Quizlet(41) 4v4u1u

USMLE Step 2 Rapid Review Study online at quizlet.com/_3ev9x6 1.

Abdominal pain, ascites, hepatomegaly

5.

Bilateral acoustic schwannomas

Budd-Chiari Syndrome (posthepatic venous thrombosis, can be related to Polycythemia vera) 2.

Achilles tendon Xanthoma

occur in cerebellopontine angle, S100 marker 6.

Familial Hyper cholesterolemia (low LDL receptor signaling) AD 3.

Neurofibromatosis type 2

7.

Adrenal hemorrhage, hypotension, DIC

Bilateral hilar adenopathy, uveitis, high ACE, hypercalcemia (activated macrophages for Vit D), interstitial fibrosis, erythema nodosum, high CD4

Sarcoidosis (non-caseating granulomas)

Black eschar on face of patient with diabetic ketoacidosis

Mucor or Rhizopus fungal infection Travels through cribiform plate vessels 8.

Blue sclera

Waterhouse-Frieerichsen syndrome (Neisseria meningitidis) 4.

Arachnodactyly (spider fingers), lens dislocation, aortic dissection or aneurysm, hyperflexible ts, pectus excavatum

Osteogenesis Imperfecta (Type I collagen defect forming triple helix) Blue due to exposure of choroidal veins

Marfan Syndrome (fibrillin defect) AD

9.

Bluish line on gingiva and basophilic stippling

12.

Cafe-au-lait spots, Lisch nodules (iris hemartoma), cutaneous neurofibromas

Burton line (lead poisoning) Basophilic stippling (rRNA remnants) Constipation, anemia, CNS impairment 10.

Bone pain, bone enlargement (hat size or hearing loss), arthritis

Neurofibromatosis Type I, pheochromocytoma, optic gliomas 13.

Paget disease of bone (Increased osteoclastic, then osteoblastic activity)

Cafe-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

Osteosarcoma or heart failure 11.

"Butterfly" facial rash or discoid rash and Raynaud phenomenon in a young female

14.

Systemic lupus erythematosus Type III Hypersensitivity (antigenantibody complexes deposit) with glomerulonephritis Type II hypersensitivity with autoimmune hemolysis

McCune-Albright syndrome (mosaicism, G-protein signaling mutation)

Calf pseudohypertrophy

Muscular dystrophy (Duchenne, due to X-linked frameshift > truncated dystrophin) Dilated cardiomyopathy (DCM) High CK

15.

Cervical lymphadenopathy, desquamating rash on palms and soles, coronary aneurysms, red conjuctivae, and strawberry tongue

18.

Chest pain, pericardial effusion/friction rub, persistent fever following MI (weeks later)

Dressler syndrome (autoimmune mediated post-MI fibrinous pericarditis, 2-12 weeks after acute episode)

Kawasaki disease (treat with IVIG and aspirin which inhibits TXA2) 16.

"Cherry-red spots" on macula

19.

Chest pain with ST depressions EKG

20.

Child with fever later develops red rash on face that spreads to body

Subendocaridal ischemia Unstable angina (troponins -, reversible) and NSTEMI (troponins +, irreversible)

Tay-Sachs (ganglioside accumulation NO hepatosplenomegaly) "Slapped cheeks" (Erythema infectiosum/fifth disease: parvovirus B19) Single-stranded DNA virus Aplastic Anemia in Sickle Cell, Bthalessemia

Niemann-Pick (sphingomyelin accumulation w/ hepatosplenomegaly) Central retinal artery occlusion 17.

Chest pain on exertion

Angina stable: with moderate exertion, cellular swelling indicates reversibility, atherosclerosis; unstable: with minimal exertion or at rest, partial occlusion

21.

Chorea, dementia, caudate degeneration

Huntington disease (AD, CAG repeat expansion) Hemiballismus caused by subthalamic nuclei (STN) Loss of GABAergic neurons

22.

Chorioretinitis, hydrocephalus (CSF acculmulation > UMN injury), intracranial calcifications

26.

Continuous "machinelike"heart murmur

PDA (close with indomethacin; open or maintain with PGE analogs) Congenital Rubella Late cyanosis in lower extremity failure of branchial arch 6

Congenital Toxoplasmosis 23.

Chronic exercise intolerance with myalgia, painful cramps, myoglobinuria, arrythemia

27.

Cutaneous/dermal edema due to connective tissue deposition

AR McArdle disease (skeletal muscle glycogen phosphorylase deficiency) -defect in anaerobic glycogen metabolism 24.

25.

Cold intolerance, weight gain, bradycardia, facial myxedema, hypercholesterolemia

Myxedema

Hypothyroidism

(caused by hypothyroidism, Graves disease [pretibial])

Dx: Thyroxine (T4) 28.

Conjugate horizontal gaze palsy, horizontal diplopia

Cutaneous flushing, diarrhea, bronchospasm

Internuclear opthalmoplegia (damage to MLF; may be unilateral or bilateral)

Carcinoid syndrome (right-sided cardiac valvular fibrous lesions, Increased 5-HIAA in urine, 5-HT in serum) Requires mets from GI to liver

29.

Dark purple skin/ mouth nodules in a patient with AIDs

30.

Deep, labored breathing/hypoventilation

31.

Mild = glossitis Severe = Broad collar Dermatitis, dementia, diarrhea,

34.

Dysphagia (esophageal webs), glossitis (beefy red tongue), iron deficiency anemia (spoon nails)

Kaposi Sarcoma, associated with HHV-8 Endothelial cell tumor, not of blood vessels (will not blanche) 35. Elastic skin, Spindle cells hyper-mobility of Spreads via blood ts, increased Kussmaul respirations (diabetic bleeding ketoacidosis) tendency Pellagra (Niacin [B3] Deficiency) Caused by Hartnups (dec trp met) or Isoniazid drug (decr B6) over dependence of corn as a staple food

32.

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

Ehlers-Danlos syndrome (type V collagen defect, type III collagen defect seen in vascular ED)

Dilated cardiomyopathy, edema, alcoholism or malnutrition

Pro collagen molecules are not cleaved (N/C removal impaired) 36.

Enlarged, hard left supraclavicular node

Wet Beriberi (Thiamine [B1] Deficiency) 33.

Dry eyes, dry mouth, arthritis, recurrent dental caries

Virchow node (abdominal metastasis) 37.

Episodic vertigo, tinnitus, hearing loss

Sjogren syndrome (autoimmune destruction of exocrine glands) Can have RF, Anti-SSA or SSB Lymphocytic sialadenitis Risk of B-cell lymphoma Meniere disease: excess of endolymph fluid in the inner ear

38.

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells

41.

Fibrous plaques in soft tissue of penis with abnormal curvature

Mycosis fungoides (Pautrier-cutaneous T-cell lymphoma) or Sezary syndrome (mycosis fungoides and malignant T cells with cerebriform nuclei in blood) 39.

Fever, chills, headache, myalgia following antibiotic treatment for syphilis

Peyronie disease (connective tissue disorder) 42.

Golden brown rings around peripheral cornea

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in endotoxin release) 40.

Fever, cough, conjunctivitis, coryza, diffuse rash

Kayser-Fleischer rings (copper accumulation from Wilson disease, check ceruloplasmin) Risk of basal Ganglia atrophy

(coryza = rhinitis = irritation and inflammation of the mucous membr in the nose)

43.

Measles (rubeola) Koplik spots (white lesions on buccal mucosa) Risk of subacute sclerosing panencephalitis (viral inclusions in white and gray matter) Fusion protein and HA (Hemagglutinin for binding) virulence factors

Gout, intellectual disability, selfmutilating behavior in a boy

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive) Build up of hypoxanthine and guanine Urate crystals on UA

44.

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands/genitalia

47.

Hyperphagia, hyper-sexuality, hyperorality, hyperdocility

Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction, increased cancer risk-mainly GI) 45.

Kluver-Bucy Syndrome (bilateral amygdala lesion)

Hepatosplenomgaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises in child

48.

Hyporeflexia, hypotonia, atrophy, fasciculations

LMN Damage 49. Hypoxemia, Gaucher disease macrophage polycythemia, (glucocerebrosidase deficiency) hypercapnia

#1 lysosomal storage disease Build up of glucocerbroside "Crinkled tissue paper cells" 46.

Hereditary nephritis, sensorineural hearing loss, cataracts in boys

"Blue bloater" (chronic bronchitis: hyperplasia of mucous cells) Clinical diagnosis from productive cough in 3+ months in at least 2 consecutive years Alport syndrome (mutation in collagen 50. Indurated, IV) ulcerated genital X-linked lesion Irregular thickening of GBM Basket Weave (thinning) on EM Isolated hematuria

Nonpainful: chancre (syphyilis) Painful, exudate: chancroid (Haemophilus ducreyi)

51.

Infant with "cherryred" spot on macula, hepatosplenomegaly, and neurodegeneration

54.

Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Niemann-Pick disease (genetic sphingomyelinase deficiency) Foam cells 52.

Infant with cleft lip/palate, microcephaly or holoprosencephaly (1 hemisphere), polydactyly, cutis aplasia

Edwards Syndrome (trisomy 18) Mnemonic: E=election age at 18 55.

Jaundice, palpable distended nontender gallbladder

Courvoisier sign (distal obstruction of biliary tree)

56.

Male child, recurrent bacterial and enterovirus/giardia (lack of IgA) infections after 6 months of life, no mature B cells

Bruton tyrosine kinase disease (X-linked agammaglobulinemia) Lack of immunoglobulin, Tx: IVIG

57.

Mucosal bleeding and prolonged bleeding time

Patau syndrome (Trisomy 13) Mnemonic: P=puberty at 13 53.

Infant with hypoglycemia, hepatomegaly (glycogen in liver), AR

Glanzmann thrombasthenia Cori disease III (debranching enzyme deficiency) Von Gierke disease IV (glucose-6phosphate deficiency in ER, more severe with increased blood lactate)

(defect in platelet aggregation due to lack of GpIIb/IIIa) 58.

Muffled heart sounds, distended neck veins, hypotension

Beck triad of cardiac tamponade AND PULSUS PARADOXUS

59.

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

62.

No lactation postpartum, absent menstruation, cold intolerance, loss of pubic hair

Sheehan syndrome (pituitary infarction) 63.

Multiple sclerosis

Gardner syndrome (subtype of FAP) 60.

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Type IV hypersensitivity Dx: Oligoclonal IgG bands and periventricular plaques on MRI 64.

AR Pompe disease II (lysosomal alpha1,4-glucosidase deficiency)

Painful blue fingers/toes, hemolytic anemia

Can't breakdown lysosomes to release glycogen in liver or muscle (PAS+) Sudden death in young athletes Differential: Myocete disarray (B-myosin heavy chain or myosin-binding protein C mutation) Tx: replace enzyme 61.

Neonate with arm paralysis following difficult birth

65.

Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)

Painful fingers/toes changing color from blue to white to red with cold or stress

Raynaud phenomenon (vasospasm in extremities)

66.

Painful, raised red lesions on pads of fingers/toes

69.

Palpable purpora on buttocks/legs, t pain, abdominal pain (child), hematuria (IgA nephropathy)

Osler nodes (infective endocarditis, immune complex deposition) 67.

Painless erythameatous lesions on palms and soles

Henoch-Schonlein purpura (IgA immune complex deposition, vasculitis effecting skin and kidneys) 70.

Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia

71.

Pink complexion, dyspnea, hyperventilation

Janeway lesions (infective endocarditis, septic emboli/microabscesses) 68.

Nephrotic syndrome

Painless jaundice

"Pink puffer" (emphysema: centracinar [smoking], panacinar [alpha-1 antitrypsin deficiency]) 72.

Cancer of the pancreatic head obstructing the bile duct

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances (overexcretion of everything), hypophosphatemic rickets

Fanconi syndrome (multiple combined dysfunction of the PCT)

73.

Pruritic, purple, polygonal planar papules and plaques - Lichen planus

79.

Sawtooth infilitrate of lymphocytes at dermal-epidermal junction Hep C association 74.

Ptosis, miosis, anhidrosis (no sweating)

Red "currant jelly" sputum in alcoholic or diabetic patients

Klebsiella pneumonia 80.

Red "currant jelly" stools

81.

Red, itchy, swollen rash of nipple/areola

Acute mesenteric ischemia (adults), intussusception (children)

Paget disease of the breast (sign of underlying neoplasm) 82.

Red urine in the morning, fragile RBCs, risk of thrombosis and AML, hemosiderosis (iron deposition)

83.

Renal cell carcinoma (bilateral), hemangioblastomas in retina/spine, angiomatosis, pheochromocytoma

Horner syndrome (sympathetic chain lesion) 75.

76.

Pupil accommodates but doesn't react

Argyll Roberson pupil (neurosyphilis)

Rapidly progressive limb weakness that ascends following GI/upper respiratory infection

Paroxysmal nocturnal hemoglobinuria DAF (GPI-anchor) deficiency due to myeloid stem cell Acidosis at night, activates complement Dx: CD55 (DAF) Tx: Eculizumab

von Hippel-Lindau disease (dominant tumor suppressor gene mutation) Guillain-Barre syndrome Autoimmune > molecular mimicry

77.

Rash on palms and soles

Coxsackie A, Secondary syphilis, Rocky Mountain spotted fever

78.

Recurrent cold (noninflamed) abscesses, unusual eczema, high serum IgE, primary teeth

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality) STAT3 mutation > low Th17

84.

Resting tremor, rigidity, akinesia, postural instability, shuffling gait Parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)

85.

Retinal hemorrhages with pale centers

Roth spots (bacterial endocarditis)

86.

Severe jaundice in neonate

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia) Absent liver conjugation enzyme AR - lack of UGT enzyme

87.

Severe RLQ pain with palpation of LLQ

Rovsing sign (acute appendicitis) Fecaliths block lumen > bacterial infection

88.

Severe RLQ pain with rebound tenderness

McBurney's sign (acute appendicitis) Fecaliths block lumen > bacterial infection

89.

Short stature, cafe au lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia

92.

Skin hyperpigmentation, hypotension, fatigue

Primary Adrenocortical insufficiency (e.g., Addison disease) causes increased ACTH and increased alpha-MSH production (skin pigment from POMC) TB is most common cause in developing 93.

Slow, progressive muscle weakness in boys

Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML) 90.

Single palmar crease, epicanthal folds, excess skin at neck, protruding tongue, upslanting palpebral fissures, ostium PRIMUM ASD (inferior part), duodenal atresia

Becker muscular dystrophy (X-linked missense mutation in dystrophin, less severe than Duchenne) 94.

Small, irregular red spots on buccal/lingual mucosa with bluewhite centers

Down syndrome (trisomy 21), VSD > 50% 91.

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Koplik spots (measles, rubeola) Vitamin A reduces morbidity Virulence: HA and Fusion protein

Kartagener syndrome (dynein arm defect affecting cilia)

95.

Smooth, moist, painless, wart-like white lesions on genitals

99.

Gout/podagra (hyperuricemia monosodium urate) Precipitated by alcohol or meat (compete with uric acid for excretion in kidney)

Condylomata lata (secondary syphilis) 96.

100.

Splinter hemorrhages in fingernails

Sudden swollen/painful big toe t, tophi

Swollen gums, mucosal bleeding, poor wound healing, petechiae, corkscrew hair

Scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis) Ascorbic Acid

Bacterial endocarditis 97.

"Strawberry tongue" 101.

Swollen, hard, painful finger ts

Scarlet fever, Kawasaki disease 98.

Streak ovaries, congenital heart disease (aortic dissection or bicuspid aortic valve), horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

Osteoarthritis Heberden's nodes are Higher up (DIP) Bouchard's nodes are close to the Body (PIP) Spares M 102.

Turner Syndrome (45 X,O)

Systolic ejection murmur (crescendodecrescendo)

Aortic stenosis

103.

Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

108.

Osler-Weber-Rendu syndrome or Hereditary Hemorrhagic Telangectasia 104.

Vomiting blood following gastroesophageal lacerations

Mallory Weiss syndrome (alcoholic and bulimic patients) 109.

Toe extension/fanning upon plantar scrape

Weight loss, diarrhea, arthritis, fever, lymphadenopathy

Babinski sign (UMN lesion) 105.

Unilateral facial drooping involving forehead

Whipple disease (Tropheryma whipplei) 110.

"Worst headache of my life"

Subarachnoid hemmorhage LMN facial nerve (CN VII) palsy, UMN lesion will spare the forehead 106.

Urethritis, conjunctivitis, arthritis in a male

107.

Vascular birthmark (portwine stain) of the face

111.

Anticentromere antibodies

Reactive arthritis associated with HLAB27

Limited Scleroderma (CREST) to fingers and face Nevus flammeus (benign but associated with Sturge-Weber syndrome > GNAQ gene, seizures, glaucoma, retardation)

112.

Anti-desmoglein (epithelial) antibodies

117.

Antineutrophil cytoplasmic antibodies (ANCAs)

Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Asthma>Churg-Strauss syndrome) (MPOANCA/p-ANCA); granulomatosis with polyangiitis (NOSE effected Wegener; PR3ANCA/c-ANCA)

Pemphigus vulgaris (blistering) 113.

Anti-glomerular basement membrane antibodies 118.

Antinuclear antibodies (ANAs: antiSmith (snRNPs) and anti-dsDNA)

Goodpasture syndrome (glomerulonephritis and hemoptysis) Linear pattern 114.

115.

Antihistone antibodies

Drug-induced SLE (e.g., hydralazine, isoniazid, phenytoin, procainamide) No renal or CNS involvement

Rheumatoid factor (IgM antibody that targets IgG Fc region), anticyclic citrullinated peptide (AntiC) antibody Rheumatoid arthritis (pannus which contracts > boutonniere deformity, spares DIP) Tx: methotrexate, TNF-alpha inhibitors

116.

Antimitochondrial antibodies (AMAs)

Primary biliary cirrhosis (female, cholestasis, portal hypertension) Vitamin ADEK deficiency

SLE (type III hypersensitivity) ds-DNA can give prognosis for renal failure 119.

Antiplatelet antibodies (IgG Antibodies to GpIIb/IIIa)

Idiopathic thrombocytopenic purpura (ITP) Increased megakaryocytes, low platelets Acute: post viral infection or immunization in kids, self-limited Chronic: SLE > can cross placenta Tx: IVIG, stall spleen from eating platelets, or splenectomy (source of antibody and destruction site)

120.

Anti-Scl-70 (anti-DNA topoisomerase I)

124.

Azurophilic peroxidase + granular peroxidase + inclusions in granulocytes and myeloblasts

Auer rods - MPO (AML, especially the promyelocytic [M3 or APML] type) t(15;17) -Retinoic Acid receptor disrupted

Diffuse systemic scleroderma Pulmonary and Kidney complications cause death 121.

125.

Antitransglutaminase/antigliadin/antiendomysial antibodies

PYR response

Positive: S. pyogenes (group A); Negative: S. galactiae (group B) Celiac Disease (Diarrhea, weight loss) 126. "Bamboo spine" Increased lymphocytes on x-ray 122.

"Apple core" lesion on barium enema x-ray

Colorectal cancer (usually left-sided) 123.

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27) Risk of aortitis and Aortic Regurgitation

Atypical lymphocytes (Reactive CD8+) 127.

Basophilic nuclear remnants in RBCs

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

EBV in oropharynx, liver, and b cells

128.

"Boot shaped heart" on x-ray

132.

Tetralogy of Fallot 1) stenosis of RV outflow 2) VSD 3) Overriding aorta 4) RV hypertrophy Squatting increases preload, and more blood goes to lung 129.

Dilated Cardiomegaly with apical atrophy

Chagas disease (Trypanosoma cruzi) 133.

Branching grampositive rods with sulfur granules (anaerobic)

Cellular crescents (fibrin and macrophages) in Bowman capsule

Rapidly progressive crescentic glomerulonephritis (RPGN), including goodpastures and granulomatosis with polyangiitis and microscopic polyangiitis Type II hypersensitivity, C3b and fibrin crescents

Actinomyces israelii 130.

Bronchogenic apical lung tumor on imaging

134.

"Chocolate cyst" of ovary

Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome) 131.

"Brown" tumor of bone Endometriosis (frequently involves both ovaries), normal uterus size (as opposed to adenomyosis which would have symmetrically enlarged uterus) Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color) Stones, bones, groans, psychiatric overtones Increased Alk Phos and cAMP

135.

Circular grouping of dark tumor cells surrounding pale neurofibrils, high mitotic index

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

136.

Colonies of mucoid Pseudomonas in lungs

141.

Desquamated epithelium casts in sputum

CF or CGD (catalase +) 137.

138.

Decrease in AFP in amniotic fluid/maternal serum

Down Syndrome (21) or Edwards (18) 18: low B-HCG and inhibin A 21: high b-HCG and inhibin A

143.

"Delta wave" on EKG, short PR interval, supraventricular tachycardia

Disarrayed cuboidal granulosa cells arranged around collections of eosinophilic fluid

Call-Exner bodies (granulosa cell tumor of the ovary, secrete estrogen), can be seen with coffee bean nuclei

Dysplastic squamous cervical cells with "raisinoid" nuclei and hyperchromasia

Koilocytes (HPV: predisposes to cervical cancer) WPW syndrome (Bundle of Kent byes AV node)

140.

142.

Degeneration of dorsal column fibers

Tabes Dorsalis (tertiary syphilis), B12 subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected) 139.

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

144.

Depigmentation of neurons in substantia nigra

Electrical alternans (alternating amplitude on EKG)

Pericaridal tamponade 145.

Enlarged cells with intracellular inclusion bodies

Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

"Owl eye" appearance of CMV

146.

Enlarged thyroid cells with ground-glass nuclei with central clearing

150.

"Orphan Annie" eyes (papillary carcinoma of the thyroid) with Psammoma bodies 147.

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Negri bodies of rabies 151.

Eosinophilic cytoplasmic inclusion in liver cell (wiggle shape)

Extracellular amyloid deposition in gray matter of brain

Mallory Body (alcoholic liver disease) 148.

Eosinophilic cytoplasmic inclusion in nerve cell

Senile plaques (Alzheimer disease), Bamyloid (from B-APP) Also with neurofibrillary tangles of intracellular hyperphospholyated taue 152.

Giant B cells with bilobed nuclei with prominent inculsions ("owl's eye")

Lewy Body (parkinson disease) Alpha-synuclein defect 149.

Eosinophilic globule in liver

Reed-Sternberg cells (Hodgkin Lymphoma) CD15 and CD30+ 153.

Glomerulus-like structure surrounding vessel in germ cells, in kids

Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis Schiller-Duval bodies (yolk sac tumor) High AFP

154.

"Hair on end" ("Crew-cut") appearance on xray

158.

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

B-thalassemia, sickle cell disease (marrow expansion) 155.

hCG elevated

Choriocarcinoma (spreads VERY fast in blood) Hydatidiform mole (occurs with and without embryo, and multiple pregnancy) Acts like FSH, LH, TSH (FLalphaT) Down's syndrome 156.

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules) 159.

High level of Ddimers

160.

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

DVT, PE, DIC BUT not radical prostateectomy or liver cirrhosis

Ghon complex, primary TB 161.

"Honeycomb lung" on x-ray or CT

Heart nodules (granulomatous)

Interstitial pulmonary fibrosis 162.

Aschoff bodies (rheumatic fever) AKA granuloma with giant cells and antischkow cells 157.

Hypercoagulability (leading to migrating DVTs and vasculitis)

IgM Heterophile antibodies (horse/sheep)

Trousseau syndrome (adenocarcinoma of pancreas or lung) Infectious mononucleosis (EBV)

163.

Hypersegmented neutrophils

Megaloblastic anemia: B12 deficiency: subacute combined degeneration of spinal cord (dorsal column and lateral corticospinal tracts), high MMA Folate deficiency: no neurologic symptoms, glossitis) 164.

Hypertension, hypokalemia, metabolic alkalosis

165.

Hypochromic, microcytic anemia

167.

Increased uric acid levels

168.

Intranuclear eosinophilic droplet-like bodies

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

Cowdry type A bodies (HSV or VZV) 169.

Iron-containing nodules in alveolar septum

Conn syndrome (primary hyperaldosteronism) Albumin (-) binds Ca++ leading to hypocalcemia > muscle weakness, parasthesias, cramps Ferruginous bodies (asbestosis: mesothelioma < bronchogenic carcinoma) 170.

Keratin pearls on a skin biopsy

Iron deficiency anemia, lead poisoning, sideroblastic anemia, thalassemia (fetal hemoglobin sometimes present) 166.

Increased AFP in amniotic fluid/maternal serum

Squamous cell carcinoma Precursor: actinic keratosis Immunsuppressives and arsenic poisoning Lower lip

Dating error, anencephaly, spina bifida (neural tube defects - posterior vertebral arch- low folic acid)

171.

Large granules in phagocytes, recurrent infections, albinism (silver hair), peripheral neuropathy, nystagmus, pancytopenia

175.

"Lumpy bumpy" or "stary sky" appearance of glomeruli on immunofluorescence, sub-epithelial bump on EM

Chediak-Higashi disease ( AR failure of microtubule phagolysosome fusion) 172.

Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3 :. Type III ) 2 weeks after GAS Anti-DNase B titers, low complement levels Worse prognosis if older in age (RPGN)

"Lead pipe" appearance of colon on abdominal imaging

176.

Lytic ("punched-out") bone lesions on xray (activated RANK by plasma cells)

Ulcerative colitis (loss of haustra) With Crypt abscesses and ulcers 173.

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

Multiple myeloma Bence Jones bodies and Rouleaux formation High IL-6 177.

Mammary gland ("blue domed") cyst

Goodpasture syndrome (Ab against collagen in lung and kidney) 174.

Low serum ceruloplasmin

Fibrocystic change of the breast

Wilson disease (hepatolenticular degeneration) Basal Ganglia Atrophy

178.

Monoclonal antibody spike

183.

Nodular eosinophilic hyaline deposits in glomeruli

Multiple myeloma (usually IgG or IgA) Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) Waldenstrom (M protein = IgM lymphoma) macroglobulinemia with visual defects and bleeding 179.

Mucin-filled cell with peripheral nucleus

Kimmelstiel-Wilson nodules (diabetic nephropathy) By Nonenzymatic glycosylation of GBM and efferent arterioles 184.

Novobiocin response

"Signet ring" (gastric carcinoma) 180.

Narrowing of bowel lumen on barium x-ray

Sensitive: S. epidermidis; resistant: S. saprophyticus 185.

Chronic ive congestion of liver due to RHF or Budd-Chiari syndrome

"String sign" (Crohn disease) 181.

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

182.

Needle-shaped, negatively birefringent crystals

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA WITH NOSE) and Goodpasture syndrome (Anti-basement membrane antibodies)

"Nutmeg" appearance of liver

186.

"Onion-skin" periosteal reaction

Ewing sarcoma (malignant small blue cell tumor) Spreads via blood t(11,22) Derived from neuroectoderm

Gout (monosodium urate crystals)

187.

Optochin response

191.

Protein aggregates in neurons from hyperphosphorylation of tau protein

Sensitive: S. pneumoniae; resistant: viridans streptococci (S. mutans, S. sanguis) 188.

Periosteum raised from bone, creating a triangular area

Neurofibrillary tangles (Alzheimer disease) and Pick silver-staining spherical tau bodies (Pick diseasefrontal/temporal dementia) 192.

Psammoma bodies (with whorled cells)

Codman triangle on x-ray, osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis 189.

Podocyte fusion or "effacement" on electron microscopy by cytokines, selecitve proteinuria (loss of albumin only)

Meningiomas Papillary thyroid carcinoma Mesothelioma Papillary serous carcinoma of the endometrium/ ovary 193.

Pseudopalisading tumor cells on brain biopsy (necrosis with vascular proliferation)

Glioblastoma multiforme Adults, GFAP, malignant Minimal change disease (child with nephrotic syndrome) Associated with hodgkin's (RS produce cytokines) Tx: steroids 190.

194.

RBC casts in urine

Polished, "ivorylike" appearance of bone at cartilage erosion Eburnation (osteoarthritis resulting in bony sclerosis) Spares M

Glomerulonephritis

195.

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

200.

Reinke crystals (Leydig cell tumor > precocious puberty in boys, hirsutism in women) 196.

Recurrent infections, eczema, thrombocytopenic purpura

Wiskott-Aldrich syndrome (WASP xlinked protein, T-cells don't recognize cytoskeleton)

197.

Renal epithelial casts in urine

Intrinsic renal failure (e.g., ischemia or toxic injury)

198.

Rhomboid crystals, positively birefringent

Ring-enhancing brain lesion in AIDS

Toxoplasma gondii, CNS lymphoma 201.

Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages ("starry sky" histology) Burkitt lymphoma (t[8:14] c-myc activation, associated with EBV; "starry sky" made up of malignant cells)

202.

Silver-staining spherical aggregation of tau proteins in neurons, frontotemporal

Pseudogout (calcium pyrophosphate dihydrate crystals) 199.

Pick bodies (Pick disease: progressive dementia, changes in personality, fronto-temporal only)

Rib notching 203.

Coarctation of the aorta, HTN in upper extremities

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign) Only tumor that arises in epiphysis

204.

"Spikes" on basement membrane, "dome-like" subepithelial deposits

208.

Streptococcus bovis bactermia

209.

"Tennis racket" shaped cytoplasmic organelles (EM) in Langerhans cells

Membranous Nephropathy GBM thickening and immune complex deposits (granular IF) SLE, solid tumors, PLA2R Abs, NSAIDs, HepB/C and #1 in Caucasians Loss of ATIII > Renal vein thrombosis 205.

Birbeck granules (Langerhans cell histiocytosis) CD1a+ and S-100+ Presents as lytic bone lesions or recurrent otitis media in children

Stacks of RBCs

210.

Thousands of polyps on colonscopy

Rouleaux formation (high ESR, multiple myeloma) High IgG light chain (excreted as bencejones proteins) with risk of amyloidosis 206.

Colon cancer

Familial adenomatous polposis (Autosomal dominant, mutation of APC gene)

"Steeple" sign on CXR 211.

Thrombi made of white/red layers

Lines of Zahn (arterial thrombus, layers of fibrin/RBCs) Croup (parainfluenza virus) Seal Bark Cough, Inspiratory Stridor Virulence: HA, NA, Fusion Protein 207.

212.

"Thumb sign" on lateral neck x-ray

Stippled vaginal epithelial cells

Epiglottitis (Haemophilus influenzae) "Clue cells" (Gardnerella vaginalis (anaerobic)

213.

Thyroid-like appearance of kidney, mimics colloid (proteinaceous material)

217.

WBC casts in urine

Acute pyelonephritis Chronic pyelonephritis (usually due to recurrent infections) 214.

WBCs that look "smudged"

"Tram-track" appearance of capillary loops of glomerular basement membranes on light microscopy PAS stain

CLL (almost always naive B cell) Warm or cold agglutinin CD5+ and CD20+ Membranoproliferative glomerulonephritis Type 1: Subendothelial immune complex deposits with granular IF, Hep B and Hep C Type 2: deposits in BM, C3 nephritic factor (c3 convertase always on)

215.

218.

219.

"Wire loop" glomerular capillary appearance on light microscopy

Triglyceride accumulation in liver cell vacuoles

Diffuse proliferative glomerulonephritis (usually seen with lupus) Granular IF and subendothelial C3 and IgG Immune complex deposistion on EM 220.

Yellowish CSF

Fatty liver disease (alcoholic or metabolic syndrome) 216.

"Waxy" casts with very low urine flow

Chronic end-stage renal disease

Xanthochromia (e.g., due to subarachnoid hemorrhage) Anterior circle of willis (anterior communicating artery) Associated with Marfan and ADPKD 221.

Absence seizures tx

Ethosuximide

222.

Acute gout attack tx

NSAIDs, colchicine, glucocorticoids

223.

Acute promyelocytic leukemia (M3) tx

All-trans retinoic acid

224.

ADHD tx

Methylphenidate, CBT, atomoxetine

225.

Alcoholism tx

Disulfiram, acamprosate, naltrexone, ive care

226.

Alcohol withdrawl tx

Long-acting benzodiazepines (chlordiazepoxide)

227.

Anorexia tx

Nutrition, psychotherapy, mirtazapine

228.

Anticoagulation during pregnancy tx

Heparin

229.

Arrhythmia in damaged cardiac tissue tx

230.

231.

Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat)

240.

Class IB antiarrhythmic (lidocaine, mexiletine)

Chronic hepatitis B or C tx

IFN-alpha (HBV and HCV); ribavirin, simeprevir, sofosbuvir (HCV)

241.

Imatinib

B12 deficiency tx

Vitamin B12 supplementation (work up cause with Schilling test)

Chronic myelogenous leukemia tx

242.

Antitoxin

Benign prostatic hyperplasia tx

Alpha-1 antagonists (terazosin, also good for HTN) 5alpha-reductase inhibitors (finasteride) PDE-5 inhibitors (sildenafil)

Clostridium botulinum tx

243.

Clostridium difficle tx

Oral metronidazole; if refractory, oral vancomycin

244.

Clostridium tetani tx

Antitoxin

245.

CMV tx

Ganciclovir, foscarnet, cidofovir

246.

Crohn disesae tx

Corticosteroids, infliximab, azathoiprine

247.

Cryptococcus neoformans tx

Fluconazole (in AIDs pts)

248.

Cyclophosphamideinduced hemorrhagic cystitis tx

Mesna

249.

Depression tx

SSRIs (first line)

250.

Diabetes insipidus tx

Desmopressin (central); HCTZ, indomethacin, amiloride (nephrogenic)

251.

DM type I treatment

Dietary intervention (low carb) + insulin replacement

252.

DM type II treatment

Dietary intervention, oral hypoglycemics, and insulin (if refractory)

253.

Diabetic ketoacidosis tx

Fluids, insulin, K+

254.

Enterococci tx

Vancomycin, aminopenicillins/cephalosporins

255.

Erectile dysfunction tx

Sildenafil, tadalafil, vardenafil (Phosphodiesterase inhibitors that decrease degradation of cGMP > relax smooth muscle and increase blood flow)

Breast cancer in postmenopausal woman tx

Aromatase inhibitor (anastrozole)

234.

Buerger disease tx

Smoking cessation

235.

Bulimia nervosa tx

SSRIs

236.

Candida albicans tx

Topical azoles (vaginitis); nystatin, fluconazole, caspofungin (oral/esophageal): fluconazole, caspofungin, amphotericin B (systemic) 237.

Doxycycline (+ ceftriaxone for gonorrhea coinfection), erythromycin eye drops (prophylaxis in infants) Chronic gout tx

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine, atypical antipsychotics)

233.

Chlamydia trachomatis tx

239.

Bipolar disorder tx

232.

238.

Carcinoid syndrome tx

Octreotide

256.

ER + breast cancer tx

Tamoxifen

269.

Immediate anticoagulation tx

Heparin

257.

Ethylene glycol (causes ATN)/methanol intoxication tx

Fomepizole (alcohol dehydrogenase inhibitor) 270.

Infertility tx

Leuprolide, GnRH (pulsatile), clomiphene

258.

Haemophilus Influenzae (B) tx

Rifampin (prophylaxis)

271.

Influenza tx

Oseltamivir, zanamivir Reassortment ability due to segmented nature

259.

Generalized anxiety disorder tx

SSRI, SNRI (first line), buspirone (second272. Kawasaki line) disease tx

260.

Granulomatosis with polyangiitis (Wegener) tx

273.

Legionella pneumophila tx

Cyclophosphamide, corticosteroids Large necrotizing granulomas 261.

HER2/neu + breast cancer tx

Trastuzumab Hyperaldosteronism tx

Spironolactone

263.

UTI

E. coli, Staphylococcus saprophyticus (young women) Tx: Bactrim, Ciprofloxacin

264.

Vertebral compression fracture

Osteoporosis (type I: postmenopausal, type II: elderly man or woman) NORMAL Labs (PTH, Ca++ etc)

265.

Viral encephalitis affecting temporal lobe

HSV-1

266.

Vitamin Deficiency (U.S.)

Folate (pregnant women at high risk, body stores only 3-4 month supply, prevents neural tube defects) High homocysteine, normal MMA

262.

267.

Hypercholesterolemia tx

Statin (first-line)

268.

Hypertriglyceridemia tx

Fibrate

IVIG, high-dose aspirin

Macrolides (e.g., azithromycin) 274.

Long-term anticoagulation tx

Warfarin, dabigatran, rivaroxaban and apixaban

275.

Malaria tx

Chloroquine, mefloquine, atovaquone/proguanil (for blood schizont), primaquine (for liver hypnozoite)

276.

Malignant hyperthermia tx

Dantrolene

277.

Medical abortion tx

Mifepristone

278.

Migraine tx

Abortive therapies (e.g., sumatriptan, NSAIDs); prophylaxis (e.g., propranolol, topiramate, CCBs, amitriptyline)

279.

Multiple Sclerosis tx

Disease-modifying therapies (e.g., Binterferon, natalizumab), for acute flares use IV steroids Baclofen for spasticity

280.

Mycobacterium tuberculosis tx

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

281.

Neisseria gonorrhoeae tx

Ceftriaxone (add doxycycline to cover likely concurrent C. trachomatis)

282.

Neisseria meningitidis tx

Penicillin/ceftriaxone, rifampin (prophylaxis)

283.

Neural tube defect prevention tx

Prenatal folic acid

284.

Osteomalacia/rickets (poor osteoid mineralization) tx

297.

SIADH tx

298.

Sickle cell disease tx

Fluid restriction, IV hypertonic saline SLOWLY to prevent central pontine myelinolysis, conivaptan/tolvaptan, demeclocycline Stop cyclophosphamide

Vitamin D supplementation 285.

Hydroxyurea (Increase fetal hemoglobin)

Osteoporosis (Trabecular spongy bone loss) tx

286.

Patent ductus arteriosus tx

287.

Pheochromocytoma tx

288.

Pneumocystis jirovecii tx

289.

299.

Sporothrix schenckii tx

Itraconazole, oral potassium iodide

300.

Stable angina tx

Sublingual Nitroglycerin

301.

Staphylococcus aureus tx

MSSA: nfacillin, oxacillin, dicloxacillin (antistaphylococcal penicillins); MRSA: vancomycin, daptomycin, linezolid, ceftaroline

Calcium/vitamin D supplementation (prophylaxis); bisphosphonates, PTH 302. Streptococcus analogs, SERMs, calcitonin, denosumab bovis tx (treatment) 303. Streptococcus Close with indomethacin; open or pneumoniae tx maintain with PGE analogs

Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis Penicillin/cephalosporin (systemic infection, pneumonia); vancomycin (meningitis)

Alpha-antagonists first (e.g., 304. Stretococcus phenoxybenzamine), then beta blockers pyogenes tx Prior to excision 305. Temporal (giant TMP-SMX (prophylaxis in AIDS patient) cell) arteritis tx

Penicillin prophylaxis

Prolactinoma tx

Cabergoline/bromocriptine (dopamine 306. Tonic-clonic agonists) seizures tx

Levetiracetam, phenytoin, valproate, carbamazepine

290.

Prostate adenocarcinoma/uterine fibroids tx

Leuprolide, GnRH analog (continuous)307. Toxoplasma gondii tx

Sulfadiazine + pyrimethamine

291.

Prostate adenocarcinoma tx

Flutamide (competitive inhibitor of androgen)

292.

Pseudomonas aeruginosa tx

Piperacillin/Tazobactam or Ticarcillin/Clav., Aminoglycosides, carbapenems

Pulmonary arterial hypertension (idiopathic) tx

Sildenafil, bosentan, epoprostenol

294.

Rickettsia Rickettsii tx

Doxycycline, Chloramphenicol

295.

Schizophrenia (negative symptoms) tx

296.

Schizophrenia (positive symptoms) tx

293.

High-dose steroids

308.

Treponema pallidum tx

Penicillin

309.

Trichomonas vaginalis tx

Metronidazole (patient and partner)

310.

Trigeminal neuralgia (tic douloureux) tx

Carbamazepine

311.

Ulcerative Colitis tx

5-ASA preparations (e.g., mesalamine), 6mercaptopurine, infliximab, colectomy (curative)

Atypical antipsychotics

312.

UTI prophylaxis tx

TMP-SMX (Bactrim)

Typical and atypical antipsychotics

313.

Warfarin reversal tx

Fresh frozen plasma (acute), vitamin K (chronic)

314.

Actinic (solar) keratosis

320.

Aortic aneurysm, thoracic

Marfan syndrome (idiopathic cystic medial degeneration > pooling of proteoglycans in media (basket weave))

Precursor to squamous cell carcinoma 315.

Acute gastric ulcer associated with CNS injury

Cushing ulcer (Increased intracranial pressure stimulates vagal gastric H+ secretion)

316.

Acute gastric ulcer associated with severe burns

Curling ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa)

317.

Alternating areas of transmural inflammation (leading to rare enterocuteaneous fistulas) and normal colon, with noncaseating granulomas

Skip lesions (Crohn Disease)

318.

Aortic aneurysm, abdominal

321.

Cause: HTN and atherosclerosis of vaso vasorum Presents with tearing chest pain to back Type A: ascending and urgent B: descending and B-blockers Complications: pericaridal tamponade or renal failure 322.

Atrophy of the mammillary bodies

Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion)

323.

Autosplenectomy (fibrosis and shrinkage)

Sickle cell disease (hemoglobin S) Gluatamic Acid to VALINE

324.

Bacteria associated with gastritis, peptic ulcer disease, and stomach cancer

Atherosclerosis > fibrosis weakens wall > turbulent flow > emboli Location: Below renal arteries and above bifurcation 319.

H. pylori 325.

Aortic aneurysm, ascending or arch

Aortic dissection

Bacterial meningitis (adults and elderly)

3* syphilis (syphilitic aortitis), vasa vasorum destruction S. pneumoniae

326.

Bacterial meningitis (newborns and kids)

327.

Bilateral ovarian metastases from gastric carcinoma

Group B streptococcus/E. coli (newborns), S. pneumoniae/N. meningitidis (kids/teens)

331.

Breast cancer

Invasive ductal carcinoma (tubular, good pronosis; mucinous not shown, poor prognosis) Krukenberg tumor (mucin-secreting signet ring cells) 328.

Bleeding disorder with GpIb deficiency

Bernard-Soulier syndrome (defect in platelet adhesion to von Willebrand factor) Enlarged platelets, and low count on blood smear (Big suckers) Normal PTT Negative ristocetin coag 329.

Breast mass

333.

Breast tumor (benign)

Fibrocystic change, Carcinoma (in postmenopausal women)

Fibroadenoma 334.

Cardiac primary tumor (kids)

Brain tumor (adults)

Supratentorial: metastasis, glioblastoma multiforme (astrocytoma), meningioma (benign), schwannoma MGM Studios 330.

332.

Brain tumor (kids)

Infratentorial: medulloblastoma (cerebellum), pilocytoma (GFAP) Supratentorial: craniopharyngioma (cerebrum) - rathke's pouch

Rhabdomyoma, often seen in tuberous sclerosis (hamartomas, renal angiofibromas, mitral regurg, and ash-leaf spots) 335.

Cardiac manifestation of lupus

Marantic/thrombotic Libman -sacks endocarditis (nonbacterial) Mitral valve regurgitation (both sides have vegetations)

336.

Cardiac tumor (adults)

342.

Congenital cardiac anomaly

VSD Size of defect determines severity Left to Right shunt reverses later in life due to pulmonary hypertension 343.

Metastasis, myxoma (90% Left atrium; "ball and valve") Blocks mitral valve > syncope 337.

Congenital conjugated hyperbilirubinemia (black liver)

Cerebellar tonsillar herniation Dubin-Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile (loss of MRP2 protein), epinephrine metabolite not degraded) 344.

Constrictive pericarditis in developing world

Tb (developing world) Idiopathic, viral illness (developed world) Kussmaul sign, JVP, pericardial knock

345.

Coronary artery involved in thrombosis

LAD > RCA > circumflex

346.

Cretinism

Iodine deficit/hypothyroidism like thyroid peroxidase def or aplasia Pot-bellied pale puffy faced child with protruding umbilicus and tongue

347.

Cushing's syndrome

Iatrogenic (from corticosteroid therapy) Adrenocortical adenoma (secretes excess cortisol) ACTH-secreting pituitary adenoma (Cushing disease) Paraneoplastic (due to ACTH secretion by tumors, ie small cell lung cancer)

348.

Cyanosis (early; less common)

Tetralogy of Fallot, transposition of the great vessels, truncus arteriosus

349.

Cyanosis (late; more common)

VSD, ASD, PDA

350.

Death in CML

Blast crisis Accelerated splenomegaly indicates risk of ALL or AML

351.

Death in SLE

Lupus nephropathy, specifically diffuse proliferative glomerulonephritis or membranous glomerulonephritis

352.

Dementia

1) Alzheimer's disease (2) Multiple infarcts (vascular dementia)

Chiari II malformation 338.

Chronic arrhythmia

Atrial fibrillation (associated w/ high risk of emboli)

339.

Chronic atrophic gastritis (autoimmune)

Predisposition to gastric carcinoma (can also cause pernicious anemia)

340.

Clear cell adenocarcinoma of the vagina

DES exposure in utero 341.

Congenital adrenal hyperplasia, hypotension

21-hydroxylase deficiency

353.

DIC causes

354.

Dietary deficit

Severe sepsis (cytokines), obstetric complications (tissue thromboplastin from amniotic fluid), cancer (auer rods > APML), adenocarcionma (mucin), burns, snake bite

360.

Gynecologic malignancy

Endometrial carcinoma (most common in US); cervical carcinoma (most common worldwide) 361.

Heart murmur

Iron (spoon nails-koilonychia, fatigue, pica) 355.

Diverticulum in pharynx

Mitral valve prolapse with mid systolic click

Zenker's diverticulum (diagnosed by barium swallow) 356.

Ejection click

Aortic stenosis

357.

Esophageal cancer

Squamous cell carcinoma (worldwide), adenocarcinoma (US)

358.

Food poisoning

S. aureus, B. cereus

359.

Glomerulonephritis (adults)

362.

Heart valve in bacterial endocarditis

Mitral Regurgitation, but chronically stenosis and fusion of commissures > Aortic (rheumatic fever) Tricuspid (IV drug abuse) Berger disease (IgA nephropathy) Mesangial proliferation with IgA immune complex deposits Gross hematuria or RBC casts after mucosal infections

363.

Helminth infection (in USA)

Enterobius vermicularis (pinworm), Ascaris lumbricoides (treeman)

364.

Hematoma epidural

368.

Autosomal dominant, most common bleeding disorder

Rupture of middle meningeal artery (arterial bleeding is fast, trauma, lens shaped) Branch from maxillary artery 365.

von Willebrand's disease Most common! AD Pettichiae but no t bleeds, normal platelet count Stabilizes factor 8 Increased PTT and increased bleeding time Abnormal ristocetin (no aggregation) Tx: desmopressin

Hematoma subdural

369.

Hereditary harmless jaundice

370.

HLA-B27

Gilbert's syndrome (benign congenital unconjugated hyperbilirubinemia)

Rupture of bridging veins (crescent shaped, slow bleeding) Between dura and arachnoid Herniation of brain tissue 366.

Hemochromatosis

Multiple blodd transfusions or heridtary HFE mutation (can result HF, "bronze diabetes," and increased risk of hepatocellular carcinoma) 367.

Hepatocellular carcinoma

Cirrhotic liver (often associated w/ Hepatitis B and C, and alocholism) Spreads via blood, hepatic vein

Ankylosing spondylitis,reactive arthritis, ulcerative colitis, psoriatic arthritis (sausage fingers) 371.

HLA-DR3

DM1, SLE, Grave's disease, Hashimoto thyroiditis

372.

Holosystolic murmur

VSD, tricuspid regurgitation, mitral regurgitation

373.

Hypercoagulability, endothelial damage, blood stasis

Virchow's triad (results in venous thrombosis)

374.

Secondary hypertension

380.

Male cancer

Renal artery stenosis, increase in plasma renin and unilateral atrophy of kidney (Fibromuscular dysplasia in young women) 375.

Hypoparathyroidism

Accidental excision during thyroidectomy

376.

Hypopituitarism

Pituitary Adenoma (usually benign) >> Rathke's pouch (surface ectoderm)

377.

Infection in blood transfusion

Hepatitis C

378.

Late cyanotic shunt (uncorrected L to R becomes R to L)

Prostatic carcinoma (dark nucleoli), grade based on architecture, not nuclear atypia Osteoblastic metastases in lumbar spine 381.

Malignancy associated w/ noninfectious fever

Hodgkin's lymphoma CD15 and CD30 + Eosinophilia (IL5) 382.

Metastasis to bone

Eisenmenger's syndrome (caused by ASD, VSD, PDA; results in pulmonary HTN/polycythemia) 379.

Liver disease

Prostate, Breast > Lung >Thyroid Alcoholic cirrhosis

383.

Metastasis to brain

Lung > breast > GU > melanoma > GI

384.

Metastasis to liver

Colon >> stomach, pancreas

385.

Mixed UMN and LMN motor neuron disease

ALS

386.

Myocarditis

390.

Obstruction of male urinary tract

BPH (periurethral zone) Coxsackie B (lymphocytes visible) 387.

391.

Malignancy (kids)

Opening snap and diastolic rumble Mitral stenosis, chronic rheumatic fever Can lead to pulmonary HTN

392.

Opportunistic infection in AIDS

ALL, Cerebellar medulloblastoma 388.

Nephrotic syndrome (black/hispanic and obese adults)

Pneumocystis jiroveci pneumonia

Focal segmental glomerulosclerosis HIV, heroin, sickle cell Sclerosis and hyalinosis C1/C3 IgM deposits Effacement of foot processes 389.

Nephrotic syndrome (kids)

Minimal change disease Normal on light microscopy, effacement of foot processes Triggers: post infection, vaccine, or lymphoma Tx: prednisone

393.

Neuron migration failure

Kallmann syndrome (hypogonadotropic hypogonadism (low GnRH) and anosmia)

394.

Nosocomial pneumonia

S. aureus, Pseudomonas, other enteric gram-negative rods

395.

Osteomyelitis

S. aureus (most common overall)

396.

Osteomyelitis in pts w/ sickle cell disease

Salmonella

397.

Osteomyelitis in IV drug s

Pseudomonas, candida, s. aureus

398.

Ovarian tumor (benign, bilateral)

Serous cystadenoma

399.

Ovarian tumor (malignant)

407.

Primary bone tumor (adults)

Multiple myeloma Calcium Renal failure Anemia Bone lesion Bence Jones bodies in urine from IgG light chains, rouleaux formation, lytic bone lesions, M spike (IgG or IgA) Differential: HTLV lymphoma with rash

Serous cystadenocarcinoma 400.

Pancreatitis (acute)

EtOH and gallstones

401.

Pancreatitis (chronic)

EtOH (adults), cystic fibrosis (kids)

402.

Pts with ALL/CLL/AML/CML

ALL: child (TdT- DNA pol) CLL: Adult >60 AML: Adult ~65 (auer rods -MPO) CML: Adult 45-85 (basophils)

403.

Pelvic inflammatory disease

C. trachomatis, Neisseria gonorrhoae

404.

Philadelphia chromosome t(9;22)

CML (may sometimes be associated with poor prognosis ALL) (bcl-abl hybrid fusion protein, tyrosine kinase oncogene) Basophils and left shift (low Fc receptors) but neg LAP (leukocyte alkaline phosphatase) Tx: Imatinib

405.

Pituitary tumor

406.

Primary amenorrhea

408.

Primary hyperaldosteronism

Adenoma of adrenal cortex 409.

Primary hyperparathyroidism

Adenomas, Hyperplasia, Carcinoma

410.

Primary liver cancer

Hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, alpha1-antitrypsin deficiency, Wilson disease)

411.

Pulmonary HTN

COPD

412.

Recurrent inflammation/thrombosis of small/medium vessels in extremities and nerves (gangrene in digits) Segmental vasculitis

Buerger disease (strongly associated w/ tobacco)

Prolactinoma, Somatotropic "acidophilic" adenoma

Turner's syndrome (XO)

413.

Renal tumor

424.

Temporal (giant cell) arteritis

Risk of ipsilateral blindness due to thrombosis of ophthalmic artery, polymyalgia rheumatica (high ESR, CRP) Elderly females Granulomas and giant cell 425.

Renal cell carcinoma: associated w/ von Hippel-Lindau and cigarette smoking; paraneoplastic syndromes (EPO, renin, PTHrP, ACTH) Invades in renal vein (Risk of left-sided varicocele) 414.

Right heart failure due to a pulmonary cause

Cor pulmonale

415.

S3 (protodiastolic gallop)

Increased ventricular filling (mitral regurgitation, HF), common in dilated ventricles

416.

S4 (presystolic gallop)

Testicular tumor

Young men: Seminoma (malignant, radiosensitive, good progonsis -- opposite of nonseminoma) Over age of 60: diffuse large B-cell lymphoma 426.

Thyroid cancer

Papillary carcinoma, spreads to cervical nodes Orphan annie nuclei and psammoma bodies, nuclear grooves Increased risk with radiation as child

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy) 417.

Secondary hyperparathyroidism

Hypocalcemia of chronic kidney disease

418.

Sexually transmitted disease

C. trachomatis (usually coinfected with N. Gonorrhoeae)

419.

SIADH

Small cell carcinoma of the lung

420.

Site of diverticula

Sigmoid colon

421.

Sites of atherosclerosis

Abdominal aorta > coronary artery > popliteal > carotid

422.

Stomach cancer

Adenocarcinoma

423.

Stomach ulcerations and high gastrin levels

Zollinger-Ellison syndrome (gastrinoma of duodenum or pancreas) istration of secretin will increase acid, rather than the expected decrease

427.

Tumor in women

Leiomyoma (estrogen dependent, not precancerous, presents with multiple tumors with whorled pattern)

428.

Tumor in infancy

431.

Type of Hodgkin's Lymphoma

Nodular sclerosing=most common, RS is in lacunar cells CD15/30 + The more lymphocytes the better the prognosis (vs. mixed cellularity (EBV - eosinophila from IL5), lymphocytic rich, lymphocytic depletion)

Strawberry Hemangioma (first increases in size, then will regresses spontaneously by childhood) 429.

Tumor of the adrenal medulla (adults)

Pheochromocytoma (usually benign) Chromaffin cells with large nuclei (neural crest) Relapsing remitting hypertension 430.

Tumor of the adrenal medulla (kids)

Neuroblastoma (malignant) Dancing-eyes dancing-feet Homer Wright rosette N-myc oncogene HVA an VMA increased

432.

Type of nonHodgkin's Lymphoma

Diffuse large B-cell lymphoma Diffuse in sheets Can develop from follicular lymphoma

433.

HLA-DR4

DM Type I, RA

434.

Intellectual disability

Down syndrome, Fragile X syndrome (macroordchidism, large jaw, MVP, CGG repeats)

435.

Sensitivity

Sensitivity = TP / (TP + FN)

436.

Specificity

Specificity = TN / (TN + FP)

437.

PPV

TP/(TP+FP)

438.

NPV

= TN / (TN + FN)

439.

Odds ratio (for case-control studies)

ad/bc

440.

Relative risk

RR = [a/(a + b)] / [c/(c + d)]

441.

Attributable risk

AR = [a/a + b] − [c/c + d]

442.

Absolute risk reduction

ARR = [c/c + d] − [a/a + b]

443.

Relative risk reduction

RRR = 1 − RR

444.

Number needed to treat

1/absolute risk reduction

445.

Number needed to harm

1/attributable risk

446.

HardyWeinberg equation

p² + 2pq + q² = 1 p+q=1

447.

Volume of distribution

Vd= (amount of drug in the body) / (plasma drug concentration)

448.

Half-life

t1/2 = (0.7 x Vd) / CL

449.

Drug clearance

CL = rate of elimination of drug/ plasma drug concentration = CL = Vd x Ke (elimination constant)

450.

Loading dose

LD = ( x Vd) / F

451.

Maintenance dose

MD = ( x CL) / F

452.

Cardiac output

Heart rate x stroke volume

453.

Mean arterial pressure

MAP = cardiac output x total peripheral resistance MAP = 2/3Diastolic + 1/3Systolic

454.

Stroke Volume

SV = EDV - ESV

455.

Ejection fraction

EF = SV/EDV = [EDV-ESV] / EDV

456.

Resistance equation

R= P/Q (flow) = 8 n(viscosity) length/ pi * r^4

457.

Capillary fluid exchange

Starling forces: Jv = KF [(PC - PI) - σ(πC πI)

458.

Renal clearance

Cx = (UxV)/(Px) X=inulin

459.

Effective renal plasma flow

ERPF = U PAH x (V/ P PAH) = C PAH

460.

Renal blood flow

RPF= RBF / (1 − Hct)

461.

Filtration fraction

FF = GFR /RPF

462.

HendersonHasselbalch equation

pH = 6.1 + log [HCO3-]/(.03*Pco2)

463.

Winters formula

Pco2 = 1.5 [HCO3-] + 8 +/- 2

464.

Physiologic dead space

VD = VT x (PaCO2 − PECO2) /PaCO2

465.

Pulmonary vascular resistance

PVR = (Ppulm artery - PL atrium) / cardiac output

466.

Alveolar gas equation

PAo2 = PIo2 - (Paco2 / R)

467.

Hep B Presentation

High ALT and AST, symptoms include fever, itchy rash, and t pain

468.

Hep B vs. Hep C histology

B: finely granular, homogenous, pale pink cytoplasm; C: lymphoid aggregates

469.

Hartnup disease

Failed absorption of tryptophan in intestine/kidneys, that causes pellagra from niacin deficiency Tx: high protein diet, nicotinic diet

470.

SIBO

Often caused by Gastric by, deficiency in all vitamins EXCEPT Vit K and Folate!

471.

Midgut rotation in embryo

472.

Necrotizing Enterocolitis

Midgut Turns around the SMA. If this process does not occur, the cecum will be fixed to the duodenum in the URQ via Ladd's Bands

Pre-term infants have lower immune function, bacteria proliferate in bowel and cause ischemia and air in the bowel. Dx: thin curvilinear lines of lucency 473.

Sphincter of Oddi malfunction

Opioid analgesics cause spasm of smooth muscle and increased bile duct pressure

474.

GU Lymph Nodes

Above dentate: Internal iliac nodes. Below dentate, scrutum, and distal vagina: Superfiical inguinal nodes Testes/Ovaries: Para-aortic nodes Uterus: External iliac, hypogastric nodes

475.

Cirrhosis prognosis tests

Hypoalbuminemia, bilirubin, PT (lack of clotting factors made)

476.

How do you test biliary tract function?

Alk Phos and gamma-glutamyl transferase

477.

NF-kB/NOD2 pathway

Activates immune response Genetic component to Crohn's disease, reduces pro-inflammatory TF (cytokines are decreased)

478.

CF vs Primary Ciliary Dyskinesia (Kartagener)

PCD: immotile sperm, situs inversus, and bronchiectasis (dilated bronchioles) CF: absence of vas deferens, pancreatic insufficiency, mucus build up in lungs

479.

Ovarian/Uterine arteries

Ovarian: suspensory/infundibulopelvic ligament Uterine: Cardinal ligament/transverse cervical

480.

Ovarian/Testicular VEINS!! (not arteries)

481.

Polyhydramnios vs. Oligohydraminos

LEFT side goes to renal vein (more likely for varicocele) RIGHT side goes to from IVC

Poly: too much, inability to swallow (duodenal atresia or anencephaly), caused by maternal diabetes, fetal anemia, multiple gestations Oligo: too little, inability to excrete urine (renal agenesis, posterior urethral valves, placental insufficiency, ARPKD with portal hypertension), can cause potter sequence including pulmonary hypoplasia 482.

484.

Adherens junction

Cadherin proteins, loss promotes metastasis 485.

Desmosomes

Gap junction

Cadherin (desmogleins, desmoplakin) proteins >> Pemphigus vulgaris 486.

Hemidesmosomes

Connexin proteins 483.

Tight junction

Integrin proteins >> Bullous pemphigoid 487.

Claudin, occludin proteins

Mild intellectual disability, long legs, cryptorchidism > infertility and low inhibin due to failing sertoli cells, testosterone production less effected by temperature > increased FSH and LH > gynecomastia

Klinefelter Syndrome (47 XXY) with inactivated X (Barr body)

488.

Direct vs. Indirect hernia

498.

Isoretinoin as a teratogen

Microcephaly, thymic hypoplasia, small ears, hydrocephalus MUST use contraception.

499.

Lithium as a teratogen

Atrialized right ventricle = Ebstein's anomaly Nephrogenic DI, hypothyroidism

500.

Methimazole as a teratogen

Thyroid drug: Aplasia cutis congenita: absent patch of epidermis on back of head (hair)

Direct: Medial to inferior epigastric 501. vessels, protrudes through abdominal wall Indirect: Lateral to inferior epigastric502. vessels, protrudes through internal/deep inguinal ring (an opening in the transversalis fascia) -- if congential due to patent processus 503. vaginalis

Phenytoin as a teratogen

Fetal Hydantoin syndrome: cleft palate, cardiac defects, nail/finger hypoplasia Neural tube defects

Tetracyclines as a teratogen

Discolored teeth

Thalidomide as a teratogen

Limb defects (flipper limbs)

489.

Twinning

Monozygotic: share a placenta, seperate amniotic fluid AKA monochorionic/diamnionic

Valproate as a teratogen

Neural tube defects: inhibition of maternal folate absorption.

490.

Sommatomammotropin (human placental lactogen)

Secreted by the syncytiotrophoblast 505. Warfarin as a teratogen (like hCG), causing insulin resistance in pregnant women and gestational diabetes 506. Alcohol as a teratogen

Bone deformities (stippled epiphysis), fetal hemorrhage, abortion, opthalmologic abnormalities, nasal hypoplasia

491.

Teratoma

Benign in women, malignant in men 492.

ACE-I as a teratogen

Renal damage (dysgenesis) > oligohydramnios

493.

Carbamazepine as a teratogen

Facial dysmorpism. Developmental delay. Neural tube defects. Finger hypoplasia.

494.

Alkylating agents as a teratogen

Absent fingers and toes

495.

Aminoglycosides as a teratogen

CN VIII toxicity = Deafness.

496.

Diethylstilbestrol as a teratogen

Vaginal clear cell adenocarcinoma. Mullerian anomalies.

497.

Folate antagonist (Methotrexate) as a teratogen

Neural tube defects

504.

Leading cause of intellectual disability in the US. Retardation, microcephaly, facial abnormalities (smooth philtrum, hypertelorism [eyes are wide apart]), limb dislocation, heart defects. Heart-lung fistula and holoprosencepahyl. Failure of cell migration

507.

Cocaine as a teratogen

Abnormal fetal growth, fetal addiction, placental abruption

508.

Nicotine/CO as a teratogen

Low birth weight, preterm labor, placental problems, IUGR, and ADHD Nicotine is vasoconstriction, CO impairs O2 delivery

509.

Iodine (excess and lack) as a teratogen

Congenital goiter or hypothyroidism (cretinism) Excess > Wolff-Chaikoff effect, gland downregulates

510.

Maternal diabetes as a teratogen

Caudal regression syndrome (anal atresia to sirenomelia) (mermaid syndrome) Transposition of the great vessels, Neural tube defects, Transient hypoglycemia and Macrosomia (beta cell hyperplasia and hyperinsulinemia) Neonatal Respiratory Distress Syndrome

511.

Vit. A excess as a teratogen

Spontaneous abortions and birth defects (cleft palate, cardiac)

512.

X-rays as a teratogen

513.

Polyarteritis nodosa

Microcephaly, intellectual disability Use lead shield

517.

Brachial Arches - same as tongue

1: V nerve, 2: VII, 3: IX, 4/6: X

518.

DRESS syndrome

Drugs, Rash, Eosinophilia, Swelling, Serum ALT

519.

Essential Tremor

AD, improves with alcohol Tx: Propranolol

520.

Ataxia, spider angiomas, IgA deficiency, high AFP

Ataxia Telangiectasia ATM mutated gene responsible for DNA break repair

521.

Macular Degeneration

Hep B +, affects multiple medium-sized arteries EXCEPT PULMONARY Transmural inflammation 514.

Arteriosclerosis types

Atherosclerosis: Large vessels, lipid plaque with fibrous cap (metalloproteinases destabilize it) Arteriolosclerosis: small vessels, hyaline thickening (benign hypertension) or hyperplastic onion skinning (severe HTN) 515.

MI evolution

0-4 hours: No damage (shock) 1 day: Dark discoloratons > Eosinophils and wavy fibers- Coag necrosis (arrhythmia) 3 days: Neutrophils (pericarditis) 1 week: Macrophages (rupture leading to tamponade) 2 weeks: Scar from granulation tissue (aneurysm and dressler's autoimmune endocarditis) Reperfusion would cause contraction bands from free radicals 516.

Right sided murmurs

Increase with inspiration

Common cause of elderly blindness, progressive loss of CENTRAL vision due (central scotoma) to fatty tissue deposition and neovascularization behind retina ("Drusen") 522.

Internal Capsule Stroke

Pure motor weakness contra laterally (arm, leg, and lower face)

523.

Thalamic Stroke

Unilateral hemisensory loss including face (R body, R face)

524.

Cheyenne-Stokes breathing

CHF patients cyclic breathing with increasing than decreasing tidal volumes until next apnea 525.

Carboxyhemoglobinemia

Carbon monoxide poisoning, normal PaO2, low SaO2 Tx: oxygen

526.

Methemoglobinemia

When the heme portion of hemoglobin has oxidant damage (Fe3+) which results in the loss of the RBC's oxygen carrying capacity. (Drugs etc) Normal PaO2, low SaO2 Chocolate-colored blood Tx: methylene blue

527.

Reversible cell injury

532.

What is amyloid?

SWELLING Loss of villi, RER swelling so decrease in protein synth, membrane blebbing 528.

Irreversible cell damage

Membrane damage Leakage of cell proteins LFT's, troponin, CK, leakage of Cyc C or leakage of lysosomal enzymes > apoptosis

529.

Loss of nucleus

Pyknosis: shrinks Karyorrhexis: breaking up Karyolysis: final break down

530.

Apoptosis

Option 1) Inactivation of Bcl2, allowing leakage of cyt c from mitochondria Option 2) FAS ligand binds CD95 (ie neg selection) Option 3) CD8+ Perforins creates pores and allows granzymes to activate caspases THEN CASPASES activate: Proteases (cytoskeleton) Endonucleases (DNA)

531.

Free radical removal (post NADPH oxidase)

Superoxide dismutase (O2), ie reperfusion injury Catalase (H2O2) Glutathione peroxidase (OH - most dangerous)

Misfolded protein that deposits in extracellular space causing damage B-pleated sheet Congo red stain/apple green birefringence Primary: AL amyloid derived from light chain causing nephrotic syndrome, restrictive cardiomyopathy (transthyretin), tongue size, pancreas (amylin) Secondary: SAA aKute phase reactant in chronic inflammatory states 533.

Medullary carcinoma of thyroid (Medullamy calcitoma)

Calcitonin deposits, parafollicular C-cells Sheets of cells in an amyloid stroma MEN2A and 2B (Ret mutations 534.

Cavernous sinus

6 most commonly damaged 535.

3

von Hippel-Lindau disease, renal cell carcinoma Increased IGF-1 and HIF transcription factor (VEGF and PDGF)

536.

4

ADPKD with PKD2 defect (less common), Huntington disease

537.

5

Cri-du-chat syndrome (microdeletion p-), familial adenomatous polyposis

538.

7

539.

9

Williams syndrome (microdeletion, elfin, extreme freindliness), cystic fibrosis

550.

BCL-2

Friedreich ataxia (GAA repeats) AR > Die from hypertrophic cardiomyopathy 540.

11

Wilms tumor, B-thalessemia

541.

13

Patau syndrome, Wilson disease

542.

15

Prader-Willi syndrome, Angelman syndrome, FBN1 MArfans

543.

16

ADPKD with PKD1 defect (more common), alpha thalessemia

544.

17

Neurofibromatosis type 1 NF1(17)

545.

18

Edwards syndrome

546.

21

Down syndrome

547.

22

Neurofibromatosis type 2, DiGeorge syndrome (22q11- cleft palate, tertrology of fallot, thymic aplasia, hypocalcemia, low PTH)

548.

X

Fragile X syndrome, X-linked agammaglobulinemia, Klinefelter syndrome (XXY)

549.

BCRABL

Oncogene Anti-apoptotic molecule, t(14;18) moves Bcl2 (18) to IgH locus Follicular and undifferentiated lymphomas 551.

BRAF

Oncogene Serine/threonine kinase Melanoma, Non-HL

552.

c-kit

Oncogene Stem cell growth factor receptor, Cytokine receptor GI stromal tumor

553.

c-myc

Oncogene Transcription factor for growth proteins, t(8;14) (myc from 8 is put on IgH 14 locus) Burkitt Lymphoma 554.

HER2/neu (c-erbB2)

Oncogene - fusion protein Tyrosine kinase, t(9;22), signal transducer CML and ALL (poor) Tx: imatinib

Oncogene Epidermal growth factor receptor, Tyrosine Kinase Breast/Ovarian/Gastric 555.

L-myc

Oncogene Transcription factor for growth proteins Lung tumor

556.

N-myc

Oncogene Transcription factor for growth proteins Neuroblastoma

557.

RAS (k-RAS)

Oncogene Signal transducer, GTPase Colon cancer, lung cancer, pancreatic cancer 558.

RET

Oncogene Neural growth factor receptor, Tyrosine kinase MEN2A and 2B, Medullary thyroid cancer

559.

APC

Tumor Suppressor (2 hit) Colorectal cancer (associated with FAP)

560.

BRCA1/BRCA2

Tumor Suppressor (2 hit) Breast and ovarian cancer DNA repair protein

561.

DCC

Tumor Suppressor (2 hit) Colon cancer DCC—Deleted in Colon Cancer

562.

DPC4/SMAD4

Tumor Suppressor (2 hit) Pancreatic cancer DPC—Deleted in Pancreatic Cancer

563.

MEN1

565.

NF2

AD Tumor Suppressor (2 hit) NeuroFibromatosis type 2 Merlin (schwannomin) protein

566.

p16

Tumor Suppressor (2 hit) Melanoma Cyclin-dependent kinase inhibitor 2A

567.

p53 aka TP53

Tumor Suppressor (2 hit) AD Most human cancers, Li-Fraumeni syndrome Transcription factor for p21, blocks G1>S phase

568.

PTEN

Tumor Suppressor (2 hit) Breast cancer, prostate cancer, endometrial cancer

569.

Rb

Tumor Suppressor (2 hit) Retinoblastoma, osteosarcoma Normally Inhibits E2F; blocks G1 > S phase Overphosphorylation of Rb 570.

TSC1/TSC2

AD Tumor Suppressor (2 hit) Tuberous sclerosis 1: Hamartin protein 2: Tuberin protein

571.

VHL

Tumor Suppressor (2 hit) von Hippel-Lindau disease, renal cell carcinoma and hemangioblastoma of the cerebellum Inhibits hypoxia inducible factor Ia

572.

WT1/WT2

AD Tumor Suppressor (2 hit) Menin Parathyroid, pancreatic endocrine, and pituitary tumors 564.

NF1

AD Tumor Suppressor (2 hit), Ch. 17 NeuroFibromatosis type 1 or Von Recklinghausen's Ras GTPase activating protein (neuro bromin)

Tumor Suppressor (2 hit) Wilms Tumor (nephroblastoma) >> blastema, children 573.

Incresed Alk Phos (osteoblasts require alkaline environment)

Metastases to bone or liver, Paget disease of bone, seminoma (placental ALP), rickets/osteomalacia

574.

Alphafetoprotien

Hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, mixed germ cell tumor. Normally made by fetus. Transiently elevated in pregnancy; high levels associated with neural tube and abdominal wall defects, low levels associated with Down syndrome.

575.

B-hcg

Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease), testicular cancer, mixed germ cell tumor. Produced by syncytiotrophoblasts of the placenta.

CA 15-3/ CA 27-29

Breast cancer.

577.

CA 19-9

Pancreatic adenocarcinoma.

578.

CA 125

Ovarian cancer.

579.

Increased Calcitonin (parafollicular C cells)

Medullary thyroid carcinoma Hematogenous spread

580.

CEA

CarcinoEmbryonic Antigen. Very nonspecific but produced by ∼ 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.

581.

Chromogranin

Neuroendocrine Carcinoid tumor/small cell tumor

582.

PSA

Prostate-specific antigen. Prostate cancer.

583.

t(8;14)

Burkitt's lymphoma (c-myc activation, transcription factor oncogene)

584.

t(11;14)

576.

585.

Follicular lymphomas (bcl-2 activation, anti-apoptotic oncogene) No tingable body macrophages = white spaces Tx: Rituximab (CD20) 586.

Mantle cell lymphoma (cyclin D1 activation, allows G1>S phase progression) CD5+ Tx: Bortezomib

t(14;18)

t(15;17)

M3 type of A[P]ML (tx: all-trans retinoic acid) Auer Rods 587.

t(12;21)

ALL, good prognosis >> Scrotum/CNS T-cell ALL has mediastinal mass and TdT+ in teenager B-cell has CD-10 and TdT+ 588.

Acetaminophen overdose tx

N-acetylcysteine (replenishes glutathione)

589.

AChE inhibitors, organophosphates overdose tx

Atropine > pralidoxime

590.

Amphetamines (basic) overdose tx

NH4Cl (acidify urine)

591.

Antimuscarinic, anticholinergic agents overdose tx

Physostigmine salicylate, control hyperthermia

592.

Benzodiazepines and non-benzodiazpene overdose tx

Flumazenil

593.

β-blockers overdose tx

Glucagon

594.

Carbon monoxide overdose tx

100% O2, hyperbaric O2

595.

Copper, arsenic, gold overdose tx

Penicillamine

596.

Cyanide overdose tx

Nitrate + thiosulfate, hydroxocobalamin

597.

Digitalis (digoxin) overdose tx

anti-dig Fab fragments

598.

Heparin overdose tx

Protamine sulfate

599.

Iron overdose tx

Deferoxamine, deferasirox

600.

Lead overdose tx

EDTA, dimercaprol, succimer, penicillamine

601.

Mercury, arsenic, gold overdose tx

Dimercaprol (BAL), succimer

602.

Methemoglobin overdose tx

Methylene blue, vitamin C

603.

Opioids overdose tx

Naloxone, naltrexone

604.

Salicylates overdose tx

NaHCO3 (alkalinize urine), dialysis

605.

TCAs overdose tx

NaHCO3 (plasma alkalinization)

606.

tPA, streptokinase, urokinase overdose tx

Aminocaproic acid

607.

Warfarin overdose tx

Vitamin K (delayed effect), fresh frozen plasma (immediate) Require epoxide reductase in liver to gamma carboxylate 2,7,9,10,C,S

608.

IL1

Secreted by macrophages AKA Osteoclast-activating factor. Causes fever, acute inflammation. Activates endothelium to express e-selectin and CAMs.

609.

IL6

Secreted by macrophages Causes fever and stimulates production of acutephase proteins like CRP, Ferritin, Fibrinogen, Hepcidin, and amyloid Downregulates Albumin and Transferring

610.

IL8

Secreted by macrophages Major chemotactic factor for neutrophils. Clear up infections

611.

IL12

Secreted by macrophages Induces differentiation of T cells into Th1 cells. Activates NK cells. Deficiency lowers TH1 response, increasing mycobacterial and fungal infections (low IFNgamma)

612.

TNF alpha

Secreted by macrophages Mediates septic shock. Activates endothelium (eselectin and CAMs). Cachexia and fever

613.

IL2

Secreted by T cells Stimulates growth of helper, cytotoxic, and regulatory T cells, and NK cells. Cortisol and Corticosteroids block IL2 production, leading to reactivation of TB and candidiasis

614.

IL3

Secreted by T cells s growth and differentiation of bone marrow stem cells. Functions like GM-CSF.

615.

IFN gamma

Secreted by Th1 cells Secreted by NK cells in response to IL-12 from macrophages; stimulates macrophages to kill phagocytose pathogens. Also activates NK cells to kill virus-infected cells. Increases MHC expression and antigen presentation by all cells.

616.

IL4

Secreted by Th2 cells Induces differentiation into Th2 cells. Promotes growth of B cells. Enhances class switching to IgE and IgG.

617.

IL5

Secreted by Th2 cells Promotes differentiation of B cells. Enhances class switching to IgA. Stimulates growth and differentiation of eosinophils.

618.

IL10

Secreted by Th2 cells Modulates inflammatory response. Decreases expression of MHC class II and Th1 cytokines. Inhibits activated macrophages and dendritic cells. Also secreted by regulatory T cells. TGF-β and IL-10 both reduce the immune response.

619.

How do cytotoxic and NK cells kill?

Perforin and Granzyme Cytotoxic also binds via MHCI, but NK does not Cytotoxic kills resp and liver cells in flu and Hep A

620.

Tregs

Suppress CD4 and CD8 Produce anti inflammatory IL10 and TGF-B Express CD3, CD4 and CD25 and FoxP3 (TF)

621.

T cell activation costimulatory signal

B7 (APC) and CD28 (T cell)

622.

B cell class switching signal with T cell

CD40 (B cell) and CD40L (T cell) Produce IL4 and IL5 to switch

623.

C3b (and IgG)

Opsonization, clears immune complex

624.

C3a, C4a, C5a

Anaphylaxis C3a and C5a activate mast cell degranulation

625.

C5a

Neutrophil chemotaxis Upregulate integrin

626.

C5b-9

Mac Complex (Neisseria) Lyses microbes by creating holes in the membrane

627.

IFN alpha and beta

Innate host defense against viruses Glycoproteins synthesized by virusinfected cells that prime uninfected cells for defense by degrading viral DNA and protein Induces Apoptosis, limiting viral amplification

628.

CD34

Hematopoietic Stem Cells

629.

CD16/56

Bind Fc region of bound Ig, activating cell NK cells Lower on reticulocytes

Anti-ACh receptor (postsynaptic NMJ)

Myasthenia gravis, thymoma or thymic hyperplasia >> Lambert-Eaton is autoantibodies to presynaptic Ca++ channels

631.

Anti-basement membrane

Goodpasture syndrome (alveolar and glomerular) Linear IF Hematuria and hemoptysis

632.

Anticardiolipin, lupus anticoagulant, Anti-B2glycoprotein1

SLE Antiphospholipid syndrome (DVT hypercoaguable state, but increased PTT) Anticardiolipin can give false positive for syphilis

630.

633.

Anti-glutamic acid decarboxylase (GAD65)

634.

Anti-Jo-1(histdyltRNA synthetase), anti-SRP, anti-Mi-2

Type 1 diabetes mellitus

Polymyositis (CD8 - endomysial inflammation) Dermatomyositis (CD4 and risk of adenocarcinomas - perimesium inflammation) Proximal muscle weakness 635.

Antimicrosomal, antithyroglobulin, antithyroidperoxidase

Hashimoto thyroiditis Hurthle cells Risk of non-hodgkin's lymphoma (marginal cell) Enlarged and NONTENDER 636.

Antinuclear antibodies

SLE, nonspeci c

637.

Anti-SSA, anti-SSB (anti-Ro, anti-La)

Sjögren syndrome ANA and Anti-ribonuclear proteins Risk of neonatal lupus and congenital heart block

638.

Anti-TSH receptor

Graves disease

639.

Anti-U1 RNP (ribonucleoprotein)

Mixed connective tissue disease

640.

IgA anti-endomysial, IgA anti-tissue transglutaminase

Celiac disease Can also have dermatitis herpetiformis (IgA deposits in dermal papillae)

641.

MPO-ANCA/p-ANCA

Microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (ChurgStrauss syndrome)

642.

Antihemidesmosome

Bullous pemphigoid 643.

Antimitochondrial

1° biliary cirrhosis

644.

Antiparietal cell

Pernicious anemia (low B12)

645.

Anti-smooth muscle

Autoimmune hepatitis

646.

PR3-ANCA/c-ANCA

Granulomatosis with polyangiitis (Wegener)

647.

MHC 1 - HLA3

Hemochromatosis

648.

HLA 1- B27

Psoriatic arthritis, ankylosing spondylitis, arthritis of inflammatory bowel disease, reactive arthritis

649.

HLA 2 - DQ2/DQ8a

Celiac Disease

650.

HLA 2 - DR2

Mulitple sclerosis, hay fever, SLE , Goodpasture syndrome

651.

HLA 2 - DR3

DM type 1, SLE, Graves disease, Hashimoto thyroiditis

652.

HLA 2 - DR4

Rheumatoid arthritis, DM Type 1

653.

HLA 2 - DR5

Pernicious anemia (Vit B12 deficiency), Hashimoto thyroiditis

654.

Th1 helper cell (CD4 cell)

Secretes IFN-gamma and IL2 Activates Macrophages and CD8 Activated by IFNgamma and IL12 Inhibited by Th2 cells and it's cytokines Responsible for granuloma formation

655.

Th2 helper cell (CD4 cell)

Secretes IL4,5,10,13 and IL2 Recruits IgE for parasites and IgE production by B cells Activated by IL4 Inhibited by Th1 cells and it's cytokine (IFNgamma)

656.

Th17 cell (CD4 cell)

Activated by TGF-B and IL-6 Secretes IL-17

657.

Regulatory T cells

CD25 and FOXP3 Suppress CD4/8 to protect gut flora, fetus, etc. Secretes IL10 and TGFB

658.

Acute Inflammation Factors

TLRs: recognize PAMPs on foreign invaders (like CD14 on macrophage recognizes LPS > septic shock) PG's vasodilate arterioles (PGE2 also mediates fever) Mast cells cross-linking dumps histamine and tryptase LTB4 (attract neutrophils and upregulate integrins, occurs later)

659.

Pain factors

PGE2 Bradykinin Sensitive sensory nerve endings

660.

Weibel-Palade Bodies in endothelial cells

vWF and p-selectin Mediated by histamine

661.

Acute inflammation

Rolling: p-selectin and e-selectin bind sialyl lewis X on leukocytes Adhesion: CAMs bind integrins on leukocytes Transmigration/chemotaxis Phagocytosis: IgG and C3b Apoptosis of neutrophils: pus Macrophages eat them up with lysozyme granules 662.

Delayed loss of umbilical cord, recurrent infections that lack pus, but lots of neutrophils within blood stream

Leukocyte Adhesion deficiency AR defect of integrin (CD18) 18 -- 1nte8rin

663.

Neutrophil chemotaxis factors

Bacterial products IL8 (produced by macrophages) C5a LTB4

664.

Recurrent catalase positive infections, NADPH oxidase defect (no O2 killing)

Chronic Granulomatous Disease (X- 673. linked) Catalase destroys H2O2 674. Nitroblue tetrazolium test - (will remain 675. colorless) S. aureus, E. coli, Aspergillus, Candida, 676. Serratia

Vimentin IF

Mesenchyme, Connective tissue Sarcoma

Desmin IF

Muscle cells

GFAP

Neuroglia cells, astrocytes

S-100

Melanoma, Schwannoma (VIII) -bilateral NF2, Langerhans histocytosis

Hairy Cell Leukemia

665.

Recurrent candida infections

MPO deficiency

666.

CD4+ activation

TLR binds MHCII B7 on APC binds CD28 on T cell

667.

Epithelioid histiocyte (macrophage with abundant pink cytoplasm)

677.

B-cell neoplasm is seen in males with massive red pulp splenomegaly, produces dry tap, and stains + (TRAP) Tx: 2-CDA (adenosine deaminase inhibitor)

Granuloma with or without giant cells 668.

669.

670.

671.

Recurrent fungal (candida), viral, and bacteria infections; risk of opportunistic infections, chronic diarrhea and failure to thrive

SCID IL-2R gamma chain defect (X-linked) Adenosine deaminase deficiency (AR) Tx: isolation and Stem cell transplant

Mutated CD40 or CD40L, Defect in Bcell differentiation to plasma cells/immunoglobulins

Common variable immunodeficiency Tx: IVIG Only have IgM and IgD

Granulation tissue

Fibroblasts (type III collagen > collagenase with zinc replace it with type I collagen) Capillaries for nutrients Myofibroblasts to contract wound

678.

Polycythemia Vera

Itching after shower due to increased basophils, blurry vision Increased hematocrit (platelets, RBCs, WBCs) Decreased Epo due to negative + JAK2 kinase Risk of Budd-chiari and leukemia Tx: phlebotomy and hydroxyurea

679.

Orotic Aciduria

Orotic acid in urine, megaloblastic anemia that is not corrected with B12 or folic acid and no hyperammonemia

680.

Acute Intermittent Porphyria

Telomerase

What disease causes port-wine colored urine, polyneuropathy and painful abdomen? 681.

An enzyme that catalyzes the lengthening of telomeres. 672.

Keratin IF

Epithelium > Carcinoma

Anterior and Posterior Pituitary secretions

Anterior: FLAT PiG Posterior: oxytocin (paraventricular) and ADH (supraoptic)

682.

Hypothalamic Hormones

SST blocks TSH and GH TRH increases TSH and Prolactin Dopamine decreases prolactin which decreases GnRH

683.

ADH hormone

V2 receptors (Serum osmolarity) V1 recepeptors (Blood pressure)

684.

Vitamin D

D3 sun, D2 food (ergo) 7-dehydrocholesterol > cholecalciferol (D3) 25-OH in liver 1,25-OH in kidney PCT (calcitriol) by alpha hydroxylase 24,25 is inactive by CYP450

685.

PTH and Mg

When Mg is low, PTH is secreted When Mg is REALLY low, PTH is NOT secreted

686.

Tender thyroid, high ESR, glanulomatous inflammation following flu-like illnes

Subacute Thyroiditis (de Quervain) Giant cells on histology

687.

Thyroid removal nerve damage

Ligate inferior thyroid artery (and recurrent laryngeal) Ligate super laryngeal artery (and nerve)

688.

Genetic Hyperarathyroidism

Pseudophypoarathyroidism: kidney unresponsive to PTH sometimes due to defective Gs protein, hypocalcemia, short 4th/5th digits, and short stature Familial hypocalciuric hypercalcemia: Defective Ca++ sensing receptor on parathyroid cells

689.

How does insulin resistance develop?

Serine kinases phosphorylate insulin receptor Caused by catecholamines, glucocorticoids, glucagon, TNF-alpha

690.

Lithium

Can cause Nephrogenic DI Tx: Thiazide

691.

Hyperthyroidism

692.

Thyroid Peroxidase

oxidizes iodide to iodine, iodinates thyroglobulin tyrosine resiues, and couples MIT and DIT to form T3 and T4 693.

Reidel Fibrosing Thyroiditis

694.

Follicular Carcinoma vs. Adenoma

Fibrosis of thyroid (hard as wood) that can extend to airway Differential: anaplastic carcinoma in older patient

Capsule invasion, requires this to make diagnosis 695.

MEN2A

pheochromocytoma, medullary thyroid cancer, hyperparathyroidism AD RET (receptor tyrosine kinase)

Hyperglycemia Hypocholesterolemia Scalloped Colloid Exophthalmos ^ Na+/K+ ATP-ase

696.

MEN2B

711.

CreutzfeldtJakob disease

Pheochromocytoma, medullary thyroid cancer, and mucosal neuromas/marfonoid habitus (ganglioneuromatosis) AD RET (receptor tyrosine kinase) 697.

SSRIs

Fluoxetime, paroxetine, sertraline, citalopram Anorgansmia and serotonin syndrome (5HT from tryptophan)

698.

SSRI overdose

Cyproheptadine

699.

SNRI

Venlafaxine and Duloxetine

700.

TCAs

-Triptyline, -pramine

701.

MAO inhibitor

Tranylcypromine, phenelzine, icsocarboxazid, selegiline Tyramine food > Phentolamine

702.

P analog

Ayrlcyclohexylamines/ketamine NMDA antagonist

703.

Weird GABA drugs

Tiagabine: inhibit GABA reuptake Vigabatrin: inhibit GABA transaminase

704.

Lamotrigine

Blocks Na+ Steven Johnsons

705.

Topiramate

Blocks Na+, Increase GABA actoin SE: Kidney stones, weight loss

706.

Thiopental

Barbiturate Terminated by rapid redistrubtion into skeletal muscle and fat

707.

Phenytoin

Na+ block, zero order Gingival hyperplasia, SLE, hirustism, increase P-450

708.

Ethosuximide

Absence seizures thalmic T type ca++ channel blocker

709.

Typical Antipsychotics

Block D2 (Gs) Haloperidol (high potency) Chlorpromazine (low)f

710.

Atypical antipsychotics

Olanzapine (obesity) Clozapine (agranulocytosis) Respiradone (increase prolactin)

Rapidly progressive dementia with startle myoclonus Prions (PrP) change from alpha to beta pleated sheet (resistant to proteases) Spongiform transformation of gray matter 712.

Pilocytic (lowgrade) astrocytoma

Well circumscribed, cerebellum GFAP + Rosenthal fibers (eosinophilic corkscrew fibers), spindle cells and tumor nodule (cystic) 713.

Unexpected Cranial nerve muscle pairings

Masseter, teMporalis, Medial pterygoid (V3) Stylopharyngeus (IX) Palatoglossus (X)

714.

Renal tubular defects

FABulous Glittering Liquids Fanconi: PCT >acidosis Bartter: Thick Ascending > alkolosis Gitelman: DCT > alkalosis Liddle: Increased reabsorption via eNaC in collecting tubules > alkalosis 11-B hydroxysteroid dehydrogenase def: low aldosterone, high BP (can be caused by licorice-glycyrrhetic acid)

715.

Macula Densa vs. JG cells

JG: picks up low BP and increased sympathetic tone (b1-receptors) > renin release MD: picks up low Na+Cl- delivery > adenosine release

716.

Anion Gap

= Na - (Cl + HCO3) Normal is between 8 and 12

717.

Kidney Stones

730.

Maple syrup urine disease ( I Love Vermont)

Defect in alpha-keto acid (leucine, isoeucine, valine) dehydrogenase Low propinoic acid and methymalonic acid CNS defect, burnt sugar urine

731.

PKU

Intellectual disability, eczema, fair skin, musty body odor AR, increased phenylalanine levels via phenylalanine hydroxide def Tx: Make sure to eat tyrosine (cannot be synthesized)

Calcium: Most common, hypercalcuria normocalcemia, envelope opaque, treat 732. Alternative with citrate and thiazide Glycolysis pathway Ammonium MgPO4: Struvite from in RBCs urease + bugs (Staghorn calculi), coffin lid, opaque How do you treat Uric Acid: Tumor lysis syndrome,733. gout pyruvate (rhomboid) dehydrogenase Cysteine: hexagonal, + sodium cyanide deficiency? nitroprusside test, staghorn caliculi in children 734. What dose left718.

Genomic Imprinting

shift or high-O2DNA methylation that can silence parts affinity hemoglobin of genes result in? Ex: Prader Willi or Angelman syndrome

719.

Helicase

Unwinds DNA at replication fork

720.

Histones

Histones help package DNA by 736. What is the start wrapping the DNA into a nucleosome, EXCEPT histone 1 wraps the histone codon? from the outside 737. PNMT

735.

What are the stop codons?

721.

Polygenic inheritance examples

Male pattern baldness, glaucoma, epilepsy, HTN, schizophrenia

722.

What decreased enzyme activity leads to lactic acidosis?

738. Ornithine Pyruvate dehyrodgenase isn't converting enough pyruvate to Acetyltranscarbamylase deficiency (OTC) CoA, so it is converted to lactate instead

723.

What is the most abundant AA in CoLlaGen?

Glycine (also lysine and proline)

724.

Western/Northern/Southern Blots

W=proteins, N=mRNA, S=DNA, SNoW DRoP

725.

Arginase deficiency

Part of urea cycle, Tx: low-protein diet without arginine

726.

P bodies

Regulate mRNA translation in the cytoplasm

727.

What activities occur within the nucleus?

Replication, Transcription, Posttranscription modifications (cap/tail)

728.

Which carbohydrate is metabolized the fastest?

Fructose-1-Phosphate

729.

Where does glucose come from when you're starving?

Overnight: Glycogenolysis (glycogen); Day 2: Gluconeogenesis from muscle

739.

740.

Thiamine deficiency

What is required for PCR?

1,3-BPG is converted to 2,3-BPG which helps to release oxygen in peripheral tissues by decreasing Hgb affinity for O2 Requires: B1, B2, B3, B5, Lipoic acid To avoid lactic acidosis and neuro dfects eat a Ketogenic diet (Avoid carbs): eat Lysine and Leucine Decreased O2 in tissues, renal hypoxia, and therefore erythropoietin synthesis UAA, UAG, UGA AUG. Conversion of NE to E in the adrenal medulla, dependent on high cortisol level Only X-linked Urea cycle disorder Vomiting, tachypnea, and confusion (hyperammonemia) with elevated urinary orotic acid and low BUN Tx: avoid proteins Dry beriberi: peripheral neuropathy, weakness Wet: ♥ failure W-K: confusion, opthalmoplegia, ataxia, perment memory loss, damage to mammillary bodies Important in pyruvate dehydrogenase, branched chain alpha-ketoacid and alpha KG dehydrogenase, and TRANSketolase Primers: nucleotide sequence of the regions flanking the target exon

741.

Tay-Sachs, AR

B-hexosaminidase A deficiency GM2 metabolite increase. Macrocephaly, startle reflex, cherry-red fovea surrounded by white macula, regression of motor skills, onion skin lysosomes, NO hepatosplenomegaly Adenylate cyclase messenger system is utilized by?

TSH, glucagon (DMI), and PTH receptors

743.

Homocystinuria

Cystathione synthase deficiency Lens subluxation, thrombosis, marfanoid, intellectual disabiliity Tx: pyridoxine

744.

X-linked sideroblastic anemia (microcytic)

742.

Delta-Aminolevulinate (ALA) synthase Low protoporphyrin synthesis, so iron accumulates in mitochondria Alcohol abuse, lead poisoning, copper deficiency, and isoniazid (B6) Ringed sideroblasts on prussian blue stain 745.

746.

Alkaptonuria

Transmembrane protein amino acids (anchoring)

AR homagentistic acid dioxygenase deficiency Arthritis and urine turns black when exposed to air, dark skin

747.

Polyol pathway: Cataracts or sperm nutrients

Glucose > Aldose reductase > Sorbitol (gets stuck) > Sorbitol dehydrogenase > Fructose Risk of cataracts and neuropathy with hyperglycemia

748.

Pyridoxine

B6 - Transamination (nitro) reaction between amino acid and a alpha-keto acid, can cause sideroblastic anemia IE: oxacloacetate and aspartate

749.

Difference between Marfan's and EhlersDanlos?

Marfan's: MicroFibrils, aortic aneurysms/dissections ED: collagen (hypermobile), berry aneurysm

750.

Porphyria cutanea tarda (PCT)

Uroporphyrinogen decarboxylase deficiency, resulting in abdominal pain, neuro symptoms, and photosensitive hyper pigmented blistering

751.

Lactate Acidosis

Shock hypo perfuses the organs, resulting in impaired oxidative phosphorylation which increases build up of lactic acid causing an acidosis

752.

Trisomy 13 vs. 18

13: cleft palette, polydactyly, high nuchal translucency 18: low-set ears, small gaw, overlapping fingers, rocker bottom feet, low labs

753.

Hereditary orotic acuduria

Anemia, high orotic acid crystals, retardation, defect in UMP synthase, supplement with uridine

754.

Nitric Oxide derivative

NO is synthesized from arginine

755.

Loss of heterozygosity

Two hit hypothesis

756.

Myotonic Dystrophy

AD, CTG trinucleotide repeat Frontal balding, testicular atrophy, muscle wasting (no fatty deposits)

757.

Vitamin E deficiency

Hemolytic anemia, posterior and spincocerebellar tract demyelination Looks like B12 def but without labs or hypersegmented neutrophils

758.

NADH/NAD ratio increased

Alcohol metabolism (alcohol dehydrogenase and acetaldehyde dehyrodgenase) Causes lactic acidosis and prevents gluconeogenesis

759.

Polyploidy

When more than two complete sets of chromosomes exist in a cell or organism (XXY or XYY)

760.

Pleiotropy

Multiple phenotypic manifestations result from a single gene mutation

Valine, Alanine, Isoleucine

761.

Homeobox

180 nucleotides that code for for DNAbinding transcription factors that are important to morphogenesis (proper formation/placement of tissues in body)

762.

Linkage Disequilibrium

When a pair of alleles from two loci are inherited together in the same gamete more/less often than random chance would expect

763.

Heteroplasty

Presence of different organellar genomes (wile type, mutated) within a single cell

764.

Law of segregation

Offspring only inherit half of each parent's composition

765.

Kinesin and Dynen

K-anterograde transport, D-retrograde transport on microtubules

766.

What artery lies between the 3rd part of the duodenum and the pancreas?

Superior Mesenteric Artery

What causes foot drop?

Injury to common peroneal nerve Fibula neck fracture Loss of dorsiflexion/eversion/dorsum sensation

767.

774.

DiGeorge Syndrome

Maldevelopment of 3 and 4 pharyngeal pouches, fascial dysmorphia, cardiac shunt, lack of T-cells, undeveloped paracortex

775.

Superficial Inguinal Nodes

All Skin from the belly button down, including the anus, excluding the testes and posterior calf

776.

Tongue Sensory

Anterior 2/3: V3 for sensation, CT (7) for taste; Posterior 1/3: Glossopharyngeal (9)

777.

What organ is most commonly injured on trauma?

The spleen (mesodermal origin), BUT the spleen is NOT retroperitoneal

778.

Pudendal nerve

Supplies sensation to external genitalia and perineum (external hemorrhoids, below dentate line)

779.

Lower Trunk of brachial Plexus Injury

Upward jerking of the arm (tree branch), damages intrinsic muscles of the hand and claw hand Also damaged with compression of nerve and subclavian vessels (extra cervical rib, pancoast tumor)

780.

Pancreatic Divisum

Ventral and dorsal pancreatic buds fail to fuse, dorsal contributes most of the pancreas, but the ventral contributes the main pancreatic duct

781.

Direct Inguinal Hernia

Older men, weakness of transversals fascia, travels medial to vessels, remains superficial

782.

Indirect inguinal hernia

Young adults and children, Patent processus vaginalis as the internal inguinal ring does not close, protrudes through deep inguinal ring and travels laterally to vessels

What is the most common association with imperforate anus?

GU abnormalities, like urinary tract defect

What vein drains most of the stomach?

Splenic vein, can get a clot when patient has pancreatitis

770.

Colon blood supply

Left: superior mesenteric, Right: inferior mesenteric, Sigmoid: internal iliac

771.

What muscle is under your armpit and along your side?

Serratus Anterior

783.

Median nerve (supracondyler fracture)

Flexor Digitorum Superficialis and Flexor digitorum profundus, pain with wrist flexion and lost sensation in first three digits

772.

How is the mandibular division of the trigeminal nerve different?

In addition to facial sensation it helps the chewing muscles and tensor tympani!! (TMJ)

784.

Piriform recess nerve

Internal laryngeal nerve (X) provides sensory innervation and the cough reflex

785.

Stapedius nerve

Branch of facial nerve, paralysis of muscle will cause increased sensitivity to sound

786.

Reflexes

L4: Patella, S1: Achilles

What part of the pituitary derives from the neuroectoderm?

Herring Bodies

787.

Wrist Drop (loss of extension)

Radial nerve injury after mid shaft humeral fracture or use of crutches, accompanied by deep brachial artery damage Loss of posterior sensation (arm/forearm/hand)

788.

Supinator Canal

Radial nerve, Failed extension of fingers and thumb

768.

769.

773.

789.

What innervates the patellar tendon?

790.

Trendelenburg Sign

Femoral nerve

Superior gluteal nerve, upper medial gluteal injection Gluteus medius/minimus injured, contralateral hip drops when he lifts his left foot off the floor

802.

Shin splints

Compartment syndrome, compression of deep perineal nerve and anterior tibial artery, weak pulses and loss of sensation between big and 1st toe

803.

What tendon runs with the dorsals pedis artery?

Extensor hallucis longus

804.

Where is the posterior tibial pulse?

Between medial malleolus and the achilles tendon

805.

Baker's (Popliteal) Cyst

Compress tibial nerve leading to inability to plantar flex and loss of plantar sensation, can't curl toes

806.

Lumbar Puncture

Between L3/L4 or L4/L5, use Iliac crest (L4) as a guide Does not pierce the PIA

807.

Disk protrusion

Damages nerve below the compression, Ie L4/L5, L5 is damaged because L4 comes out before the compression

791.

Femoral neck fracture

Surrounded by anastomasies, majority by medial circumflex femoral artery

808.

Hip dislocation

Torn ilio/ischio femoral ligments, sciatic nerve and gluteal muscles in danger

792.

Attachment points for Inguinal ligament

ASIS and pubic tubercle

809.

Winged scapula

Serratus anterior, long thoracic nerve (lateral thoracic artery) Mastectomy, no arm abduction

793.

What is in the Femoral triangle?

Femoral artery, superficial inguinal lymph nodes, femoral hernias!

810.

Dislocated shoulder

Axillary nerve (Deltoid, teres minor, and sensation over lateral part of arm) (posterior circumflex artery)

794.

Medial collateral ligament

Attached to medial meniscus, prevents abdcution of tibia

811.

Shoulder seperation

AC ligament tear, with clavicle fracture... "piano key" deformity

795.

Deltoid Ligament

Eversion sprains

812.

796.

Anterior talofibular ligament

Inversion sprain, "Low ankle sprain", most common

Ulnar nerve (Claw hand when distal)

797.

Anterior tibiofibular

High ankle sprain, inversion sprain

es posterior to the medal epicondyle, inability to flex the digitorum profundus, sensation loss at ring finger Guyon canal syndrome compression at wrist (bikers) Also hook of hamate fracture

Iliofemoral ligament

Resits anterior displacement of hip and prevents hyperextension

813.

798.

Lateral 3.5 digits of palm and DIP on back of hand

799.

Ischiofemoral ligament

Resists posterior displacement of femoral head

Median cutaneous nerve sensation

814.

800.

Prepatellar Bursistis

Housemaid's knee Working on knees, results in swelling

Superficial branch of radial nerve

Supplies sensation to dorsolateral part of the hand

801.

Fibula neck fracture

Common peroneal nerve, inability to evert the foot

815.

Deep branch of radial nerve

Motor to the extensor muscles and the supinator

816.

Lateral cutaneous nerve of forearm

Travels deep to brachioradialis

817.

Scaphoid fracture

Anatomical Snuffbox > Radial artery here Avascular necrosis, most commonly injured wrist bone

835.

Tumor in the head of the pancreas would block which structure?

Common bile duct

818.

Lunate dislocatoin

Carpal tunnel syndrome (tinel sign) Median nerve, paresthesia in the lateral 3 and half digits, difficulty opposing the thumb Can also be caused by dialysis (B2 microglobulin)

836.

Foregut supply

Celiac trunk

837.

Midgut supply

Superior Mesenteric Artery

838.

Hindgut supply

Inferior mesenteric artery

839.

"Double bubble" sign

Initiates abduction for first 15 degrees, before deltoid takes over Most common rotator cuff injury

Overfilled stomach and duodenum caused by duodenal atresia (trisomy 21)

840.

Annular pancreas

Lateral rotation of arm Pitching injury of intraspinatus teres minor also adducts (axillary nerve)

Abnormal migration of the ventral pancreatic bud, Can compress duodenum, causing vomiting

841.

Triangle of Calot

Cystic artery, bile duct, liver

842.

Left colic flexture

Vagus nerve supplies 2/3 of transverse colon, Pelvic splanchnic nerve supplies to distal colon

843.

Metanephros

Definitive kidney

844.

Obstetric conjugate

Length between pubis symphonis to the sacrum

845.

Spinal epidural nerve block

Inject anesthetic in epidural space at sacral hiatus, peritoneum is desensitized, woman can still feel contractions

846.

Median episiotomy

Cut the perineal body to make room for head Media-lateral cuts the transverse perineal muscle

847.

How to access rectouterine pouch (Pouch of douglas)?

Posterior Fornix of vagina

848.

Which part of the urethra is most likely to be damaged by trauma?

Spongy urethra

849.

Normal position of the uterus

Anteverted and anteflexed

850.

What ligaments prevent uterine prolapse?

Uterosacral, lateral/cardinal ligamnet, round ligament, pelvic diaphragm

851.

CN V

Trigeminal nerve, supplies sensation to the face

852.

Cavernous Sinus

III, IV, VI, and V1 through and VI is most likely to be affected first by hemorrhage of ICA

853.

Papiledema

Occlusion of the ophthalmic vein, swollen optic nerves

819.

820.

Supraspinatus

Teres minor/Infraspinatus

821.

Subscapularis muscle

Medial rotation and adduction

822.

Smith's Fracture

Fracture of distal radius, angled foreword, fall backward

823.

Colle's fracture

Falling forward, bones pulled posteriorly, fracture of distal radius

824.

Mechanics of breathing

Inspiration: diaphrgam; Expiration:

825.

Right coronary artery

RV, RA, posterior 1/3 of septum, AV and SA nodes

826.

Anterior interventicular artery (LAD)

Apex of heart

827.

Right or left dominant heart?

Which artery supplies the posterior interventicular artery

828.

Heart layers

Fibrous, Parietal, Visceral (Serous)

829.

Pre ductal vs. Postductal coarcation

Depends on ductus arteriosus

830.

Needle aspiration site

ABOVE the rib

831.

Costodiaphragmatic recess

8th-12th rib

832.

If you choke on a peanut, where does it go?

Right mainstream bronchus (more vertical)

833.

Left recurrent laryngeal nerve

Wraps under arch of the aorta, can display hoarseness when aorta is enlarged

834.

Superior vena cava syndrome

Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins

854.

Blink reflex

V1 sensory (long and short ciliary nerve), Facial nerve closes the orbicularis oculi

875.

Hyperchylomicronemia

AR - lipoprotein lipase or C-II cofactor deficiency Creamy layer in supernatant

855.

Parotid Tumor

Compresses the facial nerve causing facial droop

876.

856.

Bell's Palsy

Lesion to facial nerve, sensitivity to sound, facial paralysis, loss of taste (chorda tympani - anterior tongue), drooling

Peripheral neuropathy of hands and feet, angiokeratomas, renal failure

Fabry disease (XR) Def alpha galactosidease, build up of ceremide trihexoside

877.

Maturity onset diabetes of the young

AD glucokinase mutation Glucose can't be converted to G6P

878.

G6PD deficiency

857.

Horner's Syndrome

Sympathetic trunk/cervical ganglion damage, results in ptosis, pupil constriction, vasodilation, and absence of sweating

858.

Sphenopalatine artery

Profuse nosebleed

859.

Pterygoid (vidian) canal

Presynaptic parasympathetic nerve travels with facial nerve

860.

Chorda Tympani

2/3 anterior tongue, submandibular and sublingual gland

861.

Superior lyarngeal nerve

Sensation above vocal cords

862.

Recurrent laryngeal nerve

Sensation below the vocal cords

863.

Emergency situation in which you need to provide O2 and can't intubate

Cricothyroid membrane

864.

Ansa cervicalis

Infra hyoid muscles, C1-C3

865.

Carotid Sinus

866.

Low NADPH leads to hemolytic anemia (free radicals) with bite cells and heinz bodies Fava beans, sulfonamides, primiquine, dapsone X-linked recessive 879.

Watery diarrhea and garlic breath

Arsenic poisoning, blocking lipoic acid

880.

Essential fructosuria or fructose intolerance?

EF: fructokinase def, by with hexokinase FI: Aldolase B def, worse disease

Respond to blood pressure, Carotid Body responds to partial pressures of O2/CO2, supplied by glossopharyngeal nerve

881.

Galactokinase def or Classic galactosemia?

GKD: mild, avoid lactose, galactitol accumulates to form cataracts CG: G-1-P uridyl transferase deficiency, cataracts, jaundice, failure to thrive

Articular eminence

Critical in the TMJ

882.

867.

Palatoglossus

Vagus nerve supplies this tongue muscle

Sucrose Lactose Maltose

S: Fructose and Glucose L: Galactose and Glucose M: Glucose and Glucose

Uvula/Tongue deviation

Uvula deviates to good side (X), Tongue deviates to bad side (XII)

883.

868.

Riboflavin aka FADH

869.

Gag reflex

Glossopharyngeal (IX) sensory, Motor (X)

Anemia mouth or lip sores, skin disorders sore throat swelling of mucous membranes and sensitivity to light/eye fatigue

884.

Peroxisomes

Break down fatty acids and produce hydrogen peroxide

885.

DNA pol I vs. DNA pol III

Pol III is the primary one Pol I replaces RNA primer with DNA, AND has exonuclease activity

886.

Biotin (B7) Def.

Carboxylase deficiency

887.

Glutamate-Glutamine cycle ***

Within the brain, astrocytes and neurons interact to regulate the metabolism of glutamate, glutamine and ammonia.

870.

Tonsillectomy

Damage to glossopharyngeal nerve

871.

Levator veli palatini

Muscle that prevents food from going into nose

872.

Stylopharyngeus

Innervated by IX

873.

Pharyngeal Arches

1: Mastication/Jaw, 2: Facial nerve, 3: Glossopharyngeal like taste, 4 and 6: Pharynx/Palate

874.

B-100

Apolipoprotein that binds LDL

888.

Reactive Arthritis (Reiter's Syndrome) Causes

889.

Psoriasis

Chlamydia or bacterial GI infection causing triad of mono-arthritis, conjunctivitis, and urethritis, and SOMETIMES sacroillitius

Thin granulosum and thick corneum, often covered in silvery scale (T-cell mediated) Pitting of nails Risk of psoriatic arthritis Auspitz sign: pinpoint bleed 890.

Keloids

Nodules formed in wound healing due to excessive collagen, increased TGF-Beta activity

891.

Entaracept (TNF-alpha inhibitor)

Can reactivate Tb (as TNF-alpha is important to granuloma formation)

892.

Allopurinol interactions

Azathioprine, 6-MP

893.

Urinary Incontinence

Stress: dysfunctional urethra because of uned abdominal pressure Urge: detrusor overactivity

894.

6th Aortic Arch

Ductus arteriosus and pulmonary arteries

895.

4th Aortic Arch

Aortic arch and subclavian

896.

3rd Aortic Arch

Carotids

897.

Nursemaid's elbow

Annular ligament displacement

898.

Osteopetrosis (poor osteoclast function)

Carbonic anhydrase deficiency Vision and hearing impairment Anemia, thrombocytopenia Bone fractures Tx: bone marrow transplant 899.

DIC

Disseminated intravascular coagulation (pathological activation of coag cascade) Widespread microthrombi, consumption of platelets and factors > schistocytes Venipuncture oozing D-dimer (fibrin split product) 900.

Nondihydropyridine Ca++ blockers

diltiazem, verapamil

901.

Gingival hypertrophy side effects

Phenytoin, Verapamil, cyclosporine (immunosuppressant for transplants)

902.

Multi Drug Resistant 1 Gene (MDR1)

P-glycoprotein that has ATP-dependent efflux pump

903.

Lymph Node

910.

Which immunoglobulins fix complement?

IgG, IgM (not IgA)

911.

Which immunoglobulins cross the placenta?

IgG

912.

IL-2 inhibitors for transplant immunosuprression

Cyclosporine and Tacrolimus (FK506) block transcription (nephrotoxic) by inhibiting calcineurin Sirolimus prevents response to IL2 (BM supp) Daclizumab/basiliximab IL-2R antibodies

1* Follicle: Dormant b cells (dark) 2* follicle: active B-cells (pale) -seen in RA or early HIV Medula: macrophages (draining cancer in sinuses) Paracortex: T cells (viral) 904.

Superficial inguinal or popliteal?

Popliteal lymph node gets dorsolateral foot and posterior calf

913.

Waldenstrom's macroglobulinemia

Monoclonal IgM M spike, no lytic bone lesions or hypercalcemia, proliferation of plasma cells

905.

Right lymphatic duct

Right side of body above the diaphragm, everything else by thoracic duct

914.

IFN function

Inhibit protein synthesis by degrading viral mRNA

915.

Spleen pulp

What Ig goes with initial, and then secondary response?

Initial: IgM, Secondary: IgG

906.

916.

Post Strep Acute Glomerulonephritis is caused by

Deposited Immune complexes, not preventable by antibiotics

917.

What is the best way to immune-suppress transplant recipents?

Corticosteroids

918.

Humoral Immunity

B cells (B for banter)

919.

Cellular immunity

T cells

920.

Oxacillin

Beta lactamase-resistant penicillin

921.

Bruton's agammaglobulinemia (X-linked)

Defective B-cell tyrosine kinase, recurrent bacterial infections, cannot form germinal centers of lymphoid follicles, Tx: pool IgG

922.

What is a hapten?

Incomplete antigens that can induce antibodies (ie penicllin, poison ivy)

923.

Tx for Hemolytic Disease of the Newborn

Give mother Anti-Rh antibodies post-delivery

924.

SCID - Severe Combined Immune Deficiency Causes

Adenosine Deaminase Deficiency, Defective IL-2, MHC II defect

925.

SCID - Severe Combined Immune Deficiency and Tx

Adenosine accumulation is toxic to T and B cells, Recurrent viral and bacterial infections, diarrhea Tx: Bone marrow transplant

926.

Hereditary Angioedema

C1 esterase inhbitior, DO NOT USE ACE-inhibitors due to bradykinin

927.

MAC prophylaxis

Azithro at CD4 < 50

T Cells: PALSheath in white pulp B cells: white pulp follicles Marginal zone: APCs 907.

Thymus Histology

Derived from third pharyngeal pouch Cortex: immature T cells (+ selection) Medulla: mature cells (- selection) Hassall corpuscles: epithelial reticular cells 908.

MHCI vs MHCII

MHC I: nucleated cells, endogenous antigens, B2-microglubin MHC II: APCs, exogenous antigens, invariant chain

909.

Which immunoglobulins are original?

IgM and IgD

928.

Cold Agglutinins

Mycoplasma pneumo and EBV

929.

How are granulomas formed?

Th1 cells with IFNgamma and IL-2, stimulated by IL-12, TNF alpha

930.

Flu vaccine

Forms antibody response to HA to prevent virus from entering cell

931.

What cytokines help form granulomas?

IFN-gamma, IL-12, TNF alpha

932.

Chronic Granulomatous Disease

X-linked mutation affecting NADPH oxidase causing dtysfunctioning neutrophils and oxidative burst

933.

What is the difference between positive and negative selection?

Positive destroys cells that cannot recognize self in the cortex, Negative destroys cells that have an affinity TOO strong for self in the medulla

934.

Type I hypersensitivity reaction

Wheals, IgE mediated receptor aggregation causes degranulation of mast cells and basophils releasing histamine and tryptase IgE dependent: B-lactams, sulfonamides IgE independent: opioids, radioconstrast agents

935.

Hyper acute rejection

Preformed IgG antibodies against graft

936.

Opsonins

Coating proteins that promote phagocytosis: IgG and C3b

937.

Poison Ivy

dermatitis, Type IV sensitivity reaction, caused by urushiol

938.

What parts of the immunoglobulin molecule attach to what?

The FABs attach to the antigen, and the constant Fc portion attaches to receptors

What holds the heavy chain of the immunoglobulin together?

Disulfide bonds

940.

Isotope Switching

IgM >> IgG, occurs in germinal centers of lymph nodes and requires CD40R on B-cells and CD40L on T-cells

941.

Wiskott-Aldrich syndrome

Eczema, recurrent respiratory infections, thrombocytopenia, all caused by X-linked B and T lymphocyte deficiency, Caucasian

939.

942.

Recurrent mycobacterium infections

Defective IFN-gamma signaling pathway, require lifetime antimycobacterial treatment

943.

What indicates Tcell deficiency?

Candida and/or Pneumocystis

944.

Candida injection

Tests for T-cell deficiency: Macrophages, CD4, CD8, and NK should respond Type IV hypersensitivity

945.

Leukocyte adhesion deficiency

Late seperation of umbilical cord, AR loss of CD18 necessary for integrin formation, recurrent infections without pus

946.

Acute vs. Chronic rejection

Acute: dense lymphocytes, Chronic: inflammatory cells and fibrosis

947.

How do cancer cells form resistance?

MDR1 channel that is an ATP dependent transporter/efflux pump

948.

Methotrexate overdose treatment

Folinic Acid (Leucovorin or N-formyl-THF)

949.

How do you treat multiple myeloma?

Bortezimab (proteasome inhibitor to cause apoptosis)

950.

How do you treat warfarin overdose?

Fresh Frozen Plasma (faster than vitamin K)

951.

Desmopressin (DDAVP)

Increases circulating factor VIII, and secretion of vWF (both made by endothelial cells): Used for Mild hemophilia A

952.

Which drugs enhance p450 activity?

rifampin, phenobarbital, phenytoin, carbamazepine, griseofulvin

953.

Which drugs decrease p450 activity?

Cimetidine, amiodarone, bactrim, grapefruit juice

954.

5-FU

Blocks synthesis of thymidylate synthetase, and therefore cannot form DHF Megaloblastic Anemia

955.

Etoposide

Prevents Topoisomerase II from sealing the double-stranded DNA breaks it has made

956.

LMW Heparin (enoxaparin) mechanism

Binds ATIII, which then stops Xa from converting prothrombin to thrombin

957.

Mesna

Protects the kidney from acrolien metabolites from cyclophosphamide chemo treatment

958.

Abciximab

Blocks glycoprotein IIa/IIIb receptor to decrease platelet binding to fibrinogen

959.

How do you treat chemo therapy induced vomiting?

Serotonin (5HT) inhibitors like Ondansetron

960.

NNRTI

Antiretrovirals that do not require activation via intracellular phosphorylation, Nevirapine and Efavirenz, delavridine

961.

How do you treat HIT (Heparin induced thrombocytopenia)?

Hep-PF4 IgG antibodies > fragments of platelets can cause thrombosis Argatroban which binds directly to thrombin active site

962.

Trastuzumab

Monoclonal for Breast cancer with HER2, a tyrosine kinase receptor

963.

Vincristine

Inhibit microtubule formation in the M phase, side effects include peripheral neuropathy

964.

Chemo-therapy induced vomiting receptors (5)

Muscarinic, Dopaminergic, Histaminic, Serotonergic, Neurokinin

965.

Unfractionated heparin vs. LWMH

Unfractionated has longer polysaccharid units and therefore can control AT inactivating Thrombin better

966.

RiveroXAban

Factor XA direct inhibitor, used for DVT and A-fib

967.

Blood Group antibodies

Anti A - IgM, Anti-B - IgM, O AntiA/B - IgG, Anti-Rh (D) - IgG, IgG can cross the placenta

Inflammatory Leukocyte Accumulation

(1) Margination - reduces stress (2) Rolling - selectin (3) Activation - conformational change (4) Tight adhesion/crawling - ICAM (5) transmigration - PECAM

969.

How do you prevent tumor lysis syndrome?

Allopurinol or Rasburicase, Probenecid is only for patients with GOOD renal function

970.

6-MP

Used for ALL, inactivated by xanthine oxidase so allopurinol increases toxicity of drug

971.

Nasopharyngeal Carcinoma

EBV mono, with atypical lymphocytes

968.

972.

Hemolytic Uremic Syndrome

Microthrombi creating schistocytes in renal arteries Thrombocytopenia, renal failure Normal PT/PTT Often caused by EHEC 0157:H7in Kids, also caused by Shigella toxin >> 60S ribosome 973.

Hemoglobin S and C genetics

Both result from missense mutation on Bglobin of valine (or lysine for C) substitution for glutamic acid, A more negative > S > C least negative HbC crystals 974.

Haptoglobin

Binds free hemoglobin after RBC lysis to be destroyed by spleen, decreased levels in sickle cell, thalessemia, lead poisoning,etc.

975.

Acute Promyelocytic Leukemia

t(15,17) balanced translocation, associated with DIC, responds to retinoic acid therapy

976.

Erythrocytosis

Relative: Increased percentage of Hct because decreased volume load; Absolute: Increased percentage of Hct because increased RBC mass like Polycythemia vera

977.

Radiation therapy

Causes DNA double strand breakage and free radical formation

978.

Hereditary Spherocytosis

991.

Tardive Dyskinesia

Repetitive, involuntary movements of the face occurring with longterm dopamine antagonists

992.

How is bipolar I different from bipolar II?

Bipolar I: Manic episode, Bipolar II: depressive AND hypomanic episode (functioning mania)

993.

How do you differentiate substanceinduced psychotic disorders from primary psychotic disorders?

Substance-induced disorders will also present with more physical manifestations like tachycardia, HTN, diaphoresis, etc.

994.

How do you differentiate schizophreniform disorder from schizophrenia?

Schizophreniform: 1-6 months, Schizophrenia: >6 months

995.

Alcohol withdrawal

Tremors, anxiety, delirium, tachycardia, seizures

996.

Cocaine (stimulant) withdrawal

Increased appetite, hypersomnia, severe depression "crash"

997.

Benzo withdrawal

Tremors, anxiety, psychosis, insomnia, tachycardia, seizures

998.

Nicotine withdrawal

Disphoria, irritability, increased appetite

999.

Heroin withdrawal

N/V, cramping, dilated pupils, yawning

1000.

How do you treat bulimia nervosa

Fluoxetine

1001.

Buspirone

Nonbenzo anxiolytic for generalized anxiety disorder, slow onset, few side effects

1002.

Methylphenidate

ADHD, decreases reuptake of NE and dopamine

1003.

Olanzapine and Clozapine side effects?

Olanzapine: Hyperglycemia and lipidemia> obesity Clozapine: BM suppression

1004.

How do you differentiate borderline and dependent disorder?

Dependent: long term relationships, scared to leave them, Borderline: impulsivity and unstable relationships, "splitting," suicidal threats

1005.

Projection

Misattirubitng one's owns feelings to others, i.e. angry child thinks his divorcing parents are "angry" at him

1006.

Reaction formation

Responding in a manner opposite to one's feelings

RBC membrane defect in tethering proteins: spectrin/band 3.1/ankyrin, Hemolytic anemia, jauncide, and splenomegaly often after URIs 979.

Bruising mechanism

RBC's cause purple color, Heme oxygenate degrades heme to biliverdin causing green color, biliverdin reductase degrades it to yellow

980.

What are the differences between positive/negative reenforcement and punishment?

+ P: Speeding ticket, - P: taking away car keys, +R: giving candy, -R: wearing sunscreen prevents burn, ALL ARE operant conditioning

981.

Sodium Bicarbonate

For aspirin poisoning by helping raise blood pH and increasing renal elimination

982.

N-acetylcysteine

Acetaminophin poisoning

983.

AcH toxicity

Atropine and tricyclics like Amitriptyline cause "hot as a hair, dry as a bone, red as a beet, blind as a bat, mad as a hatter", due to inhibition of Na+ channels

984.

Lithium

Tx: Bipolar, SE: Induced Type I diabetes by antagonizing vasopressin preventing the CD's ability to concentrate urine, Can also affect TSH

985.

Venlafaxine

SNRI for depression, risk of developing a manic episode

986.

Phenylephrine

alpha1 agonist, decreases HR and increases vascular resistance

987.

How does lorazepam work?

Binds allosterically to GABAa receptors

988.

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes

989.

Serotonin Syndrome

Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity

990.

ADHD

Before age 12, inattentive and hyperactive symptoms in two settings (home AND school)

1007.

Rett syndrome

Neurodevelopment of child (girl, as boys die in utero) fails between age 1-4, with poor head growth

1021.

Schizoid vs. Schizotypal

1008.

Bupropion

Antidepressant with no sexual side effects or weight gain, can cause seizures

1022.

Alpha vs Beta thalessemia

1009.

Rat Poison

"Superwarfarin" Tx: fresh frozen plasma for it's clotting factors

1010.

Cyanide Poisoning

Dyspnea, palpitations, flushed skin, Tx: nitrates

1011.

Lipid Soluble Barbiturates in anesthesia

Thiopental is rapidly redistributed throughout the rest of the tissues after crossing the BBB, and loses effect (NOT due to metabolism)

Anorexia Nervosa

BMI <18.5, distorted body image, osteoporosis, amenorrhea, arrythmias, salivation gland swelling if binge eating/purging sub-type

1012.

1013.

1014.

How is bulimia nervosa different than anorexia nervosa (Subtype binging/purging)?

Patients with bulimia nervosa maintain body weight, anorexia nervosa have low BMIs

Trazadone

Antidepressant for insomnia by inhibiting serotonin reuptake, SE: priapism

1015.

Organophosphates

Found in pesticides, can cause cholinergic overstimulation by inhibiting cholinesterase, Tx: atropine

1016.

Methadone vs. Buprenorphine

Methadone: long half life, mureceptor agonist; Burprenorphine: shorter half life, partial agonist, less SE (hard to overdose)

1017.

How can you differentiate normal puberty and a psychotic disorder?

Look for child doing well in school and hanging out with friends, social isolation and academic failure would be more indicative of a disorder

1018.

Recurrent unexplained chest pain in young healthy adults

Panic Attack, Tx: benzodiazepine

1019.

Suicide interventions

Remove access to firearms, decrease stress, provide , treat psychiatric illness, manage pain

1020.

Avoidant vs. Antisocial personality disorder

Avoidant: fear of criticism/rejection; Antisocial: Disregard/violation of others, often involved in criminal behavior

Schizoid: loner, unemotional; Schizotypal: Eccentric with odd thoughts/behavior

Alpha: Gene deletion (africantrans/asian-cis) Beta: Pt mutation (Mediterranean), target cell 1023.

OCD vs OC personality disorder

OCD: compulsions, time consuming, counting OD: insistence on control and orderliness

1024.

Hepatic Adenoma

Rare, benign liver tumor, often related to oral contraceptive or anabolic steroid use; may regress spontaneously or rupture

1025.

P vs. LSD

P: nystagmus, dissociation, violence LSD: visual hallucinations, tachycardia

1026.

Alpha-1antitrypsin deficiency

Panacinar emphysema Intrahepatic accumulation of AAT molecules leading to cirrhosis PAS stain +

1027.

Hepatoduodonal ligament

Common bile duct Hepatic Artery Portal Vein

1028.

Portal hypertension or thrombosis

Esophageal varices Caput medusa Anorectal varices

1029.

Acute interstitial nephritis

NSAIDs, penicillin, diuretics Fever and rash, eosinophils in urine Can progress to renal papilary necrois (also caused by sickle cell trait/DM)

1030.

Schistosoma hematobium

Middle eastern male >> bladder squamous cell carcinoma

1031.

Where is epo made?

Renal Interstitial cells in peritubular capillary bed

1032.

Hemostasis

1) vasoconstriction (endothelin) 2) subendothelial collagen binds vwF, which binds GpIb 3) platelet conformational change, ADP and TXA2 release 4) ADP Induces GpIIBIIIa receptor on platelets, fibrinogen links platelets ------5) Coag cascasde generates thrombin which converts fibrinogen to fibrin **Tissue thromboplastin activates 7, warfarin subendothelial collagen activates 12, Heparin 6) Fibrin and fibrinogen cleaved by plasmin (from plasminogen by tPA), regulated by alpha2antiplasmin from liver 1033.

Thrombotic Thrombocytopenic Purpura (TTP)

1034.

Cerebral aqueduct stenosis

1035.

Dandy-walker formation

ADAMSTS13 deficiency or autoantibody Normal PT/PTT Can't cleave vWF into monomers Microthrombi creating schistocytes CNS abnormalities -Congenital stenosis of channel that drains CSF from the 3rd to 4th ventricle

1036.

Arnold-Chiari malformation

Type I: herniation of cerebellar tonsils, asymptomatic/headache Type II: herniation of cerebellum and medulla, often causes hydrocephalus. 1037.

Syringomyelia

Knock out anterior white commissure from C8-T1 Cavitation of the spinal cord causing bilateral loss of pain and temperature 1038.

Lacunar stroke

Microinfarctions due to hyaline arteriosclerosis (diabetes, HTN) Lenticulatestriate arteries off MCA (also have risk of charcot-bouchard aneurysms) a genesis of cerebellar vermis and cystic enlargement of 4th ventricle