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Our PP Clues Flashcards

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1
Q

Test to detect point mutations within a gene?

A

PCR

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2
Q

Only anabolic steroid used in medicine?

A

Megestrol

(Uses and increase appetite in cancer patients)

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3
Q

What steroid takes place of aldosterone in adrenal insufficiency?

A

Fludrocortisone

MCC of adrenal insufficiency
- children: congenital adrenal hyperplasia, 21-hydroxylase deficiency
- adult: forgot to take steroids

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4
Q

Steroid DOC to induce surfactant

A

Dexamethasone
(Crosses membranes fastest)

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5
Q

Steroids for pediatrics

A

“B’s for babies”
Budesonide
Beclomethasone (incr surfactant)
Betamethasone (incr surfactant)

Dexamethasone is DOC for surfactant b/c it crosses membrane fastest

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6
Q

Best steroid to take the place of cortisol in adrenal insufficiency

A

Hydrocortisone
(Topical or injectable)

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7
Q

Main inhaled steroid

A

Triamcinolone

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8
Q

Actions of steroids

A

“IKISS”
I -> inhibit PLP-A (= cannot make arachidonic acid)
K -> kills T cells and eosinophils (= decr immune system)
I -> inhibit macrophage migration
S -> stabilizes mast cells
S -> stabilizes endothelium

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9
Q

Receptors of vessels
- Arteries
- Arterioles
- Veins

A

Arteries -> alpha-1 (IP3/DAG) -> vasoconstriction

Arterioles -> beta-2 (cAMP) -> Epi -> vasodilation & decr TPR

Veins -> alpha-1 (IP3/DAG) -> venoconstriction

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10
Q

Nervous controls of vessels and their resting state
- Veins
- Arteries

A

Veins -> parasympathetic -> usually dilated

Arteries -> sympathetic -> usually constricted

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11
Q

What vessel(s) respond to hypovolemia first?

A

Venoconstriction (veins) are 1st

Then vasoconstriction (arteries) to get volume back into circulation since veins hold 60% of blood

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12
Q

What is the underlying skin disease w/ warfarin-induced skin necrosis?

A

Protein C Deficiency

(Protein C = thrombolytic)
Therefore, less likely to break up clots

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13
Q

Anticoagulation meds timeline

1st clot, known cause
2nd clot, known cause
3rd clot, known cause
Unknown cause

A

3 months
1 year
Lifelong
Lifelong

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14
Q

What is the MCC of bleeding into tissues?

A

Hypertension

(Lots of diseases cause HTN but HTN is always the MCC)

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15
Q

What are the clues for left coronary infarct?

A

Sudden death
Congested heart failure (lost >40% or EF<45%)
Recurrent ventricular arrhythmias

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16
Q

What is the clue for right coronary infarct?

A

Heart Block

Slow HR with heavy chest pain
“Hippo on chest”

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17
Q

What is the 2nd messenger of anabolic processes?

Sympathetic or parasympathetic?

A

cGMP

Parasympathetic

Active when dephosphorylated

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18
Q

NSAID with morphine strength

A

Ketorolac

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19
Q

NSAID with GABA effect

A

Baclofen

(Uses = back spasm)

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20
Q

Most potent NSAID

A

Indomethacin

(Uses = gout, close PDA)

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21
Q

What is the only irreversible COX inhibitor?

A

Aspirin

Indications?
- anti-inflammatory
- analgesic
- anti-platelet
- anti-pyretic

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22
Q

Dx of macrophages w/ sugar

(Hint: globoid cells)

A

Krabbe’s

Enzyme deficiency:
- Beta-galactocerebrosidase or galactosyl-ceramidase
Inheritance:
- autosomal recessive
Presents how?
- low energy state
- CN II atrophy globoid cells

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23
Q

Disease due to alpha-galactosidase deficiency

A

Fabry’s

Inheritance:
- X-linked recessive
Presents how?
- low energy state
- cataracts
- early renal failure

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24
Q

Dx of macrophages that look like crinkled paper and Erlenmeyer flask legs

A

Gaucher disease
AR
Enzyme: glucocerebrosidase
Demographic: Ashkenazi Jews
Gargoyle features

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25
What transporter transports triglyceride to endothelium and liver? What are they made? Carries what triglycerides? What is the surface tag?
Chylomicrons In GI tract Short and long chain C2 (E1, E4 for liver)
26
What transporter transports triglycerides from adipose to everywhere else? What is the surface tag?
IDL ApoE
27
What transporter transports triglycerides to adipose tissue for storage? Where are they made? Carries what triglycerides? What is the surface tag?
VLDL In liver LCFA (90%), cholesterol B100
28
What are the symptoms of cinchonism? Drug causes?
Tinnitus, hearing/vision loss, psychosis, and cognitive impairment Quinidine, quinine, aspirin
29
Dx of red “currant jelly” sputum in patients w/ alcohol overuse or diabetes
Klebsiella pneumoniae => pneumonia
30
What is the only electrolyte that is at Nernst #?
Chloride
31
Dx of calf pseudohypertrophy
Muscular dystrophy Most commonly: Duchenne Due to X-linked recessive frameshift mutation
32
Dx of microcytic hyperchromic anemia
Hereditary spherocytosis
33
Amino acids required to make a purine ring Which AA is most important?
Glycine (Lord Farquad) -> most important Aspartate Glutamine
34
Amino Acids (N-bonds)
Asparagine Glutamine
35
What amino acids are associated with various substrates in Kreb’s cycle (6)?
Pyruvate -> Ala, Ser, Gly Acetyl CoA -> Lys, Leu, Phe, Ile, Thr, Trp Alpha-ketoglutarate -> glutamate, glutamine Succinyl CoA -> Phe, Trp, Tyr Fumarate -> Proline OAA -> Aspartate, asparagine
36
What infection attacks the temporal lobes of the brain?
Herpes simplex virus (Temporal lobe encephalitis is more common with HSV1 over HSV2.) (Viral meningitis is more common with HSV2.)
37
Where is Wernicke’s area of the brain? What enzymes does it need? What is the necessary cofactor?
Posterior temporal lobe Transketolase Thiamine (B1)
38
Top 3 bacteria for respiratory
1) S pneumo 2) H influenza 3) M catarrhalis
39
Drug that inhibits HMG-CoA reductase
Statins - decr cholesterol synthesis - decr intrahepatic cholesterol - incr LDL receptor recycling - incr LDL catabolism
40
“Pulseless disease” Granuloma in arch of aorta
Takayasu’s arteritis = Giant cell arteritis
41
When do macrophages and T cells arrive at the site of inflammation?
Show up at day 4 Peak at day 7
42
Describe characteristics of fat soluble compounds
Uncharged Small Base Vd high Long 1/2 life (> 12 hours) Eliminated via liver (Hepatitis, myositis, pancreatitis) (C/I in liver failure)
43
List all Live vaccines
“Pick MMR B/c it VaRYS” Polio (oral) Measles Mumps Rubella BCG Varicella Rotavirus Yellow fever Smallpox
44
Need to know isomer
Glucose <-> Fructose (Same chemical makeup but different structure)
45
Disorders associated with: HLA-B27
“PAIR” (All involve sacroiliac joint & uveitis) Psoriatic arthritis (silver oral plaques on extensor surfaces, sausage digits) Ankylosing spondylitis (middle age, chronic back pain, bamboo spine, pos schober test) Inflammatory bowel disease Rheumatoid arthritis
46
Specifics for IL-1
Fever Osteoclast activating factor
47
Specifics for IL-2
Stimulates T cells, NK cells
48
Specifics for IL-3
Stimulates bone marrow
49
Specifics for IL-4
Stimulates IgE production and IgG from B cells
50
Specifics for IL-5
Stimulates IgA production from B cells
51
Specifics for IL-6
Stimulates aKute phase reactants
52
General specifics for Interleukins
“Hot T-BONE stEAK” Made by macrophages -> IL-1 and IL-6 Secreted by T cells -> IL-2 and IL-3 Secreted by Th2 cells (and B cells) -> IL-4 and IL-5
53
Drugs that cause Hemolytic Anemia
Penicillins Cephalosporins Sulfa drugs Alpha-methyldopa PTU Antimalarials Dapsone
54
Name an enzyme that uses magnesium
Kinases
55
Amino Acid (Causing kinks & bends)
Proline
56
Dx of grey exudates/membranes
Diphtheria Signs => lymphadenopathy (Bull’s neck), myocarditis A - ADP ribosylation B - B prophage C - Corynebacterium D - Diphtheriae E - EF2 G - Granules
57
MOA of Hydroxyurea
Inhibits ribonucleotide reductase (Used in sickle cell patients to increase HbF levels)
58
Where is alpha-1,4-glucosidase found? If deficient?
Only in the heart Pompe’s -> heart failure shortly after birth
59
How would you silence DNA?
Methylation Deacetylation Add more G’s and C’s
60
What are the drugs that affect PGE? (Extra function)
PGE 1 - Misoprostal: treatment of ASA/NSAID-induced ulcers; abortifacent - Alprostadil: keeps PDA open PGE 2 - Dinoprostone: labor induction
61
Drugs that cause disulfiram-like reaction
Metronidazole (#1) Cefotetan Cefamandole Etoperidone Moxalactam Chlorpropamide
62
Dx for: Basophilic stippling Elevated FEP Heme synthesis is completely blocked
Lead poisoning (Lead inhibits delta-ALA dehydratase or ferrochetolase)
63
What are the anaerobic bacteria?
“Can’t Breathe Fresh Air” Clostridium Bacterioides Fusobacterium Actinomyces
64
The only protein completely modified in the rER
Collagen
65
3 MCC of Jarisch-Herxheimer Reaction
CMV EBV Syphilis
66
Most common gram pos bacteria with a capsule
Strep pneumo
67
High cell turnover, what vitamin should be added?
Folate (B9)
68
What nucleotide is most susceptible to UV damage?
Thymidine (Forms thymidine dimers)
69
DOC to lower triglycerides
Fibrates - fenofibrate - gemfibrozil
70
What are the essential fatty acids?
Linolenic acid Linoleic acid (Used to make arachidonic acid)
71
What cells make thromboxane? How long do they function?
Platelets 2 hours Vasoconstrict, promote platelet aggregation
72
MCC of retroperitoneal bleeding in pancreatitis (anatomy)
Splenic artery
73
Dx of early cataracts in child
Galactosemia Enzyme: galactose-1-phosphate uridyl transferase deficiency Results in: osmotic burst S&Sx: seizures, N/V following meals
74
Dx of microcephaly, high-pitched cry, and intellectual disability
Cri-du-chat syndrome
75
Amino acids (O-bonds)
Serine Threonine Tyrosine
76
Need to know epimer
Glucose <-> Galactose (Some chemical makeup and structure, but differ around one chiral carbon)
77
Humoral Immune System - Protects what? - Cell type? - Stimulates cell type? - Kills what?
- protects blood - B cells - neutrophils - kill bacteria
78
What are the lactose-fermenting bacteria?
“CEEK” Citrobacter Enterobacter E.coli Klebsiella
79
MOA: Probenacid
Promotes uric acid excretion
80
What are the cofactors of Pyruvate dehydrogenase?
“PLAN F” = “Tender Loving Care For Nancy” P: TPP - Decarboxylates L: Lipoic acid - Accepts C A: CoA - Accept from lipoic acid N: NAD - oxidizes FADH2 F: FAD - oxidizes lipoic acid
81
Retinal Detachment: - from top - from bottom
- homocystinuria (“looking down at a child”) - Marfan’s (“looking up at Mars”)
82
MOA: Colchicine
Blocks microtubules Interferes w/ cell division Interferes w/ inflammatory cell mobility
83
Dx of extra white teeth and bone
Fluoride poisoning MCC of death: heart failure
84
Dx of elevated PTT and elevated Bleeding Time
Von Willebrand Disease (Only one that effects intrinsic pathway and platelets)
85
Dx of white crystals in urine
Orotic aciduria (First ringed structure in pyramidine synthesis)
86
What amino acid increases during acidosis?
Alanine
87
List all encapsulated organisms - gram pos - gram neg
Gram pos - strep pneumo Gram neg - pseudomonas aeruginosa - H influenzae B - Neisseria meningitidis - E. coli - Salmonella - Klebsiella pneumoniae
88
What are the segmented viruses?
“BOAR” Bunya (3 segments) Orthomyxo (8 segments) Arena (2 segments) Reo (10-12 segments)
89
Drug causes of nephrogenic diabetic insipidus
Lithium Demeclocycline
90
Why are galactosuria and fructosuria milder form?
The alternative enzyme hexokinase is able to fill in
91
Most common collagen disease
Marfan’s - fibrillin defect - long wingspan - arachnodactyly - retinal detachment “fans out”
92
What is the main anapleurotic enzyme? (Can fill in any of the intermediates of the Kreb cycle)
Pyruvate carboxylase
93
What is the only X-linked dominant enzyme deficiency?
Pyruvate dehydrogenase
94
Markers for SLE One of the Markers’ 4 important effects
Markers: anti-dsDNA, anti-Smith, cardiolipid 1) Stimulates intrinsic clotting factors 2) causes false elevated VDRL 3) blocks vWF 4) multiple spontaneous abortions
95
DOC for gonorrhea
Ceftriaxone Doxycycline
96
Dx of vasculitis attacking medium-sized arteries recovering Hep B
Polyarteritis nodosa (PAN) Never attacks pulmonary vessels or other large vessels (Hint: by blood in stool or blood in urine)
97
What is Autonomic Dysfunction? Causes (most common)? - Overall? - Newborns? - Parkinsonism? - Elderly?
A dysfunction in CN IX and CN X to regulate HR and BP MCC (overall) - Diabetes Mellitus In Newborns: Riley-Day Syndrome In Parkinsonism: Shy-Dragger syndrome In Elderly: Sick sinus syndrome
98
Dx of IgA nephropathy after URI
Berger’s MC nephropathy 50% resolve 50% progress to renal failure
99
Dx of IgA in the kidney
Berger’s -> 2 weeks after URI Henoch-Schonlein Purpura -> 2 weeks after gastroenteritis Alport’s -> deafness, cataracts
100
Dx of most common cause of crescent formation in kidney
Goodpasture’s
101
Dx of vasculitis, involving sinus, lungs, and kidneys (Extra hint: saddle nose in adults)
Wegener’s = Granulomatosis with polyangiitis #2 cause of crescents in kidneys c-ANCA positive
102
Dx of vasculitis leading to renal failure after eating raw hamburgers
Hemolytic uremic syndrome - MCC renal failure in kids - E. coli infection - Endemic = EHEC - Epidemic = O157:H7
103
What direction should these parameters go in relation to each other? - venous return - CO - EDV - SV - CN IX - CN X - carotid sinus stretch - HR
Venous return, EDV, CO, SV, carotid sinus stretch, CNIX firing, and CNX firing ALWAYS go in the SAME direction. (All go up or all go down) HR always goes in the opposite direction
104
Congenital defect if spiral membrane: - never developed - rotated too far to the right - did not migrate all the way down
- Transposition of great arteries - tetralogy of Fallot - truncus arteriosus
105
Dx of atrialization of right ventricle
Epstein anomaly - large right atrium, causes tricuspid regurgitation - drug causes lithium and valproate
106
Dx of vasculitis involving lungs and kidneys w/o sinus involvement
Goodpasture’s - anti-glomerular basement membrane - type IV collagen - linear Immunofluorescence on EM
107
Carcinoid syndrome is emitting what neurotransmitter? Leads to what heart sound pathology?
Serotonin Tricuspid stenosis
108
Dx of pulmonary infiltrates w/ eosinophilia
PIE syndromes - Churg-Strauss (= sudden, severe asthma in young adult) - Aspergillosis (= sudden, severe asthma in adult; moldy hay or basement) - Loeffler’s syndrome (= due to parasites)
109
Dx of vasculitis with sudden severe asthma in young adult
Churg-Strauss Syndrome - p-ANCA positive - IgE w/ pulmonary infiltrates (PIE)
110
Aortic arches derivatives
1st: M structures -> maxillary artery 2nd: S structures -> stapedial artery 3rd: C is 3rd letter -> carotid artery (common & internal) 4th: on left -> aortic arch; on right -> subclavian 5th: adios 6th: pulmonary arteries and PDA
111
Trinucleotide repeats (4)
Huntington Disease (CAG; caudate has decr ACh and GABA) Myotonic Dystrophy (CTG; cataracts, toupee, gonadal atrophy) Fragile X Syndrome (CGG; chin (protruding), giant gonads) Friedrich Ataxia (GAA; ataxic GAAit)
112
Dx of nephrotic syndrome 2 weeks after sore throat
PSGN - subendothelial humps on histology (Also seen in SLE) - strain 12 (90%) - low complement
113
Dx of anhedonia or failure to function for 2 weeks
Major Depressive Disorder - Sleep disturbance - Interest loss - Guilt or feelings of worthlessness - Energy loss - Concentration difficulties - Appetite or weight gain/loss - Psychomotor agitation - Suicidal thoughts
114
Dx of collagen vascular diseases with low complement, 2 weeks after vaccination
Serum sickness (High incidence with MMR)
115
What antiarrhythmics block Na and Ca together? For what do we need to give it?
Quinidines Procainamide Phenytoin Wolff-Parkinson-White
116
Dx of subacute endocarditis Attacks what valve?
Strep viridans Attacks mitral valve => mitral regurgitation Signs: - mycotic aneurysm (brain) - Roth spots (retina) - splinter hemorrhages (nail beds) - Osler’s nodes (painful) - Janeway lesions (painless)
117
Dx with rash on palms and soles
TRiCKSSSSS - toxic shock syndrome - Rocky Mountain spotted fever i - Coxsackie A - Kawasaki disease - Strep pyogenes - scarlet fever - scalded skin syndrome - syphilis (secondary) - streptobacillus moniliformus (rat bite fever)
118
Dx of vasculitis with auto-amputation of digits and history of smoking
Buerger’s disease - necrotizing vasculitis - increased incidence in smokers and Jews - repeated intermittent claudication of medium vessels
119
Dx of vasculitis with high platelet count
Kawasaki disease Tx: Aspirin daily for 2 years minimum, flu shot yearly
120
Dx of only vasculitis with normal platelet count
Henoch-Schonlein Purpura (HSP)
121
Dx of IgA nephropathy after gastroenteritis
Henoch-Schonlein Purpura (HSP) - only vasculitis with normal platelet count - Purpura from buttocks down - high incidence of intussusception
122
Which factor does the most to regulate flow?
Radius
123
Dx of multiple AVMs in abdomen and brain
Von Hippel-Lindau - defect of VHL gene on short arm of chromosome 3 - high risk of renal cell carcinoma
124
Dx of multiple AVMs in lungs
Older-Weber-Rendu - continuous murmur - machinery - to-and-fro - multiple AVMs in lung - MCC of death is pulmonary hemorrhage
125
What is the diagnosis if A-V oxygen is almost zero?
A-V shunt - PDA (MCC in newborns) - ASD - VSD - AVM (death from massive hemorrhage)
126
List tissues and/or organs where blood flow resistance is in series
Liver (portal to hepatic vein) Kidney (afferent to efferent artery) Spleen (filtration) Lung (oxygenation) Placenta (nutrition)
127
What are the function of the spleen? (5)
Remove old RBCs Remove damaged cells Remove encapsulated organisms Remove nuclear material Secondary erythropoiesis, if you lose bone marrow
128
Pancreatic enzymes secreted into GI of this type of endocrine secretion
Exocrine (secreted into a cavity)
129
Sweat glands of armpits and groin have this type of endocrine secretion
Holocrine - entire cell is secreted with the substance - 10% of sweat glands
130
Sweat glands of skin, breast, eyelids, and ear are this type of endocrine secretion
Apocrine - tip of cell is secreted with the substance - 90% of sweat glands
131
Thymosin & thymopoietin are secreted by the thymus, and only works on thymus are this type of endocrine secretion
Autocrine - secreted by the cell it works on
132
GI somatostatin that only works on GI hormones are an example of this endocrine secretion
Paracrine - secreted then only works in the vicinity
133
Dx of low volume state with high Na
Diabetes Insipidus Elderly neglect
134
Dx of low volume state with acidosis
Diarrhea (normal AG) DKA (elev AG) Renal tubular acidosis type 2 (normal AG)
135
Characteristics of low volume state
Decr Na serum (dilutional) Decr Cl serum (dilutional) Decr K serum (renal + dilution) Decr pH urine (aldosterone) Incr pH serum (metabolic alkalosis) Incr TPR
136
Actions of angiotensin 2 (5)
1) Vasoconstrict arteries (incr TPR d/t NE) 2) Constricts efferent arteriole more than afferent arteriole in kidney (Creates backpressure; re-establishes GFR) 3) stimulates aldosterone (Reabsorbs Na; excretes K, H) 4) stimulates ADH 5) stimulates thirst center in brain
137
Post MI (day 4-7) Complications and their symptoms
1) cardiac tamponade (Die suddenly, distant heart tones) 2) ventricular aneurysm (Double knock, pericardial knock) 3) VSD (Murmur louder w/ exhale, does not radiate to axilla) 4) Peri-infarct Pericarditis (Triphasic rub, pericardial rub) 5) mitral regurgitation (Murmur radiates to axilla)
138
4 ways that acidosis can kill/harm you
1) denatures proteins 2) causes hyperkalemia 3) kussmaul breathing 4) elevated GABA (inhibitory)
139
Organs/tissues that do not require insulin
“BRICKLE” Brain RBC Intestine Cardiac muscle/cornea Kidney Liver Exercising muscle
140
What are the tissues with resistance in series?
Liver Kidney Spleen Lung Placenta “Series wants to slow you down for a little to perform its function”
141
Heart sounds: opening snap during diastole
TS MS
142
Heart sounds: ejection click during systole
AS PS
143
Heart sounds: midsystolic click
Mitral valve prolapse - common in women - faster S1 -> standing - slower S2 -> lying down
144
Heart sounds: soft S1
TR MR Tricuspid atresia Mitral atresia Atresia due to lack of apoptosis, leads to cyanosis at birth
145
Heart sounds: loud S1
Stiff valves bangs shut or one ventricle contracting harder TS MS
146
Heart sounds: soft S2
AR PR Aortic atresia Pulmonary atresia
147
DOC for atrial fibrillation or atrial tachycardia
Verapamil Diltiazem Ca channel blockers b/c atrium and thalamus use Ca to depolarize
148
Heart sounds: paradoxical S2 splitting
Aortic stenosis or Pulmonary HTN
149
What are the fat soluble anesthetics? What are the water soluble anesthetics?
All anesthetics end in -caine Fat soluble -> amides -> Two “I”s in name = Lidocaine Water soluble -> esters = tetracaine
150
DOC for absence seizures (thalamic seizures)
Ethosuximide - blocks Ca type T channels (Thalamus and atrium use Ca to depolarize)
151
DOC for: - generalized seizure - temporal lobe seizure - status epilepticus
Phenytoin - blocks Na channels - prevents depolarization - SE: gingival hyperplasia, hirsutism Carbamazepine - blocks Na channels - prevents depolarization - SE: SIADH, aplastic anemia Diazepam - facilitates GABA to increase frequency - only rectal suppositories
152
What controls HR? What receptors does it have?
SA node Beta-1 receptors
153
Left coronary infarct clues
Sudden death Congested HF - lost >40% - EF <45% Recurrent ventricular arrhythmias
154
Right coronary infarct clue
Heart block Slow HR with chest pain described as hippo on chest
155
#1 cause of venous clots #1 cause of arterial clots
Stasis - promotes aggregation - Tx: heparin Endothelial injury - high velocity blood flow - injury promotes aggregation - Tx: aspirin
156
Virchow’s triad
Hypercoagulablity Stasis Endothelial injury
157
What is the control (nervous) of veins? - resting condition
Parasympathetic control (Usually dilated)
158
What is the control (nervous) of arteries? (Resting condition)
Sympathetic control (Usually constricted)
159
Why do plasma proteins not leak out of the blood vessel?
Heparin sulfate is a negative charge in the basement membrane that repels negatively charged plasma proteins
160
Dx of IgA Nephropathy with cataracts + deafness
Alport’s - X-linked recessive - involves type IV collagen - late onset renal failure
161
Important lab markers for iron deficiency anemia
Ferritin is low TIBC is high
162
Clue of Dx: nasal polyps
In children - asthma - cystic fibrosis
163
Top 3 causes of pancreatitis - children - adults
Children - trauma - infections (coxsackie B, mumps) - hypertriglyceridemia Adults - gallstones - alcohol - hypertriglyceridemia
164
Causes of macrosteatosis
1) obesity 2) alcohol
165
What lab findings is most indicative of a poor heart failure prognosis?
Hyponatremia (Yes: K too, but Na is the more serious of the two)
166
Anti-smooth muscle antibody
Scleroderma Autoimmune hepatitis
167
Dx of dead birds in the area with the symptoms of meningitis
West Nile virus
168
What is acanthocytes? Causes?
RBCs coated with lipids MCC hyperlipidemia - obesity - nephrotic syndrome - renal failure - pregnancy
169
What is the most common bone cancer?
Metastasis Multiple myeloma
170
Dx of slapped cheek appearance
Parvovirus B19 (Slapped cheek = 5 fingers = 5th disease d/t parvo B19)
171
Describe characteristics of water soluble compounds
Charged Large Acid Vd low Short half life (<12 hours) Excreted in kidney - nephrotoxic - check renal labs - C/I in renal failure No CNS toxicity
172
What are the bacteria that are curved rods?
Helicobacter Vibrio vulnificus Campylobacter
173
List drugs that cause pulmonary fibrosis
“My Nose Cannot Breathe Bad Air” Methotrexate Nitrofurantoin Carmustine Bleomycin Busulfan Amiodarone
174
Apoptosis - What is the gene? - What is the protein? - What is the label? - What is the enzyme?
- p53 - Cyclin D - phosphatidylserine - caspase
175
How would you determine if it’s fulminant hepatitis?
Hepatic encephalopathy Evidence of GABA
176
What’s caused by Sodium Nitroprusside?
Cyanide poisoning (Side note: best drug for HTN crises except for pregnancy or aortic dissection)
177
What is the screening tests for cystic fibrosis?
Immunoreactive trypsin Then: Chloride sweat test (use pilocarpine)
178
Top 3 bacteria for GU tract What if nitrite neg? What if post-coital?
1) E. coli 2) Proteus 3) Klebsiella Enterococcus Staph saprophyticus
179
Drug-Induced Lupus serum marker
Anti-histone antibody
180
Amino acids (Ketogenic only)
Lysine Leucine
181
Amino acids (Both glucogenic and ketogenic)
Phenylalanine Isoleucine Threonine Tryptophan
182
Causes of microsteatosis
Sign of uncoupling 1) pregnancy 2) Tylenol poisoning 3) Reye’s syndrome
183
What is the rate limiting enzyme of glycolysis?
Phosphofructokinase 1 (PFK-1)
184
If susceptible to encapsulated organisms, vaccinate against what?
Susceptible due to asplenia “No spleens here” - Neisseria meningitidis - Strep pneumo - H influenzae
185
What two membranes depolarize w/ Ca?
Atrium and thalamus (Everything else use Na to depolarize)
186
What 2nd messenger do the following use? - estrogen - progesterone - testosterone - cortisol
NONE! All steroid hormones are fat soluble hormones Do not use 2nd messenger b/c they are able to freely cross membrane
187
Which 2nd messenger systems are affected by calcium?
IP3/DAG, Calcium, Calcium-Calmodulin (Sx consistent with smooth muscle contraction, gastric, hypothalamic hormones)
188
DOC for venous clots
Heparin (Heparin before warfarin w/ 2 day bridge)
189
- periosteal erosion - only arthritis to attack C1 and C2 - only arthritis to attack pannus or synovium
Rheumatoid arthritis
190
Anti-centromere antibody
CREST syndrome - mildest form of scleroderma - calcinosis cutis - Reynaud’s phenomenon - esophageal dysmotility - sclerodactyly - telangiectasias
191
Anticoagulants used that do not require bridge therapy
Rivaroxaban Apixaban
192
Dx of elevated C-peptide and elevated insulin in: - newborns - mass in pancreas - drug
- nesidioblastosis - insulinoma - sulfonylureas
193
What is the antibody for autoimmune T1 DM?
Anti-glutamic acid decarboxylase (anti-GAD)
194
What are the X-linked recessive enzymes?
“A GOLF PATCH” Adenosine deaminase (SCID) G6PD OTC Lesch-Nyhan (HGPRT) Fabry’s (alpha-galactosidase) PRPP synthetase Adrenal leukodystrophy (CAT-1) Tyrosine kinase CGD (NADPH oxidase) Hunter’s (Iduronidase)
195
“Ragged red fiber” “Wavy red fiber”
Mitochondrial diseases
196
Chaperone HSP-70 guides proteins where?
Mitochondria
197
DOC to raise HDL
Niacin
198
Infections that cause heart block
Legionella Lyme disease Chaga’s disease Diphtheria Typhoid fever
199
What is the rate limiting enzyme of gluconeogenesis?
Pyruvate carboxylase
200
Most immunogenic bacteria
Shigella (MCC of diarrhea in daycare)
201
Amino acids (Aromatic)
Phenylalanine Tryptophan Tyrosine
202
Amino acids (Sulfur) Hormones with lots of disulfide bonds
Methionine & Cysteine “PIGI” - prolactin - insulin - growth hormone - inhibin
203
What is the 2nd messenger of smooth muscle?
Contraction by hormone or neurotransmitter - IP3/DAG Contraction by distention: - calcium-calmodulin
204
Dx of painless erythematous lesions on palms and soles
Janeway lesions - infective endocarditis - septic emboli/microabscesses
205
How would you promote DNA transcription?
Loosen DNA Acetylation Add more A’s & T’s
206
Rules for fatty acid synthesis in the body
1) Cannot synthesize beyond 16 carbons 2) can only create double bonds at least 3 carbon aparts 3) cannot create any double bonds after C-10
207
Crescent formation in kidney
Rapid progressive glomerulonephritis
208
What is the only hormone to control lipolysis & ketogenesis?
Glucagon (In DKA -> answer is STILL glucagon. There is just no insulin to shut it off)
209
Drugs that induce Lupus
“HIPPPEE” Hydralazine INH Procainamide Penicillamine Phenytoin Ethosuximide Etancercept
210
Dx of AST:ALT::1:1 Dx of AST:ALT::2:1
1:1 ratio is seen in: - liver disease - muscle disease - trauma - infection (Broad doesn’t mean a lot) 2:1 is only seen in alcoholic hepatitis b/c only alcohol can destroy mitochondrial membrane
211
Increased plasma hydrolases
I cell disease “Empty lysosome”
212
Cause if increased Ca and increased phosphate Cause if increased Ca and decreased phosphate
Vitamin D PTH
213
Heart sounds: S2 splitting
S2 -> aortic or pulmonary Widens when inhaling - increased O2 - increased RV volume - delayed closure of pulmonic valve Narrows when exhaling - decreased O2 - decreased RV volume - early closure of pulmonic valve
214
Heart sounds: fixed S2 splitting
ASD (MCC in general: septum primum)
215
Do ACE inhibitors or ARBs contain sulfur?
ACE inhibitors - avoid w/ sulfur allergies (ARBs do not contain sulfur)
216
Which ARB does not cause any angioedema?
Candesartan “Candy is so sweet to not cause swelling” (ARBs end in “-sartan”)
217
Dx of dinucleotide repeats
Lynch Syndrome (HNPCC) - mismatch repair - family hx of colon cancer w/o polyps
218
What are the strong chemoattractant for neutrophils?
LTB 4 and IL-8 (Minorly: C3a and C5a, but almost never the answer) C3a and C5a are for increased permeability of vessels to allow neutrophils/macrophages to go into the tissues.
219
List the non-immune hemolytic anemias (4)
Paroxysmal nocturnal hemoglobinuria (PNH) Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) Microangiopathic hemolytic anemia Malaria
220
What organ cannot use ketones? What cell cannot use ketones?
Liver RBCs
221
Treatment for neuropathic pain - 1st line - w/ heart failure - shooting, stabbing
- amitriptyline (TCA) - Gabapentin - Carbamazepine
222
What is the 2nd messenger of catabolic processes? Sympathetic or parasympathetic?
cAMP sympathetic Active when phosphorylated
223
Dx of Achilles tendon xanthoma
Familial hypercholesterolemia (Decreased LDL receptor signaling)
224
What is the 2nd messenger of gastrin?
Calcium
225
Dx of chorioretinitis, hydrocephalus, intracranial calcifications in children
Congenital toxoplasmosis
226
RA-related diseases - RA w/ leukopenia and splenomegaly - RA w/ GI ulcers - RA w/ xerostomia, xerophthalmia
- Felty’s syndrome - Behçet’s syndrome - Sjögren’s syndrome (Ro, La, SSA, SSB antibodies)
227
When do neutrophils arrive at the site of inflammation?
Show up at 4.5 hours Predominate 24 hours Peak at day 3
228
What pump or exchange resets membrane potential?
Na/Ca exchange (Phase 4)
229
What brain herniations cause pupil dilation? (Which one has no effect?)
Tonsillar & Uncal Subfalcine
230
What are the non-lactose fermenting bacteria?
“ShYPS” - Shigella - Yersinia - Proteus - Salmonella
231
Dx of cherry-red spots on macula
Due to central retinal artery occlusion Tay-Sach’s - ganglioside accumulation - NO hepatosplenomegaly Niemann-Pick - sphingomyelin accumulation - YES hepatosplenomegaly
232
Chaperone HSP-90 guides proteins where?
Golgi apparatus
233
Endothelin produces what? (3)
Factor V Factor VIII vWF
234
4 syndromes associated with chromosome 22
Digeorge syndrome CML (t 9;22) Neurofibromatosis (t 17;22) Ewing sarcoma (t 11;22)
235
Retroperitoneal organs
“SAD PUCKER” Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd-4th parts) Pancreas Ureters Colon (ascending & descending) Kidney Esophagus Rectum
236
When do fibroblasts arrive at the site of inflammation?
Show up at 7 days Peak at 1 month Take 6 months to complete fibrosis
237
What are the 6 actions of TCAs?
1) Blocks reuptake of catecholamines 2) strongly anticholinergic 3) blocks alpha-1 receptors 4) blocks Na channels in the ventricle 5) blocks AV conduction 6) antihistaminic
238
What is the 2nd messenger of all hypothalamic hormones? Except?
IP3/DAG (Except CRH which is cAMP)
239
Dx of strawberry tongue (2)
Scarlet fever - w/ sandpaper rash Kawasaki disease - w/ lymphadenopathy & high fever for 5 days
240
Gray baby syndrome drug
Chloramphenicol
241
What drugs are strong acids and need to be taken on empty stomach?
Tetracyclines Quinolones
242
Short amino acid sequences are added where?
rER
243
What electrolyte drive the concentration gradient?
Sodium (Biggest gradient)
244
Name the enzyme that is most active at 8PM
HMG CoA Reductase
245
Dx of splinter hemorrhages in fingernails
Infective endocarditis - acute = staph aureus - subacute = strep viridans
246
Short amino acid sequences guides proteins where?
Mitochondria
247
List sympathetic effects
Incr HR Incr BP Incr contractility Incr EF Incr SV Vasoconstriction Pupils dilation
248
What is the most common leukemia?
ALL
249
Pro-sequence guides proteins where?
Golgi
250
Gout treatments - Acute = most effective - Acute = drug of choice - w/ renal failure - chronic or recurrent - to break up crystals
- colchicine - indomethacin - steroids - allopurinol, febuxostate, probenecid - rasburicase
251
MOA: Allopurinol Febuxostat
Blocks xanthine oxidase
252
Dx of self-mutilation and always running De Novo pathway
Lesch-Nyhan syndrome - complete HGPRT deficiency - severe gout
253
Cell-mediated immunity - protects what? - cell type? - stimulates what cell type? - kill what?
Patrols your tissue T cells Macrophages Kills everything except bacteria (= virus, fungi, parasite)
254
Dx of male child with recurrent infections, no mature B cells
Bruton disease = X-linked agammaglobulinemia
255
Cause of loose or spasmodic stools
Osmotic diarrhea Inflammatory
256
Dx of CD55 and CD59 detected on surface
Paroxysmal Nocturnal Hemoglobinuria (PNH) (Tx: makes susceptible to encapsulated organisms)
257
Name an enzyme that uses Molybdenum
Xanthine oxidase
258
MCC cause of malabsorption - in children - in adults
Children: - cystic fibrosis - celiac sprue Adult: - Crohn’s disease
259
Name an enzyme group that uses Biotin (B7)
Carboxylases
260
MCC of vasculitis: - in children - in adults
Children: Henoch Schönlein Purpura Adults: HTN and DM
261
List the causes of acyanotic heart lesions in neonates (3)
Coarctation of aorta Critical aortic stenosis Single ventricle
262
What are the 6 causes of complement deposition in kidney?
“PMS in Salt Lake City” Post-streptococcal GN Membranous GN Serum sickness SBE (subacute bacterial endocarditis d/t strep viridans) Lupus Cryoglobulinemia
263
MCC of nephrotic syndrome - in children - in adults
Children: minimal change disease Adults: focal segmental GN (d/t HTN and DM)
264
Main antioxidants - in GI - in blood
Vitamin A Beta-carotene Vitamin C - GI Vitamin E - blood
265
Name an enzyme that uses vitamin B6
Transaminases
266
MCC of aplastic anemia (5)
Parvovirus B19 Drugs: chloramphenicol, benzene, AZT, vinblastine Myelofibrosis Fanconi Diamond-Blackfan
267
List all killed vaccines
“RIP-A” Rabies Influenza Polio (IV)
268
What is Ki-67?
Communicates cell-to-cell to inform the rapid cellular division (TNF is similar to alpha-macrophage 2/T cells)
269
Mitochondrial diseases (2)
Leber’s - optic - blind shortly after birth Leigh’s - chronically fatigued - “Leigh’s wants to lay down”
270
Pre-sequence guides proteins where?
rER
271
Mannose-6-phosphate tag assets are sent where?
Lysosome
272
Stretchy skin Velvety skin
Ehler’s Danlos
273
Cause of rice water or watery stool Dx (Name the only hormone one)
Secretory diarrhea 1) Vibrio cholera 2) ETEC 3) cryptosporidium 4) VIPoma (only hormone)
274
What is the first sign of diabetic nephropathy? (Treatment?)
Microalbuminuria ACE inhibitors or Ca channel blockers
275
Important lab markers for anemia of chronic diseases (3)
Hepicidin - interferes w/ transferrin ability to absorb iron Ferritin - normal or increased TIBC - decreased
276
Free Radicals - most common cause - made by - pathway - MOA
- viral - neutrophils - NADPH oxidase - perforates membranes
277
Cofactors of ribonucleotide reductase (Shut off by what?)
NADPH Thioredoxin Shut off by: dATP
278
What is the treatment DOC for metastasis to brain or spinal cord (CNS)?
1) Pain medication 2) Dexamethasone
279
What pump or exchange resets the concentration gradient?
Na/K pump (Phase 3)
280
Dx of fixed wide splitting S2
ASD
281
Blue sclera Multiple fractures at birth
Osteogenesis imperfecta
282
Location of COX types
COX 1 - GI tract COX 2 - Joints (and some 1) COX 3 - vascular endothelium
283
What is the 2nd messenger of insulin and all growth factors?
Tyrosine kinase (Interleukins can act as growth factors specifically IL3, IL4, IL5)
284
How does nitrous oxide decrease BP?
NO -> incr guanylate Cyclase -> incr cGMP -> dilates veins first -> dilates arteries later
285
What electrolyte has the most conductance at rest? (Hint: who always has channels open)
Potassium (K)
286
X-linked dominant diseases (3)
Vitamin D resistant rickets Pyruvate dehydrogenase deficiency Pseudohypoparathyroid
287
Name an enzyme that uses 5 B vitamins
Dehydrogenase B1 - TPP B2 - FADH2 B3 - NADH B4 - Lipoic acid B5 - Acetyl CoA
288
Only pro-sequence not destroyed (What hormone?)
C-peptide Insulin
289
How many CCs/kg make up 1 unit of blood for a child?
20 cc/kg = 1 unit
290
What cofactor do kinases use?
Magnesium
291
What are the gain of function (enhancer) genes? (4)
BRAF BCL2 Jun KRAS
292
List all cyanotic heart disease in neonates (hint: the 5 t’s)
Truncus arteriosus Tricuspid atresia Tetralogy of Fallot (most common) Transposition of great arteries (most common) Total anomalous pulmonary venous return (TAPVR)
293
Dx of Tri-phalangeal thumb/clover-leaf thumb (2)
Diamond-Blackfan syndrome Edward’s syndrome (trisomy 18)
294
IL-1 is produced by (cell type)? IL-1 causes what?
Produced by macrophages Causes fever, nonspecific symptoms of illness, recruits T-helpers
295
Dx bilirubin attaches to basal ganglia
Kernicterus
296
Name 2 enzyme that use vitamin B12
Homocysteine methyl-transferase Methylmalonyl CoA mutase
297
What is the underlying disease associated with sclerosing cholangitis?
Ulcerative colitis
298
Drugs to give in setting of an acute MI
1) morphine (Na channels -> decr pain) 2) Nitrates (stimulate NO -> vasodilates) 3) ASA (blocks COX 1 and COX 2) 4) Clopidogrel (blocks ADP receptor) 5) beta blockers (carvedilol, metoprolol, bisprolol-> decr mortality) 6) oxygen 7) heparin 8) tPA (= alteplase, plasminogen activator) 9) ACEi/ARBs 10) statins Stop metformin Stop CCBs
299
What are the encapsulated bugs that have IgA protease?
Strep pneumo H influenzae Neisseria catarrhalis
300
DOC for post-op urinary retention
Carbachol (= stimulate bladder emptying) Bethanechol
301
DOC to challenge for diagnosis of asthma
Methacholine
302
What is first line antiemetic for children?
Promethazine (Metoclopromide is 2nd)
303
What is first line antiemetic for adults?
Perchlorparazine (Metoclopramide is 2nd.)
304
Key finding to differentiate anticholinergic from sympathetic
Anticholinergic -> NO sweating Sympathetic -> sweating
305
How does the liver remove drugs?
Acetylation
306
What is the U wave on an EKG? - what phase of action potential? - What ion is moving and where?
- automaticity - phase 4 - Na/Ca exchange
307
EKG findings for ventricular repolarization - what part of EKG? - What phase of action potential? - What ion is moving and where?
- T wave - phase 3 - potassium is moving out
308
EKG findings for ventricular contraction - what part of EKG? - What phase of action potential? - What ion is moving and where?
- ST segment - phase 2 - Calcium moving in
309
EKG findings for ventricular depolarization - what part of EKG? Q? R? S? - what phase of action potential? - What ion is moving and where?
- QRS complex Q -> septum R -> anterior wall S -> posterior wall - phase 0 - sodium moving in
310
EKG findings for atrial depolarization - what part? - what phase of action potential? - What ion is moving and where?
- P wave - phase 0 - calcium moving in
311
Dx (MCC) of paroxysmal supraventricular tachycardia in teenagers
Wolff-Parkinson-White EKG finding = delta wave d/t accessory pathway around the AV node Drug contraindicated = Digitalis - stimulates vagus -> slowing SA/AV conduction
312
What are the top antibiotics for babies?
1) Ampicillin/Gentamicin 2) Ampicillin/Ceftriaxone
313
What are the top 3 bacteria for babies?
1) Group B strep 2) E. coli 3) Listeria
314
Only antibiotic that cover staph epidermidis
Vancomycin
315
What is the PR interval?
Atrial conduction time
316
What is the PR segment of EKG?
AV nodal pause or Sustained atrial contraction
317
What controls the development of male genitalia? - inner half - outer half
- Müllerian Inhibiting Factor - Testosterone
318
What is the main form of testosterone in women?
DHEA-S (Dehydroepiandrosterone-sulfate)
319
DOC for prostate cancer - MOA
Flutamide - Blocks DHT receptors
320
Most common causes of sinusitis (5)
1) Allergies 2) Virus 3) S pneumo 4) H influenzae 5) N catarrhalis DM -> Mucor, Rizor
321
What cancer can present with depression?
Pancreatic
322
Dx of cracked corneal lacerations (Linear, branched)
Herpes Keratitis Avoid steroids Dendrites
323
What is stress jaundice? - unconjugated levels? - conjugated levels?
Gilbert’s syndrome - decreased conjugation
324
What brain changes are seen in schizophrenia?
Frontal Lobe changes - loss of asymmetry - enlargement in ventricles
325
What brain region should you suspect if deficiencies in hearing and balance?
Temporal lobe (CNVII & CNVIII are found running through here)
326
DOC for temporal lobe seizures
Carbamazepine (Na channel blocker) - hallucinations precede seizures
327
Broad category of drugs that cause vertical or rotary nystagmus - MOA
Amphetamines - MOA: Taken up presynaptically causing release of catecholamines. Increase neurotransmitters specifically NE and DA
328
In the thalamus, all information labeled “medial” controls what?
Legs
329
Common causes of renal cell carcinoma
1) VHL 2) Tuberous sclerosis 3) Li Fraumeni
330
Changes due to chronic hypoxia
1) Mitochondrial density increases in muscles 2) angiogenesis 3) erythropoiesis
331
In the thalamus, all information labeled “lateral” controls what?
Arms
332
DOC for male patterned baldness - MOA
Finasteride - blocks 5-alpha reductase
333
What neurotransmitter causes hallucinations?
Dopamine
334
What neurotransmitter controls hallucinations?
Serotonin
335
What sensory information does not cross through the thalamus?
Olfactory nerve
336
What drug could take place of cortisol?
Hydrocortisone
337
What drug could take place of aldosterone?
Fludrocortisone
338
Dx of scaphoid abdomen and no bowel sounds on the left
Diaphragmatic hernia (Will hear bowel sounds on chest exam)
339
What vitamin would you want to put polycythemia patients on?
Folate (b/c they are making rapidly dividing cells)
340
Immunosuppressive actions of cortisol (5)
1) Kills T cells and eosinophils 2) inhibits phospholipase A 3) inhibits macrophage migration so body cannot process antigens 4) stabilizes endothelium, macrophages cannot enter tissues 5) stabilizes mast cells, so they cannot degranulate
341
Testosterone - Made by: - Stimulus: - What it does: - Where it goes: - 2nd messenger: - Misc syndromes:
- Made in: zona reticularis - Stimulus: ACTH, GnRH -> LH -> testosterone - What it does: 1) controls male external genitalia in utero 2) incr appetite, aggression, violence 3) incr libido 4) incr RBC count - Where it goes: testes, bone, muscle - 2nd messenger: none - Misc syndromes: Adrenal insufficiency: too little Hirsutism: too much
342
Physiological actions of cortisol
1) proteolysis: turning proteins into glucose (catabolic action) 2) gluconeogenesis 3) upregulates all receptors (permissive in stress)
343
Cortisol - Made by: - Stimulus: - Inhibitor: - What it does: - Where it goes: - 2nd messenger: - Misc syndromes:
- Made by: zona fasciculata - Stimulus: stress/hypoglycemia - inhibitor: hyperglycemia - What it does: upregulates ALL receptor during stress - Where it goes: everywhere - 2nd messenger: none - Misc syndromes: Adrenal insufficiency - too little Cushing syndrome - too much
344
Aldosterone - Made by: - Stimulus: - Inhibition: - What it does: - Where it goes: - 2nd messenger:
- Made by: zona glomerulosa - Stimulus: 1) hyperkalemia, 2) hypovolemia, 3) hyponatremia - Inhibition: hypervolemia - What it does: stimulate Na/K pumps & increase activity, 1) Na in with 3x H20, 2) K out, 3) H out - Where it goes: late DCT, early collecting duct, ascending colon - 2nd messenger: none
345
Erythropoietin - Made by: - Stimulus: - Inhibition: - What it does: - Where it goes: - 2nd messenger: - Misc syndromes:
- Made by: renal parenchymal cells - Stimulus: hypoxia - Inhibition: increased O2 - What it does: stimulate erythropoiesis - Where it goes: bone marrow - 2nd messenger: tyrosine kinase - Misc syndromes: Gaisbock -> elderly Stress & spurious polycythemia
346
Cancer associated with HPV
Squamous cell carcinoma of the cervix
347
Cancer associated with EBV
B cell lymphoma Nasopharyngeal carcinoma
348
Cancer associated with schistosoma haematobium
Squamous cell carcinoma of the bladder
349
Cancer associated with aflatoxin
Hepatocellular carcinoma
350
Cancer associated with myasthenia gravis
Thymoma
351
t(15;17)
AML
352
t(11;22)
Ewing’s sarcoma
353
t(14;18)
Follicular lymphoma
354
t(8;14)
Burkitt’s lymphoma
355
t(9;22)
CML
356
Which duodenal hormone activates trypsinogen to trypsin?
Enterokinase (Trypsin activates all other pancreatic enzymes)
357
Which duodenal hormones are purely inhibitory?
VIP - released from Auerbach plexus Somatostatin - released from D cells
358
Which duodenal hormone decreases secretion of stomach acid?
GIP - released from K cells - enhances insulin release
359
Which duodenal hormone stimulates peristalsis?
CCK - released from I cells - increases gallbladder contraction - increases release of digestive enzymes - in pancreas, via IP3/DAG
360
Which duodenal hormone inhibits gastric and gastric emptying?
Secretin - released from S cells - increases bicarb - in pancreas, via cAMP
361
4 causes of edema
- incr hydrostatic pressure - decr oncotic pressure - lymph obstruction - endothelial damage
362
Dx of edema but liver and kidneys intact (Classic clue of low albuminemia)
Menetrier’s disease (Rare disease characterized by thick rugal folds.) (Goblet cell hyperplasia d/t protein leaking out from GI tract.)
363
Gastritis: Location - body & fundus? - Antrum & duodenum?
- Type A - Type B
364
Most common type of Gastritis
Type B (~90% of cases)
365
Causes of Gastritis - antibodies? - breakdown in barrier?
Type A - parietal cells -> gastric atrophy -> B12 deficiency Type B - breakdown in barrier production - H pylori
366
Gastritis: cancer association - adenocarcinoma - MALToma
Type A - associated with adenocarcinoma Type B - associated with MALToma
367
Gastritis: autoimmune cause
Antiparietal cell antibody
368
3 ways to protect the stomach
- mucus production from goblet cells protect from acid erosion of GI - prostaglandin E secretion promotes mucus production - HCO3 production from alkaline tide
369
Diseases that cause Heart Block
“LSD Loves Company” - Legionella - Salmonella - Diphtheria - Lyme disease - Chagas’ disease
370
What is the most potent vasodilator in the lungs?
Oxygen
371
Flow (Q) is greater to the ___ (top/bottom) of the lungs because…
Increase at bottom b/c: 1) gravity 2) less resistance 3) more oxygen goes to the bottom of the lung with each breath
372
Dx of bag of worms in testicles
Epididymitis -> pain improves with lifting Varicocele -> acute & recurrent -> pain does not improve with lifting
373
Blood supply effected in medial medullary syndrome and symptoms
Occlusion of vertebral artery Pyramid -> C/L spastic hemiparesis CNXII -> tongue deviates towards the lesion
374
Blood supply effected in lateral medullary syndrome and symptoms
Occlusion of posterior inferior cerebellar artery (PICA) Cerebellar peduncle -> ipsilateral limb ataxic Descending hypothalamic -> ipsilateral Horner’s Nucleus ambiguus -> dysphagia, CNIX & CNX
375
Blood supply effected in lateral pontine syndrome and symptoms
Occlusion of anterior inferior cerebellar artery (AICA) CN VII -> ipsilateral facial paralysis CN VIII -> hearing loss
376
Blood supply effected in medial midbrain syndrome and symptoms (Weber)
Occlusion of posterior cerebral artery Corticospinal tract -> C/L spastic hemiparesis of upper limb CN III -> eye down and out Corticobulbar tract -> lower face (C/L)
377
What cranial nerves cross the midline?
VIII (Facial) - UMN innervations ONLY lower half of face on C/L side - LMN innervates ENTIRE same side face XII (hypoglossal) - Tongue deviates towards the lesion if above nucleus - If below nucleus, tongue deviates away - IF intranuclear, tongue same side
378
Both sensory and motor cranial nerves
some say marry money But my Brother says Big Brains matter most V (trigeminal) - V1 (ophthalmic) - V2 (maxillary) - V3 (mandibular) VII (Facial) IX (Glossopharyngeal) X (Vagus)
379
Only Motor cranial nerves
some say Marry Money but My brother says big brains Matter Most III (oculomotor) IV (trochlear) VI (abducens) XI (spinal accessory) XII (hypoglossal)
380
Only Sensory cranial nerves
Some Say marry money but my brother Says big brains matter more I (Olfactory) II (Optic) VIII (Vestibulo-cochlear)
381
Cranial nerves in medulla
IX (Glossopharyngeal) X (Vagus) XI (Spinal Accessory) XII (Hypoglossal)
382
Cranial nerves in pons
V (Trigeminal) VI (Abducens) VII (Facial) VIII (Vestibulo-cochlear)
383
Cranial nerves in midbrain
III (Oculomotor) IV (Trochlear)
384
MOA of Plan B and Drug Name
Levonorgestrel Large dose of progesterone Followed by sudden withdrawal mimics end of cycle Endometrial lining will slough off
385
What abortifacent blocks the progesterone receptor?
Mifepristone
386
Which hormone is responsible for a thick endometrial stripe?
Progesterone
387
How can you differentiate Androgen Insensitivity Syndrome (AIS) from 5-alpha reductase deficiency?
AIS has small breast 5-alpha reductase deficiency has more testosterone -> thus complete suppression of breast development
388
What hormone inhibits ovulation?
Progesterone (Incr progesterone inhibits LH via negative feedback)
389
What cancer frequency decreases with OCP use?
Ovarian cancers most common -> serous cyst adenocarcinoma (This stops ovary from cycling.)
390
Most common ovarian mass… - mass - tumor - cancer
- mass: follicular cyst - tumor: serous cystadenoma - cancer: serous cystadenocarcinoma
391
During ovulation, what levels rise? Which one first? Why?
GnRH, FSH, and LH LH because there is no feedback inhibition for first 10 days Feedback inhibition by FSH inhibited by estrogen in first 10 days
392
These changes in Graafian follicle make which stage? - cell division, no antrum - small antrum - large antrum
- primary - secondary - tertiary -> egg is off to one side, ready for ovulation
393
Dx of large soft boggy uterus on PE
Adenomyosis Risk factor -> pt’s mother on diethylstilbestrol (DES)
394
Most common causes of heavy menstrual bleeding (Anatomical)
Leiomyoma Endometriosis Adenomyosis
395
Most common causes of heavy menstrual bleeding? (Overall)
Obesity (Adipose) Fibroids = Leiomyoma Endometriosis Adenomyosis
396
What is the most common cause of painful pelvic pain in female of childbearing age?
Endometriosis (Dx w/ laparoscopy showing -> chocolate cyst, powder-burn appearance)
397
Sequence of pubic staging
T (Thelarche) A (Adrenarche) P (Pubarche) M (Menarche)
398
What bacterial membrane component is the most immunogenic?
Core antigen - more variable - different for every gram neg family member
399
If you want to add sugar, who is the carrier? - one? - couple?
- for one: UDP - for a couple: Dolechol
400
What membrane component of bacteria causes toxicity?
Lipid A
401
What is the *only* gram pos but with an endotoxin?
None (Used to be thought that Listeria monocytogenes but found to be wrong)
402
Describe the peptidoglycan walls of bacteria - Gram Positive
- Thicker than gram neg walls - minimum of 40 layers - more likely to have an exotoxin - has techoic acid
403
Describe the peptidoglycan walls of bacteria - Gram negative
- thinner than gram pos walls - only have 1 layer - more likely to have endotoxin - has a periplasmic space - has Lipid A
404
Drugs that blast the bone marrow? (Causing aplastic anemia)
Vinblastine (chemo for cancer) AZT (old HIV drug) Chloramphenicol (antibiotic at 50S) Benzene (working in factory)
405
Dx of HCT >60%
Polycythemia Rubra Vera - all cell lines increase but RBCs increase the most - itching after hot bath - uric acid stones - splenomegaly - elev LAP
406
Most common lymphoma
Follicular lymphoma - Bcl-2 marker (enhancer) - t(14;18)
407
What are the most malignant lymph nodes?
1) supraclavicular (Virchow) 2) Epitrochlear 3) Inguinal nodes
408
Dx of lymphoma with CD30 and CD is positive
Hodgkin lymphoma
409
Which lymphoma is equally present in men and women?
Hodgkin lymphoma - Reed-Sternberg cells -> CD30, CD15 pos - commonly begins as swollen lymph node
410
Dx of leukemia associated with DIC
Promyelobalst leukemia - most common form is M3 - treat with vitamin A
411
Dx of TRAP pos
Hairy Cell Leukemia - hair-like projections on the cell membrane
412
Drugs used on rapidly dividing cells
Anti-metabolites
413
Drugs used on slow-growing cells
Alkylating agents
414
Dx of: (only ask one) - elev levels of neutrophils - elev levels of monocytes - elev levels of macrophages
CML - t(9;22) - BCR-abl - age b/w 30-50y - more common in women
415
Dx of Auer rods pos (Stain pos w/ Sudan black)
AML - t(15;17) - age 15-30y - more in boys
416
Dx of: PAS pos TdT pos CALLA pos
ALL - most common from 0-15y - more in boys
417
What leukemia has the worst prognosis and why?
AML - acts on both arms of the immune system - myeloblasts give rise to: - neutrophils -> B cells -> humoral response - macrophages -> T cells -> cell-mediated
418
Most common symptomatic virus?
Adenovirus MCC - pulmonary - UTI - conjunctivitis
419
What cytokines causes weight loss?
TNF
420
Dx of leukocytosis w/ <5% blasts?
Leukemoid reaction - trauma - painful Ex: MCV, burns, extreme stress
421
Dx of leukocytosis w/ >5% blasts?
Acute leukemia
422
What is indicated by a high procalcitonin?
Bacterial infection
423
Drugs that cause agranulocytosis?
"Drugs That Can Cause Pretty Major Granulocytes Collapse" Dapsone Ticlopidine (anti-platelet) Carbamazepine (temporal lobe seizures) Clozapine PTU Methimazole Ganciclovir Colchicine
424
Most common cause of “-penia”?
1) viral 2) drugs
425
What is the main methyl donor?
SAM
426
Where are leukocytes found?
90% of leukocytes are marginated which means they are stuck along the sides of blood vessels (subendothelial)
427
Dx of: 1) fundus growing higher than predicted 2) hCG rising faster than predicted 3) HTN in 1st trimester
1) molar pregnancy 2) complete (46,XX) -> no fetal parts 3) incomplete (69,XXY) -> fetal parts
428
Human placental lactogen (HPL) effects
- elev most in 3rd trimester - blocks mom’s insulin receptors - creates insulin resistance - gestational diabetes
429
Inhibin effects
- inhibits FSH - prevents another menstrual cycle from beginning
430
Estrogen effects
- smooth muscle relaxation - stimulates protein synthesis - elev ESR, elev TBG (T4, T3) - elev clotting factors - elev angiotensinogen - hyperlipidemia -> keep baby warm - suppresses immune system - autoimmune diseases will improve
431
Progesterone effects
- elev RR from pons - incr appetite - Pica - incr RBC mass by 30% - causes acne - hyperpigmentation - incr plasma volume via aldosterone
432
What controls the delivery of the placenta during stage 3 of delivery?
Prostaglandin F - clamps down on vessels and responsible for separating the placenta
433
After implantation, what “-blast” belongs to: - the baby - the mother - both (= placenta)
- baby = trophoblast - mother = cytotrophoblast - both = syncytiotrophoblast
434
Cell stages of fertilization and where in female? - 2 cell - 16 cell - 256 to 512 cell
Zygote -> 2 cell stage - 90% fertilizations occur in ampulla - migrate into fallopian tubes Morula -> 16 cell stage - enters the uterus Blastula -> 256 to 512 cell - this is the stage that implants
435
Before sperm can leave, where does it stop and why?
1) seminal vesicles - semen - fructose 2) bulbourethral (Cowper) gland - HCO3 3) prostate - Zn (capacitation reaction) - acid phosphatase - hyaluronidase
436
Most common causes of PID
1) Chlamydia 2) Gonorrhea - purulent - Tx: ceftriaxone 500 mg
437
Dx of snowstorm appearance in uterus on U/S?
Molar pregnancy After removal, there is a ball of grapes appearance: - incr risk of choriocarcinoma - concern for uterine invasion, if not removed
438
What is responsible for maintaining the blood-testes barrier? - produces what?
Sertoli cells - produces inhibin - protect and nourish sperm to maturity - protects sperm from lymphatic flow
439
Urease pos bugs
PPUNCH SB - proteus - pseudomonas - ureaplasma - nocardia - cryptococcus - H pylori - staph saprophyticus - brucellosis
440
Acute bacterial endocarditis - organism? - valve?
- Staph aureus - tricuspid regurgitation
441
Subacute bacterial endocarditis (SBE) - organism? - valve?
- strep viridans - mitral valve prolapse
442
What are the filamentus organism? How to differentiate?
Actinomyces - gram pos - lumpy jaw Nocardia - partially acid fast
443
What is the drug of choice for vancomycin resistance? MOA?
Linezolid MOA: binds to 50S subunit
444
Type of bacterial adaption using a… - phage? - plasmid? - pili?
Phage -> transduction (90%) Plasmid -> transformation (healthcare setting) Pili -> conjugation (close proximity)
445
Most common cause of skin infections? - gram stain? - oxygen?
1) Staph aureus 2) strep pyogenes (except its #1 in UNES) - lymphangitis - impetigo - necrotizing fasciitis - erysipelas - scarlet fever Gram pos aerobic except propionibacterium acne which is gram pos anaerobe
446
What type of rejection would you see an inflammatory response that involves only T suppressor cells?
Graft vs Host - very rare - occurs almost exclusively - after a bone marrow transplant - presents w/ painful rash
447
With what type of rejection would you see fibrosis? Treatment?
Chronic rejection - irreversible, therefore you have to remove and start over
448
With what type of rejection would you see T lymphocytes and macrophages? Treatment?
Acute rejection Prednisone, cyclosporine, anti-lymphocytic antibodies, or tyrosine kinase inhibitors
449
What type of rejection is due to preformed antibodies? Test to prevent? Timeframe?
Hyperacute rejection Cross match test Occurs w/in 12 hours (1st change is swelling)
450
Function of the complement system
Responsible for coating and destroying encapsulated organisms Gram pos: strep pneumo Gram neg: pseudomonas, salmonella, Klebsiella, H influenzae, citrobacter, neisseria meningitidis
451
You can only have Rh incompatibility disease if mom is what?
ONLY if mom is negative and dad is positive
452
Which complement member can cause angioedema?
C5a (Can produce a localized anaphylaxis called angioedema) - Due to C1-esterase inhibitor deficiency - recurrent facial swelling
453
What are the most important opsins?
IgG IgM C3b - only one in complement system
454
What is an opsin? Which is the only member of the complement system that acts as an opsin?
Opsins can coat the capsule so that the macrophages can phagocytize the capsule easily C3b
455
Which antibody can fix the most complement?
IgM Fixing 2 complement molecules on each of 5 arms
456
Examples of T1 HSR
Anaphylaxis Urticaria Steven Johnson syndrome Erythema multiforme
457
What hypersensitivity has no complement involved?
Type 1 IgE does not fix complement
458
What drug can destroy CD3?
Muronamab Used in T cell lymphomas
459
What cells are CD16 and CD56 pos?
NK cells - do not go through clonal deletion - responsible for immunosurveillance - can detect cancer at the one cell stage
460
How do CD4 cells communicate with B cells? With macrophages?
- CD40 ligand - B7/CD28 molecule
461
What are the immunoprivileged sites? (No lymphatics running through them)
Brain Thymus Cornea Testicle
462
What antibody targets the Fc portion of IgG? Disease? New Marker?
Rheumatoid factor Rheumatoid arthritis Anti-citrullinated antibody
463
Why are alcoholics considered immunocompromised?
Alcohol breaks down disulfide bonds. There are a lot of disulfide bonds in antibodies, meaning no antibodies.
464
What are the amino acids that make an active site?
Glutamate Histidine Serine
465
What antibodies have memory?
IgA in secretions/mucosal surfaces IgE in allergies IgG in blood (memory) - highest affinity - arrives in 3 days - peaks at 5 years - lasts for 10 years
466
Timeline - first antibody made? - class switching time? - 2nd antibody made? - memory response start? - fully developed?
IgM 6 months IgG 12 months 15 months
467
What antibody can start being made at: - 6 months? - arrives in? - peaks in? - lasts for?
Primary IgG - class switching starts at 6 months - arrives in 2 weeks - peaks in 2 months - lasts for 1 year
468
What is the first antibody made? - arrives when? - peaks in? - lasts for?
IgM - arrives in 3 days - peaks in 2 weeks - lasts for 2 months ONLY antibody produced in a newborn until 6 months
469
What is needed to stimulate B cells?
Endotoxin Pokeweed mitogen Add labeled thymidine
470
What B cell stage of development is it if you see IgM and IgD on their surface?
Mature B cell (You need your MD to go to work.) Now a plasma cell can produce antibodies.
471
What B cell stage of development is it if you see IgM on the surface as a monomer?
Immature B cells
472
Interleukin responsible for class switching? Exception? (And it’s IL)
IL-4 (2nd messenger is tyrosine kinase b/c it is a growth factor) IL-5 (Class switching of IgA only)
473
What is the most potent interleukin? Function? Drug?
IL-2 -> recruits everybody Daclizumab -> antibody against IL-2 (Used in transplants to prevent rejection)
474
What cells are involved in germinal cell hyperplasia? What immune response? What infections?
B cells (this where they differentiate) Humoral immune (patrols blood) Protects against bacteria
475
What B cell stage of development is it if you see Mu chains? In cytoplasm?
Pre-B
476
What cells are involved in lymphoid tissue hyperplasia? What immune response? What infections?
T cells (this where they differentiate) Cell-mediated (patrols tissues) Protects against viruses, fungi (everything except bacteria)
477
Causes of eosinophilia
NAACP - neoplasias, especially lymphoma - allergies - addison’s disease - collagen vascular diseases - parasites
478
Which H2 blocker is associated with colon cancer?
Ranitidine
479
Which H2 blocker blocks p450 ?
Cimetidine (Incr estrogen causing gynecomastia)
480
What enzyme is needed to make any fluid in body? (And what is the drug that blocks it?)
Carbonic anhydrase Acetazolamide
481
What is most severe bronchoconstrictor? (What is drug to stop?) (What is enzyme to stop?)
SRS-A = slow-reacting substance of anaphylaxis Most potent bronchoconstrictor and vasoconstrictor Drug to stop? Steroids Enzyme to stop? Arylsulfatase
482
What is the 1st antibody made by B cells? In allergies?
IgM Can only get IgE from IgM from class switching
483
Most common cause of monocytosis
Monocytosis >15% - salmonella - tuberculosis - EBV (anti-heterophile pos) - CMV (anti-heterophile neg) - listeria - syphilis
484
What does a CD14 marker indicate?
Macrophages (Which are monocytes that have now entered into tissues) (Mediated by interferon gamma)
485
What does a CD4 marker indicate?
Monocytes (Which are in circulation)
486
Clues to anaerobic infections
Malodorous smell Gas formation -> on imaging: “fluid-gas levels” or “air-fluid levels”
487
What is the antibiotic of choice… - above the diaphragm? - below the diaphragm?
- clindamycin - metronidazole
488
Abscess culture bacteria? Day 1-3 Day 3-7 After day 7
Staph aureus Strep pyogenes Anaerobes
489
What is the most abundant granulocyte?
Neutrophils - arrive: 4.5 hours - predominate: 24 hours - peak at: 3 days Contains myeloperoxidase and NADPH oxidase
490
What bacteria stain with Ziehl-Neilson (acid-fast)?
Completely acid fast: - mycobacterium Partially acid fast: - gram pos -> Nocardia - Protozoa -> cryptosporidium
491
What are the important catalase positive bacteria?
Staph aureus Pseudomonas Neisseria Listeria
492
In what phase of the bacterial life cycle is the most endotoxin released? Except?
Decline phase Except Neisseria meningitidis - endotoxin released in log phase
493
What is the only bacteria that releases endotoxin while dividing? What phase?
Neisseria meningitidis Log phase (B/c it has the largest capsule) “Neisseria is not so nice”
494
What is a gram pos anaerobe?
Propioniobacterium acne
495
What constipation meds promote peristalsis?
Bisacodyl Dulcolax
496
What diseases affect the apex of the heart?
Takotsubo cardiomyopathy Chagas’ disease
497
Dx of only Gram neg pleomorphic rods
Hemophilus (Also described as a school of fish)
498
What are the encapsulated bugs that have IgA protease?
Strep pneumo H influenzae Neisseria (Moraxella) catarrhalis Influenza (virus)
499
Dx of gas gangrene
Clostridium perfringens (Associated with holiday ham or turkey) (Increased risk in diabetics)
500
Dx of GI upset within 8 hours of eating fried rice
Bacillus cereus - self-limiting - hydration
501
Dx of Wool Sorters’ Disease - membrane component? - contains what toxins?
Bacillus anthracis (anthrax) - membrane -> poly D-Glu - toxins 1) lethal factor 2) edema factor 3) protective factor
502
How do you remove spores?
Autoclave (121 C vaporized heat for at least 15 minutes)
503
What bacteria are spore farmers?
“Be Careful of spores” - Bacillus - Clostridium
504
Dx of bacteria that has a toxin the ADP ribosylates EF2
- Corynebacterium diphtheriae - Pseudomonas aeruginosa
505
What bacteria looks like Chinese letters?
Corynebacterium Diphtheriae
506
What is the only Gram pos cocci in clusters?
Staphylococcus family - Aureus -> coag pos, gold pigment - Epidermitis -> white pigment - Saprophyticus -> no pigment Enzymes - Catalase -> separates strep
507
DA-CEP What are the bacteria that are ADP-ribosylators?
EF 2 - Diphtheria - Aeruginosa G subunit - Cholera (Gs) - E. coli = ETEC (Gs) - Pertussis (Gi)
508
Which hepatitis B serum marker shows up first? Abbreviation?
Core antigen (HBc) Rises & falls before any symptoms arrive
509
Which hepatitis B serum marker is indicative of vaccination? Abbreviation?
Surface antibody (anti-HBs)
510
Which hepatitis B serum marker(s) indicate immunity? Abbreviation?
Surface antiBODY (anti-HBs) Core antiBODY (anti-HBc)
511
Which hepatitis B serum marker(s) indicate a previous infection? Abbreviation?
Core anti-BODY (anti-HBc) Does it go away? Once positive, it’s present for life, so it alone does NOT indicate a current infection, only previous infection
512
Which hepatitis B serum marker(s) indicate a current infection? Abbreviation?
Surface antiGEN (HBsAg) - infective antigen Core antiBODY (anti-HBc)
513
Which hepatitis B serum marker(s) indicate the window period? Abbreviations?
Core antiBODY (anti-HBc)
514
Which hepatitis B serum marker(s) indicate infectivity? Abbreviations?
Hepatitis envelope antigen (HBeAg)
515
What stage of hepatitis B? - pos HBsAg >6mo - neg active inflammation - neg fibrosis Transmission risk?
Chronic carrier state Yes, still pose a threat to others b/c pos HBsAg, which is the infective antigen
516
What stage of hepatitis B? - pos anti-HBs - pos HBsAg - pos anti-HBc - pos HBeAg - pos symptoms >6 mo - pos active inflammation - pos fibrosis Transmission risk?
Chronic Active Hepatitis Transmission: yes, has both HBeAg and HBsAg Incr risk of cancer & cirrhosis Treatment: interferon & lamivudine
517
What stage of hepatitis B? - neg HBeAg - pos anti-HBc - neg active inflammation - neg fibrosis - pos elevated liver enzymes >6 mo Transmission risk?
Chronic persistent hepatitis Transmission: No, b/c no HBsAg or HBeAg
518
How would you differentiate chronic hepatitis C from active vs persistent? Treatment?
Chronic Active Hep C - pos inflammation - pos fibrosis - incr risk cirrhosis & cancer Treat: Ledipsavir/sofosbuvir combo Chronic Persistent Hep C - elevated liver enzymes or persistent symptoms >6 mo - neg inflammation - neg fibrosis
519
Why does hepatitis D require coinfection with hepatitis B?
Hep D uses Hep B surface antigen
520
Which hepatitis is associated with shellfish?
Hepatitis A - RNA picornavirus - Councilman bodies on liver biopsy
521
Which hepatitis is associated with high mortality in pregnant women?
Hepatitis E - RNA HepEvirus
522
Which hepatitis is the only DNA virus?
Hepatitis B - DNA hepadnavirus
523
Most common viral cause of myocarditis and pericarditis?
Coxsackie B Myo - leads to loss of contractility (S3 murmur) - diffuse ST depression Peri - causes friction or triphasic rub - may lead to cardiac tamponade - diffuse ST elevation
524
Most common viral cause of gastroenteritis - adults - children - recent travel
Adenovirus Rotavirus (not immunized) Norovirus (immunized) Norwalk agent
525
Most common causes of cystitis
Adenovirus - virus always #1 E. coli Proteus Klebsiella
526
Most common viral cause of bronchiolitis/croup Most severe viral cause of bronchiolitis/croup Other viral causes
Parainfluenza (80%) - mild RSV (15%) - severe, hospitalized Adenovirus and influenza
527
What are the infections that cause cold agglutination? (Elev IgM titers)
Cryoglobulinemia “I AM HE” - Influenza - Adenovirus - Mycoplasma - Hepatitis B & C - EBV
528
Viral causes of encephalitis
Arboviruses - Birds -> Mosquito -> Human - St Louis encephalitis - Equine Eastern Encephalitis *More E’s = more fatal Herpesvirus - prefers temporal lobe
529
Identify the meningitis 1) pos proteins, neutrophils, decr glucose 2) pos proteins, T cells and macrophages, decr glucose 3) pos proteins, T cells and macrophages, norm or elev glucose
1) Bacterial - strep pneumo - strep agalactiae - N meningitidis 2) TB/Fungal - coccidiodomycosis - cryptococcus neoformans 3) Viral (aseptic) - enterovirus - picorna
530
Common cold causes and how to differentiate
Rhinovirus -> nose only Coronavirus -> spring/summer Adenovirus -> fall/winter - conjunctivitis - swimming pool Herpesvirus -> attacks cornea and gums Influenza virus -> Nov-Feb Cryoglobulinemia Parainfluenza -> barking cough
531
MCC of bacterial meningitis - 0-2 months - 2 months - 10 years - 10-21 years - >21 years - immunocompromised
- strep agalactiae - strep pneumo - strep meningitis - strep pneumo - cryptococcus neoformans (presence of lymphocytes)
532
Dx of painful ulcers in back of mouth, soles of feet, and palms
Coxsackie A Hand-Foot-Mouth disease
533
Dx associated with a rash that presents as a red macule THEN clear vesicles THEN pustules and THEN scarring
Varicella Chicken pox Very itchy Incr risk of skin infection -> d/t scratching 1) staph aureus 2) strep pyogenes
534
Dx that presents as RA but resolves 2 weeks later
Parvovirus B19 - Fifth disease - Aplastic anemia - red lacy rash appearance on cheeks (= slapped cheeks) Rubella (3d measles) - lymphadenopathy behind ears and neck - morbilliform rash
535
Dx of morbilliform rash (Flat, red/pink spots that merge and become raised)
Rubeola (2w measles) - 3 C’s: cough, coryza, conjunctivitis - Koplik spots - SSPE Rubella (3d measles) - lymphadenopathy behind ears and neck
536
Dx of a collection of melanocytes in sacral area
Mongolian spots - normal in people of color - typically self resolve after a couple months - or persists without complications
537
Dx of Café au lait spots
Can be normal and resolve shortly after birth Or rule out: - neurofibromatosis type 1 (Chr 17, AD) (Pigmented iris hamartomas, optic glioma, pheochromocytoma, seizures) - McCune Albright Syndrome (Gs protein activating mutation) (Unilateral café au lait spots & at least one endocrinopathy)
538
Dx of a Port Wine stain
Can be normal and resolve shortly after birth Or Sturge-Weber - congenital anomaly of neural crest derivatives => capillary vascular malformations in CN V1/V2 distribution - angiomas in retina and brain

PP Clues (40 decks)

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