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459 Cards in this Set
- Front
- Back
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What is Chloramphenicol and what is its mechanism of action?
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Antibiotic; protein synthesis inhibitor. Also inhibits P450
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What are the functions of Probenecid?
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Inhibits the renal excretion of uric acid and certain drugs. A "uricosuric" agent at high doses.
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What is the MOA of Fluoroquinolones?
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antibiotic; inhibits topoisomerase, preventing bacteria from using their own DNA
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What is the use and toxicity associated with flucytosine?
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First line drug for cryptococcal meningitis; causes bone marrow toxicity
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What is the use and toxicity of Foscarnet?
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Used to treat CMV retinitis; nephrotoxic
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What is the body's response(3) to irreversible cell injury?
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Coagulation necrosis
Liquefactive necrosis (brain) Caseous necrosis (TB) |
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What are the cell types/processes that define post cell injury? 24, 48, 72 hrs, 1 week, 2 weeks?
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Neutrophils (roll in)
Macrophages Regenerating epithelium Repaired epithelium Dense, thick, collagen fibers |
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Define the following mediators to inflammation:
Fever Vasodilatation Exudation Chemotaxis Phagocytosis Pain |
IL-1, PGS
NO, PGS Histamine, bradykinin Compliment C5a, IL-8 Compliment C3b (opsonin) PGS, bradykinin |
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How do helper T cells (CD4) activate NK cells, B cells, and macrophages?
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IL-2-->activates NK and B cells
INF-gamma-->activate macrophages |
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What are the the 2 cytokines that induce MHC-I expression?
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Alpha and Beta interferon
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FF: Mutation of the IL-2 receptor is the cause of SCIDS
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boobs
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What is the differences in the activating agents of the Classical and Alternate compliment pathways?
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Classical - triggered by antigen-antibody complex
Alternate - triggered by contact with microbial surfaces |
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What are the three types of AMYLOID and under what conditions are the seen?
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AL - Amyloid light chains - Multiple Myeloma
AA - Amyloid associated protein - chronic inflammation and aging AB - Beta Amyloid - Alzheimers |
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FF: Amyloid - When stained with Congo-Red see green birefringence under polarizing microscope
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TRALSE
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Explain the mechanism of a Type IV reaction
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Memory T cells activate macrophages and NK cells, causes erythema with induration. Seen in tuberculin reaction (delayed hypersensitivity)
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For the following oncogenes, name the associated disease:
c-myc c-abl bcl-2 ras |
Burkitt lymphoma
CML Non-Hodgkin lymphoma Colon cancer |
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What is the use of tumor markers?
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used as follow-up after treatment to detect metastases, not for screening in asymptomatic pts
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For the following tumor markers, name the associated disease:
CEA AFP PSA Acid phosphatase Alkaline phosphatase |
adenocarcinomas (colon, pancreas, lung)
hepatoma, twins, anencephalus duh prostate carcinoma bone mets, obstructive biliary dz, Paget's dz |
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What is Chediak-Higashi syndrome?
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AR disease - bacterial and fungal infections of the skin and mucus membrane d/t impaired leukocyte function
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What in the av malformation seen in AD polycystic kidney disease?
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berry aneurysms
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What is phacomatoses?
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benign tumors of the ectoderm (eye, skin, and brain)
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Match the following partial deletions with their effects:
5p 11p 13q |
cri du chat syndrome
congenital absence of iris (two eyes = 1 + 1) retinoblastoma |
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For the following Major HLA's, what diseases is/are the patient predisposed to?
A3 B27 DR2 DR3 DR4, Dw4, Dw14 |
hemochromatosis
ankylosing spondylitis Reiter's sd UC MS Narcolepsy SLE IDDM (Type 1 diabetis) RA Juvenile RA |
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Where are the following HLA's found?
HLA A-C HLA D |
all cell surfaces
mostly on B-lymphocytes |
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What is the MCC of nephrotic sd in kids v. adults?
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Kids - minimal change GN
Adults - membranous GN |
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What are the differences between abs in limited v. diffuse (systemic) sclerosis?
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Limited (CREST)-->anti-centromere
Diffuse-->anti-Scl 70 (topo I) |
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ab associated with idiopathic thrombocytopenic purpura?
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anti-structural platlet
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What is the tetrad of polyarteritis nodosa?
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Patient presents with fever, hypertension, abdominal pain, and renal disease (without glomerulonephritis)
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Triad of microscopic polyangitis
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Hemoptysis, hematuria, palpable purpura (with glomerulonephritis)
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DOC for cyanide OD?
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amyl nitrate
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DOC for benzo OD?
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flumazenil
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What is the drug known as "2-PAM" that restores cholinesterase activity?
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pralidoxime
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Briefly describe the MOA's of the following antibiotics:
penicillins and cephalosporins aminoglycosides vancomycin quinolones chloramphenicol erythromycin |
inhibit peptide cell wall synthesis
inhibit the initiation of translation inhibits phospholipid plasma membrane synthesis inhibits topoisomerase; bacteria cannot use their own DNA inhibits peptidyl transferase (macrolides) inhibit protein synthesis |
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Briefly describe MOA
tetracyclines sulfonamides trimethoprim |
inhibit tRNA binding-->inhibit protein synthesis
inhibit folate synthesis inhibits folate use |
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DOC pregger with UTI + MOA
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nitrofurantoin - accumulates in the urine, works to inhibit bacterial enzyme systems
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DOC Bacillus cereus
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vanc or clindamycin
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DOC Borrelia burgdorferi
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doxycycline
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DOC Camppylobacter jejuni
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erythromycin
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DOC Candida spp. (2)
vag systemic |
micronazole (vag)
fluconazole (systemic) |
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DOC Chlamydia trachomatis
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doxycycline; azithromycin (alt)
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DOC Clostridium difficile
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metronidazole; alt vanc
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DOC Corynebacterium diptheriae
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erythromycin
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DOC Gardnerella vaginalis
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metronidazole
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DOC Hemophilus influenzae
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cefotaxime or ceftriaxone
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DOC Hemophilus ducreyi
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azithromycin
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DOC Mycoplasma pneumoniae
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azithromycin
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DOC Neisseria gonorrheae
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ceftriaxone
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DOC Neisseria meningitdis
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penicillin G
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DOC Bacillus anthracis
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penicillin
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DOC Listeria monocytogenes
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ampicillin
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DOC Pastuella multocida
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penicillin family
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DOC Salmonella typhi
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ceftriaxone or any quinolone
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DOC Shigella species
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azithromycin or any quinolone
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DOC Treponema pallidum
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penicillin G
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DOC Trichomonas vaginalis
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metronidazole
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DOC Staph aureus
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nafcillin (naf for staph)
dicloxacillin in on skin |
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DOC Strep pyogenes
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penicillin G or V
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DOC genital warts
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podophyllin resin or burn that thing off
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DOC Group B strep
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penicillin G
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DOC Staph saprophyticus
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any cephalosporin or pen family
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DOC Strep pneumoniae
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Penicillin G
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DOC Vibrio cholerae
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doxycycline or any fluroquinolone
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DOC Giardia lamblia
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tinidazole or nitazoxanide
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DOC Entamoeba histolytica
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metronidazole or tinidazole
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DOC Ascaris lumbricoides
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bendazoles
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DOC Enterobius vermicularis (pinworm)
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bendazoles
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DOC Necator americanus
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bendazoles
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DOC Trichinella spiralis
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bendazoles
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DOC Schistosoma spp.
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praziquantel
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DOC Diphyllobothrium lantum
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praziquantel
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DOC Andenovirus
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cidofovir + probenecid
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DOC Influenza A (seasonal)
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zanamivir
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DOC Influenza B and avian (H5N1)
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oseltamivir
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DOC Measles (kids and adults) 2
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vitamin A
ribavirin |
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DOC Smallpox
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smallpox vaccine (within four days of exposure) + cidofovir
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What is Wiskott-Aldrich sd, inheritance pattern, and clinical sxs
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low IgM
X-recessive bacterial infections, thrombocytopenia, eczema |
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What do the following bleeding studies measure?
Bleeding Time PT aPTT TT |
platelet function
extrinsic + common intrinsic + common common |
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In the following bleeding disorders what bleeding studies are prolonged?
Von Willebrand (VIII-R) dz Hemophilia A (VIII) Hemophilia B (IX) Vit. K deficiency |
aPTT and BT are prolonged
aPTT prolonged aPTT prolonged PT prolonged |
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In what anemia do you see Heinz bodies (hemoglobin degradation products) and what factors aggravate this condition?
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G6PD, aggravated by viral infections, sulfa drugs, quinine, and nitrofurantoin
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In what disease states do we see cold and warm antibodies respectively?
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mycoplasma pneumonia
mononucleosis lymphoma drugs malignancies SLE |
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What is the triad of Plummer-Vinson sd?
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anemia
atrophic glossitis esophageal webs |
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What is the triad of Fanconi Anemia?
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hypoplastic thumbs
absent radii aplastic anemia MOA: inherited defect in DNA repair |
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In what conditions are the following RBCs with "special features" seen?
Heinz bodies Howell-Jolly bodies basophillic stippling siderocytes reticulocytes |
G6PD deficiency
post splenectomy (nuclear fragments) lead poisoning iron overload, Pappenheimer bodies (iron inclusion bodies) recovery from hemorrhage |
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What is the clinical picture of Felty's syndrome?
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combination of rheumatoid arthritis, splenomegaly, and neutropenia (immune mediated destruction)
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What two cells will be present with increased numbers with a TB infection?
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lymphocytes and monocytes
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What is the clinical picture of CML?
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young adult
fever, night sweats, splenomegaly poor prognosis Philadelphia chromosome (bcr/abl translocation) |
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What is the clinical picture in AML?
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any age
fever, petechiae, ecchymoses, lymphadenopathy (splenomegaly) AUER RODS IN MYELOBLASTS |
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What is a Reed-Sternburg cell and what disease is it seen in?
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binucleated cell with prominent nucleoli and clear parachromatin. Seen in Hodgekin's disease
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How is Burkitt's Lymphoma classified and what is the "starry sky" pattern?
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high grade, subtype of non-Hodgkin's Lymphoma
"stars" - benign macrophages "sky" - matrix of rapidly proliferating neoplastic B cells |
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What is Waldenstrom's disease and what PN cell is seen?
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plasma cell neoplasm
always IgM "flame cells" (eosinophilic plasma cells) hyperviscosity syndrome |
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What are the risk factors for phlebothrombosis and what is the "positive" sign that is seen?
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endothelial injury
slow blood flow hypercoagulability Trousseau's sign - migratory venous thrombosis, a/w neoplasms |
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What is Monckenbergs arteriosclerosis and what is the PN sign?
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media calcific stenosis
affects small and medium sized arteries asx "gooseneck lumps" |
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What sized vessels do hypersensitivity arteritis affect?
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small vessels
ex: Henoch-Schonlein purpura (see many small hemorrhages all over the body usually preceded by infection like pharyngitis) |
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What type of vessels and organ systems are affected in polyarteritis nodosa?
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small and medium sized vessels
kidneys, heart, muscles, and skin responds to steriods |
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What sized vessels are affected in thromboangitis obliterans (Buerger's) and what population is it seen in?
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small and medium sized vessels
smokers |
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What condition is seen in 50% of patients with giant cell arteritis?
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polymyalgia rhumatica (pain or stiffness in the neck, shoulders, and hips)
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What vessels are affects in Wergner's?
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upper and lower respiratory vasculitis + glomerulonephritis
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What vessels are affected in Takayasu (pulseless dz)?
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aorta/large arteries
Asian females |
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What is the clinical picture of Kawasaki's dz?
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aka mucocutaneous lymph node syndrome
coronary artery aneurysms fever, conjunctivitis, maculopapular rash Japanese children |
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For the following types of aneurysms, provide the typical location affected?
atherosclerotic syphilitic dissecting berry micro |
abdominal aorta (hypertension)
ascending aorta (a/w aortic insufficiency) aorta ascending or descending (Marfan's) circle of Willis (a/w adult polycystic kidney disease) cerebral: HTN retinal: diabetes |
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Describe mitral valve prolaspe
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young women, Marfan's
midsystolic click |
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Describe mitral stenosis
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rheumatic heart dz, a fib
diastolic rumble |
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Describe mitral regurg
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MI of papillary mm
acute rheumatic fever endocarditis holosystolic murmur that transmits to axilla |
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Describe aortic stenosis
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congenital
degenerative calcifications systolic murmur that transmits to carotid aa |
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Describe aortic regurg
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"water hammer" pulse
diastolic murmur "pistol shots" in femoral aa |
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Describe patent ducus arteriosus
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kept open via PGE 2
continuous "machine like" murmur |
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What is TORCH infection and what defects can be seen?
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toxoplasmosis, rubella, CMV, herpes
also see microcephaly, auditory and visual defects |
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Define stable angina
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worse with exercise/relieved by rest
ST depression tx with nitroglycerin |
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Define unstable angina
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at rest or creschendo like
often leads to MI does not respond to nitro |
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Define Prinzmetal's angina
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occurs at rest or in clusters
ST elevation tx with CCBs |
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Define and list features of an MI
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during exercise or REM sleep
ST elevation T inversion tx with nitro, morphine, lidocaine |
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What are the some defining features of tissue change after and MI for the following time peroids:
30 m 4-12 h 18-24 h 24-72 h 3-7 d 10 d 8 w |
mitrochondria swells
edema, hemorrhage neutrophils show up coag necrosis, loss of nuclei, neutrophils like whoa reabsorb dead myofibers granulation tissue scar |
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abbreviations used in this card set
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sx - symptom
a/w - always with DOC - drug of choice pt - patient PN - pathomnemonic |
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What is the clinical presentation of a patient with microscopic polyangitis?
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hemoptysis, hematuria, palpable purpura (with glomerulonephritis)
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What is the clinical presentation of polymyositis?
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proximal mm weakness, elevated mm enzymes, elevated myoglobin
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What are the two anaphylotoxins and what do they induce?
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C3a and C5b
Stimulate mast cells, basophils, platelets to release histamine Differentiate from, C3b-->opsonization of phagocytes C5a-->chemotaxis |
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A female patient presents with joint pain, a fever of 101, and inflammation of several serous membranes (P's) and was recently prescribed a new medication by her physician. Dx? Associated antibody?
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Drug-induced lupus; anti-histone
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How can you differentiate between Wergners granulomatosis and Goodpasture's syndrome?
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Wergner's - sinusitis, glomerulonephritis, and cavitary (normal lung tissue is replaced by a cavity)
Goodpasture's - SEVERE glomerulonephritis, pulmonary hemorrhage (not cavity), and dyspnea |
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Some mo' antibodies:
Hashimoto's thryoiditis Wergner's granulomatosis Goodpasture's sd Primary biliary cirrhosis |
anti-microsomal
anti-neutrophil cytoplasm (ANCA) anti-glomerular basement membrane (anti-GBM) anti-mitochondrial |
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What type of amyloid is present in a patient with reactive systemic amyloidosis as a result of chronic inflammation?
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AA - amyloid-associated protein
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What type of hypersensitivity reaction is responsible for post-streptococcal glomerulonephritis?
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type III - immune complex deposition
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What are the mechanisms for the following types of transplant rejection?
Hyperacute Acute Chronic Graft vs. Host (days to weeks) |
preformed abs bind to antigen on tissue
memory T cells recognize antigen; CD8's destroy graft abs develop over time & destroy graft vasculature T cells in graft tissue attack host |
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Where are the 4 places that alkaline phosphatase is produced?
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bone
kidney placenta biliary system |
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Define the following rare X-linked dominant diseases:
Hyperphosphatemic rickets Incontinentia pigmenti |
inherited vitamin D resistance, bowed legs
mini-teeth and patchy alopecia |
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What is Leber's optic neuropathy and what is the inheritance pattern?
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bilateral blindness with onset after ~15 y/o
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Describe the defects in PKU
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inability to metabolize phen
neurotoxicity from phenylketones inability to make melanin and monoamines (nor and dop) |
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Patient presentation with alpha1 antitrypsin deficiency
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alpha1 AT functions to inhibit elastase
result is liver destruction active elastase the lung results in emphysema |
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What is the definition of mucopolysaccharidoses
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unable to metabolize GAG's which are critical components of connective tissue
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What is Bernard-Soulier disease and what is it d/t?
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excessive bleeding d/t lack of Gp1b (platelet adhesion to VWF)
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What is Glanzmann's Thrombasthenia and what is it d/t?
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excessive bleeding d/t lack of Gp11b111a (platelet to platelet adhesion)
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What is the DOC for otitis externa
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ofloxacin drops
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What is the tx for viral conjunctivitis?
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nutin'
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DOC for neonatal conjunctivitis given the following time intervals:
2-4th day 3-10th day 2-16th day (with evidence of dendritic corneal ulcer) prophylaxis against opthalmia neonatum |
IV ceftriaxone (most likely cause, N. gonorrheae if hyperpurulent)
PO erythromycin (most likely cause, C. trachomatis) trifluridine drops (most likely cause, HSV) silver nitrate drops or erythromycin ointment |
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For the following diarrhea (hehehe) types, what is the drug treatment:
Post-antibiotic diarrhea Travelers diarrhea Prophylaxis during travel Severe (adults and kids) |
metronidazole
fluoroquinolones or rifaxamin bismuth severe adult - ciprofloxcin or levofloxacin + metronidazole severe kids - TMP/SMX + metronidazole |
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Describe the use for the following 2nd generation penicillins(beta-lactamase resistant):
methicillin dicolxacillin oxacillin and cloxacillin nafcillin flucloxacillin |
beta-lactamase staph and strep
skin infections and cellulitis also used for skin infections naf for staph (eliminated via biliary tract) reserved for serious infections |
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ampicillin and amoxicillin are examples of what
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3rd generation penicillins;target gram positive & negitive species;common prophylaxis for dental procedures in pts with high-risk cardiac conditions
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How would carbenicillin, piperacillin, and ticarcillin be classified?
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extended spectrum PCN's aka "antipseudomonals PCNs"
never used as monotherapy; always used with an aminoglycoside or ciprofloxin |
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The first generation cephalosporin, cefazolin is a DOC for what?
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skin infections and cellulitis
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What 2nd generation cephalosporin no longer available in the US causes a disulfriam-like reaction when injested with alcohol?
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cefamandole
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What is the biochemistry behind a disulfriam-like reaction?
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a reaction where aldehyde dehydrogenase is inhibited, resulting in a build-up of acetaldehyde. Sx are flushing, tachycardia, hyperventilation, n/v, palpaitations, chest pain, and hypotension
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What third generation cephalosporin, besides its HENpeck + enterics use, is used in infected patients with renal problems?
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ceftriaxone; excreted in bile; also the DOC for infections with N. gonorrhea
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Fourth generation cephalosporins and ceftazidime (3rd gen) are effective against what organism?
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pseudomonas aeruginosa
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After a splenectomy, the patient is at a higher risk for what organisms? Protocol?
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encapsulated bacteria (Haemophilus influenza B and strep pneumonae). Vaccines to both given before surgery and prophylactic antibiotics after surgery and during dental procedures
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What joint is spared in rheumatoid arthritis?
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Distal interphalangeal joints
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Describe the defect in the following congenital immunodeficiencies:
DiGeorge's Ataxia-telangiectasia X-linked hypo-IgG (Brouton's) Chronic granulomatous disease Hereditary angioedema |
T cell deficiency (lack of functioning thymus)
AR, appears at age 2, combined T and B cell deficient B cell deficiency d/t mutation of a tyrosine kinase X-linked phagocyte deficiency AD compliment deficiency-->defective C1 esterase inhibitor |
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Describe the patient presentation with left sided heart failure:
causes sxs |
ischemic heart diesase, arterial hypertension, vavular disease
sxs - pulmonary congestion, renal hypoperfusion |
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What are some causes and sxs of right sided heart failure?
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left sided heart failure-->right sided heart failure, lung disease, primary pulmonary hypertension
sxs - increased venous pressure (edema, "nutmeg liver". ascites) |
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What are the two types of infective endocartidis?
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acute and subacute
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Describe acute infective endocarditis
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caused by staph. aureus or strep spp.
previously NORMAL valves "janeway" lesions - non-tender, macular patches on the palms and soles (septic emboli) fever, chills, hematuria |
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Describe subacute infective endocartitis
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caused by strep. viridians or gram negitive bacilli
previously ABNORMAL valves Roth spots - oval retinal hemorrhages with pale center Osler nodes - red, tender lesions on the finger and toe pulps low grade fever |
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What are the two types of non-infective endocartitis?
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marantic
Libman Sacks |
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Describe Marantic endocarditis
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non-infective
a/w chronic illness thrombotic (platelet and fibrin deposits) |
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Describe Libman Sacks endocarditis
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non-infective
SLE verrucous lesions on both sides of valve leaflets |
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What are the clinical signs of pericarditis?
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low-grade fever
pericardial friction rub - chest pain aggravated by trunk movement pulsus paradoxus - exaggerated fall in inspiratory blood pressure |
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What are the three types and key features of pericarditis?
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fibrinous - transmural MI, Dressler syndrome (delayed pericarditis 2-10 weeks after MI), bread and butter appearence
serous - viral infection (MC Coxsackie), uremia suppurative - bacterial, fugal, parasitic infections |
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What are the buzzwords for rhumatic fever?
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SCHOOL-AGE CHILDREN WITH UNTREATED STREP PHARYNGITIS (group A beta hemolytic strep)
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What is the onset of acute rheumatic fever? age group? causative agent? criteria?
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1-4 weeks post tonsilitis
5-15 group A beta hemolytic strep (pyogenes) JONES: polyarthritis, erythema, subq nodes, chorea, carditis |
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What is the most common clinical presentation of acute rheumatic fever?
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migratory polyarthritis lasting 2-3 weeks with fever
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Where would one find Achoff bodies and what condition are they associated with?
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acute rheumatic fever
granulomas of focal interstitial myocardial inflammation also seen with Anitschkow cells - enlarged macrophages |
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What is the definition of obstructive lung disease and what are some examples?
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reduced air flow d/t high resistance or low elastic recoil (frc and tlc are high)
emphysema chronic bronchitis asthma bronchiectasis |
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What is the cause of Kartagener's syndrome?
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immotile cilia resulting in a lack of mucus clearance
results in bronchiectasis (widening and destruction of large airways) |
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What is the definition of restrictive lung disease?
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recoil of lungs is large
FRC, VC, and TLC are low |
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What is the difference between Goodpasture's syndrome and pulmonary hemosiderosis?
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Goodpasture's - type II, abs against basement membrane, hemoptysis, rapidly progressive GN
pulmonary hemosiderosis - alveolar capillary bleeding and accumulation of haemosiderin in the lungs without renal involvement |
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What is the definition of edema
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when filtration is greater than resorption + lymph flow
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What are some causes of pulmonary edema?
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increased hydrostatic pressure
lymphatic obstruction left sided heart failure, mitral stenosis, pulmonary vein obstruction decreased oncotic pressure microvascular injury |
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What is the presentation of classic pneumonia?
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sudden fever, cough, speutum, and dyspnea
a lobar pneumonia usually caused by pneumococcus |
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For the following pneumonias, what is/are the likely causitive agents?
bronchopneumonia lobar pneumonia "classic" atypical pneumonia Legionnaire's (severe lobar pneumonia) |
haemophilus, pseudomonas
pneumococcus, klebsiella viral, mycoplasma legionella (gram negative rod, grows on charcoal yeast extract, cultured with iron and cysteine, look for antigens in the urine and treat with erythromycin) |
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What is atypical about atypical pneumonia?
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gradual onset
dry, non-productive cough minimal clinical signs of pneumonia prominent extrapulmonary sx, myalgia etc prominent CXRAY "looks worse than patient" |
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What are the lung tumors associated with smoking? Non-smoking?
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squamous
small call large cell benign carcinoid adenocarcinoma |
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What endocrine effects are seen in the following lung tumors?
squamous small cell |
PTH-like peptide = hypercalcemia
paraneoplastic, ACTH, ADH = Cushings, SIADH |
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|
What is the difference btw Cushing's and Addison's disease?
|
Cushing's - excess endogenous or exogenous cortisol
Addison's - primary adrenal insufficiency, excess ACTH, craves salt |
|
|
What are the key distinguishing factors between nephritic and nephrotic syndromes?
|
nephritic - hematuria, RBC casts, poststreptoccal GN
nephrotic - severe proteinuria, hypoalbuminemia-->edema, hyperlipidemia d/t lipid catabolism is decreased due to lower levels of lipoprotein lipase |
|
|
What is the clinical picture of Berger's (IgA nephropathy) glomerulonephritis?
|
mild proteinuria, hematuria in children
lasts 1-2 days post respiratory infection |
|
|
Do the following have a good or poor prognosis?
minimal change disease diffuse proliferative GN |
good prognosis
|
|
|
Microscopic changes in minimal change (lipid nephrosis)
|
loss of foot processes (podocytes)
|
|
|
Microscopic changes in diffuse proliferative GN
|
subepithelial deposits
|
|
|
Microscopic changes in membranous GN
|
thickened glomerulo--basement membrane, sub-epithelial deposits of immune complexes
|
|
|
Microscopic changes in membrano-proliferative GN
|
GBM thickening + proliferation of mesangium
sub-ENDOthelial/intra-membranous deposits of immune complexes "tram tracking" appearence |
|
|
Microscopic changes in focal segmental GN
|
segmental sclerosis
IgM deposits (IgA in Berger's) |
|
|
Microscopic changes in rapidly progressive GN
|
"cresents"
oliguria, uremia |
|
|
Calcium urolithasis
|
precipitate in alkaline urine, tx with thiazide or potassium phosphate
|
|
|
Mg-NH3-Phosphate urolithasis
|
"staghorn calculi"
precipitates in alkaline urine d/t URI caused by proteus (proteus contains uresase which converts ammonia to urea which is basic) tx with antibiotics urine acidification |
|
|
Female patient presents with a testicular mass. In attempting to diagnose a germ cell tumor, you remember the key features of the following:
seminoma embryonal chroiocarcinoma yolk sac teratoma |
uniform, radiosensitive, good prognosis
more aggressive, hemorrhage, necrosis highly malignant with GYNECOMASTIA MC in children, increased serum AFP, very agressive multiple tissue type, malignant |
|
|
What location of a testicular mass determines its malignancy?
|
testicular masses = malignant
extra testicular = benign, benign and a half |
|
|
Which non germ cell testicular tumor produces hormones (androgens, estrogens, corticosteroids)
|
leydig!
sertoli (Stromboli) do not or is very minimal |
|
|
Describe the following surface epithelium ovarian tumors:
serous mucinous endometroid clear cell Brenner |
cysts, ciliated epithelium
cysts, non ciliated glandular tissue (cyclic pain) rare, malignant rare, benign, PN nests of transitional epithelium in stroma |
|
|
Describe the following germ cell ovarian tumors:
teratoma dysgerminoma endodermal sinus tumor choriocarcinoma |
mature (benign)
like seminoma, radiosensitive like yolk sac tumor, increased AFP produces HCG |
|
|
Describe the following sex cord stroma cell tumors:
granulosa-theca steroli-leydig fibroma |
produces estrogens and androgens
produces androgens which leads to masculinization Meig's snydrome--> ascites and classic right sided pleural effusion |
|
|
Describe the following types of endometriosis:
polyps hyperplasia carcinoma |
excessive bleeding, rarely goes malignant
excessive bleeding, PREMALIGNANT usually andnocarcinoma, may be asx or present with bleeding |
|
|
Compare and contrast hydatidform mole and choriocarcinoma
|
usually benign, fertilization of ovum by multiple spermies, large uterus, grape-like cystic material, HCG elevated
malignant, derived from HM, pregnancy, abortion, HCG elevated |
|
|
Compare and contrast a complete hydatidiform mole with a partial hydatidiform mole
|
no embryo, no placenta
46, XX exclusively paternal origin present embryo and placenta triploid or tetraploid karyotype |
|
|
Compare and contrast fibrocystic change with breast cancer
|
bilateral
multiple nodules cyclic variation may regress with pregnancy unilateral single mass no cyclic variation |
|
|
What is a cystosarcoma phyllodes?
|
benign breast tumor
rapidly growing, may become HUGE arises from the periductal stromal cells of the breast |
|
|
In what population are you likely to see Paget's disease of the nipple? What is the prognosis? What is it exactly?
|
older women
poor prognosis a malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast (Paget's cell normally compose the skin of the nipple) |
|
|
What is Waldenstrom's macroglobulinemia?
|
aka lymphoplasmacytic lymphoma is cancer involving lymphocytes. Excess light chains are produced (AL)
|
|
|
What are the following tumor markers associated with what disease:
5'-HIAA CA 19-9 CA 125 CD 25 CD 30 Neuron-specific enolase B-hCG |
carcinoid
colon, pancreatic, breast ovarian hairy cell leukemia, adult T cell leukemia Hodgkin's disease small cell lung CA, neuroblastoma pregger, hydatidiform mole, choriocarcinoma |
|
|
Clinically define the following glycogen storage diseases:
Von Gierke Pompe McArdle |
(MC) glucose-6-phosphatase deficient; impaired ability of liver to produce free glucose from glycogen and from gluconeogenesis
lysosomal acid alpha-glucosidase deficient; damage to mm and nn myophosphorylase deficient; presents in the 30-40s |
|
|
Regarding the AB bloods antigens on RBC's, where else in the body are the AB antigens expressed?
|
endothelium, epidermal cells, intestinal cells, leukocytes and platelets
|
|
|
FF: AB antigens elicit IgM antibodies, causing intravascular hemolysis
|
yup
|
|
|
FF: Rh antigens elicit IgG antibodies, as opposed to AB antigens which elicit IgM antibodies, causing EXTRAVASCULAR hemolysis, again as opposed to AB antigens which cause intravascular hemolysis.
|
whew
|
|
|
What is the difference between Direct and Indirect Coomb's test?
|
Direct - Pt's RBCs tested with Coomb's reagent; tests for any autoimmune hemolysis
+ test = if patient is hemolyzing, Coomb's reagent binds to the IgG attached to the RBCs, causing agglutination Indirect - patients serum is added to foreign cells; detects atypical Abs in patients serum |
|
|
So you messed up and gave a blood type A patient type B blood, whatcha guna do?
|
STOP INFUSION, treat with diuretics + fluid overload to prevent acute tubular necrosis and oliguric renal failure
|
|
|
What is the inheritance pattern in familial hypercholesterolemia and define?
|
AD; abnormal LDL receptor-->unable to process cholesterol in the liver; results in atherosclerosis (risk of CAD and strokes)
|
|
|
What is the inheritance patten in hereditary spherocytosis?
|
AD; defect in spectrin
|
|
|
What are the four types of phacomatoses aka neurocutaneous sds?
|
NF1
NF2 tuberous sclerosis von-Hippel lindau |
|
|
What is the clinical picture of NF1 "von-Recklinghausen disease"
|
neurofibromas, optic nerve gliaomas, Lisch nodules, cafe au lait spots; d/t loss of NF1 gene on chm 17
|
|
|
What is the clinical picture of NF2 "acoustic neurofibromatosis"
|
bilateral schwannomas, multiple meningiomas, hearing deficits; d/t loss of NF2 gene
|
|
|
What is the presentation of tuberous sclerosis?
|
hamatromas and benign tumors of the brain-->brain surface looks like potato with "eyes"
cysts of liver, kidney, pancreas MR facial angiomas cutaneous lesions |
|
|
What is the presentation of von-Hippel Lindau and what is the patient most at risk for developing?
|
capillary hemangiomas in cerebellum and retina
cysts of liver, kidney, pancreas HIGH risk of renal cell carcinoma |
|
|
What is Fabry disease? What causes it? Clinical presentation?
|
type of sphingolipidosis; X-linked recessive
alpha-galactosidase decreased presents with angiokeratomas (wart-like growths with telangiectasias) and renal failure |
|
|
What is the classic triad in Wiskott-Aldrich syndrome?
|
otitis media, eczema, thrombocytopenia
associated with IgM dysfunction |
|
|
What are the three "itis'" in Reiter's syndrome?
|
conjunctivitis, urethritis, arthritis
associated with HLA-B27 |
|
|
What are the common causes of osteomylelitis in the following populations:
general diabetics and sickle cell IV drug users |
staph aureus
samonella spp. serratia and pseudomonas |
|
|
ok, what is the drug treatment for samonella vs shigella
|
Samonella - ceftriataxone or any quinolone
Shigella - azithromycin or any quinolone |
|
|
What condition can cause both hematemesis and melena
|
duodenal ulcer
|
|
|
What are the four types of nephropathys associated with SLE?
|
mesangial - WHO II - MC & mild - transient proteinuria, proliferation of mesangial cells
focal proliferative nephritis - WHO III - proteinuria +hematuria + proliferation of mesangial cells + endothelial proliferation diffuse proliferative nephritis - most severe - WHO IV - nephrotic sd, gross hematuria, mesangium, endo/epithelium proliferation, renal failure, hypertension membranous GN - WHO V - nephrotic sd, endo thickening, sub-epithelial immune complex deposits |
|
|
Briefly describe the following phagocyte disorders:
Job's sd Chediak-Hagashi sd Chronic granulomatous disease |
deficient gamma-interferon; sinopulmonary infections, candidiasis, cold abcesses
impaired microtubules limiting WBC movement; bacterial/viral infections, partial albinism deficient NADPH oxidase in macrophages and neutrohils; granulomas, recurrent bacterial/fungal infections, yellow NBT test |
|
|
For a patient needing penicillin who is allergic, what is the alternate treatment?
|
erythromycin, a macroglide that inhibits protein synthesis
|
|
|
Does penicillin cross the placenta? Is it tetratogenic?
|
it does and is not tetratogenic. Kudos.
|
|
|
What are the three mechanisms that penicillins produce an antibiotic effect in actively growing organisms?
|
bind to PBP in the periplasmic space where they accumulate
inhibit transpeptidases which inhibit the cross-linking of the peptidoglycan "mesh" wall overstimulation of autolysins with damage the cell wall and lyse the bacterium |
|
|
What is the MOA of amantadine? When (time) is optimal for dosing? What limits its use?
|
antiviral
impairs viral uncoating; within 48 hours of symptom onset (before maximal uncoating has occured; enormous resistance |
|
|
MOA for interferon? DOC in what conditions?
|
antiviral
induce host cell response that inhibits RNA translation and induces MHC-1 expression; chronic HBV/HCV infections and hairy cell leukemia |
|
|
MOA of ribavirin, DOCs
|
antiviral
becomes phosphorylated to mimic GTP to block viral mRNA synthesis DOC for chronic HCV and adult measles |
|
|
What viruses are susceptible to acyclovir and why?
|
HSV-1, HSV-2, VZV, and EBV
these viruses contain THYMIDINE KINASE which phosphorylates acyclovir to "ATP"-->inhibits DNA polymerase |
|
|
MOA for vidarabine
|
antiviral
sequential phosphorylation-->"ATP" inhibiting DNA synthesis treats all herpes groups in immunocompromised patients |
|
|
MOA for ganciclovir, DOC, adverse effects
|
antiviral
viral thymidine kinase not required CMV retinitis bone marrow supression resulting in neutropenia or aplastic anemia |
|
|
What is the appearance of the tongue with the following deficiencies:
B2 (riboflavin) deficient B12 (cobalamin) deficient scarlet fever measles |
glossitis, cheilosis
smooth beefy red tongue strawberry tongue Koplik's spots (white dots with red backround) |
|
|
Which esophageal diverticula involves all layers of the esophagus?
|
traction diverticula, usually in the mid esophagus, no symptoms
|
|
|
For the following types of gastritis, name a causative agent/appearance:
acute erosive chronic type A chronic type B Menetrier's |
focal damage - alcohol, NSAIDS
fundal gastritis - autoimmune, pernicious anemia (loss of partial cells) antral gastritis - H. pylori thickened mucosa (rugae look like brain gyri) |
|
|
Which bacteria are cause toxigenic gastroentritis? Invasive?
|
campylobacter, E. coli, salmonella
shigella |
|
|
The following diseases present always with polyps and "something" else that aids in diagnosis. What is the "something" else:
Gardner's Turcot's ("turbans") Peutz-Jegher's |
+ skin and bone tumors
+brain tumors +melanin pigments on lips, palms and soles |
|
|
Got to be able to distinguish Crohn's from UC
|
rectum spared, ilium involved
skip lesions (cobblestoning), transmural granulomas, strictures/fissures MORE PAIN, LESS BLEEDING begins at rectum, progresses to IC junction continuous, mucosa/submucosa crypt abscesses, pseudopolyps risk of colon cancer, toxic megacolon MORE BLEEDING, LESS PAIN |
|
|
What is the clinical presentation of Whipple's disease? Treatment?
|
malabsorption + anemia + arthritis
d/t T. whippeli PAS + macrophages in mucosa penicillin or tetracycline |
|
|
What population is most likely to present with a cholesterol stone? Pigmented (bilirubin)?
|
fat, female, forty, fertile, honkey
Asians a/w hemolytic anemia |
|
|
What is Charcot's triad?
|
signs of cholangitis
acute onset fever with sepsis RUQ pain jaundice |
|
|
What are the differences in gall bladder and bile duct carcinoma?
|
gallbladder:
female,cholelithiasis porcelain GB (calcium deposits in wall) bile duct: male chronic infections liver fluke (C. sinensis) |
|
|
The following are examples of what?
Gilbert Crigler-Najir Rotor |
congenital causes of jaundice
|
|
|
What in the defect in congenital Rotor's jaundice?
|
impaired hepatocellular secretion
|
|
|
Got to be able to diagnose the various types of hepatitis. Let's get this done:
A B C D E |
virus in poop, acute IgM abs, late IgG abs, 2-6 week incubation
break in skin/mucous membrane, HBs-Ag earliest marker also carrier state, HBe-Ag = infective state, 2-6 month incubation period break in skin/mucous membrane, antibody ELISA, 1-2 month incubation, most likely to be CHRONIC break in skin/mucous membrane,incomplete RNA requires Hep B for replication fecal oral, South East Asia, acute and intense/severe |
|
|
So hepatitis B has some, of course, complicated serology. What do the following markers indicate?
HBe-Ag HBs-Ag anti-HBs-Ag anti-HBc-Ag |
appears after HBs-Ag and before HBs-Ag disappears, indicates infectivity!
appears before symptoms, lasts about 4 months, if more than 6 months = carrier state appears a few weeks after Hbs-Ag disappears, indicates recovery and immunity only marker present in the "window period" time after HBs-Ag disappears, but before anti-HBs-Ag is detectable |
|
|
What does cirrhosis look like in the following?
alcohol toxins/viral biliary |
early: micronodular
late: macronodular Mallory bodies in acute hepatitis (swollen hepatocytes that contain cytoplasmic inclusions of fibrillar protein) macronodular micronodular, autoimmune disease or anti-mitochondrial abs |
|
|
Primary hepatocellular carcinoma has an elevated ______.
|
AFP
|
|
|
Define Heberden's nodes and what condition are they present in?
|
osteophytes at the distal interphalangeal joints
osteoarthritis |
|
|
What is Still's disease
|
juvenile RA, acute fever, no rheumatoid factor
|
|
|
What is psoriatic arthritis
|
similar to RA without rheumatoid factors
|
|
|
What is Felty's syndrome
|
multiple joints affected with RA, enlarged spleen, low WBC, leg ulcers
|
|
|
What is the serology like in the following:
osteoporosis osteomalacia Paget's |
normal calcium and phosphate
normal alkaline phosphatase just decreased bone mass low calcium and phosphate high alkaline phosphatase (chewing up bone) impaired mineralization d/t CRF-->lack of vit. D extremely high alkaline phosphatase, excessive bone reabsorption large and deformed bones with "mosaic pattern" |
|
|
What are the key features of chondrosarcoma?
|
malignant
commonly found at spine and pelvic bones slower growing that osteosarcoma |
|
|
An osteoid osteoma presents how?
|
benign and painful mass in the diaphysis of long bones
|
|
|
Highly malignant, localized to metaphysis of long bone, and Codman's triangle are all key features of what?
|
osteosarcoma
Codman's triangle - a triangular area visible on X-ray where the periosteum, elevated by a bone tumor, rejoins the cortex of normal bone. |
|
|
What degenerative CNS disease presents with pes cavusm loss of proprioreception, + Babinski, and spinal cord atrophy?
|
Friedreich's ataxia
pes cavus - abnormally high foot arch |
|
|
How does Cushing's cause osteoporosis?
|
hypercortisolism induces a condition of hyperstress that impairs the body's repair mechanisms which become secondary
|
|
|
Bleeding disorder with a prolonged aPTT and d-dimer?
|
DIC
|
|
|
Patient presents with fever, chest pain, and headache. Blood work positive for low hemeglobin, high retic count and elevated lactate dehydrogenase. Most likely dx?
|
TTP
autoimmune in origin possible result with clopidogrel, quinine or interferon a treatment LDH = indicates ischemic organ damage |
|
|
Patient presents with bilateral anesthesia of the hands, dehydration, and acidosis after a brisk run from the po-lice. What is the amino acid substitution responsible for his condition?
|
valine for glutamate in the beta hb chain and the 6th position
sickling crisis |
|
|
117 year old patient presents with jaundice, leg ulcers, and splenomegaly. What is the defect in his globin chains?
|
decreased synthesis of beta chains
he has B-Thalassemia |
|
|
Major B-thallassemia is also known as what and presents how?
|
Cooley's anemia
severe microcytic anemia |
|
|
Patient presents with nausea, vomiting, diarrhea, and fatigue after consuming 46 sushi rolls containing raw fish. Likely agent? Possibility to cause? Tx?
|
infection with Diphyllobothrium lantum (fish tapeworm)
B12 deficiency treat with praziquantel |
|
|
What is the role of B12 and folate, respectively in DNA synthesis?
|
B12 - converts methyl-tetrahydrofolate to tetrahydrofolate. In the process converts homocysteine to methionine (deficiency would show a buildup of homocysteine)
folate - converts dihydrofolate to tetrahydrofolate |
|
|
Patient presents with microcephaly, light brown patches on skin, and recurrent aplastic anemia. PE small weird thumbs. What is the MOA of this disease and what is he/she at risk of?
|
this is Fanconi's anemia
inability to remove oxygen radicals from bone marrow HIGH risk of leukemia or lymphoma |
|
|
High serum levels of homocysteine and methylmalonic acid will be increased in ___________? Only an increased in homocysteine?
|
B12 deficiency
folate deficiency |
|
|
In iron deficiency in the elderly is considered to be d/t what until proven otherwise?
|
Colon cancer
|
|
|
Patient presents with obvious abnormal blood smear. Weirdly, you see Burr cells (echinocytes) and spur cells (acanthocytes). What are these cells associated with?
|
Burr - uremia (echinocytes) look for renal problems in stem
Spur - abetalipoproteinemia (deficient B48 and B100) B48 - synthesis of chylomicrons B100 - exporting chylomicrons |
|
|
Patient presents with hepatosplenomegaly, anemia, frontal bossing, target cells on smear, and hypercellular marrow on X-ray. Dx?
|
B-thalassemia
Frontal bossing d/t extramedullary hematopoiesis |
|
|
DOC for most fungal infections and specifically thrush.
|
fluconazole
|
|
|
Common and severe adverse reactions to drug class Imidazole?
|
hepatotoxic
anti-fungals |
|
|
Pt presents with red, itchy vagina with cheesy discharge. DOC
|
miconazole
|
|
|
Fungal infection that likes to infect the sinuses, lung and brain. DOC
|
mucormycosis
amphotericin B |
|
|
DOC, patient has respiratory difficulties and PN "fungus ball" in lungs on xray
|
amphotericin B
|
|
|
Patient presents with itchy pale spots over the trunk and proximal extremeties. Treated with drug and now experiencing low libido and is easily fatigued. What was he treated with?
|
treated with ketoconazole for tinea versicolor
AE decreased testosterone and cortisol |
|
|
You are treating an immunocompromised patient with cryptococcal meningitis and notice pancytopenia on blood smear. What drug were you treating with?
|
5-flucytosine
potential to cause bone marrow depression |
|
|
A patient is being treated at a free clinic for a fungal nail infection and presents with significant photosensitivity rash after a day in the sun, what drug was used?
|
griseofluvin
additionally causes disulfiram-like reaction and is hepatoxic SAT for a photo: Sulfonamides, amioderone, tetracyclines (griseofluvin is a sulfonamide) |
|
|
What is the cause and treatment of renal osteodystrophy?
|
chronic renal failure
Aluminum to bind phosphate |
|
|
What is the cause of bronze diabetes?
|
hemochromatosis
chronic pancreatitis/pancreas carcinoma islet cell destruction |
|
|
What the heck is a MEN?
|
Multiple endocrine neoplasia
Autosomal dominant with variable penetrance d/t a loss of tumor suppressor gene |
|
|
What are the three types of malignant skin tumors and a little info about each
|
basal cell carcinoma - pearly gray papule
squamous cell carcinoma - red, scaly or oozing (Bowen's disease = SCC in situ) melanoma - brown, black, irregular borders |
|
|
Toxins, prob going to be at least one question right?
cadmium cobalt chromium lead mercury arsenic asbestos aromatic amines benzene vinyl chloride alpha-amanitin CO cyanide |
"honeycomb" pneumonitis
cardiomyopathy lung cancer anemia; renal tubular acidosis neurotoxic; PCT necrosis lung cancer mesothelioma bladder cancer leukemia liver angiosarcoma fulminant hepatitis forms carboxyhemoglobin loss of oxygen utilization (inhibits mitochondria) |
|
|
Special stains. Gotta know em':
Ziehl Neelsen india ink giemsa PAS prussian blue congo red osmic acid ************************ |
stains acid fast bacteria RED
cryptococcus blood smears glycogen, mucopolysaccharides iron amyloid electron microscopy |
|
|
Strep viridans hangs out where on the body?
|
nasopharynx and mouth (risk of endocarditis after dental procedures)
|
|
|
What is contained in the cell walls of spores that make them so resistant?
|
dipicolinic acid (keratin coat)
|
|
|
Autoimmune mediated demyelinating disease that occurs in the peripheral motor nerves following a viral infection
|
Guillain-Barre disease
|
|
|
Clinical presentation of patient with eunuchoid pituitary hypofunction
|
gonadotropin deficient (common)
hypogonadism, primary amenorrhea |
|
|
describe Plummer's nodular toxic goiter
|
hyperthyroidism, hyperplasia and hypertrophy, colloid accumulation
|
|
|
List the typical MEN 1 and MEN 2A
|
MEN 1
primary hyperparathyroidism ZE syndrome pituitary tumors MEN 2A bilateral medullary carcinoma of thyroid bilateral phenochromocytoma primary hyperparathyroidism (rare) |
|
|
Name three high yield facts to differentiate Hodgkin's disease from non-hodgkin's lymphoma
|
Hodgkin's disease:
leukocytosis of PMNs present Reed-Sternburg cells contiguous spread non-hodgkin's lymphoma: widespread adenopathy hypercalcemia HEPATOSPLENOMEGALY |
|
|
What are the products of myeloma cells in MM? (3)
|
excess IgG or IgA, and excess light chains
osteoclast activating factor = IL-6 (produces osteolytic lesions) IL-1 = potent osteoclast activator |
|
|
Patient presents with fatigue, weakness, skin and mucosal bleeding, and visual problems. Blood smear reveals "flame cells"
|
Waldenstrom's primary macroglobulinemia (hyperviscous blood d/t over production of IgM)
|
|
|
What are the features associated with the following:
atherosclerosis Monckeberg's hyperplastic artheriolosclerosis hyline arteriolosclerosis |
d/t high LDL-cholesterol present foam cells
lumps of calcium deposits MC in radial and ulnar arteries "onion skinned" appearance on small arteries and arterioles d/t high BP results from inflammation and use |
|
|
Quick description of the following and what type of arteries do they affect:
Wegener's Henoch-Schonlein Hypersensitivity arteritis Churg-Strauss Microscopic polyangitis Thromboangiitis obliterans (Buerger's) |
Small vessels
granulomas in vessel walls; sinusitis and GN ~hypersensitivity arteritis with IgA IC deposits, kids, palpable purpura on butt, joint pain hypersensitivity d/t drugs, tumors, HCV, EBV, HIV, +p-ANCA, painful pruritic papules on butt granulomas in blood vessels, skin, LUNG AND HEART, recurrent asthma-like attacks + lung infiltrates, hx of asthma severe GN, or pulmonary capillaritis reaction to tobacco seen in the tibial and radial arteries-->possible gangrene |
|
|
Fever, fatigue, temporal headache, HI ESR, jaw claudication
|
Giant cell arteritis
|
|
|
night sweats, chest pain, weak peripheral pulse in upper extremity
|
Takayasu arteritis (aortic arch syndrome)
|
|
|
fever, conjunctivitis, maculopapular rash on hands and soles, coronary aneurysms. tx
|
Kawasaki
IVIG + asprin |
|
|
phlebitis causing painful oral and genital ulcerations (opps, it actually wasn't herpes)
|
Bechet's syndrome
+anti-human oral mucosa antibodies |
|
|
obliterative endarteritis of the vasa vasourm of the thoracic aorta, "tree barking" of the intima, +/- aortic regurg
|
luetic aneurysm d/t tertiary syphilis
|
|
|
Regarding aortic dissections there are two, of course, classification systems:
Stanford A B DeBakey 1 2 3 heck my life |
anywhere on ascending aorta
NOT involving ascending arota anywhere on the ascending/descending aorta NOT involving descending aorta Same as B - NOT involving ascending aorta |
|
|
dyspnea, recurrent persistent cough, aortic regurg with declining vitals
|
aortic arch aneurysm
|
|
|
Heart sounds, HIGH YIELD all day:
aortic stenosis aortic regurg mitral stenosis mitral regurg mitral valve prolaspe |
harsh systolic murmur
blowing diastolic murmur harsh diastolic murmur blowing systolic murmur midsystolic click |
|
|
defect next to AV valve
defect of fenestrated fossa ovale (90% of ASDs) |
ostium primum
ostium secundum |
|
|
VSD + subpulmonic stenosis +overriding aorta + RVH
|
Tet of Fallot
|
|
|
aorta to right ventricle
pulmonary artery to left ventricle |
Transposition of great arteries
|
|
|
great vessels are not separate-->one vessel
|
persistent truncus arteriosus
|
|
|
reversal of a L-R shunt to a R-L shunt with the development of pulmonary hypertension
|
Eisenmengers syndrome
|
|
|
Where do infant and adult type of coarctations of the aorta occur?
|
infant = preductal
adult = postductal with respect to the patent ductus arteriosus/ligamentum arteriosum |
|
|
petechiae, episiaxis, CNS and GI bleeds
|
thrombocytopenia
|
|
|
petechiae, purpura, epistaxis, normal white and red cell morphology
|
ITP, kid after URI, self limiting
|
|
|
intravascular hemolytic anemia, renal failure, thrombocytopenia, fever, neurologic changes
|
TTP
|
|
|
acute renal failure, bloody diarrhea, abdominal pain, seizures, acute thrombocytopenia
|
HUS
Most cases are preceded by an episode of diarrhea caused by E. coli O157:H7 |
|
|
hemolytic anemia & thrombocytopenia d/t IgG autoantibody destruction
|
Evan's syndrome
|
|
|
chronic, severe mucosal bleeds and GIANT platlets on blood smear
|
Bernard-Soulier syndrome (AR)
d/t defective GpIb receptor |
|
|
hemearthrosis (bleeding into joints), easy bruiser, prolonged aPTT, normal PT and BT
|
Hemophilia A
|
|
|
you just gave a drug for the first time and it caused acute skin necrosis d/t capillary thrombosis? What was drug? Mechanism?
|
coumadin
coumadin interferes with the synthesis of protein C (which has a short lambda) |
|
|
precursor to acute leukemia?
|
myeloproliferative diseases
|
|
|
headache, vertigo, dilopia, retinal hemorrhages, splenomegaly, and pruritus after shower?
|
polycythemia vera
|
|
|
disease of exclusion, huge platelet count, splenomegaly, ecchymosis
|
essential thrombocythemia (clonal proliferation of MKC
|
|
|
massive hepato/splenomegaly, teardrop and Howell-Jolly bodies. Keys to dx: extra medullary hematopoiesis and hypercellular marrow on Bx
|
idiopathic myelofibrosis
|
|
|
DOC malaria prophylaxis cholroquine sensitive and pregnant
|
chloroquine
|
|
|
forms of malaria that form hypnozoites
|
vivax and ovale
require primaquine |
|
|
DOC malaria prophylaxis in chloroquine resistant areas.
Pregnant? |
atovaquone/proguanil
mefloquine |
|
|
DOC treatment of chloroquine resistant falciparum
|
quinine + dox, tetra, clind (if preggers)
|
|
|
DOC tx for chloroquine resistant Vivax
|
quinine + dox or tetra +primaquine
|
|
|
FOUR ways chloroquine heckks up plasmodia's day:
|
turns food (heme) into poison
lyse plasmodia and infected RBC's alkalizes food vacule (normally acidic) = starves inhibits DNA synthesis |
|
|
DOC trichomonas vaginalis and entamoeba histolytica
|
metronidazole
|
|
|
bitten by sandfly, mucous and cutaneous ulcers. DOC
|
leishmaniasis
stibogluconate - inhibits protozoa glycolysis |
|
|
TMP/SMX in use with parasites?
|
pneumocystis jiroveci
toxoplasma enchphalitis inhibits folate use-->no DNA synthesis |
|
|
DOC for strongyloides aka worm that lays larvae in soil, intestinal infection, vomiting, diarrhea
|
Ivermectin
|
|
|
Bleeding deficiency after broad spectrum abx often results in Vit K deficiency
|
FF
|
|
|
30 pt presents with anemia, splenomegaly, and jaundice. Negative direct Coomb's test
|
Hereditary spherocytosis
|
|
|
toxins are probably important. For the following give the mechanism of how it hecks up your day:
tetanus botulinum diptheria alpha toxic shock syndrome cholera pertussis enterotoxin |
X release glycine-->mm spasms
X release ACh-->mm paralysis X protein synthesis hemolysis, necrosis, cell death induce cytokines-->anaphylactic shock stimulates adenylate cyclase (Gs) stimulates adenylate cyclase (Gi) HLabile - adenylate cyclase HStabile - guanylate cyclase |
|
|
most likely causes of pneumonia in the following age groups:
infants young adult elderly |
RSV
mycoplasma strep. pneumoniae |
|
|
MLC of bacterial meningitis in the following age groups:
neonates adults elderly |
e. coli, strep. agalactia, listeria
nesseria meningitis strep. pneumoniae |
|
|
MLC diarrhea in the following age groups:
children adults travlers |
rotavirus
campylobacter e. coli, shigella, salmonella |
|
|
identify the bacteria based on their pattern of hemolysis:
clear halo green halo no hemolysis |
beta-hemolytic strep (strep. pyogenes)
alpha-hemolytic strep (pneumococcus) gamma-hemolytic strep (enterococci) |
|
|
gram + rod, "fried rice" poising, cutaneous form = black ulcers
|
bacillus anthracis
|
|
|
the toxins of cl. perfringens (a-toxin and enterotoxin) cause what, respectively?
|
a-toxin - "lecithinase" = gas gangrene
enterotoxin - food poisoning |
|
|
forms abscesses in organs, common cause of gram-negative abdominal infections
|
B. frag
|
|
|
non-bloody, rice watery diarrhea
|
V. cholera
|
|
|
diarrhea from raw seafood
|
V. parahaemolyticus
|
|
|
watery, stinky poops, later may become bloody. MCC diarrhea USA
|
campylobacter
|
|
|
influenza like infection, large tender lymph nodes, rabbits>tics>humans
|
francisella (tularemia)
|
|
|
kid presents with a whooping cough. You suspect infection with bordetella. MOA toxin and tx
|
pertussis toxin - ADP-ribosylates inhibitory Gi-->permanent activation of adenylate cyclase
erythromycin best in catarrhal stage |
|
|
presents with respiratory infection. X-ray reveals lung lesion + calcified hilar lymph node
|
TB
|
|
|
following a tooth extraction, pt presents with inflamed sinuses with surface discharge, hmm..are those sulfur granules I see?
|
actinomyces
"lump jaw" |
|
|
recent trip to South America, presents with severe headache, fever, retro orbital pain, lumbar and joint pain.
|
Dengue fever
transmitted via mosquito |
|
|
trichophyton rubrum causes tinea pedis
|
heckn smelly feet
|
|
|
Apparently hepatitis viruses are not all the same. Describe the following:
naked capsid RNA piconavirus enveloped DNA hepadnvirus enveloped RNA flavivirus enveloped circular RNA (defective virus) naked capsid RNA calicivirus |
A
B C D E |
|
|
interuterine growth retardation. upon birth she is found to have cataracts, hearing loss, hepatosplenomegaly, and PDA.
|
congenital rubella
Mom most likely had a truncal rash during pregnancy |
|
|
Strep. pyogenes (group A)
other strep. (groups B-T) |
beta-hemolytic (clear halo)
|
|
|
pneumococcus
strep, viridans |
alpha-hemolytic (green halo)
|
|
|
enterococci (group D)
|
gamma-hemolytic (no hemolysis)
|
|
|
3 y/o pt presents with fever, fatigue, anemia, petechiae, and recurrent infections. Lab - leukocytosis
|
ALL
MC neoplasm in kids |
|
|
adult pt presents with fever, fatigue, pallor, recurrent infections, and splenomegaly. Lab - red staining needle like projections in myeloblasts
|
AML
|
|
|
Two cell types implicated in the theory of atherosclerosis
|
platelets and macrophages
|
|
|
pt presents with mental status change, papilledema, anuria, lower extremity edema, and JVD. Ddx?
|
hypertensive emergency - HTN with evidence of end organ damage
tx with nitroprusside or labeatol (DO NOT LOWER TOO QUICKLY, PT WILL HAVE A STROKE) |
|
|
DOC in various forms of HTN:
HTN emergency no comorbid HTN diabetic HTN post MI osteoporosis BPH phenochromocytoma |
nitroprusside or labetalol
diuretics or beta blockers ACE/ARB beta blockers and ACE thiazide diuretics alpha blockers alpha blockers |
|
|
Beta blockers in diabetics have what negative effects?
|
alters pt perception of hypoglycemia
increases K+ levels |
|
|
tight control of glucose in the diabetic does not reduce the risk of coronary artery disease
|
tough luckfatties
|
|
|
ST depression and eventual conduction block in a MI is d/t what cellular activity?
|
K+ leaks out out of ATP-K+ channel
|
|
|
Two types of patients that will not present with the classic signs of a MI when they are experiencing one
|
Old farts
diabetic with neuropathies |
|
|
patient is not having a good day and had an MI in the following locations. For each, declare the artery supply:
Anterior wall of left ventricle and anterior 2/3 of septum Lateral free wall Right ventricle, inferior wall of left ventricle, posterior 1/3 of septum sinoatrial and AV nodes |
LAD
left circumflex aa RCA RCA (tends to cause bradycardia 2nd to heart block) |
|
|
pt presents 8 days after an anterior MI with chest pain. ECG shows ST elevation. Whats the deal
|
ventricular aneurysm (10-20% pf pts)
arrhythmia or rupture -> Dead |
|
|
what type of infarct does not present with the standard ST elevation and Q waves?
|
subendocardial
T-wave inversion with or without ST depression |
|
|
S. aureus MCC of necrotic endocarditis
|
IV drug users = right sided valve vegetations
|
|
|
Physical exam time. For each of the following positions, name what cardiac defect it aids in dx:
lean forward while seated, exhale, hold breath valsalva lay on your left side standing squatting |
aortic insufficiency (regurg)
mitral valve prolapse mitral stenosis standing decreases ventricular filling and increases the murmurs of MVP and IHSS mitral and aortic valve insufficiencies |
|
|
pathologic heart sounds:
occurs in late diastole d/t atrial contraction forces blood into a stiffened ventricle (ventricular hypertrophy or MI) failure of aortic and pulmonary components of S2 to fuse during expiration usually d/t ASD d/t backup of blood in the venous system that leads to faster than normal ventricular filling. Heard best over the apex of the lung with the bell while the pt is in the lateral recumbent |
S4
Fixed S2 split S3 |
|
|
a serum increase in VLDLs and chylomicrons in PN for what
|
combined hyperlipidemia
|
|
|
ECG me:
Peaked T waves, wide QRS complex, long PR interval, no P waves Flat T waves, U waves, ST segment depression |
Hyperkalemia
Hypokalemia |
|
|
treatment for hyperkalemia
|
IV Ca++, insulin, albutero, sodium bicarb, K+ binding agent
|
|
|
Drugs that end with -osine/-udine are what class of drugs and MOA
|
nucleoside reverse transcriptase inhibitors (NRTIs)
drug become phosphorylated 3X and becomes involved in DNA production. Punchline = inhibits reverse transcriptase |
|
|
NNRTIs work how
|
do not mimic normally occurring nucleosides, but indirectly inhibit RT
efa-vir-enz nev-ir-apine del-avir-dine |
|
|
Drugs that end (generally) -avir are what class and MOA
|
protease inhibitors
prevent viral proteins from being cleaved into a functional product |
|
|
a drug used in HIV that prevents the fusion of HIV virus to host cell by inhibiting gp41
|
fusion inhibitors
enf-uvir-tide |
|
|
drug that blocks the integration of viral HIV DNA into host DNA
|
integrase inhibitor
ral-teg-ra-vir |
|
|
the drug mara-vir-oc blocks the CCR5 receptor on WBC targeted by HIV
|
its uh kinda toxic, hepatotoxic, MI, and some cancers
|
|
|
What are the indications for starting HIV therapy, besides being HIV+
|
AIDS defining illness
CD4 <350 hep B pregger |
|
|
Treatment for cryptococcal meningitis in HIV patient
|
amp B + flucytosine
once stable.. transition to fluconazole, continue until CD4 count > 100-200 for 6 months |
|
|
Treatment for mycobacterium avium complex (MAC) in HIV
|
clarithromycin and ethambutol
|
|
|
MOA of TMP/SMX and use in HIV prophylaxis
|
sulfa part competes with PABA for dihydropteroate synthase X folate synthesis
trimethoprim portion inhibits folate use tx and pro for pneumocystis (pro CD4<200) pro for toxoplasmosis |
|
|
DOC histoplasmosis prophylaxis in HIV pt CD4<150 that live in endemic area (eastern and central US)
|
it-ra-con-azole
|
|
|
DOC coccidioidomycosis prophylaxis in HIV pt with CD4<250 that live in endemic area (southwest US)
|
fluconazole or itraconazole
|
|
|
pulmonary edema, dyspnea of exertion, orthopnea, trouble breathing while laying down are all sx of...
|
left sided heart failure leading to CHF
|
|
|
MMC of right sided heart failure
|
left sided heart failure
|
|
|
ACE inhibitors and beta-blockers are cardioprotective because they prevent __________.
|
cardiac remodeling
|
|
|
currently treating a cardiac patient with drug X and a loop/thiazide. Patient becomes hypokalemic, develops SVT, AV block, and complains of yellow vision
|
X - digitalis
|
|
|
Which two cardiomyopathies can't relax and chill "diastolic disease"
|
hypertrophic
restrictive |
|
|
pt presents with fever, jaundice, uremia, and bleeding. Pt admits to drinking sewer water and basting in water contaminated with rat urine and feces.
|
L. interrogans
leptospirosis tx with pen G |
|
|
Chlamydia:
intracellular can't make ATP can't live outside no peptidoglycan in cell wall C.pneumoniae - walking pneumonia adults C.trachomatis - urethritis, lymphogranuloma venereum (tender inguinal nodes that may drain pus through skin), trachoma (chronic conjunctivitis -->blindness) tx all strains with TETRACYCLINE |
pickle weasel
|
|
|
Rickettsial rash: starts on the hands and feet
Typhus rash: starts on the trunk and moves outward (no involvement of the palms and soles) Q fever: no rash, no vector, negitive Felix test |
Rickettsia
|
|
|
provide the vector for the following:
Typhus: prowazekii tyhi tsutsugamushi rocky mountain spotted fever Q fever trench fever |
lice
fleas mite ticks inhalation at slaughter houses lice |
|
|
late systolic murmur with midsystolic click is know as _________syndrome, which predisposes pt to regurgitation
|
Barlow's
|
|
|
seen in severe MVP, rheumatic fever, papillary mm infarct. ECG - P wave depression in V1 indicating left atrial enlargement
|
mitral regurg
|
|
|
dilated left atrium d/t increased left atrial pressure resulting in pulmonary edema and dyspnea
|
mitral valve prolapse
|
|
|
Ortner's syndrome is d/t impingement of the __________ _________ __ by an enlarging left _________ leading to ________.
|
recurrent laryngeal n; atrium; hoarsness
|
|
|
pt presents with exertional dyspnea, orthopnea (SOB lying flat), and pulmonary edema. Murmur is amplified when patient is in left lateral decubitus
|
mitral stenosis
|
|
|
Mitral stenosis causes a decrease in CO, why is it that positive inotropic drugs are not used in treatment?
|
decreased CO is not d/t ventricular failure
|
|
|
Holy eponyms for aortic regurg, free points I guess:
Water-hammer pulse Traube's sign Corrigan's pulse Quincke's sign de Musset's sign Muller's sign Duroziez's sign |
wide pulse pressure with forcefull arterial pulse upswing with rapid fall-off
pistol-shot bruit over femoral aa large Carotid pulsations blanching and reddening of the fingernails upon light pressure head bobbing d/t carotid pulsations pulsatile bobbing of uvula fickle murmur over femoral aa heard best with mild pressure |
|
|
Low pitched mid-to-late diastolic (filling) rumble
|
mitral stenosis
|
|
|
Late systolic murmur with mid-systolic click
|
Barlow's syndrome
|
|
|
Holosystolic murmur radiates to axilla. S3
|
Mitral regurg
|
|
|
diastolic rumble louder in inspiration
|
tricuspid stenosis
|
|
|
blowing holosystoloic murmur best at left sternal boarder. Jugular and hepatic pulsations
|
tricuspid regurg
|
|
|
midsystolic crescendo-decrescendo murmur at the second right intercostal space, radiates to carotids and apex, with S4 atrial kick
|
Aortic stenosis
|
|
|
Blowing early diastolic murmur at left sternal boarder, apical diastolic murmur d/t valve flutter (Austin-Flint), midsystolic flow murmur at base
|
aortic regurg
|
|
|
loud S1, wide fixed-split S2, midsystolic ejection murmur
|
ASD
|
|
|
harsh holosystolic murmur, heard best over left intercostal space
|
VSD
|
|
|
Continuous murmur heard over the collateral vessels in the back
|
coarctation of aorta
|
|
|
Pulmonary stenosis is seen in adults with carcinoid syndrome/tumor
|
whoda thunk it
|
|
|
I have a meeting with DaMann later. Who's DaMann you may ask?
|
Nick Costanza
|
|
|
High pitched diastolic murmur at left sternal boarder, mimicking aortic regurg
|
Graham Steell murmur
d/t pulmonary regurg |
|
|
pt presents with splenomegaly, splinter hemorrhages in finger nails, painful red nodules on fingers (Osler's nodes), retinal hemorrhage (Roth spot's), and dark macules on palms/soles (Janway lesions). Textbook dx?
|
Endocarditis
|
|
|
endocarditis d/t S. bovis or C. septicum are commonly seen with GI cancer
|
check em out
|
|
|
What are the HACEK organisms that cause culture negitive endocarditis (d/t being fastidious)?
|
Hemophilus aphrophilus
Actinobacillus actin. Cardiobacterium hominis Eikenella corrodens Kingella kingae |
|
|
Cancer seeding heart valves during metastasis, malignant emboli can cause cerebral infarcts
|
Marantic endocarditis
|
|
|
In addition to presenting with 2 of the following:
Joints (migratory polyarthritis) Carditis Nodules (SubQ) Erythema marginatum Sydenham's chorea (St. Virtus dance) What else is required to dx rheumatic heart disease? |
Evidence of prior strep infection by wither culture or + antistreptolysin antibody titers
|
|
|
SLE patient presents with sx consistent with damaged heart valves. If it is d/t Libman-Sacks, what are the vegetations composed of?
|
antigen-antibody complex
|
|
|
A transmural MI or Dressler's syndrome (pericarditis 2-4 weeks after acute MI or heart surg. May be autoimmune to myocardial antigens) 2ndary to heart damage) causes what type of pericarditis?
|
fibrinous
|
|
|
Coxsackie B, uremia, acute rhumatic fever, scleroderma, and SLE can cause what type of pericarditis?
|
serous
|
|
|
Type of acute heart disease d/t a hypersensitivity reaction where immune complexes are targeted at heart valves d/t molecular mimicry
|
Rheumatic heart disease
|
|
|
Recurrent bacterial infections that lead to bronchiectasis. Other sxs sinus inversus, male sterility, and hearing deficits
|
Kartagner syndrome
|
|
|
Middle aged male presents with HIGH fever,relative bradycardia, diarrhea, productive cough, and rales on auscultation. ddx?
|
legionnaire's disease
|
|
|
What do the following have in common:
free hb (from massive hemolysis) myoglobin (from rhabdo) ethylene glycol aminoglycosides amphotericin B cisplatin |
potential causes of acute tubular necrosis
|
|
|
definition of pulsus paradoxus and name a condition it is seen in. Also what PN ECG change is seen?
|
>10mm HG in BP during inspiration
electrical alternans - a beat-to-beat change in QRS height |
|
|
distant heart sounds, JVD, hypotension, and ST elevation in all leads + pleural rub are all classic signs of what?
|
pericarditis
|
|
|
Why is aortic dissection not considered a true aneurysm?
|
the tunica media dissects, forming a false lumen
|
|
|
pt presents with abrupt onset anterior chest pain that radiates to back, lower BP in one arm, absent pulses, and widened mediastinum on CX-ray
|
aortic dissection
tx; emergently lower BP, surg |
|
|
pulmonary HTN leads to a R-->L shunt causing cyanosis (lack of blood flow to the lungs), systemic embolization d/t paradoxal emboli (venous emboli that bypass the lungs and enter systemic circulation. Dx?
|
Eisenmenger's complex
|
|
|
small VSD with left parasternal thrill and loud holosystolic murmur at the 4th intercostal space. Endocarditis prophylaxis necessary
|
Maladie de Roger syndrome
|
|
|
What congenital heart defect is treated with the NSAID indomethacin to inhibit prostaglandins. Increased incidence with premature births.
|
PDA (connection of pulmonary aa to descending aorta)
|
|
|
Congenital heart defect that predisposes pts to CHF in the 2nd and 3rd decades
|
ASD
|
|
|
neonate presents acyanotic at birth and increasing cyanosis over the 1st 6th months of life
|
Tet of fallot
|
|
|
Child presents with acute cyanosis and panicked affect. Mom reports finding child in squatting position (to improve blood flow to lungs). CX-ray "boot shaped" contour of heart d/t RVH.
|
"Tet" spell
surgery |
|
|
Marked cyanosis at birth, early digital clubbing, no murmur present. CX-ray shows a large, "egg shaped" heart (d/t increased pulmonary vasculature)
|
transposition of the great arteries
|
|
|
Asx in young child with "rib notching" (deformed surface of the ribs d/t dilation of intercostal aa) on CX-ray. In adult, continuous murmur over the collateral vessels in the back, with late systolic murmur between the scapula. Increased pulses in the upper extremities with weak pulses in legs
|
coarctation of the aorta
|
|
|
Major causes are emphysema, chronic bronchitis, and asthma. Mechanism of hypoxia is a V/Q mismatch d/t small airways and bronchospasm. Hypoxia is more severe in REM sleep d/t hypoventilation 2nd to skeletal mm paralysis
|
chronic obstructive pulmonary disease
|
|
|
pt presents with panacinar type emphysema d/t _________________. They will also present with hepatic cirrhosis .
|
alpha-1 antitrypsin deficency
PiZZ allele homozygous have an increased risk |
|
|
pt presents with wheezing crackles and cyanosis. They report coughing up phlem most days for more then 3 months at a time over then past 5 years. Reid index (thickness of gland layer to bronchial wall) > 50%. What is the dz and pathology?
|
chronic bronchitis
mucous gland hypertrophy and loss of cilla on bronchial epithelium most likely from smokin' all those cancer sticks |
|
|
Condition d/t bronchial hyperresponsiveness. Pathologically see thick bronchial basement membrane thickening, mucous plugs, and destruction of cillia. A severe exacerbation of condition is treated with B2 agonists
|
asthma
|
|
|
What are the cells that are responsible for the early and late phase reaction during a methacholine challenge test for intrinsic asthma?
|
early - nerves and inflammatory cells already present in airway --> interstitial edema and vasospasm
late - (3-8 hours) - new inflammatory cells (neutrophils and eosinophils) lead to bronchospasm. Activated T and mast cells may persist long after challenge |
|
|
pt presents with foul smelling breath, purulent sputum, history of recurrent infections, and hemoptysis. What is the pathology and what are some likely causes?
|
this is bronchietasis
d/t permanent dilation of bronchioles scarring from chronic infections (TB, granulomatous dz, recurrent pneumonia) |
|
|
What is the treatment of choice for gonorrhea
|
ceftriaxone + doxycycline or azithromycin (to cover any undiagnosed chlamydial infection)
|
|
|
EXTREME genital itching, green frothy discharge, carried asx in the rectum. DOC is metronidazole
|
Trichomoniasis vaginalis
|
|
|
Recent travel to the tropics, large palpable granulomas in inguinal lymph nodes, treat with doxycycline
|
lymphogranuloma venereum
|
|
|
Venereal disease that produces granulomas in the genitals that block lymphatic drainage, Donovan bodies visualized in macrophages. DOC tetracycline
|
granuloma inguinale
|
|
|
recent travel to tropics, PAINFUL chancre, "school of fish" on micro. DOC and causative organism
|
ceftriaxone
Hemophilus ducreyi |
|
|
PN is koilocytes (epithelial cells with perinuclear clearing). Types 16 and 18 are more likely to cause cancer. Why?
|
this is genital warts (HPV)
16 and 18 have viral genes E6 & E7 which interfere with p53 and Rb allowing an overgrowth of epithelial cells |
|
|
A positive Tzanck is what and confirms the dx of what?
|
multi-nucleated giant cells visualized on microscopy taken from a biopsy at the base of an ulcer
HSV, VZV, CMV, pemphigus vulgaris |
|
|
Often asx venereal disease if left untreated can ascend and cause PID. DOC is doxycyline
|
chlamydial cervicitis
|
|
|
What do the following testicular germ cell tumors have in common?
seminoma choriocarcinoma yolk sac teratoma |
THEY ARE ALWAYS MALIGNANT
|
|
|
Which stromal sex cell tumor, leydig or steroli, produce endocrine effects?
|
Leydig! also see intercytoplasmic Reinke crystals (basically rectangular Leydig cells). precocious puberty or gynecomastia post puberty
|
|
|
Ovarian tumors usually have sxs that show up late, then present as abdominal discomfort and mild digestive complaints.
Surface epithelium ovarian tumors peak at ___________ years Germ cell tumors of the ovary peak ______. Sex cord stromal cell tumors peak ______. |
>20 years
<20 years variable |
|
|
Surface epithelium ovarian tumors are easy to ID because the name of the tumor tells you what kind of cells are involved based on function.
Serous - fluid filled cyst, lined with cilliated fallopian cells that produce watery secretions Mucinous - fluid filled cyst, tumor lined with columnar cells that produce mucous (may yield pseudomyxoma peritonei, a rupture of cystandenocarcinoma to produce multiple intraperitoneal tumor implants) Endometroid - solid tumor compromised of glandular endometrial tissue Clear cell - tumor compromised of large epithelial cells with clear cytoplasm Brenner - aka celioblastoma, tumor compromised of bladder epithelium |
k
|
|
|
Birbeck granules are associated with?
|
Langerhan's cell histocytosis
sx are non-specific inflammatory response, which includes fever, lethargy, and weight loss |
|
|
Mature type teratoma cells are MC (90%)
Dermoid cyst = mature teratoma unusual variant = struma ovarii - has only one tissue element and can cause what syndrome? |
hyperthroidism
|
|
|
Which germ cell tumor of the ovary has an elevated alpha-feto protein? Extremely HIGH hCG?
|
endodermal sinus tumor
choriocarcinoma (aggressive and malignant) |
|
|
Granulosa-theca cell stromal sex cord tumors secrete large amounts of ________ and present Call-Exner bodies which are_____________?
|
estrogen
follicles filled with eosinophilic material |
|
|
Benign tumor that causes Meig's syndrome, which is what?
|
fibroma
ascites, pleural effusion and ovarian tumor |
|
|
Tumor of the ovary from a primary metastatic site, usually the GI. Contains characteristic "signet-ring" cells that intracytoplasmically produce mucin displacing the nucleus
|
Kurkenburg tumor
|
|
|
There are three types of endometrial growths that can be problematic, define them based of descrpition:
often asx and estrogen sensitive, benign pre-malignant, d/t high estrogen stimulation or low progesterone stimulation number one invasive carcinoma of female genital tract |
Polyps
Hyperplasia Carcinoma |
|
|
For the following descriptions of cervical intraepithelial neoplasias (in situ) define which type it is (1-3):
severe dysplasia, affecting various cells throughout the entire epithelial thickness mild dysplasia of the upper layer of cervical epithelium CIS, the entire cervical epithelial layer is replaced entirely by neoplastic cells with NO invasion beyond the basement membrane |
CIN II
CIN I CIN III |
|
|
A hydatidiform mole and choriocarcinoma present with a high B-HCG
|
indeed
|
