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388 Cards in this Set
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- Back
- 3rd side (hint)
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Amiodarone sx:
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thyroid disfunction, blue skin, corneal deposits, drug induced hepatitis, pulmonary fibrosis
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digoxin
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decrease in intracellular K+, changes in color, beware of arrhythmias
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Chloramphenichol sx:
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Aplastic anemia
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Gentamyocin
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vestibular and cholear ototoxicity
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Acyclovir
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monophosphorylation of thymidine kinase, active Herpes (no affect on dormant HSV or ZVZ), EBV
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Herpes Zoster= Famcyclovir
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Ganciclovir
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viral DNA polymerase structure, CMV in immunocompromised patients
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-navir sx:
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Protein pump inhibitor; buffalo hump, hyperglycemia, p450 inhibitor [avoid rifampin]
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Foscarnet
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nephrotoxicity, electrolyte disturbances
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Pentazocine
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partial u agonist, k agonist
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Haloperidol (tourettes)
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neuroleptic maglinant syndrome
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Vancomyocin resistance
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d-ala d-ala to d-lac d-ala in VR enterococci
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Penicillin resistance
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b-lactamase or low affinity PABA
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Tetracyclin
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high efflux, or works around the ribosome
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CHF DM is
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ACE
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Hypothyroidism
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Lithium toxicity
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Risperidone
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Hyperprolactinemia, also causes amenorrhea when used for schitzophrenia
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Dopamine
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increases anxiety and agitation in the brain
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PABA mutation
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methicillin resistant Staph
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Chlamydia
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intracellular [Chla= cloak], has no peptidoglycan cell wall
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Rifampin
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N. meningitis profilaxis
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_____rubicin cancer treatment sx:
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DILATED cardiomyopathy
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Procainimide, Hydralizine
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Drug induced lupus
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TCA
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Urinary retention in BPH
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Desmo ????
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Anti-dote in vWB disease, acts on endothelial lining
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Aspart and Lispro
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Fast acting DM insulin
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Phenytoin
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male like appearance, pseudothyroidism, gum hyperplasia
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Massive hepatic necrosis post surgery
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halothane exposure
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Microvascular hepatic damage
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Reyes syndrome
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Flutamide
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non-steroidal competitive androgen receptor binder (Prostate cancer)
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Ketoconazole
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inhibits steroid synthesis (prevent hirsuitism in Polycystic Ovarian Syndrome)
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Spirolactone
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inhibits steroid binding (prevent hirsuitism in Polycystic Ovarian Syndrome)
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Amiloride, Spirolactone, triamtirene, epleronone
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K+ sparing diuretic
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Ticlopidine
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ADP, rare neutropenia w/ mouth ulcers
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Theca interna
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produce androgens
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Granulosa cells
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convert androgens to estrogen under control of FSH
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Type II pneumoncytes
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surfactant production and alveolar regeneration
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NF- KB
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??? Cytokine production in Chron's disease
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Thyroid Binding Globulin
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total T4 increases due to increased TBG during pregnancy, estrogen therapy, or oral contraceptives
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Tryptase
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Mast cell degranulation
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5-Hydroxyindolycic acid
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5-HIA= serotonin marker, ie. carcinoid syndrome
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Homeobox genes
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code for transcription factors of genes
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pol gene in HIV
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mutates during reverse transcription treatment
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Env gene in HIV
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evades host neutralizing antibodies
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E.coli that does NOT produce glucuronidase
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0157:H7 EHEC- Shiga like toxin
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melanocytes
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location of skin cancer, derived from neural crest cells
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Allopurinol
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use as a prophylaxis in ongoing gout, NSAIDS are the best for acute treatment
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Mitral valve prolapse
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most common cause of native endocarditis
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M for Myosin
A for Actin |
M----yosin is wider
Actin is narrower |
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Where does Ca bind on the muscle
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Troponin C
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Amphoteracin B
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tears a hole in the pores, by binding ergosterol
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Azoles
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inhibit ergosterol synthesis
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Caspofungin
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inhibits synthesis of cell wall polysaccharide, used in Aspergillosis
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a2
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auto inhibitor of NE at presynapse
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Fevers, chills, hypotension in fungal therapy
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Ampho"terrible"
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naloxone
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IV treatment, so shorter half-life than most opiates
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Gemfibrozil
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use to treat hypertriglyceridemia, decreases VLDL
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Calcium channel blockers
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used to treat berry aneurisms following vasospasms
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treat any non-NSAID, H.Pylori ulcer with
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Antibiotics (ie. metro and tetracyclin)
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Anaphilaxis or asthma
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treat with epinephrine
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Corticosteroids
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use to treat adrenal crisis, ie. hyperpigmentation and shock
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Dexrazonane
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Doxyrubin sx. prevention
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Filgrastim
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G-CSF
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Leucovorin
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Methotrexate sx. preventition (folic acid related)
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Phentolamine
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a1, a2 blocker
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Acute myocarditis
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in young adult-> viral, coxsackie B
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Elevated ASO
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Only Strept B from rheumatic heart fever, not an indication of IV endocarditis
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Trousseau's sign, Pancreatic CA
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Hypercoaguable state, beware of thrombosis
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Atrial myxoma
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ball-valve like blockage, results in syncope episodes, can spread to the brain
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Contraction band necrosis
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first sign of an MI
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Neutrophil invasion
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after the first day of an MI
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Vaso vasora, tree bark
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3rd Syphillus
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MCC Contrictive Heart Disease
ie. Tamponade |
Trauma, followed by cancer
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AST, ALT
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Normal 8-20
If AST 2x ALT, think alcohol if 1:1 think viral |
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ALP
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Think Pagets or bile duct obstruction
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Atropine block Ach in the stomach mucus
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M3 receptors
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Pancreatitis w/ severe abdominal pain
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patient has developed an ileus
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Zencker's diverticulum
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upper esophageal sphincter, due to crycopharrengeal disfunction
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Macrophages
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T-H1 cells
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Case control study
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looks at previous exposure between two groups
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Mitochondria damage
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irreversible injury
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Jervell and Lange-Niesen
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Prolonged QT disorder
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Valsalva or standing up is the same physiologic effect
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Decreases venous return, INCREASING Hypertrophic murmur
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Jugular Venous Dystention
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Cardiac Tamponade
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False negative
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Subtract the number of people who aren't picked up by sensitivity test from the # of people with the disease
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Maternity "blues"
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lasts 10 days, if longer-> post-partum depression
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Inhaled anthetics
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increase cerebral blood flow
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Carbamazipine
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Na blocker, agranulocytosis
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B-blockers affect on Thryroid
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blocks convertion of T4 to T3
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Gibbs free energy
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if -G, then the reaction is favored
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Carotid body
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Plan B in people with hypercapnia (increased C02)
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ACUTE Gout
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Tx: Colchine
Stone Cold treatment for Gout |
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Post-Berry Aneurism
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Vasospasm
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Maternal inheiritance
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Think mitrochondrial
Leber's hereditary= blindness Myoclonic ___ = ragged red fibers |
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T-rna (looks like a cross)
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3' bottom binds to AA
Top part is anticodon:codon |
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Branched chain a-keto glu amino acid disease
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treat with high dose thiamine
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Thiamine def.
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Memory loss from Korsakoff is PERMANENT
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5' to 3' exonucleus activity is only found in...
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DNA Pol. 1 (it's the only one!) used to remove RNA primers
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Foramen Ovale
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Mandibular V3 nerve
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Citrulline (feeds in) and Orinthine (feeds out)
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Urea cycle
(N-acetylglutamate is #1 step in the mitochondria) |
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Primary CNS lymphoma
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#1 solitary tumor found in AIDS, made up of B-cells, associated with EBV
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Valine for Glutamate on the Beta Chain
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Sickle Cell Anemia, which affects oxygen unloading
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Increased HbA2, looks like poorly controlled DM
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Beta-thal trait
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Factor V Leiden def.
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Think Pulmonary Embolism or DVT
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Rate limiting step in heme production
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ALA synthase
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Control group
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Estimate exposure rate among the general population
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ALL with mediastinal mass
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= T-cell leukemia (more rare)
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Severe sickle cell case
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The patient looses function in the spleen, think encapsulated bugs
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Infliximab
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TNF-alpha binder, used to treat RA
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CD55 and CD59 def
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Paraxomal Nocturnal Hemoglobinuria
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Thalassemias
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lead to defective mRNA processing
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Hemolytic Anemia
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associated with lower Haptoglobin levels and HUS
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Sickle cell death
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due to vascular-occultion crisis
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Lipoic Acid (B4)
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without this, not Krebs cycle -> increase in lactic acid
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Alkapotonuria
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build up of homogenistic acid due to defect in convertion of tyrosine to fumarate (homogenistic oxidase def.)
[King George was a built-up homo, tyrant who fumes] |
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Collagen
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made entirely in the RER (only one)
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B12
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used to create Methionine
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B6
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used to create Cystiene
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Homocystienurea
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back in either B6/Cystiene or B12/Methione pathway, causes Marfanoid symptoms with eyes looking down
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Glycerol Kinase
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TGA-> Fatty acids converted into Glycerol only in the liver
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Fibrillin 1
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Marfans
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Galactosemia
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so, lack of Galactokinase to phos. into Gal-1-P leads to build up in eyes, converted to galactitol by aldose reductase-> CATARACTS
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Nucleolus
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contains rRNA-> aka RIBOSOMAL
-need these ribosomes as machinery to build proteins |
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HMP Shunt
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-creates NADPH, used in cholesterol and fatty synthesis
-also Glutathione reductase (RBC) |
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Albinism
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Tyrosinase def., no neuro problems like PKU (i.e. musty odor)
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PKU
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defect in phenylalanine hydroxylase or
TETRAHYDRObiopterin cofactor (due to Dihydrobipterin reductase) |
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Vitamin A
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prevents measles (Koplik's spots)
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Ehlers-Danlos
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due to defective cleaving at the disulfide bond terminals
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Tetrahydrobiopterin
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used in Phenyl/Tyro/DOPA and
Tryptophan/Serotonin pathway |
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Able to swallow liquids, not solids, smoker
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mid-> Squamous Cell carcinoma
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Esophageal varices
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left gastric vein, into esophag.
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Bad breath and upper diverticulum
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Zencker's, weakness of cricopharengeous muscle
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Bleeding from the nose
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platelet problem
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Dysphagia with solids and liquids, cold at the finger tips
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CREST syndrome
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Dysphagia with solids and liquids, coughing up food at night
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Achalasia
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Keratin pearls, appears on heads/neck
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Squamous cell, precursor is actinic keratosis
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Central ulceration, above lip skin cancer
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Basal cell "nests"
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Hairy Leukoplakia
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EBV
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Large rugal folds
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Menetriere's Dx, low albumin, hyperplasia of mucus-secretion
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Foramen Ovale
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V3 (O-face with Ovale)
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CFTR 7 deletion of Phe
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blocks Cl- inside the cell, more Na+ on the outside
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Child with rhabdomyoma
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associated w/ Tuberous sclerosis
(ashspot, hamartomas, renal angiodygenesis) |
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Ball and valve tumor with + JVP on inspiration
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Cardiac Myxoma in LA (+ VEGF)
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Valsalva and gets softer
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Aortic Stenosis
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Valsalva and gets louder
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Hypertrophic Cardiomyopathy
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JVP, Pulsus Paradoxis, Kussmaul breath
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Pericardial effusion, Tx: Echo to confirm
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Hand/Foot/Mouth dz with myocarditis
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Coxsackie A, B virus
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Roth spots, Osler nodes, Janeway lesions
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Type III hypersensitivity rxns
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Endocarditis w/ colon cancer
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strept bovis group D , bile sensitive
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Immediate death in Marfan's
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due to mitral valve prolapse, NOT aortic rupture which takes time
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Left Atrium
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closest to the esophageous and left recurrent laryngeal nerve, causing hoarseness
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Rheumatic Fever heart murmur
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results in acute mitral regurg, since mitral stenosis takes 10 years to develop
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Myoximatosis Degeneration
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Mitral valve prolapse due to build up in dermatin sulfate/GAG
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3 weeks post MI systolic bulge of the pericardium
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ventricular aneurysm
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6 weeks after mural thrombosis, friction rub
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autoimmune pericarditis AKA Dressler's, nonimmune takes only 1 week
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Posteriormedial papillary muscle rupture
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MC in 3-7 post MI injury, leading to mitral regurg.
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RCA
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supplies the AV node, can present as epigastric pain
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tPa
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changes plasminogen to plasma, busts up fibrin
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Chronic Heart Disease
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fibrous tissue replaces the LV muscle, indication for heart transplant
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Sudden Death Syndrome
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heart stops withing one hour, NO thrombosis or change; high risk in smokers
cause: "ISCHEMIC HEART DISEASE" (??) |
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PDA
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Rubella and differential cyanosis
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ASD
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Fetal ALCOHOL syndrome, fixed S2 splitting, paradoxical embolism
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Umbilical veins
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highest O2 content in the fetus (remember it's flipped in the mother/baby)
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6.5 Na/CL or bile resistant
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Enterococcus it has to be salt and bile rest. to live in the gut
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Optochin resistant
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Strept Viridans (still Vira after a blow to the chin)
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DiGeorge's
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T-cell def. (ie. fungal infections), Chromosome 22q, cleft palate
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Hydroxyurea
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inhibits ribonucleotide reductase
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Allopurinol
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useful only in prophilaxis of gout not acutely
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Addison's
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diagnose w/ ACTH stimulation test, low corisol, dark skin
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Heberden's "Osteoarthritis" Nodules
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treat with Acetominophen
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Telangetasia on the lips, AV shunts in the lungs
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Osler-Weber-Rendau
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Delta wave
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Wolff-Parkinson-White (tx: Amiodarone)
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Macular pigmentation of oral mucosa w/ GI hamartoma
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Peutz-Jegher (not a cancer risk, hereditary)
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AD heriditary polyposis w/ boney masses around the rest of the body
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Gardener's syndrome
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Recurrent abortions and + PTT
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Antiphospholipid antibody syndrome Tx: Warfarin
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Porphyria cutanea tarda
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most common purphyria, Uroporphyrinogen decarboxylase def. with tea colored urine
(Uroporphyrinogen III can't remove CO2) |
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AcCoA
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pathway to start Cholesterol, increased in alcholism
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LTB4
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chemotactic to neutrophils
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Phosphotidylcholine
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same as Lecthin
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Zileutin
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inhibits lipooxygenase directly (-lukasts block the receptor)
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Cromolyn, Nedacromyl
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Mast cells degranulation blocker
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SRS-A
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most potent vasoconstrictor, aka LTC4D4E4
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B-thal
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causes 2' hemosiderosis due to blood transfusions
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Hematochezia
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#1 Diverticulosis
#2 Angiodysplasia |
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Hematemesis, pain in RLQ, and melena
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Menckel's diverticulum
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Air in the biliary tree with gailstone pain
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gailstone ileus (ileocecal valve obstruction)
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Osmotic diarrhea
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lactose deficiency, brush border, etc
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MC infection transmitted by blood transfusion
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"CMV (virus= #1)
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MCC jaundice in the first 24 hrs for a newborn = ABO incompatibility
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baby will be severely anemic with Rh than will ABO incompatibility [ABO incompatibility protects against Rh sensitization]
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Air in the biliary tree with gailstone pain
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gailstone ileus (ileocecal valve obstruction)
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Osmotic diarrhea
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lactose deficiency
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Air in the urine
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colevesicular fistula (MCC diverticulosis)
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ANS, dorsal root ganglia, melanocytes, chromaffin cells of adrenal medulla, enterochromaffin cells, pia and arachnoid, celiac ganglion, Schwann cells, odontoblasts, parafollicular (C) cells of thyroid, laryngeal cartilage, bones of the skull
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Neural Crest Derivatives (S+100)
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melanoma; small cell carcinoma of the lung; bronchial carcinoid; carcinoid tumor at the tip of the appendix; neuroblastoma (secretory tumor)
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S-100 + neural crest tumors
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girl having necrotic mass coming out of her vagina, Vimentin and keratin “-“, and desmin “+”
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Embryonal rhabdomyosarcoma
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Movable mass at angle of jaw = mixed tumor (in parotid)
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MC overall salivary gland tumor (usually b9)
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16 y/o girl with sudden onset of RLQ pain, calcifications of the pelvic area
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Cystic teratoma, usually develop in midline – germ cell tumor
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Auer rods
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AML M3 (16:18)
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MC site in body for lymphoma NOT developing in lymph node
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stomach
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MC lymphoma = follicular B cell lymphoma
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knocking off apoptosis gene -14:18, B cells will make bcl-2, which inactivates apoptotic gene
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MC cancer that metastasis to bone
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breast cancer b/c the batsom system, breast to lung as well
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MC cancer of liver
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metastasis from lung into liver (not colon – colon is 2nd b/c portal vein drainage)
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Where would testicular cancer metastasize first?
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Paraortic lymph nodes; NOT the inguinal lymph nodes b/c it derived from the abdomen, and then descended
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The MC primary metastasize to Virchow’s nodes?
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stomach cancer!
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Prostate cancer is blastic!
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releases alkaline phosphatase
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MC primary site for cancer in brain
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lung
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desmin
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good stain for muscle – ie used for rhabdomyosarcoma
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keratin
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most carcinomas have keratin in it, therefore stain for that
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nuclear transcribers in the nucleus
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myc protooncogenes
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p53 + rb suppressor gene and the ras oncogenes
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point mutation (all suppressor genes are from point mutations)
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erb-2
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amplification system, creates receptors in breast cancer
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CML translocation of abl
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increase tyrosine kinase activity of 9:22, tx: Imantinib
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Translocation of 14:18; inactivation of suppressor gene
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Follicular B cell lymphoma (deadly non-Hodkins type)
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Translocation 15:17
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acute progranulocytic leukemia; Rx – Vit A (retinoic acid) b/c it matures the blasts, therefore the malignant cell becomes B9
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p53, Rb gene, adenomatos polyposis coli (familial polyposis), neurofibromatosis, wilm’s tumor gene, brca1 and 2
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All key suppressor genes
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Wegener’s granulomatosis, put on a drug and got hematuria, did cytology and saw cells, what drug is pt on?
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Cyclophosphamide (hemorrhagic cystitis); prevent with mesna, and can cause transitional cell carcinoma
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nasopharyngeal carcinoma, esp. in Chinese/Burkitts
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EBV
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rapidly increasing incidence of primary CNS lymphoma can be directly attributed to...
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HIV
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|
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MC leukemia assoc with radiation
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CML (9, 22 translocation of abl) also metastatic papillary carcinoma of the thyroid in cervical nodes
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Mutated in hereditary nonpolyposis
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Mismatch repair def.
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Mutated in Xeroderma Pigmentosum
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Nucleotide excision repair
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wiskott Aldrich, Blooms, Ataxia Telangiectasias, and Fanconi’s
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chromosomal instability syndromes, problems w/ DNA repair
|
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Cachexia, Septic shock
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TNF-alpha, causes catabolic muscle wasting
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thrombocytosis
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Fe def, splenectomy (ie see scar on abdomen), TB, anemias, #1 cancer
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MC Paraneoplastic syndrome
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hypercalcemia, also look for clubbing in primary lung disease
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vegetations (sterile) on the mitral valve
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marantic endocarditis-aka nonbacterial thrombotic endocarditis, associated w/ colon cancer
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Hypoglycemia or secondary polycythemia
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Hepatocellular carcinoma (they can make EPO or insulin-like factor)
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MC primary tumor of the brain in kids?
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Cerebellar cystic astrocytoma (B9).
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Fe def = MC and Anemia of chronic dz, thalassemias, sideroblastic anemias
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MCV < 80: Microcytic anemia’s
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B12/Folate def = MC; usually folate def in an alcoholic
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MCV > 100: Macrocytic anemia’s
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low reticulocyte ct corrected: aplastic anemia, renal dz; high corrected reticulocyte ct: hemolytic anemias – hereditary spherocytosis, sickle cell, G6PD def, autoimmune hemolytic anemia, microangiopathic
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MCV 80-100: Normocytic anemia’s:
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Target cells
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imp markers for alcoholics
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distinguish between IDA and ACDz
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there are high ferritin levels in ACDz, whereas there is a high TIBC in Fe def anemia
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Low MCV Sideroblastic Anemia
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1. Alcohol 2. G6PD def (low B6), XR. 3. Pb poisoning (low ferrochelatase, + protoporphyrin)
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has to do with splicing defects, stop codons, die from Fe overload, Hep C or HIV
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Beta-thal (over-transfusion)
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Not making any Beta chains, dead by 30
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Cooley's anemia
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MC thal in black people
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beta-delta thalassemia, aka hereditary persistance of HbF
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Deposit in epiphysis, failure to grow, cerebral edema, abdominal colic
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Lead poisoning
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prob with making DMP (deoxythymidine monophosphate)
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Macrocytic anemias
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Purpose of cobalamin (B12)
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take the methyl group off of methyltetrahydrofolate [folate]. Then it’s called tetrahydrofolate
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high serum homocysteine
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produces thromboses, including MI’s; it damages endothelial cells, leading to thromboses, and predisposing to MI (B12 or Folate def)
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odd chain FA metabolism into Succinyl CoA
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B12, most importantly Proprionyl CoA which causes dementia and proprioception loss
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R factor
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protects B12 (ileum->Chrohn's) from acid destruction in the stomach, from saliva
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Colicky RLQ pain w/ diarrhea in young person
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Crohn's disease is ONLY cause in young person
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sclerosing pericholangitis
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MCC: UC, fibrous "onion skin" around common bile duct w/ "beading", cholangiocarcinoma
beading = constriction and dilation of intrahepatic bile ducts |
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Painless bleeding polyp sticking out of an adult's ass
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internal hemorrodes bleed, external hemorrodes thrombosis
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100+ polyps
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APC 5 gene AD mutation, also ras, p53 mutation Familial Polyposis
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Polyps with brain tumors
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Turcot's (think "turban"), AR
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Flushing, diarrhea, Right sided tricuspid insufficieny + pulmonic stenosis
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Serotonin synd spread from the tip of the appendix to the TERMINAL ILEUM (hepatic mtx)
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NOT associated w/ CEA cancer
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Peutz-Jagher, hyperplastic/juevenile polyposis
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Adenovirus causing lymphoid tissue hyperplasia
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MCC of appendicitis in children
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Primary unconjugated bilirubin
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due to a hemolytic dx, increasing breakdown of RBCs
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Dark urine (due to bilirubin), clay colored stools, high conjugated bilirubin
|
obstruction of bile duct (MCC: Common Bile Duct, possible head of pancreas CA)
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Gilbert's
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loss of conjugating enzyme, jaundice under stress
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Increase in Alkaline Phosphatase and GGT
|
bile duct obstruction (causing liver damage, ie. alcoholic hepatatis)
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Decreased Albumin (protime) and increased PT
|
marker of severe liver damage
|
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Anti-mitochondrial Abs
|
Primary Biliary Cirrhosis (CREST w/ jaundice, ALP+)
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Most common viral hepatitis
|
Hep A (Heb B from needles)
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Bloody diarrhea, flask-shaped lesion, anchovy paste liver
|
Ent. Histolytica (only ameobia to phagocytise RBCs)
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Cysts in the brain and seizures after eating uncooked pork
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Fecal-oral tranmission of T. solium
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Budd Chiari
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MCC Polycystemia Rubivera
|
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Prehepatic -> portal vein
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Posthepatic -> hepatic vein
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Metabolitic Acidosis w/ increased anion gap, fibrotic liver
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Alcoholic liver damage due protein bound acetylaldehyde
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Jaundice w/ itching in female
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Cholelithisis
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Itching w/ NO jaundice
|
Primary Biliary Cirrhosis, granulomatis autoimmune portal triad destruction, increased cholesterol/Xanthomas, elevated alk phos. + bilirubin (late stage)
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Urobilinogen
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no color in urine (-ogen)
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Liver cell adenoma
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due to birth control/steroids causing benign intrahepatic cholestatis
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Hemochromatosis
|
AR genetic disease of excess Fe (DM I, fat malabsorption, etc)
|
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Hemosiderosis
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acquired by high Fe -> alcoholic, elderly (high serum Fe, low TIBC)
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Adults w/ ascites
|
E. coli === Child w/ ascites -> Strep Pneumo
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Pigment stone with leukocytosis, anemia and family hx of splenectomy
|
Congenital Spherocytosis
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C.F.
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3 nucleotide deletion of phenylalanine, lack of post-translational modification in the Golgi
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10 days post acute pancreatitis w/ high amylase
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CT of Pancreatic pseudocyst
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RUQ w/ dystrophic calcifications
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Chronic Pancreatitis (takes time to build up Ca++)
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Localized ileus with air + lack of peristalsis
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Acute Pancreatitis AKA "Sentinel sign"
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Hypotonic urine in the AM, 1.010 specific gravity
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first sign of renal failure and cheapest test (better than BUN/Cr)
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Hyaline cast
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protein, benign
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Ca oxalate
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most common kidney stone, found in ethylene gylcol poisoning
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"Worst headache of my life"
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Subarchnoid Hemorrhage
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Combo of renal tubular casts, oliguria, BUN/Cr of 10:1
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Ischemic Acute Tubular Necrosis, (- in CO with dehydration), damage to BM, straight prox. tubule and thick ascending limb (Na/K/2Cl)
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Most common drug nephrotoxicity
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Aminoglyosides, ie. Gentamyocin, etc
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Fever, flank pain, and WBC casts
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Acute Pyelonephritis, due to incompetent vesicourethral junction
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Blunting of the calyces (due to scarring)
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Chronic Pyelonephritis
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Renal papillary necrosis
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Aspirin + Acetomenphen due to free rad. + ischemia
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Chronic Renal Failure
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Metabolic Acidosis-> Osteoperosis-> Hypovitaminosis D (PTH-> 1a hyd.)-> Osteomalacia, decrease Ca+, Phos-> Hyperparathroidism
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kidney with cobblestone appearance
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nephrosclerosis due to 10+ years of HTN
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Flea bitten kidney with visable petechia
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Malignant HTN
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Absent iris and hemihypertrophy of an extremity
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Wilm's tumor, chrom 11, AD
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UTI w/ no bacteria detected
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TB or Chalmydia
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Empydidemas over the age of 35
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Pseudomonas
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Left side spermatic vein connected to Left renal vein (Nutcracker Varicocele)
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Right spermatic vein connects to IVC
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MC Testicular Cancer in a child
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Yolk sac tumor (AFP), think young egg-> yolk
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25 yo male with unilateral gynecomastia and dyspnea w/ lung masses
|
metastatic chronangiocarcinoma (+BHCG), worst prognosis
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DHEA sulfate
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androgen/test. production in female adrenal glands
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|
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Polycystic Ovarian Syndrome
|
+LH (responsible for synthesis of theca interna) -FSH (not there to develop follicles= cysts)
Risk for Endometrial Adenocarcinoma (converts high estrogens) |
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Painful Menses
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too much PGF
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Anovulatory bleeding
|
MCC of abnormal bleeding in women 20-30; too much estrogen, not enough progesterone
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Repeated dilatation/curotashes along the stratum basalis
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Asherman's Syndrome, lack of endometrial mucosa-> infertility
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Chocolate cyst, pain of defecation
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Endometriosis (estrogen glands outside)
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45/55/65
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Cervical/Endometrial/Ovarian
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Follicular cyst
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MCC of ovarian mass in a young woman
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Meigs syndrome
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ovarian fibroma, ascites, right sided pleural effusion
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MC surface derived benign; serous cystadenoma
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Psammoma bodies-> cancerous serious cystadenocarcinoma
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Cystic teratoma making thyroid
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struma ovary
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Outside layer making hormones in the placenta
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SYNcytiotrophoblast (SYNthesis of B-hcG and HPL)
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MCC of bloody nipple discharge under 50
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Intraductal papilloma, which is benign
|
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Pagets disease of the breast
|
red rash on the nipple, invasive carcinoma
|
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Bilateral breast tumor
|
lobular carcinoma, not picked up on mammography, MC tumor
|
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Complete mole, spontaneous abortion, normal pregnancy
|
choriocarcinoma; malignancy of trophoblastic tissue
|
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|
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Young woman w/ mobile firm mass, changes w/ cycle
|
Fibroadenoma (AKA Sclerosing adenosis)
|
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Caseous necrosis in the breast, filled with junk
|
comedocarcinoma
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|
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MCC of Breast Cancer
|
invasive ductal, nonspecific type
|
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Masectectomy w/ winged scapula
|
cut the long thoracic nerve
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Making too much ACTH
|
Cushing's (check w/ dexamthasone)
|
|
|
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Coagulative necrosis of the pituitary
|
Sheehan's syndrome
|
|
|
|
craniopharyngioma
|
MCC of bitemporal hemianopsia and headaches in children (Rathke's pouch origin, benign)
|
|
|
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Histidine and arginine
|
def. in Growth hormone defect, both basic aa
|
|
|
|
Low urine osm and polyuria post car accident
|
Central D.I.
|
|
|
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Urine osm above 100
|
suspect SIADH
|
|
|
|
Galactorrhea
|
remember to rule out hypothyroidism w/ a TSH level test
|
|
|
|
I 131 test
|
differential on hyperparathyroidism; increased reuptake-> Graves (hypertrophy), decrease reuptake-> taking pills (atrophy)
|
|
|
|
Midline cyst
|
Thyroglossal
|
|
|
|
Anterolateral cyst
|
branchiocleft derivatives
|
|
|
|
Exophalmos
|
due to excess GAG in Graves, test for A.Fib
|
|
|
|
T4 increases synthesis of Beta receptors
|
Treat Grave's dx w/ beta blockers
|
|
|
|
Diffuse goiter
|
MCC Iodine def (Low TSH, High T4) <-acts like Graves
|
|
|
|
pit tumor, parathyroid adenoma, pancreatic tumor (usually Zolinger Ellison, leading to peptic ulcer)
|
MEN1
|
|
|
|
medullary carcinoma, pituitary , pheochromocytoma
|
MEN IIa
|
|
|
|
medullary carcinoma, pheochromocytoma, mucosal neuroma
|
MEN IIb
|
|
|
|
Cold nodule, Psammoma bodies, Orphan Annie eyes, spreads to lymph nodes
|
Papillary cancer, easy to treat, most common
|
|
|
|
Thryroid cancer spreads to the lung and bones
|
Follicular cancer (death sentence)
|
|
|
|
Thryroid with congo red/birefrigent amyloid A, Calcitonin marker
|
Medullary cancer (think MEN IIa/b), Ret oncogene
|
|
|
|
MCC of hypocalcemia
|
low albumin (binding protein for Ca++)
|
|
|
|
Cushing's vs. Cushingoid obesity
|
24 urine cortisol test
|
|
|
|
Cushing's appearance w/ lung masses
|
small cell lung cancer
|
|
|
|
Carpal spasm w/ BP cuff (Trousseau's sign)
|
like Chvostek's sign, indicates Hypoparathyroidism (low Ca++)
|
|
|
|
HTN, hypernatremia, hypokalemia, and metabolic alkalosis
|
Patient has Conn's sydrome AKA Primary Aldosteronism
|
|
|
|
MCC meningitis in AIDS patient
|
Cryptococcus, india ink, narrow based circular budding
|
|
|
|
CD4 count of 50, space occupying lesion in brain CT
|
Toxoplasmosis
|
|
|
|
Periventricular calicifications in brain
|
CMV
|
|
|
|
CN 8 Brain tumor
|
Schwannoma
|
|
|
|
Optic nerve tumor
|
Meningioma
|
|
|
|
Precocious puberty, café au lait, bone zits
|
Albright's (look for women with short stature, maybe missing 4/5 digit-> Pseudohypoparathyroidism)
|
|
|
|
Hemartomas of the kidney called angiomyolipomas, MR, cardiac tumors (rhabdomyomas), ashgreen patches, areas of hypopigmentation, woods light shine out
|
Tuberous Sclerosis
|
|
|
|
Down and out oculomotor nerve palsy of pupil
|
Uncal herniation
|
|
|
|
No cerebellar vermis
|
Dandy Walker syndrome
|
|
|
|
Hydrocephalus with flattened base of the skull
|
Arnold Chiari, enlarged foreman magnum pulls down spinal chord
|
|
|
|
Fluid out of the ear post injury
|
fracture of basilar plate (spinal fluid leakage)
|
|
|
|
Pyridostigmine
|
long acting tx of Myasthenia gravis
|
|
|
|
B-cell hyperplasia seen in the thymus
|
found in pathology of Myasthenia gravis; germinal follicle proliferation
|
|
|
|
Anti-dsDNA
|
Kidney disease w/ Lupus
|
|
|
|
Like CREST (Anti-centromere), but with kidney disease
|
Progressive Systemic Sclerosis (Scl-70) aka Scleroderma
|
|
|
|
Raccoon's rash around the eyes, Anti-Jo, proximal muscle weakness
|
+Aldolase, +CK -> Dermatomyositis
|
|
|
|
Poxvirus, DNA linear, replicates in the cytoplasm
|
Molluscum contagiosum
|
|
|
|
Dysplastic Nevus Syndrome
|
100+ nevi, precursor to malignant melanoma
|
|
|
|
Melanoma on palms or soles of feet in black guy
|
Acroletiginous, most aggressive melanoma
|
|
|
|
Amyloid in Beta islets
|
Type 2 DM
|
|
|
|
Yellow crystal, NEGATIVELY birefringent
|
Gout (Metabolic acidosis) [toes pointing down]
|
|
|
|
Blue crystal, POSITIVELY birefringent
|
Pseudogout (calcium pyrophosphate)
|
|
|
|
Pt w/ RA develops macrocytic anemia
|
Methotrexate (RA = IgG )
|
|
|
|
Chlamydia history with conjunctivitis, arthritis, tendonitis in Achilles tendon
|
Reiter's syndrome
|
|
|
|
Disseminated gonorrhea
|
defect in complement system C5-C9 (MAC)
|
|
|
|
Osteomalacia
|
organic part of bone is normal i.e. cartilage, osteoid; decrease only in mineral component
|
|
|
|
Adolescent, sun burst app, codmans triangle, knee area
|
Osteogenic sarcoma (Rb 13 gene)
|
|
|
|
Missing dystrophin protein
|
Duchenne's muscular dystrophy (what a surprize)
|
|
|
|
Palpable purpura
|
small vessel vasculitis (99% Type III Hypersensitivity)
|
|
|
|
Infarction NOT palpable purpura
|
muscular artery vasculitis, ie. Polyarteritis Nodosa, Wegener's, Kawasaki-> coronary artery vasculitis
|
|
|
|
Takayasu's
|
predisposed to strokes due to elastic artery def. in lumen
|
|
|
|
Temporal Arteritis
|
associated w/ polymyalgia rheumatica – muscle aches and pains NOT polymyositis
|
|
|
|
Renal (take a piss) or get pneumonia (granulomatous)
|
c-ANCA, Wegener's tx: cyclophosphamide
|
|
|
|
p-ANCA, hematuria, and Hep B surface Ag
|
Polyarteritis Nodosa (nodular mass)
|
|
|
|
Raynaud's
|
IgM cold agglutinin dz or cryoglobinemia in old man with Hep C
|
|
|
|
Calcinosis (dystrophic calcification), Centromere Ab (specific for crest syndrome), Raynaud’s, Esophageal dysmotility, Sclerodactyly (finger that is very narrow), Telangiectasia
|
CREST syndrome (not renal)
|
|
|
|
Lenticulostriate vessel rupture from HTN in MCA
|
Charcot Bouchard aneurysms
|
|
|
|
Sturge Weber
|
AV malformations in the brain, not just the CN V3
|
|
|
|
Nosebleeds, telangiectasia, lung problems
|
Osler Weber Rendu aka Hereditary hemorrhagic telangiectasia
|
|
|
|
bacillary angiomatosis – due to bartenella hensilai
|
seen w/ silver stain, tx: Sulfa drug
|
|
|
|
smoker with primary lung cancer, now complaining of headache and blurry vision, retinal vein engorgement
|
Superior vena cava lung syndrome
|
|
|
|
Pregnant women are susceptible to dissecting aortic aneurysms
|
also consider dilutional anemia
|
|
|
|
Cystic medial necrosis, GAG's mix together w/ mucinous material
|
proximal dissection aka post AA cardiac tamponade
|
|
|
|
3' Syphillus
|
stretching of aortic valve ring, leading to aortic regurg and murmur
|
|
|
|
Nonenzymatic glycosylation to the basement membrane in DM
|
permeable to protein, hyaline change ie. microalbuminuria; first change in diabetic nephropathy
|
|
|
|
GnRH analog with agonist/antagonist properties
|
Leuprolide, Goserelin
(Sweet Lou is on GH) |
|
|
|
5-alpha reductase inhibitor
|
Finasteride
|
|
|
|
Antidote for increased bleeding i.e. streptokinase, tPa, (+plasminogen)
|
Aminocaproic acid
|
|
|
|
80% of cholelithiasis
|
Cholesterol monohydrate stones (yellow in photos, invisible on X-ray)
|
|
|
|
Alkaline Phosphatase
|
specific to the bile ducts and biliary tree
|
|
|
|
MCC of GI disturbance in 1 month old
|
Pyloric Stenosis (projectile vomiting w/ bile, olive sized mass)
|
|
|
|
MCC of GI disturbance in 3 month- 6 years
|
Intussusseption
|
|
