Our Clues 3 Flashcards by HM Beyea

Dx of a PE that shows a point of maximal impulse in subxiphoid space

COPD
- x-ray with cardiac shadow, long and slender -> lungs pushing heart medially

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How do you calculate anion gap?
Normal value?

Anion gap = Na - (Cl + HCO3)

Normal = 8-12
- Diarrhea
- RTA
- Acetazolamide

Incr AG = MUDPILES
- methanol
- uremia
- DKA
- paraldehyde
- iron OD/isoniazid
- lactic acid
- ethanol/ethylene glycol
- salicylates

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What are the causes of metabolic acidosis with elevated anion gap?

MUDPILES
- methanol (osmolar gap, blindness)
- uremia (renal failure)
- DKA (type 1 DM)
- Paraldehyde
- Iron tablets/Isoniazid
- Lactic acid (exercise)
- ethanol/ethylene glycol
- salicylates

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Drugs that bind to ergosterol

Antifungal

Amphotericin B
- IV, pokes holes in cells, releasing K+, Nystatin, Mycostatin

Miconazole, Clotrimazole
- Topical

Tolnaftate -> powder

Terbinafine -> Nail infection; inhibits mitosis

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Drugs that inhibit ergosterol synthesis

Antifungals
- fluconazole
- Best CNS penetration
- DOC for cryptococcus
- itraconazole
- Voriconazole
- best for aspergillosis
- Ketoconazole
- Inhibits p450
- block 5-alpha reductase

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Most common lung mass in:
- children
- adults
- MCC tumor

Hamartoma

Granuloma

Adenoma

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What are the central lung cancers?

“S’s are central”

Squamous carcinoma
- produces PTH-like peptide

Small cell carcinoma
- produces ACTH (90%)
- incr ACTH, no suppression with Dexamethasone (high or low dose)

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What are the peripheral lung cancers?

Bronchogenic adeNOcarcinoma

Bronchoalveolar adeNOcarcinoma

Large cell adeNOcarcinoma

CarciNOid syndrome

“NO, it’s not related to smoking”

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Lung pathology that cause:
- incr compliance
- decr compliance

Emphysema increases compliance
- barrel-shaped chest

Fibrosis decreases compliance

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Which lung pathology displays a V/Q mismatch?

Restrictive lung diseases
- increased A-a gradient

Ex: ARDS, sarcoidosis, pneumoconioses, pulmonary fibrosis, radiation-induced lung injury, Wegener’s

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What is the only cause of hypoxemia with decreased PaO2?

Anemia
- Hb decr
- PaO2 normal
- SaO2 normal
- Total O2 decr

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What is the only cause of hypoxemia with increased Hb?

High Altitude
- Hb incr
- PaO2 decr
- SaO2 decr
- Total O2 decr

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Restrictive Lung Characteristics
- Effects on inspiration and expiration
- Defect of?
- Biochemical effect
- Cause of death

Prolonged inspiration, Normal expiration
(Trouble getting air in)

Diffusion/perfusion defect

Respiratory alkalosis (incr pH, decr pO2, decr pCO2)

pulmonary HTN -> RVH -> cor pulmonale

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Obstructive lung characteristics
- effects on inspiration and expiration
- defect of?
- biochemical effect
- cause of death

Normal inspiration, prolonged expiration
(Trouble getting air out)

Ventilation defect

Respiratory acidosis (decr pH, incr pCO2, norm pO2)

Bronchiectasis

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What lung pathology is restrictive but acts obstructive 90% of the time?

Emphysema
“Pink puffers”

Centroacinar -> smoking
Panacinar -> alpha-1 antitrypsin

If they ask about CO2, pick obstructive

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Pneumonia causes:
- in neonates (0-6 wks)
- in children (6 wks-18 years)
- in adults (18-40 years)
- in adults (40-65 years)
- in elderly (>65 years)

Neonates (0-6 wks)
- Group B strep, E. coli, Listeria

Children (6 wks-18 years)
- S pneumo, chlamydia, mycoplasma, parainfluenza, RSV

Adults (18-40 years)
- mycoplasma, chlamydia, strep pneumo

Adults (40-65 years)
- mycoplasma, strep pneumo, H influenza, anaerobes, virus

Elderly (>65 years)
- strep pneumo, viruses, H influenza, Listeria

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What drugs are microtubules inhibitors?

Vincristine
Vinblastine
Paclitaxel
Colchicine
Griseofulvin

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What does an increased A-a gradient mean?

Diffusion problem
Restrictive lung disease
Trouble breathing in

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What are the Class III antiarrhythmics?

Potassium Channel Blockers
- treat atrial or ventricular arrhythmias

Amiodarone
- made from iodine, skin color turns blue, pulmonary fibrosis

Sotalol

Bretylium

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What ß-blockers are/can be used to treat open-angle glaucoma?

Timolol
- nonspecific ß1 & ß2

Betaxolol
- specific ß1

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What are the Class II antiarrhythmics?

ẞ-blockers
(end in -lol)
- specific ß1: begin w/ A->M (not L and C)
- nonspecific ß1 and ß2: begin w/ N->Z and L and C

Notably:
- Carvedilol & Labetalol: for HTN crisis, both ß1 and ß2 and alpha 1
- propranolol: longest acting
- esmolol: shortest acting

What are the 3 sodium channel blockers who also block calcium?

Quinidine (Class 1A)
Procainamide (Class 1A)
Phenytoin (Class 1B)

What are the Class IV antiarrhythmics?

Calcium Channel Blockers
- used for atrial arrhythmias
- Cardioselective: verapamil, diltiazem = non-DHP
- vasoselective (more gentle, muscle spasms)

DHP: end in “-dipine” -> amlodipine, felodipine, nicardipine

What are the Class IA antiarrhythmics?

Sodium channel blockers
- block phase 0 and 3

Quinidine: strong anticholinergic, cinchonism
Procainamide: neuropathy, DI, lupus
Disopyramide: mild anticholinergic

“Disco Prom Queen is #1”
Also: lidocaine

What are the holosystolic/pansystolic murmurs?

Tricuspid regurgitation - incr on inspiration Mitral regurgitation - incr on expiration MR and VSD - radiates to axilla

What is the Estrogen Connection?

Estrogen = muscle relaxant - muscle tone decr - incr GERD, constipation - incr dilated veins Causes liver to produce protein - incr ESR or CRP - lipoproteins -> incr TG, fatty liver - incr TBG (bound T4) -> incr total T4 but decr free T4 - angiotensinogen -> incr HTN - clotting factors

What is the formula for positive predictive value?

If positive, what is the chance that you really have the disease TP/TP+FP

What is the formula for specificity?

Rules IN disease TN/TN+FP

What is the formula for sensitivity?

Rules OUT disease TP/TP+FN

What type of study looks at prevalence and risk factors?

Cross-sectional studies - does NOT measure prevalence - No conclusions about causes can be made

What type of study measures Odds Ratio?

Retrospective Cohort Study

What type of study measures incidence & prevalence?

Prospective Cohort Study

What type of study measures relative risk?

Prospective Cohort Study

Dx of a saddle nose

Syphilis in kids Wegener’s in adults

Dx for: - anterior bowing of legs - razor sharp teeth - flat forehead - destroyed mandible in kid

Congenital syphilis - saddle nose - Saber shins - Hutchinson’s teeth - Rhagades: mandible syphilis likes to attack bones

Dx for: blueberry muffin rash

“Ruby” Rubella - blueberry muffin rash - PDA “heart” - hearing loss “earrings” - cataracts “I” I love my Ruby earrings

ToRCHeS infections that like to attack: - parietal lobe - bones - midline of head - temporal lobe

Parietal lobe -> Toxoplasmosis (multiple ring-enhancing lesions) Bones -> Syphilis Midline of head -> CMV (central calcifications) Temporal lobe -> Herpes (hemorrhagic encephalitis)

Dx for these abnormal pediatric extremities: - widely spaced 1st and 2nd toes - rocker-bottom feet - polydactyly - club feet

Wide spaced toes -> Down syndrome Rocker-bottom feet -> Edward’s syndrome Polydactyly -> Patau syndrome Club feet -> club feet

Regardless of hydration status, where is H2O going to be reabsorbed?

Proximal Convoluted Tubule

What is the only glycosylated HIV polyprotein?

gp160 - product of env gene - glycosylated in rER and golgi gp160 is cleaved into: - gp120 -> viral attachment - gp41 -> viral fusion

What amino acid is NO synthesized from?

Arginine Arginine + O2 — w/ eNO synthase —> NO + citrulline NO -> incr guanylate Cyclase -> incr cGMP -> elev protein kinases -> venodilates -> vasodilates

Dx with recurrent catalase positive organisms (Ex: serratia)

Chronic granulomatous disease - X-linked recessive - NADPH deficiency - absence of fluorescence on dihydrorhodamine testing

Parathyroid Hormone - Made by - Stimulus - inhibitor - where it goes - what it does - 2nd messenger

Made by: superior parathyroid (4th pharyngeal pouch) & inferior parathyroid (3rd pharyngeal pouch) Stimulus: decr Ca, incr Phosphate Inhibition: incr Ca, decr phosphate Where it goes: - Bones -> incr osteoclasts - PCT -> secrete phosphate (trashes phosphate) - DCT -> incr vit D -> incr 1-alpha hydroxylase -> reabsorption Ca Function: incr Ca, decr phosphate 2nd messenger: cAMP

Dx with: - decr PTH - decr Ca - decr phosphate

Primary hypoparathyroid (Most commonly due to thyroidectomy)

Dx with: - incr PTH - norm Ca - incr phosphate

Pseudo-pseudohypoparathyroid (G protein is defective)

Dx with: - incr PTH - incr Ca - decr phosphate

Primary hyperparathyroid (Due to parathyroid adenoma)

Dx with: - incr PTH - incr phosphate - decr calcium

Pseudohypoparathyroid - PTH receptor defective - X-linked dominant - short 3rd and 5th digit - absorb enough Ca to keep bone normal Secondary hyperparathyroid - due to renal failure - leads to renal osteodystrophy causing permanent bone damage

Calcitonin - Made by - stimulus - inhibitor - where it goes - what it does - 2nd messenger

Made by: parafollicular cells (neural crest cells) Stimulus: incr Ca Inhibitor: decr Ca Where it goes: bone What it does: inhibit osteoclastic activity 2nd messenger: cAMP

MEN 1 = Werner’s Syndrome

Pituitary adenoma Parathyroid adenoma Pancreatic adenoma

MEN 2 or 2a (= Sipple syndrome)

Medullary carcinoma of thyroid (= incr calcitonin) Pheochromocytoma Parathyroid adenoma