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170 Cards in this Set
- Front
- Back
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relantionship between prevalence and PPV |
Prevalence ∝ PPV/NPV
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top cancers by incidence
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1. breast/prostate; 2. lung; 3. colon
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top cancers by prevalence
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1. breast/prostate; 2. colon; 3. lung
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respiratory epithelium
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cilia is present all throughout; serous, mucous glands, goblet cells and cartilage dissappear
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koilocytes
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pyknotic superficial immature squamous cell with dense irregularly stainning cytoplasm and perinuclear clearing
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osteocytes
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gap junctions
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elastase
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protease secreted by alveolar macrophages
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dynein
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ATPase associated with microtubule doublets; retrograde transport and ciliary flagellar movement
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type II pneumocytes
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production of surfactant and regeneration of type I pneumocytes after injury
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Brunner glands
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only in duodenum
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Peyer patches
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mostly in ileum
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histology of large intestine
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goblet cells but no pits or villi
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stratified epithelium of the respiratory tract
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oropharynx, laryngopharynx, anterior epiglotis, true vocal cords
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strep bovis endocarditis
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associated with colon cancer 25% of cases
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dextran adherence
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viridans strep adheres to deposits of fibrin in damaged valves
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congenital rubella
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sensorineural deafness, cataracts and PDA
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fulminant hepatitis
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HEV. Not associated with chronic hepatitis.
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HCV immuno resistance
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antigen variability is responsible for lack of immune response; lacks 3'-5' proof reading activity
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non sorbitol fermenter in McKonkey's
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EHEC:0157
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dyptheria vaccine (DPT)
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antigen is beta subunit of diptheria endotoxin; active immunity IgGs
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staph epidirmidis Rx
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vancomycin
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cryptococcus infection pathogenesis
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asymptomatic infection of lungs --> meningitis; associated with pigeon droppings
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toxoplasmosis MRI
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ring-enhancing lessions
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Hib vaccine
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cell wall polysacchride conjugated with diptheria or tetanus toxoid
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congenital toxoplasmosis
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hydrocephalus, intracranial calcifications, chorioretinitis due to in-utero infection
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n. meningitidis route of entry
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nasopharynx --> blood --> choroid plexus
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H. influenzae route of infection
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pharynx --> lymphatics --> meninges
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pneumococcus route of infection
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middle ear --> meninges
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viral UTI
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adenovirus causes hemorrhagic cystitis
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subcutaneous mycosis
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sporothrix in gardners
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interstitial pneumonia
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CMV in AIDS patients; nuclear inclusion bodies; also atypical bugs: mycoplasma, RSV, chlamydia
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legionella associations
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water aerosols and humidifiers
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catalase+ bugs
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staph, pseudomonas, serratia, aspergillus, nocardia
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cold aglutinins
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IgM antibody formed against mycoplasma and EBV; reaction with RBCs results in anemia
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types of aspergyllosis
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invasive (neutropenic patients); colonizing (fungus ball); allergic (asthmatic patients)
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epiglotitis
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H. influenzae; sore throat, fever, drooling, airway obstruction, stridor
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virulence factors of mycobacteria
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sulfatides, tuberculin and serpentine cords
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Legionaire's disease
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high fever, pneumonia and diarrhea in a chronic smoker
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clue cells
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squamous epithelial cells covered by Gardnerella seen on wet mount
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POMC
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proopiomelanocorticotropin cleaved to yield ACTH, MSH and beta endorphin
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opiod receptors
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increase gK --> decrease pain
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scotoma
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visual field deficit surrounded by zones of normal vision indicates damage to macula in retina; retinitis pigmentosa, multiple sclerosis, diabetic nephropathy
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reperfusion arrhythmia
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caused by tPA, reteplase, tecteplase fibrinolytic therapy
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osteoblast markers
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LAP
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osteoclast markers
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acid phosphatase, urinary hydroxyproline
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space constant
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measure of the ability of an impulse to travel down an axon; low SC --> decrease impulse (ME)
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bounding femoral pulse
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water-hammer pulse in aortic insufficiency
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pulsus parvus et tardus
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aortic stenosis
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blood transfusions
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contain citrate which chelates calcium and results in hypocalcemic paresthesia
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iron regulation
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by epithelial cells of the gut and intracellular ferritin
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law of conservation of masses
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total flow = flow velocity * cross sectional area; flow in = flow out
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AV shunt volume loop diagram
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increased preload
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conduction velocities of heart tissue
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AV node (0.05m/sec); ventricular muscle (0,3m/sec); atrial muscle (1.1m/sec); purkinje (2.2m/sec)
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source of ACE
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lungs
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RV/TLC in obstructive diasese
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increased RV more than TLC
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hypoxic vasoconstriction
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as oxygen content decreases, arteriolar resistance increases
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perfusion-limited
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when substances equilibrate across the membrane
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diffusion-limited
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when substances do not equilibrate across membrane
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diffusion of oxygen
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perfusion limited
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oxygen supplementation in COPD patients
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COPD patients have chronic hypoxia and hypercapnia; hypoxia is main ventilatory drive so use O2 supplementation carefully
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brown adipose
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termogenin produces heat
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pulmonary vascular resistance
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increases as air is inhaled and on forced expiration due to increase tension of lung parenchyma
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pathophysiology of pneumoconiosis
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fine dust particles are phagocytosed but alveolar macrophages release growth factors that stimulate fibroblast proliferation and fibrosis
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lung clearance mechanisms
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large particles are trapped in upper respiratory tract; medium particles are cleared by mucocilliary transport; fine particles < 2.5um are phagocytosed
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causes of decreased lung compliance
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pulmonary edema, pulmonary fibrosis, decreased surfactant, pneumoconiosses, kyphoscoliosis
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alveolar gas equation
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PAO2 = 150 - (PaCO2/0.8); PaO2 is given value; use PAO2 to calculate A-a gradient: PAO2 - PaO2
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hypoxemia in pulmonary embolism
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due to Va/Q mismatch
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Va/Q mismatch
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increased A-a gradient
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hypoventilation
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hypoxemia with normal A-a gradient
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causes of hypoxemia
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hypoventilation, Va/Q mismatch, diffusion impairmnet, right-left shunt
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lipid absorption and digestion
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absorption --> jejunum; digestion --> duodenum
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S4 heart sound
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presystolic before S1; indicates decreased compliance of left ventricle
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ASD murmur
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wide fixed S2 splitting with increased pulmonic valve pressure
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prevention of calcium stones
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increase water intake and increase citrate which chelates calcium
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pericardial tamponade
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muffled distant heart sounds, hypotension, increased central venous pressure and jugular regurgitation; post MI complication results in decreased venous return and hypotension
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cardiac hybernation
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hypokalemia of heart muscle due to chronic ischemia in CAD; reversible with bypass revascularization
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ischemic preconditioning
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resistance to infarction by myocytes exposed to chronic ischemia
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ventricular remodeling
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adaptation in mass, volume and shape to compensate for increased hemodynamic load
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chemical mediators of atheromas
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PDGF and TxA2 by platelets
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reperfusion injury
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secondary to oxygen free radicals, mitochondrial damage and inflammation
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billiary tract enzymes
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gammaglutamyl transferase and alkaline phosphatase
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liver function tests
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PT, albumin, cholesterol
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hepatic integrity enzymes
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AST, ALT
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alkaline phosphatase differentiation
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if increased alkaline phosphatase, check gammaglutamyl transferase to differentiate LAP from liver AP
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aromatase
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converts androgens to estrogens; stimulated by FSH in granulosa cells; might be deficient in female pseudohermaphrodite or elevated in male pseudohermaphrodite; inhibited by anastrozole
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cardiac contractility
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depends on aerobic glycolysis to produce ATP and creatine phosphate; ischemia leads to loss of contractility in 30 seconds
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paradoxycal thromboembolism
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thrombus passes from veins to arteries through an ASD; ASD produces fixed splitting of S2
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natriuretic peptide
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synthesized by atria upon stretch and right ventricle (Brain natriuretic peptide BNP)
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cyanosis improves with squatting
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tetralogy of fallot; increased TPR/PVR ratio increases pulmonary flow
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absence of edema in early CHF or cor pulmonale
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because intrathroracic pressure becomes more negative (COPD, etc), venous return and lymphatic drainage increase
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holosystolic murmur
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mitral insufficiency, tricuspid insufficiency, VSD
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S3 heart sound
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left ventricle volume overload in CHF or mitral insuficiency
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TGF beta
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tumor suppressor, angiogenesis, fibroblasts
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metalloproteinases
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collagen degradation; released by macrophages; may result in rupture of atheroma and AMI
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hemodynamic changes in aortic stenosis/left ventricular hypertrophy
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acute atrial fibrillation --> hypotension --> pulmonary edema due to decreased preload and CO
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cholestasis
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leads to osteomalacia due to ADEK malabsorption
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Wolf-Parkinson
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pre-excitation due to accesory bundle of Kent; delta wave on ECG, decreased PR interval and widened QRS, treat with class Ia and III antiarrhythmics
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isolated systolic hypertension
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age related stiffening of the aorta
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aortic stenosis
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increased left ventricle to aorta pressure gradient
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aortic insuficiency
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palpitations due to increased stroke volume; head pounding due to high amplitude pulsations; "head bobbing" due to widened pulse pressure
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mitral stenosis murmur
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opening snap in early diastole after aortic component of S2 (immediately after closure of aortic valve) plus diastolic murmur
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acute mitral insufficiency
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due to rupture of cordae tendinae or prosthetic valve failure don’t have time for atrial adaptation; decreased compliance leads to pulmonary edema
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mitral stenosis severity
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S2-to-opening snap is short --> more severe
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hepatic encephalopathy
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decreased clearance of gut amonia by damaged liver --> increased GABA receptor activity
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gynecomastia in cirrhosis
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decreased estrogen metabolism by liver --> gynecomastia, palmar erythema, testicular atrophy, decreased body hair
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sweat in cystic fibrosis Vs. normal people
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normal --> hypotonic; CF --> hypertonic
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uric acid stones
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precipitate in acid collecting ducts; Rx alkalinization of urine + hydration + indomethacin/colchicine
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squamous lung cancer paraneoplastic syndrome
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PTH-like peptide
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RANK receptors
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mediate osteoclast differentiation; low estrogen upregulates RANK --> increased bone resorption --> less bone mass
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why is H. pylory in duodenum
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only colonizes gastric tissue; if present in duodenum it's due to metaplasia
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cystic fibrosis secretions osmolarity
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all isotonic except sweat which is hypertonic
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infectious esophagitis
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CMV (linear ulcerations), candida (pseudomembranes), HSV-1 vesicles/ulcers
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pancreatic necrosis
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intracellular activation of trypsin and all other proteolytic enzymes
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osteoporosis risk factors
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smoking, menopause, corticosteroid therapy, physical inactivity, caucassian, low BMI, alcohol
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IL-5
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associated with asthma; isotype switch to IgA
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water deprivation test
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increased urine osmolarity if primary polydipsia; no change in diabetes insipidus
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triglycerides in insulin resistance
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triglycerides and FFA increase insulin resistance in overweight individuals
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somatostinoma
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inhibits all GI hormones --> billiary stones due to decreased CCK and hyperglycemia due to decreased insulin
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how does hyperprolactinemia result in osteoporosis
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hyperprolactinemia --> hypogonadism --> decreased estrogen --> osteoporosis
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bone changes in hyperparathyroidism
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subperiosteal thinning
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dexamethasone test
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low dose suppress cortisol --> Cushing syndrome; high dose suppresses cortisol --> pituitary Cushing; no suppression --> ectopic ACTH
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sex hormones in bone growth
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sex hormones promote bone growth and epipheseal closure --> short stature in spite of growth spurt
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hormonal changes with glucocorticoid therapy
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decreased CRH, ACTH and cortisol
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hormonal changes in cryptorchidia
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affects seminiferous tubules and Sertoli cells --> decreased inhibin and increased FSH
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hormonal changes in steroid therapy
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increased testosterone, decreased LH and low sperm count
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Lisch nodules
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neurofibromatosis
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Kayser-Fleischer rings
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Wilson's
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chromosome 8
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c-myc
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mitochondrial diseases
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myoclonic epilepsy, Leber, MELAS
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Friederich ataxia
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progressive ataxia due to degeneration of spinocerebellar and dorsal column tracts, hypertrophic cardiomyopathy (50%), skeletal abnormalities, diabetes (10%), autosomal recessive
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Lesch Nyhan
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x-linked recessive deficiency of hypoxanthine guanine phosphorybosyl transferase (HGPRT)
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heteroplasmy
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mitochondrial inheritance shows phenotype depending on how many mitochondria patient has
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Prader-Willi deletion
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paternal 15q deletion but affected gene is from mother
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genetic imprinting synonym
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unisomal dysomy
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HNPCRC mutation
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DNA mismatch repair enzyme
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Xeroderma mutation
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DNA excision repair enzyme
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methylation
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silences genes
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acetylation
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activates genes; acetylation is on lysine residues
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alpha-feto protein
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increased in neural tube defects; decreased in Down's
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Sturge-Weber
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port-wine stains and angiomas on the face and ipsilateral arteriovenous malformation in the meninges
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Osler-Weber-Rendu
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hemorrhagic telangiectasia, recurrent epistaxis and GI bleeds
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Tuberous sclerosis
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autosomal dominant; mental retardation and seizures, angiofibromas, angiomyolipoma in the kidneys (80%); rhabdomyoma in the heart
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probability that a person is a carrier if both parents are carriers
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2 of 3
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CFTR abnormality
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impaired posttranslational processing with subsequent degradation
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t(15,17)
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translocation of retinoic acid receptors, no differentiation of myeloblasts
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45XO karyotype
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due to mitotic errors after fertilization
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cystic hygroma Vs. brachial cyst
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brachial cysts are uniloculated; hygroma has lymph tissue and are much larger (associated with Turner)
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Kallman's syndrome
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delayed puberty and anosmia, absence of GnRH; problem is in the hypothalamus
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G6PDH deficiency hereditary pattern
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x-linked recessive
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22q deletion
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DiGeorge
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antinflammatory cytokines
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IL-10 and TGF-beta
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diabetic nephropathy drug of choice
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ACE inhibitors and AT-1 blockers
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blood findings in ACEi therapy
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decreased angiotensin II --> decreased GFR --> increased serum creatinine
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drugs that cause tubular necrosis
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aminoglycosides, contrast agents, cisplatin, ampB, foscarnet
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gold therapy
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membranous nephropathy
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determinants of volume of distribution
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low volume of distribution: highly charged, bound to proteins, large molecular weight; large volume of distribution: drug is small and lipophylic
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pathophysiology of angina
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heart uses most energy from beta oxidation which consumes more oxygen per ATP produced than aerobic glycolisis; fatty acid synthesis inhibitors shift energy usage from b-oxidation to aerobic
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edrophonium test
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if symptoms improve --> myasthenia or myasthenia crisis (increase dose); if symptoms don’t improve --> cholinergic crisis (stop dose)
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lithium toxicity
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can be caused by NSAIDs and thiazides because they increase sodium and lithium reabsorption
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on-off phenomenon
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levodopa therapy; its unpredictable
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low MAC
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high potency
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high solubility in blood
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slow onset of action
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Rx bronchiolitis
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ribavirin
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isoniazid side effects
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vitamin B6 deficiency (sideroblastic anemia); ataxia, paresthesia, decreased pain sensation (peripheral neuropathy); hepatitis
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glucocorticoid inhalant side effects
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oral candidiasis (treat by washing mouth)
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N-acetylcysteine
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mucolytic used in CF; cleaves mucuous disulfide bonds
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prophylaxis of meningitis
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rifampin
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bosentan
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used for pulmonary hypertension; antagonist of endothelin receptors
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Leber's optic neuropathy
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mitochondrial inheritance; optic nerve degeneration; mutation arginine to histidine in ND4 gene affects subunit 4 of NADH dehydrogenase complex
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myoclonic epilepsy with ragged fibers
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mitochondrial inheritance; myoclonus, seizures, ataxia, mitochondrial myopathy; ragged look of mitochondria in muscle
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