Boards Boot Camp Comprehensive Flashcards: Segment 8

Front 1

type of polyp that occurs in the rectum and rectosigmoid colon. Very high risk for malignant transformation and may present with rectal bleeding, hypokalemia, and hypoproteinemia

Back 1

villous adenoma

Front 2

Form of FAP with mandilbe and skull tumors, epidermal cytsts, and a very high risk for abnormal dentition (messed up teeth)

Back 2

Gardner's syndrome

Front 3

Serious form of cancer d/t DNA mismatch repair genes. Increased risk for colon cancer with NO polyps. Pt is at huge risk for MULTIPLE CARCINOMAS especially the endometrium and ovary

Back 3

HNPCC

Front 4

GN recognized clinically by slow, chronic progression. LM shows double-layered basement membrane seen best with silver stain. Decreased serum C3

Back 4

membranoproliferative GN
tram-tracking

Front 5

Classical physical finding is Muehrcke's nails, paired narrow horizontal white bands on fingernails

Back 5

Most often seen with hypoalbuminemia associated with nephrotic syndrome

Front 6

pathognomonic is increased mesangial matrix either diffusely or in nodules

Back 6

this is the definition of "Kimmelstiel-Wilson nodules"
Diabetic GN

Front 7

Immune complex deposition along the glomerular basement membrane, leading to a typical granular appearance in immunofluorescence testing. This is PN for which GN?

Back 7

Type 4 Lupus GN
1 - no renal
2 - mesangial disease with focal segmental glomerular pattern
3 - focal segmental proliferative disease
5 - simply membranous GN

Front 8

Name of condition when calcium is reabsorbed from from bone d/t renal failure and PTH is increased 2nd to high levels of P++

Back 8

Osteitis fibrosa cystica

Front 9

Type of GN, labs show urine red cells and casts, decreased C3, and increased titers. EM shows subEPIthelial 'humps" and immunoflorescence shows granular IgG/ C3 deposits

Back 9

poststreptococcal GN
ASO titer
pt typically recovers

Front 10

type of GN, deposition of fibrin and proliferation of epithelial cells and monocytes, hemoptysis late in disease, rapidly progressive. Classic EM shows immunofluorescent linear deposition of IgG

Back 10

Crescentic (RP) GN
nephritis progresses to renal failure in about a month
Goodpasture's falls into this category

Front 11

Hereditary nephritis d/t collagen abnormality, sx: renal disease, deafness, lens dislocation and cataracts, EM shows GBM splitting

Back 11

Alport's syndrome
X-linked so Dad can't pass to son

Front 12

Most common world-wide nephropathy, presents concurrently or within DAYS after infection (PSGN/PIGN = weeks after infection), IgA deposits in mesangium, sx: hematuria with low-grade proteinuria

Back 12

Berger's disease (IgA nephropathy)
Eat a burger with my mouth

Front 13

Child presents with abdominal pain, vomiting, hematuria and GI bleeding post respiratory infection. PE findings raised bumps on on butt and legs

Back 13

Henoch-Schonlein purpura
also an IgA nephropathy

Front 14

GN with increased production of light chains, myleoma cells can directly invade kidney. If MM is suspected, chronic infections d/t what type of bacteria is the pt susceptible to?

Back 14

encapsulated bacteria
e. coli-->chronic RF

Front 15

Idiopathic disorder that presents in young women d/t narrowing at various points along various arteries that look like a "string of beads"

Back 15

fibromuscular dysplasia

Front 16

What is a DOC for testicular cancer and what is primary AE?

Back 16

bleomycin
pulmonary fibrosis

Front 17

Chemptheraputic alkylating agent that has an ADR to induce secondary cancers such as leukemia. Effective against hematologic malignancies like leukemia and lymphoma

Back 17

mechlorethamine

Front 18

ADR for all chemo drugs that are alkylating agents

Back 18

generating secondary malignancies

Front 19

DOC prostate cancer, synthetic analog of GnRH, which causes suppression of sex hormone synthesis, but not before a slight surge of LH and FSH. ADR is hot flashes

Back 19

leuprolide

Front 20

DOC prostate cancer, testosterone receptor blocker, ADR is gynecomastia

Back 20

flutamide

Front 21

Chemo agent that inhibits ribonucleotide reductase, key in the synthesis of WBCs-->tx leukemia. Also induces fetal Hb (HbF)-->reduces number of sickle cell crisis

Back 21

hydroxyurea

Front 22

Version of Vit A used as a chemo agent that only binds to receptors found on cells of AML. ADR is DIC

Back 22

ATRA (all-trans-retinoic-acid)

Front 23

estrogen receptor modulator that works on breast tissue. ADR are increased risk of DVT, PE and increased risk for endometrial cancer

Back 23

tamoxifen

Front 24

Chemo drug that inhibits microtubule disassembly resulting in apoptosis. Used in breast, lung, and ovarian cancers. ADR are dose-limiting bone marrow supression

Back 24

taxanes
paclitaxel and docetaxel

Front 25

ADR of NSAID that are GI ulcers, that may perforate and bleed, pancreatitis, fatal hepatitis, and aplastic anemia

Back 25

Indomethacin

Front 26

Possible causes of necrosis of the cortex of kidney with the medulla spared

Back 26

kids: abruptio placentae, sepsis, shock, HUS
Adult: pregnancy accidents, bacterial sepsis, end organ spasm, DIC

Front 27

What are two organisms that can alkanize the urine and precipitate struvite stones?

Back 27

protease and S. saprohyticus

Front 28

What is the gross change in the kidney in hydronephrosis and possible causes?

Back 28

dilation of renal pelvis and calyces with blunting of the renal pyramids
stones, BPH, preg, neurogenic bladder

Front 29

Pt complains of lumbar pain, hematuria, recurrent infection, kidney stones, and labs show uremia. Differentiate btw chronic renal failure and ADPCKD

Back 29

CRF - small kidneys
ADPCKD - large, moth eaten kidneys
done by ultrasound

Front 30

Child with ARPCKD will present early or late with what sxs?

Back 30

early - renal symptoms, poor prognosis
late - hepatic sxs, better prognosis

Front 31

Child presents with acute onset uremia outa nowhere, complains of excessive thirst and frequent urination. You notice he is small for his age. On ultrasound he has small kidneys and multiple bone lesions. He does not receive a kidney transplant in time and dies. Autopsy would show what?

Back 31

medullary cysts with tubular atrophy and interstitial fibrosis
small kidneys
this is medullary cystic disease

Front 32

Pt complains that he can never seem to fully empty his bladder and has frequent kidney stones with some hematuria. If you suspect medullary sponge disease, what is the pathology?

Back 32

tubular dilation of collecting ducts only
good prognosis

Front 33

Child with unknown cause of MR presents with mom with seizures, multiple facial lesion composed of blood vessels. Recent dx of cardiac rhabdomyoma. What is the renal component and what other condition is this associated with?

Back 33

Angiomyolipoma (benign)
tuberous sclerosis - multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. Defect is in TSC1 and TSC2, which encode for the proteins hamartin and tuberin respectively.

Front 34

von hippel lindau disease

Back 34

autosomal dominant genetic hemangioblastomas found in the cerebellum, spinal cord, kidney and retina. Associated with renal angioma, renal cell carcinoma and pheochromocytoma.
Mutation in the von Hippel–Lindau tumor suppressor gene on chromosome 3p25.3

Front 35

How will renal cell carcinoma present?

Back 35

50-70 y/o male smoker
hematuria, palpable mass, flank pain, fever, 2ndary polycythemia (ectopic EPO)

Front 36

What is the most common renal malignancy of childhood and how will it present?

Back 36

Wilm's tumor
peak 2-4 years
palpable flank mass
biopsy shows immature stroma, primitive tubules and glomeruli, possible striated mm
deletion of WT-1 suppressor gene on CHM 11
**associated with hemihypertrophy of the body (Beckwith–Wiedemann syndrome)**

Front 37

What modulates the following:
UES
LES
primary peristalsis
secondary peristalsis

Back 37

UES - excitation via recurrent laryngreal nerves
LES - myenteric plexus
swallowing
inhibitory signals to LES from vagus nerve

Front 38

PN no peristalsis, increased LES tone, no LES relaxation

Back 38

achalasia

Front 39

pt presents with dysphagia, chest pain, pt is convinced he's having a heart attack, symptoms are intermittent and occur spontaneously

Back 39

diffuse esophageal spasm

Front 40

What is the upper GI manifestations of neuromuscular disorders?

Back 40

decreased pharnygeal contraction
decreased UES relaxation

Front 41

What mm are involved in Zenker's diverticulum?

Back 41

cricopharyngeus
inferior constrictor mm

Front 42

What is the likely cause of congenital esophageal atresia

Back 42

polyhydraminos - too much fluid, bc fetus is not swallowing the fluid

Front 43

What cancer is likely to develop from Barret's esophagus?

Back 43

adenocarcinoma
squamous cell carcinoma - booze and cigs

Front 44

What is a Schatzki ring and where is it likely to develop?

Back 44

mucosal indentation at GE junction
greater than 12 mm = food lodging

Front 45

esophagitis is most likely d/t infection from?

Back 45

CMV, herpes, candia

Front 46

pulsion (inflammation of esophagus outward) and traction tend to occur where in the esophagus?

Back 46

pulsion - upper and lower (herniation of the mucosa only = false diverticula)
traction - middle

Front 47

patch of excess muscosa and submucosa, spoon nail, and iron deficiency anemia. Webs disappear with iron treatment

Back 47

Plummer-vinson sd

Front 48

What cells are located at the gastric fundus and antrum respectively?

Back 48

fundus - parietal and chief cells
antrum - mucosa and goblet cells

Front 49

Condition that develops postvagotomy with sxs of vomiting after meals, sweating, palpitations, and diarrhea. MOA? Why do patients develop reactive hypoglycemia? tx?

Back 49

this is Dumping syndrome (stop giggling)
vagotomy - rapid fluid transfer to duodenum, rapid caloric uptake (increased insulin = reactive hypoglycemia), solid emptying is delayed
pyloric sphincterotomy
metroclopramide

Front 50

Curler's ulcer in seen in which pts?
Cushing's ulcers?
Likely first + sign?

Back 50

Burn patients
post brain injury d/t increased acid levels 2nd to increased steroid levels/intracranial pressure
blood in NG tube post trauma ICU

Front 51

What are the two types of chronic gastritis and where in the stomach are each seen?

Back 51

Type A - fundal - autoimmune (pernicious anemia)
Type B - antral - H. pylori, NSAIDS, herpes, and CMV

Front 52

Define the following physical finding in GI metastatic carcinoma:
Virchow's node
Krukenberg tumor
Sister Mary Joseph sign
Blumer's shelf

Back 52

rock hard supraclavicular node
mucinous, signet ring cells from GI carcinoma to bilateral ovaries
nodule palpated around the umbilicus
nodule in rectum

Front 53

Most deadly of GI cancers, defined by infiltrating , diffuse carcinoma, stomach looks likes a "leather bottle"

Back 53

Linitis plastica

Front 54

How does carcinoid syndrome and thyrotoxicosis cause diarrhea?

Back 54

prolong the migrating motor complex of course

Front 55

Remnant of embrionic vitelline duct, may present with bloody diarrhea, peptic ulcers, intussusception causing obstruction
rules of 2

Back 55

Meckel's diverticulum
2% of population, 2 ft from ileocecal valve, 2 inches long, 2 years of life

Front 56

Two conditions that show PAS + macrophages

Back 56

Whipples disease
mycobacterium avium intracellulare in AIDS

Front 57

Enterochromaffin (EC) cells (Kulchitsky cells) are a type of enteroendocrine cell occurring in the epithelia lining the lumen of the digestive tract and the respiratory tract.

Back 57

Carcinoid syndrome
Small cell carcinoma (oat cell)

Front 58

SO YOU NEVER FORGET, LEUKEMIAS:
ALL - kids, excess lymphoblasts, crowd bone marrow, spread to other organs
AML - any age, rapid growth of abnormal white blood cells in BM, Auer rods in myeloblasts (needles), swollen spleen and lymph nodes
CML - young adult, proliferation of myeloid cells in the bone marrow and the accumulation of these cells in the blood, splenomegaly, Philadelphia chro.
CLL - elderly, B cells grow out of control and accumulate in the bone marrow and blood, low Ig levels, infections
Hairy cell leukemia - "hairy cells" (malignant B lymphocytes) accumulate in the bone marrow, hepato/splenomegaly, pancytopenia
HODGKINS DISEASE - originates from WBCs spread of disease from one lymph node group to another and by the development of systemic symptoms
NON-HODGKINS LYMPHOMA - any kind of lymphoma EXCEPT Hodgkin's:
-small lymphocytic
-large cell lymphoma
-Burkitt - cancer of the lymphatic system (in particular, B lymphocytes), translocation of c-myc gene

Back 58

x

Front 59

What are some acceptable drug regiments for Whipple's disease and how long must treatment be administered for?

Back 59

TMP/SMX (1st line)
penicillin, ampicillin, tetracycline
4-6 months, 1 year is preferable

Front 60

What type of bacteria causes Whipple's disease?

Back 60

gram-positive actinomyces

Front 61

Liver, bile duct, kidney, bone, and the placenta have high concentrations of alkaline phosphatase, might help narrow down a path question or two.

Back 61

you're welcome

Front 62

Alcoholic cirrhosis, also known as Laennec's cirrhosis, is irreversible, MCC cirrhosis, end stage of alcoholic hepatitis.
Laennec also invented the stethoscope

Back 62

Kudos, René Laennec.

Front 63

Middle aged male presents with sxs of cirrhosis, new-onset type duce diabetis, and a lovely tan. DX?

Back 63

hemochromatosis
cardiomyopathy is a common outcome

Front 64

What do the following bacteria have in common?
staph
pseudo
candida
aspergillus
enterobacteriaceae

Back 64

all are catalase-positive

Front 65

organism produces disease after consuming raw oysters, sx gastroentritis + cellulitis. tx?

Back 65

vibrio vunificus
gram-negative, comma-shaped, oxidase positive rod, sensitive to acid
tetracycline or 3rd gen ceph

Front 66

More lab tests:
cold agglutinins
dieterle silver stain
quellung reaction
requires cystine
factors X and V

Back 66

IgM - mycoplasma pneumonia
legionella
strep pneumo
francisella, legionella, brucella, pasturella
haemophilus

Front 67

Coxsackie A - hand, foot, mouth, and butt disease + disseminated multi-organ involvement. Usually resolves without issue

Back 67

kaplan

Front 68

parotitis, pancreatitis, orchitis
paramyxovirus
produces multinucleated giant cells (syncytia)
cell mediated immunity is necessary

Back 68

Mumps