Interesting Important Facts Flashcards
Where are PSAMMoma bodies found?
Papillary thyroid
Serous ovary
Meningioma
Mesothelioma
Free nerve endings Meissner corpuscles Pacinian corpuscles Merkel discs Ruffini corpuscles
Pain, temperature
Dynamic, fine/light touch, position sense
Vibration, pressure
Pressure, deep static touch, position sense
Pressure, slippage of objects along surface of skin, joint angle change
Causes of eosinophilia
Neoplasm Asthma Allergy Collagen vascular disease Parasites
Mother is Rh- and has multiple Rh+ babies
Hemolytic disease of the newborn, erythroblastosis fetalis.
Attacks blood so extramedullary hematopoiesis
Anti nuclear antibody
Anti-dsDNA, anti-smith
Anti-histone antibody
SLE nonspecific
SLE
Drug induced SLE
Rheumatoid factor
Anti-CCP cytidine cyclic phosphate
Rheumatoid Arthritis
Anti-centromere
Anti-Scl-70 (anti-DNA topoisomerase 1)
Scleroderma CREST syndrome
Scleroderma diffuse
Anti mitochondrial
Primary biliary cirrhosis
IgA antiendomysial
IgA anti-tissue transglutaminase
Celiac disease
Anti basement membrane
Goodpasture’s syndrome
Anti-desmoglein
Pemphigus vulgaris
Antimicrosomal, antithyroglobulin
Hashimoto’s thyroiditis
Anti Jo 1
Anti SRP
Anti Mi 2
Polymyositis, dermatomyositis
Anti-SSA (anti-Ro)
Anti-SSB (anti-La)
Sjögren’s syndrome
Anti-U1 RNP (ribonucleoprotein)
Mixed connective tissue disease
Anti smooth muscle
Autoimmune hepatitis
Anti-glutamate decarboxylase
Type 1 diabetes mellitus
C-ANCA (PR3-ANCA)
Granulomatosis with polyangiitis (Wegener’s)
P-ANCA (MPO-ANCA)
Microscopic polyangiitis, Churg-Strauss syndrome
Surfactant producing cells
Type 2 pneumocytes
Clara cells, aka Club cells. These are also site for cytochrome p450 dependent mixed-function oxidase activity
Schilling test
Determines cause of B12 deficiency
If low go to next stage.
Stage 1: give radio labeled b12 and normal b12 and collect urine for 24 hrs. High= dietary deficiency
Stage 2: give R b12 and oral IF. High=pernicious anemia
Stage 3: give R b12 and antibiotics. high=pernicious anemia
Stage 4: give R b12 and pancreatic enzyme. High=pancreatic insufficiency
Low=other causes like ileal resection
Mallory bodies
Intracytoplasmic hyaline inclusions derived from cyto keratin intermediate filaments
Commonly seen in primary biliary cirrhosis, Wilson’s disease, chronic cholestatic syndromes, and hepatocellular tumors
Pyknosis, karyolysis, karyorrhexis
Pyk: nuclear condensation
Karyorrhexis: fragmentation
Karyolysis: dissolution
How much is 1U of blood?
About 3% increase of hematocrit
SIRS criteria
Sepsis needs 2 or more
- Wbc count: 12000 or band>10%
- Heart rate>100
- RR>20 or PCO238 (100.4)
Menopause causes what and what causes menopause
Menopause causes: HAVOC -hot flashes -atrophy of the vagina -osteoporosis -coronary artery disease Causes of meno: Cessation of estrogen production because of a loss of ovarian sensativity to gonadotropin stimulation caused by decreased ovarian follicles and ovarian dysfunction
Sources of estrogen and potency
Ovary-estradiol
Placenta-estriol
Adipose-estrone
Estradiol>estrone>estriol
Anion gap equation
Na-(Cl+HCO3)
Normal anion gap 8-12 mEq/L
Cancer markers and association
AFP in Hepatocellular carcinoma CA 27.29 in Breast cancer CA 19.9 in pancreatic cancer CEA in colon cancer PSA in prostate cancer
Tumor Lysis Syndrome
Sxs: Acute renal failure, HYPERphosphotemia, HYPOcalcemia, Metabolic acidosis. Prevented with the use of allopurinol (axanthine oxidase inhibitor)
In Metabolic acidosis with respiratory compensation you need to look at the Anoin gap
Normal: HARD ASS
Increased: MUDPILES
HARDASS
Hyperalimentation Addison's Disease Renal Tubular Acidosis Diarrhea Acetazolamide Spironolactone Saline
MUDPILES
Methanol (formic Acid) Uremia Diabetic Ketoacidosis Propylene Glycol Iron tablets or Isoniazid Lactic Acidosis Ethylen glycol (oxalic acid) Salicylates (late)
From birth to ovulation, in what phase remains the oocyte
Prophase 1
Beta hCG is similar to what other hormones
TSH, FSH and LH
All share the same alpha subunit. It’s their beta subunit that confirms specific functionality
VIPoma
Rare, commonly in tail of pancreas.
Causes relaxation of intestinal muscles, increased secretion of water and electrolytes: diarrhea, hypokalemia, hypochlorhydria (achlorhydria)
Mittelschmerz
Woman suddenly develops abdominal pain in middle of menstraul cycle but everything points away from pregnancy.
- this is unilateral pain, due to bleeding from rupture of mature follicle
Serum osmolality
=2xNa +BUN/3+glucose/20
Rough estimate mOsm/kg
Causes for kidney stone formation
Increased urinary calcium- increased pth, immobilization, absorptive or renal hypercalciuria
Increased urinary oxalate-inflammatory bowel disease, small bowel resection
Increased uric acid excretion-hyperuricemia, gout
Abnormal urine pH
Urinary tract infection- urea splitters
Causes of pancytopenia
Decreased production: aphasia, dysplasia (b12/folate), infiltration (leukemia, lymphoma, myeloma, fibrosis or metastasis)
Sequestration (hypersplenism)
Increased destruction: immune or nonimmune
Drugs that cause aplastic anemia
Chloramphenicol Phenylbutazone Gold salts Sulfonamides Phenytoin Carbamazepine Quinacrine Tolbutamide
Dry tap for bone marrow biopsy
Hairy cell leukemia
Aplastic anemia
Myelofibrosis
What is myelodysplasia?
Group of disorders broadly characterized by cytopenias(anemia, thrombocytopenia, neutropenia) associated with a dysmorphism or abnormal appearing and usually cellular bone marrow
“Old fart disease”
Epigenetic modifacation, chemo, genetics
Renal clearance equation
Urine concentration x urine flow rate
——-———————————— ml/min
Plasma concentration
Filtered load equation
GFR x plasma concentration. mg/min
Renal plasma flow equation
Urine concentration x urine flow rate/ renal arterial concentration
Filtered fraction equation
GFR/RPF
Diabetes Mellitus Presentation
Polydipsia, Polyphagia, Lethargy, Stupor
Blurred vision, acetone breath, weight loss, Kussmal breathing (hyperventilation), Nausea, vomiting, Abdominal pain
Polyuria, Glycosuria
Risk factors for suicide (require hospitalization)
Male Age(teens and elderly) Depression Previous attempts Alcohol and drugs Sickness Organized plans No spouse (single, widow, divorce) Social support lacking
Type 1 error
False positive error.
Rejecting null hypothesis incorrectly
*you saw a difference that did not exist
Type 2 error
False negative error
Null hypothesis is not rejected when it should be
*blind to the truth
Increase the sample size to decrease this error
Test results for prediabetes
- higher values=Diabetes
- lower vales=Normal
A1C: 5.7-6.4
Fasting Plasma Glucose: 100-125
Oral Glucose Tolerance Test: 140-199
GFR Calculations
*Can assume Creatinine Clearance is equivalent
**the real equation is:
GFR=((140-AGE)(Kg))/(SCr x 72)
Pre-Renal vs Renal vs Post renal
Prerenal: volume contraction due to blood or ECF fluid loss
Renal: Ischemic renal injury due to trauma or toxic renal injury due to anesthesia
Postrenal: retroperitoneal hemorrhage, clots in the bladder causing outlet obstruction
Narcolepsy has a deficiency of what…
Hallucination before sleeping is called…
Hallucination after sleeping is called…
Orexin produced in lateral hypothalamus
Hypnagogic
Hypnopompic
Deficiencies of these hormones cause what?
Acetylcholine
Dopamine
Epinephrine/norepinephrine
Alzheimer’s
Parkinson’s
Depression
Transference vs countertransference
T: patient projects feelings about someone else on to the doctor
CT: doctor projects feelings about someone else on to the patient
Clinical reflexes
S1-2 Achilles reflex
L3-4 patellar reflex
C5-6 biceps reflex
C7-8 triceps reflex
L1-2 cremaster reflex
S3-4 anal wink reflex
Seminoma
Malignant, painless homogenous testicular enlargement. most common testicular tumor, most common in third decade,
Large cells in lobules with watery cytoplasm and fried egg appearance. Increased AFP. Excellent prognosis.
Yolk sac tumor
Yellow, mucinous, aggressive malignancy, Schiller Duvall bodies resemble primitive glomeruli
Increased AFP.
Most common in 3 yr olds
Choriocarcinoma
Malignant, disordered syncytiotrophoblastic and cytotrophoblastc elements. Hematogenous metastasis to brain and lungs. (May present with hemorrhagic stroke due to bleeding into metastasis)
Gynecomastia, sxs of hyperthyroidism ( hCG similar to TSH, LH, FSH)
Increased hCG
Embryonal carcinoma
Malignant, hemorrhagic mass with necrosis, painful, worse prognosis than Seminoma. Often glandular or papillary morphology, Pure embryonal carcinoma is rare. most commonly mixed with other tumor types
May have increased hCG, and normal AFP when pure. Increased AFP levels When mixed
Cremaster muscle derived from what abdominal muscle
Internal oblique
Mutations in these proteins cause what? Alpha synuclein Dystrophin Huntingtin Presenilin Tau
Parkinson's Duchene muscular dystrophy Huntingtons Alzheimers Frontotemporal dementia with Parkinsonism (AD, picks, palsy)
Rheumatic Fever
comes from pharyngeal infection with Group A Beta hemolytic strept.
- Affects Mitral>aortic»>tricuspid
- Associated with Aschoff Bodies (granuloma with giant cells), Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus)
- Immune mediated Type 2 HS, Ab to M protein cross react with self antigens
- *Joint (migratory ppolyarthritis)
- *Carditis
- *Nodules in skin (subcutaneous)
- *Erythema marginatum
- *Sydenham Chorea
Anti Hemidesmosomes
Bullous Pemphigoid
*Nikolsky sign in Negative (separation of epidermis upon manual stroking of skin doesnt happen)
Anti Desmoglein
Pemphigus Vulgaris
*Nikolsky sign is positive
(Desmosomes attacked)
Dermatitis herpetiformis
IgA deposits at tips of dermal papillae. Associated with celiac disease. Pruritis papules, vescicles, and bullae (usually at elblows)
I Cell Disease
Inherited Lysosomal storage disorder. Defect in N acetylglucosaminyl-1-phosphotranferase. Mannose residues not phosphorylated by Golgi apparatus. this causes it to be exocytosed instead of broken down.
*course facial features, clouded corneas, restricted joint ovement, high plasma levels of lysosomal enzymes. Often fatal
Chvostek’s Signs
facial twitch due to hypocalcemia
cluster headaches
Unilateral
last 15min-3 hours, repetative
*Excruciating periorbital pain with lacrimation and rhinorrhea. May induce horner syndrome (ptosis), more common in males
Treat with O2 therapy. Sumatriptan
Tension Headaches
Bilateral
>30min, constant, 4-6hrs
*Steady pain, no photophobia or phonophobia or auras
Tx: Analgesics, NSAIDS, Acetaminophen. Amitrptyline for chronic pain
Migraine
Unilateral
4-72 hrs
*pulsating pain with nausea, photophobia, phonophobia, aura.
**Due to irritation of CN 5, meninges, Blood vessels, p Calcitonin gene
Tx: Abortive therapies: Sumatriptan, NSAIDS, Prophylaxis: Propranolol, topiramide, Ca channel blockers, amitriptyline
Migraine
Unilateral
4-72 hrs
*pulsating pain with nausea, photophobia, phonophobia, aura.
**Due to irritation of CN 5, meninges, Blood vessels, p Calcitonin gene
Tx: Abortive therapies: Sumatriptan, NSAIDS, Prophylaxis: Propranolol, topiramide, Ca channel blockers, amitriptyline
Myasthenia Gravis
Most common NMJ disorder.
Ab to postsynaptic AChR
*Ptosis, diplopia, weakness, worsens with use
*Associated with Thymoma, Thymic hyperplasia
Tx: Give AChR inhibitor to reverse Sxs
Lamber Eaton Myasthenic Syndrome
Ab against Ca Channles on Presynaptic terminal= Decreased ACh release
- Proximal muscle weakness, autonomic SXS(dry mouth, impotence)
- Associated with Small Cell Lung Cancer
SLE
RASH OR PAIN
Rash (malar or discoid) Arthritis Soft tissue/Serositis Hematologic disorders (cytopenias) Oral/nasopharyngeal ulcers Renal Disease, Raynaud Phen. Photosensativity, +VDRL/RPR ANA Immunosuppresants Neurologic Disorders (Seizures, psychosis)
SLE Presentation
Rash, joint pain, fever, most commonly fertile female, african descent.
- Libman Sacks endocarditis- nonbacterial, wartlike vegetations on both sides of valve
- *Nephritic: Diffuse proliferative glomerulonephritis
- *Nephrotic: Membranous Glomerulonephritis
Antimicrosomal Antibody
Hashimoto Thyroiditis
Trisomy 13
Patau’s syndrome
Cleft lip, microphthalmia, mental retardation, polydactyly, Congential Heart disease, renal defects
Trisomy 18
Edward’s syndrome
Severe mental retardation, micrognathia, low set ears, congenital heart defects, limited hip abduction and rocker bottom feet
Deletion of 11p13
Wilm’s tumor and aniridia and Genital anomalies and mental retardation
*Wilms=most common childhood renal tumor and 4th most common pediatriac malignancy in US
Deletion of 5p
Cri-Du-Chat syndrome
cry sounds like meowing kitten, microcephaly, mental retardation, epicanthal folds, and cardiac defects
