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119 Cards in this Set
- Front
- Back
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What are the symptoms of juvenile rheumatoid arthritis?
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Relpasing fever, salmon-pink rash anywhere on body, polyarthritis, hemophagocytic syndrome (RBC laden macrophages)
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What cancer is most associated with a p16 mutation?
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Melanoma
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What is the presentation of Lewy body demention?
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Parkinsonism, hallucinations, dementia
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What does a positive straight leg test indicate?
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Radiculopathy, meningitis
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What drugs tend to cause methemglobinemia?
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Sulfas/dapsone and nitrites
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What is the O2 sat in cyanide, CO toxicity, methemglobinemia?
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Normal, low, low
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How do you distinguish between methemglobinemia and carbon monoxide toxicity based on treatment?
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O2 administration will make carbon monoxide better, but won't make methemglobinemia better
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What kind of hemoglobin toxicity can you get from drinking water in Colorado?
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Methemglobinemia
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What kind of G-receptor is rhodopsin attached to? What is the pathway when light hits?
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Transducin; activates cGMP phosphodiesterase => decrease cGMP => decrease activation of ligand gated sodium channel => repolarize the cell (thus remove glutamate stimulation of bipolar cells, and decrease GABA inhibition of ganglion cells by bipolar cells)
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Renal tubular acidosis type 1
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Associated with hypokalemia and risk for calcium-containing kidney stones. Defect in collecting tubule's ability to excrete H+.
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Renal tubular acidosis type 2
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Associated with hypokalemia and hypophosphatemic rickets. Defect in proximal tubule HCO3 reabsorption.
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Renal tubular acidosis type 4
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Associated with hyperkalemia and inhibition of ammonium excretion in the proxmial tubule. Leads to decrease urine pH to due to decrease buffering capacity. Hypoaldosteronism or lack of collecting tubule response to aldosterone.
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What does achlorhydria mean?
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Lack of stomach acid production (due to loss of parietal cells, somatostatin)
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What is double bubble sign assocaited with?
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Duodenal atresia (NOT PYLORIC STENOSIS)
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Is UC or Crohn's characterized by crypt abscesses with neutrophils?
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UC
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Is UC or Crohn's characterized by cobblestone mucosa?
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Crohn's
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What are hyperplastic polyps? Why are they important?
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NOT PRE-CANCER; no malignant potenital; most common polyp
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What causes dark urine with extravascular hemolysis and biliary tract obstructioN?
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Uroporphobilinogen in hemolysis; elevated conjugated bilirubin in obstructive jaundice
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What does an apple core lesion on barium enema X-ray suggest?
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Colorectal adenocarcinoma
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Damage to spenorenal ligament
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Damages splenic artery and vein.||Connects spleen to posterior abdominal wall.|
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Primary biliary cirrhosis
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Bone pain, pruritus, xanthelasma, jaundice, dark urine, light (clay-colored, acholic) stools, hepatosplenomegaly. More common in women.|Elevated conjugated bilirubin, elevated cholesterol, elevated ALP. Elevated serum mitochondrial autoantibodies (IgM).|Autoimmune reaction leading to lymphocytic infiltrate and granulomas. Associated with CREST, rheumatoid arthritis, celiac disease.|
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Cowden syndrome
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"Characterized by macrocephaly, intestinal hamartomatous polyps, and benign skin tumors, typically trichilemmomas, papillomatous papules, and acral keratoses.
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Mesenteric lymphadenitis
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Mimics appendicitis||Caused by Yersinia enterolitica or viral infection.|
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Cholesterolosis
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May predispose to gallstones.|Yellow speckling of red-tan mucosa "strawberry gallbladder".|Accumulation of cholesterol-laden macrophages in mucosa of gallbladder. |
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Klatskin tumor
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|Adenocarcinoma.|Carcinoma of the bifurcation of the left and right hepatic bile ducts.|
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Besides H. pylori and Zollinger ellison, what else increases risk of duodenal ulcers by 50%?
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Smoking
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When does fibrinous pericarditis happen after an MI?
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First two days (neutrophils) and a few months later (Dressler's autoimmune)
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What organisms can cause a negative culture bacterial endocarditis?
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HACEK
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What causes sawtooth appearance at dermal-epidermal junction and dermal lymphocytic infilitration?
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What is the severe form of erythema multiforme?
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Stevens Johnson syndrome / toxic epidermal necrolysis
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Kussmaul's sign
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Increase in JVP on inspiration.||Caused by cardiac tumors, constrictive pericarditis, along with restrictive cardiomyopathy, right sided heart failure, and cardiac tamponade.|
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Fetal alcohol syndrome
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Newborns of mothers who consumed significant amounts of alcohol during pregnancy have an increased incidence of congenital abnormalities, including pre- and postnatal developmental retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocation, and heart and lung fistulas.||Leading cause of congenital malformations in the United States. Mechanism may include inhibition of cell migration.|
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Innocent murmur
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Early to mid-systolic grade 1/2 murmur localized to left sternal border.|Decreases with standing, sitting up, valsalva maneuver||
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Ephelis
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Freckle. Hyperpigmentation due to increased number of MELANOSOMES. Normal number of melaoncytes.|||
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Staphyloccal scalded skin syndrome
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Exotoxin destroys keratinocyte attachments to the stratum granulosum only. Fever, generalized erythematous rash with sloughing of upper layers of epidermis. Seen in young children.|||
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Erythema nodosum
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Inflammatory lesions of subcutaneous fat, usually on anterior shins. Associated with cocciodiomycosis, histoplasmosis, TB, leprosy, streptococal infections, sarcoidosis.|||
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Melanoma
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Common tumor with significant risk of metastasis. Dysplastic nevus (atypical mole) is a precusor to melanoma. Look for assymetry, border irregularity, color variation, diameter > 6 mm, and a history of change.|S-100 tumor marker. Atypical pagetoid (upward spreading). BRAF activating mutation. P16 mutation.|Fair skinned persons at increased risk. DEPTH of tumor correlates with risk of metastasis.|
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Hyperkeratosis
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Increased thickness of stratum corneum (psoriasis)|||
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Acanthosis
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Epidermal hyperplasia (increased spinosum)|||
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Pulmonary alveolar proteinosis
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Very gradual worsening of dyspnea and productive cough.|Bilateral patchy pulmonary opacification due to intraalveolar accumulation of amporhous protein and phospholipid material (constituents of surfactant).|Congenital mutation of GM-CSF. Autoantibodies against GM-CSF. Imparied surfactant clearance by alveolar macrophages; lamellar bodies in alveoli.|
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Acute lung transplant rejection
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Lymphocytic perivascular and peribronchial infiltration of vasculature due to graft HLA incompatibility.|Within weeks.||
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Chronic lung transplant rejection
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Bronchiolitis obliterans (inflammation of small airways);|Within years.||
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Juvenile idiopathic arthritis
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Recurrent spiking fevers with polyarticular joint point, salmon-pink rash anywhere on body. Decreased growth rates, chronic anterior uveitis.|Rheumatoid factor negative. Hemophagocytic syndrome (macorphages laden with RBCs).||Etanercept.
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Still's disease
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IN ADULTS. Recurrent spiking fevers with polyarticular joint point, salmon-pink rash anywhere on body. Decreased growth rates, chronic anterior uveitis.|Rheumatoid factor negative. Hemophagocytic syndrome (macorphages laden with RBCs).||Etanercept.
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What type of kidney deposits are in diffuse proliferative glomerulonephritis?
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Subendothelial (SLE most common kidney presentation)
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What is the CK value in hypothyroidism?
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Elevated
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What is the symptom of excess vitamin C?
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Calcium oxalate stones
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What ion imbalance can cause nephrogenic DI?
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Hypercalcemia
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Renal tubular acidosis type 1
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Associated with hypokalemia and risk for calcium-containing kidney stones.||Defect in collecting tubule's ability to excrete H+. |
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Renal tubular acidosis type 2
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Associated with hypokalemia and hypophosphatemic rickets||Defect in proximal tubule HCO3 reabsorption.|
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Renal tubular acidosis type 4
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Associated with hyperkalemia and inhibition of ammonium excretion in the proxmial tubule. Leads to decrease urine pH to due to decrease buffering capacity.||Hypoaldosteronism or lack of collecting tubule response to aldosterone.|
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Acquired polycystic kidney disease
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Cortical and medullary cysts from long-standing dialysis.|||
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Chronic dialysis toxicity
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Renal papillary necrosis, HTN, renail failure, and transitional cellc arcinoma of pelvis and bladder.||Due to aluminium in the dialysate.|
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Cystocele
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|Prolapse of bladder into vagina. Common in middle-aged to elderly women.|
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Fetal unilateral hydronephrosis
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||Due to the failure of recanalization at the uteropelvic junction.|
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Secondary adrenal insufficiency
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No skin hyperpigmentation and no hyperkalemia. Metabolic acidosis, hypotension. ||Secondary to decreasd pituitary ACTH production. Commonly due to an abrupt withdrawal of exogenous cortisol administration without tapering (suppressed hypothalamic-pituitary-adrenal axis).|
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Wolf-Chaikoff effect
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||Transient decrease in T3/T4 levels due to excess ingestion of iodide, which inhibits iodide pump activity.|
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Jod-Basedow phenomenon
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Thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete.|||
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Hypoparathyroidism
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Hypocalcemia (tetany), hyperphosphatemia, perioral tingling, Chvostek's sign (tapping nerve causes contraction), Trousseau's sign (occlusion of brachial artery causes carpal spasm).|Low PTH, low calcium, high phosphate.|Due to accidental surgical excision (thyroid surgery), autoimmune destruction, DiGeorge syndrome, magnesium deficinecy, hemochromatosis.|
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Familial hypocalciuric hypercalcemia
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Asymptomatic. Green colored urine.|High PTH levels, hypercalcemia, hypermagnesemia, hypophosphatemia, urine calcium <200mg/day.|Mutation in CASR (calcium-sensing receptor) in parathyroid gland leading to high PTH levels despite high serum calcium levels and high calcium reabsorption in the kidney despite high serum calcium levels.|
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What causes a freckle? Increased melanosomes or increased melanocytes?
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Increased melanosomes
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Describe the histology of dysgerminoma/seminoma?
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Large cells with clear cytoplasm
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Reinke crystals are characteristic of what tumor?
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Leydig cell tumor
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What happens when you treat embryonal carcinoma?
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Differentiates into a more mature tissue; ex teratoma
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What cancers are increased by smoking?
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Cervical, pancreatic, lung, esophageal, bladder, kidney
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Female dysgerminoma
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Malignant rare eqivalent of male seminioma.|Elevated hCG, LDH. Large clear cytoplasm with granulomas or lymphocytes in stroma.||Radiosensitive.
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Fibrocystic disease
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Most common cause of "breast lumps" from age 25 to menopause. Size of mass varies with menstruation (vs breast cancer that doesn’t change with cycles).|||
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Priapism
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Painful sustained erection.||Associated with sickle cell anemia, trauma, and sidenafil.|
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What is the T/F for chloride? Urea? Phosphate?
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Chloride: small rise, urea has larger rise, phosphate has small decrease
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What increases the risk of placenta accreta?
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C-section, inflammation, placenta previa in past
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What cyst type is associated with choriocarcinoma and moles?
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Theca-lutein cyst
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What is a dermoid cyst?
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Teratoma
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What two mutations predipose to serous cystadenocarcinoma?
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BRCA1/2 and HNPCC
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What causes an increase in free vs increase in bound PSA (decrease free fraction)?
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Free: BPH; bound: prostate adenocarcinoma
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Are Leydig cells affected by temperature?
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No, only Sertoli (testosterone production not impacted w/ cyrptorchidism)
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What is the MOA of danazol?
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Partial androgen agonist
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What is fulvestrant
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Estrogen antagonist (selective estrogen receptor down-regulator)
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Dead space volume formula
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Tidal volume * (PaCO2-PeCO2)/PaCO2
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What is physiological vs anatomical dead space?
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Physiological: alveolar dead space + anatomical (conducting airway) dead space; anatomial is only the conducting airway + snorkle
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Adult T-cell lymphoma
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Adults in Japan and Carribean. Cutaneous lesions/rash, lymphadenopathy, and lytic bone lesions with hypercalcemia. Aggressive.|HTLV-1 association. CD3+,CD5+,CD4+.|Malignancy of helper T-cells.|
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Myelodysplastic syndrome
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|Sideroblasts, hyposegemented neutrophils. Pancytopenia, atypical leukocytes.||
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CCL4
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Centrilobular necrosis of liver, fatty change.|||
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Chromium and nickle
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Bronchogenic carcinoma|||
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Benzene
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Leukemia|||
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Splenic sequestration
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Acute onset left-sided abdominal pain, pallor, hypotension, tachycardia, shortness of breath.|Anemic, low PC, low hematocrit.||
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Childhood disintegrative disorder
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Normal until age 3-4. More common in males. Regression characterized loss of bowel/bladder control, motor skills, social/language skills.|||
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Adjustment disorder
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Anxiety or depression causing impariment following an identifiable psychosocial stressor (divorce, illness) lasting less than 6 months.|||
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Substance dependence
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Characterized by tolerance, withdrawal, overdose, failure to quit, continued use despite knowledge of problems it causes, reduced social/occupational/recreational activities because of substance use.|||
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Substance abuse
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Characterized by NEVER meeting criteria for substance depenence. Recurrent use resulting in failure to meet work/school/home obligations, use in hazardous situations, substance related legal problems, continued use in spite of problems.|||
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Caffeine intoxication
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Restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrhythmias.|||
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Caffeine withdrawal
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Headache, lethargy, depression, weight gain.|||
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What vitamin deficiency presents in carcinoid syndrome?
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B3 (Niacin) due to excess use of tryptophan
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How do you treat orotic aciduria?
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Uridine
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Marfan's syndrome
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Tall with long extremities, pectus excavatum, hyperextensive joints, and long, tapering fingers and toes (arachnodactyly), cystic medial necrosis of aorta leading to aortic insufficiency and dissecting aortic aneurysms; mitral prolapse. Subluxation of lenses and retinal detachment.||Defect in fibrillin 1 affecting skeleton, heart, and eyes. Chromosome 15.|
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Williams syndrome
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Elfin facies, mental retardation, well-developed verbal skills, extreme friendliness with strangers, cardiovascular problems.|Hypercalcemia (increased sensitivity to vitamin D).|7q deletion (including elastin gene).|
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Fanconi's anemia
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Hypersensitivity to DNA cross-linking agents (cyclophosmamide); develops aplastic anemia. Hypoplastic bone anomalies. Increased MDS and AML risk. Associated with polydactylyl, microcephaly, hypogonadism.||Autosomal recessive.|
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Bloom's syndrome
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Hypersensitivty to UV damage and chemotherapeutic (cross-linking?) agents.||Autosomal recessive.|
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Vitamin B2 (riboflavin) deficiency
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Magenta colored tongue, cheilosis (inflammation of lips, scaling and fissures at corners of mouth), corneal vascularization.||Cofactor in oxidation and reduction (FADH2).|
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Pyruvate dehydrogenase deficiency
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Neurological defects, ketoacidosis.||Can be congenitla or due to vitamin B1 deficiency (alcoholics).|Treat with increased intake of ketogenic nutrteins; ex. High fat content or high lysine/leucine.
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Hypophosphatemic rickets
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Soft bones, bowed legs, rachitic rosary (knobs at costochondral joints), Harrison's sulci, craniotabes (thinning of the skul), and growth retardation. |Phosphate wasting at the proximal tubule.|Vitamin D resistant rickets. X-linked dominant. |
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Hyper-IgM syndrome
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Severe pyogenic infections early in life.|Increased IgM. Decreased IgG, IgA, IgE.|Defective CD40L on helper T cells leading to inability of B-cells to class switch.|
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Hyper-IgE syndrome (Job's syndrome)
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Coarse facies, cold staphlococcal abscesses, retained primary teeth, eczema.|Increased IgE.|T-helper cells fail to produce IFN-gamma leading to inability of neutrophils to respond to chemotactic stimuli.|
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What neurotransmitter is deficient in Huntington's?
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GABA from death of caudate nucleus
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What tumor is characterized by Rosenthal fibers?
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Pilocytic astrocytoma
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How do you treat tardive dyskinesia?
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Anticholinergics
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Damage to lateral hypothalamic nucleus
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Anorexia, failure to thrive. |||
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Damage to ventromedial hypothalamic nucleus
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Hyperphagia, aggression.|||
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Damage to septal hypothalamic nucleus
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Loss of sexual urges|||
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Left internuclear ophthalmoplegia
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Left (ipsilateral) eye adduction deficit, right (contralateral) eye nystagmus to left when looking to the right.||Left MLF infarct.|
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Peripheral vertigo
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Positioning testing => there is a delayed horizontal nystagmus.||Inner ear etiology (semicircular canal debris, vestibular nerve infection, Meniere's disease).|
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Central vertigo
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Positional testing => there is an immediate nystagmus in any direction.||Due to brain stem or cerebellar lesion (vestibular nuclei, posterior fossa tumor).|
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Ependymoma
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Most common in the 4th ventricle in children and spinal cord in adults; causes hydrocephalus.|Perivascular pseudoroesettes. Rod-shaped blepharoplasts (basal ciliary bodies) near nucleus. GFAP positive.|Poor prognosis|
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Uncal herniation
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Duret hemorrhages, ipsilateral hemiparesis (due to compression of contralateral crus cerebri), ipsilateral dilated pupil/ptosis (CN III stretching), contrlaateral homonoymous hemianopia (compression of ipsilateral PCA).||Transtentorial herniation|
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Adrenoleukodystrophy
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Generalized loss of meylin in brain and adrenal insufficiency.|Accumulation of long-chain fatty acids.|X-linked recessive. Defect in beta-oxidation of fatty acids in peroxisomes.|
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Drug induced peripheral neuropathy
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||Due to vincristine, hydralazine, phenytoin.|
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Lead poisoning
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Microcytic, hypochromatic anemia. Wrist and foot drop. Abdominal colic and kidney disease. Mental retardation in children (paint chips). Headache, memory loss, and demyelination in adults (environmental exposuree; ex. factories).|Increased protoporhyrin in blood. Siderblastic anemia with basophilic stippling. Lead lines on gingivae (Burton's lines) and epiphyses of long bones in X-ray.|Inhibition of ferrochelatase and ALA dehydratase.|
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Anterior hip dislocation
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Deficit in thight adduction; medial thigh sensory deficit.||Damages obturator nerve.|
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Pelvic fracture
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Thight flexiona nd leg extension deficit. Anteiror thight and medial leg sensory deficit.||Damages femoral nerve.|
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Radial head fracture
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Wrist drop.||Damage to radial nerve.|
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