Heavy Menses
Adenomyosis |
Endometriosis |
Leiomyoma (Fibroids) |
Endometrial Hyperplasia |
Endometrial Cancer |
Male Genitalia
DHT |
External Male Genitalia+ Prostate |
Testosterone |
Internal Male Genitalia(SEED= Seminal Vesicles, Epididymis, Ejaculatory Duct, Ductus Deferens) |
*if female internal genitalia is present in a male then think Anti Mullerian Hormone deficiency |
Estrogen |
Breast development |
Aromatase |
Converts testosterone--> estrogen |
Vaginitis
If there is vaginal inflammation |
Think Trichomoniasis or Candida vaginitis |
Bacterial vaginosis |
fishy odor, clue cells(squamous epithelial cells), (+) whiff test |
Due to antibiotic use |
Treat with metronidazole |
Trichmoniasis |
frothy, yellow-green discharge, motile trichomonads, |
Due to hx of STIs |
Treat with metronidazole |
Candida |
cottage cheese, pseudohyphae |
Due to OCP use, antibiotics, immunosuppression, diabetes |
Treat with fluconazole |
Ovarian Tumor
Struma Ovarii |
Germ cell tumor |
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Associated with thyrotoxicosis (since it can secrete thyroid hormone) |
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Gross: Oily cystic mass |
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Microscopic: thyroid follicles filled with colloid and surrounded by ovarian storm |
Ducts
Paramesonephric |
form internal female genitalia (fallopian tubes, uterus, upper vagina, cervix) |
Mesonephric |
In females= degenerate to form Gartner duct |
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In males= epididymis, seminal vesicles, ductus deferens, ejaculatory ducts |
Genital Ulcers
Painful |
Painless |
Chancroid (H.Ducreyi) |
Chlamydia |
HSV |
Syphilis |
Staging/ Gleason Score
High Gleason score |
poorly differentiated |
Higher Staging |
metastasis |
Lymph Nodes
Para-Aortic |
Ovaries/ Testes |
Superficial Inguinal |
Scrotum |
Deep Inguinal |
Glans Penis |
Anorexia and Amenorrhea
Due to hypothalamic suppression of GnRH |
Hypertension in Pregnancy
Think Pre-Eclampsia/ Eclampsia |
New-onset HTN |
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Proteinuria |
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End-organ dysfunction |
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(+ seizures in eclampsia) |
Vaginal Bleeding during Pregnancy
Placenta Accreta (Painful) |
Due to absence of endometrial decide basalts |
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Or previous uterine scarring (prior C-section) |
Molar Pregnancy (Painful) |
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Partial Mole- has fetal tissue |
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Complete Mole- NO fetal tissue |
Ectopic Pregnancy (Mild Pain) |
Abruptio Placentae (Painful) |
Placenta Previa (Painless bleeding) |
Cervicitis (PID)
Neisseria Gonorrhoeae |
Chlamydia Trachomatis |
*if antibiotic coverage remains incomplete then can lead to infertility |
Combination Therapy
Buserelin and Bicalutamide |
Buserelin- continuous stimulation of pituitary gland to down-regulate GnRH--> decrease LH-->decrease testosterone |
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Bicalutamide- helps prevent the initial testosterone surge effect from the buserelin administration |
Leuprolide and Flutamide |
Leuprolide-long acting GnRH antagonist- causes a transient increase in LH-->testosterone levels |
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Flutamide-competitive testosterone receptor blocker-counteracts the initial surge of testosterone |
Drugs for pregnancy termination
Mifepristone |
-partial progesterone agonist-->causes placental separation and uterine contraction |
Misoprostol |
E1 agonist--> stimulates uterine contractions |
Methotrexate |
Folic acid antagonist-->destroys proliferating fetal cells |
Mullein Agencies vs Androgen Insensitivity
Mullein Genesis |
Stage 4: breast; Stage 4: pubic hair |
AIS |
Stage 4: breast; Stage 2: pubic hair |
Phases of Meiosis
Female |
Prophase I until ovulation |
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Metaphase 2 until fertilization |
Postmenopausal bleeding
Think Endometrial Hyperplasia or Cancer |
Testicular Torsion
Has absent cremasteric reflex |
Physiologic Changes in Pregnancy
Increase CO |
Increase Plasma Volume |
Decrease SVR |
Increase Response Tidal Volume |
Decrease FRC |
Increase GFR |
Chronic hypoventilation (-->respiratory alkalosis) |
Congenital Rubella
I heart ruby earrings: |
I("eye")--> cataracts |
Heart-->PDA |
Ruby--> Rubella (enveloped, single-stranded, positive-sense RNA virus) |
Earrings--> sensorineural hearing loss |
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Hypoglycemic Episodes
More common with Sulfonylureas: |
Inhibits K+ channel to allow for Ca2+ influx |
SGLT-2 Inhibitors (-glifozin)
decrease renal absorption of glucose and sodium |
Insulin (Endogenous vs Exogenous)
Endogenous |
insulin+C-peptide |
endopeptidases in secretory granules cleave proinsulin into insulin and C-peptide |
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Sulfonylureas and Meglitinides are the only ones that stimulate endogenous insulin production |
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Insulin producing tumors |
Exogenous |
insulin only |
Congenital Hypothyroidism
high TSH; low T4 |
Initially asymptomatic because of the presence of material thyroxine |
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Need levothyroxine treatment otherwise can lead to neurocognitive dysfunction |
SIADH
Think Euvolemic Hyponatremia |
Neonatal Hypoglycemia
Mother had gestational diabetes--> hyperglycemia in mother-->hyperglycemia in baby-> so baby was producing high levels of insulin to counteract high glucose--> pancreatic B cell hyperplasia since it is working extra--> once born then not receiving high levels of glucose from mother but still producing a lot of insulin=neonatal hypoglycemia |
MEN Syndromes
MEN 1 |
Pituitary (Usually a Prolactinoma) |
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Pancreas (Usually Zollinger Ellison syndrome) |
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Parathyroid |
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Men 2A |
Parathyroid |
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Medullary thyroid carcinoma |
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Pheochromocytoma |
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MEN 2B |
Medullary thyroid carcinoma |
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Pheochromocytoma |
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Oral Ganglioneuromas |
SIADH
Think Euvolemic Hyponatremia |
TBG Deficiency
low total T4, normal free T4, normal TSH |
Adrenal Gland Secretions
Adrenal Cortex |
Zona Glomerulosa |
Aldosterone |
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Zona Fasiculata |
Cortisol |
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Zona Reticularis |
Sex Hormones |
Adrenal Medulla |
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Catecholamines |
Ketone Bodies
Can't be utilize by RBCs since they lack mitochondria |
Symptomatic Relief of Thyrotoxicosis
Diabetes
Type 1 |
Due to autoimmune response against beta cells--> loss of insulin production |
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More susceptible to DKA |
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Younger patients |
Type 2 |
Due to insulin resistance |
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Older patients |
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Pancreatic islet amyloid deposition |
Antihyperlipidemic drugs
Statins |
Primarily lowers cholesterol |
Ezetimibe |
Lowers cholesterol and LDL |
Fibrates |
Lowers triglycerides |
Niacin |
Lowers triglyceride and LDL, Increases HDL |
Bile acid resins |
Lowers LDL |
Glucose Transporters
GLUT-4 |
Insulin Dependent--> expression increases with insulin concentration |
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Muscle cells, Adipocytes |
GLUT 1,2,3,5 |
Insulin-Independent--> does NOT increase with insulin concentration |
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Brain, Kidney, Intestine, RBCs, Liver |
Bone Formation/ Loss
PTH--> osteoblast-->Bone formation |
PTH-->RANK(osteoblasts)+RANK-L/NFkB-L (osteoclasts)-->net bone loss |
OPG-bind competitively to RANK-L to prevent bone loss |
Insulin Drugs
Long-acting (Glargine, detemir, degludec) |
mimic regular insulin |
Short-acting (Lispro, aspart, glulisine) |
mimics postprandial insulin |
Permissive Effect of Cortisol on Ne/Epi
Cortisol indirectly acts Ne/Epi receptors to upregulate them--> this then makes them available for the the catecholamines to bind to them |
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Turner syndrome (45, XO)
Widely spaced nipples |
Ovarian dysgenesis (streak ovaries) |
Horseshoe kidney |
Short |
Webbed neck |
Coarctation of aorta |
Aortic Dissection |
Bicuspid Aortic valve |
Cystic Hygroma in neck |
Klinefelter (47, XXY)
Decreased inhibin levels |
Learning disabilities |
Gynecomastia |
Small, firm testes |
Tall |
Edwards syndrome
Hypertonia |
Clenched fists |
Rocker bottom feet |
Down syndrome
Upslanting palpebral fissures |
Epicanthal folds |
Single palmer crease |
Drugs and common AE
Levothyroxine |
Atrial fibrillation |
PTU, methimazole |
Agranulocytosis (Nuetropenia) |
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PTU- Hepatotoxic (But preferred drug in last two trimesters) |
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Methimazole-Teratogenic in FIRST trimester |
Sulfonyureas |
Hypoglycemia |
HIV HAART therapy |
Lipodystrophy |
B-Blockers |
Mask Hypoglycemic episodes |
Estrogen |
ischemic stoke (therefore don't give in migraines since they already have an increased baseline for an ischemic stroke) |
Metformin |
Lactic acidosis (CI in renal insufficiency) |
Tamoxifen |
Gynecomastia |
Glucocorticoids |
Osteoporosis |
GLP-1 agonists (exenatide/liraglutide) |
Weight loss |
Trazadone |
Priapism |
Bile acid resins (Cholestyramine, Cholestipol, Colesevelam) |
Hypertriglceridemia |
Intracellular Pathways
Pathway |
Hormones |
Bind activated receptors to DNA to modify transcription |
Steroid and thyroid hormones |
Adenylyl cyclase converts ATP to cyclic amp--> activates protein kinase A |
PTH, ACTH, TSH, ADH(V2), glucagon |
Bind G protein coupled receptor that activate PLC |
GnRH, TRH, Ang II, AHDH(V1) |
PLC activates PIP3--> DAG+IP3 to then activate PKC |
GnRH, TRH, Ang II, AHDH(V1) |
JAK-STAT Pathway |
GH |
Familial Hyperlipoproteinemia (Type 1)
deficiency of LPL or Apo C-2: |
Hypertriglyceridemia |
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recurrent acute pancreatitis |
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milky appearing retinal vasculature (lipemia retinals) |
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yellow populates on extensor surfaces (eruptive xanthomas) |
Keep-it-Simple Concepts
PTH |
increase Ca+ (Primary regulator of PTH-if low then PTH increases to increase Ca2+ levels) |
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decrease PO4- |
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increase Vitamin D (by upregulating 1-a-hydroxylase) |
Ca2+ |
Calcitonin |
counteracts Ca2+ |
Insulin |
decreases glucose (bloodstream--> adipose tissue/skeletal muscle) |
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counteracts glucagon |
Glucagon |
increases glucose (adipose tissue/skeletal muscle-->bloodstream) |
Vitamin D |
increase Ca+ |
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increase PO4- |
Leydig cells |
LH-->secrete testosterone |
Sertoli cells |
FSH-->spermatogenesis and increase inhibin |
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increases glucose by glycogenolysis and gluconeogenesis in the liver |
Neimann-Pick vs Tay-Sachs
Neimann-Pick |
Hepatomegaly/Splenomegaly |
Tay-Sachs |
NO hepatomegaly/splenomegaly |
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