High Yield Flashcards
(278 cards)
1
Q
In hypovolemic shock, you give fluids to do what two things:
A
- Increase preload (extend end diastolic sarcomere length of the myocardium).
- Decrease sympathetic response of TPR
2
Q
Coronary autoregulation via two things:
A
- NO* (released in response to NE, AcH, endothelinin, bradykinin, histamine)
- adenosine
3
Q
Cardiac Catheterization:
A
Pulmonary Cathet. Wedge Pressure = Left atrium end diastolic pressure = pulmonary artery pressure distal to site of occlusion
Normal: LAEDP = LVEDP
Mitral stenosis: High LAEDP / Pulm Wedge > LVDEP
Aortic Stenosis: High LVDEP
4
Q
Paroxysmal supraventricular tachycardia
A
- most common paroxysmal
- Similar to A -fib: Due to re-entrant impulses traveling through both slow and fast segments of AV node.
Dx: Sudden HTN, Tachy, palpations
Tx: Carotid massage: increase parasymph NS –> prolongs AV node –> slows HR. (risk syncope!)
If not a choice, think:
- Pheochromocytoma (with periodic H/A)
- Cocaine (with dilated pupils and chest pain = NE inhibited repute ant post synaptic cleft)
5
Q
bobbing head + diastolic high pitch murmur
A
Aortic regurgitation: back flow (hence diastolic)
Marfans, SLE, RHA, endocarditis, syphillus, ankylosing spondylitis
6
Q
diastolic rumbling murmur over heart apex + opening snap
A
Mitral valve stenosis: valve opening
7
Q
Explain Thyroid hormone synthesis
A
- Thyroid follicles oxidize Iodide –> Iodine in the lumen
- In the Thyroglobulin via thyroid peroxidase: Iodine + tyrosine –> MIT + DIT (di-iodo-tyrosine)
DIT + DIT –> T4
DIT + MIT –> T3 - Thyroglobulin now has I2 + T4 + T3 + MIT + DIT and is ingested as a whole by lysosomes
- Iodotyrosine deiodinase recycles iodine from left over MIT and DIT AND causes T4 –> T3 –> rT3 (inactive) , for more T3 (peripheral tissue)
8
Q
thyroid hormone axis
A
Hypothalamus (teritiary)–> TRH –> Anterior Pit. (secondary) –> TSH –> Thyroid gland (primary hypothyroidism = Hashimoto) –> T3/T4
9
Q
Tan Adipose
A
- Fetal Adipose
- [Mt] = hogh O2 requirements = high capillaries
- Heat (No ATP) production via thermogen in oxidative phosphor. of UNCOUPLED ETC.
10
Q
Gestation week with highest hCG
A
Week 9 (trophoblast) - maintains corpus lute until placenta develops (estrogen)
11
Q
Human Placental Lactogen (hPL)
A
- trophoblast
- causes insulin resistance + lipolysis –> high glucose + FA + ketones to be sent to fetus
- Risk gestational diabetes when pancreas can’t overcome hPL.
12
Q
Anovulation
A
- when the hypothal-pit-ovarian axis isn’t working
- ovarian follicle is released and turns into the corpus lute, but doesn’t make progesterone (although High Estrogen due to active ovaries)
- Endometrium remains in proliferative stage = irregular menstruation
13
Q
Confirm menopause
A
-no estrogen = no active ovaries = no feed back = high FSH (early) + LH (later)
14
Q
Neurophysins
A
Carry signals from hypothalamus to posterior pituitary gland: ADH (supraoptic nuclei) + Oxytocin (paraventricular nuclei)
15
Q
Secretin
A
- Released from pancreas and stomach
- Peptide hormone for water hemostasis
- Acidic –> S cells –> secretin –> Duodenum–> basic
16
Q
Pancreatic Juices
A
- Secretin
- HCO3
- Normal Na and K
- Low Cl
Trypsin (Trypsinogen) –> activates chemotrypisin, phospholipase A2 and eleastase
Lipase: Lipids –> FA
Amylase: poly (starch) –> monosaccharides (2 glucose)
17
Q
Stomach acid secretion 3 stages
A
- Cephalic = smell/though = cholinergic + vagal
- Gastric = Gastrin = Histamine
- Intestinal = protein in duodenum = peptide YY causes low acid secretion
18
Q
40 + fat + female
A
Post fatty meal = Cholysitis
- Gall stones (i.e. biliary colic).
Risk: necrotic gallbladder = acute calculous cholecystitis (gallbladder obstruction at the cystic duct –> ischemic mucosal layer disruption –> bacterial invasion)
Mechanisms:
A) when fat enters duodenum (site of lipid resorption), I cells in duodenum and jejunum make Cholecystokinin which causes gallbladder contraction and stasis –> bile concentration –> sludge –> cholesterol stones
B) High Estrogen and Progesterone:
E –> cholesterol synthesis –> liver HMG-Coa reductase –> bile + insoluble cholesterol –> bile salts + phosphotidycholine + small water soluble cholesterol (via 7-alpha-hydroxylase)
P –> slows bile secretion –> slows gallbladder emptying
C) when 7-alpha-hydroxylase is impaired, cholesterol cannot become water soluble
D) Chrons Disease = terminal ileum inflammation –> transmural inflammation (NF-KB = cytokines = inflamm) –>
(1) stricture --> no site of bile acids recycling for FA digestion = thus bile salt has a higher ratio of cholesterol to bile acid = cholesterol ppt due to bile acid wasting (2) fistulas --> caused from inflammation which lead to ulcers. (3) non-caseating granulomas (like sarcoidosis)
In ulcerative colitis, its not transmural (only mucosa and submucosa) inflammation. Thus no fistulas forms. Has continuous mucosal damage with the rectum always involved. Bloody Diarrhea with or without ab pain. Churns Disease always has ab pain.
E) Gallstone at ileocecal valve = gallstone ileus = air in biliary tree (not calcified pancreas which is chronic pancreatitis)
F) Black pigmented gallstones = unconjugated bilirubin precipitates as calcium bilirubinate due to chronic hemolysis
19
Q
Morphine mechanism
A
- mu receptor –> 2nd messenger C coupled –> K efflux and low Ca influx –> hyper polarization at post synaptic.
- tolerance is via glutamate
20
Q
Hep A person with IgM means what?
A
Re-infection
21
Q
Jugular vein distention + low BP + High HR
A
Cardia Tamponade
22
Q
Bicuspid aortic valve causes
A
- Sudden infant death
2. the usually tricuspid arctic valves will eventually use aortic stenosis in the 50’s
23
Q
Kidney Stone composition
A
normal blood Ca + High urine Ca
(High blood Ca + Urine Ca = HyperPTH or sarcoidosis)
High oxalalate intestinal resorption
- Renal canaliculi causes stones
- You need P, Ca, low water, acid,
- High citrate will prevent it
COLA amino acids (Cysteine, ornithine, lysine, arginine) will result in stones
Cysteinuria = hexagonal shaped crystals in urine = Amino Aciduria
- COLA amino acids can’t be reabsorbed in the proximal renal tubes, leading to supersaturation and hence cystine stones
NOTE: Other kidney stone causes:
- Hypercalciuria (Sarcoidosis)
- Hyperoxaluria (Chron’s)
- Hyperuricosuria (Gout)
- Hypocitraturia (Distal tubular acidosis)
- Hyperaciduria (Cystien)
24
Q
Pyelonephritis
A
Urine back flow (vesicouretal junction) into the kidneys
- Leads to UTI in women
Labs show high WBC counts
25
Myasthemia Gravis
- Antibodies destroy AcH receptors at post synaptic cleft (overall synaptic AcH remains the same) --> no motor end plate potential --> no muscle depolarization
- Muscle weakness (Eye movement gets worse with activity, but rest relieves symptoms)
Tx: Anti-cholinesterase (increase AcH), If causes GI issues you must use a muscarinic receptor antagonist = scopolamine.
26
provoke asthma
Methacholine, histamine or cold air
27
Alpha-q-antitrypsin deficiency
emphysema or COPD (low elastase/anti-protease)
28
Lung infection (cough/sputum) + dyspnea
COPD or emphysema
| - Air is obstructed due to no elastin in bronchus and low alveolus (low surface area)
29
Chest X-ray shows flat diaphragm or hyper inflated lungs
COPD or emphysema
| - inflated lungs are due gas being stuck due to air flow resistance
30
4 causes of hypoxia
1. Hypoventilation (Resp. Acidosis)
2. Ventilation-Profusion mismatch (V/Q): embolism (Resp. alkalosis)
3. R to L shunt
4. Diffusion impairment: pulmonary fibrosis, end stage lung cancer, emphysema, exercise
31
Spirometry shows what in COPD patients
1. Low FEV1/FVC ratio
32
Restrictive lung diseases such as pulmonary fibrosis will show a
LOW FRC (functional residual capacity = RV + ERV)
33
Interstitial lung disease will be at risk for:
pulmonary fibrosis
34
Bronchitis + dyspnea + diffuse lung radiopacities
Interstitial fibrosis
- Has elastic recoiling (wide air way = radial traction, or outward pulling by fibrotic tissue, on airway walls)
Opposite of COPD Dx:
1. High FEV1/FVC
2. Low FRC, TLC, RV
35
High RR + Low Tidal Volume
Pulmonary fibrosis
36
High Lung compliance =
| Low Lung complaince =
A. Emphysema (low elastic)
| B. Pulmonary fibrosis (High elastic)
37
Paget Disease
Defect in bone metabolism: Osteoclast --> mixed phase --> osteoblast = bone over growth / mosaic lamellar bone that is dense but hypo vascular = weaker = prone to fracture
- High alkaline phosphatase (osteoblast)
- bone pain
Risk: Osteosarcoma
38
ADH acts via two mechanisms
V1 --> vasoconstriction of blood vessels -> increase BP
V2 --> medulla collecting duct --> cAMP --> aquaporin 2 --> ADH response (high urea, low water) --> decrease osmolality --> increase BP
39
Calculate renal blood flow
1. Use PAH (proximal duct secretion OR K+ collecting duct resulting in amount excreted > amount filtered)
2. RBF = RPF / 1 - hematocrit)
where RPF = PAH clearance = (urine [PAH] x urine flow / plasma [PAH])
40
mast cells will cause what in the bowel?
mast cell --> histamine (H2 receptors and increase cAMP) --> Gastric hyper secretion.
Other gastric acid stimulators:
1. AcH or grastrin + M3 receptor --> Ca+
41
High Ca + cancer
PTH related peptide (not PTH alone) = humoral hypercalcemia of malignancy
42
Normal Ca and PTH levels, but fracture prone
osteoporosis
43
multinucleus cells from bone
osteoclasts
| - Think paget disease if presented with multiple areas of bone pain
44
Frothy urine
proteinuria or bile salts in urine
45
ACE inhibitor mechanism
- Elanopril
- Decrease Angio II
Remember Angio II causes:
1. vasoconstriction of EFFERENT a.
2. increase adrenal cortical aldosterone
46
Abdominal pain + red urine after standing for 24 hours + normal liver
Porphyrin synthesis abnormality
| Tx: Dextrose
47
Urinary incontinence causes
1. Surge (laugh) = high ab. pressure > sphinctor OR urethral issue
2. Urge (frequency) = over-activation detrusor
3. Overflow (dripping or unfinished urination) = low detrusor contraction OR bladder obstruction (tumor > 50 yrs)
48
high 5-HIAA in urine
metastatic carcinoma
49
Deficient CD55, CD59
Paroxysmal nocturnal hemoglbinuria
| - Causes complement activation
50
RBC without central pallor
spherocytosis
- mild dehydration of the RBC
- RBC membrane cytoskeleton abnormalities (spectrin, ankyrin)
- causes high MCV
RISK: parovirus B19 infection, spleenomegaly, anemia, jaundice
51
high lactate dehydrogenase
Hemolysis
Ex: hemolytic anemia
Also seen in idiopathic membranous nephropathy due to renal vein thrombosis (due to loss of antithrombin III that is lost, along with other things, with the high capillary permeability found in nephrotic syndromes )
52
High gamma globulin
M protein with high monoclonal immunoglobulins
| Ex: multiple myeloma (plasma cell neoplasm)
53
Microcytic vs macrocytic anemia
```
Micro = Fe deficiency
Macro = VB12 or folate deficiency = hyper-segmented PMN. Its VB12 when you have neurological symptoms (i.e. decreases sensation)
```
54
Hypotension, Tachy, Rapid Breath, High/Low temp (fever)
OR
fever + chills + high BC + High PMN
```
Septic Shock (TNF-alpha)
- in sickle cell patients--> splenic --> encapsulated bacteria will cause septic shock = Step. pneumonia or Hem. influenza
```
55
vascular lesion + IgA + C3
OR
child + develops after a respiratory disease + bloody stools + bloody urine + palpable skin lesions
Type of immune complex vasculitis called Henoch-Schonlein purpora (most common small vessel vasculitis in children)
- Systemic hypersensitivity rxn
- Presents with rash (palpable purpura), ab pain (GI pain), polyarthralgia (joint pain)
- Risk: Glomerulonephritis
56
White pupillary reflex
Retinoblastoma (most common childhood eye cancer)
Mutations of two Rb genes
Risk: Osteosarcoma
57
Ewing Sarcoma
long and flat bones of children
- neuroectoderm
- May resemble acute osteomyelitis
58
medullablastoma
most common childhood malignant brain tumor of the cerebellum
59
immobile sperm
Primary Ciliary Diskinesia
- Form of Kartagner Syndrome
- Impaired dyne arms
- Clinical: infertility + bronchial dilation + sinusitis
60
Ventircular hypertrophy is seen in
1. HTN
2. Hemolytic anemia (due to Fe deposits)
3. Cardiomyopathy
4. CHF
5. Ischemic heart disease (results in heart failure)
Note: normal aging decreases heart size, causing sigmoid shape septums
61
Vaginal discharge + positive pregnancy test + normal villi + triploid karyotype
partial mole (low risk cancer)
NOTE: complete mole (high risk cancer)
Vaginal discharge + no positive pregnancy + 46XX or XY + trophoblast grape clusters
Both have trophoblast
62
S3 + holosystolic over heart apex + dyspnea + lung crackers + meds solve symptoms
functional mitral regurgitation (Tx: Diuretics which decrease EDV of the Left ventricle)
- When meds do not solve issue --> chorda tindinae rupture issue with infective endocarditis
63
Artheroscelrotic plaque MI risk
the plaque has a fibrous cap that is constantly being remodeled by macrophages, which degrade the college via mettaloproteinases (NOTE: the body responds by dilating the arteries...the body has time to do so because the plaque is slowly growing)
Lysyl oxidase strengthens the collagen cap!
Plaque over-all mechanism:
endothelial injury --> endothelial permeability --> leukocyte attachment + platelet + growth factors + cytokines --> smooth cells migrate from intima media
Tx: adenosine or dipurimadole
- increase in arteriole dilation. This causes more flow to normal tissue, and less to the already maximally dilated artieries affecting ischemic tissue
Body protects against platelet aggregation via endothelium secretion of prostacyclin
Irreversible Injury = Mt with vacuoles or phospholipids --> can't produce ATP via oxid. phosph
64
Zollinger-Ellison syndrome
PUD --> Gastrinoma risk (Gastric acid tumors of the pancreas)
- G cells = gastrin = gastric acid
Dx: High gastrin levels in response to secretin release (Should be opposite)
NOTE: VI peptide (Vasoactive Intestinal) is made by pancreas islet and gastric mucosa to relax GI smooth muscle, inhibit acid, and stimulate bicarb from pancreas (like secretin).
Duodenum S cells = Secretin = FA activity in duodenum = causes pancreas and bile to release bicarb = decrease acidity
Somatostatin Delta cells = decrease acid and all GI hormones
Other causes of Ulcers in duodenum = H. pylori, NSAIDs (But should see high gastric acid with low secretin)
PUD Hx + high alkaline phosphatase (bile tree destruction) + onion skin histology = sclerosing cholangitis
65
somatostatin
decreases all GI hormone (gastrin, secretin, VI peptide, cholecsyokinin)
Without somatostatin (Delta Cells) --> High gastrin --> parietal cells release acid --> duodenal ulcers
66
Types of diarrhea
1. secretory = tea colored + odorless (VIPomas)
2. inflammatory = pus + blood
3. osmotic = lactose/diet intolerance
67
Tea colored diarrhea + odorless
VIPomas
68
High bilirubin + death
think Crippler-Najjar syndrome
| - No UGT (uridinediphosphate-glucornyl-transferase) enzyme from conduction in liver ER.
69
HIV + blurred vision
CMV induced retinitis from retinal detachment due to tearing of thin, scar tissue post inflammation
Tx: Ganciclovir (similar to acyclovir but is stronger specifically against CMV DNA polymerase)
70
older person + progressive vision loss + gray macula
age related macular degeneration
Types:
1. Wet = Acute vision loss within weeks (ECM accumulation --> hypoxia --> vascular endothelial growth factor + gray/green retina
2. Dry = gradual vision loss (oxidative retina pigment damage) + retinal duress deposits
71
painful swallowing
esophagitis (in HIV, think CMV, candida or HSV-1)
72
pneumonocystic pneumonia
Pneumonocystis jiroveci (only occurs in immunocompromised patients)
73
periodic + long duration + large amplitude + non-peristalic
Angina Pectoris
74
inability of the lower esophageal sphincter to relax during swallowing
Achalasia
- relaxing of the LES is to allow the food bolus travel to the stomach.
- In achalasia, the LES is elevated to prevent this.
NOTE:
- cricopharyngeal m. is in the UES which contracts to push the food bolus into the esophagus resulting in inability to swallow = choking sensation
- uncoordinated contractions results in diffuse esophageal spasms with non-cardiac chest pains
- GERD: opposite of achalasia
75
Alcoholic that persistently vomits + mucosal wall tears
Mallord-Weiss tears
- upper esophagogastric junction mucosal tear
- leads to metabolic alkalosis (loss of gastric acid)
76
High serum iron + hereditary
Hemochromatosis
| - Intestinal absorption
77
excess copper is excreted via
hepatic excretion into bile
- Accumulation of copper in the organs (i.e. brain and eyes = Kayer-Fleischer rings of copper in cornea) is Wilson's Disease. Also see low ceruloplasmin, test via slit lamp exam.
78
Bright red blood in vomit
GI bleed --> Nitrogen --> converts to ammonia for urea release
79
Liver Cirrhosis
Gynecomastia (liver can't metabolize estrogen)
Edema
Ascites
Spider angiomata (high estradiol)
testicular atrophy / low body hair (high estradiol)
hepatic encephalopathy
malodorous breath (no ammonia recycling)
Portal HTN = esophageal varices, spleenmegaly
80
ischemic effect of myocardial cells at 60 sec and 30 min
60 sec = loss of contractility
| 30 min = irreversible damage due to loss of 50% [adenine]
81
serum creatinine kinase
cell membrane damage in heart, brain, skeletal muscle (i.e. from ischemia, DVT)
82
CHF + drug dilates arterioles and veins + diuretic
Natriuretic peptide
Types:
ANP = Aorta
BNP = Ventricles
Released in response to volume overload (i.e. CHF) to act as vasodilation --> ventricular hypertrophy
83
Dyspnea + must sleep upright
CHF
Mechanism: low renal BP --> low GFR of macula dense --> renin is secreted --> liver secretes angiotensinogen --> Angio I --> ACE converts Angio I to Angio II --> vasoconstriction (increase arteriolar resistance) + aldosterone + sodium retnetion (water retained)
84
Uterus "bunches of grapes"
Hydatidiform mole
- from trophoblast obliteration
Dx: vaginal bleeding + nausea
Risk: Choriocarconoma (monitor B-HcG)
85
Pre-ecamlampsia + seizures
Eclampsia
86
Pregnancy + HTN + edema (leg swelling) + Protenuria
Pre-Eclampsia
- RISK: HEELP
Hemolytic Anemia
Elelvated liver enzymes
Low Platelets
87
Endometrial hyperplasia
Think high Estrogen levels (supplements or tumor = granolas cell tumor)
88
female with facial hair and acne
High androgen levels
89
obesity + facial hair + abnormal menstruation
Polycycstic Ovarian Syndrome
- Obesity = insulin resistance
- Facial hair = androgens
RISK: DM II and endometrial adenocarcinoma
90
Adnexal Mass
CA-125 = Malignant ovarian epithelial tumor
due to high number of ovulations. Thus, lower number of ovulation (with oral contraceptives) result in lower cancer risk
Remember, CA-125 is a poor marker for only ovarian cancer since it codes for cervix, endometrium, fallopian tube cancers)
91
High CEA
colorectal and pancreatic tumor
92
High B-HcG
Pregnancy, trophoblast tumors (Hyadtidiform, choriocarcinomas)
93
High DHEA
Adrenal tumor
94
Cervical Intraepithelial Neoplasia III (CIN III)
HPV 16, 18 (Sex)
95
Female with Hx of PID + ammenhorea + vaginal bleeding
Ectopic Pregnancy = vaginal enlarged (but Uterus is NOT enlarged), soft uterus = hormones mimic normal pregnancy = decidualized endometrium WITHOUT embryonic tissue or chorion
96
normal appearing endometrial glands + enlarged uterus
Adenomyosis (Not ectopic pregnancy bc pt does not have enlarged uterus)
97
post menopause + abnormal bleeding
think Adenocarcinoma
| - Menopause = 50 years old
98
Hypotension + Tachy + Fever / low temp + low Na + high K + hypoglycemia
Shock + low Na + high K + low glucose = Adrenal Crisis (ie. Adrenal Hemorrhage)
99
child + fever + vomit + nuchal rigidity + rash
meningococcal meningitis (N. gonohrrea)
100
meningococcal meningitis + adrenal crisis
Waterhouse-Friderichsen syndrome
Meningitis = Child + vomit + nuchal rigidity + rash
Adrenal Crisis: Hypotension + tacky + fever + low Na + high K + low glucose
101
brain base
sella turcica = anterior (Rathkes pouch) and posterior (hypothalamus neurons) pituitary
RISK: craniopharyngiomas of the Rathke's Pouch
102
most common thyroid cancer
papillary carcinoma
103
Long fingers + arms exceeding height
Marfanoid Syndrome (Also could be MEN2 if with mucosal neuromas which are flesh colored nodules on lips and tongue; along with thyroid mass)
Risk:Medial degeneration --> Aortic disease (Aortic regurgitation/aneurysm)
104
Thyroid nodule + High Calcitonin
Medullary Thyroid Cancer (Parafollicular C cells)
105
High 17-hydroxyprogesterone + testosterone + very early puberty
21-hydroxylase deficiency (adrenal cortical hyperplasia)
| - NOT Leydig cell tumors
106
High catecholamines
Adrenal medullary hyperplasia
107
High TSH + Low T3/T4 + enlarged thyroid gland
Hypothyroidism (Hashimoto's = mononuclear infiltrate into well defined germinal centers = lack of iodine)
108
lower leg skin thickening and induration
Hyperthyroidism (Grave's Disease)
109
most common anterior pituitary gland tumor
Lactotroph (prolactin)
110
MEN1 tumors
3 Ps = Pituitary, Parathyroid, Pancrease
111
Highest risk for DM patients
Coronary artery disease (MI)
112
No dystrophin gene
Duchenne Muscular Dystrophy
- Hypertrophy of muscle fibers (early stage) --> muscle fibers replaced by fat and CT (late stage)
At 2-5 years old, the patient would "climb up" from a squat using his hands
113
High metalloproteinase
impaired healing = contraction, dehiscence (wound opening = abdomen), or scars.
NOT ulcers (which are due to unvascularized areas) or infections
Tumors will show high numbers of metalloprotineases if invasion is high
114
spongiosis
contact dermatitis (CD4 T-cells)
115
BRAFF marker
melanoma
116
SCC
keratin pearls
117
Cancer Growth
Melanoma: active vertical growth (If horizontal and superficial, then the melanoma is benign)
Nipple Inversion in Breast cancer: Suspensory Cooper ligament invasion
118
Psoriasis
Chronic inflammation of the skin --> Salmon colored crusts, well-demarcated plaques with silver skin
v thin or non-existent stratum granulosum + prominent parakerotic stratum corneum.
RISK: R.A. like symptoms
119
Eczema
Chronic inflammation of skin in response to environmental factors (i.e. contact dermatitis, food ingestion).
Impaired skin barrier --> IgE + Eosinophils
RISK: Asthma, allergic rhinitis (Allergy Triad)
120
Slowly growing skin lesion that is bright red
Capillary hemangioma: first increase in size, then regress before puberty.
- Children: Strawberry hemangioma
- Adults: Cherry hemangioma
Spider angiomas: Pregnancy due to increase in vasculature and high estrogen levels
121
Skin tags under the arms, posterior neck or groin (flexural areas) + skin condition +
Acanthosis Nigricans
1. Malignant: Gastric adenocarcinoma
2. Benign: insulin resistance
122
fecal occult test is used for diagnosing....
GI bleeds
123
subcutaneous bums at achilles tendon
xanthomas
| - Lipid filled histiocytes in derma (cholesterol, phospholipids , TGA)
124
longitudinal mucosal tears near astro-esophagus junction
mallory-weiss (Intrabdominal pressure, EtOH)
125
Anti-cholinergic symptoms from overdose of...
atropine, amitriptylin (block muscarinic receptors)
126
multiple long bone fractures risk what?
fat embolisms
127
Fever for > 5 days +
Kawasaki disease
- Medium size arteries
- RISK: coronary artery inflammation --> coronary a. aneurysm
128
Marfan Syndrome with chronic HTN will risk what?
Dissecting aneurysms of the aorta
Aortic Dissecting aneurysms
- pain that radiates to back (retrosternal pain)
- from a tear in the intima (tear from media = Giant Cell Arteritis or Takayasu; tear at vast vasorum is from tertiary syphillus)
129
H/A + epitaxis (nose bleeds) are cause by what?
HTN arteries in the head and neck
130
H/A + epitaxis + large palpable intercostal vessels (pulse on rib cage) + low perfusion on lower extremities (muscle leg weakness)
Aortic coarctation
| RISK: brain aneurysm
131
Kidney presents with a pale-wedge shape lesion, with the apex pointing to the medulla
Coagulative infarct due to the "end organ" nature of the kidneys (small number of collateral vessels)
Mostly due to systemic emboli:
- left atrium or left ventricle
- MI
- A fib
- Aortic aneurism
- infective endocarditis (S. aureus, tricuspid regurgitation)
132
Sudden death of a soccer player
Sudden Cardiac Hypertrophy
- Cardiac sacromere protein mutation --> beta myosin heavy chain --> mitral valve + interseptal obstruction --> left ventricular outflow obstruction
- Inherited
133
Recurrent epitaxis + spider like lesions
Osler-Weber-Rendu Syndrome
134
NF1 versus NF2
```
NF1 = Von Recklinghausen's Disease = peripheral NS tumor = neurofibromas, optic nerve gliomas, Lisch nodules (Iris pigmented nodules), cafe-au-lait spots (hyperpigmented cutaneous macules)
NF2 = main NS tumor = Bilateral CN 8 (vertigo, hearing loss) Shwannomas, meningiomas
```
135
Arthritis (joint pain) + pharyngitis (sore throat) + new heart murmur
Acute Rheumatic Fever (think bacterial endocarditis with young, fatigue, new murmur --> immune complex injury to kidneys)
RISK: severe myocarditis
Chronic RA = Mitral stenosis
136
Explain polyrteritis Nodosa (PAN)
segmental, transmural, necrotizing inflammation of medium to small arteries of any organs
- Can result in ischemia
- Affect: Liver, heart, kidneys, GI tract (NOT LUNGS)
137
Amlodipine
Ca channel blocker = vaso-dilator = anti-HTN = anti-angina
138
Phentolamine
alpha 1, alpha 2 adrenergic antagonist = vasodilator
139
Main cause of aortic stenosis
valve calcification
| - Heart sound: desc-asc rhythm
140
Fluid in heart risks what?
Pericardial effusion --> Cardiac tamponade (pressure) --> atrial collapse --> higher pressure than normal at ventricular septum (jugular venous pressure drops normally decrease systemic venous return --> low preload --> low output --> cariogenic shock (no O2 delivery)
RISK: Pulsus paradoxus (exaggeration of normal decrease in systolic pressure during inspiration. Found in cardiac tamponade, cor pulmonale, pericardial disease). Test with Kaussmaul sign.
141
thick, fibrous tissue in pericardial space
constrictive pericarditis. Effect similar to cardiac tamponade (Kaussmaul sign)
142
"blowing" holosystolic murmur at heart apex risks what?
Mitral Regurgitation secondary to bacterial endocarditis. - - - - Can be seen as Janeway lesions on palm, feet and under the finger nails (micro embolisms, similar but not, primary focal infections)
- RISK in Down Syndrome
143
mid-systolic "rumble" at heart apex
mitral stenosis
| - May cause ventricular dilation --> recurrent laryngeal n. impingement --> hoarseness and dyspnea.
144
machine like murmur
L --> R shunting (PDA = continuous with ascending systolic)
1. PDA = isolated cyanosis + clubbing (unoxygenated blood distal to left subclavian artery). NOTE: a small PDA may not show cyanosis. Tx: indomethacin. Risk: Rubella infections
2. ASD, VSD
Note: whole body cyanosis = teratology of fallot (R-->L)
145
pulsating abdominal mass
abdominal aortic aneurysm (below renal a.)
- transmural inflammation of artery wall --> proteases degrade elastin and collagen -> weak walls
RISK: splenic flexture involvement = watershed infarction
146
Migratory thrombophlebitis
Think Cancer
147
febrile fever (unknown origin) + salicylate
Reye's Syndrome = Liver failure (micro vesicular steatosis of hepatocytes without inflammation and jaundice) and acute encephalopathy (cerebral edema)
148
constipation + narrow rectum
Hirschsprung Disease
- Neural crest cells fail to migrate to intestinal wall.
- Dx: no ganglion cells in the narrow part of the submucosa
+ fails to pass meconium
149
hypotension + hospital bed (not DVT) + upper right abdominal pain
Aute acuculous cholesystitis = no gallstones = just an enlarged and inflammed gallbladder due to stasis
150
AST:ALT ration > 2:1
EtOH hepatitis
Stages:
1. Steatosis (reversible) = Fat vesicles in liver
2. Hepatitis = Hep B with ground class cells in liver = fine granules = eosinophilic in appearance
3. Cirrhosis (Irreversible) = portal inflammation + obstruction of bile tree + liver parenchyma
151
High ALT + High AST + High Alkaline phosphatase
Acute Viral Hepatitis
OR Dx is: IV drug user + fever + jaundice + acidic liver + mononuclear cells + hepatomegaly. The acidophilic cells are from apoptosis post staining.
152
High unconjugated bilirubin (total bilirubin)
Gilbert Syndrome
- slow bilirubin conjugation to direct bilirubin
- but NO LIVER disease
If with liver disease, think biliary atresia
153
Wrist drop + asthma + high eosinophils + antibodies neutrophil myeloperoxidase (p-ANCA)
Churg-Struss Syndrome
| - asthma, sinusitis
154
ischemic heart cells increase in size due to:
retained Ca+ (NOT K, b/c the K/Na-ATPase does not work, and Ca is recycled naturally in the Sarcoplasmic Ret)
155
Endocarditis:
(A) What is a risk factor to predisposition of endocard.
(B) consequence
(C) mechanism
A. valve inflammation and scarring (rheumatic fever)
B. ruptured chordea tendinae
C. Fibrin and platelet deposits --> vegetation
156
chewing difficulty + H/A + temporal artery tenderness
Giant Cell Arteritis (GCA)
- Granuloma inflammation of the media of the artery
- Similar to Takayasu arteritis
157
Rapid jerking involuntary movement
sydenham chorea = NOT parkinsons, but Rheumatic fever (valve heart disease)
158
sharp chest pain + relieved when sits up
not CHF, but acute pericarditis.
This may be due to MI or rheumatic fever.
Test: Frictional rub.
159
varicose veins are complicated by
ulcers, skin infections, stasis dermatitis
| - Varicose veins are dilated and complex leg views due to dysfunctional valves
160
List common sites for atherosclerotic plaque
Abdominal aorta > coronary a. > popliteal a. > nternal carotid > circle of willis
161
non-infectious endocarditis
Cancer in liver and pancreas (mucin adenocarcinomas) --> Pro-coagulants --> hyper coagulable state
- similar to Trousseau Syndrome
162
persistent lymphedema + Hx of mastectomy
RISK: Lymphangiosarcoma
163
Diet supplements risk what cardiac event?
-fluramines cause pulmonary HTN --> R ventricular hypertrophy --> cor pulmonale --> paroxymal pulsus
164
SLE is associated with?
bacterial endocarditis
165
V fib is the most common cause of death in coronary artery disease
ok
166
Mitral stenosis with pedunculated mass
myxoma --> vascular endothelial growth factors --> scattered cells in mucopoly stroma
167
V.V. high BP (240/110)
Emergency HTN --> onion ring artery thickening --> intracranial hemorrhages (papiledema = optic disc thickening)
168
Summary of murmurs
Aortic Stenosis: Loud systolic ejetion --> Ca deposits of leafs
Aortic Regurg: Head bob + femoral pulse
Aorta = Sternal border / heart Base
Mitral stenosis: snap + rumble
Mitral Regurg.: Holosystolic + blowing
Prolapse: Mid-systolic click --> [Chordea tendon] --> [CT] --> myxoma degredation
Tricuspid Regurg.: Holosystolic that increase in intensity with inspiration
PDA, VSD, AVD: L--> R
Teratology of ballot: R --> L
169
Inflammatory GI polyps (Inflam. Bowel Disease)
Think Chrons Disease or Ulcerative Colitis
If transmural inflammation (i.e. fistulas) = chrons
If only at mucosa and submucosa layer (ulcer only,no fistula) = ulcerative colitis
RISK: Toxic megacolon = no neuromuscular activity of the LARGE bowel (intestine) --> distention --> ulcer --> death
Lab Test:
IBD = Barium enema (large bowel radio dye)
Flat plain X-ray = Toxic megacolon (so it won't rupture the ulcers)
170
Malignant polyps are most likely villous or tubular?
Villous, regardless of size.
171
1st degree relative transfer + colon cancer + not the typical polyp +
Lynch Syndrome (Hereditary non-polyposis colon cancer)
- No involvement of mutations, onco-geners
- Due to mismatch repair (no proof reading of DNA)
172
Diverticulitis
Outputting of a weak organ wall via propulsion (pulsion)
Types:
Meckel Diverticulum = Transmural, congenital, intestine wall
Zencker Diverticulum = esophagus
173
Brown pigment stones
Biliary tract infection
174
Black pigment stones
Sickle Cell Disease (chronic hemolytic anemia) or Chron's Disease (due to high cycling of bilirubin)
175
Acute pancreatitis is caused by
1. EtOH
2. Gallstones
3. High Ca
4. High Triglycerides
Will see chalky white lining of mesentery + fat cell destruction (thus High TGA) and Ca deposits
NOTE:
High Cholesterol indicates artheroscleoris, with renal stones
High Urine Oxalate indicates Chron's Disease, with renal stones
176
Right vs Left side colon cancer
RIGHT: SMALLER = Exophytic masses = mimic iron deficiency anemia (weight loss, fatigue) = no obstruction
LEFT: LARGER = Intestinal obstruction (encircle the lumen) = constipation, cramps, distention, vomit, nausea)
177
p53
GI cancer (adenocarcinoma)
p53 is normally an anti-oncogene which kills via APOPTOSIS defective DNA in the GI tract
p53 + DCC = GI adenocarcinoma.
THINK p53 abnormality when sporadic cancers occur (i.e. brain, bone, breast)
BRCA-1 is normally an anti-tumor. But when mutated, causes breast and ovarian cancer.
NOTE:
k-RAS = increases poly size from early --> late adenomas
Adenocarcinoma Phases: APC --> COX 2 --> K-RAS --> p53
K-RAS is the only pro-onco gene (high replicative potential)
178
Inversion of a part of the intestine inside another part of the intestine
intussusception
RISK: meckel's diverticulum or intestinal tumor
179
Does portal vein thrombosis affect the liver?
Causes portal hypertension, but does not affect the liver
Budd-Chiari Syndrome obstructs hepatic vien, which will affect the liver.
180
High alpha-fetal protein
think Hepatocellular carcinoma (High Risk with Hep B and C, NOT Hep A)
NOTE: the most common metastatic cancer of the liver is Metastatic Liver Disease.
181
loss of stomach villi
Celiac's disease
| "flat" intestinal epithelium
182
nocturnal cough + sore throat
GERD (silent)
RISK: Barrets --> esophageal adenocarcinoma
183
Highest risk factor for pancreatic cancer
Smoking
184
neonate with projectile vomiting after every meal
pyloric stenosis
| - smooth m. (pyloric muscular) hypertrophy behind the stomach
185
Parietal Cells are found where
funds and body of stomach
Gastrin --> Parietal cells --> H+
186
Peptic Ulcers think:
NSAIDS or H. pylori
187
Least malignant GI ulcer location
First part of duodenum
188
Clinical sign of malabsorption and the types of malabsorption.
Steatorrhea (foul smelling, frothy, greasy, lots of fat in the stool)
Types:
1. Low Pancreas hormones: No digestion --> Chronic Pancreatitis, Cystic Fibrosis
2. Intestinal mucosa defect: No nutrient transport --> Celiac, Chron's
3. High bacteria: Bacteria compete for food.
Test for malabsopriton: Stool sample for [FAT].
189
Ulcer symptoms + PAS positive
Whipple disease
| Tropheryma Whippi
190
Fluctuating constipation and diahrrea + pain is relieved with bathroom use
Irritable Bowel Syndrome
191
Neonate with areas of thin lucency paralleling the bowel walls + abdominal pain + bloody stools
Necrotizing Enterocolitis
- Preterm birth risks low immune system --> Bacteria proliferation--> to gas gangrene --> perforation --> death
Survivors risk fibrosis --> bowel obstruction
192
most common benign liver tumor
Cavernous Hemangioma
- Enlarge via ectasia (not hypertrophy)
RISK hemorrhage if biopsied
193
Marker for ovarian cancer
CA-125
194
Mechanism of acute appendicitis
Fecalith lumen obstruction --> mucus retention --> distention --> hypoxia --> bacterial proliferation
195
Granulomatous bile duct destruction + infiltration
Primary Biliary Cirrhosis (leads to xanthelsma formation)
196
Tumor at lung apex
Pancoast Syndrome =
| - Arises from superior sulcus (subclavian site). Thus radiates unilaterally with pain from neck down to wrist.
197
Green Fecal mass obstructing lumen distal to ileum
small bowel obstruction
| - RISK: pneumonia or cor pulmonale
198
Asbestos exposure risks:
1. Bronchogenic Carcinoma (common)
2. malignant mesothelioma (Rare)
Mechanism:
1. Epithelial cell injury --> parietal pleural plaques --> Pleural thickening with calcifications
2. Macrophages
3. Pulmonary fibrosis --> Asbestos bodies (gold-brown rods with translucent centers, seen with prussian blue stain)
NOTE: Silica inhalation shows lung apex egg shell calcifications
199
Lung Hilar lymphadenapathy (Hilar Fullness) + Large epithelial cells (non-caseating macrophages)
Sarcoidosis
- High ACE levels
- High Calcium
- scattered granulomas
V. common in young black females
Stages:
1. Hilar fullness
2. Hilar fullness + infiltration
3. Infiltration only
4. Lung fibrosis
200
most agressive lung cancer
small cell carcinoma
- Highly metastatic, thus surgery is not an option, only chemo and radiation.
- Shows neuroendocrine markers: chromogranin and enolase, neurofilaments, synaptophysin
NOTE:
Most common malignant lung cancer: adenocarcinoma (non-small cell carcinoma)
201
air fluid levels in the lungs mean what?
Lung abscess
202
thick bronchi + infiltrates + mucous gland enlargement + squamous cell metaplasia
chronic bronchitis
- Mostly caused by smoking (environmental factor)
- severity is based on submucosal gland enlargement
203
Puffy face + dyspnea + cough + clear heart sounds + bilateral dilated vessels
Impaired venous return due to mediastinal masses = superior vena cava syndrome
RISK: lung cancer, non-hodgkin lymph
204
Harmatoma
Benign tumor of heart and lungs made of cartilage
205
green sputum
Neutrophil myeloperoxidase
| - S. pneumonia
206
CREST Syndrome
Due to pulmonary artery thickening
207
Risk factors of adult resp. distress syndrome
1. Sepsis
2. Shock
No pulmonary edema, which means normal capillary pulmonary wedge pressure
Low lung complaince
208
Neonate + persistent crying + tremors + diarrhea + tachy + Mother with Hx of Hep C
Opioid withdrawal (Neonatal Abstinence Syndrome)
Tx: Methadone or Morphine (Opioids for a short period to withdrawl)
209
Fever + rash + oliguria (Acute Renal Failure) + POST Tx with beta lactic antibiotic (Ampicillin) + Eosinophilia
Drug Induced Interstitial Nephritis (NSAIDs)
- Affects renal interstitium
- A drug induced hypersensitivity rxn (IgE + Cell Mediated Rxn = PMNs, MO)
210
Child + Acute Renal Failure (Red urine) + Diarrhea (Loose bloody stools)
Hemolytic Uremic Syndrome
| - Due to Shiga toxin and E.coli toxin --> injure preglomerular artery endothelium --> [platelets] --> microthrombi
211
Right kidney is v. smaller than the left
Renal Artery Stenosis
- When RBF juxtaglamulerous --> renin --> aldosterone --> vasoconstriction --> increase glomerular flow rate due to the resulting HTN
212
# Define:
1. Selective proteinuria
| 2. Overload proteinuria
1. loss of albumin + minimal bulky protein loss (i.e. IgG) in urine (i.e. minimal change disease --> direct podocyte damage)
2. High amount of low molecular weight proteins in urine (i.e. multiple myeloma with [immunoglobuin light chains in urine]
213
Sickle Cell Disease + Hematuria
Renal Papillary Necrosis (due to ischemia)
- Also caused by:
1. Analgesic Nephropathy (NSAIDs = decreases prostaglandin synthesis resulting in limited RBF)
2. D.M.
3. Acute pyelonephritis and UT obstruction
214
Red urine + Facial edema
Think Glomerulonephritis
| - Age determines prognosis in post-strep glomerulonephritis (Children recover well)
215
Eosinophil-hyaline material layers on small renal arteries (hematoxylin-eosin stain)
non-malignant HTN or DM
216
Surgery at the:
1. cervix risks what?
2. Prostate or bladder?
1. Ligating the ureter (RISK: Hydronephrosis)
| 2. Vesicouretal reflux (RISK: Pyelonephritis)
217
Auto dominant and Auto Rec. poly cystic kidney disease is found mostly in children or adults?
Auto Domin = Adults. As children, kidney's look completely normal where the cysts are too small to see
Auto Rec = Kids (die at first decade due to renal failure, haptic fibrosis, pulmonary hypoplasia)
218
Elderly + easy fatigue + constipation + bone pain (back pain) + renal Failure
```
Mulitple Myeloma
- Fatigue (due to anemia)
- Constipation (hypercalcemia)
- Bone pain (osteoclast via myeloma cells)
Lab: Eosinophil cast + Bence Jones Cells
```
219
painless hematuria
Think Urothelial Cancer (Renal Cell Carcinoma)
- VHL genes
- Histology will show clear cytoplasm from high lipid and glycogen content (which normally is dissolved in the lab solvent, but is retained due to the cancer)
- Golden yellow mass
- Originate from epithelial cells or proximal renal tube
220
muddy brown casts in urine
Acute Tubular Necrosis
- Can result from internal hemorrhage
- Most regain re-epithelialization and normal renal function
Stages:
Initiation: ischemic injury (MI, surgery, hemorrhage)
Maintenance: Low urine output, fluide overload, high BUN/creatinine, High K+
Recovery: High volume diuresis (from gradual inquire or output), low K, low Mg, low P, low Ca from slow tubular recovery.
221
Low RBF (as seen in MI) will affect what parts of the kidney the most?
Proximal Tubules and ASCD loop
- These structures are located outside the medulla and normally recieve low blood flow. They also use ATP to actively transport ions.
222
Hematuria + facial edema + proteinuria + pharyngial or skin infection
Post strep glomerulonephritis (Strep or impetigo)
- Both kidney glomeruli are enlarged with leukocyte infiltration
- IgG + C3 "lumpy" deposits
- Epithelial side of basement membrane humps are seen
- Will see RBCs (No RBC seen in nephrotic syndrome)
- Must have 1+ proteinuria (3/4+ is nephrotic syndrome)
223
NSAID associated chronic renal injury is characterized by what?
Papillary necrosis or chronic interstitial nephritis
| - Usually reversible when NSAID use stops
224
Crescent formation on glomerulus
Rapidly Progressive Glomerulonephritis (RPGN)
| - Renal failure
225
Nephrotic Syndrome mechanism
glomerular basement membrane thickens --> mesangial matrix expansion --> increase permeability of glomeruli to plasma proteins --> loss of negative charged proteins --> massive protein loss (Albumin) --> liver synthesis of albumin is not enough with such a rapid loss of albumin --> drop in colloid osmotic pressure in blood --> edema --> drop in RPF --> Angiotensin II system --> renin --> ADH + Aldosterone --> Na/H20 retention --> exacerbates the edema
Also, the liver is attempting to make more albumin, but also make more lipoproteins --> high cholesterol + TAG + LDL + VDL --> lipiduria
THIS IS THE SAME MECHANISM FOR Diabetic Nephropathy
TX: ACE inhibitors in diabetics
WHEN in Children
226
Child 2-8 years old + facial edema + huge loss of protein in urine
Minimal Change Disease (presents as nephrotic syndrome)
- Electron microscopy will show diffuse defacement of podocyte foot processes
- Normal glomeruli
- No immunoglobulin or complement deposits
- Normal renal function
- Excellent prognosis, even though recurrence is possible
TX: Corticosteroids are v. effective
227
Chronic kidney disease (i.e. DM) will result in what type of PTH rxn?
secondary HYPER-PTH with a high PTH secretion, but a low Ca response
228
joint pain + heart murmur
Rheumatic Heart Disease
| - M protein antibodies against strept. cross react with glycoproteins in the heart and joints
229
Granulomatosis + Polyangititis
Wegner's
- c-ANCA antibodies
- Paci immune = no immune complex or immunoglobulin deposits
230
malar rash + pleural effusion
SLE
- Circulating immune complex nephritis
- anti-ANA, ds-DNA, anti-Sm
231
dysphagia + scelodactyl
CREST syndrome
| - anti-centromere
232
child 2 years old + non-rhythmic eye movement
neuroblastoma
- Most common extra-cranial childhood cancer
- Form neuroblasts in adrenal medulla
- Abdominal mass which displaces the kidney
233
Muscle weakness that is progressive, in an ascending order
Guillain-Barre Syndrome
- Campylobacter jejuni
- segmental peripheral demylenation = endoneural inflammatory infiltration
234
Dimentia patient think what?
Alzheimers
- Low AcH in basal nucleus of Meynert (memory and cognition) and hippocampus (new memory)
- Localized amyloid deposits
- Neurofibrillary triangles
235
S-100
Neural Crest = Shwannoma and Melanoma
236
Diabetic Neuropathy Mechanism
Similar to nephrotic syndrome
In addition to:
1. Non-enzymatic glycosylation of proteins --> thick hyalinization and narrowing of artery walls --> microangiopathy of endoneural arterioles --> ischemic nerve damage
2. Intracellular hyperglycemic --> aldose reductase converts glucose to sorbitol + fructose --> sorbitol increase cell osmolarity with water influx into cell --> lysis of axons/shwann cells
237
Headache + sudden unilateral blindness
```
Temporal arteriritis (large artery arteritis)
- May be seen with polyarthritis (jaw pain during a meal)
```
RISK: Permanent blindness
TEST: ESR (> 100), although biopsy is required.
238
HIV CNS tumor
Primary CNS lymphoma
| - i.e. EBV
239
Chorea + dimentia + abnormal behavior
Huntington
- 100% penetrance (Auto Dom)
- GABA loss
- Striatum atrophy = caudate nucleus + putamen)
240
Temporal lobe hemorrhagic necrosis
HSV-1 encephalitis
241
Slow relaxation of muscles (can't release a door handle as fast)
Myotonic Dystrophy
- atrophy of muscle fibers (Type I)
- Trinucleotide repeat of CTG
- Seen with cataracts
242
Positive Babinski sign
- Extension of toes (dorsi flexion) due to loss of upper motor neurons = pyramidal
- Causes Pyramidal Signs:
1. Hyper-reflex (brisk deep tendon reflex)
2. muscle weakness/paralysis
3. spasticity (increase muscle tone)
243
no pain an temperature sensation
Syrinx (spinal cord) = Syringomylia
244
bilateral loss of sensation of first three fingers + radial 1/2 of 4th digit
```
Carpal Tunnel (not diabetic nueropathy)
- median nerve compression at the palmer surface of the wrist
```
245
HIV + dementia
HIV-associated dementia
- affected subcortical and deep grey matter
- inflammatory activation of microglial cells
HIV monocytes enter the brain --> become macrophages --> fuse to become multinuclear giant cells
246
intranuclear basophilic vs acidophilic inclusions
```
Basophils = CMV
Acidophils = HSV
```
247
Abnormal behavior + language issue
Picks Dementia
- Frontal lobe degeneration
NOTE:
Abnormal behavior + chorea = Huntington
Amyloid brain deposits + anterograde amnesia = Alzhiemers (Hippocampus)
248
MI affects which part of the brain first?
Pyramidal cells of the Hippocampus
| Perkinje cells of the Cerebellum
249
Types of Hydrocephalus (Ventricle Enlargements)
1. non-communicating hydrocephalus = obstructed CSF flow where only the ventricles close the obstruction are enlarged
2. communicating hydrocephalus = CSF flows freely between ventricles and subarachnoid space due to decreased CSF reabsorption. The entire ventricular system is enlarged.
3. True or ex vacou hydrocephalus = increase in CSF volume and pressure post brain atrophy
250
fragmented RBC
Shistocytes
Due to:
1. Mechanical valves
2. DIC (narrow valves) --> Low Haptoglobin + High LDH + High Bilirubin
3. HUS
4. Thrombocytopenic purpura
Low haptoglobin means hemolytic anemia
251
Warfarin induced skin necrosis
Hyper-coagulation due to deficient protein C or S.
Warfarin naturally drops Factor 7 and Protein C (a natural anti-coagulant)
TX: Fresh Frozen plasma increases Protein C
When Protein C resistance = Factor V Leiden mutation = RISK: DVT
252
High dose folic acid is given to treat what?
Megaloblastic anemia = low folate/folic acid or Vit B12 deficiency.
When an infusion of folate still leads to leg numbness (loss of sensation = neurologic symptoms), the Dx is Vit B12 deficiency.
Megaloblastic anemia = High MCV + low Hb. EtOH can also cause this due to thymidine deficiency!
Low MCV is Fe deficiency anemia and beta thalessemia
253
ERB-B2
Breast cancer (aggressive)
BRCA-1 (breast and ovarian cancer)
254
High HbA2 content
beta thalesemmia
255
Tumor stage vs grade
```
Stage = expansion
Grade = Differentiation
```
Stage is most important for prognosis
256
Anaplastic tumors mean what?
Undifferentiated = share no resemblance to the natural tissues = high grade tumors.
Usually high mitotic, giant cells, multinucleate, pleomorphic, high Nu: cytoplasm ratio
Dysplasia is a reversible change in epithelium. It precedes cancer.
low grade dysplasia --> High grade --> Carcinoma in-situ --> invasive carcinoma. Only the reversibility of changes (invasion) differentiates each stage.
Lymph nodes presenting with high monoclonal T-cell proliferation (T-cell gene rearrangements) are most at risk for malignancy
257
N-MYC
neuroblastoma, small cell carcinoma of the lung
258
chemical causing cancer
cytochrome P450 mirosomal monooxygenase prevents the conversion of chemical induced tumors
259
C-MYC
Burkitts lymphoma = rapidly enlarged jaw in african americans. C-MYC is a transcription activator for cell proliferation, differentiation and apoptosis.
Will see high basophilic color, high proliferation rate in HIV individuals, must think Burkitts Lymphoma
260
BCR-ABL
CML = philadelphia chromosome
261
High plasma cell count in bone marrow
```
multiple myeloma (High Plasma Cell neoplasm)
- RISK: bone reposition, high Ca, infection, amyloid, renal failure
```
262
Blast cells in blood indicate what?
Blast cells = immature hematopoietic cells
indicates leukemia
```
Types:
ALL: Children = B cell (without mediastinal compression OR T cell precursor (if with mediastinal mass compression or superior vena cava syndrome)
AML: vitamin A = retinoic acid
CML: Old people
CLL
```
263
easy bruising + lipid content in bone marrow
Aplastic anemia = High erythropoietin (hypo cellular bone marrow with fat cells)
1. bruising = hypocoagulation or low platelets
2. high lipid content = hematopoietic cell aplasia or hypoplasia
Dx: pancytopenia without splenomegaly + normocytic, normochromic RBC
264
fluctuating cervical lymphadenopathy
non-hodgkin lymphoma
- B-cell
- bcl-2 oncogene
- follicular small cleaved cell lymphoma
265
High erythrocyte production
polycethma vera
| - Mutation in JAK2 = cytoplasmic tyrosine kinase
266
EtOH will show what type of anemia?
folate deficiency (NOT Vit B12) = hypersegments ( > 6 lobes) of neutrophils
267
HbAS means what?
Sickle Cell Anemia
| - Evolutionary protection against plasmodium falciparum (malaria)
268
Normal platelet + High PT + High Bleeding time
Von Willenbrands
269
Thrombocytopenia + High PT
DIC
270
Pancytopenia + splenomegaly
cancer
271
Thrombocytopenia + normal heme + normal leukocyte + no meds + normal spleen + normal INR/PT
acquired thrombocytopenia = Immune thrombocytopenic purpura → autoimmune destruction of platelets
272
psammoma bodies
meningiomas
273
Absent thymic shadow
DiGeorge Syndrome
- 3rd/4th pharyngeal pouch
- No T-cells = No paracortex
(NOTE: B-cells = follicles)
274
Most toxic Vitamin for pregnancy
Vit A (teratogenic)
275
HIV + temporal lobe
HSV-1
276
HIV + multiple ring enhancing brain lesions
toxoplasmosis gondii
277
Exudates vs Transudate
Exudates will have HIGH: Protein, LDH, WBC, and LOW GLUCOSE
NOTE: High Amylase is seen with lung adenocarcinoma and pancreatitis.
278
Heavy menstruation
Think Leiomyoma (If not a choice, then cervical cancer)
