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180 Cards in this Set
- Front
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describe 2ndary and tertiary hyperparathyroidism
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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 |
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What does renal artier stenosis present with?
what is the most common cause of renal artery stenosis |
Sudden HTN and Low K+
athersclerotic plaque |
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what pelvic angle is used to measure if a baby will be able to exit birth canal?
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obstetric conjugate
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what anesthetic can cause intermittent porphyria
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thiopental
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what is the role of the RB gene
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a tumor suppressor to halt cellc ycle in G1 phase to not get to S
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what is the courvosier sign?
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enlarged palpable gall bladder PAINLESS . with jaundice = cancer of head of pancreas causing obstructive jaundice
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what is the RULE you always want to follow when dealing with AD/AR dz.'s
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AD- structural
AR - enzyme |
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Deficiency in C1 esterase leads to?
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Hereditary angioedema
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What does disseminated GC infection look like
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STD!
Synovitis - joints Tenosynovitis - hands Dermatitis |
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What is the Biochem problem in ataxia telangiectasia
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DNA repair Pr is dysfunctional - infections increased
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C5-8 deficiency causes what?
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increased risk for Neisseria infections
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Absent respiratory burst is seen in what?
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NADPH oxidase deficiency - Chronic granulomatous disease
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what happens in a crush injury
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muscle is damage and releases all sorts of shiyat
#1 POTASSIUM, hyper kalemia also, Creatinine kinase, myoglobin, phosphate |
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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 |
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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 |
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what are the types of sensory receptors
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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 |
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what brain damage causes left sided hemineglect
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right parietal lobe
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what are the differences between thiazides and loop diuretics
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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 |
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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 |
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most common cause of foot pain with intact range of motion
where does it attach? |
plantar fasciitis
medial tubercle of calcaneus |
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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 |
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what anti arrhythmic drugs cause QT prolongation
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class 3 - amiodarone and sotalol
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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 |
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what drugs can cause mobitz type 1 Heart block
what is lidocaine used for? |
Digoxin, CCBs and BBs
lidocaine used for ventricular arrythmias |
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how do you test for legionella?
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antigens are present in the urine
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what other sx's can you see in lewy body dementia other than parkinsons and dementia
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visual hallucinations
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how can you test for Primary biliary cirrhosis
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anti mitochondrial DNA
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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 |
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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 |
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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 |
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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 |
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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 |
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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! |
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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! |
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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 |
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difference between diverticulosis and diverticulitis
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osis - + bleeding and PAINLESS
itis - NO bleeding and painful |
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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 |
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glossitis, which is inflammation of the tongue is seen in which two conditions?
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vitamin B2 (riboflavin) deficiency
vitamin B12 (cobalamin) deficiency |
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cheilosis, which is dry scaling lips with fissuring at corners of mouth, is associated with what condition?
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vitamin B2 (riboflavin) deficiency
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smooth beefy red tongue associated with what deficiency
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vitamin b12 deficiency
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koplicks are the first sign of..
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measles
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where is a zenker's diverticulum found
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above the upper esophageal sphincter
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in a pulsion diverticulum, how many layers of the esophagus are involved?
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pulsion diverticulum is a FALSE diverticulum.....involves herniation of the mucosa only
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what are the 4 types of gastritis
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acute erosive (focal)
chronic type A (A for autoimmune) chronic type B (B for helicoBacter) mentrier's (mucosal hyperplasia) |
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chronic type A gastritis is autoimmune destruction of gastric glands, parietal cells, and IF resulting in....
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pernicious anemia (loss of IF)
achlorhydria (no HCL due to parietal cell loss) |
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chronic type A gastritis is autoimmune mediated and associated w what other autoimmune dzs?
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hasimoto thyroiditis (anti microsomal)
vitiligo addison's dz (destyoed adrenal) |
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Clinical /Labs in addison's dz
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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 |
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what is this schilings test
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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 |
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Patient comes in with painful joints, fatty stools and fever.
PAS + things on gram stain Tx? |
whipple disease
tx = TMP/SMX for 6 months! |
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chronic type A gastritis affects what part of the stomach
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fundus and body
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chronic type B gastritis affects what part of the stomach
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antrum
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chronic type B gastritis due to what?
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h. pylori infection that causes chronic irritation
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what are the 5 major types of intestinal polyps?
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hyperplastic
hamartomatous inflammatory lymphoid adenomatous |
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what is the most common colonic polyp
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hyperplastic polyp
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of the 5 types of intestinal polyps...which is the group with the highest potential for malignancy
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adenomatous polyps/adenomas
of the 3 subtypes of adenomas (tubular/villous/tubulo-villous) VILLOUS has the highest isk for malignant transformation |
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Pt walks in spotted hyperpigmentation of the lips, palms, and soles. You suspect what on inspection?
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Peutz Jegher's syndrome (AD)....he would also have hamatomatous polyps throughout the entire bowel
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Peutz Jehger's syndrome Sx
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hamartomatous polyps throughout the bowel and spotted melanin hyperpigmentation of lips, palms, soles
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what kind of polyps are involved in FAP?
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adenomatous
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what is the inheritance pattern of FAP?
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AD....loss of tumor suppressor gene APC
(lose A Perfect Colon gene and get all those polyps) |
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what is the inheritance and Sx of gardner's syndrome
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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 |
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what is the inheritance and Sx of turcot's syndrome
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turcot's syndrome is AD ...a form of FAP
Sx - classic FAP colon polyps + malignant brain tumors |
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what causes lynch sydrome
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lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is an AD dz caused by defective DNA mismatch repair genes and is associated w microsatellites
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65 year old man presents with IDA....you should immediately suspect
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colon carcinoma....rule this out and then consider other causes
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mechanism for colon cancer to arise
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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 |
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MOA mechlorethamine and side effect, what other drugs are like this
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alkylating agent, like cyclophosphamide, busulfan, and nitrosureas(carmustine, limustine)
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what drug(s) do we use for brain tumors
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Nitrosureas - limustine, carmustine, streptozocin, semustine
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doxorubicin indications and side effects?
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indications = AML, ALL, lymphomas and ovarian and breast
AEs - Red urine and dilated cardiomyopathy |
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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. |
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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 |
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typical presentation in right colon cancer
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IDA, fatigue, weak, +heme stool, no stool changes
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typical presentation in left colon cancer
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+ heme stool, change in bowel habits, crampy LLQ discomfort, pencil stools, tenesmus (painful straining w defecation)
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colon cancer preferentially metastasizes where....
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liver and lungs
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what part of the bowel is the most common place for diverticuli to form
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sigmoid colon
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what's are the two diverticular dzs and what's the difference between them
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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 |
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how to treat diverticulitis
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ciprofloxacin and metronidazole
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buzzwords for crohn's dz
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rectum spared
skip lesions (not continuous) transmural noncaseating granulomas strictures, fistulas, fissures +string sign on xray smoking is a risk factor pain > bleeding |
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buzzwords for ulcerative colitis
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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 |
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what does a schilling test look for
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schilling test ID's the cause of vitamin B12 deficiency
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describe schilling test
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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 |
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what is the rash associated w celiac sprue
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dermatitis herpetiformis
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treatment of whipples dz
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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 |
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causative agent in whipples dz
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tropheryma whippelii (a type of actinomyces)
gm + |
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Pt presents w steatorrhea, arthralgia, fever
Bx of small bowel shows PAS + macriphages in bowel mucosa you Dx... |
whipples dz
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name three kinds of gallstones
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cholesterol stone
pigment stone (bilirubin) mixed stone (bilirubin and cholesterol) |
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what's the most common type of gall stone in the US? in the world?
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US - cholesterol gall stone
world - mixed gall stone (bilirubin + cholesterol) |
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pigment stones are made of what
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excess bilirubin......can see this in hemolysis
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what is a porcelain gallbladder
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calcium lined gallbladder
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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) |
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what is charcot's triad for ascending cholangitis
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cholangitis is infection of the common bile duct
charcot's triad - fever, jaundice, RUQ pn |
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what drugs are used for wilms tumor
MOA and AEs |
Dactinomycin - intercalates DNA
VinCristine/blastine - microtubules cristine - NO BM suppression |
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Draw out the arachidonic acid pathway
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JUsT DO IT!
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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
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primary sclerosing cholangitis causes intra and extrahepatic bile duct destruction (all biliary ducts destroyed)
primary biliary cirrhosis has destruction of intrahepatic bile ducts only |
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Pt presents with sublingual icterus.....this indicates that the source of her jaundice is...
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elevated bilirubin levels probably due to biliary or hepatic causes
(and not hemolysis) |
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Labs and SSx in primary sclerosing cholangitis
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pruritis, RUQ pain, jaudice, later cirrhosis, elevated conj bilirubin and alk phosphatase, + p ANCA
hits intra and extrahepatic ducts |
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labs and SSx in primary biliary sclerosis
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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
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what is the liver enzyme that conjugates bilirubin
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uridine diphosphate glucuronosyl transferase
UDP - glucuronosyl transferase |
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describe gilbert's syndrome
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mild decrease in UDP glucuronosyl transferase
leads to elevated indirect bilirubin w stress |
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describe crigler najar type 1
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CJ I is AR....NO UDP glucuronosyl transferase....so no conjugation. lethal
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describe crigler najar type 2
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CJ II is AD...decreased UDP glucuronosyl transferase with chronic elevation of indirect bilirubin
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describe rotor's syndrome
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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) |
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describe dubin johnson syndrome
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impaired hepatocellular secretion of direct bilirubin due to a carrier defect
see BLACK liver + elevated direct bilirubin |
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of the hepatitis viruses, which is the only one that is a DNA virus and not an RNA virus
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hep B....a hepadnavirus
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serum findings in acute hep A?
in chronic hep A? |
acute hep A - HAV IgM
chronic hep A - HAV IgG (protective) |
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true or false - HIV + patients with hepatitis G live longer than those without hep G
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true
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what causes hepatitis G
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GB virus-C...(GBV-C)...an RNA flavivirus
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what is a mallory body
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intracytoplasmic eosinophilic hylaine inclusion (alcoholic hyaline) in a liver with alcoholic hepatitis
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alcoholic cirrhosis can cause what in males
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toxicity to testes leading to atrophy....high estrogen leads to gynecomastia
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pathology findings in early alcoholic cirrhosis
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micronodular
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pathology findings in late alcoholic cirrhoisis
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macronodular
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pathology findings in viral or toxic cirrhosis
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macronodular
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pathology of primary biliary cirrhosis
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micronodular
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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
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primary biliary cirrhosis
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big side effect of cloramphenicol?
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fatal aplastic anemia
grey baby in babies |
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DOC for mycoplasma pneumoniae?
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macrolides - (ACE)
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Pt w a PCN allergy should be Rxd what drug
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erythromycin
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DOC for anaerobic infections above the diaphragm
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clindamycin
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how does diphtheria toxin work
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protein synthesis inhibitor in eukaryotes
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anti-folate drugs will produce what findings on peripheral smear
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megaloblastic macrocytic anemia
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5FU blocks the production of what
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thymidine synthesis
5FU is a pyrimidine analog that inhibits DNA replication |
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Pt has a mycobacterial infection....what is the first drug you should consider
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rifampin
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4 drug Tx regimen for MAC
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rifabutin (transcription inhibitor)
streptomycin (AG) clarithromycin (macrolide) ethambutol |
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big side effects of doxorubicin/adriamycin
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dilated cardiomyopathy
red urine |
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big side effect of cyclophosphamie
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hemorrhagic cystitis that can lead to bladder fibrosis
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big side effect of bleomycin
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pulmonary fibrosis (restrictive lung dz)
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big side effect of cisplatin
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peripheral neuropathy
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big side effect of L asparaginase
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hypersensitivities (allergic rxns)
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what is c3 nephritic factor
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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
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what are muehrcke's nails?
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classic physical finding in nephrotic syndrome - paired narrow horizontal white bands on all fingernails caused by hypoalbuminemia
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what is osteitis fibrosa cystica?
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elevated PTH in renal failure stimulates calcium reabsoprtion from bone causing bony demineralization and cystic bone lesions
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classic dyad of renal artery stenosis
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sudden HTN and low K (pt not on a diuretic)
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what is the most common cause of renal artery stenosis
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atherosclerotic plaque
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Alport's syndrome
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hereditary nephritis due to genetic abnormality of collagen
EM - glomerular BM splitting SSx - renal dz, deaf, ocular abnormalities (dislocated lens) |
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poststrep glomerulonephritis presents weeks after initial infection....when does igA nephropathy present?
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concurrently or within several days of infection
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classic physical finding in henoch schonlein purpura
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"palpable purpura" on butts and legs in children and on shins in adults
usually children...this is another igA nephropathy |
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fibromuscular dysplasia is known to cause what dz process
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renal artery stenosis..usually in young women
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what will you see on renal angiography in a young woman with RAS due to fibromuscular dysplasia?
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"string of beads" sign due to luminal narrowing at various points along the vessel
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US of kidneys comes back describing them as enlarged and having a "moth eaten" appearance bilaterally
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ADPKD
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which kidney stones are radiopaque (white)
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calcium pyrophosphate
struvite (Ammonium Mg phosphate) stones |
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which kidney stones are radiolucent
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uric acid stones
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what is the most common inherited disorder of the kidney
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ADPKD
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what is the most common childhood congenital kidney lesion (note lesion, not malignancy)
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infant polycystic kidney dz (AR)
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describe the kidney of a baby with infant polycystic kidney dz
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external surface of kidney is smooth, no cysts visible
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kidney adenomas (benign)...are always located where in the kidney
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cortex
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describe tuberous sclerosis syndrome
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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) |
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what is the most common renal malignancy
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renal cell CA
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describe the cells seen in renal cell CA
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polygonal clear cells (reminiscent of adrenal cortex)
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what is the most common renal malignancy of childhood
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wilm's tumor aka nephroblastoma...peaks at 2-4 yo
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wilms tumors are associated w what gene on which chromosome
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loss of tumor suppressor gene WT-1 on chromosome 11
(wilms tumor 1 = 11 characters) |
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what is WAGR complex
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Wilms tumor
Aniridia - absence of iris genitourinary malformations MR |
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whats a weird association with wilms tumor that we never learned about
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hemihypertrophy of the body
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pseudohyphae, true hyphae, and budding yeasts
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candida albicans
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broad, based budding yeasts with a double refractile cell wall....causes pulmonary involvement
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blastomyces
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narrow angle, dichotomously branching, monomorphic filaments....may infect burned skin or cause pulmonary or systemic involvement
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aspergillus
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small intracellular yeast with no capsule and narrow neck on bud...causes pulmonary involvement
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histoplasma
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spherules and endospheres....causes pulmonary involvement
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coccidioides
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what are kayser fleischer rings
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greenish grey or brownish rings around the cornea seen in Wilson's disease (AR....copper deposition in liver and brain)
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waiter's tip position seen in erb duchenne palsy is damage to what part of the brachial plexus
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superior trunk - nerve roots c5 and c6
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klumpke palsy, such as when a baby's arm is forcefully pulled superiorly during childbirth, is damage to what part of the brachial plexus
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medial cord - c8 and t1 nerve roots
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broad non septate hyphae
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mucor and rhizopus spp.
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cigar shaped budding yeast
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sporothrix schenckii
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DOC for sporotrichosis
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itraconazole
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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 |
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what causes a cushing's ulcer
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post brain injury...leads to increase stomach acid production secondary to increased steroid levels (leads to acute erosive gastritis)
mneumonic...cushings - increase steroids) |
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who gets curling ulcers and what do curling ulcers lead to
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burn patients get curling ulcer (curling irons are hot...they burn)
curling ulcers lead to acute erosive gastritis |
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duodenal ulcer vs gastric ulcer
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duodenal ulcer pain Decrease w food
gastric ulcer pain Grows worse w food |
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what causes duodenal ulcer
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acid hypersecretion
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what is a blumer's shelf
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palpable nodule superiorly on rectal exam - indictaive of metastasis of GI cancer
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sister mary joseph sign
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metastasis of gastric cancer to umbilicus.....feel a hard nodule there...poor prog
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what is the most deadly form of gastric cancer
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linitis plastica (it's infiltrative..kills ya quick)
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duodenal ULCER and gastric CANCER are associated with different blood types..what are they
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gAstric cancer associated with blood type A
duOdenal ulcer associated with blood type O |
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most common congenital anomaly of small bowel
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meckel's diverticulum
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meckel's diverticulum is remnant of what structure
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embryonic vitelline duct
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rule of 2's meckels diverticulum
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2% popn
2 feet from ileocecal valve 2 inches long usually presents within first 2 y of life |
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anti endomysial Ab
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celiac dz
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anti tissue transglutaminase Ab
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celiac dz
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dermatitis herpetiformis, associated w celiac dz, affects what parts of body
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pruritic red papulovesicular lesions on shoulders, elbows and knees...disappear after gluten withdrawal
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2 dzs with PAS + macrophages
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whipples dz (tropheryma whippelli..inflmmatory disorder of GI tract)
MAC in AIDS |
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lactase deficiency (lactose intolerance) results in what kind of diarrhea
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osmotic....surgar draws water into bowel
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what is abetalipoproteinemia and what do you see on peripheral smear
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hereditary deficiency of apoprotein B leading to fat malabsorption
see SPUR CELLS (acanthocytes) on smear |
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pancreatitis and cystic fibrosis often lead to what....
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malabsorption!
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