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Flashcards in Goljan High Yield Deck (430):
1

Roles of cortisol (4)

1. Permissive action over glucagon and epinephrine
2. Gluconeogenesis from aa
3. Proteinolysis
4. Lipolysis

2

Roles of glucagon (5)

Liver glucogenolysis
Lvier gluconeogenesis
Ureagenesis
Ketogenesis
Lipolysis

3

Roles of epinephrine (4)

1. Liver glycogenolysis and gluconeogensis (from alanine release from skeletal muscle)
2. Skeletal Muscle glycogenolysis and gluconeogenesis.
3. Decrease glucose uptake
4. Adipose tissue lipolysis and gluconeogenesis (from glycerol)

4

Roles of growth hormone (3)

Adipose tissue lipolysis
Stimulates Protein synthesis via IGF-1
Decreases glucose tissue uptake

5

Response to hypoglycemia is largely driven by ____ (2)

Epinephrine and glucagon

6

Early sx of hypoglycemia

sweating, tremors, palpitations, hunger, nervousness => due to NE & Epi release

7

Late sx of hypoglycemia

behavioral changes, confusion, visual disturbances, stupor, seizures; and if prolonged hypoglemia, irreversile neuro deficits and death.

8

Why don't you give beta blockers in hypoglycemia?

1. Exacerbate hypoglycemia. Recall that Beta2 receptors increase liver gluconeogenes, glycogenolysis, lypolysis and skeletal muscle glycogenolysis. If this is blocked, the result is hypoglycemia.
2. Mask adrenergic symptoms. Because of inhibition of Epi & NE compensatory response.

9

Cocaine acts by ___

Decreased uptake of Serotonin/Dopa/Nor (triple reuptake inhibitor)

10

UVB light produces what DNA mutations?

Thymidine dimers

11

Cytochrome oxidase is inhibited by ___ (2)

CO and cyanide

12

Muscle atrophy in a cast is caused by ___

Polyubiquitination of proteins

13

MC vitamin deficiency in alcoholics

Folic acid (B9)

14

In the case of ambiguous genitalia, one must always confirm ___

Genetic sex

15

MC mineral deficiency in alcoholics

Magnesium

16

Caisson's disease (decompression sickness)

Due to large volumes of N2 dissolved in blood; PN2 decreases due to bubble formation and movement into tissues

17

Vitamin E toxicity

Decreases Vitamin K dependent factors

18

Pyridoxine (B6) used in ___

Transamination rxns involving AST/ALT

19

ANP acts in opposition to ___

Angiontensin II (--| ADH/aldo release, --| Na reabsorption, --| renin release, vasodilation)

20

Vitamin deficiency in baby of vegan woman

B12 (anemia)

21

EBV attaches to ____ on B cells

CD21

22

Hypogonadism, MR, and unilateral gynecomastia

Klinefelter syndrome (XXY)

23

Hypogonadism, anosmia, and color blindness

Kallmann syndrome (absent GnRH)

24

Hypogonadism, MR, and retinitis pigmentosum

Laurence-Moon-Biedl syndrome (cilia defect)

25

Male with hypogonadism, MR, short stature, and webbed neck

Noonan syndrome (similar to Turner's, RAS/MAPK defects)

26

Male pseudohermaphrodite with cryptorchidism

Testicular feminization (absent androgen receptors)

27

Microdeletion syndrome with hypogonadism, MR, short stature, obesity

Prader Willi (Chr.15 deletion, paternal origin)

28

Neurofibromatosis patient with severe diastolic HTN

Pheochromocytoma

29

Automobile workers present with headache, N&V, muscle weakness, and abdominal cramps

Lead poisoning from battery incineration

30

Newborn female with hand/foot edema and webbed neck

Turner's (45XO)

31

What has led to decreased incidence of SIDS?

Baby lies supine! (otherwise they don't move their head in response to hypercapnia and die)

32

Mature breast milk v. cow milk

Cow milk: more Vit K, B12, casein protein

Breast milk: more ascorbic acid, better-absorbed iron, whey protein

33

Vitamin absent in colostrum

Vitamin D

34

Infant fed on goat milk at risk of. . . ?

B9, B6, iron deficiency --> anemia

35

Type of UV light responsible for majority of corneal burns and cancer?

UVB ('B is bad')

36

Retinal hemorrhage in young child

Abuse (shaken baby syndrome)

37

Fire ant bites

Multiple wheals that later develop into vesicles and pustules

38

Black widow bite (latrotoxin)

Painful bite --> crampy pain in thighs/abdomen (excessive Ach release)

39

Southwest scorpion bite

Painful sting --> itching, paresthesias, N&V, HTN

40

Brown recluse spider bite

Painless bite (red papule) --> hemorrhagic blister surrounded by purpura

41

Chigger bites

Extremely pruritic discrete bright red papules on legs/waist

42

Child who ingests bottle of aspirin

AG metabolic acidosis (do NOT develop mixed metabolic acidosis/resp alkalosis)

43

Rx for aspirin OD

Gastric lavage with activated charcoal; alkalinize urine

44

____ more likely to infect fetus after first trimester

Syphilis

45

THC metabolites in urine

Marijuana

46

Causes of liver angiosarcoma

Vinyl chloride, Ar, thorotrast

47

Urine 17-ketosteroids increased in ___

21-hydroxylase, 11-hydroxylase deficiency

48

Urine 17-hydroxycorticoids increased in ___

11-hydroxylase deficiency

49

Ambiguous male genitalia in CAH

17-hydroxylase deficiency

50

Ambiguous female genitalia in CAH

21-hydroxylase, 11-hydroxylase deficiency

51

Normal aging - CV

Loss of aortic elasticity

52

Normal aging - Derm

Osteoarthritis
Loss of skin elasticity
Increased collagen cross bridging
Senile purpura (vessel instability)
Decreased skin turgor

53

Normal aging - Pulm

Senile emphysema

54

Normal aging - Special Senses

Cataracts
Presbycusis, otosclerosis
Reduced taste/small
Arcus senilis

55

Normal aging - Immuno

Increased autoantibodies
Decreased cellular immunity
CD4 > CD8

56

Normal aging - Repro

Breast/vulvovaginal/testicular atrophy
BPH
Decreased E/T
Increased FSH/LH

57

Normal aging - Renal

Decreased GFR/Cr clearance

58

Normal aging - Endocrine

Increased insulin resistance

59

Organs injured by acetaminophen toxicity

Kidney (renal medulla), liver

60

Mechanism of corticosteroid immunosuppression

Block phospholipase A2 --| PG, LT production
Block leukocyte adhesion
Neutrophilia (marginating pool knocked into circulation)
Decrease lymphocytes/eos

61

Ectopic ACTH (Cushing syndrome)

Small cell lung carcinoma, medullary thyroid carcinoma

62

SIADH (dilutional hyponatremia)

Small cell lung carcinoma

63

Ectopic calcitonin (hypocalcemia)

Medullary thyroid carcinoma

64

Ectopic EPO (polycythemia, normal PaO2)

Renal adenocarcinoma, Wilm's tumor, HCC, VHL disease, leiomyomas

65

Insulin-like peptide (hypoglycemia)

HCC, retroperitoneal tumors

66

PTH-like peptide (hypercalcemia with low PTH)

Squamous lung carcinoma, renal adenocarcinoma, breast cancer, ovarian cancer

67

Ectopic serotonin (flushing, diarrhea, R heart valvular lesions)

Carcinoid syndrome with liver mets, small cell lung carcinoma, medullary thyroid carcinoma

68

Tumor marker: AFP

HCC; germ cell tumors,: yolk sac or endodermal sinus tumors of testes/ovary

69

Tumor marker: AAT

HCC, yolk sac/endodermal sinus tumors

70

Tumor marker: beta-hCG

Trophoblastic tumors in GCTs; hyatidiform moles; choriocarcinoma

71

Tumor marker: beta2-microglobulin

Multiple myeloma

72

Tumor marker: bombesin

Small cell lung carcinoma, neuroblastoma

73

Tumor marker: CA-15

Breast cancer

74

Tumor marker: CA-19-9

Pancreatic cancer

75

Tumor marker: CA-125

Epithelial ovarian cancer

76

Tumor marker: CEA

Colorectal, pancreatic, breast, small cell lung cancer

77

Tumor marker: LDH

Hodgkin's disease, non-specific

78

Tumor marker: NSE (enolase)

Small cell carcinoma of lung, neuroblastoma

79

Tumor marker: PSA

BPH/prostate adenocarcinoma

80

Tumor: HTLV-1

Adult T cell leukemia/lymphoma

81

Tumor: HTLV-2

Hairy cell leukemia

82

Tumor: HIV

CNS malignant lymphoma

83

Tumor: HCV/HBV

HCC

84

Tumor: EBV

Burkitt's lymphoma, nasopharyngeal carcinoma, polyclonal malignant lymphoma

85

Tumor: HPV

Squamous cell carcinoma of vagina, cervix, vulva, anus, penis

86

Tumor: HHV-8

Kaposi's sarcoma

87

EM of zebra bodies in lysosomes

Niemann Pick DIsease (look like lamellar bodies in T2 pneumocytes)

88

Enamel injury in young woman

Bulimia (metabolic alkalosis from vomiting, Boehaave's syndrome)

89

Anorexia nervosa

Secondary amenorrhea, osteoporosis, ventricular arrhythmia

90

Kwashiorkor

Decreased protein intake, adequate caloric intake

Fatty liver --> decreased apolipoproteins
Pitting edema
Flaky paint dermatitis

91

Marasmus

Decreased caloric intake --> loss of all muscle mass

92

Vitamin A deficiency

Squamous metaplasia in eyes, bronchus; nyctalopia

93

Vitamin A toxicity

Increased ICP, hypercalcemia

94

Primary hypothyroidism

Beta-carotenemia from decreased conversion of beta-carotenes into retinoic acid from intestine (b/c thyroxine is a co-factor)

Yellow patient (but not sclerae!)

95

Vitamin E deficiency

Cerebellar dysfunction, hemolytic anemia

96

Vitamin C deficiency ("tea and toast diet")

Bleeding gums, glossitis, perifollicular hemorrhages

97

Thiamine deficiency

Blocks pyruvate DHGN, transketolase, ketoglutarate DHGN

Wernicke's (confusion, nystagmus, ataxia) and Korsakoff (antegrade and retrograde memory loss)

Mamillary bodies shrunken, periventricular area decreases

High-output heart failure, peripheral neuropathy

98

Niacin/B3 deficiency (corn diet, carcinoid syndrome, Hartnup's disease, tryptophan deficiency)

NAD/NADH; NADP/NADPH missing

Diarrhea, dermatitis, dementia

99

Riboflavin (B2) deficiency

FMN/FAD reactions, synthesis of glutathione

Magenta tongue, cornea neovascularization, angular stomatitis

100

Pyridoxine (B6) deficiency (INH, goat milk diet)

Transaminase, heme synthesis

Sideroblastic anemia with ringed sideroblasts, neuropathy

101

Pantothenic (B5) acid

Important in fatty acid synthase complex

102

Biotin deficiency (avidin in raw eggs)

Alopecia

103

Chromium deficiency

Glucose intolerance, peripheral neuropathy

104

Copper rxns

Lysyl oxidase (cross-links in collagen), cyt-c oxidase, SOD, ferroxidase, tyrosinase

105

Copper deficiency

Microcytic hypochromic anemia (loss of transferrin:iron binding), skeletal abnormalities, depigmentation, dissecting AA, Mencke's kinky hair syndrome

106

Copper toxicity

Wilson's disease - AR, Chr. 13, ATP7B

Liver damage, Kayser-Fleischer ring, lenticular nuclei damage (ataxia, tremor), psychosis

107

Selenium rxns

Glutathione peroxidase (prevents peroxides from wreaking havoc in cytosol, while Vit E protects membranes)

Stimulates immune system

Co-factor in peripheral T4-->T3 conversion

108

Zinc rxns

Co-factor in SOD, carbonic anhydrase, alkaline phosphatase, collagenases, RNA/DNA polymerases, thymidine kinase, EtOH DHGN

109

Zinc deficiency (diabetics, alcoholics, cirrhosis, arcodermatitis enteropathica)

Growth retardation, hypogonadism/infertility, decreased taste, rash around eyes/mouth, poor wound healing, impaired immunity

110

Vit C functions

Dietary iron (ferric-->ferrous), hydroxylation of proline/lysine for collagen, prevents nitrosamination, reduces MetHb back to Hb

111

Cyanosis not relieved by oxygen in patient coming home from camping trip

Methemoglobinemia (water has nitrites), give methylene blue

112

Fetal EtOH syndrome

Low nasal bridge, epicanthal folds, minor ear abnormalities, short palpebral fissures, smooth philtrum, thin upper lip, micrognathia

113

HbF shifts oxygen dissociation curve ___

Left

114

Raising upper limit of normal in a test

Increased specificity and PPV; decreased sensitivity and NPV

115

Adrenal atrophy in patient on corticosteroids

FR, not glomerulosa (aldosterone)

116

Normal karyotype with Down's syndrome

Acrocentric (Robertsonian) translocation of chr. 21/14

117

Sepsis in elderly man with BPH

E. coli (septic shock --> release of anaphylatoxins/NO from damaged cells --> dementia exacerbated)

118

Barbiturates increase ___ to precipitate porphyric attacks

ALA synthase

119

Normal changes in pregnancy

Increased: plasma volume, GFR/CCr, Alk Phos, T4/cortisol (increased binding proteins)

Decreased: Hb, BUN, Cr, uric acid

Respiratory alkalosis from progesterone effect

120

Children v. adults blood studies

Increased AlkPhos (osteoblasts from bone growth) and phosphate, slight Hb decrease

121

Analytes increased with hemolyzed blood sample

K+, LDH

122

Lipid most affected by fasting

TG (chylomicrons)

123

First sign of tissue hypoxia

Na/K ATPase inactivity --> swelling

124

Chemical mediators of inflammation

Histamine, C3a/b, C5a, LTB4, LTC-D-E4, bradykinin, PGs

125

Factors decreasing adhesion molecule synthesis

Catecholamines, corticosteroids, lithium

126

Suppurative inflammation is the same thing as ___

Abscess

127

Serous inflammation is the same thing as ___

Blister

128

BRCA2 is found on ___

Chromosome 13

129

Cri-du-chat is often associated with this CV defect

VSD

130

Marfan's syndrome is ____ inheritance

Autosomal dominant

131

Homocystinuria v. Marfan's

MR, vessel thrombosis

132

MCC of death in Marfan's

Aortic dissection

133

AD // Neurofibromas, pheochromocytoma, cafe au lait spots, Lisch nodules (iris hamartomas)

Neurofibromatosis 1 (Chr. 17)

134

AD // cerebellar hemangioblastomas, pheochromocytomas, bilateral renal adenocarcinoma

Von Hippel Lindau disease

135

Low grade

Well differentiated, can tell origin

136

High grade

Poorly differentiated/anaplastic, can't tell tissue of origin

137

Choristoma

Normal tissue in wrong place (i.e. pancreatic tissue in stomach wall)

138

AG

Na - [Cl + HCO3] = 12 +/- 4mEq/L

139

Why does AG rise in some forms of metabolic acidosis?

Adding an acid and its anion replaces bicarbonate used to buffer hydrogen ions

140

Examples of metabolic acidosis causes

Lactate, acetoacetate, beta-hydroxybutyrate, phosphate/sulfate in renal failure, salicylate, formate (methanol poisoning), oxalate (ethylene glycol poisoning), acetate (paraldehyde)

141

Normal AG metabolic acidosis

Lose bicarbonate, which is replaced by equal # of Cl ions

142

Examples of normal AG metabolic acidosis

HARDUPS -

Hyperalimentation, acetazolamide, RTA, diarrhea, ureteroenteric fistula, pancreaticoduodenal fistula, spironolactone

143

Type 1 RTA

Distal: cannot secrete H+ ions or reabsorb K+ (alpha intercalated cells), cannot regenerate bicarbonate

Urine pH > 5.5, hypokalemia

144

Type 2 RTA

Proximal; bicarbonate lost in urine until serum bicarb is 15mEq/L

Urine pH < 5.5, hypokalemia

145

Type 4 RTA

Aldosterone deficiency or resistance, decreased in ammonium excretion

Urine pH > 5.5, hyperkalemia

146

Tumor association: aniline dyes, benzidine, cyclophosphamide, phenacetin

Transitional cell carcinoma of urothelium

147

Tumor association: vinylchloride, thorotrast

Liver angiosarcoma

148

Tumor association: asbestos

Bronchogenic carcinoma >> mesothelioma

149

Tumor association: OCPS

Liver adenomas, HCC

150

Tumor association: aflatoxins (esp. with HBV)

HCC

151

Tumor association: cadmium

Prostate/lung cancer

152

Tumor association: polycyclic hydrocarbons (EtOH co-carcinogen)

Small cell lung carcinoma, squamous carcinoma of URT, squamous cervical carcinoma, transitional carcinoma of bladder, pancreatic adeno

153

Tumor association: chromium, nickel, uranium

Lung cancer

154

Tumor association: woodworking

Nasal cavity cancer

155

Tumor association: chewing tobacco

Verrucous oral carcinoma

156

Tumor association: alkylating agents, benzene

ALL, malignant lymphoma

157

Tumor association: DES

Clear cell adenocarcinoma of vagina/cervix

158

Tumor association: nitrosamines

Esophageal, gastric cancer

159

Tumor association: soot

Squamous carcinoma of skin/scrotum

160

Tumors with vessel invasion (4)

Renal carcinoma, HCC, choriocarcinoma, follicular thyroid cancer

161

0 ESR

Polycythemia, HbSS disease

162

Rx for SIADH

Demeclocycline, restrict water not salt

163

5 features of primary hyperaldosteronism (Conn syndrome)

1. No pitting edema (aldosterone escape, block of proximal reabsorption of Na), 2. Severe hypokalemia (muscle weakness, U waves)
3. Metabolic alkalosis (tetany from low ionized Ca)
4. Nl to increased serum Na
5. Low renin HTN

164

MC primary cancer in LN

NHL

165

MC metastatic cancer in LN

Breast

166

MC primary cancer in lung

Adenocarcinoma

167

MC metastatic cancer in lung

Breast

168

MC primary cancer in bone

Multiple myeloma

169

MC metastatic cancer in bone

Breast, prostate

170

MC primary cancer in liver

HCC

171

MC metastasis in liver

Colon

172

MC primary cancer in adrenals

Adenocarcinoma

173

MC metastatic cancer in adrenals

Lung

174

MC primary cancer in brain

GBM

175

MC metastatic cancer in brain

Lung

176

Necrosis of globus pallidus, SaO2 decreased, PaO2 normal, left shifted ODC, inhibition of cyt-oxidase

CO poisoning

177

Increased PaCO2, decreased PaO2/SaO2

Respiratory acidosis

178

Normal PaO2/SaO2, decreased Hb

Anemia

179

Normal O2 content

1.34[Hb] x SaO2 + PaO2

180

Disorders with nl O2 content

Cyanide poisoning, ischemia, uncoupled ox-phos

181

Dystrophic calcification

Atherosclerotic plaques, enzymatic fat necrotic, periventricular calcification in CMV

182

Metastatic calcification (in setting of increased serum Ca/P)

Nephrocalcinosis (hyperPTH), BG calcification (hypoPTH)

183

MC site of bone mets

Vertebrae due to Batson vertebral plexus from IVC

184

HTN in left gastric/azygous veins

Esophageal varices

185

Cryptococcus neoformans spreads via ___ route

Hematogenous

186

3Hz spike and wave activity on EEG

Absence seizures

187

Absent myenteric (Auerbach's) ganglia

Achalasia

188

Absent myenteric and submucosal (Meissner's) ganglia

Hirschsprung disease

189

Hoarseness in aortic aneurysm

Stretching of L recurrent laryngeal n.

190

Mitochondria are lost in ___ of sperm after fertilization

Tail

191

MCC of rabies in USA

Skunk bites

192

Treatment of CMV retinitis if ganciclovir fails

Foscarnet (renal toxicity, hypocalcemia/hypomagnesemia)

193

Anti-estrogen receptor, may cause endometrial cancer

Tamoxifen

194

False-positive RPR in SLE patient due to ____

Anti-cardiolipin antibodies

195

Anti-SCL-70

Systemic scleroderma

196

Features of SLE

SOAP BRAIN MD

S=serositis (pleurisy, pericarditis)
O=oral ulcers
A=arthritis
P=photosensitivity, pulmonary fibrosis
B=blood cells (hemolytic anemia, thrombocytopenia, leukopenia)
R=renal, Raynauds
A=ANA
I=immunologic (anti-Sm, anti-dsDNA, anti-Ro/La)
N=neuropsych
M=malar rash
D=discoid rash

197

Metyrapone testing

Blocks 11-hydroxylase --> increased ACTH, 11-deoxycortisol in urine in normal HPA axis

198

Osteophytes in DIP joints

Heberden's nodes

199

Flask shaped ulcers in cecum

Amebiasis

200

MC post-MI complication (3-7 days)

Ventricular wall rupture

201

MC post-MI complication (4-6 weeks)

Dressler's syndrome (autoimmune pericarditis)

202

Hemoptysis and renal failure (RPGN) with linear immunofluorescence

Goodpasture's syndrome

203

MCC of sepsis in AIDs patient

Disseminated MAI

204

MCC of infection post-transfusion

CMV (hides in donor lymphocytes)

205

Alternative causes of rusty sputum

CHF, mitral stenosis, Goodpasture's

206

Cyanosis in ToF patient depends on ___

Degree of intravalvular pulmonary stenosis

207

Baby with icterus and edema

Congenital CMV infection

208

Black granules in hepatocyte EM photo

Glycogen (disappears with 6 hours of fasting)

209

MCC of abdominal abscess

Bacteroides fragilis

210

MR, astrocyte hamartomas ("candlestick drippings on ventricles), adenoma sebaceum, angiomyolipoma of kidneys, heart rhabdomyoma

TSC (AD)

211

Increased ALA synthase and decreased porphobilinogen deaminase; severe colicky abdominal pain, neuropsych syndromes

AIP - dALA buildup

212

Decreased activity of uroporphyrinogen decarboxylase, wine-red urine, photosensitivity, hypertrichosis

Porphyria cutanea tarda

213

Yellow needles in parallel polarized light

Monosodium urate

214

Black spot, associated with Pseudomonas and UC

Ecthyma (pyoderma) gangrenosum

215

Fever in malaria occurs when ____

RBCs rupture

216

Young man with low back pain

Sacroilitis; look for HLA-B27, uveitis, aortitis, bamboo spine, UC

217

Sickle cell mutation

Valine for glutamic acid on 6th position of beta globin

218

Osteosarcoma occurs in the ___

Metaphysis

219

Osteomyelitis occurs in ___

Metaphysis

220

UC primarily targets ___

Rectum and colon

221

Gross features of UC

Friable, red mucosa that bleeds easily when touched, no skip areas, "pseudopolyps"

222

Microscopic features of UC

Mucosal inflammation with crypt abscesses

223

Complications of UC

Toxic megacolon, sclerosing cholangitis, pyoderma gangrenosum, adenocarcinoma, HLA B27

224

Clinical picture of UC

L-sided abdominal cramping with bloody diarrhea, rectal urgency, tenesmus

225

Radiograph of UC

"Lead pipe" appearance of haustra

226

Murmur of MVP moves closer to S1 with ___

Anxiety (shorter diastole)

227

Murmur of MVP moves closer to S2 with ___

Lying down (more venous return)

228

Cave explorer in Arizona with resp infection

Coccidiodomycosis

229

Begin treatment for DKA with ___

Volume replacement

230

Turner's syndrome has what type of coarctation?

Preductal

231

Lung findings in ARDS

Atelectasis (massive intrapulmonary shunting due to lack of surfactant); hyaline membranes composed of protein

232

S. aureus food poisoning

1-6 hours after eating (preformed toxin); self-limited

233

MCC of iron deficiency in young child

Meckel's diverticulum

234

Deficiency associated with ileal resection

B12, bile salts (DEAK)

235

Deficiency associated with jejeunal resection

Folate (B9), most water/sodium

236

Deficiency associated with duodenum resection

Iron

237

Unequal pulses in upper extremity

Dissecting aortic aneurysm

238

Diabetic lower leg with pigmented lesions

Necrobiosis lipoidica diabeticorum

239

MCC of esophagitis in AIDS

Herpes

240

URI in child followed by epistaxis and petechia

ITP (IgG against platelets, T2HS)

241

Bridge painter in NYC with resp infection

Histo (starling dung) or cryptococcus (pigeons) --> amphotericin

242

Rat poison ingestion

Contains warfarin; treat with Vit K, FFP

243

ABO incompatibility

Spherocytes in cord blood, + direct Coombs on cord blood RBCs, mild hemolysis (jaundice in 1st 24 hours)

244

Child with rash and skin infiltrate with CD1 cells

Histiocytosis X (most likely: Letterer Siwe dz)

245

Elderly man with low back pain -- what do you do?

Check the rectal exam, alk phos for prostate metastases

246

MC benign brain tumor

Meningioma

247

MCC of pediatric HTN

Kidneys (Wilm's, renal dysplasia), adrenals (neuroblastoma)

248

Hamman's sign

Crunching chest due to subcutaneous emphysema (trauma)

249

Athlete with jaundice and elevated serum transaminases, Alk Phos

Anabolic steroids (cholestatic jaundice)

250

Port wine nevus on face in trigeminal distribution with ipsilateral AV malformation in brain

Sturge Weber dz

251

Polyarteritis nodosa

Vasculitis with urticaria, fever, arthralgia, nephrotic syndrome, hepatitis (Hep B)

252

Flat hyperpigmented lesion on forehead/cheeks of woman

OCP/pregancy (melasma)

253

Axillary freckling in patient with HTN

Neurofibromatosis

254

Blurry vision, dry mucus membranes, ptosis, facial weakness, dilated pupils

C. botulinum food poisoning (like atropine)

255

Patient with dysphagia and fetid odor to breath

Zenker's diverticulum

256

Young man with low back pain and limited chest movement

Ankylosing spondylitis (vertebral kyphosis)

257

Oxidizing UCB into harmless water soluble dipyrroles

UV light in physiologic jaundice of newborn

258

Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: up

Graves' disease

259

Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: down

Factitious thyroiditis

260

Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: up

Thyroiditis (acute, subacute)

261

Total Serum T4: down
Resin T3 uptake: down
Free T4 index: down
TSH: increased
I-131: down

Primary hypothyroidism (Hashimoto's)

262

Total Serum T4: down
Resin T3 uptake: down
Free T4 index: down
TSH: down
I-131: down

Secondary hypothyroidism

263

Total Serum T4: up
Resin T3 uptake: down
Free T4 index: normal
TSH: normal
I-131: normal

Increased TBG (pregnancy)

264

Total Serum T4: down
Resin T3 uptake: up
Free T4 index: normal
TSH: normal
I-131: normal

Decreased TBG (androgens)

265

Flu-like syndrome, hyponatremia/hyperkalemia (interstitial nephritis), silver stain

Legionella

266

MCC of myocarditis, pericarditis, aseptic meningitis

Coxsackievirus

267

High AFP

Open neural tube defects, HCC, yolk sac tumors

268

Drugs that increase surfactant

Glucocorticoids, thyroxine

269

ECG changes in hypercalcemia

Short QT

270

ECG changes in hypokalemia

U waves

271

ECG changes in hypercalcemia

Long QT

272

ECG changes in hyperkalemia

Peaked T waves

273

Polycythemia differential

Relative polycythemia (volume depletion), polycythemia vera (Epo suppressed), epo-secreting tumors, hypoxic stimulus (low SaO2)

274

Leukemias by age:

60: CLL

275

MC ALL

CALL-A + pre-B cell ALL

276

AD, spectrin deficiency, increased osmotic fragility

Congenital spherocytosis

277

Peroxide damaged Hb in RBCs in G6PD deficiency

Heinz bodies

278

Howell Jolly body

Asplenia

279

Antibody screen of serum

Indirect Coombs test

280

Pb deposits in ___ of bone

Epiphyses

281

Generalized lymphadenopathy in elderly man, malignant B cells, hypogammaglobulinemia, massive splenomegaly

CLL

282

AST>ALT, increase in GGT

EtOH consumption

283

HLA loci associated with T1 diabetes

HLA-DQ, HLADR3/4

284

Deviation of uvula to opposite side in exudative tonsilitis

Peritonsillar abscess

285

MCC of nephrotic syndrome in children, loss of negative charge

Minimal change disease

286

MCC of nephrotic syndrome in adults, subepithelial deposits ("spikes"), HBV association

Membranous GN

287

MC renal disease in AIDS, renal transplant, IVDU

FSGS

288

Wire looping in glomerulus

SLE

289

T1 membranoproliferative GN

HCV, tram-tracking, subendothelial deposits

290

T2 membranoproliferative GN

C3 nephrotic factor (autoantibody against C3), dense deposits in GBM

291

Foamy macrophages in lamina propria

Whipple's disease

292

Childhood version of ALS

Werdnig-Hoffmann (floppy baby)

293

MC space-occupying lesion in AIDS

Toxoplasmosis

294

Prolonged PR interval

First degree block

295

Weight lifter with weakness in hand, numbness, absent pulse

Thoracic outlet syndrome (anterior scalene compresses subclavian a., brachial plexus)

296

MCC of AAA

Atherosclerosis

297

Sx of ruptured AAA

Left flank pain, hypotension, pulsatile mass

298

Wilm's tumor associations

Aniridia, HTN

299

CXR with right middle lobe pneumonia obscuring heart margin

Bronchogenic carcinoma or aspiration while supine on R side

300

Sterile pyuria (WBCs) and negative culture

Renal TB or chlamydia

301

Antimicrosomal antibodies

Graves disease and Hashimoto's thyroiditis

302

Neonatal pneumonia, afebrile, staccato cough, eosinophilia, wheezing

Chlamydia infection in birth canal

303

Platelet dysfunction and hemorrhagic pericarditis

Uremia from renal failure

304

Consequences of essential HTN

Charcot-bouchard aneurysms (putamen bleeds), concentric LVH, hyaline arteriolosclerosis, nephrosclerosis

305

Hyperextension of PIP, flexion of DIP joint

Swan neck deformity in RA

306

Flexion of PIP and extension of DIP

Boutonniere's deformity

307

Atlantoaxial joint subluxation

Associated with RA, risk for vertebrobasilar insufficiency

308

Coal worker's pneumoconiosis or silicosis + RA lung disease

Caplan's syndrome

309

RA associations

ACD, reactive amyloidosis, Sjogren's syndrome, Felty's syndrome (autoimmune neutropenia + splenomegaly), carpal tunnel syndrome, uveitis, Baker's cyst, pulmonary disease, fibrinous pericarditis

310

autoimmune neutropenia + splenomegaly in RA

Felty's syndrome

311

Psoriasis signs

Hyperkeratosis, regular rete ridge hyperplasia, munros microabscesses, superficial dermis next to epithelial surface (Auspitz sign), erythematous salmon-plaques with silvery scales, nail pitting, psoriatic arthritis (HLA-B27+), elbows + scalp

312

Fatty casts with maltese crosses

Nephrotic syndrome

313

Associations with pheochromocytoma

VHL, NF1, MENII

314

High output heart failure

Hyperthyroidism, B1 deficiency, too much isotonic saline, AV fistula, endotoxic shock, Paget's

315

Chest pain on exertion with ST depression, relieved by nitroglycerin

Stable angina (~75% occlusion)

316

Chest pain at rest, "infarct waiting to happen"

Unstable angina (Thrombosis of occlusion)

317

Chest pain from vasoconstriction, ST elevation on stress EKG

Prinzmetal angina

318

___ = massive intrapulmonary shunting

ARDS

319

MC site of diverticulosis, polyps, cancer in GI

Sigmoid colon

320

Hepatotoxicity of INH

Metabolite - acetylhydrazine, 10-20% of cases

321

Drugs causing acute hepatitis

INH, salicylates, halothane, methyldopa, phenytoin, ketoconazole

322

Hepatotoxicity of halothane

1 week post-op, fevers then jaundice, p450 metabolites

323

Drugs causing chronic hepatitis

Methyldopa (+ Coombs test), acetaminophen, aspirin, INH, nitrofurantoin, halothane

324

Zonal necrosis (I)

Yellow phosphorus, ferrous sulfate

325

Zonal necrosis (III)

Carbon tetrachloride, acetaminophen

326

Drugs causing intrahepatic cholestasis

Non-inflam: OCPs, steroids
Inflamm: erythromycin, amoxicillin-clavulanic acid, chlorpromazine, thiazides

327

Drugs causing liver fatty change

Single droplet: EtOH, corticosteroids, amiodarone

Microvesicular: tetracycline, valproic acid

328

Drugs causing liver fibrosis

MTX, too much Vit A

329

Drugs causing granulomatous hepatitis

Allopurinol, hydralazine, sulfonamides, phenylbutazone

330

MCC of ischemic ATN

Prerenal azotemia

331

MCC of nephrotoxic ATN

Aminoglycosides and contrast

332

Causes of renal papillary necrosis

Acetaminophen+ASA, DM, sickle cell, acute pyelonephritis

333

Epidydimitis

35: Ecoli, Pseudamonas

334

IUD infection

Actinomycosis with sulfur granules

335

Endometritis

Plasma cells present; group B strep

336

Goodies in the rectal pouch of Douglas

Induration 50: ovarian mets
Unclotted blood: ruptured ectopic
Pus: PID

337

B-HCG function

LH analog that maintains CL for 8-10wks of pregnancy, then placenta takes over

338

Painless vaginal bleeding in pregnancy

Placenta previa (implantation over cervical os)

339

Painful vaginal bleeding in pregnancy

Abruptio placenta (retroplacental hemorrhage, maternal HTN or cocaine use)

340

Urine estriol source

Fetal adrenal, placenta, maternal liver

341

Implantation on day 21

3 days in tube, 2 days in uterus

342

Duffy antigens

Surface receptor for P vivax, uncommon in blacks

343

I antigens

Cold agglutinins in M. pneumoniae (IgM), infectious mono (IgM)

344

O blood group

Universal blood donor; universal plasma recipient

345

AB blood group

Universal blood recipient; universal plasma donor

346

Risk of HIV + post-needle stick

1:300

347

Cryoprecipitate contains. . .

Factor VIII, fibrinogen, factor XIII, fibronectin

348

Rh HDN

Second prgenancy: anti-D IgG cross placenta --> attach to fetal RBCs --> extravascular hemolysis by fetal spleen --> unconjugated bilirubinemia, anemia --> mama liver takes care of UCB but still have risk of HF/hydrops fetalis

At delivery, baby needs exchange transfusion for UCB and anemia correction

349

Febrile transfusion rxn

Patient has anti-HLA antibodies against donor leukocytes, release of pyrogens (T2 HS)

350

Allergic transfusion rxn

Patient has H1S against donor antigens

351

Hemolytic transfusion rxn (ABO mismatch)

IGM: Complement activation --> intravascular hemolysis (T2 HS)

IGG: extravascular hemolysis, jaundice, Hb drop, + Coombs (T2 HS)

352

Polyarteritis nodosa

HBsAg, T3 HS vasculitis of muscular arteries, different ages of lesions, renal infarcts, p-ANCA, pulm sparing

353

Legg-Perthe

Femoral head, child <10, aseptic necrosis

354

Definitive test for Zollinger-Ellison

Secretin challenge: paradoxical increase in gastrin

355

Characteristic rash of glucagonoma

Necrolytic migratory erythema + DM

356

Signs of VIPoma

Normal gap metabolic acidosis, hypokalemia, achlohydria

357

Gap junction test

Dye passes from one cell to the next

358

Tibial n. function

Plantarflexion, inversion, sensory to sole of foot

359

Aortic/pulmonic valves

Lined by endothelium with abundant fbiroelastic tissue + dense collagenous core; avascular

360

Mitral/tricuspid valves

Loose connective tissue core (increased in prolapse)

361

Winged scapula

Long thoracic nerve (serratus anterior paralysis)

362

Patient with nosebleed and rhinorrhea

Fracture of cribiform plate in ethmoid sinus

363

MLF demyelination

INO

364

Meiosis I arrest for oocytes

Prophase

365

Meiosis II arrest for oocytes

Metaphase

366

What runs along the radial a.?

Median nerve

367

Artery affected in femoral neck fracture

Medial femoral circumflex a.

368

Collagen X location

Epiphyses of bone

369

Wallerian degeneration

Schwann cell proliferation --> tube for guiding axon from proximal surviving fraction

370

Nerve injured in midshaft humerus fracture

Radial n.

371

Bilateral lateral rectus palsy

Increased ICP

372

Parinaud syndrome

Paralysis of upward gaze in infant (hydrocephalus 2/2 stenosis of aqueduct of Sylvius)

373

Weakness of quads/absent knee jerk

Herniated L3-L4 disk

374

Pain in hip/lat quads, numbness of AL leg and webbed space between great toe, weakness of dorsiflexion, nl knee/ankle jerk reflex

Herniated L4-L5 disk (compresses L5)

375

Numbness along PL leg, plantar foot, absent ankle jerk

Herniated L5-S1 disk

376

What level does herniated disc affect, and why?

Protruded disc usually compresses next lower nerve as that nerve crosses level of disc in its path to its foramen (higher nerve escapes!)

377

C8-T1 nerve palsy

Klumpke's

378

C5-C6 nerve palsy

Erb-Duchenne

379

Paralysis of CNIII after head injury

Uncal herniation (ptosis, mydriasis)

380

Wrist bone with highest incidence of avascular necrosis

Scaphoid bone

381

Injury to median nerve and brachial artery --> forearm muscle damage

Volkmann's ischemic syndrome

382

A band in skeletal muscle has ___

Myosin ATPase

383

Site of obstruction in asthma, CF, chronic bronchitis

Terminal bronchioles

384

Weakened palate/gag reflex, trapezius/SCM weakness, loss of posterior taste sensation

Schwannoma in jugular foramen (X, XI, IX)

385

CNIII lesion with UMN signs and midline, midbrain lesion

Weber syndrome

386

C2 transection of fasiculus gracillis

Affects LE only

387

Loss of P/T and CL UMN signs

Mid pons lesion

388

Why cyclosporine in identical twin transplant?

Some difference in MHC sites from crossover during meiosis ?

389

Lymphocyte common marker

CD45

390

Rodents, ARDS, hemorrhage, renal failure

Hantavirus

391

Protein A

Attaches to Fc-R in macrophages and blocks opsonization

392

Pneumonitis and ova in stools

Ascaris or hookworms

393

Pneumonitis and rhabditiform larvae in stools

Strongyloides

394

Cells that attack protozoans

CD4 T cells

395

"Breakbone fever", hemorrhagic, Aedes mosquito

Dengue

396

Live vaccines

MMR, varicella, OPV, BCG, smallpox, yellow fever

397

Spring/summer colds

Adenovirus

398

Winter/fall colds

Rhinovirus

399

Pruritic skin lesion in Gulf War veteran

Cutaneous leishmaniasis from sandfly bite

400

Verrucoid lesion in LE from S. America patient

South American blastomycosis, yeast with ship's wheel appearance

401

ELISA test for HIV

anti-gp120 antibodies

402

Biochemical processes in both mitochondria/cytosol

HUG - heme synthesis, urea cycle, gluconeogenesis

403

Glucokinase

High Vm, high Km, only in liver

404

Hexokinase

Low Vm, low Km, all cells, inhibited by G6P

405

Ketoacidosis

Increased beta-oxidation of fatty acids and production of acetyl CoA --> ketone bodies synthesized by liver

406

Rx for schistosomiasis

Praziquantel

407

Rx for benzo OD

Flumazenil

408

Rx for malignant hyperthermia

Dantrolene (reduced Ca++ release from SR)

409

Rx for acetominophen OD

N-acetylcysteine (Replaces GSH)

410

Mech of loop diuretic

Blocks NKCC in TA; in renal medulla

411

Rx for cyanide poisoning

Amyl nitrite and thiosulfate

412

Xanthine oxidase rxns

Hypoxanthine --> xanthine, xanthine --> uric acid

413

Endocarditis prophylaxis

Amoxicillin

414

Blue-grey skin

Chlorpromazine and arsenic

415

Toxic epidermal necrolysis

Barbituates, sulfonamides, phenytoins, NSAIDs

416

Maculopapular rash

Amoxicillin, TMP/SMX, ampicillin/penicillin

417

Elderly woman on thiazides may develop ___

Gout

418

Antipsychotic producing visual sx

Thioridazine

419

Substitute for ASA in stroke prevention

Ticlopidine

420

Finasteride

Blocks 5-a-reductase (T-->DHT)

421

Ketoconazole

Inhibits T synthesis

422

Leuprolide

GnRH analog

423

Rx for arsenic poisoning

Dimercaprol

424

Chloroquine fails to cure malaria (vivax/ovale)

Can't hit hypnozoites in liver (use primaquine)

425

Methanol tox

Optic n. degeneration and blindness due to formic acid, rx ethanol

426

Major site of water reabsorption in GI tract

Jejeunum > ileum > colon

427

Most effective nephron site for acid excretion

PT

428

Nephron site for greatest generation of free water

TAL in medulla

429

S1 heart sound correlates with ___ wave in JVP

C wave

430

Carotid massage

Decreased HR / increased vasodilation --> inhibits tonic discharge of vasoconstrictor nerves and excites vagal innervation of heart