translated into different polypeptides?

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There is more than one way to splice an RNA transcript.

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What would you assume if you found RNA transcripts of lactose-utilizing genes within E. coli?

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the presence of lactose

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Binding of transcription factors to enhancers is not a

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type of post-transcriptional regulation of gene expression.

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Which of these is most likely to cause the development of a six-legged frog?

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mutation of homeotic genes

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The lac operon is usually in the ______ position and is activated by ______.

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off... lactose

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Possible uses of reproductive cloning include ______.

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The production of organs in pigs for transplant into humans Restocking populations of endangered animals The production of genetically identical animals for experimentation

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Many proto-oncogenes regulate ______.

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cell division

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What is a difference between embryonic and adult stem cells?

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Embryonic stem cells are undifferentiated; adult stem cells are partially differentiated.

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Jim has become particularly interested in the genetic basis of cancer and has spent considerable time reading published papers about oncogenes. He learned that as early as 1972 researchers suggested that mutations in proto-oncogenes caused by carcinogens can convert them to oncogenes. He asked you to answer a couple of questions about this because he did not have the biology background to totally understand. Jim learned that some cancer cells produce more growth-stimulating proteins than others. What would you give him as a plausible explanation?

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Proto-oncogenes may have mutated to become oncogenes in these cells.

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Jim has become particularly interested in the genetic basis of cancer and has spent considerable time reading published papers about oncogenes. He learned that as early as 1972 researchers suggested that mutations in proto-oncogenes caused by carcinogens can convert them to oncogenes. He asked you to answer a couple of questions about this because he did not have the biology background to totally understand. Jim learned that viruses can sometimes cause cancer and wants to know why. You tell him that ______.

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a human cell can acquire an oncogene from a virus.

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Introns are ______.

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noncoding DNA sequences

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What name is given to a gene that causes cancer?

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oncogene

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A high fiber diet is a

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lifestyle choice that will not increase cancer risk.

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Cells communicate with one another via

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signal-transduction pathways.

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Operon includes

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operator, lactose-utilization gene 1&2, and promoter.

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In eukaryotic cells, repressors proteins inhibit transcription by

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binding to silencers.

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Homeotic genes are genes involved in

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determining patterns of anatomical development.

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When you started out, you were a single cell. You are now made of many cells; some of these cells function as liver cells, some as muscle cells, some as red blood cell. what is the name of this process

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cellular differatitaion

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The possible uses of reproductive cloning is

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the production of organs in pigs for transplant into humans, the production of genetically identical animals for experimentation, the production of potentially valuable drugs, the improvement of the quality of farm animals.

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In order to make a clone for a mammalian cell, the cell must

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differentiate.

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A gene Operon consists of

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transcribed genes and a promoter only.

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In prokaryotes,

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the production of a single RNA transcript for a group of related genes is under the control of an Operon.

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There is more than one way to splice an RNA transcript into different polypeptides.

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...

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Attachment of RNA polymerase to the promoter

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plays a role in the regulation of transcription in both prokaryotic and eukaryotic cells.

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Proto-oncogenes

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regulate cell division.

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In prokaryotes, Operon is the name given to a

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unit that controls the turning on and off of a specific set of genes.

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The presence of lactose is indicated by

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the presence of RNA transcripts of lactose utilizing genes within E-coli?

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Inheritance of certain genes increases the risk of getting certain cancers;

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thus, it can be said that predisposition to these cancers is inherited as a recessive trait.

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A mutation in a proto-oncogene will not result in cancer unless (or until)

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there are additional mutations in genes such as tumor supressors.

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More people die of what cancer than any other type?

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lung

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Translation is

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a mechanism of controlling gene expression occurs outside of the nucleus?

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DNA packing and unpacking is the first level of

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control of eukaryotic gene transcription.

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The cells exhibit different patterns of gene expression is

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the basis of the different functions of different body tissues?

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Embryonic stem cells are undifferentiated;

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adult stem cells are partially differentiated. This is the difference between embryonic and adult stem cells.

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Eukaryotic DNA sequences called enhancers

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have a function similar to the operators of prokaryotic operons.

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To initiate a signal-transduction pathway,

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a signal binds to a receptor protein, usually located in the plasma membrane.

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One of the most potent environmental carcinogens is

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uv radiation.

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Tobacco is responsible for

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more cancers than any other carcinogen.

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Cigarette smoke, fat, uvlight and testosterone are all

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carcinogens.

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Introns are

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unexpressed DNA sequences.

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Cancer causing genes are

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oncogenes.

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A mutation of Homeotic genes is most likely

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to cause the development of a six legged frog.

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RNA polymerase binds

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to a promoter.

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The use of therapeutic cloning holds

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promise for the treatment of diseases such as Parkinson's disease.

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Developmental Biology Modified Radical Mastectomy Nursing Pharmaceutical Sciences

First Aid Funfacts – Flashcards 742 terms

Gabriela Compton

742 terms

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First Aid Funfacts – Flashcards

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ACE Inhibitors (teratogen effect)

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Renal damage

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Alkylating agents (teratogen effect)

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Absence of digits, multiple anomalies

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Aminoglycosides (teratogen effect)

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CN VIII toxicity (A mean guy hit the baby in the ear)

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Carbamazepine (teratogen effect)

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Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR

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Diethystilbestrol (DES) (teratogen effect)

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Vaginal clear cell adenocarcinoma, congenital Mullerian anomalies (T shaped uterus)

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Folate antagonists (teratogen effect)

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NTDs

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Lithium (teratogen effect)

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Ebstein's anomaly (atrialized right ventricle)

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Phenytoin (teratogen effect)

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Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, mental retardation

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Tetracyclines (teratogen effect)

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Discolored teeth, growth retardation

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Thalidomide (teratogen effect)

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Limb defects (flipper limbs)

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Valproate (teratogen effect)

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Inhibition of maternal folate absorption (NTDs)

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Warfarin (teratogen effect)

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Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities (use HEPARIN in pregnancy!!)

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Alcohol (teratogen effect)

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Fetal alcohol syndrome *leading cause of birth defects and mental retardation

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Cocaine (teratogen effect)

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Abnormal fetal development and fetal addiction, placental abruption, renal a genesis, heart defects

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Smoking (teratogen effect)

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Preterm labor, placental problems, IUGR, ADHD

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Iodide (teratogen effect)

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Congenital goiter or hypothyroidism (cretinism)

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Maternal diabetes (teratogen effect)

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Caudal regression syndrome (anal atresia to sirenomelia- legs fused together "mermaid syndrome"), congenital heart defects, NTDs, hypertrophic CM, macrosomia, hypoglycemia

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Vitamin A (teratogen effect)

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Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)

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X-rays (teratogen effect)

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Microcephaly, mental retardation

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Bugs that stain with Giemsa

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Chalmydia, Borrelia, Rickettsia, Trypanosomes, Plasmodium (Certain bugs really try my patience)

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Bugs that stain PAS+

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Stains glycogen, mucopolysaccharides- used to diagnose Whipples disease (Tropheryma whipplei)

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Bugs that stain Ziehl-Neelson (carbol fuschion)

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Acid-fast organisms (Nocardia, Mycobacterium)

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Bugs that stain with India Ink

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Cryptococcus neoformans (mucicarmine can also be used to stain thick polysaccharide capsule red)

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Bugs that stain with silver stain

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Fungi (PCP), Legionella, H. pylori

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What bug needs chocolate agar with factors V (NAD+) and X (hematin)

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H. influenza

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What bug needs Thayer-Martin (VPN) media?

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N. gonorrhea, N. meningitidis (VPN- vancomycin inhibits gram positives, Polymyxin inhibits most gram negs, Nystatin inhibits fungi)

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What bug needs Bordet-Gengou (potato) agar?

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Bordetella pertussis (BORDET needs BORDET)

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What bug needs Tellurite plate or Lofflers media?

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Corynebacterium diptheria (Cysteine-Tellurite agar - forms black colonies)

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What bug needs Lowenstein-Jensen agar?

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M. Tb

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What bug needs Eaton's agar?

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M. Pneumoniae

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What bugs form pink colonies on MacConkeys agar?

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Lactose-fermenting enterics (E. Coli, etc)

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What bug can grow on eosin-methylene blue (EMB) agar as green colonies with metallic sheen?

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E. Coli

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What bug grows on charcoal yeast extract buffered with cysteine and iron?

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Legionella

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What bug grows on Sabouraud's agar?

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Fungi (Sab's a FUN guy?)... never heard of a guy named Sab

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Encapsulated bacteria

answer

Strep pneumo, H. influenza type B, Neisseria meningitidis, E. Coli, Salmonella, Klebsiella pneumo, group B strep (SHiNE SKiS) Capsules = ANTIPHAGOCYTIC virulence factor opsonized and cleared by spleen, increased risk in asplenic patients

question

Catalase + organisms

answer

Pseudomonas, Listeria, Aspergillus, Candida, E. coli, Staph aureus, Serratia *increased risk in chronic granulomatous disease (NADPH oxidase deficiency) You need PLACESS for your CATs

question

Bacteria producing Protein A

answer

Staph aureus (prevents opsonization), binds Fc portion of Ig

question

Bacteria producing IgA protease?

answer

Strep pneumo, H influenza type B, Neisseria (SHiN) enzyme cleaves IgA

question

Bacteria producing M protein

answer

Group A strep prevents phagocytosis

question

Conjugated vaccines

answer

Strep pneumo, Neisseria, H. influenza *conjugate to diptheria toxin or tetanus toxin

question

Bacteria that inhibit protein synthesis with exotoxin against EF-2

answer

Corynebacterium diptheria Pseudomonas aeruginosa

question

Bacteria that inhibit protein synthesis by inactivating the 60S ribosome

answer

Shigella EHEC (shiga like toxin)

question

Bacteria that increase fluid secretion via exotoxins

answer

ETEC (heat labile LT toxin) over activates cAMP (inc. Cl- secretion), ST toxin over activates cGMP (decrease NaCl reabsorption) Bacillus anthracis (edema factor) - increases cAMP Vibrio cholerae (cholera toxin)- increases cAMP

question

Bacteria that use exotoxin to inhibit phagocytosis

answer

Bordatella pertussis (Pertussis toxin)- increase cAMP, disables Gi, impairs phagocytosis

question

Bacteria that inhibits release of NT via exotoxin

answer

Clostridium tetani (Tetanospasmin)- prevents release of inhibitory GABA leading to muscle rigidity and lock jaw Clostridium botulinum (botulinum toxin)- prevents release of ACh leading to flaccid paralysis

question

Bacteria that use exotoxin to lyse cell membranes

answer

Clostridium perfringens (Alpha toxin, lecithinase)- phospholipase degrades cell membranes Strep pyogenes (streptolysin O)- degrades cell membranes, lyses RBCs

question

Bacteria that use super antigens to cause shock

answer

Staph aureus (TSST-1)- bring MHC class II and TCR in proximity causing overwhelming release of IFNgamma and IL-2 (toxic shock syndrome, scalded skin syndrome (exfoliatin), food poisoning (enterotoxin) Strep pyogenes (exotoxin A)- same mechanism, causes toxic shock syndrome

question

What endocrine hormones use cAMP signaling pathway?

answer

FLAT ChAMP FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH Calcitonin, GHRH, glucagon

question

What endocrine hormones use cGMP signaling pathway?

answer

ANP, NO (EDRF) **think vasodilators

question

What endocrine hormones use IP3 signaling pathway?

answer

GGOAT GnRH, GHRH (sometimes), Oxytocin, ADH (V1), TRH, histamine (H1), ATII, gastrin *also alpha1-rec, M1 and M3 (HAV 1 M&M)

question

What endocrine hormones use steroid receptor signaling pathway?

answer

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone *VETTT CAP

question

Nuclear receptors

answer

Thyroid hormone, Retinoids, PPAR, Fatty acids

question

Cytoplasmic receptors

answer

Steroids, Androgens, Estrogen

question

What endocrine hormones use intrinsic tyrosine kinase signaling pathway?

answer

Insulin, IGF-1, FGF, PDGF, EGF **MAP-Kinase pathway (think growth factors)

question

What endocrine hormones use receptor-associated tyrosine kinase signaling pathway?

answer

Prolactin, Immunoglobulins (cytokines IL2, IL6, IL8, IFN), GH **Jak-STAT pathway (PIG)

question

What adrenergic receptors use Gi signaling?

answer

M2, alpha2, D2 (MAD 2's) *Decreased cAMP

question

What adrenergic receptors use Gq signaling?

answer

H1, alpha1, V1, M1, M3 (HAV 1 M&M) *IP3 mechanism

question

What adrenergic receptors use Gs signaling?

answer

B1, B2, D1, H2, V2 *Increased cAMP

question

Thyroid receptor

answer

thyroxine-binding globulin (TBG) and it has a nuclear receptor

question

Hashimotos thyroiditis is associated with:

answer

Hypothyroidism Ab against thyroid peroxidase, antithyroglobulin Ab HLA-DR5 Hurthle cells, lymphocytic infiltrate, germinal center Increased risk B cell lymphoma

question

Cretinism associated with:

answer

5 P's Pot-belly, puffy face, pale, protruding umbilicus, protuberant tongue (severe fetal hypothyroidism)

question

Subacute (de Quervains) thyroiditis is associated with:

answer

Self-limited hypothyroidism following flu-like illness *Granulomatous inflammation *PAINFUL, inc. ESR, jaw pain

question

Reidels thyroiditis is associated with:

answer

Hypothyroidism due to replacement by fibrous tissue *PAINLESS + antithyroid peroxidase Ab

question

Graves disease associated with:

answer

Autoimmune hyperthyroidism Thyroid-stimulating Ig, opthalmopathy, pretibial myxedema *HLA-B8, Dr3

question

Papillary thyroid carcinoma

answer

Most common thyroid cancer Empty-appearing nuclei (orphan annie) Psammoma bodies Nuclear grooves *EXCELLENT PROGNOSIS

question

Follicular thyroid carcinoma

answer

Uniform follicles WITH INVASION through capsule Can spread hematogenously to lung/bone

question

Medullary thyroid carcinoma

answer

From parafollicular "c" cells Produces calcitonin Sheets of cells in amyloid stroma Associated with MEN 2A and 2B

question

Undifferentiated/anaplastic thyroid carcinoma

answer

Most malignant, very aggressive, worst prognosis Universally FATAL

question

Hot thyroid nodules

answer

Graves, toxic goiter (rarely malignant)

question

Cold thyroid nodules

answer

cyst, adenoma, cancer

question

Thyroglobulin

answer

Marker for papillary and follicular thyroid cancer

question

Pseudohypoparathyroidism

answer

Albright's hereditary osteodystrophy AD, kidney unresponsiveness to PTH Hypocalcemia, short 4th/5th digits, short stature *Not correctable w/ exogenous PTH

question

Chvosteks sign

answer

Tapping of facial nerve --> contraction of facial muscles (hypocalcemia, tetany)

question

Trousseaus sign

answer

Occlusion of brachial artery with BP cuff --> carpal spasm

question

Sonic hedgehog gene controls:

answer

patterning along anterior-posterior axis, CNS development (failure --> holoprosencephaly)

question

Wnt-7 gene controls:

answer

organization along dorsal-ventral axis

question

FGF gene controls:

answer

lengthening of limbs, stimulates mitosis of mesoderm

question

Homeobox gene controls:

answer

segmental organization of the embryo in cranio-caudal direction, Hox mutations lead to appendages in the wrong locations (ex. Hand-foot-genital syndrome)

question

Surface ectoderm derivatives

answer

adenohypophysis (Rathke's pouch), lens of eye, epithelial lining of oral cavity, sensory organs of ear and olfactory epithelium, epidermis, anal canal below pectinate line, parotid, sweat and mammary glands

question

Neuroectoderm derivatives

answer

brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland), retina and optic nerve, spinal cord

question

Neural crest derivatives

answer

PNS (DRG, cranial nerves, celiac ganglion, schwann cells, ANS), melanocytes, chromaffin cells of adrenal medulla, parafollicular (C) cells of thyroid, pia and arachnoid, bones of skull, odontoblasts, aorticopulmonary septum

question

Mesoderm derivatives

answer

muscle, bone, connective tissue, serous lining of body cavities (ex. peritoneum), spleen (derived from foregut mesentery), cardiovascular structures, lymphatics, blood, wall of gut tube, wall of bladder, urethra, vagina, kidneys, adrenal cortex, dermis, testes, ovaries

question

Mesodermal defects

answer

VACTERL Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal defects, limb defects (bone and muscle)

question

Endoderm derivatives

answer

Gut tube epithelium (including anal canal above the pectinate line), luminal epithelial derivatives (lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells)

question

Fetal alcohol syndrome

answer

Mental retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocation, heart and lung fistulas

question

Dizygotic twins placenta

answer

dichorionic, diamniotic

question

Most common monozygotic twin placenta type

answer

monochorionic, diamniotic (cleavage occurs at day 4-8 in 75% of monozygotic twin pregnancies)

question

Urachal duct

answer

duct between bladder and yolk sac (derived from allantois) failure of obliteration can cause patent urachus (urine discharge from umbilicus), vesicourachal diverticulum (bladder outpouching), urachal sinus, urachal cyst

question

Vitelline duct (omphalomesenteric)

answer

connects yolk sac to the midgut lumen failure of vitelline duct to close causes vitellines fistula (meconium discharge from umbilicus), meckels diverticulum, enterocyst

question

1st aortic arch derivatives

answer

Maxillary artery Muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini CN V2, V3 Meckels cartilage- mandible, malleus, incus, sphenomandibular ligament

question

2nd aortic arch derivatives

answer

Stapedial artery and hyoid artery Muscles of facial expression (stapedius, stylohyoid) CN VII Reichert's cartilage- stapes, styloid process, lesser horn of hyoid, stylohyoid ligament

question

3rd aortic arch derivatives

answer

Common carotid artery, part of internal carotid artery Stylopharyngeus CN IX (glossopharyngeal nerve) Cartilage- greater horn of hyoid

question

4th aortic arch derivatives

answer

L side- aortic arch R side- proximal part of R. subclavian artery Pharyngeal constrictors, cricothyroid, levator veli palatini CN X (superior laryngeal branch) Cartilage- thyroid, cricoid, arytenoids, corniculate, cuneiform

question

6th aortic arch derivatives

answer

Proximal part of pulmonary arteries and ductus arteriosus on left All intrinsic muscles of larynx (except cricothyroid) CN X (recurrent laryngeal branch) Cartilage (same as 4th arch)

question

1st branchial pouch

answer

middle ear cavity, eustachian tube, mastoid air cells endoderm lined structures of the ear

question

2nd branchial pouch

answer

epithelial lining of palatine tonsil

question

3rd branchial pouch

answer

thymus (ventral wings) inferior parathyroids (dorsal wings)

question

4th branchial pouch

answer

superior parathyroids (dorsal wings)

question

DiGeorge syndrome

answer

aberrant development of 3rd and 4th pouches, leads to T cell deficiency and hypocalcemia (failure of parathyroid development) --> tetany, fungal/viral infections

question

MEN2A

answer

Ret mutation (neural crest cells) -adrenal medulla (pheochromocytoma) -parathyroid tumor (3rd/4th pharyngeal pouch) -parafollicular cells (medullary thyroid cancer)

question

Cleft lip

answer

failure of fusion of maxillary and medial nasal processes (maxillary prominences with intermaxillary segment) formation of primary palate

question

Cleft palate

answer

failure of fusion of lateral palatine processes, nasal septum, and/or median palatine process (formation of secondary palate)

question

Vagina and ectocervix epithelium

answer

stratified squamous

question

Endocervix epithelium

answer

simple columnar epithelium

question

Uterine epithelium

answer

simple columnar epithelium, pseudostratified tubular glands

question

Fallopian tube epithelium

answer

simple columnar, ciliated

question

Ovary epithelium

answer

simple cuboidal epithelium

question

What is in the suspensory ligament of ovary?

answer

ovarian vessels (can damage ureter when ligating ovarian vessels in oophorectomy)

question

What is in the cardinal ligament?

answer

uterine vessels (can damage ureter when ligating uterine vessels during hysterectomy)

question

What is in the round ligament of the uterus?

answer

Artery of Sampson connects uterine fundus to labia majora

question

What is in the broad ligament?

answer

ovaries, fallopian tube, round ligament of uterus *mesosalpinx, mesometrium, mesovarium

question

Emission and ejaculation are controlled by what nerves?

answer

emission- sympathetic NS (hypogastric) ejaculation- visceral & somatic nerves (pudendal nerve)

question

Meiosis I of oocyte is arrested in what stage until ovulation?

answer

PROPHASE I (primary oocyte) 46 2N, 4C

question

Meiosis II of oocyte is arrested in what stage until fertilization?

answer

METAPHASE II (secondary oocyte) 23 1N, 2C

question

Down Syndrome triple screen:

answer

Low urine estriol Low serum AFP High serum bHCG

question

HPV mechanism

answer

E6 gene product: destruction of p53 E7 gene product: destruction of Rb high risk 16 & 18

question

General ovarian cancer marker

answer

CA-125, monitors progression and recurrence

question

Surface ovarian tumors

answer

Serous cystadenoma (benign) Serous cystadenocarcinoma (malignant) Mucinous cystadenoma (benigh) Mucinous cystadenocarcinoma (malignant)

question

Tumor marker for choriocarcinoma

answer

hCG

question

Granulosa cell tumor

answer

secretes estrogen (precocious puberty in kids, endometrial hyperplasia- adults) Call-exner bodies- follicles with eosinophilic secretions abnormal uterine bleeding

question

Krukenberg tumor

answer

GI malignancy with mets to bilateral ovaries (diffuse type)

question

Meig's syndrome

answer

triad of ovarian fibroma, ascites and hydrothorax

question

Which ovarian tumor resembles urothelium?

answer

Brenner tumor (pale, yellow-tan encapsulated tumor)

question

What tumors cause mets to the ovary?

answer

Krukenberg (GI mets, mucinous signet rings) Pseudomyxoma peritonei (mets from appendix, mucinous tumor)

question

Where does lymph from lower 2/3 of vagina drain to?

answer

Inguinal nodes

question

Where des lymph from the upper 1/3 of vagina drain to?

answer

Regional iliac nodes

question

Adenosis

answer

Persistance of columnar epithelium in the upper 1/3 of vagina, increased risk with in-utero DES exposure, and increased risk of clear cell adenocarcinoma

question

Complete mole

answer

46 XX, 46 XY (sperm fertilize enucleated egg and then paternal DNA duplicates), very high beta-hCG, may progress to choriocarcinoma "snowstorm appearance" on ultrasound

question

Partial mole

answer

69 XXX, 69 XYY, 69 XXY 2 sperm fertilize one egg high beta-hCG low risk of malignancy may contain fetal parts

question

Choriocarcinoma response to chemo

answer

Sporadic (germ cell tumor)- poor response to chemo Gestational (post-molar pregnancy)- good response to chemo

question

Calcifications on mammogram

answer

DCIS Sclerosing adenosis Fat necrosis

question

Which breast cancer involves the dermal lymphatics?

answer

Inflammatory breast cancer Peau d'orange very poor prognosis, tumor has accessed lymph nodes (may look similar to acute mastitis)

question

Which breast cancer has lymphocytic infiltrate?

answer

Medullary breast cancer

question

Mutation in lobular carcinoma of breast

answer

CDH1 mutation, lack e-cadherin discohesive cells

question

Her2 receptor

answer

cell surface growth factor receptor

question

Poor prognosis breast cancer

answer

ER, PR, HER2 negative "triple negative"

question

BRCA1

answer

Increased risk medullary carcinoma of the breast Ovarian carcinoma (serous) Fallopian tube carcinoma

question

BRCA2

answer

Breast cancer in males (assoc. w/ Klinefelters) (and female breast/ovarian cancer)

question

Yolk sac tumor marker

answer

AFP Schiller-Duval bodies (glomeruloid)

question

beta-hCG mimics

answer

thyroid hormone

question

Choriocarcinoma metastasis

answer

rapidly metastasizes into the blood goes to the lung

question

Teratomas

answer

Benign in females Malignant in males *produce AFP or B-hCG

question

Most common cause of testicular mass in male >60 years old

answer

Testicular lymphoma (diffuse large B cell lymphoma)

question

Choriocarcinoma tumor marker

answer

Beta-hCG

question

Prostatic adenocarcinoma mets

answer

bone mets (lumbar spine) osteoBLASTIC lesions- sclerotic

question

Thigh ADduction

answer

Obturator (L2-L4) nerve innervates adductors longus, brevis, magnus & gracilis muscles injury due to ANTERIOR hip dislocation

question

Thigh ABduction

answer

Superior gluteal (L4-S1) nerve innervates gluteus medius and minimus injured by POSTERIOR hip dislocation

question

Thigh FLEXORS

answer

Femoral nerve (L2-L4) Iliacus & psoas muscles (lumber ventral rami L2-L3) Rectus femoris, sartorius (femoral nerve) Tensor fascia lata

question

Thigh EXTENSORS

answer

Inferior gluteal nerve (L5-S2) Gluteus maximus (inf gluteal nerve) Long head of biceps femoris (sciatic-tibial nerve)

question

Sciatic nerve splits into:

answer

common peroneal, tibial

question

Functions of common peroneal nerve

answer

PED (foot eversion, dorsiflexion) injury --> foot drop, slap, loss of sensation on dorsum of foot

question

Functions of tibial nerve

answer

TIP (foot inversion, plantar flexion) injury --> foot eversion and dorsiflexion, loss of sensation on sole of foot

question

Site of pudendal nerve block

answer

Ischial spine (S2-S4)

question

Leg extension controlled by which nerve?

answer

Femoral

question

Leg flexion controlled by which nerves?

answer

sciatic (tibial) and others

question

Thigh movements overall:

answer

ADduction- obturator nerve ABduction- superior gluteal nerve Flexion- femoral nerve Extension- inferior gluteal nerve

question

Osteoclast markers:

answer

urinary deoxypyridinoline hydroxyproline tartrate resistant acid phosphatase

question

Osteoblast marker:

answer

Alk phosphatase (bone specific)

question

Mutation in achondroplasia

answer

Activating mutation in FGF3R (sporadic or AD) inhibits chondrocyte proliferation

question

Mutation in osteopetrosis

answer

Carbonic anhydrase II (failure of normal bone resorption)

question

Potential complications of Paget's disease of bone

answer

High output cardiac failure Osteogenic sarcoma Hearing loss

question

Osteomyelitis affects what part of bone?

answer

Kids (metaphysics of long bones) Adults (epiphysis of long bones)

question

Most common causes of osteomyelitis

answer

S. aureus, N. gonorrhea Salmonella (sickle cell) Tb (Pott's disease) Pseudomonas (foot puncture) Pasturella (dog/cat bite)

question

Most common sites of AVN

answer

Femoral & humoral head Scaphoid & lunate wrist bones Talus "crescent sign"

question

Common tumor in bone epiphysis

answer

Giant cell tumor (osteoclastoma) BENIGN "double bubble" appearance

question

Common tumor in bone metaphysis

answer

Osteosarcoma (malignant), young males, Codman's triangle sign Osteochondroma (benign)- young males, mature bone with cartilaginous cap

question

Common tumor in bone diaphysis

answer

Ewing's sarcoma (malignant), young males Anaplastic small blue cell tumor Extremely aggressive, onion skin appearance Also chondrosarcoma (malignant)

question

HLA associated with RA

answer

HLA-DR4

question

Joint findings in RA

answer

Pannus formation (MCP, PIP) Subcutaneous nodules Ulnar deviation of fingers Subluxation Baker's cysts **does NOT involve DIP *Pain improves with use

question

Joint findings in osteoarthritis

answer

Subchondral cysts, sclerosis Osteophytes Eburnation Heberdens nodes (DIP), Bouchards nodes (PIP) *Pain improves with rest

question

Sjogren's syndrome

answer

Autoimmune destruction of exocrine glands Triad: xeropthalmia, xerostomia, arthritis Unilateral parotid enlargement, inc. risk of B-cell lymphoma SS-A (Ro), SS-B (La)

question

Gout

answer

Monosodium urate crystals precipitate in joints due to hyperuricemia 90% underexcretion Needle shaped, negatively birefringent, yellow crystals under parallel light

question

Pseudogout

answer

Calcium pyrophosphate crystals Rhomboid, weakly positively birefringent, blue when parallel to light

question

Seronegative spondyloarthropathies (HLA-B27 positive)

answer

Psoriatic arthritis (dactylitis, pencil-in-cup deform) Ankylosing spondylitis (sacroiliac & vertebral fusion, uveitis, aortic regurg, restrictive lung disease) IBD Reactive arthritis- conjunctivitis, urethritis, arthritis Bechets

question

Bechets

answer

Recurrent apthous & genital ulcers, uveitis, e. nodosum, inflammatory arthritis

question

Common cause of death in SLE

answer

Nephritis (most commonly diffuse proliferative glomerulonephritis) *renal failure, infection

question

Antiphospholipid syndrome

answer

Anticardiolipin (false + syphilis test) Lupus anticoagulant (falsely increased PTT) Patient is HYPERcoagulable, DVT, stroke, placental thrombosis, hepatic vein thrombosis

question

Drug induced lupus marker

answer

Anti-histone Ab *Hydralazine, isoniazid, procainamide

question

Polymyositis

answer

Progressive symmetrical proximal muscle weakness ENDOmysial inflammation CD8+ T cells

question

Dermatomyositis

answer

Malar rash, Gottron's papules, heliotrope rash, "shawl & face" rash, mechanics hands PERImysial inflammation CD4+ T cells Increased risk of lung, GI cancer

question

Marker of polymyositis, dermatomyositis

answer

anti-Jo-1 Ab Increased CK

question

Myasthenia gravis

answer

Ab against post-synaptic Ach receptor Symptoms: ptosis, diplopia, weakness WORSENS with muscle use Assoc. with thymoma, thymic hyperplasia

question

Eaton-Lambert Syndrome

answer

Ab against pre-synaptic Ca2+ channels (decrease Ach release) Symptoms: proximal muscle weakness IMPROVES with muscle use Assoc. with small cell lung cancer

question

What do you use to test for myasthenia gravis?

answer

Edrophonium (short acting anti cholinesterase)

question

Diffuse scleroderma marker

answer

anti-Scl-70 (anti-DNA topoisomerase I Ab)

question

CREST syndrome

answer

Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telangectasia Anti-centromere Ab "C" is for CREST

question

Spongiosis

answer

Seen in acute eczematous dermatitis edema, lymphocytes, eosinophils "weeping" vesicles

question

Hyperkeratosis

answer

Increased thickness of stratum CORNEUM (psoriasis, chronic eczema)

question

Parakeratosis

answer

Hyperkeratosis with retention of nuclei in stratum corneum (psoriasis)

question

Acantholysis

answer

Separation of epidermal cells (pemphigus vulgaris)

question

Acanthosis

answer

Epidermal hyperplasia (increased spinosum)- acanthuses nigricans, psoriasis

question

Dermatitis

answer

Inflammation of the skin (Atopic dermatitis)

question

Albinism

answer

NORMAL melanocyte number, decreased melanin production because of low tyrosinase activity (or failure of neural crest migration during development)

question

Vitiligo

answer

Complete depigmentation in areas due to decreased NUMBER of melanocytes (autoimmune destruction)

question

Solar lentigo

answer

Increased NUMBER of melanocytes brown macules in the elderly

question

Freckle

answer

normal number of melanocytes, INCREASED NUMBER OF MELANOSOMES, increased melanin pigment

question

Eczema

answer

Type I HSR (IgE mediated) pruritic eruption on skin acute- weeping vesicles chronic- dry, thick skin

question

Allergic contact dermatitis

answer

Type IV HSR Spongiosis

question

Leser-Trelat sign

answer

sudden appearance of multiple, seborrheic keratoses Indicates underlying malignancy (GI, lymphoid)

question

Auspitz sign

answer

pinpoint bleeding from exposure of dermal papillae when psoriatic scales are scraped off

question

Bullous pemphigoid

answer

Tense blisters Ab against hemidesmosomes (BPAG1,2) Linear IF Spares oral mucosa

question

Pemphigus vulgaris

answer

Flaccid blisters, + Nikolsky sign IgG against desmoglein 3 and/or 1 (desmosomes) Netlike IF Involves oral mucosa

question

Dermatitis herpetiformis

answer

IgA deposits at tips of dermal papillae Assoc. w/ celiac disease Neutrophils at tips of dermal papillae "micro abscesses"

question

Pemphigus vulgaris & bullous pemphigoid are Type ? HSR

answer

Type II HSR

question

Dermatitis herpetiformis is Type ? HSR

answer

Type III HSR

question

Erythema multiforme and SJS are Type ? HSR

answer

Type IV HSR Cytotoxic CD8+ T cell mediated

question

Actinic keratosis

answer

Precursor to SCC small, erythematous papules, plaques HYPERKERATOSIS, PARAKERATOSIS

question

Lichen planus is associated with?

answer

Hep C

question

Necrotizing fasciitis caused by:

answer

Strep pyogenes "flesh eating bacteria"

question

Impetigo caused by:

answer

S. aureus, S. pyogenes Honey colored crusts

question

Basal cell nevus syndrome

answer

mutation in PATCHED --> 50-100 BCC

question

Basal cell carcinoma

answer

Most common skin cancer, PATCHED mutation in 90% Sun exposed areas Pink, pearly nodules, telangectasias, rolled borders, central crusting, ulceration Palisading nuclei on histo classic location: upper lip *excellent prognosis

question

Squamous cell carcinoma

answer

2nd MC skin cancer, p53 mutations in 90% sunlight, immunosuppression, arsenic Ulcerative, red lesions, with scales (lower lip) can metastasize histology shows KERATIN pearls

question

Melanoma

answer

Significant risk of mets S-100 tumor marker Activating mutation in BRAF kinase *Leading cause of death due to skin cancer Worse prognosis with nodular and acrolentigenous types, better prognosis with superficial and lentigo types

question

Hypertensive retinopathy

answer

copper wiring AV nicking

question

Diabetic retinopathy

answer

hemorrhage, exudates, microaneurysms, vessel proliferation **SORBITOL causes damage

question

Xeroderma pigmentosum

answer

AR mut in NER of thymidine dimers from sun exposure

question

Deamination

answer

cytosine --> uracil adenine --> xanthine guanine --> hypoxanthine *repair with base excision

question

HNPCC

answer

AD defect in DNA mismatch repair

question

Ataxia telangiectasia

answer

AR defect in ATM gene that codes for DNA repair enzymes triad: cerebellar defect (ataxia), spider angiomas, IgA deficiency Inc. AFP

question

alpha-amanitin (amanita phalloides)

answer

death cap mushroom, inhibits RNA Pol II severe hepatotox. if ingested

question

beta-thalassemia

answer

splice site mutation

question

I cell disease

answer

lysosomal storage disease, failure of addition of mannose-6-P to lysosome proteins *coarse facial features, clouded corneas, restricted joint movement, fatal in childhood

question

Chediak Higashi

answer

AR mutation in LYST (MT dependent sorting of endosomal proteins) --> recurrent pyogenic infections, partial albinism, peripheral neuropathy, giant granules in leukocytes

question

Kartageners

answer

immotile cilia due to dynein arm defect infertility, bronchiectasis, recurrent sinusitis, situs inversus

question

Neuroendocrine tumor markers

answer

Chromogranin A Neuron specific enolase Synaptophysin

question

Histo stain- cytokeratin

answer

epithelium

question

Histo stain- vimetin

answer

connective tissue

question

Histo stain- desmin

answer

muscle

question

Histo stain- GFAP

answer

neuroglia

question

Histo stain- neurofilaments

answer

neurons

question

Inhibitors of Na+/K+ ATPase

answer

Oubain (binds K+ site) Digoxin (inhibit Na+/K+ directly)

question

Cartilage defects

answer

Type I (osteogenesis imperfects) Type III (ehlers-danlos) Type IV (Alport syndrome)

question

Ehlers-Danlos syndrome

answer

Defective Collagen types I & III hyperextensible skin, bleeding tendency, hypermobile joint, joint dislocation, berry aneurysm, organ rupture MCC death = AORTIC DISSECTION

question

Alport syndrome

answer

Type IV collagen defect Nepritis & deafness X-linked recessive

question

Marfans

answer

AD fibrillin-1 defect tall, long extremities, pectus excavatum, hypermobile joints, arachnodactyly, cystic medial degen of aorta (AI, dissecting aorting aneurysm), MVP, lens sublux. MCC death = AORTIC DISSECTION/aneurysm

question

karyotype can be performed on:

answer

blood, bone marrow, amniotic fluid, placental tissue *looks at metaphase chromosomes

question

Blotting techniques

answer

Southern- DNA Northern- RNA Western- Protein Southwestern- DNA-binding protein (c-Jun, c-Fos)

question

Allelic heterogeneity

answer

different mutations at same locus cause similar phenotypes (ex. duchenne and becker muscular dystrophy)

question

Phenotypic heterogeneity

answer

mutation at SAME gene leads to different phenotype

question

Heteroplasmy

answer

presence of normal and mutated mtDNA, variable expression of mitochondrial inherited disease

question

Uniparental disomy

answer

offspring receives 2 copies of chrom from 1 parent heterodisomy- meiosis I error isodisomay- meiosis II error *consider in individual manifesting recessive disorder with only 1 carrier parent

question

Prader-Willi syndrome

answer

*paternal allele NOT expressed ONLY MATERNAL EXP. (chrom 15) mental retardation, hyperphagia, obesity, hypogonadism, hypotonia

question

Angelmans syndrome

answer

*maternal allele NOT expressed ONLY PATERNAL EXP (chrom 15) mental retardation, seizures, ataxia, inappropriate laughter

question

X-linked dominant disorders

answer

Hypophosphatemic rickets

question

Mitochondrial inheritance

answer

Lebers hereditary optic neuropathy Myoclonic epilepsy with ragged red fibers (MERRF) Mitochondrial encephalopathy with stroke and lactic acidosis (MELAS)

question

ADPKD on which chrom?

answer

Chrom 16 (AD)

question

FAP on which chrom?

answer

Chrom 5 (AD)

question

Hereditary hemorrhagic telangiectasia (osler-weber-rendu synd)

answer

AD inherited disorder of blood vessels telangectasias, epistaxis, skin discolorization, AVM

question

Huntington's disease on which chrom?

answer

Chrom 4 (AD)

question

NF type 1 on which chrom?

answer

Chrom 17 (AD) Cafe-au-lait spots, neural tumors, lisch nodules, scoliosis, optic pathway gliomas

question

NF type 2 on which chrom?

answer

Chrom 22 (AD) bilateral acoustic schwanommas, juvenile cataracts

question

Tuberous sclerosis

answer

AD facial lesions (adenoma sebaceum), hypopigmented ash leaf spots, cortical/retinal hamartoma, seizures, mental retardation, renal cysts, renal angiomyolipomas, cardiac rhabdomyomas, astrocytomas

question

VHL disease is on which chrom?

answer

Chrom 3 (AD) constituitively active HIF, inc. angiogenesis via VEGF hemangioblastomas (retina, cerebellum, medulla), bilat renal cell carcinoma

question

AD diseases

answer

achondroplasia, ADPKD, FAP, familial hypercholesterolemia type IIA, hereditary hemorrhagic telangiectasia, hereditary spherocytosis, Huntington's disease, Marfans, MEN, NF1, NF2, tuberous sclerosis, VHL disease, OI type 1, hereditary angioedema

question

Diagnosis of CF

answer

Chrom 7 CFTR, del Phe from 508 Degradation of channel before reaching cell surface *nasal transepithelial gradient is more NEG than normal (increased Na+ abs) *inc conc of Cl- in sweat test

question

Deaths due to CF

answer

cardiopulmonary complications (pneumonia, bronchiectasis)

question

AR diseases

answer

albinism, ARPKD, CF, glycogen storage diseases, hemachromatosis, mucopolysaccharidoses (ex. hunters), PKU, sickle cell, sphingolipodoses (ex. fabrys), thalassemias

question

X-linked recessive disorders

answer

Brutons agammaglobulinemia, Wiskott-aldrich syndrome, Fabry's, G6PD def, ocular albinism, Lesch-Nyhan, Duchenne & beckers muscular dystrophy, Hunter's syndrome, hemophilia A & B, ornithine transcarbamoylase def *Be Wise Fools GOLD Heeds Silly HOpe

question

MCC of death in muscular dystrophy

answer

respiratory failure

question

Trinucleotide repeat disorders

answer

Fragile X (CGG)n Friedreichs ataxia (GAA)n Huntingtons (CAG)n Myotonic dystrophy (CTG)n

question

Pregnancy screen in Down Syndrome

answer

Low AFP & estriol High B-hCG and inhibin A Increased nuchal translucency

question

Pregnancy screen in Edwards syndrome (trisomy 18)

answer

Low AFP, B-hCG, estriol normal inhibin A

question

Pregnancy screen in Pataus (trisomy 13)

answer

Low free B-hCG, Low PAPP-A Increased nuchal translucency

question

Cri-du-chat

answer

Microdel. of short arm of chrom 5 microcephaly, mod-severe mental retardation, high pitch cry, epicanthal folds, cardiac abnormalities (VSD)

question

Williams syndrome

answer

Congen microdeletion of long arm of chrom 7 elfin facies, intellectual disability, hypercalcemia, well dev. verbal skills, extreme friendliness w/ strangers, cardiovascular problems

question

Microdel. of chrom 22q11

answer

CATCH-22 cleft palate, abnormal facies, thymic aplasia, cardiac def, hypocalcemia (parathyroid aplasia)

question

What vitamins are lacking in breast milk?

answer

D & K

question

Vit A deficiency

answer

Night blindness, dry skin, vulnerability to infection (ex. measles)

question

Vit A excess

answer

arthralgia, HA, fatigue, skin changes, sore throat, alopecia *TERATOGENIC

question

Vit B1 (thiamine) is used for:

answer

Pyruvate dehydrogenase alpha-ketoglutarate dehydrogenase Transketolase Branch chain AA dehydrogenase

question

Vit B1 (thiamine) deficiency:

answer

*occurs in alcoholics Wernicke-Korsikoff: confusion, opthalmoplegia, ataxia, + confabulation, personality change, memory loss (perm) Dry beri-beri- polyneuritis, symm muscle wasting Wet beri-beri- high output heart failure, edema

question

Vit B2 (riboflavin) deficiency

answer

Cheilosis, corneal vascularization

question

Vit B3 (niacin) is derived from which AA?

answer

TRYPTOPHAN + requires B6 and B2

question

Niacin deficiency (Vit B3)

answer

glossitis pellagra: diarrhea, dermatitis, dementia (caused by Hartnups disease, carcinoid synd, isoniazid therapy)

question

Vit B5 (pantothenate) deficiency

answer

dermatitis, eteritis, alopecia, adrenal insuff. (B5 used for steroid synthesis, synth of Vit A & D, cholesterol, AA, FA, and protein)

question

Vit B6 (pyridoxine) function

answer

used in transamination, decarboxylation, glycogen phosphorylase (synth. of cystathionine, heme, niacin, histamine, serotonin, GABA, epi, NE)

question

Vit B6 deficiency

answer

Convulsions, hyperirritability, peripheral neuropathy, sideroblastic anemia *Isoniazid gives you a B6 deficiency, so supplement

question

Vit B7 (biotin) function

answer

Carboxylation reactions (pyruvate carboxylase, acetyl CoA carboxylase, propionyl CoA carboxylase)

question

Vitamin B9 (folic acid) use

answer

converted to THF for 1-C transfers/methylation reactions, DNA and RNA bases

question

Vit B9 (folic acid) deficiency

answer

NTDs Macrocytic, megaloblastic anemia

question

Vit B12 (cobalamin) function

answer

cofactor for homocysteine methyltransferase & methylmalonyl-CoA mutase

question

Vit B12 (cobalamin) deficiency

answer

Macrocytic, megaloblastic anemia hypersegmented PMNs neurologic symptoms (paresthesia, subacute combined degen) *caused by malabsorption, pernicious anemia, absence of terminal ileum

question

Regeneration of methionine from homocysteine depends on:

answer

Vit B12, folate

question

Vit E deficiency

answer

Erythrocyte fragility Posterior column and spinocerebellar tract demyelination (ataxia) *seen in CF, abetalipoproteinemia

question

Vitamin K deficiency

answer

neonatal hemorrhage (inc. PT and PTT) must supplement because it is low in breastmilk

question

Zinc deficiency

answer

delayed wound healing, hypogonadism, decreased hair, dysgeusia, anosmia acrodermatitis enteropathica (rare inherited zinc def)

question

Kwashiorkor

answer

protein malnutrition edema, anemia, fatty liver

question

Marasmus

answer

energy malnutrition tissue/muscle wasting, loss of subcutaneous fat

question

What pathways happen in mitochondria?

answer

FA oxidation, acetyl CoA production, TCA cycle, ox phos

question

What pathways happen in cytoplasm?

answer

Glycolysis, FA synthesis, HMP shunt, protein synthesis (RER), steroid synthesis (SER), cholesterol synthesis

question

What pathways happen in both mito and cytoplasm?

answer

Heme synthesis, Urea cycle, Gluconeogenesis (HUGS need BOTH people)

question

Arsenic inhibits...

answer

lipoic acid *vomiting, rice water stools, garlic breath

question

Pyruvate dehydrogenase complex deficiency

answer

Mutation in X-linked gene for E1-alpha subunit of PDC *neurologic defects in infancy Treat with ketogenic nutrients (lysine, leucine) bypass PDC

question

Inhibitor of Complex I

answer

Rotenone

question

Inhibitor of complex III

answer

Antimycin

question

Inhibitor of complex IV

answer

cyanide, CO

question

Inhibitor of complex V (ATPase)

answer

Oligomycin

question

Decouplers of ox-phos

answer

2,4-DNP, aspirin, thermogenin in brown fat

question

1 NADH = how many ATP

answer

2.5

question

1 FADH2 = how many ATP

answer

1.5

question

Total ATP from malate-aspartate shuttle vs. glycerol-3-phosphate shuttle

answer

malate-aspartate = 32 glycerol-3-phosphate = 30

question

HMP shunt occurs where?

answer

CYTOPLASM lactating mammary glands, liver, adrenal cortex (fatty acid and steroid synthesis), RBCs

question

What is the defect in chronic granulomatous disease?

answer

NADPH oxidase deficiency infections by catalase + organisms (S. aureus, Aspergillus) NBT test will not turn blue (clear = abnormal)

question

Sucrose =

answer

glucose + fructose

question

Fructose intolerance- deficiency is?

answer

Aldolase B Accumulate Fructose-1-P which is toxic to liver hypoglycemia, jaundice, cirrhosis, vom, hepatomegaly

question

Deficiency in essential fructosuria

answer

fructokinase benign, asymptomatic fructose appears in blood & urine

question

Deficiency in galactokinase deficiency

answer

galactokinase... DUH mild condition, galactose in blood and urine infantile cataracts

question

Deficiency in classic galactosemia

answer

galactose-1-phosphate uridyltransferase buildup of galactose-1-P, galactitol in eye cataracts, failure to thrive, jaundice, hepatomegaly, mental retardation Tx = exclude GALACTOSE & LACTOSE

question

Lactose =

answer

glucose + galactose

question

sorbitol accumulation causes:

answer

osmotic damage (cataracts, retinopathy, peripheral neuropathy) seen in diabetes

question

Essential AA

answer

*Must be supplied in diet Glucogenic: Met, Val, His Glucogenic/ketogenic: Ile, Phe, Thr, Trp Ketogenic: Lys, Leu

question

Acidic AA

answer

Asp and Glu (negatively charged at body pH)

question

Basic AA

answer

Arg, Lys, His

question

AA with 3 titratable proteins

answer

Basic: His, Arg, Lys Acidic: Asp, Glu Cys, Tyr

question

Which AA donates NH4+ for urea cycle?

answer

Aspartate

question

Which AA is hydrolyzed in the final step of urea acid cycle?

answer

Arginine

question

Which AA commonly accepts NH3 groups?

answer

Glutamate

question

Which AA are increased in histones?

answer

Arg and Lysine (bind neg charged DNA)

question

Ammonia intoxication

answer

tremor, slurred speech, somnolence, vom, cerebral edema, blurred vision (treat with benzoate, phenyl butyrate, lactulose)

question

AA derivatives of phenylalanine

answer

Phe --> Tyrosine --> dopa --> dopamine --> NE --> epi

question

AA derivatives of tryptophan

answer

Niacin (requires B6) Serotonin (requires BH4)

question

AA derivatives of histidine

answer

histamine (uses B6)

question

AA derivatives of glycine

answer

heme (uses B6)

question

AA derivative of arginine

answer

Creatinine Urea NO

question

AA derivatives of glutamate

answer

GABA (B6) Glutatione Glut + Asp = pyrimadine Glut + Asp + glycine = purine (2 rings)

question

What AA becomes essential in PKU?

answer

tyrosine (remove phenylalanine from diet)

question

What enzyme is deficient in PKU?

answer

phenylalanine hydroxylase tetrahydrobterin cofactor (malignant PKU)

question

What enzyme is deficient in alkaptonuria?

answer

homogentisic acid oxidase (dark tissues, arthralgias)

question

What enzyme is deficient in albinism?

answer

tyrosinase or tyrosine transporter

question

Enzyme deficiencies in homocysteinuria

answer

Cystathionine synthase (decrease Met, inc Cysteine, B12 and folate in diet) Homocysteine methyltransferase (requires B12)

question

Homocysteinuria has genetic heterogeneity with ...

answer

Marfans (osteoporosis, mental retardation, tall stature, kyphosis, lens subluxation, atherosclerosis)

question

Cysteinuria

answer

defect of renal tubular AA transporter for COAL (cysteine, ornithine, arginine, lysine) in the PCT leads to renal staghorn caliculi

question

What AA can't be degraded in maple syrup urine disease?

answer

Leucine, Isoleucine, Valine "I Love Vermont maple syrup"

question

Hartnup disease leads to:

answer

pellagra (decreased tryptophan uptake)

question

Enzyme deficiency in Von Gierke's disease (type I)

answer

glucose-6-phosphatase (glucose -6-P to glucose)

question

Enzyme def. in Pompe's disease (type II)

answer

lysosomal alpha-1,4 glucosidase (acid maltase) -cardiomegaly, trashes LIVER, HEART, MUSCLE

question

Enzyme def. in Cori's disease (type III)

answer

Debranching enzyme (alpha-1,6 glucosidase)

question

Enzyme def. in McArdles disease (type V)

answer

Skeletal muscle glycogen phosphorylase *painful muscle cramps, myoglobinuria with exercise

question

Enzyme deficiency in Fabry's disease

answer

alpha-galactosidase A (ceramide trihexoside accum) XR peripheral neuropathy, angiokeratoma, renal/cardiovascular disease

question

Enzyme deficiency in Gaucher's disease

answer

Glucocerebrosidase (glucocerebroside accum) AR HSM, aseptic necrosis of femur, bone crises, Gaucher cells

question

Enzyme deficiency in Neimann-Pick disease

answer

Sphingomyelinase (sphingomyelin accum) AR progressive neurodegen, HSM, cherry red spot, foam cells

question

Enzyme deficiency in Tay-Sachs disease

answer

Hexosaminidase A (GM2 ganglioside accum) AR progressive neurodegen, cherry red spot, lysosomes with onion skin, NO HSM

question

Enzyme deficiency in Krabbe's disease

answer

Galactocerebrosidase (galactocerebroside accum) AR peripheral neuropathy, dev. delay, optic atrophy, globoid cells

question

Enzyme def. in Metachromatic leukodystrophy

answer

Arylsufatase A (cerebroside sulfate) AR Central/peripheral demyelination, ataxia, dementia

question

Enzyme def. in Hurlers syndrome

answer

alpha-L-iduronidase (heparan sulfate, dermatan sulfate) AR developmental delay, gargoylism, airway obstruction, corneal clouding, HSM

question

Enzyme def. in Hunters

answer

Iduronate sulfatase (heparan sulfate, dermatan sulfate) XR Mild hurlers + aggressive behavior (no corneal clouding)

question

Ketones

answer

acetoacetate, B-hydroxybutyrate *produced during prolonged starvation, DKA, alcoholism

question

What cells can't use ketones?

answer

RBC & liver cells

question

Starvation- order of energy production

answer

Between meals (hepatic glycogenolysis) Starvation 1-3 days (glycogenolysis, adipose release of FFA, hepatic gluconeogenesis from lactate, alanine, odd-chain FFA) After 3 days (adipose- ketones, then protein degradation)

question

Mutation in Type I hyperchylomicronemia

answer

AR Lipoprotein lipase def. or altered apo C-II (can't degrade TG in circulating CM and VLDL) *pancreatitis, HSM, eruptive/pruritic xanthomas

question

Mutation in Type IIa hypercholesterolemia

answer

AD LDL-Receptor absent or decreased *accel. atherosclerosis, tendon xanthomas, corneal arcus

question

Mutation in type IV hypertriglyceridemia

answer

AD hepatic overproduction of VLDL *pancreatitis

question

Abetalipoproteinemia

answer

AR Mutation in microsomal triglyceride transfer protein (MTP), decreased B-48 and B-100 decrease CM and VLDL synthesis and secretion, accum lipid in enterocytes --> FTT, steatorrhea, acanthocytosis, ataxia (vit E), night blindness (vit A)

question

Obligate aerobes

answer

Nocardia, pseudomonas aeruoginosa, mycobacterium tb, bacillus (Nagging Pests Must Breathe)

question

Obligate anaerobes

answer

Clostridium, Bacteroides, Actinomyces (lack catalase/ SOD) Anaerobes Cant Breathe Air

question

Obligate intracellular bugs

answer

Chlamydia, Rickettsia

question

Facultative intracellular bugs

answer

Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis "Some Nasty Bugs May Live FacultiveLY"

question

Urease positive bugs

answer

Cryptococcus, H. pylori, Proteus, Ureaplasma, Nocardia, Klebsiella, S. epidermidis, S. saprophyticus (CHuck norris hates PUNKSS)

question

Which bugs invade gut mucosa? (bloody, inflamm diarrhea)

answer

Salmonella, shigella, Yersinia enterocolitica, EIEC, campylobacter jejuni

question

Bugs with preformed exotoxin

answer

Staph aureus (enterotoxin) Bacillus cereus (cereulide) *starts and ends quickly

question

Bacteria that are lysogenized with phage

answer

ABCDE ShigA like toxin Botulinum toxin Cholera toxin Diptheria toxin Erythrogenic toxin (Strep pyogenes)

question

Endotoxin that causes shock in gram neg bacteria

answer

Lipid A (IL1, TNFalpha, NO, C3a, C5a, DIC)

question

Dominant flora of skin

answer

Staph epidermidis (also corynebacterium, pseudomonas)

question

Dominant flora of nose

answer

Staph epidermidis, colonized by Staph aureus

question

Dominant flora of mouth

answer

Viridans strep

question

Dominant flora of dental plaque

answer

Strep mutans

question

Dominant flora of colon

answer

Bacteroides fragilis > E. coli

question

Dominant flora of vagina

answer

Lactobacillus, colonized by E. coli, group B strep, candida, corynebacterium

question

Bug that mimics appendicitis

answer

Yersinia enterocolitica (mesenteric adenitis) Campylobacter jejuni

question

MCC of pneumonia in neonates (<4 weeks)

answer

Group B strep E. coli

question

MCC of pneumonia in kids 4 weeks - 18 years old

answer

RSV (viruses) Mycoplasma Chlamydia trachomatis (infants - 3yrs) C. pneumoniae (school aged children) Strep pneumo "Runts may cough chunky sputum"

question

MCC of pneumonia in adults 18-40

answer

S. pneumo H. influenza Anaerobes, viruses, mycoplasma

question

MCC of pneumo in the elderly

answer

S. pneumo Influenza virus Anaerobes H. influenza gram neg rods

question

Nocosomial pneumonia

answer

staph, enteric gram neg rods (E. coli, pseudomonas, klebsiella)

question

Immunocompromised patients pneumonia

answer

Staph, enteric gram neg rods, fungi, viruse, PCP (HIV)

question

Aspiration pneumonia

answer

anaerobes (fusobacterium, peptostreptococcus, bacteriodes)

question

Alcoholic pneumonia

answer

S. pneumo, klebsiella, staph

question

CF pneumonia

answer

PSEUDOMONAS S. aureus S. pneumo

question

Postviral pneumonia

answer

Staph H. influenza Strep pneumo

question

Atypical pneumonia

answer

Mycoplasma, Legionella, Chlamydia

question

MCC meningitis in newborns

answer

Group B strep E. coli Listeria

question

MCC meningitis in children (6 mo-6 yr)

answer

Strep pneumo N. meningitidis H. influenza type B Enterovirus (coxsackie, echovirus)

question

MCC meningitis in 6-60 year olds

answer

Strep pneumo N. meningitis (#1 in teens) Enterovirus HSV

question

MCC of meningitis in people over 60

answer

S. pneumo Gram neg rods Listeria

question

HIV meningitis

answer

Cryptococcus, CMV, toxoplasmosis, JC virus

question

Bugs infecting unimmunized children

answer

Rash- rubella, measles Meningitis- H influenza type B Pharyngitis- C. diptheriae Epiglottitis- H. influenza type B

question

Tetralogy of Fallot

answer

Pulmonary stenosis Overriding aorta RVH VSD **These kids SQUAT to increase PVR and reduce R-->L shunt and cyanosis

question

Increased lung volumes in COPD

answer

RV, FRC, TLC (FVC is decreased)

question

Renal blood flow (RBF) =

answer

RPF / (1-Hct)

question

FF =

answer

GFR/ RPF

question

Orthostatic hypotension is mediated by which adrenergic receptor?

answer

alpha-1 CONTRACTS SM and prevents orthostatic hypotension

question

alpha-1 activity

answer

contract SM mydriasis stimulate glycogenolysis

question

alpha-2 activity

answer

inhibit NT release DECREASE sympathetic outflow Platelet aggregation Contract some vascular SM inhibit lipolysis and insulin release

question

beta-1 activity

answer

Increase HR and contractility stim. RENIN release

question

beta-2 activity

answer

BRONCHODILATION UTERINE RELAXATION Vasodilation Stimulates glycogenolysis Increase HR and contractility INCREASE AQUEOUS HUMOR PROD. Stimulate INSULIN RELEASE Increase lipolysis

question

Which 2 RNA viruses replicate in the nucleus?

answer

Influenza (SS neg linear RNA, 8 segment virus) HIV (SS + linear RNA retrovirus)

question

Microsatellite instability can lead to?

answer

HNPCC (colorectal cancer)

question

Reactivated CMV in HIV patient causes:

answer

Retinitis Colitis Esophagitis

question

Testes lymph drains to

answer

para-aortic

question

Glans penis lymph drains to:

answer

deep inguinal

question

Stomach lymph drains to:

answer

celiac

question

T cell + selection occurs in:

answer

CORTEX of spleen

question

T cell - selection occurs in:

answer

MEDULLA if spleen

question

MHC Class I

answer

HLA A, B, C CD8 T cells expressed on all nucleated cells antigen presented w/ alpha chain and beta-2-microglobulin

question

MHC Class II

answer

HLADR, DP, DQ CD4 T cells expressed on APCs antigen is degraded following release of invariant chain in acidified endosome (presented w/ alpha and beta chain)

question

HLA DQ2/DQ8

answer

Celiac disease

question

HLA DR2

answer

MS, hay fever, SLE, goodpastures

question

HLA DR3

answer

DM1, Graves disease

question

HLA DR4

answer

RA, DM1

question

HLA DR5

answer

Pernicious anemia, Hashimotos thyroiditis

question

HLA A3

answer

Hemochromatosis

question

Helper T cell produces

answer

IL-12 (act TH1 cell) IL-4 (act TH2 cell)

question

T(reg) cells

answer

Express CD3, CD4, CD25 Activated Treg produce IL-10, TBF-B

question

2 major opsinins in bacterial defense

answer

C3b, IgG

question

C1 esterase inhibitor deficiency

answer

Hereditary angioedema (dont use ACE-I!)

question

C3 deficiency

answer

recurrent pyogenic sinus & respiratory tract infxns

question

C5-C9 deficiency

answer

Recurrent Neisseria infections

question

DAF deficiency

answer

complement overactivity, lysis of RBC, paroxysmal nocturnal hemoglobinuia (PNH)

question

What bugs do antigenic variation?

answer

Salmonella Borrelia (relapsing fever) N. gonorrhea (pilus protein) Influenza Hep C (vary envelope protein) Parasites (trypanosomes)

question

Passive immunity

answer

IgA in breast milk Antitoxins (tetanus, botulism, HBV, rabies) Humanized monoclonal Ab

question

Active immunity

answer

natural infection vaccines toxoid

question

Live attenuated vaccine

answer

cellular response strong, lifelong immunity *may revert to virulent form MMR, polio (sabin), varicella, yellow fever

question

Inactivated/killed vaccine

answer

humoral immunity *stable, safer, requires booster Hep A, polio (salk), rabies

question

Serum sickness

answer

Fever, urticaria, arthralgias, proteinuria, lymphadenopathy, 5-10 days after antigen exposure (ex. sulfonamides)

question

Type III HSR

answer

SLE, RA PAN, PSGN, Serum sickness, Arthus reaction

question

Type II HSR

answer

AIHA pernicious anemia ITP eryhtroblastosis fetalis acute hemolytic transfustion rxn RF, Goodpastures bullous pemphigoid, pemphigus vulgaris

question

Type IV HSR

answer

MS Guillain Barre synd. GVH disease PPD (Tb) Contact dermatitis

question

Anti-histone Ab

answer

Drug induced lupus

question

Anti-centromere Ab

answer

Scleroderma (CREST)

question

Anti-Scl 70 Ab

answer

Scleroderma diffuse

question

Antimitochondrial Ab

answer

primary biliary cirrhosis

question

Anti-Jo-1, Anti SRP, anti-Mi-2 Ab

answer

Polymyositis, Dermatomyositis

question

Anti-SSA (anti-Ro), Anti-SSB Ab (anti-La)

answer

Sjogrens

question

Anti-U1-RNP Ab

answer

mixed conn tissue disorder

question

anti - smooth muscle Ab

answer

autoimmune hepatitis

question

anti-glutamate decarboxylase Ab

answer

T1 DM

question

c-ANCA

answer

Wegeners

question

p-ANCA

answer

microscopic polyangiitis, Churg-Strauss

question

Hyper IgE syndrome

answer

Th1 cells fail to produce IFN-gamma FATED- course Facies, Abscesses, retained primary teeth, inc. IgE, derm problems

question

SCID

answer

defective IL-2 receptor (X linked) Adenosine deaminase deficiency (AR) FTT, chronic diarrhea, thrush, recurrent infxns, absent thyrmic shadow, germinal centers Treat w/ bone marrow tx

question

Ataxia telangectasia

answer

Defect in ATM gene (DNA repair enzymes)- AR triad: cerebellar defects, spider angiomata (telangectasia), IgA def *Increased AFP

question

Hyper IgM syndrome

answer

Defective CD40L on helper T cells, cant class switch severe pyogenic infections (treat w/ IVIG)

question

Wiskott-Aldrich syndrome

answer

X linked def. in WASP gene (T cells cant reorganize actin skel) TIE Triad: Thrombocytopenic purpura, Infections, Eczema High IgE and IgA (low IgM)

question

Leukocyte adhesion def (type I)

answer

Defect in LFA-1 integrin (CD18) protein on phagocytes, problem with tight adhesion recurr bacterial infxn, ABSENT PUS FORMATION, delayed sep of umbilical cord Neutrophilia

question

Chediak Higashi syndrome

answer

AR Defect in LYST (lysosomal trafficking regulator gene), recurr. PYOGENIC infxns by staph, strep partial ALBINISM, peirpheral neuropathy *Giant granules in neutrophils

question

Chronic granulomatous disease

answer

Usually X linked Lack of NADPH oxidase (absent resp. burst), decreased ROS Inc sus to catalase + organisms (S.aureus, E. coli, Aspergillus, Pseudomonas, Serratia, Nocardia) *abnormal DHR flow cytometry test *Nitroblue tetrazolium test no longer performed (but abnormal)

question

Graft vs. host disease

answer

Graft T cells attack host organs Maculopapular rash, jaundice, HSM, diarrhea *bone marrow & liver tx

question

Coagulative necrosis

answer

heart, liver, kidney

question

Liquefactive necrosis

answer

brain, bacterial abscess, pleural effusion, wet gangrene

question

caseous necrosis

answer

Tb, systemic fungi

question

spider bite?

answer

coagulative necrosis

question

fatty necrosis

answer

peripancreatic fat

question

fibrinoid necrosis

answer

blood vessels

question

gangrenous necrosis

answer

dry (ischemic coagulative) wet (bacteria) limbs & GI tract

question

Reversible cell injury

answer

Dec ATP synthesis Cell swelling (impaired Na+/K+ pump)- increased Na+ and Ca2+ in cell nuclear chromatin clumping decreased glycogen fatty change ribosome detachment

question

Irreversible cell injury

answer

nuclear pyknosis, karyolysis, karyorrhexis Ca2+ influx (caspase act) plasma mem damage lysosomal rupture mito permeability release of CK dystrophic calcifications

question

Areas most susc. to ischemia

answer

ACA/MCA/PCA boundary Subendocardium Straight seg. of proximal tubule + TAL (medulla) Area around central vein of liver splenic flexure, rectum pyramidal cells of hippocampus, purkinje cells

question

Red (hemorrhagic) infarcts

answer

liver, lung, intestines

question

Pale (white) infarcts

answer

heart, kidney, spleen

question

Leukocyte extravasation

answer

Rolling- selectin (endothelium) - Sialyl Lewis X Tight binding- ICAM-1 (endothelium) - LFA-1, MAC-1 Diapedesis (PECAM-1 - PECAM-1) Migration- LTB4, IL8, C5a, kallikrein

question

Free radical scavengers

answer

Catalase, SOD, glutatione peroxidase antioxidants (Vit A, C, E) Vit A neutralizes LDL-ox Vit C neutralizes pollutants/cig smoke

question

High ESR

answer

Infxn, inflammation (temporal arteritis) cancer, pregnancy, SLE

question

Low ESR

answer

Sickle cell, polycythemia, CHF

question

Systemic amyloid

answer

AL (primary)- Ig light chains (plasma cell disorder, MM or systemic)

question

AA (secondary)

answer

RA, IBD, spondyloarthropathy Amyloid A SAA --> AA

question

Dialysis related amyloid

answer

B2 microglobulin

question

Heritable amyloid

answer

ATTR (neuro, cardiac) TTR gene mutation

question

Senile

answer

normal TTR slow progression cardiac dysfunction

question

Alzheimers amyloid

answer

B-amyloid APP --> B-amyloid

question

Malignant tumors:

answer

Detatch from cells by decreased E-cadherin Adhere to BM via laminin Invade BM (collagenases, MMP) Stim. angiogenesis Lack contact inhibition (med by cadherins, catenin) Metastasize!

question

Transitional cell carcinoma

answer

Bladder, ureter, renal pelvis

question

Oncogenes with tyrosine kinase prod.

answer

abl (CML), Her2/neu, ret

question

Oncogenes with transcription factor products

answer

c-myc (Burkitts lymphoma) L-myc (lung tumor) N-myc (neuroblastoma, small cell lung ca)

question

Oncogene with GTPase activity

answer

ras (MAP-kinase), colon cancer

question

Oncogene with anti-apoptotic activity

answer

Bcl2 (follicular and undifferentiated lymphomas)

question

Li-Fraumemi assoc with:

answer

p53 mutation early breast cancer, soft tissue sarcoma

question

HNPCC assoc with:

answer

DNA mismatch repair genes (AD) increased risk colorectal cancer WITHOUT previous polyps

question

VHL syndrome associated with:

answer

Deletion on chrom 3p HIF-1 nuclear transcription mutation, increases VEGF cerebellar hemangioblastoma, retinal angioma, bilateral RCC, bilat pheochromocytoma

question

TSG mutations assoc w/ melanoma

answer

p16, BRAF

question

Blooms syndrome

answer

Mutation in helicase gene RecQL3 photosensitivity, short stature, erythema, telangectasia CHROMOSOMAL INSTABILITY

question

Sites where metastasis is > primary cancer

answer

LLL BB Lung, Liver, Lymph nodes Brain, Bone

question

Pathways of cancer dissemination

answer

1. lymphatic spread (carcinomas) 2. hematogenous spread (sarcoma) 3. seeding (ovarian, peripheral lung canc, glioblastoma multiforme)

question

What blocks uptake of choline into cholinergic nerve terminal?

answer

hemicholinium

question

What blocks uptake of Ach into vesicles?

answer

Vesamicol

question

What blocks release of Ach from nerve terminal?

answer

Botulinum toxin

question

What blocks tyrosine --> DOPA

answer

metyrosine

question

What blocks dopamine uptake into vesicles in the noradrenergic nerve terminal?

answer

reserpine

question

What blocks release of NE from norad nerve term?

answer

guanethidine, bretylium

question

What increases release of NE from norad nerve term?

answer

amphetamines

question

What inhibits reuptakes of NE at the nerve terminal?

answer

Cocaine, TCA, amphetamine

question

Diaphragmatic hiatus's

answer

T8: IVC T10: Esophagus & Vagus (2 trunks) T12: Aorta, Thoracic duct, Azygos vein (the red, white, and blue at 12)

question

Heart sounds: inspiration increases

answer

intensity of right heart sounds

question

Heart sounds: expiration increases

answer

intensity of left heart sounds

question

Heart sounds: handgrip increases

answer

(systemic vasc. resistance) increases MR, AR, VSD, MVP

question

Heart sounds: valsalva/sudden standing increases

answer

MVP, HCM (decreases venous return)

question

Heart sounds: rapid squatting DECREASES

answer

MVP, HCM (decreases venous return, increases preload)

question

Ejection click

answer

AS also pulsus parvus et tardus crescendo-decrescendo systolic ejection murmur

question

Midsystolic click

answer

MVP late systolic crescendo murmur

question

Opening snap

answer

MS delayed rumbling late diastolic murmur

question

murmur with bounding pulses, head bobbing

answer

AR high pitch, blowing diastolic decrescendo murmur

question

continuous machine like murmur

answer

PDA

question

congenital long QT synd

answer

Jervell & Lange-Nielsen syndrome (sensorineural deafness, syncopal episodes) Romano Ward Syndrome- AD

question

Wolf-parkinson white synd

answer

pre-excitation syndrome accessory conduction bypasses AV node SVT, short PR, Delta wave, wide QRS

question

Aflutter treatment

answer

class IA, IC, III (b-blocker or Ca2+ channel bloacker for rate control)

question

2nd degree heart block

answer

Mobitz type I (asymptomatic) Mobitz type II (dropped beats not preceded by change in length of PR), treat w/ pacemaker

question

Aortic arch receptors

answer

responds to increase in BP via VAGUS nerve

question

Carotid sinus receptors

answer

responds to changes in BP with glossopharyngeal (CN IX) nerve

question

Coarctation of aorta (preductal) assoc with:

answer

Turners syndrome

question

PDA associated with:

answer

congenital rubella

question

Differential cyanosis associated with:

answer

PDA (late cyanosis in lower extremities)

question

Heart defect associated with 22q11 syndromes

answer

truncus arteriosus, TOF

question

Heart defects assoc w/ down syndrome

answer

ASD, VSD, AV septal defect (endocardial cushion defect)

question

Heart defect assoc w. congenital rubella

answer

septal defects, PDA, pulm artery stenosis

question

Heart defect assoc w/ marfans syndrome

answer

aortic insuff. & dissection

question

Heart defect assoc. w/ infant of diabetic mother

answer

transposition of great vessels

question

Abdominal aortic aneurysm assoc. with

answer

ATHEROSCLEROSIS

question

Thoracic aortic aneurysm assoc with

answer

HTN, cystic medial necrosis (MARFANS), tertiary syphilis

question

MCC of aortic dissection

answer

HYPERTENSION! also seen in connective tissue disorders (ehlers danlos, marfans)

question

What do you use to diagnose Printzmetals angina?

answer

Ergonovine (alpha agonist, 5HT agonist)

question

Normal HTN in elderly

answer

age related decrease in compliance of aorta --> SYSTOLIC HTN

question

Causes of dilated CM

answer

Infectious myocarditis Alcohol Doxorubicin Wet beriberi Chagas disease Hemachromatosis *SYSTOLIC dysfunction ECCENTRIC HYPERTROPHY *can be caused by AD mut in dystrophin (cytosksel proteins)

question

Causes of restrictive CM

answer

Amyloidosis Sarcoidosis Metastatic cancer Inborn metabolic error Hemachromatosis (both) *DIASTOLIC dysfunction

question

Evolution of MI

answer

0-4 hr- MINIMAL CHANGE! 4-12 hr- early coag necrosis, edema, hemorrhage, wavy fibers 12-24 hours- coag necrosis, marginal contraction band fibrosis 1-5 d-coag necrosis, neutrophil infiltrate 5-10 d-macrophage phagocytosis 10-14 d-granulation tissue, neovasc 2 weeks-2mo -collagen deposition and scar dormation

question

Most common sites of coronary occlusion

answer

LAD > RCA > circumflex

question

Transmural infarct

answer

ST elevation pathologic Q waves

question

Anterior wall infarct (LAD)

answer

V1-V4

question

Anteroseptal infarct (LAD)

answer

V1-V2

question

Anterolateral infarct (LCX)

answer

V4-V6

question

Lateral wall infarct (LCX)

answer

I, AvL

question

Inferior wall infarct (RCA)

answer

II, III, aVF

question

Posterior wall infarct (PDA)

answer

question

Mi complications

answer

Early- arrythmia, CHF exacerbation, cardiogenic shock 1-3 days- fibrinous pericarditis 3-7 days- ventricular wall rupture, IV septum rupture, vent aneurysm after 2 weeks- Dressler's syndrome (autoimmune pericarditis)

question

Causes of hypertrophic CM

answer

*AD mut in B-myosin heavy chain (cardiac sarcomere gene)- hypertrophied IV septum --> outflow tract obstruction assoc w/ Friedreich's ataxia disordered myocardial fibers *DIASTOLIC DYSFUNCTION Concentric hypertrophy S4, systolic murmur, normal EF

question

Lofflers syndrome

answer

endomyocardial fibrosis with prominant eosinophilia (restrictive CM)

question

What drugs reduce mortality in CHF?

answer

ACE-inhib B-blockers ARB Spironolactone

question

ANP and BNP respond to:

answer

volume overload/CHF

question

Endocarditis bugs

answer

S.aureus- prev normal valves, rt sided, IVDA Viridans- dental procedures (low virulence) S. epidermidis- prosthetic valves S. bovis- assoc w/ colon cancer Enterococci- assoc w/ GU procedures

question

Tricuspid valve endocarditis

answer

S. aureus, Pseudomonas, Candida

question

MCC of early death in rheumatic fever

answer

MYOCARDITIS!

question

Acute pericarditis

answer

widespread ST elevation or PR depression sharp pain aggrevated by inspiration relieved by sitting up/leaning forward friction rub

question

Cardiac tamponade

answer

distant heart sounds pulsus paridoxus inc. JVD hypotension, inc HR

question

MC adult cardiac primary tumor

answer

myxoma (LA)

question

MC childhood cardiac tumor

answer

Rhabdomyoma assoc. with tuberous sclerosis

question

Major consequence of Kawasaki disease

answer

Coronary aneurysm--> MI in young child Treat with ASPIRIN!!

question

Sturge-Weber disease

answer

Port-wine stain (nevus flammeus) on face leptomeningeal angiomatosis seizures, galucoma *congenital vasc. disorder affecting small vessels

question

Liver angiosarcoma associated with

answer

VINYL CHLORIDE, ARSENIC, thorium dioxide these are malignant tumors

question

Cavernous hemangioma

answer

Benign lesion of liver/spleen small vessel endothelium (found in cerebellum/ retina in VHL disease)

question

Bilateral renal angiomyolipoma is associated with

answer

tuberous sclerosis!

question

ADH and Oxytocin go from hypothalamus to post. pit via?

answer

NEUROPHYSINS

question

Posterior pituitary derived from?

answer

Neuroectoderm (neurohypophysis)

question

Anterior pituitary derived from?

answer

Ectoderm (Rathke's pouch) its the adenohypophysis

question

Anterior pituitary produces

answer

FLAT PeG + MSH FSH, LH, ACTH, TSH, Prolactin, GH

question

GLUT distribution

answer

GLUT1- RBC, brain GLUT2- B cells, liver, kidney, SI GLUT4- skel muscle, adipose (insulin dep)

question

Can brain use ketones?

answer

Yes, only in starvation!

question

Can RBCs use ketones?

answer

NO!! They have no mitochondria for aerobic metabolism

question

Insulin release is increased by:

answer

hyperglycemia, GH, B2 agonists

question

Insulin release is decreased by:

answer

hypoglycemia, somatostatin, alpha-2 agonists

question

What inhibits glucagon release?

answer

insulin, somatostatin, hyperglycemia

question

Dopamine does what to prolactin?

answer

INHIBITS secretion

question

What factors increase prolactin release?

answer

Estrogen Serotonin ACh Opiates TRH

question

Biceps reflex

answer

question

Triceps reflex

answer

question

Patella reflex

answer

question

Achilles reflex

answer

question

Enzyme deficiency in Tay Sachs

answer

AR Hexosaminidase A (buildup of GM2)

question

Enzyme def in Gauchers

answer

AR Glucocerebrosidase (buildup of glucocerebroside)

question

Enzyme def in Fabrys

answer

XR alpha-galactosidase A (buildup of ceramide trihexoside)

question

Enzyme def in Niemann Pick

answer

AR Sphingomyelinase (buildup of sphingomyelinase)

question

Enzyme def in Metachromic leukodystrophy

answer

AR Arylsulfatase A (buildup of sulfatides)

question

Enzyme def in Krabbes

answer

AR Galactocerebrosidase (galactocerebroside)

question

Enzyme def in Hurlers disease

answer

AR alpha-L-iduronidase (buildup of heparan sulfate, dermatan sulfate) gargoylism, airway obst., corneal clouding, HSM

question

Enzyme def in Hunters disease

answer

XR Iduronate sulfatase (buildup of heparan sulfate, dermatan sulfate)

question

CMV binds what cell receptor?

answer

Cellular integrins

question

EBV binds what cell receptor?

answer

CR2 (CD21)

question

HIV binds what cell receptor?

answer

CD4, CXCR4/CCR5

question

Rabies virus binds what cell receptor?

answer

Ach

question

Rhinovirus binds what cell receptor?

answer

ICAM1 (CD54)

question

Somatostatin inhibits:

answer

GH, TSH insulin, glucagon, gastrin

question

Somatostatinoma presents like:

answer

Achlorhydria Cholelithiasis Steatorrhea

question

VIPoma presents like:

answer

Watery diarrhea Hypokalemia Achlorhydria **WDHA syndrome

question

Retroperitoneal structures

answer

SAD PUCKER Suprarenal gland, Aorta (& IVC), Duodenum (2nd, 3rd parts), pancreas (except tail), uterers, colon (descending, ascending), kidneys, esophagus (lower 2/3), rectum (lower 2/3)

question

Hepatoduodenal ligament connects and contains?

answer

connects liver to duodenum contains portal triad: PORTAL VEIN, HEPATIC ARTERY, COMMON BILE DUCT "pringle maneuver" stops bleeding

question

Gastic banding surgery goes through?

answer

LESSER omentum gastrohepatic & hepatoduodenal ligaments

question

Whats in gastrohepatic ligament?

answer

Gastric arteries

question

Leyers of digestive tract

answer

Mucosa (epithelium, lamina propria, musc. mucosa) Submucosa Muscularis externa Serosa

question

Submucosal plexus (Meissners)

answer

controls secretory activity

question

Myenteric plexus (Auerbachs)

answer

controls muscle contractions

question

SMA syndrome

answer

transverse (3rd) part of duodenum is trapped between SMA and aorta leading to intestinal obstruction

question

Abdominal aorta branches

answer

Celiac trunk (T12) SMA (L1) L. renal artery (L1) IMA (L3) Bifurcation of aorta (L4)

question

GI blood supply

answer

Foregut- Celiac artery, vagus nerve Midgut- SMA, vagus nerve Hindgut- IMA, pelvic nerve

question

Portosystemic anastamosis

answer

1. paraumbilical to epigastric (caput medusae) 2. left gastric to esophageal (esophageal varices) 3. superior rectal to middle/inferior rectal (internal hemorrhoids)

question

Hemorrhoids

answer

Internal = PAINLESS (drain to portal system) External = PAINFUL (drain to IVC), lymph to superficial inguinal nodes

question

Liver zones

answer

Zone 1 (periportal)- viral hep Zone 3 (pericentral vein)- ischemic injury, alcoholic/toxic injury, P450 system

question

Duadonal associations

answer

Part 1- gastroduodenal artery Part 2- head of pancreas Part 3 (transverse)- SMA syndrome (trapped between SMA and Aorta)

question

Indirect inguinal hernia

answer

through deep inguinal ring, superficial inguinal ring, and into the SCROTUM *failure of processus vaginalis to close (can form hydrocele also) LATERAL to inf. epigastric artery

question

Direct inguinal hernia

answer

through Hesselbachs triangle, through abdominal wall , goes through superficial inguinal ring only covered by external spermatic fascia MEDIAL to IEA

question

Whats the leading cause of bowel incarceration?

answer

Femoral hernia

question

Parts of SI

answer

DUODENUM- secretes alkaline fluid, lipid digestion, Fe absorption JEJUNUM- more goblet cells, lipid absorption, folate abs. ILEUM- peyers patches, B12 abs

question

GI hormones

answer

Gastrin (G cells- stomach antrum) CCK (I cells- duodenum, jejunum) Secretin (S cells- duodenum) Somatostatin (D cells- panc islets, GI mucosa) GIP (K cells- duodenum, jejunum) VIP (parasymp ganglia) NO Motilin (SI)

question

Saliva

answer

High HCO3-, K+ hypotonic

question

Which AA stimulate gastrin release?

answer

Phenylalanine, Tryptophan

question

Absorption of Glucose & Galactose

answer

SGLT1 (Na + dependent)

question

Absorption of Fructose

answer

Facilitated diffusion (GLUT5)

question

Fe absorbed in

answer

Duodenum

question

Folate absorbed in

answer

Jejunum

question

B12 absorbed in

answer

Ileum

question

Sucrose is broken down into

answer

fructose and glucose

question

benign salivary gland tumors

answer

pleomorphic adenoma (cartilage + epithelium) warthins tumor (cystic tumor w/ germinal centers)

question

malignant salivary gland tumor

answer

mucoepidermoid carcinoma- mucionous and squamous components painful mass, involves facial nerve

question

Achalasia has loss of which plexus?

answer

Myenteric (auerbachs)

question

Achalasia increases risk of:

answer

esophageal SCC

question

GERD increases risk of:

answer

esophageal adenocarcinoma

question

Precursor lesions to SCC of the oral cavity

answer

Leukoplakia Erythroplakia (vascularized, more suggestive of dysplasia)

question

Whipples disease

answer

Infxn with Tropheryma whipplei PAS + foamy macrophages in intestinal lamina propria (PAS stains glycoprotein) CAN- cardiac symptoms, arthralgias, neuro sympt.

question

Celiac sprue has IgA against

answer

endomysium tissue transglutaminase gliadin (assoc. with dermatitis herpetiformis)

question

Erosions only go into the:

answer

mucosa

question

Ulcers go through the

answer

submucosa

question

Type A gastritis

answer

FUNDUS/BODY autoantibodies to parietal cells pernicious anemia, achlorhydria

question

Type B gastritis

answer

ANTRUM H. pylori increase risk of MALT lymphoma

question

Menetriers disease

answer

gastric hypertrophy with protein loss, parietal cell atrophy, inc. mucous cells PRECANCEROUS

question

Mets of intestinal type gastric cancer

answer

Sister mary joseph nodule (subcut. periumbilical mets)

question

Mets of diffuse type gastric cancer

answer

Krukenbergs tumor- bilat mets to ovaries

question

Major risk factors for intestinal type gastric cancer

answer

H. pylori, NITROSAMINES, achlorhydria, chronic gastritis, type A blood

question

Duodenal ulcer

answer

pain DECREASED with meals 100% assoc w/ H. pylori generally benign seen in ZE syndrome, hypertrophy of brunners glands

question

Gastric ulcer

answer

pain INCREASED with meals 70% assoc. w/ H pylori increased risk of cancer

question

Rupture of ulcer on lesser curvature of stomach

answer

Bleeding from left gastric artery

question

Perforation of duodenal ulcer (posterior wall)

answer

Bleeding from gastroduodenal artery

question

Chrons is mediated by

answer

TH1

question

Ulcerative colitis is mediated by

answer

TH2

question

"L. sided appendicitis"

answer

diverticulitis LLQ pain, fever, leukocytosis can lead to colovesical fistula

question

Zenkers diverticulum

answer

herniation of mucosal tissue at Killians triangle (btwn thyropharyngeal and cricopharyngeal parts of inf. pharyngeal constrictor) FALSE divertivulum -halitosis, dysphagia, obstruction

question

Cause of intussusception and pancreatitis in children

answer

LYMPHOID HYPERPLASIA

question

Hirschsprings disease

answer

need to biopsy SUBMUCOSA to diagnose (rectal suction biopsy) failure of neural crest cell migration to colon (always involves rectum) --> early constipation, inability to pass stool lack of ganglion cells/enteric nerve plexuses

question

Failure of recanalization of small bowel =

answer

duodenal atresia seen in down syndrome

question

What increases risk of malignancy for colon polyps?

answer

VILLOUS histology, larger SIZE increased epithelial dysplasia

question

Peutz Jegher syndrome

answer

STK11 gene mutation AD multiple hamartomas in GI tract hyperpigmented mouth, lips, hands, genitals increased risk colon, breast, gyn, other visceral malignancies

question

Most common locations of colon cancer

answer

RECTOSIGMOID > ascending > descending

question

Ascending colon cancer symptoms

answer

iron deficiency anemia, weight loss, occult blood exophytic mass

question

Descending colon cancer symptoms

answer

infiltrating mass, partial obstruction, hematochezia, colicky pain APPLE CORE/ napkin ring lesion

question

Rectal adenocarcinoma

answer

THIN STOOL

question

HNPCC syndrome

answer

AD mut in DNA mismatch repair gene (MLH1, MSH2) assoc. with microsatellite instability pathway

question

Adenoma-carcinoma sequence

answer

1. Loss of APC (colon at risk) 2. Mut in k-RAS (leads to adenoma, increased size of polyp) 3. Loss of p53, DCC (formation of carcinoma) *increased COX also increases risk

question

Consequences of cirrhosis

answer

Liver failure - hypoalbuminemia, edema, lack clotting factors, hyperammonium, decreased catabolism of estrogen (leads to gynecomastia, test. atrophy, spider angiomata), portal hypertension

question

Histologic findings of acute hepatitis

answer

Ballooning degeneration Councilman bodies (eosinophilic)

question

Histological findings in alcoholic hepatitis

answer

swollen & necrotic hepatocytes neutrophil infiltration Mallory bodies (intracytoplasmic eosinophilic inclusions)

question

Liver tumor associated with arsenic, polyvinyl chloride

answer

Liver angiosarcoma MALIGNANT

question

Liver tumor assoc. with aflatoxin, hep B & C, Wilsons, A1aT def, etc

answer

Hepatocellular carcinoma MALIGNANT

question

Carbon tetrachloride associated with:

answer

Centrilobular necrosis, fatty change of liver

question

Defect in Dubin-Johnson syndrome

answer

MRP2 (active transport of conjugated bili out of liver) --> black liver, benign

question

Mutation in Wilsons disease

answer

AR mut of ATP7B copper accum in liver, brain, CORNEA, kidneys, joints

question

Mutation in hemachromatosis

answer

AR mut in C282Y or H63D in HFE gene Assoc w/ HLA-A3 cirrhosis, "bronze" diabetes, CHF, HCC, testicular atrophy, degen joint disease

question

Gallstones

answer

Cholesterol stones (80%) PIgment stones- black (hemolysis), brown (infection)- E. coli, ascaris, clonorchis

question

Factors that increase gallstone formation

answer

Female, Fat, forty, fertile estrogen fibrates, bile acid resins

question

Factors that decrease gallstone formation

answer

High bile salts, high phosphatidyl choline, high 7alpha-hydroxylase

question

Causes of pancreatitis

answer

GET SMASHED gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia, hyperTG, ERCP, drugs (sulfa)

question

Pancreatic pseudocyst lined by

answer

GRANULATION TISSUE

question

Whats elevated in acute pancreatitis?

answer

amylase lipase (higher specificity)

question

Trousseaus syndrome (pancreatic cancer)

answer

migratory thrombophlebitis, redness and tenderness on palpation of extremities HYPERCOAGULABILITY

question

Courvoisiers sign

answer

obstructive jaundice with palpable, nontender gallbladder

question

What is the charge barrier of the glomerular BM?

answer

heparan sulfate

question

Sites of mets in renal cell carcinoma

answer

LUNG, BONE

question

What cell type does renal cell carcinaoma originate from?

answer

proximal tubule cells POLYGONAL CLEAR CELLS filled w/ lipid and carbs

question

Paraneoplastic syndromes assoc. with RCC

answer

EPO, ACTH, PTHrP

question

Beckwith Wiedmann Synd

answer

Wilms tumor Neonatal hypoglycemia muscular hemihypertrophy organomegaly

question

Wilms tumor

answer

Del. of tumor suppressor gene (WT1) most common renal malignancy of childhood palpable flank mass, hematuria

question

WAGR syndrome

answer

Wilms tumor Aniridia GU malformaiton Mental retardation

question

Transitional cell carcinoma assoc.

answer

Phenacetin, Smoking, analine dyes, cyclophosphamide multifocal, tends to RECUR

question

Acute pyelonephritis treatment

answer

Ciprofloxacin VUR repair

question

what causes interstitial nephritis

answer

diuretics, penicillin deriv., sulfonamides, rifampin HSR, eosinophils in urine

question

what causes acute tubular necrosis?

answer

aminoglycosides, amphotericin B, contrast dye, heavy metals, ethylene glycol, urate also renal ischemia, crush injury

question

Stages of ATN

answer

1. Inciting event (dec GFR, oliguric) 2. Maintenance phase (oliguric, hyperKalemia, vol overload) 3. Recovery phase (polyuric, hypokalemia, volume depletion), re-epitheliazation of tubules

question

Signs of chronic renal failure

answer

Waxy broad casts Fixed specific gravity Free water clearance = 0 Inc. BUN and creatinine (UREMIA)

question

ADPKD is associated with:

answer

berry aneurysms, MVP, benign liver cysts

question

When will you see shrunken kidneys on ultrasound?

answer

Medullary cystic disease (AD) Chronic renal failure

question

Prolonged urinary tract obstruction leads to:

answer

Hydronephrosis atrophy of renal parenchyma fibrosis, mononuclear infiltrate, tubular atrophy

question

NTD markers

answer

High AFP High AChE in amniotic fluid

question

Anencephaly markers

answer

high AFP polyhydramnios

question

neurons stain + for

answer

synaptophysin

question

astrocyte marker

answer

GFAP

question

what cells are destroyed in MS?

answer

oligodendrocytes

question

what cells are destroyed in Guillain-barre?

answer

schwann cells

question

unmyelinated nerve fibers

answer

group C

question

Endoneurial inflammation

answer

Guillain-barre syndrome

question

answer

locus ceruleus (pons) inc in anxiety, low in depression

question

Dopamine

answer

ventral tegmentum, SNc high in schizophrenia, low in parkinsons and depression

question

5-HT

answer

raphe nucleus (pons) low in anxiety, low in depression

question

ACh

answer

basal nucleus of meynert low in alzheimers, low in hunting tons high in REM sleep

question

GABA

answer

nucleus accumbens (reward center, pleasure) Low in anxiety, low in huntingtons

question

vomiting center

answer

area postrema (dorsal surface of medulla)

question

areas not protected by BBB

answer

OVLT (senses osmolarity) area postrema (emetic center)

question

supraoptic nucleus

answer

ADH

question

paraventricular nucleus

answer

oxytocin

question

Hypothalamus

answer

Lateral- hunger Ventromedial- satiety Anterior- cooling (parasymp) Posterior- heating (symp) Suprachiasmatic nucleus- circadian rhythm

question

Thalamus

answer

VPL- sensation body VPM- sensation/taste face LGN- vision (CNII) *LIGHT = L MGN- hearing *MUSIC = M VL- motor (basal ganglia) **everything except OLFACTION relays through the thalamus

question

Dopamine in the basal ganglia

answer

FACILITATES movement activates direct pathway (D1) inhibits indirect pathway (D2)

question

Parkinsons

answer

low dopamine Lewy bodies (alpha-synuclein) tremor, cogwheel rigidity, akinesia, postural instability

question

Huntingtons

answer

low GABA, low ACh, low SP high dopamine Chorea, CAG repeats, caudate degen.

question

Treatment for essential tremor

answer

B-blockers, primidone

question

Conduction aphasia

answer

damage to arcuate fasciculus

question

PCO2 in the brain

answer

cerebral vasodilator

question

MCA lesion

answer

Upper limb/face sensory and motor loss Aphasias

question

ACA lesion

answer

lower limb sensory and motor loss urinary incontinence

question

Lateral striate stroke

answer

contralat hemiparesis, hemiplegia

question

ASA lesion

answer

"medial medullary syndrome" contralat hemiparesis of lower limbs ipstilat hypoglossal dysfunction

question

PICA lesion

answer

"lateral MEDULLARY synd" Vom, vertigo, nystagmus DYSPHAGIA, HOARSENESS, dec. gag reflex ipsilat. horners, ataxia, dysmetria CN V, VIII, IX, X, XI

question

AICA lesion

answer

"lateral PONTINE synd" Vom, vertigo, nystagmus, ataxia, dysmetria PARALYSIS OF FACE (dec. lacrimation, dec taste from ant 2/3 tongue, dec CORNEAL reflex) ipsilat. horners

question

PCA lesion

answer

contralat hemianopia with MACULAR SPARING

question

AComm lesion

answer

common site of saccular aneurysm visual field defects

question

Pcomm lesion

answer

berry aneurysms CN III palsy "down and out", ptosis, mydriasis

question

rupture of berry aneurysms cause

answer

SUBARACHNOID HEMORRHAGE (WHOML) assoc. with ADPKD, ehlers-danlos, marfans

question

Charcot-Bouchard microaneurysm is associated with

answer

chronic HTN causes small vessel hemorrhagic stroke (basal ganglia, thalamus, IC)

question

Amyloid angiopathy causes

answer

LOBAR hemorrhage

question

Bright areas on non contrast CT indicate:

answer

hemorrhage

question

Normal pressure hydrocephalus

answer

Inc. subarachnoid space volume (no inc. in pressure) Stretch cortical fibers of corona radiate --> TRIAD: urinary incontinence, ataxia, cognitive dysfunction ("wet, wobbly, wacky")

question

Lumbar puncture

answer

between L3-L4, L4-L5 dont pierce the pia!

question

Lateral horn found at

answer

T1-L2

question

ALS defect

answer

SOD1 mutation UMN & LMN defects anterior horn- LMN lesion lateral corticospinal tract- UMN lesion

question

Tabes dorsalis

answer

Degen of DORSAL columns Impaired sensation and proprioception, progressive sensory ataxia Charcot's joints, shooting pain, Argyll Robertson pupil absent DTR, + Romberg caused by tertiary syphilis

question

Subacute combined degeneration

answer

B12 or Vit E def. Demyelination of dorsal columns, lat corticospinal tracts, spinocerebellar tracts ataxia, paresthesia, impaired position & vibratory sense

question

Werdnig hoffman disease

answer

AR, congenital degen of anterior horn leading to LMN defects "floppy baby" hypotonia, tongue fasciculations, death ~7 months

question

Friedreich's ataxia

answer

AR trinuc repeat "GAA" frataxin gene, impaired mito function (iron homeostasis, respiratory function) staggering, falling, dysarthria, nystagmus, pes cavus, HYPERTROPHIC CM, kyphoscoliosis

question

Germinoma

answer

pineal gland tumor precocious puberty, obstructive hydrocephalus parinaud syndrome (vertical gaze paralysis)

question

Facial nerve palsy (complete)

answer

Ipsilateral facial paralysis Inability to close eye on involved side Decreased tearing ipsilat. Increased salivation ipsilat. HYPERACUSIS (stapes oscillates more widely) Loss of taste on ant 2/3 of tongue

question

Presbycusis

answer

High freq sensorineural hearing loss in elderly loss of hair cells at base of cochlea

question

What makes the aqueous humor?

answer

ciliary epithelium

question

CN III damage (oculomotor)

answer

eye looks "down and out" ptosis, mydriasis, loss of accommodation

question

CN IV damage (trochlear)

answer

eye moves upward contralateral head tilt problems going down stairs

question

CN VI damage (abducens)

answer

medially directed eye, can't abduct internal strabismus (horizontal diplopia)

question

test obliques while...

answer

ADDUCTING eye

question

Miosis controlled by

answer

CN III parasympathetic (short ciliary nerves to pupillary sphincter muscles)

question

Mydriasis controlled by

answer

sympathetic long ciliary nerve to pupillary dilator muscles

question

Marcus Gunn pupil

answer

**AFFERENT pupillary defect decreased bilat pupillary constriction when light shone in affected eye (swinging flashlight test)

question

Treatment for "wet" macular degeneration

answer

anti-VEGF (ranibizumab, pegaptanib)

question

Hemianopia with macular sparing

answer

PCA infarct

question

Alzheimers treatment

answer

Cholinesterase inhibitors (donepezil) Vit E (anti ox) NMDA receptor antag (memantine)

question

Pilocytic astrocytoma

answer

Rosenthal fibers CYSTIC + SOLID GFAP positive found in cerebellum benign tumor found in kids

question

Medulloblastoma

answer

Homer-wright rosettes, solid, small blue cells MALIGNANT cerebellar tumor in kids drop mets to SC

question

Ependymoma

answer

childhood brain tumor ependymal cells of 4th ventricle perivascular PSEUDOROSETTES can cause hydrocephalus

question

Hemangioblastoma

answer

Cerebellar tumor seen in VHL can produce EPO "foamy cells"

question

Craniopharyngioma

answer

benign childhood brain tumor derived from RATHKEs pouch calcifications common SUPRAtentorial

question

S-100 positive tumors

answer

schwannoma, melanoma, neuroblastoma

STUDY

Developmental Biology

module 5 self evaluation – Flashcards 50 terms

Rebecca Mallory

50 terms

Preview

module 5 self evaluation – Flashcards

question

components of dna, called ______ control how the molecular toolkit is used

answer

genetic switches

question

a morphogen is a protein that can restore totipotency to cells from an adult animal

answer

FALSE

question

pair rule genes

answer

segmentation gene

question

_________ is a shift in the relative timing of two different developmental processes that can result in new morphology

answer

heterochrony

question

Which of the following is least likely to occur from the inactivation of p53

answer

increased propensity to arrest in G1

question

The enzyme telomerase is essential for unlimited cell division since

answer

a lack of telomerase will result in chromosome shortening and cell death

question

What kind of information will be used for personalized cancer treatment?

answer

whole genome sequencing

question

Why are some individuals predisposed to getting cancer

answer

they inherit mutant alleles of genes that are involved in cancer development

question

Drugs such as gleevec and herceptin represent a modern approach to cancer treatment since they

answer

specifically target gene alterations that occur in some cancers

question

What type of segmentation gene in Drosophila is most analogous to the loss of seven cervical vertebrae produced by the recessive mouse mutation?

answer

gap gene and gene

question

Establishment of the dorsal-ventral axis of the Drosophila embryo:

answer

involves the nuclear localization of Dorsal protein in the ventral nuclei

question

The homeotic, gap, pair-rule, and segment polarity genes ALL control:

answer

aspects of the anterior posterior pattern formation AND

question

High concentration of which protein simulates the development of anterior structures?

answer

bicoid

question

the ability of an organism to modify its development in response to environmental conditions is called

answer

developmental plasticity

question

Match: ontogeny recapitulates phylogeny

answer

Ernst Haeckel

question

What are Hox genes?

answer

Homeotic selector genes that encode transription factors which give a segment its identity

question

in its active form, the RAS protein is associated with

answer

GTP

question

experimental result that supports the hypothesis that cancers are clonal

answer

cells from cancers of women have the same x chromosome inactivated

question

the term for a mutated gene that can act dominantly to predispose a cell to a cancerous phenotype

answer

oncogenes

question

the enzymatic activity of CDKs are regulated by their forming a complex with which proteins

answer

cyclins

question

the current model of cancer development is that

answer

a cancer develops from a single cell that evolves through multiple mutations

question

Which of the following statements about the gene eyeless is true?

answer

it is found in Drosophila it encodes a transcription factor Pax6 is the equivalent gene in mice

question

What is the role and relationship of egg-polarity genes, segmentation genes, pair rule genes, gap genes, and homeotic genes in Drosophila development?

answer

question

how can a mutation in a tumor suppressor behave as a recessive allele at the cellular level but appear as a dominant allele in pedigree analysis?

answer

at the cellular level both alleles need to be mutated for an effect while in a pedigree the cancer may be vertically inherited

question

which statement best describes the action of polypeptide growth factors

answer

they bind to cell surface receptors and trigger intracellular signal transduction pathways

question

activity of Rb is regulated by

answer

its phosphorylation state

question

Morphogens control cell fate at

answer

3 or more concentrations

question

Most regulatory genes have evolved little over a period of millions of years; therefore, they are said to be _______.

answer

conserved

question

matching egg-polarity genes

answer

question

what are morphogens and what do they do?

answer

question

a programmed cell change that results in cell death is referred to as

answer

apoptosis

question

a common type of genomic change that occurs in cancer cells

answer

polyploidy

question

in flies homeotic genes are present in two gene complexes

answer

true

question

which of the following is true of homeotic transformations in Drosophila

answer

they can be passed on from generation to generation

question

Deletion of the _______ gene in Drosophila converts the third thoracic segment into the second thoracic segment, resulting in a fly with two sets of fully formed wings.

answer

ubx

question

Match: antennapedia complex

answer

homeotic gene

question

Match: dorsal

answer

nuclear localization

question

The action of genes controlled by _______ determines where and when they will be expressed or suppressed.

answer

a) evolution b) None of the above c) patterning d) molecular toolboxes e) genetic switches****

question

Alterations in the spatial expression patterns of regulatory genes can result in

answer

a) mutant genotypes. b) mutant alleles. c) None of the above d) succession. e) evolutionary change.***

question

HPV inactivates p53; the fact that the loss of p53 function is oncogenic suggests that

answer

p53 normally functions to prevent uncontrolled cell division

question

the nanos mRNA is localized at the _______ end of the Drosophila egg

answer

posterior

question

What are some of the different signals that can intitiate programmed cell death?

answer

question

The ability of a cell to move to other parts of the body is known as

answer

metastasis

question

Scientist associated with eyeless and pax6 gene

answer

question

when pax6 gene is overexpressed in flies

answer

flylike eyes develop.

question

bicoid codes for

answer

question

How do developmental genes constrain evolution?

answer

a) Modifying previously existing structures b) Maintaining highly conserved genes c) Creating novel structures d) Both a and b*** e) All of the above

question

The expression of a zygotic gene product is based on the ____________________.

answer

genotype of the zygote

question

_______ allows morphological changes to occur without disrupting the entire organism.

answer

a) Developmental plasticity b) Regulatory malleability c) Heritability d) Modularity*** e) Heterochrony

question

Many of the genes that control development encode _______ that act on proteins in a cascade of events.

answer

a) transcription factors

STUDY

AP Biology Biology Developmental Biology Signal Transduction Pathways

Campbell Biology; Chapter 11: Worksheet – Flashcards 52 terms

Christine Brunetti

52 terms

Preview

Campbell Biology; Chapter 11: Worksheet – Flashcards

question

The basis of cellular differentiation is A) selective gene expression. B) the operon. C) cloning. D) mutation.

answer

selective gene expression.

question

Adult stem cells have limited therapeutic potential A) because their developmental potential is limited to certain tissues. B) due to their excessive numbers in tissues. C) because they lack a complete set of genes. D) because they are fully differentiated.

answer

because their developmental potential is limited to certain tissues.

question

In plants, most differentiated cells retain A) only a tiny fraction of their original set of genes. B) the ability to dedifferentiate, but then cannot return to their original differentiated state. C) a complete set of their genes, but lose the ability to express most of those genes. D) a complete set of their genes, and retain the ability to express those genes under certain circumstances.

answer

a complete set of their genes, and retain the ability to express those genes under certain circumstances.

question

To initiate a signal transduction pathway, a signal binds to a receptor protein usually located in the A) nucleus. B) plasma membrane. C) ER. D) cytoplasm.

answer

plasma membrane.

question

Which of the following processes occurs when a salamander regenerates a lost limb? A) The homeotic genes of the regenerating cells turn off. B) A new salamander develops from the lost limb. C) Oncogenes that cause accelerated cell division are turned on. D) Certain cells in the limb dedifferentiate, divide, and then redifferentiate to form a new limb.

answer

Certain cells in the limb dedifferentiate, divide, and then redifferentiate to form a new limb.

question

In multicellular organisms, the coordination of cellular activities relies on A) operons. B) the availability of certain "key" nutrients as cells divide. C) cell receptors that detect transcription factors. D) cell-to-cell signaling and signal transduction pathways.

answer

cell-to-cell signaling and signal transduction pathways.

question

The expression of the tryptophan operon is controlled by A) a repressor that is active when it is alone. B) a repressor that is inactive when it binds to lactose. C) a repressor that is active when it binds to tryptophan. D) an activator that turns the operon on by binding to DNA.

answer

a repressor that is active when it binds to tryptophan.

question

Which of the following statements about proto-oncogenes is false? A) Proto-oncogenes are normal genes with the potential to become oncogenes. B) A mutation in a tumor-suppressor gene can stop cell division immediately. C) A mutation must occur in a cell's DNA for a proto-oncogene to become an oncogene. D) Many proto-oncogenes code for growth factors.

answer

A mutation in a tumor-suppressor gene can stop cell division immediately.

question

In a prokaryote, a group of genes with related functions, along with their associated control sequences, defines A) a locus. B) an operon. C) an allele. D) a transposon.

answer

an operon.

question

The tortoiseshell pattern on a cat A) usually occurs in males. B) results from X chromosome inactivation. C) is the result of a homozygous recessive condition. D) is a result of alleles on the Y chromosome.

answer

results from X chromosome inactivation.

question

The genes for the enzymes of glycolysis A) and the genes for all specialized proteins are expressed in all embryonic cells. B) and the genes for all specialized proteins are expressed in all metabolizing cells. C) are inactive in all metabolizing cells, but the genes for specialized proteins are expressed in all cell types. D) are active in all metabolizing cells, but the genes for specialized proteins are expressed only in particular cell types.

answer

are active in all metabolizing cells, but the genes for specialized proteins are expressed only in particular cell types.

question

Which of the following is not a factor that contributes to normal cells becoming cancerous? A) one or more of the cell's genes being removed by a virus B) damage to a tumor-suppressor gene C) excessive replication of proto-oncogenes D) the conversion of a proto-oncogene to an oncogene

answer

one or more of the cell's genes being removed by a virus

question

A homeotic gene A) determines which end of the egg will become the head and which end will become the tail. B) represses gene transcription and promotes mRNA translation. C) is found only in adult somatic cells. D) serves as a master control gene that functions during embryonic development by controlling the developmental fate of groups of cells.

answer

serves as a master control gene that functions during embryonic development by controlling the developmental fate of groups of cells.

question

Mutations in the p53 gene can lead to cancer by A) increasing the production of growth hormones, which trigger faster cell cycles. B) causing the production of excessive amounts of relay proteins. C) causing the production of a faulty protein that is no longer able to inhibit cell division. D) promoting the expression of mRNA that can interact with DNA, resulting in new mutations.

answer

causing the production of a faulty protein that is no longer able to inhibit cell division.

question

The relationship between DNA and chromosomes is most like A) an egg yolk inside of an egg. B) the candy shell surrounding the chocolate in a piece of M & M candy. C) a spoon cradling some peas. D) thread wrapped around a spool.

answer

thread wrapped around a spool.

question

Enhancers are A) required to turn on gene expression when transcription factors are in short supply. B) required to facilitate the binding of DNA polymerases. C) DNA sequences to which activator proteins bind. D) adjacent to the gene that they regulate.

answer

DNA sequences to which activator proteins bind.

question

Which of the following mechanisms of controlling gene expression occurs outside of the nucleus? A) adding a cap and tail to RNA B) RNA splicing C) translation D) DNA packing/unpacking

answer

translation

question

Which of the following is likely to occur in E. coli cells that are grown in skim milk? A) The lac operon is shut off and the cells will not produce lactose-utilizing enzymes. B) The trp operon is turned on but the bacteria will not produce lactose-utilizing enzymes. C) The trp operon and the lac operon are both switched off. D) The trp repressor is activated and the cells will produce lactose-utilizing enzymes.

answer

The trp repressor is activated and the cells will produce lactose-utilizing enzymes.

question

Transcription factors attach to A) mRNA. B) DNA. C) plasma membrane receptors. D) signal molecules.

answer

DNA

question

Which of the following permits a single gene to code for more than one polypeptide? A) retention of different introns in the final version of the different mRNA strands B) addition of different types of caps and tails to the final version of the mRNA strands C) genetic differentiation D) alternative RNA splicing

answer

alternative RNA splicing

question

The lac operon in E. coli A) coordinates the production of tryptophan-utilizing enzymes when it is present. B) prevents lactose-utilizing enzymes from being expressed when lactose is absent from the environment. C) allows the bacterium to resist antibiotics in the penicillin family. D) regulates the rate of binary fission.

answer

prevents lactose-utilizing enzymes from being expressed when lactose is absent from the environment.

question

Silencers A) bind to promoters to promote the start of transcription. B) bind to activators to inhibit the start of transcription. C) bind to enhancers to promote the start of transcription. D) bind to DNA sequences and inhibit the start of transcription.

answer

bind to DNA sequences and inhibit the start of transcription.

question

Which of the following statements regarding stem cells is false? A) Adult stem cells are partway along the road to differentiation. B) Adult stem cells are present in adult tissues. C) Adult, but not embryonic, stem cells can be grown in laboratory culture. D) Embryonic stem cells can give rise to all the different specialized cells in the body.

answer

Adult, but not embryonic, stem cells can be grown in laboratory culture.

question

Small pieces of RNA that can regulate translation of mRNA are called A) minuteRNA. B) monoRNA. C) miniRNA. D) microRNA.

answer

microRNA.

question

Signal transduction pathways A) are mechanisms of communication that probably evolved in ancient prokaryotes. B) are found strictly in multicellular organisms, which require cell-to-cell communication. C) originally evolved in vertebrates. D) are limited for use in sexual identification.

answer

are mechanisms of communication that probably evolved in ancient prokaryotes.

question

Mutations in the proto-oncogene ras and the tumor suppressor gene p53 A) disrupt normal regulation of the cell cycle. B) can enhance further mutations, which can develop into cancer. C) can improve the chance of avoiding cancer as one ages. D) increase protein synthesis by the cell.

answer

disrupt normal regulation of the cell cycle.

question

Proteins that bind to DNA and turn on operons by making it easier for RNA polymerase to bind to a promoter are called A) operators. B) repressors. C) regulators. D) activators.

answer

activators

question

A single cell, the zygote, can develop into an entirely new organism with many different specialized cells. Which of the following statements about this process is false? A) The zygote contains all of the genetic information required for the development of many different cell types. B) Differentiation of the zygote into a multicellular organism results from selective gene expression. C) The descendant cells specialize by a process known as differentiation. D) Additional genetic information for the formation of specialized cells is passed on to the developing embryo via the placenta.

answer

Additional genetic information for the formation of specialized cells is passed on to the developing embryo via the placenta.

question

Cancer of the colon is caused by A) the proto-oncogene, lac. B) exposure of colon cells to a mutagen. C) a single gene mutation. D) several somatic cell mutations.

answer

several somatic cell mutations.

question

The use of cloning to produce special embryonic stem cells is called A) therapeutic cloning. B) reproductive cloning. C) regenerative cloning. D) transplantational cloning.

answer

therapeutic cloning.

question

A gene that can cause cancer when present in a single copy in a cell is called a(n) A) enhancer gene. B) oncogene. C) carcinogen. D) proto-oncogene.

answer

oncogene.

question

Which of the following possible uses of reproductive cloning is still considered by most to be an unresolved ethical issue? A) the production of organs in cloned pigs for transplant into humans B) cloning mammals for the production of potentially valuable drugs C) the production of genetically identical animals for experimentation D) the reproductive cloning of humans

answer

the reproductive cloning of humans

question

A gene operon consists of A) a transcribed gene only. B) a regulatory gene only. C) a promoter only. D) transcribed genes, an operator, and a promoter.

answer

transcribed genes, an operator, and a promoter.

question

The coding regions of a gene (the portions that are expressed as polypeptide sequences) are called A) introns. B) exons. C) proto-oncogenes. D) redundant coding sections.

answer

exons.

question

The lac operon of E. coli is ________ when the repressor is bound to lactose. A) unregulated B) cloned C) inactive D) active

answer

active

question

Both prokaryotic and eukaryotic cells use ________ to turn certain genes on or off. A) intron segments B) nucleosome packing C) proteins D) RNA transcriptase

answer

proteins

question

The carcinogen known to cause the most cases and types of cancer is A) tobacco. B) ultraviolet light. C) plutonium. D) alcohol.

answer

tobacco

question

Which of the following statements regarding DNA packing is false? A) Highly compacted chromatin is generally not expressed at all. B) Prokaryotes have proteins analogous to histones. C) DNA packing tends to promote gene expression. D) A nucleosome consists of DNA wound around a protein core of eight histone molecules.

answer

DNA packing tends to promote gene expression.

question

Why can some plants be cloned from a single cell? A) Plant cells can dedifferentiate and give rise to all of the specialized cells required to produce an entire plant. B) Plant cells do not differentiate even when mature, so any cell can grow into an entire plant. C) Plant cells are capable of self-renewal by utilizing cellular components from adjacent cells. D) Plant cells can produce genes to replace those lost during development.

answer

Plant cells can produce genes to replace those lost during development.

question

All of the following mechanisms are used to regulate protein production except A) the breakdown of mRNA. B) protein activation. C) DNA editing. D) protein breakdown.

answer

DNA editing.

question

RNA splicing involves the A) addition of a nucleotide "tail" to the molecule. B) removal of exons from the molecule. C) removal of introns from the molecule. D) addition of a nucleotide "cap" to the molecule.

answer

removal of introns from the molecule.

question

The term "gene expression" refers to the A) fact that each individual of a species has a unique set of genes. B) flow of information from parent to offspring. C) process by which genetic information flows from genes to proteins. D) fact that individuals of the same species have different phenotypes.

answer

process by which genetic information flows from genes to proteins.

question

The development of colon cancer occurs slowly, and colon cancer is more frequently seen in the elderly than the young. This is most likely because A) cancer cells have to wait until new blood vessels grow into the area, which takes much time. B) most cancer mutations interfere with mitosis, so cell division occurs more slowly. C) four or more somatic mutations must occur to give rise to the cancer, which takes time. D) cancer cells don't have mitochondria, so they grow slowly.

answer

four or more somatic mutations must occur to give rise to the cancer, which takes time.

question

miRNA can be used by A) cells to prevent infections from double-stranded RNA viruses. B) viruses to stop the production of new proteins. C) researchers to induce the production of more mRNA. D) researchers to artificially turn on gene expression.

answer

cells to prevent infections from double-stranded RNA viruses.

question

Yeast are able to communicate with each other A) only if they can touch each other and have merged cell walls. B) with pseudopodia. C) through chemical signaling. D) by close cell-to-cell contact.

answer

through chemical signaling.

question

Which of the following statements about fruit fly development is false? A) The location of the head and tail ends of the egg is primarily determined by the location of sperm entry during fertilization. B) Homeotic genes regulate batteries of other genes that direct the anatomical identity of body parts. C) Cascades of gene expression routinely direct fruit fly development. D) One of the earliest development events is the determination of the head and tail ends of the egg.

answer

The location of the head and tail ends of the egg is primarily determined by the location of sperm entry during fertilization.

question

The cloning of Dolly the sheep A) demonstrated that differentiated cells contain only a fraction of their full genetic potential. B) demonstrated, for the first time, that eggs are haploid and body cells are diploid. C) revealed that cloned mammals most resemble the egg donor. D) demonstrated that the nuclei from differentiated mammalian cells can retain their full genetic potential.

answer

demonstrated that the nuclei from differentiated mammalian cells can retain their full genetic potential.

question

A signal outside a cell triggers changes in the transcription and translation inside the cell through A) protein activation. B) signal transduction pathways. C) post-translational editing. D) protein breakdown. 2

answer

signal transduction pathways.

question

Which of the following statements about microarrays is false? A) Microarrays use fluorescently labeled cDNA molecules to identify particular genes expressed at a particular time. B) Microarrays are used to determine which genes are active in different tissues or in tissues of different states of health. C) Microarrays use tiny portions of double-stranded RNA fragments from a large number of genes. D) Microarrays enable scientists to determine the activity of thousands of genes at once.

answer

Microarrays use tiny portions of double-stranded RNA fragments from a large number of genes.

question

In female mammals, the inactive X chromosome in each cell A) is absorbed and used in energy production. B) is broken down, and its nucleotides are degraded and reused. C) can be activated if mutations occur in the active X chromosome. D) becomes a Barr body.

answer

becomes a Barr body.

question

Which of the following mammals has not yet been cloned and brought through the complete gestation cycle? A) pig B) human C) cow D) cat

answer

human

question

Which of the following statements regarding cancer risk factors is false? A) Mutagens are usually not carcinogens. B) Factors that alter DNA and make cells cancerous are called carcinogens. C) Eating 20-30 grams of plant fiber daily and reducing the intake of animal fat can reduce your risk of developing colon cancer. D) X-rays and ultraviolet radiation are two of the most potent carcinogens.

answer

Mutagens are usually not carcinogens.

STUDY

Developmental Biology Developmental Psychology Introductory Psychology Psychology

Cell Division, Cancer Quest – Flashcards 57 terms

Tiffany Hanchett

57 terms

Preview

Cell Division, Cancer Quest – Flashcards

question

importance of mitosis

answer

development growth- zygote, embryo, fetus, baby/child, adolescence, adult

question

importance of mitosis

answer

regeneration/repair of damaged tissue-skin wound healing (burns, cuts, scapes of skin or endothelial cells (line of GI tract) creation of new blood cells -growth (in multicellular organisms, cells become less efficient if hey are too big)

question

asexual reproduction

answer

prokaryotes/bacteria, some protists, some plants, hydras binary fission- chromosome replication-one copy of the origin, replication continues one copy of the origin is now at each end of cell, replication finishes the plasma membrane grows inward and new cells wall is deposited, two daughter cells result (clones) in prokaryotes, chromosome= a circle of DNA

question

creation of sex cells for sexual reproduction

answer

sperm + egg (created by testes and ovary cells) meiosis creates gametes (sex cells) with half # of chromosomes of body cells

question

maintain a small SA/vol ratio for efficient transport in/out of cell and access to DNA info

answer

maintain a small SA/vol ratio for efficient transport in/out of cell and access to DNA info

question

prokaryotic cell division

answer

binary fission- chromosome replication-one copy of the origin, replication continues one copy of the origin is now at each end of cell, replication finishes the plasma membrane grows inward and new cells wall is deposited, two daughter cells result (clones) -only copies one chromosome -does not need to duplicate all other organelles

question

eukaryotic chromosome structure

answer

chromatin: material made of DNA wrapped around histone proteins and then supercoiled chromosome: organized structure made of chromatin (linear pieces of DNA in eukaryotic) DNA is loosely packed during active use (interphase) --easier to use/read DNA is condensed during Cell division --easier to duplicate and move, separate

question

eukaryotic cell cycle and mitotic cell division

answer

interphase (G1,S,G2) 90% of cell cycle -g1 (gap 1): cell growth and normal metabolism; organelles are duplicated prior to S phase -s (synthesis): DNA replication takes place; all individual chromosomes become duplicated chromosomes -g2 (gap 2): further cell growth; duplicated DNA is checked for errors, which are corrected as needed; cell makes final preparations for division (make spindle proteins) mitosis (division of nucleus, prophase, metaphase, anaphase, telophase) prophase: early mitotic spindle, cytokinesis: division of cytoplasm plants: during telophase, vesicles containing cell wall material collect at the middle of the parent cell. the vesicles fuse, forming a membranous cell plate. the cell plate grows outward, accumulating more cell wall materials as more vesicles fuse with it. eventually, the outer edges of the cell plate fuse with the plasma membrane and the cell plates contents join the parent cell wall. animals: cytokinesis occurs by a process known as cleavage, the first sign is appearance of cleavage furrow, the furrow continues and eventually pinches the parent cell in two

question

how is the cell cycle regulated? roles of G1, G2, and Metaphase checkpoints in cell cycle?

answer

the cell cycle is regulated through G1, G2, and metaphase checkpoints G1: cell size is adequate, nutrient availability is sufficient, growth factors (signals from other cells) are present G2: cell size is adequate, chromosome replication is successfully completed Metaphase: all chromosomes are attached to mitotic spindle in order to divide, cells need: growth factor proteins (a "go" signal), a surface to attach to, space, nutrients, oxygen, to be big enough, to be "healthy" (no DNA mutations) adequate space (density-dependence): need low densities to ensure access to nutrients and growth factors, thus will not divide at high densities anchorage dependence: need to attach to a surface to grow and divide when regulation of cell cycle fails= cancer

question

what is the difference between a benign and a malignant tumor

answer

(tumors are abnormal masses of cells) benign: abnormal growth of a mutated cell that stops/does not spread beyond local area (usually harmless) malignant/cancerous: abnormal growth of a mutated cell that does not stop growing and can invade other tissue (beyond local area)

question

what is metastasis? how can the lymphatic and circulatory systems aid metastasis?

answer

cells from primary (original) tumor spread from the origin to a new tissue/organ, and establish secondary tumor(s). cells can travel far very quickly through a blood vessel or a lymph vessel. a few tumor cells can enter the blood and lymph vessels of the circulatory system and then move to other parts of the body where they may proliferate and form new tumors cancer cells are able to recruit new blood vessels (allows for it to gain nutrients and growth)--characteristic of cancer cells: angiogenesis (vessel creation)

question

what are the types of mutations that can cause a cell to become cancerous?

answer

-mutation that stops apoptosis of damaged cells -mutation that helps create/recruit blood vessels (helps angiogenesis) -mutation that slows or stops "tumor suppression" genes -mutation which slows or destroys a protein which normally fixes DNA mutations -mutation that "turns on" growth factors permanently and keeps cells dividing

question

what are the various risk factors and/or causes of cancer? why does cancer more frequently occur in older organisms?

answer

-carcinogens (chemicals that are known to cause cancer): asbestos, lead/heavy metals, tobacco compounds, BPA (from some plastics), coal -radiation: UV light (from sun, tanning beds, etc), microwaves, Xrays, radioactive materials (research labs, nuclear power plants) -viruses: HPV (human papilloma virus), can lead to cervical and ovarian cancer -heredity (inherited genes with mutations) -increased age -obesity -lack of physical activity -poor diet (lack of fiber and antioxidant-rich food)

question

what are the major forms of treatment of cancer? how do they work?

answer

traditional: chemotherapy- drugs that stop/kill dividing cells, useful for cancer that has metastasized, since drugs go throughout body. since cancer cells divide more reapidly than most normal cells, they are especially affected by these drugs. some normal cells that also divide fairly rapidly are also affected: bone marrow, lining of digestive tract, skin (including hair follicles)--side affects include low production of blood cells, nausea, sensitivity to UV light and hair loss surgery- physical removal of cancerous tissue, most effective with smaller tumors with clear borders/margins (that have not metastasized), may be preceded or followed by chemotherapy or radiation radiation therapy- involves killing cancer cells with penetrating beams of high energy radiation (requires beam ot be very specifically aimed at tumor cells, in low doses raditaition may cause mutations tha cause a cell to become cancerous, in high doses this radiation is lethal to all cells, radiation therapy can be used alone or in conjunction with surgery and/or chemotherapy) biological/immunotherapy hormone therapy newer/developing: anti-angiogenic drugs prevent the growth of new blood cells, effectively stopping growth of and killing tumors gene therapy

question

what is a karyotype? how are they made? what do they/ can they show?

answer

a display of micrographs of the metaphase chromosomes of a cell, arranged by size and centromere position. they are digitally created in order to get rid of other duplicate and can show the banding of the chromosomes. they can also show any abnormalities of the chromosomes

question

what is a full complement of chromosomes in a somatic cell? in a gamete?

answer

a somatic cell has 46 total individual chromosomes (2 sets) a gamete has 23 total individual chromosomes (1 set)

question

purpose of meiotic cell division in eukaryotic organisms

answer

the purpose of meiotic cell division in eukaryotic organisms is to create gametes for sexual reproduction

question

how does meiosis introduce genetic variation in reproduction?

answer

recombinant DNA generated by crossover in Prophase I: homologous chromosomes pair up and exchange homologous pieces of DNA. creates new combinations of a persons genes in their gametes, these new combinations are passed on to offspring independent (random) alignment of homologous chromosomes during metaphase I: duplicated chromosomes line up alone not homologous pairs, different arrangements create different chromosome combinations in the gametes produced

question

gamete formation (gametogenesis)

answer

sperm and egg formation by meiosis are not identical. sperm: for from testes cells, are evenly divided--creating four even haploid cells egg: form from ovary cells, cytoplasm is not evenly split, only forms 1 egg, forms 3 polar bodies

question

differences between meiosis and mitosis

answer

mitosis: produces 2 diploid cells identical to parent cell and to each other, involves 1 cell division, produces 2 daughter cells, sister chromatids separate (in anaphase), individual chromosomes line up in the middle of the cell, no crossing over occurs, produces body cells (somates) for growth and tissue repair meiosis: produces four haploid cells unlike parent cell and unlike each other, involves 2 cell divisions, produces 4 daughter cells, homologous chromosomes pair and then separate (in anaphase 1) sister chromatids separate in anaphase 2 only, tetrad structure line up in the middle of the cell, crossing over occurs between homologous chromosomes in prophase 1, produces cells for sexual reproduction (gametes)

question

chromosome

answer

organized structure made of chromatin , in prokaryotes= a circle of DNA, in eukaryotes- linear pieces of DNA

question

sister chromatids

answer

two identical parts of a duplicated chromosome in a eukaryotic cell

question

centromere

answer

the region of a duplicated chromosome where two sister chromatids are joined and where spindle microtubules attach during mitosis and meiosis. the centromere divides at the onset of anaphase during mitosis and anaphase 2 during meiosis

question

spindle fibers

answer

Spindle fibers form a protein structure that divides the genetic material in a cell. The spindle is necessary to equally divide the chromosomes in a parental cell into two daughter cells during both types of nuclear division: mitosis and meiosis.

question

chromatin

answer

material made of DNA wrapped around histone protein then supercoiled

question

histones

answer

a small protein molecule associated with DNA and important in DNA packing in the eukaryotic chromosome

question

supercoiling

answer

a double helix (as of DNA) that has undergone additional twisting in the same direction as or in the opposite direction from the turns in the original helix

question

MTOC, centrosome and centrioles

answer

centrosome: material in the cytoplasm of a eukaryotic cell that gives rise to microtubules; important in mitosis and meiosis, also called microtubule-organizing center centrioles: a structure in an animal cell composed of cylinders of microtubule triplets arranged in a 9 and 0 pattern. an animal usuallly has a centrosome with a pair of centrioles involved in cell division

question

cleavage furrow

answer

the first sign of cytokinesis during cell division in an animal cell; a shallow groove in the cell surface near the old metaphase plate

question

cell plate

answer

a double membrane across the midline of a dividing plant cell, between which the new cell wall forms during cytokinesis

question

growth factors

answer

a protein secreted by certain body cells that stimulates other cells to divide

question

tumor

answer

abnormal masses of cells

question

benign tumor

answer

abnormal growth of a mutated cell that stops/ does not spread beyond local area (usually harmless)

question

malignant tumor

answer

abnormal growth of a mutated cell that does not stop growing, and can invade other tissue beyond local area

question

metastasis

answer

the spread of cancer cells beyond their original site

question

carcinogen

answer

chemicals that are known to cause cancer

question

angiogenesis

answer

(vessel creation) creation of new blood cells, a characteristic of cancer cells

question

homologous chromosomes

answer

chromosomes that carry genes that code for the same types of traits (ex. eye color, hair color)

question

crossover

answer

homologous chromosomes pair up and exchange homologous pieces of DNA in prophase I

question

recombinant DNA/chromosome

answer

the recombined DNA molecule formed by crossover

question

diploid

answer

(2N) having two sets of chromosomes (ex. somatic cells-body cells)

question

haploid

answer

(N) cells have a set of chromosomes (ex. gamete)

question

somatic cell

answer

body cell- has 46 chromosomes

question

gamete

answer

a sex cell (egg or sperm)

question

zygote

answer

the fertilized egg, which is dilpoid, that results from the union of a sperm cell and an egg cell

question

karyotype

answer

question

autosomes

answer

the rest of the chromosomes besides the sex chromosomes

question

sex chromosomes

answer

genes determining gender

question

nondisjunction

answer

an accident of meoisis or mitosis in which a pair of homologous chromosomes or a pair of sister chromatids fail to separate at anaphase

question

ovary cell

answer

the female gonad, which produces egg cells and reproductive organs

question

ovum (egg cell)

answer

(egg cell) the female gametes, the haploid, unfertilizied egg

question

polar body

answer

each of the small cells that bud off from an oocyte at the two meiotic divisions and do not develop into ova.

question

testis cell

answer

the male gonad, produces sperm

question

sperm cell

answer

a male gamete

question

how do chromosome number abnormalities occur in meiosis?

answer

meiotic nondisjunction- an accident of meoisis or mitosis in which a pair of homologous chromosomes or a pair of sister chromatids fail to separate at anaphase

question

what are chromosomal deletions, duplications, inversions, and translocations?

answer

deletions- the loss of one or more nucleotides from a gene by mutation; the loss of a fragment of a chromosome duplication- repetition of part of a chromosome resulting from fusion with a fragment from a homologous chromosome; can result from an error in meiosis or from mutagenesis inversions-a change in a chromosome resulting from reattachment of a chromosome fragment to the original chromosome, but in a reverse direction translocation-a change in a chromosome resulting from a chromosomal fragment attaching to a nonhomologous chromosome can occur as a result of an error in meiosis

question

what are the possible results of such chromosomal abnormalities?

answer

down syndrome: 3 copies of chromosome 21 *autosomes not sex cells Turner's syndrome: female, does not have 2nd x chromsome, has 4 (XO) Klinefelter's syndrome: male, has 2 x and 1 y, person has 47 chromosomes (XXY) Triple X: extra X chromosome in females (XXX) trisomy: a condition in which an extra copy of a chromosome is present in the cell nuclei, causing developmental abnormalities. monosomy: the condition of having a diploid chromosome complement in which one (usually the X) chromosome lacks its homologous partner.

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USMLE Step 2 CK OBGYN" and secrets – Flashcards 476 terms

Joseph Fraser

476 terms

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USMLE Step 2 CK OBGYN" and secrets – Flashcards

question

Embryologic origin of uterus

answer

Fusion of the 2 Mullerian ducts

question

When is transvaginal transducer ultrasound used? Transabdominal transducer?

answer

Transvaginal transducer: ("pie shaped image") - lower pelvic masses - not influenced by thickness of maternal abdominal wall Transabdominal transducer: - entire pelvis as well as abdomen imaging Ultrasound works best when adjacent tissues have differing echodensities, particularly fluid/tissue interfaces

question

Average age range of menarche? Thelarche?

answer

menarche: 10-16.5y thelarche: breast development; 8~11y

question

What is the average age for Tanner II stage of breast development? Presentation?

answer

Tanner II: Breast development - 8-13 yrs - Breast buds begin

question

ASCUS?

answer

Atypical Squamous Cells of Uncertain Significance misreadings on Pap smears due to mechanical errors (drying, etc.)

question

Major structures of the uterus (3)

answer

Corpus (body) - Cornu (uterus join with fallopian tubes) Isthmus Cervix

question

Describe satisfactory colposcopy vs. unsatisfactory colposcopy

answer

Satisfactory colposcopy 1. T-zone does NOT extend into the endocervical canal 2. No lesions visualized within T-zone Unsatisfactory is the opposite..

question

Tanner stages: Pubic Hair

answer

Male + Female Tanner I: None (prepubertal state) Tanner II: small amount of long, downy hair with slight pigmentation on the labia majora Tanner III: hair becomes more coarse and curly and begins to extend laterally Tanner IV: adult-like hair quality, extending across pubis but sparing medial thighs Tanner V: hair extends to medial surface of the thighs

question

What are the risks of cone biopsy? (3)

answer

1. incompetent cervix (cutting too much) 2. cervical stenosis (can cause amenorrhea) 3. preterm birth

question

Traditional Pap vs. Liquid-based Pap

answer

Traditional Pap: - spatula for ectocervix* - cyto-brush for endocervical canal* (rotating in 1 direction 360°) - both specimens are smeared onto a glass slide, fixed with formalin, then stained *Potential problems* - ASCUS (atypical squamous cells of uncertain significance) cannot be diagnosed - insufficient smearing, air-drying artifacts if process is delayed, mechanical problems makes traditional technique obsolete Liquid-based Pap: - cervical broom* to collect specimens (rotated 5 times in same direction) - broom is placed into "formalin" solution and rotated 10 times to release collected material - this method is more preferred vs. traditional Pap due to absence of mechanical errors - ASCUS can also be used for HPV-DNA typing

question

What is special about Tanner IV stage of breast development?

answer

Papilla and areola forms a 2' mound not contour with surrounding breast

question

LEEP (loop electrosurgical excision procedure) description, procedure, followup, risks

answer

A thin low-voltaged loop cuts out abnormal cervical tissue identified with colposcopy advantage: visual confirmation lesions have been removed; no anesthesia needed followup Pap smear every 3-6 months for 2 years to ensure dysplastic changes to not return long-term risks of LEEP include - cervical stenosis - cervical insufficiency

question

What type of blood supply do oviducts receive? From where?

answer

Dual blood supply* Receives blood from the uterine artery and ovarian artery

question

What is the average age range for Tanner V stage of breast development?

answer

Tanner V: Breast development - 12.5~18.5 yrs - development is complete

question

What does the ovarian stroma produce?

answer

androgen Important for libido after menopause

question

Dilation and Curettage (D&C) procedure

answer

under anesthesia examines histology of endometrial lesions similar to endometrial biopsy; dilation of cervix is required to introduce curette can collect large amounts of endometrial tissue (>endometrial biopsy)

question

What are the 4 segments of the oviducts?

answer

Proximal → Distal "INTERcourse IS AMP and FUN" 1. Interstitium 2. Isthmus 3. Ampulla 4. Infundibulum

question

American Cancer Society recommendations

answer

1. initial study at age 34 if there are risk factors (breast cancer in first degree relative, BRCA genes, etc.) 2. routine screening at age 40 if there are no risk factors

question

Explain the formation of the T-zone

answer

at puberty the vaginal pH falls (due to estrogen dominance) the "native" columnar epithelium goes through metaplasia and becomes the transformation zone; normal-appearing "metaplastic" stratified squamous epithelium Old→New squamocolumnar junction (outer-to-inner)

question

Procedure associated with assessment of Asherman's syndrome

answer

HSG hysterosalpingogram

question

Cryotherapy description, procedure, followup, risks

answer

Destroys dysplastic cervical tissue identified by colposcopy and cervical biopsy; no anesthesia needed Cryo probe at -50℃ with liquid nitrogen Freeze and destroy tissue; 3 minutes intervals of freezing Watery discharge will occur over next few weeks as destroyed tissue sloughs off Followup Pap smears every 3-6 months for 2 years; disadvantage of not knowing if lesions are destroyed until followups Risks: cervical stenosis

question

Phases of development: Folliculogenesis

answer

Primordial: - dormant, small - 1 layer of flat granulosa cells Primary: - Mitotic cells - cuboidal granulosa cells Secondary: - Theca cells - Multiple layers of granulosa cells Tertiary: - Fully formed antrum Graafian (vesicular) follicle: - preovulatory follicle; fully mature

question

Tanner stages: Breast development

answer

Tanner I: no glandular tissue; areola follows skin contours of the chest (prepubertal) Tanner II: breast bud forms with small area of surrounding glandular tissue; areola beings to widen - 8-13yrs Tanner III: breast begins to become more elevated and extends beyond borders of areola; remains in contour with surrounding breast Tanner IV: increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast Tanner V: adult size; areola returns to contour of the surrounding breast, with projecting central papilla (nipple) - 12.5-18.5yrs

question

Colposcopy description

answer

"binoculars into the vagina" 1. *visually* identify where abnormal Pap smear cells originated 2. biopsy that area to send for histologic diagnosis

question

Average length of a vagina

answer

8-9cm

question

What is the lymphatic drainage of the ovaries?

answer

Pelvic nodes Para-aortic nodes

question

What are the organ systems we need to consider involving pelvic pain/pelvic mass?

answer

GI (colons) Uterus Bladder

question

What is the most common anatomical position of the uterus?

answer

Anteverted (50%) mid-position (25%) retroverted (25%)

question

Endometrial biopsy

answer

examines histology of endometrial lesions hollow suction cannula is placed into uterine cavity and suction is applied; rotation of cannula before fixing with formalin

question

Which portion of the cervix is most concerned for scrapings during a Pap smear?

answer

Transformation zone (T-zone) - 95% of cervical dysplasia and cancer develops here - screening for squamous cell carcinoma (most common cancer of the cervix 80%) - area between old (outer, "O") squamocolumnar junction and new (inner) squamocolumnar junction

question

Risks of mammography

answer

high radiation (0.7 mSv) same as background radiation in 3 months 1 rad = 10 mSv

question

What is the specimens required for a Pap smear? What diseases are they mostly screening for?

answer

2 areas 1. T-zone of the ectocervix (squamous cell carcinoma; most common cancer of cervix 80%) 2. columnar epithelium of endocervical canal (adenocarcinoma; 2nd most common cancer of cervix 15%)

question

Hysterosalpingogram (HSG) description and procedure

answer

procedure performed without anesthesia, radio-opaque fluid injected at endocervical canal allowing assessment of uterine malformations and Asherman's syndrome dye is supposed to spill into pelvic cavity; non-spillage can be a sign of fallopian tube occlusion or blockage

question

Vulvar biopsy

answer

done with punch biopsy or scalpel performed under local anesthesia, histology of vulvar lesions

question

Hysterectomy types

answer

removal of uterus "hyster" root comes from the misled belief women are crazy because of their uterus 1. subtotal: removes only teh corpus, leaving cervix in place 2. total: removes both corpus and cervix of uterus (aka simple hysterectomy) 3. radical hysterectomy: performed for early stage CIN, involves removal of the uterus, cervix, and surrounding tissues, including cardinal ligaments, uterosacral ligaments, and the upper vagina (can involve removing lymph nodes depending on stages of CIN)

question

What is the term for the surgery of removing ovaries?

answer

removal of ovaries Salpingo-oophorectomy

question

Cone biopsy: wide-shallow cone vs. narrow-deep cone

answer

Cone biopsy; both procedures need anesthesia Wide-shallow cone: - performed if Pap smear shows changes more severe than the colposcopically directed biopsy Narrow-deep cone: - performed if a lesion extends from the exocervix into teh endocervical canal

question

The pelvic floor is made up of which diaphragms? What structures do they hold?

answer

Pelvic diaphragm: - levator ani (puborectalis, pubococcygeus, ileococcygeus) - coccygeus muscles Perineal membrane (urogenital diaphragm): - triangular sheet of dense fibromuscular tissue "anterior triangle" that spans the anterior half of the pelvic outlet - vagina and urethra pass through the perineal membrane

question

Most common cause of uterine prolapse?

answer

childbirth

question

Uterine prolapse classification

answer

Grade I: cervix descends half way to introitus Grade II: cervix descends to introitus Grade III: cervix extends outside the introitus Grade IV or procidentia: entire uterus, as well as the anterior and posterior vaginal walls, extends outside the introitus

question

What is procidentia?

answer

Grade IV Uterine prolapse entire uterus + anterior and posterior vaginal walls extends outside the introitus

question

Vaginal prolapse classification

answer

Cystocele (most common): anterior vaginal wall prolapse; contains the bladder Rectocele (2nd most common): posterior vaginal wall prolapse; contains the rectum Enterocele (3rd): rectouterine pouch/pouch of Douglas prolapse

question

What is the triad for rectocele diagnosis?

answer

1. postmenopausal woman 2. Posterior vaginal wall protrusion 3. Digitally assisted removal of stool "digital splitting"

question

Management of pelvic relaxation: non-surgical

answer

Non-surgical: - Kegel exercises (learning to control pubococcygeus muscle; "magazine for better sex"; kegel weights) - Estrogen replacement in postmenopausal women - Pessaries (mechanical method)

question

Management of pelvic relaxation: surgical

answer

Surgical: when conservative methods fail - vaginal hysterectomy (with vagina vault suspension) + anterior/posterior vaginal repair - anterior and posterior colporrhaphy: uses endopelvic fascia that supports bladder and rectum

question

Diagnosis of prolapse in pelvic relaxation is done how?

answer

Tell the patient to perform Valsalva in lithotomy position

question

Average age of menopause?

answer

51-52

question

Physiology: continence vs. micturition

answer

balance between urethral closure & detrusor muscle (bladder muscle) activity urethral sphincter pressure normally > bladder pressure = urine continence urethral pressure decreases < bladder pressure = micturition/voiding Normally proximal urethra + bladder both within the pelvis (prolapse can alter this state leading to incontinence); intraabdominal pressure increases (valsalva) are transmitted equally to both, leaving the pressure difference unchanged; continence detrusor muscle spontaneous contractions are normally easily suppressed

question

Pharmacology: bladder receptors innervation

answer

α-adrenergic receptors: Sympathetic nervous system - "Sympathetic SHOOTS" hence urethral sphincters contract to inhibit incontinence during ejaculation - primarily found in urethra - *prevent* micturition; *contraction* of urethral - Drugs agonists: ephedrine, imipramine, estrogens - Drugs antagonists: phenoxybenzamine β-adrenergic receptors: Sym. nervous system - *prevents micturition*; relaxation of bladder detrusor muscles hence prevents urination - primarily in the detrusor muscle - Drugs agonists: flavoxate, progestins Cholinergic receptors: Parasympathetic innervation - *enhances micturition* - primarily also in detrusor muscle; *contraction* - Drugs agonists: bethanecol, neostigmine - Drugs antagonists: oxybutynin, propantheline

question

Cystometry Volume Measurements

answer

Post-void residual volume = <50mL Sensation of fullness = 200-225mL Urge to void = 400-500mL Normally a patient should be able to suppress the urge to void. (shown on graph) Involuntary contractions can be seen by watching saline level in the syringe rise/fall; normally there should not be any involuntary contractions

question

Sensory Irritative Incontinence: etiology, history, examination, investigative studies, management

answer

Etiology: - involuntary rises in bladder pressure - results in detrusor contractions - possible causes: infection, stone, tumor, foreign body History: - loss of urine occurs with *urgency, frequency and dysuria* - can take place *day or night* Examination: - suprapubic tenderness may be elicited - pelvic examination normal (no prolapse of any sort) - neurological exam normal (anal contraction reflex normal, S2-3-4; by stimulating labia majora we get a anal contraction) Investigative study: *urinalysis* - bacteria and WBC (infection) - RBC (stone, foreign body, tumor) - positive urine culture (infection) - normal cystometric studies (normal RV with involuntary detrusor contractions present) Management: - antibiotics (infections) - cystoscopy to diagnose and remove stones, foreign bodies, tumors

question

Inhibit voiding Tx: bladder relaxants/antispasmodics

answer

oxybutynin (Ditropan) flavoxate (Urispas)

question

Inhibit voiding Tx: bladder relaxant/anticholinergics

answer

Pro-Banthine

question

Inhibit voiding Tx: bladder relaxant/tricyclics

answer

Imipramine (Tofranil)

question

Inhibit voiding Tx: vesical neck contraction/alpha adrenergics

answer

ephedrine Imipramine Estrogen stimulates alpha receptors Progesterone stimulates beta receptors

question

Which receptors do estrogen stimulate? progesterone?

answer

Estrogen stimulates alpha receptors Progesterone stimulates beta receptors

question

Promote voiding Tx: bladder contraction/cholinergics

answer

Bethanechol (Urecholine) Neostigmine (Prostigmin)

question

Promote voiding Tx: vesicle neck relaxants/alpha antagonists

answer

methyldopa phenothiazines

question

Genuine Stress Incontinence: Etiology, history, examination, investigative studies, management

answer

Etiology: - most common form of true urinary incontinence - rises in bladder pressure because of intraabdominal pressure increase - not transmitted to proximal urethra due to pelvic relaxation and not being a part of pelvic structures anymore - *loss of bladder support* History: - loss of urine occurs in small spurts simultaneously with coughing or sneezing - *Does NOT* take place when patient is sleeping Examination: - cystocele may be seen - Neurologic examination is normal - Q-tip test is positive (q-tip placed within the urethra and patient increases intraabdominal pressure, the q-tip will rotate >30 degrees) Investigative studies: - urinalysis + culture are normal - cystometric studies are normal - *no* involuntary detrusor contractions seen Management: Mostly similar to pelvic relaxation management - Kegel exercises - estrogen replacement (stimulates alpha receptors) - surgical therapy aims to elevate the urethral sphincter (Burch procedure, MML, tension-free vaginal tape procedure)

question

What is the most common form of true urinary incontinence?

answer

Genuine stress incontinence

question

What is the only incontinence that does not result in voiding during the night?

answer

Genuine stress incontinence

question

What is the triad of stress incontinence?

answer

Involuntary loss of urine (large) with coughing and sneezing (increase abdominal pressure) No urine lost at night

question

Motor Urge (Hypertonic) Incontinence: etiology, history, examination, investigative studies, management

answer

Etiology: 'Itty-Bitty Bladder Syndrome' - involuntary rises in bladder pressure from idiopathic detrusor contractions that cannot be voluntarily suppressed History: - loss of urine occurs in large amounts; often without warning - day + night - most common symptom is urgency Examination: - pelvic examination shows normal anatomy - neurologic examination is normal Investigative studies: - urinalysis + culture normal - cystometric studies show normal residual volume - *involuntary detrusor contractions are present even with small volumes of urine in the bladder* Management: - anticholinergic medications - NSAIDS to inhibit detrusor contractions - tricyclic anti-depressants - calcium-channel blockers

question

What is the triad for hypertonic bladder?

answer

Involuntary loss of urine cannot suppress urge to void urine loss day + night

question

Hypertonic incontinence vs. Hypotonic incontinence

answer

Hypertonic: - large volume urine loss - idiopathic detrusor muscle contraction - day + night Hypotonic: - small volume urine loss (until urethral sphincter = bladder pressure) - bladder never empties; detrusor muscle relaxation - day + night

question

Overflow/Neurogenic (Hypotonic) Incontinence: etiology, history, examination, investigative studies, management

answer

etiology: - Rises in bladder pressure occur gradually from over-distended, hypotonic bladder - voiding occurs only when bladder pressure > urethral sphincter pressure - *bladder never empties*; voiding occurs only until bladder pressure = urethral sphincter pressure - may be due to denervated bladder (diabetic neuropathy, MS, or systemic medication) history: - loss of urine occurs intermittently in small amounts* - day + night - pelvic fullness is a common symptom examination: - pelvic examination may show normal anatomy - *decreased pudendal nerve sensation* investigative studies: - urinalysis and culture usually normal; may show infection - cystometric studies show markedly increased residual volume - involuntary detrusor muscle contractions do NOT occur management: - intermittent self-catheterization may be necessary - discontinue the offending systemic medications - bladder contraction stimulation (alpha receptor blocker; cholinergic drugs)

question

What is the triad for hypotonic bladder?

answer

involuntary loss of urine detrusor muscle not contracted urine loss day + night

question

Types of urinary incontinence with irregular detrusor muscle contractions

answer

Hypertonic incontinence

question

Types of urinary incontinence with no involuntary detrusor muscle contractions

answer

Stress incontinence Hypotonic incontinence

question

Fistula incontinence: etiology, history, examination, investigative studies, management

answer

etiology: - normal urethral-bladder mechanism is intact - bypassed by urine leaking out through a fistula from urinary tract history: - *radical pelvic surgery* or *pelvic radiation therapy* - loss of urine occurs continually in small amounts - day + night examination: - normal anatomy and normal neurologic findings investigative studies: - urinalysis and culture are normal - IVP (intravenous pyelogram) will demonstrate dye leakage from urinary tract fistula management: - surgical repair of the fistula

question

Triad for bypass incontinence

answer

involuntary loss of urine history: radical pelvic surgery or radiation urine loss day + night continuously* (small amounts)

question

Vaginal discharge: BV, parasitic, yeast

answer

BV; bacterial vaginosis (most common) - fishy odor - pH↑; thin grayish exudate - no inflammation; endogenous transmission - diagnostic: clue cells - Rx: metronidazole; clindamycin Trichomonas vaginalis - itching, burning "strawberry cervix" - inflammation prominent; pH↑ - green/yellowish frothy discharge - Methylene blue wet mount; mobile flagellates - Rx: Metronidazole Candida albicans - itching, burning - inflammation not as prominent as Trichomonas vaginalis; white "cottage cheese" discharge - pH stays same or ↓ - KOH: pseudohyphae/hyphae - Rx: fluconazole; azole cream Note: metronidazole is safe to use in all trimesters of pregnancy; class B

question

Most common cause of vagina discharge? 2nd? 3rd?

answer

Bacterial vaginosis (50%) Candidiasis (30%) Trichomonas (15%)...STD's

question

What is the predominant bacteria in the vagina?

answer

Lactobacillus Normal flora (70%) in BV it decreases to 15%

question

What is the normal pH of the vagina?

answer

pH < 4.5 estrogen dominance

question

Diagnostic Test: Vaginal Discharge

answer

Visual inspection: the vulva and vagina should be examined for evidence of inflammatory response; check vaginal discharge on speculum Vaginal pH: normal <4.5 Microscopic examination 2 drops of vaginal discharge are placed on glass slide (saline on one side, KOH on the other) looking for clue cells, hyphae, flagellates, WBC's

question

What is a positive "whiff" test in BV?

answer

when KOH is placed on the discharge, releasing a fishy odor KOH is for Candida albicans diagnostics; but it dissolves tissue

question

How does BV most commonly present as?

answer

asymptomatic 50%

question

Rx: Bacterial vaginosis

answer

Metronidazole - safe to use in all 3 trimesters of pregnancy - 250mg - t.i.d. for 7 days - no alcohol for 24-48 hrs Clindamycin - 300mg - b.i.d. for 7 days

question

Trimethylamineuria

answer

Fish odor syndrome AR a rare clinical entity where the patient has an offensive persistent odor that no amount of bathing can correct differential diagnosis with BV

question

What is associated with bubbly vaginal discharge?

answer

Trichomonas vaginalis

question

Trichomoniasis: Men vs. Woman symptoms

answer

Men: 90% asymptomatic Woman: 50% asymptomatic Both needs treatment despite presentations

question

What is associated with strawberry cervix?

answer

Trichomonas vaginalis

question

Rx: Vaginal Trichomoniasis

answer

Metronidazole - 24~48hrs no liquor - recommended: 2g orally in a single dose - alternative: 500mg b.i.d for 7 days - pregnancy: 2g orally in a single dose

question

Rx: Vaginal Candidiasis

answer

Oral fluconazole - 150mg single dose azole cream

question

Physiologic discharge: Sx, risk factors, speculum exam, management

answer

Sx: - most common complaint is increased watery vaginal discharge - no burning or itching Speculum: - columnar epithelium of endocervical canal extends over a wide area of the ectocervix, producing abundant mucus discharge - thin and watery - pH is normal (<4.5) Risk factors: - chronic anovulatory conditions - PCOS, etc. (polycystic ovarian syndrome) Management: - steroid contraception with progestins - convert watery thin discharge into thick sticky progestin-dominant mucus

question

Most common symptom of benign/malignant vulvar lesions

answer

Vulvar itching

question

Premalignant vulvar dermatosis

answer

benign lesions with malignant predisposition - most common symptom is vulvar itching, most lesions are asymptomatic Diseases: - Squamous hyperplasia - Lichen sclerosis - Squamous dysplasia - CIS

question

Squamous hyperplasia : appearance, palpation, histology, management

answer

premalignant vulvar dermatosis Appearance: - lesions appear whitish focal or diffuse areas Palpation: - firm and cartilaginous on palpation Histologically: - thickened keratin - epithelial proliferation Management: - fluorinated corticosteroid cream

question

Lichen sclerosis: appearance, palpation, histology, management

answer

premalignant vulvar dermatosis Appearance: - lesions are bluish-white papula that can coalesce into white plaques Palpation: - thin and parchment-like Histology: - epithelial thinning Management: - Clobetasol cream

question

Vulvar squamous dysplasia: appearance, histology, management

answer

premalignant vulvar dermatosis Appearance: - lesions are white, red, or pigmented, often multifocal in location - almost identical to cervical dysplasia Histology: - cellular atypia restricted to the epithelium without breaking through the basement membrane Management: - surgical excision

question

CIS: appearance, histology, management

answer

premalignant vulvar dermatosis Appearance: - indistinguishable from vulvar dysplasia - white, red, or pigmented, often multifocal lesions Histology: - cellular atypia is full thickness but does not penetrate the basement membrane Management: - laser vaporization and vulvar wide local excision

question

Malignant vulvar lesions

answer

uncommon gynecologic malignancy (4th most common gynecologic malignancy) mean age 65 risk factors: old age, cigarette smoking, HIV, premalignant vulvar dermatosis Diseases: - squamous cell - melanoma - Paget disease

question

Squamous cell (malignant vulvar lesion)

answer

most common type of invasive vulvar cancer (90%) association with HPV Pathogenesis is chronic inflammation (for older woman) and HPV infection (for younger women) Most common stage at diagnosis is Stage 1

question

Melanoma (malignant vulvar lesion)

answer

second most common histologic type of vulvar cancer (5%) most important prognostic factor is the depth of invasion Any dark or black lesion in vulva should be biopsied and considered for melanoma

question

Paget disease (malignant vulvar lesion)

answer

Characteristics: - red lesion - most common in postmenopausal white women Any patient with red vulvar lesion must be considered for the possibility of Paget disease Most common form of Paget disease is intraepithelial process 18~20% of cases invasion of basement membrane is identified association with other cancers (mainly GI, urinary, and breast)

question

Malignant vulvar lesions: diagnosis

answer

Biopsy

question

Malignant vulvar lesions: pattern of spread

answer

starts with local growth and extension that embolizes to inguinal lymph nodes and finally, hemtogenous spread to distant sites

question

Malignant vulvar lesions: staging

answer

Staging is surgical Stage 0: CIS (basement membrane is intact) Stage I: - tumor confined to vulva with size </= 2cm - nodes not palpable Stage IA: invasion 1mm deep Stage II: - tumor confined to the vulva with size >2cm - nodes not palpable Stage III: - Tumor any size with spread to lower urethra, vagina, or anus - unilateral nodes Stage IV: widespread metastasis Stage IVA: involves upper urethra, bladder or rectum, pelvic bone, bilateral nodes Stage IVB: distant metastasis

question

Malignant vulvar lesions: management

answer

1) Wide local excision 2) Modified radical vulvectomy 3) Radical vulvectomy 4) Pelvic exenteration 5) Radiation therapy

question

Management for stage IA malignant vulvar lesions

answer

Wide local excision only

question

Malignant vulvar lesions management: wide local excision

answer

Stage IA only risk of metastasis is negligible No lymphadenectomy is needed

question

Malignant vulvar lesions management: Modified radical vulvectomy

answer

involves radical local excision - Ipsilateral inguinal dissection is used only if stage is IB and unifocal lesion > 1cm from midline AND no palpable nodes (less sexual morbidity) - Bilateral inguinal dissection is used if at least stage IB or a centrally located lesion OR palpable inguinal nodes or positive ipsilateral nodes (lower-extremity edema)

question

Malignant vulvar lesions management: radical vulvectomy

answer

involves removal of labia minora + majora, clitoris, perineum, perineal body, mons pubis seldom performed due to high morbidity sexual dysfunction may result

question

Malignant vulvar lesions management: pelvic exenteration

answer

radical vulvectomy + removal of cervix, vagina, ovaries + lower colon, rectum + bladder create appropriate stomas if necessary seldom indicated or performed due to high morbidity

question

Malignant vulvar lesions management: radiation therapy

answer

only used for patients who cannot undergo surgery

question

Benign vulvar lesions: diseases

answer

1) Mulluscom contagiosum 2) Condylomata acuminata 3) Bartholin cyst

question

Mulluscom contagiosum: at risk group, Sx, transmission, management

answer

Benign vulvar lesion Children, sexually active adults, immunodeficient patients Sx: - spontaneously regressing, umbilicated tumors of skin Transmission: - direct skin contact Management: - observation - curettage - cryotherapy

question

Condylomata acuminata: causative agent, Sx, management

answer

Benign vulvar lesions HPV 6, 11 (no malignant predisposition) Sx: - cauliflower-like vulvar lesions Management: - treat clinical lesions only

question

Bartholin cyst: pathogenesis, management

answer

Benign vulvar lesions obstruction of the Bartholins gland duct may occur due to infection (GC) After immune defenses overcome, duct remains obstructed resulting in cystic dilation of the gland aspiration of the cyst yields sterile fluid Management: - conservative unless pressure symptoms due to size

question

gynecologic cancer rankings 1~4 and age relevance

answer

1. endometrium (61) 2. ovaries (69) 3. cervix (45) 4. vulva (65)

question

What is the type of gynecological cancer occurs earliest in life? Oldest?

answer

Cervical cancer (45) Ovaries (69)

question

Cervical polyps: description, cause, at risk group, findings, management

answer

Description: fingerlike growths that start on the surface of the cervix or originate within endocervical canal/columnar epithelium (more common), can extend out of the cervical os. Cause: - Idiopathic - Associated with chronic inflammation - Associated with increased levels of estrogen (ex: pregnancy) - Associated with thrombosed cervical blood vessels At risk group: - relatively common - older multiparous women more common Findings: - vaginal bleeding, often after intercourse - bleeding occurs between normal menstrual periods - speculum examination: smooth, red/purple, fingerlike projections from cervical canal - biopsy typically reveals mildly atypical cells and signs of infection Management: - polyps can be removed by gentle twisting or by surgical string removal method (electrocautery/laser) - due to infected polyps being common, antibiotic may be given after the removal even if there are no or few signs of infection - although most polyps are benign, pathology exam of biopsy should still be done - regrowth of polyps is uncommon

question

What are cervical polyps associated with?

answer

Associations: - chronic inflammation - increased estrogen levels (pregnancy, etc.) - thrombosed cervical blood vessels - idiopathic

question

What do people with cervical polyps most commonly present with?

answer

vaginal bleeding, mostly after intercourse bleeding between normal menstrual cycles

question

What is the management of cervical polyps?

answer

polyps can be removed by gentle twisting or by surgical string removal method - electrocautery - laser antibiotics given after procedure due to common association of polyps with infection biopsy sent to pathology regardless of nature of polyps

question

Which group of people are at risk for developing cervical polyps?

answer

older women multiparous women

question

Nabothian cysts: description, cause, findings, management

answer

Description: mucus-filled cyst on the surface of the uterine cervix. These endocervical glands can become *covered* by squamous epithelium through metaplasia. Cause: - during the metaplasia and formation of the T-zone, columnar epithelium morphs into squamous epithelium; if the columnar cells beneath did not completely go through metaplasia, they can secrete mucus which can push the squamous epithelium outwards. Findings: - benign condition; rarely large enough to cause clinically relevant problems - pelvic examination reveals small, smooth, rounded lump (or collection of bumps) - rarely, colposcopic exam can be used to distinguish nabothian cysts from other types of cervical lesions Management: - no treatment necessary - Nabothian cysts do not clear spontaneously - Easily cured through electrocautery or cryotherapy

question

The cervical canal is lined by what type of cells? Function?

answer

Glandular cells / columnar epithelium secrete mucus

question

What does the Nabothian cyst present as? How do you treat it?

answer

small, smooth, rounded lump or collection of bumps caused by mucus-fileld cysts on the surface of the cervix (ectocervix) due to incomplete metaplasia of columnar epithelium beneath the T-zone during transformation benign condition No treatment necessary - electrocautery or cryotherapy can easily cure cyst

question

Cervicitis: symptoms, examination, investigative findings, management

answer

Symptoms: - no symptoms most common - vaginal discharge Examination: - most common finding is mucopurulent cervical discharge - friable cervix: endocervical bleeding easily induced by cotton swab palpation of cervical os - No pelvic tenderness noted - Patient is afebrile Investigative findings: DNA probe - Routine cervical cultures are positive for chlamydia or gonorrhea - STDs - WBC and ESR normal (no inflammation) Management: - Oral azithromycin in single dose - Oral doxycycline BID for 7 days

question

What is the most common finding in cervicitis?

answer

mucopurulent discharge from cervix friable cervix no pelvic tenderness or febrile condition

question

How do you manage cervicitis?

answer

Oral azithromycin single dose or Oral doxycycline BID for 7 days

question

Cervical neoplasia: presentation, etiology, risk factors

answer

Presentation: - usually asymptomatic - progression from premalignant to invasive cancer has been reported to be approximately 8~10 yrs (good prognosis for early detection and slow progression) - Most regress (young women) Etiology: - most common* etiology of cervical cancer is HPV - Over 75 subtypes - most common HPV types: 16, 18, 31, 33, 35, 45 - most common for condyloma accuminata: 6, 11 risk factors: - early age intercourse - multiple sexual partners* (strong positive correlation) - cigarette smoking - immunosuppression

question

What is the most common presentation of cervical cancer? What is the most common progression? Associated age groups and types?

answer

most common presentation is asymptomatic progression is most commonly regression, especially in young women - age 14~19 has 33% HPV risk - age 20~29 has 28% HPV risk 65% regress, associated with HPV 6, 11 - young women most commonly regress, 61% within 1 yr, and 91% within 3 years 20% same + 15% progress - associated with HPV 16, 18, 30s

question

What are the risk factors for developing cervical cancer?

answer

early age of intercourse cigarette smoking multiple sex partners immunosuppression

question

What are the most common HPV types for cervical cancer? Order of malignancy? Condyloma accuminata?

answer

CIN: HPV-16, 18, 31, 33, 35, 45 (16>18>45>31>33) Condyloma accuminata: HPV-6, 11

question

What is the most effective medically cancer screening test ever developed?

answer

PAP smear 70~80% decrease of death rate

question

Which HPV is most associated with squamous cell carcinoma of cervix?

answer

HPV-16

question

Which HPV is most associated with adenocarcinoma of the cervix?

answer

HPV-18

question

Rank the most common malignant HPV types that causes cancer in the cervix + association

answer

HPV-16 (squamo)....59% HPV-18 (adeno)....12% HPV-45>31>33....squamo

question

Why do we NOT start PAP smear before age of 21?

answer

Most cases of HPV infection regresses (65%) More so, most cases of HPV infection in young woman regresses completely in 3 years (91%) HPV infection is correlated with sexual intercourse at young age if HPV is going to regress mostly in 3 years there isn't a point of starting PAP smears until after 21yrs old

question

When doing a Pap smear on pregnant women what should you use?

answer

spatula for T-zone *cotton swab for endocervical canal

question

Pap smear should be started at the following ages:

answer

Age < 21: - NO Pap test or screening for HPV, regardless of sexual activity Age 21: start Pap test with cytology alone *without HPV testing; the recommendation is the same whether HPV vaccinated or not

question

What is the frequency of recommended Pap smear for Age groups 21-29? 30-65?

answer

Age 21-29: - repeat Pap every 3 years with cytology alone; do not perform HPV testing in this age group (due to slow progression of the disease) Age 30-65: - Pap every 3 years with cytology but no HPV testing OR - repeat Pap every 5 years if both cytology + HPV (recommended choice)

question

When should Pap smears be discontinued?

answer

After age 65 - if negative cytology and/or HPV tests for past 10 years AND no history of CIN-2, 3, or cervical carcinoma Any age if total hysterectomy and no history of CIN

question

What is the system used to classify Pap smears in the U.S.?

answer

Bethesda system

question

Classification os Bethesda system

answer

Negative: No intraepithelial lesions - may report trichomoniasis, candida, BV, HSV, atrophy, etc. Abnormal squamous cells (99% of abnormal Pap smears) ASCUS: (5%~20%) - atypical squamous cells of undetermined significance - suggestive of LSIL but not adequate - decrease ASCUS findings by making a thinner prep ASCH: - atypical squamous cells can't rule out HSIL - suggestive of but not adequate to label HSIL LSIL: - low-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings of HPV, mild dysplasia, or CIN 1 HSIL: - high-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings of moderate-severe dysplasia, CIN 2, 3, CIS Squamous cell carcinoma: - biopsy expected to show histologic findings of invasive cancer Abnormal endocervical cells (1% of abnormal Pap smears) AGC-NOS: - atypical glandular cells, not otherwise specified AGC-neoplastic: - atypical glandular cells, can't rule out neoplasia - changes suggestive of but not adequate to call AIS or cancer AIS: - adenocarcinoma in situ Adenocarcinoma

question

Describe ASCH on Bethesda system

answer

atypical squamous cells can't rule out HSIL - changes suggestive of but not adequate to label HSIL

question

Describe ASCUS on Bethesda system

answer

atypical squamous cells of undetermined significance - changes suggestive of but not adequate to label LSIL

question

Describe LSIL on Bethesda system

answer

low-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings of HPV, mild dysplasia, CIN1

question

Describe HSIL on Bethesda system

answer

high-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings moderate-severe dysplasia, CIN2, CIN3, CIS

question

Squamous cell carcinoma on Bethesda system

answer

Invasive carcinoma will enter staging instead of CIN numbers Stage 1 is after CIS - <2cm lesion (1a = 1mm deep lesion)

question

Describe AGC-NOS on Bethesda system

answer

atypical glandular cells not otherwise specified

question

Describe AGC-neoplastic on Bethesda system

answer

atypical glandular cells can't rule out neoplasia

question

Describe AIS on Bethesda system

answer

adenocarcinoma in situ

question

High-grade squamous intraepithelial lesions are associated with which histologic findings?

answer

moderate-severe dysplasia CIN-2 CIN-3 CIS

question

Low-grade squamous intraepithelial lesions are associated with which histologic findings?

answer

mild dysplasia HPV CIN 1

question

How often does ASCUS show up on Pap smears? How do you decrease ASCUS diagnosis? What is the management of ASCUS?

answer

<5% but up to 20% Decrease ASCUS findings by: - make a thinner prep or HPV/DNA typing: - if 6, 11 it will most likely regress (low-risk) but repeat Pap within 1 year - if 16, 18, 30s it is high-risk and need colposcopy and biopsy

question

If you find ASCUS on Pap smear, what are the tests you could run? (3)

answer

Accelerate repeat Pap: - 4~6 month intervals until 2 consecutive negative Paps - if a repeat Pap is again ASCUS or worse, this is an indication for colposcopy HPV-DNA testing: - if liquid-based cytology was used on initial Pap smear, it can be used for DNA testing (100% diagnostic) - indications for colposcopy: high-risk HPV types Colposcopy: - uses acetic acid to make vascular patterns more visible - 10~12 times magnification - satisfactory/non-satisfactory - unsatisfactory = t-zone invading into endocervical canal

question

What if you find cells other than ASCUS on a Pap smear, what tests should you run?

answer

Colposcopy and biopsy

question

If you find cells others than ASCUS (ASC-H, LSIL, etc.) on a Pap smear, what is your plan of management?

answer

Colposcopy Endocervical curettage (ECC) - not in pregnancy - ***colposcopy shows T-zone extending into endocervical canal, etc. Ectocervical biopsy - lesions identified on ectocervix by colposcopy*** - mosaicism, punctation, white lesions, abnormal vessels - biopsy and send for histology Compare Pap smear and biopsy - ensure level of severity is comparable with colposcopy - *Pap smear should not be worse than biopsy; means you missed the more malignant area on biopsy Diagnostic Cone biopsy indications: - Pap smear is worse than biopsy - ECC: abnormal cells - Lesions entering endocervical canal*** - Biopsy: microinvasive carcinoma Manage by histology: - observation: CIN1, repeat Pap in 6~12 months, colposcopy and repeat Pap in 12 months, or HPV/DNA testing in 12 months - ablation: CIN1, 2, 3 (cryotherapy, laser vaporization, electrofulguration) - resection: CIN1, 2, 3 (LEEP, cold-knife conization) - hysterectomy: biopsy-confirmed, recurrent CIN2 or 3 only

question

What are the risk of cone biopsy?

answer

incompetent cervix cervical stenosis

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see metaplastic epithelium entering the endocervical canal, what will you do next?

answer

ECC endocervical canal curettage

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see ectocervical lesions, what will you do next?

answer

Ectocervical biopsy

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see lesions entering the endocervical canal, what will you do next?

answer

Narrow cone biopsy

question

What are follow-up options for CIN1?

answer

Observation (repeat Pap, colposcopy and Pap, HPV-DNA) Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife)

question

What are follow-up options for CIN2?

answer

Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife cone) Hysterectomy (recurrent CIN2 only)

question

What are follow-up options for CIN3?

answer

Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife cone) Hysterectomy (recurrent CIN3 only)

question

When is hysterectomy indicated in CIN?

answer

recurrent CIN2, 3

question

CIN follow-up management: Observation

answer

Indicated for CIN1 Repeat Pap in 6~12 months Colposcopy and repeat Pap in 12 months HPV-DNA testing in 12 months

question

CIN follow-up management: Ablative therapy

answer

Indicated for CIN1, 2, 3 Cryotherapy Laser vaporization Electrofulguration Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

CIN follow-up management: Excision/Resection

answer

Indicated for CIN1, 2, 3 LEEP cold-knife conization Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

CIN follow-up management: hysterectomy

answer

CIN2, 3 only indicated in recurrent infections

question

What follow-up procedures are required for ablative therapy and excisional procedure patients for CIN?

answer

Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

If cytologic findings of Pap smear reveals HSIL, what is the next step for patients ages 25-64?

answer

colposcopy + biopsy immediate LEEP**

question

Invasive Cervical Cancer definition

answer

cervical neoplasia that has penetrated through the basement membrane >CIS

question

Cervical cancer: definition, presentation, epidemiology, diagnostic findings

answer

Definition: cervical neoplasia penetrated through the basement membrane Presentation: - normal menstrual cycles - postcoital vaginal bleeding - irregular vaginal bleeding - lower extremity pain and edema in advanced stages Epidemiology: - 3rd most common gynecological carcinoma - ~45 years of age (youngest occurrence) - 250,000 deaths/yr world wide; 10,000/yr in U.S. Diagnostic Tests/Findings: - Cervical biopsy* - Metastatic workup: pelvic examination, chest x-ray, intravenous pyelogram, cystoscopy, sigmoidoscopy - Imaging studies: invasive cervical cancer is the ONLY gynecological cancer staged clinically (CT and MRI cannot be used for clinical staging)

question

What is the only gynecological carcinoma that uses clinical staging?

answer

Cervical cancer

question

Common presentation of cervical carcinoma?

answer

normal menstrual cycle postcoital vaginal bleeding irregular vaginal bleeding

question

Cervical cancer: staging

answer

CLINICAL (only gynecological carcinoma staged clinically) Stage 0: CIS (basement membrane is intact) Stage I: Spread limited to the cervix. *most common* - Ia1: 3mm but 5mm deep (frank invasion) Stage II: spread adjacent to cervix - IIa: involves upper 2/3 of vagina - IIb: invasion of parametria Stage III: spread further from the cervix - IIIA: involves lower one third of vagina - IIIB: extends to pelvic side wall or hydronephrosis Stage IV: spread furthest from cervix - IVA: involves bladder or rectum or beyond true pelvis - IVB: Distant metastasis

question

What is the most common stage of cervical cancer?

answer

Stage 1 limited to the cervix

question

What is the staging for minimally invasive cervical cancer? Management? Management in pregnancy?

answer

Ia1 </= 3mm deep total simple hysterectomy during pregnancy: cone biopsy during pregnancy follow conservatively, deliver vaginally reevaluated and treated 2 months postpartum

question

What is the staging for microinvasive cervical cancer? Management? Management in pregnancy?

answer

Ia2 <3mm but </=5mm deep modified radical hysterectomy during pregnancy: cone biopsy during pregnancy follow conservatively, deliver vaginally reevaluated and treated 2 months postpartum

question

What is the staging for frank invasion cervical cancer? Management? Management in pregnancy?

answer

IB >5mm deep radical hysterectomy or radiation (IIa) during pregnancy: based on gestational age - before 24 weeks: receive definitive treatment as shown above - after 24 weeks: conservative management to 32-33 weeks, after C-section definitive treatment can be done

question

What ist he staging for cervical cancer that has spread adjacent to the cervix? Management? Management in pregnancy?

answer

II IIa: upper 2/3 of vagina involved Management: radical hysterectomy or radiation IIb: invasion of parametria Management IIb or above: radiation therapy and chemotherapy for all ages during pregnancy: based on gestational age - before 24 weeks: receive definitive treatment as shown above - after 24 weeks: conservative management to 32-33 weeks, after C-section definitive treatment can be done

question

Cervical cancer: staging management

answer

Stage Ia1: - 3mm but 5mm frank invasion - IIa: involves upper 2/3 of vagina - radical hysterectomy with/without radiation Stage IIb, III, IV: - radiation therapy and chemotherapy for all ages

question

Cervical cancer: follow-up

answer

All patients with invasive cervical cancer should be followed up with... - Pap smear every 3 months for 2 years after treatment - then every 6 months for subsequent 3 years Patients who have local recurrence can be treated with radiation therapy Patients with distant metastases should be considered for chemotherapy treatment - Cisplatinum

question

What is the most active chemotherapeutic agent for cervical cancer?

answer

Cisplatinum

question

What is the effect of pregnancy in cervical neoplasia

answer

pregnancy does NOT predispose abnormal cytology and does not accelerate precancerous lesions progression

question

Diagnostic tests and findings for pregnant patients in cervical cancer

answer

Pregnant with abnormal Pap smear should be evaluated in the SAME FASHION - owing to increased cervical vascularity ECC is not performed during pregnancy (endocervical canal curettage)

question

What is the plan of management in pregnant patients with cervical cancer in CIN stages?

answer

Pap smear and colposcopy every 3 months during pregnancy 6~8 weeks postpartum the patient should be reevaluated with repeat colposcopy an dPap smear Any persistent lesions can be definitively treated postpartum

question

What is the plan of management for microinvasion cervical cancer in pregnant patients?

answer

evaluated with cone biopsy to ensure no rank invasion patients can be followed conservatively delivery can be vaginal reevaluation and treatment 2 months postpartum

question

What is the plan of management for frank invasion carcinoma in pregnant patients?

answer

Based on gestational age before 24 weeks - definitive treatment based on staging after 24 weeks - conservative management to about 32-33 weeks - C-section - definitive treatment after delivery

question

Gardasil: recommendation, coverage, regimen

answer

Recommendation: - females 8~26; target group 11~12yrs - Efficacy is highest before patient's immune system is exposed to HPV - No point in testing for HPV before vaccination, no easy method of identifying all HPV types - Pap smear continued to guidelines due to >70 types of HPV strains and vaccine covers only 4 most common - sexually active women can receive vaccine, same with women who has previous abnormal cervical cytology or genital warts, just less effective - patients with previous CIN, benefits limited - not recommended for pregnant, lactating, or immunosuppressed women, but no tests has been done to prove clinical relevant harm Coverage: - HPV 6, 11, 16, 18 - covers 70% of cervical cancer and 90% of genital warts of HPV strains Regimen: - initial, 2 months, 6 months - $300

question

What is the target group for Gardasil? Why?

answer

11~12 age group Efficacy best before host immune system is exposed to HPV strains

question

What strains of HPV does Gardasil cover?

answer

HPV 6, 11, 16, 18

question

When is the Gardasil vaccine contraindicated?

answer

Pregnant women Lactating women Immunosuppressed women Not clinically proven to be true

question

How many types of uterine anomalies are there? How are they divided?

answer

7 types by the American Fertility Society (1988) Divided by - failure to form - failure to fuse - failure to dissolve the septum

question

Hypoplasia/Agenesis of Uterus: description, cause, association

answer

description: - may lack a vagina, cervix, fallopian tubes, body of uterus - developmental problem with a section of both mullerian ducts association - urinary tract anomalies - urinary tract embryologically lie close to mullerian ducts

question

Unicornuate uterus: defect, description, complications, symptoms

answer

defect and description: - when ONE of the mullerian ducts fails to form - *sing-horn (banana-shaped) uterus develops from the remainder healthy mullerian duct - single uterus may stand alone complications: - 65% of women with unicornuate uterus, the defected mullerian duct may form an incomplete rudimentary horn - may or may not have cavity in the rudimentary horn but the opening that communicates with the healthy uterus is either small or nonexistent symptoms: if rudimentary horn forms - monthly pain during adolescence because no outlet for menses from rudimentary horn - risk of pregnancy in rudimentary horn, 90% ruptures due to anatomical limitations

question

Didelphys uterus: defect, description, risks

answer

defect and description: - results from complete failure of the 2 mullerian ducts to fuse together (stage 1 development) - each duct develops into a separate uterus - each uterus can have their own cervix or share a cervix - 67% of cases is associated with 2 vaginas separated by a thin wall risks: - preterm delivery is common

question

Bicornuate uterus: defects, description, types, risks

answer

defect and description: - most common congenital uterine anomaly (45%) - results from failure of fusion between the mullerian ducts at the fundus - 'complete' failure to fuse results in 2 separate single-horn uterine bodies sharing 1 cervix* - 'partial' failure to fuse results in fusion at the bottom but not the fundus causing single uterine cavity with 2 distinct horns on top and a shared cervix* Risks: - preterm delivery - malpresentations with pregnancy

question

What is the most common congenital uterine anomaly?

answer

Bicornuate uterus 45%

question

Septate uterus: defect, description, types, risks

answer

defect and description: - failure in degeneration of the median septum - complete failure: 2 single-horned uteri that share one cervix - partial failure: shared cavity at lower portion of uterus with 1 cervix - *external shape of uterus is normal-appearing* risks: - preterm delivery

question

Septate uterus vs. Bicornuate uterus

answer

septate uterus looks normal-appearing single unit exteriorly bicornuate uterus has distinct 2 separate horns at fundus both can result in separate cavity but sharing 1 cervix or partial shared cavity with 1 cervix

question

Arcuate uterus: defect, description, risks

answer

defect and description: - essentially NORMAL in shape - NORMAL in function as well - small midline indentation in the uterine fundus, results from failure to dissolve the median septum completely risks: - essentially none

question

DES uterus: defect, description, cause, risks

answer

defect and description: - *T-shaped cavity - mothers exposed to DES (diethylstilbestrol) which was used 30yrs ago to prevent miscarriages are predisposed to uterine abnormalities and clear cell carcinoma of the vagina, idiopathic risks: - cervical insufficiency

question

What teratogen is associated with predisposition of clear cell carcinoma of the vagina?

answer

DES (diethylstilbestrol) DES uterus + clear cell carcinoma of vagina idiopathic

question

Leiomyoma Uteri: description, at risk group, different locations

answer

Description: benign smooth muscle growth of myometrium causing non-tender asymmetric distortions of the uterus; most common benign uterine tumor At risk group: 5x more common in black women than white women Location: Intramural: - most common location is within uterine wall - asymptomatic and cannot be felt on examination unless enlargement of uterus is altering external contour Submucosal: - located beneath the endometrium and can distort the uterine cavity - since endometrium may not respond appropriately to normal hormonal fluctuation the result is unpredictable, often intermenstrual, bleeding* - *most common symptom is vaginal bleeding and can result in anemia Subserosal: - located beneath uterine serosa; they can distort the external contour of the uterus - pedunculated subserosal leiomyomas can become parasitic fibroids - they break away from uterus and receive their blood supply form another abdominal organ

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Leiomyoma uteri: natural history

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Natural history: - slow growth*: most leiomyomas are small, grow slowly and cause no symptoms - rapid growth: estrogen receptors are increased in leiomyomas resulting in rapid enlargement during times of high estrogen levels, such as pregnancy - degeneration: during rapid growth, myomas may outgrow their blood supply, resulting in ischemic degeneration of a fibroid (hyaline, calcific, red degeneration/carneous degeneration) - Shrinkage: when estrogen levels fall, leiomyomas will typically decrease in size; physiologically (menopause) or through treatment (GnRH agonist suppression of FSH)

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How does most leiomyomas present clinically?

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Slow growth small, grow slowly, and asymptomatic

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What is the most common form of leiomyoma of uterus?

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Intramural leiomyoma found within the uterine wall

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What is the most common presentation of a submucosal leiomyoma of the uterus?

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vaginal bleeding metrorrhagia = irregular bleeding between menses menorrhagia = heavy menses

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Which type of uterine leiomyoma can become parasitic fibroids?

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Pedunculated subserosal uterine leiomyoma Break away from uterus and receive blood supply from another organ in the abdomen

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Where is the intramural leiomyoma of the uterus found? How does it present?

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Most common location of leiomyoma uteri Found within the wall of the uterus Mostly asymptomatic and cannot be felt on examination unless it enlarges to where the normal uterine external contour is altered

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Where is the submucosal leiomyoma of the uterus found? How does it present?

answer

It is found beneath the endometrium and can distort the uterine cavity It can be pedunculated and extend into the vagina through the cervix Due to overlying endometrium may not respond appropriately to the normal hormonal fluctuations, it results in unpredictable and often intermenstrual bleeding - menorrhagia - metrorrhagia - menometrorrhagia = combined of irregular bleeding between menses and heavy menses Most common presentation is vaginal bleeding

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Where is the subserosal leiomyoma of the uterus found? How does it present?

answer

It is found beneath the uterine serosa They can distort the external contour of the uterus causing firm, nontender asymmetry Pedunculated subserosal leiomyomas can break away from uterus and form parasitic fibroids receiving blood supply from another organ

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What are the top causes of uterine enlargement?

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1. pregnancy 2. leiomyoma 3. adenomyosis 4. leiomyosarcoma (extremely rare)

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What is the cause of leiomyoma uteri degeneration? What are the types? Presentations?

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Sometimes the leiomyoma outgrows its blood supply and can result in ischemic infarction causing degeneration hyaline, calcified, red degeneration Red degeneration is also called carneous degeneration - cause extreme, acute pain - morphine and narcotics required - this is most common during pregnancy

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What is the most common type of degeneration of uterine leiomyoma during pregnancy?

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Red degeneration

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When does uterine leiomyoma present with rapid growth?

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estrogen receptors are increased in leiomyomas resulting in rapid enlargement during times of high estrogen levels example: pregnancy

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Leiomyoma uteri: management

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Observation: - most leiomyomas can be managed conservatively and followed expectantly with regular pelvic examinations Presurgical shrinkage: - 3~6 months GnRH analog therapy; leuprolide/Lupron - adjuvant to surgical removal - reduction in size up to 60%~70% - decrease in blood loss in myomectomy - makes vaginal hysterectomy possible Myomectomy: - removal of myoma - maintains fertility - laparoscopic or laparotomy - future deliveries through cesarean section Embolization: - catheter placed into vessels supplying myoma - microspheres are injected, causing ischemia and necrosis of myoma - ~10% mortality rate (wrong vessel; uterine necrosis) Hysterectomy: - definitive therapy

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How can you shrink a uterine leiomyoma before surgery? Purpose?

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3~6 months of GnRH (gonadotropin releasing hormone) analog therapy; Lupron (leuprolide) Results in 60%~70% shrinkage in size Not used for definitive cure, due to stoppage of leuprolide can cause regrowth of leiomyoma Mostly used as an adjuvant to surgical removal of myoma; decreases blood loss in myomectomy the decrease in size can also result in vaginal hysterectomy instead of abdominal hysterectomy

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Uterine leiomyoma: diagnosis methods

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Diagnosis: Pelvic examination: enlarged, asymmetric, non-tender uterus in teh absence of pregnancy most common - 20wks gestation size = uterus reaching umbilicus (belly button) - 12wks gestation size = uterus reaching pubis symphysis Sonography: ultrasound, saline infusion sonography is helpful for identifying submucosal myomas Hysteroscopy Histology is only confirmed through surgical confirmation of excised tissue

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Adenomyosis: definition, presentation, diagnosis, Sx, examination, imaging, management

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Definition: ectopic endometrial glands and stroma are located within the myometrium of the uterine wall Presentation: - most common presentation is diffuse involvement of the myometrium - adenomyoma is termed for focal involvement, surrounded by a pseudocapsule Diagnosis: - enlarged, symmetric, tender uterus in teh absence of pregnancy - definitive diagnosis is by histologic confirmation of the surgically excised tissue Sx: - mostly asymptomatic - most common symptoms are secondary dysmenorrhea and menorrhagia Examination: - uterus is globular and up to 2~3x normal size - tenderness is most common immediately before and during menses Imaging: - ultrasound - MRI - *cystic areas found within the myometrial wall Management: - surgery is the definitive treatment - LNG-IUS (levonorgestrel intrauterine system may decrease heavy menstrual bleeding)

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Primary dysmenorrhea findings

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onset 2~3yrs after menarche menarche = 11~16.5 yrs

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What is the most common presentation of adenomyosis? Otherwise?

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Most common is diffuse involvement resulting in symmetric, soft, tender enlargement of the uterus When it becomes focalized and surrounded by a pseudocapsule, it is called adenomyoma

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What is the most common symptoms of adenomyosis?

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mostly asymptomatic most common symptomatic presentation is - menorrhagia - 2° dysmenorrhea

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When does tenderness most likely occur in patients with adenomyosis?

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most common immediately before and during menses

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What is the most likely diagnosis upon seeing cystic areas found within the myometrial wall and the uterus is symmetrically enlarged?

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Adenomyosis

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What is the management for adenomyosis?

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LNG-IUS - levonorgestrel intrauterine system - T-shaped intrauterine device that secretes progesterone into the uterine cavity - decreases heavy menstrual bleeding Surgery - hysterectomy is the definitive treatment

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Define menopause

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3 continuous months of cessation of menses and elevated gonadotropins ~52 years old

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What is the most common cause of postmenopausal bleeding?

answer

vaginal or endometrial atrophy

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BMI range

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formula = kg/m² 40: obesity class 3 (very severely obese)

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Synopsis: Postmenopausal bleeding steps of diagnosis and management

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Speculum exam: rule out vaginal lesions and cervical lesions Once ruled out... obtaining upper tract tissue: - endometrial biopsy - hysteroscopy and ultrasonography - send biopsy to pathology If finding is... atrophy: - management is estrogen with progestin polyps: - benign - hysteroscopic resection hyperplasia: - simple *without atypia: progestin treatment - complex *with atypia: total vaginal or abdominal hysterectomy carcinoma: - stage & grade - total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH-BSO) + lymph node dissection - according to staging and necessary radiation + chemotherapy

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Most common cause of endometrial carcinomas?

answer

upposed estrogen without the stabilizing effect of progesterone

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What are the major risk factors of postmenopausal bleeding?

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Obesity***: increased peripheral conversion of androgen to estrogen due to increased adipose tissue hypertension, diabetes mellitus (both points towards obesity) nulliparity: no kids means no exposure to the long period of progesterone during pregnancy; equal to possible unopposed estrogen chronic anovulation conditions (PCOS, etc.): no ovulation means no progesterone

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What are some the diagnostic tests to confirm cause of postmenopausal bleeding?

answer

Endometrial sampling: - sampling process may miss diagnosis due to localized growth in the endometrium - example: dilatation and curettage of endometrial misses a small section where neoplastic growth is occurring Hysteroscopy: - with hysteroscope, cervical or endometrial polyps can be identified as cause of postmenopausal bleeding Ultrasound: - ultrasonography can be used to measure the thickness of the lining of the endometrium (postmenopausal patients should be <5mm)

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What is the endometrial lining stripe measurement supposed to be for postmenopausal women?

answer

<5mm Ultrasound

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Endometrial cancer: staging

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Most common cause of gynecological cancer Staging is surgical Stage I: spread limited to the uterus (most common stage at diagnosis) - IA: limited to the endometrium or invasion *less than 1/2 of myometrium* - IB: invasion *more than 1/2 of myometrium* Stage II: extension to teh cervix but not outside the uterus Stage III: Spread adjacent to teh uterus - IIIA: invades serosa or adnexa or positive cytology - IIIB: invasion of vagina - IIIC: invasion of pelvic or para-aortic nodes Stage IV: Spread further from the uterus - IVA: involves bladder or rectum - IVB: distant metastasis

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What is the management of atrophy of endometrium induced postmenopausal bleeding?

answer

hormone replacement therapy estrogen + progestin

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Endometrial cancer: management

answer

Stages I~IV: TAH-BSO + lymph node resection - TAH: total abdominal hysterectomy - BSO: bilateral salpingo-oophorectomy After surgery: radiation and chemotherapy - Stage I: none - Stage II: radiation - Stage III + IV: radiation + chemotherapy

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What is the management for endometrial hyperplasia? What is the most common cause?

answer

Unopposed estrogen can cause hyperplasia of endometrium Simple hyperplasia with no atypia: progestin Complex hyperplasia, no atypia: progestin Complex hyperplasia with atypia: hysterectomy or progestin for non-surgical candidates Endometrial carcinoma: staging + TAH/BSO

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Which types of hyperplasia can be managed with progestin?

answer

simple hyperplasia with no atypia complex hyperplasia with no atypia

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How does complex hyperplasia histologically present? Complex hyperplasia with atypia?

answer

decreased stroma with increased glandular tissue atypia will show misshapen nucleus, etc.

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What are some prevention methods of postmenopausal bleeding? Reproductive age women bleeding? Dietary?

answer

postmenopausal patient: - estrogen replacement therapy with progestin reproductive age women: - most likely due to chronic anovulation (PCOS, etc.) - progestin treatment Dietary - soy: 30~40% reduction of endometrial cancer risk

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Tamoxifen association with vaginal bleeding

answer

Tamoxifen is used for breast cancer prevention by its estrogen antagonistic effects on the breast However, it has estrogen agonist effects on the uterus It can induce hyperplasia and endometrial polyps

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Embryologic origin of uterus

answer

Fusion of the 2 Mullerian ducts

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When is transvaginal transducer ultrasound used? Transabdominal transducer?

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Average age range of menarche? Thelarche?

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menarche: 10-16.5y thelarche: breast development; 8~11y

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What is the average age for Tanner II stage of breast development? Presentation?

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Tanner II: Breast development - 8-13 yrs - Breast buds begin

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ASCUS?

answer

Atypical Squamous Cells of Uncertain Significance misreadings on Pap smears due to mechanical errors (drying, etc.)

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Major structures of the uterus (3)

answer

Corpus (body) - Cornu (uterus join with fallopian tubes) Isthmus Cervix

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Describe satisfactory colposcopy vs. unsatisfactory colposcopy

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Satisfactory colposcopy 1. T-zone does NOT extend into the endocervical canal 2. No lesions visualized within T-zone Unsatisfactory is the opposite..

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Tanner stages: Pubic Hair

answer

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What are the risks of cone biopsy? (3)

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1. incompetent cervix (cutting too much) 2. cervical stenosis (can cause amenorrhea) 3. preterm birth

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Traditional Pap vs. Liquid-based Pap

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What is special about Tanner IV stage of breast development?

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Papilla and areola forms a 2' mound not contour with surrounding breast

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LEEP (loop electrosurgical excision procedure) description, procedure, followup, risks

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What type of blood supply do oviducts receive? From where?

answer

Dual blood supply* Receives blood from the uterine artery and ovarian artery

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What is the average age range for Tanner V stage of breast development?

answer

Tanner V: Breast development - 12.5~18.5 yrs - development is complete

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What does the ovarian stroma produce?

answer

androgen Important for libido after menopause

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Dilation and Curettage (D&C) procedure

answer

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What are the 4 segments of the oviducts?

answer

Proximal → Distal "INTERcourse IS AMP and FUN" 1. Interstitium 2. Isthmus 3. Ampulla 4. Infundibulum

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American Cancer Society recommendations

answer

1. initial study at age 34 if there are risk factors (breast cancer in first degree relative, BRCA genes, etc.) 2. routine screening at age 40 if there are no risk factors

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Explain the formation of the T-zone

answer

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Procedure associated with assessment of Asherman's syndrome

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HSG hysterosalpingogram

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Cryotherapy description, procedure, followup, risks

answer

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Phases of development: Folliculogenesis

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Tanner stages: Breast development

answer

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Colposcopy description

answer

"binoculars into the vagina" 1. *visually* identify where abnormal Pap smear cells originated 2. biopsy that area to send for histologic diagnosis

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Average length of a vagina

answer

8-9cm

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What is the lymphatic drainage of the ovaries?

answer

Pelvic nodes Para-aortic nodes

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What are the organ systems we need to consider involving pelvic pain/pelvic mass?

answer

GI (colons) Uterus Bladder

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What is the most common anatomical position of the uterus?

answer

Anteverted (50%) mid-position (25%) retroverted (25%)

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Endometrial biopsy

answer

examines histology of endometrial lesions hollow suction cannula is placed into uterine cavity and suction is applied; rotation of cannula before fixing with formalin

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Which portion of the cervix is most concerned for scrapings during a Pap smear?

answer

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Risks of mammography

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high radiation (0.7 mSv) same as background radiation in 3 months 1 rad = 10 mSv

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What is the specimens required for a Pap smear? What diseases are they mostly screening for?

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2 areas 1. T-zone of the ectocervix (squamous cell carcinoma; most common cancer of cervix 80%) 2. columnar epithelium of endocervical canal (adenocarcinoma; 2nd most common cancer of cervix 15%)

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Hysterosalpingogram (HSG) description and procedure

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Vulvar biopsy

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done with punch biopsy or scalpel performed under local anesthesia, histology of vulvar lesions

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Hysterectomy types

answer

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What is the term for the surgery of removing ovaries?

answer

removal of ovaries Salpingo-oophorectomy

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Cone biopsy: wide-shallow cone vs. narrow-deep cone

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The pelvic floor is made up of which diaphragms? What structures do they hold?

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question

Most common cause of uterine prolapse?

answer

childbirth

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Uterine prolapse classification

answer

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What is procidentia?

answer

Grade IV Uterine prolapse entire uterus + anterior and posterior vaginal walls extends outside the introitus

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Vaginal prolapse classification

answer

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What is the triad for rectocele diagnosis?

answer

1. postmenopausal woman 2. Posterior vaginal wall protrusion 3. Digitally assisted removal of stool "digital splitting"

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Management of pelvic relaxation: non-surgical

answer

Non-surgical: - Kegel exercises (learning to control pubococcygeus muscle; "magazine for better sex"; kegel weights) - Estrogen replacement in postmenopausal women - Pessaries (mechanical method)

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Management of pelvic relaxation: surgical

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Diagnosis of prolapse in pelvic relaxation is done how?

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Tell the patient to perform Valsalva in lithotomy position

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Average age of menopause?

answer

51-52

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Physiology: continence vs. micturition

answer

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Pharmacology: bladder receptors innervation

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Cystometry Volume Measurements

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Sensory Irritative Incontinence: etiology, history, examination, investigative studies, management

answer

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Inhibit voiding Tx: bladder relaxants/antispasmodics

answer

oxybutynin (Ditropan) flavoxate (Urispas)

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Inhibit voiding Tx: bladder relaxant/anticholinergics

answer

Pro-Banthine

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Inhibit voiding Tx: bladder relaxant/tricyclics

answer

Imipramine (Tofranil)

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Inhibit voiding Tx: vesical neck contraction/alpha adrenergics

answer

ephedrine Imipramine Estrogen stimulates alpha receptors Progesterone stimulates beta receptors

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Which receptors do estrogen stimulate? progesterone?

answer

Estrogen stimulates alpha receptors Progesterone stimulates beta receptors

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Promote voiding Tx: bladder contraction/cholinergics

answer

Bethanechol (Urecholine) Neostigmine (Prostigmin)

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Promote voiding Tx: vesicle neck relaxants/alpha antagonists

answer

methyldopa phenothiazines

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Genuine Stress Incontinence: Etiology, history, examination, investigative studies, management

answer

question

What is the most common form of true urinary incontinence?

answer

Genuine stress incontinence

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What is the only incontinence that does not result in voiding during the night?

answer

Genuine stress incontinence

question

What is the triad of stress incontinence?

answer

Involuntary loss of urine (large) with coughing and sneezing (increase abdominal pressure) No urine lost at night

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Motor Urge (Hypertonic) Incontinence: etiology, history, examination, investigative studies, management

answer

question

What is the triad for hypertonic bladder?

answer

Involuntary loss of urine cannot suppress urge to void urine loss day + night

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Hypertonic incontinence vs. Hypotonic incontinence

answer

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Overflow/Neurogenic (Hypotonic) Incontinence: etiology, history, examination, investigative studies, management

answer

question

What is the triad for hypotonic bladder?

answer

involuntary loss of urine detrusor muscle not contracted urine loss day + night

question

Types of urinary incontinence with irregular detrusor muscle contractions

answer

Hypertonic incontinence

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Types of urinary incontinence with no involuntary detrusor muscle contractions

answer

Stress incontinence Hypotonic incontinence

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Fistula incontinence: etiology, history, examination, investigative studies, management

answer

question

Triad for bypass incontinence

answer

involuntary loss of urine history: radical pelvic surgery or radiation urine loss day + night continuously* (small amounts)

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Vaginal discharge: BV, parasitic, yeast

answer

question

Most common cause of vagina discharge? 2nd? 3rd?

answer

Bacterial vaginosis (50%) Candidiasis (30%) Trichomonas (15%)...STD's

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What is the predominant bacteria in the vagina?

answer

Lactobacillus Normal flora (70%) in BV it decreases to 15%

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What is the normal pH of the vagina?

answer

pH < 4.5 estrogen dominance

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Diagnostic Test: Vaginal Discharge

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question

What is a positive "whiff" test in BV?

answer

when KOH is placed on the discharge, releasing a fishy odor KOH is for Candida albicans diagnostics; but it dissolves tissue

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How does BV most commonly present as?

answer

asymptomatic 50%

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Rx: Bacterial vaginosis

answer

Metronidazole - safe to use in all 3 trimesters of pregnancy - 250mg - t.i.d. for 7 days - no alcohol for 24-48 hrs Clindamycin - 300mg - b.i.d. for 7 days

question

Trimethylamineuria

answer

Fish odor syndrome AR a rare clinical entity where the patient has an offensive persistent odor that no amount of bathing can correct differential diagnosis with BV

question

What is associated with bubbly vaginal discharge?

answer

Trichomonas vaginalis

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Trichomoniasis: Men vs. Woman symptoms

answer

Men: 90% asymptomatic Woman: 50% asymptomatic Both needs treatment despite presentations

question

What is associated with strawberry cervix?

answer

Trichomonas vaginalis

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Rx: Vaginal Trichomoniasis

answer

Metronidazole - 24~48hrs no liquor - recommended: 2g orally in a single dose - alternative: 500mg b.i.d for 7 days - pregnancy: 2g orally in a single dose

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Rx: Vaginal Candidiasis

answer

Oral fluconazole - 150mg single dose azole cream

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Physiologic discharge: Sx, risk factors, speculum exam, management

answer

question

Most common symptom of benign/malignant vulvar lesions

answer

Vulvar itching

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Premalignant vulvar dermatosis

answer

benign lesions with malignant predisposition - most common symptom is vulvar itching, most lesions are asymptomatic Diseases: - Squamous hyperplasia - Lichen sclerosis - Squamous dysplasia - CIS

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Squamous hyperplasia : appearance, palpation, histology, management

answer

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Lichen sclerosis: appearance, palpation, histology, management

answer

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Vulvar squamous dysplasia: appearance, histology, management

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CIS: appearance, histology, management

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Malignant vulvar lesions

answer

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Squamous cell (malignant vulvar lesion)

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Melanoma (malignant vulvar lesion)

answer

second most common histologic type of vulvar cancer (5%) most important prognostic factor is the depth of invasion Any dark or black lesion in vulva should be biopsied and considered for melanoma

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Paget disease (malignant vulvar lesion)

answer

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Malignant vulvar lesions: diagnosis

answer

Biopsy

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Malignant vulvar lesions: pattern of spread

answer

starts with local growth and extension that embolizes to inguinal lymph nodes and finally, hemtogenous spread to distant sites

question

Malignant vulvar lesions: staging

answer

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Malignant vulvar lesions: management

answer

1) Wide local excision 2) Modified radical vulvectomy 3) Radical vulvectomy 4) Pelvic exenteration 5) Radiation therapy

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Management for stage IA malignant vulvar lesions

answer

Wide local excision only

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Malignant vulvar lesions management: wide local excision

answer

Stage IA only risk of metastasis is negligible No lymphadenectomy is needed

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Malignant vulvar lesions management: Modified radical vulvectomy

answer

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Malignant vulvar lesions management: radical vulvectomy

answer

involves removal of labia minora + majora, clitoris, perineum, perineal body, mons pubis seldom performed due to high morbidity sexual dysfunction may result

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Malignant vulvar lesions management: pelvic exenteration

answer

radical vulvectomy + removal of cervix, vagina, ovaries + lower colon, rectum + bladder create appropriate stomas if necessary seldom indicated or performed due to high morbidity

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Malignant vulvar lesions management: radiation therapy

answer

only used for patients who cannot undergo surgery

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Benign vulvar lesions: diseases

answer

1) Mulluscom contagiosum 2) Condylomata acuminata 3) Bartholin cyst

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Mulluscom contagiosum: at risk group, Sx, transmission, management

answer

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Condylomata acuminata: causative agent, Sx, management

answer

Benign vulvar lesions HPV 6, 11 (no malignant predisposition) Sx: - cauliflower-like vulvar lesions Management: - treat clinical lesions only

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Bartholin cyst: pathogenesis, management

answer

question

gynecologic cancer rankings 1~4 and age relevance

answer

1. endometrium (61) 2. ovaries (69) 3. cervix (45) 4. vulva (65)

question

What is the type of gynecological cancer occurs earliest in life? Oldest?

answer

Cervical cancer (45) Ovaries (69)

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Cervical polyps: description, cause, at risk group, findings, management

answer

question

What are cervical polyps associated with?

answer

Associations: - chronic inflammation - increased estrogen levels (pregnancy, etc.) - thrombosed cervical blood vessels - idiopathic

question

What do people with cervical polyps most commonly present with?

answer

vaginal bleeding, mostly after intercourse bleeding between normal menstrual cycles

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What is the management of cervical polyps?

answer

question

Which group of people are at risk for developing cervical polyps?

answer

older women multiparous women

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Nabothian cysts: description, cause, findings, management

answer

question

The cervical canal is lined by what type of cells? Function?

answer

Glandular cells / columnar epithelium secrete mucus

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What does the Nabothian cyst present as? How do you treat it?

answer

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Cervicitis: symptoms, examination, investigative findings, management

answer

question

What is the most common finding in cervicitis?

answer

mucopurulent discharge from cervix friable cervix no pelvic tenderness or febrile condition

question

How do you manage cervicitis?

answer

Oral azithromycin single dose or Oral doxycycline BID for 7 days

question

Cervical neoplasia: presentation, etiology, risk factors

answer

question

What is the most common presentation of cervical cancer? What is the most common progression? Associated age groups and types?

answer

question

What are the risk factors for developing cervical cancer?

answer

early age of intercourse cigarette smoking multiple sex partners immunosuppression

question

What are the most common HPV types for cervical cancer? Order of malignancy? Condyloma accuminata?

answer

CIN: HPV-16, 18, 31, 33, 35, 45 (16>18>45>31>33) Condyloma accuminata: HPV-6, 11

question

What is the most effective medically cancer screening test ever developed?

answer

PAP smear 70~80% decrease of death rate

question

Which HPV is most associated with squamous cell carcinoma of cervix?

answer

HPV-16

question

Which HPV is most associated with adenocarcinoma of the cervix?

answer

HPV-18

question

Rank the most common malignant HPV types that causes cancer in the cervix + association

answer

HPV-16 (squamo)....59% HPV-18 (adeno)....12% HPV-45>31>33....squamo

question

Why do we NOT start PAP smear before age of 21?

answer

question

When doing a Pap smear on pregnant women what should you use?

answer

spatula for T-zone *cotton swab for endocervical canal

question

Pap smear should be started at the following ages:

answer

question

What is the frequency of recommended Pap smear for Age groups 21-29? 30-65?

answer

question

When should Pap smears be discontinued?

answer

After age 65 - if negative cytology and/or HPV tests for past 10 years AND no history of CIN-2, 3, or cervical carcinoma Any age if total hysterectomy and no history of CIN

question

What is the system used to classify Pap smears in the U.S.?

answer

Bethesda system

question

Classification os Bethesda system

answer

question

Describe ASCH on Bethesda system

answer

atypical squamous cells can't rule out HSIL - changes suggestive of but not adequate to label HSIL

question

Describe ASCUS on Bethesda system

answer

atypical squamous cells of undetermined significance - changes suggestive of but not adequate to label LSIL

question

Describe LSIL on Bethesda system

answer

low-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings of HPV, mild dysplasia, CIN1

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Describe HSIL on Bethesda system

answer

high-grade squamous intraepithelial lesion - biopsy is expected to show histologic findings moderate-severe dysplasia, CIN2, CIN3, CIS

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Squamous cell carcinoma on Bethesda system

answer

Invasive carcinoma will enter staging instead of CIN numbers Stage 1 is after CIS - <2cm lesion (1a = 1mm deep lesion)

question

Describe AGC-NOS on Bethesda system

answer

atypical glandular cells not otherwise specified

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Describe AGC-neoplastic on Bethesda system

answer

atypical glandular cells can't rule out neoplasia

question

Describe AIS on Bethesda system

answer

adenocarcinoma in situ

question

High-grade squamous intraepithelial lesions are associated with which histologic findings?

answer

moderate-severe dysplasia CIN-2 CIN-3 CIS

question

Low-grade squamous intraepithelial lesions are associated with which histologic findings?

answer

mild dysplasia HPV CIN 1

question

How often does ASCUS show up on Pap smears? How do you decrease ASCUS diagnosis? What is the management of ASCUS?

answer

question

If you find ASCUS on Pap smear, what are the tests you could run? (3)

answer

question

What if you find cells other than ASCUS on a Pap smear, what tests should you run?

answer

Colposcopy and biopsy

question

If you find cells others than ASCUS (ASC-H, LSIL, etc.) on a Pap smear, what is your plan of management?

answer

question

What are the risk of cone biopsy?

answer

incompetent cervix cervical stenosis

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see metaplastic epithelium entering the endocervical canal, what will you do next?

answer

ECC endocervical canal curettage

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see ectocervical lesions, what will you do next?

answer

Ectocervical biopsy

question

When Pap smear shows worse dysplasia than ASCUS, you use colposcopy examination and you see lesions entering the endocervical canal, what will you do next?

answer

Narrow cone biopsy

question

What are follow-up options for CIN1?

answer

Observation (repeat Pap, colposcopy and Pap, HPV-DNA) Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife)

question

What are follow-up options for CIN2?

answer

Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife cone) Hysterectomy (recurrent CIN2 only)

question

What are follow-up options for CIN3?

answer

Ablative therapy (cryotherapy, laser, electrofulguration) Excisional procedure (LEEP, cold-knife cone) Hysterectomy (recurrent CIN3 only)

question

When is hysterectomy indicated in CIN?

answer

recurrent CIN2, 3

question

CIN follow-up management: Observation

answer

Indicated for CIN1 Repeat Pap in 6~12 months Colposcopy and repeat Pap in 12 months HPV-DNA testing in 12 months

question

CIN follow-up management: Ablative therapy

answer

Indicated for CIN1, 2, 3 Cryotherapy Laser vaporization Electrofulguration Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

CIN follow-up management: Excision/Resection

answer

Indicated for CIN1, 2, 3 LEEP cold-knife conization Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

CIN follow-up management: hysterectomy

answer

CIN2, 3 only indicated in recurrent infections

question

What follow-up procedures are required for ablative therapy and excisional procedure patients for CIN?

answer

Follow-up: repeat Pap smears, colposcopy and Pap smear, or HPV-DNA testing every 4~6 months for 2 years

question

If cytologic findings of Pap smear reveals HSIL, what is the next step for patients ages 25-64?

answer

colposcopy + biopsy immediate LEEP**

question

Invasive Cervical Cancer definition

answer

cervical neoplasia that has penetrated through the basement membrane >CIS

question

Cervical cancer: definition, presentation, epidemiology, diagnostic findings

answer

question

What is the only gynecological carcinoma that uses clinical staging?

answer

Cervical cancer

question

Common presentation of cervical carcinoma?

answer

normal menstrual cycle postcoital vaginal bleeding irregular vaginal bleeding

question

Cervical cancer: staging

answer

question

What is the most common stage of cervical cancer?

answer

Stage 1 limited to the cervix

question

What is the staging for minimally invasive cervical cancer? Management? Management in pregnancy?

answer

Ia1 </= 3mm deep total simple hysterectomy during pregnancy: cone biopsy during pregnancy follow conservatively, deliver vaginally reevaluated and treated 2 months postpartum

question

What is the staging for microinvasive cervical cancer? Management? Management in pregnancy?

answer

Ia2 <3mm but </=5mm deep modified radical hysterectomy during pregnancy: cone biopsy during pregnancy follow conservatively, deliver vaginally reevaluated and treated 2 months postpartum

question

What is the staging for frank invasion cervical cancer? Management? Management in pregnancy?

answer

question

What ist he staging for cervical cancer that has spread adjacent to the cervix? Management? Management in pregnancy?

answer

question

Cervical cancer: staging management

answer

Stage Ia1: - 3mm but 5mm frank invasion - IIa: involves upper 2/3 of vagina - radical hysterectomy with/without radiation Stage IIb, III, IV: - radiation therapy and chemotherapy for all ages

question

Cervical cancer: follow-up

answer

question

What is the most active chemotherapeutic agent for cervical cancer?

answer

Cisplatinum

question

What is the effect of pregnancy in cervical neoplasia

answer

pregnancy does NOT predispose abnormal cytology and does not accelerate precancerous lesions progression

question

Diagnostic tests and findings for pregnant patients in cervical cancer

answer

Pregnant with abnormal Pap smear should be evaluated in the SAME FASHION - owing to increased cervical vascularity ECC is not performed during pregnancy (endocervical canal curettage)

question

What is the plan of management in pregnant patients with cervical cancer in CIN stages?

answer

question

What is the plan of management for microinvasion cervical cancer in pregnant patients?

answer

evaluated with cone biopsy to ensure no rank invasion patients can be followed conservatively delivery can be vaginal reevaluation and treatment 2 months postpartum

question

What is the plan of management for frank invasion carcinoma in pregnant patients?

answer

Based on gestational age before 24 weeks - definitive treatment based on staging after 24 weeks - conservative management to about 32-33 weeks - C-section - definitive treatment after delivery

question

Gardasil: recommendation, coverage, regimen

answer

question

What is the target group for Gardasil? Why?

answer

11~12 age group Efficacy best before host immune system is exposed to HPV strains

question

What strains of HPV does Gardasil cover?

answer

HPV 6, 11, 16, 18

question

When is the Gardasil vaccine contraindicated?

answer

Pregnant women Lactating women Immunosuppressed women Not clinically proven to be true

question

How many types of uterine anomalies are there? How are they divided?

answer

7 types by the American Fertility Society (1988) Divided by - failure to form - failure to fuse - failure to dissolve the septum

question

Hypoplasia/Agenesis of Uterus: description, cause, association

answer

question

Unicornuate uterus: defect, description, complications, symptoms

answer

question

Didelphys uterus: defect, description, risks

answer

question

Bicornuate uterus: defects, description, types, risks

answer

question

What is the most common congenital uterine anomaly?

answer

Bicornuate uterus 45%

question

Septate uterus: defect, description, types, risks

answer

question

Septate uterus vs. Bicornuate uterus

answer

question

Arcuate uterus: defect, description, risks

answer

question

DES uterus: defect, description, cause, risks

answer

question

What teratogen is associated with predisposition of clear cell carcinoma of the vagina?

answer

DES (diethylstilbestrol) DES uterus + clear cell carcinoma of vagina idiopathic

question

Leiomyoma Uteri: description, at risk group, different locations

answer

question

Leiomyoma uteri: natural history

answer

question

How does most leiomyomas present clinically?

answer

Slow growth small, grow slowly, and asymptomatic

question

What is the most common form of leiomyoma of uterus?

answer

Intramural leiomyoma found within the uterine wall

question

What is the most common presentation of a submucosal leiomyoma of the uterus?

answer

vaginal bleeding metrorrhagia = irregular bleeding between menses menorrhagia = heavy menses

question

Which type of uterine leiomyoma can become parasitic fibroids?

answer

Pedunculated subserosal uterine leiomyoma Break away from uterus and receive blood supply from another organ in the abdomen

question

Where is the intramural leiomyoma of the uterus found? How does it present?

answer

question

Where is the submucosal leiomyoma of the uterus found? How does it present?

answer

question

Where is the subserosal leiomyoma of the uterus found? How does it present?

answer

question

What are the top causes of uterine enlargement?

answer

1. pregnancy 2. leiomyoma 3. adenomyosis 4. leiomyosarcoma (extremely rare)

question

What is the cause of leiomyoma uteri degeneration? What are the types? Presentations?

answer

question

What is the most common type of degeneration of uterine leiomyoma during pregnancy?

answer

Red degeneration

question

When does uterine leiomyoma present with rapid growth?

answer

estrogen receptors are increased in leiomyomas resulting in rapid enlargement during times of high estrogen levels example: pregnancy

question

Leiomyoma uteri: management

answer

question

How can you shrink a uterine leiomyoma before surgery? Purpose?

answer

question

Uterine leiomyoma: diagnosis methods

answer

question

Adenomyosis: definition, presentation, diagnosis, Sx, examination, imaging, management

answer

question

Primary dysmenorrhea findings

answer

onset 2~3yrs after menarche menarche = 11~16.5 yrs

question

What is the most common presentation of adenomyosis? Otherwise?

answer

Most common is diffuse involvement resulting in symmetric, soft, tender enlargement of the uterus When it becomes focalized and surrounded by a pseudocapsule, it is called adenomyoma

question

What is the most common symptoms of adenomyosis?

answer

mostly asymptomatic most common symptomatic presentation is - menorrhagia - 2° dysmenorrhea

question

When does tenderness most likely occur in patients with adenomyosis?

answer

most common immediately before and during menses

question

What is the most likely diagnosis upon seeing cystic areas found within the myometrial wall and the uterus is symmetrically enlarged?

answer

Adenomyosis

question

What is the management for adenomyosis?

answer

question

Define menopause

answer

3 continuous months of cessation of menses and elevated gonadotropins ~52 years old

question

What is the most common cause of postmenopausal bleeding?

answer

vaginal or endometrial atrophy

question

BMI range

answer

formula = kg/m² 40: obesity class 3 (very severely obese)

question

Synopsis: Postmenopausal bleeding steps of diagnosis and management

answer

question

Most common cause of endometrial carcinomas?

answer

upposed estrogen without the stabilizing effect of progesterone

question

What are the major risk factors of postmenopausal bleeding?

answer

question

What are some the diagnostic tests to confirm cause of postmenopausal bleeding?

answer

question

What is the endometrial lining stripe measurement supposed to be for postmenopausal women?

answer

<5mm Ultrasound

question

Endometrial cancer: staging

answer

question

What is the management of atrophy of endometrium induced postmenopausal bleeding?

answer

hormone replacement therapy estrogen + progestin

question

Endometrial cancer: management

answer

question

What is the management for endometrial hyperplasia? What is the most common cause?

answer

question

Which types of hyperplasia can be managed with progestin?

answer

simple hyperplasia with no atypia complex hyperplasia with no atypia

question

How does complex hyperplasia histologically present? Complex hyperplasia with atypia?

answer

decreased stroma with increased glandular tissue atypia will show misshapen nucleus, etc.

question

What are some prevention methods of postmenopausal bleeding? Reproductive age women bleeding? Dietary?

answer

question

Tamoxifen association with vaginal bleeding

answer

STUDY

Anatomy Developmental Biology Surgical Technology

USMLE First Aid Organ Systems GI – Flashcards 70 terms

Suzette Hendon

70 terms

Preview

USMLE First Aid Organ Systems GI – Flashcards

question

Primitive GI begins to form around which week in embryological development?

answer

4th week

question

In the 4th week, the endoderm gives rise to

answer

intestinal epithelium and glands

question

In the 4th week, mesoderm gives rise to

answer

connective tissue, muscle, and wall of intestine

question

5th Week of Embryological Development

answer

intestine elongates and midgut loop herniates through umbilicus.

question

Names of limbs of midgut loop and what each limb gives rise to

answer

cranial limb becomes distal duodenum and proximal ileum caudal limb becomes distal ileum to proximal 2/3rds of transverse colon

question

What is a key event in the 10th week of development?

answer

midgut loop returns to abdominal cavity in its final fixed position after rotating a total of 270 degrees counterclockwise around axis of the superior mesenteric artery

question

Omphalocele

answer

Failure of bowel to return to the abdomen following herniation of abdominal contents into base of umbilical cord during 5th week of embryonic life. Herniated intestine is covered by peritoneal membrane. Most commonly affects children of mothers of extremes of reproductive age.

question

Presentation of Omphalocele

answer

2nd trimester ultrasound (95% of cases) or herniated sac found at birth

question

Associated anomalies of Omphalocele

answer

Beckwith-Wiedemann syndrome: Gigantis, macroglossia, umbilical defect, and hypoclycemia Pentalogy of Cantrell: Omphalocele, diaphragmatic hernia, cleft sternum, absent pericardium, and intracardiac defects

question

Diagnosis of Omphalocele

answer

alpha-Fetoprotein (AFP) serum values are elevated in 70% of cases

question

Gastroschisis

answer

Full-thickness abdominal wall defect caused by vascular injury during development allowing small or large bowel to escape abdominal cavity. No protective peritoneal membrane covers herniated intestine. Most common in children born to women younger than 20.

question

Presentation of Gastroschisis

answer

Similar to omphalocele. Extruded abdominal contents are usually right of the abdominal midline

question

Treatment of Gastroschisis

answer

Artificial covering may be used to minimize heatfluid loss and assist with temperature regulation (exposed bowel causes increased heat loss)

question

Ladd's Bands

answer

Aberrant peritoneal attachments that causes partial or complete obstruction of the duodenum due to malrotation during development

question

Midgut Volvulus

answer

Malrotated intestine twists on axis of SMA, compromising intestinal blood flow

question

Presentation of Midgut Volvulus

answer

May occur at any time during 1st year of life and presents with sudden onset of severe bilious emesis, abdominal pain and distention, and rectal bleeding

question

Bilious Emesis

answer

presumed to be midgut volvulus until proven otherwise

question

Treatment of Malrotation

answer

Ladd's procedure

question

Duodenal Atresia

answer

In weeks 6 and 7 of development, duodenum becomes completely obstructed by proliferating endoderm. Failure of duodenum to recanalize by week 10 results in duodenal atresia.

question

Presentation of Duodenal Atresia

answer

Newborn may be small for gestational age. Vomiting (often bilious) and abdominal distention within 48 hours after birth.

question

Pyloric Stenosis

answer

Idiopathic congenital elongation and thickening of pylorus, resulting in obstruction of gastric outlet.

question

Presentation of Pyloric Stenosis

answer

Nonbiliious projectile vomiting at 3-6 weeks but notable absence of other signs of illness (fever, diarrhea)

question

Diagnosis of Pyloric Stenosis

answer

Palpable mass size of an olive in epigastric region

question

Margins of Abdomen

answer

Diaphragm superiorly, inlet of pelvis inferiorly

question

Surface Landmarks of Abdominal Wall

answer

question

Linea Alba

answer

Vertical fibrous band that extends from symphysis pubis to xiphoid process and lies in midline. Formed by fusion of aponeuroses of muscles of anterior abdominal wall that is represented by a median groove.

question

Linea Seminlunaris

answer

Lateral edge of rectus abdominis muscle and crosses costal margin at tip of 9th costal cartilage

question

Inguinal Groove

answer

Formed by rolled-under margin of aponeurosis of external oblique muscle

question

Transpyloric Plane

answer

Cuts through pylorus horizontally and passes through tips of 9th costal cartilages on each side. Lies at L1.

question

What does the transpyloric plane identify?

answer

Pylorus of stomach, duodenojejunal junction, neck of pancreas, and hila of kidneys

question

Subcostal Plane

answer

Horizontal plane joining lowest point of costal margin on each side. Lies at level L3.

question

Intertubercular Plane

answer

Horizontal plane joining tubercles on iliac crests. Lies at level L5.

question

McBurney's Point

answer

RLQ at 2/3rds distance from umbilicus to anterior superior iliac spine. Pain in this location indicates appendicitis.

question

Abdominal Regions and Contents

answer

question

Right Hypochondriac Region

answer

Liver and gallbladder (Kidney) and suprarenal gland Colon, hepatic flexure

question

Epigastric Region

answer

Liver (Transverse colon) Abdominal aorta and vena cava Pylorus and duodenum (first part)

question

Left Hypochondriac Region

answer

Stomach Spleen (Kidney) and suprarenal gland Colon, splenic flexure

question

Right Lumbar Region

answer

Kidney Colon, ascending Small intestine Duodenum (first part)

question

Umbilical Region

answer

(Transverse colon) Duodenum and pancreas Abdominal aorta and vena cava Small intestine Iliac vessels

question

Left Lumbar Region

answer

Kidney Colon, descending Pancreas Small intestine (jejunum)

question

Right Iliac region

answer

Cecum Appendix Small intestine (ileum)

question

Hypocastric Region

answer

Distensible organs of pelvis (bladder/uterus) Small intestine Iliac vessels Spermatic cords

question

Left Iliac Region

answer

Sigmoid colon Small intestine

question

Layers of Anterolateral Abdominal Wall

answer

Skin Superficial fascia (fatty Camper's and membraneous Scarpa's) Deep fascia Aponeurosis External oblique muscle - lateral wall Internal oblique muscle - lateral wall Transversus abdominis muscle - lateral wall Transversalis fascia Extraperitoneal fat Parietal peritoneum

question

Abdominal Quadrants and Contents

answer

question

Inguinal Canal

answer

Site of inguinal hernias

question

Boundaries of inguinal canal

answer

Deep inguinal ring Superficial inguinal ring Anterior wall Posterior wall Roof Floor

question

Patent communication between abdominal cavity and scrotal sac

answer

Failure of processus vaginalis to obliterate

question

Boundaries of Femoral Triangle

answer

Superiorly: Inguinal ligament Laterally: Sartorius muscle Medially: Adductor longus muscle

question

Femoral Canal

answer

question

Third Spacing

answer

Non-intravascular space where fluid and edema can accumulate

question

Common causes of ascites

answer

Liver failure, right heart failure, ovarian cancer

question

Pneumoperitoneum

answer

air or other gas in peritoneal cavity (intestinal/stomach perforation, or intentional insufflation for laparoscopy)

question

Parietal Peritoneum

answer

Outer membranes that lines deep surface of abdominal walls and inferior surface of diaphragm

question

Nerve Supply of Parietal Peritoneum

answer

Nerves of surrounding abdominal muscles and skin Intercostal and phrenic nerves in abdominal region Obturator nerve in pelvic region

question

Visceral Peritoneum

answer

Membrane that directly covers abdominal organs. No somatic nerve supply.

question

Intraperitoneal Viscera

answer

Stomach First part of duodenum Jejunum, ileum, cecum, and appendix Transverse and sigmoid colon Proximal rectum Liver and gallbladder Tail of pancreas Spleen

question

Extraperitoneal Viscera

answer

Parts 2, 3, and 4 of duodenum Ascending and descending colon Distal rectum Head, neck, and body of pancreas Abdominal aorta Inferior vena cava Kidneys, ureters, and adrenal glands

question

Lesser Sac (Omental Bursa) of Peritoneal Cavity

answer

Posterior to stomach, liver, and lesser omentum

question

Epiploic Foramen (Winslow's Foramen)

answer

Enables communication between greater and lesser sac of peritoneal cavity

question

Greater Sac

answer

Subdivided by transverse mesocolon into supracolic compartment and infracolic/pelvic compartments below mesocolon

question

Supracolic Compartment

answer

Divided by falciform ligament

question

Subphrenic Recess

answer

Area to right of falciform ligament between liver and kidney

question

Mesentary

answer

Double layer of peritoneum that wraps around abdominal organs, includes blood vessels, and attaches organ to its major blood supply

question

Gradual occlusion of abdominal aorta can result in

answer

Claudication and impotence

question

3 Main Branches of Celiac Trunk

answer

Supply structures derived from foregut: Left gastric Splenic Common hepatic

question

Abdominal Aorta and Its Branches

answer

question

Celiac Trunk

answer

question

Superior Mesenteric Artery

answer

Supplies derivatives of midgut

question

Inferior Mesenteric Artery

answer

Supplies hindgut derivatives, distal 3rd of transverse colon, descending colon, sigmoid colon, superior portion of rectum

STUDY

Anatomy Developmental Biology

Neuraxial Anesthesia – Flashcards 174 terms

Candace Young

174 terms

Preview

Neuraxial Anesthesia – Flashcards

question

Spinal cord ends in _____ adult and ______ child

answer

L1; L3

question

The principal site of action for neuraxial blockade is believed to be the ______ _______

answer

nerve root

question

Differential blockade

answer

typically results in sympathetic blockade (judged by temperature sensitivity) that may be two segments or more cephalad than the sensory block (pain, light touch), which, in turn, is usually several segments more cephalad than the motor blockade; the concentration of local anesthetic decreases with increasing distance from the level of injection

question

sympathetic blockade

answer

Interruption of efferent autonomic transmission at the spinal nerve roots; typically judged by temperature sensitivity (alcohol prep pad)

question

Neuraxial blocks CV side effects

answer

decreased BP caused by vasodilation and venous pooling of blood in the viscera and lower extremities (decreased venous return and effective circulating volume) decreased heart rate caused by sympathetic blockage and unopposed vagal tone

question

Volume loading with 10-20ml/kg has been shown to _________

answer

repeatedly FAIL to prevent hypotension

question

Treatment of symptomatic bradycardia and hypotension

answer

atropine and vasopressors (ephedrine, phenylephrine, epinephrine)

question

loss of resistance

answer

encountered as the needle passes through the ligamentum flavum and enters the epidural space making it easier to push in saline or air

question

What levels can an epidural block can be performed at?

answer

1. cervical 2. thoracic 3. lumbar

question

Spinal anesthesia process

answer

the needle is advanced through the epidural space and penetrates the dura -subarachnoid membranes, as signaled by freely flowing cerebrospinal fluid

question

Epidural techniques are widely used in

answer

1. surgical anesthesia 2. obstetric analgesia 3. postoperative pain control 4. chronic pain management

question

Epidural anesthesia onset

answer

10-20min

question

The ___________ of local anesthetic needed for epidural anesthesia is________ than that needed for spinal anesthesia. _____________ is likely if a "full epidural dose" is injected intrathecally or intravascularly.

answer

quantity (volume and concentration); larger; toxicity

question

Some studies suggest that postoperative morbidity and possibly mortality may be _______ when neuraxial blockade is used either alone or in combination with general anesthesia.

answer

reduced

question

Neuraxial blocks may reduce

answer

1. venous thrombosis and pulmonary embolism 2. cardiac complications in high-risk patients 3. bleeding and transfusion requirements 4. vascular graft occlusion 5. pneumonia and respiratory depression following upper abdominal or thoracic surgery in patients with chronic lung disease 6. time until extubation and the need for mechanical ventilation

question

Neuraxial blocks may allow ______ return of gastrointestinal function following surgery.

answer

earlier

question

(T/F) Large population studies in Great Britain and the United States have shown that regional anesthesia for cesarean section is associated with reduced maternal morbidity and mortality than is general anesthesia.

answer

TRUE

question

spine

answer

provides structural support for the body and protection for the spinal cord and nerves and allows a degree of mobility in several spatial planes

question

Midline approach insertion of needle pathway

answer

1. skin 2. supraspinous ligament 3. interspinous ligament 4. ligamentum flavum 5. EPIDURAL space 6. dura mater 7. subDURAL space 8. arachnoid mater 9. subarachnoid space (SPINAL)

question

Atlas

answer

The first cervical vertebra lacks a body and has unique articulations with the base of the skull and the second vertebra; allows vertical head movement

question

Axis

answer

The second vertebra consequently has atypical articulating surfaces; allows horizontal head movement

question

sacral hiatus

answer

the laminae of S5 and all or part of S4 normally do not fuse, leaving a caudal opening to the spinal canal; is felt as a depression just above or between the gluteal clefts and above the coccyx, defining the point of entry for caudal blocks

question

Spinal segments that are CONVEX anteriorly

answer

cervical and lumbar

question

Spinal segments that are CONCAVE anteriorly

answer

thoracic and sacral

question

Spinal segments that are CONVEX posteriorly

answer

thoracic and sacral

question

Spinal segments that are CONCAVE posteriorly

answer

cervical and lumbar

question

Ventrally, the vertebral bodies and intervertebral disks are connected and supported by __________

answer

the anterior and posterior longitudinal ligaments

question

Dorsally, _________________________ provide additional stability

answer

the ligamentum flavum, interspinous ligament, and supraspinous ligament

question

meninges

answer

composed of three layers: the pia mater, the arachnoid mater, and the dura mater; all are contiguous with their cranial counterparts

question

subarachnoid space

answer

where cerebrospinal fluid (CSF) is contained between the pia and arachnoid maters

question

subdural space

answer

poorly demarcated, potential space that exists between the dura and arachnoid membranes.

question

epidural space

answer

defined potential space within the spinal canal that is bounded by the dura and the ligamentum flavum

question

cauda equina (horse's tail)

answer

lower nerve roots course some distance before exiting the intervertebral foramina; these nerve roots float in the dural sac below L1 and tend to be pushed away (rather than pierced) by an advancing needle

question

dural sac

answer

S2 adults and S3 children

question

conus medullaris

answer

end of the spinal cord

question

filum terminale

answer

extension of the pia mater that attaches the spinal cord to the coccyx

question

spinal cord blood supply

answer

ONE anterior spinal artery TWO posterior spinal arteries

question

anterior spinal artery

answer

is formed from the vertebral artery at the base of the skull and courses down along the anterior surface of the cord providing 2/3 of the blood supply

question

posterior spinal arteries

answer

arise from the posterior inferior cerebellar arteries and course down along the dorsal surface of the cord medial to the dorsal nerve roots and providing 1/3 of the blood supply

question

the artery of Adamkiewicz (arteria radicularis magna)

answer

arising from the aorta, typically unilateral and nearly always arises on the left side, providing the major blood supply to the anterior, lower two-thirds of the spinal cord; injury to this artery can result in the anterior spinal artery syndrome

question

Blockade of neural transmission (conduction) in the _______________ interrupts somatic and visceral sensation.

answer

posterior nerve root fibers

question

Blockade of neural transmission (conduction) in the _______________ prevents efferent motor and autonomic outflow.

answer

anterior nerve root fibers

question

sensory blockade

answer

two or more segments below sympathetic blockade; typically measured by pain and light touch (pin-prick or sharp point distinction)

question

Vagus nerve (CN X)

answer

not blocked by neuraxial anesthesia; physiological responses of neuraxial blockade therefore result from decreased sympathetic tone and/ or unopposed parasympathetic tone; carries visceral afferent fibers

question

Vasomotor tone is primarily determined by sympathetic fibers arising from _____ , innervating arterial and venous smooth muscle.

answer

T5- L1

question

The sympathetic cardiac accelerator fibers arise at ________

answer

T1-T4

question

Treatment of hypotension during neuraxial anesthesia

answer

1. left uterine displacement in the 3rd trimester 2. auto transfusion with the head-down position 3. IVF bolus 5-10 mL/kg (only patient's that can "handle" extra fluid)

question

phenylephrine

answer

direct α-adrenergic agonists primarily produce arteriolar constriction and may reflexively increase bradycardia, increasing systemic vascular resistance

question

ephedrine

answer

direct and indirect β-adrenergic effects that increase heart rate and contractility and indirect effects that also produce vasoconstriction

question

Pulmonary considerations for neuraxial anesthesia

answer

severe chronic lung disease may rely upon accessory muscles of respiration (intercostal and abdominal muscles) to actively inspire or exhale; therefore decreasing effective coughing and clearing of secretions

question

Some evidence suggests that postoperative thoracic epidural analgesia in high-risk patients can improve pulmonary outcome by

answer

1. decreasing the incidence of pneumonia and respiratory failure 2. improving oxygenation 3. decreasing the duration of mechanical ventilatory support

question

GI/GU considerations for neuraxial anesthesia

answer

1. increased peristalsis due to sympathetic blockade, vagal tone dominance 2. loss of autonomic bladder control leading to increased risk for urinary retention

question

Endocrine considerations for neuraxial anesthesia

answer

can partially suppress or block stress response to surgery which leads to increased concentrations of adrenocorticotropic hormone, cortisol, epinephrine, norepinephrine, and vasopressin levels, as well as activation of the RASS

question

ABSOLUTE contraindications for neuraxial anesthesia

answer

1. patient refusal 2. bleeding diathesis 3. severe hypovolemia 4. elevated ICP 5. infection at site of injection 6. severe aortic or mitral stenosis

question

RELATIVE contraindications for neuraxial anesthesia

answer

1. sepsis 2. preexisting neurological deficits 3. uncooperative patient (dementia, psychosis, emotional) 4. demyelinating lesions 5. stenotic valvular heart lesions 6. LV outflow obstruction (hypertrophic obstructive cardiomyopathy) 7. severe spinal deformity

question

CONTROVERSIAL contraindications for neuraxial anesthesia

answer

1. prior back surgery at site of injection 2. complicated surgery 3. prolonged operation 4. major blood loss 5. maneuvers that compromise respiration

question

Incidence of epidural hematoma

answer

1:150,000

question

(T/F) Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) drugs do not increase the risk of spinal hematoma from neuraxial anesthesia procedures or epidural catheter removal.

answer

TRUE

question

(T/F) "Minidose" subcutaneous heparin prophylaxis is a contraindication to neuraxial anesthesia or epidural catheter removal.

answer

FALSE

question

Removal of an epidural catheter should occur ____ prior to, or _____ following, subsequent heparin dosing.

answer

1 hour; 4 hours

question

(T/F) Neuraxial anesthesia should be avoided in patients on therapeutic doses of heparin and with increased partial thromboplastin time.

answer

TRUE

question

If postoperative LMWH thromboprophylaxis will be utilized, epidural catheters should be removed _______ prior to the first LMWH dose. If already present, the catheter should be removed at least _____ after a dose of LMWH, and subsequent dosing should not occur for another 2 hr.

answer

2 hours; 10 hours

question

The major arguments for having the patient asleep are that

answer

1. most patients, if given a choice, would prefer to be asleep 2. the possibility of sudden patient movement causing injury is markedly diminished.

question

The major argument for neuraxial blockade while the patient is still awake

answer

patient can alert the clinician to paresthesias and pain on injection

question

(T/F) There is greater consensus that thoracic and cervical punctures should, except under unusual circumstances, only be performed in asleep patients because of the risk of sudden movement

answer

FALSE

question

Minimum requirement monitoring for labor analgesia

answer

1. BP 2. pulse ox

question

(T/F) Epidural steroid injections for management of pain (when little or no local anesthetic is injected) do not require continuous monitoring.

answer

TRUE

question

The spinous processes of the cervical and lumbar spine are nearly__________ , whereas those in the thoracic spine are almost ________ and can overlap significantly.

answer

horizontal; vertical

question

In the cervical area, the first palpable spinous process is _______

answer

question

The most prominent spinous process is on vertebrae _____

answer

question

With the arms at the side, the spinous process of ____ is usually at the same level as the inferior angle of the scapulae.

answer

question

A line drawn between the highest points of both iliac crests (Tuffier's line) usually crosses the body of ______

answer

question

A line connecting the posterior superior iliac spine crosses the _____ posterior foramina.

answer

question

_______ of the spine (arching the back "like a mad cat" maximizes the "target" area between adjacent spinous processes and brings the spine closer to the skin surface

answer

flexion

question

Positions for neuraxial anesthesia

answer

1. sitting 2. lateral decubitis 3. Buie's position (jack-knife)

question

paramedian approach

answer

used for patients who cannot be positioned easily (eg, severe arthritis, kyphoscoliosis, or prior spine surgery); typically used for thoracic epidural puncture;

question

Paramedian approach insertion of needle pathway

answer

1. skin 2. paraspinous muscles 3. ligamentum flavum 4. EPIDURAL space 5. dura mater 6. subDURAL space 7. arachnoid mater 8. subarachnoid space (SPINAL)

question

Quinke needle

answer

is a cutting needle with end injection; higher risk for PDPH

question

Whitacre

answer

blunt tip / round tip (pencil-point) needles; decreased risk for PDPH

question

Sprotte

answer

is a side-injection needle with a long opening; more vigorous flow of CSF, however increased incidence of a failed block if the distal part of the opening is subarachnoid (with free flow CSF), the proximal part is not past the dura, and the full dose of medication is not delivered.

question

MAJOR factors influencing level of spinal block

answer

1. baricity of the local anesthetic solute 2. position of the patient during and immediately after injection 3. drug dosage 4. site of injection

question

CSF has a specific gravity of

answer

1.003- 1.008 at 37 ° C.

question

hyperbaric solution

answer

denser and heavier compared to CSF; tends to accumulate caudally; added glucose in solution

question

hypobaric solution

answer

less dense and lighter compared to CSF; tends to accumulate cephalic; added sterile water or fentanyl in solution

question

isobaric solution

answer

equal density as CSF; tends to stay near site of injection; mixed with CSF (1:1)

question

Other factors influencing level of spinal block

answer

1. patient height 2. vertebral column anatomy 3. direction of needle bevel or injection port 4. age 5. CSF 6. drug volume 7. intra-abdominal pressure 8. pregnancy

question

the apex of the thoracolumbar curvature is _____

answer

question

Hyperbaric solutions tend to move to the most dependent area of the spine normally _______ in the supine position

answer

T4-T8

question

Taylor approach

answer

a variant of the standard paramedian approach, the needle enters 1 cm medial and 1 cm inferior to the posterior superior iliac spine and is directed cephalad and toward the midline.

question

The lowest point is usually ______, where a hyperbaric solution tends to settle once the patient is placed supine.

answer

question

Lumbar CSF volume ________ correlates with the dermatomal spread of spinal anesthesia.

answer

inversely

question

Conditions associated with greater dermatomal spread for a given volume of injectate due to decreased volume of CSF

answer

1. increased abdominal pressure 2. engorgement of epidural veins 3. pregnancy 4. ascites 5. large ABD tumors

question

Spinal anesthetic agents

answer

ONLY preservative free

question

Addition of vasoconstrictors to spinal anesthetic agents

answer

α-adrenergic agonists, epinephrine (0.1- 0.2 mg enhance the quality and/ or prolong the duration of spinal anesthesia; seem to delay the uptake of local anesthetics from CSF and may have weak spinal analgesic properties

question

Addition of opioids to spinal anesthetic agents

answer

improve both the quality and duration of the subarachnoid block.

question

The most commonly used agents for spinal anesthesia.

answer

Hyperbaric bupivacaine and tetracaine

question

Hyperbaric bupivacaine and tetracaine for spinal anesthesia

answer

Both have a slow onset 5-10 min and a prolonged duration 90-120 min

question

Lidocaine and procaine for spinal anesthesia

answer

Both have a relatively rapid onset 3- 5 min and short duration of action 60- 90 min

question

(T/F) Repeat lidocaine doses following an initial "failed" block should be avoided.

answer

TRUE

question

"saddle block"

answer

can be achieved by keeping the patient sitting for 3- 5 min following injection, so that only the lower lumbar nerves and sacral nerves are blocked.

question

Lidocaine

answer

used for spinal anesthesia worldwide, but some experts no longer use this agent because of the phenomenon of transient neurological symptoms and cauda equina syndrome (CES)

question

septa or connective tissue bands

answer

explain the phenomenon of a one-sided epidural block

question

segmental block

answer

is characterized by a well-defined band of anesthesia at certain nerve roots; leaving nerve roots above and below unblocked.

question

epidural anesthesia

answer

using relatively dilute concentrations of a local anesthetic combined with an opioid; provides analgesia without motor block; most often performed in the lumbar region

question

cervical block

answer

are usually performed with the patient sitting, with the neck flexed, using the midline approach. Clinically, they are used primarily for the management of pain.

question

Tuohy needle

answer

most commonly used; the blunt, curved tip theoretically helps to push away the dura after passing through the ligamentum flavum instead of penetrating it.

question

standard epidural needle

answer

is typically 17- 18 gauge, 3 or 3.5 inches long , and has a blunt bevel with a gentle curve of 15- 30 ° at the tip.

question

Crawford needle

answer

Straight needles without a curved tip may have a greater incidence of dural puncture, but facilitate passage of an epidural catheter.

question

Weiss winged needle

answer

modifications include winged tips and introducer devices set into the hub designed for guiding catheter placement.

question

When using a curved tipped needle, the bevel opening is directed either cephalad or caudad, and the catheter is advanced ________ into the epidural space.

answer

2- 6 cm

question

hanging drop technique

answer

requires that the hub of the needle be filled with solution so that a drop hangs from its outside opening. The needle is then slowly advanced deeper. As long as the tip of the needle remains within the ligamentous structures, the drop remains until negative pressure pulls in the drop when the epidural space is entered

question

test dose

answer

designed to detect both subarachnoid and intravascular injection; combines local anesthetic and epinephrine, typically 3 mL of 1.5% lidocaine with 1: 200,000 epinephrine (0.005 mg/ mL). The 45 mg of lidocaine, if injected intrathecally, will produce spinal anesthesia that should be rapidly apparent with an increase ~20 % in HR from baseline (if injected intravascularly)

question

Test dose FALSE positive

answer

usually from a uterine contraction causing pain or an increase in heart rate coincident to test dosing

question

Test dose FALSE negative

answer

bradycardia and exaggerated hypertension in response to epinephrine in patients taking β-blockers

question

(T/F) Incremental dosing is a very effective method of avoiding serious complications.

answer

TRUE

question

Techniques to prevent accidental intrathecal injections

answer

1. initial test dose 2. aspirating prior to each injection 3. always uses incremental dosing

question

Rescue lipid emulsion (20% Intralipid 1.5 mL/ kg)

answer

should be available whenever epidural blocks are performed, in the event of local anesthetic toxicity.

question

In adults, _______ of local anesthetic per segment to be blocked is a generally accepted guideline for epidural blocks

answer

1- 2 mL

question

The dose required to achieve the same level of anesthesia ________ with age.

answer

decreases

question

A patient's ________ affects the extent of cephalad spread.

answer

height

question

(T/F) Opioids tend to have a greater effect on the duration of epidural anesthesia.

answer

FALSE

question

epinephrine

answer

concentrations of 5 mcg/ mL prolongs the duration and improves the quality of block, delays vascular absorption and reduces peak systemic blood levels of all epidurally administered local anesthetics.

question

chloroprocaine, lidocaine, and mepivacaine

answer

commonly used short and intermediate acting epidural agents for surgical anesthesia

question

bupivacaine, levobupivacaine, and ropivacaine

answer

Longer acting agents epidural agents for surgical anesthesia

question

chloroprocaine

answer

an ester with rapid onset, short duration, and extremely low toxicity, may interfere with the analgesic effects of epidural opioids. Previous formulations with preservatives, specifically bisulfite and ethylenediaminetetraacetic acid (EDTA), produced cauda equine syndrome when accidentally injected in a large volume intrathecally; low potency and metabolized very rapidly

question

sodium bicarbonate (1 mEq/ 10 mL of local anesthetic)

answer

immediately before injection may accelerate the onset of the neural blockade. This approach is most useful for lidocaine, mepivacaine, and chloroprocaine.

question

(T/F) Sodium bicarbonate is typically not added to bupivacaine, which precipitates above a pH of 6.8.

answer

TRUE

question

Visceral afferent fibers travel with the _______

answer

vagus nerve

question

Adverse or exaggerated physiological responses to neuraxial anesthesia

answer

1. urinary retention 2. high block 3. total spinal anesthesia 4. cardiac arrest 5. anterior spinal artery syndrome 6. Horner's syndrome

question

Complications related to needle/catheter placement

answer

1. backache 2. dural puncture/leak (PDPH, diplolia, tinnitus) 3. Neural injury (nerve/spinal cord damage, CES) 4. Bleeding (intraspinal/epidural hematoma) 5. Misplacement (no effect/partial block -subdural block, septal, inadvertent spinal/intravascular injection) 6. Catheter shearing/retention 7. Inflammation (arachnoiditis) 8. Infection (meningitis or epidural abscess)

question

Drug toxicity

answer

1. systemic local anesthetic toxicity 2. transient neurological symptoms 3. CES

question

The majority of regional anesthesia claims involved either ___________ anesthesia (42%) or _________ (34%) and tended to occur mostly in obstetric patients.

answer

lumbar epidural; spinal anesthesia

question

High neural blockade

answer

Administration of an excessive dose, failure to reduce standard doses in selected patients (eg, the elderly, pregnant, obese, or very short), or unusual sensitivity or spread of local anesthetic

question

S/Sx high neural blockade

answer

dyspnea, numbness or weakness in upper extremities, nausea, hypotension

question

Spinal anesthesia ascending into the cervical levels causes

answer

severe hypotension, bradycardia, and respiratory insufficiency

question

High spinal

answer

Unconsciousness, apnea, and hypotension resulting from high levels of spinal anesthesia

question

Total spinal

answer

when the block extends to cranial nerves

question

(T/F) Apnea is more often the result of severe sustained hypotension and medullary hypoperfusion than a response to phrenic nerve paralysis from anesthesia of C3- C5 roots.

answer

TRUE

question

Treatment of an excessively high neuraxial block involves

answer

maintaining an adequate airway and ventilation and supporting the circulation.

question

Large prospective studies continue to report a relatively high incidence perhaps as high as _________ of cardiac arrest in patients having received a spinal anesthetic

answer

1:1500

question

Major risk factors leading to cardiac arrest with neuraxial anesthesia include

answer

1. high baseline vagal tone 2. decreased preload

question

Many clinicians will not allow the heart rate to fall below _____ beats per minute during spinal anesthetic blockade.

answer

question

Local anesthetic block of ________ root fibers decreases urinary bladder tone and inhibits the voiding reflex.

answer

S2- S4

question

As with other regional anesthesia techniques, neuraxial blocks are associated with a small, but measureable, failure rate that is usually ____________ proportional to the clinician's experience.

answer

inversely

question

Intravascular injection of neuraxial anesthetics can cause

answer

CNS effects (seizures and unconsciousness; tinnitus and lingual sensations) CV effects (hypotension, bradycardia, arryhythmias, and depressed contractility)

question

lidocaine and mepivacaine

answer

intermediate in potency and toxicity

question

levobupivacaine, ropivacaine, bupivacaine, and tetracaine

answer

most potent and toxic

question

Total spinal anesthesia onset is usually rapid, because the amount of anesthetic required for epidural and caudal anesthesia is ______ times that required for spinal anesthesia.

answer

5- 10

question

A __________ injection of epidural doses of local anesthetic produces a clinical presentation similar to that of high spinal anesthesia, with the exception that the onset may be delayed for 15- 30 min and the block may be "patchy".

answer

subdural

question

Postoperative back soreness or ache

answer

1. mild and self-limited 2. last for a number of weeks 3. If treatment is sought, acetaminophen, NSAIDs, and warm or cold compresses should suffice 4. may be a clinical sign for an epidural abscess or hematoma

question

post dural puncture headache (PDPH)

answer

is bilateral, frontal or retroorbital, or occipital and extends into the neck; onset of headache is usually 12- 72 hr following the procedure; however, it may be seen almost immediately; leakage of CSF from a dural defect and intracranial hypotension. Loss of CSF at a rate faster than it can be produced causes traction on structures supporting the brain, particularly the meninges, dura, and tentorium. Increased traction on blood vessels and cranial nerves may also contribute to the pain.

question

wet tap

answer

attempted epidural usually immediately recognized as CSF pouring from the epidural needle or aspirated from an epidural catheter.

question

S/Sx of PDPH

answer

throbbing or constant HA associated with photophobia and nausea, diploplia, tinnitus; HALLMARK sign is as pain aggravated by body position (sitting or standing is worse; laying down flat makes it better), lasts weeks.

question

The incidence of PDPH is strongly related to

answer

needle size, needle type, and patient population

question

Strong risk factors for PDPH

answer

young age, female sex, and pregnancy

question

Conservative treatment PDPH involves

answer

recumbent positioning, analgesics, intravenous or oral fluid administration, and caffeine for 12-24 hours

question

epidural blood patch

answer

is an effective treatment for PDPH. It involves injecting 15- 20 mL of autologous blood into the epidural space at, or one interspace below, the level of the dural puncture; stops further leakage of CSF by either mass effect or coagulation; Approximately 90% of patients will respond, and 90% of initial nonresponders will obtain relief from a second injection.

question

neurological injury

answer

Damage to the conus medullaris may cause isolated sacral nerve dysfunction, including paralysis of the biceps femoris muscles; anesthesia in the posterior thigh, saddle area, or great toes; and loss of bowel or bladder function; most resolve spontaneously, some are permanent.

question

spinal or epidural hematoma

answer

has been estimated to be about 1: 150,000 for epidural blocks and 1: 220,000 for spinal anesthetics

question

risk factors for spinal or epidural hematoma

answer

1. abnormal coagulation secondary to disease or pharmacology 2. insertion or removal of epidural catheter

question

hematoma's mass effect

answer

pathological insult to spinal cord and nerves by compressing neural tissue and causing direct pressure injury and ischemia.

question

S/Sx of spinal or epidural hematoma

answer

include sharp back and leg pain with a motor weakness and/ or sphincter dysfunction.

question

Treatment for spinal or epidural hematoma

answer

1. immediate MRI or CT scan 2. neurosurgical consult immediately 3. surgical decompression within 8- 12 hr

question

meningitis and arachnoiditis

answer

Infection of the subarachnoid space as the result of contamination of the equipment or injected solutions, or as a result of organisms tracked in from the skin; Indwelling catheters colonized with organisms that then track deep, causing infection.

question

S/Sx of meningitis and arachnoiditis

answer

Clinically, it is marked by pain and other neurological symptoms, and, on radiographic imaging, is seen as a clumping of the nerve roots

question

4 Stages of epidural abscess

answer

1. symptoms include back or vertebral pain that is intensified by percussion over the spine; fever 2. nerve root or radicular pain develops 3. marked by motor and/ or sensory deficits or sphincter dysfunction 4. Paraplegia or paralysis

question

Most common organisms involved with EA

answer

Staphylococcus aureus and Staphylococcus epidermidis

question

Treatment for epidural abscess

answer

1. MRI or CT scanning should be performed to confirm or rule out the diagnosis 2. Early neurosurgical and infectious disease consultation 3. antibiotics 4. decompression (laminectomy) or percutaneous drainage with fluoroscopic or CT guidance

question

Prevention of EA

answer

1. minimizing catheter manipulations and maintaining a closed system 2. using a micropore (0.22-μm) bacterial filter 3. removing an epidural catheter or at least changing the catheter, filter, and solution after a defined time interval (<4 days).

question

(T/F) There is a risk of neuraxial catheters sheering and breaking off inside of tissues if they are withdrawn through the needle. If a catheter must be withdrawn while the needle remains in situ, both must be carefully withdrawn together

answer

TRUE

question

transient neurological symptoms (TNS)

answer

also referred to as transient radicular irritation, are characterized by back pain radiating to the legs without sensory or motor deficits, occurring after the resolution of spinal anesthesia and resolving spontaneously within several days; commonly associated with hyperbaric lidocaine, outpatient surgeries, males in lithotomy position

question

cauda equina syndrome (CES)

answer

characterized by bowel and bladder dysfunction together with evidence of multiple nerve root injury; lower motor neuron type injury with paresis of the legs, sensory deficits may be patchy, typically occurring in a peripheral nerve pattern.

question

Esters

answer

cocaine, procaine, benzocaine, tetracaine, 2-chloroprocaine; metabolized by plasma esterases

question

Amides

answer

lidocaine, mepivacaine, prilocaine, ropivacaine, bupivacaine, levobupivacaine, etidocaine; metabolized by liver enzymes

STUDY

Developmental Biology Nutrition Physical Activity Guidelines Reduce The Pain

Chapter 16 Nutrition – Flashcards 20 terms

Mary Moore

20 terms

Preview

Chapter 16 Nutrition – Flashcards

question

School lunches are designed to provide at least _____ of the recommended intake for certain nutrients.

answer

1/3

question

On average, about _____ of a teenager's total daily energy intake comes from snacks.

answer

1/4

question

Infants should be introduced to solid foods at approximately________months.

answer

4-6

question

Food allergies and high sugar intakes have been identified as the main causes of hyperactivity in children.

answer

false

question

Infants fed honey or corn syrup are at increased risk for

answer

botulism

question

A child known to be allergic to peanuts who begins to show signs such as difficulty breathing, swelling of the tongue, and severe abdominal discomfort is most likely in immediate need of a life-saving injection of

answer

epinephrine

question

Which of the following is a characteristic of obesity in childhood?

answer

A nonobese child of nonobese parents has a less than 10% chance of becoming obese in adulthood.

question

What organ in the infant uses more than half of the day's total energy intake?

answer

brain

question

Which of the following is the most prevalent nutrient deficiency among U.S. and Canadian children?

answer

Iron

question

What is the typical weight gain (lbs) of an infant between the first and second year of life?

answer

question

Which of the following defines nursing bottle tooth decay?

answer

Marked tooth decay of an infant due to prolonged exposure to carbohydrate rich fluids from a bottle

question

What is colostrum?

answer

A milk like substance secreted right after delivery

question

Which of the following foods are most often the cause of anaphylactic shock?

answer

Eggs, peanuts, and milk

question

Which of the following is characteristic of children who regularly eat breakfast or skip breakfast?

answer

Breakfast-skippers actually show lower scores on IQ tests than those who eat breakfast

question

A child who develops antibodies to a certain food is said to have a

answer

food allergy

question

Why should new foods be introduced to an infant one at a time?

answer

Any allergic reactions can be detected

question

Compared with cow's milk, breast milk contains

answer

less protein and calcium

question

Which of the following is an effective strategy for dealing with obesity in a child?

answer

Engage the individual in at least 1 hour per day of moderate to vigorous physical activity

question

What is the leading cause of high blood pressure in children?

answer

obesity

question

What should be the first cereal introduced to the infant?

answer

rice

STUDY

Developmental Biology Left And Right Hemispheres Neural Tube Defects

Flashcards for USMLE STEP 1 Neurology 411 terms

Lisa Currey

411 terms

Preview

Flashcards for USMLE STEP 1 Neurology

question

The notochord induces what to differentiate into what?

answer

Induces overlying ECTODERM to differentiate into NEUROECTODERM and form NUERAL PLATE

question

Neural plate then gives rise to?

answer

Neural tube and neural crest cells

question

Notochord becomes what?

answer

Nucleus pulposus of the intervertebral disks in adults

question

Alar Plate

answer

Dorsal [Sensory] Same orientation as spinal cord

question

Basal Plate

answer

Ventral [Motor] Same orientation as the spinal cord

question

How does FGF affect chordin and noggin?

answer

FGF regulates chordin and noggin to down regulate BMP which leads to neural plate induction

question

Three Primary Vesicles

answer

1. Forebrain [Prosencephalon] 2. Midbrain [Mesencephalon] 3. Hindbrain [Rhombencphaln]

question

The Forebrain gives rise to:

answer

1. Telencephalon [Cerebral hemispheres, lateral ventricles] 2. Diencephalon [Thalamus, Third Ventricle]

question

The Midbrain gives rise to:

answer

1. Mesencephalon [Midbrain, aqueduct]

question

The Hindbrain gives rise to:

answer

1. Metencephalon [Pons, cerebellum, upper part of the fourth ventricle] 2. Myelencephalon [Medulla, Lower part of the fourth ventricle]

question

CNS/PNS Origins

answer

Neuroectoderm = CNS neurons, ependymal cell [Inner lining of ventricles, makes CSF], oligodendrocytes, astrocytes Neural crest cells = PNS, schwann cells Mesoderm = Microglia [Like Macrophages, originate from Mesoderm]

question

Neural tube defects

answer

NEUROPORES fail to fuse [4th week] → Persistent connection between amniotic cavity and spinal canal Associated with: 1. Low folate levels before conception and during pregnancy 2. ↑ a-fetoprotein levels [AFP] in amniotic and maternal serum 3. ↑ AChE in amniotic fluid [Helpful confirmatory test] -- Fetal AChe in CSF transudates across defect into amniotic fluid

question

Spina bifida occulta

answer

Failure of bony spinal canal to close, NO STRUCTURAL HERNIATION Usually seen at lower vertebral levels DURA INTACT Associated w/ tuft of hair or skin dimple at level of bony defect NORMAL AFP

question

Meningocele

answer

Meninges [BUT NO NEURAL TISSUES] herniates through bony defect

question

Meningomyelocele

answer

Meninges and neural tissue herniate through bony defect Associated w/ Arnold-Chiari Type II Malformation

question

Anencephaly

answer

Malformation of the ANTERIOR NEURAL TUBE → 1. No forebrain 2. Open calvarium Clinical Findings: 1. ↑ a-fetoprotein levels [AFP] 2. Polyhydramnios [No swallowing center in brain] 3. Associated w/ MATERNAL TYPE I DIABETES 4. Maternal folate supplementation ↓ risk

question

Holoprosencephaly

answer

Failure of LEFT AND RIGHT HEMISPHERES TO SEPARATE Usually occurs during the 5th and 6th week May be related to mutations in the SONIC HEDGEHOG signaling pathway Moderate form = Cleft lip/palate Severe form = Cyclopia Seen in: 1. PATAU SYNDROME 2. FETAL ALCOHOL SYNDROME

question

Chiari Type II Malformation

answer

Posterior fossa malformation Significant HERNIATION of the CEREBELLAR TONSILS and VERMIS through FORAMEN MAGNUM with AQUEDUCTAL STENOSIS and HYDROCEPHALUS Patients often present w/: 1. Lumbosacral meningomyelocele 2. Paralysis below the defect

question

Dandy-Walker Malformation

answer

AGENESIS of CEREBELLAR VERMIS with CYSTIC ENLARGEMENT of the 4th ventricle Fills enlarged posterior fossa Associated w/: 1. Hydrocephalus 2. Spina bifida

question

Syringomyelia

answer

Cystic cavity [Syrinx] within SPINAL CORD If central canal = Hydromyelia Crossing anterior spinal commissural fibers are typically damaged CAPE-LIKE BILATERAL LOSS OF PAIN and TEMPERATURE in the UPPER EXTREMITIES Fine touch sensation is preserved Associated w/: 1. Arnold Chiari malformation 2. Trauma 3. Tumor Most common C8-T1 [CERVICAL ENLARGEMENT]

question

Arnold Chiari Type I Malformation

answer

CEREBELLAR TONSILLAR ECTOPIA > 3-5 mm Congenital Usually asymptomatic in childhood Manifests w/ HEADACHE and CEREBELLAR SYMPTOMS

question

Which arches form the anterior 2/3rds of the tongue

answer

1st and 2nd brachial arches -- Sensation via CN V -- Taste via CN VII

question

Which arches form the posterior 1/3rd of the tongue

answer

3rd and 4th brachial arches --Sensation and taste via CN IX -- Extreme posterior vagus

question

Motor innervation of the tongue

answer

CN XII [Hypoglossal nerve] to: 1. Hyoglossus = Retracts and depresses tongue 2. Genioglossus = Protrudes tongue 3. Styloglossus = Draws sides of tongue upward to create a trough for swallowing CN X [Vagus] to: 1. Palatoglossus = Elevates posterior tongue during swallowing

question

Neurons

answer

Signal-transmitting cells of the nervous system Permanent cells = DO NOT DIVIDE IN ADULTHOOD Signal relaying cells w/ dendrites [Receive input], cell bodies, and axons [Send output] CELL BODIES AND DENDRITES CAN BE SEEN ON NISSLE STAINING [Stains RER] RER is not present in an axon

question

Loss of Nissle substance indicates

answer

Irreversible hypoxic damage = Red neuron

question

Injury to axon results in what?

answer

Wallerian degeneration → 1. Degeneration distal to the injury 2. Axonal retraction proximally 3. Allows for regeneration of axon [If in PNS]

question

Astrocytes

answer

Functions: 1. Physical support 2. Repair 3. K+ metabolism 4. Removal of excess neurotransmitter 5. Component of the blood brain barrier via foot process interaction w/ perivascular space 6. Glycogen fuel reserve buffer 7. Reactive gliosis in response to neural injury 8. DERIVED FROM NEUROECTODERM

question

Astrocyte Marker

answer

GFAP

question

Microglia

answer

Phagocytic scavenger cells of CNS [Mesodermal, mononuclear origin] Activated in response to tissue damage NOT READILY DISCERNIBLE BY NISSL stain HIV-INFECTED MICROGLIA FUSE TO FORM MULTINUCLEATED GIANT CELLS IN CNS

question

Myelin

answer

↑ Conduction velocity of signals transmitted down axons → Saltatory conduction of action potential at nodes of Ranvier [HIGH CONCENTRATIONS of Na+ channels] CNS = Oligodendrocyte [Single sheath, 50 axons] PNS = Schwann cells [Single sheath, single axon] Wraps and insulates axons ↑ Space constant and ↑ Conduction velocity

question

Schwann cells

answer

Each Schwann cells myelinates only 1 PNS aon Also promotes axonal regeneration Derived from NEURAL CREST ↑ Conduction velocity of signals transmitted down axons → Saltatory conduction of action potential at nodes of Ranvier [HIGH CONCENTRATIONS of Na+ channels] May be INJURED IN GUILLAIN-BARRE SYNDROME

question

Acoustic Schwannoma

answer

Typically located in the internal acoustic meatus [CN VIII] If BILATERAL, strongly associated with NEUROFIBROMATOSIS TYPE 2

question

Oligodendroglia

answer

Myelinated axons of neurons in CNS Each oligodendrocyte can myelinate ~30 axons PREDOMINANT TYPE OF GLIAL CELL IN WHITE MATTER Derived from NEUROECTODERM FRIED EGG appearance histologically Injured in: 1. Multiple Sclerosis 2. Multifocal progressive leukoencephalopathy [PML] 3. Leukodystrophies

question

Free nerve endings

answer

C = Slow, unmyelinated fibers Aδ = Fast, myelinated fibers Location: All skin, epidermis, some viscera Sense: Pain, temperature

question

Meissner Corpuscles

answer

Large myelinated fibers, adapt quickly Location: Glabrous [Hairless] skin Senses: Dynamic, light touch/position sense

question

Pacinian Corpuscles

answer

Large, myelinated fibers, adapt quickly Location: Deep skin layers, ligaments, joints Senses: Vibration, pressure

question

Merkel Discs

answer

Large, myelinated fibers, adapt quickly Location: Fingertips, superficial skin Senses: Pressure, deep static touch [Shapes, edges], position sense

question

Ruffini Corpuscles

answer

Dendritic endings w/ CAPSULE ADAPT SLOWLY Location: Fingertips and joints Senses: Pressure, slippage of objects along surface of skin, joint angle change

question

Endoneurium

answer

Invests single nerve fiber layers [INFLAMMATORY INFILTRATE IN GUILLAIN BARRE SYNDROME] Inner

question

Perineurium

answer

PERMEABILITY BARRIER Surrounds fascicle of nerve fibers MUST BE REJOINED IN MICROSURGERY FOR LIMB REATTACHMENT Around

question

Epineurium

answer

Dense connective tissue that surrounds entire nerve [Fascicles and blood vessels] Epi = Outer

question

Norepinephrine

answer

↑ Anxiety ↓ Depression Location: Locus coeruleus [Pons] = Stress and Panic

question

Dopamine

answer

↑ Huntington's Disease ↓ Parkinson's Disease ↓ Depression Location: Ventral tegmentum and substantia nigra pars compacta [Midbrain]

question

5-HT [Serotonin]

answer

↓ Anxiety ↓ Depression Location: Raphe nuclei [Pons, medulla, midbrain]

question

ACh

answer

↑ Parkinson's Disease ↓ Alzheimer's Disease ↓ Huntington's disease Location: Basal nucleus of Meynert

question

GABA

answer

↓ Anxiety ↓ Huntington Disease Location: Nucleus Accumbens = Reward center, pleasure, addiction, fear

question

Blood brain barrier

answer

Prevents circulating substances [Bacteria and blood] from reaching the CSF/CNS Formed by 3 structures: 1. Tight Junctions between nonfenestrated capillary endothelial cells 2. Basement membrane 3. Astrocyte foot processes Glucose and amino acids cross slowly by CARRIER-MEDIATED transport mechanisms NONPOLAR/LIPID-Soluble cross rapidly via diffusion

question

Specialized brain regions w/ fenestrated capillaries and no blood brain barrier

answer

Allow molecules in blood to affect brain function 1. Area postrema = Vomiting after chemo 2. OVLT = Osmotic sensing Or neurosecretory products to enter circulation 1. Neurohypophysis = ADH release

question

Infarction and/or neoplas destroys what to cause vasogenic edema?

answer

Endothelial tight junction → vasogenic edema

question

Blood barriers:

answer

1. Blood brain barrier 2. Blood testis barrier 3. Maternal-fetal blood barrier of placenta

question

Hypothalamus

answer

Wears TAN HATS 1. Thirst and water balance 2. Adenohypophysis control [Regulates anterior pituitary] 3. Neurohypophysis [Releases hormones in hypothalamus] 4. Hunger 5. Autonomic regulation 6. Temperature 7. Sexual urges Inputs [AREAS NOT PROTECTED BY BBB] 1. OVLT = Organum vasculosum of the lamina terminalis -- Senses changes in osmolality 2. Area Postrema [Responds to emetics]

question

Vasopressin [ADH] is produced where?

answer

Supraoptic nucleus of the hypothalamus

question

Oxytocin is produced where?

answer

Paraventricular nucleus

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Lateral Area of the Hypothalamus

answer

1. Hunger 2. Destruction → Anorexia, failure to thrive 3. INHIBITED BY LEPTIN If you zap your lateral, you shrink laterally

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Ventromedial Area of the Hypothalamus

answer

1. Satiety 2. Destruction [Craniopharyngioma] → Hyperphagia 3. STIMULATED BY LEPTIN

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Anterior Hypothalamus

answer

Cooling, parasympathetic A/C = Anterior, cooling

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Posterior Hypothalamus

answer

Heating, sympathetic If you zap your Posterior hypothalamus, you become a Poikilothermic [Cold-blooded, like a snake]

question

Suprachiasmatic Nucleus

answer

CIRCADIAN RHYTHMS You sleep to be charismatic

question

Sleep cycle is regulated by what?

answer

Sleep cycle is regulated by the circadian rhythm [Driven by the suprachiasmatic nucleus of the hypothalamus] SCN is regulated by the environment [Light]

question

Circadian rhythms control nocturnal release of what?

answer

1. ACTH 2. Prolactin 3. Melatonin 4. Norepinephrine SCN → Norepinephrine release → Pineal Gland → Melatonin

question

Two Stages of Sleep:

answer

1. Rapid-eye movement [REM] and non-REM -- Extraocular movements during REM sleep due to activity of the PPRF [Paramedian pontine reticular formation/conjugate gaze center] -- Occurs every 90 minutes, duration ↑ throughout the night At night, BATS, Drink Blood Awake [Eyes open] = Beta Awake [Eyes closed] = Alpha Non-REM N1 =Theta Non-REM N2 = Spindle and K complex Non-REM N3 = Delta REM = Beta

question

What is associated w/ ↓ REM sleep and delta wave sleep?

answer

1. Alcohol 2. Benzodiazepines 3. Barbiturates 4. Norepinephrine

question

Treatment for bedwetting [Enuresis]

answer

Oral desmopressin [ADH analog] Preferred over imipramine [Due to adverse effects]

question

Treatment for night terrors and sleep-walking

answer

Benzodiazepine

question

Awake [Eye's open]

answer

Alert, active mental concentration Beta [Highest frequency, lowest amplitude]

question

Awake [Eye's closed]

answer

Alpha waves

question

Non-REM Sleep: Stage N1 [5%]

answer

Light sleep Theta waves

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Non-REM Sleep: Stage N2 [45%]

answer

Deeper sleep, when bruxism occurs Sleep spindles and K complexes

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Non-REM Sleep: Stage N3 [25%]

answer

Deepest non-REM sleep [Slow-wave sleep] When: 1. Sleepwalking 2. Night Terrors 3. Bedwetting occurs Delta wave [Lowest frequency, highest amplitude]

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REM Sleep [25%]

answer

1. LOSS OF MOTOR TONE 2. ↑ Brain O2 use 3. ↑ Variable pulse and pressure 4. When dreaming and penile/clitoral tumescence occurs 5. May serve memory processing function Beta wave

question

Thalamus

answer

Major relay for all ascending sensory information [EXCEPT OLFACTION]

question

VPL of Thalamus

answer

1. Spinothalamic and dorsal columns/medial lemniscus INFO: Pain, temperature, touch, vibration, proprioception Destination: 1° Somatosensory cortex

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VPM of Thalamus

answer

1. Trigeminal and gustatory pathway INFO: Face sensation, taste Destination: 1° somatosensory cortex Notes: Makeup goes on the face

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LGN of Thalamus

answer

1. CN II INFO: Vision Destination: Calcarine sulcus Lateral = Light

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MGN of Thalamus

answer

1. Superior olive and inferior colliculus of tectum INFO: Hearing Destination: Auditory cortex of temporal lobe Medial = Music

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VL of Thalamus

answer

1. Basal ganglia, cerebellum INFO: Motor Destination: Motor cortex

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Limbic System

answer

Collection of neural structures involved in 1. Emotion 2. Long-term memory 3. Olfactory 4. Behavior modification 5. ANS function STRUCTURES: 1. Hippocampus 2. Amygdala 3. Fornix 4. Mammillary bodies 5. Cingulate gyrus RESPONSIBLE FOR [5 F's]: 1. Feeding 2. Fleeing 3. Fightin 4. Feeling 5. Sex

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Osmotic Demyelination Syndrome [Central pontine myelinolysis]

answer

Clinical Manifestations: 1. Acute paralysis 2. Dysarthria 3. Dysphagia 4. Diplopia 5. LOC 6. Can cause locked-in syndrome MASSIVE AXONAL DEMYELINATION IN PONTINE WHITE MATTER 2° to osmotic changes [Commonly iatrogenic, can be due to overly rapid correction of hyponatremia] -- Results in cerebral edema/herniation Correcting serum Na+ too fast: 1. From low to high, your pons will die! [Osmotic Demyelination Syndrome] 2. From high to low, your brains will blow! [Cerebral edema/herniation]

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Cerebellum

answer

Modulates movement, aids in coordination and balance Input: 1. Contralateral cortex via middle cerebellar peduncle 2. Ipsilateral proprIoceptive Information via Inferior cerebellar peduncle from spInal cord Output: 1. Sends information to the contralateral cortex to modulate movement -- Output nerves = Purkinje cells → Deep nuclei of the cerebellum → Contralateral cortex via superior cerebellar peduncle Deep nuclei [Lateral to medial] = Don't Eat Greasy Foods 1. Dentate 2. Emboliform 3. Globose 4. Fastigial

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Lateral Lesions to the Cerebellum

answer

Voluntary movement of extremities PROPENSITY TO FALL TOWARD IPSILATERAL SIDE

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Medial Lesions to the Cerebellum

answer

Lesions involving midline structures [Vermal cortex, fastigial nuclei] and/or flocculonodular lobe → 1. Truncal ataxia [Wide-based cerebellar gait] 2. Nystagmus 3. Head tilting 4. Generally, midline lesions result in BILATERAL MOTOR DEFICITS affect AXIAL and PROXIMAL LIMB MUSCULATURE

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Basal Ganglia

answer

Important in voluntary movements and making postural adjustments Receives cortical input, provides negative feedback to cortex to modulate movement Striatum = Putamen [Motor] + Caudate [Cognitive] Lentiform = Putamen + Globus pallidus D1 receptor = DIrect pathway Indirect = Inhibitory

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Excitatory pathway in the basal ganglia

answer

Cortical inputs stimulate striatum, stimulating release of GABA [Disinhibits the thalamus via the GPi/SNr] = ↑ Motion

question

Inhibitory pathway in the basal ganglia

answer

Cortical inputs stimulate the striatum [Disinhibits STN via GPe, STN stimulates GPi/SNr to inhibit thalamus] = ↓ Motion

question

Dopamine binds to what in the basal ganglia

answer

D1 receptors stimulating the excitatory [Direct pathways] D2 inhibiting the inhibitory pathway → ↑ Motion

question

Athetosis

answer

Slow, writhing movements, ESPECIALLY SEEN IN FINGERS Locations of Lesion: Basal ganglia [Huntington] WRITHING, SNAKE-LIKE MOVEMENT

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Chorea

answer

Sudden, jerky, purposeless movements Location of Lesion: Basal ganglia [Huntington] CHOREA = Dance-like

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Dystonia

answer

Sudden, involuntary muscle contractions Example: Writer's cramp Blepharospasm [Sustained eye twitch]

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Essential Tremor

answer

HIGH-FREQUENCY tremor w/ SUSTAINED POSTURE [Outstretched arms], WORSENED w/ MOVEMENT Often familial Patient's often self-mediate w/ EtOH = ↓ Tremor amplitude Treatment: B-blockers, Primidone

question

Hemiballismus

answer

Sudden, wild flingin of 1 arm +/- IPSILATERAL LEG Location: CONTRALATERAL subthalamic nucleus [Lacunar stroke]

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Intention Tremor

answer

Slow zigzag motion when pointing/extending toward target Location: Cerebral dysfunction

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Myoclonus

answer

Sudden, brief, uncontrolled muscle contraction JERK HICCUPS common in metabolic abnormalities such as renal and liver failure

question

Resting tremor

answer

Uncontrolled movement of distal appendages [Most appreciable in hands] Tumor ALLEVIATED BY INTENTIONAL MOVEMENT Example: Parkinson's disease [Pill-rolling tremor]

question

Parkinson's Disease

answer

Degenerative disorder of CNS associated w/ LEWY BODIES [Composed of a-synuclein = Intracellular eosinophilic inclusions] and LOSS OF DOPAMINERGIC NEURONS [Depigmentation] of substantia nigra pars compacta Parkinson TRAPS your body: 1. Tremor [Pill-rolling tremor at rest 2. Rigidity 3. Akinesia [or bradykinesia] 4. Postural instability 5. Shuffling gait

question

Huntington's Disease

answer

AUTOSOMAL DOMINANT Trinucleotide repeat on chromosome 4 [CAG repeats] -- Caudate loses ACh and GABA Symptoms manifest between ages 20-50 Clinical Manifestations: 1. Choreiform movements 2. Aggression 3. Depression 4. Dementia [Sometimes mistaken for substance abuse] Labs: 1. ↑ Dopamine 2. ↓ ACh 3. ↓ GABA Neuronal cell death via NMDA-R binding and GLUTAMATE TOXICITY ATROPHY OF CAUDATE NUCLEI w/ ex vacuo DILATION OF FRONTAL HORNS

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Cerebral Cortex

answer

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Aphasia

answer

Higher-order inability to speak [Language deficit]

question

Dysarthria

answer

Motor inability to speak [Movement deficit]

question

Broca's Area

answer

NONFLUENT aphasia Intact comprehension with IMPAIRED REPETITION INFERIOR FRONTAL GYRUS OF FRONTAL LOBE

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Wernicke' Area

answer

FLUENT aphasia with IMPAIRED COMPREHENSION and REPETITION SUPERIOR TEMPORAL GYRUS OF TEMPORAL LOBE Wernick is Wordy but makes no sense

question

Conduction Aphasia

answer

Poor repetition but fluent speech, INTACT COMPREHENSION Caused by damage to the arcuate fasciculus Can't repeat phrases like "NO, IFS, ANDS, or BUTS"

question

Global

answer

NONFLUENT APHASIA WITH IMPAIRED COMPREHENSION Arcuate fasciculus, Broca's, and Wernicke's areas affected

question

Transcortical motor

answer

Nonfluent aphasia with good comprehension and intact repetition

question

Transcortical sensory

answer

Poor comprehension with fluent speech and intact repetition

question

Mixed transcortical

answer

Nonfluent speech, poor comprehension, INTACT REPEPTITON

question

Amygdala Lesion [Bilateral]

answer

Kluver-Bucy Syndrome = Disinhibited behavior [Hyperphagia, hypersexuality, hyperorality] Associated w/ HSV-1

question

Frontal lobe Lesion

answer

Disinhibition and deficits in concentration, orientation, judgement May have a reemergence of primitive reflexes

question

Nondominant parietal-temporal cortex Lesion

answer

HEMISPATIAL NEGLECT [Agnosia of the contralateral side of the world]

question

Dominant parietal-temporal cortex Lesion

answer

1. Agraphia 2. Acalculia 3. Finger agnosia 4. Left-right disorientation GESTERMANN SYNDROME

question

Reticular Activating System [Midbrain] Lesion

answer

Reduced levels of arousal and wakefulness [Coma]

question

Mammillary Bodies [Bilateral] Lesion

answer

Wernicke-Korsakoff Syndrome 1. Confusion 2. Ophthalmoplegia 3. Ataxia 4. Memory loss [Anterograde and retrograde amnesia] 5. Confabulation 6. Personality changes Associated w/ B1 [Thiamine] Deficiency and excessive EtOH use Can be precipitated by GLUCOSE w/out B1 to a B1-deficient patient Wernicke problems in a can of beer: 1. Confusion 2. Ataxia 3. Nystagmus

question

Basal Ganglia Lesion

answer

May result in a tremor at rest, chorea, athetosis Parkinson's Disease Huntington's Disease

question

Cerebellar Hemisphere Lesion

answer

1. Intention tremor 2. Limb ataxia 3. Loss of balance 4. Damage to cerebellum → Ipsilateral deficits FALL TOWARD THE SIDE OF THE LESION Cerebellar hemispheres are LATERALLY LOCATED and affect the LATERAL LIMBS

question

Cerebellar Vermis Lesion

answer

1. Truncal ataxia 2. Dysarthria Vermis is CENTRALLY LOCATION affects the CENTRAL LIMBs

question

Subthalamic Nucleus Lesion

answer

CONTRALATERAL hemiballismus

question

Hippocampus [Bilateral]

answer

Anterograde amnesia = Inability to make new memories

question

Paramedian Pontine Reticular Formation

answer

Eyes look away from the side of lesion

question

Frontal Eye fields

answer

Eyes look toward the side of the lesion

question

Watershed Zones

answer

Between 1. Anterior/middle cerebral 2. Posterior/Middle cerebral DAMAGE IN SEVERE HYPOTENSION 1. Upper arm/leg weakness 2. Defects in higher-order visual processing

question

Anterior Cerebral Artery

answer

question

Homunculus

answer

Topographic representation of motor and sensory areas in cerebral cortex Distorted image is due to certain body regions being more richly innervated and thus having ↑ cortical representations

question

Regulation of cerebral perfusion

answer

Brain perfusion relies on tight autoregulation Cerebral perfusion is mostly driven by PCO2 [PO2 modulates perfusion in severe hypoxia] Therapeutic hyperventilation [↓ PCO2], helps ↓ ICP in cases of 1. Acute cerebral edema [Stroke, trauma] via vasoconstriction Fainting in panic attacks due to ↓ perfusion

question

Hypoxemia and cerebral perfusion

answer

↑ cerebral perfusion pressure only when PO2 < 5o mmHg

question

Cerebral perfusion pressure is proportional to what

answer

Cerebral perfusion pressure is proportional to PCO2 until PCO2 > 90 mmHg

question

Cerebral perfusion and blood pressure

answer

Cerebral perfusion lies on pressure gradient between mean arterial pressure [MAP] and ICP ↓ blood pressure or ↑ ICP → ↓ Cerebral perfusion pressure [CPP] CPP = MAP - ICP If CPP = 0, there is not cerebral perfusion → Brain death

question

MCA Lesion

answer

1. Motor cortex = Upper limb and face [Contralateral paralysis] 2. Sensory cortex = Upper limb and face [Contralateral loss of sensation] 3. Temporal lobe = Wernicke Area 4. Frontal lobe = Broca's Area APHASIA IF IN DOMINANT [Usually left hemisphere] HEMINEGLECT IF IN NONDOMINANT [Usually right hemisphere]

question

ACA Lesion

answer

1. Motor cortex = Lower limb [Contralateral paralysis] 2. Sensory cortex = Lower limb [Contralateral loss of sensation]

question

Lenticulostriate Artery Lesion

answer

Striatum [Putamen = Motor, Caudate = Cognitive, Internal capsule Contralateral hemiparesis/hemiplegia COMMON LOCATION OF LACUNAR INFARCTS, 2° to unmanaged hypertension

question

Anterior Spinal [ASA]

answer

1. Lateral corticospinal tract = Contralateral hemiparesis [Upper and lower limbs] 2. Medial lemniscus = ↓ Contralateral proprioception 3. Caudal medulla = Hypoglossal nerve [Ipsilateral hypoglossal dysfunction = Tongue licks the lesion] STROKE COMMONLY BILATERAL

question

Medial Medullary Syndrome

answer

Caused by infarct of paramedian branches of ASA and vertebral arteries

question

PICA Lesion

answer

1. Lateral medulla -- Vestibular Nuclei -- Lateral Spinothalamic tract -- Spinal trigeminal nucleus -- Nucleus ambiguus -- Sympathetic fibers -- Inferior cerebellar peduncle [Proprioceptive information] Clinical Manifestations: 1. Vomiting 2. Vertigo 3. Nystagmus 4. ↓ Pain and temperature sensation from IPSILATERAL FACE and CONTRALATERAL BODY 5. DYSPHAGIA 6. HOARSENESS 7. ↓ Gag reflex 8. Ipsilateral horner syndrome 9. Ataxia 10. Dysmetria

question

Lateral Medullary [Wallenberg Syndrome] Lesion

answer

Nucleus ambiguus effects are SPECIFIC TO PICA lesion "Don't PICA Horse [Hoarseness] that can't eat [Dysphasia]

question

ACA

answer

LATERAL PONS 1. Cranial facial nerve 2. Vestibular nuclei 3. Facial nuclei 4. Spinal trigeminal nuclei 5. Cochlear nuclei 6. Sympathetic fibers MIDDLE AND INFERIOR CEREBELLAR PEDUNCLES 1. Ataxia 2. Dysmetria Clinical Manifestations: 1. Vomiting 2. Vertigo 3. Nystagmus 4. PARALYSIS OF FACE 5. ↓ Lacrimation, salivation 6. ↓ Taste from anterior 2/3rd of tongue 7. IPSILATERAL ↓ pain and temperature 8. CONTRALATERAL ↓ pain and temperature

question

Lateral Pontine Syndrome

answer

Facial nucleus effects are specific to AICA lesions FACIAL DROOP means AICA's pooped

question

PCA

answer

1. Occipital cortex 2. Visual cortex [CONTRALATERAL hemianopia w/ macular sparing]

question

Basilar Artery

answer

1. Pons 2. Medulla 3. Lower Midbrain 4. Corticospinal and corticobulbar tracts 5. Ocular cranial nerve nuclei 6. Paramedian pontine reticular formation Clinical Manifestation [LOCKED IN SYNDROME]: 1. Preserved consciousness and blinking 2. Quadriplegia 3. Loss of voluntary facial, mouth, and tongue movement 4. Locked-in syndrome

question

Anterior Communicating Artery [ACom]

answer

Most common lesion is ANEURYSM Can lead to STROKE SACCULAR [BERRY] aneurysm can impinge cranial nerves VISUAL FIELD DEFECTS [Due to compression of the optic chiasm] LESIONS ARE TYPICALLY ANEURYSMS, not strokes

question

Posterior Communicating Artery [PCom]

answer

Common site of saccular aneurysm CN III palsy = EYES DOWN AND OUT [Ptosis and mydriasis] LESIONS ARE TYPICALLY ANEURYSMS NOT STROKES

question

Saccular [Berry] Aneurysm

answer

Occurs at bifurcations in the CIRCLE OF WILLIS Most common site is JUNCTION OF ANTERIOR COMMUNICATING and ANTERIOR CEREBRAL Rupture [Most common complication] → Subarachnoid hemorrhage *** WORST HEADACHE OF MY LIFE Can also lead to hemorrhagic stroke Can cause: 1. Bitemporal hemianopia via compression of optic chiasm Associated with: 1. ADPKD 2. Ehlers-Danlos Syndrome 3. Advanced age 4. HTN 5. Smoking 6. ↑ Risk in black

question

Charcot-Bouchard Microaneurysm

answer

Chronic HTN Affects small vessels [Basal ganglia, thalamus]

question

Central Post-Stroke Pain Syndrome

answer

Neuropathic pain due to THALAMIC LESIONS Initial paresthesia followed in WEEKS TO MONTHS by 1. Allodynia [Ordinarily painless stimuli cause pain] 2. Dysesthesia OCCURS IN 10% of STROKE PATIENTS

question

Epidural hematoma

answer

Rupture of MIDDLE MENINGEAL ARTERY [Branch of the MAXILLARY] Often 2° to fracture of temporal bone LUCID INTERVAL Rapid expansion under systemic arterial pressure → TRANSTENTORIAL herniation, CN III Palsy CT show BICONVEX [Lentiform], Hyperdense blood collection NOT CROSSING SUTURE LINES Can cross FALX and TENTORIUM

question

Subdural hematoma

answer

Rupture of BRIDGING VEINS SLOW VENOUS BLEED [Less pressure =Hematoma develops over time] Seen in: 1. Elderly 2. Alcoholics 3. Blunt trauma 4. SHAKEN BABY SYNDROME [Predisposing factors = Brain atrophy, shaking, whiplash] CRESCENT-SHAPED hemorrhage that CROSSES SUTURE LINES MIDLINE SHIFT Cannot cross falx, tentorium

question

Subarachnoid hemorrhage

answer

Rupture of ANEURYSM [Berry/saccular aneurysm in Ehlers-Danlos and ADPKD] or ARTERIOVENOUS MALFORMATION Rapid time course WORST HEADACHE OF MY LIFE Bloody or yellow spinal tap [Xanthochromia] 2-3 days afterward, risk of vasospasm due to blood breakdown [Not visible on CT, treat w/ NIMODIPINE] and rebleed [Visible on CT]

question

Intraparenchymal [Hypertensive] Hemorrhage

answer

Commonly caused by SYSTEMIC HTN Also seen w/ 1. AMYLOID ANGIOPATHY [Recurrent lobar hemorrhagic stroke in elderly 2. Vasculitis 3. Neoplasm Typically occurs in BASAL GANGLIA, INTERNAL CAPSULE [Charcot-Bouchard Aneurysm of lenticulostriate vessels]

question

Ischemic Brain Disease/Stroke

answer

Irreversible damage begins after 5 minutes of hypoxia [Due to glucose dependence] Most vulnerable: 1. Hippocampus 2. Neocortex 3. Cerebellum 4. Watershed areas Ischemic HYPOxia = HYPOcampus most vulnerable

question

Stroke Imaging

answer

Noncontrast CT to exclude hemorrhage [Before tPA can be given] CT detects changes in 6-24 hours Diffusion weighed MRI can detect ischemia w/in 3-30 minutes

question

Time since ischemia event and histologic factors

answer

12-48 hours = Red neurons 48-72 hours = Necrosis + neutrophils 3-5 days = Macrophages [Microglia] 1-2 weeks = Reactive gliosis + vascular proliferation > 2 weeks = Glial scar

question

Hemorrhagic Stroke [15%]

answer

Intracerebral bleeding, often due to: 1. HTN 2. Anticoagulation 3. Cancer [Abnormal vessels can bleed] May be 2° to ischemic stroke followed by reperfusion [↑ Vessel fragility] BASAL GANGLIA ARE THE MOST COMMON SITE OF INTRACRANIAL HEMORRHAGE

question

Ischemic Stroke [85%]

answer

Acute blockage of vessels → Disruption of blood flow and subsequent ischemia → LIQUEFACTIVE NECROSIS Three Types 1. Thrombotic = Clot forms directly at site of infarction [Commonly MCA] 2. Embolic = Embolus from another part of the body obstructs vessel -- Can affect multiple vascular territories -- Examples: Atrial fibrillation, DVT w/ patent foramen ovale 3. Hypoxic = Hypoperfusion or hypoxemia -- Common during CARDIOVASCULAR SURGERIES -- TENDS TO AFFECT WATERSHED AREAS Treatment: tPA [If w/in 3-4.5 hours of onset and no hemorrhage/risk of hemorrhage] Reduce risk w/ medical therapy: 1. Aspirin 2. Clopidogrel 3. Optimum control of BP, blood sugars, lipids 4. Treat conditions that ↑ atrial fibrillation

question

Transient Ischemic Attack [TIA]

answer

Brief, reversible episode of focal neurologic dysfunction without acute infarction [- MRI] Majority resolves in < 15 minutes, deficits due to FOCAL ISCHEMIA

question

Dural Venous Sinuses

answer

Large venous channels that run through the dura Drain blood from cerebral veins and receive CSF from arachnoid granulation EMPTIES INTO JUGULAR VEINS

question

Ventricular System

answer

Lateral ventricle → 3rd ventricle via right and left interventricular foramen of Monro 3rd ventricle → 4th ventricle via cerebral aqueduct [of Sylvius] 4th ventricle → Subarachnoid space via 1. Formina of Luschka [Lateral] 2. Foramina of Magendie [Medial]

question

CSF

answer

Is made from the ependymal cells of the choroid plexus Reabsorbed in by subarchnoid granulation and then drains into the dural venous sinuses

question

Idiopathic Intracranial Hypertension [Pseudotumor cerebri]

answer

↑ ICP with no apparent cause on imaging [No hydrocephalus, obstruction of CSF outflow] Patients present w/: 1. Headaches 2. Diplopia [Usually from CN VI palsy] 3. Non mental status alterations 4. Papilledema [Seen on exam] Risk factors: 1. Being a woman of child-bearing years 2. Vitamin A excess 3. DANAZOL [Synthetic steroid suppresses GnRH] Lumbar Puncture reveals ↑ opening pressure and provides headache relief Treatment: 1. Weight loss 2. Acetazolamide [Carbonic anhydrase inhibitor] 3. Topiramate [Anticonvulsant] 4. Invasive procedures for refractory cases [Repeat lumbar puncture, CSF shunt placement, nerve fenestration surgery]

question

Communicating Hydrocephalus

answer

↓ CSF absorption by arachnoid granulations → ↑ ICP, papilledema, herniation [Arachnoid scarring post-meningitis + chronic subdural hematomas]

question

Normal Pressure Hydrocephalus

answer

AFFECTS ELDERLY, idiopathic CSF pressure elevated only EPISODICALLY Does not result in ↑ subarchnoid space volume EXPANSION OF VENTRICLES distorts the fibers of the CORONA RADIATA → Triad: 1. Urinary Incontinence = Wet 2. Ataxia = Wobbly 3. Cognitive Dysfunction [Sometimes reversible] = Wacky

question

Noncommunicating hydrocepahlus

answer

Caused by STRUCTURAL BLOCKAGE of CSF circulation through the ventricular system [Stenosis of aqueduct of Sylvius, Colloid cyst blocking foramen of Monro]

question

Ex vacuo ventriculomegaly

answer

Appearance of ↑ CSF on imaging is due to DECREASED BRAIN TISSUE [Neuronal atrophy] 1. Alzheimer's disease 2. Advanced HIV 3. PICK DISEASE ICP is NORMAL, Triad is not seen

question

Spinal Nerves

answer

There are 31 pairs of spinal nerves in total: 1. 8 cervical 2. 12 thoracic 3. 5 Lumbar 4. 5 Sacral 5. 2 coccygeal Nerves C1-C7 exit ABOVE the corresponding vertebrae C8 spinal nerve exits BELOW C7 and above T1 All other spinal nerves exit BELOW

question

Vertebral disk herniation

answer

Nucleus pulposus [Soft central disk] herniates through annulus fibrosus [Outer ring] Usually POSTEROLATERALLY at L4-L5, L5-S1

question

Spinal Cord - Lower Extent

answer

In adults, the spinal cord extends to the lower border of L1-L2 Subarachnoid space [Which contains CSF] extends to lower border of S2 vertebrae Lumbar puncture is usually performed at L3/L4 or L4/L5 [Level of the cauda equina]

question

Goal of lumbar puncture

answer

To obtain a sample of CSF w/out damaging spinal cord To keep the cord alive, go in between L3-L5

question

Spinal Cord Mnemonics

answer

Legs [Lumbosacral] are Lateral in Lateral Corticospinal tract Dorsal columns are organized as you are, hands at side, arms out side legs [Cuneatus outside of gracilis]

question

Ascending Tracts

answer

1. Dorsal Column [Pressure, vibration, touch, proprioception] 2. Fasciculus gracilis [Lower body, legs] 3. Fasciculus cuneatus [Upper body, arms] 4. Lateral spinothalamic tract [Pain and temperature] 5. Anterior spinothalamic tract [Touch, pressure] ASCENDING TRACTS SYNAPSE THEN CROSS

question

Descending Tracts of Spinal Cord

answer

1. Lateral corticospinal tract [Voluntary motor] 2. Anterior corticospinal tract [Voluntary motor]

question

Dorsal Column

answer

Ascending pressure, vibration, fine touch, proprioception 1st Order Neuron = -- Sensory nerve endings → Cell body in dorsal root ganglion -- Enters spinal cord, SYNAPSES IN IPSILATERAL NUCLEUS CUNEATUS OR GRACILIS → ascends ipsilaterally in dorsal column 2nd Order Neuron -- Decussates in medulla → Ascends CONTRALATERALLY in MEDIAL LEMNISCAL → Synapses in the VPL [Thalamus] 3rd Order Neuron Sensory cortex

question

Spinothalamic Tract

answer

Ascending [Lateral] pain and temperature, [Anterior] Crude touch and pressure 1st Order Neuron = -- Sensory nerve endings [Aδ and C Fibers]→ Cell body in dorsal root ganglion -- Enters spinal cord, SYNAPSES IN IPSILATERAL GRAY MATTER [Spinal cord] → 2nd Order Neuron -- Decussates at ANTERIOR WHITE COMMISSURE → Ascends CONTRALATERALLY → Synapses in the VPL [Thalamus] 3rd Order Neuron Sensory cortex

question

Lateral Corticospinal Tract

answer

Descending, Voluntary movement of contralateral limbs UMN: Cell body in 1° motor cortex → Descends ipsilaterally through INTERNAL CAPSULE, most fibers decussate at CAUDAL MEDULLA [Pyramidal decussation] → Descends CONTRALATERALLY 1st Synapse: 1. Cell body of ANTERIOR HORN LMN: Leaves spinal cord Synapse II: NMJ

question

UMN Lesions Signs

answer

Clinical Manifestations: 1. Weakness 2. Hyperreflexia 3. Hypertonia 4. Positive Babinski [Normal in infants] 5. SPASTIC paralysis 6. CLASP KNIFE SPASTICITY Upper MN = Everything up [Tone, DTR, toes]

question

LMN Lesion Signs

answer

Clinical Manifestations: 1. Weakness 2. Hyporeflexia 3. Hypotonia 4. Atrophy 5. Fasciculations [Muscle twitching] 6. FLACCID paralysis Lower MN = Everything lowered [Tone, DTR, toes]

question

Werdnig Hoffman Disease

answer

Poliomyelitis and spinal muscular atrophy LMN lesions only [Due to destruction of anterior horns] FLACCID PARALYSIS

question

Multiple Sclerosis

answer

Due to demyelination MOSTLY WHITE MATTER OF CERVICAL REGION Random and ASYMMETRIC lesions due to demyelination Clinical Manifestations: 1. Scanning speech 2. Intention tremor 3. Nystagmus

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Amyotrophic Lateral Sclerosis [ALS]

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Combined UMN and LMN deficits with NO SENSORY LOSS or oculomotor deficits Can be caused by SUPEROXIDE DISMUTASE 1 defect Clinical Manifestations: 1. Commonly presents as fasciculations with eventual ATROPHY AND WEAKNESS OF HANDS 2. Fatal 3. Riluzole treatment modestly ↑ survival by ↓ presynaptic glutamate release Lou Gehrig disease = Give RiLOUzole [Glutamate antagonist]

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Complete Occlusion of Anterior Spinal Artery

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SPARES DORSAL COLUMN and LISSAUER TRACT Upper thoracic ASA territory is WATERSHED AREA Artery of Adamkiewicz supplies ASA below T8

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Tabes Dorsalis

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Caused by 3° Syphilis Results from degeneration [Demyelination] of DORSAL COLUMNS and roots → 1. Impaired sensation and proprioception 2. Progressive sensory ataxia [Inability to sense or feel legs → poor coordination] Associated w/ 1. Charcot joints 2. Shooting pain 3. Argyll Robertson pupil 4. ABSENCE OF DTRs and + Romberg Sign

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Syringomyelia

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Sprinx expands and damages ANTERIOR WHITE COMMISSURE of SPINOTHALAMIC TRACT [2nd order neurons] 1. Bilateral loss of pain and temperature [C8-T1] 2. Seen in Chiari Type I Malformation 3. Can expand and affect other tracts

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Vitamin B12 Deficiency

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Subacute Combine Degeneration Demyelination of DORSAL COLUMNS, LATERAL CORTICOSPINAL TRACTS, and SPINOCEREBELLAR TRACTS 1. Gait ataxia 2. Paresthesia 3. Impaired position and vibration sense

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Poliomyelitis

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Caused by poliovirus [Fecal-oral transmission] Replicates in OROPHARYNX and SMALL INTESTINE before spreading via bloodstream to CNS Infection causes destruction of cells in ANTERIOR HORN of spinal cord [LMN] Symptoms [LMN Signs] 1. Weakness 2. Hypotonia 3. Flaccid paralysis 4. Fasciculations 5. Hyporeflexia 6. Muscle atrophy 7. Signs of infection [Malaise, headache, fever, nausea] Findings: 1. CSF w/ ↑ WBC and slight ↑ protein [NO CHANGE IN CSF GLUCOSE] 2. Virus recovered from throat or stool

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Spinal Muscular Atrophy [Werdnig-Hoffman Disease]

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Congential degeneration of anterior horns of spinal cord → LMN FLOPPY BABY w/ marked hypotonia and TONGUE FASCICULATIONS Infantile type has median age of death at 7 months AUTOSOMAL RECESSIVE INHERITANCE

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Friedrich Ataxia

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AUTOSOMAL RECESSIVE Trinucleotide repeat [GAA] on chromosome 9 in the gene that encodes FRATAXIN [Iron binding protein] Leads to MITOCHONDRIAL DYSFUNCTION Degeneration of multiple spinal tracts 1. Muscle weakness 2. Loss of DTRs, vibratory sense, proprioception 3. STAGGERING GAIT 4. FREQUENT FALLING 5. Nystagmus 6. Dysarthria 7. Pes Cavus 8. Hammer toes 9. DIABETES MELLITUS, HYPERTROPHIC CARDIOMYOPATHY [Cause of death] 10. Presents in childhood w/ KYPHOSCOLIOSIS

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Brown-Sequard Syndrome

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Hemisection of spinal cord Findings: 1. Ipsilateral UMN signs BELOW level of lesion 2. Ipsilateral loss of tactile, vibration, proprioception sense BELOW level of lesion [Due to dorsal column damage] 3. CONTRALATERAL pain and temperature loss below level of lesion [Loss of spinothalamic] 4. Ipsilateral loss of ALL SENSATION AT LEVEL OF LESION 5. Ipsilateral LMN signs IF lesion occurs ABOVE T1 = PATIENT WILL PRESENT WITH HORNER SYNDROME [Due to damage of the oculosympathetic pathway]

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Landmark Dermatomes: C2

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Posterior half of skull [ca]

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Landmark Dermatome: C3

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High turtleneck shirt

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Landmark Dermatome: C4

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Low collar shirt

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Landmark Dermatome: T4

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At the nippel [The Teat pore]

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Landmark Dermatome: T7

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Xiphoid Process

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Landmark Dermatome: T10

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At the umbilicus [Important for early appendicitis pain referral] T10 at the belly butTEN

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Landmark Dermatome: L1

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Inguinal ligament LI =Inguinal Ligament

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Landmark Dermatome: L4

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Included kneecap Down on ALL 4's

Developmental Biology Flashcards, test questions and answers

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