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842 Cards in this Set

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Physiologic effects of hemorrhage
drop in dlast~ ‘Aood pressure, activation of the RAA system from decreased renal blood flow and catecholamine stimulation, ~~cholamjne release from the high pressure baroreceptors (sinus tachycardia, increased cardiac contraction, increase in peripheral resistance, stimulation of the JG apparatus, venoconstriction), increased reabsorption of sodium from the kidneys, release of atrial natriuretic peptide, release of ADH.
Cause of Pneumococcus infection in HbSS
autosplenectomy or functional asplenia
Key elements in wound healing
granulation tissue, fibronectin
Aortic aneurysm
hoarseness from stretching of the left recurrent laryngeal nerve
left shifts ODC, protects newborns with sickle cell disease and severe ~-thaIasscmis, increased with hydroxyurea, resistant to alkali/acid denaturation
AIDS patient with *cute cholecystitis
Cryptosporidium and CMV are the most common causes (CMV was not listed on the last exam)
Traveler to Mexico who 1 week later develops a watery diarrhea with’ mucus and blood and colicky bowel movements
Cyanosis not relieved by oxygen in a patient coming home from * camping trip
mcthcmogiobincm1s~ (water h nitrites that oxidized iron to fenic condition); Sa02 not PaOz is decreased; methylenc blue treatment of choice; ascorbic icid has an ancillary role
County jail with outbreak of hepatitis
HAy most likely; if IVDA then HBV most likely
Picture of child with fetal alcohol syndrome
Familial polyposis
mother has, what percent chance for kids with the disease 50%, since it is an AD disease; those that have gene will get cancer~ screen with flexible sigmoidoscopy in those affected beginning age 10-12 every 1-2 years; genetic testing to confirm and to test first degree family members
high Hb due to increase in HbF
Most common cause of pneumonia in cystic fibrosis
P. aeruginosa
it fistula
polyhydramnios in mother, proximal esophagus ends blindly and distal esophagus arises from the trachea (air in the stomach) -
Raising the upper limit of normal of a test
increases specificity and predictive value of a positive test; decreases sensitivity and predictive value of a negative test result
Lung findings in RDS
atelectasis (massive intrapulmonary shunting due to lack of surfactant); hyaline membranes composed of protein
Prevalence (number of people with disease in the population studied) Incidence (number of new cases over a period of time) x Duration of the disease
Photomicrograph of sarcoid with non-caseating granuloma.s in a black man
Picture of adrenal cortex
what part is atrophied in a patient on corticosteroids
identify the x-ray with emphysema—increased A? diameter, depressed diaphragms
individual cell necrosis; normal involution of structures (atrophy, thymus), progrmnrned ccli death, loss of Mullerian structures in males and Woifflan structures in females, Councilman (acidophilic) bodies, psammoma bodies, mechanism of atrcsia in the bowel (no lumen)
PC? in AIDS patient treat with TMP/SMX; most common initial AIDS-defining lesion
Cause of death in 15-25 age bracket
MVA; Black male in this age bracket is homicide
Sjogren’s syndrome
dry mouth and eyes due to destruction of the minor salivary glands and lacrimal glands
Paraneoplastic syndromes
ectopic hormones, hypercalcemia (PTH-like peptide from primary squamous carcinoma of the lung renal adenocarcinoma), acanthosis nigricans (stomach cancer), Eaton-Lambert syndrome (myasthcnia-like; small cell carcinoma), polyrnyositis (lung cancer) lii.
Staphylococcus aureus food poisoning
1-6 hours after eating contaminated food with preformed toxin; self-limited
Meckels diverticufum
vitelline duct remnant; true diverticuluni; most common cause of iron deficiency in a newborn and young child (01 bleed)
Metalloeuzyme that aids tumor invasion of tissue
collagenase with Zn as a cofactor
117 serotype of E. coil hemolytic uremic syndrome; raw hamburger
Smoker with history of peptic ulcer disease—? advice
stop smoking
treat with primaquinc and develop acute intravascular hemolysis in G6PD deficiency
Normal karyotype in a child with Down Syndrome
probable translocation with chromosome 21 sitting on top of chromosome 14, or an acrocentric (Robertsothan) translocation of chromosome 21
Deficiency associated with terminal ifeal resection
B12 deficiency; duodenum (iron), jejunum (folate, most of the water reabsorption, most of the sodium reabsorption), ileum (812 reabsorption, bile salt/acid reabsorption)
Sepsis in a elderly man with benign prostatic hyperplasia
usually E coil and can produce endotoxic shock (warm shock due to activation of complement system and release of anaphylatoxins + release of nitric oxide from damaged endotbelial cells)
Vitamin K deficiency
causes bleeding; newborns lack bacterial colonization for K synthesis, hence the need to inject K at birth
DNA repair defects
Fanconi’s anemia (cross-linking agents)
Renal agenesis
Effect of barbiturates and other drugs that enhance the liver cytochrome system
it will decrease bane and increase activity of ALA synthase, the rate limiting enzyme in herne synthesis; dangerous in precipitating porphyric attacks
People in a room with a space heater have a headache
CO poisoning, treat with 100% oxygen
Genomic imprinting
did chromosome come from mother or father, e.g., chromosome 15 microdeletion syndromes— Prader Willi and Angehnan’s syndrome
X-ray with multiple lytic lesions in the hip in a patient with anemia and hypercalcemia
multiple myeloma
Normal changes in pregnancy
greater increase in plasmavolume than RBC mass leading to decreased Mb, increased GFR and CCr, decreased BUN, creatinine~ and uric acid; increased alkaline phosphatase; respiratory alkalosis from progesterone effect; increased T4 and cortisol from increased synthesis of their binding proteins (free hormone normal)
Girl playing soccer is on tetracycline—distribution of the rash
contact photodermatitis involving face, neck, forearms, and probably the legs (shorts); asked the same question in di; past in a baseball player (legs would not be involved)
Xeroderma pigmentosum
AR disease with absent DNA repair enzymes and increased incidence of UVB-related skin cancers
Mitochondrial DNA disorder
mother gives the disease to all of her children; affected males do not give the disease to their children, since the mitochondria are lost in the tail of the sperm after fertilization.
Main difference in adult male and female
iron studies all lower in females
CNS reaction in a stroke
giiosis due to proliferation of astrocytes; not collagen deposition
increased alkaline phosphatase (osteoblasts from bone growth) and phosphate, slight decrease in Mb
Dissecting aortic aneurysm
unequal pulses in the upper extremity-left radial absent
Analytes increased with hemolyzed blood sample
LDH, potassium
Picture of a diabetics lower leg with pigmented lesions
probably necrobiosis lipoidica diabeticorum
Lipid most affected by fasting
triglyceride component coming from chylomicrons; CM and }IDL not affected
Compare Wegener’s granulomatosis (necrotizing granulomatous vasculitis; c-ANCA antibodies) with Goodpasture’s syndrome (anti-basement membrane antibodies)
both involve the lungs and kidneys; WG involves upper airway, GP does not.
Enhance cytochrome system in the SER of the liver
alcohol, barbiturates; increase in serum GGT; decreased drug levels from increased metabolism
Gross of a mass in the kidney in an adult most likely a renal adenocarcinorna
Inhibit cytochrome system
H2 blockers, proton blockers; danger of drug toxicity
Gross of torsion of the testicle
testicle has a bluish black color
First sign of tissue hypoxia
swelling of cell from inactive Na/K ATPase pump
Gross of a colloid cyst in the third ventricle
round object in third ventricle; cause of hydrocephalus
Fatty liver
most commonly due to alcohol
Breast budding (thelarche)
first step in menarche
Examples of growth alterations
atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia; see tables in cell injury notes
Picture of an elderly patients hands with senile purpura
normal age-dependent finding and not a sigu of patient abuse
Examples of cell accumulations
melanin, iron, calcium (dystrophic, inetastatic), glycogen, bilinibin products
TE fistula, anencephaly, duodenal atresia
Cytoehrome oxidase
inhibited by CO and cyanide
FSH and LH are increased with removal of the ovaries or testes
Cell cycle
know parts of the cell cycle, role of p53 suppressor gene in inhibiting kinases, drugs that block specific areas of the cycle; see cell injury notes
Cross-section of brainstem in a child—yellowish discoloration
probably kernicterus from hemolytic disease of the newborn
Free radicals
superoxide, OH, peroxide, drugs [acetaminophen, CCL]); iron increases FR formation
Esophagitis in AIDS
Herpes I most common
Types of cell necrosis
coagulation (infarction; exception CNS), liquefactive (infections, brain infarct or infection), caseous (systemic TB and atypical TB, systemic fungi; all the rest are non-caseating), enzymatic fat necrosis (acute pancreatitis), fibrinoid (necrosis of immunologic injury; small vessel vasculitis, vegetations in RHD and LibmanSacks), gummatous (tertiary syphilis)
Hepatitis most commonly chronic
Chemical mediators of inflammation
histamine, C3a, C3b, C5a, LTB4, LTC-D-E4, bradykinin, prostaglandins; see table in inflammation notes
URI in a child followed by epistaxis and petechia
ITP (IgO antibody against platelets; type II hypersensitivity)
Factors increasing and decreasing adhesion molecule synthesis
increase CSa, LTB4, endotoxins, IL-i, TNF; decrease, catecholamines, corticosteroids, lithium
Roofer for 25 years and a smoker for 10 years
greatest risk is for primary lung cancer, not a mesothelioma
Recognize a granuloma (circumscribed, red, contain multinucleated giant cells)
example of type N hypersensitivity; macrophages when activated become epithelioid cells arid fuse into multinucleated giant cells
Bridge painter in New York City with respiratory infectiouf most likely histoplasmosls (stmlIngdimg) ti cryptococcus (pigeons); may ask what to treat the patient with
Rat poison ingestion~ contains warfarin and will cause bleeding; treat with vitamin K
Types of inflammation
suppurative (abscess), celiulitis (streptococcus), granulomatous (FB), pseudomembranous (diphtheria, C. diffidile), fibrinous (pericarditis), scrous (blister)
Patient who is going to receive a packed RBC transfusion
must do an antibody screen
Important suppressor genes
p53 (most cancers; chromosome 17), APC (familial polyposia; chromosome 5), BRCAI (breast/ovarian cancer; chromosome 17), BRCA-2 (breast cancer, chromosome 13), NP-i and -2 (neurofibromatosis), Rb (retinoblastoma; chromosome 13)
ABO incompatibility
0 mother with A or B baby; may occur in first pregnancy; no increase in severity with future pregnancies; spherocytes in cord blood; positive direct Coombs on cord blood RBCs, mild hemolytic anemia, most common cause of jaundice in first 24 hours, protects against.Rh sensitization
Fragile X syndrome
SXR disease; most common genetic cause of mental retardation in males (Down syndrome most common overall); triplet repeat; macroorchidism at puberty
Child with rash and skin infiltrate with CD1 positive cells
histiocytosis X (probably Letterer Siwe disease)
Chronic granulomatous disease of childhood
SXR disease, absent NADPH oxidase, absent respiratory burst, cannot kill catalase positive S. aureus but can kill catalase negative streptococci
Diabetes insipidus
hypernatremia, very dilute urine, thirsty, polyuria (absence of concentration), CDI corrected with vasopressin, NDI not corrected with vasopressin
deletion of short arm of chromosome 5; mental retardation, cry like a cat, relation with VSD
Elderly male with low back pain
do a rectal exam to rule out prostate cancer before any other test; if they state that the serwn alkaline phosphatase is elevated, it is osteoblastic metastasis
Marfan’s syndrome
AD; fibrillin defect in elastic tissue; MVP with sudden death; dissection most common cause of death; dislocated lens; boniocystinuria is similar (AR diseasr, differences are mental ietaidation, vessel ~wombosla from increase in homocysteine)
Most significant risk factor for child having open neural tube defect
mother’s diet lacks folate prior to pregnancy
AD; brain tumors, meningioma, acoustic neuroina, pheochromocytonia, cafe au lait, Lisch nodules (hamartomas in iris)
Treatment regimen to prevent osteoporosis in a woman who had a previous total hysterectomy and bilateral salpingo-oophorectomy
exercise + calcium 1000 mg + vitamin D 400 U + estrogen with or without pcogesteree~
Von Hippel Lindau
AD; cerebellar hemangioblastomas pheochmmocytoma renal adenocarcinoma (high incidence)
Treatment regimen to prevent osteoporosis in a 35 year old woman who Is still menstruating
exercise + calcium 1000 mg + vitamin D 400 U (does not need estrogen since she is still menstruating)
Congenital malformations
see genetics notes; alcohol number I teiatogen
Treatment regimen to prevent osteoporosis in a postmenopausal woman who had a previous radical mastectomy that was ERA-PRA positive
exercise + calcium 1000 mg + vitamin D 400 U (estrogen contraindicated, however, can give tamoxifcn which is a weak estrogen)
Oncogene relationships
erb-B2lneu [HER-2) codes for a growth factor receptor. breast, ovarian and colon cancer (erb B2); ras codes for membrane associated GTP-binding proteins (G proteins) that transduce signals received from growth factor receptors to the phosphatidyl inositol second messenger system
Oocysts that are acid-fast positive in a patient with AIDS
Grade of cancer (histologic appearance of tumor)
well differentiated [low grade) if you can tell what its origin is; poorly differentiated [high grade, anaplastic) if you cannot tell its tissue of origin
Elderly man, who lives at home with his wife, develops pneumonia
Streptococcus pneumoniae (most common community acquired typical pneumonia)
Stage of cancer
T = tumor size, N nodal metastasis, M other metastatic sites; more important than grade
Most common benign tumor in the brain of an adult
meningioma (glioblastoma multiforme is the most common primary malignant tumor)
Tumor nomenclature
carcinoma (squamous, adeno-, transitional), sarcoma (mesenchymal origin), hamartoma (not neoplastic; bronchial harnartoma, P1 polyp, hyperplastic polyp), choristoma (not neoplastic, normal pancreas in stomach wail), mixed tumor (parotid salivary gland Uumor 2 tissues from same cell layer), teratoma (tissues from ecto-, endo-, and mesoderm; cystic teratoma of ovary with teeth and hair); review first part of neoplasia notes
Most common site to evaluate in a child with hypertension
kidneys (Wilm’s tumor, renal dysplasia), adrenal medulla (neuroblastoma)
Increased AG metabolic acidosis (AG = Na - ICI + HCO3) =12+/-4 mEq/L)
adding an acid and the anion of the acid replaces the bicarbonate used to buffer the hydrogen ions; e.g., lactate, acetoacetate, ~-hydroxybutyrate, phosphate/sulfate (renal failure), sahicylate, formate (methanol poisoning), oxalate (ethylene glycol poisoning), acetate (paraldehyde)
AIDS patient diarrhea—?what organisms can be identified with the string test (Enteroteat)
Giardia, strongyloides, Cryptospondium
Picture of coagulation necrosis in an acute myocardial infarction
Adult polycystic kidney disease (APKD)
relation to CNS berry aneurysms and subarachnoid hemorrhage
Normal AG metaboJic~ acidosis
losing bicarbonate and bicarbonate is replaced by an equal number of Cl anions, hence the normal AG; type I renal tubular acidosis (distal)
Elderly man with sudden onset of abdominal pain and bloody diarrhea
thrombosis/embolism of the superior mesenteric artery with small bowel infarction (common association with heart disease and atrial fibrillation)
Acute transplant rejection
within 3 months; predominantly cellular immune reaction (type IV; CD5 cytotoxic T cells; parenchymal damage) and smaller humoral component (vessel damage with fibrosis)
Young girl with grape-like masses protruding from the vagina
embryonal rhabdomyosarcoma (most common sarcoma; not related to DES)
Chemical carcinogens
Crunching sound is noted in the neck and anterior chest in a patient involved in a head-on collision
ruptured esophagus (Hazuman’s sign in the chest due to subcutaneous emphysema from air dissecting into the tissue; other scenarios could be an alcoholic who is retching or a buliznic who. is vomiting)
Woman complains of generalized muscle weakness, ptosis of the right eye with no papillary abnormalities
myasthenia gravis (autoantibody against acetyicholine receptors; type II hypersensitivity)
Schistocytes in the peripheral blood
prosthetic heart valve, aortic stenosis (most common), DIC, thrombotic thrombocytopenic purpura, marathon runner
Most frequent cancer in the bone in an adult
metastatic cancer (breast is the overall most common cause)
Most common location in bone for osteomyelitis
metaphysis (most vascular part of bone; S. aureus most common cause; hematogenous spread)
Most appropriate treatment for an elderly woman with a headache localized to the side of her head accompanied by diffuse muscle aches and pains, and an elevated serum CK and ESR
corticosteroids (temporal arteritis with polymyalgia)
lymphatic to regional nodes (subcapsular sitius), vessel invasion (uncommon; exceptions follicular cancer of thyroid~ renal adenocarcinoma, hepatocellular carcinoma), seeding (ovarian cancers); sarcomas
Athlete presents with jaundice, no previous health problems, no history of liver disease, and no previous transfusions; serum transantinases Ii tly elevated and serum alkaline phosphatase is markedly elevated
patient is taking anabolic steroids cholestatic jiia1~e~
Most common primary brain tumor oc~ñin chil~in
cerebellum (cerebellar astrocytoma #1, medulloblastoma #2—First An) for Boards is wrong on this one [has medulloblastoma as #1])
Cause of atrophy in a muscle in a cast
lack of muscle stimulation
MCC of rabies in USA
skunk bites (not bats, dogs, or raccoons)
Sturge Weber
port wine nevus on the face in a trigeminal nerve distribution; ipsilateral AV malformation in the brain
Cancers associated with parasitic disease
squamous cancer of the bladder Schistosorira hematobium (egg has a nipple at the end), cholangiocarcinoma Clonorchis sinensis
Hepatitis associated with urticaria, fever, arthralgias, and the nephrotic syndrome
Hepatitis B (serum sickness type of disease with type 111 iinmunocomplex mechanism; vasculitis associated with polyarteritis nodosa)
Targetoid lesions on the skin
erythema multiforme (most often associated with Herpes simplex; Mycoplasma is another relationship; others include sulfonamides, NSAJDs, phenytoin Steven’s Johnson syndrome involves the mouth)
Flat, hyperpigmented lesions on the forehead and cheeks of a woman
most commonly due to oral contraceptives (pregnancy is the next most common; this is called chloasma or melasma)
Axillary freckling in a patient with hypertension
Most common cause of alopecia
genetic predetermination (most commonly in males; telogen effluviurn is when all the hairs enter the resting phase at once [postpartum, BCPs, high fever, crash diet])
Irregular patches of hair loss in child
trichotillomania (pulling out of one’s own hair, note the relationship to the 4 dominant hand)
Young woman with intermittent bouts of diarrhea and constipation associated with cramping right and left lower quadrant pain
irritable bowel syndrome; flexible sigmoidoscopy is negative; intrinsic bowel niotility problem
Immunizations given at birth to a baby whose mother is positive for HBsAg
Hep B (active immtmization) and HBIG (passive immunization)
non-disjunction in somatic cells
Treatment of pseudornembranous colitis
melronidazole (cheaper than oral vancomycin)
Farmer and his wife are brought to the ER by their son because they are too weak to walk or drive and their vision is blurry and exam reveals ptosis, facial weakness, nonreactive dilated pupils, dry mucous membranes, and normal DTRs—? diagnosis
C. botuliraim food poisoning (the toxin inhibits the release of acetylcholine at the neuromuscular junction; Rx with botulism antitoxin; danger of respiratory paralysis)
Cell cycle
p53 suppressor gene produces a protein product that has an inhibitory effect on the kinases that control the movement from one phase to the next in the cell cycle
Diabetic with wet gangrene of the foot followed by stiffening of the Jaw, neck stifihess, and increased irritability and increased hyperreflexia—? diagnosis
tetanus (Rx tetanus immune globulin, penicillin, sedation; give fill immunization with toxoid when the patient recovers since the infection does not produce high enough titers of protective antibodies) C174
Labile cells
contain stem cells; bone marrow stem cells, skin (stratum basalis), intestine (base of the glands)
Patient has hyperpigmented spots on the skin which when scratched become intensely pruritlc and red; the cells most likely responsible for this reaction arc
mast cells (the patient.~ms urticaria pigmentosa, which is a mast cell disease where pressure causes the release of histamine setting up an urticarial reaction) -173. -
Stable cells
in Go phase and must be stimulated to go into the 01 phase (e.g., hormones); most parenchyrnal cells in organs; smooth muscle; astrocytes and other neuroglial cells
Permanent cells
cannot enter the cell cycle; skeletal and cardiac muscle; neurons
Patient with dysphagia and a fetid odor to his breath
Zenker’s diverticulum (most common diverticulum in the esophagus; collects food)
Most common bone metastasized to
vertebra; due to the Batson vertebral plexus which communicates with the vena cava. Systemic Pathology Questions
Young man with low back pain and limited chest movement ankylosing spondylitis (vertebral fusion produces kyphosis, which restricts chest movement)
Drug of abuse that produces reddening of the conjunctiva
Mechanism of action of 1W light in the treatment of newborns with physiologic jaundice
oxidizing UCB into harmless water soluble dipyrroles
Differentiate all the thyroid disorders
Separate Addison’s disease from secondary hypocortisolism
main differences are in ACTH levels, and electrolytes; Addison
Calculate the reference interval of the test given the mean of the test and 1 SD
remember to double the SD, since 2 SD covering 95% of the normal used
Treatment of CMV retinitis in AIDS if ganciclovir does not work
foscarnet (renal toxicity)
Picture of patient with Cushing’s syndrome
central obesity, purple stria; use low dose dexamethasone test and 24 hour urine for catecholamines
Carcinoid syndrome
metastasis to the liver from a primary in the small intestine; measure 5-RIAA
Male with clusters of vesicles on penis
HSV II; acyclovir decreases recurrences
Treatment of condyloma venereum
topical podophyllin
Treatment of syphilis
Treatment of gonorrhea
ceftriaxone (for GC) + doxycycline (for Chiamydia)
Treatment of bacterial vaginosis
metronidazole (not the partner); clue cells, Gardnerella vsgisialis
Treatment of trichomoniasjs
mctronidazole (treat partner); Trichomonas is an anacrobe
Treatment of pseudomembranous colitis
Cause of Graves disease
stimulating thyroid stimulating antibody against the TSR receptor (type II hypersensitivity)
Factors altering the oxygen dissociation curve
left and right shift see cell injury notes or Harvey Champ biochemistry book
Primary treatment of CMV retinitis
ganciclovir retinitis most common cause of blindness in AIDS
Microcytic anemia with increased HbA2 and HbF
alpha (??)-thalassemia II
Most common anemia
iron deficiency (women <50 menorrbagia, mah <50 duodenal ulcer, man/woman >50 colorectal cancer)
Vitamin deficiency with prolonged PT
vitamin K
Most common fracture in postinenopausal osteoporosis
vertebral fracture; osteoclastic activity > osteoblastic activity
IndIa ink prep with narrow based bud
Respiratory problem with pigeons
fungus ball in abandoned TB cavity; hemoptysis, fruiting body
Frontal lobe abscess in a patient with DKA
Pseudomonas related infections
CF pneumonia (green colored sputum), most common cause of death in burns, malignant otitis externa, ecthyma gangrenosum, step on nail with smelly tennis sneakers, hot tub folliculitls, respirator infections (loves water)
water coolers, flu-like syndrome, hyponalremia and hyperkalemia from interstitial nephritis, Dicterle silver stain, erythromycin
Opportunistic infections in AIDS
know Pneumocystis, CMV, Cryptococcus, MAI, TB, Herpes (esophagitis), Candida (thrush,, esophagitis), Cryptosporidium (acid fast; diarrhea)
Vessels in esophageal varrces
left gastric and azygous veins
Mitochondrial inheritance
mother gives the disease to all her kids but her married son to none of his kids
ERA and PRA positive breast cancer
use tamoxifen, an anti-estrogen, protects against CAD and osteoporosis, can produce endometrial cancer
Pasteurella multocida
cat bite; potential for septic arthritis/tendinitis
Disseminated gonococcemia
decreased C5-C8 (final common pathway complement components)
Know how to interpret MST 11 restriction endonuclease studies to separate sickle trait from disease
see hematology notes table in hematology
Treatment for prolactinoma
bromocriptine; most common pituitary tumor, secondary amenorrhea and galactorrhea
Most common cause of myocarditis, pericarditis, aseptic meningitis
coxsackievirus; picture of lymphocytes in myocardial tissue on an endomyocardial biopsy
High MP
open neural tube defects, hepazoceliular carcinoma, yolk sac tumors of ovary or testis
Drugs that increase surfactant
glucocorticoids, thyroxine
ECG changes
short QT hypercalcemia, prolonged QT hypocalcemia, U wave bypokalcrnia, peaked T wave hyperkalemia
Most common cause of jaundice in the first 24 hours after birth
ABO incompatibility; 0 mother with an A or B baby; 0 mother normally has anti-A,B IgG antibodies
WBC abnormality in the peripheral blood in B&folate deficiency
hypersegmented neutrophil (picture on exam)
MC vitamin deficiency in alcoholics
Next step if there is a positive RPR in a patient with SLE
do an FFA-ABS to rule out a true from a false positive RPR, the latter due to anti-cardiolipin antibodies.
Tear drops in peripheral blood
myeloflbrosis in the marrow
Coarse basophilic stippling in peripheral blood
Pb poisoning
PICA for clay and ice
iron deficiency
Iron studies in iron overload
increased iron, % saturation, ferritin, but decreased TtBC (transferrin decreased)
MCC of folate deficiency
alcohol abuse (not beer)
Polycythemia differential
hematology notes; relative polycythemia (volume depletion)
Leukemias by age
<15 ALL, 15-39 AML, 40-60 AML and CML, > 60 CLL
Hairy ccli leukemia
B cell leukemia, positive TRAP stain
t9;22 translocation of c-myc oncogene, low LAP score, Philadelphia chromosome
CAILA positive pre-B cell leukemia most common
MC metal deficiency in alcoholics
Progressive systemic sclerosis
replacement of smooth muscle with normal collagen and increased subcutaneous deposition of collagen; R.aynaud’s first sign; scierodactyly; tight face; dysphagia for solids (no peristalsis, relaxed LES); restrictive lung disease; renal disease; anti-Scl-70 antibodies; CREST syndrome a variant
marker of very immature B cells and T cells
Congenital spherocytosis
AD, spectrin deficiency, increased osmotic fragility
Howell Jolly body
indicates absent or dysfunctional spleen
Heinz bodies
peroxide damaged Hb in R.BCs in G6PD deficiency
Vitamin, associated with pyruvate dehydrogenase
Always determine the genetic sex of a child with ambiguous genitalia
Libman Sachs endocarditis; immunocomplex glomenilonephritis (anti-dsDNA); fibrinous pericarditis; pleural and pericardial effusions; false positive syphilis serology; autoimmune hemolytic anemia, neutropenia, and thrombocytopenla; butterfly rash; joint pains with morning stiffness; anti-Sm and anti-dsDNk ANA positive in most cases
Effect of metyrapone
blocks adrenal cortex I 1-hydroxylase, hence decreasing cortisol, increasing ACTH~, and increasing fl~eoxycorti~pro~wna1 to the block; excellent check of ACTH reserve and adrenal function
direct detects IgG/C3 on RBC, indirect is an antibody screen of serum (e.g~, anti-i)); used in autoimmune hemolytic anemias Ferritin
Respiratory burst
NADPH oxidase conversion of molecular oxygen into superoxide free radicals; neutrophils and monocytes only
B12 metabolism and deficiency
thoroughly review B12 and folate metabolism in the hematology and nutrition notes, know role of B12 in propionate metabolism and formation of SAM from methionine (ATP + inethioninc), methyhnaionic acid increases in B12 deficiency (not folate), homocysteine increases in both B12 and folate deficiency (most common cause)
Know all the types of hepatitis
see HB notes
Photograph of mass in the vulva
Bartholin gland abscess/cyst; relationship with GC
Tzanck prep
detect viral etiology of vesicular disease; e.g. Herpes multinucleated cell with intranuclear inclusions; same for varicella
Picture of pseudohypha and yeast for Candida bilirubin metabolism and causes of jaundice (Gilbert’s, physiologic jaundice of newborn, Crigler-Najjar,
In caisson disease, what is decreased when a diver comes up too quickly
PN2 in blood, since it forms bubbles in the vessels and moves into tissue
Hypercalcemia and multiple inyeloma
secretion of osteoclast activating factor from myeloma cells
Clear cell adenocarcinoma of vagina
DES exposure; vaginal adenosis is the precursor What happens to the other kidney if one is damaged
Obstructive jaundice
fat soluble vitamin deficiencies from reduction in bile salts leading to malabsorption; bile contains cholesterol and bile salts/acids
Effects of methotrexate
megaloblastic anemia from block in dihydrofolate reductase, myelosuppression
Drug-induced SLE
procainarnide is the most common drug; no renal disease; ~ ~neand anti-saD, rather than anti-dsDNA and anti-Sm antib a
decreased uptake of DOPA and NOR.; review environmental path notes
Congenital adhesion molecule (integrins) defect failure of the umbilical cord to separate at birth no adhesion of neutrophils to the endothelial cells, no inflammatory cells in the umbilical stump
Biotin reaction
carboxylase reaction in the conversion of pyru’vate to oxaloacetate
Heberden’s nodes
osteophytes in IP oints in osteoarthritis
Cherry red inacula
Tay Sach disease
flask shaped ulcers in the cecum
Know how to interpret pedigree for all of the inheritance patterns
review genetics notes
AMI complications
rupture most common on the 3rd to 7th day; Dressier’s syndrome autoimmune pericarditis 6-8 weeks later
Pyridoxine (B6)
transarnination reactions involving the transaminases AST and ALT Know how to interpret ABGs
Goodpasture’s syndrome
anti-pulmonary and gloinenilar capillary basement membrane antibodjes~ begin, with hemoptysis and ends with renal failure (crescentic glomemlonephrjtis); linear lmmunofluo~~
review table in lymph node notes
Functions of atrial natriuretic peptide
opposite of angiotensin II— inhibition of ADH release, inhibits Alit effect on stimulating thirst~ inhibits aldosterone secretion, inhibits renal reabsorption of Na (direct effect; loss of sodium in the urine), and inhibits renin release; vasodilatation of the peripheral resistance vessels
HBV questions
review hepatobiiaiy notes
Disorders associated with smoking and alcohol
see environmental pathology notes
Sepsis in AIDS patients
disseminated MA! most common and most common cause of death
Chance of a male with cystic fibrosis having a child
<5%, since the vas deferens never fully develop or are atrctic; females with CF can get pregnant but it is difficult owing to the thick cervical mucus
Most common cause of post-transfusion hepatitis
HCV (CMV is the most common infection pos-trans1baj~ located in donor lymphocytes)
Vitamin supplements in CF
all of the fat soluble vitamins
Most common cause of septic arthritis
N. gonorrhoeae; knee, wrists, feet
Women is a pure vegan and is breast feeding her baby and the baby develops anemia
B12 deficiency.
Rusty colored sputum
Streptococcus pneurnonzae pneumonia (other causes chronic congestive heart failure, mi~a] stenosis, Goodpasture’s).
Signs/symptoms of drugs of abuse
review environmental path notes
Mechanism of spread of Cryptococcus neoformans
hematogenous rouse; most common cause of meningitis in Afl)S and other ininlunocompromised states
EBV attaches to CD~ molecule in B cells ~
Hypogonadism, mental retardation, n4 unilateral gynecomsstia Kilnefelter syndrome ( 43~ Hypogonadism and color blindness+C287
Problems in cystic fibrosis patients associated with P. aeruginosa. pneumonia, brOnehiectaSiS, sepsis
Tetralogy of Pallot
most common cyanotic CHD; degree of infravalvular pulmonary stenosis is the key to whether the patient has cyanosis or is acyanotic
Baby with icterus and edema
which virus probably congenital CMV infection C305
EM of hepatocyte
glycogen present in fed state (black granules) and disappears after 6 hours (fasting state)
Abdominal abscess
most commonly due to Bacteroides fragilLv (B. fragili.r below the diaphragrn B. melanogenicus above the diaphragm)
Tuberous sdero.1s
AD; mental retardation astrocyte hamartomas in CNS (candlestick drippings on ventricles); adenoina sebacewn; angiomyolipoma (hamartoma) of kidneys; rhabdomyoma of heart
Hypogonadism and anosmia (lack of smell)
Kallznann syndrome
Staphylococcus aureus
prn~~~~es to Fe receptor of macrophages, hence blocking opsonization of bacteria
Male pseudohermaphrodite with cryptorchidism
testicular feminizatIon (absent androgen receptors; SXR most common cause of male pseudohermaphroditism)
Acute Intermittent porphyr~~~ AD; two basic defects
an increased activity of ALA synthase when heine is decreased (drug metabolism in liver) and decreased activity of uroporphyrinogen synthase; net effect increase in 8-aminolevuljnjc acid (ALA), porphobilinogen (PBG; when oxidized by light, it becomes porphobilin, which gives port wine color to urine; “window sill” test); intermittent exacerbations of neurologic dysfunction including psychosis, neuropatiijes, severe colicky abdominal pain that is frequently mistaken for a surgical emergency (“bellyful of scars.”); periodic infusions of heme reduce the number of attacks.
Microdeletion syndrome with hypogonadiam, mental retardation, short stature, and obesity
Prader-Willi syndrome (chromosome 15 deletion is of paternal origin); Angelman syndrome deletion is of maternal origin
Porphyria cutanea tarda (PCT)
acquired disease; decreased activity of uroporphyrinogen decarboxylase; net result increased excretion of uroporphynn I (urine is wine-red color on voiding), slight increase in the formation of coproporphyrins, normal porphobilinogen levels; photosensitive skin lesions in sun-exposed areas, hyperpigmentation, fragile skin1 increased amounts of vellus type hair (hypertrichosis) C327
Patient with neurofibromatosis has severe diastolic hypertension
probable pheochromocytoma
Group A streptococcus
pharyngitis predisposes mainly to rheumatic fever (less commonly glomerulonephritis), skin infections predispose mainly to glomerulonephritis (less commonly rheumatic fever)
Serum protein etectrophoresis interpretation
see Table in inflammation notes; now difference between polyclonal (chronic inflan~imation) and monoclonal (one clone of plasma cells; monoclonal gammopathy of undetermined significance is the most common cause)
Diagnosis of rotavirus infection
Rotazyme test of stool; ELISA test with antibodies against the virus
Complications of cyclophosphamide
hemorrhagic cystitis and transitional carcinoma of the bladder
EM findings consistently present in all primary causes of nephrotic syndrome
fusion of podocytes
Decline in deaths due to SIDS is attributed to
having the baby sleep supine (babies rebreathe their own C02 those with immature central chemoreceptors do not respond to the respiratory acidosis by moving their heads and die)
Glomerular crescents
sign of increased severity of glomerulonephritis; most common ON to progress into chronic renal failure
Most important risk factor for increased morbidity/mortality in a single 25 year old Black male
unprotected sex (AIDS #1 killer in this agebracket also applies to women regardless of age, but not white men, where MVAs are the #1 killer)
. hernoptysis (first) + glomerulonephritis (crescentic ON)
Several employees that work in a car assembly plant present with headache, nausea, vomiting, muscle weakness, and abdominal cramps
lead poisoning from incineration of batteries; may change the history to people making moonshine in an old car radiator
Monosodium urate crystals in synovial fluid
needle shaped and yellow when parallel to the slow axis of the compensator
Newborn female presents with edema of the hands and feet and a cystic mass in the neck
Turner’s syndrome with a 45 XO kaiyotype
2 year old with 94% HbF
indicates hereditary persistence of Hgb F (variant of ~-thalassemia) owing to absent ~ and
Compared to mature breast milk, cow’s milk has
more vitamin K, less ascorbic acid, more vitamin B12, more casein (breast milk has low iron but it is better absorbed; casein is the key protein in cow’s milk, while whey is the primary protein in breast milk)
Mechanism of acute pyelonephrith (upper urinary tract infection) in females
vesicoureteral reflux
Vitamin that is absent in colostrum
vitamin D
Pneuniothorax in a skin diver
sudden onset of pleuritic chest pain, collapsed lung with elevation of the diaphragm and shift of trachea to the side of the collapse
Anemia in an infant that develops when switched from cow’s milk to goat’s milk
goat’s milk is low in folate, 86, iron, and high in potassium, chloride, arachidonic acids, and linoleic acids when compared to cow’s milk
Reactivation TB
in apex of lung where the oxygen is greatest; strict aerobe
Type of UV light with the greatest potential for producing a corneal burn (e.g., snow skiing)
UVB (UVB is also the culprit for cancer; B is bad)
Shift of mediastinum
tension pneumothorax where the air enters the pleural cavity but cannot exit, hence the mediastinal structures shift to the opposite side and the diaphragm is depressed on the affected side
Retinal hemorrhages in young children
possible child abuse (shaking syndrome)
Elderly male smoker with painless jaundice, weight loss
carcinoma of the head of pancreas
Absence of Y chromosome
gerrninai ridge moves in the direction of ovarian differentiation; presence of the Y chromosome —~ testes differentiation
Normal times for gynecomastja
newborn, puberty, old age; NOTE it may be unilateral (picture of a young boy with unilateral breast enlargement)
Patient is stung by a bee and begins to have respiratory difficulty, flushing, and abdominal cramping— ?treatnzent aqueous epinephrine 1
1000 sc. (0.01 mL/kg sc. or IM)
Resting tremor
Parkinson’s disease; intention tremor multiple sclerosis C373
Fire ant bites
multiple wheals that later develop into vesicles, and pustules
Lou Gehrig’s disease
same as amyotrophic lateral sclerosis; destruction of upper and lower motor neurons; defective superoxide disinutase; neuron damage by superoxide free radicals; intrinsic muscles of the band a common starting point
Black widow bite
painful bite (carrying some logs from outside, moving boxes in a basement) followed by crarnpy pain in the thighs and abdomen (Rx with muscle relaxant [calcium gluconate is excellent], tetanus prophylaxis, antivenin if available in severe cases)
Superficial dermatophytes
located in the stratum corneum
Poisonous type of scorpion bite in Southwest
painful sting followed by local itching, paresthesias, nausea and vomiting and hypertension
Hyperpiasia of JG apparatus with increased blood pressure
renal artery stenosis
Brown recluse spider bite
painless bite beginning with a slightly tender red papular lesion on the arm that latter forms a hemorrhagic blister surrounded by purpura
gross of an exostosis from a child (most common benign bone tumor, capped by benign cartilaginous tissue)
Chigger bites
extremely pruritic discrete, bright red papules on legs and around the waist
Cause of gallstones
picture of GB with stones; too much CH or too little bile salts/acids
Child who ingests 30 adult aspirins will most likely develop
an increased anion gap metabolic acidosis (children, unlike adults, do not commonly develop a mixed metabolic acidosis and respiratory alkalosis. Rx is to perform gastric lavage and add activated charcoal and to produce an alkaline urine for increased excretion of the acid)
PCi2 functions
vasodjlator, decrease platelet aggregation
What disease is more likely to infect the fetus after the first trimester
Signs and symptoms of anemias
B12/folate, exercise intolerance, dyspnea, high output failure; see tables in hematology notes
Engineer driving a train involved in a crash with an oncoming train was found to have THC metabolites in his urine—why did this occur
a delayed reaction time (it also impairs the ability to judge speed and distances)
Picture of black spot on leg
ecthyma (pyoderma) gangrenosum, due to Pseudomonas aeruginosa; forms black ulcers; relationship with ulcerative colitis
Fever in malaria
coincides with rupture of RBCs
Angiosarcoma of the liver—causes
vinyl chloride, arsenic, Thorotrast
Know sensitivity, specificity, prevalence, incidenEe, predictive value of a positive and negative test, risk ratio, odds ratio, case fatality risk
some of this is in general principles notes and the remainder in Fadem’s chapter on statistics
Treatment of astrocytoma
often precipitates hemolysis in G6PD deficiency
best protection against syphilis
Signs and symptoms of meningitis/organiams by age
nuchal rigidity, fever; causes in different age brackets (group B s1reptococcz~g in NB (<I roth; ~ coli #2, L monocytogenes #3), N. nzeningitidfs (1 mth to 18 years; S. pneumoniae #2),> 18 years old
Osteomyelitis in HbSS
Staphylococcur aureus most common; Salmonella, if producing osteoniyelitis, is most commonly seen in patients with sickle cell disease.
Most common CHD in Downs
endocardial cushion defect (ASD + VSD); most common cause of death in early age; Alzheimer’s most common cause of death after 35
Adult polycystic kidney disease
AD disease; berry aneurysm relationship and subarachnoid hemorrhage; cysts not present at birth; hypertension
Ankylosing spondylitis
HLA B27 positive relationship; young man with low back pain (sacroiiitis) progressing to bamboo spine; aortitis and uveitis as well; other relationships—Reiter’s syndrome, psoriasis, enterocolitis (Campylobacter, Yersinia, Shigella), ulcerative colitis
Most common cause of esophageal cancer
smoking (alcohol has a synergistic action)
Philadelphia chromosome
chromosome 22 with the bcrabl fusion gehe in chronic myelogenous leukemia
Cause of familial hypercholesterojemig
AD disease with absent LDL receptor
Absence seizures
abrupt onset of impaired consciousness (stare into space); 3-Hz splice and wave activity on EEG, ethosuximide treatment of choice
UVB light
produces thymidine dimers, which if not replaced with normal DNA by DNA repair enzymes, may result in cancer (basal cell, squame, melanoma)
Defect in a-chain in sickle cell frait/disease
valine for glutamic acid on 6th position of a-chain
Osteogenic sarcoma
gross of tumor in knee area; located in the metaphysis
Inflammatory bowel disease
Cause of thrombosis after angioplasty
localized dissection (not thrombosis)
Mitral valve prolapse
earliest valvular lesion in Marfans; may be a cause of sudden death; increased myxoinatous connective tissue in the valve due to an increase in mucopolysaccharides; click and murmur move closer to SI with anxiety (shorter diastole) and closer to S2 when lying down (more venous return to the heart); see cardiovascular notes and Section on physical diagnosis
Congestive cardiomyopathy
previous myocarditis (coxsackie most common cause), drugs (doxorubicin, tricyctics), postpartum, alcohol
Gross of the tricuspid valve in the right heart
infective endocarditis in an intravenous drug abuser
Aschoff body
pathogriomonic lesion of rheumatic fever
H. pylon
urease producer, gram negative coccobacillus
Treatment for recurrent ulcers
ESR increase with age
probably abnormal and indicates a disease process rather than being an age-related finding
absent myenteric ganglion (Hirschsprung both submucosal [Meissner’s] and myentcric plexus [Auerbach’s] are missing)
Rickets vs osteomajacig in adults
craniotabes and rachitic rosary in rickets, not osteomalacia; both hive an increase in unmincrajjzecj osteoid
Cave explorer in Arfr~na with respiritory infection
coccidloidomycosis (not histoplasmosis too dry a Clim~~ and mainly in Ohio and Midwest)
Vitamin E deficiency
cerebellar dysfunction; heinolytic anemia; toxicityinterferes with vitamin IC dependent factors leading to a hemorrhagic diathesis
Know the renin-angiotensin-aldosterone system
see fluid and hemodynamic notes
Vitamin C deficiency
teeth bleed when brushed; glossitis; perifollicular hemorrhagea; ~a ~d tos~t diet
Gross picture of a hydatidiform mole
Thiamin deficiency
alcohol abuse most common cause (poor nutrition); important biothemica] reactions pyruvate dehydrogenase, transketolase, ketoglutarate debydrogenase; Wernicke (confusion, ataxia, nystagrnus)-Korsajcoff (antegrade and retrograde memory deficits); ring hemorrhages in maznillaiy bodies and periventricular area; high output failure; congestive cardiomyopathy; peripheral neuropathy
Postductal coarctation
unequal pulses between upper and lower extremity; rib notching; systolic murmur between the shoulder blades; Turner’s syndrome has a preductal not postductal coarctation
Niacin deficiency
important biochemical reactions NAD/NADH, NADP/NADPH pdllagra; tryptophan can be used to synthesize niacin (1!yptophan decreased in Hartnup’s disease, carcinoid syndrome [converted into scrotonin], corn diet); diarrhea, dermatitis (hyperpignientation), dementia
Treatment of DKA
volume replacement first
Riboflavin deficiency
" important biochemical reactions NAD/NADH, NADP/NADPH pdllagra; tryptophan can be used to synthesize niacin (1!yptophan decreased in Hartnup’s disease, carcinoid syndrome [converted into scrotonin], corn diet); diarrhea, dermatitis (hyperpignientation),
Galactorrhea in 3 month old girl
probable influence of maternal hormones
Pyridoxine deficiency
" INH most common cause; important reactions
Child with scrotal enlargement and transilluminates
hydrocele due to persistence of the tunica vaginalis
Pantothenic acid
important in fatty acid synthase complex; cocnzyme tcactions
Indirect Inguinal hernia
most common type; lateral to the lateral border of the triangle of Hesselbach (lateral border superficial epigastric artery, inferior border inguinal ligament; medial border the lateral aspect of the rectus abdominis muscles)
Biotin deficiency
avdin in raw eggs binds the vitamin; alopecia
Intravenous drug abuser in prison—?type of hepatitis
Alcohol metabolism
review in cell injury notes, liver notes, or Champe-Harvey biochemistry
9 Weber syndrome
lesion of oculomotor nerve and UMN signs with.a midline, midbrain lesion Homer’s syndrome diagram of vertebra and sympathetic trunic pick cervical sympathetic ganglion 61. Pupil light reflexes with eye diagrams of pupils one set is an oculomotor nerve lesion 62. Extent of the spinal cord in adults
320.Communicating hydrocephalus
CSF communicates with the subarachnoid space; choroid plexus papillosna (makes too much CSF), block arachnoid granulations
321. Non-communicating hydrocephalus (obstructive)
no communication with subarachnoid space; block at aqueduct of Sylvius (most common), blocks in 4th ventricle, blocks at base of the brain (~B meningitis, blood), Dandy Walker syndrome, Arnold Chiari syndrome
322. AIDS dementia
most common HP/-related CNS disease; multinucleated mieroglial cells (reservoir for the virus)
323. Psoriasi~hyperkeratosis, regular rete ridge hyperplasia, Munros microabscess, superficial dermis next to epithelial surface (Auspitz sign), erythematous plaques with silvery scales, nail pitting, psoriatic arthritis if HLA-B2’7 positive, elbows and scalp
324. Read skin notes for quick coverage of main skin diseases
325. Bone tumors in order of increasing age
Ewings (“onion skinning”, fever, small cells), osteogenic sarcoma (knee area, “sunburst appearance”, “Codxnan’s triangle”), chondrosarcoma (pelvic girdle, knee area, most common malignant cartilage tumor), multiple myeloma (most common primary cancer of bone)
326. Paget’s disease of bone
male dominant; initial osteoclastic breakdown and then osteoblastic; thick, weak, mosaic bone prone to pathologic fracture; large head; AV flstulas in bone (high output failure), risk for osteogenic sarcoma, elevated alkaline phosphatase; bisphosphonates treatment of choice
327. Know CNS bleeds
epidural (top of dura, skull fracture, torn middle meningeal artery), subdural (convexities, tear of bridging veins, fluctuating levels of consciousness), atherosclerotic stroke (usually pale infarct, since no reperfusion), embolic stroke (hemorrhagic infarct extends to surface of the brain), intracerebral bleed (hypertension; rupture of lenticulostriate Charcot-Bouchard aneurysms; hernatoma not an infarct; globus pallidus/putamcn area most common), subarachnoid bleed (ruptured congenital berry aneurysm [junction of communicating branch with anterior cerebra! artery, severe occipital headache, blood covers the brain [may turn yellow after a week from breakdown into bilirubin])
328. Hodgkin’s Lymphoma
RS cell is the neoplastic cell; nodular sclerosmg most common type (females, lwmar cells, anterior mediastinum involvement); fever, night sweats, weight loss; youngest (lymphocyte predominant, very few RS cells, excellent prognosis); oldest (lymphocyte depletion; many RS óells, poor prognosis); death by second malignancies from alkylating agents (non-HI) lymphoma)
329. Breast cancer risk
overall, age most common rislq family history (mother~ sister only); history of contralateral breast cancer); unopposed estrogen ( menarche, laze menopause); history of endometrial cancer
330. ilicosis risk for TB, not cancer; nodules’ lung with crystals; foundry worker, sandblaster
331. As os
pipefitter in shipyard, roo Cr, risk for TB; smoker + asbestos primary lung cancer, non-smoker + asbestos mesotheliotna asbestos body (ferruginous body) looks like a dumbbell (fiber covered by iron)
332. Fibrocystic change
most common breast mass <50 years (atypical ductal hyperplasia only risk factor for cancer), bloody nipple discharge <50 (benign intraductal papilloina in lactiferous duct), tumOr <35 years of age (fibroadenoma); breast mass >50 (infiltrating ductal cancer)
333. Breast cancer types
infiltrating ductal (most common), Paget’s (nipple involvement by underlying cancer), medullary (bulky tumor with pushing margins), inflammatory carcinoma (peau du orange; plugging of subepiderrnal lymphatics by tumor, worst prognosis), lobular cancer (most common cancer of terminal lobules; bilaterality), comedocarcinorna (central area of necrosis in ducts resembling a zit)
334. Row to recogfllzEleukemia and leukemia typeE acute vs chronic (bone marrow exam revealing >30% blast cells is acute leukemia, blast count not high in chronic); usual profile
anemia, thrombocytopenia (CML only leukemia that may have thrornbocytosis), high WBC count with blast cells (may be a normal count, but blast cells will be present), generalized lymphadenopathy, hepatosplenomegaly, bone pain, fever; use age brackets to pick out most likely choice (see #438); always do a bone marrow to diagnose leukemia, stains PAS for ALL, specific estaase for AML, LAP score for CML, non-specific esterase for monocytic leukemias, TRAP stain for hairy cell leukemia
335. Hemangioma on face of a child
leave it alone
336. Osteopetrosis
too much bone; anemia, marble bone disease; pathologic fractures; entrapment of cranial nerves; deafness
337. Polycystic ovarian syndrome
obesity, hirsutism, irregular menses, infertility; increased LH stimulates ovary to produce testosterone and 17-ketosteroids (androgens leading to hixsutism); increased adipose aromatizes androgexis to estrogens (endometrial hyperplasia/cancer), which inhibit FSH and enhance LH release, hence continuing the cycle of LH stimulation; lack of FSH causes atresia of follicles and large ovaries with subcortical cysts; LH/FSH ratio >3/I; treat with __________if patient wants to become pregnant
338. Pituitary Cushings
no suppression with low dose dexamethasone but can be suppressed with high dose dexamethasonc (indicates only partial autonomy); cannot suppress adrenal Cushings or ectopic Cushings;
339. Anemia since birth, splenomegaly
probable congenital spherocytosis, do splenectomy
340. CT with enlarged internal acoustic meatus in a patient with tinnitus, nerve deafness, vertigo
acoustic neuroma (schwannoma, neurilemoma)
341. Hemoptysis with foul smelling stools or pneumonia with foul smelling stools (malabsorption) in a child
cystic fibrosis, do sweat test
342. Mother states that child has a salty taste when kissed
cystic fibrosis, do sweat test
343. Picture of coronary vessel
atherosclerosis (slit like spaces), dystrophic calcification (blue blotches), fibrofatty plaque (beneath intimal surface)
344. Picture with acute inflammation
numerous neutrophils (nucleus looks like squigglies, small capillaries
345. Picture with chronic inflammation
numerous round cell nuclei (lymphocytes) and plasma cells (eccentric nucleus with perinuclear clearing)
346. Picture of healed myocardial infarction
blotchy fibrosis unlike sheets of pale staining tissue as in a pale infarction
347. Heart softest and prone to rupture
3-10th day; rupture with taxnponade (pericardial sac filled with blood), posteromedial papillary muscle rupture (murmur of mitral insufficiency; pansystolic, apical, systolic; RCA thrombosis), interventricular septal rupture (systolic murmur, hole in 1VS)
348. Peripheral blood pictures
hypersegrnented neutrophil (folatef.Biz) microcytic hypochromic cells (iron deficiency, ACD, thalassemia, sideroblastic anemia), sickle cells, target cells (bullseye), sphcrocytes (no central area of pallor), macroovalocytes (PA, folate), tear drop (myeloflbrosis), Howell Jolly body (spleen surgically removed or dysfunctional spleen as in HbSS disease), platelet (small, red, anucleate cell), lymphocyte (black dot with a thin rim of cytoplasm), Auer rod (myeloblast with immature nucleus and splinter-like structures in the cytoplasm), smudge cells with lymphocytes (CLL; smudge cells are fragile lymphocytes that rupture), hairy cells (projections from cytoplasm; HCI; B cell malignancy), atypical lymphocyte (big cell with abundant sky blue cytoplasm), eosinophil (large red granules that do not cover the nucleus, same color as RBCs), basophil (large purple granules that do cover the nucleus), rouleau (RBCs with stack of coins effect), schistocytes (fragmented RBCs), reticulocyte (special stain; thin filaments representing RNA), Heinz bodies (special stain, large blue inclusions with involvement of the RBC membrane), coarse basophilic stippling (routine stain, looks like measles of the RBC)
349. Bone marrow pictures
megaloblastic marrow (all the cells appear big; giant band; B12/folate deficiency), myelofibrosis (marrow is composed of fibrous tissue, large cells represent rnegakaryocytes), aplastic anemia (empty marrow with predominantly fat, and islands of lymphocytes), multiple myeloma (piasmablasts with bright blue cytoplasm, eccentric nuclei, perinuclear halo), ringed sideroblast (Prussian blue stain, ring of blue around the nucleus of a normoblast defect in heme synthesis, sideroblastic anemias [alcohol, pyridoxine, Pb poisoning])
350. Patient with left supraclavicular node
Virchow’s node, associated with metastatic stomach cancer or any cancer arising in the abdominal cavity; right supraclavicular node drains the lung and upper neck
351. Roth’s spot in the retina, splinter hemorrhages, Osler’s nodes (palflful) on hands/feet, Janeway lesions hand and feet (painless), hematuria with EEC casts
immunocomplex vasculitis associated with infective endocarditis
352. X-ray with local dilated bowel
sentinel loop indicating localized infection, near duodenum or transverse colon acute pancreatitis, cecum retrocecal appendicitis
353. X-ray with step-ladder appearance and air/fluid levels
bowel obstruction
354. X-ray with collapsed lung and clear space along the margin
spontaneous pneumothorax
355. X-ray of baby with ioops of bowel in left pleural cavity
diapbragmatic hernia
356. Classic urine casts
EEC casts ncpbritic syndrome (post-strcptococcal, IgA nephropathy, Goodpasturc)1 WBC casts = acute pyelonephritis, renal tubular casts acute tubular necrosis, waxy casts chronic renal failure, broad casts = chronic renal failure, hyaline casts (ghost-like casts, non-refractile, smooth bordets) = proteblurla or no clinical significance, fatty casts with Maltese crosses nephrotic syndrome (niinimal change, mcmbranous GN)
757. Urine crystals
calcium oxalate (looks like the back of an envelope or a square with an X drawn in it think stone, Crohn’s disease, ethylene glycol poisoning), cystine (hexagonal ciystal, cystinuria)
358. Staghorn calcuhis in kidney
struvite stone, magnesium aznmonium phosphat~ alkaline urine that smells like ammonia indicating a urease producing urinary pathogen (e.g., Proteus)~
359. Lipid deposits
Achilles tendon xanthoma = familial hypercholesterolcmia (AD; absent LDL mceptor)i xanthelasma (yellow plaque on eyelid, consider type II hyperlipidemia with increase in LDL), arcus senilis (rim of white around the outer part of the cornea, consider increased LDL if a young patient or normal age-related change if older patient), eruptive xanthomas (yellow papular lesions over the body; increased ~ig1ycer~j
360. Psammoma bodies
dystrophic calcification of apoptotic neoplastic cells; meningioma, papillary adenocarcinoina of thyroid, serous cystadenocarcinomas of the ovaries
361. Addison’s disease
autoimmune destruction; hyperpiginentation; hypotensive; hyponatremia, hyperkalemia, normal gap metabolic acidosis from aldosterone lack; hypoglycemia from hypocortisolism (no gluconeogenesis); eosinophilia (no cortisol effect)
362. Diabetes insipidus
central DI hypernatremia (increased Posm) with very low Uosm (no concentration, losing free water from lack of ADH); slier water deprivation, Uosm increases >50% with injection of ADH—nepbrogenic DI same as for central, except ADH is present but cannot reabsorb free water in the collecting tubules and Uosin is <50% increased after ADH administration
363. Pathology of DM
non-enzymatic glycosylation
HbAIc for long-term glycemic control (4-8 weeks), byalinc arterioloscierosis (nephropathy, lacunar infarcts in the brain), enhanced large vessel atherosclerosis; osmotic damage due to conversion of glucose to sorbitol by ~ cataracts, microaneurysm in the eye, peripheral neuropathy (Schwann cell destroyed) B48
364. DM most common cause of
blindness, chronic renal disease, peripheral neuropathy (most common cause of pressure ulcers on the bottom of the feet), non-traumatic amputation of the lower leg, ketoacidosis, Charcot athic joint, glucosuria
365. KA
read endocrine notes and the discussion on diabetes mellitus
366. hromocytoma
benign tumor (brown color) of adrenal medulla; most unilateral, in adrenal medulla, benign; paroxysmal hypertension, headache, drenching sweats; screen urine VMA, metanephrines (best); associations+B51
367. Neuroblastoara
child; malignant tumor in adrenal medulla and paraganglial tissue; hypertension; metastasis to bone, skin, orbit; Homer Wright rosettes; increased urine catccholamines; SlO0 antigen positive; age <1 best prognosis
368. ZE syndrome
malignant islet cell tumor secreting gastrin; ulcers in usual place but can be multiple or in unusual places; increased basal acid output; increased gastrin with IV secretin test; Whipple’s procedure if operable; proton blockers can decrease gastrin; rule out other causes of hypergastrinemia (H2 or proton blockers, chronic atrophic gastritis of body and fundus, renal failure, gastric distention)
369. MEN I (AD inheritance)
pituitary tumor, parathyroid adenoina, 22 syndrome, peptic ulcers MEN Ha (AD inheritance)
parathyroid adenoma, pheochromocytoma, medullary carcinoma of thyroid (calcitonin tumor marker~ calcitonin converted into amyloid) MEN Ub (AD inheritance)
370. Left heart failure
decreased cardiac output. dyspnea, pulmonary edema (increased pulmonary venous hydrostatic pressure), left ventricular dilatation (volume overload), S3 heart sound, mitral insufficiency murmur (stretching of MV ring), paroxysmal nocturnal dyspnea and/or pillow orthopnea at night (increased venous return at night cannot be handled by the left heart)
371. Right heart failure
most commonly cause by LHF, decreased cardiac output, volume overload of right ventricle, S3 heart sound, murmur of tricuspid insufficiency (stretching of TV ring), jugular neck vein distention, congestive hepatomegaly (nutmeg liver, increased LDH5 isoenzyme, RHF most common cause), ascites, dependent pitting edema (kidney reabsorbs slightly more water than salt, but both are increased and are pushed into the interstitial space by the increased venous hydrostatic pressure; restrict water and salt; ACE inhibitor decreases preload and afterload; diuretics decrease preload)
372. High output failure
hyperthyroidism, thiamine deficiency, too much isotonic saline, AV fistula, endotoxic shock in early phases, Paget’s disease of bone
373. Sudden cardiac death
death within 1 hour; severe atherosclerotic CAD but no thrombus; die of ventricular arrhythmia
374. Angina
exertional (severe atherosclerotic CAD; ST depression on stress ECG; pain relieved by stopping exercise or taking nitroglycerin); Prinzinetal (vasoconstriction from release of TXA2 from platelet thrombi~ atherosclerotic CAD not primary cause of disease; ST elevation on stress ECG); unstable angina (angina at rest; severe atherosclerotic CAD; infarct waiting to happen)
375. Restrictive cardiomyopathy
cannot fill properly; glycogen (Pompe’s glycogenosis), iron (iron overload), amyloid (senile ainyloidosis; prealbuniin), endocardial fibroelastosis in child
376. Pericardial effusion
neck vein distention ~ijjtJ~ inspiration (Kussmaiil sign), pulsus paradoxus (drop in blood pressure on inspiration), muffled heart sounds, hypotension; all pressures in all chambers are increased but the cardiac output is decreased; echocardiogram first step and pencardiOcentesis is treatment
377. Constrictive pericarditis
TB most common cause worldwide; heart cannot completeiy fill; pericardial knock when ventricles hit thickened pericardium
378. Hypersensitivity pneumonitis
farmer’s lung (inhalation of thcrmopbilic actinomycetca), silo filler’s (inhalation of nitrogen dioxide fumes), byssinosis (Monday morning blues; patient works in a textile factory and has contact with cotton, linen, hemp)
379. Hamman Rich lung
honeycomb lung; end-stage of alveolitis syncfroines (interstitial pneumonitis syndromes)
380. Bronchiectasis
CF most common cause; obstruction and infection; bronchi extend to lung pcripheiy; cough up cupfuls of foul smelling sputum; other causes TB (most common worldwide), Kartagener syndrome (absent dyncin arm in cilia, situs inversus) Atelectasis most common cause of fever 24 hours after surgery; elevated diaphragm
82. Choanal atresia
baby breaks away from breast and cyanosis is relieved by crying Nasal polyps
aHergic~ aspirin (patient with headache develops asthma), cystic fibrosis (child with polyps)
384. Pulmonary hypertension
increased P2; PH leads to RVH (cor pulmonale if PH is of primary origin or due to primary lung disease not heart disease); chronic hypoxemia (vasoconstricts pulmonary vessels and vasodilates peripheral vessels), loss of pulmonary vasculature (COPD, restrictive lung diseases), left to right shunts with eventual volume overload of right heart, mitral stenosis with backup of blood into pulmonary veins; gross atherosclerosis of pulmonary arteries, smooth muscle bypertrophy of pulmonary vessels, angiomatoid lesions; primary PH mainly in young women
385. ARDS
non-cardiogenic pulmonary edema from neutrophil related injury; endotoxic shock most common cause; intrapulmonary shunting most important abnormality; separate from cardiogenic pulmonary edema by pulmonary capillary wedge pressure (measure of LV end-diastolic pressure; decreased in ARDS, increased in cardiogenic shock)
386. Lung cancer
squamous/small cell centrally located; adenocarcinomas peripherally located
387. Dysphagia for solids not liquids
think obstruction—strictures, Plummer-Vinson, esophageal omcer
388. Dysphagia for solids and liquids
think peristalsis problem—PSS, CREST syndrome, polymyositis, achalssii
389. Leukoplakic lesions in mouth or genital area
biopsy to rule out squamous dysplasia/cancer
390. Smokeless tobacco
verrucoid squamous cancer in the mouth
391. Squamous cancer in mouth
lateral border of tongue followed by lower lip; upper lip is a basal cell
392. Hairy leukoplakia of tongue
EBV glossitis, predates onset of AIDS
393. Oral pigmentation
PJ syndrome, Addison’s disease, Pb poisoning in adult
394. Gum hyperplasia
phenytoin, pregnancy, scurvy, acute monocytic leukemia
395. Leiomyoma
most common benign tumor in women (uterus location), most common tumor of GI tract (most commonly in stomach)
396. Extranodal lymphoma
most commonly in stomach (most are high grade immunoblastic lyniphomas), next in Peyer’s patches; H. pylon associated with low grade lymphomas
397. Bowel obstruction
adhesions from previous surgery (if no history of previous surgery, pick indirect inguinal hernia)
398. Intussusception
child, colicky abdominal pain, bloody diarrhea, terminal ileum into cecum
399. Carcinoid tumor
yellow tumor on tip of appendix most common overall site; terminal ileum most common sight for tumor that metastasizes to liver to produce the carcinoid syndrome
400. Colorectal cancer. left side obstructs and right side bleeds
401. Sigmoid colon most common site for
cancer in GI tract, diverticular disease, polyps
402. Hematochezia
diverticulosis followed by angiodysplasia (cecum; elderly patient)
403. Budd-Chiari syndrome
hepatic vein thrombosis (PR.V most common cause); liver congested, ascites, portal hypertension
404. AAT deficiency
PAS positive globules in hepatocytes in children; panacinar emphysema in adults (lower lobes)
405. Exfrahepatic biliary atresia
bile duct proliferation in triads, radioactive dye cannot get into the small intestine, jaundice in first week of life
407. Wilson’s disease
408. Primary biliary cirrhosis
female; early presentation with pniritus (bile salt deposition in skin), increased ~1kn1ine phosphatase. no jaundicà until late; granulomatous destruction of bile ducts in triads; increased anti-initochondrial antibodies and 1gM; association with Sjogrcn syndrome and renal tubular acidosis
409. Sclerosing pericholangitis
complication of ulcerative colitis; jaundice; ERCP for diagnosis
410. Hydatid cysts in liver
sheepherder (Basque. Greek) with liver cysts; anaphylactic shock; dog is definitive host, sheepherder is intermediate host
411. Pipestem cirrhosis
Schistosoma mansoni (sharp latcra1~~~adults lay eggs in portal vein tributaries producing fibrosis; ascites and portal hypertension
412. Stone in common bile duct
most common cause of obstructive jaundice
413. Granulomatous hepatitis
think TB if infective and sarcoid if non-infective
414. lschemic ATN
prerenal azotemia most common cause; affects multiple parts of the nephron; basement membrane disrupted; pigmented renal tubular casts
415. Nephrotoxic ATN
aminoglycosides and IVP dyes most common cause; o tubule only
416. Renal papillary necrosis
analgesic abuse (acetaminophen + aspirin), di
417. NydrOnephrosis
most commonly due to a renal stone
418. Renal stone
calcium oxalate most common stone; colicky flank pain with radiation into groin; bematuria; flat plates identifies most stones (calcium); hypercalciuria most common metabolic abnorma1it~, hydrocblorothiazidc increases calcium reabsorption in ncphron; uric acid stone non-visualized
419. Epididymitis
<35 GC, Chlainydia; >35 E~ col4 Pseudomonas
420. Varicocele
left side; bag of worms; cause of infertility; sperinatic vein comes off the left renal vein
421. Prostatic hyperplasia
transitional zone around the urethra; testosterone and estrogen mediated; prostate cancer is in peripheral zone (outside and detected by rectal exam), hence dribbling, urinary retention is more likely benign than malignant; PSA does not distinguish hyperplasia from cancer
422. Testicular cancers
serninoma most common (ciyptorchid relationship; most radiosensitive; para-aortic lymph node metastasis), choriocarcinoma most malignant (increased ~-hCG), yolk sac tumor most common in children (endodennal sinus tumor; Schiler Duval bodies; increased AFP), malignant lyinphoma most common in elderly man (metastatic)
423. Malignant hypertension
background of essential hypertension and benign nephrosclerosis; gross flea bitten kidney; micro necrotizing arteriolitis, fibrinoid necrosis in glomerular capillaries, onion skinning of arterioles (hyperplastic arteriolosclerosis) B118
424. Vulvar Paget’s disease
intraepithelial adenocarcinoma
425. Koilocytosis
HPV effect in squamous cells; pyknotic nucleus surrounded by a clear halo
426. flJD
Actinomycosis with sulfur granules; actinomycosis also for draining sinus from the jaw
427. Endometritis
plasma cells present; group B streptococcus
428. Adenomyosis
glands and stroma in myometrium; not endometriosis
429. Eudometriosis
glands and stroma outside confines of the uterus; reverse menses; most common ~ tJsNIUWy ~ dysmenorrhea ovaries most often involved (chocolate cysts); laparoscope most common for diagnosis and treatment; only in reproductive life
430. Leiomyosarcoma
most common uterine sarcoma
431. Cervical polyp
non-neoplastic; hangs out of cervical Os; posicoital bleeding
432. Endometrial polyp
no malignant potential; menorrhagia
433. Cervical cancer
death due to renal failure from extension into the retroperitoneum and blockage of ureters
434. Ectopic pregnancy
due to previous P11); rupture is most common cause of death in early pregnancy; ~-hCG initial test; vaginal ultrasound to check for amniotic sac; unclotted blood in pouch of Douglas
435. RectaL pouch of Douglas
anterior to rectum and posterior to uterus; can palpate with rectal exam; induration in young woman = endometrial implants; induration in elderly woman = seeding from primary ovarian cancer; unclotted blood = ruptured ectopic; pus = P11)
436. Follicular cyst
most common overall ovarian mass
437. Surface derived ovarian tumors
benign serous cystadenoma (most common overall benign tumor), Brenner’s tumor (Waithard’s rests); malignant serous cystadenocarcinorna (most common primary cancer of ovary; most common bilateral ovarian tumor; psammoma bodies), mucinous cystadenocarcinoma (largest ovarian tumor, most often associated with pseudomyxoma peritonei), endometrioid carcinotha (greatest association with cndometriosis)
438. Germ cell tumors of ovary
cystic teraloma most common (undergoes torsion; struma ovarii = component of thyroid tissue; teeth and bone seen on x-ray); dysgerminoma most common malignant tumor (Turner syndrome relationship; female counterpart of male seminoma with cryptorchid testis), yolk sac tumor most common tumor in girl (increased AFP)
439. Sex cord stromal tumors
fibroma most common (benign tumor, Meig syndrome fibroma, ascites, right sided pleural effusion), granulosa cell tumor (feminizing tumor, low grade malignancy; Call Exner bodies), Sertoli Lcydig cell tumor (benign; masculinizing tumor, alias androblastoma and arihenoblastoma), Leydig cell tumor (benign masculinizing tumor, alias hilar cell tumor, crystals of Reinke), gonadoblastoma (germ cell and sex cord stromal; catcifies; association with Turner’s)
440. Xrukenberg tumor~ metastatic gastric cancer to both ovaries; signet ring cells
441. Hydatidiforni moles
complete mole (46 XX, both chromosomes of paternal origin, most often associated with choriocarcinoma grape-like mass; preeclampsia in first trimester; uterus too large for gestational age; increased ~-hCG), partial mole .(trisomy; embryo present does not transform into choriocarcinoma)
442. Gestationally derived choriocarcinoma
syncytiotrophoblast (synthesizes bCG and human placental lactogen) and cytotrophoblast; not chorionic villi; metastasizes to lungs; responds dramatically to methotrexa~
443. Function of f~-hCG
LH analogue that maintains the corpus luteum of pregnancy for 8-10 weeks, then placenta takes over
444. Twin placenta
monochorionic = identical twins whether monoamniotic (Siamese twins, fetal to fetal transfusion, tangle in umbilical cord) or diamniotic; dichorionic. fraternal or identical twins
445. Abruptio placenta
painful bleeding; retroplacental hemorrhage; maternal hypertension or cocaine abuse
446. Placenta previa
painless bleeding; implantation over cervical os
447. Two umbilical arteries and one vein (oxygenated blood)
single artery has an increased incidence of congenital anomalies
448. Lecithin/Sphingomyelin ratio
>2/1 in amniotic fluid indicates adequate pulmonary surfactant
449. Urine estriol
derived from fetal adrenal, placenta, maternal liver; low levels indicate fetal, placental or maternal problem
450. Human placental lactogen
growth hormone of pregnancy; anti-insulin activity
451. Amniotic fluid
fetal urine; alkaline PH; swallowed and recycled by the fetus
452. Dysfunctional uterine bleeding
bleeding not secondary to an anatomic cause; hormonal imbalance; anovulatory bleeding most common cause of bleeding after menarche; ovulatory types inadequate luteal phase and irregular shedding
453. Ovulation
increase in temperature; subnuclear vacuoles; presence of secretory endometrium on day 21
454. Implantation on day 21
3 days in the tube and 2 days in the uterus
455. Primary amenorrhea (no menses by 16 years of age)
no bleeding post progesterone challenge means there is no estrogen primed uterus or there is an end-organ defect; hypothalamic! pituitary defect decreased FSH/LH (anorexia nervosa, weight loss syndrome, pituitary tumor); ovarian defect increased FSH/LH (probable Turner’s syndrome), end-organ defect normal FSHJLH; most cases are normal constitutional delays with good secondary sex characteristics and withdrawal bleeding think Turner’s if there are poor secondary sex characteristics, high gonadotropins, and no withdrawal bleeding; check for imperforate hymen/absent vagina if good secondary sex characteristics and no bleeding with progesterone challenge
456. Secondary amenorrhea (no menses for 3 months)
pregnancy most common cause; same classification as above; Asherman syndrome stratum basalis removed owing to repeated dilatation and curettage (end-organ defect; normal gonadotropins)
457. Cervical Pap smear
must be endocervical cells (gold standard) indicating proper sampling of the endocervical canal where dysplasia occurs; superficial squamous cells = estrogen, intermediate squamous cells = progesterone, parabasal cells unstimulated squamous cells; normal female
70% superficial and 30% intermediate; pregnancy/prepubertal
100% intermediates; atrophic predominantly parabasals
458. Lewis antibodies
naturally occurring antibodies with no clinical significance; no risk of hemolytic disease of newborn (HDN)
459. Duffy antigens
uncommon in Blacks; surface receptor for P. vivax~ hence protection against malaria
460. I antigens
anti-I is a cold agglutinin (1gM) seen in M. pneuznoniae infections; anti-i (1gM) is seen in infectious mononucleosis
461. Blood group 0
universal donor, no antigens on surface and cannot be destroyed; must receive 0 blood, increased incidence of duodenal ulcers, have 3 antibodies (anti-A 1gM, anti-B 1gM, antiA,B IgG [can cross the placenta])
462. Blood group AB
universal recipient; no antibodies to destroy transfused RBCs
463. Blood group A
has anti-B 1gM; increased incidence of gastric cancer
464. Blood group B
has anti-A 1gM
465. Rh positive
means the patient has D antigen; other Rh antigens C, c, E, e, d does not exist
466. Major crossmatch
patient serum against donor RBCs to see if there are any patient antibodies that react against donor RBCs; if compatible~ it does not guarantee that infused RBCs will not be destroyed or that the patient will not develop antibodies against other donor RBC antigens
467. HP? risk post-transfusion
468. HBV risk post-transfusion
471. Fresh frozen plasma
contains all coagulation factors; only for multiple factor deficiencies; risk of hepatitis
472. Packed RBCs
high hematocrit contains some plasma; transfuse only if patient is symptomatic and does not respond to medical therapy; risk of hepatitis
473. Platelet transfusion
only if patient is symptomatic; risk of hepatitis
474. Cryoprecipitate
all factor VIII molecules, fibrinogen, factor XIII, fibronectin; hepatitis risk
475. Rh immune globulin
anti-D from pooled human donors (passive immunization); does not cross the placenta; give to pregnant women who do not have anti-D to protect during each pregnancy; give if baby is Rh positive and mother does not have anti-D (give within 3 days); amount of Rh immune globulin to give is based on Klelhauez’Be&e teat performed on maternal blood that detects the amount of fetal-maternal bleed (fetal RBCs resistant to alkali and c14 no hepatitis risk
476. Rh HDN
mother Rh negative and baby Rh positive; first pregnancy with Rh + baby has no effect on baby but mother could be exposed to fetal RBCs with D antigen during delivery and develop antibodies (purpose of Rh immune globulin is to prevent this); if subsequent pregnancies have Rh + babies, maternal anti-D IgG antibodies cross placenta -~ attach to fetal RBCs -, RBCs extravascularly removed by fetal macrophages in the spleen —‘ unconjugated bilirubin (UCB) is end-product of hemolysis —, fetus develops anemia (chance of heart failure and hydrops fetalis) and mother’s liver takes care of the UCB —, bilirubin pigment can be detected in amniotic fluid (optical wavelength of 450) and mapped on a Liley graph to determine severity of hemolysis -+ at delivery, baby cannot handle UCB load and is often exchange transfused to prevent kernicterus, remove UCB, remove antibodies, correct anemia
477. Febrile transfusion reaction
patient has anti-HLA antibodies against HLA antigens on donor Icukocytes causing release of pyrogens from destroyed donor leulcocytes; type II hypersensitivity
478. Allergic transfusion reaction
patient develops hives against proteins in donor unit; type I hypersensitivity
479. Hemolytic transfusion reaction
ABO incompatibility (patient receives wrong blood type; e.g., patient A thas anti-B 1gM] and donor blood is B; anti-B 1gM attaches to B positive donor cells -4 activates complement system -~ intravascular hemolysis; type II hypersensitivity reaction); patient has undetected antibodies that react against donor RBC antigens (extravascular hemolysis; jaundice, drop in Hb, positive direct Coombs; type II hypersensitivity)
480. Factors preventing small vessel bleeding
heparin (enhances antithrombin III [ATm], which neutralizes most serine protease coagulation factors-prothrombin, X, DC~ XIL Xl, thrombin), P012 (synthesized by endothelial cells, vasodilator, inhibits platelet aggregation), protein C and S (inactivate factors V and VIII, enhance fibrinolysis), tissue plasminogen activator (release of plasmin, which destroys coagulation factors and clots)
481. Factors acting as procoagulants in small vessel injury
thromboxane A2 (synthesized by platelets, vasoconstrictor, enhances platelet aggregation; cyclooxygenase blocked by aspirin and NSA.1DS), von Willebrand factor (Vffl VWF; synthesized by endothelial cells and megakaryocytes, platelet adhesion factor [platelets have receptors for VIIl VWF]), extrinsic and intrinsic coagulation system B44
482. Normal events with vessel injury
vessel injury —~ activation of factor VII in the extrinsic coagulation system by tissue thromboplastin and activation of factor XII in the intrinsic system by exposed collagen —4 platelets stick to VIIJ VWF via their receptors (platelet adhesion) - stimulus for platelet release of AD? from dense bodies causing platelet aggregation and synthesis of TXA2 - temporary platelet plug with fibrinogen draped over it (fibrinogen flbrinogen into flbrin and forms a stable platelet plug -+ plasmin destroys the plug and reestablithes blood flow
483. Bleeding time
detects platelet abnormalities up to the formation of the temporary hemostatic plug (thrombocytopenia; no VflI VWF for platelet adhesion; patient on aspirin and no TXA2 for aggregation [most common cause])
484. Ristocetin cofactor assay
best test for Vffl VWF (von Willebrand factor, which is synthesized by endothelial cells and megakaryocytes and is necessary for platelet adhesion [platelets have receptors])
485. Prothrombin time (Fl)
detects extrinsic coagulation system factors down to formation of a clot—VU (extrinsic system) -~ X —~ V -4 U (prothrombin) -, I (fibrinogen) -+ clot; international normalized ratio (for patients on warfarin) standardizes the test throughout the world so all test results are the same regardless of the reagent used; PT is best test for liver synthetic function
486. Partial thromboplastin time (PTT)
detects intrinsic coagulation system factors (XII, XI, IX, Viii) down to formation of aclot-XU -, XI -4 IX -4 VIII -4 X .4 V —311 (prothrombin) - I (flbrinogen) —4 clot; used to follow heparin therapy and factor deficiencies
487. Factor VU deficiency
prolonged PT and normal PU
488. Factor VIII deficiency (hemophilia A
decreased VUI coagulant, normal VIII antigen and Vffl VWF) normal PT and prolonged PU
489. Factor X deficiency
prolonged PT and PiT
490. Patient on heparin
prolonged PT and PTT but PU is the better test to follow patients; if ovcranticoagulatcd give protamine sulfate
491. Patient on warfarin (blocks vitamin Ks ability to y-carboxylate factors U, VU, IX, X, protein C and S by blocking epoxide reductase, which normally keeps vitamin K in its active KI state)
prolonged PT and PU but PT is better test for following patients; if overanticoagulated and seriously bleeding give fresh frozen plasma and IM vitamin K; if bleeding not serious, give TM vitamin K
492. Patient with VWD (all factor VIII components decreased
VIII coagulant, Vffl normal PT and prolonged PU autigen, Vffl VWF) prolonged bleeding time, normal PT, prolonged PT!’
493. Patient with antibody against factor Vui
coagulant (circulating anticoagulant, inhibitor) and prolonged PTT normal PT and prolonged PTT; after mixing 0.5 cc of normal plasma with 0.5 cc of patient plasma, the Pfl is repeated and is still prolonged because antibodies inhibited VIII coagulant in the normal plasma as well; a true factor ViiLcoagulant deficiency would have correction of the PIT after adding normal plasma
494. Fibrinolytic system tests
fibrin (ogen) split.products (X, Y, D, E fragments) after plasmin breakdown of fibrinogen or a fibrin clot; D-dimers, which measures cross-linked fibrin monomers in a fibrin clot
495. NC
intravascular consumption of clotting factors (fibrinogen, V, VIII, prothrombin, platelets) with diffuse, oozing of blood from all breaks in the skin; causes . endotoxic shock, infections, snake envenornation, amniotic fluid embolism); prolonged PT and PU, low fibrinogen, increased split products and. D-dimer (these are the best tests for DIC), thrombocytopenia, schistocytes (RBCs hit fibrin clots); treat the underlying disease causing DIC; use blood components to keep the patient alive; heparin blocks thrombin, hence preventing clots and consumption of coagulation factors B161
496. Hereditary thrombosis syndromes
venous thrombosis and pulmonary emboli; ATIII deficiency (no prolongation of PIT after starting heparin), protein C and S deficiency
497. Heparin
prevents venous clot formation; does not dissolve the clot; can be used in pregnancy; can produce thrombocytopenia
498. Warfarin
blocks epoxide reductase (normally keeps vitamin K in its active K! state); previously y-carboxylatcd vitamin K dependent factors must disappear before patient is fully anticoagulated (reason why heparin is given along with warfarin); VII and protein C have the shortest half-life (6 hours) and prothrombin the Longest (3 days);. hemorrhagic skin necrosis patient with heterozygote protein C deficiency and 50% factor level, when put on warfarin will have 0% protein C levels in 6 hours causing thrombosis of vessels in the skin before the patient is fully anticoagulated B174
Henoch-Schoenlein’s purpura most common immunocomplex (igA-anti-IgA) vasculitis in children; URI followed by palpable purpura (sign of small vessel vasculitis), polyarthritis, bematuria (glomenilonephritis), Gi bleed
500. Thromboangiitis obliterans (Buerger’s)
smoker’s vasculitis; thrombosis of digital vessels with gangrene; quit smoking
501. Kawasaki’s disease
most common cause of childhood myocardial infarction; coronary artery vasculitis + mucous membrane inflammation and skin desquamation at tips of fingers
502. Polyarteritis nodosa
immunocomplex vasculitis of muscular arteri HBsAG —30%; vessels in different stages of healing; aneurysm formation; renal infarction; p-ANCA antibodies; 1 ose th arteriography
503. Takayasu’s arteritis
pulseless disease in Asian female; granulomatous vasculitis of aortic arch vessels; blindness; strokes
504. HbAIc
best test to following glycemic control over the last 4-8 weeks in diabetes
505. Aseptic necrosis
Legg-Perthe (femoral head; child under 10), femoral fracture in elderly (most common cause), scaphoid bone in wrist, corticosteroids (femoral head), HbSS (femoral head)
506. Osgood Schiatters
inflammation of proximal tibial apophysis at insertion of patellar tendon; active boys
507. Hypoglycemia
most commonly due to insulin overdose in a type I diabetic I
508. Bell’s palsy
droopy face; cannot close eye; association with HSV-1
509. Islet cell tumors
510. Myotonic dystrophy
511. Alcohol and CNS/PNS
Wernicke-Korsakoft cerebellar atrophy, cerebral atrophy, central pontinc mydlinolysis (too rapid infusing of sodium in hyponatremia), peripheral neuropathy
512. Guillain-Barré
autoimxrnme dernyclination of peripheral nerves primarily affecting motor fibers; follows URI; ascending paralysis (LMN symptoms); increased CSF protein, no increase in cells
513. Menetrier disease
increased endolymph; dizziness, vertigo, hearing loss, horizontal nystagmus
514. Benign positional vertigo
most common cause recurrent vertigo; no hearing loss or tinnitus; nystagmus; dislocation of otoliths
515. Multiple sclerosis
most common deniyelinating disease; association with HSV-6 and HLA-Dr2; scanning speech (sound drunk), intention tremor, nystagmus; paresthesias and muscle weakness; plaques commonly periventricular; cerebellar ataxia internuclear ophthalmoplegia; increased CSF protein and slight increase in lymphocytes
516. Parkinson’s
dcpigrnentation substantia nigra decrease in dopamine; Lewy bodies in neurons; rigidity bradykinesia, cogwheeling resting tremor (pill rolling); festinating gait; blank stare; MflP association, drugs (chiorpromazine) B179
517. Oligodendroglioma
adult; frontal lobes; benign tumor that calcifles
518. Calcium/PTH disorders
519. Kidneys with irregular white patches on the cortical surface
pale infarcts from enibolization from the left heart
520. Concentric hypertrophy of left ventricle
increased afterload; essential hypertension most common cause; aortic stenosis; not mitral stenosis (no hypertrophy, since blood is not getting into the LV)
521. Hypertrophy and dilatation of left ventricle
volume overload due to aortic or mitral valve insufficiency, left to right shunts with increased return to left heart, aortic valve ring dilatation (dissection, aortitis) Anatomy Questions
1. Gsp junction
dye passes from one cell to the next
2. Derivation of adrenal medulla
neural crest origin; neuroblasts develop into ganglia know the layers of the adrenal gland from outside in
3. Tibial nerve function
plantar flexion of toes; injury loss of plantar flexion, foot dorsiflexed and everted (calcaneovalgocavus), sensory loss on sole of foot
4. Composition of aortic valve (also pulmonic valve)
lined by endothelium and have abundant fibroclastic tissue plus a dense collagenous core; avascular~ MV and TV have a loose connective tissue core which is increased in initral/iricuspid valve prolapse (myxomatous degeneration)
5. Break humerus, wrist drop
radial nerve injury
6. Post-radical mastectomy—winged scapula
indicates injury to the long thoracic nerve; paralysis of the serratus anterior muscle
7. Patient with a nosebleed and rhinorrhea
fracture of cribrif’orm plate in ethmoid sinus
8. Medial longitudinal fasciculus demyelination in MS
internuclear ophthalmoplegia
9. Parathyroid derivation
third and fourth pharyngeal pouches
10. Aortlc arch derivatives
review in embiyology book or First Aid for Boards
11. Phase of meiosis eggs are in before and after ovulation
before mciosis I is arrested in prophase until ovulation; meiosis II is arrested in metaphase after fertilization B206
12. What runs along the radial artery
median nerve
13. Artery affected in femoral neck fracture
medial femoral circumflex artery
14. EM of egg
where does sperm penetrate (zona pellucida)
15. Where is metaphase II completed
in uterus
16. Types of collagen
I (bone, tendon, skin; greatest tensile strength), ifi (initial collagen of wound repair, replaced by type I [collagenase with Zn as a cofactor]), IV (basement membrane), X (epiphyscal plate; picture of bone on the exam and had to label where X was located)
17. Wallerian degeneration
Schwann cells begin to proliferate and form a tube that will serve to guide axon sprouts in the regeneration process; regeneration of the nerve occurs by the outgrowth of multiple axon sprouts from the proximal surviving segment of the axon; sprouts are directed distally (growth rate of 1-3 mm/day) down the tube established by the proliferating Schwann cells; sprouts are remyelinated and reestablish continuity with the motor end plate of the muscle.
18. Circle of Willis diagram
name arteries
19. Kidney CT
20. CT liver~ show where the bepatic vein drains into the inferior vena cava
21. Nerve injured in inidshaft humerus fracture
median nerve
22. Know the layers of the gastric inucosa
23. Oligodendrocytes
myelinate in the CNS, while Schwann cells myelinate in the PNS
24. Stage of eggs post-partum
meiosis I arrested in prophase
25. Eye closed cannot open and eye deviated down and out
oculomotor nerve palsy; eye down and in trochlear nerve palsy B210
26. Child with a popsicle stick in his mouth falls down causing the popsicle stick to hit the back of his throat and develops ptosis and ineiosis of the right eye
injury to the cervical sympathetic ganglion
27. Vertical diplopia is associated with
cranial nerve IV palsy
28. Patient with headache and physical findings of mydnasis in the right eye in association with mild lid lag, and deviation of the eye down and out
an aneurysm compressing cranial nerve 111 (headache is the giveaway for aneurysm)
29. Patient with a recent history of bacterial meningitis has horizontal diplopia in the left eye, which is worse on gaze to the left
cranial nerve VI palsy (lateral rectus weakness from VI nerve palsy)
30. Patient with bilateral lateral rectus muscle weakness
increase in intracranial pressure (classic sign; papilledema usually present)
31. Paralysis of upward gaze in an infant bydrocephalus secondary to stenosis of the aqueduct of Sylvius (this is called Parinaud’s syndrome)
32. Multiple ocular motor nerve disorders
diabetes mellitus (common cranial nerve palsies from osmotic damage to nerves)
33 Weakness of the quadriceps muscle and an absent knee jerk reflex
herniated L3 - L4 disk .~
36. Young child falls on his outstretched arm and has pain in the middle and lateral portion of his clavicle; upper extremity remains in abduction, extension, and internal rotation
nerve injured is C5-C6 (Erb-Duchenne syndrome, or superior brachial plexus injury due to a clavicular fracture; these are also the most common fractutas In newborns; C8-T1 are inferior brachial plexus injures or Klumpke’s syndrome)
37. Patient has paralysis of the oculomotor nerve after a head injury
uncal herniation with compression of the Ifird nerve (ptosis of eye, mydriasis)
38. Numbness of the thenar aspect of the hand
median nerve (carpal tunnel)
39. Wrist bone with greatest incidence of aseptic necrosis
navicular bone (scaphoid) _____
40. Supracondylar fracture
injury to brachial artery and median nerve; danger of ischemic contractures in forearm muscle (VoI1rm~nn’s ischemic contracture)
41. Know the fetal circuistion
ductus venosus and umbilical vein have the highest oxygen content