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561 Cards in this Set
- Front
- Back
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What is the most common malaria?
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Vivax (Viva! It's the MC)
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What is the fever pattern for P. vivax?
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48 hours (Viva the 48 hr party!!!)
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Which malaria is the most lethal?
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Falciparum (make one false step and you are dead)
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Which malaria is associated with nephrotic syndrome?
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P. malariae
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What is the fever pattern for P. falciparum?
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No pattern, it is so false that it doesn't have one
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What is the fever pattern for P. malariae?
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72 hours
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What do you find in the lab work for falciparum malariae?
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Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)
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Prophylaxis Tx for malaria?
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Chloroquine
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What drug do you use for resistant falciparum?
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Mefloquine<br>ME FLOr resistant Falciparum
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What is the Tx for all except falciparum?
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Chloroquine plus primaquine
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What is the specific Tx for falciparum?
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IV quinidine or quinine plus doxycycline<br>Falciparum is the FALSE QUEEN (quinidine)
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What leukemia has translocation t(15;17)
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Acute Promyelocytic Leukemia (M3)
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In which leukemia do you find DIC?
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Acute Promyelocytic Leukemia (M3)
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What leukemia has gum infiltration?
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Acute Monocytic Leukemia (M5)
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What leukemia has auer rods?
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Acute Myelogenous Leukemia (M2/M3)
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What are auer rods?
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fused azurophilic granules on cytosol of blast cells
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What leukemia is cured/reverse with Vitamin A (Retinol)?
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Acute Promyelocytic Leukemia (M3)
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What is the age distribution of all leukemias?
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ALL (0-14) AML (15-39) AML (40-60) AML + CML (40-60) CLL (>60 years old)
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Which leukemia has translocation t9;22?
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Chronic Myelogenous Leukemia (CML)
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What is the frequency of acute leukemias ?
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Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%
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What leukemia is associated with ABL protooncogene?
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Chronic Myelogenous Leukemia (CML)
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What is the translocation of ABL protooncogene?
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t9;22
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What chromosome is CML found in? What is the name of the chromosome?
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Chromosome 22; Philadelphia Chromosome
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What is affected in chromosome 22 for CML?
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bcr (break cluster region) bcr-ABL fusion gene
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What is the most specific test for CML?
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decrease LAP (Leukocyte Alkaline Phosphatase)
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What are other positive tests for CML?
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philadephia chromosome and bcr-ABL fusion gene
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What is the most common cancer and leukemia in children?
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ALL
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What is the most common subtype of ALL?
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pre-B (80%)
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What is a positive marker for ALL?
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CALLA; CD10 <br>Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase)<br>You are Caller No. 10!!!
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Where do B cells metastasize in ALL?
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CNS and testicles<br>think B is for Brain and Balls!
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Where do T cells metastasize in ALL?
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Anterior Mediastinal mass or acute leukemia
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Which ALL type has best prognosis?
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t(12;21)
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Gout or Pseudogout? <br>How do you tell?
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Positively Birefringement (Blue color) Pseudogout<br>Negatively Birefringement (Yellow color) Gout
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What crystal is negatively birefringent?
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Negative is Yellow in color so it's Monosodium Urate for Gout
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What crystals are positively birefringent?
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Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout
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Blue Crystals?
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Pseudublue<br>Pseudogout<br>- Blue is Calcium pyrophosphate
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Yellow Crystals?
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Gout Monosodium urate
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What joints are involved in Osteoarthritis?
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DIP + PIP
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What joints are involved in Rheumatoid Arthritis?
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MCP + PIP
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What are PIP joints inflamed called?
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Bouchard Node<br>Pouchard
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What is a Heberden Node?
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Inflamation of DIP
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What is rheumatoid factor? (RF)
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IgM Ab against IgG
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Where is rhematoid factor found?
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In synovial fluid
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What is the synovial tissue that grows over the articulate cartilage called?
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Pannus <br>Not to be confused with Tophus that is found in Gout
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Which on is symmetrical? Rheumatoid or Osteoarthritis?
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Rheumatoid
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What is it called when you get a patient with rheumatoid arthritis that expresses dry mouth and dry eyes?
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Sjogren syndrome
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Syndrome with rheumatoid arthritis with nodes in the lungs?
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Caplan Sx
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What is the Tx of Rheumatoid Arthritis?
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Methotrexate
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What are some effects of long teng methotrexate tx?<br>i.e. Arhtritis Tx
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Macrocytic Anemia<br>Hypersegmented Neutrophils<br>Also causes:<br>Intersitial Fibrosis of the Lung
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Tx for Gout?
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Indomethacine
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What drug do you give for underexcretion of uric acid?
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Probenecid<br>Sulfanpirizone
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Overproducer of uric acid?
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Allopurinol
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What is the mech. of Allopurinol?
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Block Xanthine Oxidase
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What is the mechanism of uric acid accumulation/gout in alcoholics?
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Patients with alcoholism are under metabolic acidosis<br>-All the acids compete in the excrition of proximal tubule<br>Alcoholics contain b-hydroxybutiric acid, lactic acid so they compete with uric acid to be excreted
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Dz with degenerative arthritis in vertebral columns, pee turns black?<br>cartilage is turns black
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Alkaptonuria
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What is the inheritance of alkaptonuria?
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autosomal recessive
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In alkaptonuria, what enzyme is absent and what accumulates?
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Homgentisic Acid builds up<br />homogentisic oxidase
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Patient w/ dysuria, sterile pyuria?
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Non-specific urethritis chlamydia<br />No culture in urine
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Patient with dysuria develops pain on Achilles Tendon and Conjunctivitis
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Reiter's Sx<br />HLA-27 (+) patient
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Chlamydia triggered HLA-B27?
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Yes, it made Reiter become active<br>- Ulcerative colitis can also be an environmental factor<br>- psoriasis<br>- shigella
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Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?
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Disseminated Gonococchemia
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What complement components do you need to kill Gonorrhea?
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C5-C9
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Septic arthritis?
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MC gonorrhea (GC) Gonoccocus...
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Any patient with bilateral bell-spalsy?
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Lyme Dz until proven otherwise
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MC cranial nerve involved with Lyme Dz?
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VIIth nerve
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Ticks carry both dz?
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Lyme and Babesia
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What percent of lyme infected have babeiosis?
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20% of patients have babeiosis
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What is babesia microti?
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intracellular erythrocytic parasite<br>similar to ring falciparum
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Mechanism of blue sclera?
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Color of veins is blue<br>Seein the coroidal veins<br>that give the color to the sclera since there is very little collagen I
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What is osteopetrosis?
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Brittle bone Dz<br>Defect in osteoclasts<br>no marrow, severa anemia
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Where are B cells located in lymph nodes?
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Germinal Follicles; Peripheral areas of spleen (white pulp)
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Where are T cells located?
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ParacorTex; periarteriolar sheat in spleen
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What are histiocytes and where are they located?
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Part of the Lymphatic system in sinuses; skin (Langherhan's Cells); Red Pulp in Spleen
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What is associated with Left Supraclavicular Nodes?
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Abdominal and Pancreatic CA
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What is associated with Right Supraclavicular Nodes?
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Lung Mets and Esophageal CA; Hodgkin's lymphoma
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What is the left supraclavicular node called?
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Virchow's Node
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What CA diseminates to para-aortic nodes?
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Testicular CA and Burkitt's Lymphoma
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What gene is associated with Follicular Lymphoma?
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Translocation t14;18<br />overexpression of bcl-2<br /><span style="text-decoration: underline;">Fo</span>llicular Think <span style="text-decoration: underline;">Fo</span>urteen<br />
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What gene association is found in Burkitt's?
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EBV translocation t8;14<br>African Jaw
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What does the African variant involve? (Burkitt's)
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Jaw
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Which organs does the American variant of Burkitt's Lymphoma involve?
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GI, ovaries and retroperitoneum
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What do you see in Burkitt's?
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Starry Sky Apparence
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What is the Starry Sky?
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macrophages w/ phagocytosed apoptotic bodies
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What are the cells of Hogkin's L. called?
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Reed-Sternberg Cells
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What are Reed-Sternberg Cells?
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transformed germinal center B cells
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What CD maker's do you use to detect RS cells?
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CD15 and CD30; you got to be able to REED by 15 and 30
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What does a classic RS cell look like?
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two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo
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What is elevated in vWF disease?
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Elevated Bleeding Time (platelet adh. problem)<br>aPTT increased
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What is elevated on hemophilia A?
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VIII deficient<br>aPTT increased<br>(intrinsic pathway)
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What is elevated in a person taking aspirin?
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Bleeding Time elevated
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What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
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Bleeding Time increased<br>platelets decreased
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What are two other diseases that has Bleed Time increased and decreased platelets?
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Thrombotic Thrombocytopenic Purpura<br>Hemolytic Uremic Syndrome
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What factor involved in extrinsic pathway?
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VII
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What factor involved in intrinsic pathway?
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XII, XI, IX, VIII
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What is the best test for vWF disease?
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ristocetin cofactor assay
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What anti bodies does blood group O have?
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anti A-IgM<br>anti B-IgM<br>anti AB- IgG
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What anti bodies have blood A?
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anti B
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What does group B has?
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anti A-IgM
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What does group AB has?
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nothing<br />just like new borns and old people
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What blood group has greatest incidence of gastric carcinoma?
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group A
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What is associated w/ duodenal ulcer?
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group O blood
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Who is the universal donor?
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Group O
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Who is the universal acceptor?
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AB no antibodies to attack those cells
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What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
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SIS
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What POC is associated w/ Leukemia?
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RAS
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What POC is associated w/ Breast CA?
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ERB-B2
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What POC is associated w/ Astrocytoma?
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SIS
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What POC is associated w/ Neuroblastoma?
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N-MYC
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What POC is associated w/ lung CA?
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RAS
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What POC is associated w/ CML?
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ABL
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What POC is associated w/ Burkitt's Lymphoma?
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c-MYC<br>MYC
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What POC is associated w/ colon CA?
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RAS
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What POC is associated w/ MEN IIa/IIb Syndromes?
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RET
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WhatPOC is associated w/ pancreatic CA?
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RAS
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What function does SIS have?
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GF synthesis<br>(Growth Factor)
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What fx does ERB-B2 has?
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Receptor Synthesis
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What fx does ABL has?
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Non-receptor TK activity
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WHat fx does RET have?
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Receptor Synthesis
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What fx does MYC have?
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Nuclear Transcription
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What fx does N-MYC have?
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Nuclear transcription
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WHat fx does RAS has?
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GTP signal transduction
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What two POC have the same function of Receptor Synthesis?
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ERB-B2 and RET
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What two POC have the same fx of nuclear transcription?
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c-MYC and N-MYC
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What activates RET?
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Point Mutation
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What activates RAS?
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Point Mutation
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What activates ABL?
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translocation<br />t(9;22)
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What activates c-MYC (burkitt's lymphoma)?
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t(8;14)
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What activates N-MYC?
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Amplification
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What two POC amplify?
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ERB-B2 and N-MYC
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What two POC are activated by point mutation?
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RET and RAS
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What two POC are activated by translocation?
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ABL and c-MYC
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What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
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EBV
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What POC amplifies breasts??? imagine that...
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ERB-B2<br>Breast bigger two!
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What are the tumor suppressor genes?
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TP53, RB, APC and BRCA1/2
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What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
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TP53
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What SG is assciated w/ breast, ovary and prostate CA?
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BRCA 1<br>BRCA 2
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What SG is associated w/ familial polyposis: colon cancer?
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APC
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What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
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RB
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What is the function of TP53?
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G1 to S phase inhibitor
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What is the function of BRCA 1/2 gene?
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Regulates DNA repair
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What is the APC gene function?
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Prevents nuclear transcription<br>- degrades catenin; an activator of nuclear transcription
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What is the function of RB gene?
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G1 to S phase inhibitor
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What are the genes fo anti-apoptosis?
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BCL-2 genes
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What is the function of BCL-2 genes?
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prevents the leakage of cytochrome c (signal for apoptosis)
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What disease is associated with BCL-2?
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b-cell lymphoma<br>B C L -2<br>Follicular Lymphoma t14;18
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What is another disease that involves TP53?
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Ataxia Telangiectasia<br>syceptibility to malignant lymphoma
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What virus is associated w/ TP53?
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HBV and<br>HTLV-1(T cell leukemia and lymphoma)<br>HPV 16,18 HPV16 inhibits TP53<br>RB inhibited by HPV 18
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What CA is associated w/ hypercalcemia?
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primary SCC of lung<br>Renal Adeconcarcinoma<br>PTH-like peptide
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WHat CA is associated w/ myasthenia gravis?
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Eaton-Lambert Sx<br>SCC of lung
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What CA is associated w/ sudden appearance of seborrheic keratosis?
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"Sudden"<br>Stomach Adenocarcinoma
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What CA is associated w/ hypertrophic osteoarthropathy?
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Lung CA
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What CA is associated w/ superficial migratory thrombophlebitis?
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pancreatic carcinoma<br>Troussau sign (he had it himself, self-diagnosed)
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What CA manifests Nonbacterial thrombotic endocarditis?<br>(Sterile Vegetations on Mitral Valve)
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Mucous-secreting pancreatic and colorectal CA
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WHat CA manifests w/ ADH increase? What do you find clinically?
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SCC of lung<br>Hyponatremia
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What CA manifests w/ ACTH increase? Clinical Symptoms?
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SCC of lung<br>Medullary CA of Thyroid<br>Clin: Cushing Sx
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What CA manifests increase in erythropoietin? <br />
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Renal AdenoCA<br />primary SCC of lung<br />Breast CA<br />
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What CA presents w/ inc. in B-hCG? Symp?
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Choriocarcinoma (Testis)<br>gynecomastia
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What CA presenst w/ Calcitonin increase? Symp.?
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Medullary CA of Thyroid<br>hypocalcemia
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What region of the face does BCC and SCC occur?
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BCC top of the face upper lips<br>SCC below lower lips
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WHat RNA virus is associated with TP53 suppressor?
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HTLV-1 T cell leukemia and lymphoma virus!
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What DNA virus is associated w/ TP53 suppersor gene?
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HBV and HPV 16,18 E6 inhibits it
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What two genes are knocked out by HPV 16, 18?
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E6 and E7 produced by HPV<br>E6 inhibits TP53<br>E7 inhibits RB suppressor gene
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What CA is EBV associated with?
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Burkitt's lymphoma<br />CNS lymphoma in AIDS<br />Mixed Cellularity Hodgkin's <br />Nasopharyngeal CA
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What virus is associated w/ hepatocelluar CA?
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HBV
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What RNA virus causes hepatocellular CA?
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HCV not HBV!!!<br>HBV is DNA virus
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What deffect has opening snap during diastole?
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Mitral Stenosis<br>Snap Stenosis
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What MCC of death in rheumatic fever?
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Myocarditis
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What type of Hypersensitivity is Rheumatic Fever?
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Type II
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What organism is involved in Rheumatic Fever?
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group A Strepto<br>Step. pyogenes
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What do the antibodies react to in Group A Steptococcus?
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Ab react to M proteins
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What are two common findings in rheumatic myocarditis?
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aschoff bodies<br />Anitschkow Cells<br />the two Russians
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WHat are Aschoff Bodies?
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central fibrinoid necrosis surrounded by reactive histiocytes
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How long after a group A step. pharyngitis does Rheumatic Fever occur?
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1-5 weeks after episode
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What are five signs of Rheumatic fever?
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1) Carditis<br>2) Migratory polyarthritis<br>3) Subcutaneous Nodules<br>4) Erythema Marginatum<br>5) Sydenham's Chorea
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What valve is affected with a pansystolic (holosytolic) murmur?
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Mitral Regurgitation
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What valve is involved in a mid-systolic click?
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Mitral Valve Prolapse<br>it clicks half way since the chordae restrain it
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What two diseases have Mitral Valve Prolapse?
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Marfan's Sx <br>Ehlers Danlos
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What pathology is associated with coarctation of the aorta?
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Turner Sx
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What is the MC congenital heart disease in children?
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VSD<br>very small dudes :)
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What is the MC congenital heart disease in adults?
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a is for ASD
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What are the three A's in ASD?
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Adults<br>Alchohol Fetal Sx<br>ALL from Down Syndrome
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What viral infection is involved w/ PDA?
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rubella
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What murmur is heard in PDA?
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machine like murmur during systole and diastole
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What keeps PDA open in fetus?
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PGE2
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What is the Tx for closure of PDA in newborn?
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indomethacin
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Where is the murmur best heard for PDA?
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between the shoulder blades
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What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?
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Alcohol
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What carcinogen is impilcated with stomach AdenoCA?
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nitrosamines and nitrosamides
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What carcinogen is impilcated with colorectal cancer?
|
Lithocholic acid <br>secondary bile acid
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What carcinogen is impilcated with Lung CA? (4)
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uranium<br>asbestos<br>chromium<br>nickel
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What carcinogen is impilcated with pleural mesothelioma?
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Asbestos
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What carcinogen is impilcated with breast cancer and cervical cancer?
|
Oral Contraceptives
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What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
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Arsenic
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What carcinogen is impilcated with TCC of bladder? (2)
|
cyclophosphamide<br>b-naphthylamine (dye and rubber indus.)
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What carcinogen is impilcated with acute leukemia?
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benzene
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What carcinogen is impilcated with SCC of penis?
|
Smegma in uncircumcised male
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What carcinogen is impilcated with SCC of scrotum?
|
tar, soot, oil (chimney sweeper)
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What carcinogen is impilcated with malignant lymphoma?
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Alkylating agents
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What is the mos common risk factor for BCC, SCC, melanoma?
|
UVB light
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What is the mos common risk factor for Kaposi's Sacroma?
|
HHV-8
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What is the mos common risk factor for Nasopharyngela CA?
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EBV
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What is the mos common risk factor for larynx CA?
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polycyclic HOC (hydrocarbons)
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What is the mos common risk factor for distal esophagus?
|
barret's disease
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What is the mos common risk factor for Stomach AdenoCA?
|
Helicobacter pylori
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What is the mos common risk factor for Colon adenoCA?
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preexisting polyps<br>tubular and villous adenoma
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What is the mos common risk factor for pancreas?
|
polycyclic HOC
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What is the mos common risk factor for hepatocellular CA?
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HBV or HCV cirrhosis
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What is the mos common risk factor for seminoma?
|
cryptorchid testis<br>semi-descended testis<br>semi noma
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What is the mos common risk factor for breast CA?
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age >50<br>excess estrogen:<br>1) nulliparity<br>2) early menarche<br>3) late menopause<br>4) obesity
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What is the mos common risk factor for dysgerminoma/gonadoblastoma?
|
Turner Sx XO dysgerminoma<br>XO/XY gonadoblastoma
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What is the mos common risk factor for vagina/cervix clear cell?
|
diethylestilbestrol
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What is the mos common risk factor for surface derived ovarian CA?
|
nulliparity<br>because of increase of ovulatory cycles
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What is the mos common risk factor for choriocarcinoma?
|
Complete Hydatidiform Mole
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What is the mos common risk factor for Malignant lymphoma thyroid?
|
Hashimoto's Thyroiditis
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What is the mos common risk factor for papillary CA of thyroid?
|
Ionization Radiation
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What is the mos common risk factor for medullary CA thyroid?
|
MEN IIa/IIb
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What is the mos common risk factor for osteogenic sarcoma?
|
retinoblastoma<br>radiation
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What is the mos common risk factor for Primary CNS lymphoma?
|
EBV in AIDS pat.
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What is the mos common risk factor for Burkitt's Lymphoma?
|
EBV
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Which on is protein rich? Transudate or Exude?
|
Exude<br>extra proteins inside the fluid
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What causes flushing and diarrhea in carcinoid Sx?
|
serotonin
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What mumurs are heard in systole with crescendo-decrescendo fashion??
|
Stenosis AV/PV (atrial valve/pulmonary valve)
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What murmur is heard in MV/TV regurgitation?
|
Pansystolic murmur
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What murmur is heard in AV/PV regurgitation?
|
high pitched diastolic murmur directly after S2
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What is the MC cardiomyopathy?
|
congestive (dilated) cardiomyopathy
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What causes congestive cardiomyopathy? MC Drug? MC vitamin. def?
|
- idiopathic (MC)<br>- doxorubicin/cocaine<br>- thiamine deficiency (Alcoholics)<br>- hypothyroidism
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What is the MCC of sudden death in young people?
|
Hypertrophic cardiomyopathy
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What is the MCC of infective endocartitis?
|
Strep. viridians
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What is the MCC of infective endocartitis in I.V. drug user?
|
Staph. aureus
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What is the MCC of infective endocartitis in colon cancer and ulcerative colitis?
|
Strep. bovis
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What is the MCC of infective endocartitis in prosthetic devices?
|
Staph. epidirmidis
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What is the MCC valve involved in infective endocartitis?
|
mitral valve
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What are the clinical findings in infective endocarditis?
|
1) type III; HS<br />- Roth Spots retina<br />- splinter hemorrhage<br />- glomerulonephritis w/ RBC casts
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What is associated w/ Libman Sacks endocarditis?
|
SLE
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What DZ has sterile vegetations covered on valvular surfaces?
|
SLE<br>-libman sacks endocarditis
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What two diseases are involved w/ mucin-producing sterile vegetations?
|
tumors of colon and pancreas<br>Marantic vegetations
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What is the MCC of viral myocarditis?
|
Coxsackievirus
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What other pathogens cause myocarditis?
|
Borrelia (Lyme Dz)<br>T. cruzi (Chagas)<br>Tichinella spiralis (trichinosis)
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What is the MCC of pericarditis?
|
Coxsackievirus again!
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What disease involves hypotension assciated w/ pulsus paradoxus?
|
pericarditis
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|
What is pulsus paradoxus?
|
decrease in >10mmHG in systole during inspiration
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What other sign is seen in pericarditis?
|
Kussmaul's Sign
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|
What is Kussmaul's sign?
|
neck vein distension on inspiration<br>blood refluxes to jugular vein instead of entering RA
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What is the MCC of constrictive pericarditis?
|
TB worldwide
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|
What is the problem in hypertrophic cardiomyopathy?
|
mutation in heavy chain of beta-myosin and troponins
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|
What kind of genetics does hypertrophic cardiomyopathy have?
|
autosomal dominant
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|
What is the MC site of metastasis to cardiac tissue?
|
pericardium
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|
MC benign tumor of cardiac origin? Location?
|
Cardiac Myxoma<br>Left atirum
|
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|
What is a benign tumor of the heart that arises from cardiac muscle? MC in age?
|
Cardiac Rhabdomyoma<br>infants and children
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What disease is associated with cardiac rhabdomyoma?
|
Tuberous Sclerosis
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What is associated w/ Alzheimer's Dz?
|
Depression
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|
What is the pathogenesis of mitral valve prolapse?
|
increase/accumulation of dermatan sulfate
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|
What is the characteristic murmur of mitral valve prolapse?
|
mid-systolic click
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When does the murmur approach to S1?
|
decrease in preload<br>less blood
|
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|
How do you calculate the A-a gradient?
|
Alveolar PO2= 21%O2(Atm. P-47) - pCO2/0.8<br>A= (.21)(713)- 40/0.8)<br>Usually A=100<br>A-a<br>a=95<br>Normal A-a grad= 5-30
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When is A-a gradient indicative of pulmonary pathology?
|
when A-a grad = >30
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|
Where do infactions of the lung occur?
|
Lower lobes<br>i.e. more perfusion
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|
What is the diagnosis of a child w/ Nasal Polyps? Test for?
|
Sweat Test<br>Cystic Fibrosis (CF)<br>until proven otherwise
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Patient w/ fibromyalgia and develops asthma, what is the cause of this?
|
Aspirin induced asthma<br>block PG but still produce Leukotriene build up<br>LT C-D-E4 buildup<br>(potent bronchoconstrictors)
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|
|
Causes of Hypoxemia w/ normal A-a gradient?
|
- barbiturates OD<br />- epiglottitis (Upper Airway Obstr.)<br />- Amyotrophics Lat. Sclerosis (ALS)
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|
Newborn that turns cyanotic when breast feeding; cries and turns back to pink. Diagnosis?
|
Choanal Atresia
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|
What is the complication of Sleep Apnea?
|
Pulmonary Hypertension<br />- vasoconstrictive effects of chronic hypoxemia and respiratory acidosis<br />called COR-PULOMONALE
|
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|
What sinus is involved in adults w/ sinusitis? children?
|
mAxilary ADULTS<br>ethmoid children<br>ethmall
|
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|
What is a common finding of sinusitis in diabetics?
|
Mucor sinusitis
|
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Why does Mucor species prevail in sinusitis of Diabetic patients?
|
Ketoacidosis cuases proliferation
|
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What does Mucor sp. invade?
|
frontal lobes
|
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|
What is the cause of Nasopharyngeal Carcinoma?
|
EBV<br>common in Chinese
|
|
|
What three compounds increase surfactant?
|
1) thyroxin<br>2) prolacitn<br>3) glucocorticoid
|
|
|
What happens when no primary cancer is found in cervical lymph node metastasis?
|
nasopharynx should be biopsied
|
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|
Risk factor for Laryngeal CA?
|
smoking
|
|
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What is synergistic with smoking in Laryngeal CA?
|
Alcohol ingestion<br>smoking + alcohol = bad combo
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|
What is found in the physical exploration of Atelectasis?
|
- dullness to percussion<br>- absent tactile fremitus
|
|
|
When do you see atelectasis after surgery?
|
usually 24-36 hrs post surgery
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|
What is the pathogenesis of Respiratory Distress Syndrome in Newborns?
|
Atelectasis due to loss of surfactant
|
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|
Where is surfactant made?
|
Type II neumocytes
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Where is surfactant stored?
|
lamellar bodies
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When does synthesis of surfactant begin?
|
28th week
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When is surfactant at it's peak?
|
35 weeks
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|
What disease is common to dysphagia fro liquids? (lower esophagus)
|
Achalasia MC<br />progressive systemic sclerosis/CREST Sx
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What Dz is involved in dyspaghia for liquids but in the Upper esophagus?
|
polymyositis<br />myasthemia gravis
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Why is myasthemia gravis on the upper esophagus?
|
Upper 1/3 of esophagus is striated muscle
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|
What three diseases have disphagia for solids?
|
really bad...<br />1) plummer vinson <br />2) esophageal CA<br />3) Barrett's Esophagus (ulceration and stricture)
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|
What is associated with iron deficiency and dysphagia for solids?
|
Plummer-Vinson
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What does it mean when you have dysphagia for solids but not liquids?
|
Mechanical Obstruction
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|
What does it mean when you have dysphagia for both solids and liquids?
|
peristalisis problem
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|
|
What is the MCC of odynophagia in HIV?
|
esophagitis caused by Candida albicans<br>Aids Defining
|
|
|
MC congenital esophageal disorder?
|
Tracheoesophageal fistula
|
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|
What is wrong in tracheosophageal fistula? (what ends blindly?)
|
Proximal esophagus ends blindly
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|
What are the common signs and symptoms of TE fistula in pregnancy?
|
Polyhydramnios<br />(excess fluid)<br />fetus is not reabsorbing it through mouth
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What are signs/symptoms (S/S) of Trachesophageal Fistula (TE) in babies?
|
apsiration of milk into trachea<br>- abdominal distention
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What is connected in TE fistula?
|
Trachea and Stomach!!!<br>Distal Esophagus arises from Trachea
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|
What is the VATER Sx?
|
Vertebral Abnormalities<br>Anus Imperforated<br>TE fistula<br>Renal Disease/Radius abnormality
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|
What are the causes of polyhydramnios?
|
- TE fistula<br />- Anencephaly<br />- duodenal atresia (Down/ALL)
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|
What is weakness in the esophageal wall called?
|
Zenker's Diverticulum
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What is weak in Zenker's Diverticulum?
|
cricopharyngeus muscle weakness
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What are the S/S of Zenker's Diverticulum?
|
bad breath<br>food collects in pouches
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|
What is the pathogenesis of achalasia?
|
failure of relaxation of LES sphincter
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What is absent in achalasia?
|
absent relaxation<br>absent myenteric ganglion cells
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What is substance is missing in the myenteric ganglion of achalasia?
|
VIP (vasointestinal peptide)
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What is the function of VIP?
|
relax the LES
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What sign do we see in the X-ray of achalasia?
|
bird's beak in barium study<br>dilation of proximal esophagus
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HOw are achalasia and progressive systemic sclerosis (PSS)/ CREST Sx similar?
|
both have relaxation of LES<br>absence of esophageal motility<br>manometry best diagnostic measure
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|
What does CREST stand for?
|
Calcinosis<br>Raynaud's Phenomenum<br>Esophageal Motility Dysfunction<br>Sclerodactyly<br>Telangiectasias
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What laboratory test do you use to diagnostie CREST Sx?
|
ANA (70-90%)<br>anti-SCL-70 (70%) topoisomerase I<br>anti-centromere antibodies (30%)
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|
What is the problem in GERD?
|
relaxed LES<br>acid injury leads to Barrett's esophagus and then distal AdenoCA
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|
|
What vein is most likely to have varices in esophagus?
|
left gastric coronary vein (from portal)<br>azygous vein
|
|
|
What is the MC organism causes esophagitis?
|
Candida
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|
What are other causes of esophagitis?
|
Herpes (multinucleated cells w/ intranuclear inclusions)<br>CMV (single nucleurs w/ largo basophilic inclusion)
|
|
|
What is the name of the TEAR of the DISTAL esophagus?
|
Mallory Weiss Sx
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|
When does Mallory Weiss Sx occur?
|
Alcoholics<br>bulimia
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What is the name of the RUPTURE of the DISTAL esophagus?
|
Boerhaave's Sx
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|
What is the MCC of Boerhaave's Sx?
|
Endoscopy procedure!!!
|
|
|
What is the MCC of primary cancer in the esophagus in the U.S.? What part of the esophagus?
|
Adenocarcinoma of distal esophagus
|
|
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What is the MC esophageal CA in developing countries and where is it located in the esophagus?
|
Squamous CA <br>Mid-esophagus
|
|
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MCC of hematemesis?
|
duodenal ulcer<br>2) gastric ulcer<br>3) esophageal varices
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|
Main difference between congenital pyloric stenosis and duodenal atresia?
|
Bile containing fluid in Duodenal Atresia<br>Also duodenal atresia associated w/ Down Sx<br>polyhydramnios seen in mother in Duodenal Atresia
|
|
|
What are the three functions of PGE2?
|
1) increase blood flow to mucosa<br>2) increase secretion of mucous<br>3) increase HCO3- cytoprotective
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|
What is an analog of PGE2?
|
Misoprostol<br>cytoprotective
|
|
|
What part of the stomach is affected by pernicious anemia?
|
Body and Fundus
|
|
|
What type of gastritis is pernicious anemia?
|
Type A atrophic gastitis
|
|
|
What part of the stomach does H. pylori infect?
|
pyloric antrum
|
|
|
What does H. pylori predispose to/cause? 2 things
|
AdenoCA of stomach<br>Malignant Lymphoma
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|
|
What type of gastritis does H. pylori cause?
|
Type B Atrophic Gastritis
|
|
|
Where is the ulcer and cancer located in gastric ulcer?
|
lesser curvature of antum
|
|
|
Does gastric ulcer predispose to CA?
|
NO! Gastic CA may bleed and may be confused w/ gastric ulcer!
|
|
|
What must be done w/ gastric ulcer?
|
Biopsy to rule out gastric CA!
|
|
|
When is the pain in duodenal ulcer?
|
Decreases w/ meal/eating
|
|
|
When is pain in gastric ulcer?
|
Greater fater eating
|
|
|
What is the malignant potential for a duodenal ulcer?
|
0% malignancy<br>so never biopsied!
|
|
|
What blood group is associated w/ duodenal ulcer?
|
Blood group O
|
|
|
What other pathologies are associated w/ dudoneal ulcer?
|
MEN I<br>Zollinger-Ellison Sx
|
|
|
What is the MC complication of duodenal ulcer?
|
Bleed and perforation
|
|
|
What is the presentation of duodenal ulcer w/ perforation?
|
patient w/ epigastric pain that irradiates to the left shoulder
|
|
|
What is the first step in managemente of duodenal ulcer that has perforated?
|
Flat X-ray
|
|
|
Why is the pain referred to the shoulder in perforated duodenal ulcer?
|
because the diaphragm is irritated and has the same dermatome and embryology at C4 (phrenic nerve)
|
|
|
Patient that wakes up at night w/ epigastric pain?
|
Most likely duodenal ulcer
|
|
|
What is Zollinger Ellison's (ZE) Sx?
|
malignant islet cell tumor
|
|
|
What does ZE secrete?
|
gastrin <br>increases acid in stomach
|
|
|
Why is melena black?
|
Acid acts on HB and converts it into Hematin<br />Hematin is black pigment that stains fecal matter
|
|
|
What is a picture of a stomach that is really hard petrified almost?
|
Linitis plastica<br>Stomach Cancer diffuse type
|
|
|
What type of cells do you see in linitis plastica?
|
Signet Ring Cells
|
|
|
Where else can you find signet ring cells?
|
both ovaries since linitis plastica metastasizes via hematogenous route
|
|
|
What is a kind of diffuse type linitis plastica? attacks the ovaries as well?
|
Krukengerg Tumor
|
|
|
What is the MC extranodal site of extranodal lymphoma?
|
stomach
|
|
|
What is the 2nd MC extranodal site of extranodal lymphoma?
|
peyer's patches
|
|
|
What is the MC benign tumor of GI tract?
|
Leiomyoma
|
|
|
What is the MC location for Leiomyoma?
|
stomach
|
|
|
What is the main symptom of leiomyoma?
|
bleeding
|
|
|
What is associated with dermatitis herpetiform?
|
Celiac Dz
|
|
|
What is the best test to detect Celiac Dz?
|
anti-gliadin Ab
|
|
|
What is another Dz that involves malabsorption?
|
Whipple Dz
|
|
|
What is the pathology of Celiac Dz?
|
Atrophy of villi in Duodenum and Jejunum
|
|
|
What is the pathology of Whipple's Dz?
|
blunting of villi in jejunum and ileum
|
|
|
What is the best (cheapest) screening test to determine malabsorption problem?
|
stool for fat
|
|
|
What are the three classifications of diarrhea?
|
1) invasive<br>2) secretory<br>3) osmotic
|
|
|
What is the best test for invasive diarrhea?
|
fecal leukocytes (+)
|
|
|
What is the #1 organism in invasive enterocolitis?
|
Campylobacter
|
|
|
What diarrhea's are low volume?
|
Invasive diarrhea
|
|
|
What diarrhea is high volume?
|
secretory and osmotic
|
|
|
What is secretory diarrhea?
|
high volume w/ osmolality similar to plasma
|
|
|
What is osmotic diarrhea?
|
high volume w/ osmolality lower than that of plasma
|
|
|
What are some disease that cause secretory diarrhea?
|
Vibrio cholerae (via adenylate cyclase)<br>E. coli (via guanylate cyclase)<br>Rotavirus<br>Carcinoid Sx
|
|
|
Is there mucosal inflammation in secretory diarrhea?
|
No mucosal inflammation
|
|
|
What are some common diseases that cause osmotic diarrhea?
|
lactase deficiency<br>laxatives
|
|
|
What is the MCC of cholecystitis and pancreatitis in AIDS?
|
Cytomelagolvirus (CMV)
|
|
|
What organism is associated w/ HLA-B27 spondyloarthropathy and uremic Sx?
|
Shigella
|
|
|
What is the MC contaminant of blood transfusions?
|
Yersenia enterocolitica
|
|
|
What are trophozoites phagocytosed RBCs?
|
Entameba histolytica (Ameba)
|
|
|
What is the MCC of diarrhea in AIDS?
|
Cryptosporidium parvum
|
|
|
What test is used to detect C. parvum?
|
String Test
|
|
|
What is the MCC of diarrhea from protozoa in the U.S.?
|
Giardia lamblia
|
|
|
What is the life cycle of G. lamblia?
|
cysts attach to small intestine mucosa
|
|
|
What organism causes rectal prolapse in children?
|
Trichuris trichura
|
|
|
What is the Tx of Trichuris trichura?
|
Albendazol
|
|
|
What is the reservoir of diphyllobothrium latum?
|
fish--- lake trout
|
|
|
What does D. latum cause?
|
Vitamin B12 deficiency
|
|
|
What is the Tx fro D. latum?
|
praziquantel
|
|
|
What is seen in the stool of Strongyloidse stercoralis?
|
rhabditiform larvae
|
|
|
What parasite causes bowel obstruction?
|
Ascaris Lumbricoides
|
|
|
What is the reservoir for Dyphyllobotrium latum?
|
Fish --- lake trout
|
|
|
What problems does D. latum give humans?
|
Vitamin B12 deficiency
|
|
|
What is the Tx for D. latum?
|
Praziquantel<br>got the prize for the fish!
|
|
|
What parasite in the soil penetrates the skin?
|
Strongyloides stercoralis<br>he is strong!!!
|
|
|
What is the MCC of hematochezia?
|
Diverticulosis
|
|
|
What is the 2nd MCC of hematochezia?
|
angiodysplasia
|
|
|
What is asscoaited w/ angiodysplasia?
|
von Willebrand's Dz<br>Aortic Stenosis
|
|
|
What is the MCC of iron deficiency in newborn?
|
Mecke's Diverticulum<br>bleeding GI
|
|
|
What disease has the term left sided apendicitis?
|
sigmoid diverticula
|
|
|
MC place of pathology in entire GI tract?
|
Sigmoid colon<br />includes:<br />- cancer<br />- polyps (except Peutz-Jegher's)<br />- diverticular disease
|
|
|
What is associated with embolism of transmural small bowel?
|
hear disease and atrial fibrillation
|
|
|
What is the MCC of fistulas in the GI tract?
|
diverticula
|
|
|
What is the MC fistula?
|
Colovesical Fistula
|
|
|
Ulcerative Colitis vs. Cronh's Dz
|
UC vs. Crohn's
|
|
|
What layers does UC comprise?
|
musocal and submucosal
|
|
|
What layers does Cronh's Dz comprise?
|
all layers<br>it is transmural
|
|
|
What does UC primarily target?
|
rectum
|
|
|
What is involved in Cronh's Dz in 80%?
|
Terminal Ileum Affected
|
|
|
What segment does UC attack?
|
rectum;<br>does not involve other areas of GI tract
|
|
|
What segment does Cronh's attack?
|
Cronh=Complete<br>all layers<br>and also all the GI tract <br>mouth to anus
|
|
|
What marker do you get after HBV vaccine?
|
anti-HBs
|
|
|
What is the first serology to appear in HBV?
|
HBsAg
|
|
|
What is the marker that the patient will recover from HBV?
|
HBV-DNA poymerase leaves before HBsAg
|
|
|
Markers for HBV infection is active?
|
HBe and HBV-DNA antigens are excellent markers of infectivity
|
|
|
What is considered when anti-HBcIgM is converted to HBcIgG?
|
patient has old infection
|
|
|
What marker for HBV determines a chronic carrier?
|
HBsAg for more than 6 months
|
|
|
What is a healthy carrier?
|
carries HBsAg but is negative for HBeAg/HBV-DNA
|
|
|
What two viruses are associated w/ hepatocellular CA?
|
B and C hepatitis
|
|
|
What organism causes spontaneous peritonitis in adults?
|
E. coli
|
|
|
What organism causes spontaneous peritonitis in children?
|
Step. pneumoniae
|
|
|
What causes a single abscess in the right lobe of the liver?
|
E. histolytica
|
|
|
Tx for Hepatic Amebiasis?
|
Metronidazole
|
|
|
Who is the definitive host of Echinococcosis?
|
Sheep Dog
|
|
|
Humans are what type of host for Echinococcosis?
|
intermediate host
|
|
|
Tx for Echinococcosis?
|
Albendazole
|
|
|
What organism causes cholangiocarcinoma?
|
Clonorchis sinensis
|
|
|
What is another name for Clonorchis sinensis?
|
Chinese Liver Fluke
|
|
|
How do you get Clonorchiasis?
|
Ingestion of infected fish w/ larvae
|
|
|
What is the Tx of Clonorchiasis?
|
Praziquantel
|
|
|
What is the main characteristic in the laboratory of Clonorchiasis?
|
Eosinophilia
|
|
|
What causes portal hypertension, hepatosplenomegaly, ascites and esophageal varices?
|
Schistosomiasis
|
|
|
What is the definitive host of Schistosoma mansoni?
|
Snails<br>imagine photographer taking pics of snails (he is a mason!)
|
|
|
Tx for Schistosomiasis?
|
Praziquantel
|
|
|
What is the MCC of congestive hepatomegaly?
|
Right Heart Failure (H.F.)
|
|
|
What are two clinical manifestations of PRE-hepatic obstruction?
|
1) portal vein thrombosis<br>2) ascites/varices
|
|
|
Do you find hepatomegaly in pre or post-hepatic obstruction?
|
Post-hepatic!!!
|
|
|
What is a cause of post-hepatic obstruction?
|
1) Budd-Chiari syndrome<br>2) Polycythemia vera<br>3) Oral Contraceptives
|
|
|
What is Budd-Chiari Sx?
|
hepatic vein thrombosis
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What is the MCC of post-hepatic obstruction?
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Polycythemia vera!
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Symmptoms of post-hepatic obstruction?
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1) painful liver<br />2) congested liver<br />3) ascites<br />4) portal hypertension
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What are dead hepatocytes called?
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Councilman Bodies
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When do we find Councilman Bodies?
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Hepatitis
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What alcoholic disease is irreversible?
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cirrhosis
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Are fatty change and alcoholic hepatitis reversible or irreversible?
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reversible
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What are the factors of Alcholo liver disease?
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1) amount of OH<br>2) duration of intake<br>3) more damage in females
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Where is the most important site of metabolism of OH in liver?
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cytosol
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What causes disulfiram reaction?
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acetaldehyde build up
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What is disulfiram rx?
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nausea/vomiting, flushing after ingestion of alcohol
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What drug is used in Tx of alcoholism?
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Antabuse or Disulfiram
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What enzyme is inhibited by disulfiram?
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an alcohol dehydrogenase
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Where is alcohol dehydrogenase found?
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in cytosol and mitochondria
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Why is there a build up of lactate in alcoholics?
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high levels of NADH make pyruvate go into lactate (increases anion gap)
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Why does hypoglycemia occur in alcoholics?
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again increase in NADH makes conversion of pyruvate to lactate <br>decrease in pyruvate can't go back to gluconeogenesis
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Why is there esteatosis?
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alcohol is converted to acetaldehyde and acetate and acetyl coA which makes free fatty acids<br>- increase in NADH2 favors glycerol-3-p
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What is the sequence to make TG (VLDL) from 1,3 DPG?
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1,3 DPG to Glyceraldehyde-3-P to DHAP to Glycerol-3-P + FA makes TG
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Why is ketoacidosis sometimes present in alcoholics?
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NADH once again favors conversion of:<br>Acetoacetate to B-Hydroxybutyrate (ketoacids)
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Why are alcoholics prone to gout?
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Ketoacids and Lactic Acid compete w/ uric acid for excretion in the kidneys<br>so Uric Acid Accumulates!
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What is the ratio of ALT and AST in alcoholics?
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You are an ASS because you drink<br>AST > ALT
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What is seen in alcoholic hepatitis?
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mallory bodies<br>you will have a bad body!!<br>Mal (lory) Body!
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What is very characteristic microscopically?
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fibrosis aroudn terminal hepatic venules
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MCC of obstructive jaundice?
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stone in common bile duct
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What are the symptoms in obstructive jaundice?
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- hypercholesterolemia<br>- light colored stools<br>- urine w/ conjugated bilirubin<br>- increase alkaline phosphatase (AP) and gamma-glutamyltransferas (GGT)
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What are the symptoms of primary biliary cirrhosis?
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- pruritus<br>- increase AP and GGT<br>- no jaundice until later
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What immunoglobulins and markers detect primary biliary cirrhosis?
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- increase anti-mitochrondrial Ab<br>- increase IgM
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How do you acquire primary biliary cirrhosis?
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autoimmune, granulomatous destruction of bile ducts in triads
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What disease causes primary slcerosing pericholangitis?
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ulcerative colitis<br>- complication of
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What is the clinical picture of 1ry sclerosing pericholangitis?
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jaundice
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What cancer is related to 1ry sclerosing pericholangitis?
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MCC of cholangiocarcinoma
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Name drug that causes acute hepatitis? (4)
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1) Isoniazid<br>2) Halothane<br>3) acetaminophen <br>4) methyldopa
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Name two drugs that cause cholestasis?
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1) oral contraceptives<br>2) anabolic steroids
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What drugs cause steatosis? fatty liver... 2
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1) Amiodarone<br>2) Methotrexate
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What drug causes fibrosis in the liver?
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methotrexate
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What drug causes angiosarcoma of the liver?
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Vinyl Chloride
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What drug causes Liver Cell Adenoma?
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Oral Contraceptives
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What drugs (3) causes hepatocellular carcinoma?
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1) Vinyl Chloride<br>2) Aflatoxin (Aspergillus mold)<br>3) Thorotrast
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Can O.C. cause hepatocellular CA?
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Yes
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What is fulminant hepatic failure (FHF)?
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acute liver failure w/ encephalopathy within 8 weeks of hepatic dysfunction
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What is the MCC of FHF? (drug)
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acetaminophen
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What is the MCC of FHF? (organism)
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virus
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Other cause of FHF?
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Reye's Sx
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What is hemochromatosis?
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unrestricted reabsorption of IRON (small bowel)
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What is the mode of inheritance of hemochromatosis?
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autosomal recessive
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What are the laboratory findings of hemochromatosis?
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- increase serum iron<br>- decrease TIBC<br>- increase % saturation<br>- increase serum ferritin
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What is the best screening test?
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increase serum ferritin
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What are the manifestations of hemochromatosis?
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- bronze skin
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What is the Tx of hemochromatosis?
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phlebotomy
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What is Wilson's Dz?
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defect in Copper (Cu+) secretion into bile<br>- bile is Copper deficient<br>or<br>- defect in synthesis of ceruloplasmin
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What is ceruloplasmin?
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protein that binds to Copper<br>low ceruloplasmin so can't bind Copper <br>- so increase of Cu in blood
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What are some of the clinical manifestations of Wilson's Dz?
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Kayser-Fleishcher rings in eye
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What is the Tx of Wilson's Dz?
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penicillamine
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What nuclei is attacked in Wilson's Dz?
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lenticular nuclei degeneration
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What are the symptoms of degeneration of the lenticular nuclei?
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- chorea<br>- rigidity<br>- basal ganglia dementia
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What part of the eye is affected w/ Kayser-Fleischer rings?
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outer part of decemet<br>cornea
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What organism causes chorioamnionitis?
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Step. agalactiae
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When does pre-eclampsia and eclampsia occur? trimester...
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3rd trimester
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What is the Diagnosis if pregnant woman presents w/ pre-eclampsia in first trimester?
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hydatidiform mole
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What two substances are increased in pre-eclampsia?
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Angiotensin II<br>TXA2
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What substances are decrease in pre-eclampsia?
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PGE1 and NO
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What are two substances in pre-eclampsia that are vasoconstrictors?
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Angiotensin II<br>TXA2
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What two substances are vasodilators in pre-eclampsia?
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PGE1 <br>N.O.
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Tx for Eclampsia?
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Magnesium Sulfate
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What is the clinical presentation of pre-eclampsia?
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hypertension<br>proteinuria<br>pitting edema
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What is the clinical picture of eclampsia?
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same as pre-eclampsia but w/ seizures or convulsions
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Should BUN be increase or decreased in normal pregnancy?
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decreased in normal pregnancy
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Should GFR be increased or decreased in normal pregnancy?
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Increased
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What do we find in lab. for pre/eclampsia? BUN<br>Uric Acid<br>Serum Creatinine<br>GFR<br>transaminases
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BUN increased<br>uric acid increased<br>creatinine increased<br>GFR decreased<br>transaminases increased<br>Schistocytes/anemia/thrombocytopenia
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What kind of plancenta do Siamese twins have?
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Monochorionic Monoamniotic planceta
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The gene for wilm's tumor (WT1) is located on which chromosome?
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Chromosome 11 (11p)
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The APC gene is located on which chromosome?
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chromosome 5
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Which chromosome is the Rb gene (tumor suppressor gene) located on?
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Chromosome 13
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Which chromosome are the p53, BRCA-1, and NF-1 genes located on?
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Chromsome 17
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Which chromosome is the NF-2 gene located on?
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Chromosome 22
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Cardiac Enzymes
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<img src="3dc5cac0f304e26705680eff011aafa1.bmp" />
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Kawasaki Disease
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5 Letters: 5 days, 5 y/o, 5 out of 6 criteria for Dx: <br><span style="font-weight:600; color:#5500ff;">CHILD</span><br><span style="color:#5500ff;">C</span>onjunctivitis (bilateral)<br><span style="color:#5500ff;">H</span>yperthermia > 5 days<br><span style="color:#5500ff;">I</span>diopathic polymorphic rash<br><span style="color:#5500ff;">L</span>ymphadenopathy (cervical)<br><span style="color:#5500ff;">D</span>ryness and redness of: 1. lips and mouth 2. palms and soles
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Types of vasculitis
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<span style="font-weight:600;">Small vessel:</span> palpable purpura<br><span style="font-weight:600;">medium vessel:</span> aneurysm and thrombosis<br><span style="font-weight:600;">large vessel:</span> loss of pulse and stroke
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Aneurysm rupture triad
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Left flank/back pain<br>hypotension<br>pulsatile mass
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Types of Arteriosclerosis
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<span style="font-weight:600;">Hyaline </span>(DM and benign HTN)<br><span style="font-weight:600;">Hyperplastic </span>(Malignant HTN)
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Features of Cystic Fibrosis
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<span style="font-weight:600; color:#ff0000;">FIBROSIS</span><br><span style="color:#ff0000;">F</span><span style="color:#000000;">ailure to thrive</span><br><span style="color:#ff0000;">I</span><span style="color:#000000;">nfertility in males</span><br><span style="color:#ff0000;">B</span><span style="color:#000000;">iliary cirrhosis</span><br><span style="color:#ff0000;">R</span><span style="color:#000000;">espiratory (infections + nasal polyps)</span><br><span style="color:#ff0000;">O</span><span style="color:#000000;">bstructive ileus in neonates (meconeum ileus)</span><br><span style="color:#ff0000;">S</span><span style="color:#000000;">ugar high (DM)</span><br><span style="color:#ff0000;">I</span><span style="color:#000000;">ntestinal malabsorption (Pancreas)</span><br><span style="color:#ff0000;">S</span><span style="color:#000000;">weat test</span>
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A - a gradient (PAO2 - PaO2)<br>Normal is 5 mmHg. Medically significant if above <span style="font-weight:600; color:#0000ff;">[...]</span>
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A - a gradient. <br>Normal is 5 mmHg. Medically significant if above <span style="font-weight:600; color:#0000ff;">30 mmHg</span>
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Calculate PAO2
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PAO2 = %O2 x 713 - <span style="text-decoration: underline;">PaCO2</span><br> 0.8<br>Normally: %O2 is 0.21 and PaCO2 is 40 mmHg
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What increases SHBG
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Estrogen
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What decreases SHBG
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Androgens, Obesity, Hypothyroidism
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Sites of Androgen Synthesis in a female
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<span style="font-weight:600; color:#ffaa00;">Ovaries</span> <span style="font-weight:600; color:#5500ff;">Adrenal</span><br>Testosterone <span style="font-style:italic; text-decoration: underline; color:#ffaa00;">Most</span> <span style="color:#5500ff;">Some</span><br>Androstenedione <span style="color:#ffaa00;">Equal</span> <span style="color:#5500ff;">Equal</span><br>DHEA <span style="color:#ffaa00;">Some</span> <span style="color:#5500ff;">Most</span><br>DHEA-Sulfate <span style="color:#ffaa00;">None</span> <span style="color:#5500ff;"> </span><span style="font-style:italic; text-decoration: underline; color:#5500ff;">All</span>
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Causes of Gynecomastia
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<span style="font-weight:600;">Hyperestrinism</span>: Cirrhosis, Testicular tumors, Puberty, Old age, Newborn<br><br><span style="font-weight:600;">Klinefelter's syndrome</span><br><br><span style="font-weight:600;">Drugs</span>: <span style="text-decoration: underline;">Some Drugs Create Awesome Knockers</span><br><span style="color:#ff0000;">S</span>pironolactone, <span style="color:#ff0000;">D</span>igitalis, <span style="color:#ff0000;">C</span>imetidine, <span style="color:#ff0000;">A</span>lcohol, <span style="color:#ff0000;">K</span>etoconazole <br>+ Estrogen, Heroin, Marijuana, and Psychoactive Drugs
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What decreases TGB?
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Anabolic Steroids<br>Nephrotic syndrome
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The only 2 hyperfunctioning endocrine disorders that can be <span style="text-decoration: underline;">suppressed</span>?
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Prolactinoma<br>Pituitary Cushing syndrome
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What increases TGB?
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Estrogen (pregnancy, OCP, HR)
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What effect does increased TGB have on Total T4 and Free T4?
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++ Total T4<br>normal Free T4
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<span style="font-weight:600;">Sarcoidosis</span>
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<span style="color:#ff0000;">S</span>chaumann calcifications<br><span style="color:#ff0000;">A</span>steroid bodies, <span style="color:#ff0000;">A</span>CE increased, <span style="color:#ff0000;">A</span>nergy<br><span style="color:#ff0000;">R</span>estrictive (lung disease and cardiomyopathy)<br><span style="color:#ff0000;">C</span>alcium increases (hypervitaminosis D)<br><span style="color:#ff0000;">O</span>cular lesions (uveitis)<br><span style="color:#ff0000;">I</span>g increases (polyclonal gammopathy)<br><span style="color:#ff0000;">D</span>iabetes inspidus<br><span style="color:#ff0000;">O</span>steopathy (bone marrow) + Spleen + Liver<br><span style="color:#ff0000;">S</span>kin (nodules, violaceous rash, erythema nodosum) <br><span style="color:#ff0000;">I</span>nterstitial Lung Fibrosis<br><span style="color:#ff0000;">S</span>eventh nerve palsy (Bell's) <span style="color:#ff0000;">S</span>alivary and Lacrimal gland enlargement
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Down Syndrome Triad (pregnancy hormones)
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<span style="color:#ff0000;">-- AFP</span><br><span style="color:#ff0000;">-- Urine Estriol</span><br><span style="color:#00aa00;">++ HCG (also ++ Inhibin A)</span>
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Hirsutism and Virilization can be caused by 2 main groups of disorders?
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Ovarian and Adrenal
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Ovarian causes of Hirsutism and Virilization
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POS<br>-- SHBG<br>Ovarian tumors that produce androgens
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Adrenal causes of Hirstutism and Virilization
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Adrenogenital syndrome<br>Cushing syndrome
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Fever, Jaundice, RUQ pain
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Triad of Ascending Cholangitis
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ANA and anti-smooth muscle antibodies
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Autoimmune hepatitis
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Mechanism of Reye syndrome
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Mitochondrial damage --><br>1. -- urea cycle --> hyperammonemia --> encephalopathy<br>2. -- beta oxidation of fatty acids --> fatty liver --> hepatomegaly
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HELLP Syndrome (in preeclampsia)
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<span style="text-decoration: underline;">H</span>emolytic anemia with schistocytes (due to DIC)<br><span style="text-decoration: underline;">EL</span>evated transaminases (due to periportal necrosis)<br><span style="text-decoration: underline;">L</span>ow <span style="text-decoration: underline;">P</span>latelets (due to DIC)
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++ AST and ALT
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Liver Cell Necrosis
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-- AST and ALT
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Liver Failure
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Causes of Peliosis Hepatis
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Anabolic Steroids<br>Bacillary angiomatosis (in AIDS)
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Name a toxin/drug that casues: <br>1. Cholangiocarcinoma<br>2. Hepatocellular carcinoma<br>3. Liver cell adenoma
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1. Thorium dioxide<br>2. Aflatoxin<br>3. OCPs
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Name 3 toxins that cause Angiosarcoma
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1. Vinyl chloride<br>2. Arsenic<br>3. Thorium dioxide
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Name 2-3 drug/toxin causes of:<br>1. Acute Hepatitis<br>2. Cholestasis<br>3. Fatty Change<br>4. Fibrosis
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1. INH, Halothane, Acetaminophen, Methyldopa<br>2. OCPs, Anabolic steroids<br>3. Amiodarone, Methotrexate<br>4. Amiodarone, Methotrexate, and Retinoic acid
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Non-alcoholic Hepatitis with mallory bodies?
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Amiodarone
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Causes of Hypercalcemia<br>
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<span style="text-decoration: underline;">CHIMPANZEES</span><br><br><span style="font-weight:600;">C</span>alcium ingestion<br><span style="font-weight:600;">H</span>yperparathyroidism<br><span style="font-weight:600;">M</span>ultiple Myeloma<br><span style="font-weight:600;">P</span>aget's disease<br><span style="font-weight:600;">A</span>ddison's disease<br><span style="font-weight:600;">N</span>eoplasms<br><span style="font-weight:600;">Z</span>ollinger Ellison syndrome<br><span style="font-weight:600;">E</span>xcess Vitamin D<br><span style="font-weight:600;">E</span>xcess Vitamin A<br><span style="font-weight:600;">S</span>arcoidosis
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MEN I
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3 P's<br><br>Pancreas endocrine tumors<br>Pituitary tumors (prolactin or GH)<br>Parathyroid
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mode of inheritence of MEN syndromes
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Autosomal dominant.
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MEN 2A vs. MEN 2B
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MEN 2A: Medullary thyroid carcinoma, Pheochromocytoma, Parathyroid tumors<br><br>MEN 2B: <span style="font-weight:600;">M</span>edullary thyroid carcinoma, Pheochromocytoma (Adrenal <span style="font-weight:600;">M</span>edulla), <span style="font-weight:600;">M</span>ucocutaneous neuromas
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Ret gene is involved in which 2 diseases?
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Gain of function mutation: MEN 2A and 2B<br>Loss of function mutation: Hirschsprung's disease
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t(9;22)
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CML (bcr-abl hybdrid)
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t(8;14) c-myc activation
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Burkitt's lymphoma
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t(14:18) bcl-2 activation
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follicular lymphomas
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t(15;17)
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M3 type of AML (acute promyelocytic)
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t(11;22)
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Ewing's sarcoma
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t(11;14)
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Mantle cell lymphoma
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Cardiac defects in 22q11 syndromes
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Truncus arteriosus, Tetralogy of Fallot
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Cardiac defects in Down syndrome
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ASD, VSD, AV septal defect (endocardial cushion defect)
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Cardiac defects in congenital rubella
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septal defects, PDA, pulmonary artery stenosis
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Cardiac defects in Turner's syndrome
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aortic coarcation
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Cardiac defects in Marfan's syndrome
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Aortic insufficiency
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Cardiac defects in Offspring of diabetic mother
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Transposition of great vessels
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1. an alcoholic presents with painful hematemesis <br /><br />2. an alcoholic presents with painless hematemesis
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1. Mallory-Weis syndrome<br />2. Esophageal varices
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AL protein
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Primary Amyloidosis (Ig light chain)
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AA protein
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Secondary Amyloidosis
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Transthyretin
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Senile cardiac amyloidosis
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Amylin
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Amyloidosis seen in DM type 2
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A-CAL
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Medullary carcinoma of thyroid (amyloidosis)
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beta amyloid
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Alzheimer's disease
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beta 2 microglobulin
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Dialysis associated amyloidosis (MHC class I proteins)
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CA-125
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Ovarian carcinomas
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CA-19-9
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Pancreatic adenocarcinoma
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CA-15-3
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Breast Carcinoma
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