Pathoma

Front 1

This disease is caused by excess iron

Back 1

Hemocrhomatosis, excess iron causes free radical damage

Front 2

Disorder due to autoimmune production of IgG against platelet antigens (e.g., GPIIb/IIIa)

Back 2

Idiopathic thrombocytopenic purpura (ITP)

autoantibodies against platelets are made in spleen and the platelets are consumed in the spleen. Therefore removal of spleen can treat chronic ITP.

Front 3

Pathologic formation of platelet microthrombi in small vessles is known as?

Back 3

Microangiopathic hemolytic anemia

anemia is caused by the microthrombi shearing the RBCs resulting in hemolytic anemia and schistocytes

Front 4

Microangiopathic hemolytic anemia that is caused by a decrease in ADAMTS13. ADAMTS13 is used to cleave (deactivate) vWf. This leads to microthrombi due to undegraded ADAMTS13.

Back 4

Thrombotic thrombocytopenic purpura

-most common cause is autoimmunity to ADAMTS13

Front 5

Microangiopathic hemolytic anemia that is caused by endothelial damage by drugs or infection.

Back 5

Hemolytic Uremic Syndrome

-caused by EColi O157:H7 verotoxin damaging endothelial cells resulting in platelet microthrombi

Front 6

Syndrome where there is GP1b is deficient leading to platelet adhesion impairment

Back 6

Bernard-Soulier syndrome

-GP1b on platelets are responsible for binding of vWf

Front 7

Syndrome where GP IIb/IIIa is deficient leading to deficient platelet aggregation

Back 7

Glanzmann thombasthenia

-platelet aggregation is impaired since GPIIb/IIIa is responsible for that

Front 8

Platelet destruction that arises secondary to heparin therapy is called?

Back 8

Heparin-induced thrombocytopenia (HIT)

-fragments of destroyed platelets may activate remaining platelets, leading to thrombosis. This is a feared complication.

Front 9

Pathologic activation of coagulation cascade is called?

Back 9

Disseminated Intravascular Coagulation

-activation of cascade burns up all the factors and causes microthrombi everywhere as well as bleeding from mucosal surfaces.

Front 10

This disorder resembles DIC but it has no D-dimers and normal platelet counts

Back 10

Disorders of fibrinolysis due to overactive plasmin

Front 11

What is Virchow's triad?

Back 11

The three major risk factors for thrombosis:

-Disruption of blood flow

-Endothelial cell damage

-Hypercoaguable state

Front 12

What is the mechanism for warfarin skin necrosis?

Back 12

Factor 2,7,9,10 and protein C and S need epoxide reductase. Warfarin inhibits this but protein C and S have the shorter half-lives so C and S are inhibited first leading to a hypercoagulable state.

Front 13

What defect is it when factor V lacks the cleavage site for deactivation by protein C and S?

Back 13

Factor V Leiden

-most common inherited cause of a hypercoagualble state.

Front 14

Disorder that when heparin is given it does not incrase PTT?

Back 14

ATIII deficiency - anti-thrombin 3 is responsible for inhibited thrombin. Heparin works by activating ATIII. Since there is no ATIII to activate then PTT will remain the same.

Front 15

Chronic form of gas emobli characterized by multifocal ischemic necrosis of bone.

Back 15

Caisson Disease

Front 16

What are the 4 types of microcytic anemia?

Back 16

Iron deficiency

Anemia of Chronic Disease

Sideroblastic anemia

Thallesemia

Front 17

Increased hepcidin is mechanism for what disease?

Back 17

Anemia of chronic disease. Chronic disease state produces hepcidin which sequesters iron into ferritin. So lab values:

Ferritin: High

TIBC: low

Serum iron: low

%saturation: low

Front 18

Iron deficiency anemia has what lab values?

Back 18

Ferritin: low

TIBC: high

Serum iron: low

%saturation low

Front 19

Anemia due to defect in protoporphyrin synthesis is called?

Back 19

Sideroblastic anemia

Front 20

What are lab values for sideroblastic anemia?

Back 20

Ferritin: high (macrophages eat all the extra iron)

TIBC: low

Serum Iron: high

%saturation: high

Front 21

Anemia due to defect in globin chains. Due to decreased production.

Back 21

Thalassemia

Front 22

Which anemia has target cells?

Back 22

B-thallesemia

Front 23

What are the two causes for macrocytic anemia?

Back 23

Folate deficiency

Vit B12 deficiency

Front 24

Two etiologies for normocytic anemia? and how to distinguish?

Back 24

peripheral destruction or underproduction.

Reticulocyte count.

Corrected reticulocyte count >3% suggests peripheral destruction

Corrected reticulocyte count <3% suggests underproduction

Front 25

Inherited defect of RBC cytoskeleton-membrane tethering proteins leading to normocytic anemia

Back 25

Hereditary spherocytosis

Front 26

Which disease has Howell-Jolly bodies?

Back 26

Hereditary spherocytosis

Howell-Jowell bodies are DNA in RBCs that are not removed by the spleen. This can occur when the spleen is removed to treat heriditary spherocytosis.

Front 27

Acquired defect in myeloid stem cells resulting in absent GPI (glycosylphophatidylinositol); renders cells susceptible to destruction by complement.

Back 27

Paroxysmal Nocturnal Hemoglobinuria (PNH)

-GPI binds DAF and MIRL, these molecules protect it from complement; at night when you breath shallow it causes a slight acidosis which activates complement, w/o DAF and MIRL your cells are attacked.

Front 28

Inability of Glutathione (an antioxidant) to be regenerated due to a deficiency in an enzyme leading to oxidative stress.

Back 28

G6PD deficiency-

X-linked recessive disorder resulting in reduced half-life of G6PD; renders cells susceptible to oxidative stress.

Glutathione takes the hit from oxidative stress and gets reduced back to glutathione by NADPH; NADPH is produced by G6PD

Front 29

Which disease has bite cells and Heinz bodies?

Back 29

G6PD defiency - Heinz bodies are precipitated Hb due to oxidative stress, when macrophages see those Heinz bodies they bite that part off

Front 30

Antibody-mediated (IgG or IgM) destruction of RBCs is called?

Back 30

Immune hemolytic anemia

Front 31

Coombs test is used to diagnose what disease?

Back 31

Immune hemolytic anemia

-direct tests whether the RBCs are bound by IgG

-indirect tests whether there are antibodies in the serum that can bind RBCs

Front 32

What virus infects progenitor RBCs and temporarily halts erythropoiesis?

Back 32

Parvovirus B19

Front 33

Pathologic process (e.g., metaplastic cancer) that replaces bone marrow; hematopoiesis is impaired, resulting in pancytopenia

Back 33

Myelophthisic process

Front 34

Eosinophilia is classically seen in what disease?

Back 34

Hodgkin lymphoma

Front 35

Basophilia is classically seen in what disease?

Back 35

Chronic myeloid leukemia (CML)

Front 36

Monocytosis is classically seen when?

Back 36

Chronic inflammatory states and malignancy

Front 37

Viruses normally cause lymphocytic leukocytosis, what is one bacteria that can also cause it?

Back 37

Bordetella pertussis - this bacteria creates lymphocytosis-promoting factor which blocks circulating lymphocytes from leaving the bleed to enter the lymph node.

Front 38

EBV infection that results in lymphocytic leukocytosis comprised of reactive CD8+ T cells; CMV is a less common cause.

Back 38

Infectious Mononucleosis

Front 39

How do you differentiate AML vs ALL?

Back 39

AML has Myeloperoxidase

ALL has TdT+ (DNA polymerase)

Front 40

Auer rods are made of what, and what do they indicate?

Back 40

Auer rods are made of myeloperoxidase and indicate AML.

Front 41

ALL is associated with what syndrome?

Back 41

Down syndrome after the age of 5

Front 42

ALL is subdivided into what two categories and how do you distinguish them?

Back 42

B-ALL and T-ALL

B-All expresses CD10, CD19, and CD20

T-ALL expressed CD2-CD8

Front 43

ALL seen in kids has what translocation?

Back 43

t(12;21) - good prognosis

Front 44

ALL seen in adults has what translocation?

Back 44

T(9;22) - Philidelphia+ ALL

Front 45

3T's of acute lymphoblastic lymphoma

Back 45

T-ALL

Thymic Mass

Teenagers

Front 46

AML more common in children or adults?

Back 46

Adults 50-60 years old

Front 47

Acute promyelocytic leukemia is characterized by what translocation?

Back 47

t(15;17) - disrupts retinoic acid receptor, cure is ATRA which is vitamin A, promyelocytes contain Auer rods which increase risk for DIC

Front 48

Acute monocytic leukemia is a proliferation of what cell and what tissue does it commonly involve?

Back 48

Proliferation of monocytes and commonly involves gums

Front 49

Acute megakaryoblastic leukemia is proliferation of what cell and is associated with what?

Back 49

Proliferation of megakaryoblasts and association with down syndrome before age of 5

Front 50

Which leukemia is associated with down syndrome before the age of 5 and after the age of 5?

Back 50

Acute megakaryoblastic leukemia before age of 5

ALL after age of 5

Front 51

What cell is the neoplastic proliferation of CLL? what surface markers are expressed?

Back 51

proliferation of naive B-cells, CD5 and CD20

CD5 is normally on T-cells

Front 52

Smudge cells are classically seen in what disease?

Back 52

CLL

Front 53

Neoplastic proliferation of mature B cells is what disease?

Back 53

Hairy Cell Leukemia - characterized by hair cytoplasmic processes

Front 54

Positive for tartrate-resistant acid phosphatase (TRAP) is indicative of what disease?

Back 54

Hairy Cell Leukemia

Front 55

TRAP mnemonic is for what disease and what are the 3 things it's used for?

Back 55

TRAP = Hairy Cell Leukemia

Trapped in red pulp (splenomegaly of red pulp when usually its white pulp for leukemias)

Trapped in bone marrow - dry tap with bone marrow aspiration

Since they are TRAPPED, lymphadenopathy is usually absent

Front 56

Neoplastic prliferation of mature CD4+ T cells is called?

Back 56

ATLL - Adult T-cell Leukemia/Lymphoma

Front 57

ATLL is associated with what virus?

Back 57

HTLV-1 - most commonly seen in Japan, Human lymphotropic virus 1

Front 58

Pt with lytic bone lesions with hypercalcemia WITH a RASH

Back 58

ATLL (Adult t-cell leukemia/lymphoma) - if without a rash then think multiple myeloma

Front 59

Neoplastic proliferation of mature CD4+ T cells that infiltrate the skin

Back 59

Mycosis fungoides

Front 60

What are aggregates of neoplastic cells in the epidermis called?

Back 60

Pautrier microabscesses

Front 61

Neoplastic proliferation of mature myeloid cells, especially granulocytes, basophils are characteristically increased.

Back 61

CML - Chronic Myeloid Leukemia

Front 62

CML is driven by what translocation?

Back 62

t(9;22), philidelphia chromosome

Front 63

Neoplastic proliferation of myeloid cells, especially RBCs

Back 63

Polycythemia Vera

Front 64

What are the three different causes for painless lymphadenopathy

Back 64

Chronic inflammation

metastatic carcinoma

lymphoma

Front 65

Patients with rheumatoid arthritis have expansion in what region of the lymph node?

Back 65

Follicle

Front 66

Patients with early HIV have expansion in what region of the lymph node?

Back 66

Follicle

Front 67

Patients with a viral infection have expansion in what region of the lymph node?

Back 67

Paracortex - where the T-cells live

Front 68

Follicular lymphoma is driven by what translocation? and what genes are traded?

Back 68

t(14;18) -14 has Ig heavy chain, 18 is Bcl-2,

Bcl-2 is used to stabilize the mitochondrial membrane which prevents cytochrome C from leaking which prevents apoptosis.

Front 69

Most feared complication of follicular lymphoma?

Back 69

Having it progress to diffuse large B-cell lymphoma

Front 70

Mantle cell lymphoma, marginal zone lymphoma, and follicular have expansion of what cell type?

Back 70

Neoplastic small B cells (CD20+)

Front 71

Mantle Cell lymphoma is driven by what translocation? and what genes are being switched?

Back 71

t(11;14) - 11 Cyclin D1, 14 has Ig heavy chain.

Cyclin D1 promotes G1/S transition in cell cycle

Front 72

Neoplastic INTERMEDIATE-sized B Cells (CD20+T that is associated with EBV?

Back 72

Burkitt Lymphoma

Front 73

African form of Burkitt lymphoma most commonly arises where?

Back 73

In the jaw

Front 74

Sporadic form of Burkitt lymphoma most commonly arises where?

Back 74

abdomen

Front 75

Burkitt Lymphoma is driven by what translocation?

Back 75

t(8;14) - 8 is c-myc and 14 is Ig heavy chain

c-myc oncogene promotes cell growth

Front 76

What disease has a starry sky appearance?

Back 76

Burkitt Lymphoma

Front 77

Neoplastic large B-cell (CD20+) that grow diffusely in sheets.

Back 77

Diffuse Large B-cell Lymphoma

Front 78

Most common form of non-hodgkin lymphoma?

Back 78

Diffuse Large B-cell lymphoma

Front 79

Neoplastic proliferation of Reed-Sternberg cells

Back 79

Hodgkin Lymphoma

Front 80

Reed-Sternberg cells have what surface markers?

Back 80

CD15 and CD30

Front 81

Which disease has owl-eye nulclei?

Back 81

Reed-sternberg cells of hodgkin lymphoma

Front 82

Which interleukin is high in multiple myeloma

Back 82

IL-6

Front 83

What disease has an increased serum protein with M spike on SPEP(serum protein electrophoresis) but it has none of the other features of multiple myeloma (no lytic lesions, hypercalcemia, AL amyloid, or Bence-Jones proteinuria)

Back 83

Monoconal Gammopathy of Undetermined Significance

Front 84

Waldenstrom Macroglobulinemia has what type of lymphoma with what type of Ig production?

Back 84

B-cell lymphoma with monoclonal IgM production

Front 85

Neoplastic proliferation of Langerhans Cell

Back 85

Langerhans Cell histiocytosis

Front 86

Birbeck granules (tennis racquet) is characteristic of what disease?

Back 86

Langerhans Cell histiocytosis

Front 87

2 malignant disease of langerhans cells?

Back 87

Letterer-Siwe disease

Hand-Schuller-Christian disease

Front 88

Benign proliferation of langerhans cells in bone

Back 88

Eosinophlic granuloma

Front 89

WBC differential from highest to lowest?

Back 89

Mnemonic: Neutrophils Like Making Everything Better

Neutrophils (54-62%)

Lymphocytes (25-33)

Monocytes (3-7)

Eosinophils (1-3)

Basophils (0-.75)

Front 90

CD14 is cell surface marker for which cell?

Back 90

Macrophages

Front 91

Target Cell is associated with what pathology? (4)

Back 91

"HALT" said the hunter to his target

HbC disease

Asplenia

Liver disease (alcoholism)

Thalassemia

Front 92

What pathology has glutamic acid to lysin mutation at residue 6 in Beta globin?

Back 92

HbC defect - extravascular normocytic anemia

Front 93

Apixaban and rivaroxaban

Drug class and clinical use

Back 93

Class: Direct Factor Xa inhibitor

Mechanism:Bind and directly inhibit the activity of factor Xa

C:DVT and PE

Front 94

Clopidogrel

Drug class and clinical use

Back 94

Drug class: ADP receptor inhibitor

M: inhibit platelet aggregation by irreversibly blocking ADP receptors

C: acute coronary syndrome, coronary stent, prophy for recurrent strokes

T: TTP/HUS may be seen

Front 95

Ticlopidine

Drug class and clinical use

Back 95

Drug class: ADP receptor inhibitor

M: inhibit platelet aggregation by irreversibly blocking ADP receptors

C: acute coronary syndrome, coronary stent, prophy for recurrent strokes

T: TTP/HUS may be seen, NEUTROPENIA

Front 96

Abciximab

Drug class and clinical use

Back 96

GP IIb/IIIa inhibitors

M: prevent aggregation of platelets

Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty

Front 97

Eptifibatide

Drug class and clinical use

Back 97

GP IIb/IIIa inhibitors

M: prevent aggregation of platelets

Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty

Front 98

Which cells are infected in infectious mononucelosis?

Back 98

CD8+ T-cells

Front 99

Hypersegmented neutrophils and elevated MCV is associated with what?

Back 99

Folate or B12 deficient anemias

Front 100

Which blood thinner has increased risk for neutropenia?

Back 100

Ticlopidine - ADP receptor inhibitor which inhibits platelet aggregation

Front 101

What is the mechanism for hydroxyurea in the tx of sickle cell anemia?

Back 101

It increases the formation of HbF which do not sickle.

Front 102

What drug is used for Heparin induced thrombocytopenia? and what is it's mechanism of action?

Back 102

Argatroban which is a direct thrombin inhibitor.

Bivalriduin can also be used.

Front 103

Pt with hemolytic anemia, hypercoaguable state, and thrombocytopenia suggests what disease?

Back 103

Paroxysmal Hemolytic Anemia

Front 104

Which anemia has increased MCHC (mean corpuscular hemoglobin concentration)?

Back 104

Hereditary Spherocytosis

Front 105

Which anemia has osmotic fragility?

Back 105

Hereditary Spherocytosis

Front 106

What drug reverses heparin?

Back 106

Protamine

Front 107

What causes a left shift in oxygen-hemoglobin dissociation curve? Right shift?

Back 107

Left shift = lower

Base

Lower 2,3 DPG

Lower Temperature

Right shift is opposite

Acid

Higher 2,3 DPG

Higher temperature

CADET face RIGHT

CO2

Acid

DPG

Exercise

Temperature

Front 108

What are the acute-phase reactants of inflammation? (4)

Back 108

IL-6

IL-1

TNF-a

IFN-y

Front 109

Granulomatous vasculitis that classically involves branches of the carotid artery

Back 109

Temporal (Giant Cell) Arteritis

Front 110

Granulomatous vasculitis that classically involves the aortic arch at branch points.

Back 110

Takayasu Arteritis

Front 111

Tx for granulomatous vasculitis such as Temporal (giant cell) arteritis or Takayasu arteritis

Back 111

Corticosteroids

Front 112

Pts with Temporal Giant Cell Arteritis have a high risk for what complication?

Back 112

Blindness

Front 113

Medium-Vessel Vasculitis involves what portion of the arteries?

Back 113

It commonly involves the muscular arteries that supply the organs

Front 114

(Medium-Vessel) Necrotizing vasculitis involving multiple organs; lungs are spared.

Back 114

Polyarteritis Nodosa

Front 115

This medium vessel vasculitis is associted with serum HBsAG (Hepatitis B antigen)

Back 115

Polyarteritis Nodosa

Front 116

This disease has a string-of-pearls appearance on imaging

Back 116

Polyarteritis Nodosa

Front 117

Medium-Vessel vasculitis that affects asian children <4 years old

Back 117

Kawasaki Disease

Front 118

Medium-Vessel vasculitis that commonly involves the coronary artery

Back 118

Kawasaki disease

Front 119

Medium-Vessel vasculitis that is highly associated with heavy smoking

Back 119

Buerger Disease

Front 120

What is the treatment for kawasaki disease?

Back 120

Aspirin

Front 121

Rash on the palms and rash on the soles is associated with what medium-vessel vasculitis?

Back 121

Kawasaki disease

Front 122

Necrotizing vasculitis that involves the digits

Back 122

Buerger Disease

Front 123

Necrotizing granulomatous vasculitis the involves the nasopharynx, lungs, and kidneys

Back 123

Wegener Granulomatosis

Front 124

Wegener granulomatosis involves what parts of the body?

Back 124

Nasopharynx, lungs, and kidneys

Front 125

c-ANCA is associated with which small-vessel vasculitis?

Back 125

Wegener Granulomatosis

Front 126

Necrotizing vasculitis involving multiple organs, especially lung and kidney.

Back 126

Microscopic Polyangitis

Front 127

Serum p-ANCA is associated with which small-vessel vasculitis (2)?

Back 127

Microscopic polyangitis

Churg-Strauss syndrome

Front 128

Necrotizing granulomatous vasculitis with eosinophils

Back 128

Churg-Strauss syndrome

Front 129

Which small-vessel vasculitis have granulomas?

Back 129

Wegener and Churg-Strauss

Front 130

Vasculitis due to IgA immune complex depositiion; most common vasculitis in children

Back 130

Henoch-Schnolein purpura

Front 131

This disease presents with palpable purpura on buttocks and legs, GI pain and bleeding.

Back 131

Henoch-Schnolein purpura

Front 132

This small0-vessel vasculitis presents with hematuria (IgA nephropathy)

Back 132

Henoch-Schnolein purpura

Front 133

How does angiotensin II increase blood pressure?

Back 133

-Contracts arteriolar smooth muscle increasing TPR

-Promotes adrenal release of aldosterone, which increases resorption of sodium in the distal convoluted tubule

Front 134

Two causes for renal artery stenosis, one is for elderly males and one is for young females.

Back 134

Elderly male - atherosclerosis

Young female - fibromuscular dysplasia

Front 135

Which portion of the artery becomes thickened in atherosclerosis?

Back 135

Intima

Front 136

Hyaline arterololsclerosis can be caused by what two things? and what does this lead to?

Back 136

Benign HTN - increased pressure forces proteins into the vessel wall

Diabetes - non-enzymatic glycosylation making membrane leaky

Leads to arteriolonephrosclerosis --> chronic renal failure

Front 137

Hyperplastic arteriosclerosis is caused by what? and what does it lead to?

Back 137

Malignant HTN

Acute renal failure

Front 138

Calcification of the media of muscular arteries; non-obstructive; not clinically significant

Back 138

Monckeberg Medial Calcific Sclerosis

Front 139

Intimal tear with dissection of blood through media of aortic wall is called?

Back 139

Aortic Dissection

Front 140

Most common cause of Aortic Dissection

Back 140

HTN

Front 141

Balloon-like dilation of the thoracic aorta is called

Back 141

Thoracic aneurysm

Front 142

Balloon-like dilation of the abdominal aorta is called?

Back 142

Abdominal aneurysm

Front 143

Classic cause of thoracic aneurysm is what?

Back 143

Tertiary syphillis - endarteritis of the vaso vasorum results in luminal narrowing and atrophy of the vessel wall

Front 144

"Tree bark" appearance of aorta is seen in what?

Back 144

Thoracic aneurysm due to syphillis

Front 145

Where do abdominal aortic aneurysms usually occur?

Back 145

below renal arteries but above aortic bifurcation

Front 146

Abddominal aortic aneurysm usually caused by what?

Back 146

HTN

Classically seen in male smokers > 60 years old with HTN

Front 147

Benign tumor comprised of blood vessels?

Back 147

Hemangioma

Front 148

Pt present with hypotension, pulsatile abdominal mass, and flank pain. What is the dx?

Back 148

Abdominal aortic aneurysm rupture

Front 149

Malingnant proliferation of endothelial cells

Back 149

Angiosarcoma

Front 150

This cancer is associated with exposure to PVC

Back 150

Liver angiosarcoma

Front 151

This cancer is associated with arsenic and Thorotrast

Back 151

Liver angiosarcoma

Front 152

Low-grade malignant proliferation of endothelial cells associated with HHV-8

Back 152

Kaposi Sarcoma

Front 153

What percentage of blood flow must be stopped before symptoms emerge?

Back 153

70% stenosis; stable angina does not have symptoms unless there is 70% blockage

Front 154

Which angina has the EKG show ST-segment depression and which has EKG elevation? (3)

Back 154

Stable and unstable have depression due to subendocardial ischemia, prinzmetal has elevation due to transural ischemia

Front 155

Myocardial Infarction usually affects what portion of the heart?

Back 155

Left Ventricle

Front 156

Most sensitive and specific marker for a myocardial infarction

Back 156

Troponin I

Front 157

What marker is useful for detecting reinfarction days after MI?

Back 157

CK-MB, it returns to normal by 72 hours while Troponin I stays high for 7-10 days.

Front 158

Exposure of pericardium to immune system leading to autoimmunity leading to pericarditis

Back 158

Dressler syndrome

Front 159

Stages of MI, 1 day, 1 week, 1 month

Back 159

Coag Necrosis | Neutro then Macro | Granulation Tissue | Scar Tissue

Front 160

What is the main tx for Left-Sided Heart Failure?

Back 160

ACE inhibitor

Front 161

What is the most common cause for Right-sided heart failure?

Back 161

Left-side Heart failure

Front 162

Nutmeg liver is associated with what?

Back 162

Right-sided heart failure

Front 163

Defect in the septum that divides the right and left ventricles

Back 163

Ventricular Septal Defect

Front 164

What is Ventricular septal defect associated with?

Back 164

Fetal alcohol syndrome

Front 165

5 T's of Right to left shunt

Back 165

Truncus arteriosus

Transposition of great vessels

Tricuspid atresia

Tetralogy of fallot

Total anomalous pulmonary venous return

Front 166

Two types of Atrial septal defect: which is most common, which is associated with Down syndrome?

Back 166

Ostium secundum = most common

Ostium primium = Down syndrome

Front 167

Patent ductus arteriosus is associated with what?

Back 167

Rubella

Front 168

What is Eisenmenger syndrome?

Back 168

When a Left to right shunt reverse to a right to left shunt, leading to cyanosis.

Front 169

What is the tetrology of Fallot?

Back 169

PROV

Pulmonary stenosis

Right Ventricular Hypertrophy

Overriding AORTA

Ventricular Septal defect

Front 170

Which congenital defect which becomes cyanotic stops the cyanosis when they squat?

Back 170

Tetralogy of Fallot

Front 171

Boot shaped heart on X-ray is associated with what?

Back 171

Tetralogy of Fallot

Front 172

Transposition of the great vessels is associated with what?

Back 172

Maternal diabetes

Front 173

Infantile form of Coarction of Aorta is associated with what two things and is located where on the aortic arch?

Back 173

Infantile associated with PDA and Turner syndrome and lies distal to the aortic arch but proximal to the PDA

Front 174

Adult form of coarction of aorta is located where and associated with what?

Back 174

Distal to the aortic arch, there is no PDA. Associated with bicuspid aortic valve

Front 175

This present with HTN in upper extremities and hypotension with weak pulse in lower extremities

Back 175

Adult coarction of aorta. This is because the blockage is after the aortic arch. Upper extremities gets all the blood pressure while the lower extremities are blocked by the coarction.

Front 176

Collateral circulation develops across intercostal arteries, engorged arteries causes nothing of ribs on x-ray. What pathology is this?

Back 176

Adult coarctation of aorta

Front 177

Systemic complication of pharyngitis due to group A B-hemolytic streptococci

Back 177

Acute rheumatic fever

Front 178

What is the pathophysiology of acute rheumatic fever?

Back 178

Caused by molecular mimicry; bacterial M protein resembles human tissues

Front 179

What is Jones criteria used for?

Back 179

Acute Rheumatic Fever

Front 180

What are the Major criteria for Acute Rheumatic Fever?

Back 180

Joints - migratory polyarthritis

O = heart problems - pancarditis

Nodules = Subcutaneous nodules

E = Erythema Marginatum

Sydenham chorea = rapid, involuntary muscle movement

Front 181

In acute rheumatic fever which valve is most often involved? and if another valve is involved which one?

Back 181

Alway Mitral valve maybe also aortic valve

Front 182

Acute Rheumatic fever has these two histological characteristics

Back 182

Aschoff body (foci of chronic inflammation) involving myocardium with anitschkow cells (caterpillar nuclei)

Front 183

Valve scarring that arises as a consequence of rheumatic fever

Back 183

Chronic Rheumatic Heart Disease

Front 184

Narrowing of the aortic valve orifice

Back 184

Aortic Stenosis

Front 185

Aortic stenosis is caused by what?

Back 185

Fibrosis and calcification from "wear and tear"

Front 186

Backflow of blood from aorta into the left ventricle during diastole

Back 186

Aortic Regurgitation

Front 187

Two causes for aortic regurgitation

Back 187

Aortic root dilation (e.g., syphilitic aneurysm) or valve damage (e.g., infective endocarditis)

Front 188

Hyperdynamic circulation is associated with what?

Back 188

Aortic Regurgitation

Front 189

Ballooning of mitral valve into left atrium during systole

Back 189

Mitral Valve Prolapse

Front 190

Myxoid degneration of mitral valve will lead to what?

Back 190

Mitral valve prolapse

Front 191

Reflux of blood from left ventricle into the left atrium during sytole

Back 191

Mitral regurgitation

Front 192

Narrowing of the mitral valve orifice

Back 192

Mitral Stenosis

Front 193

Mitral stenosis is usually due to?

Back 193

Chronic rheumatic valve disease

Acute rheumatic heart disease leads to mitral regurgitation.

Front 194

Most common overall cause of endocardittis

Back 194

Streptococcus viridans

Front 195

Most common cause and valve affected in endocarditis in IV drug users?

Back 195

S. Aureus, Tricuspid valve

Front 196

This bacteria is associated with prosthetic valves

Back 196

S. Epidermidis

Front 197

Endocarditis in patients due to S. Bovis usually have what other pathology?

Back 197

Colorectal carcinoma

Front 198

What are the HACEK organisms and what is the signficance?

Back 198

Haemophilus

Actinobacillus

Cardiobacterium

Eikenella

Kingella

This organisms are associated with endocarditis with negative blood cultures

Front 199

Janeway lesions (erythematous non-tender lesions on the palms and soles) is a clinical feature of what?

Back 199

Bacterial Endocarditis

Front 200

Osler nodes (tender lesions on fingers and toes) is a clinical feature of what?

Back 200

Bacterial Endocarditis

Front 201

Sterile vegatations that arise with hypercoaguable state or underlying adenocarcinoma

Back 201

Nonbacterial thrombotic endocarditis

Front 202

Sterile vegetations associated with SLE

Back 202

Libman-Sacks Endocarditis

Front 203

Dilation of all four chambers of heart

Back 203

Dilated cardiomyopathy

Front 204

Massive hypertrophy of the left ventricle usually due to genetic mutations in sarcomere proteins; most common form is autosomal dominant

Back 204

Hypertrophic cardiomyopathy

Front 205

Sudden death due to ventricular arrhythmias; common cause of sudden death in young adults

Back 205

Hypertrophic cardiomyopathy

Front 206

Decreased compliance of the ventricular endomyocardium that restricts filling during diastole

Back 206

Restrictive Cardiomyopathy

Front 207

Benign mesenchymal tumor with a gelatinous appearance and abundant ground substance on histology

Back 207

Myxoma

Front 208

Restrictive cardiomyopathy presents as what?

Back 208

Congestive heart failure

Front 209

Most common primary cardiac tumor in adults

Back 209

Myxoma

Front 210

Usually forms a pedunculated mass in the left atrium that causes syncope due to obstruction of mitral valve

Back 210

Myxoma

Front 211

This cardiac tumor is associated with tuberous sclerosis

Back 211

Rhabdomyoma

Front 212

Benign hamartoma of cardiac muscle

Back 212

Rhabdomyoma

Front 213

Fetal erythropoiesis order of organs responsible. (4)

Back 213

Yolk Sac (3-8wks)

Liver (6wks-birth)

Spleen (10-28wks)

Bone Marrow (18wks to adult)

Young Liver Synthesizes Blood

Front 214

What are the components of fetal hemoglobin and adult hemoglobin?

Back 214

A2Y2 (alpha2 gamma2) = fetal

A2B2 (alpha2 beta2) = adult

Front 215

Venodilators decrease preload or afterload?

Back 215

Venodilators decrease preload

Front 216

Vasodilators decrease preload or afterload?

Back 216

Vasodilators decrease afterload

Front 217

S1 and S2 sound is due to and where is it located?

Back 217

S1 - Mitral and tricuspid valve closure, loudest at mitral area

S2 - Aortic and pulmonary valve closure. Loudest at left sternal border

Front 218

S3 and S4 sound due to?

Back 218

S3 - in early diastole during rapid ventricular filling phase.

S4 - "atrial kick" in late diastole. High atrial pressure. Associated with ventricular hypertrophy.

Front 219

Receptors in aortic arch transmit via what nerve?

Back 219

Vagus (responds only to increase in BP)

Front 220

Receptors in carotid sinus transmit via what nerve?

Back 220

Glossopharyngeal (responds to decrease and increase of BP)

Front 221

HTN with CHF, cautious of what drug?

Back 221

B-Blockers

Front 222

HTN with Diabetes, should use what drug?

Back 222

ACE inhibitors/ARBs are protective against diabetic nephropathy

Front 223

HMG-CoA reductase inhibitors (statins) effect on LDL, HDL, Triglycerides, MOA, side effects

Back 223

3x decrease of LDL, 1x increase of HDL, 1x decrease of triglycerides. Inhibit HMG-COA reductase, hepatoxicity, rhabdomyolysis

Front 224

Niacin (Vit B3) effect on LDL, HDL, Triglyceride, MOA, side effects

Back 224

2x decrease LDL, 2x increase HDL, 1x decrease triglyceride. Inhibit lipolysis in adipose tissue, reduce hepatic VLDL synthesis. Red, flushed face which is decreased by aspirin.

Front 225

Bile acid resins (cholestyramine, colestipol, colesevelam) effect on LDL, HDL, Triglyceride, MOA, side effect

Back 225

2x decrease LDL, slight increase HDL, slight INCREASE of triglyceride. Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more. Decrease absorption of fat-soluble vitamins. Gall stones.

Front 226

Cholesterol absorption blockers (ezetimibe) effect on LDL, HDL, Tri, MOA, side effect

Back 226

2x decrease LDL, no effect on HDL or Tri, Prevent cholesterol absorption at small intestine brush border.

Front 227

Fibrates (gemfibrozil, clofibrate, -fibrates) effect on LDL, HDL, TRI, MOA, side effect.

Back 227

decrease LDL, increase HDL, 3x decrease Tri. Upregulate LPL--> TG clearance activates PPAR-a to induce HDL synthesis

Front 228

Which Lipid-lowering agent class best decreases Triglycerides?

Back 228

Fibrates (Gemfibrozil, clofibrate, bezafibrate, fenofibrate)

Front 229

Which lipid-lowering agent class best decreases LDL?

Back 229

HMG-CoA reductase (statins)

Front 230

Which lipid-lowering agent increases triglycerides?

Back 230

Bile acid resins (Cholestyramine, colestipol, colesevelam)

Front 231

Which lipid lower agent has no effect on HDL or Triglycerides?

Back 231

Cholesterol absorption blockers (ezetimibe)

Front 232

Statins in combination with what drugs has increased risk for rhabdomyolysis?

Back 232

Statins with fibrates and niacin

Front 233

When determining metabolic, respiratory, alka vs acidosis what are the steps?

Back 233

Look at pH to determine if its alka or acid, now determine if its resp or meta by looking at bicarbonate.

Front 234

How do beta blockers effect the RAAS?

Back 234

Beta blockers inhibit renin release by blocking beta-1 receptors on Juxtaglomerular cells

Front 235

Most common benign vascular tumor in children? adults?

Back 235

Strawberry hemangioma - children

Cherry hemangioma - adults

Front 236

Anti-hypertensives ending in -zosin have what MOA?

Back 236

They are alpha-1 blockers and are also useful for benign prostatic hyperplasia

Front 237

If you have a child with nasal polyps what should you also be checking for?

Back 237

Cystic fibrosis

Front 238

Pts with ASA-intolerant asthma have what triad?

Back 238

Asthma, aspirin-induced bronchospasms, and nasal polyps

Front 239

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tisse

Back 239

Angiofibroma

Front 240

If an adolescent male has profuse epitaxis what should you suspect?

Back 240

Angiofibroma

Front 241

Malignant tumor of nasopharyngeal epithelium

Back 241

Nasopharyngeal carcinoma

Front 242

Nasopharyngeal carcinoma is associated with what?

Back 242

EBV

Front 243

Nasopharyngeal carcinoma has what type of histology?

Back 243

Pleomorphic KERATIN-POSITIVE epithelial cells

Front 244

Inflammation of the upper airway

Back 244

Laryngotracheobronchitis (Croup)

Front 245

Nodule that arises on the true vocal cord

Back 245

Vocal cord nodule

Front 246

Benign papillary tumor of the vocal cord

Back 246

Laryngeal papilloma

Front 247

Laryngeal papilloma is due to what?

Back 247

HPV 6 and 11

Front 248

Laryngeal papillomas are usually (single/multiple) in adults and (single/multiple) in children

Back 248

Single in adults

Multiple in children

Front 249

Squamous cell carcinoma arising from epithelial lining of vocal cord

Back 249

Laryngeal carcinoma

Front 250

2 key chemical mediators for pain

Back 250

Prostaglandin E2 and Bradykinin

Front 251

Three patterns of pneumonia that can be seen on chest x-ray

Back 251

Lobar pneumonia, bronchopneumonia, interstitial pneumonia

Front 252

Pneumonia characterized by consolidation of an entire lobe of the lung

Back 252

Lobar pneumonia

Front 253

Pneumonia characterized by scattered patchy consolidation centered around bronchioles; often multifocal and bilateral

Back 253

Bronchopneumonia

Front 254

Pneumonia characterized by diffuse interstitial infiltrates.

Back 254

Interstitial (atypical) pneumonia

Front 255

Lobar and bronchopnemonia usually bacterial or viral?

Back 255

Bacterial

Front 256

Interstitial pneumonia is usually bacterial or viral?

Back 256

viral

Front 257

Most common cause for lobar pneumonia (2 bacterias)?

Back 257

Streptococcus Pneumoniae (95%) and Klebsiella pneumoniae

Front 258

Lobar pneumonia in patients who have high chance of enteric flora aspiration (elderly in nursing homes, alcoholics). What is the bacterial cause of the pneumonia?

Back 258

Klebsiella pneumoniae

Front 259

Which type of pneumocyte can replicate Type 1 or 2?

Back 259

Type 2 can replicate

Front 260

Which type of pneumocyte is responsible for producing surfactant?

Back 260

Type 2

Front 261

Which type of pneumocyte is responsible for the epithelial lining?

Back 261

Type 1

Front 262

What are the four classic phases of lobar pneumonia and describe each.

Back 262

Congestion - congested vessels and edma

Red hepatization - exudate, neutrophils, and hemmorrhage filling the alveolar air space

Gray hepatization - degradation of red cells within exudate

Resolution - regeneration

Front 263

Aspiration pneumonia usually affects which side?

Back 263

Right lower lobe (due to anatomy)

Front 264

Which bacteria anaerobic bacteria are normally responsible for aspiration pneumonia? (3)

Back 264

Bacteroidies, fusobacterium, and peptococcus

Front 265

Most common site for systemic spread of TB?

Back 265

Kidneys creating a sterile pyuria

Front 266

Which congenital heart defects are caused by abnormal migration of neural crest cells (3)?

Back 266

Truncus Arteriosus

Transposition of Great Vessels

Tetralogy of Fallot

Front 267

What is the DOC for Beta blocker overdose? and what is the receptor it works on?

Back 267

Glucagon, which increases HR and contractility via cAMP.

Front 268

T-lymphocyte immunodeficiency that resultsin maldevelopment of the third and fourth branchial (pharyngeal) pouches.

Back 268

DiGeorge syndrome

Front 269

DiGeorge syndrome is due to a deletion of what chromosome?

Back 269

Chromsome 22

Front 270

MOA of Dobutamine

Back 270

B1-adrenergic receptor agonist. Is used for acute heart failure due to decreased myocardial contractility

Front 271

Beta-Blockers work where on an EKG?

Back 271

PR interval, they slow AV conduction.

Front 272

(4)Hyper and (2)Hypo problems of Thiazide diuretics

Back 272

Hyperuricemia

Hypercalcemia

Hyperglycemia

Hyperlipidemia

Hypokalemia

Hypotension

Front 273

Doxorubicin can causes what problem with the heart?

Back 273

Dilated cardiomyopathy

Front 274

Sharp pain that is relieved by sitting up and leaning forward suggests what?

Back 274

Pericarditis - associated with SLE

Front 275

Nitrates mixed with drugs for erectile dysfunction are absolutely contraindicated, what is the MOA?

Back 275

Increased cyclic GMP due to nitrates synthesizing and PDE inhibitors inhibiting degradation.

Front 276

What is FVC? Normal amount?

Back 276

Forced vital capacity - breathe in all the way breath out all the way.

5L

Front 277

What is FEV1? Normal amount?

Back 277

Forced Expiratory Volume - How much air you can breath out in the first second.

4L

Front 278

In airway obstruction what are the relative decreases in FVC, FEV1, and FEV1:FVC ratio,FRC, TLC?

Back 278

FVC - decreases

FEV1 - significant decrease

FEV1:FVC ratio - decreases

FRC - Increased

TLC - increases due to trapped air

Front 279

Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking

Back 279

Chronic bronchitis

Front 280

Destruction of alveolar air sacs leading to COPD

Back 280

Emphysema

Front 281

What enzyme neutralizes proteases in alveolar air sacs?

Back 281

A1AT - a1-antitrypsin neutralizes proteases

Front 282

Deficiency in what can cause emphysema?

Back 282

A1AT - a1-antitrypsin

Front 283

Barrel-chest (increased AP diameter) is found in emphysema or chronic bronchitis?

Back 283

Emphysema

Front 284

Smoking leads to centriacinar or panacinar emphysema?

Back 284

centriacinar

Front 285

A1AT deficiency leads to centriacinar or panacinar emphysema?

Back 285

panacinar

Front 286

In A1AT, the two organs affected are what?

Back 286

Lung emphysema and liver cirrhosis

Front 287

Biopsy of liver in A1AT will reveal what?

Back 287

pink, PAS-positive globules in hepatocytes

Front 288

Prolonged expiration with pursed lips, is which COPD?

Back 288

Emphysema

Front 289

Match: Emphysema and Cystic fibrosis with Increased or Decreased Functional Residual Capacity

Back 289

Emphysema = Increased FRC

Cystic Fibrosis = Decreased FRC

Front 290

Key cytokines released by Th2 helper CD4+ T cells?

Back 290

IL-4, IL-5, IL-10

Front 291

IL-5 main job?

Back 291

recruit eosinophils

Front 292

In asthma allergens stimulate what cells to release what three cytokines which are responsible for what?

Back 292

Th2 CD4+ T cells --> IL-4,IL-5,IL-10

IL-4 = IgE Class switch

IL-5 = recruit eosinophils

IL-10 = inhibit Th1 stimulate Th2

Front 293

Reexposure to allergen has two phases, what is released in the first phase, what is released in the second phase?

Back 293

First phase = release of histamine

Second phase = Release of leukotriene C4,D4,E4

Front 294

What are leukotrienes C4,D4,E4 responsible for?

Back 294

Bronchoconstriction, inflammation, edema

Front 295

What are Charcot-Ledyden crystals and what are they assocaited with?

Back 295

Eosinophil-derived crystals associated with asthma

Front 296

What are Curschmann spirals?

Back 296

spiral-shaped mucus plugs found in asthma

Front 297

What is permanent dilation of bronchioles and bronchi?

Back 297

Bronchiectasis

Front 298

What is the classic cause of bronchiectasis?

Back 298

Classic cause is cystic fibrosis

Front 299

What syndrome is associated with Bronchiectasis, and what is defective?

Back 299

Kartagener syndrome - defect in dynein arm of cilia

Front 300

In restricted lung diseases are these values increased or decreased? TLC, FVC, FEV1,FRC, FEV1:FVC ratio

Back 300

TLC - decreased

FVC - decreased 2x

FEV1 - decreased

FRC - decreased

FEV:FVC ratio - increased

Front 301

Fibrosis of lung interstitium with unknown etiology

Back 301

Idiopathic Pulmonary Fibrosis

Front 302

What chemical mediator drives the process of idiopathic pulmonary fibrosis?

Back 302

TGF-B

Front 303

What is interstitial fibrosis due to occupational exposure

Back 303

Pneumoconioses

Front 304

What are the 4 types of Pneumoconioses?

Back 304

Coal Worker's

Silicosis - sandblasters and silica miners

Beryliosis - berylium miners and aerospace

Absestosis - construction workers, plumbers, shipyard workers

Front 305

Aerospace worker who has lung problmes, what is the dx?

Back 305

Berylliosis

Front 306

What is the name of collections of carbon-laden macrophages, like that seen in Coal Worker's pneumoconiosis?

Back 306

Anthracosis

Front 307

What pneumoconioses increases risk for TB and why?

Back 307

Silicosis - Silica impairs phagolysosome formation by macrophages.

Front 308

Which pneumoconioses has noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs, similar to sarcoidosis?

Back 308

Berylliosis - distinguish by med hx and see if they work in the aerospace industry

Front 309

Absetosis more likely to get lung carcinoma or mesothelioma?

Back 309

Lung carcinoma

Front 310

Systemic disease characterized by noncaseating granulomas in multiple organs

Back 310

Sarcoidosis

Front 311

Asteroid bodies are associated with what disease?

Back 311

Sarcoidosis - stellate inclusions that are often seen within giant cells of the granulomas

Front 312

Sarcoidosis has two lab findings what are they?

Back 312

Elevated serum ACE

Hypercalcemia

Front 313

What is the pathophysiology of hypercalcemia in sarcoidosis?

Back 313

1-alpha hydroxylase activity of epitheliod histiocytes converts vitamin D to its active form - this occurs in all non-caseating granulomas (e.g., sarcoidosis and berylliosis)

Front 314

Granulomatous reaction to inhaled organic antigens where chronic exposure leads to interstitial fibrosis.

Back 314

Hypersensitivity Pneumonitis

Front 315

Aschoff body and anischkow (caterpillar) cells are associated with what?

Back 315

Acute Rheumatic Fever

Front 316

What are plexiform lesions and what are they associated with?

Back 316

Tufts of capillaries; associated with pulmonary HTN

Front 317

Pulmonary HTN leads to what two things?

Back 317

Right ventricular hypertrophy and cor pulmonale

Front 318

If someone presents with exertional dyspnea what should come to mind?

Back 318

Pulmonary HTN

Front 319

Primary pulmonary HTN the etiology is unknown but some familial forms are related to inactivating mutations of what, which leads to what?

Back 319

BMPR2, leading to proliferation of vascular smooth muscles

Front 320

Diffuse damage to the alveolar-capillary interface leads to formation of what? What is this disease called?

Back 320

Leads to formation of hylaine membranes in alveoli, disease is Acute Respiratory Distress Syndrome

Front 321

Diffuse white-out on chest x-ray suggests what?

Back 321

Acute Respiratory Distress Syndrome

Front 322

Which pneumocytes get damaged in Acute Respiratory Distress syndrome?

Back 322

Type I and Type II both get damaged

Front 323

Respiratory distress due to inadequate surfactant levels is called?

Back 323

Neonatal Respiratory Distress syndrome

Front 324

Neonatal Respiratory Distress Syndrome associated with what 3 things?

Back 324

Prematurity

C-Section

Maternal Diabetes

Front 325

What is the major component of surfactant?

Back 325

Phosphatidylcholine (lecithin)

Front 326

Why does C-section delivery cause increased risk for Neonatal Respiratory Distress Syndrome?

Back 326

Lack of stress-induced steroids; steroids increases synthesis of surfactant

Front 327

What is particularly carcinogenic in cigarette smoke?

Back 327

Polycyclic aromatic hydrocarbons

Front 328

What type of cancer is increased in radon miners?

Back 328

Lung cancer

Front 329

Two benign "coin-lesions" that can be seen on a chest x-ray

Back 329

Granuloma and Bronchial Hamartoma

Front 330

What is a benign tumor composed of lung tissue and cartilage; often calcified on imaging?

Back 330

Bronchial Hamartoma

Front 331

Lung carcinoma is divided into what two categories? and what is the significance?

Back 331

Small cell carcinoma and non-small cell carcinoma. Small cell responds to chemo, non-small cell responds to surgery

Front 332

Non-small cell carcinoma with glands or mucin

Back 332

Adenocarcinoma

Front 333

Non-small cell carcinoma with keratin pearls or intracellular bridges

Back 333

Squamous cell carcinoma

Front 334

Non-small cell carcinoma with NO keratin pearls, intracellular bridges, glands, or mucin

Back 334

Large cell carcinoma

Front 335

Small cell carcinoma is associated with what syndrome?

Back 335

Eaton-Lambert syndrome - anti-bodies against calcium channels in NMJ leading to weakness

Front 336

Lung carcinomas that start with S (small cell carcinoma, squamous cell carcinoma) have what common attributes? (3)

Back 336

Smokers, Central, paraneoplastic syndromes

Front 337

Which lung cancer can cause hypercalcemia and what is the mechanism?

Back 337

Squamous cell carcinoma due to production of PTHrP (parathyroid hormone related Peptide)

Front 338

Which lung cancer may produce ADH or ACTH?

Back 338

Small cell carcinoma

Front 339

What is the most common tumor in non-smokers?

Back 339

Adenocarcinoma

Front 340

What is the most common tumor in female smokers?

Back 340

Adenocarcinoma

Front 341

What is the most common tumor in male smokers?

Back 341

Squamous cell carcinoma

Front 342

Name the tumor: Columnar cells that grow along preexisting bronchioles and alveoli; arises from Clara cells

Back 342

Bronchioalveolar carcinoma

Front 343

Which lung cancers are chromogranin positive?

Back 343

Carcinoid tumor and Small Cell Carcinoma

Front 344

Lung cancer with well differentiated neuroendocrine cells

Back 344

Carcinoid tumor

Front 345

Two lung cancers not related to smoking

Back 345

Bronchioalveolar carcinoma

Carcinoid tumor

Front 346

Two lung cancers that are derived from neuroendocrine cells; what is the difference?

Back 346

Small cell carcinoma - poorly differentiated

Carcinoid tumor - well differentiated

Front 347

Which lung cancer presents as a polyp-like mass in the bronchus?

Back 347

Carcinoid tumor

Front 348

Two Most common source for metastasis to lung?

Back 348

Breast and colon cancer

Front 349

This lung cancer has multiple 'cannon-ball' nodules on imaging

Back 349

Metastasis to lung

Front 350

Where do lung cancers like to metastasize?

Back 350

Adrenal gland

Front 351

Lung cancer can lead to Horner syndrome, what are the 3 characteristics?

Back 351

Compression of sympathetic chain leads to

-ptosis (drooping of eyelid)

-miosis (pinpoint pupil)

-anhidrosis (no sweating)

Front 352

Accumulation of air in the pleural space is called?

Back 352

Pneumothorax

Front 353

Pneumothorax caused by rupture of an emphysematous bleb

Back 353

Spontaneous pneumothrax

Front 354

Pneumothorax caused by penetration of chess wall

Back 354

Tension pneumothorax

Front 355

Malignant neoplasm of mesothelial cells of lung

Back 355

Mesothelioma

Front 356

Structures that perforate the diaphragm at T8, T10, T12?

Back 356

T8: IVC

T10: esophagus, (CNX vagus),

T12: aorta, thoracic duct, azygos vein

Front 357

What nerves innervate diaphragm?

Back 357

C3,4,5

Front 358

Fetal Hb has higher or lower affinity for 2,3-BPG? what does this mean?

Back 358

lower affinity for 2,3-BPG which means it has a higher affinity for O2.

Front 359

Pancoast tumors can have what 4 complications?

Back 359

Horner syndrome

SVC syndrome

Sensorimotor deficits

Hoarseness (recurrent laryngeal nerve)

Front 360

Ethambutol can be used to treat TB; what is it's most notable complication?

Back 360

Optic neuritis

Front 361

What is S. pneumoniae's main virulence factor?

Back 361

Having an outer polysaccharide capsule which prevents phagocytosis

Front 362

What should you think of when you see "new screening test"

Back 362

Lead time bias

Front 363

Arterial blood gas for Metabolic acidosis (pH, pCO2, HCO3-)

Back 363

pH decreased

PCO2 decreased

HCO3- decreased

Front 364

Arterial blood gas for Respiratory Acidosis (pH, pCO2, HCO3-)

Back 364

pH decreased

PCO2 increased

HCO3 normal or increased(compensated)

Front 365

Arterial blood gas for Metabolic alkalosis (pH, pCO2, HCO3-)

Back 365

pH increased

PCO2 increased

HCO3 increased

Front 366

Arterial blood gas for Respiratory alkalosis (pH, pCO2, HCO3-)

Back 366

pH increased

PCO2 decreased

HCO3 decreased(compensated) or normal

Front 367

Diabetic ketoacidosis leads to what kind of acid/base imbalance?

Back 367

Metabolic acidosis

Front 368

Overuse of diuretics leads to what kind of acid/base imbalance?

Back 368

Loss of hydrogen ions leading to metabolic alkalosis

Front 369

Panic attacks leads to what kind of acid/base imbalance?

Back 369

Respiratory alkalosis

Front 370

COPD leads to what kind of acid/base imbalance?

Back 370

Respiratory acidosis (compensated)

pH - decreased

PCO2 - increased

HCO3- - inceased

Front 371

What is the inheritance pattern of cystic fibrosis?

Back 371

Autosomal recessive

Front 372

Failure of neutrophils to turn blue on a nitroblue tetrazolium test indicates what disease?

Back 372

Chronic Granulomatous Disease

Front 373

Neutrophils in Chronic Granulomatous Disease are unable to kill what and why?

Back 373

Catalase producing organisms because normally bacteria will kill themselves due to their own production of H2O2. If the organism can break down its own H2O2 then it can survive. The body can not make any H2O2 since NADPH oxidase does not work.

Front 374

Cheyne-stokes breathing is commonly seen in what?

Back 374

advanced congestive heart failure

Front 375

Stimulation of vagus nerve would do what to the lungs (2)?

Back 375

Bronchoconstriction and increased mucus production

Front 376

Cystic fibrosis is caused by what genetic defect? What does it affect as far as going from gene to protein?

Back 376

3-base pair deletion of CFTR (cystic fibrosis transmembrane conductance regulator). This affects post-translational processing.

Front 377

Phospholipid content of amniocentesis is used to check for what?

Back 377

Fetal Lung development (measuring phosaphatidylcholine)

Front 378

Bronchioalveolar lavage of patients with sarcoidosis show elevation in what cell type?

Back 378

CD4+ lymphocytes

Front 379

Bronchioalveolar lavage of patients with lung transplants showing rejection would show elevation in what cell type?

Back 379

CD8+ lymphocytes

Front 380

Structure of MHC Class I

Back 380

Heavy chain and B2 microglobulin

Front 381

Structure of MHC Class II

Back 381

Alpha and beta polypeptide chains

Front 382

Which cells are MHC Class I molecules expressed?

Back 382

All cells

Front 383

Which cells are MHC Class II molecules expressed?

Back 383

Antigen Presenting Cells

Front 384

Describe V/Q in base vs apex

Back 384

Higher in apex lower in base

Front 385

What is used as a marker for mast cell activation (anaphylaxis)?

Back 385

Tryptase

Front 386

Symptoms of Theophylline overdose? (3)

Back 386

abdominal pain, vomiting, seizures

Front 387

Behcet syndrome has what 3 parts?

Back 387

Apthous ulcers, genital ulcers, and uveitis

Front 388

Pathophysiology of behcet's syndrome

Back 388

Immune complex vasculitis involving small vessels

Front 389

Most feared complication of mumps?

Back 389

Orchitis leading to sterility

Front 390

Benign cystic tumor with abundant lymphocytes and germinal centers found in salivary gland

Back 390

Warthin tumor

Front 391

Congenital defect resulting in a connection between the esophagus and trachea

Back 391

Tracheoesophageal fistula

Front 392

Thin protrusion of esophageal mucosa, most often in the upper esophagus

Back 392

Esophageal web

Front 393

What are the components of Plummer-Vinson syndrome?

Back 393

Severe iron deficiency anemia, esophageal web, beefy-red tongue due to atrophic glossitis

Front 394

Outpouching of pharyngeal mucosa through acquired defect in the muscular wall of the esophagus

Back 394

Zenker Diverticulum

Front 395

Longitudinal laceration of mucosa at the GE junction

Back 395

Mallory-Weiss syndrome

Front 396

What is the cause of Mallory-Weiss syndrome? and what 2 populations is it seen in?

Back 396

Severe vomiting due to bulimia or alcoholism

Front 397

rupture of esophagus leading to air in mediastinum and subcutaneoues emphysema

Back 397

Boerhaave syndrome

Front 398

Mallory-Weiss syndrome has a risk of what?

Back 398

Boerhaave syndrome

Front 399

Dilated submucosal veins in the lower esophagus

Back 399

Esophageal varices

Front 400

Esophageal varices arise secondary to what?

Back 400

portal HTN

Front 401

Painless hematemesis is found in what?

Painful hematemesis is found in what?

Back 401

Painless = esophageal varices

Painful = Mallory-Weiss syndrome

Front 402

Most common cause of death in cirrhosis?

Back 402

Esophageal varices that rupture

Front 403

Disordered esophageal motility with inability to relax lower esophageal sphincter

Back 403

Achalasia

Front 404

Achalasia is due to damage of what?

Back 404

Ganglion cells in MYENTERIC plexus

Front 405

Achalsia can be due to infection by what bacteria, and what is the name of the disease?

Back 405

Trypanosoma cruzi = Chagas disease

Front 406

Reflux of acid from the stomach due to reduced LES tone

Back 406

GERD

Front 407

Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

Back 407

Barrett Esophagus

Front 408

Two types of esophageal carcinoma

Back 408

Adenocarcinoma and squamous cell carcinoma

Front 409

Most common esophageal cancer worldwide

Back 409

squamous cell carcinoma

Front 410

Most common esophageal cancer in the west

Back 410

adenocarcinoma

Front 411

(1)Upper 1/3, (2)Middle 1/3, and (2)Lower 1/3 of esophageal cancers involve what lymph nodes?

Back 411

upper = cervical

middle = mediastinal and tracehobroncial nodes

lower = celiac and gastric

Front 412

Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents

Back 412

Gastroschisis

Front 413

Persistent herniation of bowel into umbilical cord

Back 413

Omphalocele

Front 414

Congenital hypertrophy of pyloric smooth muscle

Back 414

Pyloric Stenosis

Front 415

Acidic damage to the stomach mucosa

Back 415

Acute Gastritis

Front 416

Projectile nonbilious vomiting indicates?

Back 416

Pyloric stenosis

Front 417

Which cells in the stomach produce mucous?

Back 417

foveolar cells

Front 418

What is a cushing ulcer?

Back 418

Acute gastritis induced ulcer due to increased stimulation of vagus nerve to release acetylcholine which leads to increased acid production

Front 419

What are the 3 receptors on parietal cells that can induce it to secrete acid?

Back 419

Acetylcholine

Gastrin

Histamine

Front 420

What are the two types of chronic gastritis?

Back 420

Chronic Autoimmune gastritis

Chronic H pylori gastritis

Front 421

Autoimmune destruction of gastric parietal cells leads to?

Back 421

Chronic gastritis

Front 422

What regions are gastric parietal cells located in the stomach?

Back 422

Fundus and Body

NOT Cardia and Antrum

Front 423

What region is Chronic H pylori gastritis normally affect?

Back 423

Antrum

NOT fundus, body, or cardia

Front 424

Solitary mucosal ulcer that occurs in the duodenum 90% of the time and in the distal stomach 10% of the time

Back 424

Peptic ulcer disease

Front 425

Duodenal or gastric ulcers; pain improves with meals?

Back 425

Duodenal

Front 426

Malignant proliferation of surface epithelial cells in the stomach

Back 426

Gastric carcinoma

Front 427

Two types of gastric carcinoma

Back 427

intestinal type

diffuse type

Front 428

Gastric carcinoma which presents as large, irregular ulcer with heaped up margins

Back 428

intestinal type

Front 429

Gastric carcinoma which is characterized by signet ring cells that infiltrate the gastric wall

Back 429

Diffuse type

Front 430

Blood type A is associated with what cancer?

Back 430

Intestinal Type of gastric carcinoma

Front 431

describe a signet ring cell?

Back 431

Nucleus pushed off to the edge due to production of mucin

Front 432

Leser-Trelat sign can indicate what?

Back 432

Gastric carcinoma

Front 433

Gastric carcinoma normally spreads to which node?

Back 433

Left supraclavicular node (virchow node)

Front 434

Which node is Virchow node?

Back 434

Left supraclavicular node

Front 435

Distant metastasis of gastric carcinoma most commonly involves what organ?

Back 435

Liver

Front 436

Intestinal type of gastric carcinoma classically spreads where?

Back 436

Preumbilical region (Sister Mary Joseph nodule)

Front 437

Diffuse type of gastric carcinoma classically spreads where?

Back 437

Bilateral ovaries (Krukenberg tumor)

Front 438

What disease has translocation at 12,21

Back 438

ALL (kids)

Front 439

What disease has translocation at 9,22

Back 439

ALL (adults) and CML

Front 440

What disease has translocation at 15,17

Back 440

Acute Promyelocytic Leukemia

Front 441

What disease has translocation at 14,18

Back 441

Follicular lymphoma

Front 442

What disease has translocation at 11,14

Back 442

Mantle Cell Lymphoma

Front 443

What disease has translocation at 8,14

Back 443

Burkitt Lymphoma

Front 444

Congenital failure of small bowel to canalize

Back 444

Duodenal atresia

Front 445

What is duodenal atresia associated with?

Back 445

Down syndrome

Front 446

Double-bubble sign indicates what pathology?

Back 446

Duodenal atresia

Front 447

Outpouching of all three layers of bowel wall

Back 447

Meckel Diverticulum

Front 448

This pathology occurs due to failure of the vitelline duct to involute

Back 448

Meckel diverticulum

Front 449

What are the (4) Rule of 2's and what does it apply to?

Back 449

Meckel Diverticulum

Seen in 2% of population

Usually 2 inches long

Within 2 feet of ileocecal valve

Present during first 2 years of life

Front 450

Twisting of bowel along its mesentery

Back 450

Volvulus

Front 451

Telescoping of proximal segment of bowel forward into distal segment

Back 451

Intussusception

Front 452

Most common cause for intussusception in adults

Back 452

tumor

Front 453

Most common cause for intussusception in children

Back 453

Lymphoid hyperplasia

Front 454

Immune-mediate damage of small bowel villi due to gluten exposure

Back 454

Celiac disease

Front 455

What is the most pathogenic component of gluten?

Back 455

Gliadin

Front 456

What is the process by which Gliadin causes damage to villi?

Back 456

Gliadin is deamidated by tTg (tissue transgutaminase), it is then presented to APC via MHC Class II. Helper T cells mediate tissue damage

Front 457

Dermatitis herpetiformis is associated with what GI pathology?

Back 457

Celiac disease - small, herpes-like vesicles may arise on skin due to IgA deposition at the tips of dermal papillae; resolve with gluten-free diet

Front 458

What laboratory findings are there for celiac disease?

Back 458

IgA antibodies against endomysium, tTG, or gliadin

Front 459

In celiac disease which portion of the small intestine is most involved?

Back 459

Duodenum

Front 460

If there is refractory disease after continuing a gluten free diet when dx with celiac what should you suspect (2)?

Back 460

Small bowel carcinoma and T-cell lymphoma (eneteropathy associated T-cell lymphoma)

Front 461

Damage to small bowel villi due to an unknown organism resulting in malabsorption

Back 461

Tropical sprue

Front 462

In tropical sprue which portion of the small intestine is involved?

Back 462

Jejunum and Ileum

Front 463

Where is folic acid absorbed?

Back 463

Jejunum

Front 464

Where is Vit B12 absorbed?

Back 464

Ileum

Front 465

What is whipple disease?

Back 465

Systemic tissue damage characterized by macrophages loaded with Tropheryma Whippelii organisms

Front 466

Two key findings in whipple disease?

Back 466

fat malabsorption and steatorrhea

Front 467

Abetalipoproteinemia has what inheritance pattern and is a deficiency in what two proteins

Back 467

Autosomal recessive deficiency of apolipoprotein B-48 and B-100

Front 468

Patient has absent plasma VLDL and LDL, what is the dx and what is the pathophysiology?

Back 468

Abetalipoproteinemia - VLDL and LDL require apolipoprotein B-100

Front 469

Abscence of apolipoprotein B-48 indicate what disease and has what feature due to this absence?

Back 469

Abetalipoproteinemia - absence of B-48 leads to defective chylomicron formation

Front 470

Carcinoid tumor in the gut most commonly arises where?

Back 470

Small bowel

Front 471

Carcinoid tumor of small bowel secretes what? which is metabolized where?

Back 471

Serotonin metabolized in liver into 5-HIAA

Front 472

What are the 3 clinical features of carcinoid syndrome?

Back 472

bronchospasm, diarrhea, and flushing of skin

Front 473

What is the pathophysiology for carcinoid syndrome from a carcinoid tumor in the small gut?

Back 473

Metastasis of carcinoid tumor to liver allows serotonin to bypass liver metabolism leading to excess serotonin in the systemic circulation

Front 474

What is carcinoid heart disease?

Back 474

Right-sided valvular fibrosis leading to tricuspid regurgitation and pulmonary valve stenosis.

Front 475

Why do you not get left sided valvular fibrosis in carcinoid heart disease?

Back 475

Serotonin gets metabolized by MAO in the lung

Front 476

What quadrant is there pain in acute appendicitis?

Back 476

right lower quadrant (McBurney) point

Front 477

Chronic, relapsing inflammation of bowel

Back 477

Inflammatory Bowel Disease

Front 478

Which IBD has full thickness inflammation with knife-like fissures?

Back 478

Crohn disease

Front 479

Which IBD has mucosal and submucosal ulcers?

Back 479

Ulcerative colitis

Front 480

Which IBD skips around and which one is continuous?

Back 480

Ulcerative colitis is continuous, Crohn's skips around

Front 481

Which IBD has left lower quadrant pain?

Back 481

Ulcerative colitis

Front 482

Which IBD has right lower quad pain?

Back 482

Crohn disease

Front 483

Which IBD has histology with crypt abscesses with neutrophils?

Back 483

Ulcerative Colitis

Front 484

Which IBD has loss of haustra "lead pipe" sign on imaging?

Back 484

Ulcerative colitis

Front 485

Which IBD has cobblestone mucosa?

Back 485

Crohn disease

Front 486

Which IBD has pseudopolyps?

Back 486

Ulcerative colitis

Front 487

Which IBD has toxic megacolon as a complicatoin?

Back 487

Ulcerative colitis

Front 488

Which IBD has p-ANCA positivity?

Back 488

Ulcerative colitis

Front 489

Which IBD is protected by smoking?

Back 489

Ulcerative colitis

Front 490

Which IBD has increased risk due to smoking?

Back 490

Crohn disease

Front 491

Which IBD has lymphoid aggregates with granulomas?

Back 491

Crohn disease

Front 492

Which IBD has string-sign on imaging?

Back 492

Crohn disease

Front 493

Which IBD has calcium oxalate neprholithiasis?

Back 493

Crohn disease

Front 494

Defective relaxation and peristalsis of rectum and distal sigmoid colon

Back 494

Hirschsprung disease

Front 495

What is hirschsprung disease associated with?

Back 495

Down syndrome

Front 496

Rectal suction biopsy reveals lack of ganglion cells what disease is this?

Back 496

Hirschsprung disease

Front 497

Outpouching of mucosa and submucosa through the muscularis propria

Back 497

Colonic diverticula

Front 498

Acquired malformation of mucosal and submucosal capillary beds

Back 498

Angiodysplasia

Front 499

High stress on the left lower quadrant leads to what?

Back 499

Colonic diverticula

Front 500

High stress on the right colon leads to what?

Back 500

Angiodysplasia

Front 501

If a patient has stool or air in urine what is the reason and what is the disease called?

Back 501

Inflamed diverticulum ruptures and attaches to a local structure.

Colovesicular fistula due to colonic diverticula.

Front 502

What is the inheritance pattern for hereditary hemorrhagic telangiectasia?

Back 502

Autosomal dominant

Front 503

Ischemic damage to the colon usually at the splenic flexure

Back 503

Ischemic colitis

Front 504

This GI disease presents with postprandial pain and weight loss

Back 504

Ischemic colitis

Front 505

Relapsing abdominal pain with bloating, flatulence, and change in bowel habits (diarrhea or constipation)

Back 505

Irritable bowel syndrome

Front 506

Raised protrusion of colonic mucosa

Back 506

Colonic polyps

Front 507

Two most common types of colonic polyps

Back 507

Hyperplastic polyps and adenomatous polyps

Front 508

This type of polyp are due to hyperplasia of glands; classically show a serrated appearance on microscopy

Back 508

Hyperplastic polyp

Front 509

Which of the two most common colonic polyps is benign not malignant, and which is benign but premalignant?

Back 509

Hyperplastic polyp is benign

Adenomatous polyp is premalignant

Front 510

What chromosome is APC located on?

Back 510

Chromosome 5

Front 511

What is the adenoma-carcinoma sequence (3 steps)

Back 511

1.APC (adenomatous polyposis coli gene) mutation leads to increased risk for formation of polyps

2. K-ras mutation leads to formation of polyps

3. p53 mutation and increased expression of COX allow for progression to carcinoma

Front 512

What can impede the progression of adenoma to carcinoma in colonic polyps?

Back 512

Aspirin due to the inhibition of COX

Front 513

What 3 characteristics of a colon polyp biopsy indicates an increased risk for progression from adenoma to carcinoma?

Back 513

Size >2cm

sessile growth as opposed to pedunculated

villous histology as opposed to tubular

Front 514

Autosomal dominant disorder characterized by 100s to 100s of adenomatous colonic polyps

Back 514

Familial adenomatous polyposis

Front 515

What is the inheritance pattern for familial adenomatous polyposis?

Back 515

Autosomal dominant

Front 516

What is familial adenomatous polyposis with fibromatosis and osteomas?

Back 516

Gardner syndrome

Front 517

What is familial adenomatous polyposis with CNS tumors?

Back 517

Turcot syndrome

Front 518

Sporadic hamartomatous (benign) polyp that arises in children

Back 518

Juvenile polyp

Front 519

Hamartomatous (benign) polyps throughout GI tract with mucocutaneous hyperpigmentation on lips, oral mucosa, and genital skin?

Back 519

Peutz-Jeghers syndrome

Front 520

What is the inheritance pattern for Peutz-Jeghers syndrome?

Back 520

Autosomal dominant

Front 521

Peutz-Jeghers syndrome has increased risk for what 3 cancers?

Back 521

colorectal

breast

GYN

Front 522

What is the 3rd most common site of cancer and the 3rd most common cause of cancer-related death?

Back 522

Colorectal carcinoma

Front 523

What are the two pathways that colorectal carcinoma can arise?

Back 523

Adenoma-carcinoma sequence and microsatellite instability (MSI)

Front 524

Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due to inherited mutations in what?

Back 524

DNA mismatch repair enzymes

Front 525

Inherited mutations in DNA mismatch repair enzymes can lead to what hereditary GI disorder?

Back 525

Hereditary nonpolyposis colorectal carcinoma (HNPCC)

Front 526

HNPCC has increased risk for what 3 cancers?

Back 526

Colorectal (most common)

Ovarian

Endometrial carcinoma

Front 527

Which side do napkin-ring lesions for colorectal carcinoma usually arise?

Back 527

left side

Front 528

Which side do raised lesion for colorectal carcinoma usually arise?

Back 528

right side

Front 529

Colonic carcinoma is associated with an increased risk for what kind if infection?

Back 529

Streptococcus bovis endocarditis

Front 530

Left sided colorectal carcinoma is associated with what molecular pathway?

Back 530

Left Adenoma-carcinoma pathway

Right MSI pathway

Front 531

Most common site for colorectal carcinoma metastasis?

Back 531

Liver

Front 532

What serum tumor marker is useful for assessing tx response and detecting recurrence of colorectal carcinoma

Back 532

CEA

Front 533

CEA is useful for assessing tx response and detecting recurrence but not useful for what?

Back 533

Not useful for screening

Front 534

Where is Iron (Fe2+) absorbed?

Back 534

Duodenum

Front 535

Developmental malformation in which the pancreas forms a ring around the duodenum; risk of duodenal obstruction

Back 535

Annular pancreas

Front 536

Annular pancreas has an increased risk for what?

Back 536

Duodenal obstruction

Front 537

Inflammation and hemorrhage of pancreas

Back 537

Acute pancreatitis

Front 538

What is the first enzyme to get activated in acute pancreatitis?

Back 538

Trypsin

Front 539

Alcohol and gall stones are the most common cause for what?

Back 539

Acute pancreatitis - alcohol constricts sphincter of oddi and gall stones create a blockage

Front 540

Fibrosis of pancreatic pancrenchyma; secondary to recurrent acute pancreatitis

Back 540

Chronic pancreatitis

Front 541

Most commonly due to alcohol and cystic fibrosis; many cases are idiopathic

Back 541

Chronic pancreatitis

Front 542

Alcohol and cystic fibrosis are the most common cause of what?

Back 542

Chronic pancreatitis

Front 543

Adenocarcinoma arising from pancreatic ducts

Back 543

Pancreatic carcinoma

Front 544

What are the two major risk factors for pancreatic carcinoma?

Back 544

Smoking and chronic pancreatitis

Front 545

If a thin elderly female recently dx with diabetes what should you think of?

Back 545

DDX should include pancreatic carcinoma

Front 546

What is the serum tumor marker for pancreatic carcinoma?

Back 546

CA 19-9

Front 547

Failure to form or early destruction of extrahepatic biliary tree

Back 547

Biliary atresia

Front 548

Solid, round stones in the gall bladder

Back 548

Cholelithiasis (Gall stones)

Front 549

Cholelithiasis can occur due to precipitation of what two things?

Back 549

Cholesterol or bilirubin

Front 550

Important side effect of cholestyramine and MOA for the side-effect

Back 550

Gallstones due to decreased solubility of bilirubin. Bile acids are bound by cholestyramine leading to decreased solubility and formation of gall stones.

Front 551

Which gall stone is radiolucent? radiopaque?

Back 551

Cholesterol stone is radiolucent, bilirubin stone is radiopaque

Front 552

Waxing and waning right upper quadrant pain is usually due to?

Back 552

Biliary colic

Front 553

Biliary colic pathophysiology for pain

Back 553

This is due to gallbladder contracting against a stone lodged in the cystic duct

Front 554

Acute inflammation of the gallbladder wall

Back 554

Acute cholecystitis

Front 555

Right upper quadrant pain, radiating to the right scapula indicates what?

Back 555

Acute cholecystitis

Front 556

Chronic inflammation of the gallbladder

Back 556

Chronic cholecystitis

Front 557

Rokitansky-Aschoff sinus is associated with what? and what is it?

Back 557

Chronic cholecystitis - these sinuses are herniations of the gallbladder mucosa into the muscular wall. Normally you should not have mucosa into the smooth muscle.

Front 558

Porcelain gallbladder is associated with what?

Back 558

Chronic cholecystitis

Front 559

This presents with vague right upper quadrant pain, especially after eating

Back 559

Chronic cholecystitis

Front 560

Bacterial infection of bile ducts

Back 560

Ascending cholangitis

Front 561

Gallstones enters and obstructs small bowel

Back 561

Gallstone ileus

Front 562

What is gallstone ileus due to?

Back 562

Cholecystitis with fistula formation between gallbladder and small bowel

Front 563

Adenocarcinoma arising from glandular epithelium that lines the gallbladder wall

Back 563

Gallbladder carcinoma

Front 564

Elderly woman presents with cholecystitis, what does this suggest?

Back 564

Gallbladder carcinoma

Front 565

What is scleral icterus?

Back 565

yellowing of the eye

Front 566

How does extravascular hemolysis or ineffective erythropoiesis cause jaundice?

Back 566

High levels of UCB overwhelm the conjugating ability of the liver

Front 567

Dark urine in extravascular hemolysis is due to what? what is it not due to?

Back 567

Increased urobilinogen NOT UCB (UCB is not water soluble)

Front 568

Extravascular hemolysis or ineffective erytrhopoiesis has an increased risk for what hepatic disorder?

Back 568

pigmented bilirubin gallstones

Front 569

How does physiologic jaundice of the newborn cause jaundice?

Back 569

Newborn liver has transiently low UGT activity

Front 570

What enzyme conjugates unconjugated bilirubin?

Back 570

Uridine Glucuronyl Transferase (UGT)

Front 571

What is kernicterus associated with and what is the pathophysiology of it?

Back 571

Kernicterus is associated with Physiologic jaundice of the newborn and Crigler-Najjar syndrome. UCB is fat soluble and can deposit in the basal ganglia leading to neurological deficits and death.

Front 572

How does phototherapy work for physiologic jaundice of the newborn?

Back 572

It makes the UCB water soluble but does NOT conjugate the UCB

Front 573

How does Gilbert syndrome cause jaundice?

Back 573

Midly low UGT activity. Usually enough UGT not to cause jaundice but at times of high stress will cause jaundice

Front 574

What is the inheritance pattern for gilbert syndrome?

Back 574

Autosomal recessive

Front 575

How does Crigler-Najjar syndrome cause jaundice?

Back 575

Complete absence of UGT, usually fatal

Front 576

Why is Criger-Najjar syndrome usually fatal?

Back 576

Kernicterus

Front 577

What are the two syndromes with disruption of UGT?

Back 577

Gilbert Syndrome - mildly low

Criger-Najjar syndrome - complete absence

Front 578

How does Dubin-Johnson syndrome cause jaundice?

Back 578

Deficiency of bilirubin canalicular transport protein

Front 579

What is the inheritance pattern for Dubin-Johnson syndrome?

Back 579

Autosomal recessive

Front 580

Which disease that causes jaundice has a dark liver?

Back 580

Dubin-Johnson syndrome

Front 581

What syndrome is similar to Dubin-Johnson syndrome but does not have the dark liver?

Back 581

Rotor syndrome

Front 582

How does biliary tract obstruction cause jaundice?

Back 582

Buildup of CB in gallbladder leaks out into the blood

Front 583

Why is urine dark in biliary tract obstruction?

Back 583

Due to conjugated bilirubin

Front 584

How does viral hepatitis cause jaundice?

Back 584

Inflammation disrupts hepatocytes and small bile ductules leading to increase in CB and UCB

Front 585

Why is urine dark in viral hepatitis?

Back 585

Due to conjugated bilirubin

Front 586

Which disease that causes jaundice has pruritis and why does it have pruritis?

Back 586

Biliary tract obstruction - pruritis is due to increased plasma bile acids

Front 587

Which disease that causes jaundice has xanthomas and why does it have xanthomas?

Back 587

Biliary tract obstruction - hypercholestermemia leads to xanthomas

Front 588

Which disease that causes jaundice has steatorrhea with malabsorption of fat-soluble vitamins?

Back 588

Biliary tract obstruction

Front 589

Viral hepatitis is usually due to hepatitis virus but what other two viruses can cause it?

Back 589

EBV and CMV

Front 590

Viral hepatitis has elevated liver enzymes which one is higher than the other?

Back 590

ALT > AST

Front 591

Alcohol-related liver disease has elevated liver enzymes which one is higher than the other?

Back 591

AST > ALT

Front 592

Which Hepatitis virus has fecal-oral transmission?

Back 592

HAV and HEV

Front 593

Which hepatitis is commonly acquired by travelers?

Back 593

HAV

Front 594

Which hepatitis is commonly acquired from contaminated water or undercooked seafood?

Back 594

HEV

Front 595

Which hepatitis is associated with pregnant woman with fulminant hepatitis (liver failure with massive liver necrosis)?

Back 595

HEV infection

Front 596

Which hepatitis has only an acute state and no chronic state?

Back 596

HAV and HEV

Front 597

Which hepatitis is transferred parenterally?

Back 597

HBV and HCV

Front 598

What marker must be present for 6 months to indicate chronic hepatitis B?

Back 598

HBsAG (antigen)

Front 599

Presence of what indicates that you have beat hepatitis B?

Back 599

HBsAB (antibody)

Front 600

What marker indicates that HBV is infectious?

Back 600

HBeAG (envelope antigen)

Front 601

Which hepatitis often progresses to chronic phase, which hepatitis 20% of the time progresses to chronic phase?

Back 601

HCV - most of the time

HBV - 20% of time

Front 602

What marker indicates HCV infection and indicates chronic disease if persistent?

Back 602

HCV-RNA

Front 603

Which hepatitis virus needs another hepatitis virus to infect?

Back 603

HDV

Front 604

What is more severe? Superinfection of HBV/HDV or co-infection of HBV/HDV?

Back 604

Superinfection

Front 605

End-stage liver damage characterized by disruption of the normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes

Back 605

Cirrhosis

Front 606

Fibrosis of liver is mediated by what cell which secretes what cytokine?

Back 606

Stellate cells secreting TGF-B

Front 607

What are mallory bodies and what is it associated with?

Back 607

Mallory bodies are damaged intermediate filaments within hepatocytes and is associated with alcoholic hepatitis

Front 608

Nonalcoholic fatty liver disease has increased liver enzymes, which is higher than the other?

Back 608

ALT > AST

Front 609

What is nonalcoholic fatty liver disease associated with?

Back 609

obesity

Front 610

Primary Hemochromatosis has what kind of inheritance pattern?

Back 610

Autosomal recessive

Front 611

Primary hemochromatosis is due to a mutation in which gene?

Back 611

HFE gene

Front 612

Bronze skin and bronze diabetes is associated with what?

Back 612

Hemochromatosis

Front 613

For hemochromatosis hepatocytes are brown, but you need to distinguish the iron from what? what stain do you use to do this?

Back 613

Lipofuscin caused by normal wear and tear, use prussian blue stain to stain the iron.

Front 614

Autosomal recessive defect in ATP-mediated copper transport

Back 614

Wilson disease

Front 615

Wilson disease has what inheritance pattern?

Back 615

Autosomal recessive

Front 616

Autoimmune granulomatous destruction of intrahepatic bile ducts

Back 616

Primary biliary cirrhosis

Front 617

Primary biliary cirrhosis, etiology is unknown but something is present, what is it?

Back 617

antimitochondrial antibody

Front 618

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

Back 618

Primary sclerosing cholangitis

Front 619

Periductal fibrosis with an "onion-skin" appearance on histology indicates what hepatic disease?

Back 619

Primary sclerosing cholangitis

Front 620

What hepatic disorder is associated with ulcerative colitis?

Back 620

Primary sclerosing cholangitis

Front 621

What hepatic disorder is p-ANCA positive?

Back 621

Primary sclerosing cholangitis

Front 622

What is reye syndrome?

Back 622

Fulminant liver failure and encepholopathy in children with viral illness who take aspirin

Front 623

Benign tumor of hepatocytes

Back 623

Hepatic adenoma

Front 624

Reye syndrome is likely related to what kind of damage?

Back 624

mitochondrial damage of hepatocytes

Front 625

Hepatic adenoma is associated with what drug?

Back 625

oral contraceptive

Front 626

Malignant tumor of hepatocytes

Back 626

Heptaocellular carcinoma

Front 627

Alfatoxins derived from Aspergillus is associated with what cancer? what mutation does it cause?

Back 627

Hepatocellular carcinoma - p53 mutation

Front 628

What is the serum tumor marker for hepatocellular carcinoma?

Back 628

alpha-fetoprotein

Front 629

Which glucose transporter is responsible for transportation to the blood?

Back 629

GLUT-2

Front 630

Rate limiting enzyme for bile synthesis

Back 630

Cholesterol 7a-hydroxylase

Front 631

What is a curling ulcer?

Back 631

Ulcer that forms when there is decreased plasma volume (burn victims) which leads to sloughing of gastric mucosa

Front 632

Which gastric cancer is associated with nitrosamines (Smoked food)

Back 632

Intestinal

Front 633

What is Charcot triad of cholangitis?

Back 633

Jaundice, Fever, RUQ pain

Front 634

Drugs ending in -dine have what MOA?

Back 634

H2 blocker

Front 635

Drugs ending in -prazole have what MOA?

Back 635

Proton pump inhibitor

Front 636

MOA of Misoprostol

Back 636

PGE1 analog, increases gastric mucosa barrier

Front 637

MOA of Octreotide

Back 637

Long-acting somatostatin analong

Front 638

MOA of Infliximab and what is it used for?

Back 638

Monoclonal antibody to TNF-a

Chron disase, ulcerative colitis, RA, psoriasis, ankylosing spondylitis

Front 639

MOA of Sulfasalazine

Back 639

combo of sulfapyridine (antibacterial) and 5-ASA (anti-inflammatory). Activated by colonic bacteria

Front 640

MOA of Ondansetron and what is it used for?

Back 640

5-HT3 blocker; decrease vagal stimulation. Powerful central acting anti-emetic.

Front 641

MOA of Metoclopramide and what is it used for?

Back 641

D2 receptor antagonist. Increase resting tone, contractility, LES tone, motility. Used for GERD, anti-emetic, gastric emptying.

Front 642

Drugs ending in -odipine have what MOA?

Back 642

Calcium channel blockers that block L-type calcium channels, thereby reducing cardiac muscle contractility.

Front 643

MOA of hydralazine

Back 643

increase cGMP leading to smooth muscle relaxation.

Front 644

What two drugs are used in a hypertensive emergency and what is their MOA?

Back 644

Nitroprusside - increase cGMP via direct release of NO.

Fenoldopam - Dopamine D1 receptor agonist causing vasodilation.

Front 645

MOA of nitroglycerin

Back 645

Vasodilate by increasing NO in vascular smooth muscle.

Front 646

MOA of digoxin

Back 646

Direct inhibition of Na/K atapase leads to indirect inhibition of Na/Ca exchanger/antiport. Increase in Ca leads to positive inotropy (cardiac contraction). Stimulates vagus nerve to decrease HR.

Front 647

MOA of drugs ending in -en/-ine or en/-ate?

Back 647

1st gen H1 blockers (diphenhydramine, dimenhydrinate, chloropheniramine)

Front 648

MOA of drugs ending in -adine?

Back 648

2nd gen H1 blockers (Loratidine, fexofenadine, desloratadine, cetirizine

Front 649

What does guaifenesin?

Back 649

Expectorant - thins respiratory secretions, does not suppress cough reflex

Front 650

What does N-acetylcysteine do?

Back 650

Mucolytic - can loosen mucous plugs in CF patients

Front 651

MOA of dextromethorphan?

Back 651

Antitussive (antagonizes NMDA glutamate receptor)

Front 652

MOA of pseudoephedrine and phenylephrine?

Back 652

alpha agonist

Front 653

MOA of albuterol? what is it used for?

Back 653

B2 agonist, asthma

Front 654

MOA of salmeterol? what is it used for?

Back 654

B2 agonist, asthma

Front 655

MOA of formoterol? what is it used for?

Back 655

B2 agonist, asthma

Front 656

MOA of theophylline and what is it used for?

Back 656

causes bronchodilation by inhibiting phosphodiesterase which increase cAMP due to decrease in cAMP hydrolysis. Asthma.

Front 657

MOA of ipratropium and what is it used for?

Back 657

competitive block of muscarinic receptors, preventing bronchoconstriction. Asthma.

Front 658

MOA beclomethasone and what is it used for?

Back 658

Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma.

Front 659

MOA of fluticasone and what is it used for?

Back 659

Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma.

Front 660

MOA of drugs ending in -lukast (Montelukast, Zafrilukast) and what is it used for?

Back 660

block leukotriene receptors. Especially good for aspirin-induced asthma. Asthma

Front 661

MOA of Zileuton and what is it used for?

Back 661

5-lipoxygenase pathway inhibitor blocks conversion of arachidonic acid to leukotrienes. Asthma

Front 662

MOA of omalizumab and what is it used for?

Back 662

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE. Asthma

Front 663

MOA of methacoline and what is it used for?

Back 663

Muscarinic receptor agonist. Used to dx asthma

Front 664

Drugs ending in -navir have what MOA and treat what?

Back 664

Protease inhibitor, specifically inhbits HIV-1 protease (pol gene). Protease inhibitors prevent maturation of new viruses.

Front 665

MOA of Raltegravir

Back 665

Inhibits HIV genome integration to host cell chromosome by reversibly inhibiting HIV integrase

Front 666

MOA of Enfuviritide

Back 666

Binds gp41, inhibiting viral entry

Front 667

MOA of Maraviroc

Back 667

Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120

Front 668

MOA of Zidovudine

Back 668

Nucleoside Reverse Transcriptase Inhibitor

Front 669

IL-8 is responsible for what?

Back 669

Released by macrophages to recruit neutrophils

Front 670

IL-3 is responsible for what?

Back 670

Stimulating growth and differentiation of stem cells in bone marrow.

Front 671

What do each of the blotting techniques detect?North, south, west, southwest?

Back 671

North = RNA

South = DNA

West = Protein

Southwest = DNA binding protein

Front 672

MOA of Ribavarin?

Back 672

Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase

Front 673

Cricopharyngeal motor dysfunction can lead to what?

Back 673

Zenker diverticulum

Front 674

Two effects of a VIPoma and how do you treat VIPoma?

Back 674

diarrhea and inhibition of gastric. Tx with somatostatin

Front 675

MOA of diphenoxylate and what is it used for?

Back 675

opiate anti-diarrheal that slows down motility

Front 676

What is a liver specific enzyme that can use break down products of triglyceride?

Back 676

Glycerol kinase

Front 677

What two compounds are elevated in lead poisoning?

Back 677

delta-aminolevulinic acid and pyroxidal phosphate

Front 678

Where are lipids digested? where are they absorbed?

Back 678

Duodenum digests, jejenum absorbs

Front 679

Which portion of the GI tracts is ALWAYS affected in hirschprung disease?

Back 679

Rectum

Front 680

Where are Brunner's glands located and what do they secrete?

Back 680

Alkaline mucous

Front 681

Where are peyer's patches found in the small intestine?

Back 681

Ileum

Front 682

What triggers hepatocellular carcinoma when HBV infects the liver?

Back 682

Integration of the viral DNA with the host DNA.

Front 683

Conjoined kidneys usually connected at the lower pole.

Back 683

Horseshoe kidney

Front 684

Where is the horseshoe kidney located, what does it get stuck on?

Back 684

Located in lower abdomen it gets stuck on inferior mesenteric artery on its ascent.

Front 685

Absent kidney formation

Back 685

Renal agenisis

Front 686

Describe the Potter sequence?

Back 686

Bilateral renal agenesis leads to

-oligohydraminos

-lung hypolplasia

-flat face with low set ears

-development defects of extremities

Front 687

Noninherited, congenital malformation of renal parenchyma characterized by cysts and abnormal tissue.

Back 687

Dysplastic kidney

Front 688

Inherited defect leading to bilateral enlarged kidneys with cysts in the renal cortex and medulla

Back 688

Polycystic Kidney Disease

Front 689

Which cystic kidney disease is unilateral and which is bilateral?

Back 689

Dysplastic kidney - usually unilateral

Polycystic Kidney disease - bilateral

Front 690

Autosomal recessive or dominant PKD presents in infants?

Back 690

Recessive

Front 691

Autosomal recessive or dominant PKD presents with worsening renal failure and HTN?

Back 691

Recessive and Dominant

Front 692

Autosomal recessive or dominant PKD may present with potter sequence?

Back 692

Recessive

Front 693

Autosomal recessive or dominant PKD associated with congenital hepatic fibrosis and cysts?

Back 693

Recessive

Front 694

Autosomal recessive or dominant PKD presents in young adults?

Back 694

Dominant

Front 695

Autosomal dominant PKD is due to either of what two mutations?

Back 695

APKD1 or APKD2

Front 696

Autosomal recessive or dominant PKD presents with hematuria?

Back 696

Dominant

Front 697

Autosomal recessive or dominant PKD associated with berry aneurysm

Back 697

Dominant

Front 698

Autosomal recessive or dominant PKD associated with mitral valve prolapse and hepatic cysts?

Back 698

Dominant

Front 699

Autosomal dominant PKD presents with what three cysts?

Back 699

Cysts in Kidney

Cysts in Brain (berry aneurysm)

Cysts in Liver

Front 700

Medullary cystic kidney disease has what inheritance pattern?

Back 700

Autosomal Dominant

Front 701

Cysts in medullary collecting ducts

Back 701

Medullary cystic kidney disease

Front 702

Parenchymal fibrosis results in SHRUNKEN kidneys and worsening renal failure

Back 702

Medullary cystic kidney disease

Front 703

Hallmark of Acute renal failure?

Back 703

Azotemia often with oliguria

Front 704

Acute renal failure due to decreased blood flow to kidney

Back 704

Prerenal azotemia

Front 705

Acute renal failure due to obstruction of urinary tract downstream from kidney

Back 705

Postrenal azotemia

Front 706

Prerenal or postrenal azotemia: BUN:Cr ratio >15?

Back 706

Prerenal or Postrenal (early) - BUN is reabsorbed due to aldosterone secretion while creatinine can not be reabsorbed

Front 707

Prerenal or postrenal azotemia: BUN:Cr ratio <15?

Back 707

Postrenal (late) - can not reabsorb BUN because the renal tubles or no longer intact?

Front 708

Prerenal or postrenal: FENa < 1%

Back 708

Fractional Excretion of sodium < 1 percent in Prerenal

Front 709

Prerenal or postrenal: FENa >2%

Back 709

Fractional excretion of sodium is >2% in postrenal (late) azotemia

Front 710

Prerenal or postrenal: Urine osmalality > 500 mOsm/kg?

Back 710

Prerenal or postrenal (early)

Front 711

Prerenal or postrenal: Urine osmalality < 500 mOsm/kg?

Back 711

Postrenal (late) - inability to concentrate urine

Front 712

Injury and necrosis of tubular epithelial cells; most common cause of acute renal failure

Back 712

Acute tubular necrosis

Front 713

Pathophysiology of acute tubular necrosis

Back 713

Necrotic epithelial cells of tubules plug tubules; obstruction decreases GFR

Front 714

What renal disease has brown, granular casts that are seen in urine?

Back 714

Acute tubular necrosis

Front 715

Is BUN:Cr < or > 15 in acute tubular necrosis?

Back 715

BUN:CR is < 15 because of inability to reabsorb BUN

Front 716

Is FENa <1 or >2 in acute tubular necrosis?

Back 716

Fractional Excretion of Na (FENa) is >2 because of decreased reabsorption of sodium

Front 717

Is urine osm < or > 500 in acute tubular necrosis?

Back 717

Inability to concentrate urine leads to urine osm to be <500.

Front 718

What are the two major etiologies for acute tubular necrosis?

Back 718

Ischemic and nephrotoxic

Front 719

Prerenal azotemia can progress to what disease?

Back 719

Acute tubular necrosis

Front 720

Which drug class can cause acute tubular necrosis?

Back 720

Aminoglycosides

Front 721

Crush injury can lead to what?

Back 721

Myoglobinuria which leads to acute tubular necrosis

Front 722

Ingesting ethylene glycol can lead to what?

Back 722

Acute tubular necrosis

Front 723

Acute tubular necrosis leads to what acid/base imbalance?

Back 723

Metabolic acidosis

Front 724

Drug-induced hypersensitivity involving the interstitium and tubules of kidneys

Back 724

Acute interstitial nephritis

Front 725

What three drugs can cause interstitial nephritis?

Back 725

NSAIDS, PCN, and diuretics

Front 726

What is pathognomonic for acute interstitial nephritis?

Back 726

Eosinophils seen in urine

Front 727

Presents as oliguria, fever and rash days to weeks after starting a drug

Back 727

Acute interstitial nephritis

Front 728

Necrosis of renal papillae

Back 728

Renal papillary necrosis

Front 729

Glomerular disorders with proteinuria >3.5g/day characterizes what group of disorders?

Back 729

Nephrotic syndrome

Front 730

Nephrotic syndromes result in 2 hypos and 3 hypers

Back 730

Hypoalubminemia - pitting edema

Hypogammaglobulinemia - increases risk of infection

Hypercoagulable state - loss of antithrombin III

Hyperlipidemia

Hypercholesterolemia - may lead to fatty casts in urine

Front 731

Which nephrotic syndrome is associated with Hodgkin lymphoma?

Back 731

Minimal change disease

Front 732

What is the most common nephrotic syndrome in children?

Back 732

Minimal change disease

Front 733

Which nephrotic syndrome has effacement of foot processes that is mediated by cytokines?

Back 733

Minimal change disease mediated by cytokines that are released from reed-sternberg cells of hodgkin lymphoma

Front 734

Which nephrotic syndrome has normal glomeruli on H&E stain?

Back 734

Minimal change disease

Front 735

Which nephrotic syndrome has no immune complexes so negative immunofluorescence. (2)

Back 735

Minimal change disease and Focal segmenting glomerulosclerosis

Front 736

Which nephrotic syndrome has selective proteinuria? (loss of albumin but not immunoglobulin)

Back 736

Minimal change disease

Front 737

Which nephrotic syndrome has an excellent response to steroids?

Back 737

Minimal change disease because the damage is mediated by cytokines from T cells and the steroids inhibit that. No other neprhotic syndromes respond to steroids.

Front 738

Most common cause of nephrotic syndrome in hispanics and african americans?

Back 738

Focal segmental glomerulosclerosis

Front 739

Which nephrotic syndrome is associated with HIV?

Back 739

Focal segmental glomerulosclerosis

Front 740

Which nephrotic syndrome is associated with heroin use?

Back 740

Focal segmental glomerulosclerosis

Front 741

Which nephrotic syndrome is associated with sickle cell disease?

Back 741

Focal segmental glomerulosclerosis

Front 742

What is focal segmental glomerulosclerosis? (break down the name)

Back 742

Focal = some glomeruli

Segmental = involving only part of the glomerulus

Sclerosis on H&E stain

Front 743

Which nephrotic syndrome has effacement of foot processes? (2)

Back 743

Minimal change disease and focal segmenting glomerulosclerosis

Front 744

Most common cause of nephrotic syndrome in caucasian adults

Back 744

Membranous nephropathy

Front 745

Which nephrotic syndrome is associated with hepatitis B or C? (2)

Back 745

Membranous nephropathy and Type 1 membranoproliferative glomerulonephritis

Front 746

Which nephrotic syndrome is associated with solid tumors?

Back 746

Membranous nephropathy

Front 747

Which nephrotic syndrome is associated with SLE?

Back 747

Membranous nephrophaty

Front 748

Which nephrotic syndrome is associated with drugs?

Back 748

Membranous nephropathy

Front 749

Which nephrotic syndrome has a "tram-track" appearance?

Back 749

Membranoproliferative glomerulonephritis

Front 750

Which nephrotic syndromes have immune complex deposition therefore have granular immunofluorescence? (2)

Back 750

Membranous nephropathy and membranoproliferative glomerulonephritis

Front 751

Which nephrotic syndrome has a "spike and dome" appearance on EM?

Back 751

Membranous nepropathy

Front 752

What are the two types of membranoproliferative glomerulonephritis?

Back 752

Type 1 = subendothelial

Type 2 = dense deposit disease, intramembranous

Front 753

Which nephrotic syndrome is associated with an antibody called C3 nephritic factor?

Back 753

Type 2 Membranoproliferative glomerulonephritis

Front 754

Name the three nephrotic syndromes based on location: Subepithelial, intramembranous (basement membrane), subendothelial

Back 754

Subepithelial = membranous nephropathy

Intramembranous (basement membrane) = Type 2 membranoproliferative glomerulonephritis

Subendothelial = Type 1 membranoproliferative glomerulonephritis

Front 755

Which nephrotic syndrome can also cause nephritic syndrome?

Back 755

Membranoproliferative glomerulonephritis

Front 756

Why is GFR increased in diabetes induced nephrotic syndrome?

Back 756

The efferent arteriole is more affected than the afferent arteriole

Front 757

Why do ace inhibitors help the kidneys with patients who have diabetes mellitus?

Back 757

Angiotensin II constricts the efferent arteriole so by blocking it you block the vasoconstriction

Front 758

What are Kimmelstiel-Wilson nodules and what are they associated with?

Back 758

Sclerosis of mesangium of nephrons and is associated with diabetic nephropathy. Looks like an empty nephron filled with hyaline material.

Front 759

Which organ is most commonly involved in systemic amyloidosis?

Back 759

Kidney

Front 760

Which nephrotic syndrome is characterized by apple-green birefringence under polarized light?

Back 760

Nephrotic syndrome caused by systemic amyloidosis

Front 761

0-14 years old which leukemia?

Back 761

ALL

Front 762

15-39 which leukemia?

Back 762

AML blasts with auer rods

Front 763

40-59 which leukemia?

Back 763

AML and CML

Front 764

40-59 year old how do you differentiate AML from CML?

Back 764

AML has blasts greater than 30%

Front 765

60+ years old which leukemia?

Back 765

CLL

Front 766

4 hallmarks of nephritic syndrome that differentiates it from nephrotic syndrome

Back 766

Limited proteinuria <3.5g/day

RBC casts and dysmorphic RBC in urine

Glomerular inflammation

Periorbital edema

Front 767

Nephritic syndrome that arises after group A B-hemolytic streptococcal infection of the skin (impetigo) or pharynx

Back 767

Poststreptococcal Glomerulonephritis (PSGN)

Front 768

Hallmark of this nephritic syndrome are subepithelial "humps"

Back 768

Poststreptococcal glomerulonephritis

Front 769

Nephritic syndrome that progresses to renal failure in weeks to months

Back 769

Rapidly progressive glomerulonephritis

Front 770

Which nephritic syndrome is characterized by crescents in bowmans space and what are those crescents comprised of?

Back 770

Rapidly progressive glomerulonephritis - crescents are made of fibrin and macrophages

Front 771

If IF pattern shows linear (anti-basement membrane antibody) which disease caused the rapidly progressive glomerluonephritis?

Back 771

Goodpasture syndrome

Front 772

If IF pattern show Granular(immune complex deposition) which disease caused the rapidly progressive glomerulonephritis? (2)

Back 772

PSGN or diffuse proliferative glomerulonephritis

Front 773

Rapidly progressive glomerulonephritis that is due to diffuse antigen-antibody complex deposition, usually sub-endothelial

Back 773

Diffuse proliferative glomerulonephritis

Front 774

Most common type of renal disease in SLE patients?

Back 774

Diffuse proliferative glomerulonephritis

Front 775

If IF pattern show negative IF (pauci-immune) which disease caused the rapidly progressive glomerulonephritis? (3)

Back 775

Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss sydnrome

Front 776

What distinguishes Churg-Strauss from microscopic polyangiitis? (3)

Back 776

Churg-Strauss has granulomatous inflammation, eosinophilia, and asthma.

Front 777

Which nephritic syndrome has IgA immune complex deposition in mesangium of glomeruli

Back 777

IgA Nephropathy (Berger Disease)

Front 778

Which nephritic syndrome has inherited defect in type IV collagen?

Back 778

Alport syndrome

Front 779

Alport syndrome presents with what three key findings?

Back 779

Isolated hematuria

hearing loss

ocular disturbances

Front 780

Infection of bladder

Back 780

Cystitis

Front 781

Gold standard measurement for Cystitis

Back 781

Culture - greater than 100,000 CFU

Front 782

Most common cause for cystitis (bacteria)?

Back 782

E. Coli 80%

Front 783

Cystitis with an alkaline urine and an ammonia scent is most likely due to which bacteria?

Back 783

Proteius mirabilis

Front 784

Name the 5 bacterial causes for cystitis with a positive culture?

Back 784

E. Coli

Staph Saprophyticus

Klebsiella pneumonia

Proteus mirabilis

Enetercoccus faecalis

Front 785

Sterile pyuria with a negative urine culture suggests infection with what? (2)

Back 785

Chlamydia trachomatis

Neisseria gonorrhoeae

Front 786

Infection of kidney

Back 786

Pyelonephritis

Front 787

3 most common pathogens in pyelonephritis

Back 787

E. Coli

Enterococcus faecalis

Klebsiella species

Front 788

Interstitial fibrosis and atrophy of tubules due to multiple bouts of acute pyelonephritis

Back 788

Chronic pyelonephritis

Front 789

Atrophic tubules containing eosinophilic proteinaceous material resemble thyroid follicles suggests what?

Back 789

Chronic pyelonephritis

Front 790

Precipitation of a urinary solute as a stone

Back 790

Nephrolithiasis

Front 791

Treatment for calcium oxalate and/or calcium phosphate stones?

Back 791

Hyrdocholothiazide (calcium-sparing diuretic) - decreases amount of calcium going into urine.

Front 792

Most common cause of this nephrolith is idiopathic hypercalciuria

Back 792

Calcium oxalate and/or calcium phosphate

Front 793

List the four most common nephrolith in order from most to least.

Back 793

Calcium oxalate and/or calcium phosphate

Ammonium magnesium phosphate

Uric Acid

Cysteine

Front 794

Most common cause of this nephrolith is infection with urease-positive organisms (proteius vulgaris or klebsiella).

Back 794

Ammonium magnesium phosphate

Front 795

What is the pathophysiology of the ammonium magnesium phosphate stone?

Back 795

Infection with a urease positive organism leads to alkaline urine which forms a stone.

Front 796

Which nephrolith classically results in a staghorn calculi in renal calyces? (2) one is for adults and one is for children

Back 796

Ammonium magnesium phosphate (adults)

Cysteine (children)

Front 797

Which of the nephroliths are radiolucent?

Back 797

Uric acid

Front 798

This nephrolith is commonly seen in children

Back 798

Cysteine

Front 799

Where is EPO created?

Back 799

renal peritubular interstitial cells

Front 800

Hamartoma comprised of blood vessels, smooth muscle, and adipose tissue?

Back 800

Angiomyolipoma

Front 801

Angiomyolipoma have increased frequency in what?

Back 801

Tuberous sclerosis

Front 802

Malignant epithelial tumor arising from kidney tubules

Back 802

Renal Cell Carcinoma

Front 803

What is the classic triad for renal cell carcinoma

Back 803

Hematuria

Palpable Mass

Flank pain

Front 804

Which of the renal diseases can release excess EPO, renin, PTHrp, or ACTH?

Back 804

Renal cell carcinona - paraneoplastic syndrome

Front 805

Why do you only see left sided varicocele in renal cell carcinoma? why not right?

Back 805

Left spermatic vein drains into renal vein while right spermatic vein drains directly into IVC

Front 806

What kind of cells are seen in renal cell carcinoma?

Back 806

Clear cells

Front 807

What is the pathogenesis of renal cell carcinoma starting with loss of which gene?

Back 807

Loss of VHL (3p) tumor suppressor gene

-increased IGF-1 promotes growth

-increased HIF transcription factor (increases VEGF and PDGF)

Front 808

What is the key risk factor in the spontaneous pathway of renal cell carcinoma?

Back 808

Smoking

Front 809

What disease has an increased risk for renal cell carcinoma? and what other tumor does it have a increased risk for?

Back 809

Von Hippel-Lindau disease and hemangioblastoma of the cerebullum

Front 810

What is the inheritance pattern of Von Hippel-Lindau disease?

Back 810

Autosomal dominant

Front 811

Most common malignant renal tumor in children?

Back 811

Wilms tumor

Front 812

Malignant kidney tumor comprised of blastema, primitive glomeruli and tubules, and stromal cells

Back 812

Wilms tumor

Front 813

Wilms tumor is associated with what mutation?

Back 813

WT1

Front 814

What does WAGR syndrome stand for?

Back 814

Wilms tumor

Aniridia

Genital Abnormalities

Retardation

Front 815

What are the 4 features of Beckwith-Wiedemann syndrome?

Back 815

Wilms tumor

Neonatal hypoglycemia

Muscular hemihypertrophy

Organomegaly especially tongue

Front 816

Malignant tumor arising from urothelial lining of renal pelvis, ureter, bladder, or urethra.

Back 816

Urothelial carcionma

Front 817

Azo dyes increased the risk for what cancer?

Back 817

Urothelial carcinoma

Front 818

Longterm cyclophosphamide or phenacetin can increase risk for what cancer?

Back 818

Urothelial carcinoma

Front 819

What are the two pathways that urothelial carcinoma arises?

Back 819

Flat and papillary

Front 820

Which pathway for urothelial carcioma is associated with early p53 mutations?

Back 820

Flat pathway NOT papillary

Front 821

Which pathway for urothelial carcinoma starts as a high grade and which starts as a low grade?

Back 821

Flat: High grade --> invasivie

Papillary: Low grade --> high grade --> invasive

Front 822

Chronic cystitis has an increased risk for what cancer?

Back 822

Squamous cell carcinoma of lower urinary tract

Front 823

Schitosoma hematobium infection has an increased risk for what cancer? (Egyptian male)

Back 823

Squamous cell carcinoma of lower urinary tract

Front 824

Long-standing nephrolithiasis has an increased risk for what cancer?

Back 824

Squomous cell carcinoma of lower urinary tract

Front 825

A urachal remnant has an increased risk for what cancer? what is the urachas? where does this cancer normally arise?

Back 825

Adenocarcinoma of the bladder

Urachas - duct that connects the fetal bladder to the yolk sac, goes through the umbilical cord.

Arises in the dome of the bladder

Front 826

Mannitol MOA

Back 826

Osmotic diuretic

Front 827

Acetazolamide MOA

Back 827

Carbonic anhydrase inhibitor

Front 828

What are the 2 loop diuretics? and what is the MOA?

Back 828

Furosemide and Ethacrynic acid

Inhibits cotransport system (Na/K/2CL). Prevents concentration of urine.

Front 829

MOA of hydrochlorothiazide

Back 829

Inhibits NaCL reabsorption

Front 830

Name the 4 K+ sparing diuretics

Back 830

Spironolactone

Triamterene

Amiloride

Epelernone

Front 831

MOA of triamterene and amiloride

Back 831

Blocks Na channels in the cortical collecting tubules

Front 832

MOA of spironolactone and eplerenone

Back 832

Aldosterone receptor antagonists

Front 833

Where is the bartholin gland located and what is it's purpose?

Back 833

Located in the vaginal canal and produces mucus-like fluid

Front 834

Cystic dilation of the bartholin gland due to an obstruction

Back 834

Bartholin cyst

Front 835

Warty neoplasm of vulvar skin

Back 835

Condyloma

Front 836

Which viruses cause condyloma?

Back 836

HPV 6 or 11

Front 837

Histologically what are HPV-assocaited condylomas characterized by? and what does it look like?

Back 837

koilocytes - looks like a raisin

Front 838

What are the low risk HPVs and what are the high risk HPVs?

Back 838

low risk = 6 and 11

high risk = 16,18,31,33

Front 839

This vulvar lesion is characterized by thinning of the epidermis and fibrosis of the dermis

Back 839

Lichen sclerosis

Front 840

Parchment-like vulvar skin is indicative of what pathology?

Back 840

Lichen sclerosis

Front 841

This vulvar pathology is characterized by hyperplasia of vulvar squamous epithelium

Back 841

Lichen simplex chronicus

Front 842

Carcinoma arising from squamous epithelium lining the vulva

Back 842

Vulvar carcinoma

Front 843

Two types of vulvar carcinoma and what are their causes

Back 843

HPV-related = HPV 16 and 18

Non-HPV-related = long standing lichen sclerosis

Front 844

Malignant epithelial cell in the epidermis of the vulva

Back 844

Extramammary paget disease

Front 845

Paget cells vs Melanoma stains: PAS, Keratin, S100

Back 845

Paget = PAS+, Keratin+

Melanoma = S-100+

Front 846

Major side effect of amphotericin B (2)

Back 846

Hypokalemia, hypomagnesia

Front 847

Difference between paget disease of vulva vs nipple regarding underlying carcinoma

Back 847

Vulva = no underlying carcinoma

Nipple = underlying carcinoma

Front 848

Focal persistence of columnar epithelium in the upper vagina as opposed to squamous epithelium

Back 848

Adenosis

Front 849

Adenosis has increased incidence in females exposed to what?

Back 849

DES (diethylstilbestrol) estrogen like

Front 850

Malignant proliferation of glands with clear cytoplasm in the vagina

Back 850

Clear cell adenocarcinoma

Front 851

Feared complication of DES-adenosis of the vagina

Back 851

Clear cell adenocarcinoma

Front 852

DES (diethylstilbestrol) moms have a slight increased risk for what?

Back 852

Breast carcinoma

Front 853

Malignant mesenchymal proliferation of immature skeletal muscle

Back 853

Embryonal rhabdomyosarcoma

Front 854

This pathology presents as bleeding and grape-like mass protruding from vagina or penis of child

Back 854

Embryonal rhabdomyosarcoma

Front 855

Rhabdomyoblast will have positive IHC staining for what 2 things?

Back 855

Desmin and myogenin

Front 856

Carcinoma arising from squamous epithelium lining the vaginal mucosa

Back 856

Vaginal carcinoma

Front 857

Cancer from the lower 1/3 of the vagina goes to which lymph nodes? upper 2/3 of the vagina?

Back 857

lower 1/3 = inguinal nodes

upper 2/3 = iliac nodes

Front 858

What is the exocervix and endocervix lined by?

Back 858

Exocervix = squamous epithelium

Endocervix = columnar epithelium

Front 859

What makes high-risk HPV high risk?

Back 859

EG: increases destruction of p53

E7: increases destruction of Rb

Front 860

4 grades of cervical intraepithelial neoplasia and what defines each

Back 860

CIN 1: involves 1/3 thickness of epithelium

CIN 2: involves 2/3

CIN 3: slightly less than full thickness

Carcinoma In Situ = Full thickness

Front 861

Invasive carcinoma that arises from cervical epithelium

Back 861

Cervical carcinoma

Front 862

2 secondary risk factors for in HPV related cervical carcinoma

Back 862

Smoking and immunodeficiency

Front 863

Two subtypes of cervical carcinoma

Back 863

squamous cell carcinoma and adenocarcinoma

Front 864

Confirmatory test for an abnormal pap smear

Back 864

Colposcopy and biopsy

Front 865

Pap smear does not screen which carcinoma very well?

Back 865

adenocarcinoma

Front 866

Formula for fractional filtration

Back 866

FF = GFR/RPF

Front 867

Maximal effect a drug can produce is known as?

Back 867

Efficacy

Front 868

Amount of drug needed for a given effect is known as?

Back 868

Potency

Front 869

Which interleukin is an endogenous pyrogen and also is osteoclast-activating?

Back 869

IL-1

Front 870

What hormones are responsible for each of the phases of menstrual cycle. Proliferative, secretory, menstrual

Back 870

Proliferative = estrogen

Secretory = progesterone

Menstrual = loss of progesterone

Front 871

Secondary amenorrhea due to loss of basalis (regenerative layer) and scarring of the endometrium

Back 871

Asherman Syndrome - due to overaggressive dilation and currettage

Front 872

Lack of ovulation is known as?

Back 872

Anovulatory cycle

Front 873

Anovulatory cycle can cause what (pathophysiology)?

Back 873

Estrogen-driven proliferative phase without progesterone secretory phase. Leads to glands being laid on top of each other. This can cause dysfunctional uterine bleeding.

Front 874

Bacterial infection of endometrium

Back 874

Acute endometritis

Front 875

Chronic inflammation of the endometrium

Back 875

Chronic endometritis

Front 876

Lymphocytes are normally seen in the endometrium, what cell must be present in order for it to be chronic endometritis?

Back 876

Plasma cells

Front 877

Hyperplastic protusion of endometrium

Back 877

Endometrial polyp

Front 878

Endometrial polyp can be a side-effect of what drug?

Back 878

Tamoxifen

Front 879

Endometrial glands and stroma outside of the uterine endometrial lining

Back 879

Endometriosis

Front 880

Formation of a chocolate cyst in the ovaries is suggestive of what disease?

Back 880

Endometriosis

Front 881

Endometriosis with involvement of the uterine myometrium is called?

Back 881

adenomyosis

Front 882

Hyperplasia of endometrial glands relative to stroma

Back 882

Endometrial hyperplasia

Front 883

What is a consequence of unopposed estrogen?

Back 883

Endometrial hyperplasia

Front 884

Endometrial hyperplasia: histologically what is the most important predictor for progression to carcinoma?

Back 884

Cellular atypia

Front 885

Malignant proliferation of endometrial glands

Back 885

Endometrial carcinoma

Front 886

What are the two pathways for endometrial carcinoma and which is most common?

Back 886

Hyperplasia pathway (75%)

Sporadic pathway (25%)

Front 887

What is the histology of hyperplasia and sporadic pathways of endometrial carcinoma? (2)

Back 887

hyperplasia = endometriod (normal endometrium like)

sporadic = papillary serous

Front 888

Age differences for hyperplasia vs sporadic pathways of endometrial carcinoma?

Back 888

hyperplasia = 50 years old

sporadic = 70 years old

Front 889

Sporadic pathway of endometrial carcinoma is driven by what mutation?

Back 889

p53

Front 890

What are psammoma bodies and what is it associated with? (female GS)

Back 890

Concentric calcifications - Endometrial carcinoma (sporadic pathway) (serious papillary)

Front 891

What diseases are psammoma bodies found? (4)

Back 891

Papillary carcinoma of the thyroid

Meningioma

Papillary serous endometrial carcinoma

Mesothelioma

Front 892

Benign proliferation of smooth muscle arising from myometrium.

Back 892

Leiomyoma

Front 893

Describe a leiomyoma

Back 893

Multiple, well-defined white whorled masses

Front 894

Are Leiomyomas usually symptomatic or asymptomatic?

Back 894

asymptomatic

Front 895

Malignant proliferation of smooth muscle arising from the myometrium

Back 895

Leiomyosarcoma

Front 896

What is the precursor to leiomyosarcoma?

Back 896

It arises de novo, it does NOT arise from leiomyoma

Front 897

Which has multiple and which has a single lesion? Leiomyoma and leiomyosarcoma

Back 897

Leiomyoma = multiple

Leiomyosarcoma = single

Front 898

What hormones affects theca cells? and what does it produce because of it?

Back 898

Leutenizing hormone allows theca cells to make androgen

Front 899

what hormone affects granulosa cells? and does it produce because of it?

Back 899

FSH - which allows the conversion of androgen from theca cells to estradiol for the egg

Front 900

What does a residual follicle become? (Female GS)

Back 900

Corpeus luteum

Front 901

What does the corpus luteum secrete and what is it's main job?

Back 901

Secretes progesterone which prepares the endometrium for maintenance and possible pregnancy

Front 902

What hormone cascasde causes ovulation?

Back 902

Estradiol surge induces a LH surge

Front 903

Multiple ovarian follicular cysts due to hormone imbalance

Back 903

Polycystic ovarian disease

Front 904

What hormone is elevated and what hormone is decreased in polycystic ovarian disease?

Back 904

LH = increased

FSH = low

Front 905

What are the three cell types of the ovary that tumors can arise from?

Back 905

Surface epithelial, germ cells, and sex-cord stroma

Front 906

What are the four subtypes of surface epithelial tumors of the ovaries?

Back 906

Mucinous

Serous

Endometrioid

Brenner

Front 907

Of the four subtypes of surface epithelial tumors which ones are cystic?

Back 907

Serous and mucinous

Front 908

Benign tumors of mucinous or serous origin of the ovaries are known as?

Back 908

Cystadenomas

Front 909

What age do cystadenomas normally present? cystadenocarcinoma? (Female GI)

Back 909

cystadenoma: 35 years old (premenopausal)

cystadenocarcinoma: 65 years old (postmenopausal)

Front 910

Difference in gross presentation between a cystadenoma vs cystadenocarcinoma?

Back 910

benign = single cysts with simple, flat linning

malignant = complex cysts with thick, shaggy lining

Front 911

Malignant tumors of mucinous or serous origin of the ovaries are known as?

Back 911

Cystadenocarcinoma

Front 912

BRCA 1 carries have increased risk for what cancers?

Back 912

Serous carcinoma of ovary

Serous carcinoma of fallopian tube

Breast cancer

Front 913

Surface epithelial tumors of the ovaries that are composed of endometrial-like glands

Back 913

Endometrioid tumors

Front 914

Which surface epithelial tumor of the ovary is associated with endometriosis

Back 914

Endometrioid tumor

Front 915

Surface epithelial tumor of the ovary that contains urothelium

Back 915

Brenner tumor

Front 916

Usually malignant or benign? Endometrioid tumor, Brenner tumor? (female GI)

Back 916

Endometrioid usually malignant

Brenner usually benign

Front 917

Marker for surface epithelial tumor of ovaries

Back 917

CA-125

Front 918

Five subtypes of germ cell ovarian tumors (use tissues that are produced for help)

Back 918

Fetal tissue- Cystic teratoma

Fetal tissue - Embryonal carcioma

Oocytes - Dysgerminoma

Yolk sac - Endodermal Sinus tumor

Placental tissue - Choriocarcinoma

Front 919

Cystic tumor in the ovary that is derived from two or three embryologic layers

Back 919

Cystic teratoma

Front 920

What is the most common type of tissue that is immature in an immature teratoma?

Back 920

Neuroectoderm

Front 921

Cystic teratoma composed primarily of thyroid tissue

Back 921

Struma ovarii

Front 922

Germ cell tumor of the ovary that is composoed of large cells with clear cytoplasm and central nuclei

Back 922

Dysgerminoma

Front 923

Testicular counterpart to dysgerminoma

Back 923

Seminoma

Front 924

Malignant germ cell tumor of the ovary that mimics the yolk sac

Back 924

Endodermal sinus tumor

Front 925

Most common ovarian germ cell tumor in children

Back 925

Endodermal sinus tumor (yolk sac)

Front 926

Which ovarian germ cell tumor has increased alpha fetal protein?

Back 926

Endodermal sinus tumor

Front 927

What are schiller-duval bodies and what ovarian germ cell tumor is it classical seen in?

Back 927

Glomeruloid like structures - Endodermal sinus tumor pg.146

Front 928

Malignant proliferation of trophoblast and synctiotrophoblast

Back 928

Choriocarcinoma

Front 929

This germ cell tumor of the ovary has high beta-hCG

Back 929

Choriocarcinoma

Front 930

Which of the germ cell tumors have a poor response to chemotherapy?

Back 930

Choriocarcinoma

Front 931

Malignant germ cell tumor composed of large primitive cells

Back 931

Embryonal carcinoma

Front 932

Neoplasm of granulosa and theca cells

Back 932

Granulosa-theca cell tumor

Front 933

Granulosa-theca cell tumors often produce what hormone?

Back 933

Estrogen

Front 934

Which sex cord-stromal tumor of the ovary has Reinke crystals

Back 934

Sertoli-Leydig cell tumor

Front 935

Which sex cord-stromal tumor of the ovary produces androgen?

Back 935

Sertoli-Leydig cell tumor

Front 936

A woman with pleural effusion and ascites as well as a large mass in the ovary has what syndrome? and what is that mass?

Back 936

Meig's syndrome - fibroma

Front 937

Pseudomyxoma peritonei is massive amounts of mucus in the periotenum where does the tumor come from?

Back 937

Mucinous carcinoma of the appendix

Front 938

Pseudomyxoma peritonei is usually caused by mucinous carcinoma of the appendix where is the most common metastasis site?

Back 938

Ovaries

Front 939

Implantation of fertilized ovum at site other than uterine wall

Back 939

Ectopic pregnancy

Front 940

Lower quadrant abdominal pain weeks after missed period suggests what?

Back 940

Ectopic pregnancy

Front 941

Spontaneous abortions are most often due to what?

Back 941

Chromosomal anomalies especially chromosome 16

Front 942

Teratogenic effects of alcohol (3)

Back 942

Mental retardation

Facial abnormalities

Microcephaly

Front 943

Teratogenic effects of cocaine (2)

Back 943

intrauterine growth retardation

placental abruption

Front 944

Teratogenic effects of Thalidomide

Back 944

Limb defects

Front 945

Teratogenic effects of cigarette smoke

Back 945

Intrauterine growth retardation

Front 946

Teratogenic effects of isotretinoin (3)

Back 946

Spontaneous abortion

Hearing impairment

Visual impairment

Front 947

Teratogenic effects of warfarin

Back 947

Fetal bleeding

Front 948

Teratogenic effects of phenytoin

Back 948

Digit hypoplasia

Cleft lip/palate

Front 949

Implantation of placenta in lower uterine segment

Back 949

Placenta previa (preview of the placenta through the cervical os (opening))

Front 950

Separation of placenta from uterine wall (decidua) prior to delivery of fetus leading to still birth

Back 950

Placental abruption

Front 951

Improper implantation of placenta into myometrium with little or no intervening decidua

Back 951

Placenta accreta

Front 952

Pregnancy induced HTN, proteinuria, and edema

Back 952

Preeclampsia

Front 953

What is HELLP and what is it used for?

Back 953

Preeclampsia

Hemolysis

Elevated Liver enzyemes

Low Platelets

Front 954

What is preeclampsia due to?

Back 954

Abnormality of maternal-fetal vascular interface

Front 955

What is pre-eclampsia with seizures?

Back 955

Eclampsia

Front 956

Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts

Back 956

Hydatidiform mole

Front 957

This classically presents in the second trimester as passage of grape-like masses through vaginal canal

Back 957

Hydatidiform mole

Front 958

Feared complication of hydatidiform mole?

Back 958

Choriocarcinoma

Front 959

Two ways chriocarcinoma can arise? which responds well to chemotherapy? which does not?

Back 959

Gestation pathway - responds well

Germ cell pathway - does not respond well

Front 960

Opening of urethra on inferior surface of penis

Back 960

Hypospadias

Front 961

What is hypospadias due to?

Back 961

Failure of the urethral folds to close

Front 962

Opening of urethra on superior surface of penis

Back 962

Epispadias

Front 963

What is epispadias due to?

Back 963

Due to abnormal positioning of the genital tubercle

Front 964

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

Back 964

Lymphogranuloma Venereum

Front 965

Benign warty growth on genital skin

Back 965

Condyloma Acuminatum

Front 966

Condyloma Acuminatum is due to what?

Back 966

HPV 6 or 11

Front 967

Chlamydia trachomatis (L1-L3) can cause what STD which involves the lymph nodes?

Back 967

Lymphogranuloma Venereum

Front 968

Malignant proliferation of squamous cell of penile skin

Back 968

Squamous cell carcinoma

Front 969

In situ carcinoma of the penile shaft or scortum that presents as leukoplakia

Back 969

Bowen disease

Front 970

In situ carcinoma on the glans that presents as erythroplakia

Back 970

Erythroplasia of Queyrat

Front 971

In situ carcinoma that presents as multiple reddish papules on the penis

Back 971

Bowenoid papulosis

Front 972

Failure of testicle to descend into scrotal

Back 972

Crytpoorchidism

Front 973

Inflammation of testicle

Back 973

Orchitis

Front 974

Orchitis seen in young adults is normally caused by what two organisms?

Back 974

Chlamydia trachomatis (D-K)

Neisseria Gonorrhoeae

Front 975

Orchitis seen in older adults is normally caused by what two organisms?

Back 975

E. Coli

Pseudomonas

Front 976

Orchitis seen in teenage males is normally caused by what organism?

Back 976

Mumps virus

Front 977

This is characterized by granulomas involving seminiferous tubules

Back 977

Autoimmune orchitis

Front 978

Twisting of the spermatic cord leading to congestion and hemorrhagic infarction

Back 978

Testicular torsion

Front 979

Granulomas in the testicle can be caused by what two things?

Back 979

TB -necrotizing granulomas

autoimmune orchitis - granulomas

Front 980

Absent cremasteric reflex (touching inner thigh leading to scrotum to move up) is indicative of what?

Back 980

Testicular torsion

Front 981

Dilation of spermatic vein due to impaired drainage

Back 981

Varicocele

Front 982

Presents as a scrotal swelling with "bag of worms' appearance

Back 982

Varicocele

Front 983

Varicocele are usually on what side?

Back 983

Left side

Front 984

Fluid collection within tunica vaginalis of the testicle

Back 984

Hydrocele

Front 985

What are the two types of testicular tumors?

Back 985

Germ cells or sex-cord stroma

Front 986

Why are testicular tumors not biopsied?

Back 986

Risk of seeding scrotum; removed via radical orchiectomy

Front 987

Two risk factors for germ cell tumors in males

Back 987

Cryptorchidism and Klinefelter syndrome

Front 988

What are the two types of germ cell tumors of the testicles?

Back 988

Seminoma and nonseminoma

Front 989

Which of the two subtypes of germ cell tumors of the testicles are highly responsive to radiotherapy?

Back 989

Seminoma not nonseminoma

Front 990

Which of the two subtypes of germ cell tumors of the testicles metastasizes late?

Back 990

Seminoma not nonseminoma

Front 991

Which of the two subtypes of germ cell tumors of the testicles has an excellent prognosis?

Back 991

Seminoma not nonseminomas

Front 992

Malignant tumor of the testicle with large cells with clear cytoplasm and central nuclei

Back 992

Seminoma, similar description to dysgerminoma

Front 993

Which of the testicular tumors is a homogenous mass with no hemorrhage or necrosis?

Back 993

Seminoma

Front 994

Which testicular cancer can produce beta-hCG although it is rare to happen?

Back 994

Seminoma

Front 995

What are the 4 nonseminomas of the testicular?

Back 995

Embryonal carcinoma

Yolk sac (endodermal sinus) tumor

Choriocarcinoma

Teratorma

Front 996

Malignant tumor of testicles made of immature, primitive cells that may form glands.

Back 996

Embryonal carcinoma

Front 997

This testicular tumor is a hemorrhage mass with necrosis

Back 997

Embryonal carcinoma

Front 998

Chemotherapy may cause this testicular tumor to differntiate

Back 998

Embryonal carcinoma

Front 999

These testicular tumors has increased AFP or beta-hCG (2)

Back 999

Embryonal carcinoma and Teratoma

Front 1000

Testicular tumor that resembles a yolk sac

Back 1000

Yolk sac tumor (endodermal sinus)

Front 1001

Most common testicular tumor in children

Back 1001

Yolk sac tumor

Front 1002

AFP is elevated in this testicular tumor

Back 1002

Yolk sac tumor

Front 1003

Schiller-Duval bodies are found in which testicular tumor?

Back 1003

Yolk sac tumor (endodermal sinus)

Front 1004

Malignant testicular tumor of synctiotrophoblasts and cytotrophoblasts

Back 1004

Choriocarcinoma

Front 1005

B-hCG is elevated in this testicular carcinoma

Back 1005

Choriocarcinoma

Front 1006

Teratoma is malignant in which sex?

Back 1006

Males

Front 1007

Lymphoma of testicles are usually composed of what?

Back 1007

Diffuse large B-cell type

Front 1008

Leydig cell tumors produce what hormone?

Back 1008

Androgen

Front 1009

Which sex-cord stromal tumor is comprised of tubules?

Back 1009

Sertoli cell tumor

Front 1010

Acute inflammation of prostate, usually due to bacteria

Back 1010

Acute prostatitis

Front 1011

Which two organisms are responsible for acute prostatitis in young adults?

Back 1011

C trachomatis

N gonorrhoeae

Front 1012

Which two organisms are responsible for Acute prostatitis in older adults?

Back 1012

E Coli

Pseudomonas

Front 1013

Chronic inflammation of prostate

Back 1013

Chronic prostatitis

Front 1014

Hyperplasia of prostatic stroma and glands

Back 1014

Benign Prostatic Hyperplasia (BPH)

Front 1015

Where does BPH occur within the prostate?

Back 1015

Periurethral zone

Front 1016

Conversion of what hormone to what other hormone causes BPH? what enzyme is responsible for the conversion?

Back 1016

Testosterone --5a-reductase--> DHT

Front 1017

What two types of drugs are used for BPH?

Back 1017

A1 antagonists and 5a-reductase inhibitors

Front 1018

Alpha inhibitors can be used to treat BPH what are the two types and what are the indications for each?

Back 1018

A1-antagonist (relax smooth muscles) - terazosin

Selective A1a-antagonist so that it does not effect blood vessels in normotensive individuals - tamulosin

Front 1019

Malignant proliferation of prostatic glands

Back 1019

Prostate adenocarcinoma

Front 1020

What grading system is used for prostate adenocarcinoma? This grading system is not based on atypia but instead base on what?

Back 1020

Gleason grading system - based on architecture

Front 1021

MOA of leuprolide and what is it used for?

Back 1021

Continuous - GnRH analog that shut does the anterior pituitary gonadotrophs (LH and FSH). used for prostate adenocarcinoma

Pulsatile - agonist when used pulsatile

Front 1022

MOA of flutamide and what is it used for?

Back 1022

Antagonist of androgen receptor used for prostate adenocarcinoma

Front 1023

Common metastasis site for prostate adenocarcinoma

Back 1023

lumbar spine

Front 1024

MOA of terazosin and what is it used for?

Back 1024

A1 antagonist. HTN and BPH

Front 1025

MOA of tamulosin and what is it used for?

Back 1025

Selective A1a antagonist. BPH in normotensive patients

Front 1026

Benign rathke pouch tumor with cholesterol crystals, calcifications

Back 1026

Craniopharyngioma

Front 1027

What is the role of the synctiotrophoblast and which layer?

Back 1027

Secrete hCG (similar to LH), which stimulates the corpeus luteum to continue secreting progesterone. Outer layer

Front 1028

What is the role of the cytotrophoblast? which layer?

Back 1028

Inner layer which makes cells

Front 1029

Umbilical artery contains oxygenated or deoxygenated blood?

Back 1029

Deoxygenated

Front 1030

MOA of finasteride

Back 1030

Inhibits 5a-reductase leading to decreased formation of DHT from testosterone

Front 1031

Chromosomes of Klinefelter

Back 1031

XXY

Front 1032

Chromosomes of Turner syndrome

Back 1032

XO

Front 1033

Which hydatidiform mole has fetal parts and which does not have fetal parts?

Back 1033

Partial = partial fetus

Complete = No fetal parts

Front 1034

MOA of Clomiphene and what is it used for?

Back 1034

Antagonist at estrogen receptor in hypthalamus which blocks feedback inhibition and increase LH and FSH. Used for infertility.

Front 1035

MOA of Tamoxifen

Back 1035

Estrogen antagonist at breast tissue.

Front 1036

MOA of Raloxifene and what is it used for?

Back 1036

Estrogen agonist on bone. Osteoporosis

Front 1037

MOA of Mifepristone (RU-486) and what is it used for?

Back 1037

Competitive inhibitor of progestins at progesterone receptors. Used to terminate pregnancy. Used with misoprostol (PGE1)

Front 1038

MOA of Terbutaline and what is it used for?

Back 1038

B2 - agonist that relaxes the uterus, used to decrease contraction frequency of women during labor

Front 1039

MOA of Danazol and what is it used for?

Back 1039

Synthetic androgen, partial agonist at androgen receptors. Used for endometriosis and hereditary angioedema.

Front 1040

MOA of flutamide and what is it used for?

Back 1040

Nonsteroidal inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma.

Front 1041

MOA of ketoconazole and what is it used for?

Back 1041

Inhibit steroid synthesis (inhibits 17,20-desmolase). Used for PCOD to prevent hirsutism.

Front 1042

MOA of spironolactone and what is it used for?

Back 1042

Inhibit steroid binding (17a-hydroxylase, 17-20 desmolase). Used for PCOD to prevent hirsutism.

K+ sparing diuretic - aldosterone receptor antagonist

Front 1043

MOA of sildenafil and what is it used for?

Back 1043

Inhibit phosphodiesterase 5, leading to increase of cGMP. Erectile dysfunction.

Front 1044

MOA of vardenafil and what is it used for?

Back 1044

Inhibit phosphodiesterase 5, leading to increase in cGMP. Erectile dysfunction.

Front 1045

What does adnexal mass refer to?

Back 1045

A lump of tissue in the adnexa of the uterus

Front 1046

What prevents lactation during pregnancy even though prolactin is elevated?

Back 1046

Estrogen and progesterone

Front 1047

A 32 year old female presents to your office complaining of small amount of vaginal discharge. Application of KOH solution to the discharge yields a strong fishy odor. What is the dx? and organism responsible?

Back 1047

Bacterial vaginosis caused most commonly by Gardnerella vaginalis

Front 1048

Primary amennorrhea in a pt with fully developed secondary sexual characteristics is most commonly due to what two things?

Back 1048

Imperforate hymen or mullerian duct anomaly

Front 1049

Imperfrorate hymen presents with what three key characteristics?

Back 1049

Primary amennorrhea

Cyclical pain

Palpable mass anterior to the rectum

Front 1050

What hormone causes maternal insulin resistance?

Back 1050

human placental lactogen

Front 1051

Define primigravada

Back 1051

A woman who is pregnant for the first time

Front 1052

What vitamins are not found in breast milk?

Back 1052

Vitamin D and K

Front 1053

Attrition bias is what type of bias? Bias that occurs because people die in a study

Back 1053

Selection bias

Front 1054

Which cells in the testicle produce testosterone?

Back 1054

Leydig cells in response to LH

Front 1055

Which cells nurse the sperm?

Back 1055

Sertoli cells

Front 1056

Nonfunctional tumors of the pituitary present with mass effect: what are the 3 symptoms?

Back 1056

Bitemporal hemianopsia

Hypopituitarism

Headache

Front 1057

Most common pituitary tumor?

Back 1057

Prolactinoma

Front 1058

How does a prolactinoma cause amenorrhea?

Back 1058

Prolactin inhibits GnRH which decreases LH and FSH leading to amenorrhea

Front 1059

Galactorrhea and amenorrhea suggests what tumor?

Back 1059

Prolactinoma

Front 1060

Decreased libido and headaches in a male suggests what type of endocrine tumor?

Back 1060

Prolactinoma

Front 1061

How do you treat prolactinoma? (2)

Back 1061

dopamine agonists or surgery

Front 1062

MOA of bromocriptine and what is it used for (2)?

Back 1062

Dopamine agonist used for prolactinomas and for parkinson's

Front 1063

MOA of cabergoline and what is it used for?

Back 1063

Dopamine agonist used for prolactinomas

Front 1064

How does a growth hormone adenoma cause secondary diabetes mellitus?

Back 1064

GH induces liver gluconeogenesis

Front 1065

In growth hormone adenoma Growth hormone is not responsible fro the growth of tissue, instead it activates something else. What is that?

Back 1065

IGF-1

Front 1066

MOA of octreotide

Back 1066

Somatstatin analog, blocks release of GH.

Front 1067

Pregnancy-related infarction of the pituitary gland

Back 1067

Sheehan syndrome

Front 1068

Pathophysiology of Sheehan syndrome

Back 1068

Gland doubles in size during pregnancy, but blood supply does not increase significantly; blood loss during parturition precipitates infarction.

Front 1069

A pt after giving birth presents with poor lactation, loss of pubic hair, and fatigue. What is the dx?

Back 1069

Sheehan syndrome

Front 1070

Herniation of the arachnoid and CF into the sella compresses and destroys the pituitary gland

Back 1070

Empty sella syndrome

Front 1071

What hormones are produced in the posterior pituitary and how is it transported?

Back 1071

ADH and oxytocin which are transported via axons from hypothalamus

Front 1072

ADH deficiency leads to what?

Back 1072

Centra diabetes insipidus

Front 1073

Impaired renal response to ADH

Back 1073

Nephrogenic diabetes insipidus

Front 1074

MOA of desmopressin and what is it used for?

Back 1074

ADH analog used for central diabetes insipidus

Front 1075

Excessive ADH secretion

Back 1075

Syndrome of inappropriate ADH (SIADH) secretion

Front 1076

What is the treatment for syndrome of inappropriate ADH secretion

Back 1076

demeclocycline - blocks the affect of ADH

Front 1077

A patient who has syndrome of inappropriate ADH secretion and cancer most likely has what kind of cancer?

Back 1077

Small cell carcinoma of the lung

Front 1078

How does hyperthyroidism increase BMR?

Back 1078

increased synthesis of Na-K ATPase

Front 1079

How does hyperthyroidism increase sympathetic nervous system activity?

Back 1079

Increased expression of B1-adrenergic receptors

Front 1080

Hyperthyroidism has increased or decreased cholesterol and glucose levels?

Back 1080

Hypocholesterolemia

Hyperglycemia

Front 1081

Autoantibody that stimulate TSH receptor

Back 1081

Graves disease

Front 1082

What type of antibody is responsible for Grave's disease?

Back 1082

IgG

Front 1083

What type of hypersensitivity is grave's disease?

Back 1083

Type II

Front 1084

What is exophthalmos due to in grave's disease?

Back 1084

Fibroblasts behind the orbit express the TSH receptor. Not the increased thyroid hormone.

Front 1085

Scalloped colloid is found in what endocrine disorder?

Back 1085

Grave's disease

Front 1086

MOA of PTU (propylthiouracil)

Back 1086

Inhibits peroxidase-mediated oxidation, organification, and coupling steps of thyroid synthesis as well as peripheral conversion of T4 to T3.

Front 1087

Hypothyroidism in neonates and infants

Back 1087

Cretinism

Front 1088

Most common enzyme to be deficient in cretinism?

Back 1088

thyroid peroxidase

Front 1089

Hypothyroidism in an older child or adult

Back 1089

Myxedma

Front 1090

Autoimmune destruction of thyroid gland

Back 1090

Hashimoto Thyroiditis

Front 1091

Hashimoto thyroiditis is associated with what HLA?

Back 1091

HLA-DR5

Front 1092

What are hurthle cells and what are they associated with?

Back 1092

Hurthle cells are eosinophilic metaplasia of cells that line follices. Associated with hashimoto's thyroiditis

Front 1093

Which thyroid disorder has chronic inflammation with germinal centers?

Back 1093

Hashimoto Thyroiditis

Front 1094

Hashimoto thyroiditis has an increased for what kind of lymphoma?

Back 1094

B-cell (marginal zone) lymphoma

Front 1095

A pt presents with hashimoto thyroiditis and an enlarging thyroid gland what is most likely the cause?

Back 1095

B-cell (marginal zone) lymphoma

Front 1096

Granulomatous thyroiditis that follows a viral infection

Back 1096

Subacute (deQuervain) Granulomatous thyroiditis

Front 1097

A young woman presents with tender thyroid what is the most likely dx?

Back 1097

Subacute (deQuervain) granulomatous thyroiditis

Front 1098

Chronic inflammation with extensive fibrosis of thyroid

Back 1098

Reidel fibrosing thyroiditis

Front 1099

Reidel fibrosing thyroiditis hyper or hypo thyroidism?

Back 1099

Hypothyroidism

Front 1100

Subacute (de quervain) granulomatous thyroiditis hyper or hypo thyroidism?

Back 1100

Hyperthyroidism may progress to hypothyroidism

Front 1101

A patient presents with a hard as wood nontender thyroid gland?

Back 1101

Reidel fibrosing thyroiditis

Front 1102

A YOUNG patient with a fibrosing thyroid that is invading local structures like the airway is most likely what?

Back 1102

Reidel fibrosing thyroiditis since they are young, if they were older then more likely anaplastic carcinoma.

Front 1103

How do you biopsy the thyroid? and why is that technique used?

Back 1103

Fine needle aspiration (FNA) because the thyroid is very vascular

Front 1104

Benign proliferation of follicles surrounded by a fibrous capsule (thyroid)

Back 1104

Follicular adenoma

Front 1105

Which thyroid neoplasia has a fibrous capsule?

Back 1105

Follicular adenoma

Front 1106

What are the four types of thyroid carcinomas?

Back 1106

Papillary

Follicular

Medullary

Anaplastic

Front 1107

Which thyroid carcinoma's major risk factor is ionizing radiation in childhood?

Back 1107

Papillary carcinoma

Front 1108

What is Orphan Annie eye nuclei and what are they associated with?

Back 1108

Orphan annie eye nuclei are nuclei with a central white clearing. It is associated with papillary carcinoma.

Front 1109

Which thyroid carcinoma has psammoma bodies?

Back 1109

Papillary carcinoma

Front 1110

Which nodes do papillary carcinomas usually spread to?

Back 1110

Cervical nodes

Front 1111

Malignant proliferation of follicles (thyroid)

Back 1111

Follicular carcinoma

Front 1112

Which thyroid neoplasia has a fibrous capsule with invasion through capsule?

Back 1112

Follicular carcinoma

Front 1113

Why can you not differentiate follicular adenoma from follicular carcinoma with fine needle aspiration?

Back 1113

Follicular adenoma and follicular carcinoma histologically look the same, the difference is in the capsule integrity which can not be seen with FNA. Follicular adneoma has an intact capsule, follicular carcinoma does not.

Front 1114

Which four carcinomas like to spread via blood?

Back 1114

Renal cell carcinoma - renal viens

Follicular carcinoma

Hepatocellular carcinoma - hepatic veins

Choriocarcinoma

Front 1115

Malignant proliferation of parafollicular C cells

Back 1115

Medullary carcinoma

Front 1116

Which thyroid carcinoma has high levels of calcitonin?

Back 1116

Medullary carcinoma

Front 1117

Fine need aspiration that shows malignant cells in an amyloid stroma is indicative of what thyroid neoplasia?

Back 1117

Medullary carcinoma

Front 1118

Detection of what mutation warrants prophylactic thyroidectomy and why?

Back 1118

RET mutation, thyroid may progress to medullary carcinoma

Front 1119

Undifferentiated malignant tumor of thyroid

Back 1119

Anaplastic carcinoma

Front 1120

Which thyroid neoplasia likes to invade local structures?

Back 1120

Anaplastic carcinoma

Front 1121

What are the three actions of PTH?

Back 1121

Increase bone osteoclast activity

Increase small bowel absorption of calcium and phosphate

Increase renal calcium reabsorption

Decrease renal phosphate reabsorption

Front 1122

Excess PTH due to disorder of the parathyroid gland

Back 1122

Primary Hyperparathyroidism

Front 1123

Pituitary adenoma can cause what to the pancreas?

Back 1123

Acute pancreatitis

Front 1124

Osteitis fibrosa cystica is associated with what endocrine disorder?

Back 1124

Parathyroid adenoma

Front 1125

Nephrocalcinosis is associated with what endocrine disorder?

Back 1125

Parathyroid adenoma

Front 1126

Lab findings for parathyroid adenoma: increased or decreased for PTH, calcium, phsophate, cAMP, serum alkaline phosphatase

Back 1126

PTH increased

Calcium Increased

Phosphate decreased

Urinary cAMP increased

Serum alkaline phosphatase increased

Front 1127

Excess production of PTH due to a disease process extrinsic to the parathyroid gland

Back 1127

Secondary hyperparathyroidism

Front 1128

Most common cause for secondary hypoparathyroidism

Back 1128

Chronic renal failure

Front 1129

How does chronic renal failure cause secondary hyperparathyroidism?

Back 1129

Renal insufficiency leads to decreased phosphate excretion

Increased serum phosphate binds calcium

Low free calcium stimulate parathyroids

Increased PTH leads to bone resorption

Front 1130

Lab findings for secondary hypoparathyroidism due to CRF: Increased or decreased PTH, serum calcium, serum phosphate, alkaline phosphtase

Back 1130

PTH increased

Serum calcium decreased

Serum phosphate increased

Alkaline phosphatase increased

Front 1131

What endocrine disorder can occur due to DiGeorge syndrome?

Back 1131

Hypoparathyroidism

Front 1132

What is trousseau sign and what does it indicate?

Back 1132

tetany that is elicited with filling of blood pressure cuff - hypoparathyroidism

Front 1133

What is Chvostek sign and what does it indicate?

Back 1133

Tapping of facial nerve leads to spams - hypoparaythyroidism

Front 1134

End-organ resistance to PTH is called

Back 1134

Pseudohypoparathyroidism

Front 1135

What protein is defective in pseudohypoparathyroidism?

Back 1135

Gs (G stimulatory protein)

Front 1136

What are the lab values for calcium and PTH in pseudohypoparathyroidism?

Back 1136

Decreased calcium

Increased PTH

Front 1137

A pt with short stature and short 4th and 5th digits most likely has what endocrine disorder?

Back 1137

Pseudohypoparathyroidism

Front 1138

What cells secrete insulin and where are they relative to the islets?

Back 1138

Beta cells; lie in center of islets

Front 1139

What cells secrete glucagon?

Back 1139

Alpha cells

Front 1140

What cells destroys the beta cells in type 1 diabetes mellitus?

Back 1140

T Lymphocytes

Front 1141

Which HLA is type 1 diabetes associated with?

Back 1141

HLA-DR3 and DR4

Front 1142

What is the mechanism of insulin resistance in type II diabetes?

Back 1142

Obesity leads to decreased numbers of insulin receptors

Front 1143

Glucose can freely enter what areas without insulin?

Back 1143

Schwann cells

pericytes of retinal blood vessels

lens

Front 1144

What enzyme is responsible for converting glucose to sorbitol, resulting in osmotic damage in diabetes?

Back 1144

Aldose reductase

Front 1145

What are the three parts of MEN type 1?

Back 1145

3 P's

Pituitary Tumors

Parathyroid Tumors

Pancreatic Tumors

Front 1146

What are the three parts of MEN type 2A?

Back 1146

2P's

Parathyroid hyperplasia

Pheochromocytoma

Medullary thyroid carcinoma

Front 1147

What are the three parts of MEN type 2b?

Back 1147

1P

Pheochromocytoma

Medullary thyroid carcinoma

Mucosal neuromas

Front 1148

This pancreatic endocrine neoplasm presents with episodic hypoglycemia with mental status changes that are relieved by administration of glucose?

Back 1148

Insulinoma

Front 1149

This pancreatic endocrine neoplasm presents with treatment-resistant peptic ulcers

Back 1149

Gastrinomas (Zollinger-Ellison syndrome)

Front 1150

This pancreatic endocrine neoplasm presents with achlorhydria and cholelithiasis with steatorrhea

Back 1150

Somatostatinomas

achlorhydria - inhibits gastrin

steatorrhea - inhibits CCK

Front 1151

This pancreatic endocrine neoplasm presents with watery diarrhea, hypokalemia, and achlorhydria

Back 1151

VIPomas

Front 1152

Which pancreatic endocrine neoplasm has cholelithiasis?

Back 1152

Somatostatinoma

Front 1153

Adrenal cortex has three layers and what do each of the layers produce?

Back 1153

Glomerulosa - mineralocorticoids

Fasciculata - glucocoritcoids

Reticularis - sex steroids

Front 1154

Endocrine disorder with excess cortisol

Back 1154

Cushing syndrome

Front 1155

What are the three ways cortisol suppresses the immune system?

Back 1155

Inhibits these three things:

Phospholipase A2 = inflammatory mediator

IL-2 = T-cell growth factor

Histamines = vasodilation

Front 1156

What are the 4 causes for cushing syndrome?

Back 1156

Exogenous corticosteroids

Primary adrenal adenoma, hyperplasia or carcinoma

ACTH-secreting pituitary adenoma

Paraneoplastic ACTH secretion

Front 1157

How does a dexamethasone test distinguish pituitary vs small cell carcinoma cause for cushing?

Back 1157

Dexamethasone is a powerful cortisol analog which should suppress ACTH. In pituitary adenoma cortisol will be decreased due to negative feedback of ACTH. In small cell cell carcinoma cortisol remains high because there is no negative feedback.

Front 1158

Endocrine disorder with excess aldosterone

Back 1158

Conn syndrome

Front 1159

Excess aldosterone (conn syndrome) will cause what 3 things to happen in the collecting tubles of the kidney? what two cells are they affecting?

Back 1159

Principle cell:

Reabsorb Na --> Hypernatremia

Secrete K --> Hypokalemia

alpha-intercalated cell:

Secrete H+ --> metabolic alkalosis

Front 1160

In primary hyperaldosteronism what are the levels of aldosterone and renin?

Back 1160

Aldosterone is high because it is being secreted by an adenoma

Renin is low because high blood pressure lowers renin

Front 1161

In secondary hyperaldosteronism what are the levels of aldosterone and renin?

Back 1161

Renin is high because the renin-angiotensin system is activated

Aldosterone is high because Angiotensin II caused its release

Front 1162

Excess steroids with hyperplasia of both adrenal glands

Back 1162

Congential adrenal hyperplasia

Front 1163

What is deficient in congenital adrenal hyperplasia?

Back 1163

21-hydroxylase

Front 1164

What is the pathophysiology of congenital adrenal hyperplasia?

Back 1164

21-hydroxylase deficiency leads to increased production of sex steroids. Cholesterol is converted to pregnenolone which then converted to the 3 steroids (mineral, cortico, and sex). Mineral and cortico require 21 hydroxylase but sex does not so there is a lot of sex steroids. Deficiency of cortico leads to increase in ACTH which causes bilateral adrenal hyperplasia

Front 1165

If a patient presents with 21-hydroxylase deficiency symptoms but does not have salt wasting, hypokalemia, or hypovolemia what should you suspect and why?

Back 1165

11-hydroxylase deficiency because a little mineralocorticoids are still being produced by corticosteroids are still deficient.

Front 1166

What syndrome has adrenal insufficiency?

Back 1166

Waterhouse-Friderichsen syndrome

Front 1167

Pathophysiology of Waterhouse-Friederichsen syndrome?

Back 1167

N meningitidis infection leads to DIC which leads to hemorrhagic necrosis of adrenal glands

Front 1168

Sack of blood adrenals is associated with what?

Back 1168

Waterhous-Friederichsen syndrome

Front 1169

What are the 3 causes for chronic adrenal insufficiency?

Back 1169

Autoimmune destruction

TB

Metastatic carcinoma (e.g. lungs)

Front 1170

What is the adrenal medulla derived from?

Back 1170

Neural crest-derived chromaffin cells

Front 1171

Tumor of chromaffin cell

Back 1171

Pheochromoctyoma

Front 1172

A brown tumor of the adrenal gland suggests what pathology?

Back 1172

Pheochromocytoma

Front 1173

MOA of phenoxybenzamine and what is it used for?

Back 1173

Irreversible a-blocker used for pheochromocytoma

Front 1174

What is increased in serum in pheochromocytoma? (2)

Back 1174

metanephrines

vanillylmandelic acid

Front 1175

What are the rule of 10s for pheochromocytoma? (4)

Back 1175

10% bilateral

10% familial

10% malignant

10% located outside of adrenal medulla

Front 1176

Where do pheochromoctyomas like go if they are not in the adrenals?

Back 1176

bladder wall

Front 1177

What syndromes are associated with pheochromocytoma?

Back 1177

MEN 2A

MEN 2B

VHL disease

NF type 1

Front 1178

What are the Na, K, and plasma levels in congenital adrenal hyperplasia?

Back 1178

Decreased Na

Increased K

Hypvolemia

Front 1179

What is IL-4 responsible for?

Back 1179

IgE class switch

Front 1180

What is IL-10 responsible for?

Back 1180

inhibit Th1; stimulate Th2

Front 1181

What is IL-2 responsible for?

Back 1181

T-cell growth factor

Front 1182

What are the two layers of of epithelium in lobules and ducts of the breast? which one is outer and which is inner? what is the function of each?

Back 1182

Luminal = inner, makes milk

Myoepithelial = outer, contractile ejection of milk

Front 1183

What hormones cause the breast tissue to develop?

Back 1183

Estrogen and progesterone

Front 1184

Bacterial infection of the breast, usually S. aureus

Back 1184

Acute mastitis

Front 1185

Acute mastitis is usually due to what bacteria?

Back 1185

S. aureus

Front 1186

Inflammation of the subareolar ducts in breast

Back 1186

Periductal mastitis

Front 1187

Periductal mastitis has a relative deficiency in what vitamin?

Back 1187

Vitamin A

Front 1188

This breast infection presents with nipple retraction, but is not cancer.

Back 1188

Periductal mastitis

Front 1189

Inflammation with dilation of the subareolar ducts

Back 1189

Mammary duct ectasia

Front 1190

This presents as a perioareolar mass with green-brown nipple discharge

Back 1190

Mammary duct ectasia

Front 1191

Mammary duct ectasia clasically arises in what population?

Back 1191

multiparous postmenopasual women

Front 1192

Cysts that have a blue-dome appearance on gross exam (breast)

Back 1192

Fibrocystic change

Front 1193

How much increased risk for breast carcinoma: apocrine metaplasia

Back 1193

zero increased risk

Front 1194

How much increased risk for breast carcinoma: ductal hyperplasia

Back 1194

2x

Front 1195

How much increased risk for breast carcinoma: sclerosing adenosis

Back 1195

2x

Front 1196

How much increased risk for breast carcinoma: atypical metaplasia

Back 1196

5x

Front 1197

Papillary growth, usually into a large duct (breast)

Back 1197

Intraductal papilloma

Front 1198

This breast pathology classically presents as a bloody nipple discharge in a premenopausal woman

Back 1198

Intraductal papilloma

Front 1199

Histologically what differentiates intraductal papilloma from papillary carcinoma?

Back 1199

Intraductal papilloma contains myoepithelial cells while papillary carcinoma does not

Front 1200

Tumor of fibrous tissue and glands in the breast

Back 1200

Fibroadenoma

Front 1201

Pt presents with a mass in her breast that grows during pregnancy and is painful during menstrual cycle. What is it?

Back 1201

Fibroadenoma

Front 1202

Fibroadenoma-like tumor with overgrowth of fibrous component

Back 1202

Phyllodes tumor

Front 1203

Can phyllodes tumor of breast be malignant?

Back 1203

Yes, but not fibroadenoma

Front 1204

Can fibroadenoma of breast be malignant?

Back 1204

No, but phyllodes tumor can be malignant

Front 1205

Malignant proliferation of cells in ducts with no invasion of the basement membrane

Back 1205

Ductal carcinoma in situ (DCIS)

Front 1206

Ductal carcinoma in situ that extend up the ducts to involve the skin of the nipple

Back 1206

Paget disease of the nipple

Front 1207

What 3 things can show up as calcifications in the breast?

Back 1207

Fat necrosis

Fibrocystic change

Ductal carcinoma in situ

Front 1208

Invasive carcinoma that classically forms duct like structures

Back 1208

Invasive ductal carcinoma

Front 1209

This breast cancer has retraction of the nipple

Back 1209

Invasive ductal carcinoma

Front 1210

What are the 4 subtypes of invasive ductal carcinoma

Back 1210

Tubular carcinoma

Mucinous carcinoma

Medullary carcinoma

Inflammatory carcinoma

Front 1211

This invasive ductal carcinoma has well differentiated tubules that lack myoepithelial cells, what is the prognosis?

Back 1211

Tubular carcinoma, relative good prognosis

Front 1212

This invasive ductal carcinoma has abundant extracellular mucin, what is the prognosis?

Back 1212

Mucinous carcioma, relatively good prognosis

Front 1213

This invasive ductal carcinoma has large, high-grade cells growing in sheets with associated lymphocytes and plasma cells, what is the prognosis?

Back 1213

Medullary carcinoma, relatively good prognosis

Front 1214

This invasive ductal carcinoma has cancer in dermal lymphatics, what is the prognosis?

Back 1214

Inflammatory carcinoma, poor prognosis

Front 1215

Which invasive ductal carcinoma can be mistaken for acute mastitis due to a swollen breast?

Back 1215

Inflammatory carcinoma

Front 1216

Which invasive ductal carcinoma has increased incidence in BRCA1 carriers?

Back 1216

Medullary carcinoma

Front 1217

Malignant proliferation of cells in lobules with no invasion of the basement membrane

Back 1217

Lobular carcinoma in situ (LCIS)

Front 1218

This breast cancer has dyscohesive cells lacking E-cadherin

Back 1218

Lobular carcinoma in situ

Front 1219

Which breast cancer is treated with tamoxifen?

Back 1219

Lobular carcinoma in situ

Front 1220

This invasive carcinoma grows in a single-file pattern, why?

Back 1220

Invasive lobular carcinoma because it lacks E-cadherin

Front 1221

This carcinoma lacks duct formation due to lack of E-cadherinI

Back 1221

Invasive lobular carcinoma

Front 1222

In TNM staging what is the most important prognostic factor?

Back 1222

Metastasis - if there is metastases, very bad

Front 1223

In TNM staging what is the most useful prognostic factor?

Back 1223

Lymph nodes - since most pts do not have metastases this is more useful

Front 1224

What are the three predictive factors in breast cancer and which drugs are they useful for?

Back 1224

Estrogen receptor - responds to tamoxifen

Progesterone receptor - responds to tamoxifen

HER2/neu gene amplification status - responds to trastuzumab

Front 1225

MOA of transtuzumab and what is it used for?

Back 1225

designer antibody directed against HER2 receptor, HER2/neu breast cancer

Front 1226

What is a triple negative breast cancer? what is the significance?

Back 1226

ER, PR, HER2neu negative and it has a poor prognosis

Front 1227

BRCA1 mutation is associated with what cancers?

Back 1227

Medullary breast carcinoma and Serous ovarian carcinoma and Fallopian tube carcinoma

Front 1228

BRCA2 mutation is associated with what cancers?

Back 1228

breast carcinoma in males

Front 1229

What syndrome is associated with male breast cancer?

Back 1229

Klinefelter syndrome

Front 1230

Male breast cancer is most likely which subtype?

Back 1230

invasive ductal carcinoma

Front 1231

Cholecalciferol to 1,25 dihydrocholecalciferol, what organs and what adds 1 and what adds 25 and what order

Back 1231

1st liver adds 25

2nd kidneys add 1

Front 1232

Patient with gynecomastia and small firm testes, abnormally long extremeties. Increased/Decreased: LH,FSH, Testosterone, sperm count

Back 1232

LH,FSH: Increased

Testosterone: Decreased

Sperm count: Decreased

In klinefelter sertoli and leydig cells are destroyed leading to low testosterone. Feedback loop makes LH and FSH increase.

Front 1233

What enzymatic conversion is deficient in biotin deficiency?

Back 1233

Pyruvate to oxaloacetate

Front 1234

Which organ must be tested when pts are using amiodarone?

Back 1234

Thyroid - Serum TSH

Front 1235

Perchlorate and Pertechnate have what MOA and what do they treat?

Back 1235

Block iodide absorption into thyroid by competitive inhibition. Used for hyperthyroidism

Front 1236

MOA of metyrapone test

Back 1236

metyrapone prevents conversion of 11-deoxycortisol to cortisol causing decrease negative feedback loop leading to increase in ACTH in patients with an intact HPA.

Front 1237

What is glucokinase used for?

Back 1237

Insulin receptor in pancreatic beta cells

Front 1238

What GLUT responds most to insulin and in which tissue is it found?

Back 1238

GLUT-4 found in muscles and adipose tissue

Front 1239

Thyroid peroxidase is responsible for what enzymatic reaction?

Back 1239

Oxidation of iodide to iodine

Iodination of thyroglobulin tyrosine

Iodotyrosine coupling of T3 and T4

Front 1240

Which insulins are good for post-prandial? (3)

Back 1240

Lispro

Aspart

Glulisine

Front 1241

Which insulins are good for daily maintenance, once a day? (2)

Back 1241

Glargine

Detemir

Front 1242

Which drug can treat benign prostate hypertrophy as well as male pattern baldness and what is the MOA?

Back 1242

Finasteride - 5a-reductase inhibitor

Front 1243

Neurophysin is an important carrier for what two hormones?

Back 1243

ADH and Oxytocin

Front 1244

Which hypothalamic hormone is inhibited by constant stimulation via dopamine?

Back 1244

Prolactin

Front 1245

MOA of sulfonylureas

Back 1245

Insulin secretagogue

Front 1246

MOA of meglitnides

Back 1246

Insulin secretagogue

Front 1247

Pt is 14 years old and shows no sign of masculinity, he also can't smell. What is the syndrome? what is the defect?

Back 1247

Kallmann syndrome - absence of GnRH secretory neurons

Front 1248

What hormone is the negative feedback for LH? FSH?

Back 1248

LH = testosterone

FSH = Inhibin B

Front 1249

What hormone is the negative feedback for GnRH?

Back 1249

Testosterone

Front 1250

MOA of methimazole

Back 1250

Inhibit thyroid peroxidase centrally does not act peripherally

Front 1251

Name two thionamide drugs and what is a potential complication?

Back 1251

PTU and Methimazole

Agranulocytosis

Front 1252

Which class of heart drugs should not be used with diabetes?

Back 1252

Beta blockers because they mask the adrenergic symptoms of hypoglycemia.

Front 1253

Estrogen does what to thyroid hormone levels and why?

Back 1253

Estrogen increases thyro binding globulin. Which increases the total amount of BOUNDED T4 and T3. This will increase the pool (bound + free) but the free amount will remain the same.

Front 1254

First thing that comes to mind with cryptococcus?

Back 1254

Pigeons

Front 1255

Chagas disease can cause what?

Back 1255

Achalasia

Front 1256

Eosinophils in urine, what is the dx?

Back 1256

acute interstitial nephritis

Front 1257

Neural crest forms what?

Back 1257

PNS

Front 1258

Neural tube forms what?

Back 1258

CNS

Front 1259

Hollow lumen of neural tube forms what?

Back 1259

Ventricles

Front 1260

Low folate levels prior to conception is associated with what?

Back 1260

Neural tube defects

Front 1261

Frog-like appearance of the fetus is associated with?

Back 1261

Anencephaly

Front 1262

Absence of skull and brain is called?

Back 1262

Anencephaly

Front 1263

Maternal polyhydraminos is assocaited with what neural tube defect?

Back 1263

Anencephaly

Front 1264

Failure of posterior vertebral arch to close

Back 1264

Spina bifida

Front 1265

What is spina bifida occulta

Back 1265

Dimple or patch of hair overlying vertebral defect

Front 1266

Congenital stenosis of the channel that drains CSF from the 3rd and 4th ventricles

Back 1266

Cerebral aqueduct stenosis

Front 1267

How does CSF drain starting with lateral ventricle

Back 1267

Lateral

Foramen of Monro

3rd

Cerebral aqueduct

4th

Luschka

subarachnoid space

Front 1268

Congenital failure of the cerebellar vermis to develop

Back 1268

Dandy-Walker Malformation

Front 1269

This presents as a massively dilated 4th ventricle with an absent cerebellum

Back 1269

Dandy-Walker Malformation

Front 1270

Protrusion of meninges is called?

Back 1270

Menigocele

Front 1271

Protrusion of meninges and spinal cord is called?

Back 1271

Meningomyocele

Front 1272

Spina bifida presents with cystic protrusion of the underlying tissue through the vetebral defect, what two cystic protrusions can there be?

Back 1272

Meningocele - protrusion of meninges

Meningomyelocye - protrusion of meningees and spinal cord

Front 1273

Congenital extension of cerebellar tonsils through foramen magnum

Back 1273

Arnold-Chiari Malformation

Front 1274

Hydrocephalus can occur with what two neural tube defects?

Back 1274

Cerebral aqueduct stenosis

Arnold-Chiari Malformation

Front 1275

Cystic degeneration of the spinal cord

Back 1275

Syringomyelia

Front 1276

Syringomyelia may arise with what malformation?

Back 1276

Arnold-Chiari malformation

Front 1277

This presents as loss of pain and temperature sensation in the upper extremities

Back 1277

Syringomyelia

Front 1278

Syringomyelia is due to involvement of what portion of the spinal cord?

Back 1278

Anterior white commisure

Front 1279

Syringomyelia may lead to what syndrome if the lateral horn of the hypothalamospinal tract is involved?

Back 1279

Horner

ptosis

miosis

anhidrosis

Front 1280

Damage to the anterior motor horn due to poliovirus infection

Back 1280

Poliomyelitis

Front 1281

Inherited degeneration of anterior motor horn

Back 1281

Werdnig-Hoffman disease

Front 1282

Werdnig-Hoffman disease has what inheritance pattern?

Back 1282

Autosomal recessive

Front 1283

Presents as floppy baby; death occurs within a few years after birth. Congenital disease.

Back 1283

Werdnig-Hoffman Disease

Front 1284

Lowor motor neurons is controlled by what part of the spinal cord?

Back 1284

Anterior motor horn

Front 1285

Upper motor neurons is controlled by what part of the spinal cord?

Back 1285

Lateral corticospinal tract

Front 1286

Spastic paralysis with hyperreflexia, increased muscle tone, and positive Babinski sign is LMN or UMN disorder?

Back 1286

UMN

Front 1287

Flaccid paralysis with muscle atrophy, fasiculations, weakness and decreased muscle tone, and negative babinski sign is LMN or UMN disorder?

Back 1287

LMN

Front 1288

What distinguished ALS from syringomyelia?

Back 1288

ALS does not have sensory impairment

Front 1289

Familial ALS is associated with a mutation in what?

Back 1289

Zinc-Copper superoxide dismutase

Front 1290

Degenerative disorder of cerebellum and spinal cord tracts

Back 1290

Friederich Ataxia

Front 1291

Inheritance pattern of Friederich Ataxia

Back 1291

Autosomal Recessive

Front 1292

Unstable trinucleotide repeate (GAA) in frataxin gene describes what disorder?

Back 1292

Friedereich ataxia

Front 1293

Which spinal cord lesion is associated with hypertrophic cardiomyopathy?

Back 1293

Friederich ataxia

Front 1294

Meningitis is inflammation of what?

Back 1294

Leptomeninges

Front 1295

Leptomeninges is composed of what?

Back 1295

Pia and arachnoid, NOT DURA

Front 1296

3 most common organism to cause meningitis in neonates

Back 1296

Group B Strept

E. Coli

Listeria Monocytogenes

Front 1297

most common organisms to cause meningitis in children and teenagers

Back 1297

N Meningitidis

Front 1298

most common organisms to cause meningitis in adults and elderly

Back 1298

Strep pneumo

Front 1299

most common organism to cause meningitis in nonvaccinated infants

Back 1299

H flu

Front 1300

Most common organism to cause meningitis in immunocompromised?

Back 1300

Fungi

Front 1301

Most common viral cause of meningitis?

Back 1301

Coxsackievirus

Front 1302

Where are lumbar punctures done? why?

Back 1302

L4-L5 , spinal cord ends at L2 but the subarchnoid space and cauda equina ends at S2

Front 1303

With a lumber puncture what are you piercing and where do you stop at?

Back 1303

Skin, ligament, epidural space, dura, arachnoid, DO NOT PIERCE PIA

Front 1304

LP with neutrophils with low glucose suggest what cause of meningitis?

Back 1304

Bacterial

Front 1305

LP with lymphocytes with normal CSF glucose suggest what cause of meningitis?

Back 1305

Viral

Front 1306

LP with lymphocytes with low CSF glucose suggests what cause of meningitis?

Back 1306

Fungal

Front 1307

Complications with meningitis is usually seen with what type of meningitis?

Back 1307

Bacterial

Front 1308

In moderate global cerebral ischemia what are the highly vulnerable regions?

Back 1308

Pyramidal neurons of cerebral cortex - layers 3,5,6 (laminar necrosis)

Pyramidal neurons of hippocampus

Purkinje layer of cerebellum

Front 1309

Ischemia of pyramidal neurons of cerebral cortex damages what layers and leads to what type of necrosis?

Back 1309

Layers 3,5,6, laminar necrosis

Front 1310

This type of stroke is due to rupture of an athersclerotic plaque

Back 1310

Thrombotic stroke

Front 1311

Thrombotic strokes usually have what kind of infarct?

Back 1311

Pale infarct

Front 1312

This type of stroke is due to thromboemboli

Back 1312

Emoblic stroke

Front 1313

Embolic stroke usually have what kind of infarct?

Back 1313

Hemorrhagic Infarct

Front 1314

This stroke occurs secondarily to hyaline arteriosclerosis, a complication of HTN.

Back 1314

Lacunar stroke

Front 1315

Which vessels are most commonly involved in lacunar strokes?

Back 1315

lenticulostriae vessels

Front 1316

Ischemic strokes result in what kind of necrosis?

Back 1316

Liquefactive

Front 1317

Stages of Ischemic stroke , 1 day, 1 week, 1 month

Back 1317

Red neurons | Neutro then Mircoglial | Granulation Tissue | Cyst (gliosis)

Front 1318

What is the most common site for intracerebral hemorrhage?

Back 1318

Basal ganglia

Front 1319

Charcot-Bouchard microaneurysms are associated with what?

Back 1319

Intracerebral hemorrhage

Front 1320

Pt presents with worst headache of my life, what is the dx?

Back 1320

Subarachnoid hemorrhage

Front 1321

Bleeding on the bottom of the brain, what is the dx?

Back 1321

Subarachnoid hemorrhage

Front 1322

Lumbar puncture shows xanthochromia (yellow hue to bilirubin breakdown) what is the dx?

Back 1322

Subarachnoid hemorrhage

Front 1323

Most common cause of a subarachnoid hemmorrhage?

Back 1323

Berry aneurysm

Front 1324

What is the most frequent location of berry aneurysm?

Back 1324

anterior circle of willis (branch points of anterior communicating artery)

Front 1325

What are berry aneurysms associated with?

Back 1325

Marfan and ADPKD

Front 1326

Why is it easy for berry aneurysms to rupture?

Back 1326

they lack a media layer

Front 1327

Collection of blood between the dura and the skull

Back 1327

Epidural Hematoma

Front 1328

Epidural hematoma are usually due to what?

Back 1328

Fracture of temporal bone with rupture of middle meningeal artery

Front 1329

This head trauma has lucid intervals that may precede neurologic signs "talk and die"

Back 1329

Epidural hematoma

Front 1330

Collection of blood underneath the dura; blood covers the surface of the brain.

Back 1330

Subdural hematoma

Front 1331

Subdural hematomas are usually due to what?

Back 1331

tearing of bridging vein between dura and arachnoid

Front 1332

Epidural and subdural hematoma has what lethal complication?

Back 1332

Herniation

Front 1333

Displacement of brain tissue due to mass effect or increased intracranial pressure

Back 1333

Herniation

Front 1334

Name the herniation and the complication that arises from it: displacement of cerebellar tonsils into the foramen magnum

Back 1334

Tonsillar herniation: compression of brain stem leads to cardiopulmonary arrest

Front 1335

Name the herniation and the complication that arises from it: Displacement of cingulate gyrus under the falx cerebri

Back 1335

Subfalcine herniation: compression of anterior cerebral artery leads to infarction

Front 1336

Name the herniation and the complication that arises from it: displacement of temporal lobe uncus under the tentorium cerebelli

Back 1336

Uncal Herniation

Compression of cranial nerve III (oculomotor), eye moves down and out and a dilate pupil

Compression of posterior cerebral artery leads to infarction of occipital lobe (contralateral homonymous hemianopsia)

Rupture of the paramedian artery leads to Duret (brainstem) hemorrhage

Front 1337

Deficiency of arylsulfatase leads to what disorder?

Back 1337

Metachromatic leukodystrophy

Front 1338

Metachromatic leukodystrophy has a deficiency in what? and what does this lead to?

Back 1338

Arylsulfatase - myelin cannot be degraded; accumulates in lysosomes

Front 1339

Deficiency of galactocerbroside B-galactosidase leads to what disorder?

Back 1339

Krabbe disease - a form of leukodystrophy

Front 1340

Krabbe disease has a deficiency in what? and what does this lead to?

Back 1340

galactocerbroside B-galactosidase - galactocerebroside accumulates in macrophages

Front 1341

Impaired addition of coenzyme A to long-chain fatty acids leads to what disorder?

Back 1341

Adrenoleukodystrophy

Front 1342

Adrenoleukodystrophy has what deficiency? what does this lead to?

Back 1342

Impaired addition of coenzyme A to long-chain fatty acids - fatty acids accumulate damaging adrenal gland and white matter

Front 1343

Autoimmune destruction of CNS myelin and oligodendrocytes

Back 1343

Multiple Sclerosis

Front 1344

Multiple Sclerosis is associated with which HLA?

Back 1344

HLA-DR2

Front 1345

What disease is more commonly seen in regions away from the equator?

Back 1345

Multiple sclerosis

Front 1346

What is internuclear ophthalmoplegia and what is it associated it with?

Back 1346

Multiple sclerosis - when you try to move the eyes to one side only one eye moves because of a defect in the medial longitudinal fasciculus

Front 1347

LP of multiple sclerosis would show what?

Back 1347

Oligoclonal IgG bands

Front 1348

Oligoclonal IgG bands are found in what CNS disorder?

Back 1348

Multiple sclerosis

Front 1349

How do you slow the progression of multiple sclerosis?

Back 1349

Interferon beta

Front 1350

Progressive, debilitating encephalitis leading to death

Back 1350

Subacute sclerosing panencephalitits

Front 1351

What is subacute sclerosing panencephatlitis due to?

Back 1351

persistent infection of the brain by measles virus

Front 1352

Persistent infection of the brain by measles virus leads to what?

Back 1352

Subacute sclerosing panencephalitis

Front 1353

JC virus infection of oligodendrocytes leads to what?

Back 1353

Progressive multifocal leukoencephalopathy

Front 1354

Progressive multifocal leukoencephalopathy is due to what?

Back 1354

JC virus infection of oligodendrocytes

Front 1355

Focal demyelination of pons

Back 1355

Central Pontine Myelinolysis

Front 1356

Rapid IV correction of hyponatremia can cause what?

Back 1356

Central pontine myelinolysis

Front 1357

What CNS disorder presents with acute paralysis giving a "locked in" syndrome?

Back 1357

Central Pontine Myelinolysis

Front 1358

Degeneration of brainstem and basal ganglia leads to what kind of disorders?

Back 1358

Movement disorders

Front 1359

E4 apolipoprotein E associated with increased or decreased risk of alzheimer

Back 1359

Increased - because more ABeta-protein is being made

Front 1360

E2 apolipoprotein E associated with increased or decreased risk of alzheimer?

Back 1360

Decreased

Front 1361

Familial cases of early alzheimers associated with what?

Back 1361

Presenelin 1

Front 1362

Why is there early onset alzheimers in down syndrome patietns?

Back 1362

Amyloid precurrsor protein (APP) is on chromosome 21. Increased APP can increase amount converted into Abeta amyloid which will cause down syndrome.

Front 1363

Hydrocephalus ex vacuo - what is it and what is it associated with?

Back 1363

Dilated ventricles due to atrophy of brain, associated with alzheimer

Front 1364

AB amyloid depositing around blood vessels in the brain: what is it called and what is the consequence?

Back 1364

Cerebral amyloid angiopathy - increased likelihood of rupture into brain.

Front 1365

What are neurofibrillary tangles composed of? what is it associated with?

Back 1365

Composed of hyperphosphorylated Tau, associated with Alzheimer Disease

Front 1366

What type of protein is Tau?

Back 1366

Microtubule associated protein - hyperphosphoyrlated Tau assocaited with Alzheimer

Front 1367

Multifocal infarction and injury of the brain due to HTN, atherosclerosis, or vasculitis

Back 1367

Vascular dementia

Front 1368

Degenerative disease of FRONTAL and TEMPORAL cortex; spares parietal occipital lobes

Back 1368

Pick Disease

Front 1369

Pick Disease primarily affects which portion of the brain?

Back 1369

Frontal and Temporal, spares parietal and occiptal lobes

Front 1370

Round aggregates of tau protein is associated with what brain disease?

Back 1370

Pick disease

Alzheimer has neurofibrilary tangles assocaited with tau

Front 1371

Parkinson disease has a degenerative loss of what type of neurons where?

Back 1371

Dopaminergic neurons - substantia nigra pars compacta of the basal ganglia

Front 1372

Contamination of illicit drugs with MPTP is associated with what disorder?

Back 1372

Parkinson Disease

Front 1373

What are Lewy bodies associated with and what are they?

Back 1373

Parkinson's disease - round eosinophilic inclusions of alpha-synuclein

Front 1374

Parkinson with early dementia is called what? how do you distinguish them?

Back 1374

Lewy body dementia - the lewy bodies are found in the cortex instead

Front 1375

Degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia.

Back 1375

Huntington Disease

Front 1376

Inheritance pattern for Huntington

Back 1376

Autosomal disorder

Front 1377

Pathophysiology of chorea in Huntington disease

Back 1377

Degeneration of GABAergic neurons leads to loss of inhibition from the caudate nucleus of the basal ganglia to the cortex. This results in random movement.

Front 1378

What is the expanded trinucleotide repeat in the huntingtin gene (what is the actual code)?

Back 1378

CAG

Front 1379

Further expansion of the trinucleotide repeat in huntington disaese happens where/when?

Back 1379

Spermatogenesis

Front 1380

Increase CSF resulting in dilated vdentricles

Back 1380

Normal Pressure Hydrocephalus

Front 1381

What is the triad for normal pressure hydrocephalus?

Back 1381

Wet, Wacky, Wobbly

Urinary incontinence

Dementia

Gait instability

Front 1382

What are the two treatments for normal pressure hydrocephalus

Back 1382

Lumbar puncture, ventriculuperitoneal shunting.

Front 1383

Degenerative disease due to prion protein

Back 1383

Spongiform Encephalopathy

Front 1384

Pathophysiology of Spongiform encephalopathy

Back 1384

Prion proteins (PrPc) in the alpha helical form being converted to Prion proteins in the Beta pleated (PrPsc).

Front 1385

Creutzfeldt-Jakob disease presents with what kind of dementia?

Back 1385

Rapidly progressive dementia

Front 1386

Familial fatal insomnia is what type of CNS disease?

Back 1386

Spongiform encephalopathy

Front 1387

Metastatic brain cancer usually come from where?

Back 1387

Lung, Breast, Kidney

Front 1388

Brain tumors in adults usually arise where relative to tentorium?

Back 1388

Supratentorial - adults

Infratentorial - kids

Front 1389

Malignant, high-grade tumor of astrocytes

Back 1389

Gliobastoma Multiforme - Normally found in adults, most common malignant CNS tumor in adults

Front 1390

What is the most common malignant CNS tumor in adults

Back 1390

Glioblastoma Multiforme

Front 1391

Which CNS tumor crosses the corpus callosum?

Back 1391

Glioblastoma Multiforme

Front 1392

Which CNS tumor is GFAP positive? (2)

Back 1392

Glioblastoma Multiforme and Pilocytic Astrocytoma

Front 1393

Benign tumor of arachnoid cells

Back 1393

Meningioma - most common benign CNS tumor in adults

Front 1394

Meningioma is most common in what poppulation?

Back 1394

Adult Females

Front 1395

Which CNS tumor has a whorled pattern on histology

Back 1395

Meningioma

Front 1396

Which CNS tumor has psammoma bodies

Back 1396

Meningioma

Front 1397

Benign tumor of Schwann cells

Back 1397

Schwannoma

Front 1398

Bilateral schwannomas of cranial nerve VIII is seen in what disorder?

Back 1398

Neurofibromatosis 2

Front 1399

Which CNS tumor is S-100 positive?

Back 1399

Schwannoma

Front 1400

Malignant tumor of oligodendrocytes

Back 1400

Oligodendroglioma

Front 1401

Calcified tumor in white matter of the CNS

Back 1401

Oligodendroglioma

Front 1402

Which CNS tumor has a fried egg appearance on biopsy?

Back 1402

Oligodendroglioma

Front 1403

Which CNS tumor involves the frontal lobe that may present with seizures?

Back 1403

Oligodendroglioma

Front 1404

Benign tumor of astrocytes

Back 1404

Pilocytic astrocytoma

Front 1405

Most common benign brain tumor in children

Back 1405

Pilocystic astrocytoma

Front 1406

This CNS tumor reveals a cystic lesion with a mural nodule

Back 1406

Pilocystic astrocytoma

Front 1407

Biopsy of this tumor shows Rosenthal fibers, what is the tumor and what are rosenthal fibers?

Back 1407

Pilocystic astrocytoma - rosenthal fibers are thick eosinophilic granular bodies

Front 1408

Malignant tumor derived from granular cells of cerebellum

Back 1408

Medulloblastoma

Front 1409

What are drop metastases and what is it associated with? (CNS)

Back 1409

Metastasis to cauda equina - Medulloblastoma

Front 1410

Malignant tumor of ependymal cells

Back 1410

Ependymoma

Front 1411

Which CNS tumor most commonly arises in 4th ventricle, may present with hydrocephalus.

Back 1411

Ependymoma

Front 1412

Which CNS tumor can present with bitemporal hemianopsia?

Back 1412

Craniopharyngioma

Front 1413

What is a Brenner tumor?

Back 1413

Surface epithelial tumor of the ovary that contains urothelium

Front 1414

What prostaglandin analogue treats glaucoma?

Back 1414

Latanaprost

Front 1415

MOA of Latanaprost and what does it do?

Back 1415

Prostaglandin analogue that treats glaucoma

Front 1416

What are streak ovaries associated with?

Back 1416

Turners syndrome

Front 1417

Marcophages express this surface receptor

Back 1417

CD 14

Front 1418

CNS tumors that stain with synaptophysin generally originate from what cell?

Back 1418

Neurons

Front 1419

What amino acids must be restricted in Maple Syrup Urine Disease?

Back 1419

leucine, isoleucine, valine

Front 1420

Name this immature defense: Tantrums

Back 1420

Acting out - expressing unacceptable feelings and though through actions

Front 1421

Name this immature defense: Extreme forms can result in dissociative identity disorders

Back 1421

Dissociation - Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotioanl stress

Front 1422

Name this immature defense: a common reaction to newly diagnosed AIDS and cancer patients

Back 1422

Denial - Avoiding the awareness of some painful reality

Front 1423

Name this immature defense: mother yells at her child because her husband is yelling at her

Back 1423

Displacement - transferring avoided ideas and feelings to some neutral person or object

Front 1424

Name this immature defense: Men fixating on sports games

Back 1424

Fixation - partially remaining at a more childish level of development

Front 1425

Name this immature defense: Abused child identifies with an abuser

Back 1425

Identification - Modeling behavior after another person who is more powerful

Front 1426

Name this immature defense: Describing murder in graphic details with no emotional response

Back 1426

Isolation (of affect) - separating feeling from ideas and events

Front 1427

Name this immature defense: A man who wants another woman thinks his wife is cheating on him

Back 1427

Projection - attributing an unacceptable internal impulse to an external source

Front 1428

Name this immature defense: After getting fired, claiming that the job was not important anyway.

Back 1428

Rationalization - proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame

Front 1429

Name this immature defense: A patient with lustful thoughts enters a monastery.

Back 1429

Reaction formation - replacing a warded-off idea or feeling by an emphasis on its opposite

Front 1430

Name this immature defense: Seen in children under stress such as illness, punishment, or birth of a new sibling (bedwetting in a previously toilet-trained child when hospitilized)

Back 1430

Regression - turning back the maturational clock

Front 1431

Name this immature defense: Not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious

Back 1431

Repression - involuntary withholding an idea or feeling from conscious awareness

Front 1432

Name this immature defense: A patient says that all nurses are cold and insensitive but that the doctors are warm and friendly.

Back 1432

Splitting - believing that people are either all good or all bad at different times due to intolerance of ambiguity.

Front 1433

Name this mature defense: Mafia boss makes large donation to charity

Back 1433

Altruism

Front 1434

Name this mature defense: Nervous medical student jokes about the boards

Back 1434

Humor

Front 1435

Name this mature defense: Teenager's aggression toward his father is redirected to perform well in sports

Back 1435

Sublimation

Front 1436

Name this mature defense: Choosing to not worry about the big game until it is time to play

Back 1436

Suppression

Front 1437

Achondroplasia is due to what kind of mutation and where? What does this mutation cause?

Back 1437

Activating mutation in FGFR3 - over expression of FGFR3 inhibits growth.

Front 1438

Inheritance pattern for achondroplasia

Back 1438

Autosomal dominant

Front 1439

Autosomal dominant defect in collagen type 1 syntehsis

Back 1439

Osteogeneis Imperfecta

Front 1440

Inherited defect of bone resorption resulting in abnormally thick, heavy bone that fracture easily

Back 1440

Osteopetrosis

Front 1441

Carbonic anhydrase II mutation can lead to what disorder?

Back 1441

Osteopetrosis

Front 1442

Defective mineralization of osteoid due to low levels of vitamin D

Back 1442

Rickets/Osteomalacia

Front 1443

Rachitic rosary - deposoition of osteoid at the constochondral junction is associated with what disease?

Back 1443

Rickets

Front 1444

How do you distinguish osteomalacia from osteoporosis?

Back 1444

Lab values

Osteomalacia has low calcium, phosphate, increased PTH and alkaline phosphatase. In Osteoporosis everything is normal

Front 1445

Most feared complication of Paget Disease of Bone

Back 1445

Osteosarcoma

Front 1446

Which bone disease can cause high-output cardiac failure

Back 1446

paget disease - creation of AV shunts in bone

Front 1447

Most common location for osteomyelitis in the bones for children? adults?

Back 1447

children - metaphysis

adults - epiphysis

Front 1448

Most common bacteria to cause osteomyelitis?

Back 1448

S. aureus

Front 1449

This bone tumor pain resolves with aspirin

Back 1449

Osteoid Osteoma

Front 1450

Benign tumor of osteoblasts surrounded by rim of reactive bone

Back 1450

Osteoid osteoma

Front 1451

What differentiates osteoblastoma from osteoid osteoma?

Back 1451

Greater than 2cm and does not respond to aspirin

Front 1452

Most common benign tumor of bone

Back 1452

Osteochhondroma

Front 1453

Malignant proliferation of osteoblasts

Back 1453

Osteosarcoma

Front 1454

Risk factors for osteosarcoma (3)

Back 1454

Familial retinoblastoma

Paget disease

Radiation exposure

Front 1455

Which portion of bone do osteosarcomas normally arise?

Back 1455

Metaphysis of long bones

Front 1456

Which bone tumor arises in the epiphysis?

Back 1456

Giant Cell Tumor

Front 1457

Which bone tumor is comprised of multnucleated giant cells and stromal cells

Back 1457

Giant Cell tumor

Front 1458

Soap bubble appearance on X-ray suggests what bone tumor?

Back 1458

Giant Cell Tumor

Front 1459

Malignant proliferation of poorly-differentiated cell derived from neuroectoderm

Back 1459

Ewing Sarcoma

Front 1460

This bone tumor usually arises in the medulla of small bones of the hands and feet

Back 1460

Chondroma

Front 1461

This bone tumor normally arises in medulla of the pelvis or central skeleton

Back 1461

Chondrosarcoma

Front 1462

Ewing sarcoma is derived from what germ cell?

Back 1462

Neuroectoderm

Front 1463

What is the translocation for ewing sarcoma?

Back 1463

11;22

Front 1464

Which bone tumor has onion-skinning on x-ray?

Back 1464

Ewing sarcoma

Front 1465

Joint surfaces are lined by hyalin cartilage, what type of collagen is this?

Back 1465

Type II

Front 1466

This arthritis presents with stiffness in the morning that gets worst during the day

Back 1466

Osteoarthritis

Front 1467

This arthritis affects DIP and PIP (distal and proximal interphalagnes)

Back 1467

Osteoarthritis

Front 1468

What are Herbeden and Bouchard nodes?

Back 1468

Herberden nodes = osteophytes on DIP

Bouchard nodes = osteophytes on PIP

Found in osteoarthritis

Front 1469

Rheumatoid arthritis is associated with which HLA?

Back 1469

HLA-DR4

Front 1470

What is the hallmark of rheumatoid arhtritis?

Back 1470

Synovitis leading to formation of pannus (inflamed granulation tissue)

Front 1471

This arthritis presents with morning stiffness that improves with activity

Back 1471

Rheumatoid arthritis

Front 1472

This arthritis only involves PIP leading to swan-neck deformity

Back 1472

Rheumatoid arthritis

Front 1473

What is swelling of bursa behind the knee associated with?

Back 1473

Rheumatoid arthritis - this is called a baker cyst

Front 1474

This pathology presents with IgM autoantibody against Fc portion of IgG

Back 1474

Rheumatoid Arthritis - Rheumatoid Factor

Front 1475

Rheumatoid arthritis presents with this immulogical finding

Back 1475

Rheumatoid factor - IgM autoantibody against Fc portion of IgG

Front 1476

What are the two complications that can arise from Rheumatoid arthritis?

Back 1476

anemia of chronic disease - chronic inflammation increases hepcidin

secondary amyloidosis - SAA gets made and converted to AA leading to amyloidosis

Front 1477

Seronegative spondyloarthritis is characterized by what 3 things?

Back 1477

Lack of rheumatoid factor

Axial involvement - spondylo

HLA-B27 assocaition

Front 1478

What is the triad for Reiter syndrome

Back 1478

Can't see, can't pee, can't climb a tree

-arthritis

-urethritis

-conjunctivits

Front 1479

Involves axial and peripheral joints; DIP joints of hands and feet are most commonly affected, leading to sausage finger or toes

Back 1479

Psoriatic arthritis

Front 1480

Arthritis due to an infectious agent, usually bacterial

Back 1480

Infectious arthritis

Front 1481

Most common cause for infectious arthritis (organism)

Back 1481

N gonorrhoeae

Front 1482

Deposition of monosodium urate crystals in tissues, especially joints

Back 1482

Gout

Front 1483

3 causes for secondary gout

Back 1483

Leukemia and myeloproliferative disorders

Lesch-Nyhan syndrome

Renal insufficiency

Front 1484

How does leukemia and myeloproliferative disroders cause gout?

Back 1484

Increased cell turnover leads to hyperuricemia

Front 1485

How does Lesch-Nyhan syndrome cause gout?

Back 1485

Deficiency in hypoxanthine-guanine phosphoribosyltransferase (HGPRT) leads to increased xanthine and uric acid since hypoxanthine and guanine can no longer be salvaged.

Front 1486

3 parts of Lesch-Nyhan syndrome

Back 1486

Self-mutilation

Gout

Mental retardation

Front 1487

How does renal insufficiency cause gout?

Back 1487

Kidneys can no longer excrete uric acid

Front 1488

What is podagra?

Back 1488

Painful arthritis of the great toe caused by acute gout

Front 1489

What are the two things that can cause acute gout?

Back 1489

Alcohol or consumption of meat

Front 1490

What are tophi? and what are they assocaited with?

Back 1490

Uric acid crystals in soft tissue or joints - Chronic Gout

Front 1491

Chronic gout can lead to what two things?

Back 1491

Tophi - uric acid crystals in soft tissue or joints

Renal failure - urate cyrstals deposit in kidney tubules

Front 1492

This pathology presents with synovial fluid showing needle shaped crystals with negative birefringence under polarized light

Back 1492

Gout

Front 1493

This pathology presents with synovial fluid showing rhomboid-shaped crystals with weakly positive biirefrigence under polarized light

Back 1493

Pseudogout

Front 1494

Pseudogout is due to deposition of what?

Back 1494

Calcium pyrophosphate

Front 1495

Inflammatory disorder of the skin and skeletal muscle

Back 1495

Dermatomyositis

Front 1496

It a pt presents with dermatomyositis what should you be worried about?

Back 1496

Underlying carcinoma especially gastric carcinoma

Front 1497

What is the hallmark of dermatomyositis

Back 1497

Bilateral proximal muscle weakness

Front 1498

What two disease can have malar rash?

Back 1498

SLE and Dermatomyositis

Front 1499

When muscle is damaged what is elevated in blood?

Back 1499

Creatine kinase

Front 1500

What diseases have a positive ANA? (2)

Back 1500

Lupus and Dermatomyositis

Front 1501

Anti-Jo-1 antibody is indicative of what disease?

Back 1501

Dermatomyositis

Front 1502

Perymysial inflammation is found in what?

Back 1502

Dermatomyositis - perymysial (close to the skin)

Polymyositis = endomysial

Front 1503

Endomysial inflammation is found in what?

Back 1503

Polymyositis = endomysial

Dermatomyositis = perimysial

Front 1504

Inflammatory disorder of skeletal muscle without skin involement

Back 1504

Polymyositis

Front 1505

Degenerative disorder characterized by muscle wasting and replacement of skeletal muscle with adipose tissue

Back 1505

X-Linked Muscular dystrophy

Front 1506

In X-linked muscular dystrophy what is the skeletal muscle replaced with?

Back 1506

Adipose tissue

Front 1507

Deletions in what gene is responsible for Duchenne muscular dystrophy

Back 1507

Dystrophin

Front 1508

What is the difference between x-linked muscular dystrophy and Duchenne?

Back 1508

X-linked = mutated dystrophin

Duchenne = deletion of dystrophin

Front 1509

What causes becker muscular dystrophy?

Back 1509

mutation of dystrophin

Front 1510

Calf pseudohypertrophy is characteristic finding of what disease?

Back 1510

Muscular dystrophy

Front 1511

Autoantibodies against the postsynaptic acetylcholine receptor of NMJ

Back 1511

Myasthenia gravis

Front 1512

What is the pathophysiology of myasthenia gravis

Back 1512

Autoantibodies against the postsynaptic acetylcholine receptor of NMJ

Front 1513

What type of drugs are used for myastehnia gravis?

Back 1513

anticholinesterase agents

Front 1514

This is associated with thymic hyperplasia or thymoma; thymectomy improves symptoms

Back 1514

Myasthenia Gravis

Front 1515

Antibodies against presynaptic calcium channels of the NMJ

Back 1515

Lambert-Eaton syndrome

Front 1516

Myasthenia gravis classically involves what part of the body?

Back 1516

Eyes

Front 1517

Myasthenia gravis clasically involves the eyes, what syndrome spares the eye?

Back 1517

Lambert-Eaton

Front 1518

Lambert-Eaton vs Myasthenia Gravis = which improves with use, which does not?

Back 1518

Myasthenia Gravis = does not

Lambert-Eaton = improves

Front 1519

Most common benign soft tissue tumor in adults

Back 1519

Lipoma

Front 1520

What is the characteristic cell of liposarcoma?

Back 1520

Lipoblast

Front 1521

Most common malignant soft tissue tumor in adults

Back 1521

Liposarcoma

Front 1522

Cardiac rhabdomyoma is associated with what?

Back 1522

Tuberous sclerosis

Front 1523

Most common malignant soft tissue tummor in children?

Back 1523

Rhabdomyosarcoma

Front 1524

What is the classic site for rhabdomyosarcoma in young girls?

Back 1524

Vagina

Front 1525

Atopic dermatitis (Eczema) is what type of hypersensitivity?

Back 1525

Type 1 - associated with asthma and allergic rhinitis

Front 1526

Contact dermatitis is what type of hypersensitivity?

Back 1526

Type 4

Front 1527

What bacteria is responsible for acne vulgaris?

Back 1527

Propinibacterium acnes

Front 1528

What is psoriasis due to?

Back 1528

excessive keratinocyte proliferation

Front 1529

What is acanthosis?

Back 1529

Epidermal hyperplasia

Front 1530

What is auspitz sign and what is it associated with?

Back 1530

Thinning of epidermis above elongated dermal papillae; resulting in bleeding when scale is picked off. Psoriasis

Front 1531

What is lichen planus associated with?

Back 1531

hepatitis C virus infection

Front 1532

Autoimmune destruction of desmosomes between keratinocytes

Back 1532

Pemphigus vulgaris

Front 1533

What is pemphigus vulgaris due to?

Back 1533

IgG antibody against desmoglein

Front 1534

What type of hypersensitivity is pemphigus vulgaris?

Back 1534

Type II

Front 1535

Autoimmune destruction of hemidesmosomes between basal cells and the underlying basement membranes

Back 1535

Bullous pemphigoid

Front 1536

What is bullus pemphigoid due to?

Back 1536

IgG antibody against hemidesmosome components of the basement membrane

Front 1537

Autoimmune deposition of IgA at tips of dermal papillae

Back 1537

Dermatitis Herptiformis

Front 1538

Hypersensitivity reaction characterized by targetoid rash and bullae.

Back 1538

Erythema Multiforme

Front 1539

What is erythema multiforme most commonly associated with?

Back 1539

HSV infection

Front 1540

What is Steven Johnson Syndrome?

Back 1540

Erythema multiforme with oral mucosa/lip involvement and fever

Front 1541

What is the severe form of steven johnson syndrome?

Back 1541

Toxic Epidermal Necrolysis

Front 1542

Most common cause for toxic epidermal necrolysis?

Back 1542

adverse drug reaction

Front 1543

Benign squamous proliferation common tumor in elderly

Back 1543

Seborrheic keratosis

Front 1544

Epidermal hyperplasia with darkening of the skin

Back 1544

Acanthosis Nigricans

Front 1545

What is acanthosis nigricans associated with? (2)

Back 1545

insulin resistance and malignancy

Front 1546

What is the most common cutaneous malignancy?

Back 1546

Basal cell carcinoma

Front 1547

Xeroderma pigmentosum what is the defect?

Back 1547

can not repair DNA damage so pyrimidine dimers persist

Front 1548

What is the most common cancer to arise from immunosuppresive therapy?

Back 1548

Squamous cell carcinoma

Front 1549

What malignancy is associated with arsenic poisoning?

Back 1549

Squamous cell carcinoma

Front 1550

well differentiatned squamous cell carcinoma that develops and rapidly regresses

Back 1550

Keratoacanthoma

Front 1551

Where are melanocytes derived from?

Back 1551

Neural crest

Front 1552

Localized loss of skin pigmentation due to autoimmune destruction of melanocytes

Back 1552

Vitiligo

Front 1553

Albinism is usually due to what?

Back 1553

Enzyme defect (usually tyrosinase) that impairs melanin production

Front 1554

Freckle is due to increased of what?

Back 1554

Increased in melanosomes not melanocytes

Front 1555

Benign neoplasm of melanocytes

Back 1555

Nevus (mole)

Front 1556

Most common mole in children

Back 1556

Junctional nevus

Front 1557

Junctional nevus that grows into the dermis is called?

Back 1557

compound nevus

Front 1558

Most common mole in adults

Back 1558

Intradermal nevus

Front 1559

What is the progression for moles?

Back 1559

Junctional nevus becomes compound becomes intradermal

Front 1560

What are the ABCD of Melanoma?

Back 1560

Assymetry

Border are irregular

Color is not uniform

Diameter > 6mm

Front 1561

What is the most important prognostic factor in melanoma?

Back 1561

Depth of extension (Breslow thickness)

Front 1562

Name the melanoma: radial growth, lentiginous proliferation

Back 1562

Lentigo maligna melanoma

Front 1563

Name the melanoma: early radial growth

Back 1563

Superficial spreading

Front 1564

Name the melanoma: early vertical growth

Back 1564

nodular

Front 1565

Most common type of melanoma

Back 1565

superficial spreading

Front 1566

What is impetigo most often due to? (2 organisms)

Back 1566

S aureus or S pyogenes

Front 1567

What is cellulitis most often due to? (2 organisms)

Back 1567

S aureus or S pyogenes

Front 1568

What is crepitus and what is it associated with?

Back 1568

When you can hear crackling of air underneath the skin, associated with necrotizing fascitis

Front 1569

Sloughing of skin with erythematous rash and fever

Back 1569

Staphylococcal Scalded Skin Syndrome

Front 1570

What bacteria causes Scalded Skin Syndrome? what is the pathophysiology?

Back 1570

Staphylococcal Aureus release exfoliative A and B toxin resulting in epidoermolysis of the stratum granulosum

Front 1571

Difference between toxic epidermal necrolysis and scalded skin syndrome in regard to layers

Back 1571

TEN = dermal-epidermal junction

Scalded Skin Syndrome = Stratum granulosum

Front 1572

Firm, pink, umbilicated papules due to poxvirus

Back 1572

Molluscum Contagiosum

Front 1573

Name the melanoma: arises on palm and or soles, often in dark-skinned individuals

Back 1573

Acral Lentigerous

Front 1574

Exposure to sunlight allows conversion of what to what in Vitamin D metabolism?

Back 1574

7-dehydrocholesterol to cholecalciferol

Front 1575

2 years of mild depression is called what?

Back 1575

Dysthymic disorder

Front 1576

Ehlers-Danlos syndrome is caused by a defect in what?

Back 1576

Collagen formation

Front 1577

Marfan syndrome is caused by a defect in what?

Back 1577

Fibrillin 1

Front 1578

Congenital hypothyroidism presents with what 4 features?

Back 1578

Umbilical hernia

Macroglossia

Hypotonia

Jaundice

Front 1579

What is caudal regression syndrome associated with? Poorly developed lumbar spine and sacrum at birth.

Back 1579

Maternal diabetes

Front 1580

Young football player suddenly dies from splenic rupture what is the dx?

Back 1580

Infectious mononucleosis caused by Epstein Barr Virus

Front 1581

Bamboo spine associated with what?

Back 1581

Ankylosing spondylitis

Front 1582

CD4+ vs CD8+ for Polymyositis and dermatomyositis

Back 1582

Dermatomyositis = CD4+

Polymyositis = CD 8+

Front 1583

Crest is associated with what antibody?

Back 1583

Anti-centromere

Front 1584

What is CREST?

Back 1584

Calcinosis

Raynaud Phenomenon

Esophagueal dysmotility

Sclerodactyly

Teangiectasia

Front 1585

What does leukotriene B4 do?

Back 1585

Neutrophil chemotactic

Front 1586

What does PGI2 do? (2)

Back 1586

inhibits platelet aggregation and promotes vasodilation

Front 1587

MOA of celecoxib

Back 1587

Cox-2 ihibitor

Front 1588

MOA of kettorolac

Back 1588

NSAID

Front 1589

MOA of Diclofenac

Back 1589

NSAID

Front 1590

MOA of allopurinol and what is it used for?

Back 1590

Inhibits xanthine oxidase - Gout

Front 1591

MOA of febuxostat and what is it used for?

Back 1591

Inhibits xanthine oxidase - gout

Front 1592

MOA of colchicine and what is it used for?

Back 1592

Stabilizes tubulin which inhibits microtubule polymeration impairing leukocyte chemotaxis and degranulation - gout

Front 1593

MOA of etanercept and what is it used for?

Back 1593

Etanercept is a TNF decoy RECEPTOR - used for rheumatoid arthritis, psoriasis

Front 1594

MOA of adalimunmab

Back 1594

Anti-TNFa antibody - IBD, rheumatoid, ankylosing spondylitits, psoriasis

Front 1595

MOA of Probenecid and what is it used for?

Back 1595

Inhibits reabsorption of uric acid in PCT

Front 1596

Pts with retinoblastoma have increased risk of what other kind of cancer?

Back 1596

Osteosarcoma

Front 1597

Influenza vaccine works how?

Back 1597

Antibodies against hemagluttinin

Front 1598

Which vein is used in CABG?

Back 1598

Saphenous vein

Front 1599

Progressive onset of CHF over many years due to chronic ischemic myocardial damage

Back 1599

Chronic Ischemic Heart Disease

Front 1600

Death from cardiac causes within 1 hr usually due to lethal arryhtmia

Back 1600

Sudden Cardiac Death

Front 1601

How does sudden cardiac death cause death?

Back 1601

Lethal arrhthmia

Front 1602

Which part of the HPA do long term corticosteroids suppress?

Back 1602

The whole thing. ACTH, CRH, Cortisol are all decreased after long term use.

Front 1603

In Nieman-Pick disease what enzyme is deficient?

Back 1603

Sphingomyelinase

Front 1604

How do you tell the difference between Vit B12 and Folate deficiency?

Back 1604

Deficiency Vit B12 causes neurologic problems.

Front 1605

Aldose reductase turns glucose into sorbitol, what is the next enzyme and the next sugar?

Back 1605

Sorbitol dehydrogenase into Fructose

Front 1606

Low alpha-fetoprotein in utero is associated with what?

Back 1606

Trisomy 21

Front 1607

Increased alpha-fetoprotein in utero is associated with what?

Back 1607

multiple gestation

neural tube defects

abdominal wall defects

Front 1608

What is cyanocobalamin?

Back 1608

Vit B12

Front 1609

Thrombophlebitis at various sites may indicate what?

Back 1609

Visceral malignancy

Front 1610

Anorexia has what effect on hormones?

Back 1610

Loss of pulsatile release of GnRH

Front 1611

Where are serotenergic neurons found in the brain?

Back 1611

Raphe nuclei

Front 1612

What is used as a chemoprophylaxis for N. meningitidis infections?

Back 1612

Rifampin

Front 1613

Overuse of vitamin A can cause what?

Back 1613

Hepatosplenamegaly

Intracranial HTN

Skin changes

Front 1614

What is the antibiotic of choice for rickettsial diseases?

Back 1614

Doxycycline

Front 1615

What does PT stand for and what pathway is it?

Back 1615

Protrombin Time - Extrinsic

Front 1616

What does aPTT stand for and which pathway is it?

Back 1616

activated partial thromboplastin time - Intrinsic

Front 1617

Eukaryotes and prokaryotes have similar replication times but eukaryotic DNA is much larger. How do eukaryotes speed up DNA synthesis?

Back 1617

Multiple origins of replication

Front 1618

What is the most common cause for E. Coli bactermeia?

Back 1618

UTI

Front 1619

What is the DOC for absence seizures and associated tonic-clonic seizures?

Back 1619

Valproate

Front 1620

What can treat absence seizures but not tonic-clonic seizures?

Back 1620

Ethosuximide

Front 1621

Isoniazid has what toxicity?

Back 1621

Hepatic toxicity

Front 1622

Pt presents with jugular vein distension, pulsus paradoxus, and tachycardia. What's the dx?

Back 1622

Cardiac tamponade

Front 1623

Supine dyspnea that is relieved by sitting up is specific for what pathology?

Back 1623

Left sided heart failure -