Classic Presentations Flashcards
Abdominal pain, diarrhea, leukocytosis, recent antibiotic use
Clostridium dificile infection
Achilles tendon xanthoma
Familial hypercholesterolemia
decreased LDL receptor signaling
Adrenal hemorrhage, hypotension, DIC
Waterhouse-Friderichsen syndrome (meningococcus)
Anaphylaxis following a blood transfusion
IgA deficiency
Anterior drawer sign (+)
ACL injury
Athlete w/ polycythemia
Secondary to EPO injxn
Back pain, fever, night sweats
Pott disease
vertebral TB
Bilateral acoustic schwannoma
NFT type II
Bilateral hilar lymphadenopathy, uveitis
Sarcoidosis
Black eschar on the face of a patient w/ diabetic ketoacidosis
Mucor or Rhizopus infxn
Blue sclera
Osteogenesis imperfecta
Type I collagen defect
Bluish line on the gingiva
Burton line
Lead poisoning
Bone pain, bone enlargement, arthritis
Paget disease of the bone
Increased osteoblastic and osteoclastic activity
Bounding pulses, diastolic heart murmur, head bobbing
Aortic regurgitation
Butterfly facial rash and Raynaud phenomenon in a young female
SLE
Rash
Arthritis
Serositis
Hematologic disorders
Oral ulcers
Raynaud’s Phenomenom/ Renal disease
Photosensitivity
Antinuclear abs
Immunosuppressants
Neurologic disorders (seizures, psychosis)
Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
McCune-Albright syndrome
mosaic G-protein signaling mutation
Cafe-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytommas, optic gliomas
NFT Type I
Cervical Lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae, red tongue
Kawasaki disease
(Tx. w/ IVIG and aspirin)
CRASH and burn
Calf pseudohypertrophy
Muscular dystrophy
most commonly Duchenne, due to X-linked recessive mutation of dystrophin gene
“Cherry-red” spots on the macula
Tay-Sachs Disease
(ganglioside accumulation)
Nieman-Pick’s Disease
(sphingomyelin accumulation)
Central retinal artery occlusion
Chest pain on exertion
Angina (stable)
Chest pain, pericardial effusion/friction rub, persistent fever following an MI
Dressler Syndrome (AI-mediated post-MI fibrinous pericarditis, 2-12 weeks after episode)
Chest pain w/ ST depressions on EKG
Unstable angina
Child uses arms to stand up from squat
Gower’s Sign
Duchenne’s muscular dystrophy
Child w/ fever later develops red rash on face that spreads to body
“Slapped cheeks”
(erythema infectiosum/fifth disease; parvovirus B19
Chorea, dementia, caudate degeneration
Huntington’s Disease
AD CAG repeat expansion
Chorioretinitis, hydrocephalus, intracranial calcifications
in newborn
Congenital toxoplasmosis
Chronic exercise intolerance w/ myalgia, fatigue, painful cramps, myoglobinuria
McArdle’s Disease
(Skeletal muscle glycogen phosphorylase deficiency)
(Type V glycogen storage disease)
Cold intolerance
Hypothyroidism
Conjugate horizontal gaze palsy
Internuclear ophthalmoplegia
damage to MLF; may be unilateral or bilateral
Continuous “machine-like” heart murmur
PDA
Close w/ indomethacin; open or maintain w/ PGE
Cutaneous/dermal edema due to connective tissue deposition
Myxedema
(Caused by hypothyroidism, Grave’s Disease)
-Commonly pretibial
Cutaneous flushing, diarrhea, bronchospasms
Carcinoid syndromem
Right sided cardiac valvular lesions, increased 5-HIAA
Dark purple skin/mouth nodules in a patient w/ AIDS
Kaposi’s Sarcoma
HHV-8
Deep, labored breathing/hyperventilation
Kussmaul respirations
Diabetic Ketoacidosis
Dermatitis, dementia, diarrhea
Pellagra
Niacin deficiency
Dilated cardiomyopathy, edema, alcoholism or malnutrition
Wet beriberi
Thiamine deficiency
Dog or cat bite resulting in infxn
Pasteurella multocida
cellulitis at infxn site
Dry eyes, dry mouth, arthritis
Sjogren syndrome
AI destruction of salivary glands
Dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer-Vinson Syndrome
May progress to esophageal SCC
Elastic skin, hypermobility of joints, increased bleeding tendency
Ehlers-Danlos syndrome
Type V collagen defect; type III collagen defect seen in vascular subtype of EDS
Enlarged, hard left supraclavicular node
Virchow node
Abdominal metastasis
Episodic vertigo, tinnitus, hearing loss
Meniere Disease
Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells
Mycosis fungiodes
(cutaneous T-cell lymphoma)
Sezary Syndrome
(mycosis fungiodes+malignant T-cells in blood)
Facial muscle spasm on tapping
Chvostek sign
hypocalcemia
Fat, female, forty, fertile
Cholelithiasis
Fever, chills, headache, myalgia following antibiotic tx. for syphilis
Jaisch-Herxheimer reaction
Rapid lysis of spirochetes resulting in endotoxin release
Fever, cough, conjunctivitis, coryza, diffuse rash
Measles
Fever, night sweats, weight loss
B-sx. of lymphoma (likely Hodgkin’s)
Fibrous plaques in soft tissue of penis w/ abnormal curvature
Peyronie disease
Connective tissue disorder
Golden brown rings around peripheral cornea
Kayser-Fleischer rings)
Cu2+ accumulation in Wilson’s disease
Gout, intellectual disability, self-mutilating behavior in a boy
Lesch-Nyhan Syndrome
HGPRT deficience, X-linked recessive
Hamartomous GI polpys, hyperpigmentation of mouth/feet/hands/genitalia
Peutz-Jeghers syndrome
inherited, benign polyposis can cause bowel obstruction; increased cancer risk, mainly GI but others too
Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises
Gaucher’s Disease
glucocerbrosidase deficiency
Abdominal pain, ascites, hepatomegaly
Budd-chiari syndrome
posthepatic venous thrombosis
Hereditary nephritis, sensorineural hearing loss, cataracts
Alport syndrome
Defective type IV collagen
Hyperphagia, hypersexuality, herporality, hyperdocity
Kluver-Bucy Syndrome
Bilateral amygdala lesion
Hyperreflexia, hypertonia, Babinski
UMN damage
Hyporeflexia, hypotonia, atrophy, fasciculations
LMN damage
Hypoxemia, polycythemia, hypercapnia
Blue bloater
Chronic bronchitis; hyperplasia of mucous cells
Indurated, ulcerated genital lesion
Nonpainful: chancre (Primary syphilis)
Painful: Chancroid (Haemophils ducreyi)
Infant w/ cherry-red spot on macula, hepatosplenomegaly, neurodegeneration
Niemann-Pick Disease
Sphingomyelinase deficiency
Infant w/ cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia
Patau syndrome
Infant w/ hypoglycemia, hepatomegaly
Cori disease (debranching enzyme deficiency)
Von Gierke disease (glucose-6-phosphatase deficiency; more severe)
Infant w/ rocker-bottom feet, microcephaly, clenched hands, structural heart defect
Edwards syndrome
Jaundice, palpable distended non-tender gallbladder
Distal obstruction of biliary tree
Large rash w/ bulls-eye appearance
Erythema migrans (Lyme disease from Ixodes TICK bite)
Lucid interval after traumatic brain injury
Epidural hematoma
Middle meningeal artery rupture
Male child, recurrent infxns, no mature B-cells
Bruton’s Disease (X-linked agammaglobulinemia)
Mucosal bleeding and prolonged bleeding timme
Glanzmann thrombasthenia
defect in platelet aggregation due to lack of GPIIb/IIIa
Muffled heart sounds, distended neck veins, hypotension
Beck’s triad
Indicates cardiac tamponade
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth
Gardner Syndrome
Subtype of FAP
Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance
Pompe Disease (lysosomal a1,4-glucosidase deficiency)
Neonate w/ arm paralysis following difficult birth
Erb-Duchenne palsy (superior trunk injury from C5-C6)
Results in waiter’s tip
No lactation postpartum, absent menstruation, cold intolerance
Sheehan syndrome
Pituitary infarct
Nystagmus, intention tremor, scanning speech, bilateral internuclear opthalmoplegia
MS
Painful blue fingers/toes, hemolytic anemia
Cold agglutinin disease
Mycoplasma pneumonia= anti-I
Mono= anti-i
Painful fingers/toes changing color from white to blue to red with cold or stress
Raynaud’s phenomenon
Vasospasm
Painful, raised red lesions on pads of fingers/toes
Osler nodes
Indicates infective endocarditis
Painless erythematous lesions on palms and soles
Janeway lesions
Indicates infective endocarditis, septic emboli
Painless jaundice
Cancer of the pancreatic head obstructing the bile duct
Palpable purpura on buttocks/legs, joint pain, abdominal pain, hematuria
Henoch-Schonlein purura
IgA vasculitis affecting skin and kidneys
Pancreatic, pituitary, parathyroid tumors
MEN 1 (AD)
Periorbital and peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia
Nephrotic syndrome
Pink complexion, dyspnea, hyperventilation
Pink puffer
Emphysema
Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic Rickett’s
Fanconi syndrome
Multiple combined dysfnxn of the PCT
Pruritic, purple, planar, polygonal papules and plaques
Lichen planus
Assoc. w/ HCV
Ptosis, miosis, anhydrosis
Horner Syndrome
Sympathetic chain lesion
Pupil accommodates but doesn’t react
Argyll-Robertson pupil
Neurosyphilis; “Prostitute’s pupil”
Rapidly progressive limb weakness that ascends following GI/URI
Guillain-Barre syndrome
Acute inflammatory demyelinating polyradiculopathy subtype
Rash on palms and soles
Coxsackie A, secondary syphilis, Rocky Mountain Spotted Fever
Recurrent cold abscesses, unusual eczema, high serum IgE
Hyper IgE syndrome
Neutrophil chemotaxis abnormality
Red “currant jelly” sputum in alcoholic or diabetic pts.
Klebsiella pneumoniae pneumonia
Red “currant jelly” stools
Acute mesenteric ischemia (adults)
Intussusception (children)
Red, itchy, swollen rash of nipple/areola
Paget’s disease of the breast
Red urine in the morning, fragile RBCs
Paroxysmal nocturnal hemoglobinuria
Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma
von-Hippel Lindau disease
Dominant TSG mutation
Resting tremor, akinesia, rigidity, postural instability, shuffling gait
Parkinson disease
Loss of dopaminergic neurons in the SN pars compacta
Retinal hemorrhages w/ pale centers
Roth spots
Indicates bacterial endocarditis
Severe jaundice in neonate
Cirgler-Najjar syndrome
Congenital unconjugated hyperbilirubinemia
Severe RLQ pain / palpation of LLQ
Rovsing sign
Acute appendicitis indicator
Severe RLQ pain w/ rebound tenderness
McBurney sign
Acute appendicitis indicator
Short stature, cafe-au-lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia
Fanconi anemia
Genetic loss of DNA crosslink repair; often progresses to AML
Single palmar crease
Down syndrome
Situs inversus, chronic sinusitis, bronchiectasis, infertility
Kartagener syndrome
Dynein arm defect affecting cilia
Skin hyperpigmentation, hypotension, fatigue
Addison’s disease
Increased ACTH and a-MSH production; due to adrenocortical insufficiency
Slow, progressive muscle weakness in boys
Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne’s)
Small, irregular red spots on buccal/lingual mucosa w/ blue-white centers
Koplik spots
Measles (rubeola)
Smooth, moist, painless, wart-like lesions on the genitals
Condylomata lata
Secondary syphilis
Splinter hemorrhages in fingernails
Bacterial endocarditis
“Strawberry tongue”
Scarlet Fever
or
Kawasaki disease
Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema
Turner Syndrome
45 XO
Sudden swollen/painful big toe joint
Gout
Swollen gums, mucosal bleeding, poor wound healing, petechiae
Scurvy
Vitamin C deficiency (cant hydroxylate proline/lysine for collagen synthesis)
Swollen, hard, painful finger joints
Osteoarthritis
Osteophytes on PIP, DIP
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
Telangectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria
Osler-Weber-Rendau syndrome
Thyroid and parathyroid tumors, pheochromocytoma
MEN 2A
AD RET mutation
Thyroid tumors, pheochromocytoma, ganglioneuromatosis, marfoid habitus
MEN 2B
AD RET mutation
Toe extension/fanning upon plantar scrape
Babinski sign
Unilateral facial drooping involving forehead
LMN facial nerve palsy; UMN lesions will spare the forehead
Urethritis, conjunctivitis, arthritis in male
Reactive arthritis assoc. w/ HLA-b27
Vascular birthmark (port-wine stain) of the face
Nevus flammeus
Assoc. w/ Sturge-Weber syndrome
Vomiting blood following gastroesophageal lacerations
Mallory-Weiss syndrome
Usually in alcoholic and bullemic patients
Weight loss, diarrhea, arthritis, fever, adenopathy
Whipple disease
Caused by Tropheryma whipplei
“Worst headache of my life”
Subarachnoid hemorrhage
Delayed separation of the umbilical cord
Leukocyte Adhesion Deficiency
-defect in LFA-1 integrin causing poor PMN migration
Partial albinism, peripheral neuropathy, recurrent infxns
Chediak-Higashi syndrome
Ataxia, spider angiomas, IgA deficiency
Ataxia-telangectasia
-Asoc w/ increased AFP; cause by defect in ATM gene causing decreased DNA double strand break repair
Cheilosis, Corneal vascularization
2 C’s of B2 deficiency; decreased capability of some redox reactions
-cheliosis is inflammation and fissure formation at the corners of the mouth
Diarrhea
Dermatitis
Dementia
3 Ds of D3
Dementia- hallucinations
Dermatitis- rash on sun-exposed areas, especially around the collar
Excessive egg white consumption
Biotin (B7) deficiency
-Needed for carboxylase enzymes (deficiencies cause decreased FA production, breakdown, and gluconeogenesis)
Clinical: Dermatitis, alopecia, enteritis
Upward gaze palsy, absent pupillary light reflex, impaired convergence
Parinaud Syndrome
-possibly due to a pinealoma
Utricle
Contains hair cells that respond to linear acceleration and the force of gravity
What later of the meninges is the sclera continuous with?
The dura mater
Location of the canal of Schlemm
The limbus (sclerocorneal jnxn)
Obstruction causes glaucoma
Retinitis pigmentosa
Inherited degeneration of the rods associated with Abetalipoproteinemia
➡️night blindness, “gun-barrel” vision
Tx: Vitamin A
Embryonic Sources of the adult diaphragm
- Septum Transversum (part of the central tendon of the diaphragm in the adult)
- Paired Pleuroperitoneal membranes
- Dorsal mesentary of the esophagus
(Forms the Crura of the diaphragm in an adult) - Body wall
hPL
Hormone produced by the placenta that induces lipolysis to increase FFA levels in the mother
“Pregnancy growth hormone”
APGAR
Appearance Pulse Grimace Activity Respiratory effort
0-3 = life-threatening situation
3-7 = ventilation support needed
Peurperium
The 6 weeks it takes for normal uterine fnxn to return after having a baby
May manifest as after pains, some uterine discharge
-If lactating, may take 10 weeks
Newborn with digit hypoplasia, Craniofacial defects, mental and growth retardation, and a cleft palate
Fetal Hydantoin syndrome
HCTZ and pregnancy
Causes fetal jaundice and thrombocytopenia
Irreversible damage to hepatocytes signified by…
Damage to the connective tissue architecture of the liver
Integrins
Bind intracellular cytoskeletal elements (like actin) to extracellular proteins (like fibronectin)
RAS proteins are activated by what type of receptor?
Growth factors (usually TKs)
CDK1
Controls the G2 =» M transition
-Regulated by CDKIs which can be activated by TGF-B
Gene knockout therapy is performed on what kind of cells?
Embryologic stem cells (represent a totipotent type of stem cell)
MAP Kinase
Activated by growth factor signals and increase RAS activation and DNA transcription
CCR5 and CXCR4 are what type of receptors?
Chemokine receptors; utilized by HIV for entry into macros and CD4 cells
MCC tumors assoc. w/ HIV
B-cell non Hodgkin’s lymphoma and Kaposi’s sarcoma
Juvenile Rheumatoid Arthritis
Child presenting w/ arthritis involving the large joints of the lower extremities
- RF will be ABSENT
- Most cases spontaneously resolve w/ no long term consequences
Hereditary Angioedema
Pts. present w/ recurrent episodes of edema throughout their life; possible dyspnea accompanying episodes but no increase in IgE, eos, or other HSN markers
-ACEIs are CI’d
IL-17
Made by Th17 cells; play a role in Type IV HSN
Protein that allows tumor cells to attach to new BMs
Laminins
HNPCC mutations
DNA mismatch repair genes PMS1, PMS2, MLH1
TNM
Tumor size (>distant metastases)
Unilateral orbital swelling, travel to SA, megacolon/megaesophagus, dilated cardiomyopathy with apical atrophy
Trypanosoma cruzi
Tx: Nifurtimox/benznidazole
Fever and sporadic hemolytic anemia, Maltese cross on Blood smear
Babesia
Tx: Atovaquone and Azithromycin
Botulism EPPs
EPP is the only thing that goes down; actual Ach response remains the same
Internal Validity
Reflects the amount of bias in a study; inversely related
Immunohistochemistry
Fluorescent antibodies used to identify proteins including CDs
Drug used to control postpartum bleeds
Oxytocin; has vasoconstrictive properties
RF for stomach ulcers
Smoking; increased gastric blood flow needed to drain excess acid and prevent exacerbation of ulcer
Common causes of prematurity
Smoking
Cocaine
Cephalosporins
ARE NOT B-lactam DRUGS; they do bind to PBPs to fnxn tho
VDJ recombination
Occurs in T-cells
Diabetic neuropathy presentation
Can present as burning pain as well as loss of sensation
Kid w/ a new puppy and diarrhea
Campylobactter
Sucrose
Glucose + Fructose
-Avoid this in aldolase B deficiency!
Proximal Lesser curvature of the stomach artery
Left gastric artery
Origin: Celiac
Artery of the distal lesser curvature of the stomamch
Right gastric artery
Origin: Proper hepatic
Artery of the proximal greater curvature of the stomach
Left gastroepiploic artery
Origin: splenic
Artery of the distal greater curvature of the stomach
Right gastroepiploic artery
Origin: gastroduodenal
Proximal greater curvature of the stomach arterial supply
Short gastric arteries
Origin: splenic
Ventricular free wall rupture
Occurs 5-14 days post-MI; will see coagulative necrosis w/ PMN and macro infiltrate
Clinical: Pericardial tamponade Distant heart sounds JVD Profound hypotension Cardiogenic shock
Thromboangitis obliterans inflammation pattern
Transmural, segmental
-Extends into the nerves and veins producing pain and ulceration/gangrene respectively
Nerve that looks like 2 nerves leaving the brainstem
CN VII
Mitochondrial appearance on EM
Wavy, crystal looking circles
Constitutive heterochromatin
Always condensed heterochromatin that contains repetitive DNA near the centromere
Positively charged AAs
Lysine and arginine
-Make up histones so they can bind DNA
Bloom Syndrome
Mutation in DNA repair enzymes
Clinical: Long, narrow face
Erythema/teleangectiasia in butterfly distribution
Protuberant ears
Patches of hyper/hypopigmentation
Immunodeficiency (decreased IgG, IgM, IgA)
G2 phase specific anticancer drug
Bleomycin
ATM kinase
Responds to dsDNA breaks; activates p53
p53 =» increased p21 which inhibits Cdk2-cyclin E from forming
-Also increased p16 which inhibits Cdk4/6-cyclin D
***Ultimately, all of this inhibits the phosphorylation of Rb
CD1 marker
Positive in histiocytosis
Adrenoleukodystrophy
x-linked defect in ATP-binding cassette transporter which Fnxns to transport long FA-chains into peroxisomes
Clinical: Adrenocortical failure
Inflammatory demyelination causing dementia
Increased startle response
Tay-Sachs
Aprepitabt, Fosaprepitant
Prevent substance P release to area postrema
-Use if odansetron fails
Eosinophilic casts
Tamm-Horsfall protein which leads to increase free light chains (BJ) in the urine as well
-Cause tubular destruction, Mesangial deposition, and epithelial injury
Piriform recess
Lie on either side of the pharyngeal orifice
- Internal laryngeal nerve travels beneath it carrying sensory innervation
- Damage =» loss of cough reflex
VA teratogen risk
Neural tube defects
Combined absence and tonic-clonic seizure tx
Valproate
Pulmonary fibrosis
Gradual onset of dyspnea w/ end-inspiratory crackles
CXR: Bilateral, diffuse reticulonodular opacities
-most pronounced in lower lobes
-Possible sequelae of RA, IBD, or cancer tx.
Greatest mortality reduction for MI and diabetes
Smoking cessation
Legionnaire’s Disease
Infxn following exposure to contaminated H2O sources (cruises, spas, hospitals)
Clinical: High fever Radiological evidence of pneumonia Bradycardia Diarrhea, nausea Increased liver enzymes ***Hyponatremia
ADH
Fnxns to increase H2O AND UREA reabsorption in the medullary collecting duct
Obesity-related restrictive lung disease
Due to decreased lung compliance
-Most lung testing show decreases except RV
Nonbacterial thrombotic endocarditis
Common w/ advance malignancy (esp. mucinous adenocarcinomas) and other chronic inflammatory states
-May be momentarily asymptomatic but can dislodge and embolize
Deep Q waves and inverted t waves
Recent MI
Location and fnxn of Brunner’s glands
1st part of the duodenum; secretes HCO3
Tx for drug induced Parkinsonism
Benztropine, trihexyphenidyl
ARPKD
Mutation in PKHD1 gene => decreased fibrocystin
- Baby will present w/ POTTER sequence
- Later will have HTN and hepatomegaly
Invasive Pulmonary Aspergillosis
Fever, chest pain, cough, hemoptysis
CXR: consolidated cavitary lesions
RFs: Prolonged febrile neutropenia (like pts. on chemo)
Placental abruption
Leads to increased Factor III release (tissue factor) =» DIC
-Also vaginal bleeding, uterine tenderness, retroplacental hematoma
Damage to the posterior triangle of the neck
Damaged CN XI
- Loss of trapezius (elevation of scapula; shoulder stabilization)
- Possible loss of SCM
Aldosterone escape
Potential finding in hyperaldosteronism due to increased ANP
-Decreased Na+ retention but hypokalemia and increased HCO3 still present
Immediate Tx for hemophilia
Thrombin
Left-sided colon cancer
Obstruction; narrows the lumen of the rectosigmoid colon
Southwestern Blot
Stains proteins that bind to DNA
c-Jun; c-Fos
Leucine zipper proteins
nuclear transcription proteins
Buspirone
Partial 5-HTa agonist used to tx. GAD
-Only prob is it takes a LONG time to take effect
Supplement needed for breastfed babies
Vitamin D
Thick, yellow green, frothy discharge
Trichomonas
Women w/ irregular menses and decreased AFP on US
Probably just inaccurate dating of the fetus
Acute Salicylate Poisoning
1st =» Respiratory alkalosis
2nd =» Anion gap metabolic acidosis (3hrs later)
*Normal pH at this point
Infant w/ hypertension, recurrent pyelonephritis, enlarged upper and lower poles of kidney
Vesicoureteral reflux
-Due to ureters entering the bladder at a perpendicular angle causing decreased flap fnxn
Nasal polyp associations
CF
Aspirin-intolerant asthma
Bacteria causing COPD superinfxn
H. Influenzae
Bronchial hamartoma
Bending mass of lung tissue and cartilage that can be mistaken for Cancer
Best lung cancer prognosis
Bronchioloalveolar carcinoma
S rule of lung cancers
S= central, smoking, syndromes
MC metastatic site of lung cancer
Adrenal glands
Potential obstructive sleep apnea Tx.
Electrical stimulation of CN XII; moves the tongue forward to remove some obstruction of the pharynx
Decreased UMP synthase
Hereditary oroditc aciduria
Orotic acid needed to produce IMP and GMP
Clinical: MR
MEGALOBLASTIC anemia
Orotic aciduria
Tx: Uridine
Propionyl CoA carboxylase
Product of branched AA catabolism along with threonine and methionine
*Requires what cofactor???
Deficiencies cause hypotonia, poor feeding, vomiting, anion gap acidosis, and decreased methlmalonyl CoA
Methlmalonyl CoA isomerase
Converts methylmalonyl made from propionyl CoA to a-ketoglutarate
-Requires B12
Chromosome 22q11.2 deletion
DiGeorge Syndrome
Cardiac trunk (TOF, truncus arteriosus)
Abnormal face (low set ears)
Thymic aplasia
Craniofacial abnormalities (cleft palate)
Hypocalcemia
Dihydropterine reductase reactions
Forms tyrosine and DOPA
Also converts tryptophan =» serotonin
-If deficient in BH4 or dihydropterine reductase, will likely see increased Phe and Trp
Hypertensive Arteriolar Sclerosis
Chronic HTN causing an occlusion leading to an ischemic stroke
CT scan initially looks ok but weeks later will see a small infarct
*Usually affects the internal capsule or pons
Drug used to decrease alcohol CRAVINGS
Naltrexone
-Disulfarim can be used in people who have lost cravings
Porto-caval anastamoses (3)
Esophageal Varices:
Left gastric vein Esophageal veins
Hemorrhoids:
Superior rectal veins Middle and inferior rectal veins
Caput Medusae:
Paraumbilical veins Superior and inferior epigastric veins
Question that mentions retroperitoneal or unknown source of bleeding
Think retroperitoneal organs
Spleen Aorta and IVC Duodenum Pancreas Ureters Colon Kidneys Esophagus Rectum
Rate limiting enzyme in bile salt synthesis
Cholesterol 7a-hydroxylase
***Inhibited by fibrates =» cholesterol stones
Most important prognostic factor for colon cancer
Invasion into the muscularis propria
Tx. Of refractory depression
Lithium
Medicare coverage
Lifetime taxpayers over 65
ALS
ESRD
Young people w/ disabilities
Craniopharyngioma components
- Cystic: filled w/ “motor oil” liquid
- Solid: composed of the actual tumor cells
- Calcifications
- As always, this is a remnant of Rathke’s pouch
Synaptophysin
Transmembrane glycoprotein found in neurons
-Stains positive in CNS tumors composed of NEURONS
Giant Cell Arteritis Inflammation
Segmental, granulomatous lesions
-Same as Takayasu arteritis
Constriction of the efferent arteriole
Decreases RPF
Hypothyroid myopathy
Muscle pain and weakness of the proximal muscles due to decreased Ca2+ reabsorption in the SR
Clinical: Increased CK
Delayed reflexes
Myoedema
Other signs of hypothyroidism
Mallet Finger
Jamming of the finger rips the extensor digitorum tendon as it goes over the DIP
=»Inability to extend the finger
Arterial anastamoses around the scapula
Blockages in the subclavian or axillary artery is bypassed via the subscapular or thyrocervical trunk vessels
Cubital fossa contents
Lateral =» Medial
Biceps brachii tendon =» Brachial artery =» Median nerve
-Site of venipuncture= Median cubital vein
Propofol
Short-acting anesthetic used to induce anesthesis via GABA-A induction
-Causes profound vasodilation tho
MAC
Essentially the ED50 of inhaled anesthetics; inversely proportional to the potency
Fracture of the femoral neck tx.
Hip replacement; do this to prevent osteonecrosis due to disrupted blood supply
-Common in osteoporotic women
Good schizophrenic prognostic factors
Late onset
Obvious precipitating factor
Acute onset
Presence of mood disorder sx.
Family history
Good support system
Presence of positive sx.
What causes dimpling in breast cancer?
Growth of the tumor to involve the suspensory ligaments
Phrenic nerve
Innervates the fibrous pericardium, the mediastinal and diaphragmatic pleura, and the muscular diaphragm
Cardiac shadow on CXR
Right side: SVC and Right atrium
Left side: Aortic arch, pulmonary trunk, left auricle, and left ventricle
Nodal branch
Arises from the RCA and supplies the SA and AV nodes
Blood supply to the apex of the heart
The LAD; also supplies the anterior 2/3 of the IVS, the anterior heart wall, and the Bundle of His
Defective part of a VSD
The membranous part of the ventricular septum
Keratoderma blenorrhagica
Hyper pigmented plaques and nodules on soles and palms that are assoc. With reactive arthritis
Excessive egg white consumption
B7 deficiency; egg whites prevent adequate absorption of biotin
Velocity of blood flow equation
v=Q/A
Valsalva maneuver
Expiring against a closed glottis ➡️ ⬇️ VR ➡️ ⬇️ CO ➡️ ⬆️ Sympathetic outflow to the heart
⭐️ Used to test the integrity of the Baroreceptor reflex
Angiotensin II Fnxns (4)
- Increases aldosterone synthesis
- Increases Na-H exchange in the PCT
- Stimulates thirst
- Causes vasoconstriction of the Arterioles
Auscultation of inferior lobes
Performed on the posterior chest wall
Auscultation of the middle lobe
In b/w the 4th and 6th rib
Location of abdominal nerves
Deep to the internal oblique muscles and superficial to the transversalis fascia
Rectouterine pouch
Possible location of pelvic abscess
Abnormal migration of the ventral pancreatic bud
Annular pancreas
Incomplete fusion of the dorsal and ventral pancreatic buds
Pancreatic divisum
-Common and typically asymptomatic
HbS sickling
Valine is a nonpolar AA; this causes the nonpolar, hydrophobic residues of Hb to clump together
=» sickling
Suspected elder abuse
Interview elder alone; even if they are slightly impaired
-If severe cognitive impairment, notify protective services
VonRecklinghausen’s Disease
NF1
-Pheochromocytomas, Lisch nodules,
Cave exploration in the Ohio River Valley/ Mississippi River Valley
Histoplasma infxn
-Can present as an acute pulmonary disease
Estrogen effects on TSH
Transient increase; will normalize tho
-Increased estrogen increases TBG synthesis leading to increased synthesis of T4 and T3 to return free levels to normal
Schizoaffective Disorder
Major depressive OR MANIC episodes concurrent w/ schizophrenia
Crohn’s Disease complications
GI: Fistulas, strictures, increased risk of adenocarcinoma
Skin: Erythema nodosa
Malabsorption: Gallstones, *Kidney oxalate stones (due to decreased calcium absorption) b12 and folate deficiency
-Also arthritis and uveitis
Pts. at risk for B12 deficiency
Usually in people who have been strict vegetarians for at least 5 years
Sulfonylurea w/ decreased likelihood for hypoglycemia
Glipizide
-2nd generation are shorter acting
POMC derivatives
- ACTH
- MSH
- Endorphins, enkephalins
MCCo hypothyroidism
Hashimoto’s
Assoc. With HLA-DR5; pts. At an increased risk for non-Hodgkin’s lymphoma
Histo shows Germinal centers hurthule cells
Locally invasive thyroid tumor
Anaplastic carcinoma
-Produces dysphagia and respiratory compromise
Stones, bones, groans, and psychiatric overtones
Hyperparathyroidism
- Hypercalciuria (Nephronopthisis)
- Osteitis fibrosa cystica
- constipation and weakness
- depression
Venous waves
ATRIAL SYSTOLE
A - atrial contraction
C- triCuspid closure
VENTRICULAR SYSTOLE
X descent - emptying
V- Maximum atrial filling pressure
y-descent
Eccentric Cardiac Hypertrophy
Heart increases in size by adding new sarcomeres in series w/ existing sarcomeres
=»Lengthening (not thickening) of fibers; allows the heart to receive a greater volume of blood
-Results from volume overload (heavy aerobic exercise)
Dilated Cardiomyopathy causes
Alcohol
Beriberi
Coxsackie B
Cocaine
Chagas
Doxorubicin
-Presents as HF, S3, balloon appearance on CXR
Tx: Na+ restriction; digoxin; ACEIs and BBs
X-ray artifact
Abnormal x-ray finding due to user error or hardware failure
Hartnup’s Disease
Deficiency of neutral AA transporters in the kidney and gut
=» Increased excretion and decreased absorption
***Tryptophan deficiency =» Niacin deficiency =» PELLAGRA
Tx: High protein diet; nicotinic acid
Urokinase
Activates plasmin
⭐️Excess release after radical prostatectomy
➡️Bleeding
Tx: Aminocaproic acid (blocks activation)
a-2 anti plasmin
Inactivates plasmin
-Liver cirrhosis ➡️⬇️ levels ➡️ ️Bleeding
Thrombomodulin
Activates protein C
➡️ inhibition of factors V and VIII
Palmar xanthoma
Familial Dysbetalipoproteinemia
Cilostazol
PDE inhibitor
-Go to for Buerger disease
Macular degeneration
Can be identified as Drusen deposits on the retina; pts. will progress to a central scotoma
Possible exacerbating factor for MS
Heat, stress, exercise
Gastric erosions
DO NOT EXTEND INTO MUSCULARIS MUCOSA
- ONLY STAY IN THE MUCOSA LAYER
- Once in the submucosa, they become ULCERS
PAS stains
Stains glycoproteins, polysaccharides, mucopolysaccharides, glycogen
Gets C-C bonds, not lipids
Neuroblastoma (adrenal)
Abdominal mass that goes past the midline and usually assoc. w/ n-MYC mutation
Clinical: HTN, weight loss
Paraneoplastic associations = Opsoclonus, myoclonus, pancytopenia, hepatomegaly, SC compression
-Even those are weird, if you see an abdominal mass w/ HTN and weight loss, you think horseys
MC predisposing factor for infective endocarditis in developed world
Mitral valve prolapse
Neurocysticercosis infxn
Accidental ingestion of cysts from contaminated feces
-Symptoms take a while to develop; is why the people are usually MIGRANTS
Most important prognostic factor for urothelial carcinoma
Depth of invasion
-Involvement of muscular layer= T2
Antiarrhythmics
Class IA: Quinidine, Procainimide, Disopyramide
-Affects both Na+ influx and AP length
Class IB: Lidocaine, Mexilitine
-DECREASES AP LENGTH
Class IC: Fleicanide, Propafenone
-STRONG INCREASE IN NA+ LENGTH WITH NO CHANGE IN AP LENGTH
Eggshell calcifications, birefringent particles, fibrous tissue
Silicosis
-Findings otherwise similar to sarcoidosis