Last Set Flashcards
ADPKD associated with (4)
Berry aneurysms
MVP
Benign hepatic
Diverticulosis
Anaerobes
Anaerobes Cant Breath Fresh Air
Clostridium
Bacteroides
Fusobacterium
Actinomyces
Facultative intracellular
Some Nasty Bugs May Live FacultativeLY
Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia pestis
Urease positive
Pee CHUNKSS
Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus
Catalase positive organisms
Cats Need PLACESS to Belch their Hairballs
Catalase
Nocrrdia Pseudomonas Listeria Aspergillus Candida E coli Staphylococci Serratia B cepacia H pylori
Live attenuated vaccine
“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly
Adenovirus Typhoid Polio (Oral) Varicella Small pox BCG Yellow fever Influena (intranasal) MMR Rotavirus
Killed vaccine
RIP Always
Rabies
Influenza (injection)
Polio (injectable)
Hepatitis A
Gardner
Dimorphic fungus
Pustule on puncture site
Nodules follow draining lymphatics
Tx
Sporothrix schenckii
Tx: Itraconazole (first line)
potassium iodine
Bloody diarrhea
Flask shaped ulcers
RUQ pain
- type organism
- transmittered
- diagnosis
- tx
Entamoeba histolytica
Liver abscesses
Fecal-oral route
- eating food or water contaminated with feces that contain cysts
Trophozoites or cysts in stool
Treatment
- trophozoites= metronidazole or tinidazole
- cysts= iodoquinol or paromomycin
Ingest helminths
“EAT”
Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis
Penetrating helminths
“Sand”
Stronglyoides
Ancylostoma
Necator
D
Giant limbs
- type
- transmitted
- tx
Wuchereria bancrofti
Helminth, neomatoid
Round worm in GI
Mosquitoes
Migrate to lymphatics
Elephantiasis of limbs
Hydrocele of scrotum
Tx
Diethylcarbamazine
Hydatid cyst lesion in liver
RUQ pain
Well circumscribed circular lesion
- transmitted
- can find where in body
- symptom
- tx
Echinococcus granulosus
dog feces
Egg shell calcifications
Form mature larval cysts in liver and lungs
Anaphylaxis
Surgical removal of cysts
Ixodes deer tick
Borrelia burgdorferi
Anaplasma
Babesia
Giemsa Stain
Rickettsia Chlamydia Trypanosomes Plasmodium Borrelia Helicobacter pylori (Histoplasma)
Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha
Chinese Painted wHores Bow To Rich
Silver stain
Fungi
- Coccidioides
- Pneumocytstis jirovecii
- Legionella
- H. pylori
Drug binds to cell wall glycoproteins
Drug interferes with DNA replication proteins
Drug binds to ribosomal proteins
Drug binds to transpeptidases
Vancomycin
Fluoroquinolones, binds DNA gyrase
Macrolides, tetracyclines
Pencillin, cephalosporins
1st generation cephalosporins
Cefazolin
Cephalexin
Gram + cocci
PEcK
Proteus mirabilis
E. coli
Klebsiella
UTIs
URIs
Prophylaxis viridans strep endocarditis
2nd generation cephalosporins
Cefoxitin
Cefaclor
Cefuroxime
Cefprozil
HENS PEcK H. influenza Enterobacter Neisseria Serratia marcescens Proteus mirabilis Ecoli Klebsiella
Not used for gonorrhea
3rd generation cephalosporins
Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir
Serious gram - infections
HENS PEcK E.coli Proteus mirabilis Klebsiella Enterobacter Serratia Citrobacter Neisseria H. influenza Strep pneumoniae **
4th generation cephalosporin
- use
- coverage
cefepime
broad spectrum
Pseudomonas
Gram + coverage
5th generation cephalosporin
Ceftaroline
Broad spectrum
MRSA
Protein synthesis inhibitors
mneumonic
Buy AT 30, CCELL at 50
30S inhibitors
- Aminoglycosides
- Tetracyclines
50S
- Chloramphenicol
- Clindamycin
- Erythromycin, macrolides
- Lincomycin
- Linezolid
TCA
- MOA
- coverage
- avoid with
- toxicity
Binds 30S
Prevents attachment of aminoacyl tRNA
VACUUM THe BedRoom Vibrio cholerae Acne Chlamydia Ureapolasma urelyticum Mycoplasma pneumoniae Tularemia Helicobacter pylori Borrelia burgdorferi Rickettsia
Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)
Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)
Sulfa drug allergies
“Sulfa Pills Frequently Cause Terrible Allergy Symptoms”
Sulfasalazine Probenecid Furosemide Celecoxib Thaizide (TMP-SMX) Acetazolamide Sulfonyureas
Vaccines
1) 1st Given
2) Who gets flu shot
3) 2 months
4) 4 months
5) 6 months
1) Hep B- 1st given
2) Yearly from 6 months
2,4,6 (8) who do we appreciate STRIPPERS
“Damn BaBy, ROTate that ass on the POLe”
3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal)
4) DTaP, Hib, Polio, PCV, Rotavirus
5) DTAP, Hib, PCV, RV
CCR-5 antagonist
Maraviroc
CCR-5 on macrophages and CD4 T cells
Inhibits gp120 conformational change
Only in patients with all R5 virus
HIV drug causes
- Bone marrow suppression
- Pancreatitis
- Hepatic steatosis
- Hypersensitivity rxn
- Rash
- Nightmares, vivid dreams, depression
- False-positive to drug test for cannabinoids
- Teratogenic
- Nephrolithiasis
- Increases bilirubin
- peripheral neuropathy
- Zidovudine (NRTI)
- Didanosine (NRTI)
Ritonavir (PI) - Didanosine (NRTI)
- Abacovir (NRTI)
- NNRTIs
- Efavirenz (NNRTI)
- Efavirenz (NNRTI)
- Efavirenz (NNRTI)
- Indinavir, Atazanavir (protease inhibitor)
- Atazanavir (protease inhibitor)
- Didanosine
Antifungal that
- Disrupts membrane
- Disrupts microtubules
- Blocks precursors to pyrimidines
- Blocks Squalene to lanosterol
- Blocks lanosterol to ergosterol
- Nystatin, Amphotericin B
- Griseofulvin
- Flucytosine
- Terbinafine
- -azoles
Terbinafine
- use
- side effects
Inhibits enzyme squalene epoxidase
uses superficial fungal infections
Hepatotoxicity
GI symptoms
Headache
TASTE disturbance
Haemophilus influenzae can be grown
tx
Chocoalte agar w/ factor V and X
or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs
Tx: Amoxicillin +/- clavulanate (mucosal infxn)
Ceftriaxone (meningitis)
Rifampin prophylaxis
S or comma shaped
Campylobacter jejuni
- bloody diarrhea
Vibrio cholerae
- water diarrhea
Constipation Red spots of abdomen Abdominal pain Fever Followed by diarrhea
Tx
Salmonella typhi
Ceftriaxone
Fluroquinolone
Myalgia of calves
Jaundice
Photophobia
Flu like
Tx
Leptospira interrogans
Water contaminated with animal urine
Pencillin
Ceftriaxone
Doxycycline
Tongue ulcers
Splenomegaly
Histoplasmosis
Severe diarrhea in AIDS
Cryptosporidium
Oocytes in water
Oocytes on acid fast
Nitazoxaninde in IC hosts
What viruses uses this receptor
1) Integrins
2) CD21
3) CD4, CXCR4, CCR5
4) P antigen on RBCs
5) Nicotinic AChR
6) ICAM-1
1) Integrins= CMV
2) CD21= EBV
3) CD4, CXCR4, CCR5= HIV
4) P antigen on RBCs= ParvoB19
5) Nicotinic AChR= Rabies
6) ICAM-1= Rhinovirus
Rotavirus
- causes
- type of virus
- MOA
infantile gastroenteritis
Segmented ds RNA virus (reovirus)
Diarrhea
- day care center
Villous destruction with atrophy leads to decreased absorption of Na and loss K
Paramyxovirus Prophylaxis
Palivizumab
paramyxovirus causes RSV, croup, mumps, measles
Strawberry cervix
Trichomoniasis
Trichomonas vaginalis
Daptomycin
- MOA
- uses
- adverse effects
Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels
S aureus skin infections
(MRSA), bacteremia, endocarditis, VRE
Adverse
- myopathy
- rhabdomyolysis
S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types
Panton-Valentine Leukocidin
Neutrophils
Macrophages
Gram positive rods
Clostridum (anaerobes)
Corynebacterium
Listeria
Bacillus
Gram negative oxidase positive diplococci
1) sputum from COPD
2) Urethral discharge
3) CSF
1) sputum from COPD= Moraxella catarrhalis
2) Urethral discharge= N. gonorrhoeae
3) CSF= N. meningitis
Gram negative cocci
Gram negative coccobacill
Cocci
- N. meningitidis
- N. gonorrhea
- Moraxella catarrhalis
Coccobacilli
- H. influenza
- Bordatella pertussis
- Pasteurella
- Brucella
Gram negative Lactose fermenting rods
Gram negative non lactose fermenting rods
Lactose (Fast)
- Klebsiella
- E.coli
- Enterobacter
Lactose (slow)
- Citrobacter
- Settaria
Non lactose fermenter
- Shigella
- Salmonella
- Proteus
- Yersinia
- Pseudomonas (oxidase +)
Painful enlarged swollen LN in groin
Came into contact with animal
Yersinia pestis
Safety pin on staining
Prarie dog
New mexico
[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin]
1) Ototoxicity
2) Pseudomembranous colitis
3) Prolonged QT
4) Gray baby syndrome
5) PHotosensitivity
6) MRSA/ VRE coverage
7) Anaerobic coverage
8) Discolored teeth
9) Atypical pneumonia coverage
1) Aminoglycosides
2) Clindamycin
3) Macrolide
4) Chloramphenicol
5) Tetracycline
6) Linezolid
7) Clindamycin
8) Tetracycline
9) Macrolide
MOA of each drug
1) Sulfamethoxazole
2) Trimethoprim
3) Levofloxacin
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B
1) Sulfamethoxazole
- Inhibit dihydropteroate synthetase
2) Trimethoprim
- inhibit dihydrofolate reductase
3) Levofloxacin
- Inhibit DNA gyrase (topoisomerase II)
4) Nitrofurantoin
- Inhibit bacterial ribosomes
5) Metronidazole
- Forms toxic free radicals that damages DNA
6) Polymyxin B
- Acts like cationic detergent
1) Vomiting and watery diarrhea on cruise
2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria
1) Norovirus
2) Clostridium perfringens
Which RNA virus
1) Hand, foot, and mouth
2) Break bone fever
3) Common COld
4) Fever, jaundice, black vomit
5) Meningitis in summer months
6) Tourniquet test helps diagnose hemorrhagic disease
7) Infects motor neurons of anterior horn
1) Hand, foot, and mouth= coxsackievirus
2) Break bone fever= dengue
3) Common COld= rhinovirus, coronavirus
4) Fever, jaundice, black vomit= yellow fever
5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses
6) Tourniquet test helps diagnose hemorrhagic disease= dengue
7) Infects motor neurons of anterior horn= poliovirus, west nile virus
Which antiviral
1) Prophylaxis for influenza A
2) used to tx for chronic hep C
3) First line for herpes simplex virus or VZV
1) Prophylaxis for influenza A= zonamivir, oseltamivir
2) used to tx for chronic hep C= ribavirin + IFN-alpha
3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir
Bilateral interstitial infiltrates
Silver stain
Tx
Pneumocystis jirovecii
circular ring with clear center
TMP-SMX
Flu vaccine against what part
Humoral response to hemaglutinin
Organisms that cause granulomatous disease
- Bacteria
- Fungal
- Parasitic
Bacteria
- Mycobacteria (tuberculosis, leprosy)
- Bartonella henselae (cat scratch)
- Listeria monocytogenes
- Treponema pallidum (tertiary syphilis)
Fungal
- Histoplasmosis
Parasitic
- Schistosomiasis
Zoonotic bacteria
1) Cat scratch
2) Rodents to Tick
3) Cattle fluids
4) Birds and pigs
5) Birds
6) Infected placenta or contaminated fluid of newborn farm animals
7) Lone star tick
8) Rabbit or squirrel
9) Infected animal urine
10) Nine-banded armadillo
11) dog bit
12) Lice
13) Fleas
14) Tick, rash on palms
15) Fleas, prairie dogs
1) Cat scratch= Bartonella henselae
2) Rodent to tick= Borrelia burgdorferi
3) Cattle fluids= Brucellosis
4) Birds and pigs= Campylobacter
5) Birds= Chlamydophila psittaci
6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii
7) Lone star tick= Ehrlichia chaffeensis
8) Rabbit or squirrel= Francisella tularensis
9) Infected animal urine= Leptospira
10) Nine-banded armadillo= Mycobacterium leprae
11) Dog bite= Pasteurella multocida
12) Lice= Rickettsia prowazekii
13) Fleas= Rickettsia typhi
14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever)
15) Fleas, prairie dogs= Yersinia pestis
Obligate anaerobes (3)
Tx
Clostridium species
Actinomyces (Gram +)
Bacteroides (Gram -)
Tx metronidazole
Clindamycin
Headache
Fever
Rash on wrist and ankles moves to palms soles and trunk
Ricketta ricksttsii
Rocky mountain spotted fever
Pseudoappendicitis
Yersinia enterocolitica
Heat stable toxin
Increase cGMP
Common infectious organism of tonsils and adenoids
Common infectious organism of salivary gland
S. pyogenes
S. aureus, viridans group streptococci
Bacteria vaccine
- toxin
- capsular polysaccharides
- killed bacteria
- live attenuated bacteria
Toxin
- Tetanus toxoid
Capsular polysaccharides
- S. pneumoniae
- H. influenzae
Killed bacteria
- Vibrio cholerae
Live attenuated bacteria
- Typhoid vaccine
- BCG vaccine
Lactose non-fermenters
Urease producing
-Creates what
Proteus spp
Alkaline urine Struvite stones (Staghorn calculi)
What is the unique features of gram negative bacteria cell wall
Outer membrane
- endotoxin (LPS)
- induce IL-1, TNF alpha
Periplasmic space (between membranes) - beta lactamase
Spore forming bacteria
Bacillus anthracis
Bacillus cereus
Clostridum spp
(perfringens, tetani, botulinum, difficle)
Coxiella burnetti
Weight loss Lymphadenopathy Hyperpigmentation Cardiac symptoms Arthralgias Neurlogic symptoms PAS+ Foamy macrophages in lamina propria
Whippe disease Tropheryma whipplei (Gram +)
Penicillin
Ampicillin
Tetracycline
Nef
tat
HIV regulatory genes
Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells
tat: is a transcriptional activator that promotes viral gene expression
5 y.o difficulty breathing
dysphagia
drooling fever
Swollen and cherry red epiglottis
sign
H. influenzae type B
thumb sign
Headache Fever Malaise Cough Nodular infiltrates Clumping once room temp
Mycoplasma pneumoniae
Walking pneumoniae
Cross reactive IgM
Activate complement –> erythrocyte lysis
Cold agglutinins
1) Parasite eggs in stool
2) Perianal egg deposition
3) Proglottids in the stool
4) Rhabdoitiform larvae in the stool
5) Trophozoites and cysts in the stool
1) Schistosoma mansoni or S. japonicum
2) Enterobius vermicularis (pinworms)
3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum)
4) Strongyloides stercoralis
5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)
Four obligate aerobic bacteria
Nagging Pest Must Breathe
Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus
Fever Headache Nuchal rigidity Normal glucose elevated protein
Aseptic meningitis
Enteroviruses
- coxsackievirus
- echovirus
- poliovirus
Pig farmer
Loeffler syndrome
Ascaris infection
Eosinophilic invasion due to parasitic infection
Goes with?
Lecithinase
M protein
Protein A
Trehalose dimycolate
Polyribosylribitol phosphate (PRP)
Lecithinase: toxin A, clostridium perfringens
- results in cell lysis and gas gangrene
M protein: strep. pyogenes
-Binds factor H to prevent opsonization and destruction by alternative complement pathway
Protein A: staph aureus
- prevent opsonization by binding Fc region of immunoglobulins
Trehalose dimycolate: cellw all component , mycobacterium tuberculosis
- protects from being killed by macrophages and stimulates granuloma formation
Polyribosylribitol phosphate: Haemophilus influenzae type b
- capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells
1) Budding yeast with thick capsule
2) Macropahges with intracellular small yeast
3) Round spherules iwth multiple endospores
4) Septate hyphae with dichotomous branching
5) Yeasts with pseudohyphae and blastoconidia
1) Cryptococcus neoformans
- bird droppings
- immunocompromised
- meningoencephalitis
2) Histoplasma capsulatum
- Missouri caves
- fever nonproductive cough
3) Coccidioides immitis
- pulmonary disease
4) Aspergilus fumigatus
- V shaped branching
- AIDS
Multiple ulcers
Mucosal erosions
Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`
CMV
herpesvirus
Rash followed by desquamation of hands and feet (sloughing of skin)
Snuffles (blood tinged nasal secretions)
Skeletal abnromalities
Hepatomegaly
Early manifestations Congenital syphilis (during first 2 years)
Identify
1) Multiple painful ulcers
2) Painful single ulcer
3) Painless ulcer, raised indurated edges
4) School of fish
5) Granulomatous lesions on skin ( large areas of dying flesh)
1) Herpes simplex
2) Haemophilus ducreyi
3) Syphilis
4) Haemophilus ducreyi
5) Tertiary syphilis
- Gummatous syphilis
Severe fetal anemia
Ascites
Pleural effusions
Hydrops fetalis
Parvovirus B19
Clostridium perfringens toxins
Alpha toxin (phospholipase)
- Gas gangrene
- Myonecrosis
Enterotoxin
- Food poisoning
- Food left out too long once cooked
Bacteria w/ capsule pneumonic
Even Some Pretty Nasty Killers have Shiny Bodies
E coli Strep pneumonia Pseudomonas Neisseria meningitidis Klebsiella Haemophilius influenza type B Salmonella Group B strep
Cryptococcus neoformans
- encapsulated yeast
Bilateral facial nerve palsy
Tx
Borrelia burgdorferi
Ixodes tick
Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)
Rash involving palms and soles
Maculopapular
Kawasaki disease
Coxsackie A virus
Rocky mountain spotted fever
Syphillis
Meningococcemia
You drive Kawaski CARS with your hands and feet
What three bacteria are obligate intracellular bacteria
Rickettsia
Coxiella
Chlamydia
Replicative process
1) DS dna –> DS dna template –> ds DNA progeny
2) DS dna -> +RNA template -> partially ds-DNA
3) ssDNA –> ds DNA template –> ss DNA progeny
4) ss +RNA –> ds DNA template –> ss +RNA progeny
5) ss +RNA –> - RNA template –> ss + RNA progeny
6) ss -RNA –> +RNA template –> ss -RNA progeny
1) Adenovius, herpesvirus, poxvirus
2) Hepatitis virus
3) Parvovirus B19
4) Retroviruses (HIV)
5) poliovirus
6) Influenza virua, measles virus, rabies virus
Facial infection of jaw/mandible
Sinus tracts draining pus
Actinomyces israelii
Shiga toxin
Cleaves host rRNA at adenine base in 60S ribosomal subunit
Inhibition of protein synthesis
Shigella
Repetitive unilateral shooting/ shock like pain in face. Triggered by chewing, talking touching certain parts of face. Lasts seconds to minutes. Increase in intensity and frequency over time
Tx
Trigeminal neuralgia
Carbamazepine
- Blocks Na channels
Appendectomy, Anesthesia by mask to quickly anesthetize would have what characteristic
A. High blood solubility B. High cerebrospinal fluid solubility C. High lipid solubility D. Low blood solubility E. Low lipid solubility
D. Low Blood solubility
CNS drugs must be lipid soluble (cross the bbb)
Drugs with low solubility in blood= rapidly induction and recovery time
Increase solubility in lipids= increased potency
A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
c) Decreased concentration of the GpIb/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
F) Deficient binding of von Willebrand factor to the GpIb/IX complex
A) ITP
C) Bernard-Soulier
D) Glanzman thromboasthenia
F) Von Willebrand def
Blistering lesions in sun exposed areas. Recurrent hx of these lesions.
Increased Total porphyrin
Increase Urine uroporphyrin III
Precursor to uroporphyrin?
Dx: Porphyria
Precursor= Succinyl-CoA
Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia.
Succinyl-CoA combines with glycine to form ALA start of heme synthesis
Enlarged tongue Progressive weakness Hypotonia Cardiomegaly Increased glycogen
Impairment of what enzyme?
A. Branching enzyme B. Glucose-6-phosphatase C. alpha-1,4-glucosidase D. Glycogen synthase E. Phosphoglucomutase
C. Alpha-1,4- glucosidase
Pompe disease
Heart transplant
One year later, increase BP and creatinine. Which immunosuppressive drug would cause this?
A) Azathioprine B) Corticosteroid C) Cyclophosphamide D) Cyclosporine E) Muromonab CD3
D) Cyclosporine
- Nephrotoxicity
- HTN
- Gingival hyperplasia
- Hirsutism
Azathioprine
- Pancytopenia
Cyclophosphamade
- Hemorrhagic ycstitis
- SIADH
Bulimia values
K
HCO3
Anion Gap
pH
Increase pH
Increase HCO3
Decrease K
Normal Anion gap
Blood dots on tongue and lips
Progressive SOB
Nosebleeds
CLubbing nails
Disease?
What is causing SOB
Hereditary hemorrhagic telangiectasia (osler-weber-rondu)
Arteriovenous malformations (AVMS) - atrial septal defect
Hematocrit
Volume of RBC compared to total volume
Major manifestations
Familial chylomicronemia assoc with
Familial hypercholesterolemia assoc with
Familial dysbetalipoproteinemia assoc with
Familial hypertriglyceridemia
Familial chylomicronemia - Acute pancreatitis - Hepatomegaly - Eruptive skin xanthomas (Tendon xanthomas)
Familial hypercholesterolemia
- Premature MI
- Tendon xanthomas
- Corneal arcus
Familial dysbetalipoproteinemia
- Premature MI
- Palmar xanthomas
Familial hypertriglyceridemia
- Pancreatitis risk
- Obesity
- Insulin resistance
Nest of polygonal cells with congo red positive deposits
Medullary thyroid cancer
Polygonal shaped cells with extramedullary amyloid deposits
Polygonal or spindle shaped cells with extrameduallary amyloid deposits
Branching structures with interspersed calcified bodies
Papillary thyroid cancer
Psammoma bodies
Pleomorphic giant cell nests with occasional multinucleated cells
Anaplastic thyroid cancer, aggressive
Often irregular giant cells and biphasic spindle cells
Fabry disease most at risk for developing
Renal failure
Neuropathic pain Angiokeratomas Telangiectasias glomerular disease (proteinuria) Cerebrovascular disease (stroke) Cardiac disease (left ventricular hypertrophy)
13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient
A. 21-hydroxylase B. 17a- hydroxylase C. 11b-hydroxylase D. Side chain cleavage enzyme E. 5a-reductase
B. 17a- hydroxylase
Spliceosomes remove introns at
GU at 5’ splice site
AG at 3’ splice site
Progressive back pain
Intermittent fever
Vertebral boen destruction with fluid collection
Mycobacterium tuberculosis spondylitis (potts disease)
Pruritic skin rash
Pink papules symmetrically over anterior surface of shins and ankles
Hyperkeratosis with a thickened granular layer
Rete ridges with sawtooth appearance
Scattered colloid bodies
Lichen Planus
Acute dystonic reaction
- is what
- due to
Spasmodic torticollis
Antipsychotic medication
D2 antagonism of nigrostriatal pathway
Name
1) Bile soluble
2) Bacitracin sensitive
3) Complete hemolysis
4) Optochin sensitive
5) Growth in hypertonic saline
6) Optochin resistance
7) Bile insoluble
1) Bile soluble= S. pneu
2) Bacitracin sensitive= Streptococcus pyogenes
3) Complete hemolysis= Group A Strep (s. pyogenes)
Group B Strep ( S. agalactiae)
4) Optochin sensitive= S. pneu
5) Growth in hypertonic saline= gamma- hemolytic ( No hemolysis )
Enterococci
S. bovis
6) Optochin resistance= Viridans group streptococci
7) Bile insoluble= VIridans group streptococci
More chloride in RBC
Enzyme responsible
Excess HCO3 transferred out of RBC in exchange for Cl
Carbonic anhydrase
Thickening of pleural membranes around whole lung
Disease
Due to
Histology
Mesothelioma
- Asbestos exposure
Spindle cell positive for cytokeratin
Central areas of whorled collagen fibers in lungs
SIlicosis
- inhaled silica
Nodules of whorled collagen fibers and dust-laden macrophages
Riboflavin deficiency
WHat enzyme impaired? A. Fumarase B. G6PD C. HMG-COA reductase D. Isocitrate dehydrogenase E. Malate dehydrogenase F. Succinate dehydrogenase G. Succinate thiokinase
F. Succinate dehydrogenase
Cytotoxic exotoxin organisms
Clostridium botulinum
Clostridium tetani
Corynebacterium diphtheriae
Promote host cell death
Dysphagia Dry mouth Blurred vision Mydriasis Poorly reactive pupils
Suggests
Clostridium botulinum toxin
- neurotoxin
Inhibit ACh release
Canned foods
Nephrotic syndromes
- proteinuria
- albumin
- feature
Does not have
Examples
Heavy proteinuria
Low albumin
Edema
No hematuria or red blood cell casts
Diabetic nephropathy
Membranous nephropathy
Minimal change disease
Nephritic syndrome
- proteinuria
- albumin
- features
<3.5 proteinuria
Hematuria
Red blood cell casts
Azotemia
HTN
PSGN
Membranoproliferative
Lupus nephritis
IgA nephropathy
Nephritic syndrome associated iwth normal complement levels
IgA neprhopathy
Oliguria
High serum creatinine level
Intranasal ulcer that wont heal
Ab against?
A. Glomerular basement membrane B. Smooth m. cells C. Neutrophils D. Erythrocytes E. Platelets F. Mitochondria
C. Neutrophils
Granulomatosis with polyangiitis (wegners)
Nasal mucosal ulcerations and glomerulonephritis
+ c-ANCA
( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)
Excessive bleeding in patient with renal dysfunction due to
Accumulation of uremic toxins
Impair platelet aggregation and adhesion
Prolonged bleeding
Normal platelet count
Normal PT and PTT
Sore throat and fever
Mild tonsillar erythema and exudates
Clumped gram positive bacteria with polar granules that stain deeply with analine dyes
Pathogenesis?
Diphtheria
AB Exotoxin
- B binds heparin-binding epidermal growth factor
- A inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor EF-2
Impairment of protein synthesis
Jejunum removal requires what supplementation after
Decrease in gastric acidity as diminishes iron absorption
Iron absorption duodenum and proximal jejunum
Ascorbic acid absorbed where
Pyridoxine absorbed where
Biotin absorbed where
Panthothenic acid absorbed where
Vit C: distal small bowel
Pyridoxine (B6) jejunum and ileum
Biotin (B7) small and large intestine
Panthothenic aicd (B5) small and large intestine
Large cells iwth intranuclear eosinophilic inclusions, intracytoplasmic basophilic inclusions
- Presentation
- Tx
CMV
Fever, fatigue, abdominal pain, diarrhea
Ganciclovir
- interferes with viral replication by competitvely inhibiting the incorporation of guanosine triphosphate into CMV stands by CMV DNA polymerase
Right gaze
- right eye: right
- left eye: forward
Neutral normal
Left gaze
- both look left
Convergence: normal
Left internuclear ophthalmoplegia
Damage to medial longitudinal fasciculus
Lesion at left dorsal pons
Fever Body aches Generalized weakness Rash on legs Abdominal pain and weight loss Decreased sensation in leftfoot Edema Biopsy: necrotizing vasculitis without IgA deposition c-ANCA and p-ANCA negative Image: red dots all over legs
What is most likely associated with the vasculitis?
A. Hepatitis B seropositivity B. History of heavy smoking C. Jaw claudication D. Recent upper respiratory infection E. Weak pulses in upper extremities
A. Hepatitis B seropositivity
Patient has polyarteritis nodosa (PAN)
Vasculitis of medium vessels Spares lungs Palpable purpura Assoc w/ Hep B Necrotizing inflammatory lesions HTN Asymmetric polyneuropathy Skin lesions GI
+ p-ANCA
Lungs
Kidneys
Nasophagyngeal
Microscopic polyangitis
5 y.o low grade fever and rash
Bright red erythemaous rash on face prominent on cheeks
Blanching reticulated rash on arms and trunk. Up to date on vaccinations. Facial rash erupted 3 days ago and body rash this morning. Reticulocytopenia
A. Coxsackievirus A B. Human herpesvirus 6 C. Measles D. Parvovirus B19 E. Streptococcus pyogenes
D. Parvovirus B19
Fifth’s disease
Erythema infectiosum
Slapped cheek
- respiratory droplets
- bone marrow suppression
Sand paper rash
Strep pyogenes
Scarlet fever
Delayed type skin reactivity to pyrogenic exotoxins
Bone tumor
1) Anaplastic stromal cells make a tumor osteoid bone matrix
2) Epitheloid clusters with vesicular nuclei and abundant vacuolated soap bubble like cytoplasm
3) Sheets of oval/spindle cell with interspersed large multinuclearted ostoclast like giant cells
4) Small round cells some of which are binucleated with abundant cartilage like matrix
1) Osteosarcoma
2) Chordomas
3) Giant cell tumor
4) Chondrosarcoma
Cardiogenic shock
A. High cardiac output B. Hyperkalemic hyponatremic metabolic acidosis C. Inadequate ventricular function D. Low cardiac filling pressures E. Low pulmonary wedge pressure
C. Inadequate ventricular function
Shock
- Low blood pressure
- Hypoperfusion
- Adequate blood volume
Inability of heart to generate flow thorughout the body due to myocardial infarction
Unable to maintain oxygenation of its tissues
A. High cardiac output
- Septic shock early presentation
B. Hyperkalemic hyponatremic metabolic acidosis
- adrenal shock secondary to addisonian crisis
D. Low cardiac filling pressure
- opposite in shock, have high cardiac filling pressures due to failure of cardiac output to match venous return
E. Wedge pressure= left atrial pressure is elevated in shock
Describes what
1) 2 micron spherical micro-organism in the brush border
2) 4-6 micron single cell organisms in the lumen near teh absorptive surface
3) Macrophages in the lamina propria bearing PAS positive bacteria
4) Superficial penertrating ulcers with a mixed inflammatory infiltrate perhaps containing non-caseating granulomas
1) Cryptosporidia
- malabsorption in immunocompromised
2) Giardiasis
- prevent absorption of nutrients
- nausea
- purple burps
- belching sulfurous taste
Ghost face on stain (ghost balloon)
3) whipple disease
4) crohns disease
CTG trinucleotide in a serine-threonine kinase
- caused by
Instability during both maternal and paternal meiosis
Instability during paternal meiosis
Myotonic dystrophy type I (DM1)
-Instability during maternal meiosis
Friedreich ataxia
- AR
- GAA repeat
- Limb and gait ataxia
- Cardiomyopathy
- DM
Huntington disease
CAG repeat
Uncontrollable facial and chest flushing
Diarrhea
Wheezing
Elevated 5-HIAA
Tx
Can led to
Additonal finding
Carcinoid syndrome
- secretion of serotonin
Octreotide
Niacin deficiency
Tricuspid regurgitation
H2S enterobacteriaceae
Salmonella
1) Microcytic hypochromic RBC with coarse basophilic stippling
2) Microcytic hypochromic RBC with elongation
1) Beta-thalassemia
2) Iron deficiency anemia
Hypertensive crisis
Severe HTN End organ symptoms Tachycardia Cardia arrthymias Stroke
Too much monoamine oxidase inhibitors
or taken with drugs that potentiate catecholamine activity or tyramine (wine cheese)
Neuroleptic malignant syndrome
Adverse drug rxn to antipsychotic
Increased dopamine blockade throughout body
Autonomic instability
Muscle rigidity
high fever
Decreased reflexes
"FEVER" Fever Encephalopathy Vital signs unstable Elevated creatine phosphokinase Rigidity of muscle
What would increase MVP murmur
Valsalva maneuver
Decrease volume of left ventricle, causes the prolapse to occur sooner
Increase preload maneuver
Squatting
Isometric handgrip
Aortic regurg louder
Inspiration on heart murmur
increase right heart sounds
Hand grip
Increase afterload
Increase intensity MR, AR, VSD
Decrease hypertrophic cardiomyopathy and AS murmurs
Valsalva
Decrease preload
Decrease intensity of most murmurs
Increase hypertrophic cardiomyopathy
MVP earlier onset
Rapid squatting
Increase venous return
Increase preload
Incerase afterload
Decrease intensity of hypertrophy cardiomyopathy
Increase MR, AR, and VSD murmur
MVP later onset
VHL syndrome
- inheritence
- 3 features
AD
Multiple tumors including hemangioblastomas, RCC, pheochromocytomas
Enlarged bilateral cystic ovaries in obese infertile female
due to
lab values
associated with
Polycystic ovarian syndrome
Increased LH production and slightly decreased FSH
Abnormal fxn of HPO axis
Deranged steroid synthesis by theca cells
Increased LH Decreased FSH Increased testosterone Increased androgens Increased estrogen
Insulin resistance type 2 DM
Slowest and highest amplitude waves on EEG
Delta brain waves
non-REM stage 3
Used to tx? STI
1) 5-flurouracil
2) Acyclovir
3) Metronidazole
4) Penicillin
1) HPV
2) HSV
3) Gardnerella vaginalis
4) Syphilis (trepponema pallidum)
Turkish Mediterranean descent Mouth and genital ulcers No sexual history Uveitis Erythema nodosum
What is it
Associated with
Behcet syndrome
Immune complex vasculitis
Associated iwth HLA-B51
Alcoholic with swelling in extremities. Shifting dullness to percussion. Periumbilical vessels. Tender nodules at 5th intercostal space. Mechanism of edema?
A. Decreased plasma colloid oncotic pressure
B. Increased capillary hydrostatic pressure
C. Increased interstitial colloid oncotic pressure
D. Increased interstitial glycosaminoglycans accumulation
E. Increased permeability of the capillary walls
A. Decreased plasma colloid oncotic pressure
Cirrhosis of liver
Decreased production of albumin
Alcoholic in ER Weakness, dizzinuess Numbness in both lower extremities Malnourished Homeless Bilateral rotatry nystagmus Angular cheilitis
Microcytic hypochromic red cells with coarse basophilic granules
Vitamin B6 deficiency
Sideroblastic anemia
Numbness of extremities
Glossitis
Cheilosis
Organism?
1) Cleaving SNARE protein required for neurotransmitter release
2) Inactivation of the 60S ribosome by cleaving rRNA
3) Inactivation of mitogen-activated protein kinase kinases
1) Clostridium tetani
2) Shigella species
- dysentery due to shiga toxin
- shiga toxin works by inactivating 60S ribosome through cleaving rRNA
3) Bacillus anthracis
- black eschar
- Protective factor and lethal factor combine on surface they form lethal toxin
- Lethal toxin is a Zn-dependent endoprotease that clips off the N-terminus of mitogen-activated protein kinase kinases (MAPKK)
Diarrhea
1) Motile trophozoites on microscopy
2) Genome identified by reverse transcriptase PCR
3) growth at 42 C (107.6 F)
4) Growth on thiosulphase citrate bile salt sucrose agar
5) Lactose fermentation on MacConkey agar
1) Giardia lamblia
2) Norovirus
3) Campylobacter jejuni
4) Vibrio cholerae
5) E. Coli
Patient with MS and spasticity tx
Baclofen
(Agonist at the GABA-B receptor)
Tizanidine
(alpha 2 agonist)
Tumor penetration of basement membrane uses which substances
Collagenases and hydrolases (Metalloproteinase)
Myelofibrosis
- type of malignancy
- clonal expansion of
- secretion of
Hematopoietic stem cell malignancy
Megakaryocytes
TGF-beta secretion
- stimualtes fibroblasts to fill medullary space with collagen.
Solid left adnexal mass
Ovarian mass is yellow and firm
Small cuboidal cells in sheet with glandular structures containing acidophilic material
Cells are arranged in microfollicular pattern around a pink eosinophilic center
Granulosa cell tumor
- secreting estrogen
Call-Exner bodies
Duchenne muscular dystrophy mRNA change
Nonsense mutation
UCA –> [ UAA, UAG, UGA]
Rituximab
Infliximab
Imatinib
Abciximab
Rituximab= Monoclonal Ab for CD20
Infliximab= TNF-alpha monoclonal Ab
BCR/ ABL (CML)
Monoclonal Ab againts platelet GP IIb/IIIa receptor
Neurologic regression
Hepatosplenomegaly
Diminished reflexes
Cherry red spot
Niemann Pick
- Spingomyelin
Total gastrectomy need to supplement
A water soluble vitamin
B12
Lysing of blood cells when incubated in hypotonic saline with glycerol
Hereditary spherocytosis (HS)
Progressive weakness and fatigue over last year. Loss of expression of mutation that codes for a protein found on basolateral surface of hepatocytes and enterocytes. Protein is known to interact with transferrin receptor
Greatest risk of developing?
Primary hemochromatosis
- mutation of HFE protein
Detects falsely low iron levels
Get iron accumulation
Enterocytes: increase apical expression of DMT1, increasing iron absorption
Hepatocytes: decreasing hepcidin synthsis, increased feroportin expression –> increased iron secretion
Iron excess –> bronze diabetes
At risk for hepatocellular carcinoma
Type 2 DM
Confusion lethargy
Hypoglycemia
Elevated C-protein
What drug was used
Medication that stimulates pancreatic insulin secretion independent of blood glucose levels
Sulfonylureas (glyburide)
- glyburide
- glimepiride
- glipizide
Painless Testicular tumor
Elevated lactate dehydrogenase
Elevated alpha fetoprotein
Nonseminomatous germ cell tumor
- embryonal carcinoma
- yolk sac tumor
- choriocarcinoma
hCG
AFP
Flutamide MOA
Leuprolide MOA
Anastrozole MOA
Finasteride MOA
Flutamide: Impaired androgen receptor interaction
Competitive testosterone receptor inhibitor
Leuprolide: Long acting GnRH agonist
- decrease testicular leydig cell stimualtion
Anastrozole: Aromatase inhibitors
-Decrease peripheral conversion of androgens to estrogen
Finasteride: Decreases peripheral conversion of testosterone to DHT by binding 5alpha reductase
Shigella infects via what cell
microfold (M) cells at base of mucosal villi within a Peyers patch
Intranuclear inclusions in oligodendrocytes
Progressive multifocal leukocencephalopathy due to JC virus
Bone pain
Hearing impairment
Multinucleated cells with over 100 nuclei
-Factor essential for differentiation of cells
Paget’s disease of bone
RANK-L
Receptor activator of nuclear factor kappa-B ligand
Mitral regurgitation
- Afterload
- Preload
- Ejection fraction
Afterload: decrease
(regurg so low resistance)
Preload: increase
(LV end-diastolic volume)
EF: Increase
(decreased afterload –> increase EF)
Polyp formation mutation steps
1) Normal mucosa –> small adenomatous polyp (adenoma)
= APC mutation
2) Increase size of adenoma
= KRAS mutation
3) Malignant transformation, adenoma to carcinoma
= TP53 mutation
5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs.
Infection?
Complication
Hookworm
- Necator americanus
- Ancylostoma duodenale
Egg-containing human feces in soil
- skin direct contact with soil
Larvae to lungs, rupture, coughed up and swallowed. In small intestine, mature into adults and attach to GI mucosa and feed on uman blood by lacerating capillaries
Iron- deficiency anemia
Microcytic anemia
Fever HA confusion
Allergic to penicillin
Antibiotic started
Low Erythrocytes
Low Platelets
Low Leukocytes
which antibiotic?
A. Chloramphenicol B. Clindamycin C. Gentamicin D. Metronidazole E. Vancomycin
A. Chloramphenicol
Aplastic anemia
- Carbamazepine
- Chloramphenicol
- Sulfonamides
Brain natriuretic effect on kidney
Increases sodium excretion
Increase GFR
Unilateral painless testicular enlargement. Bilateral gynecomastia. Elevated serum beta human chorionic gonadotropin level.
A. Choriocarcinoma B. Diffuse large B cell lymphoma C. Leydig cell tumor D. Sertoli cell tumor E. Yolk sac tumor
A. Choriocarcinoma
hCG has an analogue similar to LH –> precocious puberty, gynecomastia, impotence or loss of libido
Leydig
- increased testosterone
- Virulization and gynecomastia
Sertoli
- androgens or estrogens
- not enough to cause endocrinologic changes
Yolk Sac tumor
- infants and children
- painless bulky testicular mass
- Alpha-fetoprotein
Leydig cell tumor
- secretion
- causes
- description
- feature associated with
- Marker
- histology
Sertoli cell tumor
- secretion
- causes
- description
- histology
- feature associated with
- marker
Yolk Sac tumor
- affects who
- description
- pattern
- histology
- feature associated with and description of
- marker
Leydig
- increased testosterone
- Virulization and gynecomastia
- yellow tan color
- solid lobulated
- Reinke crystals
- Inhibin A
- round nuclei, single prominent nucleoli and abundant eosinophilic cytoplasm or clear cytoplasm
Sertoli
- androgens or estrogens
- not enough to cause endocrinologic changes
- well circumscribed, pale yellow to whitish gray
- tall polyhedral cells arranged in nests, sheets and cords resembling spermatic tubules
- perinuclear aggregates of intermediate filaments
- Inhibin A marker
Yolk Sac tumor - infants and children - painless bulky testicular mass -honey comb pattern - reticular network is formed by vacuolated cytoplasm of tumor cells -Schiller-Duvall bodies (Central vessel rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space - Alpha-fetoprotein
First line A-fib
First line tx SVT
1) Afib
- Dofetilide (Class III antiarrhythmic)
- Blocks K channels
2) SVT
- Adenosine
Spiking fevers
hepatosplenomegaly
Pancrytopenia
- Disease
- organism
- transmitted
- tx
Kala-azar
aka visceral leishmaniasis
Caused by parasite Leishmania donovani
Sand fly
India
Sodium stibogluconate
MRI of child’s brain reveals enamel-like calcifications and tumor that is located supratentorially
A. Containing foamy cells that are highly vascular
B. A remnant of Rathke’s pouch
C. Containing solid rosettes of small blue cells
D. Composed of Rosenthal fibers
E. Having a “Fried egg” appearance on histology
B. A remnant of Rathke’s pouch
Craniopharyngioma
Ectoderm
Supra cellar calcifications
Brain tumor
1) Highly vascular foamy cells
2) Containing solid rosettes of small blue cells
3) Composed of Rosenthal fibers
4) Having a “fried egg” appearance on histology
1) Von Hippel-Lindau disease
2) Neuroblastoma
3) Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in optic gliomas of neurofibromatosis 1 and pilocystic astrocytomas
- AD
- Cafe au lait
- visual disturbances
4) Oligodendrogliomas
Tumor in proximal colon
Signet ring cells
Father and grandfather same presentation
A. Alternative splicing B. Base excision repair C. Mismatch repair D. Nucleotide excision repair E. Purine salvage
Lynch syndrome
- Hereditary nonpolyposis colorectal cancer
C. Mismatch repair
21 month old Sick all the time Oral thrush RSV and influenza Impetigo and exudative tonsillitis
Severe combined immunodeficiency
50 y.o man. Fatigue, fevers, joint and muscle pain and weight loss. Cough and dyspnea and occasional hemoptysis. Denies upper respiratory involvement. Peripheral sensory loss. Palpable purpura on skin and elevated erythrocyte sedimentary rate. Hematuria and mild proteinuira. Biopsy: vasculitis with an absence of granuloma formation.
Diagnosis
Marker
Tx
Microscopic polyangiitis (MPA)
Males 50 y.o
[Dont have chronic sinusitis seen in granulomatosis w/ polyangiitis]
Necrotizing vasculitis involving kidneys, lungs and skin with pauci-immune glomerulonephritis and palpable purpura
p-ANCA +
(anti-myeloperoxidase)
Tx Cyclophosphamide
Nausea, vomiting Vertigo Numbness on right side of face Dysarthria and dysphagia Uvula deviation to left Hemianalgesia on right side of face and left side of body Ataxia
Artery involved
Lateral medullary syndrome
RIght PICA
Loss of pain and temp on face and body
Ipsl facial hemiparesis
Ipsilateral deafness
C/L body analgesia
Lateral pontine syndrome
AICA
Fever that rises and falls through day Night sweats Joint pain Heart murmur Mexico Goat cheese and unpasteurized milk
Brucellosis
Recurrent pyogenic infections
Oculocutaneous albinism
Progressive neurologic abnormalities
Coagulation defects
Chediak-Higashi syndrome
- AR
Abnormal lysosomal trafficking protein that results in defective phagolysosome formation
Nephritic vs Nephrotic types
Nephritic [ HTN, Inc BUN/CR, Oliguria, RBC casts] 1) Post streptococcal glomerul 2) Rapidly progressive glomer 3) IgA nephropathy (berger) 4) Alport 5) Membranoproliferative glome
Nephrotic [Proteinuria, edema] 1) Focal segmental glomeruloscl 2) Minimal change 3) Membranous nephropathy 4) Amyloidosis 5) Diabetic glomerulonephri
Nephritic/Nephrotic
- Diffuse proliferative glomerulonephrtis
- Membranoproliferative glomerulonephritis
Temporal vs parietal radiation visual defect
Temporal
-upper right quadrant
Parietal
- Lower left quadrant
Fever Rash Dysuria Urinary urgency Hematuria, mild proteinuria WBC (eosinophils) in urine Azotemia Costovertebral angle tenderness
Diagnosis
Caused by
Acute interstitial nephritis
Drug induced
5 P's Pee (diuretics) Pain-free (NSAIDs) Penicillins and cephalosporins Proton pump inhibitors RifamPin
