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Male Repro, Female Repro, Endocrine, Neuro, Derm

Psychogenic causes of ED PA (perf anx-- not Prince Albert), strained relationship, depression, psychosis
"Organic" causes of ED neurogenic, hormonal, vascular, drug side-effects, mechanical/anatomical
Erection (involuntarily) lasting more than 4-6 hours priaprism
Causes of primary priaprism malfunction in the blood vessels and the nerves in the penis
Causes of secondary priaprism misuse of ED meds. Some antidepressant and anxiolytic medications may also cause priapism. Blood thinners and other HTN drugs may also sometimes cause the condition
Risk factors for penile cancer Old age, smoking, HPV, UV exposure, "AIDS patient." Shahid is obsessed with genital hygiene so add uncircumcised & poor foreskin washing.
Disorders of scrotum & testes crytpoorchidism, hydrocele (fluid in tunica vaginalis), hematocele (blood in tunica vaginalis), spermatocele (sperm CYST in the epididymis), variocele (varicosities of pampiniform plexus of veins supplying the testes), testicular torsion, epididymitis
Cryptoorchidism consequences sterility (95% of cases). But also 6-fold increased risk of malignancy. (Also possible psychological effects of empty scrotum).
Classify testicular tumors. Stage 1= confined to testes, epididymis, spermatic cord. Stage 2=spread to retroperitoneal LN and BELOW DIAPHRAGM. Stage 3=spread beyond retroperitoneal LN or above diaphragm
Which testicular tumors are most common? GERM CELL IN ORIGIN (as opposed to sex cord/gonadal stroma)
What may be a special manifestation of Leydig cell tumor? they often produce either testosterone or estrogens, and their presence can cause PRECOCIOUS PUBERTY in pre-adolescent males
What are the causative organisms of acute bacterial prostatitis? usually E. coli (but others include pseudonomas, klebsiella, and proteus)
What are the symptoms of acute bacterial prostatitis? fever & chills, "irritative" voiding symptoms (frequent, urgent, painful), dull rectal or perineum pain, swollen, tender, warm prostate on digital exam. (Urinalysis shows pyuria, bacteriuria, hematuria.)
What are the characteristics of benign prostatic hyperplasia (BPH)? large, discrete lesions in the PERIURETHRAL region of the prostate (NOT peripheral zones-- these are affected by prostate CANCER)
What is the pathology of benign prostatic hyperplasia (BPH)? "truly a hyperplastic process": hyperplasia of GLANDS (epithelium) + increased fibromuscular STROMA
What are the hormonal influences of carcinoma of the prostate? testosterone "plays a role"
What are the sites of metastases of carcinoma of the prostate? local LN and vertebrae, "other bones," internal organs
What are the risk factors for carcinoma of the urinary bladder? Smoking "accounts" for 60% of cases. Exposure to industrial dyes/solvents accounts for 15%.
What are the histologic types of carcinoma of the urinary bladder? 90% are transitional cell carcinomas
What are the clinical features of carcinoma of the urinary bladder? Blood in urine (gross or microscopic), "chronic or intermittent." Most patients fail to have ´signs´ "b/c of its superficial nature"
Causes of vaginitis in premarchal women? Usually bugs or FB :)
Causes of vaginitis in WOCBA? Candida (fungus), trichomonas (fungus), gardnerella (bacteria)
Causes of vaginitis in PMM? atrophic vaginitis ;(
Characteristics of cervical polyps Red velvet cupcakes (but hanging like grapes)
Symptoms of cervical polyps post-coital bleeding and/or spotting between periods
Incidence of cervical polyps MOST COMMON CERVICAL LESION
Treatment of cervical polyps Excision and examination
Risk factors for cervical cancer Total life time "activity"/exposure down there, so: start early (pregnancy, marriage), lots of pregnancies, lots of partners (or partner with lots of partners), OC, HPV. Also smoking and immunosuppression.
Clinical features of cervical cancer intra-epithelial neoplasia typically preceeds frank cancer (by 15 years). Cervical cancer can be ASYMPTOMATIC. Or there can be post-coital bleeding.
Dx procedure for cervical cancer Pap smear
Endometritis Inflammation or irritation of the lining of the uterus (endometrium) d/t chlamydia, gonorrhea, or other bacteria
Endometriosis the presence of endometrial tissue outside of the uterus (typically on the ovaries, FTs, or within the peritoneal cavity or cul de sacAdn)
Adenomyosis uterine thickening that occurs when endometrial tissue (GLANDS & STROMA) moves into the outer muscular walls (MYOMETRIUM) of the uterus
Leiomyoma aka fibroids= benign neoplasm of smooth muscle tissue origin. "Most common pelvic tumor"
Pathogenesis of endometriosis Suspected to involve "retrograde" or regurgative menstruation (up and out the FTs and into the peritoneal cavity)
How to dx endometriosis Triad of symptoms: pain at menstruation, pain at intercourse, infertility. THE ONLY METHOD OF ACCURATE DX IS LAPAROSCOPY.
Manifestations of 3 types of leiomyomas INTRAmural and SUBserosal typically cause only pressure/pain, but SUBmucosal more likely to cause BLEEDING, necrosis and infection.
Complications of 3 types of leiomyomas Subserosal (and intramural) tumors can compress the rectum and urinary bladder. Submucosal tumors tend to grow into endometrial cavity and cause menstrual irregularities and endometrial BLEEDING (necrosis & infection).
Name the 3 tyypes of leiomyomas SUBmucosal, SUBserosal, INTRAmural
Most common form of pelvic tumor MYOMA/LEIOMYOMA (of the 3 tyypes, INTRAmural is most common)
Lesion caused by HSV2 painful, recurrent, grouped blisters on the VULVA or PERIANAL skin
Lesion caused by HPV genotypes 6 and 11 produce labial, vaginal, cervical warts (condylomae)
Lesion caused by syphilis primary syphilis produces vulvar or penile CHANCRE
Chancre usually occurs (penis, labia, cervix, anorectal area) 3 weeks after syphilis infection; it is a single, red papule that gradually begins to erode, forming a painless, clean ulcer with a smooth, raised border. (Extragenital sites include lips and tongue!)
Risk factors for PID swinging, young single chick: >24 years old, multiple partners, no live births. (also history of PID, but that's kind of a DUH)
Potential complicatios of PID Fallopian tubes become red, swollen, pus filled. Tubo-ovarian ABSCESS may develop as infection spreads to ovaries. PERITONITIS may result. Other risks/complications include INFERTILITY and ECTOPIC PREGNANCY.
Most common site for ectopic pregnancy? The F tubes
Predisposing factors for ectopic pregnancy? PID, history of ectopic pregnancy, use of fertility drugs to induce ovulation, morning after pill or failed contraception. Other weird things on list: therapeutic abortion, tubal ligation or reversal, intrauterine exposure to DES, "infertility."
Manifestations of PCOS? menstrual irregularities, infertility, virilization/hirsutism (all brought on by hormonal disturbances). LH levels will be high, with normal FSH and estrogen numbers.
Pathogenesis of PCOS? Hormonal d/o or the H-P-O axis with pathologically enlarged ovaries studded with (follicular) cysts
Most common GYN cancer? UTERINE (endometrial) CANCER IS #1!! (ovarian cancer is #2-- but OVARIAN cancer is #1 cause gyn cancer cause of death)
Significance of Krukenberg tumor? is a metastasis from cancer SOMEWHERE else in the body (most often from stomach cancer, but sometimes also intestine or even breast)-- to the OVARIES!!
Physical symptoms of PMS Painful, swollen breast, bloating/ab pain, headache/backache
Psychologic symptoms of PMS Depression, irritability, anxiety, "behavioral changes"
Causative agent of acute mastitis? Pyogenic bacteria (most often Staph aureus)
How common is fibrocystic breast disease? MOST FREQUENT "LESION" OF THE BREAST
What are the pathological changes in fibrocystic breast disease? fibrosis and cyst formation
What are the manifestations of fibrocystic breast disease? Pain, nodularity, (often extreme) sensitivity upon palpation
What is the age distribution for fibroadenoma of breast? Found in women from 15 to 35 ("most common benign tumor of the breast")
What are the examination findings for fibroadenoma of breast? "well-encapsulated mass, 2-5 cm in diameter," solitary and freely movable (composed of fibrous stroma & glandular epithelium). Easily removed surgically-- and does not recur.
Risk factors for breast cancer? Genetics factors (BRCA1/2 mut), white race>AA>Asian, family history, increased lifetime exposure to estrogen (=early menarche, late menopause, no kids, late first kid, HRT, high fat diet), BREAST IRRADIATION (!!), old age, other cancers (ovarian, uterine)
Clinical presentation of breat ca? Possible mass on palpation, smaller tumor by mammography, possible mastodynia (although Shahid initially said "cancers do not create pain"). Late stage c/b nipple retraction, "eczematoid reaction," discharge
Causes of male infertility? (one set of answers) Problems with sperm (azoospermia (no sperm), oligospermia (small amount), asthenospermia (sperm not feeling well)
What are the causes of male infertility? (a second set of answers) variocele, ejac dysfx, HYPERprolactin, HYPOgonadism, infection, anti-sperm Abs, obstruction, congenital abnormalities
Hallmarks of pre-eclampsia HTN, edema, proteinuria
Hallmarks of eclampsia HTN, edema, proteinuria, SEIZURES
Causes of hyperthyroidism Autoimmune (Graves'), goiter, tumor (thyroid adenoma), misuse of thyroid replacement hormones (factitious thyrotoxicosis)
Manifestations of hyperthyroidism Irritability, anxiety, restlessness, heat intolerance, increased sweating. Tachycardia, palpitations. Increased appetite, diarrhea, weight loss. Thin, silky hair and skin. Dyspnea.
Etiology of Graves' disease autoimmune d/o caused by abnormal stimulating of thyroid by Abs
Precipating factors for thyroid storm stress, DKA, thyroidectomy
Manifestations of Graves' disease bulging eyes, swollen tibial crests, enlarged thyroid
Manifestations of thyroid storm VERY HIGH FEVER. Tachycardia/angina. SEVERE CNS EFFECTS (agitation/delirium)
Consequences of the hyperCa* in hyperparathyroidism Calcification of soft tissue. Kidney stones. Heart electrical problems. Muscle weakness.
Manifestations of hyperparathyroidism Stones, bones, moans, groans
Causes of Cushing's (syndrome) adrenal tumor, ectopic production of ACTH by small cell lung carcinoma. WIKIPEDIA SAYS... most common cause of Cushing's syndrome is exogenous administration of glucocorticoids used to treat other diseases such as asthma, RA, or after an organ transplant.
Manifestations of Cushing's syndrome moon face, buffalo hump, muscle (limbs) wasting, osteoporosis, central obesity
Pathophysiology of adrenogenital syndrome congenital deficiency of enzyme necessary for synthesis of cortisol (this results in excess production of ACTH and then excess production of adrenal androgens)
Manifestations of adrenogenital syndrome freakishly large penis in baby boys, ambiguous genitalia bodering on hemaphroditism in baby girls
What are the manifestations of adrenocortical hypofunction (Addison’s disease)? "Addled" by fatique, nausea/diarrhea, weight loss, hypotension, syncope, hyperpigmentation of skin ("fadded pig")
What is pheochromocytoma? (literally, "dusky color growing cell") Usually a benign tumor of MEDULLA of adrenal glands IN ADULTS. (Dx´d by "vanilla" acid in urine: VMA). There can be paroxysmal HTN.
Compare the characteristics of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. DKA is an acute complication of, mostly, Type 1. HHS is an acute complication of, mostly, Type 2.
Compare the characteristics of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. DKA is overproduction of ketones (which are acidic) by the liver as it breaks down fats for fuel (instead of sugar-- since there is no insulin). Hyperosmolar hyperglycemic state is hyperosmolarity of the blood d/t extremely high levels of GLUCOSE in it.
What is the pathogenesis of polyuria, polydipsia, and polyphagia in diabetes mellitus? Too much sugar in blood tells KD to pee, pee, pee. That results in dehydration/thirst. The "big appetite" comes from "abnormal utilization of protein/carbs/fats" (because there is no insulin to break down sugar)
What is the pathogenesis of retinopathy in diabetes mellitus? "Microangiopathy" of retina leads to microaneurysm, hemorrhage and ischemia/infarct (of retina)
Define stroke interruption of blood flow to cerebral vessel
Casues of ischemic stroke THROMBUS (usually in atherosclerotic vessel)
Causes of hemorrhagic stroke HTN, aneurysm, arteriovenous malformation (hemorrhagic stroke is bleeding into brain tissue from a ruptured BV)
Risks for cerebral aneurysm Polycystic kidney disease, coarctation of aorta
Define cerebral aneurysm Abnormal bulge or ballooning of a BV supplying the CEREBRUM (typically at arterial bifurcations)
What is the pathophysiology of multiple sclerosis? immune medicated inflammatory disease that attacks myelinated axons of the CNS
What are the MRI findings in multiple sclerosis? "periventricular plaques," as well as multiple focal demyelination in brain & spinal cord
What are CSF findings in multiple sclerosis? increased levels of IgG in many patients
What are the pathophysiological processes involved in Alzheimer’s disease? loss of neurons and synapses in cerebral cortex and some subcorticoid regions
How do β-amyloid proteins contribute to the pathology of Alzheimer’s disease? deposition and aggregation of beta amyloid proteins lead to neuronal death
How do neurofibrillatory tangles contribute to the pathology of Alzheimer’s disease? NFTs are aggregates of hyperphosphorylated tau protein, In its hyperphosphorylated state, the tau protein is unable to bind to the microtubules and they become unstable and begin disintegrating.
Which neurotransmitter is DECREASED in the CNS in Alzheimer’s disease? acetycholine
What are the manifestations of early stage Alzheimer’s disease? loss of short-term memory, problems with word finding, mood swings, personality changes. Agnosia (problems identifying objects). Apraxia (problems performing previously learned motor activities). Aphasia (impaired ability to use or comprehend language).
What are the manifestations of late stage Alzheimer’s disease? Inability to perform the tasks of daily living. Inability to walk. Inability to feed oneself. Complete loss of short- and long-term memory. Incontinence. Inability to swallow. Could eventually become mute.
What are the screening tests for Alzheimer’s? short-term memory test (also "formal mental state examination")
What are the diagnostic tests for Alzheimer’s disease? LAB: Complete Blood Count, Liver Funtion Test (??), Thyroid Stimulating Hormone, B12 levels RADIOLOGY: CT or MRI (to rule out other causes)
What are the bacteria that most commonly cause meningitis in neonates? Staph agalactiae, Listeria, E. coli
What are the bacteria that most commonly cause meningitis in adults? Staph pneumoniae
What are the CSF pictures of bacterial meningitis? the bacteria feed on sugar, so GLUCOSE levels greatly reduced. Neutrophil (and protein) counts elevated. (Makes sense since neutrophils would multiply to fight off bacterial pathogen.)
What are the CSF pictures of viral meningitis? increase in B lymphocytes ("mononuclear cells"). Makes sense since B cells make Abs. Protein levels may or may not be elevated. Glucose normal.
What is amyotrophic lateral sclerosis (ALS)? loss of lower motor neurons of spinal cord/brain stem and upper motor neurons of corticospinal tracts. Degeneration of upper and lower motor neurons leads to muscle weakness and atrophy through the body.
What is "a known cause" of ALS? 5-10% of cases familial (fALS), autosomal dominant. (25% of these are caused by mutation of SOD1 gene in Chromosome 21!)
What is the genetic basis of Huntington disease? a trinucleotide repeat disorder (CAGCAGCAGCAG). Instead of a single glutamine (CAG), you end up with a "polyglutamine tract." >36 repeated CAG sequences --> cytoplasmic protein Huntington; >36 repeated CAG sequences --> mHtt.
What are symptoms of Huntington disease? CHOREA: jerky, hyperkinetic, sometimes dystonic movements involving all parts of the body
What is the pathophysiology of Huntington disease? atrophy of the CAUDATE NUCLEUS and PUTAMEN (of basal ganglia)
Give examples of prion diseases. In humans, Creutzfeldt-Jakob Disease (CJD and vCJD) and (in Central Africa and New Guinea) kuru. In cattle, Bovine Spongiform Encephalopathy (BSE).
Which prion disease is the most common? CJD
What is the pathogenesis of prion diseases? Problem with PrP protein in neurons: presence of abnormal "beta-pleated sheet" instead of normal alpha-helix isoform. The mutated form is resistant to "diegestion" by proteases, and accumulation of PrP in neural tissue (and DEMENTIA) ensue.
What are the causes of neural tube defects? Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, a portion of the spinal cord can protrude out through the opening in the bones.
What are the different types of spina bifida? oculta, cystica with meningocele (just meninges protudes out), cystica with myelomeningocele (both meninges AND spinal cord protrude out)
Classify CNS tumors. Primary ("true") and secondary
What are the three main categories of brain tumor? glioma, meningioma, pituitary adenoma (PAMG)
What are the (three main) consequences of brain tumor? intracranial HTN, dysfunction, irritation (abnormal fatigue, tremors, seizures)
What are the risk factors for carpal tunnel syndrome? RA, DM, hypothryroidism, ACROMEGALY!, pregnancy, repetitive Flex/Ext of wrist
What are the most common causes of polyneuropathy? autoimmune (Guillian-Barré), poisoning (lead, arsenic, ETOH), metabolic (DM, uremia)
What is the etiology of Gullain-Barré syndrome? Autoimmune (thought to be triggered by infection, surgery, vaccination, campylobacter or other diarrheal pathogens, herpes viruses, mycoplasma)
What is the pathology of Gullain-Barré syndrome? "infiltration of MONONUCLEAR CELLS around the capillaries of PERIPHERAL NEURONS and subsequent demyelination of VENTRAL SPINAL NERVE ROOTS
How is Gullain-Barré syndrome diagnosed? Ask about possible triggers in recent past. Look at CSF for super elevated protein level?
What are the manifestations of autonomic neuropathy in long-standing diabetes mellitus GI and GU disturbances" GI= gastroparesis w/ delayed gastric emptying and NOCTURNAL DIARRHEA! GU= neurogenic bladder, impotence in men. Also orthostatic hypotension leading to postural syncope, dizziness/lightheadedness.
What is the pathophysiology of myasthenia gravis? autoimmune disorder of the NEUROMUSCULAR JUNCTION
What are the symptoms of myasthenia gravis? episodic muscle weakness and/or quickly fatigued muscles (even talking, chewing)
How is myasthenia gravis diagnosed? "TRIAL OF EDROPHONIUM" (IV infusion that temporarily blocks the Ab/T-cell attack on the acetylcholine receptors). ACH-receptor Abs present in many pts.
Most important skin carciongen UV rays (sun)
Causes of bullae formation on the skin sunburn?
Macule flat, slightly hyperpigmented skin lesion (patch) less than 1 cm (FRECKLE)
Papule slightly elevated skin lesion (ALLERGIC ECZEMA)
Vesicle fluid filled elevation of epidermis (cold sore on lip)
Bulla a large vesicle (burns)
Pustule pus filled vesicle less than 1 cm (IMPETIGO)
Ulcer discontinuity of skin showing complete loss of epidermis (CHANCRE)
Scale keratin layers or flakes covering the skin (PSORIASIS, SEBORRHEIC KERATOSIS)
Effects of sun on skin hyperemia (increased blood flow to the area), 1st and 2nd degree burns
Appearance of rash in impetigo Honey Crusted Lesions
Appearance of measles rash maculopapular rash (brick red)
Koplik's spot whitish patches near parotid duct (at 2nd molar) just before measles outbreak
HSV2 outbreak on labia or genitals recurrent, grouped, small vesicles on erythematous base (RGSVOEB)
Which one had the SPAGHETTI & MEATBALLS ? Tinea versicolor (think of the red color of the sauce?)
And the cottage cheese? candida albicans
Pathogenesis of acne androgen overproduction of keratin AND sebum (and then feeding on sebum by bacteria whose 'waste products' are pro-inflammatory fatty acids (omega 6?))
Factors contributing to acne androgen surge and hypertrophy of sebaceous glands
What are the lesions of acne (vulgaris)? inflammatory (teenage acne) and non-inflammatory (black heads, white heads) comedones
How does seborrheic dermatitis (aka dandruff) typically present? Reddening, scaling, itching (scalp, nasolabial folds, eyebrows)
What is the appearance of the lesions of psoriasis? red plaques covered with SILVERY SCALES (extensor aspect)
What is the appearance of seborrheic keratosis? wartlike lesions with "stuck on" appearance. Loosely attached and easily removed
Name the skin tumors. There are 3. The bad ones are BCC and SCC. The benign one is the "wartlike lesions with stuck on appearance": seborrheic keratosis
What is most common epithelial malignant tumor of skin? the BBC (BCC)
What is the appearance of basal cell carcinoma? remember that the BBC HQ is a round building with an open courtyard in the center: "Slightly elevated nodule with central depression."
What is the HALLMARK of basal cell carcinoma appearance under microscope? blood vessel like "telangiectactic nodules" at its center
What is the pathogenesis of skin cancer from chronic exposure to sunlight? Capacity of DNA repair enzymes is overwhelmed by the task at hand. Faulty or incomplete DNA repair results in unchecked cell growth.
What is the appearance of actinic keratosis? Flesh-colored skin lesions (plaques) on sun exposed areas that FEEL LIKE SANDPAPER and are TENDER when the finger is drawn over them
What is the significance of actinic keratosis "lesions?" AK can become SCC (sandpaper lesions on face hands get SACCK'd)
Name pigmented (of melanocytes) skin lesions. Lentigo, nevus, malignant melanoma
Which pigmented lesion of the skin is likely to progress to malignant melanoma? Dyplastic nevi (mole that starts to grow, especially irregularly)
What are the diagnostic criteria for malignant melanoma? A-B-C-D. A for asymmetry. B for irregular borders. C for color change. D for increase (>6mm should cause concern) in diameter
Created by: mrbarr