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514 Cards in this Set
- Front
- Back
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What is necrosis?
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Non-Programmed cell death
Nucleus destroyed first |
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What is apoptosis?
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Programmed cell death
No inflammation |
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What is pyknosis?
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Nucleus turns into blobs
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What is karryohexis?
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Nucleus fragments
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What is Karyolysis?
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Nucleus dissolves
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What is a somatotrope?
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GH
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What is a gonadotrope?
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LH, FSH
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What is a thyrotrope?
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TSH
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What is a corticotrope?
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ACTH
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What is a lactotrope?
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PRL
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What receptors do protein hormones use?
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Cell membrane receptors
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What receptors do steroid hormones use?
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Nuclear membrane receptors
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What are the steroid hormones?
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"PET CAD"
Progesterone Estrogen Testosterone Cortisol Aldosterone Vitamin D *TSH (Acts like a steroid) |
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What does endocrine mean?
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Secreted into blood
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What does exocrine mean?
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Secreted into non blood
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What is autocrine?
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Works on itself
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What is paracrine?
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Works on its neighbor
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What is merocrine?
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Cell is maintained (exocytosis)
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What is apocrine?
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Apex of cell is secreted
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What is holocrine?
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Whole cell is secreted
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What organs do not require insulin?
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BRICKLE
Brain RBC Instestine Cornea/Cardia Kidney Liver Exercising Muscle |
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What does GnRH do?
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Stimulates LH, FSH
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What doe GRH do?
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Stimulates GH
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What does CRH do?
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Stimulates ACTH
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What does TRH do?
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Stimulates TSH
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What does PRH do?
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Stimulates PRL
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What does DA do?
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Inhibits PRL
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What does Somatostatin do?
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Inhibits GH
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What does ADH do?
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Conserves water, vasoconstricts
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What does oxytocin do?
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Milk letodwn
baby letdown |
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What does GH do?
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IGF-1 Release from liver
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What does TSH do?
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T3, T4 release from thyroid
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What does LH do?
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Testosterone release from testes. Estrogen and Progesterone release from ovary
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What does FSH do?
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Sperm or egg growth
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What does PRL do?
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Milk production
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What does ACTH do?
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Cortisol release from adrenal gland
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What does MSH do?
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Skin pigmentation
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What are the stress hormones and time frames?
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Epi: Immediate
Glucagon: 20 minutes Insulin: 30 minutes ADH: 30 Minutes Cortisol: 2-4 hrs GH: 24 hours |
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What does ADH do?
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Concentrates Urine
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What is Diabetes Insipidus?
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Too little ADH (urinate a lot)
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What is central DI?
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Brain not making ADH
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What is nephrogenic DI?
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Block of ADH V2 Aquaporin receptor
Can be caused by lithium, demeclocycline |
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What is central DI?
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Brain not making ADH
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What does the water deprivation test tell you?
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Water deprivation --> DI fails to concentrate urine
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What does giving DDAVP tell you?
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DDAVP central DI concentrates urine
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What is SIADH?
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Too much ADH---> expanded plasma volume
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What is the difference between DI and SIADH?
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DI has dilute urine
SIADH has concentrated urine |
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What is psychogenic polydypsia?
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Pathologic water drinking ---> low plasma osmolarity
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What does aldosterone do?
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Reabsorbs Na and 3 waters
Secretes H+ via H/K pump |
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What is a neuroblastoma?
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Adrenal tumor in kids
Dancing eyes/feet Secretes catecholamines |
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What is a pheochromocytoma?
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Adrenal medulla tumor in adults
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What does Z. Glomerulosa make?
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Aldosterone "salt"
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What does zona fasciculata make?
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Cortisol "sugar"
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What does Zona reticularis make?
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androgens "sex"
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What is Conn's syndrome?
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High Aldosterone (tumor--primary)
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What does ANP do?
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Inhibits aldosterone
Dilates renal artery (affterent arteroiole) |
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What does calcitonin do?
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Inhibits osteoclasts --->low serum Ca2+
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What is MEN 1
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Wermer's 3 P's
Pancrease Pituitary Parathyroid |
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What is MEN II a
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Sipple's
Pheochromocytoma Medullary carcinoma of the Thyroid +/- Parathyroid |
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What is MEN II b
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Pheochromocytoma
Medullary carcinoma of the thyroid Oral/GI Neuromas |
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What does CCK do?
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Gallbladder contraction
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What does cortisol do?
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Gluconeogenesis by proteolysis --->thin skin
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What is Addison's disease?
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Autoimmune destruction of adrenal cortex
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What is Waterhouse Friderichsen?
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Adrenal hemorrhage
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What is Cushing's syndrome?
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High Cortisol
Pituitary tumor, adrenal tumor or small cell CA of the lung |
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What is Nelson's syndrome?
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Hyperpigmentation after adrenalectomy
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If low dose dexamethasone test supresses, what does taht tell you?
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Depressed, obese or normal variant
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If low dose Dexamethasone test does not supress, what does that tell you?
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Cushings. Do high dose test
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If high dose Dexamethasone test supresses, what does that tell you?
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pituitary tumor -->ACTH
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If high dose Dexamethasone test does not supress, what does that tell you?
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Test ACTH
Low ACTH: Adrenal Adenoma -->cortisol High ACTH: Small cell CA of the lung --->ACTH |
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What are the survival hormones?
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Cortisol: Permissive under stress
TSH: Permissive under normal |
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What does epinephrine do?
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Gluconeogenesis/
Glycogenolysis |
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What does Erythropoietin do?
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Makesw RBCs
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What does gastrin do?
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Stimulates parietal cells to produce IF and H+
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What does GH do?
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Growth: sends somatomedian to growth plates
Gluconeogenesis by proteolysis |
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What is achondroplasia (laron dwarf)?
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Abnormal FGF receptors in extremities
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What is a midget?
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Decreased somatomedian receptor sensitivity
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What is acromegaly?
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Adult bones stretch
Coarse facial features Large, furrowed tongue Deep, husky voice Jaw protrusion Increased IGF-1 d/t GH tumor |
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What is gigantism?
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Childhood acromegaly
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What does GIP do?
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Increase insulin action leading to post prandial hypoglycemia
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What does glucagon do?
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Gluconeogenesis
Glycogenolysis Lipolysis Ketogenesis |
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What does insulin do?
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Pushes glucose into cells and K+ follows
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What is Type I DM?
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Anti-islet cell Ab
Coxsackie B Low insulin DKA Polyuria Polydypsia |
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What is Type II DM?
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Insulin receptor insensitivity
High Insulin HONK coma Acanthosis nigricans |
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How does DKA present?
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Kussmaul respirations
Fruity breath (acetone) Altered mental status |
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What is the Dawn phenomenon?
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AM Hyperclycemia secondary to growth hormone
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What is the Somogyi Effect?
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AM hyperglycemia secondary to every gypoglycemia?
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What is factitious hypglycemia?
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Injected insulin (Increased insulin, decreased C Peptide)
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What is an insulinoma?
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Insulin secreting tumor (increased insulin and increased C peptide)
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What is metabolic syndrome X?
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"Pre DM"
HTN Dyslipidemia Hyperinsulinemia Acanthosis Nigricans |
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What are foot ulcer risk factors?
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DM/Glycemic Control
Male Smoking Bony abnormalities Previous ulcers |
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What conditions cause weight gain?
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Obesity
Hypothyroidism Depressions Cushing's Anasarca |
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What does motilin do?
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Stimulates Segmentation (primary peristalsis, MMC)
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What does PTH do?
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Stimulates osteoblast to turn on osteoclast
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What does vitamin D do?
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Helps in Ca2+ reabsorption from the GI tract
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What do parathyroid chief cells secrete?
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PTH
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What do stomach chief cells secrete?
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Pepsin
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What is the difference between norepinephrine and epinephrine?
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NE= neurotransmitter
Epi=Hormone |
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What is primary hyperparathyroidism?
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Parathyroid adenoma
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What is secondary hyperparathyroidism?
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Renal failure
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What is familial hypocalciuria/hypercalcemia?
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Decreased Ca2+ excretion
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What if both serum Ca and PO4 decrease?
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Vitamin D Deficiency
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What if serum Ca and PO4 change in opposite directions?
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Hypoparathyroidism
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What is the MCC of primary hypoparathyroidism?
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Thyroidectomy
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What is pseudohypoparathyroidism?
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Bad kidney PTH receptor
Decreased urinary cAMP |
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What is pseudopseudohypoparathyroidism?
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G Protein defect, no calcium problem
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What is Hungry Bone Syndrome?
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Remove PTH -->Bone sucks in Ca
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What does secretin do?
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Secretion of bicarb
Inhibit gastrin Tighten pyloric sphincter |
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What does somatostatin do?
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Inhibits secretin, motilin, CCK
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What do T3 and T4 do?
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Growth, differentiation
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What disease has exopthalmous?
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Grave's
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What disease has enopthalmous?
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Horner's
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Grave's Disease
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Expothalmos
Pretibial Myxedema TSH receptor Antibody |
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Dequervain Disease
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Viral (self limiting) hyperthyroidsm
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Silent thyroiditis
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Post partum hypothyroidism
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Plummer's
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Bening adenomona 50 yo hyperthyroidism
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Jod-Basedow
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Transient hyperthyroidism due to increased iodine
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Hashimoto's Thyroiditis
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Antimicrosomal Ab = TPO Ab
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Reidel's struma
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Woody
Hypothyroidism |
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Cretinism
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Hypothyroid mom and baby
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Euthyroid sick syndrome
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Low T3 syndrome
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Wolff-Chaikoff
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Transient Hypothyroidism
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What is Plummer's syndrome?
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Hyperthyroid adenoma
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What is Plummer-Vinson syndrome?
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Esophageal webs
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What does testosterone do?
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Makes external male genetilia
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What does Mullerian inhibiting factor do?
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Makes internal male genetilia
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What do TPO and Thymosin do?
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Help T cells mature
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What does VIP do?
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Inhibits secretin, motilin, CCK
Opens sphincters |
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How does a VIPoma present?
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Watery diarrhea
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How does a somatostatinoma present?
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Constipation
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What are the hormones with disulfide bonds
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PRL
Insulin GH Inhibin |
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Which hormones have the same alpha subunits?
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LH, FSH, TSH
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Which hormones are produced by acidophils?
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GH
PRL |
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What hormones are produced by basophils?
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FSH
LH ACTH TSH |
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What hormones are released from the posterior pituitary?
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ADH (supraoptic nucleus)
Oxytocin (paraventricular nucleus) |
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Elevated cholesterol
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Xanthomas on extensor surfaces
Increased risk for CAD |
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Elevated triglycerides
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Xanthelasmas on eyelids and face
Increased risk of pancreatitis |
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Chylomicrons
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Takes triglycerides from GI to liver and endothelium
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VLDL
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Takes triglycerides from liver to adipose
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IDL
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Takes triglycerides from adipose to tissue
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LDL
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only one to carry cholesterol
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VLDL is made?
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only one made in liver
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IDL+ LDL
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Breakdown products of VLDL
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Tx for Hypercholesterolemia
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Statins PASL
Pravastatin (only one renally excreted) Atorvastatin Lovastatin Simvistatin Liver enzyme check every 3 months |
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MOA of statins
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Inhibit HMG-CoA Reductase
Most active around 8 PM. Must take at night for max efficiency |
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Acute recurrent Hepatitis Infection
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HBcAg+, HBsAg+ (HBcAb+/-)
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Recent Hepatitis Immunization within 2 wks
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HBsAg+ only
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Hepatitis immunization greater than 2 wks ago
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HBsAb+ only
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Previous hepatitis infection, now immune
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HBcAb+, HBsAb+, HBsAg-
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Marker of Hepatitis Infectivity
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HBeAb+
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Patient is non infectious re: hepatitis
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HBeAg-
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Patient is a chronic carrier of Hepatitis
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HBsAg+ for more than 6 months
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Labs in the window period of Hepatitis
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HBeAb+, HBcAb+, HBsAg-
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Type I hyperlipidemia
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Defect of the liver type of lipoprotein lipase. Chylomicrons increased.
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Type IIa Hyperlipidemia
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Clathrin Pit or B100 Deficiency. LDL increased
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Type IIb Hyperlipidemia
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LDL/VLDL receptor deficiency. LDL and VLDL increased. This is the most common in the general population
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Type III hyperlipidemia
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Apo E deficiency. IDL increased
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Type IV hyperlipidemia
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Defect of the adipose type of lipoprotein lipase. VLDL increased.
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Type V hyperlipidemia
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Enzyme and receptor defect of HDL CII. Chylomicrons and VLDL increased. Assoc w/ DM
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GI X-Ray Corkscrew
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Esophageal spasm
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GI X-Ray Apple Core
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Cancer
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GI X-Ray Stacked Coin
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Intussusception
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GI X Ray Abrupt cutoff
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Volvulus
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GI X Ray Bird's Beak
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Achalasia
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GI X Ray String sign
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Pyloric stenosis
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Causes of solid dysphgia
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Schatzki's rings
Stricture Cancer |
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Schatzki's rings
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Lower esophageal webs
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Causes of liquid dysphagia
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Scleroderma
Achalasia |
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Barrerr's Esophagus
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Metaplasia
Increased adenocarcinoma risk |
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Esophageal varices
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Due to portal hypertension
Vomit blood when they rupture |
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Mallory-Weiss
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Chronic vomiters
Tear at the LES mucosa |
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Boerhaave's esophagus
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"Trasmural" tear of the esophagus. All layers are involved.
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Achalasia (also Chagas)
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Increased LES pressure
Decreased peristalsis Loss of LES Auerbach's plexus Bird's beak on X-Ray |
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Hirschprung's
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Congenital lack of Auerbach's in the rectum. Newborn won't pass meconium
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Zenker's Diverticulum
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Above UES. Cough undigested food. Halitosis
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Traction Diverticulum
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Below the UES.
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Plummer-Vinson Syndrome
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Esophageal webs (UES)
Spoon nails Fe Def Anemia |
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TE Fistula (H-Type_)
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Choke w/ each feeding
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Esophageal atresia w/ TE Fistula (C Type)
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Vomi with first feeding
Huge gastric bubble |
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Duodenal Atresia
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Bilious vomiting with first feeding
Double bubble Down's syndrome |
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Pyloric Stenosis
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Non-bilious projectile vomiting (3-4 wks old) RUQ olive sign
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Choanal Atreis
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Turns blue w/ feeding (smurf on a nipple) (vs TOF which turns blue when crying)
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Beozar
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Antrum obstruction due to mass of undigestible material
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Type A Gastritis
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Autoimmune
Anti-Parietal cell antibodies Atrophic/Achlorhydria Adenocarcinoma (Increased Risk) |
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Type B Gastritis
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H. Pylori
Spicy Foods |
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Dudoenal Ulcer
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Loss of barrier
Pain after meal and during the night Relieved by eating (weight gain) Assoc w/ H Pylori, Type O blood |
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Gastric Ulcer
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Loss of barrier
Pain during meals Assoc w/ NSAIDS, Type A blood |
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Sliding Hiatal Hernia
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Fundus slides through esophageal hiatus into thorax
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Rolling Hiatal Hernia
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Bowel protrudes through a defect in hte diaphragm. Strangulates bowel.
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Menetrier's disease
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Loose protein through the rugal folds (generalized edema). Thick rugal folds
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Diarrhea
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>200g/day
Osmotic: Watery Secretory: Laxative use Inflammatory: Blood/pus |
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celiac Sprue
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Jejunum
Wheat allergy Villous atrophy Anti Gluten/Gliadan antibodies |
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Tropical Sprue
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Distal Ileum
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Mesenteric Ischemia
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Pain out of proportion to exam
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Bugs that cause bloody diarrhea
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CASES
Campylobacter Amoeba (E. Histolytica) Shigella E. Coli Salmonella |
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Cholangitis
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Inflammation of the bile duct
Charcot's triad: Jaundice, Fever (usually w/ rigors), RUQ pain Reynold's Pentad: Triad above + Hypotension and change in mental status |
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Ascending Cholangitis
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common bild duct infection due to stone
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Primary Sclerosing Cholangitis
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p-ANCA
Bile Duct Inflammation Beading Assoc W/ Ulcerative Colitis |
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Cholestasis
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Obstruction of Bile Duct
Pruritis Increased Alk Phos Jaundice |
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Cholelithiasis
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Formation of Gallstones
RUQ colic |
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Choledocholithiasis
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Gallstone obstructs bile duct
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MC Gallstone
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Cholesterol (invisible on X Ray)
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Gallstone seen on XR
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Calcium bilirubinate
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Conjugated bilirubin
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Water soluble
Direct |
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Unconjugated bilirubin
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Fat soluble
Indirect |
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Signs of alcoholic cirrhosis
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Spider angioma
Palmar erythema Gynecomastia |
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Hepatorenal syndrome
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build up of liver toxins causes renal failure
|
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Xanthoma
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Cholesterol buildup (elbow, achilleus)
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High cholesterol leads to
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Atherosclerosis
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Xanthelasma
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Triglyceride buildup under the eye
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High triglycerides causes
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Pancreatitis
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Criglar Najjar Type I
|
Unconjugated bilirubin build up in infants
|
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Gilbert's syndrome
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Stress leads to increase in unconjugated bilirubin
Increased load saturates glucouronyl transferase |
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Rotor's syndrome
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Bab bilirubin storage leads to increased conjugated bilirubin
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Dubin Johnson
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Bad bilirubin excretion leads to black liver and increased conjugated bilirubin
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|
|
Hemorrhagic pancreatitis
|
Cullen's sign: Bleeding around the umbilicus
Turner's sign: Bleeding into flank |
|
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Tests for following pancreatitis
|
Amylase (sensative) breaks down carbohydrates
Lipase (specific) breaks down triglycerides |
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Ranson's criteria
|
Prognosis for pancreatitis
|
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Ranson's criteria at presentation:
|
WBC>16
Age >55 Glucose > 200 (islet cells affected) LDH>350 AST>250 |
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Ranson's Criterial at 48 hours
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BUN Increase> 5mg
Ca<8mg HCT drops >10% Sequester >6L fluid pO2<60 |
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Carcinoid syndrome
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Flushing, Wheezing, Diarrhea
|
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Currant Jelly Sputum
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Klebsiella
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Currant Jelly Stool
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Intussusception
|
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Familial Polyposis
|
100% risk of colon cancer
APC defect Begin annual colonoscopy at 5 yo |
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Gardener's syndrome
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Familial polyposis with bone tumors
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Turbot's syndrome
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Familial polyposis with brain tumors
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Puetz-Jegher syndrome
|
Hyperpigmented mucosa
|
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Crohn's disease
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IBD w/ cobblestones, melena, creeping fat, fistulas
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Ulcerative Colitis
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IBD w/ pseudopolyps, hematochezia, lead pipe colon, toxic megacolon
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Intussusception
|
Currant jelly stool, stacked coin enema
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How does diverticulosis present?
|
Bleeds
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How does diverticulitis present?
|
LLQ Pain
|
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How does spastic colon present?
|
Intermittent Severe Cramps
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How does IBS present?
|
Alternating diarrhea/constipation with a history of stress
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How do external hemmorhoids present?
|
Pain on defecation
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How do internal hemmorhoids present?
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No pain
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What is pseudomembranous colitis?
|
Overgrowth of C. Diff d/t normal flora being killed off (usually because of Clindamycin use)
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What is Whipple's disease?
|
T. whippelii destroy GI tract, then spread causing malabsorption, arthralgia
|
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What color is an upper GI bleed?
|
Black
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weight gain
0-6m 6-12m doubles, triples, x4? length 0-6m 6-12m 1 y head circum 0-6 6-12 |
Wt- regains birth wt by 2wks
0-6mos: 5-7 oz/wk, 2lbs/mo 6-12mos; 3-4oz/wk, 1lb/mo 5-6mos: doubles birth wt 1 year: triples birth wt 2 1/2 yrs: quadruples birth wt Length: 0-6mos: 1in/mo 6-12mos: 1/2in/mo (add 6in) 1 year: 1 1/2 times birth length Head circ: 0-6mos: 1/2 in/mo 6-12 mos: 1/4in/mo |
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What adds color to stool?
|
Stercobilinogen being oxidized to stercobilin
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What gives urine its yellow color?
|
Urobilinogen being oxidized to urobilin
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|
|
What is the default color of stool?
|
Clay colored
|
|
|
Dx Major Depression
|
5+ of the following >2/52
Sleep disturbances (early wakign) Guilt Energy loss Concentration loss Appetite loss Psychomotor agitation Suicidal ideation |
|
|
Autism
|
Repetitive movements
Lack of verbal skills Lack of bonding |
|
|
Asperger's
|
Impaired relationships
Good communication No mental retardation |
|
|
Rett's
|
Girls only
Normal until 5 mo Decreased head growth Lose motor skills Hand wringing |
|
|
Childhood disintegrative disorder
|
Stops walking and talking
|
|
|
Selective mutism
|
Talks sometimes
|
|
|
Separation anxiety
|
Screams when mom leaves
|
|
|
ADHD
|
Overactivity, difficulty in school
|
|
|
Dysthymia
|
Low level sadness >2 yrs
|
|
|
Cyclothymia
|
Dysthymia w/ hypomania
|
|
|
Double depression
|
depression w/ dysthymia
|
|
|
Bipolar I
|
Depression and mania
|
|
|
Bipolar II
|
Depression and hypomania
|
|
|
Loose associations
|
Incoherent ideas, switches topics
|
|
|
Word Salad
|
Unrelated word combinations
|
|
|
Perseveration
|
repeates same words
|
|
|
Neologisms
|
makes new words
|
|
|
Delusion
|
False belief
|
|
|
Illusion
|
Misinterpreted stimulus
|
|
|
Hallucination
|
Falso sensory perception. Formication in EtOH withdrawl or cocaine intoxication
|
|
|
Nihilism
|
Thinks the world has stopped
|
|
|
Loss of Ego boundaries
|
No concpet of where I end and you begin
|
|
|
Cataplexy
|
Loss of muscle tone due to emotional stress
|
|
|
Paranoid personality disorder
|
Suspicious about everything, uses projection
|
|
|
Schizotypal personality disorder
|
Odd behavior, magical thinking; people leave them alone b/v they're weird but they will interact if approached
|
|
|
Schizoid personality disorder
|
Recluse, don't want interaction with others
|
|
|
Antisocial personality disorder
|
Lie, cheat, steal, act on impulses
|
|
|
Conduct Disorder
|
Bite. <15yo w/ traits of antisocial personality disorder
|
|
|
Oppositional Defiant Disorder
|
Bark. Defiant, noncompliant, resists authority
|
|
|
Histrionic personality disorder
|
Theatrical, sexually provocative, uses repression as a defense mechanism
|
|
|
Borderline personality disorder
|
"perpetual teenager" uses projection, acts out, self-mutilation, uses splitting as defense mechanism
|
|
|
Narcissistic Personality Disorder
|
Pompous, no empathy
|
|
|
Dependent personality disorder
|
Clingy, submissive, low self-esteem, uses regression
|
|
|
Obsessive-Compulsive Disorder
|
Perfectionist, doesn't show feelings, uses isolation
|
|
|
Avoidant personality disorder
|
Socially withdrawn, wants to fit in but fears rejection
|
|
|
Kleptomania
|
Steals for the fun of it
|
|
|
Pyromania
|
Starts fires
|
|
|
Intermittent explosive disorder
|
loses self control disproportionately to circumstances
|
|
|
Trichotillomania
|
Pulls out their own hair and eats it
|
|
|
Lewy Body Dementia
|
Stiff, visual hallucinations
|
|
|
Normal pressure hydrocephalus
|
Ataxia (magnetic gait)
Incontenence Dementia |
|
|
Korsakoff Psychosis
|
Alcoholic B1 deficiency
|
|
|
Vascular dementia
|
Multi-infarct
Sudden onset uneven progression "Stair step" decline |
|
|
Huntington's Chorea
|
Trinucleotide repeate disorder
Chromosome 4 CAG Personality change Choreiform movement |
|
|
Creutzfeld-Jacob
|
Prion induced
Die within 1 year Corneal transplant |
|
|
Pick's disease
|
Frontal lobe atrophy
Disinhibition |
|
|
Alzheimer's
|
Decreased Ach in nucleus basilis of Meynert
Bad Apo E Amyloid plaques Tau protein |
|
|
Parkinson's
|
Substantia nigra
Lewy bodies Bradykinesia Pill rolling tremor |
|
|
Somatization
|
Psychological trigger gets them sick
Pain in 4 places, 2 GI problems |
|
|
Hypochondirasis
|
Find in themselves the symptoms of other sick people, seek medical attention
|
|
|
Body dismorphic disorder
|
Imagined physical defect
|
|
|
Pain disorder
|
Prolonged pain not explained by physical findings
|
|
|
Conversion disorder
|
blindness, mutism triggered by a stressor
|
|
|
Malingering
|
Fakes illness for monetary gain or getting out of jail. Avoids actual treatment.
|
|
|
Factitious disorder
|
Fakes illness for attention
Seeks treatment |
|
|
Factitious disorder by proxy
|
Fakes illness of a child to get attention
|
|
|
Multiple personality disorder association
|
Incest
|
|
|
Sublimation
|
substitute acceptable for unacceptable behavior (pt likes to fight so becomes a boxer)
|
|
|
Identification
|
Defense mechanism, acts like someone else
|
|
|
Displacement
|
Takes anger out on someone else
|
|
|
Idealization
|
Sees only good in someone despite evidence to the contrary
|
|
|
Transferance
|
Patient views Dr as parent
|
|
|
Countertransferrance
|
Dr views pt as child
|
|
|
Acting out
|
Expression of impulse (tantrums)
|
|
|
Regression
|
Immature behavior (go back in development)
|
|
|
Rationalization
|
Makes excuses for behavior in advance
|
|
|
Justificaiton
|
Makes excuses for behavior afterwards
|
|
|
Intellectualization
|
Acts like a know it all in order to aboid feeling situational emotions
|
|
|
Isolation
|
Isolate feelings in order to keep on functioning
|
|
|
Supression
|
Consciously blocks memory
|
|
|
Reaction formation
|
Unconsciously act opposite to how you feel (tears on a clown)
|
|
|
Undoing
|
Doing exactly opposite of what you used to do in order to try to right a wrong
|
|
|
Compensation
|
Doing something different from what you used to do in order to fix a wrong
|
|
|
Alzheimer's Drugs
|
AchInh---> Donezepil
NMDA Receptor BLocker: Memantine |
|
|
Parkinsons Neurotransmitters
|
Decreased Dopamine and Decreased Ach
|
|
|
Parkinsons Drugs (list)
|
Levodopa
Carbidopa Bromocriptine Amantadine Selegeline Benztropine |
|
|
Levodopa MOA
|
Pro drug---> Dopamine in the brain
|
|
|
Carbidopa MOA
|
Inhibits decarboxylation of levodopa in periphery
|
|
|
Bromocriptine MOA
|
Dopamine Agonist
|
|
|
Selegiline MOA
|
Selective MAO-B Inhibitor
|
|
|
Benztropine MOA
|
Antichoinergic
|
|
|
Typical Antipsychotics
|
Antagonists at D2
Haloperidol: NMS Thioridazine: Retinitis pigmentosa |
|
|
Atypical Antipsychotics
|
Antagonize D2 and Increase Ser
Risperidone Olanzepine: Obesity and agranylocytosis Clozapine: Agranulocytosis |
|
|
Tricyclic Antidepressents
|
1) NE + Ser Reuptake Inh
2) Alpha Blocker 3) Antimuscarinic Amitryptaline, Imipramie (used for bedwetting) |
|
|
SSRI
|
Selective Serotonin Reuptake Inhibitors
Fluoxetine, Citalopram |
|
|
MAO-I
|
Tyramine oxidase inhibitors
Penelzine,, Tranycypromie |
|
|
Heterocyclics (list)
|
Trazodone
Venlafaxine Mirtazepine Buproprion |
|
|
Trazodone
|
Ser Reuptake Inhibitor
Heterocyclic Priapism |
|
|
Venlafaxine
|
Ser, NE, Dopamine reuptake inh
Heterocyclic |
|
|
Mertazepine
|
Heterocyclic
Alpha 2 blocker |
|
|
Buproprion
|
Heterocyclic
Ser, NE, Nicotinic reuptake inh |
|
|
Ethosuxamide
|
Absence Seizures in children
T-Channel Deprendent Calcium Blocker |
|
|
Na Channel Blockers (anticonvulsants)
|
Valproic Acid
Carbemazepine (Hepatotoxic, Aplastic Anemia) Phenytoin (Gingical Hyperplasia, lymphadenopathy) Topiramate (also a GABA enchancer) |
|
|
GABA Agonists
|
Gabapentin
PerGAGAlin |
|
|
GABA Enhancers
|
Topiramate (also NA Channel BLocker)
Tiagabine |
|
|
Benzo MOA
|
Increase the frequency of Chloride Channel Opening leading to GABA potentiation
|
|
|
Short acting Benzo
|
Alprazolam
|
|
|
Medium Acting Benzo
|
Lorazepam
|
|
|
Long Acting Benzo
|
Diazepam, Chlordiepoxide
|
|
|
Barbiturates MOA
|
Increased DURATION of CL channel opening
|
|
|
6 Low complement associated Nephritic Syndromes
|
Serum Sickness
SLE SBE PSGN MPGNII Cryoglobulinemia |
|
|
Hormones with disulfide bonds
|
"PIGI"
Prolactin Inhibin GH Insulin |
|
|
Psammoma bodies
|
Papillary CA of Thyroid
Serous cystadenoma of Ovary Meningioma Mesothelioma |
|
|
Jones criteria for ARF
|
"J<3NES"
Joints (polyarthritis) Carditis Nodules Subcutaneous Erythema MArginatum Sydenham Chorea |
|
|
IgA Nephropathies
|
Henoch-Schonlein Purpura (HSP)
Berber's Alports |
|
|
Renal Induced Acidosis
|
Plasma (RTA)
Ammonia production in the CD (10% Of Urea Cycle) Glutaminase Carbonic Anhydrase |
|
|
Hormones produced by small cell CA of Lung
|
ACTH (MC)
ADH PTH TSH ANP |
|
|
5 Causes of SIADH
|
"SIADH"
Small cell carcinoma Increased ICP A Pain Drugs Hypoxia |
|
|
Low volume state with ACIDOSIS
|
RTA
Diarrha |
|
|
Types of Kidney stones
|
Ca Oxalate (80%)
Struvite Uric Acid Cysteine |
|
|
Pseudogout
|
Ca Pyrophosphate
+ Birefrengent Crystals Rhomboid Crystals MC older pts Seen equally in both genders |
|
|
Bladder Cancer Risk Factors
|
Smoking
Aniline Dyes Benzene Aflatoxin Cyclophosphamide Schistosoma haematobium Von Hippel Lindau Tubular Sclerosis |
|
|
Causes of Papillary Necrosis
|
Vasculitides
AIDS |
|
|
3 Anatomic Narrowings of the Ureter
|
Hilum
Pelvic Brim Entrance of Bladder |
|
|
Nephritic Syndrome
|
Hypertension
Hematuria RBC Casts Protein Loss <3.5 g |
|
|
Nephrotic Syn
|
Edema
Hyperlipidemia (VLDL) Hypercoaguable (2,7,9,10 C and S) Decreased serum albumin Increased urine albumin Protein loss greater than 3.5g |
|
|
MCC of UTI
|
1) E. Coli
2) Proteus 3) Klebsiella |
|
|
Most frequent UTI in F 5-10 and 18-24
|
S. Saprophyticus because they stick things inside themselves
|
|
|
Pre-Renal Failure
|
Serum BUN:Creatinine > 20:1
Urine Na+ Low Fractional Na exc <1% Concentrated Urine |
|
|
Intrarenal Failure
|
Serum BUN 10-15
Urine Na+ High Fraction Na excretion >2% Dilute urine (low specific gravity) |
|
|
Renal artery stenosis
|
Clot in front of renal artery
|
|
|
GN
|
Inflammed glomeruli
|
|
|
Interstitial Nephritis
|
Clot off medulla
|
|
|
Focal Segmental GN
|
Clot off pieces of nephron
|
|
|
RPGN
|
Crescent Formations
|
|
|
MC Nephritic Disease in adults
|
Membranous GN
|
|
|
MC renal disease in blacks and hispanics
|
FSGN
|
|
|
MC renal disease in HIV/IV Drug Users
|
FSGN
|
|
|
MC Renal mass
|
Cyst
|
|
|
MC malignant renal tumor in adults
|
adenocarcinoma
|
|
|
MC malignant renal tumor in kids
|
Wilms Tumor
|
|
|
MCC of RPGN
|
Goodpasture's
|
|
|
MC Nephritic disease in kids
|
Minimal change disease
|
|
|
Oxalate stone in 3yo white F
|
Cystic Fibrosis
|
|
|
Oxalate stone in 5 yo black F
|
Celiac Sprue
|
|
|
Oxalate stone in Adult F
|
Whipple's Disease
|
|
|
Oxalate stone in adult M or F
|
Chron's disease
|
|
|
Type I RTA
|
High Urine pH
Metabolic Acidosis Frequent UTI Stones |
|
|
Type II RTA
|
High Urine pH early....low pH late d/t depeletion of HCO3-
Hypokalemia No carbonic anhydrase in PCT |
|
|
Type IV RTA
|
Diabetics
Hyperkalemia No Aldosterone (infarcted JG apparatus) |
|
|
Which part of the nephron concentrates urine?
|
Medulla
|
|
|
What is Glodblatt's Kidney?
|
Flea-bitten kidney (contralateral side)
|
|
|
What is uremia?
|
Azotemia + Symptoms
|
|
|
What is azotemia?
|
Renal failure
|
|
|
What is nephritic kidney disease?
|
Protein loss <3.5
|
|
|
What is nephrotic kidney disease?
|
Protein loss >3.5
Massive proteinuria and lipiduria |
|
|
What is seen in RPGN?
|
Crescents
|
|
|
What is post strep GN?
|
Subepithelial humps
|
|
|
What is interstitial nephritis?
|
Urine eosinophils (drugs), toxins
|
|
|
What is lupus nephritis?
|
Glomerular destruction
Autoimmune complexes ds-DNA |
|
|
What is MGN (Membranoglomerulonephritis)
|
Deopsition
|
|
|
What is MPGN?
|
Tram tracks (type II)
Low C3 |
|
|
What is minimal change disease?
|
Kids (up to age 20)
Fused foot processes Loss of charge barrier |
|
|
What is FSGS? (focal segmental glomerulosclerosis)
|
HIV Patients
|
|
|
What are the vasculitides with low C3?
|
PMS is Salt Lake City
Post Strep GN MPGN Type II SBE Serum Sickness Lupus Cryoglobulinemia |
|
|
What is the MCC of kidney stones?
|
Dehydration
|
|
|
What is the most common type of kidney stone?
|
Calcium pyrophosphate (oxylate)
|
|
|
What type of kidney stones have coffin lid crystals?
|
Triple phosphate
|
|
|
What type of kidney stones have rosette crystals?
|
Uric acid
|
|
|
What type of kidney stones have hexagonal crystals?
|
Cysteine
|
|
|
What type of kidney stones have envelope or dumbbell shaped crystals?
|
Oxalate
|
|
|
What disease has aniridia?
|
Wilm's Tumor
|
|
|
What is phimosis
|
Foreskin scarred at penis head
|
|
|
What is paraphimosis?
|
Foreskin scarred at penis base
|
|
|
What is urge incontinence?
|
Detruso spasticity leads to small bladder volume
|
|
|
What is stress incontinence?
|
Weak pelvic floor muscles (estrogen effect). Urogenital diaphragm.
|
|
|
What is overflow incontinence?
|
Cannot completely empty bladder
|
|
|
What structure in the GU system have one way valves?
|
Urethra
Ejaculatory duct |
|
|
What has WBC casts?
|
Nephritis
|
|
|
What has WBC casts ONLY?
|
Pyelonephritis (sepsis)
|
|
|
What has WBC casts + eosinophils?
|
Interstitial nephritis (allergies)
|
|
|
What has WBC casts plus RBC casts?
|
Glomerulonephritis
|
|
|
What has fat casts?
|
Nephrotic syndrome
|
|
|
What has waxy casts?
|
Chronic renal failure
|
|
|
What has tubular casts?
|
ATN (acute tubular necrosis)
|
|
|
What has muddy brown casts?
|
ATN (acute tubular necrosis)
|
|
|
What has hyaline casts?
|
Normal sloughing
|
|
|
What has epithelial casts?
|
Normal sloughing
|
|
|
What has crescents?
|
RPGN
|
|
|
How do you measure afferent renal function?
|
Creatinine (or inulin)
|
|
|
How do you measure efferent renal function?
|
BUN or PAH
|
|
|
What is pre-renal failure?
|
Low blood flow to kidneys (BUN:CR> 20:1)
|
|
|
What is intrarenal failure?
|
Damaged glomerulus BUN:CR<20:1
|
|
|
What is post renal failure?
|
Obstruction
|
|
|
What is the job of the proximal tubule?
|
Reabsorb 60-80% of everything filtered
|
|
|
What is the job of the thick descending limb?
|
Reabsorbs water
|
|
|
What is the job of the thick ascending limb?
|
Make the concentration gradient by reabsorbing Na, K, Cl, Mg, Ca without water
|
|
|
What is the job of the early distal tubule?
|
Concentrate urine by reabsorbing NaCl
|
|
|
What is the job of the late distal tubule and collecting duct?
|
Final concentration of urine by reabsorbing water. Excretion of uric acid and make new HCO3-
|
|
|
What does the macula densa do?
|
Measures osmolarity (Na+)
|
|
|
What does the J-G aparatus do?
|
Measures volume
|
|
|
What is Fanconi's syndrome?
|
Old tetracycline use- destroys PCT
Urine phosphates, glucose, amino acids |
|
|
What is Bartter's syndrome?
|
Defective triple transporter. Decreased Na, Cl, K but normal BP
|
|
|
What is psychogenic polydypsia?
|
Dilute urine due to excess water intake
|
|
|
What is central pontine myelenosis?
|
Due to correcting na_ faster than 0.5mEq/hr
|
|
|
Causes of widened S2
|
Increased pO2
Increased volume in R vent Blood transfusion Supplemental O2 Pregnancy IV fluids ASD (fixed split) Deep breating |
|
|
AVMs
|
Machinery murmur
Heart: PDA Elbow: Dialysis Fistula Brain: Von Hippel Lindau Lungs: Oslet-Weber-Rendu |
|
|
Heart block clue
|
Pain with normal heart rate
HR should increase by 10 bpm for every 1 degree increase in temperature |
|
|
Maximum sinus rate
|
220-age in years
|
|
|
P wave Ions
|
Ca++
|
|
|
QRS complex ions
|
Na+
|
|
|
ST interval ion
|
Ca++
|
|
|
T wave ion
|
K+
|
|
|
U wave ion
|
Na+
|
|
|
MC non cyanotic congenital heart disease
|
VSD
ASD PDA Coarctation of Aorta |
|
|
Pansystolic murmur
|
Mitral regurg
Tricuspid regurg VSD |
|
|
MI- Enzymes
|
Troponin I- Appears 2 hrs, Peaks 2 days, gone 7 days
CKMB: Appears 6 hrs, peaks 12 hours, gone 2 days LDH: Appears 1 day, peaks 2 days, gone 3 days |
|
|
P Wave
|
Atrium
Phase 0 |
|
|
PR Interval
|
AV node
Phase 2 |
|
|
Q wave
|
Septum
Phase 2 |
|
|
R upstroke
|
Anterior wall
Phase 2 |
|
|
S downstroke
|
Posterior wall
Phase 2 |
|
|
ST interval
|
Ventricle
Phase 2 |
|
|
T wave
|
Ventrucle
Phase 3 |
|
|
U Wave
|
Ventricle
Phase 4 |
|
|
What organs have resistence in series?
|
Liver, Kidney
|
|
|
What organ has the highest AV-O2 difference at rest?
|
Heart
|
|
|
What organ has the highest AV-O2 different after exercise?
|
Muscle
|
|
|
What organ has the highest AVO2 difference after a meal?
|
Gut
|
|
|
What organ has the highest AVO2 different during an exam?
|
Brain
|
|
|
What organ has the lowest AVO2 difference?
|
Kidney
|
|
|
Where does a type A thoracic dissection occur?
|
Ascending aorta
(cystic medial necrosis, syphillis) |
|
|
Where does type B thoracic aortic dissection occur?
|
Descending aorta
(Trauma, atherosclerosis) |
|
|
What layers does a true aortic aneurysm involve?
|
Intima and media
|
|
|
What layers does a pseudo aortic aneurysm involved?
|
Intima and media
|
|
|
What vessel has the thickest layer of smooth muscle?
|
Aorta
|
|
|
What vessels have the most smooth muscle?
|
Arterioles
|
|
|
What vessels have the largest cross sectional area?
|
Capillaries
|
|
|
What vessel has the highest compliance?
|
Aorta
|
|
|
What vessel has the highest capacitance?
|
Veins and venules
|
|
|
What stain is used to see amyloidosis?
|
Congo Red (apple green birefrengence
|
|
|
What is hemochromatosis?
|
Fe Deposition in organs, hyperpigmentation, arthritis, DM
|
|
|
What is cardiac tamponade?
|
Pressure equalizes in all 4 chambers
Quiet precordium No pulse or BP Kussmahl's sign Pulsus paradoxus (Decrease in systolic pressure on inspiration) |
|
|
What is a transudate?
|
Effusion of mostly water
Too much water: Heart failure, renal failure Not enough protein: Cirrhosis, Nephrotic syndrome |
|
|
What is an exudate?
|
Effusion of mostly protein
Purulent: Bacteria Hemorrhagic: Truama, Cancer, PE Fibrinous: Collagen vascular disease, Uremia, TB Granulomatous: Non Bacterial |
|
|
What murmur has a watterhammer pulse?
|
AR
|
|
|
What murmur has pulsus tardus?
|
AS
|
|
|
What cardiomyopathy has pulsus alternans?
|
Dilated cardiomyopathy
|
|
|
What disease has pulsus bigeminus?
|
IHSS
|
|
|
What murmur has an irregularly irregular pulse?
|
A fib
|
|
|
What murmur radiates to the carotids?
|
AS, AR
|
|
|
What murmur radiates to the axilla?
|
MR
|
|
|
What murmur radiates to the back?
|
PS
|
|
|
What disease has a boot shaped X-Ray?
|
Right ventricular hypertrophy
|
|
|
What disease has a bananna shaped X-Ray?
|
IHSS
|
|
|
What disease has an egg shaped X-Ray?
|
Transposition of the great arteries
|
|
|
What disease has a snowman shaped X Ray?
|
Total anomolous pulmonary venous return
|
|
|
What disease has a 3 shaped xray?
|
Aortic coarctation
|
|
|
What is Osler-Weber-Rendu?
|
AVM in lung, gut, CNS. Sequesters platelets leading to telangiectasias
|
|
|
What is Von Hippel Lindau?
|
AVM in head, retina (Increased risk of renal cell CA)
|
|
|
When do valves make noise?
|
Closure
|
|
|
What valves make noise at the start of systole?
|
M & T (S1)
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What murmurs occur during systole?
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Holosystolic (pansystolic): MR, TR, VSD
Ejection: AS, PS, HCM |
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What are the diastolic murmurs?
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Blowing: AR, PR
Rumbling: MS, TS |
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What valves make noise at the start of diastole?
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A&P (S2)
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What murmurs are continuous?
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PDA, AVM
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What has a friction rub while breating?
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Pleuritis
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What has a friction rub while you hold your breat?
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Pericarditis
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What does a mid-systolic click tell you?
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MVP
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What does an ejection click tell you?
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AS, PS
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What does an opening snap tell you?
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MS, TS
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What does S2 splitting tell you?
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Normal on inspiration b/c pulmonic valve closes later
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What does wide S2 splitting tell you?
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Increased O2
Increased RV volume Delayed PV opening |
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What does fixed wide S2 splitting tell you?
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ASD
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What is Cor Pulmonale?
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Pulmonary HTN leading to RV failure
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What is Eisenmenger's?
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Pulmonary HTN leading to a reversal L-R to R-L shunt
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What is transposition of the great arteries?
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Aorticopulmonary septum did not spiral
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What is tetraolgy of Fallot?
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Overriding aorta
PS (prognostic) RV hypertrophy VSD (L to R shunt) |
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What is truncus arteriosus?
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Spiral membrane did not develop (neural crest origin)
One A/P trunk (mixed blood) |
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What is Epstein's anomaly?
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Tricuspid sits very low (large R atria)
Teratogenic effect of lithium |
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What is cinchonism?
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Hearing loss, tinnitus, thrombocytopenia
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