Do Not Confuse Flashcards
Mitral Regurg with CNS disease
Tuberous Scerlosis
Angiofibromas
Tuberous Sclerosis
Ash leaf spots
Tuberous Sclerosis
Cardiac rhabdomyoma
Tuberous Sclerosis
Renal angiomyolipoma
Tuberous Sclerosis
Shagreen patches
Tuberous Sclerosis
Subependymal astrocytoma
Tuberous Sclerosis
Cafe au lait
NF1
Lisch nodules
NF2
Pheochromocytoma
MEN, NF1, VHL
Cavernous hemangiomas
VHL
Renal cell carcinoma
VHL
Hemangioblastoma
VHL
Retinal angiomas
VHL
What substances are neither secreted nor reabsorbed in the kidney?
Inulin and Creatinine
Doe Hep b cause chronic infection?
In adult it is less likely but VERY high chance in neonates that get it from a mom with HbeAg! Neonates will not show very elevated LFTs
What is bethanechol?
Cholinergic agent that activates bowel and bladder.
What is bethamethasone?
Prenatal to improve surfactant production
What is beclamethasone?
Chronic asthma
What presents with myoclonus, nonrhythmic conjugate eye movement, and abdominal mass in a kid?
Neuroblastoma
How does CFTR work in the lungs and sweat in cystic fibrosis?
Lungs: doesn’t secrete Cl and doesn’t inhibit Enac so Na is reabsorbed
Sweat: causes Na and Cl secretion
Pancreas is same as lung
What is nucleus accumbens vs ambiguus?
Accumbens: where GABA is made
Amibguus: where the nuclei for 9,10,11 are
What does histology for type 1 DM look like?
Islet leukocyte infiltration
Destruction in T1DM primarily through cell mediated immunity
What does histology for type 2 DM look like?
Islet amyloid deposition
What has microabscesses at tips of papillae?
Dermatitis herpetiformis
What is the mutation in the inherited form of pulm. HTN?
Inactivating mutation in BMPR2 (normally inhibits vascular smooth muscle proliferation)
Two hit hypothesis (first insult is mutation, second is infection, drugs etc)
What cells have high telomerase activity?
Cancer cells and stem cells (like in the epidermis and BM)
How does maternal diabetes affect the baby?
Too much glucose from mom crosses to the baby and it causes fetal beta cell hyperplasia. The glucose gets absorbed and deposited (responsible for macrosomia and big baby). After detachment from mother, the hyperinsulinemia in baby continues transiently causing baby to be hypoglycemic
What causes tissue damage and resultant abscess formation?
Lysosomal enzyme release from neutrophils and macrophages
What is galacatosyl beta 1,4 glucose?
Lactose!
Broken down into galactose and glucose
What causes eggshell calcifications of hilar nodes and birefringent particles surrounded by fibrous tissue?
Silicosis
What causes calcified pleural plaques and ferruginous bodies?
Asbestosis
What disease does the pathogenesis of nonbacterial thrombotic endocarditis (NBTE) resemble?
Trousseau
NBTE often involves hypercoagule state. When hypercoagulable state from procoagulant effects of circulating cancer products then vegetations on valve may be called marantic. Migratory thrombophlebitis (trosseau) is also from release of procoagulants of cancer.
Why do you see urinary incontinence with normal pressure hydrocephalus?
Because the enlarged ventricles mess up the corona radiata (cortical afferent/efferent fibers) so the cortex cannot inhibit the sacral micturition reflex (s2-s4 stimualte bladder wall)
How long does it take to lose myocardial contractility after ischemia?
60 seconds! After 30 minutes it is irreversible.
What is likely the cause of SCD if soon after an MI or CAD event?
VENTRICULAR FIBRILLATION!
Thromboemboli and mural thrombosis are not till later!
What is acute acalculous cholecystitis?
Acute inflammation of GB in absence of gallstones. MC in hospitalized and severely ill
What causes fibrotic and shrunken GB?
Chronic cholecystitis
Hippocampal atrophy on MRI is highly suggestive of what disease?
Alzheimers!
What GF stimulate angiogenesis?
VEGF and FGF
What does EGF do?
Promote mitosis in epithelial, hepatocytes, and fibroblast cells
Amino acid charges based on pH and pKa?
pH > pKa: protons dissociate
How do you treat neuroleptic malignant syndrome?
Dantrolene or Bromocriptine
How do you treat antipsychotic related EPS symptoms?
Benztropine or diphenhydramine
What happens to TLC and RV in obstructive lung disease?
RV/TLC increases!
Where do you see inflammatory inflammation in Guillan Barre?
Endoneural!!
Endomysial was polymyositis and is muslce!
What will be normal after pancreaticectomy?
D-xylose absorption
used to test for malabsorption vs pancreatic dysfunction
If someone presents with vit A deficiency what is a possible cause?
Biliary obstruction! (fat soluble malabsorption)
What is aspirated in aspiration pneumonia?
Oropharyngeal contents
Anaerobic bacteria in oral cavity or S. aureus causes the lung abscess
What happens if maxillary prominences fail to properly fuse with intermaxillary segment?
Cleft lip
What happens if palatine shelves of maxillary prominence don’t fuse with one another?
Cleft palate
What cells line the walls of a cyst in the brain after months/years after ischemic event?
Astrocytes! They are what make up the glial scar
What do you use for diagnosing toxic megacolon from UC?
X-ray
Is PBC of PSC a complication of UC?
PSC
What is heliotrope?
Erythematous periorbital rash
Aw/ dermatomyositis
What has precipitated hemoglobin?
Heinz
What has precipitated nuclear fragments?
Howell Jolly
What presents with non rhythmic conjugate eye movements, myoclonus, hypotonia?
Neuroblastoma
What is a cell with bilobed nucleus and a lot o granules?
Eosinophil
Neutro have multilobed nuclei but no granules
What can induce mania in susceptible patients (like those with unrecognized bipolar)?
Antidepressants
What has cavernous blood filled vascular spaces lined by single epithelial layer?
Cavernous hemangioma
MC benign liver tumor
What is the cosyntropin stimulation test used for?
Adrenocortical insufficiency
What is the high dose dexamethasone suppression test used for?
To determine if it is a pituitary adenoma (will suppress) or ectopic ACTH (like small cell)
Can also do a CRH stimulation test (inc ACTH if pituitary adenoma but no inc if ectopic)
What is low dose dexamethasone suppression test for?
To determine if its a adrenal tumor (dec ACTH) or a pituitary adenoma/ectopic ACTH (inc ACTH)
What does PBC resemble?
GVHD because they both have granulomatous bile duct destruction and lymphocyte infiltrate
What has florid duct lesions?
PBC
What causes autosplenectomy in sickle cell patients?
Vaso occlusive crises causes repetitive infarcts of the spleen leading to it become shrunken and fibrotic over time.
Diagnosis: bleeding from venupuncture sites, immature myeloid cells with giant cytoplasmic granules, and bruising?
APL
Granules = auer rods
Infection and coagulopathy causing hemorrhagic signs (remember they get DIC)
What do you think if multiple cysts in liver with only mildly elevated liver enzymes?
Metastaes to liver (won’t really mess up enzymes until later, tends to multiple, and MC than hepatocellular carcinoma)
What happens to aldosterone levels with ARB?
They DECREASE!
ARB inhibits Angiotensin II receptors so ang II can’t stimulate aldosterone release from the adrenal glands
Which way does PCL go?
When looking at the knee from the front, it is from bottom left to top right
Attaches to anterior part of lateral surface of medial epicondyle of femur
What do you use for arsenic posioning?
Pencillamine or dimercaprol
What do you use EDTA for?
Lead poisoning
What happens in Sheehan syndrome?
Pituitary enlarges due to inc estrogen in pregnancy. If significant ischemia (ie if as during postpartum hemorrhage), pituitary can undergo ischemic necrosis –> deficiency of pituitary hormones
What is the hemodynamic response to volume overload by aortic regurg to maintain CO?
Increase LVEDV (ie preload). Also do eccentric left ventricular hypertrophy (causing dilation and “in series” sarcomeres)
Remember concentric is hypertrophic
What does the vascular reaction to intimal injury?
Smooth muscle cells (they cause intimal hyperplasia, fibrosis, ECM deposition) lading to fibrou atheroma formation
What type of fluid loss do you get with hemorrhaging?
Isotonic ECF loss (no effect on ICF)
What type of fluid loss do you get with adrenal insufficiency?
Hypoosmotic volume contraction
Loss of NaCl in the urine so serum is hypoosmotic but euvolemic. Since hypoosmotic, ECF fluid moves into ICF>
What type of fluid loss do you get with diabetes inspidius?
Hyperosmotic volume contraction
Why do you see the on off phenomena with levodopa?
Due to progressive nigrostriatal neurodegeneration leading to decreased therapeutic window for levodopa. Leads to unpredictable drug response
What intensifies the S4 sound?
Expiration because blood flows from lungs to left atrium
What is the MCC of aortic dissection?
HTN!!
or cystic medial degeneration
What causes thoracic aorta aneurysms?
Cystic medial degeneration from HTN (older) or marfan (younger) and obliteration of vaso vasorum
What tests attention and concentration on MMSE?
Counting down from 100, reciting months in reverse order, and spelling words backword
What tests comprehension on MMSE?
Following multistep commands
What is myc?
A transcription factor
What are the anaerobes?
Clostridium, Actinomyces, and Bacteroides
What is released because of rhabdomyolysis?
Myoglobin! It can damage kidneys
Increased exertion usually cause myoglobin release
CK when there is muscle damage
Why do people with interstitial lung fibrosis have greater than normal expiratory flow volumes?
Increased radial traction
They have increased elastic recoil which causes increased radial traction (outward pulling) due to fibrotic lung tissue pulling
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer wright rosettes
What is yellowish CSF?
Xanthochromia seen with subarachnoid hemorrhage
What is the MCC of death in duchenne?
Dilated CM
What do you treat hyperammonemia with?
Lactulose, benzoate, phenylbutyrate
Why does leprosy only infect skin and superficial nerves?
Because it likes cool temperatures
Which one has flagella? Salmonella or Shigella?
Salmonella
Which one has an animal reservoir? Salmonella or Shigella?
Salmonella
Which one does not have hematogenous spread: salmonella or shigella?
Shigella
What is Jarisch Herxheimer reaction?
Flu like syndrome after antibiotics started due to bacteria releasing pyrogens
What causes VDRL false positives?
Viruses
Drugs
Rheumatic fever
Lupus and leprosy
What do the ABC serotypes for chlamydia do?
Blindness from follicular conjunctivitis in Africa
ABC = Africa, blindness, chronic infection
How do you treat mycoplasma?
Macrolide, doxycycline, fluoroquinolone
What does T. brucei present with?
Lymphadenopathy, recurring fever (ferom antigenic variation), somnolence, coma
What does babesia present with?
fever and hemolytic anemia in NE US
Same tick as lyme (ixodes)
What are the flavivirus?
HCV, yellow fever, dengue, west nile
What is test for the diagnosis for HIV?
ELISA: sensitive
Western blot: specific
What is the toxicity for carbapenem?
CNS toxicity at high doses, skin rash, GI distress
What is the antibiotic with NMJ blockade as a toxicity?
Aminoglycoside
What are aminoglycosides for?
Gram negative rods
