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7/19 Flashcards

1
Q

what is central DI

A

ADH deficiency

you diurese and urinate too much,
loss of free water

polyuria and polydipsia with life-threatening dehydration
Hypernattremia (concentrating Na in blood from straight water/volume loss)
dilute urine (straight water loss)

water deprivation test does not concentrate urine

treat with desmopressin, ADH analog

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2
Q

what is nephrogenic DI

A

impaired response to ADH

could be 2/2 lithium, antibiotics

clinical features are similar to central DI
(polyuria, polydipsia, hypernatremia, dilute urine)
but NO RESPONSE to desmopressin

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3
Q

what is SIADH

A

excessive ADH secretion
you don’t pee, you’re holding on to all free water

retention of free water will cause:
hyponatremia (diluted blood)
mental status changes, seizures (neuronal swelling)

treatment: water restriction, or demeclocycline, which blocks ADH effect

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4
Q

what is hyperaldosteronism

A

high aldosterone

aldosterone normally acts on collecting duct to:
retain Na, and therefore retain H2O
dump K
dump H+

presents:
HTN (high Na, high water in blood)
hypokalemia (dump)
metabolic alkalosis (dumped H+ in urine)

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5
Q

what is hyperaldosteronism

A

high aldosterone

aldosterone normally acts on collecting duct to:
retain Na, and therefore retain H2O
dump K
dump H+

presents:
HTN (high Na, high water in blood)
hypokalemia (dump)
metabolic alkalosis (dumped H+ in urine)

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6
Q

what are the buzzwords for asbestos

A

shipyards
roofing
plumbing

“ivory white” calcified supra diaphragmatic and pleural plaques are pathognomic

also ferruginous bodies (golden-brown fusiform rods resembling dumbbells) with Prussian blue stain

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7
Q

what are the buzzwords for berylliosis

A

aerospace and manufacturing

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8
Q

what are the buzzwords for coal workers pneumoconiosis

A

coal dust exposure

anthracosis is what normal city-dwellers probably have

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9
Q

what are the buzzwords for silicosis

A

foundries
sandbalsting
mines
“eggshell calcifications” on hilar lymph nodes

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10
Q

where do the pneumoconiosis present in the lung

A

Lower lobes:
asbestos

Upper lobes:
beryllium
Coal
Silicosis

“asbestos is from the roof, but affects the floor”
“silica and coal are from the earth, but affect the roof”

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11
Q

what are Calcium oxalate stones

A

most common
from hypocitraturia
radiopaque

shaped like envelope or dumbbell- square with an X

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12
Q

what can cause Calcium oxalate stones

A

can result from ethylene glycol (antifreeze)

vitamin C abuse
hypocitraturia
malabsorption (Crohn’s!)

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13
Q

what are calcium phosphate stones

A

radiopaque (like calcium oxalate)

wedge-shaped prisms

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14
Q

what are ammonium magnesium phosphate stones

A

radiopaque
AKA Struvite
associated with high pH

urease positive organisms!!! (NH3 spray bottles)

shaped like coffin lids

commonly form the stag horn calculi

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15
Q

what are uric acid stones

A

radiolucent

shaped like yellow/brown rhombus

strong association with hyperuricemia/gout or high cell turnover (leukemia)

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16
Q

what are cysteine stones

A

radiolucent

shaped like hexagons- flat, may be clear or yellow
(sounds like 6) “CYSTINE stones have 6 sides”

associated with hereditary condition where Cysteine-Reabsorbing PCT transporter loses function, causing Cysteinuria and COLA

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17
Q

how does Cystinuria present

A 
defect in renal PCT and intestinal transporter that cannot reabsorb COLA:
Cystine
Ornithine
Lysine
Arginine

recurrent hexagonal “six-tine” stones

treat by alkalizing the urine and proper hydrating

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18
Q

what is adenomyosis

A

extension of endometrial tissue into uterine myometrium

presents w/ dysmenorrhea, menorrhagia, and uniformly enlarged, soft, GLOBULAR UTERUS (bulky/tender)

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19
Q

what is leiomyoma of endometrium

A

AKA Fibroid

most common tumor of females

presents w/ multiple discrete tumors
benign smooth muscle
estrogen sensitive- so it grows/shrinks

“irregular uterine enlargement” that may lead to constipation or urine problems, or asymptomatic

histo shows whorled pattern of SM bundles with well-demarcated borders

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20
Q

what is endometrial hyperplasia

A

abnormal endometrial gland proliferation,
usually 2/2 excess estrogen

presents:
postmenopausal bleeding, or irregular bleeding premenopausal

increased risk for endometrial carcinoma

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21
Q

what’s the greatest risk for endometrial hyperplasia to turn into carcinoma

A

nuclear atypia

not complex architecture

22
Q

what is endometritis

A

inflammation of endometrium- an infection of decidua

associated with retained products of conception, miscarriage, abortion, or foreign bodies/IUDs.

23
Q

what is endometriosis

A

non-neoplastic endometrial tissue OUTSIDE THE ENDOMETRIAL CAVITY

most commonly found in ovary (CHOCOLATE CYST),
pelvis
peritoneum

presents:
cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility
normal-sized uterus

24
Q

distinguish RA from OA joint findings

A 
RA:
symmetric joints
"soft, spongy, warm joints"
systemic symptoms
soft tissue swelling and inflammation (WBCs)
involves MCP, PIP, wrist
NOT DIP OR CMC

OA:
asymmetric 
"hard, bony enlarged joints"
weight bearing joints
osteophytes/bone spurs
no swelling (no/low WBCs)
involves DIP and PIP and CMC
NOT MCP
25
what is the buzzword for white parchment-like skin over vulva
lichen sclerosis thinning of epidermis, fibrosis/sclerosis of dermis
26
what is the buzzword for thick, leathery vulvar skin
lichen simplex chronicus
27
what are MUDPILES
anion gap metabolic acidosis ``` Methanol (formic acid) Uremia DKA Propylene glycol Iron or Isoniazid Lactic acidosis Ethylene glycol (antifreeze, oxalic acid) Salicylates (late, aspirin) ```
28
how do you calculate anion gap
Na - (Cl + HCO3) greater than 12 = anion gap
29
what are the normal-gap metabolic acidosis
HARDASS ``` Hyperalimentation Addison Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```
30
what is Winters formula used for
calculates the predicted respiratory compensation for a simple metabolic acidosis.
31
how do you use Winters
use it to determine what type of respiratory compensation you have during metabolic acidosis Calculate a CO₂: CO₂ = 1.5 [HCO3-] + 8 +/- 2 compare the calculated/predicted CO₂ to the measured CO₂ (the pt's given lab value) If lab < calculated, you have superimposed respiratory alkalosis (hyperventilation) if lab > calculated, you have superimposed respiratory acidosis (hypoventilation- CO₂ is still high, you're not blowing enough off- think respiratory failure) if lab values is in the range of your calculated value, then you just have a metabolic acisosi
32
what causes hypercalcemia in sarcoidosis
1,25-dihydroxycholecalciferol
33
which drug inhibits transport of cholesterol through the intestinal wall
Ezetimibe Z-SHAPED EEL the eel likes to stay thin, so he's going to get rid of cholesterol
34
which drug inhibits transport of bile acids through the intestinal wall
Cholestyramine- bile acid resins GOLD LOBSTER (steers clear of cholesterol, goes for the bile acids instead); or the lobster can clamp down on bile acids but not the gold bars of cholestyramine
35
what presents with bronze diabetes
hemochromatosis folks
36
what is hemochromatosis's path
HFE gene mutation (C282Y) where you have abnormal iron sensing, so high intestinal absorption of Iron high ferritin/storage high iron low TIBC/transferrin saturation
37
what do you stain Iron with
Prussian Blue stain
38
what's a unique treatment for hemochromatosis
discourage Vitamin C, which helps increase intestinal iron absorption
39
what does sulfasalazine treat
ulcerative colitis, Crohns activated by colonic bacteria
40
whats the buzzword for umbilicated blisters
molluscum contagiosum- flesh colored, umbilicated blisters on kids in clusters, 2-4mm. Pox-virus
41
what do skews do to mean, median, and mode
positive skew: the tail trials positively mode is always at the highest peak, then median then mean out with the tail mean, median, mode in alphabetical order. it just depends on which skew you're looking at with which order they go
42
how does neisseria travel
``` nasopharynx invades mucosal epithelium blood stream spreads to choroid plexus crosses BBB to get into CNS ```
43
what treats acute delirium
high potency first generation antipsychotics (haloperidol) and some 2nd generations benzodiazepines may worsen confusion, especially in elderly. they're only appropriate to tx alcohol-withdrawal delirium
44
what is seen on cholera stool exam
mucus and some sloughed epithelial cells it's a purely toxin-mediated watery diarrhea. these toxins modify electrolytes but do not cause cell death, so no RBCs or WBCs will be seen on stool microscopy
45
how do you prevent neonatal tetanus
vaccinate pregnant mom, so they'll give passive immunity via IgG vaccinate infant at 2months with activate vaccination
46
what is anorexia nervosa
low BMI intense fear of becoming fat distorted body image can be either binge/purge or restriction legitimate med complications: osteoporosis amenorrhea cardiopathy
47
what is bulimia nervosa
recurrent binge/purge and preoccupation with body image maintain normal BMI don't have signs/symptoms of malnutrition or starvation BINGE BUT MAINTAIN BMI
48
what is associated with chronic dopamine antagonist meds
tardive dyskinesia commonly caused by first-generation antipsychotics
49
what is repetitive, rhythmic, involuntary movements of tongue, lips, face, trunk, and extremities
tardive dyskinesia
50
what might develop acutely after starting a dopamine antagonist
acute extrapyramidal syndromes involuntary contraction of neck, mouth, tongue, or eyes akathisia: physical restlessness, difficulty sitting still, and compelling need to move drug-induced parkinsonism: tremor, bradykinesia, and cogwheel rigidity
51
what causes HbS to sickle
deoxygenated state and associated conditions: low pH (high CO₂, high H+) high levels of 2,3-bisphosphoglycerate
52
which amino acid is most abundant in collagen
glycine, every 3rd AA to form alpha chains held together by hydrogen bonds, forming a rope-like triple helix (collagen molecule)

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