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180 Cards in this Set

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describe 2ndary and tertiary hyperparathyroidism
2ndary - due to renal disease, cannot excrete phosphate and it is elevated - stimulates PTH to secrete.


tertiary - since PTH mainly responds to serum Phos, continuously increasing PTH, continually increasing phos leads to chronic PTH secretion, and glandular hypertrophy, leading to autonomous hypersescretion of PTH. even after calcium/phos levels are corrected, PTH stays high
What does renal artier stenosis present with?

what is the most common cause of renal artery stenosis
Sudden HTN and Low K+

athersclerotic plaque
what pelvic angle is used to measure if a baby will be able to exit birth canal?
obstetric conjugate
what anesthetic can cause intermittent porphyria
thiopental
what is the role of the RB gene
a tumor suppressor to halt cellc ycle in G1 phase to not get to S
what is the courvosier sign?
enlarged palpable gall bladder PAINLESS . with jaundice = cancer of head of pancreas causing obstructive jaundice
what is the RULE you always want to follow when dealing with AD/AR dz.'s
AD- structural
AR - enzyme
Deficiency in C1 esterase leads to?
Hereditary angioedema
What does disseminated GC infection look like
STD!
Synovitis - joints
Tenosynovitis - hands
Dermatitis
What is the Biochem problem in ataxia telangiectasia
DNA repair Pr is dysfunctional - infections increased
C5-8 deficiency causes what?
increased risk for Neisseria infections
Absent respiratory burst is seen in what?
NADPH oxidase deficiency - Chronic granulomatous disease
what happens in a crush injury
muscle is damage and releases all sorts of shiyat
#1 POTASSIUM, hyper kalemia
also, Creatinine kinase, myoglobin, phosphate
what does insuling to do serum potassium

what else can do this?
it will shift potassium into cells and cause hypokalemia.

Beta agonists also do this
alkalosis and hypo-osmolarity
how do you treat asthma attack, what do you not use!

what does theophyline do?
Oxygen, SABA and IV steroids.

No LABA or beta blockers

Theophylline - bronchodilator by inhibiting phosphodiesterase - always an alternate tx
what are the types of sensory receptors
pacinian - vibration and deep touch
meisner - on hairless areas, light touch
merckel - fingertips, hairy areas, and oral/anal - light and crude touch
ruff ini - in joints for proprioception
what brain damage causes left sided hemineglect
right parietal lobe
what are the differences between thiazides and loop diuretics
Loops - work in ascending limb, block Na/K/Cl channel, and will let potassium OUT

Thiazides will block Na reabsorption and the charge will push calcium BACK into blood. HYPER CALCEMIA. also use same transporter as uric acid
what does odansetron do?

what does scopolamine and meclizine do?
odansetron - 5HT3 blocker, anti emesis for chemo therapy
Scop - anticholin - motion sickness
Meclizine - antihistamine - same
Benzos are good for anticipitory emesis for anxiety
most common cause of foot pain with intact range of motion
where does it attach?
plantar fasciitis

medial tubercle of calcaneus
what bones make up the medial longitudinal arch of the foot?

the lateral?
calcaneus, talus, navicular, cuneiforms, and 1-3 metaT's

lateral - Calcaneus, cuboid, metaT's
what anti arrhythmic drugs cause QT prolongation
class 3 - amiodarone and sotalol
What hole does CN 9,10,11 go through?

CN 3,4,6?

CN 7 and 8?

the middle meningial artery?
jugular foramen

Superior orbital fissure

external auditory meatus

Foramen spinosum
what drugs can cause mobitz type 1 Heart block

what is lidocaine used for?
Digoxin, CCBs and BBs

lidocaine used for ventricular arrythmias
how do you test for legionella?
antigens are present in the urine
what other sx's can you see in lewy body dementia other than parkinsons and dementia
visual hallucinations
how can you test for Primary biliary cirrhosis
anti mitochondrial DNA
which of the TB drugs can cause peripheral neuropathy?

which can cause vision problems
which can cause orange tears
INH - peripheral neuropathies
Ethambutol - Vision
Rifampin orange tears
in what deficiency would you see cheilosis?

what other thing may you see with this?
B2 - riboflavin deficiency
may also see glossitis - inflam of tounge
what causes type A chronic gastritis

what other dz.'s are associated with it?
immunologic problems -
autoimmune against gastric, parietal or IF.
may present as acholohydria or pernicious anemia

associated with hashimotos, addisons, or vitiligo
what is a hamatomatous polyp

associate with what disease?
polyp that represents malformation in glands and stroma, causing overgrowth of MATURE tissue

Little risk of malignancy
can occur in association wiht
Peutz Jeghers syndrome
Person presents with dark staining lesions on his lips and bloody diarrhea

what kind of disease is this?
peutz jegher syndrome,

familial polyposis syndrome of hamatomatous polyps that are NOT malignant
BUT
You have increased risk of other cancers
patient presents with a weird bump on his skull and jaw and bloody diarrhea, which on colonoscopy shows to be 1000 polyps.

what dz is related
Gardner syndrome
FAP+ benign mandible and skull tumors, and epidermal cysts + high risk of abnormal tooth development

turbot syndrome is related
FAP + malignant brain tumors

BOTH ARE AD!
what is lynch syndrome?
inheritance?
biochem?
associated dz's
AKA HNPCC
AD
Defective DNA mismatch repair - MICROSATELLITES

can get cancer of almost anywhere
and colon cancer is not Adenomatous!
describe the genes:
APC
RAS
P53
APC - tumor suppressor - colon
K-Ras - proto oncogene - GTPase - colon
P53 - another tumor suppressor - associated with most human cancers - P53 gene product normally blocks G1->S
difference between diverticulosis and diverticulitis
osis - + bleeding and PAINLESS

itis - NO bleeding and painful
between UC and crohns

which has higher risk of colon cancer?
what happens to tissue?
what are the testS?
UC - Higher risk of colon cancer and Toxic megacolon, NON granulomatous lesions (mucosal ulcers) on mucosa and submucosa. Lead pipe colon on barium. MORE BLEEDING and less PAIN than crohns

Crohns - ileum usually involved, transmural lesions - fistulas, GRANULOMAS 9 non cosseting). (+) sting sign on barium. MODERATE colon CA risk, MORE PAIN less bleeding
glossitis, which is inflammation of the tongue is seen in which two conditions?
vitamin B2 (riboflavin) deficiency

vitamin B12 (cobalamin) deficiency
cheilosis, which is dry scaling lips with fissuring at corners of mouth, is associated with what condition?
vitamin B2 (riboflavin) deficiency
smooth beefy red tongue associated with what deficiency
vitamin b12 deficiency
koplicks are the first sign of..
measles
where is a zenker's diverticulum found
above the upper esophageal sphincter
in a pulsion diverticulum, how many layers of the esophagus are involved?
pulsion diverticulum is a FALSE diverticulum.....involves herniation of the mucosa only
what are the 4 types of gastritis
acute erosive (focal)
chronic type A (A for autoimmune)
chronic type B (B for helicoBacter)
mentrier's (mucosal hyperplasia)
chronic type A gastritis is autoimmune destruction of gastric glands, parietal cells, and IF resulting in....
pernicious anemia (loss of IF)

achlorhydria (no HCL due to parietal cell loss)
chronic type A gastritis is autoimmune mediated and associated w what other autoimmune dzs?
hasimoto thyroiditis (anti microsomal)
vitiligo
addison's dz (destyoed adrenal)
Clinical /Labs in addison's dz
low aldosterone
leads to hyperkalemia and hyponatremia
increased ACTH and its precursor POMC (bc low aldosterone)
POMC produces MSH..melanocyte stimulating hormone
body wide hyperpigmentation bc increased melanin
what is this schilings test
Test for cause of a B12 deficiency

give radioactive b12 and check urine
then give Radioactive b12 and IF and check urine

failure to get B12 in urine after 2nd test - Diff dx = chronic panreatitis, bacterial overgrowth or ileum disease where B12 is absorbed
Patient comes in with painful joints, fatty stools and fever.

PAS + things on gram stain

Tx?
whipple disease

tx = TMP/SMX for 6 months!
chronic type A gastritis affects what part of the stomach
fundus and body
chronic type B gastritis affects what part of the stomach
antrum
chronic type B gastritis due to what?
h. pylori infection that causes chronic irritation
what are the 5 major types of intestinal polyps?
hyperplastic
hamartomatous
inflammatory
lymphoid
adenomatous
what is the most common colonic polyp
hyperplastic polyp
of the 5 types of intestinal polyps...which is the group with the highest potential for malignancy
adenomatous polyps/adenomas

of the 3 subtypes of adenomas (tubular/villous/tubulo-villous) VILLOUS has the highest isk for malignant transformation
Pt walks in spotted hyperpigmentation of the lips, palms, and soles. You suspect what on inspection?
Peutz Jegher's syndrome (AD)....he would also have hamatomatous polyps throughout the entire bowel
Peutz Jehger's syndrome Sx
hamartomatous polyps throughout the bowel and spotted melanin hyperpigmentation of lips, palms, soles
what kind of polyps are involved in FAP?
adenomatous
what is the inheritance pattern of FAP?
AD....loss of tumor suppressor gene APC

(lose A Perfect Colon gene and get all those polyps)
what is the inheritance and Sx of gardner's syndrome
gardner's syndrome is AD ...a form of FAP
Sx - classic FAP colon polyps + benign mandible and skull tumors + epidermal cysts + high risk of abnl dentition
what is the inheritance and Sx of turcot's syndrome
turcot's syndrome is AD ...a form of FAP
Sx - classic FAP colon polyps + malignant brain tumors
what causes lynch sydrome
lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is an AD dz caused by defective DNA mismatch repair genes and is associated w microsatellites
65 year old man presents with IDA....you should immediately suspect
colon carcinoma....rule this out and then consider other causes
mechanism for colon cancer to arise
loss of function of tumor suppressor APC gene

then gain of function of onocgene k-ras

then loss of function of tumor suppressor p53 gene
MOA mechlorethamine and side effect, what other drugs are like this
alkylating agent, like cyclophosphamide, busulfan, and nitrosureas(carmustine, limustine)
what drug(s) do we use for brain tumors
Nitrosureas - limustine, carmustine, streptozocin, semustine
doxorubicin indications and side effects?
indications = AML, ALL, lymphomas and ovarian and breast

AEs - Red urine and dilated cardiomyopathy
child Px presents with staggering gait, frequent falling, nystagmus, hammer toes, and kyphoscoliosis

what is the genetics?
frederich ataxia

Trinucleotide repeat - GAA in gene that encodes Frataxin

favorite frat brother always staggering, and falling.
what are some drugs of chocie for testicular cancers

MOA and Aes
Vinblastine - tubulin binder
cisplatin - DNA crosslinks. CNS (bc heavy metal) and KIDNEY. and strong emetic - agonize 5HT.

Bleomycin - induces ROS to DNA and breaks strands. Pulmonary fibrosis
typical presentation in right colon cancer
IDA, fatigue, weak, +heme stool, no stool changes
typical presentation in left colon cancer
+ heme stool, change in bowel habits, crampy LLQ discomfort, pencil stools, tenesmus (painful straining w defecation)
colon cancer preferentially metastasizes where....
liver and lungs
what part of the bowel is the most common place for diverticuli to form
sigmoid colon
what's are the two diverticular dzs and what's the difference between them
diverticulosis and diverticulitis
diverticulosis is just that diverticuli are present...you can have painless, bloody stools
diverticulitis is an infection of a diverticuli because something got stuck in one and bacteria built up...heme negative stool w LLQ pn, F, PMNS elevated
how to treat diverticulitis
ciprofloxacin and metronidazole
buzzwords for crohn's dz
rectum spared
skip lesions (not continuous)
transmural
noncaseating granulomas
strictures, fistulas, fissures
+string sign on xray
smoking is a risk factor
pain > bleeding
buzzwords for ulcerative colitis
begins at rectum and progresses proximally
continuous lesions
mucosa/submucosa ONLY
mucosal ulcers
pseudopolyps
lead pipe colon on barium enema
smoking is protective?
high risk colon CA and toxic megacolon
bleeding > pain
what does a schilling test look for
schilling test ID's the cause of vitamin B12 deficiency
describe schilling test
give radioactive B12 and collect urine 24 hours. If the radioactive B12 doesnt show up in urine = B12 deficiency.
Now give radioactive B12 w IF. If you get the B12 in the urine now, you know it's pernicious anemia...if not, then something else is going on...chronic pancreatitis, bacterial infection, disease of the ileum where B12 absorbed
what is the rash associated w celiac sprue
dermatitis herpetiformis
treatment of whipples dz
bactrim 1st line
or PCN or ampicillin or tetra (2nd liners)
Abx Tx must be for at least 4-6 months but preferably 1 year
causative agent in whipples dz
tropheryma whippelii (a type of actinomyces)

gm +
Pt presents w steatorrhea, arthralgia, fever
Bx of small bowel shows PAS + macriphages in bowel mucosa
you Dx...
whipples dz
name three kinds of gallstones
cholesterol stone
pigment stone (bilirubin)
mixed stone (bilirubin and cholesterol)
what's the most common type of gall stone in the US? in the world?
US - cholesterol gall stone
world - mixed gall stone (bilirubin + cholesterol)
pigment stones are made of what
excess bilirubin......can see this in hemolysis
what is a porcelain gallbladder
calcium lined gallbladder
Pt presents with RUQ pain, jaundice, clay colored stool and tea colored urine
Labs show elevated alk phosphatase and conjugated bilirubin. You Dx
choledocholithiasis......

caused by obstruction of common bile duct (see dilated CBD on US)
what is charcot's triad for ascending cholangitis
cholangitis is infection of the common bile duct

charcot's triad - fever, jaundice, RUQ pn
what drugs are used for wilms tumor

MOA and AEs
Dactinomycin - intercalates DNA

VinCristine/blastine - microtubules
cristine - NO BM suppression
Draw out the arachidonic acid pathway
JUsT DO IT!
both primary sclerosing cholangitis and primary biliary cirrhosis cause destruction of bile ducts....but they differ in which parts of the ducts are affected....explain
primary sclerosing cholangitis causes intra and extrahepatic bile duct destruction (all biliary ducts destroyed)
primary biliary cirrhosis has destruction of intrahepatic bile ducts only
Pt presents with sublingual icterus.....this indicates that the source of her jaundice is...
elevated bilirubin levels probably due to biliary or hepatic causes
(and not hemolysis)
Labs and SSx in primary sclerosing cholangitis
pruritis, RUQ pain, jaudice, later cirrhosis, elevated conj bilirubin and alk phosphatase, + p ANCA
hits intra and extrahepatic ducts
labs and SSx in primary biliary sclerosis
starts w pruritis, then jaundice, steatorrhea, xanthelasmas (cholesterol deposits under skin), + anti mitochondrial Ab, elevated alk phosphatase, elevated GGT (gamma glutamyl transpeptidase), later elevated bilirubin
what is the liver enzyme that conjugates bilirubin
uridine diphosphate glucuronosyl transferase

UDP - glucuronosyl transferase
describe gilbert's syndrome
mild decrease in UDP glucuronosyl transferase

leads to elevated indirect bilirubin w stress
describe crigler najar type 1
CJ I is AR....NO UDP glucuronosyl transferase....so no conjugation. lethal
describe crigler najar type 2
CJ II is AD...decreased UDP glucuronosyl transferase with chronic elevation of indirect bilirubin
describe rotor's syndrome
impaired hepatocellular secretion of conjugated bilirubin due to a carrier defect
causes elevated direct bilirubin
(rotors has been described as a milder form of dubin johnson)
describe dubin johnson syndrome
impaired hepatocellular secretion of direct bilirubin due to a carrier defect
see BLACK liver + elevated direct bilirubin
of the hepatitis viruses, which is the only one that is a DNA virus and not an RNA virus
hep B....a hepadnavirus
serum findings in acute hep A?

in chronic hep A?
acute hep A - HAV IgM

chronic hep A - HAV IgG (protective)
true or false - HIV + patients with hepatitis G live longer than those without hep G
true
what causes hepatitis G
GB virus-C...(GBV-C)...an RNA flavivirus
what is a mallory body
intracytoplasmic eosinophilic hylaine inclusion (alcoholic hyaline) in a liver with alcoholic hepatitis
alcoholic cirrhosis can cause what in males
toxicity to testes leading to atrophy....high estrogen leads to gynecomastia
pathology findings in early alcoholic cirrhosis
micronodular
pathology findings in late alcoholic cirrhoisis
macronodular
pathology findings in viral or toxic cirrhosis
macronodular
pathology of primary biliary cirrhosis
micronodular
45 yo female patient presents with pruritis that is worse at night. Her labs return with increased alk phosphatase. your DDx should include what dz
primary biliary cirrhosis
big side effect of cloramphenicol?
fatal aplastic anemia

grey baby in babies
DOC for mycoplasma pneumoniae?
macrolides - (ACE)
Pt w a PCN allergy should be Rxd what drug
erythromycin
DOC for anaerobic infections above the diaphragm
clindamycin
how does diphtheria toxin work
protein synthesis inhibitor in eukaryotes
anti-folate drugs will produce what findings on peripheral smear
megaloblastic macrocytic anemia
5FU blocks the production of what
thymidine synthesis

5FU is a pyrimidine analog that inhibits DNA replication
Pt has a mycobacterial infection....what is the first drug you should consider
rifampin
4 drug Tx regimen for MAC
rifabutin (transcription inhibitor)
streptomycin (AG)
clarithromycin (macrolide)
ethambutol
big side effects of doxorubicin/adriamycin
dilated cardiomyopathy
red urine
big side effect of cyclophosphamie
hemorrhagic cystitis that can lead to bladder fibrosis
big side effect of bleomycin
pulmonary fibrosis (restrictive lung dz)
big side effect of cisplatin
peripheral neuropathy
big side effect of L asparaginase
hypersensitivities (allergic rxns)
what is c3 nephritic factor
autoAb against C3 convertase found in membranoproliferative glomerulonephritis (type II). bc of this enzyme you will see decreased serum levels of C3 w this dz
what are muehrcke's nails?
classic physical finding in nephrotic syndrome - paired narrow horizontal white bands on all fingernails caused by hypoalbuminemia
what is osteitis fibrosa cystica?
elevated PTH in renal failure stimulates calcium reabsoprtion from bone causing bony demineralization and cystic bone lesions
classic dyad of renal artery stenosis
sudden HTN and low K (pt not on a diuretic)
what is the most common cause of renal artery stenosis
atherosclerotic plaque
Alport's syndrome
hereditary nephritis due to genetic abnormality of collagen
EM - glomerular BM splitting
SSx - renal dz, deaf, ocular abnormalities (dislocated lens)
poststrep glomerulonephritis presents weeks after initial infection....when does igA nephropathy present?
concurrently or within several days of infection
classic physical finding in henoch schonlein purpura
"palpable purpura" on butts and legs in children and on shins in adults
usually children...this is another igA nephropathy
fibromuscular dysplasia is known to cause what dz process
renal artery stenosis..usually in young women
what will you see on renal angiography in a young woman with RAS due to fibromuscular dysplasia?
"string of beads" sign due to luminal narrowing at various points along the vessel
US of kidneys comes back describing them as enlarged and having a "moth eaten" appearance bilaterally
ADPKD
which kidney stones are radiopaque (white)
calcium pyrophosphate
struvite (Ammonium Mg phosphate) stones
which kidney stones are radiolucent
uric acid stones
what is the most common inherited disorder of the kidney
ADPKD
what is the most common childhood congenital kidney lesion (note lesion, not malignancy)
infant polycystic kidney dz (AR)
describe the kidney of a baby with infant polycystic kidney dz
external surface of kidney is smooth, no cysts visible
kidney adenomas (benign)...are always located where in the kidney
cortex
describe tuberous sclerosis syndrome
cerebral cortical glial nodules/distorted neurons

SSx - epileptic seizures, MR, adenoma baceum (Facial skin lesion w malformed blood vessels and CT), cardiac rhabdomyomas and renal angiomyolipomas (hamartoma)
what is the most common renal malignancy
renal cell CA
describe the cells seen in renal cell CA
polygonal clear cells (reminiscent of adrenal cortex)
what is the most common renal malignancy of childhood
wilm's tumor aka nephroblastoma...peaks at 2-4 yo
wilms tumors are associated w what gene on which chromosome
loss of tumor suppressor gene WT-1 on chromosome 11

(wilms tumor 1 = 11 characters)
what is WAGR complex
Wilms tumor
Aniridia - absence of iris
genitourinary malformations
MR
whats a weird association with wilms tumor that we never learned about
hemihypertrophy of the body
pseudohyphae, true hyphae, and budding yeasts
candida albicans
broad, based budding yeasts with a double refractile cell wall....causes pulmonary involvement
blastomyces
narrow angle, dichotomously branching, monomorphic filaments....may infect burned skin or cause pulmonary or systemic involvement
aspergillus
small intracellular yeast with no capsule and narrow neck on bud...causes pulmonary involvement
histoplasma
spherules and endospheres....causes pulmonary involvement
coccidioides
what are kayser fleischer rings
greenish grey or brownish rings around the cornea seen in Wilson's disease (AR....copper deposition in liver and brain)
waiter's tip position seen in erb duchenne palsy is damage to what part of the brachial plexus
superior trunk - nerve roots c5 and c6
klumpke palsy, such as when a baby's arm is forcefully pulled superiorly during childbirth, is damage to what part of the brachial plexus
medial cord - c8 and t1 nerve roots
broad non septate hyphae
mucor and rhizopus spp.
cigar shaped budding yeast
sporothrix schenckii
DOC for sporotrichosis
itraconazole
CN v2 exits the cranium through which opening?

CN v3?
CN v2 - foramen rotundum

CN v3 - foramen ovale

your nose can Run for rotundum
make your mouth into an O for ovale
what causes a cushing's ulcer
post brain injury...leads to increase stomach acid production secondary to increased steroid levels (leads to acute erosive gastritis)
mneumonic...cushings - increase steroids)
who gets curling ulcers and what do curling ulcers lead to
burn patients get curling ulcer (curling irons are hot...they burn)

curling ulcers lead to acute erosive gastritis
duodenal ulcer vs gastric ulcer
duodenal ulcer pain Decrease w food

gastric ulcer pain Grows worse w food
what causes duodenal ulcer
acid hypersecretion
what is a blumer's shelf
palpable nodule superiorly on rectal exam - indictaive of metastasis of GI cancer
sister mary joseph sign
metastasis of gastric cancer to umbilicus.....feel a hard nodule there...poor prog
what is the most deadly form of gastric cancer
linitis plastica (it's infiltrative..kills ya quick)
duodenal ULCER and gastric CANCER are associated with different blood types..what are they
gAstric cancer associated with blood type A

duOdenal ulcer associated with blood type O
most common congenital anomaly of small bowel
meckel's diverticulum
meckel's diverticulum is remnant of what structure
embryonic vitelline duct
rule of 2's meckels diverticulum
2% popn
2 feet from ileocecal valve
2 inches long
usually presents within first 2 y of life
anti endomysial Ab
celiac dz
anti tissue transglutaminase Ab
celiac dz
dermatitis herpetiformis, associated w celiac dz, affects what parts of body
pruritic red papulovesicular lesions on shoulders, elbows and knees...disappear after gluten withdrawal
2 dzs with PAS + macrophages
whipples dz (tropheryma whippelli..inflmmatory disorder of GI tract)

MAC in AIDS
lactase deficiency (lactose intolerance) results in what kind of diarrhea
osmotic....surgar draws water into bowel
what is abetalipoproteinemia and what do you see on peripheral smear
hereditary deficiency of apoprotein B leading to fat malabsorption

see SPUR CELLS (acanthocytes) on smear
pancreatitis and cystic fibrosis often lead to what....
malabsorption!