Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

INCORRECT > INCORRECT > Flashcards

INCORRECT Flashcards

(649 cards)

Start Studying
1
Q

Typical onset of psychogenic erectile dysfunction?

A

After severe medical or emotional stressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Do beta blockers & thiazides cause ED?

A

Yes
nocturnal & nonsexual erections are also affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic granulomatous disease results from what?

A

Defective NADPH oxidase
Patients with CGD develop recurrent bacterial & fungal infections that are catalase +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Granuloma formation involves what?

A

Chronic Th1 & macrophage activation

Interferon gamma activates macrophages to induce granuloma formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Th2 is involved in the pathogenesis of what disease?

A

Ulcerative colitis
They produce IL-5 & IL-13 which contribute to the inflammation & damage of the intestinal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Typical features of fetal alcohol syndrome?

A

Short palpebral fissures
Thin upper lip
Smooth philtrum
Retarded
Behavior issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathogenesis of alcohol-induced hepatic steatosis?

A

Excess NADH production via ethanol metabolism which inhibits free fatty oxidation & promotes lipogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx of myasthenia gravis?

A

Cholinesterase inhibitor

Cholinesterase inhibitors may cause adverse effects to muscarinic overstimulation – Tx with antimuscarinic agents such as glycopyrrolate or hyoscyamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does nephritic syndrome present?

A

GBM damage w/ loss of RBCs into urine (hematuria)
RBC casts in urine
Increase in renin – HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does nephrotic syndrome present?

A

Massive proteinuria
Podocyte damage
Increase hepatic lipogenesis
Frothy urine w/ Fatty casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Anti-GBM disease?

A

Cause nephritic syndromes (hematuria, RBC Casts)
Cause rapidly progressive crescentic disease
RPGN (Goodpasture) (Granulomatosis with polyangiitis w/ no C3 deposition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Membranoproliferative glomerulonephritis is often associated with?

A

Hepatitis B or C
Thickening of GBM
Large hypercellular glomeruli are often seen (unlike Membranous nephropathy)
“tram track” appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Multiple Sclerosis pathogenesis

A

Autoimmune inflammation & demyelination of CNS w/ axonal damage
Optic neuritis (painful monocular visual loss)
Scanning speech, intention tremor
electric shock like sensation w/ neurogenic bladder
Increase in IgG level & myelin basic protein in CSF
MRI is gold standard
TX = Natalizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hand-foot-and-mouth disease characterized by?

A

painful, vesicular mouth lesions, ulcers on extremities
Caused by enterovirus (Coxsackievirus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

De Quervain thyroiditis presents how?

A

Also called subacute granulomatous thyroiditis

Typically a transient hyperthyroidism - Euthyroid – Hypothyroid – back to euthyroid

Precedes viral infection

Increase in ESR

Very tender & PAINFUL THYROID

Histology = GRANULOMATOUS INFLAMMATION

Macrophages & multinucleated cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Papillary thyroid cancer characterized by?

A

Branching papillary structures with concentric calcifications (psammoma bodies)
Presents with enlargement w/o pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Riedel thyroiditis?

A

Characterized by extensive fibrosis
Hard & non tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is seen on biopsy in Grave’s disease?

A

Diffuse hyperplastic follicles with tall and crowded cells forming intrafollicular projections
Increase in radioiodine uptake due to excessive TSH receptor stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 5-alpha reductase inhibitors?

A

Finasteride & dutasteride

Used in the treatment of BPH

Block the conversion of testosterone to DHT

The excess testosterone then is available for conversion to estrogens (estradiol) by aromatase – Which then leads to GYNECOMASTIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are Flutamide & Bicalutamide used for?
MOA?

A

Nonsteroidal competitive inhibitors at androgen receptors (decreases steroid binding)
Used in Prostate cancer
Also causes gynecomastia just like Finasteride so don’t get it confused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Spironolactone

A

Androgen receptor & 17-alpha hydroxylase inhibitor
Used in PCOS
Amenorrhea is common SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

KRAS

A

Colorectal
Lung
Pancreatic cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common complications of radiotherapy?

A

Inflammation & fibrosis
Neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is congenital diaphragmatic hernia?

A

Develops in the 1st trimester
Compression of lungs results in pulmonary hypoplasia
Scaphoid abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Pneumothorax is characterized by?
Loss of negative intrapleural pressure Mediastinal shift
26
VIPomas are what type of tumors?
Pancreatic islet cell tumors that hypersecrete VIP which increases intestinal chloride loss into stool -- causing excess losses of water, sodium, and potassium VIP also inhibits gastric acid secretion Somatostatin inhibits the secretion of VIP & tx's symptoms
27
Pericardium is supplied by what nerve?
Phrenic nerve Right phrenic nerve injury occurs during ablation
28
Features suggestive of pathologic gynecomastia?
Onset before or after midpuberty (w/ no secondary sexual characteristics) Tanner stage 1 or 5 Findings consistent w/ systemic illness Location eccentric to nipple areolar complex
29
How does acute pancreatitis present?
Acute epigastric pain often radiating to the back Increase serum amylase or lipase (more specific) Can cause hypocalcemia
30
How does chronic pancreatitis present?
Calcification of the pancreas Major risk factor includes alcohol Manifests with steatorrhea (fat malabsorption), fat soluble vitamin deficiency, & diabetes Amylase & lipase may or may not be elevated (always in acute)
31
Shoulder muscles and nerves?
Supraspinatus -- subscapular nerve -- abducts arm initially right before deltoid Infraspinatus -- suprascapular nerve -- externally rotates (pitching injury) Teres Minor -- axillary nerve -- adducts & externally rotates Subscapularis -- subscapular nerve -- internally rotates arm & adducts Most by C5-C6
32
Trapezius action at shoulder?
Arm abduction past 90 degrees Innervated by accessory nerve Commonly injured in posterior triangle
33
Where is aortic stenosis best heard?
RIGHT UPPER STERNAL BORDER -- radiates to carotids Bicuspid aortic valve usually presents earlier than those who get AS from rheumatic heart disease MCC in the US is a bicuspid aortic valve Similar murmur in Turner's syndrome
34
Marfan's is associated with what cardiac dysfunction?
Aortic root dilation -- causes aortic regurgitation Aortic root aneurysm RUPTURE or DISSECTION is MCC of death Increase risk in Mitral valve prolapse & spontaneous pneumothorax UPWARD lens dislocation
35
Mitral Valve prolapse produces what type of murmur?
Mid systolic click Mitral Regurgitation Best heard at cardiac apex
36
VSD is best heard where?
Holosystolic murmur best heard at left lower sternal border
37
What is the most common cardiovascular manifestation associated with SLE?
Pericarditis Sharp pleuritic chest pain that is relieved by sitting up & leaning forward
38
Eosinophilic granulomatosis with polyangiitis characterized by?
Small vessel vasculitis Late onset asthma, rhinosinusitis, & eosinophilia + peripheral neuropathy Antibodies against neutrophil myeloperoxidase (P-ANCA) necrotizing vasculitis with eosinophilia
39
How does Taenia solium present?
Adult-onset seizure in patients from an endemic area TX = Praziquantel Albendazole for neurocysticercosis
40
What is a meningioma?
Common & benign FEMALES more affected May present with SEIZURES Whorled pattern -- PSAMMOMA bodies (laminated CALCIFICATIONS)
41
Chronic graft failure features?
Vascular wall thickening & luminal narrowing Interstitial fibrosis & parenchymal atrophy
42
What is the first line anticoagulation therapy used in patients with pulmonary embolism, thrombosis, unstable angina pectoris, & DIC?
Heparin Selectively binds to Antithrombin III to potentiate it & inhibit Factor Xa Decrease prothrombin & fibrin Monitor PTT
43
What is the test of choice for a DVT?
Compression US D dimer level is to rule out DVT
44
What accumulates in the neuronal cells in Tay-Sachs disease?
GM2 gangliosides Due to a deficiency of beta-hexosaminidase A
45
What is the hallmark sign of cold agglutinin disease?
Acrocyanosis in response to cold temperatures IgM autoantibodies located on surface of erythrocytes & can lead to increase turnover of RBCs = hemolytic anemia Dx = Direct coombs test -- binds autoantibodies
46
Methylene blue staining or wright stains visualize what?
Ribosomal RNA
47
Signs & symptoms of cardiac myxomas?
Noncancerous tumor composed of connective tissue Murmur mimicking mitral stenosis (mid-diastolic rumble @ apex) Most common in left atrium Myxoma secretes IL-6 causing fever Scattered cells within a mucopolysaccharide stroma Amorphous extracellular matrix on histopathologic exam
48
Ovarian arteries branch off directly from the?
Abdominal aorta just below renal arteries at the level of L2
49
Nerve most commonly damaged from anterior shoulder dislocation?
Axillary nerve Dermatome is over the lateral shoulder
50
What is a hypertensive emergency?
Severely elevated BP usually above 180/120 In the kidneys -- fibrinoid necrosis with hyperplastic arteriosclerosis "onion skin" Microangiopathic hemolytic anemia
51
Temporal giant arteritis features?
Granulomatous inflammation of media
52
Mifepristone MOA?
Progesterone antagonist that is used with Misoprostol (prostaglandin E1 agonist) to terminate first trimester pregnancy
53
Misoprostol MOA?
PGE1 analog Increases the production & secretion of gastric mucous barrier Used to prevent NSAID-Induced peptic ulcers Off label use for induction of labor
54
What is propionic acidemia?
Causes a decrease in methylmalonic acid Low protein diet TX - VOMIT -- avoid Valine, Odd chain fatty acids, Methionine, Isoleucine, Threonine
55
What does Parathyroid hormone do?
Increases bone resorption Increases serum calcium levels Increase in renal phosphate excretion
56
Which interleukin plays a major role in pathogenesis of inflammatory bowel diseases?
IL-10 IL-10 attenuates the inflammatory response -- Decreases expression of MHC class II & Th1 cytokines TGF-beta & IL-10 both attenuate the immune response
57
Gabapentin MOA?
Inhibits high voltage Calcium channels Used for peripheral neuropathy & postherpetic neuralgia Blocks fusion & release of neurotransmitter vesicles
58
Spondylolysis
Fracture occurs at the pars interarticularis
59
Spondylolisthesis
Bilateral disruption of pars interarticularis that leads to anterior displacement
60
Phthirus pubis
Intense pruritus & associated excoriations TX = Topical Permethrin
61
Hurler & Hunter syndrome -- What enzyme is deficient & what is accumulated?
Alpha-L-Iduronidase is deficient in Hurler's Iduronate-2-Sulfatase is deficient in Hunter's Accumulation of Heparan sulfate in both Corneal clouding in Hurler's NO clouding in Hunter's - Hunter's need to see (Hunter's is XR)
62
Nursemaid's elbow AKA Radial head subluxation is the displacement of what ligament?
Annular ligament Patient presents with the elbow flexed & forearm pronated
63
Injury to the long thoracic nerve causes what? What region is associated with injury?
Weakness of serratus anterior muscle w/ winging of scapula Dissection of axillary lymph nodes can injure the long thoracic nerve
64
When cells within the heart, brain, or skeletal muscle are injured, what enzyme increases?
Creatine kinase leaks across the damaged membranes and into circulation Reperfusion injury
65
What is HELLP syndrome?
Preeclampsia with thrombotic microangiopathy of the liver Hemolysis Elevated liver enzymes (increased indirect bilirubin) Low platelets TX = immediate delivery
66
Pretreatment with what drug before administering epinephrine?
Propranolol -- Eliminates the Beta effects of epinephrine (vasodilation & tachy) Leaving only the alpha effects of vasoconstriction
67
What must be monitored when administering testosterone therapy?
Hematocrit -- Can cause erythrocytosis Also associated with increase in PSA
68
What is the MOA of drug used in prostate cancer?
Abiraterone -- 17 Alpha hydroxylase inhibitor (SE = HTN, Hypokalemia, Increase in mineralocorticoids) Flutamide & Bicalutamide -- Non steroidal competitive inhibitors at androgen receptors
69
What is the Reid index?
Thickness of the mucosal gland layer to thickness of the wall between epithelium & cartilage Seenin chronic bronchitis
70
What is Syringomyelia?
Cape like, bilateral, symmetrical loss of pain & temperature sensation in the UE Associated with Chiari 1 malformation (Cerebellar tonsils) Presents with scoliosis Most commonly cervical
71
Where does HIV preferentially infect in the CNS?
Macrophages
72
MOA of Amphotericin B? What must you monitor?
Binds ergosterol in fungal cell membranes to form holes Renal toxicity is the most notorious side effect -- Increase hydration Must monitor serum potassium & magnesium
73
What confirms the diagnosis of menopause?
Elevated serum FSH
74
What should you always think of when you hear Sarcoidosis?
NONCASEATING granulomas -- Macrophages & multinucleated giant cells Black females, enlarged lymph nodes & Hypercalcemia TB shows Caseating granulomas (don't get it confused)
75
What are the physiologic effects of ANP & BNP?
Released in response to increased blood volume / pressure -- Increase in GFR Causes vasodilation & decrease in Na+ reabsorption Decreases Renin Dilates afferent arteriole -- promotes natriuresis
76
Visual loss in only one eye indicates what?
That the lesion is anterior to the optic chiasm
77
Rotation & sidebending for C2-C7 occur in what directions?
Always occur in the same direction
78
What ions increase in tumor lysis syndrome?
POTASSIUM & phosphorus & Uric acid PATIENTS PRESENT WITH SX OF GOUT AND/OR NEPHROLITHASIS SECONDARY TO URIC ACID CONTAINING STONES Uric acid precipitates in the distal tubules & collecting ducts Prevention includes urine alkalization & AGGRESSIVE HYDRATION High urine flow & high pH prevents crystallization & precipitation of uric acid Allopurinol + Rasburicase
79
What findings are consistent with schizotypal personality disorder?
Cluster A personality disorder Can include brief psychotic episodes (delusions) Long-standing pattern of eccentric behavior, odd beliefs, perceptual distortions and social anxiety
80
What is avoidant personality disorder?
Cluster C Hypersensitive to rejection & criticism Timid (Cowardly) Desires relationships with others (vs. schizoid)
81
What is borderline personality disorder?
Cluster B Unstable mood & interpersonal relationships Splitting is a major defense mechanism Self-mutilation / impulsivity
82
What is OCD?
Cluster C Perfectionism & control
83
What is paranoid personality disorder?
Cluster A Pervasive distrust (Accusatory) Hypervigilant, cynical view of the world
84
What is schizoid personality disorder?
Type A Prefers social withdrawal & solitary activities (vs. avoidant) Indifferent to others opinions Schizoid says fuck everyone else I don't give a fuck. Avoidant is hypersensitive to rejection but actually desires relationships
85
What should you think about when you hear Blastomyces dermatidis?
Dimorphic Ohio & Mississippi river Great lakes Found in soil Branching hyphae Large round yeasts with doubly refractile wall & single broad based bud
86
What should you think about with Sporothrix Schenckii?
Dimorphic Gardening Cigar shape at 37 degrees Presentation -- Pustules, ulcer, subcutaneous nodules along lymphatics TX = Itraconazole or potassium iodide Think of a rose gardener who smokes a cigar & pot
87
What should you think about with Coccidioides immitis?
Dimorphic Disseminated form to bones / skin Southwestern states (desert) Flu-like illness Erythema nodosum or multiforme Arthralgias Dust exposure, earthquakes
88
What should you think about with Histoplasma capsulatum?
Dimorphic Mississippi & Ohio river valleys Soil, bird, & bat droppings Similar to TB -- Granulomas with calcifications Oval yeasts WITHIN macrophages (histo hides within macrophages) Palatal / tongue ulcers w/ splenomegaly
89
What should you think about with Paracoccidioides Brasilensis?
Dimorphic Latin America Budding yeast with "captain's wheel" formation Similar to blastomycosis
90
Organophosphate poisoning results in what?
Irreversibly inhibit AChE Leads to sx of muscarinic & nicotinic cholinergic hyperstimulation DUMBBELS TX = ATROPINE (competitive inhibitor of acetylcholine at the muscarinic receptor) Also give Pralidoxime (Cholinesterase reactivating agent that treats both nicotinic & muscarinic sx) Diarrhea / Diaphoresis Urination Miosis (pinpoint) Bronchospasms Emesis Lacrimation Salivation
91
What are accessory nipples?
Most common congenital breast anomaly Results from failed regression of the mammary ridge in utero
92
What should you think about with Ascaris Lumbricoides?
Giant roundworm Transmitted via food / water Eggs migrate to alveoli May develop early pulmonary manifestations (Loeffler syndrome)
93
What is placental abruption?
Abrupt painful vaginal bleeding in the 3rd trimester Can cause hypovolemic shock & DIC Life threatening to mother & baby
94
Placenta Previa painful or painless?
Painless (unlike placental abruption) Presents in the 3rd trimester Placenta attaches over internal cervical os
95
Milrinone MOA? Indications?
PDE-3 inhibitor In cardiomyocytes = Increase in cAMP & Increase in calcium influx In smooth muscle = Increase in cAMP & vasodilation = Decreased preload & afterload Used in acute decompensated HF
96
What effect does estrogen have on Thyroxine binding globulin?
TBG increases in pregnancy, OCP use (estrogen increases TBG) which in turn increases total T3/T4
97
What is usually the cause of injury for the common (fibular) peroneal nerve? (L4-S2)
Trauma or compression of the lateral aspect of the leg / Fibular neck fracture Peroneal nerve normally everts & dorsiflexes If injured = FOOT DROPPED Foot drop = Inverted & plantarflexed at rest LOSS of Eversion & Dorsiflexion
98
What position do you place a patient in during lumbar HVLA?
Patient is positioned on the side that the vertebra is rotated toward (if rotated right, then right lateral recumbent)
99
GI & neuro symptoms of hypothyroid?
Constipation Decreased reflexes Diffuse alopecia
100
S3 best heard where? In what position? What makes it worse?
Best heard at cardiac apex Best heard in the Left lateral decubitus position The end of expiration exaggerates murmur
101
Fluticasone Budesonide MOA and indications?
Inhibit the synthesis of all cytokines Inactivate NF-kappa B (needed by TNF alpha) Both inhaled glucocorticoids used for chronic asthma Budesonide used in Chron's disease to reduce bowel inflammation
102
What is selective IgA deficiency?
Most common primary immunodeficiency AAAAA Asymptomatic, Airway, Autoimmune, Atopy, Anaphylaxis to IgA blood products
103
Heparin MOA?
Binds & activates antithrombin III This binding decreases the actions of factors IIa & Xa Used immediately in PE & MI or DVT Monitor PTT Factor Xa can no longer convert prothrombin to thrombin -- less thrombin is produced resulting in an anticoagulation effect
104
What is Pott disease?
Typically occurs months to years following primary pulmonary infection of TB Intermittent fever with lower lumbar / thoracic spine pain
105
What is the most common primary lung cancer?
Adenocarcinoma of the lung (Most common subtype in people who do not smoke) Located in the periphery Females KRAS mutation Associated with hypertrophic osteoarthropathy (clubbing) Mucin +
106
Small cell lung cancer located where?
Centrally Undifferentiated & very aggressive Can cause neurologic & endocrine paraneoplastic syndrome (Cushing, SIADH) MYC oncogenes Chromogranin A (+) & Synaptophysin +
107
Squamous cell carcinoma of the lung located where?
Centrally -- Just like SCLC Hilar mass Strongly associated with smoking just like SCLC Cavitation, cigarettes, HyperCalcemia (produces PTHrP (Decrease in PTH via - feedback) Intercellular bridges + desmosomes
108
Large cell carcinoma of the lung located where?
Periphery just like adenocarcinoma Strong association with tobacco May produce hCG -- causes gynecomastia Pleomorphic GIANT (large) cells
109
Ulcers arising in the setting of trauma or burns are called?
Curling ulcers
110
Ulcers caused from intracranial injury are caused by direct vagal stimulation & are called what?
Cushing ulcers
111
Normal anion gap metabolic acidosis
Anion gap around 8-12 HARDASS Hyperchloremia / Hyperalimentation Addison disease RTA Diarrhea Acetazolamide Spironolactone Saline infusion Diarrhea causes loss of bicarb in the stool blood pH is low, paCo2 is low, and Bicarb is low
112
Increase anion gap metabolic acidosis
More than 12 GOLDMARK Glycols Oxoproline (acetaminophen chronic use) L & D lactate Methanol - and other alcohols Aspirin Renal failure Ketones (diabetes, starvation)
113
Placenta Accreta
Attaches to myometrium instead of decidua basalis Most common type
114
CN 1 foramen?
Cribriform plate
115
CN2 foramen?
Optic canal
116
CN 3, 4, V 1, & 6 foramen?
Superior orbital fissure think about SO4
117
Middle meningeal artery foramen?
Foramen spinosum
118
CN 7 & 8 foramen?
Internal acoustic meatus
119
Cranial nerve 9, 10, & 11 foramen?
Jugular foramen
120
Cranial nerve 12 foramen?
Hypoglossal canal
121
PRPP is responsible for the ribose necessary for de novo synthesis of purine & pyrimidines, what disease is it involved in?
Gout
122
Acute gout drugs?
NSAIDs Colchicine when NSAIDs contraindicated Both inhibit neutrophils
123
Chronic gout drugs besides allopurinol?
Pegloticase -- Makes uric acid to allantoin Febuxostat -- Inhibits Xanthine oxidase (just like Allopurinol) Probenecid -- Inhibits uric acid reabsorption in PCT (sulfa allergy)
124
Who is responsible for the increase in swelling hours after a type I hypersensitivity Rxn?
Major basic protein
125
When should ADHA be diagnosed?
Only be established after age 4 Coexists with difficulties in school but normal intelligence TX = Methylphenidate or alpha 2 agonists such as Clonidine
126
Conduct disorder?
Pervasive behavior violating societal norms or basic rights of others After age 18, classified as antisocial personality disorder VIOLENT
127
Disruptive mood dysregulation disorder?
Onset before age 10 Severe recurrent temper tantrums Constantly angry
128
Oppositional defiant disorder?
Pattern of anger w/ argumentative, vindictive, defiant behavior toward authority figures lasting longer than 6 months
129
Cardiac tamponade triad?
Hypotension, distended neck veins, distant heart sounds Increase in HR Pulsus paradoxus -- During inspiration Diastolic RV collapse
130
What must you monitor for patients on Clozapine?
Regular NEUTROPHIL monitoring due to risk of life-threatening AGRANULOCYTOSIS CLOZAPINE is used for refractory psychotic disorders or persistent suicidality Very high risk of weight gain Monitor WBCs CLOZely
131
Ondansetron & Granisetron MOA? Uses? SE?
5-HT receptor antagonists Used for chemo / radiotherapy Headache, QT prolongation, Serotonin syndrome, Constipation
132
Prochlorperazine & Metoclopramide MOA? Uses? SE?
ANTI-EMTICS D2 receptor antagonists Metoclopramide also causes increase in gastric emptying and increases LES tone Metoclopramide is also used in gastroparesis (diabetic) or persistent GERD Extrapyramidal symptoms, hyperprolactinemia HYPERPROLACTINEMIA IS EASY TO REMEMBER BECAUSE THIS IS A D2 RECEPTOR ANTAGONISTS YOU STUPID FUCK
133
Aprepitant & Fosaprepitant MOA? Uses? SE?
Neurokinin 1 receptor antagonists Chemotherapy-induced nausea & vomiting Fatigue
134
Most common SE of statin therapy?
Muscle & liver toxicity Must monitor hepatic transaminases
135
Sacubitril MOA? Uses? SE?
NEPRILYSIN INHIBITOR-- Prevents breakdown of bradykinin, Ang II & substance P Increases VASODILATION & DECREASES ECF VOLUME Used in combination with Valsartan (an ARB) to tx HFrEF Can cause cough Contraindicated w/ ACE inhibitors due to angioedema (both drugs INCREASE BRADYKININ)
136
What does LH stimulate in a male? What does FSH stimulate in a male?
LH stimulates release of testosterone from Leydig cells of the testes FSH stimulates the release of inhibin B from the Sertoli cells in the seminefrous tubules
137
What labs do you always get before initiating Metformin therapy? Why?
Always check Serum creatinine because Metformin can cause severe Lactic acidosis
138
Nutcracker syndrome and complications?
Compression of Left renal vein b/t SMA & aorta Flank pain, hematuria, left sided varicocele Varicocele refresher = Dilated veins in the prampiniform plexus due to Increase in venous pressure MCC scrotal enlargement in adult males Right sided indicates IVC obstruction Infertility due to Increased temperature Does NOT transilluminate on ultrasound
139
Anterior cerebral artery occlusion has sensory & motor deficits where?
Of the contralateral leg
140
Primary infection of TB affects what part of lung?
Lower lobe
141
Opioids pseudoallergic response?
They directly activate mast cells to stimulate degranulation which releases histamine Mimics True IgE mediated type 1 Hypersensitivity
142
Dantrolene MOA? Uses? SE?
PREVENTS CALCIUM release from ER in inhibiting Ryanodine receptor Used in MALIGNANT HYPERTHERMIA from toxicity of inhaled anesthetics & SUCCINYLCHOLINE & NEUROLEPTIC MALIGNANT SYNDROME from antipsychotic toxicity
143
What causes the hypercalcemia seen in Sarcoidosis?
Caused by parathyroid hormone INDEPENDENT formation of 1,25 dihydroxyvitamin D by activated MACROPHAGES Leading to INCREASED intestinal ABSORPTION of calcium
144
What neuropeptides show up in CSF of patients with narcolepsy?
Hypocretin-1
145
Where is the most often implantation site for ectopic pregnancy? How does ectopic present? What is it commonly mistaken for?
Ampulla of the fallopian tube Presents with 1st trimester bleeding & lower abdominal pain Mistaken for appendicitis
146
What are the CYP450 Inducers?
CRAPGPS Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonyureas
147
What are the CYP450 Inhibitors?
SICKFACES Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Acute alcohol Chloramphenicol Erythromycin Sulfonamides Grapefruit juice
148
Basal cell & squamous cell -- which is below & above?
Basal cell above UPPER lip Squamous cell below LOWER lip
149
Basal cell carcinoma features?
Most common Usually found on face -- locally invasive but rarely metastasizes Appear as nonhealing ulcers Palisading aligned nuclei
150
Squamous cell carcinoma features?
Second most common skin cancer -- associated with immunosuppression Marjolin ulcer -- SCC arising in chronic wounds or scars usually after 20 years Keratin pearls Actinic keratosis is a scaly plaque that is a precursor to squamous cell carcinoma
151
Acute dystonia is usually caused by? What's the treatment?
Caused by typical antipsychotics & anticonvulsants Presents with sudden onset muscle spasms / stiffness hours to days after medication use TX = Benztropine -- Muscarinic antagonist used in Parkinson disease
152
What type of murmur is usually present with pulmonary hypertension?
Due to right ventricular enlargement, a holosystolic murmur of tricuspid regurgitation is present
153
Pulmonary hypertension secondary to what 3 things?
Left sided HF -- Ends up causing RV failure Chronic lung disease / hypoxia Chronic pulmonary thromboembolism
154
What is Bosentan used for? MOA? SE?
Used in pulmonary hypertension Competitively antagonizes endothelin-1 receptors -- lowers pulmonary arterial pressure Hepatotoxic -- Monitor LFTs BOSE headphones for my lungs
155
How does trypsinogen form into trypsin?
Converted to active enzyme trypsin by enterokinase / enteropeptidase
156
Ovarian torsion pathogenesis?
Twisting of the ovary & fallopian tube around the infundibulopelvic ligament & ovarian ligament Presents with acute pelvic pain w/ associated n/v The obstructed blood flow is through the infundibulopelvic ligament
157
What ligament can be damaged during a hysterectomy?
Cardinal ligament
158
Does herpes have a painful inguinal lymphadenopathy?
Yes Vesicular ulcers on genitals
159
What are the two 30S inhibitors?
Aminoglycosides & tetracyclines
160
Aminoglycosides MOA? Clinical use? SE?
Bactericidal -- irreversible inhibition of initiation complex through binding of the 30S subunit Misreading of mRNA Used for severe gram - rod infections Nephrotoxic Neuromuscular blockade -- Contraindicated in myasthenia gravis patients Ototoxicity Teratogenic
161
How does Pheochromocytoma present? Lab findings? Treatment?
Most common tumor of the adrenal medulla in adults Derived from Chromaffin cells Presents with the 5 P's of Pressure, Pain (headache), Perspiration, Palpitations, Pallor Increased catecholamines & metanephrines (homovanillic acid) Chromogranin & synaptophysin + Treatment is Phenoxybenzamine -- irreversible alpha antagonist Alpha blockade must be achieved before giving beta blockers to avoid hypertensive crisis
162
PFT readings for COPD?
Functional residual capacity, residual volume, & total lung capacity are increased Decreased FEV1 Decreased FEV1 / FVC Increase in TLC
163
Pathogenesis of Primary Myelofibrosis? How does it manifest?
Disorder of clonal megakaryocytes -- secrete TGF beta which stimulates fibroblasts to produce collagen -- this leads to hematopoietic stem cells migrating to liver & spleen & causes extramedullary hematopoiesis Presents with severe fatigue, hepatomegaly + MASSIVE splenomegaly Dacrocytes (Teardrop RBCs) on peripheral bloom smear Dry tap aspiration due to fibrosis
164
Other than the gynecomastia seen with spironolactone, what is the major adverse effect of Potassium-sparing diuretics?
Hyperkalemia -- lead to arrhythmias Metabolic acidosis These drugs are competitive aldosterone receptor antagonists in the cortical collecting tubule Spironolactone, Eplerenone, Amiloride, Triamterene
165
MOA of clonidine? SE?
Stimulates central alpha 2 adrenergic receptors Causes a decrease in presynaptic release of NE & decrease in sympathetic outflow Can cause orthostatic syncope
166
How do you differentiate between follicular adenoma & follicular thyroid carcinoma?
Follicular adenoma -- MC benign thyroid neoplasm, displays numerous neoplastic follicular cells & are completely encapsulated Follicular thyroid carcinomas are characterized by invasion of the tumor capsule
167
What is often found as a precursor to malignant lesion in medullary thyroid carcinoma?
C cell hyperplasia that secrete calcitonin
168
What is unique about the labs for Paget disease of the bone?
Serum calcium, phosphorus & PTH are all normal INCREASE IN SERUM ALKALINE PHOSPHATASE -- ALP Mosaic pattern of woven & lamellar bone Increase risk of osteosarcoma HEARING LOSS is common due to skull deformity TX = Bisphosphonates Rare SE = Osteonecrosis of the jaw
169
What are the Labs for SLE?
ANA + Anti DS DNA Anti Smith LOW complement levels
170
Anti mitochondrial antibodies?
Primary biliary cirrhosis Presents with cholestatic symptoms -- Pruritus, jaundice, malabsorption
171
C5a is involved with what?
Neutrophil chemotaxis
172
Serum sickness is what type of hypersensitivity rxn?
Type III Antibodies to foreign proteins appear 1-2 weeks later Antibody antigen complex form & deposit in tissues Decrease in serum C3 & C4 C3a & C5a are increased - neutrophil chemotaxis
173
Phenylephrine MOA? Applications?
Selective alpha 1 agonist with no effect on alpha 2 or beta receptors Used in hypotension Causes peripheral vasoconstriction that increases systemic vascular resistance & blood pressure but does no direct effect on the heart Decreases HR & cardiac output
174
Cardiovascular effects of adrenergic agonists?
Alpha 1 -- Peripheral vasoconstriction -- Increase SVR Beta 1 -- Increase HR & contractility -- Increase CO Beta 2 -- Peripheral vasodilation -- Decrease SVR D1 -- Renal arteriolar vasodilation
175
Dobutamine MOA? Applications?
Primarily a beta 1 agonist with partial activity on beta 2 receptors Increases the production of cAMP Decreases BP Increases HR & CO Used for cardiac stress testing, acute decompensated HF with cardiogenic shock
176
Dopamine dosage with response to cardiovascular effects?
Low dose is strong dopamine 1 receptor -- Decreases BP & Increases HR High dose is alpha 1 receptor primarily -- Increases BP & Decreases HR
177
Epinephrine dosing and cardiovascular effects?
Low dose is primarily beta 1 > beta 2 > alpha 1 -- Decreases BP & increases HR High dose is primarily alpha 1 > beta 1 > beta 2 -- Increases BP & decreases HR
178
ACE inhibitors MOA? Clinical use? SE?
Inhibit ACE -- Decreased Angiotensin II -- Leads to decrease in GFR by preventing constriction of efferent arterioles -- Increase in renin due to loss of (-) feedback Inhibition of ACE also prevents inactivation of Bradykinin (potent vasodilator) Used in HTN, HF (decreases mortality), Proteinuria, diabetic nephropathy IMPORTANT -- Prevents unfavorable heart remodeling as a result of Chronic HTN / Post-MI (attenuates left ventricular chamber dilation) SE = Cough, angioedema (due to increased bradykinin) Contraindicated in C1 esterase inhibitor deficiency Teratogen Increases Creatinine (Decrease in GFR) Hyperkalemia & hypotension Captopril, Enalapril, Lisinopril, Ramipril
179
Pathogenesis of sickle cell anemia? Complications? Key words?
Point mutation in beta-globin gene -- Glutamic acid to Valine Mutant HbA is termed HbS Causes extravascular & intravascular hemolysis Newborns asymptomatic because of HbF in abundance Heterozygotes have resistance to malaria Crew cut on skull x ray due to marrow expansion Aplastic crisis -- arrest of erythropoiesis due to Parvovirus B19 Autosplenectomy -- Howell-Jolly bodies (risk of infection with encapsulated organisms such as S. Pneumoniae) Salmonella osteomyelitis Painful vaso-occlusive crises Acute chest syndrome -- respiratory distress, new pulmonary infiltrates on CXR -- common cause of death Sickling in renal medulla causes renal papillary necrosis & hematuria TX = Hydroxyurea to increase HbF
180
Bipolar 1 disorder diagnosis?
Patients with more than 1 manic episode with or without a hypomanic or depressive episode are diagnosed with bipolar 1 disorder Manic episodes can occur with or without psychotic features
181
Bipolar 2 disorder diagnosis?
Involves hypomanic episodes (less severe than mania & without psychotic features) & major depressive episodes For at least 4 days
182
Brief psychotic disorder diagnosis?
Acute onset of 1 psychotic symptom lasting 1 or more days but less than a month with eventual complete resolution
183
Schizophreniform disorder diagnosis?
2 or more schizophrenic symptoms Psychotic symptoms occurred only in the context of a manic episode & been present for more than a month
184
What is the most common GI disorder in patients with cystic fibrosis?
Pancreatic insufficiency Thick viscous secretions in the lumens of the pancreas that result in obstruction & fibrosis Clinical manifestations include steatorrhea, failure to thrive, & deficiency of fat soluble vitamins
185
What is prepatellar bursitis?
Inflammation of the prepatellar bursa in front of the knee cap Caused by trauma or pressure from kneeling Also called "housemaids" knee
186
What are popliteal cysts?
Also called Baker cyst Fluid collection in gastrocnemius & semimembranosus bursa Related to osteoarthritis or inflammatory joint disease
187
What is a "jersey finger" injury?
When an active flexed DIP joint is forcefully hyperextended Most commonly ring finger Results in absent DIP flexion Flexor digitorum profundus
188
What acts as the central regulator of iron homoeostasis?
Hepcidin -- it is synthesized in the liver
189
Alpha-fetoprotein is a serum tumor marker that is often moderately elevated in patients with?
CHRONIC VIRAL HEPATITIS It can be strikingly elevated in those with HEPATOCELLULAR CARCINOMA
190
Reye syndrome findings?
Fatty liver, hypoglycemia, vomiting, hepatomegaly, coma Avoid aspirin in children except KawASAki disease Causes hepatic steatosis, hyperammonemia, & diffuse astrocyte swelling
191
Virion's & their cellular receptors
CMV -- Integrins EBV -- CD21 (CR2) HIV -- CD4 & CXCR4 & 5 Rabies -- Nicotinic acetylcholine receptor Rhinovirus -- ICAM1 (CD54)
192
Atropine OD symptoms? Antidote?
Atropine is an anticholinergic medication Physostigmine is a cholinesterase inhibitor that penetrates BBB
193
Hereditary breast cancer is most commonly associated with what mutations?
BRCA1 & BRCA2 -- Tumor suppressor genes involved in DNA repair Mutations lead to increase risk in breast & ovarian cancer
194
What is the MOA of Cyclosporine & Tacrolimus?
Calcineurin inhibitors Blocks T cell activation by preventing IL-2 transcription Used for RA & Immunosuppression following organ transplant Highly nephrotoxic
195
What is the best medication to use Post MI or for acute ventricular arrthymias?
Class 1B -- Lidocaine, Phenytoin, Mexiletine Weak sodium channel blockade Decreases AP duration
196
Adenosine MOA? Uses? SE?
Adenosine kicks potassium out of cells -- hyperpolarizing the cell and decreasing intracellular calcium -- causing a decrease in AV node conduction DOC in diagnosing / terminating Supraventricular tachyarrhythmias Effects are blunted by theophylline & caffeine SE = Flushing, bronchospasm, sense of impending doom
197
Digoxin MOA? Uses? SE?
Direct inhibition of Na/K+ ATPase Indirect inhibition of Na/CA2 exchanger Increase in Intracellular Calcium = Positive inotropy Stimulates Vagus nerve to decrease HR Used in HF, Afib -- Decreases conduction at AV node & depression of SA node SE = Hypokalemia Drugs that displace digoxin -- Verapamil, Amiodarone, Quinidine Blurry YELLOW VISION
197
Digoxin MOA? Uses? SE?
Direct inhibition of Na/K+ ATPase Indirect inhibition of Na/CA2 exchanger Increase in Calcium = Positive inotropy Stimulates Vagus nerve to decrease HR Used in HF, Afib -- Decreases conduction at AV node & depression of SA node SE = Hyperkalemia (poor prognosis) Antidote = anti-digoxin & Magnesium
198
Diltiazem & Verapamil MOA? Uses? SE?
Class IV calcium channel blockers Decrease conduction velocity Increase ERP & PR interval Used for prevention of nodal arrhythmias (SVT) & rate control in Afib SE = Constipation, flushing, edema
199
Amiodarone, Ibutilide, Dofetilide, Sotalol MOA? Uses? SE?
Class III potassium channel blockers Increase AP duration, Increase ERP, & Increase QT interval Used for Afib & Atrial flutter & ventricular tachycardia Sotalol -- Torsades de pointes, excessive beta blockade Ibutilide -- Torsades de pointes Amiodarone -- Pulmonary fibrosis, hypo or hyper thyroidism, Corneal deposits, blue/gray skin deposits -- photodermatitis Check PFTs, LFTs, & TFTs when using amiodarone
200
Class II antiarrhythmics MOA? Uses? SE?
Decrease SA & AV nodal activity by decreasing cAMP, decrease calcium currents, & suppress abnormal pacemakers by decreasing slope of phase 4 Increases PR interval Beta blockers used in patients with acute or recent MI to reduce risk of ventricular arrthymias by decreasing automaticity & reduce oxygen demand Used in SVT, ventricular rate control, Afib, & atrial flutter SE = Impotence, exacerbation of COPD & asthma May MASK signs of HYPOGLYCEMIA (tx w/ glucagon) Metoprolol can cause dyslipidemia Propranolol can exacerbate vasospasm in vasospastic angina Treat beta blocker overdose with saline, atropine, glucagon
201
Quinidine, Procainamide, Disopyramide MOA? Uses? SE?
Class I sodium channel blockers Slow or block conduction, Decrease slope of phase 0 depolarization Moderate sodium channel blockade Increase AP duration, Increase effective refractory period PROLONGED QT INTERVAL Used in both atrial & ventricular arrhythmias -- especially reentrant & ectopic SVT & VT SE = CINCHONISM (headache, tinnitus with quinidine) Reversible SLE like syndrome with Procainamide HF with Disopyramide Thrombocytopenia, Torsades de pointes due to Increase in QT interval
202
What is an Iliopsoas abscess?
Collection of Pus in iliopsoas compartment Presents with flank pain, fever, (+) psoas sign (hip extension exacerbates lower abdominal pain)
203
Diagnosis criteria for schizophrenia?
Requires 2 of the following (at least 1 symptom has to be from numbers 1-3 Delusions (1) Hallucinations, often auditory (2) Disorganized speech (3) Disorganized or catatonic behavior Negative symptoms (flat affect, apathy, anhedonia, social withdrawal) Symptoms have to be at least 6 months prior to diagnosis with at least 1 month of active symptoms over the past 6 months
204
Exudative pleural effusions?
Cloudy cellular fluid Usually due to infection / malignancy INCREASE IN LDH & PROTEIN
205
Transudative pleural effusions?
Clear hypocellular fluid Due to INCREASE IN HYDROSTATIC PRESSURE Usually from HF or sodium retention Or reduced oncotic pressure i.e. cirrhosis or nephrotic syndrome LOW PROTEIN LOW LDH
206
What is Chiari 1 malformation?
Ectopia of cerebellar tonsils inferior to foramen magnum Usually asymptomatic in childhood Adulthood manifestations of headache & cerebellar symptoms Associated with spinal cavitations (syringomyelia)
207
What is Chiari 2 malformation?
Herniation of cerebellum & medulla through foramen magnum Noncommunicating hydrocephalus -- defined as structural blockage of CSF within ventricular system More severe than Chiari 1 Presents early in life with dysphagia, stridor, apnea, & limb weakness
208
What is a Dandy-Walker malformation?
Agenesis of the cerebellar vermis CYSTIC enlargement of the 4TH VENTRICLE that fills the enlarged POSTERIOR fossa Associated with NONCOMMUNICATING hydrocephalus & spina bifida
209
What chamber of the heart is at risk for penetrating injury?
The right ventricle -- composes the majority anterior surface of the heart
210
Giemsa stain used for what?
Chlamydia Rickettsia Trypanosomes Borrelia Helicobacter pylori Plasmodium
211
What is pseudotumor cerebri?
Called idiopathic intracranial hypertension Increased ICP with no obvious findings on imaging Risk factors -- female, tetracyclines, obesity, vitamin A excess, Danazol female TOAD Presents with headache, tinnitus, diplopia Papilledema & transient visual disturbances because of increased intracranial pressure compressing the optic nerves -- resulting in impaired axoplasmic flow & optic disc edema
212
What is piriformis syndrome?
The piriformis acts to EXTERNALLY rotate the THIGH when EXTENDED & ABDUCT the thigh when FLEXED The piriformis passes through the greater sciatic foramen & involved with EXTERNAL HIP ROTATION -- injury or hypertrophy can compress the nerve causing piriformis syndrome
213
What enzymes are involved in normal tissue remodeling but also assist in tumor invasion through the basement membrane & connective tissue?
Metalloproteinases
214
Tumor cells detach from surrounding cells by increased or decreased E-Cadherin?
Decrease in E-cadherins
215
What is vasospastic angina?
Involves hyperreactivity of coronary artery smooth muscle Transient ST elevation Patients are usually young (<50) & without significant risk factors for CAD Present with recurrent episodes of chest discomfort that typically occur during rest or sleep & resolve within 15 minutes Treat with calcium channel blockers / nitrates
216
2nd leading cause of lung cancer after cigarette smoke?
Radon Gas
217
Alirocumab & Evolocumab MOA? SE?
LIPID LOWERING AGENTS Inactivation of LDL-receptor degradation -- INCREASED REMOVAL OF LDL FROM BLOODSTREAM PCSK9 binds to LDL-receptor on hepatocyte cell surface increases degradation of LDL-Receptor -- leading to decreased uptake of circulating LDL Basically decrease LDL-receptor degradation -- resulting in a greater uptake of LDL in the liver & lowers circulating LDL levels SE = Myalgias & Neurocognitive effects
218
What medication is used for migraine prophylaxis?
Topiramate Blocks sodium channels -- Increases GABA action SE = Kidney stones, weight loss, glaucoma Can also use beta blockers, tricyclic antidepressants
219
What drug should you not use in patients with hereditary angioedema?
Since they have low c1 esterase inhibitor activity -- do NOT use ACE inhibitors Characterized by a DECREASE in C4 levels Unregulated activation of Kallikrein Increases Bradykinin production
220
What are the positives of Bupropion? Negatives?
Does not cause sexual side effects or weight gain Also used for smoking cessation Seizure risk MOA: Inhibits NE & dopamine reuptake (Increase in dopamine = seizure)
221
Neonatal hypoglycemia is common in infants of what mothers?
Diabetic mothers Maternal hyperglycemia causes fetal hyperglycemia & compensatory hyperfunctioning of the pancreas (hyperinsulinemia) After birth, persistently elevated insulin levels lead to transient hypoglycemia
222
Metformin MOA? Uses? SE?
Inhibits mitochondrial glycerol-3-phosphate dehydrogenase Inhibition of hepatic gluconeogenesis (think about it) & action of glucagon Increases glycolysis & peripheral glucose uptake Increases insulin sensitivity SE = Lactic acidosis (use with caution in renal insufficiency) SE = Vitamin B12 deficiency
223
Thiazolidinedione's "glits" PioGLITazone & RosiGLITazone MOA? Uses? SE?
Activate PPAR-kappa (a nuclear receptor) -- this increases insulin sensitivity & levels of adiponectin SE = Edema, HF, Increase risk of fractures Delayed onset of action (weeks) Rosiglitazone -- Increase risk of MI & CV DEATH
224
Sulfonylureas MOA? Uses? SE? Meglitinides "Glins" MOA? Uses? SE?
Chlorpropamide & Tolbutamide are 1st gen GLIPIZIDE & GLYBURIDE are 2nd gen (MC) Close K+ (potassium) channels in pancreatic beta cell membrane - cell depolarizes - insulin release via increased Ca2+ INFLUX This class overall increases insulin SECRETION SE = Disulfiram like reaction with 1st gen. HYPOGLYCEMIA IN THESE BITCHES (Increased risk of renal insufficiency) Meglitinides -- NateGLINide & RepaGLINide have the same MOA & SE
225
GLP-1 Analogs MOA? Uses? SE?
EXENATIDE, LIRAGLUTIDE, SEMAGLUTIDE Think GLP-ESL (fat Faiz needs insulin) Increase GLUCOSE-INDUCED insulin secretion Decrease glucagon release, DECREASE GASTRIC EMPTYING SE = PANCREATITIS
226
DPP-4 Inhibitors MOA? Uses? SE?
GLIPS -- LINA, SAXA, & SEXY SITA LinaGLIPtin, SaxaGLIPtin, SitaGLIPtin Inhibit DPP-4 enzyme that deactivates GLP-1, this decreases glucagon release, DECREASES GASTRIC EMPTYING Increases glucose-dependent insulin release SE = RESPIRATORY & URINARY infections + satiety (desired) & weight neutral
227
What are the sodium-glucose co-transporter 2 inhibitors MOA? Uses? SE?
GLIFS -- CANA, DAPA, & EMPA CanaGLIFlozin, DapaGLIFlozin, EmpaGLIFlozin Block reabsorption of glucose in PCT SE = Glucosuria (UTIs, Vulvovaginal candidiasis), dehydration (orthostatic hypotension) Use with caution in renal insufficiency -- Decreased efficacy with decreased GFR
228
Alpha glucosidase inhibitors MOA? Uses? SE?
Acarbose, Miglitol Decrease glucose absorption Inhibit intestinal brush border alpha glucosidases to delay carbohydrate hydrolysis & glucose absorption This decreases postprandial hyperglycemia SE = GI upset & bloating
229
Pramlintide MOA? Uses? SE?
Amylin analog (diabetes drug) Decrease glucagon release, decrease gastric emptying SE = hypoglycemia, nausea, satiety
230
Patellofemoral syndrome?
Overuse injury in female athletes Presents as ANTERIOR knee pain Exacerbated by prolonged sitting or flexed knee Loss of strength of QUADS muscle
231
What is paraneoplastic cerebellar degeneration most commonly associated with?
Antibodies against antigens in purkinje cells Most common is small cell lung cancer Hodgkins Small Cell Carcinoma refresher -- Central location Undifferentiated -- very aggressive Neurologic paraneoplastic syndromes & endocrine i.e. SIADH & Cushing Amplification of MYC oncogenes MC
232
Rituximab MOA? Uses? SE?
Monoclonal AB directed against CD20 -- cell surface receptor on developing & mature B CELLS Overall reduce B cell population to reduce inflammatory symptoms of a wife range of rheumatologic diseases Used in Non-Hodgkin lymphoma, CLL, RA, Multiple sclerosis, ITP, TTP, AIHA SE = Infusion reaction due to cytokine release w/ its target on B cells
233
Dislocation of the Lunate could impinge what nerve?
Median nerve -- causing carpal tunnel syndrome
234
Fracture of the hook of hamate can cause what?
Ulnar syndrome
235
What is the most commonly fractured carpal bone?
Scaphoid -- high risk of avascular necrosis
236
Radial nerve injury findings?
WRIST DROP ABSENT TRICEP REFLEX Weakness of forearm, hand & finger EXTENSORS
237
Hypothyroidism effect on LDL?
Hypothyroidism decreases expression of LDL receptors in the liver Leads to decreased clearance of LDL & increased blood LDL levels Also causes hypertriglyceridemia due to decreased expression of lipoprotein lipase
238
Gastric ulcer pain with meals?
GREATER with meals Patients PRESENT W/ WEIGHT LOSS H. Pylori infection or NSAIDs -- decrease mucosal protection against gastric acid INCREASED risk of carcinoma
239
Duodenal ulcer pain with meals?
Duodenal -- DDDDD Decreases with meals Patients have GAINED weight H. Pylori or Zollinger-Ellison syndrome Increase in gastric acid secretion Generally benign ZES = Gastrin-secreting tumor of the duodenum or pancreas Acid hypersecretion causes recurrent ulcers in duodenum Associated w/ MEN1
240
Treatment for both gastric & duodenal ulcers?
PPI (Omeprazole) & antibiotics (tetracycline, metronidazole)
241
Tamoxifen MOA? Uses? SE?
SERM Blocks the binding of estrogen to estrogen receptor in ER (+) cells ANTAGONIST at BREAST Partial AGONIST at UTERUS, BONE SE = Hot flashes, Increase risk of thromboembolic event -- especially with tobacco ENDOMETRIAL CANCER Used to treat & prevent recurrence of ER/PR (+) breast cancer & to PREVENT GYNECOMASTIA in patients undergoing prostate cancer therapy
242
Raloxifene MOA? Uses? SE?
SERM Antagonist at breast & Uterus Agonist at bone ANTAGONIST @ UTERUS IS THE ONLY DIFFERENCE W/ THIS & TAMOXIFEN (so this doesn't cause endometrial cancer) SE = Hot flashes, thromboembolic events NO Increased risk of endometrial cancer (VS Tamoxifen) so you can "relax" with Tamoxifen Used primarily for osteoporosis
243
Infant difficulty latching crazy OMM BS?
Treat with occipital condyle decompression
244
Burkitt lymphoma occurs in? Translocation? Important associations?
Young adults I knew Daniel Burkitt (my neighborhood) @ 8 years old & we became distanced @ 14 T(8;14) -- C MYC & heavy chain Starry sky appearance w/ interspersed macrophages Associated with EBV Jew lesion in endemic form in Africa Pelvis or abdomen in sporadic form
245
Iron deficiency anemia classification? Labs? Manifest into?
Microcytic hypochromic anemia Decreased iron due to chronic bleeding, malnutrition or increased demand (pregnancy) Labs -- Decrease in iron, ferritin Increase in TIBC & free erythrocyte protoporphyrin May manifest as glossitis, cheilosis, Plummer-Vinson syndrome (triad of iron anemia, esophageal web, dysphagia)
246
Hepatitis D virus must be coated with what?
Must be coated by external coat hepatitis B surface antigen - HBsAg of HBV to penetrate the hepatocyte HDV infection can arise either as an acute coinfection with HBV or as a superinfection of a chronic HBV carrier
247
Treatment for adrenal insufficiency?
Aggressive fluid resuscitation & glucocorticoid supplementation
248
Ventricular septal defect murmur?
Holosystolic, harsh sounding murmur Loudest at tricuspid area Congenital -- Murmur increases w/ HAND CLENCHING LEFT to RIGHT shunting of oxygenated blood from LV to RV RV oxygen saturation is increased compared to normal
249
Typical & Atypical antipsychotics effects on endocrine for women?
Antipsychotics cause HYPERPROLACTINEMIA by BLOCKING D2 receptors on LACTOTROPHS ELEVATED PROLACTIN leads to AMENORRHEA (inhibition of GnRh) Decreased GNRH = no period bitch Galactorrhea
250
Exogenous hyperthyroidism thyroid biopsy findings?
Because there is high T4 & low TSH likely secondary to LEVOTHYROXINE misuse -- overtime the lack of TSH stimulation cause the THYROID FOLLICLES to become ATROPHIC
251
The most common cause of digital clubbing in adults is what
Pulmonary malignancy -- especially LUNG ADENOCARCINOMA More generally, clubbing is a sign of chronic CARDIOPULMONARY disease associated with activation of hypoxic inflammatory signaling
252
What is the only thing decreased in Mitral stenosis?
END DIASTOLIC VOLUME because of impaired ventricular filling -- at the end of the Diastole, how much blood is in the LV? PCWP closely reflects left atrial & left ventricular END DIASTOLIC PRESSURE Mitral stenosis leads to increase in LA pressure that is reflected as elevated PCWP
253
Ganciclovir Use? SE?
Used in CMV for immunocompromised patients Inhibits viral DNA polymerase via CMV viral kinase SE = Myelosuppression -- Leukopenia, neutropenia, thrombocytopenia, & renal toxicity
254
Complement deficiency of C5-C9 results in recurrent infections by what bacteria?
Encapsulated bacteria i.e. Strep. pneumo & N. Meningitidis Unable to form Membrane Attack Complex
255
VSD Intracardiac pressure changes on heart valves?
Right atrium is unchanged RV, LA, & LV all have increased intracardiac pressure due to a left to right shunt (LV into RV)
256
Syringomyelia pathogenesis? What part of the brain is damaged? What are the findings?
Formation of a cavity in the cervical region of the spinal cord Syrinx damages the ventral white commissure (Spinothalamic tract) & leads to bilateral loss of pain & temperature usually in the UE Find touch is preserved
257
What is the DOC for uncomplicated malaria?
Chloroquine is the DOC in a chloroquine sensitive region Primaquine is added for P. Vivax & P. Ovale infections to eradicate intrahepatic stages (hypnozoites) -- responsible for relapse
258
What usually accounts for the severity in patients infected with Dengue virus (Flavivirus, transmitted by Aedes mosquito)
If patient was infected with a different serotype after their initial infection due to antibody-dependent enhancement of disease
259
How do you characterize borderline personality disorder?
Cluster B Persistent pattern of unstable relationships, mood lability, & impulsivity May exhibit suicidal ideation or behavior during interpersonal crisis
260
What is the MOA of Apixaban, Edoxaban, & Rivaroxaban? Uses? SE?
Directly inhibit factor Xa Treatment & prophylaxis for DVT & PE Stroke prophylaxis for patients with Afib SE = Bleeding (Antidote is Andexanet alfa) to reverse anticoagulation effect
261
TNF-alpha inhibitors Infliximab, Adalimumab, Certolizumab, & Golimumab MOA? Use? SE?
Anti-TNF alpha monoclonal Antibody Used in IBD, RA, Ankylosing spondylitis, & psoriasis SE = predisposed to infection including latent TB since TNF is important in granuloma formation & stabilization Can also lead to drug induced lupus / Serum sickness -- Decreased C3 & C4 complement levels (Type III)
262
Antifungal agent that targets Mitosis?
Griseofulvin Interferes with microtubule function -- disrupts mitosis Deposits in Keratin-containing tissues Inhibits growth of dermatophytes (tinea, ringworm) SE = Teratogenic, carcinogenic, confusion, HA, disulfiram like reaction, Increase in CYP450, & Warfarin metabolism
263
Antifungal medication that targets DNA & RNA synthesis? MOA? Uses? SE?
Flucytosine Inhibits DNA & RNA biosynthesis by conversion to 5-FU by cytosine deaminase Systemic fungal infections -- especially Cryptococcus (w/ Ampho B) SE = Myelosuppression
264
Antifungal medication that targets the Cell wall? MOA? Uses? SE?
Caspofungin (Echinocandins) Inhibits cell wall synthesis by inhibiting synthesis of beta glucan Invasive aspergillosis & Candida SE = GI upset, Flushing (histamine release)
265
Antifungal medication that targets the cell membrane? MOA? Uses? SE?
Amphotericin B Binds ergosterol -- membrane pores form that allow leakage of electrolytes Serious & systemic mycoses SE = Fever / chills Hypotension, nephrotoxic, IV Phlebitis, Arrhythmias Supplement K+ & Magnesium because of altered renal tubule permeability Hydrate to decrease nephrotoxicity
266
Hyperoxia can increase production of what?
Reactive oxygen species Leads to injury of airways & lung parenchyma Oxygen typically manifests with substernal heaviness, cough / dyspnea within 24 hours
267
Traumatic pneumothorax presents how?
Air in pleural space Patients usually experience chest pain & difficulty breathing Crepitus -- caused by air in the subcutaneous tissue of the chest wall is present on physical exam
268
Pneumothorax deviation?
Tracheal deviation away from the affected lung
269
Muscle energy is used to lengthen hypertonic / shortened muscles using what type of relaxation?
Postisometric relaxation (Golgi tendon mediated muscle relaxation following isometric contraction
270
Traumatic aortic rupture caused by? Most commonly which part of aorta?
Trauma & or deceleration injury Aortic isthmus (proximal descending aorta)
271
What is the most common eye related complication of congenital CMV?
Chorioretinitis (Also Toxo)
272
Prostacyclin is secreted to inhibit what?
Inhibit platelet aggregation & causes vasodilation to oppose the functions of Thromboxane A2 & maintain vascular homeostasis
273
Inflammatory invasive carcinoma presents how? Mistaken for what?
Dermal lymphatic space invasion Itchy breast rash w/ pain & breast is warm with swollen skin around hair follicles (orange shit) Mistaken for mastitis or Paget disease Lacks a palpable mass
274
Uncal transtentorial herniation affects what brain region? Main symptoms?
Affects the medial temporal lobe Patients often develop ipsilateral CN III Palsy with a fixed & dilated pupil
275
Treatment for C. Difficile?
Oral Fidamoxicin or oral Vancomycin Fidaxomicin is a macrolide that inhibits RNA polymerase
276
Abciximab, Eptifibatide, & Tirofiban MOA? Uses?
Blocks GpIIb & GPIIIa (fibrinogen receptor) on activated platelets -- Decreases platelet aggregation Abciximab is used to treat Glanzmann thrombasthenia -- GPIIb or IIIa is deficient or defective in these patients Used in unstable angina as well
277
Patients with psoas syndrome have low back pain & lumbar dysfunction on what side?
Lumbar dysfunction on the affected side Pelvic Shift to the opposite side Psoas syndrome = Flexure contracture of the psoas muscle
278
Digoxin toxicity presents with what symptoms? Most common complication?
nonspecific GI symptoms & neurologic symptoms Changes in color vision Life threatening ventricular arrhythmias are most serious complication
279
What is countertransference?
Provider's response toward a patient based on past personal relationships Can be positive or negative
280
What is the MOA of PTU & Methimazole? Uses? SE?
Block thyroid peroxidase -- inhibiting oxidation of iodide Inhibits thyroid hormone synthesis PTU also blocks conversion of T4 to T3 Used in Hyperthyroidism (Grave's) PTU is used in 1st trimester of pregnancy because Methimazole is teratogenic Methimazole is used in 2nd & 3rd trimester due to risk of PTU induced hepatotoxicity SE = Rash, Agranulocytosis, hepatotoxicity PTU has been associated with ANCA positive vasculitis Methimazole is a possible teratogen
281
What is pill esophagitis caused by?
Tetracyclines Bisphosphonates (Alendronate) Potassium Chloride NSAIDs Direct mucosal injury
282
What is Wilson disease? What accumulates? How does it present? Treatment?
AR mutation in hepatocyte COPPER ATPase COPPER accumulates especially in liver & brain cornea & kidneys Increase in urine copper Presents before 40 w/ liver disease KAYSER-FLEISCHER rings on SLIT LAMP exam (Basal Ganglia Atrophy) TX = Chelation with penicillamine
283
What are the hallmark signs of PCP intoxication?
Ataxia & nystagmus (vertical or horizontal)
284
What are the cardiovascular effects of high altitude?
Hypoxic pulmonary vasoconstriction -- Increases pulmonary vascular resistance Increased sympathetic activity to increase CO Aldosterone suppression to reduce plasma volume
285
Acetazolamide MOA? Uses? SE?
Carbonic anhydrase inhibitor -- Works @ PCT Decreases total body bicarb stores -- Increased excretion of Bicarb = urine alkalized = low blood pH but HIGH urine pH Alkalinizes urine Used in Glaucoma, metabolic alkalosis (altitude sickness) SE = Type 2 RTA (proximal) HYPOKALEMIA due to Increase in urine potassium due to distal reabsorption of Na+ Renal calcium phosphate stones
286
Loop diuretics' MOA? Uses? SE?
Furosemide, Bumetanide, Torsemide Inhibit cotransport system of Na/K/2CL of thick ascending limb of loop of Henle Inhibited by NSAIDs Increase in CALCIUM EXCRETION (Hypocalcemia) LOOPS LOSE CALCIUM Used for HF, cirrhosis, nephrotic syndrome, edema SE = Ototoxicity, hypomagnesemia, nephritis, Sulfa allergy SEVERE HYPOKALEMIA Only thing Hyper is HYPERURICEMIA = GOUT
287
Ethacrynic Acid MOA? Uses? SE?
Nonsulfonamide inhibitor of cotransport Na/K/2CL of thick ascending loom of Henle Used for diuresis in patients with sulfa allergy SE = similar to furosemide but more OTOtoxic
288
Thiazide diuretics MOA? Uses? SE?
Hydrochlorothiazide, Chlorthalidone, Metolazone Inhibit NaCl reabsorption in early DCT Decreases calcium excretion in urine (HYPERCALCEMIA) Used in HTN, HF, idiopathic hypercalciuria Hyperglycemia, Hyperlipidemia, Hypercalcemia, Hyperuricemia
289
Potassium sparing diuretics MOA? Uses? SE?
Spironolactone, Eplerenone, Amiloride, Triamterene Spiro & Eplerenone are competitive aldosterone receptor antagonists in cortical collecting tubule Triamterene & Amiloride block sodium channels at the same part of the tubule Used in hyperaldosteronism, Potassium depletion, HF, nephrogenic DI (Amiloride) SE = Hyperkalemia Commonly used w/ loop or thiazide diuretics to prevent hypokalemia
290
Azoles MOA? Uses? SE?
Clotrimazole, Fluconazole, Itraconazole, Ketoconazole, Voriconazole Inhibit fungal sterol synthesis by inhibiting the CYP450 enzyme that converts Lanosterol to Ergosterol (Ergosterol synthesis is decreased) Fluconazole for cryptococcal meningitis & Candida infections of all types Itraconazole for Blastomeres, Coccidioides, Histoplasma, Sporothrix Clotrimazole for topical infections Voriconazole for Aspergillus Isavuconazole for serious Aspergillus SE = Testosterone synthesis inhibited Gynecomastia (especially ketoconazole) QT prolongation
291
What are the 2 diastolic murmurs?
1. Aortic regurgitation Early diastolic decrescendo high pitched blowing murmur Best heard at base or left sternal border Causes include, bicuspid aortic valve, endocarditis, aortic root dilation, rheumatic fever Head bobbing when severe & chronic 2. Mitral stenosis Follows opening snap Delayed rumbling mid to late murmur Late sequelae of rheumatic fever Chronic MS can result in LA dilation & pulmonary congestion LA pressure is greater than LV pressure during diastole Best heart at cardiac APEX (Left 5th intercostal space)
292
Propranolol for the use in Grave's disease (hyperthyroidism) not only helps blunt the adrenergic manifestations but also does what?
Reduce the conversion of T4 to T3 by inhibiting 5'monodeiodinase (just like PTU)
293
What is Erb Palsy?
Traction or tear of upper trunk -- C5 to C6 nerve roots Infants -- Lateral traction on neck during delivery Adults -- Trauma leading to neck traction Deltoid / Supraspinatus deficit -- Causes abduction (arm by side) Infraspinatus, supraspinatus deficit -- Causes lateral rotation Biceps brachii deficit -- Causes flexion, supination -- Arm extended & pronated
294
What is Klumpke palsy?
Traction or tear of lower trunk -- C8 to T1 nerve roots Infants -- Upward force on arm during delivery Adults -- Grabbing a tree branch to break a fall Muscle deficits -- Intrinsic hand muscles, lumbricals, interossei, thenar Results in claw hand
295
Most common cause of SCID? 2nd most common cause? Presents?
Most common cause is X-linked IL-2R gamma mutation 2nd most common cause is adenosine deaminase deficiency Presents with failure to thrive, thrush, recurrent infections from every microbe Decreased T cell receptor Absent thymic shadow & T cells
296
ACTH dependent Cushing syndrome?
Cushing disease -- ACTH secreting pituitary adenoma Ectopic ACTH secretion Hyperpigmentation, Hyperandrogenism, Hirsutism, amenorrhea High ACTH High urinary cortisol High serum DHEAS -- ACTH stimulates production of adrenal androgens (Increase in DHEAS)
297
ACTH independent Cushing syndrome?
Adrenal mass (adenoma or carcinoma) Exogenous glucocorticoids Decrease levels of ACTH
298
Ankylosing spondylitis is characterized by what? Findings? Most common in who? Treatment?
Symmetric involvement of spine & SI joints*** Joint fuses (ankylosis) Causes Uveitis & aortic regurgitation Presents with Bamboo spine, back & buttocks pain Pain is worse with rest (overnight & morning) Can cause restrictive lung disease More common in males 20-40 ** Increased osteoclast activity -- Erodes new bone + forms new bone Elevated ESR & CRP + HLA-B27 positive
299
Severe vomiting leads to acidosis or alkalosis?
Metabolic alkalosis through multiple mechanisms Loss of hydrogen ions through GI tract Volume & chloride depletion that induces renal retention of bicarb Hypokalemia induced intracellular shifting of hydrogen pH above 7.45 Bicarb more than 28
300
Celecoxib MOA? Uses? SE?
Reversibly & selectively inhibits COX-2
301
PDE-5 inhibitors MOA? Uses? SE?
Sildenafil, Vardenafil, Tadalafil, Avanafil Decrease hydrolysis of cGMP Rise in intracellular cGMP Smooth muscle relaxation by enhancing NO Used for ED, Pulmonary HTN, BPH (Tadalafil only) SE = Headache, sweaty, hypotension Sildenafil -- Cyanopia (blue tinted vision) via inhibition of PDE-6 in retina
302
What is actinic keratosis?.
Appears as a scaly erythematous lesion in sun exposed areas Does not invade full thickness of epidermis Premalignant lesions caused by sun exposure -- Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia
303
What is seborrheic keratoses? Who does it affect usually?
Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts that look "stuck on" Common benign neoplasm of older persons Indicates possible malignancy -- GI Adenocarcinoma
304
Why no Neisseria vaccine?
Antigenic variation
305
Pulmonary hypertension heart sound?
Loud pulmonic component of S2 & accentuated palpable impulse at left sternal border
306
Treatment of Chlamydia?
Ceftriaxone & Doxycycline Ceftriaxone alone for prophylaxis
307
Osteogenesis imperfecta pathogenesis? Clinical findings? Treatment?
Defective synthesis of type 1 collagen by osteoblasts Fractures after minimal trauma, Blue sclerae, Hearing loss Treat with bisphosphonates to decrease fracture risk
308
What is the benefit of using Apixaban, Edoxaban, or Rivaroxaban for conditions such as DVT?
Due to less variability in therapeutic drug effect (Vs Vitamin K antagonists) Also do not require laboratory monitoring
309
Secondary polycythemia is an expected finding in what diseases?
Conditions that cause significant chronic hypoxemia -- COPD, Interstitial lung disease Erythropoietin is released which stimulates bone marrow to increase production of RBCs -- Increase in hematocrit is secondary polycythemia
310
What is Guyon canal syndrome?
Ulnar nerve enters wrist between hook of the hamate & pisiform in a tunnel known as Guyon's canal Ulnar nerve is most commonly injured at the elbow "funny bone" but also can be at wrist through Guyon's canal Basically pinky has sensory loss
311
Testosterone is converted to DHT by what enzyme?
5-alpha reductase (inhibited by Finasteride)
312
In males, Androgens are converted to estrogens by what?
Aromatase (adipose tissue, testis)
313
Anabolic-androgenic steroid use suppresses what? Presents with?
Androgen abuse suppresses GnRH, LH, & FSH secretion -- leads to reduced endogenous testosterone secretion, impaired spermatogenesis, & testicular atrophy Also, excess testosterone is converted by aromatase to estradiol -- Gynecomastia
314
What is Glioblastoma? What are the histologic findings?
Grade IV astrocytoma Most common & highly malignant primary brain tumor with less than a year survival Found in the cerebral hemispheres Crosses corpus callosum "butterfly glioma" Associated with EGFR amplification GFAP (+) Pseudopalisading necrosis with vascular proliferation Pleomorphic tumor cells
315
Aortic stenosis sound & location?
Crescendo-decrescendo @ right upper sternal border (heart base) A2 soft & delayed
316
Mitral / Tricuspid regurgitation sound & location?
Holosystolic high pitched blowing murmur @ apex & radiates to axilla S3 gallop
317
Hypertrophic cardiomyopathy sound & location?
Crescendo decrescendo at mid left sternal border
318
Mitral valve prolapse sound & location?
Midsystolic click followed by late systolic murmur Best heard over apex -- Loudest just before S2
319
Atrial septal defect sound & location?
Midsystolic with wide & fixed splitting of S2
320
VSD sound & location?
Holosystolic @ left sternal border (tricuspid are)
321
Gestational thrombocytopenia occurs due to?
Hemodilution (maternal plasma volume expansion) & increased sequestration of platelets in the placenta
322
GERD is associated with erosive esophagitis with esophageal ulcers -- Marked by what?
Marked by worsening of baseline GERD symptoms & development of Odynophagia (painful swallowing)
323
Barrett esophagus?
Metaplastic COLUMNAR EPITHELIUM replaces the normal stratified squamous epithelium in the DISTAL esophagus Premalignant condition for esophageal adenocarcinoma
324
How is sarcoidosis characterized?
Immune mediated widespread noncaseating granulomas Elevated serum ACE levels Elevated CD4/CD8 ratio Black females Enlarged lymph nodes Pulmonary infiltrates w/ hilar adenopathy Associated with Bell palsy, uveitis, granulomas Hypercalcemia / skin changes, uveitis, vitamin D activation TX = glucocorticoids
325
Lateral pterygoid are the only muscles in mastication that aid in what?
Depressing the mandible (opening the jaw)
326
Alveolar hemosiderin-laden macrophages indicate what?
Alveolar hemorrhage Most commonly result from chronic elevation of pulmonary capillary hydrostatic pressure in the setting of lead sided HF
327
Fibromuscular dysplasia manifestations? Presentation? Diagnosis?
Fibromuscular webs alternating with areas of aneurysmal dilation Abnormal tissue growth within arterial walls -- stenotic & tortuous arteries that cause ischemia & prone to aneurysm Loss of internal elastic lamina -- women under 55 Presents as resistant hypertension (RAS) Headache, TIA, stroke, aneurysm
328
What provides major blood supply to the femoral head & neck & is prone to avascular necrosis due to injury?
Medial circumflex femoral artery
329
Which ribs are true? Which ribs are pump handle? Which ribs are bucket handle?
Ribs 1-7 are true ribs Ribs 1-5 are pump handle Ribs 6-10 are bucket handle
330
Syphilis causative agent? Description of pain? Diagnosis?
Treponema pallidum Single, painless ulcer @ inoculation site with heaped-up borders & clean base Bilateral, nonpainful lymphadenopathy VDRL/RPR & Darkfield microscopy
331
Herpes Causative agent? Description of pain? Diagnosis?
HSV Multiple, painful, superficial vesicles or ulcerations with erythematous base Bilateral & painful lymphadenopathy Diagnose with PCR / Tzanck smear
332
Stress incontinence pathogenesis? Associations? Treatment?
Urethral hypermobility or intrinsic sphincter deficiency Leaks with increased intra abdominal pressure Coughing / Valsalva causes leakage Associated with obesity, pregnancy, vaginal delivery, prostate surgery Treatment = Pelvic floor muscle strengthening -- Levator Ani
333
Urgency incontinence pathogenesis? Associations? Treatment?
Detrusor muscle overactivity -- Leaks with urge to void immediately Associated with UTIs Treatment is pelvic floor strengthening, timed voiding, relaxation techniques Antimuscarinics (Oxybutynin) -- Block M3 receptors @ the bladder to prevent detrusor contractions. Do not give with elderly Sympathomimetics (Stimulate Beta 3 receptors, Mirabegron) -- Causes detrusor smooth muscle relaxation
334
Overflow incontinence pathogenesis? Associations? Treatment?
Detrusor underactivity -- Leak with overfilling Increase in postvoid residual Associated with polyuria, BPH, spinal cord injury Treatment = Catheterization & alpha blockers for BPH
335
Increased iodine uptake is what type of nodule? What diseases?
Hot nodule Seen in Grave's disease or nodular goiter
336
Decreased iodine uptake is what type of nodule? What diseases?
Cold nodule Adenoma / Carcinoma Often warrants biopsy
337
Papillary thyroid carcinoma risk factor? Biopsy?
Most common type of thyroid carcinoma Exposure to ionizing radiation in childhood is a risk factor Papillae lined by cells with clear "orphan Annie eye" nuclei w/ dispersed chromatin & nuclear grooves (inclusions) Psammoma bodies -- Laminated calcium deposits
338
Follicular thyroid carcinoma pathogenesis? Metastasis?
Malignant proliferation of follicles surrounded by a FIBROUS CAPSULE w/ invasion through the capsule (distinguish b/t adenoma) FNA cannot make the distinction -- all depends on presence of capsular invasion Metastasis occurs hematogenously RAS mutation
339
Medullary carcinoma pathogenesis? Biopsy? Mutation?
Parafollicular C cells produce calcitonin Sheets of polygonal cells in amyloid stroma Stains w/ Congo Red Associated with MEN2A & MEN2B (RET mutations)
340
Anaplastic carcinoma population? symptoms? mutation?
Older patients -- presents with rapidly enlarging neck mass Compressive symptoms -- dyspnea, dysphagia, hoarseness TP53 mutation
341
Giant cell (temporal) arteritis pathogenesis? Labs? Treatment?
Patient presents with headaches w/ intermittent blurred vision & muscular symptoms Enlarged tender temporal artery Increase in ESR & IL-6 Granulomatous infiltrate composed of lymphocytes -- CD4 (+) T cells & macrophages Multinucleated giant cells Associated with polymyalgia rheumatica TX = High dose glucocorticoids prior to biopsy to prevent blindness Tocilizumab (Monoclonal AB against IL-6)
342
Takayasu arteritis pathogenesis? Presentation?
Asian females under 40 Pulseless disease -- Weak UE pulses Fever, night sweats, skin nodules Granulomatous thickening & narrowing of aortic arch Increase in ESR
343
What is pathogenesis of Beurger disease? treatment?
Associated with heavy tobacco smoking -- males over 40 Intermittent claudication Can lead to gangrene -- autoamputation of digits & superficial nodular phlebitis Raynaud phenomenon is present Segmental thrombosing vasculitis with vein & nerve involvement Smoking cessation
344
What is Kawasaki disease? Presentation? Treatment?
Asian children under 4 Bilateral nonexudative bulbar conjunctivitis Rash Adenopathy (cervical) Strawberry tongue Hand & foot changes (erythema) Fever Coronary artery aneurysms -- rupture causes death TX = IV immunoglobulin & aspirin
345
Polyarteritis nodosa pathogenesis? associations? treatment?
Middle aged males Hepatitis B (+) in 30% of patients Abdominal pain, melena HTN, neurologic dysfunction, cutaneous eruptions Renal & visceral vessels Different stages of transmural inflammation w/ FIBRINOID NECROSIS Innumerable renal microaneurysms & spasms on arteriogram TX = Glucocorticoids & cyclophosphamide
346
What is Bechet syndrome? Associations?
Increased incidence with the fuckin Ayrabs Recurrent aphthous ulcers, genital ulcerations, uveitis, erythema nodosum Precipitated by HSV or Parvovirus Immune complex vasculitis -- HLA-B51
347
What is Cutaneous small vessel vasculitis? Associations?.
7-10 days after medications -- Penicillin's, Cephalosporins, Sulfonamides, Phenytoin, Allopurinol, or infections such as HCV or HIV Palpable purpura w/ no visceral involvement Immune complex mediated leukocytoclastic vasculitis
348
How does eosinophilic granulomatosis w/ polyangiitis present? associations?
Asthma, sinusitis, skin nodules, peripheral neuropathy (wrist/foot drop) Heart, GI, kidney involvement Formerly called Churg-Strauss syndrome Granulomatous necrotizing vasculitis with eosinophilia Myeloperoxidase (MPO) & P-ANCA (+)
349
How does Granulomatosis with polyangiitis present? Triad? Associations?
URI -- Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis LRI -- Hemoptysis, cough Renal -- Hematuria, RBC casts Triad of Focal necrotizing vasculitis, necrotizing granulomas in lung & upper airway Necrotizing glomerulonephritis PR3-ANCA (+) Large nodular densities on X ray TX = Glucocorticoids w/ Rituximab or cyclophosphamide
350
How does immunoglobulin A vasculitis present? Associations?
Most common childhood systemic vasculitis Often follows URI Triad of Hinge pain (arthralgias), Stomach pain (intussusception), & palpable purpura on buttocks & legs Formerly called Henoch-Schonlein Purpura -- Vasculitis secondary to IgA immune complex deposition Associated with IgA nephropathy (Berger disease)
351
How does microscopic polyangiitis present?
Necrotizing vasculitis commonly involving lung, kidneys, & skin with Pauci-immune glomerulonephritis & palpable purpura Presents similar to granulomatosis w/ polyangiitis but NO nasopharyngeal involvement No granulomas TX = Cyclophosphamide
352
hat is mixed cryoglobulinemia?
Often due to viral infections -- Especially HCV Triad of palpable purpura, weakness, arthralgias Peripheral nephropathy Vasculitis due to mixed IgG & IgM immune complex deposition
353
Acyclovir MOA? Uses? SE?
Guanosine analog Monophosphorylated by HSV & VZV thymidine kinase Inhibits Viral DNA polymerase by chain termination No activity against CMV b/c CMV does not have thymidine kinase Herpes zoster -- Famciclovir Obstructive crystalline nephropathy if not adequately hydrated
354
What is gallstone ileus?
Mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen Triad of Pneumobilia, small bowel obstruction, & gall stone Fistula b/t gallbladder & GI tract -- stone enters lumen & obstructs @ ileocecal valve Air in the biliary tree
355
Albinism pathogenesis? Associations?
Normal melanocyte number but decreased melanin production Due to a decrease in Tyrosinase activity Increased risk of skin cancer Baby has white skin & hair Oculocutaneous albinism -- abnormal development of fovea & optic nerve fivers -- nystagmus & acuity issues
356
Electrical stimulation of what nerve in tx of OSA?
Hypoglossal nerve -- Increases diameter of oropharyngeal airway
357
Pathogenesis of Alzheimer disease? Presentation? Findings?
Most common cause of dementia in older adults Advanced age is the strongest risk factor Increase incidence in Down syndrome Decreased Acetylcholine Widespread cortical atrophy Senile plaques -- Beta amyloid core -- can cause intracranial hemorrhage Neurofibrillary tangles -- Intracellular hyperphosphorylated tau protein -- Microtubule associated
358
Alpha 1 receptor stimulated change in second messenger?
Increase in IP3 Peripheral vasoconstriction Urethral constriction Pupillary dilation
359
Alpha 2 receptor stimulated change in second messenger?
Decrease in cAMP CNS sympatholytic Decrease insulin release & intestinal motility
360
Beta 1 stimulated change in second messenger?
Increase in cAMP Increase cardiac contractility & HR Increase renin release by JG cells in kidney
361
Beta 2 stimulated change in second messenger?
Increase in cAMP Peripheral vasodilation Bronchodilation
362
Muscarinic stimulated change in second messenger?
Decrease cAMP Decrease cardiac contractility & HR
363
Muscarinic 3 stimulated change in second messenger?
Increase IP3 Bronchoconstriction Increase insulin & intestinal Bladder contraction Pupillary constriction Peripheral vasodilation
364
Chronic mercury toxicity presentation?
Mercury impairs breakdown of catecholamines -- stimulation of SNS -- tachycardia, HTN, diaphoresis Desquamating hypersensitivity rash Tremor
365
What is Locked-in syndrome? symptoms?
Basilar artery ischemia Lesion in pons mostly, medulla Corticospinal & corticobulbar tracts affected Loss of horizontal, but NOT vertical eye movements
366
Barbiturate's MOA? Uses? SE?
Phenobarbital, & all Bital cousins Increase GABA-A action by increasing DURATION of chloride channel opening Thiopental for anesthesia induction SE = Respiratory depression, CNS depression (alcohol exacerbates) Induces CYP450 CI in porphyria
367
Benzodiazepines MOA? Uses? SE?
Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chlordiazepoxide, Alprazolam Increase GABA-A by increasing FREQUENCY of chloride channel opening FRENZOdiazepines = Increase FREquency Decrease REM sleep Used for anxiety, panic, seizure, night terrors, sleep walking Lorazepam, Oxazepam, & Temazepam for those with liver disease who drink a LOT SE = Addiction Overdose = Treat with Flumazenil Can precipitate seizures by causing acute benzodiazepine withdrawal Never use with other sedative medications, like H1 receptor antagonists such as Diphenhydramine & Chlorpheniramine
368
What is Lateral Medullary (Wallenberg) syndrome?
Leads to vertigo, loss of pain/temperature sensation on ipsilateral face & contralateral body (spinothalamic tract) bulbar weakness & ipsilateral Horner syndrome Dysphagia, hoarseness, Absent gag reflex Lateral medulla lesion is on side of affected gag reflex PICA
369
What is the role of TNF alpha?
Activates endothelium WBC recruitment -- vascular leak Released from activated macrophages Cachexia in malignancy Granuloma maintenance in TB Mediate fever & sepsis along with IL-1 & IL-6
370
G6PD deficiency pathogenesis? Inheritance pattern? Histology?
NADPH is decreased in RBCs -- Hemolytic anemia RBCs have poor defense against oxidizing agents such as fava beans, sulfonamides, nitrofurantoin, primaquine, chloroquine, anti TB drugs X LINKNED RECESSIVE disorder -- MC human enzyme deficiency HEINZ bodies & BITE cells (from splenic macrophages)
371
Pilocytic astrocytoma description? histology?
Most common primary brain tumor in children (NOT the MC Supratentorial -- that would be Craniopharyngioma) Well circumscribed (Benign) Found in posterior fossa -- SUPRATENTORIAL Astrocyte in origin -- GFAP (+) Bipolar neoplastic cells with hairlike projections Microcysts with ROSENTHAL fibers Differentiate from Medulloblastoma by presence of both CYSTIC & SOLID components on imaging
372
Medulloblastoma description & histology?
Most common MALIGNANT brain tumor in childhood Involves CEREBELLUM Compressing 4TH VENTRICLE causing NONCOMMUNICATING hydrocephalus Headaches & PAPILLEDEMA TRUNCAL ATAXIA HOMER-WRIGHT ROSETTES-- small blue cells with central area of neuropil SYNAPTOPHYSIN (+) NOT CYSTIC like pilocytic astrocytoma Imaging reveals a solid lesion
373
Ependyoma characteristics? Histology?
Most commonly found in 4th ventricle (POSTERIOR FOSSA) Can cause hydrocephalus Ependymal cell origin Characteristic PERIVASCULAR PSEUDOROSETTES Rod shaped basal ciliary bodies
374
Craniopharyngioma characteristics? Histology?
Most common childhood SUPRATENTORIAL tumor Can be confused for pituitary adenoma -- Both cause BITEMPORAL HEMIANOPIA Remnants of Rathke pouch CALCIFICATION is common CHOLESTEROL crystals found in motor oil like fluid within tumor
375
Pineal gland tumors description & histology?
Most common EXTRAGONADAL germ cell tumors Increase incidence in MALES Obstructive hydrocephalus upon presentation (cerebral aqueduct compression) Parinaud syndrome -- Compression of dorsal midbrain Triad of UPWARD GAZE PALSY, convergence retraction NYSTAGMUS & light near dissociation
376
How are you going to diagnose cocaine intoxication on a question?
Psychotic symptoms such as DELUSIONS & PARANOIA Sympathetic stimulation PRESSURED speech Paranoid delusions Physical signs indicating sympathetic stimulation assist in differentiating cocaine from psychiatric disorders
377
What is the hallmark of Chron's disease?
NONCASEATING GRANULOMAS Distinguishes from UC, which does not form granulomas Crohn's also has transmural inflammation RLQ pain vs LLQ with UC
378
All the clues for Chron's?
Any portion of GI tract -- usually TERMINAL ILEUM Skip lesions -- rectal sparing Transmural inflammation -- fistulas Cobblestone mucosa, bowel thickening -- string sign Linear ulcers, fissures NONCASEATING GRANULOMAS*** Hallmark Fistulas -- can cause recurrent UTI Diarrhea can or can not be bloody Kidney stones --CALCIUM OXALATE gall stones TX = Azathioprine, antibiotics, infliximab
379
All the clues for Ulcerative colitis?
CONTINUOUS colonic lesions -- ALWAYS with rectal involvement Mucosal & submucosal inflammation only Loss of haustra -- Lead pipe appearance on imaging Crypt abscesses / ulcers w/ BLEEDING-- NO granulomas Toxic megacolon, perforation Bloody diarrhea -- usually nocturnal & w/ pain Primary sclerosing cholangitis -- Myeloperoxidase/ ANCA Mesalamine, Infliximab
380
What is the first line therapy for BPH?
Tamsulosin Alpha 1 ANTAGONIST selective receptors in prostate Decrease smooth muscle tone & increase urine flow
381
What is the medication responsible for decreasing prostate VOLUME in patients with BPH?
FINASTERIDE 5 alpha reductase inhibitor -- DECREASES conversion of testosterone to DHT in the prostate These drugs are responsible for the affect on prostate volume vs tamsulosin for the urinary symptoms
382
Severe iron deficiency anemia
Hypochromic, microcytic erythrocytes on blood smear Low RBC count Low hepcidin High transferrin (TIBC) Increase in Erythropoietin -- but not enough iron to generate erythrocytes so reticulocyte count is low
383
Pituitary adenoma presentation? Histology?
Nonfunctioning (SILENT) or hyperfunctioning (HORMONE PRODUCING) Nonfunctional presents with mass effect -- Bitemporal hemianopia Pituitary apoplexy -- hypopituitarism Prolactinoma classically presents as galactorrhea or amenorrhea Decrease in bone density due to suppression of estrogen in females Treatment = Bromocriptine, Cabergoline (Dopamine agonists) Hyperplasia most commonly from LACTOTROPHS (prolactin) -- HYPERPROLACTINEMIA Hyperprolactinemia suppresses secretion of GnRH which leads to reduced estrogen (which leads to decreased bone density)
384
What is the treatment for Wilson's Disease?
Autosomal recessive disorder characterized by excessive copper deposition in the liver, basal ganglia, & cornea Impaired hepatocellular copper transport -- Decreased biliary excretion of copper -- Intracellular copper causes apoptosis of hepatocytes -- Liver dysfunction marked by ELEVATED TRANSAMAINASES Excess copper goes into blood & causes ATAXIA / TREMOR DOC is Penicillamine -- Copper chelating agent that binds free copper -- Overall increases urinary copper excretion
385
Ruptured gastric ulcer on the lesser curvature of the stomach -- which artery? An ulcer on the posterior wall of the duodenum -- Which artery?
Lesser curvature of stomach = Left gastric artery Posterior wall of duodenum = Gastroduodenal artery
386
What type of vaccine for rabies?
Inactivated
387
What are the best symptoms to focus on for people that are depressed?
Nonsomatic symptoms such as loss of interest, anhedonia, worthlessness, guilt, & suicidality
388
Defect in the common or extrinsic pathway does what to PT / PTT / bleeding time?
Prothrombin Time (PT) is increased Play Tennis OUTside (Extrinsic pathway)
389
Defect in the common or intrinsic pathway does what to PT / PTT / Bleeding time?
Defect increases Partial thromboplastin time (PTT) Play Table Tennis INside (Intrinsic)
390
Coagulation studies for Factor VIII deficiency?
Hemophilia A Normal bleeding time Normal Prothrombin time (PT) Increase in Partial thromboplastin time (PTT) (INTRINSIC)
391
Factor VII deficiency coagulation studies?
Increase in PT Normal PTT Normal bleeding time
392
Mannitol MOA? Uses? SE? Contraindications?
Osmotic diuretic that works by increasing plasma or tubular fluid osmolality Increased plasma & fluid osmolality causes extraction of water from the interstitial space into the vascular space or tubular lumen -- subsequent diuresis In the brain, water redistribution from the tissues into the plasma helps reduce edema & intracranial pressure in the setting of cerebral edema Increases serum osmolality -- Fluid shift from interstitial to intravascular space -- Increase in urine flow & decrease intracranial pressure Used in drug overdose / Increased intracranial or intraocular pressure SE = Dehydration, hypo or hypernatremia, Pulmonary edema Contraindicated in Anuria (making no pee) & HF
393
Common (fibular) peroneal nerve? Innervation? Cause of injury? Presentation?
L4-S2 Sensory information for dorsum (top) of foot & lateral leg INJURY DUE TO Trauma or compression of LATERAL leg -- FIBULAR neck fracture Presents -- FOOT DROP, loss of sensation dorsum (TOP) of foot. Loss of Dorsiflexion & Eversion -- So foot is INVERTED & PLANTARFLEXED @ rest Extensor Hallucis Longus weakness
394
Type 1 pneumocytes description?
Squamous 97% of alveolar surfaces Thinly line the alveoli for optimal gas exchange
395
Type 2 pneumocytes description?
Cuboidal & clustered Serve as stem cell precursors for 2 cells types -- type 1 & 2 pneumocytes Type 2 PROLIFERATE DURING LUNG DAMAGE
396
Surfactant description?
Decrease alveolar surface tension Decrease alveolar collapse Decrease lung recoil Increase lung compliance Composed of multiple lecithin's -- mainly DPPC Synthesis begins around 20 weeks & is mature around 35 Glucocorticoids important
397
Neonatal RDS? Treatment? Complications?
Surfactant deficiency Increase in surface tension leads to alveolar collapse -- ground glass appearance TX = Maternal glucocorticoids before birth; exogenous surfactant for infant Therapeutic supplemental oxygen can result in retinopathy of prematurity, intraventricular hemorrhage or bronchopulmonary dysplasia Screening = Lecithin-Sphingomyelin ratio
398
What are the labs for Von Willebrand Factor?
Normal platelets Normal PT Prolonged PTT -- Due to low levels of Factor VIII
399
What is X-linked agammaglobulinemia?
Defect in BTK gene -- Tyrosine kinase No B cell maturation Low or absent circulating mature B cells -- CD19, CD20, & CD21 Increased in boys -- X linked recessive Recurrent bacterial & enteroviral infections after 6 months -- Maternal IgG depleted Absent B cells in peripheral blood Decreased Ig of all classes Absent lymph nodes Live vaccines contraindicated (polio)
400
Two drug classes and drugs for motion sickness?
Antimuscarinics (anticholinergics) = Scopolamine Antihistamines -- 1st & 2nd gen 1st generation -- Diphenhydramine, Dimenhydrinate, Chlorpheniramine, & Doxylamine Used for allergies, motion sickness, pregnancy nausea, & sleep aid SE = Sedation, antimuscarinic & antiadrenergic 2nd generation -- Loratadine, Fexofenadine, Desloratadine Used for allergies Far less sedating
401
Effects of Desmopressin therapy for Mild hemophilia A or Von Willebrand disease?
Increases circulating factor VIII & endothelial secretion of vWF to stop bleeding
402
Effects of Desmopressin therapy for Central diabetes insipidus & nocturnal enuresis?
Binds to V2 receptors in renal tubular cells -- Leading to increased aquaporin channels Increased water reabsorption & decreased urine output
403
How does superior vena cava syndrome present?
Presents with facial swelling, distended collateral veins, headache, dyspnea Extrinsic compression of the SVC by mediastinal mass -- impaired venous return from upper part of body SWOLLEN EVERYWHERE ABOVEEEE!!!
404
Noise induced hearing loss damages what part of the ear?
Damage to sterociliated cells in the organ of Corti Loss of high frequency first
405
When do children understand the finality of death?
Around age 7 Before then, they may have magical thoughts that death is temporary or reversible and believe that other people's grief is their fault
406
Central venous pressure is equal to what?
Right heart preload
407
Pulmonary capillary wedge pressure is equal to what?
Left heart preload
408
Systemic vascular resistance is equal to what?
Afterload
409
What is the primary disturbance in distributive shock?
Sepsis, anaphylaxis The disturbance is profound peripheral vasodilation -- in the case of anaphylaxis, resulted from the widespread IgE mediated release of histamine Arteriolar vasodilation causes decreased SVR (Afterload) Venular vasodilation causes decreased CVP (Right heart preload) & reduces venous return to RA With reduced venous return to the RA -- There is reduced RV output & reduced blood delivery to the LA & LV -- This leads to decrease in PCWP (Left heart preload) Cardiac output is often increased due to reduced SVR & a baroreceptor reflex mediated increase in HR
410
What do you see on arterial blood gas for pulmonary embolism?
PE presents with hypoxemia due to V/Q mismatch Acute respiratory alkalosis due to hyperventilation
411
What is Wernicke encephalopathy? What can it lead to?
Thiamine (B1) Deficiency The MAMMILLARY bodies in the brain are most susceptible due to high metabolic demand Thiamine deficiency very common in patients with ALCOHOL use disorder -- but also with malnutrition Chronic effects of thiamine deficiency leads to Korsakoff syndrome Korsakoff has triad of confusion, ophthalmoplegia, & ataxia
412
When you hear dysphagia / hoarseness when it comes to stroke, what do you think?
Lateral medullary (Wallenberg) syndrome Usually vertebral artery occlusion (PICA) IPSILAERAL loss of pain & temperature sensation in the face CONTRALATERAL loss of pain & temperature in the body Ipsilateral Horner Ipsilateral ataxia
413
Rheumatoid Arthritis classically arises in which population? Associated with what? Hallmark?
Arises in women of late childbearing age Associated with HLA-DR4 Hallmark is synovitis loading to formation of a pannus (inflamed granulation tissue) Leads to destruction of cartilage & ankylosis (fusion) of joint
414
Clinical features of RA? Which joints are involved? What’s spared?
Pain & swelling with morning stiffness that IMPROVES with activity Symmetric involvement of the PIP joints (Swan neck) Affects the PIP & MCP Spares the DIP Baker cyst -- Swollen bursa behind the knee Pleural effusions, lymphadenopathy & interstitial lung fibrosis Rheumatoid nodules -- central zone of necrosis surrounded by epithelioid histiocytes -- in skin & visceral organs Cervical subluxation -- extension of the neck during intubation worsens the subluxation & leads to acute compression followed by paralysis
415
Treatment for RA?
NSAIDs Glucocorticoids Methotrexate -- Folic acid analog that competitively inhibits dihydrofolate reductase -- Reduces dTMP & decreases DNA synthesis (SE = Myelosuppression, pulmonary fibrosis, folate deficiency, nephrotoxicity) Sulfasalazine -- Combo of sulfapyridine (antibacterial) & 5-aminosalicyclic acid (anti-inflammatory) Activated by colonic bacteria (SE = Oligospermia) TNF-alpha inhibitors
416
Lab findings for RA?
IgM autoantibody against Fc portion of IgG (rheumatoid factor); marker of tissue damage & disease activity Neutrophils & high protein in synovial fluid
417
Atrial septal defect characteristic auscultatory finding?
Fixed wide splitting of S2 Characterized by left to right shunt due to higher pressure in the LA compared to the RA This increase in flow causes right sided volume overload -- delayed closure of pulmonic valve (wide S2) Ostium secundum defect is the most common O2 saturation in is increased in RA, RV & pulmonary artery Associated with down syndrome
418
What is Eisenmenger syndrome?
Uncorrected left to right shunt (VSD,ASD,PDA) Increase in pulmonary blood flow causes pathologic remodeling of vasculature This causes pulmonary arterial hypertension RVH occurs to compensate -- Shunt becomes right to left when RV pressure is greater than LV pressure Late cyanosis, clubbing, & polycythemia Repair to prevent irreversible changes to the pulmonary vessels
419
What is Acanthosis Nigricans?
Hyperpigmented thickening of skin -- especially in neck, axilla Associated with insulin resistance Plaque on back of neck & skin tags (Daddy's)
420
What is Lichen Planus?
5 P's Polygonal, Planar, Pruritic, Purplish plaques on the wrists, hands, trunk & legs White (Wickham) striae Associated with Hepatitis C
421
Vinca Alkaloids Vincristine & Vinblastine MOA, Uses? SE?
Bind beta-tubulin Prevents the FORMATION of mitotic spindle (vs. Taxanes that prevent breakdown) Used for leukemias, lymphomas Vincristine (Crisps the nerves) neuropathy, constipation Vinblastine (blasts the marrow) myelosuppression
422
What is the main effect of glucagon when treating hypoglycemia?
Increasing hepatic glycogenolysis -- release of glucose from preexisting hepatic glycogen stores
423
What is a major SE of Carbamazepine?
Causes SIADH by increasing ADH secretion & renal sensitivity to ADH MOA = blocks Na+ channels DOC for focal tonic-clonic seizures & Trigeminal neuralgia SE = Blood dyscrasias such as leukopenia = AGRANULOCYTOSIS DRESS syndrome -- 2-8 weeks post exposure w/ eosinophilia (also Phenytoin)
424
What is SIADH?
Increased ADH secretion ADH is released by the hypothalamus & posterior pituitary & stimulates the renal collecting ducts to reabsorb more water into systemic circulation Serum sodium & osmolality decreasing -- Hypotonic hyponatremia Urinary water excretion decreases -- Increasing osmolality & concentrated urine Clinical Euvolemic (absence of edema, lung crackles, or JVD Elevated BUN & Creatinine Caused by head trauma, ectopic ADH (SCLC) Exogenous hormones (vasopressin, desmopressin, oxytocin) Lung disease Drugs -- SSRIs, Carbamazepine, Cyclophosphamide Treatment = water restriction & Demeclocycline (ADH antagonist)
425
What lung cancer targets non-smokers & women? Location?
Adenocarcinoma Peripheral Most common primary lung cancer Associated with clubbing & hypertrophic osteoarthropathy (arthritis) Mucin (+) KRAS, EGFR, & ALK mutations
426
Prostate adenocarcinoma arises where on the prostate? How is it diagnosed? Labs? Metastasis?
Posterior, peripheral lobe Diagnosed with needle core biopsies (transrectal, US guided) -- multiple samples Increase in total PSA Decrease in % of free PSA Does not produce urinary symptoms Metastasis to the spine -- Increase in serum ALP
427
Dofetilide & Ibutilide SE?
Class III -- K+ channel blocker MOA = Increase AP duration, Increase ERP, Increase QT Used for rhythm control & Afib QT interval prolonged leads to increase risk of Torsade de pointes -- a form of polymorphic ventricular tachycardia that can cause syncope & sudden death
428
Which insurance has low monthly premiums?
HMO
429
How does acute hepatitis B present?
Jaundice with mixed & unconjugated bilirubin Dark urine, fever, malaise Elevated liver enzymes (ALT>AST) Joint pain, lymphadenopathy, pruritic urticarial rash
430
Cluster headaches localization? duration? description? treatment?
Unilateral 15 minutes to 3 hours -- During sleep or similar timing daily Excruciating periorbital pain w/ autonomic symptoms Lacrimation, rhinorrhea Horner syndrome possible Males > females Sumatriptan for acute w/ 100% oxygen Verapamil for prevention
431
Migraine headache localization? duration? description? treatment?
Unilateral 4-72 hours Females > males Pulsating & throbbing pain w/ nausea or photophobia CN V irritation TX acute = NSAIDs, triptans, dihydroergotamine, antiemetics TX prevention = Beta blockers, amitriptyline, Topiramate, Valproate
432
Tension headache localization? duration? description? treatment?
Bilateral Female > male 4-6 hours; constant (months to years) Steady "bandlike" pain -- No photophobia / aura Dull & tight pain Muscle tenderness in the head, neck, or shoulders
433
What is a common cause of chronic mediastinitis
Histoplasma capsulatum OHIOOOOOO
434
Type 1 Hypersensitivity reactions?
IgE Basophils / Mast cells Cell surface bound antibody linking by antigen
435
Type 2 hypersensitivity reactions?
IgG & IgM autoantibodies Complement mediated cytotoxicity NK Cells, Neutrophils, Macrophages Autoimmune hemolytic anemia & Goodpasture
436
Type 3 hypersensitivity reactions?
Deposition of antibody-antigen-complement complexes Neutrophils Serum sickness, PSGN, lupus nephritis
437
Type IV hypersensitivity?
T cells & macrophages CD8 cytotoxic T cells Contact dermatitis / Tuberculin skin test DOES NOT INVOLVE ANTIBODIES
438
Cauda equina syndrome pathogenesis? findings?
Compression of the spinal roots L2 & BELOW -- due to lumbar disc herniation or tumor Motor deficits = Broad based shuffling gait, absent knee or ankle reflex Saddle anesthesia -- impaired sensation in butt / perianal area Autonomic dysfunction = Bowel or bladder dysfunction or sexual dysfunction (S3-S5 damaged) Confirm with MRI
439
What is pituitary apoplexy? Presentation?
Acute pituitary hemorrhage Severe headache Bitemporal hemianopsia (compression of optic chiasm) Usually occurs in a preexisting pituitary adenoma (patient with chronic headaches & low libido) likely due to hyperprolactinemia Acute loss of ACTH secretion leads to adrenal crisis TX = urgent glucocorticoids to prevent adrenal crisis
440
Polycythemia Vera pathogenesis? presentation? Labs?
Disorder of UNCONTROLLED ERYTHROCYTE PRODUCTION Presents with headache, facial plethora (flushed face) & splenomegaly Itching after shower (aquagenic pruritus) Associated w/ PUD & gouty arthritis Acquired JAK2 mutation (Cytoplasmic tyrosine kinase) DECREASED IN ERYTHROPOIETIN (EPO) vs. secondary polycythemia
441
Sirolimus MOA? Uses? SE?
Also called Rapamycin mTOR inhibitor Blocks T cell activation & B cell differentiation by PREVENTING response to IL-2 Used specifically for kidney transplant rejection prophylaxis SE = Pancytopenia, hyperlipidemia
442
Congenital hypothyroidism pathogenesis? Findings?
Formerly called cretinism Most commonly by thyroid dysgenesis (abnormal development) Pot bellied, pale, puffy face child with protruding umbilicus & protuberant tongue After maternal thyroxine wanes (weeks to month) DX = Increase in TSH & Decrease in free thyroxine (T4) levels
443
Above the pectinate line is what type of pathology?
INTERNAL hemorrhoids or adenocarcinoma Internal hemorrhoids -- Older age & chronic constipation Receive VISCERAL innervation & therefore NOT painful A(I)bove
444
Below the pectinate line is what type of pathology?
External hemorrhoids, anal fissures, SQUAMOUS CELL CARCINOMA (Vs adenocarcinoma with internal hemorrhoids) External hemorrhoids -- Receive somatic innervation from PUDENDAL nerve -- VERY PAINFUL Typically without bleeding but very PAINFUL Anal fissure -- Tear in the abdomen below pectinate line, pain while pooping, blood on toilet paper, located in POSTERIOR midline because this area is poorly perfused -- Associated with low fiber diets & constipation B(E) it’s literally the first 2 letter
445
Imiquimod MOA? Uses? SE?
Binds toll-like receptor of macrophages to activate them Topical antitumor immune response modifier Used in anogenital warts / actinic keratosis
446
How do you treat norepinephrine extravasation?
Phentolamine -- alpha receptor blocker that leads to vasodilation -- counteracting the vasoconstrictive effects of NE
447
PCOS presentation? Which hormones are increased? Cancer risk? TX?
INCREASE in LH — DECREASE in FSH HIRSUTISM & ACNE INCREASE RISK OF ENDOMETRIAL CANCER Increase in estrogen & testosterone — reason for risk of cancer due to unopposed estrogen LH induces excess androgen production from Theca cells Androgens are converted to Estrone in adipose tissue Estrone feedback inhibits FSH Common cause of infertility Enlarged ovaries / obesity / hirsutism & acne TX = OCPs to prevent endometrial hyperplasia due to unopposed estrogen (PCOS increases risk for endometrial cancer) Spironolactone for hirsutism
448
Acute tubular necrosis diagnosis? Findings?
ATN caused by renal ischemia Oliguria, Increased serum creatinine MUDDY BROWN CASTS Proximal tubules & thick ascending limb are most affected HYPERKALEMIA w/ metabolic acidosis During the recovery stage, the GFR improves so electrolyte wasting (resulting in hypokalemia) can occur
449
How does Wiskott-Aldrich syndrome present?
Mutation in WAS gene 6-12 months of age Defective ANTIGEN PRESENTATION Thrombocytopenia, ECZEMA, Recurrent (pyogenic) infections Fewer & smaller platelets
450
Trazodone MOA? SE?
Serotonin modulator used for insomnia May cause priapism -- Persistent erection
451
What is the most common pediatric arrhythmia?
Supraventricular tachycardia SVT occurs when an impulse originates at an abnormal focus above the ventricles -- most likely a reentrant circuit within the AV node HR is super elevated -- above 220 in infants Narrow QRS & absent P waves Ventricular diastole is shortened due to persistent tachycardia = causes hypotension
452
Gram positive rod that causes tissue necrosis & gas in tissues?
C. Perfringens Alpha toxin of lecithinase splits phospholipids
453
What is the only diuretic that causes hypercalcemia & hyperglycemia & Bicarb?
Thiazide diuretics Hydrochlorothiazide, Chlorthalidone, Metolazone Decrease calcium EXCRETION in urine — That means increase in serum calcium Inhibits sodium chloride reabsorption in early DCT Increase in Bicarb causes metabolic alkalosis
454
What is the only diuretic that causes hyperkalemia?
Potassium sparing diuretics Spironolactone, Eplerenone, Amiloride, Triamterene Competitive aldosterone receptor antagonist in cortical collecting tubule Triamterene & Amiloride block sodium at that same part
455
Which Interleukin should you think of when you think of eosinophils?
Eosinophils are recruited & activated by IL-5 secreted by Th2 type T cells
456
Piriformis syndrome is impingement of what nerve? What other buzzwords?
Sciatic nerve impingement Pain radiating down posterior leg / thigh (S1 dermatome)
457
Psoas syndrome associated with radiculopathy?
No -- no numbness or paresthesia Pain does radiate to the groin Psoas is a major HIP FLEXOR -- So pain is elicited on Hip EXTENSION
458
Candida buzz words?
Pseudohyphae with blastoconidia Mucocutaneous or invasive infections i.e. candidemia due to vascular catheter
459
Blastomycoses buzz words?
Yeast with BROAD BASED BUDDING Inhaled — SKIN to BONE
460
Coccidioides buzz words?
SPHERULES with ENDOSPORES Transient pulmonary syndrome Meninges & bone
461
Cryptococcus buzz words?
ENCAPSULATED (in a crypt) yeast Meningitis in immunocompromised patients
462
Histoplasma buzz words?
Small oval yeast within MACROPHAGES Subclinical but can cause community acquired pneumonia with dissemination
463
How does Sarcoidosis present? buzz words?
FEMALE, enlarged lymph nodes, HILAR LYMPHADENOAPTHY NONCASEATING GRANULOMAS Mild hepatomegaly with increased ACE levels HYPER-CALCEMIA
464
Anterior cerebral artery occlusion result? Middle cerebral artery occlusion result?
ACA -- Contralateral LOWER extremity deficits MCA -- Contralateral UPPER extremity & LOWER FACIAL deficits
465
Physiologic response to hypothermia?
Increased Sympathetic activity Increased thyroid hormone release Shivering Peripheral vasoconstriction Reducing heat loss & increasing metabolic rate to promote thermogenesis
466
If systolic pressure is high, what is the problem? If diastolic pressure is high, what is the problem?
Systolic = resistance Diastolic = volume Both = both, but usually its a volume problem (i.e. excess aldosterone)
467
Postoperative ileus OMM bull shit to reduce sympathetic chain?
Paraspinal inhibition -- improves bowel motility
468
Who produces Interferon gamma?
T lymphocytes IF-Gamma activates macrophages in TB
469
AA joint dysfunction is what?
C1 (atlas) about the dens of the axis C2 (axis) Flex neck 45 degrees AA joint movement is rotation
470
What is the precursor to serotonin?
Tryptophan
471
Tyrosine is a precursor for what?
Dopamine, epinephrine, norepinephrine
472
Which interleukin stimulates immunoglobulin class switching to IgE responsible for type 1 hypersensitivity?
IL-4
473
What is the CV4 technique?
Used in patients with SBS compression Decompresses the fourth ventricle & normalizes CRI
474
Atopic dermatitis begins when? Also known as? Associated with?
Begins in early infancy or childhood Eczema IgE is stimulated by plasma cells Increases risk for allergic rhinitis, asthma, & food allergies
475
Paroxysmal nocturnal hemoglobinuria pathogenesis? How does it present? Labs?
Mutated PIGA gene Impaired GPI anchor protein -- GPI attaches CD55 (CD55 inactivates complement) So with GPI being fucked, CD55 can't inactivate complement, which means you get uncontrolled complemented mediated intrinsic hemolysis COOMBS NEGATIVE Pancytopenia PINK / RED urine in the MORNING & thrombosis @ atypical sites Chronic hemolysis can cause iron deposition in the kidney (hemoosiderosis)
476
Acute Tubular Necrosis key finding?
GRANULAR MUDDY BROWN casts Can be caused by Aminoglycosides, cisplatin, ethylene glycol
477
RBC casts?
Glomerulonephritis
478
WBC casts?
Indicate a nephritis Acute pyelonephritis / Transplant rejection
479
Granular casts?
ATN -- Muddy brown
480
Fatty casts?
NEPHROTIC syndrome every single time
481
Waxy casts?
CKD / End stage renal disease
482
How does hereditary hemochromatosis present?
LOW HEPCIDIN production. INCREASED INTESTINAL IRON ABSORPTION Iron accumulates everywhere Prussian blue stain Presents AFTER 40 when total body iron is above 20 Hyperpigmentation Chronic fatigue Arthritis -- particularly in the 2nd / 3rd MCP joints Chondrocalcinosis Hepatomegaly Diabetes / hypopituitarism DILATED CARDIOMYOPATHY -- HCC cause of death
483
NON-REM sleep stages?
Stage N1 -- Light sleep (Theta Waves) Stage N2 -- Deeper sleep, Twoth bruxism occurs here (sleep spindles & K complexes) Stage N3 -- Sleepwalking, bedwetting (Delta) REM sleep - Beta waves
484
Proto-Oncogenes 1 hit GAIN of function RAS, MYC, EGFR, HER2, ABL, BRAF
RAS -- Cholangiocarcinoma & Pancreatic Adenocarcinoma MYC -- Burkitt Lymphoma EGFR -- Lund adenocarcinoma HER2 -- Breast cancer ABL -- Chronic Myelogenous Leukemia (CML) BRAF -- Hairy cell leukemia & melanoma
485
Tumor suppressor genes 2 hit LOSS of function BRCA1/2, APC/Beta-Catenin, TP53, RB, WT1, VHL
BRCA1/2 -- Breast & Ovarian cancer APC / Beta-Catenin -- Colon, Gastric & pancreatic cancer / FAP TP53 -- Most cancers / Li-Fraumeni syndrome RB -- Retinoblastoma / Osteosarcoma WT1 -- Wilm's tumor VGL -- Renal cell carcinoma
486
Galbreath can help children with Otitis Media, and also in what cases?
Acute rhinosinusitis Applying anterior & medial traction on the MANDIBLE
487
How does SCID present?
Failure to thrive Chronic diarrhea Oral thrush Recurrent viral, bacterial, fungal, & protozoal infections ABSENT thymic shadow
488
Phenytoin MOA? SE?
Blockade of sodium channels in neurons -- efflux of sodium out of cells Hirsutism GINGIVAL HYPERPLASIA Megaloblastic anemia & Osteomalacia
489
Vegan diet deficient in what?
Vitamin B12 (Cobalamin) Calcium Vitamin D Iron deficiency in women
490
Patients with CKD develop hyperphosphatemia -- What is secreted in response?
FGF23 -- Lowers plasma phosphate by reducing intestinal absorption & renal reabsorption of phosphate Promotes excretion
491
Turner syndrome due to?
Loss of X chromosome -- 45 XO Streak ovaries (replaced by connective tissue) Primary Ovarian insufficiency BICUSPID aortic valve Increased risk for AORTIC DISSECTION Horseshoe kidney -- Fusion of lower poles
492
Lead poisonings key findings?
Increased levels of D-ALA & PROTOPORPHYRIN BASOPHILIC STIPPLING -- blue granules in cytoplasm of red cells lead lines at gum tooth line WRIST & FOOT DROP TX = Dimercaprol, EDTA, DMSA (Succimer)
493
Acute promyelocytic leukemia characterized by?
Translocation 15;17
494
Acute myeloid leukemia markers?
MPO + Crystal aggregates seen as Auer rods Increase risk for DIC Treatment with Retinoic acid
495
Down syndrome before 5 YO - What leukemia? Down syndrome after 5 YO - What leukemia?
Before -- Acute MEGAKARYOBLASTIC leukemia (Before 5 has bad manners, BM) After -- Acute LYMPHOBLASTIC leukemia
496
CML characteristics?
Basophilia w/ granulocytes BCR-ABL -- Tyrosine kinase activity increased 9;22 Imatinib is tx LAP (-)
497
Polycythemia Vera characteristics?
JAK2 kinase mutation Hype viscosity of blood Blurry vision & headache Itching after bathing (increased histamine from mast cells) Thrombosis -- Budd Chiari syndrome EPO is DECREASED In reactive polycythemia due to high altitude -- EPO is INCREASED -- high altitude = high EPO
498
Essential thrombocytopenia
Proliferation of platelets JAK2 kinase mutation Increased bleeding risk
499
Myelofibrosis characteristics?
Splenomegaly due to extramedullary hematopoiesis JAK2 kinase mutation Megakaryocytes produce excess PDGF -- Causes marrow fibrosis Tear drop Leucoerythroblastic smear
500
Painful lymphadenopathy associated with? Painless lymphadenopathy associated with?
Painful = acute infection Painless = Chronic inflammation, carcinoma, lymphoma
501
Follicular lymphoma features?
Proliferation of small B cells CD20 (+) Late adulthood w/ painless lymphadenopathy Driven by t(14;18) BCL2 expression is INCREASED = Inhibits apoptosis Tx = Rituximab Differs from reactive follicular hyperplasia by disruption in lymph node architecture & BCL2 expression in follicles
502
Mantle cell lymphoma features?
Proliferation of small B cells that expands the mantle zone CD20 (+) Late adulthood w/ painless lymphadenopathy Driven by t(11;14) Cyclin D1 is overexpressed -- promotes G1/S transition -- facilitating neoplastic proliferation
503
Marginal zone lymphoma features?
Proliferation of small b cells that expands the marginal zone CD20 (+) Associated with Hashimoto, Sjogren, H. Pylori Gastritis Marginal zone is formed by post-germinal center B cells MALToma is marginal zone lymphoma in mucosal sites Gastric MALToma may regress w/ treatment for H. Pylori
504
Burkitt lymphoma features?
Proliferation of Intermediate sized B cells CD20 (+) EBV association Extranodal mass in child or young adult Sporadic form involves the abdomen C-MYC translocation -- t(8;14) MYC overexpression oncogene promotes cell growth Starry sky
505
Diffuse Large B cell lymphoma features?
Proliferation of large B cells CD20 (+) Most common form of Non-Hodgkin lymphoma High grade Arises sporadically or from transformation i.e. follicular lymphoma Adulthood presentation as enlarging lymph node or Extranodal mass
506
Hodgkin lymphoma features?
Proliferation of Reed-Sternberg cells Large B cells w/ MULTILOBED nuclei CD15 & CD30 (+) Reed Sternberg secretes cytokines Can lead to fibrosis
507
Nodular sclerosis subtype of HL features?
Enlarging cervical or mediastinal lymph node in young adult, usually female Lymph node divided by bands of sclerosis
508
Multiple Myeloma features?
Proliferation of plasma cells in the bone marrow High IL-6 -- stimulates plasma cell growth & Ig production Bone pain w/ hypercalcemia RANK receptor on osteoclasts leads to bone destruction M spike -- due to IgG or IgA Rouleaux formation of RBCs on blood smear Primary AL amyloidosis -- Free light chains circulate in serum & deposit in tissues Proteinuria
509
Langerhans cell histiocytosis features?
Proliferation of Langerhans (skin) cells Derived from bone marrow monocytes Birkbeck granules CD1a (+) & S-100 (+)
510
Schizoid (cluster A) features?
Social withdrawal & solitary activities (vs. avoidant) No motivation for relationships (vs. avoidant) Blunt affect
511
Schizotypal Personality Disorder Features?
Eccentric fucking MAGICAL thinking Symptom & genetic overlap with schizophrenia
512
Borderline Personality Disorder Features?
Unstable mood Negative self image Border b/t neurotic & psychotic Cut themselves Perceive the world as all good or all bad "splitting" -- CLASSIC TEST QUESTION Recurrent interpersonal difficulty throughout life
513
Histrionic personality disorder features?
Highly attention seeking & outwardly emotional Center of attention
514
Antisocial personality disorder features?
No regard for others Tend to be CRIMINALS, violent, "sociopaths" Likeable due to manipulation Associated with Enuresis (bedwetting) MUST BE above 18 If under 18, Conduct Disorder
515
Obsessive Compulsive Personality Disorder Features?
Overly rigid Preoccupied with order & control Doing things "my way" Perfectionists EgoSyntonic (vs. OCD) EgoDystonic is OCD -- Meaning the patient does NOT like it
516
Huntington's Disease Features?
Autosomal Dominant -- CAG repeat -- Toxic gain of function b/t ages 20-50 Anticipation from repeats Caudate nucleus loses ACh & GABA Ex Vacuo Ventriculomegaly -- Enlargement of lateral ventricles Increase in Dopamine Decrease in GABA & ACh Neuronal death via NMDA-R binding & glutamate excitotoxicity
517
Muscles responsible for Hip Flexion?
Iliopsoas Rectus Femoris TFL
518
Muscles responsible for Hip Extension?
Gluteus maximus Semitendinosus Semimembranosus Biceps Femoris -- Long head
519
Muscles responsible for Hip Abduction?
Gluteus Medius Gluteus Minimus
520
Muscles responsible for Hip Adduction?
Adduction Brevis Adductor Longus Adductor Magnus
521
Celiac Disease Features?
Gluten (Gliadin) Consumption -- Immune mediated small intestine inflammation All leading to chronic malabsorption Iron Deficiency anemia & Dermatitis Herpetiformis (PRERITIC VESICLAR RASH ON ELBOWS) HLA DQ (+) Affects DISTAL DUODENUM or PROXIMAL JEJUNUM -- Steatorrhea due to malabsorption Tissue Transglutaminase IgA Antiendomysial antibodies Duodenal biopsy reveals intraepithelial lymphocytes w/ crypt hyperplasia BLUNTED OR ABSENT VILLI Associated with T1D & T cell lymphoma
522
Emphysema Pulmonary Labs?
Increase in FRC, RV, TLC Increase in elastase = INCREASE in LUNG COMPLIANCE DECREASE in ELASTICITY Increased AP diameter Decrease in FEV1 & Recoil Macrophages & neutrophils activate proteases Neutrophils are the inflammatory cells here DLCO from destruction of alveolar walls
523
Smoking associated with which emphysema?
Centriacinar Destruction of Alveolar air sacs Affects bronchioles Spares the distal alveoli In the UPPER lobes -- Smoke rises up
524
Panacinar emphysema features?
Affects respiratory bronchioles & alveoli Associated with A1-antitrypsin deficiency LOWER Lobes
525
Scabies features?
Intensely pruritic rash (Worse at night) Rash is on flexor surfaces of the wrist, fingers, elbows, axillary folds Excoriations w/ red papules Mites ova & feces under LM TX = Permethrin cream or oral ivermectin
526
Zona Glomerulosa Secretes What? Zona Fasciculata Secretes What? Zona Reticularis Secretes What? Adrenal Medulla Secretes What?
G -- Secretes mineralocorticoids -- primarily Aldosterone F -- Glucocorticoids -- Primarily Cortisol R -- Androgens -- Primarily DHEA M -- Chromaffin cells -- Stimulates ACH to secrete Catecholamines -- E (80%) & NE (20%)
527
Chronic Kidney Disease does what to phosphate levels?
Hyperphosphatemia & low vitamin D The resulting hypocalcemia causes secondary hyperparathyroidism
528
Pyuria w/ negative urine culture suggests what?
Urethritis due to Chlamydia or Neisseria
529
Acute Pyelonephritis increased risk with what?
Vesicoureteral reflux
530
Labs for Acute Pyelonephritis?
WBCs in urine w/ or w/o WBC casts CT shows striated parenchymal enhancement
531
Chronic Pyelonephritis is classically seen in who? Features?
Children due to Vesicoureteral reflux or obstruction Cortical Scarring & Blunted calyces Renal Tubules contain eosinophilic casts resembling THYROID TISSUE
532
What is characteristic of Vesicureteral reflux?
Scarring @ Upper & Lower Pole of Kidney
533
Calcium Oxalate kidney stone features?
Radiopaque Envelope or dumbbell shape MCC is idiopathic hypercalciuria -- Must r/o hypercalcemia Associated with Chron's disease Can result from ethylene glycol (antifreeze) TX = Thiazides (HCZ) / Citrate HCZ -- Calcium sparing
534
Ammonium Magnesium Phosphate stone features?
MCC is infection w/ urease (+) i.e. Proteus / Klebsiella Alkaline urine forms the stone Only one that causes Increase in pH Staghorn calculi in renal calyces TX = surgery / abx
535
Uric Acid Stone Features?
Radiolucent -- NOT VISIBLE ON X RAY ACIDIC pH Rhomboid / Rosette shape Strong association with hyperuricemia i.e. gout Also seen w/ high cell turnover i.e. leukemia TX = Alkaliniziation of urine -- Hydration & Potassium BiCarb ALLOPURINOL for Gout patients
536
Consequences of Renal Failure?
MAD HUNGER Metabolic Acidosis w/ anion gap Dyslipidemia -- Especially TGs High potassium -- Secondary hyperparathyroidism Uremia Na+ retention -- HF / Pulmonary edema = Hyperkalemia Growth retardation Erythropoietin deficiency -- anemia -- EPO is produced by renal peritubular interstitial cells Renal osteodystrophy PHOSPHATE is NORMAL in early stages due to Increase in FGF23 -- Fights Fosphate -- Hyperphosphatemia Hyperphosphatemia -- Increase in free serum phosphate due to Decreased excretion (i.e. renal failure)
537
Serum calcium in renal failure?
Hypocalcemia Hyperphosphatemia -- Phosphate behinds to the free calcium Hypocalcemia causes PTH levels to rise -- osteitis fibrosa
538
How does Tracheoesophageal fistula present?
Polyhydramnios due to inability of fetus to swallow amniotic fluid Significant DROOLING Cyanosis w/ Feeds X ray shows failure to pass nasogastric tube into stomach
539
Cataracts presentation?
Painless, bilateral opacification of lens Decreased night vision ABSENT red reflex Prolonged steroid use Congenital risk factors -- Trisomy 13,18,21 Rubella, Marfan, Alport, NF-2
540
Alcohol (Ethanol) does what to glucose?
Ethanol is metabolized by alcohol dehydrogenase NADH/NAD+ ratio is INCREASED Inhibits gluconeogenesis & causes hypoglycemia
541
S1 Heart Sound
Closure of Mitral & Tricuspid valve
542
S2 Heart Sound
Aortic & pulmonary valve closure
543
2 Drugs used for Hypertensive emergency?
Nitroprusside -- Short acting vasodilator -- Increases cGMP via direct release of NO -- SE = Cyanide toxicity Fenoldopam -- Dopamine 1 receptor agonist Decreases BP & Increases Natriuresis
544
Does Nitroglycerin & the Isosorbide medications affect arteries or veins?
Vasodilate by Increase in NO in vascular smooth muscle Increases cGMP Dilates VEINS more than arteries DECREASES Preload
545
Isoniazid MOA? SE? HY?
Decreases Mycolic Acid synthesis -- Requires bacterial Catalase peroxidase by KatG to convert into active metabolite ALWAYS GIVE PYRIDOXINE (B6) SE = Hepatoxic & toxic to neurons SEIZURES in high doses that is refractory to Benzodiazepines
546
Tetralogy of Fallot pathology? What improves the cyanosis?
Anterosuperior displacement of the infundibular septum MCC of early childhood cyanosis Pulmonary stenosis RVH Overriding aorta VSD Pulmonary stenosis forces right to left flow across VSD -- RVH = "tet spells" SQUATTING Increases SVR & decreases the right to left shunt
547
Carcinoid tumors arise from what type of cells? complications? Labs?
Arise from Neuroendocrine cells -- Commonly in intestine or lung 5-HT undergoes hepatic first pass metabolism & enzymatic breakdown by MAO in the lung Carcinoid syndrome is when 5-HT reaches systemic circulation via liver metastasis SYNDROME presents w/ flushing, diarrhea, right sided valve disease Niacin Deficiency INCREASE in 5-HIAA Prominent Rosettes -- Chromogranin A (+) & Synaptophysin (+) Tx = Octreotide
548
High Dose Dexamethasone Test results in Suppression, what is it?
Cushing Disease -- ACTH secreting pituitary adenoma
549
High Dose Dexamethasone test results in NO Suppression, what is it?
Ectopic ACTH secretion -- Skin hyperpigmentation Due to either SCLC or Carcinoid
550
Stellate (Ito) cells?
Cells in the space of Disse -- Store vitamin A Responsible for hepatic fibrosis
551
BPH complication?
Bladder outlet obstruction Overtime, Increased urinary pressures can cause hydronephrosis Leading to renal parenchymal atrophy with scarring -- Eventual CKD
552
Preeclampsia diagnosis made how?
New-onset HTN w/ either proteinuria or end organ dysfunction AFTER 20 weeks gestation Before 20 -- Consider molar pregnancy
553
Preeclampsia pathogenesis?
Abnormal placental spiral arteries Leads to endothelial dysfunction -- Vasoconstriction TX = IV magnesium sulfate to PREVENT seizures -- Always check DTR
554
How is Ecclampsia diagnosed?
Preeclampsia w/ seizures TX = IV magnesium sulfate
555
HEELP syndrome diagnosis?
PREECLAMPSIA w/ Thrombotic microangiopathy of the LIVER Hemolysis Elevated Liver enzymes (Increase ALT, AST) Low Platelets Can lead to hepatic subscapular hematomas DIC due to release of tissue factor from injured placenta
556
Beta Blocker side effect that you keep forgetting?
Masks hypoglycemia -- Due to beta2 receptor antagonism TX = Glucagon -- Increases cAMP
557
Aspirin toxicity presentation?
TINNITUS Fever Respiratory alkalosis early Metabolic Acidosis late Antidote == Sodium Bicarb
558
Acetaminophen toxicity presentation?
RUQ pain Centrilobular necrosis of liver Antidote = N-acetylcysteine
559
Warfarin or rat poision toxicity presentation?
Bleeding from nose, stool, urine Elevated PT Antidote - Vitamin K (minor bleed) or FFP
560
Von Willebrand disease HY?
Increase in BT & PTT (intrinsic) Intrinsic pathway coagulation defect that causes a Decrease in vWF vWF carries & protects factor VIII TX = Desmopressin -- Releases vWF in endothelium
561
What is the most common valvular disease associated w/ rheumatic heart disease?
Mitral stenosis -- Loud S1 w/ mid diastolic rumble Cardiac apex
562
Torsade de Pointe etiology & treatment?
Excessive QT prolongation Procainamide, Sotalol, Flecainide Macrolides Haloperidol TX = Magnesium Sulfate
563
Imaging of Bone metastases & diagnoses
Blastic -- Prostate cancer & SCLC & HL Lytic -- Multiple Myeloma, NONsmall cell lung cancer, NON-Hodgkin lymphoma, thyroid cancer, Renal cell carcinoma, Melanoma Mixed -- GI & breast
564
Sciatic Nerve innervation? Injury?
Motor innervation to semitendinosus, semimembranosus, biceps Femoris, adductor magnus Herniated disc or POSTERIOR HIP DISLOCATION MC injuries Impaired knee flexion
565
Femoral Nerve L2-L4 Injury?
Pelvic fracture Decrease in leg extension Absent patellar reflex Sensory innervation to anterior thigh & medial leg
566
Axillary nerve (C5-C6) Injury? Presentation?
Surgical neck of humerus Anterior dislocation of humerus Flattened Deltoid Loss of arm abduction @ shoulder (>15 degrees) Loss of sensation over deltoid & lateral arm
567
Musculocutaneous (C5-C7) Injury? Presenation?
Upper trunk compression -- usually lifting weights Decreased biceps reflex (C5-C6) Loss of forearm flexion & supination Loss of sensation over radial & dorsal forearm
568
Radial (C5-T1) Injury? Presentation?
Compression of axilla Due to crutches or sleeping w/ arm over chair MIDSHAFT fracture of humerus Repetitive pronation/supination of forearm due to screwdriver use = "Finger Drop" Associated injury to deep brachial artery Injury can occur @ supinator muscle Wrist drop -- Loss of elbow, wrist, & finger EXTENSION DECREASED grip strength BELOW the elbow causes paresthesias W/O wrist drop Triceps function & Posterior arm sensation SPARED if midshaft fracture
569
Median (C5-T1) Injury? Presentation
Supracondylar fracture of humerus -- Proximal lesion of nerve Carpal tunnel syndrome & wrist laceration -- Distal lesion of nerve Loss of wrist flexion Impaired function of 2 lateral lumbricals, Opponens pollicis, & Flexor pollicis Brevis
570
Ulnar (C8-T1) Injury? Presentation?
Fracture of medial epicondyle of humerus -- Proximal lesion Fracture of hook of hamate -- Distal lesion (outstretched hand) Ulnar nerve compresses against hamate as the wrist rests on handlebar during cycling Radial deviation of wrist upon flexion -- Proximal lesion Decreased flexion of ulnar fingers
571
Bisphosphonates MOA? SE?
Alendronate ( & other Dronates) Pyrophosphate analogs Bind to hydroxyapatite in bone -- INHIBITS OsteoCLAST activity SE = Esophagitis (take w/ water) OSTEONECROSIS OF JAW Atypical femoral stress fractures
572
Scaphoid fractures?
Anatomic snuff box Fall on an outstretched hand Complications -- Proximal scaphoid fractures include AVASCULAR NECROSIS & nonunion due to retrograde blood supply from radial artery DOES NOT always show on initial x ray
573
Scaphoid fractures?
Anatomic snuff box Fall on an outstretched hand Complications -- Proximal scaphoid fractures include AVASCULAR NECROSIS & nonunion due to retrograde blood supply from radial artery DOES NOT always show on initial x ray
574
McMurray Test for Lateral Meniscal tear? Medial Meniscal tear?
Popping on internal rotation & VARUS force = Lateral meniscal tear Popping on External rotation & VALGUS force = Medial meniscal tear
575
Valsalva CV changes? What murmurs increase? What murmurs decrease?
Decreases Preload -- Decreases LV volume Murmurs that increase -- MVP & HCM Murmurs that decrease -- Almost all -- Decreases flow through stenotic or regurgitant valve
576
Passive Leg Raise CV changes? What murmurs increase? What murmurs decrease?
Increase preload Murmurs that increase -- Most Murmurs that decrease -- MVP & HCM
577
Squatting CV changes? What murmur increases? What murmur decreases?
Increase in preload & afterload Murmurs that increase -- Most Murmurs that Decrease -- MVP & HCM
578
Handgrip CV changes? What murmurs increase? What murmurs decrease?
Big increase in afterload -- Increases SVR Murmurs that increase -- Most left-sided murmurs (AR>MR>VSD)
579
Seated flexion test is (-) when?
Symmetrical sacral dysfunction i.e. bilateral sacral flexion or extension Bilateral sacral FLEXION most associated with pregnancy
580
Patients with tumor lysis syndrome present with hyperkalemia -- How do you manage this?
ECG -- Peaked T waves Treat w/ CALCIUM GLUCONATE (only if there are ECG changes) Sodium Bicarb is also used Or Loop diuretics
581
Internuclear Ophthalmoplegia?
Medial Longitudinal Fasciculus Pair of tracts that interconnect CN VI & CN III nuclei Coordinates both eyes to move in the same horizontal direction Classically seen in MS or stroke
582
MLF lesion -- Which side has the what?
Whichever side has the nystagmus -- The lesion is OPPOSITE to the side i.e. left nystagmus = RIGHT MLF lesion
583
MS treatment? SE?
Pyridostigmine -- Acetylcholinesterase inhibitor (increases acetylcholine) SE = Increased salivation, lacrimation, miosis (pinpoint), diarrhea, urination, bradycardia, bronchoconstriction ASTHMA exacerbation
584
Saccular (also called Berry) Aneurysm features? Presentation?
Occurs @ bifurcations in circle of Willis Most common site is junction of Anterior communicating & Anterior cerebral Associated with ADPKD, & Ehlers-Danlos syndrome Causes SUBARACHNOID HEMORRHAGE ACom compression = BITTEMPORAL HEMIANOPIA (compression of optic chiasm) Ischemia in ACA -- contralateral LE hemiparesis & sensory deficits `
585
Pancoast tumor can cause what?
Thoracic outlet syndrome Atrophy of intrinsic hand muscles Can affect the T2 nerve root w/ pain along ulnar nerve distribution & numbness & atrophy of 4th & 5th digits
586
Niacin -- Lipid lowering agent MOA & SE?
Decreases secretion of VLDL by hepatocytes & prevents lipolysis (HSL) Flushed face (prostaglandin mediated) Decreased w/ NSAIDs Hyperglycemia HYPERURICEMIA -- GOUTY
587
Innervation to Latissimus Dorsi?
Thoracodorsal nerve
588
Innervationto Levator Scapulae?
Dorsal Scapular nerve
589
Innervation to Serratus Anterior?
Long thoracic
590
Innervation to Trapezius muscle?
Spinal accessory nerve Cranial Nerve XI
591
L4 Nerve root
Courses anterior across the knee & into the MEDIAL FOOT Weakness of Knee EXTENSION DECREASED PATELLAR REFLEX
592
L5 Nerve root
Laterally across the thigh & Knee Into the DORSUM of the foot Weakness in DORSIFLEXION Difficulty in HEEL WALKING L5 innervates all 3 gluteus muscles NO spinal reflex associated
593
S1 Nerve Root
Posterolateral aspect of thigh & leg Weakness of PLANTAR FLEXION Difficulty in TOE WALKING DECREASED ACHILLES reflex
594
Oculomotor nerve innervates the?
Pupillary sphincter muscle Causes pupil constriction Innervates all extraocular muscles EXCEPT superior oblique & lateral rectus
595
High levels of Uric acid in the urine indicate what tx? Low levels of uric acid in the urine indicate what tx?
High levels = Allopurinol Low levels = Probenecid
596
Omega 3 FA (Fish oil) MOA?
Inhibits delivery of free FA to liver Decreases activity of enzymes that produce TG SE = Belching & fishy mouth taste Slightly Increases LDL & HDL -- but decreases TG
597
SE of Loop Diuretics?
Ototoxicity -- tinnitus Hypokalemic metabolic alkalosis Hypomagnesemia HYPOCALECEMIA Hyperuricemia Good for acute HF exacerbations
598
Indication for Clopidogrel use? SE?
Blocks Adenosine Diphosphate Receptor Decreases ADP induced expression of GPIIb/IIIa Same clinical use as ASA (Acute coronary syndrome, stroke risk, coronary stenting) Used for patients with ASA allergy SE = Neutropenia (Ticlopidine) TTP
599
What is Hemiballismus? What is the MCC?
Unilateral flailing of a limb Caused by disruption of the contralateral subthalamic nucleus MCC is LACUNAR stroke
600
What medication closes PDA? What medication keeps PDAs open?
NSAIDs -- Indomethacin or ibuprofen CLOSE the PDA -- Ligamentum arteriosum Prostaglandins E1 & E2 kEEp PDA Open (Alprostadil)
601
Always check what before starting a patient on magnesium sulfate?
DTRs Hyporeflexia indicates imminent diaphragm paralysis & respiratory failure
602
Beta-thalassemia minor labs?
Increased Hemoglobin A2 Misleadingly low hemoglobin A1c Level
603
Methamphetamine intoxication presentation?
Diaphoresis Agitation, psychosis Physical signs of tooth decay &injections marks on arm Skin excoriations Withdrawal = vivid dreams & hyperphagia
604
Histoplasmosis located where? pathologic features? unique signs?
Mississippi & Ohio River Valleys DIMORPHIC= MOLD IN THE COLD (20), YEAST IN THE HEAT (37) Macrophage filled -- SMALLER than RBCs Ovoid bodies Palatal / tongue ulcers HEPATOSPLENOMEGALY W/ CALCIFICATIONS (Disseminated) ERYTHEMA NODOSUM -- PAINFUL NODULES ON SHIN Birds & Bats Histo Hides within macrophages Can mimic TB in presentation DX via urine / serum antigen
605
Blastomycosis located where? pathologic features? unique signs?
Located in Eastern & Central US -- GREAT LAKES Pigeon droppings BROAD BASED BUDDING (same size as RBC) Inflammatory lung disease -- Patchy alveolar infiltrate Disseminates to BONE & SKIN w/ Verrucous lesions (Black Skin nodules) Dimorphic
606
Coccidioidomycosis located where? Pathologic features? Unique signs?
Southwest US -- California SPHEREULE RELEASES ENDOSPORES (Not yeast) in tissue -- HUGE - much larger than RBC Disseminates to bone & skin Erythema nodosum or multiforme Arthralgias Meningitis Dust exposure in endemic areas -- earthquakes
607
If the bone tumor starts with an O, it is more common in who?
bOys
608
If you hear Epiphysis as a description for bone tumor, what is it automatically?
Giant cell tumor MC in females in their 20-40s Often in the knee Neoplastic mononuclear cells that express RANKL & reactivate multinucleated giant cells
609
Whipple Disease presentation? unique features?
Infection w/ Tropheryma Wipplei (Intracellular Gram (+)) PAS (+) ***** FOAMY MACROPHAGES in intestinal lamina propria Cardiac symptoms w/ Arthralgias Neurologic symptoms Diarrhea late in disease course
610
SCID defect? Presentation? Findings?
Defective IL-2r Gamma chain or adenosine deaminase deficiency Presents with failure to thrive, chronic diarrhea, thrush Current viral, bacterial, fungal, protozoal infections Decreased T-Cell receptor excision circles ABSCENCE of THYMIC SHADOW Germinal centers
611
Hypocalcemia leads to what symptoms?
Peripheral neuromuscular excitability -- paresthesias & muscle spasms MCC w/ very rapid transfusion rates
612
Facial nerve functions?
Facial movement + eye closure Taste from anterior 2/3 of tongue Parasympathetic innervation to submandibular & lacrimal glands Sound dampening
613
Tricyclic antidepressants MOA & SE?
Amitriptyline, Nortriptyline, Imipramine, PRAMINES MOA -- Inhibit 5-HT & NE reuptake CCC -- Convulsions, coma, cardiotoxicity -- due to sodium (Na+) blockade Overdose TX = Sodium Bicarbonate
614
Patau (13) Edwards (18) Down's (21)
13 -- Midline facial defects (cleft palate), Polydactyly, Umbilical hernias 18 -- Fetal growth retardation, HYPERtonia, clenched hands w/ overlapping fingers, rocker bottom feet 21 -- Flat facies, up slanting palpebral fissures, low set small ears, single PALMAR CREASE, HYPOtonia
615
What presents as wet, wobbly, & wacky?
Normal pressure hydrocephalus Older adults; idiopathic CSF elevates episodically Ventricle expansion Stretching of the descending cortical fibers (corona radiata) Triad of urinary incontinence, gait apraxia, & cognitive dysfunction
616
Primary Sclerosing Cholangitis presents how?
Middle aged males w/ UC or IBD Inflammation & fibrosis of the extrahepatic (common bile duct) & intrahepatic) biliary tree
617
Primary Sclerosing Cholangitis presents how?
Middle aged males w/ UC or IBD Inflammation & fibrosis of the extrahepatic (common bile duct) & intrahepatic) biliary tree
618
Which nerve roots from brachial plexus damaged from a fall & medial side of arm is numb?
C8-T1
619
Hashimoto presentation? Findings? Serology? Histology?
HLA-DR3 association Increase risk of primary thyroid lymphoma Nontender thyroid (+) Antithyroid peroxidase (+) Antimicrosomal (+) Antithyroglobulin antibodies Hurthle cells -- Lymphoid aggregates w/ GERMINAL CENTERS
620
Serotonin syndrome treatment?
Cyproheptadine -- 1st generation anti-histamine Patient's taking MAOIs are especially vulnerable to serotonin syndrome
621
Lenticulostriate artery area of lesion? Symptoms?
Striatum & Internal Capsule Contralateral paralysis Absent cortical signs (i.e. Visual & speech intact)
622
Lewy Body Dementia description?
2nd MC type of degenerative dementia next to Alzheimer's Progressive cognitive decline VISUAL HALLUCINATIONS Spontaneous parkinsonian features Urinary incontinence REM sleep disorders (Sleepwalk & Sleep Talk) Defect in Alpha-Synuclein Called Lewy if the cognitive & motor symptoms are less than a year apart
623
Achalasia pathology?
Failure of the LES to relax due to degeneration of inhibitory neurons Destruction of Nitric oxide producing neurons in the esophagus Increased LES resting pressure
624
21 Hydroxylase deficiency labs?
DECREASE IN mineralocorticoids DECREASE in Blood pressure DECREASE in Cortisol INCREASE in potassium & Sex hormones Adrenal cortex can not produce glucocorticoids & mineralocorticoids --- This leads to HYPOTENSION (Salt wasting) In turn, Renin system activated & Angiotensin II is elevated Increase in 17
625
CAH disorders: If the deficiency begins with a 1 i.e. 11B-hydroxylase or 17A-hydroxylase? If the deficiency ends with a 1 i.e. 21 or 11?
Begins with 1 = HYPERTENSION Ends with 1 = VIRILIZATION
626
Left side of Ovarian / Testicular Vein drains where?
Left Renal Vein (Also MC site for varicocele) Right = Directly into IVC
627
How is Compartment syndrome diagnosed?
Pain w/ tense swollen compartments with passive stretch of muscles in that compartment Decreased pulses
628
Cocaine effects on birth?
Preterm birth -- Fetal growth restriction
629
Dermatomyositis key findings & facts?
Gottron papules -- Papules on the extensor surfaces of the joints of the hands Heliotrope eruption -- Rash on the upper eyelids w/ occasional edema of the eyelid Increased risk of Interstitial lung disease (Adenocarcinoma) Perimysial inflammation & atrophy with CD4 T+ cells Symmetric proximal muscle weakness -- Deltoids, neck flexors, hip flexors
630
Tumor Markers Association CA 19-9 CA 15-3 CA 125 HER2 AFP hCG-beta S100 Calcitonin CEA
CA 19-9 = Liver / Biliary / Pancreatic CA 15-3 = Breast Cancer CA 125 = Ovarian Cancer HER2 = Breast & Gastric Cancer AFP = Hepatocellular & Yolk Sac Tumor hCG-B = Choriocarcinoma S-100 = Melanoma Calcitonin = Medullary Thyroid Cancer CEA = Colorectal & Pancreatic Cancer
631
Hypovolemic Shock MOA? Heart changes?
Caused by hemorrhage, dehydration, & burns ONLY SVR (AFTERLOAD) is INCREASED Makes sense because you are not pumping out
632
Cardiogenic Shock MOA? Heart changes?
Caused by MI, HF, & Inadequate ventricular function LEFT heart dysfunction Severe decrease in CO Increase in Preload & Afterload
633
Obstructive shock MOA? Heart changes?
Cardiac tamponade, PE, Tension pneumothorax RIGHT heart dysfunction Same heart changes as cardiogenic shock Severe decrease in CO Increase in Preload & Afterload
634
Distributive shock MOA? Heart changes?
Due to sepsis & anaphylaxis Systemic Vasodilation Skin is WARM INCREASE IN CO
635
What is the only thumb movement not controlled by the median nerve?
Thumb ADDuction Controlled by Ulnar Nerve Associated with weakness of fingers 4 & 5
636
Piriformis Counterstrain treatment?
Flexion of the hip & ABduction
637
Inferior Gluteal (L5-S2) cause of injury? Presentation?
Posterior hip dislocation Difficulty climbing stairs & rising from seated position LOSS of hip extension
638
Chronic Lymphocytic leukemia HY?
Men above 60 YO CD20 ++ Autoimmune hemolytic anemia -- COOMBS test +
639
Acute lymphocytic Leukemia HY?
MC in children B lineage is most common Down syndrome association 12;21 = good 9;22 = very bad
640
Hairy cell leukemia HY?
Adult males B cell tumor Marrow fibrosis -- dry tap on aspiration MASSIVE SPLENOMEGALY & PANCYTOPENIA TRAP stain ++
641
Acute Myelogenous leukemia HY?
Onset 65 YO Myeloperoxidase ++ Responds to vitamin A DIC is common presentation Auer rods
642
Chronic Myelogenous Leukemia HY
9;22 BCR-ABL High number of basophils Imatinib is TX -- BCR-ABL tyrosine kinase inhibitor
643
Angiodysplasia poop color? Association with what murmur?
Maroon colored stool (Melena) Aortic stenosis Dilated submucosal veins -- Right side of colon
644
Diverticulosis HY?
Most commonly in the SIGMOID Increase in INTRALUMINAL PRESSURE Obesity & low fiber diet Painless Hematochezia OSIS bleeds
645
Diverticulitis HY?
LLQ PAIN Leukocytosis #1 cause of FISTULA in elderly patients "left sided appendicitis"
646
Meckel Diverticulum HY?
Rule of 2's 2x likely in males 2 inches long 2 feet from ileocecal valve First 2 years of life Persistence of the Vitelline duct MC congenital anomaly of the GI tract RLQ pain -- TERMINAL ILEUM
647
Zenker Diverticulum HY?
False diverticulum Inferior pharyngeal constrictor Dysphagia, FOUL BREATH & Neck mass -- Older males
648
Cholecystitis HY?
Murphy sign -- Inspiratory arrest on RUQ palpation due to pain Pain radiates to right shoulder -- Phrenic nerve Gallstone impaction in the CYSTIC DUCT Gallstone Ileus -- @ Ileocecal valve w/ AIR in the biliary tree

INCORRECT (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions