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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

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Opportunistic infxns in AIDS

pneumocystis, CMV, cryptococcus, MAI, TB, Herpes (esophagitis), candida (thrush, esophagitis), cryptosporidium (acid fast, diarrhea)

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Cocaine

decreased uptake of Dopa and Norepi

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Polyclonal inflammation

chronic

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Monoclonal inflammation

one clone of plasma cells

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Absence of Y chromosome

germinal ridge moves in direction of ovarian differentiation instead of testes

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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

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ESR increase with age

probably abnormal, indicative of a disease process (not an age-associated finding)

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Key elements in wound healing

granulation tissue, fibronectin

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Cause of death in 15-25yo bracket

MVA (mc); black males = homicide

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Xeroderma pigmentosum

AR dz w/absence of DNA repair enzymes; inc incidence of UVB-related skin cancers

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Cytochrome oxidase

inhibited by CO and cyanide

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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

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Cause of atrophy in a muscle in a cast

lack of muscle stimulation

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Mosaicism

non-disjunction in somatic cells

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mc vitamin deficiency in alcoholics

folate

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mc metal deficiency in alcoholics

magnesium

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vitamin a/w pyruvate dehydrogenase

thiamin

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child born with ambiguous genitalia

determine genetic sex

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Respiratory burst

NADPH oxidase conversion of molecular O2 into superoxide free radicals; neutrophils and monocytes only

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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

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Clear cell adenocarcinoma of vagina

DES exposure; vaginal adenosis is precursor

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what happens to other kidney if one is damaged?

it hypertrophies

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Vitamin E toxicity

decreases levels of vit K dependent factors; inc incidence of hemorrhagic strokes; potentiates action of warfarin

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Biotin reaction

carboxylase reaction in conversion of pyruvate to oxaloacetate

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Cherry red macula

Tay Sach disease

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Pyridoxine (B6)

transamination reactions involving transaminases AST and ALT

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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

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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)

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Vitamin supplements in CF

give all fat soluble vitamins

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Woman is pure vegan and breast feeding, why does baby develop anemia?

B12 deficiency

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EBV attaches to:

CD21 on Bcells

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Hypogonadism, MR, unilateral gynecomastia

Kleinfelter's syndrome

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Hypogonadism, anosmia and color blindness

Kallmann syndrome (absent GnRH)

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Hypogonadism, MR, retinitis pigmentosum

Laurence-Moon-Biedl syndrome

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Male with hypogonadism, MR, short stature and web neck

Noonan syndrome (similar to turner's), can also occur in females

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Male pseudohermaphrodite with cryptorchidism (mc cause of male pseudohermaphroditism)

testicular feminization (absent androgen receptors; SXR;

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Microdeletion syndrome with hypogonadism, MR, short stature, and obesity

Prader-Willi syndrome (paternal Chrom 15)

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Angelman syndrome

microdeletion of maternal origin chrom 15 with MR, DevDelay, laughter

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Pt with neurofibromatosis has severe diastolic HTN

probable pheochromocytoma

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Complications of cyclophosphamide

hemorrhagic cystitis and transitional carcinoma of bladder

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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)

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Most important risk factor for inc morbidity/mortality in a single 25yo black male

unprotected sex (AIDS is #1 killer)

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Most important risk factor for inc morbidity/mortality in a single 25yo white male

motor vehicle accidents

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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

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Newborn girl with edema of hands and feet and cystic mass in neck

Turner's syndrome; 45 XO karyotype

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Components of Cow's milk (versus breast milk)

more vit K, less ascorbic acid, more B12, more casein

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Mature breast milk components (versus cow's milk)

low iron, but better absorption, whey protein is primary protein

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Vitamin that is abscent in colostrum

vit D

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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

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Type of UV light a/w corneal burn (ex: snow skiing) and cancer

UBV; B is bad

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Retinal hemorrhage in young child

possible cause is shaken baby syndrome

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Pt stung by bee, has respiratory difficulty, flushing, abd cramping - Tx?

aqueous epinephrine IM

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Fire ant bites

multiple wheals that later develop into vesicles and pustules

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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

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Poisonous scorpian bite in SW

painful sting followed by local itching, paresthesias, N/V, HTN

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Brown recluse spider bite

painless bite beginning with slightly tender red papule on arm that later forms a hemorrhagic blister surrounded by purpura

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Chigger bites

extremely pruritic, discrete, bright red papules on legs and around waist

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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

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What disease is more likely to infect the fetus after the first trimester

syphilis

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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)

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Causes of Angiosarcoma of liver

vinyl chloride, arsenic, Thorotrast

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Ambiguous genitalia - Male

17-hydroxylase deficiency; female appearing, no male homrones, male pseudohermaphrodite

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Ambiguous genitalia - Female

female pseudohermaprodite; 21-hydroxylase deficiency or 11-hydroxylase deficiency

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Salt loser with volume depletion a/w

21-hydroxylase deficiency

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Salt retention with HTN a/w

11-hydroxylase deficiency and 17-hydroxylase deficiency

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Plasma ACTH abnormality

increased adrenal steroid production of 21-, 11-, and 17-hydroxylase

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Hypocortisolism a/w

adrenal deficiency in 21-, 11-, and 17-hydroxylase

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Urine 17-ketosteroids a/w

increased adrenal secretion of 21- and 11-hydroxylase, and decreased 17-hydroxylase

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Urine 17-hydroxycorticoids a/w

adrenal hyposecretion of 21- and 17-hydroxylase and increased 11-hydroxylase

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Age dependent cardiovascular change

loss of elasticity in aorta

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Age related cardiovascular change

atherosclerosis, ischemic heart dz, temporal arteritis, aortic stenosis

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Age dependent respiratory change

"senile emphysema" overinflation of lung (COPD-like),dec elasticity, dec FEV1, inc fxnl residual capacity, dec PaO2

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Age related respiratory change

cancer and pneumonia

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Age dependent musculoskeletal change

osteoarthritis

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Age related musculoskeletal change

osteoporosis, fractures (vertebral mc), RA, Paget's dz

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Age dependent CNS/special senses changes

cataracts, presbycusis (inner ear degen), otosclerosis (conductive loss), dec smell/taste, arcus senilis (white rim on cornea)

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Age related CNS/special senses changes

dementia (Alzheimer's, multi-infarct), cererbral atrophy, TIAs, Parkinson's, subdural hematoma, stroke

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Age dependent immune system changes

inc CD4 and dec CD8 Tcells, inc synthesis of autoantibodies, dec cellular immunity

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Age related immune system changes

inc monoclonal gammopathy of undetermined significance, inc incidence of multiple myeloma, inc susceptibility to influenza

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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)

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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)

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Age dependent reproductive changes

breast/vulvovaginal atrophy, dec serum estrogens and inc gonadotropins, testicular atrophy w/dec testosterone levels, prostate hyperplasia/cancer

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Age related reproductive changes

inc incidence of cancers of vulva, vagina, cervix, endometrium, ovary, breast; spermatocytic seminoma and malignant lymphoma of testis (metastatic)

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Age dependent renal changes

dec GFR (40% drop); dec creatinine clearance (important to adjust drug dosages to avoid toxicity)

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Age related renal changes

inc incidence of renal adenocarcinoma and renovascular HTN secondary to atherosclerosis

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Age dependent endocrine changes

inc CHO intolerance (less insulin receptors from increased adipose)

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Age related endocrine changes

Type II diabetes

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Target organs for acetaminophen injury

liver and kidneys (renal medulla); free radical injury

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Low AFP on amnioscentesis

Down syndrome

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Corticosteroid MOA

block phopholipase A2 hence dec prostaglandin and leukotriene production; dec leukocyte adhesion (inc PMNs, dec lymphos and eosinophils)

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Ectopic ACTH

mc ectopic secretion; Tumors (small cell carcinoma of lung, medullary carcinoma of thyroid); Syndromes (Cushing - hyperpigmentation)

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Ectopic ADH

Tumors (small cell carcinoma of lung); Syndrome (dilutional hyponatremia)

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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)

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Ectopic calcitonin

Tumors (medullary carcinoma of thyroid); Syndromes (hypocalcemia)

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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)

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Ectopic Insulin-like protein

Tumors (hepatocellular carcinoma, retroperitoneal tumors); Syndromes (hypolglycemia)

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Ectopic PTH-like peptide

Tumors (Squamous cell of lung, renal adenocarcinoma, breast and ovarian cancer); Syndromes (hypercalcemia w/low PTH)

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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)

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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

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AAT tumor marker

Enzyme; hepatocellular carcinoma, yolk sac or endodermal sinus tumor of ovary/testis

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b-hCG tumor marker

hormone; trophoblastic tumor in germ cell of ovary/testis/placenta; benign (hydatiform and invasive mole), malignant (choriocarcinoma)

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b2-microglobulin tumor marker

protein; multiple myeloma (excellent Px): light chains in urine (aka Bence Jones ptn)

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Bombesin tumor marker

peptide; small cell carcinoma of lung; neuroblastoma

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CA 15-3 tumor marker

glycoprotein (cancer antigen); breast cancer

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CA 19-9 tumor marker

glycoprotein (cancer antigen); pancreatic cancer

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CA 125 tumor marker

glycoprotein (cancer antigen); surface derived ovarian cancer

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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)

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LDH tumor marker

enzyme; Hodgkin's dz; non-specific marker in general

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Neuron specific enolase (NSE) tumor marker

enzyme; small cell carcinoma of lung, neuroblastoma

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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

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HTLV-1 oncogenic RNA virus a/w

adult Tcell leukemia/lymphoma

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HTLV-2 oncogenic RNA virus a/w

hairy cell leukemia

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HIV oncogenic RNA virus a/w

CNS malignant lymphoma

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HCV oncogenic RNA virus a/w

hepatocellular carcinoma

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HBV oncogenic DNA virus a/w

hepatocellular carcinoma (aflatoxin B is a cocarcinogen)

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EBV oncogenic DNA virus a/w

Burkitt's lymphoma, nasopharyngeal carcinoma, polyclonal malignant lymphoma

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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)

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HSV-8 oncogenic DNA virus a/w

Kaposi's sarcoma

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EM of zebra bodies in lysosomes in Niemann Pick Dz look like

lamellar bodies in type II pneumocytes

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Enamel injury in young woman

bulimia; metabolic acidosis from vomiting; Boerhaave's syndrome

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Anorexia nervosa

secondary amenorrhea (<15% ideal body wt, dec GnRH and gonadotropins), distorted body image, osteoporosis, ventricular arrhythmias are mc cause of death)

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Kwashiorkor

dec protein intake with normal caloric intake (all CHOs); fatty liver from dec apolipoproteins; pitting edema; flanky pain dermatitis; "little red johnny"

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Marasmus

decreased total caloric intake; loss of muscle mass

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Vitamin A deficiency

squamous metaplasia in eyes, bronchus; nyctalopia (night blindness)

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Vitamin A toxicity

increased intracranial pressure; hypercalcemia

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Primary hypothyroidism

b-carotenemia from dec conversion of b-carotenes into retinoic acid in intestine (thyroxine is cofactor); pt is yellow excepe eyes

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Rickets vs osteomalacia in adults

Rickets (craniotabes and rachitic rosary); Both have an increase in unmineralized osteoid

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Vitamin E deficiency

cerebellar dysfxn; hemolytic anemia; toxicity: interferes w/vit K dependent factors leading to hemorrhagic diathesis

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Vitamin C deficiency

teeth bleed when brushed; glossitis; perifollicular hemorrhages; a/w tea and toast diet

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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

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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

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Riboflavin deficiency

imp rxns (FMN and FAD, synth of glutathione); magenta tongue, neovascularization of cornea, angular stomatitis

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Pyridoxine deficiency

MCC is INH; imp rxns (transaminase, heme synthesis (sideroblastic anemia w/ringed sideroblasts), NT synthesis, absent in goat's milk

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Pantothenic acid

imp in fatty acid synthase complex; co-enzyme A rxns

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Biotin deficiency

avidin in raw eggs binds the vitamin; alopecia

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Chromium fxn

potentiates insulin activity for glucose tolerance; deficiency a/w glucose intolerance and peripheral neuropathy

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Copper fxn

cofactor in red-ox rxns to bind oxygen; inc in pregnancy, inflammation, w/OCPs; bound to ceruloplasmin

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Copper cofactor for Lysyl oxidase

forms x-links in collagen and elastic tissue to inc tensile strength

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Copper as cofactor for Cytochrome C oxidase

electron transport system

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Copper as cofactor for superoxide dismutase

antioxidant that neutralizes oxygen free radicals

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Copper as coenzyme for ferroxidase

converts iron to +3 so it can bind transferrin

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Copper as cofactor for tyrosinase

converts tyrosine to DOPA in melanin synthesis

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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)

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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

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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

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Selenium deficiency

muscle pain, weakness, cardiomyopathy

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Zinc fxn

cofactor in superoxide dismutase, carbonic anhydrase, alkaline phosphatase, collagenases, RNA and DNA polymerases, thymidine kinase, alcohol DH

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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)

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Goat's milk causes

Vit B6 (pyridoxine) and Folate deficiency

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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

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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)

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Newborn has high Hb d/t

increase in HbF

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HbF

left shifts ODC, protects newborns with sickle cell dz and severe b-thalessemia, inc w/hydroxyurea, resistant to alkali/acid denaturation

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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

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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

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Part of adrenal cortex that is atrophied in pt on corticosteroids

fasciculata and reticularis (not glomerulosa where aldosterone is)

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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)

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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)

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Oncogenesis of HPV

gene products E6 and E7 in HPV infections inhibit p53 tumor suppressor gene leading to cancer

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Metalloenzyme that aids in tumor invasion of tissues

collagenase with Zn as cofactor

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Smoker with history of peptic ulcer disease

advise them to stop smoking to avoid cancer

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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

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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)

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DNA repair defects

Fanconi's anemia (x-linking agents)

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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

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Genomic imprinting

did chrom come from mother or father; ex: Chrom 15 microdeletions (Prader willi and Angelmans)

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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)

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Main difference btw adult male and female

iron studies all lower in females

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Children

inc alk phos (osteoblasts from bone growth) and phosphate, slight decrease in Hb

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Analytes increased with hemolyzed blood sample

LDH, potassium

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Lipid most affected by fasting

triglyceride component coming from chylomicrons; CH and HDL not affected

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Enhance cytochrome system

H2 blockers, proton blockers; danger of drug toxicity

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First sign of tissue hypoxia

swelling of cell from inactive Na/K ATPase pump

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Fatty liver

most commonly d/t alcohol

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Examples of growth alterations

atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia

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Examples of cell accumulations

melanin, iron, calcium (dystrophic, metastatic), glycogen, bilirubin products

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Free radicals

superoxide, OH, peroxide, drugs (acetaminophen, CCL4); iron increases FR formation

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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)

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Chemical mediators of inflammation

histamine, C3a, C3b, C5a, LTB4, LTC-D-E4, bradykinin, prostaglandins

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Factors increasing and decreasing adhesion molecule synthesis

Increase (C5a, LTB4, endotoxins, IL-1, TNF); Decrease (catecholamines, corticosteroids, lithium)

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Recognize a granuloma (circumscribed, red, contain multinucleated giant cells)

example of Type IV hypersensitivity; MQs when activated become epithelioid and fuse into multinucleated masses

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Key factors in wound healing

role of fibronectin and granulation tissue; (infxn interferes)

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Types of inflammation

Suppurative (abscess); Cellulitis (streptococcus); Granulomatous (TB); Pseudomembranous (Diptheria, C. difficile); Fibrinous (pericarditis); Serous (blister)

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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)

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Fragile X syndrome

SXR disease; mc genetic cause of MR in males (Downs mc overall); triplet repeat; macroorchidism at puberty

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Cri-du-chat syndrome

deletion of short arm of Chrom 5; MR, cry like cate, relation with VSD

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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)

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Neurofibromatosis

AD; brain tumors: meningioma, acoustic neuroma, pheochromocytoma, cafe au lait, Lisch nodules (hamartomas in iris)

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Von Hippel Lindau

AD; cerebellar hemangioblastomas; pheochromoctoma; renal adenocarcinoma (high incidence)

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Number 1 teratogen for Congenital malformations

alcohol

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erb-B2/neu (HER-2)

codes for growth factor receptor; breast, ovarian, and colon cancer

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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)

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abl

produces non-receptor ptns on inner cel membrane surface; t9:22 (CML)

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c-myc

located in nucleus, produces ptn products that activate nuclear transcription; t8:14 (Burkitt's lymphoma)

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N-myc

neuroblastoma

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ret

MEN IIa and IIb

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bcl-2

t14:18; leads to inactivation of apoptosis gene on B cells leading to immortal cell and follicular B cell lymphoma

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Grade of cancer (histology)

well differentiated (low grade; you can tell what origin is); poorly differentiated (high grade, anaplastic; cannot tell tissue of origin)

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Stage of cancer

T (tumor size), N (nodal metastasis), M (other metastasis sites); more important than grade

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Carcinoma

squamous, adeno-, transitional

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Sarcoma

mesenchymal origin

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Hamartoma

not neoplastic; bronchial hamartoma, PJ polyp, hyperplastic polyp

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Choristoma

not neoplastic; normal pancreas in stomach wall

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Mixed tumor

parotid salivary gland tumor; 2 tissues from same cell layer)

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Teratoma

tissues of ecto-, endo- and mesoderm; cystic teratoma (of ovary; has hair and teeth)

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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)

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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

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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)

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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

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Diarrhea metabolic acidosis

lose sodium, K, and bicarb; the latter replaced by chloride

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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)

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Aniline dye chemical carcinogen

transitional cell carcinoma of bladder, ureters, renal pelvis

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Benzidine chemical carcinogen

transitional cell carcinoma of bladder, ureters, renal pelvis

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Cyclophosphamide chemical carcinogen

transitional cell carcinoma of bladder, ureters, renal pelvis

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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

🗑

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