Goljan Pathology Synopsis - Systemic 1 - Hematology To Gi

Front 1

Erythropoietin

Back 1

synthesized in peritubular capillaries

Front 2

Reticulocyte count

Back 2

measure of effective erythropoiesis; correct for degree of anemia

Front 3

Extramedullary hematopoiesis

Back 3

hematopoiesis outside bone marrow (e.g., spleen)

Front 4

Newborn physiologic anemia

Back 4

drop in Hb due to replacement of HbF RBCs with HbA

Front 5

Pregnancy

Back 5

Hb and Hct decreased; greater increase in plasma volume than RBC mass

Front 6

Anemia

Back 6

normal O2 saturation and arterial PO2

Front 7

MCV

Back 7

average volume of RBCs; useful for anemia classification

Front 8

MCHC

Back 8

average Hb concentration in RBCs

Front 9

MCHC

Back 9

↓ in microcytic anemias; ↑ in spherocytosis

Front 10

Thalassemias

Back 10

↓ MCV, ↑ RBC count

Front 11

RDW

Back 11

RBC size variation; ↑ iron deficiency; normal in other microcytic anemias

Front 12

Mature RBC

Back 12

anaerobic glycolysis; no mitochondria or HLA antigens

Front 13

Total iron binding capacity

Back 13

↑ iron deficiency; ↓ anemia chronic disease, sideroblastic anemia

Front 14

% Saturation

Back 14

↓ iron deficiency, anemia chronic disease; ↑ sideroblastic anemia

Front 15

Serum ferritin

Back 15

↓ iron deficiency; ↑ anemia chronic disease, sideroblastic anemia; normal thalassemia

Front 16

Microcytic anemias

Back 16

iron deficiency MC, anemic chronic disease, thalassemia, sideroblastic anemia

Front 17

Iron deficiency child

Back 17

MCC Meckel’s diverticulum

Front 18

Iron deficiency woman < 50

Back 18

MCC menorrhagia

Front 19

Iron deficiency man < 50

Back 19

MCC peptic ulcer disease

Front 20

Iron deficiency men/woman > 50

Back 20

MCC colon cancer

Front 21

Stages iron deficiency

Back 21

↓ ferritin; ↓ Fe and % saturation, ↑ TIBC; normocytic then microcytic anemia

Front 22

Anemia chronic disease

Back 22

MC anemia in malignancy and alcoholics

Front 23

α-Thalassemia trait

Back 23

AR; two α-globin gene deletions; normal Hb electrophoresis

Front 24

HbH disease

Back 24

three α-globin gene deletions; hemolytic anemia; four β-globin chains

Front 25

Hb Bart’s disease

Back 25

four α-globin gene deletions; four γ-globin chains

Front 26

β-Thalassemia minor

Back 26

AR; DNA splicing defect; ↑ HbA2 and F; ↓ HbA

Front 27

β-Thalassemia major

Back 27

nonsense mutation with stop codon; hemolytic anemia; ↑↑ HbF, ↑ HbA2

Front 28

Sideroblastic anemia

Back 28

defect in mitochondrial heme synthesis producing ringed sideroblasts

Front 29

Causes sideroblastic anemia

Back 29

alcohol, pyridoxine deficiency (isoniazid Rx of TB), Pb poisoning

Front 30

Pb poisoning

Back 30

inhibition ferrochelatase, d-aminolevulinic acid dehydrase, ribonuclease

Front 31

S/S Pb poisoning children

Back 31

growth retardation; Pb in epiphyses (lead lines); abdominal colic; encephalopathy

Front 32

S/S Pb poisoning adult

Back 32

peripheral neuropathy; proximal renal tubule damage (Fanconi’s syndrome)

Front 33

Lab Pb poisoning

Back 33

coarse basophilic stippling RBCs; ↓ MCV; ↑ blood Pb; ↑ d-aminolevulinic acid

Front 34

Vitamin B12

Back 34

animal products; requires intrinsic factor for reabsorption in terminal ileum

Front 35

Vitamin B12

Back 35

transfers methyl group to homocysteine

Front 36

R factor

Back 36

binds with B12 in mouth, removed by pancreatic enzymes in small intestine

Front 37

Vitamin B12

Back 37

involved in propionate metabolism; end-product succinyl CoA

Front 38

Causes B12 deficiency

Back 38

vegan, pernicious anemia MC, fish tapeworm, pancreatitis, bacterial overgrowth, Crohn’s disease

Front 39

Pernicious anemia

Back 39

autoimmune destruction parietal cells; chronic gastritis body/fundus; achlorhydria; ↑ gastrin

Front 40

Causes folate deficiency

Back 40

alcohol MCC, poor diet, drugs, malabsorption, pregnancy, goat milk

Front 41

Drugs and folate deficiency

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alcohol, OC, phenytoin, methotrexate, trimethoprim, 5-fluorouracil

Front 42

Intestinal conjugase in folate metabolism

Back 42

inhibited by phenytoin

Front 43

Jejunal uptake of monoglutamate form of folate

Back 43

inhibited by alcohol and OC

Front 44

Dihydrofolate reductase

Back 44

inhibited by methotrexate, trimethoprim

Front 45

Thymidylate synthetase

Back 45

inhibited by 5-fluorouracil

Front 46

Folate deficiency

Back 46

MCC of increased serum homocysteine

Front 47

Lab in B12/folate deficiency

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pancytopenia; hypersegmented neutrophils; ↑ homocysteine

Front 48

Lab findings unique to B12 deficiency

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↑ gastrin (pernicious anemia), ↑ methylmalonic acid

Front 49

B12 reabsorbed absorbed after administration of intrinsic factor

Back 49

PA

Front 50

B12 reabsorbed absorbed after administration of antibiotics

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bacterial overgrowth

Front 51

B12 reabsorbed absorbed after administration of pancreatic extract

Back 51

chronic pancreatitis

Front 52

Acute blood loss

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initially normal Hb and Hct; 0.9% saline uncovers RBC deficit

Front 53

Aplastic anemia

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drugs (e.g., phenylbutazone); infection (e.g., parvovirus); benzene

Front 54

Lab findings aplastic anemia

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pancytopenia; hypocellular bone marrow

Front 55

Anemia in renal disease

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normocytic; decreased EPO

Front 56

Extravascular hemolysis

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macrophage phagocytosis of RBCs; ↑ unconjugated bilirubin and urine UBG

Front 57

Intravascular hemolysis

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↓ serum haptoglobin; hemoglobinuria; hemosiderinuria

Front 58

Congenital spherocytosis

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AD; defect in spectrin; extravascular hemolysis; splenomegaly

Front 59

Blood findings in spherocytosis

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normocytic anemia; dense RBCs, ↑ MCHC, ↑ osmotic fragility

Front 60

PNH

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missing decay accelerating factor; complement destruction RBCs, neutrophils, platelets

Front 61

S/S PNH

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pancytopenia; hemoglobinuria; positive sugar water test and acidified serum test

Front 62

HbSS

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AR; missense mutation (valine for glutamic acid 6th positive β-globin chain)

Front 63

Causes of sickling

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↑ deoxyhemoglobin (hypoxemia, acidosis); HbS > 60%

Front 64

HbF

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inhibits sickling; hydroxyurea ↑ HbF

Front 65

Pathophysiology HbSS

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vasoocclusive crises, hemolytic anemia (extravascular)

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HbSS children

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dactylitis (6-9 months); Streptococcus pneumoniae sepsis (dysfunctional spleen)

Front 67

HbSS osteomyelitis

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Salmonella paratyphi

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HbSS complications

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aplastic crisis (parvovirus B-19), acute chest syndrome, autosplenectomy, calcium bilirubinate gallstones, priapism, aseptic necrosis

Front 69

HbAS

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microhematuria from sickling in renal medulla; renal papillary necrosis

Front 70

Hb electrophoresis

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HbAS-HbA 55-60%, HbS 40-45%; HbSS-HbS 90-95%, HbF 5-10%

Front 71

Blood findings in HbSS

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sickle cells; target cells; Howell-Jolly bodies (nuclear remnants)

Front 72

G6PD deficiency

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XR; oxidant damage (peroxide) to Hb (e.g., primaquine; dapsone; fava beans)

Front 73

Blood findings G6PD deficiency

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Heinz bodies (denatured Hb; special stain); bite cells

Front 74

Pyruvate kinase deficiency

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↓ ATP; RBCs dehydrated; ↑ 2,3-BPG (right-shifted OBC)

Front 75

Warm type AIHA

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IgG; extravascular hemolysis; e.g., SLE, drugs

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Cold type AIHA

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IgM intravascular hemolysis; e.g., CLL, Mycoplasma

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Penicillin

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IgG antibody against penicillin attached to RBC (type II hypersensitivity)

Front 78

Methyldopa

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drug alters Rh antigens; IgG antibody against Rh antigens (type II hypersensitivity)

Front 79

Quinidine

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drug-IgM IC; intravascular hemolysis; type III hypersensitivity

Front 80

Lab findings AIHA

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positive direct Coombs’; spherocytes

Front 81

Micro-macroangiopathic hemolysis

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mechanical damage causing intravascular hemolysis

Front 82

Causes of micro/macro hemolysis

Back 82

aortic stenosis (MCC), DIC, TIP, HUS

Front 83

Peripheral blood findings micro/macro hemolysis

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schistocytes; iron deficiency from hemoglobinuria

Front 84

Malaria

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intravascular hemolysis correlates with fever; falciparum-ring forms and gametocytes

Front 85

Leukemoid reaction

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exaggerated WBC response to infection; usually due to infection

Front 86

Leukoerythroblastic reaction

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marrow infiltrative disease peripheralizes myeloblasts/nucleated RBCs

Front 87

Causes of leukoerythroblastic reaction

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bone metastasis MCC, myelofibrosis

Front 88

Eosinophilia

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type I hypersensitivity (e.g., penicillin reaction); invasive helminthic infection

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Helminthes not producing eosinophilia

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pinworms, adult worms in ascariasis

Front 90

Atypical lymphocytes

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mononucleosis; CMV; toxoplasmosis; viral hepatitis; phenytoin

Front 91

Mononucleosis

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due to EBV; EBV attaches to CD21 receptors on B cells

Front 92

Clinical findings mono

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exudative tonsillitis, generalized lymphadenopathy, hepatosplenomegaly

Front 93

Lab findings mono

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atypical lymphocytosis; IgM heterophile antibodies against horse RBCs

Front 94

Lymphopenia

Back 94

T cell deficiencies (HIV); combined B/T deficiency (adenine deaminase deficiency)

Front 95

Lymphocytosis

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viral infections, whooping cough

Front 96

Corticosteroids

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lymphopenia, eosinopenia, neutrophilia

Front 97

Chronic MPD

Back 97

neoplastic stem cell disorder; splenomegaly; marrow fibrosis; risk for leukemia

Front 98

Examples of MPD

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polycythemia vera, myelofibrosis and myeloid metaplasia

Front 99

Relative polycythemia

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↓ plasma volume; ↑ RBC count; normal RBC mass

Front 100

Absolute polycythemia

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↓ RBC count and RBC mass

Front 101

Appropriate polycythemia

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hypoxic stimulus for EPO to generate RBCs

Front 102

Causes of appropriate absolute polycythemia

Back 102

lung disease, cyanotic heart disease, high altitude

Front 103

Appropriate absolute polycythemia

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normal plasma volume; ↑ RBC mass; ↓ SaO2; ↑ EPO

Front 104

Inappropriate absolute polycythemia

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no hypoxic stimulus for EPO

Front 105

Causes of inappropriate polycythemia

Back 105

ectopic secretion EPO, polycythemia vera

Front 106

Polycythemia vera

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↑ plasma volume and RBC mass; normal SaO2; ↓ EPO

Front 107

Ectopic EPO (renal cell carcinoma)

Back 107

normal plasma volume; ↑ RBC mass; normal SaO2; ↑ EPO

Front 108

Myelofibrosis myeloid metaplasia

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marrow fibrosis; extramedullary hematopoiesis; splenomegaly

Front 109

Lab findings in myelofibrosis

Back 109

tear drop RBCs; dry bone marrow aspirate (marrow fibrosis)

Front 110

Essential thrombocythemia

Back 110

MPO with increase in abnormal appearing platelets

Front 111

Myelodysplastic syndrome

Back 111

severe anemia in elderly; 30% develop leukemia; ringed sideroblasts

Front 112

Benzene

Back 112

aplastic anemia; acute leukemia

Front 113

Leukemia by age

Back 113

ALL, newborn-14; AML, 15-60; CML, 40-60; CLL, >60

Front 114

Acute vs. chronic leukemia

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acute, blasts >30% in bone marrow; chronic, blasts <10% in bone marrow

Front 115

AML

Back 115

Auer rods in myeloblasts

Front 116

Acute promyelocytic leukemia

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t(15;17); defect in retinoic acid; Rx retinoic acid (↑ maturation); DIC

Front 117

Acute monocytic leukemia

Back 117

gum infiltration

Front 118

CML

Back 118

t(9;22) of ABL POC; Philadelphia chromosome 22; ↓ alkaline phosphatase score

Front 119

ALL

Back 119

early pre-B (80%); CALLA (CD10) and TdT positive; CNS and testicle involvement

Front 120

ALL

Back 120

t(12;21) offers good prognosis

Front 121

CLL

Back 121

B cell neoplasm; ↓ γ-globulins; MCC generalized lymphadenopathy patients> 60-yrs-old

Front 122

Adult T cell leukemia

Back 122

HTLV-1; CD4 T cells; skin infiltration; lytic bone lesions with hypercalcemia

Front 123

Hairy cell leukemia

Back 123

positive TRAP stain; splenomegaly; Rx with purine nucleosides

Front 124

Nodal sites

Back 124

germinal follicles, B cells; paracortex, T cells; sinuses, histiocytes

Front 125

Testicular cancer

Back 125

metastasizes to para-aortic nodes

Front 126

Stomach cancer

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metastasizes to left supraclavicular nodes (Virchow node)

Front 127

Phenytoin

Back 127

atypical lymphocytosis

Front 128

Cat scratch disease

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Bartonella henselae; granulomatous microabscesses

Front 129

Follicular B-cell lymphoma

Back 129

t(14;18); overexpression of BCL-2 anti-apoptosis gene

Front 130

Burkitt lymphoma

Back 130

t(8;14); EBV association; common childhood NHL; “starry sky” appearance

Front 131

Extra nodal lymphomas

Back 131

risk factors H. pylori (stomach); Sjogren’s syndrome

Front 132

Mycosis fungoides

Back 132

CD4 T cell neoplasm; skin lesions with Pautrier’s microabscesses

Front 133

Sezary syndrome

Back 133

leukemic phase of mycosis fungoides

Front 134

Polyclonal gammopathy

Back 134

sign of chronic inflammation

Front 135

Monoclonal gammopathy

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M component (spike); sign of plasma cell disorder

Front 136

Confirmatory tests

Back 136

serum and urine immunoelectrophoresis; bone marrow aspirate

Front 137

Bence Jones protein

Back 137

light chains in urine; predictive of a malignant plasma cell disorder

Front 138

Multiple myeloma

Back 138

M spike; lytic bone lesions; pathologic fractures; hypercalcemia; renal failure

Front 139

MGUS

Back 139

MC monoclonal gammopathy; may progress to myeloma

Front 140

Findings in MGUS

Back 140

elderly patient; no BJ protein; no malignant plasma cells

Front 141

Waldenstrom’s macroglobulinemia

Back 141

lymphoplasmacytic lymphoma; IgM M spike; hyperviscosity

Front 142

Hodgkin’s lymphoma

Back 142

neoplastic component, Reed Stemberg (RS) cell; CD15 CD30 positive

Front 143

Lymphocyte predominant Hodgkin’s

Back 143

infrequent classic RS cells

Front 144

Nodular sclerosing Hodgkin’s

Back 144

female dominant; supraclavicular nodes + anterior mediastinal nodes

Front 145

Mixed cellularity Hodgkin’s

Back 145

male dominant; numerous RS cells; EBV association

Front 146

Hodgkin’s prognosis

Back 146

stage of disease and type of Hodgkin’s most important factors

Front 147

Alkylating agents in Rx of Hodgkins

Back 147

↑ risk for second malignancies (leukemia; NHL)

Front 148

Langerhan’s histiocytes

Back 148

CD1 positive; Birbeck granules

Front 149

Letterer-Siwe disease

Back 149

malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement

Front 150

Hand-Christian-Christian disease

Back 150

malignant; lytic skull lesions, diabetes insipidus, exophthalmos

Front 151

Eosinophilic granuloma

Back 151

benign histiocytosis; lytic bone lesions with pathologic fractures

Front 152

Mast cells

Back 152

release histamine (pruritus; swelling); metachromatic granules positive with toluidine blue

Front 153

Urticaria pigmentosum

Back 153

localized mastocytosis; skin lesions swell and itch with scratching

Front 154

Amyloid

Back 154

twisted β-sheet; apple green birefringence with Congo red

Front 155

Primary amyloidosis

Back 155

AL amyloid derived from light chains; plasma cell disorders

Front 156

Secondary amyloidosis

Back 156

AA amyloid derived from serum-associated amyloid; chronic infections

Front 157

Alzheimer’s disease

Back 157

amyloid precursor protein gene product chromosome 21; amyloid-β

Front 158

Gaucher’s disease

Back 158

macrophages have fibrillary appearance; deficiency glucocerebrosidase

Front 159

Niemann Pick’s disease

Back 159

macrophages have soap bubble appearance; deficiency sphingomyelinase

Front 160

Hypersplenism

Back 160

splenomegaly; peripheral blood cytopenias; portal hypertension MCC

Front 161

Splenic dysfunction

Back 161

Howell Jolly bodies; susceptible to Streptococcus pneumoniae sepsis

Front 162

Anticoagulants

Back 162

tissue plasminogen activator, heparin, PGI2 ATIII, protein C/S

Front 163

Heparin

Back 163

enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)

Front 164

Protein C/S

Back 164

neutralize V and VIII

Front 165

Procoagulants

Back 165

coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)

Front 166

Protein C and S

Back 166

inactivate factors V and VIII; enhance fibrinolysis

Front 167

von Willebrand factor

Back 167

complexes with factor VIII to enhance VIII:C activity; platelet adhesion

Front 168

Platelets

Back 168

receptors for von Willebrand factor and fibrinogen; synthesize thromboxane A2

Front 169

GpIb

Back 169

platelet receptor for von Willebrand factor

Front 170

GpIIb:IIIa

Back 170

platelet receptor for fibrinogen

Front 171

Extrinsic system factor

Back 171

VII

Front 172

Intrinsic system factors

Back 172

XII, XI, IX, VIII

Front 173

Final common pathway factors

Back 173

X, V, prothrombin (II), fibrinogen (I)

Front 174

Factor XIII

Back 174

cross-links insoluble fibrin; strengthens fibrin clots

Front 175

Vitamin K-dependent factors

Back 175

prothrombin, VII, IX, X, protein C and S

Front 176

Factors consumed in a clot

Back 176

fibrinogen, prothrombin, V, VIII; fluid is called serum

Front 177

Plasmin

Back 177

cleaves fibrinogen and insoluble fibrin into degradation products

Front 178

Bleeding time

Back 178

evaluates platelet function (adhesion, release reaction, aggregation)

Front 179

Aspirin

Back 179

MCC of a prolonged bleeding time

Front 180

Tests for vWF

Back 180

ristocetin cofactor assay; vWF antigen assay; agar electrophoresis

Front 181

PT

Back 181

evaluates extrinsic pathway to fibrin clot

Front 182

PTT

Back 182

evaluates intrinsic pathway to stable fibrin clot

Front 183

Fibrinolysis tests

Back 183

fibrin(ogen) degradation products; D-dimers (cross-linked insoluble fibrin)

Front 184

S/S platelet dysfunction

Back 184

cannot form temporary plug; epistaxis; petechiae; bleeding from scratches

Front 185

Idiopathic thrombocytopenic purpura (ITP)

Back 185

children; antibodies against GpIIb:IIIa; no splenomegaly

Front 186

Chronic autoimmune thrombocytopenic purpura

Back 186

SLE; antibodies against GpIIb:IIIa receptors

Front 187

Heparin

Back 187

thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets

Front 188

PF4

Back 188

heparin neutralizing factor

Front 189

HIV

Back 189

thrombocytopenia MC hematologic abnormality; similar to ITP

Front 190

TTP

Back 190

platelet thrombi develop in areas of endothelial damage in small vessels; consumption of platelets

Front 191

S/S

Back 191

fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits

Front 192

Lab findings TTP

Back 192

thrombocytopenia, prolonged bleeding time, normal PT and PTT

Front 193

HUS

Back 193

similar to TTP; endothelial injury from Shiga-like toxin of 0157:H7 E. coli in undercooked beef

Front 194

S/S factor deficiency

Back 194

no stable fibrin clot-late rebleeding; menorrhagia; GI bleeding; hemarthroses

Front 195

Hemophilia A

Back 195

XR; hemarthroses; prolonged PTT, ↓ factor VIII activity, normal VIII antigen

Front 196

von Willebrand’s disease

Back 196

AD; platelet adhesion defect + factor VIII deficiency

Front 197

Lab findings in VWD

Back 197

↓ vWF, VIII antigen, and VIII:C; prolonged bleeding time

Front 198

Desmopressin acetate

Back 198

Rx of choice for mild von Willebrand’s disease and hemophilia A

Front 199

Circulating anticoagulants

Back 199

antibodies destroy coagulation factors

Front 200

Lab finding in circulating anticoagulant

Back 200

prolonged PT and/or PTT corrected with mixing studies

Front 201

Vitamin K deficiency

Back 201

↓ epoxide reductase activity (↓ function vitamin K); hemorrhagic diathesis; ↑ PT

Front 202

Causes vitamin K deficiency

Back 202

antibiotics MC, newborn, malabsorption, warfarin

Front 203

DIC

Back 203

activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage

Front 204

DIC

Back 204

consumption coagulation factors by fibrin clots; patient also anticoagulated

Front 205

Causes

Back 205

septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid

Front 206

S/S

Back 206

bleeding from all scratches, holes, needle sites

Front 207

Lab findings DIC

Back 207

thrombocytopenia, ↑ PT and PTT, D-dimers (best test), anemia

Front 208

Antiphospholipid antibodies

Back 208

lupus anticoagulant and anticardiolipin antibodies; vessel thrombosis

Front 209

Warfarin

Back 209

inhibits epoxide reductase; PT best test but PTT also prolonged

Front 210

Warfarin

Back 210

full anticoagulation in 3 days when -carboxylated prothrombin disappears

Front 211

Warfarin

Back 211

ingredient in rat poison; danger to children in households with grandparents on warfarin

Front 212

Rx warfarin over anticoagulation

Back 212

intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)

Front 213

Heparin

Back 213

enhances ATIII; PTT best test but PT also prolonged

Front 214

OC

Back 214

estrogen ↑ coagulation factor synthesis and ATIII; predisposes to thrombosis

Front 215

Factor V Leiden

Back 215

MC hereditary thrombosis; resistant to degradation by protein C/S

Front 216

ATIII deficiency

Back 216

no prolongation of PTT with administration of heparin

Front 217

Hemorrhagic skin necrosis

Back 217

post-warfarin therapy in patient with heterozygote protein C deficiency

Front 218

M cells

Back 218

specialized cells that transfer foreign antigens to lymphocytes in Peyer’s patches

Front 219

Blood group O

Back 219

some patients have anti-AB-IgG antibodies; increased incidence duodenal ulcers

Front 220

Blood group A

Back 220

increased incidence of gastric carcinoma

Front 221

Newborns

Back 221

do not have natural blood group antibodies at birth (e.g., anti-A-lgM)

Front 222

Elderly

Back 222

may lose natural blood group antibodies; no hemolytic reaction to mismatched blood

Front 223

Rh antigens

Back 223

inherited in autosomal codominant fashion; Rh antigens include D, C, c, E, e

Front 224

Atypical antibodies

Back 224

antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)

Front 225

Duffy antigen

Back 225

receptor for Plasmodium vivax; blacks often lack Duffy antigen

Front 226

Antibody screen

Back 226

indirect Coomb’s test; detects atypical antibodies in serum

Front 227

Cytomegalovirus

Back 227

MC infection transmitted by blood transfusion; MC antibody

Front 228

Hepatitis C

Back 228

MCC of post-transfusion hepatitis

Front 229

Major crossmatch

Back 229

patient serum reacted against donor RBCs; does not guarantee RBC survival

Front 230

Universal donor

Back 230

blood group O; no antigens on the surface of RBCs

Front 231

Universal recipient

Back 231

blood group AB; no natural blood group antibodies in serum

Front 232

Packed RBC transfusion

Back 232

raises Hb by 1 gm/dL and Hct by 3%

Front 233

Cryoprecipitate

Back 233

fibrinogen and factor VIII

Front 234

Fresh frozen plasma

Back 234

replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)

Front 235

Allergic transfusion reaction

Back 235

type I IgE-mediated hypersensitivity reaction

Front 236

Febrile transfusion reaction

Back 236

recipient anti-HLA antibodies react against donor leukocytes

Front 237

Intravascular HTR

Back 237

transfusion of ABO incompatible blood (e.g., A person receives B blood)

Front 238

Extravascular HTR

Back 238

antibody attaches to donor RBCs; macrophage phagocytosis and hemolysis

Front 239

Positive direct Coomb’s test

Back 239

present in both types of hemolytic transfusion reactions

Front 240

S/S

Back 240

jaundice, no increase in Hb, hemoglobinuria

Front 241

ABO HDN

Back 241

mother O and baby A or B; transplacental passage of maternal anti-AB-IgG

Front 242

ABO HDN

Back 242

positive direct Coomb’s test; spherocytes; MCC unconjugated hyperbilirubinemia first 24 hrs

Front 243

Rh HDN

Back 243

mother Rh (D antigen) negative and fetus Rh (O antigen) positive

Front 244

Rh HDN

Back 244

no hemolysis in first Rh incompatible pregnancy

Front 245

Rh HDN

Back 245

maternal anti-D crosses placenta; potential for hydrops fetalis; high risk for kernicterus

Front 246

Rh immune globulin

Back 246

anti-D; coats D antigen site on fetal RBCs in maternal circulation

Front 247

Rh HDN lab

Back 247

positive direct Coomb’s; severe anemia and hyperbilirubinemia

Front 248

ABO HDN

Back 248

protects mother from Rh sensitization (development of anti-D antibodies)

Front 249

O Rh negative mother with A Rh positive baby

Back 249

A+ cells destroyed by mothers anti A-lgM

Front 250

Blue fluorescent light

Back 250

converts unconjugated bilirubin in skin into harmless water soluble dipyrrole

Front 251

MV auscultation

Back 251

apex

Front 252

TV auscultation

Back 252

left parasternal border

Front 253

AV auscultation

Back 253

right 2nd intercostal space

Front 254

PV auscultation

Back 254

left 2nd intercostal space

Front 255

S1

Back 255

closure MV and TV

Front 256

S2

Back 256

closure AV and PV

Front 257

Inspiration

Back 257

split in A2 and P2; due to increased blood in right side of heart

Front 258

S3

Back 258

abnormal; due to blood entering volume overloaded ventricle in early diastole

Front 259

Causes S3

Back 259

valve regurgitation; congestive heart failure

Front 260

S4

Back 260

abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole

Front 261

Causes S4

Back 261

volume overloaded ventricle, hypertrophy

Front 262

Murmurs

Back 262

stretching valve ring or damage to valve

Front 263

Inspiration

Back 263

increases right sided abnormal heart sounds and murmurs

Front 264

Expiration

Back 264

increases left sided abnormal heart sounds and murmurs

Front 265

Stenosis murmurs

Back 265

problem in opening valve

Front 266

Regurgitation murmurs

Back 266

problem in closing valve

Front 267

Valves opening in systole

Back 267

AV and PV

Front 268

Valves opening in diastole

Back 268

MV and TV

Front 269

Valves closing in systole

Back 269

MV and TV

Front 270

Valves closing in diastole

Back 270

AV and PV

Front 271

LDL

Back 271

primary vehicle for carrying cholesterol

Front 272

VLDL

Back 272

primary vehicle for carrying liver-synthesized triglyceride

Front 273

Familial hypercholesterolemia (type II)

Back 273

AD; deficiency of LDL receptors; ↑ LDL

Front 274

Type III hyperlipoproteinemia

Back 274

deficiency apo E; ↑ remnants (chylomicron, intermediate density)

Front 275

Type IV hyperlipoproteinemia

Back 275

↑ VLDL; alcoholics

Front 276

Apo B deficiency

Back 276

deficiency apo B48 (chylomicrons) and B100 (VLDL); ↓ CH and TG

Front 277

Clinical findings in apo B deficiency

Back 277

malabsorption; hemolytic anemia

Front 278

Atherosclerosis

Back 278

reaction to injury of endothelial cells

Front 279

Risk factors

Back 279

smoking, ↑ LDL, ↑ homocysteine, Chlamydia pneumoniae infection

Front 280

Cells involved

Back 280

platelets, macrophages, smooth muscle cells, T cells with cytokine release

Front 281

Fibrous plaque

Back 281

pathognomonic lesion of atherosclerosis

Front 282

C-reactive protein

Back 282

marker of an inflammatory atheromatous plaque

Front 283

Inflammatory atheromatous plaque

Back 283

predisposes to platelet thrombosis

Front 284

Increased plasma homocysteine

Back 284

↑ vessel thrombosis; folate (MC)/vitamin B12 deficiency

Front 285

Hyaline arteriolosclerosis

Back 285

small vessel disease of DM and hypertension; excess protein in vessel wall

Front 286

Mechanisms hyaline arteriolosclerosis in DM

Back 286

non-enzymatic glycosylation

Front 287

Non-enzymatic glycosylation

Back 287

glucose attaches to amino acids in BM; causes ↑ permeability to protein

Front 288

Mechanisms hyaline arteriolosclerosis in hypertension

Back 288

pressure pushes proteins into vessel wall

Front 289

Abdominal aortic aneurysm rupture

Back 289

due to atherosclerosis; flank pain, hypotension, pulsatile mass

Front 290

Syphilitic aneurysm

Back 290

vasculitis of vasa vasorum of aortic arch; aortic regurgitation

Front 291

Aortic dissection

Back 291

due to hypertension and collagen tissue disorders (e.g., Marfan)

Front 292

Cystic medial degeneration

Back 292

elastic tissue degeneration creates spaces filled with mucopolysaccharides

Front 293

Intimal tear in aorta

Back 293

due to wall stress from hypertension and structural weakness

Front 294

Types of dissection

Back 294

proximal (MC); distal or combination of both

Front 295

S/S proximal aortic dissection

Back 295

chest pain radiating to back, lack of pulse; cardiac tamponade MC COD

Front 296

Marfan’s

Back 296

AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death

Front 297

MC COD Marfan’s and Ehlers Danlos

Back 297

aortic dissection

Front 298

Phlebothrombosis

Back 298

stasis of blood flow; deep veins below knee MC site

Front 299

Pulmonary thromboembolism

Back 299

emboli originate from femoral veins

Front 300

Superficial migratory thrombophlebitis

Back 300

sign of carcinoma of head of pancreas

Front 301

Thoracic outlet syndrome

Back 301

absent radial pulse with positional change

Front 302

Turner’s syndrome

Back 302

lymphedema hands/feet in newborn; preductal coarctation

Front 303

Spider telangiectasia

Back 303

arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)

Front 304

Capillary hemangioma in newborn

Back 304

regress with age; do not surgically remove

Front 305

Kaposi’s sarcoma

Back 305

HHV-8; vascular malignancy; MC cancer in AIDS

Front 306

Bacillary angiomatosis

Back 306

Bartonella henselae; vascular infection in AIDS

Front 307

Small vessel vasculitis

Back 307

palpable purpura; e.g., Henoch Schonlein purpura

Front 308

Muscular artery vasculitis

Back 308

vessel thrombosis with infarction; e.g., classical polyarteritis nodosa

Front 309

Elastic artery vasculitis

Back 309

absent pulse, stroke

Front 310

Takayasu’s arteritis

Back 310

pulseless disease; young Asian woman

Front 311

Giant cell arteritis

Back 311

temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)

Front 312

Classical polyarteritis nodosa

Back 312

muscular artery vasculitis with vessel thrombosis infarction

Front 313

Path findings

Back 313

vessel inflammation at different stages; aneurysms from vessel weakness

Front 314

S/S

Back 314

infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%

Front 315

Diagnosis

Back 315

angiography identifies aneurysms and thrombosis

Front 316

Kawasaki’s disease

Back 316

coronary artery vasculitis/thrombosis/aneurysms in children

Front 317

S/S

Back 317

chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy

Front 318

Rx

Back 318

IV γ-globulin

Front 319

Buerger’s disease (thromboangiitis obliterans)

Back 319

smoker’s digital vasculitis; digital infarction

Front 320

Raynaud’s syndrome

Back 320

digital vasculitis in PSS and CREST syndrome

Front 321

S/S

Back 321

digital pain; white-blue-red color changes

Front 322

Cryoglobulinemia

Back 322

protein gels in cold temperature; Raynaud’s syndrome; HCV association

Front 323

S/S

Back 323

acral cyanosis relieved by coming indoors

Front 324

Wegener’s granulomatosis

Back 324

association with c-ANCA; sinusitis, lung infarction, crescentic GN

Front 325

Microscopic polyangiitis

Back 325

palpable purpura; crescentic GN; association with p-ANCA

Front 326

Henoch-Schönlein purpura

Back 326

IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN

Front 327

Serum sickness vasculitis

Back 327

e.g., horse antivenin in Rx of rattlesnake envenomation

Front 328

Rocky Mountain spotted fever

Back 328

tick borne

Front 329

Meningococcemia

Back 329

sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome

Front 330

Essential HTN blacks

Back 330

defect in renal excretion of sodium; ↑ plasma volume, ↓ PRA

Front 331

Renovascular HTN

Back 331

atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women

Front 332

S/S

Back 332

epigastric bruit; ↑ PRA affected kidney, ↓ PRA unaffected kidney

Front 333

Endocrine HTN

Back 333

1º HPTH, Graves/hypothyroidism, Cushing’s, 1º aldosteronism, phaeochromocytoma

Front 334

Hypertension

Back 334

LVH MC complication; AMI MC COD followed by stroke and renal failure

Front 335

Afterload

Back 335

resistance ventricles contract against

Front 336

Preload

Back 336

volume ventricles must eject

Front 337

Concentric LVH

Back 337

increased afterload; e.g., essential HTN, aortic stenosis

Front 338

LVH with dilation/hypertrophy

Back 338

increased preload; e.g., valve regurgitation; left to right shunts

Front 339

LHF

Back 339

forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea

Front 340

Systolic dysfunction

Back 340

LHF due to decreased ventricular contractility (ischemia)

Front 341

Diastolic dysfunction

Back 341

LHF due to decreased ventricular compliance (hypertrophy)

Front 342

RHF

Back 342

backward failure; ↑ venous hydrostatic pressure; neck vein distention, hepatomegaly, edema

Front 343

ACE inhibitors

Back 343

decrease afterload and preload in heart failure

Front 344

Diuretics in CHF

Back 344

reduce preload

Front 345

Non-pharmacologic Rx in CHF

Back 345

restrict salt and water

Front 346

AMI

Back 346

MC COD in United States; left anterior descending coronary artery thrombosis MCC

Front 347

Exertional angina

Back 347

coronary artery atherosclerosis; subendocardial ischemia; ST depression

Front 348

Prinzmetal’s angina

Back 348

coronary artery vasospasm; transmural ischemia; ST elevation

Front 349

Sudden cardiac death

Back 349

death within 1 hr of symptoms

Front 350

Path findings

Back 350

severe coronary artery atherosclerosis; absence of occlusive thrombosis

Front 351

LAD coronary artery

Back 351

anterior portion left ventricle, anterior 2/3rds IVS

Front 352

RCA

Back 352

posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle

Front 353

AMI

Back 353

rupture of inflammatory plaque produces platelet thrombus

Front 354

Ventricular fibrillation

Back 354

MC COD in AMI

Front 355

AMI

Back 355

no gross changes until 24 hrs

Front 356

S/S AMI

Back 356

retrosternal pain radiating down arms, diaphoresis

Front 357

AMI ruptures

Back 357

3rd-7th day

Front 358

Anterior wall rupture

Back 358

MC type; LAD thrombosis; cardiac tamponade

Front 359

Posteromedial papillary muscle rupture

Back 359

RCA thrombosis; mitral regurgitation with LHF

Front 360

IVS rupture

Back 360

LAD thrombosis; left to right shunt; RHF

Front 361

Mural thrombus

Back 361

anterior AMI; danger embolization

Front 362

Pericarditis

Back 362

first week in transmural AMI; 6 wks later autoimmune

Front 363

S/S

Back 363

friction rub; leaning forward relieves pain

Front 364

Ventricular aneurysms

Back 364

late manifestation of AMI; precordial systolic bulge; CHF MC COD

Front 365

Right ventricular infarction

Back 365

RCA thrombosis; hypotension, RHF, preserved left ventricular function

Front 366

Diagnosis of AMI

Back 366

CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days

Front 367

LDH isoenzymes

Back 367

no longer used; LDH 1/2 flip indicates AMI

Front 368

Reinfarction

Back 368

reappearance CK-MB after 3 days

Front 369

ECG findings in AMI

Back 369

inverted T waves; ST elevation; Q waves

Front 370

Ejection fraction

Back 370

EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66

Front 371

By-pass surgery

Back 371

use internal mammary artery and saphenous veins (“arterialize” after 10 yrs)

Front 372

Angioplasty complication

Back 372

localized dissection with thrombosis

Front 373

Umbilical vein

Back 373

highest O2 saturation

Front 374

Ductus arteriosis in fetus

Back 374

shunts blood from pulmonary artery to aorta; PGE keeps it open

Front 375

Ductus arteriosus in newborn

Back 375

closes and becomes ligamentum arteriosum

Front 376

Eisenmenger’s syndrome

Back 376

cyanosis due to reversal of left to right shunt

Front 377

VSD

Back 377

MC congenital heart disease; ↑ SaO2 right ventricle (RV), pulmonary artery (PA)

Front 378

ASD

Back 378

patent foramen ovale; ↑ SaO2 right atrium (RA), RV, PA; MC adult congenital heart disease

Front 379

Down syndrome

Back 379

endocardial cushion defect (combined ASD and VSD)

Front 380

PDA

Back 380

machinery murmur; close with indomethacin; ↑ SaO2 PA

Front 381

Tetralogy of Fallot

Back 381

degree of pulmonic stenosis determines if cyanosis is present

Front 382

Tetralogy of Fallot

Back 382

↓ left ventricle, aorta

Front 383

Tetralogy of Fallot

Back 383

ASD and PDA are cardioprotective

Front 384

Complete transposition

Back 384

cyanosis; aorta empties RV; PA empties left ventricle

Front 385

Complications cyanotic heart disease

Back 385

2° polycythemia; infective endocarditis; metastatic abscesses

Front 386

Pre-ductal coarctation

Back 386

Turner’s syndrome

Front 387

Post-ductal coarctation

Back 387

constriction distal to ligamentum arteriosum

Front 388

S/S

Back 388

upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN

Front 389

Acute rheumatic fever

Back 389

type II hypersensitivity; group A streptococcus pharyngeal infection

Front 390

Acute rheumatic fever

Back 390

sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule

Front 391

S/S

Back 391

polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea

Front 392

Mitral stenosis

Back 392

chronic rheumatic fever; opening snap followed by mid-diastolic rumble

Front 393

Mitral stenosis

Back 393

left atrial dilation hypertrophy - atrial fibrillation, thrombus, pulmonary edema, RHF

Front 394

MVP

Back 394

myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos

Front 395

S/S

Back 395

mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae

Front 396

MVP click/murmur close to S1

Back 396

decrease preload (stand, Valsalva, anxiety)

Front 397

MVP click/murmur close to S2

Back 397

increase preload (supine, squat, clench fist)

Front 398

Mitral regurgitation

Back 398

pansystolic murmur; S3 and S4 common

Front 399

Causes

Back 399

LHF, infective endocarditis, acute rheumatic fever

Front 400

Aortic stenosis

Back 400

systolic ejection murmur; syncope and angina with exercise; hemolytic anemia

Front 401

Aortic stenosis murmur increased preload

Back 401

worsens obstruction and increases murmur intensity

Front 402

Aortic stenosis murmur decreased preload

Back 402

decreases obstruction and decreases murmur intensity

Front 403

Causes

Back 403

bicuspid aortic valve; age-related sclerosis

Front 404

Aortic regurgitation

Back 404

bounding pulses; early diastolic blowing murmur

Front 405

Austin Flint murmur

Back 405

diastolic murmur; regurgitant flow on anterior leaflet mitral valve

Front 406

Significance Austin Flint murmur

Back 406

sign for AV replacement

Front 407

Causes aortic regurgitation

Back 407

essential HTN, infective endocarditis, acute rheumatic fever, dissection

Front 408

Tricuspid regurgitation

Back 408

pansystolic murmur ↑ intensity with inspiration

Front 409

Causes

Back 409

endocarditis IV drug abuse; RHF; carcinoid heart disease

Front 410

Carcinoid heart disease

Back 410

tricuspid regurgitation, pulmonic stenosis

Front 411

Infective endocarditis (IE)

Back 411

Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA

Front 412

IE prosthetic heart valve

Back 412

Staphylococcus epidermidis (coagulase negative)

Front 413

IE ulcerative bowel disease

Back 413

Streptococcus bovis

Front 414

S/S

Back 414

IC vasculitis-Roth spot, splinter hemorrhages; regurgitant murmurs; metas1atic abscesses

Front 415

Lab findings

Back 415

positive blood culture Libman Sacks endocarditis

Front 416

Coxsackievirus

Back 416

MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis

Front 417

Parasitic cause myocarditis

Back 417

leishmania in Chagas disease

Front 418

Pericardial effusion

Back 418

all chamber pressures are uniformally increased

Front 419

S/S

Back 419

muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention

Front 420

Dx and Rx

Back 420

echocardiogram, pericardiocentesis, respectively

Front 421

Pulsus paradoxus

Back 421

drop in blood pressure >10 mmHg with inspiration

Front 422

Constrictive pericarditis

Back 422

TB MCC worldwide; pericardial knock

Front 423

Congestive cardiomyopathy

Back 423

generalized chamber enlargement; low ejection fraction

Front 424

Causes

Back 424

postpartum, cardiotoxic drugs, hypothyroidism, alcohol

Front 425

Hypertrophic cardiomyopathy

Back 425

MCC of sudden death in young person (due to conduction defects)

Front 426

Site of obstruction

Back 426

anterior leaflet mitral valve drawn against asymmetric thickened IVS

Front 427

Effect decreased preload on systolic murmur

Back 427

worsens obstruction and increases murmur intensity

Front 428

Effect increased preload on systolic murmur

Back 428

reduces obstruction and decreases murmur intensity

Front 429

Restrictive cardiomyopathy

Back 429

decreased compliance

Front 430

Causes

Back 430

iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis

Front 431

Cardiac myxoma

Back 431

benign tumor left atrium; embolization; syncope

Front 432

Cardiac rhabdomyoma

Back 432

childhood tumor; association with tuberous sclerosis

Front 433

U wave

Back 433

hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)

Front 434

Peaked T wave

Back 434

hyperkalemia; MCC renal failure

Front 435

ST depression

Back 435

subendocardial ischemia (e.g., classical angina pectoris)

Front 436

ST elevation

Back 436

transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm

Front 437

Atrial fibrillation

Back 437

MC chronic arrhythmia; absent P waves; danger for embolization

Front 438

Ventricular premature beats

Back 438

wide QRS complexes; MC arrhythmia in coronary care unit

Front 439

Ventricular fibrillation

Back 439

MCC of death in an AMI

Front 440

Anterior AMI

Back 440

Q waves in I and V1-V4

Front 441

Inferior AMI

Back 441

Q waves in II, III, and aVF; right coronary artery thrombosis.

Front 442

Wolff-Parkinson-White

Back 442

short PR interval with normal P wave; delta wave on upstroke of R wave

Front 443

Alveolar O2 calculation

Back 443

% O2 breathing (713) - PCO2/0.8

Front 444

Increased A-a gradient

Back 444

primary lung disease; left to right shunts in heart

Front 445

Forced vital capacity

Back 445

total amount of air expelled after a maximal inspiration

Front 446

Forced expiratory volume/1 second (FEV1)

Back 446

amount of air expelled in I second after maximal inspiration

Front 447

Choanal atresia

Back 447

cyanotic when breast feeding; turns pink when crying

Front 448

Nasal polyps

Back 448

allergic (MC; adults only), aspirin, cystic fibrosis

Front 449

Nasal polyp in a child

Back 449

requires sweat test to exclude cystic fibrosis

Front 450

Triad asthma

Back 450

patient on aspirin (pain syndrome) with nasal polyps, asthma

Front 451

Obstructive sleep apnea (OSA)

Back 451

snoring with intervals of apnea (respiratory acidosis with hypoxemia)

Front 452

S/S

Back 452

danger cor pulmonale; requires sleep test; Rx. O2 with continuous positive airway pressure

Front 453

Sinusitis

Back 453

maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC

Front 454

Nasopharyngeal carcinoma

Back 454

association with EBV; metastasize to cervical nodes

Front 455

Laryngeal carcinoma

Back 455

smoking MCC; hoarseness; squamous cell carcinoma

Front 456

Resorption atelectasis

Back 456

MCC of fever 24-36 hours after surgery

Front 457

S/S

Back 457

↓ percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm

Front 458

RDS

Back 458

decreased production surfactant; airway collapse; hyaline membranes

Front 459

Type II pneumocytes

Back 459

synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies

Front 460

Surfactant

Back 460

reduces surface tension in airways; ↑ synthesis cortisol, thyroxine; ↓ synthesis insulin

Front 461

Causes RDS

Back 461

prematurity, maternal diabetes, C-section

Front 462

Maternal diabetes

Back 462

maternal hyperglycemia → fetal hyperglycemia → fetal insulin which ↓ surfactant

Front 463

Complications RDS

Back 463

O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis

Front 464

Typical community acquired pneumonia

Back 464

Streptococcus pneumoniae MCC

Front 465

Typical pneumonia

Back 465

bronchopneumonia, lobar pneumonia

Front 466

S/S

Back 466

productive cough; consolidation - ↓ percussion, ↑ tactile fremitus

Front 467

Atypical community acquired pneumonia

Back 467

interstitial pneumonia; Mycoplasma pneumoniae MCC

Front 468

S/S

Back 468

low grade fever, non-productive cough, no signs consolidation

Front 469

Nosocomial pneumonia

Back 469

Pseudomonas, aeruginosa MCC (respirators); others - S. aureus, E. coli

Front 470

Rhinovirus

Back 470

MCC common cold; hand to mouth transmission

Front 471

Respiratory syncytial virus

Back 471

MCC pneumonia and bronchiolitis in child

Front 472

Parainfluenza virus

Back 472

MCC croup in child; trachea area of obstruction

Front 473

Cytomegalovirus

Back 473

basophilic intranuclear inclusion surrounded by halo

Front 474

Influenza

Back 474

superimposed pneumonia with S. aureus increases mortality

Front 475

Rubeola

Back 475

Warthin-Finkeldey multinucleated giant cells

Front 476

Chlamydia pneumoniae

Back 476

atypical pneumonia; association with coronary artery disease

Front 477

Chlamydia trachomatis

Back 477

pneumonia in newborns; staccato cough; wheezing

Front 478

Coxiella burnetii

Back 478

only rickettsia without a vector

Front 479

Mycoplasma pneumoniae pneumonia

Back 479

crowded condition; cold agglutinins; azithromycin

Front 480

Streptococcus pneumoniae pneumonia

Back 480

gram positive diplococcus; azithromycin

Front 481

Staphylococcus aureus pneumonia

Back 481

tension pneumatocysts in children with cystic fibrosis

Front 482

Corynebacterium diphtheriae

Back 482

toxin produces ADP ribosylation of elongation factor 2

Front 483

Haemophilus influenzae

Back 483

exacerbation chronic bronchitis; acute epiglottis in children

Front 484

Inspiratory stridor child

Back 484

croup, epiglottitis

Front 485

Pseudomonas aeruginosa

Back 485

MCC of pneumonia and death in cystic fibrosis; green sputum

Front 486

Klebsiella pneumoniae

Back 486

mucoid sputum in alcoholic

Front 487

Legionella pneumophila

Back 487

silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest)

Front 488

Mycobacterium tuberculosis

Back 488

strict aerobe; MC COD due to infectious disease worldwide

Front 489

Candida albicans

Back 489

vessel invader; yeasts and pseudohyphae

Front 490

Cryptococcus immitis

Back 490

pigeon excreta; narrow-based bud

Front 491

Aspergillus fumigatus

Back 491

septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader

Front 492

Mucor species

Back 492

non-septate; vessel invader; frontal lobe abscess in diabetic ketoacidosis

Front 493

Coccidioides immitis

Back 493

Southwest deserts; inhale arthrospores in dust; spherule with endospores

Front 494

S/S

Back 494

erythema nodosum (painful nodules lower legs)

Front 495

Histoplasma capsulatum

Back 495

Ohio/central Mississippi river valley; excreta bats (spelunker), chickens

Front 496

H. capsulatum

Back 496

simulates TB; yeasts phagocytosed by macrophages

Front 497

Blastomyces dermatitidis

Back 497

overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer

Front 498

Pneumocystis carinii

Back 498

cysts and trophozoites; pneumonia in HIV; Rx. trimethoprim/sulfamethoxazole

Front 499

Primary TB

Back 499

upper portion lower lobe, lower portion upper lobe

Front 500

Primary TB

Back 500

Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)

Front 501

Reactivation TB

Back 501

cavitating lesion in upper lobe; kidney MC extrapulmonary site

Front 502

Mycobacterium avium intracellulare (MAI)

Back 502

atypical TB; MC TB in AIDS

Front 503

CF

Back 503

AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)

Front 504

S/S

Back 504

pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD

Front 505

Lung abscess

Back 505

MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray - air/fluid level

Front 506

Aspiration sitting

Back 506

posterobasal segment right lower lobe

Front 507

Aspiration supine

Back 507

superior segment right lower lobe

Front 508

Aspiration right side

Back 508

right middle lobe, posterior segment right upper lobe

Front 509

Pulmonary thromboembolism

Back 509

most derive from femoral vein

Front 510

Bronchial artery

Back 510

branch of aorta/intercostal artery; protects against developing pulmonary infarction

Front 511

Saddle embolus

Back 511

sudden death due to acute right heart strain

Front 512

S/S pulmonary infarction

Back 512

dyspnea and tachypnea; pleuritic chest pain; pleural effusion

Front 513

Dx

Back 513

ventilation/perfusion scan; respiratory alkalosis; hypoxemia

Front 514

Pain on inspiration

Back 514

pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax

Front 515

Pathogenesis pulmonary hypertension (PH)

Back 515

hypoxemia and respiratory acidosis

Front 516

Hypoxemia + respiratory acidosis

Back 516

vasoconstriction pulmonary vessels; vasodilation cerebral vessels

Front 517

Causes PH

Back 517

1° lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts

Front 518

Cor pulmonale

Back 518

PH + RVH

Front 519

S/S

Back 519

dyspnea; accentuated P2 (PH); parasternal heave (RVH)

Front 520

Restrictive lung disease

Back 520

↓ compliance, ↑ elasticity; interstitial fibrosis/edema

Front 521

Restrictive lung disease (RLD)

Back 521

↓ all volumes and capacities; ↑ FEV1sec/FVC ratio

Front 522

ARDS

Back 522

RLD; non-cardiogenic pulmonary edema due to alveolar injury

Front 523

ARDS

Back 523

neutrophil destruction of type I and II pneumocytes; hyaline membranes

Front 524

Causes

Back 524

septic shock (MC), aspiration gastric contents, severe trauma

Front 525

Pneumoconiosis

Back 525

inhalation mineral dust causing interstitial fibrosis; particles <0.5 μm to reach alveoli

Front 526

Caplan syndrome

Back 526

pneumoconiosis + rheumatoid nodules in lungs

Front 527

Coal worker’s

Back 527

“black lung” disease; progressive massive fibrosis; no increased incidence cancer or TB

Front 528

Silicosis

Back 528

quartz; nodular opacities; foundry workers; ↑ incidence cancer and TB

Front 529

Sources asbestos

Back 529

roofing material, old buildings (9/11), pipe-fitter shipyard

Front 530

Ferruginous bodies

Back 530

asbestos fiber coated by iron

Front 531

Asbestosis

Back 531

benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma

Front 532

Mesothelioma

Back 532

malignancy of serosa; no smoking association

Front 533

Sarcoidosis

Back 533

RLD; MC non-infectious lung and liver granulomatous disease

Front 534

S/S

Back 534

dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions

Front 535

Lab findings

Back 535

↑ ACE, hypercalcemia (macrophages synthesize 1-α-hydroxylase)

Front 536

Kveim test

Back 536

intradermal injection sarcoid antigens causes skin reaction

Front 537

Farmer’s lung

Back 537

RLD; lung reaction against thermophilic bacteria in moldy hay

Front 538

Silo filler’s disease

Back 538

RLD; reaction against nitrogen dioxide in fermenting corn

Front 539

Byssinosis

Back 539

RLD; reaction against cotton, linen, hemp products in textile industry

Front 540

Goodpasture’s syndrome

Back 540

RLD; anti-BM antibodies; begins in lungs and ends in renal failure

Front 541

Collagen vascular RLD

Back 541

SLE, rheumatoid arthritis, systemic sclerosis

Front 542

Drugs RLD

Back 542

amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin

Front 543

Obstructive lung disease

Back 543

↑ compliance, ↓ elasticity

Front 544

Obstructive lung disease

Back 544

↑ RV, TLC; ↓ TV, VC; ↓ FEV1sec and FVC; ↓ FEV1sec/FVC ratio

Front 545

Obstructive lung disease

Back 545

asthma, emphysema, chronic bronchitis, bronchiectasis

Front 546

Asthma

Back 546

extrinsic (type I hypersensitivity) and intrinsic types

Front 547

S/S

Back 547

expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors

Front 548

Charcot-Leyden crystals

Back 548

derive from crystalline material in eosinophil granules

Front 549

Lab findings

Back 549

initial respiratory alkalosis; respiratory acidosis requires intubation

Front 550

Emphysema

Back 550

destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer

Front 551

Respiratory unit

Back 551

respiratory bronchiole, alveolar duct, alveoli

Front 552

Radiograph emphysema

Back 552

↑ AP diameter; depressed diaphragms; vertical heart

Front 553

Pathogenesis

Back 553

↓ AAT, ↑ neutrophil destruction of elastic tissue

Front 554

Centriacinar emphysema

Back 554

destruction/distention respiratory bronchioles upper lobe in smokers; THINK

Front 555

Panacinar emphysema

Back 555

destruction/distention entire respiratory unit lower lobes; AAT deficiency

Front 556

Paraseptal emphysema

Back 556

upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax

Front 557

Lab findings

Back 557

normal to decreased PCO2 (respiratory alkalosis)

Front 558

Chronic bronchitis

Back 558

productive cough 3 months/2 consecutive years; blue bloater (cyanosis)

Front 559

Site of obstruction

Back 559

terminal bronchioles (proximal to respiratory unit)

Front 560

Lab findings

Back 560

respiratory acidosis/hypoxemia

Front 561

Bronchiectasis

Back 561

obstruction/infection key causes; dilated bronchioles extend to periphery

Front 562

Causes

Back 562

CF MCC, TB, immotile cilia syndrome

Front 563

Immotile cilia syndrome

Back 563

absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus

Front 564

Central lung cancers

Back 564

squamous cancer and small cell cancer; men > women

Front 565

Peripheral lung cancers

Back 565

adenocarcinoma; women > men

Front 566

Squamous lung cancer

Back 566

cavitate; secrete PTH-related protein

Front 567

Small cell carcinoma

Back 567

neuroendocrine tumor; secrete ACTH and ADH

Front 568

Bronchioloalveolar carcinoma

Back 568

no smoking relationship; lung consolidation resembling pneumonia

Front 569

Scar carcinoma

Back 569

usually adenocarcinoma developing in old TB scar

Front 570

Bronchial carcinoid

Back 570

low grade malignant; hemoptysis; rare cause carcinoid syndrome

Front 571

Metastatic lung cancer

Back 571

more common than primary cancer; breast cancer MCC

Front 572

Pancoast tumor

Back 572

squamous carcinoma posterior mediastinum; destruction superior cervical ganglion

Front 573

S/S

Back 573

Horner’s syndrome - lid lag, miosis, anhydrosis; lower brachial plexus injury

Front 574

Solitary coin lesion

Back 574

granuloma MCC

Front 575

Superior vena caval syndrome

Back 575

primary lung cancer obstructs vessel; venous congestion

Front 576

Anterior mediastinal masses

Back 576

thymoma; nodular sclerosing Hodgkin’s; teratomas

Front 577

Posterior mediastinal masses

Back 577

usually neurogenic tumors of ganglia

Front 578

Myasthenia gravis

Back 578

B cell hyperplasia of thymus MC abnormality; association with thymoma

Front 579

Thymoma

Back 579

association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia

Front 580

Pleural effusions

Back 580

transudates or exudates; CHF MCC

Front 581

Spontaneous pneumothorax

Back 581

rupture subpleural or intrapleural bleb; air/pleural cavity pressure same

Front 582

S/S

Back 582

pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds

Front 583

Tension pneumothorax

Back 583

flap-like pleural tear; increased pleural cavity pressure; compression atelectasis

Front 584

S/S

Back 584

as above except tracheal shift to opposite side

Front 585

Cleft lip/palate

Back 585

failure of fusion of facial processes

Front 586

Herpes labialis

Back 586

multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep

Front 587

Hairy leukoplakia

Back 587

EBV glossitis; pre-AIDS defining lesion; not precursor to cancer

Front 588

Mumps

Back 588

bilateral parotitis; unilateral orchitis; ↑ amylase

Front 589

Diphtheria

Back 589

pseudomembrane pharynx and trachea with cervical lymphadenopathy

Front 590

Congenital syphilis

Back 590

notched central incisors

Front 591

Actinomycosis

Back 591

anaerobic gram + filamentous bacteria; complication extracted dental abscess

Front 592

S/S

Back 592

draining sinuses with sulfur granules

Front 593

Exudative tonsillitis

Back 593

majority are viral; 20% group A streptococcus

Front 594

Oral thrush

Back 594

common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae

Front 595

Dental caries

Back 595

Streptococcus mutans

Front 596

Peutz-Jegher’s syndrome

Back 596

mucosal pigmentation; hamartomatous polyps

Front 597

Leukoplakia/erythroleukoplakia

Back 597

biopsy to rule out squamous dysplasia or cancer

Front 598

Squamous cell carcinoma

Back 598

smoking and alcohol association; lower lip MC site

Front 599

Smokeless tobacco

Back 599

verrucoid squamous cell carcinoma

Front 600

Gum hyperplasia

Back 600

phenytoin, pregnancy, scurvy

Front 601

Pleomorphic adenoma

Back 601

MC benign tumor of salivary glands; parotid MC site

Front 602

Mucoepidermoid carcinoma

Back 602

MC malignant tumor major and minor salivary glands

Front 603

Dysphagia for solids only

Back 603

lesion obstructing esophagus; e.g., cancer, web

Front 604

Plummer-Vinson syndrome

Back 604

iron deficiency anemia causes esophageal web, glossitis, achlorhydria (↓ HCl in gastric acid)

Front 605

Dysphagia for solids and liquids

Back 605

motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome

Front 606

TE fistula

Back 606

polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea

Front 607

VATER syndrome

Back 607

vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality

Front 608

Zenker’s diverticulum

Back 608

MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES

Front 609

GERD

Back 609

relaxation of lower esophageal sphincter (LES) with acid reflux

Front 610

GERD

Back 610

MCC nocturnal cough and asthma

Front 611

AIDS esophagitis

Back 611

Candida MC, CMV, HSV

Front 612

Barrett’s esophagus

Back 612

glandular metaplasia distal esophagus in GERD

Front 613

Complications of Barrett’s

Back 613

precursor for adenocarcinoma, stricture

Front 614

Esophageal varices

Back 614

dilated left gastric vein; sign of portal hypertension due to cirrhosis

Front 615

Mallory Weiss syndrome

Back 615

tear of distal esophagus from retching in alcoholic or bulimic

Front 616

Boerhaave’s syndrome

Back 616

rupture of distal esophagus from retching; pneumomediastinum

Front 617

Hamman’s mediastinal crunch

Back 617

pneumomediastinum (air in subcutaneous tissue)

Front 618

LES ganglion cells

Back 618

contain VIP - relaxes LES

Front 619

Achalasia

Back 619

failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus

Front 620

S/S

Back 620

aperistalsis/dilation of esophagus; regurgitation of undigested food at night

Front 621

X-ray achalasia

Back 621

bird’s beak appearance

Front 622

Acquired achalasia

Back 622

Chagas’ disease; leishmania destroy ganglion cells

Front 623

Distal adenocarcinoma esophagus

Back 623

MC primary cancer; due to Barrett’s esophagus

Front 624

Squamous cell carcinoma of esophagus

Back 624

smoking MCC; alcohol also causes

Front 625

Melena

Back 625

sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC

Front 626

Hematemesis

Back 626

vomiting blood; peptic ulcers MCC

Front 627

Congenital pyloric stenosis

Back 627

hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks

Front 628

Acute hemorrhagic (erosive) gastritis

Back 628

NSAIDs MCC

Front 629

Mucous barrier stomach

Back 629

maintained by PGE; misoprostol PGE analog

Front 630

Type A chronic gastritis

Back 630

due to PA; achlorhydria with ↑ serum gastrin

Front 631

Type B chronic gastritis

Back 631

due to H. pylori; involves pylorus and antrum

Front 632

H. pylori

Back 632

curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma

Front 633

Gastric ulcer

Back 633

lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain

Front 634

Duodenal ulcer

Back 634

never malignant; ↑ acid production; food relieves pain

Front 635

Perforated peptic ulcer

Back 635

air under diaphragm causes pain in left shoulder

Front 636

Menetrier’s disease

Back 636

giant rugal hyperplasia; protein loss from increased mucus

Front 637

Zollinger-Ellison syndrome

Back 637

malignant islet cell tumor secreting gastrin; part of MEN I syndrome

Front 638

S/S

Back 638

PUD in usual locations; sometimes multiple ulcers

Front 639

Hypergastrinemia

Back 639

ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure

Front 640

Leiomyoma

Back 640

MC benign tumor of stomach

Front 641

Intestinal type adenocarcinoma

Back 641

H pylori related; ↓ incidence; lesser curvature pylorus/antrum

Front 642

Diffuse type adenocarcinoma

Back 642

linitis plastica; signet ring cells; Krukenberg tumors ovaries

Front 643

Gastric lymphoma

Back 643

stomach MC site for extranodal lymphomas; H. pylori associated

Front 644

Malabsorption

Back 644

steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease

Front 645

Causes bile salt deficiency

Back 645

liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn’s

Front 646

D-xylose screen

Back 646

failure to reabsorb xylose indicates small bowel disease

Front 647

Calcification of pancreas

Back 647

chronic pancreatitis cause of malabsorption

Front 648

Celiac disease

Back 648

autoimmune disease; antibodies against gliadin in gluten; flat villi

Front 649

Celiac disease

Back 649

association with dermatitis herpetiformis

Front 650

Whipple’s disease

Back 650

systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa

Front 651

S/S

Back 651

fever, polyarthritis, skin pigmentation

Front 652

Invasive diarrhea

Back 652

Campylobacter jejuni MCC; positive fecal smear for leukocytes

Front 653

Secretory diarrhea

Back 653

loss isotonic fluid; enterotoxins from E. coli and V. cholerae

Front 654

Osmotic diarrhea

Back 654

hypotonic loss fluid; laxatives, lactase deficiency

Front 655

Rotavirus

Back 655

MCC diarrhea in children

Front 656

Norwalk virus

Back 656

MCC diarrhea in adults

Front 657

Cytomegalovirus

Back 657

common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS

Front 658

Staphylococcus aureus

Back 658

preformed toxin causes food poisoning; culture food

Front 659

Bacillus cereus

Back 659

preformed toxin in fried rice and tacos; gram positive rods in stool

Front 660

Clostridium botulinum (adult)

Back 660

preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis

Front 661

Clostridium botulinum (child)

Back 661

colonization of bowel with release of neurotoxin; eating honey

Front 662

Clostridium difficile

Back 662

pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole

Front 663

Shigella sonnei

Back 663

produces dysentery (bloody diarrhea); associated with HUS

Front 664

Salmonella enteritidis

Back 664

gastroenteritis; animal reservoirs - poultry, turtles

Front 665

Salmonella paratyphi

Back 665

sepsis; osteomyelitis in HbSS

Front 666

Salmonella typhi

Back 666

typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly

Front 667

Carrier state site

Back 667

gallbladder

Front 668

M. tuberculosis

Back 668

MCC intestinal TB in United States (swallow TB); Peyer’s patch site of infection

Front 669

Enterotoxigenic E. coli

Back 669

secretory diarrhea (traveler’s diarrhea); toxin stimulates guanylate cyclase

Front 670

Vibrio cholerae

Back 670

secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP

Front 671

Oral Rx cholera

Back 671

solution must contain glucose to reabsorb Na+ (co-transport)

Front 672

Yersinia enterocolitica

Back 672

mesenteric lymphadenitis; sepsis in iron overload states

Front 673

Entamoeba histolytica

Back 673

dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole

Front 674

Cryptosporidium parvum

Back 674

MCC diarrhea in AIDS; acid-fast oocysts

Front 675

Giardia lamblia

Back 675

MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole

Front 676

Trichuris trichiura

Back 676

rectal prolapse in children

Front 677

Enterobius vermicularis

Back 677

anal pruritus; urethritis in girls; no eosinophilia

Front 678

Ascaris lumbricoides

Back 678

intestinal obstruction due to adult worms; no eosinophilia

Front 679

Necator americanus

Back 679

hookworm; iron deficiency anemia

Front 680

Strongyloides stercoralis

Back 680

rhabditiform larvae in stool not eggs

Front 681

Diphyllobothrium latum

Back 681

fish tapeworm; vitamin B12 deficiency

Front 682

Signs of small bowel obstruction

Back 682

colicky pain; constipation and obstipation

Front 683

Radiograph small bowel obstruction

Back 683

air-fluid levels on x-ray

Front 684

MCC small bowel obstruction

Back 684

adhesions from previous surgery

Front 685

Duodenal atresia

Back 685

vomiting bile-stained fluid at birth; double bubble sign; Down syndrome

Front 686

Hirschsprung disease

Back 686

absent ganglion cells in submucosal/myenteric plexus rectosigmoid

Front 687

S/S

Back 687

proximal bowel dilated but peristalses; no stool in rectal vault

Front 688

Hirschsprung association

Back 688

Down syndrome; Chagas disease

Front 689

Intussusception

Back 689

terminal ileum telescopes into cecum; obstruction plus bloody diarrhea

Front 690

Meconium ileus

Back 690

complication of cystic fibrosis

Front 691

Indirect inguinal hernia

Back 691

second MCC of small bowel obstruction; common in weight lifting

Front 692

Gallstone ileus

Back 692

obstruction of small bowel with gallstone + air in biliary tree

Front 693

Volvulus

Back 693

MC due to sigmoid colon twisting around mesentery

Front 694

Direct inguinal hernia

Back 694

protrudes through center of triangle of Hesselbach; no obstruction

Front 695

Umbilical hernia

Back 695

common in black children; may entrap bowel in adults

Front 696

Sigmoid colon

Back 696

MC site for polyps, cancer, diverticula

Front 697

Small bowel infarction

Back 697

diffuse abdominal pain with bloody diarrhea

Front 698

Causes small bowel infarction

Back 698

embolism (atrial fibrillation), thrombosis SMA or SMV

Front 699

Ischemic colitis

Back 699

splenic flexure pain with bloody diarrhea

Front 700

Mesenteric angina

Back 700

pain in splenic flexure 30 minutes after eating

Front 701

Angiodysplasia

Back 701

submucosal dilation of venules in cecum; cause of hematochezia

Front 702

Hematochezia

Back 702

massive loss of blood per rectum; diverticulosis MCC

Front 703

Meckel’s diverticulum

Back 703

persistence omphalomesenteric duct

Front 704

S/S

Back 704

bleeding MC (iron deficiency in children), diverticulitis

Front 705

Meckel’s diverticulitis

Back 705

mimics acute appendicitis; cannot differentiate without radionuclide scan

Front 706

Sigmoid diverticulum

Back 706

diverticulitis MC complication; MCC hematochezia and fistula formation

Front 707

Diverticulitis

Back 707

“left-sided acute appendicitis”

Front 708

Ulcerative colitis

Back 708

mucosal/submucosal ulceration; starts in rectum; crypt abscess; ↑ risk adenocarcinoma

Front 709

S/S

Back 709

left lower quadrant crampy pain with bloody diarrhea

Front 710

UC associations

Back 710

primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy

Front 711

Crohn’s disease

Back 711

transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions

Front 712

S/S

Back 712

colicky pain and diarrhea; fistulas (anal, bowl to bowel)

Front 713

Carcinoid tumor

Back 713

appendix MC site; terminal ileum MC site for carcinoid syndrome

Front 714

Carcinoid syndrome

Back 714

liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA

Front 715

Tubular adenomas

Back 715

precursor lesion colon cancer; size and number determine risk of malignancy

Front 716

Villous adenoma

Back 716

greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium

Front 717

Familial polyposis

Back 717

AD with 100% penetrance for developing colon cancer

Front 718

Gardner’s syndrome

Back 718

AD, polyposis plus osteomas and desmoid tumors

Front 719

Turcot’s syndrome

Back 719

AD, polyposis plus brain tumors

Front 720

Colorectal cancer

Back 720

second MC cancer and cancer killer in adults

Front 721

Left-sided colorectal cancer

Back 721

obstruct; MC location rectosigmoid

Front 722

Right-sided colorectal cancer

Back 722

bleed

Front 723

Acute appendicitis

Back 723

due to lymphoid hyperplasia in children and obstruction by fecalith in adults

Front 724

External hemorrhoids

Back 724

thrombose

Front 725

Internal hemorrhoids

Back 725

bleed; prolapse out of rectum

Front 726

Urobilinogen (UBG)

Back 726

breakdown product CB in bowel (color of stool)

Front 727

UBG

Back 727

enterohepatic circulation to liver and kidney (color of urine)

Front 728

Alcoholic liver disease

Back 728

serum AST>ALT; ↑ serum GGT

Front 729

Viral hepatitis

Back 729

serum ALT>AST

Front 730

Cholestasis markers

Back 730

serum AP and GGT

Front 731

Unconjugated bilirubin

Back 731

macrophage degradation of heme; lipid soluble; never in urine

Front 732

Conjugated bilirubin (CB)

Back 732

water soluble; never normal in urine

Front 733

% CB <20% (unconjugated)

Back 733

Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN

Front 734

Gilbert’s disease

Back 734

AD; ↓ uptake and conjugation; bilirubin increases with fasting

Front 735

Physiologic jaundice newborn

Back 735

unconjugated hyperbilirubinemia; begins on day three

Front 736

% CB 20-50%

Back 736

viral/alcoholic hepatitis

Front 737

% CB >50%

Back 737

bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas

Front 738

Negative urine bilirubin + trace urobilinogen

Back 738

normal urine

Front 739

Positive urine bilirubin, absent urobilinogen

Back 739

obstructive jaundice

Front 740

Positive urine bilirubin + increased urobilinogen

Back 740

hepatitis

Front 741

Negative urine bilirubin + increased urobilinogen

Back 741

extravascular hemolytic anemia

Front 742

Markers of severity of liver disease

Back 742

albumin, PT

Front 743

Hepatitis A

Back 743

protective antibodies; day care centers, jails, homosexuals, traveling; not chronic

Front 744

Hepatitis B

Back 744

protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma

Front 745

Hepatitis C

Back 745

no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma

Front 746

Hepatitis D

Back 746

no protective antibodies; requires HBsAg to replicate

Front 747

Anti-HBs alone

Back 747

vaccination

Front 748

Anti-HBs + anti-HBc-IgG

Back 748

recovered from HBV

Front 749

HBsAg + HBeAg + HBVDNA + anti-HBc-IgM

Back 749

acute HBV/chronic HBV infective carrier if >6 months

Front 750

Anti HBc-IgM alone

Back 750

serologic gap; not infective

Front 751

HBsAg + anti-HBc-IgM

Back 751

chronic HBV healthy carrier

Front 752

Fulminant hepatic failure

Back 752

viral hepatitis and acetaminophen MCCs

Front 753

Spontaneous peritonitis

Back 753

E. coli in adults; S. pneumoniae in children; complication of ascites

Front 754

Granulomatous hepatitis

Back 754

TB MC bacteria

Front 755

Amebiasis

Back 755

Entamoeba histolytica; flash shaped ulcers in cecum; liver abscess; Rx

Front 756

Echinococcosis

Back 756

Echinococcus granulosis; sheep dog definitive host; man intermediate host

Front 757

Schistosomiasis

Back 757

Schistosoma mansoni; adult worms in portal vein; “pipe stem cirrhosis”

Front 758

Clonorchiasis

Back 758

Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma

Front 759

Congestive hepatomegaly (centrilobular necrosis)

Back 759

“nutmeg” liver; RHF MCC

Front 760

Hepatic vein thrombosis

Back 760

Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension

Front 761

Portal vein thrombosis

Back 761

ascites, portal hypertension, no hepatomegaly

Front 762

Alcohol related disorders

Back 762

fatty change; alcoholic hepatitis; cirrhosis

Front 763

Hypertriglyceridemia in alcoholics

Back 763

↑ synthesis of glycerol 3P (substrate for TG synthesis)

Front 764

Hypoglycemia in alcoholics

Back 764

↓ gluconeogenesis (↑ NADH causes pyruvate to convert to lactate)

Front 765

Ketoacidosis in alcoholics

Back 765

↑ lactate, ↑ ßOHB (acetyl CoA converted to AcAc and then ßOHB)

Front 766

Primary biliary cirrhosis

Back 766

granulomatous destruction triad bile ducts; anti-mitochondrial antibody

Front 767

Primary sclerosing cholangitis

Back 767

association with ulcerative colitis; MCC of cholangiocarcinoma

Front 768

Extrahepatic biliary atresia

Back 768

neonatal cholestasis

Front 769

Drugs causing hepatitis

Back 769

acetaminophen, isoniazid, halothane

Front 770

Anabolic steroids

Back 770

intrahepatic cholestasis

Front 771

Estrogen/oral contraceptives

Back 771

intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)

Front 772

Methotrexate

Back 772

liver fibrosis, fatty change

Front 773

Liver angiosarcoma

Back 773

vinyl chloride

Front 774

Hemochromatosis

Back 774

AR; increased iron reabsorption; liver target organ

Front 775

S/S

Back 775

cirrhosis; “bronze diabetes” - skin pigmentation + destruction of islet cells; malabsorption

Front 776

Lab

Back 776

↑ serum ferritin, iron, % saturation; ↓ TIBC

Front 777

Wilson’s disease

Back 777

AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin

Front 778

S/S

Back 778

cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet’s membrane)

Front 779

Lab

Back 779

↓ ceruloplasmin (causes ↓ total copper); ↑ serum/urine free copper

Front 780

HELLP syndrome

Back 780

pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets

Front 781

AAT deficiency in child

Back 781

AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma

Front 782

Reye syndrome

Back 782

coma and microvesicular fatty change post viral infection; increased ammonia

Front 783

Cirrhosis

Back 783

irreversible fibrosis; regenerative nodules; portal hypertension

Front 784

Causes cirrhosis

Back 784

alcohol (MC), HBV/HCV, hemochromatosis, Wilson’s, AAT deficiency, 1° biliary

Front 785

Hepatic encephalopathy

Back 785

mental status changes; ↑ serum ammonia

Front 786

Portal hypertension

Back 786

ascites; varices; splenomegaly; hemorrhoids; caput medusae

Front 787

Cause of ascites

Back 787

portal hypertension; hypoalbuminemia; secondary aldosteronism

Front 788

Rx

Back 788

use aldosterone blocker (acidosis increases loss ammonium in stool)

Front 789

Hyperestrinism in men

Back 789

gynecomastia; spider angiomas; female hair distribution

Front 790

Lab findings cirrhosis

Back 790

↓ BUN, glucose, sodium, potassium, calcium (↓ vitamin D); ↑ PT

Front 791

Liver cell adenoma

Back 791

estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage

Front 792

Liver cancer

Back 792

metastasis MC cancer; lung cancer MC primary site

Front 793

Hepatocellular carcinoma

Back 793

chronic HBV and HCV MCC; ↑ AFP; hepatic/portal vein invasion

Front 794

Cholangiocarcinoma

Back 794

primary sclerosing cholangitis MCC, C.C sinensis

Front 795

Pathogenesis of cholesterol stones

Back 795

bile with too much cholesterol and too little bile salts

Front 796

Black pigment stones

Back 796

sign of extravascular hemolytic anemia (spherocytosis, HbSS)

Front 797

Acute cholecystitis

Back 797

stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder

Front 798

Chronic cholecystitis

Back 798

chemical inflammation

Front 799

Gallbladder cancer

Back 799

risk factors - cholelithiasis and porcelain gallbladder

Front 800

Acute pancreatitis

Back 800

causes - alcohol and gallstones; ↑ amylase and lipase (more specific)

Front 801

S/S

Back 801

epigastric pain with radiation into back

Front 802

Sentinel loop

Back 802

localized ileus of duodenum due to acute pancreatitis

Front 803

Pancreatic pseudocyst

Back 803

abdominal mass; persistence of ↑ serum amylase >1 week

Front 804

Chronic pancreatitis

Back 804

alcohol abuse, CF; malabsorption, pain, type I diabetes

Front 805

Pancreatic cancer

Back 805

smoking MCC

Front 806

S/S

Back 806

jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau's sign); ↑ CA 19-9

Front 807

First sign tubule cell dysfunction

Back 807

inability to concentrate urine

Front 808

Fixed specific gravity

Back 808

chronic renal failure; cannot concentrate or dilute urine

Front 809

Negative urine bilirubin + trace urobilinogen

Back 809

normal urine

Front 810

Positive urine bilirubin, absent urobilinogen

Back 810

obstructive jaundice

Front 811

Positive urine bilirubin + increased urobilinogen

Back 811

hepatitis

Front 812

Negative urine bilirubin + increased urobilinogen

Back 812

extravascular hemolytic anemia

Front 813

Positive urine nitrite + positive urine leukocyte esterase

Back 813

urinary tract infection

Front 814

Sterile pyuria

Back 814

positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis

Front 815

Prerenal azotemia

Back 815

↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)

Front 816

Renal azotemia

Back 816

↑ BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)

Front 817

Postrenal azotemia

Back 817

↑ BUN and creatinine due to obstruction to urine flow

Front 818

Serum BUN:creatinine ratio

Back 818

<15:1 (renal failure); >15:1 (prerenal or postrenal azotemia)

Front 819

BUN 80 mg/dL:creatinine 8 mg/dL

Back 819

ratio 10/1 - renal failure

Front 820

BUN 80 mg/dL:creatinine 2 mg/dL

Back 820

ratio 40/1 - prerenal azotemia or postrenal azotemia

Front 821

Creatinine clearance

Back 821

measures GFR

Front 822

Proteinuria

Back 822

important sign of renal dysfunction

Front 823

RBC casts

Back 823

nephritic type of glomerulonephritis

Front 824

WBC casts

Back 824

acute pyelonephritis, acute tubulointerstitial nephritis

Front 825

Fatty casts with Maltese crosses

Back 825

nephrotic syndrome

Front 826

Hyaline casts

Back 826

normal unless associated with proteinuria

Front 827

Renal tubular cell casts

Back 827

acute tubular necrosis

Front 828

Waxy or broad casts

Back 828

chronic renal failure

Front 829

Cystinuria

Back 829

hexagonal crystals

Front 830

Horseshoe kidney

Back 830

Turner’s syndrome; lower poles fused

Front 831

Renal dysplasia

Back 831

MC childhood cystic disease; abnormal development; flank mass

Front 832

Maternal oligohydramnios

Back 832

fetal juvenile polycystic kidney disease; Potter’s facies in newborn

Front 833

Adult polycystic kidney disease

Back 833

AD; hypertension MC sign; cerebral berry aneurysms

Front 834

Visceral epithelial cells

Back 834

synthesize basement membrane

Front 835

Glomerular BM

Back 835

negative charge due to heparan sulfate

Front 836

Nephritic syndrome

Back 836

oliguria; RBC casts; hypertension; mild to moderate proteinuria

Front 837

Nephrotic syndrome

Back 837

proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes

Front 838

Immunofluorescence

Back 838

linear (anti-glomerular BM antibodies); granular (IC deposition)

Front 839

IgA GN

Back 839

MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits

Front 840

Post-streptococcal GN

Back 840

nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B

Front 841

SLE type IV GN

Back 841

nephritic; subendothelial deposits; anti-DNA antibodies

Front 842

Crescentic GN

Back 842

crescents from parietal cell proliferation; worst GN; Goodpasture’s, Wegener’s

Front 843

Goodpasture’s

Back 843

nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN

Front 844

S/S

Back 844

young male with hemoptysis progressing to renal failure

Front 845

Minimal change disease (lipoid nephrosis)

Back 845

MCC childhood nephrotic syndrome

Front 846

Lipoid nephrosis

Back 846

podocyte fusion; loss of negative charge in glomerular BM

Front 847

Focal segmental glomerulosclerosis

Back 847

nephrotic syndrome; AIDS and IV heroin abuse

Front 848

Membranous GN

Back 848

MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes

Front 849

Causes membranous GN

Back 849

HBV, ACE inhibitors, cancer

Front 850

Type I MPGN

Back 850

nephrotic; subepithelial deposits; HCV association; tram tracks

Front 851

Type II MPGN

Back 851

nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)

Front 852

DM nodular glomerulosclerosis

Back 852

microalbuminuria first sign

Front 853

DM glomerulosclerosis

Back 853

nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles

Front 854

ACE inhibitors

Back 854

inhibit angiotensin II vasoconstriction of efferent arterioles

Front 855

Alport’s syndrome

Back 855

XD hereditary nephritis with sensorineural hearing loss

Front 856

Ischemic ATN

Back 856

prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1

Front 857

Ischemic ATN

Back 857

disruption of BM in proximal tubule and thick ascending limb

Front 858

Nephrotoxic ATN

Back 858

aminoglycosides, IVP dye, Pb/mercury poisoning

Front 859

Nephrotoxic ATN

Back 859

proximal tubule dysfunction; intact BM

Front 860

Oliguria

Back 860

prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia

Front 861

Acute pyelonephritis

Back 861

vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain

Front 862

Chronic pyelonephritis

Back 862

U-shaped scars overlying blunt calyces

Front 863

Drug-induced tubulointerstitial nephritis

Back 863

type I/IV reaction; e.g., penicillin

Front 864

S/S

Back 864

ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts

Front 865

Analgesic nephropathy

Back 865

aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect

Front 866

Myeloma kidney

Back 866

BJ protein produces foreign body reaction in tubules

Front 867

Urate nephropathy

Back 867

prevent by giving allopurinol prior to chemotherapy

Front 868

CRF

Back 868

fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts

Front 869

Renal osteodystrophy CRF

Back 869

hypovitaminosis D (no 1-α-hydroxylase); produces osteomalacia

Front 870

Renal osteodystrophy CRF

Back 870

osteoporosis from metabolic acidosis

Front 871

Renal osteodystrophy CRF

Back 871

secondary HPTH with increased osteoclastic activity

Front 872

S/S CRF

Back 872

pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures

Front 873

Benign nephrosclerosis

Back 873

kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis

Front 874

Malignant hypertension

Back 874

renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside

Front 875

Renal findings

Back 875

necrotizing arteriolitis; “flea bitten” kidney; hyperplastic arteriolosclerosis

Front 876

Renal infarction

Back 876

pale infarcts; hematuria; common in polyarteritis nodosa

Front 877

Hydronephrosis

Back 877

renal stone MCC; atrophy of cortex/medulla; postrenal azotemia

Front 878

Renal stones

Back 878

most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor

Front 879

S/S

Back 879

colicky pain radiating into groin, hematuria; x-ray usually shows stone

Front 880

Staghorn calculus

Back 880

due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell

Front 881

Angiomyolipoma

Back 881

hamartoma; associated with tuberous sclerosis

Front 882

Renal cell carcinoma

Back 882

smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored

Front 883

S/S

Back 883

flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele

Front 884

Renal pelvis transitional cell carcinoma

Back 884

smoking MCC, phenacetin, aniline dyes, cyclophosphamide

Front 885

Wilm’s tumor

Back 885

hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types

Front 886

Urine draining from umbilicus

Back 886

persistent urachus

Front 887

Retroperitoneal fibrosis

Back 887

produces hydronephrosis

Front 888

Bladder extrophy

Back 888

abdominal wall defect + epispadias

Front 889

Bladder diverticula

Back 889

most commonly due to prostatic hyperplasia with urethral obstruction

Front 890

Acute cystitis

Back 890

E. coli; females > males; no fever, flank pain, or WBC casts

Front 891

Bladder transitional cell carcinoma

Back 891

smoking MCC, aniline dyes, cyclophosphamide; papillary

Front 892

S/S

Back 892

hematuria; hydronephrosis

Front 893

Bladder adenocarcinoma

Back 893

risk factors persistent urachus, extrophy

Front 894

Bladder squamous cell carcinoma

Back 894

Schistosoma hematobium infection

Front 895

Hypospadias

Back 895

ventral opening on penis due to failure closure of urethral folds

Front 896

Epispadias

Back 896

dorsal opening on penis due to defect in genital tubercle

Front 897

Peyronie’s disease

Back 897

painful curvature penis due to fibromatosis

Front 898

Priapism

Back 898

persistent/painful erection; HbSS

Front 899

Squamous cell carcinoma penis

Back 899

HPV and lack of circumcision most important risk factors

Front 900

Cryptorchidism

Back 900

undescended testis; risk for seminoma applies to cryptorchid testis and normal testis

Front 901

Orchitis

Back 901

mumps usually unilateral (infertility uncommon)

Front 902

Epididymitis

Back 902

<35 - N. gonorrhoeae, C. trachomatis; >35 - E. coli, P. aeruginosa

Front 903

S/S

Back 903

scrotal pain relieved by elevation of scrotum (Prehn’s sign)

Front 904

Varicocele

Back 904

left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common

Front 905

Varicocele

Back 905

may be due to invasion of left renal vein by renal cell carcinoma

Front 906

Hydrocele

Back 906

persistent tunica vaginalis; scrotum transilluminates

Front 907

Torsion of testicle

Back 907

testicle high in canal; absent cremasteric reflex

Front 908

Testicular cancer

Back 908

unilateral painless mass that does not transilluminate

Front 909

Risk factors

Back 909

cryptorchid testis, Klinefelter’s, testicular feminization

Front 910

Seminoma

Back 910

MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ↑hCG

Front 911

Spermatocytic variant

Back 911

>65 yrs of age

Front 912

Embryonal carcinoma

Back 912

hemorrhage/necrosis; hematogenous spread before lymphatic; ↑AFP, hCG

Front 913

Yolk sac tumor

Back 913

MC testicular cancer in boys; ↑AFP

Front 914

Choriocarcinoma

Back 914

most aggressive testicle cancer; ↑hCG

Front 915

Teratoma

Back 915

more often benign in children than adult

Front 916

Teratocarcinoma

Back 916

teratoma + embryonal carcinoma

Front 917

Malignant lymphoma

Back 917

MC type in elderly; metastasis not primary cancer

Front 918

Prostate

Back 918

DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer

Front 919

Prostatitis

Back 919

perineal pain, fever; WBCs at end of voiding

Front 920

Benign prostatic hyperplasia

Back 920

DHT/estrogen-mediated; glandular/smooth muscle hyperplasia

Front 921

S/S

Back 921

all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx

Front 922

Prostate cancer

Back 922

DHT-mediated; palpable with rectal exam; osteoblastic metastasis (↑ AP)

Front 923

PSA

Back 923

sensitive but not specific for prostate cancer; ↑ in hyperplasia

Front 924

Kallmann’s syndrome

Back 924

absent GnRH, anosmia, absence of taste

Front 925

Impotence

Back 925

failure to sustain an erection; psychogenic in most cases (erections present at night)

Front 926

Erection

Back 926

parasympathetic response

Front 927

Ejaculation

Back 927

sympathetic response

Front 928

Leydig cell failure

Back 928

↑ LH; ↓ testosterone, sperm count; normal FSH

Front 929

Seminiferous tubule failure

Back 929

↑ FSH (↓inhibin); ↓ sperm count; normal LH and testosterone

Front 930

Leydig and seminiferous tubule failure

Back 930

↑ FSH and LH; ↓ testosterone and sperm count

Front 931

Y chromosome

Back 931

determines genetic sex

Front 932

Testosterone

Back 932

develops seminal vesicles, epididymis, vas deferens

Front 933

Dihydrotestosterone (DHT)

Back 933

develops prostate and male external genitalia

Front 934

Male pseudohermaphrodite

Back 934

genetic male; phenotypically female

Front 935

Testicular feminization

Back 935

XR; deficient androgen receptors; MCC male pseudohermaphrodite

Front 936

Klinefelter’s syndrome

Back 936

XXY; 1 Barr body; female secondary sex characteristics

Front 937

Herpes genitalis

Back 937

recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions

Front 938

Human papilloma virus

Back 938

condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo)

Front 939

Chlamydia trachomatis

Back 939

metaplastic squamous cells with vacuoles containing elementary bodies

Front 940

S/S

Back 940

non-specific urethritis, cervicitis, PID, ophthalmia neonatorum

Front 941

Neisseria gonorhoeae

Back 941

urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus

Front 942

Ophthalmia neonatorum first week

Back 942

N gonorrhoeae

Front 943

Ophthalmia neonatorum second week

Back 943

C. trachomatis

Front 944

Lymphogranuloma venereum

Back 944

C. trachomatis subtype

Front 945

S/S

Back 945

scrotal/vulva lymphedema; granulomatous microabscesses; rectal strictures in females

Front 946

Chancroid

Back 946

painful ulcer, adenopathy, Hemophilus ducreyi

Front 947

Granuloma inguinale

Back 947

Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy

Front 948

Treponema pallidum

Back 948

spirochete; produces vasculitis of arterioles (plasma cell infiltrate)

Front 949

Primary syphilis

Back 949

painless chancre

Front 950

Secondary syphilis

Back 950

rash on palms/soles; condyloma lata; generalized adenopathy

Front 951

Tertiary syphilis

Back 951

neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas

Front 952

RPR/VDRL

Back 952

reagin antibodies against cardiolipin; ↓ titer with Rx of syphilis

Front 953

RPR/VDRL

Back 953

false positive with anticardiolipin antibodies (common in SLE)

Front 954

FTA-ABS

Back 954

confirmatory test for syphilis; not distinguish active from treated disease

Front 955

FTA-ABS

Back 955

remains positive after Rx

Front 956

Trichomonas vaginalis

Back 956

flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners

Front 957

Gardnerella vaginalis

Back 957

vaginal pH >5; bacterial vaginosis; clue cells; Rx metronidazole

Front 958

Candida vaginitis

Back 958

white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole

Front 959

Vulvar squamous cancer

Back 959

MC vulvar cancer; HPV association

Front 960

Vulvar leukoplakia

Back 960

biopsy to R/O squamous dysplasia/cancer

Front 961

Lichen sclerosis vulva

Back 961

epidermal atrophy; slight risk for squamous cancer

Front 962

Squamous hyperplasia vulva

Back 962

leukoplakia; no cancer risk

Front 963

Paget’s disease

Back 963

intraepithelial adenocarcinoma (mucin production) of vulva

Front 964

Malignant melanoma

Back 964

vulva location; similar to Paget cells but not mucin positive

Front 965

Gartner’s duct cyst

Back 965

lateral wall vagina; persistent mesonephric duct

Front 966

Embryonal rhabdomyosarcoma

Back 966

bloody, grape-like vaginal mass young girl

Front 967

Vaginal adenosis

Back 967

maternal exposure to DES; precursor clear cell adenocarcinoma vagina

Front 968

Vaginal squamous cancer

Back 968

usually extension of cervical cancer

Front 969

Rokitansky-Kiister-Hauser

Back 969

absence of vagina and uterus

Front 970

Nabothian cysts

Back 970

endocervical glands covered by metaplastic squamous epithelium

Front 971

Pathologic cervicitis

Back 971

trichomonas, HSV-2, C. trachomatis (follicular cervicitis)

Front 972

Cervical Pap

Back 972

superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone)

Front 973

Normal

Back 973

70% superficial, 30% intermediate

Front 974

Atrophic

Back 974

100% parabasal cells

Front 975

Hyperestrinism

Back 975

100% superficial cells

Front 976

Pregnancy

Back 976

100% intermediate cells

Front 977

Endocervical cells

Back 977

sign of adequately performed Pap smear

Front 978

Cervical polyp

Back 978

bleeding after intercourse; non-neoplastic

Front 979

Cervical dysplasia

Back 979

begins in transformation zone; associated with low and high risk HPV

Front 980

Risk factors cervical dysplasia/cancer

Back 980

early onset sexual activity; multiple partners; smoking; OC

Front 981

CIN

Back 981

cervical intraepithelial dysplasia; mild, moderate, severe (in-situ)

Front 982

Cervical cancer

Back 982

↓ incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters

Front 983

S/S

Back 983

cervical discharge; bleeding after intercourse

Front 984

Sequence to menarche

Back 984

breast budding, growth spurt, pubic hair, axillary hair, menarche

Front 985

Proliferative phase cycle

Back 985

estrogen-dependent; ↑estrogen inhibits FSH and stimulates LH

Front 986

Ovulation

Back 986

day 14-I6; LH surge; subnuclear vacuoles; ↑body temperature

Front 987

Secretory phase cycle

Back 987

progesterone-dependent

Front 988

Menses

Back 988

drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting

Front 989

FSH

Back 989

stimulates follicle and aromatase synthesis in granulosa cells

Front 990

LH

Back 990

stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase

Front 991

Day 21

Back 991

day of implantation of fertilized egg

Front 992

Pregnancy

Back 992

↑plasma volume > RBC mass; ↑GFR; ↑thyroxine/cortisol (increased binding proteins)

Front 993

hCG

Back 993

LH analogue produced by syncytiotrophoblast

Front 994

hCG

Back 994

stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks

Front 995

Estrone

Back 995

estrogen of postmenopausal woman; aromatization of adrenal androstenedione

Front 996

Estradiol

Back 996

estrogen of non-pregnant woman in reproductive life; aromatization of testosterone

Front 997

Estriol

Back 997

estrogen of pregnancy

Front 998

Menopause

Back 998

↑ FSH (best screen; due to ↓estrogen), ↑LH

Front 999

S/S

Back 999

secondary amenorrhea, hot flushes

Front 1000

Hirsutism

Back 1000

↑ hair in normal areas

Front 1001

Virilization

Back 1001

hirsutism + male secondary sex characteristics (clitoromegaly)

Front 1002

Test for hirsutism/virilization

Back 1002

↑ testosterone - ovarian source; ↑DHEA-sulfate - adrenal source

Front 1003

Polycystic ovarian syndrome (POS)

Back 1003

↑ LH; ↓ FSH; ↑ estrogen and androgens

Front 1004

S/S

Back 1004

hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH >2:1

Front 1005

Menorrhagia

Back 1005

excess menstrual flow; MCC iron deficiency in women

Front 1006

Dysmenorrhea

Back 1006

painful menses; 1° PGF2α, 2° endometriosis

Front 1007

DUB

Back 1007

bleeding related to hormone rather than anatomic causes

Front 1008

Anovulatory DUB

Back 1008

menarche and perimenopause; estrogen excess without progesterone

Front 1009

Ovulatory DUB

Back 1009

irregular shedding, inadequate luteal phase

Front 1010

Primary amenorrhea

Back 1010

no menses by 16 years old

Front 1011

Secondary amenorrhea

Back 1011

no menses for 3 months

Front 1012

Amenorrhea-hypothalamic/pituitary dysfunction

Back 1012

↓ FSH/LH; e.g., hypopituitarism

Front 1013

Amenorrhea-ovarian dysfunction

Back 1013

↑FSH/LH; e.g., Turner’s syndrome

Front 1014

Amenorrhea-end-organ disease

Back 1014

normal FSH/LH; e.g., imperforate hymen

Front 1015

Asherman syndrome

Back 1015

surgical removal of stratum basalis

Front 1016

Primary amenorrhea-normal secondary sex characteristics

Back 1016

constitutional delay MCC

Front 1017

Primary amenorrhea-lack secondary sex characteristics

Back 1017

Turner’s

Front 1018

Turner’s syndrome

Back 1018

XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs)

Front 1019

S/S

Back 1019

newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; 1° amenorrhea

Front 1020

Secondary amenorrhea

Back 1020

pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma

Front 1021

Asherman syndrome

Back 1021

removal of stratum basalis causing scarring; secondary amenorrhea

Front 1022

Endometritis

Back 1022

group B streptococcus; intrauterine device (Actinomyces); chronic - plasma cells

Front 1023

Endometrial polyp

Back 1023

menorrhagia; not a precursor for endometrial cancer

Front 1024

Adenomyosis

Back 1024

functioning endometrial glands and stroma in myometrium; enlarged uterus

Front 1025

Endometriosis

Back 1025

functioning glands and stroma outside uterus; reverse menses; ovary MC site

Front 1026

S/S

Back 1026

dysmenorrhea, painful stooling, bowel obstruction; “powder burn” appearance

Front 1027

Endometrial hyperplasia

Back 1027

unopposed estrogen; simple/complex types; precursor endometrial cancer

Front 1028

Causes

Back 1028

obesity, estrogen Rx, polycystic ovarian syndrome

Front 1029

Endometrial cancer

Back 1029

obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective

Front 1030

S/S

Back 1030

bleeding in postmenopausal woman

Front 1031

Leiomyoma uterus

Back 1031

menorrhagia, obstructive delivery; not a precursor for leiomyosarcoma

Front 1032

Leiomyosarcoma

Back 1032

MC sarcoma

Front 1033

Ectopic pregnancy

Back 1033

PID MC risk factor; intraperitoneal hemorrhage; screen with ß-hCG

Front 1034

Follicular cyst

Back 1034

MC ovarian mass in young woman

Front 1035

Risk factors ovarian tumors

Back 1035

nulliparity and genetic factors; OC protective

Front 1036

Serous ovarian tumors

Back 1036

surface-derived; ↑ bilaterality; psammoma bodies in malignant type

Front 1037

Mucinous ovarian tumors

Back 1037

surface-derived; pseudomyxoma peritonei in malignant type

Front 1038

Endometrioid carcinoma

Back 1038

resembles endometrial cancer; association with endometriosis

Front 1039

Cystic teratoma

Back 1039

MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications

Front 1040

Dysgerminoma

Back 1040

MC malignant germ cell tumor; associated with streak gonads of Turners

Front 1041

Yolk sac tumor

Back 1041

MC germ cell tumor young girl; ↑AFP; Schiller-Duval bodies

Front 1042

Meigs syndrome

Back 1042

ovarian fibroma, ascites, right-sided pleural effusion

Front 1043

Granulosa tumor

Back 1043

low grade malignant; hyperestrinism, Call Exner bodies

Front 1044

Thecoma

Back 1044

benign; yellow color; hyperestrinism

Front 1045

Leydig cell and Sertoli cell tumors

Back 1045

hyperandrogenism

Front 1046

Gonadoblastoma

Back 1046

XY phenotype of Turner’s

Front 1047

Krukenberg tumors

Back 1047

metastatic stomach cancer; signet ring cells

Front 1048

Single umbilical artery

Back 1048

↑ incidence congenital defects

Front 1049

Syncytiotrophoblast

Back 1049

lining of villi; produces hCG and human placental lactogen

Front 1050

Human placental lactogen

Back 1050

responsible for mild glucose intolerance in pregnancy

Front 1051

Abruptio placenta

Back 1051

retroplacental clot; painful bleeding; hypertension, cocaine, smoking

Front 1052

Placenta previa

Back 1052

placenta implanted over cervical os; painless bleeding

Front 1053

Placenta accreta

Back 1053

direct implantation into myometrium without intervening decidua; hysterectomy

Front 1054

Twin placenta

Back 1054

monochorionic always identical twins; dichorionic may be identical or fraternal

Front 1055

Siamese twins

Back 1055

monoamniotic monochorionic twin placenta

Front 1056

Enlarged placenta

Back 1056

DM, Rh HDN, syphilis

Front 1057

Complete mole

Back 1057

benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male)

Front 1058

S/S

Back 1058

preeclampsia in first trimester; ↑ incidence choriocarcinoma

Front 1059

Partial mole

Back 1059

embryo present; 68 XXY; no transformation into choriocarcinoma

Front 1060

Choriocarcinoma

Back 1060

malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast)

Front 1061

Risk factors

Back 1061

complete mole (MC), spontaneous abortion, normal pregnancy

Front 1062

S/S

Back 1062

↑hCG; lung metastasis; good prognosis

Front 1063

Chorioamnionitis

Back 1063

group B streptococcus (S. agalactiae) infection

Front 1064

Preeclampsia

Back 1064

abnormal placentation causing placental ischemia; ↑ in vasoconstrictors (ATII)

Front 1065

S/S

Back 1065

hypertension, proteinuria, pitting edema; begins in third trimester

Front 1066

Spontaneous abortion

Back 1066

50% have karyotype deformity (trisomy 16)

Front 1067

Amniotic fluid

Back 1067

fetal urine

Front 1068

Polyhydramnios

Back 1068

TE fistula, duodenal atresia, open neural tube defects

Front 1069

Oligohydramnios

Back 1069

infantile polycystic disease

Front 1070

↑ Serum AFP

Back 1070

open neural tube defect

Front 1071

↓ Serum AFP

Back 1071

Down syndrome

Front 1072

Urine estriol

Back 1072

fetal adrenal, placental, maternal liver involved in its production

Front 1073

Down syndrome triad

Back 1073

↑ ß-hCG, ↓ serum AFP, ↓ urine estriol

Front 1074

Fibrocystic change

Back 1074

MC breast mass <50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts

Front 1075

Sclerosing adenosis

Back 1075

component of FCC; involves terminal lobules often has microcalcifications

Front 1076

Fibroadenoma

Back 1076

benign stromal tumor; MC movable mass in women <35-yrs-old

Front 1077

Intraductal papilloma

Back 1077

benign tumor lactiferous duct/sinus; MCC bloody nipple discharge <50-yr-old

Front 1078

Invasive ductal cancer

Back 1078

MCC breast mass in woman >50-yrs-old

Front 1079

Breast cancer risk

Back 1079

unopposed estrogen; family history first-degree relatives

Front 1080

Breast cancer

Back 1080

painless mass upper outer quadrant in woman >50-yrs-old

Front 1081

Mammography

Back 1081

screening test to detect non-palpable masses

Front 1082

Palpable breast mass

Back 1082

order fine needle aspiration (not a mammogram)

Front 1083

Ductal carcinoma in situ

Back 1083

necrotic centers (comedo); microcalcifications common

Front 1084

Paget’s disease of breast

Back 1084

invasive ductal cancer into nipple; Paget’s cells similar to vulvar Paget’s

Front 1085

Medullary carcinoma

Back 1085

bulky tumor with large cells and lymphoid infiltrate; more common in Pt with BRCA 1 mutation

Front 1086

Inflammatory carcinoma

Back 1086

orange peel appearance; lymphatics blocked by tumor (lymphedema)

Front 1087

Lobular cancer

Back 1087

MC cancer of terminal lobule; ↑ bilaterality

Front 1088

Phyllodes tumor

Back 1088

low grade malignant tumor of stroma

Front 1089

ER-PR positive tumors

Back 1089

tumors responding to hormones; candidate for tamoxifen (anti-estrogen)

Front 1090

ERB-B2 oncogene positive breast cancer

Back 1090

aggressive breast cancer

Front 1091

Gynecomastia

Back 1091

estrogen stimulation of male breast

Front 1092

Gynecomastia

Back 1092

normal in newborn, puberty (no surgery), old age; (micronodular) cirrhosis MC pathologic cause

Front 1093

Overactive endocrine syndrome

Back 1093

most often adenomas; use suppression tests (most do not suppress)

Front 1094

Tumors that suppress

Back 1094

prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)

Front 1095

Underactive endocrine syndrome

Back 1095

autoimmune destruction MCC; stimulation tests

Front 1096

Hypopituitarism adults

Back 1096

non-functioning adenoma MCC, Sheehan’s postpartum necrosis (stop lactation)

Front 1097

Hypopituitarism in children

Back 1097

craniopharyngioma (Rathke’s pouch remnant) MCC; visual field defects

Front 1098

S/S ↓ FSH and LH

Back 1098

amenorrhea, ↓ testosterone in male

Front 1099

Growth hormone functions

Back 1099

muscle growth, gluconeogenesis; release of insulin growth factor (IGF)

Front 1100

IGF

Back 1100

synthesized in liver; bone and cartilage growth

Front 1101

S/S ↓ GH/IGF in children

Back 1101

growth retardation; ↓ height and weight

Front 1102

Sleep and arginine infusion

Back 1102

stimulation tests for GH and IGF

Front 1103

S/S ↓ GH/IGF in adults

Back 1103

hypoglycemia

Front 1104

S/S ↓ TSH

Back 1104

secondary hypothyroidism; ↓ T4, ↓ TSH; muscle weakness, dry skin

Front 1105

S/S ↓ ACTH

Back 1105

secondary hypocortisolism; ↓ cortisol, ↓ ACTH; fatigue; hypoglycemia

Front 1106

Metyrapone

Back 1106

stimulation test for ACTH reserve

Front 1107

Metyrapone

Back 1107

blocks adrenal 11-hydroxylase → ↑ ACTH and 11-deoxycortisol (proximal to block)

Front 1108

Metyrapone test ↓ ACTH and 11-deoxycortisol

Back 1108

pituitary/hypothalamic dysfunction

Front 1109

Metyrapone test ↑ ACTH and 11-deoxycortisol

Back 1109

Addison's disease

Front 1110

Diabetes insipidus

Back 1110

loss ADH (central), refractory to ADH (nephrogenic); always diluting urine

Front 1111

Central diabetes insipidus (CDI)

Back 1111

↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm > 50%

Front 1112

Causes CDI

Back 1112

pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)

Front 1113

Nephrogenic diabetes insipidus (NDI)

Back 1113

↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm < 50%

Front 1114

Causes NDI

Back 1114

lithium, demeclocycline, nephrocalcinosis, severe hypokalemia

Front 1115

Gigantism

Back 1115

GH secreting pituitary adenoma before epiphyses have fused

Front 1116

Acromegaly

Back 1116

GH secreting pituitary adenoma after epiphyses have fused

Front 1117

S/S acromegaly

Back 1117

cardiomyopathy; large hands, feet, jaw; hyperglycemia

Front 1118

Prolactin

Back 1118

inhibited by dopamine

Front 1119

Prolactinoma

Back 1119

MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH

Front 1120

Rx

Back 1120

surgery or bromocriptine (dopamine analog)

Front 1121

Other causes hyperprolactinemia

Back 1121

primary hypothyroidism, drugs

Front 1122

Inappropriate ADH syndrome

Back 1122

hyponatremia <120 mEq/L; ↑ UOsm (always concentrating urine)

Front 1123

Causes

Back 1123

small cell carcinoma lung, CNS injury, chlorpropamide

Front 1124

Rx

Back 1124

restrict water; demeclocycline in small cell carcinoma

Front 1125

Serum T4

Back 1125

↑ or ↓ in free hormone or thyroid binding globulin (TBG)

Front 1126

↑ Serum T4 and normal TSH

Back 1126

↑ TBG; due to ↑ in estrogen

Front 1127

↑ Serum T4 and ↓ TSH

Back 1127

thyrotoxicosis

Front 1128

↓ Serum T4 and normal TSH

Back 1128

↓ TBG; due to anabolic steroids

Front 1129

↓ Serum T4 and ↑ TSH

Back 1129

primary hypothyroidism

Front 1130

↓ Serum T4 and ↓ TSH

Back 1130

secondary hypothyroidism

Front 1131

TSH

Back 1131

negative feedback with T4 and T3; best screening test

Front 1132

I131 uptake

Back 1132

↑ in Graves; ↓ in thyroiditis, patient taking excess thyroid, hypothyroidism

Front 1133

Cold nodule

Back 1133

non-functioning nodule; no uptake I131

Front 1134

Hot nodule

Back 1134

functioning nodule; ↑ uptake I131

Front 1135

Thyroglossal duct cyst

Back 1135

midline cystic mass

Front 1136

Branchial cleft cyst

Back 1136

cyst in anterolateral neck

Front 1137

Acute/subacute thyroiditis

Back 1137

painful thyroid; early thyrotoxicosis; ↓ I131 uptake

Front 1138

Hashimoto’s thyroiditis

Back 1138

MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody

Front 1139

Hashimoto’s thyroiditis

Back 1139

↑ anti microsomal and thyroglobulin antibodies

Front 1140

S/S

Back 1140

muscle weakness, periorbital puffiness, ↓ reflexes, diastolic hypertension, constipation, dry skin

Front 1141

Lab

Back 1141

↓ T4, ↑ TSH

Front 1142

Cretinism

Back 1142

maternal hypothyroidism before fetal thyroid developed, genetic disorder

Front 1143

S/S

Back 1143

mental retardation; short stature and increased weight; coarse skin

Front 1144

Thyrotoxicosis

Back 1144

any cause ↑ thyroid hormone activity; Graves disease, excess hormone, thyroiditis

Front 1145

Hyperthyroidism

Back 1145

↑ synthesis thyroid hormone; Graves disease and toxic nodular goiter

Front 1146

Graves disease

Back 1146

autoantibody against TSH receptor (type II reaction); HLA Dr3

Front 1147

S/S unique to Graves

Back 1147

exophthalmos, pretibial myxedema

Front 1148

S/S thyrotoxicosis

Back 1148

tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes

Front 1149

Lab thyrotoxicosis

Back 1149

↑ T4, ↓ TSH, ↑ glucose, ↑ calcium

Front 1150

I131 uptake

Back 1150

↑ Graves, toxic nodular goiter; ↓ thyroiditis, excess hormone, hypothyroidism

Front 1151

Rx Graves disease

Back 1151

ß-blocker; drug to decrease hormone synthesis (propylthiouracil)

Front 1152

Toxic nodular goiter

Back 1152

hyperthyroidism; develops out of a multinodular goiter; no exophthalmos

Front 1153

Goiter

Back 1153

enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency

Front 1154

S/S

Back 1154

rapid enlargement due to hemorrhage into cyst; Rx thyroxine

Front 1155

Solitary thyroid nodule woman

Back 1155

most often benign (cyst)

Front 1156

Solitary thyroid nodule man or child

Back 1156

often malignant

Front 1157

Papillary carcinoma thyroid

Back 1157

MC thyroid cancer; radiation exposure; psammoma bodies

Front 1158

Follicular carcinoma thyroid

Back 1158

invades blood vessels

Front 1159

Medullary carcinoma thyroid

Back 1159

parafollicular cells; calcitonin; amyloid (calcitonin conversion)

Front 1160

MEN I syndrome

Back 1160

3 P's; pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or ß-islet cell tumor)

Front 1161

MEN IIa syndrome

Back 1161

2 P's; medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma

Front 1162

MEN IIb syndrome

Back 1162

1 P; medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas

Front 1163

Alkalotic pH

Back 1163

tetany with normal total calcium, ↓ ionized calcium and ↑ PTH

Front 1164

Hypoalbuminemia

Back 1164

↓ total calcium, normal ionized calcium and PTH

Front 1165

Tetany

Back 1165

↓ ionized calcium level; threshold potential comes closer to resting potential

Front 1166

S/S

Back 1166

thumb adducts into palm, twitching after tapping of facial nerve

Front 1167

PTH

Back 1167

maintains ionized Ca2+; ↑ Ca2+ renal reabsorption; ↓ phosphate/bicarbonate reabsorption in kidneys

Front 1168

Primary HPTH

Back 1168

↑ Ca2+, hypophosphatemia, ↑ PTH

Front 1169

Cause

Back 1169

adenoma MCC, hyperplasia, cancer

Front 1170

S/S

Back 1170

renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification

Front 1171

Secondary HPTH

Back 1171

↓ Ca2+, ↑ PTH; hypovitaminosis D from renal failure MCC

Front 1172

Malignancy-induced hypercalcemia

Back 1172

↑ Ca2+, ↓ PTH; all other non-parathyroid causes same results

Front 1173

Causes hypercalcemia

Back 1173

osteolytic lesions, sarcoidosis, ↑ vitamin D, PTH-related peptide, myeloma

Front 1174

Tertiary HPTH

Back 1174

hypercalcemia developing from secondary HPTH

Front 1175

Primary hypoparathyroidism

Back 1175

↓ Ca2+ and ↓ PTH

Front 1176

Causes

Back 1176

previous thyroid surgery, autoimmune, DiGeorge syndrome

Front 1177

S/S

Back 1177

tetany; calcification basal ganglia

Front 1178

Pseudohypoparathyroidism

Back 1178

↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH

Front 1179

Other causes ↓ Ca2+

Back 1179

hypomagnesemia (↓ PTH), ↓ vitamin D, DiGeorge

Front 1180

↓ Ca2+ and ↓ PTH

Back 1180

primary hypoparathyroidism

Front 1181

↓ Ca2+ and ↑ PTH

Back 1181

secondary hyperparathyroidism

Front 1182

↑ Ca2+ and ↑ PTH

Back 1182

primary hyperparathyroidism

Front 1183

↑ Ca2+ and ↓ PTH

Back 1183

malignancy induced hypercalcemia; other causes hypercalcemia

Front 1184

Waterhouse-Friderichsen syndrome

Back 1184

meningococcemia with bilateral adrenal hemorrhage due to DIC

Front 1185

Addison’s disease

Back 1185

autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis

Front 1186

S/S

Back 1186

hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia

Front 1187

Lab

Back 1187

↓ sodium, ↓ cortisol, ↑ potassium, ↑ ACTH

Front 1188

Adrenogenital syndrome

Back 1188

AR; enzyme deficiency; hypocortisolism; hyperpigmentation from ↑ ACTH

Front 1189

21-Hydroxylase deficiency

Back 1189

↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite

Front 1190

11-Hydroxylase deficiency

Back 1190

↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite

Front 1191

17-Hydroxylase deficiency

Back 1191

↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite

Front 1192

MCC Cushings

Back 1192

long-term corticosteroid therapy

Front 1193

Tests Cushings syndrome

Back 1193

low/high dose dexamethasone suppression; urine free cortisol (best test)

Front 1194

Normal dexamethasone suppression

Back 1194

cortisol analogue; ↓ ACTH and ↑ cortisol

Front 1195

Pituitary Cushings

Back 1195

MCC Cushing’s; ACTH secreting pituitary tumor

Front 1196

Lab

Back 1196

low dose dexamethasone not suppress cortisol; high dose suppresses

Front 1197

Adrenal Cushings

Back 1197

adrenal adenoma secreting cortisol; suppressed ACTH

Front 1198

Lab

Back 1198

no suppression with low/high dose dexamethasone

Front 1199

Ectopic Cushings

Back 1199

ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels

Front 1200

Lab

Back 1200

no suppression with low/high dose dexamethasone

Front 1201

S/S Cushings

Back 1201

purple stria, truncal obesity, hypertension, DM

Front 1202

Primary aldosteronism

Back 1202

benign adenoma in zona glomerulosa

Front 1203

S/S

Back 1203

hypertension and muscle weakness (hypokalemia), no pitting edema

Front 1204

Lab

Back 1204

hypernatremia, hypokalemia, metabolic alkalosis, ↑ urine K+ and Na+

Front 1205

Pheochromocytoma

Back 1205

benign tumor in adrenal medulla in adults

Front 1206

Associations

Back 1206

von Hippel Lindau, neurofibromatosis, MEN IIa and IIb

Front 1207

S/S

Back 1207

labile hypertension, anxiety, sweating, headache

Front 1208

Lab

Back 1208

↑ 24 hr urine for VMA and metanephrines

Front 1209

Neuroblastoma

Back 1209

malignant tumor adrenal medulla child; widespread metastasis; hypertension

Front 1210

ß-islet cell tumor (insulinoma)

Back 1210

benign tumor; hypoglycemia, ↑ insulin and C-peptide

Front 1211

Patient taking excess insulin

Back 1211

hypoglycemia, ↑ insulin, ↓ C-peptide

Front 1212

Glucagonoma

Back 1212

malignant α-islet cell tumor; hyperglycemia and rash

Front 1213

Zollinger Ellison syndrome

Back 1213

malignant islet cell tumor secreting gastrin; peptic ulcers

Front 1214

Somatostatinoma

Back 1214

malignant δ islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria

Front 1215

VIPoma

Back 1215

malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria

Front 1216

DM

Back 1216

organ damage correlates with glycemic control

Front 1217

Type 1

Back 1217

young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis

Front 1218

Type 2

Back 1218

older person; obese; relative insulin deficiency (↓ insulin receptors, postreceptor problems)

Front 1219

Type 2

Back 1219

family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma

Front 1220

↑ Non-enzymatic glycosylation

Back 1220

glucose attaches to amino acids in basement membranes

Front 1221

Non-enzymatic glycosylation

Back 1221

↑ vessel permeability producing hyaline arteriolosclerosis

Front 1222

Osmotic damage

Back 1222

glucose converted into sorbitol by aldose reductase

Front 1223

Osmotic damage

Back 1223

lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)

Front 1224

Pathogenesis hyperglycemia

Back 1224

↑ gluconeogenesis (most important), glycogenolysis

Front 1225

Pathogenesis hyperlipidemia

Back 1225

no insulin to stimulate capillary lipoprotein lipase; ↑ chylomicrons/VLDL

Front 1226

Pathogenesis ketoacidosis

Back 1226

↑ oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies

Front 1227

Most commons due to DM

Back 1227

neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation

Front 1228

Glycosylated HbA1c

Back 1228

measure of long term glycemic control (8-12 weeks)

Front 1229

Gestational DM

Back 1229

↑ placental size, human placental lactogen

Front 1230

Complications

Back 1230

macrosomia (↑ muscle/fat from insulin), RDS, newborn hypoglycemia (↑ insulin)

Front 1231

Hypoglycemia

Back 1231

insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency

Front 1232

Carnitine deficiency

Back 1232

no ß-oxidation of fatty acids; all cells compete for glucose

Front 1233

Monosodium urate crystals (MSU)

Back 1233

yellow when parallel to slow ray of compensator

Front 1234

Calcium pyrophosphate crystals (pseudogout)

Back 1234

blue when parallel to slow ray of compensator

Front 1235

Osteoarthritis

Back 1235

degeneration articular cartilage; subchondral cysts; eburnation; osteophytes at margins

Front 1236

Joints

Back 1236

weight bearing (femoral head); DIP joint (Heberden’s nodes), PIP joints (Bouchard nodes)

Front 1237

Neuropathic joint

Back 1237

2° to neurologic disease; DM, syringomyelia, tabes dorsalis

Front 1238

Erythropoietin

Back 1238

synthesized in peritubular capillaries

Front 1239

Reticulocyte count

Back 1239

measure of effective erythropoiesis; correct for degree of anemia

Front 1240

Extramedullary hematopoiesis

Back 1240

hematopoiesis outside bone marrow (e.g., spleen)

Front 1241

Newborn physiologic anemia

Back 1241

drop in Hb due to replacement of HbF RBCs with HbA

Front 1242

Pregnancy

Back 1242

Hb and Hct decreased; greater increase in plasma volume than RBC mass

Front 1243

Anemia

Back 1243

normal O2 saturation and arterial PO2

Front 1244

MCV

Back 1244

average volume of RBCs; useful for anemia classification

Front 1245

MCHC

Back 1245

average Hb concentration in RBCs

Front 1246

MCHC

Back 1246

↓ in microcytic anemias; ↑ in spherocytosis

Front 1247

Thalassemias

Back 1247

↓ MCV, ↑ RBC count

Front 1248

RDW

Back 1248

RBC size variation; ↑ iron deficiency; normal in other microcytic anemias

Front 1249

Mature RBC

Back 1249

anaerobic glycolysis; no mitochondria or HLA antigens

Front 1250

Total iron binding capacity

Back 1250

↑ iron deficiency; ↓ anemia chronic disease, sideroblastic anemia

Front 1251

% Saturation

Back 1251

↓ iron deficiency, anemia chronic disease; ↑ sideroblastic anemia

Front 1252

Serum ferritin

Back 1252

↓ iron deficiency; ↑ anemia chronic disease, sideroblastic anemia; normal thalassemia

Front 1253

Microcytic anemias

Back 1253

iron deficiency MC, anemic chronic disease, thalassemia, sideroblastic anemia

Front 1254

Iron deficiency child

Back 1254

MCC Meckel’s diverticulum

Front 1255

Iron deficiency woman < 50

Back 1255

MCC menorrhagia

Front 1256

Iron deficiency man < 50

Back 1256

MCC peptic ulcer disease

Front 1257

Iron deficiency men/woman > 50

Back 1257

MCC colon cancer

Front 1258

Stages iron deficiency

Back 1258

↓ ferritin; ↓ Fe and % saturation, ↑ TIBC; normocytic then microcytic anemia

Front 1259

Anemia chronic disease

Back 1259

MC anemia in malignancy and alcoholics

Front 1260

α-Thalassemia trait

Back 1260

AR; two α-globin gene deletions; normal Hb electrophoresis

Front 1261

HbH disease

Back 1261

three α-globin gene deletions; hemolytic anemia; four β-globin chains

Front 1262

Hb Bart’s disease

Back 1262

four α-globin gene deletions; four γ-globin chains

Front 1263

β-Thalassemia minor

Back 1263

AR; DNA splicing defect; ↑ HbA2 and F; ↓ HbA

Front 1264

β-Thalassemia major

Back 1264

nonsense mutation with stop codon; hemolytic anemia; ↑↑ HbF, ↑ HbA2

Front 1265

Sideroblastic anemia

Back 1265

defect in mitochondrial heme synthesis producing ringed sideroblasts

Front 1266

Causes sideroblastic anemia

Back 1266

alcohol, pyridoxine deficiency (isoniazid Rx of TB), Pb poisoning

Front 1267

Pb poisoning

Back 1267

inhibition ferrochelatase, d-aminolevulinic acid dehydrase, ribonuclease

Front 1268

S/S Pb poisoning children

Back 1268

growth retardation; Pb in epiphyses (lead lines); abdominal colic; encephalopathy

Front 1269

S/S Pb poisoning adult

Back 1269

peripheral neuropathy; proximal renal tubule damage (Fanconi’s syndrome)

Front 1270

Lab Pb poisoning

Back 1270

coarse basophilic stippling RBCs; ↓ MCV; ↑ blood Pb; ↑ d-aminolevulinic acid

Front 1271

Vitamin B12

Back 1271

animal products; requires intrinsic factor for reabsorption in terminal ileum

Front 1272

Vitamin B12

Back 1272

transfers methyl group to homocysteine

Front 1273

R factor

Back 1273

binds with B12 in mouth, removed by pancreatic enzymes in small intestine

Front 1274

Vitamin B12

Back 1274

involved in propionate metabolism; end-product succinyl CoA

Front 1275

Causes B12 deficiency

Back 1275

vegan, pernicious anemia MC, fish tapeworm, pancreatitis, bacterial overgrowth, Crohn’s disease

Front 1276

Pernicious anemia

Back 1276

autoimmune destruction parietal cells; chronic gastritis body/fundus; achlorhydria; ↑ gastrin

Front 1277

Causes folate deficiency

Back 1277

alcohol MCC, poor diet, drugs, malabsorption, pregnancy, goat milk

Front 1278

Drugs and folate deficiency

Back 1278

alcohol, OC, phenytoin, methotrexate, trimethoprim, 5-fluorouracil

Front 1279

Intestinal conjugase in folate metabolism

Back 1279

inhibited by phenytoin

Front 1280

Jejunal uptake of monoglutamate form of folate

Back 1280

inhibited by alcohol and OC

Front 1281

Dihydrofolate reductase

Back 1281

inhibited by methotrexate, trimethoprim

Front 1282

Thymidylate synthetase

Back 1282

inhibited by 5-fluorouracil

Front 1283

Folate deficiency

Back 1283

MCC of increased serum homocysteine

Front 1284

Lab in B12/folate deficiency

Back 1284

pancytopenia; hypersegmented neutrophils; ↑ homocysteine

Front 1285

Lab findings unique to B12 deficiency

Back 1285

↑ gastrin (pernicious anemia), ↑ methylmalonic acid

Front 1286

B12 reabsorbed absorbed after administration of intrinsic factor

Back 1286

PA

Front 1287

B12 reabsorbed absorbed after administration of antibiotics

Back 1287

bacterial overgrowth

Front 1288

B12 reabsorbed absorbed after administration of pancreatic extract

Back 1288

chronic pancreatitis

Front 1289

Acute blood loss

Back 1289

initially normal Hb and Hct; 0.9% saline uncovers RBC deficit

Front 1290

Aplastic anemia

Back 1290

drugs (e.g., phenylbutazone); infection (e.g., parvovirus); benzene

Front 1291

Lab findings aplastic anemia

Back 1291

pancytopenia; hypocellular bone marrow

Front 1292

Anemia in renal disease

Back 1292

normocytic; decreased EPO

Front 1293

Extravascular hemolysis

Back 1293

macrophage phagocytosis of RBCs; ↑ unconjugated bilirubin and urine UBG

Front 1294

Intravascular hemolysis

Back 1294

↓ serum haptoglobin; hemoglobinuria; hemosiderinuria

Front 1295

Congenital spherocytosis

Back 1295

AD; defect in spectrin; extravascular hemolysis; splenomegaly

Front 1296

Blood findings in spherocytosis

Back 1296

normocytic anemia; dense RBCs, ↑ MCHC, ↑ osmotic fragility

Front 1297

PNH

Back 1297

missing decay accelerating factor; complement destruction RBCs, neutrophils, platelets

Front 1298

S/S PNH

Back 1298

pancytopenia; hemoglobinuria; positive sugar water test and acidified serum test

Front 1299

HbSS

Back 1299

AR; missense mutation (valine for glutamic acid 6th positive β-globin chain)

Front 1300

Causes of sickling

Back 1300

↑ deoxyhemoglobin (hypoxemia, acidosis); HbS > 60%

Front 1301

HbF

Back 1301

inhibits sickling; hydroxyurea ↑ HbF

Front 1302

Pathophysiology HbSS

Back 1302

vasoocclusive crises, hemolytic anemia (extravascular)

Front 1303

HbSS children

Back 1303

dactylitis (6-9 months); Streptococcus pneumoniae sepsis (dysfunctional spleen)

Front 1304

HbSS osteomyelitis

Back 1304

Salmonella paratyphi

Front 1305

HbSS complications

Back 1305

aplastic crisis (parvovirus B-19), acute chest syndrome, autosplenectomy, calcium bilirubinate gallstones, priapism, aseptic necrosis

Front 1306

HbAS

Back 1306

microhematuria from sickling in renal medulla; renal papillary necrosis

Front 1307

Hb electrophoresis

Back 1307

HbAS-HbA 55-60%, HbS 40-45%; HbSS-HbS 90-95%, HbF 5-10%

Front 1308

Blood findings in HbSS

Back 1308

sickle cells; target cells; Howell-Jolly bodies (nuclear remnants)

Front 1309

G6PD deficiency

Back 1309

XR; oxidant damage (peroxide) to Hb (e.g., primaquine; dapsone; fava beans)

Front 1310

Blood findings G6PD deficiency

Back 1310

Heinz bodies (denatured Hb; special stain); bite cells

Front 1311

Pyruvate kinase deficiency

Back 1311

↓ ATP; RBCs dehydrated; ↑ 2,3-BPG (right-shifted OBC)

Front 1312

Warm type AIHA

Back 1312

IgG; extravascular hemolysis; e.g., SLE, drugs

Front 1313

Cold type AIHA

Back 1313

IgM intravascular hemolysis; e.g., CLL, Mycoplasma

Front 1314

Penicillin

Back 1314

IgG antibody against penicillin attached to RBC (type II hypersensitivity)

Front 1315

Methyldopa

Back 1315

drug alters Rh antigens; IgG antibody against Rh antigens (type II hypersensitivity)

Front 1316

Quinidine

Back 1316

drug-IgM IC; intravascular hemolysis; type III hypersensitivity

Front 1317

Lab findings AIHA

Back 1317

positive direct Coombs’; spherocytes

Front 1318

Micro-macroangiopathic hemolysis

Back 1318

mechanical damage causing intravascular hemolysis

Front 1319

Causes of micro/macro hemolysis

Back 1319

aortic stenosis (MCC), DIC, TIP, HUS

Front 1320

Peripheral blood findings micro/macro hemolysis

Back 1320

schistocytes; iron deficiency from hemoglobinuria

Front 1321

Malaria

Back 1321

intravascular hemolysis correlates with fever; falciparum-ring forms and gametocytes

Front 1322

Leukemoid reaction

Back 1322

exaggerated WBC response to infection; usually due to infection

Front 1323

Leukoerythroblastic reaction

Back 1323

marrow infiltrative disease peripheralizes myeloblasts/nucleated RBCs

Front 1324

Causes of leukoerythroblastic reaction

Back 1324

bone metastasis MCC, myelofibrosis

Front 1325

Eosinophilia

Back 1325

type I hypersensitivity (e.g., penicillin reaction); invasive helminthic infection

Front 1326

Helminthes not producing eosinophilia

Back 1326

pinworms, adult worms in ascariasis

Front 1327

Atypical lymphocytes

Back 1327

mononucleosis; CMV; toxoplasmosis; viral hepatitis; phenytoin

Front 1328

Mononucleosis

Back 1328

due to EBV; EBV attaches to CD21 receptors on B cells

Front 1329

Clinical findings mono

Back 1329

exudative tonsillitis, generalized lymphadenopathy, hepatosplenomegaly

Front 1330

Lab findings mono

Back 1330

atypical lymphocytosis; IgM heterophile antibodies against horse RBCs

Front 1331

Lymphopenia

Back 1331

T cell deficiencies (HIV); combined B/T deficiency (adenine deaminase deficiency)

Front 1332

Lymphocytosis

Back 1332

viral infections, whooping cough

Front 1333

Corticosteroids

Back 1333

lymphopenia, eosinopenia, neutrophilia

Front 1334

Chronic MPD

Back 1334

neoplastic stem cell disorder; splenomegaly; marrow fibrosis; risk for leukemia

Front 1335

Examples of MPD

Back 1335

polycythemia vera, myelofibrosis and myeloid metaplasia

Front 1336

Relative polycythemia

Back 1336

↓ plasma volume; ↑ RBC count; normal RBC mass

Front 1337

Absolute polycythemia

Back 1337

↓ RBC count and RBC mass

Front 1338

Appropriate polycythemia

Back 1338

hypoxic stimulus for EPO to generate RBCs

Front 1339

Causes of appropriate absolute polycythemia

Back 1339

lung disease, cyanotic heart disease, high altitude

Front 1340

Appropriate absolute polycythemia

Back 1340

normal plasma volume; ↑ RBC mass; ↓ SaO2; ↑ EPO

Front 1341

Inappropriate absolute polycythemia

Back 1341

no hypoxic stimulus for EPO

Front 1342

Causes of inappropriate polycythemia

Back 1342

ectopic secretion EPO, polycythemia vera

Front 1343

Polycythemia vera

Back 1343

↑ plasma volume and RBC mass; normal SaO2; ↓ EPO

Front 1344

Ectopic EPO (renal cell carcinoma)

Back 1344

normal plasma volume; ↑ RBC mass; normal SaO2; ↑ EPO

Front 1345

Myelofibrosis myeloid metaplasia

Back 1345

marrow fibrosis; extramedullary hematopoiesis; splenomegaly

Front 1346

Lab findings in myelofibrosis

Back 1346

tear drop RBCs; dry bone marrow aspirate (marrow fibrosis)

Front 1347

Essential thrombocythemia

Back 1347

MPO with increase in abnormal appearing platelets

Front 1348

Myelodysplastic syndrome

Back 1348

severe anemia in elderly; 30% develop leukemia; ringed sideroblasts

Front 1349

Benzene

Back 1349

aplastic anemia; acute leukemia

Front 1350

Leukemia by age

Back 1350

ALL, newborn-14; AML, 15-60; CML, 40-60; CLL, >60

Front 1351

Acute vs. chronic leukemia

Back 1351

acute, blasts >30% in bone marrow; chronic, blasts <10% in bone marrow

Front 1352

AML

Back 1352

Auer rods in myeloblasts

Front 1353

Acute promyelocytic leukemia

Back 1353

t(15;17); defect in retinoic acid; Rx retinoic acid (↑ maturation); DIC

Front 1354

Acute monocytic leukemia

Back 1354

gum infiltration

Front 1355

CML

Back 1355

t(9;22) of ABL POC; Philadelphia chromosome 22; ↓ alkaline phosphatase score

Front 1356

ALL

Back 1356

early pre-B (80%); CALLA (CD10) and TdT positive; CNS and testicle involvement

Front 1357

ALL

Back 1357

t(12;21) offers good prognosis

Front 1358

CLL

Back 1358

B cell neoplasm; ↓ γ-globulins; MCC generalized lymphadenopathy patients> 60-yrs-old

Front 1359

Adult T cell leukemia

Back 1359

HTLV-1; CD4 T cells; skin infiltration; lytic bone lesions with hypercalcemia

Front 1360

Hairy cell leukemia

Back 1360

positive TRAP stain; splenomegaly; Rx with purine nucleosides

Front 1361

Nodal sites

Back 1361

germinal follicles, B cells; paracortex, T cells; sinuses, histiocytes

Front 1362

Testicular cancer

Back 1362

metastasizes to para-aortic nodes

Front 1363

Stomach cancer

Back 1363

metastasizes to left supraclavicular nodes (Virchow node)

Front 1364

Phenytoin

Back 1364

atypical lymphocytosis

Front 1365

Cat scratch disease

Back 1365

Bartonella henselae; granulomatous microabscesses

Front 1366

Follicular B-cell lymphoma

Back 1366

t(14;18); overexpression of BCL-2 anti-apoptosis gene

Front 1367

Burkitt lymphoma

Back 1367

t(8;14); EBV association; common childhood NHL; “starry sky” appearance

Front 1368

Extra nodal lymphomas

Back 1368

risk factors H. pylori (stomach); Sjogren’s syndrome

Front 1369

Mycosis fungoides

Back 1369

CD4 T cell neoplasm; skin lesions with Pautrier’s microabscesses

Front 1370

Sezary syndrome

Back 1370

leukemic phase of mycosis fungoides

Front 1371

Polyclonal gammopathy

Back 1371

sign of chronic inflammation

Front 1372

Monoclonal gammopathy

Back 1372

M component (spike); sign of plasma cell disorder

Front 1373

Confirmatory tests

Back 1373

serum and urine immunoelectrophoresis; bone marrow aspirate

Front 1374

Bence Jones protein

Back 1374

light chains in urine; predictive of a malignant plasma cell disorder

Front 1375

Multiple myeloma

Back 1375

M spike; lytic bone lesions; pathologic fractures; hypercalcemia; renal failure

Front 1376

MGUS

Back 1376

MC monoclonal gammopathy; may progress to myeloma

Front 1377

Findings in MGUS

Back 1377

elderly patient; no BJ protein; no malignant plasma cells

Front 1378

Waldenstrom’s macroglobulinemia

Back 1378

lymphoplasmacytic lymphoma; IgM M spike; hyperviscosity

Front 1379

Hodgkin’s lymphoma

Back 1379

neoplastic component, Reed Stemberg (RS) cell; CD15 CD30 positive

Front 1380

Lymphocyte predominant Hodgkin’s

Back 1380

infrequent classic RS cells

Front 1381

Nodular sclerosing Hodgkin’s

Back 1381

female dominant; supraclavicular nodes + anterior mediastinal nodes

Front 1382

Mixed cellularity Hodgkin’s

Back 1382

male dominant; numerous RS cells; EBV association

Front 1383

Hodgkin’s prognosis

Back 1383

stage of disease and type of Hodgkin’s most important factors

Front 1384

Alkylating agents in Rx of Hodgkins

Back 1384

↑ risk for second malignancies (leukemia; NHL)

Front 1385

Langerhan’s histiocytes

Back 1385

CD1 positive; Birbeck granules

Front 1386

Letterer-Siwe disease

Back 1386

malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement

Front 1387

Hand-Christian-Christian disease

Back 1387

malignant; lytic skull lesions, diabetes insipidus, exophthalmos

Front 1388

Eosinophilic granuloma

Back 1388

benign histiocytosis; lytic bone lesions with pathologic fractures

Front 1389

Mast cells

Back 1389

release histamine (pruritus; swelling); metachromatic granules positive with toluidine blue

Front 1390

Urticaria pigmentosum

Back 1390

localized mastocytosis; skin lesions swell and itch with scratching

Front 1391

Amyloid

Back 1391

twisted β-sheet; apple green birefringence with Congo red

Front 1392

Primary amyloidosis

Back 1392

AL amyloid derived from light chains; plasma cell disorders

Front 1393

Secondary amyloidosis

Back 1393

AA amyloid derived from serum-associated amyloid; chronic infections

Front 1394

Alzheimer’s disease

Back 1394

amyloid precursor protein gene product chromosome 21; amyloid-β

Front 1395

Gaucher’s disease

Back 1395

macrophages have fibrillary appearance; deficiency glucocerebrosidase

Front 1396

Niemann Pick’s disease

Back 1396

macrophages have soap bubble appearance; deficiency sphingomyelinase

Front 1397

Hypersplenism

Back 1397

splenomegaly; peripheral blood cytopenias; portal hypertension MCC

Front 1398

Splenic dysfunction

Back 1398

Howell Jolly bodies; susceptible to Streptococcus pneumoniae sepsis

Front 1399

Anticoagulants

Back 1399

tissue plasminogen activator, heparin, PGI2 ATIII, protein C/S

Front 1400

Heparin

Back 1400

enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)

Front 1401

Protein C/S

Back 1401

neutralize V and VIII

Front 1402

Procoagulants

Back 1402

coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)

Front 1403

Protein C and S

Back 1403

inactivate factors V and VIII; enhance fibrinolysis

Front 1404

von Willebrand factor

Back 1404

complexes with factor VIII to enhance VIII:C activity; platelet adhesion

Front 1405

Platelets

Back 1405

receptors for von Willebrand factor and fibrinogen; synthesize thromboxane A2

Front 1406

GpIb

Back 1406

platelet receptor for von Willebrand factor

Front 1407

GpIIb:IIIa

Back 1407

platelet receptor for fibrinogen

Front 1408

Extrinsic system factor

Back 1408

VII

Front 1409

Intrinsic system factors

Back 1409

XII, XI, IX, VIII

Front 1410

Final common pathway factors

Back 1410

X, V, prothrombin (II), fibrinogen (I)

Front 1411

Factor XIII

Back 1411

cross-links insoluble fibrin; strengthens fibrin clots

Front 1412

Vitamin K-dependent factors

Back 1412

prothrombin, VII, IX, X, protein C and S

Front 1413

Factors consumed in a clot

Back 1413

fibrinogen, prothrombin, V, VIII; fluid is called serum

Front 1414

Plasmin

Back 1414

cleaves fibrinogen and insoluble fibrin into degradation products

Front 1415

Bleeding time

Back 1415

evaluates platelet function (adhesion, release reaction, aggregation)

Front 1416

Aspirin

Back 1416

MCC of a prolonged bleeding time

Front 1417

Tests for vWF

Back 1417

ristocetin cofactor assay; vWF antigen assay; agar electrophoresis

Front 1418

PT

Back 1418

evaluates extrinsic pathway to fibrin clot

Front 1419

PTT

Back 1419

evaluates intrinsic pathway to stable fibrin clot

Front 1420

Fibrinolysis tests

Back 1420

fibrin(ogen) degradation products; D-dimers (cross-linked insoluble fibrin)

Front 1421

S/S platelet dysfunction

Back 1421

cannot form temporary plug; epistaxis; petechiae; bleeding from scratches

Front 1422

Idiopathic thrombocytopenic purpura (ITP)

Back 1422

children; antibodies against GpIIb:IIIa; no splenomegaly

Front 1423

Chronic autoimmune thrombocytopenic purpura

Back 1423

SLE; antibodies against GpIIb:IIIa receptors

Front 1424

Heparin

Back 1424

thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets

Front 1425

PF4

Back 1425

heparin neutralizing factor

Front 1426

HIV

Back 1426

thrombocytopenia MC hematologic abnormality; similar to ITP

Front 1427

TTP

Back 1427

platelet thrombi develop in areas of endothelial damage in small vessels; consumption of platelets

Front 1428

S/S

Back 1428

fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits

Front 1429

Lab findings TTP

Back 1429

thrombocytopenia, prolonged bleeding time, normal PT and PTT

Front 1430

HUS

Back 1430

similar to TTP; endothelial injury from Shiga-like toxin of 0157:H7 E. coli in undercooked beef

Front 1431

S/S factor deficiency

Back 1431

no stable fibrin clot-late rebleeding; menorrhagia; GI bleeding; hemarthroses

Front 1432

Hemophilia A

Back 1432

XR; hemarthroses; prolonged PTT, ↓ factor VIII activity, normal VIII antigen

Front 1433

von Willebrand’s disease

Back 1433

AD; platelet adhesion defect + factor VIII deficiency

Front 1434

Lab findings in VWD

Back 1434

↓ vWF, VIII antigen, and VIII:C; prolonged bleeding time

Front 1435

Desmopressin acetate

Back 1435

Rx of choice for mild von Willebrand’s disease and hemophilia A

Front 1436

Circulating anticoagulants

Back 1436

antibodies destroy coagulation factors

Front 1437

Lab finding in circulating anticoagulant

Back 1437

prolonged PT and/or PTT corrected with mixing studies

Front 1438

Vitamin K deficiency

Back 1438

↓ epoxide reductase activity (↓ function vitamin K); hemorrhagic diathesis; ↑ PT

Front 1439

Causes vitamin K deficiency

Back 1439

antibiotics MC, newborn, malabsorption, warfarin

Front 1440

DIC

Back 1440

activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage

Front 1441

DIC

Back 1441

consumption coagulation factors by fibrin clots; patient also anticoagulated

Front 1442

Causes

Back 1442

septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid

Front 1443

S/S

Back 1443

bleeding from all scratches, holes, needle sites

Front 1444

Lab findings DIC

Back 1444

thrombocytopenia, ↑ PT and PTT, D-dimers (best test), anemia

Front 1445

Antiphospholipid antibodies

Back 1445

lupus anticoagulant and anticardiolipin antibodies; vessel thrombosis

Front 1446

Warfarin

Back 1446

inhibits epoxide reductase; PT best test but PTT also prolonged

Front 1447

Warfarin

Back 1447

full anticoagulation in 3 days when -carboxylated prothrombin disappears

Front 1448

Warfarin

Back 1448

ingredient in rat poison; danger to children in households with grandparents on warfarin

Front 1449

Rx warfarin over anticoagulation

Back 1449

intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)

Front 1450

Heparin

Back 1450

enhances ATIII; PTT best test but PT also prolonged

Front 1451

OC

Back 1451

estrogen ↑ coagulation factor synthesis and ATIII; predisposes to thrombosis

Front 1452

Factor V Leiden

Back 1452

MC hereditary thrombosis; resistant to degradation by protein C/S

Front 1453

ATIII deficiency

Back 1453

no prolongation of PTT with administration of heparin

Front 1454

Hemorrhagic skin necrosis

Back 1454

post-warfarin therapy in patient with heterozygote protein C deficiency

Front 1455

M cells

Back 1455

specialized cells that transfer foreign antigens to lymphocytes in Peyer’s patches

Front 1456

Blood group O

Back 1456

some patients have anti-AB-IgG antibodies; increased incidence duodenal ulcers

Front 1457

Blood group A

Back 1457

increased incidence of gastric carcinoma

Front 1458

Newborns

Back 1458

do not have natural blood group antibodies at birth (e.g., anti-A-lgM)

Front 1459

Elderly

Back 1459

may lose natural blood group antibodies; no hemolytic reaction to mismatched blood

Front 1460

Rh antigens

Back 1460

inherited in autosomal codominant fashion; Rh antigens include D, C, c, E, e

Front 1461

Atypical antibodies

Back 1461

antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)

Front 1462

Duffy antigen

Back 1462

receptor for Plasmodium vivax; blacks often lack Duffy antigen

Front 1463

Antibody screen

Back 1463

indirect Coomb’s test; detects atypical antibodies in serum

Front 1464

Cytomegalovirus

Back 1464

MC infection transmitted by blood transfusion; MC antibody

Front 1465

Hepatitis C

Back 1465

MCC of post-transfusion hepatitis

Front 1466

Major crossmatch

Back 1466

patient serum reacted against donor RBCs; does not guarantee RBC survival

Front 1467

Universal donor

Back 1467

blood group O; no antigens on the surface of RBCs

Front 1468

Universal recipient

Back 1468

blood group AB; no natural blood group antibodies in serum

Front 1469

Packed RBC transfusion

Back 1469

raises Hb by 1 gm/dL and Hct by 3%

Front 1470

Cryoprecipitate

Back 1470

fibrinogen and factor VIII

Front 1471

Fresh frozen plasma

Back 1471

replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)

Front 1472

Allergic transfusion reaction

Back 1472

type I IgE-mediated hypersensitivity reaction

Front 1473

Febrile transfusion reaction

Back 1473

recipient anti-HLA antibodies react against donor leukocytes

Front 1474

Intravascular HTR

Back 1474

transfusion of ABO incompatible blood (e.g., A person receives B blood)

Front 1475

Extravascular HTR

Back 1475

antibody attaches to donor RBCs; macrophage phagocytosis and hemolysis

Front 1476

Positive direct Coomb’s test

Back 1476

present in both types of hemolytic transfusion reactions

Front 1477

S/S

Back 1477

jaundice, no increase in Hb, hemoglobinuria

Front 1478

ABO HDN

Back 1478

mother O and baby A or B; transplacental passage of maternal anti-AB-IgG

Front 1479

ABO HDN

Back 1479

positive direct Coomb’s test; spherocytes; MCC unconjugated hyperbilirubinemia first 24 hrs

Front 1480

Rh HDN

Back 1480

mother Rh (D antigen) negative and fetus Rh (O antigen) positive

Front 1481

Rh HDN

Back 1481

no hemolysis in first Rh incompatible pregnancy

Front 1482

Rh HDN

Back 1482

maternal anti-D crosses placenta; potential for hydrops fetalis; high risk for kernicterus

Front 1483

Rh immune globulin

Back 1483

anti-D; coats D antigen site on fetal RBCs in maternal circulation

Front 1484

Rh HDN lab

Back 1484

positive direct Coomb’s; severe anemia and hyperbilirubinemia

Front 1485

ABO HDN

Back 1485

protects mother from Rh sensitization (development of anti-D antibodies)

Front 1486

O Rh negative mother with A Rh positive baby

Back 1486

A+ cells destroyed by mothers anti A-lgM

Front 1487

Blue fluorescent light

Back 1487

converts unconjugated bilirubin in skin into harmless water soluble dipyrrole

Front 1488

MV auscultation

Back 1488

apex

Front 1489

TV auscultation

Back 1489

left parasternal border

Front 1490

AV auscultation

Back 1490

right 2nd intercostal space

Front 1491

PV auscultation

Back 1491

left 2nd intercostal space

Front 1492

S1

Back 1492

closure MV and TV

Front 1493

S2

Back 1493

closure AV and PV

Front 1494

Inspiration

Back 1494

split in A2 and P2; due to increased blood in right side of heart

Front 1495

S3

Back 1495

abnormal; due to blood entering volume overloaded ventricle in early diastole

Front 1496

Causes S3

Back 1496

valve regurgitation; congestive heart failure

Front 1497

S4

Back 1497

abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole

Front 1498

Causes S4

Back 1498

volume overloaded ventricle, hypertrophy

Front 1499

Murmurs

Back 1499

stretching valve ring or damage to valve

Front 1500

Inspiration

Back 1500

increases right sided abnormal heart sounds and murmurs

Front 1501

Expiration

Back 1501

increases left sided abnormal heart sounds and murmurs

Front 1502

Stenosis murmurs

Back 1502

problem in opening valve

Front 1503

Regurgitation murmurs

Back 1503

problem in closing valve

Front 1504

Valves opening in systole

Back 1504

AV and PV

Front 1505

Valves opening in diastole

Back 1505

MV and TV

Front 1506

Valves closing in systole

Back 1506

MV and TV

Front 1507

Valves closing in diastole

Back 1507

AV and PV

Front 1508

LDL

Back 1508

primary vehicle for carrying cholesterol

Front 1509

VLDL

Back 1509

primary vehicle for carrying liver-synthesized triglyceride

Front 1510

Familial hypercholesterolemia (type II)

Back 1510

AD; deficiency of LDL receptors; ↑ LDL

Front 1511

Type III hyperlipoproteinemia

Back 1511

deficiency apo E; ↑ remnants (chylomicron, intermediate density)

Front 1512

Type IV hyperlipoproteinemia

Back 1512

↑ VLDL; alcoholics

Front 1513

Apo B deficiency

Back 1513

deficiency apo B48 (chylomicrons) and B100 (VLDL); ↓ CH and TG

Front 1514

Clinical findings in apo B deficiency

Back 1514

malabsorption; hemolytic anemia

Front 1515

Atherosclerosis

Back 1515

reaction to injury of endothelial cells

Front 1516

Risk factors

Back 1516

smoking, ↑ LDL, ↑ homocysteine, Chlamydia pneumoniae infection

Front 1517

Cells involved

Back 1517

platelets, macrophages, smooth muscle cells, T cells with cytokine release

Front 1518

Fibrous plaque

Back 1518

pathognomonic lesion of atherosclerosis

Front 1519

C-reactive protein

Back 1519

marker of an inflammatory atheromatous plaque

Front 1520

Inflammatory atheromatous plaque

Back 1520

predisposes to platelet thrombosis

Front 1521

Increased plasma homocysteine

Back 1521

↑ vessel thrombosis; folate (MC)/vitamin B12 deficiency

Front 1522

Hyaline arteriolosclerosis

Back 1522

small vessel disease of DM and hypertension; excess protein in vessel wall

Front 1523

Mechanisms hyaline arteriolosclerosis in DM

Back 1523

non-enzymatic glycosylation

Front 1524

Non-enzymatic glycosylation

Back 1524

glucose attaches to amino acids in BM; causes ↑ permeability to protein

Front 1525

Mechanisms hyaline arteriolosclerosis in hypertension

Back 1525

pressure pushes proteins into vessel wall

Front 1526

Abdominal aortic aneurysm rupture

Back 1526

due to atherosclerosis; flank pain, hypotension, pulsatile mass

Front 1527

Syphilitic aneurysm

Back 1527

vasculitis of vasa vasorum of aortic arch; aortic regurgitation

Front 1528

Aortic dissection

Back 1528

due to hypertension and collagen tissue disorders (e.g., Marfan)

Front 1529

Cystic medial degeneration

Back 1529

elastic tissue degeneration creates spaces filled with mucopolysaccharides

Front 1530

Intimal tear in aorta

Back 1530

due to wall stress from hypertension and structural weakness

Front 1531

Types of dissection

Back 1531

proximal (MC); distal or combination of both

Front 1532

S/S proximal aortic dissection

Back 1532

chest pain radiating to back, lack of pulse; cardiac tamponade MC COD

Front 1533

Marfan’s

Back 1533

AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death

Front 1534

MC COD Marfan’s and Ehlers Danlos

Back 1534

aortic dissection

Front 1535

Phlebothrombosis

Back 1535

stasis of blood flow; deep veins below knee MC site

Front 1536

Pulmonary thromboembolism

Back 1536

emboli originate from femoral veins

Front 1537

Superficial migratory thrombophlebitis

Back 1537

sign of carcinoma of head of pancreas

Front 1538

Thoracic outlet syndrome

Back 1538

absent radial pulse with positional change

Front 1539

Turner’s syndrome

Back 1539

lymphedema hands/feet in newborn; preductal coarctation

Front 1540

Spider telangiectasia

Back 1540

arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)

Front 1541

Capillary hemangioma in newborn

Back 1541

regress with age; do not surgically remove

Front 1542

Kaposi’s sarcoma

Back 1542

HHV-8; vascular malignancy; MC cancer in AIDS

Front 1543

Bacillary angiomatosis

Back 1543

Bartonella henselae; vascular infection in AIDS

Front 1544

Small vessel vasculitis

Back 1544

palpable purpura; e.g., Henoch Schonlein purpura

Front 1545

Muscular artery vasculitis

Back 1545

vessel thrombosis with infarction; e.g., classical polyarteritis nodosa

Front 1546

Elastic artery vasculitis

Back 1546

absent pulse, stroke

Front 1547

Takayasu’s arteritis

Back 1547

pulseless disease; young Asian woman

Front 1548

Giant cell arteritis

Back 1548

temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)

Front 1549

Classical polyarteritis nodosa

Back 1549

muscular artery vasculitis with vessel thrombosis infarction

Front 1550

Path findings

Back 1550

vessel inflammation at different stages; aneurysms from vessel weakness

Front 1551

S/S

Back 1551

infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%

Front 1552

Diagnosis

Back 1552

angiography identifies aneurysms and thrombosis

Front 1553

Kawasaki’s disease

Back 1553

coronary artery vasculitis/thrombosis/aneurysms in children

Front 1554

S/S

Back 1554

chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy

Front 1555

Rx

Back 1555

IV γ-globulin

Front 1556

Buerger’s disease (thromboangiitis obliterans)

Back 1556

smoker’s digital vasculitis; digital infarction

Front 1557

Raynaud’s syndrome

Back 1557

digital vasculitis in PSS and CREST syndrome

Front 1558

S/S

Back 1558

digital pain; white-blue-red color changes

Front 1559

Cryoglobulinemia

Back 1559

protein gels in cold temperature; Raynaud’s syndrome; HCV association

Front 1560

S/S

Back 1560

acral cyanosis relieved by coming indoors

Front 1561

Wegener’s granulomatosis

Back 1561

association with c-ANCA; sinusitis, lung infarction, crescentic GN

Front 1562

Microscopic polyangiitis

Back 1562

palpable purpura; crescentic GN; association with p-ANCA

Front 1563

Henoch-Schönlein purpura

Back 1563

IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN

Front 1564

Serum sickness vasculitis

Back 1564

e.g., horse antivenin in Rx of rattlesnake envenomation

Front 1565

Rocky Mountain spotted fever

Back 1565

tick borne

Front 1566

Meningococcemia

Back 1566

sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome

Front 1567

Essential HTN blacks

Back 1567

defect in renal excretion of sodium; ↑ plasma volume, ↓ PRA

Front 1568

Renovascular HTN

Back 1568

atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women

Front 1569

S/S

Back 1569

epigastric bruit; ↑ PRA affected kidney, ↓ PRA unaffected kidney

Front 1570

Endocrine HTN

Back 1570

1º HPTH, Graves/hypothyroidism, Cushing’s, 1º aldosteronism, phaeochromocytoma

Front 1571

Hypertension

Back 1571

LVH MC complication; AMI MC COD followed by stroke and renal failure

Front 1572

Afterload

Back 1572

resistance ventricles contract against

Front 1573

Preload

Back 1573

volume ventricles must eject

Front 1574

Concentric LVH

Back 1574

increased afterload; e.g., essential HTN, aortic stenosis

Front 1575

LVH with dilation/hypertrophy

Back 1575

increased preload; e.g., valve regurgitation; left to right shunts

Front 1576

LHF

Back 1576

forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea

Front 1577

Systolic dysfunction

Back 1577

LHF due to decreased ventricular contractility (ischemia)

Front 1578

Diastolic dysfunction

Back 1578

LHF due to decreased ventricular compliance (hypertrophy)

Front 1579

RHF

Back 1579

backward failure; ↑ venous hydrostatic pressure; neck vein distention, hepatomegaly, edema

Front 1580

ACE inhibitors

Back 1580

decrease afterload and preload in heart failure

Front 1581

Diuretics in CHF

Back 1581

reduce preload

Front 1582

Non-pharmacologic Rx in CHF

Back 1582

restrict salt and water

Front 1583

AMI

Back 1583

MC COD in United States; left anterior descending coronary artery thrombosis MCC

Front 1584

Exertional angina

Back 1584

coronary artery atherosclerosis; subendocardial ischemia; ST depression

Front 1585

Prinzmetal’s angina

Back 1585

coronary artery vasospasm; transmural ischemia; ST elevation

Front 1586

Sudden cardiac death

Back 1586

death within 1 hr of symptoms

Front 1587

Path findings

Back 1587

severe coronary artery atherosclerosis; absence of occlusive thrombosis

Front 1588

LAD coronary artery

Back 1588

anterior portion left ventricle, anterior 2/3rds IVS

Front 1589

RCA

Back 1589

posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle

Front 1590

AMI

Back 1590

rupture of inflammatory plaque produces platelet thrombus

Front 1591

Ventricular fibrillation

Back 1591

MC COD in AMI

Front 1592

AMI

Back 1592

no gross changes until 24 hrs

Front 1593

S/S AMI

Back 1593

retrosternal pain radiating down arms, diaphoresis

Front 1594

AMI ruptures

Back 1594

3rd-7th day

Front 1595

Anterior wall rupture

Back 1595

MC type; LAD thrombosis; cardiac tamponade

Front 1596

Posteromedial papillary muscle rupture

Back 1596

RCA thrombosis; mitral regurgitation with LHF

Front 1597

IVS rupture

Back 1597

LAD thrombosis; left to right shunt; RHF

Front 1598

Mural thrombus

Back 1598

anterior AMI; danger embolization

Front 1599

Pericarditis

Back 1599

first week in transmural AMI; 6 wks later autoimmune

Front 1600

S/S

Back 1600

friction rub; leaning forward relieves pain

Front 1601

Ventricular aneurysms

Back 1601

late manifestation of AMI; precordial systolic bulge; CHF MC COD

Front 1602

Right ventricular infarction

Back 1602

RCA thrombosis; hypotension, RHF, preserved left ventricular function

Front 1603

Diagnosis of AMI

Back 1603

CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days

Front 1604

LDH isoenzymes

Back 1604

no longer used; LDH 1/2 flip indicates AMI

Front 1605

Reinfarction

Back 1605

reappearance CK-MB after 3 days

Front 1606

ECG findings in AMI

Back 1606

inverted T waves; ST elevation; Q waves

Front 1607

Ejection fraction

Back 1607

EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66

Front 1608

By-pass surgery

Back 1608

use internal mammary artery and saphenous veins (“arterialize” after 10 yrs)

Front 1609

Angioplasty complication

Back 1609

localized dissection with thrombosis

Front 1610

Umbilical vein

Back 1610

highest O2 saturation

Front 1611

Ductus arteriosis in fetus

Back 1611

shunts blood from pulmonary artery to aorta; PGE keeps it open

Front 1612

Ductus arteriosus in newborn

Back 1612

closes and becomes ligamentum arteriosum

Front 1613

Eisenmenger’s syndrome

Back 1613

cyanosis due to reversal of left to right shunt

Front 1614

VSD

Back 1614

MC congenital heart disease; ↑ SaO2 right ventricle (RV), pulmonary artery (PA)

Front 1615

ASD

Back 1615

patent foramen ovale; ↑ SaO2 right atrium (RA), RV, PA; MC adult congenital heart disease

Front 1616

Down syndrome

Back 1616

endocardial cushion defect (combined ASD and VSD)

Front 1617

PDA

Back 1617

machinery murmur; close with indomethacin; ↑ SaO2 PA

Front 1618

Tetralogy of Fallot

Back 1618

degree of pulmonic stenosis determines if cyanosis is present

Front 1619

Tetralogy of Fallot

Back 1619

↓ left ventricle, aorta

Front 1620

Tetralogy of Fallot

Back 1620

ASD and PDA are cardioprotective

Front 1621

Complete transposition

Back 1621

cyanosis; aorta empties RV; PA empties left ventricle

Front 1622

Complications cyanotic heart disease

Back 1622

2° polycythemia; infective endocarditis; metastatic abscesses

Front 1623

Pre-ductal coarctation

Back 1623

Turner’s syndrome

Front 1624

Post-ductal coarctation

Back 1624

constriction distal to ligamentum arteriosum

Front 1625

S/S

Back 1625

upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN

Front 1626

Acute rheumatic fever

Back 1626

type II hypersensitivity; group A streptococcus pharyngeal infection

Front 1627

Acute rheumatic fever

Back 1627

sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule

Front 1628

S/S

Back 1628

polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea

Front 1629

Mitral stenosis

Back 1629

chronic rheumatic fever; opening snap followed by mid-diastolic rumble

Front 1630

Mitral stenosis

Back 1630

left atrial dilation hypertrophy - atrial fibrillation, thrombus, pulmonary edema, RHF

Front 1631

MVP

Back 1631

myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos

Front 1632

S/S

Back 1632

mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae

Front 1633

MVP click/murmur close to S1

Back 1633

decrease preload (stand, Valsalva, anxiety)

Front 1634

MVP click/murmur close to S2

Back 1634

increase preload (supine, squat, clench fist)

Front 1635

Mitral regurgitation

Back 1635

pansystolic murmur; S3 and S4 common

Front 1636

Causes

Back 1636

LHF, infective endocarditis, acute rheumatic fever

Front 1637

Aortic stenosis

Back 1637

systolic ejection murmur; syncope and angina with exercise; hemolytic anemia

Front 1638

Aortic stenosis murmur increased preload

Back 1638

worsens obstruction and increases murmur intensity

Front 1639

Aortic stenosis murmur decreased preload

Back 1639

decreases obstruction and decreases murmur intensity

Front 1640

Causes

Back 1640

bicuspid aortic valve; age-related sclerosis

Front 1641

Aortic regurgitation

Back 1641

bounding pulses; early diastolic blowing murmur

Front 1642

Austin Flint murmur

Back 1642

diastolic murmur; regurgitant flow on anterior leaflet mitral valve

Front 1643

Significance Austin Flint murmur

Back 1643

sign for AV replacement

Front 1644

Causes aortic regurgitation

Back 1644

essential HTN, infective endocarditis, acute rheumatic fever, dissection

Front 1645

Tricuspid regurgitation

Back 1645

pansystolic murmur ↑ intensity with inspiration

Front 1646

Causes

Back 1646

endocarditis IV drug abuse; RHF; carcinoid heart disease

Front 1647

Carcinoid heart disease

Back 1647

tricuspid regurgitation, pulmonic stenosis

Front 1648

Infective endocarditis (IE)

Back 1648

Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA

Front 1649

IE prosthetic heart valve

Back 1649

Staphylococcus epidermidis (coagulase negative)

Front 1650

IE ulcerative bowel disease

Back 1650

Streptococcus bovis

Front 1651

S/S

Back 1651

IC vasculitis-Roth spot, splinter hemorrhages; regurgitant murmurs; metas1atic abscesses

Front 1652

Lab findings

Back 1652

positive blood culture Libman Sacks endocarditis

Front 1653

Coxsackievirus

Back 1653

MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis

Front 1654

Parasitic cause myocarditis

Back 1654

leishmania in Chagas disease

Front 1655

Pericardial effusion

Back 1655

all chamber pressures are uniformally increased

Front 1656

S/S

Back 1656

muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention

Front 1657

Dx and Rx

Back 1657

echocardiogram, pericardiocentesis, respectively

Front 1658

Pulsus paradoxus

Back 1658

drop in blood pressure >10 mmHg with inspiration

Front 1659

Constrictive pericarditis

Back 1659

TB MCC worldwide; pericardial knock

Front 1660

Congestive cardiomyopathy

Back 1660

generalized chamber enlargement; low ejection fraction

Front 1661

Causes

Back 1661

postpartum, cardiotoxic drugs, hypothyroidism, alcohol

Front 1662

Hypertrophic cardiomyopathy

Back 1662

MCC of sudden death in young person (due to conduction defects)

Front 1663

Site of obstruction

Back 1663

anterior leaflet mitral valve drawn against asymmetric thickened IVS

Front 1664

Effect decreased preload on systolic murmur

Back 1664

worsens obstruction and increases murmur intensity

Front 1665

Effect increased preload on systolic murmur

Back 1665

reduces obstruction and decreases murmur intensity

Front 1666

Restrictive cardiomyopathy

Back 1666

decreased compliance

Front 1667

Causes

Back 1667

iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis

Front 1668

Cardiac myxoma

Back 1668

benign tumor left atrium; embolization; syncope

Front 1669

Cardiac rhabdomyoma

Back 1669

childhood tumor; association with tuberous sclerosis

Front 1670

U wave

Back 1670

hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)

Front 1671

Peaked T wave

Back 1671

hyperkalemia; MCC renal failure

Front 1672

ST depression

Back 1672

subendocardial ischemia (e.g., classical angina pectoris)

Front 1673

ST elevation

Back 1673

transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm

Front 1674

Atrial fibrillation

Back 1674

MC chronic arrhythmia; absent P waves; danger for embolization

Front 1675

Ventricular premature beats

Back 1675

wide QRS complexes; MC arrhythmia in coronary care unit

Front 1676

Ventricular fibrillation

Back 1676

MCC of death in an AMI

Front 1677

Anterior AMI

Back 1677

Q waves in I and V1-V4

Front 1678

Inferior AMI

Back 1678

Q waves in II, III, and aVF; right coronary artery thrombosis.

Front 1679

Wolff-Parkinson-White

Back 1679

short PR interval with normal P wave; delta wave on upstroke of R wave

Front 1680

Alveolar O2 calculation

Back 1680

% O2 breathing (713) - PCO2/0.8

Front 1681

Increased A-a gradient

Back 1681

primary lung disease; left to right shunts in heart

Front 1682

Forced vital capacity

Back 1682

total amount of air expelled after a maximal inspiration

Front 1683

Forced expiratory volume/1 second (FEV1)

Back 1683

amount of air expelled in I second after maximal inspiration

Front 1684

Choanal atresia

Back 1684

cyanotic when breast feeding; turns pink when crying

Front 1685

Nasal polyps

Back 1685

allergic (MC; adults only), aspirin, cystic fibrosis

Front 1686

Nasal polyp in a child

Back 1686

requires sweat test to exclude cystic fibrosis

Front 1687

Triad asthma

Back 1687

patient on aspirin (pain syndrome) with nasal polyps, asthma

Front 1688

Obstructive sleep apnea (OSA)

Back 1688

snoring with intervals of apnea (respiratory acidosis with hypoxemia)

Front 1689

S/S

Back 1689

danger cor pulmonale; requires sleep test; Rx. O2 with continuous positive airway pressure

Front 1690

Sinusitis

Back 1690

maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC

Front 1691

Nasopharyngeal carcinoma

Back 1691

association with EBV; metastasize to cervical nodes

Front 1692

Laryngeal carcinoma

Back 1692

smoking MCC; hoarseness; squamous cell carcinoma

Front 1693

Resorption atelectasis

Back 1693

MCC of fever 24-36 hours after surgery

Front 1694

S/S

Back 1694

↓ percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm

Front 1695

RDS

Back 1695

decreased production surfactant; airway collapse; hyaline membranes

Front 1696

Type II pneumocytes

Back 1696

synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies

Front 1697

Surfactant

Back 1697

reduces surface tension in airways; ↑ synthesis cortisol, thyroxine; ↓ synthesis insulin

Front 1698

Causes RDS

Back 1698

prematurity, maternal diabetes, C-section

Front 1699

Maternal diabetes

Back 1699

maternal hyperglycemia → fetal hyperglycemia → fetal insulin which ↓ surfactant

Front 1700

Complications RDS

Back 1700

O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis

Front 1701

Typical community acquired pneumonia

Back 1701

Streptococcus pneumoniae MCC

Front 1702

Typical pneumonia

Back 1702

bronchopneumonia, lobar pneumonia

Front 1703

S/S

Back 1703

productive cough; consolidation - ↓ percussion, ↑ tactile fremitus

Front 1704

Atypical community acquired pneumonia

Back 1704

interstitial pneumonia; Mycoplasma pneumoniae MCC

Front 1705

S/S

Back 1705

low grade fever, non-productive cough, no signs consolidation

Front 1706

Nosocomial pneumonia

Back 1706

Pseudomonas, aeruginosa MCC (respirators); others - S. aureus, E. coli

Front 1707

Rhinovirus

Back 1707

MCC common cold; hand to mouth transmission

Front 1708

Respiratory syncytial virus

Back 1708

MCC pneumonia and bronchiolitis in child

Front 1709

Parainfluenza virus

Back 1709

MCC croup in child; trachea area of obstruction

Front 1710

Cytomegalovirus

Back 1710

basophilic intranuclear inclusion surrounded by halo

Front 1711

Influenza

Back 1711

superimposed pneumonia with S. aureus increases mortality

Front 1712

Rubeola

Back 1712

Warthin-Finkeldey multinucleated giant cells

Front 1713

Chlamydia pneumoniae

Back 1713

atypical pneumonia; association with coronary artery disease

Front 1714

Chlamydia trachomatis

Back 1714

pneumonia in newborns; staccato cough; wheezing

Front 1715

Coxiella burnetii

Back 1715

only rickettsia without a vector

Front 1716

Mycoplasma pneumoniae pneumonia

Back 1716

crowded condition; cold agglutinins; azithromycin

Front 1717

Streptococcus pneumoniae pneumonia

Back 1717

gram positive diplococcus; azithromycin

Front 1718

Staphylococcus aureus pneumonia

Back 1718

tension pneumatocysts in children with cystic fibrosis

Front 1719

Corynebacterium diphtheriae

Back 1719

toxin produces ADP ribosylation of elongation factor 2

Front 1720

Haemophilus influenzae

Back 1720

exacerbation chronic bronchitis; acute epiglottis in children

Front 1721

Inspiratory stridor child

Back 1721

croup, epiglottitis

Front 1722

Pseudomonas aeruginosa

Back 1722

MCC of pneumonia and death in cystic fibrosis; green sputum

Front 1723

Klebsiella pneumoniae

Back 1723

mucoid sputum in alcoholic

Front 1724

Legionella pneumophila

Back 1724

silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest)

Front 1725

Mycobacterium tuberculosis

Back 1725

strict aerobe; MC COD due to infectious disease worldwide

Front 1726

Candida albicans

Back 1726

vessel invader; yeasts and pseudohyphae

Front 1727

Cryptococcus immitis

Back 1727

pigeon excreta; narrow-based bud

Front 1728

Aspergillus fumigatus

Back 1728

septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader

Front 1729

Mucor species

Back 1729

non-septate; vessel invader; frontal lobe abscess in diabetic ketoacidosis

Front 1730

Coccidioides immitis

Back 1730

Southwest deserts; inhale arthrospores in dust; spherule with endospores

Front 1731

S/S

Back 1731

erythema nodosum (painful nodules lower legs)

Front 1732

Histoplasma capsulatum

Back 1732

Ohio/central Mississippi river valley; excreta bats (spelunker), chickens

Front 1733

H. capsulatum

Back 1733

simulates TB; yeasts phagocytosed by macrophages

Front 1734

Blastomyces dermatitidis

Back 1734

overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer

Front 1735

Pneumocystis carinii

Back 1735

cysts and trophozoites; pneumonia in HIV; Rx. trimethoprim/sulfamethoxazole

Front 1736

Primary TB

Back 1736

upper portion lower lobe, lower portion upper lobe

Front 1737

Primary TB

Back 1737

Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)

Front 1738

Reactivation TB

Back 1738

cavitating lesion in upper lobe; kidney MC extrapulmonary site

Front 1739

Mycobacterium avium intracellulare (MAI)

Back 1739

atypical TB; MC TB in AIDS

Front 1740

CF

Back 1740

AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)

Front 1741

S/S

Back 1741

pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD

Front 1742

Lung abscess

Back 1742

MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray - air/fluid level

Front 1743

Aspiration sitting

Back 1743

posterobasal segment right lower lobe

Front 1744

Aspiration supine

Back 1744

superior segment right lower lobe

Front 1745

Aspiration right side

Back 1745

right middle lobe, posterior segment right upper lobe

Front 1746

Pulmonary thromboembolism

Back 1746

most derive from femoral vein

Front 1747

Bronchial artery

Back 1747

branch of aorta/intercostal artery; protects against developing pulmonary infarction

Front 1748

Saddle embolus

Back 1748

sudden death due to acute right heart strain

Front 1749

S/S pulmonary infarction

Back 1749

dyspnea and tachypnea; pleuritic chest pain; pleural effusion

Front 1750

Dx

Back 1750

ventilation/perfusion scan; respiratory alkalosis; hypoxemia

Front 1751

Pain on inspiration

Back 1751

pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax

Front 1752

Pathogenesis pulmonary hypertension (PH)

Back 1752

hypoxemia and respiratory acidosis

Front 1753

Hypoxemia + respiratory acidosis

Back 1753

vasoconstriction pulmonary vessels; vasodilation cerebral vessels

Front 1754

Causes PH

Back 1754

1° lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts

Front 1755

Cor pulmonale

Back 1755

PH + RVH

Front 1756

S/S

Back 1756

dyspnea; accentuated P2 (PH); parasternal heave (RVH)

Front 1757

Restrictive lung disease

Back 1757

↓ compliance, ↑ elasticity; interstitial fibrosis/edema

Front 1758

Restrictive lung disease (RLD)

Back 1758

↓ all volumes and capacities; ↑ FEV1sec/FVC ratio

Front 1759

ARDS

Back 1759

RLD; non-cardiogenic pulmonary edema due to alveolar injury

Front 1760

ARDS

Back 1760

neutrophil destruction of type I and II pneumocytes; hyaline membranes

Front 1761

Causes

Back 1761

septic shock (MC), aspiration gastric contents, severe trauma

Front 1762

Pneumoconiosis

Back 1762

inhalation mineral dust causing interstitial fibrosis; particles <0.5 μm to reach alveoli

Front 1763

Caplan syndrome

Back 1763

pneumoconiosis + rheumatoid nodules in lungs

Front 1764

Coal worker’s

Back 1764

“black lung” disease; progressive massive fibrosis; no increased incidence cancer or TB

Front 1765

Silicosis

Back 1765

quartz; nodular opacities; foundry workers; ↑ incidence cancer and TB

Front 1766

Sources asbestos

Back 1766

roofing material, old buildings (9/11), pipe-fitter shipyard

Front 1767

Ferruginous bodies

Back 1767

asbestos fiber coated by iron

Front 1768

Asbestosis

Back 1768

benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma

Front 1769

Mesothelioma

Back 1769

malignancy of serosa; no smoking association

Front 1770

Sarcoidosis

Back 1770

RLD; MC non-infectious lung and liver granulomatous disease

Front 1771

S/S

Back 1771

dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions

Front 1772

Lab findings

Back 1772

↑ ACE, hypercalcemia (macrophages synthesize 1-α-hydroxylase)

Front 1773

Kveim test

Back 1773

intradermal injection sarcoid antigens causes skin reaction

Front 1774

Farmer’s lung

Back 1774

RLD; lung reaction against thermophilic bacteria in moldy hay

Front 1775

Silo filler’s disease

Back 1775

RLD; reaction against nitrogen dioxide in fermenting corn

Front 1776

Byssinosis

Back 1776

RLD; reaction against cotton, linen, hemp products in textile industry

Front 1777

Goodpasture’s syndrome

Back 1777

RLD; anti-BM antibodies; begins in lungs and ends in renal failure

Front 1778

Collagen vascular RLD

Back 1778

SLE, rheumatoid arthritis, systemic sclerosis

Front 1779

Drugs RLD

Back 1779

amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin

Front 1780

Obstructive lung disease

Back 1780

↑ compliance, ↓ elasticity

Front 1781

Obstructive lung disease

Back 1781

↑ RV, TLC; ↓ TV, VC; ↓ FEV1sec and FVC; ↓ FEV1sec/FVC ratio

Front 1782

Obstructive lung disease

Back 1782

asthma, emphysema, chronic bronchitis, bronchiectasis

Front 1783

Asthma

Back 1783

extrinsic (type I hypersensitivity) and intrinsic types

Front 1784

S/S

Back 1784

expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors

Front 1785

Charcot-Leyden crystals

Back 1785

derive from crystalline material in eosinophil granules

Front 1786

Lab findings

Back 1786

initial respiratory alkalosis; respiratory acidosis requires intubation

Front 1787

Emphysema

Back 1787

destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer

Front 1788

Respiratory unit

Back 1788

respiratory bronchiole, alveolar duct, alveoli

Front 1789

Radiograph emphysema

Back 1789

↑ AP diameter; depressed diaphragms; vertical heart

Front 1790

Pathogenesis

Back 1790

↓ AAT, ↑ neutrophil destruction of elastic tissue

Front 1791

Centriacinar emphysema

Back 1791

destruction/distention respiratory bronchioles upper lobe in smokers; THINK

Front 1792

Panacinar emphysema

Back 1792

destruction/distention entire respiratory unit lower lobes; AAT deficiency

Front 1793

Paraseptal emphysema

Back 1793

upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax

Front 1794

Lab findings

Back 1794

normal to decreased PCO2 (respiratory alkalosis)

Front 1795

Chronic bronchitis

Back 1795

productive cough 3 months/2 consecutive years; blue bloater (cyanosis)

Front 1796

Site of obstruction

Back 1796

terminal bronchioles (proximal to respiratory unit)

Front 1797

Lab findings

Back 1797

respiratory acidosis/hypoxemia

Front 1798

Bronchiectasis

Back 1798

obstruction/infection key causes; dilated bronchioles extend to periphery

Front 1799

Causes

Back 1799

CF MCC, TB, immotile cilia syndrome

Front 1800

Immotile cilia syndrome

Back 1800

absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus

Front 1801

Central lung cancers

Back 1801

squamous cancer and small cell cancer; men > women

Front 1802

Peripheral lung cancers

Back 1802

adenocarcinoma; women > men

Front 1803

Squamous lung cancer

Back 1803

cavitate; secrete PTH-related protein

Front 1804

Small cell carcinoma

Back 1804

neuroendocrine tumor; secrete ACTH and ADH

Front 1805

Bronchioloalveolar carcinoma

Back 1805

no smoking relationship; lung consolidation resembling pneumonia

Front 1806

Scar carcinoma

Back 1806

usually adenocarcinoma developing in old TB scar

Front 1807

Bronchial carcinoid

Back 1807

low grade malignant; hemoptysis; rare cause carcinoid syndrome

Front 1808

Metastatic lung cancer

Back 1808

more common than primary cancer; breast cancer MCC

Front 1809

Pancoast tumor

Back 1809

squamous carcinoma posterior mediastinum; destruction superior cervical ganglion

Front 1810

S/S

Back 1810

Horner’s syndrome - lid lag, miosis, anhydrosis; lower brachial plexus injury

Front 1811

Solitary coin lesion

Back 1811

granuloma MCC

Front 1812

Superior vena caval syndrome

Back 1812

primary lung cancer obstructs vessel; venous congestion

Front 1813

Anterior mediastinal masses

Back 1813

thymoma; nodular sclerosing Hodgkin’s; teratomas

Front 1814

Posterior mediastinal masses

Back 1814

usually neurogenic tumors of ganglia

Front 1815

Myasthenia gravis

Back 1815

B cell hyperplasia of thymus MC abnormality; association with thymoma

Front 1816

Thymoma

Back 1816

association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia

Front 1817

Pleural effusions

Back 1817

transudates or exudates; CHF MCC

Front 1818

Spontaneous pneumothorax

Back 1818

rupture subpleural or intrapleural bleb; air/pleural cavity pressure same

Front 1819

S/S

Back 1819

pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds

Front 1820

Tension pneumothorax

Back 1820

flap-like pleural tear; increased pleural cavity pressure; compression atelectasis

Front 1821

S/S

Back 1821

as above except tracheal shift to opposite side

Front 1822

Cleft lip/palate

Back 1822

failure of fusion of facial processes

Front 1823

Herpes labialis

Back 1823

multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep

Front 1824

Hairy leukoplakia

Back 1824

EBV glossitis; pre-AIDS defining lesion; not precursor to cancer

Front 1825

Mumps

Back 1825

bilateral parotitis; unilateral orchitis; ↑ amylase

Front 1826

Diphtheria

Back 1826

pseudomembrane pharynx and trachea with cervical lymphadenopathy

Front 1827

Congenital syphilis

Back 1827

notched central incisors

Front 1828

Actinomycosis

Back 1828

anaerobic gram + filamentous bacteria; complication extracted dental abscess

Front 1829

S/S

Back 1829

draining sinuses with sulfur granules

Front 1830

Exudative tonsillitis

Back 1830

majority are viral; 20% group A streptococcus

Front 1831

Oral thrush

Back 1831

common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae

Front 1832

Dental caries

Back 1832

Streptococcus mutans

Front 1833

Peutz-Jegher’s syndrome

Back 1833

mucosal pigmentation; hamartomatous polyps

Front 1834

Leukoplakia/erythroleukoplakia

Back 1834

biopsy to rule out squamous dysplasia or cancer

Front 1835

Squamous cell carcinoma

Back 1835

smoking and alcohol association; lower lip MC site

Front 1836

Smokeless tobacco

Back 1836

verrucoid squamous cell carcinoma

Front 1837

Gum hyperplasia

Back 1837

phenytoin, pregnancy, scurvy

Front 1838

Pleomorphic adenoma

Back 1838

MC benign tumor of salivary glands; parotid MC site

Front 1839

Mucoepidermoid carcinoma

Back 1839

MC malignant tumor major and minor salivary glands

Front 1840

Dysphagia for solids only

Back 1840

lesion obstructing esophagus; e.g., cancer, web

Front 1841

Plummer-Vinson syndrome

Back 1841

iron deficiency anemia causes esophageal web, glossitis, achlorhydria (↓ HCl in gastric acid)

Front 1842

Dysphagia for solids and liquids

Back 1842

motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome

Front 1843

TE fistula

Back 1843

polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea

Front 1844

VATER syndrome

Back 1844

vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality

Front 1845

Zenker’s diverticulum

Back 1845

MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES

Front 1846

GERD

Back 1846

relaxation of lower esophageal sphincter (LES) with acid reflux

Front 1847

GERD

Back 1847

MCC nocturnal cough and asthma

Front 1848

AIDS esophagitis

Back 1848

Candida MC, CMV, HSV

Front 1849

Barrett’s esophagus

Back 1849

glandular metaplasia distal esophagus in GERD

Front 1850

Complications of Barrett’s

Back 1850

precursor for adenocarcinoma, stricture

Front 1851

Esophageal varices

Back 1851

dilated left gastric vein; sign of portal hypertension due to cirrhosis

Front 1852

Mallory Weiss syndrome

Back 1852

tear of distal esophagus from retching in alcoholic or bulimic

Front 1853

Boerhaave’s syndrome

Back 1853

rupture of distal esophagus from retching; pneumomediastinum

Front 1854

Hamman’s mediastinal crunch

Back 1854

pneumomediastinum (air in subcutaneous tissue)

Front 1855

LES ganglion cells

Back 1855

contain VIP - relaxes LES

Front 1856

Achalasia

Back 1856

failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus

Front 1857

S/S

Back 1857

aperistalsis/dilation of esophagus; regurgitation of undigested food at night

Front 1858

X-ray achalasia

Back 1858

bird’s beak appearance

Front 1859

Acquired achalasia

Back 1859

Chagas’ disease; leishmania destroy ganglion cells

Front 1860

Distal adenocarcinoma esophagus

Back 1860

MC primary cancer; due to Barrett’s esophagus

Front 1861

Squamous cell carcinoma of esophagus

Back 1861

smoking MCC; alcohol also causes

Front 1862

Melena

Back 1862

sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC

Front 1863

Hematemesis

Back 1863

vomiting blood; peptic ulcers MCC

Front 1864

Congenital pyloric stenosis

Back 1864

hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks

Front 1865

Acute hemorrhagic (erosive) gastritis

Back 1865

NSAIDs MCC

Front 1866

Mucous barrier stomach

Back 1866

maintained by PGE; misoprostol PGE analog

Front 1867

Type A chronic gastritis

Back 1867

due to PA; achlorhydria with ↑ serum gastrin

Front 1868

Type B chronic gastritis

Back 1868

due to H. pylori; involves pylorus and antrum

Front 1869

H. pylori

Back 1869

curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma

Front 1870

Gastric ulcer

Back 1870

lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain

Front 1871

Duodenal ulcer

Back 1871

never malignant; ↑ acid production; food relieves pain

Front 1872

Perforated peptic ulcer

Back 1872

air under diaphragm causes pain in left shoulder

Front 1873

Menetrier’s disease

Back 1873

giant rugal hyperplasia; protein loss from increased mucus

Front 1874

Zollinger-Ellison syndrome

Back 1874

malignant islet cell tumor secreting gastrin; part of MEN I syndrome

Front 1875

S/S

Back 1875

PUD in usual locations; sometimes multiple ulcers

Front 1876

Hypergastrinemia

Back 1876

ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure

Front 1877

Leiomyoma

Back 1877

MC benign tumor of stomach

Front 1878

Intestinal type adenocarcinoma

Back 1878

H pylori related; ↓ incidence; lesser curvature pylorus/antrum

Front 1879

Diffuse type adenocarcinoma

Back 1879

linitis plastica; signet ring cells; Krukenberg tumors ovaries

Front 1880

Gastric lymphoma

Back 1880

stomach MC site for extranodal lymphomas; H. pylori associated

Front 1881

Malabsorption

Back 1881

steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease

Front 1882

Causes bile salt deficiency

Back 1882

liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn’s

Front 1883

D-xylose screen

Back 1883

failure to reabsorb xylose indicates small bowel disease

Front 1884

Calcification of pancreas

Back 1884

chronic pancreatitis cause of malabsorption

Front 1885

Celiac disease

Back 1885

autoimmune disease; antibodies against gliadin in gluten; flat villi

Front 1886

Celiac disease

Back 1886

association with dermatitis herpetiformis

Front 1887

Whipple’s disease

Back 1887

systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa

Front 1888

S/S

Back 1888

fever, polyarthritis, skin pigmentation

Front 1889

Invasive diarrhea

Back 1889

Campylobacter jejuni MCC; positive fecal smear for leukocytes

Front 1890

Secretory diarrhea

Back 1890

loss isotonic fluid; enterotoxins from E. coli and V. cholerae

Front 1891

Osmotic diarrhea

Back 1891

hypotonic loss fluid; laxatives, lactase deficiency

Front 1892

Rotavirus

Back 1892

MCC diarrhea in children

Front 1893

Norwalk virus

Back 1893

MCC diarrhea in adults

Front 1894

Cytomegalovirus

Back 1894

common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS

Front 1895

Staphylococcus aureus

Back 1895

preformed toxin causes food poisoning; culture food

Front 1896

Bacillus cereus

Back 1896

preformed toxin in fried rice and tacos; gram positive rods in stool

Front 1897

Clostridium botulinum (adult)

Back 1897

preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis

Front 1898

Clostridium botulinum (child)

Back 1898

colonization of bowel with release of neurotoxin; eating honey

Front 1899

Clostridium difficile

Back 1899

pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole

Front 1900

Shigella sonnei

Back 1900

produces dysentery (bloody diarrhea); associated with HUS

Front 1901

Salmonella enteritidis

Back 1901

gastroenteritis; animal reservoirs - poultry, turtles

Front 1902

Salmonella paratyphi

Back 1902

sepsis; osteomyelitis in HbSS

Front 1903

Salmonella typhi

Back 1903

typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly

Front 1904

Carrier state site

Back 1904

gallbladder

Front 1905

M. tuberculosis

Back 1905

MCC intestinal TB in United States (swallow TB); Peyer’s patch site of infection

Front 1906

Enterotoxigenic E. coli

Back 1906

secretory diarrhea (traveler’s diarrhea); toxin stimulates guanylate cyclase

Front 1907

Vibrio cholerae

Back 1907

secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP

Front 1908

Oral Rx cholera

Back 1908

solution must contain glucose to reabsorb Na+ (co-transport)

Front 1909

Yersinia enterocolitica

Back 1909

mesenteric lymphadenitis; sepsis in iron overload states

Front 1910

Entamoeba histolytica

Back 1910

dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole

Front 1911

Cryptosporidium parvum

Back 1911

MCC diarrhea in AIDS; acid-fast oocysts

Front 1912

Giardia lamblia

Back 1912

MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole

Front 1913

Trichuris trichiura

Back 1913

rectal prolapse in children

Front 1914

Enterobius vermicularis

Back 1914

anal pruritus; urethritis in girls; no eosinophilia

Front 1915

Ascaris lumbricoides

Back 1915

intestinal obstruction due to adult worms; no eosinophilia

Front 1916

Necator americanus

Back 1916

hookworm; iron deficiency anemia

Front 1917

Strongyloides stercoralis

Back 1917

rhabditiform larvae in stool not eggs

Front 1918

Diphyllobothrium latum

Back 1918

fish tapeworm; vitamin B12 deficiency

Front 1919

Signs of small bowel obstruction

Back 1919

colicky pain; constipation and obstipation

Front 1920

Radiograph small bowel obstruction

Back 1920

air-fluid levels on x-ray

Front 1921

MCC small bowel obstruction

Back 1921

adhesions from previous surgery

Front 1922

Duodenal atresia

Back 1922

vomiting bile-stained fluid at birth; double bubble sign; Down syndrome

Front 1923

Hirschsprung disease

Back 1923

absent ganglion cells in submucosal/myenteric plexus rectosigmoid

Front 1924

S/S

Back 1924

proximal bowel dilated but peristalses; no stool in rectal vault

Front 1925

Hirschsprung association

Back 1925

Down syndrome; Chagas disease

Front 1926

Intussusception

Back 1926

terminal ileum telescopes into cecum; obstruction plus bloody diarrhea

Front 1927

Meconium ileus

Back 1927

complication of cystic fibrosis

Front 1928

Indirect inguinal hernia

Back 1928

second MCC of small bowel obstruction; common in weight lifting

Front 1929

Gallstone ileus

Back 1929

obstruction of small bowel with gallstone + air in biliary tree

Front 1930

Volvulus

Back 1930

MC due to sigmoid colon twisting around mesentery

Front 1931

Direct inguinal hernia

Back 1931

protrudes through center of triangle of Hesselbach; no obstruction

Front 1932

Umbilical hernia

Back 1932

common in black children; may entrap bowel in adults

Front 1933

Sigmoid colon

Back 1933

MC site for polyps, cancer, diverticula

Front 1934

Small bowel infarction

Back 1934

diffuse abdominal pain with bloody diarrhea

Front 1935

Causes small bowel infarction

Back 1935

embolism (atrial fibrillation), thrombosis SMA or SMV

Front 1936

Ischemic colitis

Back 1936

splenic flexure pain with bloody diarrhea

Front 1937

Mesenteric angina

Back 1937

pain in splenic flexure 30 minutes after eating

Front 1938

Angiodysplasia

Back 1938

submucosal dilation of venules in cecum; cause of hematochezia

Front 1939

Hematochezia

Back 1939

massive loss of blood per rectum; diverticulosis MCC

Front 1940

Meckel’s diverticulum

Back 1940

persistence omphalomesenteric duct

Front 1941

S/S

Back 1941

bleeding MC (iron deficiency in children), diverticulitis

Front 1942

Meckel’s diverticulitis

Back 1942

mimics acute appendicitis; cannot differentiate without radionuclide scan

Front 1943

Sigmoid diverticulum

Back 1943

diverticulitis MC complication; MCC hematochezia and fistula formation

Front 1944

Diverticulitis

Back 1944

“left-sided acute appendicitis”

Front 1945

Ulcerative colitis

Back 1945

mucosal/submucosal ulceration; starts in rectum; crypt abscess; ↑ risk adenocarcinoma

Front 1946

S/S

Back 1946

left lower quadrant crampy pain with bloody diarrhea

Front 1947

UC associations

Back 1947

primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy

Front 1948

Crohn’s disease

Back 1948

transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions

Front 1949

S/S

Back 1949

colicky pain and diarrhea; fistulas (anal, bowl to bowel)

Front 1950

Carcinoid tumor

Back 1950

appendix MC site; terminal ileum MC site for carcinoid syndrome

Front 1951

Carcinoid syndrome

Back 1951

liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA

Front 1952

Tubular adenomas

Back 1952

precursor lesion colon cancer; size and number determine risk of malignancy

Front 1953

Villous adenoma

Back 1953

greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium

Front 1954

Familial polyposis

Back 1954

AD with 100% penetrance for developing colon cancer

Front 1955

Gardner’s syndrome

Back 1955

AD, polyposis plus osteomas and desmoid tumors

Front 1956

Turcot’s syndrome

Back 1956

AD, polyposis plus brain tumors

Front 1957

Colorectal cancer

Back 1957

second MC cancer and cancer killer in adults

Front 1958

Left-sided colorectal cancer

Back 1958

obstruct; MC location rectosigmoid

Front 1959

Right-sided colorectal cancer

Back 1959

bleed

Front 1960

Acute appendicitis

Back 1960

due to lymphoid hyperplasia in children and obstruction by fecalith in adults

Front 1961

External hemorrhoids

Back 1961

thrombose

Front 1962

Internal hemorrhoids

Back 1962

bleed; prolapse out of rectum

Front 1963

Urobilinogen (UBG)

Back 1963

breakdown product CB in bowel (color of stool)

Front 1964

UBG

Back 1964

enterohepatic circulation to liver and kidney (color of urine)

Front 1965

Alcoholic liver disease

Back 1965

serum AST>ALT; ↑ serum GGT

Front 1966

Viral hepatitis

Back 1966

serum ALT>AST

Front 1967

Cholestasis markers

Back 1967

serum AP and GGT

Front 1968

Unconjugated bilirubin

Back 1968

macrophage degradation of heme; lipid soluble; never in urine

Front 1969

Conjugated bilirubin (CB)

Back 1969

water soluble; never normal in urine

Front 1970

% CB <20% (unconjugated)

Back 1970

Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN

Front 1971

Gilbert’s disease

Back 1971

AD; ↓ uptake and conjugation; bilirubin increases with fasting

Front 1972

Physiologic jaundice newborn

Back 1972

unconjugated hyperbilirubinemia; begins on day three

Front 1973

% CB 20-50%

Back 1973

viral/alcoholic hepatitis

Front 1974

% CB >50%

Back 1974

bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas

Front 1975

Negative urine bilirubin + trace urobilinogen

Back 1975

normal urine

Front 1976

Positive urine bilirubin, absent urobilinogen

Back 1976

obstructive jaundice

Front 1977

Positive urine bilirubin + increased urobilinogen

Back 1977

hepatitis

Front 1978

Negative urine bilirubin + increased urobilinogen

Back 1978

extravascular hemolytic anemia

Front 1979

Markers of severity of liver disease

Back 1979

albumin, PT

Front 1980

Hepatitis A

Back 1980

protective antibodies; day care centers, jails, homosexuals, traveling; not chronic

Front 1981

Hepatitis B

Back 1981

protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma

Front 1982

Hepatitis C

Back 1982

no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma

Front 1983

Hepatitis D

Back 1983

no protective antibodies; requires HBsAg to replicate

Front 1984

Anti-HBs alone

Back 1984

vaccination

Front 1985

Anti-HBs + anti-HBc-IgG

Back 1985

recovered from HBV

Front 1986

HBsAg + HBeAg + HBVDNA + anti-HBc-IgM

Back 1986

acute HBV/chronic HBV infective carrier if >6 months

Front 1987

Anti HBc-IgM alone

Back 1987

serologic gap; not infective

Front 1988

HBsAg + anti-HBc-IgM

Back 1988

chronic HBV healthy carrier

Front 1989

Fulminant hepatic failure

Back 1989

viral hepatitis and acetaminophen MCCs

Front 1990

Spontaneous peritonitis

Back 1990

E. coli in adults; S. pneumoniae in children; complication of ascites

Front 1991

Granulomatous hepatitis

Back 1991

TB MC bacteria

Front 1992

Amebiasis

Back 1992

Entamoeba histolytica; flash shaped ulcers in cecum; liver abscess; Rx

Front 1993

Echinococcosis

Back 1993

Echinococcus granulosis; sheep dog definitive host; man intermediate host

Front 1994

Schistosomiasis

Back 1994

Schistosoma mansoni; adult worms in portal vein; “pipe stem cirrhosis”

Front 1995

Clonorchiasis

Back 1995

Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma

Front 1996

Congestive hepatomegaly (centrilobular necrosis)

Back 1996

“nutmeg” liver; RHF MCC

Front 1997

Hepatic vein thrombosis

Back 1997

Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension

Front 1998

Portal vein thrombosis

Back 1998

ascites, portal hypertension, no hepatomegaly

Front 1999

Alcohol related disorders

Back 1999

fatty change; alcoholic hepatitis; cirrhosis

Front 2000

Hypertriglyceridemia in alcoholics

Back 2000

↑ synthesis of glycerol 3P (substrate for TG synthesis)

Front 2001

Hypoglycemia in alcoholics

Back 2001

↓ gluconeogenesis (↑ NADH causes pyruvate to convert to lactate)

Front 2002

Ketoacidosis in alcoholics

Back 2002

↑ lactate, ↑ ßOHB (acetyl CoA converted to AcAc and then ßOHB)

Front 2003

Primary biliary cirrhosis

Back 2003

granulomatous destruction triad bile ducts; anti-mitochondrial antibody

Front 2004

Primary sclerosing cholangitis

Back 2004

association with ulcerative colitis; MCC of cholangiocarcinoma

Front 2005

Extrahepatic biliary atresia

Back 2005

neonatal cholestasis

Front 2006

Drugs causing hepatitis

Back 2006

acetaminophen, isoniazid, halothane

Front 2007

Anabolic steroids

Back 2007

intrahepatic cholestasis

Front 2008

Estrogen/oral contraceptives

Back 2008

intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)

Front 2009

Methotrexate

Back 2009

liver fibrosis, fatty change

Front 2010

Liver angiosarcoma

Back 2010

vinyl chloride

Front 2011

Hemochromatosis

Back 2011

AR; increased iron reabsorption; liver target organ

Front 2012

S/S

Back 2012

cirrhosis; “bronze diabetes” - skin pigmentation + destruction of islet cells; malabsorption

Front 2013

Lab

Back 2013

↑ serum ferritin, iron, % saturation; ↓ TIBC

Front 2014

Wilson’s disease

Back 2014

AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin

Front 2015

S/S

Back 2015

cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet’s membrane)

Front 2016

Lab

Back 2016

↓ ceruloplasmin (causes ↓ total copper); ↑ serum/urine free copper

Front 2017

HELLP syndrome

Back 2017

pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets

Front 2018

AAT deficiency in child

Back 2018

AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma

Front 2019

Reye syndrome

Back 2019

coma and microvesicular fatty change post viral infection; increased ammonia

Front 2020

Cirrhosis

Back 2020

irreversible fibrosis; regenerative nodules; portal hypertension

Front 2021

Causes cirrhosis

Back 2021

alcohol (MC), HBV/HCV, hemochromatosis, Wilson’s, AAT deficiency, 1° biliary

Front 2022

Hepatic encephalopathy

Back 2022

mental status changes; ↑ serum ammonia

Front 2023

Portal hypertension

Back 2023

ascites; varices; splenomegaly; hemorrhoids; caput medusae

Front 2024

Cause of ascites

Back 2024

portal hypertension; hypoalbuminemia; secondary aldosteronism

Front 2025

Rx

Back 2025

use aldosterone blocker (acidosis increases loss ammonium in stool)

Front 2026

Hyperestrinism in men

Back 2026

gynecomastia; spider angiomas; female hair distribution

Front 2027

Lab findings cirrhosis

Back 2027

↓ BUN, glucose, sodium, potassium, calcium (↓ vitamin D); ↑ PT

Front 2028

Liver cell adenoma

Back 2028

estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage

Front 2029

Liver cancer

Back 2029

metastasis MC cancer; lung cancer MC primary site

Front 2030

Hepatocellular carcinoma

Back 2030

chronic HBV and HCV MCC; ↑ AFP; hepatic/portal vein invasion

Front 2031

Cholangiocarcinoma

Back 2031

primary sclerosing cholangitis MCC, C.C sinensis

Front 2032

Pathogenesis of cholesterol stones

Back 2032

bile with too much cholesterol and too little bile salts

Front 2033

Black pigment stones

Back 2033

sign of extravascular hemolytic anemia (spherocytosis, HbSS)

Front 2034

Acute cholecystitis

Back 2034

stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder

Front 2035

Chronic cholecystitis

Back 2035

chemical inflammation

Front 2036

Gallbladder cancer

Back 2036

risk factors - cholelithiasis and porcelain gallbladder

Front 2037

Acute pancreatitis

Back 2037

causes - alcohol and gallstones; ↑ amylase and lipase (more specific)

Front 2038

S/S

Back 2038

epigastric pain with radiation into back

Front 2039

Sentinel loop

Back 2039

localized ileus of duodenum due to acute pancreatitis

Front 2040

Pancreatic pseudocyst

Back 2040

abdominal mass; persistence of ↑ serum amylase >1 week

Front 2041

Chronic pancreatitis

Back 2041

alcohol abuse, CF; malabsorption, pain, type I diabetes

Front 2042

Pancreatic cancer

Back 2042

smoking MCC

Front 2043

S/S

Back 2043

jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau's sign); ↑ CA 19-9