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1623 Cards in this Set
- Front
- Back
This disease is caused by excess iron |
Hemocrhomatosis, excess iron causes free radical damage |
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Disorder due to autoimmune production of IgG against platelet antigens (e.g., GPIIb/IIIa) |
Idiopathic thrombocytopenic purpura (ITP) autoantibodies against platelets are made in spleen and the platelets are consumed in the spleen. Therefore removal of spleen can treat chronic ITP. |
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Pathologic formation of platelet microthrombi in small vessles is known as? |
Microangiopathic hemolytic anemia anemia is caused by the microthrombi shearing the RBCs resulting in hemolytic anemia and schistocytes |
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Microangiopathic hemolytic anemia that is caused by a decrease in ADAMTS13. ADAMTS13 is used to cleave (deactivate) vWf. This leads to microthrombi due to undegraded ADAMTS13. |
Thrombotic thrombocytopenic purpura -most common cause is autoimmunity to ADAMTS13 |
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Microangiopathic hemolytic anemia that is caused by endothelial damage by drugs or infection. |
Hemolytic Uremic Syndrome -caused by EColi O157:H7 verotoxin damaging endothelial cells resulting in platelet microthrombi |
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Syndrome where there is GP1b is deficient leading to platelet adhesion impairment |
Bernard-Soulier syndrome -GP1b on platelets are responsible for binding of vWf
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Syndrome where GP IIb/IIIa is deficient leading to deficient platelet aggregation |
Glanzmann thombasthenia -platelet aggregation is impaired since GPIIb/IIIa is responsible for that |
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Platelet destruction that arises secondary to heparin therapy is called? |
Heparin-induced thrombocytopenia (HIT) -fragments of destroyed platelets may activate remaining platelets, leading to thrombosis. This is a feared complication. |
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Pathologic activation of coagulation cascade is called? |
Disseminated Intravascular Coagulation -activation of cascade burns up all the factors and causes microthrombi everywhere as well as bleeding from mucosal surfaces. |
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This disorder resembles DIC but it has no D-dimers and normal platelet counts |
Disorders of fibrinolysis due to overactive plasmin |
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What is Virchow's triad? |
The three major risk factors for thrombosis: -Disruption of blood flow -Endothelial cell damage -Hypercoaguable state |
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What is the mechanism for warfarin skin necrosis? |
Factor 2,7,9,10 and protein C and S need epoxide reductase. Warfarin inhibits this but protein C and S have the shorter half-lives so C and S are inhibited first leading to a hypercoagulable state. |
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What defect is it when factor V lacks the cleavage site for deactivation by protein C and S? |
Factor V Leiden -most common inherited cause of a hypercoagualble state. |
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Disorder that when heparin is given it does not incrase PTT? |
ATIII deficiency - anti-thrombin 3 is responsible for inhibited thrombin. Heparin works by activating ATIII. Since there is no ATIII to activate then PTT will remain the same. |
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Chronic form of gas emobli characterized by multifocal ischemic necrosis of bone. |
Caisson Disease |
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What are the 4 types of microcytic anemia? |
Iron deficiency Anemia of Chronic Disease Sideroblastic anemia Thallesemia |
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Increased hepcidin is mechanism for what disease? |
Anemia of chronic disease. Chronic disease state produces hepcidin which sequesters iron into ferritin. So lab values: Ferritin: High TIBC: low Serum iron: low %saturation: low |
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Iron deficiency anemia has what lab values? |
Ferritin: low TIBC: high Serum iron: low %saturation low |
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Anemia due to defect in protoporphyrin synthesis is called? |
Sideroblastic anemia |
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What are lab values for sideroblastic anemia? |
Ferritin: high (macrophages eat all the extra iron) TIBC: low Serum Iron: high %saturation: high
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Anemia due to defect in globin chains. Due to decreased production. |
Thalassemia |
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Which anemia has target cells? |
B-thallesemia |
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What are the two causes for macrocytic anemia? |
Folate deficiency Vit B12 deficiency |
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Two etiologies for normocytic anemia? and how to distinguish? |
peripheral destruction or underproduction. Reticulocyte count. Corrected reticulocyte count >3% suggests peripheral destruction Corrected reticulocyte count <3% suggests underproduction
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Inherited defect of RBC cytoskeleton-membrane tethering proteins leading to normocytic anemia |
Hereditary spherocytosis |
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Which disease has Howell-Jolly bodies? |
Hereditary spherocytosis Howell-Jowell bodies are DNA in RBCs that are not removed by the spleen. This can occur when the spleen is removed to treat heriditary spherocytosis. |
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Acquired defect in myeloid stem cells resulting in absent GPI (glycosylphophatidylinositol); renders cells susceptible to destruction by complement. |
Paroxysmal Nocturnal Hemoglobinuria (PNH) -GPI binds DAF and MIRL, these molecules protect it from complement; at night when you breath shallow it causes a slight acidosis which activates complement, w/o DAF and MIRL your cells are attacked. |
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Inability of Glutathione (an antioxidant) to be regenerated due to a deficiency in an enzyme leading to oxidative stress. |
G6PD deficiency- X-linked recessive disorder resulting in reduced half-life of G6PD; renders cells susceptible to oxidative stress. Glutathione takes the hit from oxidative stress and gets reduced back to glutathione by NADPH; NADPH is produced by G6PD |
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Which disease has bite cells and Heinz bodies? |
G6PD defiency - Heinz bodies are precipitated Hb due to oxidative stress, when macrophages see those Heinz bodies they bite that part off |
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Antibody-mediated (IgG or IgM) destruction of RBCs is called? |
Immune hemolytic anemia |
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Coombs test is used to diagnose what disease? |
Immune hemolytic anemia -direct tests whether the RBCs are bound by IgG -indirect tests whether there are antibodies in the serum that can bind RBCs |
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What virus infects progenitor RBCs and temporarily halts erythropoiesis? |
Parvovirus B19 |
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Pathologic process (e.g., metaplastic cancer) that replaces bone marrow; hematopoiesis is impaired, resulting in pancytopenia |
Myelophthisic process |
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Eosinophilia is classically seen in what disease? |
Hodgkin lymphoma |
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Basophilia is classically seen in what disease? |
Chronic myeloid leukemia (CML) |
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Monocytosis is classically seen when? |
Chronic inflammatory states and malignancy |
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Viruses normally cause lymphocytic leukocytosis, what is one bacteria that can also cause it? |
Bordetella pertussis - this bacteria creates lymphocytosis-promoting factor which blocks circulating lymphocytes from leaving the bleed to enter the lymph node. |
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EBV infection that results in lymphocytic leukocytosis comprised of reactive CD8+ T cells; CMV is a less common cause. |
Infectious Mononucleosis |
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How do you differentiate AML vs ALL? |
AML has Myeloperoxidase ALL has TdT+ (DNA polymerase) |
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Auer rods are made of what, and what do they indicate? |
Auer rods are made of myeloperoxidase and indicate AML. |
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ALL is associated with what syndrome? |
Down syndrome after the age of 5 |
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ALL is subdivided into what two categories and how do you distinguish them? |
B-ALL and T-ALL B-All expresses CD10, CD19, and CD20 T-ALL expressed CD2-CD8 |
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ALL seen in kids has what translocation? |
t(12;21) - good prognosis |
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ALL seen in adults has what translocation? |
T(9;22) - Philidelphia+ ALL |
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3T's of acute lymphoblastic lymphoma |
T-ALL Thymic Mass Teenagers |
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AML more common in children or adults? |
Adults 50-60 years old |
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Acute promyelocytic leukemia is characterized by what translocation? |
t(15;17) - disrupts retinoic acid receptor, cure is ATRA which is vitamin A, promyelocytes contain Auer rods which increase risk for DIC |
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Acute monocytic leukemia is a proliferation of what cell and what tissue does it commonly involve? |
Proliferation of monocytes and commonly involves gums |
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Acute megakaryoblastic leukemia is proliferation of what cell and is associated with what? |
Proliferation of megakaryoblasts and association with down syndrome before age of 5 |
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Which leukemia is associated with down syndrome before the age of 5 and after the age of 5? |
Acute megakaryoblastic leukemia before age of 5 ALL after age of 5 |
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What cell is the neoplastic proliferation of CLL? what surface markers are expressed? |
proliferation of naive B-cells, CD5 and CD20 CD5 is normally on T-cells |
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Smudge cells are classically seen in what disease? |
CLL |
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Neoplastic proliferation of mature B cells is what disease? |
Hairy Cell Leukemia - characterized by hair cytoplasmic processes |
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Positive for tartrate-resistant acid phosphatase (TRAP) is indicative of what disease? |
Hairy Cell Leukemia |
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TRAP mnemonic is for what disease and what are the 3 things it's used for? |
TRAP = Hairy Cell Leukemia Trapped in red pulp (splenomegaly of red pulp when usually its white pulp for leukemias) Trapped in bone marrow - dry tap with bone marrow aspiration Since they are TRAPPED, lymphadenopathy is usually absent |
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Neoplastic prliferation of mature CD4+ T cells is called? |
ATLL - Adult T-cell Leukemia/Lymphoma |
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ATLL is associated with what virus? |
HTLV-1 - most commonly seen in Japan, Human lymphotropic virus 1 |
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Pt with lytic bone lesions with hypercalcemia WITH a RASH |
ATLL (Adult t-cell leukemia/lymphoma) - if without a rash then think multiple myeloma |
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Neoplastic proliferation of mature CD4+ T cells that infiltrate the skin |
Mycosis fungoides |
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What are aggregates of neoplastic cells in the epidermis called? |
Pautrier microabscesses |
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Neoplastic proliferation of mature myeloid cells, especially granulocytes, basophils are characteristically increased. |
CML - Chronic Myeloid Leukemia |
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CML is driven by what translocation? |
t(9;22), philidelphia chromosome |
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Neoplastic proliferation of myeloid cells, especially RBCs |
Polycythemia Vera |
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What are the three different causes for painless lymphadenopathy |
Chronic inflammation metastatic carcinoma lymphoma |
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Patients with rheumatoid arthritis have expansion in what region of the lymph node? |
Follicle |
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Patients with early HIV have expansion in what region of the lymph node? |
Follicle |
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Patients with a viral infection have expansion in what region of the lymph node? |
Paracortex - where the T-cells live |
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Follicular lymphoma is driven by what translocation? and what genes are traded? |
t(14;18) -14 has Ig heavy chain, 18 is Bcl-2, Bcl-2 is used to stabilize the mitochondrial membrane which prevents cytochrome C from leaking which prevents apoptosis. |
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Most feared complication of follicular lymphoma? |
Having it progress to diffuse large B-cell lymphoma |
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Mantle cell lymphoma, marginal zone lymphoma, and follicular have expansion of what cell type? |
Neoplastic small B cells (CD20+) |
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Mantle Cell lymphoma is driven by what translocation? and what genes are being switched? |
t(11;14) - 11 Cyclin D1, 14 has Ig heavy chain. Cyclin D1 promotes G1/S transition in cell cycle |
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Neoplastic INTERMEDIATE-sized B Cells (CD20+T that is associated with EBV? |
Burkitt Lymphoma |
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African form of Burkitt lymphoma most commonly arises where? |
In the jaw |
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Sporadic form of Burkitt lymphoma most commonly arises where? |
abdomen |
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Burkitt Lymphoma is driven by what translocation? |
t(8;14) - 8 is c-myc and 14 is Ig heavy chain c-myc oncogene promotes cell growth |
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What disease has a starry sky appearance? |
Burkitt Lymphoma |
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Neoplastic large B-cell (CD20+) that grow diffusely in sheets. |
Diffuse Large B-cell Lymphoma |
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Most common form of non-hodgkin lymphoma? |
Diffuse Large B-cell lymphoma |
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Neoplastic proliferation of Reed-Sternberg cells |
Hodgkin Lymphoma |
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Reed-Sternberg cells have what surface markers? |
CD15 and CD30 |
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Which disease has owl-eye nulclei? |
Reed-sternberg cells of hodgkin lymphoma |
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Which interleukin is high in multiple myeloma |
IL-6 |
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What disease has an increased serum protein with M spike on SPEP(serum protein electrophoresis) but it has none of the other features of multiple myeloma (no lytic lesions, hypercalcemia, AL amyloid, or Bence-Jones proteinuria) |
Monoconal Gammopathy of Undetermined Significance |
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Waldenstrom Macroglobulinemia has what type of lymphoma with what type of Ig production? |
B-cell lymphoma with monoclonal IgM production |
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Neoplastic proliferation of Langerhans Cell |
Langerhans Cell histiocytosis |
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Birbeck granules (tennis racquet) is characteristic of what disease? |
Langerhans Cell histiocytosis |
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2 malignant disease of langerhans cells? |
Letterer-Siwe disease Hand-Schuller-Christian disease |
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Benign proliferation of langerhans cells in bone |
Eosinophlic granuloma |
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WBC differential from highest to lowest? |
Mnemonic: Neutrophils Like Making Everything Better Neutrophils (54-62%) Lymphocytes (25-33) Monocytes (3-7) Eosinophils (1-3) Basophils (0-.75)
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CD14 is cell surface marker for which cell? |
Macrophages |
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Target Cell is associated with what pathology? (4) |
"HALT" said the hunter to his target HbC disease Asplenia Liver disease (alcoholism) Thalassemia |
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What pathology has glutamic acid to lysin mutation at residue 6 in Beta globin? |
HbC defect - extravascular normocytic anemia |
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Apixaban and rivaroxaban Drug class and clinical use |
Class: Direct Factor Xa inhibitor Mechanism:Bind and directly inhibit the activity of factor Xa C:DVT and PE |
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Clopidogrel Drug class and clinical use |
Drug class: ADP receptor inhibitor
M: inhibit platelet aggregation by irreversibly blocking ADP receptors C: acute coronary syndrome, coronary stent, prophy for recurrent strokes T: TTP/HUS may be seen |
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Ticlopidine Drug class and clinical use |
Drug class: ADP receptor inhibitor
M: inhibit platelet aggregation by irreversibly blocking ADP receptors C: acute coronary syndrome, coronary stent, prophy for recurrent strokes T: TTP/HUS may be seen, NEUTROPENIA |
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Abciximab Drug class and clinical use |
GP IIb/IIIa inhibitors M: prevent aggregation of platelets Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty |
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Eptifibatide Drug class and clinical use |
GP IIb/IIIa inhibitors M: prevent aggregation of platelets Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty |
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Which cells are infected in infectious mononucelosis? |
CD8+ T-cells |
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Hypersegmented neutrophils and elevated MCV is associated with what? |
Folate or B12 deficient anemias |
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Which blood thinner has increased risk for neutropenia? |
Ticlopidine - ADP receptor inhibitor which inhibits platelet aggregation |
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What is the mechanism for hydroxyurea in the tx of sickle cell anemia? |
It increases the formation of HbF which do not sickle. |
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What drug is used for Heparin induced thrombocytopenia? and what is it's mechanism of action? |
Argatroban which is a direct thrombin inhibitor. Bivalriduin can also be used. |
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Pt with hemolytic anemia, hypercoaguable state, and thrombocytopenia suggests what disease? |
Paroxysmal Hemolytic Anemia |
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Which anemia has increased MCHC (mean corpuscular hemoglobin concentration)? |
Hereditary Spherocytosis |
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Which anemia has osmotic fragility? |
Hereditary Spherocytosis |
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What drug reverses heparin? |
Protamine |
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What causes a left shift in oxygen-hemoglobin dissociation curve? Right shift? |
Left shift = lower Base Lower 2,3 DPG Lower Temperature Right shift is opposite Acid Higher 2,3 DPG Higher temperature
CADET face RIGHT CO2 Acid DPG Exercise Temperature |
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What are the acute-phase reactants of inflammation? (4) |
IL-6 IL-1 TNF-a IFN-y |
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Granulomatous vasculitis that classically involves branches of the carotid artery |
Temporal (Giant Cell) Arteritis |
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Granulomatous vasculitis that classically involves the aortic arch at branch points. |
Takayasu Arteritis |
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Tx for granulomatous vasculitis such as Temporal (giant cell) arteritis or Takayasu arteritis |
Corticosteroids |
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Pts with Temporal Giant Cell Arteritis have a high risk for what complication? |
Blindness |
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Medium-Vessel Vasculitis involves what portion of the arteries? |
It commonly involves the muscular arteries that supply the organs |
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(Medium-Vessel) Necrotizing vasculitis involving multiple organs; lungs are spared. |
Polyarteritis Nodosa |
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This medium vessel vasculitis is associted with serum HBsAG (Hepatitis B antigen) |
Polyarteritis Nodosa |
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This disease has a string-of-pearls appearance on imaging |
Polyarteritis Nodosa |
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Medium-Vessel vasculitis that affects asian children <4 years old |
Kawasaki Disease |
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Medium-Vessel vasculitis that commonly involves the coronary artery |
Kawasaki disease |
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Medium-Vessel vasculitis that is highly associated with heavy smoking |
Buerger Disease |
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What is the treatment for kawasaki disease? |
Aspirin |
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Rash on the palms and rash on the soles is associated with what medium-vessel vasculitis? |
Kawasaki disease |
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Necrotizing vasculitis that involves the digits |
Buerger Disease |
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Necrotizing granulomatous vasculitis the involves the nasopharynx, lungs, and kidneys |
Wegener Granulomatosis |
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Wegener granulomatosis involves what parts of the body? |
Nasopharynx, lungs, and kidneys |
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c-ANCA is associated with which small-vessel vasculitis? |
Wegener Granulomatosis |
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Necrotizing vasculitis involving multiple organs, especially lung and kidney. |
Microscopic Polyangitis |
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Serum p-ANCA is associated with which small-vessel vasculitis (2)? |
Microscopic polyangitis Churg-Strauss syndrome |
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Necrotizing granulomatous vasculitis with eosinophils |
Churg-Strauss syndrome |
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Which small-vessel vasculitis have granulomas? |
Wegener and Churg-Strauss |
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Vasculitis due to IgA immune complex depositiion; most common vasculitis in children |
Henoch-Schnolein purpura |
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This disease presents with palpable purpura on buttocks and legs, GI pain and bleeding. |
Henoch-Schnolein purpura |
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This small0-vessel vasculitis presents with hematuria (IgA nephropathy) |
Henoch-Schnolein purpura |
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How does angiotensin II increase blood pressure? |
-Contracts arteriolar smooth muscle increasing TPR -Promotes adrenal release of aldosterone, which increases resorption of sodium in the distal convoluted tubule |
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Two causes for renal artery stenosis, one is for elderly males and one is for young females. |
Elderly male - atherosclerosis Young female - fibromuscular dysplasia |
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Which portion of the artery becomes thickened in atherosclerosis? |
Intima |
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Hyaline arterololsclerosis can be caused by what two things? and what does this lead to? |
Benign HTN - increased pressure forces proteins into the vessel wall Diabetes - non-enzymatic glycosylation making membrane leaky
Leads to arteriolonephrosclerosis --> chronic renal failure |
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Hyperplastic arteriosclerosis is caused by what? and what does it lead to? |
Malignant HTN Acute renal failure |
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Calcification of the media of muscular arteries; non-obstructive; not clinically significant |
Monckeberg Medial Calcific Sclerosis |
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Intimal tear with dissection of blood through media of aortic wall is called? |
Aortic Dissection |
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Most common cause of Aortic Dissection |
HTN |
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Balloon-like dilation of the thoracic aorta is called |
Thoracic aneurysm |
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Balloon-like dilation of the abdominal aorta is called? |
Abdominal aneurysm |
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Classic cause of thoracic aneurysm is what? |
Tertiary syphillis - endarteritis of the vaso vasorum results in luminal narrowing and atrophy of the vessel wall |
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"Tree bark" appearance of aorta is seen in what? |
Thoracic aneurysm due to syphillis |
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Where do abdominal aortic aneurysms usually occur? |
below renal arteries but above aortic bifurcation |
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Abddominal aortic aneurysm usually caused by what? |
HTN Classically seen in male smokers > 60 years old with HTN |
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Benign tumor comprised of blood vessels? |
Hemangioma |
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Pt present with hypotension, pulsatile abdominal mass, and flank pain. What is the dx? |
Abdominal aortic aneurysm rupture |
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Malingnant proliferation of endothelial cells |
Angiosarcoma |
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This cancer is associated with exposure to PVC |
Liver angiosarcoma |
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This cancer is associated with arsenic and Thorotrast |
Liver angiosarcoma |
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Low-grade malignant proliferation of endothelial cells associated with HHV-8 |
Kaposi Sarcoma |
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What percentage of blood flow must be stopped before symptoms emerge? |
70% stenosis; stable angina does not have symptoms unless there is 70% blockage |
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Which angina has the EKG show ST-segment depression and which has EKG elevation? (3) |
Stable and unstable have depression due to subendocardial ischemia, prinzmetal has elevation due to transural ischemia |
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Myocardial Infarction usually affects what portion of the heart? |
Left Ventricle |
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Most sensitive and specific marker for a myocardial infarction |
Troponin I |
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What marker is useful for detecting reinfarction days after MI? |
CK-MB, it returns to normal by 72 hours while Troponin I stays high for 7-10 days. |
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Exposure of pericardium to immune system leading to autoimmunity leading to pericarditis |
Dressler syndrome |
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Stages of MI, 1 day, 1 week, 1 month |
Coag Necrosis | Neutro then Macro | Granulation Tissue | Scar Tissue |
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What is the main tx for Left-Sided Heart Failure? |
ACE inhibitor |
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What is the most common cause for Right-sided heart failure? |
Left-side Heart failure |
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Nutmeg liver is associated with what? |
Right-sided heart failure |
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Defect in the septum that divides the right and left ventricles |
Ventricular Septal Defect |
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What is Ventricular septal defect associated with? |
Fetal alcohol syndrome |
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5 T's of Right to left shunt |
Truncus arteriosus Transposition of great vessels Tricuspid atresia Tetralogy of fallot Total anomalous pulmonary venous return |
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Two types of Atrial septal defect: which is most common, which is associated with Down syndrome? |
Ostium secundum = most common Ostium primium = Down syndrome |
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Patent ductus arteriosus is associated with what? |
Rubella |
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What is Eisenmenger syndrome? |
When a Left to right shunt reverse to a right to left shunt, leading to cyanosis. |
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What is the tetrology of Fallot? |
PROV Pulmonary stenosis Right Ventricular Hypertrophy Overriding AORTA Ventricular Septal defect |
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Which congenital defect which becomes cyanotic stops the cyanosis when they squat? |
Tetralogy of Fallot |
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Boot shaped heart on X-ray is associated with what? |
Tetralogy of Fallot |
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Transposition of the great vessels is associated with what? |
Maternal diabetes |
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Infantile form of Coarction of Aorta is associated with what two things and is located where on the aortic arch? |
Infantile associated with PDA and Turner syndrome and lies distal to the aortic arch but proximal to the PDA |
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Adult form of coarction of aorta is located where and associated with what? |
Distal to the aortic arch, there is no PDA. Associated with bicuspid aortic valve |
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This present with HTN in upper extremities and hypotension with weak pulse in lower extremities |
Adult coarction of aorta. This is because the blockage is after the aortic arch. Upper extremities gets all the blood pressure while the lower extremities are blocked by the coarction. |
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Collateral circulation develops across intercostal arteries, engorged arteries causes nothing of ribs on x-ray. What pathology is this? |
Adult coarctation of aorta |
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Systemic complication of pharyngitis due to group A B-hemolytic streptococci |
Acute rheumatic fever |
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What is the pathophysiology of acute rheumatic fever? |
Caused by molecular mimicry; bacterial M protein resembles human tissues |
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What is Jones criteria used for? |
Acute Rheumatic Fever |
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What are the Major criteria for Acute Rheumatic Fever? |
Joints - migratory polyarthritis O = heart problems - pancarditis Nodules = Subcutaneous nodules E = Erythema Marginatum Sydenham chorea = rapid, involuntary muscle movement |
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In acute rheumatic fever which valve is most often involved? and if another valve is involved which one? |
Alway Mitral valve maybe also aortic valve |
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Acute Rheumatic fever has these two histological characteristics |
Aschoff body (foci of chronic inflammation) involving myocardium with anitschkow cells (caterpillar nuclei) |
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Valve scarring that arises as a consequence of rheumatic fever |
Chronic Rheumatic Heart Disease |
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Narrowing of the aortic valve orifice |
Aortic Stenosis |
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Aortic stenosis is caused by what? |
Fibrosis and calcification from "wear and tear" |
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Backflow of blood from aorta into the left ventricle during diastole |
Aortic Regurgitation |
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Two causes for aortic regurgitation |
Aortic root dilation (e.g., syphilitic aneurysm) or valve damage (e.g., infective endocarditis) |
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Hyperdynamic circulation is associated with what? |
Aortic Regurgitation |
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Ballooning of mitral valve into left atrium during systole |
Mitral Valve Prolapse |
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Myxoid degneration of mitral valve will lead to what? |
Mitral valve prolapse |
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Reflux of blood from left ventricle into the left atrium during sytole |
Mitral regurgitation |
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Narrowing of the mitral valve orifice |
Mitral Stenosis |
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Mitral stenosis is usually due to? |
Chronic rheumatic valve disease Acute rheumatic heart disease leads to mitral regurgitation. |
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Most common overall cause of endocardittis |
Streptococcus viridans |
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Most common cause and valve affected in endocarditis in IV drug users? |
S. Aureus, Tricuspid valve |
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This bacteria is associated with prosthetic valves |
S. Epidermidis |
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Endocarditis in patients due to S. Bovis usually have what other pathology? |
Colorectal carcinoma |
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What are the HACEK organisms and what is the signficance? |
Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
This organisms are associated with endocarditis with negative blood cultures |
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Janeway lesions (erythematous non-tender lesions on the palms and soles) is a clinical feature of what? |
Bacterial Endocarditis |
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Osler nodes (tender lesions on fingers and toes) is a clinical feature of what? |
Bacterial Endocarditis |
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Sterile vegatations that arise with hypercoaguable state or underlying adenocarcinoma |
Nonbacterial thrombotic endocarditis |
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Sterile vegetations associated with SLE |
Libman-Sacks Endocarditis |
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Dilation of all four chambers of heart |
Dilated cardiomyopathy |
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Massive hypertrophy of the left ventricle usually due to genetic mutations in sarcomere proteins; most common form is autosomal dominant |
Hypertrophic cardiomyopathy |
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Sudden death due to ventricular arrhythmias; common cause of sudden death in young adults |
Hypertrophic cardiomyopathy |
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Decreased compliance of the ventricular endomyocardium that restricts filling during diastole |
Restrictive Cardiomyopathy |
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Benign mesenchymal tumor with a gelatinous appearance and abundant ground substance on histology |
Myxoma |
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Restrictive cardiomyopathy presents as what? |
Congestive heart failure |
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Most common primary cardiac tumor in adults |
Myxoma |
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Usually forms a pedunculated mass in the left atrium that causes syncope due to obstruction of mitral valve |
Myxoma |
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This cardiac tumor is associated with tuberous sclerosis |
Rhabdomyoma |
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Benign hamartoma of cardiac muscle |
Rhabdomyoma |
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Fetal erythropoiesis order of organs responsible. (4) |
Yolk Sac (3-8wks) Liver (6wks-birth) Spleen (10-28wks) Bone Marrow (18wks to adult) Young Liver Synthesizes Blood |
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What are the components of fetal hemoglobin and adult hemoglobin? |
A2Y2 (alpha2 gamma2) = fetal A2B2 (alpha2 beta2) = adult |
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Venodilators decrease preload or afterload? |
Venodilators decrease preload |
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Vasodilators decrease preload or afterload? |
Vasodilators decrease afterload |
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S1 and S2 sound is due to and where is it located? |
S1 - Mitral and tricuspid valve closure, loudest at mitral area S2 - Aortic and pulmonary valve closure. Loudest at left sternal border |
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S3 and S4 sound due to? |
S3 - in early diastole during rapid ventricular filling phase. S4 - "atrial kick" in late diastole. High atrial pressure. Associated with ventricular hypertrophy. |
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Receptors in aortic arch transmit via what nerve? |
Vagus (responds only to increase in BP) |
|
Receptors in carotid sinus transmit via what nerve? |
Glossopharyngeal (responds to decrease and increase of BP) |
|
HTN with CHF, cautious of what drug? |
B-Blockers |
|
HTN with Diabetes, should use what drug? |
ACE inhibitors/ARBs are protective against diabetic nephropathy |
|
HMG-CoA reductase inhibitors (statins) effect on LDL, HDL, Triglycerides, MOA, side effects |
3x decrease of LDL, 1x increase of HDL, 1x decrease of triglycerides. Inhibit HMG-COA reductase, hepatoxicity, rhabdomyolysis |
|
Niacin (Vit B3) effect on LDL, HDL, Triglyceride, MOA, side effects |
2x decrease LDL, 2x increase HDL, 1x decrease triglyceride. Inhibit lipolysis in adipose tissue, reduce hepatic VLDL synthesis. Red, flushed face which is decreased by aspirin. |
|
Bile acid resins (cholestyramine, colestipol, colesevelam) effect on LDL, HDL, Triglyceride, MOA, side effect |
2x decrease LDL, slight increase HDL, slight INCREASE of triglyceride. Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more. Decrease absorption of fat-soluble vitamins. Gall stones. |
|
Cholesterol absorption blockers (ezetimibe) effect on LDL, HDL, Tri, MOA, side effect |
2x decrease LDL, no effect on HDL or Tri, Prevent cholesterol absorption at small intestine brush border. |
|
Fibrates (gemfibrozil, clofibrate, -fibrates) effect on LDL, HDL, TRI, MOA, side effect. |
decrease LDL, increase HDL, 3x decrease Tri. Upregulate LPL--> TG clearance activates PPAR-a to induce HDL synthesis |
|
Which Lipid-lowering agent class best decreases Triglycerides? |
Fibrates (Gemfibrozil, clofibrate, bezafibrate, fenofibrate) |
|
Which lipid-lowering agent class best decreases LDL? |
HMG-CoA reductase (statins) |
|
Which lipid-lowering agent increases triglycerides? |
Bile acid resins (Cholestyramine, colestipol, colesevelam) |
|
Which lipid lower agent has no effect on HDL or Triglycerides? |
Cholesterol absorption blockers (ezetimibe) |
|
Statins in combination with what drugs has increased risk for rhabdomyolysis? |
Statins with fibrates and niacin |
|
When determining metabolic, respiratory, alka vs acidosis what are the steps? |
Look at pH to determine if its alka or acid, now determine if its resp or meta by looking at bicarbonate. |
|
How do beta blockers effect the RAAS? |
Beta blockers inhibit renin release by blocking beta-1 receptors on Juxtaglomerular cells |
|
Most common benign vascular tumor in children? adults? |
Strawberry hemangioma - children Cherry hemangioma - adults |
|
Anti-hypertensives ending in -zosin have what MOA? |
They are alpha-1 blockers and are also useful for benign prostatic hyperplasia |
|
If you have a child with nasal polyps what should you also be checking for? |
Cystic fibrosis |
|
Pts with ASA-intolerant asthma have what triad? |
Asthma, aspirin-induced bronchospasms, and nasal polyps |
|
Benign tumor of nasal mucosa composed of large blood vessels and fibrous tisse |
Angiofibroma |
|
If an adolescent male has profuse epitaxis what should you suspect? |
Angiofibroma |
|
Malignant tumor of nasopharyngeal epithelium |
Nasopharyngeal carcinoma |
|
Nasopharyngeal carcinoma is associated with what? |
EBV |
|
Nasopharyngeal carcinoma has what type of histology? |
Pleomorphic KERATIN-POSITIVE epithelial cells |
|
Inflammation of the upper airway |
Laryngotracheobronchitis (Croup) |
|
Nodule that arises on the true vocal cord |
Vocal cord nodule |
|
Benign papillary tumor of the vocal cord |
Laryngeal papilloma |
|
Laryngeal papilloma is due to what? |
HPV 6 and 11 |
|
Laryngeal papillomas are usually (single/multiple) in adults and (single/multiple) in children |
Single in adults Multiple in children |
|
Squamous cell carcinoma arising from epithelial lining of vocal cord |
Laryngeal carcinoma |
|
2 key chemical mediators for pain |
Prostaglandin E2 and Bradykinin |
|
Three patterns of pneumonia that can be seen on chest x-ray |
Lobar pneumonia, bronchopneumonia, interstitial pneumonia |
|
Pneumonia characterized by consolidation of an entire lobe of the lung |
Lobar pneumonia |
|
Pneumonia characterized by scattered patchy consolidation centered around bronchioles; often multifocal and bilateral |
Bronchopneumonia |
|
Pneumonia characterized by diffuse interstitial infiltrates. |
Interstitial (atypical) pneumonia |
|
Lobar and bronchopnemonia usually bacterial or viral? |
Bacterial |
|
Interstitial pneumonia is usually bacterial or viral? |
viral |
|
Most common cause for lobar pneumonia (2 bacterias)? |
Streptococcus Pneumoniae (95%) and Klebsiella pneumoniae |
|
Lobar pneumonia in patients who have high chance of enteric flora aspiration (elderly in nursing homes, alcoholics). What is the bacterial cause of the pneumonia? |
Klebsiella pneumoniae |
|
Which type of pneumocyte can replicate Type 1 or 2? |
Type 2 can replicate |
|
Which type of pneumocyte is responsible for producing surfactant? |
Type 2 |
|
Which type of pneumocyte is responsible for the epithelial lining? |
Type 1 |
|
What are the four classic phases of lobar pneumonia and describe each. |
Congestion - congested vessels and edma Red hepatization - exudate, neutrophils, and hemmorrhage filling the alveolar air space Gray hepatization - degradation of red cells within exudate Resolution - regeneration |
|
Aspiration pneumonia usually affects which side? |
Right lower lobe (due to anatomy) |
|
Which bacteria anaerobic bacteria are normally responsible for aspiration pneumonia? (3) |
Bacteroidies, fusobacterium, and peptococcus |
|
Most common site for systemic spread of TB? |
Kidneys creating a sterile pyuria |
|
Which congenital heart defects are caused by abnormal migration of neural crest cells (3)? |
Truncus Arteriosus Transposition of Great Vessels Tetralogy of Fallot
|
|
What is the DOC for Beta blocker overdose? and what is the receptor it works on? |
Glucagon, which increases HR and contractility via cAMP. |
|
T-lymphocyte immunodeficiency that resultsin maldevelopment of the third and fourth branchial (pharyngeal) pouches. |
DiGeorge syndrome |
|
DiGeorge syndrome is due to a deletion of what chromosome? |
Chromsome 22 |
|
MOA of Dobutamine |
B1-adrenergic receptor agonist. Is used for acute heart failure due to decreased myocardial contractility |
|
Beta-Blockers work where on an EKG? |
PR interval, they slow AV conduction. |
|
(4)Hyper and (2)Hypo problems of Thiazide diuretics |
Hyperuricemia Hypercalcemia Hyperglycemia Hyperlipidemia
Hypokalemia Hypotension |
|
Doxorubicin can causes what problem with the heart? |
Dilated cardiomyopathy |
|
Sharp pain that is relieved by sitting up and leaning forward suggests what? |
Pericarditis - associated with SLE |
|
Nitrates mixed with drugs for erectile dysfunction are absolutely contraindicated, what is the MOA? |
Increased cyclic GMP due to nitrates synthesizing and PDE inhibitors inhibiting degradation. |
|
What is FVC? Normal amount? |
Forced vital capacity - breathe in all the way breath out all the way. 5L |
|
What is FEV1? Normal amount? |
Forced Expiratory Volume - How much air you can breath out in the first second. 4L |
|
In airway obstruction what are the relative decreases in FVC, FEV1, and FEV1:FVC ratio,FRC, TLC? |
FVC - decreases FEV1 - significant decrease FEV1:FVC ratio - decreases FRC - Increased TLC - increases due to trapped air |
|
Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking |
Chronic bronchitis |
|
Destruction of alveolar air sacs leading to COPD |
Emphysema |
|
What enzyme neutralizes proteases in alveolar air sacs? |
A1AT - a1-antitrypsin neutralizes proteases |
|
Deficiency in what can cause emphysema? |
A1AT - a1-antitrypsin |
|
Barrel-chest (increased AP diameter) is found in emphysema or chronic bronchitis? |
Emphysema |
|
Smoking leads to centriacinar or panacinar emphysema? |
centriacinar |
|
A1AT deficiency leads to centriacinar or panacinar emphysema? |
panacinar |
|
In A1AT, the two organs affected are what? |
Lung emphysema and liver cirrhosis |
|
Biopsy of liver in A1AT will reveal what? |
pink, PAS-positive globules in hepatocytes |
|
Prolonged expiration with pursed lips, is which COPD? |
Emphysema |
|
Match: Emphysema and Cystic fibrosis with Increased or Decreased Functional Residual Capacity |
Emphysema = Increased FRC Cystic Fibrosis = Decreased FRC |
|
Key cytokines released by Th2 helper CD4+ T cells? |
IL-4, IL-5, IL-10 |
|
IL-5 main job? |
recruit eosinophils |
|
In asthma allergens stimulate what cells to release what three cytokines which are responsible for what? |
Th2 CD4+ T cells --> IL-4,IL-5,IL-10 IL-4 = IgE Class switch IL-5 = recruit eosinophils IL-10 = inhibit Th1 stimulate Th2 |
|
Reexposure to allergen has two phases, what is released in the first phase, what is released in the second phase? |
First phase = release of histamine Second phase = Release of leukotriene C4,D4,E4 |
|
What are leukotrienes C4,D4,E4 responsible for? |
Bronchoconstriction, inflammation, edema |
|
What are Charcot-Ledyden crystals and what are they assocaited with? |
Eosinophil-derived crystals associated with asthma |
|
What are Curschmann spirals? |
spiral-shaped mucus plugs found in asthma |
|
What is permanent dilation of bronchioles and bronchi? |
Bronchiectasis |
|
What is the classic cause of bronchiectasis? |
Classic cause is cystic fibrosis |
|
What syndrome is associated with Bronchiectasis, and what is defective? |
Kartagener syndrome - defect in dynein arm of cilia |
|
In restricted lung diseases are these values increased or decreased? TLC, FVC, FEV1,FRC, FEV1:FVC ratio |
TLC - decreased FVC - decreased 2x FEV1 - decreased FRC - decreased FEV:FVC ratio - increased |
|
Fibrosis of lung interstitium with unknown etiology |
Idiopathic Pulmonary Fibrosis |
|
What chemical mediator drives the process of idiopathic pulmonary fibrosis? |
TGF-B |
|
What is interstitial fibrosis due to occupational exposure |
Pneumoconioses |
|
What are the 4 types of Pneumoconioses? |
Coal Worker's Silicosis - sandblasters and silica miners Beryliosis - berylium miners and aerospace Absestosis - construction workers, plumbers, shipyard workers |
|
Aerospace worker who has lung problmes, what is the dx? |
Berylliosis |
|
What is the name of collections of carbon-laden macrophages, like that seen in Coal Worker's pneumoconiosis? |
Anthracosis |
|
What pneumoconioses increases risk for TB and why? |
Silicosis - Silica impairs phagolysosome formation by macrophages. |
|
Which pneumoconioses has noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs, similar to sarcoidosis? |
Berylliosis - distinguish by med hx and see if they work in the aerospace industry |
|
Absetosis more likely to get lung carcinoma or mesothelioma? |
Lung carcinoma |
|
Systemic disease characterized by noncaseating granulomas in multiple organs |
Sarcoidosis |
|
Asteroid bodies are associated with what disease? |
Sarcoidosis - stellate inclusions that are often seen within giant cells of the granulomas |
|
Sarcoidosis has two lab findings what are they? |
Elevated serum ACE Hypercalcemia |
|
What is the pathophysiology of hypercalcemia in sarcoidosis? |
1-alpha hydroxylase activity of epitheliod histiocytes converts vitamin D to its active form - this occurs in all non-caseating granulomas (e.g., sarcoidosis and berylliosis) |
|
Granulomatous reaction to inhaled organic antigens where chronic exposure leads to interstitial fibrosis. |
Hypersensitivity Pneumonitis |
|
Aschoff body and anischkow (caterpillar) cells are associated with what? |
Acute Rheumatic Fever |
|
What are plexiform lesions and what are they associated with? |
Tufts of capillaries; associated with pulmonary HTN |
|
Pulmonary HTN leads to what two things? |
Right ventricular hypertrophy and cor pulmonale |
|
If someone presents with exertional dyspnea what should come to mind? |
Pulmonary HTN |
|
Primary pulmonary HTN the etiology is unknown but some familial forms are related to inactivating mutations of what, which leads to what? |
BMPR2, leading to proliferation of vascular smooth muscles |
|
Diffuse damage to the alveolar-capillary interface leads to formation of what? What is this disease called? |
Leads to formation of hylaine membranes in alveoli, disease is Acute Respiratory Distress Syndrome |
|
Diffuse white-out on chest x-ray suggests what? |
Acute Respiratory Distress Syndrome |
|
Which pneumocytes get damaged in Acute Respiratory Distress syndrome? |
Type I and Type II both get damaged |
|
Respiratory distress due to inadequate surfactant levels is called? |
Neonatal Respiratory Distress syndrome |
|
Neonatal Respiratory Distress Syndrome associated with what 3 things? |
Prematurity C-Section Maternal Diabetes |
|
What is the major component of surfactant? |
Phosphatidylcholine (lecithin) |
|
Why does C-section delivery cause increased risk for Neonatal Respiratory Distress Syndrome? |
Lack of stress-induced steroids; steroids increases synthesis of surfactant |
|
What is particularly carcinogenic in cigarette smoke? |
Polycyclic aromatic hydrocarbons |
|
What type of cancer is increased in radon miners? |
Lung cancer |
|
Two benign "coin-lesions" that can be seen on a chest x-ray |
Granuloma and Bronchial Hamartoma |
|
What is a benign tumor composed of lung tissue and cartilage; often calcified on imaging? |
Bronchial Hamartoma |
|
Lung carcinoma is divided into what two categories? and what is the significance? |
Small cell carcinoma and non-small cell carcinoma. Small cell responds to chemo, non-small cell responds to surgery |
|
Non-small cell carcinoma with glands or mucin |
Adenocarcinoma |
|
Non-small cell carcinoma with keratin pearls or intracellular bridges |
Squamous cell carcinoma |
|
Non-small cell carcinoma with NO keratin pearls, intracellular bridges, glands, or mucin |
Large cell carcinoma |
|
Small cell carcinoma is associated with what syndrome? |
Eaton-Lambert syndrome - anti-bodies against calcium channels in NMJ leading to weakness |
|
Lung carcinomas that start with S (small cell carcinoma, squamous cell carcinoma) have what common attributes? (3) |
Smokers, Central, paraneoplastic syndromes |
|
Which lung cancer can cause hypercalcemia and what is the mechanism? |
Squamous cell carcinoma due to production of PTHrP (parathyroid hormone related Peptide) |
|
Which lung cancer may produce ADH or ACTH? |
Small cell carcinoma |
|
What is the most common tumor in non-smokers? |
Adenocarcinoma |
|
What is the most common tumor in female smokers? |
Adenocarcinoma |
|
What is the most common tumor in male smokers? |
Squamous cell carcinoma |
|
Name the tumor: Columnar cells that grow along preexisting bronchioles and alveoli; arises from Clara cells |
Bronchioalveolar carcinoma |
|
Which lung cancers are chromogranin positive? |
Carcinoid tumor and Small Cell Carcinoma |
|
Lung cancer with well differentiated neuroendocrine cells |
Carcinoid tumor |
|
Two lung cancers not related to smoking |
Bronchioalveolar carcinoma Carcinoid tumor |
|
Two lung cancers that are derived from neuroendocrine cells; what is the difference? |
Small cell carcinoma - poorly differentiated Carcinoid tumor - well differentiated |
|
Which lung cancer presents as a polyp-like mass in the bronchus? |
Carcinoid tumor |
|
Two Most common source for metastasis to lung? |
Breast and colon cancer |
|
This lung cancer has multiple 'cannon-ball' nodules on imaging |
Metastasis to lung |
|
Where do lung cancers like to metastasize? |
Adrenal gland |
|
Lung cancer can lead to Horner syndrome, what are the 3 characteristics? |
Compression of sympathetic chain leads to -ptosis (drooping of eyelid) -miosis (pinpoint pupil) -anhidrosis (no sweating) |
|
Accumulation of air in the pleural space is called? |
Pneumothorax |
|
Pneumothorax caused by rupture of an emphysematous bleb |
Spontaneous pneumothrax |
|
Pneumothorax caused by penetration of chess wall |
Tension pneumothorax |
|
Malignant neoplasm of mesothelial cells of lung |
Mesothelioma |
|
Structures that perforate the diaphragm at T8, T10, T12? |
T8: IVC T10: esophagus, (CNX vagus), T12: aorta, thoracic duct, azygos vein |
|
What nerves innervate diaphragm? |
C3,4,5 |
|
Fetal Hb has higher or lower affinity for 2,3-BPG? what does this mean? |
lower affinity for 2,3-BPG which means it has a higher affinity for O2. |
|
Pancoast tumors can have what 4 complications? |
Horner syndrome SVC syndrome Sensorimotor deficits Hoarseness (recurrent laryngeal nerve) |
|
Ethambutol can be used to treat TB; what is it's most notable complication? |
Optic neuritis |
|
What is S. pneumoniae's main virulence factor? |
Having an outer polysaccharide capsule which prevents phagocytosis |
|
What should you think of when you see "new screening test" |
Lead time bias |
|
Arterial blood gas for Metabolic acidosis (pH, pCO2, HCO3-) |
pH decreased PCO2 decreased HCO3- decreased |
|
Arterial blood gas for Respiratory Acidosis (pH, pCO2, HCO3-) |
pH decreased PCO2 increased HCO3 normal or increased(compensated) |
|
Arterial blood gas for Metabolic alkalosis (pH, pCO2, HCO3-) |
pH increased PCO2 increased HCO3 increased |
|
Arterial blood gas for Respiratory alkalosis (pH, pCO2, HCO3-) |
pH increased PCO2 decreased HCO3 decreased(compensated) or normal |
|
Diabetic ketoacidosis leads to what kind of acid/base imbalance? |
Metabolic acidosis |
|
Overuse of diuretics leads to what kind of acid/base imbalance? |
Loss of hydrogen ions leading to metabolic alkalosis |
|
Panic attacks leads to what kind of acid/base imbalance? |
Respiratory alkalosis |
|
COPD leads to what kind of acid/base imbalance? |
Respiratory acidosis (compensated) pH - decreased PCO2 - increased HCO3- - inceased |
|
What is the inheritance pattern of cystic fibrosis? |
Autosomal recessive |
|
Failure of neutrophils to turn blue on a nitroblue tetrazolium test indicates what disease? |
Chronic Granulomatous Disease |
|
Neutrophils in Chronic Granulomatous Disease are unable to kill what and why? |
Catalase producing organisms because normally bacteria will kill themselves due to their own production of H2O2. If the organism can break down its own H2O2 then it can survive. The body can not make any H2O2 since NADPH oxidase does not work. |
|
Cheyne-stokes breathing is commonly seen in what? |
advanced congestive heart failure |
|
Stimulation of vagus nerve would do what to the lungs (2)? |
Bronchoconstriction and increased mucus production |
|
Cystic fibrosis is caused by what genetic defect? What does it affect as far as going from gene to protein? |
3-base pair deletion of CFTR (cystic fibrosis transmembrane conductance regulator). This affects post-translational processing. |
|
Phospholipid content of amniocentesis is used to check for what? |
Fetal Lung development (measuring phosaphatidylcholine) |
|
Bronchioalveolar lavage of patients with sarcoidosis show elevation in what cell type? |
CD4+ lymphocytes |
|
Bronchioalveolar lavage of patients with lung transplants showing rejection would show elevation in what cell type? |
CD8+ lymphocytes |
|
Structure of MHC Class I |
Heavy chain and B2 microglobulin |
|
Structure of MHC Class II |
Alpha and beta polypeptide chains |
|
Which cells are MHC Class I molecules expressed? |
All cells |
|
Which cells are MHC Class II molecules expressed? |
Antigen Presenting Cells |
|
Describe V/Q in base vs apex |
Higher in apex lower in base |
|
What is used as a marker for mast cell activation (anaphylaxis)? |
Tryptase |
|
Symptoms of Theophylline overdose? (3) |
abdominal pain, vomiting, seizures |
|
Behcet syndrome has what 3 parts? |
Apthous ulcers, genital ulcers, and uveitis |
|
Pathophysiology of behcet's syndrome |
Immune complex vasculitis involving small vessels |
|
Most feared complication of mumps? |
Orchitis leading to sterility |
|
Benign cystic tumor with abundant lymphocytes and germinal centers found in salivary gland |
Warthin tumor |
|
Congenital defect resulting in a connection between the esophagus and trachea |
Tracheoesophageal fistula |
|
Thin protrusion of esophageal mucosa, most often in the upper esophagus |
Esophageal web |
|
What are the components of Plummer-Vinson syndrome? |
Severe iron deficiency anemia, esophageal web, beefy-red tongue due to atrophic glossitis |
|
Outpouching of pharyngeal mucosa through acquired defect in the muscular wall of the esophagus |
Zenker Diverticulum |
|
Longitudinal laceration of mucosa at the GE junction |
Mallory-Weiss syndrome |
|
What is the cause of Mallory-Weiss syndrome? and what 2 populations is it seen in? |
Severe vomiting due to bulimia or alcoholism |
|
rupture of esophagus leading to air in mediastinum and subcutaneoues emphysema |
Boerhaave syndrome |
|
Mallory-Weiss syndrome has a risk of what? |
Boerhaave syndrome |
|
Dilated submucosal veins in the lower esophagus |
Esophageal varices |
|
Esophageal varices arise secondary to what? |
portal HTN |
|
Painless hematemesis is found in what? Painful hematemesis is found in what? |
Painless = esophageal varices Painful = Mallory-Weiss syndrome |
|
Most common cause of death in cirrhosis? |
Esophageal varices that rupture |
|
Disordered esophageal motility with inability to relax lower esophageal sphincter |
Achalasia |
|
Achalasia is due to damage of what? |
Ganglion cells in MYENTERIC plexus |
|
Achalsia can be due to infection by what bacteria, and what is the name of the disease? |
Trypanosoma cruzi = Chagas disease |
|
Reflux of acid from the stomach due to reduced LES tone |
GERD |
|
Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells |
Barrett Esophagus |
|
Two types of esophageal carcinoma |
Adenocarcinoma and squamous cell carcinoma |
|
Most common esophageal cancer worldwide |
squamous cell carcinoma |
|
Most common esophageal cancer in the west |
adenocarcinoma |
|
(1)Upper 1/3, (2)Middle 1/3, and (2)Lower 1/3 of esophageal cancers involve what lymph nodes? |
upper = cervical middle = mediastinal and tracehobroncial nodes lower = celiac and gastric |
|
Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents |
Gastroschisis |
|
Persistent herniation of bowel into umbilical cord |
Omphalocele |
|
Congenital hypertrophy of pyloric smooth muscle |
Pyloric Stenosis |
|
Acidic damage to the stomach mucosa |
Acute Gastritis |
|
Projectile nonbilious vomiting indicates? |
Pyloric stenosis |
|
Which cells in the stomach produce mucous? |
foveolar cells |
|
What is a cushing ulcer? |
Acute gastritis induced ulcer due to increased stimulation of vagus nerve to release acetylcholine which leads to increased acid production |
|
What are the 3 receptors on parietal cells that can induce it to secrete acid? |
Acetylcholine Gastrin Histamine |
|
What are the two types of chronic gastritis? |
Chronic Autoimmune gastritis Chronic H pylori gastritis |
|
Autoimmune destruction of gastric parietal cells leads to? |
Chronic gastritis |
|
What regions are gastric parietal cells located in the stomach? |
Fundus and Body NOT Cardia and Antrum |
|
What region is Chronic H pylori gastritis normally affect? |
Antrum NOT fundus, body, or cardia |
|
Solitary mucosal ulcer that occurs in the duodenum 90% of the time and in the distal stomach 10% of the time |
Peptic ulcer disease |
|
Duodenal or gastric ulcers; pain improves with meals? |
Duodenal |
|
Malignant proliferation of surface epithelial cells in the stomach |
Gastric carcinoma |
|
Two types of gastric carcinoma |
intestinal type diffuse type |
|
Gastric carcinoma which presents as large, irregular ulcer with heaped up margins |
intestinal type |
|
Gastric carcinoma which is characterized by signet ring cells that infiltrate the gastric wall |
Diffuse type |
|
Blood type A is associated with what cancer? |
Intestinal Type of gastric carcinoma |
|
describe a signet ring cell? |
Nucleus pushed off to the edge due to production of mucin |
|
Leser-Trelat sign can indicate what? |
Gastric carcinoma |
|
Gastric carcinoma normally spreads to which node? |
Left supraclavicular node (virchow node) |
|
Which node is Virchow node? |
Left supraclavicular node |
|
Distant metastasis of gastric carcinoma most commonly involves what organ? |
Liver |
|
Intestinal type of gastric carcinoma classically spreads where? |
Preumbilical region (Sister Mary Joseph nodule) |
|
Diffuse type of gastric carcinoma classically spreads where? |
Bilateral ovaries (Krukenberg tumor) |
|
What disease has translocation at 12,21 |
ALL (kids) |
|
What disease has translocation at 9,22 |
ALL (adults) and CML |
|
What disease has translocation at 15,17 |
Acute Promyelocytic Leukemia |
|
What disease has translocation at 14,18 |
Follicular lymphoma |
|
What disease has translocation at 11,14 |
Mantle Cell Lymphoma |
|
What disease has translocation at 8,14 |
Burkitt Lymphoma |
|
Congenital failure of small bowel to canalize |
Duodenal atresia |
|
What is duodenal atresia associated with? |
Down syndrome |
|
Double-bubble sign indicates what pathology? |
Duodenal atresia |
|
Outpouching of all three layers of bowel wall |
Meckel Diverticulum |
|
This pathology occurs due to failure of the vitelline duct to involute |
Meckel diverticulum |
|
What are the (4) Rule of 2's and what does it apply to? |
Meckel Diverticulum Seen in 2% of population Usually 2 inches long Within 2 feet of ileocecal valve Present during first 2 years of life |
|
Twisting of bowel along its mesentery |
Volvulus |
|
Telescoping of proximal segment of bowel forward into distal segment |
Intussusception |
|
Most common cause for intussusception in adults |
tumor |
|
Most common cause for intussusception in children |
Lymphoid hyperplasia |
|
Immune-mediate damage of small bowel villi due to gluten exposure |
Celiac disease |
|
What is the most pathogenic component of gluten? |
Gliadin |
|
What is the process by which Gliadin causes damage to villi? |
Gliadin is deamidated by tTg (tissue transgutaminase), it is then presented to APC via MHC Class II. Helper T cells mediate tissue damage |
|
Dermatitis herpetiformis is associated with what GI pathology? |
Celiac disease - small, herpes-like vesicles may arise on skin due to IgA deposition at the tips of dermal papillae; resolve with gluten-free diet |
|
What laboratory findings are there for celiac disease? |
IgA antibodies against endomysium, tTG, or gliadin |
|
In celiac disease which portion of the small intestine is most involved? |
Duodenum |
|
If there is refractory disease after continuing a gluten free diet when dx with celiac what should you suspect (2)? |
Small bowel carcinoma and T-cell lymphoma (eneteropathy associated T-cell lymphoma) |
|
Damage to small bowel villi due to an unknown organism resulting in malabsorption |
Tropical sprue |
|
In tropical sprue which portion of the small intestine is involved? |
Jejunum and Ileum |
|
Where is folic acid absorbed? |
Jejunum |
|
Where is Vit B12 absorbed? |
Ileum |
|
What is whipple disease? |
Systemic tissue damage characterized by macrophages loaded with Tropheryma Whippelii organisms |
|
Two key findings in whipple disease? |
fat malabsorption and steatorrhea |
|
Abetalipoproteinemia has what inheritance pattern and is a deficiency in what two proteins |
Autosomal recessive deficiency of apolipoprotein B-48 and B-100 |
|
Patient has absent plasma VLDL and LDL, what is the dx and what is the pathophysiology? |
Abetalipoproteinemia - VLDL and LDL require apolipoprotein B-100 |
|
Abscence of apolipoprotein B-48 indicate what disease and has what feature due to this absence? |
Abetalipoproteinemia - absence of B-48 leads to defective chylomicron formation |
|
Carcinoid tumor in the gut most commonly arises where? |
Small bowel |
|
Carcinoid tumor of small bowel secretes what? which is metabolized where? |
Serotonin metabolized in liver into 5-HIAA |
|
What are the 3 clinical features of carcinoid syndrome? |
bronchospasm, diarrhea, and flushing of skin |
|
What is the pathophysiology for carcinoid syndrome from a carcinoid tumor in the small gut? |
Metastasis of carcinoid tumor to liver allows serotonin to bypass liver metabolism leading to excess serotonin in the systemic circulation |
|
What is carcinoid heart disease? |
Right-sided valvular fibrosis leading to tricuspid regurgitation and pulmonary valve stenosis. |
|
Why do you not get left sided valvular fibrosis in carcinoid heart disease? |
Serotonin gets metabolized by MAO in the lung |
|
What quadrant is there pain in acute appendicitis? |
right lower quadrant (McBurney) point |
|
Chronic, relapsing inflammation of bowel |
Inflammatory Bowel Disease |
|
Which IBD has full thickness inflammation with knife-like fissures? |
Crohn disease |
|
Which IBD has mucosal and submucosal ulcers? |
Ulcerative colitis |
|
Which IBD skips around and which one is continuous? |
Ulcerative colitis is continuous, Crohn's skips around |
|
Which IBD has left lower quadrant pain? |
Ulcerative colitis |
|
Which IBD has right lower quad pain? |
Crohn disease |
|
Which IBD has histology with crypt abscesses with neutrophils? |
Ulcerative Colitis |
|
Which IBD has loss of haustra "lead pipe" sign on imaging? |
Ulcerative colitis |
|
Which IBD has cobblestone mucosa? |
Crohn disease |
|
Which IBD has pseudopolyps? |
Ulcerative colitis |
|
Which IBD has toxic megacolon as a complicatoin? |
Ulcerative colitis |
|
Which IBD has p-ANCA positivity? |
Ulcerative colitis |
|
Which IBD is protected by smoking? |
Ulcerative colitis |
|
Which IBD has increased risk due to smoking? |
Crohn disease |
|
Which IBD has lymphoid aggregates with granulomas? |
Crohn disease |
|
Which IBD has string-sign on imaging? |
Crohn disease |
|
Which IBD has calcium oxalate neprholithiasis? |
Crohn disease |
|
Defective relaxation and peristalsis of rectum and distal sigmoid colon |
Hirschsprung disease |
|
What is hirschsprung disease associated with? |
Down syndrome |
|
Rectal suction biopsy reveals lack of ganglion cells what disease is this? |
Hirschsprung disease |
|
Outpouching of mucosa and submucosa through the muscularis propria |
Colonic diverticula |
|
Acquired malformation of mucosal and submucosal capillary beds |
Angiodysplasia |
|
High stress on the left lower quadrant leads to what? |
Colonic diverticula |
|
High stress on the right colon leads to what? |
Angiodysplasia |
|
If a patient has stool or air in urine what is the reason and what is the disease called? |
Inflamed diverticulum ruptures and attaches to a local structure. Colovesicular fistula due to colonic diverticula. |
|
What is the inheritance pattern for hereditary hemorrhagic telangiectasia? |
Autosomal dominant |
|
Ischemic damage to the colon usually at the splenic flexure |
Ischemic colitis |
|
This GI disease presents with postprandial pain and weight loss |
Ischemic colitis |
|
Relapsing abdominal pain with bloating, flatulence, and change in bowel habits (diarrhea or constipation) |
Irritable bowel syndrome |
|
Raised protrusion of colonic mucosa |
Colonic polyps |
|
Two most common types of colonic polyps |
Hyperplastic polyps and adenomatous polyps |
|
This type of polyp are due to hyperplasia of glands; classically show a serrated appearance on microscopy |
Hyperplastic polyp |
|
Which of the two most common colonic polyps is benign not malignant, and which is benign but premalignant? |
Hyperplastic polyp is benign Adenomatous polyp is premalignant |
|
What chromosome is APC located on? |
Chromosome 5 |
|
What is the adenoma-carcinoma sequence (3 steps) |
1.APC (adenomatous polyposis coli gene) mutation leads to increased risk for formation of polyps 2. K-ras mutation leads to formation of polyps 3. p53 mutation and increased expression of COX allow for progression to carcinoma |
|
What can impede the progression of adenoma to carcinoma in colonic polyps? |
Aspirin due to the inhibition of COX |
|
What 3 characteristics of a colon polyp biopsy indicates an increased risk for progression from adenoma to carcinoma? |
Size >2cm sessile growth as opposed to pedunculated villous histology as opposed to tubular |
|
Autosomal dominant disorder characterized by 100s to 100s of adenomatous colonic polyps |
Familial adenomatous polyposis |
|
What is the inheritance pattern for familial adenomatous polyposis? |
Autosomal dominant |
|
What is familial adenomatous polyposis with fibromatosis and osteomas? |
Gardner syndrome |
|
What is familial adenomatous polyposis with CNS tumors? |
Turcot syndrome |
|
Sporadic hamartomatous (benign) polyp that arises in children |
Juvenile polyp |
|
Hamartomatous (benign) polyps throughout GI tract with mucocutaneous hyperpigmentation on lips, oral mucosa, and genital skin? |
Peutz-Jeghers syndrome |
|
What is the inheritance pattern for Peutz-Jeghers syndrome? |
Autosomal dominant |
|
Peutz-Jeghers syndrome has increased risk for what 3 cancers? |
colorectal breast GYN |
|
What is the 3rd most common site of cancer and the 3rd most common cause of cancer-related death? |
Colorectal carcinoma |
|
What are the two pathways that colorectal carcinoma can arise? |
Adenoma-carcinoma sequence and microsatellite instability (MSI) |
|
Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due to inherited mutations in what? |
DNA mismatch repair enzymes |
|
Inherited mutations in DNA mismatch repair enzymes can lead to what hereditary GI disorder? |
Hereditary nonpolyposis colorectal carcinoma (HNPCC) |
|
HNPCC has increased risk for what 3 cancers? |
Colorectal (most common) Ovarian Endometrial carcinoma |
|
Which side do napkin-ring lesions for colorectal carcinoma usually arise? |
left side |
|
Which side do raised lesion for colorectal carcinoma usually arise? |
right side |
|
Colonic carcinoma is associated with an increased risk for what kind if infection? |
Streptococcus bovis endocarditis |
|
Left sided colorectal carcinoma is associated with what molecular pathway? |
Left Adenoma-carcinoma pathway Right MSI pathway |
|
Most common site for colorectal carcinoma metastasis? |
Liver |
|
What serum tumor marker is useful for assessing tx response and detecting recurrence of colorectal carcinoma |
CEA |
|
CEA is useful for assessing tx response and detecting recurrence but not useful for what? |
Not useful for screening |
|
Where is Iron (Fe2+) absorbed? |
Duodenum |
|
Developmental malformation in which the pancreas forms a ring around the duodenum; risk of duodenal obstruction |
Annular pancreas |
|
Annular pancreas has an increased risk for what? |
Duodenal obstruction |
|
Inflammation and hemorrhage of pancreas |
Acute pancreatitis |
|
What is the first enzyme to get activated in acute pancreatitis? |
Trypsin |
|
Alcohol and gall stones are the most common cause for what? |
Acute pancreatitis - alcohol constricts sphincter of oddi and gall stones create a blockage |
|
Fibrosis of pancreatic pancrenchyma; secondary to recurrent acute pancreatitis |
Chronic pancreatitis |
|
Most commonly due to alcohol and cystic fibrosis; many cases are idiopathic |
Chronic pancreatitis |
|
Alcohol and cystic fibrosis are the most common cause of what? |
Chronic pancreatitis |
|
Adenocarcinoma arising from pancreatic ducts |
Pancreatic carcinoma |
|
What are the two major risk factors for pancreatic carcinoma? |
Smoking and chronic pancreatitis |
|
If a thin elderly female recently dx with diabetes what should you think of? |
DDX should include pancreatic carcinoma |
|
What is the serum tumor marker for pancreatic carcinoma? |
CA 19-9 |
|
Failure to form or early destruction of extrahepatic biliary tree |
Biliary atresia |
|
Solid, round stones in the gall bladder |
Cholelithiasis (Gall stones) |
|
Cholelithiasis can occur due to precipitation of what two things? |
Cholesterol or bilirubin |
|
Important side effect of cholestyramine and MOA for the side-effect |
Gallstones due to decreased solubility of bilirubin. Bile acids are bound by cholestyramine leading to decreased solubility and formation of gall stones. |
|
Which gall stone is radiolucent? radiopaque? |
Cholesterol stone is radiolucent, bilirubin stone is radiopaque |
|
Waxing and waning right upper quadrant pain is usually due to? |
Biliary colic |
|
Biliary colic pathophysiology for pain |
This is due to gallbladder contracting against a stone lodged in the cystic duct |
|
Acute inflammation of the gallbladder wall |
Acute cholecystitis |
|
Right upper quadrant pain, radiating to the right scapula indicates what? |
Acute cholecystitis |
|
Chronic inflammation of the gallbladder |
Chronic cholecystitis |
|
Rokitansky-Aschoff sinus is associated with what? and what is it? |
Chronic cholecystitis - these sinuses are herniations of the gallbladder mucosa into the muscular wall. Normally you should not have mucosa into the smooth muscle. |
|
Porcelain gallbladder is associated with what? |
Chronic cholecystitis |
|
This presents with vague right upper quadrant pain, especially after eating |
Chronic cholecystitis |
|
Bacterial infection of bile ducts |
Ascending cholangitis |
|
Gallstones enters and obstructs small bowel |
Gallstone ileus |
|
What is gallstone ileus due to? |
Cholecystitis with fistula formation between gallbladder and small bowel |
|
Adenocarcinoma arising from glandular epithelium that lines the gallbladder wall |
Gallbladder carcinoma |
|
Elderly woman presents with cholecystitis, what does this suggest? |
Gallbladder carcinoma |
|
What is scleral icterus? |
yellowing of the eye |
|
How does extravascular hemolysis or ineffective erythropoiesis cause jaundice? |
High levels of UCB overwhelm the conjugating ability of the liver |
|
Dark urine in extravascular hemolysis is due to what? what is it not due to? |
Increased urobilinogen NOT UCB (UCB is not water soluble) |
|
Extravascular hemolysis or ineffective erytrhopoiesis has an increased risk for what hepatic disorder? |
pigmented bilirubin gallstones |
|
How does physiologic jaundice of the newborn cause jaundice? |
Newborn liver has transiently low UGT activity |
|
What enzyme conjugates unconjugated bilirubin? |
Uridine Glucuronyl Transferase (UGT) |
|
What is kernicterus associated with and what is the pathophysiology of it? |
Kernicterus is associated with Physiologic jaundice of the newborn and Crigler-Najjar syndrome. UCB is fat soluble and can deposit in the basal ganglia leading to neurological deficits and death. |
|
How does phototherapy work for physiologic jaundice of the newborn? |
It makes the UCB water soluble but does NOT conjugate the UCB |
|
How does Gilbert syndrome cause jaundice? |
Midly low UGT activity. Usually enough UGT not to cause jaundice but at times of high stress will cause jaundice |
|
What is the inheritance pattern for gilbert syndrome? |
Autosomal recessive |
|
How does Crigler-Najjar syndrome cause jaundice? |
Complete absence of UGT, usually fatal |
|
Why is Criger-Najjar syndrome usually fatal? |
Kernicterus |
|
What are the two syndromes with disruption of UGT? |
Gilbert Syndrome - mildly low Criger-Najjar syndrome - complete absence |
|
How does Dubin-Johnson syndrome cause jaundice? |
Deficiency of bilirubin canalicular transport protein |
|
What is the inheritance pattern for Dubin-Johnson syndrome? |
Autosomal recessive |
|
Which disease that causes jaundice has a dark liver? |
Dubin-Johnson syndrome |
|
What syndrome is similar to Dubin-Johnson syndrome but does not have the dark liver? |
Rotor syndrome |
|
How does biliary tract obstruction cause jaundice? |
Buildup of CB in gallbladder leaks out into the blood |
|
Why is urine dark in biliary tract obstruction? |
Due to conjugated bilirubin |
|
How does viral hepatitis cause jaundice? |
Inflammation disrupts hepatocytes and small bile ductules leading to increase in CB and UCB |
|
Why is urine dark in viral hepatitis? |
Due to conjugated bilirubin |
|
Which disease that causes jaundice has pruritis and why does it have pruritis? |
Biliary tract obstruction - pruritis is due to increased plasma bile acids |
|
Which disease that causes jaundice has xanthomas and why does it have xanthomas? |
Biliary tract obstruction - hypercholestermemia leads to xanthomas |
|
Which disease that causes jaundice has steatorrhea with malabsorption of fat-soluble vitamins? |
Biliary tract obstruction |
|
Viral hepatitis is usually due to hepatitis virus but what other two viruses can cause it? |
EBV and CMV |
|
Viral hepatitis has elevated liver enzymes which one is higher than the other? |
ALT > AST |
|
Alcohol-related liver disease has elevated liver enzymes which one is higher than the other? |
AST > ALT |
|
Which Hepatitis virus has fecal-oral transmission? |
HAV and HEV |
|
Which hepatitis is commonly acquired by travelers? |
HAV |
|
Which hepatitis is commonly acquired from contaminated water or undercooked seafood? |
HEV |
|
Which hepatitis is associated with pregnant woman with fulminant hepatitis (liver failure with massive liver necrosis)? |
HEV infection |
|
Which hepatitis has only an acute state and no chronic state? |
HAV and HEV |
|
Which hepatitis is transferred parenterally? |
HBV and HCV |
|
What marker must be present for 6 months to indicate chronic hepatitis B? |
HBsAG (antigen) |
|
Presence of what indicates that you have beat hepatitis B? |
HBsAB (antibody) |
|
What marker indicates that HBV is infectious? |
HBeAG (envelope antigen) |
|
Which hepatitis often progresses to chronic phase, which hepatitis 20% of the time progresses to chronic phase? |
HCV - most of the time HBV - 20% of time |
|
What marker indicates HCV infection and indicates chronic disease if persistent? |
HCV-RNA |
|
Which hepatitis virus needs another hepatitis virus to infect? |
HDV |
|
What is more severe? Superinfection of HBV/HDV or co-infection of HBV/HDV? |
Superinfection |
|
End-stage liver damage characterized by disruption of the normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes |
Cirrhosis |
|
Fibrosis of liver is mediated by what cell which secretes what cytokine? |
Stellate cells secreting TGF-B |
|
What are mallory bodies and what is it associated with? |
Mallory bodies are damaged intermediate filaments within hepatocytes and is associated with alcoholic hepatitis |
|
Nonalcoholic fatty liver disease has increased liver enzymes, which is higher than the other? |
ALT > AST |
|
What is nonalcoholic fatty liver disease associated with? |
obesity |
|
Primary Hemochromatosis has what kind of inheritance pattern? |
Autosomal recessive |
|
Primary hemochromatosis is due to a mutation in which gene? |
HFE gene |
|
Bronze skin and bronze diabetes is associated with what? |
Hemochromatosis |
|
For hemochromatosis hepatocytes are brown, but you need to distinguish the iron from what? what stain do you use to do this? |
Lipofuscin caused by normal wear and tear, use prussian blue stain to stain the iron. |
|
Autosomal recessive defect in ATP-mediated copper transport |
Wilson disease |
|
Wilson disease has what inheritance pattern? |
Autosomal recessive |
|
Autoimmune granulomatous destruction of intrahepatic bile ducts |
Primary biliary cirrhosis |
|
Primary biliary cirrhosis, etiology is unknown but something is present, what is it? |
antimitochondrial antibody |
|
Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts |
Primary sclerosing cholangitis |
|
Periductal fibrosis with an "onion-skin" appearance on histology indicates what hepatic disease? |
Primary sclerosing cholangitis |
|
What hepatic disorder is associated with ulcerative colitis? |
Primary sclerosing cholangitis |
|
What hepatic disorder is p-ANCA positive? |
Primary sclerosing cholangitis |
|
What is reye syndrome? |
Fulminant liver failure and encepholopathy in children with viral illness who take aspirin |
|
Benign tumor of hepatocytes |
Hepatic adenoma |
|
Reye syndrome is likely related to what kind of damage? |
mitochondrial damage of hepatocytes |
|
Hepatic adenoma is associated with what drug? |
oral contraceptive |
|
Malignant tumor of hepatocytes |
Heptaocellular carcinoma |
|
Alfatoxins derived from Aspergillus is associated with what cancer? what mutation does it cause? |
Hepatocellular carcinoma - p53 mutation |
|
What is the serum tumor marker for hepatocellular carcinoma? |
alpha-fetoprotein |
|
Which glucose transporter is responsible for transportation to the blood? |
GLUT-2 |
|
Rate limiting enzyme for bile synthesis |
Cholesterol 7a-hydroxylase |
|
What is a curling ulcer? |
Ulcer that forms when there is decreased plasma volume (burn victims) which leads to sloughing of gastric mucosa |
|
Which gastric cancer is associated with nitrosamines (Smoked food) |
Intestinal |
|
What is Charcot triad of cholangitis? |
Jaundice, Fever, RUQ pain |
|
Drugs ending in -dine have what MOA? |
H2 blocker |
|
Drugs ending in -prazole have what MOA? |
Proton pump inhibitor |
|
MOA of Misoprostol |
PGE1 analog, increases gastric mucosa barrier |
|
MOA of Octreotide |
Long-acting somatostatin analong |
|
MOA of Infliximab and what is it used for? |
Monoclonal antibody to TNF-a Chron disase, ulcerative colitis, RA, psoriasis, ankylosing spondylitis |
|
MOA of Sulfasalazine |
combo of sulfapyridine (antibacterial) and 5-ASA (anti-inflammatory). Activated by colonic bacteria |
|
MOA of Ondansetron and what is it used for? |
5-HT3 blocker; decrease vagal stimulation. Powerful central acting anti-emetic. |
|
MOA of Metoclopramide and what is it used for? |
D2 receptor antagonist. Increase resting tone, contractility, LES tone, motility. Used for GERD, anti-emetic, gastric emptying. |
|
Drugs ending in -odipine have what MOA? |
Calcium channel blockers that block L-type calcium channels, thereby reducing cardiac muscle contractility. |
|
MOA of hydralazine |
increase cGMP leading to smooth muscle relaxation. |
|
What two drugs are used in a hypertensive emergency and what is their MOA? |
Nitroprusside - increase cGMP via direct release of NO. Fenoldopam - Dopamine D1 receptor agonist causing vasodilation. |
|
MOA of nitroglycerin |
Vasodilate by increasing NO in vascular smooth muscle. |
|
MOA of digoxin |
Direct inhibition of Na/K atapase leads to indirect inhibition of Na/Ca exchanger/antiport. Increase in Ca leads to positive inotropy (cardiac contraction). Stimulates vagus nerve to decrease HR. |
|
MOA of drugs ending in -en/-ine or en/-ate? |
1st gen H1 blockers (diphenhydramine, dimenhydrinate, chloropheniramine) |
|
MOA of drugs ending in -adine? |
2nd gen H1 blockers (Loratidine, fexofenadine, desloratadine, cetirizine |
|
What does guaifenesin? |
Expectorant - thins respiratory secretions, does not suppress cough reflex |
|
What does N-acetylcysteine do? |
Mucolytic - can loosen mucous plugs in CF patients |
|
MOA of dextromethorphan? |
Antitussive (antagonizes NMDA glutamate receptor) |
|
MOA of pseudoephedrine and phenylephrine? |
alpha agonist |
|
MOA of albuterol? what is it used for? |
B2 agonist, asthma |
|
MOA of salmeterol? what is it used for? |
B2 agonist, asthma |
|
MOA of formoterol? what is it used for? |
B2 agonist, asthma |
|
MOA of theophylline and what is it used for? |
causes bronchodilation by inhibiting phosphodiesterase which increase cAMP due to decrease in cAMP hydrolysis. Asthma. |
|
MOA of ipratropium and what is it used for? |
competitive block of muscarinic receptors, preventing bronchoconstriction. Asthma. |
|
MOA beclomethasone and what is it used for? |
Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma. |
|
MOA of fluticasone and what is it used for? |
Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma. |
|
MOA of drugs ending in -lukast (Montelukast, Zafrilukast) and what is it used for? |
block leukotriene receptors. Especially good for aspirin-induced asthma. Asthma |
|
MOA of Zileuton and what is it used for? |
5-lipoxygenase pathway inhibitor blocks conversion of arachidonic acid to leukotrienes. Asthma |
|
MOA of omalizumab and what is it used for? |
Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE. Asthma |
|
MOA of methacoline and what is it used for? |
Muscarinic receptor agonist. Used to dx asthma |
|
Drugs ending in -navir have what MOA and treat what? |
Protease inhibitor, specifically inhbits HIV-1 protease (pol gene). Protease inhibitors prevent maturation of new viruses. |
|
MOA of Raltegravir |
Inhibits HIV genome integration to host cell chromosome by reversibly inhibiting HIV integrase |
|
MOA of Enfuviritide |
Binds gp41, inhibiting viral entry |
|
MOA of Maraviroc |
Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120 |
|
MOA of Zidovudine |
Nucleoside Reverse Transcriptase Inhibitor |
|
IL-8 is responsible for what? |
Released by macrophages to recruit neutrophils |
|
IL-3 is responsible for what? |
Stimulating growth and differentiation of stem cells in bone marrow. |
|
What do each of the blotting techniques detect?North, south, west, southwest? |
North = RNA South = DNA West = Protein Southwest = DNA binding protein |
|
MOA of Ribavarin? |
Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase |
|
Cricopharyngeal motor dysfunction can lead to what? |
Zenker diverticulum |
|
Two effects of a VIPoma and how do you treat VIPoma? |
diarrhea and inhibition of gastric. Tx with somatostatin |
|
MOA of diphenoxylate and what is it used for? |
opiate anti-diarrheal that slows down motility |
|
What is a liver specific enzyme that can use break down products of triglyceride? |
Glycerol kinase |
|
What two compounds are elevated in lead poisoning? |
delta-aminolevulinic acid and pyroxidal phosphate |
|
Where are lipids digested? where are they absorbed? |
Duodenum digests, jejenum absorbs |
|
Which portion of the GI tracts is ALWAYS affected in hirschprung disease? |
Rectum |
|
Where are Brunner's glands located and what do they secrete? |
Alkaline mucous |
|
Where are peyer's patches found in the small intestine? |
Ileum |
|
What triggers hepatocellular carcinoma when HBV infects the liver? |
Integration of the viral DNA with the host DNA. |
|
Conjoined kidneys usually connected at the lower pole. |
Horseshoe kidney |
|
Where is the horseshoe kidney located, what does it get stuck on? |
Located in lower abdomen it gets stuck on inferior mesenteric artery on its ascent. |
|
Absent kidney formation |
Renal agenisis |
|
Describe the Potter sequence? |
Bilateral renal agenesis leads to -oligohydraminos -lung hypolplasia -flat face with low set ears -development defects of extremities |
|
Noninherited, congenital malformation of renal parenchyma characterized by cysts and abnormal tissue. |
Dysplastic kidney |
|
Inherited defect leading to bilateral enlarged kidneys with cysts in the renal cortex and medulla |
Polycystic Kidney Disease |
|
Which cystic kidney disease is unilateral and which is bilateral? |
Dysplastic kidney - usually unilateral Polycystic Kidney disease - bilateral |
|
Autosomal recessive or dominant PKD presents in infants? |
Recessive |
|
Autosomal recessive or dominant PKD presents with worsening renal failure and HTN? |
Recessive and Dominant |
|
Autosomal recessive or dominant PKD may present with potter sequence? |
Recessive |
|
Autosomal recessive or dominant PKD associated with congenital hepatic fibrosis and cysts? |
Recessive |
|
Autosomal recessive or dominant PKD presents in young adults? |
Dominant |
|
Autosomal dominant PKD is due to either of what two mutations? |
APKD1 or APKD2 |
|
Autosomal recessive or dominant PKD presents with hematuria? |
Dominant |
|
Autosomal recessive or dominant PKD associated with berry aneurysm |
Dominant |
|
Autosomal recessive or dominant PKD associated with mitral valve prolapse and hepatic cysts? |
Dominant |
|
Autosomal dominant PKD presents with what three cysts? |
Cysts in Kidney Cysts in Brain (berry aneurysm) Cysts in Liver |
|
Medullary cystic kidney disease has what inheritance pattern? |
Autosomal Dominant |
|
Cysts in medullary collecting ducts |
Medullary cystic kidney disease |
|
Parenchymal fibrosis results in SHRUNKEN kidneys and worsening renal failure |
Medullary cystic kidney disease |
|
Hallmark of Acute renal failure? |
Azotemia often with oliguria |
|
Acute renal failure due to decreased blood flow to kidney |
Prerenal azotemia |
|
Acute renal failure due to obstruction of urinary tract downstream from kidney |
Postrenal azotemia |
|
Prerenal or postrenal azotemia: BUN:Cr ratio >15? |
Prerenal or Postrenal (early) - BUN is reabsorbed due to aldosterone secretion while creatinine can not be reabsorbed |
|
Prerenal or postrenal azotemia: BUN:Cr ratio <15? |
Postrenal (late) - can not reabsorb BUN because the renal tubles or no longer intact? |
|
Prerenal or postrenal: FENa < 1% |
Fractional Excretion of sodium < 1 percent in Prerenal |
|
Prerenal or postrenal: FENa >2% |
Fractional excretion of sodium is >2% in postrenal (late) azotemia |
|
Prerenal or postrenal: Urine osmalality > 500 mOsm/kg? |
Prerenal or postrenal (early) |
|
Prerenal or postrenal: Urine osmalality < 500 mOsm/kg? |
Postrenal (late) - inability to concentrate urine |
|
Injury and necrosis of tubular epithelial cells; most common cause of acute renal failure |
Acute tubular necrosis |
|
Pathophysiology of acute tubular necrosis |
Necrotic epithelial cells of tubules plug tubules; obstruction decreases GFR |
|
What renal disease has brown, granular casts that are seen in urine? |
Acute tubular necrosis |
|
Is BUN:Cr < or > 15 in acute tubular necrosis? |
BUN:CR is < 15 because of inability to reabsorb BUN |
|
Is FENa <1 or >2 in acute tubular necrosis? |
Fractional Excretion of Na (FENa) is >2 because of decreased reabsorption of sodium |
|
Is urine osm < or > 500 in acute tubular necrosis? |
Inability to concentrate urine leads to urine osm to be <500. |
|
What are the two major etiologies for acute tubular necrosis? |
Ischemic and nephrotoxic |
|
Prerenal azotemia can progress to what disease? |
Acute tubular necrosis |
|
Which drug class can cause acute tubular necrosis? |
Aminoglycosides |
|
Crush injury can lead to what? |
Myoglobinuria which leads to acute tubular necrosis |
|
Ingesting ethylene glycol can lead to what? |
Acute tubular necrosis |
|
Acute tubular necrosis leads to what acid/base imbalance? |
Metabolic acidosis |
|
Drug-induced hypersensitivity involving the interstitium and tubules of kidneys |
Acute interstitial nephritis |
|
What three drugs can cause interstitial nephritis? |
NSAIDS, PCN, and diuretics |
|
What is pathognomonic for acute interstitial nephritis? |
Eosinophils seen in urine |
|
Presents as oliguria, fever and rash days to weeks after starting a drug |
Acute interstitial nephritis |
|
Necrosis of renal papillae |
Renal papillary necrosis |
|
Glomerular disorders with proteinuria >3.5g/day characterizes what group of disorders? |
Nephrotic syndrome |
|
Nephrotic syndromes result in 2 hypos and 3 hypers |
Hypoalubminemia - pitting edema Hypogammaglobulinemia - increases risk of infection Hypercoagulable state - loss of antithrombin III Hyperlipidemia Hypercholesterolemia - may lead to fatty casts in urine |
|
Which nephrotic syndrome is associated with Hodgkin lymphoma? |
Minimal change disease |
|
What is the most common nephrotic syndrome in children? |
Minimal change disease |
|
Which nephrotic syndrome has effacement of foot processes that is mediated by cytokines? |
Minimal change disease mediated by cytokines that are released from reed-sternberg cells of hodgkin lymphoma |
|
Which nephrotic syndrome has normal glomeruli on H&E stain? |
Minimal change disease |
|
Which nephrotic syndrome has no immune complexes so negative immunofluorescence. (2) |
Minimal change disease and Focal segmenting glomerulosclerosis |
|
Which nephrotic syndrome has selective proteinuria? (loss of albumin but not immunoglobulin) |
Minimal change disease |
|
Which nephrotic syndrome has an excellent response to steroids? |
Minimal change disease because the damage is mediated by cytokines from T cells and the steroids inhibit that. No other neprhotic syndromes respond to steroids. |
|
Most common cause of nephrotic syndrome in hispanics and african americans? |
Focal segmental glomerulosclerosis |
|
Which nephrotic syndrome is associated with HIV? |
Focal segmental glomerulosclerosis |
|
Which nephrotic syndrome is associated with heroin use? |
Focal segmental glomerulosclerosis |
|
Which nephrotic syndrome is associated with sickle cell disease? |
Focal segmental glomerulosclerosis |
|
What is focal segmental glomerulosclerosis? (break down the name) |
Focal = some glomeruli Segmental = involving only part of the glomerulus Sclerosis on H&E stain |
|
Which nephrotic syndrome has effacement of foot processes? (2) |
Minimal change disease and focal segmenting glomerulosclerosis |
|
Most common cause of nephrotic syndrome in caucasian adults |
Membranous nephropathy |
|
Which nephrotic syndrome is associated with hepatitis B or C? (2) |
Membranous nephropathy and Type 1 membranoproliferative glomerulonephritis |
|
Which nephrotic syndrome is associated with solid tumors? |
Membranous nephropathy |
|
Which nephrotic syndrome is associated with SLE? |
Membranous nephrophaty |
|
Which nephrotic syndrome is associated with drugs? |
Membranous nephropathy |
|
Which nephrotic syndrome has a "tram-track" appearance? |
Membranoproliferative glomerulonephritis |
|
Which nephrotic syndromes have immune complex deposition therefore have granular immunofluorescence? (2) |
Membranous nephropathy and membranoproliferative glomerulonephritis |
|
Which nephrotic syndrome has a "spike and dome" appearance on EM? |
Membranous nepropathy |
|
What are the two types of membranoproliferative glomerulonephritis? |
Type 1 = subendothelial Type 2 = dense deposit disease, intramembranous |
|
Which nephrotic syndrome is associated with an antibody called C3 nephritic factor? |
Type 2 Membranoproliferative glomerulonephritis |
|
Name the three nephrotic syndromes based on location: Subepithelial, intramembranous (basement membrane), subendothelial |
Subepithelial = membranous nephropathy Intramembranous (basement membrane) = Type 2 membranoproliferative glomerulonephritis Subendothelial = Type 1 membranoproliferative glomerulonephritis |
|
Which nephrotic syndrome can also cause nephritic syndrome? |
Membranoproliferative glomerulonephritis |
|
Why is GFR increased in diabetes induced nephrotic syndrome? |
The efferent arteriole is more affected than the afferent arteriole |
|
Why do ace inhibitors help the kidneys with patients who have diabetes mellitus? |
Angiotensin II constricts the efferent arteriole so by blocking it you block the vasoconstriction |
|
What are Kimmelstiel-Wilson nodules and what are they associated with? |
Sclerosis of mesangium of nephrons and is associated with diabetic nephropathy. Looks like an empty nephron filled with hyaline material. |
|
Which organ is most commonly involved in systemic amyloidosis? |
Kidney |
|
Which nephrotic syndrome is characterized by apple-green birefringence under polarized light? |
Nephrotic syndrome caused by systemic amyloidosis |
|
0-14 years old which leukemia? |
ALL |
|
15-39 which leukemia? |
AML blasts with auer rods |
|
40-59 which leukemia? |
AML and CML |
|
40-59 year old how do you differentiate AML from CML? |
AML has blasts greater than 30% |
|
60+ years old which leukemia? |
CLL |
|
4 hallmarks of nephritic syndrome that differentiates it from nephrotic syndrome |
Limited proteinuria <3.5g/day RBC casts and dysmorphic RBC in urine Glomerular inflammation Periorbital edema |
|
Nephritic syndrome that arises after group A B-hemolytic streptococcal infection of the skin (impetigo) or pharynx |
Poststreptococcal Glomerulonephritis (PSGN) |
|
Hallmark of this nephritic syndrome are subepithelial "humps" |
Poststreptococcal glomerulonephritis |
|
Nephritic syndrome that progresses to renal failure in weeks to months |
Rapidly progressive glomerulonephritis |
|
Which nephritic syndrome is characterized by crescents in bowmans space and what are those crescents comprised of? |
Rapidly progressive glomerulonephritis - crescents are made of fibrin and macrophages |
|
If IF pattern shows linear (anti-basement membrane antibody) which disease caused the rapidly progressive glomerluonephritis? |
Goodpasture syndrome |
|
If IF pattern show Granular(immune complex deposition) which disease caused the rapidly progressive glomerulonephritis? (2) |
PSGN or diffuse proliferative glomerulonephritis |
|
Rapidly progressive glomerulonephritis that is due to diffuse antigen-antibody complex deposition, usually sub-endothelial |
Diffuse proliferative glomerulonephritis |
|
Most common type of renal disease in SLE patients? |
Diffuse proliferative glomerulonephritis |
|
If IF pattern show negative IF (pauci-immune) which disease caused the rapidly progressive glomerulonephritis? (3) |
Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss sydnrome |
|
What distinguishes Churg-Strauss from microscopic polyangiitis? (3) |
Churg-Strauss has granulomatous inflammation, eosinophilia, and asthma. |
|
Which nephritic syndrome has IgA immune complex deposition in mesangium of glomeruli |
IgA Nephropathy (Berger Disease) |
|
Which nephritic syndrome has inherited defect in type IV collagen? |
Alport syndrome |
|
Alport syndrome presents with what three key findings? |
Isolated hematuria hearing loss ocular disturbances |
|
Infection of bladder |
Cystitis |
|
Gold standard measurement for Cystitis |
Culture - greater than 100,000 CFU |
|
Most common cause for cystitis (bacteria)? |
E. Coli 80% |
|
Cystitis with an alkaline urine and an ammonia scent is most likely due to which bacteria? |
Proteius mirabilis |
|
Name the 5 bacterial causes for cystitis with a positive culture? |
E. Coli Staph Saprophyticus Klebsiella pneumonia Proteus mirabilis Enetercoccus faecalis |
|
Sterile pyuria with a negative urine culture suggests infection with what? (2) |
Chlamydia trachomatis Neisseria gonorrhoeae |
|
Infection of kidney |
Pyelonephritis |
|
3 most common pathogens in pyelonephritis |
E. Coli Enterococcus faecalis Klebsiella species |
|
Interstitial fibrosis and atrophy of tubules due to multiple bouts of acute pyelonephritis |
Chronic pyelonephritis |
|
Atrophic tubules containing eosinophilic proteinaceous material resemble thyroid follicles suggests what? |
Chronic pyelonephritis |
|
Precipitation of a urinary solute as a stone |
Nephrolithiasis |
|
Treatment for calcium oxalate and/or calcium phosphate stones? |
Hyrdocholothiazide (calcium-sparing diuretic) - decreases amount of calcium going into urine. |
|
Most common cause of this nephrolith is idiopathic hypercalciuria |
Calcium oxalate and/or calcium phosphate |
|
List the four most common nephrolith in order from most to least. |
Calcium oxalate and/or calcium phosphate Ammonium magnesium phosphate Uric Acid Cysteine |
|
Most common cause of this nephrolith is infection with urease-positive organisms (proteius vulgaris or klebsiella). |
Ammonium magnesium phosphate |
|
What is the pathophysiology of the ammonium magnesium phosphate stone? |
Infection with a urease positive organism leads to alkaline urine which forms a stone. |
|
Which nephrolith classically results in a staghorn calculi in renal calyces? (2) one is for adults and one is for children |
Ammonium magnesium phosphate (adults) Cysteine (children) |
|
Which of the nephroliths are radiolucent? |
Uric acid |
|
This nephrolith is commonly seen in children |
Cysteine |
|
Where is EPO created? |
renal peritubular interstitial cells |
|
Hamartoma comprised of blood vessels, smooth muscle, and adipose tissue? |
Angiomyolipoma |
|
Angiomyolipoma have increased frequency in what? |
Tuberous sclerosis |
|
Malignant epithelial tumor arising from kidney tubules |
Renal Cell Carcinoma |
|
What is the classic triad for renal cell carcinoma |
Hematuria Palpable Mass Flank pain |
|
Which of the renal diseases can release excess EPO, renin, PTHrp, or ACTH? |
Renal cell carcinona - paraneoplastic syndrome |
|
Why do you only see left sided varicocele in renal cell carcinoma? why not right? |
Left spermatic vein drains into renal vein while right spermatic vein drains directly into IVC |
|
What kind of cells are seen in renal cell carcinoma? |
Clear cells |
|
What is the pathogenesis of renal cell carcinoma starting with loss of which gene? |
Loss of VHL (3p) tumor suppressor gene -increased IGF-1 promotes growth -increased HIF transcription factor (increases VEGF and PDGF) |
|
What is the key risk factor in the spontaneous pathway of renal cell carcinoma? |
Smoking |
|
What disease has an increased risk for renal cell carcinoma? and what other tumor does it have a increased risk for? |
Von Hippel-Lindau disease and hemangioblastoma of the cerebullum |
|
What is the inheritance pattern of Von Hippel-Lindau disease? |
Autosomal dominant |
|
Most common malignant renal tumor in children? |
Wilms tumor |
|
Malignant kidney tumor comprised of blastema, primitive glomeruli and tubules, and stromal cells |
Wilms tumor |
|
Wilms tumor is associated with what mutation? |
WT1 |
|
What does WAGR syndrome stand for? |
Wilms tumor Aniridia Genital Abnormalities Retardation |
|
What are the 4 features of Beckwith-Wiedemann syndrome? |
Wilms tumor Neonatal hypoglycemia Muscular hemihypertrophy Organomegaly especially tongue |
|
Malignant tumor arising from urothelial lining of renal pelvis, ureter, bladder, or urethra. |
Urothelial carcionma |
|
Azo dyes increased the risk for what cancer? |
Urothelial carcinoma |
|
Longterm cyclophosphamide or phenacetin can increase risk for what cancer? |
Urothelial carcinoma |
|
What are the two pathways that urothelial carcinoma arises? |
Flat and papillary |
|
Which pathway for urothelial carcioma is associated with early p53 mutations? |
Flat pathway NOT papillary |
|
Which pathway for urothelial carcinoma starts as a high grade and which starts as a low grade? |
Flat: High grade --> invasivie Papillary: Low grade --> high grade --> invasive |
|
Chronic cystitis has an increased risk for what cancer? |
Squamous cell carcinoma of lower urinary tract |
|
Schitosoma hematobium infection has an increased risk for what cancer? (Egyptian male) |
Squamous cell carcinoma of lower urinary tract |
|
Long-standing nephrolithiasis has an increased risk for what cancer? |
Squomous cell carcinoma of lower urinary tract |
|
A urachal remnant has an increased risk for what cancer? what is the urachas? where does this cancer normally arise? |
Adenocarcinoma of the bladder Urachas - duct that connects the fetal bladder to the yolk sac, goes through the umbilical cord. Arises in the dome of the bladder |
|
Mannitol MOA |
Osmotic diuretic |
|
Acetazolamide MOA |
Carbonic anhydrase inhibitor |
|
What are the 2 loop diuretics? and what is the MOA? |
Furosemide and Ethacrynic acid Inhibits cotransport system (Na/K/2CL). Prevents concentration of urine. |
|
MOA of hydrochlorothiazide |
Inhibits NaCL reabsorption |
|
Name the 4 K+ sparing diuretics |
Spironolactone Triamterene Amiloride Epelernone |
|
MOA of triamterene and amiloride |
Blocks Na channels in the cortical collecting tubules |
|
MOA of spironolactone and eplerenone |
Aldosterone receptor antagonists |
|
Where is the bartholin gland located and what is it's purpose? |
Located in the vaginal canal and produces mucus-like fluid |
|
Cystic dilation of the bartholin gland due to an obstruction |
Bartholin cyst |
|
Warty neoplasm of vulvar skin |
Condyloma |
|
Which viruses cause condyloma? |
HPV 6 or 11 |
|
Histologically what are HPV-assocaited condylomas characterized by? and what does it look like? |
koilocytes - looks like a raisin |
|
What are the low risk HPVs and what are the high risk HPVs? |
low risk = 6 and 11 high risk = 16,18,31,33 |
|
This vulvar lesion is characterized by thinning of the epidermis and fibrosis of the dermis |
Lichen sclerosis |
|
Parchment-like vulvar skin is indicative of what pathology? |
Lichen sclerosis |
|
This vulvar pathology is characterized by hyperplasia of vulvar squamous epithelium |
Lichen simplex chronicus |
|
Carcinoma arising from squamous epithelium lining the vulva |
Vulvar carcinoma |
|
Two types of vulvar carcinoma and what are their causes |
HPV-related = HPV 16 and 18 Non-HPV-related = long standing lichen sclerosis |
|
Malignant epithelial cell in the epidermis of the vulva |
Extramammary paget disease |
|
Paget cells vs Melanoma stains: PAS, Keratin, S100 |
Paget = PAS+, Keratin+ Melanoma = S-100+ |
|
Major side effect of amphotericin B (2) |
Hypokalemia, hypomagnesia |
|
Difference between paget disease of vulva vs nipple regarding underlying carcinoma |
Vulva = no underlying carcinoma Nipple = underlying carcinoma |
|
Focal persistence of columnar epithelium in the upper vagina as opposed to squamous epithelium |
Adenosis |
|
Adenosis has increased incidence in females exposed to what? |
DES (diethylstilbestrol) estrogen like |
|
Malignant proliferation of glands with clear cytoplasm in the vagina |
Clear cell adenocarcinoma |
|
Feared complication of DES-adenosis of the vagina |
Clear cell adenocarcinoma |
|
DES (diethylstilbestrol) moms have a slight increased risk for what? |
Breast carcinoma |
|
Malignant mesenchymal proliferation of immature skeletal muscle |
Embryonal rhabdomyosarcoma |
|
This pathology presents as bleeding and grape-like mass protruding from vagina or penis of child |
Embryonal rhabdomyosarcoma |
|
Rhabdomyoblast will have positive IHC staining for what 2 things? |
Desmin and myogenin |
|
Carcinoma arising from squamous epithelium lining the vaginal mucosa |
Vaginal carcinoma |
|
Cancer from the lower 1/3 of the vagina goes to which lymph nodes? upper 2/3 of the vagina? |
lower 1/3 = inguinal nodes upper 2/3 = iliac nodes |
|
What is the exocervix and endocervix lined by? |
Exocervix = squamous epithelium Endocervix = columnar epithelium |
|
What makes high-risk HPV high risk? |
EG: increases destruction of p53 E7: increases destruction of Rb |
|
4 grades of cervical intraepithelial neoplasia and what defines each |
CIN 1: involves 1/3 thickness of epithelium CIN 2: involves 2/3 CIN 3: slightly less than full thickness Carcinoma In Situ = Full thickness |
|
Invasive carcinoma that arises from cervical epithelium |
Cervical carcinoma |
|
2 secondary risk factors for in HPV related cervical carcinoma |
Smoking and immunodeficiency |
|
Two subtypes of cervical carcinoma |
squamous cell carcinoma and adenocarcinoma |
|
Confirmatory test for an abnormal pap smear |
Colposcopy and biopsy |
|
Pap smear does not screen which carcinoma very well? |
adenocarcinoma |
|
Formula for fractional filtration |
FF = GFR/RPF |
|
Maximal effect a drug can produce is known as? |
Efficacy |
|
Amount of drug needed for a given effect is known as? |
Potency |
|
Which interleukin is an endogenous pyrogen and also is osteoclast-activating? |
IL-1 |
|
What hormones are responsible for each of the phases of menstrual cycle. Proliferative, secretory, menstrual |
Proliferative = estrogen Secretory = progesterone Menstrual = loss of progesterone |
|
Secondary amenorrhea due to loss of basalis (regenerative layer) and scarring of the endometrium |
Asherman Syndrome - due to overaggressive dilation and currettage |
|
Lack of ovulation is known as? |
Anovulatory cycle |
|
Anovulatory cycle can cause what (pathophysiology)? |
Estrogen-driven proliferative phase without progesterone secretory phase. Leads to glands being laid on top of each other. This can cause dysfunctional uterine bleeding. |
|
Bacterial infection of endometrium |
Acute endometritis |
|
Chronic inflammation of the endometrium |
Chronic endometritis |
|
Lymphocytes are normally seen in the endometrium, what cell must be present in order for it to be chronic endometritis? |
Plasma cells |
|
Hyperplastic protusion of endometrium |
Endometrial polyp |
|
Endometrial polyp can be a side-effect of what drug? |
Tamoxifen |
|
Endometrial glands and stroma outside of the uterine endometrial lining |
Endometriosis |
|
Formation of a chocolate cyst in the ovaries is suggestive of what disease? |
Endometriosis |
|
Endometriosis with involvement of the uterine myometrium is called? |
adenomyosis |
|
Hyperplasia of endometrial glands relative to stroma |
Endometrial hyperplasia |
|
What is a consequence of unopposed estrogen? |
Endometrial hyperplasia |
|
Endometrial hyperplasia: histologically what is the most important predictor for progression to carcinoma? |
Cellular atypia |
|
Malignant proliferation of endometrial glands |
Endometrial carcinoma |
|
What are the two pathways for endometrial carcinoma and which is most common? |
Hyperplasia pathway (75%) Sporadic pathway (25%) |
|
What is the histology of hyperplasia and sporadic pathways of endometrial carcinoma? (2) |
hyperplasia = endometriod (normal endometrium like) sporadic = papillary serous |
|
Age differences for hyperplasia vs sporadic pathways of endometrial carcinoma? |
hyperplasia = 50 years old sporadic = 70 years old |
|
Sporadic pathway of endometrial carcinoma is driven by what mutation? |
p53 |
|
What are psammoma bodies and what is it associated with? (female GS) |
Concentric calcifications - Endometrial carcinoma (sporadic pathway) (serious papillary) |
|
What diseases are psammoma bodies found? (4) |
Papillary carcinoma of the thyroid Meningioma Papillary serous endometrial carcinoma Mesothelioma
|
|
Benign proliferation of smooth muscle arising from myometrium. |
Leiomyoma |
|
Describe a leiomyoma |
Multiple, well-defined white whorled masses |
|
Are Leiomyomas usually symptomatic or asymptomatic? |
asymptomatic |
|
Malignant proliferation of smooth muscle arising from the myometrium |
Leiomyosarcoma |
|
What is the precursor to leiomyosarcoma? |
It arises de novo, it does NOT arise from leiomyoma |
|
Which has multiple and which has a single lesion? Leiomyoma and leiomyosarcoma |
Leiomyoma = multiple Leiomyosarcoma = single |
|
What hormones affects theca cells? and what does it produce because of it? |
Leutenizing hormone allows theca cells to make androgen |
|
what hormone affects granulosa cells? and does it produce because of it? |
FSH - which allows the conversion of androgen from theca cells to estradiol for the egg |
|
What does a residual follicle become? (Female GS) |
Corpeus luteum |
|
What does the corpus luteum secrete and what is it's main job? |
Secretes progesterone which prepares the endometrium for maintenance and possible pregnancy |
|
What hormone cascasde causes ovulation? |
Estradiol surge induces a LH surge |
|
Multiple ovarian follicular cysts due to hormone imbalance |
Polycystic ovarian disease |
|
What hormone is elevated and what hormone is decreased in polycystic ovarian disease? |
LH = increased FSH = low |
|
What are the three cell types of the ovary that tumors can arise from? |
Surface epithelial, germ cells, and sex-cord stroma |
|
What are the four subtypes of surface epithelial tumors of the ovaries? |
Mucinous Serous Endometrioid Brenner |
|
Of the four subtypes of surface epithelial tumors which ones are cystic? |
Serous and mucinous |
|
Benign tumors of mucinous or serous origin of the ovaries are known as? |
Cystadenomas |
|
What age do cystadenomas normally present? cystadenocarcinoma? (Female GI) |
cystadenoma: 35 years old (premenopausal) cystadenocarcinoma: 65 years old (postmenopausal) |
|
Difference in gross presentation between a cystadenoma vs cystadenocarcinoma? |
benign = single cysts with simple, flat linning malignant = complex cysts with thick, shaggy lining
|
|
Malignant tumors of mucinous or serous origin of the ovaries are known as? |
Cystadenocarcinoma |
|
BRCA 1 carries have increased risk for what cancers? |
Serous carcinoma of ovary Serous carcinoma of fallopian tube Breast cancer |
|
Surface epithelial tumors of the ovaries that are composed of endometrial-like glands |
Endometrioid tumors |
|
Which surface epithelial tumor of the ovary is associated with endometriosis |
Endometrioid tumor |
|
Surface epithelial tumor of the ovary that contains urothelium |
Brenner tumor |
|
Usually malignant or benign? Endometrioid tumor, Brenner tumor? (female GI) |
Endometrioid usually malignant Brenner usually benign |
|
Marker for surface epithelial tumor of ovaries |
CA-125 |
|
Five subtypes of germ cell ovarian tumors (use tissues that are produced for help) |
Fetal tissue- Cystic teratoma Fetal tissue - Embryonal carcioma Oocytes - Dysgerminoma Yolk sac - Endodermal Sinus tumor Placental tissue - Choriocarcinoma |
|
Cystic tumor in the ovary that is derived from two or three embryologic layers |
Cystic teratoma |
|
What is the most common type of tissue that is immature in an immature teratoma? |
Neuroectoderm |
|
Cystic teratoma composed primarily of thyroid tissue |
Struma ovarii |
|
Germ cell tumor of the ovary that is composoed of large cells with clear cytoplasm and central nuclei |
Dysgerminoma |
|
Testicular counterpart to dysgerminoma |
Seminoma |
|
Malignant germ cell tumor of the ovary that mimics the yolk sac |
Endodermal sinus tumor |
|
Most common ovarian germ cell tumor in children |
Endodermal sinus tumor (yolk sac) |
|
Which ovarian germ cell tumor has increased alpha fetal protein? |
Endodermal sinus tumor |
|
What are schiller-duval bodies and what ovarian germ cell tumor is it classical seen in? |
Glomeruloid like structures - Endodermal sinus tumor pg.146 |
|
Malignant proliferation of trophoblast and synctiotrophoblast |
Choriocarcinoma |
|
This germ cell tumor of the ovary has high beta-hCG |
Choriocarcinoma |
|
Which of the germ cell tumors have a poor response to chemotherapy? |
Choriocarcinoma |
|
Malignant germ cell tumor composed of large primitive cells |
Embryonal carcinoma |
|
Neoplasm of granulosa and theca cells |
Granulosa-theca cell tumor |
|
Granulosa-theca cell tumors often produce what hormone? |
Estrogen |
|
Which sex cord-stromal tumor of the ovary has Reinke crystals |
Sertoli-Leydig cell tumor |
|
Which sex cord-stromal tumor of the ovary produces androgen? |
Sertoli-Leydig cell tumor |
|
A woman with pleural effusion and ascites as well as a large mass in the ovary has what syndrome? and what is that mass? |
Meig's syndrome - fibroma |
|
Pseudomyxoma peritonei is massive amounts of mucus in the periotenum where does the tumor come from? |
Mucinous carcinoma of the appendix |
|
Pseudomyxoma peritonei is usually caused by mucinous carcinoma of the appendix where is the most common metastasis site? |
Ovaries |
|
Implantation of fertilized ovum at site other than uterine wall |
Ectopic pregnancy |
|
Lower quadrant abdominal pain weeks after missed period suggests what? |
Ectopic pregnancy |
|
Spontaneous abortions are most often due to what? |
Chromosomal anomalies especially chromosome 16 |
|
Teratogenic effects of alcohol (3) |
Mental retardation Facial abnormalities Microcephaly |
|
Teratogenic effects of cocaine (2) |
intrauterine growth retardation placental abruption |
|
Teratogenic effects of Thalidomide |
Limb defects |
|
Teratogenic effects of cigarette smoke |
Intrauterine growth retardation |
|
Teratogenic effects of isotretinoin (3) |
Spontaneous abortion Hearing impairment Visual impairment |
|
Teratogenic effects of warfarin |
Fetal bleeding |
|
Teratogenic effects of phenytoin |
Digit hypoplasia Cleft lip/palate |
|
Implantation of placenta in lower uterine segment |
Placenta previa (preview of the placenta through the cervical os (opening)) |
|
Separation of placenta from uterine wall (decidua) prior to delivery of fetus leading to still birth |
Placental abruption |
|
Improper implantation of placenta into myometrium with little or no intervening decidua |
Placenta accreta |
|
Pregnancy induced HTN, proteinuria, and edema |
Preeclampsia |
|
What is HELLP and what is it used for? |
Preeclampsia Hemolysis Elevated Liver enzyemes Low Platelets |
|
What is preeclampsia due to? |
Abnormality of maternal-fetal vascular interface |
|
What is pre-eclampsia with seizures? |
Eclampsia |
|
Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts |
Hydatidiform mole |
|
This classically presents in the second trimester as passage of grape-like masses through vaginal canal |
Hydatidiform mole |
|
Feared complication of hydatidiform mole? |
Choriocarcinoma |
|
Two ways chriocarcinoma can arise? which responds well to chemotherapy? which does not? |
Gestation pathway - responds well Germ cell pathway - does not respond well |
|
Opening of urethra on inferior surface of penis |
Hypospadias |
|
What is hypospadias due to? |
Failure of the urethral folds to close |
|
Opening of urethra on superior surface of penis |
Epispadias |
|
What is epispadias due to? |
Due to abnormal positioning of the genital tubercle |
|
Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes |
Lymphogranuloma Venereum |
|
Benign warty growth on genital skin |
Condyloma Acuminatum |
|
Condyloma Acuminatum is due to what? |
HPV 6 or 11 |
|
Chlamydia trachomatis (L1-L3) can cause what STD which involves the lymph nodes? |
Lymphogranuloma Venereum |
|
Malignant proliferation of squamous cell of penile skin |
Squamous cell carcinoma |
|
In situ carcinoma of the penile shaft or scortum that presents as leukoplakia |
Bowen disease |
|
In situ carcinoma on the glans that presents as erythroplakia |
Erythroplasia of Queyrat |
|
In situ carcinoma that presents as multiple reddish papules on the penis |
Bowenoid papulosis |
|
Failure of testicle to descend into scrotal |
Crytpoorchidism |
|
Inflammation of testicle |
Orchitis |
|
Orchitis seen in young adults is normally caused by what two organisms? |
Chlamydia trachomatis (D-K) Neisseria Gonorrhoeae |
|
Orchitis seen in older adults is normally caused by what two organisms? |
E. Coli Pseudomonas |
|
Orchitis seen in teenage males is normally caused by what organism? |
Mumps virus |
|
This is characterized by granulomas involving seminiferous tubules |
Autoimmune orchitis |
|
Twisting of the spermatic cord leading to congestion and hemorrhagic infarction |
Testicular torsion |
|
Granulomas in the testicle can be caused by what two things? |
TB -necrotizing granulomas autoimmune orchitis - granulomas |
|
Absent cremasteric reflex (touching inner thigh leading to scrotum to move up) is indicative of what? |
Testicular torsion |
|
Dilation of spermatic vein due to impaired drainage |
Varicocele |
|
Presents as a scrotal swelling with "bag of worms' appearance |
Varicocele |
|
Varicocele are usually on what side? |
Left side |
|
Fluid collection within tunica vaginalis of the testicle |
Hydrocele |
|
What are the two types of testicular tumors? |
Germ cells or sex-cord stroma |
|
Why are testicular tumors not biopsied? |
Risk of seeding scrotum; removed via radical orchiectomy |
|
Two risk factors for germ cell tumors in males |
Cryptorchidism and Klinefelter syndrome |
|
What are the two types of germ cell tumors of the testicles? |
Seminoma and nonseminoma |
|
Which of the two subtypes of germ cell tumors of the testicles are highly responsive to radiotherapy? |
Seminoma not nonseminoma |
|
Which of the two subtypes of germ cell tumors of the testicles metastasizes late? |
Seminoma not nonseminoma |
|
Which of the two subtypes of germ cell tumors of the testicles has an excellent prognosis? |
Seminoma not nonseminomas |
|
Malignant tumor of the testicle with large cells with clear cytoplasm and central nuclei |
Seminoma, similar description to dysgerminoma |
|
Which of the testicular tumors is a homogenous mass with no hemorrhage or necrosis? |
Seminoma |
|
Which testicular cancer can produce beta-hCG although it is rare to happen? |
Seminoma |
|
What are the 4 nonseminomas of the testicular? |
Embryonal carcinoma Yolk sac (endodermal sinus) tumor Choriocarcinoma Teratorma |
|
Malignant tumor of testicles made of immature, primitive cells that may form glands. |
Embryonal carcinoma |
|
This testicular tumor is a hemorrhage mass with necrosis |
Embryonal carcinoma |
|
Chemotherapy may cause this testicular tumor to differntiate |
Embryonal carcinoma |
|
These testicular tumors has increased AFP or beta-hCG (2) |
Embryonal carcinoma and Teratoma |
|
Testicular tumor that resembles a yolk sac |
Yolk sac tumor (endodermal sinus) |
|
Most common testicular tumor in children |
Yolk sac tumor |
|
AFP is elevated in this testicular tumor |
Yolk sac tumor |
|
Schiller-Duval bodies are found in which testicular tumor? |
Yolk sac tumor (endodermal sinus) |
|
Malignant testicular tumor of synctiotrophoblasts and cytotrophoblasts |
Choriocarcinoma |
|
B-hCG is elevated in this testicular carcinoma |
Choriocarcinoma |
|
Teratoma is malignant in which sex? |
Males |
|
Lymphoma of testicles are usually composed of what? |
Diffuse large B-cell type |
|
Leydig cell tumors produce what hormone? |
Androgen |
|
Which sex-cord stromal tumor is comprised of tubules? |
Sertoli cell tumor |
|
Acute inflammation of prostate, usually due to bacteria |
Acute prostatitis |
|
Which two organisms are responsible for acute prostatitis in young adults? |
C trachomatis N gonorrhoeae |
|
Which two organisms are responsible for Acute prostatitis in older adults? |
E Coli Pseudomonas |
|
Chronic inflammation of prostate |
Chronic prostatitis |
|
Hyperplasia of prostatic stroma and glands |
Benign Prostatic Hyperplasia (BPH) |
|
Where does BPH occur within the prostate? |
Periurethral zone |
|
Conversion of what hormone to what other hormone causes BPH? what enzyme is responsible for the conversion? |
Testosterone --5a-reductase--> DHT |
|
What two types of drugs are used for BPH? |
A1 antagonists and 5a-reductase inhibitors |
|
Alpha inhibitors can be used to treat BPH what are the two types and what are the indications for each? |
A1-antagonist (relax smooth muscles) - terazosin Selective A1a-antagonist so that it does not effect blood vessels in normotensive individuals - tamulosin |
|
Malignant proliferation of prostatic glands |
Prostate adenocarcinoma |
|
What grading system is used for prostate adenocarcinoma? This grading system is not based on atypia but instead base on what? |
Gleason grading system - based on architecture |
|
MOA of leuprolide and what is it used for? |
Continuous - GnRH analog that shut does the anterior pituitary gonadotrophs (LH and FSH). used for prostate adenocarcinoma Pulsatile - agonist when used pulsatile |
|
MOA of flutamide and what is it used for? |
Antagonist of androgen receptor used for prostate adenocarcinoma |
|
Common metastasis site for prostate adenocarcinoma |
lumbar spine |
|
MOA of terazosin and what is it used for? |
A1 antagonist. HTN and BPH |
|
MOA of tamulosin and what is it used for? |
Selective A1a antagonist. BPH in normotensive patients |
|
Benign rathke pouch tumor with cholesterol crystals, calcifications |
Craniopharyngioma |
|
What is the role of the synctiotrophoblast and which layer? |
Secrete hCG (similar to LH), which stimulates the corpeus luteum to continue secreting progesterone. Outer layer |
|
What is the role of the cytotrophoblast? which layer? |
Inner layer which makes cells |
|
Umbilical artery contains oxygenated or deoxygenated blood? |
Deoxygenated |
|
MOA of finasteride |
Inhibits 5a-reductase leading to decreased formation of DHT from testosterone |
|
Chromosomes of Klinefelter |
XXY |
|
Chromosomes of Turner syndrome |
XO |
|
Which hydatidiform mole has fetal parts and which does not have fetal parts? |
Partial = partial fetus Complete = No fetal parts |
|
MOA of Clomiphene and what is it used for? |
Antagonist at estrogen receptor in hypthalamus which blocks feedback inhibition and increase LH and FSH. Used for infertility. |
|
MOA of Tamoxifen |
Estrogen antagonist at breast tissue. |
|
MOA of Raloxifene and what is it used for? |
Estrogen agonist on bone. Osteoporosis |
|
MOA of Mifepristone (RU-486) and what is it used for? |
Competitive inhibitor of progestins at progesterone receptors. Used to terminate pregnancy. Used with misoprostol (PGE1) |
|
MOA of Terbutaline and what is it used for? |
B2 - agonist that relaxes the uterus, used to decrease contraction frequency of women during labor |
|
MOA of Danazol and what is it used for? |
Synthetic androgen, partial agonist at androgen receptors. Used for endometriosis and hereditary angioedema. |
|
MOA of flutamide and what is it used for? |
Nonsteroidal inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma. |
|
MOA of ketoconazole and what is it used for? |
Inhibit steroid synthesis (inhibits 17,20-desmolase). Used for PCOD to prevent hirsutism. |
|
MOA of spironolactone and what is it used for? |
Inhibit steroid binding (17a-hydroxylase, 17-20 desmolase). Used for PCOD to prevent hirsutism.
K+ sparing diuretic - aldosterone receptor antagonist |
|
MOA of sildenafil and what is it used for? |
Inhibit phosphodiesterase 5, leading to increase of cGMP. Erectile dysfunction. |
|
MOA of vardenafil and what is it used for? |
Inhibit phosphodiesterase 5, leading to increase in cGMP. Erectile dysfunction. |
|
What does adnexal mass refer to? |
A lump of tissue in the adnexa of the uterus |
|
What prevents lactation during pregnancy even though prolactin is elevated? |
Estrogen and progesterone |
|
A 32 year old female presents to your office complaining of small amount of vaginal discharge. Application of KOH solution to the discharge yields a strong fishy odor. What is the dx? and organism responsible? |
Bacterial vaginosis caused most commonly by Gardnerella vaginalis |
|
Primary amennorrhea in a pt with fully developed secondary sexual characteristics is most commonly due to what two things? |
Imperforate hymen or mullerian duct anomaly |
|
Imperfrorate hymen presents with what three key characteristics? |
Primary amennorrhea Cyclical pain Palpable mass anterior to the rectum |
|
What hormone causes maternal insulin resistance? |
human placental lactogen |
|
Define primigravada |
A woman who is pregnant for the first time |
|
What vitamins are not found in breast milk? |
Vitamin D and K |
|
Attrition bias is what type of bias? Bias that occurs because people die in a study |
Selection bias |
|
Which cells in the testicle produce testosterone? |
Leydig cells in response to LH |
|
Which cells nurse the sperm? |
Sertoli cells |
|
Nonfunctional tumors of the pituitary present with mass effect: what are the 3 symptoms? |
Bitemporal hemianopsia Hypopituitarism Headache |
|
Most common pituitary tumor? |
Prolactinoma |
|
How does a prolactinoma cause amenorrhea? |
Prolactin inhibits GnRH which decreases LH and FSH leading to amenorrhea |
|
Galactorrhea and amenorrhea suggests what tumor? |
Prolactinoma |
|
Decreased libido and headaches in a male suggests what type of endocrine tumor? |
Prolactinoma |
|
How do you treat prolactinoma? (2) |
dopamine agonists or surgery |
|
MOA of bromocriptine and what is it used for (2)? |
Dopamine agonist used for prolactinomas and for parkinson's |
|
MOA of cabergoline and what is it used for? |
Dopamine agonist used for prolactinomas |
|
How does a growth hormone adenoma cause secondary diabetes mellitus? |
GH induces liver gluconeogenesis |
|
In growth hormone adenoma Growth hormone is not responsible fro the growth of tissue, instead it activates something else. What is that? |
IGF-1 |
|
MOA of octreotide |
Somatstatin analog, blocks release of GH. |
|
Pregnancy-related infarction of the pituitary gland |
Sheehan syndrome |
|
Pathophysiology of Sheehan syndrome |
Gland doubles in size during pregnancy, but blood supply does not increase significantly; blood loss during parturition precipitates infarction. |
|
A pt after giving birth presents with poor lactation, loss of pubic hair, and fatigue. What is the dx? |
Sheehan syndrome |
|
Herniation of the arachnoid and CF into the sella compresses and destroys the pituitary gland |
Empty sella syndrome |
|
What hormones are produced in the posterior pituitary and how is it transported? |
ADH and oxytocin which are transported via axons from hypothalamus
|
|
ADH deficiency leads to what? |
Centra diabetes insipidus |
|
Impaired renal response to ADH |
Nephrogenic diabetes insipidus |
|
MOA of desmopressin and what is it used for? |
ADH analog used for central diabetes insipidus |
|
Excessive ADH secretion |
Syndrome of inappropriate ADH (SIADH) secretion |
|
What is the treatment for syndrome of inappropriate ADH secretion |
demeclocycline - blocks the affect of ADH |
|
A patient who has syndrome of inappropriate ADH secretion and cancer most likely has what kind of cancer? |
Small cell carcinoma of the lung |
|
How does hyperthyroidism increase BMR? |
increased synthesis of Na-K ATPase |
|
How does hyperthyroidism increase sympathetic nervous system activity? |
Increased expression of B1-adrenergic receptors |
|
Hyperthyroidism has increased or decreased cholesterol and glucose levels? |
Hypocholesterolemia Hyperglycemia |
|
Autoantibody that stimulate TSH receptor |
Graves disease |
|
What type of antibody is responsible for Grave's disease? |
IgG |
|
What type of hypersensitivity is grave's disease? |
Type II |
|
What is exophthalmos due to in grave's disease? |
Fibroblasts behind the orbit express the TSH receptor. Not the increased thyroid hormone. |
|
Scalloped colloid is found in what endocrine disorder? |
Grave's disease |
|
MOA of PTU (propylthiouracil) |
Inhibits peroxidase-mediated oxidation, organification, and coupling steps of thyroid synthesis as well as peripheral conversion of T4 to T3. |
|
Hypothyroidism in neonates and infants |
Cretinism |
|
Most common enzyme to be deficient in cretinism? |
thyroid peroxidase |
|
Hypothyroidism in an older child or adult |
Myxedma |
|
Autoimmune destruction of thyroid gland |
Hashimoto Thyroiditis |
|
Hashimoto thyroiditis is associated with what HLA? |
HLA-DR5 |
|
What are hurthle cells and what are they associated with? |
Hurthle cells are eosinophilic metaplasia of cells that line follices. Associated with hashimoto's thyroiditis |
|
Which thyroid disorder has chronic inflammation with germinal centers? |
Hashimoto Thyroiditis |
|
Hashimoto thyroiditis has an increased for what kind of lymphoma? |
B-cell (marginal zone) lymphoma |
|
A pt presents with hashimoto thyroiditis and an enlarging thyroid gland what is most likely the cause? |
B-cell (marginal zone) lymphoma |
|
Granulomatous thyroiditis that follows a viral infection |
Subacute (deQuervain) Granulomatous thyroiditis |
|
A young woman presents with tender thyroid what is the most likely dx? |
Subacute (deQuervain) granulomatous thyroiditis |
|
Chronic inflammation with extensive fibrosis of thyroid |
Reidel fibrosing thyroiditis |
|
Reidel fibrosing thyroiditis hyper or hypo thyroidism? |
Hypothyroidism |
|
Subacute (de quervain) granulomatous thyroiditis hyper or hypo thyroidism? |
Hyperthyroidism may progress to hypothyroidism |
|
A patient presents with a hard as wood nontender thyroid gland? |
Reidel fibrosing thyroiditis |
|
A YOUNG patient with a fibrosing thyroid that is invading local structures like the airway is most likely what? |
Reidel fibrosing thyroiditis since they are young, if they were older then more likely anaplastic carcinoma. |
|
How do you biopsy the thyroid? and why is that technique used? |
Fine needle aspiration (FNA) because the thyroid is very vascular |
|
Benign proliferation of follicles surrounded by a fibrous capsule (thyroid) |
Follicular adenoma |
|
Which thyroid neoplasia has a fibrous capsule? |
Follicular adenoma |
|
What are the four types of thyroid carcinomas? |
Papillary Follicular Medullary Anaplastic |
|
Which thyroid carcinoma's major risk factor is ionizing radiation in childhood? |
Papillary carcinoma |
|
What is Orphan Annie eye nuclei and what are they associated with? |
Orphan annie eye nuclei are nuclei with a central white clearing. It is associated with papillary carcinoma. |
|
Which thyroid carcinoma has psammoma bodies? |
Papillary carcinoma |
|
Which nodes do papillary carcinomas usually spread to? |
Cervical nodes |
|
Malignant proliferation of follicles (thyroid) |
Follicular carcinoma |
|
Which thyroid neoplasia has a fibrous capsule with invasion through capsule? |
Follicular carcinoma |
|
Why can you not differentiate follicular adenoma from follicular carcinoma with fine needle aspiration? |
Follicular adenoma and follicular carcinoma histologically look the same, the difference is in the capsule integrity which can not be seen with FNA. Follicular adneoma has an intact capsule, follicular carcinoma does not. |
|
Which four carcinomas like to spread via blood? |
Renal cell carcinoma - renal viens Follicular carcinoma Hepatocellular carcinoma - hepatic veins Choriocarcinoma
|
|
Malignant proliferation of parafollicular C cells |
Medullary carcinoma |
|
Which thyroid carcinoma has high levels of calcitonin? |
Medullary carcinoma |
|
Fine need aspiration that shows malignant cells in an amyloid stroma is indicative of what thyroid neoplasia? |
Medullary carcinoma |
|
Detection of what mutation warrants prophylactic thyroidectomy and why? |
RET mutation, thyroid may progress to medullary carcinoma |
|
Undifferentiated malignant tumor of thyroid |
Anaplastic carcinoma |
|
Which thyroid neoplasia likes to invade local structures? |
Anaplastic carcinoma |
|
What are the three actions of PTH? |
Increase bone osteoclast activity Increase small bowel absorption of calcium and phosphate Increase renal calcium reabsorption Decrease renal phosphate reabsorption |
|
Excess PTH due to disorder of the parathyroid gland |
Primary Hyperparathyroidism |
|
Pituitary adenoma can cause what to the pancreas? |
Acute pancreatitis |
|
Osteitis fibrosa cystica is associated with what endocrine disorder? |
Parathyroid adenoma |
|
Nephrocalcinosis is associated with what endocrine disorder? |
Parathyroid adenoma |
|
Lab findings for parathyroid adenoma: increased or decreased for PTH, calcium, phsophate, cAMP, serum alkaline phosphatase |
PTH increased Calcium Increased Phosphate decreased Urinary cAMP increased Serum alkaline phosphatase increased |
|
Excess production of PTH due to a disease process extrinsic to the parathyroid gland |
Secondary hyperparathyroidism |
|
Most common cause for secondary hypoparathyroidism |
Chronic renal failure |
|
How does chronic renal failure cause secondary hyperparathyroidism? |
Renal insufficiency leads to decreased phosphate excretion Increased serum phosphate binds calcium Low free calcium stimulate parathyroids Increased PTH leads to bone resorption |
|
Lab findings for secondary hypoparathyroidism due to CRF: Increased or decreased PTH, serum calcium, serum phosphate, alkaline phosphtase |
PTH increased Serum calcium decreased Serum phosphate increased Alkaline phosphatase increased |
|
What endocrine disorder can occur due to DiGeorge syndrome? |
Hypoparathyroidism |
|
What is trousseau sign and what does it indicate? |
tetany that is elicited with filling of blood pressure cuff - hypoparathyroidism |
|
What is Chvostek sign and what does it indicate? |
Tapping of facial nerve leads to spams - hypoparaythyroidism |
|
End-organ resistance to PTH is called |
Pseudohypoparathyroidism |
|
What protein is defective in pseudohypoparathyroidism? |
Gs (G stimulatory protein) |
|
What are the lab values for calcium and PTH in pseudohypoparathyroidism? |
Decreased calcium Increased PTH |
|
A pt with short stature and short 4th and 5th digits most likely has what endocrine disorder? |
Pseudohypoparathyroidism |
|
What cells secrete insulin and where are they relative to the islets? |
Beta cells; lie in center of islets |
|
What cells secrete glucagon? |
Alpha cells |
|
What cells destroys the beta cells in type 1 diabetes mellitus? |
T Lymphocytes |
|
Which HLA is type 1 diabetes associated with? |
HLA-DR3 and DR4 |
|
What is the mechanism of insulin resistance in type II diabetes? |
Obesity leads to decreased numbers of insulin receptors |
|
Glucose can freely enter what areas without insulin? |
Schwann cells pericytes of retinal blood vessels lens |
|
What enzyme is responsible for converting glucose to sorbitol, resulting in osmotic damage in diabetes? |
Aldose reductase |
|
What are the three parts of MEN type 1? |
3 P's Pituitary Tumors Parathyroid Tumors Pancreatic Tumors |
|
What are the three parts of MEN type 2A? |
2P's Parathyroid hyperplasia Pheochromocytoma Medullary thyroid carcinoma |
|
What are the three parts of MEN type 2b? |
1P Pheochromocytoma Medullary thyroid carcinoma Mucosal neuromas |
|
This pancreatic endocrine neoplasm presents with episodic hypoglycemia with mental status changes that are relieved by administration of glucose? |
Insulinoma |
|
This pancreatic endocrine neoplasm presents with treatment-resistant peptic ulcers |
Gastrinomas (Zollinger-Ellison syndrome) |
|
This pancreatic endocrine neoplasm presents with achlorhydria and cholelithiasis with steatorrhea |
Somatostatinomas achlorhydria - inhibits gastrin steatorrhea - inhibits CCK |
|
This pancreatic endocrine neoplasm presents with watery diarrhea, hypokalemia, and achlorhydria |
VIPomas |
|
Which pancreatic endocrine neoplasm has cholelithiasis? |
Somatostatinoma |
|
Adrenal cortex has three layers and what do each of the layers produce? |
Glomerulosa - mineralocorticoids Fasciculata - glucocoritcoids Reticularis - sex steroids |
|
Endocrine disorder with excess cortisol |
Cushing syndrome |
|
What are the three ways cortisol suppresses the immune system? |
Inhibits these three things: Phospholipase A2 = inflammatory mediator IL-2 = T-cell growth factor Histamines = vasodilation |
|
What are the 4 causes for cushing syndrome? |
Exogenous corticosteroids Primary adrenal adenoma, hyperplasia or carcinoma ACTH-secreting pituitary adenoma Paraneoplastic ACTH secretion |
|
How does a dexamethasone test distinguish pituitary vs small cell carcinoma cause for cushing? |
Dexamethasone is a powerful cortisol analog which should suppress ACTH. In pituitary adenoma cortisol will be decreased due to negative feedback of ACTH. In small cell cell carcinoma cortisol remains high because there is no negative feedback. |
|
Endocrine disorder with excess aldosterone |
Conn syndrome |
|
Excess aldosterone (conn syndrome) will cause what 3 things to happen in the collecting tubles of the kidney? what two cells are they affecting? |
Principle cell: Reabsorb Na --> Hypernatremia Secrete K --> Hypokalemia alpha-intercalated cell: Secrete H+ --> metabolic alkalosis
|
|
In primary hyperaldosteronism what are the levels of aldosterone and renin? |
Aldosterone is high because it is being secreted by an adenoma Renin is low because high blood pressure lowers renin |
|
In secondary hyperaldosteronism what are the levels of aldosterone and renin? |
Renin is high because the renin-angiotensin system is activated Aldosterone is high because Angiotensin II caused its release |
|
Excess steroids with hyperplasia of both adrenal glands |
Congential adrenal hyperplasia |
|
What is deficient in congenital adrenal hyperplasia? |
21-hydroxylase |
|
What is the pathophysiology of congenital adrenal hyperplasia? |
21-hydroxylase deficiency leads to increased production of sex steroids. Cholesterol is converted to pregnenolone which then converted to the 3 steroids (mineral, cortico, and sex). Mineral and cortico require 21 hydroxylase but sex does not so there is a lot of sex steroids. Deficiency of cortico leads to increase in ACTH which causes bilateral adrenal hyperplasia |
|
If a patient presents with 21-hydroxylase deficiency symptoms but does not have salt wasting, hypokalemia, or hypovolemia what should you suspect and why? |
11-hydroxylase deficiency because a little mineralocorticoids are still being produced by corticosteroids are still deficient. |
|
What syndrome has adrenal insufficiency? |
Waterhouse-Friderichsen syndrome |
|
Pathophysiology of Waterhouse-Friederichsen syndrome? |
N meningitidis infection leads to DIC which leads to hemorrhagic necrosis of adrenal glands |
|
Sack of blood adrenals is associated with what? |
Waterhous-Friederichsen syndrome |
|
What are the 3 causes for chronic adrenal insufficiency? |
Autoimmune destruction TB Metastatic carcinoma (e.g. lungs) |
|
What is the adrenal medulla derived from? |
Neural crest-derived chromaffin cells |
|
Tumor of chromaffin cell |
Pheochromoctyoma |
|
A brown tumor of the adrenal gland suggests what pathology? |
Pheochromocytoma |
|
MOA of phenoxybenzamine and what is it used for? |
Irreversible a-blocker used for pheochromocytoma |
|
What is increased in serum in pheochromocytoma? (2) |
metanephrines vanillylmandelic acid |
|
What are the rule of 10s for pheochromocytoma? (4) |
10% bilateral 10% familial 10% malignant 10% located outside of adrenal medulla |
|
Where do pheochromoctyomas like go if they are not in the adrenals? |
bladder wall |
|
What syndromes are associated with pheochromocytoma? |
MEN 2A MEN 2B VHL disease NF type 1 |
|
What are the Na, K, and plasma levels in congenital adrenal hyperplasia? |
Decreased Na Increased K Hypvolemia |
|
What is IL-4 responsible for? |
IgE class switch |
|
What is IL-10 responsible for? |
inhibit Th1; stimulate Th2 |
|
What is IL-2 responsible for? |
T-cell growth factor |
|
What are the two layers of of epithelium in lobules and ducts of the breast? which one is outer and which is inner? what is the function of each? |
Luminal = inner, makes milk Myoepithelial = outer, contractile ejection of milk |
|
What hormones cause the breast tissue to develop? |
Estrogen and progesterone |
|
Bacterial infection of the breast, usually S. aureus |
Acute mastitis |
|
Acute mastitis is usually due to what bacteria? |
S. aureus |
|
Inflammation of the subareolar ducts in breast |
Periductal mastitis |
|
Periductal mastitis has a relative deficiency in what vitamin? |
Vitamin A |
|
This breast infection presents with nipple retraction, but is not cancer. |
Periductal mastitis |
|
Inflammation with dilation of the subareolar ducts |
Mammary duct ectasia |
|
This presents as a perioareolar mass with green-brown nipple discharge |
Mammary duct ectasia |
|
Mammary duct ectasia clasically arises in what population? |
multiparous postmenopasual women |
|
Cysts that have a blue-dome appearance on gross exam (breast) |
Fibrocystic change |
|
How much increased risk for breast carcinoma: apocrine metaplasia |
zero increased risk |
|
How much increased risk for breast carcinoma: ductal hyperplasia |
2x |
|
How much increased risk for breast carcinoma: sclerosing adenosis |
2x |
|
How much increased risk for breast carcinoma: atypical metaplasia |
5x |
|
Papillary growth, usually into a large duct (breast) |
Intraductal papilloma |
|
This breast pathology classically presents as a bloody nipple discharge in a premenopausal woman |
Intraductal papilloma |
|
Histologically what differentiates intraductal papilloma from papillary carcinoma? |
Intraductal papilloma contains myoepithelial cells while papillary carcinoma does not |
|
Tumor of fibrous tissue and glands in the breast |
Fibroadenoma |
|
Pt presents with a mass in her breast that grows during pregnancy and is painful during menstrual cycle. What is it? |
Fibroadenoma |
|
Fibroadenoma-like tumor with overgrowth of fibrous component |
Phyllodes tumor |
|
Can phyllodes tumor of breast be malignant? |
Yes, but not fibroadenoma |
|
Can fibroadenoma of breast be malignant? |
No, but phyllodes tumor can be malignant |
|
Malignant proliferation of cells in ducts with no invasion of the basement membrane |
Ductal carcinoma in situ (DCIS) |
|
Ductal carcinoma in situ that extend up the ducts to involve the skin of the nipple |
Paget disease of the nipple |
|
What 3 things can show up as calcifications in the breast? |
Fat necrosis Fibrocystic change Ductal carcinoma in situ |
|
Invasive carcinoma that classically forms duct like structures |
Invasive ductal carcinoma |
|
This breast cancer has retraction of the nipple |
Invasive ductal carcinoma |
|
What are the 4 subtypes of invasive ductal carcinoma |
Tubular carcinoma Mucinous carcinoma Medullary carcinoma Inflammatory carcinoma |
|
This invasive ductal carcinoma has well differentiated tubules that lack myoepithelial cells, what is the prognosis? |
Tubular carcinoma, relative good prognosis |
|
This invasive ductal carcinoma has abundant extracellular mucin, what is the prognosis? |
Mucinous carcioma, relatively good prognosis |
|
This invasive ductal carcinoma has large, high-grade cells growing in sheets with associated lymphocytes and plasma cells, what is the prognosis? |
Medullary carcinoma, relatively good prognosis |
|
This invasive ductal carcinoma has cancer in dermal lymphatics, what is the prognosis? |
Inflammatory carcinoma, poor prognosis |
|
Which invasive ductal carcinoma can be mistaken for acute mastitis due to a swollen breast? |
Inflammatory carcinoma |
|
Which invasive ductal carcinoma has increased incidence in BRCA1 carriers? |
Medullary carcinoma |
|
Malignant proliferation of cells in lobules with no invasion of the basement membrane |
Lobular carcinoma in situ (LCIS) |
|
This breast cancer has dyscohesive cells lacking E-cadherin |
Lobular carcinoma in situ |
|
Which breast cancer is treated with tamoxifen? |
Lobular carcinoma in situ |
|
This invasive carcinoma grows in a single-file pattern, why? |
Invasive lobular carcinoma because it lacks E-cadherin |
|
This carcinoma lacks duct formation due to lack of E-cadherinI |
Invasive lobular carcinoma |
|
In TNM staging what is the most important prognostic factor? |
Metastasis - if there is metastases, very bad |
|
In TNM staging what is the most useful prognostic factor? |
Lymph nodes - since most pts do not have metastases this is more useful |
|
What are the three predictive factors in breast cancer and which drugs are they useful for? |
Estrogen receptor - responds to tamoxifen Progesterone receptor - responds to tamoxifen HER2/neu gene amplification status - responds to trastuzumab |
|
MOA of transtuzumab and what is it used for? |
designer antibody directed against HER2 receptor, HER2/neu breast cancer |
|
What is a triple negative breast cancer? what is the significance? |
ER, PR, HER2neu negative and it has a poor prognosis |
|
BRCA1 mutation is associated with what cancers? |
Medullary breast carcinoma and Serous ovarian carcinoma and Fallopian tube carcinoma |
|
BRCA2 mutation is associated with what cancers? |
breast carcinoma in males |
|
What syndrome is associated with male breast cancer? |
Klinefelter syndrome |
|
Male breast cancer is most likely which subtype? |
invasive ductal carcinoma |
|
Cholecalciferol to 1,25 dihydrocholecalciferol, what organs and what adds 1 and what adds 25 and what order |
1st liver adds 25 2nd kidneys add 1 |
|
Patient with gynecomastia and small firm testes, abnormally long extremeties. Increased/Decreased: LH,FSH, Testosterone, sperm count |
LH,FSH: Increased Testosterone: Decreased Sperm count: Decreased In klinefelter sertoli and leydig cells are destroyed leading to low testosterone. Feedback loop makes LH and FSH increase. |
|
What enzymatic conversion is deficient in biotin deficiency? |
Pyruvate to oxaloacetate |
|
Which organ must be tested when pts are using amiodarone? |
Thyroid - Serum TSH |
|
Perchlorate and Pertechnate have what MOA and what do they treat? |
Block iodide absorption into thyroid by competitive inhibition. Used for hyperthyroidism |
|
MOA of metyrapone test |
metyrapone prevents conversion of 11-deoxycortisol to cortisol causing decrease negative feedback loop leading to increase in ACTH in patients with an intact HPA. |
|
What is glucokinase used for? |
Insulin receptor in pancreatic beta cells |
|
What GLUT responds most to insulin and in which tissue is it found? |
GLUT-4 found in muscles and adipose tissue |
|
Thyroid peroxidase is responsible for what enzymatic reaction? |
Oxidation of iodide to iodine Iodination of thyroglobulin tyrosine Iodotyrosine coupling of T3 and T4 |
|
Which insulins are good for post-prandial? (3) |
Lispro Aspart Glulisine |
|
Which insulins are good for daily maintenance, once a day? (2) |
Glargine Detemir |
|
Which drug can treat benign prostate hypertrophy as well as male pattern baldness and what is the MOA? |
Finasteride - 5a-reductase inhibitor |
|
Neurophysin is an important carrier for what two hormones? |
ADH and Oxytocin |
|
Which hypothalamic hormone is inhibited by constant stimulation via dopamine? |
Prolactin |
|
MOA of sulfonylureas |
Insulin secretagogue |
|
MOA of meglitnides |
Insulin secretagogue |
|
Pt is 14 years old and shows no sign of masculinity, he also can't smell. What is the syndrome? what is the defect? |
Kallmann syndrome - absence of GnRH secretory neurons |
|
What hormone is the negative feedback for LH? FSH? |
LH = testosterone FSH = Inhibin B |
|
What hormone is the negative feedback for GnRH? |
Testosterone |
|
MOA of methimazole |
Inhibit thyroid peroxidase centrally does not act peripherally |
|
Name two thionamide drugs and what is a potential complication? |
PTU and Methimazole Agranulocytosis |
|
Which class of heart drugs should not be used with diabetes? |
Beta blockers because they mask the adrenergic symptoms of hypoglycemia. |
|
Estrogen does what to thyroid hormone levels and why? |
Estrogen increases thyro binding globulin. Which increases the total amount of BOUNDED T4 and T3. This will increase the pool (bound + free) but the free amount will remain the same. |
|
First thing that comes to mind with cryptococcus? |
Pigeons |
|
Chagas disease can cause what? |
Achalasia |
|
Eosinophils in urine, what is the dx? |
acute interstitial nephritis |
|
Neural crest forms what? |
PNS |
|
Neural tube forms what? |
CNS |
|
Hollow lumen of neural tube forms what? |
Ventricles |
|
Low folate levels prior to conception is associated with what? |
Neural tube defects |
|
Frog-like appearance of the fetus is associated with? |
Anencephaly |
|
Absence of skull and brain is called? |
Anencephaly |
|
Maternal polyhydraminos is assocaited with what neural tube defect? |
Anencephaly |
|
Failure of posterior vertebral arch to close |
Spina bifida |
|
What is spina bifida occulta |
Dimple or patch of hair overlying vertebral defect |
|
Congenital stenosis of the channel that drains CSF from the 3rd and 4th ventricles |
Cerebral aqueduct stenosis |
|
How does CSF drain starting with lateral ventricle |
Lateral Foramen of Monro 3rd Cerebral aqueduct 4th Luschka subarachnoid space |
|
Congenital failure of the cerebellar vermis to develop |
Dandy-Walker Malformation |
|
This presents as a massively dilated 4th ventricle with an absent cerebellum |
Dandy-Walker Malformation |
|
Protrusion of meninges is called? |
Menigocele |
|
Protrusion of meninges and spinal cord is called? |
Meningomyocele |
|
Spina bifida presents with cystic protrusion of the underlying tissue through the vetebral defect, what two cystic protrusions can there be? |
Meningocele - protrusion of meninges Meningomyelocye - protrusion of meningees and spinal cord |
|
Congenital extension of cerebellar tonsils through foramen magnum |
Arnold-Chiari Malformation |
|
Hydrocephalus can occur with what two neural tube defects? |
Cerebral aqueduct stenosis Arnold-Chiari Malformation |
|
Cystic degeneration of the spinal cord |
Syringomyelia |
|
Syringomyelia may arise with what malformation? |
Arnold-Chiari malformation |
|
This presents as loss of pain and temperature sensation in the upper extremities |
Syringomyelia |
|
Syringomyelia is due to involvement of what portion of the spinal cord? |
Anterior white commisure |
|
Syringomyelia may lead to what syndrome if the lateral horn of the hypothalamospinal tract is involved? |
Horner ptosis miosis anhidrosis |
|
Damage to the anterior motor horn due to poliovirus infection |
Poliomyelitis |
|
Inherited degeneration of anterior motor horn |
Werdnig-Hoffman disease |
|
Werdnig-Hoffman disease has what inheritance pattern? |
Autosomal recessive |
|
Presents as floppy baby; death occurs within a few years after birth. Congenital disease. |
Werdnig-Hoffman Disease |
|
Lowor motor neurons is controlled by what part of the spinal cord? |
Anterior motor horn |
|
Upper motor neurons is controlled by what part of the spinal cord? |
Lateral corticospinal tract |
|
Spastic paralysis with hyperreflexia, increased muscle tone, and positive Babinski sign is LMN or UMN disorder? |
UMN |
|
Flaccid paralysis with muscle atrophy, fasiculations, weakness and decreased muscle tone, and negative babinski sign is LMN or UMN disorder? |
LMN |
|
What distinguished ALS from syringomyelia? |
ALS does not have sensory impairment |
|
Familial ALS is associated with a mutation in what? |
Zinc-Copper superoxide dismutase |
|
Degenerative disorder of cerebellum and spinal cord tracts |
Friederich Ataxia |
|
Inheritance pattern of Friederich Ataxia |
Autosomal Recessive |
|
Unstable trinucleotide repeate (GAA) in frataxin gene describes what disorder? |
Friedereich ataxia |
|
Which spinal cord lesion is associated with hypertrophic cardiomyopathy? |
Friederich ataxia |
|
Meningitis is inflammation of what? |
Leptomeninges |
|
Leptomeninges is composed of what? |
Pia and arachnoid, NOT DURA |
|
3 most common organism to cause meningitis in neonates |
Group B Strept E. Coli Listeria Monocytogenes |
|
most common organisms to cause meningitis in children and teenagers |
N Meningitidis |
|
most common organisms to cause meningitis in adults and elderly |
Strep pneumo |
|
most common organism to cause meningitis in nonvaccinated infants |
H flu |
|
Most common organism to cause meningitis in immunocompromised? |
Fungi |
|
Most common viral cause of meningitis? |
Coxsackievirus |
|
Where are lumbar punctures done? why? |
L4-L5 , spinal cord ends at L2 but the subarchnoid space and cauda equina ends at S2 |
|
With a lumber puncture what are you piercing and where do you stop at? |
Skin, ligament, epidural space, dura, arachnoid, DO NOT PIERCE PIA |
|
LP with neutrophils with low glucose suggest what cause of meningitis? |
Bacterial |
|
LP with lymphocytes with normal CSF glucose suggest what cause of meningitis? |
Viral |
|
LP with lymphocytes with low CSF glucose suggests what cause of meningitis? |
Fungal |
|
Complications with meningitis is usually seen with what type of meningitis? |
Bacterial |
|
In moderate global cerebral ischemia what are the highly vulnerable regions? |
Pyramidal neurons of cerebral cortex - layers 3,5,6 (laminar necrosis) Pyramidal neurons of hippocampus Purkinje layer of cerebellum |
|
Ischemia of pyramidal neurons of cerebral cortex damages what layers and leads to what type of necrosis? |
Layers 3,5,6, laminar necrosis |
|
This type of stroke is due to rupture of an athersclerotic plaque |
Thrombotic stroke |
|
Thrombotic strokes usually have what kind of infarct? |
Pale infarct |
|
This type of stroke is due to thromboemboli |
Emoblic stroke |
|
Embolic stroke usually have what kind of infarct? |
Hemorrhagic Infarct |
|
This stroke occurs secondarily to hyaline arteriosclerosis, a complication of HTN. |
Lacunar stroke |
|
Which vessels are most commonly involved in lacunar strokes? |
lenticulostriae vessels |
|
Ischemic strokes result in what kind of necrosis? |
Liquefactive |
|
Stages of Ischemic stroke , 1 day, 1 week, 1 month |
Red neurons | Neutro then Mircoglial | Granulation Tissue | Cyst (gliosis) |
|
What is the most common site for intracerebral hemorrhage? |
Basal ganglia |
|
Charcot-Bouchard microaneurysms are associated with what? |
Intracerebral hemorrhage |
|
Pt presents with worst headache of my life, what is the dx? |
Subarachnoid hemorrhage |
|
Bleeding on the bottom of the brain, what is the dx? |
Subarachnoid hemorrhage |
|
Lumbar puncture shows xanthochromia (yellow hue to bilirubin breakdown) what is the dx? |
Subarachnoid hemorrhage |
|
Most common cause of a subarachnoid hemmorrhage? |
Berry aneurysm |
|
What is the most frequent location of berry aneurysm? |
anterior circle of willis (branch points of anterior communicating artery) |
|
What are berry aneurysms associated with? |
Marfan and ADPKD |
|
Why is it easy for berry aneurysms to rupture? |
they lack a media layer |
|
Collection of blood between the dura and the skull |
Epidural Hematoma |
|
Epidural hematoma are usually due to what? |
Fracture of temporal bone with rupture of middle meningeal artery |
|
This head trauma has lucid intervals that may precede neurologic signs "talk and die" |
Epidural hematoma |
|
Collection of blood underneath the dura; blood covers the surface of the brain. |
Subdural hematoma |
|
Subdural hematomas are usually due to what? |
tearing of bridging vein between dura and arachnoid |
|
Epidural and subdural hematoma has what lethal complication? |
Herniation |
|
Displacement of brain tissue due to mass effect or increased intracranial pressure |
Herniation |
|
Name the herniation and the complication that arises from it: displacement of cerebellar tonsils into the foramen magnum |
Tonsillar herniation: compression of brain stem leads to cardiopulmonary arrest |
|
Name the herniation and the complication that arises from it: Displacement of cingulate gyrus under the falx cerebri |
Subfalcine herniation: compression of anterior cerebral artery leads to infarction |
|
Name the herniation and the complication that arises from it: displacement of temporal lobe uncus under the tentorium cerebelli |
Uncal Herniation Compression of cranial nerve III (oculomotor), eye moves down and out and a dilate pupil Compression of posterior cerebral artery leads to infarction of occipital lobe (contralateral homonymous hemianopsia) Rupture of the paramedian artery leads to Duret (brainstem) hemorrhage
|
|
Deficiency of arylsulfatase leads to what disorder? |
Metachromatic leukodystrophy |
|
Metachromatic leukodystrophy has a deficiency in what? and what does this lead to? |
Arylsulfatase - myelin cannot be degraded; accumulates in lysosomes |
|
Deficiency of galactocerbroside B-galactosidase leads to what disorder? |
Krabbe disease - a form of leukodystrophy |
|
Krabbe disease has a deficiency in what? and what does this lead to? |
galactocerbroside B-galactosidase - galactocerebroside accumulates in macrophages |
|
Impaired addition of coenzyme A to long-chain fatty acids leads to what disorder? |
Adrenoleukodystrophy |
|
Adrenoleukodystrophy has what deficiency? what does this lead to? |
Impaired addition of coenzyme A to long-chain fatty acids - fatty acids accumulate damaging adrenal gland and white matter |
|
Autoimmune destruction of CNS myelin and oligodendrocytes |
Multiple Sclerosis |
|
Multiple Sclerosis is associated with which HLA? |
HLA-DR2 |
|
What disease is more commonly seen in regions away from the equator? |
Multiple sclerosis |
|
What is internuclear ophthalmoplegia and what is it associated it with? |
Multiple sclerosis - when you try to move the eyes to one side only one eye moves because of a defect in the medial longitudinal fasciculus |
|
LP of multiple sclerosis would show what? |
Oligoclonal IgG bands |
|
Oligoclonal IgG bands are found in what CNS disorder? |
Multiple sclerosis |
|
How do you slow the progression of multiple sclerosis? |
Interferon beta |
|
Progressive, debilitating encephalitis leading to death |
Subacute sclerosing panencephalitits |
|
What is subacute sclerosing panencephatlitis due to? |
persistent infection of the brain by measles virus |
|
Persistent infection of the brain by measles virus leads to what? |
Subacute sclerosing panencephalitis |
|
JC virus infection of oligodendrocytes leads to what? |
Progressive multifocal leukoencephalopathy |
|
Progressive multifocal leukoencephalopathy is due to what? |
JC virus infection of oligodendrocytes |
|
Focal demyelination of pons |
Central Pontine Myelinolysis |
|
Rapid IV correction of hyponatremia can cause what? |
Central pontine myelinolysis |
|
What CNS disorder presents with acute paralysis giving a "locked in" syndrome? |
Central Pontine Myelinolysis |
|
Degeneration of brainstem and basal ganglia leads to what kind of disorders? |
Movement disorders |
|
E4 apolipoprotein E associated with increased or decreased risk of alzheimer |
Increased - because more ABeta-protein is being made |
|
E2 apolipoprotein E associated with increased or decreased risk of alzheimer? |
Decreased |
|
Familial cases of early alzheimers associated with what? |
Presenelin 1 |
|
Why is there early onset alzheimers in down syndrome patietns? |
Amyloid precurrsor protein (APP) is on chromosome 21. Increased APP can increase amount converted into Abeta amyloid which will cause down syndrome. |
|
Hydrocephalus ex vacuo - what is it and what is it associated with? |
Dilated ventricles due to atrophy of brain, associated with alzheimer |
|
AB amyloid depositing around blood vessels in the brain: what is it called and what is the consequence? |
Cerebral amyloid angiopathy - increased likelihood of rupture into brain. |
|
What are neurofibrillary tangles composed of? what is it associated with? |
Composed of hyperphosphorylated Tau, associated with Alzheimer Disease |
|
What type of protein is Tau? |
Microtubule associated protein - hyperphosphoyrlated Tau assocaited with Alzheimer |
|
Multifocal infarction and injury of the brain due to HTN, atherosclerosis, or vasculitis |
Vascular dementia |
|
Degenerative disease of FRONTAL and TEMPORAL cortex; spares parietal occipital lobes |
Pick Disease |
|
Pick Disease primarily affects which portion of the brain? |
Frontal and Temporal, spares parietal and occiptal lobes |
|
Round aggregates of tau protein is associated with what brain disease? |
Pick disease Alzheimer has neurofibrilary tangles assocaited with tau |
|
Parkinson disease has a degenerative loss of what type of neurons where? |
Dopaminergic neurons - substantia nigra pars compacta of the basal ganglia |
|
Contamination of illicit drugs with MPTP is associated with what disorder? |
Parkinson Disease |
|
What are Lewy bodies associated with and what are they? |
Parkinson's disease - round eosinophilic inclusions of alpha-synuclein |
|
Parkinson with early dementia is called what? how do you distinguish them? |
Lewy body dementia - the lewy bodies are found in the cortex instead |
|
Degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia. |
Huntington Disease |
|
Inheritance pattern for Huntington |
Autosomal disorder |
|
Pathophysiology of chorea in Huntington disease |
Degeneration of GABAergic neurons leads to loss of inhibition from the caudate nucleus of the basal ganglia to the cortex. This results in random movement. |
|
What is the expanded trinucleotide repeat in the huntingtin gene (what is the actual code)? |
CAG |
|
Further expansion of the trinucleotide repeat in huntington disaese happens where/when? |
Spermatogenesis |
|
Increase CSF resulting in dilated vdentricles |
Normal Pressure Hydrocephalus |
|
What is the triad for normal pressure hydrocephalus? |
Wet, Wacky, Wobbly Urinary incontinence Dementia Gait instability
|
|
What are the two treatments for normal pressure hydrocephalus |
Lumbar puncture, ventriculuperitoneal shunting. |
|
Degenerative disease due to prion protein |
Spongiform Encephalopathy |
|
Pathophysiology of Spongiform encephalopathy |
Prion proteins (PrPc) in the alpha helical form being converted to Prion proteins in the Beta pleated (PrPsc). |
|
Creutzfeldt-Jakob disease presents with what kind of dementia? |
Rapidly progressive dementia |
|
Familial fatal insomnia is what type of CNS disease? |
Spongiform encephalopathy |
|
Metastatic brain cancer usually come from where? |
Lung, Breast, Kidney |
|
Brain tumors in adults usually arise where relative to tentorium? |
Supratentorial - adults Infratentorial - kids |
|
Malignant, high-grade tumor of astrocytes |
Gliobastoma Multiforme - Normally found in adults, most common malignant CNS tumor in adults |
|
What is the most common malignant CNS tumor in adults |
Glioblastoma Multiforme |
|
Which CNS tumor crosses the corpus callosum? |
Glioblastoma Multiforme |
|
Which CNS tumor is GFAP positive? (2) |
Glioblastoma Multiforme and Pilocytic Astrocytoma |
|
Benign tumor of arachnoid cells |
Meningioma - most common benign CNS tumor in adults |
|
Meningioma is most common in what poppulation? |
Adult Females |
|
Which CNS tumor has a whorled pattern on histology |
Meningioma |
|
Which CNS tumor has psammoma bodies |
Meningioma |
|
Benign tumor of Schwann cells |
Schwannoma |
|
Bilateral schwannomas of cranial nerve VIII is seen in what disorder? |
Neurofibromatosis 2 |
|
Which CNS tumor is S-100 positive? |
Schwannoma |
|
Malignant tumor of oligodendrocytes |
Oligodendroglioma |
|
Calcified tumor in white matter of the CNS |
Oligodendroglioma |
|
Which CNS tumor has a fried egg appearance on biopsy? |
Oligodendroglioma |
|
Which CNS tumor involves the frontal lobe that may present with seizures? |
Oligodendroglioma |
|
Benign tumor of astrocytes |
Pilocytic astrocytoma |
|
Most common benign brain tumor in children |
Pilocystic astrocytoma |
|
This CNS tumor reveals a cystic lesion with a mural nodule |
Pilocystic astrocytoma |
|
Biopsy of this tumor shows Rosenthal fibers, what is the tumor and what are rosenthal fibers? |
Pilocystic astrocytoma - rosenthal fibers are thick eosinophilic granular bodies |
|
Malignant tumor derived from granular cells of cerebellum |
Medulloblastoma |
|
What are drop metastases and what is it associated with? (CNS) |
Metastasis to cauda equina - Medulloblastoma |
|
Malignant tumor of ependymal cells |
Ependymoma |
|
Which CNS tumor most commonly arises in 4th ventricle, may present with hydrocephalus. |
Ependymoma |
|
Which CNS tumor can present with bitemporal hemianopsia? |
Craniopharyngioma |
|
What is a Brenner tumor? |
Surface epithelial tumor of the ovary that contains urothelium |
|
What prostaglandin analogue treats glaucoma? |
Latanaprost |
|
MOA of Latanaprost and what does it do? |
Prostaglandin analogue that treats glaucoma |
|
What are streak ovaries associated with? |
Turners syndrome |
|
Marcophages express this surface receptor |
CD 14 |
|
CNS tumors that stain with synaptophysin generally originate from what cell? |
Neurons |
|
What amino acids must be restricted in Maple Syrup Urine Disease? |
leucine, isoleucine, valine |
|
Name this immature defense: Tantrums |
Acting out - expressing unacceptable feelings and though through actions |
|
Name this immature defense: Extreme forms can result in dissociative identity disorders |
Dissociation - Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotioanl stress |
|
Name this immature defense: a common reaction to newly diagnosed AIDS and cancer patients |
Denial - Avoiding the awareness of some painful reality |
|
Name this immature defense: mother yells at her child because her husband is yelling at her |
Displacement - transferring avoided ideas and feelings to some neutral person or object |
|
Name this immature defense: Men fixating on sports games |
Fixation - partially remaining at a more childish level of development |
|
Name this immature defense: Abused child identifies with an abuser |
Identification - Modeling behavior after another person who is more powerful |
|
Name this immature defense: Describing murder in graphic details with no emotional response |
Isolation (of affect) - separating feeling from ideas and events |
|
Name this immature defense: A man who wants another woman thinks his wife is cheating on him |
Projection - attributing an unacceptable internal impulse to an external source |
|
Name this immature defense: After getting fired, claiming that the job was not important anyway. |
Rationalization - proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame |
|
Name this immature defense: A patient with lustful thoughts enters a monastery. |
Reaction formation - replacing a warded-off idea or feeling by an emphasis on its opposite |
|
Name this immature defense: Seen in children under stress such as illness, punishment, or birth of a new sibling (bedwetting in a previously toilet-trained child when hospitilized) |
Regression - turning back the maturational clock |
|
Name this immature defense: Not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious |
Repression - involuntary withholding an idea or feeling from conscious awareness |
|
Name this immature defense: A patient says that all nurses are cold and insensitive but that the doctors are warm and friendly. |
Splitting - believing that people are either all good or all bad at different times due to intolerance of ambiguity. |
|
Name this mature defense: Mafia boss makes large donation to charity |
Altruism |
|
Name this mature defense: Nervous medical student jokes about the boards |
Humor |
|
Name this mature defense: Teenager's aggression toward his father is redirected to perform well in sports |
Sublimation |
|
Name this mature defense: Choosing to not worry about the big game until it is time to play |
Suppression |
|
Achondroplasia is due to what kind of mutation and where? What does this mutation cause? |
Activating mutation in FGFR3 - over expression of FGFR3 inhibits growth. |
|
Inheritance pattern for achondroplasia |
Autosomal dominant |
|
Autosomal dominant defect in collagen type 1 syntehsis |
Osteogeneis Imperfecta |
|
Inherited defect of bone resorption resulting in abnormally thick, heavy bone that fracture easily |
Osteopetrosis |
|
Carbonic anhydrase II mutation can lead to what disorder? |
Osteopetrosis |
|
Defective mineralization of osteoid due to low levels of vitamin D |
Rickets/Osteomalacia |
|
Rachitic rosary - deposoition of osteoid at the constochondral junction is associated with what disease? |
Rickets |
|
How do you distinguish osteomalacia from osteoporosis? |
Lab values Osteomalacia has low calcium, phosphate, increased PTH and alkaline phosphatase. In Osteoporosis everything is normal |
|
Most feared complication of Paget Disease of Bone |
Osteosarcoma |
|
Which bone disease can cause high-output cardiac failure |
paget disease - creation of AV shunts in bone |
|
Most common location for osteomyelitis in the bones for children? adults? |
children - metaphysis adults - epiphysis |
|
Most common bacteria to cause osteomyelitis? |
S. aureus |
|
This bone tumor pain resolves with aspirin |
Osteoid Osteoma |
|
Benign tumor of osteoblasts surrounded by rim of reactive bone |
Osteoid osteoma |
|
What differentiates osteoblastoma from osteoid osteoma? |
Greater than 2cm and does not respond to aspirin |
|
Most common benign tumor of bone |
Osteochhondroma |
|
Malignant proliferation of osteoblasts |
Osteosarcoma |
|
Risk factors for osteosarcoma (3) |
Familial retinoblastoma Paget disease Radiation exposure |
|
Which portion of bone do osteosarcomas normally arise? |
Metaphysis of long bones |
|
Which bone tumor arises in the epiphysis? |
Giant Cell Tumor |
|
Which bone tumor is comprised of multnucleated giant cells and stromal cells |
Giant Cell tumor |
|
Soap bubble appearance on X-ray suggests what bone tumor? |
Giant Cell Tumor |
|
Malignant proliferation of poorly-differentiated cell derived from neuroectoderm |
Ewing Sarcoma |
|
This bone tumor usually arises in the medulla of small bones of the hands and feet |
Chondroma |
|
This bone tumor normally arises in medulla of the pelvis or central skeleton |
Chondrosarcoma |
|
Ewing sarcoma is derived from what germ cell? |
Neuroectoderm |
|
What is the translocation for ewing sarcoma? |
11;22 |
|
Which bone tumor has onion-skinning on x-ray? |
Ewing sarcoma |
|
Joint surfaces are lined by hyalin cartilage, what type of collagen is this? |
Type II |
|
This arthritis presents with stiffness in the morning that gets worst during the day |
Osteoarthritis |
|
This arthritis affects DIP and PIP (distal and proximal interphalagnes) |
Osteoarthritis |
|
What are Herbeden and Bouchard nodes? |
Herberden nodes = osteophytes on DIP Bouchard nodes = osteophytes on PIP Found in osteoarthritis |
|
Rheumatoid arthritis is associated with which HLA? |
HLA-DR4 |
|
What is the hallmark of rheumatoid arhtritis? |
Synovitis leading to formation of pannus (inflamed granulation tissue) |
|
This arthritis presents with morning stiffness that improves with activity |
Rheumatoid arthritis |
|
This arthritis only involves PIP leading to swan-neck deformity |
Rheumatoid arthritis |
|
What is swelling of bursa behind the knee associated with? |
Rheumatoid arthritis - this is called a baker cyst |
|
This pathology presents with IgM autoantibody against Fc portion of IgG |
Rheumatoid Arthritis - Rheumatoid Factor |
|
Rheumatoid arthritis presents with this immulogical finding |
Rheumatoid factor - IgM autoantibody against Fc portion of IgG |
|
What are the two complications that can arise from Rheumatoid arthritis? |
anemia of chronic disease - chronic inflammation increases hepcidin secondary amyloidosis - SAA gets made and converted to AA leading to amyloidosis |
|
Seronegative spondyloarthritis is characterized by what 3 things? |
Lack of rheumatoid factor Axial involvement - spondylo HLA-B27 assocaition |
|
What is the triad for Reiter syndrome |
Can't see, can't pee, can't climb a tree -arthritis -urethritis -conjunctivits |
|
Involves axial and peripheral joints; DIP joints of hands and feet are most commonly affected, leading to sausage finger or toes |
Psoriatic arthritis |
|
Arthritis due to an infectious agent, usually bacterial |
Infectious arthritis |
|
Most common cause for infectious arthritis (organism) |
N gonorrhoeae |
|
Deposition of monosodium urate crystals in tissues, especially joints |
Gout |
|
3 causes for secondary gout |
Leukemia and myeloproliferative disorders Lesch-Nyhan syndrome Renal insufficiency |
|
How does leukemia and myeloproliferative disroders cause gout? |
Increased cell turnover leads to hyperuricemia |
|
How does Lesch-Nyhan syndrome cause gout? |
Deficiency in hypoxanthine-guanine phosphoribosyltransferase (HGPRT) leads to increased xanthine and uric acid since hypoxanthine and guanine can no longer be salvaged. |
|
3 parts of Lesch-Nyhan syndrome |
Self-mutilation Gout Mental retardation |
|
How does renal insufficiency cause gout? |
Kidneys can no longer excrete uric acid |
|
What is podagra? |
Painful arthritis of the great toe caused by acute gout |
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What are the two things that can cause acute gout? |
Alcohol or consumption of meat |
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What are tophi? and what are they assocaited with? |
Uric acid crystals in soft tissue or joints - Chronic Gout |
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Chronic gout can lead to what two things? |
Tophi - uric acid crystals in soft tissue or joints Renal failure - urate cyrstals deposit in kidney tubules |
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This pathology presents with synovial fluid showing needle shaped crystals with negative birefringence under polarized light |
Gout |
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This pathology presents with synovial fluid showing rhomboid-shaped crystals with weakly positive biirefrigence under polarized light |
Pseudogout |
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Pseudogout is due to deposition of what? |
Calcium pyrophosphate |
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Inflammatory disorder of the skin and skeletal muscle |
Dermatomyositis |
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It a pt presents with dermatomyositis what should you be worried about? |
Underlying carcinoma especially gastric carcinoma |
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What is the hallmark of dermatomyositis |
Bilateral proximal muscle weakness |
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What two disease can have malar rash? |
SLE and Dermatomyositis |
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When muscle is damaged what is elevated in blood? |
Creatine kinase |
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What diseases have a positive ANA? (2) |
Lupus and Dermatomyositis |
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Anti-Jo-1 antibody is indicative of what disease? |
Dermatomyositis |
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Perymysial inflammation is found in what? |
Dermatomyositis - perymysial (close to the skin) Polymyositis = endomysial |
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Endomysial inflammation is found in what? |
Polymyositis = endomysial Dermatomyositis = perimysial |
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Inflammatory disorder of skeletal muscle without skin involement |
Polymyositis |
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Degenerative disorder characterized by muscle wasting and replacement of skeletal muscle with adipose tissue |
X-Linked Muscular dystrophy |
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In X-linked muscular dystrophy what is the skeletal muscle replaced with? |
Adipose tissue |
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Deletions in what gene is responsible for Duchenne muscular dystrophy |
Dystrophin |
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What is the difference between x-linked muscular dystrophy and Duchenne? |
X-linked = mutated dystrophin Duchenne = deletion of dystrophin |
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What causes becker muscular dystrophy? |
mutation of dystrophin |
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Calf pseudohypertrophy is characteristic finding of what disease? |
Muscular dystrophy |
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Autoantibodies against the postsynaptic acetylcholine receptor of NMJ |
Myasthenia gravis |
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What is the pathophysiology of myasthenia gravis |
Autoantibodies against the postsynaptic acetylcholine receptor of NMJ |
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What type of drugs are used for myastehnia gravis? |
anticholinesterase agents |
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This is associated with thymic hyperplasia or thymoma; thymectomy improves symptoms |
Myasthenia Gravis |
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Antibodies against presynaptic calcium channels of the NMJ |
Lambert-Eaton syndrome |
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Myasthenia gravis classically involves what part of the body? |
Eyes |
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Myasthenia gravis clasically involves the eyes, what syndrome spares the eye? |
Lambert-Eaton |
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Lambert-Eaton vs Myasthenia Gravis = which improves with use, which does not? |
Myasthenia Gravis = does not Lambert-Eaton = improves |
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Most common benign soft tissue tumor in adults |
Lipoma |
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What is the characteristic cell of liposarcoma? |
Lipoblast |
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Most common malignant soft tissue tumor in adults |
Liposarcoma |
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Cardiac rhabdomyoma is associated with what? |
Tuberous sclerosis |
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Most common malignant soft tissue tummor in children? |
Rhabdomyosarcoma |
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What is the classic site for rhabdomyosarcoma in young girls? |
Vagina |
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Atopic dermatitis (Eczema) is what type of hypersensitivity? |
Type 1 - associated with asthma and allergic rhinitis |
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Contact dermatitis is what type of hypersensitivity? |
Type 4 |
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What bacteria is responsible for acne vulgaris? |
Propinibacterium acnes |
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What is psoriasis due to? |
excessive keratinocyte proliferation |
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What is acanthosis? |
Epidermal hyperplasia |
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What is auspitz sign and what is it associated with? |
Thinning of epidermis above elongated dermal papillae; resulting in bleeding when scale is picked off. Psoriasis |
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What is lichen planus associated with? |
hepatitis C virus infection |
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Autoimmune destruction of desmosomes between keratinocytes |
Pemphigus vulgaris |
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What is pemphigus vulgaris due to? |
IgG antibody against desmoglein |
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What type of hypersensitivity is pemphigus vulgaris? |
Type II |
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Autoimmune destruction of hemidesmosomes between basal cells and the underlying basement membranes |
Bullous pemphigoid |
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What is bullus pemphigoid due to? |
IgG antibody against hemidesmosome components of the basement membrane |
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Autoimmune deposition of IgA at tips of dermal papillae |
Dermatitis Herptiformis |
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Hypersensitivity reaction characterized by targetoid rash and bullae. |
Erythema Multiforme |
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What is erythema multiforme most commonly associated with? |
HSV infection |
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What is Steven Johnson Syndrome? |
Erythema multiforme with oral mucosa/lip involvement and fever |
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What is the severe form of steven johnson syndrome? |
Toxic Epidermal Necrolysis |
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Most common cause for toxic epidermal necrolysis? |
adverse drug reaction |
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Benign squamous proliferation common tumor in elderly |
Seborrheic keratosis |
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Epidermal hyperplasia with darkening of the skin |
Acanthosis Nigricans |
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What is acanthosis nigricans associated with? (2) |
insulin resistance and malignancy |
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What is the most common cutaneous malignancy? |
Basal cell carcinoma |
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Xeroderma pigmentosum what is the defect? |
can not repair DNA damage so pyrimidine dimers persist |
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What is the most common cancer to arise from immunosuppresive therapy? |
Squamous cell carcinoma |
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What malignancy is associated with arsenic poisoning? |
Squamous cell carcinoma |
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well differentiatned squamous cell carcinoma that develops and rapidly regresses |
Keratoacanthoma |
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Where are melanocytes derived from? |
Neural crest |
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Localized loss of skin pigmentation due to autoimmune destruction of melanocytes |
Vitiligo |
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Albinism is usually due to what? |
Enzyme defect (usually tyrosinase) that impairs melanin production |
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Freckle is due to increased of what? |
Increased in melanosomes not melanocytes |
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Benign neoplasm of melanocytes |
Nevus (mole) |
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Most common mole in children |
Junctional nevus |
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Junctional nevus that grows into the dermis is called? |
compound nevus |
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Most common mole in adults |
Intradermal nevus |
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What is the progression for moles? |
Junctional nevus becomes compound becomes intradermal |
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What are the ABCD of Melanoma? |
Assymetry Border are irregular Color is not uniform Diameter > 6mm |
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What is the most important prognostic factor in melanoma? |
Depth of extension (Breslow thickness) |
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Name the melanoma: radial growth, lentiginous proliferation |
Lentigo maligna melanoma |
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Name the melanoma: early radial growth |
Superficial spreading |
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Name the melanoma: early vertical growth |
nodular |
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Most common type of melanoma |
superficial spreading |
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What is impetigo most often due to? (2 organisms) |
S aureus or S pyogenes |
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What is cellulitis most often due to? (2 organisms) |
S aureus or S pyogenes |
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What is crepitus and what is it associated with? |
When you can hear crackling of air underneath the skin, associated with necrotizing fascitis |
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Sloughing of skin with erythematous rash and fever |
Staphylococcal Scalded Skin Syndrome |
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What bacteria causes Scalded Skin Syndrome? what is the pathophysiology? |
Staphylococcal Aureus release exfoliative A and B toxin resulting in epidoermolysis of the stratum granulosum |
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Difference between toxic epidermal necrolysis and scalded skin syndrome in regard to layers |
TEN = dermal-epidermal junction Scalded Skin Syndrome = Stratum granulosum |
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Firm, pink, umbilicated papules due to poxvirus |
Molluscum Contagiosum |
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Name the melanoma: arises on palm and or soles, often in dark-skinned individuals |
Acral Lentigerous |
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Exposure to sunlight allows conversion of what to what in Vitamin D metabolism? |
7-dehydrocholesterol to cholecalciferol |
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2 years of mild depression is called what? |
Dysthymic disorder |
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Ehlers-Danlos syndrome is caused by a defect in what? |
Collagen formation |
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Marfan syndrome is caused by a defect in what? |
Fibrillin 1 |
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Congenital hypothyroidism presents with what 4 features? |
Umbilical hernia Macroglossia Hypotonia Jaundice
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What is caudal regression syndrome associated with? Poorly developed lumbar spine and sacrum at birth. |
Maternal diabetes |
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Young football player suddenly dies from splenic rupture what is the dx? |
Infectious mononucleosis caused by Epstein Barr Virus |
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Bamboo spine associated with what? |
Ankylosing spondylitis |
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CD4+ vs CD8+ for Polymyositis and dermatomyositis |
Dermatomyositis = CD4+ Polymyositis = CD 8+ |
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Crest is associated with what antibody? |
Anti-centromere |
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What is CREST? |
Calcinosis Raynaud Phenomenon Esophagueal dysmotility Sclerodactyly Teangiectasia |
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What does leukotriene B4 do? |
Neutrophil chemotactic |
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What does PGI2 do? (2) |
inhibits platelet aggregation and promotes vasodilation |
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MOA of celecoxib |
Cox-2 ihibitor |
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MOA of kettorolac |
NSAID |
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MOA of Diclofenac |
NSAID |
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MOA of allopurinol and what is it used for? |
Inhibits xanthine oxidase - Gout |
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MOA of febuxostat and what is it used for? |
Inhibits xanthine oxidase - gout |
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MOA of colchicine and what is it used for? |
Stabilizes tubulin which inhibits microtubule polymeration impairing leukocyte chemotaxis and degranulation - gout |
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MOA of etanercept and what is it used for? |
Etanercept is a TNF decoy RECEPTOR - used for rheumatoid arthritis, psoriasis |
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MOA of adalimunmab |
Anti-TNFa antibody - IBD, rheumatoid, ankylosing spondylitits, psoriasis |
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MOA of Probenecid and what is it used for? |
Inhibits reabsorption of uric acid in PCT |
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Pts with retinoblastoma have increased risk of what other kind of cancer? |
Osteosarcoma |
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Influenza vaccine works how? |
Antibodies against hemagluttinin |
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Which vein is used in CABG? |
Saphenous vein |
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Progressive onset of CHF over many years due to chronic ischemic myocardial damage |
Chronic Ischemic Heart Disease |
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Death from cardiac causes within 1 hr usually due to lethal arryhtmia |
Sudden Cardiac Death |
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How does sudden cardiac death cause death? |
Lethal arrhthmia |
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Which part of the HPA do long term corticosteroids suppress? |
The whole thing. ACTH, CRH, Cortisol are all decreased after long term use. |
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In Nieman-Pick disease what enzyme is deficient? |
Sphingomyelinase |
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How do you tell the difference between Vit B12 and Folate deficiency? |
Deficiency Vit B12 causes neurologic problems. |
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Aldose reductase turns glucose into sorbitol, what is the next enzyme and the next sugar? |
Sorbitol dehydrogenase into Fructose |
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Low alpha-fetoprotein in utero is associated with what? |
Trisomy 21 |
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Increased alpha-fetoprotein in utero is associated with what? |
multiple gestation neural tube defects abdominal wall defects |
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What is cyanocobalamin? |
Vit B12 |
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Thrombophlebitis at various sites may indicate what? |
Visceral malignancy |
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Anorexia has what effect on hormones? |
Loss of pulsatile release of GnRH |
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Where are serotenergic neurons found in the brain? |
Raphe nuclei |
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What is used as a chemoprophylaxis for N. meningitidis infections? |
Rifampin |
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Overuse of vitamin A can cause what? |
Hepatosplenamegaly Intracranial HTN Skin changes |
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What is the antibiotic of choice for rickettsial diseases? |
Doxycycline |
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What does PT stand for and what pathway is it? |
Protrombin Time - Extrinsic |
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What does aPTT stand for and which pathway is it? |
activated partial thromboplastin time - Intrinsic |
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Eukaryotes and prokaryotes have similar replication times but eukaryotic DNA is much larger. How do eukaryotes speed up DNA synthesis? |
Multiple origins of replication |
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What is the most common cause for E. Coli bactermeia? |
UTI |
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What is the DOC for absence seizures and associated tonic-clonic seizures? |
Valproate |
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What can treat absence seizures but not tonic-clonic seizures? |
Ethosuximide |
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Isoniazid has what toxicity? |
Hepatic toxicity |
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Pt presents with jugular vein distension, pulsus paradoxus, and tachycardia. What's the dx? |
Cardiac tamponade |
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Supine dyspnea that is relieved by sitting up is specific for what pathology? |
Left sided heart failure - |