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188 Cards in this Set
- Front
- Back
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Which three mediators of inflammation vasodilate?
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Prostaglandins
Nitric oxide Bradykinin |
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What produces IL -4, -5 and where does it act?
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Produced by CD4 T Cells
Stimulates B Cells |
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What are the class I HLA antigens?
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HLA-A
HLA-B HLA-C |
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Antigen presenting cells (APC) have which HLA?
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Class 2 (HLA-DP, HLA-DQ, HLA-DR)
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What do INF-a and INF-b do?
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Induces MHC-1 and has anti-viral effects
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The acute phase response is activated and induced by?
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IL-1
IL-6 TNF-a |
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What activates the alternative pathway?
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Cobra venom
Endotoxin (Gram Negative Bacteria) Complex polysaccharides (fungal capsules) |
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The classical and alternative pathway go to ___ so as to make ___.
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C3
Membrane attack complex C5b-9 |
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What is the antidote for heparin?
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Protamine
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What are the symptoms of organophosphate poisoning?
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SLUDGE
Slavation Lacrimation Urination Defication GI upset Emesis (due to overabundance of ACh) |
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What is one of the first line drugs for treating cryptococcal menigitis?
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Flucytosine
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What is a serious side effect of primaquine?
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May cause G6PD deficiency exacerbation
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What are 2 serious side effects of PDE-5 inhibitors?
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Non-arteritic anterior ischemic optic neuropathy
Ototoxicity |
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Which drug can cause tendon ruptures?
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quinolones
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What is Rifampin and what should you avoid when taking it?
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Used for TB (prophylaxis and tx)
avoid alcohol use b/c liver damage |
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What are the drugs that are easily displaced from albumin?
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Sulfonamides
Coumadin Sulfonylurea Phenylbutazone |
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What is L-dopa used to treat and what are its effects on P450?
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Used for Parkinson's
Induces P450 |
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What is ethanol's effect on P450?
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induces P450
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Why do babies and premies often retain certain drugs?
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They have incompletely developed tubular secretory mechanisms
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What are some clinical findings with regards to tissue texture changes in chronic somatic dysfunction?
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Tissues will be pale, fibrotic, ropy, stringy, dry, scaly, pimply, contracted, hypotonic muscles
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Fryette's principles only apply to which parts of the spine?
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Throacic and lumbar
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When naming a type 2 Fryette's ___ proceeds ___ in motion mechanics and nomenclature
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Rotation proceeds sidebending
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T1 is rotated right. Rotation increases with flexion and returns to a more neutral position in extension. What is the SD?
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Extension somatic dysfunction
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In which axis and plane of motion does rotation occur?
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Rotation occurs in a transverse plane around a vertical axis
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What is isometric contraction?
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muscle contract that increases tension w/o approximating the two ends
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What is the sequence of treatment for OMT?
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Central --> peripheral
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What is a tender point that in non-responsive to counterstrain called?
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Maverick point
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In post-isometric relaxation the activation of ___ allows relaxation of ___ muscle?
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Golgi tendon organ
Agonist muscle |
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You feel restriction of left OA translation, what is your DX?
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Sidebent Left, Rotated Right
Remember that translation tests sidebending on opposite side. So if you are restricted in translation left you are restricted in sidebending right. Also, sidebending and rotation are opposite in the OA and AA. |
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How is the AA tested?
OPP question |
AA is tested by flexing head 45 degrees and rotating head.
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Which muscles aid in elevation of the first rib?
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Anterior and Middle Scalenes
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Which ligament holds the dens in place?
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Transverse ligament
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What is the autoantibody for scleroderma?
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Anti-Scl 70
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What is the triad for pemphigus?
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Nikolsky's sign, oral and skin erosions, older
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What is the triad for Wegner's granulomatosis?
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Sinusitis
glomerulonephritis lung lesions |
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What is the autoantibody for Myasthenia gravis?
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Anti-ACh receptor
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What is the protein deposited in the brain causing Alzheimer's disease?
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amyloid-beta protein
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Hyperacute transplant rejection is caused by what type of hypersensitivity?
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Type II
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Describe Type II hypersensitivity
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immune complex deposition
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Which tumor marker is used to track renal cell carcinoma?
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Alkaline phosphatase
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What is a common source of breast cancer metases?
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To the brain
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Describe X-linked dominant disorders
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Never skips a generation
No male-male transmission |
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What is the most common lethal autosomal recessive genetic disease of Caucasians?
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Cystic fibrosis
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What are the three types of mucopolysaccharidoses?
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1. Hurler
2. Scheie 3. Hunter |
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What is the cause of Bernard-Soulier disease?
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Lack of GpIb (needed for platelet adhesion to VWF)
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What kind of inheritance pattern is familial hypercholesterolemia?
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Autosomal dominant
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Bilateral schwannomas, hearing deficits are a result from
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NF 2
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What is the trinucleotide repeat of Huntington's Disease?
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CAG
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What are three clinical findings for Fragile X?
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Macroochidism
Large ears and jaw Mental retardation |
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What is the deficiency of Lesch-Nyhan syndrome?
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HGPRT
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What is the partial deltion of retinoblastoma?
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13q
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What is the HLA associated with SLE?
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DR3
Remember: DR3...SLE, give the insulin to me (DM1) for no diarrhea (celiac disease) |
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Most common cause of osteomyelitis in IV drug users?
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Serratia
Pseudomonas aeruginosa |
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What is the most common cause of cold in the summer/spring?
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Adenovirus
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What are the 4 types of nephropathy a SLE patient can get?
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1. Mesangial disease
2. Focal proliferative nephritis 3. Diffuse proliferative nephritis 4. Membranous glomerulonephropathy |
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Name 3 phagocyte disorders
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1. Job's Syndrome
2. Chediak-Higashi Syndrome 3. Chronic granulomatous disease |
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What is the pathology of Bruton's agammglobulinemia?
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No mature B cells
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What are the signs and symptoms of Wiskott-Aldrich syndrome?
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Recurrent bacterial infections (otitis media)
Eczema Thrombocytopenia Low IgM |
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What would you use to test the intrinsic pathway?
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PTT
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Hemophillia A is a lack of what?
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Factor XIII (intrinsic pathway so measure with PTT)
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What will be increase in labs for Von Willebrand Disease?
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PTT and Bleeding time
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Which drug prevents vitamin K activation of factors 2, 7, 9, 10?
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Warfarin
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Spherocytosis is cause by
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deficiency in spectrin
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What is the sole means of producing NADPH in RBCS?
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Pentose PO4 pathway which needs G6PD
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What is the disorder with sickle cell anemia?
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Amino acid substution (valine for glutamate) in beta globin chain at 6th amino acid position
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What kind of agglutin antiboides does Mycoplasma pneumonia have?
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COLD
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What is Plummer-Vinson disease?
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Low grade, long-term iron deficiency that causes esophageal webs and dysphagia for solids
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What is seen in RBC which are poisoned with lead?
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Basophilic stippling
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Heinz bodies are see with
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G6PD
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Marker for Hairy Cell Leukemia?
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+ TRAP
CD25 |
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Reed-Sternberg cells are associated with
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Hodgkin's Lymphoma
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What is Monckebergs?
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Calcium deposits in blood vessels media producing lumps
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What is usually seen in people who have Polyarteritis nodosa?
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Hep B
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What is positive in someone with Microscopic polyangitits?
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P-anca
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What is the cause of Buerger's disease?
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Smoking
*causes necrosis of fingers and toes |
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Giant cell artertis treatment?
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Steroids immediately if you suspect because of blindness risk of temporal arteritis
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What is posistive in Wegner's Granulomatosis?
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C-anca
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What do you give in Kawasaki disease?
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Aspirin and IgG
*asian kids with rash on hand and soles |
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A harsh cardiac sound is usually caused by
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Blood hitting a surface (stenosis)
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A blowing cardiac sound is usually caused by
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Blood going the wrong way (regurgitation)
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Characteristics of Tetralogy of Fallot
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VSD
Overriding Aorta RV hypertrophy Pulmonic stenosis |
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Eisenmenger's syndrome is caused by
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Reversal of a Left to Right Shunt to
Right to left shunt (due to pulmonary hypertension) |
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Where is the coarctation of aorta in someone who is an adult?
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Past the PDA (will find high pressure in extremity and low pressure in lower extremity)
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Pain relief with Nitroglycerin will be seen in these two types of ischemic heart disease?
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Stable angina
Prinzmetal's |
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Tropoinin will be elevated in these ischemic heart diseases
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Non-Q wave MI (ST depression)
Q-wave MI (ST elevation) |
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What are the signs and symptoms of right-sided heart failure?
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Ankle edema, JVD
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Subacute infective endocarditis only occurs in
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Those with prior valve pathology
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Libman-Sacks endocarditis occurs in
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SLE patients
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Aschoff body is usually seen in
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Acute rheumatic fever
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What is the FEV1/FVC ratio in obstructive lung disease?
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Low
<80% |
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Panacinar pulmonary emphysema is caused by
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alpha-1 antitrpsin deficiency
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What is Kartagner syndrome?
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Recurrent bronchial infections causing bronchiectasis.
They have situs inversus, male sterility, hearing deficits b/c non-functional cilia. |
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Who do you find Charcot-Leyden crystals and Curshmann spirals?
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Asthmatics, it's caused by eosinophilia
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Diffues injury to endothelium of the lung cuases
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ARDS
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What will you see in pneumonconiosis caused by asbestosis?
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Ferruginous bodies
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Neonatal ARDS is cause by
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Lecithin:sphingomyelin ration <2 (surfactant)
Premature birth prior to 33-34 weeks |
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Goodpasture's syndrome is autoimmune disease mediated by
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anti-glomerular basement membrane antboides
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Primary causes of brochopneumonia
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Hemphilus
Pseudomonas Staphlyococcus |
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What does atypical pneumonia look like and what are its causes?
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Patchy bilateral infiltrates
Viruses, Mycoplasma pneumonia |
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Which lung cancer affects non-smokers in addition to smokers?
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Adenocarcinoma
*associated with previous lung scar |
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What is carcinoid syndrome?
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A tumor that produces serotonin and histmaine causing flushing, diarrhea, bronchospasm, hypotension.
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Signs of nephritic syndrome
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Hematuria
RBC casts edema increased BUN and creatinine Azotemia |
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What can small cell carcinoma of lung cause?
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Eaton-Lambert Syndrome
increase ADH (edema) increase ACTH (cushings) |
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Signs of nephrotic syndrome
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Severe proteinuria >3.5 g
edema hyperlipidemia |
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What is found on biopsy of Minimal Change disease?
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Loss of foot processes
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What is the most common adult nephrotic disorder?
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Membranous glomerulonephritis
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Kidney bipsoy shows spike and dome pattern
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Membranous glomerulonephritis
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Muddy brown casts are seen on urinalysis, what do you think it might be?
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Acute tubular necrosis
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Causes of pre-renal ATN
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hypotension
dehydration hemorrhage CHF shock |
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Common drugs that cause intrinsic ATN by causing tubular injury
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cyclosporin
amphotericin B aminoglycosides ethylene glycol hemoglobinuria myoglobinuria metals |
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How does hypocalcemia occur in chronic renal failure?
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Decrease phosphate excretion from kidneys -->
Phosphate binds and precipitates calcium --> Hypocalcemia Also, kidney doesn't respond to PTH (low reabsorbtion of Ca) |
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What is the most common type of kidney stone?
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Calcium
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A staghorn calculus is composed of what?
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Mg-NH4-Phosphate
The NH4 is common caused by Proteus and Staphylococcus saprophyticus (urase-splitting) |
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Who is at risk for a uric acid urolithiasis?
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gout
leukemia tx excessive purine consumption |
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Frothy green vag discharge is commonly caused by
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Trichomonas vaginalis (darting trichomonads)
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What do you treat Chlamydia trachomatis?
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Doxycyline for the Chlamydia and then empirical treatment of ceftriaxon for possible Gonorrhea
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Someone has a painful chancroid on their genitals, what might it be?
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Hemophilus ducreyi
*give them ceftriaxone |
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Biopsy of codyloma acuminatum would reveal
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koliocytes
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Which protein of HPV-16 messes with something important in a human?
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E6 messes with p53 (tumor suppressor gene)
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What is the most common germ cell tumor of males?
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Seminoma
presents as painless enlargement of testes around age 35 |
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Precocious puberty or gynocomastia after puberty would be a sign of this testicular tumor
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Leydig cell tumor
*too much testosterone is produced |
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Which ovarian tumor accounts for about half of all ovarian carcinomas?
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serous cytadenocarcinoma
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What is pseudomyxoma peritonei?
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Rupture of mucinous cystadenocarcinoma causing implants of tumor
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A woman has a sex-cord tumor and presents with a beard, clitoromegaly, and a deep voice. What does she have?
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Sertoli-Leydig cell (should not be in a woman)
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Neoplasm of trophoblast in woman
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Choricocarcinoma
*VERY aggressive and high hCG |
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You biopsy a tumor in the ovary that has a signet-ring appearance. What does you patient have?
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Krukenberg tumor from a metastasis elsewhere
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If you see ___ of the endometrium, this is pre-malignant.
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Hyperplasia
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Are cervical polyps neoplasms?
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No...just an area of inflammation in cervical epithelium
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PCOS will present with which hormone elevated
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LH which causes thecas cells to produce androstenedion (androgens)
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A chocolate cyst in the endometrium is significant for
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Endometriosis
*presents as dsymenorrhea, dyschezia, dyspareunia |
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What is the number 1 tumor in woman overall?
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Uterine leiomyoma
*whorled pattern of SM |
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Very high B-hCG, large uterus, grape like cysts is all significant for
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Hydatidiform mole
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Preggo that does coke is at risk for
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Placental abruption (vag bleeding, pain, fetal distress)
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Mobile, marble shapped mass in <30 yo boobies, benign
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Fibroadenoma
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Log shaped tumor in >60 yo boobies, benign
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Phylloides tumor
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You see peau d'orange, nipple retraction, dimpling in boobie, what might it be?
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Invasive ductal carcinoma
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Boobie that has fissured nipple, that is ulcerated, oozing, hyperemic and edematous
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Paget's disease
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What are three important tumor suppressor genes in boobie cancer?
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BRCA-1, BRACA-2, p53
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Important oncogenes in boobie cancer?
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HER-2/neu
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A smooth beefy red tounge is associated with
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B12 deficiency
(cobalmin) |
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Chronic type A gastritis is caused by what and affects which part of stomach?
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Auto-immune (ex. against intrinsic factor)
Fundus (top) |
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What is the most common type of colonic polpy that has little to no risk for malignant transformation?
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Hyperplastic polyp
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An adenomatous polpy is (neoplastic/non-neoplastic)
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Neoplastic
*villous adenoma has highest risk of malignancy |
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What is special about Peutz-Jeghers syndrome?
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They get harmartomatous polyps in colon.
They are at increased risk for colon cancer (not because of the polyp) and other cancers. |
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What 2 molecular mechanisms are responsible for colon cancer?
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1. APC/Beta-catenin pathway
2. k-RAS mutated and p53 is inactivated *p53 is tumor suppressor *k-RAS is oncogene *APC is tumor suppressor |
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What do you need to work up in everyone who is >50 and iron-deficiency anemia?
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Possible colon carcinoma
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Patient presents with LLQ pain, fever, elevated neutrophils, diarrhea, (-) hemoccult
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Possible diverticulitis
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String sing on barium x-ray, skip lesions, rectum is spared...what kind of IBD?
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Crohn's disease
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Lead pipe colon, continuous lesions, bleeding...what kind of IBD?
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Ulcerative colitis
*smoking seems to be protective |
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People with celiac sprue are at increased risk for
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MALT lymphoma (non-hodgkins kind)
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What is choledocholithiasis?
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Obstruction of common bile duct
*clay-colored stool, tea-colored urine, elevated alkaline phosphatase and conjugated bilirubin |
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Cholelithiasis due to cholesterol stones are most common in
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fat, female, >40, fertile
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Autoimmune destruction of intrahepatic bile ducts is called?
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Primary biliary cirrhosis
*pruritis, jaundice, steatorrhea, xanthelasmas |
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What is indirect bilirubin?
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Unconjugated, hasn't been to the liver yet
*Remember direct is CONJUGATED. It came from directly the liver. |
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Name 2 general causes of elevated unconjugated bilirubin
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1. Hemolysis (G6PD def, sickle cell)
2. Deficiency of Glucuronosyl Transferase (Gilbert's and Crigler-Najjar) |
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Name 2 general causes of elevated conjugated bilirubin
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1. Defects in transport of bilirubin from hepatocyte to bile (hepatitis, Dubin-Johnson syndrome)
2. Obstruction of biliary system (choledocholithiasis, sclerosing cholangitis) |
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This hepatitis is transmitted parenterally
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HCV
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In an acute hepatitis A, which antibody does your body produce?
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HAV IgM
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This hepatitis occurs primarily in SE Asia and Middle Easy.
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Hep E
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Patient has (+) anti-HBs and (-)anti-Hbc. What is the dx?
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Immunity b/c of vaccination
*anti-HBs = surface antigen *anti-HBc = core antigen |
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Pt has (+) HBsAg and (+) HBeAg. What is the dx?
|
Very infectious acute Hep B
*HBeAg is secreted by actively infecting virus |
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Pt has (+) anti-Hbs and (+) ant-HBc. Dx?
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Immune to Hep B due to resolved Hep B infection
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Name four drugs that are major causes for toxic hepatitis
|
1. Methotrexate
2. Cholramphenicol 3. Halothane 4. Isoniazid |
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What is a classic neurological sign of hepatic encephalopathy?
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Asterixis (wrist flapping when in extension)
*due to too much ammonia |
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Which steroid hormone can be elevated in those with alcoholic cirrhosis?
|
Estrogen
*causes: spider angiomata, gynecomastia, palmar erythema |
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Pt presents with cirrhosis, new onset of DM, skin pigmentation, and cardiomyopathy. Dx?
|
Hemochromatosis
|
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What is the tumor marker for the most common primary liver cancer?
|
alpha-fetoprotein
*Hepatocellular carcinoma |
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You see orange rings on a pt's eye. Dx?
|
Wilson's disease = accumulation of copper due to decreased ceruloplasmin
*Kayser-Fleischer rings |
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What is the greatest risk factor for Cholangiocarcinoma?
|
Clonorchis sinensis infection (liver fluke)
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Risk factor for necrotizing enterocolitis?
|
NSAID use in mother. This dz is in neonates.
|
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What are found at the DIP and PIP of osteoarthritis pts?
|
Heberden's nodes =DIP
Bouchards's nodes = PIP *remember that stiffness decreases with activity |
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What are the HLAs of Rheumatoid arthritis?
|
HLA-DR4, Dw4, Dw14
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Which collagen is effected in osteogenesis imperfecta?
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Type I
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An active kid comes in with leg pain. What might they have?
|
Osgood-Schlatter dz
A type of aseptic necrosis to tibial tuberosity |
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What is the difference between osteoblast and osteoclasts?
|
Osteoblast = bone formation
Osteoclast = remove bone tissue You have to build something before you crush it. Blast = build, Clast = crush |
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What is the optimal dose of calcium for someone with osteoporosis?
|
1000-1500 mg/day
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How does vitamin D become active?
|
Vit D ---> liver = 25-hydroxyvitamin D --> kidney = 1,25 dihydroxyvitamin D
|
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What is the active form of vitamin D?
|
1,25 dihydroxyvitamin D
|
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What is von Recklinghausen dz of bone?
|
hyperparathyroidism causing deminerlaization of bone
|
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Paget's disease of bone is cause by
|
increased uncontrolled bone turnover resulting in chalkstick fractures
|
|
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Name a malignant tumor of cartilage
|
Chondrosacrcoma
*occurs in spine and pelvic bones |
|
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Name a malignant bone tumor associated with a Codman's triangle
|
Osteosarcoma
|
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What is the chromosomal translocation of Ewing's sarcoma?
|
11-22
*has onion skin look on x-ray |
|
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What is the most common brain tumor of adults?
|
Glioblastoma multiforme
*astrocytoma |
|
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What is the most common brain tumor of kids?
|
Pilocystic astrocytoma
|
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Benign brain tumor with a whirling pattern
|
Menigimoa
|
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Crainopharyngima are dervied from
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Ranthke's pouch
|
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Symptoms of a prolactinoma
|
galactorrhea
loss of libido infertility visual disturbances |
