Set 13 (Endocrine + GI) Flashcards by Ruby Chang

Dsyphagia for liquids
Difficulty belching
Dilated esophagus

Achalasia

usually congenital, also Trypanosoma cruzi if from Central/South America

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Sheep, goats

Fever, malaise, LAD, HSM

Brucellosis

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Chagas disease

Trypanosoma cruzi (central/south america)

Destroy myenteric plexi (esophagus, intestine, ureters
achalasia, megacolon, megaureter)

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Parafollicular (C cells) of the thyroid: embryology

Neural crest

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Foregut

Esophagus, stomach
Liver, GB, Pancreas
UPPER duodenum
(celiac trunk supplies these)

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Midgut

LOWER duodenum
SI
Ascending colon –> prox 2/3 of transverse colon
(SMA supplies these)

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Hindgut

Distal 1/3 of transverse
Descending and sigmoid
(IMA supplies these)

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Live (oral attenuated) vs. Killed (Salk inactivated) polio vaccine: defense

Live promote more PROLONGED synthesis and secretion of LOCAL mucosal IgA
(protection @ normal site of viral entry)

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Posterior duodenal ulcer: can cause ulceration of what artery?

Gastroduodenal

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Pancreatic pseudocyst

Wall=granulation tissue and fibrosis

NOT lined by epithelium (“pseudo”cyst)

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Dofetilide

Class III antiarrythmic (K+ channel blocker)

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Crohn’s disease: stones

Oxalate stones
(2/2 decreased calcium absorption, less calcium available to bind oxalate in INTESTINE --> less oxalate able to be excreted --> more oxalate ABSORBED into blood --> kidney --> stones)

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Corticosteroid on CBC

INCREASED neutrophils (demargination)
DECREASED everything else.

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Elevated CK

HYPOthyroidism
Statins
Polymyositis/Dermatomyosisits
Muscular dystrophies

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Hyperparathyroidism: bone

Increased breakdown: SUBPERIOSTEAL thinning

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Subperiosteal thinning

“salt and pepper” appearance of calvarium

HYPERparathyroidism

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Recurrent renal colic
Peptic ulcer dz
HIGH serum calcium, LOW serum potassium

Primary HYPERparathyroidism
(adenoma or hyperplasia)
(stones, bones, moans, psychiatric overtones)

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HNPCC (Lynch) syndrome: mutation

DNA mismatch repair genes

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BB in diabetes

USE SELECTIVE B1
(b2 blocker: inhibit gluconeogenesis and glycolysis)
NON-selective BB masks signs of HYPOglycemia

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Pyrmidine dimers are fixed by?

Nucleotide EXCISION repair

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Empty sugar phosphate residues are fixed by?

Base excision repair

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Mallory-Weiss tears occur due to?

Increased intraluminal gastric pressure

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Diabetes mellitus
Necrolytic erythema
Anemia

Glucagonoma

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Octreotide

Snthetic somatostatin analog

tx of carcinoid syndrome

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Flutamate

Competitive androgen inhibitor

Spleen: embryological origin

Mesodermal dorsal mesentery | NOT foregut derivative, but recieve blood supply from splenic artery of the celiac trunk--a foregut derivative

Kidney: embryology

Retroperitoneal organ from MESODERM | NOT derived from gut

Craniopharyngiomas

Tumors arising from Rathke's pouch remnants in AP | solid, cystic, calcified components

ANY supraseller mass w/ 3 components: | Solid, Cystic, Calcified

HIGHLY suspicious for Craniopharyngioma

C. diff: toxin

``` Toxin A (enterotoxin): neutrophil chemoattractant Toxin B (cytotoxin): actin depolymerization ```

Gastrinoma: which MEN?

MEN1 | Pancreatic tumor= gastrinoma

VHL

Hemangioblastoma Pheochromocytoma Renal cell carcinoma

Adenoma-to-carcinoma sequence

APC (small polyp) K-ras (increase size of polyp) p53 and DCC (malignant transformation)

Garlic odor

Arsenic poisoning | tx: dimercaprol

Arsenic poisoning: tx?

Dimercaprol

Acute lead and mercury poisoning: tx

CaNa2-EDTA

Cyanide poisoning: tx

Amyl nitrite

Positive skew

Mean > Median > Mode | negative skew: Mode > Median > Mean

Leptin stimulates production of? Leptin inhibit production of? In the arcuate nucleus.

Stimulate: POMC --> alpha-MSH --> inhibit food intake Inhibit: neuropeptide Y (which is an appetite stimulant)

G-protein/AC/PKA pathway used by what hormones?

TSH PTH Gluagon

Growth hormone EPO Cytokines (interferron) acts through what pathway?

JAK-STAT

Pear-shaped Bilaterally symmetric Four pairs of flagella, two nuclei

Giardia lamblia | NEED IgA!!!

Children w/ these more susceptible to Giardia lamblia infections

X-linked agammaglobulinemia Common variable immune deficiency IgA deficiency

Lesser omentum contains?

Hepatogastric ligament | Heaptoduodenal ligament

hCG has structural similarities to?

LH, FSH, TSH

Strict vegetarian diet: what vit deficiency?

Cobalamin

DDAVP (desmopressin) can be used for tx of?

Mild vWF disease (induce secretion of vWF from endothelial cells) Enuresis

HYPERtension HYPOkalemia Supressed renin NON-suppressible aldosterone

Primary mineralocorticoid excess | notice: NO HYPERnatremia b/c of "aldosterone escape"

Traction diverticula

2/2 inflammation and subsequent scarring | TRUE diverticula

Basophilic cluster on surface of intestinal mucosal cells Profuse, watery, non-bloody diarrhea AIDS

Cryptosporidiosis

Flask-shaped colonic ulcers

Entamoeba histolytica

Diphenoxylate

Opiate anti-diarrheal (~structure to meperidine) (Binds mu opiate receptors --> slow gastric motility) (combined w/ atropine to decrease abuse)

Octreotide is useful for _____________ diarrhea.

Secretory

BB in thyrotoxicosis

BB decrease symapthetic impulses | BB also decrease peripheral conversion of T4 --> T3

Aldolase reductase

Glucose --> sorbitol | Galactose --> galactitol

Sorbitol metabolism

Glucose --> Sorbitol --> Fructose | most active in seminal vesicle: sperm use FRUCTOSE as primary energy source

Insulin --> Receptor tyrosine kinase --> ?

Protein phosphatase-1 | (dephosphorylates glycogen synthase, fructose-1,6-bisphosphatase.

Ras gene mutation: which thyroid carcinoma?

Follicular.

p53 gene mutation: which thyroid caricinoma?

Anaplastic.

Bcl-2 mutation: which thyroid carcinoma?

Follicular.

Picornaviridae

Rhinovirus: acid LABILE Enterovirus: acid STABLE

Chronic gastritis w/ antral sparing

Autoimmune gastritis

Chronic antral-predominant gastritis

H. pylori

Gastric ulcers m/c located at?

Lesser curvature.

Rectum is ALWAYS involved in Crohn's or Ulcerative colitis?

Ulcerative colitis

Cytokines that DOWN-regulate local cytokine production and inflammatory rxns

TGF-beta | IL-10

DOC for mucormycosis

Amphotericin B

Amphotericin B: most notorious A/E

Renal toxicity | renal vasoCONSTRICTION --> decrease GFR, ATN, HYPOkalemia, HYPOmagnesemia

Amphotericin B should be administered w?

Potassium | Magnesium

Sporadic renal cell carcinoma: also has this mutation?

``` VHL gene (deletion on chromosome 3p) ```

Rb gene is on? NF-1 gene is on? VHL gene is on? WT-1 gene is on?

Rb 13 NF 17 VHL 3 WT 11

Thiazides work at?

DCT | inhibit apical Na/Cl symporter

Filtration fraction

GRF/RPF or (creatinine clearance)/(PAH clearance)

Clearance

(Urine cc)(Urine Flow Rate)/(Plasma cc)

Creatinine or Inulin clearance estimates?

GFR

PAH clearance estimates

RPF | PLASMA flow, NOT blood flow

PAH

ALL PAH excreted (freely filtered and secreted) =RPF

Creatinine

Freely filtered NOT secreted, NOT reabsorbed =GFR

60-40-20

60=water 40=INTRAcellular 20=EXTRAcellular (plasma + interstitial)

Serum osmolarity

290mOsm/L

Plasma volume estimated by? | Extracellular volume estimated by?

Albumin=plasma | Inulin = EXTRAcellular volume

MOST dilute of nephron

DCT | relatively IMpermeable to water, solute continued to be absorbed

Primase

DNA-dependent RNA polymerase

Subacute thyroiditis: iodine uptake

DECREASED | cause thyrotoxicosis due to increased RELEASE of thyroid hormone, NOT production

Thyroid: | Mixed, cellular infiltarte w/ occasional multinucleate giant cell

Subacute thyroiditis (granulomatous thyroiditis)

Thyroid: | Diffuse MONOnuclear infiltration w/ formation of GERMINAL CENTERs

Chornic lymphocytic thyroiditis | Hashimoto's thyroiditis

Elevated ESR TENDER thyroid Granulomatous

Subacute thyroiditis

NONtender thyroid Rubbery texture Anti-thyroid peroxidase autoantibody Normal ESR

Hashimoto's thyroiditis

Winter's formula

Co2= 1.5Bicarb+8 (+/-2)

Acute salicylate intoxication

Acute respiratory ALKalosis --> Metabolic ACIDosis --> if vomiting: metabolic ALKalosis

Nephron: most susceptible to renal ischemia

Proximal tubule | TAL

Papillary necrosis is a/w?

DM Analgesic nephropathy Sickle cell dz

Minimize radiocontrast-induced allergic nephrotoxicity

Prednisone

Acyclovir and kidney

Crystalline nephropathy if adequate HYDRATION not provided

Acute renal allograft rejection

Antibody OR cell-mediated | LYMPHOCYTIC infiltration

Rituximab

Anti-CD20 | ri "TU" ximab = Twenty

Muromonab (OKT3)

Anti-CD3 (inhibit T-lymphocytes) (Tx of acute rejection w/ kidney, heart, liver transplants)

Express receptors for: MHC class II IL-2

CD4+ T lymphocytes

Leads to INSULIN release (cell MOA)

ATP --> KATP channel --> KATP channel CLOSE | Cell depol --> VG-Ca2+ channel open --> INSULIN RELEASE

Digoxin: clearance

KIDNEY!