RX FLASH 256 Flashcards
(94 cards)
1
Q
- Seizures are rare
- CD4 count less than 100
- Delirium confusion
- FND (focal neural defects)
- Dementia
- Retinitis can cause vision to be messed up
A
CMV encephalitis in HIV
2
Q
- HIV-pneumonia
- CD4 count
A
Pneumocystis jirovecii
3
Q
Primary hypothyroidism
A
- Thyroxine = DECREASED
- TSH = INCREASED
- Triiodothyronine resin uptake = DECREASED
4
Q
Most common cause of Hypothyroidism in the USA
A
Hashimoto thyroiditis
- Anti-thyroglobulin
- Antithyroid peroxidase
- Anti-TSH receptor antibodies
5
Q
Histological findings of Hashimoto thyroiditis
A
Lymphocytic infiltration and germinal center formation HURTHLE CELLS (epithelial cells w/eosinophilic granular cytoplasm)
6
Q
Subacute (de Quervain) thyroiditis
- Mumps and Coxsackievirus
- Flu-illness and a painful, tender thyroid
A
Focal destruction of normal thyroid tissue w/GRANULOMATOUS INFLAMMATION
7
Q
Sheets of homogenous cells in an amyloid-containing stroma
A
Medullary Carcinoma
Originates from the C-cells of the thyroid
Produce calcitonin (tones down blood calcium)
Associated with MEN IIa and IIb
8
Q
Replacement of normal thyroid tissue w/fibrosis
A
Riedel thyroiditis
Idiopathic w/ diffuse fibrosis
Mimics carcinoma
9
Q
Isoproterenol
A
- Non-selective AGONIST of beta-receptors
- Vasodilation (B2)
- Increased Inotropic/chronotopic (B1)
10
Q
- Hypernatremia
- High serum osmolality > 290mOsm/L
- Low urine osmolality
- Low urine specific gravity
A
Diabetes Insipidus (DI)
11
Q
-Preventing relapse and acute manic events
A
Lithium
12
Q
Cause of TE fistula
A
-Tracheoesophageal septum fails to develop
13
Q
Most common form of TE fistula
A
- Blind upper esophagus with the lower esophagus having an anomalous connection to trachea
- Polyhydramnios is seen in all TE fistulas
14
Q
Double bubble sign
A
- Duodenal atresia
- Failure of duodenal recanalization
- Polyhydramnios
15
Q
Winged scapula
A
-Long thoracic Nerve (injury to axilla or breast surgery)
16
Q
Axillary nerve damage
A
-Deltoid muscle fibers (middle fibers) = arm abduction
17
Q
Axillary nerve damage can occur from=
A
Injury to surgical neck of humorous or anterior shoulder dislocation
18
Q
Ulnar nerve damage
A
- Injury to medial epicondyle of humerus
- CLAW HAND
- Ab/adduction weakness in fingers
- Adduction of the thumb (Lucas says you MUST know this)→spared in C-tunnel
- Extension of fingers
19
Q
Median nerve damage
A
- Supracondylar area of distal humerus
- Similar to C-Tunnel syndrome
20
Q
Vitamin B12 neuropathy/Subacute combined degeneration of spinal cord
A
- Demyelination of axons in the dorsal columns and spinocerebeller tracts (arm and leg ataxia)
- Associated with pernicious anemia
21
Q
Charcot-Marie-Tooth disease/ peroneal muscular atrophy
A
- Loss of conscious proprioception (posterior columns)
- Lower motor neuron signs (anterior horn motor neurons)
22
Q
Xp21 abnormality
A
- DMD
- Codes for dystrophin (myocyte-anchoring protein)
- X-linked recessive
23
Q
- Excessive iron reabsorption
- Micronodular cirrhosis, pancreatic fibrosis, and bronze skin pigmentation
A
Hemochromatosis (AR)
24
Q
G6PD inheritance
A
X-linked recessive
25
Physiologic Dead space (VD)
Vd= VT * [(PaCO2-PeCO2)/PaCO2]
26
Drug that can be used to prevent GVHD
Cyclosporine
27
Cyclosporine MOA
- Inhibits T-lymphocyte activation (IL-2)
| - Renal toxicity
28
Mycophenolate mofetil ADRs
- N/V, nausea, vomiting, abdominal pain,
| - LEUKOPENIA and ANEMIA
29
- Converted to mycophenolic acid in gut
- Potent, reversible, noncompetitive inhibitor of IMP dehydrogenase
- Inhibit de novo PURINE synthesis
Mycophenolate mofetil
30
Muromonab-CD3 ADR
- Anaphylactoid reactions
| - CNS (seizure and headache)
31
- Immunosuppressant after organ transplant
- Binds CD3
- Blocks access of the antigen recognition site (disrupts t-cell functioning)
Muromonab-CD3
32
- Monoclonal antibody that acts against an interleukin IL-2 receptor antagonist
- T-cells cannot proliferate if their receptor is blocked
- GI is main adverse effect
Daclizumab
33
- Pro-drug that is converted to 6MP
- NUCLEOTIDE analog
- IMMUNOSPPRESSIVE
- ADR: BONE MARROW SUPPRESSION
Azathioprine
| Used in RA, UC, etc
34
Risedronate and alendronate
- Bisphosphonates
- Treats metastatic bone diseases (multiple myeloma) and osteoporosis
- Reduce activating of osteoclasts
- ARD: GI and Hypocalcemia
35
- Cough
- Angioedema
- Proteinuria
- TASTE CHANGES
- RASH
- HYPERKALEMIA
ACE Inhibitor ADR
36
Vinca Alkaloids
- Vinblastine and Vincristine
- Testicular carcinoma
- Hodgkin
- Non-Hodgkin
37
Criteria for Chronic Bronchitis
- Productive cough lasting at least 3 months a year for at least 2 consecutive years
- Decreased FEV1 and FEV1: FVC
- Hypotrophy of mucus glands
- Monocytes and CD8+ T-cells
38
Reid index
Ratio of gland depth to the total thickness of bronchial wall
Normal:
39
Chronic Bronchitis Biopsy
- CD8+ T-cells and monocytes
- Squamous cell metaplasia and fibrosis
- Narrowing of bronchioles by mucus plugs
40
-Infiltration of eosinophils and CD4+ and Th2 lymphocytes
Asthma Histo
41
-Rare glucagon-secreting tumor that can cause hyperglycemia, diarrhea and weight loss
Glucagonoma
42
What rash is Glucagonoma associated with?
- Necrolytic migratory erythema
| - Painful, pruritic, erythematous papules that blister, erode and crust over
43
- Present w/ fasting HYPOglycemia
- Diaphoresis, palpitations, tremulousness, behavior changes and confusion
- Can be mistaken for neuro disorder
- Weight gain
Insulinomas
44
Adenocarcinoma of the pancreatic tail rash
- Migratory thrombophlebitis (Trousseau Syndrome)
| - Extremities become red and tender
45
Aschoff Body
- Focal area of interstitial/perivascular inflammation characterized by fragmented collagen
- Mononuclear cells (Antischkow)—can be seen in normal myocardium
- Multinucleated giant cells (Aschoff)
46
- Rare endocrine tumors
- Arise from pancreatic islets
- Chronic profuse, watery diarrhea
- Can cause hyperglycemia and a pancreatic mass on CT
VIPomas
47
- Central area of necrosis w/ macrophages
| - Surrounded by lymphocytes and plasma cells
Caseating granuloma
48
Foam cells
- Present in atherosclerosis plaques
| - Lipid-laden macrophages
49
Marfan’s (AD) Findings I still didn’t know…
- Arm span exceeding height (ratio>1.05)
- Reduced upper-to-low body segment ratio
- Arachnodactyly
- Scoliosis greater than 20 degrees
- Dural Ectasia
- Aortic involvement (dilation of root→regurgitation)
50
AD
15
Fibrillin (component of microfibrils)
Microfibrils are critical in: Elastin of aorta, suspensory ligaments of lens of eye, and other connective tissue
Marfan’s Chromosome
51
Treatment of hemochromatosis
Regular phlebotomy
| DEFEROXAMINE (iron-chelating agent)
52
- Deficiency of a biliary cooper-excreting ATPase
- Hepatic cooper accumulation and toxicity
- Ceruloplasmin decreased
Wilson disease (AR)
53
-Decreased TIBC (indirect measure of serum transferrin)
Note- Transferrin (binds iron in blood) is down-regulated in iron overload b/c decreased need for iron absorption
-FERRITIN VERY HIGH (iron storage)
Hemochromatosis “Bronze diabetes”
54
Where is ferritin (iron storage) found?
-Liver and erythroid cell line
55
Ion: Ca2+ (increased inward current)
Physiologic Effect: Conduction velocity
Site of action: AV node
Dromotropy
56
Ca2+
Contractility
Cardiac myocytes (site of action)
Inotropy
57
Na+ Ca2+
Heart rate
Site of action= SA node
Chronotropy
58
In contrast to Wegner’s granulomatosis, which vasculitis has the lungs spared?
PAN (polyarteritis nodosa)
59
- Spares lungs
- Different stages inflammation coexist in different vessels
- Bead of pearls
- HepB Ag-Antibody
Polyarteritis nodosa “Buzz phrases”
60
PAN skin rash?
Livedo reticularis: ulcerations and a purplish discoloration
| In addition: anemia, CPR increased, neutrophilic leukocytosis
61
- Necrotizing vasculitis that affects small vessels
- All vessels are typically at the same stage of inflammation
- MPO-ANCA (P-ANCA)
- Lung and kidney most common affected
Microscopic polyangiitis
62
Microscopic polyangiitis
- Necrotizing vasculitis that affects small vessels
- All vessels are typically at the same stage of inflammation
- MPO-ANCA (P-ANCA)
- Lung and kidney most common affected
63
- Tx for sickle cell
- Also for decreasing burden of high WBC counts in acute leukemia and CML
- Anti-metabolite that works in S phase
- MYELOSUPPRESSION= ADR
Hydroxyurea
64
At least two of the following symptoms must be present at least 6 months
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic behavior
- Negative symptoms (flat affect, lack of motivation, poverty of speech)
Diagnosis of schizophrenia requires what?
65
Besides CML what else does Imantinib treat?
Gastrointestinal STROMAL tumors
66
Must have for at least one month
- Non-bizarre delusions that are not attributable to another psychiatric condition
- Does not impair normal life
Delusion Disorder Criteria
67
What are the negative symptoms of schizo?
- Flat affect
- Lack of motivation
- Poverty of speech
68
Schizo in populations
Affects 1%
69
Presence of at least one of the following for AT LEAST A DAY but LESS THAN A MONTH:
- Hallucinations
- Delusions
- Disorganized speech
- Grossly disorganized behavior
Brief psychotic disorder
70
History of hypotonia, stretchy skin, and abnormal joints
- Ehlers-Danlos syndrome (defect in collagen synthesis)
| - Normal intelligence and meet milestones
71
-Reduces surface tension by disrupting INTERMOLECULAR FORCES (hydrogen bonds) of alveoli
Surfactant
72
- Manifest in newborns as muscle hypotonia and joint laxity
- May be present at birth or manifest later
- Respiratory complications and recurrent joint dislocations
- Hyperextensible skin and typically velvety, pale and translucent with poor wound healing
- Vascular fragility w/spontaneous rupture
Kyphoscoliosis form of Ehlers-Danlos
73
Kyphoscoliosis form of Ehlers-Danlos defect
Most common= Lysyl hydroxylase (enzyme that cross-links collagen fibrils)
74
Pompe disease
Type II glycogen storage disease
75
- Lysosomal alpha-1-4-glucosidase→cardiomegaly, hepatomegaly and skeletal myopathy
- Die of respiratory failure by 2 years of age
Pompe disease deficiency
76
- Osteoclast cannot appropriately reabsorb bone → form of osteoporosis
- Multiple fractures
- HSM from extramedullary hematopoiesis
Deficiency of carbonic anhydrase II
77
Neurofibromin
Tumor suppressor gene = inactivated in NF1
- Remember skeletal abnormalities also seen
- AD
78
- COL5A1 or COL5A2 mutations
- Type V collagen defect
- Large and small joint hypermobility
- Widen scars
- Hyperextensible and fragile skin
- MOLLUSCUM PEUDOTUMORS
- Hernias
EDS (Ehlers-Danlos Syndrome): Classic Subtype
79
EDS (Ehlers-Danlos Syndrome): Arthrochalsia subtype
- COL1A1 or COL1A2 mutations (type I collagen defect)
- Joint hypermobility
- CONGENITAL HIP DISLOCATION
- RECURRENT DISLOCATIONS/SUBLUXATIONS
80
- Unknown pathogenesis
- Large and small join hypermobility
- AUTONOMIC INSTABILITY
- DELAYED GASTRIC EMPTYING
- IBS
EDS (Ehlers-Danlos Syndrome): Hypermobility subtype
81
EDS (Ehlers-Danlos Syndrome): Dermatosparaxis subtype
-ADAMTS2 mutation (procollagen)
82
- COL3A1 mutations (type III procollagen defect
- SMALL JOINT hypermobility
- Thin translucent skin
- THIN FACE
- Easy bruising
- Arterial, uterine and intestinal rupture
EDS (Ehlers-Danlos Syndrome): Vascular Subtype
83
EDS (Ehlers-Danlos Syndrome): Kyphoscoliosis subtype
- PLOD1 mutation (Lysyl hydroxylase deficiency
- Joint hypermobility
- CONGENITAL HYPOTONIA
- SCOLIOSIS
- Fragile sclera
- Retinal detachment
- Glaucoma
- Medium-sized arterial rupture
84
- COL1A1 or COL1A2 mutations (type I collagen defect)
- Joint hypermobility
- CONGENITAL HIP DISLOCATION
- RECURRENT DISLOCATIONS/SUBLUXATIONS
EDS (Ehlers-Danlos Syndrome): Arthrochalsia subtype
85
EDS (Ehlers-Danlos Syndrome): Hypermobility subtype
- Unknown pathogenesis
- Large and small join hypermobility
- AUTONOMIC INSTABILITY
- DELAYED GASTRIC EMPTYING
- IBS
86
EDS (Ehlers-Danlos Syndrome): Vascular Subtype
- COL3A1 mutations (type III procollagen defect
- SMALL JOINT hypermobility
- Thin translucent skin
- THIN FACE
- Easy bruising
- Arterial, uterine and intestinal rupture
87
- PLOD1 mutation (Lysyl hydroxylase deficiency
- Joint hypermobility
- CONGENITAL HYPOTONIA
- SCOLIOSIS
- Fragile sclera
- Retinal detachment
- Glaucoma
- Medium-sized arterial rupture
EDS (Ehlers-Danlos Syndrome): Kyphoscoliosis subtype
88
-ADAMTS2 mutation (procollagen)
EDS (Ehlers-Danlos Syndrome): Dermatosparaxis subtype
89
Langhans giant cells
-Granulomatous lung diseases (ex: TB)
90
LangERhans Cells
-Seen specifically in pulmonary Langerhans cell histiocytosis
91
Birbeck Granules
- Seen in histolytic cells that are closely related to Langerhans’ cells of skin
- Tennis racket cytoplasmic inclusions
92
Intra-arterial thrombus with RBC extravasation on histology
Pulmonary embolism
93
Marked intra-alveolar fibrin and cellular debris (microscopic)
ARDS
94
Thick-walled spherules containing endospores with surrounding inflammatory cells
-Coccidoidomycosis
