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DIT/Boards > June 6th > Flashcards

June 6th Flashcards

1
Q

Differential Dx of Eosinophilia

A 
"CANADA-P" 
Collagen vascular disease 
Atopic disease (Allergy, asthma, Church Strauss) 
Neoplasm 
Acute interstitial nephritis 
Drugs 
Addison Disease (Adrenal insufficiency) 
Parasites
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2
Q

What substances act on smooth muscle myosin light chain kinase? How does this affect blood pressure?

A

DHP CCB
Epinephrine
Prostaglandin E2
Causes vascular smooth muscle relaxation and a decrease in blood pressure

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3
Q

Vit deficiency with convulsions and irritability

A

Vit B6 Pyridoxine

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4
Q

Anemia caused by B12 and B9 (folate)

A

Megaloblastic anemia

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5
Q

Where is B12 absorbed?

A

Terminal ileum

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6
Q

Vit deficiency with peripheral neuropathy and glossitis

A

B6 pyridoxine

B12

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7
Q

Vit deficiency with dermatitis, diarrhea and dementia

A

Niacin B3

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8
Q

Vit used in oxidation/reduction reactions

A 
B2 riboflavin (has both o & r for ox/redox) 
B3 niacin (NAD+ NADPH)
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9
Q

Vit used in carboxylation reactions

A

B7 biotin (has o for carboxy)

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10
Q

Vit used by pyruvate dehydrogenase, alpha ketoglutarate dehydrogenase and transketolase

A

think “ATP” reactions

Thiamine Vit B1

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11
Q

Vit used to elevated HDL/LDL

A

Niacin B3

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12
Q

Vit deficiency caused by INH use

A

B6 pyridoxine

B3 niacin

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13
Q

Colbalt found in this vitamin

A

B12 cobalamin

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14
Q

Critical vit for DNA synthesis

A

B9 folate

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15
Q

Dilated cardiomyopathy, edema and polyneuropathy with high output cardiac failure

A

Wet beriberi (ber1ber1)

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16
Q

Perpiheral neuropathy with foot/wrist drop and symmetrical muscle weakness

A

Dry beriberi (think Ber1ber1)

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17
Q

Vit deficiency with dermatitis cheilosis glossitis and angular stomatitis

A

B2 riboflain

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18
Q

Niacin derived from

A

tryptophan

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19
Q

Causes of niacin deficiency

A 
Hartnup disease (decreased tryptophan) 
Malignant carcinoid syndrome (increased tryptophan metabolism) 
INH (decreases B6
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20
Q

How do you avoid flushing with Niacin supplements?

A

Take aspirin with dose

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21
Q

Vit B5 deficiency

A

Pantothenic acid
Component of coenzyme A
dermatitis enteritis alopecia adrenal insufficiency

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22
Q

B vitamin used in synthesis of neurotransmitters and as cofactor for transamination and deamination

A

Pyridoxine B6

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23
Q

Pyridoxine used to make what NT and other substances?

A 
B6 
Niacin 
Heme 
Cystathionine 
histamine 
serotonin 
epi 
NE 
dopamine 
gaba
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24
Q

Where is B9 found naturally and where is it absorbed?

A

Folate = foliage
leafy green vegetables
absorbed in jejunum

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25
Q

Drugs causing B9 deficiency

A 
(Folate)
Phenytoin 
Sulfonamides 
Methotrexate 
TMP
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26
Q

B9 deficiency

A 
(Folate) 
Diarrhea
Depression
Confusion 
Glossititis 
Decreased growth 
Megaloblastic anemia (hypersegmented PMNs = neurtophils)
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27
Q

B12 deficiency and where is it found?

A

Only animal products
Parasthesias
Degeneration of DCML, LCST, spinocerebellar tracts due to abnormal myelin = ataxia, memory loss, dementia, severe weakness

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28
Q

Dx of B12 deficiency

A

elevated serum homocytseine and methymalonic acid
Schilling test with radio labeled B12 if low in urine then deficient absorption
Absorbed in terminal ileum

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29
Q

Dx of B12 deficiency

A

elevated serum homocytseine and methymalonic acid
Schilling test with radio labeled B12 if low in urine then deficient absorption
Absorbed in terminal ileum

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30
Q

Acute phase cytokines

A

IL-1 IL-6 and TNF-alpha

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31
Q

Parkinson’s Drugs

A 
"BALSA" 
Bromocriptine 
Amantidine 
Levidopa/Carbidopa 
Selegiline (Etacapone/Tolcapone) 
Antimuscarinics (Benztropine)
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32
Q

Pancreatic CA tumor markers

A

CA19-9 (more specific)

CEA (gastric and colon cancer)

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33
Q

Endocrine hormones using cAMP

A 
FSH 
LH 
ACTH 
TSH 
CRH 
hCG 
ADH V2 receptor 
MSH 
PTH 
Calcitonin 
GHRH 
Glucagon 
(FLAT ChAMP + CGG)
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34
Q

Endocrine hormones using cGMP

A

ANP
BNP
NO
(Think vasodilators)

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35
Q

Endocrine hormones using intrinsic tyrosine kinase (MAP kinase)

A 
Insulin 
IGF-1
FGF
PDGF 
EGF 
(Think growth factors)
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36
Q

Endocrine hormones using receptor associated tyrosine kinase (JAK/STAT)

A 
Prolactin 
Cytokines 
Growth hormone 
G-CSF 
EPO 
Thrombopoietin
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37
Q

Endocrine hormones using intracellular receptors

A 
Steroid hormones = 
Vitamine D 
Estrogen Testosterone Progesterone 
Thryoid hormone 
Glucocorticoids 
Aldosterone 
Cortisol
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38
Q

Stimulates bone/muscle growth

A

Growth hormone

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39
Q

Responsible for female secondary sex characteristics

A

Estrogen

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40
Q

Stimulates metabolic activity

A

Thryoid hormone

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41
Q

Increase blood glucose level and decreased protein synthesis

A

Cortisol

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42
Q

Stimulates adrenal cortex to synthesize and secrete cortisol

A

ACTH (Adrenal corticotrophic hormone)

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43
Q

Stimulates follicle maturation in females and spermatogenesis in males

A

FSH

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44
Q

Increased plasma Ca and increased bone resorb

A

PTH

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45
Q

Decreased plasma Ca and increased bone formation

A

Calcitonin

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46
Q

Stimulates ovulation in females and testosterone synthesis in males

A

LH

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47
Q

Stimulates TH production and iodine uptake in thyroid

A

TH

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48
Q

Anterior Pituitary Hormones

A

GH, Prolactin, FSH, TSH, LH, ACTH

49
Q

Hypothalmic Hormones (name specific nuclei)

A

ADH (supraoptic nuclei)
Oxytocin (Paraventricular nuclei) “next to the production site of milk/CSF”
Both stored in PP

50
Q

Calcitonin made in

A

Parafollicular C cells of thyroid

51
Q

Estrone made in

A

Fat cells

52
Q

Estrogen in males made in

A

Testes

53
Q

Somatostatin made in

A

D cells of pancreas

54
Q

Two nervous system plexi in GI tract and location?

A 
Meissner's = submucosa 
Myenteric/Auerbachs = btw layers of lamina propria
55
Q

Diseases damaging ant horn

A

Polio
West Nile
ALS
Werdnig Hoffman (Spinal muscular atrophy)

56
Q

CT scan shows b/l hilar lymphadenopathy, Dx?

A

Sarcoidosis

57
Q

Empty sella turscica

A

Usually ASx, enough residual hormone tissue left to maintain hormone levels
May present as hormone deficiency

58
Q

Hyperprolactinemia Sx

A

HYPOGONADISM
amenorrhea, oligomenorrhea, infertility, may have galactorrhea
Males low testosterone, decreased libido, impotence, infertility, gynecomastia

59
Q

Tx of hyperprolactinemia

A

Dopamine antagonists
Antipsychotics (haloperidol, risperidone)
Domperidone
Metoclopramide

60
Q

Describe type 1 a error

A

False positive

Saying there is an effect or difference when none exists

61
Q

Describe type 2 beta error

A

False negative

Saying there is no effect or difference when one exists

62
Q

Abdominal aortic aneurysm due to

A

Smoking

Atherosclerosis

63
Q

Pulsus paradoxus due to

A

Cardiac tamponade
Asthma
COPD
Hyper inflated lungs

64
Q

Memory tool for congenital adrenal insufficiencies?

A

1 in first = HTN
1 in second = masculinization
Think 21 you want to sleep with not 11

65
Q

All congenital adrenal insufficiencies have what gross finding?

A

Hyperplasia of adrenal cortex due to increased ACTH (all have low cortisol levels)

66
Q

3B-Hydroxysteroid Dehydrogenase Deficiency findings

A

Deficiency of aldosterone, cortisol, and androgens and testosterone
Severe salt wasting in urine
Resultant hypovolemia and hypovolemic shock
Early death
HypoNa, Hyper K

67
Q

How is hnRNA processed before leaving the nucleus?

A

Poly A tail 5’cap

Introns spliced out

68
Q

Cushing Syndrome Sx/Side effects of long term corticosteroids

A 
BAM CUSHINGOID 
Buffalo hump 
Amenorrhea 
Moon facies 
Crazy (psychosis & agitation)
Ulcers 
Skin changes (thin & striae) 
HTN 
Infection (cortisol suppresses immune fxn)
Necrosis of femoral head 
Glaucoma 
Osteoporosis 
Immunosuppressed 
Diabetes
69
Q

Tx for Nephrogenic Diabetes Insipidus

A

HCTZ as diuretic
Indomethacin to decrease RBF
Amiloride when there is lithium induced nephrogenic DI

70
Q

Tx of pheochromocytoma

A

First irreversible alpha antagonist = Phenoxybenzamine
Then beta blocker to control tacycardia
Then surgical resection
Treat alphabetically!

71
Q

Rule of 10’s/90’s pheochromocytoma

A 
10% of population 
10% extra-adrenal (90% adrenal medulla) 
10% calcifcy 
10% in kids (90% adults) 
10% malignant (90% benign) 
10% bilateral (90% unilateral)
72
Q

Pheochromocytoma associations

A

MEN 2A and 2B
Can secrete EPO = polycythemia
Neurofibromatosis 1

73
Q

Adrenal Neuroblastoma buzzwords

A 
Homer-Wright psuedorossettes 
Bombesin tumor marker 
Neurofilament stain 
Overexpression of N-myc oncogene 
HMA + VMA in blood & urine
74
Q

What two MEN syndromes are associated with the RET oncogene?

A

MEN 2A & 2B

75
Q

Give the characteristics of MEN1

A

MEN1 = PPP
Parathyroid adenoma
Pituitary tumor
Pancreatic endocrine tumors (ZE, insulinomas, VIPomas, glucagonomas)

76
Q

Give the characteristics of MEN2A

A 
PPM 
Parathryoid hyperplasia 
Pheochromocytoma 
Medullary thryoid carcinoma (neck mass) 
Associated with RET oncogene
77
Q

Give the characteristics of MEN2B

A 
PMM 
Pheochromocytoma 
Medullary thryoid carcinoma 
Mucosal neuromas = Oral/intestinal ganglioneuromatosis 
Associated with RET oncogene
78
Q

Skin hyper pigmentation

A

Primary Adrenal Insufficiency due to excess ATCH and POMC activating MSH

79
Q

Triad of Conn Syndrome

A

Primary Hyperaldosteronism
HTN
HypoK
Metabolic Alkalosis

80
Q

Most common cause of Conn Syndrome

A

Hyperaldosteronism

Adrenal adenoma

81
Q

What causes of vaginosis cause pH to be high and which ones cause it to be low?

A

pH>5.5 = trichomonas & garderella

pH

82
Q

Tx of thyroid storm

A

3 P’s
Propoanolol (B-blocker)
Propylthiouracil
Prednisone (Glucocorticoids)

83
Q

Most common location of ectopic thyroid tissue

A

tongue

84
Q

Recent study with IV iodine contrast cause of hyperthyroid?

A

Jod-Basedown phenomenon

Iodine induced hyperthryoidism

85
Q

Pregnancy affect on serum thyroid hormone levels?

A

Increased TBG
Increased total T3/T4
Normal serum T3/T4
Decreased TSH due to similarity to hCG

86
Q

Hashimoto Buzzwords (6)

A

Autoimmune destruction by Anti-thyroid peroxidase Ab = Anti-TPO Ab
Painless goiter + hypothyroid
HLA- DR5
HLA- B5
Increased risk for B-cell lymphoma
Lymphoid aggregates with germinal centers on histo

87
Q

Hypothyroid + lymphoid infiltrate

A

Hashimotos

88
Q

Hypothyroid + granulomatous infiltrate

A

Subacute DeQueivans Thryoiditis

89
Q

Hypothyroid + fibrosis

A

Reidels

90
Q

Pt stops taking levothyroxine pills - what labs have changed?

A

Hypercholesterolemia

Increased total cholesterol and LDL

91
Q

Most common thyroid cancer

A

Papillary carcinoma

92
Q

Enlarged thyroid cells with ground glass nuclei

A

Orphan Annie nuclei of Papillary Carcinoma

93
Q

Second most common thyroid cancer

A

Follicular carcinoma

94
Q

Thyroid carcinoma with activation of receptor tyrosine kinases

A

Papillary and medullar

95
Q

Thyroid carcinoma with RAS mutation or PAX8-PPARg1 mutation

A

Follicular

96
Q

Hashimotos thyroiditis increased risk of this CA

A

B cell lymphoma

97
Q

Cancer of parafollicular C cells and findings

A

Medullary thyroid cancer
Increased calcitonin
MEN2A/2B
RET mutation

98
Q

Thyroid carcinoma with BRAF RET NTRK1 mutation

A

Papillary carcinoma

99
Q

Rock hard thyroid nodule in older patient that is fixed and appears to have invaded into nearby structures

A

Undifferentiated anaplastic carcinoma

Very poor prognosis

100
Q

Rock hard thyroid nodule in younger patient that is fixed and appears to have invaded into nearby structures

A

Reidels thryoiditis

101
Q

Thyroid cancer that spreads hematogenously

A

Follicular carcinoma

102
Q

Follicular carcinoma vs. follicular adenoma

A

Both have uniform follicular proliferation
Carcinoma invades capsule
Adenoma does not invade capsule and can produce TH

103
Q

Thyroid cancer with psammoma bodies, nuclear grooves and orphan annie nuclei

A

Papillary carcinoma

104
Q

HLAB35

A

Subacute thyroiditis

105
Q 
Transient hyperthyroid/hypothyoid 
Recent viral flu-like illness 
Rapid enlargement 
Painful thryoid 
Granulomatous inflammation
A

Subacute thryoiditis

106
Q

Drugs that can cause hypothyroid

A

Amiodarone
Lithium
Tyrosine kinase inhibitors

107
Q

Insulin dependent GLUT4 receptors found

A

On SKM and adipose tissue

108
Q

GLUT2 non-insulin dependent receptors found

A

Beta cells pancreas
Small intestine
Liver
Kidney

109
Q

Does DM1 or DM2 have strong genetic predisposition?

A

DM2

110
Q

What HLA’s is DM1 associated with and what is the antibody

A

HLA-DR3-DQ2
HLA-DR4-DQ8
Anti-glutamic acid decarboxylase (GAD) Ab to islet cells

111
Q

What skin changes are associated with DM2?

A

Acanthosis nigricans

112
Q

What enzyme converts glucose to sorbitol?

A

Aldose reductase

113
Q

What enzyme converts sorbitol to fructose?

A

Sorbitol dehydrogenase

114
Q

What tissues lack sorbitol dehydrogenase and what does this lead to?

A 
Schwann cells 
Retina 
Kidney
Lens 
Causes osmotic swelling and damage
115
Q

How is HbA1c attached to glucose?

A

Nonenzymatic glycosylation

116
Q

Nonenzymatic glycation damage of DM includes

A

Retinopathy
Nephropathy
Large vessel atherosclerosis

117
Q

Osmotic damage of DM includes

A

Neuropathy

Cataracts

118
Q

Attributable risk equation

A

AR= A/A+B - C/C+D

119
Q

ECG leads showing inferior wall infarction?

A

Leads 2,3 and aVF

DIT/Boards (22 decks)

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