Usmle - Day 12 - Flex2

Front 1

Cancer associated w/ Lambert-Eaton

Back 1

Thymoma and small cell lung cancer

Front 2

Migrating thrombophelbitis
Definition and associated diseases

Back 2

Red and tender extremities on palpation
Pancreatic cancer

Front 3

What structures does the cardinal ligament connect?

Back 3

Cervix to the side wall of the pelvis

Front 4

Call-Exner bodies

Back 4

Follicles filled with eosinophilic secretions
Found in granulosa cell tumors

Front 5

Acute gastritis

Back 5

Causes:
Stress
NSAIDs
Alcohol
Uremia
Trauma/Burn --> Curlings ulcer --> dec blood volume leads to sloughing off of gastric mucosa; generally in duodenum

Brain injury/Inc ICP --> Cushings ulcer --> ACh stimulation --> Acid production

Front 6

Chronic gastritis of the antrum

Back 6

Type B
Usually due to H. pylori
Most common type
Inc risk MALToma

Front 7

Chronic gastritis; anrum sparing

Back 7

Type A
Pernicious anemia
Autoimmune
Achlorydia

Front 8

Relationship between the esophagus and trachea

Back 8

Esophagus is posterior

Front 9

Accumulation of glycogen in lysosomes associated with what?

Back 9

Pompes disease

Front 10

Not from foregut, but receives blood from celiac

Back 10

Spleen

Front 11

Ventral pancreatic bud gives rise to

Back 11

pancreas head and uncinate process and main pancreatic duct

Front 12

Rash, fever, and hypotension after treatment of this oganism

Back 12

Treponema pallidum
Jarisch-Herxheimer reaction
Due to rapid release of toxic products

Front 13

Etiology of weight gain a patient with duodenal ulcers

Back 13

Pain decreases when they eat food

Front 14

What is ras?

Back 14

G protein that is active w/ ATP bound

Front 15

What is jun?

Back 15

transcription factor

Front 16

Lactase deficiency lab values

Back 16

Increased breath hydrogen
Dec luminal pH
Increased osmotic gap

Front 17

Osmotic gap

Back 17

280-2(stool Na + stool K)

Front 18

Classic sx of whipples

Back 18

Arthraligas
Fever
Cardiac
Neurologic

Front 19

Products of TH1 cells

Back 19

IL-2
INF gamma

Front 20

Porcelain gallbladder

Back 20

Diffusely calcifec gallbladder (dystorphic)
Bluish and brittle

Chronic cholestasis is a predisposing risk factor

Predispose to gallbladder cancer, and therefore should be removed

Front 21

Causes of acalculous acute cholecystis

Back 21

AIDS --> CMV
Ischemia (volume depletion)

Front 22

Treatment for Wilson's Disease

Back 22

Penicillamine
Triantine

Front 23

CEA is a marker for what?

Back 23

Mainly colorectal

also pancreatic

also, also, breast and gastric

Front 24

Effect of estrogen on gallstones

Back 24

Upregulates HMG-CoA reductase

Front 25

Effect of progesterone on gallstones

Back 25

Progesterone inhibits bile acid secretion and slows gb emptying
Inhibiting bile acid secretion will increase bile in GB and downregulate 7alpha hydroxylase, which convertes cholesterol into bile salts

Front 26

Most likely outcome of HCV infection?

Back 26

Chronic hepatitis

Front 27

%TBW intracellular
% TBW extracellular

Back 27

Intra = 40%
Extra = 20%

Front 28

How to measure plasma volume

Back 28

Radiolabled albumin
Evans blue

Front 29

How to measure extracellular volume

Back 29

Inulin
mannitol

Front 30

Serum osmolarity

Back 30

2(Na) + Glu/18 + BUN/2.8

Front 31

Filtration barrier & role of individual parts

Back 31

Basement membrane - heparan sulfate neg charge barrier
Fenestrated capillaries - size barrier

Front 32

Clearance formula & units

Back 32

Cx = Ux*V / Px = X mL/min

Front 33

How does creatinine reflect GFR?

Back 33

Slightly overestimates it b/c some creatinine is secrteted in the distal tubules

Front 34

RBF formula

Back 34

RBF = RPF/(1-Hct)

Front 35

How does ERPF reflect RPF?

Back 35

ERPF underestimates ~10%

Front 36

Blood flow, starting w/ renal artery to renal vein

Back 36

Renal a --> interlobar a. --> interlobular a. --> afferent arteriole --> glomerulus --> efferent arteriole --> vasa recta --> interlobular v. --> interlobar v. --> renal v.

Front 37

FF formula

Back 37

FF = GFR/RPF

Front 38

Where is free water generated

Back 38

TAL and early distal tubule

Front 39

Equation for Free water

Back 39

Ch2o = V - Cosm

Front 40

What is threshold for glucose

Back 40

160-200 mg/dL

Front 41

What is the fxn of the thin descending limb

Back 41

Makes urine hypertonic due to medullary hypertonicity

Front 42

Things w/ TF/P <1
what is the meaning of this?

Back 42

Solute is reabsorped quicker than water

HCO3
AA
Glucose
Pi

Front 43

How does Cl reabsorption in the PCT compare to sodium?

Back 43

It gets reabsorbed slower for teh first 1/3, and then equals rate. Therefore relative concentration increases before it plateaus.

Front 44

What receptor does ANP work through?

Back 44

cGMP

Front 45

Fxns of AII

Back 45

1) Vasocontrition of vascualr smooth muscle
2) Vasoconstrict efferent arteriole
3) Stimulate thirst
4) stimulate Aldo
5) stimulate ADH
6) Stimulate Na/H channels in PCT

Front 46

Where are the JG cells located?

Back 46

afferent arteriole

Front 47

Where is EPO released from?

Back 47

Endothelial cells of the peritubular capillaries

Front 48

Fxn of PGs in kidney?

Back 48

Vasodilate afferent arterioles

Front 49

K+ shift into cell

Back 49

1. Insulin (Inc Na/K ATPase)
2. B agonist (Inc Na/K ATPase)
3. Alkalosis (K/H exchanger)
4. Hypo-osmolarity

Front 50

K+ shift out of cell

Back 50

1. Cell lysis
2. Hyperosmolarity
3. B antagonist
4. Lack of insulin
5. Digitalis
6. Acidosis, severe exercise

Front 51

Winter's formula

Back 51

In metabolic acidosis, PCO2 = 1.5(HCO3) + 8 +/- 2

Front 52

Anion gap

Back 52

Anion gap = Na - (Cl + HCO3)

Front 53

Causes for inc anion gap

Back 53

MUDPILES
Methanol
Uremia
DKA
Paraldehyde/phenformin
INH/Iron tablets
Lactic acidos
Ethelyne glycol
Salicylates

Front 54

Most common cause of death in SLE

Back 54

Diffuse proliferative glomerulonephritis

Front 55

Membranoproliferative Glomerulonephritis

Back 55

Nephrotic

Usually progresses slowly to CRF
LM: Subendothelial ICs
IF: granular

Type I
HCV>HBV
Tram-track b/c of GBM splitting d/t mesangial ingrowth

Type II
C3 nephritic factor
Dense deposits

Front 56

Radiopaque
Radiolucent

Stones

Back 56

Radiolucent - uric acid
Radiopque -- all else

Front 57

Common sites for RCC metastasis

Back 57

Lung & Bone

Front 58

Paraneoplastic syndromes of RCC

Back 58

EPO
PTH-rp
ACTH
PRL

Front 59

WAGR

Back 59

Wilms tumor
Aniridia
GU malformations
mental-motor Retardation

Front 60

Cancer caused by schistosomiasis

Back 60

Squamous cell bladder cancer

Front 61

Causes of Transitional cell carcinoma and most common presentation

Back 61

Aniline dyes
Smoking
Phenacetin
Cycolophosphamide

Painless hematuria = bladder cancer

Front 62

Causes of renal papillary necrosis

Back 62

DM
Acetomeniphne
Acute pyelonephritis
Sickle cell anemia

Front 63

BUN/Cr >20

Back 63

Prerenal

Front 64

BUN/Cr <15

Back 64

Intra-renal

Front 65

Conditions associated w/ ADPKD

Back 65

Berry aneurysms
Polycystic liver disease
Mitral valve prolapse

Front 66

Liver problem that is associated w/ ARPKD

Back 66

Congenital hepatic fibrosis

Front 67

EKG changes w/ hyper/hypokalemia

Back 67

Hypokalemia: U waves, flat T waves

Hyperkalemia: Wide QRS, peak T waves

Front 68

Sx of Hypermagnesiemia

Back 68

Delirum
Dec DTRs
Cardiopulmonary arrest

Front 69

Acute Tubular Necorsis
Cause

Back 69

Etiology: Ischemia, myoglobinuria (crush injury), toxin (contrast or nephrotoxic drugs)

Stages:
1. inciting injury
2. Oliguric stage
3. Recovery

Front 70

Characteristics of maintenance stage of ATN

Back 70

1. Hyperkalemia (can lead to arrythmias)
2. Edema, CHF, pulmonary vascular congestion
3. Dec Na and Ca; Inc Mg and PO3
4. High anion gap metabolic acidosis (retention of H and anions)
5. Dec Uosm, FeNa > 1, Inc Una

Front 71

Characteristics of recovery stage of ATN

Back 71

Intense diuresis, can lead to hypokalemia
Dehydration

Front 72

Graft-vs-Host
Cause & Sx

Back 72

Transplant competent T cells into an immunocompromised patient
Lead to rash, diarrhea, hepatosplenomegaly, jaundice

Front 73

Threshold for glucose

Back 73

160-200 mg/dL see glucosuria (threshold)
350 mg/dL is Tm

Front 74

Amt of Na normally reabsorbed

Back 74

99%

Front 75

Amt Urea normally reabsorbed

Back 75

45%

Front 76

Describe tonicity of urine as it flows through the nephron

Back 76

PCT - Isotonic
As it moves through descending loop of henle, becomes hypertonic, b/c imperable to Na. The loop of henle has the most concentrated urine in the nephron (w/o ADH present)
TAL - hypotonic, b/c impermeable to water
DCT - low water permeability
CD - most concentrated urine (w/ ADH)

Front 77

Where is the lowest pH found in the nephron?

Back 77

Distal tubule and CD

Front 78

Medullary cystic disease

Back 78

US shows small kidney
Cysts in the medulla
Poor prognosis
Fibrosis and progressive renal insuficiency due to urinary concentrating defects

Front 79

Renal Cell carcinoma

Back 79

Age: 50-70
Mets: Lung and bone
Derived from: Renal tubule cells
Clinical manifesatations: Flank pain, hematuria, polycythemia, abdominal mass, fever, weight loss
Inc incidence w/: Obesity, smoking VHL and gene deltion on ch 3
Most common renal malignancy

Front 80

What rib(s) would you fracture to damage the spleen?

Back 80

9-11

Front 81

What rib(s) would you fracture to damage the left kidney?

Back 81

12

Front 82

Action of V2 receptors on medullary CD

Back 82

Inc permeability for urea and water

Front 83

Pathogenesis of Alports

Back 83

Mutation in Type IV collagen
Split basement membrane

Front 84

Syndromes w/ GBM splitting

Back 84

Alports
MPGN Type I

Front 85

Different presentations of SLE in the kidney

Back 85

Nephritic - Diffuse Proliferateive Glomerulonephritis
Granular IF

Nephrotic - Membranous glomerulonephropathy (spike and dome - subepithelial)

Front 86

HSP

Back 86

Age 2-10
Purpura on buttocks and legs
Abdominal pain, intestinal hemorrhage, risk for intussception
Arthralgias (knee and ankle most common)
Renal IgA nephropathy

Front 87

Treatment of Minimal change disease

Back 87

Excellent response to corticosteroids (predinsone)

Front 88

Sx of Fructose Intolerance

Back 88

Jaundice
Hepatomegaly
Cirrhosis
Vomiting
Hypoglycemia

Front 89

Thyroid hormone feed back on the HPA

Back 89

T3 downregulates TRH receptors on the pituitary

Front 90

How is thyroid hormone removed from system?

Back 90

Glucuronidation in the liver

Front 91

Formation of T4, T3, and are rT3

Back 91

T4 makes T3 and rT3

Front 92

Fxns of TSH on the thyroid gland

Back 92

Activates:
NIS
Deiodinase
Thyroid hormone release (proteolysis)
Formation of thyroglobulin

Front 93

Fxns of peroxidase on the thyroid gland

Back 93

Oxidation (I- --> I2)
Organification (Formation of MIT and DIT)
Coupling DIT and MIT

Front 94

Glucagonoma

Back 94

Anemia
DM
Necrolytic erythema

Stomatitis, cheliosis, abdominal pain

Front 95

TRH functions on what kind of receptor?

Back 95

Gq