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AM- STEP1 > GI/ Heme/ Oncology Review > Flashcards

GI/ Heme/ Oncology Review Flashcards

1
Q

Midgut development

  • 6th week
  • 10th week
A

6th week
- midgut herniates through umbilical ring

10th week

  • returns to abdominal cavity
  • rotates around superior mesenteric artery (270 degrees)
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2
Q

Pyloric stenosis associated with exposure to

A

Macrolides

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3
Q

Posterior duodenal ulcers penetrate the

A

gastroduodenal artery

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4
Q

Anterior duodenal ulcer perforate into

A

the anterior abdominal cavity

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5
Q

Stomach ulcer along lesser curve penetrates the

A

left gastric

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6
Q

Sites of anastomosis and what vessels involved (3)

A

1) Esophagus
- Esophageal varices
- L gastric and azygos

2) Umbilicus
- Caput medusae
- Paraumbilical and small epigastric veins of anterior abdominal wall

3) Rectum
- Anorectal varices
- Superior rectal with middle and inferior rectal

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7
Q

Above the pectinate line

  • arterial supply
  • venous drainage
  • innervation
  • lymphatic drainage
A

Above pectinate line

Arterial supply
- superior rectal artery (branch IMA)

Venous drainage
- superior rectal vein –> inferior mesenteric vein –> splenic vein –> portal vein

Innervation
- visceral innervation, not painful

Lymphatic drainage
- Internal iliac lymph nodes

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8
Q

Below Pectinate Line

  • Arterial supply
  • Venous drainage
  • Innervation
  • Lymphatic drainage
A

Below pectinate line

Arterial supply
- Inferior rectal artery (branch of internal pudendal artery)

Venous drainage
- Inferior rectal vein –> internal pudendal vein –> internal iliac vein –> common iliac vein –> IVC

Innervation

  • Somatic innervation
  • Inferior rectal branch of pudendal n.
  • Painful

Lymphatic drainage
- superficial inguinal nodes

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9
Q

Yellow fever affects what zone of liver architecture

A

Zone II: intermediate zone

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10
Q

Zone affected of liver by viral hepatitis

A

Zone I: periportal zone

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11
Q

Diaphragmatic hernia

  • what side
  • due to
A

Left side due to relative protection of right hemidiaphragm by liver

Congenital defect of pleuroperitoneal membrane

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12
Q

Indirect inguinal hernia

  • goes through
  • in reference to inferior epigastric vessels
  • due to
  • covered by
A

Goes through the internal (deep) inguinal ring, external (superfical) inguinal ring and into the scrotum

Lateral to inferior epigastric vessels

Due to failure of processus vaginalis to close

Can form hydrocele

Covered by all 3 layers of spermatic fascia

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13
Q

Direct inguinal hernia

  • goes through
  • in reference to inferior epigastric vessels
  • due to
  • covered by
A

Protrudes through the inguinal (Hesselbach) triangle. Bulges directly through the parietal peritoneum. Goes through external (superficial) inguinal ring only

Medial to inferior epigastric vessels
(lateral to rectus abdominis)

Due to acquired weakness in the transversalis fascia

Covered by external spermatic fascia

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14
Q

Secreted by duodenum and function

A

Cholecystokinin

  • I cells
  • increase pancreatic secretion
  • Increase gallbladder contraction
  • Decrease gastric emptying
  • Increase sphincter of Oddi relaxation

Secretin

  • S cells
  • Increase pancreatic HCO3 secretion
  • Decrease gastric acid secretion
  • increase bile secretion

GIP (Glucose-dependent insulinotropic peptide)

  • K cells
  • Decrease Gastric H secretion
  • increase insulin release
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15
Q

Iron, Folate and B12 absorbed where

A

Iron: duodenum

Folate: Small bowel

B12: terminal ileum

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16
Q

Bile acids conjugated to ____ (2) to make them _____

What catalyzes teh RL step of bile acid synthesis

A

Conjugated to glycine or taurine to make bile acids water soluble

Cholesterol 7alpha-hydroxylase

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17
Q

Mass in parotid gland, biopsy shows cystic with central mass of pale staining B cells

A

Papillary cystadenoma lymphomatosum
(Warthin tumor)

Benign cystic tumor with germinal center

Smokers

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18
Q

Birds beak appear on CT

A

volvulus

Bird beak on barium= achalasia

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19
Q

Esophageal varices located where

A

Lower 1/3 of esophagus

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20
Q

Plummer-Vinson syndrome

A

Plumbers DIE

Dysphagia
Iron deficiency anemia
Esophageal webs

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21
Q

Globus sensation

A

“something is stuck in throat”

Worse w/ swallowing saliva

Alleviated with food and liquid

Associated with anxiety

Functional disorder

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22
Q

Hypertrophied rugae

  • disease
  • pathogenesis
  • results in
A

Looks like brain gyri

Menetrier disease

Hyperplasia of gastric mucosa –> hypertrophied rugae, excess mucus production

With resultant loss of protein and parietal cell atrophy –> decrease gastric acid production

Enteric protein loss –> hypoalbuminemia –> edema

Precancerous

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23
Q

Gastric cancer

- Intestinal vs Diffuse

A

Intestinal

  • Due to H pylori
  • or smoked foods, tobacco smoking, chronic gastritis
  • On Lesser curvature
  • Looks like ulcer with raised margins

Diffuse
- Signet ring cells
- stomach wall grossly thickened and leathery
(linitis plastica)

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24
Q

Signet ring cells in ovaries

A

Krukenberg tumor

Gastric cancer spread to ovaries

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25
Q

Zollinger-Ellison syndrome causes what type of ulcers

Tx

A

Duodenal ulcers

PPI (omeprazole) +/- Octeotide (if hemorrhage)

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26
Q

Common feature of duodenal ulcers (2)

A

Pain decreases with eating

Hypertrophy of Brunner glands

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27
Q

Test for malabsorption syndromes

- test for fecal fat

A

Sudan stain

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28
Q

Celiac disease

  • intolerance of what protein
  • Associated with what HLA
  • Assoc w/ condition
  • Ab to
  • Histology of intestine
  • location
A

Intolerance of gliadin (gluten protein in wheat)

HLA-DQ2 and HLA-DQ8

Dermatitis herpetiformis, decreased bone density

IgA anti-tissue transglutaminase (IgA tTG)

Villous atrophy, blunting
Crypt hyperplasia

Distal duodenum and/or proximal jejunum

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29
Q

Foamy macrophages (distended) in intestinal lamina propria

Confusion
Inflamed joints
Trouble walking
Diarrhea
Chest pain
WL
LAD
Hyperpigmentation

Tx

A

Whipple Disease

Tropheryma whipplei

Tx
- Penicillin
- Ampicillin
- Tetracycline
(Takes 1-2 yrs)
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30
Q

Zenker diverticulum location

A

Between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor

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31
Q

Congenital megacolon

  • disease
  • Lack of
  • due to
  • Mutation
  • Symptoms
A

Hirschsprung disease

Lack of ganglion cells/ enteric nervous plexuses (Auerbach and Meissner plexuses) in distal segment of colon

Due to failure of neural crest cell migration

RET mutation

Bilious emesis, abdominal distention and failure to pass meconium within 48 hrs

Similar to appendicitis but longer than 1 month

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32
Q

Volvulus

  • Children
  • Elderly
  • pattern
A

Twisting of bowel around mesentery

Midgut: infants and children

Sigmoid: elderly (coffee bean on xray)

Whirl pattern on CT
Distended loops proximal to volvulus

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33
Q

Abdominal pain
Currant jelly stools
Telescoping
Coiled spring

  • Location
  • Lead point
  • May be associated with
A

Intussusception

Ileocecal junction

Meckel diverticulum

May be associated with recent viral infection (adenovirus) –> peyer patch hyperplasia –> lead point

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34
Q

Infant

Swollen bowel full of air

A

Necrotizing enterocolitis

Formula fed infants with immature immune system
- received oral food too soon

Necrosis of intestinal mucosa

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35
Q

Hyperpigmented mouth, lips, hands and genitalia

Numberous hamartomas throught out GI

A

Peutz-Jeghers syndrome

AD

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36
Q

Man brought into ER after seizure. Has never had one before. Has had intermittent bloody stools for past 4 months. Head CT reveals irregular masses extending from right to left hemisphere. CT of abdomen shows multiple polyploid masses in sigmoid colon

(A) Familial adenomatous polyposis
(B) Gardner syndrome
(C) Hereditary nonpolyposis colorectal carcinoma
(D) Tuberous sclerosis
(E) Turcot syndrome
A

E. Turcot syndrome

FAP/Lynch + Malignant CNS tumors (medulloblastoma, glioma)

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37
Q

Lynch syndrome

  • disease
  • symptoms
  • inheritence
  • mutation
  • progression
  • Location
  • Associated with
A

Hereditary nonpolyposis colorectal cancer (HNPCC)

15-20 polyps, family history of colorectal cancer

AD

Mutation of DNA mismatch repair with microsatellite instability
(Mutation or methylation of mismatch repair genes MLH1)

Progress to colorectal cancer

Proximal colon always involved

Associated with endometrial, ovarian and skin cancers

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38
Q

Apple core lesions on barium enema xray

A

Colorectal cancer

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39
Q

Main liver cancer

- assoc with

A

Hepatocellular carcinoma

HCV, alcoholic and nonalcoholic fatty liver disease, alpha 1 antitripsin)

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40
Q

Budd-Chiari

  • is what
  • due to
  • absence
  • assoc with
  • appearance
A

Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis

Congestive liver disease

Absence of JVD

Hypercoagulable states (polycythemia vera, postpartum, HCC)

Nutmeg liver (mottled appearance) 
- Right sided heart failure
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41
Q

Wilson’s disease

  • Mutation
  • chromosome
  • decreased
  • symptoms
  • Degeneration of
  • Tx
A

ATP7B
Chromosome 13

Decreased ceruloplasmin

Copper accumulates
Hepatitis
Dysarthria, tremor
Moody
Yellow eyes (green rings)

Hepatolenticular degeneration
- lenticular nucleus: putamen and globus pallidus

Tx: Penicillamine

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42
Q

Hemochromatosis

  • Inheritence
  • Mutation
  • Chromsome
  • HLA
  • defect
  • Labs
  • clinical
  • Death due to

Tx

A

Recessive mutation in HFE gene on Chr 6

Assoc with HLA-A3

Increased iron sensing and intestinal absorption

Increased ferritin, iron, transferrin
Decreased TIBC

Bronze diabetes
Cirrhosis
DM
Hypogonadism

HCC common cause of death

Deferoxamine, Phlebotomy

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43
Q

Acute pancreatitis causes

A

I GET SMASHED

Idiopathic
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcemia/ Hyertriglyceridemia
ERCP
Drugs (sulfa, NRTIs, protease inhibitors)
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44
Q

Abdominal pain radiating to back
Migratory thrombophlebitis
Obstructive jaundice with palpable non tender gallbladder

A

Pancreatic adenocarcinoma

Head to pancreas

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45
Q

H2 blockers

  • example
  • use
  • adverse effects
A

-dine
(cimetidine, ranitidine, famotidine, nizatidine)

Reversible block H2 receptor

Peptic ulcer, gastritis, mild esophageal reflux

Cimetidine

  • P-450 inhibitor
  • Gynecomastic
  • impotence
  • Cross BBB (confusion, dizziness)
  • Cross placenta
  • Decrease methomoglobin levels
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46
Q

Proton pump inhibitors

  • example
  • MOA
  • Uses
A

-prazole
(Omeprazole, lansoprazole, pantoprazole…)

Irreversibly inhibit H/K ATPase in stomach parietal cells

Peptic ulcer, gastritis, reflux, zollinger ellison,
Stress ulcer prophylaxis

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47
Q

Aluminum hydroxide

A

Alter gastric and urinary pH

Hypokalemia

Constipation
Hypophospahtemia
Proximal muscle weakness
Seizures

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48
Q

Calcium carbonate

A

Alter gastric and urinary pH

Hypokalemia

Hypercalcemia
Rebound acid increase

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49
Q

Magnesium hydroxide

A

Alter gastric and urinary pH

Hypokalemia

Diarrhea
Hyporeflexia
Hypotension
Cardiac arrest

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50
Q

Bind to ulcer base, provide physical protein and allowing HCO3 secretion to reestablish pH gradient

  • requires
A

Bismuth (peptobismal)
Sucralfate

Requires acidic environment (Sucralfate)

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51
Q

PGE1 analog

  • MOA
  • Use
  • adverse effect
A

Misoprostol

Increase production and secretion of gastric mucous barrier

Decrease acid production

Prevention of NSAID induced peptic ulcers
Off label use for induction of labor (ripens cervix)

Diarrhea

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52
Q

Octreotide

  • MOA
  • uses
  • Adverse effects
A

Long acting somatostatin analog

Inhibits various splanchnic vasodilatory hormones

Acute variceal bleeds
Acromegaly
VIPoma
Carcinoid tumors

Nausea, cramps
Steatorrhea
Increase risk cholithiasis due to CCK inhibition **

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53
Q

Sulfasalazine

  • MOA
  • Use
  • Adverse
A

Combo of sulfapyridine (antibacterial) and 5- aminosalicylic acid (anti-inflammatory)

Activated by colonic bacteria

UC and chrons

Nausea, sulfa toxicity
Oligospermia** (reversible)

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54
Q

Loperamide

  • MOA
  • Use
  • Adverse effects
A

Agonist at mu opoid receptor
Slows gut motility

Poor CNS penetration

Used for diarrhea

AE: constipation, nausea

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55
Q

Ondansetron

  • MOA
  • Use
  • Adverse effects
A

5-HT3 antagonist (serotonin)
Decrease vagal stimulation

Central- acting aniemetic

Control vomiting post-op and in chemo

Adverse

  • Headache **
  • Constipation
  • QT prolongation **
  • Serotonin syndrome
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56
Q

Metoclopramide

  • MOA
  • Use
  • Adverse effects
A

D2 receptor antagonist
( Stimulates 5-HT, inhibits D2)

Increase resting tone, contractility, LES tone, motility, promotes gastric emptying.

Use: DM and post surgery gastroparesis, antiemetic, persistent GERD

Adverse

  • Parkinson effect **
  • Tardive dyskinesia
  • Seizures **
  • Restlessness
  • Depression
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57
Q

Orlistat

  • MOA
  • Use
  • Adverse effects
A

Inhibits gastric and pancreatic lipase

Decrease breakdown and absorption of dietary fats

Use: Weight loss

Adverse

  • Steatorrhea
  • Decrease absorption of fat soluble vitamins
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58
Q

Laxatives
- Psyllium, methylcellulose

  • Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose
  • Senna
  • Docusate
A

Psyllium, methylcellulose

  • Bulk forming
  • soluble fibers draw water into lumen
  • AE: bloating

Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose

  • Osmotic laxatives
  • Provide osmotic load to draw water into GI lumen
  • AE: diarrhea, dehydration

Senna

  • Stimulants
  • Enteric nerve stimulation –> colonic contraction
  • Diarrhea
  • Melanosis coli: lumen of gut is pigmented with brown color

Docusate

  • Emollient
  • Osmotic draw into lumen, increase water absorption by stool
  • AE: diarrhea
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59
Q

Aprepitant

  • Type
  • MOA
  • Use
A

Substance P antagonist

Blocks NK1 receptors in brain

Antiemetic for chemotherapy induced nausea and vomiting

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60
Q

Thrombocyte contains what 2 things

A

Dense granules
- ADP, Ca

Alpha granules
- vWF, fibrinogen, fibronectin

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61
Q

vWF receptor

A

GpIb

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62
Q

Fibrinogen receptor

A

GpIIb/IIIa

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63
Q

Neutrophil chemotactic agents

A 
C5a
IL-8
LTB4
kallikrein
Platelet activating factor
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64
Q

Target cell seen in

A

HALT

HbC disease
Asplenia
Liver
Thalassemia

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65
Q

Drugs that target P2Y12 receptor

A

Inhibit ADP induced expression of GpIIb/IIIa via P2Y12 receptor

Clopidogrel
Prasugrel
Ticlopidine

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66
Q

Drugs that target GpIIb/IIIA

A

Inhibit directly

Abciximab
Eptifibatide
Tirofiban

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67
Q

Microcytic hypochromic anemia

A

MCV < 80
Hypochromic (central pallor)

LIST

Lead poisoning
Iron deficiency
Sideroblastic anemia
Thalassemia (Alpha, Beta)

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68
Q

Macrocytic anemia

A

MCV > 100

Megaloblastic anemia
Folate deficiency
Vit B 12 deficiency (neurologic symptoms)
Orotic aciduria (no hyperammonia)
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69
Q

Non hemolytic, normocytic anemia

A

Anemia of chronic disease

Aplastic anemia

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70
Q

Pyruvate kinase deficiency

A

AR

Pyruvate kinase defect
Decreased ATP
Rigid RBCs
Extravascular hemolysis

Increased levels of 2,3 BPG
Decreased hemoglobin affinity for O2

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71
Q

Crystals inside RBCs

Target cells

A

HbC disease

Glutamic acid –> lyCine (lysine) mutation in beta globin

Causes extravascular hemolysis

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72
Q

Sickle cell vasoocculsion due to

A

abnormal hemoglobin polymerization

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73
Q

Lead poisoning

  • affected enzyme
  • accumulated substance
  • symptoms
A

Affected

  • ferrochelatase
  • ALA dehydratase

Accumulated (blood)

  • Protoporphyrin
  • ALA

Mental deterioration
HA
Memory loss

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74
Q

Acute intermittent porphyria

  • inheritence
  • affected enzyme
  • Accumulation
  • symptoms
  • tx
A

AD

Affected
- porphobilinogen deaminase
(previously known as uroporphyrinogen I synthase)

Accumulation

  • Porphobilinogen
  • ALA

5 P’s

  • Painful abdomen
  • Port wine colored urine (reddish urine darkens on exposure to light and air)
  • Polyneuropathy
  • Psychological disturbances
  • Precipitated by drugs (barbiturates, seizure drugs, rifampin, metoclopramide)

Tx Glucose and heme (dextrose)

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75
Q

Porphyria cutanea tarda

  • Inheritence
  • Affected enzyme
  • Accumulation
  • symptoms
A

Affected enzyme

  • AD
  • Uroporphyrinogen decarboxylase

Accumulation
- Uroporphyrin

Symptoms

  • Tea colored Urine
  • Blistering to sun
  • Hyperpigmentation to sun exposure
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76
Q

Bernard-Soulier

  • platelet count
  • bleeding time
  • defect
A

Normal or decreased platelets
Increased bleeding time

Defect in platelet plug formation

  • Large platelets
  • Decreased GpIb
  • defect platelet to vWF adhesion
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77
Q

Glanzmann thrombasthenia

  • platelet count
  • bleeding time
  • defect
  • blood smear
A

Normal platelet count
Increased bleeding time

Defect in platelet integrin (GpIIb/IIIa)
- defect in aggreagation

Blood smear shows no clumping

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78
Q

HUS

  • platelet count
  • bleeding time
  • defect
  • features
A

Decreased platelets
Increased bleeding time

Acute renal failure
Children
Diarrhea and E.coli

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79
Q

Immune thrombocytopenia

  • platelet count
  • bleeding time
  • defect
  • bone marrow biopsy
A

Decreased platelets
Increased bleeding time

Anti-GpIIb/IIIa antibodies

Increased megakaryocytes on bone marrow biopsy

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80
Q

Thrombotic thrombocytopenic purpura

  • platelet count
  • bleeding time
  • defect
  • increased
  • labs
A

Decreased platelets
Increased bleeding time

Inhibition or deficiency of ADAMTS 13 (vWF metalloprotease) –> decreased degradation of vWF multimers

Increased platelet adhesion, aggregation and thrombosis

Schistocytes, increased lactate dehydrogenase, thrombocytopenia

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81
Q

Owl eyes

- surface marker for this cell type

A

Reed Sternberg cells
- Hodgkin lymphoma

CD15 and CD 30 B cell

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82
Q

Mandible Mass
Night sweats
Sheets of lymphocytes with interspersed “tingible body” macrophages

  • Translocation
  • gene
  • assoc with
A

Burkitt lymphoma

t(8;14)
c-myc

EBV

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83
Q

t(8;14)

A

Burkitt lymphoma

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84
Q

t(14;18)

A

Follicular lymphoma

BCL-2

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85
Q

t(11;14)

A

Mantle cell lymphoma

Tranlocation of cyclin D1 (11) and heavy chain Ig (14), CD5+

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86
Q

t(11;18)

A

Marginal zone lymphoma

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87
Q

Older adult

Rapidly growing mass

A

Diffuse large B cell lymphoma

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88
Q

Waxing and waning lymphadenopathy

A

Follicular lymphoma

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89
Q

Cutaneous lesions
Lytic bone lesions
Hypercalcemia

A

Adult T cell lymphoma

HTLV mutation

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90
Q

Skin patches/ plaques characterized by typical CD4 + cells with cerebriform nuclei and intraepidermal neoplastic ell aggregates

A

Mycosis fungoides/ Sezary syndrome

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91
Q

Tx multiple myeloma

A

Proteasome inhibitor

Borteozomib
- boronic acid containing dipeptidase

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92
Q

Rouleaux formation

A

Multiple myeloma

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93
Q

Multiple myeloma symptoms/ features

A

CRAB

hyperCalcemia
Renal involvement
Anemia
Bone lytic lesions/ Back pain
Monoclonal M protein spike
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94
Q

t(12;21)

A

ALL

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95
Q

Splenomegaly
Pancytopenia
Marrow fibrosis “Dry tap”
Positive TRAP (tartrate resistant acid phosphatase)

TX

A

Hairy cell leukemia
- mature B cellt umor

Hair like projections on LM

Treatment

  • Cladribine
  • Pentostatin
96
Q

Cell with small amount of purplish clear cytoplasm, large purple nucleus. Small purple particle/ spinter on periphery

  • disease
  • cell type
  • positive for
  • translocation
  • tx
A

AML

Auer rods

Myeloperoxidase positive

t(15;17)

TX
- all-trans retinoic acid (vit A)

97
Q

t (15;17)

A

AML

98
Q

t(9;22)

  • disease
  • lab
  • tx
A

BCL-ABL
Philiadelphia chromosome

CML

Very low LAP

Bcl-abl tyrosine kinase inhibitors
- Imatinib

99
Q

Myeloproliferative disorders

  • examples
  • mutation
A

Polycythemia vera
Essential thrombocythemia
Myelofibrosis
CML

JAK2 mutation

100
Q

Intense itching after hot shower

  • Due to
  • Lab
  • Tx
A

Polycythemia vera

Due to episodic blood clots in vessels of the extremities

Decreased EPO

Increased RBC, WBC, Platelets

TX

  • Phlebotomy
  • Hydroxyurea
  • Ruxolitinib (JAK1/2 inhibitor)
101
Q

Massive splenomegaly
Tear drop RBCs

  • Disease
  • Due to
  • Lab
A

Myelofibrosis

Obliteration of bone marrow with fibrosis due to increased fibroblast activity

Decreased RBC

Dry tap

102
Q

Lytic bone lesions
Skin rash
Recurrent otitis media
EM: Tennis racket

  • What do cells express
A

Langerhans cell histicytosis

S-100
CD1a

103
Q

Heparin

  • MOA
  • Adverse effects
  • Reversal
  • Administered
  • Site of action
A

Binds antithrombin III which then inhibits Factor Xa and neutralize thrombin

AE

  • Bleeding
  • Thrombocytopenia
  • Osteoporosis

Protamine sulfate
(binds to heparin)

IV or SQ

Blood

104
Q

Low molecular weight heparins

A

Enoxaparin
Dalteparin

Act predominantly on factor Xa

105
Q

Fondaparinux

  • type
  • MOA
  • 4 features
A

Low molecular weight heparin

Acts only on Factor Xa

Better bioavailability
Longer half life
Adminstered SQ
Not easily reversible

106
Q

Heparin induced thrombocytopenia (HIT)

A

development of IgG antibodies against heparin bound platelet factor 4 (PF4)

Antibody-heparin-PF4 complex activates platelets –> thrombosis and thrombocytopenia

107
Q

Similar to anticoagulant used by leeches, hirudin

A

Bivalirudin

Direct thrombin inhibitor

Directly inhibits activity of free and clot associated thrombin

108
Q

Direct thrombin inhibitors

  • examples
  • oral one
  • MOA
  • use
  • reversal
A

Bivalirudin
Argatroban
Dabigatran (only oral)

Directly inhibits activity of free and clot associated thrombin

Use

  • venous thromboembolism
  • Afib

Dabigatran can be reversed with idarucizumab

109
Q

Warfarin

  • MOA
  • Lab
  • Adverse effects
  • Route of admission
  • Site of action
A

Interferes with gamma-carboxylation of vit K- dependent clotting factors II, VII, IX, X and protein C and S

Inhibits epoxide reductase

Extrinsic pathway
Increase PT

Adverse effects

  • Bleeding
  • Teratogenic
  • Skin/ tissue necrosis ** (due to small vessel microthrombosis)
  • Transient hypercoagulability when first use due to Protein C and S

Oral

LIver

110
Q

Apixaban

  • type
  • other
  • MOA
  • Use
A

Direct Factor Xa inhibitors

-Xaban
Apixaban
Rivaroxaban

Bind to and directly inhibit factor Xa

TX for DVT and PE, stroke prophylaxis in patients w/ Afib

111
Q

Thrombolytics

  • examples
  • MOA
  • Lab
  • Use
A

Alteplase (tPA), reteplase (rPA), streptokinase, tenecteplase (TNK-tPA)

Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots

Increase PT, PTT, no change in platelet

Early MI, direct thrombolysis of severe PE

Dont use in patient with active bleeding or history of bleeding issues

112
Q

Antifibrinolytics

A

Aminocaproic acid

Tranexamic acid

113
Q

Clopidogrel

  • type
  • examples
  • MOA
  • Prevents
  • Use
  • Adverse effect
A

ADP receptor inhibitors

Clopidogrel
Prasugrel
Ticagreolar (reversible)
Ticlopidine

Inhibit platelet aggregation by IRREVERSIBLY block ADP (P2Y12) receptor.

Prevent expression of glycoproteins IIb/IIIa) on platelet surface

Use: Coronary stenting

Adverse effect

  • Neutropenia (ticlopidine)
  • TTP
114
Q

Cilostazol

  • type
  • other example
  • MOA
  • Use
  • Adverse effect
A

Phosphodiesterase inhibitors

Dipyridamole

Increase cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators

Use

  • Intermittent claudication
  • coronary vasodilation

Adverse effects

  • Nausea, HA
  • Facial Flushing
  • Hypotension
  • Abdominal pain
115
Q

Abciximab

  • Type
  • Other examples
  • MOA
  • Use
  • Adverse
A

Glycoprotein IIb/IIIa inhibitors

Abciximab
Eptifibatide
Tirofiban

Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation.

Use
- Unstable angina

Adverse

  • bleeding
  • thrombocytopenia
116
Q

Dipyridamole

  • type
  • other example
  • MOA
  • Use
  • Adverse effect
A

Phosphodiesterase inhibitors

Cilostazol

Increase cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators

Use

  • Intermittent claudication
  • coronary vasodilation

Adverse effects

  • Nausea, HA
  • Facial Flushing
  • Hypotension
  • Abdominal pain
117
Q

Eptifibatide

  • Type
  • Other examples
  • MOA
  • Use
  • Adverse
A

Glycoprotein IIb/IIIa inhibitors

Abciximab
Eptifibatide
Tirofiban

Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation.

Use
- Unstable angina

Adverse

  • bleeding
  • thrombocytopenia
118
Q

Cancer drugs that affect S phase of cell cycle

A

Antimetabolites

Azathioprine
Cladribine
Cytarabine
5-fluorouracil
Hydroxyurea
Methotrexate
6-mercaptopurine

Topoisomerase inhibitors (S and G2)

  • Etoposide
  • Teniposide
  • Irinotecan
  • Topotecan
119
Q

Cancer drugs that affect both S phase and G2 phase

A

Topoisomerase inhibitors

  • Etoposide
  • Teniposide
  • Irinotecan
  • Topotecan
120
Q

Tirofiban

  • Type
  • Other examples
  • MOA
  • Use
  • Adverse
A

Glycoprotein IIb/IIIa inhibitors

Abciximab
Eptifibatide
Tirofiban

Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation.

Use
- Unstable angina

Adverse

  • bleeding
  • thrombocytopenia
121
Q

Cancer drugs that affect G2 phase of cell cycle

A

G2 only
- Bleomycin

Topoisomerase inhibitors (S and G2)

  • Etoposide
  • Teniposide
  • Irinotecan
  • Topotecan
122
Q

Cancer drugs that inhibit M phase of cell cycle

A

Microtubule inhibitors

  • Paclitaxel
  • Vinblastine
  • Vincristine
123
Q

Cancer drugs that are independent of cell cycle

A

Platinum agents (cisplatin)

Alkylating agents

  • Busulfan
  • Cyclophosphamide
  • Ifosfamide
  • Nitrosoureas (carmustine)
124
Q

Cancer drugs that target nucleotide synthesis (4)

A

MTX, 5-FU
- decrease thymidine synthesis

6-MP
- decrease de novo purine synthesis

Hydroxyurea
- inhibit ribonucleotide reductase

125
Q

Cancer drugs that target DNA (9)

A

Alkylating agents, platinum agents
- Cross link DNA

Bleomycin
- DNA strand breakage

Dactinomycin, Doxorubicin
- DNA intercalators

Etoposide/ teniposide
- Inhibit topoisomerase II

Irinotecan/ topotecan
- inhibit topoisomerase I

126
Q

Use to prevent organ rejection, RA, IBD, SLE

  • MOA
  • Adverse effects
A

Azathioprine
6-mercaptopurine

Adverse effects
- myelosuppresion

127
Q

Use to tx hairy cell leukemia

  • MOA
  • Adverse effect
A

Cladribine

Purine analog –> multiple mechanism

  • Inhibition of DNA polymerase
  • DNA strand breaks

Myelosuppression
Nephrotoxicty
Neurotoxicity

128
Q

Tx Leukemia (AML) and lymphomas

  • MOA
  • Adverse effect
A

Cytarabine (arbinofuranosyl cytidine)

Pyrimidine analog
Inhibition of DNA polymerase

Myelosuppresion with megaloblastic anemia

CYTarabine causes panCYTopenia

129
Q

Cancer drug can result in hand foot syndrome (palmar-plantar erythrodysesthesia)

  • MOA
  • Use
A

5-fluorouracil

Pyrimidine analog
Inhibits thymidylate syntehase
Decrease DNA synthesis

Colon cancer
Pancreatic caner
Basal cell carcinoma

130
Q

Myelosuppression reversible with

A

Leucovorin

131
Q

What drug’s effects are enhanced by leucovorin

A

5-fluorouracil

132
Q

Mouth ulcers
Hepatotoxicity
Pulmonary fibrosis

From what drug

A

Methotrexate

133
Q

Testicular cancer tx (non-alkylating )

  • Drug
  • MOA
  • Other use
  • Adverse effect
A

Bleomycin

Induces free radical formation –> breaks in DNA strands

Testicular cancer
Hodgkin lymphoma

Pulmonary fibrosis
Hyperpigmentation

134
Q

Cancer drug causes

1) Pulmonary fibrosis
2) Hyperpigmentation
3) Nephrotoxicity, Neurotoxicity
4) Megaloblastic anemia, myelosuppression
5) Redness, swelling and pain on palms or soles
6) Hepatotoxicty
7) Cardiotoxicity
8) Convulsions, dizziness, ataxia
9) Mouth ulcers
10) Alopecia
11) Neuropathy and hypersensitivity
12) Areflexia, peripheral neuritis, constipation
13) Nephrotoxicity, peripheral neuropathy, ototoxicity
14) Diarrhea and myelosuppression
15) Hemorrhagic cystitis
16) Hemorrhage, blood clots, impaired wound healing
17) Rash only
18) Rash, Elevated LFTs, diarrhea
19) Fluid retention
20) Increased risk of thromboembolic events

A

1) Methotrexate, Bleomycin, Busulfan
2) Bleomycin, Busulfan
3) Cladribine
4) Cytarabine
5) 5-fluorouracil
6) Methotrexate
7) Doxorubicin, Daunorubicin , Trastuzumab (Herceptin)
8) Nitrosoureas
9) Methotrexate
10) Doxorubicin, Daunorubicin, Etoposide, teniposide
11) Paclitaxel
12) Vincristine, Vinblastine
13) Cisplatin, carboplatin
14) Irinotecan, topotecan
15) Cyclophosphamide, ifosfamide
16) Bevacizumab
17) Erlotinib
18) Cetuximab
19) Imatinib
20) Tamoxifen, Raloxifene

135
Q

Used to childhood tumors

  • Wilms tumor
  • Ewing sarcoma
  • Rhabdomyosarcoma

MOA

A

Dactinomycin (actinomycin D)

Intercalates DNA

136
Q

Doxorubicin
Daunorubicin

MOA
Use
Adverse
- Tx adverse

A

Anthrocyclines

Generates free radicals

Intercalate in DNA –> breaks DNA –> decrease replication
(Wedge into DNA between base pairs, forms tight bond, DNA cant unwind to replicate)

Solid tumors
Leukemia, lymphomas

Cardiotoxicity (dilated cardiomyopathy)
Alopecia

Dextrazoxane

  • iron chelating agent
  • prevent cardiotoxicity
137
Q

Use to prevent cardiotoxicity in patients taking doxorubicin or daunorubicin

A

Dextrazoxane

138
Q

Tx CML

MOA
Adverse
Other use
Adverse effects

A

Busulfan

Cross links DNA

Also used to ablate patient’s bone marrow before bone marrow transplantation

Pulmonary fibrosis
Hyperpigmentation

139
Q

Alkylating agent that can cross BBB

  • Needs
  • MOA
  • Use
  • Adverse effect
A

Nitrosoureas
- mustine
(carmustine, lomustine, semustine)

Requires bioactivation
Cross BBB

Cross link DNA

Use
- Brain tumors (glioblastoma)

Adverse
- CNS toxicity (convulsions, dizziness, ataxia)

140
Q

Cisplatin, carboplatin

  • MOA
  • Use
  • Adverse effect
  • Prevent adverse with
A

Cross link DNA

Testicular
Bladder
Ovary
Lung carcinoma

Nephrotoxicity
Peripheral neuropathy
Ototoxicity

Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis

141
Q

Prevent nephrotoxicity with

A

Amifostine

Free radical scavenger

142
Q

Aminocapric acid

Tranexamic acid use to reverse

A

Thrombolytics

Alteplase
Reteplase
Streptokinse
Tenecteplase

143
Q

Dexarazoxane

A

Iron chelating agent

Used to prevent cardiotoxity in Doxorubicin, and daunorubicin

144
Q

Amifostine

A

Free radical scavenger

Prevent nephrotoxicity in platins

145
Q

Cyclophosphamide

  • MOA
  • Other drug
  • Uses
  • Adverse effect
A

Cross- link DNA at guanine N-7

Requires bioactivation by liver
Nitrogen mustard

Solid tumors, leukemia, lymphoma
Immunosuppressant
(SLE, Polyarteritis nodosa)

Hemorrhagic cystitis
(Prevented by mesna- thio group of mesna binds toxic metabolites or N-acetylcysteine)

146
Q

Mesna

A

Binds toxic metabolites

Prevents Hemorrhagic cystitis

Cyclophosphamide

147
Q

Hydroxyurea

  • MOA
  • Use
A

Inhibits ribonucleotide reductase

Inhibit DNA synthesis in S phase

Myeloproliferative disorders
- CML
- Polycythemia vera
Sickle cells
Melanoma
148
Q

Monoclonal Ab

1) VEGF
- Use
- adverse

2) EGFR
- Use
- Adverse

3) CD20
- Use
- Adverse

4) HER-2
- use
- adverse

A

1) VEGF monoclonal Ab= Bevacizumab

  • Inhibits angiogenesis (blood vessel formation)
  • Solid tumors (colorectal cancer, renal cell carcinoma)
  • Hemorrhage, blood clots, impaired wound healing

2) EGFR monoclonal Ab= Cetuximab

  • Stage IV colorectal cancer (wild type KRAS)
  • Head and neck cancer
  • Rash, elevated LFTS, diarreha

3) CD20 monoclonal AB= Rituximab

  • CD20 on most B cell neoplasma
  • Non-hodgkin lymphoma, CLL, ITP, RA
  • Increased risk of progressive multifocal leukoencphalopathy

4) Trastuzumab (Herceptin)

  • HER2 breast cancer and gastric cancer
  • Cardiotoxicity. “Heartceptin” damages the heart
149
Q

Erlotinib

  • Type
  • Use
  • Adverse
A

EGFR tyrosine kinase inhibitor

Non-small cell lung carcinoma

Rash

150
Q

Imatinib

  • Type
  • Use
  • Adverse
A

Tyrosine kinase inhibitor of BCR-ABL and c-kt

CML, GI stromal tumors (GIST)

Fluid retention

151
Q

Borteozomib

  • type
  • MOA
  • Other example
  • Use
  • Adverse
A

Proteasome inhibitor

Induce arrest at G2-M phase and apoptosis
- Results in accumulation of toxic intracellular proteins excess pro-apoptotic proteins –> induce apoptosis

Boronic acid containing dipeptide

Multiple myeloma
Mantle cell lymphoma

Adverse

  • Peripheral neuropathy
  • herpes zoster reactivation (shingles)
152
Q

Carfilzomib

  • type
  • MOA
  • Other example
  • Use
  • Adverse
A

Proteasome inhibitor

Induce arrest at G2-M phase and apoptosis
- Results in accumulation of toxic intracellular proteins excess pro-apoptotic proteins –> induce apoptosis

Multiple myeloma
Mantle cell lymphoma

Adverse

  • Peripheral neuropathy
  • herpes zoster reactivation
153
Q

Raloxifene

  • MOA
  • Use
  • Adverse effect
A

Selective estrogen receptor modulators (SERMs)

  • antagonist in breast
  • agonist in bone
  • blocks binding of estrogen to ER + cells

Prevent osteoporosis
(Not direct tx for breast cancer but helps)

Antagonist in endometrial tissue

Increased risk of thromboembolic events

154
Q

Tamoxifen

  • MOA
  • Use
  • Adverse effect
A

Selective estrogen receptor modulators (SERMs)

  • antagonist in breast
  • agonist in bone
  • blocks binding of estrogen to ER + cells

Breast cancer treatment and prevention

Partial agonist in endometrium
- increase risk of endometrial cancer “ hot flashes”
Increased risk of thromboembolic events

155
Q

Vemurafenib

A

Small molecule inhibitor of BRAF oncogene + melanoma

V600E-mutated BRAF inhibition

VE-MU- RAF-enib is for V600E-MUtated bRAF inhibition

Serine/ threonine kinase

Metastatic melanoma

156
Q

Tx of cancer

Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia

Treatment

A

Tumor lysis syndrome

Agressive hydration
Allopurinol
Rasburicase

157
Q

Rasburicase

A

Recombinant uricase that catalyzes metabolism of uric acid to allantoin

Prevention and tx of tumor lysis syndrome

158
Q

What can trigger toxic megaclon

A

Antibiotics –> clostridum difficile

159
Q

Sensation of anterior 2/3 on tongue
Taste
Motor

A

Sensation: Mandibular branch of trigeminal n. (CN V3)

Taste: facial

Motor: hypoglossal n.

160
Q

Salivary gland stimulated secretions

A

Sympathetic

  • Thick secretions
  • Superior cervical ganglion

Parasympathetic

  • Watery
  • CN VII and CN IX
161
Q

What nerve runs through parotid gland and can be damaged with parotid gland surgery

A

CN VII

162
Q

Infection common of tonsils and adenoids

A

S. pyogenes

163
Q

Infection most common of salivary gland

A

S. aureus

Viridans group strep

164
Q

Pleomorphic adenoma

- composed of

A

Most common salivary gland tumor

Epithelial and mesenchymal cells

165
Q

Tumor of salivary gland

Double layer of columnar epithelium around cyst. Stroma is lymphoid.

  • Can form
A

Warthin tumor
- Benign cystic tumor

Can form germinal center

166
Q

Child with immune disorder has recurrent staphylococcal abscess. Found that neutrophils fail to respond because the chemotactic stimuli are deficient. Most likely?

A

Hyperimmunoglobulin E syndrome (Job syndrome)
- IFN-gamma low

Leukocyte adhesion deficiency

167
Q

Esophagitis

1) Esophagitis reveals large, pink intranuclear inclusions and host cell chromatin that is pushed to the edge of nucleus
2) Esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions and a clear perinuclear halo
3) Biopsy reveals a lack of ganglion cells between the inner and outer muscosal layers
4) Protrusion of mucosa in the upper esophagus

A

1) HSV esophagitis
2) CMV esophagitis
3) Achalasia
4) Plummer-vinson syndrome

168
Q

Dark urine
Clay colored stools
Jaundice

A

Extrahepatic biliary atresia

Incomplete recanalization

169
Q

Tx Esophageal variceal bleed

A

Vasopressin

Octreotide
Propranolol or nadolol (beta blocker)

170
Q

Vagus nerve directly stimulates what in GI

  • receptors
  • inhibited by

Vagus indirectly stimulates what

  • This secretes what
  • Inhibited by
A

Parietal cells to secrete gastric acid

  • M3 ACh receptors
  • Can be inhibited by atropine

Indirectly stimulates G cells to release Gastrin via Gastrin-releasing peptide

  • Gastrin stimulates enterochromaffin like (ECL) cells to secrete histamine
  • Stimulates parietal cells to make gastric acid
  • Atropine has no effect
  • H2 blockers (Cimetidine, Ranitidine)
171
Q

Upper GI problem

1) Stomach biopsy reveals neutrophils above the basement membrane loss of surface epithelium and fibrin containing purulent exudate
2) Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells and atrophy of glandular structures
3) Diffuse thickening of gastric folds, elevates serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

A

1) Acute gastritis
2) Chronic gastritis
3) Zollinger-Ellison syndrome

172
Q

Peptic ulcer treatment

Additional tx if hemorrhage

A

Triple therapy- H. pylori

  • PPI + clarithromycin + amoxicillin
  • PPI + clarithromycin + metronidazole

Quadruple therapy
- PPI + Bismuth + metronidazole + tetracycline

Hemorrhage= Octreotide (somatostatin)
- decrease splanchnic blood flow

173
Q

Vasoactive intestinal peptide (VIP)

A

Smooth muscle cells

Parasympathetic ganglia
Enteric nervous system

Relaxes smooth muscle and sphincters in GI tract

Increase secretion of electrolytes and water

Copious watery diarrhea

174
Q

Brunner glands

  • job
  • location
A

Secretes alkaline mucus
Neutralize gastric acid

Duodenal submucosa

175
Q

Ligaments that have to be cut to remove spleen

A

Gastrosplenic lig

Splenorenal lig

176
Q

Macrolides fxn in GI

A

Stimulate smooth muscle motilin receptors

177
Q

Pain out of proportion to physical exam

A

Ischemic colitis

178
Q

Downs syndrome GI problems

A

Dont Have A Clue

Duodenal atresia
Hirschsprung Disease
Annular pancreas
Celiac disease

179
Q

Preop Tx for appendicitis

A

Hydration
Cefoxitin
Ampicillin + sulbactam

180
Q

Stops in Chromosomal instability APC pathway

A

1) Loss of APC gene
2) KRAS mutation (increased growth stimulus)

3) Loss of tumor suppressor genes
- p53
- DCC (chr 18 q)

181
Q

Familial adenomatous polyposis

A

FAP

AD

Lots of polyps

182
Q

Fatty bulge under skin (fatty tumor)- Lipoma
Bone soft tissue tumors (osteomas)
- Extra bone growth (spur)
Lots of polyps in colon
Retinal hyperplasia (dark black spot in eye)

A

Gardner syndrome

183
Q

Tx Crohns

A

Initial for mild
- 5-ASA agents (5-aminosalicylic)
(Mesalamine, sulfasalazine)

Azathioprine or mercaptopurine

Anti-TNF if arthrtic component (infliximab, adalimumab)

184
Q

Diverticulitis tx

A

Metronidazole (anaerobic bacteria)

TMP-SMX or fluoroquinolone

185
Q

Pancreas derived from

A

Endocerm

186
Q 
Diabetes
Depression
Dermatitis
DVT 
Wt loss
A

Glucoagonoma

Tumor of pancreatic alpha cells

TX: octreotide

187
Q

Diabetes
Steatorrhea
Gallstones
Achlorhydrdia

A

Somatostatinoma

188
Q

Hormones stimulate pancreatic secretion

A

CCK (pancreas and GB)
Secretin (stimulate bicarb secretion)
Acetylcholine (CN X)

189
Q

Liver from what germ layer

A

Endoderm

190
Q

Metabolic Liver failure can cause an increase in

A

Increased estradiol levels

  • Testicular atrophy
  • Gynecomastia
  • Spider angioma (telangiectasia)
  • Palmar erythema (red palms)
191
Q

Medications for cirrhosis

  • Tx ascites and edema
  • Tx varices
  • Tx Hepatic encephalopathy
A

Diuretic (tx ascites and edema)

  • Spironolactone
  • Furosemide

Beta blockers (varices)

  • Propranolol
  • Nadolol

Vit K

Lactulose (tx hepatic encephalopathy)
- Trap ammonium in gut so gets excreted in stool

Rifamacin (refractory hepatic encephalopathy)

192
Q

Tx Hep B

A 
Tenofovir
Entacavir
Telbivudine
Lamivudine
Adefovir

Pregnant
- Lamivudinie

193
Q

Tx Hep D

A

Pegylated IFN-alpha

194
Q

Tx Hep C

A

Ledipasvir-Sofosbuvir

Ombitasvir-paritaprevir-ritonavir + dasabuvir

195
Q

Anti-smooth muscle ab

A

Autoimmune hepatitis

196
Q

Genus and family

1) Hep A
2) Hep B
3) Hep C
4) Hep D
5) Hep E

A

1) Hep A
- ssRNA
- hepatovirus
- picronavirus

2) Hep B
- dsDNA
- orthohepadnavirus
- Hepadnaviridae

3) Hep C
- ssRNA
- hepacivirus
- Flavivirdae

4) Hep D
- ssRNA
- deltavirdae

5) Hep E
- ssRNA
-

197
Q

Primary Biliary cholangitis (PBC)

  • MOA
  • Identifies
  • Tx
A

Autoimmune

T cells attack bile ductules within the liver parenchyma

Granulomas
Cirrhosis

Antimitochondrial antibody (AMA)

Tx: Ursodiol (ursodeoxycholic acid)
- bile acid that decreases the synthesis of cholesterol in the liver

198
Q

Primary Sclerosing Cholangitis (PSC)

  • MOA
  • Causes
  • Identifier
  • Associated with
  • Tx
A

Concentric fibrosis of bile ducts

Irregular ares of stricturing and areas of dilation “Beads on a string”

(+) p-anca

Associated with UC and cholangiocarcinoma

Tx: liver transplant

199
Q

RL of coagualtion pathway

A

Factor X

200
Q

Factor V Leiden

A

Makes Factor Va resistant to inactivation by protein C

More coagulation

201
Q

Hypercoagulable

Resistant to Heparin

A

Antithrombin deficiency

Unable to inactivate thrombin

202
Q

Protein C deficiency

A

Unable to inactivate factor V and VIII

203
Q

PT

A

Extrinsic
Starts with VII

Monitor Warfarin

204
Q

PTT

A

Intrinic
start w/ XII

Monitor heparin

205
Q

RL step in heme synthesis

A

delta-ALA synthase

206
Q

Chipmunk facies
Hair on end appearance X ray
Target cells
Microcytic anemia

A

Beta thalassemia

Increase Hemoglobin F (2 alpha 2 gamma)

207
Q

Orotic acid in urine
megaloblastic anemia
No hyperammonemia

A

Orotic aciduria

Def: UMP synthase

208
Q

Cold agluttings

A

Ab against RBC that interact more strongly at low temps

IgM

EBV or mycoplasma

209
Q

Warm agglutins

A

Ab react against RBC at body temp

IgG

EBV, HIV
Lupus
Malignancies (CLL, non-hodgkin)
Congenital immune abnormalities

210
Q

Hereditary spheocytosis defects in

A

Ankyrin
Spectrin
Band 3
Protein 4.2

211
Q

Tx Sickle cell

A

Hydroxyurea (increase HbF)

212
Q

Order of bands on hemoglobin electrophoresis

A

A F S C

213
Q

Ham’s test

A

Paroxysmal nocturnal hemoglobinuria

Red urine in morning
RBC missing surface markers
-CD55 adn CD59

214
Q

Increase in PTT and bleeding time

A

Von Willebrand factor (vWF) deficiency

215
Q

Von willebrand disease test

A

Ristsocetin cofactor assay

Causes platelets to aggregate if vWF present

216
Q

Tx vWF disease

A

DDAVP
- desmopressin (synthetic ADH)

Increases vWF release from storage sites

217
Q 
Painless non-tender lympadenopathy
Low grade fever
Night sweats 
weight loss
Pruritis
A

Hodgkin lymphoma

B cell symptoms

218
Q

Neutrophils iwth two lobed nucleus connected by thin strand

Neutrophil: lots of light blue/ purple cytoplasm

A

Pelger-Huet Anomaly

Myelodysplastic syndromes

219
Q

Small cell lung cancer paraneoplastic syndromes (3)

A

ACTH –> cushing syndrome

ADH –> SIADH
- Hyponatremia

Lambert-Eaton syndrome
- Ab against presynaptic Ca channels at NMJ

220
Q

Cancer that secretes PTHrP

A

Squamous cell lung cancer

Any squamous cell cancer

221
Q

Tx Actinic keratosis

A

5-fluorouracil

222
Q

CA-125 screening

A

Ovarian cancer

223
Q

Alpha feto protein screening

A

hepatocellular carcinoma

Testicular tumors

224
Q

CA 19-9 screening

A

Pancreatic cancer

225
Q

S-100

A

Melanoma

Schwannoma

226
Q

Tartrate resistant acid phosphatase (TRAP)

A

Hairy cell leukemia

227
Q

Tx testicular cancer (3)

A

Eradicate Ball Cancer

Etoposide + Bleomycin + Cisplatin
Etoposide + ifosfamide + Cisplatin

228
Q

Tx choricocarcinoma

A

Methotrexate

Vincristine

229
Q

Tx Childhood tumors

  • Wilms
  • Ewing
A

VIncristine

Dactinomycin

230
Q

Tx for philadelphia chromosome

A

Imantinib

Targets mutant BCR-ABL`

231
Q

Elevated Liver aminotransferases. Hx of drug use. Panlobular mononuclear cell infiltration taht crooss into adjacent lobules. Occasionally see a intensely Eosinophilic round bodies that are seen scattered amongst the hepatic parenchyma. What could cause this?

A

Acute viral hepatitis due to drug use

Hepatocytes may undergo cytotoxic T cell mediated apoptosis due to presence of viral antigens on the hepatocyte surface

These apoptotic cells appear as round acidophilic (pink) bodies known as councilman bodies

232
Q

Epigastric pain, nausea and bloating. Diffuse erythema of antral mucosa. Infiltrate involving the superficial mucosal layers. The underlying cause will lead to

A

H. pyrloi induced chronic gastritis

–>Gastric lymphoma

233
Q

Develop resistance to chemotherapy via

A

P-glycoprotein, a transmembrane protein taht functions as a ATP dependent efflux pump.

Pumps out chemotherapeutic agents

234
Q

Shrunken liver on autopsy

A

Drug induced liver injury
- Inhaled anesthetic (halothane)

widespread centrilobular necrosis and inflammation of portal tracts and parenchymas are observed

Elevated AST ALT
Prolonged PT
Leukocytosis and eosinophilia

235
Q

Gallbladder hypomotility causes waht with bile

A

Biliary sludge

236
Q

Hirschsprung disease

A

Constipation and abdominal distention

Narrow rectum and rectosigmoid area. Rest of colon is dilated.

Failure to pass meconium
Bilious vomiting

Failure of neural crest cells to migrate to intestinal wall or submucosa (meissner) and myenter (auerbach) plexi.

Submucosa of rectum (narrowed segment) should be biopsied

AM- STEP1 (20 decks)

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