IMS III Flashcards
(322 cards)
1
Q
What disorder is characterized by the phildadelphia chromosome?
A
CML
ber-abl oncogene, translocation of 9&22
blast crisis
2
Q
What is the best sign of primary myelofibrosis?
A
splenomegaly - the spleen tries to produce cells & enlarges
can cause polycythemia vera
3
Q
What are the myeloproliferative disorders?
A
- Chronic Myelogenous Leukemia (CML)
- Primary myelofibrosis
- Polycythemia vera
4
Q
What are myelodysplastic syndromes?
A
bone marrow produces abnormal cells w/o enough healthy cells
- Refractory neutropenia
- Refractory thrombocytopenia
- Refractory anemia
- Myelodysplastic syndromes w/ multiple lineage affected
5
Q
What are the myelodysplastic/myeloproliferative disorders?
A
- Chronic myelomonocytic leukemia (CMML)
- Atypical chronic myelogenous leukemia (aCML)
- Juvenile myelomonocytic leukemia (JMML)
- Unclassified
6
Q
What disorder is characterized by auer rods?
A
Acute Myeloid Leukemias (AML)
20% or more blasts in bone marrow
5 genetic abnormalities
auto/allogenic stem cell transplant
7
Q
What does the FAB classification tell you?
A
at what point the cell line is affected
8
Q
Induction vs. consolidation
A
i - high dose of chemo
c - maintenance of chemo
9
Q
Which WBC disorder is mostly found in kids?
A
ALL - Acute Lymphocytic Leukemia
10
Q
What is affected in ALL?
A
80% B cell
20% T cell
11
Q
What is the most common lymphoma?
A
Diffuse Large B-cell Lymphoma
12
Q
What disorder is characterized by M protein?
A
Plasma Cell Myeloma (Multiple Myeloma)
abnormality of B cells leads to overproduction of M protein
-punched out sternum, urine = Bence-Jones protein
13
Q
What disorder is characterized by a punched out sternum?
A
Plasma Cell Myeloma (multiple myeloma)
14
Q
What disorder is characterized by Bence-Jones protein in the urine?
A
Plasma Cell Myeloma (multiple myeloma)
15
Q
What are the characteristics of multiple myeloma (plasma cell myeloma)
A
- M protein
- Punched out sternum
- Bence-Jones protein in urine
16
Q
What is T-cell lymphoma/leukemia characterized by?
A
- Mycosis fungoides
- Sezary syndrome
pruritis & eczematous patches/plaques often on buttocks & thighs
17
Q
What are the characteristics of Hodgkin’s disease?
A
EBV/HIV
- Painful lymph node swelling provoked by EtOH
- Reed-Sternberg cells on Bx (owl’s eye)
18
Q
What is pancytopenia?
A
aplastic anemia with all cell lines affected
19
Q
Which leukemia is indolent?
A
CLL - Chronic Lymphocytic Leukemia
20
Q
What happens when mesangial cells contract?
A
in glomerulus
they dec. surface area & dec. GFR
21
Q
Which part of the loop stimulates renin secretion?
A
Thick ascending limb
senses changes in [NaCl]
22
Q
Where is the site of action for loop diuretics?
A
Thick ascending limb of loop of Henle
they block the Na, K, & Cl pumps
23
Q
What hormones act upon the distal convoluted tububle?
A
aldosterone & Ang II - resorb H2O
ANP & urodilatin inhibits H2O resorption
24
Q
Describe the diff. btwn the principal vs. intercalated cells in collecting duct
A
P - respond to ADH
I - acid/base balance by regulating secretion of acid
25
Describe the diff btwn diabetes insipidus & nephrogenic diabetes insipidus
d - low ADH from pituitary damage
n - collecting tubules unresponsive to ADH -genetic defect
large V of dilute urine, severe fluid imbalances
26
How do thiazide diuretics work?
They block Na+ resorption, water follows
27
How do Potassium wasting diuretics work?
they cause K+ excretion, water follows
28
Which disease can progress to ESRD by age 15?
Autosomal recessive cystic kidney disease
-chr 6p
enlarged kidneys at birth, severe HTN, liver problems
29
What causes the cysts in autosomal dominant cystic kidney disease?
low intracellular [Ca2+] & high [cAMP]
most common type of CKD
chr. 16, chr 4, PKDIII
w/ low GFR, cysts develop in other areas
30
What renal disease is strongly associated w/ tuberous sclerosis?
Angiomyolipoma
yellow tumors
31
Which renal disease is usually found during autopsy?
Renal adenoma
32
What are the benign renal tumors?`
1. Renal adenoma
2. Renal oncocytoma
3. Angiomyolipma
33
What benign renal disease is difficult to differentiate btwn renal cell carcinoma?
Renal oncocytoma
mahogany-brown tumors
34
What is the most common 1st symptom of malignant renal tumors?
hematuria
35
What is the most common type of renal cell carcinoma?
CA of renal tubular of ductal epithelial cells
**clear cell RCC
-arises from proximal tubular cells
yellow-orange in color
36
What is the most common renal cell carcinoma in kids?
Wilm's tumor
37
What is the tell-tale sign of glomerular diseases?
proteinura
38
What is the biggest cause for ESRD?
Glomerular diseases ---90%!!!
39
What causes glomerular diseases?
immune/inflammatory processes
| -hereditary/environmental factors
40
What is the diff. btwn primary & secondary glomerular diseases?
1 - only in 1 kidney
2 - from other diseases, meds
ex. Goodpasture syndrome - affects alveoli of lung, SLE, diabetic nephropathy
41
Describe the classifications of glomerular disease
1. Diffuse - all glomeruli
2. Focal - some, not all
3. Global - affecting all parts of glomerulus
4. Segmental - only certain parts of glomerulus
5. Membranous - thickening of capillaries from deposition of IgG
6. Sclerotic - scarring
42
Where are the common sites of deposition for glomerular diseases?
1. Mesangial
2. Subendothelial
3. Subepithelial
43
What is the best sign for nephrotic syndrome?
protein loss >3-3.5g in 24 hours
NephrItic is <3g/24h
44
What is the most common primary cause of nephrotic syndrome?
Membranous glomerulopathy
the barrier mechanism is gone
45
What is the main cause of nephrotic syndrome in kids?
Minimal change disease - 90%
-alteration of podocytes
46
Name the types of glomerulonephritis
1. Acute
2. Post-infectious acute
3. IgA Nephropathy
4. Crescentic
5. Goodpasture syndrome
6. Chronic
protein loss <3g/24h
47
What is the most common cause of post-infectious acute glomerulonephritis?
Group A Beta-hemolytic strep (GAHBS)
begins 1-2 wks after onset of infection
smoky/coffee colored urine
48
Which glomerulonephritis is characterized by lysosomal degradation of the basement membrane?
acute
49
What are the triggers for IgA nephropathy?
URI/GI viral infections
IgA deposits in mesgangium
most common in developed countries
50
Which glomerulonephritis is characterized by crescent shaped lesions?
Crescentic glomerulonephritis
causes: infection/disease/drugs/primary
acute onset, decline w/in 6 mo
51
What is goodpasture syndrome?
an autoimmune disorder characterized by a Type II hypersensitivity rxn
IgG forms against the basement membrane of the glomeruli & alveoli
-SOB & hemoptysis (bc attacks lungs too)
52
Which glomerulonephritis often progresses to ESRD?
chronic glomerulonephritis
| -sclerosis & fibrosis of kidney
53
What disruptions does acute renal failure cause?
1. Disruption of fluid, electrolyte & acid/base balance
2. Retention of nitrogenous waste products
3. Inc. serum creatinine
4. Dec. GFR
54
What can acute renal failure lead to?
acute tubular necrosis
55
Describe prerenal acute renal failure
any condition that dec. blood flow to the kidney
low GFR, urine Na+, oliguria, high sp. gravity & osmolality
56
Describe postrenal acute renal failure
obstruction w/in the urinary collecting system
| inc. P in Bowmann's capsule
57
Describe intrinsic acute renal failure
primary dysfunction of nephrons & kidney itself
vascular - dec. renal blood flow, hypoxia, vasoconstriction
tubular - inflammation & reperfusion injury, causes casts, obstructs urine flow, tubular back leap
58
If untreated, which acute renal failure disorder can lead to ESRD?
Intrinsic
59
What is the most common cause of acute renal failure in hospitalized patients?
acute tubular necrosis
mostly due to sepsis & other organ failure
60
What are the phases of acute tubular necrosis of the kidneys?
1. Prodromal
2. Oliguric
3. Post-oliguric
61
Describe the prodromal phase of acute tubular necrosis
normal or declining urine output, inc. BUN & creatinine
during of this phase depends upon cause of injury, amount of toxin ingested, duration & severity of HTN
62
Describe the oliguric phase of acute tubular necrosis
may last up to 8 weeks w/ normal urine output/oliguria, progressive uremia, low GFR, hpervolemia, hyperkalemia
63
Describe the post-oliguric phase of acute tubular necrosis
represents renal recovery, inc. urine output
| may last 2-10 days & fully recovered after 1 year
64
What is the GFR requirements for chronic renal failure?
<60mL/min for 3 months
loss of nephrons
65
What are the biggest risk factors for chronic renal disease?
**diabetes & HTN
kidneys can compensate until 75-80% of nephrons stop working
66
Describe the stages of chronic renal failure
I & II - minimize risk factors
III - S/S appear, Tx begins
IV - plan for dialysis/transplant GFR <15 mL/min
V - transplant or die!!!
67
What type of cells line the esophagus?
stratified squamous epithelium
68
What are the salivary glands?
1. Parotid
2. Submandibular
3. Sublingual
69
What is an atresia?
Abnormal partitioning during development
70
What is omphalocele?
herniation of viscera into base of umbilical cord
71
What is sialadenitis?
a salivary gland disorder caused by an infection
72
What is silalithiasis?
a salivary gland disorder caused by stones/calcifications that obstruct salivary ducts
73
What is Sjoren's syndrome
a salivary gland disorder: autoimmune, destroys exocrine glands
**dry eyes, dry mouth
74
What enzymes in saliva prevent bacterial growth?
1. Lysozyme - attacks bacterial cell walls
2. Lactoferrin - chelates Fe
3. IgA binding protein
75
Are a-amylase & lipase deactivated by stomach acid?
a-amylase is, 75% of starches are digested by saliva
lipase - hydrolyzes triglycerides
76
What is the esophagus controlled by?
Upper - extrinsic cranial nerves
Middle & lower - enteric nervous system
77
What is the pH & cell type of the stomach?
pH - 1-2
simple columnar epithelium
78
What are the function of G cells?
located in the antral epithelium in the stomach
induce parietal cells & stimulates release of histamine which also induces parietal cells
induces constriction of LES, inc. motility of gall bladder & intestine
79
Where do the proton pump inhibitors act?
on the parietal cells, it uses a proton pump to secrete HCl
80
What do NSAIDS act on in the stomach?
they inhibit prostaglandins
prostaglandins inhibit histamine
so since histamine is no longer inhibited, it can stimulate HCl secretion
81
What stimulates parietal cells?
1. Gastrin cells
2. Histamine
3. ACh
82
What do parietal cells produce?
1. HCl to digest food
| 2. Intrinsic factor for B12 absorption
83
What are common causes of B12 deficiency?
1. Pernicious anemia - autoimmune, destruction of parietal cells
2. Gastric bypass
84
What do chief cells secrete in the stomach?
pepsinogen
which is converted to pepsin by HCl to digest proteins
85
What is the function of mucus cells in the stomach?
to protect the lining of the stomach
it is alkaline to neutralize the acid
86
What are the Crypts of Lieberkuhn?
glands that secrete ~2L of fluid/day into the lumen of the small intestine
if you lose this, you lose goblet cells & endocrine glands
87
What are the layers of the intestinal wall?
1. Serosa
2. Longitudinal muscle - peristalsis
3. Circular muscle - churning
4. Submucosa
5. Mucosa
88
Describe the neural control of the GI tract
1. CNS - autonomic
| 2. ENS
89
Describe the CNS control of the GI tract
parasympathetic - stimulates GI tract via vagus nerve
sympathetic - inhibits GI activity by NE
90
Describe the ENS control of the GI tract
Myenteric plexus - btwn. muscular layers, stimulation inc. GI activity by Ach
Submucosal plexus - w/in submucosa, sensory function, absorption, secretion
91
What hormones influence the GI tract?
1. Gastrin
2. CCK
3. Ghrelin & motilin
4. Secretin
5. Somatostatin
6. Incretins
92
How does CCK act upon the GI tract?
produced by jejunum
inc. GB contractility, bile, pancreatic secretion
regulates gastric emptying, bowel motility, induces satiety
93
How does ghrelin & motilin act upon the GI tract?
inc. GI motility
Ghrelin inc. appetite, rises before meals, falls after
dec. levels = satiety
causes wt. gain
94
How does secretin act upon the GI tract?
produced by duodenal mucosa in response to gastric juices
stimulates pancreas
95
What hormones does somatostatin inhibit in the GI tract?
inhibits:
1. Secretin
2. Motilin
3. Pancreatic function
4. GH
short 1/2 life
96
How does incretins act upon the GI tract?
produced in responsed to food
inc. insulin
dec. appetite
short 1/2 life
97
Which hormones induce satiety?
1. High CCK
2. High Amylin
3. High Incretins
4. Low Ghrelin
98
Which nerves are involved in swallowing?
IX - glossopharyngeal
X - vagus
XII - hypoglossal
99
What induces vomiting?
Nucleus Tract Solitarius - in medulla
| input from pharynx, abdomen, labyrinths, Vagus X
100
What is the gastrocolic reflex?
Stimulated by the vagus nerve, causes mass mvmts in colon for pooping
101
What is stomatitis?
inflammation of the oral mucosa
102
What is achalasia & what is it characterized by?
LES does not relax to allow food entry into the stomach
**esophagram = bird beak
103
How is scleroderma related to the esophagus?
connective tissue disease that can cause fibrosis of the esophagus
104
What are Schatzki rings?
smooth, circumferential structures in the lower esophagus
may be caused by stomach acid
105
What is Zenker's diverticulum?***
pouching of esophagus
may be due to loss of elasticity at UES & reduced opening
s/s- regurgitation of undigested food, dysphagia, cough, nocturnal choking, halitosis
106
What disease is characterized by pouching of the esophagus?
Zenker's diverticulum***
107
What disorder causes a bird beak on an esophagram?
Achalasia***
108
Who is at risk for infectious esophagitis?
immunocompromised Pts
common pathogens: candida, CMV, Herpes
109
What is a DDx for cough?
GERD
| Tx: H2 antagonists, PPIs
110
What is Barrett's esophagus?
columnar metaplasia of distal esophagus due to chronic inflammation**
Z-line at GE junction
risk factor for adenocarcinoma***
111
What esophageal disorder is at risk for adenocarcinoma?
Barrett's esophagus
112
What can chronic inflammation of the esophagus cause?
Barrett's esophagus
| -columnar metaplasia of distal esophagus
113
What is a Mallory-Weiss Tear?
a benign condition, VSS***
tear in the esophagus
hematemesis usually due to vomiting, retching
114
What disorders can cause abdominal pain but aren't abdominal disorders?
1. MI - common in women
2. Pneumonia - common in kids
3. GU - PID, ectopic pregnancy, testicular torsion, nephrolithiasis
115
What are some causes of constipation?
1. Diet low in fiber
2. Aging
3. Dec. activity
4. Meds
5. Masses
6. Hypothyroidism
7. Diabetes
8. Parkinson's
9. MS
116
What are the 4 different types of diarrhea?
1. Osmotic
2. Secretory
3. Exudate
4. Motility disturbance
117
Describe the physiology of secretory diarrhea
activation of cAMP cycle causes excretion of Cl- into lumen, Na+ & H2O follows
ex. cholera, enterotoxins
118
What is gastritis & common causes?
inflammation of the stomach
causes: NSAIDS, peptic ulcer disease
119
What is gastroenteritis & common causes?
Inflammation of the stomach & small intestine
causes: norwalk virus, N/V/D
120
How is NSAID gastropathy caused?
NSAIDS block COX1 & COX2 causing inc. acid & mucus, causing inflammation & pain
121
What are the different types of peptic ulcer disease?
1. Gastric
2. Duodenal
3. H. Pylori
122
What is gastric peptic ulcer disease & when is it exacerbated?
breakdown of mucosal lining that allows epithelial cells to be exposed to acid
worse on empty stomach or immediately after food
123
What is duodenal peptic ulcer disease & when is it exacerbated?
inappropriate acid secretion in pyloric atrum cells
worse 2-3 hrs after a meal, food relieves it
124
What percentage of each peptic ulcer diseases does H. pylori cause?
75% duodenal
60% gastric
125
What is the name for the gastrin secreting pancreas tumor?
Zollinger-Ellison syndrome
RARE
126
What is the tell-tale sign of Crohn's?
cobblestoning - skip lesions***
chronic granulomatomous lesions
127
Describe Crohn's
disease of small bowel, IBD
may extend & form fistulas w/ other organs
S/S - diarrhea, cramping, wt loss, eye involvement, arthritis, anemia
abs. issues - ferritin, Fe, B12
Cobblestoning - skip lesions
128
What are the different small bowel obstructions?
1. Adynamic ileus
| 2. Mechanical ileus
129
Adynamic ileus vs. mechanical ileus
A - dec. intestinal motility, meds, surgery, electrolyte imbalance
M - post op. adhesions, hernias, neoplasms, blockage
130
A disease process that has sever pain followed by vomiting is????
mesenteric ischmia
| uncommon but deadly! older Pts, occlusion, vasospasm, vasoconstriction of superior/inferior mesenteric artery
131
What are the large bowel disorders?
1. Ulcerative colitis
2. Diverticulitis/diverticulosis
3. Toxic megacolon
4. Large bowel obstruction
5. Pseudomembranous colitis
132
What is the S/S of diverticulitis?
LLQ ab. pain***, fever
133
Describe diverticulitis
herniation through muscles of intestinal wall
-from low fiber diet, may be asymptomatic
bowel rest, no colonoscopy for 6 wks, high fiber diet, wt loss
134
What are the causes & risks of toxic megacolon?
c - ulcerative colitis, Chron's, infections
r - sepsis & bowel perforation
135
What is twisting of the bowel called?
volvulus
cecum & sigmoid most common, may constrict blood flow
136
What is telescoping of the bowel called?
Intussusception
| excacerbated peristalsis
137
Large bowel obstructions may lead to...?
1. Gangrene
2. Shock
3. Perforation
138
Another name for pseudomembranous colitis?
antibiotic assoc. colitis
| = C. Diff!!!!
139
What is a tell-tale sign of IBS?
Mucousy diarrhea****/constipation
| NOT IBS = blood, wt loss, fevers
140
What is Hirschsprungs?
congenital
-absence of autonomic nerve ganglia, ENS
usually affects rectosigmoid region
complications - constipation, bacterial growth, diarrhea & enterocolitis
141
Which substances does Celiac cause a dec. absorption?
Fe, B12, folate, Vit D & K
--anemia
autoimmune
142
What is Whipple's disease?
Very rare bacterial infection, farmer's soil
| S/S - steatorrhea, wasting, edema, endocarditis, uveitis, lymphadenopathy, dementia
143
What disease is from a loss of your pyloric sphincter?
Dumping syndrome!!!
| small gastric capacity, water pulled into intestine
144
Name the inflammation diseases of GI
1. Stomatitis
2. Esophagitis
3. Gastritis
4. Peptic ulcer disease
5. Crohn's
6. Ulcerative colitis
7. Enterocolitis
8. Diverticulitis
145
Name the motility disorders of GI
1. Achalasia
2. IBS
3. Obstruction
4. Volvulus
5. Intussusception
6. Hirschsprung
146
Name the malabsorption disorders of GI
1. Celiac
2. Dumping
3. Short Bowel Syndrome
147
What are the S/S of esophageal cancers?
wt. loss
dysphagia
hoarseness
148
Describe squamous cell carcinoma esophageal cancer
most common in old black men, EtOH, tobacco, poor diet
149
Describe adenocarcinoma esophageal cancer
CA of glands
| Barrett's esophagus & other high acid states
150
What is a tell-tale sign of gastric cancer?
Epigastric mass***
151
What are the risk factors for colon cancer?
2nd leading cause of CA death, risk doubles every decade
IBD, ulcerative colitis, Hx adenomatous polyps, 1st degree relative, tobacco, obesity, diet, high fat, low fiber
Familial adenomatous polyposis***
Hereditary non-polyposis colon CA***
watch CEA-125***
152
Describe bile composition
1. Water
2. Electrolytes
3. Bile acids
4. Cholesterol
5. Pigment
6. Phospholipids
153
What is the function of bile?
digestion of lipids/fat
| transport waste from liver (bilirubin, IgA, toxins, cholesterol)
154
What are the risk factors of gall stones?
```
Fat
Female
Fertile
Forty
FH
```
155
What can gall stones be made of?
70% cholesterol
Bilirubin
CaCO3
phosphate
156
What is biliary colic?
Transient cystic obstruction
157
What is acute cholecystitis & what is the best sign?
persistent cystic obstruction
RUQ pain to R scapula****
158
What is characterized by RUQ pain to the R scapula?
acute cholecystitis
159
What is choledocholithiasis?
cacluli in common bile duct?
160
How do you diagnose cholelithiasis?
US, HIDA scan, CT, MRCA, ERCP
161
What are the complications of cholelithiasis?
gangrene, empyema, cholecystoenteric fistula, biliary peritonitis/sepsis, cholangitis
162
What happens if there is an obstruction in the common bile duct?
cholecystitis & jaundice
163
What happens if there is an obstruction in the sphincter of oddi or hepatopancreatic duct?
pancreatitis
164
What is acalculous cholecystitis?
inflammation of gall bladder w/o gall stones
165
What is primary sclerosing colangitis?
inflammation & fibrosis of the biliary tree
may also involve inra/extrahepatic ducts
S/S - RUQ pain, jaundice, fevers, wt loss
RF - IBD, ulcerative colitis, Crohn's, AIDS, fasciola hepatica
166
Describe biliary malignancy
rare, asymptomatic & insidious until late stages, only about 1/5 are found before they metastasize
167
What are the phases of pancreatic secretion?
1. Cephalic - olfactory & visual signals
2. Gastric - gastrin
3. Intestinal - CCK & Secretin
168
What enzymes does the pancreas secrete?
1. Amylase - carbs
2. Lipase - fat, phospholipase A & lecithinase
3. Proenzymes - protein, trypsinogen & others, inactive until duodenum
4. Bicarb
169
What are the causes of acute pancreatitis?
1. Obstruction of pancreatic duct - digests itself
2. Alcohol
3. Biliary obstruction
4. Hypertriglyceridemia
Others: meds, sphinter of oddi dysfunction, idiopathic, infections
170
S/S of acute pancreatitis?
steady & boring epigastric pain
N/V
Ranson criteria assesses pancreatitis
171
What are the complications of pancreatitis?
1. Necrotizing
2. Pseudocysts - inc. enzymes, needs drained
3. Abscess formation - results in liquefaction & necrosis of pancreatic tissue, collections of pus
172
What is the most common cause of chronic pancreatitis?
chronic alcoholism
173
How do you diagnose pancreatitis?
Lipase - specific, returns to normal w/in 7-14 days
Amylase - returns to normal w/in 2-3 days, does not predict severity
inc. WBC, triglycerides, bilirubin, ALP, AST, LDH
CT abdomen w/ contrast
174
Where in the pancreas is the most cancer found?
```
head
3:1 chance in head than tail
2% of new CA, 4th leading cause of CA death
usually mets if showing S/S
Dx CA 19-9
```
175
What are the fat soluble vitamins?
A D E K
if liver probs, can't abs these
176
What hormones does the liver metabolize & what problems can liver disease cause as a result?
glucocorticoids & sex hormones
men - gynecomastia, impotence, testicular atrophy
women - irregular menses
177
What are the functions of cholesterol?
Build & maintain cell membrane, myelin sheath
intracellularly - precursor, bile, vit D, steroid hormones
20-25% produced in liver
178
What are the prehepatic causes of inc. bilirubin?
1. Hemolysis
2. Gilberts
3. Sickle cell
4. Crigler-Najarr syndrome
179
What has high serum unc. bilirubin, with no bilirubin and high urobilinogen in urine?
pre-hepatic causes of inc. bilirubin
180
What are the hepatocellular causes of bilirubin problems?
probs getting through biliary tree
1. Liver disease/CA
2. Hepatitis
3. Primary sclerosing cholangitis
4. Dubin-Johnson syndrome
181
What has high serum conj. bilirubin, with high conj. bilirubin with no or little bilinogen in the urine?
hepatocellular or post-hepatic bilirubin problems
182
What are the post-hepatic causes of bilirubin problems?
obstruction - gallstones, pancreatitis
183
Describe the process & causes of cirrhosis?
inflammation to fibrosis to scar tissue & nodules
irreversible****
Causes: alcoholism, autoimmune primary biliary cirrhosis
184
What can cause esophageal & periumbilical varices ascites?
Portal HTN
185
What causes hepatic encephalopathy?
an inc. NH4+ from liver disease that crosses the blood-brain barrier
186
What can worsen hepatic encephalopathy?
1. GI bleeding
2. Azotemia/renal failure
3. Constipation
4. Inc. protein intake
5. Hypokalemia
6. Hypoxia
7. Hypercarbia
8. Sepsis
9. CNS depressants
Graded: 1-4, 4 is worst (flap)
187
What are the causes of ascites?
1. Cirrhosis
2. CA
3. CHF
4. TB
5. Pancreatitis
Tx - Na restriction, diuresis
188
What is hepatorenal syndrome?
renal failure w/o intrinsic kidney disease
causes: disturbance of arterial blood flow assoc. w/ portal HTN
Tx: hemodialysis
189
What are the causes of fatty liver disease?
1. Alcoholism
2. Non-alcoholic steatohepatitis (NASH)
obesity, DM, protein malnutrition, TPN, drugs, rapid wt loss/starvation
190
What is the main cause of liver transplant in the U.S.?
Hepatitis C
191
What are the toxic storage diseases?
1. Hereditary hemachromatosis
| 2. Wilson's disease
192
Describe hereditary hemachromatosis
abnormal Fe abs. & cirrhosis of liver
autosomal recessive, abnormal HFE gene
-alcohol inc. risks
193
What is Wilson's disease?
Toxic storage disease
abnormal deposition of Cu in liver, stripped from ceruloplasmin
Kaiser-Fleisher rings in eyes***
194
What is Gilbert's disorder?
can't conjugate bilirubin
| autosomal dominant
195
What disease is characterized by Kaiser-Fleischer rings?
Wilson's disease
196
What are the S/S & causes of liver abscesses?
S/S - fever, RUQ pain
c - portal vein infection, ascending cholangitis, bacteremia
197
What are the causes of a hepatoma?
hep B & C, cirrhosis, hemachromatosis
mostly metastatic
198
What hormone is derived from tyrosine amines?
Catecholamines
water sol, faster acting
199
What are the different cell membrane receptors?
1. G-linked
| 2. Protein kinase
200
Which hormones use a protein kinase receptor?
1. Insulin
2. GH
3. Prolactin
201
Define permissiveness
inc. # of receptors for a diff. hormone to inc. response
| ex. thyroid hormone & E
202
Specificity vs. affinity
fit
| tightness
203
Describe the structure of the adrenal & which hormones are produced
1. Medulla - NE & E
2. Reticularis - steroids & androgens
3. Fasciculata - cortisol
4. Glomerulosa - aldosterone
204
Growth hormone is inc. when??
night!
205
Acromegaly is caused by?
inc. GH
peaks in 4/5th decade
also assoc. w/ diabetes due to effect of GH on liver
206
What is Grave's disease?
autoantibodies stimulate TSH receptors on thyroid inc. T3&T4...causes goiter
this dec. TSH from neg. feedback
causes exophthalmos from autoimmune injury to eye
207
What is Hashimotos?
Most common cause of hypothyroidism aka lymphocytic thyroiditis
autoimmune causing dec. T3&T4
208
What is Addison's?
Primary insufficiency
| Dec. cortisol from autoimmune destruction of adrenal cortex
209
What is secondary insufficiency of cortisol?
inadequate secretion of ACTH from APG
210
What is tertiary insufficiency of cortisol?
dec. CRH secretion from hypothalamus
211
What are S/S of dec. cortisol?
electrolyte imbalances (hyponatremia), weakness, malaise, hyperpigmentation of skin
212
Why does dec. cortisol cause hyperpigmentation of the skin?
there is no neg. feedback of ACTH production so it stimulates melanocytes & promotes pigmentation
213
What is inc. cortisol called & S/S?
Cushings
caused by adenomas of adrenal cortex (1) or pituitary (2)
S/S - stretch marks (ab. striae), dorsocervical fat pad & kyphosis (buffalo hump), large, round, ruddy face (moon faces)
214
What is pheochromocytoma?
a tumor that causes excessive production of catecholamines (NE & E)
secondary cause of HTN if they complain of HA, tachycardia, diaphoresis***
215
What happens to Ca in hyperparathyroidism & what is the common cause?
inc.
adenoma
S/S - Stones, Bones, Ab. Groans (pancreatitis) & Psychological Moans
216
What are nociceptors stimulated by?
- direct damage to nerve endings or release of chem. at site of injury
1. Histamine
2. Serotonin
3. Bradykinin
4. Prostaglandin
217
What types of fibers transmit nociception signals?
1. A delta
| 2. C fibers
218
A delta fibers vs. C fibers***
nociceptors transmission
A - myelinated, very fast transmission, sharp, stinging & highly localized, provide specific info. about pain location w/ minimal emotional involvement
C - unmyelinated, dull, aching, poorly localized, assoc. w/ aversive emotional response
219
Why do people experience referred pain?
afferent nerve fibers enter the spinal cord via posterior nerve roots in the lamina
the lamina V has somatic & visceral fibers
220
What is a dermatome?***
an area of the body surface, each spinal nerve contains nociceptive fibers for each area
221
Which neurotransmitter is involved in synaptic memory?
Glutamate
has an excitatory effect, binds w/ NMDA receptors
when C fibers are repeatedly stimulated, they become sensitized & mild stimuli can be painful (chronic pain syndromes)
222
What factors can influence perception?
fear, fatigue, anxiety, previous experiences, etc.
223
Pain threshold vs. tolerance
Theshold - level of painful stimulus required to be percieved
Tolerance - degree of pain that one is willing to bear before seeking relief
224
Why do some people rub/shake a painful area after injury?
stimulation of large touch neurons can inhibit transmission of nociceptor impulses
225
What are the naturally produced opioids?
1. Endorphins
| 2. Enkephalins
226
What are the types of opioid receptors?
1. Mu
2. Kappa
3. Sigma
4. Delta
Mu & Kappa have analgesic effects
The other effects account for narcotic side effects - constipation, pruritis, N/V
227
What drugs are used to reverse a narcotic overdose?
Naloxone & naltrexone
opioid antagonists
228
What is physiologic pain?
tissue is injured, pain is preventative for further injury
ex. touching a hot stove
229
What is pathologic pain?
occurs after tissue injury
changes in somatosensory pathways
1. Hyperalgesia
2. Allodynia
230
What is hyperalgesia?
significantly enhanced pain sensations
type of pathologic pain
231
What is allodynia?
non-noxious stimuli causes pain
type of pathologic pain
232
Acute vs. chronic pain
A - result of direct tissue injury, resolves when injury heals, usually 3 months, pain is self-perpetuating
233
What is neuropathic pain?
Nerve injury, GABA inhibitory neurons depleted, hyperalgesia & allodynia, burning shock-like pain
can be disabling & difficult to manage
Ex. trigeminal neuralgia, diabetic neuropathy, postherpetic neuralgia
234
Describe diabetic neuropathy
inflammation/destruction/demyelination of larger peripheral nerves
loss of inhibitory input & unopposed nociceptive input, burning pain in "stocking-glove" distributions, fine touch & vibratory sensation lost
235
What is intermittent claudication?***
chronic ishemic pain, intermittent, atherosclerotic, crampy quality relieved w/ rest
236
What are the 4 mechanisms of pain mgmt?
1. Interrupt peripheral transmission (ex. NSAIDS, ice)
2. Modulate pain transmission at the spinal cord (ex. massage, acupuncture)
3. Spinal cord intervention (ex. epidural)
4. Alter perception of pain (ex. opioid analgesic)
237
Where is the CSF contained?
subarachnoid space - btwn arachnoid & pia mater
238
What is an epidural hematoma?
bleeding btwn the dura mater & skull
usually from tear of arteries
239
What is a subdural hematoma?
bleeding btwn dura & arachnoid mater
usually from traumatic injury
240
What is an arachnoid hemorrhage?
bleeding in subarachnoid space (btwn arachnoid & pia mater)
usually caused by cerebral aneurysm
Pts complain of thunderclap headache
241
What is wrong when someone complains of a thunderclap headache?
arachnoid hemorrhage***
242
What is hydrocephalus?***
if there is a blockage & CSF keeps being produced causing inc. size of the ventricles
243
What is it called when someone loses the ability to produce language?
Broca's aphagia***
244
What is Wernicke's area?***
ability to comprehend language
Brodmann areas 39, 40 & 22
loss of this = receptive aphasia
245
What is global aphasia?
Broken Wernicke's & Broca's area
loss of ability to produce & comprehend language
246
Which lobe is associated with societal behavioral norms?
frontal love
247
Which system deals w/ memory, emotion & smell?
limbic system
248
Which basal ganglia is associated with OCD?
Caudate nucleus
dec. activity = depression, schizophrenia
249
Which basal ganglia is associated with Tourettes?
Putamen
250
Which basal ganglia is associated with Parkinson's?
Substantia nigra***
251
Name the basal ganglia
1. Caudate nucleus
2. Putamen
3. Globus pallidus
4. Subthalamus
5. Substantia nigra
252
Name the parts of the diencephalon
1. Thalamus - relay center
2. Hypothalamus/pituitary
3. Pineal gland
253
What does cerebellar dysfunction lead to?
1. Ataxia - balance disturbance
2. Intention tremor
3. Past pointing in finger-nose-testing
4. Dysdiadochokinesia - failure of rapid alternating movements
254
Intention tremor vs. Parkinson's
I - no tremor at rest but as they reach toward target the tremor inc.
P - tremor at rest, resolves as they approach target
255
What is decussation and where does it occur?***
crossing over of sensory & motor tracts
occurs in medullary pyramids
256
Where is swallowing, vomiting, coughing & sneezing regulated?
medulla oblongata
also decussation
257
Name the sensory tracts
ascending
1. Dorsal column-lemniscal tract
2. Anterolateral spinothalamic tract
258
Describe the dorsal column-lemniscal tract
sensory ascending tract
fine touch, vibration, proprioception
runs ipsilateral & crosses over in medulla
lesion above medulla - contralateral defecit
lesion below medulla - ipsilateral defecit
259
Describe the anterolateral spinothalamic tract
sensory ascending tract
pain, itch, temperature
crosses over at spinal level
260
What does the Romberg test measure?
proprioception
| needs vision & vestibular system to maintain
261
Name the motor tracts
```
descending
1. Corticospinal
Extrapyramidal tracts
2. Rubrospinal
3. Reticulospinal
4. Tectospinal
5. Vestibulospinal
```
262
Describe the corticospinal tract
motor descending tract
anterior & lateral
majority crosses over in medullary pyramids
coordinate mvmt of extermities
263
What do the extrapyrimidal tracts control?
Proximal muscles including the axial skeleton & facial expressions
Areas involved: cerebellum, substantia nigra, red nucleius, reticular nucleus & vestibular nuclei
264
Give an example of an extrapyrimidal disoder
Parkinsons***
deterioration of the dopaminergic neurons in the substantia nigra
impaired motor function w/ tremor & bradykinesia
"masked facies"
dec. dopamine, treat w. COMT inhibitors & MAO inhibitors
265
What is the neurotransmitter for preganglionic neurons?
ACh***
266
What is the neurotransmitter of postganglionic neurons?***
SNS - NE
sweat glands & some skeletal muscle - ACh
alpha 1, 2, B 1, 2, 3, DA receptors
PSNS - ACh
skeletal muscle - nicotinic ACh receptors
organs - muscarinic ACh receptors
267
What is the function of astrocytes?
blood-brain barrier
268
What is the function of oligodendrocytes/Schwann cells?
form myelin sheath***
269
What is the function of ependymal cells?
line ventricles & central canal of spinal cord, producing CSF & maintaining CSF-brain barrier***
270
What is myasthenia gravis?***
an autoimmune disorder that causes destruction of nicotinic receptors
muscle weakness in eyes 1st
271
What are the ACh receptors?
Nicotinic - ionotropic, direct effect on ligand gated channels
Muscarinic - metabotropic, 2nd messenger action, usually G protein
272
What is dopamine degraded by?
COMT & MAO
inhibit this in Parkinson's
273
What are the neurotransmitters?
1. ACh
2. Dopamine
3. NE
4. Serotonin
5. Glutamate
6. GABA
274
What is glutamate & what is the receptor?
excitatory neurotransmitter***
memory
high doses - may be neurotoxin
NDMA receptors
275
What is the excitatory neurotransmitter?
glutamate
276
What neurotransmitter is associated with depression?
serotonin - low levels
277
What is an inhibitory neurotransmitter?
GABA***
barbituates & benzodiazepines inc. GABA activity causing sedation & depression
278
How is glucose taken into the cell w/ insulin?
GLUT4 receptors
in muscle & adipose
279
What hormones are produced in the Islets of Langerhans in the pancreas?
B - insulin + amylin
a - glucagon
delta - somatostatin
280
What does amylin do?
peptide hormone produced by beta cells w/ insulin
| inhibits gastric emptying, induces satiety, suppresses glucagon
281
Describe Type I diabetes
destruction of beta cells in pancreas = no insulin!
| autoimmune
282
S/S of diabetes?***
1. Polyuria
2. Polydipsia
3. Polyphagia
283
What disease has Kussmaul's breathing?
hyperventilation
diabetic ketoacidosis
284
S/S of ketoacidosis
N/V, ab pain, wt loss, weakness/malaise, lethargy, fatigue, hypovolemia & dehydration
hypokalemia***
hyponatremia, inc. anion gap
285
Describe Type II diabetes
1. Insulin resistance
2. Lack of insulin from beta cell burn out
absent 1st phase spike, dimished second phase
retinopathy - occurs in phases
286
S/S of type II diabetes
1. Polyuria
2. Polydipsia
3. Unexplained wt loss
4. Frequent UTIs***
5. Frequent yeast infections
6. Paresthesias
287
Which diabetes med is good for fat people?***
Metformin - may experience wt loss
inhibits hepatic gluconeogenesis
288
What diabetes med is good for skinny people?***
Sulfonylureas
stimulate beta cells to inc. insulin production
289
What med decreases peripheral insulin resistance?***
Thiazolidinedione (TZDs)
290
Somogyi effect vs. Dawn phenomenon
S - low blood sugar in am - dec. pm insulin
D - high blood sugar in am - inc. pm insulin
291
What should you test with your diabetic Pts?
HbgA1C q 3 months
annual dilated eye exam
foot care
292
Which disorder has Reed-Steinberg cells?
Hodgkin's lymphoma
293
If you have Familial adenomatous polyposis, what do you have an inc. risk of?
Colon cancer
294
Clinical dehydration is a combination of what two disorders?
1. ECF Volume defecit
| 2. Hypernatremia
295
What is excess volume in the interstitial compartment called?
edema
296
Which electrolytes are higher inside the cells?
K, Mg, PO4
297
Which electrolytes are most important in the body?
1. Na
2. K
3. Ca
4. Mg
5. Cl
6. HCO3
7. PO4
298
Which electrolyte is most important for the RMP?
K
299
Why does hypocalcemia cause hyperexcitability?
Na channels left open
with hypercalcemia the Na channels are closed so there isn't any depolarization
300
Why does hypomagnesia cause inc. excitability?
inc. in ACh
caused by alcoholism
301
Name the buffers in the blood
1. Bicarb - in ECF
2. Phosphate - in ICF & urine
3. Hgb - in erythrocytes
4. Protein - ICF & blood
302
What does the blood pH need to stay between?
6. 9<7.8
| 20: 1 ratio of bicarb to carbonic acid to maintain normal pH
303
What is the renal compensation of low pH?
excretion of NH4+ b/c H+ binds and can get rid of acid
304
What is the renal compensation of high pH?
excrete HCO3- & dec. secretion of NH4+
305
What ion reflects the effectiveness of renal regulation of metabolic acidosis?
bicarb
if low bicarb, more bound to buffer b/c more acids in blood
306
What type of lymphoma can develop into diffuse large B cell lymphoma?
Follicular lymphoma
Indolent course
307
What lymphoma is common in the GI tract?
MALT
308
Which virua is associated with Burkitt's lymphoma?
EBV
309
Which lymphomas are associated with HIV?
1. Diffuse Large B-cell
2. Burkitt's
3. PCNSL
4. Hodgkin's
310
What type of nephrons create concentrated urine?
Juxtamedullary - longer loop of Henle
create renin
311
Which disease shows smoky or coffee colored urine?
Post-infectious acute glomerulonephritis
from GABHS
312
What are some reasons for starting dialysis?
ATN or CKD in stage 5 to remove metabolic wastes, correct fluid & elecrolyte abnormalities
GFR ~ 15 mg/dL
development of uremia & hyperkalemia
313
visceral vs. somatic pain
v - diffuse, poorly localized, collicky
s - localized & continuous
314
What hormones decrease the effects of insulin?
1. Glucagon
2. Cortisol
3. GH (inc. peripheral insulin resistance)
4. Catecholamines
315
What can Norwalk virus cause?
Gastroenteritis
also can be caused by N/V/D
316
Descibe colon cancer surveillance
CEA-125 q3mo for 2 yrs, q6 mo up to 5 yrs
Colonoscopy - 1 yr, 3yrs, then 5yrs
US/CT abdomen (liver) q6 mo for 3 yrs
317
How long does it take for jaundice to occur with hepatitis A?
5-7 days***
no longer contagious after jaundice
318
Which hormones stimulate the pancreas?
1. CCK
2. Secretin
3. Incretins (insulin, inhibits glucagon)
319
Which hormones stimulate motility in the GI tract?
1. CCK
2. Ghrelin
3. Motilin
320
Which hormones affect gastric emptying?
1. Amylin - inhibits
| 2. CCK
321
If a Pt has HTN & has a HA, tachycardia & diaphoresis, what could it be?***
pheochromocytoma
autoimmune disorder where you produce too much NE & E
322
Which hormones affect the gall bladder?
1. CCK
| 2. Gastrin
