Comp 2 - Patho 1

End stage liver disease

"_____" is synonymous with cirrhosis

Galactorrhea

(1) an abnormally abundant flow of milk in a lactating woman. (2) spontaneous milk flow not associated with childbirth or the nursing of an infant

Hematogenous

(1) involving, spread by, or arising in the blood, or (2) producing blood

White lesions in the mouth that cannot ordinarily be scraped off and cannot be ascribed to any other disease

(Oral) leukoplakia

Surface epithelium; germ cell; sex cord stromal tumors (Of course, each of these has several associated subtypes, and there are two other groups of ovarian tumors: those that defy classification, and metastases from other organs.)

(_____, _____, and _____) Most tumors of the ovary ultimately arise from one of three ovarian tissues; list these resulting three types of ovarian tumors.

Serous; mucinous; endometrioid

(_____, _____, and _____) Surface epithelial tumors of the ovary are usually subdivided into three subtypes; list those three subtypes.

ovarian cyst

159. _A(n) _____________________________ is any collection of fluid, surrounded by a very thin wall, within an ovary.

Uterine tube

A

Which ONE of the following is NOT TRUE of the treatment for canker sores? A. Antivirals like acylclovir can clear the virus causing the lesions B. Analgesics like benzocaine and lidocaine can help relieve the pain C. Avoidance of toothpastes with sodium lauryl sulfate can reduce the frequency and intensity of the lesions D. Steroids such as dexamethasone can help relieve the inflammation E. Most cancker sores are minor inconveniences and require no treatment F. (None. All of the above are true of the treatment for canker sores)

A (Canker sores do not appear to be caused by a virus, so antivirals would be ineffective but they are useful to treat cold sores)

Which ONE of the following is NOT TRUE regarding carcinoma of the esophagus? A. Prognosis is excellent if treated with aggressive chemotherapy B. Symptoms include pain, dysphagia, hematemesis, and malodorous breath C. Carcinoma of the esophagus is locally invasive, and regularly spreads to mediastinal lymph nodes D. Most esophageal carcinomas are squamous cell carcinomas which generally arise in the middle to lower esophagus E. The incidence of esophageal carcinoma is higher in Iran, South Africa, and China; in China, even the poultry have a higher incidence of this disease F. (None. All of the above are true regarding esophageal carcinoma)

A (Esophageal cancer does not have a favorable prognosis, period. In actuality, the 2 year survival rate is about 5%, making the prognosis rather abysmal)

Which ONE of the following is NOT TRUE regarding adenocarcinoma of the intestine? A. Intestinal adenocarcinoma occurs about 50x more frequently in the ileum than in other parts of the large or small intestine B. Adenocarcinomas of the right colon tend to be clinically silent, producing only nonspecific signs such as weakness and fatigue C. Adenocarcinomas of the left colon tend to narrow and obstruct the passage of feces, characteristically resulting in pencil feces as well as occult or even frank bleeding D. Adenocarcinoma may occur in the small or large intestine E. (None. All of the above are true regarding intestinal adenocarcinoma)

A (Intestinal adenocarcinoma occurs about 50x more frequently in the large intestine, and 1/3 of these cases occur in the sigmoid or rectal region)

Which ONE of the following is NOT TRUE regarding celiac sprue? A. Celiac sprue is associated with colonization of the small intestine by pathogenic protozoa, which disrupts digestion and nutrient absorption and results in malabsorption B. Celiac sprue is characterized by hypersensitivity to gluten in dietary grains C. Celiac sprue is mostly found in Caucasians; it is rare in Asians and Africans D. Celiac sprue involves a chronic inflammatory and an autoimmune response in the intestinal wall E. Histologically, in patients with celiac sprue, regular ingestion of gluten results in atrophy of intestinal villi, which eventually disappear altogether F. (None. All of the above are true regarding celiac sprue)

A (No pathogens- celiac sprue is due to hypersensitivity to gluten in food)

T/F: The changes typical of Crohn's disease are found most often in the: A. Terminal ileum B. Transverse colon C. Sigmoid colon D. Rectum E. Anus

A (Terminal ileum; ulcerative colitis, on the other hand, starts in the rectum but usually doesn't reach back far enough to affect the ileum.)

Which ONE of the following is NOT TRUE with regard to dysphagia? A. Dysphagia to solids alone is usually a sign of a motility (peristalsis) problem B. Myasthenia gravis often causes esophageal dysmotility in the upper part of the esophagus C. Nutcracker esophagus is a dysphagia due to excessive force generation during esophageal peristalsis D. Plummer-Vinson syndrome results in esophageal webs that physically interfere with the swallowing of solids E. Esophageal cancer, at least in its earlier stages, typically causes dysphagias to solids but not liquids F. Progressive systemic sclerosis (scleroderma), wherein fibrous deposits accumulate in tissues around the bodyincluding the esophagus- is another cause of esophageal dysmotility G. (None. All of the above are true regarding dysphagia)

A (This is reversed—dysphagia to solids alone is usually a sign of esophageal obstruction of some sort, while dysphagia to both solids and liquids is usually a sign of motility problems.)

spirometer

A _____ is a device that measures the volume of air breathed in and out.

pheochromocytoma

A _____ is a hyperfunctional tumor of the chromaffin cells of the adrenal medulla.

Pancoast tumor (which can cause either Pancoast syndrome or Horner syndrome.)

A _____ refers to a lung cancer growing in the apical area of the lung.

thoracentesis

A _____is a medical procedure to remove fluid from the pleural cavity.

saddle embolus (As mentioned, a saddle embolus is one of the few causes of virtually instantaneous death.)

A _____refers to a massive thromboembolus that usually forms in the femoral vein and lodges at the bifurcation of the pulmonary truck, thus instantly blocking both pulmonary arteries.

Gardnerella vaginalis

A bacterium that typically causes vaginitis; this infection is characterized by the presence of "clue cells" and a vaginal discharge with a fishy odor.

Teratoma

A benign NSGCT which contains various mature tissues such as hair, skin, or brain.

Teratoma

A benign germ cell tumor containing only mature (somatic) tissue- hair, skin, brain, bone, etc., but no malignant stem cells.

Papilloma

A benign, finger- or nipple-shaped tumor; in the breasts, they protrude into the ductal lumen.

unwanted urine leakage (as in stress incontinence); incomplete emptying of the bladder.

A bladder that has dropped down from its normal position (e.g., because of a cystocele) may cause two kinds of problems: _____ and _____.

Small cell carcinoma

A cancer of the neuroendocrine cells of the lungs; formerly called "oat cell carcinoma" this malignancy is often involved in several paraneoplastic syndromes

COPD

A catch-all phrase for lung disease characterized by chronic airway obstruction, specifically, a decreased expiratory rate due to obstructive or restrictive factors; includes chronic bronchitis and emphysema

Pulmonary tuberculosis

A chronic bacterial infection of the lung caused by Mycobacterium tuberculosis

Asthma

A chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, SOB, chest tightness, dyspnea, and cough, usually associated with widespread but variable bronchoconstriction and airflow restriction

Syphilis

A chronic, systemic, sexually-acquired infectious disease caused by the spirochete Treponema pallidum subsp. pallidum

ARDS

A clinical term used to describe changes occurring in the lungs under a variety of conditions, all of which cause acute respiratory failure

Middle respiratory syndrome

A collection of mostly childhood diseases involving the anatomic structures between the larynx and bronchioles

Adenomyosis

A common cause of uterine bleeding, esp. just before the menstrual period, as nests of endometrial tissue within the uterine wall undergo swelling, degeneration, and hemorrhage

Jaundice (general description)

A condition caused by hyperbilirubinemia and characterized by a yellowish discoloration of the skin and mucosa

Endometrial hyperplasia

A condition characterized by endometrial proliferation; its subtypes show varying degrees of endometrial gland crowding, complexity, and atypia

Emphysema

A condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of the alveolar walls (and the elastin therein) but without obvious fibrosis; because of the loss of pulmonary elasticity, patients with this condition have difficulty exhaling all the air from their lungs

Cholelithiasis

A condition where gallstones are present in the bile; having gallstones

Hypospadias

A congenital defect in which the urethra opens on the underside of the penis.

Cryptorchidism

A congenital malpositioning of the testes outside their normal scrotal position

Antagonist

A drug which mimics a natural ligand (hormone, etc) by binding to a receptor but not eliciting any activity; essentially it occupies the receptor so that the hormone cannot bind, thus blocking any of the normal cellular responses.

Anovulatory cycle

A dysfunction where the ovaries fail to enter the luteal phase, hence causing the endometrium to remain in the proliferative phase; this dysfunction expands the time of unopposed estrogen, and is a common cause of abnormal bleeding in a young woman

Coccidioidomycosis

A fungal infection caused by a fungus found in the desert southwest (including California); the fungus grows as a yeast in the body, primarily the lungs

Porcelain gallbladder

A gallbladder whose walls have undergone dystrophic calcification as a result of hydrops

Embryonal carcinoma

A germ cell tumor containing only malignant stem cells that resemble embryonic stem cells- endoderm, mesoderm, and ectoderm.

Dysgerminoma

A germ cell tumor of the ovaries containing only cells resembling oocytes.

Seminoma

A germ cell tumor of the testes containing only cells resembling spermatocytes.

Amenorrhea, primary

A girl of pubertal age does not have her first period

Adenocarcinoma

A lung epithelial cancer (involving the ciliated or mucous cells) which histologically resembles glandular tissue

Squamous cell carcinoma

A lung epithelial cancer arising from metaplasic/dysplasic flattened epithelial cells lining the (major) airways

Teratocarcinoma

A malignant NSGCT which contains various mature tissues such as hair, skin, or brain.

Teratocarcinoma

A malignant germ cell tumor containing not only malignant stem cells but also mature tissue including hair, skin, brain, bone, and even placental tissue.

Choriocarcinoma

A malignant tumor of placental cells.

Sarcoidosis

A multisystemic granulomatous disease in which abnormal collections of chronic inflammatory cells (granulomas) form as nodules in multiple organs

Aspergillosis

A nasty fungal infection caused by a mycelial fungus which has a tendency to (1) grow in the lungs, where it produces 'fungus balls', and (2) invade the arteries, causing thrombi.

Leydig cell tumor

A neoplasm likely to secrete significant levels of sex hormones; due to estrogen secretion, these neoplasms may cause feminization in a man

Herpesvirus

A nonbacterial pathogen that typically causes vesicles in the anogenital or perioral areas; these vesicles then rupture, giving rise to shallow ulcers.

Herpesvirus

A nonbacterial pathogen that typically causes vesicles on the glans penis; these vesicles then rupture, giving rise to shallow ulcers

Mumps virus

A pathogen, usually spread via the hematogenous route, which is a common cause of isolated orchitis

Mumps virus

A pathogen, usually spread via the hematogenous route, which is a common cause of orchitis in males and an occasional cause of oophoritis in females.

A (Lymphocytes. URIs are caused by viruses, against which neutrophils -PMNs- and basophils are ineffective. Lymphocytes- T cells, B cells and plasma cells- are specialists at fighting viruses, and would be called upon to lead such a fight.)

A patient comes to you presenting with all the classical signs of a URI—including an upper respiratory tract mucosa that is congested, edematous, and infiltrated with inflammatory cells. What type of inflammatory cells would you expect to find in abundance if this person were suffering from a viral URI (i.e., the flu)? A. Lymphocytes B. PMNs C. Basophils D. Neutrophils

Bronchiectasis

A permanent dilatation of the bronchi caused be destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections

Trichomonas vaginalis

A protozoan which, in women, produces a greenish, frothy vaginal discharge accompanied by itching.

Benign prostatic hyperplasia

A reactive enlargement of the periurethral portion of the prostate and the so-called median lobe (a part of the prostate located at the neck of the urinary bladder)

Amenorrhea, secondary

A reproductive age woman who has been having her periods stops having them

Polycystic ovarian syndrome

A syndrome characterized by (1) clinical manifestations related to excess androgen secretion, (2) persistent anovulation, and (3) ovaries with many small subcapsular cysts

Teratoma

A tumor also known as a dermoid cyst

Scirrhous tumor

A tumor which presents as a hard, sometimes gritty mass; often found the breast or liver cancer.

Human papilloma virus

A virus that causes warts (common and genital) and is associated with cervical cancer.

Staphylococcus aureus

A widespread bacterium (e.g., it is usually found in the human mouth or on human skin) that may cause genital infections via either the ascending or descending routes.

Candida albicans

A yeast that typically causes vulvovaginitis.

ovarian follicle (It is important to realize that those 'surrounding specialized cells' are thecal and granulosa cells. They are derived from the ovarian stroma. Why is that important? It explains why some sex cord stromal tumors- such as granulosa and theca cell tumors- secrete hormones.)

A(n) _____ is a developing oocyte and its surrounding specialized cells.

cystocele (pubocervical fascia is another name for the vesicovaginal septum.)

A(n) _____ is a herniation of the urinary bladder through the pubocervical fascia and into the vagina.

colporrhaphy

A(n) _____ is a medical procedure to suture the vagina, usually to close an incision made during surgery.

rectocele.

A(n) _____ is a nerniation of the rectum through the rectovaginal septum and into the vagina.

pessary

A(n) _____ is a small plastic or silicone medical device that is inserted into the vagina and held in place by the pelvic floor musculature; therapeutic versions are used to support the uterus, vagina, urinary bladder, or rectum.

orchiopexy

A(n) _____ is a surgical procedure to free an undescended testicle and implant it (i.e., suture it) into the scrotum

endometrioma

A(n) _____ is another name for a chocolate cyst found on an ovary in cases of moderate to severe endometriosis.

fibroid (During a woman's reproductive years fibroids usually have lots of smooth muscle in them, but after menopause, the muscles regresses -no estrogen- and then fibroids become mostly a mass of connective tissue stroma -i.e., FIBROUS tissue)

A(n) _____ is another name for a uterine leiomyoma.

corpus luteum

A(n) _____ is the cholesterol-packed ovarian structure that develops from a ruptured follicle following ovulation.

subserosal (The perimetrium is, of course, the serosa of the uterus, but if I had said 'beneath the serosa' that would have made the question way too easy.)

A(n) _____ leiomyoma develops just beneath (just deep to) the perimetrium.

intramural (Meaning literally 'within the wall'.)

A(n) _____ leiomyoma develops within the myometrium itself.

sessile

A(n) _____ polyp arises directly off the underlying tissue, without an intervening stalk.

pedunculated

A(n) _____ polyp is borne at the end of a stalk.

inadequate luteal phase (Without an adequate luteal phase, progesterone is not secreted, so that the uterus does not become fully receptive for implantation, and without progesterone withdrawal, menstruation does not begin. The net effect is that estrogen just continues to stimulate the endometrium, and it grows and grows and grows.)

A(n) _____ refers to a condition where a woman ovulates, but the residual follicular cells fail to develop into a proper corpus luteum; thus her cycle does not evolve into a normal luteal phase

ectopic pregnancy ('ecto'=out + 'topo'=place, location. ectopic='out of place'.)

A(n) _____ refers to implantation of a zygote anywhere but the normal location in the uterus.

chancre (remember this is pronounced 'SH?NG-k?r'.)

A(n) _____ refers to the lesion of primary syphilis; a hard, nonsensitive, dull red papule or area of infiltration that begins at the site of treponemal infection after an interval of 10 to 30 days.

myomectomy ('myoma', muscle + 'ectomy', to cut out.)

A(n) _____ refers to the surgical removal of a muscle tumor, but especially to fibroids in the uterus.

pregnancy test (the answer to this question should be obvious)

A(n) _____ should always be the first workup for a patient with secondary amenorrhea

pedunculated ('peduncle' means 'little foot,' so pedunculated fibroids sit on a stalk. The opposite condition- sessile- means there is no stalk and the fibroid rises right up out of the underlying tissue.)

A(n) __________ fibroid dangles or projects from a stalk.

Scirrhous

A(n) ___________ tumor refers to a hard, often gritty tumor; such tumors often occur in the breast.

Lumpectomy

A(n) ____________ involves removal of just the tumorous or swollen tissue of a breast.

Ascites

AKA Hydoperitoneum

Gonorrhea

AKA The "Clap"

Failure of the lower esophageal sphincter to relax in response to swallowing and the absence of peristalsis in the body of the esophagus.

Achalasia

_____ refers to a spasm of the lower esophageal sphincter, such that swallowed food cannot enter the stomach but rather accumulates in the esophagus

Achalasia

_____ refers to the lack of HCl in the gastric juice.

Achlorhydria (A decreased output of acid, but not its total absence, is hypochlorhydria)

An immune-mediated inflammatory glomerulopathy that occurs 1-4 weeks after an infection, most often a streptococcal infection of the upper respiratory tract or the skin

Acute Glomerulonephritis

Precocious pseudopuberty

Adrenogenital syndrome causes _____ in boys.

Virilization

Adrenogenital syndrome causes _____ in girls.

Dust cells

Aka 'alveolar macrophages'

mineralocorticoids

Aldosterone is the most important of the [mineralocorticoids/ glucocorticoids/ gonadocorticoids].

Neisseria gonorrhoeae

Also known as gonococcus.

D

Altho cirrhotic livers all share certain histologic changes, the colors of such livers varies considerably. Which ONE of the following is NOT TRUE regarding the colors of cirrhotic livers and their associated pathologies? A. In biliary cirrhosis the nodules—and hence the overall liver— may be yellow or green, owing to the accumulation of bilirubin and biliverdin, respectively B. Alcoholic cirrhosis is marked by fat and cholesterol accumulation, which colors the nodules—and hence the overall liver— yellow C. In some types of cirrhosis, the liver nodules retain their normal brown color, while yet in other types (such as cirrhosis due to iron overload) the liver nodules become a rusty-brown color D. (None. All of the above are true regarding the colors of cirrhotic livers)

Parainfluenza virus

Although this pathogen is also a common cause of influenza, it is the most frequent cause of croup

Croup

An acute, sometimes fatal, inflammation of the larynx, most commonly seen in children

Escherichia coli

An example of a uropathogen commonly causing of prostatitis

Hirsutism

An excess of hair in a women in normal hair-bearing areas

Rhinovirus

Another pathogen potentially causing the common cold

A common but idiopathic disease characterized by painful, recurrent small ulcers of the oral mucosa

Aphthous stomatitis

Aka "canker sores"

Aphthous stomatitis

These casts usually form as Tamm-Horsfall protein precipitates and encases particles present in the nephron

Applies to all the listed casts

E (A very active area for disease)

Approximately 50% of all carcinomas of the intestine develop in the: A. Small intestine B. Ascending colon C. Transverse colon D. Descending colon E. Rectosigmoid area

C (Cigarette smoking. This makes lung cancer, to a great extent, a largely preventable disease.)

Approximately 90% of all patients with lung cancer present with a history of... A. Alcoholism B. Hereditary cancer syndromes C. Cigarette smoking D. Exposure to chemical carcinogens in food and water E. Obesity F. Tuberculosis and/or pneumonia

_____ infections are the more common type of urinary tract infection.

Ascending (hematogenous infections arise in the context of septicemia (bacteremia), which is not as common as UTIs)

_____ gastritis is a chronic, diffuse inflammatory disease of the stomach that is restricted to the body and fundus and is associated with autoimmune phenomena.

Autoimmune atrophic (the reason AAG is restricted to the body and fundus is that is where the parietal cells are located; AAG involves antibodies to parietal cells, therefore AAG will also be found in the body and fundus)

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Higher incidence in Ashkenazi Jews.

B

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Its etiology has an immunologic component.

B

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Peak incidence of 20-30 years of age.

B

Infundibulum

B

Which ONE of the following is NOT TRUE regarding acute gastritis? A. The common factor in acute gastritis seems to be the break-down in the mucosal barrier, allowing acid induced injury B. Acute gastritis is almost always associated with Helicobacter pylori infection C. Acute gastritis is associated with erosions and ulcers in the gastric wall D. The lesions of acute gastritis may be caused by circulatory disturbances resulting from stress or shock E. The lesions of acute gastritis may be caused by certain drugs, such as the NSAID, aspirin F. Acute gastritis tends to resolve on its own in a few days G. (None. All of the above are true regarding acute gastritis)

B (H. pylori is associated with chronic gastritis; acute gastritis is typically associated with direct damage to the gastric mucosa, as caused by ingested chemicals or circulatory disturbances)

Which ONE of the following is NOT TRUE regarding membranous glomerulopathy (MG)? A. MG is an immune-mediated condition B. MG is characterized by large-scale inflammation of the glomeruli, which become infiltrated with numerous inflammatory cells C. In MG, the urine is devoid of RBCs (no hematuria) and inflammatory cells D. In MG, the glomeruli have thickened basement membranes E. As MG advances, the thickened glomerular membranes may encroach into the capillary lumen, resulting in glomerular sclerosis F. In MG, the leakiness of the glomerular capillary wall probably stems from initial fixation of complement proteins G. (None. All of the above are true of membranous glomerulpathy)

B (MG is characterized by large-scale inflammation of the glomeruli, which become infiltrated with numerous inflammatory cells ---NO!)

Which ONE of the following lists the tunics (layers) of the GI tract in correct order from innermost (i.e., next to the lumen) to outermost? A. (innermost) Mucosa - Muscularis externa - Submucosa - Serosa (outermost) B. (innermost) Mucosa - Submucosa - Muscularis externa - Serosa (outermost) C. (innermost) Mucosa - Submucosa - Serosa - Muscularis externa (outermost) D. (innermost) Serosa - Muscularis externa - Submucosa - Mucosa (outermost) E. (innermost) Serosa - Submucosa - Muscularis externa - Mucosa (outermost) F. (innermost) Serosa - Mucosa - Submucosa - Muscularis externa (outermost) G. (None of the above list the GI tract tunics in their correct order)

B (Some organs, of course, like the esophagus, have an adventitia instead of a serosa.)

Which ONE of the following is NOT TRUE regarding hiatal hernias? A. Paraesophageal and sliding are two types of hiatal hernias B. Hiatal hernias lead to displacement of the LES and lower portions of the esophagus from the thoracic cavitythrough the diaphragmatic hiatus and into the abdominal cavity C. Hiatal hernias are the leading cause of reflux esophagitis D. Hiatal hernias alter the function of the LES and facilitate reflux of gastric juice from the stomach into theesophagus E. The tone of the LES may be lowered by smoking and caffeine F. (None. All of the above are true of hiatal hernias)

B (This is reversed—the displacement is of the stomach/LES upward through the hiatus and into the thoracic cavity.)

Which ONE of the following is NOT TRUE of diverticula? A. Diverticula are essentially outpocketings of the intestinal wall B. Diverticula typically measure 8-10 cm in length C. Diverticula occur in all parts of the GI tract, but from a clinical point of view, the most important (80%) are those involving the sigmoid colon D. Diverticula may be solitary or multiple E. Diverticula are especially common in older persons experiencing chronic constipation F. Diverticula often form where arteries enter the intestinal wall G. (None. All of the above are true regarding diverticula)

B (Typically diverticula measure about a cm in length)

Which ONE of the following is NOT TRUE of urinary calculi? A. Calcium stones are most common B. Urinary stones occur more commonly in women than men C. Hematuria and urinary colic are two common symptoms of urinary stones D. Most stones are small and can be voided spontaneously E. Struvite stones may be larger than others, eventually growing larger enough to form a cast of the renal pelvis F. (None. All of the above are typical of urinary calculi)

B (Urinary stones occur more commonly in women than men- NO!)

Metaplasia of the lower esophagus from a stratified squamous epithelium to a simple columnar (glandular) epithelium; this condition is usually caused by acid reflux and greatly increases the risk of developing esophageal cancer.

Barrett esophagus

B (this is basically just describing one of the figures in the lecture notes.)

Below are listed— in NO particular order— a number of events (but not necessarily ALL the events) which occur during the development bacterial pneumonia. a. Bacteria gain access to an alveolar lumen and begin proliferating b. As the infection develops, the alveoli become fully congested with mucus and other fluid, as well as PMNs; RBCs leak in from damaged pulmonary capillaries; this stage is referred to as "red hepatization" since the lungs at this stage have the look and feel of normal liver tissue c. Alveolar edema begins, as inflammatory cells (PMNs) migrate into the alveolar lumen d. As the inflammatory process continues, PMNs die and their cell debris adds to the alveolar congestion; macrophages infiltrate the alveoli, cleaning up much of the congestive debris; at this point the ruddy color abates, and this stage is known as "grey hepatization" e. With appropriate antibiotic therapy, the pneumonial infection can be cured and the exudates resorbed or coughed out with complete restitution of the normal alveolar spaces What is the most likely temporal order of these events? A. (earliest) a-b-c-d-e (latest) B. (earliest) a-c-b-d-e (latest) C. (earliest) a-c-d-b-e (latest) D. (earliest) a-b-d-c-e (latest)

Leiomyomas

Benign tumors of smooth muscle origins; in the uterus, these are also known as "fibroids."

border line

Benign, _____, and malignant are the three categories of ovarian tumors; the first is not cancerous, the second is low-grade cancer, while the third is high-grade cancer.

Interlobular

Between lobules, e.g., in breasts, a stroma is hormonally insensitive connective tissue found surrounding and between the lobules

Describe the symptoms of severe ulcerative colitis (UC).

Bloody bowel movements, sometimes exceeding 20 per day; Fever, dehydration, anemia, electrolyte imbalance; Toxic megacolon is a severe complication. (Extraintestinal manifestations are also possible: arthritis, eye inflammation, skin lesions, liver disease, etc)

A syndrome characterized by rips in the esophageal wall near the gastroesophageal junction; these lesions perforate the esophageal wall and lead to pneumomediastinum.

Boerhaave syndrome

D (Anovulatory cycles typically result in simple endometrial hyperplasia, and this type of hyperplasia progresses to cancer about 1% of the time, not 25%)

Both endometrial hyperplasia and anovulatory cycles result in a thickened, hyperplastic uterus. Which ONE of the following is NOT TRUE regarding these two conditions? A. Anovulatory cycles typically result in simple hyperplasia B. The uterine hyperplasia of anovulatory cycles typically shows minimal gland crowding and no atypia C. The higher the degree of gland crowding, complexity, and atypia, the greater the chance of progression to cancer D. The uterine hyperplasia of anovulatory cycles progresses to cancer about 25% of the time E. Other potential causes of endometrial hyperplasia include polycystic ovarian syndrome and functional granulosa tumors of the ovary F. The endometrial thickening seen in both of these conditions is due to unopposed estrogen stimulation of the uterus (endometrium) H. (None. All of the above are true regarding endometrial hyperplasia and anovulatory cycles)

cavernosa; spongiosum

Both the corpora _____ and the _____ must be adequately filled with blood in order to achieve erection.

(a) Cromoglicate-based drugs: Prevent mast cell degranulation, blocking histamine release (b) Beta adrenergic agonists: Bronchodilators (c) Corticosteroids: Minimize inflammation (d) Theophylline: Muscle relaxant that can help deepen bronchodilation

Briefly explain the reasoning/actions behind the use of each of these 4 classes of drugs in treating asthma.

Seminomas; NSGCTs (over 80% of testicular tumors are either seminomas or NSGCTs.)

By far, ______ and _____ (sometimes occurring together as a mixed tumor) form the majority of testicular tumors.

Ampulla

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): "Skip" lesions are present.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Confluent linear ulcers are present.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Fissures and fistulas are common.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Luminal narrowing is present.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Perianal fistulas are common if the rectum is involved.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Results in a "cobblestone" appearance to affected regions of the colon.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): The inflammation is segmental (patchy).

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): The inflammation is transmural.

C

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Usually involves the ileum.

C

The most common viral cause of sialadenitis is: A. Herpes virus B. Measles virus C. Mumps virus D. Cytomegalovirus E. Epstein-Barr virus F. HTLV-1 (human T-cell lymphoma virus)

C

Which ONE of the following is NOT TRUE about pepsinogen/pepsin? A. Pepsinogen is released by chief cells in the gastric glands of the stomach B. Pepsinogen is the inactive form of the protease, pepsin C. Pepsin is most active as an enzyme at a pH of about 8.0 D. Pepsinogen is activated to pepsin by acid and active pepsin itself E. Pepsin is an enzyme which breaks down proteins to smaller substances

C

Which ONE of the following is NOT a typical constituent of urinary calculi? A. Uric acid B. Magnesium ammonium phosphate C. Cholesterol D. Cystine and other products of abnormal amino acid metabolism E. Calcium oxalate perhaps with calcium phsophate F. (None. All of the above are typical constituents of urinary calculi)

C (Cholesterol - NO!)

Which of the following countries have rates of gastric adenocarcinoma 7-8 times higher than in the US? A. Nicaragua and Costa Rica B. New Zealand and Papua New Guinea C. Japan and Chile D. Sweden and Finland E. Mongolia and Central Siberia F. South Africa and the Mediterranean countries

C (Japan and Chile.)

Most malignant tumors of the esophagus are histologically classified as: A. Adenocarcinoma B. Small cell carcinoma C. Squamous cell carcinoma D. Sarcomas E. Mucoepidermoid carcinoma

C (Squamous cell carcinoma. Another way to phrase this question is, 'What is the most common malignancy of the esophagus?')

Which ONE of the following is NOT TRUE regarding the relationship between diabetes mellitus (DM) and glomerulopathies? A. DM causes glomerular changes leading to glomerulosclerosis B. In DM, the advancing glomerulosclerosis alters the glomerular membrane sufficiently that eventually, over 10-20 years, proteinuria ensues C. The proteinuria developed as a result of DM-induced glomerulosclerosis is mild, and does not develop into nephrotic syndrome D. Severe proteinuria in patients with DM often heralds the onset of end-stage kidney disease E. (None. All of the above are true of diabetes mellitus and kidney disease)

C (The proteinuria developed as a result of DM-induced glomerulosclerosis is mild, and does not develop into nephrotic syndrome. In fact, diabetics frequently develop nephrotic syndrome)

Which ONE of the following best describes the alimentary canal? The alimentary canal... A. ..consists of the liver, pancreas, gall bladder, mouth, esophagus, stomach, intestines, rectum, and anus B. ...is 100% synonymus with the digestive system C. ...consists of the tube through which foodstuffs pass; does not include the liver, gallbladder, or pancreas D. ...consists of the stomach and intestines, where foodstuffs are actually digested E. ...(none of the above describes the alimentary canal)

C (Thus the alimentary canal is a subset of the whole digestive system)

Mesothelioma

Cancer of the pleural membranes; especially aggressive, with an abysmal prognosis

B (Upper outer quadrant' and in the '2 o'clock position'.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure. _____Where was the primary breast lesion located? A. Under the pigmented area of the breast B. About an inch and a half to the upper left of the nipple/areolar area of the left breast C. Near the axilla and under the shoulder blade

C (No 'erythema'; No 'edema'; No 'lymphadenopathy'.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure. Other associated findings were... A. Redness and swelling B. Enlarged lymph nodes under the armpits C. (None of the above)

B (But recall that first-generation anti-estrogen drugs like tamoxifen are a mixed blessing. They do act as estrogen antagonists in breast tissue, inhibiting susceptible breast tumors, but they act as weak estrogen agonists on endometrial tissue, so that a woman on tamoxifen has an increased risk of developing endometrial cancer. Also, this underscores the importance of testing for estrogen sensitivity; tamoxifen would be useless if the tumor was not estrogen sensitive.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure. Tamoxifen was prescribed because... A. The tumor was found to be nonresponsive to estrogen B. The tumor was found to be responsive to estrogen, and tamoxifen is an estrogen antagonist C. The tumor was a stage I carcinoma

A (A 'scirrhous' tumor.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure. The tumor was composed of... A. Dense connective tissue, giving it a hard structure B. Soft, glandular tissue C. Cells that had extended into the skin overlying the tumor

F (Choices A - D are analytical/diagnostic procedures; although they were all performed, they do not qualify as 'additional therapy'. E qualifies, but F is the better answer.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure. What additional therapy was undertaken? A. Bone scan B. Liver chemistries C. Complete blood count (CBC) D. Chest x-ray E. Radiation to the breast F. Radiation to the breast and hormonal treatment G. (All of the above)

C (Neither A nor B address the question of whether or not the tumor has metastasized.)

Case Report: A 52-year old married woman presented to her physician with a painless mass in her left breast. During breast examination a 1.0-cm, firm, nontender mass was palpated in the upper outer quadrant located at the 2 o'clock position (2 o'clock proceeding clockwise from the 12 o'clock position, which points directly superiorly), 3 cm from the areola. The mass was not fixed to the skin, and there was no cutaneous erythema or edema. No axillary or supraclavicular lymphadenopathy was noted. An excisional biopsy of the mass was performed. The pathology report described a gross specimen of fatty breast tissue. Microscopic evaluation of the nodule revealed a scirrhous carcinoma. The margins of the excision were free of tumor. Biopsy of nearby lymph nodes (a sentinel biopsy) revealed no involvement. A portion of the specimen was sent for estrogen receptor assay and proved to be positive. The patient was informed of the diagnosis and underwent additional studies, including chest x-ray, liver chemistries, CBC, and bone scan—all of which were negative. The patient was staged as having a stage 1 carcinoma of the left breast. She was referred to a radiation oncologist for primary radiation therapy. After completion of radiotherapy, she was treated with tamoxifen. Prognosis is excellent for cure.What procedure gave evidence that the tumor had not yet metastasized? A. Estrogen receptor assay B. Excisional biopsy of the mass C. Lymph node biopsy

Hepatitis A

Characteristics of this hepatitis or its treatment: • This hepatitis is spread by the fecal-oral route • This hepatitis is generally short-lived and mild, and is often accompanied by jaundice • This hepatitis does not progress into cirrhosis or chronic hepatitis • This hepatitis does not predispose to liver cancer • A vaccine is currently available for this hepatitis

Hepatitis E

Characteristics of this hepatitis or its treatment: • This hepatitis is spread by the fecal-oral route • This hepatitis presents clinically as similar to hepatitis B, only milder, or is asymptomatic • This hepatitis does not progress into cirrhosis or chronic hepatitis • This hepatitis does not predispose to liver cancer • This hepatitis is endemic in some parts of the world, including Asia, Africa, South and Central America • Infection with this virus has a poor prognosis in pregnant women • A vaccine is not currently available for this hepatitis

Hepatitis B

Characteristics of this hepatitis or its treatment: • This hepatitis is spread by the parenteral-sexual route • This hepatitis may be symptomatic (icteric) or asymptomatic; if icteric, the jaundice generally dissipates after several weeks • In some 10% of cases, this hepatitis progresses into cirrhosis or chronic hepatitis • This hepatitis may predispose to liver cancer • A vaccine is currently available for this hepatitis

Hepatitis D

Characteristics of this hepatitis or its treatment: • This hepatitis is spread by the parenteral-sexual route • This hepatitis presents clinically as similar to HBV infection • In some 10% of cases, this hepatitis progresses into cirrhosis or chronic hepatitis • This hepatitis (itself) does not predispose to liver cancer (although the HBV co-infection may) • This virus causing this hepatitis is an incomplete virus, requiring HBV co-infection in order to replicate itself • A vaccine is not currently available for this hepatitis

Hepatitis C

Characteristics of this hepatitis or its treatment: • This hepatitis is spread by the parenteral-sexual route • This hepatitis presents clinically as similar to HBV infection, only milder • In some 50% of cases, this hepatitis progresses into cirrhosis or chronic hepatitis • This hepatitis may predispose to liver cancer • A vaccine is not currently available for this hepatitis

Inflammation of the antral (distal) part of the stomach, thought to be caused by H. pylori infection.

Chronic antral gastritis

Seminomatous germ cell tumor

Collective term for dysgerminomas and seminomas

Nonseminomatous germ cell tumor

Collective term for teratomas, teratocarcinomas, and embryonal carcinomas

Centrilobular emphysema is marked by widening of the airspace in the center of a lobule, i.e., the respiratory bronchiole alone; this is the most common type (95%) and is typically seen in smokers. Panacinar emphysema involves all the airspace distal to the terminal bronchiole, i.e., the respiratory bronchiole and the alveoli, otherwise known as the entire acinus. Panacinar emphysema may be caused by smokers, but is seen in certain genetic disorders as well.

Compare centrilobular and panacinar emphysema.

Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis. Primary tuberculosis is a localized lung inflammation that heals as a calcified granuloma with central caseous necrosis. The Ghon complex represents a peripheral tuberculous granuloma with enlarged regional lymph nodes. Secondary tuberculosis most often develops as a result of reactivation of a dormant primary infection. In secondary tuberculosis, the bacteria typically spread to the apex of the lung and produce large cavities, which cause hemoptysis. Miliary tuberculosis refers to widespread seeding of the bacteria in the lungs and distant organs.

Compare primary and secondary tuberculosis.

spiral arteries

Contractions of the _____ in the endometrium cause/facilitate the shedding of the stratum functionalis during menstruation.

A motility disorder of the (entire) esophagus characterized by uncoordinated contractions of the esophagus; most or all of the esophagus is involved, and it is thrown into a long spiral shape.

Corkscrew esophagus

A transmural, chronic inflammatory disease that may affect any part of the digestive tract but principally occurs in the terminal ileum and right colon.

Crohn disease

Disease (all other causes of hypercortisolism is refered to as Cushing syndrome.)

Cushing [disease/ syndrome] refers to hypercortisolism due to a pituitary corticotropic adenoma.

Inflammation of the urinary bladder

Cystitis

Isthmus

D

Which ONE of the following is NOT TRUE regarding chronic gastritis? A. Chronic gastritis refers to long-term inflammatory diseases of the stomach ranging from mild superficial involvement of the gastric mucosa to severe atrophy B. Chronic gastritis may be either an immune or an environmental disorder, the latter including infection by H. pylori C. The predominant symptom of chronic gastritis is dyspepsia, although many individuals with chronic gastritis are asymptomatic D. (None. All of the above are true regarding chronic gastritis)

D (Again, chronic gastritis is associated with H. pylori infection)

Which ONE of the following is NOT considered a risk factor for head and neck squamous cell carcinoma (HNSCC)? A. Chronic smokers of tobacco E. Industrial chemical like nickel and chromium B. Chronic alcohol users F. Woodworking and leatherworking C. Human papilloma virus G. (None. All of the above are risk factors for HNSCC) D. Salty or smoked foods

D (But salty or smoked foods are risk factors for stomach cancer)

Which ONE of the following is NOT TRUE of Helicobacter pylori? A. H. pylori preferentially colonize the antrum, which has no acid-secreting parietal cells. B. H. pylori use their flagella to tunnel through the mucous layer so that they can grow away from the acid. C. H. pylori produce urease, which generates ammonia that, in turn, can neutralize or buffer stomach acids. D. H. pylori invade the gastric mucosa, evading the stomach acid in the process. E. H. pylori secrete toxins that cause localized inflammation that, in turn, weakens the mucosal barrier. F. (None. All of the above are true of H. pylori)

D (H. pylori do not invade the stomach mucosa, colonizing instead the surface of the gastric epithelium.)

Which ONE of the following is NOT a common symptom of congenital megacolon? A. Delayed passage of meconium by a newborn B. In less severe cases: constipation, abdominal distention, and pencil feces C. Development of vomiting by a newborn in the first few days of life D. Hematochezia E. (None. All of the above are typical symptoms of congenital megacolon)

D (Hematochezia. Why would the colon bleed?)

Which ONE of the following is NOT TRUE regarding achalasia? A. Achalasia is caused by spasms of the LES, such that the portion of the esophagus proximal to the spasms becomes distended B. Achalasia makes swallowing difficult or even impossible C. Achalasia is most often idiopathic D. Achalasia predisposes an individual to Barrett's esophagus E. (None. All of the above are true regarding achalasia)

D (If you think about it, if anything, achalasia would decrease the likelihood of developing Barrett's esophagus since the LES spasms decrease the reflux of gastric acid.)

Which ONE of the following is NOT TRUE regarding peptic ulcers? A. Peptic ulcers typically develop only in parts of the GI tract exposed to pepsin and HCl B. Corticosteroids are ulcerigenic, at least at pharmacological levels C. Smoking, stress, and NSAID use are peptic ulcer risk factors D. Peptic ulcers commonly spread to adjacent abdominal organs, such as the liver, pancreas, or gallbladder E. Peptic ulcers typically appear as sharply punched out, round defects of the mucosa extending into the deep layers of the stomach or duodenum F. (None. All of the above are true regarding peptic ulcers)

D (Recall that peptic ulcers require gastric acid to form. Since liver, pancreas, and gallbladder are not typically acidic organs, unless there's a fistula or fissure, peptic ulcers will not occur there.)

Which ONE of the following is NOT TRUE about bile? A. Bile contains bicarbonate buffers to neutralize stomach acid in the duodenum B. Bile salts emulsify fats C. Bile salts are produced by the liver D. Bile contains digestive enzymes such as lipases to aid in duodenal digestion E. Bile pigments, initially produced by the spleen, are a waste product in the bile F. Bile contains NaCl to help it stay liquid and watery G. Bile contains cholesterol and phospholipids (lecithin) to help in fat emulsification H. (None— all of the above are true about the liver)

D (There are no digestive enzymes in bile; its main digestive functions are to buffer stomach acids and emulsify fats.)

Systemic signs (fever, chills); Local signs (coughing, chest pain, with rales, rhonchi and other signs of Consolidation); Dyspnea, SOB, and tachypnea (due to impaired gas exchange); Mucopurulent; (To make a diagnosis, these clinical findings must be confirmed by further studies, including chest radiography, sputum culture, and peripheral blood studies)

Describe 4 common clinical signs of pneumonia. How is this disease diagnosed?

(a) Chronic bronchitis (b) Prolonged coughing spells, expectoration of thick or purulent mucus, dyspnea, orthopnea (c) Hypoxia due to inadequate ventilation during the coughing spells (d) Enlarged heart (due to cor pulmonale from the pulmonary fibrosis of chronic bronchitis)

Describe a "blue bloater" in terms of (a) What diffuse pulmonary disease is typically associated with this condition, (b) What are common associated symptoms, (c) What causes the underlying "blueness", and (d) What would be a typical radiological finding?

(a) Medial, and sometimes intimal, hypertrophy of the larger pulmonary arteries (b) Smooth muscle hyperplasia in the walls of the larger pulmonary arteries (c) Atheromas in the pulmonary arteries (d) Right ventricular hypertrophy

Describe four characteristic morphological changes seen in pulmonary hypertension.

Symptoms: . Shortness of breath (SOB) . Fatigue . Non-productive cough . Angina pectoris . Syncope (fainting) . Peripheral edema (swelling around the ankles and feet) . Rarely, hemoptysis (coughing up blood) Signs: . Loud S2 (pulmonic valve closure sound) . (Para)-Sternal heave . Jugular venous distension . Pedal edema . Clubbing

Describe four symptoms and four signs typical of pulmonary hypertension.

(a) Blepharoptosis of the upper eyelid on the affected side (b) Constriction of the pupil (miosis) on the affected side (c) Absence of sweating (anhidrosis, presenting as dry skin) on the affected side

Describe three characteristic symptoms or signs seen in Horner syndrome.

(a) Bronchodilators may ease breathing (b) Oxygen therapy may ease breathing (c) Antibiotics may reduce infection (d) Corticosteroids may reduce inflammation and damage (e) In emphysema, lung volume reduction surgery may be of benefit, as may a lung transplant

Describe three measures commonly used to treat COPD.

_____ is defined as an increase in stool mass, frequency, or fluidity.

Diarrhea

Inflammation/infection of a diverticulum.

Diverticulitis

A herniation of the mucosa and submucosa through the muscular layers of the colon.

Diverticulosis

low; low (Examine the chart on or about slide 75)

During the early part of the follicular phase of the ovarian cycle, serum estrogen levels are [ high / low ] and serum progesterone levels are [ high / low ].

high; low (Examine the chart on or about slide 75)

During the late part of the follicular phase of the ovarian cycle, serum estrogen levels are [high / low ] and serum progesterone levels are [ high / low ].

high; high (Examine the chart on or about slide 75)

During the middle part of the luteal phase of the ovarian cycle, serum estrogen levels are [high / low ] and serum progesterone levels are [ high / low ].

estrogen (There is very little progesterone around at this time, and uterine tissue is not responsive to LH and FSH.)

During the proliferative phase of the uterine cycle, the hormone(s) [estrogen / progesterone / estrogen & progesterone / LH / FSH ] act on the endometrium and signal it to grow (proliferate).

estrogen and progesterone (The two act together. Estrogen continues the proliferation of the endometrial tissue, while progesterone transforms the endometrium into a tissue receptive to- and ideal for- implantation. Note that in this question, as worded, neither estrogen not progesterone alone would completely answer the question- both are required to effect all the changes mentioned in the stem of the question.)

During the secretory phase of the uterine cycle, the hormone(s) [estrogen / progesterone / estrogen & progesterone / LH / FSH ] act on the endometrium, signaling it to (1) continue growing (proliferateing), (2) become edematous so that it forms a soft medium ideal for implantation, and (3) transform its uterine glands into secretory structures.

_____ is defined as painful, bloody, small-volume diarrhea.

Dysentery

_____ refers to difficulty or pain in digestion.

Dyspepsia

Difficulty in swallowing, sometimes (but not always) accompanied by pain.

Dysphagia (general)

_____ refers to difficulty (including pain) in swallowing.

Dysphagia (to be more specific, odynophagia refers to pain on swallowing. Since painful swallowing is difficult swallowing, odynophagia can be considered as part of dysphagia.)

List three symptoms of early gastric adenocarcinoma.

Dysphagia; Dyspepsia; Nausea

_____ refers to pain or burning on urination.

Dysuria

Uterus

E

Approximately 50% of all carcinomas of the intestine develop in the: A. Small intestine B. Ascending colon C. Transverse colon D. Descending colon E. Rectosigmoid area

E (A very active area for disease)

Which ONE of the following is NOT a common symptom of peptic ulcers? A. Maximal pain typically on the midline of the epigastrium B. Pain 1-3 hours post-cibum and at night C. Non-specific symptoms: nausea, vomiting, loss of appetite D. Pain can be temporarily relieved with alkaline agents or food E. Achalasia F. (None. All of the above are typical symptoms of peptic ulcers)

E (Achalasia)

Which ONE of the following is NOT TRUE regarding end stage glomerulopathy (ESG)? A. Several kidney conditions can lead to ESG B. In ESG, the kidneys appear symmetrically shrunken C. In ESG, the kidneys appear finely ganular, the granules being what's left of the functional tubules D. In ESG, histologic examination shows that the glomeruli are filled with eosinophilic material, obliterating their lumina E. In most patients, ESG develops quickly and leads to death within about 6 months F. ESG is relentlessly progressive and eventually dialysis or renal transplantation is required to maintain life G. Symptoms of ESG range from such nonspecific symptoms as loss of appetite, anemia, vomiting, fatigue and weakness, to more specific symptoms/findings such as proteinuria, hypertension, azotemia, or edema H. (None. All of the above are true of end stage glomerulpathy)

E (In most patients, ESG develops quickly and leads to death within about 6 months)

Which ONE of the following is NOT TRUE regarding esophageal varices? A. Esophageal varices are often found when portal hypertension is present B. Esophageal varieces are associated with cirrhosis and other liver diseases C. Esophageal varies tend to bleed, often leading to hematemesis D. Esophageal varices can be treated with agents which lower portal hypertension or sclerosis the varicose veins E. Esophageal varices tend to heal on their own, without serious complications, and hence are best considered as an inconvenience F. (None. All of the above are true regarding esophageal varices)

E (In truth, esophageal varices usually continue to grow and may become life-threatening if they rupture)

Which ONE of the following is NOT a typical clinical finding of nephritic syndrome? A. Generalized edema B. Moderate proteinuria and hypoalbuminemia C. Hematuria and oliguria D. Hypertension E. Megaloblastic anemia F. (None. All of the above are typical clinical findings of nephritic syndrome)

E (Megaloblastic anemia--NO!)

Which ONE of the following is NOT TRUE regarding the symptoms of diverticulosis? A. Some patients with diverticulosis complain of episodic colicky pain B. Flatulence is common C. Both constipation and diarrhea, sometimes alternating, may occur D. Most persons with diverticulosis are asymptomatic E. (None. All of the above are symptoms of diverticulosis)

E (None. All of the above are symptoms of diverticulosis)

Which ONE of the following is NOT TRUE regarding urinary tract infections (UTIs)? A. Acute pyelonephritis may result in abscess formation within the kidneys. B. Chronic pyelonephritis may evolve from the acute form. C. The kidneys are often affected asymmetrically in chronic pyelonephritis, with one kidney normal sized and the other small and shrunken. D. In cystitis, the bladder wall appears thickened, hemorrhagic, ulcerated, or coated with foci of pus. E. (None. All of the above are true of UTIs)

E (None. All of the above are true of UTIs)

Which ONE of the following is NOT a typical symptom of cystitis? A. Frequent urination, sometimes every 15 to 20 minutes B. Microhematuria or even frank hematuria (the urine being pinkish or dull red) C. Lower abdominal pain localized over the bladder or suprapubic region D. Dysuria- pain or burning on urination E. (None. All of the above are typical and common symptoms of cystitis)

E (None. All of the above are typical and common symptoms of cystitis)

Diverticula of the intestine as most often located in the: A. Jejunum B. Ileum C. Cecum D. Transverse colon E. Sigmoid colon

E (Remember that the sigmoid colon is the number one location for diverticular disease, Intestinal polyps, and Colorectal cancer.)

Which ONE of the following is NOT TRUE regarding autoimmune atrophic gastritis (AAG)? A. AAG seldom involves the antrum B. Antibodies against parietal cells and intrinsic factor can be demonstrated in most cases of chronic gastritis C. The predominant symptom of AAG is dyspepsia (due to lack of HCl), although many individuals with chronic gastritis are asymptomatic D. AAG is associated with achlorhydria and pernicious anemia, which may superimpose additional symptoms E. (None. All of the above are true regarding autoimmune atrophic gastritis)

E (They're all true)

D (Estrogen. Have I stressed this enough already? Estrogen unopposed by progesterone!)

Endometrial hyperplasia is typically a result of prolonged exposure to: A. Vitamin A B. Androgens C. Vitamin D D. Estrogen E. Thyroid hormones F. Progesterone H. None of the above

Gynecomastia

Enlargement or development of the male breast; development of duct tissue in a male breast.

Corpus cavernosum

Erectile tissue arranged in 2 columns and responsible for most of the effects of erection

Corpus spongiosum

Erectile tissue surrounding the male urethra in the penile shaft

Esophageal cancer that usually arises in the context of Barrett esophagus.

Esophageal adenocarcinoma

The most common type of esophageal cancer.

Esophageal squamous cell carcinoma

Swollen, varicose veins in the distal portion of the esophageal or upper part of the stomach.

Esophageal varices

An uncommon esophageal condition characterized by ledge-like protrusions of mucosa that may cause obstruction.

Esophageal webs

Inflammation of the esophagus.

Esophagitis

Chronic bronchitis

Excessive production of tracheobronchial mucus causing cough and expectoration for at least 3 months during 2 consecutive years

(a) Arterial: Vasoconstriction of pulmonary arteries increases vascular resistance (b) Venous: Due to backup of blood from left heart dysfunction (c) Hypoxic: Low levels of blood oxygen causes vasoconstriction, which increases pulmonary arterial pressure (d) Thromboembolic: Pulmonary vessels are blocked with thromboemoli, which increases pulmonary vascular resistance (e) Miscellaneous: Idiopathic cases

Explain in one sentence or less the mechanism behind each of the following types of pulmonary hypertension- in each case, what actually causes the pulmonary hypertension? (a) Arterial: (b) Venous: (c) Hypoxic: (d) Thromboembolic: (e) Miscellaneous:

Endometrium

F

T(Bad)/F(Good) Re: Calcium Kidney Stones- Drinking enough water so that urinary output is around 2 liters per day.

F

T(Bad)/F(Good) Re: Calcium Kidney Stones- Drinking orange juice.

F

T(Bad)/F(Good) Re: Calcium Kidney Stones- Having a diet rich in dietary calcium (meaning calcium-rich foods in your meals).

F

T(Bad)/F(Good) Re: Calcium Kidney Stones- Taking hydrochlorothiazide.

F

T/F: In late stage Sjögren syndrome, patients present with hematuria, oliguria, and azotemia

F

T/F: It is thought that a diet high in indigestible fiber ("roughage") predisposes to diverticulosis.

F

T/F: Sjögren syndrome is an acute, infectious sialadenitis caused by staphylococcal bacteria.

F

T/F: Sjögren syndrome results when peptic esophagitis is repaired by metastatic epithelium, such that the normal stratified squamous epithelium is replaced by a glandular epithelium that resembles the intestine

F

Which ONE of the following is NOT TRUE of esophagitis and Barrett's esophagus? A. Esophagitis is more commonly caused by viruses than by bacteria B. Peptic esophagitis is caused by the repeated destructive actions of acid and pepsin on the esophageal wall C. Barrett's esophagus results when peptic esophagitis is repaired by metastatic epithelium, such that the normal stratified squamous epithelium is replaced by a glandular epithelium that resembles the intestine D. Barrett's esophagus may give rise to peptic ulcers E. Barrett's esophagus increases the risk for esophageal cancer F. (None. All of the above are consistent with esophagitis and Barrett's esophagus)

F

T/F: The esophageal wall is composed entirely of a mucosa; the other three GI tract tunics are absent.

F (ALL parts of the GI tract have a four-layered wall, consisting of mucosa, submucosa, muscularis externa, and serosa/adventitia.)

T/F: Another name for irritable bowel syndrome is celiac sprue

F (Celiac sprue is gluten-sensitive enteropathy)

T/F: Irritable bowel syndrome is typically caused by bacterial or parasitic pathogens, and is associated with intestinal abscesses and well-marked areas of PMN infiltration

F (IBS is a functional disorder- try as we might, we can't find anything physically wrong. No bacteria. No abscesses. No inflammation. The etiology is unknown, but the symptoms are very real to those who suffer from this disorder.)

T/F: Invasive diarrhea is a high volume diarrhea, whereas osmotic and secretory diarrheas are low volume.

F (It is backwards- Invasive diarrhea is low volume, and the other two are high volume.)

T/F: Membranous glomerulopathy presents with typical nephritic syndrome.

F (MG results in pretty massive proteinuria and is the classic nephrosis)

Which ONE of the following is NOT TRUE regarding the progression and treatment of membranous glomerulopathy (MG)? A. The proteinuria of MG is nonselective and does not usually respond to corticosteroid therapy B. MG presents with the typical symptoms of nephrotic syndrome C. Progression in MG is associated with increasing sclerosis of glomeruli D. Progression in MG is associated with rising BUN reflecting renal insufficiency, and development of hypertension E. Ca. 40% of patients eventually develop renal insufficiency & about 10% die of renal failure within 10 years F. (None. All of the above are true of membranous glomerulpathy)

F (None. All of the above are true of membranous glomerulpathy)

Which ONE of the following is NOT TRUE regarding the complications of diverticulosis? A. Diverticula are easily obstructed with fecal material, causing bleeding or inflammation B. Perforation of diverticula may lead to peritonitis, pericolonic abscesses, fistulae, or pericolonic fibrosis C. Chronic blood loss from hemorrhagic diverticula may lead to anemia D. Sudden, painless, and severe bleeding from colonic diverticula are a cause of serious lower GI tract hemorrhage in the elderly E. Hemorrhagic diverticula may cause occult bleeding F. (None. All of the above are true of the complications of diverticulosis)

F (None. All of the above are true of the complications of diverticulosis)

Which ONE of the following is NOT TRUE regarding irritable bowel syndrome (IBS)? A. IBS is the most common malady of the gastrointestinal tract B. Typical IBS symptoms include diarrhea, constipation, bloating, and crampy, colicky, lower abdominal pain C. IBS is classified as a functional disorder D. IBS is also known as spastic colon or functional bowel syndrome E. Despite extensive examination, the intestines appear normal, with no apparent physical abnormality to explain the IBS symptoms F. IBS is typically treated with a combination of anti-inflammatories- NSAIDs (usually 5-aminosalicylate) and corticosteroids. G. (None. All of the above are true regarding IBS)

F (Remember in IBS there is nothing physically wrong that we can see- including no inflammation. How would the antiinflammatories help when there is no inflammation to begin with?)

T/F: Squamous cell carcinoma is a cancer of the Langerhans cells in the skin and mucous membranes.

F (SCC is cancer of the keratinocytes which, of course, eventually become the squamous epithelial cells of skin and mucous membranes)

T/F: Sjögren patients seem to be at increased risk for acute myelogenous leukemia and multiple myeloma

F (Sjögren syndrome DOES increase the risk of developing non-Hodgkin lymphoma)

Which ONE of the following is NOT TRUE regarding esophageal tears? A. Mallory-Weiss syndrome involves longitudinal tears that rip partway through the esophageal near the gastroesophageal junction B. Boerhaave syndrome involves tears that perforate through the entire esophageal wall. C. Mallory-Weiss tears and Boerhaave syndrome are usually brought about by hyperemesis D. Mallory-Weiss tears usually heal quickly and completely E. Complications of Boerhaave syndrome include mediastinitis and pneumomediastinum F. Hamman's crunch is characteristic of Mallory-Weiss tears G. (None. All of the above are true regarding esophageal tears)

F (The crunching sound comes from air in the mediastinum, and every heartbeat produces a crunching sound. The air gets into the mediastinum through an esophageal perforation, which would be Boerhaave syndrome, not Mallory-Weiss.)

T/F: The most important factors in the development of esophageal adenocarcinoma are cigarette smoking and alcoholism.

F (The single greatest risk factor for esophageal adenocarcinoma is Barrett esophagus; there is an association with cigarette smoking, but there appears to be no link between esophageal adenocarcinoma and alcohol use. This is in contradistinction to squamous cell carcinoma of the esophagus, where most cases are due to alcohol and/or cigarette use.)

Which ONE of the following is NOT associated, either commonly or rarely, with peptic ulcers? A. Mild hemorrhage (tho hemorrhage may become serious if a large artery is involved) B. Melena rather than hematemesis C. Peritonitis, pancreatitis, and pneumoperitoneum D. Antral or intestinal stenosis, or even obstruction E. Perforation of the GI tract wall, accompanied by severe and intractable pain F. (None. All of the above are true regarding complications of peptic ulcers)

F (They are all true)

T/F: Squamous cell carcinoma is the most common cancer of the stomach.

F (adenocarcinoma is the most common.)

T/F: Autosomal dominant diseases such as ADPKD typically present early in life, often at or shortly after birth

F (autosomal dominant diseases tend to have late manifestation, with the age of onset being anywhere from the second to the fifth or sixth decade of life)

T/F: In an HIV-positive patient, thrush in the mouth is AIDS-defining.

F (but it is pre-AIDS)

T/F: Canker sores are most common in elderly patients.

F (canker sores are most common in the first two decades of life)

T/F: Canker sores are contagious.

F (cold sores are contagious, not canker sores)

T/F: Dysphagia to solids and liquids is generally due to esophageal obstruction.

F (dysphagia to solids and liquids generally indicates a peristalsis problem.)

T/F: Myasthenia gravis and scleroderma both may cause dysphagia; myasthenia gravis tends toaffect the lower esophagus, while scleroderma affects the upper esophagus.

F (it is backwards. Myasthenia gravis is a disease affecting skeletal muscle, so it hits the upper esophagus, while scleroderma is a connective tissue disorder affecting smooth muscle; it hits the lower esophagus.)

T/F: The esophagus is lined internally by a simple columnar epithelium.

F (simple columnar epithelia are typical of secretory epithelia, such as in the intestines. The esophagus is not secretory except for mucus, but it must resist abrasion; for that it is lined with stratified squamous epithelium.)

T/F: Approximately 2.5% of oral leukoplakic lesions are precancerous.

F (the number is 10 times higher: 25%. Numbers that high mean remove the lesions when they are found.)

T/F: At its core, nephrotic syndrome is an inflammatory glomerulopathy, while nephritic syndrome is the result of changes in the glomerular membrane, rendering it more permeable to proteins.

F (this is backwards. Nephritic syndrome—"nephritis"—is the inflammatory condition, whereas nephrosis shows little evidence of inflammation)

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) ADPKD is a precancerous condition, and most ADPKD patients progress to renal cell carcinoma within 5 years

False

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) The kidneys appear small and shrunken, weighing less than half of their normal weight

False

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) The many cysts of ADPKD are derived from obstructed and inflated glomerular capillaries

False

(Indicate T/F regarding end stage glomerulpathy (ESG) In ESG, the only pathologic change seen in the glomeruli is a thickened basement membrane

False

(Indicate T/F regarding end stage glomerulpathy (ESG) In most patients, ESG develops quickly and leads to death within about 6 months

False

(Indicate T/F regarding membranous glomerulopathy (MG) MG is characterized by large-scale inflammation of the glomeruli, which become infiltrated with numerous inflammatory cells

False

Formed from the breakdown of lipid-rich epithelial cells, these casts contain fat globule inclusions

Fatty Cast

C

Fungus grows in the body not as a yeast but as a typical mycelial fungus A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

C

Fungus often invades the arteries, causing thrombi to form A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

Myometrium

G

Which ONE of the following is NOT TRUE regarding the malabsorption syndromes? A. Malabsorption syndromes are a collection of disorders marked by an inability of the intestines to absorb nutrients B. Many conditions can cause malabsorption syndrome, including Crohn's disease, parasitic infections, and obstructive jaundice C. All malabsorption syndromes are characterized by a deficiency of nutrients that evolves over a period of time D. Malabsorption syndrome may evolve into marked protein deficiency E. Malabsorption of fat often results in steatorrhea F. Bleeding disorders are a common complication of malabsorption syndromes, due to small stores and insufficient stores of vitamin K G. (None. All of the above are true regarding the malabsorption syndromes)

G (They are all true)

_____ refers to pain in the stomach; a stomach ache.

Gastralgia

A false negative might be seen in an anergic individual, i.e., a person who cannot mount an immune response; an AIDS patient would be an example. A false positive might come from a person who has had and cleared a pneumonial infection, or from a person who has had enough tuberculin tests that they are now generating antibodies to the PPD; in either case, the patient would have a positive tuberculin test but would not have a pneumonial infection.

Give an example and a brief description of the cause, of a false negative and a false positive on the tuberculin skin test.

Perimetrium

H

White lesions in the mouth which can't be scraped off and which appear "shaggy;" these lesions are caused by Epstein-Barr virus and can be trieated with antivirals such as acyclovir.

Hairy leukoplakia

_____ refers to vomiting of blood.

Hematemesis

_____, in a broad sense, refers to bright red streaks of blood in the stools (and is often abbreviated BRBPR- bright red blood per rectum); in a more restricted sense (as used by many pathologists) this word refers to a dripping of blood from the anus.

Hematochezia

A common herpesvirus infection of the lips and oral mucosa presenting as vesiculobullous lesions which evolve into painful ulcers

Herpetic stomatitis

Aka "cold sores"

Herpetic stomatitis

A disease in which colonic dilatation results from a defect in (i.e., a lack of) innervation of the colorectum.

Hirschsprung disease

_____ is a disease in which colonic dilatation results from a defect in (i.e., a lack of) ganglionic innervation of the colorectum.

Hirschsprung disease (congenital megacolon)

A benign cast sometimes seen after exercise or dehydration

Hyaline Cast

Dilation of the renal pelvis and calices, due to an accumulation of urine resulting from obstruction of normal outflow

Hydronephrosis

_____ refers to the dilation of the renal pelvis and calices, due to an accumulation of urine resulting from obstruction of normal outflow.

Hydronephrosis

_____ refers to the dilation of a ureter, due to an accumulation of urine resulting from obstruction of normal outflow.

Hydroureter

Dilation of the renal pelvis and calices and the associated ureter, due to an accumulation of urine resulting from obstruction of normal outflow

Hydroureteronephrosis

_____ refers to the dilation of the renal pelvis and calices and the associated ureter, due to an accumulation of urine resulting from obstruction of normal outflow.

Hydroureteronephrosis

_____ refers to elevated calcium levels in the blood.

Hypercalcemia

_____ refers to elevated levels of calcium in the urine.

Hypercalciuria

Cervical canal

I

anthracosis

In [ anthracosis / silicosis/ asbestos / talcosis ], the lungs show black discoloration but no significant lung dysfunction.

alveolar (Note that while lobar pneumonia and bronchopneumonia are types of alveolar pneumonia, because of the phrase 'air sacs of the entire lung' those two choices do not quite work here.)

In [alveolar / interstitial / lobar / broncho-] pneumonia, the air sacs of the entire lung (or part of the lung) become filled with a purulent exudate; this type of pneumonia is usually caused by bacterial infection.

interstitial (this type of pneumonia is usually milder than alveolar pneumonia as well)

In [alveolar / interstitial / lobar / broncho-] pneumonia, the alveolar wall becomes inflamed but the air sacs do not fill with purulent exudate; this type of pneumonia is usually caused by viral or Mycoplasma infection

Coal workers' pneumoconiosis

In [antracosis / silicosis/ asbestosis / Coal workers' pneumoconiosis ] the lungs are completely blackened and show significant dysfunction, often from fibrosis.

Salt-wasting (this manifestation of adrenogenital syndrome kills babies - dehydration, electrolyte imbalances)

In _____ adrenogenital syndrome (or congenital adrenal hyperplasia), a total lack of 21-hydroxylase activity results in no synthesis of either cortisol or aldosterone; such an individual cannot retain their sodium.

congenital

In _____ syphilis, spirochetes (i.e., the treponemal infection) are spread from mother to fetus.

panacinar

In ________________ emphysema, the entire acinus- respiratory bronchioles and alveoli- are widened.

centriacinar

In ________________ emphysema, the respiratory bronchioles alone (not the alveoli) are widened.

Virilization

In a women, an excess of hair in normal hair-bearing areas plus secondary male sex characteristics, esp. clitoromegaly

saccular; or cystic

In bronchiectasis, ________________ dilatation is usually seen in the larger airways.

cylindrical

In bronchiectasis, ________________ dilatation is usually seen in the smaller airways.

LH and FSH (Actually, these gonadotropins perform the same function in males, except that the cells they are stimulating are Leydig and Sertoli cells, not follicle cells.)

In females, [LH and FSH/ androgens/ GnRH/ prolactin/ oxytocin] stimulate(s) follicle cells to secrete sex hormones.

LH (LH stimulates testosterone production in both sexes -but women end up converting most of theirs to estrogen)

In males, [LH /FSH/ androgens/ GnRH/ prolactin/ oxytocin] stimulate(s) the testes to secrete testosterone.

Suppressed; decreased (This should make sense. If the purpose of the RAA system is to increase secretion of aldosterone, but aldosterone levels are already elevated, it makes sense that the RAA system would then be inhibited- 'We don't need no more stinkin' aldosterone!' Similarly, if renin activates the RAA system, but the RAA system is suppressed, then it makes sense that renin secretion will also be suppressed. 'We don't need no renin, either!')

In primary hyperaldosteronism, the renin-angiotensin-aldosterone system will be [suppressed / activated ] and plasma renin activity will be [ increased / decreased ].

asbestosis

In time, [antracosis / silicosis/ asbestosis / talcosis ] will usually progress to fibrosis, pleural plaques, lung cancer, and/or mesothelioma; in this condition, the lungs are not black as in some other pneumoconioses.

6,7,8

In which tumor(s) might you find malignant placental or extra-embryonic cells?

4

In which tumor(s) might you find various somatic tissues, such as skin, hair, teeth, and brain cells, but no placental or extra-embryonic tissue?

1; 2

In which tumor(s) might you find various somatic tissues, such as skin, hair, teeth, and brain cells?

1

In which tumor(s) will you NOT find neoplastic stem cells?

4

In which tumor(s) will you NOT find neoplastic stem cells?

Adenosis

Increase in the number of acini per lobule, a normal response in pregnant women but not otherwise.

Nor, Nor, Nor (End organ problems involve issues with the uterus or vagina, neither of which lie on the HPO axis. Thus, end organ problems will not affect a woman's HPO hormone levels- they will all be normal.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ___ ___ ____ A woman doesn't menstruate because she lacks a complete vagina (Mayer-Rokitansky-Küster-Hauser syndrome)

Dec Dec Dec (Recall that prolactin acts to inhibit hypothalamic release of GnRH the reason women are initially amenrrheic after giving birth. So GnRH levels are down, as are LH/FSH levels. This in turn depresses ovarian hormone E&P levels.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ___ ___ A pituitary prolactinoma hypersecretes prolactin and produces hyperprolactinemia

Dec Dec Dec (Since the tumor affects both the hypothalamus and the pituitary, GnRH and gonadotropin levels will be reduced. The effect of this will be to also reduce ovarian hormone E&P levels. Yes, the low levels of E&P will remove feedback inhibition on the hypothalamus in an effort to try to raise the GnRH levels, but remember that the hypothalamus is being compressed by that tumor so it cannot properly respond- GnRH levels remain stubbornly low despite the lack of feedback inhibition.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A large tumor compresses both the hypothalamus and the pituitary, reducing their secretory functions.

Nor Nor Nor (End organ problems involve issues with the uterus or vagina, neither of which lie on the HPO axis. Thus, end organ problems will not affect a woman's HPO hormone levels- they will all be normal.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A woman apparently doesn't menstruate because she has an imperforate hymen (cryptomenorrhea)- she's been menstruating all along, but the menstrual blood can't get out.

Nor, Nor, Nor (End organ problems involve issues with the uterus or vagina, neither of which lie on the HPO axis. Thus, end organ problems will not affect a woman's HPO hormone levels- they will all be normal.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A woman fails to menstruate because repeated D&C's have scraped away her endometrium right down to the muscle- she has no stratum basale left! (Asherman syndrome)

Inc Inc Dec (Without ovaries a woman cannot make appreciable quantities of E&P, so the ovarian hormone levels will be nil. As discussed above, this will remove the feedback inhibition on the hypothalamus and pituitary, so that GnRH and LH/FSH levels will be increased.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A woman has had a bilateral oophorectomy.

Dec Dec Dec (Since her hypothalamus is not secreting GnRH because of the stress, she is not secreting LH/FSH either. This in turn means her ovaries are not secreting E&P either. Again, the low E&P levels would remove the feedback inhibition on her hypothalamus, but as long as the stress continues to suppress her HPO axis, her HPO hormone levels will be abnormal.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A woman is going through an extremely stressful period in her life, and the stress has caused her hypothalamus to stop secreting GnRH.

Inc Inc Dec (Since her ovaries are failing, she obviously won't be able to secrete E&P in normal amounts, so ovarian hormone levels will be reduced. This, in turn, will remove feedback inhibition on the hypothalamus, so that hypothalamic GnRH and pituitary LH & FSH outputs will rise. The rise in LH & FSH will be futile, of course, since the ovaries are failing and cannot properly respond.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ A woman's ovaries are experiencing premature ovarian failure.

Inc Dec Dec (In this case, the enlarged post-partum pituitary is suffering and unable to secrete gonadotropins. This of course will reduce ovarian hormones E&P which, in turn, will remove feedback inhibition on the hypothalamus so that GnRH levels will rise. The rise in GnRH levels will be futile, or course, because the pituitary is necrotic and unable to function.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ Post-partum necrosis of the pituitary has reduced the pituitary's ability to secrete hormones.

Inc, Inc, Dec (Here the problem is that a woman's follicles cannot 'see' the gonadotropins in her blood, so she cannot respond to them. Thus ovarian hormone output will be low. This in turn will remove feedback inhibition on the hypothalamus and pituitary, so that GnRH and LH/FSH levels will be high. As before, this attempt to stimulate the ovarian follicles is futile, since they cannot respond to LH & FSH.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ The follicles in a woman's ovaries do not express normal LH and FSH receptors, and thus her follicles are not responsive to LH and FSH.

Inc Inc Dec (Recall that in Turner's syndrome a women experiences menopause before menarche- she depletes her follicles before she even has her first period! Without follicles, or course, she cannot properly secrete E&P, so ovarian hormone levels are depressed. As before, this removes the feedback inhibition on her hypothalamus and pituitary, so the levels of GnRH and LH/FSH are high.)

Indicate whether the circulating levels of hypothalamic releasing hormone (H), pituitary gonadotropins LH & FSH (P), and ovarian (O) hormones (estrogen and progesterone) are increased, decreased, or normal by placing "Inc", "Dec", or "Nor" in the spaces to the left. The first statement has already been answered for you. H P O ____ ____ ____ Turner's syndrome has caused a woman, now 20 years old, to "use up" her follicles before she even entered menarche.

Orchitis

Inflammation of one or both testes

Cholecystitis

Inflammation of the gallbladder

Balanitis

Inflammation of the glans penis

Allergic rhinitis

Inflammation of the nasal epithelium; an acute vasomotor response mediated by histamine and related vasoactive substances released locally in the nose from mast cells coated with IgE

Fibrinous pleuritis

Inflammation of the pleura accompanied by accumulation of a fibrin-rich fluid in the pleural cavity; typical of bacterial pleuritis

Serous pleuritis; hydrothorax

Inflammation of the pleura accompanied by accumulation of a watery, serum-like fluid in the pleural cavity; typical of viral pleuritis

A term used for two closely related but nonetheless distinct diseases: Crohn disease (CD) and ulcerative colitis (UC).

Inflammatory bowel disease

Discuss three lines of evidence which supports the contention that Helicobacter pylori is a pathogen responsible for chronic antral gastritis (CAG).

Ingestion; Eradication; Distribution of Colonization

Cysts, Follicular

Instead of regressing, follicles that fail to rupture (and thus fail to ovulate) continue to enlarge as they fill with follicular (antral) fluid

Cysts, Leuteal

Instead of transforming into a functional corpus luteum and then involuting (regressing) to become a fibrotic corpus albicans, some follicles instead seal shortly after ovulation and enlarge as their cavities fill with fluid

[ Irritable bowel syndrome / Celiac sprue/ Inflammatory bowel disease] is a functional disorder, meaning that despite the persistence of symptoms, no physical abnormalities can be found.

Irritable bowel syndrome.

Vagina

J

Ovary

K

Fimbriae

L

_____ are specialized initial lymphatics found in the intestinal villi which function to pick up and transport hydrophobic digestion products; their name reflects their contents, which is generally a milky-white liquid.

Lacteals

En bloc

Latin for "in a block." Usually this is applied to a procedure where multiple parts are performed at once or as a unit. An example is a radical mastectomy where the breast and its connective tissue, the underlying skeletal muscle, and the ipsilateral axillary lymph nodes are removed "all at once."

(a) Excessive retention of water caused by tumor secretion of antidiuretic hormone (b) Hypercalcemia caused by tumor secretion of a parathyroid hormone-like peptide (c) Cushing's syndrome caused by tumor secretion of ACTH, which stimulates the adrenals

List 3 common paraneoplastic syndromes which are associated with lung carcinoma, and in one phrase describe the underlying cause.

1- Severe and unrelenting epigastric pain 2- Destruction of acinar cells reduces capacity of the pancreas to make digestive enzymes, which results in malabsorption and steatorrhea 3- Lack of trypsin & chymotrypsin results in malabsorption of proteins 4- Lipase deficiency accounts for fatty stools and inadequate absorption of fat and fat soluble vitamins (A, D, E, and K) 5- Most patients feel weak and lose weight 6- Signs of vitamin deficiency are seen in severe cases 7- Signs of diabetes are seen in advanced cases 8- Bulky, fatty stools

List eight classic symptoms of chronic pancreatitis

(a) Lack of energy; fatigue unchanged by sleep (b) Anorexia and weight loss (c) Arthritis and other aches and pains; swelling of the knees (d) Xerophthalmia and blurry vision (e) SOB and a dry hacking cough (f) Skin lesions (g) Low-grade fever and night sweats (h) X-ray studies show pulmonary nodules and hilar lymph node enlargement (i) Peripheral lymphadenopathy, hepatosplenomegaly, and skin nodules (erythema nodosum) are occasionally found (j) Enlargement of the lacrimal and salivary glands is a useful diagnostic finding (k) Uveitis, uveoparotitis

List five common symptoms or signs of sarcoidosis.

Chest radiography; Bacteriologic studies of the sputum; Peripheral blood studies; Blood gas analysis and pH measurements.

List four ways (four lab findings) by which the diagnosis of pneumonia is confirmed. Here, I'm NOT looking for signs (e.g., egophony) heard on auscultation, but rather the results of various lab tests.

(a) Small tumors are asymptomatic. (b) Large subserosal tumors exert a "mass effect" on nearby organs, compressing the bladder and/or rectum and producing such symptoms as urinary urgency, abdominal heaviness, constipation, even outright pain (c) Submucosal tumors tend to grow into the endometrial cavity, causing menstrual irregularities, endometrial bleeding, and impaired fertility (d) Pedunculated tumors may infarct and become painful if they undergo torsion. (e) Vaginal pedunculated tumors may interfere with conception.

List three common symptoms of uterine leiomyomas. (a) (b) (c)

Pleuritis (potentially leading to pyothorax, empyema, or pleural fibrosis); Lung abscesses (and suppuration); Chronic lung disease (with fibrosis); Bronchiectasis (or organizing tuberculosis)

List three of the most important potential complications of pneumonia.

(a) Dyspnea, shortness of breath, gasping for air (b) Lab findings confirm hypoxemia and hypercapnea (c) Chest x-rays show diffuse consolidation of the lungs (pulmonary edema), so that the lungs appear to be airless

List three symptoms, signs, or lab findings consistent with acute respiratory distress syndrome (ARDS).

Cervix

M

Cowper's gland

Male accessory gland whose clear mucous secretion (1) helps neutralize residual acids in the urethra, and (2) helps lubricate the sex act

Prostate gland

Male accessory gland whose secretions include the nutrient citrate and several enzymes such as fibrinolysin

Seminal vesicles

Male accessory glands whose secretions include fructose, fibrinogen, and prostaglandins

A syndrome characterized by longitudinal rips (lesions) in the esophageal wall near the gastroesophageal junction; the lesions do not perforate the wall.

Mallory-Weiss syndrome

A type of fatty cast containing cholesterol or cholesterol derivatives; they have a characteristic appearance under polarized light, and usually accompany nephrotic syndrome

Maltese Cross

(a) Anovulation is common in pubertal girls in whom the normal cycle of the hypothalamus has not yet been established. (b) Psychological factors-anxiety and stress- are known causes. (c) Anovulation is typically associated with bulimia and anorexia nervosa, and is common in athletes. (d) Anovulation may be caused by pituitary tumors, including prolactinomas with the resulting hyperprolactinemia, or by ovarian tumors such as a functional thecoma. (e) Other causes include polycystic ovaries, obesity, severe malnutrition, systemic disease. (f) Many times anovulatory cycles are idiopathic.

Many conditions can cause anovulatory cycles. Limiting yourself to just the conditions I discussed in class, list three such conditions. (a) (b) (c)

C (Asthma. Her symptoms are typical of asthma. Moreover, I would expect to see eosinophilia if blood work were done.)

Mary Jones has recurrent episodes of dyspnea, coughing, and wheezing. She has never been hospitalized, but requires daily therapy with a bronchodilator. Which of the following conditions does Mary most likely suffer from? A. Emphysema B. Sinusitis C. Asthma D. Pleuritis E. Tracheoesophageal fistula

D

May be treated with amphotericin or itraconazole A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

C

May fill pre-existing cavities (such as in the lung), forming so-called 'fungus balls' A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

verrucae

Medically, warts are known as _____.

_____ refers to dark, tarry streaks of congealed blood in the stools.

Melena (remember that if hemoglobin is exposed to stomach acid, it is converted into hematin, which is very dark in color.)

An immune-mediated condition characterized by diffuse thickening of the glomerular basement membrane secondary to a massive deposition of immune complexes

Membranous Glomerulopathy

What is the common treatment (Western medicine) for congenital megacolon?

Mild- changing diet. Severe- resection and anastomosis.

4 (Four is the typical number, though someindividuals are known to have up to 8 parathyroid glands located anywhere in the neck or upper chest.)

Most individuals have [1/ 2 / 3 / 4 / 6 / 8 / 10] parathyroid glands, located on the posterior aspect of the thyroid gland.

Contains smooth muscle which throws the overlying tissue (i.e., the tissue lining the lumen) into folds to increase lumenal surface area.

Mucosa

The innermost layer containing an epithelium (usually with glands) and underlying connective tissue

Mucosa

Contains the smooth muscle layers largely responsible for GI motility (peristalsis and segmentation).

Muscularis externa

An acquired autoimmune disease characterized by abnormal muscular fatigability and caused by circulating antibodies to the acetylcholine receptor (AchR) at all neuromuscular junctions; may cause peristalsis problems in the upper esophagus.

Myasthenia gravis

Allergic; Infectious; Exercise-induced; Emotion-induced; Drug-induced

Name five types of asthma.

(Indicate Nephrotic/Nephritic/Both) Inflammatory damage to the patient's kidneys impairs glomerular flow and filtration to such an extent that it causes renal insufficiency, fluid retention, and hypertension

Nephritic

(Indicate Nephrotic/Nephritic/Both) Patient presents with hematuria, oliguria, and azotemia

Nephritic

(Indicate Nephrotic/Nephritic/Both) Patient's glomeruli have undergone inflammatory changes, such as infiltration by leukocytes, hyperplasia of glomerular cells, and some necrosis

Nephritic

An inflammatory condition characterized by hematuria, variable degrees of proteinuria, and decreased glomerular filtration rate

Nephritic Syndrome

(Indicate Nephrotic/Nephritic/Both) Compensatory synthesis of proteins by the liver results in hyperlipidemia, hypercholesterolemia, and lipuria

Nephrotic

(Indicate Nephrotic/Nephritic/Both) Patient develops severe hypoproteinemia: the loss of anticoagulants & antiplasmin results in thrombi and thromboemboli

Nephrotic

(Indicate Nephrotic/Nephritic/Both) Patient develops severe hypoproteinemia: the loss of gamma globulins (antibodies) and complement proteins predisposes to infections

Nephrotic

(Indicate Nephrotic/Nephritic/Both) Patient experiences a protein loss in the urine of 4 g/day

Nephrotic

(Indicate Nephrotic/Nephritic/Both) Patient retains Na+ and water, and develops edema

Nephrotic

A set of symptoms, including severe proteinuria, resulting from increased permeability of glomerular capillaries

Nephrotic Syndrome

hypoglycemia (remember that glucose brings the blood sugar- and other fuels- down in concentration.)

Normally, [hypoglycemia/ hyperglycemia] results from hypersecretion of insulin.

A motility disorder of the esophagus caused by transient but greatly elevated (> 180 mmHg) pressures during peristalsis; typically the spasms are localized and do not include the entire esophagus.

Nutcracker esophagus

Gallstone ileus

Obstruction of the intestine with gallstones

_____ blood refers to blood which is present but not apparent in the stools.

Occult (Occult means hidden, and occult blood in the stools is blood that is present but cannot be seen by the unaided eye. A slow intestinal bleed, for example, may cause this condition.)

_____ refers to pain while swallowing

Odynophagia

List the three types of diarrhea:

Osmotic; Secretory; Invasive

_____cells in the gastric glands secrete HCl (hydrochloric acid).

Parietal cells (they also secrete something called intrinsic factor, which is important in vitamin B12 protection and absorption.)

emphysema

Patients with [ chronic bronchitis / bronchiectasis / emphysema / asthma] are most likely to show an overexpanded 'barrel' chest.

Dysmenorrhea, secondary

Pelvic pain during a menstrual period that does not resolve with the onset of menses; in this form, instead of a functional problem there is an organic problem with the uterus, e.g., endometriosis, fibroids, PID

Dysmenorrhea, primary

Pelvic pain during a menstrual period that does not resolve with the onset of menses; in this form, the problem is with the uterus, e.g., it hypersecretes prostaglandin

A term referring to breaks in the wall of the stomach and/or small intestine- principally the proximal duodenum- that are produced by the action of gastric secretions.

Peptic ulcer disease

dull & heavy (In consolidation, fluid replaces air in the lung tissue. When percussed, such consolidated tissue produces a dull, heavy 'thud' rather than the more normal, light and resonant sound.)

Percussion over consolidated lung tissue is usually heard as a [light & resonant/ dull & heavy] sound.

Acinar

Pertaining to a pattern of growth often seen in glandular (or lung) tissue, consisting of a cluster of secretory epithelial cells surrounding a central cavity and duct, and into which materials are secreted; in the lungs, this includes a respiratory bronchiole and all its accompanying alveoli.

Multiparous

Pertaining to a woman who has borne more than one offspring

Nulliparous

Pertaining to a woman who has borne no offspring

_____ are lymphatic (germinal) follicles found in the GI tract wall (and elsewhere) which function to prevent entry of would-be pathogens into the body; collectively, all such follicles in the mucosae of the body are known as MALT (mucosa associated lymphoid tissue).

Peyer's patches

A syndrome characterized by (1) esophageal webs, (2) cheilosis due to iron or B12 deficiency, (3) iron (or B12) deficiency anemia, and (4) glossitis.

Plummer-Vinson syndrome

_____ refers to the presence of air in the urine.

Pneumaturia (this might be a sequela, e.g., of a colovesical fistula.)

_____ refers to air in the peritoneal cavity.

Pneumoperitoneum (this might be a sequela, e.g., of a perforating peptic ulcer.)

A hereditary disorder characterized by multiple expanding cysts of both kidneys that ultimately destroy the renal parenchyma and cause renal failure

Polycystic Kidney Disease

Upper respiratory infection

Presents as a collection of mostly viral, acute inflammations involving some combination of the nose, paranasal sinuses, pharynx, and larynx

B

Prevalent in the Midwestern states, esp. the Mississippi, Missouri, and Ohio river valleys A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

A

Prevalent in the soils of the desert southwest (New Mexico, Arizona, southern California) A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

Conn syndrome

Primary hyperaldosteronism is also known as _____.

Inflammation of one or both kidneys

Pyelonephritis

_____ refers to infection (and inflammation) of the kidney including the renal pelvis

Pyelonephritis

These casts indicate hematuria and are usually seen in nephritic syndrome

RBC Cast

Describe the symptoms of ulcerative colitis (UC).

Rectal bleeding; Tenesmus; Typically limited to rectum; Stays mild all of life

Describe the symptoms of moderate ulcerative colitis (UC).

Recurrent episodes of loose, tarry stools; Crampy, colicky abdominal pain; Frequent, low grade fever lasting weeks; Mild anemia due to blood loss

T

Referring to primary hyperparathyroidism- T/F: "Painful bones, renal stones, abdominal groans, and psychic moans"

T ('Psychic moans'.)

Referring to primary hyperparathyroidism- T/F: Depression, lethargy, and eventually seizures

F (Weakness and fatigue are the norm, not hyperactivity.)

Referring to primary hyperparathyroidism- T/F: Hyperactivity

F

Referring to primary hyperparathyroidism- T/F: Hypotension

T ('Renal stones')

Referring to primary hyperparathyroidism- T/F: Kidney stones and nephrocalcinosis

T (Recall that metastatic calcification is due to high circulating levels of calcium.)

Referring to primary hyperparathyroidism- T/F: Metastatic calcification in body tissues

T ('Abdominal groans')

Referring to primary hyperparathyroidism- T/F: Pancreatitis, cholelithiasis, constipation

F (Muscle spasms are more likely to occur with hypocalcemia.)

Referring to primary hyperparathyroidism- T/F: Tetany

T ('Painful bones'; PTH activates osteoclasts.)

Referring to primary hyperparathyroidism- T/F: Eroded bone matrix and osteoporosis

D

Results in the formation of non-caseating granulomas A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

Similar to esophageal webs but thicker and more circumferential, these mucosal infoldings typically occur at the gastroesophageal junction.

Schatzki rings

AKA Progressive Systemic Sclerosis, this systemic autoimmune disease of connective tissue causes loss of smooth muscle and replacement with fibrous tissue; may cause peristalsis problems in the lower esophagus.

Scleroderma

The outermost layer of the GI tract which may either be part of the mesenteric system or simply fibrous connective tissue to anchor the GI organ to surrounding tissue.

Serosa/Adventitia

(a) Regurgitation/Implantation theory. Endometrial tissue flows retrograde up the uterine tubes and implants in the tubes or on the surface of peritoneal organs. (b) Metaplastic theory. Endometriosis could arise directly from the surface epithelium of the peritoneum, from which the endometrium originates during fetal development. (c) Vascular/lymphatic dissemination theory. Dispersal via the pelvic veins and lymphatics; this explains the appearance of endometriotic lesions in the lungs and lymph nodes.

Several theories exist for the origin of endometriotic tissue (i.e., the tissue of endometriosis). One such theory is given below. Name or describe two other theories. (a) (b) (c)

Inflammation of the salivary glands.

Sialadenitis

_____ refers to inflammation of the salivary glands.

Sialadenitis.

_____ refers to the presence of salivary stones.

Sialolithiasis

_____ refers to the over production of saliva.

Sialorrhea.

Goblet cells (Interestingly, goblet cells are the only example in the human body where a single cell acts as an independent, solitary gland; all other glands- including the other mucous glands found in the walls of the airways (bronchi and bronchioles) are multicellular.

Single-celled mucous glands

Immunologically mediated sialadenitis which invariably involves destruction of salivary and lacrimal gland tissue.

Sjögren syndrome

B

Spread by inhaling (dust containing) spores from the guano of bats and starlings A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

The most common cancer of the mucous membranes of the head and neck.

Squamous cell carcinoma

I

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Carcinoma confined to the endometrium

II

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Carcinoma extending into the cervix and invading the myometrium

III

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Carcinoma extending through the wall of the uterus but not outside the true pelvis

IV

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Carcinoma infiltrating the bladder or the rectum or extending outside the true pelvis

IV

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Five year survival rate: 5%

I

Stage the following endometrial cancers by placing the number of the relevant stage (I-IV) _____ Five year survival rate: 80%

Contains a nerve plexus (Meissner's) which regulates the glands and muscles mentioned above in i) and ii).

Submucosa

Oophorectomy

Surgical removal of the ovaries.

Eating rhubarb, spinach, and beet greens (everyday, all week, yum!)

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Alkalinizing the urine (in a calcium phosphate stone former).

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Drinking grapefruit juice.

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Drinking lots of green tea.

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Eating chocolate (what would life be like without chocolate?)

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- High sodium (salt) intake, leading to hypernatriuria.

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Taking acetazolamide (in a calcium phosphate stone former).

T

T(Bad)/F(Good) Re: Calcium Kidney Stones- Taking calcium supplements or calcium rich medications.

T

T/F: Alcohol and tobacco use are two big risk factors for the development of oral leukoplakia.

T

T/F: Although Sjögren syndrome may manifest systemically or especially in other glands, invariably it involves an immunologically mediated destruction of the salivary and lacrimal glands

T

T/F: As a group squamous cell carcinomas tend to infiltrate locally before they metastasize to distant sites.

T

T/F: In Sjögren syndrome, affected glands initially enlarge, but eventually become fibrotic and atrophied

T

T/F: In late stage Sjögren syndrome, glandular parenchyma is often replaced with fat

T

T/F: It is thought that in the intestine, increased intraluminal pressures generated by excessive straining during defecation may contribute to evagination of the mucosa between the muscle fibers, and thus promote diverticulosis.

T

T/F: Most children recover completely from acute glomerulonephritis, whereas slightly over half of adults do; the others fail to resolve and often progress to chronic glomerulonephritis.

T

T/F: Mumps provides an example of viral sialadenitis.

T

T/F: Nutcracker esophagus and corkscrew esophagus are sometimes treated with calcium channel blockers to relax the esophagus.

T

T/F: Pain, vomiting, dyspepsia, bleeding, and systemic consequences such as iron deficiency anemia are all symptoms of gastritis, peptic ulcer, and gastric carcinoma.

T

T/F: Recurrent canker sores may be associated with celiac disease of inflammatory bowel disease

T

T/F: Sicca syndrome is a typical symptom of Sjögren syndrome

T

T/F: Sjögren syndrome involves inflammatory infiltration of the lacrimal and salivary glands

T

T/F: Sjögren syndrome may occur as an isolated disorder (primary SS) or in association with another autoimmunedisease (secondary SS), such as systemic lupus erythematosus

T

T/F: Symptoms of Sjögren syndrome also include ulceration of the oral mucosa, corneal epithelium, and nasal septum

T

T/F: The overall 5-year survival rate for gastric adenocarcinoma is about 30%.

T

T/F: Esophageal rings are circumferential while esophageal webs form ledges that do not encircle the esophageal lumen.

T (Schatzki rings also tend to occur at the gastroesophageal junction, while webs tend to be higher in the esophagus.)

T/F: Ulcerative colitis is several times more common than Crohn disease.

T (about four times more common, in fact)

T/F: "No acid, no ulcer."

T (acid creates the lesions of peptic ulcers, so in regions of the GI tract where there is no acid.....)

T/F: The upper third of the esophagus is skeletal muscle, the lower third is smooth muscle, and the middle third is a mixture of the two.

T (and this will become important when we talk about dysphagias.)

T/F: In an HIV-positive patient, thrush in the esophagus is AIDS-defining.

T (by the time Candida colonizes the esophagus, the helper T-cell count has fallen way below 200 cells per microliter, which is AIDS defining.)

T/F: Heart disorders may secondarily cause dysphagia.

T (e.g., mitral stenosis may cause left atrial hypertrophy; the enlarged left atrium, in turn, being the posteriormost part of the heart, may compress the esophagus and cause dysphagia.)

T/F: Adenocarcinoma is the most common malignant neoplasm of the intestine

T (in 95 to 98% of intestinal neoplasia cases, the lesions occur in the sigmoid or rectal region.)

T/F: The main function of the gall bladder is to store and concentrate bile.

T (it also delivers bile, on demand, to the duodenum.)

T/F: Sugars can only be absorbed as simple sugars; even disaccharides cannot be absorbed

T (lack of disaccharidase enzymes is the basis for malabsorption syndromes such as lactose intolerance)

T/F: Bile salts are largely responsible for emulsification of fats in the GI tract.

T (so that insufficient bile may lead to fat malabsorption)

T/F: Peptic ulcers are often treated with antibiotics to eliminate the H. pylori infection, and H-2 antagonists to reduce stomach acidity.

T (stomach acidity may also be reduced through proton inhibitors such as Prilosec)

T/F: The primary type of motility in the esophagus is peristalsis.

T (the esophagus does not release any digestive enzymes- it only serves as a conduit to move food from the mouth to the stomach. Thus, peristalsis is the only motility that the esophagus really needs.)

T/F: Once introduced into the body, herpesvirus will tend to remain there for the rest of one's life (though it may be asymptomatic for long periods of time).

T (the shingles virus is the same way)

T/F: Urinary tract infections are more common in women than in men.

T (the shorter urethra in women allows easier entry of bacteria from the exterior to the bladder)

T/F: Mesenteries are formed from infolding of the dorsal or ventral peritonea.

T (to a histologist, the mesenteries form the serosa where they touch visceral organs.)

T/F: A fecal smear for leukocytes tests positive with invasive diarrhea but negative for secretory and osmotic diarrheas.

T (with invasive diarrhea, the pathogens are invading the intestine, causing inflammation and exudation of leukocytes. With osmotic and secretory diarrheas, there is no invasion, no inflammation, so no leukocytes found in the stool.)

T (This describes emphysema in a nutshell.)

T/F: A critical component of emphysema is the loss of elastin from the walls of the affected airways; such airways loose the ability to recoil and thus have difficulty expelling air.

T (A history of alcohol abuse is the biggie for chronic pancreatitis)

T/F: A history of alcohol abuse can be found in most patients with chronic pancreatitis

F (Although the actual definition varies from authority to authority, three missed cycles in a row seems to be an accepted minimum to qualify a amenorrhea.)

T/F: A woman misses 2 cycles in a row. This qualifies for amenorrhea.

T (in a woman, elevated testosterone levels- ovarian problem; elevated DHEA sulfate- adrenal problem.)

T/F: A woman with hirsutism and elevated DHEA sulfate levels most likely has an adrenal problem.

F (There is an outside chance that she has an adrenal problem, but remember: if the elevated androgen is testosterone, she most likely has an ovarian problem. If the elevated androgen is DHEA sulfate, then she most likely has an adrenal problem.)

T/F: A woman with hirsutism and elevated testosterone levels most likely has an adrenal problem.

F (ARDS is a disease of the respiratory zone, affecting the pulmonary capillary endothelium or the alveolar epithelium or both.)

T/F: ARDS is primarily a disease affecting the primary bronchi and other large airways of the lungs.

F (GTD describes abnormal conditions of the placental trophoblastic cells- they proliferate or mature abnormally, or they undergo malignant transformation. Only hydatidiform mole and choriocarcinoma fit this definition.)

T/F: Abruptio placentae, placenta accrete, hydatidiform mole, and choriocarcinoma are all examples of gestational trophoblastic disease.

F (AEP presents with mild symptoms of pancreatitis; it is so mild that most patients do not require hospitalization, and mortalities are rare)

T/F: Acute edematous pancreatitis presents with severe symptoms of pancreatic necrosis and is associated with a high mortality rate

F (In fact, there is no effective treatment for acute pancreatitis; antibiotics are not useful since most pancreatitis is sterile, corticosteroids would not lessen the deleterious effects of prematurely-activated pancreatic enzymes)

T/F: Acute pancreatitis is usually treated with broad spectrum antibiotics and glucocorticoids

T

T/F: Acute pancreatitis may be an antecedent to chronic pancreatitis

F (This association is seen in chronic pancreatitis)

T/F: Acute pancreatitis may be associated with Sjögren syndrome and inflammatory bowel disease

F (This is a chronic disease, which takes a chronic, slowly progressive course. About 90% of the adrenal cortex needs to be lost before this disorder becomes clinically apparent.)

T/F: Addison disease progresses quickly, and when about 50% of the adrenal cortex (of both glands) is lost, it becomes clinically apparent.

T (95 to 98% of intestinal neoplasia cases, the lesions occur in the sigmoid or rectal region.)

T/F: Adenocarcinoma is the most common malignant neoplasm of the intestine.

T (This places these cancers very close to the rectum, which is why they are easily palpated by digital rectal exam)

T/F: Adenocarcinoma of the prostate originates in the peripheral (posterior lobe) of the gland.

T (Recall that in adenomyosis the myometrium may be so riddled with nests of endometrial tissue -and chocolate cysts- that hysterectomy seems the only option.)

T/F: Adenomyosis is a common cause of hysterectomy, since the uterus is often enlarged.

F

T/F: Afflicted individuals often show apprehensiveness and hyperhidrosis

T (Furthermore, as the corpus luteum degenerates, progesterone levels plummet, which brings about menstruation.)

T/F: After ovulation, the follicular remnants transform into a corpus luteum; the corpus luteum, in turn, degenerates within two weeks if fertilization and implantation have not occurred

T

T/F: After the initial infection of herpes simplex virus, the virus typically enters nerves, where it may remain dormant and asymptomatic for years or decades

T

T/F: After the initial infection of herpes simplex virus, the virus typically enters nerves, where it may remain dormant and asymptomatic for years or decades.

F (Under normal circumstances, ACTH has little to do with aldosterone secretion, which is regulated by the renin- angiotensin-aldosterone system.)

T/F: Aldosterone secretion is regulated by the pituitary hormone ACTH.

F (Non-proliferative fibrocystic changes do not increase cancer risk, while proliferative fibrocystic changes without atypia carry only a 1-2 fold increase.)

T/F: All fibrocystic changes in the breast are precancerous, and increase the risk of cancer 5- or 6- fold.

T (If it ain't derived from cholesterol, it can't be a steroid. Period.)

T/F: All steroid hormones are cholesterol derivatives.

T

T/F: All the signs of secondary syphilis are self-limited and will disappear spontaneously even without antibiotic treatment

F (The two big HPV types associated with cervical cancer are types 16 and 18, and to a lesser extent, a few others I named in lecture. The remainders may cause warts, but they are not associated with cancer.)

T/F: All types of HPV are associated with cervical cancer.

F (Most women should, but there is little benefit in Pap screening women who have not had sex -since HPV is spread via sexual contact).

T/F: All women aged 18 to 65 years should seek out regular Pap smear testing.

T

T/F: Allergy shots are effective because they raise the numbers of anti-allergen IgG antibodies; these antibodies, in turn, help clear the allergen but do not bind to mast cells in the process (so histamine is not released)

T

T/F: Although HCC may grow into the vena cava or portal system, it typically metastasizes first to the lungs, and then to other sites

T (Also, mass effects- compression, etc., due to the bulk of a tumor- may also occur. Such bulk effects would include bowel obstruction and urinary urgency.)

T/F: Although benign ovarian tumors (and some malignant tumors) may be asymptomatic, common symptoms of malignant tumors include pain and abdominal distention.

F(similar causes and similar treatment)

T/F: Although breast cancer occurs in both men and women, the causes for breast cancer in men are substantially different from the causes in women.

T (If treated early, cure rates are in the 80-100% range. These tumor melt with chemo, even if they've metastasized.)

T/F: Although choriocarcinoma is an aggressive tumor, it responds well to methotrexate chemotherapy.

T (Centriacinar: cigarette smoking, Panacinar: alpha-1 anti-trypsin deficiency.)

T/F: Although it may be caused by cigarette smoking, the most likely cause of panacinar emphysema is an alpha-1 anti-trypsin deficiency.

T

T/F: Although most cryptorchid testes surgically repositioned in the scrotum in early infancy develop normally, signs of atrophy and hypospermatogenesis are not uncommon.

T

T/F: Although most fungal infections are asymptomatic, those that are mildly symptomatic usually present with flu-like symptoms: fever, headache, cough, mild skin rash.

T (This is due to a great extent to the fact that ovarian cancers are often clinically silent until they become advanced tumors, by which time they have already spread locally and to distant sites.)

T/F: Although ovarian cancer ranks third in frequency among cancers of the female reproductive tract, they account for more deaths than any other gynecologic cancer.

T (That is why they should be resected once they are found. BTW, the malignant transformation usually only happens in older patients.)

T/F: Although teratomas are benign tumors, they can, if left in place for too long, undergo malignant transformation.

F (This is a silly statement. Mom would notice a problem right away, as her baby has problems swallowing milk.)

T/F: Although tracheoesophageal fistulas can be corrected by surgery, they are often not diagnosed until a year or two after birth.

T (Types 16 and 18 are the two biggies for high risk lesions; these two strains cause about 70% of cervical cancers.)

T/F: Although warts are caused by human papilloma virus (HPV), the strains of HPV causing common skin warts are not the same as the "high risk" strains causing precancerous and cancerous lesions.

T (it has to do with prolactin inhibiting GnRH release from the hypothalamus.)

T/F: Amenorrhea is normal for some variable number of months following a pregnancy.

F (Ovarian cancers are often asymptomatic until they are quite advanced, while the other two are much more easily detected via Pap smears -cervical cancer- or abnormal bleeding -endometrial cancer.)

T/F: Among the triad of cervical cancer/endometrial (uterine) cancer/ovarian cancer, the latter (ovarian cancer) is the most readily detected and hence most easily treated.

T (Recall that PAI is due to adrenocortical destruction, while SAI is due to low ACTH levels. Recall also that ACTH largely controls cortisol, and to a lesser extent, gonadocorticoid levels, while the renin-angiotensin-aldosterone system controls aldosterone levels. In PAI, where the adrenal cortex is being destroyed, ALL corticosteroid levels will be down, whereas in in SAI, the low ACTH will depress cortisol and gonadocorticoid levels but leave aldosterone levels relatively untouched.)

T/F: Another distinction between primary (PAI) and secondary (SAI) adrenocortical insufficiency is that aldosterone levels are depressed in the former (PAI) but (near) normal in the latter (SAI).

F

T/F: Another typical development of secondary syphilis are syphilitic granulomas known as gummas, which may occur in any organ

T (The menstrual cycle is often somewhat irregular in teenaged women, especially if they are also athletically active. The cycles will usually settle down by the time a woman enters her 20's.)

T/F: Anovulation is common in pubertal girls in whom the normal cycle of the hypothalamus has not yet been established

T (Recall that a functional cause refers to a cause that has no organic component and usually involves hormones. The continual high estrogen levels found in both of these conditions will certainly have an effect on the uterus, causing endometrial hyperplasia and ultimately, bleeding)

T/F: Anovulatory cycles and inadequate luteal phase are examples of functional causes of menometrorrhagia.

T (it is that unopposed estrogen thing again.)

T/F: Anovulatory cycles often result in endometrial hyperplasia

T (Polycystic ovarian syndrome is accompanied by high levels of estrogen; this, in turn, results in endometrial hyperplasia, which can then lead to cancer.)

T/F: As a group, women with polycystic ovarian syndrome show higher incidences of endometrial adenocarcinoma.

F (The symptoms seen in atypical pneumonias are usually milder than in the more classical pneumonias.)

T/F: Atypical pneumonias generally present with more severe symptoms than the more classic pneumonias.

F (While such infections may trigger a bout of bronchitis, there is no evidence that they initiate -i.e., cause- the disease)

T/F: Bacterial or viral infections are also important initiating factors in the genesis of chronic bronchitis.

T (which is why their prognosis is so abysmal)

T/F: Basically, carcinomas of the pancreas remain silent until they invade adjacent tissues, causing pain; by this time the cancers are usually beyond cure.

T (Thus, skin ulceration and nipple discharge are quite common in men with breast cancer.)

T/F: Because of the relatively sparse amount of breast tissue present, breast cancers in men tend to spread rather easily to the underlying thoracic wall (e.g., pectoralis major m.) and overlying skin.

T

T/F: Because of their invasive growth, endometrial carcinomas penetrate into the myometrium and may extend all the way to the serosa.

F

T/F: Because the ovaries are endocrine organs, most ovarian tumors are functional (i.e., they release hormones).

F (In fact, benign endometrial tumors are not recognized clinically. This does not necessarily mean that endometrial adenomas do not form. Perhaps they are indistinguishable from endometrial hyperplasia. Perhaps the adenomas get flushed out with the menstrual blood each period.)

T/F: Benign endometrial tumors- endometrial adenomas- are even more frequent than endometrial adenocarcinoma.

T (it seems that both testosterone and estrogen play pivotal roles)

T/F: Benign prostatic hyperplasia is believed to have a hormonal basis, with the sex hormones playing a central role

T

T/F: Blood clots that occlude the large pulmonary arteries are almost always embolic in origin.

F (The hyperpigmentation comes from the link between high ACTH and high MSH and POMC levels. Except that in secondary adrenocortical insufficiency ACTH levels are depressed, so that SAI would not lead to hyperpigmentation.)

T/F: Both primary and secondary adrenocortical insufficiency usually result in hyperpigmentation.

F (Teratomas consist only of SOMATIC cells, which do not secrete hCG or alpha fetoprotein. Teratocarcinomas, on the other hand, may very well contain placental tissue or extra-embryonic tissue, and may thus secrete hCG and/or AFP.)

T/F: Both teratomas and teratocarcinomas secrete hCG and AFP, which thus serve as serologic markers for the presence of either of these tumors.

T (This equates to 1500 new cases and 400 deaths per year in the US.)

T/F: Breast cancer in men occurs about 1/100 as often as in women.

F(Dissemination patterns are the same in men and women, with almost half of the tumors spreading to the lymph nodes in the upper lateral quadrant.)

T/F: Breast cancers in men tend to disseminate to the medial (mediastinal) lymph nodes (in contrast to the upper lateral quadrant in women).

T (Acquired from tumors and infections, congenital from cystic fibrosis)

T/F: Bronchiectasis may be acquired or congenital.

F (That honor falls to squamous cell carcinoma followed closely by adenocarcinoma.)

T/F: Bronchioalveolar carcinoma is the most common type of lung cancer.

T (the number I gave in class was 98%)

T/F: By far, most primary prostatic tumors are adenocarcinomas.

F (The most common cause is a parathyroid adenoma. In fact, parathyroid carcinoma is downright rare.)

T/F: By far, the most common cause of hyperparathyroidism is a parathyroid carcinoma.

T

T/F: By far, the most common overall cause of emphysema is cigarette smoking.

T (Over 90% of chronic bronchitis cases are attributable to smoking.)

T/F: By far, the single greatest cause of chronic bronchitis is smoking tobacco.

F (Lung cancer is the number one cause of cancer death worldwide, including the US. In 2004, about 160,000 died from lung cancer in the US - about 40,000 died from breast cancer, by comparison.)

T/F: Cancer of the lung is the 6th leading cause of cancer death worldwide, including the US.

F (this 'honor' falls to endometrial cancer.)

T/F: Cervical carcinoma is the most common malignant tumor of the female reproductive tract.

T (Note that this means that the earlier stages of CIN coincide with dysplasia, while late CIN III is synonymous with carcinoma in situ. In this scheme, we have normal cervical structure, CIN, and invasive carcinoma.)

T/F: Cervical dysplasia and CIS (carcinoma in situ) are collectively known as cervical intraepithelial neoplasia, or CIN.

F

T/F: Chancres are confined to the genital area of the body

T

T/F: Chancres are indurated and painless lesions.

T

T/F: Chancres are often accompanied by inguinal lymphadenopathy

F

T/F: Chancres are pruritic lesions

F

T/F: Chancres are seen in secondary syphilis.

T

T/F: Chancres typically develop 1-12 weeks after exposure to the T. pallidum bacterium

F

T/F: Chancres typically occur in clusters of 12 to 15 indivisual lesions

T (episiotomy and large baby deliveries are two others.)

T/F: Chronic constipation and straining to pass bowel movements are two potential of rectocele.

T

T/F: Chronic pancreatitis is characterized by irregular fibrosis replacing parts of the normal pancreatic parenchyma

F (Chronic pancreatitis is progressive and irreversible)

T/F: Chronic pancreatitis is often reversible if treated in the early stages

F (About 20% of cases of chronic pancreatitis are idiopathic)

T/F: Chronic pancreatitis is unusual in that idiopathic cases are unknown

T (The viral connection is probably the big one, but these non-viral risk factors are pretty well established.)

T/F: Cigarette smoking and chlamydial infection are known risk factors for cervical cancer.

T

T/F: Cigarette smoking is the common trigger seen in most patients with chronic bronchitis or emphysema.

F

T/F: Cirrhosis can be effectively managed with modern medications, and many patients recover completely after several years of treatment

F

T/F: Cirrhotic livers all show hepatomegaly

F (This is backwards. Hyperplasia usually hits all four glands -or at least two or three- while parathyroid adenoma is solitary - as is carcinoma)

T/F: Classically, parathyroid adenoma involves all four glands, while parathyroid hyperplasia is almost always solitary.

T

T/F: Clinically, chronic pancreatitis usually presents as recurrent or persisting abdominal pain often accompanied by pancreatic exocrine or endocrine insufficiency

T (these and a few other causes were listed in the lecture notes)

T/F: Common causes of secondary dysmenorrhea include endometriosis, fibroids, PID, and IUD problems

T

T/F: Complications of pelvic inflammatory disease or endometriosis are common causes of tubal pregnancies.

T

T/F: Conjugated bilirubin is quite soluble in plasma

T

T/F: Conjugated bilirubin is secreted into the bile, where most of it is eliminated with the feces

F

T/F: Conjugated bilirubin is transported in the blood bound to serum albumin

F (Conn syndrome is primary hyperaldosteronism. Instead of treating it with aldosterone, you would treat it with an aldosterone antagonist, such as spironolactone.)

T/F: Conn syndrome is often treated by administration of aldosterone.

F (This is exactly opposite of the truth. Normal lung tissue is already 'light and airy' in texture. Consolidation replaces air with fluid, so that the affected areas of lung become dense and more x-ray opaque - white on x-ray studies.)

T/F: Consolidation of the lung involves replacement of lung parenchyma with large air pockets; thus, consolidated lungs are very light and "airy" in texture.

F (Cor pulmonale is characterized by pulmonary hypertension. In cases of acute cor pulmonale, the hypertension has a very sudden onset, such as the sudden lodging of an embolus in a pulmonary vessel; this can indeed occur -e.g., a saddle embolus-, often with quickly fatal consequences.)

T/F: Cor pulmonale is always chronic; acute cor pulmonale does not occur

F (Courvoisier's sign refers to an enlarged, palpable gallbladder; the migratory thrombophlebitis thing is Trousseau's syndrome)

T/F: Courvoisier's sign is due to procoagulants released by a tumor, resulting in migratory thrombophlebitis

F (most testes undescended at birth will complete their descent within the first year -the three months, really. There is usually no need to rush to surgery, and most doctors and parents will take a 'wait and see' attitude, since it is quite likely that the testis will complete its descent on its own.

T/F: Cryptorchidism is a medical emergency and must be treated surgically within the first three postnatal weeks

F

T/F: Currently, vaccines only exist for hepatitis A, C, and E viruses (HAV, HCV, and HEV)

T (Cystic fibrosis causes inspissated mucus plus in the pancreatic ducts, while the high iron levels of hemochromatosis causes oxidative damage to the acinar cells)

T/F: Cystic fibrosis and hemochromatosis are risk factors for chronic pancreatitis

F (DHEA is a gonadocorticoid; the most important mineralocorticoid is aldosterone.)

T/F: DHEA is the most important of the mineralocorticoids.

F (Viral pneumonia and toxic fumes damage the cells lining the alveoli; septicemia and ingestion of cytotoxic drugs damage the pulmonary capillary endothelium.)

T/F: Damage to either pulmonary capillary endothelial cells or alveolar wall epithelial cells may initiate ARDS. Specifically, viral pneumonia and inhalation of toxic fumes damages the endothelial cells.

T

T/F: Dark brown urine is often one of the earliest signs of viral hepatitis

F (as noted elsewhere, the endocrine pancreas tends to degenerate late in the disease, not early)

T/F: Diabetes mellitus often develops early in the course of chronic pancreatitis

F (CIS -whether ductal or not- IS cancer; it is early epithelial cancer that has not yeat learned to cross the basement membrane.)

T/F: Ductal carcinoma in situ (DCIS) is a pre-cancerous or benign condition that often develops into cancer.

F (the numbers are higher than this: half to three-quarters of women are affected by this condition, 5-10% severely enough to lose time at work or school.)

T/F: Dysmenorrhea affects about 10% of all women, and it affects about 10% of those (i.e., about 1% of all women) severely.

T

T/F: Dysmenorrhea presents as excessive low pelvic pain, which may be sharp, throbbing, or dull, and may extend into the back or legs.

T (this means cure rates approach -or are- 100%.)

T/F: Early (Stage 0) cervical carcinoma is curable.

T

T/F: Eclampsia and pre-eclampsia are both marked by the triad of hypertension, edema, and proteinuria.

F (endometrial hyperplasia is due to uterine overstimulation by estrogen unopposed by progesterone. The hyperplasia is NOT due to stimulation by progesterone alone, but by estrogen alone.)

T/F: Endometrial hyperplasia is the result of uterine overstimulation by unopposed progesterone.

F (They are usually seen in women in the 40's or 50's.)

T/F: Endometrial polyps occur most frequently in teenaged women.

F (This is backwards. Endometrioid tumors are solid. Serous and mucinous tumors are cystic and filled with watery fluid and jelly-like material, respectively. How could you be filled with fluid if you were a solid tumor?)

T/F: Endometrioid tumors are cystic, while serous and mucinous tumors are solid.

F (Serous tumors are the most common)

T/F: Endometrioid tumors are the most common type of surface epithelial tumor.

F (endometriosis progresses to cancer maybe 2% of the time- certainly not 25% of the time)

T/F: Endometriosis progresses to cancer with relatively high frequency (>25%).

T (being a complication of urethritis or prostatitis means that epididymitis is usually caused by the same pathogens causing those infections as well)

T/F: Epididymitis is caused by ascending infections and is usually a complication of urethritis or prostatitis.

F (The statistics are a little better than this- 1 woman in 9 will develop breast cancer sometime in her lifetime.)

T/F: Estimates are that 1 in 2 women will develop breast cancer at some point in their lives.

T (But remember the two caveats regarding negative feedback of estrogen on gonadotropin release from the anterior pituitary, 1- Estrogen by itself can totally suppress FSH release, and it has pretty much done so by Day 10 or so in the cycle. But estrogen by itself can only partially suppress LH release -it takes estrogen plus progesterone to totally suppress it. 2- At low levels, estrogen exerts a negative feedback on LH release -it suppresses it partially- but at higher concentrations estrogen exerts apoistive feedback on LH release- it stimulates it. This is what brings about the LH peak on about Day 14, with ovulation normally following within about 24 hours.

T/F: Estrogen inhibits GnRH & gonadotropin release in typical negative feedback fashion.

F (5-year survival rates for advanced cervical carcinoma are in the 10-15% range, not 79%.)

T/F: Even advanced (Stage IV) cervical carcinoma has a good prognosis, with 5-year survival rates exceeding 70%.

F (In fact, premature activation of these enzymes within the pancreas is the whole basis of acute pancreatitis.)

T/F: Even under pathological conditions, pancreatic proenzymes are not activated within the pancreas itself.

F (The enzymes and cell types are paired properly, but the gonadotropins are switched. LH puts oxidoreductase into thecal cells, while FSH puts aromatase into granulosa cells.)

T/F: FSH is responsible for putting oxidoreductase into the thecal cells (so they can convert cholesterol into androgens) while LH puts aromatase into granulosa cells (so they can convert androgens into estrogens).

T (The name tells you this: 'fibro-' means fibrous and 'adeno-' means gland.)

T/F: Fibroadenomas are composed of two components: fibrous stroma and glandular epithelium.

F

T/F: Fibroadenomas are malignant tumors.

F (Fibroadenomas only rarely transform to malignancy.)

T/F: Fibroadenomas frequently transform into malignant tumors, and thus should be resected immediately when found.

F (Fibroadenoma mostly affects prepubertal and recently postpubertal women in their teens, 20's and 30's.)

T/F: Fibroadenomas most affect elderly women in their 60's and 70's.

T (Small fibroids may produce no symptoms whatsoever. But think about the effects of an abdominal fibroid the size of a softball!)

T/F: Fibroid symptoms range from asymptomatic to almost debilitating, and are a common source of infertility.

F (Fibroids -leiomyomas- are the most common of uterine tumors. Approximately 20% of reproductive age women have them.)

T/F: Fibroids are a rather rare form of uterine tumor.

F (most fibroids are asymptomatic and don't require treatment. They do not, as the question implies, evolve along a dangerous path, in that cancer very seldom develops within them.)

T/F: Fibroids evolve along a dangerous path and should be removed promptly when discovered.

T

T/F: Fibrolamellar carcinoma has a more favorable prognosis than other types of HCC

F

T/F: Fibrolamellar carcinoma is the most lethal form of HCC; it occurs mostly in persons over 50

T (they are functional in the sense that they usually secrete sex hormones, which may disrupt the HPO axis and cause other hormonal problems.)

T/F: Follicular cysts provide an example of functional ovarian cysts.

T (It is surprising that, in spite of all these hormonal disruptions, many women with either of these conditions still have semiregular periods.)

T/F: For many women, the first symptoms to appear from anovulatory cycles or inadequate luteal phase are fertility issues.

F (cryptorchid testes have a 10-fold higher risk of developing cancer- usually a seminoma- than do normal testes. Orchiopexy at an early age reduces this risk but does not eliminate it completely.)

T/F: For some peculiar reason, cryptorchid testes have a lower rate of malignant transformation (i.e., developing cancer) than normally descended testes.

F (This disease invades and metastasizes early, making it highly invasive, highly metastatic)

T/F: Fortunately, pancreatic adenocarcinoma tends to invade and metastasize only late in the disease; early stages tend to remain in situ.

F (Genital herpes is caused by a virus, which will be unaffected by antibiotics. Treatment with anti-virals such as acyclovir can help lessen the intensity of outbreaks and thus provide some relief, but they do not eradicate the virus.)

T/F: Genital herpes is easily resolves after treatment with antibiotics such as doxycycline or tetracycline.

F (Genital herpes is caused by a virus, which will be unaffected by antibiotics. Treatment with anti-virals such as acyclovir can help lessen the intensity of outbreaks and thus provide some relief, but they do not eradicate the virus.)

T/F: Genital herpes is easily resolves after treatment with antibiotics such as doxycycline or tetracycline.

F (Glucagon targets the liver; insulin would target all these organs, and more.)

T/F: Glucagon targets the liver, muscles, and adipose tissue.

F (Insulinomas are the most common.)

T/F: Glucagonomas are the most common tumors of the endocrine pancreas.

T (while penicillin was once the drug of choice, but due to antibiotic resistance, ceftriaxone is the antibiotic of choice today.)

T/F: Gonococcal infections can usually be treated effectively with antibiotics.

T

T/F: Gonococcus and Chlamydia trachomatis are two pathogens that are common causes of pelvic inflammatory disease.

T (but remember that many times gonorrhea is asymptomatic in women)

T/F: Gonorrhea is a bacterial infection that can cause endocervicitis in women and purulent urethritis in men.

F (gonorrhea is often asymptomatic in women, but it produces purulent urethritis in men)

T/F: Gonorrhea is often asymptomatic in both men and women

T

T/F: Gummas are most common in skin, bones, and joints

F (And surprisingly so. With the higher estrogen levels seen in gynecomastia one would also expect to see a higher incidence of male breast cancer, but this does not appear to be the case.)

T/F: Gynecomastia is a major risk factor in the development of breast cancer in males.

T (This means that conditions favoring hyperestrinism in a male also favor gynecomastia.)

T/F: Gynecomastia often develops as a result of an imbalance between estrogens, which stimulate breast tissue, and androgens, which counteract these effects.

T

T/F: HCC may occur as a single, usually large mass, or as a collection widely distributed nodules of variable size, or even as a diffusely infiltrative cancer

T Do you see the connection- it increases her risk of contracting a viral (HPV) or bacterial (e.g., syphilis or chlamydia) infection.

T/F: Having intercourse at an early age increases a woman's risk of developing cervical cancer.

T (again; Same connection- it increases her risk of contracting a viral -HPV- or bacterial -e.g., syphilis or chlamydia infection.)

T/F: Having many sex partners increases a woman's risk of developing cervical cancer.

T (An example provided in class is mitral stenosis.)

T/F: Heart disease can cause pulmonary hypertension.

F (HSV can also be transmitted via viral shedding, e.g., from saliva or skin moisture)

T/F: Herpes simplex virus is only transmitted person-to-person via direct contact with the clear but virus-laden fluid from the herpetic vesicles.

F (the genital region is only the preferred site of HSV type II- it can cause lesions elsewhere on the body, including cold sores around the mouth.)

T/F: Herpes simplex virus type II causes genital herpes but does not- and cannot- cause cold sores in the perioral areas.

F (Herpesvirus is typically spread via sexual contact.)

T/F: Herpesvirus is typically spread by aerosolized droplets, or by touching contaminated surfaces such as doorknobs or table tops.

T (This is an area of active research.)

T/F: Herpesvirus may be associated with Bell palsy.

T (LH puts the oxidoreductase into the thecal cells so they readily convert cholesterol into androgen, and FSH puts aromatase into granulosa cells so they readily convert androgens into estrogens. Without FSH, a woman will produce plenty of androgen without her granulosa cells being able to convert them to estrogen.)

T/F: High LH levels coupled with low FSH levels will cause high androgen levels in an otherwise healthy woman

T

T/F: High estrogen levels, unopposed by progesterone, support the development of endometrioid tumors.

T (This makes sense, since the exocervixis lined by a squamous epithelium.)

T/F: Histologically, carcinoma of the cervix is a squamous cell carcinoma.

F (Endometrial cancer is an adenocarcinoma. This makes sense if you think about it. The endometrium is a secretory layer- i.e., a glandular layer. It is typical of cancer of this kind of glandular tissue will present as an adenocarcinoma.)

T/F: Histologically, endometrial cancer is a squamous cell carcinoma, as with cervical cancer.

F (There are several things wrong with this statement. First, gynecomastia does not lead to the development of numerous mature lobules- this would mean that the gynecomastic breast breast was essentially the mature, lactating breast of pregnancy. Not true. Gynecomastic breasts have been likened to the breasts of adolescent girls: there is definitely breast development, but it is mostly tubular development, not lobular. Secondly, recall that even in women, lobular development does not reach its pinnacle until the end of pregnancy. Since the gynecomastic breast is not a functional, lactating breast, it clearly does not have 'numerous mature lobules'.)

T/F: Histologically, gynecomastia results in the development of numerous mature lobules in the male breast.

F (This is almost correct, except the direction of the pumps. Sodium is pumped back INTO the body -from the urine- and potassium is pumped OUT of the body -into the urine. Thus hyperaldosteronism leads to hypernatremia and hypokalemia.)

T/F: Hyperaldosteronism leads to enhanced activity of the Na+-K+ pumps in the kidney tubules, and usually results in hyponatremia and hyperkalemia.

T

T/F: Hyperbilirubinemia may be due to either conjugated or unconjugated bilirubin

F (Hyperparathyroidism is one of the most common endocrine disorders, occurring four times more often in women that men and typically occurring inolder adults -older 50 years of age)

T/F: Hyperparathyroidism is a rare disorder most common in young to middle-aged men.

T (Remember, PTH raises blood calcium levels, so oversecretion of PTH.)

T/F: Hyperparathyroidism results in hypercalcemia.

F (Hyperprolactinemia causes erectile dysfunction and gynecomastia in men. In this respect, remember that amenorrhea is to a woman what erectile dysfunction is to a man.)

T/F: Hyperprolactinemia is seen in up to one-third of sarcoidosis patients. Hyperprolactinemia has no clinical manifestation in men.

T

T/F: Hyperprolactinemia is seen in up to one-third of sarcoidosis patients. In women, hyperprolactinemia manifests as amenorrhea and galactorrhea

T (The nuclear DNA all comes from dad and, oddly enough, the egg has totally lost its nucleus.)

T/F: In a complete hydatidiform mole, all the genetic material in the nucleus is paternal in origin.

T (Students should also know what a grade 1 and grade 3 cystocele is, as on an exam I might switch this question to one of the other grades.)

T/F: In a grade 2 cystocele, the bladder sinks far enough to reach the introitus.

F (The duct of Wirsung makes this connection. The duct of Santorini is the accessory pancreatic duct, with its own opening into the duodenum)

T/F: In a pancreas with normal anatomy, the duct of Santorini connects the main pancreatic duct with the papilla (ampulla) of Vater.

F (osteoblasts contain abundant alkaline phosphatase, so in a patient with prostate cancer, its elevation in the serum would suggest metastasis to the bones.)

T/F: In a patient with prostatic adenocarcinoma, elevated serum levels of alkaline phosphatase typically indicate that the tumor has spread into the nearby rectum.

F (gonorrhea is spread by sexual contact, not toilet seats)

T/F: In addition to sexual contact, gonorrhea is also spread by unsanitary toilets and bathrooms.

F (This sentence doesn't even make sense. First of all, the antibodies involved in allergic rhinitis -or any other type I hypersensitivity- are IgE antibodies, not IgA. Secondly, it is mast cells that degranulate and release histamine, not antibodies. Antibodies are proteins- how could they possibly release histamine at all?)

T/F: In allergic rhinitis, allergens bind to IgA antibodies, causing them to release histamine, a potent vasodilator.

T

T/F: In areas of the world where HBV infections are not prevalent, HCC often occurs in the setting of cirrhosis

T

T/F: In children, upper respiratory infections often extend into the middle ear because the auditory tubes of children are shorter and more horizontally oriented, both of which allow for easier passage of nasopharyngeal secretions into the middle ear.

T (I showed a picture in class of stones in the pancreatic duct)

T/F: In chronic pancreatitis, stones (of pancreatic material) are often found in the major pancreatic ducts

F (This is backwards- the islet cells tend to degenerate later, so endocrine insufficiency- diabetes mellitus- shows up later in the disease)

T/F: In chronic pancreatitis, the islet cells tend to degenerate first, followed later by the acinar cells

T (80% of cases involve one or the other, or both)

T/F: In clinical practice, acute pancreatitis mainly occurs in the context of gallstones or alcohol abuse.

T (This forms a handy lab test to distinguish between primary and secondary hyperaldosteronism. Aldosterone and renin levels elevated- secondary hyperaldosteronism. Aldosterone elevated, renin normal- Conn syndrome.)

T/F: In contrast to Conn syndrome, secondary hyperaldosteronism is associated with hyperreninemia due to excessive activation of the renin-angiotensin-aldosterone system.

T

T/F: In essence, polycystic ovarian syndrome is due to high levels of estrogen which, in turn, results in high LH and low FSH levels; clearly such a woman is hormonally out of balance.

T

T/F: In fibrolamellar carcinoma, nests of malignant hepatocytes are encased in a dense stroma of collagen fibers

T

T/F: In general, pancreatic acinar cells release an enzyme-rich fluid while pancreatic ductal cells release a buffer-rich (bicarbonate-rich) fluid.

F (Actually most starch digestion occurs in the duodenum under the action of pancreatic amylase.)

T/F: In humans, starch digestion occurs completely in the mouth; it is initiated and completed by salivary amylase.

T (This is known as congenital adrenal hyperplasia. The hyperplasia is due to a chain of events, starting with low cortisol levels, which then cause high ACTH levels, which in turn stimulates the adrenal glands and results in hyperplasia.

T/F: In neonates, adrenogenital syndrome is typically caused by mutation of one of the enzymes involved in steroid metabolism.

T

T/F: In some cases ARDS is attributable to injury of both the alveolar lining cells and of the endothelial cells, e.g., inhalation of hot air causes pulmonary burns and can destroy the entire alveolar wall.

F (In stage II endometriosis the superficial lesions are present but so are some deep lesions in the pouch of Douglas - the cul-de-sac.)

T/F: In stage II endometriosis, only superficial lesions are present, possibly with a few adhesions as well, but deep lesions are not present.

T

T/F: In stage IV endometriosis, superficial and deep lesions are present as well as large endometriomas on the ovaries, accompanied by extensive adhesions.

F (It's the other way around.)

T/F: In the endocrine pancreas, alpha cells secrete insulin and beta cells secrete glucagon.

F (one third of cases involve both testes, but two-thirds -i.e., the majority- involve only one testis.)

T/F: In the majority of cryptorchidism cases, both testes are undescended

F ('Germ cell' does not have anything to do with microbes. Germ cells are cells that have the ability, or are in the process of, forming gametes. The correct statement here is that germ cell tumors arise from activated oocytes.)

T/F: In the ovaries, germ cell tumors arise from virus- or bacteria-infected ovarian cells.

T

T/F: In the terminal stages of cirrhosis, most livers are small, shriveling to about one-third their normal size and weight

T

T/F: In their pure forms, emphysema is a disease at the acinar level while asthma, bronchitis, and bronchiectasis are at the bronchial level.

F (Normal ovarian secretion of progesterone requires a properly functioning corpus luteum. If the corpus luteum is inadequate, then obviously the progesterone levels will be inadequate -i.e., low- as well.)

T/F: Inadequate luteal phase results in high progesterone levels unopposed by estrogen.

F

T/F: Inflammatory cells, such as lymphocytes and macrophages, rarely infiltrate the tissues of chronic pancreatitis

T

T/F: Insulinomas and gastrinomas account for almost all of the tumors of the endocrine pancreas.

T (This follows from the definitions of 'intra-' and 'inter-'.)

T/F: Interlobular stroma is connective tissue occurring between breast lobules, while intralobular stroma is connective tissue occurring within a breast lobule.

F (This is reversed. INTRA-lobular stroma is estrogen sensitive.)

T/F: Interlobular stroma is estrogen sensitive, while intralobular stroma is usually not.

T

T/F: Intestinal obstruction and ascites are commonly seen with pancreatic adenocarcinomas

T (This is true, at least for carcinomas. Remember also that carcinomas are not automatically invasive-they must learn how to negotiate the basement membrane; once they do this, they progress from carcinoma in situ to invasive carcinoma. Incidentally, this ability to negotiate the basement membrane is one of the least understood steps in oncogenesis. It may indeed be a function acquired by the carcinoma in situ cells, as I presented in class, but it is also possible that turning invasive is not an acquired trait of cancer cells but rather a loss of function of the basement membrane and/or the cells that maintains it. In this model, the transition from in situ to invasive carcinoma is due to the inability of the basement membrane to contain the cancer cells, not to a unique ability of the cancer cells themselves. Fact is, we just don't know.)

T/F: Invasive breast cancers is thought to be preceeded by a non-invasive stage known as carcinoma in situ (CIS).

F (In fact, bronchiectasis DOES often develop into pneumonia, as that purulent material seeps down into the alveoli.)

T/F: It is surprising that bronchiectasis, with all its purulent material in the bronchi and bronchioles, does not develop into pneumonia.

T

T/F: It is the slight 'negative pressure' in the pleural cavity that keeps the lungs inflated.

T

T/F: Large emboli lodge in the pulmonary trunk, its main branches, or at the bifurcation (saddle embolus), whereas smaller emboli travel out into the more peripheral vessels of the lung.

F (There is no evidence that Legionella spreads by any method other than inhalation of aerosols from infected water samples - i.e., from stagnant water in the environment, not from coughing individuals)

T/F: Legionella pneumophila, the cause Legionnaires' disease, is spread human-to-human by inhalation of respiratory fluids from an infected individual that have been aerosolized via coughing and sneezing.

T (Humidifiers, air conditioners, air ducts in humid environments, and even misters in the produce section at the grocery store can disseminate mist droplets containing infected amoebae.)

T/F: Legionella pneumophila, the cause Legionnaires' disease, lives in amoebae and is transmitted to humans by inhalation of mist droplets containing the infected amoebae.

F (Leiomyomas can and do occur in smooth muscle elsewhere in the body- e.g., the arrector pili muscles associated with hair follicles, the smooth muscles associated with blood vessels, etc.)

T/F: Leiomyomas are exclusively tumors of uterine smooth muscle; they do not occur elsewhere in the body.

T (In either case they are deprived of their estrogen support.)

T/F: Leiomyomas are seldom found in prepubertal girls, and they seldom develop in postmenopausal women.

F (Fibroids are definitely sensitive to estrogen levels, but apparently they are not caused by- not initiated by- estrogen. Frankly, we don't know what causes fibroids.)

T/F: Leiomyomas are sensitive to, and also caused by, estrogen.

F (fibroids are the most common type of uterine tumor and thankfully they are benign.)

T/F: Leiomyomas are the third most common uterine tumor.

F (Very rarely leiomyosarcomas may arise within a leiomyoma, but this is very rare. Typically, leiomyomas do not evole into cancer.)

T/F: Leiomyomas have a tendency to progress to their cancerous form, leiomyosarcomas.

T (after their estrogen support is withdrawn, the uterine smooth muscle component atrophies, leaving behind the fibrous stroma.)

T/F: Leiomyomas tend to regress after menopause.

T (since Leydig and Sertoli cell tumors are so rare, are either benign or for Leydig cell tumors low-grade malignant)

T/F: Leydig cell tumors may cause gynecomastia and feminization in a male.

F

T/F: Like other forms of HCC, fibrolamellar carcinoma usually occurs in a setting of cirrhosis or viral infection

T (Just think about it, if the pancreatic acinar cells made active protease, they would digest themselves!)

T/F: Like pepsin in the stomach, pancreatic proteases are released as inactive precursors which are activated in the GI tract.

T (The elevated hCG levels serves as a serologic marker for this tumor)

T/F: Like trophoblastic cells themselves, choriocarcinoma cells are highly invasive and secrete hCG.

T

T/F: Liver diseases causing liver hypofunction often result in hypoproteinemia since the liver is the sole source of virtually all plasma proteins except the serum immunoglobulins

T (Bronchopneumonia involves scattered foci of infection, whereas lobar pneumonia one or more entire lobes is involved.)

T/F: Lobar pneumonia is more extensive (more widespread) than bronchopneumonia.

T (Chronic bronchitis is not as benign as we once thought.)

T/F: Long standing chronic bronchitis often leads to pulmonary fibrosis which, in turn, leads to cor pulmonale and heart failure.

F (Staphylococcus aureus is the most common cause of lung abscess)

T/F: Lung abscesses are most commonly caused by Kelbsiella pneumoniae or Pseudomonas aeruginosa.

T

T/F: Lung abscesses tend to connect with the airways, spewing their purulent content into the airways as they expand.

F (While luteal cysts certainly may secrete progesterone, they are CYSTS, and the definition of a cyst is a sac filled with fluid or semi-fluid material. Thus cysts are not filled with solid material.)

T/F: Luteal cysts are typically filled with solid, progesterone-secreting tissue.

T (they are functional in the sense that they usually secrete sex hormones, which may disrupt the HPO axis and cause other hormonal problems.)

T/F: Luteal cysts provide an example of functional ovarian cysts.

T

T/F: Lysing liver cells are the major source of the aspartate aminotransferase (AST) and alanine amino-transferase (ALT) enzymes, and the liver function tests (LFTs) assess liver functionality by measuring the activity of these enzymes in the blood

T

T/F: M. tuberculosis, the causative pathogen of pulmonary tuberculosis, can, in some circumstances, cause a fulminant lobular or lobar pneumonia.

F (M. tuberculosis can infect about any organ in the body- tuberculosis of the bones or small intestines are just two common examples. This infection is well known for its effects on the lungs, but it can easily affect other organs as well.)

T/F: M. tuberculosis, the causative pathogen of pulmonary tuberculosis, is restricted to growth in the lungs; tuberculosis does not spread to other organs.

T (Although the conclusive proof of this viral relationship still is elusive.)

T/F: Many authorities consider carcinoma of the cervix to be an infectious disease transmitted by intercourse and caused by viruses.

T (Thus in cases where a patient's condition is part bronchitis and part emphysema the term COPD can be used instead.)

T/F: Many patients show damage at both the acinar (emphysema) and bronchial (bronchitis) levels, and in these cases. the umbrella term "chronic obstructive pulmonary disease" is applied.

T (Women are taught from an early age to be wary of lumps in the breast, and seek medical attention quickly when lumpy breast changes occur. Men, on the other hand, are not taught this. When a breast lesion or lump arises, many men will ignore it, believing that -1- it can't be cancer 'cos men don't get breast cancer, or -2- it will go away on its own so just ignore it. Thus, by the time men seek medical advice the tumor has had many months to grow, and is correspondingly more advanced.)

T/F: Men with breast cancer tend to present at a more advanced stage than women.

F (Lung cancers tend to metastasize early and frequently to the regional lymph nodes, and also to the brain, bone, and liver, and for some peculiar reason, particularly to the adrenals)

T/F: Metastasizing lung cancers tend to remain in the lung and not form distant metastases.

F (Molar pregnancies are most common and the ends of a woman's reproductive years- either just after menarche, or just before menopause.)

T/F: Molar pregnancies are most common in the middle of a woman's reproductive years, specifically in the 25 to 35 age group.

T (70% by one year, 90% by two years.)

T/F: Most HPV infections in young women spontaneously disappear within two years.

F (Most breast cancers are derived from epithelial tissue and hence are carcinomas.)

T/F: Most breast cancers derive from interlobular connective tissue and hence are sarcomas.

F (The most common position -45%- is the upper outer quadrant.)

T/F: Most breast carcinomas occur on the side of the breast medial to the areola.

T

T/F: Most cases of chronic pancreatitis have an insidious onset and a progressive, irreversible course

F (Although pancreatitis may be caused by infectious agents such as enteric bacteria, most cases are sterile in nature and not associated with infections.)

T/F: Most cases of pancreatitis are due to infectious agents like enteric bacteria.

T (Also, this area is visible via colposcopy, which facilitates easier detection.)

T/F: Most cervical cancers arise in the transformation zone, where the endocervix and exocervix meet.

F (Perhaps inexplicably so.)

T/F: Most cigarette smokers eventually develop COPD.

T

T/F: Most commonly, choriocarcinomas arise from pre-existing complete hydatidiform moles.

T

T/F: Most commonly, the symptoms of pancreatic adenocarcinoma are relatively nonspecific and include abdominal pain, weight loss, loss of appetite, nausea, and vomiting.

T (But serous and mucinous tumors may be benign, borderline malignant, or malingant.)

T/F: Most endometrioid tumors are malignant.

T

T/F: Most fibroadenomas probably represent an abnormal response of breast tissue to sex hormones.

T

T/F: Most gallstones are asymptomatic or produce minor nonspecific symptoms that require no treatment

F (Most gastrinomas are malignant. )

T/F: Most gastrinomas are benign tumors.

F (Germ cell tumors don't secrete sex hormones -tho some of them secrete human chorionic gonadotropin).

T/F: Most germ cell tumors secrete sex hormones.

T

T/F: Most insulinomas are benign tumors.

F

T/F: Most liver cancers arise from bile duct cells and hence are ductal carcinomas

F (60% of these tumors occur in the head of the pancreas.)

T/F: Most pancreatic adenocarcinomas are found in the tail of pancreas, where they cause problems with the adjacent spleen.

T (About 90% actually)

T/F: Most pheochromocytomas are benign.

T (If they secrete estrogens and/or progesterone, they can easily disrupt a woman's menstrual cycle. If they secrete androgens, they may virilize her.)

T/F: Most sex cord stromal tumors secrete sex hormones.

F (90% of testicular tumors are malignant)

T/F: Most testicular tumors are benign.

F (testicular tumors are most common in middle-aged men -specifically the 25 - 45 year old age group)

T/F: Most testicular tumors are found in elderly men over age 70.

T (seminomas and non-seminomatous germ cell tumors)

T/F: Most testicular tumors are germ cell tumors.

F

T/F: Most unconjugated bilirubin travels freely in the blood, simply dissolved in blood plasma and not bound to any "carrier" molecules

F (Most are caused by viruses. )

T/F: Most upper respiratory tract infections are caused by bacteria.

T

T/F: Most upper respiratory tract infections are recognized clinically as the common cold.

F (In fact, most viral pneumonias cause only minor alveolar damage and resolve rather quickly, without major consequences.)

T/F: Most viral pneumonias cause major alveolar damage, are slow to resolve, and often evolve into major complications.

F (NSAIDs suppress prostaglandin synthesis, and that will do nothing to resolve an anovulatory cycle. Progesterone- a birth control pill- is what is needed to break the anovulatory cycle and bring on menstruation and a new cycle.)

T/F: NSAIDs often work well in resolving anovulatory cycles

T (Recall that prostaglandins stimulate myometrial contraction and that primary dysmenorrhea is usually due to overproduction of prostaglandins. NSAIDs like aspirin provide relief by inhibiting prostaglandin synthesis)

T/F: NSAIDs often work well in resolving primary dysmenorrhea

T (a good reason for men to give themselves regular testicular exams.)

T/F: NSGCTs are more malignant than seminomas and tend to metastasize early (usually before they are even diagnosed)

F (nocturia yes, but pain no.)

T/F: Nocturia and pain on urination are both common complaints in patients with benign prostatic hyperplasia.

T

T/F: Non-endometrioid, or type II, adenocarcinomas of the endometrium usually are found in older women and typically do not arise in the context of hyperestrinism.

F

T/F: Normal serum bilirubin levels are in the 12-14 mg/dL range

F (It is backwards. Thecal cells convert cholesterol into androgens, and granulosa cells convert androgens into estrogens.)

T/F: Normally, granulosa cells convert cholesterol into androgens while thecal cells convert androgens into estrogens.

T (the descent toward and into the inguinal canal starts in about the seventh month.)

T/F: Normally, testes begin fetal development in the abdomen, pass through the inguinal canal, and then become entrapped in the scrotum.

F (During the follicular phase of the ovarian cycle, maturing follicles release increasing amounts of estrogen. This is before a corpus luteum has even formed. Also, adipose tissue can aromatize androgens into estrogens -though this would happen under the non-normal conditions of high androgen and extra adipose)

T/F: Normally, the only significant source of estrogen in non-pregnant women is the corpus luteum.

T (This true because prior to ovulation, maturing follicles do not secrete progesterone. After ovulation, a corpus luteum forms and it releases both estrogen and progesterone.)

T/F: Normally, the only significant source of progesterone in non-pregnant women is the corpus luteum.

F

T/F: Obstruction by gallstones is an important risk factor for the development of chronic pancreatitis

T (These cause backup of pancreatic juice and premature activation of proenzymes)

T/F: Obstruction of pancreatic ducts by cancer or inspissated mucus plugs is a risk factor for the development of chronic pancreatitis

T (Remember that in obstructive lung disease the 'obstruction' may be due to physical blockage -e.g., bronchitis and asthma- or to loss of recoil -e.g., emphysema.)

T/F: Obstructive lung diseases show a decrease in forced expiratory volume, while restrictive lung diseases show a decreased expansion of the lungs during inspiration.

T

T/F: On gross examination, the pancreas of chronic pancreatitis usually appears fibrotic and firm

F (This is wrong. Dysplasia won't cross the basement membrane- that requires cancer. CIS is early cancer- it means that the cancer has NOT yet crossed the basement membrane- it is a cancer but it is still confined to the epithelial layer in which it arose. When it finally does cross the basement membrane, then we call it invasive carcinoma.)

T/F: Once cervical dysplasia crosses the basement membrane, it is known as carcinoma in situ, or CIS.

T

T/F: One third of sarcoidosis patients show granulomas in the lacrimal and salivary glands.

T

T/F: Pain, fibrosis, and calcification are common with chronic pancreatitis

T

T/F: Pancreatic adenocarcinoma causes a desmoplastic response, resulting in a hard, fibrous tumor.

F (it is the fourth or fifth leading cause of cancer deaths in the US)

T/F: Pancreatic adenocarcinoma is a relatively rare cancer.

T

T/F: Pancreatic adenocarcinoma is an incurable disease, with a 5-year survival rate of less than 5%.

T

T/F: Pancreatic adenocarcinoma occurs with equal frequency in men and women, except in the under 50 age group, where it is 3x more common in men than women.

F (Pancreatic adenocarcinoma is a disease of old age and is rare before 40 years of age.)

T/F: Pancreatic adenocarcinoma occurs with highest frequency in the third to fourth decade of life (i.e., the 20's and 30's).

F (These cancers usually spread to the liver, or less commonly, the lungs and bones.)

T/F: Pancreatic adenocarcinomas tend to metastasize to the ovaries, brain, and for some peculiar reason, to the adrenal glands.

F (Although endometrial cancer cells do show up in vaginal/cervical Pap smears, the test is not as reliable for endometrial cancers. Still useful, but not as efficient.)

T/F: Pap smears are as effective at detecting endometrial cancer as they are for cervical cancer.

T (This makes sense since men do not have the lobular development that a woman has, so that breast cancer in men is skewed toward ductal carcinomas, esp. of the papillary type.)

T/F: Papillary (ductal) carcinomas are more common in men (than women) and lobular carcinomas less common.

T (another possibility is the fusion of a haploid egg with a single abnormal but diploid sperm.)

T/F: Partial hydatidiform moles feature triploid cells, usually the result of the fertilization of one haploid egg by two haploid sperm.

T

T/F: Patients being treated for endometrioid carcinomas that have not yet spread outside the ovary have a 5-year survival rate in excess of 80%.

T

T/F: Patients with all forms of hypoparathyroidism are successfully treated with vitamin D and calcium supplementation.

F (this is backwards. Pertussis, or whooping cough, produces a series of 5-15 coughs, typically followed by a loud whoop, while croup produces the inspiratory stridor with every breath.)

T/F: Pertussis usually produces an inspiratory stridor which is audible with virtually every breath, while croup produces a series of coughs ending with a loud inspiratory whoop

F (Recall that the renin-angiotensin-aldosterone system is not controlled by the pituitary but by plasma sodium and blood volume/pressure. Thus, pituitary disoders do not directly cause secondary hyperaldosteronism.)

T/F: Pituitary disorders are the most common cause of secondary hyperaldosteronism.

T (the resulting fluid in the pleural cavity is often removed via a thoracentesis.)

T/F: Pleural effusions may cause compression atelectasis.

T (The high estrogen levels totally suppress FSH secretion by the anterior pituitary. Without FSH, granulosa cells do not aromatize androgens to estrogens. Instead, the androgens are secreted into the blood, where they cause hirsutism. If a woman has a little extra adipose tissue, the fat cells can aromatize androgens to estrogen, in which case she will have high serum levels of BOTH androgens and estrogens.)

T/F: Polycystic ovarian syndrome is perhaps the most common cause of hirsutism.

T

T/F: Pores connect adjacent alveoli, so that air may travel directly from one alveolus to another (at least within the same alveolar sac).

F (It is eclampsia, not pre-eclampsia, that is marked by seizures.)

T/F: Pre-eclampsia presents with seizures which may be life-threatening.

T (Again, this forms the whole basis of acute pancreatitis.)

T/F: Premature activation of the pancreatic proenzymes within the pancreas results in pancreatic autodigestion.

T (unfortunately.)

T/F: Presently, genital herpes cannot be cured.

F (I tried to trick you with this one. Here 'primary' is used a little differently than you might be accustomed to, since primary amenorrhea refers to a condition where a women has never started menstruating. Compare that to secondary amenorrhea, where she has stopped menstruating -during her reproductive years).

T/F: Primary amenorrhea refers to amenorrhea where the problem lies with the uterus.

F (the three mentioned antibiotics can be used to treat primary or secondary syphilis, but tertiary syphilis is currently incurable and untreatable- neither doxycycline nor tetracycline can effectively treat it.

T/F: Primary and secondary syphilis can be treated with penicillin, but tertiary syphilis must be treated with stronger antibiotics such as doxycycline or tetracycline.

F

T/F: Primary biliary cirrhosis develops as a result of prolonged obstruction of bile flow, most often by gallstones, whereas secondary biliary cirrhosis is an autoimmune disease which scars and obstructs the bile ducts over a period of several decades

F (primary dysmenorrhea is usually due to overproduction of prostaglandins)

T/F: Primary dysmenorrhea refers to dysmenorrhea where the problem lies with the ovaries

F (Secondary tumors easily reach the lungs via the blood and the lymphatics, so secondary lung tumors are actually more frequent than primaries.)

T/F: Primary lung cancers are more common than lung metastases from other sites (i.e., secondary lung cancer).

T (The sputum may be bloody as well.)

T/F: Prolonged coughing and expectoration are the two most common presenting symptoms of lung cancer.

T

T/F: Prostatitis is a disease affecting older men and is usually related to stagnation of urine.

T

T/F: Pseudocysts are found in about 10% of patients with chronic pancreatitis

T

T/F: Pseudocysts may grow large enough to compress or perforate into nearby organs

F (Pseudocysts are found in both acute and chronic pancreatitis)

T/F: Pseudocysts occur in acute pancreatitis but not chronic pancreatitis

T (Recall that a lowered blood calcium level decreases the threshold of neurons and muscle cells, so that they are excited and depolarize -i.e., fire a nerve signal- more easily. This translates into highly excitable- irritable- nerves and spastic muscles.)

T/F: Pseudohypoparathyroidism presents with hypocalcemia, such that tetany and cramping are common.

F (Idiopathic pulmonary hypertension is a rare disease; the other forms are not so rare- e.g., up to 60% of scleroderms patients and 21% of rheumatoid arthritis patients present with pulmonary hypertension.)

T/F: Pulmonary hypertension is a rare disease.

T (This is about one-fifth the systolic pressure in the systemic circuit)

T/F: Pulmonary hypertension is defined as pulmonary arterial pressures at or above 25 mm Hg at rest.

F (Pulmonary infarcts occur along a bronchus and its tributaries, which gives it a triangular shape with the apex pointing toward the hilum. Additionally, the pain is sharp and easily pinpointed, not diffuse.)

T/F: Pulmonary infarcts tend to be spherical in shape and cause a diffuse pain over the entire lobe.

F (But the statement is true of endometrioid tumors- endometrioid tumors of the ovary are often associated with endometrioid -type I- tumors of the endometrium.)

T/F: Quite frequently, mucinous tumors are accompanied by uterine tumors, suggesting some sort of special relationship between the two.

T (this happens in about 3-4% of newborn boys. Recall that it is the cremaster muscle that pulls the testes back and forth.)

T/F: Retractile testes occur when the inguinal canal remains open after birth, so that the testes can pass back and forth between the scrotum and the inguinal canal or abdomen

F (First, we don't really have any good medications to treat a rhinovirus infection - it is viral! Second, it is certain streptococcal infections, not rhinovirus, that may evolve into rheumatic fever or acute glomerulonephritis)

T/F: Rhinovirus flu may evolve into rheumatic fever or acute glomerulnephritis, and thus should be treated promptly with medication.

F (sarcoidosis is more common in women)

T/F: Sarcoidosis has a higher incidence in men than in women.

T

T/F: Sarcoidosis is a disease of unknown etiology.

F (sarcoidosis is a disease of unknown etiology. There is a group of parasites called schistosomes- blood flukes- and they do cause some nasty human diseases, but sarcoidosis is not one of them.)

T/F: Sarcoidosis is caused by a parasitic worm of the genus Schistosoma.

T (Scleroderma causes vascular inflammation, intimal fibrosis, and medial hypertrophy, all of which lead to pulmonary hypertension)

T/F: Scleroderma is an example of a connective tissue disorder that can cause pulmonary hypertension.

T (Usually this is due to kidney disease, but other factors- such as hypovitaminosis D- can cause it as well.)

T/F: Secondary hyperparathyroidism occurs in the context of chronic hypocalcemia.

F (Seminomas are not aggressive tumors, held in check by a number of factors which I discussed. They are certainly less aggressive -less malignant- than NSGCTs. Seminomas have a good prognosis if they are treated early.)

T/F: Seminomas are aggressive tumors with an abysmal prognosis.

F (human chorionic gonadotropin -hCG- and alpha fetoprotein -AFP- are not elevated by seminomas, so they are useless as serologic markers for this disease)

T/F: Seminomas are easily detected by testing for the presence of the serologic markers hCG and AFP.

T (See the photo on or about Slide 174.)

T/F: Serous tumors often consist of several cysts lumped together within a common outer capsule.

F (Most instances of Conn tumor are due to a hypersecreting tumor of adrenal cortex. Medullary tumors would be pheochromocytomas.)

T/F: Seventy percent of cases of Conn syndrome are due to a hypersecreting tumor of the adrenal medulla.

T

T/F: Severe AHP commonly leads to shock, which may become life-threatening

T (In fact, circulatory shock is a common cause of mortality in AHP)

T/F: Severe AHP commonly leads to shock, which may become life-threatening

F

T/F: Severe epigastric pain, nausea, and vomiting are typical symptoms of AHP

T

T/F: Signs of secondary syphilis include lymphadenopathy, truncal rashes, and condyloma lata

T (If hypovitaminosis was the underlying cause of the secondary hypoparathyroidism.)

T/F: Some cases of secondary hyperparathyroidism respond to dietary vitamin D supplementation.

T (pneumonia commonly develops secondary to urinary or GI tract infections, via the hematogenous route)

T/F: Some pneumonial pathogens reach the lungs via hematogenous spread.

T

T/F: Some women experience nausea and vomiting with dysmenorrhea.

T

T/F: Splenomegaly or hepatomegaly are commonly associated with pancreatic carcinoma

T

T/F: Squamous cell carcinomas and adenocarcinomas each account for roughly one-third of lung cancers.

T (Since the tissue of endometriosis swells and involutes with the changing levels of ovarian hormones -we're talking estrogen here- then it makes sense that suppressing the high levels of unopposed estrogen will reduce the size of the endometriotic tissue. This alone may alleviate some of the pain and discomfort.)

T/F: Suppression of menstruation (i.e., contraceptive pills) may alleviate the pain and discomfort of endometriosis.

T (Remember that tamoxifen is an estrogen antagonist in breast tissue, but a weak estrogen agonist in endometrial tissue. Thus tamoxifen discourages the growth of some breast tumors but encourages the growth of endometrial tissue.)

T/F: Tamoxifen, an anti-estrogen drug used to treat some breast cancers, appears to encourage the growth of endometrial polyps in some women.

F (This is backwards- respiratory bronchioles are involved in gas exchange, while terminal bronchioles are strictly conduits.)

T/F: Terminal bronchioles are involved in gas exchange, while the respiratory bronchioles are merely air conduits and thus not involved in gas exchange.

T

T/F: Tertiary syphilitic often manifests with perivasculitis, particularly aortic vasculitis Testicular Neoplasms (slides 51 - 66)

T (The tumor -such as a Leydig cell tumor- may hypersecrete estrogen.)

T/F: Testicular cancer may cause Gynecomastia.

F (In fact, it only protects agains four types of HPV.)

T/F: The Gardasil® vaccine provides protection against infection by all types of HPV.

F

T/F: The HPV types that cause genital warts also cause cervical cancer.

F (The pain radiates to the back)

T/F: The abdominal pain of AHP often radiates down the intestines into the pelvic area

T (which means that basement membrane diseases, such as lupus, may have pulmonary involvement.)

T/F: The alveolar wall and the capillary endothelial wall are separated from each other by a basement membrane.

F

T/F: The appearance of ascites is an early development of cirrhosis; most cirrhosis patients live for 2-3 decades after the initial appearance of ascites

F (the dilations of bronchiectasis are not reversible; once the bronchial walls have been damaged to the point of dilation, there's no way to reverse the changes.)

T/F: The bronchial dilatations of bronchiectasis are reversible, if corticosteroids are promptly administered.

T (If the tumor ruptures, the jelly-like material fills the peritoneum and leads to a condition called 'jelly belly'.)

T/F: The cavity of mucinous tumors is filled with thick, yellowish or white, jelly-like mucus.

T (In the complete moles, all the chromosomes come from dad, while in the partial moles, 2 sets come from dad and one set from mom.)

T/F: The cells of complete hydatidiform moles possess the normal number of chromosomes (46), while those of incomplete moles possess an abnormal number (69) of chromosomes.

T

T/F: The chocolate cysts of endometriosis provide an example of a non-functional ovarian cyst.

F (The corpus luteum is an extremely important source of estrogen and progesterone during Trimester 1, but in Trimesters 2 & 3 the placenta itself is the major sources of those hormones.)

T/F: The corpus luteum is the major source of estrogens and progesterone throughout all three trimesters of a pregnancy.

T (Chronic pancreatitis is progressive and irreversible.)

T/F: The course of chronic pancreatitis is relentless- it cannot be stopped or reversed.

F (We currently have no way of reversing emphysema. Since emphysema is not an infectious condition, antibiotics would be of little use anyway (unless, or course, there is a secondary bacterial superinfection).

T/F: The course of emphysema may be stopped or even reversed by prompt administration of strong antibiotics.

T (Recall that the root of the problem is an abundance of LH and no FSH. LH puts oxidoreductase into the theca cells, so they are quite capable of converting cholesterol into androgens. However, without FSH, the granulosa cells are unable to convert androgen to estrogen. Recall also that estrogen alone can totally suppress FSH release from the anterior pituitary, but both estrogen AND progesterone are required to suppress LH. By supplying the progesterone in a birth control pill, then both LH and FSH will be suppressed, androgen synthesis will be inhibited, and hopefully the woman's body can reset itself and resume a normal cycle.)

T/F: The cycle of polycystic ovarian syndrome can usually be broken by administration of progestin (birth control pill).

F (Recall that in polycystic ovarian syndrome FSH levels are very low -suppressed by the high estrogen. Without FSH, there will be no mature follicles, and hence no ovulation. Without FSH, the hormonal environment does not allow follicles to develop and mature. Thus, the logic of the question is screwy since there would be no mature follicles and no ovulation.)

T/F: The cysts of polycystic ovarian syndrome are derived from ovarian follicles which, after ovulation, enlarge as they accumulate fluid and become cystic.

F (The exocrine pancreas secretes pancreatic juice into the duodenum. It is the ENDOCRINE pancreas that secrete hormones like insulin.)

T/F: The exocrine pancreas secretes the hormone insulin.

F

T/F: The fecal-oral route is the most common mode of transmission for all the hepatitis viruses (A thru E)

T

T/F: The fibrosis of chronic pancreatitis may extend into nearby nerves or organs (such as the duodenum) causing pain or duodenal stenosis

F (The cells of granulomas consist of lymphocytes and macrophages - the latter of which can form other cells, such as epithelioid cells and giant cells).

T/F: The granulomas found in tuberculosis contain several layers of neutrophils and eosinophils surrounding a necrotic center.

T (As we'll see, the granulomas of fungal infections do not show caseous necrosis.)

T/F: The granulomas found in tuberculosis show caseous necrosis at their centers.

T

T/F: The hallmark of hypoparathyroidism is tetany, due to the accompanying hypocalcemia.

F (The head is actually on the far right right of the organ, putting it near the body midline in the epigastric region.)

T/F: The head of the pancreas is located on the far left of the organ, near the spleen in the left hypochondriac region

F

T/F: The highest annual incidence of HCC occurs in the populations of North & Central America.

F (The hilum is on the medial side of each lung and is the area where the LARGE airways (primary bronchi) and blood vessels enter/leave the lung. Thus, in the lungs, hilum is NOT synonymous with apex.)

T/F: The hilum of the lung refers to the superiormost part of the lung, i.e., the lung apex.

F (its testosterone)

T/F: The hormone most important in testicular descent is oxytocin

F (the incidence in reproductive aged women is much higher than this- perhaps as high as one in five women)

T/F: The incidence of endometriosis in reproductive-aged women is less than 2%.

T

T/F: The liver withdraws unconjugated bilirubin from the blood and chemically combines it with a sugar acid to form conjugated bilirubin

F (follicular cysts may cause endometrial hyperplasia if they are secreting lots of estrogen, but the MAIN complication is mild intraperitoneal bleeding and pain.)

T/F: The main complication of follicular cysts is that they cause endometrial hyperplasia.

F (Only 15%- a minority- of AHP cases are idiopathic)

T/F: The majority of cases of AHP are idiopathic

F (Only about 10% of pulmonary emboli cause pulmonary infarcts. This is partly due to the fact that the cells of the airways do gas exchange directly with the air passing by them, and partly due to the fact that the lungs have a secondary blood supply via the bronchial arteries -meaning the pulmonary arteries are not the only source of arterial blood to the lungs.)

T/F: The majority of pulmonary emboli cause pulmonary infarcts.

F (The median age of women diagnosed with CIN is 35 years, but invasive carcinoma doesn't usually follow for another 15 years or so. This gives a woman a decade and a half to be diagnosed and treated before the invasive cancer develops.)

T/F: The median age of women diagnosed with CIN is 35 years, and usually invasive carcinoma develops within 1 or 2 years of this.

F (Mortality rate is 3-4% per year, reaching 50% within 20 or 25 years.)

T/F: The mortality rate of chronic pancreatitis is about 20% per year, reaching about 90% within five years.

F (In fact, cervical cancer mortality rates have been declining, due to better detection -Pap smear- and better treatment options.)

T/F: The mortality rates from cervical cancer have been steadily on the rise over the last 40 years, peaking in 2008 in the US.

F (Asbestos exposure does cause mesothelioma, but it may take 40 years post-exposure for that cancer to develop. Asbestos exposure also causes primary lung cancers, and these might only take 10 years post-exposure to develop. This means that most people with asbestos exposure will die of primary lung cancer before they ever develop mesothelioma.)

T/F: The most common asbestos-related lung cancer is a mesothelioma- cancer of the pleural membrane.

T

T/F: The most common cause of adrenogenital syndrome in adult women is an androgen-producing tumor.

F ( While Klinefelter syndrome may raise estrogen levels and thus lead to gynecomastia, the most common cause is cirrhosis of the liver. Recall that the liver is the main metabolic organ of the body. One of the tasks it is charged with is to metabolize - i.e., degrade- hormones like estrogen. If the liver is sick, it cannot degrade estrogens and thus hyperestrinism may result, leading to gynecomastia. This can clearly be seen on advanced alcoholics- most of them have boob development.)

T/F: The most common cause of gynecomastia is Klinefelter syndrome.

F (Recall that secondary dysmenorrhea is due to a cause other than pelvic congestion, e.g., endometriosis, or fibroids. Prostaglandin overproduction is not the issue in this case.)

T/F: The most common cause of secondary dysmenorrhea is excessive prostaglandin secretion.

F (Endometrioid tumors are for more common than the type II tumors.)

T/F: The most common endometrial adenocarcinoma is a type II tumor.

T

T/F: The most common symptoms of gallstones are biliary colic, obstructive jaundice, and malabsorption of fats

F (Ductal carcinoma is by far the most common cancer of the breast -80%.)

T/F: The most common type of breast carcinoma is lobular carcinoma, followed closely by tubular carcinoma.

F (While I'm not saying these bacteria are never inhaled in air-borne droplets, the most common way S. pneumoniae and S. aureus reach the lungs is by being aspirated. Both are part of the normal oral flora, so simply aspirating oral or pharyngeal secretions brings them directly down to the lungs.)

T/F: The most common way for Streptococcus pneumoniae and Staphylococcus aureus to reach the lungs to cause pneumonia is by being inhaled in air-borne droplets (such as those produced when an infected person coughs or sneezes).

F (Moles are not infectious conditions and don't naturally progress to PID. Complete moles do progress to cancer- to be exact, choriocarcinomas about 2% of the time. Partial moles do not progress to choriocarcinoma.)

T/F: The most important complication of a complete hydatidiform mole is the development of pelvic inflammatory disease.

T (we'll study diabetes in the chapter on Endocrine Pathologies.)

T/F: The most important disease affecting the endocrine pancreas is diabetes mellitus.

T (The average age of diagnosis is 63, with 7-fold more diagnoses at 60 than at 40.)

T/F: The occurrence of endometrial cancer rises with increasing age.

T

T/F: The pain of chronic pancreatitis is usually epigastric and unremitting.

T

T/F: The pancreas is largely is largely retroperitoneal.

F (PTH raises serum calcium levels.)

T/F: The parathyroid glands release parathyroid hormone (PTH), the most important hormone in lowering serum calcium levels.

F (Or more properly, Not Necessarily. She could have a teratocarcinoma, but the most likely reason her hCG is elevated is that she is pregnant.)

T/F: The presence of elevated serum hCG in a woman strongly suggests the presence of ovarian cancer- a teratocarcinoma or one if its derivatives (e.g., choriocarcinoma).

T (hCG in a man is a pretty sure sign that he has testicular cancer.)

T/F: The presence of serum hCG in a man strongly suggests the presence of testicular cancer- a teratocarcinoma or one if its derivatives (e.g., choriocarcinoma).

T (Over 90% of chronic bronchitis cases are attributable to smoking.)

T/F: The primary or initiating factor in the genesis of chronic bronchitis appears to be chronic irritation by inhaled substances such as tobacco smoke.

F (In fact, sarcoidosis is one of the few pulmonary diseases with a higher prevalence in nonsmokers.)

T/F: The primary risk factor for sarcoidosis is cigarette smoking.

T

T/F: The principal signs of primary syphilis are chancres and inguinal lymphadenopathy

T (Simple hyperplasia progresses to cancer ~1% of the time, complex hyperplasia 3%, and complex hyperplasia with atypia 25%.)

T/F: The rate of progression from endometrial hyperplasia to endometrial cancer ranges from about 1% to 25%, depending on the type of hyperplasia.

T

T/F: The right lung is composed of three lobes whereas the left lung is only composed of two lobes.

T (Remember that sine qua non means, 'That without which there is no other', meaning you will not have a pheochromocytoma of any size without elevated E/NE levels.)

T/F: The sine qua non of a pheochromocytoma is the elevated levels of epinephrine and norepinephrine.

F (alcoholism may be a risk factor but that link is not proven. The strongest recognized link is to smoking.)

T/F: The strongest epidemiological link to pancreatic adenocarcinoma is with alcohol abuse.

T (This is because adipose tissue expresses the aromatase enzyme?)

T/F: The term "venereal infection" is a synonym for "sexually transmitted disease".

F (The thick waxy capsule shields M. tuberculosis from PMNs, so the body must use another means to control the bacterium.)

T/F: The thick, waxy capsule of Mycobacterium tuberculosis is very effective at attracting PMNs, which then attack and kill the bacterium.

F

T/F: The three greatest and well-established risk factors for HCC are HAV infection, cigarette smoking, and drug abuse

F (Treatment for endometrial cancer usually necessitates a hysterectomy.)

T/F: The treatment for endometrial cancer usually involves laser ablation or curettage to remove the tumor.

T

T/F: The treatment of existing pulmonary embolism often includes anticoagulation, preceded in some cases by thrombolytic therapy.

T

T/F: The typical treatment for hypercortisolism is resection of a hypersecreting tumor, or cessation of glucocorticoid administration, whichever is appropriate.

T

T/F: There exists a high correlation between HCC and HBV infection

F (treponemes are quite fragile and can be killed by dessication or washing with soap.

T/F: Treponemes are very robust bacteria, and simple hand-washing will not kill them.

T

T/F: Tumors develop more frequently in cryptorchid testes.

F (Tumors in the body and tail of the pancreas tend to invade the celiac plexus, causing pain but not jaundice)

T/F: Tumors in the body and tail tend to obstruct the common bile duct and cause jaundice

F (Tumors in the head of the pancreas tend to obstruct the common bile duct and cause jaundice)

T/F: Tumors in the head of the pancreas tend to invade the celiac plexus, causing pain but not jaundice

F (insulin levels may very well be normal in NIDDM; the problem is that target cells cannot respond properly to insulin, so injecting more insulin will not help. To be more precise, it may help initially, by flooding the body with so much insulin that it overcomes the hyporesponsiveness, but eventually the target cells stop responding to these high insulin levels, at which point further insulin injections will be of little help.)

T/F: Type II diabetes mellitus responds well to a lifetime of insulin injections.

T

T/F: Typical complications of tertiary syphilis affecting the CNS (neurosyphilis) are tabes dorsalis, paralysis, and dementia

F (First, there is no 'typical' therapy for sarcoidosis. We don't know what causes it, and we don't have a universal treatment for it. Although some patients find relief with corticosteroids, it is far from a universal treatment. Since sarcoid does not appear to be an infectious disease, tetracycline would offer little help.)

T/F: Typical therapy for sarcoidosis involves simulataneous administration of tetracycline, 5- aminosalicylate, and corticosteroids.

T (The two most common antecedents to AHP)

T/F: Typically AHP occurs in patients with a history of gallstones or alcoholism

T (but remember that either virus type can cause lesions elsewhere on the body)

T/F: Typically herpes simplex virus (HSV) type I causes cold sores while HSV type II causes genital herpes.

T

T/F: Unconjugated bilirubin is a breakdown product of heme, itself a breakdown product of hemoglobin from RBCs; in normal circumstances, most unconjugated bilirubin is formed by the spleen

F

T/F: Unconjugated bilirubin is quite soluble in aqueous solutions (e.g., blood plasma)

F

T/F: Unconjugated bilirubin is transported by the lymphatic system from the liver to the spleen for further processing

T (This is because adipose tissue expresses the aromatase enzyme.)

T/F: Under certain conditions, adipose tissue can convert androgens into estrogens.

F

T/F: Under conditions of hyperbilirubinemia, both conjugated and unconjugated bilirubins may be excreted in the urine

T

T/F: Unless antibiotic therapy is instituted immediately, Waterhouse-Friderichsen Syndrome may kill within hours to a few days.

T

T/F: Unlike tuberculosis, the granulomas of sarcoidosis are non-caseating; there is usually no necrosis at the granuloma center.

T (the obstruction is, of course, related to prostatic enlargement)

T/F: Urinary tract infections are typically acute and sexually acquired in younger men, but tend to be more chronic and related to urinary tract obstruction in older men

F (This is backwards.)

T/F: Usually with a digital rectal exam (DRE), benign prostatic hyperplasia is more posterior (close to rectum) and thus easily palpable, whereas prostatic adenocarcinoma is more anterior and therefore harder to detect.

F

T/F: Viral hepatitis of any type predisposes to hepatocellular carcinoma

T

T/F: Whatever the ultimate cause, in bronchiectasis the bronchi and bronchioles are filled with thick, mucupurulent secretions that cannot be easily expelled by coughing.

T

T/F: When found, CIN is usually resected via several techniques, incuding laser ablation, cryotherapy, or electrocautery.

F (When matched for stage the prognoses are the same between men and women. But keep in mind that men tend to present at a more advanced stage, so overall the prognosis tends to be worse in men.)

T/F: When matched for stage, men with breast cancer have a much better prognosis than women.

F (Chronic pancreatitis usually presents with epigastric pain as well, sometimes severe)

T/F: While acute pancreatitis usually presents with severe epigastric pain, chronic pancreatitis is usually painless

F (in fact infants are the most susceptible due to their immature immune systems)

T/F: While croup is most prevalent in children, pertussis occurs with highest frequency in the elderly (those over 60 years of age)

F (In men and women, ascending infections predominate- descending -hematogenous- infections are far less common.)

T/F: While most urinary tract infections in women are ascending infections, in males descending infections predominate

T (4-5 weeks were the numbers I gave)

T/F: Whooping cough, unlike the typical common cold, is a prolonged infection that usually takes a month or longer to resolve

F (This progression is much slower, more like 15 to 20 years. This is fortunate, as it provides pleanty of opportunity for detection and treatment.)

T/F: With HPV infections, progression from precancerous lesion to cervical cancer is fairly rapid, typically occurring in two years or less.

F (While some of the five-year survival rates are in excess of 60%, unfortunately Stages III and IV are not.)

T/F: With aggressive treatment, breast cancer patients have 5-year survival rates in excess of 60%, regardless of the stage of the cancer.

F (The hilum is on the medial side of each lung and is the area where the LARGE airways, primary bronchi, and blood vessels enter/leave the lung. The smallest bronchioles and alveoli occur at the periphery of the lung, not centrally on the medial side.)

T/F: Within the lungs the smallest airways occur in the hilar area.

T (the numbers I gave in class were 60%-80% risk for women and about 20% risk for men)

T/F: Women have a considerably higher risk of contracting gonococcal infection from a single act of vaginal intercourse than do men.

____ refers to rectal pressure and discomfort; the ineffectual urge to defecate (when, in fact, there are no feces in the rectum).

Tenesmus.

corpora cavernosa (remember that the spongiosum mainly keeps the urethra open and is not found in the clitoris)

The [corpus spongiosum/ corpora cavernosa/ dartos muscle/ prepuce] is/are primarily responsible for erection of the penis or clitoris

exocrine

The [endocrine / exocrine / proximal / retroperitoneal ] pancreas is responsible for secreting pancreatic juice into the duodenum.

luteal

The [follicular/ luteal/ gestational] phase of the ovarian cycle occurs after ovulation from about days 14 to 28.

follicular

The [follicular/ luteal/ gestational] phase of the ovarian cycle occurs before ovulation from days 1 to about 14.

Mantoux (The question asks about intradermal INJECTIONS, as in hypodermic needles. The heaf and tines test uses small teeth to simply scratch the skin surface, but does not 'inject' PPD into the skin.)

The [heaf & tines/ Mantoux /Ghon] test involves intradermal injection of PPD.

follicular

The [menstrual/ follicular/ proliferative/ secretory] phase is the only phase (of those four) which is not part of the uterine cycle.

mineralocorticoids

The [mineralocorticoids / glucocorticoids/ gonadocorticoids ] are the corticosteroids that help regulate electrolyte balance.

stratum functionalis

The [stratum basalis / stratum functionalis / myometrium] is the portion of the endometrium which is responsive to female sex hormones; every cycle, it proliferates in preparation for implantation, and is shed if conception does not occur

stratum basalis

The [stratum basalis / stratum functionalis/ myometrium] is the persistent portion of the endometrium which is not so responsive to female sex hormones, at least in that it does not undergo the monthly cycles of regeneration and degeneration.

rectouterine pouch; pouch of Douglas.

The _____ , or _____ , refers to the cul-de-sac between the uterus and the rectum; it is often sampled during culdocentesis.

vulva ; pudenda

The _____ / _____ refers to the external female genitalia.

Islets of Langerhans

The _____ are clusters of hormone-secreting cells found in the pancreas; collectively these cells form the endocrine pancreas.

common bile duct (recall that the combining form 'choledoch/o' refers to the common bile duct)

The _____ drains bile from the cystic duct (draining the gallbladder) and the common hepatic duct (draining the liver).

upper respiratory tract

The _____ includes the nose and nasal cavity, paranasal sinuses, pharynx and larynx

vestibule

The _____ is the recess enclosed by the labia minora; 4 structures open into this space: two Bartholin's glands, the vagina, and the urethra.

Sphincter of Oddi (which, in turn, is part of the papilla of Vater)

The _____ is the ring of smooth muscle which controls the release of bile and/or pancreatic juice into the duodenum.

endometrium

The _____ refers to innermost layer of the uterus; a portion of this layer develops during the initial phases of the uterine cycle, and then is shed during menstruation if fertilization has not occurred.

perimetrium

The _____ refers to outermost, serous covering of the uterus.

infundibulum (It is the infundibulum that bears the fimbriae and is responsible for bringing an ovulated oocyte into the uterine tubes.)

The _____ refers to the initial, funnel-shaped portion of the uterine tube which is open to the peritoneal cavity.

myometrium (The muscle found here is, of course, smooth muscle.)

The _____ refers to the middle, muscular layer of the uterus.

hilum (Note that hilar areas are not restricted to the lungs. For example, the kidneys have a hilum on their medial side as well)

The _____ refers to the part or area of an organ where structures such as blood vessels, nerves, bronchi (lungs), and lymphatic vessels enter or leave.

introitus

The _____ refers to the vaginal orifice- the outer or vestibular opening to the vagina.

epiglottis (If you depresses your tongue way down, open your mouth and look in a mirror, you will be able to actually)

The ______________________________ is one of the nine cartilages of the larynx; it is composed of elastic cartilage that folds down and seals off the opening to the larynx when we swallow

Anorchia

The absence of testes in a male

Empyema

The accumulation of pus in a pre-existing body cavity, such as the pleurae, gallbladder, sinuses, etc. Usually in this condition the pus is walled off by the deposition of fibrinous material

Pyothorax

The accumulation of pus in the pleural cavity

medulla

The adrenal _____ is the innermost part of the adrenal gland; it releases the sympathetic hormones epinephrine and norepinephrine.

cortex

The adrenal _____ is the outermost part of the adrenal gland; it releases the adrenal steroid hormones.

E

The adrenal layer that mostly secretes glucocorticoids. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

C

The adrenal layer that mostly secretes gonadocorticoids. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

D

The adrenal layer that mostly secretes mineralocorticoids. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

B

The adrenal region that secretes epinephrine and norepinephrine. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

F

The adrenal region that secretes renin. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

Neisseria gonorrhoeae

The bacterium responsible for gonorrhea

Neisseria gonorrhoeae

The bacterium responsible for gonorrhea.

Chlamydia trachomatis

The bacterium responsible for many cases of cervicitis and non-gonorrheal urethritis; it is an important pathogen causing PID is women, and an important cause of blindness due to eye infections passed from mother to child during delivery.

Chlamydia trachomatis

The bacterium responsible for most cases of non-gonorrheal urethritis

Treponema pallidum

The bacterium responsible for syphilis

Treponema pallidum

The bacterium responsible for syphilis.

mesothelium (Remember, the epithelium that 1- lines the cardiovascular system is endothelium; 2- lines the urinary system is urothelium; and 3- lines the serous membranes -pleurae, peritoneum, pericardium- is mesothelium.)

The cells lining the pleural cavity (as well as the peritoneal and pericardial cavities) are a type of epithelium known as _____.

Dust cells (Alveolar macrophages are a large part of the 'cleanup crew,' mopping up mucus, red blood cells, and other junk that finds its way into the alveolus.)

The cells phagocytize particles in the alveoli, such as red blood cells or inhaled matter

Papillomatosis

The condition of having Papillomas.

Choledocholithiasis

The condition of having gallstones in the common bile duct

Glans

The conical-shaped distal end of the penis

Proliferative fibrocystic change (Papillomatosis and the precancerous condition indicate proliferative fibrocystic changes.)

The development of tubal papillomas in this disorder is considered pre-cancerous and thus unfavorable.

F (Metastatic calcification requires hypercalcemiak which is not the case here)

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) or hemorrhagic (AHP). T/F: Necrotic tissue foci tend to attract calcium and undergo metastatic calcification

T (Specifically, this is Type I diabetes caused by destruction of insulin-secreting beta cells.)

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) or hemorrhagic (AHP). T/F: AHP may result in diabetes mellitus as it destroys islet cells.

T

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) or hemorrhagic (AHP). T/F: If pseudocysts become infected, they may produce abscesses

T

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) or hemorrhagic (AHP). T/F: Peritoneal rigidity signals the onset of peritonitis, which is usually accompanied by paralytic ileus

T (Lipase is the best marker, since salivary glands also produce amylase and may complicate serum amylase analysis)

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) or hemorrhagic (AHP). T/F: Serum tests reveal marked elevation in amylase and lipase levels

T

The following "true or false" statements refer to acute pancreatitis, either edematous (AEP) orhemorrhagic (AHP). T/F: Chemical peritonitis is a potential complication of AHP

C (Bronchiectasis. Note: If this question appears on the exam, I will probably change it from bronchiectasis to another disease, probably one of the other listed disorders. Be sure you can distinguish these disorders based upon their symptoms.

The following pathological changes and symptoms are associated with a certain lung disease: • The bronchi are dilated • The dilated bronchi and bronchioli are filled with mucopurulent material • Patient presents with a severe, persistent cough, expectorating foul-smelling, sometimes bloody, sputum • Patient presents with dyspnea and orthopnea What is that lung disease? A. Asthma B. Chronic bronchitis C. Bronchiectasis D. Emphysema E. Pulmonary tuberculosis F. Pulmonary hypertension G. Sarcoidosis

A (Yes. Bronchiectasis is a COPD, as are chronic bronchitis, asthma, and emphysema. Note that if I change this question to another disease, that disease may or may not be a COPD, so don't just memorize 'yes'. For example, TB is not a COPD, nor is sarcoidosis.)

The following pathological changes and symptoms are associated with a certain lung disease: • The bronchi are dilated • The dilated bronchi and bronchioli are filled with mucopurulent material • Patient presents with a severe, persistent cough, expectorating foul-smelling, sometimes bloody, sputum • Patient presents with dyspnea and orthopnea Would a person with this condition be described as having COPD? A. Yes B. No C. Only during full moons

Prepuce

The foreskin; a loose cuff of skin that covers the distal penis

C (Yes, the glottis is not a physical structure but an airspace.)

The glottis is... A. ...the soft tissue surrounding each vocal cord B. ...the connective tissue binding the laryngeal cartilages together C. ...the airspace between the vocal cords D. (None of the above)

Erectile dysfunction

The inability of a male to achieve or maintain an erection sufficient for satisfactory sexual performance

C

The innermost layer of the adrenal cortex. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

E

The layer of the adrenal cortex that is most strongly stimulated by ACTH. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

E

The middle layer of the adrenal cortex. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

F (95% of ectopic pregnancies are tubal pregnancies- implantation in the fallopian tubes.)

The most common place for an ectopic pregnancy is on the ovaries themselves.

B (Infertility)

The most important complication of endometriosis is: A. Vaginal bleeding B. Infertility C. Pelvic inflammatory disease D. Polycystic ovarian syndrome E. Malignant transformation: Endometrial cancer F. Malignant transformation: Cervical cancer

D

The outermost layer of the adrenal cortex. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

Endometriosis

The presence of endometrial glands and stroma outside the uterus

Adenomyosis

The presence of endometrial glands and stroma within the myometrium

Monorchism

The presence of only one testis in a male

Polyorchidism

The presence of three or more testes in a male

A

The region of the adrenal cortex that secretes the corticosteroids. A. adrenal cortex B. adrenal medulla C. zona reticularis D. zona glomerulosa E. zona fasciculata F. (none of the above applies)

Bartholin's (Their counterpart in the male is Cowper's glands)

The secretions of the two _____ glands keep the vestibule moist and lubricated.

Basal cells (It is from these cells that we can regenerate lost epithelium in our respiratory tract.)

The stem cells of the respiratory epithelium, capable of replacing other cells that have been lost

gonocyte

The term _____ refers to a cell that produces gametes- either an oocyte or a spermatocyte.

Urethra

The terminal tube of the male reproductive system; ends with the urinary meatus at the tip of the penis

Metaplasia

The transformation of one mature tissue type into another. For example, columnar epithelium changing to squamous epithelium.

Cystic follicles

The umbrella term for follicular and luteal cysts.

Type I pneumocytes (Type I pneumonocytes are also the cells that are so severely damaged in ARDS, which we discuss in this chapter.)

These cells form the bulk of the alveolar wall

Neuroendocrine cells (When transformed, these cells can produce an aggressive cancer known as a small-cell carcinoma, which frequently shows paraneoplastic activity.)

These cells release chemical messengers (small molecules) that help regulate the other cells in the airway/alveolar walls

Type II pneumocytes (Recall that the type II pneumocytes mature rather late in a pregnancy, so premature babies are at risk of having insufficient surfactant due to lack of mature type I pneumocytes. This is the basis for Respiratory Disease of the Newborn. Recall also that cortisol increases type I pneumocyte activity, while insulin suppresses it.)

These cells secrete surfactant, which decreases the surface tension of the thin layer of fluid in the alveoli

Proliferative fibrocystic change (Atypia and the precancerous condition equates to proliferative fibrocystic changes.)

This condition may show epithelial hyperplasia with atypia, a definite pre-cancerous development.

Fibrocystic changes (general) (Since proliferation is not in consideration here, this must be referring to fibrocystic changes in general)

This disorder is marked by cystic dilations of terminal ducts and relative increase in stroma, with or without proliferation of ductal epithelium.

Jaundice of choldecholithiasis

This jaundice is usually accompanied by biliary colic

Jaundice of portal cirrhosis

This jaundice is usually mild but persistent

Jaundice of viral hepatitis

This jaundice is usually short-lived and resolves on its own

Jaundice of primary biliary cirrhosis

This jaundice, caused by immune destruction of the bile ducts, may be mild or severe; if the latter, an unfavorable outcome is predicted

Bordetella pertussis

This pathogen causes whooping cough

Respiratory syncytial virus

This pathogen is a common cause of bronchiolitis in children

Haemophilus influenzae

This pathogen is a common cause of epiglottitis in school children and adolescents

Proliferative fibrocystic change (Precancerous equates to proliferative fibrocystic change)

This pre-cancerous condition is often treated with surgical resection of the affected tissue.

Nonproliferative fibrocystic change (Not precancerous, no atypia, no proliferation = nonproliferative fibrocystic change.)

This specific disorder involves cystic dilation of the terminal ducts and stromal expansion but without proliferation of the ductal epithelium or atypia; this condition is not pre-cancerous

Proliferative fibrocystic change (Since this specific condition is precancerous it must be referring to proliferative fibrocystic changes.)

This specific disorder involves hyperplasia of the ductal epithelium in a context of cystic dilation of the terminal ducts and stromal expansion; this condition is pre-cancerous

A fungal infection of the mouth, throat, or esophagus caused by the fungus C. albicans.

Thrush

Aka "candidiasis"

Thrush

Treatment includes antifungals and perhaps unsweetened yogurt with live cultures

Thrush

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) As the cysts develop, renal parenchyma disappears until renal failure sets in

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Both kidneys are affected and contain numerous cysts

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Many patients with polycystic kidney disease remain asymptomatic for years

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Many polycystic kidney patients also have extrarenal anomalies, such as liver cysts or mitral valve prolapse

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Patients of advanced polycystic kidney disease may have to rely on dialysis or renal transplantation

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Polycystic kidney patients often survive for years with azotemia slowly progressing to uremia and kidney failure

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Typical age of onset of ADPKD cysts is during the second decade of life

True

(Indicate T/F in regards to ADPKD (polycyctic kidney disease) Usually the initial symptom of ADPKD is hematuria, followed by other signs of renal insufficiency (proteinuria, etc.)

True

(Indicate T/F regarding end stage glomerulpathy (ESG) ESG is relentlessly progressive and eventually dialysis or renal transplantation is required to maintain life

True

(Indicate T/F regarding end stage glomerulpathy (ESG) In ESG, the kidneys appear finely granular, the granules being what's left of the functional tubules

True

(Indicate T/F regarding end stage glomerulpathy (ESG) In ESG, the kidneys appear symmetrically shrunken

True

(Indicate T/F regarding end stage glomerulpathy (ESG) Several kidney conditions can lead to ESG

True

(Indicate T/F regarding end stage glomerulpathy (ESG) Symptoms of ESG range from such nonspecific symptoms as loss of appetite, anemia, vomiting, fatigue and weakness, to more specific symptoms/findings such as proteinuria, hypertension, azotemia, or edema

True

(Indicate T/F regarding membranous glomerulopathy (MG) About 40% of patients eventually develop renal insufficiency & ~10% die of renal failure within 10 yrs

True

(Indicate T/F regarding membranous glomerulopathy (MG) As MG advances, the thickened glomerular membranes may encroach into the capillary lumen, resulting in glomerular sclerosis, which may eventually progress to kidney failure

True

(Indicate T/F regarding membranous glomerulopathy (MG) In MG, the glomeruli have thickened basement membranes due to the dense deposition of immune complexes

True

(Indicate T/F regarding membranous glomerulopathy (MG) In MG, the leakiness of the glomerular capillary wall probably stems from initial fixation of complement proteins

True

(Indicate T/F regarding membranous glomerulopathy (MG) MG is an immune-mediated condition

True

(Indicate T/F regarding membranous glomerulopathy (MG) Progression in MG is associated with rising BUN reflecting renal insufficiency, and development of hypertension

True

(Indicate T/F regarding membranous glomerulopathy (MG) The proteinuria of MG is nonselective and does not usually respond well to corticosteroid therapy

True

The most common pathogens causing suppurative bacterial sialadenitis are Staphylococcus and Streptococcus.

True

(Indicate T/F regarding membranous glomerulopathy (MG) MG presents with the typical symptoms of nephrotic syndrome

True (True but MG is not an inflammatory condition)

(Indicate T/F regarding membranous glomerulopathy (MG) In MG, the urine is devoid of RBCs (no hematuria) and inflammatory cells

True (this means that all the plasma proteins appear in the urine, not just some of them)

Ejaculatory duct

Tube of the male reproductive system extending from seminal vesicle to prostate gland

These casts include tubular epithelial cells and usually indicate tubular necrosis

Tubular Cell Cast

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Results in "pseudopolyposis" of the affected regions of the colon.

U

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): Tends to start in the anorectum and develop proximally.

U

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): The inflammation is usually limited to the mucosa.

U

Crohn's ("C"), ulcerative colitis ("U"), or both ("B"): The lesions are diffuse, and more severe distally.

U

A superficial inflammation of the colon and rectum characterized by chronic diarrhea and rectal bleeding, with a pattern of exacerbation and remission.

Ulcerative colitis

The condition of having urinary stones

Urolithiasis

E

Usually treated with penicillin or erythromycin A) Coccidioidomycosis B) Histoplasmosis C) Aspergillosis D) All (A, B, and C) E) None of these diseases

Dysfunctional uterine bleeding

Uterine bleeding due to a functional, or hormonal, cause; anovulatory cycles are a common source of this condition

Chocolate cysts

Uterine tissue growing on the ovaries (i.e., endometriosis) that becomes hemorrhagic and cystic, expanding and filling with a brownish fluid that is mostly decomposed blood

_____ are finger-like projections into the small intestine lumen which greatly increase the surface area of the intestinal lining; these projections, each about 1 mm long, contain capillaries and lymphatic vessels.

Villi.

C. albicans (Chlamydia albicans)

Vulvovaginitis accompanied by a curd-like vaginal discharge (lacking clue cells) is typical of infection by [ C. albicans / C. trachomatis / T. vaginalis / G. vaginalis ].

These casts usually indicate an infection, often pyelonephritis

WBC Cast

List three symptoms of advanced gastric adenocarcinoma.

Weight loss; Anorexia; Changes in bowel habits; Anemia; Bleeding; Gastralgia

A primary, malignant tumor of the lining of the serous cavities (pleura, peritoneum, pericardium, or tunica vaginalis. Pleural and peritoneal mesotheliomas are found almost exclusively in people exposed to asbestos)

What is a mesothelioma?

Bronchiectasis is a permanent dilatation of the bronchi. It is the most common complication of chronic bronchitis. Bronchiectasis is caused by persistent inflammation, where the larger bronchi show saccular dilatation and fill with stagnant mucopurulent exudates.

What is bronchiectasis, and how does it develop?

B (Without these rings, our trachea would collapse when we inhaled- which would NOT have survival value!)

What is the function of the cartilaginous rings in the trachea and bronchi? A. They direct airflow B. They keep the airways patent (open) C. They contain the respiratory alveoli D. They attach the airways to the surrounding mediastinum

Severe, persistent, paroxysmal cough with expectoration of foul-smelling, sometimes bloody, sputum

What is the most common symptom of bronchiectasis?

hCG (human chorionic gonadotropin)

When Doris missed her period, her doctor checked Doris' urine for the presence of [LH / hCG / FSH / estrogen / GH] to see if she was pregnant.

egophony (or e-to-a transition)

When auscultating over consolidated lung tissue, with [egophony / tactile fremitus / whispered / pectoriloqui / percussion], the patient says 'e' but the auscultator hears a higher pitched 'a' sound in her stethoscope.

whispered pectoriloqui

When auscultating over consolidated lung tissue, with [egophony / tactile fremitus / whispered / pectoriloqui / percussion], the patient speaks very softly but the auscultator hears the patient loud and clear in her stethoscope.

D

Which ONE of the following best describes the cause of hepatic encephalopathy (HE)? A. HE is due to infiltration of CNS tissue by hepatic macrophages (Kupffer cells), causing inflammation and brain cell necrosis B. HE is caused by hepatocytes which die and release neurotoxic compounds in the blood C. HE is caused by abnormal liver proteins which erode the blood-brain barrier and result in massive overstimulation of CNS neurons D. HE occurs when toxins in the portal blood are not removed (due to a failing liver) or bypass the liver altogether (via opened portal-systemic anastomoses); such toxins enter the systemic circulation and cause cerebral dysfunction E. (None. None of the above describe the cause of hepatic encephalopathy)

C

Which ONE of the following best describes the difference between portal and biliary cirrhosis? A. Portal cirrhosis is limited to the portal triads/liver lobules, while biliary cirrhosis is limited to the extrahepatic biliary tree B. Portal cirrhosis is limited to the portal triads/liver lobules, while biliary cirrhosis is limited to the intrahepatic biliary tree C. Portal cirrhosis develops via necrosis and fibrotic ingrowth from the portal tracts (triads), while biliary cirrhosis develops as a result of the hepatotoxic effects of backed-up bile when bile outflow becomes obstructed D. (None. None of the above describes the process difference between portal and biliary cirrhosis)

B

Which ONE of the following best describes the process/progression of cirrhosis? A. The liver initially swells from inflammatory infiltration, and then becomes homogenously fibrotic as fibroblasts replace the liver stroma and parenchyma B. Parenchymal losses—liver cell necrosis—are replaced by fibrous scars, which eventually limit regeneration to unorganized islands ("nodules") of hepatocytes surrounded and restricted by fibrous tissue C. Inflammatory infiltrates gradually pervade the liver, transforming it into a firm, heavy mass with concomitant loss of liver function D. (None. None of the above describes the process/progression of cirrhosis)

E

Which ONE of the following does NOT describe pathological changes typically seen in acute viral hepatitis? A. Irreversible hepatocellular changes; as hepatocytes become necrotic, they lose their nuclei and become transformed into round, anuclear, cytoplasmic fragments B. Reversible hepatocellular changes, such as the cytoplasm becoming granular and vacuolated C. Inflammatory infiltrates; damaged and dead liver cells are phagocytized by macrophages that invade the liver lobule, and native liver macrophages (Kupffer cells) also proliferate D. Regeneration of hepatocytes; however, as liver cells regenerate, they do so at random and do not rebuild the typical liver architecture E. (None. All of the above are typical pathological changes seen in acute viral hepatitis)

A (CCK is released by the duodenum in response to the entry of fats and proteins from the stomach)

Which ONE of the following hormones causes the pancreatic acinar cells to release an enzymerich fluid? A. Cholecystokinin B. Secretin C. Gastrin D. VIP (vasoactive intestinal peptide) E. Epinephrine F. None of the above hormones has any significant effect on the pancreas

B (Secretin is released by the duodenum in response to HCl in the duodenum)

Which ONE of the following hormones causes the pancreatic ductal cells to release a bicarbonate-rich fluid? A. Cholecystokinin B. Secretin C. Gastrin D. VIP (vasoactive intestinal peptide) E. Epinephrine F. None of the above hormones has any significant effect on the pancreas

F (Altho IDDM has a predilection for younger individuals, it can -and does- appear at any age, even in the elderly.)

Which ONE of the following is NOT TRUE of Type I diabetes mellitus (IDDM)? A. IDDM is the less common form of diabetes mellitus B. IDDM appears to be an autoimmune disease and is characterized by loss of insulin-secreting beta cells in the pancreas C. Blood insulin levels are typically quite low in IDDM individuals D. IDDM can be managed with life-long insulin injections E. IDDM is also known as juvenile onset diabetes F. IDDM is only found in juveniles G. (None, i.e., all of the above are true of Type I diabetes mellitus)

B (Remember that insulin only affects the up-regulation of the GLUT4 glucose transporter; cells -such as brain cells- that use other GLUT transporters will not respond to insulin under any circumstances. This makes sense, since brain cells need constant access to glucose, and could not tolerate having access at some times -high insulin- and not at other times -low insulin- to blood glucose.)

Which ONE of the following is NOT TRUE of Type II diabetes mellitus (NIDDM)? A. NIDDM is the more common form of diabetes mellitus B. The insulin hyporesponsiveness of NIDDM extends to all cells in the body; all cells are essentially starved for glucose C. NIDDM may involve problems with the insulin receptors themselves, or perhaps with intracellular processes occurring after receptor activation D. Because of insulin hyporesponsiveness, target cells cannot respond properlyto insulin and internalize glucose E. NIDDM involves insulin resistance: target cells do not respond adequately to insulin F. In NIDDM, target cells are effectively starved for glucose even tho blood levels of glucose are high G. NIDDM responds well to dietary restriction and exercise H. (None, i.e., all of the above are true of Type II diabetes mellitus)

H (These all pertain to ARDS. In fact, this is how ARDS develops, and does its damage to the lungs)

Which ONE of the following is NOT TRUE of acute respiratory distress syndrome (ARDS)? A. Alveolar macrophages and other cells releases cytokines, which are chemotactic to PMNs B. Attracted by the cytokines, PMNs immigrate into the alveolar lumen C. Capillary damage causes leakage of a protein-rich exudate producing hyaline membranes and pulmonary edema D. PMNs damage type I and II pneumocytes, and many disappear E. Decrease in surfactant causes atelectasis with intrapulmonary shunting F. All of the abovementioned events impair gas exchange, resulting in hypoxia, hypercapnea, and acute respiratory acidosis G. The disrupted pulmonary blood circulation strains the heart and patients die of cardiopulmonary failure H. (None. All of the above pertain to ARDS)

D

Which ONE of the following is NOT TRUE of acute viral hepatitis (AVH)? A. AVH is the most prevalent liver disease in the world B. AVH is often asymptomatic C. Many Americans have been exposed to the virus, as evidenced by circulating anti-viral antibodies, and yet have no recollection of ever having the disease D. "Acute viral hepatitis"—as defined in clinical practice—can be caused by any of 5 hepatotropic viruses, as well as a collection of other viruses such as herpesvirus and cytomegalovirus E. (None. All of the above are consistent with acute viral hepatitis)

D (Bronchopneumonia DOES cause fluid exudation and lung consolidation and it is usually caused by bacteria. Inflammation of just the alveolar septa is interstitial -not broncho- pneumonia, which is typically caused by viruses or by Mycoplasma.)

Which ONE of the following is NOT TRUE of bronchial pneumonia (bronchopneumonia)? A. It is an alveolar pneumonia involving scattered foci of infection either within a lobe or within several lobes B. It is usually of bacterial origin C. It may progress to chronic pneumonia if not completely cured D. It typically involves inflammation of the alveolar septa without fluid exudation and lung consolidation

F (Endometriosis rarely progresses to cancer.)

Which ONE of the following is NOT TRUE of endometriosis? A. Endometrial lesions expand with the menstrual cycle B. Because endometriallesions are infiltrated with blood at the time of menstruation, they often cause peritoneal irritation and pain C. Ovarian endometriosis may present with relatively large cystic lesions D. Ovarian cysts due to endometriosis are filled with a brownish fluid that is primarily decomposing blood E. Ovarian cysts due to endometriosis are often referred to as "chocolate cysts" F. Ovarian cysts due to endometriosis are pre-cancerous and usually progress to surface epithelial cancer of the ovaries G. (None. All of the above are true of endometriosis)

B (Most pancreatic tumors arise not in the endocrine pancreas but in the exocrine pancreas- from ductal cells, to be exact.)

Which ONE of the following is NOT TRUE of most (95%) pancreatic tumors? A. They are adenocarcinomas B. They are derived from islet cells C. They are solid, not cystic D. They are functionally silent, secreting neither hormones nor enzymes E. (None- all of the above are true of most pancreatic tumors)

F (In humans corpora lutea are not found during the follicular phase- they don't form until after ovulation.)

Which ONE of the following is NOT TRUE of the follicular phase of the ovarian cycle? A. The follicular phase is dominated by the presence of maturing follicles. B. The follicular phase is brought to an end by a surge of pituitary LH, which causes ovulation. C. The follicular phase is dominated by large amounts of estrogen. D. The follicular phase lacks any significant amount of progesterone. E. During the follicular phase, follicles develop, in part, because of the presence of FSH. F. During the follicular phase, the corpus luteum releases large amounts of sex hormones. G. (None. All of the above are true of the follicular phase of the ovarian cycle).

C (The pituitary gland does indeed release gonadotropins- FSH and LH, to be exact- but human chorionic gonadotropin is a placental hormone. So hCG does not maintain the placenta, it is a product of the placenta.)

Which ONE of the following is NOT TRUE of the hormonal secretions from the anterior pituitary that are involved in reproductive physiology? A. An LH surge induces ovulation at about mid-cycle. B. LH also promotes luteinization. C. Human chorionic gonadotropin maintains the placenta. D. Every cycle, FSH selects primordial follicles for maturation. E. Both LH and FSH are inhibited by progesterone (negative feedback). F. (None. All of the above are true regarding anterior pituitary reproductive hormones).

G (All choices are true of the luteal phase.)

Which ONE of the following is NOT TRUE of the luteal phase of the ovarian cycle? A. The luteal phase is dominated by the presence of the corpus luteum. B. The luteal phase is brought to an end by the degeneration of the corpus lutem. C. The luteal phase is dominated by large amounts of progesterone and estrogen as well. D. The luteal phase lacks developing follicles. E. The luteal phase begins at ovulation. F. During the luteal phase, the corpus luteum releases large amounts of sex hormones. G. (None. All of the above are true of the luteal phase of the ovarian cycle).

E (they are all true of the menstrual phase of the uterine cycle)

Which ONE of the following is NOT TRUE of the menstrual phase of the uterine cycle? A. The menstrual phase occurs from days 1-5 of the uterine cycle. B. The menstrual phase occurs when FSH and LH reach minimum levels, so that there is no significant follicular development in the ovaries (and hence little estrogen and no progesterone). C. Because of the lack of estrogen and progesterone support during the menstrual phase, the endometrium is shed; menstruation occurs. D. During the menstrual phase, endometrial tissue is not growing and proliferating. E. (None. All of the above are true of the menstrual phase of the uterine cycle).

F (The proliferative phase of the uterine cycle co-occurs with the follicular phase of the ovaries- a time when estrogen abounds but no progesterone.)

Which ONE of the following is NOT TRUE of the proliferative phase of the uterine cycle? A. The proliferative phase occurs from days 6-14 of the uterine cycle. B. The proliferative phase occurs before ovulation, and hence is also known as the preovulatory phase. C. The proliferative phase is marked by rising estrogen levels from developing follicles in the ovary. D. During the proliferative phase, endometrial tissue is growing and proliferating (hence the name). E. During the proliferative phase, estrogen causes endometrial tissue to express progesterone receptors. F. During the proliferative phase, estrogen & progesterone team up to cause proliferation of endometrial tissue. G. (None. All of the above are true of the proliferative phase of the uterine cycle).

F (The secretory phase of the uterine cycles co-occurs with the luteal phase of the ovarian cycle- a time of high estrogen and progesterone. Those two hormones, through negative feedback, act to suppress the release of gonadotropins from the anterior pituitary. Thus, during this period, LH and FSH levels are low, not high.)

Which ONE of the following is NOT TRUE of the secretory phase of the uterine cycle? A. The secretory phase occurs from days 15-28 of the uterine cycle. B. The secretory phase occurs after ovulation, and hence is also known as the postovulatory phase. C. The secretory phase is marked by high progesterone (and moderate estrogen) levels from the corpus luteum. D. During the secretory phase, endometrial tissue is swelling and preparing for implantation. E. During the secretory phase, progesterone causes the endometrium to secrete glycogen to sustain the embryo (and hence the name "secretory"). F. During the secretory phase, the anterior pituitary is secreting high levels of LH and FSH. G. (None. All of the above are true of the secretory phase of the uterine cycle).

F (Responses A-E are all true- this question should be a give-away!)

Which ONE of the following is NOT TRUE of upper respiratory tract infections? A. They usually are caused by viruses and clear spontaneously in about a week B. The upper respiratory tract mucosa is typically edematous and inflamed C. Classic symptoms include rhinorrhea, dysphagia, and a hacking cough D. Malaise and pyrexia are also symptoms E. The appearance of purulent discharges or deep throat expectoration is usually a sign of bacterial superinfection F. (None, Mr. Silly! All of the above are true regarding URIs! Haven't you ever had a cold?)

E (Viral pneumonias may cause extensive wall damage, but antibiotic treatment would be of little value to fight viruses - however, antibiotics may be useful to fight a secondary bacterial superinfection, but that is not the question here.)

Which ONE of the following is NOT TRUE of viral pneumonia? A. Viral pneumonia primarily affects the alveolar septa, giving rise to the term "interstitial pneumonia" B. Viral pneumonia does not result in exudation of PMNs into the alveolar lumen C. Instead, in viral pneumonia, the pathogens cause cell necrosis and induce an infiltrate predominately restricted to the alveolar septa D. Because fluids are not filling the alveolar lumina, major consolidations are not typically seen E. Most viral pneumonias cause extensive and permanent alveolar wall damage and require antibiotic treatment for resolution F. (None. All of the above are true regarding viral pneumonia)

A (Intestinal adenocarcinoma occurs about 50x more frequently in the large intestine, and 1/3 of these cases occur in the sigmoid or rectal region)

Which ONE of the following is NOT TRUE regarding adenocarcinoma of the intestine? A. Intestinal adenocarcinoma occurs about 50x more frequently in the ileum than in other parts of the large or small intestine B. Adenocarcinomas of the right colon tend to be clinically silent, producing only nonspecific signs such as weakness and fatigue C. Adenocarcinomas of the left colon tend to narrow and obstruct the passage of feces, characteristically resulting in pencil feces as well as occult or even frank bleeding D. Adenocarcinoma may occur in the small or large intestine E. (None. All of the above are true regarding intestinal adenocarcinoma)

D (Asthma does have an inflammatory component -eosinophils- but it is not a disease involving bacterial colonization -at least not in pure asthma.)

Which ONE of the following is NOT TRUE regarding asthma? A. Asthma is probably caused by a persistent inflammation of the bronchial mucosa B. The triggers for asthmatic attacks may include extrinsic allergens such as pollen or intrinsic factors such as exercise or exposure to cold C. The majority of cases of asthma begin in childhood, with some 10% of children in the US being affected D. Asthma is an inflammatory disorder, and is almost always accompanied by purulent bacterial colonization of the alveolar space E. Asthma is an inflammatory disorder, and its symptoms seem to arise from the effects of paracrine agents released by inflammatory cells

B (Bronchiectasis is not a disease of faulty collagen; it is a disease of permanent airway dilatation -due to enzymatic digestion of airway walls- and secretion of thick, mucopurulent material into the bronchi and bronchioles.)

Which ONE of the following is NOT TRUE regarding bronchiectasis? A. Enzymes released from bacteria and leukocytes weaken airway walls, allowing them to more easily expand B. Faulty collagen leads to weak walls with little strength C. Mechanical pressure from the inside, exerted by bronchial contents, tend to 'push' on the airways from within, and causing them to expand D. Traction of the fibrous scars tend to 'pull' on the airways from outside and causing them to expand E. Bronchiectasis may arise from bronchial obstructions, which then lead to inflammation and infection in the distal airways F. Bronchiectasis may arise from bronchial inflammation and infection, which then leads to necrosis, fibrosis, and eventual dilatation of the airways G. (None. All of the above are true of bronchiectasis)

A

Which ONE of the following is NOT TRUE regarding cholelithiasis and gallstones? A. Pigmentary stones are far more common than cholesterol stones B. Cholesterol stones form in bile that is supersaturated with cholesterol and, at the same time, contains decreased amounts of bile salts (bile acids) and lecithin C. Estrogen and pregnancy promote gallstone formation D. Cholesterol stones are hard, almost crystalline concretions of cholesterol, and have a yellowish appearance E. Pigmentary stones are composed of calcium bilirubinate and other compounds, and appear dark in color (sometimes jet black) F. Risk factors for the development of cholesterol stones are the "4 F's": Female, over Forty, Fertile & Fat G. (None. All of the above are true regarding cholelithiasis and gallstones)

G (Herpes infections cannot be cured; the antivirals work to lessen the symptoms but do not cure.)

Which ONE of the following is NOT TRUE regarding herpesvirus, its infection, or its treatment? A. Typically, HSV type 2 causes genital herpes B. Both type 1 and type 2 herpesvirus invade the skin and mucosal cells, producing vesicles filled with clear fluid C. Herpes of the eye typically presents as blepharoconjunctivitis or conjunctivitis rather than uveitis or iriditis. D. In its latent phase, the herpesvirus may spend years, even decades, dormant in certain nerves. E. In addition to herpetic vesicles, women often experience additional symptoms of herpesvirus infection such as cervicitis and dysuria F. Pain, itching, or burning sensations are common with herpesvirus infections G. Herpesvirus infections can be cured with antivirals such as acyclovir and famcyclovir H. (None. All of the above are true regarding herpesvirus, its infection, or its treatment)

C (Trypsin is a protease, so instead of causing fat autodigestion it causes protein digestion and overall tissue necrosis.)

Which ONE of the following is NOT TRUE regarding pancreatic autodigestion? A. Regardless of the precipitating cause of acute pancreatitis, tissue damage occurs and is always caused by pancreatic digestive enzymes B. Elastase (chymotrypsin) acts on elastic tissue causing large gaps in the blood vessel walls and massive hemorrhage C. Activation of the proenzyme trypsinogen to trypsin leads to fat autodigestion and fat necrosis D. Premature activation of lipase leads to fat necrosis in and around the pancreas E. (None- all of the above are true regarding pancreatic autodigestion)

D (PID does increase the risk of ectopic pregnancy. Scar tissue in the fallopian tubes may entrap the conceptus, resulting in a tubal pregnancy.)

Which ONE of the following is NOT TRUE regarding pelvic inflammatory disease (PID)? A. PID occurs when pathogens ascend into the uterine cavity B. Typical symptoms of PID include severe lower abdominal pain, fever, nausea, and vaginal discharge or bleeding C. PID predisposes the fallopian tubes to scarring and obstruction, which may lead to infertility D. Although PID may lead to infertility, it does not increase a woman's risk of ectopic pregnancy. E. PID is the most important complication of all lower genital tract infections F. In PID, the fallopian tubes bear the brunt of the infection (i.e., salpingitis) G. Another potential complication of PID is peritonitis H. (None. All of the above are true regarding PID)

F (They are all true. Lots of pathogens can cause pneumonia, and many/most of them are bacterial.)

Which ONE of the following is NOT TRUE regarding pneumonia? A. About 75% of pneumonias are caused by bacteria B. Other causative agents include viruses, fungi, protozoa, or parasites C. Normal upper respiratory tract bacteria, such as Staphylococcus or Streptococcus, may cause pneumonia if they reach the lungs D. Enteric bacteria, such as E. coli, may cause pneumonia if they reach the lungs, e.g., by the hematogenous route E. Some airborne bacteria, such as Legionella, can cause pneumonia if inhaled F. (None. All of the above are true of pneumonia)

E (This sentence has both true and false elements -but overall it is false. M. tuberculosis is an obligate aerobe, and oxygen concentrations are lowest in the lower and outer parts of the lung, but that is not the preferred location for this bacterium to grow. M. tuberculosis will seek out HIGHER oxygen levels, which are up toward the lung apex where bronchioles are shorter and air mixing is better, resulting in higher oxygen levels.)

Which ONE of the following is NOT TRUE regarding pulmonary tuberculosis? A. Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. B. M. tuberculosis has a thick, waxy capsule; it does not attract PMNs nor does it cause purulent lesions. C. M. tuberculosis elicits the formation of granulomas, which are composed of lymphocytes and macrophages, epithelioid and giant cells, all organized around a center of caseous necrosis. D. Primary tuberculosis generally produces localized lesions known as Ghon complexes, which usually heal spontaneously after undergoing calcification. E. On secondary activation, M. tuberculosis, being an obligate aerobe, tends to grow in the lower lateral parts of the lung, where oxygen concentration is lowest. F. Healed and calcified Gohn complexes are easily visible on chest x-rays.

D (surface epithelial tumors are almost all adenomas or adenocarcinomas.)

Which ONE of the following is NOT TRUE regarding surface epithelial tumors of the ovary? A. It seems that surface epithelium tumors are related to the fact that, each cycle, the ovarian epithelium is ruptured and then heals as a result of each ovulation. B. Women who do not ovulate- as in Turner syndrome- do not develop ovarian cancer. C. Oral contraceptives, which suppress ovulation, also reduce the incidence of ovarian cancer D. Surface epithelial tumors of the ovary are almost all squamous cell carcinomas E. (None. All of the above are true regarding surface epithelial tumors of the ovary)

D (There is no direct link between cirrhosis per se and acute pancreatitis)

Which ONE of the following is NOT TRUE regarding the causes of acute pancreatitis? A. If gallstones block the papilla of Vater, bile reflux into the pancreas could result in autodigestion B. Obstruction of the main pancreatic duct is a potentially important cause of pancreatitis C. Mechanical disruption of pancreatic cells followed by acute pancreatitis can develop in patients after abdominal trauma D. Portal cirrhosis and unconjugated hyperbilirubinemia cause acute pancreatitis by prematurely activating pancreatic proenzymes E. An increased incidence of pancreatitis is seen in alcoholics, though the mechanism is unclear F. Overstimulation of pancreatic cells by secretin could be the cause of pancreatitis after repeated indulgence in fatty foods G. (None- all of the above are true regarding the causes of acute pancreatitis)

D (Granulosa cells do indeed convert testosterone into estradiol, but the enzyme to accomplish this -oxidoreductase- is put into the granulose cells by FSH not LH. LH puts aromatase into the thecal cells to convert cholesterol into androgens)

Which ONE of the following is NOT TRUE regarding the production of steroid hormones in follicular and adipose cells? A. Stimulated by LH, thecal cells convert cholesterol into the 17-keto steroids DHEA and androstenedione B. Stimulated by LH, thecal cells convert DHEA and androstenedione into testosterone C. In thecal cells, LH stimulates the production of the enzyme oxidoreductase D. Stimulated by LH, granulosa cells convert testosterone into estradiol, a strong estrogen E. The enzyme that converts testosterone into estradiol is known as aromatase F. Fat cells also contain aromatase, and thus adipose tissue can be a significant source of estrogen in overweight women suffering from high androgen levels G. (None, i.e., all of the above are true of the production of steroid hormones in follicular and adipose cells)

F (In class we discussed false positives and false negatives to these tests. Also, let me re-iterate that in your studying, it is not good study policy to just memorize the wrong answers -such as F here- to the multiple choice questions- that amounts to pattern memorization; on the exam, I will make changes to discourage pattern memorization. For example, on this question, imagine I drop F and switch 'Mantoux' with 'heaf and tine' in E; the correct response -the incorrect statement- would now be E. Or imagine that I simply drop response F; now there are no incorrect statements , and response G is correct. You'll have a much easier time navigating such changes if you understand why the various responses are correct or incorrect, rather than just memorizing the correct response be it the single true or the single false statement among the group.)

Which ONE of the following is NOT TRUE regarding tuberculin and TB skin tests? A. Tuberculin is an extract of Mycobacterium species, usually M. tuberculosis. B. Purified protein derivative (PPD) is one example of tuberculin C. A skin test wherein PPD is injected intradermally is known as the Mantoux test D. A skin test wherein PPD is applied to multiple skin punctures is known as the heaf and tine test E. The Mantoux test is the most commonly used TB test in the world F. A positive skin reaction to a TB test (such as the Mantoux test) always indicates an active TB infection G. (None; all of the above are true regarding tuberculin and TB skin tests)

F (Leiomyomas rarely evolve into cancer - leiomyosarcoma)

Which ONE of the following is NOT TRUE regarding uterine leiomyomas? A. Many uterine leiomyomas are asymptomatic B. Uterine leiomyomas may grow large enough to impress upon nearby organs C. Common symptoms of large uterine leiomyomas include outright pain, urinary urgency, constipation, and feelings of heaviness or fullness in the pelvic region D. Submucosal tumors may cause menstrual irregularities and fertility problems E. Stalked uterine leiomyomas may twist as they undergo torsion, causing pain F. Uterine leiomyomas predictably evolve into cancer if not removed early enough G. (None, i.e., all of the above are true of uterine leiomyomas)

E (Hypercalcemia; aldosterone affects sodium and potassium, not calcium.)

Which ONE of the following is NOT a common symptom associated with hyperaldosteronism? A. HYPERTENSION B. Hypernatremia C. Hypokalemia D. Muscle weakness E. Hypercalcemia F. Fatigue G. Polyuria and polydipsia H. Metabolic alkalosis I. If hypokalemia, then paresthesias and even frank tetany J. (None; all of the above are symptoms consistent with hyperaldosteronism)

D (You knew this one already.)

Which ONE of the following is NOT a function of the nasal mucus? A. It contains substances to help fight would-be bacterial pathogens B. It helps to clean the air by entrapping bacteria and particles C. It helps moisten air in the nasal cavity D. (All of the above are functions of the nasal mucus)

F (All of these processes can prematurely activate pancreatic proenzymes and thus cause pancreatic autodigestion.)

Which ONE of the following is NOT a mechanism by which pancreatic autodigestion can be induced? A. Injection of bile or other chemicals into the pancreatic duct, e.g., reflux of bile B. Mechanical disruption of the pancreatic acinar cells C. Obstruction of the main pancreatic duct D. Overstimulation of pancreatic acinar cells E. Chemical injury of pancreatic acinar cells F. (None- all of the above are potential mechanisms to induce pancreatic autodigestion)

D (No fibrosis in asthma, no collagen deposition)

Which ONE of the following is NOT a pathophysiologic change characteristic of asthma? A. Mucus secretions filling the bronchial lumens B. Hyperplasia of bronchial smooth muscle C. Inflammation and thickening of the basement membrane beneath the bronchial epithelium D. Hyperplasia of submucosal fibroblasts, resulting in fibrosis due to the deposition of collagen and elastin E. Hypertrophy of the bronchial mucous glands F. Goblet cell hyperplasia G. Inflammatory infiltrates in the bronchial wall, especially rich in eosinophils H. (None. All of the above are characteristic of the pathophysiologic changes of asthma)

G (Note that all of these conditions can mess with the Hypothalamic - Pituitary - Ovarian axis, and thus alter the normal ovarian cycle.)

Which ONE of the following is NOT a potential cause of anovulatory cycles? A. Anxiety and stress B. Bulimia and anorexia nervosa C. Pituitary tumors such as prolactinomas D. Severe malnutrition E. Ovarian tumors such as functional thecomas F. Polycystic ovaries G. (None, Mr. Silly! All of the above are potential causes of anovulatory cycles)

E (All of the listed conditions are potential complications of anovulatory cycles and/or inadequate luteal phase.)

Which ONE of the following is NOT a potential complication of anovulatory cycles and/or inadequate luteal phase? A. Infertility B. Polycystic ovarian syndrome C. Endometrial hyperplasia and cancer D. Dysfunctional uterine bleeding (DUB) E. (None. All of the above are potential complications of anovulatory cycles and inadequate luteal phase)

D (Remember that aldosterone conserves sodium at the expense of potassium. In adrenocortical insufficiency, aldosterone levels are deficient, which will thus result in hyponatremia and hyperkalemia.)

Which ONE of the following is NOT a symptom commonly associated with Addison disease? A. GI disturbances such as diarrhea and nausea B. Weakness and easy fatigability C. Hyperpigmentation D. Hypernatremia and hypokalemia E. Hypovolemia and hypotension F. Poor resistance to stress G. Cardiac conduction problems H. (None of the above, i.e., they are all true about the symptoms of Addison disease)

E (This is a very serious syndrome, and without immediate antibiotic therapy it may kill within hours or a few days.)

Which ONE of the following is NOT a symptom consistent with Waterhouse-Friderichsen syndrome. A. Rapidly progressing hypotension B. Shock C. Disseminated intravascular coagulopathy D. Widespread purpura E. (None; all of the above are symptoms of Waterhouse-Friderichsen syndrome)

F (All except anhidrosis are simply symptoms of increased sympathetic activity. Sweating is a sympathetic phenomenon, so anhidrosis- lack of sweating- would not be consistent with the heightened sympathetic activity of these tumors.)

Which ONE of the following is NOT a symptom consistent with a tumor of the chromaffin cells of the adrenal medulla? A. Hyperglycemia B. Increased metabolic rate C. Rapid heart beat and palpitations D. Hypertension E. Intense nervousness F. Anhidrosis G. (None of the above, i.e., they are all true about chromaffin cell tumors of the adrenal medulla)

G

Which ONE of the following is NOT a symptom consistent with cirrhosis? A. Kidney hypoperfusion and hepatorenal syndrome B. Ascites with hyperaldosteronism and hypernatremia C. Endocrine abnormalities such as impotence or anovulation D. Hypothyroidism due to the deficiency of thyroid hormone-transporting proteins in the blood E. Bone problems related to abnormal calcium homeostasis F. Esophageal varices, splenomegaly, and other complications of portal hypertension G. (None. All of the above are symptoms consistent with cirrhosis)

G

Which ONE of the following is NOT a symptom of diabetes mellitus? A. Polyuria and dehydration B. Polydipsea C. Electrolyte imbalances D. Polyphagia E. Appearance of ketone bodies in the blood F. Lipidemia G. (None, i.e., all of the above are symptoms of diabetes mellitus)

D (Spread via the lymphatic system. S. pneumoniae and other pneumonial bacterial tend to reach the lungs by being inhaled or aspirated rather than via the lymphatics.)

Which ONE of the following is NOT a typical (i.e., common) route by which pneumonial bacteria reach the lungs? A. Inhalation of pathogens in air droplets B. Hematogenous spread C. Aspiration of infected particles in gastric contents, food, or drinks D. Spread via the lymphatic system E. Aspiration of infected secretions from the upper respiratory tract

C (Cytomegalovirus.)

Which ONE of the following is NOT a typical cause of the "flu" or common cold? A. Influenza virus B. Parainfluenza virus C. Cytomegalovirus D. Rhinovirus E. Coronavirus

G (Acute pancreatitis. Remember that the initial cause of acute pancreatitis is almost always sterile -it is caused by autodigestion- so bacterial pneumonia would not cause pancreatitis. But all of the mentioned LUNG conditions, as well as pulmonary abscesses, are possible with pneumonia.)

Which ONE of the following is NOT a typical complication of bacterial pneumonia? A. Abscess formation B. Bronchiectasis C. Chronic lung disease with pulmonary fibrosis D. Pleuritis E. Pleural effusion, pyothorax, and/or empyema F. Pleural fibrosis G. Acute pancreatitis H. (None, Mr. Silly!. All of the above are typical complications of bacterial pneumonia)

F

Which ONE of the following is NOT a typical complication of gonorrhea? A. In males, prostatitis and epididymitis B. In females, endometritis, salpihgitis, and pelvic inflammatory disease C. Infertility D. Arthritis E. Heart valve problems (bacterial endocarditis) F. (None. All of the above are typical complications of gonorrhea)

A

Which ONE of the following is NOT a typical complication of portal hypertension? A. Cor pulmonale B. Ascites C. Splenomegaly D. Functional anastomoses (varices) between the portal and systemic circulations E. (None. All of the above are typical complications of portal hypertension)

A. (Cor pulmonale - Recall that cor pulmonale results when vascular changes cause narrowing or compression of pulmonary vessels; TB does not cause such changes.)

Which ONE of the following is NOT a typical complication of pulmonary tuberculosis? A. Cor pulmonale B. Miliary tuberculosis C. Tuberculous pneumonia D. Pleuritis E. Extrapulmonary tuberculosis

E (ARDS is not a granulomatous disease, so no granulomas. But also, the main inflammatory cells immigrating into the alveolar lumen are neutrophils, not lymphocytes and not macrophages -and remember that the alveoli already contain their own resident macrophages.)

Which ONE of the following is NOT a typical feature seen in the histology of acute respiratory distress syndrome (ARDS)? A. On gross examination (at autopsy), the lungs are heavy, filled with edema fluid, and therefore empty of air B. Histologically, the alveolar spaces are dilated and filled with proteinaceous edema fluid C. The plasma extravasates into the alveoli and clots, forming fibrin-rich hyaline membranes D. Alveolar capillaries are engorged with blood, which hemorrhages (escapes) focally into the alveoli E. Lymphocytes and macrophages immigrate into the alveolar wall, forming granulomas just under the basement membrane F. In patients who survive the acute phase of ARDS, fibroblasts proliferate in the interstitial spaces and deposit collagen in the alveolar walls G. In patients who recover completely, fibroblast proliferation ceases, the collagen and hyaline material is metabolized, and the normal pulomonary structure and function returns H. In patients who do not recover completely, end-stage pulmonary fibrosis with cyst formation usually ensures I. (None. All of the above pertain to the histopathology of ARDS)

E (Breast lumps that deflate when pierced are a good sign- it means the lump is probably a benign cyst and not cancerous.)

Which ONE of the following is NOT a typical sign of breast cancer? A. Tumors lacking sharp margins, because they lack a defined capsule and just infiltrate into the surrounding tissue B. Puckering of the skin and retraction of the nipple, due to the dense connective tissue pulling on adjacent tissue C. Tumors which feel firm on palpation D. Tumors located either in the upper lateral quadrant or centrally, under the areola E. Tumors ("lumps") which deflate when pierced and drained with a fine hypodermic needle F. (None. All of the above are typical signs of breast cancer)

C (Rhinorrhea - runny nose.)

Which ONE of the following is NOT a typical symptom of epiglottitis? A. Dysphagia B. Dysphonia (hoarseness) C. Rhinorrhea D. Cherry-red, inflamed epiglottis E. Epiglottic edema F. (None. They are all typical symptoms of epiglottitis)

I (No jaundice. Keep in mind that on an exam I might substitute a different 'wrong' answer for jaundice. Those of you searching for 'jaundice' might be surprised when you do not find it. I might just delete the 'wrong' answer, so that 'All of the above' becomes the correct response. I do these things to discourage pattern memorization. Anyone who memorizes the correct symptoms will not be flustered by the abovementioned changes.)

Which ONE of the following is NOT a typical symptom of genital herpes? A. In males, lesions on the penis or other genital areas B. In females, lesions on the mons pubis, labia, clitoris, or vulva C. Dysuria and cervicitis in women D. Pain, itching, or burning sensations in affected areas E. Penile or vaginal discharges F. Fever, headaches, malaise G. Myalgia, Lymphadenopathy H. Herpetic proctitis in those practicing anal intercourse I. Jaundice J. (None. All of the above are typical symptoms of genital herpes)

B (Incidentally, the paradoxical association of hypocalcemia with intracranial calcification may be due to increased phosphate levels, resulting in tissue deposits with locally produced calcium.)

Which ONE of the following is NOT a typical symptom/sign of hypoparathyroidism? A. Paresthesias B. Renal calculi C. Tetany D. Cataracts E. Parkinsonian-like movement disorders due to calcification of the basal nuclei F. Anxiety, depression, confusion G. Increased intracranial pressure H. (None; all of the above are typical symptoms/signs of hypoparathyroidism)

C (As our stress hormones, glucocorticoids don't lower glucose levels- just the opposite, they raise them. The body is in a stressful situation, and glucocorticoids ensure that body cells at least have enough fuel- glucose- to deal with the stress.)

Which ONE of the following is NOT an action of glucocorticoids like cortisol? A. Glucocorticoids stimulate gluconeogenesis in liver cells. B. Glucocorticoids promote glucose sparing. C. Glucocorticoids lower blood glucose levels D. Glucocorticoids promote protein and lipid breakdown E. Glucocorticoids, at pharmacologic levels, suppress the immune system. F. (None of the above, i.e., they are all true about glucocorticoids like cortisol)

G (All of these conditions are associated with polycystic ovarian syndrome.)

Which ONE of the following is NOT commonly associated with polycystic ovarian syndrome? A. Anovulation B. Amenorrhea C. Endometrial hyperplasia and endometrial adenocarcinoma D. Dysfunctional uterine bleeding E. Hirsutism F. Multiple ovarian cysts G. (None, i.e., all of the above are true commonly associated with polycystic ovarian syndrome)

A (Living in Asia- not necessarily being of Asian descent- is a NEGATIVE risk factor for breast cancer- it makes a woman less likely to develop the disease.)

Which ONE of the following is NOT considered a POSITIVE risk factor for breast cancer (meaning it makes a person more likely to develop breast cancer)? A. Living in Asia B. Having ovarian or endometrial cancer C. Having proliferative fibrocystic changes D. Having a mother or siblings with breast cancer E. Long-term exposure to estrogen F. (None. All of the above are positive risk factors for breast cancer)

C (Heavy infiltration of lung tissue with PMNs. Because of their thick, waxy cell wall -lots of unique lipids and mycolic acid, Mycobacterium spp. resist attack by neutrophils PMNs; in fact, PMNs are not attracted to M. tuberculosis cells in the first place. Hence pneumonitis with PMN infiltration is not the norm in TB cases; instead we see granulomas with leukocytes and macrophages.)

Which ONE of the following is NOT supportive for a diagnosis of pulmonary tuberculosis? A. Calcified Gohn complexes can be seen in x-ray studies B. A positive tuberculin test C. Heavy infiltration of lung tissue with PMNs D. The demonstration of bacilli in sputum stained with the Ziehl-Neelsen technique E. (None. All of the above are supportive for a diagnosis of pulmonary tuberculosis)

E (no hyperacidity and no peptic ulcers.)

Which ONE of the following is NOT true of the pathology of acute hemorrhagic pancreatitis? A. The pancreas appears swollen and permeated with blood B. Yellow or smudgy brownish-yellow areas of necrosis appear 2-3 days after the onset of the attack C. Leakage of digestive enzymes into the abdominal cavity may cause peritoneal irritation, and chemical peritonitis may follow D. Areas of fat necrosis appear as grayish-yellow discolorations that gradually calcify and become whitish E. The premature activation of the pancreatic enzymes results in duodenal hyperacidity and duodenal peptic ulcers F. By the end of the first week pseudocysts appear as small cavities filled with liquified tissue and pancreatic enzymes G. Histologically the hallmarks of normal pancreatic tissue are lost H. (None- all of the above are true of the pathology of acute hemorrhagic pancreatitis)

C (For the explanations given below, keep in mind that PAI is slow destruction of the adrenal cortex, and ACTH cannot stimulate a cortex that has been lost. SAI, on the other hand, is a problem with the pituitary secretion of ACTH; the adrenals are healthy but are not receiving enough ACTH.)

Which ONE of the following is a valid distinction between primary (PAI) vs secondary (SAI) adrenocortical insufficiency? A. In PAI cortisol levels are elevated while in SAI cortisol levels are depressed. B. In PAI and SAI, ACTH levels are depressed. C. Exogenously administered ACTH would raise cortisol levels in SAI but not in PAI D. Exogenously administered cortisol would raise ACTH levels in PAI but not in SAI E. Lowered blood sodium levels would activate the renin-angiotensin-aldosterone system and ultimately raise aldosterone levels in PAI F. ACTH has no effect on the adrenals in either PAI or SAI. G. (None. None of the above statements are a valid distinction between PAI and SAI)

C and F (on an exam I would use only one of these. Endometriosis can occur in either the pleura or lung -in either case it is called thoracic endometriosis- or the vagina, yet these are definitely rare locations for endometriotic tissue. The other locations listed are much more common locations for endometriosis.

Which ONE of the following is not a common location for endometriosis? A. Ovaries B. Pelvic peritoneum C. Pleura D. Uterine ligaments E. Rectouterine septum F. Vagina G. (None. All of the above are common sites for endometriosis)

D (The symptoms of hypoglycemia listed in this question are either due to reflexive activation of sympathetic nervous system caused by the hypoglycemia or to insufficient glucose to the brain. Decreased sweating and bradycardia are not sympathetic effects- increased sweating and tachycardia are. Thus D is the incorrect answer.)

Which ONE of the following is not a common symptom of hypoglycemia? A. Tremulousness, weakness B. Headache and confusion C. Hunger, nervousness D. Decreased sweating and bradycardia E. Slurred speech F. (None; all of the above are symptoms consistent with hypoglycemia)

D (PTH is not known to affect calcium uptake by body tissues.)

Which ONE of the following is not a recognized mode of action of parathyroid hormone (PTH) in raising serum calcium levels? A. PTH causes bone cells to absorb the bony matrix & release calcium into blood B. PTH causes the kidneys to reabsorb more Ca++, thus reclaiming calcium from the urine and returning it to the plasma. C. Via vitamin D, PTH increases absorption of Ca++ by the intestinal mucosa D. PTH causes the tissues of the body to take up less calcium from the plasma, thereby helping to keep plasma levels high. E. PTH stimulates the conversion of relatively inactive vitamin D to its more active form, calcitriol. F. (None. All of the above are recognized modes of action of PTH.)

A (Dysgerminomas are germ cell tumors.)

Which ONE of the following is not a sex cord stromal tumor? A. Dysgerminoma B. Theca cell tumor C. Sertoli-Leydig tumor D. Granulosa cell tumor E. (None. All of the above are sex cord stromal tumors)

E (Recall that in CAH, cortisol levels are down, whereas truncal obesity and moon face are seen in hypercortisolism. Thus they would not be present in CAH. Also, while several other enzyme deficiencies could be the cause of CAH -such as 11 hydroxylase- a 21 hydroxylase is by far the most common enzyme that is lacking.)

Which ONE of the following is not a symptom/sign consistent with late-onset congenital adrenal hyperplasia? A. 21 hydroxylase deficiency B. Delayed menarche C. Oligomenorrhea D. Hirsutism E. Truncal obesity and moon face F. (None. All of the above are consistent with congenital adrenal hyperplasia)

A (Cystic fibrosis is due to a faulty gene and is not acquired as a result of having chronic bronchitis)

Which ONE of the following is not a typical sequela seen in cases of long-standing, persistent chronic bronchitis? A. Cystic fibrosis, due to the constant presence of tenacious mucus B. Chronci obstructive airway disease C. Cor pulmonale and heart failure D. Metaplasia and dysplasia that could lead to cancer E. (None. All of the above are potential sequelae to long-standing chronic bronchitis)

C (Endometrial hyperplasia. Endometrial hyperplasia is the result of estrogen overstimulation)

Which ONE of the following is not a typical symptom of one stage or another of rectocele? A. A sense of pressure within the vagina. B. A sensation that the rectum has not been emptied after a bowel movement. C. Endometrial hyperplasia D. Difficulty passing stool E. Dyspareunia F. Constipation G. Vaginal bleeding H. Intermittent fecal incontinence I. Prolapse of the bulge through the introitus J. (None. All of the above are typical symptoms of one stage or another of rectocele.)

C (In fact, just the opposite is true- in chronic bronchitis, the surface epithelium is usually maintained, except perhaps for a little focal -i.e., localized- ulceration.)

Which ONE of the following is not a typical symptom or histologic feature of chronic bronchitis? A. Hypertrophy of the submucosal mucus glands B. Hyperplasia of goblet cells C. Loss of long stretches of surface epithelium along the trachea, bronchi, and bronchioles D. Hypersecretion of mucus E. Chronic inflammation of the airways, primarily due to lymphocytes F. Hyperemia and edema of the whole lung G. (None. All of the above are true regarding the symptoms and features of chronic bronchitis)

D (No Procrit®. Even though it would increase the oxygen carrying capacity of the blood, it would also increase blood viscosity and increase the workload on the heart and lungs)

Which ONE of the following is not a typical treatment for chronic bronchitis? A. Corticosteroid administration, to reduce inflammation B. Bronchodilators, to increase airway diameters and facilitate breathing C. Antibiotics, to quell an infection, if present D. Procrit®, an erythropoietin agonist, to increase red blood cell concentration and arterial oxygenation E. Oxygen therapy, to increase arterial oxygen saturation F. (None. All of the above are typical treatments for chronic bronchitis)

C

Which ONE of the following is not a valid distinction between terminal bronchioles and respiratory bronchioles? A. Terminal bronchioles are larger in diameter than respiratory bronchioles B. Respiratory bronchioles bear alveoli, and terminal bronchioles do not C. As fresh air is drawn in through the trachea and into the lungs, it encounters the respiratory bronchioles before the terminal bronchioles D. Virtually all gas exchange occurs in respiratory bronchioles, not in terminal bronchioles E. Terminal bronchioles are the most distal part of the conducting zone, while respiratory bronchioles are the most proximal part of the respiratory zone

E

Which ONE of the following is not an effect of angiotensin II? Angiotensin II... A. ...causes vasoconstriction of arteries. B. ...acts on the hypothalamic thirst center to increase the sensation of thirst. C. ...increases ADH secretion by the posterior pituitary, causing the kidneys to reabsorb more water. D. ... increases aldosterone secretion by the adrenal cortex, causing the kidneys to reabsorb more sodium. E. (None. All of the above are effects of angiotensin II)

A (DUB is certainly an example of abnormal uterine bleeding, but it is a functional disturbance not an organic one. DUB is due to abnormal endocrine function, while all the other choices here obviously involve organic - i.e. physical- problems, such as tumors and inflammation.)

Which ONE of the following is not an organic cause of abnormal uterine bleeding? A. Dysfunctional uterine bleeding B. Endometrial hyperplasia C. Chronic endometritis D. Submucosal leiomyomas E. Endometrial polyps F. Tumors G. (None. All of the above are potential organic causes of abnormal uterine bleeding)

B (Amongst all causes, the most common cause is ingestion or absorption of glucocorticoid drugs.Amongst just the endogenous causes, the most common is a pituitary corticotropic adenoma.)

Which ONE of the following is the most common cause of Cushing syndrome? A. Pituitary corticotropic adenoma (ACTH hypersecretion) B. Exogenous glucocorticoids such as prednisone C. Functional adrenocorticotropic tumors D. Paraneoplasty; functional extrapituitary tumors that hypersecrete ACTH H. (None; the most common cause of Cushing syndrome is not listed above)

A (Upper respiratory infection- the common cold, by far!)

Which ONE of the following is the most common of all the respiratory infections? A. Upper respiratory infection B. Middle respiratory syndrome C. Tracheitis D. Pneumonia E. Pleuritis F. Laryngitis

A (Prolonged coughing and expectoration. Cough, cough, cough. These can, of course, occur with other diseases so they are not definitive for lung cancer, but they are a common warning sign nonetheless.)

Which ONE of the following is the most common presenting symptom of lung cancer? A. Prolonged coughing and expectoration B. Bleeding C. Chest pain D. Pleural effusion E. Hoarseness due to nerve paralysis

D (cigarette smoking. Of course if we break the question down further we'd see that alpha-1 anti-trypsin deficiency causes panacinar emphysema, while smoking causes centriacinar -and sometimes panacinar- emphysema. However, since centriacinar emphysema is far more common than panacinar, the question still stands, and smoking remains the most common cause of emphysema in general.)

Which ONE of the following is the most important overall cause of emphysema? A. AIDS B. Air pollution in the cities C. Tuberculosis D. Cigarette smoking E. Asthma F. Lobar pneumonia

B (The terminal bronchioles are the smallest airways of the conducting zone, so they do not participate in gas exchange. The respiratory bronchioles, on the other hand, along with their alveoli, is where gas exchange occurs.)

Which ONE of the following lists the structures of the respiratory system in the order encountered as air is inhaled (i.e., as air moves from external to internal)? A. (ext.) pharynx - larynx - trachea - bronchi - respiratory bronchioles - terminal bronchioles - alveoli (int.) B. (ext.) pharynx - larynx - trachea - bronchi - terminal bronchioles - respiratory bronchioles - alveoli (int.) C. (ext.) pharynx - trachea - larynx - bronchioles - bronchi - alveoli (int.) D. (ext.) larynx - pharynx - trachea - bronchi - bronchioles - alveoli (int.) E. (ext.) larynx - pharynx - trachea - bronchi - alveoli - bronchioles (int.)

A (most students forget about the ejaculatory duct)

Which ONE of the following lists the tubular systems of the male reproductive tract in order of fluid movement, leading up to ejection from the urinary meatus? A. (Deepest) seminiferous tubules - epididymis - vas deferens - ejaculatory duct - urethra - urinary meatus B. (Deepest) epididymis - seminiferous tubules - ejaculatory duct - vas deferens - urethra - urinary meatus C. (Deepest) seminiferous tubules - ejaculatory duct - epididymis - vas deferens - urethra - urinary meatus D. (Deepest) seminiferous tubules - vas deferens - epididymis - urethra - ejaculatory duct - urinary meatus

Streptococcus pneumoniae (All the other pathogens listed can cause pneumonia, but S. pneumoniae by itself is responsible for 50% of cases.)

Which ONE of the following pathogens is the leading cause of pneumonia? A. Streptococcus pneumoniae B. Haemophilus influenzae C. Staphylococcus aureus D. Mycobacterium tuberculosis E. Mycoplasma pneumoniae F. Aspergillus fumigatus G. Legionella pneumophila H. Influenza virus

A (Examine the steroid biosynthesis chart on or about Slide 161. Recall that many mutations can alter 21 hydroxylase activity. If a patient has NO hydroxylase activity, then they will have extreme hypocortisolism with salt wasting -lack of aldosterone- a very serious medical condition. On the other hand, some hydroxylase mutations will abolish cortisol synthesis but leave adequate aldosterone sythesis. Such individuals will experience hypocortisolism without the salt-wasting. In either case, lack of cortisol -with or without lack of aldosterone- shunts adrenal resources into gonadocorticoid synthesis, resulting in adrenogenital syndrome.)

Which ONE of the following statements best describes the steroid deficiency or deficiencies accompanying a total lack of 21 hydroxylase activity? A. Cortisol and aldosterone B. Cortisol only C. Cortisol and progesterone D. Progesterone and estrogens E. Testosterone and estrogen F. Progesterone, estrogen, and testosterone G. All corticosteroids H. (None. Corticosteroid synthesis is not affected by a lack of 21 hydroxylase)

D (Otherwise known as hCG.)

Which fetal/placental hormone is responsible for maintaining the corpus luteum during the initial trimester of pregnancy? A. Estrogen. B. Progesterone. C. Oxytocin. D. Human chorionic gonadotropin. E. Luteinizing hormone. F. Prolactin.

B; D; F (B- The kidneys monitor oxygen carrying capacity of the blood, and release erythropoietin when it drops too low. D- The parathyroid glands monitor plasma calcium levels and release PTH when it drops too low. F- The hypothalamus monitors the hydration state of the blood and increases or decreases the secretion of ADH accordingly.)

Which of the following (may be more than one) does not trigger (i.e., stimulate) the renin-angiotensin-aldosterone system? A. Decreased plasma sodium B. Decreased red blood cell count (increased hypoxia) C. Decreased plasma volume D. Decreased plasma calcium E. Decreased arterial blood pressure F. Increased water retention G. (None; all of the above stimulate the renin-angiotensin-aldosterone system)

C (Both estrogen and progesterone.)

Which of the following best describes the hormonal secretions of corpora lutea? A. Estrogen only. B. Progesterone only. C. Both estrogen and progesterone. D. Human chorionic gonadotropin (hCG). E. Both LH and FSH. F. Estrogen, progesterone, and oxytocin.

A (Dysmenorrhea. All the other conditions result in hyperestrinism, which can cause endometrial hyperplasia)

Which of the following conditions is NOT typically associated with endometrial hyperplasia? A. Dysmenorrhea B. Anovulatory cycles C. Polycystic ovarian syndrome D. Functional granulosa cell tumors of the ovary E. Estrogen replacement therapy F. Obesity G. (None. All of the above are associated with endometrial hyperplasia)

C (Because high levels of circulating estrogen- unopposed by progesterone- will cause endometrial hyperplasia, any of which can progress to cancer. Don't you hate multiple choice questions with an answer like G- 'More than one of the above'? I know I did.)

Which of the following endocrine disorders is a recognized risk factor for endometrial carcinoma? A. Hyperthyroidism B. Hypothyroidism C. Hyperestrinism D. Hypoparathyroidism E. Hypoinsulinism F. Hyperprogesteronism G. (More than one of the above)

E (Virilization involves elevated anderogens- testosterone from her ovaries or DHEA sulfate from her adrenals. Progesterone is not an androgen, and it does not masculinize an individual)

Which of the following is NOT TRUE regarding hirsutism and virilization in adult women? A. Virilization and hirsutism are both caused by excessive androgens in adult women B. Virilization and hirsutism are usually caused by endocrinological problems involving either the ovaries or adrenals C. Hirsutism is defined as an excess of hair in normal hair-bearing areas D. Hirsutism due to adrenal dysfunction usually involves DHEA sulfate E. Virilization due to ovarian dysfunction usually involves elevated levels of progesterone F. Probably the most common causes of hirsutism is polycystic ovarian syndrome G. Most women with excess androgens develop hirsutism, maybe with a little acne, but most don't have clitoromegaly H. (None of the above, i.e., they are all true about hirsutism and virilization)

F (Because of the diabetogenic effect of cortisol, Cushing syndrome cause hyperglycema, from which come glycosuria, polyuria, and polydipsia. The low resistance to infections is due to the fact the high levels of glucocorticoids suppresses the immune system.)

Which of the following is NOT a typical manifestation of Cushing syndrome? A. "Buffalo hump" in the lower neck/upper back region B. "Moon face" C. Low resistance to infections D. Cutaneous striae, dermal atrophy E. Menstrual irregularities F. Hypoglycemia, oliguria G. (None; all of the above are typical manifestations of Cushing syndrome).

2; 3; 4

Which of the numbered BOXES (1-4) refer to malignant tumors?

3,5,6,7,8

Which of the numbered BOXES (1-8) refer to malignant tumors?

8

Which tumor is a choriocarcinoma?

3

Which tumor is a seminoma or dysgerminoma?

4

Which tumor is a seminoma?

2

Which tumor is a teratocarcinoma?

6

Which tumor is a teratocarcinoma?

1

Which tumor is a teratoma?

4

Which tumor is a teratoma?

3

Which tumor is an embryonal carcinoma?

5

Which tumor is an embryonal carcinoma?

5

Which tumor is composed of neoplastic embryonic cells- cells resembling the embryonic germ layer cells (cells of the mesoderm, ectoderm and/or endoderm) or their derivatives (mature tissues) and which give rise to the non-seminomatous germ cell tumors?

2

Which tumor is composed of neoplastic embryonic cells- cells resembling the embryonic germ layer cells (cells of the mesoderm, ectoderm and/or endoderm)?

6

Which tumor is composed only of neoplastic germ cells- the father of all the other tumor cells shown here?

1

Which tumor is composed only of neoplastic germ cells- the parent of all the other tumor cells shown here?

Intralobular

Within a lobule, e.g., in breasts, a stroma that is hormonally-sensitive connective tissue found within each lobule.

_____ refers to a decrease in lacrimal gland output, resulting in dry eyes.

Xerophthalmia (And xerophthalmia + xerostomia = sicca syndrome.)

_____ refers to a decrease in salivary output, resulting in dry mouth.

Xerostomia

Blue bloaters

[ Blue bloaters / Pink puffers ] refers to COPD patients presenting predominantly with chronic bronchitis.

Pink puffers

[ Blue bloaters / Pink puffers ] refers to COPD patients presenting predominantly with emphysema.

Conjugated

[ Conjugated/ Unconjugated ] hyperbilirubinemia may result in darkly colored urine, as this type of bilirubin is soluble and can be excreted by the kidneys

Dengue fever (which is caused by the dengue virus. This virus is spread by mosquitoes, and in the US is mainly found along the southeastern seaboard.)

[ Yaws / Dengue fever / Bejel / Pinta / Syphilis ].is the only disease in the list that is NOT caused by Treponema pallidum.

Partial (Complete moles also exist, but I just made up the last two.)

[Complete / Partial / Molar / Trophoblastic ] hydatidiform mole refers to a placenta that has grossly swollen chorionic villi- resembling bunches of grapes- in which there are varying degrees of trophoblastic proliferation and usually recognizable fetal parts.

Complete (Partial moles also exist, but I just made up the last two.)

[Complete / Partial / Molar / Trophoblastic ] hydatidiform mole refers to a placenta that has grossly swollen chorionic villi- resembling bunches of grapes- in which there are varying degrees of trophoblastic proliferation but no recognizable fetus.

Tactile fremitus

[Egophony / Tactile fremitus / Whispered pectoriloqui / Percussion] is a vibration felt on a patient's chest during low frequency vocalization, often using phrases such as '99' or 'neun-undneunzig.'

Hypocalcemia

[Hypercalcemia / Hypocalcemia] is the consistent result of hypoparathyroidism.

Pseudohypoparathyroidism (remember that knuckle-knuckle-dimple-knuckle is a sign of Turner syndrome.)

[Hyperparathyroidism / Hypoparathyroidism / Pseudohypoparathyroidism / Turner syndrome] can often be recognized clinically by the presence of shortened metacarpals, the so-called knuckle-knuckle-dimple-dimple sign.

Corticosteroids

[Mineralocorticoids/ Glucocorticoids/ Gonadocorticoids / Corticosteroids] are the primary steroid hormones made and released by adrenal cortex.

Prehepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - A common cause of this jaundice is an increased rate of destruction of RBCs

Posthepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - A common cause of this jaundice is bile stasis caused by choledocholithiasis

Prehepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - Also known as hemolytic jaundice

Posthepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - Also known as obstructive jaundice

Hepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - This type of jaundice might be caused, e.g., by a diseased liver which is unable to conjugate bilirubin

Prehepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - This type of jaundice occurs when the liver is presented bilirubin in amounts in excess of normal, and it is more than a normal liver can handle

Prehepatic

[Prehepatic / Hepatic /Posthepatic] Jaundice? - This type of jaundice usually results in pure unconjugated hyperbilirubinemia

Secondary

[Primary/ Secondary] hyperaldosteronism is usually caused by conditions that reduce blood flow to the kidneys and thus excessive activation of the renin-angiotensin-aldosterone system.

Surgery (they took out the parathyroids!)

[Surgery/ Autoimmune phenomena / Parathyroid agenesis / Genetic mutations] is/are themost common cause of hypoparathyroidism.

Hypertension; blood pressure elevation

_____ (AKA _____) is the most common manifestation of primary hyperaldosteronism.

Trousseau's syndrome (Sometimes associated with pancreatic adenocarcinoma.

_____ , or migratory thrombophlebitis, refers to venous thrombi that appear and resolve, only to re-appear elsewhere; this give the appearance that the thrombi are migrating about the body.

Waterhouse-Friderichsen syndrome (this may not become symptomatic until 90% of the adrenals are destroyed, and even today it still kills many of its victims.)

_____ , or primary acute adrenocortical insufficiency, is acute, bilateral, hemorrhagic infarction of the adrenal cortex, most commonly secondary to meningococcal or pseudomonal septicemia.

Endometrial hyperplasia

_____ - marked thickening of the inner uterine mucosa- is the result of continued stimulation of this tissue by estrogen unopposed by progesterone.

Late-onset (this form of AS may be asymptomatic, or may present as hirsutism and menstrual irregularities.)

_____ adrenogenital syndrome (AS) (or congenital adrenal hyperplasia), the most common type of AS, is due to partial deficiency of 21-hydroxylase activity; such indiviuals can still make cortisol and aldosterone, though at lower levels than normal.

Dysgerminomas; seminomas

_____ and _____ are germ cell tumors of the ovaries and testes whose malignant cells retain their resemblance to gonocytes.

Urethral compression; retention of urine (These show up as difficulty starting the stream -hesitation, weak stream, dribbling after voiding, increased urgency and thus increased frequency of urination, etc. Cystitis is a potential complication, due to the larger residual volume of urine left in the bladder = more bacteria)

_____ and _____ are the two common causes leading to most of the clinical symptoms of benign prostatic hyperplasia.

Nonenzymatic glycosylation; osmotic damage

_____ and _____ are the two primary mechanisms by which the high blood sugar of diabetes mellitus damages tissues around the body.

Cholesterol; pigmentary

_____ and _____ gallstones are the two types of gallstones, distinguished on the basis of chemical composition

Seminomas (recall that seminomas are tumors composed of a single cell type that resembles seminal epithelium-like cells)

_____ and non-seminomatous germ cell tumors are the two broad categories of testicular germ cell tumors recognized today.

Condylomata acuminatum

_____ are also known as anogenital, genital, or venereal warts.

Androgens (I might add that the adrenal cortex makes them as well)

_____ are any of several steroids, produced as hormones by the testes or made synthetically, that promote development of male sexual organs and male secondary sexual characteristics; testosterone is the best-known example

Amylases (here 'simpler molecules' refer to simple sugars like glucose and galactose or to disaccharides such as maltose; glucose-glucose)

_____ are enzymes that digest complex carbohydrates like starch and glycogen into simpler molecules.

Lipases (here, 'simpler molecules' refer to glycerol and fatty acids.)

_____ are enzymes that digest fats into simpler molecules.

Proteases (here 'simpler molecules' refer to peptides and individual amino acids, depending on the protease)

_____ are enzymes that digest proteins into simpler molecules.

Endometrial polyps

_____ are exophytic masses of variable size that project into the endometrial cavity.

Pseudocysts (This should make sense- with all those pancreatic enzymes around, they just turn whole areas of the pancreas to goo.)

_____ are fluid-filled cavities that are not lined with epithelium; they are common in pancreatitis.

Xenoestrogens

_____ are foreign estrogens or chemicals having estrogenic effects on the body.

Pneumoconioses.

_____ are pulmonary diseases caused by the inhalation of organic or inorganic dusts.

Anovulatory cycles. (Anovulatory cycles and inadequate luteal phase are common causes of dysfunctional uterine bleeding.)

_____ are the most common cause of abnormal bleeding in a young woman from menarche to about 20 years of age.

Luteal

_____ cysts are derived from ruptured ovarian follicles that fail to become normal corpora lutea; instead the structure seals, wnlarges as it fills with fluid, and becomes cystic.

Follicular

_____ cysts are derived from unruptured ovarian follicles that enlarge and become cystic; these are extremely common.

Adrenogenital syndrome

_____ is a condition in which hypersecretion of adrenal sex steroids (androgens) leads to masculinization in girls and precocious pseudopuberty in boys.

Tracheoesophageal fistula (Remember that a fistula is an abnormal and open connection between two hollow organs -or between a hollow organ and the body surface, as in a perianal fistula. Thus, this condition refers to an abnormal connection between the trachea and the esophagus.)

_____ is a congenital respiratory defect characterized by an abnormal tube-like connection between the trachea and the esophagus.

Choriocarcinoma

_____ is a malignant tumor derived from trophoblastic cells, i.e., a cancer of the placenta.

Gestational trophoblastic disease

_____ is an umbrella term embracing the spectrum of trophoblastic disorders that exhibit abnormal proliferation and maturation of trophoblastic cells as well as neoplasms derived from the trophoblast.

Secondary hyperparathyroidism (Notice that low calcium levels stimulate the parathyroid glands just like TSH stimulates the thyroids.)

_____ is caused by any condition that gives rise to chronic hypocalcemia, which in turn leads to compensatory overactivity of the parathyroid glands; it is encountered mainly in patients with chronic renal failure.

Inadequeate luteal phase.

_____ occurs when a properly functioning corpus luteum fails to form from the follicular remnants after ovulation; as a result, progesterone levels remain abnormally low.

Metronidazole

_____ otherwise known as Flagyl®, is the drug typically used to treat trichomoniasis.

Multiparous

_____ pertains to a woman who has born more than one child.

Nulliparous

_____ pertains to a woman who has not borne any children.

PSA (or prostate specific antigen; Recall that PSA normally functions to liquefy semen within the first minute or so postejaculation.)

_____ provides a serologic marker for prostatic adenocarcinoma; this protein is elevated in the plasma in over half of the cases of prostatic cancer.

Allergens (think of allergens as IgE antigens that are actually harmless to the body but to which the body is hypersensitive- it over-reacts to them anyway, all out of proportion to their threat to the body.)

_____ refers to IgE antigens which cause inappropriate inflammation (allergic response); common examples include pollen and animal dander.

Abruptio placentae

_____ refers to a complication of pregnancy, where the placental lining has separated from the uterus.

monorchism

_____ refers to a condition in which only one testis is apparent, the other being absent or undescended

polyorchidism

_____ refers to a condition of having more than two testes

Hypospadias (which is much more common than epispadias. Note that the undersurface of the penis is referred to as the 'ventral' surface. This has nothing to do with the body's dorsal and ventral surfaces. Here, 'ventral' sort of means 'special'- the underside is special because it is the side containing the urethra and spongiosum tissue, and which faces the scrotum.)

_____ refers to a congenital condition in which the opening of the urethra is situated on the underside (i.e., the ventral side) of the penis (or on the scrotum) instead of at its tip

Epispadias (which is much less common than hypospadias. Note that the upper surface of the penis is referred to as the dorsal surface. This has nothing to do with the body's dorsal and ventral surfaces. Here, 'ventral' sort of means 'special'- the underside is special because it is the side containing the urethra and spongiosum tissue, and which faces the scrotum. Thus, the 'dorsal' side- the upper side- is the 'not-so-special' side.)

_____ refers to a congenital defect in which the urethra opens upon the upper surface (i.e., the dorsal surface) of the penis

Cryptorchidism (a common cause of monorchism)

_____ refers to a congenital malpositioning of the testes outside their normal scrotal position

Hydatidiform mole (this definition applies whether the mole is complete or partial.)

_____ refers to a cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation.

Dysmenorrhea

_____ refers to a difficult or painful monthly flow; pelvic pain during a menstrual period that does not resolve with the onset of menses

Courvoisier's sign (Sometimes associated with pancreatic adenocarcinoma.)

_____ refers to a gallbladder that is so dilated that it is palpable on physical examination; usually this is the result of cholestasis.

Polymenorrhea

_____ refers to a menstrual period where the cycle is abnormally short (<22 days)

Hypermenorrhea

_____ refers to a monthly flow where the duration is long and/or the amount heavy; aka menorrhagia

Hypomenorrhea

_____ refers to a monthly flow where the duration is short and the amount scant.

Cryptomenorrhea

_____ refers to a monthly flow wherein, for a variety of reasons, the products of menstruation remain internal

Menorrhea

_____ refers to a normal monthly flow

Esophageal atresia (Recall that 'atresia' has several meanings, one of which is that an object -e.g., a channel, a tube- that should have been open -connected to something else- instead is closed -i.e, ends blindly. Thus esophageal atresia refers to an upper esophagus that should have connected to the lower esophagus but instead just ends abruptly.)

_____ refers to an esophagus which ends blindly, i.e., does not empty into any organ.

Hirsutism

_____ refers to an excess of hair in normal hair-bearing areas

Virilization

_____ refers to an excess of hair in normal hair-bearing areas plus secondary male sex characteristics, esp. clitoromegaly

Trachoma (caused by the bacterium Chlamydia trachomatis. Globally, 41 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease.)

_____ refers to an infectious eye disease caused by chlamydial bacteria; it is a leading cause of blindness worldwide.

Retroperitoneal

_____ refers to an organ located behind the peritoneum; thus only a part of the organ surface is in contact with the peritoneum.

Placenta accreta

_____ refers to deep penetration of the placental villi into the uterine wall (at least to and possibly through the endometrium).

Dyspareunia

_____ refers to difficult or painful sexual intercourse.

Adrenal diabetes

_____ refers to elevated blood sugar levels as a result of hypercortisolism.

Hyperestrinism

_____ refers to elevated levels of estrogen in the blood.

Menometrorrhagia

_____ refers to excessive uterine bleeding at and between menstrual periods

Endocervicitis (The endocervix refers to the cervical canal)

_____ refers to inflammation of the cervical canal.

Pelvic inflammatory disease (PID)

_____ refers to inflammation of the entire female reproductive system.

Balanitis (included in this definition are many syphilitic chancres, since they are often found on the glans in males)

_____ refers to inflammation of the glans penis.

Endometritis

_____ refers to inflammation of the inner lining of the uterus.

Otitis media (if it oozes pus, it is referred to as suppurative otitis media)

_____ refers to inflammation of the middle ear.

Oophoritis

_____ refers to inflammation of the ovaries.

Salpingitis

_____ refers to inflammation of the uterine (fallopian) tubes.

Metritis

_____ refers to inflammation of the uterus.

Colpitis.

_____ refers to inflammation of the vagina; aka vaginitis.

Oligomenorrhea

_____ refers to infrequent menstrual periods (36 days to 6 months), usually with scanty flow as well

Hepatorenal syndrome

_____ refers to kidney failure which develops secondary to the hypoproteinemia of liver failure

neurosarcoidosis.

_____ refers to sarcoidosis affecting the brain or nerves.

Galactorrhea (Usually hyperprolactinemia will be present as well.)

_____ refers to spontaneous milk production unrelated to pregnancy.

anorchia

_____ refers to the congenital absence of testes

Pneumothorax (Note that atelectasis is NOT the same as pneumothorax. Atelectasis refers to airspace collapse, whereas pneumothorax refers to air in the pleural cavity. Yes, pneumothorax frequently leads to atelectasis, but they are two separate conditions.)

_____ refers to the entrance of air into the pleural cavity.

Placenta previa

_____ refers to the implantation of the zygote in the lower segment of the uterus, with consequent positioning of the placental disk over the internal orifice of the cervix.

Amenorrhea

_____ refers to the lack of menstruation in a reproductive-aged woman.

Cor pulmonale. (Remember that cor pulmonale is to the right heart -pulmonary hypertension- what systemic hypertension is to the left heart.

_____ refers to the right ventricular hypertrophy, dilation, and possible failure which occurs secondary to pulmonary vascular changes that restrict pulmonary blood flow and cause pulmonary hypertension.

Gray hepatization (Recall that as alveolar pneumonia resolves, the hemorrhaging subsides and the affected lung tissue changes from a ruddy, liver-like color -red hepatization- to a more neutral -non-red- color -grey hepatization. Thus, grey hepatization is a good sign, because it means the pneumonia is resolving.)

_____ refers to the stage of alveolar pneumonia where hemorrhaging in the alveoli has subsided, and the affected lung tissue has lost its ruddy, liver-like appearance and assumed a more neutral or natural color; this stage is a sign that the pneumonia is resolving.

Red hepatization (Recall that as alveolar pneumonia resolves, the hemorrhaging subsides and the affected lung tissue changes from a ruddy, liver-like color -red hepatization- to a more neurtral - non-red color - grey hepatization.)

_____ refers to the stage of alveolar pneumonia where the alveoli in whole areas of the lung are filled with edematous and hemorrhagic fluid, PMNs, and pathogens, producing heavy consolidation; in this state the affected portion of the lung resembles liver tissue in gross appearance.

Primary hyperparathyroidism

_____ refers to the syndrome caused by excessive secretion of PTH by a parathyroid adenoma, primary hyperplasia of all the parathyroids, or parathyroid carcinoma.

Pseudohypoparathyroidism (In other words, pseudohypoparathyroidism is due to PTH insensitivity in the target organ- the cells can't 'see' PTH that is present.)

_____ reflects target organ insensitivity to PTH, and designates a group of hereditary conditions characterized by hypocalcemia.

Hypoparathyroidism

_____ results from decreased secretion of parathyroid hormone (PTH) or from decreased end-organ sensitivity to PTH.

Horner syndrome

_____ results when sympathetic influence to one-half of the head is decreased or abolished by a Pancoast tumor.

Herpetic whitlow

_____ seen on dentists and health care workers, produces herpetic vesicles on the thumbs or fingers.

Klinefelter (A related condition is Turner syndrome, where individuals have only one sex chromosome - a 45,X karyotype)

_____ syndrome is due to trisomy of the sex chromosomes; affected individuals are male with a (47, XXY) karyotype, atrophic testes, and are infertile.

Reiter's (recall that uveitis is inflammation of the uvea, the middle tunic of the eye including the iris and choroid body)

_____ syndrome refers to the triad of urethritis, uveitis, & arthritis, as sometimes occurs with chlamydial urethritis.

Miliary (Named after the fact that the small granulomas resemble millet seeds in size.)

_____ tuberculosis refers to the widespread seeding of M. tuberculosis in the lungs or other organs resulting in the formation of small granulomas.

Endometrioid

_____ tumors are solid tumors composed of glands resembling endometrial glands.

Glucagonomas (recall that glucagon acts to RAISE blood sugar levels, so an excess of glucagon.....)

_____ usually present with hyperglycemia, mimicking diabetes mellitus

Gastrinomas (recall that gastrin stimulates gastric activity, including acid secretion, so an excess of gastrin......)

_____ usually present with hypersecretion of acid in the stomach and intractable peptic ulcers.

Insulinomas (recall that insulin acts to LOWER blood sugar levels, so an excess of insulin.....)

_____ usually present with hypoglycemia and sometimes syncope.

Hydroperitoneum; ascites

_____, also known as _____, refers to an abnormal accumulation of serous fluid in the peritoneal cavity, often as a result of portal hypertension

Addison disease (Although autoimmune adrenalitis is the most common cause of Addison disease, any process that slowly destroys the adrenal cortex, such as infection, can cause this disorder.)

_____, or primary chronic adrenocortical insufficiency, is marked by progressive destruction of the adrenal cortex, usually by autoimmune phenomena.

Endometrioid

_____, or type I endometrial carcinoma, contain structures resembling endometrial glands; these tumors typically arise in the settings of endometrial hyperplasia and hyperestrinism.

Ketones (or ketone bodies. Acetone and acetoacetic acid are two examples. These are commonly created in diabetes mellitus, where adequate sugar -carbohydrate- is not imported into cells.)

_____, some of which are strong organic acids, are created when fats are metabolized without adequate levels of carbohydrates.

Vaginal bleeding

______ is the most common presenting symptom of endometrial adenocarcinoma.

Fibroadenoma

_________ is the most important and the most common of the benign tumors of the breast.

Hyperestrenism

__________ refers to elevated levels of estrogen in the blood.

Radical mastectomy

____________ involves en bloc removal of a breast, all associated axillary lymph nodes, and underlying chest wall muscles.

Gynecomastia

____________ refers to enlargement of, or development of tubules in, the male breast.

Cyanosis

a blue coloration of the skin and mucous membranes, usually due to hypercapnia

Leydig cells

a cell of interstitial tissue of the testis that is usually considered the chief source of testicular androgens and especially testosterone; also called interstitial cell

Leydig cell

a cell of interstitial tissue of the testis that is usually considered the chief source of testicular androgens and especially testosterone; also called interstitial cell

Fistula

a channel or canal connecting a hollow organ with either another hollow organ, or with the surface of the body

paraneoplastic syndrome

a condition where tumors release functional hormones and/or hormone-like molecules, which then cause endocrine disturbances in the body

paralytic ileus

a condition which paralysis of intestinal muscles results in functional obstruction; a common cause of this condition are bacterial endotoxins, which inhibit smooth muscle contraction and result in aperistalsis

Pneumocyte, Type II

a cuboidal epithelial cell found in the alveolar wall. These cells produce surfactant, and when necessary, can reproduce both type I and II pneumocytes

Tunica vaginalis

a double-layered serous membrane that surrounds each testis; while it is derived from the peritoneum, it is no longer in communication with it

Tunica vaginalis

a double-layered serous membrane that surrounds each testis; while the tunica vaginalis is derived from the peritoneum, it is no longer in communication with it

tyrosinemia

a genetic disorder that results in increased blood levels of the amino acid tyrosine

endocrine gland

a gland whose secretion is a chemical messenger known as a hormone. Hormones are secreted into interstitial fluid, from which they quickly diffuse into the blood

exocrine gland

a gland whose secretion is a fluid, such as the lacrimal and salivary glands. Fluids are secreted onto the epithelial layer from which the gland itself is derived

Stridor

a high pitched wheezing sound resulting from turbulent air flow in the upper airway; it is primarily inspiratory

amylase

a hydrolytic enzyme which digests complex carbohydrates such as starch and glycogen to simpler sugars.

elastase

a hydrolytic enzyme which digests elastic tissue, such as the elastic laminae found in blood vessel walls

lipase

a hydrolytic enzyme which digests fats to fatty acids and glycerol

nuclease

a hydrolytic enzyme which digests nucleic acids (DNA and RNA) to oligonucleotides or even individual nucleotides

protease

a hydrolytic enzyme which digests proteins to peptides and/or amino acids

Glomerulonephritis

a kidney condition involving inflammation of the glomeruli

Cryptomenorrhea

a monthly flow wherein the products of menstruation remain internal because of an imperforate hymen, or blockage of cervical canal, or cervical atresia

Cremaster muscle

a muscle with origin from the internal oblique and inguinal ligament, with insertion into the cremasteric fascia and pubic tubercle, with nerve supply from the genitofemoral nerve, and whose action raises the testicle. In the male, the muscle envelops the spermatic cord and the testis; in the female, it envelops the round ligament of the uterus.

Stenosis

a narrowing or stricture

hypersplenism

a poorly understood syndrome marked by a triad of (1) splenomegaly, (2) anemia, leucopenia, or thrombocytopenia, in any combination, associated with marrow hyperplasia, and (3) correction of the blood cytopenias by splenectomy

Paroxysm

a severe, sudden attack or a sudden increase in intensity of a disease, usually recurring periodically

Papule

a small solid usually conical elevation of the skin (i.e., it's palpable) caused by inflammation, accumulated secretion, or hypertrophy of tissue elements;

Pneumocyte, Type I

a squamous epithelial cell that lines the alveolus; accounting for over 95% of the surface area of the alveolar wall, these cells are extremely important as mediators of gas exchange. They are also vulnerable to toxic insult of many types, and they are unable to replicate themselves

Atresia

a structure (body part) which should have been open (connected to another body part) is not; usually result from congenital malformation and simply end blindly

Episiotomy

a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor. The incision, which can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic, and is sutured closed after delivery.

Menarche

a woman's first menstrual period, marking the passage of a girl into womanhood

Gynecomastia

abnormal overdevelopment of the breasts in a male; occurrence of breast tissue (not fat!) on a male; boobs on a man

Nocturia

abnormally excessive urination during the night

Amenorrhea

absence of a menstrual period during a woman's reproductive years; during this period, amenorrhea is normal only during and shortly after pregnancy

Anhidrosis

absence of sweating

Hemothorax

accumulation of blood in the pleural cavity

Pleural effusion

accumulation of fluid (serous, blood, etc) within the alveoli of the lungs

Chylothorax

accumulation of lymph in the pleural cavity

hydroperitoneum

accumulation of peritoneal fluid (transudate) in the peritoneal cavity

Pyosalpinx

accumulation of pus in the uterine tube(s)

Hydrothorax

accumulation of serous fluid in the pleural cavity

spasm of the lower esophageal sphincter, such that swallowed food cannot enter the stomach but rather accumulates in the esophagus

achalasia

a lack of acid (HCl) in the gastric juice

achlorhydria

an epithelial cancer in which, histologically, the malignant epithelial cells form glandlike structures (ducts, etc.)

adenocarcinoma

increased excretion of serum albumin in the urine

albuminuria

hyperaldosteronism

an endocrine disorder due to hypersecretion of aldosterone, which controls sodium and potassium levels; results in sodium retention (possibly hypernatremia) and potassium loss (possibly hypokalemia)

adenocarcinoma

an epithelial cancer in which, histologically, the malignant epithelial cells form gland-like structures (ducts, etc.)

proenzymes

an inactive enzyme; an enzyme which has yet to be activated

Eosinophila

an increase in the number of circulating eosinophils (i.e., eosinophils in the blood)

Lymphocytosis

an increase in the numbers of circulating white blood cells, above the normal 10,000 cells per microliter

Gonocyte

an oocyte or spermatocyte; a cell that produces gametes

Germ cells

an ovum or a sperm cell or one of their developmental precursors

Cul-de-sac

another name for the pouch of Douglas, or rectouterine pouch

The _____ is the distal portion of the stomach that tapers to the opening to the duodenum.

antrum

lack of urine production

anuria

Sertoli cells

any of the elongated striated cells in the seminiferous tubules of the testis to which the spermatids become attached and from which they apparently derive nourishment; also known as nurse cells

These casts usually begin forming in the loop of Henle; hence they are found in the proximal convoluted tubule and collecting duct

applies to all the listed casts

The portion of the right colon extending superiorly to the hepatic flexure

ascending colon

Atheromas

atherosclerotic plaques found in the larger arteries

excess nitrogenous waste in the blood

azotemia

Bacteremia

bacteria in the blood

Example of Invasive Diarrhea:

bacterial or protozoal (Giardia or Entamoeba) dysentery

the presence of abnormally high levels of bacteria in the urine

bacteriuria

The main, midportion of the stomach

body

Thrombolysis

breakdown of clots. various drugs are used to dissolve or breakdown clots that have formed in the blood vessels

dystrophic calcification

calcification which occurs in the absence of hypercalcemia. Some tissues, such as lesions and tumors, have a tendency to accumulate calcium even when the blood levels are normal.

metastatic calcification

calcification which occurs within the setting of hypercalcemia. Most tissues will pick up calcium if the blood levels are high enough.

The initial part of the large intestine, this pouch receives digestive contents from the small intestine

cecum

The gastric gland cell type which secretes pepsinogen

chief cells

Example of Secretory Diarrhea:

cholera, or traveler's diarrhea

The creamy paste into which foodstuffs are converted by the GI tract

chyme

pertaining to the colon and urinary bladder

colovesical

Maculopapular

combining the characteristics (or containing both) of macules and papules

choledocholithiasis

condition of having gallstones in the common bile duct

Fibrinopurulent

containing both fibrous material (fibrin fibers) and pus

Mucopurulent

containing both mucus and pus

inflammation (infection) of the urinary bladder

cystitis

The portion of the left colon extending inferiorly from the splenic flexure

descending colon

gynecomastia

development of the breast tissue on a male

Dysuria

difficult urination

Dyspnea

difficulty in breathing

Dysphagia

difficulty in swallowing; the difficulty may be due to pain, dryness, swelling, muscular incoordination, etc.

Dysphonia

difficulty speaking; hoarseness

Proteolysis

digestion or breakdown of proteins

Hypogonadism

diminished hormonal or reproductive functioning in the testes or the ovaries

Suppurative

discharging pus

Hematogenous spread

dissemination via the blood, as in bacteria spreading around the body in that manner

Blepharoptosis

drooping/dropping of the upper eyelid; often referred to simply as 'ptosis'

Beta-adrenergic agonists

drugs which mimic adrenaline (epinephrine) and produce typical adrenalinerelated responses

The [ stomach/ duodenum / jejunum / ileum/ cecum/ sigmoid colon ] is the part of the GI tract that is most active in the absorption iron.

duodenum

The initial (proximal) portion of the small intestine, about 25 cm long

duodenum

difficulty in digestion; indigestion

dyspepsia

difficulty or pain while swallowing

dysphagia

difficult (painful) urination

dysuria

Precocious puberty

early puberty; puberty before the typical age

Hypercalcemia

elevated blood calcium levels

hypernatremia

elevated blood sodium levels, usually accompanied by water retention and expansion of the ECF

Hyperinsulinemia

elevated levels of insulin in the blood

Hyperprolactinemia

elevated levels of prolactin in the blood

hyperbilirubinemia

elevated serum levels of bilirubin; normal levels are 1.2 mg/dL, and levels in excess of 3 mg/dL typically result in jaundice

Thromboemboli

emboli produced from a thrombus; clot material that have broken off, traveled freely in the blood stream, and then lodged at some distant sites

Trophoblastic cells

embryonic cells that form a large part of the placenta and which secrete the placental hormone (human) chorionic gonadotropin, or hCG

Trophoblastic cells

embryonic cells that form a large part of the placenta and which secrete the placental hormone (human) chorionic gonadotropin, or hCG

Clitoromegaly

enlargement of the clitoris, in some cases assuming the appearance of a small penis

hepatomegaly

enlargement of the liver

Hepatosplenomegaly

enlargement of the liver and spleen

splenomegaly

enlargement of the spleen

The ________________ is the local nervous system of the GI tract.

enteric brain.

Aromatase

enzyme that converts androgens into estrogens. Found in adipose tissue and, when FSH is present, in granulose cells

A(n) _____ refers to a superficial lesion of the GI tract mucosa; it does not involve the entire mucosa.

erosion

Wearing away or loss of epidermis; they do not penetrate below the dermoepidermal junction in skin (or below the mucosa in mucosal membranes). They occur as a result of inflammation or injury and heal without scarring.

erosions

Hypercapnia

excessive carbon dioxide in the blood

Menorrhagia

excessive or heavy uterine bleeding during the menstrual periods

Pyrexia

fever; body temperature above normal

Adhesions

fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected

Exudate

fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues.

Transudate

fluid that oozes out of blood vessels due to inflammation and is deposited in nearby tissues; typically contains fluid and electrolytes but is low in protein and cellular elements.

Xenoestrogens

foreign estrogens or chemicals having estrogenic effects on the body

cholecystoenteric fistulas

formation of a channel allowing communication between the gall bladder and the intestine

Fibrothorax

formation of fibrinous adhesions between the parietal and visceral pleurae

thrombophlebitis

formation of thrombi within the veins of the body; in migratory conditions, the thrombi appear and then disappear in veins around the body

The [ cardia/ fundus / body / antrum / pylorus ] refers to the upper part of the stomach, specifically, that part which is above (superior to) the lower esophageal sphincter.

fundus

The superiormost portion of the stomach located above (superior to) the cardiac sphincter

fundus

pain in the stomach; a stomach ache

gastralgia

Deep invaginations within the gastric wall which collectively produce gastric juice

gastric glands

Anasarca

generalized (bodywide) edema with accumulation of serum in connective tissues

a disease affecting the glomeruli of the kidneys

glomerulopathy

inflammation of the tongue; e.g., seen in Plummer-Vinson syndrome

glossitis

increased excretion of glucose in the urine

glycosuria

hepatrotropic

growing in or attacking only liver cells; e.g., _____ viruses only infect liver cells

Endophytic

growing inward; proliferating on the interior of an organ or structure, or growing into the tissues of an organ or the walls of a tubular organ. E.g., tumors usually present as crater-like ulcerations that grow into the cervical wall

Exophytic

growing outward; in oncology, proliferating on the exterior or surface epithelium of an organ or other structure in which the growth originated. E.g., tumors protrude into the vagina and are cauliflower-like fungating masses

Indurated

having become firm or hard especially by increase of fibrous elements

Caseous

having the consistency of cottage cheese (AKA "curdy")

blood in the vomitus; vomiting blood

hematemesis

bright red blood per rectum (BRBPR) (i.e., in the stools); the bleeding is from the colon or lower small intestine, and remains bright red. In broad usage, the bleeding may be either coating the stools or dripping from the anus; in more restricted usage, it is a drip-drip-drip bleed from the anus, whereas the other condition is then referred to as "blood in (or coating) the stools."

hematochezia

the presence of blood in the urine

hematuria

The near-right angle turn of the colon in the right subcostal area

hepatic flexure

A condition in which urine collects in the ureter because of an obstructed outflow

hydroureter

elevated blood calcium levels

hypercalcemia

elevated calcium levels in the urine

hypercalciuria

elevated blood cholesterol levels

hypercholesterolemia

"excessive" vomiting; retching; vomiting with extremely powerful abdominal contractions

hyperemesis

elevated blood potassium levels

hyperkalemia

elevated oxalate levels in the urine

hyperoxaluria

decreased amounts of albumin (a plasma protein) in the blood

hypoalbuminemia

a deficiency of acid (HCl) in the gastric juice

hypochlorhydria

decreased amounts of plasma proteins in the blood

hypoproteinemia

The _____ valve controls the entry of material from the small intestine to the large intestine.

ileocecal (valve)

The [ stomach/ duodenum/ jejunum / ileum / cecum/ sigmoid colon ] is the part of the GI tract that is most active in absorption of vitamin B12.

ileum

The portion of the intestinal tract where vitamin B12 is absorbed

ileum

The terminal (distal) portion of the small intestine, several meters long

ileum

acinus

in the pancreas, the actual cells that secrete proenzymes and enzymes, as opposed to the ductal cells which form a conduit to the duodenum

Erectile dysfunction

inability to maintain an erection while attempting sexual intercourse

Atelectasis

incomplete expansion of a lung or a part thereof (such as a lobe)

Filariasis

infection by filarial worms in the blood and lymph channels, lymph glands, and other tissues, the various species causing skin swellings, blindness, or elephantiasis if untreated

Salpingitis

inflammation of a uterine (Fallopian) tube

Bartholinitis

inflammation of the Bartholin glands, paired exocrine glands whose secretions hydrate and lubricate the vestibule

Perivasculitis

inflammation of the adventitia or the tissues surrounding a blood vessel or lymphatic vessel.

Perivasculitis

inflammation of the adventitia or tissues surrounding a blood vessel or lymphatic vessel.

Bronchitis

inflammation of the bronchial tubes

Cervicitis

inflammation of the cervix

Keratitis

inflammation of the cornea of the eye

Endocarditis

inflammation of the endocardium, which includes the heart valves

cholecystitis

inflammation of the gall bladder

Endocervicitis

inflammation of the lining of the uterine cervix

Endometritis

inflammation of the lining of the uterus (the endometrium)

Meningitis

inflammation of the meninges, the connective tissue sheets that surround the central nervous system

Otitis media

inflammation of the middle ear; may or may not be suppurative

Rhinorrhea

inflammation of the nasal mucosa

pancreatitis

inflammation of the pancreas

Pleuritis

inflammation of the pleura(e)

Uveitis

inflammation of the uvea (vascular tunic) of the eye, usually including the iris and ciliary body, or both

Vaginitis

inflammation of the vagina; aka colpitis

Vulvitis

inflammation of the vulva

Vulvovaginitis

inflammation of the vulva and vagina

Hypoxemia

insufficient (deficiency) of oxygen in arterial blood

Xerophthalmia

insufficient production of tears; dry eyes

Stress incontinence

insufficient strength of the pelvic floor muscles, so that there is an involuntary release of urine during periods of stress (e.g., coughing, laughing, etc.)

A substance found in gastric juice which is required for vitamin B12 absorption.

intrinsic factor

Pruritic

itchy

The [ stomach/ duodenum/ jejunum / ileum/ cecum/ sigmoid colon ] is the part of the GI tract that is most active in absorption of the B vitamin folate (folic acid).

jejunum

The middle portion of the small intestine, several meters long

jejunum

the presence of ketones in the urine

ketonuria

Gonorrhea

l. _____ A sexually-acquired infectious disease caused by the bacterium Neisseria gonorrhoeae; in males, it produces purulent urethritis

Example of Osmotic Diarrhea:

lactose intolerance, or laxatives

the presence of lipid in the urine

lipuria (lipiduria)

retroperitoneal

located dorsal to the peritoneum. _____ organs include the kidneys and adrenal glands, abdominal aorta and inferior vena cava, and most of the pancreas and duodenum.

Hyponatremia

low blood sodium levels

The _____ sphincter guards the entry of foodstuff from the esophagus into the stomach.

lower esophageal (cardiac)

A muscular thickening found at the gastroesophageal junction which controls the passage of swallowed materials from the esophagus to the stomach

lower esophageal sphincter

The failure of this muscular ring often results in backflow of gastric juice into the esophagus (gastroesophageal reflux), causing heartburn

lower esophageal sphincter

Consolidated

lung tissue which as become firm and heavy due to the accumulation of fluid; percussion over consolidated lung tissue produces dullness instead of the normal resonance

Virilization

masculinization

Sputum

matter coughed up and usually ejected from the mouth, including saliva, foreign material, and substances such as mucus or phlegm, from the respiratory tract

appearance of dark, tarry streaks of blood in the stools; results from bleeding high in the GI tract (stomach, duodenum) where blood has had a chance to be affected by stomach acid and stomach/duodenal enzymes

melena

The _____ are microscopic projections on the luminal side of intestinal (esp. duodenal) epithelial cells; their plasma membranes contain various digestive enzymes.

microvilli (the continuous layer of microvilli, formed from thousands and thousands of intestinal epithelial cells, are collectively known as the brush border.)

stenosis

narrowing

Gynecomastia

occurrence of breast tissue (not fat!) on a male; boobs on a man

Fulminant

occurring suddenly, rapidly, and with great severity or intensity; expanding or spreading quickly, like an explosion

pain on swallowing

odynophagia

Febrile

of, relating to, or characterized by fever; feverish

decreased production of urine

oliguria

Pharyngalgia

pain in the throat; a sore throat

The gastric gland cell type which secretes HCl

parietal cells

The gastric gland cell type which secretes intrinsic factor

parietal cells

The _____ gland is a large salivary gland just anterior to the ears.

parotid (gland)

Macule

patch of skin that is altered in color but usually not elevated (i.e., not palpable) and that is a characteristic feature of various diseases (as smallpox);

the frequency, under given environmental conditions, with which a gene produces its effect (shows its phenotype)

penetrance

An active enzyme found in gastric juice which digests proteins to simpler substances

pepsin

An inactive enzyme precursor in gastric juice; this inactive substance can be activated by hydrochloric acid

pepsinogen

pertaining to the region near or surrounding the anus

perianal

Menopause

period of life when, prompted by hormonal changes, ovulation and menstruation cease

Contralateral

pertaining to the opposite side of the body

Ipsilateral

pertaining to the same side of the body

Nosocomial

pertaining to, or acquired in, hospitals; e.g., a nosocomial infection

Proteinaceous

pertaining to, or composed of, protein

air in the mediastinal cavity

pneumomediastinum

Pneumonia

pneumonitis; inflammation of lung tissue

air in the peritoneal cavity

pneumoperitoneum

the presence of air in the urine

pneumoturia

increased production of urine

polyuria

Bacteremia

presence of bacteria in the bloodstream

Fibrogenic

producing fibrous tissue

Suppurative

producing or discharging pus

thyroglobulins

proteins which bind thyroid hormones and ferry them about in the blood

increased excretion of protein in the urine

proteinuria

Miosis

pupillary constriction

Empyema

pus filling a pre-existing body cavity; with regards to the pleural cavity, generally refers to the filling of a pocket of the cavity which has been defined or walled-off by fibrosis or fibrinous inflammation

Pyothorax

pus filling the entire pleural cavity

Inflammation of both the parenchyma of the kidney and the lining of its pelvis; usually due to bacterial infection

pyelonephritis

The distal (inferior) portion of the stomach, endowed with a thick wall

pyloric antrum

Muscular thickening at the gastroduodenal junction that controls passage of gastric contents to the duodenum

pylorus; pyloric sphincter

the presence of pus in the urine, with many PMNs

pyuria

Tachypnea

rapid breathing

The terminal (distal) portion of the colon, where feces are stored prior to defecation

rectum

Erythema

reddened in color, usually because of hyperema (increased blood flow)

Endometriosis.

refers to the presence of endometrial glands and stroma outside the uterus.

Adenomyosis.

refers to the presence of endometrial glands and stroma within the uterus (i.e., within the myometrium).

Ptosis

see blepharoptosis

patchy in distribution; e.g., the _____ distribution of Crohn Disease means that affected parts of bowel are separated from each other by unaffected parts

segmental

Desquamation

shedding; a peeling and casting off, as of the superficial epithelium, mucous membranes, renal tubules, or the epidermis of the skin

Cardiogenic shock

shock (collapse of the cardiovascular system) due to heart failure, as from a heart attack

condition of salivary stones; such stones are formed from lithogenic saliva and are frequently found lodged in the salivary ducts

sialolithiasis

overproduction of saliva

sialorrhea

An "S"-shaped portion of the colon near its terminus (distal end)

sigmoid colon

A

simple (S), complex (C), or complex with atypia (A). In this hyperplasia, the glands have a complex, maze-like architecture and show glandular crowding, and nuclear atypia is present.

C

simple (S), complex (C), or complex with atypia (A). This hyperplasia exhibits marked complexity and crowding but no atypia.

S

simple (S), complex (C), or complex with atypia (A). This hyperplasia exhibits minimal glandular complexity, minimal crowding, and no cytoplasmic atypia.

S

simple (S), complex (C), or complex with atypia (A). This hyperplasia progresses to adenocarcinoma about 1% of the time.

A

simple (S), complex (C), or complex with atypia (A).: This hyperplasia progresses to adenocarcinoma about 25% of the time.

S

simple (S), complex (C), or complex with atypia (A): This hyperplasia describes the endometrial changes seen as a result of anovulatory cycles.

Vasa vasorum

small blood vessels that supply or drain the walls of the larger arteries and veins and connect with a branch of the same vessel or a neighboring vessel

Alveolus

small hollow or cavity; air sac in the lungs, or milk-secreting unit of a mammary gland

Bronchospasm

spasm of the smooth muscle in the walls of the bronchi (and possibly bronchioles as well), resulting in bronchoconstriction

The _____ is the ring of smooth muscle which controls the release of bile and/or pancreatic juice into the duodenum.

sphincter of Oddi

whitish streaks of fat in the stools, usually due to incomplete fat digestion

steatorrhea

The _____ gland is a large salivary gland just anteromedial to the mandibular angle.

submandibular (gland)

Thoracentesis

surgical puncture of the pleural cavity to remove fluid

rectal pressure and discomfort; the ineffectual urge to defecate (when, in fact, there are no feces in the rectum)

tenesmus

Lymphadenopathy

term meaning 'disease of the lymph nodes'; it is, however, almost synonymously used with 'abnormally swollen/enlarged lymph nodes'. It could be due to infection, auto-immune disease, or malignancy

Lymphadenopathy

term meaning 'disease of the lymph nodes'; it is, however, almost synonymously used with 'swollen/enlarged lymph nodes'. It could be due to infection, auto-immune disease, or malignancy

Alopecia

the absence of hair from normal hair-bearing areas; e.g., _____ capitis totalis is the loss of all hair on the head

cholestasis

the blockage or stoppage of bile flow

Endocervix

the canal of the cervix

parenchyma

the cells that carry out the main functions of an organ; the "business" cells of an organ, such as hepatocytes in the liver and myocytes in the heart.

Chemotaxis

the characteristic movement or orientation of an organism or cell along a chemical concentration gradient either toward or away from the chemical stimulus; in pathology, it usually refers to the immigration of inflammatory cells into an area as they are drawn toward some chemical signal

stroma

the connective tissue framework of an organ.

Infundibulum

the distal-most part of the uterine tubes, whose fimbriae enclose the ovary

Hydroureteronephrosis

the distention of the ureter and kidney with urine due to blockage

Hydroureter

the distention of the ureter with urine due to blockage

Pneumothorax

the entrance of air into the pleural cavity, often resulting in atelectasis

Orthopnea

the inability to breathe easily unless one is sitting up straight or standing erect; shortness of breath (dyspnea) which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. It is the opposite of platypnea

Bronchioles, Respiratory

the initial airways of the respiratory zone; these airways participate in gas exchange and lead into the alveoli and alveolar sacs

Follicular Phase

the initial phase of the ovarian cycle, where is follicle is selected, matures, and is ovulated

Intima

the inner layer of a blood vessel wall, located inside the tunica media

Granulosa cells

the innermost cells of an ovarian follicle, closely surrounding the oocyte; convert androgens into estrogens

Extravasation

the leakage of a fluid out of its container. In the case of inflammation, it refers to the movement of white blood cells and plasma from the capillaries to the tissues surrounding them. In the case of hemorrhage, it refers to the loss of blood into the surrounding tissues.

Chancre

the lesion of primary syphilis; a hard, nonsensitive, dull red papule or area of infiltration that begins at the site of treponemal infection after an interval of 10 to 30 days.

Media

the middle layer of a blood vessel wall, located just outside the tunica intima

Thecal cells

the outermost cells of a follicle, enclosing the oocyte and granulose cells; Responsible for converting cholesterol into androgens like testosterone

Exocervix

the part of the cervix facing the vagina

Ampulla

the part of the fallopian tube connecting the isthmus and infundibulum; the part of the uterine tube that makes a sharp turn as the tube extends toward the ovary. The part of the tube where fertilization usually happens

Hilum

the part or area of an organ where structures such as blood vessels, nerves, bronchi (lungs), and lymphatic vessels enter or leave.

viremia

the presence of active virus in the blood

Hemoptysis

the presence of bright red blood (from the respiratory tract) in the sputum

fibrosis

the process by which fibrous tissue, usually high in collagen, replaces normal tissue in an organ

Luteal phase

the second phase of the ovarian cycle, where the remnants of an ovulated follicle are transformed into an endocrine body known as the corpus luteum. This phase is dominated by estrogen and progesterone

Mesothelium

the simple squamous epithelium that lines serous cavities (pleurae, peritoneum, pericardium)

Bronchioles, Terminal

the smallest, most distal airways of the conducting zone; the last of the airways of the lungs that do not participate significantly in gas exchange

Uvea

the vascular tunic of the eye, comprising the iris, choroid coat, and ciliary body

inspissated

to undergo thickening or cause to thicken, as by evaporation or the absorption of fluid

varices

tortuous, dilated veins which tend to rupture easily and bleed profusely; aka varicosities

extending through or across the entire wall (all layers) of an organ

transmural

cystic tumors

tumors whose contents are fluid or semi-fluid rather than solid

A(n) _____ is a lesion which, in the GI tract, extends through the entire mucosa, and sometimes beyond.

ulcer

Open sore on the skin or on a mucous membrane, penetrating below the epidermis (or mucosa) and into the deeper layers.

ulcers

"urine in the blood"; a condition seen when lack of urine production allows metabolic wastes to accumulate in the blood

uremia

pain associated with repeated peristalsis as a ureter tries to push a kidney stone through it

urinary colic

condition of having urinary stones

urolithiasis

Metrorrhagia

uterine bleeding between the menstrual periods

Uveoparotitis

uveitis with parotid gland inflammation

A worm-like appendage of the large intestine, this structure plays no role in digestion, though it does have some lymphoid tissue and thus probably has immune value

vermiform appendix

a decrease in lacrimal gland output, resulting in dry eyes.

xerophthalmia

decreased flow of saliva to the mouth; "dry mouth"

xerostomia