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USMLE Goljan 2 Flashcards

1
Q

What murmur is heard in MV/TV regurgitation?

A

Pansystolic murmur

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2
Q

What murmur is heard in AV/PV regurgitation?

A

high pitched diastolic murmur directly after S2

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3
Q

What is the MC cardiomyopathy?

A

congestive (dilated) cardiomyopathy

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4
Q

What causes congestive cardiomyopathy? MC Drug? MC vitamin. def?

A
  • idiopathic (MC)
  • doxorubicin/cocaine
  • thiamine deficiency (Alcoholics)
  • hypothyroidism
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5
Q

What is the MCC of sudden death in young people?

A

Hypertrophic cardiomyopathy

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6
Q

What is the MCC of infective endocartitis?

A

Strep. viridians

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7
Q

What is the MCC of infective endocartitis in I.V. drug user?

A

Staph. aureus

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8
Q

What is the MCC of infective endocartitis in colon cancer and ulcerative colitis?

A

Strep. bovis

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9
Q

What is the MCC of infective endocartitis in prosthetic devices?

A

Staph. epidirmidis

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10
Q

What is the MCC valve involved in infective endocartitis?

A

mitral valve

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11
Q

What are the clinical findings in infective endocarditis?

A

1) type III; HS
- Roth Spots retina
- splinter hemorrhage
- glomerulonephritis w/ RBC casts

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12
Q

What is associated w/ Libman Sacks endocarditis?

A

SLE

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13
Q

What DZ has sterile vegetations covered on valvular surfaces?

A

SLE

-libman sacks endocarditis

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14
Q

What two diseases are involved w/ mucin-producing sterile vegetations?

A

tumors of colon and pancreas

Marantic vegetations

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15
Q

What is the MCC of viral myocarditis?

A

Coxsackievirus

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16
Q

What other pathogens cause myocarditis?

A

Borrelia (Lyme Dz)
T. cruzi (Chagas)
Tichinella spiralis (trichinosis)

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17
Q

What is the difference between myocarditis and pericarditis?

A

pericarditis adds AMI and Dressler’s syndrome

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18
Q

What is the MCC of pericarditis?

A

Coxsackievirus again!

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19
Q

What disease involves hypotension assciated w/ pulsus paradoxus?

A

pericarditis

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20
Q

What is pulsus paradoxus?

A

decrease in >10mmHG in systole during inspiration

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21
Q

What other sign is seen in pericarditis?

A

Kussmaul’s Sign

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22
Q

What is Kussmaul’s sign?

A

neck vein distension on inspiration

blood refluxes to jugular vein instead of entering RA

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23
Q

What is the MCC of constrictive pericarditis?

A

TB worldwide

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24
Q

What is the problem in hypertrophic cardiomyopathy?

A

mutation in heavy chain of beta-myosin and troponins

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25
Q

What kind of genetics does hypertrophic cardiomyopathy have?

A

autosomal dominant

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26
Q

What is the MC site of metastasis to cardiac tissue?

A

pericardium

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27
Q

MC benign tumor of cardiac origin? Location?

A

Cardiac Myxoma

Left atirum

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28
Q

What is a benign tumor of the heart that arises from cardiac muscle? MC in age?

A

Cardiac Rhabdomyoma

infants and children

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29
Q

What disease is associated with cardiac rhabdomyoma?

A

Tuberous Sclerosis

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30
Q

What is associated w/ Alzheimer’s Dz?

A

Depression

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31
Q

What is the pathogenesis of mitral valve prolapse?

A

increase/accumulation of dermatan sulfate

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32
Q

What is the characteristic murmur of mitral valve prolapse?

A

mid-systolic click

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33
Q

When does the murmur approach to S1?

A

decrease in preload

less blood

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34
Q

How do you calculate the A-a gradient?

A

Alveolar PO2= 21%O2(Atm. P-47) - pCO2/0.8

A= (.21)(713)- 40/0.8)
Usually A=100

A-a
a=95
Normal A-a grad= 5-30

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35
Q

When is A-a gradient indicative of pulmonary pathology?

A

when A-a grad = >30

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36
Q

Where is ventilation most prominent in the lungs?

A

Apex

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37
Q

What is more prominent at the base of the lungs? Vent. or Perf.

A

Perfusion

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38
Q

Where do infactions of the lung occur?

A

Lower lobes

i.e. more perfusion

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39
Q

What is the diagnosis of a child w/ Nasal Polyps? Test for?

A

Sweat Test

Cystic Fibrosis (CF)
until proven otherwise
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40
Q

Patient w/ fibromyalgia and develops asthma, what is the cause of this?

A

Aspirin induced asthma
block PG but still produce Leukotriene build up

LT C-D-E4 buildup
(potent bronchoconstrictors)

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41
Q

Causes of Hypoxemia w/ normal A-a gradient?

A
  • barbiturates OD
  • epiglottitis (Upper Airway Obstr.)
  • Amyotrophics Lat. Sclerosis (ALS)
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42
Q

Newborn that turns cyanotic when breast feeding; cries and turns back to pink. Diagnosis?

A

Choanal Atresia

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43
Q

What is the complication of Sleep Apnea?

A

Pulmonary Hypertension
- vasoconstrictive effects of chronic hypoxemia and respiratory acidosis
called COR-PULOMONALE

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44
Q

What sinus is involved in adults w/ sinusitis? children?

A

mAxilary ADULTS

ethmoid children
ethmall

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45
Q

What is a common finding of sinusitis in diabetics?

A

Mucor sinusitis

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46
Q

Why does Mucor species prevail in sinusitis of Diabetic patients?

A

Ketoacidosis cuases proliferation

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47
Q

What does Mucor sp. invade?

A

frontal lobes

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48
Q

What is the cause of Nasopharyngeal Carcinoma?

A

EBV

common in Chinese

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49
Q

What three compounds increase surfactant?

A

1) thyroxin
2) prolacitn
3) glucocorticoid

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50
Q

What happens when no primary cancer is found in cervical lymph node metastasis?

A

nasopharynx should be biopsied

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51
Q

Risk factor for Laryngeal CA?

A

smoking

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52
Q

What is synergistic with smoking in Laryngeal CA?

A

Alcohol ingestion

smoking + alcohol = bad combo

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53
Q

What is found in the physical exploration of Atelectasis?

A
  • dullness to percussion

- absent tactile fremitus

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54
Q

When do you see atelectasis?

A

usually 24-36 hrs post surgery

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55
Q

What three compounds increase surfactant?

A

thyroxin
prolactin
glucocorticoids

that’s why glucocorticoids given to mother before 32 weeks

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56
Q

What is the pathogenesis of Respiratory Distress Syndrome in Newborns?

A

Atelectasis due to loss of surfactant

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57
Q

Where is surfactant made?

A

Type II neumocytes

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58
Q

Where is surfactant stored?

A

lamellar bodies

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59
Q

When does synthesis of surfactant begin?

A

28th week

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60
Q

When is surfactant at it’s peak?

A

35 weeks

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61
Q

What disease is common to dysphagia fro solids? (lower esophagus)

A

Achalasia MC

progressive systemic sclerosis/CREST Sx

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62
Q

What Dz is involved in dyspaghia for solids but in the Upper esophagus?

A

polymyositis

myasthemia gravis

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63
Q

Why is myasthemia gravis on the upper esophagus?

A

Upper 1/3 of esophagus is striated muscle

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64
Q

What three diseases have disphagia for liquids?

A

really bad…

1) plummer vinson
2) esophageal CA
3) Barrett’s Esophagus (ulceration and stricture)

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65
Q

What is associated with iron deficiency and dysphagia for solids?

A

Plummer-Vinson

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66
Q

What does it mean when you have dysphagia for solids but not liquids?

A

Mechanical Obstruction

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67
Q

What does it mean when you have dysphagia for both solids and liquids?

A

peristalisis problem

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68
Q

What is the MCC of odynophagia in HIV?

A

esophagitis caused by Candida albicans

Aids Defining

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69
Q

MC congenital esophageal disorder?

A

Tracheoesophageal fistula

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70
Q

What is wrong in tracheosophageal fistula? (what ends blindly?)

A

Proximal esophagus ends blindly

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71
Q

What are the common signs and symptoms of fistula in pregnancy?

A

Polyhydramnios
(excess fluid)
fetus is not reabsorbing it through mouth

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72
Q

What are signs/symptoms (S/S) of Trachesophageal Fistula (TE) in babies?

A

apsiration of milk into trachea

- abdominal distention

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73
Q

What is connected in TE fistula?

A

Trachea and Stomach!!!

Distal Esophagus arises from Trachea

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74
Q

What is the VATER Sx?

A

Vertebral Abnormalities
Anus Imperforated
TE fistula
Renal Disease/Radius abnormality

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75
Q

What are the causes of polyhydramnios?

A
  • TE fistula
  • Anacephaly
  • duodenal atresia (Down/ALL)
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76
Q

What is weakness in the esophageal wall called?

A

Zenker’s Diverticulum

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77
Q

What is weak in Zenker’s Diverticulum?

A

cricopharyngeus muscle weakness

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78
Q

What are the S/S of Zenker’s Diverticulum?

A

bad breath

food collects in pouches

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79
Q

What is the pathogenesis of achalasia?

A

failure of relaxation of LES sphincter

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80
Q

What is absent in achalasia?

A

absent relaxation

absent myenteric ganglion cells

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81
Q

What is substance is missing in the myenteric ganglion of achalasia?

A

VIP (vasointestinal peptide)

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82
Q

What is the function of VIP?

A

relax the LES

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83
Q

What sign do we see in the X-ray of achalasia?

A

bird’s beak in barium study

dilation of proximal esophagus

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84
Q

HOw are achalasia and progressive systemic sclerosis (PSS)/ CREST Sx similar?

A

both have relaxation of LES
absence of esophageal motility
manometry best diagnostic measure

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85
Q

What does CREST stand for?

A 
Calcinosis
Raynaud's Phenomenum
Esophageal Motility Dysfunction
Sclerodactyly
Telangiectasias
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86
Q

What laboratory test do you use to diagnostie CREST Sx?

A

ANA (70-90%)
anti-SCL-70 (70%) topoisomerase I
anti-centromere antibodies (30%)

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87
Q

What is the problem in GERD?

A

relaxed LES

acid injury leads to Barrett’s esophagus and then distal AdenoCA

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88
Q

What vein is most likely to have varices in esophagus?

A

left gastric coronary vein (from portal)

azygous vein

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89
Q

What is the MC organism causes esophagitis?

A

Candida

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90
Q

What are other causes of esophagitis?

A

Herpes (multinucleated cells w/ intranuclear inclusions)

CMV (single nucleurs w/ largo basophilic inclusion)

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91
Q

What is the name of the TEAR of the DISTAL esophagus?

A

Mallory Weiss Sx

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92
Q

When does Mallory Weiss Sx occur?

A

Alcoholics

bulimia

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93
Q

What is the name of the RUPTURE of the DISTAL esophagus?

A

Boerhaave’s Sx

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94
Q

What is the MCC of Boerhaave’s Sx?

A

Endoscopy procedure!!!

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95
Q

What is the MCC of primary cancer in the esophagus in the U.S.? What part of the esophagus?

A

Adenocarcinoma of distal esophagus

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96
Q

What is the MC esophageal CA in developing countries and where is it located in the esophagus?

A

Squamous CA

Mid-esophagus

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97
Q

MCC of hematemesis?

A

duodenal ulcer

2) gastric ulcer
3) esophageal varices

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98
Q

Main difference between congenital pyloric stenosis and duodenal atresia?

A

Bile containing fluid in Duodenal Atresia

Also duodenal atresia associated w/ Down Sx

polyhydramnios seen in mother in Duodenal Atresia

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99
Q

What are the three functions of PGE2?

A

1) increase blood flow to mucosa
2) increase secretion of mucous
3) increase HCO3- cytoprotective

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100
Q

What is an analog of PGE2?

A

Misoprostol

cytoprotective

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101
Q

What part of the stomach is affected by pernicious anemia?

A

Body and Fundus

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102
Q

What type of gastritis is pernicious anemia?

A

Type A atrophic gastitis

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103
Q

What part of the stomach does H. pylori infect?

A

pyloric antrum

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104
Q

What does H. pylori predispose to/cause? 2 things

A

AdenoCA of stomach

Malignant Lymphoma

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105
Q

What type of gastritis does H. pylori cause?

A

Type B Atrophic Gastritis

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106
Q

Where is the ulcer and cancer located in gastric ulcer?

A

lesser curvature of antum

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107
Q

Does gastric ulcer predispose to CA?

A

NO! Gastic CA may bleed and may be confused w/ gastric ulcer!

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108
Q

What must be done w/ gastric ulcer?

A

Biopsy to rule out gastric CA!

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109
Q

When is the pain in duodenal ulcer?

A

Decreases w/ meal/eating

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110
Q

When is pain in gastric ulcer?

A

Greater fater eating

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111
Q

What is the malignant potential for a duodenal ulcer?

A

0% malignancy

so never biopsied!

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112
Q

What blood group is associated w/ duodenal ulcer?

A

Blood group O

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113
Q

What other pathologies are associated w/ dudoneal ulcer?

A

MEN I

Zollinger-Ellison Sx

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114
Q

What is the MC complication of duodenal ulcer?

A

Bleed and perforation

115
Q

What is the presentation of duodenal ulcer w/ perforation?

A

patient w/ epigastric pain that irradiates to the left shoulder

116
Q

What is the first step in managemente of duodenal ulcer that has perforated?

A

Flat X-ray

117
Q

Why is the pain referred to the shoulder in perforated duodenal ulcer?

A

because the diaphragm is irritated and has the same dermatome and embryology at C4 (phrenic nerve)

118
Q

Patient that wakes up at night w/ epigastric pain?

A

Most likely duodenal ulcer

119
Q

What is Zollinger Ellison’s (ZE) Sx?

A

malignant islet cell tumor

120
Q

What does ZE secrete?

A

gastrin

increases acid in stomach

121
Q

Why is there black melena?

A

Acid acts on HB and converts it into Hematin

Hematin is black pigment that stains fecal matter

122
Q

What is a picture of a stomach that is really hard petrified almost?

A

Linitis plastica

Stomach Cancer diffuse type

123
Q

What type of cells do you see in linitis plastica?

A

Signet Ring Cells

124
Q

Where else can you find signet ring cells?

A

both ovaries since linitis plastica metastasizes via hematogenous route

125
Q

What is a kind of diffuse type linitis plastica? attacks the ovaries as well?

A

Krukengerg Tumor

126
Q

What is the MC extranodal site of extranodal lymphoma?

127
Q

What is the 2nd MC extranodal site of extranodal lymphoma?

A

peyer’s patches

128
Q

What is the MC benign tumor of GI tract?

129
Q

What is the MC location for Leiomyoma?

130
Q

What is the main symptom of leiomyoma?

131
Q

What is associated with dermatitis herpetiform?

132
Q

What is the best test to detect Celiac Dz?

A

anti-gliadin Ab

133
Q

What is another Dz that involves malabsorption?

A

Whipple Dz

134
Q

What is the pathology of Celiac Dz?

A

Atrophy of villi in Duodenum and Jejunum

135
Q

What is the pathology of Whipple’s Dz?

A

blunting of villi in jejunum and ileum

136
Q

What is the best (cheapest) screening test to determine malabsorption problem?

A

stool for fat

137
Q

What are the three classifications of diarrhea?

A

1) invasive
2) secretory
3) osmotic

138
Q

What is the best test for invasive diarrhea?

A

fecal leukocytes (+)

139
Q

What is the #1 organism in invasive enterocolitis?

A

Campylobacter

140
Q

What diarrhea’s are low volume?

A

Invasive diarrhea

141
Q

What diarrhea is high volume?

A

secretory and osmotic

142
Q

What is secretory diarrhea?

A

high volume w/ osmolality similar to plasma

143
Q

What is osmotic diarrhea?

A

high volume w/ osmolality lower than that of plasma

144
Q

What are some disease that cause secretory diarrhea?

A

Vibrio cholerae (via adenylate cyclase)

E. coli (via guanylate cyclase)

Rotavirus
Carcinoid Sx

145
Q

Is there mucosal inflammation in secretory diarrhea?

A

No mucosal inflammation

146
Q

What are some common diseases that cause osmotic diarrhea?

A

lactase deficiency

laxatives

147
Q

What is the MCC of diarrhea, cholecystitis and pancreatitis in AIDS?

A

Cytomelagolvirus (CMV)

148
Q

What organism is associated w/ HLA-B27 spondyloarthropathy and uremic Sx?

149
Q

What is the MC contaminant of blood transfusions?

A

Yersenia enterocolitica

150
Q

What are trophozoites phagocytosed RBCs?

A

Entameba histolytica (Ameba)

151
Q

What is the MCC of diarrhea in AIDS?

A

Cryptosporidium parvum

152
Q

What test is used to detect C. parvum?

A

String Test

153
Q

What is the MCC of diarrhea from protozoa in the U.S.?

A

Giardia lamblia

154
Q

What is the life cycle of G. lamblia?

A

cysts attach to small intestine mucosa

155
Q

What organism causes rectal prolapse in children?

A

Trichuris trichura

156
Q

What is the Tx of Trichuris trichura?

A

Albendazol

157
Q

What is the reservoir of diphyllobothrium latum?

A

fish— lake trout

158
Q

What does D. latum cause?

A

Vitamin B12 deficiency

159
Q

What is the Tx fro D. latum?

A

praziquantel

160
Q

What is seen in the stool of Strongyloidse stercoralis?

A

rhabditiform larvae

161
Q

What parasite causes bowel obstruction?

A

Ascaris Lumbricoides

162
Q

What is the reservoir for Dyphyllobotrium latum?

A

Fish — lake trout

163
Q

What problems does D. latum give humans?

A

Vitamin B12 deficiency

164
Q

What is the Tx for D. latum?

A

Praziquantel

got the prize for the fish!

165
Q

What parasite in the soil penetrates the skin?

A

Strongyloides stercoralis

he is strong!!!

166
Q

What is the MCC of hematochezia?

A

Diverticulosis

167
Q

What is the 2nd MCC of hematochezia?

A

angiodysplasia

168
Q

What is asscoaited w/ angiodysplasia?

A

von Willebrand’s Dz

Aortic Stenosis

169
Q

What is the MCC of iron deficiency in newborn?

A

Mecke’s Diverticulum

bleeding GI

170
Q

What disease has the term left sided apendicitis?

A

sigmoid diverticula

171
Q

MC place of pathology in entire GI tract?

A 
Sigmoid colon
includes:
- cancer
- polyps (except Peutz-Jegher's)
- diverticular disease
172
Q

What is associated with embolism of transmural small bowel?

A

hear disease and atrial fibrillation

173
Q

What is the MCC of fistulas in the GI tract?

A

diverticula

174
Q

What is the MC fistula?

A

Colovesical Fistula

175
Q

Ulcerative Colitis vs. Cronh’s Dz

A

UC vs. Crohn’s

176
Q

What layers does UC comprise?

A

musocal and submucosal

177
Q

What layers does Cronh’s Dz comprise?

A

all layers

it is transmural

178
Q

What does UC primarily target?

179
Q

What is involved in Cronh’s Dz in 80%?

A

Terminal Ileum Affected

180
Q

What segment does UC attack?

A

rectum;

does not involve other areas of GI tract

181
Q

What segment does Cronh’s attack?

A

Cronh=Complete
all layers
and also all the GI tract
mouth to anus

182
Q

What marker do you get after HBV vaccine?

183
Q

What is the first serology to appear in HBV?

184
Q

What is the marker that the patient will recover from HBV?

A

HBV-DNA poymerase leaves before HBsAg

185
Q

Markers for HBV infection is active?

A

HBe and HBV-DNA antigens are excellent markers of infectivity

186
Q

What is considered when anti-HBcIgM is converted to HBcIgG?

A

patient has old infection

187
Q

What marker for HBV determines a chronic carrier?

A

HBsAg for more than 6 months

188
Q

What is a healthy carrier?

A

carries HBsAg but is negative for HBeAg/HBV-DNA

189
Q

What two viruses are associated w/ hepatocellular CA?

A

B and C hepatitis

190
Q

What organism causes spontaneous peritonitis in adults?

191
Q

What organism causes spontaneous peritonitis in children?

A

Step. pneumoniae

192
Q

What causes a single abscess in the right lobe of the liver?

A

E. histolytica

193
Q

Tx for Hepatic Amebiasis?

A

Metronidazole

194
Q

Who is the definitive host of Echinococcosis?

195
Q

Humans are what type of host for Echinococcosis?

A

intermediate host

196
Q

Tx for Echinococcosis?

A

Albendazole

197
Q

What organism causes cholangiocarcinoma?

A

Clonorchis sinensis

198
Q

What is another name for Clonorchis sinensis?

A

Chinese Liver Fluke

199
Q

How do you get Clonorchiasis?

A

Ingestion of infected fish w/ larvae

200
Q

What is the Tx of Clonorchiasis?

A

Praziquantel

201
Q

What is the main characteristic in the laboratory of Clonorchiasis?

A

Eosinophilia

202
Q

What organism causes cholangiocarcinoma?

A

Clonorchis sinensis

203
Q

What is another name for Clonorchis sinensis?

A

Chinese Liver Fluke

204
Q

How do you get Clonorchiasis?

A

Ingestion of infected fish w/ larvae

205
Q

What is the Tx of Clonorchiasis?

A

Praziquantel

206
Q

What is the main characteristic in the laboratory of Clonorchiasis?

A

Eosinophilia

207
Q

What causes portal hypertension, hepatosplenomegaly, ascites and esophageal varices?

A

Schistosomiasis

208
Q

What is the definitive host of Schistosoma mansoni?

A

Snails

imagine photographer taking pics of snails (he is a mason!)

209
Q

Tx for Schistosomiasis?

A

Praziquantel

210
Q

What is the MCC of congestive hepatomegaly?

A

Right Heart Failure (H.F.)

211
Q

What are two clinical manifestations of PRE-hepatic obstruction?

A

1) portal vein thrombosis

2) ascites/varices

212
Q

Do you find hepatomegaly in pre or post-hepatic obstruction?

A

Post-hepatic!!!

213
Q

What is a cause of post-hepatic obstruction?

A

1) Budd-Chiari syndrome
2) Polycythemia vera
3) Oral Contraceptives

214
Q

What is Budd-Chiari Sx?

A

hepatic vein thrombosis

215
Q

What is the MCC of post-hepatic obstruction?

A

Polycythemia vera!

216
Q

Symmptoms of post-hepatic obstruction?

A

1) painful liver
2) congested liver
3) ascites
4) portal hypertension

217
Q

What are dead hepatocytes called?

A

Councilman Bodies

218
Q

When do we find Councilman Bodies?

219
Q

What alcoholic disease is irreversible?

220
Q

Are fatty change and alcoholic hepatitis reversible or irreversible?

A

reversible

221
Q

What are the factors of Alcholo liver disease?

A

1) amount of OH
2) duration of intake
3) more damage in females

222
Q

Where is the most important site of metabolism of OH in liver?

223
Q

What causes disulfiram reaction?

A

acetaldehyde build up

224
Q

What is disulfiram rx?

A

nausea/vomiting, flushing after ingestion of alcohol

225
Q

What drug is used in Tx of alcoholism?

A

Antabuse or Disulfiram

226
Q

What enzyme is inhibited by disulfiram?

A

an alcohol dehydrogenase

Acetaldehyde Dehydrogenase

227
Q

Where is alcohol dehydrogenase found?

A

in cytosol and mitochondria

228
Q

Why is there a build up of lactate in alcoholics?

A

high levels of NADH make pyruvate go into lactate (increases anion gap)

229
Q

Why does hypoglycemia occur in alcoholics?

A

again increase in NADH makes conversion of pyruvate to lactate
decrease in pyruvate can’t go back to gluconeogenesis

230
Q

Why is there esteatosis?

A

alcohol is converted to acetaldehyde and acetate and acetyl coA which makes free fatty acids
- increase in NADH2 favors glycerol-3-p

231
Q

What is the sequence to make TG (VLDL) from 1,3 DPG?

A

1,3 DPG to Glyceraldehyde-3-P to DHAP to Glycerol-3-P + FA makes TG

232
Q

Why is ketoacidosis sometimes present in alcoholics?

A

NADH once again favors conversion of:

Acetoacetate to B-Hydroxybutyrate (ketoacids)

233
Q

Why are alcoholics prone to gout?

A

Ketoacids and Lactic Acid compete w/ uric acid for excretion in the kidneys

so Uric Acid Accumulates!

234
Q

What is the ratio of ALT and AST in alcoholics?

A

You are an ASS because you drink

AST > ALT

235
Q

What is seen in alcoholic hepatitis?

A

mallory bodies

you will have a bad body!!

Mal (lory) Body!

236
Q

What is very characteristic microscopically?

A

fibrosis aroudn terminal hepatic venules

237
Q

MCC of obstructive jaundice?

A

stone in common bile duct

238
Q

What are the symptoms in obstructive jaundice?

A
  • hypercholesterolemia
  • light colored stools
  • urine w/ conjugated bilirubin
  • increase alkaline phosphatase (AP) and gamma-glutamyltransferas (GGT)
239
Q

What are the symptoms of primary biliary cirrhosis?

A
  • pruritus
  • increase AP and GGT
  • no jaundice until later
240
Q

What immunoglobulins and markers detect primary biliary cirrhosis?

A
  • increase anti-mitochrondrial Ab

- increase IgM

241
Q

How do you acquire primary biliary cirrhosis?

A

autoimmune, granulomatous destruction of bile ducts in triads

242
Q

What disease causes primary slcerosing pericholangitis?

A

ulcerative colitis

  • complication of
243
Q

What is the clinical picture of 1ry sclerosing pericholangitis?

244
Q

What cancer is related to 1ry sclerosing pericholangitis?

A

MCC of cholangiocarcinoma

245
Q

Name drug that causes acute hepatitis? (4)

A

1) Isoniazid
2) Halothane
3) acetaminophen
4) methyldopa

246
Q

Name two drugs that cause cholestasis?

A

1) oral contraceptives

2) anabolic steroids

247
Q

What drugs cause steatosis? fatty liver… 2

A

1) Amiodarone

2) Methotrexate

248
Q

What drug causes fibrosis in the liver?

A

methotrexate

249
Q

What drug causes angiosarcoma of the liver?

A

Vinyl Chloride

250
Q

What drug causes Liver Cell Adenoma?

A

Oral Contraceptives

251
Q

What drugs (3) causes hepatocellular carcinoma?

A

1) Vinyl Chloride
2) Aflatoxin (Aspergillus mold)
3) Thorotrast

252
Q

Can O.C. cause hepatocellular CA?

253
Q

What is fulminant hepatic failure (FHF)?

A

acute liver failure w/ encephalopathy within 8 weeks of hepatic dysfunction

254
Q

What is the MCC of FHF? (drug)

A

acetaminophen

255
Q

What is the MCC of FHF? (organism)

256
Q

Other cause of FHF?

A

Reye’s Sx

257
Q

What is hemochromatosis?

A

unrestricted reabsorption of IRON (small bowel)

258
Q

What is the mode of inheritance of hemochromatosis?

A

autosomal recessive

259
Q

What are the laboratory findings of hemochromatosis?

A
  • increase serum iron
  • decrease TIBC
  • increase % saturation
  • increase serum ferritin
260
Q

What is the best screening test?

A

increase serum ferritin

261
Q

What are the manifestations of hemochromatosis?

A
  • bronze skin
  • pancreas (malabsorption and DM)
  • restrictive cardiomyopathy
  • liver anormalities including hepatocellular CA in 30%
262
Q

What is the Tx of hemochromatosis?

A

phlebotomy

263
Q

What is Wilson’s Dz?

A

defect in Copper (Cu+) secretion into bile

  • bile is Copper deficient

or

  • defect in synthesis of ceruloplasmin
264
Q

What is ceruloplasmin?

A

protein that binds to Copper

low ceruloplasmin so can’t bind Copper
- so increase of Cu in blood

265
Q

What are some of the clinical manifestations of Wilson’s Dz?

A

Kayser-Fleishcher rings in eye

266
Q

What is the Tx of Wilson’s Dz?

A

penicillamine

267
Q

What nuclei is attacked in Wilson’s Dz?

A

lenticular nuclei degeneration

268
Q

What are the symptoms of degeneration of the lenticular nuclei?

A
  • chorea
  • rigidity
  • basal ganglia dementia
269
Q

What part of the eye is affected w/ Kayser-Fleischer rings?

A

outer part of decemet

cornea

270
Q

What organism causes chorioamnionitis?

A

Step. agalactiae

271
Q

When does pre-eclampsia and eclampsia occur? trimester…

A

3rd trimester

272
Q

What is the Diagnosis if pregnant woman presents w/ pre-eclampsia in first trimester?

A

hydatidiform mole

273
Q

What two substances are increased in pre-eclampsia?

A

Angiotensin II

TXA2

274
Q

What substances are decrease in pre-eclampsia?

A

PGE1 and NO

275
Q

What are two substances in pre-eclampsia that are vasoconstrictors?

A

Angiotensin II

TXA2

276
Q

What two substances are vasodilators in pre-eclampsia?

277
Q

Tx for Eclampsia?

A

Magnesium Sulfate

278
Q

What is the clinical presentation of pre-eclampsia?

A

hypertension
proteinuria
pitting edema

279
Q

What is the clinical picture of eclampsia?

A

same as pre-eclampsia but w/ seizures or convulsions

280
Q

Should BUN be increase or decreased in normal pregnancy?

A

decreased in normal pregnancy

281
Q

Should GFR be increased or decreased in normal pregnancy?

282
Q 
What do we find in lab. for pre/eclampsia? BUN
Uric Acid
Serum Creatinine
GFR
transaminases
A 
BUN increased
uric acid increased
creatinine increased
GFR decreased
transaminases increased

Schistocytes/anemia/thrombocytopenia

283
Q

What kind of plancenta do Siamese twins have?

A

Monochorionic Monoamniotic planceta

USMLE (13 decks)

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