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BR-6
Random facts
| Question | Answer |
|---|---|
| Physiologic effects of hemorrhage | dec diastolic bp, activation of RAAS (d/t dec renal blood flow and catecholamine stim), catecholamine release (from hi pressure baroreceptors; sinus tachy, inc contraction/PR, stim JG apparatus, venoconstrict); Na reabsorption; release of ANP and ADH |
| Opportunistic infxns in AIDS | pneumocystis, CMV, cryptococcus, MAI, TB, Herpes (esophagitis), candida (thrush, esophagitis), cryptosporidium (acid fast, diarrhea) |
| Cocaine | decreased uptake of Dopa and Norepi |
| Polyclonal inflammation | chronic |
| Monoclonal inflammation | one clone of plasma cells |
| Absence of Y chromosome | germinal ridge moves in direction of ovarian differentiation instead of testes |
| UBV light | produces thymidine dimers, which if not replaced with normal DNA by DNA repair enzymes, may result in cancer (basal cell, squamous, melanoma); a/w xeroderma pigmentosum |
| ESR increase with age | probably abnormal, indicative of a disease process (not an age-associated finding) |
| Key elements in wound healing | granulation tissue, fibronectin |
| Cause of death in 15-25yo bracket | MVA (mc); black males = homicide |
| Xeroderma pigmentosum | AR dz w/absence of DNA repair enzymes; inc incidence of UVB-related skin cancers |
| Cytochrome oxidase | inhibited by CO and cyanide |
| Chronic granulomatous disease of childhood | SXR; absence of NADPH oxidase; absent respiratory burst; cannot kill catalase positive S. aureus, but CAN kill catalase negative Streptococci |
| Cause of atrophy in a muscle in a cast | lack of muscle stimulation |
| Mosaicism | non-disjunction in somatic cells |
| mc vitamin deficiency in alcoholics | folate |
| mc metal deficiency in alcoholics | magnesium |
| vitamin a/w pyruvate dehydrogenase | thiamin |
| child born with ambiguous genitalia | determine genetic sex |
| Respiratory burst | NADPH oxidase conversion of molecular O2 into superoxide free radicals; neutrophils and monocytes only |
| Caisson Disease: what is decreased when a diver comes up to the surface too quickly | PN2 in blood, since it forms bubbles in vessels and moves into tissue |
| Clear cell adenocarcinoma of vagina | DES exposure; vaginal adenosis is precursor |
| what happens to other kidney if one is damaged? | it hypertrophies |
| Vitamin E toxicity | decreases levels of vit K dependent factors; inc incidence of hemorrhagic strokes; potentiates action of warfarin |
| Biotin reaction | carboxylase reaction in conversion of pyruvate to oxaloacetate |
| Cherry red macula | Tay Sach disease |
| Pyridoxine (B6) | transamination reactions involving transaminases AST and ALT |
| Functions of ANP (atrial natriuretic peptide) | opposite of angiotensin-II (inhibits ADH release, inhibits AT-II effect on stimulating thirst, inhibits aldosterone and renin secretion, and renal reabsorption of Na); Direct Effect = loss of Na in urine |
| Chance of male w/CF to have a child | <5% since vas deferens isn't fully developed or are atretic; (females can but cervical mucus is thick) |
| Vitamin supplements in CF | give all fat soluble vitamins |
| Woman is pure vegan and breast feeding, why does baby develop anemia? | B12 deficiency |
| EBV attaches to: | CD21 on Bcells |
| Hypogonadism, MR, unilateral gynecomastia | Kleinfelter's syndrome |
| Hypogonadism, anosmia and color blindness | Kallmann syndrome (absent GnRH) |
| Hypogonadism, MR, retinitis pigmentosum | Laurence-Moon-Biedl syndrome |
| Male with hypogonadism, MR, short stature and web neck | Noonan syndrome (similar to turner's), can also occur in females |
| Male pseudohermaphrodite with cryptorchidism (mc cause of male pseudohermaphroditism) | testicular feminization (absent androgen receptors; SXR; |
| Microdeletion syndrome with hypogonadism, MR, short stature, and obesity | Prader-Willi syndrome (paternal Chrom 15) |
| Angelman syndrome | microdeletion of maternal origin chrom 15 with MR, DevDelay, laughter |
| Pt with neurofibromatosis has severe diastolic HTN | probable pheochromocytoma |
| Complications of cyclophosphamide | hemorrhagic cystitis and transitional carcinoma of bladder |
| Decline in deaths d/t SEDS is attributed to | having baby sleep supine (avoids inspiration of own CO2; those w/immature central chemoreceptors don't respond to respiratory acidosis by moving head and therefore die) |
| Most important risk factor for inc morbidity/mortality in a single 25yo black male | unprotected sex (AIDS is #1 killer) |
| Most important risk factor for inc morbidity/mortality in a single 25yo white male | motor vehicle accidents |
| Several workers from car assembly plant (or making moonshine in old car radiator) have HA, N/V, muscle weakness, abd cramps | lead poisoning from incinerating batteries |
| Newborn girl with edema of hands and feet and cystic mass in neck | Turner's syndrome; 45 XO karyotype |
| Components of Cow's milk (versus breast milk) | more vit K, less ascorbic acid, more B12, more casein |
| Mature breast milk components (versus cow's milk) | low iron, but better absorption, whey protein is primary protein |
| Vitamin that is abscent in colostrum | vit D |
| Anemia in an infant that develops when switched from cow's milk to goat's milk | goat's milk is low in folate, B6, iron and is high in K, Cl, arachidonic acids and linolenic acids when compared to cow's milk |
| Type of UV light a/w corneal burn (ex: snow skiing) and cancer | UBV; B is bad |
| Retinal hemorrhage in young child | possible cause is shaken baby syndrome |
| Pt stung by bee, has respiratory difficulty, flushing, abd cramping - Tx? | aqueous epinephrine IM |
| Fire ant bites | multiple wheals that later develop into vesicles and pustules |
| Black widow bite | painful bite followed by crampy pain in thighs and abdomen; scenario includes carrying logs in from outside or moving boxes in basement; Tx = muscle relaxant (Ca-gluconate), tetanus prophylaxis, and antivenom if severe |
| Poisonous scorpian bite in SW | painful sting followed by local itching, paresthesias, N/V, HTN |
| Brown recluse spider bite | painless bite beginning with slightly tender red papule on arm that later forms a hemorrhagic blister surrounded by purpura |
| Chigger bites | extremely pruritic, discrete, bright red papules on legs and around waist |
| Child who ingests 30 adult aspirins will most likely develop | inc anion gap metabolic acidosis (rather than a mixed metabolic acidosis/respiratory alkalosis seen in adults); Rx = gastric lavage, activated charcoal, production of alkaline urine |
| What disease is more likely to infect the fetus after the first trimester | syphilis |
| Engineer driving train involved in crash with oncoming train had THC metabolites in urine...why did accident occur? | delayed reaction time (also impaired ability to judge speed and distance) |
| Causes of Angiosarcoma of liver | vinyl chloride, arsenic, Thorotrast |
| Ambiguous genitalia - Male | 17-hydroxylase deficiency; female appearing, no male homrones, male pseudohermaphrodite |
| Ambiguous genitalia - Female | female pseudohermaprodite; 21-hydroxylase deficiency or 11-hydroxylase deficiency |
| Salt loser with volume depletion a/w | 21-hydroxylase deficiency |
| Salt retention with HTN a/w | 11-hydroxylase deficiency and 17-hydroxylase deficiency |
| Plasma ACTH abnormality | increased adrenal steroid production of 21-, 11-, and 17-hydroxylase |
| Hypocortisolism a/w | adrenal deficiency in 21-, 11-, and 17-hydroxylase |
| Urine 17-ketosteroids a/w | increased adrenal secretion of 21- and 11-hydroxylase, and decreased 17-hydroxylase |
| Urine 17-hydroxycorticoids a/w | adrenal hyposecretion of 21- and 17-hydroxylase and increased 11-hydroxylase |
| Age dependent cardiovascular change | loss of elasticity in aorta |
| Age related cardiovascular change | atherosclerosis, ischemic heart dz, temporal arteritis, aortic stenosis |
| Age dependent respiratory change | "senile emphysema" overinflation of lung (COPD-like),dec elasticity, dec FEV1, inc fxnl residual capacity, dec PaO2 |
| Age related respiratory change | cancer and pneumonia |
| Age dependent musculoskeletal change | osteoarthritis |
| Age related musculoskeletal change | osteoporosis, fractures (vertebral mc), RA, Paget's dz |
| Age dependent CNS/special senses changes | cataracts, presbycusis (inner ear degen), otosclerosis (conductive loss), dec smell/taste, arcus senilis (white rim on cornea) |
| Age related CNS/special senses changes | dementia (Alzheimer's, multi-infarct), cererbral atrophy, TIAs, Parkinson's, subdural hematoma, stroke |
| Age dependent immune system changes | inc CD4 and dec CD8 Tcells, inc synthesis of autoantibodies, dec cellular immunity |
| Age related immune system changes | inc monoclonal gammopathy of undetermined significance, inc incidence of multiple myeloma, inc susceptibility to influenza |
| Age dependent Integument system changes | loss of skin elasticity, inc collagen x-bridging, inc body fat, ecchymoses from vessel instability (senile purpura on hands), dec skin turgor (tenting when pinched) |
| Age related integument changes | inc UV-induced skin cancers (actinic keratosis is precursur for squamous cell; basal cell is mc); inc in seborrheic keratosis (pigmented lesions) |
| Age dependent reproductive changes | breast/vulvovaginal atrophy, dec serum estrogens and inc gonadotropins, testicular atrophy w/dec testosterone levels, prostate hyperplasia/cancer |
| Age related reproductive changes | inc incidence of cancers of vulva, vagina, cervix, endometrium, ovary, breast; spermatocytic seminoma and malignant lymphoma of testis (metastatic) |
| Age dependent renal changes | dec GFR (40% drop); dec creatinine clearance (important to adjust drug dosages to avoid toxicity) |
| Age related renal changes | inc incidence of renal adenocarcinoma and renovascular HTN secondary to atherosclerosis |
| Age dependent endocrine changes | inc CHO intolerance (less insulin receptors from increased adipose) |
| Age related endocrine changes | Type II diabetes |
| Target organs for acetaminophen injury | liver and kidneys (renal medulla); free radical injury |
| Low AFP on amnioscentesis | Down syndrome |
| Corticosteroid MOA | block phopholipase A2 hence dec prostaglandin and leukotriene production; dec leukocyte adhesion (inc PMNs, dec lymphos and eosinophils) |
| Ectopic ACTH | mc ectopic secretion; Tumors (small cell carcinoma of lung, medullary carcinoma of thyroid); Syndromes (Cushing - hyperpigmentation) |
| Ectopic ADH | Tumors (small cell carcinoma of lung); Syndrome (dilutional hyponatremia) |
| Ectopic b-hCG | Tumors (Trophoblastic: benign (hydatiform mole, invasive mole), Malignant (choriocarcinoma), Germ cell tumors of ovary/testis); Syndromes (gynecomastia (LH analogue), hyperthyroidism (similar to TSH), precocious puberty) |
| Ectopic calcitonin | Tumors (medullary carcinoma of thyroid); Syndromes (hypocalcemia) |
| Ectopic Erythropoietin | Tumors (renal adenocarcinoma, Wilm's, hepatocellular ca, von Hippel-Lindau (cerebellar hemangioblastoma, renal adenocarcinoma), renal cysts/hydronephrosis, uterine leiomyomas/hydroneprhosis); Syndromes (2* polycythemia w/in RBC mass, nml PaO2 &plasma vol) |
| Ectopic Insulin-like protein | Tumors (hepatocellular carcinoma, retroperitoneal tumors); Syndromes (hypolglycemia) |
| Ectopic PTH-like peptide | Tumors (Squamous cell of lung, renal adenocarcinoma, breast and ovarian cancer); Syndromes (hypercalcemia w/low PTH) |
| Ectopic Serotonin | Tumors (carcinoid syndrome d/t metastatic smal bowel carcinoid to liver, small cell of lung, bronchial carcinoid, medullary carcinoma of thyroid); Syndromes (Carcinoid = flushing, diarrhea, valvular lesions w/tricuspid insufficiency and pulmonic stenosis) |
| AFP tumor marker | Oncofetal antigen gene product; Hepatocellular carcinoma, germ cell tumors (yolk sac or endodermal sinus tumor of testicle/ovary); Testicular or ovarian cancer |
| AAT tumor marker | Enzyme; hepatocellular carcinoma, yolk sac or endodermal sinus tumor of ovary/testis |
| b-hCG tumor marker | hormone; trophoblastic tumor in germ cell of ovary/testis/placenta; benign (hydatiform and invasive mole), malignant (choriocarcinoma) |
| b2-microglobulin tumor marker | protein; multiple myeloma (excellent Px): light chains in urine (aka Bence Jones ptn) |
| Bombesin tumor marker | peptide; small cell carcinoma of lung; neuroblastoma |
| CA 15-3 tumor marker | glycoprotein (cancer antigen); breast cancer |
| CA 19-9 tumor marker | glycoprotein (cancer antigen); pancreatic cancer |
| CA 125 tumor marker | glycoprotein (cancer antigen); surface derived ovarian cancer |
| CEA tumor marker | oncofetal antigen gene product; colorectal, pancreatic, breast and small cell cancer of lung; Bad Px if elevated preoperatively (inc incidence of undetected mets) |
| LDH tumor marker | enzyme; Hodgkin's dz; non-specific marker in general |
| Neuron specific enolase (NSE) tumor marker | enzyme; small cell carcinoma of lung, neuroblastoma |
| PSA tumor marker | glycoprotein; prostate adenocarcinoma. excellent sensitivity, but poor specificity (inc in prostatic hyperplasia too); excellent indicator of tumor burden, not inc after rectal exam, free PSA is more indicative of BPH |
| HTLV-1 oncogenic RNA virus a/w | adult Tcell leukemia/lymphoma |
| HTLV-2 oncogenic RNA virus a/w | hairy cell leukemia |
| HIV oncogenic RNA virus a/w | CNS malignant lymphoma |
| HCV oncogenic RNA virus a/w | hepatocellular carcinoma |
| HBV oncogenic DNA virus a/w | hepatocellular carcinoma (aflatoxin B is a cocarcinogen) |
| EBV oncogenic DNA virus a/w | Burkitt's lymphoma, nasopharyngeal carcinoma, polyclonal malignant lymphoma |
| HPV (HSV-2 as possible cocarcinogen) oncogenic DNA virus a/w | squamous cell carcinoma of cervix, vagina, vulva and anus; laryngeal papillomas (may progress to cancer) |
| HSV-8 oncogenic DNA virus a/w | Kaposi's sarcoma |
| EM of zebra bodies in lysosomes in Niemann Pick Dz look like | lamellar bodies in type II pneumocytes |
| Enamel injury in young woman | bulimia; metabolic acidosis from vomiting; Boerhaave's syndrome |
| Anorexia nervosa | secondary amenorrhea (<15% ideal body wt, dec GnRH and gonadotropins), distorted body image, osteoporosis, ventricular arrhythmias are mc cause of death) |
| Kwashiorkor | dec protein intake with normal caloric intake (all CHOs); fatty liver from dec apolipoproteins; pitting edema; flanky pain dermatitis; "little red johnny" |
| Marasmus | decreased total caloric intake; loss of muscle mass |
| Vitamin A deficiency | squamous metaplasia in eyes, bronchus; nyctalopia (night blindness) |
| Vitamin A toxicity | increased intracranial pressure; hypercalcemia |
| Primary hypothyroidism | b-carotenemia from dec conversion of b-carotenes into retinoic acid in intestine (thyroxine is cofactor); pt is yellow excepe eyes |
| Rickets vs osteomalacia in adults | Rickets (craniotabes and rachitic rosary); Both have an increase in unmineralized osteoid |
| Vitamin E deficiency | cerebellar dysfxn; hemolytic anemia; toxicity: interferes w/vit K dependent factors leading to hemorrhagic diathesis |
| Vitamin C deficiency | teeth bleed when brushed; glossitis; perifollicular hemorrhages; a/w tea and toast diet |
| Thiamin deficiency | MCC alcoholism; imp rxns (pyruv DH, transketolase, ketoglutarate DH); Wernicke (confusion, ataxia, nystagmus); Korsakoff (antero/retrograde loss); ring hemorrhage in mamillary body/periventricular area; hi output failure/dilated CM, periph neuropathy |
| Niacin deficiency | imp rxns (NAD/NADH, NADP/NADPH); pellagra; tryptophan can be used to synthesize niacin (tryptophan is dec in Hartnup's dz, carcinoid syndrome (converted to serotonin), corn diet); diarrhea, hyperpigmentation, dementia |
| Riboflavin deficiency | imp rxns (FMN and FAD, synth of glutathione); magenta tongue, neovascularization of cornea, angular stomatitis |
| Pyridoxine deficiency | MCC is INH; imp rxns (transaminase, heme synthesis (sideroblastic anemia w/ringed sideroblasts), NT synthesis, absent in goat's milk |
| Pantothenic acid | imp in fatty acid synthase complex; co-enzyme A rxns |
| Biotin deficiency | avidin in raw eggs binds the vitamin; alopecia |
| Chromium fxn | potentiates insulin activity for glucose tolerance; deficiency a/w glucose intolerance and peripheral neuropathy |
| Copper fxn | cofactor in red-ox rxns to bind oxygen; inc in pregnancy, inflammation, w/OCPs; bound to ceruloplasmin |
| Copper cofactor for Lysyl oxidase | forms x-links in collagen and elastic tissue to inc tensile strength |
| Copper as cofactor for Cytochrome C oxidase | electron transport system |
| Copper as cofactor for superoxide dismutase | antioxidant that neutralizes oxygen free radicals |
| Copper as coenzyme for ferroxidase | converts iron to +3 so it can bind transferrin |
| Copper as cofactor for tyrosinase | converts tyrosine to DOPA in melanin synthesis |
| Copper Deficiency is a/w | microcytic hypochromatic anemia (can't bind transferrin); skeletal (defective collagen, osteoporosis); Skin depigmentation (prob w/tyrosinase); dissecting aortic aneurysms (d/t collagen/elastase); Mencke's kinky hair (rare, sex-linked; impaired utilizati) |
| Copper Toxicity is a/w | Wilson's disease; auto recessive defect in excretion of copper into bile, leads to liver damage, deposition in eye (Kayser-Fleischer ring) and lenticular nuclei; Total copper is dec d/t dec ceruloplasmin production from liver, but FREE levels are increase |
| Selenium fxn | metalloenzyme glutathione peroxidase (an anti-oxidant that destroys peroxides in the cytosol); it neutralizes peroxides (vit E prevents peroxide formation in cell membranes); inhibits DNA synth/stim immune system; cofactor for T4 --> T3 conversion |
| Selenium deficiency | muscle pain, weakness, cardiomyopathy |
| Zinc fxn | cofactor in superoxide dismutase, carbonic anhydrase, alkaline phosphatase, collagenases, RNA and DNA polymerases, thymidine kinase, alcohol DH |
| Zinc deficiency | growth retardation, hypogonad/infertility, dec taste (dysgeusia), rash around eyes/mouth, poor wound healing, impaired cellular immunity; deficiency is common in diabetics, alcoholics, cirrhosis; Acrodermatitis enteropathica (recessive dec Zn absorption) |
| Goat's milk causes | Vit B6 (pyridoxine) and Folate deficiency |
| Fxns of Vit C | reduce dietary iron from ferric to ferrous for reabsorption; hydroxylation of proline and lysine (binding site for x-bridges); prevnts nitrosamination; reduces metHb back to reduced Hb |
| Cyanosis not relieved by O2 in pt coming home from camping trip | methemoglobulinemia (water has nitrates that oxidized iron to ferric condition); SaO2 not PaO2 is decreased; Tx = methylene blue (ascorbic acid has ancillary role) |
| Newborn has high Hb d/t | increase in HbF |
| HbF | left shifts ODC, protects newborns with sickle cell dz and severe b-thalessemia, inc w/hydroxyurea, resistant to alkali/acid denaturation |
| Raising upper limit of normal of a test | increases the specificity and predictive value of a positive test; decreases sensitivity and predictive value of a negative test result |
| Prevalence | number of people with a disease in the population studied; it equals the incidence (number of new cases over a period of time) times the duration of the disease |
| Part of adrenal cortex that is atrophied in pt on corticosteroids | fasciculata and reticularis (not glomerulosa where aldosterone is) |
| Apoptosis | individual cell necrosis; normal involution of structures (thymus), programmed cell death, loss of Mullerian structures in males/Wolffian in females; Councilman (acidophilic) bodies, psammoma bodies, mechanism of bowel atresia (no lumen) |
| Paraneoplastic syndromes | ectopic hormones, hypercalcemia (PTH-like peptide - 1* SSC of lung, renal adeno), Acanthosis nigricans (stomach), Eaton-Lambert (myasthenia-like; SSC), polymyositis (lung cancer) |
| Oncogenesis of HPV | gene products E6 and E7 in HPV infections inhibit p53 tumor suppressor gene leading to cancer |
| Metalloenzyme that aids in tumor invasion of tissues | collagenase with Zn as cofactor |
| Smoker with history of peptic ulcer disease | advise them to stop smoking to avoid cancer |
| Normal karyotype in child with Down syndrome | probable translocation with chrom 21 sitting on top of chrom 14, or acrocentric (Roberstonian) translocation of chrom 21 |
| Sepsis in elderly man with benign prostatic hyperplasia | usu E. coli; can produce endotoxic shock (warm d/t activation of complement system and release of anaphylatoxins + release of nitric oxide from damaged endothelial cells) |
| DNA repair defects | Fanconi's anemia (x-linking agents) |
| Effect of barbituates and other drugs that enhance liver cytochrome system | decreases heme and increases activity of ALA synthase, the rate limiting enzyme in heme synthesis; dangerous in precipitating porphyric attacks |
| Genomic imprinting | did chrom come from mother or father; ex: Chrom 15 microdeletions (Prader willi and Angelmans) |
| Normal changes in pregnancy | greater inc in plasma vol than RBV mass leading to dec Hb; inc GFR and CCr, dec BUN, creatinine, uric acid, inc alkphos, respiratory alkalosis from progesterone; inc T4 and cortisol from inc synthesis of their binding ptns (free hormone normal) |
| Main difference btw adult male and female | iron studies all lower in females |
| Children | inc alk phos (osteoblasts from bone growth) and phosphate, slight decrease in Hb |
| Analytes increased with hemolyzed blood sample | LDH, potassium |
| Lipid most affected by fasting | triglyceride component coming from chylomicrons; CH and HDL not affected |
| Enhance cytochrome system | H2 blockers, proton blockers; danger of drug toxicity |
| First sign of tissue hypoxia | swelling of cell from inactive Na/K ATPase pump |
| Fatty liver | most commonly d/t alcohol |
| Examples of growth alterations | atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia |
| Examples of cell accumulations | melanin, iron, calcium (dystrophic, metastatic), glycogen, bilirubin products |
| Free radicals | superoxide, OH, peroxide, drugs (acetaminophen, CCL4); iron increases FR formation |
| Types of cell necrosis | coagulation (infarct, except CNS); Liquefactive (infxn, brain infarct or infxn); Caseous (TB, systemic fungi); Enzymatic fat necrosis (acute pancreatitis), Fibrinoid (immunologic, sm vasculitis, RHD vegetation, Libman-Sacks), Gummatous (3* syphilis) |
| Chemical mediators of inflammation | histamine, C3a, C3b, C5a, LTB4, LTC-D-E4, bradykinin, prostaglandins |
| Factors increasing and decreasing adhesion molecule synthesis | Increase (C5a, LTB4, endotoxins, IL-1, TNF); Decrease (catecholamines, corticosteroids, lithium) |
| Recognize a granuloma (circumscribed, red, contain multinucleated giant cells) | example of Type IV hypersensitivity; MQs when activated become epithelioid and fuse into multinucleated masses |
| Key factors in wound healing | role of fibronectin and granulation tissue; (infxn interferes) |
| Types of inflammation | Suppurative (abscess); Cellulitis (streptococcus); Granulomatous (TB); Pseudomembranous (Diptheria, C. difficile); Fibrinous (pericarditis); Serous (blister) |
| Important suppressor genes | p53 (most cancers, chrom 17); APC (familial adenomatous polyposis; chrom 5); BRCA-1 (breast/ovarian ca; chrom 17); BRCA-2 (breast ca; chrom 13); NF-1, -2 (neurofibromatosis); Rb (retinoblastoma; chrom 13) |
| Fragile X syndrome | SXR disease; mc genetic cause of MR in males (Downs mc overall); triplet repeat; macroorchidism at puberty |
| Cri-du-chat syndrome | deletion of short arm of Chrom 5; MR, cry like cate, relation with VSD |
| Marfan's syndrome | AD; fibrillin defect in elastic tissue; MVP w/sudden death; dissection is MCC of death; dislocated lens; (homocystinuria is a similar AR dz; differences: MR, vessel thrombosis d/t inc in homocysteine) |
| Neurofibromatosis | AD; brain tumors: meningioma, acoustic neuroma, pheochromocytoma, cafe au lait, Lisch nodules (hamartomas in iris) |
| Von Hippel Lindau | AD; cerebellar hemangioblastomas; pheochromoctoma; renal adenocarcinoma (high incidence) |
| Number 1 teratogen for Congenital malformations | alcohol |
| erb-B2/neu (HER-2) | codes for growth factor receptor; breast, ovarian, and colon cancer |
| ras | codes for membrane associated GTP-binding ptn that transduce signals from growth factor receptors to phosphatidyl inositol second messenger system; a/w ~30% of cancers (lung, colon, pancreas, leukemia) |
| abl | produces non-receptor ptns on inner cel membrane surface; t9:22 (CML) |
| c-myc | located in nucleus, produces ptn products that activate nuclear transcription; t8:14 (Burkitt's lymphoma) |
| N-myc | neuroblastoma |
| ret | MEN IIa and IIb |
| bcl-2 | t14:18; leads to inactivation of apoptosis gene on B cells leading to immortal cell and follicular B cell lymphoma |
| Grade of cancer (histology) | well differentiated (low grade; you can tell what origin is); poorly differentiated (high grade, anaplastic; cannot tell tissue of origin) |
| Stage of cancer | T (tumor size), N (nodal metastasis), M (other metastasis sites); more important than grade |
| Carcinoma | squamous, adeno-, transitional |
| Sarcoma | mesenchymal origin |
| Hamartoma | not neoplastic; bronchial hamartoma, PJ polyp, hyperplastic polyp |
| Choristoma | not neoplastic; normal pancreas in stomach wall |
| Mixed tumor | parotid salivary gland tumor; 2 tissues from same cell layer) |
| Teratoma | tissues of ecto-, endo- and mesoderm; cystic teratoma (of ovary; has hair and teeth) |
| Increased AG metabolic acidosis (AG = Na - [Cl + HCO3] = 12 +/- 4 mEq/L) | adding an acid and the anion of the acid replaces bicarb to buffer the H+ (ex: lactate, acetoacetate, b-hydroxybutyrate, phosphate/sulfate (renal failure), slicylate, formate (methanol), oxalate (ethylene glycol), acetate (paraldehyde) |
| Normal AG metabolic acidosis | losing bicarb and bicarb is replaced by an equal number of Cl anions (the normal AG); Renal tubular acidosis and diarrhea |
| Type 1 renal tubular acidosis (distal) | aldosterone mediated H+ pump in collecting duct is dysfxnl (cannot secrete H+ which combine with Cl to form HCL; cannot regenerate bicarb; urine pH >5.5) |
| Type II renal tubular acidosis (proximal) | lower threshold for bicarb reclamation (~15mEq/L), then bicarb can be reclaimed (initially urine pH >5.5, but when equib is reached btw threshold ans serum bicarb level it drops |
| Diarrhea metabolic acidosis | lose sodium, K, and bicarb; the latter replaced by chloride |
| Acute transplant rejection | w/in 3 months; predominantly cellular immune reaction (type IV; CD8 cytotoxic T cells; parenchymal damage) and smaller humoral compenent (vessel damage w/fibrosis) |
| Aniline dye chemical carcinogen | transitional cell carcinoma of bladder, ureters, renal pelvis |
| Benzidine chemical carcinogen | transitional cell carcinoma of bladder, ureters, renal pelvis |
| Cyclophosphamide chemical carcinogen | transitional cell carcinoma of bladder, ureters, renal pelvis |
| Phenacetin chemical carcinogen | Transitional cell carcinoma of bladder, ureters, renal pelvis |
| Vinyl chloride chemical carcinogen | angiosarcoma of liver |
| Polycyclic hydrocarbons (tobacco smoke); alcohol is cocarcinogen for oral, esophageal and laryngeal cancers | small cell carcinoma of lung; squamous cancers of oral cavity, esophagus, laryngx, lung, cervix; Transitional carcinoma of bladder; Adenocarcinoma of pancreas |
| Chromium chemical carcinogen | lung cancer |
| Nickel chemical carcinogen | lung, nasal cavity cancer |
| Uranium (radon gas) chemical carcinogen | lung cancer |
| Woodworking chemical carcinogen | nasal cavity cancer |
| Thorotrast chemical carcinogen | angiosarcoma of liver, hepatocellular carcinoma |
| Arsenic chemical carcinogen | angiosarcoma of liver, squamous carcinoma of skin, lung cancer |
| Asbestos chemical carcinogen | primary lung cancer in smoker; Mesothelioma in non-smoker |
| Oral contraceptives chemical carcinogen | liver cell adenomas, hepatocellular carcinoma |
| Aflatoxins (aspergillus flavus; cocarcinogen w/HBV) | hepatocellular carcinoma |
| Cadmium chemical carcinogen | prostate cancer, lung cancer |
| Chewing tobacco chemical carcinogen | verrucous carcinoma in mouth |
| Alkylating agents chemical carcinogen | acute leukemia, malignant lymphoma |
| Benzene chemical carcinogen | acute leukemia |
| Diethylstilbestrol (DES) chemical carcinogen | clear cell adenocarcinoma of cervix/vagina |
| Nitrosamines (inhibited by ascorbic acid and refrigeration) chemical carcinogen | Esophageal and gastric cancers |
| Tars, soots, oils chemical carcinogen | squamous carcinoma of skin (scrotum in chimney sweeps) |
| Carcinoma Metastasis | Lymphatic to regional nodes (subcapsular sinus), vessel invasion (uncommon; follicular cancer of thyroid, renal adeno, hepatocellular), seeding (ovarian) |
| Sarcoma Metastasis | Primarily vascular (lung and bone); tumor cells bind adhesion molecules on endothelial surface and bind to fibronectin and laminin receptors when infiltrating tissue |
| ESR | increased in acute/chronic inflammation and monoclonal gammopathies, best initial screen for temporal arteritis, sero sed rate in HbSS dz and polycythemias |
| SiADH | small cell carcinoma of lung, any CNS injury, any pulmon infxn, chlorpropamide; hyponatremia (<120mEq/L); inc Na in urine (Uosm > Posm [ ]ed urine); no pitting edema (TBW inc, not TBNa); Restrict water not salt; Demeclocycline allows pt to drink water |
| Primary aldosteronism (Conn Syndrome) | benign adenoma in zona glomerulosa; low renin HTN, no pitting edema (escape mechanism from block of proximal Na reabsorption); severe hypoK (muscle weakness, U waves); metabolic acidosis (tetany from low ionized Ca), normal to inc serum Na |
| Cancer incidence mortality in males in descending order | Lung > prostate > colorectal |
| Cancer incidence mortality in females in descending order | breast > lung > colorectal |
| Cancers decreasing in incidence | stomach, cervical (d/t pap smear), endometrial (pap, bx with bleeding) |
| Cancers increasing in incidence | breast (mammography), prostate (PSA screen), colorectal, pancreas, malignant lymphoma, malignant melanoma (most rapidly inc in world), multiple myeloma; generaly cancer is more common in blacks than whites |
| Gynecological cancers in order of decreasing incidence and mortality | Incidence: endometrial > ovarian > cervical; Mortality: Ovarian > Cervical > Endometrial |
| Most common metastasis site of Non-Hodgkin's lymphoma | breast |
| Most common metastasis site of Lung Adenocarcinoma | breast |
| Most common metastasis site of Bone Multiple Myeloma | Breast |
| Most common metastasis site of Liver Hepatocellular Carcinoma | Lung |
| Most common metastasis site of Adrenal Adenocarcinoma | Lung |
| Most common metastasis site of Brain Glioblastoma Multiforme | Lung |
| Smoking and alcohol have synergistic effect on | producing cancers of oral cavity, esophagus and larynx |
| Birth control pills protect against | Ovarian Cancer and Gonorrhea?? (not chlamydia) |
| CO Poisoning causes | necrosis of globus pallidus; Parkinson's; SaO2 decreased, PaO2 normal; left shif ODC; Inhibition of cytochrome oxidase |
| Respiratory acidosis | inc PaCO2, dec PaO2 and SaO2 |
| Anemia | normal PaO2 and SaO2, but decreased Hb concentration |
| Normal O2 content (1.34 [Hb] x SaO2 + PaO2) | cyanide poisoning, ischemia, uncoupling of oxidative phosphorylation |
| Dystrophic calcification | normal serum calcium/phosphate but deposit of Ca into damaged tissue; atherosclerotic plaques, enzymatic fat necrosis, periventricular calcification in CMV |
| Metastatic calcification | inc serum Ca and/or phosphate with deposition of Ca in normal tissue; nephrocalcinosis in primary hyperparathyroidism, calcification of basal ganglia in primary hypoparathyroidism (high phosphorus) |
| Cell cycle: p53 | suppressor gene produces a ptn product that has inhibitory effect on kinases that control the movement from one phase to the next in the cell cycle |
| Labile cells | contain stem cells; bone marrow stem cells, skin (stratum basalis), intestine (base of the glands) |
| Stabile cells | in Go phase and must be stimulated to go into G1 phase (ex: hormones); most parenchymal cells in organs, smooth muscle, astrocytes and other neuroglial cells |
| Permanent cells | cannot enter cell cycle; skeletal and cardiac muscle; neurons |
| Most common bone metastasized to: | vertebra d/t Batson vertebral plexus which communicates with the vena cava |
| Arterial ulcers | pain at night relieved by dependency on extremity; chronic ischemia/intermittent claudication; hairless pale skin; absent pulses |
| Neurotropic ulcers | punch-out ulcer w/deep sinus; usu over pressure point/callus; hyperesthesia/diminished position sense; ulcer is painless |
| Venous ulcer | typical location is inner ankle region; venous HTN is present; mild pain relieved by elevation |
| Argyll Robertson Pupil | "prostitute's" accommodates, but does not react to light!! pathognomonic for 3* syphilis |
| Amyloidosis | multiple causes; all deposits show green birefringence on Congo red stain; systemic forms affect kidney, heart... |
| Amyloid light chains are seen in: | plasma cell dyscrasias (multiple myeloma, Waldenstrom's); Often fatal |
| Amyloid-associated protein is acquired... | 2* to a chronic inflammatory disorder; there are familial variants |
| ATTR amyloid Transthyretin | this is a serum transport protein; familial or acquired in elderly |
| A-beta amyloidosis is a major component of: | Alzheimer's plaques |
| Beta-2 microglobulin amyloidosis deposits in: | tendons and joints in dialysis patients |
| Aschoff bodies and Antischkow's cells are found in... | Rheumatic heart disease (think of 2 RHussians with RHeumatic heart disease) |
| Granulomas in giant cells are called | Aschoff bodies; Rheumatic heart dz |
| Activated histiocytes are called | Anitschkow's cells in Rheumatic heart dz |
| Auer bodies/rods are peroxidase positive...and found in _ patients? | cytoplasmic inclusions in granulocytes and myeloblasts; Acute promyelocytic leukemia (M3) |
| RBC casts are d/t | glomerular inflammation from nephritis syndromes, ischemia, or malignant hypertension |
| WBC casts are d/t | inflammation in renal interstitium, tubules and glomeruli |
| Hyaline casts are seen in | normal urine |
| Waxy casts are seen in | chronic renal failure |
| WBCs in urine | a/w acute cystitis |
| RBCs in urine | a/w bladder cancer |
| Erythrocyte sedimentation rate can diagnose and monitor: | temporal arteritis and polymyalgia rheumatica; it measures acute phase reactants |
| What will dramatically increase ESR? | infxn, malignancy, CT disease, pregnancy, inflammatory dz and anemia |
| What will decrease ESR? | Sickle cell anemia, CHF and polycythemia |
| Name 4 hyperlipidemia signs: | Atheroma (plaque in vessel wall), Xanthoma (lipid-laden histiocyte/MQ nodule in skin, esp eyelids), Tendinous xanthoma (lipid deposit in tendon, esp Achilles), Corneal arcus (lipid deposit) |
| PSaMMoma bodies | Papillary (thyroid), Serous (ovary), Meningioma, Mesothelioma; laminated concentric calcific spherules in these cancers |
| Spherocyte RBC | hereditary spherocytosis, autoimmune hemolysis |
| Elliptocyte RBC | hereditary condition |
| Macro-ovalocyte RBC | megaloblastic anemia (hypersegmented PMNs too); marrow failure |
| Helmet cell, Schistocyte RBC | DIC, traumatic hemolysis |
| Teardrop RBC | myeloid metaplasia in myelofibrosis |
| Acanthocyte RBC | spiny appearance in abetalipoproteinuria |
| Target cell RBC | HALT = HbC disease, Asplenia, Liver dz, Thalassemia |
| Poikilocytes RBC | non-uniform shapes in TTP/HUS, microvascular damage, DIC |
| Burr cell RBC | TTP/HUS |
| HLA B27 | PAIR = psoriasis, alkylosing spondylitis, inflammatory bowel, reiter's syndrome (reactive arthritis) |
| HLA B8 | Grave's dz, Celiac sprue |
| HLA D2 | Multiple sclerosis, hay fever, SLE, Goodpasture's |
| HLA D3 | Diabetes mellitus type I |
| HLA D4 | Rheumatoid arthritis, DM type I |
| HLA DR5 | pernicious anemia (B12 deficiency), Hashimoti's thyroiditis |
| HLA DR7 | Steroid-responsive nephrotic syndrome (minimal change) |
| Reed Sternberg cells | Distinctive tumor giant cell in Hodgkin's disease (binucleate or bilobed "owl eye" symmetry); not required for diagnosis; variancts include lacunar cells in nodular sclerosis variant |
| Aminotransferases in myocardial infarction | AST only |
| Aminotransferases in viral hepatitis | ALT > AST |
| Aminotransferases in alcoholic hepaitis | AST > ALT |
| GGT | elevated in obstructive liver diseases (alk phos usu also elevated) |
| Amylase | acute pancreatitis, mumps |
| Lipase | acute pancreatitis |
| CPK | muscle disorders (duchenne's dystrophy), MI (CPK-MB) |
| LDH-1 | MI (fraction 1 > fraction 2) |
| Low Ceruloplasmin | Wilson's disease |
Created by:
bscaryp