Unit 1 Lectures

Question 1

what is the most likely explanation for hyperthyroidism in pregnant women?

Answer 1

hCG is homologous to TSH (thyrotropin) and stimulates excess release of TH from thyroid gland

Question 2

what is hyperemesis gravidarum?

Answer 2

intractable nausea, may be caused by extremely high hCG (also due to hyperthyroidism)

Question 3

what is a complete VS incomplete/partial hydatidiform mole?

Answer 3

complete: empty ovum is fertilized with an X sperm that duplicated
- proliferates widely as a tumor, isntead of a normal fetus

incomplete: egg was fertilized by 2 sperm or 1 sperm that duplicated, so it becomes 69 or 92 Xm
- usually dies quickly

Question 4

explain the gravida and para X-X-X-X system?

Answer 4

gravida = how many times one has been pregnant
para = full term - pre-term - abortion - living children
-Floriday Power and Light

Question 5

what are the three MUST GIVES for OB-GYNs?

Answer 5

1. betamethasone - improve outcomes for neonates that are delivered prematurely
   - intramuscular to decrease intra-cranial hemorrhage, necrotizing encephalitis
2. zidovudine - prevent vertical transmission of HIV to baby
3. progesterone supplementation

Question 6

what is consumptive coagulopathy?

Answer 6

inability to clot following hemorrhage, because so many clotting factors have been used up
-can lead to DIC

Question 7

what is Sheehan syndrome?

Answer 7

pan-pituitary dysfunction

• susceptible to hypoperfusion in times of shock
• usually anterior pituitary, but can be both

Question 8

why is the GTT important to perform in PCOS women?

Answer 8

for every year a woman has PCOS, the risk for developing glucose intolerance and/or DMII rises
-GTT is most reliable test to rule out clinically significant glucose intolerance

Question 9

what are myoepithelial cell markers (normally)?

Answer 9

calponin
smooth muscle myosin heavy chain
p53

Question 10

what is a sclerosing adenosis?

Answer 10

lobulocentric proliferative lesion

• mostly in association with fibrocystic change
• may to detectable upon palpation and X-ray
• usually <2 cm
• often associated with calcifications
• show 1.5 to 2-fold increase in breast cancer risk

Question 11

what are details on fibroadenomas?

Answer 11

stromal cells express ER-beta, while epithelial cells variably express Er-alpha
-both express PR

Question 12

what is adenomyoepithelioma of the breast?

Answer 12

uncommon benign lesion composed of proliferating epithelial and myoepithelial cells

Question 13

explain what “triple negative” and “basal-like” means for breast cancer?

Answer 13

3-: it means it is negative for ER, PR (hormone receptors), and HER2/Neu (about 10-20% of breast cancers)

basal: tumors have cells with features similar to basal cells surrounding mammary (most have p53 mutations)
- most, but not all, triple-negative are basal-like (and vice versa)
- occur in younger and African-American women
- most BRCA1 tumors are both triple-negative and basal-like
- often aggressive with poor prognosis

Question 14

what are stats on BRCA1/2 mutations?

Answer 14

• increase risk of ovarian cancer from 2% up to 70%
• reduce risk by having prophylactic oophorectomy
• increased risk of pancreatic, prostate, colon, and second primary cancer
• defective tumors have specific patterns of genetic alterations required for tumor genesis
• 1:400 to 1:800 people have BRCA1/2 mutation
• -1:40 Ashkenazi Jews

Question 15

relationship between Myb, p53, and BRCA1 mutation?

Answer 15

Myb amplification and p53 mutation with different pattern frequently occur in BRCA1 deficient tumros compared to sporadic ones

Question 16

what is beer potomania?

Answer 16

hyponatremia/kalemia due to excessive beer

-cause dizziness, muscle weakness, neurological impairment, seizures

Question 17

is the osmotic force exerted by PRO and phosphates greater in intracellular space or extracellular space? what prevents them from swelling?

Answer 17

intracellular space

-Na/K ATPase prevent lysing

Question 18

how is extracellular osmolality determined? how is this different from normal serum tonicity?

Answer 18

(Na+ x 2) + (Glu / 18) + (BUN / 2.8) + alcohol (usually 0) = usually 289

• x2 takes Cl- into account
• 18 is MW of glucose
• 2.8 is MW of N2

NST doesn’t include BUN or alcohol (=285)

Question 19

what are DDx for hypovolemia (low Na, low water)?

Answer 19

increased renal losses (high FENa)

• aldosterone deficiency
• glucocorticoid deficiency
• Barrter’s/Gitelman’s syndrome
• Fanconi’s syndrome
• Diuretics (acutely)

Increasex extrarenal losses (low FENa)

• GI losses
• skin losses
• hemorrhage
• sepsis

Question 20

what are DDx for euvolemia (unchanged Na, high water)?

Answer 20

low free water clearance (high Uosm)

• SIADH
• hypothyroidism
• reset osmostat

high water intake (low Uosm)

• primary/psychogenic polydipsia
• beer potomania
• “tea and toast”
• hypokalemia

Question 21

what are DDx for hypervolemia (high Na, higher water)

Answer 21

renal issue (high FENa)
-renal failure

extrarenal issue (low FENa)

• congestive heart failure
• cirrhosis
• nephrotic syndrome
• severe hypothyroidism

Question 22

what can prevent acute kidney injury (AKI)?

Answer 22

• volume expansion
• allopurinol
• rasburicase
• dialysis
• phosphate binder

Question 23

how can intracellular shifts of K+ into extracellular space cause hyperkalemia?

Answer 23

• insulin deficiency (diabetes)
• acidemia (usually metabolic)
• cell lysis (TLS, rhabdomyolysis, hemolysis)

Question 24

how can decreased excretion from kidney cause hyperkalemia?

Answer 24

• not filtered (AKI, CKD, ESRD)
• insufficient Na+ delivery to distal tubule (pre-renal)
• aldosterone issue (lack of production, resistance problem from medications or cell damage)

Question 25

what are three types of treatment of hyperkalemia?

Answer 25

1. stabilizers (Ca++ only if EKG changes are noted) 2. shifters (insulin+glucose, beta-2 agonist, sodium bicarbonate) 3. removers (Kayexalate+sorbitol if colon working, kaliuretic or sodium bicarbonate if kidneys working, dialysis)

Question 26

treatment if hyperkalemia without EKG changes

Answer 26

K+ level is: 5-5.5 --> dietary restriction 5.5-6.5 --> above plus excretion enhancer 6.5-7 --> above plus compartmental shifters >6.5 --> dialysis if above cannot help

Question 27

what are causes of anion gap acidosis?

Answer 27

``` gain of non-HCl exogenous -methanol -ethylene glycol -ethyl alcohol -isopropyl alcohol -salicylic acid -paraldehyde ``` endogenous - diabetic ketoacidosis - L-lactic acidosis (shock) - D-lactic acidosis (gut flora, small bowel loss) - uremia

Question 28

what are causes of hyperchloremic acidosis?

Answer 28

``` loss of bicarbonate/gain of Cl GI losses (diarrhea, ureteral-enteric diversions) renal losses (renal tubular acidosis, excessive saline infusion) ```

Question 29

what tests can support carcinoid?

Answer 29

urine 5-HIAA

Question 30

PCOS patients have high serum levels of what hormones?

Answer 30

C-peptide LH:FSH ratio testosterone NOT PRL

Question 31

what is an intestinal-type adenocarcinoma?

Answer 31

gastric adenocarcinoma | elevated mass with heaped up borders and central ulceration

Question 32

what is linitis plastica?

Answer 32

gastric adenocarcinoma | gastric wall is markedly thickened and regal folds are partially lost

Question 33

what is the "normal" number of antral follicles?

Answer 33

16-30

Question 34

what is normal male: - ejaculate volume - sperm concentration - motility - rapid progressive motility - normal morphology

Answer 34

``` >1.5 mL >15 million/mL >40% >32% >4% ```

Question 35

what is the modified Ferrima-Gallwey Scale?

Answer 35

where hair would distribute in PCOS Part 1: upper lip, chin, chest, anterior abdomen above umbilicus, genitalia to umbilicus Part 2: upper arms/thighs/back/shoulder, lower back/buttocks

Question 36

what is a cold cone biopsy?

Answer 36

a large area of tissue around the cervix is excised for examination

Question 37

what are the stages for cervical cancer? 0 to IV and 5-year survival

Answer 37

0: carcinoma in-situ (100%) I: confined to cervix (85%) II: disease beyond cervix but not to pelvic wall or lower 1/3 of vagina (65%) III: disease to pelvic wall or lower 1/3 vagina (35%) IV: invades bladder, rectum, or metastasis (7%) AKA FIGO staging

Question 38

explain Hodgkin's staging (I - IV)

Answer 38

I: single lymph node region or single extralymphatic site (Ie) II: 2+ sites, same side of diaphragm or contiguous extralymphatic site (IIe) III: both sides of diaphragm or spleen (IIIs) or contiguous extralymphatic site (IIIe) IV: diffuse involvement of extralymphatic sites +/- nodal disease

Question 39

what are major symptoms of Hodgkin's lymphoma?

Answer 39

1. unexplained weight loss > 10% in 6 mo 2. fever 3. night sweats

Question 40

diagnostic criteria for gestational hypertension

Answer 40

BP > 140/90

Question 41

diagnostic criteria for mild preeclampsia

Answer 41

BP > 140/90 proteinuria > 1+ protein:creatinine > 0.3 24h protein > 300 mg

Question 42

diagnostic criteria for severe preeclampsia

Answer 42

``` BP > 160/110 proteinuria > 3+ 24h protein > 5,000 mg creatinine > 1.2 mg/dL elevated transaminase headache, visual changes, upper abdominal pain oliguria, eclampsia, thrombocytopenia, pulmonary edema fetal growth restriction ```

Question 43

explain the triad of preeclampsia

Answer 43

1. vasoconstriction 2. endothelial cell dysfunction/death 3. tissue hypoxia when the burden becomes clinically significant, the result is end-organ dysfunction -as organs are affected, nature of end organ dysfunction becomes predictable

Question 44

what is HELLP?

Answer 44

syndrome of hemolysis, elevated liver enzymes, low platelets

Question 45

relationship between preeclampsia and kidney

Answer 45

glomerular endotheliosis - primary changes: swelling of damaged endothelial cells, leading to partial closure of many capillary lumens - mitosis within an endothelial cell is a sign of cellular repair - diffuse IgM deposition shows nonspecific entrapment of larger proteins in the more permeable glomerular capillary wall, instead of forming immune complexes

Question 46

what are brain and liver related complications of preeclampsia?

Answer 46

- massive intraventricular hemorrhage | - hepatic infarction and necrosis

Question 47

preoperative evaluation of molar pregnancy

Answer 47

- baseline quantitative hCG level - baseline chest XR to check for metastatic disease - complete blood count - blood type and Ab screen - clotting function studies (protime, partial thromboplastin time, fibrinogen) - thyroid function studies, preeclampsia, HELLP syndrome work up

Question 48

early signs of ovarian cancer

Answer 48

1. increased abdominal girth or bloating, with pain/pressure/discomfort 2. fatigue 3. indigestion, early satiety, inability to eat normally, constipation 4. urinary frequency/incotinence (recent) 5. back pain/pressure/discomfort 6. unexplained weight loss

Question 49

what is FIGO staging? (I-IV)

Answer 49

for primary ovarian and fallopian tube cancer | -international federation of gynocology and obstetrics

Question 50

risk factors for cervical intraepithelial neoplasm (CIN)

Answer 50

1. >1 sexual partner, or male partner with >1 sexual partner 2. first intercourse at <18 years 3. male partner with previous partner with cervical cancer 4. smoking 5. HIV infection, or previous STI 6. solid organ transplant 7. history of cervical cancer or HGSIL (high grade squamous intraepithelial lesion) 8. infrequent or absent Pap screens

Question 51

what is the 2001 Bethesda system?

Answer 51

used to grade Pap smears for cervical cancers