Professional Documents
Culture Documents
How do you calculate the A-a Difference in partial pressure of Oxygen, PO2, between the alveolar
gradient? PO2 and arterial PO2 PAO2=FiO2(713) - arterial PCO2/0.8
What causes an A-a gradient A-a gradient is caused by a mismatch between ventilation and
and how is it useful in perfusion. Hypoxemia of pulmonary origin causes an increased A-a
differentiating causes of gradient (>30). Hypoxemia of extrapulmonary origin has a normal
hypoxemia? A-a gradient.
What are some causes of Impaired O2 delivery to the alveoli for gas exchange, e.g. from
ventilation defects? airway collapse due to respiratory distress syndrome or atelectasis.
What are some causes of Decreased or absent blood flow to the alveoli, e.g. pulmonary
perfusion defects? embolus
What are some causes of O2 cannot diffuse across alveolar-capillary interface, e.g.
diffusion defects? pulmonary fibrosis or pulmonary edema. Causes decreased DLCO
What are some causes of A shunt is technically blood going from right to left because of
shunting? heart issues, e.g. right to left shunting from tetralogy of fallot.
Depression of the respiratory center in the medulla (barbiturates,
What are some causes of brain injury); upper airway obstruction (epiglottitis, croup); Chest
hypoxemia with a normal A- bellows dysfunction (paralyzed diaphragm, ALS with degeneration
a gradient? of anterior horn cells).
What are bronchovesicular Normal breath sounds over the main bronchi with an equal
breath sounds? inspiratory and expiratory ratio.
Extra sounds, usually inspiratory, that sound like (you guessed it),
crackles! Early and midinspiratory crackles are due to secretions in
proximal large to medium sized airways. These clear with
coughing. Late inspiratory crackles are due to reopening of distal
airways partially occluded by increased interstitial pressure (fluid,
What are crackles and how transudate, pus). These do not clear with coughing and vary from
are they caused? fine to course
High pitched musical sound usually in expiration. Caused by
inflammation of segmental bronchi and small airways by asthma or
chronic bronchitis; pulmonary edema constricting airway (cardiac
What is wheezing and how is asthma); pulmonary infarction (release of TXA from platelets in the
it caused? embolus causes bronchoconstriction
Low pitched snoring sounds during inspiration or expiration. Due
What are Rhonchi and how to secretions in large airways (bronchus or trachea). Usually clear
are they caused? with coughing, common in chronic bronchitis
High pitched inspiratory sound. Indicates upper airway
What is inspiratory stridor obstruction. Caused by epiglottitis (H. Influenzae), croup
and how is it caused? (parainfluenza)
What are signs and Infects lower respiratory tract and then spreads systemically thus
symptoms of SARS severe respiratory infection and systemic symptoms.
What is Hantavirus Transmission is via inhalation of urine/feces from deer mice in SW
pulmonary syndrome? US. Causes ARDS, hemorrhage and renal failure.
What is the second most
common (bacterial) cause of Chlamydophilia pneumoniae. Has a seroepidemiologic association
atypical pneumonia? with coronary artery disease. Treat with doxycycline.
What is a common bacterial Chlamydia trachomatis from passage through infected birth canal.
cause of newborn Afrebile with staccato cough, conjunctivitis and wheezing. Treat
pneumonia? with erythromycin.
What is the most common Mycoplasma Pneumoniae. Insidious onset with low grade fever. Can
baterial cause of atypical cause bullous myringitis(inflamed Tympanic membrane), cold
pneumonia? autoimmune hemolytic anemia from anti-IgM antibodies.
Describe the signs and
symptoms of Coxiella Atypical pneumonia, myocarditis, granulomatous hepatitis.
Burnetti infection Associated with dairy farmers and vetrinarians.
What are signs and Normal flora in tonsils and adenoids. Can produce draining sinuses
symptoms of Actinomyces in the jaw, chest cavity and abdomen. Pus contains yellow specks
infection? (sulfur granules) which contain the bacteria.
What are signs and
symptoms of Nocardia Granulomatous microabscesses in the lungs. Often disseminates
infection? to CNS and kidneys.
What are signs and Green sputum (pyocyanin), nosocomial pneumonia and pneumonia
symptoms of infection with in CF patients. Often associated with infarction from vessel
Pseudomonas Aeruginosa? invasion.
Most common gram negative that causes lobar pneumonia and
What are signs and typical pneumonia in nursing home patients and alcoholics.
symptoms of Klebsiella Associated with blood tinged, thick, mucoid sputum, lobar
Pneumoniae infection? consolidations and abscesses.
Pneumonia associated with high fever, dry cough, flu like
symptoms. May produce tubulointerstitial disease with destruction
What are signs and of the JG apparatus leading to hyporeninemic hypoaldosteronism
symptoms of infection with (type IV renal tubular acidosis-hyponatremia, hyperkalemia,
Legionella Pneumophila? metabolic acidosis). Urine antigen is an excellent screen.
Venous clot, most commonly from the femoral vein. Risk factors
are Virchow's triad-stasis of blood flow, hypercoagulable states and
trauma to the vessel. Clot breaks off and goes to the lung-size of
What is the pathophysiology the embolus determines what it will block. Large embolus blocks
of a pulmonary major vessels (saddle embolus) while small emboli occlude
thromboembolism? medium and small vessels.
Increase in pulmonary artery pressure, decreased flow to
pulmonary parenchyma which can cause hemorrhagic infarct, see a
What are consequences of red-blue, raised, wedge shaped area that extends to the pleural
pulmonary surface. Fibrinous exudate on the pleural surface and hemorrhagic
thromboembolism? pleural effusion.
How do you treat pulmonary Diuretics, O2, vasodilators-Ca channel blockers, prostanoids,
hypertension? endothelin receptor antagonists, lung transplant
Pulmonary hemorrhage with hemoptysis often preceding renal
What is Goodpasture's failure. Autoantibodies to Type IV collagen in basement membrane
Syndrome? of lung and glomerulus.
"I think I've got the black lung pop…" Coal dust, aka aanthracotic
pigment comes from coal mines, large cities, second hand smoke,
etc. Deposits in alveolar macrophages creating "dust cells."
Fibrotic opacities smaller than 1 cm in upper lobes and coal
deposits adjacent to respiratory bronchioles producing centriacinar
emphysema- simple CWP. Complicated CWP involves large fibrotic
opacities, crippling lung disease (black lung), may have cor
Describe Coal Worker's pulmonale or large cavitating rheumatoid nodules (Caplan
Pneumoconiosis. Syndrome). No increase in TB or primary lung cancers.
Common occupational disease from quartz/silicon dioxide,
foundries, sandblasting and working in mines. Quartz is fibrogenic
and deposits in the upper lungs, activates and is cytolytic to
alveolar macrophages. Macrophages release cytokines resulting in
What is silicosis? fibrosis.
Ground glass appearance on CXR or nodular opacities in more
advanced disease (concentric layers of collagen w/wo central
cavitation). Dystrophic calcification of lymph nodes. Can cause cor
Describe clinical findings in pulmonale or Caplan syndrome and increased risk of lung cancer
silicosis. and TB.
Serpentine asbestos-interstitial fibrosis and lung cancer; amphilobe
asbestos-interstitial fibrosis, lung cancer and mesothelioma.
Deposits in respiratory bronchioles, alveolar ducts and alveoli.
How do asbestos related Comes from insulating pipes, naval shipyards, roofing material,
diseases occur? ceiling tiles, old floor tiles and demolition of old buildings.
Fibers are coated in iron and protein (ferruginous bodies) which are
then pahgocytosed, coated with ferritin and look golden and
beaded in sputum or distal small airways. Causes calcified pleural
plaques which don't predispose to mesothelioma, diffuse interstitial
fibrosis, primary bronchogenic carcinoma (esp if smoker),
What is the pathogenesis of malignant mesothelioma of the pleura arising from serosal cells of
asbestos related disease? the pleura. Can cause cor pulmonale or Caplan syndrome.
What are some features of 2nd most common tumor, greatest smoking association. Tends to
squamous cell carcinoma? be centrally located (mainstem bronchus)
What are common sites for Hilar lymph nodes (most common), adrenal glands, liver, brain,
metastasis? bone
Which cancers are most
commonly responsible for
lung metastasis? Primary breast cancer, colon cancer and renal cell carcinoma.
Where in the lung do tumors Parenchyma, pleura and pleural space (pleural effusions),
commonly metastasize? lymphatics (causes severe dyspnea)
What are common findings Cough, weight loss, chest pain, hemoptysis, dyspnea, superior
in primary lung cancer? vena cava syndrome
Describe an exudate Protein-rich and cell-rich fluid from increased vessel permeability.
Indicates interruption of the thoracic duct. Turbid, milky
appearance. Can be from malignancy, trauma (iatrogenic) or too
Describe Chylous fluid many chylomicrons
Turbid, milky appearance from increased inflammation with
Describe Pseudochylous fluid necrotic debris. Most often from rheumatoid lung disease.
Ratio of pleural fluid protein and LDH to serum protein and LDH.
How do you distinguish PF protein/serum protein <0.5 is transudate, >0.5 is exudate. PF
between exudate and LDH/serum LDH <0.6 is transudate, >0.6 is exudate. PF LDH
transudate? <200 U/L is transudate, >200 U/L is exudate
Commonly seen in tall, thin young men, 20-40 yrs old, increased
risk with smoking. Can be caused by rupture of apical subpleural
blebs (secondary to high negative intrapleural pressure), COPD,
Marfan syndrome, scuba diving, insertion of a subclavian catheter.
How does a spontaneous Loss of negative intrapleural pressure causes collapse of lung.
pneumothorax happen? Sudden onset of dyspnea with pleuritic chest pain.
Penetrating trauma to the lungs, rupture of tension pneumocytes.
Flap like tear in pleura allows air into pleural cavity but prevents its
release resulting in increasing positive intrapleural pressure. This
results in compression atelectasis. Sudden onset of severe
dyspnea and plueritic chest pain, can cause trachea and
What is the pathogenesis of mediastinal structures to deviate to contralateral side. Can cause
a Tension Pneumothorax? compromised venous return to the heart.
Reproductive
Left Gonadal vein to the left renal vein to the IVC. Right ovary/testis drains to right gonadal vein straight to
What vein drains the ovaries/testes? the IVC.
What is the lymphatic drainage of the
Ovaries/Testes? Ovary/Testis drains to the para-aortic lymph nodes.
Where does lymph from the Distal 1/3 of the vagina/vulva/scrotum drains to the superficial lymph nodes. Proximal 2/3 of vagina/uterus
vagina/vulva/scrotum drain to? drains to the obturator, external iliac and hypogastric lymph nodes
What does the suspensory ligament of
the ovaries connect? Connects ovaries to the lateral pelvic wall and contains the ovarian vessels.
What does the Cardinal ligament
connect? Connects the cervix to the side wall of the pelvis and contains the uterine vessels.
What does the Round ligament of the
uterus connect? Contains the Uterine fundus to the labia majora but carries no structures.
What is the round ligament of the
uterus derive from? Derivative of the Gubernaculum. Travels through the round inguinal canal.
What does the Broad Ligament Connects the uterus, fallopian tubes, and ovaries to the pelvic side wall. Contains the ovaries, fallopian
connects? tubes, and round ligaments of the uterus.
What does the Ligament of the ovary
connect? Connects the ovary to the uterus and does not contain any structures.
What does the Genital Tubercle
become? Becomes the Glans Penis or Clitoris
What does the Urogenital Fold
become? Becomes the shaft of the penis or the labia minora
What does the labioscrotal swelling
become? Scrotum and Labia majora
What is the pathway of sperm during (SEVEN UP) Seminiferous tubules to epididymis to vas deferens to ejaculatory ducts (nothing) to urethra to
ejaculation? the penis
Erection-Parasympathetic nervous system (pelvic nerve). Nitric oxide increases cGMP which causes smooth
What is the autonomic innervation muscle relaxation which causes vasodilation and is proerectile. Also Norepinephrine causes an increase in
causing an erection? Calcium which causes smooth muscle contraction which causes vasoconstriction and is antierectile.
Describe the general process of Spermatogenesis begins at puberty with spermatogonia. Full development takes 2 months. Occurs in
spermatogenesis seminiferous tubules. Produces spermatids that undergo spermiogenesis to form mature spermatozoa
Maturation of sperm as they lose their cytoplasmic contents, gain an acrosomal cap and become mature
What is spermiogenesis? spermatozoa
Spermatogonium (diploid 2N) copies genome to make Primary spermatid (Diploid 4N). Primary spermatocyte
Describe the process of divides into 2 secondary spermatocytes (Haploid 2N). The Secondary spermatids divide again to produce 4
spermatogenesis. spermatids (Haploid, 1N). These undergo spermiogenesis to form mature spermatozoa
Hypothalamus releases GnRH which causes FSH and LH release from the anterior pituitary. LH stimulates
testosterone release from Leydig cells which release testosterone into the seminiferous tubules and the
blood. FSH stimulates Sertoli cells to produce Androgen Binding Protein and Inhibin. Testosterone from the
Leydig cells stimulates spermatogenesis and stimulates the Sertoli Cells to nurse the Spermatozoa. Inhibin
Describe the hormonal regulation of from the Sertoli cells feeds back and downregulates FSH release. Testosterone from Leydig cells feeds back
Spermatogenesis. and downregulates LH production and GnRH release.
What are the common Androgens? Testosterone (Testes), Dihydrotestosterone (Converted peripherally) and Androstendione (Adrenal)
Differentiation of the Epididymis, Vas deferens and seminal vesicles. Growth spurt of the penis, the seminal
What are the functions of Testosterone vesicles, sperm, muscle, and red blood cell growth. Deepening of voice, closing of epiphyseal plates (via
in development? estrogen converted from testosterone) and Libido.
What is the function of In early differentiation it causes development of the penis, scrotum and prostate. In later/pubertal
Dihydrotestosterone in development? development it causes prostate growth and sebaceous gland activity.
How is testosterone converted to
DHT? 5 Alpha reductase converts Testosterone to DHT.
What are the sources of Estrogen in a Ovary makes 17 Beta estradiol, Placenta makes estriol and blood/peripheral tissues can aromatize androgens
woman? to estrogen.
What is the function of Estrogen in
development? Development of genitalia (external) and breast, and female fat distribution.
Growth of the follicle, endometrial proliferation, increased myometrial excitability. Upregulates LH, FSH and
estrogen receptors and thus upregulates itself. Feedback inhibition of LH and FSH and then the LH surge.
What are the typical functions of Stimulates prolactin secretion but blocks its action at the breast. Increases transport of proteins, Steroid
estrogen beyond development? hormone binding globulin synthesis, increases HDL and decreases LDL.
How much do estrogens increase in
pregnancy? 50 fold increase in estradiol and estrone. 1000 fold increase in estriol indicates fetal well being.
Pulsatile GnRH from the Hypothalamus causes release of FSH and LH from the anterior pituitary. FSH
stimulates the granulosa cells of the ovaries to increase Aromatase which can then convert androstendione to
Describe the hormonal regulation of estrogen. LH acts on the Theca cells to upregulate Desmolase which convert cholesterol to androstendione.
estrogen. The androstendione goes to the granulosa cells to be converted to estrogen.
What is the source of Progesterone? Corpus Luteum, placenta, adrenal cortex and testes (in men obviously)
What does elevation of progesterone
indicate? Ovulation!!!
Stimulation of endometrial glandular secretions and spiral artery development. Maintains pregnancy.
Decreases myometrial excitability. Increases production of thick cervical mucous, which inhibits sperm entry
into the uterus. Increases body temperature (hence why you take your temp), inhibits gonadotropins (LH
and FSH), relaxes uterine smooth muscle (prevents contraction) and decreases estrogen receptor
What is the function of Progesterone? expressivity.
Granulosa cells respond to FSH and stimulate growth of 10-20 follicles. LH responsive Theca cells stimulate
growth of the corpus luteum and produce androgens which are converted to estrogen by granulosa cells (to
stimulate the developing follicle). Estrogen encourages growth of the endometrium and provides positive
feedback to the anterior pituitary to stimulate release of more FSH/LH leading to the midcycle gonadotropin
What happens during the surge. About 1 week before ovulation, one follicle becomes dominant meaning that it becomes more
proliferative/follicular phase of a responsive to FSH. The follicle secretes lots of inhibin which downregulates FSH and causes atresia of the
woman's cycle? other follicles.
When is follicular growth fastest? 2nd week of the proliferative phase.
What stimulates endometrial
proliferation? Estrogen
A primordial follicle consists of an oocyte surrounded by a single layer of squamuos granulosa cells. The
granulosa cells enlarge and become cuboidal turning the follicle into a primary follicle. The primary follicle
then enlarges and the granulosa cells form more than one layer. The Zona Pellucida then forms around the
oocyte. The structure becomes a secondary follicle when fluid filled vesicles develop among the granulosa
cells and a well developed capsule, Theca layer, becomes apparent around the granulosa cells. The Theca
Describe the maturation of the Follicle has both internal and external layers. It becomes a mature follicle when the vesicles form a single antrum.
(see Reproductive Attachment 2). At full maturity, the oocyte is located in the cumulus mass.
During ovulation, the oocyte is released with some granulosa cells called the corona radiata. The remaining
granulosa cells divide rapidly and enlarge to form the corpus luteum which makes progesterone for the
What happens to the follicle during remainder of the cycle or the beginning of pregnancy. The corpus luteum then degenerates to form the
ovulation? corpus albicans and eventually becomes fibrotic.
What hormonal changes are seen Increased estrogen, increased GnRH and increased GnRH receptors on anterior pituitary, estrogen surge
during ovulation? precedes LH surge. Increased temperature from increased progesterone.
What is Mittelschmerz? Blood from ruptured follicles which can cause peritoneal irritation that mimics appendicitis.
Primary oocytes begin Meiosis I during fetal life but don't complete Meiosis I until just before ovulation. Thus
When does oogenesis begin and when Meiosis I is arrested in Prophase for years until ovulation. Meiosis II arrests in metaphase until fertilization.
is it completed? If there is no fertilization, the secondary oocyte degenerates.
Begins with a diploid Oogonium (2N) which replicates (interphase) to become a diploid primary oocyte (4N).
The Primary oocyte then arrests in Prophase I until ovulation. During ovulation it divides to become a
secondary haploid oocyte (2N) and a polar body which degenerates. It arrests in Metaphase II here until
fertilization. The secondary Oocyte divides again to become a Haploid Ovum (1N) and another polar body
What is the process of oogenesis? that degenerates.
Where does Fertilization most Most commonly happens in the upper end of the Fallopian tube (the ampulla). Typically within a day after
commonly happen? ovulation.
When does implantation into the wall 6 days after fertilization. The trophoblast secretes Beta-HCG which is detectable in the blood 1 week after
of the uterus typically occur? conception and in urine (home test) 2 weeks after conception.
How is lactation induces after labor? The decrease in maternal steroids induces lactation.
How is milk production maintained Suckling increases nerve stimulation which increases oxytocin and prolactin production thus maintaining milk
after birth? production.
What is the role of Prolactin in the
female? PRL induces and maintains lactation and decreases reproductive function.
What is the role of Oxytocin in the
female? Helps with milk letdown and may be involved with uterine contractions.
Where is hCG made? Syncytiotrophoblast of the placenta.
Maintains corpus luteum (thus progesterone) for the first trimester by acting LH. The Placenta synthesizes its
What is the function of hCG? own estriol and progesterone during the 2nd and 3rd trimester and the corpus luteum degenerates.
How is pregnancy detected? hCG is used to detect pregnancy because it appears early in the urine.
What changes in hCG are there in hCG is elevated in Hydatidiform moles, Choriocarcinoma, Gestational trophoblastic tumors (and other tumors
pathologic states? I think)
Decreased Estrogen production due to age linked decline in follicles. Significantly increased FSH, increased
What hormonal changes are seen in LH, increased GnRH. Average age of onset is 51, earlier in smokers. Usually preceded by a few years of
menopause? irregular periods.
What is the main source of Estrogen Estrone from peripheral conversion of androgens. Increased androgens can cause hirsutism (that's why your
after menopause? grandma has a mustache)
What are some symptoms of
menopause? HHAVOC-Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
47 (XXY). Causes testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair
What is Klinefelter's Syndrome? distribution. May cause developmental delay. Usually a Barr body is present (inactive X chromosome)
How does Klinefelter's Syndrome Dysgenesis of seminiferous tubules causes decreased inhibin which leads to increased FSH. Abnormal Leydig
cause infertility? cell function causes decreased testosterone and increased LH and estrogen.
45 (XO). Causes short stature, ovarian dysgenesis (streak ovaries), shield chest, bicuspid aortic valve,
webbing of the neck from cystic hygroma, preductal coarctation of the aorta, no Barr body and primary
What is Turner's Syndrome? amenorrhea.
Describe a double Y male 47 (XYY). Phenotypically normal, very tall, severe acne, antisocial behavior in 1-2%, normal fertility.
What hormonal changes would you
see with a defective androgen
receptor? Increased testosterone and increased LH (female phenotype I think)
Inability to convert testosterone to DHT. Ambiguous genitalia until puberty when the massive testosterone
increase causes masculinization and increased growth of the external genitalia. Testosterone/estrogen levels
What is 5 alpha reductase deficiency? are normal; LH is normal or increased. Internal genitalia are normal.
Cystic Swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast) that presents with
abnormal vaginal bleeding. Most common cause of Choriocarcinoma. See increased Beta-hCG, a
honeycombed uterus, looks like a cluster of grapes (if a cluster of grapes is totally disgusting looking). See
What is a Hyaditiform Mole? an abnormally enlarged uterus.
2 sperm with a completely empty egg. Classically have a snowstorm appearance with no fetus during first
sonogram. Moles can lead to uterine rupture. Treat with dilitation and curettage and methotrexate. Monitor
What is a complete Hyaditiform Mole? Beta-hCG.
What characteristics are seen in a Karyotype is 46,XX or 46, XY. Massively increased hCG, increased uterine size, 2% convert to
complete mole? adenocarcinoma, no fetal parts, 2 sperm +empty egg, 15-20% form malignant trophoblastic disease.
What characteristics are seen in a Karyotype is 69,XXY, slightly increased hCG, no change in uterine size, rare for it to convert to
partial mole? choriocarcinoma, 2 sperm+1 egg, risk of malignancy is less than 5%
What are some common causes of during the 1st weeks- low progesterone levels (no response to Beta-hCG, 1st trimester-chromosomal
recurrent miscarriages? abnormalities, 2nd trimester-bicornate uterus
What is pre-eclampsia? Combination of hypertension, proteinuria and edema.
What is eclampsia? Pre-eclampsia + Seizures
What are some risk factors for pre-
eclampsia? Pre-existing hypertension, diabetes, chronic renal disease and autoimmune disorders.
What is the pathogenesis of Pre- Caused by placental ischemia due to impaired vasodilation or spiral arteries, resulting in increased vascular
eclampsia? tone. May be an issue with implantation.
What is HELLP Syndrome? Hemolysis, Elevated LFT's, Low Platelets from Pre-eclampsia
What are some clinical features of Headache, blurred vision, abdominal pain, edema of the face and extremities, altered mentation,
Pre-eclampsia? hyperreflexia. Lab findings include thrombocytopenia and hyperuricemia.
How do you treat Pre-Eclampsia or Delivery of the fetus as soon as it's viable. Otherwise bed rest, salt restriction, and monitoring/treatment of
Eclampsia? hypertension. Treatment is IV magnesium sulfate and diazepam to prevent seizures of eclampsia.
Premature detachment of the the placenta from the implantation site. Fetal death and DIC may occur.
What is Abruptio Placentae? Increase in risk with smoking, hypertension and cocaine use.
Defective decidual layer allows the placenta to attach to the myometrium. No separation of the placenta after
birth. May cause massive bleeding after delivery. Associated with prior C-Section. Acreta does not penetrate
What is Placenta Acreta? the entirety of the myometrium.
What is Placenta Increta? Just like Placenta Acreta but extends further into the myometrium.
The worst form of Placenta Acreta which involves the placenta extending all the way through the myometrium
What is Placenta Percreta? to the serosa. The placenta may then attach to other organs like the bladder or rectum.
Attachment of the placenta to the lower uterine segment. May then occlude the internal os (so baby can't
What is Placenta Previa? get out). Associated with multiparity and prior C-Section.
Pregnancy that isn't in the uterus. Most often in the Fallopian tubes. Suspect with increased hCG and
What is an Ectopic Pregnancy? sudden lower abdominal pain. Confirm with ultrasound. May be clinically mistaken for appendicitis.
What is the problem with retained
placental tissue? May cause postpartum hemorrhage.
What are some risk factors associated History of infertility, Salpingitis/PID, ruptured appendix (at any point), prior tubal surgery or any lower
with ectopic pregnancy? abdominal surgery, endometriosis.
Greater than 1.5-2 Liters of amniotic fluid. Associated with esophageal and duodenal atresia, causing
What is Polyhydramnios? inability to swallow amniotic fluid. Also associated with anencephaly.
Less than 0.5 Liters of amniotic fluid. Associated with placental insufficiency, bilateral renal agenesis or
What is Oligohydramnios? posterior urethral valves (in men) and thus an inability to excrete urine. Can cause Potter's syndrome.
Atypical appearance of the fetus in the womb as a result of oligohydramnios. Causes clubbed feet,
What is Potter's Syndrome? pulmonary hypoplasia and cranial anomalies.
Describe Dysplasia and Carcinoma in Disordered epithelial growth. Begins at the basal layer of the squamo-columnar junction and extends
Situ of the cervix. outward. Classified as CIN I, CIN II or CIN III (Carcinoma in Situ), depending on the extent of the dysplasia.
What virus is associated with Cervical
dysplasia? HPV 16 and 18
What risk factors are associated with
cervical dysplasia? Multiple sexual partners, smoking, early sexual intercourse, HIV infection
Pretty much the cervical cancer gone really nasty. Often squamous cell carcinoma. Papsmear can catch
Describe invasice carcinoma of the cervical dysplasia (koilocytes) before it becomes invasive carcinoma. Lateral invasion can block ureters
cervix causinf renal failure.
Cervical cell infected with HPV that is undergoing dysplasia. See large nuclei and large ring of cytoplasm.
What is a Koilocyte? See Attachment 3 for some pics.
Most common cause of all tumors in females. Essentially a Fibroid. Often causes multiple tumors with well
demarcated borders. This is a benign smooth muscle tumor and malignant transformation is very rare.
Mostly occurs between 20-40 years old and is often asymptomatic. may cause abnormal uterine bleeding or
result in miscarriage. If bleeding is severe it may cause Iron deficiency anemia. See a whorled pattern of
Describe a Leiomyoma? smooth muscle bundles (doesn't become Leiomyosarcoma). See attachment 4 for a picture.
Bulky, irregularly shaped tumor with areas of necrosis and hemorrhage. Nasty tumor. Typically arises de
novo, not from a Leiomyoma. Highly aggressive tumor with a tendency to recur. May protrude out of the
What is a Leiomyosarcoma? cervix and bleed (yuck!). More common in middle aged women and African American women.
What is the epidemiology of
gynecologic tumors? Incidence- Endometrial>Ovarian>Cervical. Worst Prognosis- Ovarian>Cervical>Endometrial
Premature atresia of ovarian follicles in women of reproductive age. Presents with signs of menopause after
What is premature Ovarian failure? puberty but before age 40. See decreased estrogen but increased LH and FSH b/c no feedback.
Polycystic ovarian syndrome, obesity, Asherman's Syndrome (adhesions), HPO axis abnormalities, premature
what are the most common causes of ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, Cushing Syndrome and adrenal
anovulation? insufficiency
What is a Follicular Cyst? Distention of a ruptured Grafian Follicle. May be associated with hyperestrinism and endometrial hyperplasia.
What is a Corpus Luteum cyst? Hemorrhage into persistent corpus luteum. Commonly regresses spontaneously.
Commonly bilateral or multiple cysts. Due to gonadotropin stimulation. Associated with choriocarcinoma and
What is a Theca Lutein Cyst? moles.
What is a Chocolate Cyst? Blood-containing cyst from ovarian endometriosis. Varies with the menstrual cycle.
What age group most commonly gets
Ovarian Cell Tumors? Most common in adolescents
Malignant, equivalent to a male seminoma, but rarer (1% vs 30%). Sheets of uniform cells with hCG and
What is a Dysgerminoma? LDH.
Rare but malignant. Can develop during pregnancy in mother or the baby. Large, hyperchromatic
syncitiotrophoblastic cells. Increased frequency of theca-lutein cysts. Along with moles, comprise spectrum
What is a Choriocarcinoma? of gestational trophoblastic neoplasia. hCG is the tumor marker.
Aggressive malignancy in the ovaries (testes in boys) and sacrococcygeal area of young children. These are
What is a yolk sac (endodermal sinus) yellow, friable, solid masses. 50% have Schiller Duval bodies that resemble glomeruli. Alpha fetoprotein is
tumor? the tumor marker.
90% of ovarian germ cell tumors. Contain cells from 2-3 germ layers. Mature teratomas/Dermoid cysts are
the most frequent benign ovarian tumors/teratomas. Immature teratomas are aggressively malignant.
What is a teratoma? Struma Ovarii contain functional thyroid tissue. Can present as hyperthyroidism.
Makes up about 20% of ovarian tumors. Frequently bilateral, lined with Fallopian tube-like epithelium.
What is a serous cystadenoma? Benign.
What is a serous cystadenocarcinoma? Makes up about 50% of ovarian tumors, malignant and frequently bilateral.
What is a Mucinous Cystadenoma? Multilobular cyst lined by mucus-secreting epithelium. Benign. Intestine-like tissue.
What is a Mucinous Malignant! Pseudomyxoma peritonei- intraperitoneal accumulation of mucinous material from ovarian or
Cystadenocarcinoma? appendiceal tumor.
What is a Brenner tumor? Benign tumor that looks like the bladder.
What is a Fibroma? Bundles of spindle shaped fibroblasts.
Associated with Fibromas. Triad of ovarian fibroma, ascites and hydrothorax. Causes pulling sensation in the
What is Meigs' Syndrome? groin.
Secretes estrogen-causes precocious puberty. Can cause endometrial hyperplasia or carcinoma in adults.
What is a Granulosa Cell Tumor? See Call-Exner bodies-small follicles filled with eosinophilic secretions. Abnormal uterine bleeding.
What is a Krukenberg tumor? GI Malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma.
What causes squamous cell carcinoma
of the vagina? Secondary to squamous cell carcinoma of the cervix.
What predisposes to Clear Cell
Adenocarcinoma? Affects women who had exposure to DES in utero.
Who is affected by Sarcoma
Botryoides (variant of
Rhabdomyosarcoma) Affects girls < 4 years of age. Spindle shaped tumor cells that are desmin positive.
How do Bartholin's gland cyst
present? Rare. Present with pain in the labia majora. Can result from previous infection.
Small, mobile, firm mass with sharp edges. Most common tumor in those <25 years. See increasing siza
What is a Fibroadenoma of the breast? and tenderness with increasing estrogen such as during menstruation. Not a precursor to breast cancer.
Small tumor that grows in lactiferous ducts. Typically beneath areola. See serous or bloody nipple
What is an Intraductal Papilloma? discharge. Slight (1.5-2X) increased risk for breast carcinoma.
Large bulky mass of connective tissue and cysts with "Leaf like projections." Most common in the 6th
What is a Phyllodes Tumor? decade. Some may become malignant.
How do malignant breast tumors arise Common postmenopause. Arise from mammary duct epithelium or lobular glands. Overexpression of
and when/where are they most estrogen/progesterone receptors on erb-B2 (HER-2 and EGF Receptor) is common. Affects therapy and
common? prognosis. Axillary lymph node involvement is the single most important prognostic factor.
Risk factors are increased estrogen exposure. Increased total number of menstrual cycles, older age at 1st
What are some risk factors for live birth, obesity (adipose tissue serves as a major source of estrogen in post-menopausal women by
malignant breast tumors? converting androstenedione to estrone).
What is a Ductal Carcinom in Situ Malignant tumor of the breast that fills the ductal lumen. Arises from ductal hyperplasia. Early malignancy
(DCIS)? without basement membrane penetration.
Worst and most invasive ductal carcinoma but also most common. Forms firm, fibrous, rock hard masses
What is invasive ductal carcinoma? with sharp margins and small, glandular duct like cells.
What is an invasive Lobular tumor? Malignant breast tumor, often multiple and often bilateral. See an orderly row of cells.
What is a medullary tumor of the
breast? Malignant tumor with a good prognosis. See fleshy, cellular, lymphatic infiltrate.
What is a comedocarcinoma of the
breast? Subtype of DCIS. See ductal caseous necrosis.
What is an inflammatory tumor of the Nasty, malignant tumor with a 50% 5 year survival. See dermal lymphatic invasion by breast carcinoma.
breast? See Peau d'orange-breast skin looks like orange peel.
Eczematous patches on nipples. Paget cells are large cells in the epidermis with clear halo around them.
What is Paget's disease? May also be seen on the vulva. Suggests an underlying carcinoma.
Most common cause of breast lumps after age 25. Presents with premenstrual breast pain and multiple
lesions, often bilaterally. See a fluctuation in size of the mass. Usually does not indicate increased risk of
What is Fibrocystic disease? carcinomas.
Fibrosis-hyperplasia of breast stroma. Cystic-fluid filled, blue dome. Ductal dilation. Sclerosing adenosis-
increases acini and intralobular fibrosis. Associated with calcifications. Epithelial hyperplasia-increase in
What are the histologic subtypes of number of epithelial cell layers in terminal duct lobule. Increases risk of carcinoma with atypical cells.
Fibrocystic disease? Occurs in women >30 years of age.
Breast abscess. During breast feeding. Increases risk of bacterial infection through cracks in the nipple.
What is acute mastitis? Staph Aureus is the most common pathogen.
A benign, painless lump. Forms as a result of injury to breast tissue. Up to 50% of patients may not report
What is Fat Necrosis? trauma.
Results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter's syndrome or drugs
(estrogen, marijuana, heroin, psychoactive drugs, Spironolactone, Digitalis, Cimetidine, Alcohol,
What is Gynecomastia? Ketoconazole).
What is the order of structures in the
breast starting at the nipple? Nipple, Lactiferous sinus, major duct, terminal duct, lobules. All surrounded by stroma
Nipple-Paget's disease, breast abscesses. Lactiferous sinus-Intraductal papilloma, breast abscess, mastitis.
What tumors occur at each of these Major duct-Fibrocystic change, ductal cancer. Terminal ducts-Tubular carcinoma. Lobules-lobular carcinoma,
structures? sclerosing adenitis. Stroma-Fibroadenoma, phyllodes tumor.
How does prostatitis present? Dysuria, frequency, urgency, low back pain.
Hyperplasia (not hypertrophy) of the prostate gland. May be due to an age related increase in estradiol with
possible sensitization of the prostate to the growth-promoting effects of DHT. Characterized by a nodular
enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit.
Often present with increased frequency of urination, nocturia, difficulaty starting and stopping the stream of
What is Benign Prostatic Hyperplasia urine and dysuria. May lead to distention and hypertrophy of the bladder, hydronephrosis and UTI's. Not
(BPH)? considered premalignant. Do see increased free PSA but not rapidly increasing like in cancer.
How do you treat BPH? Use alpha antagonists like Terazosin, tamulosin, which cause relaxation of smooth muscle.
Common in men >50. Arises most frequently from the posterior lobe of the prostate(peripheral zone) and is
most commonly diagnosed by digital rectal exam and prostate biopsy. Prostatic acid phosphatase and PSA
are the most useful tmor markers. See increased total PSA with decreased fraction of free PSA. Osteoblastic
metastases in bone may develop in later stages and appears as lower back pain and an increase in serum
What is Prostatic adenocarcinoma? alkaline phosphatase and PSA.
Undescended testis. Lack of spermatogenesis due to increased body temperature. Also associated with
What is cryptorchidism? increased risk of germ cell tumors. Prematurity increases the risk of cryptorchidism.
How common are testicular germ cell
tumors? 95% of all testicular tumors. May present as a mixed germ cell tumor.
Malignant, painless, homogenous testicular enlargement. Most common testicular tumor, mostly affecting
males age 15-35. See large cells in lobules with watery cytoplasm and a fried egg appearance. These are
What is a Seminoma? radiosensitive, only metastasize late and have a great prognosis.
Malignant, painful tumor with a worse prognosis than a seminoma. Often glandular or papillary morphology.
What is an embryonal carcinoma? Can differentiate and become other tumors and is associated with increased AFP and hCG.
What is a yolk sac (endodermal sinus) Yellow, mucinous tumor analagous to an ovarian yolk sac tumor. See Schiller Duval bodies which resemble
tumor in a man? primitive glomeruli.
Malignant, hCG secreting tumor. Has distinct syncytiotrophoblastic and cytotrophoblastic elements. Causes
What is a Choriocarcinoma in a man? hematogenous metastases.
What is a teratoma in a man? Similar to females except that mature teratomas in men are usually malignant.
How common are testicular non-germ
cell tumors? 5% of all testicular tumors, most of which are benign.
Androgen producing tumor which causes gynecomastia in men, precocious puberty in boys. Contains Reinke
What is a Leydig Cell Tumor? crystals and is golden brown in color.
What is a Sertoli Cell Tumor? Androblastoma from the sex cord stroma.
What is testicular lymphoma? Most common testicular cancer in older men. It's pretty much lymphoma in the testicles.
What is a tunica vaginalis lesion? A lesion in the serous covering of the testis. Presents as testicular masses that can be transilluminated.
What is a Variocele? Dilated vein in pampinoform plexus which can result in infertility. Looks like a bag of worms.
What is a Hydrocele? Increased fluid secondary to incomplete fusion of the processus vaginalis
What is a spermatocele? Dilated epididymal duct
Gray, solitary, crusty plaque, usually on the shaft of the penis or on the scrotum. Peak incidence is in the 5th
What is Bowen's Disease? decade of life. Progresses to invasive squamous cell carcinoma in <10% of cases.
Qhat is Erythroplasia of Queyrat? Red, velvety plaques, usually involving the glans penis. Otherwise similar to Bowen's disease.
What is Bowenoid papulosis? Multiple papular lesions. Affects younger men but isn't usually invasive
What is Squamous Cell Carcinoma of Essentially like any other SCC, just on the penis. Commonly associated with HPV and lack of circumcision.
the penis? More common in Asia, Africa and South America.
What is Peyronie's Disease? Bent penis due to acquired fibrous tissue formation.
What changes are seen in Glycogen and lipid accumulation, extra-cellular matrix changes, prolactin and IGF binding proteins increased,
Decidualization? COX-2 increase which increases PGE2, and influx od dedidual NK cells.
When does Blastocyst hatching occur? When the blastocyst enters the endometrial cavity, about 5 days after fertilization.
What is the Zona Pellucida? Non-cellular, porous layer of glycoproteins around the oocyte.
What proteins characterize Early pregnancy factor, Platelet activating factor, human Chorionic Gonadotropin, Matrix Metalloproteinases
preimplantation of the embryo? and Inhibitors of Matrix Metalloproteinases, Heparin binding-EGF like growth factor receptors
What are the three stages of
implantation? Apposition, Adhesion and Invasion
What is the Decidua Basalis? Decidua that forms underneath the embryo
What is the Decidua Capsularis? Capsule of decidua over the embryo
What is the Decidua Paritalis? Other decidua lining the uterine cavity
What happens to RBC and Plasma
volume and mass in pregnancy? Both are increased but plasma is increased more than RBC. This results in a dilutional effect in hematocrit.
Creatinine clearance is increased. GFR increases fairly significantly. Increased clearance of creatinine and
What happens to GFR and Creatinine urea results in serum creatinine and urea that are really low. Thus normal creatinine and urea are
Clearance during pregnancy? problematic.
Estrogen and progesterone both stimulate the respiratory center. Greater tidal volume and increased
Why does respiratory alkalosis happen respiration rate also cause increased minute ventilation, thus more CO2 is blown off. Thus respiratory
during pregnancy? alkalosis from decreased PaCO2
Why do women get dyspnea during
pregnancy? May be due to decreased CO2 stimulating the respiratory center and causing subjective shortness of breath.
hCG simulates TSH since they share the same alpha subunit. Thus it stimulates T4 secretion during the first
Why are Thyroxin and Cortisol 10 weeks. Estrogen promotes growth of the pituitary and the thyroid and synthesis of thyroid binding
increased in pregnancy? globulin. Thus T4 and cortisol are increased but free T4 and cortisol are the same.
What defines menopause? No menses for one year after age 40.
Waxing and waning of estrogen levels from decreased ovarian function. Depletion of granulosa and thecal
What are the physiologic causes of cells. Lack of response to gonadotropins. Increased LH stimulates androgen production in stromal cells
menopause? (thus hirsutism)
What are non-physiologic causes of Surgical removal or radiation of ovaries. Turner syndrome. Family history of early menopause and left
menopause? handedness (seriously???)
What is the average age of
menopause and how is age at Average age is 51. The age at which it's determined is genetically determined, but smokers reach
menopause determined? menopause early and peri-menopause is mid-to late 40's.
Secondary amenorrhea, hot flushes, night sweats, atrophic vaginitis with pruritis, burning, bleeding and
What are some clinical findings in dyspareunia. Also see mood swings, anxiety, depression, insomnia, decreased libido, urinary incontinence,
menopause? headaches, tiredness, lethargy, and osteoporosis with increased risk of Colle's and vertebral fractures.
What are some labroratory findings in
menopause? Increase in LH and FSH from a drop in estrogen (LH) and progesterone (FSH)
What are some treatment options for
symptomatic menopause? Estrogen replacement, progestins added if the uterus is still present to prevent endometrial adenocarcinoma.
What are risks of long term hormone Thromboembolism, Coronary heart disease, stroke, slightly increased risk for breast cancer, increased risk for
replacement? dementia in women over 65.
What is Hirsutism? Excess hair in normal hair-bearing areas.
What is virilization? Hirsutism plus male secondary sex characteristics
What are male secondary sex
characteristics? Increased muscle mass, acne, enlarged clitoris
Both caused by increased androgens of either ovarian or adrenal origin. In the ovaries, the androgen is
What causes virilization or hirsutism? testosterone, in the adrenals it's DHEA-S
Polycystic ovary syndrome, idiopathic causes, adrenogenital syndrome, insuline resistance, drugs like
androgenic progestins, phenytoin, cyclosporin, minoxidil. Can also be from ovarian tumors like a leydig or
What are some causes of virilization sertoli-leydig cell tumor, adrenal tumors producing Cushing syndrome, decreased steroid hormone binding
and hirsutism? globulin from obesity and hypothyroidism.
Syndrome that occurs around menarche. See increased synthesis of LH and decreased synthesis of FSH.
Increased LH increases androgen synthesis resulting most often in hirsutism. Androgens are then aromatized
to estrogen in adipose cells increasing the risk of endometrial carcinoma. The increased estrogen feeds back
positively on LH and negatively on FSH. Suppression of FSH causes follicle degeneration resulting in fluid
What is Polycystic Ovarian Syndrome? accumulating and producing subcortical cysts that then enlarge the ovaries.
What are clinical findings in polycystic
ovarian syndrome? Menstrual irregularities, mostly oligomenorrhea and often hirsutism, infertility or obesity.
What are some lab findings in PCOS? LH:FSH ratio >2. Increased serum testosterone and androstendione. Increased serum estrogen.
Weight reduction in obese women. Low dose OCP's or medroxyprogesterone to suppress steroidogenesis and
LH. Can use Spironolactone if OCP's are unacceptable to block androgen receptors on the hair follicle. LH-
What is the treatment in PCOS? releasing hormone analogs inhibit ovarian androgen production.
Loss of blood >80 mL per period. It's likely if sheets are stained despite heavy protection. Excessive
What is Menorrhagia? passage of clots indicates that plasmin does not have enough time to dissolve clot.
Painful menses, occuring in approximately 50% of women. Primary type occurs in ovulatory cycles due to
increased prostaglandin PGF-2alpha. See increased uterine contractions from increased prostaglandins. The
What is Dysmenorrhea? secondary type is from endometriosis, adenomyosis, leiomyomas, or cervical stenosis.
What is the treatment for Primary
Dysmenorrhea? NSAID's, OCP, nifedipine, magnesium sulfate
What is the treatment for secondart
Dysmenorrhea? Essentially deal with the underlying disease.
What is dysfunctional uterine
bleeding? Abnormal uterine bleeding that is unrelated to an anatomic cause. Note that this is a diagnosis of exclusion.
What are some types of dysfunctional
uterine bleeding? Menorrhagia, Hypomenorrhea, Metrorrhagia, Menometrorrhagia, Oligomenorrhea, Polymenorrhea
What is most common cause of
irregular bleeding? Anovulatory cycle in 90% of cases but less than 10% due to anovulation during reproductive years.
What causes anovulatory Excessive estrogen stimulation relative to progesterone resulting in an absent secretory phase. It produces
dysfunctional uterine bleeding? excessive endometrial hyperplasia and excessive bleeding.
Inadequate luteal phase resulting in inadequate maturation of the corpus luteum. This causes inadequate
What causes ovulatory dysfunctional synthesis of progesterone and delay in the development of the secretory phase. May see decreased 17-OH
uterine bleeding? progesterone .
How do you treat ovulatory If the follicle size is normal, supplement progesterone. If the follicle size is inadequate, give clomiphene
dysfunctional uterine bleeding? sulfate.
Absence of menses by age 16. Most cases are due to constitutional delay with a family history of delayed
What is Primary Amenorrhea? menses.
What is Secondary Amenorrhea? Absence of menses for 3 months, most commonly due t pregnancy.
What are some causes of Hypothalamic or pituitary dysfunction resulting in decreased LH and FSH which results in decreased estrogen
amenorrhea? and progesterone. Ovarian disorders cause problems in synthesis of estrogen or progesterone.
What are causes of abnormal vaginal Vulvovaginitis, poor hygeine, infection, gonrrhea, sexual abuse, foreign bodies, embryonal
bleeding in a pre-pubertal girl? rhabdomyosarcoma
What are some causes of abnormal
vaginal bleeding between menarche
and 20 years? Anovulatory dysfunctional uterine bleeding, Von Willebrand's disease
What are some causes of abnormal Pregnancy and related complications, ovulatory dysfunctional uterine bleeding, PID, hypothyroidism,
vaginal bleeding between ages 20-40? submucosal leiomyomas, adenomyosis, endometrial polyp, endometriosis
How should you treat a placental Treat prophylactically with IV Ampicillin+Erythromycin followed by PO amoxicillin and erythromycin. If
infection even if culture is negative? culture positive you can give IV penicillin or ampicillin
What is Funisitis? Infection of the umbillical cord
What is Placentitis? Infection of the placenta
What is chorioamnionitis? Infection of the fetal membranes
What complications might arise from
chorioamnionitis? Neonatal sepsis and meningitis. Treat with Cefoxitin or Ticaricillin-Clavulanate
What is Placenta Previa? Implantation over cervical os. Previous C Section is major risk factor
Painless vaginal bleeding, usually second or third trimester. The uterus is soft and non-tender and fetal
How does Placenta Previa present? distress is usually not present.
Do not do a pelvic exam. Transabdominal ultrasound localizes the placenta and transvaginal ultrasound
How do you diagnose Placenta Previa? confirms placenta previa.
Premature separation of the placenta due to formation of a retroplacental clot. This separates the placenta
What is Abruptio Placentae? from the implantation site. This is most common cause of late pregnancy bleeding
Hypertension, smoking, cocaine, advanced maternal age, trauma, chorioamnionitis, premature membrane
What are risks for abruptio placentae? rupture, previous abruptio placentae.
What are the clinical signs of abruptio Painful uterine bleeding, forceful uterine contractions or signs of preterm labor, usually see evidence of fetal
placentae? distress
Direct implantation into muscle without intervening decidua. Causes great risk for hemorrhage during
What is Placenta Acreta? delivery, commonly requiring surgery to control bleeding. Often requires hysterectomy.
Umbilical cord inserts away from the placental edge-the vessels pass to the placenta through the membranes
between the amnion and chorion. Causes increased risk for hemorrhage if the vessels are torn. Deliver by C
What is Velamentous insertion? Section to avoid vessel tear.
What risks do accessory lobes of the
placenta pose? Increased risk of hemorrhage if they are detached.
What can cause an enlarged placenta? Diabetes mellitus, Rh hemolytic disease of the newborn, congenital syphilis
What type of placentas do
Monozygotic twins have? Monochorionic and monoamniotic although they can have dichorionic placentas
What are risk factors for First pregnancy, more common in women <20 years and >35 years, history of previous preeclampsia,
Preeclampsia? positive family history, multiple gestations, african american, thrombocytosis, obesity
Abnormal placentation causing mechanical or functional obstruction of the spiral arteries. The abnormal
What is the pathogenesis of Pre- trophoblastic tissue invades the spiral arteries. Imbalance favors vasoconstriction over vasodilation
eclampsia? (decreased PGE2 and NO, increased TXA2, Ang II and increased sensitivity to Ang II)
What are pathologic findings in Pre-
Eclampsia? Premature aging of the placenta, multiple placental infarctions, spiral arteries show atherosclerosis
Hypertension, proteinuria from leaky capillaries (increased inflammation), dependent pitting edema from loss
What are clinical findings in Pre- of albumin, weight gain, seizures in eclampsia, swollen endothelial cells in glomerular capillaries producing
Eclampsia? oliguria.
What are some other symptoms in Right upper quadrant pain and hepatomegaly, periportal necrosis with increased transaminases, HELLP
Pre-Eclampsia? syndrome
What is a Hyaditiform Mole? Benign tumor of the chorionic villus from an empty egg and 2 sperm or an egg and 2 sperm.
The entire placenta is neoplastic. Dilated swollen villi without fetal blood vessels. No embryo is present.
Ovum 46, XX, lacking maternal chromosomes. The chromosomesare derived from the father, either 2 sperm
What is a complete Hyaditiform Mole? or duplicated 23X sperm in the ovum
Complete mole. Presents with painless vaginal bleeding in fourth, fifth month of pregnancy. Causes severe
Which type of Mole has an increased vomiting, pre-eclampsia, uterus that is too large for gestational age, increased hCG for gestational age, and
risk of Choriocarcinoma? snowstorm appearance on ultrasound.
Not all villi are neoplastic or dilated? Embryo is present but this is triploid. Egg with 23X is fertilized by 23X
and 23Y sperm. (Not that if the embryo is doubled, it's not considered a mole). This has a low risk of
What is a partial Hyaditiform Mole? choriocarcinoma.
malignant tumor composed of syncytiotrophoblast and cytotrophoblast without chorionic villi. Risks are
What is a Choriocarcinoma? complete mole, spontaneous abortion and normal pregnancy
Where does Choriocarcinoma
metastasize? Lungs and vagina-hemorrhagic lesions
What is the composition of amniotic Predominantly fetal urine, initially plasma ultra-filtrate from mom. High salt content causes ferning when
fluid? dried on a slide-good sign of premature rupture of amniotic sac.
What is the quantity of amniotic flud
maintained? Swallowed and recycled by the fetus.
Excessive amniotic fluid. Causes are tracheoesophageal fistula, duodenal atresia, maternal diabetes-
What is Polyhydramnios? maternal hyperglycemia causes fetal hyperglycemia resulting in fetal polyuria.
Decreased amount of amniotic fluid. Caused by juvenile polycystic kidney disease, fetal genitourinary
What is Oligohydramnios? obstruction, uteroplacental insufficiency and premature rupture of membranes.
What can Alpha Fetoprotein indicate in Increased maternal AFP indicates open neural tube defects (often related to Folate deficiency). Decreased
pregnancy? maternal AFP can indicate Down syndrome.
What does the Lecithin to Lecithin is synthesized by type II Pneumocytes which decreases alveolar tension to prevent atelectasis. L:S
Sphingomyelin ratio indicate? ratio >2 indicates adequate surfactant.
What can increase surfactant Cortisol and thryroxine increase surfactant synthesis. Maternal administration of glucocorticoids can increase
production in the fetus? surfactant if the baby must be delivered before term. Insulin inhibits surfactant synthesis.
Where is estriol made in pregnancy? Derived from fetal adrenal gland (DHEA-S) which is aromatized by the placenta.
Ducts are estrogen sensitive. See papillary proliferation called papillomatosis, apocrine metaplasia (change
What is Ductal Hyperplasia? to sweat producing glands), and atypical ductal hyperplasia (increased risk for carcinoma)
What is Mammary duct Main ducts fill up with debris causing dilation, rupture and inflammation. Results in greenish-brown nipple
ectasia/plasma cell mastitis? discharge. May result in skin and nipple retraction stiulating cancer but no increased risk for breast cancer.
Trauma to breast tissue. Microscopic findings are lipid-laden macrophages with foreign body giant cells,
fibrosis and dystrophic calcification. See a painless indurated mass which is painful in the acute stage and
What is traumatic fat necrosis? may produce skin retraction stimulating cancer.
Most common breast tumor in women <35 years. Discrete movable, painless or painful mass. It's a benign
tumor derived from the stroma which proliferates and compresses the ducts. The duct epithelium is not
neoplastic. Estrogen sensitive so increases in size during pregnancy. May spontaneously involute during
What is a Fibroadenoma of the breast? menopause.
Bulky tumor derived from stromal cells. Most commonly benign but can be malignant in some cases-see
hypercellular stroma with signs of mitoses in malignancy. Lobulated tumor with cystic spaces containing leaf-
What is a Phyllodes tumor? like extensions.
Most common cause of bloody nipple discharge in women <50. Develops in the lactiferous ducts or sinuses.
What is an Intraductal Papilloma? No increased risk for cancer.
What are risk factors for breast Prolonged estrogen stimulation, genetic susceptibility, especially if first generation relatives. Prolonged
cancer? estrogen stimulation from either early menarche or late menopause or nulliparity.
What are some genetic markers for
breast cancer? BRCA 1 and BRCA 2, Li-Fraumeni, RAS oncogene, ERBB2, RB suppressor gene
What decreases risk for breast
cancer? Breast feeding, moderate or vigorous physical training, healthy body weight.
What are clinical findings in breast Painless mass in the breast, usually the upper outer quadrant. Skin or nipple retraction, painless axillary
cancer? lymphadenopathy, hepatomegaly and bone pain if there are metastases.
What is the primary screening test for Mammography-detects 80-90% of non-palpable breast masses. Does not distinguish benign from malignant
breast cancer? lesions. Can identify microcalcifications and spiculated masses with or without microcalcification.
Where do microcalcifications most Ductal carcinoma in situ, and sclerosing adenosis. Five or more microcalcifications that are punctate,
commonly occur? microlinear or branching all suggest malignancy
How is estrogen and progesterone
receptor expression related to
prognosis? ER/PR expression generally confers a good prognosis whereas ERB2/NEU has a poor prognosis if amplified.
What is a Ductal Carcinom in Situ Nonpalpable mass. Forms a cribiform pattern (seive like) or comodo like pattern (necrotic center).
(DCIS)? Commonly contains microcalcifications which allow it to be detected on mammogram.
Nonpalpable mass. Virtually always an incidental finding on breast biopsy for something else. Not
What is a Lobular Carcinoma in Situ identifiable on mammography. Lobules are distended with bland neoplastic cells. Usually ER/PR positive.
(LCIS)? Increased incidence of cancer in the opposite breast, that isn't LCIS.
Malignant, invasive breast tumor. Has a stellate morphology. Indurated, gray-white tumor. 1/3 have ERB2
amplification conferring poor prognosis. These look gritty on cut section and have reactive desmoplasia
What is Infiltrating Ductal Carcinoma? causing induration.
Extension of DCIS into the lactiferrous ducts and skin of the nipple producing a rash with or without nipple
What is Paget's disease? retraction. Palpable mass often present, see Paget's cells as well.
What is Medullary Carcinoma of the Invasive tumor associated with BRCA1 mutations. Bluky, soft tumor with large cells and a lymphoid infiltrate.
breast? Most are ER/PR negative.
Invasive tumor that presents with erythematous breast with dimpling of the skin like an orange peel from
What is inflammatory carcinoma of fixed opening of the sweat glands. Plugs of tumor block the lumen of dermal lymphatics causing localized
the breast? lymphedema. Has a very poor prognosis.
What is Invasive Lobular Carcinoma? Invasive mass of neoplastic cells arranged in a linear fashion or in concentric circles.
What is Tubular Carcinoma? Invasive mass that develops in terminal ductules. Increased incidence of cancer in the opposite breast.
What is a Colloid (Mucinous)
Carcinoma? Invasive mass that usually occurs in older women. Neoplastic cells surrounded by extracellular mucin.
Benign glandular proliferation in the male breast due to estrogen from increased enstrogens, decreased
androgens or a defect in androgen receptors. Most often unilateral. Normal in newborns, puberty or the
What is Gynecomastia? elderly.
Cirrhosis causes an inability to metabolize estrogen or to metabolize 17-ketosteroids which are then
aromatized to estrone. Genetic diseases like Klinefelter's and testicular feminization cuase gynecomastia.
Drugs that displace estrogen from SHBG, such as spironolactone or ketoconazole or drugs with estrogen
What causes pathologic activity like DES or digoxin, or androgen blocking drugs like spironolactone or flutamide or that decrease
gynecomastia? androgen production like leuprolide. These all increase estrogen.
What is the most common cause of
Bartholin gland abscesses? Infection with Neisseria Gonorrhea
What is Lichen Sclerosis? Thinning of the epidermis with parchment appearing skin. Most commonly in post-menopausal women.
White plaque like skin lesion (leukoplakia) due to squamous cell hyperplasia. Small risk for developing
What is Lichen Simplex Chronicus? Squamous Cell Carcinoma.
What is a Papillary Hidradenoma? Benign tumor of the apocrine sweat gland. Causes painful nodule on the labia majora.
What is Vulvar Intraepithelial Dysplasia of the vulva, ranging from mild to carcinoma in situ. Strong association with HPV 16 and high risk
Neoplasia? of developing squamous cell carcinoma
What types of lesions result from Yeast and pseudohyphae which should be part of the normal vaginal flora. Causes vaginitis, pruritic vaginitis
infection with Candida Albicans? with a white discharge and fiery red mucosa. Risk factors are diabetes, antibiotics, pregnancy and OCP's
STD-commonly coinfecting with Neisseria Gonorrhea. See red inclusions (reticulate bodies) in squamous
cells which then divide and form elementary bodies which can reinfect other cells. Causes sterile pyuria,
epididdmitis, proctitis (in males obviously) and urethritis, cervicitis, PID, perihepatitis (Fitz-Hugh Curtis),
What type of lesion results form proctitis and bartholin gland abscesses (in females obviously). Can also cause conjunctivitis and pneumonia
infection with Chlamydia Trachomatis? in a newborn.
What types of lesions result from Lymphogranuloma venerum, papules with no ulceration, inguinal lymphadenitis with granulomatous
infection with Chlamydia Trachomatis microabscesses and draining sinuses. Lymphedema of the scrotum or vulva and possibly rectal strictures in
subspecies? women
What types of lesions are seen with Gram negative rod that causes bacterial vaginosis. Most common vaginitis which presents with malodorous
infection by Gardnerella Vaginalis? discharge. Organisms adhere to the squamous epithelium forming clue cells.
What types of lesions result from Gram negative rod that causes Chancroid. Male dominant disease, often correlated with HIV. Causes painful
infection with Hemophilus Ducreyi? genital warts and perianal ulcers with suppurative inguinal nodes which main have draining sinuses.
What types of lesions result from STD with the virus remaining latent in the sensory ganglia. Causes recurrent vesicles that ulcerate on the
infection with HSV-2? vulva, penis, cervix and perianal area. See multinucleated squamous cells on Tzanck prep
Types 6 and 11 associated with Condyloma Acuminata (warts)-fernlike or flat lesions in the genital area.
What types of lesions result from Types 16 and 18 associated with dysplasia and squamous cell carcinoma. See koilocytes in squamous
infection with HPV? epithelium. Cells have wrinkled, pyknotic nuclei surrounded by a clear halo.
How do you treat HPV? Vaccine! Topical podophyllin, alpha-IFN injections and imiquimod cream
Gram negative diplococcus that infects glandular transitional epithelium in sites similar to Chalmydia. Causes
What types of lesions result from prululent lesions and urethritis. Can cause ectopic pregnancy, male sterility, disseminated gonococcemia,
infection with Neisseria Gonorrhoeae? septic arthritis, and Fitz Hugh Curtis.
What are signs of disseminated
Gonococcemia? Septic arthritis in the knee, tenosynovitis of the hands and feet, pustules on the hands and feet
Gram negative spirochete that causes syphillis. Primary syphillis presents with a solitary, painless, indurated
chancre on the penis, labia or mouth. Secondary presents with a maculopapular rash on the trunk, palms
What types of lesions result from and soles along with generalized lymphadenopathy, condylomata lata (flat lesions) and alopecia. Tertiary
infection with Treponema Pallidum? syphillis presents with neurosyphillis, aortitis and gummas.
What are the non-specific screening
tests for Syphillis? RPR or VDRL. Titers should decrease after treatment.
What are the confirmatory tests for
Syphillis? FTA-ABS which is positive with or without treatment
What is the Jarisch-Herxheimer Intensification of rash in primary or secondary syphillis after proteins are released from the dead organisms
reaction? following penicillin treatment
what types of lesion results from Flagellated protozoan with jerky motility which produces vaginitis, cervicitis and urethritis. Causes a
infection with Trichamonas Vaginalis? strawberry colored cervix and fiery red vaginal mucosa with greenish, frothy discahrge.
What is Rokitansky-Kuster Hauser
Syndrome? Absence of the upper vagina and uterus resulting in primary amenorrhea
What is a Gartner's Duct cyst? Remnant of the Wolffian/mesonephric duct which presents as a cyst on the lateral wall of the vagina.
What is a Rhabdomyoma? Benign tumor of skeletal muscle in the vagina (can also be on the tongue or heart)
What is an Embryonal
Rhabdomyosarcoma? Necrotic, grape like mass protruding from the vagina, most often in girls <5 years
What is clear cell adenocarcinoma of Adenocarcinoma of the vaginal wall (pretty self explanatory). Occurs in women with DES exposure since DES
the vagina? inhibits mullerian differentiation-tubes, uterus, cervix and upper third of the vagina
Precursor lesion for squamous cell carcinoma. Produces red, superficial ulcerations in the upper portion of
What is Vaginal Adenosis? the vagina
What are some other DES related Abnormally shaped uterus that thwarts implantation (T shape). Cervical incompetence which can cause
abnormalities? recurrent miscarriage.
What is vaginal squamous cell It's what it sounds like. That said, primary SCC is associated with HPV 16. Most of these are actually
carcinoma? extensions of cervical SCC into the vagina.
What does the cervix actually consist
of? Endocervix and exocervix. The exocervix begins at the cervical os
What lines the exocervix? squamous epithelium
What lines endocervical glands? Mucus secreting columnar cells
How does the endocervical epithelium Endocervical epithelium migrates down to the exocervix where exposure to the acid pH of the vagina causes
transform into the exocervical squamous metaplasia. This area is called the transformation zone and is the most likely location for
epithelium? squamous dysplasia and cancer.
What is the pathogenesis of a Metaplastic squamous cells block endocervical gland orifices resulting in obstruction to outflow of mucus.
Nabothian cyst? This is a normal finding however.
Acute inflammation is often present in the transformation zone, however pathologic acute inflammation may
What is acute cervicitis? be due to infection-Chlamydia, Neisseria, Trichomonas, Candida, HSV, HPV.
What are clinical findings in acute Vaginal discharge, pelvic pain, dyspareunia, pain on palpation (chandelier sign), easy bleeding and
cervicitis? erythematous or exudative cervical os.
What causes chronic cervicitis? Essentially persistence of acute cervicitis
What is follicular cervicitis? Pronounced lymphoid infiltrate with germinal centers caused by Chlamydia Trachomatis.
What is the purpose of a Cervical Pap
test? Screening test for squamous dysplasia and cancer. Evaluate the hormone status of the patient.
What do superficial squamous cells
indicate on Pap? Adequate estrogen
What do intermediate squamous cells
on Pap indicate? Adequate progesterone
What do parabasal cells on Pap
indicate? Lack of estrogen and progesterone.
What types of cells are seen on Pap
from a non-pregnant and pregnant Non-pregnant: 70% superficial, 30% intermediate squamous cells. Pregnant: 100% intermediate squamous
woman? cells from progesterone effect.
Non-neoplastic polyp that protrudes from the cervical os. Arises from the endocervix, most commonly in
What is a Cervical Polyp? perimenopausal or multigravida women.
Describe Cervical Intraepithelial Most cases associated with HPV which produces koilocytes in squamous cells. Associated with early age of
Neoplasia, CIN sexual intercourse, multipe high-risk partners, high risk HPV types, smoking, OCP's and immunodeficiency.
What is CIN I? Mild dysplasia involving the lower third of the epithelium
What is CIN II? Moderate dysplasia involving the lower 2/3 of the epithelium
What is CIN III? Severe dysplasia to carcinoma in situ involving the full thickness of the epithelium
What is the epidemiology of cervical Least common GYN cancer with higher incidence in developing countries. Most are squamous cell carcinomas
cancer? with the same risk factors as CIN
What are clinical findings in cervical
cancer? Abnormal vaginal bleeding, often post coital, malodorous discharge
Cancer often extends down into the vagna and out into the lateral wall of the cervix and vagina. May
What are some characteristics of infiltrate the bladder wall and obstruct the uterus causing postrenal azotemia and possibly death. May
cervical cancer? metastasize distantly, e.g. to the lungs.
What is the sequence to menarche? Breast budding (Thelarche), growth spurt, pubic hair, axillary hair, menarche (mean age is 12.8 years).
When does ovulation occur? Between days 14 and 16
What mediates the secretory phase of
the cycle? Progesterone
Fertilization usually occurs in the ampullary portion of the Fallopian tube. The fertilized egg spends 3 days
there, 2 days in the uterine cavity and then implants in the endometrial mucosa on day 21. There is an
What changes occur after fertilization? exaggerated secretory phase in pregnancy called the Arias-Stella phenomenon.
What initiates menses? Drop-off in serum estrogen and progesterone signalling endometrial cells to undergo apoptosis.
Prepares the follicle of the month, increases aromatase synthesis in the granulosa cells, increased synthesis
What are the functions of FSH? of LH receptors.
Increases synthesis of 17-ketosteroids in the theca interna (DHEA and androstenedione). Convert DHEA to
androstenedione and androstenedione to testosterone. Increase aromatization of testosterone. (Obviously
What are the functions of LH? LH isn't doing these things directly but it uprgulates necessary enzymes)
What hormonal changes are seen in Human chorionic gonadotropin-synthesized in the syncytiotrophoblast lining the chorionic villus. hCG acts as
pregnancy? an LH analog and maintains the corpus luteum to produce progesterone.
Mixture of estrogens and progestins which then prevent the midcycle LH surge and ovulation. Progestin
What is in Oral Contraceptive Pills and arrests the proliferative phase and cause gland atrophy and also inhibit LH directly. OCP's also render the
how do they work? cervical mucus hostile to sperm and alter Fallopian tube motility.
Where does Estradiol come from? Aromatized testosterone in granulosa cells. Primary estrogen in non-pregnant women.
Where does Estrone come from? Weak estrogen produced during menopause from adipose cell aromatization of androstendione
End product of estradiol metabolism. Primary estrogen of pregnancy derived from fetal adrenal, placenta and
Where does Estriol come from? maternal liver.
Where does androstendione come
from in a woman? Equal derivation from ovaries and adrenal cortex
Where does DHEA come from in a
woman? Almost exclusively from the adrenal cortex
Where does testosterone come from derived from conversion of androstenedione to testosterone in the ovaries and adrenal glands. Can be
in a woman? converted to DHT peripherally.
What is Sex Hormone Binding Binding protein for both estrogen and testosterone, mostly synthesized in the liver. Androgens, obesity and
Globulin? hypothyroidism all decrease SHBG
What does SHBG have a greater
affinity for? SHBG preferentially binds testosterone over estrogen thus lack of SHBG can cause hirsutism in women.
Acute inflammation of the endometrium, most commonly as a result of bacterial infection following delivery
What is acute endometritis? or miscarriage. Group B strep, staph a, bacteroides, C. trachomatis, N. Gonorrhoeae, E Coli.
What are clinical findings in acute
endometritis? Fever, uterine tenderness, prululent or foul vaginal discharge and abdominal pain.
What causes chronic endometritis? Retained placenta, gonorrhea, IUD (with infection)
What is the key histologic finding in
chronic endometritis? Like all chronic inflammatory conditions, you see plasma cells
Invagination of the stratum basalis into the myometrium. See glands and stroma thickening in the
What is Adenomyosis? myometrium and general enlargement of the uterus.
What are clinical findings in
adenomyosis? Menorrhagia, dysmenorrhea or pelvic pain
Functioning endometrial glands and stroma located outside the uterus causing cyclic bleeding of gland and
stromal implants. Essentially reverse menses through the Fallopian tube allows inplantation of viable
endometrial cells. Can also be from vascular spread. Most common sites are ovaries, rectal pouch, Fallopian
What is Endometriosis? tubes and intestines.
What are clinical findings in Dysmenorrhea, abnormal bleeding, painful stooling during menses, intestinal obstruction and bleeding during
Endometriosis? menses, increased risk for ectopic pregnancy and enlargement of the ovaries with blood filled cysts
Benign polyp on the endometrium that enlarges with estrogen stimulation. Does not progress to endometrial
What is an endometrial polyp? carcinoma but it can protrude through the cervix into the vagina.
What are clinical findings of an
endometrial polyp? Common cause of menorrhagia, spotting in between periods or after menopause
What is a Hyatid Cyst of Morgagni? Cystic mullerian remnant most often in the fibriated end of the tube. May undergo torsion causing pain.
Inflammation in the pelvis, often due to N. Gonorrhoeae or C. Trachomatis. See Fallopian tubes that are filled
with pus or see hydrosalpinx (clear fluid in Fallopian tube). Causes fever, lower abdominal pain, cervical
motion tenderness, abnormal uterine bleeding, vaginal discharge, mucopurulent discharge in the cervical os,
What is pelvic inflammatory disease? and right upper quadrant pain (FHC Syndrome)
What are some risk factors for PID? Multiple sex partners, vaginal douching, prior PID, unprotected sex
What is Salpingitis Isthmica Nodosa Invagination of the mucosa of the tube into muscle (tubal diverticulosis). Produces nodules in the tube that
(SIN)? narrow the lumen. Most likely a result of infection and can result in infertility and ectopic pregnancy.
Pregnancy that isn't in the uterus. Most often in the Fallopian tubes. Suspect with increased hCG and
What is ectopic pregnancy? sudden lower abdominal pain. Confirm with ultrasound. May be clinically mistaken for appendicitis.
What are risk factors for ectopic Scarring from previous PID, Endometriosis, Altered tubal motility (SIN), progestin only pill, previous tubal
pregnancy? ligation, prior abdominal surgery.
Nulliparity-increased number of ovulatory cycles increases risk, also causes increased risk for surface-derived
ovarian tumors. Genetic factors are BRCA1 and BRCA2 suppressor gene mutations, Lynch syndrome, Turner
What are risk factors for Ovarian syndrome (dysgerminoma), Peutz-Jeghers syndrome (sex cord tumors with annular tubules), history of
cancer? breast cancer, postmenopausal estrogen replacement, obesity
cancers are similar to those seen in the testicle, not many are malignant. Sex cord stromal tumors-derive
from stromal cells, may be hormone producing, most are benign. Metastases-most commonly from breast,
How can ovarian tumors be classified? and stomach (Krukenberg tumors)
Abdominal enlargement from fluid. Malignant ascites may cause induration in the rectal pouch on digital
rectal exam and intestinal obstruction with colicky pain. Palpable ovarian mass in postmenopausal woman,
What are some clinical findings in malignant pleural effusion, torsion and infarction (cystic teratomas), signs of hyperestrinism in estrogen
Ovarian tumors? secreting tumors or virilization in androgen secreting tumors.
What is a common tumor marker of
malignant ovarian tumors? Increased CA-125- only in surface derived tumors
Most common group of primary benign and malignant tumors, many are bilateral. Cysts are lined by ciliated
cells (like Fallopian tubes). A Serous Cystadenoma is benign. A Serous Cystadenocarcinoma is malignant
What is a Serous Ovarian tumor? and has psammoma bodies and dystrophic calcification.
Cysts lined by mucus-secreting cells (like endocervical cells). Cause large multi-nucleated tumors. Seeding
What is a Mucinous tumor of the of tumor produces pseudomyxoma peritonei. A mucinous cystadenoma is benign and may be associated with
ovary? Brenner tumors. A mucinous cystadenocarcinoma is malignant.
What is an endometroid tumor? Malignant tumor associated with endometrial carcinoma. Commonly bilateral
What is a Brenner tumor? Usually a benign tumor that contains Walthard's rests (traditional-like epithelium)
Most common benign germ cell tumor. See ectodermal differentiation (hair, sebaceous glands, teeth) mostly
found in a nipple like structure called Rokitansky Tubercle. A Struma Ovarii subtype has functioning thyroid
What is a cystic teratoma? tissue
What is a Thecoma-Fibroma? Benign tumor associated with Meigs' syndrome (ascited, right sided pleural effusions). Commonly calcify.
What is a Granulosa-Theca cell tumor? Low grade malignant tumor which produces estrogen and contains Call-Exner bodies
What is a Sertoli-Leydig cell tumor? Benign tumor that produces androgens. Pure leydig cell tumors contain cells with crystals of Reinke.
Malignant tumor with a mixture of germ cells (dysgerminoma) and sex-cord stromal cells. Associated with
What is a Gonadoblastoma? abnormal sexual development. May calcify
What is a Krukenberg tumor? Metastasis to the ovary. Contains signet ring cells from hematogenous spread of gastric cancer.
Renal
What does the urinary system Intermediate mesoderm of the posterior wall of the abdominal
derive from? cavity.
How many sets of kidneys are Three sets of kidneys-pronephros, mesonephros and
there? metanephros
What is the pronephros? First kidney. Nonfunctional and disappears by week 4
What are the limb deformities Clubfoot, flipper hands, hyperextensible joints, and compressed
in Potter's Syndrome? thorax
Sloping forehead, flattened nose, recessed chin, low floppy
What are the facial deformities ears. Results from compression of the fetus against the wall of
in Potter's Syndrome? the the amniotic sac.
Why does Pulmonary Fetal lungs mature through swallowing of amnion which allows
Hypoplasia result from Potter's the lungs to expand. Thus decreased amnion causes decreased
Syndrome? expansion of the lungs.
Where do the ureters pass in Water goes under the bridge. Pass across the bifurcation of the
relation to the uterine artery common iliac and pass under the uterine arteries or vas
or vas deferens? deferens and then join the bladder on the posteroinferior side.
What is the arterial supply to
the kidneys? Renal arteries which branch off the abdominal aorta
What is the venous return
from the kidneys? Renal veins drain into the IVC
What is unique about the Left It also drains blood from the left gonad and is longer than the
Renal Vein? right renal vein since it must cross the IVC
Glomerulus surrounded by Bowman's capsule then proximal
What are the structures of the convoluted tubule the the straight portion of the proximal
Renal filtration system in the tubule, then thick descending, the Loop of Henle, then thick
order in which filtrate would ascending limb, then the distal collecting tubule followed by the
pass through? collecting duct.
What is the direction of
urinary drainage out of the Renal pyramids to the renal papillae to the minor calyces to the
kidneys? major calyces
Transitional epithelium as it exits the bladder, then stratified
What types of epithelium line columnar epithelium followed by stratified squamous
the Urethra? epithelium.
What are extraglomerular Contractile cells with receptors for angiotensin II and natriuretic
mesangial cells? factor allowing them to regulate glomerular flow.
What are the clinical No change in ICF, ECF decreased, no change in osm.
implications of Diarrhea? Essenitally volume and solute contraction but equal contraction.
What are the clinical
implications of Adrenal ICF increased, ECF decreased, Osm decreased. Volume and
Insufficiency? solute contracted because not holding onto water and salt
What are the clinical
implications of Infusion of ICF unchanged, ECF increased, osm unchanged. Giving
isotonic NaCl? increasing amounts of fluid and solute so volume expansion.
What are the clinical
implications of high NaCl ICF decreased, ECF increased, osm increased. Volume
intake? expansion but solute pulls water into ECF
What are the clinical ICF increased, ECF increased, osm decreased. Holding onto
implications of SIADH? water and salt but water in excess of salt.
Cx=UxV/Px Volume of plasma from which the substance is
completely cleared per unit of time. C-clearance of X, U-urine
concentration of X, V-urine flow rate, P-plasma concentration of
What is Renal Clearance? X. (mL/minute)
How is Inulin used to calculate Inulin can be used because it is freely filtered and neither
GFR? reabsorbed nor secreted. GFR=Uinulin *V/Pinulin = Cinulin
Creatinine Clearance is an approximate measure of GFR.
How are Creatinine Clearance Slightly overestimates GFR because there is moderate secretion
and GFR related? of creatinine by the renal tubules.
What does it mean if Tubular Solute is being reabsorbed more slowly than water or there is
Fluid (TF)/Plasma (P) >1? net secretion of solute.
What does it mean if TF/P=1 Solute and water are reabsorbed at equal rates
What does it mean if TF/P<1 Solute is reabsorbed more quickly than water.
Affects baroreceptors, limits reflex bradycardia which would
normally accompany pressors. Constricts efferent arterioles-
increased FF to maintain GFR in low volume states. Increases
What is the function of proximal tubule Na/H activity and can stimulate thirst in the
Angiotensin II? hypothalamus.
Released from the atria in response to low volume. Relaxes
vascular smooth muscle via cGMP resulting in increased GFR
What is the function of ANP? and decreased renin.
What is respiratory alkalosis? Decreased PCO2. Compensate with less bicarb reabsorption.
What are some causes of Hypoventilation-Airway obstruction, acute lung disease, chronic
Respiratory Acidosis? lung disease, opiods/narcotics, weak respiratory muscles.
MUDPILES-Methanol, Uremia, Diabetic Ketoacidosis,
What are some causes of Paraldehyde or Phenformin, Iron tablets or INH, Lactic Acidosis,
Anion Gap Metabolic Acidosis? Ethylene glycol, Salicylates
What is Type 1 (Distal) Renal Defect in the collecting tubule's ability to excrete H. Associated
Tubular Acidosis? with hypokalemia and risk for Ca containing kidney stones.
What is Type 2 (proximal) Defect in proximal tubule HCO3 reabsorption. Associated with
Renal Tubular Acidosis? hypokalemia and hypophosphatemic rickets.
Hyperaldosteronism or lack of collecting tubule response to
aldosterone causes hyperkalemia- inhibition of ammonia
What is Type 4 (hyperkalemic) excretion in proximal tubule. Leads to decreased urine pH due
Renal Tubular Acidosis? to decreased buffering capacity.
How much should CO2 rise in For every 10 mmol/L rise in HCO3, PCO2 should increase
response to increased bicarb? 6mmHg
Excretes harmful waste (urea, creatinine, uric acid, etc.),
Maintains acid-base homeostasis, Reabsorbs essential
substances, Regulates water and sodium metabolism, Maintains
What are the general functions vascular tone, Produces erythropoeitin, Maintains calcium
of the Kidneys? homeostasis.
Blood in the urine. Causes fro, the upper urinary tract- renal
stone, glomerulonephritis (dysmorphic RBC's), Renal cell
carcinoma. Causes from the lower urinary tract- Infection,
transitional cell carcinoma, benign prostatic hyperplasia. Drug
What is hematuria and what related causes-anticoagulants, cyclophosphamide (hemorrhagic
are some common causes? cystitis and risk for transitional cell carcinoma)
What is Proteinuria? Protein >150 mg/24 hours or >30 mg/dL via dipstick.
What are diagnostic tests for Dipstick-detects albumin only. Sulfosalicylic acid-detects
proteinuria? albumin and globulins.
Protein <2g/24 hour, not associated with renal disease. Causes
What is Functional Proteinuria? are fever, exercise, CHF.
Postural-only occurs when standing. First void in the morning
What is Orthostatic has no protein but subsequent during the day does have
Proteinuria? protein. No association with renal disease.
Variable protein loss with LMW proteins. Essentially the amount
filtered is greater than the tubular reabsorption. Causes are
multiple myeloma with Bence Jones proteinuria, Hemoglobinuria
from intravascular hemolysis, myoglobinuria from crush
injuries, McArdle's glycogenosis and increases in serum creatine
What is Overflow proteinuria? kinase.
What does black urine after Alkaptonuria. Deficiency of homogentisate oxidase resulting in
exposure to light indicate? buildup of homogentisic acid
What do ketones in the urine Acetone and acetoacetic acid. Ketonuria from DKA, starvation,
indicate? ketogenic diets, pregnancy and isopropyl alcohol poisoning
What does bilirubin in the
urine indicate? Bilirubinuria may indicate hepatitis or obstructive jaundice
What is a fatty cast? Cast of cells with lots of lipid. Indicates nephrotic syndrome
What is a Waxy/Broad cast? Refractile, acellular cast seen in chronic renal failure.
Calcium oxalate crystals-pure vegan diet, ethylene glycol
poisoning, calcium oxalate stone. Uric acid crystals-
hyperuricemia from gout or massive cell destruction after
What types of crystals can be chemotherapy. Triple phosphate crystals-sign of UTI from
seen in the urine and what do urease producing pathogens like Proteus. Cystine crystals-
they indicate? hexagonal crystals seen in Cystinuria
Renal cortex receives 90% of the blood supply. Medulla is
relatively ischemic from reduced blood supply. Renal vessels
are all end arteries with no collateral circulation so occlusion of
any branch produces infarction. Afferent blood flow is
Describe the blood supply to controlled by renal-derived PGE2 and renin. Efferent blood flow
the kidney. is controlled by ATH (vasoconstrictor)
What is minimal change Loss of charge of the glomerular basement membrane which
disease? produces selective proteinuria.
What protein produces the
charge on the glomerular
basement membrane? Heparan Sulfate
Deposition of immunocomplexes such as in membranous
What are some causes of GBM glomerulopathy. Increased synthesis of Type IV Collagen such
thickening? as in DM.
Production of the GBM. Contain podocytes and slit pores
between podocytes which serve as a distal barrier to prevent
What do Visceral Epithelial protein loss in the urine. Podocytes fuse in nephrotic
Cells do in the glomerulus? syndrome, no matter what the cause.
What do parietal epithelial Lining cells of Bowman's capsule. Proliferation causes crescents
cells do in the glomerulus? that encroach upon and destroy the glomerulus.
What other types of conditions Cysts present in liver. Associated with congenital hepatic
are seen in Juvenile Polycystic fibrosis which leads to portal hypertension. Also associated
Kidney Disease? with oligohydramnios and Potter's Syndrome.
What is Membranoproliferative
Glomerulonephritis? Thick GBM, hypercellular glomeruli
What is Focal Segmental
Glomerulosclerosis? Fibrosis involving only a segment of the involved glomerulus
What is Crescentic Proliferation of the parietal cells around the glomerulus (in
Glomerulonephritis? Bowman's Space, thus forming a crescent)
What is Primary Glomerular Involves only glomeruli and no other target organs. Essentially
Disease? something like minimal change disease.
What is Secondary Glomerular
Disease? Involves glomeruli and other organs, e.g. SLE
Look at Golijan page 400 and
go through all the histology Ya, definitely do that :-)
What does a Linear pattern
indicate on Antibodies line upagainst evenly distributed antigens in the
Immunofluorescence? GBM. Think Goodpasture's Syndrome
What does a Granular or
Lumpy Bumpy appearance
indicate on Think immunocomplex deposits in the glomerulus forming
Immunofluorescence? lumps of Ig. Not attached to the GBM.
Electron dense giving them a dark color. Subendothelial are
trapped between the endothelial cell and GBM. Subepithelial
What do immune complexes has passed through the GBM but is stuck in the podocytes.
look like on Electron Intramembranous is within the GBM and Mesangial is within the
Microscopy? mesangium.
How does Type III Immune Circulate and deposit in glomeruli or develop in situ. Immune
complex disease cause complexes then activate complement, procude C5a which is
glomerular disease? chemotactic to neutrophils which attack the GBM.
How does something like
Goodpasture's Disease cause
glomerular damage? Anti GBM antibodies attack the glomerular basement membrane
How does T Cell production of Cytokines cause the GBM to lose its negative charge. Cytokines
cytokines damage the GBM? also damage podocytes causing them to fuse.
What are clinical
manifestations of glomerular Nephritic syndrome, nephrotic syndrome and chronic
disease? glomerulonephritis
What lab tests are indicative of Increased DNAase B titers. ASO is degraded by oil in the skin
Post-Strep and is thus not increased. Streptozyme test is positive (anti-
Glomerulonephritis? DNAase B, ASO, anti-AH and anti-NAD antibodies).
How do you distinguish ATN usually presents with pigmented tubular casts. In
postrenal azotemia from ATN? postrenal azotemia, the sediment is usually normal.
What should you suspect if
there is staph a. cultured in
the urine? Hematogenous spread of the infection to the kidneys.
What are gross and Grayish white areas of abscess formation in the cortex and
microscopic findings in medulla. Microabscesses form in the tubular lumens and
pyelonephritis? interstitium.
What are the clinical and lab Clinical-spiking fever, flank pain, frequency and dysuria. Lab-
findings in pyelonephritis? WBC casts, pyuria, bacteruria, hematuria
What are complications of Chronic Pyelonephritis, Perinephric Abscess, Renal Papillary
Acute Pyelonephritis? necrosis, septicemia with endotoxic shock
What are pathological findings U shaped cortical scars overlying a blunt calyx, visible on IV
in Chroninc Pyelonephritis? pyelogram.
What pathological findings are
seen in obstructive Chronic Uniform dilation of the calyces and diffuse thinning of cortical
Pyelonephritis? tissue.
Chromic inflammation with scarring of the glomeruli. Tubular
What are microscopic findings atrophy-tubules contain eosinophilic material resembling thyroid
of Chronic Pyelonephritis? tissue (thyroidization)
What drugs are associated Penicillin esp. methicillin. Rifampin, sulfonamides, NSAIDs,
with acute drug induced ATN? diuretics
Combination of Type I and IV hypersensitivity. Abrupt onset of
fever, oliguria and rash that resolves with withdrawal of the
What is the pathogenesis of drug. Causes tubular disease with a BUN:Cr <15, eosinophilia
Drug induced ATN? and eosinophiluria
What are some clinical Compression atrophy of the renal medulla and cortex and
findings of hydronephrosis? dilated ureters and renal pelvis
What are risks for Renal Cell Smoking, Von Hippel-Lindau, Adult PKD, obesity, asbestos and
Carcinoma? lead exposure, and gasoline or petroleum product exposure.
AD disease with defect on chr 3. Increased VEGF causes
What is Von Hippel Lindau hemangiobalstomas of the cerebellum and retina and bilateral
disease? renal cell carcinomas.
What are some gross and Upper pole mass with cysts and hemorrhage composed of clear
microscopic findings in Clear cells that contain lipids and glycogen. Tendency for renal vein
Cell renal carcinoma? invasion and invasion into the IVC and right heart.