USMLE 2CK - Goljan High-Yield
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| PO2 | driving force for diffusion of O2 into tissue
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| SaO2 | percent heme groups occupied by O2
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| Cyanosis | decreased O2 saturation (SaO2); O2 content
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| Oxygen | electron acceptor in oxidative pathway
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| Hypoxia | inadequate O2 leads to ATP depletion
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| Ischemia | decreased arterial (or venous) blood flow
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| Respiratory acidosis | retention of CO, always decreases PaO2
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| Ventilation defect | impaired delivery of O2 to alveoli; intrapulmonary shunting of blood (e.g., RDS)
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| Perfusion defect | absent blood flow to alveoli; increased alveolar dead space (e.g., pulmonary embolus)
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| Diffusion defect | O2 cannot cross alveolar-capillary interface; interstitial lung disease (e.g., sarcoidosis)
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| Methemoglobin | ↓ SaO2; heme Fe+3; oxidizing agents (sulfur/nitro drugs); Rx with IV methylene blue
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| Clinical methemoglobinemia | cyanosis not corrected by O2; chocolate colored blood
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| Carbon monoxide | ↓ SaO2; left-shift O2 binding curve; inhibits cytochrome oxidase
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| Causes carbon monoxide poisoning | car exhaust, space heaters, smoke inhalation
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| S/S carbon monoxide poisoning | headache; cherry red color skin
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| Cyanide | inhibits cytochrome oxidase; systemic asphyxiant
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| Carbon monoxide + cyanide poisoning | house fires
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| Left-shifted O2 curve | ↓ 2, 3 BPG, carbon monoxide, alkalosis, HbF, methemoglobin, hypothermia
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| Right-shifted O2 curve | ↑ 2, 3 BPG, high altitude, acidosis, fever
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| High altitude | respiratory alkalosis enhances glycolysis; ↑ synthesis 2,3 BPG
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| Mitochondrial poisons | damages membrane and drains off protons; alcohol, salicylates
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| Uncoupling agents in mitochondria | drain off protons; dinitrophenol, thermogenin (brown fat)
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| Complication mitochondrial poisons/uncoupling agents | hyperthermia
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| Decreased ATP | impaired Na+/K+ ATPase pump (cellular swelling); reversible
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| Anaerobic glycolysis | ATP synthesis in hypoxia; lactate ↓ intracellular pH, denatures proteins
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| Irreversible injury hypoxia | membrane/mitochondrial damage
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| Mitochondrial damage | release cytochrome c activates apoptosis
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| Irreversible injury hypoxia | ↑ cytosolic Ca2+ activates phospholipase, proteases, endonuclease
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| Free radicals | unpaired electron in outer orbit; damage cell membranes and DNA
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| Free radicals | superoxide, hydroxyl, peroxide, drugs (acetaminophen)
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| Superoxide dismutase | neutralizes superoxide
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| Glutathione | neutralizes peroxide, drug FRs
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| Catalase | neutralizes peroxide
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| Lipofuscin | indigestible lipid of lipid peroxidation; brown pigment increased in atrophy and FR damage
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| Reperfusion injury in heart | superoxide FRs + calcium
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| Mitochondrial injury | cytochrome c in cytosol initiates apoptosis
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| SER hyperplasia | alcohol, barbiturates, phenytoin
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| Complications SER hyperplasia | increases drug metabolism (e.g., oral contraceptives); low vitamin D
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| Chediak-Higashi | membrane protein defect in transferring lysosomal enzymes to phagocytic vacuoles
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| Chediak-Higashi | AR; giant lysosomes
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| I cell disease | absent enzyme marker in Golgi apparatus (mannose 6-phosphate); empty lysosomes
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| Rigor mortis | stiff muscles after death due to ATP depletion
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| Fatty change in liver | MCC alcohol (increase in NADH); DHAP → G3P → TG
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| Fatty change in liver | VLDL pushes nucleus to side
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| Causes fatty change | ↑ synthesis TG/FAs, beta-oxidation of FAs, synthesis apoproteins/release VLDL
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| Fatty change in kwashiorkor | ↓ synthesis of apoproteins
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| Ferritin | primary iron storage protein; soluble in blood; serum level reflects marrow storage iron
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| Hemosiderin | insoluble ferritin degradation product visible with Prussian blue stain
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| Atrophy | reduction in cell/tissue mass by either loss or cell shrinkage
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| Brain atrophy | ischemia; Alzheimer's
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| Exocrine gland atrophy in CF | duct obstruction by thick secretions
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| Labile cells | stem cells (skin, marrow, GI tract) →←→⇦
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| Stable cells | in G0 phase (smooth muscle, hepatocytes); can enter cell cycle (growth factors, hormones)
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| Permanent cells | cannot replicate; cardiac/striated muscle; neurons
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| Hypertrophy | increase in cell size (structural components, DNA)
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| LVH | increased preload (valve regurgitation), increased afterload (hypertension, aortic stenosis)
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| RVH | pulmonary hypertension
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| Bladder smooth muscle hypertrophy | prostate hyperplasia constricts urethra
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| Removal of kidney | hypertrophy of remaining kidney
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| Hyperplasia | increase in number of cells
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| Endometrial hyperplasia | unopposed estrogen (obesity, taking estrogen)
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| RBC hyperplasia | increased EPO (blood loss, ectopic secretion, high altitude)
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| Prostate hyperplasia | increased dihydrotestosterone (DHEA)
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| Gynecomastia | hyperplasia male breast tissue; normal in newborn, adolescent, elderly
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| Metaplasia | one adult cell type replaces another cell type
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| Squamous metaplasia in bronchus | smoking
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| Intestinal metaplasia in stomach | Paneth cells, goblet cells; H pylori chronic atrophic gastritis
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| Squamous metaplasia bladder | Schistosoma hematobium infection
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| Barrett's esophagus | glandular metaplasia of distal esophagus; due to GERD
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| Dysplasia | atypical hyperplasia and metaplasia are precursors for cancer
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| Squamous dysplasia in cervix | human papilloma virus
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| Squamous dysplasia in bronchus | smoking
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| Necrosis | death of groups of cells
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| Coagulation necrosis | preservation of structural outline (due to ↑ lactic acid)
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| Infarction | pale (e.g., heart, kidney); hemorrhagic (e.g., lung, small bowel); dry gangrene
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| Liquefactive necrosis | brain infarct, bacterial infections; wet gangrene
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| Caseous necrosis | variant coagulation necrosis; granulomas due to TB/systemic fungi
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| Granulomas | activated macrophages (epithelioid cells); multinucleated giant cells; CD4 TH1 cells
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| Epithelioid cells | γ-interferon released by CD4 T cells activates macrophages
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| Multinucleated giant cells | fusion of epithelioid cells
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| Granulomas | type IV hypersensitivity
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| Enzymatic fat necrosis | associated with pancreatitis; soap formation (Ca2+ + fatty acids)
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| Fibrinoid necrosis | necrosis of immune reactions (immune vasculitis/endocarditis)
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| Postmortem necrosis | autolysis; no inflammatory reaction
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| Dystrophic calcification | calcification of damaged tissue; normal serum calcium
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| Dystrophic calcification | pancreatitis; atherosclerotic plaque
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| Metastatic calcification | calcification of normal tissue; increased serum calcium or phosphorus
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| Nephrocalcinosis | metastatic calcification of collecting tubule basement membranes
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| S/S nephrocalcinosis | polyuria due to nephrogenic diabetes insipidus; renal failure
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| Apoptosis | gene regulated individual cell death
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| Signals activating apoptosis | mullerian inhibitory factor, tumor necrosis factor, hormone withdrawal
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| Signal modulators of apoptosis | TP53 suppressor gene, BCL-2 genes
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| BCL-2 genes | anti-apoptosis gene; prevents cytochrome c from leaving mitochondria
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| Caspases | responsible for enzymatic cell death in apoptosis; proteases and endonucleases
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| Markers of apoptosis | eosinophilic cytoplasm, pyknotic (ink dot) nucleus
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| Apoptosis | loss Mullerian epithelium in male fetus; thymus involution; killing cancer cells
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| Histamine | key chemical in acute inflammation; mast cell; arteriole vasodilation; ↑ venular permeability
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| Rubor acute inflammation | redness; arteriole vasodilation (histamine)
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| Calor acute inflammation | heat; arteriole vasodilation (histamine)
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| Tumor acute inflammation | swelling; ↑ vessel permeability (histamine)
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| Dolor acute inflammation | pain; bradykinin, PGE
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| Acute inflammation | neutrophil dominant; ↑ IgM
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| Initial vessel events | transient vasoconstriction → arteriolar vasodilation → ↑ venular permeability
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| Neutrophil rolling acute inflammation | due to selectins
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| Integrins | neutrophil adhesion molecules; C5a and leukotriene B, activate; neutrophil margination
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| CD11/CD18 | markers for integrins
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| Endothelial cell adhesion molecules | activated by IL-1 and TNF
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| ICAM | intercellular adhesion molecule
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| VCAM | vascular cell adhesion molecule Leukocyte adhesion molecule defect
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| Activation neutrophil adhesion molecules | neutrophilic leukocytosis; corticosteroids
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| Activation neutrophil adhesion molecules | neutropenia; endotoxins
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| Chemotaxis | directed movement; C5a and LTB4
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| Opsonizing agents | IgG, C3b; enhance phagocytosis
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| Neutrophils, monocytes, macrophages | receptors for IgG, C3b
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| O2-dependent MPO system | most potent microbicidal system; neutrophils, monocytes
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| ProductionofsuperoxidefromO2 | NADPH oxidase with NADPH cofactor; produces respiratory burst
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| Nitro blue tetrazolium (NBT) | test for respiratory burst
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| Superoxide dismutase | converts superoxide to peroxide
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| Myeloperoxidase | lysosomal enzyme that combines peroxide + Cl to form bleach (HOCl)
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| Microbicidal defects | chronic granulomatous disease childhood (XR), myeloperoxidase deficiency (AR)
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| Chronic granulomatous disease | absent NADPH oxidase; no respiratory burst
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| Chronic granulomatous disease | Staphylococcus aureus not killed (catalase positive)
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| Chronic granulomatous disease | Streptococcus killed (catalase negative)
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| Myeloperoxidase deficiency | AR; respiratory burst present; no bleach produced
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| Opsonization defect | Bruton's agammaglobulinemia (XR, decreased IgG)
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| Phagocytosis defect | Chediak-Higashi (see cell injury); also has defect in microtubule polymerization
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| COX inhibitors | non-steroidals (non-selective), selective COX-2 inhibitors
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| PGE2 | vasodilation, fever
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| PGI2 | vasodilator; prevent platelet aggregation
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| Nitric oxide | vasodilator; FR gas from conversion arginine to citrulline
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| IL-1 and TNF | fever, synthesis acute phase reactants in liver, leukocytosis
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| IL-6 | stimulated by IL-1; stimulates synthesis of acute phase reactants
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| Acute phase reactants | fibrinogen, ferritin, C-reactive protein
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| Bradykinin | kinin produced in conversion of factor XII to factor XI
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| Bradykinin | pain, vasodilator, vessel permeability; cough/angioedema, ACE inhibitors
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| Anaphylatoxins | C3a and C5a; directly stimulate mast cell release of histamine
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| Prostaglandin I2 | synthesized by endothelial cells; vasodilator, inhibits platelet aggregation
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| Lipoxygenase | hydroxylation of arachidonic acid
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| Zileuton | inhibits lipoxygenase
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| Zafirlukast, montelukast | block lipoxygenase receptor
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| LTC4, -D4, -E4 | bronchoconstrictors
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| TXA2 | synthesized by platelets; platelet aggregation, vasoconstriction, bronchoconstriction
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| Dipyridamole | inhibits thromboxane synthase
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| Corticosteroids | inhibits phospholipase A2, activation neutrophil adhesion molecules
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| Corticosteroids | neutrophilic leukocytosis, lymphopenia, eosinopenia
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| Fever | right shift OBC; hostile to bacterial/viral replication
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| Chronic inflammation | monocyte/macrophage; ↑ IgG; repair by fibrosis
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| Granuloma | cellular immunity; macrophages interact with TH1 class cells (memory cells)
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| Positive PPD | Langerhan's cells process PPD and interact with TH1 class cells
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| Suppurative inflammation | abscess; Staphylococcus aureus (coagulase)
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| Cellulitis | subcutaneous inflammation; Streptococcus pyogenes (hyaluronidase)
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| Pseudomembranous inflammation | toxins from Corynebacterium diphtheriae, Clostridium difficile
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| Cell cycle | key checkpoint G1 to S phase
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| TP53 and RB suppressor genes | arrests cell in G1 phase for DNA repair or apoptosis
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| BAX gene | stimulates apoptosis; activated by TP53 suppressor gene if too much DNA damage
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| Extracellular matrix | basement membrane, interstitial matrix
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| Complete restoration | cell must be capable of duplication, no damage to basement membrane
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| Scar tissue | end-product of repair by connective tissue
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| Collagen | triple helix of cross-linked α chains
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| Collagen | cross-links at points of hydroxylation (lysyl oxidase) increase tensile strength
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| Type I collagen | bones, tendons
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| Type II collagen | early wound repair
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| Type IV collagen | basement membrane
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| Type X collagen | epiphyseal plate
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| Laminin | key basement membrane glycoprotein
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| Fibronectin | key interstitial matrix glycoprotein
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| Angiogenesis in repair | basic fibroblast growth factor, vascular endothelial growth factor
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| Key event in wound repair | granulation tissue formation; fibronectin responsible
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| Granulation tissue | becomes scar tissue
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| Collagenases | zinc cofactor (metalloprotease); type III collagen replaced by type I collagen
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| Tensile strength of healed wound | 80% original strength
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| Inhibition wound healing | infection (MCC S. aureus), zinc deficiency, DM
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| Ehlers-Danlos syndrome | defects in collagen synthesis and structure; hyperelasticity
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| Scurvy | ↓ collagen tensile strength by decreasing cross-links at points of hydroxylation
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| Keloid | excessive type III collagen; common in blacks
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| Pyogenic granuloma | exuberant granulation tissue; bleeds when touched
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| Healing by primary intention | clean wound; appose wound margins with suture
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| Healing by secondary intention | infected wound; leave wound open; myofibroblasts important
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| Liver injury | regenerative nodules; abnormal cytoarchitecture
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| Lung injury | type II pneumocyte repair cell
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| CNS injury | astrocyte and microglial cell repair cells; gliosis
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| WBC alterations in acute inflammation | neutrophilic leukocytosis, left shift, toxic granulation
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| Erythrocyte sedimentation rate | increased fibrinogen enhances rouleaux
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| C-reactive protein | indicator of acute inflammation and inflammatory atheromatous plaque
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| Polyclonal gammopathy | diffuse ↑ of γ-globulins; ↑ IgG; chronic inflammation
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| Total body water | ECF (plasma, interstitial fluid) + ICF (cytosol)
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| Osmosis | H20 shift between ECF and ICF; controlled by serum Na+ and glucose
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| Edema | increased fluid in interstitial space or body cavities; transudate, exudate, lymph
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| Transudate | protein and cell-poor fluid in interstitial space/body cavity; alteration Starling's forces
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| Starling's forces | oncotic pressure (albumin) keeps fluid in vessels, hydrostatic pressure pushes fluid out
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| Pitting edema | decreased oncotic pressure and/or increased hydrostatic pressure
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| ↑ Hydrostatic pressure | pulmonary edema in LHF; pitting edema of legs in RHF; portal hypertension
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| Renal retention sodium and water | ↑ hydrostatic pressure and ↓ oncotic pressure
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| Causes of renal retention of sodium/water | ↓ cardiac output (activation RAA system), primary renal disease
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| ↓ Oncotic pressure (hypoalbuminemia) | kwashiorkor; nephrotic syndrome; cirrhosis
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| Ascites in cirrhosis | ↓ oncotic pressure, ↑ hydrostatic pressure
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| Exudate | protein and cell rich (pus); acute inflammation with ↑ vessel permeability
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| Lymphedema | radical mastectomy; filariasis; inflammatory carcinoma (lymphatics plugged by tumor)
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| Thrombus | endothelial injury, stasis, hypercoagulability
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| Venous thrombus | fibrin clot with entrapped RBCs, WBCs, platelets; deep veins below knee (stasis)
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| Heparin/warfarin | anticoagulants that prevent venous clot formation
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| Arterial thrombus | endothelial injury; platelets held together by fibrin
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| Aspirin | prevents platelet thrombus in arteries
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| Pulmonary thromboembolism | femoral vein site of origin
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| Systemic thromboembolism | majority from left heart
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| Fat embolus | long bone fractures; delayed symptoms (48 hrs); thrombocytopenia, hypoxemia
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| Amniotic fluid embolism | DIC; lanugo hair in maternal pulmonary arteries
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| Diving | 1 atmosphere pressure increase with 33 foot descent into water; N2 gas dissolved in tissue
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| Decompression sickness | release of N2 gas from tissue with rapid ascent; ischemic damage
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| Dyspnea, chest pain underwater | pulmonary embolus
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| Dyspnea, chest pain rising to surface | spontaneous pneumothorax
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| Hypovolemic shock (blood loss) | ↓ CO and LVEDP; ↑ PVR
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| Cardiogenic shock | ↓ CO; ↑ LVEDP and PVR
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| Septic shock | ↑ CO (↑ venous return); ↓ PVR (vasodilation)
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| Kidneys | most susceptible organ in shock; straight portion proximal tubule most susceptible
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| Shock complications | ischemic ATN, multiorgan failure, ↑ AG metabolic acidosis
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| Tumors | parenchyma neoplastic component
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| Benign tumors | epithelial (e.g., adenoma) or connective tissue (e.g., lipoma, leiomyoma)
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| Carcinoma | epithelial origin; squamous cell carcinoma, adenocarcinoma, transitional cell carcinoma
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| Basal cell carcinoma | invades but does not metastasize
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| Squamous cell carcinoma | lower lip, oral pharynx, larynx, lung, esophagus, skin, cervix
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| Adenocarcinoma | distal esophagus → colon, kidney, liver, pancreas, prostate, breast, lung, endometrium
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| Transitional cell carcinoma | renal pelvis, ureter, bladder
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| Sarcoma | malignancy of connective tissue origin; e.g., osteogenic sarcoma (bone)
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| Liposarcoma | MC sarcoma in adults
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| Embryonal rhabdomyosarcoma | MC sarcoma in children
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| Teratoma | ectoderm, endoderm, mesoderm derivatives; bone/teeth visible on x-ray
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| Hamartoma | normal tissue, normal site; bronchial hamartoma, Peutz Jeghers polyp
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| Choristoma | normal tissue aberrant tissue location; pancreatic tissue stomach wall
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| Mixed tumor | different morphologic patterns, same germ cell layer; pleomorphic adenoma parotid
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| Leukemia | malignancy of stem cells in bone marrow
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| Lymphoma | malignancy of lymph nodes
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| Extranodal lymphoma sites | stomach (MC), Peyer's patches
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| Malignant tumors | invade and metastasize; benign tumors do not
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| Upregulate telomerase | increases telomere length; found in all neoplastic cells
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| Monoclonality | key finding in neoplastic vs. normal cells
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| E-Cadherin | intercellular adhesion; lose adhesion in malignant cells
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| Malignant cells | receptors for laminin (basement membrane), fibronectin (ECM)
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| Invasion enzyme | type IV collagenase (basement membrane)
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| Angiogenesis | basic fibroblast growth factor, vascular endothelium growth factor
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| Metastasis | lymphatic, hematogenous, seeding; often more common than primary cancer
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| Carcinoma | lymph node -> hematogenous
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| Vessel invading carcinomas | renal cell carcinoma (renal vein, vena cava), hepatocellular carcinoma
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| Sarcoma | hematogenous
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| Seeding | ovarian cancer, periphery lung, CNS via spinal fluid
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| Sites where metastasis more common primary cancer | lung, bone, brain, liver, adrenal
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| Sites where primary cancer more common than metastasis | GI tract, kidney, urogenital
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| Bone metastasis | osteoblastic (radiodense); osteolytic (radiolucent)
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| Bone sites metastasis | vertebra MC (Batson venous plexus)
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| Osteoblastic metastasis | prostate cancer; increased serum AP, hypercalcemia
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| Osteolytic metastasis | breast cancer
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| EM neurosecretory granules | carcinoid tumors, small cell carcinoma, neuroblastoma
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| EM thin and thick myofilaments | rhabdomyosarcoma
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| EM Birbeck granules | histocytic neoplasms (Langerhan's histiocytosis)
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| Primary prevention | stop smoking; sun screen; high fiber diet
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| Cancers in children | leukemia (MC), CNS tumors, Burkitt's, Ewing's, neuroblastoma
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| Cancer vaccine | hepatitis B vaccine; prevents hepatocellular carcinoma
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| Cancer incidence men | prostate → lung → colorectal
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| Cancer incidence women | breast → lung → colorectal
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| Cancer mortality men | lung → prostate → colorectal
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| Cancer mortality women | lung → breast → colorectal
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| Gynecologic cancers | endometrium → ovary → cervix
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| Cervical Pap smear | decreased incidence of cervical cancer; detects cervical dysplasia
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| Malignant melanoma | fastest increasing in world
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| Southeast China | nasopharyngeal carcinoma (EBV)
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|
||||
| Southeast Asia | hepatocellular carcinoma (HBV + aflatoxin)
🗑
|
||||
| Japan | stomach cancer
🗑
|
||||
| Africa | Burkitt's lymphoma, Kaposi sarcoma (HHV-8)
🗑
|
||||
| Squamous dysplasia oropharynx, larynx, bronchus, cervix | risk for squamous cell carcinoma (SCC)
🗑
|
||||
| Chronic irritation sinus orifices, third degree burn scars | risk for SCC
🗑
|
||||
| Actinic (solar) keratosis | risk factor for SCC
🗑
|
||||
| Glandular metaplasia of esophagus (Barrett's) | risk factor for adenocarcinoma
🗑
|
||||
| Endometrial hyperplasia | risk factor for adenocarcinoma
🗑
|
||||
| Glandular (intestinal) metaplasia of stomach (Helicobacter) | risk factor for adenocarcinoma
🗑
|
||||
| Chronic ulcerative colitis | risk factor for adenocarcinoma
🗑
|
||||
| Villous adenoma of rectum | risk factor for adenocarcinoma
🗑
|
||||
| Tubular adenoma of colon | risk factor for adenocarcinoma
🗑
|
||||
| Scar tissue in lung | risk factor for adenocarcinoma
🗑
|
||||
| Regenerative nodules in cirrhosis | risk factor for hepatocellular carcinoma
🗑
|
||||
| Complete hydatidiform mole | risk factor for choriocarcinoma
🗑
|
||||
| Dysplastic mole | MC risk factor for malignant melanoma
🗑
|
||||
| UVB light | MC risk factor for BCC, SCC, melanoma
🗑
|
||||
| HHV-8 | MC risk factor for Kaposi's sarcoma
🗑
|
||||
| EBV | MC risk factor for nasopharyngeal carcinoma
🗑
|
||||
| Polycyclic hydrocarbons | MC risk factor for larynx (SCC), lung cancers
🗑
|
||||
| Asbestos | MC risk factor for mesothelioma
🗑
|
||||
| Polycyclic hydrocarbons | MC risk factor for oral cavity, mid-esophagus SCC
🗑
|
||||
| Barrett's esophagus | MC risk factor for distal esophagus adenocarcinoma
🗑
|
||||
| H. pylori | MC risk factor for stomach adenocarcinoma and lymphoma
🗑
|
||||
| Tubular adenoma, villous adenoma | MC risk factors for colon adenocarcinoma
🗑
|
||||
| HBV and HCV | MC risk factors for hepatocellular carcinoma
🗑
|
||||
| Vinyl chloride | MC risk factor for liver angiosarcoma
🗑
|
||||
| Gallstones, porcelain gallbladder | MC risk factor for gallbladder adenocarcinoma
🗑
|
||||
| Polycyclic hydrocarbons | MC risk factor for pancreas adenocarcinoma
🗑
|
||||
| Polycyclic hydrocarbons | MC risk factor for renal cell carcinoma
🗑
|
||||
| Polycyclic hydrocarbons | MC risk factor for urinary bladder
🗑
|
||||
| HPV + lack of circumcision | MC risk factor for penis SCC
🗑
|
||||
| Age | MC risk factor for prostate adenocarcinoma
🗑
|
||||
| Cryptorchid testis | MC risk factor for seminoma
🗑
|
||||
| Age >50 with excess estrogen exposure | MC risk factor for breast and endometrial carcinoma
🗑
|
||||
| HPV 16/18 | MC risk factor for vulva, vagina, cervix SCC
🗑
|
||||
| DES | MC risk factor for vagina/cervix clear cell carcinoma
🗑
|
||||
| Nulliparity | MC risk factor for surface derived ovarian cancer
🗑
|
||||
| Complete mole | MC risk factor for choriocarcinoma
🗑
|
||||
| Turner syndrome (XO) | MC risk factor for dysgerminoma of ovary
🗑
|
||||
| Turner syndrome (XO/XY) | gonadoblastoma of ovary
🗑
|
||||
| Ionizing radiation | MC risk factor for papillary cancer of thyroid
🗑
|
||||
| Family history (MEN IIa/IIb) | MC risk factor for medullary carcinoma thyroid
🗑
|
||||
| Hashimoto's thyroiditis | MC risk factor for malignant lymphoma thyroid
🗑
|
||||
| Ionizing radiation | MC risk factor for osteogenic sarcoma
🗑
|
||||
| EBV | MC risk factor for primary CNS lymphoma in AIDS and Burkitt's lymphoma
🗑
|
||||
| Ionizing radiation | MC risk factor for acute/chronic myelogenous leukemia
🗑
|
||||
| EBV | MC risk factor for Burkitt's lymphoma
🗑
|
||||
| HTLV-1 | MC risk factor for T cell leukemia/lymphoma
🗑
|
||||
| Bacterial causes of cancer | H. pylori (stomach adenocarcinoma and lymphoma)
🗑
|
||||
| Parasitic causes of cancer | S. hematobium (SCC bladder), C. sinensis (cholangiocarcinoma)
🗑
|
||||
| Carcinogenesis | mutations involving regulatory genes
🗑
|
||||
| Regulatory genes | proto-oncogenes, suppressor genes, anti-apoptosis genes
🗑
|
||||
| Types mutations | point mutation MC, translocation, amplification (↑ copies), overexpression (↑ activity)
🗑
|
||||
| Translocations | Burkitt's t(8;14); CML t(9;22); follicular lymphoma t(14;18); APL leukemia t(15;17)
🗑
|
||||
| Key cancer genes | TP53 suppressor gene, RAS protooncogene
🗑
|
||||
| Point mutation | inactivates suppressor genes (e.g., TP53), activates proto-oncogenes (e.g., RAS)
🗑
|
||||
| Amplification | activates ERB-B2
🗑
|
||||
| Overexpression | enhances activity of BCL-2
🗑
|
||||
| S/S POC | function-growth factor synthesis; mutation-overexpression
🗑
|
||||
| ERB-B2 POC | function growth factor receptor; activation bad prognostic sign for breast carcinoma
🗑
|
||||
| RAS POC | function-GTP signal transduction; point mutation; 30% of all human cancer
🗑
|
||||
| ABL POC | function-non-receptor tyrosine kinase activity; translocation (9;22) causing CML
🗑
|
||||
| MYC POC | function nuclear transcription; translocation (8; 14) causing Burkitt's lymphoma
🗑
|
||||
| Inactivation suppressor genes | majority are point mutations; loss of suppression
🗑
|
||||
| Sporadic retinoblastoma | two hit theory; two separate point mutations of RB suppressor gene on
🗑
|
||||
| AD retinoblastoma | one hit theory; one already inactivated in germ cells
🗑
|
||||
| TP53 suppressor gene functions | G,-S phase inhibition, DNA repair, activation BAX apoptosis gene
🗑
|
||||
| Inactivation TP 53 suppressor gene | inactivation causes majority of human cancers
🗑
|
||||
| RB suppressor gene function | G1-S phase inhibition
🗑
|
||||
| Inactivation RB suppressor gene | retinoblastoma, osteogenic sarcoma
🗑
|
||||
| APC suppressor gene function | prevents nuclear transcription by catenin
🗑
|
||||
| Inactivation APC suppressor gene | familial polyposis (FAP)
🗑
|
||||
| BRCA1/2 suppressor genes function | DNA repair inactivation
🗑
|
||||
| BRCA 1/2 suppressor genes | breast, ovarian cancers
🗑
|
||||
| BCL-2 function | anti apoptosis gene (keeps cytochrome c in mitochondria)
🗑
|
||||
| BCL-2 gene | t(14;18) translocation of heavy chain causes overexpression; follicular B cell lymphoma [think t(14;18) = t(l4;lB) for foLLicular B]
🗑
|
||||
| Xeroderma pigmentosum | AR; defect in DNA repair enzymes; ↑ risk for UVB light cancers
🗑
|
||||
| Hereditary non-polyposis syndrome (HNPCC) | AD; inactivation DNA mismatch genes; colorectal cancer
🗑
|
||||
| Chromosome instability syndromes | AR; susceptibility to DNA damage; leukemias, lymphomas
🗑
|
||||
| Examples chromosome instability | Bloom syndrome, ataxia telangiectasia, Wiskott-Aldrich syndrome
🗑
|
||||
| Carcinogens | chemicals (MC), viruses, radiation, H. pylori, physical (squamous cancer in bum scar)
🗑
|
||||
| Polycyclic hydrocarbons | key chemical carcinogen (cigarette smoke)
🗑
|
||||
| Aflatoxins | produced from Aspergillus; hepatocellular carcinoma
🗑
|
||||
| Asbestos | lung cancer, mesothelioma
🗑
|
||||
| Thorium dioxide | hepatocellular carcinoma, cholangiocarcinoma
🗑
|
||||
| Aniline dyes | transitional cell carcinoma
🗑
|
||||
| Vinyl chloride | angiosarcoma of liver
🗑
|
||||
| Benzene | leukemia
🗑
|
||||
| Cyclophosphamide | transitional cell carcinoma of bladder
🗑
|
||||
| EBV | Burkitt's; CNS lymphoma (AIDS); Hodgkin's mixed cellularity; nasopharyngeal carcinoma
🗑
|
||||
| HBV and HCV | hepatocellular carcinoma
🗑
|
||||
| HPV | cervical, penis, and anorectal squamous cancers
🗑
|
||||
| HHV-8 | Kaposi sarcoma
🗑
|
||||
| UVB cancers | basal cell carcinoma, squamous cell carcinoma, malignant melanoma
🗑
|
||||
| Key host defense | cytotoxic CD8 T cells (type IV hypersensitivity)
🗑
|
||||
| Cachexia | due to tumor necrosis factor-α
🗑
|
||||
| Most common anemia | anemia chronic disease
🗑
|
||||
| Most common coagulopathy | hypercoagulability
🗑
|
||||
| Most common COD in cancer | gram negative infection
🗑
|
||||
| Clubbing | possible marker for lung cancer
🗑
|
||||
| Non-bacterial thrombotic endocarditis mitral valve | possible marker for pancreatic cancer
🗑
|
||||
| TNM staging | metastasis more important than nodal involvement
🗑
|
||||
| AFP | hepatocellular carcinoma, yolk sac tumors
🗑
|
||||
| PSA | prostate cancer
🗑
|
||||
| CEA | recurrence colorectal cancer
🗑
|
||||
| BJ (Bence-Jones) protein | multiple myeloma
🗑
|
||||
| β-human chorionic gonadotropin | choriocarcinoma
🗑
|
||||
| Calcitonin | medullary carcinoma thyroid; hypocalcemia
🗑
|
||||
| Small cell carcinoma lung | ADH (hyponatremia), ACTH (ectopic Cushing's)
🗑
|
||||
| Renal cell carcinoma | EPO (polycythemia), PTH-related peptide (hypercalcemia)
🗑
|
||||
| Hepatocellular carcinoma | EPO (polycythemia), insulin-like factor (hypoglycemia)
🗑
|
||||
| Medullary carcinoma of thyroid | calcitonin (hypocalcemia), ACTH (ectopic Cushing's)
🗑
|
||||
| Squamous cell carcinoma of lung | PTH-related peptide (hypercalcemia)
🗑
|
||||
| Erythropoietin | synthesized in peritubular capillaries
🗑
|
||||
| Reticulocyte count | measure of effective erythropoiesis; correct for degree of anemia
🗑
|
||||
| Extramedullary hematopoiesis | hematopoiesis outside bone marrow (e.g., spleen)
🗑
|
||||
| Newborn physiologic anemia | drop in Hb due to replacement of HbF RBCs with HbA
🗑
|
||||
| Pregnancy | Hb and Hct decreased; greater increase in plasma volume than RBC mass
🗑
|
||||
| Anemia | normal O2 saturation and arterial PO2
🗑
|
||||
| MCV | average volume of RBCs; useful for anemia classification
🗑
|
||||
| MCHC | average Hb concentration in RBCs
🗑
|
||||
| MCHC | ↓ in microcytic anemias; ↑ in spherocytosis
🗑
|
||||
| Thalassemias | ↓ MCV, ↑ RBC count
🗑
|
||||
| RDW | RBC size variation; ↑ iron deficiency; normal in other microcytic anemias
🗑
|
||||
| Mature RBC | anaerobic glycolysis; no mitochondria or HLA antigens
🗑
|
||||
| Total iron binding capacity | ↑ iron deficiency; ↓ anemia chronic disease, sideroblastic anemia
🗑
|
||||
| % Saturation | ↓ iron deficiency, anemia chronic disease; ↑ sideroblastic anemia
🗑
|
||||
| Serum ferritin | ↓ iron deficiency; ↑ anemia chronic disease, sideroblastic anemia; normal thalassemia
🗑
|
||||
| Microcytic anemias | iron deficiency MC, anemic chronic disease, thalassemia, sideroblastic anemia
🗑
|
||||
| Iron deficiency child | MCC Meckel's diverticulum
🗑
|
||||
| Iron deficiency woman < 50 | MCC menorrhagia
🗑
|
||||
| Iron deficiency man < 50 | MCC peptic ulcer disease
🗑
|
||||
| Iron deficiency men/woman > 50 | MCC colon cancer
🗑
|
||||
| Stages iron deficiency | ↓ ferritin; ↓ Fe and % saturation, ↑ TIBC; normocytic then microcytic anemia
🗑
|
||||
| Anemia chronic disease | MC anemia in malignancy and alcoholics
🗑
|
||||
| α-Thalassemia trait | AR; two α-globin gene deletions; normal Hb electrophoresis
🗑
|
||||
| HbH disease | three α-globin gene deletions; hemolytic anemia; four β-globin chains
🗑
|
||||
| Hb Bart's disease | four α-globin gene deletions; four γ-globin chains
🗑
|
||||
| β-Thalassemia minor | AR; DNA splicing defect; ↑ HbA2 and F; ↓ HbA
🗑
|
||||
| β-Thalassemia major | nonsense mutation with stop codon; hemolytic anemia; ↑↑ HbF, ↑ HbA2
🗑
|
||||
| Sideroblastic anemia | defect in mitochondrial heme synthesis producing ringed sideroblasts
🗑
|
||||
| Causes sideroblastic anemia | alcohol, pyridoxine deficiency (isoniazid Rx of TB), Pb poisoning
🗑
|
||||
| Pb poisoning | inhibition ferrochelatase, d-aminolevulinic acid dehydrase, ribonuclease
🗑
|
||||
| S/S Pb poisoning children | growth retardation; Pb in epiphyses (lead lines); abdominal colic; encephalopathy
🗑
|
||||
| S/S Pb poisoning adult | peripheral neuropathy; proximal renal tubule damage (Fanconi's syndrome)
🗑
|
||||
| Lab Pb poisoning | coarse basophilic stippling RBCs; ↓ MCV; ↑ blood Pb; ↑ d-aminolevulinic acid
🗑
|
||||
| Vitamin B12 | animal products; requires intrinsic factor for reabsorption in terminal ileum
🗑
|
||||
| Vitamin B12 | transfers methyl group to homocysteine
🗑
|
||||
| R factor | binds with B12 in mouth, removed by pancreatic enzymes in small intestine
🗑
|
||||
| Vitamin B12 | involved in propionate metabolism; end-product succinyl CoA
🗑
|
||||
| Causes B12 deficiency | vegan, pernicious anemia MC, fish tapeworm, pancreatitis, bacterial overgrowth, Crohn's disease
🗑
|
||||
| Pernicious anemia | autoimmune destruction parietal cells; chronic gastritis body/fundus; achlorhydria; ↑ gastrin
🗑
|
||||
| Causes folate deficiency | alcohol MCC, poor diet, drugs, malabsorption, pregnancy, goat milk
🗑
|
||||
| Drugs and folate deficiency | alcohol, OC, phenytoin, methotrexate, trimethoprim, 5-fluorouracil
🗑
|
||||
| Intestinal conjugase in folate metabolism | inhibited by phenytoin
🗑
|
||||
| Jejunal uptake of monoglutamate form of folate | inhibited by alcohol and OC
🗑
|
||||
| Dihydrofolate reductase | inhibited by methotrexate, trimethoprim
🗑
|
||||
| Thymidylate synthetase | inhibited by 5-fluorouracil
🗑
|
||||
| Folate deficiency | MCC of increased serum homocysteine
🗑
|
||||
| Lab in B12/folate deficiency | pancytopenia; hypersegmented neutrophils; ↑ homocysteine
🗑
|
||||
| Lab findings unique to B12 deficiency | ↑ gastrin (pernicious anemia), ↑ methylmalonic acid
🗑
|
||||
| B12 reabsorbed absorbed after administration of intrinsic factor | PA
🗑
|
||||
| B12 reabsorbed absorbed after administration of antibiotics | bacterial overgrowth
🗑
|
||||
| B12 reabsorbed absorbed after administration of pancreatic extract | chronic pancreatitis
🗑
|
||||
| Acute blood loss | initially normal Hb and Hct; 0.9% saline uncovers RBC deficit
🗑
|
||||
| Aplastic anemia | drugs (e.g., phenylbutazone); infection (e.g., parvovirus); benzene
🗑
|
||||
| Lab findings aplastic anemia | pancytopenia; hypocellular bone marrow
🗑
|
||||
| Anemia in renal disease | normocytic; decreased EPO
🗑
|
||||
| Extravascular hemolysis | macrophage phagocytosis of RBCs; ↑ unconjugated bilirubin and urine UBG
🗑
|
||||
| Intravascular hemolysis | ↓ serum haptoglobin; hemoglobinuria; hemosiderinuria
🗑
|
||||
| Congenital spherocytosis | AD; defect in spectrin; extravascular hemolysis; splenomegaly
🗑
|
||||
| Blood findings in spherocytosis | normocytic anemia; dense RBCs, ↑ MCHC, ↑ osmotic fragility
🗑
|
||||
| PNH | missing decay accelerating factor; complement destruction RBCs, neutrophils, platelets
🗑
|
||||
| S/S PNH | pancytopenia; hemoglobinuria; positive sugar water (Ham's) test and acidified serum test
🗑
|
||||
| HbSS | AR; missense mutation (valine for glutamic acid 6th positive β-globin chain)
🗑
|
||||
| Causes of sickling | ↑ deoxyhemoglobin (hypoxemia, acidosis); HbS > 60%
🗑
|
||||
| HbF | inhibits sickling; hydroxyurea ↑ HbF
🗑
|
||||
| Pathophysiology HbSS | vasoocclusive crises, hemolytic anemia (extravascular)
🗑
|
||||
| HbSS children | dactylitis (6-9 months); Streptococcus pneumoniae sepsis (dysfunctional spleen)
🗑
|
||||
| HbSS osteomyelitis | Salmonella paratyphi
🗑
|
||||
| HbSS complications | aplastic crisis (parvovirus B-19), acute chest syndrome, autosplenectomy, calcium bilirubinate gallstones, priapism, aseptic necrosis
🗑
|
||||
| HbAS | microhematuria from sickling in renal medulla; renal papillary necrosis
🗑
|
||||
| Hb electrophoresis | HbAS-HbA 55-60%, HbS 40-45%; HbSS-HbS 90-95%, HbF 5-10%
🗑
|
||||
| Blood findings in HbSS | sickle cells; target cells; Howell-Jolly bodies (nuclear remnants)
🗑
|
||||
| G6PD deficiency | XR; oxidant damage (peroxide) to Hb (e.g., primaquine; dapsone; fava beans)
🗑
|
||||
| Blood findings G6PD deficiency | Heinz bodies (denatured Hb; special stain); bite cells
🗑
|
||||
| Pyruvate kinase deficiency | ↓ ATP; RBCs dehydrated; ↑ 2,3-BPG (right-shifted OBC)
🗑
|
||||
| Warm type AIHA | IgG; extravascular hemolysis; e.g., SLE, drugs
🗑
|
||||
| Cold type AIHA | IgM intravascular hemolysis; e.g., CLL, Mycoplasma
🗑
|
||||
| Penicillin | IgG antibody against penicillin attached to RBC (type II hypersensitivity)
🗑
|
||||
| Methyldopa | drug alters Rh antigens; IgG antibody against Rh antigens (type II hypersensitivity)
🗑
|
||||
| Quinidine | drug-IgM IC; intravascular hemolysis; type III hypersensitivity
🗑
|
||||
| Lab findings AIHA | positive direct Coombs'; spherocytes
🗑
|
||||
| Micro-macroangiopathic hemolysis | mechanical damage causing intravascular hemolysis
🗑
|
||||
| Causes of micro/macro hemolysis | aortic stenosis (MCC), DIC, TIP, HUS
🗑
|
||||
| Peripheral blood findings micro/macro hemolysis | schistocytes; iron deficiency from hemoglobinuria
🗑
|
||||
| Malaria | intravascular hemolysis correlates with fever; falciparum-ring forms and gametocytes
🗑
|
||||
| Leukemoid reaction | exaggerated WBC response to infection; usually due to infection
🗑
|
||||
| Leukoerythroblastic reaction | marrow infiltrative disease peripheralizes myeloblasts/nucleated RBCs
🗑
|
||||
| Causes of leukoerythroblastic reaction | bone metastasis MCC, myelofibrosis
🗑
|
||||
| Eosinophilia | type I hypersensitivity (e.g., penicillin reaction); invasive helminthic infection
🗑
|
||||
| Helminthes not producing eosinophilia | pinworms, adult worms in ascariasis
🗑
|
||||
| Atypical lymphocytes | mononucleosis; CMV; toxoplasmosis; viral hepatitis; phenytoin
🗑
|
||||
| Mononucleosis | due to EBV; EBV attaches to CD21 receptors on B cells
🗑
|
||||
| Clinical findings mono | exudative tonsillitis, generalized lymphadenopathy, hepatosplenomegaly
🗑
|
||||
| Lab findings mono | atypical lymphocytosis; IgM heterophile antibodies against horse RBCs
🗑
|
||||
| Lymphopenia | T cell deficiencies (HIV); combined B/T deficiency (adenine deaminase deficiency)
🗑
|
||||
| Lymphocytosis | viral infections, whooping cough
🗑
|
||||
| Corticosteroids | lymphopenia, eosinopenia, neutrophilia
🗑
|
||||
| Chronic MPD | neoplastic stem cell disorder; splenomegaly; marrow fibrosis; risk for leukemia
🗑
|
||||
| Examples of MPD | polycythemia vera, myelofibrosis and myeloid metaplasia
🗑
|
||||
| Relative polycythemia | ↓ plasma volume; ↑ RBC count; normal RBC mass
🗑
|
||||
| Absolute polycythemia | ↓ RBC count and RBC mass
🗑
|
||||
| Appropriate polycythemia | hypoxic stimulus for EPO to generate RBCs
🗑
|
||||
| Causes of appropriate absolute polycythemia | lung disease, cyanotic heart disease, high altitude
🗑
|
||||
| Appropriate absolute polycythemia | normal plasma volume; ↑ RBC mass; ↓ SaO2; ↑ EPO
🗑
|
||||
| Inappropriate absolute polycythemia | no hypoxic stimulus for EPO
🗑
|
||||
| Causes of inappropriate polycythemia | ectopic secretion EPO, polycythemia vera
🗑
|
||||
| Polycythemia vera | ↑ plasma volume and RBC mass; normal SaO2; ↓ EPO
🗑
|
||||
| Ectopic EPO (renal cell carcinoma) | normal plasma volume; ↑ RBC mass; normal SaO2; ↑ EPO
🗑
|
||||
| Myelofibrosis myeloid metaplasia | marrow fibrosis; extramedullary hematopoiesis; splenomegaly
🗑
|
||||
| Lab findings in myelofibrosis | tear drop RBCs; dry bone marrow aspirate (marrow fibrosis)
🗑
|
||||
| Essential thrombocythemia | MPO with increase in abnormal appearing platelets
🗑
|
||||
| Myelodysplastic syndrome | severe anemia in elderly; 30% develop leukemia; ringed sideroblasts
🗑
|
||||
| Benzene | aplastic anemia; acute leukemia
🗑
|
||||
| Leukemia by age | ALL, newborn-14; AML, 15-60; CML, 40-60; CLL, >60
🗑
|
||||
| Acute vs. chronic leukemia | acute, blasts >30% in bone marrow; chronic, blasts <10% in bone marrow
🗑
|
||||
| AML | Auer rods in myeloblasts
🗑
|
||||
| Acute promyelocytic leukemia | t(15;17); defect in retinoic acid; Rx retinoic acid (↑ maturation); DIC
🗑
|
||||
| Acute monocytic leukemia | gum infiltration
🗑
|
||||
| CML | t(9;22) of ABL POC; Philadelphia chromosome 22; ↓ alkaline phosphatase score
🗑
|
||||
| ALL | early pre-B (80%); CALLA (CD10) and TdT positive; CNS and testicle involvement
🗑
|
||||
| ALL | t(12;21) offers good prognosis
🗑
|
||||
| CLL | B cell neoplasm; ↓ γ-globulins; MCC generalized lymphadenopathy patients> 60-yrs-old
🗑
|
||||
| Adult T cell leukemia | HTLV-1; CD4 T cells; skin infiltration; lytic bone lesions with hypercalcemia
🗑
|
||||
| Hairy cell leukemia | positive TRAP stain; splenomegaly; Rx with purine nucleosides; (+)CD11c
🗑
|
||||
| Nodal sites | germinal follicles, B cells; paracortex, T cells; sinuses, histiocytes
🗑
|
||||
| Testicular cancer | metastasizes to para-aortic nodes
🗑
|
||||
| Stomach cancer | metastasizes to left supraclavicular nodes (Virchow node)
🗑
|
||||
| Phenytoin | atypical lymphocytosis
🗑
|
||||
| Cat scratch disease | Bartonella henselae; granulomatous microabscesses
🗑
|
||||
| Follicular B-cell lymphoma | t(14;18); overexpression of BCL-2 anti-apoptosis gene
🗑
|
||||
| Burkitt lymphoma | t(8;14); EBV association; common childhood NHL; "starry sky" appearance
🗑
|
||||
| Extra nodal lymphomas | risk factors H. pylori (stomach); Sjogren's syndrome
🗑
|
||||
| Mycosis fungoides | CD4 T cell neoplasm; skin lesions with Pautrier's microabscesses
🗑
|
||||
| Sezary syndrome | leukemic phase of mycosis fungoides
🗑
|
||||
| Polyclonal gammopathy | sign of chronic inflammation
🗑
|
||||
| Monoclonal gammopathy | M component (spike); sign of plasma cell disorder
🗑
|
||||
| Confirmatory tests | serum and urine immunoelectrophoresis; bone marrow aspirate
🗑
|
||||
| Bence Jones protein | light chains in urine; predictive of a malignant plasma cell disorder
🗑
|
||||
| Multiple myeloma | M spike; lytic bone lesions; pathologic fractures; hypercalcemia; renal failure
🗑
|
||||
| MGUS | MC monoclonal gammopathy; may progress to myeloma
🗑
|
||||
| Findings in MGUS | elderly patient; no BJ protein; no malignant plasma cells
🗑
|
||||
| Waldenstrom's macroglobulinemia | lymphoplasmacytic lymphoma; IgM M spike; hyperviscosity
🗑
|
||||
| Hodgkin's lymphoma | neoplastic component, Reed Stemberg (RS) cell; CD15 & CD30 positive
🗑
|
||||
| Lymphocyte predominant Hodgkin's | infrequent classic RS cells
🗑
|
||||
| Nodular sclerosing Hodgkin's | female dominant; supraclavicular nodes + anterior mediastinal nodes
🗑
|
||||
| Mixed cellularity Hodgkin's | male dominant; numerous RS cells; EBV association
🗑
|
||||
| Hodgkin's prognosis | stage of disease and type of Hodgkin's most important factors
🗑
|
||||
| Alkylating agents in Rx of Hodgkins | ↑ risk for second malignancies (leukemia; NHL)
🗑
|
||||
| Langerhan's histiocytes | CD1 positive; Birbeck granules
🗑
|
||||
| Letterer-Siwe disease | malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement
🗑
|
||||
| Hand-Christian-Christian disease | malignant; lytic skull lesions, diabetes insipidus, exophthalmos
🗑
|
||||
| Eosinophilic granuloma | benign histiocytosis; lytic bone lesions with pathologic fractures
🗑
|
||||
| Mast cells | release histamine (pruritus; swelling); metachromatic granules positive with toluidine blue
🗑
|
||||
| Urticaria pigmentosum | localized mastocytosis; skin lesions swell and itch with scratching
🗑
|
||||
| Amyloid | twisted β-sheet; apple green birefringence with Congo red
🗑
|
||||
| Primary amyloidosis | AL amyloid derived from light chains; plasma cell disorders
🗑
|
||||
| Secondary amyloidosis | AA amyloid derived from serum-associated amyloid; chronic infections
🗑
|
||||
| Alzheimer's disease | amyloid precursor protein gene product chromosome 21; amyloid-β
🗑
|
||||
| Gaucher's disease | macrophages have fibrillary appearance; deficiency glucocerebrosidase
🗑
|
||||
| Niemann Pick's disease | macrophages have soap bubble appearance; deficiency sphingomyelinase
🗑
|
||||
| Hypersplenism | splenomegaly; peripheral blood cytopenias; portal hypertension MCC
🗑
|
||||
| Splenic dysfunction | Howell Jolly bodies; susceptible to Streptococcus pneumoniae sepsis
🗑
|
||||
| Anticoagulants | tissue plasminogen activator, heparin, PGI2 ATIII, protein C/S
🗑
|
||||
| Heparin | enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)
🗑
|
||||
| Protein C/S | neutralize V and VIII
🗑
|
||||
| Procoagulants | coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)
🗑
|
||||
| Protein C and S | inactivate factors V and VIII; enhance fibrinolysis
🗑
|
||||
| von Willebrand factor | complexes with factor VIII to enhance VIII:C activity; platelet adhesion
🗑
|
||||
| Platelets | receptors for von Willebrand factor and fibrinogen; synthesize thromboxane A2
🗑
|
||||
| GpIb | platelet receptor for von Willebrand factor
🗑
|
||||
| GpIIb:IIIa | platelet receptor for fibrinogen
🗑
|
||||
| Extrinsic system factor | VII
🗑
|
||||
| Intrinsic system factors | XII, XI, IX, VIII
🗑
|
||||
| Final common pathway factors | X, V, prothrombin (II), fibrinogen (I)
🗑
|
||||
| Factor XIII | cross-links insoluble fibrin; strengthens fibrin clots
🗑
|
||||
| Vitamin K-dependent factors | prothrombin, VII, IX, X, protein C and S
🗑
|
||||
| Factors consumed in a clot | fibrinogen, prothrombin, V, VIII; fluid is called serum
🗑
|
||||
| Plasmin | cleaves fibrinogen and insoluble fibrin into degradation products
🗑
|
||||
| Bleeding time | evaluates platelet function (adhesion, release reaction, aggregation)
🗑
|
||||
| Aspirin | MCC of a prolonged bleeding time
🗑
|
||||
| Tests for vWF | ristocetin cofactor assay; vWF antigen assay; agar electrophoresis
🗑
|
||||
| PT | evaluates extrinsic pathway to fibrin clot
🗑
|
||||
| PTT | evaluates intrinsic pathway to stable fibrin clot
🗑
|
||||
| Fibrinolysis tests | fibrin(ogen) degradation products; D-dimers (cross-linked insoluble fibrin)
🗑
|
||||
| S/S platelet dysfunction | cannot form temporary plug; epistaxis; petechiae; bleeding from scratches
🗑
|
||||
| Idiopathic thrombocytopenic purpura (ITP) | children; antibodies against GpIIb:IIIa; no splenomegaly
🗑
|
||||
| Chronic autoimmune thrombocytopenic purpura | SLE; antibodies against GpIIb:IIIa receptors
🗑
|
||||
| Heparin | thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets
🗑
|
||||
| PF4 | heparin neutralizing factor
🗑
|
||||
| HIV | thrombocytopenia MC hematologic abnormality; similar to ITP
🗑
|
||||
| TTP | platelet thrombi develop in areas of endothelial damage in small vessels; consumption of platelets
🗑
|
||||
| S/S | fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits
🗑
|
||||
| Lab findings TTP | thrombocytopenia, prolonged bleeding time, normal PT and PTT
🗑
|
||||
| HUS | similar to TTP; endothelial injury from Shiga-like toxin of 0157:H7 E. coli in undercooked beef
🗑
|
||||
| S/S factor deficiency | no stable fibrin clot-late rebleeding; menorrhagia; GI bleeding; hemarthroses
🗑
|
||||
| Hemophilia A | XR; hemarthroses; prolonged PTT, ↓ factor VIII activity, normal VIII antigen
🗑
|
||||
| von Willebrand's disease | AD; platelet adhesion defect + factor VIII deficiency
🗑
|
||||
| Lab findings in VWD | ↓ vWF, VIII antigen, and VIII:C; prolonged bleeding time
🗑
|
||||
| Desmopressin acetate | Rx of choice for mild von Willebrand's disease and hemophilia A
🗑
|
||||
| Circulating anticoagulants | antibodies destroy coagulation factors
🗑
|
||||
| Lab finding in circulating anticoagulant | prolonged PT and/or PTT corrected with mixing studies
🗑
|
||||
| Vitamin K deficiency | ↓ epoxide reductase activity (↓ function vitamin K); hemorrhagic diathesis; ↑ PT
🗑
|
||||
| Causes vitamin K deficiency | antibiotics MC, newborn, malabsorption, warfarin
🗑
|
||||
| DIC | activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage
🗑
|
||||
| DIC | consumption coagulation factors by fibrin clots; patient also anticoagulated
🗑
|
||||
| Causes | septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid
🗑
|
||||
| S/S | bleeding from all scratches, holes, needle sites
🗑
|
||||
| Lab findings DIC | thrombocytopenia, ↑ PT and PTT, D-dimers (best test), anemia
🗑
|
||||
| Antiphospholipid antibodies | lupus anticoagulant and anticardiolipin antibodies; vessel thrombosis
🗑
|
||||
| Warfarin | inhibits epoxide reductase; PT best test but PTT also prolonged
🗑
|
||||
| Warfarin | full anticoagulation in 3 days when -carboxylated prothrombin disappears
🗑
|
||||
| Warfarin | ingredient in rat poison; danger to children in households with grandparents on warfarin
🗑
|
||||
| Rx warfarin over anticoagulation | intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)
🗑
|
||||
| Heparin | enhances ATIII; PTT best test but PT also prolonged
🗑
|
||||
| OC | estrogen ↑ coagulation factor synthesis and ATIII; predisposes to thrombosis
🗑
|
||||
| Factor V Leiden | MC hereditary thrombosis; resistant to degradation by protein C/S
🗑
|
||||
| ATIII deficiency | no prolongation of PTT with administration of heparin
🗑
|
||||
| Hemorrhagic skin necrosis | post-warfarin therapy in patient with heterozygote protein C deficiency
🗑
|
||||
| M cells | specialized cells that transfer foreign antigens to lymphocytes in Peyer's patches
🗑
|
||||
| Blood group O | some patients have anti-AB-IgG antibodies; increased incidence duodenal ulcers
🗑
|
||||
| Blood group A | increased incidence of gastric carcinoma
🗑
|
||||
| Newborns | do not have natural blood group antibodies at birth (e.g., anti-A-lgM)
🗑
|
||||
| Elderly | may lose natural blood group antibodies; no hemolytic reaction to mismatched blood
🗑
|
||||
| Rh antigens | inherited in autosomal codominant fashion; Rh antigens include D, C, c, E, e
🗑
|
||||
| Atypical antibodies | antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)
🗑
|
||||
| Duffy antigen | receptor for Plasmodium vivax; blacks often lack Duffy antigen
🗑
|
||||
| Antibody screen | indirect Coomb's test; detects atypical antibodies in serum
🗑
|
||||
| Cytomegalovirus | MC infection transmitted by blood transfusion; MC antibody
🗑
|
||||
| Hepatitis C | MCC of post-transfusion hepatitis
🗑
|
||||
| Major crossmatch | patient serum reacted against donor RBCs; does not guarantee RBC survival
🗑
|
||||
| Universal donor | blood group O; no antigens on the surface of RBCs
🗑
|
||||
| Universal recipient | blood group AB; no natural blood group antibodies in serum
🗑
|
||||
| Packed RBC transfusion | raises Hb by 1 gm/dL and Hct by 3%
🗑
|
||||
| Cryoprecipitate | fibrinogen and factor VIII
🗑
|
||||
| Fresh frozen plasma | replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)
🗑
|
||||
| Allergic transfusion reaction | type I IgE-mediated hypersensitivity reaction
🗑
|
||||
| Febrile transfusion reaction | recipient anti-HLA antibodies react against donor leukocytes
🗑
|
||||
| Intravascular HTR | transfusion of ABO incompatible blood (e.g., A person receives B blood)
🗑
|
||||
| Extravascular HTR | antibody attaches to donor RBCs; macrophage phagocytosis and hemolysis
🗑
|
||||
| Positive direct Coomb's test | present in both types of hemolytic transfusion reactions
🗑
|
||||
| S/S | jaundice, no increase in Hb, hemoglobinuria
🗑
|
||||
| ABO HDN | mother O and baby A or B; transplacental passage of maternal anti-AB-IgG
🗑
|
||||
| ABO HDN | positive direct Coomb's test; spherocytes; MCC unconjugated hyperbilirubinemia first 24 hrs
🗑
|
||||
| Rh HDN | mother Rh (D antigen) negative and fetus Rh (O antigen) positive
🗑
|
||||
| Rh HDN | no hemolysis in first Rh incompatible pregnancy
🗑
|
||||
| Rh HDN | maternal anti-D crosses placenta; potential for hydrops fetalis; high risk for kernicterus
🗑
|
||||
| Rh immune globulin | anti-D; coats D antigen site on fetal RBCs in maternal circulation
🗑
|
||||
| Rh HDN lab | positive direct Coomb's; severe anemia and hyperbilirubinemia
🗑
|
||||
| ABO HDN | protects mother from Rh sensitization (development of anti-D antibodies)
🗑
|
||||
| O Rh negative mother with A Rh positive baby | A+ cells destroyed by mothers anti A-lgM
🗑
|
||||
| Blue fluorescent light | converts unconjugated bilirubin in skin into harmless water soluble dipyrrole
🗑
|
||||
| MV auscultation | apex
🗑
|
||||
| TV auscultation | left parasternal border
🗑
|
||||
| AV auscultation | right 2nd intercostal space
🗑
|
||||
| PV auscultation | left 2nd intercostal space
🗑
|
||||
| S1 | closure MV and TV
🗑
|
||||
| S2 | closure AV and PV
🗑
|
||||
| Inspiration | split in A2 and P2; due to increased blood in right side of heart
🗑
|
||||
| S3 | abnormal; due to blood entering volume overloaded ventricle in early diastole
🗑
|
||||
| Causes S3 | valve regurgitation; congestive heart failure
🗑
|
||||
| S4 | abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole
🗑
|
||||
| Causes S4 | volume overloaded ventricle, hypertrophy
🗑
|
||||
| Murmurs | stretching valve ring or damage to valve
🗑
|
||||
| Inspiration | increases right sided abnormal heart sounds and murmurs
🗑
|
||||
| Expiration | increases left sided abnormal heart sounds and murmurs
🗑
|
||||
| Stenosis murmurs | problem in opening valve
🗑
|
||||
| Regurgitation murmurs | problem in closing valve
🗑
|
||||
| Valves opening in systole | AV and PV
🗑
|
||||
| Valves opening in diastole | MV and TV
🗑
|
||||
| Valves closing in systole | MV and TV
🗑
|
||||
| Valves closing in diastole | AV and PV
🗑
|
||||
| LDL | primary vehicle for carrying cholesterol
🗑
|
||||
| VLDL | primary vehicle for carrying liver-synthesized triglyceride
🗑
|
||||
| Familial hypercholesterolemia (type II) | AD; deficiency of LDL receptors; ↑ LDL
🗑
|
||||
| Type III hyperlipoproteinemia | deficiency apo E; ↑ remnants (chylomicron, intermediate density)
🗑
|
||||
| Type IV hyperlipoproteinemia | ↑ VLDL; alcoholics
🗑
|
||||
| Apo B deficiency | deficiency apo B48 (chylomicrons) and B100 (VLDL); ↓ CH and TG
🗑
|
||||
| Clinical findings in apo B deficiency | malabsorption; hemolytic anemia
🗑
|
||||
| Atherosclerosis | reaction to injury of endothelial cells
🗑
|
||||
| Risk factors | smoking, ↑ LDL, ↑ homocysteine, Chlamydia pneumoniae infection
🗑
|
||||
| Cells involved | platelets, macrophages, smooth muscle cells, T cells with cytokine release
🗑
|
||||
| Fibrous plaque | pathognomonic lesion of atherosclerosis
🗑
|
||||
| C-reactive protein | marker of an inflammatory atheromatous plaque
🗑
|
||||
| Inflammatory atheromatous plaque | predisposes to platelet thrombosis
🗑
|
||||
| Increased plasma homocysteine | ↑ vessel thrombosis; folate (MC)/vitamin B12 deficiency
🗑
|
||||
| Hyaline arteriolosclerosis | small vessel disease of DM and hypertension; excess protein in vessel wall
🗑
|
||||
| Mechanisms hyaline arteriolosclerosis in DM | non-enzymatic glycosylation
🗑
|
||||
| Non-enzymatic glycosylation | glucose attaches to amino acids in BM; causes ↑ permeability to protein
🗑
|
||||
| Mechanisms hyaline arteriolosclerosis in hypertension | pressure pushes proteins into vessel wall
🗑
|
||||
| Abdominal aortic aneurysm rupture | due to atherosclerosis; flank pain, hypotension, pulsatile mass
🗑
|
||||
| Syphilitic aneurysm | vasculitis of vasa vasorum of aortic arch; aortic regurgitation
🗑
|
||||
| Aortic dissection | due to hypertension and collagen tissue disorders (e.g., Marfan)
🗑
|
||||
| Cystic medial degeneration | elastic tissue degeneration creates spaces filled with mucopolysaccharides
🗑
|
||||
| Intimal tear in aorta | due to wall stress from hypertension and structural weakness
🗑
|
||||
| Types of dissection | proximal (MC); distal or combination of both
🗑
|
||||
| S/S proximal aortic dissection | chest pain radiating to back, lack of pulse; cardiac tamponade MC COD
🗑
|
||||
| Marfan's | AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death
🗑
|
||||
| MC COD Marfan's and Ehlers Danlos | aortic dissection
🗑
|
||||
| Phlebothrombosis | stasis of blood flow; deep veins below knee MC site
🗑
|
||||
| Pulmonary thromboembolism | emboli originate from femoral veins
🗑
|
||||
| Superficial migratory thrombophlebitis | sign of carcinoma of head of pancreas
🗑
|
||||
| Thoracic outlet syndrome | absent radial pulse with positional change
🗑
|
||||
| Turner's syndrome | lymphedema hands/feet in newborn; preductal coarctation
🗑
|
||||
| Spider telangiectasia | arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)
🗑
|
||||
| Capillary hemangioma in newborn | regress with age; do not surgically remove
🗑
|
||||
| Kaposi's sarcoma | HHV-8; vascular malignancy; MC cancer in AIDS
🗑
|
||||
| Bacillary angiomatosis | Bartonella henselae; vascular infection in AIDS
🗑
|
||||
| Small vessel vasculitis | palpable purpura; e.g., Henoch Schonlein purpura
🗑
|
||||
| Muscular artery vasculitis | vessel thrombosis with infarction; e.g., classical polyarteritis nodosa
🗑
|
||||
| Elastic artery vasculitis | absent pulse, stroke
🗑
|
||||
| Takayasu's arteritis | pulseless disease; young Asian woman
🗑
|
||||
| Giant cell arteritis | temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)
🗑
|
||||
| Classical polyarteritis nodosa | muscular artery vasculitis with vessel thrombosis infarction
🗑
|
||||
| Path findings | vessel inflammation at different stages; aneurysms from vessel weakness
🗑
|
||||
| S/S | infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%
🗑
|
||||
| Diagnosis | angiography identifies aneurysms and thrombosis
🗑
|
||||
| Kawasaki's disease | coronary artery vasculitis/thrombosis/aneurysms in children
🗑
|
||||
| Kawasaki's disease|S/S | chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy
🗑
|
||||
| Kawasaki's disease|Rx | IV γ-globulin
🗑
|
||||
| Buerger's disease (thromboangiitis obliterans) | smoker's digital vasculitis; digital infarction
🗑
|
||||
| Raynaud's syndrome | digital vasculitis in PSS and CREST syndrome
🗑
|
||||
| S/S | digital pain; white-blue-red color changes
🗑
|
||||
| Cryoglobulinemia | protein gels in cold temperature; Raynaud's syndrome; HCV association
🗑
|
||||
| S/S | acral cyanosis relieved by coming indoors
🗑
|
||||
| Wegener's granulomatosis | association with c-ANCA; sinusitis, lung infarction, crescentic GN
🗑
|
||||
| Microscopic polyangiitis | palpable purpura; crescentic GN; association with p-ANCA
🗑
|
||||
| Henoch-Schönlein purpura | IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN
🗑
|
||||
| Serum sickness vasculitis | e.g., horse antivenin in Rx of rattlesnake envenomation
🗑
|
||||
| Rocky Mountain spotted fever | tick borne
🗑
|
||||
| Meningococcemia | sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome
🗑
|
||||
| Essential HTN blacks | defect in renal excretion of sodium; ↑ plasma volume, ↓ PRA
🗑
|
||||
| Renovascular HTN | atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women
🗑
|
||||
| S/S | epigastric bruit; ↑ PRA affected kidney, ↓ PRA unaffected kidney
🗑
|
||||
| Endocrine HTN | 1º HPTH, Graves/hypothyroidism, Cushing's, 1º aldosteronism, phaeochromocytoma
🗑
|
||||
| Hypertension | LVH MC complication; AMI MC COD followed by stroke and renal failure
🗑
|
||||
| Afterload | resistance ventricles contract against
🗑
|
||||
| Preload | volume ventricles must eject
🗑
|
||||
| Concentric LVH | increased afterload; e.g., essential HTN, aortic stenosis
🗑
|
||||
| LVH with dilation/hypertrophy | increased preload; e.g., valve regurgitation; left to right shunts
🗑
|
||||
| LHF | forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea
🗑
|
||||
| Systolic dysfunction | LHF due to decreased ventricular contractility (ischemia)
🗑
|
||||
| Diastolic dysfunction | LHF due to decreased ventricular compliance (hypertrophy)
🗑
|
||||
| RHF | backward failure; ↑ venous hydrostatic pressure; neck vein distention, hepatomegaly, edema
🗑
|
||||
| ACE inhibitors | decrease afterload and preload in heart failure
🗑
|
||||
| Diuretics in CHF | reduce preload
🗑
|
||||
| Non-pharmacologic Rx in CHF | restrict salt and water
🗑
|
||||
| AMI | MC COD in United States; left anterior descending coronary artery thrombosis MCC
🗑
|
||||
| Exertional angina | coronary artery atherosclerosis; subendocardial ischemia; ST depression
🗑
|
||||
| Prinzmetal's angina | coronary artery vasospasm; transmural ischemia; ST elevation
🗑
|
||||
| Sudden cardiac death | death within 1 hr of symptoms
🗑
|
||||
| Path findings | severe coronary artery atherosclerosis; absence of occlusive thrombosis
🗑
|
||||
| LAD coronary artery | anterior portion left ventricle, anterior 2/3rds IVS
🗑
|
||||
| RCA | posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle
🗑
|
||||
| AMI | rupture of inflammatory plaque produces platelet thrombus
🗑
|
||||
| Ventricular fibrillation | MC COD in AMI
🗑
|
||||
| AMI | no gross changes until 24 hrs
🗑
|
||||
| S/S AMI | retrosternal pain radiating down arms, diaphoresis
🗑
|
||||
| AMI ruptures | 3rd-7th day
🗑
|
||||
| Anterior wall rupture | MC type; LAD thrombosis; cardiac tamponade
🗑
|
||||
| Posteromedial papillary muscle rupture | RCA thrombosis; mitral regurgitation with LHF
🗑
|
||||
| IVS rupture | LAD thrombosis; left to right shunt; RHF
🗑
|
||||
| Mural thrombus | anterior AMI; danger embolization
🗑
|
||||
| Pericarditis | first week in transmural AMI; 6 wks later autoimmune
🗑
|
||||
| S/S | friction rub; leaning forward relieves pain
🗑
|
||||
| Ventricular aneurysms | late manifestation of AMI; precordial systolic bulge; CHF MC COD
🗑
|
||||
| Right ventricular infarction | RCA thrombosis; hypotension, RHF, preserved left ventricular function
🗑
|
||||
| Diagnosis of AMI | CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days
🗑
|
||||
| LDH isoenzymes | no longer used; LDH 1/2 flip indicates AMI
🗑
|
||||
| Reinfarction | reappearance CK-MB after 3 days
🗑
|
||||
| ECG findings in AMI | inverted T waves; ST elevation; Q waves
🗑
|
||||
| Ejection fraction | EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66
🗑
|
||||
| By-pass surgery | use internal mammary artery and saphenous veins ("arterialize" after 10 yrs)
🗑
|
||||
| Angioplasty complication | localized dissection with thrombosis
🗑
|
||||
| Umbilical vein | highest O2 saturation
🗑
|
||||
| Ductus arteriosis in fetus | shunts blood from pulmonary artery to aorta; PGE keeps it open
🗑
|
||||
| Ductus arteriosus in newborn | closes and becomes ligamentum arteriosum
🗑
|
||||
| Eisenmenger's syndrome | cyanosis due to reversal of left to right shunt
🗑
|
||||
| VSD | MC congenital heart disease; ↑ SaO2 right ventricle (RV), pulmonary artery (PA)
🗑
|
||||
| ASD | patent foramen ovale; ↑ SaO2 right atrium (RA), RV, PA; MC adult congenital heart disease
🗑
|
||||
| Down syndrome | endocardial cushion defect (combined ASD and VSD)
🗑
|
||||
| PDA | machinery murmur; close with indomethacin; ↑ SaO2 PA
🗑
|
||||
| Tetralogy of Fallot | degree of pulmonic stenosis determines if cyanosis is present
🗑
|
||||
| Tetralogy of Fallot | ↓ left ventricle, aorta
🗑
|
||||
| Tetralogy of Fallot | ASD and PDA are cardioprotective
🗑
|
||||
| Complete transposition | cyanosis; aorta empties RV; PA empties left ventricle
🗑
|
||||
| Complications cyanotic heart disease | 2° polycythemia; infective endocarditis; metastatic abscesses
🗑
|
||||
| Pre-ductal coarctation | Turner's syndrome
🗑
|
||||
| Post-ductal coarctation | constriction distal to ligamentum arteriosum
🗑
|
||||
| S/S | upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN
🗑
|
||||
| Acute rheumatic fever | type II hypersensitivity; group A streptococcus pharyngeal infection
🗑
|
||||
| Acute rheumatic fever | sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule
🗑
|
||||
| S/S | polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea
🗑
|
||||
| Mitral stenosis | chronic rheumatic fever; opening snap followed by mid-diastolic rumble
🗑
|
||||
| Mitral stenosis | left atrial dilation hypertrophy - atrial fibrillation, thrombus, pulmonary edema, RHF
🗑
|
||||
| MVP | myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos
🗑
|
||||
| Mitral valve prolapse|S/S | mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae
🗑
|
||||
| MVP click/murmur close to S1 | decrease preload (stand, Valsalva, anxiety)
🗑
|
||||
| MVP click/murmur close to S2 | increase preload (supine, squat, clench fist)
🗑
|
||||
| Mitral regurgitation | pansystolic murmur; S3 and S4 common
🗑
|
||||
| Causes | LHF, infective endocarditis, acute rheumatic fever
🗑
|
||||
| Aortic stenosis | systolic ejection murmur; syncope and angina with exercise; hemolytic anemia
🗑
|
||||
| Aortic stenosis murmur increased preload | worsens obstruction and increases murmur intensity
🗑
|
||||
| Aortic stenosis murmur decreased preload | decreases obstruction and decreases murmur intensity
🗑
|
||||
| Causes | bicuspid aortic valve; age-related sclerosis
🗑
|
||||
| Aortic regurgitation | bounding pulses; early diastolic blowing murmur
🗑
|
||||
| Austin Flint murmur | diastolic murmur; regurgitant flow on anterior leaflet mitral valve
🗑
|
||||
| Significance Austin Flint murmur | sign for AV replacement
🗑
|
||||
| Causes aortic regurgitation | essential HTN, infective endocarditis, acute rheumatic fever, dissection
🗑
|
||||
| Tricuspid regurgitation | pansystolic murmur ↑ intensity with inspiration
🗑
|
||||
| Causes | endocarditis IV drug abuse; RHF; carcinoid heart disease
🗑
|
||||
| Carcinoid heart disease | tricuspid regurgitation, pulmonic stenosis
🗑
|
||||
| Infective endocarditis (IE) | Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA
🗑
|
||||
| IE prosthetic heart valve | Staphylococcus epidermidis (coagulase negative)
🗑
|
||||
| IE ulcerative bowel disease | Streptococcus bovis
🗑
|
||||
| S/S | IC vasculitis-Roth spot, splinter hemorrhages; regurgitant murmurs; metastatic abscesses
🗑
|
||||
| Lab findings | positive blood culture Libman Sacks endocarditis
🗑
|
||||
| Coxsackievirus | MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis
🗑
|
||||
| Parasitic cause myocarditis | leishmania in Chagas disease
🗑
|
||||
| Pericardial effusion | all chamber pressures are uniformally increased
🗑
|
||||
| S/S | muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention
🗑
|
||||
| Dx and Rx | echocardiogram, pericardiocentesis, respectively
🗑
|
||||
| Pulsus paradoxus | drop in blood pressure >10 mmHg with inspiration
🗑
|
||||
| Constrictive pericarditis | TB MCC worldwide; pericardial knock
🗑
|
||||
| Congestive cardiomyopathy | generalized chamber enlargement; low ejection fraction
🗑
|
||||
| Causes | postpartum, cardiotoxic drugs, hypothyroidism, alcohol
🗑
|
||||
| Hypertrophic cardiomyopathy | MCC of sudden death in young person (due to conduction defects)
🗑
|
||||
| Site of obstruction | anterior leaflet mitral valve drawn against asymmetric thickened IVS
🗑
|
||||
| Effect decreased preload on systolic murmur | worsens obstruction and increases murmur intensity
🗑
|
||||
| Effect increased preload on systolic murmur | reduces obstruction and decreases murmur intensity
🗑
|
||||
| Restrictive cardiomyopathy | decreased compliance
🗑
|
||||
| Causes | iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis
🗑
|
||||
| Cardiac myxoma | benign tumor left atrium; embolization; syncope
🗑
|
||||
| Cardiac rhabdomyoma | childhood tumor; association with tuberous sclerosis
🗑
|
||||
| U wave | hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)
🗑
|
||||
| Peaked T wave | hyperkalemia; MCC renal failure
🗑
|
||||
| ST depression | subendocardial ischemia (e.g., classical angina pectoris)
🗑
|
||||
| ST elevation | transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm
🗑
|
||||
| Atrial fibrillation | MC chronic arrhythmia; absent P waves; danger for embolization
🗑
|
||||
| Ventricular premature beats | wide QRS complexes; MC arrhythmia in coronary care unit
🗑
|
||||
| Ventricular fibrillation | MCC of death in an AMI
🗑
|
||||
| Anterior AMI | Q waves in I and V1-V4
🗑
|
||||
| Inferior AMI | Q waves in II, III, and aVF; right coronary artery thrombosis.
🗑
|
||||
| Wolff-Parkinson-White | short PR interval with normal P wave; delta wave on upstroke of R wave
🗑
|
||||
| Alveolar O2 calculation | % O2 breathing (713) - PCO2/0.8
🗑
|
||||
| Increased A-a gradient | primary lung disease; left to right shunts in heart
🗑
|
||||
| Forced vital capacity | total amount of air expelled after a maximal inspiration
🗑
|
||||
| Forced expiratory volume/1 second (FEV1) | amount of air expelled in 1 second after maximal inspiration
🗑
|
||||
| Choanal atresia | cyanotic when breast feeding; turns pink when crying
🗑
|
||||
| Nasal polyps | allergic (MC; adults only), aspirin, cystic fibrosis
🗑
|
||||
| Nasal polyp in a child | requires sweat test to exclude cystic fibrosis
🗑
|
||||
| Triad asthma | patient on aspirin (pain syndrome) with nasal polyps, asthma
🗑
|
||||
| Obstructive sleep apnea (OSA) | snoring with intervals of apnea (respiratory acidosis with hypoxemia)
🗑
|
||||
| S/S | danger cor pulmonale; requires sleep test; Rx. O2 with continuous positive airway pressure
🗑
|
||||
| Sinusitis | maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC
🗑
|
||||
| Nasopharyngeal carcinoma | association with EBV; metastasize to cervical nodes
🗑
|
||||
| Laryngeal carcinoma | smoking MCC; hoarseness; squamous cell carcinoma
🗑
|
||||
| Resorption atelectasis | MCC of fever 24-36 hours after surgery
🗑
|
||||
| S/S | ↓ percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm
🗑
|
||||
| RDS | decreased production surfactant; airway collapse; hyaline membranes
🗑
|
||||
| Type II pneumocytes | synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies
🗑
|
||||
| Surfactant | reduces surface tension in airways; ↑ synthesis cortisol, thyroxine; ↓ synthesis insulin
🗑
|
||||
| Causes RDS | prematurity, maternal diabetes, C-section
🗑
|
||||
| Maternal diabetes | maternal hyperglycemia → fetal hyperglycemia → fetal insulin which ↓ surfactant
🗑
|
||||
| Complications RDS | O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis
🗑
|
||||
| Typical community acquired pneumonia | Streptococcus pneumoniae MCC
🗑
|
||||
| Typical pneumonia | bronchopneumonia, lobar pneumonia
🗑
|
||||
| S/S | productive cough; consolidation - ↓ percussion, ↑ tactile fremitus
🗑
|
||||
| Atypical community acquired pneumonia | interstitial pneumonia; Mycoplasma pneumoniae MCC
🗑
|
||||
| S/S | low grade fever, non-productive cough, no signs consolidation
🗑
|
||||
| Nosocomial pneumonia | Pseudomonas, aeruginosa MCC (respirators); others - S. aureus, E. coli
🗑
|
||||
| Rhinovirus | MCC common cold; hand to mouth transmission
🗑
|
||||
| Respiratory syncytial virus | MCC pneumonia and bronchiolitis in child
🗑
|
||||
| Parainfluenza virus | MCC croup in child; trachea area of obstruction
🗑
|
||||
| Cytomegalovirus | basophilic intranuclear inclusion surrounded by halo
🗑
|
||||
| Influenza | superimposed pneumonia with S. aureus increases mortality
🗑
|
||||
| Rubeola | Warthin-Finkeldey multinucleated giant cells
🗑
|
||||
| Chlamydia pneumoniae | atypical pneumonia; association with coronary artery disease
🗑
|
||||
| Chlamydia trachomatis | pneumonia in newborns; staccato cough; wheezing
🗑
|
||||
| Coxiella burnetii | only rickettsia without a vector
🗑
|
||||
| Mycoplasma pneumoniae pneumonia | crowded condition; cold agglutinins; azithromycin
🗑
|
||||
| Streptococcus pneumoniae pneumonia | gram positive diplococcus; azithromycin
🗑
|
||||
| Staphylococcus aureus pneumonia | tension pneumatocysts in children with cystic fibrosis
🗑
|
||||
| Corynebacterium diphtheriae | toxin produces ADP ribosylation of elongation factor 2
🗑
|
||||
| Haemophilus influenzae | exacerbation chronic bronchitis; acute epiglottis in children
🗑
|
||||
| Inspiratory stridor child | croup, epiglottitis
🗑
|
||||
| Pseudomonas aeruginosa | MCC of pneumonia and death in cystic fibrosis; green sputum
🗑
|
||||
| Klebsiella pneumoniae | mucoid sputum in alcoholic
🗑
|
||||
| Legionella pneumophila | silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest)
🗑
|
||||
| Mycobacterium tuberculosis | strict aerobe; MC COD due to infectious disease worldwide
🗑
|
||||
| Candida albicans | vessel invader; yeasts and pseudohyphae
🗑
|
||||
| Cryptococcus immitis | pigeon excreta; narrow-based bud
🗑
|
||||
| Aspergillus fumigatus | septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader
🗑
|
||||
| Mucor species | non-septate; vessel invader; frontal lobe abscess in diabetic ketoacidosis
🗑
|
||||
| Coccidioides immitis | Southwest deserts; inhale arthrospores in dust; spherule with endospores
🗑
|
||||
| S/S | erythema nodosum (painful nodules lower legs)
🗑
|
||||
| Histoplasma capsulatum | Ohio/central Mississippi river valley; excreta bats (spelunker), chickens
🗑
|
||||
| H. capsulatum | simulates TB; yeasts phagocytosed by macrophages
🗑
|
||||
| Blastomyces dermatitidis | overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer
🗑
|
||||
| Pneumocystis carinii | cysts and trophozoites; pneumonia in HIV; Rx. trimethoprim/sulfamethoxazole
🗑
|
||||
| Primary TB | upper portion lower lobe, lower portion upper lobe
🗑
|
||||
| Primary TB | Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)
🗑
|
||||
| Reactivation TB | cavitating lesion in upper lobe; kidney MC extrapulmonary site
🗑
|
||||
| Mycobacterium avium intracellulare (MAI) | atypical TB; MC TB in AIDS
🗑
|
||||
| CF | AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)
🗑
|
||||
| S/S | pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD
🗑
|
||||
| Lung abscess | MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray - air/fluid level
🗑
|
||||
| Aspiration sitting | posterobasal segment right lower lobe
🗑
|
||||
| Aspiration supine | superior segment right lower lobe
🗑
|
||||
| Aspiration right side | right middle lobe, posterior segment right upper lobe
🗑
|
||||
| Pulmonary thromboembolism | most derive from femoral vein
🗑
|
||||
| Bronchial artery | branch of aorta/intercostal artery; protects against developing pulmonary infarction
🗑
|
||||
| Saddle embolus | sudden death due to acute right heart strain
🗑
|
||||
| S/S pulmonary infarction | dyspnea and tachypnea; pleuritic chest pain; pleural effusion
🗑
|
||||
| Dx | ventilation/perfusion scan; respiratory alkalosis; hypoxemia
🗑
|
||||
| Pain on inspiration | pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax
🗑
|
||||
| Pathogenesis pulmonary hypertension (PH) | hypoxemia and respiratory acidosis
🗑
|
||||
| Hypoxemia + respiratory acidosis | vasoconstriction pulmonary vessels; vasodilation cerebral vessels
🗑
|
||||
| Causes PH | 1° lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts
🗑
|
||||
| Cor pulmonale | PH + RVH
🗑
|
||||
| S/S | dyspnea; accentuated P2 (PH); parasternal heave (RVH)
🗑
|
||||
| Restrictive lung disease | ↓ compliance, ↑ elasticity; interstitial fibrosis/edema
🗑
|
||||
| Restrictive lung disease (RLD) | ↓ all volumes and capacities; ↑ FEV1sec/FVC ratio
🗑
|
||||
| ARDS | RLD; non-cardiogenic pulmonary edema due to alveolar injury
🗑
|
||||
| ARDS | neutrophil destruction of type I and II pneumocytes; hyaline membranes
🗑
|
||||
| Causes | septic shock (MC), aspiration gastric contents, severe trauma
🗑
|
||||
| Pneumoconiosis | inhalation mineral dust causing interstitial fibrosis; particles <0.5 μm to reach alveoli
🗑
|
||||
| Caplan syndrome | pneumoconiosis + rheumatoid nodules in lungs
🗑
|
||||
| Coal worker's | "black lung" disease; progressive massive fibrosis; no increased incidence cancer or TB
🗑
|
||||
| Silicosis | quartz; nodular opacities; foundry workers; ↑ incidence cancer and TB
🗑
|
||||
| Sources asbestos | roofing material, old buildings (9/11), pipe-fitter shipyard
🗑
|
||||
| Ferruginous bodies | asbestos fiber coated by iron
🗑
|
||||
| Asbestosis | benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma
🗑
|
||||
| Mesothelioma | malignancy of serosa; no smoking association
🗑
|
||||
| Sarcoidosis | RLD; MC non-infectious lung and liver granulomatous disease
🗑
|
||||
| S/S | dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions
🗑
|
||||
| Lab findings | ↑ ACE, hypercalcemia (macrophages synthesize 1-α-hydroxylase)
🗑
|
||||
| Kveim test | intradermal injection sarcoid antigens causes skin reaction
🗑
|
||||
| Farmer's lung | RLD; lung reaction against thermophilic bacteria in moldy hay
🗑
|
||||
| Silo filler's disease | RLD; reaction against nitrogen dioxide in fermenting corn
🗑
|
||||
| Byssinosis | RLD; reaction against cotton, linen, hemp products in textile industry
🗑
|
||||
| Goodpasture's syndrome | RLD; anti-BM antibodies; begins in lungs and ends in renal failure
🗑
|
||||
| Collagen vascular RLD | SLE, rheumatoid arthritis, systemic sclerosis
🗑
|
||||
| Drugs RLD | amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin
🗑
|
||||
| Obstructive lung disease | ↑ compliance, ↓ elasticity
🗑
|
||||
| Obstructive lung disease | ↑ RV, TLC; ↓ TV, VC; ↓ FEV1sec and FVC; ↓ FEV1sec/FVC ratio
🗑
|
||||
| Obstructive lung disease | asthma, emphysema, chronic bronchitis, bronchiectasis
🗑
|
||||
| Asthma | extrinsic (type I hypersensitivity) and intrinsic types
🗑
|
||||
| S/S | expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors
🗑
|
||||
| Charcot-Leyden crystals | derive from crystalline material in eosinophil granules
🗑
|
||||
| Lab findings | initial respiratory alkalosis; respiratory acidosis requires intubation
🗑
|
||||
| Emphysema | destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer
🗑
|
||||
| Respiratory unit | respiratory bronchiole, alveolar duct, alveoli
🗑
|
||||
| Radiograph emphysema | ↑ AP diameter; depressed diaphragms; vertical heart
🗑
|
||||
| Pathogenesis | ↓ AAT, ↑ neutrophil destruction of elastic tissue
🗑
|
||||
| Centriacinar emphysema | destruction/distention respiratory bronchioles upper lobe in smokers; THINK
🗑
|
||||
| Panacinar emphysema | destruction/distention entire respiratory unit lower lobes; AAT deficiency
🗑
|
||||
| Paraseptal emphysema | upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax
🗑
|
||||
| Lab findings | normal to decreased PCO2 (respiratory alkalosis)
🗑
|
||||
| Chronic bronchitis | productive cough 3 months/2 consecutive years; blue bloater (cyanosis)
🗑
|
||||
| Site of obstruction | terminal bronchioles (proximal to respiratory unit)
🗑
|
||||
| Lab findings | respiratory acidosis/hypoxemia
🗑
|
||||
| Bronchiectasis | obstruction/infection key causes; dilated bronchioles extend to periphery
🗑
|
||||
| Causes | CF MCC, TB, immotile cilia syndrome
🗑
|
||||
| Immotile cilia syndrome | absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus
🗑
|
||||
| Central lung cancers | squamous cancer and small cell cancer; men > women
🗑
|
||||
| Peripheral lung cancers | adenocarcinoma; women > men
🗑
|
||||
| Squamous lung cancer | cavitate; secrete PTH-related protein
🗑
|
||||
| Small cell carcinoma | neuroendocrine tumor; secrete ACTH and ADH
🗑
|
||||
| Bronchioloalveolar carcinoma | no smoking relationship; lung consolidation resembling pneumonia
🗑
|
||||
| Scar carcinoma | usually adenocarcinoma developing in old TB scar
🗑
|
||||
| Bronchial carcinoid | low grade malignant; hemoptysis; rare cause carcinoid syndrome
🗑
|
||||
| Metastatic lung cancer | more common than primary cancer; breast cancer MCC
🗑
|
||||
| Pancoast tumor | squamous carcinoma posterior mediastinum; destruction superior cervical ganglion
🗑
|
||||
| S/S | Horner's syndrome - lid lag, miosis, anhydrosis; lower brachial plexus injury
🗑
|
||||
| Solitary coin lesion | granuloma MCC
🗑
|
||||
| Superior vena caval syndrome | primary lung cancer obstructs vessel; venous congestion
🗑
|
||||
| Anterior mediastinal masses | thymoma; nodular sclerosing Hodgkin's; teratomas
🗑
|
||||
| Posterior mediastinal masses | usually neurogenic tumors of ganglia
🗑
|
||||
| Myasthenia gravis | B cell hyperplasia of thymus MC abnormality; association with thymoma
🗑
|
||||
| Thymoma | association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia
🗑
|
||||
| Pleural effusions | transudates or exudates; CHF MCC
🗑
|
||||
| Spontaneous pneumothorax | rupture subpleural or intrapleural bleb; air/pleural cavity pressure same
🗑
|
||||
| S/S | pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds
🗑
|
||||
| Tension pneumothorax | flap-like pleural tear; increased pleural cavity pressure; compression atelectasis
🗑
|
||||
| S/S | as above except tracheal shift to opposite side
🗑
|
||||
| Cleft lip/palate | failure of fusion of facial processes
🗑
|
||||
| Herpes labialis | multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep
🗑
|
||||
| Hairy leukoplakia | EBV glossitis; pre-AIDS defining lesion; not precursor to cancer
🗑
|
||||
| Mumps | bilateral parotitis; unilateral orchitis; ↑ amylase
🗑
|
||||
| Diphtheria | pseudomembrane pharynx and trachea with cervical lymphadenopathy
🗑
|
||||
| Congenital syphilis | notched central incisors
🗑
|
||||
| Actinomycosis | anaerobic gram + filamentous bacteria; complication extracted dental abscess
🗑
|
||||
| S/S | draining sinuses with sulfur granules
🗑
|
||||
| Exudative tonsillitis | majority are viral; 20% group A streptococcus
🗑
|
||||
| Oral thrush | common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae
🗑
|
||||
| Dental caries | Streptococcus mutans
🗑
|
||||
| Peutz-Jegher's syndrome | mucosal pigmentation; hamartomatous polyps
🗑
|
||||
| Leukoplakia/erythroleukoplakia | biopsy to rule out squamous dysplasia or cancer
🗑
|
||||
| Squamous cell carcinoma | smoking and alcohol association; lower lip MC site
🗑
|
||||
| Smokeless tobacco | verrucoid squamous cell carcinoma
🗑
|
||||
| Gum hyperplasia | phenytoin, pregnancy, scurvy
🗑
|
||||
| Pleomorphic adenoma | MC benign tumor of salivary glands; parotid MC site
🗑
|
||||
| Mucoepidermoid carcinoma | MC malignant tumor major and minor salivary glands
🗑
|
||||
| Dysphagia for solids only | lesion obstructing esophagus; e.g., cancer, web
🗑
|
||||
| Plummer-Vinson syndrome | iron deficiency anemia causes esophageal web, glossitis, achlorhydria (↓ HCl in gastric acid)
🗑
|
||||
| Dysphagia for solids and liquids | motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome
🗑
|
||||
| TE fistula | polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea
🗑
|
||||
| VATER syndrome | vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality
🗑
|
||||
| Zenker's diverticulum | MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES
🗑
|
||||
| GERD | relaxation of lower esophageal sphincter (LES) with acid reflux
🗑
|
||||
| GERD | MCC nocturnal cough and asthma
🗑
|
||||
| AIDS esophagitis | Candida MC, CMV, HSV
🗑
|
||||
| Barrett's esophagus | glandular metaplasia distal esophagus in GERD
🗑
|
||||
| Complications of Barrett's | precursor for adenocarcinoma, stricture
🗑
|
||||
| Esophageal varices | dilated left gastric vein; sign of portal hypertension due to cirrhosis
🗑
|
||||
| Mallory Weiss syndrome | tear of distal esophagus from retching in alcoholic or bulimic
🗑
|
||||
| Boerhaave's syndrome | rupture of distal esophagus from retching; pneumomediastinum
🗑
|
||||
| Hamman's mediastinal crunch | pneumomediastinum (air in subcutaneous tissue)
🗑
|
||||
| LES ganglion cells | contain VIP - relaxes LES
🗑
|
||||
| Achalasia | failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus
🗑
|
||||
| S/S | aperistalsis/dilation of esophagus; regurgitation of undigested food at night
🗑
|
||||
| X-ray achalasia | bird's beak appearance
🗑
|
||||
| Acquired achalasia | Chagas' disease; leishmania destroy ganglion cells
🗑
|
||||
| Distal adenocarcinoma esophagus | MC primary cancer; due to Barrett's esophagus
🗑
|
||||
| Squamous cell carcinoma of esophagus | smoking MCC; alcohol also causes
🗑
|
||||
| Melena | sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC
🗑
|
||||
| Hematemesis | vomiting blood; peptic ulcers MCC
🗑
|
||||
| Congenital pyloric stenosis | hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks
🗑
|
||||
| Acute hemorrhagic (erosive) gastritis | NSAIDs MCC
🗑
|
||||
| Mucous barrier stomach | maintained by PGE; misoprostol PGE analog
🗑
|
||||
| Type A chronic gastritis | due to PA; achlorhydria with ↑ serum gastrin
🗑
|
||||
| Type B chronic gastritis | due to H. pylori; involves pylorus and antrum
🗑
|
||||
| H. pylori | curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma
🗑
|
||||
| Gastric ulcer | lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain
🗑
|
||||
| Duodenal ulcer | never malignant; ↑ acid production; food relieves pain
🗑
|
||||
| Perforated peptic ulcer | air under diaphragm causes pain in left shoulder
🗑
|
||||
| Menetrier's disease | giant rugal hyperplasia; protein loss from increased mucus
🗑
|
||||
| Zollinger-Ellison syndrome | malignant islet cell tumor secreting gastrin; part of MEN I syndrome
🗑
|
||||
| S/S | PUD in usual locations; sometimes multiple ulcers
🗑
|
||||
| Hypergastrinemia | ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure
🗑
|
||||
| Leiomyoma | MC benign tumor of stomach
🗑
|
||||
| Intestinal type adenocarcinoma | H pylori related; ↓ incidence; lesser curvature pylorus/antrum
🗑
|
||||
| Diffuse type adenocarcinoma | linitis plastica; signet ring cells; Krukenberg tumors ovaries
🗑
|
||||
| Gastric lymphoma | stomach MC site for extranodal lymphomas; H. pylori associated
🗑
|
||||
| Malabsorption | steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease
🗑
|
||||
| Causes bile salt deficiency | liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn's
🗑
|
||||
| D-xylose screen | failure to reabsorb xylose indicates small bowel disease
🗑
|
||||
| Calcification of pancreas | chronic pancreatitis cause of malabsorption
🗑
|
||||
| Celiac disease | autoimmune disease; antibodies against gliadin in gluten; flat villi
🗑
|
||||
| Celiac disease | association with dermatitis herpetiformis
🗑
|
||||
| Whipple's disease | systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa
🗑
|
||||
| S/S | fever, polyarthritis, skin pigmentation
🗑
|
||||
| Invasive diarrhea | Campylobacter jejuni MCC; positive fecal smear for leukocytes
🗑
|
||||
| Secretory diarrhea | loss isotonic fluid; enterotoxins from E. coli and V. cholerae
🗑
|
||||
| Osmotic diarrhea | hypotonic loss fluid; laxatives, lactase deficiency
🗑
|
||||
| Rotavirus | MCC diarrhea in children
🗑
|
||||
| Norwalk virus | MCC diarrhea in adults
🗑
|
||||
| Cytomegalovirus | common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS
🗑
|
||||
| Staphylococcus aureus | preformed toxin causes food poisoning; culture food
🗑
|
||||
| Bacillus cereus | preformed toxin in fried rice and tacos; gram positive rods in stool
🗑
|
||||
| Clostridium botulinum (adult) | preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis
🗑
|
||||
| Clostridium botulinum (child) | colonization of bowel with release of neurotoxin; eating honey
🗑
|
||||
| Clostridium difficile | pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole
🗑
|
||||
| Shigella sonnei | produces dysentery (bloody diarrhea); associated with HUS
🗑
|
||||
| Salmonella enteritidis | gastroenteritis; animal reservoirs - poultry, turtles
🗑
|
||||
| Salmonella paratyphi | sepsis; osteomyelitis in HbSS
🗑
|
||||
| Salmonella typhi | typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly
🗑
|
||||
| Carrier state site | gallbladder
🗑
|
||||
| M. tuberculosis | MCC intestinal TB in United States (swallow TB); Peyer's patch site of infection
🗑
|
||||
| Enterotoxigenic E. coli | secretory diarrhea (traveler's diarrhea); toxin stimulates guanylate cyclase
🗑
|
||||
| Vibrio cholerae | secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP
🗑
|
||||
| Oral Rx cholera | solution must contain glucose to reabsorb Na+ (co-transport)
🗑
|
||||
| Yersinia enterocolitica | mesenteric lymphadenitis; sepsis in iron overload states
🗑
|
||||
| Entamoeba histolytica | dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole
🗑
|
||||
| Cryptosporidium parvum | MCC diarrhea in AIDS; acid-fast oocysts
🗑
|
||||
| Giardia lamblia | MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole
🗑
|
||||
| Trichuris trichiura | rectal prolapse in children
🗑
|
||||
| Enterobius vermicularis | anal pruritus; urethritis in girls; no eosinophilia
🗑
|
||||
| Ascaris lumbricoides | intestinal obstruction due to adult worms; no eosinophilia
🗑
|
||||
| Necator americanus | hookworm; iron deficiency anemia
🗑
|
||||
| Strongyloides stercoralis | rhabditiform larvae in stool not eggs
🗑
|
||||
| Diphyllobothrium latum | fish tapeworm; vitamin B12 deficiency
🗑
|
||||
| Signs of small bowel obstruction | colicky pain; constipation and obstipation
🗑
|
||||
| Radiograph small bowel obstruction | air-fluid levels on x-ray
🗑
|
||||
| MCC small bowel obstruction | adhesions from previous surgery
🗑
|
||||
| Duodenal atresia | vomiting bile-stained fluid at birth; double bubble sign; Down syndrome
🗑
|
||||
| Hirschsprung disease | absent ganglion cells in submucosal/myenteric plexus rectosigmoid
🗑
|
||||
| S/S | proximal bowel dilated but peristalses; no stool in rectal vault
🗑
|
||||
| Hirschsprung association | Down syndrome; Chagas disease
🗑
|
||||
| Intussusception | terminal ileum telescopes into cecum; obstruction plus bloody diarrhea
🗑
|
||||
| Meconium ileus | complication of cystic fibrosis
🗑
|
||||
| Indirect inguinal hernia | second MCC of small bowel obstruction; common in weight lifting
🗑
|
||||
| Gallstone ileus | obstruction of small bowel with gallstone + air in biliary tree
🗑
|
||||
| Volvulus | MC due to sigmoid colon twisting around mesentery
🗑
|
||||
| Direct inguinal hernia | protrudes through center of triangle of Hesselbach; no obstruction
🗑
|
||||
| Umbilical hernia | common in black children; may entrap bowel in adults
🗑
|
||||
| Sigmoid colon | MC site for polyps, cancer, diverticula
🗑
|
||||
| Small bowel infarction | diffuse abdominal pain with bloody diarrhea
🗑
|
||||
| Causes small bowel infarction | embolism (atrial fibrillation), thrombosis SMA or SMV
🗑
|
||||
| Ischemic colitis | splenic flexure pain with bloody diarrhea
🗑
|
||||
| Mesenteric angina | pain in splenic flexure 30 minutes after eating
🗑
|
||||
| Angiodysplasia | submucosal dilation of venules in cecum; cause of hematochezia
🗑
|
||||
| Hematochezia | massive loss of blood per rectum; diverticulosis MCC
🗑
|
||||
| Meckel's diverticulum | persistence omphalomesenteric duct
🗑
|
||||
| S/S | bleeding MC (iron deficiency in children), diverticulitis
🗑
|
||||
| Meckel's diverticulitis | mimics acute appendicitis; cannot differentiate without radionuclide scan
🗑
|
||||
| Sigmoid diverticulum | diverticulitis MC complication; MCC hematochezia and fistula formation
🗑
|
||||
| Diverticulitis | "left-sided acute appendicitis"
🗑
|
||||
| Ulcerative colitis | mucosal/submucosal ulceration; starts in rectum; crypt abscess; ↑ risk adenocarcinoma
🗑
|
||||
| S/S | left lower quadrant crampy pain with bloody diarrhea
🗑
|
||||
| UC associations | primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy
🗑
|
||||
| Crohn's disease | transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions
🗑
|
||||
| S/S | colicky pain and diarrhea; fistulas (anal, bowl to bowel)
🗑
|
||||
| Carcinoid tumor | appendix MC site; terminal ileum MC site for carcinoid syndrome
🗑
|
||||
| Carcinoid syndrome | liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA
🗑
|
||||
| Tubular adenomas | precursor lesion colon cancer; size and number determine risk of malignancy
🗑
|
||||
| Villous adenoma | greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium
🗑
|
||||
| Familial polyposis | AD with 100% penetrance for developing colon cancer
🗑
|
||||
| Gardner's syndrome | AD, polyposis plus osteomas and desmoid tumors
🗑
|
||||
| Turcot's syndrome | AD, polyposis plus brain tumors
🗑
|
||||
| Colorectal cancer | second MC cancer and cancer killer in adults
🗑
|
||||
| Left-sided colorectal cancer | obstruct; MC location rectosigmoid
🗑
|
||||
| Right-sided colorectal cancer | bleed
🗑
|
||||
| Acute appendicitis | due to lymphoid hyperplasia in children and obstruction by fecalith in adults
🗑
|
||||
| External hemorrhoids | thrombose
🗑
|
||||
| Internal hemorrhoids | bleed; prolapse out of rectum
🗑
|
||||
| Urobilinogen (UBG) | breakdown product CB in bowel (color of stool)
🗑
|
||||
| UBG | enterohepatic circulation to liver and kidney (color of urine)
🗑
|
||||
| Alcoholic liver disease | serum AST>ALT; ↑ serum GGT
🗑
|
||||
| Viral hepatitis | serum ALT>AST
🗑
|
||||
| Cholestasis markers | serum AP and GGT
🗑
|
||||
| Unconjugated bilirubin | macrophage degradation of heme; lipid soluble; never in urine
🗑
|
||||
| Conjugated bilirubin (CB) | water soluble; never normal in urine
🗑
|
||||
| % CB <20% (unconjugated) | Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN
🗑
|
||||
| Gilbert's disease | AD; ↓ uptake and conjugation; bilirubin increases with fasting
🗑
|
||||
| Physiologic jaundice newborn | unconjugated hyperbilirubinemia; begins on day three
🗑
|
||||
| % CB 20-50% | viral/alcoholic hepatitis
🗑
|
||||
| % CB >50% | bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas
🗑
|
||||
| Negative urine bilirubin + trace urobilinogen | normal urine
🗑
|
||||
| Positive urine bilirubin, absent urobilinogen | obstructive jaundice
🗑
|
||||
| Positive urine bilirubin + increased urobilinogen | hepatitis
🗑
|
||||
| Negative urine bilirubin + increased urobilinogen | extravascular hemolytic anemia
🗑
|
||||
| Markers of severity of liver disease | albumin, PT
🗑
|
||||
| Hepatitis A | protective antibodies; day care centers, jails, homosexuals, traveling; not chronic
🗑
|
||||
| Hepatitis B | protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma
🗑
|
||||
| Hepatitis C | no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma
🗑
|
||||
| Hepatitis D | no protective antibodies; requires HBsAg to replicate
🗑
|
||||
| Anti-HBs alone | vaccination
🗑
|
||||
| Anti-HBs + anti-HBc-IgG | recovered from HBV
🗑
|
||||
| HBsAg + HBeAg + HBVDNA + anti-HBc-IgM | acute HBV/chronic HBV infective carrier if >6 months
🗑
|
||||
| Anti HBc-IgM alone | serologic gap; not infective
🗑
|
||||
| HBsAg + anti-HBc-IgM | chronic HBV healthy carrier
🗑
|
||||
| Fulminant hepatic failure | viral hepatitis and acetaminophen MCCs
🗑
|
||||
| Spontaneous peritonitis | E. coli in adults; S. pneumoniae in children; complication of ascites
🗑
|
||||
| Granulomatous hepatitis | TB MC bacteria
🗑
|
||||
| Amebiasis | Entamoeba histolytica; flask shaped ulcers in cecum; liver abscess; Rx
🗑
|
||||
| Echinococcosis | Echinococcus granulosis; sheep dog definitive host; man intermediate host
🗑
|
||||
| Schistosomiasis | Schistosoma mansoni; adult worms in portal vein; "pipe stem cirrhosis"
🗑
|
||||
| Clonorchiasis | Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma
🗑
|
||||
| Congestive hepatomegaly (centrilobular necrosis) | "nutmeg" liver; RHF MCC
🗑
|
||||
| Hepatic vein thrombosis | Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension
🗑
|
||||
| Portal vein thrombosis | ascites, portal hypertension, no hepatomegaly
🗑
|
||||
| Alcohol related disorders | fatty change; alcoholic hepatitis; cirrhosis
🗑
|
||||
| Hypertriglyceridemia in alcoholics | ↑ synthesis of glycerol 3P (substrate for TG synthesis)
🗑
|
||||
| Hypoglycemia in alcoholics | ↓ gluconeogenesis (↑ NADH causes pyruvate to convert to lactate)
🗑
|
||||
| Ketoacidosis in alcoholics | ↑ lactate, ↑ ßOHB (acetyl CoA converted to AcAc and then ßOHB)
🗑
|
||||
| Primary biliary cirrhosis | granulomatous destruction triad bile ducts; anti-mitochondrial antibody
🗑
|
||||
| Primary sclerosing cholangitis | association with ulcerative colitis; MCC of cholangiocarcinoma
🗑
|
||||
| Extrahepatic biliary atresia | neonatal cholestasis
🗑
|
||||
| Drugs causing hepatitis | acetaminophen, isoniazid, halothane
🗑
|
||||
| Anabolic steroids | intrahepatic cholestasis
🗑
|
||||
| Estrogen/oral contraceptives | intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)
🗑
|
||||
| Methotrexate | liver fibrosis, fatty change
🗑
|
||||
| Liver angiosarcoma | vinyl chloride
🗑
|
||||
| Hemochromatosis | AR; increased iron reabsorption; liver target organ
🗑
|
||||
| S/S | cirrhosis; "bronze diabetes" - skin pigmentation + destruction of islet cells; malabsorption
🗑
|
||||
| Lab | ↑ serum ferritin, iron, % saturation; ↓ TIBC
🗑
|
||||
| Wilson's disease | AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin
🗑
|
||||
| S/S | cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet's membrane)
🗑
|
||||
| Lab | ↓ ceruloplasmin (causes ↓ total copper); ↑ serum/urine free copper
🗑
|
||||
| HELLP syndrome | pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets
🗑
|
||||
| AAT deficiency in child | AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma
🗑
|
||||
| Reye syndrome | coma and microvesicular fatty change post viral infection; increased ammonia
🗑
|
||||
| Cirrhosis | irreversible fibrosis; regenerative nodules; portal hypertension
🗑
|
||||
| Causes cirrhosis | alcohol (MC), HBV/HCV, hemochromatosis, Wilson's, AAT deficiency, 1° biliary
🗑
|
||||
| Hepatic encephalopathy | mental status changes; ↑ serum ammonia
🗑
|
||||
| Portal hypertension | ascites; varices; splenomegaly; hemorrhoids; caput medusae
🗑
|
||||
| Cause of ascites | portal hypertension; hypoalbuminemia; secondary aldosteronism
🗑
|
||||
| Rx | use aldosterone blocker (acidosis increases loss ammonium in stool)
🗑
|
||||
| Hyperestrinism in men | gynecomastia; spider angiomas; female hair distribution
🗑
|
||||
| Lab findings cirrhosis | ↓ BUN, glucose, sodium, potassium, calcium (↓ vitamin D); ↑ PT
🗑
|
||||
| Liver cell adenoma | estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage
🗑
|
||||
| Liver cancer | metastasis MC cancer; lung cancer MC primary site
🗑
|
||||
| Hepatocellular carcinoma | chronic HBV and HCV MCC; ↑ AFP; hepatic/portal vein invasion
🗑
|
||||
| Cholangiocarcinoma | primary sclerosing cholangitis MCC, C.C sinensis
🗑
|
||||
| Pathogenesis of cholesterol stones | bile with too much cholesterol and too little bile salts
🗑
|
||||
| Black pigment stones | sign of extravascular hemolytic anemia (spherocytosis, HbSS)
🗑
|
||||
| Acute cholecystitis | stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder
🗑
|
||||
| Chronic cholecystitis | chemical inflammation
🗑
|
||||
| Gallbladder cancer | risk factors - cholelithiasis and porcelain gallbladder
🗑
|
||||
| Acute pancreatitis | causes - alcohol and gallstones; ↑ amylase and lipase (more specific)
🗑
|
||||
| S/S | epigastric pain with radiation into back
🗑
|
||||
| Sentinel loop | localized ileus of duodenum due to acute pancreatitis
🗑
|
||||
| Pancreatic pseudocyst | abdominal mass; persistence of ↑ serum amylase >1 week
🗑
|
||||
| Chronic pancreatitis | alcohol abuse, CF; malabsorption, pain, type I diabetes
🗑
|
||||
| Pancreatic cancer | smoking MCC
🗑
|
||||
| S/S | jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau's sign); ↑ CA 19-9
🗑
|
||||
| First sign tubule cell dysfunction | inability to concentrate urine
🗑
|
||||
| Fixed specific gravity | chronic renal failure; cannot concentrate or dilute urine
🗑
|
||||
| Negative urine bilirubin + trace urobilinogen | normal urine
🗑
|
||||
| Positive urine bilirubin, absent urobilinogen | obstructive jaundice
🗑
|
||||
| Positive urine bilirubin + increased urobilinogen | hepatitis
🗑
|
||||
| Negative urine bilirubin + increased urobilinogen | extravascular hemolytic anemia
🗑
|
||||
| Positive urine nitrite + positive urine leukocyte esterase | urinary tract infection
🗑
|
||||
| Sterile pyuria | positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
🗑
|
||||
| Prerenal azotemia | ↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)
🗑
|
||||
| Renal azotemia | ↑ BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
🗑
|
||||
| Postrenal azotemia | ↑ BUN and creatinine due to obstruction to urine flow
🗑
|
||||
| Serum BUN:creatinine ratio | <15:1 (renal failure); >15:1 (prerenal or postrenal azotemia)
🗑
|
||||
| BUN 80 mg/dL:creatinine 8 mg/dL | ratio 10/1 - renal failure
🗑
|
||||
| BUN 80 mg/dL:creatinine 2 mg/dL | ratio 40/1 - prerenal azotemia or postrenal azotemia
🗑
|
||||
| Creatinine clearance | measures GFR
🗑
|
||||
| Proteinuria | important sign of renal dysfunction
🗑
|
||||
| RBC casts | nephritic type of glomerulonephritis
🗑
|
||||
| WBC casts | acute pyelonephritis, acute tubulointerstitial nephritis
🗑
|
||||
| Fatty casts with Maltese crosses | nephrotic syndrome
🗑
|
||||
| Hyaline casts | normal unless associated with proteinuria
🗑
|
||||
| Renal tubular cell casts | acute tubular necrosis
🗑
|
||||
| Waxy or broad casts | chronic renal failure
🗑
|
||||
| Cystinuria | hexagonal crystals
🗑
|
||||
| Horseshoe kidney | Turner's syndrome; lower poles fused
🗑
|
||||
| Renal dysplasia | MC childhood cystic disease; abnormal development; flank mass
🗑
|
||||
| Maternal oligohydramnios | fetal juvenile polycystic kidney disease; Potter's facies in newborn
🗑
|
||||
| Adult polycystic kidney disease | AD; hypertension MC sign; cerebral berry aneurysms
🗑
|
||||
| Visceral epithelial cells | synthesize basement membrane
🗑
|
||||
| Glomerular BM | negative charge due to heparan sulfate
🗑
|
||||
| Nephritic syndrome | oliguria; RBC casts; hypertension; mild to moderate proteinuria
🗑
|
||||
| Nephrotic syndrome | proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
🗑
|
||||
| Immunofluorescence | linear (anti-glomerular BM antibodies); granular (IC deposition)
🗑
|
||||
| IgA GN | MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits
🗑
|
||||
| Post-streptococcal GN | nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B
🗑
|
||||
| SLE type IV GN | nephritic; subendothelial deposits; anti-DNA antibodies
🗑
|
||||
| Crescentic GN | crescents from parietal cell proliferation; worst GN; Goodpasture's, Wegener's
🗑
|
||||
| Goodpasture's | nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
🗑
|
||||
| S/S | young male with hemoptysis progressing to renal failure
🗑
|
||||
| Minimal change disease (lipoid nephrosis) | MCC childhood nephrotic syndrome
🗑
|
||||
| Lipoid nephrosis | podocyte fusion; loss of negative charge in glomerular BM
🗑
|
||||
| Focal segmental glomerulosclerosis | nephrotic syndrome; AIDS and IV heroin abuse
🗑
|
||||
| Membranous GN | MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
🗑
|
||||
| Causes membranous GN | HBV, ACE inhibitors, cancer
🗑
|
||||
| Type I MPGN | nephrotic; subepithelial deposits; HCV association; tram tracks
🗑
|
||||
| Type II MPGN | nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
🗑
|
||||
| DM nodular glomerulosclerosis | microalbuminuria first sign
🗑
|
||||
| DM glomerulosclerosis | nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
🗑
|
||||
| ACE inhibitors | inhibit angiotensin II vasoconstriction of efferent arterioles
🗑
|
||||
| Alport's syndrome | XD hereditary nephritis with sensorineural hearing loss
🗑
|
||||
| Ischemic ATN | prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1
🗑
|
||||
| Ischemic ATN | disruption of BM in proximal tubule and thick ascending limb
🗑
|
||||
| Nephrotoxic ATN | aminoglycosides, IVP dye, Pb/mercury poisoning
🗑
|
||||
| Nephrotoxic ATN | proximal tubule dysfunction; intact BM
🗑
|
||||
| Oliguria | prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
🗑
|
||||
| Acute pyelonephritis | vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
🗑
|
||||
| Chronic pyelonephritis | U-shaped scars overlying blunt calyces
🗑
|
||||
| Drug-induced tubulointerstitial nephritis | type I/IV reaction; e.g., penicillin
🗑
|
||||
| S/S | ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
🗑
|
||||
| Analgesic nephropathy | aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
🗑
|
||||
| Myeloma kidney | BJ protein produces foreign body reaction in tubules
🗑
|
||||
| Urate nephropathy | prevent by giving allopurinol prior to chemotherapy
🗑
|
||||
| CRF | fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts
🗑
|
||||
| Renal osteodystrophy CRF | hypovitaminosis D (no 1-α-hydroxylase); produces osteomalacia
🗑
|
||||
| Renal osteodystrophy CRF | osteoporosis from metabolic acidosis
🗑
|
||||
| Renal osteodystrophy CRF | secondary HPTH with increased osteoclastic activity
🗑
|
||||
| S/S CRF | pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
🗑
|
||||
| Benign nephrosclerosis | kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
🗑
|
||||
| Malignant hypertension | renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside
🗑
|
||||
| Renal findings | necrotizing arteriolitis; "flea bitten" kidney; hyperplastic arteriolosclerosis
🗑
|
||||
| Renal infarction | pale infarcts; hematuria; common in polyarteritis nodosa
🗑
|
||||
| Hydronephrosis | renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
🗑
|
||||
| Renal stones | most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
🗑
|
||||
| S/S | colicky pain radiating into groin, hematuria; x-ray usually shows stone
🗑
|
||||
| Staghorn calculus | due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
🗑
|
||||
| Angiomyolipoma | hamartoma; associated with tuberous sclerosis
🗑
|
||||
| Renal cell carcinoma | smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
🗑
|
||||
| S/S | flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
🗑
|
||||
| Renal pelvis transitional cell carcinoma | smoking MCC, phenacetin, aniline dyes, cyclophosphamide
🗑
|
||||
| Wilm's tumor | hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
🗑
|
||||
| Urine draining from umbilicus | persistent urachus
🗑
|
||||
| Retroperitoneal fibrosis | produces hydronephrosis
🗑
|
||||
| Bladder extrophy | abdominal wall defect + epispadias
🗑
|
||||
| Bladder diverticula | most commonly due to prostatic hyperplasia with urethral obstruction
🗑
|
||||
| Acute cystitis | E. coli; females > males; no fever, flank pain, or WBC casts
🗑
|
||||
| Bladder transitional cell carcinoma | smoking MCC, aniline dyes, cyclophosphamide; papillary
🗑
|
||||
| S/S | hematuria; hydronephrosis
🗑
|
||||
| Bladder adenocarcinoma | risk factors persistent urachus, extrophy
🗑
|
||||
| Bladder squamous cell carcinoma | Schistosoma hematobium infection
🗑
|
||||
| Hypospadias | ventral opening on penis due to failure closure of urethral folds
🗑
|
||||
| Epispadias | dorsal opening on penis due to defect in genital tubercle
🗑
|
||||
| Peyronie's disease | painful curvature penis due to fibromatosis
🗑
|
||||
| Priapism | persistent/painful erection; HbSS
🗑
|
||||
| Squamous cell carcinoma penis | HPV and lack of circumcision most important risk factors
🗑
|
||||
| Cryptorchidism | undescended testis; risk for seminoma applies to cryptorchid testis and normal testis
🗑
|
||||
| Orchitis | mumps usually unilateral (infertility uncommon)
🗑
|
||||
| Epididymitis | <35 - N. gonorrhoeae, C. trachomatis; >35 - E. coli, P. aeruginosa
🗑
|
||||
| S/S | scrotal pain relieved by elevation of scrotum (Prehn's sign)
🗑
|
||||
| Varicocele | left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common
🗑
|
||||
| Varicocele | may be due to invasion of left renal vein by renal cell carcinoma
🗑
|
||||
| Hydrocele | persistent tunica vaginalis; scrotum transilluminates
🗑
|
||||
| Torsion of testicle | testicle high in canal; absent cremasteric reflex
🗑
|
||||
| Testicular cancer | unilateral painless mass that does not transilluminate
🗑
|
||||
| Risk factors | cryptorchid testis, Klinefelter's, testicular feminization
🗑
|
||||
| Seminoma | MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ↑hCG
🗑
|
||||
| Spermatocytic variant | >65 yrs of age
🗑
|
||||
| Embryonal carcinoma | hemorrhage/necrosis; hematogenous spread before lymphatic; ↑AFP, hCG
🗑
|
||||
| Yolk sac tumor | MC testicular cancer in boys; ↑AFP
🗑
|
||||
| Choriocarcinoma | most aggressive testicle cancer; ↑hCG
🗑
|
||||
| Teratoma | more often benign in children than adult
🗑
|
||||
| Teratocarcinoma | teratoma + embryonal carcinoma
🗑
|
||||
| Malignant lymphoma | MC type in elderly; metastasis not primary cancer
🗑
|
||||
| Prostate | DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer
🗑
|
||||
| Prostatitis | perineal pain, fever; WBCs at end of voiding
🗑
|
||||
| Benign prostatic hyperplasia | DHT/estrogen-mediated; glandular/smooth muscle hyperplasia
🗑
|
||||
| S/S | all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx
🗑
|
||||
| Prostate cancer | DHT-mediated; palpable with rectal exam; osteoblastic metastasis (↑ AP)
🗑
|
||||
| PSA | sensitive but not specific for prostate cancer; ↑ in hyperplasia
🗑
|
||||
| Kallmann's syndrome | absent GnRH, anosmia, absence of taste
🗑
|
||||
| Impotence | failure to sustain an erection; psychogenic in most cases (erections present at night)
🗑
|
||||
| Erection | parasympathetic response
🗑
|
||||
| Ejaculation | sympathetic response
🗑
|
||||
| Leydig cell failure | ↑ LH; ↓ testosterone, sperm count; normal FSH
🗑
|
||||
| Seminiferous tubule failure | ↑ FSH (↓inhibin); ↓ sperm count; normal LH and testosterone
🗑
|
||||
| Leydig and seminiferous tubule failure | ↑ FSH and LH; ↓ testosterone and sperm count
🗑
|
||||
| Y chromosome | determines genetic sex
🗑
|
||||
| Testosterone | develops seminal vesicles, epididymis, vas deferens
🗑
|
||||
| Dihydrotestosterone (DHT) | develops prostate and male external genitalia
🗑
|
||||
| Male pseudohermaphrodite | genetic male; phenotypically female
🗑
|
||||
| Testicular feminization | XR; deficient androgen receptors; MCC male pseudohermaphrodite
🗑
|
||||
| Klinefelter's syndrome | XXY; 1 Barr body; female secondary sex characteristics
🗑
|
||||
| Herpes genitalis | recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions
🗑
|
||||
| Human papilloma virus | condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo)
🗑
|
||||
| Chlamydia trachomatis | metaplastic squamous cells with vacuoles containing elementary bodies
🗑
|
||||
| S/S | non-specific urethritis, cervicitis, PID, ophthalmia neonatorum
🗑
|
||||
| Neisseria gonorhoeae | urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus
🗑
|
||||
| Ophthalmia neonatorum first week | N gonorrhoeae
🗑
|
||||
| Ophthalmia neonatorum second week | C. trachomatis
🗑
|
||||
| Lymphogranuloma venereum | C. trachomatis subtype
🗑
|
||||
| S/S | scrotal/vulva lymphedema; granulomatous microabscesses; rectal strictures in females
🗑
|
||||
| Chancroid | painful ulcer, adenopathy, Hemophilus ducreyi
🗑
|
||||
| Granuloma inguinale | Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy
🗑
|
||||
| Treponema pallidum | spirochete; produces vasculitis of arterioles (plasma cell infiltrate)
🗑
|
||||
| Primary syphilis | painless chancre
🗑
|
||||
| Secondary syphilis | rash on palms/soles; condyloma lata; generalized adenopathy
🗑
|
||||
| Tertiary syphilis | neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas
🗑
|
||||
| RPR/VDRL | reagin antibodies against cardiolipin; ↓ titer with Rx of syphilis
🗑
|
||||
| RPR/VDRL | false positive with anticardiolipin antibodies (common in SLE)
🗑
|
||||
| FTA-ABS | confirmatory test for syphilis; not distinguish active from treated disease
🗑
|
||||
| FTA-ABS | remains positive after Rx
🗑
|
||||
| Trichomonas vaginalis | flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners
🗑
|
||||
| Gardnerella vaginalis | vaginal pH >5; bacterial vaginosis; clue cells; Rx metronidazole
🗑
|
||||
| Candida vaginitis | white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole
🗑
|
||||
| Vulvar squamous cancer | MC vulvar cancer; HPV association
🗑
|
||||
| Vulvar leukoplakia | biopsy to R/O squamous dysplasia/cancer
🗑
|
||||
| Lichen sclerosis vulva | epidermal atrophy; slight risk for squamous cancer
🗑
|
||||
| Squamous hyperplasia vulva | leukoplakia; no cancer risk
🗑
|
||||
| Paget's disease | intraepithelial adenocarcinoma (mucin production) of vulva
🗑
|
||||
| Malignant melanoma | vulva location; similar to Paget cells but not mucin positive
🗑
|
||||
| Gartner's duct cyst | lateral wall vagina; persistent mesonephric duct
🗑
|
||||
| Embryonal rhabdomyosarcoma | bloody, grape-like vaginal mass young girl
🗑
|
||||
| Vaginal adenosis | maternal exposure to DES; precursor clear cell adenocarcinoma vagina
🗑
|
||||
| Vaginal squamous cancer | usually extension of cervical cancer
🗑
|
||||
| Rokitansky-Kiister-Hauser | absence of vagina and uterus
🗑
|
||||
| Nabothian cysts | endocervical glands covered by metaplastic squamous epithelium
🗑
|
||||
| Pathologic cervicitis | trichomonas, HSV-2, C. trachomatis (follicular cervicitis)
🗑
|
||||
| Cervical Pap | superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone)
🗑
|
||||
| Normal | 70% superficial, 30% intermediate
🗑
|
||||
| Atrophic | 100% parabasal cells
🗑
|
||||
| Hyperestrinism | 100% superficial cells
🗑
|
||||
| Pregnancy | 100% intermediate cells
🗑
|
||||
| Endocervical cells | sign of adequately performed Pap smear
🗑
|
||||
| Cervical polyp | bleeding after intercourse; non-neoplastic
🗑
|
||||
| Cervical dysplasia | begins in transformation zone; associated with low and high risk HPV
🗑
|
||||
| Risk factors cervical dysplasia/cancer | early onset sexual activity; multiple partners; smoking; OC
🗑
|
||||
| CIN | cervical intraepithelial dysplasia; mild, moderate, severe (in-situ)
🗑
|
||||
| Cervical cancer | ↓ incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters
🗑
|
||||
| S/S | cervical discharge; bleeding after intercourse
🗑
|
||||
| Sequence to menarche | breast budding, growth spurt, pubic hair, axillary hair, menarche
🗑
|
||||
| Proliferative phase cycle | estrogen-dependent; ↑estrogen inhibits FSH and stimulates LH
🗑
|
||||
| Ovulation | day 14-I6; LH surge; subnuclear vacuoles; ↑body temperature
🗑
|
||||
| Secretory phase cycle | progesterone-dependent
🗑
|
||||
| Menses | drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting
🗑
|
||||
| FSH | stimulates follicle and aromatase synthesis in granulosa cells
🗑
|
||||
| LH | stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase
🗑
|
||||
| Day 21 | day of implantation of fertilized egg
🗑
|
||||
| Pregnancy | ↑plasma volume > RBC mass; ↑GFR; ↑thyroxine/cortisol (increased binding proteins)
🗑
|
||||
| hCG | LH analogue produced by syncytiotrophoblast
🗑
|
||||
| hCG | stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks
🗑
|
||||
| Estrone | estrogen of postmenopausal woman; aromatization of adrenal androstenedione
🗑
|
||||
| Estradiol | estrogen of non-pregnant woman in reproductive life; aromatization of testosterone
🗑
|
||||
| Estriol | estrogen of pregnancy
🗑
|
||||
| Menopause | ↑ FSH (best screen; due to ↓estrogen), ↑LH
🗑
|
||||
| S/S | secondary amenorrhea, hot flushes
🗑
|
||||
| Hirsutism | ↑ hair in normal areas
🗑
|
||||
| Virilization | hirsutism + male secondary sex characteristics (clitoromegaly)
🗑
|
||||
| Test for hirsutism/virilization | ↑ testosterone - ovarian source; ↑DHEA-sulfate - adrenal source
🗑
|
||||
| Polycystic ovarian syndrome (POS) | ↑ LH; ↓ FSH; ↑ estrogen and androgens
🗑
|
||||
| S/S | hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH >2:1
🗑
|
||||
| Menorrhagia | excess menstrual flow; MCC iron deficiency in women
🗑
|
||||
| Dysmenorrhea | painful menses; 1° PGF2α, 2° endometriosis
🗑
|
||||
| DUB | bleeding related to hormone rather than anatomic causes
🗑
|
||||
| Anovulatory DUB | menarche and perimenopause; estrogen excess without progesterone
🗑
|
||||
| Ovulatory DUB | irregular shedding, inadequate luteal phase
🗑
|
||||
| Primary amenorrhea | no menses by 16 years old
🗑
|
||||
| Secondary amenorrhea | no menses for 3 months
🗑
|
||||
| Amenorrhea-hypothalamic/pituitary dysfunction | ↓ FSH/LH; e.g., hypopituitarism
🗑
|
||||
| Amenorrhea-ovarian dysfunction | ↑FSH/LH; e.g., Turner's syndrome
🗑
|
||||
| Amenorrhea-end-organ disease | normal FSH/LH; e.g., imperforate hymen
🗑
|
||||
| Asherman syndrome | surgical removal of stratum basalis
🗑
|
||||
| Primary amenorrhea-normal secondary sex characteristics | constitutional delay MCC
🗑
|
||||
| Primary amenorrhea-lack secondary sex characteristics | Turner's
🗑
|
||||
| Turner's syndrome | XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs)
🗑
|
||||
| S/S | newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; 1° amenorrhea
🗑
|
||||
| Secondary amenorrhea | pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma
🗑
|
||||
| Asherman syndrome | removal of stratum basalis causing scarring; secondary amenorrhea
🗑
|
||||
| Endometritis | group B streptococcus; intrauterine device (Actinomyces); chronic - plasma cells
🗑
|
||||
| Endometrial polyp | menorrhagia; not a precursor for endometrial cancer
🗑
|
||||
| Adenomyosis | functioning endometrial glands and stroma in myometrium; enlarged uterus
🗑
|
||||
| Endometriosis | functioning glands and stroma outside uterus; reverse menses; ovary MC site
🗑
|
||||
| S/S | dysmenorrhea, painful stooling, bowel obstruction; "powder burn" appearance
🗑
|
||||
| Endometrial hyperplasia | unopposed estrogen; simple/complex types; precursor endometrial cancer
🗑
|
||||
| Causes | obesity, estrogen Rx, polycystic ovarian syndrome
🗑
|
||||
| Endometrial cancer | obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective
🗑
|
||||
| S/S | bleeding in postmenopausal woman
🗑
|
||||
| Leiomyoma uterus | menorrhagia, obstructive delivery; not a precursor for leiomyosarcoma
🗑
|
||||
| Leiomyosarcoma | MC sarcoma
🗑
|
||||
| Ectopic pregnancy | PID MC risk factor; intraperitoneal hemorrhage; screen with ß-hCG
🗑
|
||||
| Follicular cyst | MC ovarian mass in young woman
🗑
|
||||
| Risk factors ovarian tumors | nulliparity and genetic factors; OC protective
🗑
|
||||
| Serous ovarian tumors | surface-derived; ↑ bilaterality; psammoma bodies in malignant type
🗑
|
||||
| Mucinous ovarian tumors | surface-derived; pseudomyxoma peritonei in malignant type
🗑
|
||||
| Endometrioid carcinoma | resembles endometrial cancer; association with endometriosis
🗑
|
||||
| Cystic teratoma | MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications
🗑
|
||||
| Dysgerminoma | MC malignant germ cell tumor; associated with streak gonads of Turners
🗑
|
||||
| Yolk sac tumor | MC germ cell tumor young girl; ↑AFP; Schiller-Duval bodies
🗑
|
||||
| Meigs syndrome | ovarian fibroma, ascites, right-sided pleural effusion
🗑
|
||||
| Granulosa tumor | low grade malignant; hyperestrinism, Call Exner bodies
🗑
|
||||
| Thecoma | benign; yellow color; hyperestrinism
🗑
|
||||
| Leydig cell and Sertoli cell tumors | hyperandrogenism
🗑
|
||||
| Gonadoblastoma | XY phenotype of Turner's
🗑
|
||||
| Krukenberg tumors | metastatic stomach cancer; signet ring cells
🗑
|
||||
| Single umbilical artery | ↑ incidence congenital defects
🗑
|
||||
| Syncytiotrophoblast | lining of villi; produces hCG and human placental lactogen
🗑
|
||||
| Human placental lactogen | responsible for mild glucose intolerance in pregnancy
🗑
|
||||
| Abruptio placenta | retroplacental clot; painful bleeding; hypertension, cocaine, smoking
🗑
|
||||
| Placenta previa | placenta implanted over cervical os; painless bleeding
🗑
|
||||
| Placenta accreta | direct implantation into myometrium without intervening decidua; hysterectomy
🗑
|
||||
| Twin placenta | monochorionic always identical twins; dichorionic may be identical or fraternal
🗑
|
||||
| Siamese twins | monoamniotic monochorionic twin placenta
🗑
|
||||
| Enlarged placenta | DM, Rh HDN, syphilis
🗑
|
||||
| Complete mole | benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male)
🗑
|
||||
| S/S | preeclampsia in first trimester; ↑ incidence choriocarcinoma
🗑
|
||||
| Partial mole | embryo present; 68 XXY; no transformation into choriocarcinoma
🗑
|
||||
| Choriocarcinoma | malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast)
🗑
|
||||
| Risk factors | complete mole (MC), spontaneous abortion, normal pregnancy
🗑
|
||||
| S/S | ↑hCG; lung metastasis; good prognosis
🗑
|
||||
| Chorioamnionitis | group B streptococcus (S. agalactiae) infection
🗑
|
||||
| Preeclampsia | abnormal placentation causing placental ischemia; ↑ in vasoconstrictors (ATII)
🗑
|
||||
| S/S | hypertension, proteinuria, pitting edema; begins in third trimester
🗑
|
||||
| Spontaneous abortion | 50% have karyotype deformity (trisomy 16)
🗑
|
||||
| Amniotic fluid | fetal urine
🗑
|
||||
| Polyhydramnios | TE fistula, duodenal atresia, open neural tube defects
🗑
|
||||
| Oligohydramnios | infantile polycystic disease
🗑
|
||||
| ↑ Serum AFP | open neural tube defect
🗑
|
||||
| ↓ Serum AFP | Down syndrome
🗑
|
||||
| Urine estriol | fetal adrenal, placental, maternal liver involved in its production
🗑
|
||||
| Down syndrome triad | ↑ ß-hCG, ↓ serum AFP, ↓ urine estriol
🗑
|
||||
| Fibrocystic change | MC breast mass <50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts
🗑
|
||||
| Sclerosing adenosis | component of FCC; involves terminal lobules often has microcalcifications
🗑
|
||||
| Fibroadenoma | benign stromal tumor; MC movable mass in women <35-yrs-old
🗑
|
||||
| Intraductal papilloma | benign tumor lactiferous duct/sinus; MCC bloody nipple discharge <50-yr-old
🗑
|
||||
| Invasive ductal cancer | MCC breast mass in woman >50-yrs-old
🗑
|
||||
| Breast cancer risk | unopposed estrogen; family history first-degree relatives
🗑
|
||||
| Breast cancer | painless mass upper outer quadrant in woman >50-yrs-old
🗑
|
||||
| Mammography | screening test to detect non-palpable masses
🗑
|
||||
| Palpable breast mass | order fine needle aspiration (not a mammogram)
🗑
|
||||
| Ductal carcinoma in situ | necrotic centers (comedo); microcalcifications common
🗑
|
||||
| Paget's disease of breast | invasive ductal cancer into nipple; Paget's cells similar to vulvar Paget's
🗑
|
||||
| Medullary carcinoma | bulky tumor with large cells and lymphoid infiltrate; more common in Pt with BRCA 1 mutation
🗑
|
||||
| Inflammatory carcinoma | orange peel appearance; lymphatics blocked by tumor (lymphedema)
🗑
|
||||
| Lobular cancer | MC cancer of terminal lobule; ↑ bilaterality
🗑
|
||||
| Phyllodes tumor | low grade malignant tumor of stroma
🗑
|
||||
| ER-PR positive tumors | tumors responding to hormones; candidate for tamoxifen (anti-estrogen)
🗑
|
||||
| ERB-B2 oncogene positive breast cancer | aggressive breast cancer
🗑
|
||||
| Gynecomastia | estrogen stimulation of male breast
🗑
|
||||
| Gynecomastia | normal in newborn, puberty (no surgery), old age; (micronodular) cirrhosis MC pathologic cause
🗑
|
||||
| Overactive endocrine syndrome | most often adenomas; use suppression tests (most do not suppress)
🗑
|
||||
| Tumors that suppress | prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)
🗑
|
||||
| Underactive endocrine syndrome | autoimmune destruction MCC; stimulation tests
🗑
|
||||
| Hypopituitarism adults | non-functioning adenoma MCC, Sheehan's postpartum necrosis (stop lactation)
🗑
|
||||
| Hypopituitarism in children | craniopharyngioma (Rathke's pouch remnant) MCC; visual field defects
🗑
|
||||
| S/S ↓ FSH and LH | amenorrhea, ↓ testosterone in male
🗑
|
||||
| Growth hormone functions | muscle growth, gluconeogenesis; release of insulin growth factor (IGF)
🗑
|
||||
| IGF | synthesized in liver; bone and cartilage growth
🗑
|
||||
| S/S ↓ GH/IGF in children | growth retardation; ↓ height and weight
🗑
|
||||
| Sleep and arginine infusion | stimulation tests for GH and IGF
🗑
|
||||
| S/S ↓ GH/IGF in adults | hypoglycemia
🗑
|
||||
| S/S ↓ TSH | secondary hypothyroidism; ↓ T4, ↓ TSH; muscle weakness, dry skin
🗑
|
||||
| S/S ↓ ACTH | secondary hypocortisolism; ↓ cortisol, ↓ ACTH; fatigue; hypoglycemia
🗑
|
||||
| Metyrapone | stimulation test for ACTH reserve
🗑
|
||||
| Metyrapone | blocks adrenal 11-hydroxylase → ↑ ACTH and 11-deoxycortisol (proximal to block)
🗑
|
||||
| Metyrapone test ↓ ACTH and 11-deoxycortisol | pituitary/hypothalamic dysfunction
🗑
|
||||
| Metyrapone test ↑ ACTH and 11-deoxycortisol | Addison's disease
🗑
|
||||
| Diabetes insipidus | loss ADH (central), refractory to ADH (nephrogenic); always diluting urine
🗑
|
||||
| Central diabetes insipidus (CDI) | ↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm > 50%
🗑
|
||||
| Causes CDI | pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)
🗑
|
||||
| Nephrogenic diabetes insipidus (NDI) | ↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm < 50%
🗑
|
||||
| Causes NDI | lithium, demeclocycline, nephrocalcinosis, severe hypokalemia
🗑
|
||||
| Gigantism | GH secreting pituitary adenoma before epiphyses have fused
🗑
|
||||
| Acromegaly | GH secreting pituitary adenoma after epiphyses have fused
🗑
|
||||
| S/S acromegaly | cardiomyopathy; large hands, feet, jaw; hyperglycemia
🗑
|
||||
| Prolactin | inhibited by dopamine
🗑
|
||||
| Prolactinoma | MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH
🗑
|
||||
| Rx | surgery or bromocriptine (dopamine analog)
🗑
|
||||
| Other causes hyperprolactinemia | primary hypothyroidism, drugs
🗑
|
||||
| Inappropriate ADH syndrome | hyponatremia <120 mEq/L; ↑ UOsm (always concentrating urine)
🗑
|
||||
| Causes | small cell carcinoma lung, CNS injury, chlorpropamide
🗑
|
||||
| Rx | restrict water; demeclocycline in small cell carcinoma
🗑
|
||||
| Serum T4 | ↑ or ↓ in free hormone or thyroid binding globulin (TBG)
🗑
|
||||
| ↑ Serum T4 and normal TSH | ↑ TBG; due to ↑ in estrogen
🗑
|
||||
| ↑ Serum T4 and ↓ TSH | thyrotoxicosis
🗑
|
||||
| ↓ Serum T4 and normal TSH | ↓ TBG; due to anabolic steroids
🗑
|
||||
| ↓ Serum T4 and ↑ TSH | primary hypothyroidism
🗑
|
||||
| ↓ Serum T4 and ↓ TSH | secondary hypothyroidism
🗑
|
||||
| TSH | negative feedback with T4 and T3; best screening test
🗑
|
||||
| I131 uptake | ↑ in Graves; ↓ in thyroiditis, patient taking excess thyroid, hypothyroidism
🗑
|
||||
| Cold nodule | non-functioning nodule; no uptake I131
🗑
|
||||
| Hot nodule | functioning nodule; ↑ uptake I131
🗑
|
||||
| Thyroglossal duct cyst | midline cystic mass
🗑
|
||||
| Branchial cleft cyst | cyst in anterolateral neck
🗑
|
||||
| Acute/subacute thyroiditis | painful thyroid; early thyrotoxicosis; ↓ I131 uptake
🗑
|
||||
| Hashimoto's thyroiditis | MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody
🗑
|
||||
| Hashimoto's thyroiditis | ↑ anti microsomal and thyroglobulin antibodies
🗑
|
||||
| S/S | muscle weakness, periorbital puffiness, ↓ reflexes, diastolic hypertension, constipation, dry skin
🗑
|
||||
| Lab | ↓ T4, ↑ TSH
🗑
|
||||
| Cretinism | maternal hypothyroidism before fetal thyroid developed, genetic disorder
🗑
|
||||
| S/S | mental retardation; short stature and increased weight; coarse skin
🗑
|
||||
| Thyrotoxicosis | any cause ↑ thyroid hormone activity; Graves disease, excess hormone, thyroiditis
🗑
|
||||
| Hyperthyroidism | ↑ synthesis thyroid hormone; Graves disease and toxic nodular goiter
🗑
|
||||
| Graves disease | autoantibody against TSH receptor (type II reaction); HLA Dr3
🗑
|
||||
| S/S unique to Graves | exophthalmos, pretibial myxedema
🗑
|
||||
| S/S thyrotoxicosis | tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes
🗑
|
||||
| Lab thyrotoxicosis | ↑ T4, ↓ TSH, ↑ glucose, ↑ calcium
🗑
|
||||
| I131 uptake | ↑ Graves, toxic nodular goiter; ↓ thyroiditis, excess hormone, hypothyroidism
🗑
|
||||
| Rx Graves disease | ß-blocker; drug to decrease hormone synthesis (propylthiouracil)
🗑
|
||||
| Toxic nodular goiter | hyperthyroidism; develops out of a multinodular goiter; no exophthalmos
🗑
|
||||
| Goiter | enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency
🗑
|
||||
| S/S | rapid enlargement due to hemorrhage into cyst; Rx thyroxine
🗑
|
||||
| Solitary thyroid nodule woman | most often benign (cyst)
🗑
|
||||
| Solitary thyroid nodule man or child | often malignant
🗑
|
||||
| Papillary carcinoma thyroid | MC thyroid cancer; radiation exposure; psammoma bodies
🗑
|
||||
| Follicular carcinoma thyroid | invades blood vessels
🗑
|
||||
| Medullary carcinoma thyroid | parafollicular cells; calcitonin; amyloid (calcitonin conversion)
🗑
|
||||
| MEN I syndrome | 3 P's; pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or ß-islet cell tumor)
🗑
|
||||
| MEN IIa syndrome | 2 P's; medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma
🗑
|
||||
| MEN IIb syndrome | 1 P; medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas
🗑
|
||||
| Alkalotic pH | tetany with normal total calcium, ↓ ionized calcium and ↑ PTH
🗑
|
||||
| Hypoalbuminemia | ↓ total calcium, normal ionized calcium and PTH
🗑
|
||||
| Tetany | ↓ ionized calcium level; threshold potential comes closer to resting potential
🗑
|
||||
| S/S | thumb adducts into palm, twitching after tapping of facial nerve
🗑
|
||||
| PTH | maintains ionized Ca2+; ↑ Ca2+ renal reabsorption; ↓ phosphate/bicarbonate reabsorption in kidneys
🗑
|
||||
| Primary HPTH | ↑ Ca2+, hypophosphatemia, ↑ PTH
🗑
|
||||
| Cause | adenoma MCC, hyperplasia, cancer
🗑
|
||||
| S/S | renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification
🗑
|
||||
| Secondary HPTH | ↓ Ca2+, ↑ PTH; hypovitaminosis D from renal failure MCC
🗑
|
||||
| Malignancy-induced hypercalcemia | ↑ Ca2+, ↓ PTH; all other non-parathyroid causes same results
🗑
|
||||
| Causes hypercalcemia | osteolytic lesions, sarcoidosis, ↑ vitamin D, PTH-related peptide, myeloma
🗑
|
||||
| Tertiary HPTH | hypercalcemia developing from secondary HPTH
🗑
|
||||
| Primary hypoparathyroidism | ↓ Ca2+ and ↓ PTH
🗑
|
||||
| Causes | previous thyroid surgery, autoimmune, DiGeorge syndrome
🗑
|
||||
| S/S | tetany; calcification basal ganglia
🗑
|
||||
| Pseudohypoparathyroidism | ↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH
🗑
|
||||
| Other causes ↓ Ca2+ | hypomagnesemia (↓ PTH), ↓ vitamin D, DiGeorge
🗑
|
||||
| ↓ Ca2+ and ↓ PTH | primary hypoparathyroidism
🗑
|
||||
| ↓ Ca2+ and ↑ PTH | secondary hyperparathyroidism
🗑
|
||||
| ↑ Ca2+ and ↑ PTH | primary hyperparathyroidism
🗑
|
||||
| ↑ Ca2+ and ↓ PTH | malignancy induced hypercalcemia; other causes hypercalcemia
🗑
|
||||
| Waterhouse-Friderichsen syndrome | meningococcemia with bilateral adrenal hemorrhage due to DIC
🗑
|
||||
| Addison's disease | autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis
🗑
|
||||
| S/S | hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia
🗑
|
||||
| Lab | ↓ sodium, ↓ cortisol, ↑ potassium, ↑ ACTH
🗑
|
||||
| Adrenogenital syndrome | AR; enzyme deficiency; hypocortisolism; hyperpigmentation from ↑ ACTH
🗑
|
||||
| 21-Hydroxylase deficiency | ↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite
🗑
|
||||
| 11-Hydroxylase deficiency | ↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite
🗑
|
||||
| 17-Hydroxylase deficiency | ↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
🗑
|
||||
| MCC Cushings | long-term corticosteroid therapy
🗑
|
||||
| Tests Cushings syndrome | low/high dose dexamethasone suppression; urine free cortisol (best test)
🗑
|
||||
| Normal dexamethasone suppression | cortisol analogue; ↓ ACTH and ↑ cortisol
🗑
|
||||
| Pituitary Cushings | MCC Cushing's; ACTH secreting pituitary tumor
🗑
|
||||
| Lab | low dose dexamethasone not suppress cortisol; high dose suppresses
🗑
|
||||
| Adrenal Cushings | adrenal adenoma secreting cortisol; suppressed ACTH
🗑
|
||||
| Lab | no suppression with low/high dose dexamethasone
🗑
|
||||
| Ectopic Cushings | ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels
🗑
|
||||
| Lab | no suppression with low/high dose dexamethasone
🗑
|
||||
| S/S Cushings | purple stria, truncal obesity, hypertension, DM
🗑
|
||||
| Primary aldosteronism | benign adenoma in zona glomerulosa
🗑
|
||||
| S/S | hypertension and muscle weakness (hypokalemia), no pitting edema
🗑
|
||||
| Lab | hypernatremia, hypokalemia, metabolic alkalosis, ↑ urine K+ and Na+
🗑
|
||||
| Pheochromocytoma | benign tumor in adrenal medulla in adults
🗑
|
||||
| Associations | von Hippel Lindau, neurofibromatosis, MEN IIa and IIb
🗑
|
||||
| S/S | labile hypertension, anxiety, sweating, headache
🗑
|
||||
| Lab | ↑ 24 hr urine for VMA and metanephrines
🗑
|
||||
| Neuroblastoma | malignant tumor adrenal medulla child; widespread metastasis; hypertension
🗑
|
||||
| ß-islet cell tumor (insulinoma) | benign tumor; hypoglycemia, ↑ insulin and C-peptide
🗑
|
||||
| Patient taking excess insulin | hypoglycemia, ↑ insulin, ↓ C-peptide
🗑
|
||||
| Glucagonoma | malignant α-islet cell tumor; hyperglycemia and rash
🗑
|
||||
| Zollinger Ellison syndrome | malignant islet cell tumor secreting gastrin; peptic ulcers
🗑
|
||||
| Somatostatinoma | malignant δ islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria
🗑
|
||||
| VIPoma | malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria
🗑
|
||||
| DM | organ damage correlates with glycemic control
🗑
|
||||
| Type 1 | young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis
🗑
|
||||
| Type 2 | older person; obese; relative insulin deficiency (↓ insulin receptors, postreceptor problems)
🗑
|
||||
| Type 2 | family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma
🗑
|
||||
| ↑ Non-enzymatic glycosylation | glucose attaches to amino acids in basement membranes
🗑
|
||||
| Non-enzymatic glycosylation | ↑ vessel permeability producing hyaline arteriolosclerosis
🗑
|
||||
| Osmotic damage | glucose converted into sorbitol by aldose reductase
🗑
|
||||
| Osmotic damage | lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)
🗑
|
||||
| Pathogenesis hyperglycemia | ↑ gluconeogenesis (most important), glycogenolysis
🗑
|
||||
| Pathogenesis hyperlipidemia | no insulin to stimulate capillary lipoprotein lipase; ↑ chylomicrons/VLDL
🗑
|
||||
| Pathogenesis ketoacidosis | ↑ oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies
🗑
|
||||
| Most commons due to DM | neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation
🗑
|
||||
| Glycosylated HbA1c | measure of long term glycemic control (8-12 weeks)
🗑
|
||||
| Gestational DM | ↑ placental size, human placental lactogen
🗑
|
||||
| Complications | macrosomia (↑ muscle/fat from insulin), RDS, newborn hypoglycemia (↑ insulin)
🗑
|
||||
| Hypoglycemia | insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency
🗑
|
||||
| Carnitine deficiency | no ß-oxidation of fatty acids; all cells compete for glucose
🗑
|
||||
| Monosodium urate crystals (MSU) | yellow when parallel to slow ray of compensator
🗑
|
||||
| Calcium pyrophosphate crystals (pseudogout) | blue when parallel to slow ray of compensator
🗑
|
||||
| Osteoarthritis | degeneration articular cartilage; subchondral cysts; eburnation; osteophytes at margins
🗑
|
||||
| Joints | weight bearing (femoral head); DIP joint (Heberden's nodes), PIP joints (Bouchard nodes)
🗑
|
||||
| Neuropathic joint | 2° to neurologic disease; DM, syringomyelia, tabes dorsalis
🗑
|
||||
| Rheumatoid arthritis (RA) | female dominant; HLA Dr4
🗑
|
||||
| RF | IgM antibody against Fc portion IgG; causes inflammation of synovial tissue
🗑
|
||||
| Pannus | inflamed hyperplastic synovial tissue destroys articular cartilage; joint fusion
🗑
|
||||
| Joints | MCP and PIP joints
🗑
|
||||
| S/S | morning stiffness; ulnar deviation of hands; carpal tunnel (entrapped median nerve)
🗑
|
||||
| Rx | methotrexate often used as initial therapy, aspirin
🗑
|
||||
| Sjogren's syndrome | destruction lacrimal and minor salivary glands; RA; anti-SS-Ro/SS-La (SSa and SSb)
🗑
|
||||
| S/S | dry eyes and dry mouth
🗑
|
||||
| Caplan syndrome | pneumoconiosis + rheumatoid nodules in lungs
🗑
|
||||
| Felty's syndrome | RA + splenomegaly with hypersplenism
🗑
|
||||
| Gouty arthritis | underexcretion of uric acid; big toe first affected; tophus in soft tissue sign chronic gout
🗑
|
||||
| Gout associations | alcohol, Pb poisoning
🗑
|
||||
| Tophus | MSU crystals produce foreign body giant cell reaction next to joint
🗑
|
||||
| Uricosuric agents | probenecid and sulfinpyrazone
🗑
|
||||
| Allopurinol | ↓ synthesis uric acid; xanthine oxidase inhibitor
🗑
|
||||
| Pseudogout | involves knee; linear calcification in articular cartilage
🗑
|
||||
| Ankylosing spondylitis | HLA-B27 seronegative (RF negative) spondyloarthropathy; male dominant
🗑
|
||||
| S/S | sacroiliitis; bamboo spine causing kyphosis; aortitis; uveitis
🗑
|
||||
| Associations | C. trachomatis MC, psoriasis, ulcerative colitis, Shigella, Campylobacter, Yersinia
🗑
|
||||
| Reiter's syndrome | HLA-B27; Chlamydia urethritis; arthritis; conjunctivitis; Achilles tendon periostitis
🗑
|
||||
| Osteomyelitis children | hematogenous spread of Staphylococcus aureus to metaphysis
🗑
|
||||
| Osteomyelitis in HbSS | Salmonella paratyphi
🗑
|
||||
| Pseudomonas aeruginosa osteomyelitis | puncture of foot when wearing rubber foot wear
🗑
|
||||
| Tuberculous osteomyelitis | usually involves vertebra (Pott's disease)
🗑
|
||||
| Disseminated gonococcemia | female dominant; C6-C9 deficiency
🗑
|
||||
| Disseminated gonococcemia | septic arthritis (knee); tendinitis/synovitis and skin pustules in feet/wrists
🗑
|
||||
| Lyme disease | bite Ixodes tick; Borrelia burgdorjeri; reservoirs white footed mouse, white tailed deer
🗑
|
||||
| Early S/S | erythematous concentric rash (erythema chronicum migrans), Rx doxycycline
🗑
|
||||
| Late S/S | arthritis, Bell's palsy (often bilateral), myocarditis, Rx doxycycline
🗑
|
||||
| Babesiosis | carried by Ixodes tick; Babesia are intraerythrocytic parasites; hemolytic anemia
🗑
|
||||
| Cat bite | potential for Pasteurella multocida septic arthritis
🗑
|
||||
| Osgood Schlatter's | inflammation proximal tibial apophysis at patellar tendon insertion; knobby knee
🗑
|
||||
| Osteogenesis imperfecta | AD; ↓ synthesis type I collagen; pathologic fractures; blue sclera
🗑
|
||||
| Blue sclera | reflection choroidal veins
🗑
|
||||
| Achondroplasia | AD; impaired enchondral calcification and premature closure of epiphyses
🗑
|
||||
| S/S | normal head/vertebral column, short extremities
🗑
|
||||
| Osteopetrosis | AD/AR; osteoclast defect; too much bone; pathologic fractures
🗑
|
||||
| Osteoporosis | ↓ bone mass and density; pathologic fractures
🗑
|
||||
| Postmenopausal osteoporosis | estrogen deficiency - ↑ osteoclastic activity, ↓ osteoblastic activity
🗑
|
||||
| S/S | vertebral compression fractures, Colles fracture
🗑
|
||||
| Colles fracture | fractured distal radius with dinner fork appearance
🗑
|
||||
| Prevention | estrogen (under investigation), calcium, vitamin D, stress exercises (walking, weight lifting)
🗑
|
||||
| Aseptic necrosis femoral head | femoral head fracture, corticosteroids, sickle cell disease; MRI best test
🗑
|
||||
| Scaphoid bone fracture | aseptic necrosis in wrist bone
🗑
|
||||
| Volkmann's ischemic contracture | fracture of distal radius; damage to brachial artery and median nerve
🗑
|
||||
| Legg-Perthe's disease | aseptic necrosis of ossification center (femoral head) in children
🗑
|
||||
| Paget's disease | elderly males; lytic/blastic bone lesions produce thick, weak bone
🗑
|
||||
| S/S | pathologic fractures; ↑ serum AP; ↑ risk for osteogenic sarcoma
🗑
|
||||
| Osteoid osteoma | radiolucent lesion in cortex proximal femur; nocturnal pain relieved by aspirin
🗑
|
||||
| Osteogenic sarcoma | adolescent male; RB suppressor gene association; distal femur; ↑ AP
🗑
|
||||
| Radiograph | "sunburst" appearance, Codman's triangle
🗑
|
||||
| Ewing's sarcoma | primitive neuroectodermal tumor; round cell tumor
🗑
|
||||
| Radiograph | "onion skinning"
🗑
|
||||
| Osteochondroma | MC benign bone tumor; exophytic growth off metaphysis of distal femur
🗑
|
||||
| Chondrosarcoma | MC malignant cartilaginous tumor; pelvic bones, proximal femur
🗑
|
||||
| Giant cell tumor | epiphysis distal femur/proximal tibia; giant cells + neoplastic mononuclear cells
🗑
|
||||
| Muscle weakness | primary muscle disease, neurosynapse disease, neurogenic disease
🗑
|
||||
| Duchenne's muscular dystrophy | XR; deficiency dystrophin; ↑ serum CK at birth; waddling gait
🗑
|
||||
| Dystrophin | attaches portions of cell membrane to sarcomere; important in contraction
🗑
|
||||
| Becker's dystrophy | XR, defective dystrophin
🗑
|
||||
| Myotonic dystrophy | AD; trinucleotide repeat disorder; cannot release grip
🗑
|
||||
| Myasthenia gravis | autoantibody against acetylcholine receptors (type II); thymic hyperplasia B cells
🗑
|
||||
| S/S | diplopia at end of day first sign; dysphagia solids/liquids upper esophagus; thymoma
🗑
|
||||
| Dupuytren's contracture | fibromatosis palmar fascia
🗑
|
||||
| Lipoma | MC soft tissue tumor
🗑
|
||||
| Liposarcoma | MC adult sarcoma
🗑
|
||||
| Embryonal rhabdomyosarcoma | MC childhood sarcoma
🗑
|
||||
| Autoimmune disease | loss of self-tolerance
🗑
|
||||
| Serum ANA | greatest sensitivity for detecting SLE
🗑
|
||||
| SLE | type III reaction; confirm with anti-dsDNA, anti-Sm
🗑
|
||||
| S/S | malar rash, photophobia, joint pain, fibrinous pericarditis, nephritic GN
🗑
|
||||
| Drug-induced lupus | procainamide, hydralazine; anti-histone antibodies
🗑
|
||||
| Antiphospholipid antibodies | lupus anticoagulant, anti-cardiolipin antibodies; vessel thrombosis
🗑
|
||||
| PSS | excess collagen; anti-topoisomerase antibodies
🗑
|
||||
| S/S | dysphagia solids/liquids, Raynaud's, interstitial lung disease, renal failure
🗑
|
||||
| CREST | centromere antibody/calcinosis; Raynaud; esophageal dysmotility; sclerodactyly; telangiectasia
🗑
|
||||
| Dermatomyositis/polymyositis | ↑ serum CK; risk of malignancy
🗑
|
||||
| Mixed connective tissue disease | anti-ribonucleoprotein antibody
🗑
|
||||
| Antibody against acetylcholine receptor | myasthenia gravis
🗑
|
||||
| Antibody against basement membrane | Goodpasture's syndrome
🗑
|
||||
| Antibody against endomysium and gliadin | celiac disease
🗑
|
||||
| Antibody against insulin and islet cell | type I diabetes
🗑
|
||||
| Antibody against intrinsic factor and parietal cell | pernicious anemia
🗑
|
||||
| Antibody against microsome and thyroglobulin | Hashimoto's thyroiditis
🗑
|
||||
| Antibody against mitochondria | primary biliary cirrhosis
🗑
|
||||
| Antibody against proteinase 3 of neutrophil (cANCA) | Wegener's granulomatosis
🗑
|
||||
| Antibody against myeloperoxidase of neutrophils (pANCA) | microscopic polyangiitis
🗑
|
||||
| Antibody against TSH receptor | Graves disease
🗑
|
||||
| Ichthyosis vulgaris | ↑ thickness of stratum corneum; absent granular layer
🗑
|
||||
| Solar lentigo | "liver spot" in elderly; increased melanocytes
🗑
|
||||
| Senile purpura | trauma to fragile vessels on dorsum of hands; normal finding in elderly
🗑
|
||||
| Acute eczema | weeping rash with vesicles
🗑
|
||||
| Chronic eczema | dry, thickened, pruritic skin
🗑
|
||||
| Atopic dermatitis | dry skin, eczema (type I reaction); children - face, intertriginous areas
🗑
|
||||
| Allergic contact dermatitis | type IV hypersensitivity; poison ivy, nickel rash
🗑
|
||||
| Contact photodermatitis | tetracycline; rash in sun exposed areas
🗑
|
||||
| Superficial dermatophytoses | KOH preparation shows fungi located in stratum corneum
🗑
|
||||
| Tinea capitis | Trichophyton tonsurans MCC (negative Wood's lamp)
🗑
|
||||
| Tinea capitis child with dog | Microsporum canis (positive Wood's lamp)
🗑
|
||||
| Tinea versicolor | hypopigmentation; Malassezia furfur; "spaghetti" (hyphae)/"meatball" KOH
🗑
|
||||
| Seborrheic dermatitis | dandruff; Malassezia furfur
🗑
|
||||
| Molluscum contagiosum | poxvirus; bowl-shaped with central depression filled with keratin
🗑
|
||||
| Rubeola | Koplik's spots; Warthin-Finkeldey giant cells
🗑
|
||||
| Rubella | teratogenic; rash; postauricular adenopathy; arthritis in adults
🗑
|
||||
| Parvovirus | "slapped face"; RBC aplasia, aplastic anemia (HbSS), spontaneous abortions, arthritis
🗑
|
||||
| Roseola | HSV-6; high fever and then rash
🗑
|
||||
| Toxic shock syndrome | toxin-producing S. aureus; tampon wearing; hypotension, desquamating rash
🗑
|
||||
| Scarlet fever | group A streptococcus with erythrogenic toxin; strawberry tongue
🗑
|
||||
| Actinic (solar) keratosis | precursor for squamous cell carcinoma; recur when scrapped off
🗑
|
||||
| Psoriasis | elevated salmon-colored plaques covered by silver-colored scales; nail pitting
🗑
|
||||
| Pityriasis rosea | herald patch followed by rash in lines of cleavage
🗑
|
||||
| Varicella | chickenpox; rash at different stages; Reye syndrome association
🗑
|
||||
| Herpes zoster | vesicular rash following a sensory dermatome
🗑
|
||||
| HSV and Varicella-zoster virus | remain latent in sensory ganglia
🗑
|
||||
| Impetigo | group A streptococcus; honey crusted lesions on face
🗑
|
||||
| Pemphigus vulgaris | autoimmune disease; IgG antibodies against intercellular attachment sites
🗑
|
||||
| Pemphigus vulgaris | intraepidermal bullae; acantholytic cells; row of tombstones
🗑
|
||||
| Bullous pemphigoid | autoimmune disease; IgG antibodies against basement membrane
🗑
|
||||
| Bullous pemphigoid | subepidermal bullae
🗑
|
||||
| Pemphigus vulgaris/bullous pemphigoid | type II hypersensitivity
🗑
|
||||
| Dermatitis herpetiformis | autoimmune disease; IgA ICs; subepidermal bullae with neutrophils
🗑
|
||||
| Dermatitis herpetiformis | association with celiac disease
🗑
|
||||
| Erythema multiforme | vesicles and bullae; bullseye appearance
🗑
|
||||
| Risk factors | drugs, M. pneumoniae infection
🗑
|
||||
| Stevens Johnson syndrome | erythema multiforme involving mouth
🗑
|
||||
| Acne vulgaris | androgen dependent (receptor on sebaceous glands)
🗑
|
||||
| Acne vulgaris | Propionibacterium acnes lipases produce fatty acids causing inflammation
🗑
|
||||
| Acne rosacea | pustular, erythematous lesion on face resembling malar rash
🗑
|
||||
| Urticaria | type I and III reactions; type I due to mast cell release of histamine (drugs, fire ant bites)
🗑
|
||||
| Angioedema | subcutaneous swelling
🗑
|
||||
| Causes | ACE inhibitor (bradykinin); C1 esterase inhibitor deficiency (C2 and C4 decreased)
🗑
|
||||
| Sporotrichosis | traumatic implantation of Sporothrix fungus into subcutaneous tissue
🗑
|
||||
| Causes | rose gardener, lobster fisherman (sphagnum moss)
🗑
|
||||
| S/S | chain of subcutaneous nodules
🗑
|
||||
| Tuberculoid leprosy | intact cellular immunity (positive lepromin skin test); granulomas; no organisms
🗑
|
||||
| S/S | autoamputation of digits; skin depigmentation and anesthesia
🗑
|
||||
| Lepromatous leprosy | defective cellular immunity (negative lepromin skin test); no granulomas
🗑
|
||||
| S/S | leonine face, erythema nodosum during treatment
🗑
|
||||
| Histology | Grenz zone (zone free organisms) foamy macrophages with organisms
🗑
|
||||
| Rx | dapsone
🗑
|
||||
| Erythema nodosum | painful nodule on shins; subcutaneous fat inflammation
🗑
|
||||
| Associations | coccidioidomycosis, TB, leprosy
🗑
|
||||
| Keratoacanthoma | benign neoplasm; mimics squamous cancer; spontaneously resolves
🗑
|
||||
| UVB light cancers | basal cell carcinoma, squamous cell carcinoma, malignant melanoma
🗑
|
||||
| Vitiligo | autoimmune destruction melanocytes producing skin depigmentation
🗑
|
||||
| Seborrheic keratosis | pigmented, wart-like lesion; "stuck on" appearance
🗑
|
||||
| Leser-Trelat sign | multiple outcroppings seborrheic keratosis; consider stomach cancer
🗑
|
||||
| Acanthosis nigricans | verrucoid pigmented lesion usually in axilla; associated with gastric cancer
🗑
|
||||
| Chloasma | pregnancy mask due to increased melanocytes
🗑
|
||||
| Nevocellular nevus | benign pigmented tumor modified melanocytes
🗑
|
||||
| Histology | nevus cells proliferate along basal cell area, dermis, or both
🗑
|
||||
| Dysplastic nevus | precursor for malignant melanoma
🗑
|
||||
| Malignant melanoma | malignant tumor of melanocytes; most rapidly increasing cancer worldwide
🗑
|
||||
| ABCD for melanoma | A, asymmetry; B, irregular border; C, color change; D, increased diameter
🗑
|
||||
| Risk factors | severe sunburn at early age (MC), dysplastic nevi
🗑
|
||||
| Radial growth phase | spreads laterally in epidermis/superficial dermis but does not result in metastasis
🗑
|
||||
| Vertical growth | malignant cells penetrate into dermis; potential for metastasis
🗑
|
||||
| Lentigo malignant melanoma | face of elderly
🗑
|
||||
| Superficial spreading melanoma | lower extremities, back
🗑
|
||||
| Nodular melanoma | aggressive tumor with no radial growth phase
🗑
|
||||
| Acral lentiginous melanoma | palms, soles, under nails; may occur in blacks
🗑
|
||||
| Prognosis | depends most on depth of invasion
🗑
|
||||
| Prevention | sunscreen >15
🗑
|
||||
| Porphyria cutanea tarda | photosensitive bullous disease; deficiency uroporphyrinogen decarboxylase
🗑
|
||||
| S/S | hypertrichosis, fragile skin, port wine colored urine (uroporphyrins)
🗑
|
||||
| Black widow (Latrodectus) envenomation | neurotoxin; abdominal muscle cramps
🗑
|
||||
| Brown recluse (Loxosceles) envenomation | necrotoxin; skin ulcer
🗑
|
||||
| CSF | choroid plexus in ventricles; enters subarachnoid space; removed by arachnoid granulations
🗑
|
||||
| CSF | less protein and glucose than serum; scant number of cells; ↑ chloride
🗑
|
||||
| Xanthochromia | yellow colored CSF due to bilirubin pigment; indicates subarachnoid hemorrhage
🗑
|
||||
| Papilledema of optic nerve | sign of cerebral edema (intracranial hypertension)
🗑
|
||||
| Uncal herniation | intracranial hypertension; medial portion temporal lobe through tentorium cerebelli
🗑
|
||||
| S/S | midbrain hemorrhage; CN III palsy (pupil down/out); mydriasis
🗑
|
||||
| Mydriasis in uncal herniation | compression of parasympathetic system
🗑
|
||||
| Cerebellar tonsils herniate into foramen magnum | intracranial hypertension
🗑
|
||||
| Hydrocephalus | ↑ CSF volume with distention of ventricles
🗑
|
||||
| Non-communicating | blockage aqueduct Sylvius MCC newborn
🗑
|
||||
| Communicating | choroid plexus papilloma; scarring of arachnoid granulations
🗑
|
||||
| Adults with hydrocephalus | progressive dementia, wide-based gait, urinary incontinence; THINK
🗑
|
||||
| Open neural tube defects | folate must be adequate before pregnancy; ↑ AFP
🗑
|
||||
| Spina bifida occulta | dimple overlying skin L5-S1; vertebral arch not completely closed
🗑
|
||||
| Meningocele | vertebral defect with meninges
🗑
|
||||
| Meningomyelocele | vertebral defect with meninges and spinal cord
🗑
|
||||
| Arnold Chiari syndrome | elongation medulla/cerebellar tonsils through foramen magnum
🗑
|
||||
| S/S | hydrocephalus, syringomyelia, meningomyelocele
🗑
|
||||
| Dandy Walker syndrome | hypoplasia of cerebellar vermis; hydrocephalus
🗑
|
||||
| Syringomyelia | enlarged cervical cord; fluid filled cyst in cervical spinal cord
🗑
|
||||
| S/S | loss pain/temperature upper extremities (spinothalamic); motor loss in hands (anterior horn cells)
🗑
|
||||
| Tuberous sclerosis | AD; mental retardation; hamartomas CNS/kidney; shagreen patches skin
🗑
|
||||
| Tuberous sclerosis | angiomyolipomas kidneys; rhabdomyoma of heart
🗑
|
||||
| Neurofibromatosis | AD; pigmented neurofibromas; cafe au lait spots
🗑
|
||||
| Associations | pheochromocytoma, brain tumors, acoustic neuromas
🗑
|
||||
| Meningitis | nuchal rigidity
🗑
|
||||
| CSF findings viral meningitis | ↑ CSF protein, normal CSF glucose, ↑ lymphocytes
🗑
|
||||
| CSF findings bacterial meningitis | ↑ CSF protein, ↓ CSF glucose, ↑ neutrophils
🗑
|
||||
| Encephalitis | inflammation of brain; mental status abnormalities; coma
🗑
|
||||
| Coxsackievirus | MCC viral meningitis
🗑
|
||||
| HSV-1 | hemorrhagic necrosis in temporal lobes
🗑
|
||||
| Rabies | skunk and bat common vectors; Negri bodies in neurons; hydrophobia; flaccid paralysis
🗑
|
||||
| CMV | intranuclear inclusions; periventricular calcification in congenital infection
🗑
|
||||
| Polio virus | destruction of anterior horn cells; flaccid paralysis
🗑
|
||||
| Subacute sclerosing panencephalitis | slow virus disease due to rubeola (measles virus)
🗑
|
||||
| Progressive multifocal leukoencephalopathy | slow virus disease due to JC virus; common in AIDS
🗑
|
||||
| Creutzfeldt-Jakob disease | prions; spongiform encephalopathy
🗑
|
||||
| Risk factors | contact with human brain or contaminated beef (bovine disease)
🗑
|
||||
| Meningitis newborn | Streptococcus agalactiae (group B) MCC; E. coli, 2nd MCC
🗑
|
||||
| Listeria monocytogenes | newborn meningitis; gram + rods; pregnant mother should avoid soft cheeses
🗑
|
||||
| Neisseria meningitidis | MCC meningitis 1 month - 18-yrs-old; petechia and DIC characteristic
🗑
|
||||
| Streptococcus pneumoniae | MCC meningitis >18-yrs-old
🗑
|
||||
| Mycobacterium tuberculosis | complication primary TB; base of brain meningitis with vasculitis
🗑
|
||||
| Neurosyphilis | CSF with positive VDRL
🗑
|
||||
| Meningovascular syphilis | vasculitis causing strokes
🗑
|
||||
| General paresis | syphilis with dementia and brain atrophy
🗑
|
||||
| Tabes dorsalis | posterior root ganglia/posterior column; ataxia; absent deep tendon reflexes; Argyll-Robertson pupil
🗑
|
||||
| Argyll-Robertson pupil | pupil accommodates but does not react to direct light; THINK
🗑
|
||||
| Cryptococcus neoformans | MC opportunistic CNS fungal disease; positive India ink
🗑
|
||||
| Mucor species | frontal lobe abscess in diabetic ketoacidosis
🗑
|
||||
| Toxoplasma gondii | MCC space occupying lesion in AIDS; avoid cat litter and raw meat in pregnancy
🗑
|
||||
| Congenital toxoplasmosis | calcification basal ganglia; blindness; mental retardation
🗑
|
||||
| Naegleria and Acanthamoeba | amoeba in fresh water; meningoencephalitis
🗑
|
||||
| Taenia solium | pork tapeworm; adult with worms definitive host; adult with larva intermediate host
🗑
|
||||
| Cysticercosis | larval form of T. solium; produces blindness and calcified cysts in CNS (seizures)
🗑
|
||||
| Coup injuries | contusions at site of injury
🗑
|
||||
| Contrecoup injuries | contusion on opposite side of injury; frontal and temporal lobes
🗑
|
||||
| Epidural hematoma | temporoparietal skull fracture; tear middle meningeal artery
🗑
|
||||
| Subdural hematoma | tear bridging veins; venous blood clot; fluctuating levels of consciousness
🗑
|
||||
| Hypoxic injury | neurons more susceptible to damage than neuroglial cells
🗑
|
||||
| Laminar necrosis | liquefactive necrosis at watershed areas in cortex
🗑
|
||||
| Atherosclerotic stroke | pale infarction (liquefactive necrosis) extending to periphery of cerebral cortex
🗑
|
||||
| Causes atherosclerotic stroke | thrombosis of middle cerebral artery or carotid artery
🗑
|
||||
| MCA stroke | contralateral weakness/sensory loss; expressive aphasia if left hemisphere stroke
🗑
|
||||
| Amaurosis fugax | loss vision described as curtain going down and then up
🗑
|
||||
| Cause | embolus atherosclerotic plaque to branch of retinal artery (Hollenhorst plaque)
🗑
|
||||
| Vertebrobasilar stroke | vertigo, ataxia, ipsilateral sensory loss face/contralateral hemiparesis/sensory
🗑
|
||||
| Embolic stroke | hemorrhagic infarction extending to periphery cerebral cortex due to embolization
🗑
|
||||
| Intracerebral hemorrhage | complication hypertension
🗑
|
||||
| Cause of intracerebral hemorrhage | rupture of aneurysm of lenticulostriate vessels
🗑
|
||||
| Location of intracerebral hemorrhage | basal ganglia MC site
🗑
|
||||
| Subarachnoid hemorrhage | rupture of congenital berry aneurysm; severe occipital headache
🗑
|
||||
| Lacunar stroke | microinfarctions; due to hyaline arteriolosclerosis (hypertension, diabetes)
🗑
|
||||
| Pure motor stroke | posterior limb internal capsule
🗑
|
||||
| Pure sensory stroke | thalamus
🗑
|
||||
| Multiple sclerosis | autoimmune destruction myelin sheath/oligodendrocytes; plaques in white matter
🗑
|
||||
| S/S | scanning speech, intention tremor, nystagmus, paresthesias, weakness
🗑
|
||||
| Bilateral internuclear ophthalmoplegia | multiple sclerosis; demyelination MLF
🗑
|
||||
| CSF with oligoclonal bands | sign of demyelination
🗑
|
||||
| Central pontine myelinolysis | rapid intravenous correction of hyponatremia in alcoholic
🗑
|
||||
| Alzheimer's disease | MCC dementia Alzheimer's disease
🗑
|
||||
| Alzheimer's disease | ↑ amyloid-ß destroys neurons; occipital lobe spared
🗑
|
||||
| Alzheimer's disease | ↑ density of neurofibrillary tangles and senile plaques
🗑
|
||||
| Down syndrome | develop Alzheimer's disease at early age; 3 functioning chromosome 21s
🗑
|
||||
| Apo E gene allele ε4 | gene product has high affinity for amyloid-ß
🗑
|
||||
| Parkinson's disease | depigmentation substantia nigra neurons; Lewy bodies; ↓ dopamine
🗑
|
||||
| S/S | extrapyramidal (muscle rigidity), resting tremor, festinating (shuffling) gait
🗑
|
||||
| Causes | CO poisoning, Wilson's, MPTP (meperidine derivative), drugs
🗑
|
||||
| Huntington's disease | AD; atrophy of the head of the caudate nucleus; trinucleotide repeat disorder (anticipation)
🗑
|
||||
| S/S | movement disorder; dementia
🗑
|
||||
| Amyotrophic lateral sclerosis (ALS) | degeneration of lower/upper motor neurons; no sensory changes
🗑
|
||||
| Werdnig Hoffman disease | childhood type of ALS
🗑
|
||||
| Wilson's disease | AR; excess copper; cystic degeneration of putamen/globus pallidus
🗑
|
||||
| Vitamin B12 deficiency | posterior column (↓ proprioception, vibration); lateral corticospinal tract (UMN)
🗑
|
||||
| Alcohol | Wernicke-Korsakoff syndrome, cerebellar atrophy, central pontine myelinolysis
🗑
|
||||
| Wernicke encephalopathy | thiamine deficiency; IV with glucose can prompt acute attack
🗑
|
||||
| Wernicke encephalopathy | mammillary body hemorrhage (ring hemorrhages)
🗑
|
||||
| S/S | confusion, ataxia, nystagmus, ophthalmoplegia
🗑
|
||||
| Korsakoff's psychosis | limbic system; antegrade and retrograde memory deficits
🗑
|
||||
| Acute intermittent porphyria (AIP) | AD; deficiency uroporphyrinogen synthase; ↑ porphobilinogen
🗑
|
||||
| S/S | drug induced (alcohol, barbiturates); abdominal pain ("bellyful of scars"); dementia
🗑
|
||||
| Window sill test | urine in AIP colorless; turns port wine color with exposure to light (porphobilin)
🗑
|
||||
| Rx | heme infusions (inhibits δ-aminolevulinic acid synthetase)
🗑
|
||||
| Adult brain tumors | 70% supratentorial; frontal lobe MC site
🗑
|
||||
| Childhood brain tumors | 70% infratentorial; cerebellum MC site
🗑
|
||||
| Adult brain tumors (descending order) | GBM, meningioma, acoustic neuroma
🗑
|
||||
| GBM | high grade astrocytoma; hemorrhage and necrosis; may cross corpus callosum
🗑
|
||||
| Meningioma | female dominant; arise from arachnoid granulations; psammoma bodies; seizures
🗑
|
||||
| Acoustic neuroma | schwannoma of the VIIIth nerve; tinnitus; sensorineural hearing loss; neurofibromatosis
🗑
|
||||
| Childhood brain tumors | astrocytoma cerebellum (MC), medulloblastoma
🗑
|
||||
| Astrocytoma | MC primary brain tumor; frontal lobe MC site in adult; cerebellum MC site in child
🗑
|
||||
| Medulloblastoma | malignant tumor cerebellum; invades fourth ventricle
🗑
|
||||
| Ependymoma | arises in 4th ventricle in children and cauda equina in adults
🗑
|
||||
| Oligodendroglioma | frontal lobe tumor with dystrophic calcification
🗑
|
||||
| CNS lymphomas | metastasis MCC; primary CNS lymphoma associated with EBV in AIDS
🗑
|
||||
| Metastasis | MC brain malignancy; lung cancer MC site of origin; junction gray and white matter
🗑
|
||||
| Schwannoma | benign tumor Schwann cell; MC peripheral nerve tumor; alternating dark and light areas
🗑
|
||||
| AIDS dementia | due to HIV; multinucleated microglial cells
🗑
|
||||
| CMV retinitis | MCC of blindness in AIDS; Rx. ganciclovir (foscarnet if unsuccessful)
🗑
|
||||
| Peripheral neuropathy | myelin destruction (sensory; paresthesias); axon destruction (muscle atrophy)
🗑
|
||||
| Peripheral neuropathy | DM MCC; thiamine/pyridoxine deficiency; vinca alkaloids (vincristine)
🗑
|
||||
| Guillain-Barre syndrome | MCC autoimmune demyelination of peripheral and spinal nerves
🗑
|
||||
| Risk factors | M. pneumoniae, influenza vaccine, Campylobacter jejuni
🗑
|
||||
| S/S | ascending paralysis; CSF increased protein, lymphocytes; Rx. plasmapheresis
🗑
|
||||
| Charcot-Marie-Tooth | AD; common peroneal nerve palsy; inverted bottle appearance
🗑
|
||||
| Idiopathic Bell's palsy | facial muscle paralysis due to inflammation of cranial nerve VII
🗑
|
||||
| Lyme disease | facial nerve MC cranial nerve involved; bilateral Bell's palsy
🗑
|
||||
| Bacterial conjunctivitis | Staphylococcus aureus
🗑
|
||||
| Viral conjunctivitis | adenovirus MC; HSV-1 (dendritic ulcers)
🗑
|
||||
| Sudden loss of vision | amaurosis fugax, central retinal artery or vein occlusion
🗑
|
||||
| Uveitis | inflammation of iris, choroid, ciliary body; blurry vision; ankylosing spondylitis, sarcoidosis
🗑
|
||||
| Optic neuritis | multiple sclerosis MCC; methyl alcohol poisoning
🗑
|
||||
| Glaucoma | increased intraocular pressure; fluid cannot exit canal of Schlemm; causes optic atrophy
🗑
|
||||
| Optic atrophy | blindness; pale disc; glaucoma, optic neuritis
🗑
|
||||
| Macular degeneration | MCC permanent visual loss in elderly
🗑
|
||||
| Meniere's disease | increased endolymph; tinnitus, vertigo, sensorineural hearing loss
🗑
|
||||
| Presbycusis | MCC sensorineural hearing loss in elderly
🗑
|
||||
| Otosclerosis | MCC conductive hearing loss in elderly; fusion of ear ossicles
🗑
|
||||
| Impacted wax in outer ear canal | conduction hearing loss
🗑
|
||||
| Weber test lateralizes to left ear, bone>air conduction (Rinne test) | conduction loss left ear
🗑
|
||||
| Weber test lateralizes to left ear, air>bone conduction both ears | sensorineural hearing loss right ear
🗑
|
||||
| Otitis media | MCC conduction hearing loss in children; S. pneumoniae MCC
🗑
|
||||
| Malignant external otitis in diabetic | Pseudomonas aeruginosa
🗑
|
||||
| T cells | 60-70% total lymphocyte count; ↓ AIDS, DiGeorge, adenine deaminase deficiency
🗑
|
||||
| B cells | 10-20% total lymphocyte count; ↓ Bruton's, adenine deaminase deficiency
🗑
|
||||
| Antigen presenting cells | B cells, macrophages, dendritic cells
🗑
|
||||
| Langerhan's cells | antigen presenting cell in skin
🗑
|
||||
| Major histocompatibility complex | chromosome 6; HLA genes for self-identity
🗑
|
||||
| Class I proteins | recognized by CD8 T cells and NK cells
🗑
|
||||
| Class II proteins | recognized by CD4 TH cells
🗑
|
||||
| Type I reactions | IgE antibodies; mast cells; wheal and flare with bee sting
🗑
|
||||
| Type II reactions | antibody-mediated; Goodpasture's syndrome, rheumatic fever
🗑
|
||||
| Type III reactions | immune complex-mediated; SLE glomerulonephritis
🗑
|
||||
| Type IV reactions | cellular immunity; granuloma, positive PPD
🗑
|
||||
| Delayed reaction hypersensitivity reactions | CD4 TH cells and macrophages
🗑
|
||||
| Cytotoxic reactions | CD8 T cells; killing viral infected cells and neoplastic cells
🗑
|
||||
| Graft viability | ABO compatibility most important; HLA match
🗑
|
||||
| Fetus | allograft that is not rejected
🗑
|
||||
| Hyperacute rejection | type II hypersensitivity; ABO incompatibility or anti-HLA antibodies
🗑
|
||||
| Acute rejection | predominately cell-mediated reaction; MC rejection
🗑
|
||||
| Graft vs. host reaction | jaundice, rash, bloody diarrhea
🗑
|
||||
| IgA immunodeficiency | MC hereditary immunodeficiency; giardiasis, allergies
🗑
|
||||
| Bruton's agammaglobulinemia | XR; pre B cannot develop into B cells; S. pneumoniae infections
🗑
|
||||
| DiGeorge syndrome | failure 3rd/4th pharyngeal pouches to develop; T cell deficiency; absent thymus
🗑
|
||||
| S/S DiGeorge syndrome | absent thymic shadow; Candida, Pneumocystis infections; hypoparathyroidism
🗑
|
||||
| Adenine deaminase deficiency | AR; combined B and T cell deficiency; gene therapy
🗑
|
||||
| Wiskott Aldrich syndrome | XR; combined B and T cell deficiency; eczema, thrombocytopenia
🗑
|
||||
| AIDS | MC acquired immunodeficiency HIV
🗑
|
||||
| HIV transmission | MC sexually-transmitted; anal intercourse in homosexuals MCC
🗑
|
||||
| HIV transmission in health care workers | accidental needle stick from HIV positive patient
🗑
|
||||
| Follicular dendritic cell | reservoir for HIV in lymph nodes in latent phase
🗑
|
||||
| AIDS | HIV positive plus CD4, TH cell ≤200 cells/μL or AIDS-defining condition
🗑
|
||||
| Pneumocystis carinii pneumonia | MC AIDS-defining disorder
🗑
|
||||
| Screening test for HIV | ELISA test; detects anti-gp120
🗑
|
||||
| Confirmatory test for HIV | Western blot
🗑
|
||||
| HIV test with two peaks | p24 antigen; positive prior to seroconversion and when AIDS is diagnosed
🗑
|
||||
| MC cancer in AIDS | Kaposi sarcoma
🗑
|
||||
| MC infections CD4 TH <100 cells/μL | CMV, toxoplasmosis, M. avium-intracellulare
🗑
|
||||
| Hereditary angioedema | deficiency C1 esterase inhibitor; ↓ C2, C4, normal C3
🗑
|
||||
| Osmosis | H2O shift between ECF and ICF; controlled by serum Na+ and glucose
🗑
|
||||
| Serum Na+ ~ TBNa+/TBW | decreased TBNa+ dehydration; increased TBNa+ pitting edema
🗑
|
||||
| Isotonic loss | serum Na+ normal; adult diarrhea, loss whole blood; Rx with 0.9% saline
🗑
|
||||
| Isotonic gain | serum Na+ normal; Rx with salt and H2O restriction
🗑
|
||||
| Hyponatremia | ICF expanded; central pontine myelinolysis with rapid IV correction
🗑
|
||||
| Hyponatremia hypotonic gain pure water | inappropriate ADH syndrome
🗑
|
||||
| Hyponatremia hypotonic gain TBNa+ and TBW | pitting edema; cirrhosis, RHF
🗑
|
||||
| Hyponatremia hypertonic loss TBNa+ | dehydration; loop diuretic, Addison's, 11-hydroxylase deficiency
🗑
|
||||
| Hypertonic state | hypernatremia or hyperglycemia; ICF contraction
🗑
|
||||
| Hypernatremia hypertonic gain TBNa+ | pitting edema; sodium bicarbonate
🗑
|
||||
| Hypernatremia hypotonic loss water | diabetes insipidus
🗑
|
||||
| Hypernatremia hypotonic loss TBNa+ and TBW | osmotic diuresis, sweat, baby diarrhea
🗑
|
||||
| Acidosis | potential for hyperkalemia (shift out of ICF)
🗑
|
||||
| Alkalosis | potential for hypokalemia (shift into ICF)
🗑
|
||||
| Hypokalemia | loop and thiazide diuretics MCC; alkalosis, albuterol/insulin; U wave
🗑
|
||||
| Hyperkalemia | renal failure MCC; acidosis, ß-blocker, digitalis toxicity; peaked T wave
🗑
|
||||
| Rx hyperkalemia | calcium gluconate → insulin with glucose → loop diuretic
🗑
|
||||
| Respiratory acidosis | PaCO2 >45 mm Hg; compensation metabolic alkalosis
🗑
|
||||
| Respiratory acidosis | chronic bronchitis, ARDS, barbiturate poisoning, paralysis diaphragms
🗑
|
||||
| Respiratory alkalosis | PaCO2 <33 mm Hg; compensation metabolic acidosis
🗑
|
||||
| Respiratory alkalosis | pulmonary embolus, anxiety, early bronchial asthma, restrictive lung disease
🗑
|
||||
| Metabolic alkalosis | HCO3- >28 mEq/L; compensation respiratory acidosis
🗑
|
||||
| Metabolic alkalosis | loop/thiazide diuretics, vomiting, primary aldosteronism
🗑
|
||||
| Metabolic acidosis | HCO3- <2 mEq/L; compensation respiratory alkalosis
🗑
|
||||
| ↑ AG metabolic acidosis | add anions of acid to extracellular fluid
🗑
|
||||
| ↑ AG metabolic acidosis | lactate, AcAc, ß-OHB, salicylate, oxalate (ethylene glycol), formate (methyl alcohol), phosphate/sulfate (renal failure)
🗑
|
||||
| Ethylene glycol, methyl alcohol | compete with alcohol for alcohol dehydrogenase
🗑
|
||||
| Ethylene glycol poisoning | antifreeze; converted to oxalic acid; renal failure
🗑
|
||||
| Methyl alcohol poisoning | window wiper fluid; converted to formic acid; blindness
🗑
|
||||
| Normal AG metabolic acidosis | lose HCO3-; e.g., diarrhea, proximal/distal renal tubular acidosis
🗑
|
||||
| AFP | increased in open neural tube defects; decreased in Down syndrome
🗑
|
||||
| PCR | uses DNA polymerase
🗑
|
||||
| Barr body | inactive X chromosome on nuclear membrane; 1 Barr body in females
🗑
|
||||
| Missense mutation | point mutation with different amino acid; sickle cell trait/disease, Marfan
🗑
|
||||
| Nonsense mutation | point mutation producing stop codon; ß-thalassemia major
🗑
|
||||
| Frameshift mutation | insertion or deletion nucleotides alters reading frame; Tay-Sachs
🗑
|
||||
| Trinucleotide repeat | disease worse in future generations (anticipation)
🗑
|
||||
| Trinucleotide repeat disorders | fragile X (XR), Huntington's (AD), myotonic dystrophy (AD)
🗑
|
||||
| Nondisjunction | meiosis; unequal numbers of chromosomes
🗑
|
||||
| Robertsonian translocation | Down syndrome with 46 chromosomes
🗑
|
||||
| Microdeletion syndrome | genomic imprinting; chromosome 15
🗑
|
||||
| Paternal microdeletion | Prader-Willi; obese, mental retardation
🗑
|
||||
| Maternal microdeletion | Angelman's syndrome; happy puppy syndrome, mental retardation
🗑
|
||||
| Advanced maternal age | increased risk for trisomies
🗑
|
||||
| Down syndrome | trisomy 21; leading cause mental retardation
🗑
|
||||
| S/S | slanted eyes; simian crease; endocardial cushion defect; Alzheimer's
🗑
|
||||
| Turner's syndrome | XO; no Barr bodies; short stature and primary amenorrhea; streak ovaries
🗑
|
||||
| Klinefelter's syndrome | XXY; 1 Barr body; female secondary sex characteristics
🗑
|
||||
| AR | homozygous (aa) for disease; heterozygotes (Aa) asymptomatic
🗑
|
||||
| AR | most inborn errors metabolism, sickle cell, cystic fibrosis, hemochromatosis, Wilson's
🗑
|
||||
| AD | homozygote (aa) or heterozygote (Aa) express disease
🗑
|
||||
| AD | spherocytosis, Marfan's syndrome, neurofibromatosis, von Willebrand, familial polyposis, polycystic kidney
🗑
|
||||
| AD | delayed manifestation; penetrance; variable expressivity
🗑
|
||||
| XR | male transmits to all daughters; female carrier transmits to 50% of sons
🗑
|
||||
| XR | G6PD deficiency, Bruton, Lesch-Nyhan, testicular feminization, fragile X, hemophilia A/B
🗑
|
||||
| Fragile X | mental retardation; macroorchidism at puberty; trinucleotide repeat
🗑
|
||||
| Lesch Nyhan | XR; deficiency HGPRT; hyperuricemia; mental retardation
🗑
|
||||
| Multifactorial inheritance | gout, type 2 diabetes, essential hypertension
🗑
|
||||
| Mitochondrial DNA disorder | maternal transmission to all children; no paternal transmission
🗑
|
||||
| Y chromosome | determines genetic sex
🗑
|
||||
| Testosterone | develops seminal vesicles, epididymis, vas deferens
🗑
|
||||
| Dihydrotestosterone | develops prostate and male external genitalia
🗑
|
||||
| Male pseudohermaphrodite | genetic male; phenotypically female
🗑
|
||||
| Female pseudohermaphrodite | genetic female; phenotypically male
🗑
|
||||
| Testicular feminization | XR; deficient androgen receptors; MCC male pseudohermaphrodite
🗑
|
||||
| 21-Hydroxylase deficiency | ↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite
🗑
|
||||
| 11-Hydroxylase deficiency | ↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite
🗑
|
||||
| 17-Hydroxylase deficiency | ↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
🗑
|
||||
| Calculate prevalence | carrier rate 1:30; couples at risk
🗑
|
||||
| Calculate carrier rate | 1:3600; 3600 /4 = 900; √900) = 1:30
🗑
|
||||
| Malformation | intrinsic problem with morphogenesis
🗑
|
||||
| HOX gene | involved in embryogenesis
🗑
|
||||
| Alcohol | MCC of malformations; mental retardation; atrial septal defect
🗑
|
||||
| Isotretinoin acid | craniofacial and cardiac defects
🗑
|
||||
| Female with cystic acne needs Rx with retinoic acid | do pregnancy test before placing female on drug
🗑
|
||||
| DES | problem with mullerian development; clear cell carcinoma of vagina
🗑
|
||||
| Thalidomide | limb abnormalities
🗑
|
||||
| Vertical transmission | transplacental (MC), delivery, breast feeding
🗑
|
||||
| Congenital CMV | MC congenital infection; periventricular calcification; culture urine
🗑
|
||||
| Congenital toxoplasmosis | basal ganglia calcification; blindness; avoid cat litter in pregnancy
🗑
|
||||
| Congenital rubella | sensorineural hearing loss (MC); cataracts
🗑
|
||||
| Congenital syphilis | transplacental after 5-6 months; saddle nose, rhagades, blindness, deformed teeth
🗑
|
||||
| Congenital herpes | contracted during delivery; encephalitis
🗑
|
||||
| Deformation | extrinsic problem in fetal development; oligohydramnios causing Potter's facies
🗑
|
||||
| Tobacco | leading cause premature death and cancer in United States
🗑
|
||||
| Nicotine | most addictive substance; attaches to nicotinic cholinergic receptors
🗑
|
||||
| Tobacco induced cancers | lung, oropharynx, larynx, pancreas, kidney, bladder
🗑
|
||||
| Alcohol | CNS depressant (cortex, limbic system); legally drunk 80-100 mg/dL
🗑
|
||||
| Alcohol | induces SER hyperplasia; increases alcohol metabolism
🗑
|
||||
| Alcohol MCC of | folate/thiamine deficiency; sideroblastic anemia; liver fatty change; pancreatitis
🗑
|
||||
| Alcohol | hypoglycemia; lactic/ketoacidosis; ↑ triglyceride; AST>ALT; ↑ GGT
🗑
|
||||
| Ketoacidosis in alcoholic | ß-hydroxybutyric acid
🗑
|
||||
| Heroin | poppy plant; non-cardiogenic pulmonary edema; focal segmental glomerulosclerosis
🗑
|
||||
| MPTP | meperidine derivative; produces parkinsonism
🗑
|
||||
| Cocaine | blocks uptake of dopamine/norepinephrine; mydriasis; AMI, CNS infarction
🗑
|
||||
| Marijuana | tetrahydrocannabinol (THC) binds basal ganglia receptors; delayed reaction time; red conjunctiva
🗑
|
||||
| Intravenous drug abuse | HBV hepatitis MC systemic disease
🗑
|
||||
| Acetaminophen toxicity | damage by FR acetaminophen; liver cell necrosis; renal papillary necrosis
🗑
|
||||
| Rx acetaminophen toxicity | N-acetylcysteine (increases synthesis of glutathione)
🗑
|
||||
| Salicylate toxicity | metabolic acidosis + respiratory alkalosis; hyperthermia; tinnitus, vertigo
🗑
|
||||
| Estrogen risks | thromboembolism; cholestasis; endometrial/breast cancer
🗑
|
||||
| Oral contraceptives | cholestasis, thrombosis, folate deficiency, hypertension, hepatic adenoma
🗑
|
||||
| Hemolytic anemia | penicillin, methyldopa, quinidine
🗑
|
||||
| Aplastic anemia | benzene, chloramphenicol
🗑
|
||||
| Qualitative platelet dysfunction | NSAIDs
🗑
|
||||
| Thrombocytopenia | heparin, quinidine
🗑
|
||||
| Macrocytic anemia | methotrexate, 5-fluorouracil, phenytoin, OC, alcohol
🗑
|
||||
| Congestive cardiomyopathy | doxorubicin, daunorubicin
🗑
|
||||
| Interstitial fibrosis | bleomycin, methotrexate
🗑
|
||||
| Hemorrhagic gastritis | iron toxicity, NSAIDs
🗑
|
||||
| Liver necrosis | acetaminophen, isoniazid, salicylates, halothane, isotretinoin acid
🗑
|
||||
| Cholestasis | anabolic steroids, OC
🗑
|
||||
| Fatty change in liver | amiodarone, tetracycline, alcohol
🗑
|
||||
| Photosensitive rash | tetracycline
🗑
|
||||
| SLE | procainamide, hydralazine
🗑
|
||||
| Isopropyl alcohol | ↑ acetone; CNS dysfunction
🗑
|
||||
| Lead | microcytic anemia, nephrotoxic ATN (proximal tubule), gout, encephalopathy, neuropathy
🗑
|
||||
| Mercury | fish (tuna, salmon); nephrotoxic ATN; constricted visual fields
🗑
|
||||
| Organophosphates | blocks acetylcholine esterase; miosis; paralysis; Rx. atropine, pralidoxime
🗑
|
||||
| Polyvinyl chloride | plastic pipes; angiosarcoma of liver
🗑
|
||||
| Scorpion sting | paralysis, hypertension, pancreatitis
🗑
|
||||
| Crotaline bite | rattlesnakes, water moccasin, copperhead; DIC; serum sickness
🗑
|
||||
| Coral snake bite | neurotoxin; binds to presynaptic nerve terminals and acetylcholine receptors
🗑
|
||||
| Contact gunshot wound | soot + gunpowder (fouling)
🗑
|
||||
| Intermediate gunshot wound | powder tattooing
🗑
|
||||
| Distant gunshot wound | no powder tattooing; exit wound larger than entrance
🗑
|
||||
| Motor vehicle accidents | leading cause accidental death between 1-39 yrs of age
🗑
|
||||
| Burns | Pseudomonas aeruginosa sepsis MC COD
🗑
|
||||
| First degree burn | painful; complete healing
🗑
|
||||
| Second degree burn | painful; blister; complete healing
🗑
|
||||
| Third degree burn | painless; scarring
🗑
|
||||
| Frostbite | painless; ice crystallization in cells
🗑
|
||||
| Electrical injury | AC worse than DC; decreasing resistance (wet skin) increases current
🗑
|
||||
| House fires | carbon monoxide and cyanide poisoning
🗑
|
||||
| Heat exhaustion | fever and sweating
🗑
|
||||
| Heat stroke | fever and anhydrosis
🗑
|
||||
| Near drowning | survival following asphyxia due to submersion
🗑
|
||||
| Wet drowning | initial laryngospasm then relaxation and water into lungs
🗑
|
||||
| Dry drowning | intense laryngospasm without aspiration
🗑
|
||||
| Cold water drowning | shunts blood from periphery to central core
🗑
|
||||
| Drowning | hypoxemia key COD
🗑
|
||||
| Acute mountain sickness | headache MC; non-cardiogenic pulmonary edema (immediate descent)
🗑
|
||||
| High altitude | normal %O2; decreased barometric pressure; respiratory alkalosis; ↑ 2, 3 BPG
🗑
|
||||
| Ionizing radiation | DNA most susceptible protein
🗑
|
||||
| Ionizing radiation | lymphoid tissue most radiosensitive; bone least radiosensitive
🗑
|
||||
| Ionizing radiation cancers | leukemia (most common); thyroid cancer; osteogenic sarcoma
🗑
|
||||
| UVB-related cancers | basal cell carcinoma (most common); squamous cancer; melanoma
🗑
|
||||
| Carbohydrates | digestion begins in mouth
🗑
|
||||
| Fats | digestion begins in small intestine
🗑
|
||||
| Essential fatty acid deficiency | dermatitis, hair loss, poor wound healing
🗑
|
||||
| Proteins | digestion begins in stomach
🗑
|
||||
| Kwashiorkor | ↓ protein intake; ↓ visceral protein; ↓ albumin (pitting edema); fatty liver
🗑
|
||||
| Marasmus | total calorie deprivation; ↓ somatic protein; broomstick extremities
🗑
|
||||
| Anorexia nervosa | starvation; secondary amenorrhea (↓ GnRH); osteoporosis; ventricular MC COD
🗑
|
||||
| Bulimia nervosa | binging with vomiting; hypokalemic metabolic alkalosis; ventricular MC COD
🗑
|
||||
| Body mass index (BMI) | weight in kg/height in m2
🗑
|
||||
| Obesity | hypertension (MC), cholecystitis, osteoarthritis, type 2 DM, endometrial/breast cancer
🗑
|
||||
| Leptin | obesity gene product released from adipose; maintains energy balance
🗑
|
||||
| All-trans retinoic acid | Rx acute promyelocytic leukemia; matures blasts to neutrophils
🗑
|
||||
| Vitamin A | maintain visual purple, prevent squamous metaplasia, growth
🗑
|
||||
| Vitamin A deficiency | night blindness; blindness; squamous metaplasia
🗑
|
||||
| Vitamin A toxicity | ↑ intracerebral pressure; papilledema; hepatic necrosis
🗑
|
||||
| Vitamin D | maintain ionized Ca2+; mineralization of bone
🗑
|
||||
| Vitamin D metabolism | skin photoconversion or reabsorb in gut → 1st hydroxylation liver → 2nd hydroxylation proximal tubule (1-α-hydroxylase) Vitamin D deficiency
🗑
|
||||
| Causes | renal failure MCC; malabsorption; liver disease; ↓ sunlight
🗑
|
||||
| Lab | ↓ Ca2+, ↓ phosphate (malabsorption), ↑ phosphate renal failure, ↑ PTH
🗑
|
||||
| Hypervitaminosis D | ↑ Ca2+, renal stones
🗑
|
||||
| Vitamin E | prevents FR damage of cell membrane
🗑
|
||||
| Vitamin E deficiency | hemolytic anemia; posterior column/spinocerebellar tract degeneration
🗑
|
||||
| Vitamin E toxicity | ↓ synthesis vitamin K-dependent procoagulation factors; anticoagulated
🗑
|
||||
| Vitamin K | γ-carboxylates vitamin K-dependent factors
🗑
|
||||
| Vitamin K deficiency | ↓ epoxide reductase activity (↓ function vitamin K); hemorrhagic diathesis; ↑ PT
🗑
|
||||
| Warfarin | inhibits epoxide reductase
🗑
|
||||
| Causes vitamin K deficiency | antibiotics MC, newborn, malabsorption, warfarin
🗑
|
||||
| Thiamine functions | transketolase; dehydrogenase reactions (NADH for ATP synthesis)
🗑
|
||||
| Example of dehydrogenase reaction | pyruvate → acetyl CoA; pyruvate dehydrogenase
🗑
|
||||
| Thiamine deficiency | alcohol MCC; ↓ ATP synthesis
🗑
|
||||
| S/S | dry beriberi - Wernicke's, Korsakoff's, peripheral neuropathy; wet beriberi - cardiomyopathy
🗑
|
||||
| Niacin | oxidation-reduction reactions; NAD; NADP
🗑
|
||||
| Niacin deficiency | pellagra; dermatitis, diarrhea, dementia
🗑
|
||||
| Tryptophan | synthesis niacin, serotonin
🗑
|
||||
| Tryptophan deficiency | Hartnup's disease (↓ reabsorption neutral amino acids); carcinoid syndrome
🗑
|
||||
| S/S niacin deficiency | diarrhea, dermatitis, dementia
🗑
|
||||
| Corn | deficient in niacin and tryptophan
🗑
|
||||
| Pyridoxine | heme synthesis, transamination, neurotransmitter synthesis
🗑
|
||||
| Cause | taking isoniazid
🗑
|
||||
| Pyridoxine (B6) deficiency | sideroblastic anemia; convulsions; peripheral neuropathy
🗑
|
||||
| Vitamin B12/folate | DNA maturation, odd chain fatty acid metabolism (propionyl CoA)
🗑
|
||||
| Vitamin B12/folate deficiency | macrocytic anemia
🗑
|
||||
| Biotin | carboxylase reactions (pyruvate → oxaloacetate)
🗑
|
||||
| Cause | eating raw eggs (avidin binds vitamin)
🗑
|
||||
| S/S | alopecia, dermatitis
🗑
|
||||
| Vitamin C | antioxidant, reduce ferric iron, hydroxylation proline/lysine, dopamine → norepinephrine
🗑
|
||||
| Vitamin C deficiency | scurvy; hemorrhagic diathesis; poor wound healing
🗑
|
||||
| Alkalotic state | lowers ionized Ca2+ producing tetany; total Ca2+ normal
🗑
|
||||
| Hypoalbuminemia | lowers total Ca2+; no tetany
🗑
|
||||
| Hypophosphatemia | decreased ATP; myoglobinuria
🗑
|
||||
| Hypomagnesemia | causes hypocalcemia by inhibiting PTH synthesis/release
🗑
|
||||
| Zinc deficiency | poor wound healing; dysgeusia (cannot taste); anosmia; perioral rash
🗑
|
||||
| Copper deficiency | iron deficiency; poor wound healing (cofactor lysyl oxidase); aortic dissection
🗑
|
||||
| Iodine deficiency | produces goiter and hypothyroidism
🗑
|
||||
| Chromium deficiency | glucose intolerance
🗑
|
||||
| Selenium | antioxidant that neutralizes peroxide
🗑
|
||||
| Fluoride deficiency | dental caries
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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