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BR-1
Path
| Question | Answer |
|---|---|
| Causes of pneumococcus infxn in HbSS | autosplenectomy or functional asplenia |
| Vessels in esophageal varices | left gastric and azygous veins |
| Congenital adhesion molecule (integrin) defects | failure of umbilical cord to separate at birth; no adhesion of PMNs to endothelial cells, no inflammatory cells in umbilical stump |
| Mechanism of spread of Cryptococcus neoformans | hematogenous; mc cause of meningitis in AIDS and other immunocompromised states |
| Diagnosis of rotavirus infxn | rotazyme in stool; ELISA test with antibodies against virus |
| Normal times for gynecomastia | newborn, puberty, old age...it may be unilateral in a young boy |
| Treatment of astrocytoma | radiation |
| Absence seizures | abrupt onset; impaired LOC (staring); 3-Hz spike and wave on EEG |
| Treatment of absence seizures | ethosuximide - treatment of choice |
| Achalasia | absence of myenteric ganglion |
| Hirschsprung disease | achalasia with loss of both submucosal (Meissner's) and Myenteric (Auerbach's) plexuses |
| Sjogren's syndrome | dry mouth/eyes d/t destruction of minor salivary and lacrimal glands d/t antibodies |
| Mitochondrial DNA disorder | mother gives dz to all kids (male children lose maternal cytoplasm in tail of sperm and do not pass it on) |
| Hormones that increase after removal of testes or ovaries | FSH and LH |
| Diabetes insipidus | hypernatremia, very dilute urine, thirsty, polyuria (not [ ]) |
| Treatment of Central Diabetes Insipidus | vasopressin (does not work for nephrogenic) |
| Adult polycystic kidney disease | relation with CNS berry aneurysms and subarachnoid hemorrhage |
| MCC of rabies in US | skunk bites! |
| Treatment of pseudomembranous colitis | metronidazole (cheaper than oral vancomycin) |
| Treatment of CMV retinitis in AIDS if ganciclovir doesn't work | foscarnet (has renal toxicity) |
| Primary treatment of CMV retinitis | ganciclovir |
| MCC of blindness in AIDS | CMV retinitis |
| Treatment of ERA and PRA positive breast cancer | Tamoxifen (anti-estrogen); protects against CAD and osteoporosis; can produce endometrial cancer |
| Next step with an SLE patient that is positive RPR (syphilis) test | do an FTA-ABS to rule out a true from a false positive (d/t anti-cardiolipin Abs) |
| Progressive systemic sclerosis | 1st sign is Raynauds; smooth muscle replaced by collagen; sclerodactyly, tight face, dysphagia for solids (no peristalsis, relaxed LES); restrictive lung dz, renal dz, anti-Scl-70; CREST varient |
| SLE | Libman Sachs endocarditis, immunocomplex GN (anti-dsDNA), fibrinous pericarditis, pleural/pericardial effusions, false+ syphilis serology, AI hemolytic anemia, neutropenia, thrombocytopenia, butterfly rash, joint pain/am stiffness; anti-Sm, ANA+ |
| Effect of metyrapone | blocks adrenal cortex 11-hydroxylase to decrease cortisol, increase ACTH, and increase 11-deoxycortisol proximal to block; GOOD TEST for ACTH reserve and adrenal function |
| Hypercalcemia and multiple myeloma | secretion of osteoclast activating factor from myeloma cells |
| Obstructive jaundice | fat soluble vit deficiency from reduction in bile salts leading to malabsorption |
| Contents of bile | cholesterol and bile salts/acids |
| Effects of methotrexate | megaloblastic anemia from block in dihydrofolate reductase; myelosuppression |
| MCC of Drug-induced SLE | Procainamide (no renal dz, anti-histone and anti-ssDNA) |
| Heberden's nodes | osteophytes in DIP joints in osteoarthritis |
| Amebiasis | flask shaped ulcers in cecum |
| mc AMI complication w/in 3-7 days | rupture |
| AMI complication w/in 6-8wks | Dressler's syndrome (autoimmune pericarditis) |
| Goodpasture's Syndrome | anti-pulmonary and glomerular capillary BM antibodies; begins with hemoptysis and ends with renal failure (cresenteric GN); linear immunofluorescence |
| MCC of Sepsis and Death in AIDS pts | disseminated Mycobacterium avium intracellularae |
| MCC of post-transfusion hepatitis | HCV |
| mc post-transfusion infection | CMV (located in donor lymphocytes) |
| MCC of septic arthritis | N. gonorrheae (knee, wrist, feet) |
| Rusty colored sputum | Streptococcus pneumoniae pneumonia (also d/t chronic CHF, mitral stenosis, Goodpastures) |
| Problems in CF pts a/w Pseudomonas aeruginosa | pneumonia, bronchiectasis, sepsis |
| Tetralogy of Fallot | mc cyanotic CHD (level of cyanosis is related to degree of infravalvular pulmonary stenosis) |
| Viral cause of a baby with icterus and edema | congenital CMV infxn |
| EM of hepatocyte | glycogen present in fed state (black granules); disappears in 6hrs (fasting) |
| MCC of Abdominal abscess | Bacteroides fragilis (below diaphragm) |
| Tuberous sclerosis | AD; MR, astrocyte hamartomas in CNS (candlestick drippings on ventricle); adenoma sebaceum; angiomyolipoma (hamartoma) of kidneys; rhabdomyoma of heart |
| Staphylococcus aureus virulence factor | protein A attaches to Fc receptor of MQs (blocks oponization of bacteria) |
| Acute intermittent porphyria | AD; inc ALA synthase activity when heme is low AND dec activity of uroporphyrinogen synthase; NET: inc in ALA, porphobilinogen (oxidized to porphobilin by light - wine color urine); intermittent psychosis/neuropathies, colicky abdominal pain |
| Porphyria cutanea tarda | acquired; dec activity of uroporphyrinogen decarboxylase; NET: inc uroporphyrin-I urine (wine color on voiding); normal porphobilinogen levels; photosensitive skin lesions (hyperpigmented, fragile skin w/inc vellus type hair (hypertrichosis)) |
| Group A streptococcus pharyngitis | predisposes to Rheumatic Fever (less commonly glomerulonephritis) |
| Group A streptococcus skin infection | predisposes mainly to glomerulonephritis (less commonly rheumatic fever) |
| EM findings in all primary causes of nephrotic syndrome | fusion of podocytes |
| Glomerular cresents | sign of inc severity of glomerulonephritis; MCC of GN to progress to chronic renal failure |
| Monosodium urate crystals in synovial fluid | needle shaped and yellow when parallel to slow axis of compensator |
| 2yo w/94% HbF | indicative of hereditary presence (variant of b-thalessemia); compatible with life b/c it is uniform in all RBCs; absent HbA and HbA2 |
| Mechanism of acute pyelonephritis in females | vesicoureteral reflux |
| Pneumothorax in skin diver | sudden onset of pleuritic chest pain; collapsed lung with elevation of diaphragm and shift of trachea to side of collapse |
| Reactivation TB | located in apex of lung where O2 is greatest; strict aerobe |
| Shift of mediastinum | tension pneumo where air enters pleural cavity and cannot exit; diaphragm depressed on affected side; mediastinum shifts to opposite side |
| Elderly male smoker w/painless jaundice and weight loss | carcinoma of head of pancreas |
| Resting tremor | Parkinson's dz |
| Intentional tremor | multiple sclerosis |
| Lou Gehrig's Dz/Amyotropic Lateral Sclerosis | destruction of upper and lower motor neurons; defective superoxide dismutase; neuron damage by superoxide free radicals; starts in intrinsic muscles of hand |
| Superficial dermatophytes | located in stratum corneum |
| Hyperplasia of JG apparatus w/inc BP | renal artery stenosis |
| Exostosis | mc benign bond tumor capped with cartilaginous tissue |
| Cause of gallstones | too much cholesterol or too little bile salts/acids |
| PG-I2 functions | vasodilation, decreased platelet aggregation |
| Sx/Sx of anemias | exercise intolerance, dyspnea, high output failure |
| Black spot on leg: ecthyma (pyoderma) gangrenosum | d/t Pseudomonas aeruginosa; forms black ulcers; a/w ulcerative colitis |
| Mechanism of fever in malaria | coincides with rupture of RBCs |
| Primaquine | precipitates hemolysis in G6PD deficiency |
| Best protection against Syphilis | condom |
| Meningitis in newborns <1month | Group B strep (#1), E. coli (#2), L. monocytogenes (#3) |
| Meningitis 1mo - 18yo | N. meningitidis (#1), S. pneumoniae (#2) |
| Meningitis >18yo | S. pneumoniae (#1), N. meningitidis (#2) |
| Osteomyelitis in HbSS | Staphylococcus areus (mc); Salmonella (only in this population) |
| MC CHD in Downs Syndrome | endocardial cushion defect (ASD + VSD); also most cause of premature death |
| Ankylosing spondylitis | HLA-B27; young man w/low back pain (sacroiliitis); progresses to bamboo spine; aortitis and uveitis; (also a/w Reiter's syndrome, psoriasis, enterocolitis (Campylobacter, Yersinia, Shigella) ulcerative colitis |
| MCC of esophageal cancer | smoking (alcohol is synergistic) |
| Philadelphia chromosome | chrom 22, bcr:abl fusion gene in chronic myelogenous leukemia |
| cause of familial hypercholesterolemia | AD; absence of LDL receptor |
| Defect in b-chain in sickle cell trait/dz | valine --> glutamic acid at 6th position |
| Osteogenic sarcoma | tumor located in metaphysis (knee) |
| Ulcerative colitis | targets rectum; pseudo/inflammatory polyps (residual delicate mucosa); ulcers/hemorrhage; no skips; crypt abscess; dysplasia/cancer; left sided cramping; diarrhea w/blood mucus; lead pipe appearance; toxic megacolon complication |
| Crohn's dz | ileum/colon/anus; fat creeping serosa; narrow lumen; SKIP areas; FISTULAS; deep linear ulcers, cobblestone; non-caseating granulomas; transmural inflammation w/lympho infiltrates; obstruction;colicky RLQ pain w/diarrhea & blood; string sign narrowing |
| Cause of thrombosis after angioplasty | localized dissection |
| Mitral valve prolapse | earliest valvular lesion in Marfans; can cause sudden death; inc myxomatous CT in valve d/t inc in mucopolysaccharides; click/murmur closer to S1 w/anxiety (short diastole) and S2 while supine (inc venous return) |
| Congestive cardiomyopathy | previous myocarditis (coxsackie); drugs (doxyrubicin, tricyclics), postpartum, alcohol |
| Tricuspid valve in IVDA | infective endocarditis |
| H. pylori | urease producer, Gram (-) coccobacillus |
| Treatment for recurrent ulcers | vagotomy |
| Cave explorer in Arizona w/respiratory infxn | coccicidiomycosis |
| Cave explorere in Ohio/midwest with respiratory infxn | histoplasmosis |
| Postductal coarctation | unequal pulses btw upper and lower extremity; rib notching; systolic murmur btw shoulder blades |
| Coarctation a/w Turner's syndrome | preductal |
| Treatment of DKA | 1st is volume replacement |
| Galactorrhea in 3 month old girl | probable influence of maternal hormones |
| Child with scrotal enlargement and transilluminations | hydrocele d/t persistence of tunica vaginalis |
| Indirect inguinal hernia | mc type; lateral to lateral border of Hesselbach's triangle |
| Hesselbach's triangle | lateral border - superficial epigastric artery, inferior border - inguinal ligament, medial border - lateral aspect of rectus abdominis |
| IVDA in prison has what type of hepatitis | HBV |
| AIDS pt w/acute cholecystitis | d/t cryptosporidium or CMV |
| Traveler to Mexico who develops watery diarrhea 1wk later w/mucus, blood and colicky bowel movements | amebiasis |
| County jail outbreak of hepatitis | HAV |
| Familial polyposis; mother has it, what is chance of kids? | 50% b/c it is AD; start screening at age 10 b/c of risk of cancer |
| MCC of pneumonia in CF | P. aeruginosa |
| TE fistula | d/t polyhydraminos in mother; proximal esophagus ends blindly and distal esophagus arises from trachea (air in stomach) |
| Lung findings in RDS | atelectasis (massive intrapulmonary shunting d/t lack of surfactant); hyaline membrane composed of ptns |
| Xray of emphysema | increased AP diameter; depressed diaphragms |
| Tx of PCP in AIDS pt | TMP/SMX |
| mc initial AIDS defining lesion | PCP |
| Staph aureus food poisoning | 1-6hrs after eating contaminated food with PREFORMED TOXIN; self-limiting |
| Meckels diverticulum | vitelline duct remnant; "true" |
| mc cause of iron deficiency in newborn/young child | Meckel's diverticulum (GI bleeds) |
| O157:H7 serotype of E. coli | hemolytic uremic syndrome; acquired from raw hamburger |
| Complication of Primaquine Tx for Malaria | acute intravascular hemolysis in G6PD pt |
| Deficiency a/w terminal ileal resection | Vit B12 deficiency |
| Deficiency a/w duodenal resection | iron |
| Deficiency a/w jejunum resection | folate; most water reabsorption; most sodium reabsorption |
| Deficiency a/w ileum resection | B12 reabsorption; bile salt/acid reabsorption |
| Vitamin K deficiency | causes bleeding; newborns lack bacterial colonization and need injection at birth |
| Renal agenesis | a/w oligohydramnios |
| People in room w/space heater have headache | CO poisoning; treat w/100% O2 |
| Xray w/multiple lytic lesions in hip in pt w/anemia and hypercalcemia | multiple myeloma |
| Girl soccer player on tetracycline develops rash | contact photodermatitis on face, neck, forearms, legs (shorts only) |
| CNS reaction in stroke | gliosis d/t proliferation of astrocytes (NOT collagen deposition) |
| Dissecting aortic aneurysm | unequal pulses in upper extremity; Left radial puls is absent |
| Pigmented lesion on diabetic leg | mecrobiosis lipoidica diabeticorum |
| Wegener's granulomatosis | necrotizing granulomatous vasculitis; c-ANCA antibodies; involves lung and kidney and upper airway |
| Goodpasture's syndrome | anti-basement membrane antibodies; involve lung and kidney |
| most likely cause of an adult kidney mass | adenocarcinoma |
| One cause of hydrocephalus | colloid cyst; round object in 3rd ventricle |
| First step in menarche | breast budding (thelarche) |
| Senile purpura | normal age-dependent finding |
| Polyhydramnios congenital defects | TE fistula, anencephaly, duodenal atresia |
| Cross-section of brainstem in child w/yellowish discoloration | kernicterus from hemolytic disease of newborn |
| MCC of Esophagitis in AIDS | Type I Herpes |
| Most common Chronic hepatitis | HCV |
| URI in child followed by epistaxis and petechia | ITP (IgG Ab against platelets; type II hypersensitivity rxn) |
| Cancer most likely to be found in a roofer for 25yrs and smoker for 10 | primary lung cancer |
| Bridge painter in NYC w/respiratory infxn | histoplasmosis (from starling dung) or Cryptococus (pigeon dung); Tx with amphotericin |
| Rat poison ingestion | contains warfarin and will cause bleeding; Tx with vitamin K |
| Before giving packed RBCs... | get Ab screen |
| ABO incompatibility | O mom w/A or B baby; may occur in 1st pregnancy; no inc in severity w/future pregnancies; spherocytes in cord blood; positive Direct Coombs on cord blood; mild hemolytic anemia; protects against Rh sensitization; mc cause of jaundice in first 24hrs |
| Child w/rash and skin infiltrate w/CD1 positive cells | Histiocytosis X (Letterer Siwe dz) |
| Elderly male w/low back pain | do a rectal to r/o prostate cancer before any other test; Osteoblastic Metastasis (if serum AlkPhos is elevated) |
| Tx regimen to prevent osteoporosis in menstruating woman | exercise + 1000mg Ca + 400U Vit D (no estrogen) |
| Osteoporosis prevention after total hysterectomy and bilateral salpingo-oophorectomy | exercise + 1000mg Ca + 400U Vit D + estrogen w/or w/o progesterone |
| Osteoporosis prevention in post-menopausal woman w/previous radical mastectomy that was ERA-PRA positive | exercise + 1000mg Ca + 400U Vit D (estrogen contraindicated; tamoxifen ok) |
| Oocysts that are acid-fast in pt w/AIDS | Cryptosporidium |
| Elderly man who lives w/wife at home develops pneumonia | Strep pneumoniae (mc community acquired typical pneumonia) |
| mc benign tumor of adult brain | meningioma |
| mc primary malignant tumor of brain | glioblastoma multiforme |
| mc site to evaluate in a child w/HTN | kidneys (Wilm's tumor, renal dysplasia), adrenal medulla (neuroblastoma) |
| AIDS pt w/diarrhea (which bug can be IDed w/string test) | Giardia, strongyloides, Cryptosporidium |
| elderly man, sudden onset of abdominal pain and bloody diarrhea | thrombosis/embolism of superior mesenteric artery w/small bowel infarction (common association w/heart disease and atrial fibrillation) |
| young girl with grape-like masses protruding from vagina | embryonal rhabdomyosarcoma (mc sarcoma); not a/w DES |
| Crunching sound in neck and anterior chest in pt involved in head-on collision (or retching alcoholic or bulemic) | ruptured esophagus (Hamman's sign in chest d/t subcutaneous emphysema from air leaking into tissue |
| woman w/generalized muscle weakness, ptosis of right eye w/o pupillary abnormalities | myasthenia gravis (autoantibody against ACh receptors; type II hypersensitivity) |
| Schistocytes in peripheral blood | aortic stenosis (mc), prosthetic heart valve, DIC, thrombotic thrombocytopenia purpura, marathon runner |
| mc bone cancer in adult | metastatic cancer (mcc - breast cancer) |
| mc location in bone for osteomyelitis | metaphysis (most vascular) d/t hematogenous S. aureus |
| Best Tx for elderly woman w/HA on side of head, diffuse muscle aches, elevated serum CK and ESR (temporal arteritis and polymyalgia) | ccsteroids |
| athlete w/jaundice, no other health probs or h/o liver dz, transfusion; w/mildly elevated serum transaminases and markedly elevated AlkPhos | d/t anabolic steroids; causing cholestatic jaundice |
| mc primary brin tumor location in kids | cerebellum (#1 is Cerebellar Astrocytoma, #2 Medulloblastoma) |
| Sturge weber | port wine nevus on face in trigeminal nerve distribution; ipsilateral arterio-venous malformation in brain |
| Cancers a/w parasitic dz | squamous cancer of bladder (Schistosoma hematobium; egg has nipple at end), Cholangiocarcinoma (Clonorchis sinensis) |
| Hepatitis a/w urticaria, fever, arthralgias, and nephrotic syndrome | HBV (serum sickness; type III immunocomplex mechanism); vasculitis a/w polyarteritis nodosa |
| Targetoid lesions on skin | erythema multiforme (a/w Herpes simplex (mc), mycoplasma, sulfonamides, NSAIDs, phenytoin); SJS involves mouth |
| Flat, hyperpigmented lesions of forehead and cheeks in woman | usu d/t oral contraceptives (or pregnancy); called "chloasma" or "melasma") |
| Axillary freckling in pt w/HTN | neurofibromatosis |
| MCC of alopecia | genetics (mc in males); telogen effluvium (all hairs enter resting phase at once: postpartum, BCPs, hi fever, crash diet) |
| Irregular patches of hair loss in child | trichotillomania (pulling out one's own hair; usu w/dominant hand) |
| young woman w/intermittent bouts of diarrhea and constipation a/w cramping R and L lower quadrant pain | irritable bowel syndrome; flexible sigmoidoscopy is negative; intrinsic bowel motility problem |
| Immunizations given at birth to baby whose mom is HBsAg positive | HBV (active immunization) and HBIG (passive immunization) |
| Farmer and wife brought to ER b/c they are weak and having blurry vision, ptosis, facial weakness, non-reacting dilated pupils, dry mucus membranes, normal DTRs | C. botulinum food poisoning (toxins inhibit release of ACh at NMJ); Treat with botulism antitoxin d/t risk of respiratory paralysis |
| Diabetic w/wet gangrene of foot, stiff jaw, neck and inc irritability and hyperreflexia | Tetanus; Treat w/tetanus immune globulin, PCN, sedation; give full immunization after pt recovers to get titers up to protective levels |
| Hyperpigmented spots on skin that turn pruritic/red when scratched d/t: | mast cells from urticaria pigmentosa (pressure releases histamine) |
| Young man w/fatigue, muscle cramps after exercise, pink urine after exercise, and no rise in lactic acid | McArdle's disease; absence of muscle phophorylase that is required to break down glycogen to glucose; muscle has no energy and lactic acid cannot accumulate if glucose isn't metabolized) |
| Patient w/dysphagia and fetid odor on breath | Zenker's diverticulum (mc type in esophagus; collects food) |
| Young man w/low back pain and limited chest movement | ankylosing spondylitis (kyphosis) |
| Mechanism of action of UV light in treatment of newborns w/physiologic jaundice | oxidation of UCB into harmless water soluble dipyrroles |
| Addison's dz - primary hypocortisolism | inc ACTH, severe hyponatremia, hyperkalemia, metabolic acidosis, no response to ACTH stimulation, hypoglycemia |
| Secondary hypocortisolism | dec ACTH, mild hyponatremia, hypoglycemia, adrenal response to ACTH stimulation |
| Cushing's | central obesity, purple striae, use low dose Dexamethasone test and 24hr urine catacholamine test |
| Carcinoid syndrome | metastasis to liver from primary in small intestine; measure 5-HIAA |
| Male w/clusters of vesicles on penis | herpes type II; treat with acyclovir to dec recurrences |
| Tx of condyloma venereum | topical podophyllin |
| Treatment of syphilis | PCN |
| Tx of gonorrhea | ceftriaxone (GC) + doxycycline (chlamydia) |
| Tx of bacterial vaginosis | metronidazole (not for the partner); clue cells; d/t Gardnerella vaginalis |
| Tx of trichomoniasis | metronidazole (treat partner) (anaerobe) |
| Treatment of pseudomembranous colitis | metronidazole |
| Cause of Graves dz | stimulating thyroid stimulating Ab against TSH receptor (type II hypersensitivity) |
| mc anemia | iron deficiency (women <50 menorrhagia; men <50 duodenal ulcer, man/woman >50 colorectal cancer) |
| Vitamin deficiency with prolonged PT | vitamin K |
| mc fracture in postmenopausal osteoporosis | vertebral (osteoclastic activity > osteoblastic activity) |
| India ink prep with narrow based bud | cryptococcus |
| Aspergillus | fungus ball in abandoned TB cavity; hemoptysis, fruiting body |
| Frontal lobe abscess in pt with DKA | mucormycosis |
| Pseudomonas related infxns | CF pneumonia (green sputum), MCC of death in burns, malignant otitis externa, ecthyma gangrenosum, step on nail w/old tennis sneakers, hot tub folliculitis, respirator infxns (loves water) |
| Legionella | water coolers, flu-like syndrome, hyponatremia, hyperkalemia (interstitial nephritis), Dieterle silver stain |
| Treatment for Legionella | Erythromycin |
| Pateurella multocida | cat bite; potential for septic arthritis/tendinitis |
| Disseminated gonococcemia | decreased C5-C8 (final common pathway complement components |
| Treatment for prolactinoma (mc pituitary tumor; 2* amenorrhea/galactorrhea) | Bromocriptine |
| MCC of myocarditis, pericarditis, aseptic meningitis (lymphocytes in mycardial tissue) | coxsackievirus |
| High AFP | open neural tube defects, hepatocellular carcinoma, yolk sac tumors of ovary or testis |
| Drugs that increase surfactant | glucocorticoids, thyroxine |
| ECG changes - hypercalcemia | short QT |
| ECG changes - hypocalcemia | prolonged QT |
| ECG changes - hypokalemia | U wave |
| ECG changes - hyperkalemia | peaked T wave |
| MCC of jaundice in first 24hrs after birth | ABO incompatibility (O mom, A or B baby; mom has anti-A and -B Abs) |
| WBC abnormalitiy in peripheral smear d/t B12/folate deficiency | hypersegmented neutrophils |
| Tear drops in peripheral blood | myelofibrosis in marrow |
| Coarse basophilic stippling in peripheral blood | Pb poisoning |
| PICA for clay and ice | symptom of iron deficiency |
| Iron overload | increased iron, % saturation, ferritin, but decreased TIBC (transferrin dec) |
| MCC of folate deficiency | alcohol abuse (not beer) |
| Leukemia <15yo | ALL (acute lymphoblastic) |
| Leukemia 15-39yo | AML (acute myelogenous) |
| Leukemia 40-60yo | AML and CML |
| Leukemia >60yo | CLL (chronic lymphoblastic) |
| Hairy cell leukemia | B cell; positive TRAP stain (tartrate resistant acid phosphatase) |
| Chronic myelogenous leukemia | t9:22 translocation (philadelphia chrom) of c-myc oncogene; low LAP (leukocyte AlkPhos) score |
| Acute lymphoblastic leukemia | CALLA (common Ag) positive; pre-B cell leukemia; mc in kids |
| TdT | marker for very immature B and T cells |
| Congenital spherocytosis | AD, spectrin deficiency, inc osmotic fragility |
| Howell Jolly body | indicates absent or dysfxnl spleen |
| Heinz bodies | peroxide damage in Hb in RBCs in G6PD deficiency |
| Direct Coombs test | detects IgG/C3 on RBC; used in autoimmune hemolytic anemias |
| Indirect Coombs test | screens serum for Ab (ex: anti-D); used in autoimmune hemolytic anemias |
| Ferritin | best screen for Fe deficiency and ACD (anemia of chronic dz) |
| Blood Pb | best screen/confirmation for Pb poisoning |
| CLL | MCC of generalized lymphadenopathy in people >60yo; malignant Bcells; hypogammaglobulinemia; massive splenomegaly |
| Lactase deficiency | aka brush border/disaccharidase enzyme; osmotic diarrhea, hydrogen breath test |
| Secretory diarrhea | stimulation of cAMP; E. coli traveler's diarrhea, cholera |
| Streptococcus bovis endocarditis/sepsis | a/w colon cancer |
| Alcohol enzyme abnormalities | AST > ALT; increase in GGT (marker of induction of cytochrome system in liver); SER hyperplasia on EM |
| Hypoglycemia in newborn of diabetic mother | baby's insulin in too high since it was necessary to lower the glucose levels in uteru in respone to mother's hyperglycemia |
| Nabothian cysts | blocked endocervical glands with mucus retention |
| Chronic renal failure - why is Ca reabsorption decreased in bowel? | vit D deficiency from loss of 1alpha-hydroxylase enzyme and no second hydroxylation |
| Deviation of uvula to the opposite side in a pt w/exudative toonsilitis | peritonsillar abscess |
| Minimal change disease | MCC of nephrotic syndrome in children; loss of negative charge in GBM |
| Membranous GN | MCC of nephrotic syndreom in adults; subepithelial deposits; epimembranous spikes with silver stains; related to HBV |
| Focal segmental glomerulosclerosis | MCC of nephrotic renal disease in AIDS, renal transplant pts, IVDAs |
| Diabetic nephropathy | "christmas balls" in the mesangium and hyaline arteriosclerosis in afferent/efferent arterioles |
| Prevention of diabetic nephropathy | ACE inhibitors |
| Wire looping in glomerulus | SLE glomerulonephritis |
| Type I membranoproliferative GN | nephrotic; a/w HCV; tram tracking; subENDOthelial deposits |
| Type II membranoproliferative GN | C3 nephritis factor (autoantibody against C3; very low C3 levels); dense deposits in GBM |
| Bartholin gland abscess/cyst | vulvar mass; a/w gonorrhea |
| Tzanck prep | detects viral etiology of vesicular dz (herpes); multinucleated cell with intranuclear inclusions (also for varicella) |
| Photo of Candida | pseudohypha and yeast |
| Picture of trichomonas | pear shaped w/flagella |
| Picture of Giardia | "owl eyes" with flagella |
| Picture of celiac dz | no villi present; anti-gliadin Abs |
| Picture of Whipple's dz | foamy MQs in lamina propria; infectious dz |
| Lyme dz | erythema chronicum migrans; Ixodes tick, Borrelia burgdorferi, Bell's palsy, arthritis |
| Treatment for lyme dz | early: Doxycycline; Late: Ceftriaxone |
| Role of dietary fiber in decreasing colon cancer | dec transit time in stool; lithocholic acid has less chance of producing mutations |
| Werdnig Hoffmann's dz | childhood version of ALS |
| Bisphosphonates | treatment for osteoporosis; dec osteoclastic activity; Treatment of choice for Paget's dz of bone |
| Calcitonin | marker for medullary carcinoma of thyroid; inhibits osteoclast activity |
| Orbital cellulitis vs cavernous sinus thrombosis | both have proptosis of the eye and poor eye movements; Cavernous sinus thrombosis has papilledema |
| Most common benign tumor of brain in adults | meningioma |
| mc malignant brain tumor in adults | glioblastoma multiforme |
| Acoustic neuroma | brain tumor a/w neurofibromatosis; zebra tumor w/alternating dark and light bands; (schwannoma, neurilemmoma, tinnitus, nerve deafness, sensory changes in face from trigeminal involvement |
| Toxoplasmosis | mc space occupying lesion in AIDS |
| Asymptomatic african american with hematuria | do sickle cell screen to r/o sickle cell trait |
| Osteomyelitis in HbSS | Staphylococcus is still more common than Salmonella |
| ECG of first degree block | prolonged PR interval |
| Auer rod in myeloblast | only in acute myelogenous leukemia (not chronic, not lymphocytic, not monocytic) |
| Weight lifter with weakness in hand, numbness and absent pulse | thoracic outlet syndrome (scalenus anticus muscle spasm compresses subclavian artery and brachial plexus) |
| MCC of abdominal aortic aneurysm | atherosclerosis; NOT hypertension; rupture is mc complication (left flank pain, hypotension, pulsatile mass); Diagnostic Gold Standard is ultrasound |
| Child with blue sclera | osteogenic imperfecta (brittle bone dz) d/t defect in type I collagen synthesis |
| X-ray showing osteopenia, normal AlkPhos, serum protein electrophoresis, and serum calcium | compatible with osteoporosis; rules out osteomalacia, multile myeloma and both, respectively |
| Wilm's tumor | a/w chromosome 11; aniridia, HTN; pediatric kidney cancer |
| Arrhythmia complication a/w AMI | ventricular |
| Burkitt's lymphoma | mc lymphoma in kids; abdominal cavity; B cell malignancy; high grade; a/w EBV; t8:14 translocation of c-myc oncogene |
| CXR with middle lobe pneumonia (obscuring right margin of heart) | related to obstruction by a bronchogenic carcinoma; could also be aspiration w/pt lying on R side |
| Adrenal hyperplasia a/w: | adrenogenital syndrome (low cortisol inc ACTH); pituitary Cushing's (inc in ACTH); ectopic Cushings (small cell carcinoma; inc ACTH); CONTRAST with atrophy of gland in adrenal Cushings (inc cortisol suppresses ACTH) |
| Pancoast tumor | squamous caner at lung apex involving brachial plexus and superior cervical ganglion (Horner's syndrome) |
| Tricuspid insufficiency in infective endocarditis | pansystolic murmur increases with inspiration (common in all R-sided murmurs d/t filling of R heart/negative intrathoracid pressure); giant C-V jugular venous pulse wave; pulsatile liver |
| Rheumatic fever | crossreactivity/mimicry of Ag in M proteins similar to those in heart; |
| mc sign of rheumatic fever | polyarthritis (carditis, subcutaneous nodules, erythema marginatum, chorea --> Jone's criteria); negative blood culture (not a septicemia) |
| Anterior chest pain, widening of aortic root on echocardiogram, death in 3 days by tamponade | proximal dissecting aortic aneurysm; aortic insufficiency murmur and unequal pulses can occur |
| CXR of CHF | hemosiderin-laden macrophages |
| Rhematoid factor | IgM antibody against IgG |
| Pseudogout crystal | if needle shaped; blue when parallel to slow axis of compensator; chunky crystal is always calcium pyrophosphate; a/w chondrocalcinosis of knee in primary hyperparathyroidism |
| Sterile pyuria (WBCs in urine) and negative culture after 24hrs | always thing renal TB; could also be Chlamydia trachomatis |
| Child develops rash after running in bushes | probably poison ivy; type IV contact dermatitis |
| Antimicrosomal Abs | Hashimotos thyroiditis AND Graves dz (differentiate w/stem of question) |
| Exopthalmos and pretibial myxedema | unique to Graves dz and no other cause of hyperthyroidism |
| Hepatocellular carcinoma | HBV (or HCV) |
| Trophozoite of E. histolytica phagocytizes RBCs | protozoan; pt has h/o diarrhea and ulcers |
| Neonatal neumonia, afebrile, staccato cough, eosinophilia, wheezing | C. trachomatis contracted while passing thru birth canal |
| ABO typing of mother and father to see if child is theirs | AB parents cannot have an O child; O parents cannot have an AB child |
| Pt with hemolytic anemia post dapsone and aspirin | G6PD deficiency |
| Test for infectious mononucleosis | heterophile antibody |
| Eisenmenger's syndrome | when a L ==> R shunt reverses to a R ==> L shunt owing to pulmonary HTN and RVH leading to cyanosis (cyanosis tardive) |
| Duchenne's muscular dystrophy | deficiency of dystrophin (gene deletion); inc serum CK; pseudohypertrophy of calf muscles |
| Becker's muscular dystrophy | milder variante of dystrophin deficiency (gene mutation, not deletion) |
| Jevenile polycystic kidney disease | AR; bilateral disease; oligohydramnios in mom; cysts in other organs |
| Cystic fibrosis | AR; chrom7 (CF transport of Cl ions) dec Cl reabsorp in sweat glands, inc Na reabsorp/dec Cl secretion in term bronchioles; resp infxns (P. aeruginosa MCC of death), 2* biliary cirrhosis, male infertility, DM, meconium ileus in newborn; MCC bronchiectasis |
| alpha-Thalassemia | AR; blacks/asians; 4 genes control a-chain synthesis; all hemoglobins underproduced (normal Hb electrophoresis in 1 and 2 deletions); 3 deletions = Hb H dz (4 b-chains); 4 gene deletions Hb Bart dz (4-gamma chains; incompatible w/life; hydrops fetalis) |
| Cardiac myxoma | most common heart tumor; LEFT or right atrium; embolize, fever, syncope, benign |
| Cardiac rhabdomyoma | children; part of tuberous sclerosis complex |
| Colon cancer risk factors | age, tubular adenoma >2cm; familial polyposis (100% penetrance); villous adenoma, low fiber diet; Screen with stool guaiac yearly after 50yo and sigmoidoscopy every 3-5yrs |
| Chronic renal failure | loss of dilution; inc BUN/creatinine ratio; waxy/broad casts; normocytic anemia (loss of erythropoietin), VitD def (low Ca w/normal-hi PO4), 2* hyperparathyroidism, renal osteodystrophy, osteoporosis (bone buffer for acidosis), inc bleeding time (platelet |
| MCC of diabetic nephropathy | chronic renal failure |
| Essential hypertension | mc; Na retention inc plasma vol and stroke vol (inc systolic pressure); Na in smooth muscle of peripheral resistance arterioles open Ca channels (inc vasoconstriction and diastolic pressure); low renin HTN d/t inc plasma vol |
| Risks in essential HTN | blacks; MCC of death is AMI; controlling BP will reduce incidence of stroke; hyaline arteriolosclerosis small vessel dz; nephrosclerosis; LVH; intracranial bleeds (Charcot-Bouchard aneurysm near putamen) |
| HTN in young woman | birth control pills increase synthesis of angiotensinogen in liver HTN |
| Renovascular HTN | mc secondary cause of hypertension; atherosclerosis of renal artery in male; firbromuscular hyperplasia in female; high renin HTN; uninvolved kidney has suppressed renin levels; buit in epigastric area; marked inc baseline renin; Tx captopril |
| Waterhouse-Friderichsen syndrome | disseminated meningococcemia w/adrenal hemorrhage from DIC; petechial lesions over body |
| Hemophilia A | SXR, prolonged PTT, normal PT, low VIII:C, normal VIII:antigen; normal VIII:vWF; hemarthroses, late rebleeding, mucous membrane bleeds; Treatment = recombinant factor VIII for severe cases; DDAVP for mild cases |
| Classical vWD | AD; prolonged bleeting time; prolonged PTT; normal PT; low VIII:C; low VIII:antigen; low VIII:vWF; mc genetic coagulopathy; Treatment = DDAVP, Cryoprecipitate |
| Thrombotic thrombocytopenic purpura | small vessel damage w/consumption of platelets (d/t platelet thrombi not DIC); microangiopathic hemolytic anemia (RBCs hit platelet plugs, schistocytes); fever, CNS probs, renal failure; Brain is worst hit organ!! Tx = Plasmaphoresis |
| HUS | kids; similar to thrombotic thrombocytopenic purpura except kidney failure is the worst hit organ!! a/w O157:H7 E. coli |
| Sudden death in a young athlete | probably hypertrophic cardiomyopathy |
| Hypertrophic cardiomyopathy | aberrent myofibers; conduction disturbance; decreased cardiac contractility to increase filling (b-blocker, CCB); Improves with increased venous return to heart (squating, lying down); Worsened with valsalva, cardiac inotropic agents and venodilators |
| Communicating hydrocephalus | CSF communicates with subarachnoid space; choroid plexus papilloma (makes too much CSF) or blocked arachnoid granulations |
| Non-communicating hydrocephalus | obstructive; no communication with subarachnoid space; block is at aqueduct of Sylvius (mc), 4th ventricle, base of brain (TB meningitis, blood), Dandy Walker or Arnold Chiari Syndome |
| AIDS dementia | mc HIV related CNS disease; multinucleated microglial cells (reservoir for virus) |
| Psoriasis | hyperkeratosis; regular rete ridge hyperplasia; munros microabscess; superfician dermis next to epithelial surface (Auspitz sign); erythematous plaques w/silvery scale, nail pitting, psoriatic arthritis (HLA-B27), elbows, scalp |
| Bone tumors in order of increasing age | Ewings ("onion skin", fever, small cells); Osteogenic sarcoma (knee, "sunburst"); Chondrosarcoma (pelvic girdle, knee, mc malignant cartilage tumor); Multiple myeloma (mc primary bone cancer) |
| Paget's Dz of Bone | male dominant; initial osteoclastic breakdown, then osteoblastic activity; thick, weak mosaic bone prone to pathologic fx; large head; A-V fisttulas in bone (high output failure); risk of osteogenic sarcoma; elevated AlkPhos; Treatment = Bisphosphonates |
| Epidural bleed | top of dura; skull fx; torn middle meningeal artery |
| Subdural bleed | convexities; tear of bridging veins; fluctuation levels of consciousness |
| Atherosclerotic stroke | usu pale infarct; no reperfusion |
| Embolic stroke | hemorrhagic infarct extends to surface of brain |
| Intracerebral bleed | a/w HTN; rupture of lenticulostriate Charco-Bouchard aneurysms; hematoma NOT infarct; globus pallidus/putamen area (mc) |
| Subarachnoid bleed | ruptured congenital berry aneurysm (jxn of communicating branch w/anterior cerebral artery); severe occipital HA; blood covers brain (may turn yellow after a week from breakdown to bilirubin |
| Hodgkin's Lymphoma | RS (reed sternberg) cell in neoplastic cell; Fever, night sweats, weight loss; death by second malignancies from alkylating agents (non-HD lymphoma) |
| MC type of Hodgkin's | Nodular Sclerosing (females, lacunar cells, involves anterior mediastinum) |
| Youngest type of Hodgkin's | Lymphocyte Predominant; very few RS cells; EXCELLENT prognosis |
| Oldest type of Hodgkin's | Lymphocyte Depletion; many RS cells; POOR probnosis |
| Breast cancer risk | overall AGE is mc risk; family history (mother and sister ONLY); h/o contralateral breast cancer; unopposed estrogen (early menarche, late menopause; h/o endometrial cancer |
| Silicosis | risk for TB; not cancer; NODULES in lung w/crystals; Foundry (iron/steel) worker, Sandblaster |
| Asbestosis | pipefitter in shipyard, roofer; NO risk for TB; Smoker has greatest risk for primary lung cancer Vs. Non-smoker risk for Mesothelioma; Ferruginous body looks like dumbbell (fiber covered w/iron) |
| Firbrocystic change | mc breast mass <50yo |
| Atypical ductal hyperplasia | only risk factor for cancer |
| Bloody nipple discharge <50yo | benign intraductal papilloma in lactiferous duct |
| Breast tumor <35yo | fibroadenoma |
| Breast mass >50yo | infiltrating ductal cancer |
| Infiltrating ductal breast cancer | most common |
| Paget's disease of the breast | nipple involvement by underlying cancer |
| Medullary breast cancer | bulky tumor with pushing margins |
| Inflammatory carcinoma of the breast | peau du orange; plugging of subepidermal lymphatics by tumor, worst prognosis |
| Lobular carcinoma of breast | mc cancer of terminal lobules; occurs BILATERALLY |
| Comedocarcinoma of the breast | central area of necrosis in ducts resembling a zit |
| Acute versus Chronic Leukemia | bone marrow >30% blasts is ACUTE (lower levels a/w chronic) |
| The only leukemia that may have thrombocytosis | Chronic Myelongenous Leukemia |
| Diagnosis of leukemia | bone marrow biopsy; PAS stain (ALL), Specific esterase stain (AML), LAP score (CML), Non-specific Esterase (Monocytic leukemia); TRAP stain (hairy cell) |
| What do you do about a hemangioma on a child's face | leave it alone |
| Osteopetrosis | too much bone; anemia; marble bone dz; pathologic fx; entraptment of cranial nerves; deafness |
| Polycystic Ovarian Syndrome | obesity, hirsutism, irregular menses, inc LH (ovary produces testosterone &17-ketosteroid androgens); Inc adipose aromatizes androgens to estrogens (endometrial hyperplasia/cancer); inhib FSH (follicle atresia); stim LH; Tx = BCP or Clomiphene (fertility) |
| Pituitary Cushings | Suppression only with HIGH dose Dexamethasone (indicates only partial autonomy) |
| Cushing's types that cannot be suppressed with Dexamethasone | adrenal and ectopic |
| Anemia since birth with splenomegaly | congenital spherocytosis...Tx = splenectomy |
| CT with enlarged internal acoustic meatus in pt with tinnitus, nerve deafness, vertigo | Acoustic neuroma (schwannoma, neurilemoma) |
| Hemoptysis w/foul smelling stools or pneumonia w/foul smelling stools in a child | d/t malabsorption; cystic fibrosis; diagnose with sweat test |
| Child tastes salty | Cystic fibrosis; do sweat test |
| Photo of atherosclerosis of coronary vessel | slit like spaces |
| Dystrophic calcification in coronary vessel | dystrophic calcification (blue blotches) |
| Fibrofatty plaques in coronary vessels | located beneath intimal surface |
| Picture with acute inflammation | numerous neutrophils (squiggle nuclei) and small capillaries |
| Picture with chronic inflammation | numerous round cell nuclei (lymphocytes) and plasma cells (eccentric nucleus w/perinuclear clearing) |
| Picture of healed myocardial infarction | blotchy fibrosis unlike sheets of pale staining tissues as in a pale infarction |
| Heart softest and prone to rupture post-MI | 3-10th day |
| Rupture with tamponade | pericardial sac filled w/blood |
| Posteromedial papillary muscle rupture | murmur of mitral insufficiency; pansystolic, apical, systolic; RCA thrombosis |
| Interventricular septal rupture | systolic murmur, hole in IVS |
| ypersengemented neutrophil | folate/B12 deficiency |
| Microcytic hypochromic cells | iron deficiency, ACD, thalassemia, sideroblastic anemia |
| Spherocytes | no central area of pallor |
| Macroovalocytes | Pernicious anemia, folate deficiency |
| Tear drop RBCs | myelofibrosis |
| Howell Jolly body RBCs | spleen surgically removed or dysfunctional (ex: HbSS dz) |
| Platelets | small, red, anucleate cell |
| Lymphocyte | black dot with a thin rim of cytoplasm |
| Auer rod | myeloblast with immature nucleus and splinter-like structures in cytoplasm |
| Smudge cells with lymphocytes | CLL; fragile lymphocytes that rupture |
| Hairy cells | projections from cytoplasm; HCL; B cell malignancy |
| Atypical lymphocyte | big cell with abundant sky blue cytoplasm |
| Eosinophil | large red granules that do no cover the nucleus; same color as RBCs |
| Basophil | large purple granules that DO cover the nucleus |
| Rouleau | RBCs with stack of coins effect |
| Schistocytes | fragmented RBCs |
| Reticulocyte | special stain; thin filaments representing RNA |
| Heinz bodies | special stain; large blue inclusions with involvment of RBC membrane |
| Course basophilic stippling | routine stain; looks like measles of the RBC |
| Megaloblastic marrow | all cells are big; giant band; B12/folate deficiency |
| Myelofibrosis | marrow is composed of fibrous tissue; large cells represent megakaryoctyes |
| Aplastic anemia | empty marrow with predominantly fat and islands of lymphocytes |
| Multiple myeloma | plasmablasts with bright blue cytoplasm, eccentric nuclei, perinuclear halo |
| Ringed sideroblast | Prussian blue stain; ring of blue around nucleus of normoblast; defect in heme synthesis; anemia |
| Causes of sideroblastic anemia | Alcohol, pyridoxine, Pb poisoning |
| Pt with left supraclavicular node | aka Virchow's node; a/w metastatic stomach cancer or any other arising from abdominal cavity |
| Right supraclavicular node | drains lung, upper neck, breast |
| Immunocomplex vasculitis a/w infective endocarditis | Roth's spot in retina, splinter hemorrhages, Osler's nodes (painful) on hands/feet; Janeway lesions (painless) hands/feet; hematuria w/RBC casts |
| Xray with local dilated bowel | "sentinel loop" indicating localized infection, near duodenum/transverse colon = acute pancreatitis; near Cecum = retrocecal appendicitis |
| Xray with step-ladder appearance and air/fluid levels | bowel obstruction |
| Xray of baby with loops of bowel in left pleural cavity | diaphragmatic hernia |
| RBC casts | nephritic syndrome (post-streptococcal, IgA nephropathy, Goodpastures) |
| WBC casts | acute pyelonephritis |
| Renal tubular casts | acute tubular necrosis |
| Waxy casts | chronic renal failure |
| Broad casts | Chronic renal failure |
| Hyaline casts | ghost-like; non-refractile, smooth borders; proteinuria or no clinical significance |
| Fatty casts w/maltese crosses | nephrotic syndrome (minimal change, membranous GN) |
| Calcium oxalate crystals | looks like back of an envelope; think stone, Crohn's dz, ethylene glycol poisoning |
| Cysteine crystals | hexagonal; cystinuria |
| Staghorn calculus in kidney | struvite stone, magnesium ammonium phosphate, alkaline urine that smells like ammonia indicating a urease producing urinary pathogen (ex: Proteus) |
| Lipid deposits: Achilles tendon xanthoma | familial hypercholesterolemia (AD; absent LDL receptor) |
| Xanthelasma | yellow plaque on eyelid; consider type II hyperlipidemia w/inc in LDL |
| Arcus senilis | rim of white around the outer part of the cornea; consider inc LDL if a young pt or normal age-related change in older pt |
| Eruptive xanthomas | yellow papular lesions over body; inc TGs |
| Psammoma bodies | dystrophic calcification of apoptotic neoplastic cell; a/w meningioma, papillary adenocarcinoma of thyroid, serous cystadenocarcinoma of ovaries |
| Addison's dz | autoimmune destruction; hyperpigmentation; hypotensive; hyponatremia, hyperkalemia, normal gap metabolic acidosis (d/t lack of aldosterone); hypoglycemia (d/t hypocortisolism and no GNG); eosinophilia (no cortisol effect) |
| Central Diabetes insipidus | hypernatremia (inc Posm) w/low Uosm (no [ ], lose free water d/t lack of ADH); After water deprivation, Uosm inc >50% w/injection of ADH |
| Nephrogenic Diabetes Insipidus | hypernatremia (inc Posm), low Uosm (no [ ]); ADH is present, but cannot reabsorb free water in collecting tubules; Uosm is <50% increased after ADH administration |
| Pathology of Diabetes Mellitus | non-enzymatic glycosylation; HbAIc (4-8wks); hyaline arteriolosclerosis (nephropathy, lacunar brain infarcts); lg vessel atherosclerosis; osmotic damage d/t glucose --> sorbitol via ALDOLASE REDUCTASE; cataract/microaneurysms, periph neuropathy (schwann) |
| DM is MCC of | blindness, chronic renal dz, peripheral neuropathy (MMC of pressure ulcers on bottom of feet); non-traumatic amputation of lower leg; ketoacidosis; Charcot neuropathic joint; glucosuria |
| Pheochromocytoma | benign tumor (brown) of adrenal medulla; usu unilateral; paroxysmal HTN, HA, drenching sweat; Screen urine for VMA & Metanephrines (best); a/w Neurofibromatosis, MENIIa, IIb, von Hippel Lindau |
| Neuroblastoma | kids (<1yo is best Px); malignant tumor in adrenal medulla and paraganglial tissue; HTN; metastasis to bone, skin, orbit; Homer Wright rosettes; inc urine catecholamines; S100 Ag positive |
| Zollinger-Ellison (ZE) Syndrome | malignant islet cell tumor secreting gastrin; ulcers in usu place but can be multiple or in unusual places; Inc basal acid output; inc gastrin w/IV secretin test; Whipple's procedure if operable; Tx = proton blockers to dec gastrin; r/o other causes |
| Causes of hypergastrinemia | H2 or proton blockers, chronic atrophic gastritis of body/fundus; renal failure; gastric distention; Zollinger-Ellison syndrome |
| MEN I | AD; pituitary tumor, parathyroid adenoma, ZE syndrome, peptic ulcers |
| MEN IIa | AD; PARATHYROID adenoma, pheochromocytoma, medullary carcinoma of thyroid (calcitonin tumor marker; calcitonin converted to amyloid) |
| MEN IIb | AD; mucosal neuromas in lips; pheochromocytoma; medullary carcinoma of thyroid |
| Left heart failure | dec cardiac output; dyspnea, pulm edema (inc pulm venous hydrostatic P); LV dilation (vol overload); S3 heart sound; mitral insufficiency murmur (stretch of MV ring); paroxysmal nocturnal dyspnea &/or pillow orthopnea (inc venous return at night) |
| Right heart failure | usu d/t LHF; dec CO; vol overload of RV; S3 sound; murmur of tricuspid insufficiency; jugular distention; congestive hepatomegaly (inc LDH5); ascites, pitting edema |
| Pitting Edema | kidney reabsorbes slightly more water than salt, but both are increased and are pushed into interstitial space by increased hydrostatic pressure |
| Tx for HF | restrict water and salt; ACE inhibitor (dec preload and afterload); diuretics (dec preload only) |
| High output heart failure | d/t hyperthyroidism; thiamine deficiency, too much isotonic saline, AV fistula, endotoxic shock in early phases, Paget's dz of bone |
| Sudden cardiac death | death w/in 1hr; severe atherosclerotic CAD but no thrombus; die of ventricular arrhythmia |
| Angina: exertional | severe atherosclerotic CAD; ST depression on ECG; pain relieved by stopping exercise or taking nitroglycerin |
| Prinzmetal Angina | vasoconstriction from release of TXA2 from platelet thrombi; ST elevation on stress ECG; (atherosclerotic CAD is NOT cause of dz) |
| Unstable Angina | angina at rest; severe atherosclerotic CAD; infarct waiting to happen |
| Restrictive cardiomyopathy | cannot fill properly; glycogen (Pompe's glycogenosis); Iron (iron overload); Amloid (senile amyloidosis; prealbumin); endocardial fibroelastosis in child |
| Pericardial effusion | neck vein distention w/inspiration (Kussmaul sign); pulsus paradoxus (drop in BP on inspiration); muffled heart sounds; hypotension; all pressures in all chambers increased but CO is decreased; echocardiogram is diagnostic; Tx = Pericardiocentesis |
| Constrictive pericarditis | TB is MCC worldwide; heart cannot completely fill; pericardial knock when ventricles hit thickened pericardium |
| Hypersensitivity pneumonitis: Farmer's Lung | inhalation of thermophilic actinomycetes |
| Hypersensitiveity Pneumonitis: Silo Filler's | inhalation of nitrogen dioxide fumes |
| Hypersensitiveity Pneumonitis: Byssinosis | monday morning blues; pt works in textile factory and has contact w/cotton, linen, hemp |
| Hamman Rich Lung | hoenycomb lung; end-stage of alveolitis syndromes (interstitial pneumonitis syndromes) |
| Bronchiectasis | CF is MCC; obstruction and infection; bnronchi extend to lung periphery; cough up cupfuls of foul smelling sputum; (other causes: TB (mc worldwide), Kartagener syndrome (absent dynein arm in cilia; situs inversus)) |
| Atelectasis | MCC of fever 24hrs after surgery; elevated diaphragm |
| Choanal atresia | baby breaks away from breast and cyanosis is relieved by crying (complete nasal obstruction in newborn) |
| Nasal polyps | allergic; aspirin (pt w/HA develops asthma); CF (child w/polyps) |
| Pulmonary HTN | inc P2; causes RVH (cor pulmonale if heart isn't prob); Chronic hypoxemia (vasoconstricts pulm vessels/vasodilates peripheral vessels); loss of pulm vasculature (COPD, restrictive); L-->R shunts overload R heart; mitral stenosis (blood backs into pulm vv) |
| Primary Pulmonary HTN | mc in young women |
| ARDS (adult respiratory distress syndrome) | non-cardiogenic pulmonary edema from neutrophil related injury; MCC is endotoxic shock; intrapulmonary shunting (imp abnormality); separate from cardiogenic pulmonary edema by pulmonary capillary wedge pressure (DECREASED LV end-diastolic pressure) |
| Cardiogenic shock | Increased LV end-diastolic capillary wedge pressure |
| Lung cancer | squamous/small cell centrally located; Adenocarcinomas are peripherally located |
| Dysphagia for solids (not liquids) | think obstruction (strictures, Plummer-Vinson, Esophageal cancer) |
| Dysphagia for solids AND liquids | think Peristalsis Problem (PSS (progressive systemic sclerosis), CREST syndrome, Polymyositis, Achalasia) |
| Leukoplakic lesions in mouth | lateral border of tongue followed by lower lip (upper lip is basal cell carcinoma) |
| Hairy Leukoplakia of tongue | EBV glossitis, predates onset of AIDS |
| Oral pigmentation | PJ (Peutz-Jegher’s) syndrome; Addison's dz; Pb poisoning in adult |
| Gum hyperplasia | Phenytoin, pregnancy, scurvy, acute monocytic leukemia |
| Leiomyoma | mc benign tumor in women (uterine); mc tumor in GI tract (usu stomach) |
| Extranodal lymphoma | mc in stomach (most are high grade immunoblastic); mc#2 is Peyer's patches; H. pylori a/w low grade tumors |
| Bowel obstruction | adhesions from previous surgery (if no h/o of previous surgery, pick indirect inguinal hernia) |
| Intussusception | child, colicky abdominal pain, bloody diarrhea, terminal ileum into cecum |
| Carcinoid tumor | yellow tumor on tip of appendix (mc site overall); terminal ileum (mc site for tumor that metastasizes to liver to produce carcinoid syndrome) |
| Colorectal cancer | left side obstructs; right side bleeds |
| Sigmoid colon is most common site for: | cancer in GI tract, diverticular dz, and polyps |
| Hematochezia | bloody stools; diverticulosis followed by angiodysplasia (cecum; elderly pt) |
| Budd-Chiari Syndrome | hepatic vein thrombosis (PRV: Polycythemia rubra vera is MCC); liver congested, ascites, portal hypertension |
| Alpha-1-antitrypsin deficiency | PAS positive globules in hepatocytes in kids; Panacinar emphysema in adults (lower lobes) |
| Extrahepatic biliary atresia | bile duct proliferation in triads; radioactive dye cannot get into small intestine; jaundice in 1st week of life |
| Actue hepatitis | isoniazid (toxic metabolite acetylhydrazine); Salicylates; Halothane (1wk delay in sx - fever, jaundice; P450 metabolites); Methyldopa (positive Coombs test); Phenytoin, Ketoconazole |
| Actue hepatitis | Ketoconazole |
| Actue hepatitis | Phenytoin |
| Actue hepatitis | Methyldopa (positive Coombs test) |
| Actue hepatitis | Halothane (1wk delay in sx - fever, jaundice; P450 metabolites) |
| Actue hepatitis | Salicylates |
| Actue hepatitis | isoniazid (toxic metabolite acetylhydrazine) |
| Chronic active hepatitis | Methyldopa, Acetaminophen, Aspirin, Isoniazid, Nitrofurantoin, Halothane |
| Hepatic Zonal necrosis: Zone I | yellow phosphorus poisoning; ferrous sulfate poisoning |
| Hepatic Zonal necrosis: Zone III | Carbon tetrachloride poisoning (CCl3; free radical); Acetaminophen (free radical; acetylcysteine therapy replaces glutathione to neutralize free radicals); Amanita poisoning |
| Non-Inflammatory Intrahepatic cholestasis | Oral contraceptives (estrogen interferes with intrahepatic bile excretion); Anabolic steroids |
| Inflammatory Intrahepatic Cholestasis | Erythromycin estolate, Amoxicillin-Clavulanic acid, Chlorpromazine, Thiazides |
| Single Droplet Fatty liver change | (displaces nucleus to periphery); ethanol, corticosteroids, amiodarone (looks like alcoholic hepatitis including Mallory bodies and progression to cirrhosis) |
| Microvesicular Fatty liver change | (droplets w/o nucleus displacement); Tetracycline, Valproic Acid |
| Fibrosis | Methotrexate, Hypervitaminosis A |
| Budd-Chiari Vascular lesions | oral contraceptives |
| Peliosis hepatis Vascular lesions | oral contraceptives, anabolic steroids |
| Angiosarcoma vascular liver lesion | vinyl chloride; arsenic; Thorotrast |
| Hepatic Nodular Hyperplasia | Azathioprine, anticancer agents |
| Benign hepatic tumors (hepatic adenoma) | oral contraceptives |
| Malignant tumors (hepatocellular carcinoma) | oral contraceptives |
| Granulomatous hepatitis | allopurinol, hydralazine, sulfonamides, phenylbutazone |
| Wilson's Disease | AR; defect in copper secretion in bile; chronic liver dz; low ceruloplasmin (low total copper, but hi free copper); KF ring in eye; lenticular degeneration (chorea, rigidity) |
| Primary biliary cirrhosis | female; early sx is pruritis (bile salt deposit in skin); inc AlkPhos; no jaundice till late; granulomatous destruction of bile ducts in triads; inc anti-mitochondrial Abs; a/w Sjogren syndrome and renal tubular acidosis |
| Sclerosing pericholangitis | complication of ulcerative colitis; jaundice, ERCP (Endoscopic retrograde cholangiopancreatography) for diagnosis |
| Hydatid cysts in liver | sheepherder (Basque, Greek) with liver cysts; anaphylactic shock; dog is difinitive host, sheepherder is intermediate host |
| Pipestem cirrhosis | Schistosoma mansoni (sharp lateral SPINE); adults lay eggs in protal vein tributaries produsing fibrosis; ascites and portal HTN |
| Stone in common bile duct | MCC of obstructive jaundice |
| Granulomatous hepatitis | think TB if infective; think sarcoid if non-infective |
| Ischemic Acute Tubular Necrosis | MCC is prerenal azotemia; affects multiple parts of nephron; basement membrane disrupted; pigmented renal tubular casts |
| Nephrotoxic Acute Tubular Necrosis | MCC are aminoglycosides and IVP dyes; hits PROXIMAL tubule ONLY |
| Renal papillary necrosis | d/t analgesic abuse (acetaminophen + aspirin); DM, sicke cell trait/dz; acute pyelonephritis |
| Hydronephrosis | most commonly d/t renal stone |
| Renal stone | Calcium oxylate (mc); colicky flank pain w/radiation to groin; Hematuria, flat plates indentify stone (calcium); Hypercalciuria (mc metabolic abnormality); Hydrochlorathiazide (inc Ca absorption in nephron); Uric acid stone (non-visualized) |
| Epididymitis | <35yo (gonorrhea or Chlamydia); >35yo (e. coli, pseudomonas) |
| Varicocele | left side; bag of worms; cause of infertility; spermatic vein comes off left renal vein |
| Prostatic hyperplasia | transitional zone around urethra; testosterone and estrogen mediated; Prostate cancer (peripheral zone; outside; detected by digital exam); dribbling; urinary retention (a/w more w/benign); PSA does NOT distinguish hyperplasia from cancer |
| Seminoma testicular cancer | mc; a/w cryptorchidism; usu radiosensitive; para-aortic node metastasis |
| Testicular choriocarcinoma | most malignant; increased b-hCG |
| Testicular yolk-sac tumor | mc in children; endodermal sinus tumor; Schiller Duval bodies; inc AFP |
| Malignant testicular lymphoma | mc in elderly; metastatic |
| Malignant hypertension | background of essential hypertension and benign nephrosclerosis; Gross - flea bitten kidney; Micro - necrotizing arteriolitis, fibrinoid necrosis in glomerular capillaries, onion skinning of arterioles (hyperplastic arteriolosclerosis) |
| Vulvular Paget's Disease | intraepithelial adenocarcinoma |
| Koilocytosis | HPV effect in squamous cells; pyknotic nucleus surrounded by clear halo |
| IUD infxn | actinomycosis w/sulfur granules; (actinomycosis also for draining sinus from jaw) |
| Endometritis infxn | plasma cells present; Group B streptococcus |
| Uterine Adenomyosis | glands and stroma WITHIN myometrium; NOT endometriosis |
| Endometriosis | glands and stroma OUTSIDE confines of uterus; reverse menses; MCC of secondary dysmonorrhea; ovaries most often involved (chocolate cysts); laparascope - mc diagnostic/treatment; present only in reproductive life |
| Leiomyosarcoma | mc uterine sarcoma |
| Cervical polyp | non-neoplastic; hangs out of cervical os; post-coital bleeding |
| Endometrial polyp | no malignant potential; menorrhagia |
| Cervical cancer | death d/t renal failure from extension into retroperitoneum and blockage of ureters |
| Ectopic pregnancy | d/t previous PID; rupture is mc cause of death in early pregnancy; b-hCG initial test; vaginal ultrasound to check for amniotic sac; unclotted blood in pouch of Douglas |
| Rectal pouch of Douglas | anterior to rectum and posterior to uterus; can palpate with rectal exam; induration in young women = endometrial implants; induration in elderly = seeding from primary ovarian cancer; unclotted blood = ruptured ectopic; pus = PID |
| Follicular cyst | mc overal ovarian mass |
| Benign Surface derived ovarian tumor | serous cystadenoma (mc overall benign tumor); Brenner's tumor (Walthard's rests) |
| serous cystadenocarcinoma | malignant surface derived ovarian tumor; mc primary ovarian cancer; mc bilateral ovarian tumor; psammoma bodies |
| Cystic teratoma | mc germ cell tumor of ovary; undergoes torsion; struma ovarii = component of thyroid tissue; teeth and bone seen on xray |
| Dysgerminoma | most common malignant germ cell tumor of ovary; a/w Turner syndrome; female counterpart of male seminoma w/cryptorchidism |
| Yolk sac ovarian tumor | mc germ cell tumor in girls; inc AFP |
| Mucinous cystadenocarcinoma | malignant surface derived ovarian tumor; largest; a/w pseudomyxoma peritonei |
| Endometriod carcionma | malignant surface derived ovarian tumor; greatest a/w endometriosis |
| Ovarian Fibroma | mc sex cord stromal tumor; benign; Meig Syndrome |
| Meig Syndrome | ovarian fibroma, ascites, right sided pleural effusion |
| Granulosa cell tumor | sex cord stromal tumor; feminizing tumor; low grade malignancy; Call Exner bodies |
| Sertoli Leydig cell tumor of ovary | benign sex cord stromal tumor; masculinizing tumor; alias androblastoma and arrhenoblastoma |
| Leydig cell tumor of ovary | benign sex cord stromal tumor; masculinizing; alias "hilar cell tumor;" crystals of Reinke |
| Gonadoblastoma of ovary | germ cell and sex cord tumor; calcifies; a/w Turner's |
| Krukenberg tumor | metastatic gastric cancer to both ovaries; Signet Ring cells |
| Complete Hydatiform moles | 46XX, both chromosomes from dad; a/w choriocarcinoma; grape-like mass; preeclampsia in 1st trimester; uterus too large for gestational age; inc b-hCG |
| Partial Hydatiform mole | trisomy; embryo present; does NOT transform into choriocarcinoma |
| Gestationally derived choriocarcinoma | Syncytiotrophoblast (synthesizes hCG and human placental lactogen) AND Cytotrophoblast; Not chorionic villi; Metastasizes to lungs; Tx = Methotrexate (dramatic response) |
| Function of b-hCG | LH analogue that maintains corpus luteum of pregnancy for 8-10wks before placenta takes over |
| Twin placentas: Monochorionic | identical twins, whether monoamniotic (Siamese, fetat to fetal transfusion, tangle in umbilical cord) or diamniotic |
| Twin Placentas: Dichorionic | Fraternal OR identical twins |
| Abruptio placenta | PAINFUL bleeding; retroplacental hemorrhage; maternal hypertension or cocaine abuse |
| Placenta previa | PAINLESS bleeding; implantation over cervical os |
| Two umbilical arteries and one vein | vein carries oxygenated blood; if only 1 artery, there is an inc incidence of congenital anomalies |
| Lecithin/Sphingomyelin ratio | >2/1 in amniotic fluid indicates adequate pulmonary surfactant |
| Urine estriol | derived from fetal adrenal, placenta, maternal liver; low levels indicate fetal, placental or maternal problem |
| Human placental lactogen | growth hormone of pregnancy; anti-insulin activity |
| Amniotic fluid | fetal urine; alkaline pH; swallowed and recycled by fetus |
| Dysfunctional uterine bleeding | bleeding not secondary to an anatomic cause; homonal imbalance; anovulatory bleeding (mc cause after menarche); ovulatory types: inadequate luteal phase and irregular shedding |
| Ovulation | increase in temperature, subnuclear vacuoles, presence of secretory endometrium on day 21 |
| Implantation day | 21; 3 days in tube; 2 days in uterus |
| Primary amenorrhea | no menses by age 16; no bleeding post-progesterone challenge means there is no estrogen preimed uterus or there is an end organ defect; |
| Hypothalamic/pituitary defect and primary amenorrhea | dec FSH/LH; anorexia nervosa, wt loss syndrome; pituitary tumor |
| Ovarian defect and primary amenorrhea | inc FSH/LH; a/w Turner's syndrome |
| End organ defect and primary amenorrhea | normal FSH/LH; most cases are normal constitutional delays w/good secondary sex characteristics and withdrawal bleeding; (think Turner's if there is poor 2* sex characteristics, high gonadotropins and no withdrawal bleeding w/progesterone challenge) |
| Secondary amenorrhea | no menses for 3months; pregnancy is mc cause; same classification as primary |
| Asherman syndrome | secondary amenorrhea; stratum basalis removed owing to repeated dilation and curettage (end organ defect; normal gonadotropins) |
| Cervical pap smear | must be endocervical cells (gold standard) indicating proper sampling of endocervical canal where dysplasia occurs; |
| Superficial squamous cells of cervix | estrogen stimulation |
| Intermediat squamous cells of cervix | progesterone stimulation |
| Parabasal cells of cervix | unstimulated squamous cells |
| Normal female cervical cells | 70% superficial squamous and 30% intermediate squamous cells |
| Pregnant/prepubertal cervix cellular composition | 100% intermediate squamous cells |
| Atrophic cervix cellular composition | predominantly parabasals |
| Lewis antibodies | naturally occurring antibodies w/o clinical significance; no risk of hemolytic dz of newborn |
| Duffy antigens | uncommon in blacks; surface receptor for P. vivax; protection against malaria |
| I antigens | anti-I is a cold agglutinin (IgM) seen in M. pneumoniae infxn; anti-i (IgM) seen in infectious mononucleosis |
| Blood group O | universal donor; no antigens on surface; cannot be destroyed; must receive O blood; inc incidence of duodenal ulcers; 3 Abs (anti-A IgM, anti-B IgM, anti-AB IgG; all cross placenta) |
| Blood group AB | universal recipient; no Abs to destroy transfused RBCs |
| Blood group A | has anti-B IgM; inc incidence of gastric cancer |
| Blood group B | has anti-A IgM |
| Rh positive | pt has D antigen; |
| Major crossmatch | pt serum against donor RBCs to see if there are any pt antibodies that react against donor RBCs; if compatible it does not guarantee that transfused RBCs will not be destroyed or that the pt will not develop Abs against other donor RBC antigens |
| HIV risk post-transfusion | 1:676,000 risk per unit |
| HBV risk post-transfusion | 1:200,000 risk per unit |
| HCV risk post-transfusion | 1:3,300 risk per unit |
| Risk of HIV positivity post-accidental needle stick | 1:300; mc route of medical personnel infxn |
| Needle-stick infection rates | 30% for HBV, 3-5% for HCV and 0.3% for HIV. |
| Fresh frozen plasma | contains all coagulation factors; only for multiple factor deficiencies; risk of hepatitis |
| Packed RBCs | high hematocrit; contains some plasma; transfuse only if pt is symptomatic and does not respond to medical therapy; risk of hepatitis |
| Platelet transfusion | only if pt is symptomatic; risk of hepatitis |
| Cryoprecipitate | all factor VIII molecules, fibrinogen, factor XIII, fibronectin; hepatitis risk |
| Rh immune globulin (Rhogam) | anti-D (passive immunity); does NOT X placenta; give to prego w/o anti-D (w/in 3 days); amt given based on Kleihauer-Betke test on maternal blood that detects the amount of fetal-maternal blood; retal RBC resistant to acid/alkali; no hepatitis risk |
| Rh Hemolytic disease of newborn | mother Rh+, baby Rh(-); first pregnancy w/Rh+ baby has no effect on baby, but exposed mom produces anti-D Abs (Rhogam can prevent this) |
| Mechanism of hemolytic dz of newborn | Ab later x placenta, attach to fetal RBCs, removed by spleen; unconj bilirubin from hemolysis causes fetal anemia/heart failure/hydrops fetalis; bilirubin is detected in amnion (map on Liley graph to determine severity) |
| Delivery of baby with hemolytic dz of newborn | cannot handle unconjugated bilirubin (UCB) load; do exchange transfusion to prevent kernicterus; remove UCB; remove antibodies; correct anemia |
| Febrile transfusion reaction | pt has anti-HLA Abs against HLA Ags on donor WBCs; causes release of pyrogens from destroyed donor WBCs; type II hypersensitivity |
| Allergic transfusion reaction | pt develops hives against proteins in donor unit; type I hypersensitivity |
| Hemolytic transfusion reaction: ABO incompatibility | pt receives wrong blood type); activation of complement system, intravascular hemolysis; type II hypersensitivity |
| Hemolytic transfusion reaction: Pt has undetected antibodies that react against donor RBC antigens | extravascular hemolysis; jaundice, drop in Hb; positive Direct Coombs test; type II hypersensitivity |
| Heparin | prevents small vessel bleeding; enhances antithrombin III which neutralizes most serine protease coagulation factors (prothrombin X, IX, XII, XI, thrombin) |
| Prostaglandin -I2 | prevents small vessel bleeding; synthesized by endothelial cells, vasodilator, inhibits platelet aggregation |
| Factors preventing small vessel bleeding | heparin, prostaglandin I2, protein C and S, tissue plasminogen activator |
| Protein C and S | inactivate factors V and VIII; enhance fibrinolysis |
| Tissue plasminogen activator | release of plasmin wthich destroys coagulation factors and clots |
| Factors acting as procoagulants in small vessel injury | thromboxane A2, von Willebrand factor, extrinsic and intrinsic coagulation systems |
| Thromboxane A2 | synthesized by platelets, vasoconstrictor, enhances platelet aggregation, cyclooxygenase blocked by aspirin and NSAIDs |
| von Willebrand factor | VIII:vWF; synthesized by endothelial cells and megakaryocytes, platelet adhesion factor (platelets have receptro for VIII:vWF) |
| Normal events w/vessel injury to stop bleeding | activate factorVII (ext coag) by thromboplastin AND activation factorXII (intrinsic coag) by exposed collagen - platelet adhesion via VII:vWF receptors - ADP release from dense bodies cause aggregation/TXA2 synth - temporary platelet plug w/fibrinogen cap |
| Resolution of clot in vessel injury | thrombin from coag pathway converts fibrinogen to fibrin forming a stable plug - plasmin destroys plug and reestablishes blood flow |
| Bleeding time | detects platelet abnormalities up to formation of temporary hemostatic plug (thrombocytopenia; no VIII:vWF for platelet adhesion); mc cause is pt on aspirin (no TXA2 for aggregation) |
| Ristocetin cofactor assay | best test for VIII:vWF (vWF made by endothelial cells/megakaryocytes necessary for platelet adhesion) |
| Prothrombin time (PT) | detects extrinsic coag system factors down to formation of a clot - VII (extrinsic) --> X --> V --> II (prothrombin) --> I (fibrinogen) --> clot; international normalized ratio (for pts on warfarin); Best test for Liver Synthetic Function |
| Partial Thromboplastin Time (PTT) | detects INtrinsic coagulation system factors (XII, XI, IX, VIII) down to formation of a clot - XII --> XI --> IX --> VIII --> X --> V --> II (prothrombin) --> I (fibrinogen) --> clot; used to follow HEPARIN therapy and Factor Deficiencies |
| Factor VII deficiency | prolonged PT and normal PTT |
| Factor VIII deficiency | hemophilia A (decreased VIII:coagulant; Normal VIII:antigen and VIII:vWF); Normal PT, Prolonged PTT |
| Factor X deficiency | prolonged PT and PTT |
| Patient on heparin | prolonged PT and PTT (but PTT is better test to follow pts; if overanticoagulated, give PROTAMINE SULFATE |
| Patient on warfarin | blocks vitK ability to g-carboxylate factors II, VII, IX & X, ptn C/S by blocking epoxide reductase (normally keeps vitK in active K1 state) Prolonged PT & PTT (but PT is better test for monitoring; if overanticoagulated/bleeding IM vitK; bad bleed = FFP |
| Patient with von Willebrand's Disease | all factor VIII components decreased (VIII:coagulant, VIII:antigen, VIII:vWF); Prolonged Bleeding Time, Normal PT, Prolonged PTT |
| Patient with antibody against factor VIII:coagulant (circulating anticoag, inhibitor) and Prolonged PTT | normal PT, Prolonged PTT; after mixing 0.5cc of normal plasma w/0.5cc pt plasma, the PTT is repeated and still prolonged b/c Abs inhibit VIII:coagulant in normal plasma as well; a TRUE Factor VIII:coag deficiency has correctable PTT w/normal plasma |
| Fibrinolytic system tests | Fibrin (ogen) splits products (X, Y, D, E fragments) after plasmin breakdown of fibrinogen or a fibrin clot; D-dimers (measure x-linked fibrin monomers in fibrin clot) |
| Disseminated Intravascular Coagulation | intravascular consumption of clotting factors (fibrinogen, V, VIII, prothrombin, platelets) with diffuse oozing of blood from all breaks in skin; Caused by: endotoxic shock, infxn, snake envenomation, amniotic fluid |
| Tests/Tx for DIC | **BEST = Increased split products and D-dimer;** prolonged PT and PTT; low fibrinogen; Use blood components to keep pt alive; Heparin blocks thrombin (prevents clots and consumption of coag factors) |
| Hereditary thrombosis syndromes | venous thrombosis and pulmonary emboli; ATIII deficiency (no prolongation of PTT after starting heparin); Protein C and S deficiency |
| Heparin | prevents venous clot formation; does NOT dissolve clot; can be used in pregnancy; can produce thrombocytopenia |
| Warfarin | blocks epoxide reductase (normally keeps vit K in active K1 state); previously g-carboxylated vitK dep-factors must disappear b/f pt is fully anticoagulated (reason why heparin is given along with warfarin) |
| Warfarin and Factor VII, protein C, prothrombin | have shortest half-lives (6hrs) and prothrombin the longest (3 days); hemorrhagic skin necrosis; pt with heterozygote ptn C deficiency and 50% factor level (when put on warfarin will have 0% ptn C in 6hrs causes thrombosis in skin bf full anticoagulation) |
| Henoch-Schoenlein Purpura | mc immuncomplex (IgA-anti-IgA) vasculitis in kids; URI followed by palpable purpura (small vessel vasculitis); polyarthritis, hematuria (glomerulonephritis), GI bleed |
| Thromboangiitis obliterans (Buerger's) | smoker's vasculitis; thrombosis of digital vessels w/gangrene; Tx = quit smoking |
| Kawasaki's dz | MCC of childhood myocardial infarction; coronary artery vasculitis + mucous membrane inflammation and skin desquamation at tips of fingers |
| Polyarteritis nodosa | immunocomplex vasculitis of muscular arteries; HBsAG in 30%; vessels in different stages of healing; aneurysm formation; renal infarction; p-ANCA antibodies; Diagnosis = arteriography |
| Takayasu's Arteritis | pulseless disease of Asian female; granulomatous vasculitis of aortic arch vessels; blindness; strokes |
| HbA1C | best test to follow glycemic control over the last 4-8wks in diabetes |
| Aseptic necrosis | Legg-Perthe; femoral head in child <10yo; Femoral fracture in elderly (MCC) |
| Osgood Schlatters | inflammation of proximal tibial apophysis at insertion of patellar tendon; active boys |
| Hypoglycemia | most commonly d/t insulin overdose in type I diabetic |
| Bell's Palsy | CN VII; droopy face, cannot close eye; a/w HSV-1 |
| Insulinoma | benign tumor arising from b-islet cells; produces fasting hypoglycemia; 80% a/w MEN-I syndrome; mc islet cell tumor; secretes high levels of insulin AND *C-peptides* & inhibit GNG; forgetfulness and mental status change (neuroglycopenia) |
| Gastrinoma (Zollinger-Ellison Syndrome) | malignant islet tumor of G cells; produces Gastrin >600pg/mL causing hyperacidity & PUD (mc1; duodenum mc2); a/w MEN-1; usu 1 ulcer in nml location (suspect if multiple or unusual loci); abdominal pain, diarrhea (malabsorption d/t acidic pH) |
| Gastrinoma Tests | Best Screen = Basal acid output; Confirm = IV Secretin Test (paradoxical inc in gastrin); r/o H2 blockers (lo acid/hi gastrin), atrophic gastritis (typeA no acid/stim gastrin), pyloric obstruction (antral distension/stim gastrin), duode ulcer (hi Gastrin) |
| Glucagonoma | malignant tumor of islet alpha cells w/excess glucagon secretion; DM (glucagon is gluconeogenic); characteristic rash = necrolytic migratory erythema |
| Somatostatinoma | malignant tumor of delta islet cells secretes excess somatostatin; Achlorohydria (inhib gastrin) Cholelithiasis (inhibits cholecystokinin), DM (inhibs gastric inhib peptide that normally stim insulin release), steatorrhea (inhibs secretin/cholecystokinin) |
| VIPoma or pancreatic cholera or Verner Morrison Syndrome | malignant tumor of islets w/excess secretion of VIP; severe secretory diarrhea (stim cAMP like cholera & e.coli toxin); Hypokalemia; nml gap acidosis (lose bicarb/K in stool), achlorohydria |
| Myotonic dystrophy | AD; triplet repeat mutation; mc adult dystrophy; cannot release hand grip; BALDING; Cataracts; heart disease; hypogonadism |
| Wernicke-Korsakoff | cerebellar atrophy, cerebral atrophy, central pontine myelinolysis (too rapid infusion of Na in hyponatremia); peripheral neuropathy; d/t alcohol |
| Guillain-Barre | autoimmune demyelination of peripheral nerves primarily affecting motor fibers; follows URI; ascending paralysis (LMN symptoms); increased CSF ptn; no increase in cells |
| Meneir's disease | increased endolymph; dizziness, vertigo, hearing loss, horizontal nystagmus |
| Benign positional vertigo | MCC of recurrent vertigo; no hearing loss or tinnitus; nystagmus; dislocation of otoliths |
| Multiple sclerosis | mc demyelinating disease; a/w HSV-6 and HLA-Dr2; scanning speech (sounds drunk); intention tremor, nystagmus; paresthesias/muscle weakness; periventricular plaques; cerebellar ataxia; internuclear ophthalmoplegia; inc CSF ptn/lymphos (minor) |
| Parkinson's | depigmentation of substantia nigra; dec in dopamine; Lewy bodies in neurons; rigidity; bradykinesia, cogwheeling, resting tremor (pill rolling), fenestrating gait, blank stare; a/w MPTP abuse and chlorpromazeine can cause pseudoparkinsonism |
| Oligodendroglioma | benign calcifying tumor in adults; frontal lobes |
| Primary hyperPTH | inc Ca, dec PO4, inc PTH |
| Malignancy (PTH-like peptide) | inc Ca, dec PO4, dec PTH |
| Primary Hypoparathyroidism | dec Ca, inc PO4, dec PTH |
| Pseudohypoparathyroidism | dec Ca, inc PO4, normal-inc PTH |
| Secondary hyperPTH (malabsorption) | dec Ca, dec PO4, inc PTH |
| Secondary hyperPTH (renal failure) | dec Ca, inc PO4, inc PTH |
| Hypoalbuminemia | dec Ca, normal PO4, normal PTH |
| Alkalosis | normal Ca (dec ionized Ca); normal PO4, Inc PTH |
| Kidneys w/irregular white patches on cortical surface | pale infarcts from embolization from L heart |
| Concentric hypertrophy of left ventricle | inc afterload; essential HTN is MCC; aortic stenosis (not mitral stenosis); (No hypertrophy since blood is NOT getting to LV) |
| Hypertrophy and dilatation of left ventricle | volume overload d/t aortic OR mitral valve insufficiency; left to right shunts w/INC RETURN to L heart; aortic valve ring dilatation (dissection, aortitis) |
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bscaryp