USMLE Goljan 1 Flashcards
1
Q
What is the most common malaria?
A
Vivax (Viva! It’s the MC)
2
Q
What is the fever pattern for P. vivax?
A
48 hours (Viva the 48 hr party!!!)
3
Q
Which malaria is the most lethal?
A
Falciparum (make one false step and you are dead)
4
Q
Which malaria is associated with nephrotic syndrome?
A
P. malariae
5
Q
What is the fever pattern for P. falsiparirum?
A
No pattern, it is so false that it doesn’t have one
6
Q
What is the fever pattern for P. malariae?
A
72 hours
7
Q
What do you find in the lab work?
A
Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)
8
Q
Prophylaxis Tx for malaria?
A
Chloroquine
9
Q
What drug do you use for resistant falciparum?
A
Mefloquine
ME FLOr resistant Falciparum
10
Q
What is the Tx for all except falciparum?
A
Chloroquine plus primaquine
11
Q
What is the specific Tx for falciparum?
A
IV quinidine or quinine plus doxycycline
Falciparum is the FALSE QUEEN (quinidine)
12
Q
What leukemia has translocation t(15;17)
A
Acute Promyelocytic Leukemia (M3)
13
Q
In which leukemia do you find DIC?
A
Acute Promyelocytic Leukemia (M3)
14
Q
What leukemia has gum infiltration?
A
Acute Monocytic Leukemia (M5)
15
Q
What leukemia has auer rods?
A
Acute Myelogenous Leukemia (M2/M3)
16
Q
What are auer rods?
A
fused azurophilic granules on cytosol of blast cells
17
Q
What leukemia is cured/reverse with Vitamin A (Retinol)?
A
Acute Promyelocytic Leukemia (M3)
18
Q
What is the age distribution of all leukemias?
A
ALL (0-14) AML (15-39) AML (40-60) CML (40-60) CLL (>60 years old)
19
Q
Which leukemia has translocation t9;22?
A
Chronic Myelogenous Leukemia (CML)
20
Q
What is the frequency of acute leukemias ?
A
Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%
21
Q
What leukemia is associated with ABL protooncogene?
A
Chronic Myelogenous Leukemia (CML)
22
Q
What is the translocation of ABL protooncogene?
A
t9;22
23
Q
What chromosome is CML found in? What is the name of the chromosome?
A
Chromosome 22; Philadelphia Chromosome
24
Q
What is afected in chromosome 22 for CML?
A
bcr (break cluster region) bcr-ABL fusion gene
25
What is the most specific test for CML?
decrease LAP (Leukocyte Alkaline Phosphatase)
26
What are other positive tests for CML?
philadephia chromosome and bcr-ABL fusion gene
27
What is the most common cancer and leukemia in children?
ALL
28
What is the most common subtype?
pre-B (80%)
29
What is a positive marker for ALL?
CALLA; CD10
Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase)
You are Caller No. 10!!!
30
Where do B cells metastasize in ALL?
CNS and testicles
think B is for Brain and Balls!
31
Where do T cells metastasize in ALL?
Anterior Mediastinal mass or acute leukemia
32
Which ALL type has best prognosis?
t(12;21)
33
Gout or Pseudogout?
| How do you tell?
Positively Birefringement (Blue color) Pseudogout
Negatively Birefringement (Yellow color) Gout
34
What crystal is negatively birefringent?
Negative is Yellow in color so it's Monosodium Urate for Gout
35
What crystals are positively birefringent?
Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout
36
Blue Crystals?
Pseudublue
Pseudogout
- Blue is Calcium pyrophosphate
37
Yellow Crystals?
Gout Monosodium urate
38
What joints are involved in Osteoarthritis?
DIP + PIP
39
What joints are involved in Rheumatoid Arthritis?
MCP + PIP
40
What are PIP joints inflamed called?
Bouchard Node
Pouchard
41
What is a Heberden Node?
Inflamation of DIP
42
What is rheumatoid factor? (RF)
IgM Ab against IgG
43
Where is rhematoid factor found?
In synovial fluid
44
What is the synovial tissue that grows over the articulate cartilage called?
Pannus
Not to be confused with Tophus that is found in Gout
45
Which on is symmetrical? Rheumatoid or Osteoarthritis?
Rheumatoid
46
What is it called when you get a patient with rheumatoid arthritis that expresses dry mouth and dry eyes?
Schoegrem Sx
47
Syndrome with rheumatoid arthritis with nodes in the lungs?
Kaplan Sx
48
What is the Tx of Rheumatoid Arthritis?
Methotrexate
49
What are some effects of long teng methotrexate tx?
| i.e. Arhtritis Tx
Macrocytic Anemia
Hypersegmented Neutrophils
Also causes:
Intersitial Fibrosis of the Lung
50
Tx for Gout?
Indomethacine
51
What drug do you give for underexcretion of uric acid?
Probenecid
| Sulfanpirizone
52
Overproducer of uric acid?
Allopurinol
53
What is the mech. of Allopurinol?
Block Xanthine Oxidase
54
What is the mechanism of uric acid accumulation/gout in alcoholics?
Patients with alcoholism are under metabolic acidosis
-All the acids compete in the excrition of proximal tubule
Alcoholics contain b-hydroxybutiric acid, lactic acid so they compete with uric acid to be excreted
55
Dz with degenerative arthritis in vertebral columns, pee turns black?
cartilage is turns black
Alkaptonuria
56
What is the inheritance of alkaptonuria?
autosomal recessive
57
What enzyme is absent and what accumulates?
Homgentisic Acid builds up
homogentisic oxidase
58
Patien w/ disuria, sterile piuria?
Non-specific urethritis chlamydia
No culture in urine
59
Same patient develops pain on Achilles Tendon? Conjunctivitis
Reiter's Sx
HLA-27 (+) patient
60
Chlamydia triggered HLA-B27?
Yes, it made Reiter become active
- Ulcerative colitis can also be an environmental factor
- psoriasis
- shigella
61
Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?
Disseminated Gonococchemia
62
STD?
Sinovitis
Tinosinovitis (hands)
Dermititis (pustules hand and feet)
63
What components do you need to kill Gonorrhea?
C5-C9
64
Septic arthritis?
MC gonorrhea (GC) Gonoccocus...
65
Any patient with bilateral bell-spalsy?
Lyme Dz until proven otherwise
66
MC cranial nerve involved with Lyme Dz?
VIIth nerve
67
Hemolytic Anemia? What do you see in this patient?
Babesia Micro
68
Ticks carry both dz?
Lyme and Babesia
69
What percent of lyme infected have babeiosis?
20% of patients have babeiosis
70
What is babesia microti?
intracellular erythrocytic parasite
similar to ring falciparum
71
Tx for chronic?
Ceftriaxone
72
Tx for acute?
Tetracycline
73
Mechanism of blue sclera?
Color of veins is blue
Seein the coroidal veins
that give the color to the sclera since there is very little collagen I
74
What is osteopetrosis?
Brittle bone Dz
Defect in osteoclasts
no marrow, severa anemia
75
Where are B cells located in lymph nodes?
Germinal Follicles; Peripheral areas of spleen (white pulp)
76
Where are T cells located?
ParacorTex; periarteriolar sheat in spleen
77
What are histiocytes and where are they located?
Part of the Lymphatic system in sinuses; skin (Langherhan's Cells); Red Pulp in Spleen
78
What is associated with Left Supraclavicular Nodes?
Abdominal and Pancreatic CA
79
What is associated with Right Supraclavicular Nodes?
Lung Mets and Esophageal CA; Hodgkin's lymphoma
80
What is the left supraclavicular node called?
Virchow's Node
81
What CA diseminates to para-aortic nodes?
Testicular CA and Burkitt's Lymphoma
82
What gene is associated with Follicular Lymphoma?
Translocation t14;18
overexpression of bcl-2
Follicular Think Fourteen
Fo Fo
83
What gene association is found in Burkitt's?
EBV translocation t8;14
African Jaw
84
What does the African variant involve? (Burkitt's)
Jaw
85
What does the American variant involve? (Burkitt's)
GI, ovaries and retroperitoneum
86
What do you see in Burkitt's?
Starry Sky Apparence
87
What is the Starry Sky?
macrophages w/ phagocytosed apoptotic bodies
88
What are the characteristic cells in Hodgkin's Lymjphoma?
association w/ EBV; cutaneous anergy to common antigens
89
What are the cells of Hogkin's L. called?
Reed-Sternberg Cells
90
What are Reed-Sternberg Cells?
transformed germinal center B cells
91
What CD maker's do you use to detect RS cells?
CD15 and CD30; you got to be able to REED by 15 and 30
92
What does a classic RS cell look like?
two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo
93
What is elevated in vWF disease?
Elevated Bleeding Time (platelet adh. problem)
| aPTT increased
94
What is elevated on hemophilia A?
```
VIII deficient
aPTT increased
(intrinsic pathway)
```
95
What is elevated in a person taking aspirin?
Bleeding Time elevated
96
What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
Bleeding Time increased
| platelets decreased
97
What are two other diseases that has Bleed Time increased and decreased platelets?
Thrombotic Thrombocytopenic Purpura
| Hemolytic Uremic Syndrome
98
What factor involved in extrinsic pathway?
VII
99
What factor involved in intrinsic pathway?
XII, XI, IX, VIII
100
What is the best test for vWF diases?
ristocetin cofactor assay
101
What anti bodies does blood group O have?
anti A-IgM
anti B-IgM
anti AB- IgG
102
What anti bodies have blood A?
anti B
103
What does group B has?
anti A-IgM
104
What does group AB has?
nothing
just like new borns and old people
105
What blood group has greatest incidence of gastric carcinoma?
group A
106
What is associated w/ duodenal ulcer?
group O blood
107
Who is the universal donor?
Group O
108
Who is the universal acceptor?
AB no antibodies to attack those cells
109
What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
SIS
110
What POC is associated w/ Leukemia?
RAS
111
What POC is associated w/ Breast CA?
ERB-B2
112
What POC is associated w/ Astrocytoma?
SIS
113
What POC is associated w/ Neuroblastoma?
N-MYC
114
What POC is associated w/ lung CA?
RAS
115
What POC is associated w/ CML?
ABL
116
What POC is associated w/ Burkitt's Lymphoma?
c-MYC
| MYC
117
What POC is associated w/ colon CA?
RAS
118
What POC is associated w/ MEN IIa/IIb Syndromes?
RET
119
WhatPOC is associated w/ pancreatic CA?
RAS
120
What function does SIS have?
GF synthesis
| Growth Factor
121
What fx does ERB-B2 has?
Receptor Synthesis
122
What fx does ABL has?
Non-receptor TK activity
123
WHat fx does RET have?
Receptor Synthesis
124
What fx does MYC have?
Nuclear Transcription
125
What fx does N-MYC have?
Nuclear transcription
126
WHat fx does RAS has?
GTP signal transduction
127
What two POC have the same function of Receptor Synthesis?
ERB-B2 and RET
128
What two POC have the same fx of nuclear transcription?
c-MYC and N-MYC
129
What does SIS activate?
Overexpression
130
What does ERB-B2 activate?
Amplification
131
What does RET Activate?
Point Mutation
132
What does RAS activate?
Point Mutation
133
What does ABL activate?
translocation
| t(9;22)
134
What does MYC activate?
c-MYC translocation t(8;14)
135
What does N-MYC activate?
Amplification
136
What two POC amplify?
ERB-B2 and N-MYC
137
What two POC activate point mutation?
RET and RAS
138
What two POC activate translocation?
ABL and c-MYC
139
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
EBV
140
What POC amplifies breasts??? imagine that...
ERB-B2
| Breast bigger two!
141
What are the inactivation of suppressor genes?
TP53, RB, APC and BRCA1/2
142
What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
TP53
143
What SG is assciated w/ breast, ovary and prostate CA?
BRCA 1
| BRCA 2
144
What SG is associated w/ familial polyposis: color cancer?
APC
145
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
RB
146
What is the function of TP53?
G1 to S phase inhibitor
147
What is the function of BRCA 1/2 gene?
Regulates DNA repair
148
What is the APC gene function?
Prevents nuclear transcription
| - degrades catenin; an activator of nuclear transcription
149
What is the function of RB gene?
G1 to S phase inhibitor
150
What are the genes fo anti-apoptosis?
BCL-2 genes
151
What is the function of BCL-2 genes?
prevents the leakage of cytochrome c (signal for apoptosis)
152
What disease is associated with BCL-2?
b-cell lymphoma
B C L -2
Follicular Lymphoma t14;18
153
What is another disease that involves TP53?
Ataxia Telangiectasia
| syceptibility to malignant lymphoma
154
What virus is associated w/ TP53?
HBV and
HTLV-1(T cell leukemia and lymphoma)
HPV 16,18 HPV16 inhibits TP53
RB inhibited by HPV 18
155
What CA is associated w/ hypercalcemia?
primary SCC of lung
Renal Adeconcarcinoma
PTH-like peptide
156
WHat CA is associated w/ myasthenia gravis?
Eaton-Lambert Sx
| SCC of lung
157
What CA is associated w/ sudden appearance of seborrheic keratosis?
"Sudden"
| Stomach Adenocarcinoma
158
What CA is associated w/ hypertrophic osteoarthropathy?
Lung CA
159
What CA is associated w/ superficial migratory thrombophlebitis?
pancreatic carcinoma
Troussau sign (he had it himself, self-diagnosed)
160
What CA manifests Nonbacterial thrombotic endocarditis?
| Sterile Vegetations on Mitral Valve
Mucous-secreting pancreatic and colorectal CA
161
WHat CA manifests w/ ADH increase? What do you find clinically?
SCC of lung
Hyponatremia
162
What SG is associated w/ familial polyposis: color cancer?
APC
163
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
RB
164
What is the function of TP53?
G1 to S phase inhibitor
165
What is the function of BRCA 1/2 gene?
Regulates DNA repair
166
What is the APC gene function?
Prevents nuclear transcription
| - degrades catenin; an activator of nuclear transcription
167
What SG is associated w/ familial polyposis: color cancer?
APC
168
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
RB
169
What is the function of TP53?
G1 to S phase inhibitor
170
What is the function of BRCA 1/2 gene?
Regulates DNA repair
171
What is the APC gene function?
Prevents nuclear transcription
| - degrades catenin; an activator of nuclear transcription
172
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
EBV
173
What POC amplifies breasts??? imagine that...
ERB-B2
| Breast bigger two!
174
What are the inactivation of suppressor genes?
TP53, RB, APC and BRCA1/2
175
What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
TP53
176
What SG is assciated w/ breast, ovary and prostate CA?
BRCA 1
| BRCA 2
177
What does SIS activate?
Overexpression
178
What does ERB-B2 activate?
Amplification
179
What does RET Activate?
Point Mutation
180
What does RAS activate?
Point Mutation
181
What does ABL activate?
translocation
| t(9;22)
182
What POC is associated w/ lung CA?
RAS
183
What POC is associated w/ CML?
ABL
184
What POC is associated w/ Burkitt's Lymphoma?
c-MYC
| MYC
185
What POC is associated w/ colon CA?
RAS
186
What POC is associated w/ MEN IIa/IIb Syndromes?
RET
187
What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
SIS
188
What POC is associated w/ Leukemia?
RAS
189
What POC is associated w/ Breast CA?
ERB-B2
190
What POC is associated w/ Astrocytoma?
SIS
191
What POC is associated w/ Neuroblastoma?
N-MYC
192
What does group B has?
anti A-IgM
193
What does group AB has?
nothing
just like new borns and old people
194
What blood group has greatest incidence of gastric carcinoma?
group A
195
What is associated w/ duodenal ulcer?
group O blood
196
Who is the universal donor?
Group O
197
What is elevated in vWF disease?
Elevated Bleeding Time (platelet adh. problem)
| aPTT increased
198
What is elevated on hemophilia A?
```
VIII deficient
aPTT increased
(intrinsic pathway)
```
199
What is elevated in a person taking aspirin?
Bleeding Time elevated
200
What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
Bleeding Time increased
| platelets decreased
201
What are two other diseases that has Bleed Time increased and decreased platelets?
Thrombotic Thrombocytopenic Purpura
| Hemolytic Uremic Syndrome
202
What CA manifests w/ ACTH increase? Clinical Symptoms?
SCC of lung
Medullary CA of Thyroid
Clin: Cushing Sx
203
What CA manifests increase in erythropoietin?
| Clinical?
Renal AdenoCA
primary SCC of lung
Breast CA
hypercalcemia
204
What CA presents w/ inc. in B-hCG? Symp?
Choriocarcinoma (Testis)
gynecomastia
205
What CA presenst w/ Calcitonin increase? Symp.?
Medullary CA of Thyroid
hypocalcemia
206
What region of the face does BCC and SCC occur?
BCC top of the face upper lips
| SCC below lower lips
207
WHat RNA virus is associated with TP53 suppressor?
HTLV-1 T cell leukemia and lymphoma virus!
208
What DNA virus is associated w/ TP53 suppersor gene?
HBV and HPV 16,18 E6 inhibits it
209
What two genes are knocked out by HPV 16, 18?
E6 and E7 produced by HPV
E6 inhibits TP53
E7 inhibits RB suppressor gene
210
What CA does EBV is associated with?
Burkitt's lymphoma
CNS lymphoma in AIDS
Mixed Cellularity Hodgkin's
Nasopharyngeal CA
211
What virus is associated w/ hepatocelluar CA?
HBV
212
What RNA virus causes hepatocellular CA?
HCV not HBV!!!
HBV is DNA virus
213
What deffect has opening snap during diastole?
Mitral Stenosis
Snap Stenosis
214
What MCC of death in rheumatic fever?
Myocarditis
215
What type of Hypersensitivity is Rheumatic Fever?
Type II
216
What organism is involved in Rheumatic Fever?
group A Strepto
Step. pyogenes
217
What do the antibodies react to in Group A Steptococcus?
Ab react to M proteins
218
What are two common findings in myocarditis?
aschoff bodies
Anitschkow Cells
the two Russians
219
WHat are Aschoff Bodies?
central fibrinoid necrosis surrounded by reactive histiocytes
220
How long after a group A step. pharyngitis does Rheumatic Fever occur?
1-5 weeks after episode
221
What are five signs of Rheumatic fever?
1) Carditis
2) Migratory polyarthritis
3) Subcutaneous Nodules
4) Erythema Marginatum
5) Sydenham's Chorea
222
What valve is affected with a pansystolic (holosytolic) murmur?
Mitral Regurgitation
223
What valve is involved in a mid-systolic click?
Mitral Valve Prolapse
it clicks half way since the chordae restrain it
224
What two diseases have Mitral Valve Prolapse?
Marfan's Sx
| Ehlers Danlos
225
What pathology is associated with coarctation of the aorta?
Turner Sx
226
What is the MC congenital heart disease in children?
VSD
| very small dudes :)
227
What is the MC congenital heart disease in adults?
a is for ASD
228
What are the three A's in ASD?
Adults
Alchohol Fetal Sx
ALL from Down Syndrome
229
What viral infection is involved w/ PDA?
rubella
230
What murmur is heard in PDA?
machine like murmur during systole and diastole
231
What keeps PDA open in fetus?
PGE2
232
What is the Tx for closure of PDA in newborn?
indomethacin
233
Where is the murmur best heard for PDA?
between the shoulder blades
234
What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?
Alcohol
235
What carcinogen is impilcated with stomach AdenoCA?
nitrosamines and nitrosamides
236
What carcinogen is impilcated with colorectal cancer?
Lithocholic acid
| secondary bile acid
237
What carcinogen is impilcated with Lung CA? (4)
uranium
asbestos
chromium
nickel
238
What carcinogen is impilcated with pleural mesothelioma?
Asbestos
239
What carcinogen is impilcated with breast cancer and cervical cancer?
Oral Contraceptives
240
What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
Arsenic
241
What carcinogen is impilcated with TCC of bladder? (2)
cyclophosphamide
| b-naphthylamine (dye and rubber indus.)
242
What carcinogen is impilcated with acute leukemia?
benzene
243
What carcinogen is impilcated with SCC of penis?
Smegma in uncircumcised male
244
What carcinogen is impilcated with SCC of scrotum?
tar, soot, oil (chimney sweeper)
245
What carcinogen is impilcated with malignant lymphoma?
Alkylating agents
246
What is the mos common risk factor for BCC, SCC, melanoma?
UVB light
247
What is the mos common risk factor for Kaposi's Sacroma?
HHV-8
248
What is the mos common risk factor for Nasopharyngela CA?
EBV
249
What is the mos common risk factor for larynx CA?
polycyclic HOC (hydrocarbons)
250
What is the mos common risk factor for distal esophagus?
barret's disease
251
What is the mos common risk factor for Stomach AdenoCA?
Helicobacter pylori
252
What is the mos common risk factor for Colon adenoCA?
preexisting polyps
| tubular and villous adenoma
253
What is the mos common risk factor for pancreas?
polycyclic HOC
254
What is the mos common risk factor for hepatocellular CA?
HBV or HCV cirrhosis
255
What is the mos common risk factor for seminoma?
cryptorchid testis
semi-descended testis
semi noma
256
What is the mos common risk factor for breast CA?
```
age >50
excess estrogen:
1) nulliparity
2) early menarche
3) late menopause
4) obesity
```
257
What is the mos common risk factor for dysgerminoma/gonadoblastoma?
Turner Sx XO dysgerminoma
| XO/XY gonadoblastoma
258
What is the mos common risk factor for vagina/cervix clear cell?
diethylestilbestrol
259
What is the mos common risk factor for surface derived ovarian CA?
nulliparity
| because of increase of ovulatory cycles
260
What is the mos common risk factor for choriocarcinoma?
Complete Hydatidiform Mole
261
What is the mos common risk factor for Malignant lymphoma thyroid?
Hashimoto's Thyroiditis
262
What is the mos common risk factor for papillary CA of thyroid?
Ionization Radiation
263
What is the mos common risk factor for medullary CA thyroid?
MEN IIa/IIb
264
What is the mos common risk factor for osteogenic sarcoma?
retinoblastoma
| radiation
265
What is the mos common risk factor for Primary CNS lymphoma?
EBV in AIDS pat.
266
What is the mos common risk factor for Burkitt's Lymphoma?
EBV
267
Which on is protein rich? Transudate or Exude?
Exude
extra proteins inside the fluid
268
What causes flushing and diarrhea in carcinoid Sx?
serotonin
269
What mumurs are heard in systole with crescendo-decrescendo fashion??
Stenosis AV/PV (atrial valve/pulmonary valve)
270
When do Mitral Valve and tricuspid valve occur?
Opening Snap in mid-diastole
