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USMLE > Goljan 3 - Sheet1 > Flashcards

Goljan 3 - Sheet1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Achalasia

A

failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus

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2
Q

S/S

A

aperistalsis/dilation of esophagus; regurgitation of undigested food at night

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3
Q

X-ray achalasia

A

birdÕs beak appearance

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4
Q

Acquired achalasia

A

ChagasÕ disease; leishmania destroy ganglion cells

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5
Q

Distal adenocarcinoma esophagus

A

MC primary cancer; due to BarrettÕs esophagus

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6
Q

Squamous cell carcinoma of esophagus

A

smoking MCC; alcohol also causes

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7
Q

Melena

A

sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC

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8
Q

Hematemesis

A

vomiting blood; peptic ulcers MCC

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9
Q

Congenital pyloric stenosis

A

hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks

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10
Q

Acute hemorrhagic (erosive) gastritis

A

NSAIDs MCC

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11
Q

Mucous barrier stomach

A

maintained by PGE; misoprostol PGE analog

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12
Q

Type A chronic gastritis

A

due to PA; achlorhydria with ? serum gastrin

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13
Q

Type B chronic gastritis

A

due to H. pylori; involves pylorus and antrum

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14
Q

H. pylori

A

curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma

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15
Q

Gastric ulcer

A

lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain

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16
Q

Duodenal ulcer

A

never malignant; ? acid production; food relieves pain

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17
Q

Perforated peptic ulcer

A

air under diaphragm causes pain in left shoulder

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18
Q

MenetrierÕs disease

A

giant rugal hyperplasia; protein loss from increased mucus

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19
Q

Zollinger-Ellison syndrome

A

malignant islet cell tumor secreting gastrin; part of MEN I syndrome

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20
Q

S/S

A

PUD in usual locations; sometimes multiple ulcers

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21
Q

Hypergastrinemia

A

ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure

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22
Q

Leiomyoma

A

MC benign tumor of stomach

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23
Q

Intestinal type adenocarcinoma

A

H pylori related; ? incidence; lesser curvature pylorus/antrum

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24
Q

Diffuse type adenocarcinoma

A

linitis plastica; signet ring cells; Krukenberg tumors ovaries

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25
Q

Gastric lymphoma

A

stomach MC site for extranodal lymphomas; H. pylori associated

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26
Q

Malabsorption

A

steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease

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27
Q

Causes bile salt deficiency

A

liver disease, bile salt resins, cholestasis, bacterial overgrowth, CrohnÕs

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28
Q

D-xylose screen

A

failure to reabsorb xylose indicates small bowel disease

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29
Q

Calcification of pancreas

A

chronic pancreatitis cause of malabsorption

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30
Q

Celiac disease

A

autoimmune disease; antibodies against gliadin in gluten; flat villi

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31
Q

Celiac disease

A

association with dermatitis herpetiformis

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32
Q

WhippleÕs disease

A

systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa

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33
Q

S/S

A

fever, polyarthritis, skin pigmentation

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34
Q

Invasive diarrhea

A

Campylobacter jejuni MCC; positive fecal smear for leukocytes

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35
Q

Secretory diarrhea

A

loss isotonic fluid; enterotoxins from E. coli and V. cholerae

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36
Q

Osmotic diarrhea

A

hypotonic loss fluid; laxatives, lactase deficiency

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37
Q

Rotavirus

A

MCC diarrhea in children

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38
Q

Norwalk virus

A

MCC diarrhea in adults

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39
Q

Cytomegalovirus

A

common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS

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40
Q

Staphylococcus aureus

A

preformed toxin causes food poisoning; culture food

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41
Q

Bacillus cereus

A

preformed toxin in fried rice and tacos; gram positive rods in stool

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42
Q

Clostridium botulinum (adult)

A

preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis

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43
Q

Clostridium botulinum (child)

A

colonization of bowel with release of neurotoxin; eating honey

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44
Q

Clostridium difficile

A

pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole

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45
Q

Shigella sonnei

A

produces dysentery (bloody diarrhea); associated with HUS

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46
Q

Salmonella enteritidis

A

gastroenteritis; animal reservoirs - poultry, turtles

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47
Q

Salmonella paratyphi

A

sepsis; osteomyelitis in HbSS

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48
Q

Salmonella typhi

A

typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly

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49
Q

Carrier state site

A

gallbladder

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50
Q

M. tuberculosis

A

MCC intestinal TB in United States (swallow TB); PeyerÕs patch site of infection

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51
Q

Enterotoxigenic E. coli

A

secretory diarrhea (travelerÕs diarrhea); toxin stimulates guanylate cyclase

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52
Q

Vibrio cholerae

A

secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP

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53
Q

Oral Rx cholera

A

solution must contain glucose to reabsorb Na+ (co-transport)

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54
Q

Yersinia enterocolitica

A

mesenteric lymphadenitis; sepsis in iron overload states

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55
Q

Entamoeba histolytica

A

dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole

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56
Q

Cryptosporidium parvum

A

MCC diarrhea in AIDS; acid-fast oocysts

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57
Q

Giardia lamblia

A

MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole

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58
Q

Trichuris trichiura

A

rectal prolapse in children

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59
Q

Enterobius vermicularis

A

anal pruritus; urethritis in girls; no eosinophilia

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60
Q

Ascaris lumbricoides

A

intestinal obstruction due to adult worms; no eosinophilia

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61
Q

Necator americanus

A

hookworm; iron deficiency anemia

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62
Q

Strongyloides stercoralis

A

rhabditiform larvae in stool not eggs

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63
Q

Diphyllobothrium latum

A

fish tapeworm; vitamin B12 deficiency

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64
Q

Signs of small bowel obstruction

A

colicky pain; constipation and obstipation

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65
Q

Radiograph small bowel obstruction

A

air-fluid levels on x-ray

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66
Q

MCC small bowel obstruction

A

adhesions from previous surgery

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67
Q

Duodenal atresia

A

vomiting bile-stained fluid at birth; double bubble sign; Down syndrome

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68
Q

Hirschsprung disease

A

absent ganglion cells in submucosal/myenteric plexus rectosigmoid

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69
Q

S/S

A

proximal bowel dilated but peristalses; no stool in rectal vault

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70
Q

Hirschsprung association

A

Down syndrome; Chagas disease

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71
Q

Intussusception

A

terminal ileum telescopes into cecum; obstruction plus bloody diarrhea

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72
Q

Meconium ileus

A

complication of cystic fibrosis

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73
Q

Indirect inguinal hernia

A

second MCC of small bowel obstruction; common in weight lifting

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74
Q

Gallstone ileus

A

obstruction of small bowel with gallstone + air in biliary tree

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75
Q

Volvulus

A

MC due to sigmoid colon twisting around mesentery

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76
Q

Direct inguinal hernia

A

protrudes through center of triangle of Hesselbach; no obstruction

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77
Q

Umbilical hernia

A

common in black children; may entrap bowel in adults

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78
Q

Sigmoid colon

A

MC site for polyps, cancer, diverticula

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79
Q

Small bowel infarction

A

diffuse abdominal pain with bloody diarrhea

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80
Q

Causes small bowel infarction

A

embolism (atrial fibrillation), thrombosis SMA or SMV

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81
Q

Ischemic colitis

A

splenic flexure pain with bloody diarrhea

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82
Q

Mesenteric angina

A

pain in splenic flexure 30 minutes after eating

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83
Q

Angiodysplasia

A

submucosal dilation of venules in cecum; cause of hematochezia

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84
Q

Hematochezia

A

massive loss of blood per rectum; diverticulosis MCC

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85
Q

MeckelÕs diverticulum

A

persistence omphalomesenteric duct

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86
Q

S/S

A

bleeding MC (iron deficiency in children), diverticulitis

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87
Q

MeckelÕs diverticulitis

A

mimics acute appendicitis; cannot differentiate without radionuclide scan

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88
Q

Sigmoid diverticulum

A

diverticulitis MC complication; MCC hematochezia and fistula formation

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89
Q

Diverticulitis

A

Òleft-sided acute appendicitisÓ

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90
Q

Ulcerative colitis

A

mucosal/submucosal ulceration; starts in rectum; crypt abscess; ? risk adenocarcinoma

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91
Q

S/S

A

left lower quadrant crampy pain with bloody diarrhea

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92
Q

UC associations

A

primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy

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93
Q

CrohnÕs disease

A

transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions

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94
Q

S/S

A

colicky pain and diarrhea; fistulas (anal, bowl to bowel)

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95
Q

Carcinoid tumor

A

appendix MC site; terminal ileum MC site for carcinoid syndrome

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96
Q

Carcinoid syndrome

A

liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA

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97
Q

Tubular adenomas

A

precursor lesion colon cancer; size and number determine risk of malignancy

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98
Q

Villous adenoma

A

greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium

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99
Q

Familial polyposis

A

AD with 100% penetrance for developing colon cancer

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100
Q

GardnerÕs syndrome

A

AD, polyposis plus osteomas and desmoid tumors

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101
Q

TurcotÕs syndrome

A

AD, polyposis plus brain tumors

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102
Q

Colorectal cancer

A

second MC cancer and cancer killer in adults

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103
Q

Left-sided colorectal cancer

A

obstruct; MC location rectosigmoid

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104
Q

Right-sided colorectal cancer

A

bleed

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105
Q

Acute appendicitis

A

due to lymphoid hyperplasia in children and obstruction by fecalith in adults

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106
Q

External hemorrhoids

A

thrombose

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107
Q

Internal hemorrhoids

A

bleed; prolapse out of rectum

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108
Q

Urobilinogen (UBG)

A

breakdown product CB in bowel (color of stool)

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109
Q

UBG

A

enterohepatic circulation to liver and kidney (color of urine)

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110
Q

Alcoholic liver disease

A

serum AST>ALT; ? serum GGT

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111
Q

Viral hepatitis

A

serum ALT>AST

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112
Q

Cholestasis markers

A

serum AP and GGT

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113
Q

Unconjugated bilirubin

A

macrophage degradation of heme; lipid soluble; never in urine

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114
Q

Conjugated bilirubin (CB)

A

water soluble; never normal in urine

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115
Q

% CB <20% (unconjugated)

A

Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN

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116
Q

GilbertÕs disease

A

AD; ? uptake and conjugation; bilirubin increases with fasting

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117
Q

Physiologic jaundice newborn

A

unconjugated hyperbilirubinemia; begins on day three

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118
Q

% CB 20-50%

A

viral/alcoholic hepatitis

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119
Q

% CB >50%

A

bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas

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120
Q

Negative urine bilirubin + trace urobilinogen

A

normal urine

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121
Q

Positive urine bilirubin, absent urobilinogen

A

obstructive jaundice

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122
Q

Positive urine bilirubin + increased urobilinogen

A

hepatitis

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123
Q

Negative urine bilirubin + increased urobilinogen

A

extravascular hemolytic anemia

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124
Q

Markers of severity of liver disease

A

albumin, PT

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125
Q

Hepatitis A

A

protective antibodies; day care centers, jails, homosexuals, traveling; not chronic

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126
Q

Hepatitis B

A

protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma

127
Q

Hepatitis C

A

no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma

128
Q

Hepatitis D

A

no protective antibodies; requires HBsAg to replicate

129
Q

Anti-HBs alone

A

vaccination

130
Q

Anti-HBs + anti-HBc-IgG

A

recovered from HBV

131
Q

HBsAg + HBeAg + HBVDNA + anti-HBc-IgM

A

acute HBV/chronic HBV infective carrier if >6 months

132
Q

Anti HBc-IgM alone

A

serologic gap; not infective

133
Q

HBsAg + anti-HBc-IgM

A

chronic HBV healthy carrier

134
Q

Fulminant hepatic failure

A

viral hepatitis and acetaminophen MCCs

135
Q

Spontaneous peritonitis

A

E. coli in adults; S. pneumoniae in children; complication of ascites

136
Q

Granulomatous hepatitis

A

TB MC bacteria

137
Q

Amebiasis

A

Entamoeba histolytica; flash shaped ulcers in cecum; liver abscess; Rx

138
Q

Echinococcosis

A

Echinococcus granulosis; sheep dog definitive host; man intermediate host

139
Q

Schistosomiasis

A

Schistosoma mansoni; adult worms in portal vein; Òpipe stem cirrhosisÓ

140
Q

Clonorchiasis

A

Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma

141
Q

Congestive hepatomegaly (centrilobular necrosis)

A

ÒnutmegÓ liver; RHF MCC

142
Q

Hepatic vein thrombosis

A

Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension

143
Q

Portal vein thrombosis

A

ascites, portal hypertension, no hepatomegaly

144
Q

Alcohol related disorders

A

fatty change; alcoholic hepatitis; cirrhosis

145
Q

Hypertriglyceridemia in alcoholics

A

? synthesis of glycerol 3P (substrate for TG synthesis)

146
Q

Hypoglycemia in alcoholics

A

? gluconeogenesis (? NADH causes pyruvate to convert to lactate)

147
Q

Ketoacidosis in alcoholics

A

? lactate, ? §OHB (acetyl CoA converted to AcAc and then §OHB)

148
Q

Primary biliary cirrhosis

A

granulomatous destruction triad bile ducts; anti-mitochondrial antibody

149
Q

Primary sclerosing cholangitis

A

association with ulcerative colitis; MCC of cholangiocarcinoma

150
Q

Extrahepatic biliary atresia

A

neonatal cholestasis

151
Q

Drugs causing hepatitis

A

acetaminophen, isoniazid, halothane

152
Q

Anabolic steroids

A

intrahepatic cholestasis

153
Q

Estrogen/oral contraceptives

A

intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)

154
Q

Methotrexate

A

liver fibrosis, fatty change

155
Q

Liver angiosarcoma

A

vinyl chloride

156
Q

Hemochromatosis

A

AR; increased iron reabsorption; liver target organ

157
Q

S/S

A

cirrhosis; Òbronze diabetesÓ - skin pigmentation + destruction of islet cells; malabsorption

158
Q

Lab

A

? serum ferritin, iron, % saturation; ? TIBC

159
Q

WilsonÕs disease

A

AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin

160
Q

S/S

A

cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (DescemetÕs membrane)

161
Q

Lab

A

? ceruloplasmin (causes ? total copper); ? serum/urine free copper

162
Q

HELLP syndrome

A

pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets

163
Q

AAT deficiency in child

A

AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma

164
Q

Reye syndrome

A

coma and microvesicular fatty change post viral infection; increased ammonia

165
Q

Cirrhosis

A

irreversible fibrosis; regenerative nodules; portal hypertension

166
Q

Causes cirrhosis

A

alcohol (MC), HBV/HCV, hemochromatosis, WilsonÕs, AAT deficiency, 1¡ biliary

167
Q

Hepatic encephalopathy

A

mental status changes; ? serum ammonia

168
Q

Portal hypertension

A

ascites; varices; splenomegaly; hemorrhoids; caput medusae

169
Q

Cause of ascites

A

portal hypertension; hypoalbuminemia; secondary aldosteronism

170
Q

Rx

A

use aldosterone blocker (acidosis increases loss ammonium in stool)

171
Q

Hyperestrinism in men

A

gynecomastia; spider angiomas; female hair distribution

172
Q

Lab findings cirrhosis

A

? BUN, glucose, sodium, potassium, calcium (? vitamin D); ? PT

173
Q

Liver cell adenoma

A

estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage

174
Q

Liver cancer

A

metastasis MC cancer; lung cancer MC primary site

175
Q

Hepatocellular carcinoma

A

chronic HBV and HCV MCC; ? AFP; hepatic/portal vein invasion

176
Q

Cholangiocarcinoma

A

primary sclerosing cholangitis MCC, C.C sinensis

177
Q

Pathogenesis of cholesterol stones

A

bile with too much cholesterol and too little bile salts

178
Q

Black pigment stones

A

sign of extravascular hemolytic anemia (spherocytosis, HbSS)

179
Q

Acute cholecystitis

A

stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder

180
Q

Chronic cholecystitis

A

chemical inflammation

181
Q

Gallbladder cancer

A

risk factors - cholelithiasis and porcelain gallbladder

182
Q

Acute pancreatitis

A

causes - alcohol and gallstones; ? amylase and lipase (more specific)

183
Q

S/S

A

epigastric pain with radiation into back

184
Q

Sentinel loop

A

localized ileus of duodenum due to acute pancreatitis

185
Q

Pancreatic pseudocyst

A

abdominal mass; persistence of ? serum amylase >1 week

186
Q

Chronic pancreatitis

A

alcohol abuse, CF; malabsorption, pain, type I diabetes

187
Q

Pancreatic cancer

A

smoking MCC

188
Q

S/S

A

jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau’s sign); ? CA 19-9

189
Q

First sign tubule cell dysfunction

A

inability to concentrate urine

190
Q

Fixed specific gravity

A

chronic renal failure; cannot concentrate or dilute urine

191
Q

Negative urine bilirubin + trace urobilinogen

A

normal urine

192
Q

Positive urine bilirubin, absent urobilinogen

A

obstructive jaundice

193
Q

Positive urine bilirubin + increased urobilinogen

A

hepatitis

194
Q

Negative urine bilirubin + increased urobilinogen

A

extravascular hemolytic anemia

195
Q

Positive urine nitrite + positive urine leukocyte esterase

A

urinary tract infection

196
Q

Sterile pyuria

A

positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis

197
Q

Prerenal azotemia

A

? BUN and creatinine; ? renal blood flow (e.g. heart failure, hypovolemia)

198
Q

Renal azotemia

A

? BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)

199
Q

Postrenal azotemia

A

? BUN and creatinine due to obstruction to urine flow

200
Q

Serum BUN:creatinine ratio

A

15:1 (prerenal or postrenal azotemia)

201
Q

BUN 80 mg/dL:creatinine 8 mg/dL

A

ratio 10/1 - renal failure

202
Q

BUN 80 mg/dL:creatinine 2 mg/dL

A

ratio 40/1 - prerenal azotemia or postrenal azotemia

203
Q

Creatinine clearance

A

measures GFR

204
Q

Proteinuria

A

important sign of renal dysfunction

205
Q

RBC casts

A

nephritic type of glomerulonephritis

206
Q

WBC casts

A

acute pyelonephritis, acute tubulointerstitial nephritis

207
Q

Fatty casts with Maltese crosses

A

nephrotic syndrome

208
Q

Hyaline casts

A

normal unless associated with proteinuria

209
Q

Renal tubular cell casts

A

acute tubular necrosis

210
Q

Waxy or broad casts

A

chronic renal failure

211
Q

Cystinuria

A

hexagonal crystals

212
Q

Horseshoe kidney

A

TurnerÕs syndrome; lower poles fused

213
Q

Renal dysplasia

A

MC childhood cystic disease; abnormal development; flank mass

214
Q

Maternal oligohydramnios

A

fetal juvenile polycystic kidney disease; PotterÕs facies in newborn

215
Q

Adult polycystic kidney disease

A

AD; hypertension MC sign; cerebral berry aneurysms

216
Q

Visceral epithelial cells

A

synthesize basement membrane

217
Q

Glomerular BM

A

negative charge due to heparan sulfate

218
Q

Nephritic syndrome

A

oliguria; RBC casts; hypertension; mild to moderate proteinuria

219
Q

Nephrotic syndrome

A

proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes

220
Q

Immunofluorescence

A

linear (anti-glomerular BM antibodies); granular (IC deposition)

221
Q

IgA GN

A

MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits

222
Q

Post-streptococcal GN

A

nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B

223
Q

SLE type IV GN

A

nephritic; subendothelial deposits; anti-DNA antibodies

224
Q

Crescentic GN

A

crescents from parietal cell proliferation; worst GN; GoodpastureÕs, WegenerÕs

225
Q

GoodpastureÕs

A

nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN

226
Q

S/S

A

young male with hemoptysis progressing to renal failure

227
Q

Minimal change disease (lipoid nephrosis)

A

MCC childhood nephrotic syndrome

228
Q

Lipoid nephrosis

A

podocyte fusion; loss of negative charge in glomerular BM

229
Q

Focal segmental glomerulosclerosis

A

nephrotic syndrome; AIDS and IV heroin abuse

230
Q

Membranous GN

A

MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes

231
Q

Causes membranous GN

A

HBV, ACE inhibitors, cancer

232
Q

Type I MPGN

A

nephrotic; subepithelial deposits; HCV association; tram tracks

233
Q

Type II MPGN

A

nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)

234
Q

DM nodular glomerulosclerosis

A

microalbuminuria first sign

235
Q

DM glomerulosclerosis

A

nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles

236
Q

ACE inhibitors

A

inhibit angiotensin II vasoconstriction of efferent arterioles

237
Q

AlportÕs syndrome

A

XD hereditary nephritis with sensorineural hearing loss

238
Q

Ischemic ATN

A

prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1

239
Q

Ischemic ATN

A

disruption of BM in proximal tubule and thick ascending limb

240
Q

Nephrotoxic ATN

A

aminoglycosides, IVP dye, Pb/mercury poisoning

241
Q

Nephrotoxic ATN

A

proximal tubule dysfunction; intact BM

242
Q

Oliguria

A

prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia

243
Q

Acute pyelonephritis

A

vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain

244
Q

Chronic pyelonephritis

A

U-shaped scars overlying blunt calyces

245
Q

Drug-induced tubulointerstitial nephritis

A

type I/IV reaction; e.g., penicillin

246
Q

S/S

A

ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts

247
Q

Analgesic nephropathy

A

aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect

248
Q

Myeloma kidney

A

BJ protein produces foreign body reaction in tubules

249
Q

Urate nephropathy

A

prevent by giving allopurinol prior to chemotherapy

250
Q

CRF

A

fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts

251
Q

Renal osteodystrophy CRF

A

hypovitaminosis D (no 1-?-hydroxylase); produces osteomalacia

252
Q

Renal osteodystrophy CRF

A

osteoporosis from metabolic acidosis

253
Q

Renal osteodystrophy CRF

A

secondary HPTH with increased osteoclastic activity

254
Q

S/S CRF

A

pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures

255
Q

Benign nephrosclerosis

A

kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis

256
Q

Malignant hypertension

A

renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside

257
Q

Renal findings

A

necrotizing arteriolitis; Òflea bittenÓ kidney; hyperplastic arteriolosclerosis

258
Q

Renal infarction

A

pale infarcts; hematuria; common in polyarteritis nodosa

259
Q

Hydronephrosis

A

renal stone MCC; atrophy of cortex/medulla; postrenal azotemia

260
Q

Renal stones

A

most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor

261
Q

S/S

A

colicky pain radiating into groin, hematuria; x-ray usually shows stone

262
Q

Staghorn calculus

A

due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell

263
Q

Angiomyolipoma

A

hamartoma; associated with tuberous sclerosis

264
Q

Renal cell carcinoma

A

smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored

265
Q

S/S

A

flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele

266
Q

Renal pelvis transitional cell carcinoma

A

smoking MCC, phenacetin, aniline dyes, cyclophosphamide

267
Q

WilmÕs tumor

A

hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types

268
Q

Urine draining from umbilicus

A

persistent urachus

269
Q

Retroperitoneal fibrosis

A

produces hydronephrosis

270
Q

Bladder extrophy

A

abdominal wall defect + epispadias

271
Q

Bladder diverticula

A

most commonly due to prostatic hyperplasia with urethral obstruction

272
Q

Acute cystitis

A

E. coli; females > males; no fever, flank pain, or WBC casts

273
Q

Bladder transitional cell carcinoma

A

smoking MCC, aniline dyes, cyclophosphamide; papillary

274
Q

S/S

A

hematuria; hydronephrosis

275
Q

Bladder adenocarcinoma

A

risk factors persistent urachus, extrophy

276
Q

Bladder squamous cell carcinoma

A

Schistosoma hematobium infection

277
Q

Hypospadias

A

ventral opening on penis due to failure closure of urethral folds

278
Q

Epispadias

A

dorsal opening on penis due to defect in genital tubercle

279
Q

PeyronieÕs disease

A

painful curvature penis due to fibromatosis

280
Q

Priapism

A

persistent/painful erection; HbSS

281
Q

Squamous cell carcinoma penis

A

HPV and lack of circumcision most important risk factors

282
Q

Cryptorchidism

A

undescended testis; risk for seminoma applies to cryptorchid testis and normal testis

283
Q

Orchitis

A

mumps usually unilateral (infertility uncommon)

284
Q

Epididymitis

A

35 - E. coli, P. aeruginosa

285
Q

S/S

A

scrotal pain relieved by elevation of scrotum (PrehnÕs sign)

286
Q

Varicocele

A

left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common

287
Q

Varicocele

A

may be due to invasion of left renal vein by renal cell carcinoma

288
Q

Hydrocele

A

persistent tunica vaginalis; scrotum transilluminates

289
Q

Torsion of testicle

A

testicle high in canal; absent cremasteric reflex

290
Q

Testicular cancer

A

unilateral painless mass that does not transilluminate

291
Q

Risk factors

A

cryptorchid testis, KlinefelterÕs, testicular feminization

292
Q

Seminoma

A

MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ?hCG

293
Q

Spermatocytic variant

A

> 65 yrs of age

294
Q

Embryonal carcinoma

A

hemorrhage/necrosis; hematogenous spread before lymphatic; ?AFP, hCG

295
Q

Yolk sac tumor

A

MC testicular cancer in boys; ?AFP

296
Q

Choriocarcinoma

A

most aggressive testicle cancer; ?hCG

297
Q

Teratoma

A

more often benign in children than adult

298
Q

Teratocarcinoma

A

teratoma + embryonal carcinoma

299
Q

Malignant lymphoma

A

MC type in elderly; metastasis not primary cancer

300
Q

Prostate

A

DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer

301
Q

Prostatitis

A

perineal pain, fever; WBCs at end of voiding

302
Q

Benign prostatic hyperplasia

A

DHT/estrogen-mediated; glandular/smooth muscle hyperplasia

303
Q

S/S

A

all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx

304
Q

Prostate cancer

A

DHT-mediated; palpable with rectal exam; osteoblastic metastasis (? AP)

305
Q

PSA

A

sensitive but not specific for prostate cancer; ? in hyperplasia

306
Q

KallmannÕs syndrome

A

absent GnRH, anosmia, absence of taste

307
Q

Impotence

A

failure to sustain an erection; psychogenic in most cases (erections present at night)

308
Q

Erection

A

parasympathetic response

309
Q

Ejaculation

A

sympathetic response

310
Q

Leydig cell failure

A

? LH; ? testosterone, sperm count; normal FSH

311
Q

Seminiferous tubule failure

A

? FSH (?inhibin); ? sperm count; normal LH and testosterone

312
Q

Leydig and seminiferous tubule failure

A

? FSH and LH; ? testosterone and sperm count

313
Q

Y chromosome

A

determines genetic sex

314
Q

Testosterone

A

develops seminal vesicles, epididymis, vas deferens

USMLE (16 decks)

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