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Goljan High Yield Flashcards

1
Q

Roles of cortisol (4)

A
  1. Permissive action over glucagon and epinephrine
  2. Gluconeogenesis from aa
  3. Proteinolysis
  4. Lipolysis
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2
Q

Roles of glucagon (5)

A 
Liver glucogenolysis
Lvier gluconeogenesis
Ureagenesis
Ketogenesis
Lipolysis
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3
Q

Roles of epinephrine (4)

A
  1. Liver glycogenolysis and gluconeogensis (from alanine release from skeletal muscle)
  2. Skeletal Muscle glycogenolysis and gluconeogenesis.
  3. Decrease glucose uptake
  4. Adipose tissue lipolysis and gluconeogenesis (from glycerol)
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4
Q

Roles of growth hormone (3)

A

Adipose tissue lipolysis
Stimulates Protein synthesis via IGF-1
Decreases glucose tissue uptake

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5
Q

Response to hypoglycemia is largely driven by ____ (2)

A

Epinephrine and glucagon

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6
Q

Early sx of hypoglycemia

A

sweating, tremors, palpitations, hunger, nervousness => due to NE & Epi release

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7
Q

Late sx of hypoglycemia

A

behavioral changes, confusion, visual disturbances, stupor, seizures; and if prolonged hypoglemia, irreversile neuro deficits and death.

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8
Q

Why don’t you give beta blockers in hypoglycemia?

A
  1. Exacerbate hypoglycemia. Recall that Beta2 receptors increase liver gluconeogenes, glycogenolysis, lypolysis and skeletal muscle glycogenolysis. If this is blocked, the result is hypoglycemia.
  2. Mask adrenergic symptoms. Because of inhibition of Epi & NE compensatory response.
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9
Q

Cocaine acts by ___

A

Decreased uptake of Serotonin/Dopa/Nor (triple reuptake inhibitor)

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10
Q

UVB light produces what DNA mutations?

A

Thymidine dimers

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11
Q

Cytochrome oxidase is inhibited by ___ (2)

A

CO and cyanide

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12
Q

Muscle atrophy in a cast is caused by ___

A

Polyubiquitination of proteins

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13
Q

MC vitamin deficiency in alcoholics

A

Folic acid (B9)

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14
Q

In the case of ambiguous genitalia, one must always confirm ___

A

Genetic sex

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15
Q

MC mineral deficiency in alcoholics

A

Magnesium

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16
Q

Caisson’s disease (decompression sickness)

A

Due to large volumes of N2 dissolved in blood; PN2 decreases due to bubble formation and movement into tissues

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17
Q

Vitamin E toxicity

A

Decreases Vitamin K dependent factors

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18
Q

Pyridoxine (B6) used in ___

A

Transamination rxns involving AST/ALT

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19
Q

ANP acts in opposition to ___

A

Angiontensin II (–| ADH/aldo release, –| Na reabsorption, –| renin release, vasodilation)

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20
Q

Vitamin deficiency in baby of vegan woman

A

B12 (anemia)

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21
Q

EBV attaches to ____ on B cells

A

CD21

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22
Q

Hypogonadism, MR, and unilateral gynecomastia

A

Klinefelter syndrome (XXY)

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23
Q

Hypogonadism, anosmia, and color blindness

A

Kallmann syndrome (absent GnRH)

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24
Q

Hypogonadism, MR, and retinitis pigmentosum

A

Laurence-Moon-Biedl syndrome (cilia defect)

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25
Male with hypogonadism, MR, short stature, and webbed neck
Noonan syndrome (similar to Turner's, RAS/MAPK defects)
26
Male pseudohermaphrodite with cryptorchidism
Testicular feminization (absent androgen receptors)
27
Microdeletion syndrome with hypogonadism, MR, short stature, obesity
Prader Willi (Chr.15 deletion, paternal origin)
28
Neurofibromatosis patient with severe diastolic HTN
Pheochromocytoma
29
Automobile workers present with headache, N&V, muscle weakness, and abdominal cramps
Lead poisoning from battery incineration
30
Newborn female with hand/foot edema and webbed neck
Turner's (45XO)
31
What has led to decreased incidence of SIDS?
Baby lies supine! (otherwise they don't move their head in response to hypercapnia and die)
32
Mature breast milk v. cow milk
Cow milk: more Vit K, B12, casein protein Breast milk: more ascorbic acid, better-absorbed iron, whey protein
33
Vitamin absent in colostrum
Vitamin D
34
Infant fed on goat milk at risk of. . . ?
B9, B6, iron deficiency --> anemia
35
Type of UV light responsible for majority of corneal burns and cancer?
UVB ('B is bad')
36
Retinal hemorrhage in young child
Abuse (shaken baby syndrome)
37
Fire ant bites
Multiple wheals that later develop into vesicles and pustules
38
Black widow bite (latrotoxin)
Painful bite --> crampy pain in thighs/abdomen (excessive Ach release)
39
Southwest scorpion bite
Painful sting --> itching, paresthesias, N&V, HTN
40
Brown recluse spider bite
Painless bite (red papule) --> hemorrhagic blister surrounded by purpura
41
Chigger bites
Extremely pruritic discrete bright red papules on legs/waist
42
Child who ingests bottle of aspirin
AG metabolic acidosis (do NOT develop mixed metabolic acidosis/resp alkalosis)
43
Rx for aspirin OD
Gastric lavage with activated charcoal; alkalinize urine
44
____ more likely to infect fetus after first trimester
Syphilis
45
THC metabolites in urine
Marijuana
46
Causes of liver angiosarcoma
Vinyl chloride, Ar, thorotrast
47
Urine 17-ketosteroids increased in ___
21-hydroxylase, 11-hydroxylase deficiency
48
Urine 17-hydroxycorticoids increased in ___
11-hydroxylase deficiency
49
Ambiguous male genitalia in CAH
17-hydroxylase deficiency
50
Ambiguous female genitalia in CAH
21-hydroxylase, 11-hydroxylase deficiency
51
Normal aging - CV
Loss of aortic elasticity
52
Normal aging - Derm
``` Osteoarthritis Loss of skin elasticity Increased collagen cross bridging Senile purpura (vessel instability) Decreased skin turgor ```
53
Normal aging - Pulm
Senile emphysema
54
Normal aging - Special Senses
Cataracts Presbycusis, otosclerosis Reduced taste/small Arcus senilis
55
Normal aging - Immuno
Increased autoantibodies Decreased cellular immunity CD4 > CD8
56
Normal aging - Repro
Breast/vulvovaginal/testicular atrophy BPH Decreased E/T Increased FSH/LH
57
Normal aging - Renal
Decreased GFR/Cr clearance
58
Normal aging - Endocrine
Increased insulin resistance
59
Organs injured by acetaminophen toxicity
Kidney (renal medulla), liver
60
Mechanism of corticosteroid immunosuppression
Block phospholipase A2 --| PG, LT production Block leukocyte adhesion Neutrophilia (marginating pool knocked into circulation) Decrease lymphocytes/eos
61
Ectopic ACTH (Cushing syndrome)
Small cell lung carcinoma, medullary thyroid carcinoma
62
SIADH (dilutional hyponatremia)
Small cell lung carcinoma
63
Ectopic calcitonin (hypocalcemia)
Medullary thyroid carcinoma
64
Ectopic EPO (polycythemia, normal PaO2)
Renal adenocarcinoma, Wilm's tumor, HCC, VHL disease, leiomyomas
65
Insulin-like peptide (hypoglycemia)
HCC, retroperitoneal tumors
66
PTH-like peptide (hypercalcemia with low PTH)
Squamous lung carcinoma, renal adenocarcinoma, breast cancer, ovarian cancer
67
Ectopic serotonin (flushing, diarrhea, R heart valvular lesions)
Carcinoid syndrome with liver mets, small cell lung carcinoma, medullary thyroid carcinoma
68
Tumor marker: AFP
HCC; germ cell tumors,: yolk sac or endodermal sinus tumors of testes/ovary
69
Tumor marker: AAT
HCC, yolk sac/endodermal sinus tumors
70
Tumor marker: beta-hCG
Trophoblastic tumors in GCTs; hyatidiform moles; choriocarcinoma
71
Tumor marker: beta2-microglobulin
Multiple myeloma
72
Tumor marker: bombesin
Small cell lung carcinoma, neuroblastoma
73
Tumor marker: CA-15
Breast cancer
74
Tumor marker: CA-19-9
Pancreatic cancer
75
Tumor marker: CA-125
Epithelial ovarian cancer
76
Tumor marker: CEA
Colorectal, pancreatic, breast, small cell lung cancer
77
Tumor marker: LDH
Hodgkin's disease, non-specific
78
Tumor marker: NSE (enolase)
Small cell carcinoma of lung, neuroblastoma
79
Tumor marker: PSA
BPH/prostate adenocarcinoma
80
Tumor: HTLV-1
Adult T cell leukemia/lymphoma
81
Tumor: HTLV-2
Hairy cell leukemia
82
Tumor: HIV
CNS malignant lymphoma
83
Tumor: HCV/HBV
HCC
84
Tumor: EBV
Burkitt's lymphoma, nasopharyngeal carcinoma, polyclonal malignant lymphoma
85
Tumor: HPV
Squamous cell carcinoma of vagina, cervix, vulva, anus, penis
86
Tumor: HHV-8
Kaposi's sarcoma
87
EM of zebra bodies in lysosomes
Niemann Pick DIsease (look like lamellar bodies in T2 pneumocytes)
88
Enamel injury in young woman
Bulimia (metabolic alkalosis from vomiting, Boehaave's syndrome)
89
Anorexia nervosa
Secondary amenorrhea, osteoporosis, ventricular arrhythmia
90
Kwashiorkor
Decreased protein intake, adequate caloric intake Fatty liver --> decreased apolipoproteins Pitting edema Flaky paint dermatitis
91
Marasmus
Decreased caloric intake --> loss of all muscle mass
92
Vitamin A deficiency
Squamous metaplasia in eyes, bronchus; nyctalopia
93
Vitamin A toxicity
Increased ICP, hypercalcemia
94
Primary hypothyroidism
Beta-carotenemia from decreased conversion of beta-carotenes into retinoic acid from intestine (b/c thyroxine is a co-factor) Yellow patient (but not sclerae!)
95
Vitamin E deficiency
Cerebellar dysfunction, hemolytic anemia
96
Vitamin C deficiency ("tea and toast diet")
Bleeding gums, glossitis, perifollicular hemorrhages
97
Thiamine deficiency
Blocks pyruvate DHGN, transketolase, ketoglutarate DHGN Wernicke's (confusion, nystagmus, ataxia) and Korsakoff (antegrade and retrograde memory loss) Mamillary bodies shrunken, periventricular area decreases High-output heart failure, peripheral neuropathy
98
Niacin/B3 deficiency (corn diet, carcinoid syndrome, Hartnup's disease, tryptophan deficiency)
NAD/NADH; NADP/NADPH missing Diarrhea, dermatitis, dementia
99
Riboflavin (B2) deficiency
FMN/FAD reactions, synthesis of glutathione Magenta tongue, cornea neovascularization, angular stomatitis
100
Pyridoxine (B6) deficiency (INH, goat milk diet)
Transaminase, heme synthesis Sideroblastic anemia with ringed sideroblasts, neuropathy
101
Pantothenic (B5) acid
Important in fatty acid synthase complex
102
Biotin deficiency (avidin in raw eggs)
Alopecia
103
Chromium deficiency
Glucose intolerance, peripheral neuropathy
104
Copper rxns
Lysyl oxidase (cross-links in collagen), cyt-c oxidase, SOD, ferroxidase, tyrosinase
105
Copper deficiency
Microcytic hypochromic anemia (loss of transferrin:iron binding), skeletal abnormalities, depigmentation, dissecting AA, Mencke's kinky hair syndrome
106
Copper toxicity
Wilson's disease - AR, Chr. 13, ATP7B Liver damage, Kayser-Fleischer ring, lenticular nuclei damage (ataxia, tremor), psychosis
107
Selenium rxns
Glutathione peroxidase (prevents peroxides from wreaking havoc in cytosol, while Vit E protects membranes) Stimulates immune system Co-factor in peripheral T4-->T3 conversion
108
Zinc rxns
Co-factor in SOD, carbonic anhydrase, alkaline phosphatase, collagenases, RNA/DNA polymerases, thymidine kinase, EtOH DHGN
109
Zinc deficiency (diabetics, alcoholics, cirrhosis, arcodermatitis enteropathica)
Growth retardation, hypogonadism/infertility, decreased taste, rash around eyes/mouth, poor wound healing, impaired immunity
110
Vit C functions
Dietary iron (ferric-->ferrous), hydroxylation of proline/lysine for collagen, prevents nitrosamination, reduces MetHb back to Hb
111
Cyanosis not relieved by oxygen in patient coming home from camping trip
Methemoglobinemia (water has nitrites), give methylene blue
112
Fetal EtOH syndrome
Low nasal bridge, epicanthal folds, minor ear abnormalities, short palpebral fissures, smooth philtrum, thin upper lip, micrognathia
113
HbF shifts oxygen dissociation curve ___
Left
114
Raising upper limit of normal in a test
Increased specificity and PPV; decreased sensitivity and NPV
115
Adrenal atrophy in patient on corticosteroids
FR, not glomerulosa (aldosterone)
116
Normal karyotype with Down's syndrome
Acrocentric (Robertsonian) translocation of chr. 21/14
117
Sepsis in elderly man with BPH
E. coli (septic shock --> release of anaphylatoxins/NO from damaged cells --> dementia exacerbated)
118
Barbiturates increase ___ to precipitate porphyric attacks
ALA synthase
119
Normal changes in pregnancy
Increased: plasma volume, GFR/CCr, Alk Phos, T4/cortisol (increased binding proteins) Decreased: Hb, BUN, Cr, uric acid Respiratory alkalosis from progesterone effect
120
Children v. adults blood studies
Increased AlkPhos (osteoblasts from bone growth) and phosphate, slight Hb decrease
121
Analytes increased with hemolyzed blood sample
K+, LDH
122
Lipid most affected by fasting
TG (chylomicrons)
123
First sign of tissue hypoxia
Na/K ATPase inactivity --> swelling
124
Chemical mediators of inflammation
Histamine, C3a/b, C5a, LTB4, LTC-D-E4, bradykinin, PGs
125
Factors decreasing adhesion molecule synthesis
Catecholamines, corticosteroids, lithium
126
Suppurative inflammation is the same thing as ___
Abscess
127
Serous inflammation is the same thing as ___
Blister
128
BRCA2 is found on ___
Chromosome 13
129
Cri-du-chat is often associated with this CV defect
VSD
130
Marfan's syndrome is ____ inheritance
Autosomal dominant
131
Homocystinuria v. Marfan's
MR, vessel thrombosis
132
MCC of death in Marfan's
Aortic dissection
133
AD // Neurofibromas, pheochromocytoma, cafe au lait spots, Lisch nodules (iris hamartomas)
Neurofibromatosis 1 (Chr. 17)
134
AD // cerebellar hemangioblastomas, pheochromocytomas, bilateral renal adenocarcinoma
Von Hippel Lindau disease
135
Low grade
Well differentiated, can tell origin
136
High grade
Poorly differentiated/anaplastic, can't tell tissue of origin
137
Choristoma
Normal tissue in wrong place (i.e. pancreatic tissue in stomach wall)
138
AG
Na - [Cl + HCO3] = 12 +/- 4mEq/L
139
Why does AG rise in some forms of metabolic acidosis?
Adding an acid and its anion replaces bicarbonate used to buffer hydrogen ions
140
Examples of metabolic acidosis causes
Lactate, acetoacetate, beta-hydroxybutyrate, phosphate/sulfate in renal failure, salicylate, formate (methanol poisoning), oxalate (ethylene glycol poisoning), acetate (paraldehyde)
141
Normal AG metabolic acidosis
Lose bicarbonate, which is replaced by equal # of Cl ions
142
Examples of normal AG metabolic acidosis
HARDUPS - Hyperalimentation, acetazolamide, RTA, diarrhea, ureteroenteric fistula, pancreaticoduodenal fistula, spironolactone
143
Type 1 RTA
Distal: cannot secrete H+ ions or reabsorb K+ (alpha intercalated cells), cannot regenerate bicarbonate Urine pH > 5.5, hypokalemia
144
Type 2 RTA
Proximal; bicarbonate lost in urine until serum bicarb is 15mEq/L Urine pH < 5.5, hypokalemia
145
Type 4 RTA
Aldosterone deficiency or resistance, decreased in ammonium excretion Urine pH > 5.5, hyperkalemia
146
Tumor association: aniline dyes, benzidine, cyclophosphamide, phenacetin
Transitional cell carcinoma of urothelium
147
Tumor association: vinylchloride, thorotrast
Liver angiosarcoma
148
Tumor association: asbestos
Bronchogenic carcinoma >> mesothelioma
149
Tumor association: OCPS
Liver adenomas, HCC
150
Tumor association: aflatoxins (esp. with HBV)
HCC
151
Tumor association: cadmium
Prostate/lung cancer
152
Tumor association: polycyclic hydrocarbons (EtOH co-carcinogen)
Small cell lung carcinoma, squamous carcinoma of URT, squamous cervical carcinoma, transitional carcinoma of bladder, pancreatic adeno
153
Tumor association: chromium, nickel, uranium
Lung cancer
154
Tumor association: woodworking
Nasal cavity cancer
155
Tumor association: chewing tobacco
Verrucous oral carcinoma
156
Tumor association: alkylating agents, benzene
ALL, malignant lymphoma
157
Tumor association: DES
Clear cell adenocarcinoma of vagina/cervix
158
Tumor association: nitrosamines
Esophageal, gastric cancer
159
Tumor association: soot
Squamous carcinoma of skin/scrotum
160
Tumors with vessel invasion (4)
Renal carcinoma, HCC, choriocarcinoma, follicular thyroid cancer
161
0 ESR
Polycythemia, HbSS disease
162
Rx for SIADH
Demeclocycline, restrict water not salt
163
5 features of primary hyperaldosteronism (Conn syndrome)
1. No pitting edema (aldosterone escape, block of proximal reabsorption of Na), 2. Severe hypokalemia (muscle weakness, U waves) 3. Metabolic alkalosis (tetany from low ionized Ca) 4. Nl to increased serum Na 5. Low renin HTN
164
MC primary cancer in LN
NHL
165
MC metastatic cancer in LN
Breast
166
MC primary cancer in lung
Adenocarcinoma
167
MC metastatic cancer in lung
Breast
168
MC primary cancer in bone
Multiple myeloma
169
MC metastatic cancer in bone
Breast, prostate
170
MC primary cancer in liver
HCC
171
MC metastasis in liver
Colon
172
MC primary cancer in adrenals
Adenocarcinoma
173
MC metastatic cancer in adrenals
Lung
174
MC primary cancer in brain
GBM
175
MC metastatic cancer in brain
Lung
176
Necrosis of globus pallidus, SaO2 decreased, PaO2 normal, left shifted ODC, inhibition of cyt-oxidase
CO poisoning
177
Increased PaCO2, decreased PaO2/SaO2
Respiratory acidosis
178
Normal PaO2/SaO2, decreased Hb
Anemia
179
Normal O2 content
1.34[Hb] x SaO2 + PaO2
180
Disorders with nl O2 content
Cyanide poisoning, ischemia, uncoupled ox-phos
181
Dystrophic calcification
Atherosclerotic plaques, enzymatic fat necrotic, periventricular calcification in CMV
182
Metastatic calcification (in setting of increased serum Ca/P)
Nephrocalcinosis (hyperPTH), BG calcification (hypoPTH)
183
MC site of bone mets
Vertebrae due to Batson vertebral plexus from IVC
184
HTN in left gastric/azygous veins
Esophageal varices
185
Cryptococcus neoformans spreads via ___ route
Hematogenous
186
3Hz spike and wave activity on EEG
Absence seizures
187
Absent myenteric (Auerbach's) ganglia
Achalasia
188
Absent myenteric and submucosal (Meissner's) ganglia
Hirschsprung disease
189
Hoarseness in aortic aneurysm
Stretching of L recurrent laryngeal n.
190
Mitochondria are lost in ___ of sperm after fertilization
Tail
191
MCC of rabies in USA
Skunk bites
192
Treatment of CMV retinitis if ganciclovir fails
Foscarnet (renal toxicity, hypocalcemia/hypomagnesemia)
193
Anti-estrogen receptor, may cause endometrial cancer
Tamoxifen
194
False-positive RPR in SLE patient due to ____
Anti-cardiolipin antibodies
195
Anti-SCL-70
Systemic scleroderma
196
Features of SLE
SOAP BRAIN MD ``` S=serositis (pleurisy, pericarditis) O=oral ulcers A=arthritis P=photosensitivity, pulmonary fibrosis B=blood cells (hemolytic anemia, thrombocytopenia, leukopenia) R=renal, Raynauds A=ANA I=immunologic (anti-Sm, anti-dsDNA, anti-Ro/La) N=neuropsych M=malar rash D=discoid rash ```
197
Metyrapone testing
Blocks 11-hydroxylase --> increased ACTH, 11-deoxycortisol in urine in normal HPA axis
198
Osteophytes in DIP joints
Heberden's nodes
199
Flask shaped ulcers in cecum
Amebiasis
200
MC post-MI complication (3-7 days)
Ventricular wall rupture
201
MC post-MI complication (4-6 weeks)
Dressler's syndrome (autoimmune pericarditis)
202
Hemoptysis and renal failure (RPGN) with linear immunofluorescence
Goodpasture's syndrome
203
MCC of sepsis in AIDs patient
Disseminated MAI
204
MCC of infection post-transfusion
CMV (hides in donor lymphocytes)
205
Alternative causes of rusty sputum
CHF, mitral stenosis, Goodpasture's
206
Cyanosis in ToF patient depends on ___
Degree of intravalvular pulmonary stenosis
207
Baby with icterus and edema
Congenital CMV infection
208
Black granules in hepatocyte EM photo
Glycogen (disappears with 6 hours of fasting)
209
MCC of abdominal abscess
Bacteroides fragilis
210
MR, astrocyte hamartomas ("candlestick drippings on ventricles), adenoma sebaceum, angiomyolipoma of kidneys, heart rhabdomyoma
TSC (AD)
211
Increased ALA synthase and decreased porphobilinogen deaminase; severe colicky abdominal pain, neuropsych syndromes
AIP - dALA buildup
212
Decreased activity of uroporphyrinogen decarboxylase, wine-red urine, photosensitivity, hypertrichosis
Porphyria cutanea tarda
213
Yellow needles in parallel polarized light
Monosodium urate
214
Black spot, associated with Pseudomonas and UC
Ecthyma (pyoderma) gangrenosum
215
Fever in malaria occurs when ____
RBCs rupture
216
Young man with low back pain
Sacroilitis; look for HLA-B27, uveitis, aortitis, bamboo spine, UC
217
Sickle cell mutation
Valine for glutamic acid on 6th position of beta globin
218
Osteosarcoma occurs in the ___
Metaphysis
219
Osteomyelitis occurs in ___
Metaphysis
220
UC primarily targets ___
Rectum and colon
221
Gross features of UC
Friable, red mucosa that bleeds easily when touched, no skip areas, "pseudopolyps"
222
Microscopic features of UC
Mucosal inflammation with crypt abscesses
223
Complications of UC
Toxic megacolon, sclerosing cholangitis, pyoderma gangrenosum, adenocarcinoma, HLA B27
224
Clinical picture of UC
L-sided abdominal cramping with bloody diarrhea, rectal urgency, tenesmus
225
Radiograph of UC
"Lead pipe" appearance of haustra
226
Murmur of MVP moves closer to S1 with ___
Anxiety (shorter diastole)
227
Murmur of MVP moves closer to S2 with ___
Lying down (more venous return)
228
Cave explorer in Arizona with resp infection
Coccidiodomycosis
229
Begin treatment for DKA with ___
Volume replacement
230
Turner's syndrome has what type of coarctation?
Preductal
231
Lung findings in ARDS
Atelectasis (massive intrapulmonary shunting due to lack of surfactant); hyaline membranes composed of protein
232
S. aureus food poisoning
1-6 hours after eating (preformed toxin); self-limited
233
MCC of iron deficiency in young child
Meckel's diverticulum
234
Deficiency associated with ileal resection
B12, bile salts (DEAK)
235
Deficiency associated with jejeunal resection
Folate (B9), most water/sodium
236
Deficiency associated with duodenum resection
Iron
237
Unequal pulses in upper extremity
Dissecting aortic aneurysm
238
Diabetic lower leg with pigmented lesions
Necrobiosis lipoidica diabeticorum
239
MCC of esophagitis in AIDS
Herpes
240
URI in child followed by epistaxis and petechia
ITP (IgG against platelets, T2HS)
241
Bridge painter in NYC with resp infection
Histo (starling dung) or cryptococcus (pigeons) --> amphotericin
242
Rat poison ingestion
Contains warfarin; treat with Vit K, FFP
243
ABO incompatibility
Spherocytes in cord blood, + direct Coombs on cord blood RBCs, mild hemolysis (jaundice in 1st 24 hours)
244
Child with rash and skin infiltrate with CD1 cells
Histiocytosis X (most likely: Letterer Siwe dz)
245
Elderly man with low back pain -- what do you do?
Check the rectal exam, alk phos for prostate metastases
246
MC benign brain tumor
Meningioma
247
MCC of pediatric HTN
Kidneys (Wilm's, renal dysplasia), adrenals (neuroblastoma)
248
Hamman's sign
Crunching chest due to subcutaneous emphysema (trauma)
249
Athlete with jaundice and elevated serum transaminases, Alk Phos
Anabolic steroids (cholestatic jaundice)
250
Port wine nevus on face in trigeminal distribution with ipsilateral AV malformation in brain
Sturge Weber dz
251
Polyarteritis nodosa
Vasculitis with urticaria, fever, arthralgia, nephrotic syndrome, hepatitis (Hep B)
252
Flat hyperpigmented lesion on forehead/cheeks of woman
OCP/pregancy (melasma)
253
Axillary freckling in patient with HTN
Neurofibromatosis
254
Blurry vision, dry mucus membranes, ptosis, facial weakness, dilated pupils
C. botulinum food poisoning (like atropine)
255
Patient with dysphagia and fetid odor to breath
Zenker's diverticulum
256
Young man with low back pain and limited chest movement
Ankylosing spondylitis (vertebral kyphosis)
257
Oxidizing UCB into harmless water soluble dipyrroles
UV light in physiologic jaundice of newborn
258
``` Total Serum T4: up Resin T3 uptake: up Free T4 index: up TSH: suppressed I-131: up ```
Graves' disease
259
``` Total Serum T4: up Resin T3 uptake: up Free T4 index: up TSH: suppressed I-131: down ```
Factitious thyroiditis
260
``` Total Serum T4: up Resin T3 uptake: up Free T4 index: up TSH: suppressed I-131: up ```
Thyroiditis (acute, subacute)
261
``` Total Serum T4: down Resin T3 uptake: down Free T4 index: down TSH: increased I-131: down ```
Primary hypothyroidism (Hashimoto's)
262
``` Total Serum T4: down Resin T3 uptake: down Free T4 index: down TSH: down I-131: down ```
Secondary hypothyroidism
263
``` Total Serum T4: up Resin T3 uptake: down Free T4 index: normal TSH: normal I-131: normal ```
Increased TBG (pregnancy)
264
``` Total Serum T4: down Resin T3 uptake: up Free T4 index: normal TSH: normal I-131: normal ```
Decreased TBG (androgens)
265
Flu-like syndrome, hyponatremia/hyperkalemia (interstitial nephritis), silver stain
Legionella
266
MCC of myocarditis, pericarditis, aseptic meningitis
Coxsackievirus
267
High AFP
Open neural tube defects, HCC, yolk sac tumors
268
Drugs that increase surfactant
Glucocorticoids, thyroxine
269
ECG changes in hypercalcemia
Short QT
270
ECG changes in hypokalemia
U waves
271
ECG changes in hypercalcemia
Long QT
272
ECG changes in hyperkalemia
Peaked T waves
273
Polycythemia differential
Relative polycythemia (volume depletion), polycythemia vera (Epo suppressed), epo-secreting tumors, hypoxic stimulus (low SaO2)
274
Leukemias by age:
60: CLL
275
MC ALL
CALL-A + pre-B cell ALL
276
AD, spectrin deficiency, increased osmotic fragility
Congenital spherocytosis
277
Peroxide damaged Hb in RBCs in G6PD deficiency
Heinz bodies
278
Howell Jolly body
Asplenia
279
Antibody screen of serum
Indirect Coombs test
280
Pb deposits in ___ of bone
Epiphyses
281
Generalized lymphadenopathy in elderly man, malignant B cells, hypogammaglobulinemia, massive splenomegaly
CLL
282
AST>ALT, increase in GGT
EtOH consumption
283
HLA loci associated with T1 diabetes
HLA-DQ, HLADR3/4
284
Deviation of uvula to opposite side in exudative tonsilitis
Peritonsillar abscess
285
MCC of nephrotic syndrome in children, loss of negative charge
Minimal change disease
286
MCC of nephrotic syndrome in adults, subepithelial deposits ("spikes"), HBV association
Membranous GN
287
MC renal disease in AIDS, renal transplant, IVDU
FSGS
288
Wire looping in glomerulus
SLE
289
T1 membranoproliferative GN
HCV, tram-tracking, subendothelial deposits
290
T2 membranoproliferative GN
C3 nephrotic factor (autoantibody against C3), dense deposits in GBM
291
Foamy macrophages in lamina propria
Whipple's disease
292
Childhood version of ALS
Werdnig-Hoffmann (floppy baby)
293
MC space-occupying lesion in AIDS
Toxoplasmosis
294
Prolonged PR interval
First degree block
295
Weight lifter with weakness in hand, numbness, absent pulse
Thoracic outlet syndrome (anterior scalene compresses subclavian a., brachial plexus)
296
MCC of AAA
Atherosclerosis
297
Sx of ruptured AAA
Left flank pain, hypotension, pulsatile mass
298
Wilm's tumor associations
Aniridia, HTN
299
CXR with right middle lobe pneumonia obscuring heart margin
Bronchogenic carcinoma or aspiration while supine on R side
300
Sterile pyuria (WBCs) and negative culture
Renal TB or chlamydia
301
Antimicrosomal antibodies
Graves disease and Hashimoto's thyroiditis
302
Neonatal pneumonia, afebrile, staccato cough, eosinophilia, wheezing
Chlamydia infection in birth canal
303
Platelet dysfunction and hemorrhagic pericarditis
Uremia from renal failure
304
Consequences of essential HTN
Charcot-bouchard aneurysms (putamen bleeds), concentric LVH, hyaline arteriolosclerosis, nephrosclerosis
305
Hyperextension of PIP, flexion of DIP joint
Swan neck deformity in RA
306
Flexion of PIP and extension of DIP
Boutonniere's deformity
307
Atlantoaxial joint subluxation
Associated with RA, risk for vertebrobasilar insufficiency
308
Coal worker's pneumoconiosis or silicosis + RA lung disease
Caplan's syndrome
309
RA associations
ACD, reactive amyloidosis, Sjogren's syndrome, Felty's syndrome (autoimmune neutropenia + splenomegaly), carpal tunnel syndrome, uveitis, Baker's cyst, pulmonary disease, fibrinous pericarditis
310
autoimmune neutropenia + splenomegaly in RA
Felty's syndrome
311
Psoriasis signs
Hyperkeratosis, regular rete ridge hyperplasia, munros microabscesses, superficial dermis next to epithelial surface (Auspitz sign), erythematous salmon-plaques with silvery scales, nail pitting, psoriatic arthritis (HLA-B27+), elbows + scalp
312
Fatty casts with maltese crosses
Nephrotic syndrome
313
Associations with pheochromocytoma
VHL, NF1, MENII
314
High output heart failure
Hyperthyroidism, B1 deficiency, too much isotonic saline, AV fistula, endotoxic shock, Paget's
315
Chest pain on exertion with ST depression, relieved by nitroglycerin
Stable angina (~75% occlusion)
316
Chest pain at rest, "infarct waiting to happen"
Unstable angina (Thrombosis of occlusion)
317
Chest pain from vasoconstriction, ST elevation on stress EKG
Prinzmetal angina
318
___ = massive intrapulmonary shunting
ARDS
319
MC site of diverticulosis, polyps, cancer in GI
Sigmoid colon
320
Hepatotoxicity of INH
Metabolite - acetylhydrazine, 10-20% of cases
321
Drugs causing acute hepatitis
INH, salicylates, halothane, methyldopa, phenytoin, ketoconazole
322
Hepatotoxicity of halothane
1 week post-op, fevers then jaundice, p450 metabolites
323
Drugs causing chronic hepatitis
Methyldopa (+ Coombs test), acetaminophen, aspirin, INH, nitrofurantoin, halothane
324
Zonal necrosis (I)
Yellow phosphorus, ferrous sulfate
325
Zonal necrosis (III)
Carbon tetrachloride, acetaminophen
326
Drugs causing intrahepatic cholestasis
Non-inflam: OCPs, steroids | Inflamm: erythromycin, amoxicillin-clavulanic acid, chlorpromazine, thiazides
327
Drugs causing liver fatty change
Single droplet: EtOH, corticosteroids, amiodarone Microvesicular: tetracycline, valproic acid
328
Drugs causing liver fibrosis
MTX, too much Vit A
329
Drugs causing granulomatous hepatitis
Allopurinol, hydralazine, sulfonamides, phenylbutazone
330
MCC of ischemic ATN
Prerenal azotemia
331
MCC of nephrotoxic ATN
Aminoglycosides and contrast
332
Causes of renal papillary necrosis
Acetaminophen+ASA, DM, sickle cell, acute pyelonephritis
333
Epidydimitis
35: Ecoli, Pseudamonas
334
IUD infection
Actinomycosis with sulfur granules
335
Endometritis
Plasma cells present; group B strep
336
Goodies in the rectal pouch of Douglas
Induration 50: ovarian mets Unclotted blood: ruptured ectopic Pus: PID
337
B-HCG function
LH analog that maintains CL for 8-10wks of pregnancy, then placenta takes over
338
Painless vaginal bleeding in pregnancy
Placenta previa (implantation over cervical os)
339
Painful vaginal bleeding in pregnancy
Abruptio placenta (retroplacental hemorrhage, maternal HTN or cocaine use)
340
Urine estriol source
Fetal adrenal, placenta, maternal liver
341
Implantation on day 21
3 days in tube, 2 days in uterus
342
Duffy antigens
Surface receptor for P vivax, uncommon in blacks
343
I antigens
Cold agglutinins in M. pneumoniae (IgM), infectious mono (IgM)
344
O blood group
Universal blood donor; universal plasma recipient
345
AB blood group
Universal blood recipient; universal plasma donor
346
Risk of HIV + post-needle stick
1:300
347
Cryoprecipitate contains. . .
Factor VIII, fibrinogen, factor XIII, fibronectin
348
Rh HDN
Second prgenancy: anti-D IgG cross placenta --> attach to fetal RBCs --> extravascular hemolysis by fetal spleen --> unconjugated bilirubinemia, anemia --> mama liver takes care of UCB but still have risk of HF/hydrops fetalis At delivery, baby needs exchange transfusion for UCB and anemia correction
349
Febrile transfusion rxn
Patient has anti-HLA antibodies against donor leukocytes, release of pyrogens (T2 HS)
350
Allergic transfusion rxn
Patient has H1S against donor antigens
351
Hemolytic transfusion rxn (ABO mismatch)
IGM: Complement activation --> intravascular hemolysis (T2 HS) IGG: extravascular hemolysis, jaundice, Hb drop, + Coombs (T2 HS)
352
Polyarteritis nodosa
HBsAg, T3 HS vasculitis of muscular arteries, different ages of lesions, renal infarcts, p-ANCA, pulm sparing
353
Legg-Perthe
Femoral head, child <10, aseptic necrosis
354
Definitive test for Zollinger-Ellison
Secretin challenge: paradoxical increase in gastrin
355
Characteristic rash of glucagonoma
Necrolytic migratory erythema + DM
356
Signs of VIPoma
Normal gap metabolic acidosis, hypokalemia, achlohydria
357
Gap junction test
Dye passes from one cell to the next
358
Tibial n. function
Plantarflexion, inversion, sensory to sole of foot
359
Aortic/pulmonic valves
Lined by endothelium with abundant fbiroelastic tissue + dense collagenous core; avascular
360
Mitral/tricuspid valves
Loose connective tissue core (increased in prolapse)
361
Winged scapula
Long thoracic nerve (serratus anterior paralysis)
362
Patient with nosebleed and rhinorrhea
Fracture of cribiform plate in ethmoid sinus
363
MLF demyelination
INO
364
Meiosis I arrest for oocytes
Prophase
365
Meiosis II arrest for oocytes
Metaphase
366
What runs along the radial a.?
Median nerve
367
Artery affected in femoral neck fracture
Medial femoral circumflex a.
368
Collagen X location
Epiphyses of bone
369
Wallerian degeneration
Schwann cell proliferation --> tube for guiding axon from proximal surviving fraction
370
Nerve injured in midshaft humerus fracture
Radial n.
371
Bilateral lateral rectus palsy
Increased ICP
372
Parinaud syndrome
Paralysis of upward gaze in infant (hydrocephalus 2/2 stenosis of aqueduct of Sylvius)
373
Weakness of quads/absent knee jerk
Herniated L3-L4 disk
374
Pain in hip/lat quads, numbness of AL leg and webbed space between great toe, weakness of dorsiflexion, nl knee/ankle jerk reflex
Herniated L4-L5 disk (compresses L5)
375
Numbness along PL leg, plantar foot, absent ankle jerk
Herniated L5-S1 disk
376
What level does herniated disc affect, and why?
Protruded disc usually compresses next lower nerve as that nerve crosses level of disc in its path to its foramen (higher nerve escapes!)
377
C8-T1 nerve palsy
Klumpke's
378
C5-C6 nerve palsy
Erb-Duchenne
379
Paralysis of CNIII after head injury
Uncal herniation (ptosis, mydriasis)
380
Wrist bone with highest incidence of avascular necrosis
Scaphoid bone
381
Injury to median nerve and brachial artery --> forearm muscle damage
Volkmann's ischemic syndrome
382
A band in skeletal muscle has ___
Myosin ATPase
383
Site of obstruction in asthma, CF, chronic bronchitis
Terminal bronchioles
384
Weakened palate/gag reflex, trapezius/SCM weakness, loss of posterior taste sensation
Schwannoma in jugular foramen (X, XI, IX)
385
CNIII lesion with UMN signs and midline, midbrain lesion
Weber syndrome
386
C2 transection of fasiculus gracillis
Affects LE only
387
Loss of P/T and CL UMN signs
Mid pons lesion
388
Why cyclosporine in identical twin transplant?
Some difference in MHC sites from crossover during meiosis ?
389
Lymphocyte common marker
CD45
390
Rodents, ARDS, hemorrhage, renal failure
Hantavirus
391
Protein A
Attaches to Fc-R in macrophages and blocks opsonization
392
Pneumonitis and ova in stools
Ascaris or hookworms
393
Pneumonitis and rhabditiform larvae in stools
Strongyloides
394
Cells that attack protozoans
CD4 T cells
395
"Breakbone fever", hemorrhagic, Aedes mosquito
Dengue
396
Live vaccines
MMR, varicella, OPV, BCG, smallpox, yellow fever
397
Spring/summer colds
Adenovirus
398
Winter/fall colds
Rhinovirus
399
Pruritic skin lesion in Gulf War veteran
Cutaneous leishmaniasis from sandfly bite
400
Verrucoid lesion in LE from S. America patient
South American blastomycosis, yeast with ship's wheel appearance
401
ELISA test for HIV
anti-gp120 antibodies
402
Biochemical processes in both mitochondria/cytosol
HUG - heme synthesis, urea cycle, gluconeogenesis
403
Glucokinase
High Vm, high Km, only in liver
404
Hexokinase
Low Vm, low Km, all cells, inhibited by G6P
405
Ketoacidosis
Increased beta-oxidation of fatty acids and production of acetyl CoA --> ketone bodies synthesized by liver
406
Rx for schistosomiasis
Praziquantel
407
Rx for benzo OD
Flumazenil
408
Rx for malignant hyperthermia
Dantrolene (reduced Ca++ release from SR)
409
Rx for acetominophen OD
N-acetylcysteine (Replaces GSH)
410
Mech of loop diuretic
Blocks NKCC in TA; in renal medulla
411
Rx for cyanide poisoning
Amyl nitrite and thiosulfate
412
Xanthine oxidase rxns
Hypoxanthine --> xanthine, xanthine --> uric acid
413
Endocarditis prophylaxis
Amoxicillin
414
Blue-grey skin
Chlorpromazine and arsenic
415
Toxic epidermal necrolysis
Barbituates, sulfonamides, phenytoins, NSAIDs
416
Maculopapular rash
Amoxicillin, TMP/SMX, ampicillin/penicillin
417
Elderly woman on thiazides may develop ___
Gout
418
Antipsychotic producing visual sx
Thioridazine
419
Substitute for ASA in stroke prevention
Ticlopidine
420
Finasteride
Blocks 5-a-reductase (T-->DHT)
421
Ketoconazole
Inhibits T synthesis
422
Leuprolide
GnRH analog
423
Rx for arsenic poisoning
Dimercaprol
424
Chloroquine fails to cure malaria (vivax/ovale)
Can't hit hypnozoites in liver (use primaquine)
425
Methanol tox
Optic n. degeneration and blindness due to formic acid, rx ethanol
426
Major site of water reabsorption in GI tract
Jejeunum > ileum > colon
427
Most effective nephron site for acid excretion
PT
428
Nephron site for greatest generation of free water
TAL in medulla
429
S1 heart sound correlates with ___ wave in JVP
C wave
430
Carotid massage
Decreased HR / increased vasodilation --> inhibits tonic discharge of vasoconstrictor nerves and excites vagal innervation of heart

Boards Review (9 decks)

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