Classic Presentations Flashcards
(298 cards)
1
Q
Abdominal pain, diarrhea, leukocytosis, recent antibiotic use
A
Clostridium dificile infection
2
Q
Achilles tendon xanthoma
A
Familial hypercholesterolemia
decreased LDL receptor signaling
3
Q
Adrenal hemorrhage, hypotension, DIC
A
Waterhouse-Friderichsen syndrome (meningococcus)
4
Q
Anaphylaxis following a blood transfusion
A
IgA deficiency
5
Q
Anterior drawer sign (+)
A
ACL injury
6
Q
Athlete w/ polycythemia
A
Secondary to EPO injxn
7
Q
Back pain, fever, night sweats
A
Pott disease
vertebral TB
8
Q
Bilateral acoustic schwannoma
A
NFT type II
9
Q
Bilateral hilar lymphadenopathy, uveitis
A
Sarcoidosis
10
Q
Black eschar on the face of a patient w/ diabetic ketoacidosis
A
Mucor or Rhizopus infxn
11
Q
Blue sclera
A
Osteogenesis imperfecta
Type I collagen defect
12
Q
Bluish line on the gingiva
A
Burton line
Lead poisoning
13
Q
Bone pain, bone enlargement, arthritis
A
Paget disease of the bone
Increased osteoblastic and osteoclastic activity
14
Q
Bounding pulses, diastolic heart murmur, head bobbing
A
Aortic regurgitation
15
Q
Butterfly facial rash and Raynaud phenomenon in a young female
A
SLE
Rash
Arthritis
Serositis
Hematologic disorders
Oral ulcers
Raynaud’s Phenomenom/ Renal disease
Photosensitivity
Antinuclear abs
Immunosuppressants
Neurologic disorders (seizures, psychosis)
16
Q
Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
A
McCune-Albright syndrome
mosaic G-protein signaling mutation
17
Q
Cafe-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytommas, optic gliomas
A
NFT Type I
18
Q
Cervical Lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae, red tongue
A
Kawasaki disease
(Tx. w/ IVIG and aspirin)
CRASH and burn
19
Q
Calf pseudohypertrophy
A
Muscular dystrophy
most commonly Duchenne, due to X-linked recessive mutation of dystrophin gene
20
Q
“Cherry-red” spots on the macula
A
Tay-Sachs Disease
(ganglioside accumulation)
Nieman-Pick’s Disease
(sphingomyelin accumulation)
Central retinal artery occlusion
21
Q
Chest pain on exertion
A
Angina (stable)
22
Q
Chest pain, pericardial effusion/friction rub, persistent fever following an MI
A
Dressler Syndrome (AI-mediated post-MI fibrinous pericarditis, 2-12 weeks after episode)
23
Q
Chest pain w/ ST depressions on EKG
A
Unstable angina
24
Q
Child uses arms to stand up from squat
A
Gower’s Sign
Duchenne’s muscular dystrophy
25
Child w/ fever later develops red rash on face that spreads to body
"Slapped cheeks"
(erythema infectiosum/fifth disease; parvovirus B19
26
Chorea, dementia, caudate degeneration
Huntington's Disease
| AD CAG repeat expansion
27
Chorioretinitis, hydrocephalus, intracranial calcifications
| in newborn
Congenital toxoplasmosis
28
Chronic exercise intolerance w/ myalgia, fatigue, painful cramps, myoglobinuria
McArdle's Disease
(Skeletal muscle glycogen phosphorylase deficiency)
(Type V glycogen storage disease)
29
Cold intolerance
Hypothyroidism
30
Conjugate horizontal gaze palsy
Internuclear ophthalmoplegia
| damage to MLF; may be unilateral or bilateral
31
Continuous "machine-like" heart murmur
PDA
| Close w/ indomethacin; open or maintain w/ PGE
32
Cutaneous/dermal edema due to connective tissue deposition
Myxedema
(Caused by hypothyroidism, Grave's Disease)
-Commonly pretibial
33
Cutaneous flushing, diarrhea, bronchospasms
Carcinoid syndromem
| Right sided cardiac valvular lesions, increased 5-HIAA
34
Dark purple skin/mouth nodules in a patient w/ AIDS
Kaposi's Sarcoma
HHV-8
35
Deep, labored breathing/hyperventilation
Kussmaul respirations
| Diabetic Ketoacidosis
36
Dermatitis, dementia, diarrhea
Pellagra
Niacin deficiency
37
Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi
Thiamine deficiency
38
Dog or cat bite resulting in infxn
Pasteurella multocida
| cellulitis at infxn site
39
Dry eyes, dry mouth, arthritis
Sjogren syndrome
| AI destruction of salivary glands
40
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson Syndrome
| May progress to esophageal SCC
41
Elastic skin, hypermobility of joints, increased bleeding tendency
Ehlers-Danlos syndrome
| Type V collagen defect; type III collagen defect seen in vascular subtype of EDS
42
Enlarged, hard left supraclavicular node
Virchow node
| Abdominal metastasis
43
Episodic vertigo, tinnitus, hearing loss
Meniere Disease
44
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells
Mycosis fungiodes
(cutaneous T-cell lymphoma)
Sezary Syndrome
(mycosis fungiodes+malignant T-cells in blood)
45
Facial muscle spasm on tapping
Chvostek sign
| hypocalcemia
46
Fat, female, forty, fertile
Cholelithiasis
47
Fever, chills, headache, myalgia following antibiotic tx. for syphilis
Jaisch-Herxheimer reaction
| Rapid lysis of spirochetes resulting in endotoxin release
48
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
49
Fever, night sweats, weight loss
B-sx. of lymphoma (likely Hodgkin's)
50
Fibrous plaques in soft tissue of penis w/ abnormal curvature
Peyronie disease
| Connective tissue disorder
51
Golden brown rings around peripheral cornea
Kayser-Fleischer rings)
| Cu2+ accumulation in Wilson's disease
52
Gout, intellectual disability, self-mutilating behavior in a boy
Lesch-Nyhan Syndrome
| HGPRT deficience, X-linked recessive
53
Hamartomous GI polpys, hyperpigmentation of mouth/feet/hands/genitalia
Peutz-Jeghers syndrome
| inherited, benign polyposis can cause bowel obstruction; increased cancer risk, mainly GI but others too
54
Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises
Gaucher's Disease
| glucocerbrosidase deficiency
55
Abdominal pain, ascites, hepatomegaly
Budd-chiari syndrome
| posthepatic venous thrombosis
56
Hereditary nephritis, sensorineural hearing loss, cataracts
Alport syndrome
Defective type IV collagen
57
Hyperphagia, hypersexuality, herporality, hyperdocity
Kluver-Bucy Syndrome
Bilateral amygdala lesion
58
Hyperreflexia, hypertonia, Babinski
UMN damage
59
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
60
Hypoxemia, polycythemia, hypercapnia
Blue bloater
Chronic bronchitis; hyperplasia of mucous cells
61
Indurated, ulcerated genital lesion
Nonpainful: chancre (Primary syphilis)
Painful: Chancroid (Haemophils ducreyi)
62
Infant w/ cherry-red spot on macula, hepatosplenomegaly, neurodegeneration
Niemann-Pick Disease
Sphingomyelinase deficiency
63
Infant w/ cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
Patau syndrome
64
Infant w/ hypoglycemia, hepatomegaly
Cori disease (debranching enzyme deficiency)
Von Gierke disease (glucose-6-phosphatase deficiency; more severe)
65
Infant w/ rocker-bottom feet, microcephaly, clenched hands, structural heart defect
Edwards syndrome
66
Jaundice, palpable distended non-tender gallbladder
Distal obstruction of biliary tree
67
Large rash w/ bulls-eye appearance
Erythema migrans (Lyme disease from Ixodes TICK bite)
68
Lucid interval after traumatic brain injury
Epidural hematoma
Middle meningeal artery rupture
69
Male child, recurrent infxns, no mature B-cells
Bruton's Disease (X-linked agammaglobulinemia)
70
Mucosal bleeding and prolonged bleeding timme
Glanzmann thrombasthenia
defect in platelet aggregation due to lack of GPIIb/IIIa
71
Muffled heart sounds, distended neck veins, hypotension
Beck's triad
Indicates cardiac tamponade
72
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Gardner Syndrome
Subtype of FAP
73
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe Disease (lysosomal a1,4-glucosidase deficiency)
74
Neonate w/ arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk injury from C5-C6)
Results in waiter's tip
75
No lactation postpartum, absent menstruation, cold intolerance
Sheehan syndrome
Pituitary infarct
76
Nystagmus, intention tremor, scanning speech, bilateral internuclear opthalmoplegia
MS
77
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease
Mycoplasma pneumonia= anti-I
Mono= anti-i
78
Painful fingers/toes changing color from white to blue to red with cold or stress
Raynaud's phenomenon
Vasospasm
79
Painful, raised red lesions on pads of fingers/toes
Osler nodes
Indicates infective endocarditis
80
Painless erythematous lesions on palms and soles
Janeway lesions
Indicates infective endocarditis, septic emboli
81
Painless jaundice
Cancer of the pancreatic head obstructing the bile duct
82
Palpable purpura on buttocks/legs, joint pain, abdominal pain, hematuria
Henoch-Schonlein purura
IgA vasculitis affecting skin and kidneys
83
Pancreatic, pituitary, parathyroid tumors
MEN 1 (AD)
84
Periorbital and peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
85
Pink complexion, dyspnea, hyperventilation
Pink puffer
Emphysema
86
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic Rickett's
Fanconi syndrome
Multiple combined dysfnxn of the PCT
87
Pruritic, purple, planar, polygonal papules and plaques
Lichen planus
Assoc. w/ HCV
88
Ptosis, miosis, anhydrosis
Horner Syndrome
Sympathetic chain lesion
89
Pupil accommodates but doesn't react
Argyll-Robertson pupil
Neurosyphilis; "Prostitute's pupil"
90
Rapidly progressive limb weakness that ascends following GI/URI
Guillain-Barre syndrome
Acute inflammatory demyelinating polyradiculopathy subtype
91
Rash on palms and soles
Coxsackie A, secondary syphilis, Rocky Mountain Spotted Fever
92
Recurrent cold abscesses, unusual eczema, high serum IgE
Hyper IgE syndrome
Neutrophil chemotaxis abnormality
93
Red "currant jelly" sputum in alcoholic or diabetic pts.
Klebsiella pneumoniae pneumonia
94
Red "currant jelly" stools
Acute mesenteric ischemia (adults)
Intussusception (children)
95
Red, itchy, swollen rash of nipple/areola
Paget's disease of the breast
96
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
97
Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
von-Hippel Lindau disease
Dominant TSG mutation
98
Resting tremor, akinesia, rigidity, postural instability, shuffling gait
Parkinson disease
Loss of dopaminergic neurons in the SN pars compacta
99
Retinal hemorrhages w/ pale centers
Roth spots
Indicates bacterial endocarditis
100
Severe jaundice in neonate
Cirgler-Najjar syndrome
Congenital unconjugated hyperbilirubinemia
101
Severe RLQ pain / palpation of LLQ
Rovsing sign
Acute appendicitis indicator
102
Severe RLQ pain w/ rebound tenderness
McBurney sign
Acute appendicitis indicator
103
Short stature, cafe-au-lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia
Fanconi anemia
Genetic loss of DNA crosslink repair; often progresses to AML
104
Single palmar crease
Down syndrome
105
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome
Dynein arm defect affecting cilia
106
Skin hyperpigmentation, hypotension, fatigue
Addison's disease
Increased ACTH and a-MSH production; due to adrenocortical insufficiency
107
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne's)
108
Small, irregular red spots on buccal/lingual mucosa w/ blue-white centers
Koplik spots
Measles (rubeola)
109
Smooth, moist, painless, wart-like lesions on the genitals
Condylomata lata
| Secondary syphilis
110
Splinter hemorrhages in fingernails
Bacterial endocarditis
111
"Strawberry tongue"
Scarlet Fever
or
Kawasaki disease
112
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner Syndrome
45 XO
113
Sudden swollen/painful big toe joint
Gout
114
Swollen gums, mucosal bleeding, poor wound healing, petechiae
Scurvy
Vitamin C deficiency (cant hydroxylate proline/lysine for collagen synthesis)
115
Swollen, hard, painful finger joints
Osteoarthritis
| Osteophytes on PIP, DIP
116
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
117
Telangectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria
Osler-Weber-Rendau syndrome
118
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A
AD RET mutation
119
Thyroid tumors, pheochromocytoma, ganglioneuromatosis, marfoid habitus
MEN 2B
AD RET mutation
120
Toe extension/fanning upon plantar scrape
Babinski sign
121
Unilateral facial drooping involving forehead
LMN facial nerve palsy; UMN lesions will spare the forehead
122
Urethritis, conjunctivitis, arthritis in male
Reactive arthritis assoc. w/ HLA-b27
123
Vascular birthmark (port-wine stain) of the face
Nevus flammeus
Assoc. w/ Sturge-Weber syndrome
124
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome
Usually in alcoholic and bullemic patients
125
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple disease
Caused by Tropheryma whipplei
126
"Worst headache of my life"
Subarachnoid hemorrhage
127
Delayed separation of the umbilical cord
Leukocyte Adhesion Deficiency
-defect in LFA-1 integrin causing poor PMN migration
128
Partial albinism, peripheral neuropathy, recurrent infxns
Chediak-Higashi syndrome
129
Ataxia, spider angiomas, IgA deficiency
Ataxia-telangectasia
-Asoc w/ increased AFP; cause by defect in ATM gene causing decreased DNA double strand break repair
130
Cheilosis, Corneal vascularization
2 C's of B2 deficiency; decreased capability of some redox reactions
-cheliosis is inflammation and fissure formation at the corners of the mouth
131
Diarrhea
Dermatitis
Dementia
3 Ds of D3
Dementia- hallucinations
Dermatitis- rash on sun-exposed areas, especially around the collar
132
Excessive egg white consumption
Biotin (B7) deficiency
-Needed for carboxylase enzymes (deficiencies cause decreased FA production, breakdown, and gluconeogenesis)
Clinical: Dermatitis, alopecia, enteritis
133
Upward gaze palsy, absent pupillary light reflex, impaired convergence
Parinaud Syndrome
-possibly due to a pinealoma
134
Utricle
Contains hair cells that respond to linear acceleration and the force of gravity
135
What later of the meninges is the sclera continuous with?
The dura mater
136
Location of the canal of Schlemm
The limbus (sclerocorneal jnxn)
Obstruction causes glaucoma
137
Retinitis pigmentosa
Inherited degeneration of the rods associated with Abetalipoproteinemia
➡️night blindness, "gun-barrel" vision
Tx: Vitamin A
138
Embryonic Sources of the adult diaphragm
1. Septum Transversum (part of the central tendon of the diaphragm in the adult)
2. Paired Pleuroperitoneal membranes
3. Dorsal mesentary of the esophagus
(Forms the Crura of the diaphragm in an adult)
4. Body wall
139
hPL
Hormone produced by the placenta that induces lipolysis to increase FFA levels in the mother
"Pregnancy growth hormone"
140
APGAR
```
Appearance
Pulse
Grimace
Activity
Respiratory effort
```
0-3 = life-threatening situation
3-7 = ventilation support needed
141
Peurperium
The 6 weeks it takes for normal uterine fnxn to return after having a baby
May manifest as after pains, some uterine discharge
-If lactating, may take 10 weeks
142
Newborn with digit hypoplasia, Craniofacial defects, mental and growth retardation, and a cleft palate
Fetal Hydantoin syndrome
143
HCTZ and pregnancy
Causes fetal jaundice and thrombocytopenia
144
Irreversible damage to hepatocytes signified by...
Damage to the connective tissue architecture of the liver
145
Integrins
Bind intracellular cytoskeletal elements (like actin) to extracellular proteins (like fibronectin)
146
RAS proteins are activated by what type of receptor?
Growth factors (usually TKs)
147
CDK1
Controls the G2 =>> M transition
-Regulated by CDKIs which can be activated by TGF-B
148
Gene knockout therapy is performed on what kind of cells?
Embryologic stem cells (represent a totipotent type of stem cell)
149
MAP Kinase
Activated by growth factor signals and increase RAS activation and DNA transcription
150
CCR5 and CXCR4 are what type of receptors?
Chemokine receptors; utilized by HIV for entry into macros and CD4 cells
151
MCC tumors assoc. w/ HIV
B-cell non Hodgkin's lymphoma and Kaposi's sarcoma
152
Juvenile Rheumatoid Arthritis
Child presenting w/ arthritis involving the large joints of the lower extremities
- RF will be ABSENT
- Most cases spontaneously resolve w/ no long term consequences
153
Hereditary Angioedema
Pts. present w/ recurrent episodes of edema throughout their life; possible dyspnea accompanying episodes but no increase in IgE, eos, or other HSN markers
-ACEIs are CI'd
154
IL-17
Made by Th17 cells; play a role in Type IV HSN
155
Protein that allows tumor cells to attach to new BMs
Laminins
156
HNPCC mutations
DNA mismatch repair genes PMS1, PMS2, MLH1
157
TNM
Tumor size (>distant metastases)
158
Unilateral orbital swelling, travel to SA, megacolon/megaesophagus, dilated cardiomyopathy with apical atrophy
Trypanosoma cruzi
Tx: Nifurtimox/benznidazole
159
Fever and sporadic hemolytic anemia, Maltese cross on Blood smear
Babesia
Tx: Atovaquone and Azithromycin
160
Botulism EPPs
EPP is the only thing that goes down; actual Ach response remains the same
161
Internal Validity
Reflects the amount of bias in a study; inversely related
162
Immunohistochemistry
Fluorescent antibodies used to identify proteins including CDs
163
Drug used to control postpartum bleeds
Oxytocin; has vasoconstrictive properties
164
RF for stomach ulcers
Smoking; increased gastric blood flow needed to drain excess acid and prevent exacerbation of ulcer
165
Common causes of prematurity
Smoking
Cocaine
166
Cephalosporins
ARE NOT B-lactam DRUGS; they do bind to PBPs to fnxn tho
167
VDJ recombination
Occurs in T-cells
168
Diabetic neuropathy presentation
Can present as burning pain as well as loss of sensation
169
Kid w/ a new puppy and diarrhea
Campylobactter
170
Sucrose
Glucose + Fructose
-Avoid this in aldolase B deficiency!
171
Proximal Lesser curvature of the stomach artery
Left gastric artery
Origin: Celiac
172
Artery of the distal lesser curvature of the stomamch
Right gastric artery
Origin: Proper hepatic
173
Artery of the proximal greater curvature of the stomach
Left gastroepiploic artery
Origin: splenic
174
Artery of the distal greater curvature of the stomach
Right gastroepiploic artery
Origin: gastroduodenal
175
Proximal greater curvature of the stomach arterial supply
Short gastric arteries
Origin: splenic
176
Ventricular free wall rupture
Occurs 5-14 days post-MI; will see coagulative necrosis w/ PMN and macro infiltrate
```
Clinical: Pericardial tamponade
Distant heart sounds
JVD
Profound hypotension
Cardiogenic shock
```
177
Thromboangitis obliterans inflammation pattern
Transmural, segmental
-Extends into the nerves and veins producing pain and ulceration/gangrene respectively
178
Nerve that looks like 2 nerves leaving the brainstem
CN VII
179
Mitochondrial appearance on EM
Wavy, crystal looking circles
180
Constitutive heterochromatin
Always condensed heterochromatin that contains repetitive DNA near the centromere
181
Positively charged AAs
Lysine and arginine
-Make up histones so they can bind DNA
182
Bloom Syndrome
Mutation in DNA repair enzymes
Clinical: Long, narrow face
Erythema/teleangectiasia in butterfly distribution
Protuberant ears
Patches of hyper/hypopigmentation
Immunodeficiency (decreased IgG, IgM, IgA)
183
G2 phase specific anticancer drug
Bleomycin
184
ATM kinase
Responds to dsDNA breaks; activates p53
p53 =>> increased p21 which inhibits Cdk2-cyclin E from forming
-Also increased p16 which inhibits Cdk4/6-cyclin D
***Ultimately, all of this inhibits the phosphorylation of Rb
185
CD1 marker
Positive in histiocytosis
186
Adrenoleukodystrophy
x-linked defect in ATP-binding cassette transporter which Fnxns to transport long FA-chains into peroxisomes
Clinical: Adrenocortical failure
Inflammatory demyelination causing dementia
187
Increased startle response
Tay-Sachs
188
Aprepitabt, Fosaprepitant
Prevent substance P release to area postrema
-Use if odansetron fails
189
Eosinophilic casts
Tamm-Horsfall protein which leads to increase free light chains (BJ) in the urine as well
-Cause tubular destruction, Mesangial deposition, and epithelial injury
190
Piriform recess
Lie on either side of the pharyngeal orifice
- Internal laryngeal nerve travels beneath it carrying sensory innervation
- Damage =>> loss of cough reflex
191
VA teratogen risk
Neural tube defects
192
Combined absence and tonic-clonic seizure tx
Valproate
193
Pulmonary fibrosis
Gradual onset of dyspnea w/ end-inspiratory crackles
CXR: Bilateral, diffuse reticulonodular opacities
-most pronounced in lower lobes
-Possible sequelae of RA, IBD, or cancer tx.
194
Greatest mortality reduction for MI and diabetes
Smoking cessation
195
Legionnaire's Disease
Infxn following exposure to contaminated H2O sources (cruises, spas, hospitals)
```
Clinical: High fever
Radiological evidence of pneumonia
Bradycardia
Diarrhea, nausea
Increased liver enzymes
***Hyponatremia
```
196
ADH
Fnxns to increase H2O AND UREA reabsorption in the medullary collecting duct
197
Obesity-related restrictive lung disease
Due to decreased lung compliance
-Most lung testing show decreases except RV
198
Nonbacterial thrombotic endocarditis
Common w/ advance malignancy (esp. mucinous adenocarcinomas) and other chronic inflammatory states
-May be momentarily asymptomatic but can dislodge and embolize
199
Deep Q waves and inverted t waves
Recent MI
200
Location and fnxn of Brunner's glands
1st part of the duodenum; secretes HCO3
201
Tx for drug induced Parkinsonism
Benztropine, trihexyphenidyl
202
ARPKD
Mutation in PKHD1 gene => decreased fibrocystin
* Baby will present w/ POTTER sequence
- Later will have HTN and hepatomegaly
203
Invasive Pulmonary Aspergillosis
Fever, chest pain, cough, hemoptysis
CXR: consolidated cavitary lesions
RFs: Prolonged febrile neutropenia (like pts. on chemo)
204
Placental abruption
Leads to increased Factor III release (tissue factor) =>> DIC
-Also vaginal bleeding, uterine tenderness, retroplacental hematoma
205
Damage to the posterior triangle of the neck
Damaged CN XI
- Loss of trapezius (elevation of scapula; shoulder stabilization)
- Possible loss of SCM
206
Aldosterone escape
Potential finding in hyperaldosteronism due to increased ANP
-Decreased Na+ retention but hypokalemia and increased HCO3 still present
207
Immediate Tx for hemophilia
Thrombin
208
Left-sided colon cancer
Obstruction; narrows the lumen of the rectosigmoid colon
209
Southwestern Blot
Stains proteins that bind to DNA
210
c-Jun; c-Fos
Leucine zipper proteins
| nuclear transcription proteins
211
Buspirone
Partial 5-HTa agonist used to tx. GAD
-Only prob is it takes a LONG time to take effect
212
Supplement needed for breastfed babies
Vitamin D
213
Thick, yellow green, frothy discharge
Trichomonas
214
Women w/ irregular menses and decreased AFP on US
Probably just inaccurate dating of the fetus
215
Acute Salicylate Poisoning
1st =>> Respiratory alkalosis
2nd =>> Anion gap metabolic acidosis (3hrs later)
*Normal pH at this point
216
Infant w/ hypertension, recurrent pyelonephritis, enlarged upper and lower poles of kidney
Vesicoureteral reflux
-Due to ureters entering the bladder at a perpendicular angle causing decreased flap fnxn
217
Nasal polyp associations
CF
Aspirin-intolerant asthma
218
Bacteria causing COPD superinfxn
H. Influenzae
219
Bronchial hamartoma
Bending mass of lung tissue and cartilage that can be mistaken for Cancer
220
Best lung cancer prognosis
Bronchioloalveolar carcinoma
221
S rule of lung cancers
S= central, smoking, syndromes
222
MC metastatic site of lung cancer
Adrenal glands
223
Potential obstructive sleep apnea Tx.
Electrical stimulation of CN XII; moves the tongue forward to remove some obstruction of the pharynx
224
Decreased UMP synthase
Hereditary oroditc aciduria
Orotic acid needed to produce IMP and GMP
Clinical: MR
MEGALOBLASTIC anemia
Orotic aciduria
Tx: Uridine
225
Propionyl CoA carboxylase
Product of branched AA catabolism along with threonine and methionine
*Requires what cofactor???
Deficiencies cause hypotonia, poor feeding, vomiting, anion gap acidosis, and decreased methlmalonyl CoA
226
Methlmalonyl CoA isomerase
Converts methylmalonyl made from propionyl CoA to a-ketoglutarate
-Requires B12
227
Chromosome 22q11.2 deletion
DiGeorge Syndrome
Cardiac trunk (TOF, truncus arteriosus)
Abnormal face (low set ears)
Thymic aplasia
Craniofacial abnormalities (cleft palate)
Hypocalcemia
228
Dihydropterine reductase reactions
Forms tyrosine and DOPA
Also converts tryptophan =>> serotonin
-If deficient in BH4 or dihydropterine reductase, will likely see increased Phe and Trp
229
Hypertensive Arteriolar Sclerosis
Chronic HTN causing an occlusion leading to an ischemic stroke
CT scan initially looks ok but weeks later will see a small infarct
*Usually affects the internal capsule or pons
230
Drug used to decrease alcohol CRAVINGS
Naltrexone
-Disulfarim can be used in people who have lost cravings
231
Porto-caval anastamoses (3)
Esophageal Varices:
Left gastric vein Esophageal veins
Hemorrhoids:
Superior rectal veins Middle and inferior rectal veins
Caput Medusae:
Paraumbilical veins Superior and inferior epigastric veins
232
Question that mentions retroperitoneal or unknown source of bleeding
Think retroperitoneal organs
```
Spleen
Aorta and IVC
Duodenum
Pancreas
Ureters
Colon
Kidneys
Esophagus
Rectum
```
233
Rate limiting enzyme in bile salt synthesis
Cholesterol 7a-hydroxylase
***Inhibited by fibrates =>> cholesterol stones
234
Most important prognostic factor for colon cancer
Invasion into the muscularis propria
235
Tx. Of refractory depression
Lithium
236
Medicare coverage
Lifetime taxpayers over 65
ALS
ESRD
Young people w/ disabilities
237
Craniopharyngioma components
1. Cystic: filled w/ "motor oil" liquid
2. Solid: composed of the actual tumor cells
3. Calcifications
- As always, this is a remnant of Rathke's pouch
238
Synaptophysin
Transmembrane glycoprotein found in neurons
-Stains positive in CNS tumors composed of NEURONS
239
Giant Cell Arteritis Inflammation
Segmental, granulomatous lesions
-Same as Takayasu arteritis
240
Constriction of the efferent arteriole
Decreases RPF
241
Hypothyroid myopathy
Muscle pain and weakness of the proximal muscles due to decreased Ca2+ reabsorption in the SR
Clinical: Increased CK
Delayed reflexes
Myoedema
Other signs of hypothyroidism
242
Mallet Finger
Jamming of the finger rips the extensor digitorum tendon as it goes over the DIP
=>>Inability to extend the finger
243
Arterial anastamoses around the scapula
Blockages in the subclavian or axillary artery is bypassed via the subscapular or thyrocervical trunk vessels
244
Cubital fossa contents
Lateral =>> Medial
Biceps brachii tendon =>> Brachial artery =>> Median nerve
-Site of venipuncture= Median cubital vein
245
Propofol
Short-acting anesthetic used to induce anesthesis via GABA-A induction
-Causes profound vasodilation tho
246
MAC
Essentially the ED50 of inhaled anesthetics; inversely proportional to the potency
247
Fracture of the femoral neck tx.
Hip replacement; do this to prevent osteonecrosis due to disrupted blood supply
-Common in osteoporotic women
248
Good schizophrenic prognostic factors
Late onset
Obvious precipitating factor
Acute onset
Presence of mood disorder sx.
Family history
Good support system
Presence of positive sx.
249
What causes dimpling in breast cancer?
Growth of the tumor to involve the suspensory ligaments
250
Phrenic nerve
Innervates the fibrous pericardium, the mediastinal and diaphragmatic pleura, and the muscular diaphragm
251
Cardiac shadow on CXR
Right side: SVC and Right atrium
Left side: Aortic arch, pulmonary trunk, left auricle, and left ventricle
252
Nodal branch
Arises from the RCA and supplies the SA and AV nodes
253
Blood supply to the apex of the heart
The LAD; also supplies the anterior 2/3 of the IVS, the anterior heart wall, and the Bundle of His
254
Defective part of a VSD
The membranous part of the ventricular septum
255
Keratoderma blenorrhagica
Hyper pigmented plaques and nodules on soles and palms that are assoc. With reactive arthritis
256
Excessive egg white consumption
B7 deficiency; egg whites prevent adequate absorption of biotin
257
Velocity of blood flow equation
v=Q/A
258
Valsalva maneuver
Expiring against a closed glottis ➡️ ⬇️ VR ➡️ ⬇️ CO ➡️ ⬆️ Sympathetic outflow to the heart
⭐️ Used to test the integrity of the Baroreceptor reflex
259
Angiotensin II Fnxns (4)
1. Increases aldosterone synthesis
2. Increases Na-H exchange in the PCT
3. Stimulates thirst
4. Causes vasoconstriction of the Arterioles
260
Auscultation of inferior lobes
Performed on the posterior chest wall
261
Auscultation of the middle lobe
In b/w the 4th and 6th rib
262
Location of abdominal nerves
Deep to the internal oblique muscles and superficial to the transversalis fascia
263
Rectouterine pouch
Possible location of pelvic abscess
264
Abnormal migration of the ventral pancreatic bud
Annular pancreas
265
Incomplete fusion of the dorsal and ventral pancreatic buds
Pancreatic divisum
-Common and typically asymptomatic
266
HbS sickling
Valine is a nonpolar AA; this causes the nonpolar, hydrophobic residues of Hb to clump together
=>> sickling
267
Suspected elder abuse
Interview elder alone; even if they are slightly impaired
-If severe cognitive impairment, notify protective services
268
VonRecklinghausen's Disease
NF1
-Pheochromocytomas, Lisch nodules,
269
Cave exploration in the Ohio River Valley/ Mississippi River Valley
Histoplasma infxn
-Can present as an acute pulmonary disease
270
Estrogen effects on TSH
Transient increase; will normalize tho
-Increased estrogen increases TBG synthesis leading to increased synthesis of T4 and T3 to return free levels to normal
271
Schizoaffective Disorder
Major depressive OR MANIC episodes concurrent w/ schizophrenia
272
Crohn's Disease complications
GI: Fistulas, strictures, increased risk of adenocarcinoma
Skin: Erythema nodosa
Malabsorption: Gallstones, *Kidney oxalate stones (due to decreased calcium absorption) b12 and folate deficiency
-Also arthritis and uveitis
273
Pts. at risk for B12 deficiency
Usually in people who have been strict vegetarians for at least 5 years
274
Sulfonylurea w/ decreased likelihood for hypoglycemia
Glipizide
-2nd generation are shorter acting
275
POMC derivatives
1. ACTH
2. MSH
3. Endorphins, enkephalins
276
MCCo hypothyroidism
Hashimoto's
Assoc. With HLA-DR5; pts. At an increased risk for non-Hodgkin's lymphoma
Histo shows Germinal centers hurthule cells
277
Locally invasive thyroid tumor
Anaplastic carcinoma
-Produces dysphagia and respiratory compromise
278
Stones, bones, groans, and psychiatric overtones
Hyperparathyroidism
- Hypercalciuria (Nephronopthisis)
- Osteitis fibrosa cystica
- constipation and weakness
- depression
279
Venous waves
ATRIAL SYSTOLE
A - atrial contraction
C- triCuspid closure
VENTRICULAR SYSTOLE
X descent - emptying
V- Maximum atrial filling pressure
y-descent
280
Eccentric Cardiac Hypertrophy
Heart increases in size by adding new sarcomeres in series w/ existing sarcomeres
=>>Lengthening (not thickening) of fibers; allows the heart to receive a greater volume of blood
-Results from volume overload (heavy aerobic exercise)
281
Dilated Cardiomyopathy causes
Alcohol
Beriberi
Coxsackie B
Cocaine
Chagas
Doxorubicin
-Presents as HF, S3, balloon appearance on CXR
Tx: Na+ restriction; digoxin; ACEIs and BBs
282
X-ray artifact
Abnormal x-ray finding due to user error or hardware failure
283
Hartnup's Disease
Deficiency of neutral AA transporters in the kidney and gut
=>> Increased excretion and decreased absorption
***Tryptophan deficiency =>> Niacin deficiency =>> PELLAGRA
Tx: High protein diet; nicotinic acid
284
Urokinase
Activates plasmin
⭐️Excess release after radical prostatectomy
➡️Bleeding
Tx: Aminocaproic acid (blocks activation)
285
a-2 anti plasmin
Inactivates plasmin
-Liver cirrhosis ➡️⬇️ levels ➡️ ️Bleeding
286
Thrombomodulin
Activates protein C
➡️ inhibition of factors V and VIII
287
Palmar xanthoma
Familial Dysbetalipoproteinemia
288
Cilostazol
PDE inhibitor
-Go to for Buerger disease
289
Macular degeneration
Can be identified as Drusen deposits on the retina; pts. will progress to a central scotoma
290
Possible exacerbating factor for MS
Heat, stress, exercise
291
Gastric erosions
DO NOT EXTEND INTO MUSCULARIS MUCOSA
- ONLY STAY IN THE MUCOSA LAYER
- Once in the submucosa, they become ULCERS
292
PAS stains
Stains glycoproteins, polysaccharides, mucopolysaccharides, glycogen
Gets C-C bonds, not lipids
293
Neuroblastoma (adrenal)
Abdominal mass that goes past the midline and usually assoc. w/ n-MYC mutation
Clinical: HTN, weight loss
Paraneoplastic associations = Opsoclonus, myoclonus, pancytopenia, hepatomegaly, SC compression
-Even those are weird, if you see an abdominal mass w/ HTN and weight loss, you think horseys
294
MC predisposing factor for infective endocarditis in developed world
Mitral valve prolapse
295
Neurocysticercosis infxn
Accidental ingestion of cysts from contaminated feces
-Symptoms take a while to develop; is why the people are usually MIGRANTS
296
Most important prognostic factor for urothelial carcinoma
Depth of invasion
-Involvement of muscular layer= T2
297
Antiarrhythmics
Class IA: Quinidine, Procainimide, Disopyramide
-Affects both Na+ influx and AP length
Class IB: Lidocaine, Mexilitine
-DECREASES AP LENGTH
Class IC: Fleicanide, Propafenone
-STRONG INCREASE IN NA+ LENGTH WITH NO CHANGE IN AP LENGTH
298
Eggshell calcifications, birefringent particles, fibrous tissue
Silicosis
-Findings otherwise similar to sarcoidosis
