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63 Cards in this Set

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What are the segmented viruses? What type of genetic info exchange can they participate in?
All RNA = BOAR
- Bunya
- Orthomyxo (flu)
- Arena
- Reo
undergo reassortment (exchange whole segments)
What is the nitroblue tetrazolium test for?
NAPDH-Oxidase deficiency = Chronic Granulomatous Dz (XLR)
What do hydrocephalus, intracranial calcifications, and chorioretinits in an infant represent?
Congenital Toxoplasmosis (mother handled cats)
Transmission is transplacentally in the first 6 months of development
What are the physical signs specific for Dermatomyositis?
Gottron's papules (on bony prominences: MCP/PIP/DIP)
Heliotrope rash (upper eyelids, periorbital skin)

Anti-Jo-1 Ab's in both DMyo and PolyMyo
What causes hemorrhagic disease of the newborn?
Vitamin K deficiency
- adults get from plants (Phylloquinone) and gut bacteria (Menaquinone)
What causes cerebral vasodilation in a COPD patient?
pCO2 high (hypercapnia) = most potent cerebral vasodilator
When is Rifampin monotherapy used?
Prophylaxis of exposure to N. meningitidis (meningococcus) and H. influenzae
What is Vitamin B5?
Pantothenic Acid = CoA
What causes a patient to develop flushing, diaphoresis, and nausea accompanied by low BP and HR?
Cholinergic agonists (e.g. Bethanechol) used to treat postoperative ileus / bladder atonia;
What condition is extramedullary hematopoeisis a/w?
Chronic severe hemolytic anemias like ß-Thalassemia
What causes chipmunk facies?
Marrow expansion d/t ß-thalassemia major
What is Gower's maneuver?
Using one's hands to raise from a squat/seat - seen in proximial muscle weakness (e.g. Duchenne's Muscular Dystrophy)
DMD d/t XLR deletion of Dystrophin gene
What organisms use IgA proteases to evade mucosal protective mechanisms and invade?
Neisseria sp.
(Gonococcus in genital region; Meningococcus in nasopharynx)
What is the Dx of a kid that has vesicular blistering eruptions that eventually form a golden yellow crust?
Impetigo - usually Staph aureus or GAS (pyogenes)
if GAS, can lead to PSGN (Rheumatic fever only in throat infx)
What autoimmune illness classically follows a chlamydia infection?
Reiter/Reactive Arthritis → Urethritis, Uveitis/Conjunctivitis, and Arthritis (large joints)
What histological change in the adrenals occurs in Cushing's syndrome?
HyperPLASIA of the Fasciculata (actually more cells) leading to increased Cortisol secretion
What is the S-100 tumor marker a/w?
1) Schwannomas (Sh-One-oma)
2) Melanoma

Schwann cells and melanocytes both from Neural Crest origin
What are the Adult Primary Brain Tumors (in order of most to least common)
1) Glioblastoma Multiforme (Butterfly glioma; pseudopalisading)
2) Meningioma (Psammoma)
3) Schwannoma (S-100)
4) Oligodendroglioma (Fried Egg)
5) Pituitary Adenoma (PRL usually; Rathke's pouch, Bitemporal hemianopsia)
Which esophageal cancer is a/w smoking and drinking? Which one w/ heartburn?
1) Squamous Cell Carcinoma (African Americans and Asians)
2) Adenocarcinoma (Barrett's Esophagus; GERD)
What are the types of Xanthomas and their associations?
1) Eruptive = ↑Chol/TG
2) Tuberous/Tendinous
3) Plane = PBC
4) Xanthelasma = eyelids/periorbial; 50% no lipid abnormalities (and no inflammation)
Which lung cancers are a/w with syndromes?
Small cell = Cushing (ACTH), SIADH (ADH), Lambert-Eaton
Squamous Cell = Hypercalcemia (PTH)
Which lung cancer is a/w gynecomastia & galactorrhea?
Large Cell Carcinoma of the Lung
What the hell is cor pulmonale?????
RVH (w/ or w/o CHF) d/t pulmonary hypertension
- COPD is most common (obliterating the pulmonary vasculature)
- Idiopathic (women 20-40
What is polyglutamation?
It is a biochemical mechanism that prevents Folic Acid and DHF from leaving the cell, essentially storing for later; The same occurs to MTX, as it is a folic acid analog
What would cause sudden onset abdominal /flank pain, gross hematuria, and a varicocele?
Renal vein thrombosis d/t Nephrotic syndrome (probably Membranous = #1 most common cause)
Loss of AT-III in the urine leads to a hypercoagulable state and the formation of a thrombus int he renal vein blocks drainage from the L testicle → varicocele
What are the symptoms of a Pheochromocytoma?
Episodic:
- ↑ BP
- Flushing
- Diaphoresis
- Headaches
What disorders are a/w an "M Peak" on serum protein electrophoresis (SPEP)?
1) Multiple Myeloma
2) Waldenstrom macroglobulinemia
3) some lymphomas
Why would a woman w/ SLE be more @ risk to have recurrent miscarriages?
If she is 10-30% of SLE pts that have lupus anticoagulant (APLA Syndrome)
What muscle is affected by severing the long thoracic nerve?
Serratus anterior → Winged scapula
What mediates the vascular reaction to endothelial injury (intimal hyperplasia and fibrosis)??
Smooth muscle cells that migrate from the media to the intima (activated by growth factors like PDGF)
What conditions predispose to Uric acid kidney stones and in what part of the nephron do they form?
U-ric acid:
1) goUt
2) leUkemia
3) tUmor lysis syndrome
Most acidic parts of the nephron = Distal tubules and Collecting ducts
What renal measurement can be calculated using the PAH clearance?
The Renal Plasma Flow (RPF)
CL(PAH) = ([PAH]urine x urine flow rate)/[PAH]plasma
Which amino acids have 3 titratable protons?
CHArLy got Tyr-ed and thrown in Acid
Cystine
Histidine
Arginine
Lysine
Tyrosine
Glutamic Acid
Aspartic Acid
How do you differentiate a leukamoid reaction w/ a leukemia?
Leukamoid has HIGH leukocyte Alkaline Phosphatase
What is Imatinib?
It's a RTK inhibitor specific for the bcr-abl one in CML (Philadelphia chromosome)
What lab value do you need to follow if someone's on Metformin? What groups are contraindicated from using it?
Want serum Cr to check renal function b/c of increased risk of lactic acidosis.
Contraindicated in patients w/ Renal failure as well as:
- Liver dysfunctino (alcoholics included)
- CHF
- Sepsis
What lab value do you need to follow if someone's using Amiodarone? What are side effects?
Class III - KV blocker = Check TFT's, LFT's, and PFT's:
- Thyroid (hypothyroidism; is 40% Iodine by weight)
- Hepatitis (drug related)
- Pulmonary fibrosis
- Skin = blue-grey discoloration
- Eyes = corneal micro deposits
What combo of drugs for hyperlipidemia increases risk of myopathy? Gallstones?
Myopathy = Fibrates + Statins
Gallstones = Fibrates + Bile acid-binders (cholestyramine)
What causes secondary polycythemia?
Anything that causes the kidneys to experience chronic hypoxia: (& peritubular cells of cortex release EPO)
- OSA
- COPD
- Right to Left shunts (the T's)
- High altitude
What are the side effects of thiazide diuretics?
Hypers: Glycemia, Lipidemia, Uricemia, Calcemia
Hypos: K+, H+ (MAlk), BP (that's the goal)
Allx: Sulfa
What are the Polyenes, what is their MOA and what do they Tx?
Amphotericin B and Nystatin - bind Ergosterol in fungal membrane
- AmphoB = Systemic
- Immunocompromised = Candida, Aspergillus, Crypto
- Immunocompetent = Histo, Blasto, Coccidio
- Nystatin = Oral/Topical (too toxic)
- "Swish and Swallos" for oral candidiasis
- TOP for vaginal/diaper candidiasis
What is the e.g. of a pyrimidine antifungal?
Flucytosine - inhibits DNA synthesis by conversion to 5-FU
used in Cryptococcal Meningitis in AIDS (along w/ Ampho-B)
What are the Echinocandins and what do they tx?
Inhibit fungal cell wall synthesis (ß-Glucan) = e.g. Caspofungin
- CASPofungin = CAndida and ASPergillosis
What is Griseofulvin?
Antifungal that disrupts MT's (mitosis) - PO but deposits in keratin containing tissues (hair and nails) to tx fungi there
What is Terbinafine?
Fungal Squaline Epoxidase inhibitor (so can't make lanosterol which becomes ergosterol)
Accumulates in skin and nails so used for dermatophytes and onchomycoses
What drug causes hemorrhagic cystitis?
Cyclophosphamide (and other Nitrogen-mustard based chemo agents)
prevented w/ Mesna (2-MercaptoEthaneSulfoNAte)
What causes increased HbA2?
ß-thalassemia minor or intermedia (more α than ß leads to A2 = 2α's)
What is Jervell & Lange-Nielsen syndrome?
It's a congenital long QT syndrome that presents w/ sensorineural deafness.

Other congenital long QT = Romano Ward (but doesn't have the deafness)
What are the rules of 10 for Pheochromocytoma?
10% hereditary (MEN2 A & B, vHL)
10% bilateral
10% extra-adrenal
10% malignant (90% benign)
What is Mallory-Weiss syndrome?
Hematemesis from longitudinal mucosal tears (from rapidly increasing intraabdominal pressure d/t repeated vomiting).
Seen in bulemia and alcoholics
10% of upper GI hemorrhages
What is Libman-Sacks Endocarditis?
SLE induced verrucous endocarditis (25% of SLE pts); sterile valvular vegetations d/t immune complex deoposition
Coupled w/ antiphospholipid (lupus "anti"coagulant) making it a hypercoagulable state, @ risk of coronary artery embolism → MI in someone w/o atherosclerosis
How would you Dx Prinzmetal's Angina?
Using Ergonavine stimulation (α and 5HT cause vasoconstrictor)
= transient anginal chest pain occuring during night
What drug interferes with cholesterol turning into bile acids? What enzyme is affected?
Enzyme = 7α-Hydroxylase
Drug = Fibrates (gemfibrozil) - one of the 2 ways they increase gallstones
What causes abnormal bleeding in patients w/ uremia?
Patients w/ ESRF (Uremia) are unable to clear platelet-inhibitory factors, so while the clotting factors (PT, aPTT) are fine, and the platelet COUNT is fine, they are not working properly so only the BT is elevated.
What is the cause of vertical diplopia?
CN IV - Trochlear nerve palsy
What's the most common cause of bacterial meningitis in adults?
Streptococcus pneumoniae
"Lancet-shaped Gram Positive cocci in pairs"
What is Lesch-Nyhan syndrome?
XLR deficiency of HGPRT (hypoxanthine-guanine phophoribosyltransferase) - part of the "Purine salvage" that brings hypoxanthine and guanine back up to IMP and GMP
w/o it, you have increased uric acid excretion, and purine synthesis has to rev up to make up for lost purines
What is the method for vancomycin resistance in Enterococci?
VRE change the D-alanine to D-lactate in their peptidoglycan cell wall precursors so Vancomycin can't bind
Which GI adenoma can have cauliflower-like projections?
Villous adenomas; these are larger, sessile, and more severely dysplastic than tubular adenomas
What is Quetiapine?
It's an atypical (2nd generation) antipsychotic
good for tx of schizophrenia b/c affects BOTH positive AND negative symptoms
What do keratin pearls on an esophageal Bx mean?
Squamous Cell Carcinoma of the esophagus
RF's = Smoking and Drinking
Keratin pearls indicate well-differentiated tumor
What are NON-trisomy causes of Down Syndrome?
Unbalanced Robertsonian Translocation (2-3%) - extra arm of 21
Mosaicism = Patient has 2 cell lines (one w/ normal, one trisomy)
How does biliary obstruction lead to Nyctalopia?
Night blindness d/t Vitamin A deficiency (seen along w/ dry skin)
Biliary obstruction causes malabsorption (of fat soluble vitamins A, D, E, K)