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Describe the pathogenesis and features of chancroid. painful ulcer w/ ragged border caused by gram (-) rod H. ducreyi; "school of fish" appearance on gram stain
Describe the pathogenesis and features of LGV. papules w/ no ulceration, inguinal lymhadenitis; caused by L1-3 of C. trachomatis
Describe Gardnerella vaginalis infection. gram (-) rod produces bacterial vaginosis w/ malodorous discharge; clue cells = epithelial cells w/ adherent coccobacilli
Embryonal rhabdomyosarcoma girls <5 years old, necrotic, grape-like mass protrudes from the vagina
What happens to plasma volume and RBC mass in pregnancy? Both are increased, but plasma volume increased more causing a drop in Hgb
What effects do progesterone and estrogen have on the respiatory center during pregnancy? stimulate it causing respiratory alkalosis
What is a common cause of hirsutism in women? decreased estrogen, decreased SHBG, increased free testosterone
Define metrorrhagia excessive flow and duration at irregular intervals
Define adenomyosis. invagination of the stratum basalis intot he myometrium; glands and stroma thicken the myometrial tissue
What is the most common cause of endometriosis? reverse menses through fallopian tubes
What is Fitz-Hughes-Curtis syndrome? RUQ pain (perihepatitis) associated with PID
What is Salpingitis isthmica nodosa? invagination of mucosa into muscle (diverticuli) produces nodules in tube that narrows lumen
What is stromal hyperthecosis? vacuolated stromal hilar cells that synthesize excess androgens; associated with obesity
Where do surface-derived ovarian tumors most commonly seed? omentum; abdominal enlargement due to malignant ascites is most common sign
What is placenta accreta? What is the mother at risk for? direct implantation into muscle w/o intervening decidua; risk for hemorrhage during delivery
In placental development, what forms first, amnion or chorion? chorion at day 3, amnion day 8
What is the pathogenesis of preeclampsia? mechanical/functional obstruction of spiral arteries due to abnormal trophoblastic tissue invasion into spiral arteries favoring vasoconstriction; placental ischemia
What is the most common cause of increased maternal AFP? open neural tube defect
What is the most common cause of decreased maternal AFP? Down syndrome
Describe process of estriol synthesis. fetal zone of adrenal cortex makes DHEA-sulfate which is hydoxylated in the liver; placental sulfatase and aromatase convert it to unbound estriol, conjugated in maternal liver, excreted in urine
Mammary duct ectasia dilation, rupture, inflammation of ducts; greenish brown nipple discharge
What are the microscopic findings of traumatic fat necrosis of the breast? lipid-laden macrophages w/ foreign body giant cells; fibrosis and dystrophic calcification
Common breast tumor in women < 35 y.o. fibroadenoma, stroma proliferates and compresses the ducts; increases in size during pregnancy
What is the most common cause of bloody nipple discharge in women < 50 y.o.? intraductal papilloma; develops in lactiferous ducts or sinuses
What is Paget's disease of the nipple? extension of DCIS into lactiferous ducts and skin of nipple; rash w/ or w/o nipple retraction
What lymph nodes do the ovaries/testes drain to? para-arotic lymph nodes
Which nerve controls emission from the penis? ejaculation? emission - hypogastric n (SNS); ejaculation - pudendal n. (visceral and somatic n.)
What protects gametes from autoimmune attack in the seminiferous tubules? blood-testis barrier formed by tight junctions between Sertoli cells
How long does full development of sperm take (spermatogenesis)? 2 months
What is the process of converting spermatid to spermatozoan? loss of cytoplasmic contents, gain of acrosomal cap
What are the functions of DHT in male development? EARLY - penis, scrotum, prostate; LATE - BPH, balding, sebaceous gland activity
When is endometrial receptivity the best? What contributes to it? Days 20-24 ; pinopods (surface epithelial cells) lose their microvilli and develop smooth protrusions (after peak in progesterone)
5-alpha reductase deficiency ambiguous genitalia until puberty when testosterone surges
What is a common cause of death in preeclampsia? cerebral hemorrhage and ARDS
Which type of ovarian cyst is associated with choriocarcinoma? theca-lutein cysts
Describe Paget cells large cells in epidermis with clear halo
What are the microscopic findings of a testicular seminoma? large cells in lobules with watery cytoplasm, "fried egg" appearance
Which type of testicular cancer is painful? embryonal carcinoma; worse prognosis than seminoma; often glandular/papillary
What is a PGE2 analog that causes cervical dilation and uterine contraction? Dinoprostone
Which type of ovarian cyst is associated with endometrial hyperplasia? follicular cyst
What are the microscopic findings of serous cystadenocarcinoma? epithelial cells in papillary arrangement w/ psammoma bodies
What is a Schiller Duval body? papillary structure w/ central blood vessel, resembles a glomeruli
What is the most common benign ovarian tumor? dermoid cysts; will see calcifications; presents as a single mural mass (Rokitanski nodule)
Where does gestational choriocarcinoma spread to? lungs (hematogenous)
What is the histologic finding in Medullary carcinoma of the breast? lymphocytic infiltrate
Where do the islets of Langerhans arise from? Where are they most numerous? pancreatic buds; tail of the pancreas
What interactions keep the alpha and beta chain of human proinsulin together? disulfide bonds between cysteine residues
How does Cortisol have permissive effects on NE and Epinephrine? upregulates alpha1 receptors on arterioles
How does Mg affect PTH? Decr free Mg, Decr PTH secretion; Common causes: diarrhea, aminoglycosides, diuretics, alcohol abuse
Which endocrine hormones use IP3 as signaling pathway? GnRH, GHRH, Oxytocin, ADH (V1), TRH = "GGOAT"
Which endocrine hormones use cAMP as signaling pathway? FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calicitonin, Glucagon = "CG is a FLAT CHAMP"
Which endocrine hormones use tyrosine kinase as a signaling pathway? Insulin, IGF-1, FGF, PDGF, Prolactin, GH
What is the function of thyroid peroxidase? oxidation and organification of iodide and couple of MIT and DIT
How do thyroid hormones increase BMR? increase Na/K ATPase activity and increase O2 consumption
What is the most common tumor of the adrenal medulla in children? What do you look for in uine? neuroblastoma (N-myc oncogene), anywhere along sympathetic chain; look for HVA (DA breakdown)
What are Hurthle cells? What are they characteristic of? epithelial cells w/ eosinophlic granular cytoplasm; Hashimoto's thyroiditis
Which HLA is Hashimoto's associated with? HLA-DR5
What are some clinical sx of Subacute (de Quervain's) thyroiditis? painful thyroid gland w/ granulomatous inflammation; elevated ESR, follows flu-like illness
What is the Jod-Basedow phenomenon? thyroxtoxicosis occurs if a pt with a iodine deficiency goiter is made iodine replete
Which type of thyroid cancer demonstrates nests of polygonal clear cells with congo red (+) amyloid deposits? Medullary Carcinoma, associated with MEN 2a and 2b syndromes
What is the mutation in Albright's hereditary osteodystrophy? GNAS1 which encodes certain G proteins
What are the HLA associations with DM1? HLA-DR3 and DR4
What is the most common tumor of the appendix? When will you see sx and what are they? carcinoid tumor; only see sx if mets to other areas (liver clears it); flushing, diarrhea, right-sided valvular disease, wheezing
What gene mutation do MEN 2a and 2b have? What is its function? ret - transmembrane receptor tyrosine kinase
What are the side effects of the 1st gen sulfonylureas (chlorpropamide, tolbutamide)? disulfram-like effects; acetaldehyde syndrome
What is the probably MOA of Metformin? alters intracellular enzymes to decrease gluconeogenesis and incr glycoslysis; decreases insulin resistance
What are the side effects of the thiazolidinediones? wt gain, edema, hepatotoxicity - check LFTs!!
What is the MOA of Exenatide? incr insulin, decr glucagon release (GLP-1 mimetics)
What type of visual disturbance is caused by a pineal gland tumor? Parinaud's syndrome (paralysis of upward conjugate gaze)
What is the most common cause of hypopituitarism in children? craniopharyngioma (benign Rathke's pouch tumor); cystic w/ hemorrhage and calcifications
What is the most common cause of death in a pt with acromegaly? cardiomyopathy
Describe the pathogenesis of Hashimoto's thyroiditis cytotoxic T cells destroy parenchyma (type IV HSN); IgG Ab block TSH receptor; antimicrosomal and thyroglobulin Ab DEVELOP but have no causal role
What is the cause of yellowing of the skin in hypothyroidism? less conversion of beta-carotenes into retinoic acid
What happens to T3 conversion in Euthroid Sick Syndrome? an OUTER ring deiodinase is blocked and INNER ring deiodinase converts T4 to inactive reverse T3
What are the functions of calcitriol? incr Ca reabsorption in duodenum, incr phosphorus reabsorption in jejunum and ileum, incr bone resorption (induces monocytic stem cells to become osteoclasts)
How can Primary HPT lead to PUD? Ca stimulates gastrin, stimulates gastric acid secretion
What is the most common cause of hypophosphatemia in the hospital setting? respiratory/metabolic alkalosis activates PFK-1 which leads to phosphorylation of glucose
What is a good screening test to distinguish b/w the different types of CAH? 17-OH progesterone (Incr in 21, 11 OH deficiency but Decr in 17OH deficiency)
What enzyme converts NE to EPI? Where is it found? N-methyltransferase; adrenal medulla and organ of Zuckerkandl
What are the clinical findings of neuroblastoma? opsoclonus-myoclonus syndrome: myoclonic jerks of extremities and chaotic eye movements
What is the treatment for peripheral neuropathy associated with DM? duloxetine, topical capsaicin, amitriptyline
What electryoltes are important to watch when treating a pt with DKA? potassium (rapid shift back into cells and lost in osmotic diuresis) and phosphate (follows glucose into cells)
What disorders are associated with TYPE I polyglandular syndrome? AR; Addison's disease, Primary HypOparathyroidism, mucocutaneous candidiasis
What disorders are associated with TYPE II polyglandular syndrome? AD; HLADR3 and DR4; Addison's disease, Hashimoto's thyroiditis, DM1
What are the clinical signs of fasting hypoglycemia? neuroglycopenic: dizziness, confusion, HA, seizures, visual disturbances, coma
What are the microscopic findings of a craniopharyngioma? nests and cords of sqamous or columnar cells in loose stroma, resemble embryonic tooth bud; tumor is often cystic and filled yellow cholesterol remnants
Define Plummer disease. hyperthyroidism, nodular goiter, absence of exopthalmos
Besides MEN IIa and IIb, what are diseases can pheochromocytoma be associated with? Neurofibromatosis or von Hippel-Lindaus
What are the clinical features of Maturity-onset diabetes mellitus of the young? AD; mild hyperglycemia and hyposecretion of insulin, but no loss of beta cells
What are the clinical features of Cretinism? developmental delay, dwarfism, protuberant abdomen, macroglossia
Created by: ash0403



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