DIT Rapid-Fire Facts Flashcards
Most common cause of congenital malformations in the US
Alcohol use during pregnancy
Most common cause of neural tube defects
Folate deficiency
*most common vitamin deficiency in the US
Most common cause of congenital mental retardation in US
Fetal Alcohol Syndrome
Hyperflexible joints, arachnodactyly, aortic dissection, lens discoloration
Marfan Syndrome
-defect in fibrillin (scaffold for elastin)
Hereditary nephritis, cataracts, sensorineural hearing loss
Alport syndrome
-defect in Type IV collagen (BM)
Unilateral facial drooping involving the forehead
Bell’s palsy
Ptosis, miosis, anhidrosis
Horner’s syndrome
“Worst headache of my life”
Subarachnoid hemorrhage
Lucid interval following head trauma
Epidural hematoma
Bloody CSF on LP
Subarachnoid hemorrhage
Most common cause of subdural hematoma
Rupture of bridging veins
Most common cause of epidural hematoma
Rupture of middle meningeal artery
Toe extension upon stimulating the sole of the foot with a blunt instrument
Babinski sign
Hyperreflexia, increased muscle tone, positive Babinski sign
UMN Lesion
Hyporeflexia, decreased muscle tone, muscle atrophy
LMN lesion
Depigmentation of the substantia nigra
Parkinson’s disease
Chorea, dementia, atrophy of caudate and putamen
Huntington’s disease
Eosinophilia inclusions of cytoplasm of neurons
Levy bodies
- Parkinson’s disease
- Lewy body dementia
Conjugate lateral gaze palsy, with nystagmus and diplopia during lateral gaze
Internuclear opthalmoplegia
-occurs with multiple sclerosis
Degeneration of the dorsal columns
Tabes dorsalis
-Tertiary syphilis
Demyelinating disease in young women
Multiple sclerosis
Mixed upper and lower motor neuron disease
Amyotrophic Lateral Sclerosis
Newborn with arm paralysis following difficult labor
Erb palsy
Pupil that accommodates but doesn’t react to light
Argyll-Robertson pupil
Most common cause of dementia
Alzheimer’s
Second most common cause of dementia
Multi-infarct dementia
Extracellular amyloid deposits in grey matter
Senile plaques - Alzheimer’s
Intracellular deposits of hyperphosphorylated tau protein
Neurofibrillary tangles - Alzheimer’s
Intracellular spherical aggregates of tau protein, seen on silver stain
Pick bodies - Pick’s disease
Treatment for absence seizures
Ethosuximide
Treatment for tonic-colonic seizures
Phenytoin, Valproic acid, Carbamazepine
Amyloid deposits in the gray matter of the brain
Alzheimer’s disease
Drooling farmer
Organophosphate poisoning
Inability to breast feed, amenorrhea, cold intolerance, secondary hypothyroidism
Sheehan’s syndrome
Infertility, galactorrhea, bitemporal hemianopsia
Prolactinoma/ Pituitary adenoma
Most common causes of Cushing syndrome
- Exogenous cortisol
- Ectopic ACTH
- ACTH-secreting pituitary adenoma (Cushing Disease)
- Cortisol secreting Adrenal adenoma
Most common tumor of adrenal gland
Benign adrenal adenoma
Most common tumor of adrenal medulla in adults
Pheochromocytoma
Most common tumor of adrenal medulla in kids
Neuroblastoma
Most common cause of primary hyperaldosteronism
Adrenal adenoma
Medical treatment for hyperaldosteronism
Spironolactone (K+ sparing diuretic, acts as an aldosterone antagonist)
Medical treatment for pheochromocytoma
Irreversible a-antagonist: phenoxybenzamine, phentolamine + B-blocker
*DO NOT give B-blocker alone bc will worsen HTN
Pheochromocytoma, medullary thyroid cancer, parathyroid hyperplasia (hyperparathyroidism)
MEN 2A
Pheochromocytoma, medullary thyroid cancer, mucosal neuromas
MEN 2B
Adrenal disease associated with skin pigmentation
Addison’s disease
HTN, Hypokalemia, Metabolic alkalosis, Low plasma renin
Primary Hyperaldosteronism (Conn’s Syndrome)
Most common thyroid cancer
Papillary carcinoma
Cold intolerance
Hypothyroidism
Enlarged thyroid cells with ground-glass nuclei
Papillary thyroid carcinoma
-Orphan-Annie eye nuclei
Amyloid deposits in gray matter of the brain
Alzheimer’s disease senile plaques
Drooling farmer
Organophosphate poisoning/ Cholinergic toxicity
Standard treatment for DKA
IV Fluids, IV Insulin, K+ replacement
Standard treatment for Type I DM
Insulin, low sugar diet
Standard treatment for Type II DM
Oral hypoglycemics, probably insulin, low sugar diet, weight loss
Most common cause of hypercalcemia
Primary hyperparathyroidism
Most common cause of primary hyperparathyroidism
Parathyroid adenoma
Most common cause of secondary hyperparathyroidism
Chronic renal failure –> hypocalcemia
Most common cause of hypoparathyroidism
Accidental removal during thyroidectomy
Facial spasm when tapping on the cheek
Chvostek sign
Parathyroid, pancreatic, pituitary tumors
MEN 1
Dysphagia, glossitis, iron deficiency anemia
Plummer-Vinson Syndrome
Hematemesis with retching
Mallory-Weiss Syndrome
Mucin-filled cell with a peripheral nucleus
Signet ring cell
Most common type of stomach cancer
Adenocarcinoma
Ovarian metastasis from gastric cancer
Krukenburg tumor
Gastric ulceration and high gastrin levels
Zollinger-Ellison Syndrome
Acute gastric ulcer associated with elevated ICP or head trauma
Cushing ulcer
Acute gastric ulcer associated with severe burns
Curling ulcer
Pancreatic jaundice
Pancreatic cancer
-esp of head of pancreas
Most common cause of acute pancreatitis
Gallstones, Alcohol
Most common cause of chronic pancreatitis
Alcohol abuse
Weight loss, diarrhea, arthritis, fever, adenopathy, hyperpigmentation
Whipple disease
Anti-transglutaminase/ Anti-gliadin / Anti-endomysial antibodies
Celiac sprue
Vitamin given to pregnant women to prevent neural tube defects
Folate
Triglyceride accumulation in hepatocytes
Fatty Liver Disease
Eosinophilic inclusions in the cytoplasm of hepatocytes
Mallory Bodies- Alcoholic Hepatitis
Cancer closely linked to cirrhosis
Hepatocellular carcinoma
Severe hyperbilirubinemia in a neonate
Crigler-Najjar-I
Mild, benign hyperbilirubinemia
Gilbert Syndrome
Hepatomegaly, abdominal pain, ascites
Budd-Chiari Syndrome
NO JVD
Green/yellow corneal deposits
Wilson’s disease
Low serum ceruloplasmin
Wilson’s disease
Cirrhosis, diabetes, hyperpigmentation
Hemochromatosis
Treatment for chronic hepatitis
IFN-a
Most common cancer of the appendix
Carcinoid tumor
Most common surgical emergency
Appendicitis
GI hamartomas, hyperpigmentation of the mouth and hands
Peutz-Jeghers Syndrome
Multiple colon polyps, osteomas, soft tissue tumors
Gardner Syndrome
Severe RLQ pain with rebound tenderness
Appendicitis; McBurney’s sign
“Apple core” lesion on barium enema
Colorectal carcinoma
Corneal clouding, coarse facies, HSM, skeletal abnormalities,restricted joint movement +/- mental retardation
I- cell disease
Deficiency in phosphotransferase –> deficiency in M6P
Nuclear localization sequence is rich in which AAs
Lysine, Arginine, Proline
NLS is necessary for protein entry into nucleus
Mutation in Nuclear Lamins leads to
Progeria
Muscular dystrophy
Bronchiectasis, recurrent sinus infections, infertility, situs inversus
Kartagener syndrome
-defect in dyenin arm leads to immobile cilia
PDGF, Growth factors, Insulin, Insulin-GF act on what receptor
Tyrosine kinase receptor
- bind Extracellular ligand, conformation change, intracellular domain transfers phosphate group from ATP to selected tyrosine side chains
- autophosphorylation is 1st step in signaling cascade that uses this receptor
What are the two most abundant substances in plasma membranes
Cholesterol, Phospholipids
Labile cells
Bone marrow, gut epithelium, skin, hair follicles, germ cells
-constantly regenerate therefore G0 is absent and G1 is short
What are the mechanisms of cell injury
- ATP depletion
- Mitochondrial damage
- Ca2+ influx
- Accumulation of oxygen free radicals
Enzymes that handle oxygen free radicals
Superoxide dismutase, Catalase, Glutathione peroxidase
Elevated ESR
- Polymyalgia rheumatica
- Temporal arteritis
- Disease activity in RA and SLE
- Infection, Inflammation i.e. Osteomyelitis
- Malignancy
Cell that generates fibrinogen and CRP
Hepatocyte
Metals that facilitate generation of oxygen free radicals
Iron, Copper
Blue sclera, multiple fractures with minimal trauma, hearing loss, dental imperfections, presentation can be confused with child abuse
Osteogenesis imperfecta
- Type I: AD, mutation in alpha chains of Type I collagen or mutation/defect in glycosylation of preprocollagen to form procollagen
- Type II: AR, mutation in Type II collagen, often die in utero
Joint instability, Hypermobile joints, Hyperextensible skin, vascular sx, organ rupture, berry aneurysm, aortic aneurysm, tendency to bleed
Ehlers-Danlos syndrome
- defect in collagen synthesis- typically Type I&III
- Type III collagen defect —> vascular sx, risk of organ rupture
- Type V collagen defect —> hyperextensible skin
Chediak-Higashi syndrome
Dysfunction in microtubule polymerization leads to defect in lysosomes and phage some formation
Lipofuscin granule
Result of free radical lipid peroxidation; brown pigmented residual body within cell
Amino acids modified in the Golgi apparatus
Serine, Threonine, Asparagine
Incr AFP
Anencephaly or abdominal wall defect
Main inhibitory NT in brain
GABA
-decr levels in Huntingon’s disease and Anxiety
Main inhibitory NT in SC
Glycine
Main excitatory NT in brain
Glutamate
NT levels in Anxiety disorder
Incr. NE
Decr. GABA, 5-HT
Principle NT in REM Sleep
ACh
Acetylcholinesterases used to treat Alzheimer’s
Donepezil, Galantamine, Rivastigmine
Group of genes responsible for skeletal development
HOX genes
Drugs used to treat urge incontinence
Oxybutinin, Tolteridine, Darifenacin, Solifenacin, Trospium
Substances that inhibit NE Reuptake
Cocaine, TCAs
Substances that stimulate NE release from neurons
Amphetamine, Ephedrine, Tyramine, Ca2+, ATII (maybe)
Pancreatic beta cells
Insulin
Pancreatic alpha cells
Glucagon
Pancreatic delta cells
Somatostatin
Estradiol
Ovaries
Estriol
Placenta
Estrone
Adipose tissue
Anterior pituitary hormones
GH, FSH, LH, ACTH, PRL, TSH
Posterior pituitary hormones
- Oxytocin: made in paraventricular nucleus of hypothalamus
- ADH/Vasopressin: made in supraoptic nucleus of hypothalamus
Hypothalamic hormones
TRH, CRH, GnRH, GHRH
Adrenal cortex- Zona Reticularis
Testosterone
Adrenal cortex- Zona Fasciculata
Glucocorticoids
Adrenal cortex- Zona Glomerulosa
Mineralocorticoids (aldosterone)
What are the side effects of glucocorticoid use
- Iatrogenic Cushing disease: moon facies, buffalo hump, truncal obesity, muscle wasting, easy bruising, thin skin
- Insomnia, Psychosis
- Acne, Glaucoma
- Osteporosis, Glucose intolerance/ Diabetes, Peptic ulcer
MEN 2A and 2B are associated with what gene mutation
Ret
Neuroblastoma is associated with what gene mutation
N-myc oncogene overexpression
What is the main synthetic mineralocorticoid given to stimulate aldosterone receptors in patients with Aldosterone deficiency
Fludrocortisone
Tumors that secrete EPO
- Pheochromocytoma
- Renal cell carcinoma
- Hemangioblastoma
- Hepatocellular carcinoma
Drug of choice for anaphylactic shock
Epinephrine
- b>a; a1, a2, b1, b2
Drug of choice for cardiogenic shock
Dobutamine
-b1>b2, a
Drug of choice for septic shock
Norepinephrine
-a1>a2>b1
What abnormalities are often found with an Arnold-Chiari malformation?
Syringomyelia, Myelomeningocele
Classic presenting symptoms of Syringomyelia
Bilateral loss of pain and temperature sensation in a cape-like distribution (C8-T1) in the upper extremities/ back
-severe cases that expand to involve the anterior horn –> weakness and atrophy of the muscles of the hand
Increased AFP
Anencephaly, Failure of abdominal wall to close, Hepatocellular carcinoma
Decreased AFP
Down syndrome
4 major dopaminergic pathways
- Mesocortical
- Mesolimbic
- Nigrostriatal
- Tuberoinfundibular
Blocking Mesocortical pathway
Incr. negative symptoms of psychosis
Blockage of Mesolimbic pathway
Relief of psychosis
-target of Dopamine antagonists
Blockage of Nigrostriatal pathway
Parkinsonism sx
Stimulation of Nigrostriatal pathway
Extrapyramidal symptoms
Blockage of Tuberoinfundibular pathway
Incr. release of Prolactin from pituitary –> Hypogonadism –> Amenorrhea in women, Decr. Libido, Gynecomastia, Galactorreha in men
Treatment of Prolactinoma
Dopamine agonist- Bromocriptine
Degeneration of basal nucleus of Meynert, decr. CNS ACh
Alzheimer’s disease
What are the thalamic nuclei
- Paraventricular
- Supraoptic
- Anterior
- Preoptic
- Suprachiasmatic
- Dorsomedial
- Posterior
- Lateral
- Mamillary
- Ventromedial
- Arcuate
Arcuate nucleus
Hypothalamic nucleus
-releasing hormones (CRH, GHRH, GnRH, TRH) affect anterior pituitary
Ventromedial nucleus
Hypothalamic nucleus
-satiety; stimulated by leptin
Lateral nucleus
Hypothalamic nucleus
-hunger; inhibited by leptin
Posterior
Hypothalamic nucleus
-hearing, sympathetic nervous system
Dorsomedial nucleus
Hypothalamic nucleus
- GI
- stimulation –> savage behavior, obesity
Suprachiasmatic
Hypothalamic nucleus
-circadian rhythm
Preoptic area
Hypothalamic nucleus
-GnRH
Anterior nucleus
Hypothalamic nucleus
-cooling, parasympathetic nervous system
Supraoptic nucleus
Hypothalamic nucleus
-makes ADH
Paraventricular nucleus
Hypothalamic nucleus
-Makes oxytocin
What secondary messenger do FSH, LH, ACTH, TSH use
cAMP
What secondary messenger does CRH use
cAMP
What secondary messenger do GHRH, TRH, GnRH, Oxytocin and ADH use
IP3
What molecules use cGMP as a secondary messenger
AMP, NO
What molecules act on tyrosine kinase receptors
Insulin, IGF-1, GH, PDGF, FGF, Cytokines, Prolactin
Decreases endocrine and exocrine secretion, reduces splanchnic blood flow, reduces gastric motility and gallbladder contraction, inhibits secretion of most gastrointestinal hormones
Somatostatin
What do LH, FSH, TSH and hCG have in common
a-subunit
Clinical features of acromegaly
- large hands and feet
- deep voice
- impaired glucose tolerance
- coarse facial features, large tongue, incr. spacing of teeth
Caused by Cystic fibrosis
Meconium ileus
Caused by adhesions
Small bowel obstruction
“Bulls eye” on ultrasound
Intussusception
Common in post op
Intestinal ileus
Currant jelly stool
Intussusception
GI pain out of proportion to exam
Ischemic colitis
Impaired defection with alternating diarrhea and constipation
Irritable bowel syndrome
Most common congenital anomaly of the GI tract
Meckel’s diverticulum
Diverticulum that contains 2 types of epithelium? What are those types?
Meckel’s diverticulum- pancreatic and gastric epithelium
Pneumatosis intestinalis
Necrotizing enterocolitis
AST > ALT
> 2:1
Alcoholic cirrhosis
Incr. GGT, Incr. ALP
Biliary tract disease
Incr. ALP
Bone formation, obstructive hepatobiliary disease, Hepatocellular carcinoma, bone disease
Budd-Chiari syndrome
Ascites, hepatomegaly, no JVD
Decr. Ceruloplasmin, kayser- fleischer rings
Wilson’s disease
Cirrhosis, Diabetes Mellitus, Skin pigmentation
Incr. Ferritin, decr. TIBC, incr. Transferring saturation
Hemochromatosis
a1-anti trypsin deficiency affects what organs
Liver –> Cirrhosis
Lungs –> Panacinar emphysema
Treatment of Wilson’s disease
Penicillinamine or Trientine
Treatment of Hemochromatosis
Repeated phlebotomy, deferasirox, deferoxamine
Charcot’s Triad of Cholangitis
Jaundice, Fever, Right upper quadrant pain
Reynold’s Pentad
Jaundice, Fever, RUQ pain, hypotension, altered mental status
+ Murphy sign
Inspiratory arrest on RUQ palpating d/t pain
-occurs with Cholecystitis
Fructose intolerance
Aldolase B deficiency
Essential Fructosuria
Fructokinase
Classic Galactosemia
Galactose-1-phosphotransferase
What structures run through the cavernous sinus
CN III, IV, V1, V2, VI
Hartnup disease
Autosomal recessive; deficiency of neutral amino acid transporters in proximal renal tubular cells and on enterocytes
Can lead to pellagra like sx
Lack of NADPH Oxidase
Chronic granulomatous disease
Rate limiting enzyme of HMP shunt (pentose phosphate pathway)
G6P-Dehydrogenase deficiency
Defect in fructokinase
Essential Fructosuria
Deficiency of Aldolase B
Fructose intolerance
Hereditary deficiency of galactokinase
Galactokinase deficiency
Absence of galactose-1-phosphate uridyltransferas
Classic Galactosemia
Most common urea cycle disorder
Ornithine transcarbamylase deficiency
-X-linked recessive
Decr. Phenylalanine hydroxylase or decr. BH4
Phenylketonuria
Homogentisate oxidase deficiency
Alkaptonuria
Cystathione synthase deficiency
Homocystinuria
Decr. affinity of cystathionine synthase for pyridoxal phosphate
Homocystinuria
Hereditary defect of renal PCT and intestinal amino acid transporter for cysteine, ornithine, lysine, arginine
Cystinuria
Decr. a-ketoacid dehydrogenase
Maple Syrup Urine Disease
Want are the symptoms of PKU
Intellectual disability, growth retardation, seizures, fair skin, eczema, musty body odor
Rate limiting enzyme for Glycolysis
Phosphofructokinase
Rate limiting enzyme for Gluconeogenesis
Fructose-1,6-bisphosphatase
Rate limiting enzyme for TCA cycle
Isocitrate dehydrogenase
Rate limiting enzyme for Glycogen synthesis
Glycogen synthase
Rate limiting enzyme for Glycogenolysis
Glycogen phosphorylase
Mineral compounds used to treat esophageal reflux
Aluminum hydroxide, Magnesium hydroxide, Calcium carbonate
Side effects of glucocorticoid use
Osteoporosis, glucose intolerance/ diabetes, insomnia, psychosis, glaucoma, acne, peptic ulcer, iatrogenic Cushing syndrome (moon facies, buffalo hump, thin skin, truncal obesity, easy bruising, muscle wasting)
Cofactors required for Pyruvate Dehydrogenase
Thiamine pyrophosphate, Lipoic acid, CoA, FAD, NAD
Cofactors required for a-ketoglutarate
Thiamine pyrophosphate, Lipoic acid, CoA, FAD, NAD
CTLs against donor MHC
Acute rejection
- cell mediated
- occurs in weeks-months
T-cells perceive donor MHC as non-self
Chronic rejection
- Ab mediated
- occurs in months-yrs
Preformed Abs to Donor Ags
Hyperacute rejection
-immediate
Stomach biopsy reveals neutrophils above BM, loss of surface epithelium, fibrin containing purulent exudate
Acute Gastritis
Stomach biopsy reveals lymphoid aggregates in lamina propria, columnar absorptive cells, atrophy of glandular structures
Chronic Gastritis
Diffuse thickening of gastric folds, elevated serum gastric levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia
Zollinger-Ellison Syndrome
Receptors found on gastric parietal cells that regulate acid secretion
H2: responds to histamine CCK-B: responds to gastric M3: responds to ACh Prostaglandin receptor Somatostatin receptor
Two most common causes underlying hospital administration for a bleeding peptic ulcer
H. pylori, NSAIDs
PMNs don’t respond to IFN-y and chemotactic stimuli
Job Syndrome- Hyper IgE
Small intestine mucosa laden with distended macrophages in the lamina propria (filled with PAS + granules and rod shaped bacilli seen on EM)
T. whippeli; Whipple disease
Total or subtotal atrophy of small bowel villi, plasma cell and lymphocyte infiltration into the lamina propria and epithelium, hyperplasia/elongation of crypts
Celiac sprue
Classic symptoms of Carcinoid Syndrome
Bronchospasm, Diarrhea, Flushing, R. Sided heart disease
Common causes of Small Bowel Obstruction
- adhesions (75%)
- hernia
- cancer (metastatic colorectal carcinoma)
Signs of Portal HTN
Ascites, esophageal varies, portosystemic shunts, hepatosplenomegaly, Hematemesis, Caput medusae, melena
Risk factors for development of Hepatocellular carcinoma
- Budd-Chiari Syndrome
- Hemochromatosis
- a1-Antitrypsin deficiency
- Wilson’s disease
- Hepatitis B & C
- Alcoholic Cirrhosis
- Aflatoxin, Aspergillus
- Hepatic adenoma
Treatment for Chronic Hepatitis
IFN-a
Antibodies present in Autoimmune Hepatitis
ANA(+)
Anti-microsomal (+)
Anti-smooth muscle (+)
Anti-mitochondrial (-)
Treatment of severe Cirrhosis
- Lactulose: treat encephalopathy
- Vitamin K: maximize clotting potential
- Diuretics: decrease ascites and edema
- B-blocker: prevent bleeding from esophageal varices
Increased bilirubin production occurs in which disorders
Unconjugated Hyperbilirubinemias:
- Hemolytic Anemia
- Sickle Cell disease
- Hematoma breakdown
Impaired bilirubin uptake and storage occurs in which disorders
Unconjugated Hyperbilirubinemias:
- Post viral Hepatitis
- Tx with Rifampin
Decreased UDP-GT activity occurs in which disorders
Unconjugated Hyperbilirubinemias:
- Gilbert Syndrome
- Crigler-Najjar Type I & II
- Neonatal physiologic jaundice
Impaired transport of bilirubin occurs in which disorders
Conjugated Hyperbilirubinemias:
- Dubin-Johnson Syndrome
- Rotor Syndrome
Biliary epithelial damage occurs in which disorders
Conjugated Hyperbilirubinemias:
- Hepatitis
- Cirrhosis
- Liver failure
Intrahepatic biliary obstruction occurs in which disorders
Conjugated Hyperbilirubinemias:
- Primary Biliary Cirrhosis
- Sclerosing Cholangitis
- Arsenic
- Tx with Chlorpromazine
Extrahepatic biliary obstruction occurs in which disorders
Conjugated Hyperbilirubinemias:
- Pancreatic neoplasm
- Pancreatitis
- Cholangiocarcinoma
- Choledocholithiasis
GI Problems associated with a Down Syndrome
- Duodenal Atresia
- Hirschsprung disease
- Annular pancreas
- Celiac disease
Chorioretinitis, Hydrocephalus, Intracranial Calcifications
Congenital toxoplasmosis
Most common site of colonic diverticula
Sigmoid colon
“String sign” on contrast X-Ray
Crohn’s disease
“Lead pipe” appearance of colon on contrast X-Ray
Ulcerative Colitis
Causes of Eosinophilia
Drugs, Neoplasia, Atopic (asthma, allergy, eczema), Addison’s disease, Acute Interstitial Nephritis, Collagen vascular disease (SLE, Churgg-Strauss), parasites (Ascaris –> Loeffler eosinophilia pneumonitis)
Most common infections seen in Chronic Granulomatous Disease
Catalase + organisms:
- Pseudomonas
- S.aureus
- Klebsiella
- E.coli
- Aspergillus
- Candida
Eczema, recurrent URI, high serum IgE
Hyper IgE syndrome (Job syndrome)
Large lysosomal vesicles in phagocytes
Chediak-Higashi syndrome
Nephrotoxic/Ototoxic drugs
-Vancomycin, Aminoglycosides, Loop Diuretics, Cisplatin
Hemorrhagic cystitis
Cyclophosphamide
-d/t metabolite: Acrolein
+ Hams test
Paroxysmal Nocturnal Hemoglobinuria
X-linked immunodeficiencies
- Wiskott-Aldrich syndrome
- Bruton’s Agammaglobulinemia
- Chonic Granulomatous dz
- Hyper IgM syndrome
Most common infections seen in Chronic Granulomatous disease
Catalase + organisms:
-Pseudomonas, S. aureus, Klebseilla, E. coli, Aspergillus, Candida
Eczema, recurrent URI, high serum IgE
Hyper IgE syndrome/ Job syndrome
Large lysosomal vesicles in phagocytes
Chediak-Higashi syndrome
Boy with self-mutilating behavior, mental retardation, gout
Lesch-Nyhan syndrome
-HGPRT Deficiency
Elevated Uric acid levels
- Gout
- Lesch-Nyhan syndrome
- Tumor lysis syndrome
- Use of loop or thiazide diuretics
Bluish colored lines on gingivae
Lead poisoning- Burton’s lines
Treatment of choice for Rickets or Osteomalacia
Vitamin D
Swollen gums, poor wound healing, bleeding mucous membranes, spots on the skin
Scurvy (Vitamin C deficiency)
Most common vitamin deficiency in the US
Folate
Hyper segmented neutrophils
Megaloblastic anemia
Dilated cardiomyopathy, edema, poly neuropathy
B1 (thiamine) deficiency - Beri-Beri
Patient presents with convulsions and irritability. What vitamin deficiency is causing these symptoms
B6
Dark purple modules on the skin in an HIV PT
Kaposi sarcoma
Large cells with owls eye inclusions
CMV
Treatment for CMV
Ganciclovir
Most common opportunistic infection in HIV patients
Pneumocystis jirovecii pneumonia
Drug used to prevent Pneumocystis pneumonia
TMP/SMX
Food poisoning due to exotoxin
S. aureus, B. cereus
Osteomyelitis in sickle cell disease
Salmonella
Ring enhancing brain lesion in an HIV PT
Toxoplasma gondii
Treatment for Trichomonas vaginalis
Metronidazole
Most common protozoal diarrhea
Giardia lamblia
Most common helminthic infection in the US
Enterobius vermicularis
Second most common helminthic infection in the US
Ascaris lumbricoides
Most common bacteria implicated in exotoxin-mediated food poisoning
S. aureus, B. cereus
Branching gram positive rods with sulfur granules
Actinomyces
Inactivated EF2 via ADP ribosylation
C. diptheriae
a & y toxins
C. Perfringens
Lethal factor and edema factor
B. Anthracis
Most common urea cycle disorder
Ornithine transcarbamylase deficiency
Calcified granuloma in the lungs, hilar lymphadenopathy
Ghon complex
Back pain, fever, night sweats, weight loss
Pott’s disease- M. Tuberculosis in vertebrae
Standard treatment for TB
Rifampin + INH + Pyrazinamide + Ethambutol + B6 (INH will cause B6 deficiency so must supplement)
Lactic acidosis is a rare but worrisome side effect of what medication
Metformin
Most common side effect of sulfonylureas is
Hypoglycemia
Closes K+ channel on B-cells which leads to depolarization, Ca++ influx and then insulin release
Sulfonylureas
Inhibits a-glucosidase at intestinal brush border
a-glucosidase inhibitor
-Acarbose
Standard treatment for T. Pallium
Pencillin G
Cellulitis from a dog or cat bite
Past rubella multicoda
A non-painful indurated, ulcerated genital lesion
Painless chancre- Primary syphilis
Moist, smooth, flat, white genital lesion
Condyloma lata- Secondary syphilis
Large bulls-eye rash
Erythema chronicum migrans
-early Lyme dz
Gummas, aortitis, tabes dorsalis, Argyll-Robertson pupil, Charcot joints
Tertiary syphilis
Preferred anticoagulant for immediate anti-coagulantion
Heparin or LMWH (Enoxaprin, Dalteparin)
Preferred anticoagulant for long term anticoagulation
Warfarin
Preferred anticoagulant during pregnancy
Heparin
Causes hypochromic, microcytic anemia
Fe deficiency, Thalassemia, Pb poisoning
Hyper segmented neutrophils
Megaloblastic anemia: B12 or a Folate deficiency
Skull x-Ray shows “hair on end” appearance
Marrow hyperplasia
- B thalassemia
- Sickle cell disease
Basophils stippling of RBCs
Pb poisoning
Painful cyanosis of the fingers and toes with painful hemolytic anemia
Cold agglutinins
-IgM
Red urine in the morning, fragile RBCs
Paroxysmal Nocturnal Hemoglobinuria
Basophils nuclear remnants in RBCs
Howell-Jolly bodies
-Asplenic PTs
Autosplenectomy
Sickle-cell disease
Drug used to treat Sickle cell disease
Hydroxyurea
Antiplatelet antibodies
ITP
Bleeding disorder with GpIb deficiency
Bernard-Soulier disease
Most common lymphoma in the US
Diffuse large B cell lymphoma
Reed-Sternberg cells
Hodgkin lymphoma
Particularly associated with EBV
Burkett lymphoma
Hodgkin lymphoma
Associated with long term Celiac disease
Intestinal T-cell lymphoma
Lymphoma equivalent of CLL
SLL
“Starry sky” pattern d/t phagocytosis of apoptotic tumor cells
Burkitt lymphoma
Associated with Sjogren syndrome, Hashimoto thyroiditis, H. Pylori
Marginal cell MALToma
Cancer most commonly associated with a non infectious fever
Hodgkin lymphoma
“Smudge cells”
CLL
“Punched out” lytic bone lesions
Multiple Myeloma
Sheets of lymphoid cells, with a “starry sky” appearance
Burkitt lymphoma
RBCs clumped together like a stack of coins
Multiple Myeloma
-Rouleaux formation
Monoclonal antibody spike
Multiple Myeloma
- MGUS
- Waldenstrom Macroglobulinemia
Reddish-pink rods in the cytoplasm of leukemic blasts
Auer-rods
-AML
Large B-cells with bilobed nuceli and prominent “owls eye inclusions”
Reed-Sternberg cells
-Hodgkin lymphoma
Chronic sinusitis, infertility, situs inversus
Kartagener’s syndrome
-dyenin arm defect leads to immotile cilia
Elevated D-dimers
Pulmonary embolism, DVT
Hypercoagulability, endothelial damage, stasis of blood
Virchow’s triad
Blue bloater
Chronic bronchitis
- hypoxemia
- hypercapnia
Pink puffer
Emphysema
-dyspnea, hyperventilation
Curshmann’s spirals
Asthma
-shed epithelial cells
Most common cause of pulmonary hypertension
COPD
What are the two HIV envelope proteins? What drugs interfere with them?
- gp41- Enfuvirtide
- gp120- Maraviroc
Bilateral hilar adenopathy, uveitis
Sarcoidosis
Vasculitic, glomerulonephritis
Goodpasture’s or Wegener’s
Honeycomb lung on x-Ray
Interstitial fibrosis
Anti-glomerular basement membrane antibodies
Goodpasture’s
“Tennis racket” shaped cytoplasmic granules
Birbeck granules
-Eosinophilic granuloma
Most common cause of nosocomial pneumonia
Klebsiella, E. Coli, Pseudomonas
Lung cancer associated with SIADH
Small cell lung cancer
Iron containing nodules in the alveolar septum
Ferruginous bodies
-Asbestos
Continuous machine like heart murmur
PDA
“Boot shaped heart”
Tertralogy of Fallot or RVH in an adult
Rib notching
Coarctation of the aorta
Most common congenital cardiac anomaly
VSD
Cor pulmonale
RHF d/t pulmonary disease
Nutmeg liver
Passive congestion of liver d/t RHF or Budd-Chiari syndrome
Pitting edema
- excess amount of fluid in absence of additional colloid
- often seen in legs
Non-pitting edema
-colloid in interstitial fluid balances the excess fluid
Low output failure
Hypovolemia, Heart failure
High output failure
Sepsis/Anaphylaxis, Neurogenic
Incr SVR, Decr CO
Hypovolemic shock
Incr. CO, compensatory decr. SVR
Sepsis/ Anaphylactic shock
Decr. CO, compensatory Incr. SVR
Heart failure
Decr. SVR and CO
Neurogenic shock
Bounding pulses, head bobbing, diastolic murmur
Aortic regurgitation
Most common congenital heart murmur
MV prolapse
Irregularly irregular, no p-waves
Atrial fibrillation
Sawtooth pattern on EKG
Atrial flutter
PR > 200ms
1st degree heart block
Incr. PR until dropped beat
Mobitz I
No warning before dropped beat
Mobitz II
Atria and ventricles contract independently of each other
3rd degree heart block
Delta waves on EKG
Wolff-Parkinson White
Wide QRS after long pause
Ventricular escape beat
Wide QRS and tachycardia
Ventricular tachycardia
Torsades de pointe
Undulating amplitude of QRS
Erratic rhythm on EKG
Ventricular fibrillation
Splinter hemorrhages
Bacterial endocarditis
Retinal hemorrhages
Roth spots
-Bacterial endocarditis
Heart valve most commonly involved in bacterial endocarditis
Mitral valve
Heart valve most commonly involved in an IV drug used with bacterial endocarditis
Tricuspid valve
Granulomatous nodules in the heart
Aschoff bodies
Most common cardiac tumor in adults
Metastasis
Left atrial myxoma
Most common primary cardiac tumor in children
Rhabdomyoma
Most common cause of constrictive pericarditis
Lupus in US
Tuberculosis in developing countries
Cold, pale, painful digits
Raynaud phenomenon
c-ANCA
Wegener’s Granulomatosis
p-ANCA
Microscopic polyangiitis, Churg-Strauss syndrome
Treatment for Berger disease
Smoking cessation
Treatment for temporal arteritis
High dose steroids
Bone enlargement, bone pain, arthritis
Paget disease of the bone
Vertebral compression fracture
Osteoporosis
Positive anterior drawer sign
ACL injury
Swollen, red, acutely painful great toe joint
Gout
Swollen, hard, painful finger joints
Osteoarthritis
Swollen, boggy, painful finger joints
Rheumatoid arthritis
Arthritis, dry mouth, dry eyes
Sjogren syndrome
Positively birefringent rhomboid shaped crystals
Pseudogout
Negatively birefringent needle-shaped crystals
Gout
Cartilage erosion with polished bone beneath
Enburnation
-suggestive of osteoarthritis
Keratin pearls on skin biopsy
Squamous cell carcinoma
Most common malignant skin tumor
Basal cell carcinoma
Bamboo spine on X-ray
Ankylosing Spondylitis
HLA-B27
Seronegative spondyloarthropathies
Anti-smith and Anti-dsDNA antibodies
SLE
Anti-histone antibodies
Drug induced lupus
Anti-centromere antibodies
CREST scleroderma
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
Facial rash and Raynaud phenomenon in a young woman
SLE
Most common cause of death in SLE
Lupus Nephritis
Most common cardiac manifestation of SLE
Libman-Sacks Endocarditis
Most common opportunistic infection in HIV PTs
Pneumocystis jirovecii
Prophylaxis for Cryptococcus in AIDS PTs
Fluconazole
Prophylaxis for PCP in AIDS PTs
TMP-SMX
Treatment for Sporothrix schenckii
Oral K+ iodide or Itraconazole
Treatment for oral candidiasis
Nystatin or Fluconazole
Treatment for Systemic Candidiasis
Amphotericin B
Most common medication used for UTI prophylaxis
TMP-SMX
Most common bacteria in a PT with struvite kidney stones
Proteus mirabilis, S.aureus
Dark purple nodules on the skin in an HIV PT
Kaposi sarcoma (HHV-8)
Owl’s eye inclusions in monocytes
CMV infection
Intranuclear eosinophilic droplets
Type A cowdry bodies
-HSV, VZV, CMV
Aplastic anemia in a PT with sickle cell dz
Parvovirus B19
Child with fever and “slapped cheek” rash on the face that spreads to his body
Fifth’s disease (Parvovirus B19)
Fever, runny nose, cough, conjunctivitis
Measles virus (Rubeola)
Small, irregular blue-gray spots on buccal mucosa surrounded by a base of red
Koplik spots- Measles
Most common etiology of nosocomial pneumonia
Klebsiella > E. coli, Pseudomonas
Most common etiology of bacterial meningitis in neonates
Group B Strep > E. coli
Most common etiology of bacterial meningitis in children
S. pneumo, N. meningitidis
Most common etiology of bacterial meningitis in adults
S. pneumo
Osteomyelitis in an IV drug abuser
S. aureus, Pseudomonas
Osteomyelitis in a sickle cell PT
Salmonella
Most common reportable STD
Chlamydia
Non-painful indurated, ulcerated genital lesion
Primary syphilis chancre
Painful, indurated, ulcerated genital lesion with exudate
Chancroid- H. ducreyi
Stippled vaginal epithelial cells on wet mount prep of vaginal discharge
Clue cells- Gardernella
Common tx for Syphilis
Penicillin G
Common tx for Trichomonas
Metronidazole
Common treatment for Chlamydia
Doxycycline/ Azithromycin
Common treatment for gonorrhea
Ceftriaxone
Most common inherited bleeding disorder
von Willebrand’s disease
-incr. PTT and bleeding time
Keratin pearls on skin biopsy
Squamous cell carcinoma
Most common malignant skin tumor
Basal cell carcinoma
Most common medication for ADHD
Methylphenidate
Most common medication for Bulimia nervosa
Fluoxetine
Medical treatment for alcohol withdrawal
Benzodiazepines
Most effective treatment for alcohol abuse
Alcoholics anonymous
Atrophy of the mammillary bodies
Wernicke encephalopathy
Treatment for central DI
Desmopressin
Treatment for Nephrogenic DI
HCTZ, Indomethacin, Amiloride
Treatment for lithium-induced Nephrogenic DI
Amiloride
Modular hyaline deposits in glomeruli
Kimmelsteil-Wilson lesions
Glomerulonephritis + Pulmonary Vasculitis
Wegener’s Granulomatosis, Goodpasture’s syndrome
Red cell casts
Glomerulonephritis
Waxy casts
Chronic renal failure
Thyroid-like appearance of kidney
Chronic pyelonephritis
Most common renal tumor
Renal cell carcinoma
Most common type of renal stone
Calcium stones
Type of renal stone associated with Proteus vulgaris
Struvite stone
Most common cancer in men
Prostate adenocarcinoma
Most common cause of urinary obstruction in men
BPH
Most common treatment for erectile dysfunction
Sildenafil
Dysplastic cervical cells with enlarged, dark nuclei
Koilocytes
DES exposure
Vaginal clear cell adenocarcinoma
Most common tumor in women
Leiomyoma
Most common gynecological malignancy in the US
Endometrial carcinoma
Most common gynecological malignancy worldwide
Cervical cancer
Chocolate cyst of the ovary
Endometriosis
Most common benign ovarian tumor
Serous cystadenoma
Most common malignant ovarian tumor
Serous cystadenocarcinoma
Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies
-Granulosa-theca cell tumors
Incr. AFP on amniocentesis
- Neural tube defect
- Anencephaly
- Incorrect dating of pregnancy
Most common genetic cause of mental retardation
Down syndrome
Second most common genetic cause of mental retardation
Fragile X
Horseshoe kidney, congenital heart defects, streak ovaries, cystic hygroma
Turner syndrome
Rocker-bottom feet, clenched hands, microcephaly with prominent occiput and small jaw
Edwards syndrome (Trisomy 18)
Most common cancer in women in the US
Breast cancer
Most common benign breast tumor
Fibroadenoma
Most common malignant breast tumor
Infiltrating ducal adenocarcinoma
Blue dome cyst in the breast
Fibrocystic change
Treatment for ER+ breast cancer
SERM: Tamoxifen
Red, itchy, swollen rash on areola and nipple
Paget dz of Breast
Breast pathology with histological “leaf-like projections”
Phyllodes tumor
Treatment of Vertigo
Meclizine
-antihistamine H1
What drug inhibits 17,20 desmolase
Ketoconazole
- used to decr steroid synthesis in tx of PCOS to prevent hirsutism
- s.e. Gynecomastia, Amenorrhea
Non-steroidal competitive inhibitor of androgens at testosterone receptor
Flutamide
-used to tx Prostate cancer
MOA Spironolactone
Inhibits steroid binding, 17a hydroxylase and 17,20 desmolase
- used to decr steroid synthesis in tx of PCOS to prevent hirsutism
- s.e. Gynecomastia, Amenorrhea
What drug decreases contraction frequency in women during labor
Terbutaline
-b2 agonist: relaxes uterus
Mg and CCBs decrease muscular contractions
NSAIDs decr. PG synthesis and decr. inflammation
Hypertensive crisis
Occurs when PTs on MAOIs ingest food with tyramine
MAOIs are contraindicated with
SSRI, TCA, Meperidine, Dexteomethorphan, St. John’s wort
Doxepin and Amoxapine are in what drug class
TCAs
Which TCA has a high seizure incidence
Desipramine
Treatment for Serotonin Syndrome
Cyproheptadine- 5-HT2 receptor antagonist
Cooling, Benzos
