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Flashcards in June 6th Deck (119):
1

Differential Dx of Eosinophilia

"CANADA-P"
Collagen vascular disease
Atopic disease (Allergy, asthma, Church Strauss)
Neoplasm
Acute interstitial nephritis
Drugs
Addison Disease (Adrenal insufficiency)
Parasites

2

What substances act on smooth muscle myosin light chain kinase? How does this affect blood pressure?

DHP CCB
Epinephrine
Prostaglandin E2
Causes vascular smooth muscle relaxation and a decrease in blood pressure

3

Vit deficiency with convulsions and irritability

Vit B6 Pyridoxine

4

Anemia caused by B12 and B9 (folate)

Megaloblastic anemia

5

Where is B12 absorbed?

Terminal ileum

6

Vit deficiency with peripheral neuropathy and glossitis

B6 pyridoxine
B12

7

Vit deficiency with dermatitis, diarrhea and dementia

Niacin B3

8

Vit used in oxidation/reduction reactions

B2 riboflavin (has both o & r for ox/redox)
B3 niacin (NAD+ NADPH)

9

Vit used in carboxylation reactions

B7 biotin (has o for carboxy)

10

Vit used by pyruvate dehydrogenase, alpha ketoglutarate dehydrogenase and transketolase

think "ATP" reactions
Thiamine Vit B1

11

Vit used to elevated HDL/LDL

Niacin B3

12

Vit deficiency caused by INH use

B6 pyridoxine
B3 niacin

13

Colbalt found in this vitamin

B12 cobalamin

14

Critical vit for DNA synthesis

B9 folate

15

Dilated cardiomyopathy, edema and polyneuropathy with high output cardiac failure

Wet beriberi (ber1ber1)

16

Perpiheral neuropathy with foot/wrist drop and symmetrical muscle weakness

Dry beriberi (think Ber1ber1)

17

Vit deficiency with dermatitis cheilosis glossitis and angular stomatitis

B2 riboflain

18

Niacin derived from

tryptophan

19

Causes of niacin deficiency

Hartnup disease (decreased tryptophan)
Malignant carcinoid syndrome (increased tryptophan metabolism)
INH (decreases B6

20

How do you avoid flushing with Niacin supplements?

Take aspirin with dose

21

Vit B5 deficiency

Pantothenic acid
Component of coenzyme A
dermatitis enteritis alopecia adrenal insufficiency

22

B vitamin used in synthesis of neurotransmitters and as cofactor for transamination and deamination

Pyridoxine B6

23

Pyridoxine used to make what NT and other substances?

B6
Niacin
Heme
Cystathionine
histamine
serotonin
epi
NE
dopamine
gaba

24

Where is B9 found naturally and where is it absorbed?

Folate = foliage
leafy green vegetables
absorbed in jejunum

25

Drugs causing B9 deficiency

(Folate)
Phenytoin
Sulfonamides
Methotrexate
TMP

26

B9 deficiency

(Folate)
Diarrhea
Depression
Confusion
Glossititis
Decreased growth
Megaloblastic anemia (hypersegmented PMNs = neurtophils)

27

B12 deficiency and where is it found?

Only animal products
Parasthesias
Degeneration of DCML, LCST, spinocerebellar tracts due to abnormal myelin = ataxia, memory loss, dementia, severe weakness

28

Dx of B12 deficiency

elevated serum homocytseine and methymalonic acid
Schilling test with radio labeled B12 if low in urine then deficient absorption
Absorbed in terminal ileum

29

Dx of B12 deficiency

elevated serum homocytseine and methymalonic acid
Schilling test with radio labeled B12 if low in urine then deficient absorption
Absorbed in terminal ileum

30

Acute phase cytokines

IL-1 IL-6 and TNF-alpha

31

Parkinson's Drugs

"BALSA"
Bromocriptine
Amantidine
Levidopa/Carbidopa
Selegiline (Etacapone/Tolcapone)
Antimuscarinics (Benztropine)

32

Pancreatic CA tumor markers

CA19-9 (more specific)
CEA (gastric and colon cancer)

33

Endocrine hormones using cAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH V2 receptor
MSH
PTH
Calcitonin
GHRH
Glucagon
(FLAT ChAMP + CGG)

34

Endocrine hormones using cGMP

ANP
BNP
NO
(Think vasodilators)

35

Endocrine hormones using intrinsic tyrosine kinase (MAP kinase)

Insulin
IGF-1
FGF
PDGF
EGF
(Think growth factors)

36

Endocrine hormones using receptor associated tyrosine kinase (JAK/STAT)

Prolactin
Cytokines
Growth hormone
G-CSF
EPO
Thrombopoietin

37

Endocrine hormones using intracellular receptors

Steroid hormones =
Vitamine D
Estrogen Testosterone Progesterone
Thryoid hormone
Glucocorticoids
Aldosterone
Cortisol

38

Stimulates bone/muscle growth

Growth hormone

39

Responsible for female secondary sex characteristics

Estrogen

40

Stimulates metabolic activity

Thryoid hormone

41

Increase blood glucose level and decreased protein synthesis

Cortisol

42

Stimulates adrenal cortex to synthesize and secrete cortisol

ACTH (Adrenal corticotrophic hormone)

43

Stimulates follicle maturation in females and spermatogenesis in males

FSH

44

Increased plasma Ca and increased bone resorb

PTH

45

Decreased plasma Ca and increased bone formation

Calcitonin

46

Stimulates ovulation in females and testosterone synthesis in males

LH

47

Stimulates TH production and iodine uptake in thyroid

TH

48

Anterior Pituitary Hormones

GH, Prolactin, FSH, TSH, LH, ACTH

49

Hypothalmic Hormones (name specific nuclei)

ADH (supraoptic nuclei)
Oxytocin (Paraventricular nuclei) "next to the production site of milk/CSF"
Both stored in PP

50

Calcitonin made in

Parafollicular C cells of thyroid

51

Estrone made in

Fat cells

52

Estrogen in males made in

Testes

53

Somatostatin made in

D cells of pancreas

54

Two nervous system plexi in GI tract and location?

Meissner's = submucosa
Myenteric/Auerbachs = btw layers of lamina propria

55

Diseases damaging ant horn

Polio
West Nile
ALS
Werdnig Hoffman (Spinal muscular atrophy)

56

CT scan shows b/l hilar lymphadenopathy, Dx?

Sarcoidosis

57

Empty sella turscica

Usually ASx, enough residual hormone tissue left to maintain hormone levels
May present as hormone deficiency

58

Hyperprolactinemia Sx

HYPOGONADISM
amenorrhea, oligomenorrhea, infertility, may have galactorrhea
Males low testosterone, decreased libido, impotence, infertility, gynecomastia

59

Tx of hyperprolactinemia

Dopamine antagonists
Antipsychotics (haloperidol, risperidone)
Domperidone
Metoclopramide

60

Describe type 1 a error

False positive
Saying there is an effect or difference when none exists

61

Describe type 2 beta error

False negative
Saying there is no effect or difference when one exists

62

Abdominal aortic aneurysm due to

Smoking
Atherosclerosis

63

Pulsus paradoxus due to

Cardiac tamponade
Asthma
COPD
Hyper inflated lungs

64

Memory tool for congenital adrenal insufficiencies?

1 in first = HTN
1 in second = masculinization
Think 21 you want to sleep with not 11

65

All congenital adrenal insufficiencies have what gross finding?

Hyperplasia of adrenal cortex due to increased ACTH (all have low cortisol levels)

66

3B-Hydroxysteroid Dehydrogenase Deficiency findings

Deficiency of aldosterone, cortisol, and androgens and testosterone
Severe salt wasting in urine
Resultant hypovolemia and hypovolemic shock
Early death
HypoNa, Hyper K

67

How is hnRNA processed before leaving the nucleus?

Poly A tail 5'cap
Introns spliced out

68

Cushing Syndrome Sx/Side effects of long term corticosteroids

BAM CUSHINGOID
Buffalo hump
Amenorrhea
Moon facies
Crazy (psychosis & agitation)
Ulcers
Skin changes (thin & striae)
HTN
Infection (cortisol suppresses immune fxn)
Necrosis of femoral head
Glaucoma
Osteoporosis
Immunosuppressed
Diabetes

69

Tx for Nephrogenic Diabetes Insipidus

HCTZ as diuretic
Indomethacin to decrease RBF
Amiloride when there is lithium induced nephrogenic DI

70

Tx of pheochromocytoma

First irreversible alpha antagonist = Phenoxybenzamine
Then beta blocker to control tacycardia
Then surgical resection
Treat alphabetically!

71

Rule of 10's/90's pheochromocytoma

10% of population
10% extra-adrenal (90% adrenal medulla)
10% calcifcy
10% in kids (90% adults)
10% malignant (90% benign)
10% bilateral (90% unilateral)

72

Pheochromocytoma associations

MEN 2A and 2B
Can secrete EPO = polycythemia
Neurofibromatosis 1

73

Adrenal Neuroblastoma buzzwords

Homer-Wright psuedorossettes
Bombesin tumor marker
Neurofilament stain
Overexpression of N-myc oncogene
HMA + VMA in blood & urine

74

What two MEN syndromes are associated with the RET oncogene?

MEN 2A & 2B

75

Give the characteristics of MEN1

MEN1 = PPP
Parathyroid adenoma
Pituitary tumor
Pancreatic endocrine tumors (ZE, insulinomas, VIPomas, glucagonomas)

76

Give the characteristics of MEN2A

PPM
Parathryoid hyperplasia
Pheochromocytoma
Medullary thryoid carcinoma (neck mass)
Associated with RET oncogene

77

Give the characteristics of MEN2B

PMM
Pheochromocytoma
Medullary thryoid carcinoma
Mucosal neuromas = Oral/intestinal ganglioneuromatosis
Associated with RET oncogene

78

Skin hyper pigmentation

Primary Adrenal Insufficiency due to excess ATCH and POMC activating MSH

79

Triad of Conn Syndrome

Primary Hyperaldosteronism
HTN
HypoK
Metabolic Alkalosis

80

Most common cause of Conn Syndrome

Hyperaldosteronism
Adrenal adenoma

81

What causes of vaginosis cause pH to be high and which ones cause it to be low?

pH>5.5 = trichomonas & garderella
pH

82

Tx of thyroid storm

3 P's
Propoanolol (B-blocker)
Propylthiouracil
Prednisone (Glucocorticoids)

83

Most common location of ectopic thyroid tissue

tongue

84

Recent study with IV iodine contrast cause of hyperthyroid?

Jod-Basedown phenomenon
Iodine induced hyperthryoidism

85

Pregnancy affect on serum thyroid hormone levels?

Increased TBG
Increased total T3/T4
Normal serum T3/T4
Decreased TSH due to similarity to hCG

86

Hashimoto Buzzwords (6)

Autoimmune destruction by Anti-thyroid peroxidase Ab = Anti-TPO Ab
Painless goiter + hypothyroid
HLA- DR5
HLA- B5
Increased risk for B-cell lymphoma
Lymphoid aggregates with germinal centers on histo

87

Hypothyroid + lymphoid infiltrate

Hashimotos

88

Hypothyroid + granulomatous infiltrate

Subacute DeQueivans Thryoiditis

89

Hypothyroid + fibrosis

Reidels

90

Pt stops taking levothyroxine pills - what labs have changed?

Hypercholesterolemia
Increased total cholesterol and LDL

91

Most common thyroid cancer

Papillary carcinoma

92

Enlarged thyroid cells with ground glass nuclei

Orphan Annie nuclei of Papillary Carcinoma

93

Second most common thyroid cancer

Follicular carcinoma

94

Thyroid carcinoma with activation of receptor tyrosine kinases

Papillary and medullar

95

Thyroid carcinoma with RAS mutation or PAX8-PPARg1 mutation

Follicular

96

Hashimotos thyroiditis increased risk of this CA

B cell lymphoma

97

Cancer of parafollicular C cells and findings

Medullary thyroid cancer
Increased calcitonin
MEN2A/2B
RET mutation

98

Thyroid carcinoma with BRAF RET NTRK1 mutation

Papillary carcinoma

99

Rock hard thyroid nodule in older patient that is fixed and appears to have invaded into nearby structures

Undifferentiated anaplastic carcinoma
Very poor prognosis

100

Rock hard thyroid nodule in younger patient that is fixed and appears to have invaded into nearby structures

Reidels thryoiditis

101

Thyroid cancer that spreads hematogenously

Follicular carcinoma

102

Follicular carcinoma vs. follicular adenoma

Both have uniform follicular proliferation
Carcinoma invades capsule
Adenoma does not invade capsule and can produce TH

103

Thyroid cancer with psammoma bodies, nuclear grooves and orphan annie nuclei

Papillary carcinoma

104

HLAB35

Subacute thyroiditis

105

Transient hyperthyroid/hypothyoid
Recent viral flu-like illness
Rapid enlargement
Painful thryoid
Granulomatous inflammation

Subacute thryoiditis

106

Drugs that can cause hypothyroid

Amiodarone
Lithium
Tyrosine kinase inhibitors

107

Insulin dependent GLUT4 receptors found

On SKM and adipose tissue

108

GLUT2 non-insulin dependent receptors found

Beta cells pancreas
Small intestine
Liver
Kidney

109

Does DM1 or DM2 have strong genetic predisposition?

DM2

110

What HLA's is DM1 associated with and what is the antibody

HLA-DR3-DQ2
HLA-DR4-DQ8
Anti-glutamic acid decarboxylase (GAD) Ab to islet cells

111

What skin changes are associated with DM2?

Acanthosis nigricans

112

What enzyme converts glucose to sorbitol?

Aldose reductase

113

What enzyme converts sorbitol to fructose?

Sorbitol dehydrogenase

114

What tissues lack sorbitol dehydrogenase and what does this lead to?

Schwann cells
Retina
Kidney
Lens
Causes osmotic swelling and damage

115

How is HbA1c attached to glucose?

Nonenzymatic glycosylation

116

Nonenzymatic glycation damage of DM includes

Retinopathy
Nephropathy
Large vessel atherosclerosis

117

Osmotic damage of DM includes

Neuropathy
Cataracts

118

Attributable risk equation

AR= A/A+B - C/C+D

119

ECG leads showing inferior wall infarction?

Leads 2,3 and aVF