Pathophysiology 2 Flashcards
The kidney excretes nitrogenous wastes in the form of BUN, this is made in the:
○ A: Liver
○ B: Kidney
○ C: Heart
○ D: Colon
A: Liver
§ In LR Failure- BUN↓, NH₃↑ § Protein>N>NH₃>LR>BUN>KD>Excretion
• Sperm production by the seminiferous tubular cells is controlled by:
○ A: LH ○ B: FSH ○ C: Testosterone ○ D: Estrogen
○ B: FSH
○ LH & FSH- from anterior pituituary gland
§ FSH-Seminiferous tubular cells-Sperm
§ LH-Testosterone-Leydic cells
• In chronic renal failure, the anemia is d/t:
○ A: lack of erythropoetin ○ B: lack of renin ○ C: persistent hematuria ○ D: repeated blood testing
○ A: lack of erythropoetin
§ Stimulates bone marrow RBC production
• The active form of vitamin D is made in the:
○ A: Liver ○ B: Lung ○ C: Kidney ○ D: Skin
○ C: Kidney
○ Source vit D= sun + food
§ LR convert to 25 D
§ KD convert to 1,25 D (active form)
• During a normal menstrual cycle, ovulation occurs on:
○ A: first day ○ B: 14th day ○ C: 28th day ○ D: 7th day
○ B: 14th day
§ Ovulation- d/t LH surge § Maximum fertility= days 14-21 +/-
○ 1st day= day of 1st bleed
○ 28th day= cycle completion
○ 7th day= end of bleed (5-7 days)
• In type 2 Diabetes Mellitus
○ A: there is no insulin ○ B: patients cannot utilize insulin properly ○ C: the insulin produced is biologically inactive ○ D: none of the above
○ B: patients cannot utilize insulin properly
• Chronic complications of Diabetes Mellitus include all except:
○ A: heart disease ○ B: kidney disease ○ C: liver disease ○ D: blindness
○ C: Liver disease
○ HKBL² § Heart disease § Kidney disease § Blindness § Limb loss
• Acute complications of diabetes include all except:
○ A: DKA ○ B: Hypoglycemia ○ C: Acute pancreatitis ○ D: infections
○ C: acute pancreatitis
○ DKA= diabetic ketoacidosis
○ Infections d/t WBC’s not functioning as well
• The commonest kind of kidney stone is:
○ A: calcium stones ○ B: triple phosphate stones ○ C: uric acid stones ○ D: cystine stones
○ A: calcium stones= 80%
○ Triple phosphate (struvite)- w/ chronic UTI
○ Uric acid stone- w/ gout, any disease w/ ↑cellular nucleus destruction
• RBC casts are seen in diseases of the:
○ A: kidneys ○ B: urinary bladder ○ C: prostate ○ D: urethra
○ A: kidneys
§ Urinary casts of Loop of Henle
□ KD rel UTI
§ UB- no urinary cast
• In nephrotic syndrome, all are present except:
○ A: proteinuria
○ B: edema
○ C: hematuria
○ D: hyperlipidemia
○ C: hematuria- (nephritic syndrome)
○ “O for PRO”
○ Nephrotic syndrome § Proteinuria (>3.5/24hrs) § Hypoproteinemia § Hyperlipidemia § Edema (d/t low oncotic pressure)
• Calcium containing urinary stones may be present in:
○ A: hyperparathyroidism ○ B: Repeated urinary tract infection ○ C: Increase intake of dietary calcium ○ D: gout
○ A: hyperparathyroidism
§ ↑PTH- Ca↑ d/t PTH stim breakdown of bones by osteoclasts
○ Rpt UTI- struvite/triple phosphate stones
○ Gout- ↑Uric acid- uric acid stones
• Pedal edema in patients w/ nephrotic syndrome is d/t:
○ A: lack of intravascular oncotic pressure
○ B: the KD disease that causes impairment of water excretion
○ C: there is HT disease
○ D: none of the above
○ A: lack of intravascular oncotic pressure
§ d/t severe proteinuria > hypoproteinemia
• What are the causes of acute pancreatitis?
○ GB disease
○ Alcohol
○ Trauma
○ Mumps
○ GB + Alcohol= 80%
• What are acute complications of Diabetes mellitus?
○ DKA
○ Hypoglycemia
○ Infection
• Pre-renal kidney failure results from:
○ A: obstruction ○ B: dehydration ○ C: Renal parenchymal problem ○ D: none of the above
○ B: dehydration
○ Pre-renal= dehydration
○ Post-renal= obstruction
• In hypocalcemia:
○ A: Trousseau's sign may be present ○ B: is caused by hyperparathyroidism ○ C: Is caused by hyperthyroidism ○ D: need not be corrected
○ A: Trousseau’s sign may be present
§ Sign of latent tetany observed in patients w/ low calcium- blood pressure cuff placed around arm and inflated to pressure greater than systolic blood pressure and held for 3 minutes-will occlude brachial artery-will induce spasm hand and forearm muscles-wrist and metacarpophalangeal joints flex, DIP and PIP joints extend, and the fingers adduct.
§ Or Chvostek- facial nerve tapped at angle of jaw (i.e. masseter muscle), facial muscles on same side face will contract
§ Hyperparathyroidism > hypercalcemia
§ Hyperthyroidism> no rel. calcium
• The differential diagnosis of a scrotal mass include:
○ A: inguinal hernia ○ B: cancer of the testicle ○ C: hydrocele ○ D: all of the above
○ D: all of the above
○ D/D scrotal mass: § Inguinal hernia § Hydrocele § Spermatocele § Hematoma/trauma § Orchitis § Epididymitis § Cancer
• Severe pain in the testicular area may be caused by:
○ A: hematoma of the testicle ○ B: torsion of the testicle ○ C: epididymitis ○ D: all of the above
○ D: all of the above
○ Testicular cancer usually painless
○ D/D Testicular pain: § Hematoma/trauma § Torsion of testicle (check @ 12) § Epididymitis § Hydrocele § Varicocle § Inguinal hernia
• If the blood sugar falls below 30 mg% there may be:
○ A: confusion ○ B: convulsion ○ C: coma ○ D: all of the above
○ D: all of the above
• Causes of hematuria include
○ A: Kidney stone ○ B: Cancer of the urinary bladder ○ C: cancer of the kidney ○ D: all of the above
○ D: all of the above
§ KD stone- hematuria + pain § UB cancer- no pain, only hematuria, normal CT § KD cancer- no pain, blood, + w/ CT
○ D/D hematuria: § Infection (UB/KD) § Stones § Cancer (no pain) § Trauma (pt. history) § Menstrual contamination
• In Klinefelter’s Syndrome, which one of the following is present:
○ A: cancer of the testicle ○ B: infertility ○ C: testicular enlargement ○ D: Increased levels of testosterone
○ B: infertility § XXY § male § Testicular shrinkage/atrophy § Gynecomastia § ↓testosterone § ↑FSH § ↑LH
• Melanoma ABC’s
○ A malignant tumor of melanocytes
§ Melanocytes= cells that produce melanin (give skin color)
§ Causes 75% deaths rel. skin cancer
§ ABC's: □ A: asymmetry □ B: borders (irregular) □ C: color (varigated) □ D: diameter (>6mm) □ E: evolving over time
• S/S Acute glomerular nephritis:
○ Hematuria
○ Proteinuria
○ Acute renal failure
○ Good prognosis
○ “hey people a cute girl”
• Repeated vaginal yeast infection may be d/t:
○ A: congenital problem ○ B: diabetes mellitus ○ C: herpes infection ○ D: chronic urine infection
○ B: diabetes mellitus
§ Acute complications D.M.
□ DKA
□ Hypoglycemia
□ Infection
• The hormone produced by the pancreas is:
○ A: glucagon ○ B: glycogen ○ C: gastrin ○ D: thyroxin
○ A: glucagon
○ Glycogen= stored form of glucose
○ Gastrin= ST secretion
○ Thyroxin= thyroid secretion
Many of the women of a village in South America are found to have large goiters. The conclusion that can be made from that observation is that:
○ A: the region is low in iodine
○ B: There is a carcinogen present resulting in a high incidence of thyroid cancer
○ C: No conclusions can be made w/o biopsy
○ D: all of the above
○ A: The region is low in iodine
Unlike ovulation in the female, testosterone production in men, can continue until age:
○ A: 50 ○ B: 60 ○ C: 70 ○ D: may continue indefinitely
○ D: may continue indefinitely
The commonest malignant testicular tumor is:
○ A: Seminoma ○ B: Teratoma ○ C: Leydig cell tumor ○ D: Lymphoma
○ A: Seminoma
○ Teratoma= ovarian malignancy forms from dermoid cyst
• In type 2 Diabetes Mellitus
○ A: there is no insulin
○ B: patients cannot utilize insulin properly
○ C: The insulin produced is biologically inactive
○ D: none of the above
○ B: patients cannot utilize insulin properly
Risk factors for the cancer of the urinary bladder include:
○ A: Undescended testicle ○ B: human papiloma virus infection ○ C: unclean personal hygiene ○ D: tobacco use
○ D: tobacco use
○ Tobacco related cancers: § Esophagus § Bladder § Mouth § Lung
The acute complications of Diabetes include all except:
○ A: DKA
○ B: Hypoglycemia
○ C: Acute pancreatitis
○ D: infections
○ C: acute pancreatitis
○ Acute complications of D.M.:
§ DKA
§ Hypoglycemia
§ Infections
Tertiary syphilis can lead to:
○ A: aneurysm of the aorta ○ B: Dementia ○ C: Tabes dorsalis ○ D: all of the above
○ D: all of the above
○ Primary syphilis:
§ Chancre (lesions)
○ Secondary:
§ Systemic s/s
○ Tertiary:
§ Dementia
§ Aortic aneurysm
§ Tabes dorsalis
RBC casts are seen in diseases of the:
○ A: Kidneys ○ B: Urinary Bladder ○ C: Prostate ○ D: Urethra
○ A: kidneys
§ From loop of henle
In nephrotic syndrome, all are present except:
○ A: proteinuria ○ B: edema ○ C: hematuria
D: hyperlipidemia
○ C: hematuria
○ Nephrotic syndrome (O for PRO) § Proteinuria >3.5g/24 hrs § Hypoproteinemia § Edema § Hyperlipidemia
Name the cancer of the kidney in infants:
○ Wilm’s tumor
Calcium containing urinary stones may be present in:
○ A: hyperparathyroidism ○ B: Repeated urinary tract infections ○ C: increase intake of dietary calcium ○ D: gout
○ A: hyperparathyroidism
§ ↑PTH goes to bone, stimulates osteoclasts- crush bone- release Ca
○ Repeat UTI> Struvite/Triple Phosphate
○ Gout> ↑Uric acid
• In hypocalcemia:
○ A: Trousseau's sign may be present ○ B: Is caused by hyperparathyroidism ○ C: Is caused by hyperthyroidism ○ D: Need not be corrected
○ A: Trousseau’s sign may be present
§ Also Chvolstek
Torsion of the testicle:
○ A: should be treated immediately
○ B: should not be treated immediately
○ C: wait and watch policy should be followed
○ D: if there is any doubt about the diagnosis,
re-evaluation should be made w/in 48 hrs
○ A: should be treated immediately
○ Def: spermatic cord twists causing ischemia (cut testicular blood supply)
Risk factors for the cancer of the penis include:
○ A: undescended testicle ○ B: HPV infection ○ C: unclean personal hygiene ○ D: Tobacco use
○ C: unclean personal hygiene
○ Phimosis- adherence of prepuce to head of penis d/t smegma collection
§ Phimosis–> cancer of penis
The differential diagnosis of a scrotal mass include:
○ A: Inguinal hernia ○ B: Cancer of the testicle ○ C: Hydrocele ○ D: all of the above
○ D: all of the above
○ D/D Scrotal mass: § Inguinal hernia § Epidiymitis § Orchitis § Hydrocele § Hematoma § Torsion of the testicle § Testicular cancer (seminoma= most common)
Severe pain in the testicular area may be caused by:
○ A: hematoma of the testicle ○ B: torsion of the testicle ○ C: epididymitis ○ D: all of the above
○ D: all of the above
○ No pain w/ cancer until progressed
During a 3 day starvation, the body continues to produce glucose from:
○ A: Fat ○ B: Protein ○ C: Carbohydrate ○ D: none of the above
○ B: Protein
§ 2 days glycogen store
§ The break down muscles for usable proteins
Which of the following is not a sexually transmitted disease:
○ A: Gonorrhea ○ B: Syphilis ○ C: Pyelonephritis ○ D: HIV infection
○ C: Pyelonephritis
§ KD disease
In Klinefelter’s Syndrome, which one of the following is present?
○ A: Cancer of the breast ○ B: Infertility ○ C: Testicular enlargement ○ D: increased levels testosterone
○ B: infertility
§ XXY § Male § Gynecomastia § Testicular atrophy § ↓Testosterone § ↑LH
Pre-renal kidney failure results from:
○ A: obstruction ○ B: dehydration ○ C: Renal parenchymal problem ○ D: none of the above=
○ B: dehydration
○ Post-renal= obstruction
What stimulates the Graafian (ovarian) follicle?
○ FSH (Follicle stimulating hormone)
§ From anterior pituitary
What causes ovulation?
○ LH surge
What is the name of the follicle after ovulation and the ova is gone?
○ Corpus luteum
When is maximum fertility?
○ 14-21
○ Ovulation = +/- day 14
What is measured when doing a pregnancy test?
○ HCG (Human chorionic gonadotropin)
§ Urine
§ Blood- more accurate & shows earlier
What is the test for menopause?
○ FSH↑
§ (b/c estrogen↓)
What are the hormones produced by the corpus luteum?
○ Progesterone
○ Estrogen
What stops sperm production and how does it work?
○ Inhibin
§ Hormone produced by the gonads that inhibit FSH production by the pituitary gland
§ Is a negative feedback system
Give some examples of common vaginal infections:
○ Gardnerella vaginalis (g. vaginalis) ○ Candida ○ Trichomonas vaginalis ○ Herpes simplex ○ Gonorrhea ○ Chlamydia ○ Syphilis ○ Human papiloma virus (HPV)
What test would you use for a suspected UTI?
○ Urine dip stick
○ UTI if nitrites +/or WBC present
○ If no, but burning/pain/discomfort- could be other infection (Chlamydia, etc.)
What joint disease is related to a bacterial infection such as Chlamydia? What are the signs and symptoms associated?
○ Reiter’s Syndrome aka Reactive Arthritis
§ w/ Chlamydia infection
○ Category: spondyloarthropathy
○ S/S: § Urethritis § Conjunctivitis § Scaling skin heels & palms § Joint discomfort
On which day of the menstrual cycle is a woman most fertile?
○ Day 14-21
A 36 year old para 1 gravida 1 female comes in with a singular complaint of breast milk secretion. Her last menstruation was six months ago. What is your diagnosis and what tests will you order?
○ Prolactinoma
○ Tests:
§ HCG/Pregnancy
§ Prolactin
§ CT Scan (tumor of Ant. Pituitary)
○ Para= pregnancy
○ Gravida/grava= baby birthed
○ Gen presentation in men:
§ impotence
• What are the risk factors for:
○ A: Cancer of the cervix ○ B: Cancer of the uterus ○ C: Cancer of the testicle ○ D: Cancer of the penis ○ E: Cancer of the urinary bladder
○ A: Cervix: § Intercourse began @ early age § Multiple sexual partners § HPV infection § Other venereal diseases
○ B: uterus:
§ Unopposed estrogen
§ Nulliparity
○ C: testicle:
§ Undescended testicle
○ D: penis:
§ Poor hygiene
□ Smegma collection–> phimosis–> cancer
○ E: UB:
§ Smoking tobacco
What is genotype?
○ Genetic constitution or type
What are three different origins of ovarian neoplasm? From which one does a teratoma arise?
○ Types:
§ Primarily cystic
□ Ex: mucinous cystadenoma
§ primarily solid □ Ex: fibroma § Mixed □ Ex: dermoid (teratoma)
○ Surface epithelium affected
germ cell (ova)- teratoma arise from germ cell
What is placenta previa?
Placenta grown in front of baby b/c fertilized ovum doesn’t attach to sticky surface of uterus
What are causes of hematuria?
○ Infection (KD/UB) ○ Stones (KD/UB) ○ Cancer (no pain) ○ Trauma ○ Menstrual contamination
What are causes of a scrotal mass?
○ Inguinal hernia ○ Epididymitis (pain) ○ Orchitis (↑WBC) ○ Hydrocele ○ Hematoma ○ Torsion of testcle ○ Testicular cancer (#1= seminoma, no pain)
What are the presenting features of toxemia of pregnancy?
○ Pre-eclampsia toxemia:
§ ↑Proteinuria
§ ↑BP
○ Eclampsia: § +Seizures/convulsions § +comatose § +very ill § +potential loss baby + mother
What is the peak for gestational diabetes?
2nd trimester (week 22-ish)
What are the presenting features of nephrotic syndrome?
○ Proteinuria (>3.5g/24hr)
○ Hypoproteinemia
○ Hyperlipidemia
○ Edema
A 22 y.o woman who has been pregnant for the last three months comes in w/ complaints of passage of grape like tissue from her vagina. What is your diagnosis?
○ Dx: Gestational trophoblastic disease
○ +Pregancy test (making HCG)
○ no period
○ Placental disease
○ Tx:
§ Remove placenta
§ D & C (dilation & curettage- dilate cervix remove
uterine contents)
What are the features of Benign Prostatic Hyperplasia?
○ Difficult urination
○ Frequent urination
○ ↓Power stream (urine)
What is the lab test for cancer of the prostate. At what age should screening for this start?
○ PSA (antiquated)
○ Rectal exam- w/ biopsy if mass/tumor
○ Begin +/- 40 y.o
§ 15 y.o. for testicles
What are the lab abnormalities in Klinefelter’s syndrome?
○ ↓testosterone
○ FSH↑
○ LH↑
○ Karyotyping: XXY
○ S/S:
§ Impotence
§ Testicular atrophy
§ Gynecomatia
What is the name of a hernia in the groin for a man? For women?
○ Man: inguinal hernia
○ Female: femoral hernia
What are features of Turner’s syndrome?
○ XO genotype ○ Female phenotype ○ No estrogen (no ovaries) ○ Webbing neck ○ No secondary sex characteristics @ puberty
○ Test: Karyotyping
○ Tx:
§ 6 month unopposed estrogen
§ Then: cycle estrogen/progesterone
Give 5 features of Rheumatoid arthritis:
○ Morning stiffness ○ Wrist pain ○ Ulnar deviation ○ Proximal phalangeal joint deformity ○ Anemia (of chronic illness)
Give 4 pathogenic features of osteoarthritis:
○ Pain ○ Deformity ○ Herberden (Buchard) nodules ○ Distal joint deformity ○ Crepitis
Classify spondyloarthropathy:
○ Ankylosing spondylitis
○ Reactive arthritis
○ Enteropathic arthrits (Crohn’s/ulcerative colitis)
○ Psoriatic arthritis
Give 5 features of Ankylosing spondylitis:
○ Low back pain ○ Morning stiffness ○ Pain at night ○ Uveitis/eye problems ○ Aortic incompetence
○ Predom. Affect young men
○ Test: HLA B27
Give 4 causes of Carpal Tunnel Syndrome:
○ Repeat trauma (jack-hammer)
○ Pregnancy
○ Hypothyroidism
○ Rheumatoid arthritis
○ w/ hypothyroid- Test TSH, Free-T4- Tx & S/S resolve
What is pannus?
In Rheumatoid arthrits, is a thick covering of joint made by attacking and protecting cells
What are the differences in the hand of a patient w/ osteoarthritis & Rheumatoid arthritis?
○ Osteo- DISTAL jt deformity
(herberden/bouchards nodules)
○ R.A.- PROXIMAL jt deformity
Give 4 features of Gout. Make sure you include origin of uric acid & age of onset of gout.
○ 3 places deposit:
§ Joint (esp big toe)
§ Ear (tophi)
§ KD (uric acid stones)
○ Age: young male
○ KD failure ↑Uric acid
○ Gout- congenital
Give 4 features of reiter’s syndrome:
○ S/S: § Joint pain § Urethritis § Conjunctivitis § Exfoliation- esp of palms & soles of feet
○ A reactive arthritis
○ Related to bacterial infection (ex: chlamydia)
What is Charcot foot?
○ Foot bones become fragmented
○ From tabes dorsalis causing repeated trauma to arch & foot bones
§ Rel. Diabetes M. & tertiary syphilis
Describe 4 different kinds of fracture of the bone:
○ Compound
§ Skin broken/complete fracture
○ Simple
§ Complete or incomplete
§ No break in skin
○ Comminuted
§ Shattered
○ Green stick
§ In children, bone still cartilaginous, therefore bends
What 3 bones commonly result in fracture secondary to osteoporosis? Which is worst? How can you help?
○ 3 bones:
§ Hip/femur neck
§ Wrist
§ Spine
○ Hip/femur neck= worst
§ If not Tx w/ surgery- lead to death (pneumonia, etc.)
○ Prevention:
§ Calcium & vit. D
§ Weight bearing exercise
○ Exacerbated by:
§ Steriods (>7 weeks- will cause)
§ Cusings Disease
§ Make worse- ↓bone density
○ Test: Dexa scan
○ Tx:
§ androgens- to reduce impact of just estrogen
§ Mix estrogen/testosterone short time
Charcot foot:
○ A: is a result of rheumatoid arthritis
○ B: is a destructive lesion d/t diabetic neuropathy
○ C: is a destructive lesion d/t Myasthenia gravis
○ D: is a destructive lesion d/t Osteoporosis
○ B: is a destructive lesion d/t diabetic neuropathy
○ Diabetes & tertiary syphilis> tabes dorsalis> charcot foot
The commonest site of ectopic pregnancy is: ○ A: the fallopian tube ○ B: the ovary ○ C: the cervix ○ D: the colon
○ A: the fallopian tube
○ No s/s
○ If persist> rupture & death
○ Test: ultrasound, ↑amylase
○ Tx: D&C (dilation & curettage- dilate cervix remove
uterine contents)
Which one of the following is not an STD? ○ A: Gonorrhea ○ B: Syphilis ○ C: Pyelonephritis ○ D: HIV infection
○ C: Pyelonephritis (KD infection)
○ STD D/D: § HPV § Infectious vaginitis: □ Trichomonas vaginalis □ Gardnerella vaginalis □ Candida albicans § Chlamydia § Gonorrhea § Syphilis
In Klinefelter's Syndrome, which one of the folling is present: ○ A: cancer of the breast ○ B: Infertility ○ C: testicular enlargement ○ D: Increased levels of testosterone
○ B: infertility
○ S/S:
§ Gynecomastia
§ Testicular atrophy
§ Impotence
○ Test:
§ Karyotypling (XXY)
§ Testosterone↓
§ FSH↑
○ Tx:
§ Testosterone
§ Mamoplasty
Risk factors for the cancer of the urinary bladder include:
○ A: undescended testicle ○ B: Human Papiloma Virus (HPV) infection ○ C: Unclean personal hygiene ○ D: tobacco use
○ D: tobacco use
○ Cancers rel. Tobacco use: § UB § Esophagus § Lung § Mouth
In type 2 Diabetes mellitus:
○ A: there is no insulin ○ B: patients cannot utilize insulin properly ○ C: the insulin produced is biologically inactive ○ D: none of the above
○ B: patients cannot utilize insulin properly
Chronic complications of diabetes mellitus include all except:
○ A: Heart disease ○ B: Kidney disease ○ C: Liver disease ○ D: Blindness
C: Liver disease
○ HKBL² § HT disease § KD disease § Blindness § Non-traumatic peripheral LIMB LOSS
The initial lesion of primary Syphilis is a:
○ A: Chancre ○ B: cyst ○ C: Tumor ○ D: Abscess
○ A: Chancre
○ Primary: chancre ○ Secondary: systemic s/s ○ Tertiary: § Dementia § Tabes dorsalis § Aortic aneurysm
Osteoporosis is often seen in: ○ A: Menopause ○ B: Cushing's Syndrome ○ C: Hyperparathyroidism ○ D: All of the above
○ D: all of the above
§ Menopause- no estrogen
§ Cushings- deactivates osteoblasts
§ Hyperparathryoid- PTH stim osteoclasts PTH↑ Calcium↑
○ D/D Causes: § Menopause § Lack sex hormones § Steroid intake (>7wks) § Endocrine disease (Cushings, hyperparathyroid) § Vit. D or Ca xu § Immobility
The chromosomal pattern of Turners Syndrome is:
○ A: XXY ○ B: XX ○ C: XO ○ D: XY
○ C: XO
§ XXY= Klinefelter’s
§ XX= female
§ XY= male
Herberden’s nodules are seen in:
○ A: Rheumatoid arthritis ○ B: gout ○ C: osteoarthritis ○ D: osteomyelitis
○ C: osteoarthritis
§ Herberden= Bouchards
○ R.A= Rhumatoid nodules
○ Osteomyelitis
§ Myelo= marro
§ Inflammation of bone marrow
In hypocalcaemia:
○ A: Trousseau's sing may be present ○ B: is caused by hyperparathyroidism ○ C: is caused by hyperthyroidism ○ D: need not be corrected
○ A: Trousseau’s sign may be present
§ Or Chvostek
○ Trousseau: Bp cuff maintain ↑ systolic for 3 min- hand form crane
○ Chvostek: tap @ masseter (facial nerve)- cringe response face
○ Hyperthyroidism- calcitonin from thyroid lowers calcium
○ Hypoparathyroid (ex: surgical removal)
○ Hypercalcemia:
§ Hyperparthyroid
§ Bone disease (ex: bone cancer- osteoma)
□ w/ low PTH
§ Excess vitamin D
□ Water based vitamins in excess can pee out
□ Oil based- body cannot excrete
Osteomyelitis is a bone disease caused by: ○ A: metabolic disease ○ B: tumor ○ C: infection ○ D: heredity
○ C: infection
§ Osteo=bone, myelo=marrow, -itis= inflammation
○ Def. osteomyelitis:
§ Infection & inflammation of bone or bone marrow
○ Test: ↑Sed rate, ↑WBC
§ If chronic, WBC may not be so elevated
Osteomalacia results from:
○ A: Vitamin D xu ○ B: Vitamin C xu ○ C: infection ○ D: trauma
○ A: Vitamin D xu
○ S/S:
§ Bowing of spine
§ Can’t hold own weight
○ Test: 25D (it’s always around)
○ =Rickets in children
In nephrotic syndrome, all are present except:
○ A: proteinuria ○ B: edema ○ C: hematuria ○ D: hyperlipidemia
○ C: hematuria
○ S/S: § Proteinuria (>3.5g/24hrs) § Hypoalbuminemia § Edema § Hyperlipidemia
During a 4 day starvation, the body continues to produce glucose from:
○ A: Fat ○ B: protein ○ C: Carbohydrate ○ D: none of the above
○ B: protein
○ Day 1-2: glucose from glycogen stores
§ Also energy from fat always (ketones in urine)
§ Brain needs glucose
○ Day 2+: breakdown glucogenic amino acids
§ (proteins from muscles)
The test for the diagnosis of Polymyalgia rheumatica is:
○ A: MRI ○ B: Sed rate ○ C: biopsy ○ D: skin test
○ B: Sed rate (ONLY TEST!!) ↑↑
○ S/S: § Transient unilateral blindness (early) □ From temporal arteritis § Lingual gangrene (advanced) □ Lingual arteritis> ischemia
Prolonged morning stiffness is seen in:
○ A: Ankylosing spondylitis ○ B: Osteoarthritis ○ C: Gout ○ D: Charcot foot
○ A: Ankylosing spondylitis
§ Also w/ Rheummatoid arthritis
○ Osteoarthrits S/S
§ Pain, deformity, Herberden nodules- distal jts
○ Gout S/S:
§ Big toe pain/uric acid KD stone/ tophi ear
§ Pain dv’t overnight- acute
○ Charcot foot S/S:
§ Neurophatic/Stomping gate
§ foot=bag fragmented bones
§ rel. Tabes Dorsalis (Diabetes or tertiary Syphilis)
Risk factors for the cancer of the Cervix include:
○ A: Nulliparity ○ B: Human Papiloma Virus (HPV) infection ○ C: unclean personal hygiene ○ D: Tobacco use
○ B: Human Papiloma Virus (HPV) infection
○ Risk factors: § Sex @ early age § Multiple sex partners § HPV infection § Other venereal diseases
Problems encountered at the time of menopause include:
○ A: temperature intolerance ○ B: depression ○ C: dyspareunia (painful intercourse) ○ D: all of the above
○ D: all of the above
§ Can also lead to osteoporosis
§ Tx: dyspareunia-lubrication,estrogen/progesterone
At the time of menopause:
○ A: serum FSH is increased
○ B: serum FSH is decreased
○ C: only a small # of ova are left in the ovary
○ D: Conception, if happens, results in congenital birth defects
○ A: serum FSH is increased
§ b/c ↓estrogen, ↑FSH
§ Negative feedback b/c ovary not producing
estrogen b/c no more ova
§ Pituitary gland continues FSH to stimulate ovary
§ Menopause is not a point in time § Think perimenopause § Can last 1-3 years § If elderly woman & FSH↓- maybe pituitary tumor
Rheumatoid arthritis:
○ A: is characterized by pannus formation ○ B: affects the interphalangeal joints ○ C: is an autoimmune disease ○ D: all of the above
○ D: all of the above
○ S/S: § Morning stiffness § Wrist pain § Ulnar deviation § Proximal jts § Rheumatoid nodules § Pannus formation
○ Test:
§ Blood: Rheumatoid factor, ↑Sed rate
§ JT fluid: Rheumatoid factor, PMN
(polymorphonuclear leukocytes)
§ X-ray- shows deformity
Repeated vaginal yeast infection may be d/t:
○ A: congenital genital problem ○ B: Diabetes mellitus ○ C: herpes infection ○ D: chronic urine infection
○ B: Diabetes mellitus
○ S/S D.M.: § Polyuria § Polydypsia § Poor vision § Repeat vaginal yeast infections
○ Dx: Fasting blood sugar (> 126 g/dL)
A skin disease presenting with slightly elevated papules especially on the knees and elbows that are covered w/ silvery scales, is suggestive of:
○ A: Eczema ○ B: Psoriasis ○ C: Squamous cell carcinoma ○ D: Melanoma
○ B: Psoriasis
§ Biggest complaint is cosmetic, some itching, very little pain
§ If combo w/ joint pain= Psoriatic Arthritis
Charcot foot:
○ A: is a result of Rheumatoid arthritis ○ B: is a destructive lesion d/t diabetic neuropathy ○ C: is a destructive lesion d/t Myasthenia gravis ○ D: is a destructive lesion d/t osteoporosis
○ B: is a destructive lesion d/t diabetic neuropathy
§ & tertiatry syphilis
§ Both rel.- tabes dorsalis
§ S/S: □ No sense of pain, temperature or touch □ Loss of arch □ Foot= bag of bones
The neurotransmitter used at the myoneural junction is:
○ A: Acetylcholine ○ B: Norepinephrine ○ C: Adrenaline ○ D: Dopamine
○ A: Acetylcholine
§ Absent/very low in Myasthenia Gravis d/t autoimmune destruction
○ Norepinephrine & adrenaline/epinephrine- from adrenal medulla
○ Dopamine- neurotransmitter in brain absent in Parkinson’s
Functions of the skin include all except:
○ A: formation of vitamin D ○ B: protection from invasive organisms ○ C: temperature regulation ○ D: formation of immune mediators
○ D: formation of immune mediators
§ B-Cells - (b-lymphocyte)- make plasma cells- which produce antibodies
□ Formed in bone marrow by stem cells
In Myasthenia Gravis:
○ A: there is a malfunction at the myoneural junction
○ B: removal of the thymus may help
○ C: repetitive movements are effected
○ D: all of the above
○ D: all of the above
○ Myasthenia Gravis:
§ Autoimmune disease
§ Very little ACT b/c devpt antibodies against
vesicles that produce ACT
§ w/ repetitive movts- ACT runs out- therefore
movts peter out
§ S/S: □ Tired all the time □ Ptosis (drooping eyelids) □ Diplopia (double vision) □ All repetitive muscular mov'ts peter out
§ Physical exam:
□ Simple repetitive muscular mov't
□ Counting
§ Test: EMP (electromyogram)
□ Measure action potential
§ Lab: ACT antibodies
§ Tx: ACT-like substance + Choline esterase
inhibitors
Risk factors for cancer of the uterus include:
○ A: Sexually transmitted viral infection ○ B: smoking ○ C: hematuria ○ D: unopposed estrogen
○ D: unopposed estrogen
§ Also nulliparity
○ STI/STD- cervix risk factor
○ Smoking- UB risk factor
Causative factors of acne include:
○ A: puberty
○ B: androgenic hormones
○ C: hyperkeratosis & blockage of discharge of sebum
○ D: all of the above
○ D: all of the above
○ Tx: Retinine (caution: cause deformity to in-utero fetus)
The test for the diagnosis of Polymyalgia rheumatica is:
○ A: MRI ○ B: Sed. Rate ○ C: Biopsy ○ D: skin test
○ B: Sed. Rate ↑↑ (ONLY TEST)
Prolonged morning stiffness is seen in:
○ A: Ankylosing Spondylitis ○ B: Osteoarthritis ○ C: Gout ○ D: Charcot foot
○ A: Ankylosing Spondylitis
§ Also w/ Rheumatoid arthritis
Osteoarthritis usually affects the:
○ A: Proximal interphalangeal joints ○ B: Distal interphalangeal joints ○ C: the big toe ○ D: all of the above
○ B: distal interphalangeal joints
§ Herberden/Bouchard’s nodules
○ R.A: proximal jts
○ Gout: big toe
In endometriosis, ectopic endometrial tissue may be present in:
○ A: the ovaries ○ B: the colon wall ○ C: anywhere in the pelvis ○ D: all of the above
○ D: all of the above
What is the most common pituitary tumor?
○ Prolactinoma
○ General Pit. Tumor S/S: § Headache § Loss of peripheral vision § Endocrine s/s □ No period □ Milk secretion □ Not pregnant
□ Men= impotence
What is a disease spurred by a GH Pituitary tumor?
Acromegaly
What is Multiple Endocrine Neoplasia/Adinoma?
Many endocrine glands affected simultaneously
What are the 5 conditions related to Multiple Endocrine Adinomas (neoplasia)?
○ Hypothyroid ○ Addison's Disease ○ Diabetes Mellitus ○ Pernicious anemia ○ Premature menopause
Where is the visual cortex located in the brain?
○ Occipital lobe
What does the temporal lobe of the brain dominate?
○ Hearing
○ Smell
What does the frontal lobe of the brain dominate?
Psychiatric
What does the cerebellum dominate?
○ Coordination
○ Balance
○ Ex: Gate
Describe how an image meeting the eye gets translated in the brain.
Retina (eye)> optic nerve> optic chiasm> optic tract> visual cortex
What are the coverings of the brain, from outermost to innermost?
○ Dura mater
○ Arachnoid mater
○ Pia mater
What are the three components of the brainstem?
○ Midbrain
○ Pons
○ Medulla oblongata
Where does sensation connect in the brain?
All sensation connects @ Thalamus- then goes to sensory area- most anterior area of parietal lobe
Which part of the spinal cord does sensation come in?
○ Posterior horn cell
§ >thalmus
□ >sensory area brain
What is the difference between an upper motor neuron paralysis and a lower motor neuron paralysis? (Ex: the difference between a CVA vs. Polio)
○ Upper motor neuron paralysis:
§ Ex: CVA/stroke
§ Exacerbated long tendon jerks
○ Lower motor neuron paralysis
§ Ex: Polio
§ Complete paralysis/no response tendon jerks
Which horn of the spinal cord deals with sensory function?
○ Posterior horn cell
Which part of the spinal cord relates to motor function?
○ Anterior horn cell
What is hemiplegia?
○ One sided loss from stroke
What is paraplegia?
○ Two sided loss from stroke
What is a warning sign for a stroke or CVA?
○ TIA (Transient Ischemic Attack)
§ Temporary loss motor or sensory (depend area)
§ TIA= temporary blockage of blood supply
What are the two types of CVA’s? Which is more prevelant?
○ Thrombo-embolic= 80%
○ Hemorrhagic =20%
What is DEXTER CARDIA?
○ Heart on opposite side of body
What is SITUS INVERTUS?
○ Reversal of body organization- complete system reversal
○ Not pathological
○ More common in men (RT testicle lower w/ this)
Generally, in men, which testicle hangs lower?
Left testicle
What disease is characterized by bleeding to the touch, swelling, & no sensation of the nipple & areola + visible areolar skin discoloration?
○ Pagets disease of the breast
○ Malignancy
What is the first sign of malignancy in the breast?
○ Stipple cell calcification
○ Dx: Biopsy
§ under mammography- insert needle- then send
for surgical biopsy
What is the best test for acute diverticulitis?
○ CT Scan
colonoscopy is contraindicated b/c can lead to perforation
What are the most common ovarian tumors?
○ Tumors of surface epithelium =70%
§ Overgrowth of surface tissue
○ Germ cell tumors= 20%
§ Ova becomes teeth, hair, etc.
§ =teratomas (dermoid cyst)
○ Sex cord-stromal tumors= 10/5%
§ Tumor making hormones (estrogen, androgen-
more rare)
• What are the three primary sites for metastic tumors?
○ 1: Endometrium
○ 2: Breast
○ 3: Stomach
○ Ovarian cancers/tumors- may be secondary site
What is tested in a pregnancy test?
HCG
What are the three layers of the eye?
○ Retina
○ Choroid
○ Sclera
What disease is characterized by increased intraocular pressure in the anterior chamber?
○ Glaucoma
§ Canal of Schlemm not draining
What disease is characterized by a clouding of the lens of the eye?
Cataracts
What disease is characterized by an inflammation of the conjunctiva?
Conjunctivitis
Give two examples of causes of increased retinal pressure:
○ High BP/ Hypertension
○ Diabetes Mellitus
What disease is characterized by weakness in a leg & visual blurriness intermittently?
○ Multiple sclerosis
§ Autoimmune attack of myelin sheath
§ CT Scan brain: plaque
What is the disease called when multiple sclerosis is only affecting the eye?
○ Devic’s Disease
What is the commonest ear problem in childhood?
○ Otitis media (middle ear infection)
What is a common ear problem w/ adults in old age?
○ Otosclerosis
§ Scarification of stapes> deafness
§ Tx: laser stapedectomy
What disease is characterized by vertigo, hearing loss, and tinnitus?
Meniere’s disease
What nerve does an acoustic neuroma affect?
8th Nerve
Tumor
What are the features of Nephrotic Syndrome.
○ Proteinuria (>3.5g/24hrs)
○ Hypoproteinemia/hypoalbuminemia
○ Edema
○ Hyperlipidemia
