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76 Cards in this Set

  • Front
  • Back
What are the majority of primary lung tumors due to?
smoking
What is the difference between a carcinoid tumor and a carcinoma and what are the different types?
carcinoid tumor = specialized serotonin and histamine-producing benign or malignant tumor arising usually from the GI mucosa (usually stomach or appendix) --> if it metastasizes to the liver, carcinoid syndrome may develop: flushing, diarrhea, bronchospasm, right heart valve lesions, hypotension
carcinoma - malignant tumor of epithelial origin with the first symptom being a new onset cough or a change in the frequency or character of a cough --> adenocarcinoma, squamous cell carinoma, large cell carcinoma, small cell carcinoma
Of the lung carcinomas, adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and small cell carincoma, which ones arise in the perphery? are NOT associated with smoking? and carries the the worst prognosis?
periphery - adenocarcinoma and large cell carcinoma
not with smoking - adenocarcinoma (with pre-existing lung fields)
worst prognosis = small cell carcinoma
Signs and symptoms of hematuria, red cells casts*, hypertension, edema, increased BUN and creatinine are associated with nephrotic or nephritic syndrome? does this have an acute or prolonged onset and what are a couple examples of this disease?
nephritic syndrome
acute onset
Post-strep glomerulonephritis
Goodpasture's syndrome
Diffuse proliferative glomerulonephritis
Signs and symptoms fo severe proteinuria, frothy urine, hypoalbuminemia, hyperlipidemia, edema are associated with nephrotic or nephritic syndrome? does this have a proloned or acute onset and what are a couple of examples of this disease?
Nephrotic syndrome
prolonged onset
Minimal change disease
Membranous GN
What is the most severe form of nephritic syndrome?
Rapidly Progressive Glomerulonephritis
What are the 3 types of RPGN and what are they caused by?
Type I RPGN (antibody-mediated cytotoxicity): idiopathic, Goodpasture's
Type II RPGN (immune complex disease): idiopathic, SLE, Henoch-Schonlein, post-infectious
Type III RPGN (pseudo-immune --> + ANCA disorders): idiopathic, Wegner's, microscopic polyangiitis, and occasionally, advanced, terminal polyarteritis nodosa
most common childhood nephrotic syndrome: on bioposy loss of foot processses
minimal change disease
most common adult nephrotic syndrome: on biopsy - thickened basement membranes with subepitehlial deposits of IgG and C3 complement in a "spike and dome" pattern
membranous glomerulonephritis
patient with a history of chornic ureteral reflux and heroin abuse; demonstrate hematuria, hypertension, and/or renal insuffiency; on biopsy --> sclerosis of the glomerulus in a focal and segmental pattern; this progresses to be a diffuse and global pattern that then causes chronic renal failure
focal segmental glomerulosclerosis (nephrotic)
hx of recent URI -->result of immune complex deposition; starts as a nephritic syndrome but can wind up as a nephrotic syndrome; on biopsy --> mesangial cell proliferation with capillary basement membrane thickening and splitting, plus subendothelial deposits of C3 complement; shows a "tram track" pattern
labs: decrease completment
membranoproliferative glomerulonephritis
occurs after a group A strep infection, + ASO titers and decreased C3 complement; biospy shows: mesangial proliferation with subepithelial deposits of IgG and C3 complement in a coarsely granular ("lumpy-bumpy" or "hump-like") pattern
acute porliferative glomerulonephritis
due to anti-GBM; deposited antibodies activate complement system and damage membranes, causing severe inflammation; biopsy - mesangial proliferation and linear depositions of IgG and C3 on bm. Crescnets in those who progress to RPGN
anti-glomerular basement membrane disease (Goodpasture's syndrome)
following a viral or GI infection; biopsy: focal and segmental glomerular mesangial prliferation, with IgA immune complex deposits; labs show increased IgA
IgA nephropathy (Berger's Disease)
biopsy: diffuse glomerulosclerosis - marked thickening of glomerular capillary basement membranes; known as diffuse diabetic glomerulosclerosis
diabetic glomerulosclerosis (Kimmelstiel-Wilson syndrome)
What is the most common cause of ATN? and what is the pathognomonic finding for it?
pre-renal acute renal failure; muddy brown casts
What is pre-renal acute renal failure due to?
due to hypoperfusion of kidney, with inadequate blood delivery to the glomerulus
due to: hypotension, dehydration, hemorrhage, severe congestive heart failure, and shock and reuslts in oliguria
What is acute renal failure due to and what are the associated lab findings?
many causes, all of which cause damage to the kidney tissue and its tubules; (ie acute tubular injury, acute glomerulonephritis, acute tubulointerstitial nephritis, acute vascular nephropathy, infiltrative diseases)
labs: hi BUN and creatinine, with a BUN:creatinine ratio of <10:1; there is also elevated potassium, sodium, magnesium, and chloride, with decreased calcium
What causes post-renal acute renal failure?
due to the obstruction of outflow from the urine.
BPH, bladder stone, B/L urolithiasis of the ureters, renal collecting system injury from trauma
What is CKD?
aka chronic renal disease or chronic renal failure
permanent reduction in renal function that progresses over weeks, months, and years
What do the majority of CKD cases occur secondary to?
diabetes, glomerulonephritis, or hypertension
What is the best treatment for calcium stones (restlessness!) and what is the back up treatment if this does not work?
oral and IV fluids; lithotripsy if unsuccessful
What type of disorder are cysteine stones due to and what nucleic acids have an impaired uptake?
cysteine, ornithine, arginine, lysine
AR- result of cystinuria
pH <4.5; white color; bready odor; micro = germ tubes + psuedohyphae
Candidiasis
pH >4.5; yellow-green color; putrid odor; micro = darting trichomonads
trichomonas - STI = treat the partner too!
pH > 4.5, grey-white color; fishy smell via + Whiff test; micro = clue cells - what is this caused by
bacterial vaginosis - caused by overgrowth of bacteria natural to vagina (ep Gardenella and Mobiluncus)
A patient presens with large palpable granulomas which develop on the inguinal lymph nodes and erupt on the skin surface - and is found primarily in the tropics- what is the DOC for this disease
Veneral disease - lymphogranuloma venereum - DOC = doxycyline
What disease is caused by Klebsiella granulomatis, visualized as a Donovan body and causes granulomas to develop on the genitals and block lymphatic drainage and what is the DOC?
Granuloma inguinale
tetracycline
What disease is caused by Hemophilus ducrei, found primarily in the tropics, and causes a "school of fish" appearance on microscopic exam and what is the DOC
Chancroid = produces soft PAINFUL cancre
DOC = cefrtiazone
How does Treponema pallidum - Syphilus present and what is the DOC to treat it?
DOC = pen G
1st stage = PAINLESS hard chancre
2nd stage = maculopapular red rash on palms, condyloma lata on genitals
3rd stage = gummas, tables dorsalis, psychosis, dementia, luetic aneruysm, aortitis, aortic regurgitation
What disease presents with hard, PAINLESS chancre?
What presents with a soft, PAINFUL chancre?
painless = stage 1 syphilus
painful == chancroid
Where is the most common sites for latency for oral and genital herpes? What test will be positive? and what is the DOC?
sensory ganglion cells (trigmenial ganglion for oral and lumbar and sacral ganglion for genital)
(+) Tzanck test on vesicular fluid (will see multi-nucleated giant cells)
DOC is acyclovir
What can Chlamydial cervicitis cause if left untreated and what is the DOC for it?
PID
doxycycline (plus ceftriaxone if gonorroea has not been ruled out by NAAT)
What causes painless enlargment of the testes around 35 that is the most common germ cell tumor and is always malignant?
Seminoma (analogous to the ovarian dysgerminoma)
What is painful testicular tumor with early metastases that occurs less than 35 years old that is the second most common germ cell tumor and has an elevated hCG and poor prognosis?
Embyonal
What testicular tumor is rare and has a peak in the teens-20s and is always malignant, analogous to the ovarian choriocarcioma, and presents with significantly elevated hCG?
Choriocarcinoma
What type of testicular tumor is also known as infantile type embyonal carcinoma or endodermal sinus tumor that peaks in infancy/ early childhood, is always malignant and presents with elevated serum alpha-fetoprotein?
Yolk Sac
What type of testicular tumor is comprised of 2 or more germ layers, is usually malignant because usually comprised of immature neoplastic cells, and has a variable age of occurrence?
Teratoma
How does a Leydig cell tumor (interstitial cell tumor) present pre- and post-puberty?
(+) intracytoplasmic Reinke crystals
precocious puberty if occurs before puberty
gynecomastia occurs post-puberty
Is a Sertoli cell tumor (androblastoma) usually benign or malignant?
usually benign and endocrinologically asymptomatic
Who do lymphomas usually occur in?
elderly and immunocompromised
What are the 5 types of surface epithlium tumors of the ovary and what age group are they associated with?
serous, mucinous, endometrioid, clear cell, Brenner
females >20
What tumor is always lined wtih cells like fallopian tube epithelium (ciliated and secreted a watery secretion) and is always cystic?
Serous
What tumor may yield pseudomyxoma peritonei (rupture of the mucinous cystadenocarcinoma to produce multiple intraperitoneal tumor implants) and is lined with columnar cells that produce mucus (cystic)?
Mucinous
What tumor is comproised of glandular tissues resembling endometrial tissue, is usually malignant, and is a solid tumor?
Endometrioid
What is a rare tumor that is comprised of large epithelial cells with large, clear cytoplasm? It sometimes occurs in association with endometriosis or endometroid carcinoma of the ovary and is usually malignant?
Clear Cell
What is a rare tumor also known as celioblastoma that is comprised of cells like those found in the baldder epithelium?
Brenner
What are the 4 types of germ cell tumors of ovary and what age group are they most common in?
women <20
teratoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma
What is a mature teratoma called and what is a rarer variety that only has 1 tissue element?
Dermoid cyst = mature teratoma
Stuma ovarii = only 1 tissues element and can result in the thyroid from hyperthyroidism
What type of ovarian germ tumor is like the seminoma of the testicle and is always malignant?
dysgerminoma
What ovarian germ cell tumor is like the yolk sac tumor of the testicle and is always malignant with an elevated alpha-fetoprotein?
endodermal sinus tumor
What ovarian germ cell tumor is a neoplasm of trophoblast (placental tissue) and is AGGRESSIVE, malignant and has extremely elevated hCG?
choriocarcinoma
What are the 3 major types of stromal sex cord tumors?
granulosa-theca cell tumor
Sertoli-Leydig cell tumor
fibroma
What type of stromal sex cord tumor secretes large quanitites of estrogen, has (+) Call-Exner bodies (follicle filled with eosinophilic material) and is associated with causing secondary endometrial hyperplasia or endometrial CA?
Granulosa-Theca Cell tumor
What is also known as an androblastoma or arrhenoblastoma that produces large quantities of testosterone and causes virilization in the female (clitoromegaly, hirsutism, deepening of the voice - irreversible)?
Sertoli-Leydig cell tumor
What is a benign stromal sex cord tumor that can cause Meig's syndrome --> ascites, pleural effusion, + ovarian tumor and is a solid tumor of spindle-shaped fibroblasts?
Fibroma
What is a signet-ring cell and what is it associated with?
cells of the Krunkenberg tumor that produces large quantities of mucin-intracytoplasmically, thus displacing the cell's nucleus (giving the appearance of a signet ring)
How do anti-tumor necrosis factor agents (thalidomide, pentoxyfilline, infliximab, and etanercept) work and and are they used for?
decrease inflammation by decreasing TNF effects or TNF levels
severe inflammatory conditions - rheumatoid arthritis
What is the DOC for acute attacks of gout and how does it work?
Colchicine - works by binding tubulin
What drug inhibits xanthine oxidase and can inhibit uric acid production thereby stopping gout?
Allopurinol
What drug should be used to treat chronic gout?
propenacid
What drug should never be used in the treatment of gout?
aspirin (NSAIDs are ok!)
What level is the sternal notch at?
T2
What level is the spine of the scapula at?
T3
What level is the sternal angle (Angle of Louis) at?
T4
What level is the angle of the scapula at?
T7
What are the two innominates joined at and which bones make them up?
joined at the acetabular notch
made up of: ilium, ischum, pubic bone
Why is the sacroiliac ligament considered different from the others and what does it do?
it is considered to be a true ligament (unlike sacrotuberous ligament, iliolumbar, and sacroiliac which are considered accessory)
three of them: anterior, posterior, and interosseous all of which aid in the stabilizaiton of the SI joints
Where does the sciatic nerve originiate from and what anomalies can exist in its anatomy?
branch of sacral plexus and originates from L4-S3; usually runs through the greater sciatic notch just below the pirifomis muscle; other anomalies can exist and and it can run through the muscle itself
How does the sacrum move during craniosacral extension and flexion?
craniosacral extension - "nutatae" --> sacrum "dips forward" into flexsion
craniosacral flexion - "counternutate" --> tips backward into extension
Is L5 rotation and SB opposite or ipsilateral with the sacrum's rotation and axis?
L5 rotation is opposite sacral rotation
L5 SB is ipsilateral to sacral SB
What is the difference between what a standing and seated flexion tests looks at?
standing flexion test --> innominates, sacrum AND LE
seated flexion test --> innominates and sacrum
What is the difference in the sypmtoms of how an anterior innominate and posterior innominate would present?
anterior innominate --> hamstring tightness, sciatica (due to piriformis dysfunction) with a longer leg ipsilaterally (ASIS inferior, PSIS superior)

posterior innominate --> groin pain, and/or medial knee pain with a short leg ipsilaterally (ASIS superior with PSIS inferior)
What is the difference between how a superior and inferior innominate shear would present?
superior --> pelvic pain or contralateral SI joint pain and/or low back pain --> from a fall or thurst up the ipsilateral gluteal area (ie surprise step off a curb into a hole)

inferior --> pelvic pain or contralateral SI joint pain (trauma or car accident)
What is the difference between the symptoms of aa superior pubic shear and an inferior pubic shear?
superior --> tender inguinal area with or without dysuria or frequency ie third trimester pregnancy or delivery
inferior --> pelvic or SI joint pain
Do you do a seated or standing flexion test for sacral SD?
seated