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USMLE Step 1 > Pathology (all categories) > Flashcards

Pathology (all categories) Flashcards

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USMLE® Step 1 flashcards
1
Q

Type 1 Renal Tubular Acidosis (defect and findings)

A

Distal. pH > 5.5
Defect in ability of alpha intercalated cells to secrete H+. (new HCO3- is not generated).
Associated with hypokalemia. Inc risk for calcium phosphate kidney stones (due to inc urine pH and inc bone turnover)

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2
Q

Type 2 Renal Tubular Acidosis (defect and findings)

A

Proximal. pH < 5.5
Defect in proximal tubule HCO3- reabsorption results in inc excretion of HCO3- in urine. Metabolic acidosis. Urine is acidified by alpha intercalated cells in collecting tubule.
Hypokalemia. Inc risk for hypophosphatemic rickets (impaired bicarb reabsorption)

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3
Q

Type 1 Renal Tubular Acidosis (causes)

A

Causes: amphotericin B toxicity, multiple myeloma

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4
Q

Type 2 Renal Tubular Acidosis (causes)

A

Fanconi syndrome; chemicals (lead; aminoglycosides), carbonic anhydrase inhibitors

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5
Q

Type 4 Renal Tubular Acidosis (cause and findings)

A

*Hyperkalemia
pH < 5.5
Hypoaldosteronism, aldosterone resistance or K+ sparing diuretics. Impairs ammoniagenesis in the proximal tubule.

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6
Q

Renal Tubular Defects (mnemonic)

A 
The kidneys put out FABulous Glittering Liquid:
FAnconi syndrome (PCT)
Bartter syndrome (thick ascending loop of Henle)
Gitelman syndrome (DCT)
Liddle syndrome (collecting tubule)
all are "reabsorptive defects"
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7
Q

Fanconi Syndrome

A

Reabsorptive defect PCT
inc excretion of amino acids, glycose, bicarb, and phosphate
–> metabolic acidosis (only one)
causes: hereditary defects (wilson disease), ischemia

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8
Q

Bartter Syndrome

A

Reabsorptive defect TAL
Affects Na/K/2Cl transporter
–> hypokalemia and metabolic alkalosis WITH hypercalciuria (chloride build up = loss of driving force for reabsorption)

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9
Q

Gitelman Syndrome

A

Reabsorptive defect of NaCl in DCT

Hypokalemia and metabolic alkalosis WITHOUT hypercalciuria. b/c here Ca2+ depends on Vit D channels

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10
Q

Liddle Syndrome

A

INCREASED Na+ reabsorption in distal and collecting tubules.
Result: hypertension, hypokalemia, metabolic alkalosis.
Dec aldosterone.
Treatment: Amiloride (block Na+ channels)

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11
Q

Treacher Collins Syndrome

A

Failure of 1st-arch neural crest to migrate. Mandibular hypoplasia and facial abnormalities

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12
Q

Congenital Pharyngo-cutaneous Fistula

A

Persistence of cleft AND pouch –> fistula between tonsillar area and lateral neck

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13
Q

Branchial cleft cyst

A

Persistent cervical sinus: clefts 2-4 should have obliterated by proliferation of 2nd arch mesenchyme
Does NOT move with swallowing (unlike a thyroglossal duct cyst)

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14
Q

4th Branchial Arch (nerve, muscle, cartilage, and blood)

A

Nerve: CN X: Superior Laryngeal Branch
Muscle: pharyngeal constrictors. Cricothyroid
Cartilage: Thyroid and Cricocoid
Blood: Aortic Arch and Right Subclavian

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15
Q

6th Branchial Arch (nerve, muscle and blood)

A

Nerve: CN X: Recurrent laryngeal branch
Muscle: intrinsic muscles of larynx EXCEPT cricothyroid
Blood: Pulm Artery and Ductus Arteriosus

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16
Q

3rd Pouch

A

Dorsal wings: Inferior Parathyroid

Ventral wings: Thymus (ThImus)

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17
Q

4th Pouch

A

Superior parathyroid

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18
Q

Surface Ectoderm

A

Adenohypophysis; lens of eye; oral cavity; epidermis; anal canal below pectinate line; parotid, sweat and mammary glands

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19
Q

Neuroectoderm

A

CNS: Brain, retina, and optic nerve; spinal cord

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20
Q

Neural Crest

A

PSN: cranial nerves; dorsal roota ganglia; melanocytes; parafollicular C cells of thyroid; bones of skull

21
Q

Mesoderm

A

Muscle, bone, connective tissue; most organs

Heart and lymphatics. blood; kidneys;

22
Q

Notochord

A

Induces ectoderm to form neuroectoderm (neural plate)

Only becomes nucleus pulposus of the intervertebral disc

23
Q

Endoderm

A

Gut tube epithelium. luminal epithelial derivatives (lung, liver, gallbladder, pancreas, thymus, parathyroid)
GI, GU, Resp

24
Q

Gestational HTN vs Preeclampsia vs Eclampsia

A

Gestational: + HTN - proteinuria - seizure
Preeclampsia: + HTN + proteinuria - seizure
Eclampsia: + HTN + proteinuria + seizure

25
Q

Wolff-Chaikoff effect

A

excess iodine temporarily inhibits thyroid peroxidase –> dec iodine organification –> dec H3/T4 production

26
Q

Conn Syndrome

A

Primary Hyperaldosteronism
aldosterone-secreting adrenal adenoma
– HTN, hypokalemia, metabolic alkalosis (tetany), and LOW plasma renin
Treatment: remove the tumor; use spironolactone

27
Q

Secondary Hyperaldosteronism

A

Kidneys think low intravascular volume –> overactive RAAS
cause: renal artery stenosis, CHF, cirrhosis, or nephrotic syndrome
HIGH renin levels

28
Q

Addison Disease

A

chronic primary adrenal insufficiency due to adrenal atrophy or destruction by disease
deficiency of aldosterone and cortisol –> hypotension, hyperkalemia, acidosis and skin and mucosal hyperpigmentation (ACTH –> MSH)
ALL 3 cortical levels (spares medulla)

29
Q

Fixed, hard and painless neck mass

A

Riedel thyroiditis

30
Q

Very tender thyroid

A

de Quervian (subacute thyroiditis)

31
Q

Moderately enlarged, nontender thyroid

A

Hashimoto thyroiditis

32
Q

Subacute thyroiditis (de Quervain)

A

self limited hypothryoidism following a flu-like illness (post viral infection; ex coxsackie or mumps)
granulomatous inflammation (multinucleated giant cells)
jaw pain and very tender thyroid

33
Q

Hasimoto thyroiditis

A

hypothyroidsm: autoimmune disorder
markers: anti-thyroid peroxidase and antithryroglobulin Ab
inc risk of non-Hodgkins lymphoma
Hurthle cells, lymphoid aggregate with germinal centers
nontender thyroid

34
Q

Riedel thyroiditis

A

Thyroid replaced by fibrous tissue (hypothyroid)

Similar to anaplastic carcinoma but this is younger patient and cancer is older patient

35
Q

Jod-Basedow phenomenon

A

thyrotoxicosis if a patietn with iodine deficiency goiter is given iodine too fast
(wgt loss but high appetite, tremor of hands, heat intolerance, anxiety, oligomenorrhea)

36
Q

Graves Disease

A

Hyperthyroidism
IgG autoantibodies stimulate TSH receptors; retro-orbital fibroblasts secrete glycosaminoglycans and cause swelling behind eyes = proptosis); dermal fibroblasts (pretibial myxedema)
Need beta-blocker as A Fib is common

37
Q

Toxic multinodular goiter

A

Focal patches of hyperfunctioning follicular cells working independently of TSH. inc release of T3 and T4

38
Q

Thyroid Storm

A

stress-induced catecholamine surge: serious complication of Graves disease
Agitation, delirium, fever, diarrhea, coma and tachyarrhythmia (cause of death)
treat: beta-blocker, propylthiouracil, and corticosteroids

39
Q

Pseudohypoparathyroidism

A

PTH receptor mutation
normal PTH levels (or high) but can not stimulate receptor
Hypocalcemia, short 4th/5th digit, short stature

40
Q

Insulinoma

A

Tumor of beta cells –> hypoglycemia
Whipple Triad of CNS symptoms: lethargy, syncope, and diplopia
dec blood glucose and inc C-peptide
can be part of MEN1

41
Q

Glucagonoma

A

Tumor of alpha cells –> hyperglycemia
** leg rash: necrolytic migratory erythema
Treatment: octreotide

42
Q

Somatostatinoma

A

Tumor of delta cells: increased somatostatin

cholelithiasis + steatorrhea, diabetes mellitus, dec gastrin; dec cholecystokinin

43
Q

Cortisol

A

BIG FIB

inc: BP, Insulin resistance, Gluconeogenesis (proteolysis)
dec: Fibroblast activation, Inflammation/Immune, Bone formation

44
Q

Long Acting Insulin

A

Glargine and Detemir

GD: Good Day (only have to take once a day)

45
Q

Regular Insulin

A

Short acting

46
Q

Rapid Acting Insulin

A

Lispro, Aspart, Glulisine

47
Q

Intermediate Acting Insulin

A

NPH

48
Q

Carnitine Deficiency

A

inability to transport LCFAs into the mitochondria
– toxic accumulation
causes: weakness, hypotonia, and hypoketotic hypoglycemia
CARnitine = CARnage of fatty acids

49
Q

Acyl-CoA dehydrogenase deficiency

A

decreased glucose AND ketones with fast

USMLE Step 1 (8 decks)

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