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554 Cards in this Set
- Front
- Back
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Question
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Answer
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What is the most common malaria?
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Vivax (Viva! It's the MC)
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What is the fever pattern for P. vivax?
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48 hours (Viva the 48 hr party!!!)
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Which malaria is the most lethal?
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Falciparum (make one false step and you are dead)
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Which malaria is associated with nephrotic syndrome?
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P. malariae
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What is the fever pattern for P. falsiparirum?
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No pattern, it is so false that it doesn't have one
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What is the fever pattern for P. malariae?
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72 hours
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What do you find in the lab work?
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Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)
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Prophylaxis Tx for malaria?
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Chloroquine
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What drug do you use for resistant falciparum?
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Mefloquine
ME FLOr resistant Falciparum |
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What is the Tx for all except falciparum?
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Chloroquine plus primaquine
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What is the specific Tx for falciparum?
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IV quinidine or quinine plus doxycycline
Falciparum is the FALSE QUEEN (quinidine) |
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What leukemia has translocation t(15;17)
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Acute Promyelocytic Leukemia (M3)
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In which leukemia do you find DIC?
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Acute Promyelocytic Leukemia (M3)
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What leukemia has gum infiltration?
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Acute Monocytic Leukemia (M5)
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What leukemia has auer rods?
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Acute Myelogenous Leukemia (M2/M3)
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What are auer rods?
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fused azurophilic granules on cytosol of blast cells
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What leukemia is cured/reverse with Vitamin A (Retinol)?
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Acute Promyelocytic Leukemia (M3)
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What is the age distribution of all leukemias?
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ALL (0-14) AML (15-39) AML (40-60) CML (40-60) CLL (>60 years old)
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Which leukemia has translocation t9;22?
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Chronic Myelogenous Leukemia (CML)
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What is the frequency of acute leukemias ?
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Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%
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What leukemia is associated with ABL protooncogene?
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Chronic Myelogenous Leukemia (CML)
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What is the translocation of ABL protooncogene?
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t9;22
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What chromosome is CML found in? What is the name of the chromosome?
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Chromosome 22; Philadelphia Chromosome
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What is afected in chromosome 22 for CML?
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bcr (break cluster region) bcr-ABL fusion gene
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What is the most specific test for CML?
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decrease LAP (Leukocyte Alkaline Phosphatase)
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What are other positive tests for CML?
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philadephia chromosome and bcr-ABL fusion gene
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What is the most common cancer and leukemia in children?
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ALL
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What is the most common subtype?
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pre-B (80%)
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What is a positive marker for ALL?
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CALLA; CD10
Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase) You are Caller No. 10!!! |
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Where do B cells metastasize in ALL?
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CNS and testicles
think B is for Brain and Balls! |
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Where do T cells metastasize in ALL?
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Anterior Mediastinal mass or acute leukemia
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Which ALL type has best prognosis?
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t(12;21)
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Gout or Pseudogout?
How do you tell? |
Positively Birefringement (Blue color) Pseudogout
Negatively Birefringement (Yellow color) Gout |
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What crystal is negatively birefringent?
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Negative is Yellow in color so it's Monosodium Urate for Gout
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What crystals are positively birefringent?
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Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout
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Blue Crystals?
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Pseudublue
Pseudogout - Blue is Calcium pyrophosphate |
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Yellow Crystals?
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Gout Monosodium urate
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What joints are involved in Osteoarthritis?
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DIP + PIP
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What joints are involved in Rheumatoid Arthritis?
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MCP + PIP
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What are PIP joints inflamed called?
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Bouchard Node
Pouchard |
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What is a Heberden Node?
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Inflamation of DIP
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What is rheumatoid factor? (RF)
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IgM Ab against IgG
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Where is rhematoid factor found?
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In synovial fluid
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What is the synovial tissue that grows over the articulate cartilage called?
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Pannus
Not to be confused with Tophus that is found in Gout |
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Which on is symmetrical? Rheumatoid or Osteoarthritis?
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Rheumatoid
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What is it called when you get a patient with rheumatoid arthritis that expresses dry mouth and dry eyes?
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Schoegrem Sx
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Syndrome with rheumatoid arthritis with nodes in the lungs?
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Kaplan Sx
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What is the Tx of Rheumatoid Arthritis?
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Methotrexate
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What are some effects of long teng methotrexate tx?
i.e. Arhtritis Tx |
Macrocytic Anemia
Hypersegmented Neutrophils Also causes: Intersitial Fibrosis of the Lung |
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Tx for Gout?
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Indomethacine
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What drug do you give for underexcretion of uric acid?
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Probenecid
Sulfanpirizone |
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Overproducer of uric acid?
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Allopurinol
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What is the mech. of Allopurinol?
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Block Xanthine Oxidase
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What is the mechanism of uric acid accumulation/gout in alcoholics?
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Patients with alcoholism are under metabolic acidosis
-All the acids compete in the excrition of proximal tubule Alcoholics contain b-hydroxybutiric acid, lactic acid so they compete with uric acid to be excreted |
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Dz with degenerative arthritis in vertebral columns, pee turns black?
cartilage is turns black |
Alkaptonuria
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|
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What is the inheritance of alkaptonuria?
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autosomal recessive
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What enzyme is absent and what accumulates?
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Homgentisic Acid builds up
homogentisic oxidase |
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Patien w/ disuria, sterile piuria?
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Non-specific urethritis chlamydia
No culture in urine |
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Same patient develops pain on Achilles Tendon? Conjunctivitis
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Reiter's Sx
HLA-27 (+) patient |
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Chlamydia triggered HLA-B27?
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Yes, it made Reiter become active
- Ulcerative colitis can also be an environmental factor - psoriasis - shigella |
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Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?
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Disseminated Gonococchemia
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STD?
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Sinovitis
Tinosinovitis (hands) Dermititis (pustules hand and feet) |
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What components do you need to kill Gonorrhea?
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C5-C9
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Septic arthritis?
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MC gonorrhea (GC) Gonoccocus...
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Any patient with bilateral bell-spalsy?
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Lyme Dz until proven otherwise
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MC cranial nerve involved with Lyme Dz?
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VIIth nerve
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Hemolytic Anemia? What do you see in this patient?
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Babesia Micro
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Ticks carry both dz?
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Lyme and Babesia
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What percent of lyme infected have babeiosis?
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20% of patients have babeiosis
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What is babesia microti?
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intracellular erythrocytic parasite
similar to ring falciparum |
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Tx for chronic?
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Ceftriaxone
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Tx for acute?
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Tetracycline
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Mechanism of blue sclera?
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Color of veins is blue
Seein the coroidal veins that give the color to the sclera since there is very little collagen I |
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What is osteopetrosis?
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Brittle bone Dz
Defect in osteoclasts no marrow, severa anemia |
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Where are B cells located in lymph nodes?
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Germinal Follicles; Peripheral areas of spleen (white pulp)
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Where are T cells located?
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ParacorTex; periarteriolar sheat in spleen
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What are histiocytes and where are they located?
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Part of the Lymphatic system in sinuses; skin (Langherhan's Cells); Red Pulp in Spleen
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What is associated with Left Supraclavicular Nodes?
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Abdominal and Pancreatic CA
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What is associated with Right Supraclavicular Nodes?
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Lung Mets and Esophageal CA; Hodgkin's lymphoma
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What is the left supraclavicular node called?
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Virchow's Node
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What CA diseminates to para-aortic nodes?
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Testicular CA and Burkitt's Lymphoma
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What gene is associated with Follicular Lymphoma?
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Translocation t14;18
overexpression of bcl-2 Follicular Think Fourteen Fo Fo |
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What gene association is found in Burkitt's?
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EBV translocation t8;14
African Jaw |
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What does the African variant involve? (Burkitt's)
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Jaw
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What does the American variant involve? (Burkitt's)
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GI, ovaries and retroperitoneum
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What do you see in Burkitt's?
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Starry Sky Apparence
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What is the Starry Sky?
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macrophages w/ phagocytosed apoptotic bodies
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What are the characteristic cells in Hodgkin's Lymjphoma?
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association w/ EBV; cutaneous anergy to common antigens
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What are the cells of Hogkin's L. called?
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Reed-Sternberg Cells
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What are Reed-Sternberg Cells?
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transformed germinal center B cells
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What CD maker's do you use to detect RS cells?
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CD15 and CD30; you got to be able to REED by 15 and 30
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What does a classic RS cell look like?
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two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo
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What is elevated in vWF disease?
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Elevated Bleeding Time (platelet adh. problem)
aPTT increased |
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What is elevated on hemophilia A?
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VIII deficient
aPTT increased (intrinsic pathway) |
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What is elevated in a person taking aspirin?
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Bleeding Time elevated
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What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
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Bleeding Time increased
platelets decreased |
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What are two other diseases that has Bleed Time increased and decreased platelets?
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Thrombotic Thrombocytopenic Purpura
Hemolytic Uremic Syndrome |
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What factor involved in extrinsic pathway?
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VII
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What factor involved in intrinsic pathway?
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XII, XI, IX, VIII
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What is the best test for vWF diases?
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ristocetin cofactor assay
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What anti bodies does blood group O have?
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anti A-IgM
anti B-IgM anti AB- IgG |
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What anti bodies have blood A?
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anti B
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What does group B has?
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anti A-IgM
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What does group AB has?
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nothing
just like new borns and old people |
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What blood group has greatest incidence of gastric carcinoma?
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group A
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What is associated w/ duodenal ulcer?
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group O blood
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Who is the universal donor?
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Group O
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Who is the universal acceptor?
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AB no antibodies to attack those cells
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What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
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SIS
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What POC is associated w/ Leukemia?
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RAS
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What POC is associated w/ Breast CA?
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ERB-B2
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What POC is associated w/ Astrocytoma?
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SIS
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What POC is associated w/ Neuroblastoma?
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N-MYC
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What POC is associated w/ lung CA?
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RAS
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What POC is associated w/ CML?
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ABL
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What POC is associated w/ Burkitt's Lymphoma?
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c-MYC
MYC |
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What POC is associated w/ colon CA?
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RAS
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What POC is associated w/ MEN IIa/IIb Syndromes?
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RET
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WhatPOC is associated w/ pancreatic CA?
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RAS
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What function does SIS have?
|
GF synthesis
(Growth Factor) |
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What fx does ERB-B2 has?
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Receptor Synthesis
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What fx does ABL has?
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Non-receptor TK activity
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WHat fx does RET have?
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Receptor Synthesis
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What fx does MYC have?
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Nuclear Transcription
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What fx does N-MYC have?
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Nuclear transcription
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WHat fx does RAS has?
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GTP signal transduction
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What two POC have the same function of Receptor Synthesis?
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ERB-B2 and RET
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What two POC have the same fx of nuclear transcription?
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c-MYC and N-MYC
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What does SIS activate?
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Overexpression
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What does ERB-B2 activate?
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Amplification
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What does RET Activate?
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Point Mutation
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What does RAS activate?
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Point Mutation
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What does ABL activate?
|
translocation
t(9;22) |
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What does MYC activate?
|
c-MYC translocation t(8;14)
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What does N-MYC activate?
|
Amplification
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What two POC amplify?
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ERB-B2 and N-MYC
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What two POC activate point mutation?
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RET and RAS
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What two POC activate translocation?
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ABL and c-MYC
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What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
|
EBV
|
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What POC amplifies breasts??? imagine that...
|
ERB-B2
Breast bigger two! |
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What are the inactivation of suppressor genes?
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TP53, RB, APC and BRCA1/2
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What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
|
TP53
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What SG is assciated w/ breast, ovary and prostate CA?
|
BRCA 1
BRCA 2 |
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What SG is associated w/ familial polyposis: color cancer?
|
APC
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What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
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RB
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What is the function of TP53?
|
G1 to S phase inhibitor
|
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What is the function of BRCA 1/2 gene?
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Regulates DNA repair
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What is the APC gene function?
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Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription |
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What is the function of RB gene?
|
G1 to S phase inhibitor
|
|
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What are the genes fo anti-apoptosis?
|
BCL-2 genes
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What is the function of BCL-2 genes?
|
prevents the leakage of cytochrome c (signal for apoptosis)
|
|
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What disease is associated with BCL-2?
|
b-cell lymphoma
B C L -2 Follicular Lymphoma t14;18 |
|
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What is another disease that involves TP53?
|
Ataxia Telangiectasia
syceptibility to malignant lymphoma |
|
|
What virus is associated w/ TP53?
|
HBV and
HTLV-1(T cell leukemia and lymphoma) HPV 16,18 HPV16 inhibits TP53 RB inhibited by HPV 18 |
|
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What CA is associated w/ hypercalcemia?
|
primary SCC of lung
Renal Adeconcarcinoma PTH-like peptide |
|
|
WHat CA is associated w/ myasthenia gravis?
|
Eaton-Lambert Sx
SCC of lung |
|
|
What CA is associated w/ sudden appearance of seborrheic keratosis?
|
"Sudden"
Stomach Adenocarcinoma |
|
|
What CA is associated w/ hypertrophic osteoarthropathy?
|
Lung CA
|
|
|
What CA is associated w/ superficial migratory thrombophlebitis?
|
pancreatic carcinoma
Troussau sign (he had it himself, self-diagnosed) |
|
|
What CA manifests Nonbacterial thrombotic endocarditis?
(Sterile Vegetations on Mitral Valve) |
Mucous-secreting pancreatic and colorectal CA
|
|
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WHat CA manifests w/ ADH increase? What do you find clinically?
|
SCC of lung
Hyponatremia |
|
|
What SG is associated w/ familial polyposis: color cancer?
|
APC
|
|
|
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
|
RB
|
|
|
What is the function of TP53?
|
G1 to S phase inhibitor
|
|
|
What is the function of BRCA 1/2 gene?
|
Regulates DNA repair
|
|
|
What is the APC gene function?
|
Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription |
|
|
What SG is associated w/ familial polyposis: color cancer?
|
APC
|
|
|
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
|
RB
|
|
|
What is the function of TP53?
|
G1 to S phase inhibitor
|
|
|
What is the function of BRCA 1/2 gene?
|
Regulates DNA repair
|
|
|
What is the APC gene function?
|
Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription |
|
|
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
|
EBV
|
|
|
What POC amplifies breasts??? imagine that...
|
ERB-B2
Breast bigger two! |
|
|
What are the inactivation of suppressor genes?
|
TP53, RB, APC and BRCA1/2
|
|
|
What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
|
TP53
|
|
|
What SG is assciated w/ breast, ovary and prostate CA?
|
BRCA 1
BRCA 2 |
|
|
What does SIS activate?
|
Overexpression
|
|
|
What does ERB-B2 activate?
|
Amplification
|
|
|
What does RET Activate?
|
Point Mutation
|
|
|
What does RAS activate?
|
Point Mutation
|
|
|
What does ABL activate?
|
translocation
t(9;22) |
|
|
What POC is associated w/ lung CA?
|
RAS
|
|
|
What POC is associated w/ CML?
|
ABL
|
|
|
What POC is associated w/ Burkitt's Lymphoma?
|
c-MYC
MYC |
|
|
What POC is associated w/ colon CA?
|
RAS
|
|
|
What POC is associated w/ MEN IIa/IIb Syndromes?
|
RET
|
|
|
What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
|
SIS
|
|
|
What POC is associated w/ Leukemia?
|
RAS
|
|
|
What POC is associated w/ Breast CA?
|
ERB-B2
|
|
|
What POC is associated w/ Astrocytoma?
|
SIS
|
|
|
What POC is associated w/ Neuroblastoma?
|
N-MYC
|
|
|
What does group B has?
|
anti A-IgM
|
|
|
What does group AB has?
|
nothing
just like new borns and old people |
|
|
What blood group has greatest incidence of gastric carcinoma?
|
group A
|
|
|
What is associated w/ duodenal ulcer?
|
group O blood
|
|
|
Who is the universal donor?
|
Group O
|
|
|
What is elevated in vWF disease?
|
Elevated Bleeding Time (platelet adh. problem)
aPTT increased |
|
|
What is elevated on hemophilia A?
|
VIII deficient
aPTT increased (intrinsic pathway) |
|
|
What is elevated in a person taking aspirin?
|
Bleeding Time elevated
|
|
|
What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
|
Bleeding Time increased
platelets decreased |
|
|
What are two other diseases that has Bleed Time increased and decreased platelets?
|
Thrombotic Thrombocytopenic Purpura
Hemolytic Uremic Syndrome |
|
|
What CA manifests w/ ACTH increase? Clinical Symptoms?
|
SCC of lung
Medullary CA of Thyroid Clin: Cushing Sx |
|
|
What CA manifests increase in erythropoietin?
Clinical? |
Renal AdenoCA
primary SCC of lung Breast CA hypercalcemia |
|
|
What CA presents w/ inc. in B-hCG? Symp?
|
Choriocarcinoma (Testis)
gynecomastia |
|
|
What CA presenst w/ Calcitonin increase? Symp.?
|
Medullary CA of Thyroid
hypocalcemia |
|
|
What region of the face does BCC and SCC occur?
|
BCC top of the face upper lips
SCC below lower lips |
|
|
WHat RNA virus is associated with TP53 suppressor?
|
HTLV-1 T cell leukemia and lymphoma virus!
|
|
|
What DNA virus is associated w/ TP53 suppersor gene?
|
HBV and HPV 16,18 E6 inhibits it
|
|
|
What two genes are knocked out by HPV 16, 18?
|
E6 and E7 produced by HPV
E6 inhibits TP53 E7 inhibits RB suppressor gene |
|
|
What CA does EBV is associated with?
|
Burkitt's lymphoma
CNS lymphoma in AIDS Mixed Cellularity Hodgkin's Nasopharyngeal CA |
|
|
What virus is associated w/ hepatocelluar CA?
|
HBV
|
|
|
What RNA virus causes hepatocellular CA?
|
HCV not HBV!!!
HBV is DNA virus |
|
|
What deffect has opening snap during diastole?
|
Mitral Stenosis
Snap Stenosis |
|
|
What MCC of death in rheumatic fever?
|
Myocarditis
|
|
|
What type of Hypersensitivity is Rheumatic Fever?
|
Type II
|
|
|
What organism is involved in Rheumatic Fever?
|
group A Strepto
Step. pyogenes |
|
|
What do the antibodies react to in Group A Steptococcus?
|
Ab react to M proteins
|
|
|
What are two common findings in myocarditis?
|
aschoff bodies
Anitschkow Cells the two Russians |
|
|
WHat are Aschoff Bodies?
|
central fibrinoid necrosis surrounded by reactive histiocytes
|
|
|
How long after a group A step. pharyngitis does Rheumatic Fever occur?
|
1-5 weeks after episode
|
|
|
What are five signs of Rheumatic fever?
|
1) Carditis
2) Migratory polyarthritis 3) Subcutaneous Nodules 4) Erythema Marginatum 5) Sydenham's Chorea |
|
|
What valve is affected with a pansystolic (holosytolic) murmur?
|
Mitral Regurgitation
|
|
|
What valve is involved in a mid-systolic click?
|
Mitral Valve Prolapse
it clicks half way since the chordae restrain it |
|
|
What two diseases have Mitral Valve Prolapse?
|
Marfan's Sx
Ehlers Danlos |
|
|
What pathology is associated with coarctation of the aorta?
|
Turner Sx
|
|
|
What is the MC congenital heart disease in children?
|
VSD
very small dudes :) |
|
|
What is the MC congenital heart disease in adults?
|
a is for ASD
|
|
|
What are the three A's in ASD?
|
Adults
Alchohol Fetal Sx ALL from Down Syndrome |
|
|
What viral infection is involved w/ PDA?
|
rubella
|
|
|
What murmur is heard in PDA?
|
machine like murmur during systole and diastole
|
|
|
What keeps PDA open in fetus?
|
PGE2
|
|
|
What is the Tx for closure of PDA in newborn?
|
indomethacin
|
|
|
Where is the murmur best heard for PDA?
|
between the shoulder blades
|
|
|
What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?
|
Alcohol
|
|
|
What carcinogen is impilcated with stomach AdenoCA?
|
nitrosamines and nitrosamides
|
|
|
What carcinogen is impilcated with colorectal cancer?
|
Lithocholic acid
secondary bile acid |
|
|
What carcinogen is impilcated with Lung CA? (4)
|
uranium
asbestos chromium nickel |
|
|
What carcinogen is impilcated with pleural mesothelioma?
|
Asbestos
|
|
|
What carcinogen is impilcated with breast cancer and cervical cancer?
|
Oral Contraceptives
|
|
|
What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
|
Arsenic
|
|
|
What carcinogen is impilcated with TCC of bladder? (2)
|
cyclophosphamide
b-naphthylamine (dye and rubber indus.) |
|
|
What carcinogen is impilcated with acute leukemia?
|
benzene
|
|
|
What carcinogen is impilcated with SCC of penis?
|
Smegma in uncircumcised male
|
|
|
What carcinogen is impilcated with SCC of scrotum?
|
tar, soot, oil (chimney sweeper)
|
|
|
What carcinogen is impilcated with malignant lymphoma?
|
Alkylating agents
|
|
|
What is the mos common risk factor for BCC, SCC, melanoma?
|
UVB light
|
|
|
What is the mos common risk factor for Kaposi's Sacroma?
|
HHV-8
|
|
|
What is the mos common risk factor for Nasopharyngela CA?
|
EBV
|
|
|
What is the mos common risk factor for larynx CA?
|
polycyclic HOC (hydrocarbons)
|
|
|
What is the mos common risk factor for distal esophagus?
|
barret's disease
|
|
|
What is the mos common risk factor for Stomach AdenoCA?
|
Helicobacter pylori
|
|
|
What is the mos common risk factor for Colon adenoCA?
|
preexisting polyps
tubular and villous adenoma |
|
|
What is the mos common risk factor for pancreas?
|
polycyclic HOC
|
|
|
What is the mos common risk factor for hepatocellular CA?
|
HBV or HCV cirrhosis
|
|
|
What is the mos common risk factor for seminoma?
|
cryptorchid testis
semi-descended testis semi noma |
|
|
What is the mos common risk factor for breast CA?
|
age >50
excess estrogen: 1) nulliparity 2) early menarche 3) late menopause 4) obesity |
|
|
What is the mos common risk factor for dysgerminoma/gonadoblastoma?
|
Turner Sx XO dysgerminoma
XO/XY gonadoblastoma |
|
|
What is the mos common risk factor for vagina/cervix clear cell?
|
diethylestilbestrol
|
|
|
What is the mos common risk factor for surface derived ovarian CA?
|
nulliparity
because of increase of ovulatory cycles |
|
|
What is the mos common risk factor for choriocarcinoma?
|
Complete Hydatidiform Mole
|
|
|
What is the mos common risk factor for Malignant lymphoma thyroid?
|
Hashimoto's Thyroiditis
|
|
|
What is the mos common risk factor for papillary CA of thyroid?
|
Ionization Radiation
|
|
|
What is the mos common risk factor for medullary CA thyroid?
|
MEN IIa/IIb
|
|
|
What is the mos common risk factor for osteogenic sarcoma?
|
retinoblastoma
radiation |
|
|
What is the mos common risk factor for Primary CNS lymphoma?
|
EBV in AIDS pat.
|
|
|
What is the mos common risk factor for Burkitt's Lymphoma?
|
EBV
|
|
|
Which on is protein rich? Transudate or Exude?
|
Exude
extra proteins inside the fluid |
|
|
What causes flushing and diarrhea in carcinoid Sx?
|
serotonin
|
|
|
What mumurs are heard in systole with crescendo-decrescendo fashion??
|
Stenosis AV/PV (atrial valve/pulmonary valve)
|
|
|
When do Mitral Valve and tricuspid valve occur?
|
Opening Snap in mid-diastole
|
|
|
What murmur is heard in MV/TV regurgitation?
|
Pansystolic murmur
|
|
|
What murmur is heard in AV/PV regurgitation?
|
high pitched diastolic murmur directly after S2
|
|
|
What is the MC cardiomyopathy?
|
congestive (dilated) cardiomyopathy
|
|
|
What causes congestive cardiomyopathy? MC Drug? MC vitamin. def?
|
- idiopathic (MC)
- doxorubicin/cocaine - thiamine deficiency (Alcoholics) - hypothyroidism |
|
|
What is the MCC of sudden death in young people?
|
Hypertrophic cardiomyopathy
|
|
|
What is the MCC of infective endocartitis?
|
Strep. viridians
|
|
|
What is the MCC of infective endocartitis in I.V. drug user?
|
Staph. aureus
|
|
|
What is the MCC of infective endocartitis in colon cancer and ulcerative colitis?
|
Strep. bovis
|
|
|
What is the MCC of infective endocartitis in prosthetic devices?
|
Staph. epidirmidis
|
|
|
What is the MCC valve involved in infective endocartitis?
|
mitral valve
|
|
|
What are the clinical findings in infective endocarditis?
|
1) type III; HS
- Roth Spots retina - splinter hemorrhage - glomerulonephritis w/ RBC casts |
|
|
What is associated w/ Libman Sacks endocarditis?
|
SLE
|
|
|
What DZ has sterile vegetations covered on valvular surfaces?
|
SLE
-libman sacks endocarditis |
|
|
What two diseases are involved w/ mucin-producing sterile vegetations?
|
tumors of colon and pancreas
Marantic vegetations |
|
|
What is the MCC of viral myocarditis?
|
Coxsackievirus
|
|
|
What other pathogens cause myocarditis?
|
Borrelia (Lyme Dz)
T. cruzi (Chagas) Tichinella spiralis (trichinosis) |
|
|
What is the difference between myocarditis and pericarditis?
|
pericarditis adds AMI and Dressler's syndrome
|
|
|
What is the MCC of pericarditis?
|
Coxsackievirus again!
|
|
|
What disease involves hypotension assciated w/ pulsus paradoxus?
|
pericarditis
|
|
|
What is pulsus paradoxus?
|
decrease in >10mmHG in systole during inspiration
|
|
|
What other sign is seen in pericarditis?
|
Kussmaul's Sign
|
|
|
What is Kussmaul's sign?
|
neck vein distension on inspiration
blood refluxes to jugular vein instead of entering RA |
|
|
What is the MCC of constrictive pericarditis?
|
TB worldwide
|
|
|
What is the problem in hypertrophic cardiomyopathy?
|
mutation in heavy chain of beta-myosin and troponins
|
|
|
What kind of genetics does hypertrophic cardiomyopathy have?
|
autosomal dominant
|
|
|
What is the MC site of metastasis to cardiac tissue?
|
pericardium
|
|
|
MC benign tumor of cardiac origin? Location?
|
Cardiac Myxoma
Left atirum |
|
|
What is a benign tumor of the heart that arises from cardiac muscle? MC in age?
|
Cardiac Rhabdomyoma
infants and children |
|
|
What disease is associated with cardiac rhabdomyoma?
|
Tuberous Sclerosis
|
|
|
What is associated w/ Alzheimer's Dz?
|
Depression
|
|
|
What is the pathogenesis of mitral valve prolapse?
|
increase/accumulation of dermatan sulfate
|
|
|
What is the characteristic murmur of mitral valve prolapse?
|
mid-systolic click
|
|
|
When does the murmur approach to S1?
|
decrease in preload
less blood |
|
|
How do you calculate the A-a gradient?
|
Alveolar PO2= 21%O2(Atm. P-47) - pCO2/0.8
A= (.21)(713)- 40/0.8) Usually A=100 A-a a=95 Normal A-a grad= 5-30 |
|
|
When is A-a gradient indicative of pulmonary pathology?
|
when A-a grad = >30
|
|
|
Where is ventilation most prominent in the lungs?
|
Apex
|
|
|
What is more prominent at the base of the lungs? Vent. or Perf.
|
Perfusion
|
|
|
Where do infactions of the lung occur?
|
Lower lobes
i.e. more perfusion |
|
|
What is the diagnosis of a child w/ Nasal Polyps? Test for?
|
Sweat Test
Cystic Fibrosis (CF) until proven otherwise |
|
|
Patient w/ fibromyalgia and develops asthma, what is the cause of this?
|
Aspirin induced asthma
block PG but still produce Leukotriene build up LT C-D-E4 buildup (potent bronchoconstrictors) |
|
|
Causes of Hypoxemia w/ normal A-a gradient?
|
- barbiturates OD
- epiglottitis (Upper Airway Obstr.) - Amyotrophics Lat. Sclerosis (ALS) |
|
|
Newborn that turns cyanotic when breast feeding; cries and turns back to pink. Diagnosis?
|
Choanal Atresia
|
|
|
What is the complication of Sleep Apnea?
|
Pulmonary Hypertension
- vasoconstrictive effects of chronic hypoxemia and respiratory acidosis called COR-PULOMONALE |
|
|
What sinus is involved in adults w/ sinusitis? children?
|
mAxilary ADULTS
ethmoid children ethmall |
|
|
What is a common finding of sinusitis in diabetics?
|
Mucor sinusitis
|
|
|
Why does Mucor species prevail in sinusitis of Diabetic patients?
|
Ketoacidosis cuases proliferation
|
|
|
What does Mucor sp. invade?
|
frontal lobes
|
|
|
What is the cause of Nasopharyngeal Carcinoma?
|
EBV
common in Chinese |
|
|
What three compounds increase surfactant?
|
1) thyroxin
2) prolacitn 3) glucocorticoid |
|
|
What happens when no primary cancer is found in cervical lymph node metastasis?
|
nasopharynx should be biopsied
|
|
|
Risk factor for Laryngeal CA?
|
smoking
|
|
|
What is synergistic with smoking in Laryngeal CA?
|
Alcohol ingestion
smoking + alcohol = bad combo |
|
|
What is found in the physical exploration of Atelectasis?
|
- dullness to percussion
- absent tactile fremitus |
|
|
When do you see atelectasis?
|
usually 24-36 hrs post surgery
|
|
|
What three compounds increase surfactant?
|
thyroxin
prolactin glucocorticoids that's why glucocorticoids given to mother before 32 weeks |
|
|
What is the pathogenesis of Respiratory Distress Syndrome in Newborns?
|
Atelectasis due to loss of surfactant
|
|
|
Where is surfactant made?
|
Type II neumocytes
|
|
|
Where is surfactant stored?
|
lamellar bodies
|
|
|
When does synthesis of surfactant begin?
|
28th week
|
|
|
When is surfactant at it's peak?
|
35 weeks
|
|
|
What disease is common to dysphagia fro solids? (lower esophagus)
|
Achalasia MC
progressive systemic sclerosis/CREST Sx |
|
|
What Dz is involved in dyspaghia for solids but in the Upper esophagus?
|
polymyositis
myasthemia gravis |
|
|
Why is myasthemia gravis on the upper esophagus?
|
Upper 1/3 of esophagus is striated muscle
|
|
|
What three diseases have disphagia for liquids?
|
really bad...
1) plummer vinson 2) esophageal CA 3) Barrett's Esophagus (ulceration and stricture) |
|
|
What is associated with iron deficiency and dysphagia for solids?
|
Plummer-Vinson
|
|
|
What does it mean when you have dysphagia for solids but not liquids?
|
Mechanical Obstruction
|
|
|
What does it mean when you have dysphagia for both solids and liquids?
|
peristalisis problem
|
|
|
What is the MCC of odynophagia in HIV?
|
esophagitis caused by Candida albicans
Aids Defining |
|
|
MC congenital esophageal disorder?
|
Tracheoesophageal fistula
|
|
|
What is wrong in tracheosophageal fistula? (what ends blindly?)
|
Proximal esophagus ends blindly
|
|
|
What are the common signs and symptoms of fistula in pregnancy?
|
Polyhydramnios
(excess fluid) fetus is not reabsorbing it through mouth |
|
|
What are signs/symptoms (S/S) of Trachesophageal Fistula (TE) in babies?
|
apsiration of milk into trachea
- abdominal distention |
|
|
What is connected in TE fistula?
|
Trachea and Stomach!!!
Distal Esophagus arises from Trachea |
|
|
What is the VATER Sx?
|
Vertebral Abnormalities
Anus Imperforated TE fistula Renal Disease/Radius abnormality |
|
|
What are the causes of polyhydramnios?
|
- TE fistula
- Anacephaly - duodenal atresia (Down/ALL) |
|
|
What is weakness in the esophageal wall called?
|
Zenker's Diverticulum
|
|
|
What is weak in Zenker's Diverticulum?
|
cricopharyngeus muscle weakness
|
|
|
What are the S/S of Zenker's Diverticulum?
|
bad breath
food collects in pouches |
|
|
What is the pathogenesis of achalasia?
|
failure of relaxation of LES sphincter
|
|
|
What is absent in achalasia?
|
absent relaxation
absent myenteric ganglion cells |
|
|
What is substance is missing in the myenteric ganglion of achalasia?
|
VIP (vasointestinal peptide)
|
|
|
What is the function of VIP?
|
relax the LES
|
|
|
What sign do we see in the X-ray of achalasia?
|
bird's beak in barium study
dilation of proximal esophagus |
|
|
HOw are achalasia and progressive systemic sclerosis (PSS)/ CREST Sx similar?
|
both have relaxation of LES
absence of esophageal motility manometry best diagnostic measure |
|
|
What does CREST stand for?
|
Calcinosis
Raynaud's Phenomenum Esophageal Motility Dysfunction Sclerodactyly Telangiectasias |
|
|
What laboratory test do you use to diagnostie CREST Sx?
|
ANA (70-90%)
anti-SCL-70 (70%) topoisomerase I anti-centromere antibodies (30%) |
|
|
What is the problem in GERD?
|
relaxed LES
acid injury leads to Barrett's esophagus and then distal AdenoCA |
|
|
What vein is most likely to have varices in esophagus?
|
left gastric coronary vein (from portal)
azygous vein |
|
|
What is the MC organism causes esophagitis?
|
Candida
|
|
|
What are other causes of esophagitis?
|
Herpes (multinucleated cells w/ intranuclear inclusions)
CMV (single nucleurs w/ largo basophilic inclusion) |
|
|
What is the name of the TEAR of the DISTAL esophagus?
|
Mallory Weiss Sx
|
|
|
When does Mallory Weiss Sx occur?
|
Alcoholics
bulimia |
|
|
What is the name of the RUPTURE of the DISTAL esophagus?
|
Boerhaave's Sx
|
|
|
What is the MCC of Boerhaave's Sx?
|
Endoscopy procedure!!!
|
|
|
What is the MCC of primary cancer in the esophagus in the U.S.? What part of the esophagus?
|
Adenocarcinoma of distal esophagus
|
|
|
What is the MC esophageal CA in developing countries and where is it located in the esophagus?
|
Squamous CA
Mid-esophagus |
|
|
MCC of hematemesis?
|
duodenal ulcer
2) gastric ulcer 3) esophageal varices |
|
|
Main difference between congenital pyloric stenosis and duodenal atresia?
|
Bile containing fluid in Duodenal Atresia
Also duodenal atresia associated w/ Down Sx polyhydramnios seen in mother in Duodenal Atresia |
|
|
What are the three functions of PGE2?
|
1) increase blood flow to mucosa
2) increase secretion of mucous 3) increase HCO3- cytoprotective |
|
|
What is an analog of PGE2?
|
Misoprostol
cytoprotective |
|
|
What part of the stomach is affected by pernicious anemia?
|
Body and Fundus
|
|
|
What type of gastritis is pernicious anemia?
|
Type A atrophic gastitis
|
|
|
What part of the stomach does H. pylori infect?
|
pyloric antrum
|
|
|
What does H. pylori predispose to/cause? 2 things
|
AdenoCA of stomach
Malignant Lymphoma |
|
|
What type of gastritis does H. pylori cause?
|
Type B Atrophic Gastritis
|
|
|
Where is the ulcer and cancer located in gastric ulcer?
|
lesser curvature of antum
|
|
|
Does gastric ulcer predispose to CA?
|
NO! Gastic CA may bleed and may be confused w/ gastric ulcer!
|
|
|
What must be done w/ gastric ulcer?
|
Biopsy to rule out gastric CA!
|
|
|
When is the pain in duodenal ulcer?
|
Decreases w/ meal/eating
|
|
|
When is pain in gastric ulcer?
|
Greater fater eating
|
|
|
What is the malignant potential for a duodenal ulcer?
|
0% malignancy
so never biopsied! |
|
|
What blood group is associated w/ duodenal ulcer?
|
Blood group O
|
|
|
What other pathologies are associated w/ dudoneal ulcer?
|
MEN I
Zollinger-Ellison Sx |
|
|
What is the MC complication of duodenal ulcer?
|
Bleed and perforation
|
|
|
What is the presentation of duodenal ulcer w/ perforation?
|
patient w/ epigastric pain that irradiates to the left shoulder
|
|
|
What is the first step in managemente of duodenal ulcer that has perforated?
|
Flat X-ray
|
|
|
Why is the pain referred to the shoulder in perforated duodenal ulcer?
|
because the diaphragm is irritated and has the same dermatome and embryology at C4 (phrenic nerve)
|
|
|
Patient that wakes up at night w/ epigastric pain?
|
Most likely duodenal ulcer
|
|
|
What is Zollinger Ellison's (ZE) Sx?
|
malignant islet cell tumor
|
|
|
What does ZE secrete?
|
gastrin
increases acid in stomach |
|
|
Why is there black melena?
|
Acid acts on HB and converts it into Hematin
Hematin is black pigment that stains fecal matter |
|
|
What is a picture of a stomach that is really hard petrified almost?
|
Linitis plastica
Stomach Cancer diffuse type |
|
|
What type of cells do you see in linitis plastica?
|
Signet Ring Cells
|
|
|
Where else can you find signet ring cells?
|
both ovaries since linitis plastica metastasizes via hematogenous route
|
|
|
What is a kind of diffuse type linitis plastica? attacks the ovaries as well?
|
Krukengerg Tumor
|
|
|
What is the MC extranodal site of extranodal lymphoma?
|
stomach
|
|
|
What is the 2nd MC extranodal site of extranodal lymphoma?
|
peyer's patches
|
|
|
What is the MC benign tumor of GI tract?
|
Leiomyoma
|
|
|
What is the MC location for Leiomyoma?
|
stomach
|
|
|
What is the main symptom of leiomyoma?
|
bleeding
|
|
|
What is associated with dermatitis herpetiform?
|
Celiac Dz
|
|
|
What is the best test to detect Celiac Dz?
|
anti-gliadin Ab
|
|
|
What is another Dz that involves malabsorption?
|
Whipple Dz
|
|
|
What is the pathology of Celiac Dz?
|
Atrophy of villi in Duodenum and Jejunum
|
|
|
What is the pathology of Whipple's Dz?
|
blunting of villi in jejunum and ileum
|
|
|
What is the best (cheapest) screening test to determine malabsorption problem?
|
stool for fat
|
|
|
What are the three classifications of diarrhea?
|
1) invasive
2) secretory 3) osmotic |
|
|
What is the best test for invasive diarrhea?
|
fecal leukocytes (+)
|
|
|
What is the #1 organism in invasive enterocolitis?
|
Campylobacter
|
|
|
What diarrhea's are low volume?
|
Invasive diarrhea
|
|
|
What diarrhea is high volume?
|
secretory and osmotic
|
|
|
What is secretory diarrhea?
|
high volume w/ osmolality similar to plasma
|
|
|
What is osmotic diarrhea?
|
high volume w/ osmolality lower than that of plasma
|
|
|
What are some disease that cause secretory diarrhea?
|
Vibrio cholerae (via adenylate cyclase)
E. coli (via guanylate cyclase) Rotavirus Carcinoid Sx |
|
|
Is there mucosal inflammation in secretory diarrhea?
|
No mucosal inflammation
|
|
|
What are some common diseases that cause osmotic diarrhea?
|
lactase deficiency
laxatives |
|
|
What is the MCC of diarrhea, cholecystitis and pancreatitis in AIDS?
|
Cytomelagolvirus (CMV)
|
|
|
What organism is associated w/ HLA-B27 spondyloarthropathy and uremic Sx?
|
Shigella
|
|
|
What is the MC contaminant of blood transfusions?
|
Yersenia enterocolitica
|
|
|
What are trophozoites phagocytosed RBCs?
|
Entameba histolytica (Ameba)
|
|
|
What is the MCC of diarrhea in AIDS?
|
Cryptosporidium parvum
|
|
|
What test is used to detect C. parvum?
|
String Test
|
|
|
What is the MCC of diarrhea from protozoa in the U.S.?
|
Giardia lamblia
|
|
|
What is the life cycle of G. lamblia?
|
cysts attach to small intestine mucosa
|
|
|
What organism causes rectal prolapse in children?
|
Trichuris trichura
|
|
|
What is the Tx of Trichuris trichura?
|
Albendazol
|
|
|
What is the reservoir of diphyllobothrium latum?
|
fish--- lake trout
|
|
|
What does D. latum cause?
|
Vitamin B12 deficiency
|
|
|
What is the Tx fro D. latum?
|
praziquantel
|
|
|
What is seen in the stool of Strongyloidse stercoralis?
|
rhabditiform larvae
|
|
|
What parasite causes bowel obstruction?
|
Ascaris Lumbricoides
|
|
|
What is the reservoir for Dyphyllobotrium latum?
|
Fish --- lake trout
|
|
|
What problems does D. latum give humans?
|
Vitamin B12 deficiency
|
|
|
What is the Tx for D. latum?
|
Praziquantel
got the prize for the fish! |
|
|
What parasite in the soil penetrates the skin?
|
Strongyloides stercoralis
he is strong!!! |
|
|
What is the MCC of hematochezia?
|
Diverticulosis
|
|
|
What is the 2nd MCC of hematochezia?
|
angiodysplasia
|
|
|
What is asscoaited w/ angiodysplasia?
|
von Willebrand's Dz
Aortic Stenosis |
|
|
What is the MCC of iron deficiency in newborn?
|
Mecke's Diverticulum
bleeding GI |
|
|
What disease has the term left sided apendicitis?
|
sigmoid diverticula
|
|
|
MC place of pathology in entire GI tract?
|
Sigmoid colon
includes: - cancer - polyps (except Peutz-Jegher's) - diverticular disease |
|
|
What is associated with embolism of transmural small bowel?
|
hear disease and atrial fibrillation
|
|
|
What is the MCC of fistulas in the GI tract?
|
diverticula
|
|
|
What is the MC fistula?
|
Colovesical Fistula
|
|
|
Ulcerative Colitis vs. Cronh's Dz
|
UC vs. Crohn's
|
|
|
What layers does UC comprise?
|
musocal and submucosal
|
|
|
What layers does Cronh's Dz comprise?
|
all layers
it is transmural |
|
|
What does UC primarily target?
|
rectum
|
|
|
What is involved in Cronh's Dz in 80%?
|
Terminal Ileum Affected
|
|
|
What segment does UC attack?
|
rectum;
does not involve other areas of GI tract |
|
|
What segment does Cronh's attack?
|
Cronh=Complete
all layers and also all the GI tract mouth to anus |
|
|
What marker do you get after HBV vaccine?
|
anti-HBs
|
|
|
What is the first serology to appear in HBV?
|
HBsAg
|
|
|
What is the marker that the patient will recover from HBV?
|
HBV-DNA poymerase leaves before HBsAg
|
|
|
Markers for HBV infection is active?
|
HBe and HBV-DNA antigens are excellent markers of infectivity
|
|
|
What is considered when anti-HBcIgM is converted to HBcIgG?
|
patient has old infection
|
|
|
What marker for HBV determines a chronic carrier?
|
HBsAg for more than 6 months
|
|
|
What is a healthy carrier?
|
carries HBsAg but is negative for HBeAg/HBV-DNA
|
|
|
What two viruses are associated w/ hepatocellular CA?
|
B and C hepatitis
|
|
|
What organism causes spontaneous peritonitis in adults?
|
E. coli
|
|
|
What organism causes spontaneous peritonitis in children?
|
Step. pneumoniae
|
|
|
What causes a single abscess in the right lobe of the liver?
|
E. histolytica
|
|
|
Tx for Hepatic Amebiasis?
|
Metronidazole
|
|
|
Who is the definitive host of Echinococcosis?
|
Sheep Dog
|
|
|
Humans are what type of host for Echinococcosis?
|
intermediate host
|
|
|
Tx for Echinococcosis?
|
Albendazole
|
|
|
What organism causes cholangiocarcinoma?
|
Clonorchis sinensis
|
|
|
What is another name for Clonorchis sinensis?
|
Chinese Liver Fluke
|
|
|
How do you get Clonorchiasis?
|
Ingestion of infected fish w/ larvae
|
|
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What is the Tx of Clonorchiasis?
|
Praziquantel
|
|
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What is the main characteristic in the laboratory of Clonorchiasis?
|
Eosinophilia
|
|
|
What organism causes cholangiocarcinoma?
|
Clonorchis sinensis
|
|
|
What is another name for Clonorchis sinensis?
|
Chinese Liver Fluke
|
|
|
How do you get Clonorchiasis?
|
Ingestion of infected fish w/ larvae
|
|
|
What is the Tx of Clonorchiasis?
|
Praziquantel
|
|
|
What is the main characteristic in the laboratory of Clonorchiasis?
|
Eosinophilia
|
|
|
What causes portal hypertension, hepatosplenomegaly, ascites and esophageal varices?
|
Schistosomiasis
|
|
|
What is the definitive host of Schistosoma mansoni?
|
Snails
imagine photographer taking pics of snails (he is a mason!) |
|
|
Tx for Schistosomiasis?
|
Praziquantel
|
|
|
What is the MCC of congestive hepatomegaly?
|
Right Heart Failure (H.F.)
|
|
|
What are two clinical manifestations of PRE-hepatic obstruction?
|
1) portal vein thrombosis
2) ascites/varices |
|
|
Do you find hepatomegaly in pre or post-hepatic obstruction?
|
Post-hepatic!!!
|
|
|
What is a cause of post-hepatic obstruction?
|
1) Budd-Chiari syndrome
2) Polycythemia vera 3) Oral Contraceptives |
|
|
What is Budd-Chiari Sx?
|
hepatic vein thrombosis
|
|
|
What is the MCC of post-hepatic obstruction?
|
Polycythemia vera!
|
|
|
Symmptoms of post-hepatic obstruction?
|
1) painful liver
2) congested liver 3) ascites 4) portal hypertension |
|
|
What are dead hepatocytes called?
|
Councilman Bodies
|
|
|
When do we find Councilman Bodies?
|
Hepatitis
|
|
|
What alcoholic disease is irreversible?
|
cirrhosis
|
|
|
Are fatty change and alcoholic hepatitis reversible or irreversible?
|
reversible
|
|
|
What are the factors of Alcholo liver disease?
|
1) amount of OH
2) duration of intake 3) more damage in females |
|
|
Where is the most important site of metabolism of OH in liver?
|
cytosol
|
|
|
What causes disulfiram reaction?
|
acetaldehyde build up
|
|
|
What is disulfiram rx?
|
nausea/vomiting, flushing after ingestion of alcohol
|
|
|
What drug is used in Tx of alcoholism?
|
Antabuse or Disulfiram
|
|
|
What enzyme is inhibited by disulfiram?
|
an alcohol dehydrogenase
Acetaldehyde Dehydrogenase |
|
|
Where is alcohol dehydrogenase found?
|
in cytosol and mitochondria
|
|
|
Why is there a build up of lactate in alcoholics?
|
high levels of NADH make pyruvate go into lactate (increases anion gap)
|
|
|
Why does hypoglycemia occur in alcoholics?
|
again increase in NADH makes conversion of pyruvate to lactate
decrease in pyruvate can't go back to gluconeogenesis |
|
|
Why is there esteatosis?
|
alcohol is converted to acetaldehyde and acetate and acetyl coA which makes free fatty acids
- increase in NADH2 favors glycerol-3-p |
|
|
What is the sequence to make TG (VLDL) from 1,3 DPG?
|
1,3 DPG to Glyceraldehyde-3-P to DHAP to Glycerol-3-P + FA makes TG
|
|
|
Why is ketoacidosis sometimes present in alcoholics?
|
NADH once again favors conversion of:
Acetoacetate to B-Hydroxybutyrate (ketoacids) |
|
|
Why are alcoholics prone to gout?
|
Ketoacids and Lactic Acid compete w/ uric acid for excretion in the kidneys
so Uric Acid Accumulates! |
|
|
What is the ratio of ALT and AST in alcoholics?
|
You are an ASS because you drink
AST > ALT |
|
|
What is seen in alcoholic hepatitis?
|
mallory bodies
you will have a bad body!! Mal (lory) Body! |
|
|
What is very characteristic microscopically?
|
fibrosis aroudn terminal hepatic venules
|
|
|
MCC of obstructive jaundice?
|
stone in common bile duct
|
|
|
What are the symptoms in obstructive jaundice?
|
- hypercholesterolemia
- light colored stools - urine w/ conjugated bilirubin - increase alkaline phosphatase (AP) and gamma-glutamyltransferas (GGT) |
|
|
What are the symptoms of primary biliary cirrhosis?
|
- pruritus
- increase AP and GGT - no jaundice until later |
|
|
What immunoglobulins and markers detect primary biliary cirrhosis?
|
- increase anti-mitochrondrial Ab
- increase IgM |
|
|
How do you acquire primary biliary cirrhosis?
|
autoimmune, granulomatous destruction of bile ducts in triads
|
|
|
What disease causes primary slcerosing pericholangitis?
|
ulcerative colitis
- complication of |
|
|
What is the clinical picture of 1ry sclerosing pericholangitis?
|
jaundice
|
|
|
What cancer is related to 1ry sclerosing pericholangitis?
|
MCC of cholangiocarcinoma
|
|
|
Name drug that causes acute hepatitis? (4)
|
1) Isoniazid
2) Halothane 3) acetaminophen 4) methyldopa |
|
|
Name two drugs that cause cholestasis?
|
1) oral contraceptives
2) anabolic steroids |
|
|
What drugs cause steatosis? fatty liver... 2
|
1) Amiodarone
2) Methotrexate |
|
|
What drug causes fibrosis in the liver?
|
methotrexate
|
|
|
What drug causes angiosarcoma of the liver?
|
Vinyl Chloride
|
|
|
What drug causes Liver Cell Adenoma?
|
Oral Contraceptives
|
|
|
What drugs (3) causes hepatocellular carcinoma?
|
1) Vinyl Chloride
2) Aflatoxin (Aspergillus mold) 3) Thorotrast |
|
|
Can O.C. cause hepatocellular CA?
|
Yes
|
|
|
What is fulminant hepatic failure (FHF)?
|
acute liver failure w/ encephalopathy within 8 weeks of hepatic dysfunction
|
|
|
What is the MCC of FHF? (drug)
|
acetaminophen
|
|
|
What is the MCC of FHF? (organism)
|
virus
|
|
|
Other cause of FHF?
|
Reye's Sx
|
|
|
What is hemochromatosis?
|
unrestricted reabsorption of IRON (small bowel)
|
|
|
What is the mode of inheritance of hemochromatosis?
|
autosomal recessive
|
|
|
What are the laboratory findings of hemochromatosis?
|
- increase serum iron
- decrease TIBC - increase % saturation - increase serum ferritin |
|
|
What is the best screening test?
|
increase serum ferritin
|
|
|
What are the manifestations of hemochromatosis?
|
- bronze skin
- pancreas (malabsorption and DM) - restrictive cardiomyopathy - liver anormalities including hepatocellular CA in 30% |
|
|
What is the Tx of hemochromatosis?
|
phlebotomy
|
|
|
What is Wilson's Dz?
|
defect in Copper (Cu+) secretion into bile
- bile is Copper deficient or - defect in synthesis of ceruloplasmin |
|
|
What is ceruloplasmin?
|
protein that binds to Copper
low ceruloplasmin so can't bind Copper - so increase of Cu in blood |
|
|
What are some of the clinical manifestations of Wilson's Dz?
|
Kayser-Fleishcher rings in eye
|
|
|
What is the Tx of Wilson's Dz?
|
penicillamine
|
|
|
What nuclei is attacked in Wilson's Dz?
|
lenticular nuclei degeneration
|
|
|
What are the symptoms of degeneration of the lenticular nuclei?
|
- chorea
- rigidity - basal ganglia dementia |
|
|
What part of the eye is affected w/ Kayser-Fleischer rings?
|
outer part of decemet
cornea |
|
|
What organism causes chorioamnionitis?
|
Step. agalactiae
|
|
|
When does pre-eclampsia and eclampsia occur? trimester...
|
3rd trimester
|
|
|
What is the Diagnosis if pregnant woman presents w/ pre-eclampsia in first trimester?
|
hydatidiform mole
|
|
|
What two substances are increased in pre-eclampsia?
|
Angiotensin II
TXA2 |
|
|
What substances are decrease in pre-eclampsia?
|
PGE1 and NO
|
|
|
What are two substances in pre-eclampsia that are vasoconstrictors?
|
Angiotensin II
TXA2 |
|
|
What two substances are vasodilators in pre-eclampsia?
|
PGE1
N.O. |
|
|
Tx for Eclampsia?
|
Magnesium Sulfate
|
|
|
What is the clinical presentation of pre-eclampsia?
|
hypertension
proteinuria pitting edema |
|
|
What is the clinical picture of eclampsia?
|
same as pre-eclampsia but w/ seizures or convulsions
|
|
|
Should BUN be increase or decreased in normal pregnancy?
|
decreased in normal pregnancy
|
|
|
Should GFR be increased or decreased in normal pregnancy?
|
Increased
|
|
|
What do we find in lab. for pre/eclampsia? BUN
Uric Acid Serum Creatinine GFR transaminases |
BUN increased
uric acid increased creatinine increased GFR decreased transaminases increased Schistocytes/anemia/thrombocytopenia |
|
|
What kind of plancenta do Siamese twins have?
|
Monochorionic Monoamniotic planceta
|
