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388 Cards in this Set

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Amiodarone sx:
thyroid disfunction, blue skin, corneal deposits, drug induced hepatitis, pulmonary fibrosis
digoxin
decrease in intracellular K+, changes in color, beware of arrhythmias
Chloramphenichol sx:
Aplastic anemia
Gentamyocin
vestibular and cholear ototoxicity
Acyclovir
monophosphorylation of thymidine kinase, active Herpes (no affect on dormant HSV or ZVZ), EBV
Herpes Zoster= Famcyclovir
Ganciclovir
viral DNA polymerase structure, CMV in immunocompromised patients
-navir sx:
Protein pump inhibitor; buffalo hump, hyperglycemia, p450 inhibitor [avoid rifampin]
Foscarnet
nephrotoxicity, electrolyte disturbances
Pentazocine
partial u agonist, k agonist
Haloperidol (tourettes)
neuroleptic maglinant syndrome
Vancomyocin resistance
d-ala d-ala to d-lac d-ala in VR enterococci
Penicillin resistance
b-lactamase or low affinity PABA
Tetracyclin
high efflux, or works around the ribosome
CHF DM is
ACE
Hypothyroidism
Lithium toxicity
Risperidone
Hyperprolactinemia, also causes amenorrhea when used for schitzophrenia
Dopamine
increases anxiety and agitation in the brain
PABA mutation
methicillin resistant Staph
Chlamydia
intracellular [Chla= cloak], has no peptidoglycan cell wall
Rifampin
N. meningitis profilaxis
_____rubicin cancer treatment sx:
DILATED cardiomyopathy
Procainimide, Hydralizine
Drug induced lupus
TCA
Urinary retention in BPH
Desmo ????
Anti-dote in vWB disease, acts on endothelial lining
Aspart and Lispro
Fast acting DM insulin
Phenytoin
male like appearance, pseudothyroidism, gum hyperplasia
Massive hepatic necrosis post surgery
halothane exposure
Microvascular hepatic damage
Reyes syndrome
Flutamide
non-steroidal competitive androgen receptor binder (Prostate cancer)
Ketoconazole
inhibits steroid synthesis (prevent hirsuitism in Polycystic Ovarian Syndrome)
Spirolactone
inhibits steroid binding (prevent hirsuitism in Polycystic Ovarian Syndrome)
Amiloride, Spirolactone, triamtirene, epleronone
K+ sparing diuretic
Ticlopidine
ADP, rare neutropenia w/ mouth ulcers
Theca interna
produce androgens
Granulosa cells
convert androgens to estrogen under control of FSH
Type II pneumoncytes
surfactant production and alveolar regeneration
NF- KB
??? Cytokine production in Chron's disease
Thyroid Binding Globulin
total T4 increases due to increased TBG during pregnancy, estrogen therapy, or oral contraceptives
Tryptase
Mast cell degranulation
5-Hydroxyindolycic acid
5-HIA= serotonin marker, ie. carcinoid syndrome
Homeobox genes
code for transcription factors of genes
pol gene in HIV
mutates during reverse transcription treatment
Env gene in HIV
evades host neutralizing antibodies
E.coli that does NOT produce glucuronidase
0157:H7 EHEC- Shiga like toxin
melanocytes
location of skin cancer, derived from neural crest cells
Allopurinol
use as a prophylaxis in ongoing gout, NSAIDS are the best for acute treatment
Mitral valve prolapse
most common cause of native endocarditis
M for Myosin
A for Actin
M----yosin is wider
Actin is narrower
Where does Ca bind on the muscle
Troponin C
Amphoteracin B
tears a hole in the pores, by binding ergosterol
Azoles
inhibit ergosterol synthesis
Caspofungin
inhibits synthesis of cell wall polysaccharide, used in Aspergillosis
a2
auto inhibitor of NE at presynapse
Fevers, chills, hypotension in fungal therapy
Ampho"terrible"
naloxone
IV treatment, so shorter half-life than most opiates
Gemfibrozil
use to treat hypertriglyceridemia, decreases VLDL
Calcium channel blockers
used to treat berry aneurisms following vasospasms
treat any non-NSAID, H.Pylori ulcer with
Antibiotics (ie. metro and tetracyclin)
Anaphilaxis or asthma
treat with epinephrine
Corticosteroids
use to treat adrenal crisis, ie. hyperpigmentation and shock
Dexrazonane
Doxyrubin sx. prevention
Filgrastim
G-CSF
Leucovorin
Methotrexate sx. preventition (folic acid related)
Phentolamine
a1, a2 blocker
Acute myocarditis
in young adult-> viral, coxsackie B
Elevated ASO
Only Strept B from rheumatic heart fever, not an indication of IV endocarditis
Trousseau's sign, Pancreatic CA
Hypercoaguable state, beware of thrombosis
Atrial myxoma
ball-valve like blockage, results in syncope episodes, can spread to the brain
Contraction band necrosis
first sign of an MI
Neutrophil invasion
after the first day of an MI
Vaso vasora, tree bark
3rd Syphillus
MCC Contrictive Heart Disease
ie. Tamponade
Trauma, followed by cancer
AST, ALT
Normal 8-20

If AST 2x ALT, think alcohol
if 1:1 think viral
ALP
Think Pagets or bile duct obstruction
Atropine block Ach in the stomach mucus
M3 receptors
Pancreatitis w/ severe abdominal pain
patient has developed an ileus
Zencker's diverticulum
upper esophageal sphincter, due to crycopharrengeal disfunction
Macrophages
T-H1 cells
Case control study
looks at previous exposure between two groups
Mitochondria damage
irreversible injury
Jervell and Lange-Niesen
Prolonged QT disorder
Valsalva or standing up is the same physiologic effect
Decreases venous return, INCREASING Hypertrophic murmur
Jugular Venous Dystention
Cardiac Tamponade
False negative
Subtract the number of people who aren't picked up by sensitivity test from the # of people with the disease
Maternity "blues"
lasts 10 days, if longer-> post-partum depression
Inhaled anthetics
increase cerebral blood flow
Carbamazipine
Na blocker, agranulocytosis
B-blockers affect on Thryroid
blocks convertion of T4 to T3
Gibbs free energy
if -G, then the reaction is favored
Carotid body
Plan B in people with hypercapnia (increased C02)
ACUTE Gout
Tx: Colchine
Stone Cold treatment for Gout
Post-Berry Aneurism
Vasospasm
Maternal inheiritance
Think mitrochondrial
Leber's hereditary= blindness
Myoclonic ___ = ragged red fibers
T-rna (looks like a cross)
3' bottom binds to AA
Top part is anticodon:codon
Branched chain a-keto glu amino acid disease
treat with high dose thiamine
Thiamine def.
Memory loss from Korsakoff is PERMANENT
5' to 3' exonucleus activity is only found in...
DNA Pol. 1 (it's the only one!) used to remove RNA primers
Foramen Ovale
Mandibular V3 nerve
Citrulline (feeds in) and Orinthine (feeds out)
Urea cycle
(N-acetylglutamate is #1 step in the mitochondria)
Primary CNS lymphoma
#1 solitary tumor found in AIDS, made up of B-cells, associated with EBV
Valine for Glutamate on the Beta Chain
Sickle Cell Anemia, which affects oxygen unloading
Increased HbA2, looks like poorly controlled DM
Beta-thal trait
Factor V Leiden def.
Think Pulmonary Embolism or DVT
Rate limiting step in heme production
ALA synthase
Control group
Estimate exposure rate among the general population
ALL with mediastinal mass
= T-cell leukemia (more rare)
Severe sickle cell case
The patient looses function in the spleen, think encapsulated bugs
Infliximab
TNF-alpha binder, used to treat RA
CD55 and CD59 def
Paraxomal Nocturnal Hemoglobinuria
Thalassemias
lead to defective mRNA processing
Hemolytic Anemia
associated with lower Haptoglobin levels and HUS
Sickle cell death
due to vascular-occultion crisis
Lipoic Acid (B4)
without this, not Krebs cycle -> increase in lactic acid
Alkapotonuria
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]
Collagen
made entirely in the RER (only one)
B12
used to create Methionine
B6
used to create Cystiene
Homocystienurea
back in either B6/Cystiene or B12/Methione pathway, causes Marfanoid symptoms with eyes looking down
Glycerol Kinase
TGA-> Fatty acids converted into Glycerol only in the liver
Fibrillin 1
Marfans
Galactosemia
so, lack of Galactokinase to phos. into Gal-1-P leads to build up in eyes, converted to galactitol by aldose reductase-> CATARACTS
Nucleolus
contains rRNA-> aka RIBOSOMAL
-need these ribosomes as machinery to build proteins
HMP Shunt
-creates NADPH, used in cholesterol and fatty synthesis
-also Glutathione reductase (RBC)
Albinism
Tyrosinase def., no neuro problems like PKU (i.e. musty odor)
PKU
defect in phenylalanine hydroxylase or
TETRAHYDRObiopterin cofactor (due to Dihydrobipterin reductase)
Vitamin A
prevents measles (Koplik's spots)
Ehlers-Danlos
due to defective cleaving at the disulfide bond terminals
Tetrahydrobiopterin
used in Phenyl/Tyro/DOPA and
Tryptophan/Serotonin pathway
Able to swallow liquids, not solids, smoker
mid-> Squamous Cell carcinoma
Esophageal varices
left gastric vein, into esophag.
Bad breath and upper diverticulum
Zencker's, weakness of cricopharengeous muscle
Bleeding from the nose
platelet problem
Dysphagia with solids and liquids, cold at the finger tips
CREST syndrome
Dysphagia with solids and liquids, coughing up food at night
Achalasia
Keratin pearls, appears on heads/neck
Squamous cell, precursor is actinic keratosis
Central ulceration, above lip skin cancer
Basal cell "nests"
Hairy Leukoplakia
EBV
Large rugal folds
Menetriere's Dx, low albumin, hyperplasia of mucus-secretion
Foramen Ovale
V3 (O-face with Ovale)
CFTR 7 deletion of Phe
blocks Cl- inside the cell, more Na+ on the outside
Child with rhabdomyoma
associated w/ Tuberous sclerosis
(ashspot, hamartomas, renal angiodygenesis)
Ball and valve tumor with + JVP on inspiration
Cardiac Myxoma in LA (+ VEGF)
Valsalva and gets softer
Aortic Stenosis
Valsalva and gets louder
Hypertrophic Cardiomyopathy
JVP, Pulsus Paradoxis, Kussmaul breath
Pericardial effusion, Tx: Echo to confirm
Hand/Foot/Mouth dz with myocarditis
Coxsackie A, B virus
Roth spots, Osler nodes, Janeway lesions
Type III hypersensitivity rxns
Endocarditis w/ colon cancer
strept bovis group D , bile sensitive
Immediate death in Marfan's
due to mitral valve prolapse, NOT aortic rupture which takes time
Left Atrium
closest to the esophageous and left recurrent laryngeal nerve, causing hoarseness
Rheumatic Fever heart murmur
results in acute mitral regurg, since mitral stenosis takes 10 years to develop
Myoximatosis Degeneration
Mitral valve prolapse due to build up in dermatin sulfate/GAG
3 weeks post MI systolic bulge of the pericardium
ventricular aneurysm
6 weeks after mural thrombosis, friction rub
autoimmune pericarditis AKA Dressler's, nonimmune takes only 1 week
Posteriormedial papillary muscle rupture
MC in 3-7 post MI injury, leading to mitral regurg.
RCA
supplies the AV node, can present as epigastric pain
tPa
changes plasminogen to plasma, busts up fibrin
Chronic Heart Disease
fibrous tissue replaces the LV muscle, indication for heart transplant
Sudden Death Syndrome
heart stops withing one hour, NO thrombosis or change; high risk in smokers
cause: "ISCHEMIC HEART DISEASE" (??)
PDA
Rubella and differential cyanosis
ASD
Fetal ALCOHOL syndrome, fixed S2 splitting, paradoxical embolism
Umbilical veins
highest O2 content in the fetus (remember it's flipped in the mother/baby)
6.5 Na/CL or bile resistant
Enterococcus it has to be salt and bile rest. to live in the gut
Optochin resistant
Strept Viridans (still Vira after a blow to the chin)
DiGeorge's
T-cell def. (ie. fungal infections), Chromosome 22q, cleft palate
Hydroxyurea
inhibits ribonucleotide reductase
Allopurinol
useful only in prophilaxis of gout not acutely
Addison's
diagnose w/ ACTH stimulation test, low corisol, dark skin
Heberden's "Osteoarthritis" Nodules
treat with Acetominophen
Telangetasia on the lips, AV shunts in the lungs
Osler-Weber-Rendau
Delta wave
Wolff-Parkinson-White (tx: Amiodarone)
Macular pigmentation of oral mucosa w/ GI hamartoma
Peutz-Jegher (not a cancer risk, hereditary)
AD heriditary polyposis w/ boney masses around the rest of the body
Gardener's syndrome
Recurrent abortions and + PTT
Antiphospholipid antibody syndrome Tx: Warfarin
Porphyria cutanea tarda
most common purphyria, Uroporphyrinogen decarboxylase def. with tea colored urine
(Uroporphyrinogen III can't remove CO2)
AcCoA
pathway to start Cholesterol, increased in alcholism
LTB4
chemotactic to neutrophils
Phosphotidylcholine
same as Lecthin
Zileutin
inhibits lipooxygenase directly (-lukasts block the receptor)
Cromolyn, Nedacromyl
Mast cells degranulation blocker
SRS-A
most potent vasoconstrictor, aka LTC4D4E4
B-thal
causes 2' hemosiderosis due to blood transfusions
Hematochezia
#1 Diverticulosis
#2 Angiodysplasia
Hematemesis, pain in RLQ, and melena
Menckel's diverticulum
Air in the biliary tree with gailstone pain
gailstone ileus (ileocecal valve obstruction)
Osmotic diarrhea
lactose deficiency, brush border, etc
MC infection transmitted by blood transfusion
"CMV (virus= #1)
MCC jaundice in the first 24 hrs for a newborn = ABO incompatibility
baby will be severely anemic with Rh than will ABO incompatibility [ABO incompatibility protects against Rh sensitization]
Air in the biliary tree with gailstone pain
gailstone ileus (ileocecal valve obstruction)
Osmotic diarrhea
lactose deficiency
Air in the urine
colevesicular fistula (MCC diverticulosis)
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
Neural Crest Derivatives (S+100)
melanoma; small cell carcinoma of the lung; bronchial carcinoid; carcinoid tumor at the tip of the appendix; neuroblastoma (secretory tumor)
S-100 + neural crest tumors
girl having necrotic mass coming out of her vagina, Vimentin and keratin “-“, and desmin “+”
Embryonal rhabdomyosarcoma
Movable mass at angle of jaw = mixed tumor (in parotid)
MC overall salivary gland tumor (usually b9)
16 y/o girl with sudden onset of RLQ pain, calcifications of the pelvic area
Cystic teratoma, usually develop in midline – germ cell tumor
Auer rods
AML M3 (16:18)
MC site in body for lymphoma NOT developing in lymph node
stomach
MC lymphoma = follicular B cell lymphoma
knocking off apoptosis gene -14:18, B cells will make bcl-2, which inactivates apoptotic gene
MC cancer that metastasis to bone
breast cancer b/c the batsom system, breast to lung as well
MC cancer of liver
metastasis from lung into liver (not colon – colon is 2nd b/c portal vein drainage)
Where would testicular cancer metastasize first?
Paraortic lymph nodes; NOT the inguinal lymph nodes b/c it derived from the abdomen, and then descended
The MC primary metastasize to Virchow’s nodes?
stomach cancer!
Prostate cancer is blastic!
releases alkaline phosphatase
MC primary site for cancer in brain
lung
desmin
good stain for muscle – ie used for rhabdomyosarcoma
keratin
most carcinomas have keratin in it, therefore stain for that
nuclear transcribers in the nucleus
myc protooncogenes
p53 + rb suppressor gene and the ras oncogenes
point mutation (all suppressor genes are from point mutations)
erb-2
amplification system, creates receptors in breast cancer
CML translocation of abl
increase tyrosine kinase activity of 9:22, tx: Imantinib
Translocation of 14:18; inactivation of suppressor gene
Follicular B cell lymphoma (deadly non-Hodkins type)
Translocation 15:17
acute progranulocytic leukemia; Rx – Vit A (retinoic acid) b/c it matures the blasts, therefore the malignant cell becomes B9
p53, Rb gene, adenomatos polyposis coli (familial polyposis), neurofibromatosis, wilm’s tumor gene, brca1 and 2
All key suppressor genes
Wegener’s granulomatosis, put on a drug and got hematuria, did cytology and saw cells, what drug is pt on?
Cyclophosphamide (hemorrhagic cystitis); prevent with mesna, and can cause transitional cell carcinoma
nasopharyngeal carcinoma, esp. in Chinese/Burkitts
EBV
rapidly increasing incidence of primary CNS lymphoma can be directly attributed to...
HIV
MC leukemia assoc with radiation
CML (9, 22 translocation of abl) also metastatic papillary carcinoma of the thyroid in cervical nodes
Mutated in hereditary nonpolyposis
Mismatch repair def.
Mutated in Xeroderma Pigmentosum
Nucleotide excision repair
wiskott Aldrich, Blooms, Ataxia Telangiectasias, and Fanconi’s
chromosomal instability syndromes, problems w/ DNA repair
Cachexia, Septic shock
TNF-alpha, causes catabolic muscle wasting
thrombocytosis
Fe def, splenectomy (ie see scar on abdomen), TB, anemias, #1 cancer
MC Paraneoplastic syndrome
hypercalcemia, also look for clubbing in primary lung disease
vegetations (sterile) on the mitral valve
marantic endocarditis-aka nonbacterial thrombotic endocarditis, associated w/ colon cancer
Hypoglycemia or secondary polycythemia
Hepatocellular carcinoma (they can make EPO or insulin-like factor)
MC primary tumor of the brain in kids?
Cerebellar cystic astrocytoma (B9).
Fe def = MC and Anemia of chronic dz, thalassemias, sideroblastic anemias
MCV < 80: Microcytic anemia’s
B12/Folate def = MC; usually folate def in an alcoholic
MCV > 100: Macrocytic anemia’s
low reticulocyte ct corrected: aplastic anemia, renal dz; high corrected reticulocyte ct: hemolytic anemias – hereditary spherocytosis, sickle cell, G6PD def, autoimmune hemolytic anemia, microangiopathic
MCV 80-100: Normocytic anemia’s:
Target cells
imp markers for alcoholics
distinguish between IDA and ACDz
there are high ferritin levels in ACDz, whereas there is a high TIBC in Fe def anemia
Low MCV Sideroblastic Anemia
1. Alcohol 2. G6PD def (low B6), XR. 3. Pb poisoning (low ferrochelatase, + protoporphyrin)
has to do with splicing defects, stop codons, die from Fe overload, Hep C or HIV
Beta-thal (over-transfusion)
Not making any Beta chains, dead by 30
Cooley's anemia
MC thal in black people
beta-delta thalassemia, aka hereditary persistance of HbF
Deposit in epiphysis, failure to grow, cerebral edema, abdominal colic
Lead poisoning
prob with making DMP (deoxythymidine monophosphate)
Macrocytic anemias
Purpose of cobalamin (B12)
take the methyl group off of methyltetrahydrofolate [folate]. Then it’s called tetrahydrofolate
high serum homocysteine
produces thromboses, including MI’s; it damages endothelial cells, leading to thromboses, and predisposing to MI (B12 or Folate def)
odd chain FA metabolism into Succinyl CoA
B12, most importantly Proprionyl CoA which causes dementia and proprioception loss
R factor
protects B12 (ileum->Chrohn's) from acid destruction in the stomach, from saliva
Colicky RLQ pain w/ diarrhea in young person
Crohn's disease is ONLY cause in young person
sclerosing pericholangitis
MCC: UC, fibrous "onion skin" around common bile duct w/ "beading", cholangiocarcinoma
beading = constriction and dilation of intrahepatic bile ducts
Painless bleeding polyp sticking out of an adult's ass
internal hemorrodes bleed, external hemorrodes thrombosis
100+ polyps
APC 5 gene AD mutation, also ras, p53 mutation Familial Polyposis
Polyps with brain tumors
Turcot's (think "turban"), AR
Flushing, diarrhea, Right sided tricuspid insufficieny + pulmonic stenosis
Serotonin synd spread from the tip of the appendix to the TERMINAL ILEUM (hepatic mtx)
NOT associated w/ CEA cancer
Peutz-Jagher, hyperplastic/juevenile polyposis
Adenovirus causing lymphoid tissue hyperplasia
MCC of appendicitis in children
Primary unconjugated bilirubin
due to a hemolytic dx, increasing breakdown of RBCs
Dark urine (due to bilirubin), clay colored stools, high conjugated bilirubin
obstruction of bile duct (MCC: Common Bile Duct, possible head of pancreas CA)
Gilbert's
loss of conjugating enzyme, jaundice under stress
Increase in Alkaline Phosphatase and GGT
bile duct obstruction (causing liver damage, ie. alcoholic hepatatis)
Decreased Albumin (protime) and increased PT
marker of severe liver damage
Anti-mitochondrial Abs
Primary Biliary Cirrhosis (CREST w/ jaundice, ALP+)
Most common viral hepatitis
Hep A (Heb B from needles)
Bloody diarrhea, flask-shaped lesion, anchovy paste liver
Ent. Histolytica (only ameobia to phagocytise RBCs)
Cysts in the brain and seizures after eating uncooked pork
Fecal-oral tranmission of T. solium
Budd Chiari
MCC Polycystemia Rubivera
Prehepatic -> portal vein
Posthepatic -> hepatic vein
Metabolitic Acidosis w/ increased anion gap, fibrotic liver
Alcoholic liver damage due protein bound acetylaldehyde
Jaundice w/ itching in female
Cholelithisis
Itching w/ NO jaundice
Primary Biliary Cirrhosis, granulomatis autoimmune portal triad destruction, increased cholesterol/Xanthomas, elevated alk phos. + bilirubin (late stage)
Urobilinogen
no color in urine (-ogen)
Liver cell adenoma
due to birth control/steroids causing benign intrahepatic cholestatis
Hemochromatosis
AR genetic disease of excess Fe (DM I, fat malabsorption, etc)
Hemosiderosis
acquired by high Fe -> alcoholic, elderly (high serum Fe, low TIBC)
Adults w/ ascites
E. coli === Child w/ ascites -> Strep Pneumo
Pigment stone with leukocytosis, anemia and family hx of splenectomy
Congenital Spherocytosis
C.F.
3 nucleotide deletion of phenylalanine, lack of post-translational modification in the Golgi
10 days post acute pancreatitis w/ high amylase
CT of Pancreatic pseudocyst
RUQ w/ dystrophic calcifications
Chronic Pancreatitis (takes time to build up Ca++)
Localized ileus with air + lack of peristalsis
Acute Pancreatitis AKA "Sentinel sign"
Hypotonic urine in the AM, 1.010 specific gravity
first sign of renal failure and cheapest test (better than BUN/Cr)
Hyaline cast
protein, benign
Ca oxalate
most common kidney stone, found in ethylene gylcol poisoning
"Worst headache of my life"
Subarchnoid Hemorrhage
Combo of renal tubular casts, oliguria, BUN/Cr of 10:1
Ischemic Acute Tubular Necrosis, (- in CO with dehydration), damage to BM, straight prox. tubule and thick ascending limb (Na/K/2Cl)
Most common drug nephrotoxicity
Aminoglyosides, ie. Gentamyocin, etc
Fever, flank pain, and WBC casts
Acute Pyelonephritis, due to incompetent vesicourethral junction
Blunting of the calyces (due to scarring)
Chronic Pyelonephritis
Renal papillary necrosis
Aspirin + Acetomenphen due to free rad. + ischemia
Chronic Renal Failure
Metabolic Acidosis-> Osteoperosis-> Hypovitaminosis D (PTH-> 1a hyd.)-> Osteomalacia, decrease Ca+, Phos-> Hyperparathroidism
kidney with cobblestone appearance
nephrosclerosis due to 10+ years of HTN
Flea bitten kidney with visable petechia
Malignant HTN
Absent iris and hemihypertrophy of an extremity
Wilm's tumor, chrom 11, AD
UTI w/ no bacteria detected
TB or Chalmydia
Empydidemas over the age of 35
Pseudomonas
Left side spermatic vein connected to Left renal vein (Nutcracker Varicocele)
Right spermatic vein connects to IVC
MC Testicular Cancer in a child
Yolk sac tumor (AFP), think young egg-> yolk
25 yo male with unilateral gynecomastia and dyspnea w/ lung masses
metastatic chronangiocarcinoma (+BHCG), worst prognosis
DHEA sulfate
androgen/test. production in female adrenal glands
Polycystic Ovarian Syndrome
+LH (responsible for synthesis of theca interna) -FSH (not there to develop follicles= cysts)
Risk for Endometrial Adenocarcinoma (converts high estrogens)
Painful Menses
too much PGF
Anovulatory bleeding
MCC of abnormal bleeding in women 20-30; too much estrogen, not enough progesterone
Repeated dilatation/curotashes along the stratum basalis
Asherman's Syndrome, lack of endometrial mucosa-> infertility
Chocolate cyst, pain of defecation
Endometriosis (estrogen glands outside)
45/55/65
Cervical/Endometrial/Ovarian
Follicular cyst
MCC of ovarian mass in a young woman
Meigs syndrome
ovarian fibroma, ascites, right sided pleural effusion
MC surface derived benign; serous cystadenoma
Psammoma bodies-> cancerous serious cystadenocarcinoma
Cystic teratoma making thyroid
struma ovary
Outside layer making hormones in the placenta
SYNcytiotrophoblast (SYNthesis of B-hcG and HPL)
MCC of bloody nipple discharge under 50
Intraductal papilloma, which is benign
Pagets disease of the breast
red rash on the nipple, invasive carcinoma
Bilateral breast tumor
lobular carcinoma, not picked up on mammography, MC tumor
Complete mole, spontaneous abortion, normal pregnancy
choriocarcinoma; malignancy of trophoblastic tissue
Young woman w/ mobile firm mass, changes w/ cycle
Fibroadenoma (AKA Sclerosing adenosis)
Caseous necrosis in the breast, filled with junk
comedocarcinoma
MCC of Breast Cancer
invasive ductal, nonspecific type
Masectectomy w/ winged scapula
cut the long thoracic nerve
Making too much ACTH
Cushing's (check w/ dexamthasone)
Coagulative necrosis of the pituitary
Sheehan's syndrome
craniopharyngioma
MCC of bitemporal hemianopsia and headaches in children (Rathke's pouch origin, benign)
Histidine and arginine
def. in Growth hormone defect, both basic aa
Low urine osm and polyuria post car accident
Central D.I.
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