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MEMORIZE ME > Memorization > Flashcards

Memorization Flashcards

1
Q

Burkitt’s Lymphoma translocation?

A

t (8;14)

c-myc

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2
Q

Hodgkin’s lymphoma markers?

A

CD15 & CD30

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3
Q

Mantle cell lymphoma translocation

A

t (11;14)

cyclin D1

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4
Q

Follicular lymphoma

A

t (14;18)

bcl-2

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5
Q

Mantle cell poor prognosis marker

A

CD5

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6
Q

virus causing adult T-cell lymphoma

A

HTLV-1

Tax protein retrovirus

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7
Q

Mycosis fungides indolent course marker

A

CD4

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8
Q

pathogmnemonic cell in Mycosis fungiodes

A

cerebriform nucleus/ sezary cell

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9
Q

pathogmnemonic for Hodgkin’s lymphoma

A

Reed-Sternberg cell (owl’s eyes)

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10
Q

pathogmnemonic for Multiple myeloma?

A

fried egg appearance– monoclonal plasma cell

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11
Q

Ig increased in multiple myeloma

A

IgG or IgA

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12
Q

Bence Jones protein

A

Ig kappa light chains

multiple myeloma

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13
Q

Waldenstroms macroglobulinemia

A

IgM

M spike, no lytic lesions

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14
Q

ALL buzz word

A

mediastinal mass in kid

very high blasts

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15
Q

marker for ALL

A

TdT+ (Pre-T & Pre-B)
CALLA+
CD10

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16
Q

good prognosis translocation for ALL

A

t (12;21)

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17
Q

CLL pathogmnemonic

A 
smudge cells 
(d/t autoimmune hemolytic anemia)
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18
Q

Hairy cell leukemia stain

A

TRAP +

tartate-resistant acid phosphataste

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19
Q

AML pathogmnemonic

A

Auer rods (peroxidase +)
(M3 = promyelocytic)
responds to Vit A (all-trans retinoid acid)
leads to DIC

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20
Q

AML translocation (M3)

A

t (15;17)

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21
Q

treat CLL

A

anti-CD52 (alemtuzumab)

directly cytotoxic

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22
Q

CML translocation

A

t (9;22) bcr-abl hybrid

philadelphia chromosome

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23
Q

treat CML

A

imatinib (inhibits philly chrom– targets bcr-abl tyrosine kinase)

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24
Q

CML unique bc

A

no JAK2 mutation (all other chronic myeloproliferative d/o) +JAK mut)
low Alk Phos (all others inc Alk Phos)
+ Phil chrom hybrid

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25
Q

locus 14 in translocations

A

heavy chain Ig

lymphoma

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26
Q

markers for Langerhans cell histiocytosis

A

CD1a (dendritic/ langerhans)

S-100 (neural crest origin via monocytes)

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27
Q

pathogmnemonic Langerhands cell histiocytosis

A

Birbeck granules

tennis rackets on EM

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28
Q

intense itching after hot shower

A

polycythemia vera

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29
Q

teardrop cell (dacrocyte)

A

myelofibrosis of BM (dec rbc, etc)

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30
Q

cause of HIT

A

IgG abs against hep bound to PF4

complex activates platelets–> thombosis & TCP

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31
Q

Heparin antidote

A 
Protamine sulfate
(+ charge = binds - heparin charge)
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32
Q

Warfarin antidote

A

Vit K

fresh frozen plasma

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33
Q

Extrinsic Pathway

A

PT (INR)

Warfarin

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34
Q

Intrinsic pathway

A

PTT

Heparin

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35
Q

MOA of heaprin

A

+ Antithrombin III

decreases thrombin (IIa) and Xa

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36
Q

MOA of warfarin

A

inhibits synthesis & gamma-carboxylation of Vit K-dep clotting factors

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37
Q

Vit K-dep clotting factors

A

II, VII, IX, X

Proteins C & S

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38
Q

Low MW heparin acts mostly on

A

Factor Xa

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39
Q

thrombolytic labs

A

inc PT & inc PTT

no change platelet ct

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40
Q

Antidote to thrombolytic toxicity

A

aminocaproic acid

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41
Q

ASA labs

A

inc BT
no change PT or PTT
dec TXA2 & PGs

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42
Q

Costimulatory signal for T cell activation

A

CD28

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43
Q

both CD4 & CD8 T cells have

A

CD3

TCR Ag marker for all T- cells– role in signal transduction

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44
Q

prevent mast cell degradation

A

cromolyn sodium

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45
Q

B lymphocytes markers

A

CD 19, 20 & 21

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46
Q

All lymphocytes marker

A

CD45

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47
Q

EBV marker

A

CD21

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48
Q

Marker for class switching

A

CD40

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49
Q

Helper T cell Marker

A

CD4

MHC II

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50
Q

Cytotoxic T cell Marker

A

CD8

MHC I

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51
Q

Rh treatment

A

IgG Rho (D)-isoimmunization

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52
Q

INF role

A

inhibits viral protein synthesis via ribonuclease

degrades viral mRNA

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53
Q

INF-alpha dz

A

Chronic Hep B & C
Kaposi’s sarcoma
Malignant Melanoma
HPV

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54
Q

INF-beta dz

A

Multiple Sclerosis

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55
Q

INF-gamma dz

A

Chronic Granulomatous dz

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56
Q

cytokines secreted by macrophages

A

IL-1,6,8,12 & TNF-alpha

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57
Q

IL-1

A

pyrogen

+ hypothalamus to produce PGE2 –> fever

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58
Q

IL–6

A

pyrogen & acute-phase protein production

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59
Q

IL-8

A

neutrophil chemotaxis

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60
Q

IL-12

A 
granuloma formation (TH1)
activates NK cells
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61
Q

TNF-alpha

A

septic shock & cahexia

+leuk recruit & vascular leakage

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62
Q

cytokines secreted by T cells

A

IL-2 & IL-3

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63
Q

IL-2

A

stimulates T cells

activated via calcineurin (protein phosphatase dephosphorylates NFAT)

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64
Q

IL-3

A

Bone marrow stem cell growth & diff

similar to GM-CSF

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65
Q

Cytokine secreted from Th1 cells

A

INF-gamma
anti-tumor & anti-viral = +Th1 & phages (dec Th2)
activates granuloma formation = activated epithelioid histiocytes

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66
Q

Cytokines from Th2 cells

A

IL-4, IL-5, IL-10

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67
Q

IL-4

A 
class switching = IgE (& IgG)
promotes B cell growth
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68
Q

IL-5

A 
class switching = IgA
promotes B cell diff
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69
Q

IL-10

A

DECREASES inflamm response
inhibits Th1 & activated Tcells
secreted also by Treg cells

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70
Q

TGF-beta

A

DECREASES inflamm response

dec T cell prolif & cytokine production

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71
Q

C1 esterase inhibitor deficiency

A

Hereditary Angioedema (periorbital & pitting edema)
inc kallikrein & inc bradykinin
*ACE-I Contraindicated

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72
Q

C3 deficiency

A

severe, reccurent pyogenic sinus & resp infxns

inc susceptibility to Type III HSR

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73
Q

C5-9 deficiency

A

recurrent Neisseria infxns

No MAC formation

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74
Q

DAF (Decay- Accelerating Factor) deficiency

GPI anchored enzyme

A

paroxysmal nocturnal hemoglobinuria

  • complement-mediated lysis of self- RBCs
  • sx: red urine & thrombosis
  • d/t NO glycophosphatidylinositol (no membrane protective protein)
  • only acquired hemolytic anemia d/t intrinsic defect
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75
Q

Classical Complement pathway activation

A

Antigen-antibody complexes
IgM- whole C pathway (acute inflammation)
IgG- stops at C3 (chronic inflammation)

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76
Q

Alt pathway complement activation

A

microbe surface molecules

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77
Q

Lectin pathway complement activation

A

mannose on microbe surface

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78
Q

Anaphylaxis mediators

A

C3a & C5a

+Histamine release from mast cells

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79
Q

primary opsonins

A

C3b & IgG

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80
Q

neutrophil chemotaxis in complement

A

C5a

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81
Q

MAC

A

C5b & C6-9

defends against gram-neg bacteria

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82
Q

HLA-A3

A

hemochromatosis

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83
Q

HLA-B27

A

Ankylosing Spondylitis
Psoriasis
Reiter’s Syndrome
IBD

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84
Q

HLA-DQ2 & DQ-8

A

Celiac Disease

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85
Q

HLA-DR2

A

Multiple Sclerosis
SLE
Goodpasture’s
Hay fever

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86
Q

HLA-DR3

A

Grave’s disease

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87
Q

HLA-DR4

A

RA

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88
Q

HLA-DR3 & DR4

A

DM-type I

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89
Q

HLA-DR5

A 
Pernicious Anemia (B12 def)
Hashimoto's Thyroiditis
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90
Q

Splenectomy/ Splenic Dysfunction

A 
inc susceptibility to encapsulated orgs:
Strep pneumo
Haemophilus influenza (B)
Neisseria meningitidis
Salmonella
Klebsiella
Group B strep

*low IgM, low complement activation, low C3b opsonization

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91
Q

Cells seen post-splenectomy

A

Howell-Jolly bodies
Target cells
(and thrombocytosis)

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92
Q

MHC I HLA’s

A

HLA- A, B & C

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93
Q

MCH II HLA’s

A

HLA-DR, DP & DQ

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94
Q

MHC I works?

A

beta-2 microglobulin (transport to clel surface)

  • MHC I on all nucleated cells (NOT RBCs)
  • Ag is in RER w/ intracellular peptides
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95
Q

MHC II works?

A
  • AG is loaded after invariant chain release in acidified endosome
  • expressed only on APCs
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96
Q

Type I HSR

A

anaphylactic & atopic
histamine, mast cells, basophils (cross-links IgE) d/t preformed antibody (rapid response)
test– skin/ scratch test

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97
Q

Type II HSR

A

antibody mediated via IgM or IgG
cytotoxic via NK cells, C-mediated lysis w/ MAC, or opsonization
tests– direct & indirect Coombs

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98
Q

Type III HSR

A

immune complex mediated
Ag-Ag-Complement stuck together = attracts neutrophils & releases lysosomal enzymes
test– IF stain

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99
Q

Type IV HSR

A

Delayed type (T-cell mediated)
sensitized & release lymphokines, leading to macrophage activation – NO ANTIBODY involved
*NOT transferrable by serum bc cell-mediated
test- patch, PPD

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100
Q

Type I HSR dz

A

anaphylaxis
allergy
asthma, rhinitis, hay fever, eczema, hives

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101
Q

Type II HSR dz

A 
invasive helminth (parasitic)
Autoimmune hemolytic transfusion reaction
Erythroblastosis fetalis
Autoimmune hemolytic anemia
Pernicious anemia
ITP
Rheumatic fever
Goodpasture's
Bullous pemphigoid
Pemphigus vulgaris
Myasthenia Gravis
Grave's Disease
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102
Q

Type III HSR dz

A 
SLE
RA
PAN
HSP
cryoglobinemia
Arthus rxn (local, intradermal)
Serum sickness (haptens 5 days later)
post-strep GN
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103
Q

Type IV HSR dz

A 
PPD
Contact dermatitis (poison ivy, nickel allergy)
GVHD (transplant rejections)
GBS
MS
Hashimoto's thyroiditis
leprosy
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104
Q

T-cell deficiency

A

viral & fungal infxn

CMV, EBV, VZV, PCP, Candida

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105
Q

B-cell deficiency

A

bacterial infxn– encapsulated

enteroviral encephalitis & poliovirus & GI giardiasis (no IgA)

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106
Q

Allergic blood transfusion rxn

A

Type I HSR against plasma proteins

urticaria, pruritis, wheeze, fever

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107
Q

Anaphylactic rxn to blood transfusion

A

severe. if IgA-def, must get blood products w/o IgA
via C3a & C5a anaphylatoxins
dyspnea, bronchospasm, hypotension, resp arrest, shock

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108
Q

Febrile nonhemolytic transfusion rxn

A

Type II HSR
host Ab agaist donor HLA Ag
fever, HA, chills, flush

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109
Q

Acute hemolytic transfusion rxns

A

Type II HSR
intravascular hemolysis (ABO incompatibility)
OR extracascular hemolysis (host Ab rxn against donor RBC/ foreign Ag)
via MAC (RBC lysis)
fever, hypotension, SOB, chills, tachypnea, tachycardia, chest pain, flank pain, hemoglobinuria, DIC
hemoglobinemia– intravascular
jaundice– extravascular

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110
Q

ANA

A

SLE
Poly/dermatomyositis
non specific

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111
Q

Anti-dsDNA

A

SLE

specific

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112
Q

Anti-Smith

A

SLE

specific

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113
Q

Anti-histone

A

Drug-induced lupus

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114
Q

Rheumatoid factor

A

RA
nonspecific
Anti-IgG*

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115
Q

Anti-CCP

A

RA

specific

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116
Q

Anti-centromere

A

Scleroderma- CREST Syndrome

  • C- Calcinosis (Ca deposit in soft tissue)
  • R- Raynaud’s
  • E- Esophageal dysmotility (achalasia)
  • S- Sclerodactyly
  • T- Telangiectasia

-less skin involvement (fingers/face), benign

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117
Q

Anti-Scl-70

A

Scleroderma (diffuse)

  • excess fibrosis and collagen deposition
  • puffy tight skin, no wrinkles
  • early visceral involvement, rapid progression
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118
Q

Anti-DNA top I

A

Scleroderma (diffuse)

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119
Q

Anti-mitochondrial (AMA)

A

primary biliary cirrhosis

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120
Q

IgA antiendomysial

A

Celiac Disease

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121
Q

IgA anti-tissue transglutaminase

A

Celiac Disease

*TTG = screening

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122
Q

Anti-gliadin antibody

A

Celiac Disease

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123
Q

Anti-BM

A

Goodpasture’s

Anti-GBM & Anti-alveolar BM

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124
Q

Anti-desmoglein

A 
Pemphigus vulgaris
IgG against desmoglian 3 (part of desmosome)
*reticular/ net-like IF
* tombsones on BM & acantholysis
*flaccid blister 
*+ Nikolsky's
*+skin & oral mucosa
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125
Q

Anti-hemidesmosomes

A 
Bullous pemphigoid
IgG against hemidesmosomes (under BM)
*linear IF
*eosinophils
*tense blister
*- Nikolsky's
* + skin, - oral mucosa
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126
Q

Anti-U1 RNP

A

mixed CT disease

ribonucleoprotein

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127
Q

Polymyositis

A

CD8+ T cells

  • endomysial inflammation
  • inc CK, + ANA, + Anti-Jo-1 AB, inc aldolase
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128
Q

Dermatomyositis

A

CD4+ T cells

  • perimysial inflammation/ atrophy
  • grotton’s papules & heliotrope rash
  • inc CK, + ANA, + Anti-Jo-1 AB, inc aldolase
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129
Q

Anti-Jo-1

A

Polymyositis & dermatomyositis

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130
Q

Anti-SRP

A

Polymyositis & dermatomyositis

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131
Q

anti-Mi-2

A

Polymyositis & dermatomyositis

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132
Q

Anti-SSA (anti-Ro) & Anti-SSB (anti-La)

A

Sjogren’s Syndrome

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133
Q

Anti-smooth muscle

A

Autoimmune hepatitis

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134
Q

Anti-glutamate decarboxylase

A

Type I DM

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135
Q

c-ANCA

A

Wegener’s Granulomatosis (Gramulomatosis w/ polyangiitis)

*PR3-ANCA

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136
Q

p-ANCA

A

Churg-Strauss
Microscopic Polyangiitis
*MPO-ANCA

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137
Q

Hyperacute transplant rejection

A
  • minutes
  • Type II HSR (Ab mediated)– preformed anti-donor Abs against ABO
  • occludes graft vessels = ischemia + necrosis
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138
Q

Acute transplant rejection

A
  • weeks
  • Cell-mediated (CTLs against foreign MHCs)- Host T cell sensitization against graft MHC Ags
  • vasculitis in graft vessels w/ dense interstitial lmphocytic infliltrate w/ mononuclear cells
  • reversible w/ immunosuppressants)
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139
Q

Chronic transplant rejection

A
  • months–> yrs
  • Host B & T cell sensitization against graft MHC (MHC-I non-self = perceived as MHC-I self presenting non-self Ag)
  • Irreversible damage (via T cell & Ab) = obliterative vascular fibrosis
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140
Q

GVHD

A
  • timing variable
  • Grafted immunocompetent T cells proliferate in irradiated host and reject host MHC Ags
  • severe organ dysfxn– maculopapular rash, jaundice, HSM, diarrhea.
  • MC in BM & Liver transplant (lymphocyte rich)
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141
Q

B-cell immune deficiencies

A

Bruton’s Agammaglobulinemia (XL)
Selective IgA Deficiency
Common Variable Immunodeficiency (CVID)

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142
Q

T-cell immune deficiencies

A

Thymic Aplasia (DiGeorge)
IL-12 Receptor deficiency
Hyper-IgE syndrome (Job’s)
Chronic Mucocutaneous Candidiasis

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143
Q

Combined B & T cell immune deficiencies

A

SCID
Ataxia-telangiectasia
Hyper-IgM Syndrome
Wiskott-Aldrich Syndrome

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144
Q

Phagocyte dysfunction immune deficiencies

A

Lekocyte Adhesion Deficiency (type I)
Chediak-Higashi Syndrome
Chronic Granulomatous Dz

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145
Q

Bruton’s Agammaglobulinemia

A
  • XLR
  • BTK tyrosine kinase gene defect = no B cell maturation (low CD19)
  • opsonization defect
  • Die of: recurrent pyogenic bacterial infections after 6 mo (birth-6mo = mom IgG)
  • no tonsils, no germinal centers
  • Labs = low mature B (N-pro-B), low B cell #, low Ig (all classes)
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146
Q

Selective IgA deficiency

A
  • MC primary immunodeficiency- unknown path
  • sinopulmonary infxns, GI infxns, autoimmune dz, anaphylaxis to Ig-A containing blood products
  • Labs- IgA <7, NORMAL- IgG & IgM & IgG vaccine titers, Inc b-hCG (false + bc heterophile AB), inc WBC stool
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147
Q

CVID

A
  • defective B cell maturation
  • inc risk CA (lymphoma) & AI dz,sinopulm infxns
  • normal B cells, LOW PLASMA CELLS & Ig
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148
Q

DiGeorge syndrome

A
  • Ch 22q11 deletion = failure of 3rd & 4th pharyngeal pouches = thymic aplasia
  • tetany (hypo-Ca), Abn facies, recurrent viral & fungal infxn, congenital heart & great vessel defects
  • absent thymic shadow on CXR
  • Labs- low T cells, low PTH, low Ca
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149
Q

IL-12 Receptor deficiency

A
  • low Th1 response
  • disseminated mycobacterial infxn (cannot form granuloma to wall off)
  • low INF-gamma (gamma = granuloma)
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150
Q

Hyper-IgE Syndrome (Jobs)

A
  • Th1 fails to respond to IFN-gamma = neutrophils cannot respond to chemotactic stimuli
  • SX: coarse Facies, cold staph Abscesses (un-inflamed), retained baby Teeth, Derm problems (eczema)
  • inc IgE (>2000)
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151
Q

Chronic Mucocutaneous Candidiasis

A
  • T cell dysfxn

* Skin & mucous membrane Candida infxns

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152
Q

SCID Varieties

A

1) Defective IL-2 Receptor (MC) = XLR

2) Adenosine deaminase deficiency = AR

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153
Q

SCID

A
  • Both B & T cell deficiencies
  • FTT, chronic diarrhea, thrush, recurrect infxns of all types (fungal, bacterial, viral, protozoal)
  • No thymic shadow, no germinal centers (LN Bx)
  • Labs- dec TRECs (t-cell rco excision circles), low B cells, low T cells, inc adenine.
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154
Q

Ataxia telangiectasia

A
  • AR
  • Defect in ATM gene on Ch 11 = codes for DNA repair enzymes = inc risk DNA translocations and ds-DNA breaks
  • TRIAD- atazia, telangiectasia (spider angioma), IgA deficiency
  • Labs- dec IgA, Inc AFP
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155
Q

Hyper- IgM Syndrome

A
  • CD40 L defect on Th cells = cannot class switch (have ONLY IgM)
  • severe pyogenic infxn early in life
  • Labs- Inc IgM, low IgG, low IgA, low IgE, inc WBC
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156
Q

Wiskott-Aldrich Syndrome

A
  • XLR
  • defect in WASP gene on x chrom = T cells cannot recognize actin cytoskeleton (affected endocytosis, phagocytosis, migration, no polysaccharide Ag)
  • TRIAD– TCP (thrombocytopenic purpura = petechia & purpura), Infxn, Eczema
  • Inc IgE, Inc IgA, LOW IgM, Low platelets
  • inc risk malignant lymphoma
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157
Q

Leukocyte adhesion deficiency

A
  • defect in LFA-1 integrin (beta-2 integrin) protein on phagocytes (CD18- type I, CD15- type II)
  • delayed umbilical cord separation, absent pus formation, recurrent bact infxns
  • Bx umbilical- no neutrophils
  • labs- Inc neutrophils in blood (not sticking)
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158
Q

Chediak-Higashi Syndrome

A
  • AR
  • defect in LYST (lysosomal trafficking regulator gene) = microtubule dysfxn in phago-lysosome fusion
  • recurrent pyogenic infxns– staph & strep, partial albinism, peripheral neuropathy, photophobia, nystagmus, seizures, motor DF
  • Labs- giant granules in neutrophils (large lysosomal vesicles within phagocytes)
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159
Q

Chronic granulomatous disease

A
  • AR
  • lack of NADPH oxidase = no respiratory burst in neutrophils (low ROIs)
  • inc infxn with catalase + orgs (S. aureus*, Pseudomonas, Aspergillus, Listeria, Candida, Serratia)
  • Dx- 1) NBT dye (not blue neutrophils)
    2) Flow cytometry w/ DHR (dihydroorhodamine)- abnormal
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160
Q

endocrine hormones using cAMP signaling pathways

A 
FSH
LH
ACTH
CRH
hCG
ADH (V2 receptor)
MSH
PTH
Glucagon
Calcitonin
GHRH
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161
Q

endocrine hormones using cGMP signaling pathways

A

ANP
NO (EDRF)
(vasodilators)

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162
Q

endocrine hormones using IP3 signaling pathways

A 
GnRH
Oxytocin
ADH (V1 receptor)
TRH
Histamine (H1)
Angiotensin II
Gastrin
(minor role of GHRH-- it is principally involved in cAMP signaling)
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163
Q

endocrine hormones using Steroid receptor

A 
Vit D
Estrogen
Testosterone
T3 & T4
Corisol
Aldosterone
Progesterone
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164
Q

endocrine hormones using Intrinsic Tyrosine Kinase

A 
Insulin
IGF-1
FRF
PDGF
EGF

*use MAP kinase pathway & RAS/RAF with GTP

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165
Q

endocrine hormones using Receptor-Associated tyrosine kinase

A 
Prolactin
Immunomodulators (cytokines-- IL-2, IL-6, IL-8, IFN)
GH
EPO
CSF

*JAK/STAT pathway (acidophiles & cytokines)

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166
Q

Ewing’s Sarcoma translocation

A

t(11;22)
EWS gene

*diaphyseal, anaplastic, small blue cell CA w/ onion skin bone

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167
Q

Common chromosome 7 disorders

A

Cystic Fibrosis
Ehlers-Danlos syndrome
Osteogenesis Imperfecta

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168
Q

Common Chromosome 16 disorders

A

PKD

Tuberous Sclerosis

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169
Q

Chromosome 20 disorder

A

DM-1

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170
Q

Chromosome 22q11 disorder

microdeletion

A 
Cleft Lip/ Palate
Abnormal facies
Thymic aplasia-- DiGeorge Syndrome
Cardiac defects
Hypocalcemia-- secondary to parathyroid aplasia
  • DiGeorge Syndrome
  • Velocardiofacial syndrome– palate, facial & cardiac defects.
  • all due to aberrant development of 3rd/4th branchial pouches
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171
Q

Down’s Associations

A

MR, flat facies, epicanthal folds, simian crease, gap btw 1st 2 toes
duodenal atresia, congenital heart dz– ASD (ostium primum)
inc risk ALL & Alzheimer’s

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172
Q

Down’s Pregnancy Quad screen

A

low AFP & estriol
high hCG & Inhibin A
inc nuchal translucency on US

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173
Q

Edwards trisomy

A

Trisomy 18

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174
Q

Edwards Associations

A

severe MR, rocker-bottom feet, micrognathia, low-set ears, clenched hands, prominent occiput, congenital heart dz.
death within 1 yr

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175
Q

Edwards pregnancy quad screen

A

low AFP, estriol & hCG

normal inhibin A

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176
Q

Patau’s trisomy

A

Trisomy 13

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177
Q

Patau’s Associations

A

severe MR, rocker-bottom feet, micropthalmia, microcephaly, cleft lip & palate, holoprosencephaly, polydactyly, congenital heart dz
death within 1 yr

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178
Q

Pregnancy screen in Patau’s (1st trimester)

A

low hCG, PAPP-A

inc nuchal translucency on US

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179
Q

Esophagitis types

A

white pseudomembrane = candida
punched out ulcers = HSV-1
linear ulcers = CMV
+eosinophils in mucosa

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180
Q

Plummer-Vinson Syndrome

A

TRIAD:
dysphagia– esophageal webs (+mucosal ring)
glossitis (atrophic + chelosis/ angular stomatitis)
IDA (microcytic/hypochromic)

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181
Q

Types of dysphagia

A

progressive to solids & liquids = Achalasia

solids only = obstruction, Plummer-Vinson

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182
Q

Malabsorptive syndromes

A 
Tropical sprue (entire small bowel)
Whipples disease
Celiac sprue
Disaccharidase deficiency
Abetalipoproteinemia
Pancreatic insufficiency
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183
Q

Location of Celiac Sprue

A

proximal jejunum*, distal duodenum

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184
Q

Celiac assocated with

A

dermatitis herpetiformis

  • prupritic papules, vesicles & bullae
  • IgA dpeosition at dermal papillae
  • FHx = + HLA-DQ
  • extensor surfaces
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185
Q

Celiac inc risk of

A

T cell lymphoma

osteoporosis

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186
Q

Lactose tolerance test +

A

sx with admin of lactose
AND
glucose rises less than 20 mg/dL

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187
Q

Abetalipoproteinemia path

A

dec synthesis of apolipoprotein B
cannot generate chylomicrons to transport fat
decreased secretion of cholesterol & VLDL into bloodstream

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188
Q

Abetalipoproteinemia histo

A

foamy cells in cytoplasm = fat accumulation in enterocytes

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189
Q

Abetalipoproteinemia presentation

A

5 mo with FTT & bulky greasy stools
+ neuro manifestations (malabsorptive)
+/- Retinitis pigmentosa & progressive ataxia?

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190
Q

Pancreatic insufficiency due to

A

1) CF
2) chronic pancreatitis
3) obstructing carcinoma

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191
Q

Pancreatic insufficiency labs

A

low ADEK (fat sol vitamins)
fat malabsorption
low lipase (more diagnostic) & amylase
increasd neutral fat in stool (24 hr fecal fat)

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192
Q

Whipples disease due to

A

gram + rod: Tropheryma whipplei

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193
Q

Histo on whipples disease

A

PAS+ foamy macrophages in LP & mesenteric nodes

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194
Q

SX for Whipple’s dz

A 
malabsorption sx (diarrhea, stetorrhea, wt loss, weakness, vit/mineral dz)
cardiac sx, arthralgias & neuro sx
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195
Q

Celiac’s histo

A

blunting of villi

lymphocytes in the LP

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196
Q

Curling’s ulcer

A

acute gastritis ulcer
due to burns
decreased plasma volume
sloughing of gastric mucosa

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197
Q

Cushing’s ulcer

A

acute gastritis ulcer
due to brain injury
increased vagal stimulation = increased ACh = increased H+ production

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198
Q

MCC Acute gastritis (erosive gastritis)

A

Alcoholics & people taking daily NSAIDS (RA, etc)

NSAIDS decrease PGE1 which decreases gastric mucosal protection & causes inflammation and ulcer formation

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199
Q

Type A chronic gastritis (nonerosive gastritis)

A

location: fundus/ body
cause: Pernicous Anemia
etiology: autoimmune– autoantibodies to parietal cells
labs: achlorhydria (dec HCl secertion) , decreased IF, decreased B12

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200
Q

Type B chronic gastritis (nonerosive gastritis)

A

location: antrum
cause: H. pylori
dx: urease breath test
histo: comma, S-shaped w/ silver stain (seagull wing)
aka: atrophic gastritis
risk: inc MALT lymphoma
MC than type A

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201
Q

Menetrier’s dz

A

gastric hypertrophy (stomach rugae appear as brain gyri)
parietal cell atrophy, increase in mucous cells
protein losing enteropathy
*precancerous metaplasia

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202
Q

Intestinal type adenocarcinoma

A

location: lesser curvature
gross: ulcer w/ raised margins
cause: H. pylori, chronic gastritis, nitrosamines, achlorhydria, A-blood
acanthosis nigricans

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203
Q

Diffuse type adenocarcinoma

A

gross: thickened & leathery
histo: signet ring cells (mucin filled cell with peripheral nuclei)
AKA: linitis plastica
*not associated with H. pylori
acanthosis nigricans

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204
Q

Virchow’s node

A

Left supraclavicular node involvement

metastasis from stomach

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205
Q

Krukenberg’s Tumor

A

B/L ovarian mets from stomach.
abundant mucus
signet ring cells

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206
Q

Sister Mary Joseph nodules

A

subQ periumbilical mets from stomach

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207
Q

MC location of gastric ulcer

A

lesser curvature

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208
Q

Gross image of gastric ulcer

A

punched-out margins– clean & unraised edges

in contrast to intestinal type adenocarcinoma of the stomach

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209
Q

Pain in gastric ulcer

A

increases with meals –> eat less –> weight loss

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210
Q

Duodenal ulcer MC location

A

1st part of duodenum

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211
Q

Pain in duodenal ulcer

A

decreases with meals –> eat more –> weight gain

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212
Q

Histo in duodenal ulcer

A

brunner’s glands hypertrophy (inc bicarb secretion)

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4
5
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213
Q

rupture of gastric ulcer along lesser curvature (proximal)

A

left gastric artery bleed

stems from celiac a.

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214
Q

rupture of duodenal ulcer on posterior wall of duodenum

A

gatroduodenal artery bleed

MC ruptures anterior –> referred pain to shoulder

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215
Q

rupture of gastric ulcer along distal lesser curvature

A

right gastric artery

stems from proper hepatic a.

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216
Q

rupture of gastric ulcer along proximal greater curvature

A

Left gastroepiploic artery

stems from splenic a.

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217
Q

rupture of gastric ulcer along distal greater curvature

A

right gastroepiploic artery

stems from gastroduodenal a.

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218
Q

rupture of gastric ulcer along proximal greater curvature above the splenic artery

A

short gastric artery

stems from splenic artery

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219
Q

Crohn’s disease mediated by?

A

Th1 (granulomas)

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220
Q

Ulcerative colitis mediated by?

A

Th2 (see interleukins, no granulomas)

221
Q

Histo in Crohn’s disease?

A

non-caseating granulomas & lymphoid aggregates

222
Q

Histo in ulcerative colitis?

A

crypt abscesses and ulcers

bleeding

223
Q

Crohn’s disease location

A

terminal ileum MC
any portion of the GI tract– skip lesions
NOT rectum

224
Q

Ulcerative colitis location:

A

Colon– continuous lesions

ALWAYS rectal involvement

225
Q

inflammation in Crohn’s

A

transmural

226
Q

inflammation in ulcerative colitis

A

mucosal & submucosal only

227
Q

imaging in Crohn’s

A

string sign on barium swallow

due to bowel wall thickening

228
Q

imaging in ulcerative colitis

A

lead pipe on barium swallow

due to loss of haustra

229
Q

complications in Crohn’s

A

linear ulcers, fissures, strictures, fistulas, perianal disease
colorectal CA
malnutrition

230
Q

complications in ulcerative colitis

A

toxic megacolon
sclerosing cholangitis (bile duct inflamm)
colorectal CA (worse if R-side or pan-colitis)
malnutrition

231
Q

Extraintestinal manifestations in crohns

A 
migratory polyarthritis
erythema nodosum
kidney stones
ankylosing spondylitis (both)
uveitis (both)
232
Q

Extraintestinal manifestations in ulcerative colitis

A

Sclerosing cholangitis (primary)
pyoderma gangrenosum
ankylosing spondylitis (both)
uveitis (both)

233
Q

gross in Crohn’s

A

cobblestone mucosa
creeping fat
+/- bloody diarrhea

234
Q

Gross in ulcerative colitis

A

Pseudopolyps (friable mucosal)
free hanging mesentery
+bloody diarrhea

235
Q

Drugs in Crohns

A

adalimumab, infliximab, methotrexate, azathioprine, corticosteroids

236
Q

drugs in UC

A

sulfasalazine (ASA prep), 6-MP, infliximab, colectomy.

237
Q

Location of diverticulosis

A

sigmoid colon (distal/ left)

238
Q

false diverticulum

A

only mucosa and submucosa– no muscularis externa involved

*occur where vasa recta perforate muscularis externa

239
Q

true diverticulum

A

all 3 layers (+ muscularis externa)

Meckel’s

240
Q

Sx in diverticulitis

A

LLQ pain (L-sided appendicitis)
fever
leukocytosis
+/- perforation, +/- hematochezia

241
Q

zenker’s diverticulum

A

pharynx-esophageal jxn
killian’s triangle– btw thyropharyneal & cricopharyngeal parts of inferial pharyngeal constricton (FALSE = mucosal herniation)
Sx- halitosis, dysphagia, obstruction, regurge

242
Q

Meckel’s diverticulum info

A

cause: vitelline duct (yolk stalk) persistence
location: terminal ileum
complications: intussusception, volvulus, obstruction, bleeding, ulcers

243
Q

Meckel’s diverticulum rule of 2’s

A

(five 2’s)
2 inches long, 2 ft from ileocecal valve, 2% of population, usually presents by 2 yo, 2 types of epithelium present (ectopic acid-secreting gastric mucosa or pancreatic tissue)

244
Q

Meckel’s presentation

A

young kid with appendicitis sx, anal bleeding, peritonitis and no other obvious cause.

245
Q

MC location of intussusception

A

ileocecal jxn

proximal telescopes into distal

246
Q

MCC intussusception

A

children– adenovirus

emergency– colicky baby with pallow, emesis, abd distention, dehydration

247
Q

stools in intussusception

A

sausage stools

currant jelly stools

248
Q

MC location of volvulus

A

cecum or sigmoid colon
redundant mesentery (twists portion of bowel around its mesentery)
MC in elderly

249
Q

Hirschprung’s

A

congenital megacolon
loack of gabglion cells & enteric nervous plexus (BOTH auerbach & meissners plexus lacking on intestinal bx)
due to failure of neural crest migration
cannot pass meconium, dilated proximally creating transition zone
inc risk with Down’s

250
Q

Achalasia cause

A

loss of myenteric plexus (Auerbach’s)
cannot relax LES = high LED opening pressure & uncoordinated peristalsis
a/w: Chagas’ dz & CREST syndrome

251
Q

Meconium ileus

A

meconium plug obstructing intestion = failure to pass meconium
Cystic fibrosis

252
Q

DX Meckel’s

A

pertechnetate study for ectopic uptake (99 mTc)

253
Q

Duodenal atresia

A

Sx: early bilious vomit (after 1st feed) & proximal stomach distention
XR: double bubble*
cause: failure of recanalization of small bowel
A/W: Down’s & polyhydramnios

254
Q

MC location of angiodysplasia

A

cecum
terminal ileum
ascending colon
*R side pain + hematochezia

255
Q

MC location of ischemic colitis

A

splenic flexure & distal colon

  • ATH, PMHx CVD or low CO
  • dec bowel sounds
  • pain worse than PE findings
256
Q

necrotizing enterocolitis

A

intestinal mucosal necrosis
MC in preemies bc low immunity (risk inc with mouth feeding)
MC location– colon

257
Q

Colonic polyps location

A

rectosigmoid

258
Q

Juvenile polyposis syndrome

A

multiple juvenile polyps in GI (MC rectum) less than 5 yo

inc risk CRC

259
Q

Peutz-Jegher’s Syndrome

A

AD
multiple nonmalignant hamartomas in GI tract
hyperpigmented: mouth, lips, hands, genitals (freckles in weird places)
inc risk of visceral malig & CRC

260
Q

Familial adenomatous polyposis

A 
AD
APC gene mutation-- Ch. 5
2 hit hypothesis
100% progress to CRC
thousands; pancolonic- always involves rectum
261
Q

Gardner’s Syndrome

A

AD
FAP + osseous and soft tissue tumors
congenital retinal pigment epithelium hypertrophy + impacted/supermammary teeth

262
Q

Turcot’s Syndrome

A

FAP + malignant CNS tumors (TURban)

263
Q

HNPCC = Lynch Syndrome

A

AD
mutated DNA mismatch repair genes
*PROXIMAL COLON (vs. pancolonic in FAP)
80% progress to CRC (vs. 100% in FAP)

264
Q

MC locations of CRC

A

rectosigmoid > ascending > descending

265
Q

Ascending CRC

A

exophytic mass
IDA
wt loss

266
Q

Descending CRC

A 
infiltrating mass
hematochezia
colicky pain (LLQ) + partial obstruction
annnular, napkin-ring = pencil-thin stools
general CRC = aple core
267
Q

Bacteremia risk in CRC

A

Streptococcus bovis

268
Q

APC/ Beta-cetenin (chromosomal instability) pathway (MC)

A

1) Loss of APC (dec intercellular adhesion & inc proliferation = at risk colon)
2) K-RAS mutation (unregulated signal transduction = adenoma)
3) loss of p-53 (tumorigenesis = carcinoma)

269
Q

Carcinoid tumor location

A

appendix
ileum
rectum
(MC malig in small intestine)

270
Q

Labs in carcinoid tumor

A

inc 5-HT (serotonin) in serum
5-HIAA in urine (lung breakdown of 5-HT)
ONLY if metastases (MC to liver) outside of GI system
(liver metabolizes 5-HT if remain within GI system therefore no carcinoid syndrome or elevated 5-HT)

271
Q

Carcinoid Syndrome

A

diffuse flushing
diarrhea
wheezing
*R-sided heart murmurs

272
Q

Tx carcinoid tumor

A

resect
octreotide
somatostatin

273
Q

Budd-Chiari syndrome

A

IVC or hepatic vein occlusion
SX: hepatomegaly, ascites, abdominal pain, NO JVD, +/- varices
histo: centrilobar congestion & necrosis = congestive liver dz
A/w: hypercoagualbe states, PCV, preg, HCC

274
Q

HCC Sx

A 
jaundice
tender hepatomegaly
ascites
polycythemia
hypoglycemia
275
Q

alpha-1 antitrypsin deficiency

A

misfolded gene product protein aggregates in hepatocellular ER
cirrhosis with PAS+ globules in liver
in lungs– enzyme lack = cannot block elastase from breaking down elastin = panacinar emphysema
codominant

276
Q

ALP inc

A

obstructive liver dz
bone disease
bile duct disease

277
Q

inc GGT

A

liver & biliary disease (obstructive)
heavy alcohol consumption
NOT bone dz

278
Q

dec ceruloplasmin

A

Wilson’s disease

279
Q

Microvesicular fatty change

A

pregnancy
reye’s syndrome
tetracycline toxicity

280
Q

Macrovesicular fatty change

A

hepatic steatosis (alcoholic liver dz),
NAFLD
MTX toxicity

281
Q

distal tracheoesophageal fistula +/- esophageal atresiea

A

air in stomach on CXR
drool, choke, vomit w/ 1st feeding, failure to pass NG tube
A/W: polyhydramnios

282
Q

pyloric stenosis (congenital)

A

pyloric hypertrophy

  • olive like mass (palpable) in epigastrum
  • nonbilious projectile vomit (2 wks)
283
Q

MeiSSner’s plexus

A

Submucosal nerve
in Submucosa
causes gland Secretion
(S’s)

284
Q

Auerbach’s plexus

A

Myenteric nerve plexus
in Muscularis externa
causes Muscle contraction
(M’s)

285
Q

Zone I

A

periportal (hepatic a, portal v, bile duct)

1st affected by viral hepatitis

286
Q

Zone II

A

intermediate zone

287
Q

Zone III

A

centrilobar (pericentral vein to hepatic vein/ systemic circulation)
1st affected by ischemia, alcoholic hepatitis, most sensitive to toxic injiry
*contains P450 system

288
Q

AST > ALT by 1.5

A

alcoholic hepatitis

289
Q

ALT > AST

A

viral hepatitis

290
Q

inc amylase

A

acute pancreatitis

mumps

291
Q

Sx in Reye’s

A

hypoglycemia
vomiting
hepatomegaly
coma

292
Q

cause of Reye’s

A

aspirin decreases beta-oxidation by reversible inhibition of mitochondiral enzyme
giving mito abn & microvesicular fatty change and hepatoencephalopathy
a/w: viral infxn– esp VZV & influenza B with ASA in children

*ASA okay in KAWASKI dz only!!

293
Q

inc AFP

A

HCC

294
Q

Hepatocellular Jaundice (direct hepatocellular injury)

A

inc BOTH cong & uncong bili
inc urine bili
dec urine urobilinogen

295
Q

Obstructive Jaundice (Obstruction to bile flow = post-hepatic injury)

A

inc cong bili
inc urine bili
dec urine urobilinogen

296
Q

biliary atresia

A

infant w/ extrahepatic bile duct obstruction
inc ALP, inc GGT
Sx: dark urine, pale stools, itchy skin

297
Q

Hemolytic Jaundice (pre-hepatic jaundice)

A

inc uncong bili
achloruia (no urine bili)
inc urine urobilinogen

298
Q

physiologic neonatal jaundice

A

immature UGT = inc unconjugated bili

causing jaundice and kernicterus

299
Q

Gilbert’s Syndrome

A

AR
mild dec UGT = dec bilirubin uptake
inc uncong bili in stress & fasting (otherwise asx)

300
Q

Crigler-Najjar (Type I)

A

AR
Absent UGT (no conjugation)
inc uncong bili = +jaudice & kernicterus
Tx- plasmaphersis & phototherapy, die in a few yrs (NO response to enzyme boosters)

301
Q

Crigler-Najjar (Type II)

A

AR
absent UGT
inc uncong bili = +jaundice & kernicterus
LESS SEVERE THAN TYPE I
*responds to liver enzyme boozers = Phenobartital

302
Q

Dubin-Johnson Syndrome

A

defective liver excretion of bili
inc cong bili
grossly black liver, benign

303
Q

Rotor’s syndrome

A

defective liver excretion of bili
inc cong bili
NO black liver, milder sx than DJS

304
Q

Hepatic encephalopathy

A

caused by alcoholism and GI bleed = inc ammonia & nitrogen gut absorption
cannot metabolize waste and detox ammonia into urea
Sx- hypovolemia, hypokalemia, metab acidosis, hypoxia, hypoglycemia, asterixis, abd distention, gynecomastia, confusion
tx- lactulose (disacchardies promote N+ excretion as NH4+) & causese acidification of colonic contents trapping ammonia so it may not be absorbed

305
Q

Wilson’s dz cause

A

AR- Ch 13 mutation in Cu-transport ATPase (ATP7B)
Copper accumulation
(inadequate Cu excretion & failure to enter circulation as ceruloplasmin)

306
Q

Wilson’s Dz Sx

A

Ceruloplasmin 250 Cu dry wt on liver bx)
HCC
Hemolytic anemia
Basal ganglia degeneration = parkinsonian Sx:
Asterixis, Ataxia, Dementia, Dyskinesia, Dysarthria

307
Q

Treat Wilson’s dz

A

penicillamine

chelates Cu

308
Q

Hemochromatosis dz

A

deposition of hemosiderin
primary (AR)= C282Y or H63D mutation on HFE gene
secondary = chronic transfusions (ex: B-thal)
A/W: HLA-A3

309
Q

Hemachromatosis Sx

A

TRIAD:
Cirrhosis (micronodular + hepatomegaly)
DM
Bronze skin pigmentation

  • Complications = CHF, testicular atrophy, inc risk HCC
  • stain hemosiderin w/ Prussian blue
310
Q

Labs in Hemochromatosis

A

inc ferritin, inc Fe
dec TIBC
inc transferrin saturation (>50%)

311
Q

Tx hemochromatosis

A

phlebotomy
deferasirox
deferoxamine

312
Q

Biliary Tract disease Labs

A

inc cong bili
inc ALP
inc cholesterol

313
Q

Biliary tract disease SX

A 
pruritis
jaundice
dark urine
light stools (acholic)
hepatosplenomegaly
314
Q

Primary biliary cirrhosis

A 
autoimmune rxn = cytotoxic T cells destroy bile duct
\+ lymphocytic infiltrate 
\+ granulomas
INC AMA/ ANA (and IgM)
A/w other AI dz (middle-aged Female)
315
Q

Secondary biliary cirrhosis

A

extrahepatic biliary obstruction (ie: gallstone, stricture, chronic panc, CA of panc head)
increased pressure in intrahepativ ducts d/t obstruction = injury, fibrosis & stasis
comp = ascending cholangitis

316
Q

Primary sclerosing cholangitis

A

onion skin bile duct fibrosis (concentric)
alternating strictures & dilation w/ beading on intra & extra hepatic bile ducts on ERCP
unknown cause
inc IgM
A/w: ulcerative colitis, inc risk cholangioCA, may lead to SBC

317
Q

Charcot’s triad of cholangitis

A

Jaundice
Fever
RUQ pain

318
Q

Cholelithiasis

A 
\+ Murphys
Dx- HIDA scan (radionuclide biliary scan)
\+ failed gallbladder visualization
\+/- US
inc ALP
Tx- cholecystectomy
319
Q

Cholesterol Cholelithiasis

A

radiolucent, +/- Caclification to make opaque
yellow in color
A/W: obesity, Crohn’s, CF, inc age, clofibrate, estrogen, multipartity, rapid wt loss, native american
Comp: gallstone ileus (air in biliary tree bc ileocecal valve ostruction), fista btw GB & SI (air in biliary tree), cholecystitis & biliary colic, ascending cholangitis (parasite, gram neg bact), bile stasis.

320
Q

Pigment Cholelithiasis

A

Radiopaque
Black– chronic hemolysis, spiculated
Brown– infxn, irregular shape
A/W: alcoholic cirrhosis, biliary infxn, hemolysis, inc age

321
Q

Acute Pancreatitis Sx

A

epigastric pain stabbing and radiating to back
anorexia
nausea
rigid guarding

322
Q

Complications of Acute Pancreatitis

A

DIC, ARDS, diffuse fat necrosis, hypocalcemia (collects in soap deposits), pancreatic pseudocyst (granulation tissue), hemorrhage, infxn, multiorgan failure.

323
Q

causes of acute pancreatitis

A 
gallstones
ethanol
trauma
steroids
mumps
autoimmune dz
scoprion sting
hyperCa & triglycerides
ERCP
Drugs-- esp sulfa Rx.
idiopathic
324
Q

Chronic panc

A

Ca of pancreas on CXR
less elevated lipase & amylase than acute
pancreatic insufficiency– steatorrhea, fat sol vit def, DM
inc risk CA

325
Q

Pancreatic CA markers

A

CA-19-9

CEA (less specific)

326
Q

Pancreatic CA RF’s

A

tobacco (NOT ETOH)
chronic pancreatitis
age >50 yo
jewish & AAM

327
Q

SX of pancreatic CA

A 
abd pain radiating to back
wt loss (malabsorptive & anorexia)
migratory thrombophlebitis
Obstructive jaundice (inc cong bili)
\+Courvoisier's sign = palpable, NONtender GB
328
Q

Trousseau’s Syndrome

A

Migratory thrombophlebitis
redness & tenderness on palpation of extremities
due to hypercoagulable state
think: Cancer

329
Q 
p450 inducers
(inc liver enzyme metabolism = dec drugs using p450 action)
A 
Modafinil
Barbiturates
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
Chronic alcohol use

*Momma Barb Steals Phen-phen and Refuses Greasy Carbs Chronically

330
Q 
p450 inhibitors
(inhibit liver enzymes = increase drug concententration if using p450)
A 
Macrolides
Amiodarine
Grapefruit juice
Isoniazid
Cimetidine
Ritonavir
Acute Alcohol abuse
Ciprofloxacin
Ketoconazole
Sulfonamides
Gemfibrozil
Quinine

*MAGIC RACKS in GQ

331
Q

Sulfa Drugs

A 
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfonamide ABX
Sulfasalazine
Sulfonylureas

*Popular FACTSSS
(think sulfa allergy– fever, UTI, pruritic rash, SJS, hemolytic anemia, TCP, agranulocytosis, urticaria. range of sx)

332
Q

VIPoma

A
  • islet cell pancreatic tumor that secretes VIP (vasoactive intestinal polypeptide).
  • VIP = water, electrolyte secretion, relaxation of sm muscle & sphincters
  • SX = WDHA SYNDROME
  • copious Watery Diarrhea
  • Hypokalemia
  • Achlorhydria
333
Q

Bile Salt make up

A

bile acids
conjugated to: glycine or taurine
making them water soluble

334
Q

Bile acid fxn

A

1) digest lipid & ADEK
2) only way to elim cholesterol (excrete)
3) antimicrobial (outer membrane disruption)

335
Q

Gonococcal arthritis

A

asymmetrical migratory arthritis
red painful & swollen
+STD = synovitis, tenovitis, dermatitis
*NO EYE SX

336
Q

Labs in osteoporosis

A

Normal
dec bone mass/ trabecular bone
inc resorption

337
Q

Labs in osteopetrosis

A

inc ALP & dec Ca

  • thick dense bone
  • no clasts (no CA-II)
338
Q

Labs in osteomalacia

A

inc ALP, PTH
dec Ca, PO4, Vit D
-soft bones– mineralization defect/ calcification of osteoid defect

339
Q

labs in osteitis fibrosa cystica

A

inc ALP, PTH, Ca
dec PO4
*primary hyperparathyroidism
*brown tumors

340
Q

labs in paget’s dz of bone

A

inc ALP only

  • mosaic woven bone architecture
  • inc clasts & blasts
341
Q

XRay sign on osteonecrosis

A

crescent sign
due to subcondral collapse
avascular necrosis of bone & marrow

342
Q

XR giant cell tumor of bone

A

soap bubble

  • spindle cells with MN-giant cells
  • epiphysis
343
Q

XR osteochondroma

A

cartilage cap on exophytic bone

*metaphysis

344
Q

XR osteosarcoma

A

codman’s triangle (periosteal elevation)
sunburst pattern (soft tissue ossification)
mixed lysis & sclerosis w/ reactive new bone formation (mixed radio lucent & radio dense)
*metaphysis

345
Q

XR Ewings

A

onion skin bone
lytic pseudorosettes
small blue cell tumor at diaphysis
t (11;22) EWS gene

346
Q

Chondrosarcoma XA

A

expansile glistening mass– intramedullary

older men

347
Q

anklyosing spondylitis

A

ankylosis/ bamboo spine
uveitis
aortic regurg

348
Q

reiter’s/ reactive arthritis

A

conjunctivitis, anterior uveitis
urethritis
arthritis

349
Q

psoriatic arthritis

A

asymmetric, patchy + psoriasis
dactylitis
pencil in a cup

350
Q

sarcoidosis

A

non-caseating granulomas
elevated serum ACE
black females
CXR– B/L hilar adenopathy & reticular opacities
A/W– restrictive LD, erythema nodosum, bell’s palsy, epithelial granulomas, Schauman & asteroid bodies, uveitis, hypercalcemia– d/t 1-alpha-hydroxylase activation of epithelioid macrophages)

351
Q

polymyalgia rheumatica

A

NO muscle weakness
arthritis sx
fever, malaise, wt loss

  • only inc ESR
  • tx- low dose CS
352
Q

erythema multiforme

A

infxn (m. pneumo & HSV), drugs (sulfa, beta-lactams, phenytoin), cancer, AI dz

  • target lesions (dusky center = epi disruption)
  • multiple lesion types– macules, papules, vesicles, etc.
353
Q

erythema nodosum

A

inflamm lesions of subQ fat on ANT SHINS
A/W:
sarcoidosis, coccidiomycosis, histoplasmosis, TB, strep infxn, leprosy, Crohn’s

354
Q

actinic keratosis

A

rough sand-paper like
small red, brown papule/ plaque
*scraped off lesion– grew back
premalignant d/t sun exposure

355
Q

seborrheic keratosis

A 
flat, graesy pigmented squamous epi prolif.
horn cysts = keratin-filled
looks stuck-on
head, trunk neck, ext
benign

*Leser-Trelat = multiple & sudden = CA

356
Q

lichen planus

A

pruritic, purple, polygonal planar papules and plaques
sawtooth lymphocyte infiltrate at DEJ
+ wickhams striae
*A/W: hep C

357
Q

lichen sclerosis

A

vaginal pain, pruritis, dyspareunia, dysuria
*atrophic thinned skin w/ cutaneous white macules & patches.
tx– cs *NOT azoles

358
Q

pityriasis rosea

A

herald patch 1st
christmas tree distribution w/ collarette scale
spont remission 6-8 wks

359
Q

scalded skin syndrome

A

staph exotoxin– destroys keratinocyte attachments at STRATUM GRANULOSUM ONLY
+ fever & red rash in new borns

360
Q

hairy leukoplakia

A

white, painless plaques– CANNOT BE SCRAPED OFF (tongue)

  • EBV mediated
  • HIV positive
361
Q

BCC skin

A

pink, pearly nodules w/ telangiectasias
upper lip, face
palisading nuclei
MCC skin CA (d/t sun), locally invasive- no mets

362
Q

SCC skin

A

face, lower lip, sun exposure
local invasion & lymph spread
ulcerative red lesions w/ scale & keratin pearls on histo
+chronic draining sinus

363
Q

keratoacanthoma

A

rapid growth (month) variant of SCC

364
Q

melanoma markers

A

S-100
BRAF kinase mutation common
if BRAF v600E mutation– tx with vemurafenib (BRAF kinase inhibitor)

365
Q

neural tube defect labs

A

inc AFP & inc AChE (confirmatory)

366
Q

anencephaly

A
  • malf Ant neural tube
  • no forebrain, open calvarium = frog like
  • polyhdramnios
  • a/w maternal DM-1, low folate
367
Q

holoprosencephaly

A
  • L & R hemisphere failed separation
  • sonic hedgehog mutations
    • cleft lip/palate with cyclopia
  • a/w patau’s syndrome
368
Q

Arnold-Chiari

A
  • cerebellar tonsillar & vermian herniation
  • small posterior fossa/ foramen magnum
  • aqueductal stenosis & hydrocephalus
  • a/w T-L meningomyelocele + paralysis below, syringomyelia
369
Q

Dandy-Walker

A
  • agenesis of cerebellar vermis
  • cystic enlargement of 4th ventricle
  • fills enlarged post fossa
  • a/w hydrocephalus and spina bifida
370
Q

syringomyelia

A

spinothalamic tract 1st damaged

  • cape distribution
  • B/L loss pain & temp in UE
  • hand muscle atrophy
  • MC at C8-T1
  • cystic enlargement of central canal of SC
371
Q

Oligodendroglia vs Schwann

A

1) Oligo = CNS
- myelinates multiple CNS axons (50)
- neuroectoderm origin
- destroyed = MS (fried egg)
2) Schwann = PNS
- myelinates ONE PNS axon
- neural crest origin
- destroyed = GBS (+endoneurial inflamm infiltrate)

372
Q

NT CHANGES

A 
NE = from locus ceruleus in pons = inc anx, dec depression
DOPA = from VTA and SNc in midbrain = inc schizo, dec parkinsons, dec depression
5-HT = from raphe nuc in pons = dec anx & depression
ACh = from basal nuc of Maynert = dec Alz, dec Huntington's, inc REM
GABA = from nucleus accumbens = inc anx, dec Huntington's
373
Q

lesion lateral hypothalamus

A

anorexia
(shrink laterally)

*normally + hunger, inhibited by leptin

374
Q

lesion ventromedial area

A

hyperphagia (craniopharyngioma)
(grown ventral & medial)

*normally +satiety, stim by leptin

375
Q

Ant hypothalamus fxn

A

A/C =
pArasympathetic & Cooling

(post hypothalaums = heating and SNS)

376
Q

lesion lateral cerebellum

A

fall towards lesion (ipsilateral)

  • lateral = extremities
  • medial = truncal coordination
377
Q

Parkinson’s

A

*Lewy bodies (alpha-synculein intracellular inclusion– ubi neurofilament)
*Dec DOPA
*BX = depigmented substaintia nigra (PC)
Sx = TRAP:
-Tremor (resting/ pill rolling)
-Rigidity (cogwheel)
-Akinesia (bradykinesia)
-Postural instability

378
Q

Huntingtons

A
  • dec Ach & GABA
  • d/t NMDA-R binding and glutamate toxicity
  • BX = striatal atrophy of caudate
  • SX = chorea, athetosis, aggression, depression, dementia, suicide
379
Q

Central Pontine Myelinosis

A
  • d/t = overly rapid correction of hyponatremia (iatrogenic)
  • Sx = acute paralysis, dysarthria, dysphagia, diplopia, LOC, locked-in syndrome
  • massive pons demyelination of white matter tracts
380
Q

medial medullary syndrome

A

infarct of paramedian branches of ASA & vertebral arteries (B/L stroke common)
*contralateral hemiparesis & spastic paralysis LE (lateral corticospinal tract)
*dec contralateral proprioception (medial lemniscus)
*ipsilateral hypoglossal d/f = lick the lesion
(caudal medulla– CN 12)

381
Q

lateral medullary syndrome

Wallenberg’s syndrome

A

PICA leaion with nucleus ambiguus (MOTOR OF CN IX & X) effects
*SX = dysphagia & hoarseness, and dec gag reflex (NA)
also– vomit, vertigo, nystagmus, dec pain & temp to face, ipsilat horners, ataxia, dysmetria
*ipsilat loss of facial pain & temp
*contral loss of body pain & temp
(spinothalamc tract)

-affected = lateral medulla (vestibular nuceli, lateral spinothalamic tract, spinal trigem nucleus, nucleus ambiguus, sympathetic fibers, inf cerebellar peduncle

382
Q

Lateral pontine syndrome

A

*AICA lesion
*facial nucleus specific
*sx = facial paralysis/ droop, dec lacrimation & salivation, dec taste at ant 2/3 tongue, dec corneal reflex, ipsilat dec hearing.
also– dec pain & temp of face, ipsilat horner’s, ataxia, dysmetria

-affected = facial nucleus, cochlear nuclei, cranial nerve nuclei, vestibular nucli, spinal trigem nuc & SNS fibers, middle/inf cerebellar peduncles

383
Q

ACA stroke

A

contralateral paralysis & loss of sensation in LOWER LIMB

384
Q

MCA stroke

A

contralateral paralysis & loss of sensationin UPPER LIMB & FACE
APHASIA– if dominant hemisphere (wernicke/broca)
HEMINEGLECT– if nondominant hemisphere

385
Q

Lat striate artery stroke

A

ant circulation lesion of striatum & internal capsule

  • contralat hemiparesis/ hemiplegia
  • commonly secondary to unmanaged HTN
386
Q

PCA stroke

A

contralateral hemianopsia w/ macular spaing

*occipital & visual cortex assoc.

387
Q

AComm & PComm strokes

A

ACOMM– visual field defects d/t berry aneurysm (MC LOCATION)
PCOMM– CN3 palsy (down & out) w/ ptosis & pupil dilation d/t berry aneurysm

388
Q

Charcot-Bouchard microaneurysm

A

a/w chronic HTN
affects small vessels— basal ganglia & internal capsule & thalamus
may cause intraparenchymal hemorrhage.

389
Q

Epidural vs. Subdural

A 
Epi = Fast, arterial bleed. Biconvex shape, does not cross suture lines- no midline shift. may cross falx/tentorium
Subdural = slow,  venous bleed. crescent shape, does cross suture lines-- midline shift. cannot cross falx/tentorium
390
Q

xanthochromic/ bloody spinal tap

A

subarachnoid hemorrhage
(berry aneurysm rupture w/ WHOML)
-blood in cisterns on CT & serpentine filling (follows brain contours)

391
Q

most vulnerable to ischemia in brain?

A

watershed areas
hippocampus
cerebellum
neocortex

392
Q

ischemic brain disease progression of histo

A 
red neurons (12-48 hr)
necrosis + neutrophils (24-72)
macrophages (day 3-5)
reactive gliosis + vascular prolif (1-2 wks)
glial scar (>2 wk)
393
Q

bright area on noncontrast CT

A

hemorrhage

*tPA contraindicated (tPA okay if no risk hemorrhage and within 3 hrs onset sx)

394
Q

Communicating hydrocephalus

A

nonobstructive
dec CSF absorption by arachnoid granulations
Inc ICP, papilledema, herniation
(commonly post-meningitis/infxn)

395
Q

Noncommunicating hydrocephalus

A

obstructive
structural blockage of CSF circulation within ventricular system
(stenosis of aqueduct of sylvius, A-C malformation, DW malformation, AVM, abscess, neoplasm)

396
Q

Normal pressure hydrocephalus

A

inc subarachnoid space volume without inc in CSF pressure

  • expanded ventricles distorts fibers of corona radiatia
  • WET, WOBBLY, WACKY = urinary incontinence, ataxia, cognitive dysfunction
  • reversible dementia in elderly bc brain atrophy
397
Q

hydrocephalus ex vacuo

A

apparent inc CSF to fill atrophied spaces, enlarged lateral ventricles.

  • Alzheimer’s, advanced HIV, picks
  • normal ICP, no triad
398
Q

Poliomyelitis & Werdnig-Hoffman SC lesion

A
  • LMN Lesion only = only LMN signs
  • ant horn lesion
  • flaccid paralysis
  • Polio = infxn + CSF inc WBC, slight inc protein
  • WHD congenital degen = floppy baby w/ hypotonia, tongue fasciculations
399
Q

Multiple Sclerosis SC lesion

A
  • random asymmetric white matter demyelination in cervical region
  • scanning speech, intention tremor, nystagmus
400
Q

ALS SC lesion

A

*UMN + LMN defects & signs
*lesion = ant horn, corticospinal tract
*no sensory, cognitive or oculomotor defects
*combo UMN & LMN signs
*fasciculations with atrophy
+/- superoxide dismutase 1
+/- bunina bodies (PAS+)
tx= riluzole (dec presynaptic glutamate release)

401
Q

ASA complete occlusion SC lesion

A
  • spared dorsal columns (PSA)

* upper thoracic = watershed

402
Q

Tabes Dorsalis SC lesion

A
  • dorsal columns & roots
  • demyelination causing impaired sensation, proprioception, vibration, sensory ataxia, no DTR, + Romberg
    • lightning pain, AR pupil, Charcot joint, +VDRL
403
Q

Syringomyelia SC lesion

A
  • anterior white commissure initially involved (spinothalamic tract affected = b/l loss of pain & temp sensation) in shawl distribution
  • MC C8-T1
  • a/w chiari malformation
404
Q

Vit B12 or E deficency

A

subacute combined degeneration:

1) dorsal columns (demyelinated = loss of proprioception & vibration & B/L paresthesia)
2) lateral corticospinal tracts (motor)
3) spinocerebellar tracts (ataxic gait)

  • +babinski, band-like sensation around joints
  • no effect on spinothalamic or peripheral nerves
405
Q

Friedrich’s ataxia

A
  • dorsal column
  • spinocerebellar degen
  • ataxia, falls, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic CM, chilhood kyphoscoliosis
  • AR trinuc repeat of GAA = frataxin (impaired mito fxn) = +FHx
406
Q

Brown Sequared Syndrome

A

hemisection of SC:

1) corticospinal tract damage (IPSI UMN signs- below lesion)
2) dorsal column damage (IPSI loss vibration, proprioception- below level)
3) spinothalamic tract damage (CONTRA loss pain & temp- below lesion)
4) Sensation– IPSI loss- at level
5) flaccid paralysis = IPSI LMN signs- at level

*if above T1 = + horner’s

407
Q

Parinaud syndrome

A

paralysis of conjugate vertical gaze = upward gaze

  • superior colliculi (pinealoma)
  • accomodates but no light reflex

*pinealoma may also cause precocious puberty and obstructive hydrocephalus d/t aqueductal compression)

408
Q

CN Pathways– cribiform plate

A

CN 1

ethmoid bone

409
Q

CN Pathways– sphenoid bone

A

1) optic canal– CN 2, ophthalmic artery, central retinal vein
2) SOF– CN 3, 4, 5-1, (ophthalmic br), 6, ophthalmic vein, SNS fibers
3) foramen rotundum– CN 5-2 (maxillary br)
4) foramen ovale– CN 5-3 (mandibular br)
5) foramen spinosum– MMA

410
Q

CN Pathways– temporal/occipital bone

A

1) int auditory meatus– CN 7, 8
2) jugular foramen– CN 9, 10, 11, jugular vein
3) hypoglossal canal– CN 12
4) foramen magnum– CN 11 spinal roots, brain stem, vertebral arteries

411
Q

cavernous sinus syndrome

A 
d/t = mass effect, fistula, thrombosis
sx = ophthalmoplegia, dec corneal & maxillary sensation w/ normal vision

*travel thru cavernous sinus = CN 3, 4, 5 (branches 1 & 2 only), 6 and post-gang SNS fibers

412
Q

cavernous sinus syndrome

A 
d/t = mass effect, fistula, thrombosis
sx = ophthalmoplegia, dec corneal & maxillary sensation w/ normal vision

*travel thru cavernous sinus = CN 3, 4, 5 (branches 1 & 2 only), 6 and post-gang SNS fibers

413
Q

CN V motor lesion

A

jaw deviated TOWARDS lesion
(unopposed pterygoid mm)

*JAW JAGS TOWARDS

414
Q

CN X lesion

A

uvula deviates AWAY from lesion
(weak side collapses)

*UVULA = UWAY

415
Q

CN XII lesion (LMN)

A

tongue deviates TOWARDS

lick the lesion

416
Q

CN XII lesion (LMN)

A

tongue deviates TOWARDS

lick the lesion

417
Q

Markers associated with early onset Alzheimer’s

A

APP
Presenilin-1
Presenilin-2

418
Q

Markers for late onset Alzheimer’s

A

APOE4

419
Q

Protective markers against Alzheimer’s

A

APOE2

420
Q

Senile plaques

A

Extracellular beta-amyloid core

Synthesized by Amyloid precursor protein (APP)

421
Q

Neurofibrillary tangles

A

Intercellular abnormally phosphorylated tau protein
Insoluble cytoskeleton elements
(Ubiquitin tagged)
+ in Alzheimer’s and picks dz

422
Q

Pick bodies

A

Spherical tau protein aggregates

+silver stain

423
Q

Picks dz

A

Frontotemporal
Spares parietal lobe
Sx= dementia, aphasia, Parkinson’s sx, personality Changes**

424
Q

Lewy body dementia

A

Parkinsonism with dementia and visual hallucinations

+ alpha-synuclein defect

425
Q

CJD

A

Rapid progression dementia with startle myoclonus
Spongiform cortex
PrSC beta pleated sheets resistant to proteases

426
Q

Findings in MS

A

Inc IgG in CSF
Oligoclonal bands
MRI- peri ventricular plaques
(Lose oligodendrocytes + reactive gliosis and axon destruction)

427
Q

CSF in GBS

A

Inc protein but No inc WBC or flu
* albuminocytologic dissociation

(Inc ICP & papilledema)

428
Q

GBS attacks?

A

Schwann cells– acute peripheral demyelination
Symmetric and ascending

*previous campylobacter or CMV infxn

429
Q

Tuberous sclerosis

A 
HAMARTOMAS:
H- hamartomas (skin and cns)
A- adenoma sebaceum (cutaneous angiofibromas)
M- mitral regurge
A- ash leaf spots (hypopigmented)
R- rhabdomyoma (cardiac)
T- tuberous sclerosis
O- dOminant (AD)- CH. 16
M- mental retardation
A- angiomyolipoma (renal)
S- seizures
430
Q

UMN facial lesion

A

CONTRA paralysis of LOWER FACE only

lesion in motor cortex or corticobulbar tract

431
Q

LMN facial lesion

A

IPSILAT paralysis of UPPER & LOWER FACE

432
Q

Facial nerve palsy

A 
LMN LESION (ipsilateral upper & lower face paralysis)
inability to close eye on affected side
d/t facial nucleus destruction or efferents
433
Q

Causes of facial nerve palsy

A 
AIDS
Lyme Dz
HSV & VZV
Sarcoidosis
Tumors
DM
  • ALexander graHam BELL has STD”
  • Bell’s palsy if idiopathic
434
Q

CN III lesion

A

look: down & out
ptosis
pupil dilation
loss of accommodation

435
Q

CN IV lesion

A

look: upward (cannot look down)– sup oblique
contralat gaze & head tilt

*SO = abduct, intort, depress while adducted

436
Q

CN VI lesion

A

look: medially & cannot abduct (Lat rectus)

up & in

437
Q

Focal Segmental Glomerulosclerosis

A 
nephrotic
segmental sclerosis & hyalinosis
foot process effacement
focal IF = IgM & C3
MCC nephrotic
HIV*, IVDA, CKD
438
Q

Nephrotic syndrome

A 
> 3.5 g/day proteinuria
frothy urine
fatty casts (maltese cross + polarization)
hyperlipidemia
inc TE (AT III loss = hypercoag state)
inc infxn (IG loss)
hypoalbuminemia
protein malnut
439
Q

Membranous nephropathy

A 
nephrotic
diffuse uniform capillary & GBM thickening
spike & dome subepi deposits
granular IF = IgG & C3 (IC)
*SLE nephrotic
440
Q

Minimal change dz

A 
nephrotic
normal glom on LM & IF
foot process effacement
selective albumin loss (no Ig in urine)
*recent infxn in kid w/ periorbital edema 
(Tx = CS)
441
Q

Amyloidosis

A

nephrotic
apple-green birefrigement w/ pol light on congo stain
eosinophilic amorphous deposits at mesangium & interstitium (fibrillar)
*chronic dz = MM, TB, RA

442
Q

MPGN (membrano-proliferative)

A 
nephrotic
TYPE I--
subendo IC deposits- IgG & C3 (lobular)
mesangial prolif & matrix thickening
GBM splitting = tram track
*Hep B & C

TYPE II–
intramembranous IC deposits (C3)
dense deposits
*C3 nephritic factor (autoAB to C3 convertase)

443
Q

Diabetic Glomeruloneuropathy

A 
nephrotic
mesangial expansion (NEG efferent arterioles = inc GFR) & GBM thickening (NEG GBM = inc permeability)
*Kimmelstiel-wilson lesion = round nodular eosinophilic glomerulosclerosis
444
Q

Nephritic syndrome

A 
inflammatory
hematuria
RBC casts
azotemia
oliguria
HTN (Na retention)
proteinuria < 3.5/day
445
Q

APSGN

A

nephritic
post-strep infxn (pyogenes)- kids (periorbital edema, HTN, dark urine)
type III HSR
enlarged glom & hypercellular neutrphils
lumpy bumpy
subepi IC humps (IgG, IgM, C3)
IF- granular (IC deposits @ GBM & mesang)

446
Q

RPGN (rapid progressive)

A

nephritic
crescentic
laminated fibrin and plasma proteins + parietal cells, monocytes, macrophages
TYPES–
1) Goodpastures– Type II HSR, anti-GBM Abs and anti-alveoliar BM. linear IF (IgG + C3) (+hematuria & hemoptysis)
2) Wegeners (granulomatosis w/ polyangitis) = c-ANCA, no IF, pauci-immune
3) Microscopic polyangiitis = p-ANCA, no IF, pauci-immune

447
Q

DPGN (diffuse proliferative)

A 
nephritic
wire-loop capillaries
subendo/ intramemb IgG and C3 IC depo
IF- granular
*SLE (MCC death) or MPGN
448
Q

Berger’s Disease

A 
nephritic
IgA nephropathy (FPGN)
mesangial prolif & IC deposits
IF- Ig-A IC mesangial deposits
*HSP assoc (+URI/GI)
449
Q

Alport’s Syndrome

A

nephritic (FPGN)
XLR- mutation in type IV collagen
split BM & basket-weave
*sensorineural deafness, cataracts/eye dz

450
Q

Kidney Stones & pH

A 
high pH (alk) = CaPO4 stones, AMP (struvite)
low pH (acid) = Ca-Oxalate, Uric Acid, Cystine

MC = Ca Oxalate –> hypercalcuria & normocalcemia, +ethylene glycol, vit C

*all radiopaque except uric acid

451
Q

Wilms tumor

A 
huge, non-tender palpable flank mass, +/- hematuria
WT1 on Ch. 11
WAGR/ Beck-wtih Wiedemann:
Wilms tumor
Aniridia
GU malf (gonadal dysgenesis)
MR
452
Q

ATN causes

A

ischemia (focal necrosis + Tamm-horsefall)
shock
burns
sepsis
crush injury
toxins drugs- MC at PCT (extensive necrosis)
-EXT toxins: aminoglycosides, ampho B, radio contrast dye, heavy metals
-INT toxins: BJ proteins, Mb, uric acid

453
Q

ATN Stages

A

1) inciting event = vasosconstriction
2) Maintenance = oliguric phase, risk inc K
3) Recovery/ Diuretic = polyuric, BUN & Cr fall, risk dec K

454
Q

renal papillary necrosis

A 
slough papillae (gross hematuria & proteinuria)
d/t: DM, phenacetin use, sickle cell, acute pyelo
455
Q

prerenal azotemia

A

dec RBF (hypotension) = dec GFR
Na/H2O retention to converse vol
high urine osmol (>500), low urine Na (20)
low FeNa (<1%)

456
Q

intrinsic renal failure

A

d/t ATN or ischemia/toxins
patchy necrosis = debris obstructs tubule
dec GFR
+ epithelial/granular casts
dec BUN:Cr (cannot reabsorb BUN) (40, FeNa > 2%

457
Q

Postrenal azotemia

A 
outflow obstruction (stone, BPH, CA, reflux) = ONLY IF BILATERAL
urine osmol 40, FeNa (>2% or 4%), serum BUN/CR >15
458
Q

Electrolyte changes in diuretics

A

Acetazolamide = dec HCO3, inc Cl, inc NH3, Metab Acidosis
Furosemide= dec Ca & K, inc uric acid, alk
Ethacrynic acid = inc uric acid
HCTZ = dec K & Na, inc Ca, uric acid, lipids, glu, Metab Alk
Spironolactone, etc = inc K, acidosis, dec aldo

459
Q

General electrolyte changes in diuretics

A
  • all inc urine NaCl (dec serum NaCl)
  • all inc urine K (except K-sparing)
  • Acidemia = CAIs, K-sparing
  • Alkalemia = loops & HCTZ
  • hypocalcemia = loops (inc urine Ca)
  • hypercalcemia = HCTZ (dec urine Ca)
460
Q

ACE-I vs. B-blocker

A

ACE-I: dec Ang II, dec Aldo, inc Ang I, inc renin, inc brady

BB: dec renin, Ang I, Ang II, Also, no change brady

461
Q

Mesodermal defects

A

VACTERL

  • Vertebral defects
  • Anal atresia
  • Cardiac defects
  • TE fistula
  • Renal defect
  • Limb defect
462
Q

Branchial system

A

CAP-
Clefts = eCtoderm
Arches = mesoderm & neural crest
Pouches = endoderm

463
Q

aortic arch derivatives

A

1st = maxillary artery (external carotid br)
2nd = stapedial artery (&hyoid artery)
3rd = Common Carotid (& prox int carotid)
4th = L–> aortic arch; R –> R subclavian (prox)
*NO 5th
6th = pulmonary arteries (R&L), ductus arteriosus (L)

464
Q

Branchial cleft derivatives

A 
1st = ext auditory meatus
2nd-4th = cervical sinuses (obliterated by 2nd arch mesenchyme)
465
Q

persistent cervical sinus

A

branchial cleft cyst in LATERAL neck

failure to obliterate 2nd cleft

466
Q

branchial arch derivatives

A

“at the golden arches, 1st chew, then smile, then stylish swallow, then simple swallow, then speak”
1st arch = Mastication mm, CN V2 & V3, Meckel’s cartilage, Maleus & incus
2nd arch = Smile (CN VII), stapedius, stylohyoid, post-digastric, stapes (Reichert’s cartilage)
3rd arch = sylopharengeus (CN IX), greater horn of hyoid
4th arch = CN X (sup laryngeal br) = swallow, cricothyroid, pharyngeal constrictors
6th arch = CN x (recurrent laryngeal br) = speak, intrinsic mm larynx except cricothryoid.

*ALL CNS both Motor & Sensory (except V2 = sensory only)

467
Q

Treacher-Collins Syndrome

A

1st arch neural crest fails to migrate

*mandibular hypoplasia, facial abns

468
Q

Congenital pharyngocutaneous fistula

A

persistence cleft & pouch = fistula at tonsils, cleft at lat neck

469
Q

Branchial Pouch derivatives

A

“Ear, Tonsils, bottom-to-top”
1st pouch = middle ear cavity, eustacian tube, mastoid air cells
2nd = palatine tonsil (epi lining)
3rd = inf parathyroids (dorsal), thymus (ventral)
4th = sup parathyroids (dorsal)

470
Q

mullerian duct abn

A

primary amenorrhea w/ normal secondary sex characteristics

  • failed female internal = fallopian tube, uterus, upper vagina
  • NORMAL ovary & lower vagina (urogenital sinus)
471
Q

mesonephros

A 
male internal except prostate
(SEED)
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens
472
Q

no sertoli cells (or no MIF)

A

both female & male internal genetalia

male external genetalia (+ T from leydig)

473
Q

5 alpha reductase deficiency

A

male internal genetalia

ambiguous external genetalia until puberty

474
Q

no TDF in XY

A

female int & ext genetalia

no sertoli or leydig cells

475
Q

defective T receptor

A

XY with female int & ext genetalia

inc T and LH

476
Q

what phase are eggs arrested in until ovulation?

A

prophase I of meiosis I

primary oocytes = 2N, 4C- diploid

477
Q

what phase are eggs arrested in until fertilization?

A

metaphase II of meiosis II
(secondary oocytes = 1N, 2C- haploid)

if no fertilization in 24 hrs = degeneration

478
Q

hormone changes in menopause

A

dec estrogen (estradiol)
major inc in FSH*, inc LH (but no surge)
inc GnRH
inc estrone (peripheral androgen conversion in adipose tissue)

*inc FSH is best test to confirm (estrogen loss causes loss of negative feedback)

479
Q

exogenous steroids/ testosterone- secreting tumor

A

inc T

dec LH

480
Q

primary hypogonadism

A

dec T

inc LH

481
Q

hypogonadotropic hypogonadism

A

dec T

dec LH

482
Q

Klinefelter’s

A

XXY male- 47 ch

  • inc FSH (low inhibin bc ST dysgenesis)
  • inc LH (low T bc abn leydig fxn)
  • inc estrogen (bc inc LH)

Sx– testicular atrophy (hypogonadism), eunuchoid body shape (no secondary sex chars), tall w/ long ext, gynecomastia, female hair distribution, dvt delay, infertility
*barr body present

483
Q

Turner Syndrome

A

XO- 45 ch
*ovarian failure = low estrogen = inc LH & FSH

Sx = short stature, streak ovary (ovarian dysgenesis), shield chest, cystic hygroma, lymphedema, horseshoe kidney, dysgerminoma, bicuspid aortic valve, preductal coarct of aorta

  • MCC primary amenorrhea
  • no barr body
484
Q

Double Y male

A

XYY

normal pheno, tall, severe ache, antisocial behavior, normal fertility

485
Q

female pseudohermaphroditism

A

XX
present ovaries, but virilized/ambiguous ext genetalia
*d/t excess androgenic steroids in gestation

486
Q

male pseudohermaphroditism

A

XY
present testes, but female/ambiguous external genetalia
*MC d/t androgen insensitivity syndrome (testicular feminization)
SX = breasts, low pubic/axillary hair, no wollfian or mullarian structures

487
Q

true hermaphrodite

A

both ovaries & testicles present

ambiguous genetalia

488
Q

androgen insensitivity syndrome

A

XY
defective androgen receptor = normal ext female
rudimentary vegina, no uterus, no fallopian tubes
testes in labia majora or inguinal hernia
scant sexual hair
*Inc T, Inc estrogen & LH

489
Q

Kallmann syndrome

A

defective GnRH migration and formation of olfactory bulb

  • low GnRH, low FSH, low LH, low T, los sperm ct
  • anosmia
  • no secondary sex characteristics
490
Q

polyhydramnios

A

> 1.5-2 L
*esophageal/ duodenal atresia
*anencephaly
(cannot swallow = lots of fluid)

491
Q

oligohydramnios

A

s sequence

492
Q

HPV 16 & 18 cell changes

A 
E6 = inhibits p53
E7 = inhibits RB
493
Q

PCOS Hormone changes

A

inc LH
dec FSH & progesterone
inc T & inc estrogen (estrone)

*hyperplastic theca cells (inc LH)
atrophied granulosa cells (dec FSH)

494
Q

dysgerminoma (ovarian)

A

hCG, LDH
sheets of uniform cells- malig germ cell tumor
a/w = turners

495
Q

choriocarcinoma- ovary & testicle

A 
malig trophoblastic tissue (NOT villi)
germ cell tumor
hematogenous lung spread
inc hCG
Female--  during/after preg (mom or baby)
inc theca-lutein cysts
Male-- gynecomastia (hCG = inc LH)
496
Q

endodermal sinus tumor/ yolk sac- ovary & testicle

A

AFP
malig yellow friable solid mass- germ cell tumor
schiller-duval bodies (glom-like)

497
Q

teratoma female & male

A

MC ovarian germ cell tumor
mature = dermoid cyst, benign, MC
immature= malig, aggressive
*struma ovarii- functional thyroid tissue (hyper-thryoid

male– mature is malig (unless child- benign)
inc hCG/ AFP 50% in males

498
Q

serous cystadenoma

A

epithelial tumor, benign, bilateral

fallopian-tube like epi

499
Q

serous cystadenocarcinoma

A

epithelial tumor, malig, bilateral

*pSamomma bodies

500
Q

mucinous cystadenoma

A

epithelial tumor, benign
multilocular cyst with mucus-secreting epi
intestine-like tissue

501
Q

mucinous cystadenocarcinoma

A

malig epithelial tumor

*pseudomyxoma peritonei (jelly belly) = peritoneal accumulation of mucinous material

502
Q

brenner tumor

A

Benign epi tumor, U/L
looks like Bladder
solid, pale tan, encapsulated
coffee-Bean nuc

503
Q

fibroma

A

bundles of spindle-shaped fibroblasts
*Meig’s syndrome= triad of ovarian fibroma, ascites, hydrothroax (pleural effusions)
pulling sensation in groin

504
Q

granulosa cell tumor

A

estrogen-secretion = precocious puberty (kids), endometrial hyperplasia (adults)
*Call-exner bodies– eosinophilic follicles
abn uterine bleed

505
Q

krukenberg tumor

A

GI malignancy that mets to ovaries

*mucin-secretion = signet cell adenoCA

506
Q

sertoli-leydig cell tumor

A 
androgen production (gynecomastia in men, precocious puberty in boys)
\+reinke crystals = leydig (golden brown)

*sertoli = tubules, androblastoma from sex cord stroma

507
Q

sarcoma botyoides

A

desmin positive– spindle shaped tumor cells

bunch of grapes

508
Q

fibroadenoma breast

A

small, mobile, firm, MC, benign

estrogen sensitive

509
Q

intraductal papilloma

A

in lactiferous duct, subareolar
*bloody discharge
slight inc CA risk

510
Q

phyllodes tumor

A

lg bulky mass of CT and cysts

*leaf-like projections (fibrous overgrowth)

511
Q

comedocarcinoma

A

ductal non-invasive CA (subtype of DCIS from ductal hyperplasia & no BM penetration)
*Caseous necrosis

512
Q

invasive ductal CA

A

firm, fibrous, rock hard, stellate

*MC, most invasive, worst

513
Q

invasive lobular CA

A

indian file orderly row of cells (+signet)

MC bilateral

514
Q

medullary invasive CA

A

lymphocytic infiltrate

fleshy, cellular, good prog

515
Q

inflammatory invasive CA

A

dermal lymph invasion- poor prognosis

*Peau d’orange

516
Q

paget’s disease

A

eczematous patches on nipple
lg cells in epidermis w/ clear halo
underlying DCIS (also in vulva)

517
Q

fibrocystic change

A

MCC breast lump, premenstrual and b/l

  • fibrosis (hyperplasia) + apocrine snout
  • cystic (blue dome & fluid filled)
  • sclerosing adenosis (Ca, inc acini, fibrosis)
  • epi hyperplasia (inc # cells, inc risk CA if atypical cells)
518
Q

mastitis

A 
staph aureus, tx = continued pump
suppurative inflammation (breast abscess)
519
Q

drugs causing gynecomastia

A

Some Drugs Create Awk Kockers:

  • Spironolactone
  • Digitalis
  • Cimetidine
  • Alcohol
  • Ketoconazole

*also– estrogen, heroin, marijuana, psychoactive rx

520
Q

lobes affected in BPH

A

lateral & middle (periurethral)

  • hyperPLASIA*
  • nodular
521
Q

lobes affected in prostate CA

A

posterior (peripheral zone)
*hard lump on DRE
(adenocarcinoma)

522
Q

hormone changes in cryptorchidism

A

dec inhibin
inc FSH & LH
(imparied sertoli cells/ spermatogenesis, normal testosterone & leydig)

*UNLESS B/L = low Testosterone

523
Q

varicocoele

A 
disappears when recumbent
MC Left side
bag of worms
dilated pampiniform plexus
infertility bc inc temp
524
Q

testicular seminoma

A

malig- painless, MC (15-35)
watery cyto with fried egg
inc PLAP
good prog, radiosensitive, late mets

525
Q

embryonal CA- testicular

A

malig, PAINFUL
mixed MC (inc hCG & AFP)
glandular & papillary morph
worse prog than seminoma

526
Q

testicular lymphoma

A

MC testicular CA in old men
from METS to testes– not primary
aggressive (DLBT)

527
Q

dec compliance lung dz

A

pulm fibrosis
pneumonia
pulm edema

528
Q

inc compliance lung dz

A

emphysema

normal aging

529
Q

what causes dec O2 sat & dec O2 content

A

methemoglobin

CO

530
Q

inc O2 content

A

polycythemia

531
Q

dec O2 content?

A

anemia (*normal O2 sat & PaO2)
hypoxemia
dec cardiac output
CO & CN poisoning

532
Q

what is diffusion limited?

A

emphysema (O2)
fibrosis (O2)– also inc A-a gradient
CO
(gas does no equilibrate)

533
Q

low PaO2?

A

normal A-a gradient = high altitude, hypoventilation

inc A-a gradient = V/Q mismatch, diffusion limitation, R-> L shunt

534
Q

obstructive lung disease lung volumes

A

major dec FEV1, dec FVC = dec FEV1/FVC ratio (<80%)*

  • inc RV, inc TLC and inc FRC
  • V/Q mismatch
535
Q

chronic bronchitis

A

mucus-secreting glad hypertrophy (>50% reid)
productive cough, cyanosis, late dyspnea
*dec O2, inc Co2
*polycythemia

536
Q

emphysema

A

enlarged air spaces d/t destruction of alveolar walls
inc elastase = inc compliance (lose elastic fibers = dec recoil)
*Dec DLCO (dec diffusion bc dec area)

537
Q

asthma

A

hyperresponsive bronchioles with smooth muscle hypertrophy
+Curshmann spirals (mucus)
+Charcot-Leyden crystals (eosinophils)
*inc DLCO

538
Q

bronchiectasis

A

chronic necrotizing infxn of bronchi = permanently dilated airways
+purulent sputum, recurrent infxn, hemoptysis
a/w: kartageners, CF, ABPA, smoking, obstruction

539
Q

cystic fibrosis

A

combo restrictive and obstructive lung dz

*dec FEV1/FVC, dec TLC, dec DLCO

540
Q

restrictive lung dz lung volumes

A

dec TLC, dec RV, slight dec FEV1, FEV1/FVC ratio >80%

  • if interstitial lung dz = dec diffusion (bc inc thickness & inc A-a gradient)
  • if poor breathing mechanics = extrapulm, normal A-a, peripheral hypoventilation)
541
Q

pneumoconioses

A 
anthracosis = upper lobe (coal miners)
silicosis = upper lobes (sandblast, macrophage response, egg-shell Ca of hilar LN)
asbestosis = lower lobe (ivory white calcified pleural plaques + ferruginous bodies)
542
Q

RDS (hyaline membrane dz)

A

xray = ground glass reticulogranular density
L:S ratio <1.5
low O2 tension (inc risk PDA)

543
Q

ARDS

A

diffuse endothelial damage = inc alveolar capillary permeability and protein-rich leakage into alveoli + hyaline membrane
*inc work, V/Q mismatch, dec compliance, inc cap permeability, N-PCWP
XR = b/l lung opacities (WHITE OUT)

544
Q

pleural effusion PE

A

dec breath sounds

dull percussion

545
Q

atelectasis

A

dec breath sounds
dull percussion
*trachea deviates TOWARDS lesion

546
Q

spontaneous pneumothorax

A

dec breath sounds
hyperresonant lungs
*trachea deviates TOWARDS lesion

547
Q

tension pneumothorax

A

dec breath sounds
hyperresonant lungs
*trachea deviates AWAY from lesion

548
Q

Consolidation (lobar pneumo & PE)

A

bronchial breath sounds & late inspiratory crackles
dull percussion
inc tactile fremitus

MEMORIZE ME (3 decks)

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