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153 Cards in this Set

  • Front
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Cushing triad
hypertension, bradycardia, respiratory depression (increased intracranial pressure)
Congenital heart disease, Right-to-left shunts
The 5 T’s: Tetralogy, Transposition, Truncus, Tricuspid, TAPVR
Congenital cardiac defect associations: 22q11 syndromes
Truncus arteriosus, tetralogy of Fallot
Congenital cardiac defect associations: Down syndrome
ASD, VSD, AV septal defect (endocardial cushion defect)
Congenital cardiac defect associations: Congenital rubella
Septal defects, PDA, pulmonary artery stenosis
Congenital cardiac defect associations: Turner’s syndrome
Coarctation of aorta
Congenital cardiac defect associations: Marfan’s syndrome
Aortic insufficiency (late complication)
Congenital cardiac defect associations: Infant of diabetic mother
Transposition of great vessels
Churg-Strauss syndrome
Granulomatous vasculitis with eosinophilia. Most often presents with asthma. sinusitis, skin lesions, and peripheral neuropathy (e.g., wrist/foot drop); can also involve heart, GI, and kidneys. p-ANCA.
Sturge-Weber disease
Congenital vascular disorder that affects capillary-sized blood vessels. Manifests with port-wine stain on face and ipsilateral leptomeningeal angiomatosis (intracerebral AVM). seizures, and early-onset glaucoma.
Henoch-Schönlein purpura
Most common form of childhood systemic vasculitis. Skin rash on buttocks and legs (palpable purpura). arthralgia, intestinal hemorrhage, abdominal pain, and melena. Follows URIs. IgA immune complexes. Association with IgA nephropathy. Common triad: 1. skin, 2. joints, 3. GI
Vascular disease, affects small vessels
Raynaud's disease, Wegener's granulomatosis, Microscopic polyangiitis, 1° pauci-immune crescentic glomerulonephritis, Churg-Strauss syndrome, Sturge-Weber disease, Henoch-Schönlein purpura,
Vascular disease, affects small and medium vessels
Buerger's disease, Kawasaki disease, Polyarteritis nodosa
Vascular disease, affects medium and large vessels
Takayasu's arteritis, Temporal arteritis (giant cell arteritis),
Takayasu’s arteritis
pulseless disease––granulomatous thickening of aortic arch and/or proximal great arteries. Associated with an ↑ ESR. Primarily affects Asian females < 40 years old. Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities. FAN MY SKIN On Wednesday.
Most common vasculitis that affects medium and large arteries
Temporal arteritis (giant cell arteritis)
Embolus types
FAT BAT: Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor.
Hydralazine
↑ cGMP→smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction. Severe hypertension, CHF, First-line therapy for hypertension in pregnancy, with methyldopa. Frequently co-administered with a β-blocker to prevent reflex tachycardia.
Minoxidil
K+ channel opener —hyperpolarizes and relaxes vascular smooth muscle. Severe hypertension. Toxicily: Hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention
Calcium channel blockers efficacy
Vascular smooth muscle—nifedipine > diltiazem > verapamil; Heart —verapamil > diltiazem > nifedipine
Antiarrhythmics IA
Quinidine, Procainamide, Disopyramide
Antiarrhythmics IB
Lidocaine, Mexiletine, Tocainide
Antiarrhythmics IC
Flecainide, encainide, propafenone
Antiarrhythmics III
Sotalol, ibutilide, bretylium, amiodarone
Pituitary gland hormones
Acidophils––GH, prolactin. B-Flat: Basophils––FSH, LH, ACTH, TSH
Don't need insulin for glucose uptake
BRICK L: Brain, RBCs, Intestine, Cornea, Kidney, Liver
Cortisol function
BBIIG: 1. Maintains Blood pressure (by upregulating α1 receptors on arterioles); 2. ↓Bone formation; 3. Anti-Inflammatory; 4. ↓immune function; 5. ↑Gluconeogenesis, lipolysis, proteolysis.
Signaling pathways of endocrine hormones: cAMP
FLAT CHAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 receptor), MSH, PTH, Calcitonin, Glucagon
Signaling pathways of endocrine hormones: cGMP
ANP, NO (EDRF)
Signaling pathways of endocrine hormones: IP3
GGOAT: GnRH, GHRH, Oxytocin, ADH (V1 receptor), TRH
Signaling pathways of endocrine hormones: Steroid receptor
Glucocorticoid, Estrogen, Progesterone, Testosterone, Aldosterone, Vitman D, T3/T4
Signaling pathways of endocrine hormones: Tyrosine kinase
Insulin, IGF-1, FGF, PDGF, Prolactin, GH
T3 functions
4 B’s: Brain maturation, Bone growth, Beta-adrenergic effects, BMR ↑
Pheochromocytoma symptoms
5 P’s: Pressure (elevated blood pressure), Pain (headache), Perspiration, Palpitations (tachycardia), Pallor
Hypercalcemia
CHIMPANZEES: Calcium ingestion (milk-alkali syndrome), Hyperparathyroid, Hyperthyroid, Iatrogenic (thiazides), Multiple myeloma, Paget’s disease, Addison’s disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D, Excess vitamin A, Sarcoidosis.
SIADH
Sx: 1. Excessive water retention. 2. Hyponatremia. 3, Urine osmolarity > seruin osmolarity. Causes include: 1. Ectopic ADH (small cell lung cancer). 2. CNS disorders/head trauma. 3. Pulmonary disease. 4. Drugs (e.g., cyclophosphamide).
Carcinoid syndrome
Rule of 1/3s: 1/3 metastasize; 1/3 present with 2nd malignancy; 1/3 multiple
pramlintide
mimetics for DM type 2, ↓glucagon
exenatide
GLP-1 mimetics. ↑insulin, ↓glucagon release. Type 2 DM
orlistat
inhibits pancreatic lipases. Long-term obesity management. SE: Steatorrhea. Gl discomfort, reduced absorption of fat-soluble vitamins, headache.
sibutramine
Sympathomimetic serotonin and norepinephrine reuptake inhibitor. Short-term and long-term obesity management. SE: Hypertension and tachycardia
Demeclocycline
ADH antagonist (member of the tetracycline family). For SIADH.
Submucosal nerve plexus
Meissner’s plexus, Regulates local Secretions, blood flow, and absorption.
Myenteric nerve plexus
Auerbach’s plexus, Coordinates Motility along entire gut wall. Located between inner (circular) and outer (longitudinal) layers of smooth muscle in GI tract wall.
Femoral region
NAVEL: Lateral to medial: Nerve-Artery-Vein-Empty space-Lmphatics.
Hesselbach’s triangle
Inferior epigastric artery, Lateral border of rectus abdominis, Inguinal ligament
Peyer’s patches
Unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine. IgA
most serous and most mucinous Salivary glands
Serous on the Sides (parotids); Mucinous in the Middle (sublingual).
the only GI submucosal glands
Brunner’s glands, Located in duodenal submucosa
what activates trypsinogen
enterokinase/enteropeptidase, an enzyme secreted from duodenal mucosa. Trypsin activates other proenzymes and more trypsinogen (positive feedback loop).
2° achalasia
Chagas’ disease; Scleroderma (CREST syndrome) is associated with esophageal dysmotility involving low pressure proximal to LES.
Boerhaave syndrome
Transmural esophageal rupture due to violent retching
Esophageal cancer
ABCDEF. Alcohol/Achalasia, Barrett’s esophagus, Cigarettes, Diverticuli (e.g., Zenker’s diverticulum), Esophageal web (e.g., Plummer-Vinson)/Esophagitis, Familial
Ménétrier’s disease
Gastric hypertrophy with protein loss, parietal cell atrophy, and ↑ mucous cells. Precancerous. Rugae of stomach are so hypertrophied that they look like brain gyri.
Most common congenital anomaly of the GI tract.
Meckel's diverticulum. five 2’s: 2 inches long, 2 feet from the ileocecal valve, 2% of population, Commonly presents in first 2 years of life, May have 2 types of epithelia (gastric/pancreatic).
Hirschsprung’s disease
Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses (Auerbach’s and Meissner’s plexuses) in segment on intestinal biopsy. Due to failure of neural crest cell migration.
Familial adenomatous polyposis (FAP)
[AD] mutation of APC gene on chromosome 5q. Thousands of polyps; pancolonic; always involving the rectum. 100% progress to CRC.
Gardner’s syndrome
FAP+osseous and soft tissue tumors, retinal hyperplasia.
Turcot’s syndrome
FAP+malignant CNS tumor.
Hereditary nonpolyposis colorectal caneer (HNPCC/Lynch syndrome)
[AD] Mutations of DNA mismatch repair genes. ~80% progress to CRC. Proximal colon always involved.
risk factor of CRC
IBD, Streptococcus bovis bacteremia, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers syndrome.
Reye’s syndrome
Rare, often fatal childhood hepatoencephalopathy. Findings: mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, coma. Associated with viral infection (especially VZV and influenza B) that has been treated with salicylates. Aspirin is not recommended for children (use acetaminophen, with caution).
Wilson’s disease
[AR] ABCD. Asterixis, Basal ganglia degeneration (parkinsonian symptoms), Ceruloplasmin ↓, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Dementia. Hemolytic anemia. Treat with penicillamine.
Hemochromatosis (classic triad)
micronodular Cirrhosis, Diabetes mellitus, skin pigmentation → “bronze” diabetes. HLA-A3.
Acute pancreatitis (risk factors)
GET SMASHeD. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs (e.g., sulfa drugs).
WBC differential from highest to lowest:
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils. (Neutrophils Like Making Everything Better).
Causes of eosinophilia
NAACP: Neoplastic, Asthma, Allergic processes, Collagen vascular diseases, Parasites
Target cell
HALT: HbC disease, Asplenia, Liver disease, Thalassemia.
Basophilic stippling
TAIL: Thalassemias, Anemia of chronic disease, Iron deficiency, Lead poisoning.
Schistocyte, helmet cell
DIC, TTP/HUS, traumatic hemolysis.
Sideroblastic anemia
Defect in heme synthesis. [XR] X-linked defect in δ-aminolevulinic acid synthase gene. Treatment: pyridoxine (B6) therapy. ↑ iron, normal TIBC, ↑ ferritin.
Acute intermittent porphyria
5 P's: Painful abdomen, Pink urine,Polyneuropathy, Psychological disturbances, Precipitated by drugs.
Lead poisoning
LEAD: Lead Lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray. Encephalopathy and Erythrocyte basophilic stippling. Abdominal colic and sideroblastic Anemia. Drops—wrist and foot drop. Dimercaprol and EDTA 1st line of treatment. Succimer for kids.
DIC
STOP Making New Thrombi: Sepsis (gram-negative). Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome. Transfusion.
Factor V Leiden
Production of mutant factor V that cannot be degraded by protein C. Most common cause of inherited hypercoagulability.
Multiple myeloma
CRAB: hyperCalcemia, Renal insufficiency, Anemia, Bone/Back pain
imatinib
anti-bcr-abl antibody, bcr-abl tyrosine kinase inhibitor. treat CML. Toxicity: fluid retention.
t(15;17)
M3 type of AML, (responsive to all-trans retinoic acid)
t(11;22)
Ewing's sarcoma
t(11;14)
Mantle cell lymphoma
rescue drug. Methotrexate (MTX)
leucovorin
rescue drug. 5-fluorouracil (5-FU)
thymidine
6-mercaptopurine (6-MP) ↑ toxicity with
allopurinol (metabolized by xanthine oxidase)
Trastuzumab (Herceptin)
Monoclonal antibody against HER-2 (erb-B2). Treat Metastatic breast cancer.
Unhappy triad/knee injury
medial collateral ligament (MCL) , anterior cruciate ligament(ACL), and lateral (not medial) meniscus.
Epithelial cell junctions
Zona occludens (tight junction), Zona adherens (intermediate junction), Macula adherens (desmosoma), Gap junction, Hemidesmosome
Rotator cuff muscles
SItS: Supraspinatus—helps deltoid abduct arm. Infraspinatus—laterally rotates arm. Teres minor—adducts and laterally rotates arm. Subscapularis—medially rotates and adducts arm.
Sicca syndrome
dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis. No arthritis.
SLE features
I'M DAMN SHARP: Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid), Malar rash, Discoid rash, Antinuclear antibody, Mucositis (oropharyngeal ulcers), Neurologic disorders, Serositis (pleuritis, pericarditis), Hematologic disorders, Arthritis, Renal disorders, Photosensitivity.
Positive antinuclear antibodies
SLE, Sjogren's (and sicca), scleroderma, polymyositis, dermatomyositis, rheumatoid arthritis, juvenile arthritis, mixed connective tissue disease.
Sarcoidosis
GRAIN: Gammaglobulinemia, Rheumatoid arthritis, ACE increase, Interstitial fibrosis, Noncaseating granulomas.
Mixed connective tissue disease
Raynand's FAME. Raynaud's phenomenon. Fatigue, Arthralgias, Myalgias, and Esophageal hypomotility. Antibodies lo UI RNP.
CREST syndrome
Calcinosis, Raynaud's phenomenon. Esophageal dysmotilily, Sclerodactyly, and Telangiectasia. Associated with antiCentromere antibody (C for CREST).
Auspitz sign
bleeding spots when scales are scraped off. Psoriasis
IgG antibody against desmosomes
Pemphigus vulgaris
IgG antibody against hemidesmosomes
Bullous pemphigoid
Nikolsky's sign
separation of epidermis upon manual stroking of skin. Pemphigus vulgaris.
dermatitis herpetiformis
Pruritic papules and vesicles. Deposits of IgA at the tips of dermal papillae. Associated with celiac disease.
Lichen planus
Pruritic, Purple, Polygonal Papules, Sawtooth infiltrate of lymphocytes at dermal-epidermal junction. Associated with hepatitis C.
Acanthosis nigricans
Hyperplasia of stratum spinosum. Associated with hyperinsulinemia (e.g., from Cushing's disease, diabetes) and visceral malignancy.
PGI2
Platelet-Gathering Inhibitor. (prostacyclin) inhibils platelet aggregation and promotes vasodilation.
Astrocyte marker
GFAP
Hypothalamus function
TAN HATS: Thirsl and waler balance, Adenohypophysis control, Neurohypophysis releases hormones from hypothalamus. Hunger, Autonomic regulation. Temperature regulation. Sexual urges.
Where dose ADH been made
supraoptic nucleus
Where dose oxytocin been made
Paraventricular nucleus
Limbic system
The famous 5 F's: Feeding, Fleeing, Fighting, Feeling, and sex.
Hemiballismus
Sudden, wild flailing of 1 arm +/- leg. contralateral subthalamic nucleus lesion (e.g.. lacunar stroke in a patient with a history of hypertension).
Paramedian pontine reticular formation (PPRF)
Eyes look away from side of lesion
Frontal eye fields
Eyes look toward lesion
Central pontine myelinolysis
Acute paralysis, dysarthria, dysphagia, diplopia, and loss of conscionsuess. Commonly caused by very rapid correction of hyponatremia.
Broca's aphasia
Broca's Broken Boca. Nonfluent aphasia with intact comprehension. Broca's area —inferior frontal gyrus.
Wernicke's aphasia
Wernicke's is Wordy but makes no sense. Fluent aphasia with impaired comprehension. Wernicke's area —superior temporal gyrus.
Condunction aphasia
Poor repetition but fluent speech, intact comprehension. Arcuate fasciculus —connects Broca's, Wernicke's areas.
Berry aneurysms
Associated with adult polycystic kidney disease. Ehlers-Danlos syndrome, and Marfan's syndrome.
Hydrocephalus triad
dementia, ataxia, and urinary incontinence
Parinaud syndrome
paralysis of conjugale vertical gaze due to lesion in superior colliculi (e.g., pinealoma).
Bell's palsy
AIDS, Lyme disease, Herpes zoster, Sarcoidosis, Tumors, Diabetes
KLM sounds
Kuh-kuh-kuh tests palate elevation (CN X—vagus); La-la-la tests tongue (CN Xll —hypoglossal); Mi-mi-mi tests lips (CN Vll-facial)
CN III damage
eye looks down and out; ptosis, pupillary dilation, loss of accommodation.
CN IV damage
diplopia with a defective downward gaze (adjust by tilling head toward lesion). innervates the Superior Oblique.
CN VI damage
medially directed eye. innevates the Lateral Rectus.
Marcus Gunn pupil
afferent pupillary defect (e.g., due to optic nerve damage or retinal detachment). ↓bilayteral pupillary constriction when light is shone in affected eye.
ARMD
Age-related macular degeneration. Degeneration of macula, causes loss of central vision (scotomas). "Dry"/atrophic- ARMD is slow, due to fat deposits and causes gradual ↓ in vision. "Wet" ARMD is rapid, due to neovascularization.
Uncal herniation
Ipsilaleral dilated pupil/ptosis (Stretching of CN III); Contralateral homonymous hemianopia (Compression of ipsilateral posterior cerebral artery); Ipsilateral paresis. Duret hemorrhages.
Differential diagnosis of brain lesions: Ring-enhancing lesion
Metastases, abscesses, toxoplasmosis, AIDS lymphoma.
Differential diagnosis of brain lesions: Uniformly enhancing lesion
Lymphoma, meningioma, metastases (usually ring enhancing).
Differential diagnosis of brain lesions: Heterogeneously enhancing lesion
Glioblastoma mulltiforme.
Ethosuximide
EFGH — Ethosuximide, Fatigue, GI, Headache.
Short acting Benzodiazepines
TOM: Triazolam. Oxazepam, Midazolam. Highest addictive potential.
Parkinson's disease drugs
BALSA: Bromocriptine, Amantadine, Levodopa (with carbidopa), Selegiline (and COMT inhibitors), Antimuscarinics (Benztropine).
Alzheimer's drugs
Memantine, Donepezil, galantamine, rivastigmine
Intelligence quotient
Stanford-Binet IQ test, WAIS III, WISC for Children,
Manic episode
Maniacs DIG FAST (3 or more). 1. Distractibility, 2. Irresponsibility—seeks pleasure without regard to consequences (hedonistic). 3. Grandiosity—inflated self-esteem. 4. Flight of ideas—racing thoughts. 5. ↑in goal-directed Activity/psychomotor Agitation. 6. ↓need for Sleep. 7. Talkativeness or pressured speech.
Major depressive episode
SIG E CAPS (5 or more). 1. Sleep disturbance. 2. Loss of Interest (anhedonia). 3. Guilt or feelings of worthlessness. 4. Loss of Energy. 5. Loss of Concentration. 6. Change in Appetite/weight. 7. Psychomotor retardation or agitation. 8. Suicidal ideations. 9. Depressed mood.
Risk factors for suicide completion
SAD PERSONS. Sex (male), Age (teenager or elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness (medical illness, 3 or more prescription medications), Organized plan, No spouse (divorced, widowed, or single, especially if childless), Social support lacking.
Panic disorder
PANICS. Palpitations, Paresthesias, Abdominal distress, Nausea, Intense fear of dying or losing control, lIght-headedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of breath.
Neuroleptic malignant syndrome (NMS)
toxicity of antipsychotics. FEVER: Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles
Lithium side effects
LMNOP: Movement (tiemor), Nephrogenic diabetes insipidus, HypOthyroidism, Pregnancy problems
increased Anion Gap in metabolic acidosis
MUDPILES: Methanol (formic acid), Uremia, Diabelic ketoacidosis, Paraldehyde or Phenformin, Iron tablets or INH, Lactic acidosis, Ethylene glycol (oxalic acid), Salicylates.
Renal tubular acidosis (RTA)
Type 1 (distal), Type 2 (proximal), Type 4 (hyperkalemic)
WAGR complex
Wilms' tumor. Aniridia, Genitourinary malformation. and mental-motor Retardation.
Transitional cell carcinoma risk factors
Pee SAC: Phenacetin. Smoking. Aniline dyes, and Cyclophosphamide
Most common cause of acute renal failure in hospital
Acute tubular necrosis
Furosemide Toxicity
OH DANG! Ototoxicity, Hypokalemia. Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout.
Thiazide Toxicity
HyperGLUC. Hypokalemic metabolic alkalosis, hyponatremia. hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia. Sulfa allergy.
ACE inhibitors Toxicity
CAPTOPRIL. Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Lower angiotensin II. Also hyperkalemia.
Pathway of sperm during ejaculation
SEVEN UP: Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (Nothing), Urethra, Penis.
Mittelschmerz
blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis.
Menopause causes
HHAVOC: Hirsutism. Hot flashes. Atrophy of the Vagina, Osteoporosis. Coronary artery disease.
HELLP syndrome
Hemolysis. Elevated LFT's, Low- Platelets. (associated with pregnacy-induced hypertension)
Oxygen-hemoglobin dissociation curve shift to right
CADET: CO2, Acid/Altitude, 2,3-DPG, Exercise, Temperature
DVT
Virchow's triad: Stasis, Hypercoagulability, Endothelial damage. Homan's sign: dorsiflexion of foot → tender calf muscle.
Lung cancer complications
SPHERE: Superior vena cava syndrome, Pancoast's tumor, Horner's syndrome, Endocrine (paraneoplastic), Recurrent laryngeal symptoms (hoarseness), Effusions (pleural or pericardial).