Goljan Flashcards
What do we find in lab. for pre/eclampsia? BUN Uric Acid Serum Creatinine GFR transaminases
BUN increased uric acid increased creatinine increased GFR decreased transaminases increased Schistocytes/anemia/thrombocytopenia
Should GFR be increased or decreased in normal pregnancy?
Increased
Should BUN be increase or decreased in normal pregnancy?
decreased in normal pregnancy
What is the clinical picture of eclampsia?
same as pre-eclampsia but w/ seizures or convulsions
What is the clinical presentation of pre-eclampsia?
hypertension proteinuria pitting edema
Tx for Eclampsia?
Magnesium Sulfate
What two substances are vasodilators in pre-eclampsia?
PGE1 N.O.
What are two substances in pre-eclampsia that are vasoconstrictors?
Angiotensin II TXA2
What substances are decrease in pre-eclampsia?
PGE1 and NO
What two substances are increased in pre-eclampsia?
Angiotensin II TXA2
What is the Diagnosis if pregnant woman presents w/ pre-eclampsia in first trimester?
hydatidiform mole
When does pre-eclampsia and eclampsia occur? trimester…
3rd trimester
What organism causes chorioamnionitis?
Step. agalactiae
What part of the eye is affected w/ Kayser-Fleischer rings?
outer part of decemet cornea
What are the symptoms of degeneration of the lenticular nuclei?
- chorea - rigidity - basal ganglia dementia
What nuclei is attacked in Wilson’s Dz?
lenticular nuclei degeneration
What is the Tx of Wilson’s Dz?
penicillamine
What are some of the clinical manifestations of Wilson’s Dz?
Kayser-Fleishcher rings in eye
What is ceruloplasmin?
protein that binds to Copper low ceruloplasmin so can’t bind Copper - so increase of Cu in blood
What is Wilson’s Dz?
defect in Copper (Cu+) secretion into bile - bile is Copper deficient or - defect in synthesis of ceruloplasmin
What is the Tx of hemochromatosis?
phlebotomy
What are the manifestations of hemochromatosis?
- bronze skin
What is the best screening test?
increase serum ferritin
What are the laboratory findings of hemochromatosis?
- increase serum iron - decrease TIBC - increase % saturation - increase serum ferritin
What is the mode of inheritance of hemochromatosis?
autosomal recessive
What is hemochromatosis?
unrestricted reabsorption of IRON (small bowel)
Other cause of FHF?
Reye’s Sx
What is the MCC of FHF? (organism)
virus
What is the MCC of FHF? (drug)
acetaminophen
What is fulminant hepatic failure (FHF)?
acute liver failure w/ encephalopathy within 8 weeks of hepatic dysfunction
Can O.C. cause hepatocellular CA?
Yes
What drugs (3) causes hepatocellular carcinoma?
1) Vinyl Chloride 2) Aflatoxin (Aspergillus mold) 3) Thorotrast
What drug causes Liver Cell Adenoma?
Oral Contraceptives
What drug causes angiosarcoma of the liver?
Vinyl Chloride
What drug causes fibrosis in the liver?
methotrexate
What drugs cause steatosis? fatty liver… 2
1) Amiodarone 2) Methotrexate
Name two drugs that cause cholestasis?
1) oral contraceptives 2) anabolic steroids
Name drug that causes acute hepatitis? (4)
1) Isoniazid 2) Halothane 3) acetaminophen 4) methyldopa
What cancer is related to 1ry sclerosing pericholangitis?
MCC of cholangiocarcinoma
What is the clinical picture of 1ry sclerosing pericholangitis?
jaundice
What disease causes primary slcerosing pericholangitis?
ulcerative colitis - complication of
How do you acquire primary biliary cirrhosis?
autoimmune, granulomatous destruction of bile ducts in triads
What immunoglobulins and markers detect primary biliary cirrhosis?
- increase anti-mitochrondrial Ab - increase IgM
What are the symptoms of primary biliary cirrhosis?
- pruritus - increase AP and GGT - no jaundice until later
What are the symptoms in obstructive jaundice?
- hypercholesterolemia - light colored stools - urine w/ conjugated bilirubin - increase alkaline phosphatase (AP) and gamma-glutamyltransferas (GGT)
MCC of obstructive jaundice?
stone in common bile duct
What is very characteristic microscopically?
fibrosis aroudn terminal hepatic venules
What is seen in alcoholic hepatitis?
mallory bodies you will have a bad body!! Mal (lory) Body!
What is the ratio of ALT and AST in alcoholics?
You are an ASS because you drink AST > ALT
Why are alcoholics prone to gout?
Ketoacids and Lactic Acid compete w/ uric acid for excretion in the kidneys so Uric Acid Accumulates!
Why is ketoacidosis sometimes present in alcoholics?
NADH once again favors conversion of: Acetoacetate to B-Hydroxybutyrate (ketoacids)
What is the sequence to make TG (VLDL) from 1,3 DPG?
1,3 DPG to Glyceraldehyde-3-P to DHAP to Glycerol-3-P + FA makes TG
Why is there esteatosis?
alcohol is converted to acetaldehyde and acetate and acetyl coA which makes free fatty acids - increase in NADH2 favors glycerol-3-p
Why does hypoglycemia occur in alcoholics?
again increase in NADH makes conversion of pyruvate to lactate decrease in pyruvate can’t go back to gluconeogenesis
Why is there a build up of lactate in alcoholics?
high levels of NADH make pyruvate go into lactate (increases anion gap)
Where is alcohol dehydrogenase found?
in cytosol and mitochondria
What enzyme is inhibited by disulfiram?
an alcohol dehydrogenase
What drug is used in Tx of alcoholism?
Antabuse or Disulfiram
What is disulfiram rx?
nausea/vomiting, flushing after ingestion of alcohol
What causes disulfiram reaction?
acetaldehyde build up
Where is the most important site of metabolism of OH in liver?
cytosol
What are the factors of Alcholo liver disease?
1) amount of OH 2) duration of intake 3) more damage in females
Are fatty change and alcoholic hepatitis reversible or irreversible?
reversible
What alcoholic disease is irreversible?
cirrhosis
When do we find Councilman Bodies?
Hepatitis
What are dead hepatocytes called?
Councilman Bodies
Symmptoms of post-hepatic obstruction?
1) painful liver 2) congested liver 3) ascites 4) portal hypertension
What is the MCC of post-hepatic obstruction?
Polycythemia vera!
What is Budd-Chiari Sx?
hepatic vein thrombosis
What is a cause of post-hepatic obstruction?
1) Budd-Chiari syndrome 2) Polycythemia vera 3) Oral Contraceptives
Do you find hepatomegaly in pre or post-hepatic obstruction?
Post-hepatic!!!
What are two clinical manifestations of PRE-hepatic obstruction?
1) portal vein thrombosis 2) ascites/varices
What is the MCC of congestive hepatomegaly?
Right Heart Failure (H.F.)
Tx for Schistosomiasis?
Praziquantel
What is the definitive host of Schistosoma mansoni?
Snails imagine photographer taking pics of snails (he is a mason!)
What causes portal hypertension, hepatosplenomegaly, ascites and esophageal varices?
Schistosomiasis
What is the main characteristic in the laboratory of Clonorchiasis?
Eosinophilia
What is the Tx of Clonorchiasis?
Praziquantel
How do you get Clonorchiasis?
Ingestion of infected fish w/ larvae
What is another name for Clonorchis sinensis?
Chinese Liver Fluke
What organism causes cholangiocarcinoma?
Clonorchis sinensis
Tx for Echinococcosis?
Albendazole
Humans are what type of host for Echinococcosis?
intermediate host
Who is the definitive host of Echinococcosis?
Sheep Dog
Tx for Hepatic Amebiasis?
Metronidazole
What causes a single abscess in the right lobe of the liver?
E. histolytica
What organism causes spontaneous peritonitis in children?
Step. pneumoniae
What organism causes spontaneous peritonitis in adults?
E. coli
What two viruses are associated w/ hepatocellular CA?
B and C hepatitis
What is a healthy carrier?
carries HBsAg but is negative for HBeAg/HBV-DNA
What marker for HBV determines a chronic carrier?
HBsAg for more than 6 months
What is considered when anti-HBcIgM is converted to HBcIgG?
patient has old infection
Markers for HBV infection is active?
HBe and HBV-DNA antigens are excellent markers of infectivity
What is the marker that the patient will recover from HBV?
HBV-DNA poymerase leaves before HBsAg
What is the first serology to appear in HBV?
HBsAg
What marker do you get after HBV vaccine?
anti-HBs
What segment does Cronh’s attack?
Cronh=Complete all layers and also all the GI tract mouth to anus
What segment does UC attack?
rectum; does not involve other areas of GI tract
What is involved in Cronh’s Dz in 80%?
Terminal Ileum Affected
What does UC primarily target?
rectum
What layers does Cronh’s Dz comprise?
all layers it is transmural
What layers does UC comprise?
musocal and submucosal
Ulcerative Colitis vs. Cronh’s Dz
UC vs. Crohn’s
What is the MC fistula?
Colovesical Fistula
What is the MCC of fistulas in the GI tract?
diverticula
What is associated with embolism of transmural small bowel?
hear disease and atrial fibrillation
MC place of pathology in entire GI tract?
Sigmoid colon includes: - cancer - polyps (except Peutz-Jegher’s) - diverticular disease
What disease has the term left sided apendicitis?
sigmoid diverticula
What is the MCC of iron deficiency in newborn?
Mecke’s Diverticulum bleeding GI
What is asscoaited w/ angiodysplasia?
von Willebrand’s Dz Aortic Stenosis
What is the 2nd MCC of hematochezia?
angiodysplasia
What is the MCC of hematochezia?
Diverticulosis
What parasite in the soil penetrates the skin?
Strongyloides stercoralis he is strong!!!
What is the Tx for D. latum?
Praziquantel got the prize for the fish!
What problems does D. latum give humans?
Vitamin B12 deficiency
What is the reservoir for Dyphyllobotrium latum?
Fish — lake trout
What parasite causes bowel obstruction?
Ascaris Lumbricoides
What is seen in the stool of Strongyloidse stercoralis?
rhabditiform larvae
What is the Tx fro D. latum?
praziquantel
What does D. latum cause?
Vitamin B12 deficiency
What is the reservoir of diphyllobothrium latum?
fish— lake trout
What is the Tx of Trichuris trichura?
Albendazol
What organism causes rectal prolapse in children?
Trichuris trichura
What is the life cycle of G. lamblia?
cysts attach to small intestine mucosa
What is the MCC of diarrhea from protozoa in the U.S.?
Giardia lamblia
What test is used to detect C. parvum?
String Test
What is the MCC of diarrhea in AIDS?
Cryptosporidium parvum
What are trophozoites phagocytosed RBCs?
Entameba histolytica (Ameba)
What is the MC contaminant of blood transfusions?
Yersenia enterocolitica
What organism is associated w/ HLA-B27 spondyloarthropathy and uremic Sx?
Shigella
What is the MCC of diarrhea, cholecystitis and pancreatitis in AIDS?
Cytomelagolvirus (CMV)
What are some common diseases that cause osmotic diarrhea?
lactase deficiency laxatives
Is there mucosal inflammation in secretory diarrhea?
No mucosal inflammation
What are some disease that cause secretory diarrhea?
Vibrio cholerae (via adenylate cyclase) E. coli (via guanylate cyclase) Rotavirus Carcinoid Sx
What is osmotic diarrhea?
high volume w/ osmolality lower than that of plasma
What is secretory diarrhea?
high volume w/ osmolality similar to plasma
What diarrhea is high volume?
secretory and osmotic
What diarrhea’s are low volume?
Invasive diarrhea
What is the #1 organism in invasive enterocolitis?
Campylobacter
What is the best test for invasive diarrhea?
fecal leukocytes (+)
What are the three classifications of diarrhea?
1) invasive 2) secretory 3) osmotic
What is the best (cheapest) screening test to determine malabsorption problem?
stool for fat
What is the pathology of Whipple’s Dz?
blunting of villi in jejunum and ileum
What is the pathology of Celiac Dz?
Atrophy of villi in Duodenum and Jejunum
What is another Dz that involves malabsorption?
Whipple Dz
What is the best test to detect Celiac Dz?
anti-gliadin Ab
What is associated with dermatitis herpetiform?
Celiac Dz
What is the main symptom of leiomyoma?
bleeding
What is the MC location for Leiomyoma?
stomach
What is the MC benign tumor of GI tract?
Leiomyoma
What is the 2nd MC extranodal site of extranodal lymphoma?
peyer’s patches
What is the MC extranodal site of extranodal lymphoma?
stomach
What is a kind of diffuse type linitis plastica? attacks the ovaries as well?
Krukengerg Tumor
Where else can you find signet ring cells?
both ovaries since linitis plastica metastasizes via hematogenous route
What type of cells do you see in linitis plastica?
Signet Ring Cells
What is a picture of a stomach that is really hard petrified almost?
Linitis plastica Stomach Cancer diffuse type
Why is there black melena?
Acid acts on HB and converts it into Hematin Hematin is black pigment that stains fecal matter
What does ZE secrete?
gastrin increases acid in stomach
What is Zollinger Ellison’s (ZE) Sx?
malignant islet cell tumor
Patient that wakes up at night w/ epigastric pain?
Most likely duodenal ulcer
Why is the pain referred to the shoulder in perforated duodenal ulcer?
because the diaphragm is irritated and has the same dermatome and embryology at C4 (phrenic nerve)
What is the first step in managemente of duodenal ulcer that has perforated?
Flat X-ray
What is the presentation of duodenal ulcer w/ perforation?
patient w/ epigastric pain that irradiates to the left shoulder
What is the MC complication of duodenal ulcer?
Bleed and perforation
What other pathologies are associated w/ dudoneal ulcer?
MEN I Zollinger-Ellison Sx
What blood group is associated w/ duodenal ulcer?
Blood group O
What is the malignant potential for a duodenal ulcer?
0% malignancy so never biopsied!
When is pain in gastric ulcer?
Greater fater eating
When is the pain in duodenal ulcer?
Decreases w/ meal/eating
What must be done w/ gastric ulcer?
Biopsy to rule out gastric CA!
Does gastric ulcer predispose to CA?
NO! Gastic CA may bleed and may be confused w/ gastric ulcer!
Where is the ulcer and cancer located in gastric ulcer?
lesser curvature of antum
What type of gastritis does H. pylori cause?
Type B Atrophic Gastritis
What does H. pylori predispose to/cause? 2 things
AdenoCA of stomach Malignant Lymphoma
What part of the stomach does H. pylori infect?
pyloric antrum
What type of gastritis is pernicious anemia?
Type A atrophic gastitis
What part of the stomach is affected by pernicious anemia?
Body and Fundus
What is an analog of PGE2?
Misoprostol cytoprotective
What are the three functions of PGE2?
1) increase blood flow to mucosa 2) increase secretion of mucous 3) increase HCO3- cytoprotective
Main difference between congenital pyloric stenosis and duodenal atresia?
Bile containing fluid in Duodenal Atresia Also duodenal atresia associated w/ Down Sx polyhydramnios seen in mother in Duodenal Atresia
MCC of hematemesis?
duodenal ulcer 2) gastric ulcer 3) esophageal varices
What is the MC esophageal CA in developing countries and where is it located in the esophagus?
Squamous CA Mid-esophagus
What is the MCC of primary cancer in the esophagus in the U.S.? What part of the esophagus?
Adenocarcinoma of distal esophagus
What is the MCC of Boerhaave’s Sx?
Endoscopy procedure!!!
What is the name of the RUPTURE of the DISTAL esophagus?
Boerhaave’s Sx
When does Mallory Weiss Sx occur?
Alcoholics bulimia
What is the name of the TEAR of the DISTAL esophagus?
Mallory Weiss Sx
What are other causes of esophagitis?
Herpes (multinucleated cells w/ intranuclear inclusions) CMV (single nucleurs w/ largo basophilic inclusion)
What is the MC organism causes esophagitis?
Candida
What vein is most likely to have varices in esophagus?
left gastric coronary vein (from portal) azygous vein
What is the problem in GERD?
relaxed LES acid injury leads to Barrett’s esophagus and then distal AdenoCA
What laboratory test do you use to diagnostie CREST Sx?
ANA (70-90%) anti-SCL-70 (70%) topoisomerase I anti-centromere antibodies (30%)
What does CREST stand for?
Calcinosis Raynaud’s Phenomenum Esophageal Motility Dysfunction Sclerodactyly Telangiectasias
HOw are achalasia and progressive systemic sclerosis (PSS)/ CREST Sx similar?
both have relaxation of LES absence of esophageal motility manometry best diagnostic measure
What sign do we see in the X-ray of achalasia?
bird’s beak in barium study dilation of proximal esophagus
What is the function of VIP?
relax the LES
What is substance is missing in the myenteric ganglion of achalasia?
VIP (vasointestinal peptide)
What is absent in achalasia?
absent relaxation absent myenteric ganglion cells
What is the pathogenesis of achalasia?
failure of relaxation of LES sphincter
What are the S/S of Zenker’s Diverticulum?
bad breath food collects in pouches
What is weak in Zenker’s Diverticulum?
cricopharyngeus muscle weakness
What is weakness in the esophageal wall called?
Zenker’s Diverticulum
What are the causes of polyhydramnios?
- TE fistula - Anacephaly - duodenal atresia (Down/ALL)
What is the VATER Sx?
Vertebral Abnormalities Anus Imperforated TE fistula Renal Disease/Radius abnormality
What is connected in TE fistula?
Trachea and Stomach!!! Distal Esophagus arises from Trachea
What are signs/symptoms (S/S) of Trachesophageal Fistula (TE) in babies?
apsiration of milk into trachea - abdominal distention
What are the common signs and symptoms of fistula in pregnancy?
Polyhydramnios (excess fluid) fetus is not reabsorbing it through mouth
What is wrong in tracheosophageal fistula? (what ends blindly?)
Proximal esophagus ends blindly
MC congenital esophageal disorder?
Tracheoesophageal fistula
What is the MCC of odynophagia in HIV?
esophagitis caused by Candida albicans Aids Defining
What does it mean when you have dysphagia for both solids and liquids?
peristalisis problem
What does it mean when you have dysphagia for solids but not liquids?
Mechanical Obstruction
What is associated with iron deficiency and dysphagia for solids?
Plummer-Vinson
What three diseases have disphagia for liquids?
really bad… 1) plummer vinson 2) esophageal CA 3) Barrett’s Esophagus (ulceration and stricture)
Why is myasthemia gravis on the upper esophagus?
Upper 1/3 of esophagus is striated muscle
What Dz is involved in dyspaghia for solids but in the Upper esophagus?
polymyositis myasthemia gravis
What disease is common to dysphagia fro solids? (lower esophagus)
Achalasia MC progressive systemic sclerosis/CREST Sx
When is surfactant at it’s peak?
35 weeks
When does synthesis of surfactant begin?
28th week
Where is surfactant stored?
lamellar bodies
Where is surfactant made?
Type II neumocytes
What is the pathogenesis of Respiratory Distress Syndrome in Newborns?
Atelectasis due to loss of surfactant
When do you see atelectasis?
usually 24-36 hrs post surgery
What is found in the physical exploration of Atelectasis?
- dullness to percussion - absent tactile fremitus
What is synergistic with smoking in Laryngeal CA?
Alcohol ingestion smoking + alcohol = bad combo
Risk factor for Laryngeal CA?
smoking
What happens when no primary cancer is found in cervical lymph node metastasis?
nasopharynx should be biopsied
What three compounds increase surfactant?
1) thyroxin 2) prolacitn 3) glucocorticoid
What is the cause of Nasopharyngeal Carcinoma?
EBV common in Chinese
What does Mucor sp. invade?
frontal lobes
Why does Mucor species prevail in sinusitis of Diabetic patients?
Ketoacidosis cuases proliferation
What is a common finding of sinusitis in diabetics?
Mucor sinusitis
What sinus is involved in adults w/ sinusitis? children?
mAxilary ADULTS ethmoid children ethmall
What is the complication of Sleep Apnea?
Pulmonary Hypertension - vasoconstrictive effects of chronic hypoxemia and respiratory acidosis called COR-PULOMONALE
Newborn that turns cyanotic when breast feeding; cries and turns back to pink. Diagnosis?
Choanal Atresia
Causes of Hypoxemia w/ normal A-a gradient?
- barbiturates OD - epiglottitis (Upper Airway Obstr.) - Amyotrophics Lat. Sclerosis (ALS)
Patient w/ fibromyalgia and develops asthma, what is the cause of this?
Aspirin induced asthma block PG but still produce Leukotriene build up LT C-D-E4 buildup (potent bronchoconstrictors)
What is the diagnosis of a child w/ Nasal Polyps? Test for?
Sweat Test Cystic Fibrosis (CF) until proven otherwise
Where do infactions of the lung occur?
Lower lobes i.e. more perfusion
What is more prominent at the base of the lungs? Vent. or Perf.
Perfusion
Where is ventilation most prominent in the lungs?
Apex
When is A-a gradient indicative of pulmonary pathology?
when A-a grad = >30
How do you calculate the A-a gradient?
Alveolar PO2= 21%O2(Atm. P-47) - pCO2/0.8 A= (.21)(713)- 40/0.8) Usually A=100 A-a a=95 Normal A-a grad= 5-30
When does the murmur approach to S1?
decrease in preload less blood
What is the characteristic murmur of mitral valve prolapse?
mid-systolic click
What is the pathogenesis of mitral valve prolapse?
increase/accumulation of dermatan sulfate
What is associated w/ Alzheimer’s Dz?
Depression
What disease is associated with cardiac rhabdomyoma?
Tuberous Sclerosis
What is a benign tumor of the heart that arises from cardiac muscle? MC in age?
Cardiac Rhabdomyoma infants and children
MC benign tumor of cardiac origin? Location?
Cardiac Myxoma Left atirum
What is the MC site of metastasis to cardiac tissue?
pericardium
What kind of genetics does hypertrophic cardiomyopathy have?
autosomal dominant
What is the problem in hypertrophic cardiomyopathy?
mutation in heavy chain of beta-myosin and troponins
What is the MCC of constrictive pericarditis?
TB worldwide
What is Kussmaul’s sign?
neck vein distension on inspiration blood refluxes to jugular vein instead of entering RA
What other sign is seen in pericarditis?
Kussmaul’s Sign
What is pulsus paradoxus?
decrease in >10mmHG in systole during inspiration
What disease involves hypotension assciated w/ pulsus paradoxus?
pericarditis
What is the MCC of pericarditis?
Coxsackievirus again!
What is the difference between myocarditis and pericarditis?
pericarditis adds AMI and Dressler’s syndrome
What other pathogens cause myocarditis?
Borrelia (Lyme Dz) T. cruzi (Chagas) Tichinella spiralis (trichinosis)
What is the MCC of viral myocarditis?
Coxsackievirus
What two diseases are involved w/ mucin-producing sterile vegetations?
tumors of colon and pancreas Marantic vegetations
What DZ has sterile vegetations covered on valvular surfaces?
SLE -libman sacks endocarditis
What is associated w/ Libman Sacks endocarditis?
SLE
What are the clinical findings in infective endocarditis?
1) type III; HS - Roth Spots retina - splinter hemorrhage - glomerulonephritis w/ RBC casts
What is the MCC valve involved in infective endocartitis?
mitral valve
What is the MCC of infective endocartitis in prosthetic devices?
Staph. epidirmidis
What is the MCC of infective endocartitis in colon cancer and ulcerative colitis?
Strep. bovis
What is the MCC of infective endocartitis in I.V. drug user?
Staph. aureus
What is the MCC of infective endocartitis?
Strep. viridians
What is the MCC of sudden death in young people?
Hypertrophic cardiomyopathy
What causes congestive cardiomyopathy? MC Drug? MC vitamin. def?
- idiopathic (MC) - doxorubicin/cocaine - thiamine deficiency (Alcoholics) - hypothyroidism
What is the MC cardiomyopathy?
congestive (dilated) cardiomyopathy
What murmur is heard in AV/PV regurgitation?
high pitched diastolic murmur directly after S2
What murmur is heard in MV/TV regurgitation?
Pansystolic murmur
When do Mitral Valve and tricuspid valve occur?
Opening Snap in mid-diastole
What mumurs are heard in systole with crescendo-decrescendo fashion??
Stenosis AV/PV (atrial valve/pulmonary valve)
What causes flushing and diarrhea in carcinoid Sx?
serotonin
Which on is protein rich? Transudate or Exude?
Exude extra proteins inside the fluid
What is the mos common risk factor for Burkitt’s Lymphoma?
EBV
What is the mos common risk factor for Primary CNS lymphoma?
EBV in AIDS pat.
What is the mos common risk factor for osteogenic sarcoma?
retinoblastoma radiation
What is the mos common risk factor for medullary CA thyroid?
MEN IIa/IIb
What is the mos common risk factor for papillary CA of thyroid?
Ionization Radiation
What is the mos common risk factor for Malignant lymphoma thyroid?
Hashimoto’s Thyroiditis
What is the mos common risk factor for choriocarcinoma?
Complete Hydatidiform Mole
What is the mos common risk factor for surface derived ovarian CA?
nulliparity because of increase of ovulatory cycles
What is the mos common risk factor for vagina/cervix clear cell?
diethylestilbestrol
What is the mos common risk factor for dysgerminoma/gonadoblastoma?
Turner Sx XO dysgerminoma XO/XY gonadoblastoma
What is the mos common risk factor for breast CA?
age >50 excess estrogen: 1) nulliparity 2) early menarche 3) late menopause 4) obesity
What is the mos common risk factor for seminoma?
cryptorchid testis semi-descended testis semi noma
What is the mos common risk factor for hepatocellular CA?
HBV or HCV cirrhosis
What is the mos common risk factor for pancreas?
polycyclic HOC
What is the mos common risk factor for Colon adenoCA?
preexisting polyps tubular and villous adenoma
What is the mos common risk factor for Stomach AdenoCA?
Helicobacter pylori
What is the mos common risk factor for distal esophagus?
barret’s disease
What is the mos common risk factor for larynx CA?
polycyclic HOC (hydrocarbons)
What is the mos common risk factor for Nasopharyngela CA?
EBV
What is the mos common risk factor for Kaposi’s Sacroma?
HHV-8
What is the mos common risk factor for BCC, SCC, melanoma?
UVB light
What carcinogen is impilcated with malignant lymphoma?
Alkylating agents
What carcinogen is impilcated with SCC of scrotum?
tar, soot, oil (chimney sweeper)
What carcinogen is impilcated with SCC of penis?
Smegma in uncircumcised male
What carcinogen is impilcated with acute leukemia?
benzene
What carcinogen is impilcated with TCC of bladder? (2)
cyclophosphamide b-naphthylamine (dye and rubber indus.)
What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
Arsenic
What carcinogen is impilcated with breast cancer and cervical cancer?
Oral Contraceptives
What carcinogen is impilcated with pleural mesothelioma?
Asbestos
What carcinogen is impilcated with Lung CA? (4)
uranium asbestos chromium nickel
What carcinogen is impilcated with colorectal cancer?
Lithocholic acid secondary bile acid
What carcinogen is impilcated with stomach AdenoCA?
nitrosamines and nitrosamides
What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?
Alcohol
Where is the murmur best heard for PDA?
between the shoulder blades
What is the Tx for closure of PDA in newborn?
indomethacin
What keeps PDA open in fetus?
PGE2
What murmur is heard in PDA?
machine like murmur during systole and diastole
What viral infection is involved w/ PDA?
rubella
What are the three A’s in ASD?
Adults Alchohol Fetal Sx ALL from Down Syndrome
What is the MC congenital heart disease in adults?
a is for ASD
What is the MC congenital heart disease in children?
VSD very small dudes :)
What pathology is associated with coarctation of the aorta?
Turner Sx
What two diseases have Mitral Valve Prolapse?
Marfan’s Sx Ehlers Danlos
What valve is involved in a mid-systolic click?
Mitral Valve Prolapse it clicks half way since the chordae restrain it
What valve is affected with a pansystolic (holosytolic) murmur?
Mitral Regurgitation
What are five signs of Rheumatic fever?
1) Carditis 2) Migratory polyarthritis 3) Subcutaneous Nodules 4) Erythema Marginatum 5) Sydenham’s Chorea
How long after a group A step. pharyngitis does Rheumatic Fever occur?
1-5 weeks after episode
WHat are Aschoff Bodies?
central fibrinoid necrosis surrounded by reactive histiocytes
What are two common findings in myocarditis?
aschoff bodies Anitschkow Cells the two Russians
What do the antibodies react to in Group A Steptococcus?
Ab react to M proteins
What organism is involved in Rheumatic Fever?
group A Strepto Step. pyogenes
What type of Hypersensitivity is Rheumatic Fever?
Type II
What MCC of death in rheumatic fever?
Myocarditis
What deffect has opening snap during diastole?
Mitral Stenosis Snap Stenosis
What RNA virus causes hepatocellular CA?
HCV not HBV!!! HBV is DNA virus
What virus is associated w/ hepatocelluar CA?
HBV
What CA does EBV is associated with?
Burkitt’s lymphoma CNS lymphoma in AIDS Mixed Cellularity Hodgkin’s Nasopharyngeal CA
What two genes are knocked out by HPV 16, 18?
E6 and E7 produced by HPV E6 inhibits TP53 E7 inhibits RB suppressor gene
What DNA virus is associated w/ TP53 suppersor gene?
HBV and HPV 16,18 E6 inhibits it
WHat RNA virus is associated with TP53 suppressor?
HTLV-1 T cell leukemia and lymphoma virus!
What region of the face does BCC and SCC occur?
BCC top of the face upper lips SCC below lower lips
What CA presenst w/ Calcitonin increase? Symp.?
Medullary CA of Thyroid hypocalcemia
What CA presents w/ inc. in B-hCG? Symp?
Choriocarcinoma (Testis) gynecomastia
What CA manifests increase in erythropoietin? Clinical?
Renal AdenoCA primary SCC of lung Breast CA hypercalcemia
What CA manifests w/ ACTH increase? Clinical Symptoms?
SCC of lung Medullary CA of Thyroid Clin: Cushing Sx
WHat CA manifests w/ ADH increase? What do you find clinically?
SCC of lung Hyponatremia
What CA manifests Nonbacterial thrombotic endocarditis? (Sterile Vegetations on Mitral Valve)
Mucous-secreting pancreatic and colorectal CA
What CA is associated w/ superficial migratory thrombophlebitis?
pancreatic carcinoma Troussau sign (he had it himself, self-diagnosed)
What CA is associated w/ hypertrophic osteoarthropathy?
Lung CA
What CA is associated w/ sudden appearance of seborrheic keratosis?
“Sudden” Stomach Adenocarcinoma
WHat CA is associated w/ myasthenia gravis?
Eaton-Lambert Sx SCC of lung
What CA is associated w/ hypercalcemia?
primary SCC of lung Renal Adeconcarcinoma PTH-like peptide
What virus is associated w/ TP53?
HBV and HTLV-1(T cell leukemia and lymphoma) HPV 16,18 HPV16 inhibits TP53 RB inhibited by HPV 18
What is another disease that involves TP53?
Ataxia Telangiectasia syceptibility to malignant lymphoma
What disease is associated with BCL-2?
b-cell lymphoma B C L -2 Follicular Lymphoma t14;18
What is the function of BCL-2 genes?
prevents the leakage of cytochrome c (signal for apoptosis)
What are the genes fo anti-apoptosis?
BCL-2 genes
What is the function of RB gene?
G1 to S phase inhibitor
What is the APC gene function?
Prevents nuclear transcription - degrades catenin; an activator of nuclear transcription
What is the function of BRCA 1/2 gene?
Regulates DNA repair
What is the function of TP53?
G1 to S phase inhibitor
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
RB
What SG is associated w/ familial polyposis: color cancer?
APC
What SG is assciated w/ breast, ovary and prostate CA?
BRCA 1 BRCA 2
What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
TP53
What are the inactivation of suppressor genes?
TP53, RB, APC and BRCA1/2
What POC amplifies breasts??? imagine that…
ERB-B2 Breast bigger two!
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
EBV
What two POC activate translocation?
ABL and c-MYC
What two POC activate point mutation?
RET and RAS
What two POC amplify?
ERB-B2 and N-MYC
What does N-MYC activate?
Amplification
What does MYC activate?
c-MYC translocation t(8;14)
What does ABL activate?
translocation t(9;22)
What does RAS activate?
Point Mutation
What does RET Activate?
Point Mutation
What does ERB-B2 activate?
Amplification
What does SIS activate?
Overexpression
What two POC have the same fx of nuclear transcription?
c-MYC and N-MYC
What two POC have the same function of Receptor Synthesis?
ERB-B2 and RET
WHat fx does RAS has?
GTP signal transduction
What fx does N-MYC have?
Nuclear transcription
What fx does MYC have?
Nuclear Transcription
WHat fx does RET have?
Receptor Synthesis
What fx does ABL has?
Non-receptor TK activity
What fx does ERB-B2 has?
Receptor Synthesis
What function does SIS have?
GF synthesis (Growth Factor)
WhatPOC is associated w/ pancreatic CA?
RAS
What POC is associated w/ MEN IIa/IIb Syndromes?
RET
What POC is associated w/ colon CA?
RAS
What POC is associated w/ Burkitt’s Lymphoma?
c-MYC MYC
What POC is associated w/ CML?
ABL
What POC is associated w/ lung CA?
RAS
What POC is associated w/ Neuroblastoma?
N-MYC
What POC is associated w/ Astrocytoma?
SIS
What POC is associated w/ Breast CA?
ERB-B2
What POC is associated w/ Leukemia?
RAS
What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
SIS
Who is the universal acceptor?
AB no antibodies to attack those cells
Who is the universal donor?
Group O
What is associated w/ duodenal ulcer?
group O blood
What blood group has greatest incidence of gastric carcinoma?
group A
What does group AB has?
nothing just like new borns and old people
What does group B has?
anti A-IgM
What anti bodies have blood A?
anti B
What anti bodies does blood group O have?
anti A-IgM anti B-IgM anti AB- IgG
What is the best test for vWF diases?
ristocetin cofactor assay
What factor involved in intrinsic pathway?
XII, XI, IX, VIII
What factor involved in extrinsic pathway?
VII
What are two other diseases that has Bleed Time increased and decreased platelets?
Thrombotic Thrombocytopenic Purpura Hemolytic Uremic Syndrome
What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
Bleeding Time increased platelets decreased
What is elevated in a person taking aspirin?
Bleeding Time elevated
What is elevated on hemophilia A?
VIII deficient aPTT increased (intrinsic pathway)
What is elevated in vWF disease?
Elevated Bleeding Time (platelet adh. problem) aPTT increased
What does a classic RS cell look like?
two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo
What CD maker’s do you use to detect RS cells?
CD15 and CD30; you got to be able to REED by 15 and 30
What are Reed-Sternberg Cells?
transformed germinal center B cells
What are the cells of Hogkin’s L. called?
Reed-Sternberg Cells
What are the characteristic cells in Hodgkin’s Lymjphoma?
association w/ EBV; cutaneous anergy to common antigens
What is the Starry Sky?
macrophages w/ phagocytosed apoptotic bodies
What do you see in Burkitt’s?
Starry Sky Apparence
What does the American variant involve? (Burkitt’s)
GI, ovaries and retroperitoneum
What does the African variant involve? (Burkitt’s)
Jaw
What gene association is found in Burkitt’s?
EBV translocation t8;14 African Jaw
What gene is associated with Follicular Lymphoma?
Translocation t14;18 overexpression of bcl-2 Follicular Think Fourteen Fo Fo
What CA diseminates to para-aortic nodes?
Testicular CA and Burkitt’s Lymphoma
What is the left supraclavicular node called?
Virchow’s Node
What is associated with Right Supraclavicular Nodes?
Lung Mets and Esophageal CA; Hodgkin’s lymphoma
What is associated with Left Supraclavicular Nodes?
Abdominal and Pancreatic CA
What are histiocytes and where are they located?
Part of the Lymphatic system in sinuses; skin (Langherhan’s Cells); Red Pulp in Spleen
Where are T cells located?
ParacorTex; periarteriolar sheat in spleen
Where are B cells located in lymph nodes?
Germinal Follicles; Peripheral areas of spleen (white pulp)
What is osteopetrosis?
Brittle bone Dz Defect in osteoclasts no marrow, severa anemia
Mechanism of blue sclera?
Color of veins is blue Seein the coroidal veins that give the color to the sclera since there is very little collagen I
Tx for acute?
Tetracycline
Tx for chronic?
Ceftriaxone
What is babesia microti?
intracellular erythrocytic parasite similar to ring falciparum
What percent of lyme infected have babeiosis?
20% of patients have babeiosis
Ticks carry both dz?
Lyme and Babesia
Hemolytic Anemia? What do you see in this patient?
Babesia Micro
MC cranial nerve involved with Lyme Dz?
VIIth nerve
Any patient with bilateral bell-spalsy?
Lyme Dz until proven otherwise
Septic arthritis?
MC gonorrhea (GC) Gonoccocus…
What components do you need to kill Gonorrhea?
C5-C9
STD?
Sinovitis
Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?
Disseminated Gonococchemia
Chlamydia triggered HLA-B27?
Yes, it made Reiter become active - Ulcerative colitis can also be an environmental factor - psoriasis - shigella
Same patient develops pain on Achilles Tendon? Conjunctivitis
Reiter’s Sx HLA-27 (+) patient
Patien w/ disuria, sterile piuria?
Non-specific urethritis chlamydia No culture in urine
What enzyme is absent and what accumulates?
Homgentisic Acid builds up homogentisic oxidase
What is the inheritance of alkaptonuria?
autosomal recessive
Dz with degenerative arthritis in vertebral columns, pee turns black? cartilage is turns black
Alkaptonuria
What is the mechanism of uric acid accumulation/gout in alcoholics?
Patients with alcoholism are under metabolic acidosis -All the acids compete in the excrition of proximal tubule Alcoholics contain b-hydroxybutiric acid, lactic acid so they compete with uric acid to be excreted
What is the mech. of Allopurinol?
Block Xanthine Oxidase
Overproducer of uric acid?
Allopurinol
What drug do you give for underexcretion of uric acid?
Probenecid Sulfanpirizone
Tx for Gout?
Indomethacine
What are some effects of long teng methotrexate tx? i.e. Arhtritis Tx
Macrocytic Anemia Hypersegmented Neutrophils Also causes: Intersitial Fibrosis of the Lung
What is the Tx of Rheumatoid Arthritis?
Methotrexate
Syndrome with rheumatoid arthritis with nodes in the lungs?
Kaplan Sx
What is it called when you get a patient with rheumatoid arthritis that expresses dry mouth and dry eyes?
Schoegrem Sx
Which on is symmetrical? Rheumatoid or Osteoarthritis?
Rheumatoid
What is the synovial tissue that grows over the articulate cartilage called?
Pannus Not to be confused with Tophus that is found in Gout
Where is rhematoid factor found?
In synovial fluid
What is rheumatoid factor? (RF)
IgM Ab against IgG
What is a Heberden Node?
Inflamation of DIP
What are PIP joints inflamed called?
Bouchard Node Pouchard
What joints are involved in Rheumatoid Arthritis?
MCP + PIP
What joints are involved in Osteoarthritis?
DIP + PIP
Yellow Crystals?
Gout Monosodium urate
Blue Crystals?
Pseudublue Pseudogout - Blue is Calcium pyrophosphate
What crystals are positively birefringent?
Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout
What crystal is negatively birefringent?
Negative is Yellow in color so it’s Monosodium Urate for Gout
Gout or Pseudogout? How do you tell?
Positively Birefringement (Blue color) Pseudogout Negatively Birefringement (Yellow color) Gout
Which ALL type has best prognosis?
t(12;21)
Where do T cells metastasize in ALL?
Anterior Mediastinal mass or acute leukemia
Where do B cells metastasize in ALL?
CNS and testicles think B is for Brain and Balls!
What is a positive marker for ALL?
CALLA; CD10 Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase) You are Caller No. 10!!!
What is the most common subtype of ALL?
pre-B (80%)
What is the most common cancer and leukemia in children?
ALL
What are other positive tests for CML?
philadephia chromosome and bcr-ABL fusion gene
What is the most specific test for CML?
decrease LAP (Leukocyte Alkaline Phosphatase)
What is afected in chromosome 22 for CML?
bcr (break cluster region) bcr-ABL fusion gene
What chromosome is CML found in? What is the name of the chromosome?
Chromosome 22; Philadelphia Chromosome
What is the translocation of ABL protooncogene?
t9;22
What leukemia is associated with ABL protooncogene?
Chronic Myelogenous Leukemia (CML)
What is the frequency of acute leukemias ?
Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%
Which leukemia has translocation t9;22?
Chronic Myelogenous Leukemia (CML)
What is the age distribution of all leukemias?
ALL (0-14) AML (15-39) AML (40-60) CML (40-60) CLL (>60 years old)
What leukemia is cured/reverse with Vitamin A (Retinol)?
Acute Promyelocytic Leukemia (M3)
What are auer rods?
fused azurophilic granules on cytosol of blast cells
What leukemia has auer rods?
Acute Myelogenous Leukemia (M2/M3)
What leukemia has gum infiltration?
Acute Monocytic Leukemia (M5)
In which leukemia do you find DIC?
Acute Promyelocytic Leukemia (M3)
What leukemia has translocation t(15;17)
Acute Promyelocytic Leukemia (M3)
What is the specific Tx for falciparum?
IV quinidine or quinine plus doxycycline Falciparum is the FALSE QUEEN (quinidine)
What is the Tx for all except falciparum?
Chloroquine plus primaquine
What drug do you use for resistant falciparum?
Mefloquine ME FLOr resistant Falciparum
Prophylaxis Tx for malaria?
Chloroquine
What do you find in the lab work for falciparum malariae?
Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)
