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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
Drugs causing B9 deficiency
``` (Folate) Phenytoin Sulfonamides Methotrexate TMP ```
26
B9 deficiency
``` (Folate) Diarrhea Depression Confusion Glossititis Decreased growth Megaloblastic anemia (hypersegmented PMNs = neurtophils) ```
27
B12 deficiency and where is it found?
Only animal products Parasthesias Degeneration of DCML, LCST, spinocerebellar tracts due to abnormal myelin = ataxia, memory loss, dementia, severe weakness
28
Dx of B12 deficiency
elevated serum homocytseine and methymalonic acid Schilling test with radio labeled B12 if low in urine then deficient absorption Absorbed in terminal ileum
29
Dx of B12 deficiency
elevated serum homocytseine and methymalonic acid Schilling test with radio labeled B12 if low in urine then deficient absorption Absorbed in terminal ileum
30
Acute phase cytokines
IL-1 IL-6 and TNF-alpha
31
Parkinson's Drugs
``` "BALSA" Bromocriptine Amantidine Levidopa/Carbidopa Selegiline (Etacapone/Tolcapone) Antimuscarinics (Benztropine) ```
32
Pancreatic CA tumor markers
CA19-9 (more specific) | CEA (gastric and colon cancer)
33
Endocrine hormones using cAMP
``` FSH LH ACTH TSH CRH hCG ADH V2 receptor MSH PTH Calcitonin GHRH Glucagon (FLAT ChAMP + CGG) ```
34
Endocrine hormones using cGMP
ANP BNP NO (Think vasodilators)
35
Endocrine hormones using intrinsic tyrosine kinase (MAP kinase)
``` Insulin IGF-1 FGF PDGF EGF (Think growth factors) ```
36
Endocrine hormones using receptor associated tyrosine kinase (JAK/STAT)
``` Prolactin Cytokines Growth hormone G-CSF EPO Thrombopoietin ```
37
Endocrine hormones using intracellular receptors
``` Steroid hormones = Vitamine D Estrogen Testosterone Progesterone Thryoid hormone Glucocorticoids Aldosterone Cortisol ```
38
Stimulates bone/muscle growth
Growth hormone
39
Responsible for female secondary sex characteristics
Estrogen
40
Stimulates metabolic activity
Thryoid hormone
41
Increase blood glucose level and decreased protein synthesis
Cortisol
42
Stimulates adrenal cortex to synthesize and secrete cortisol
ACTH (Adrenal corticotrophic hormone)
43
Stimulates follicle maturation in females and spermatogenesis in males
FSH
44
Increased plasma Ca and increased bone resorb
PTH
45
Decreased plasma Ca and increased bone formation
Calcitonin
46
Stimulates ovulation in females and testosterone synthesis in males
LH
47
Stimulates TH production and iodine uptake in thyroid
TH
48
Anterior Pituitary Hormones
GH, Prolactin, FSH, TSH, LH, ACTH
49
Hypothalmic Hormones (name specific nuclei)
ADH (supraoptic nuclei) Oxytocin (Paraventricular nuclei) "next to the production site of milk/CSF" Both stored in PP
50
Calcitonin made in
Parafollicular C cells of thyroid
51
Estrone made in
Fat cells
52
Estrogen in males made in
Testes
53
Somatostatin made in
D cells of pancreas
54
Two nervous system plexi in GI tract and location?
``` Meissner's = submucosa Myenteric/Auerbachs = btw layers of lamina propria ```
55
Diseases damaging ant horn
Polio West Nile ALS Werdnig Hoffman (Spinal muscular atrophy)
56
CT scan shows b/l hilar lymphadenopathy, Dx?
Sarcoidosis
57
Empty sella turscica
Usually ASx, enough residual hormone tissue left to maintain hormone levels May present as hormone deficiency
58
Hyperprolactinemia Sx
HYPOGONADISM amenorrhea, oligomenorrhea, infertility, may have galactorrhea Males low testosterone, decreased libido, impotence, infertility, gynecomastia
59
Tx of hyperprolactinemia
Dopamine antagonists Antipsychotics (haloperidol, risperidone) Domperidone Metoclopramide
60
Describe type 1 a error
False positive | Saying there is an effect or difference when none exists
61
Describe type 2 beta error
False negative | Saying there is no effect or difference when one exists
62
Abdominal aortic aneurysm due to
Smoking | Atherosclerosis
63
Pulsus paradoxus due to
Cardiac tamponade Asthma COPD Hyper inflated lungs
64
Memory tool for congenital adrenal insufficiencies?
1 in first = HTN 1 in second = masculinization Think 21 you want to sleep with not 11
65
All congenital adrenal insufficiencies have what gross finding?
Hyperplasia of adrenal cortex due to increased ACTH (all have low cortisol levels)
66
3B-Hydroxysteroid Dehydrogenase Deficiency findings
Deficiency of aldosterone, cortisol, and androgens and testosterone Severe salt wasting in urine Resultant hypovolemia and hypovolemic shock Early death HypoNa, Hyper K
67
How is hnRNA processed before leaving the nucleus?
Poly A tail 5'cap | Introns spliced out
68
Cushing Syndrome Sx/Side effects of long term corticosteroids
``` 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
Tx for Nephrogenic Diabetes Insipidus
HCTZ as diuretic Indomethacin to decrease RBF Amiloride when there is lithium induced nephrogenic DI
70
Tx of pheochromocytoma
First irreversible alpha antagonist = Phenoxybenzamine Then beta blocker to control tacycardia Then surgical resection Treat alphabetically!
71
Rule of 10's/90's pheochromocytoma
``` 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
Pheochromocytoma associations
MEN 2A and 2B Can secrete EPO = polycythemia Neurofibromatosis 1
73
Adrenal Neuroblastoma buzzwords
``` Homer-Wright psuedorossettes Bombesin tumor marker Neurofilament stain Overexpression of N-myc oncogene HMA + VMA in blood & urine ```
74
What two MEN syndromes are associated with the RET oncogene?
MEN 2A & 2B
75
Give the characteristics of MEN1
MEN1 = PPP Parathyroid adenoma Pituitary tumor Pancreatic endocrine tumors (ZE, insulinomas, VIPomas, glucagonomas)
76
Give the characteristics of MEN2A
``` PPM Parathryoid hyperplasia Pheochromocytoma Medullary thryoid carcinoma (neck mass) Associated with RET oncogene ```
77
Give the characteristics of MEN2B
``` PMM Pheochromocytoma Medullary thryoid carcinoma Mucosal neuromas = Oral/intestinal ganglioneuromatosis Associated with RET oncogene ```
78
Skin hyper pigmentation
Primary Adrenal Insufficiency due to excess ATCH and POMC activating MSH
79
Triad of Conn Syndrome
Primary Hyperaldosteronism HTN HypoK Metabolic Alkalosis
80
Most common cause of Conn Syndrome
Hyperaldosteronism | Adrenal adenoma
81
What causes of vaginosis cause pH to be high and which ones cause it to be low?
pH>5.5 = trichomonas & garderella | pH
82
Tx of thyroid storm
3 P's Propoanolol (B-blocker) Propylthiouracil Prednisone (Glucocorticoids)
83
Most common location of ectopic thyroid tissue
tongue
84
Recent study with IV iodine contrast cause of hyperthyroid?
Jod-Basedown phenomenon | Iodine induced hyperthryoidism
85
Pregnancy affect on serum thyroid hormone levels?
Increased TBG Increased total T3/T4 Normal serum T3/T4 Decreased TSH due to similarity to hCG
86
Hashimoto Buzzwords (6)
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
Hypothyroid + lymphoid infiltrate
Hashimotos
88
Hypothyroid + granulomatous infiltrate
Subacute DeQueivans Thryoiditis
89
Hypothyroid + fibrosis
Reidels
90
Pt stops taking levothyroxine pills - what labs have changed?
Hypercholesterolemia | Increased total cholesterol and LDL
91
Most common thyroid cancer
Papillary carcinoma
92
Enlarged thyroid cells with ground glass nuclei
Orphan Annie nuclei of Papillary Carcinoma
93
Second most common thyroid cancer
Follicular carcinoma
94
Thyroid carcinoma with activation of receptor tyrosine kinases
Papillary and medullar
95
Thyroid carcinoma with RAS mutation or PAX8-PPARg1 mutation
Follicular
96
Hashimotos thyroiditis increased risk of this CA
B cell lymphoma
97
Cancer of parafollicular C cells and findings
Medullary thyroid cancer Increased calcitonin MEN2A/2B RET mutation
98
Thyroid carcinoma with BRAF RET NTRK1 mutation
Papillary carcinoma
99
Rock hard thyroid nodule in older patient that is fixed and appears to have invaded into nearby structures
Undifferentiated anaplastic carcinoma | Very poor prognosis
100
Rock hard thyroid nodule in younger patient that is fixed and appears to have invaded into nearby structures
Reidels thryoiditis
101
Thyroid cancer that spreads hematogenously
Follicular carcinoma
102
Follicular carcinoma vs. follicular adenoma
Both have uniform follicular proliferation Carcinoma invades capsule Adenoma does not invade capsule and can produce TH
103
Thyroid cancer with psammoma bodies, nuclear grooves and orphan annie nuclei
Papillary carcinoma
104
HLAB35
Subacute thyroiditis
105
``` Transient hyperthyroid/hypothyoid Recent viral flu-like illness Rapid enlargement Painful thryoid Granulomatous inflammation ```
Subacute thryoiditis
106
Drugs that can cause hypothyroid
Amiodarone Lithium Tyrosine kinase inhibitors
107
Insulin dependent GLUT4 receptors found
On SKM and adipose tissue
108
GLUT2 non-insulin dependent receptors found
Beta cells pancreas Small intestine Liver Kidney
109
Does DM1 or DM2 have strong genetic predisposition?
DM2
110
What HLA's is DM1 associated with and what is the antibody
HLA-DR3-DQ2 HLA-DR4-DQ8 Anti-glutamic acid decarboxylase (GAD) Ab to islet cells
111
What skin changes are associated with DM2?
Acanthosis nigricans
112
What enzyme converts glucose to sorbitol?
Aldose reductase
113
What enzyme converts sorbitol to fructose?
Sorbitol dehydrogenase
114
What tissues lack sorbitol dehydrogenase and what does this lead to?
``` Schwann cells Retina Kidney Lens Causes osmotic swelling and damage ```
115
How is HbA1c attached to glucose?
Nonenzymatic glycosylation
116
Nonenzymatic glycation damage of DM includes
Retinopathy Nephropathy Large vessel atherosclerosis
117
Osmotic damage of DM includes
Neuropathy | Cataracts
118
Attributable risk equation
AR= A/A+B - C/C+D
119
ECG leads showing inferior wall infarction?
Leads 2,3 and aVF

DIT/Boards (22 decks)

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