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181 terms

DIT Day 13

STUDY
PLAY
RR: LENS SHAPED LESION ON HEAD ON CT SCAN
Epidural Hematoma
RR: COMMON UNDERLYING CAUSE OF INTUSSUSCEPTION
Meckels Diverticulum
Adenovirus infection causing Peyer's patches
RR: NO MILK PRODUCTION IN THE POSTPARTUM PERIOD
Sheehan's Syndrome
RR: PIGMENTED HAMARTOMAS IN THE IRIS
Lisch Nodules of neurofibromatosis
RR: HOWEL-JOLLY BODIES
DNA remnants in asplenia
RR: CANCER A/W ASBESTOS
Mesothelioma
Bronchogenic Carcinoma
RR: OWL'S EYE INCUSIONS
CMV
RR: OWL'S EYE NUCLEUS
Hodgkins Reed Sternberg Cells
RR: OWL'S EYE PROTOZOAN
Giardia Lamblia
RR: 50 YO MALE WITH NEW UNEXPLAINED SKIN YELLOWING AND NO OTHER SYMPTOMS
Cancer of the head of the Pancreas
What category does the drug belong to: Cholestyramine?
Bile Acid Binding Resin (Cholesterol lowering drug)
What category does the drug belong to: Venlafaxine?
SNRI
What category does the drug belong to: Fluphenazine?
Typical Neuroleptic (increased potency)
What category does the drug belong to: Phentolamine?
Reverse Non-Selective alpha blocker
What category does the drug belong to: Captopril?
Ace Inhibitor
What category does the drug belong to: Trazadone?
Anti-Depressant
What category does the drug belong to: Carteolol?
Beta Blocker (Glaucoma tx)
What category does the drug belong to: Clarithromycin?
Macrolide
What category does the drug belong to: Famotidine?
H2 blocker
What category does the drug belong to: Fluvoxamine?
SSRI
What category does the drug belong to: 6-mercaptopurine?
AntiCancer drug (inhibits purine synthesis)
What category does the drug belong to: Selegiline?
MAOI (parkinsons tx)
What category does the drug belong to: Terbinafine?
Anti Fungal (Onymonoch; nail fungus tx)
What category does the drug belong to: Clozapine?
Atypical Antipsychotic
What type of information does the Ventral Posterior Lateral (VPL) of the thalamus relay?
Somatosensory information from the body
What type of information does the lateral geniculate of the thalamus relay?
Visual retinal information to the occipital lobe
What type of information does the VPM (ventral posterior medial) of the thalamus relay?
Somatosensory information from the face
What type of information does the ventral anterior of the thalamus relay?
Motor basal ganglia to the cortex
What is the antidote for copper, gold and arsenic?
Penicillamine
What is the antidote for Arsenic, mercury, and gold?
Dimercaprol
Succimer
What is the antidote for t-PA and streptokinase?
AMinocaproic Acid
What is the antidote for digitalis?
Stop digitalis
Normalize Potassium levels
Lidocaine or anti digitalis fragments
What are the 4 main pharmocokinetic equations?
Vd = amt of drug in body / plasma drug conc
CL = .7 X Vd / t1/2; LD = Css X Vd; MD = Css X CL
Where does fetal erythropoiesis take place?
(Young Liver Synthesizes Blood)
Yolk Sac
Liver
Spleen
Bone Marrow
What adult bones are involved with erythropoeisis?
Vertebrae
Sternum
Pelvis
Ribs
Cranial Bones
Tibia and femur
What aneurysm causes the eye to look down and out?
Posterior Communicating Artery
What aneurysm causes bilateral loss of lateral visual fields?
Anterior Communicating Artery
What artery is damaged in Broca's or Wernicke's Aphasia?
Middle Cerebral Artery
What artery is damaged when there is unilateral lower extremity sensory and/or motor loss?
Anterior Cerebral Artery
What artery is damaged when there is unilateral facial and arm sensory and/or motor loss?
Middle Cerebral Artery
What hormones use steroid receptors?
Steroid Hormones
Estrogen
Progesterone
Testosterone
Aldosterone
Vitamin D
Thyroxine T3 T4
Glucocorticoids
What hormones use tyrosine kinase receptors?
Insulin
IGF 1
FGF
PDGF
Prolactin
Growth Hormone
What histological change takes place in the trachea of a smoker?
Metaplasia: Ciliated columnar to squamous
A pt is in the ER having anaphylaxis; you make an incision beneath the thyroid cartilage to establish an airway; what structure was cut?
Cricothyroid membrane
What structures transverse the diaphragm and at what vertebral angle do they pass?
IVC at T8
Esophagus and Vagus at T10
Aorta, Thoracic Duct, Azygous Vein at T12
What type of cell proliferates during lung damage?
Type II pneumocytes
What amniotic fluid measurement is indicative of fetal lung maturity?
Lecithin to Sphingomyelin ratio > 2
A young woman has infertility; recurrent URI's; and dextrocardia; which of her proteins is defective?
Dyenin Arm Defect due to Kartagner's syndrome
The following lung capacities are obtained from an elderly smoker:
FRC 5.0 L
IRV 1.5L
IC 2.0L
VC 3.5L
What is the TLC?
TLC = FRC + IC
5.0 + 2.0 = 7.0
What substances are known for causing methemoglobinemia?
Chloroquine Primaquine; Dapsone Sulfonamides; Local Anesthetics; Metoclopramide; Nitrates
A 42 yo woman with fibroids is chronically tired; what is the most likely dx and what changed have occured in the O2 content and saturation?
Hypochromic Microcytic Anemia
No change in O2 content or saturation; but not as much Hemoglobin to be saturated
A pt is shown to have hypoxia and CXR reveals an enalrged heart; what is the most likely cause of hypoxia?
CHF; lungs are not perfused well enough to get O2 to the rest of the body.
What is the differential diagnosis for eosinophilia?
(DNAAACP)
Drugs
Neoplasms
Atopic disease (allergy/asthma/churg strauss)
Addisons
Acute interstitial nephritis
Collagen Vascular disease
Parasites (lofflers eosinophilic pneumonitis due to ascaris lumbricoides)
A pt presents with an asthma attack; what immunological reaction is taking place that is responsible for the anaphylaxis in the pt?
Mast Cell mediate; antigen cross linking of mast cells and IgE; Type I Hypersensitivity
What asthma medication is the inhaled tx of choice for chronic asthma?
Inhaled steroids
What asthma medication is the inhaled DOC for acute exacerbations?
Albuterol
(with Ipratroprium)
What asthma medication has a narrow therapeutic index; drug of last resort?
Theophylline
What asthma medication blocks conversion of arachidonic acid to leukotriene?
Zileutin
What asthma medication inhibits mast cell release of mediators, used for prophylaxis only?
Cromolyn
What asthma medication is an inhaled treatment that blocks muscuranic receptors?
Ipratropium
What asthma medication is an inhaled long acting beta 2 agonist?
Salmuterol
What asthma medication blocks leukotriene receptors?
Zafirlukast
Montelukast
A pt has extended expiratory phase; what is the disease process?
Obstructive Lung Disease
H&E of a lung biopsy from a plumber shows elongated structures with clubbed ends in tissue; what is the dx and what is he at risk for?
Asbestosis leading to mesothelioma and bronchiogenic carcinoma
A preterm infant has difficulty breathing. An xray reveals a diffuse ground glass appearance with air bronchograms; what is the dx and what would've prevented this?
Neonatal Respiratory Distress Syndrome
Prevented with tx mother with steroids before birth.
A pt develops ARDS from an occupational inhalation of NO2; what histo change is likely to be seen in a pt recovering from ARDS?
Proliferation of type II pneumocytes
A CXR shows pleural effusions; what are the clinical findings?
Decreased breath sounds over the effusion
Dull resonance
Decreased fremitus
A tall thin male teenager has abrupt onset dyspnea and left sided chest pain. Percussion on the affected side reveals hyperresonance and breath sounds are diminished; what is the dx?
Spontaneous pneumothorax
A CXR shows collapse of the middle lobe of the right lung and mass in the right bronchus; pt has history of recurrent pneumonias; what is the dx?
Bronchial Adenocarcinoma
A pt of yours develops bronchogenic lung cancer but has never smoked. He is a coal miner. Exposure to what substance has put him at risk for developing lung cance?
Radon
What complications can arise from lung cancer?
(SPHERE)
Superior Vena Cava Syndrome
Pancoast Tumor
Horner's Syndrome
Endocrine (paraneoplastic syndrome)
Recurrent Laryngeal Nerve Symptoms (Hoarseness)
Effusions (pleural or pericardial)
What is the most common cause of pneumonia in immunocompromised pts?
Pneumocystis Jirovecci
What is the most common cause of atypical/walking pneumonia?
Mycoplasma
What is the most common causative agent of pneumonia in alcoholics?
Klebsiella
What can cause an interstitial pneumonia in bird handlers?
Chlamydia Pstici
Pneumonia a/w bats and bat droppings?
Histoplasma
Often cause of pneumonia in a pt visiting SW USA?
Coccicioides
Pneumonia a/w "currant jelly" sputum?
Klebsiella
Q fever is a/w what organism?
Coxiella Burneti
A/w pneumonia acquired from ACs?
Legionella
Most common cause of pneumonia in children 1 yo and younger?
RSV
Most common cause of pneumonia in neonate (B to 28 days old)?
Group B Strep
E coli
Most common cause of pneumonia in children and young adults (college students; recruits; prison inmates)?
Mycoplasma
Common cause of pneumonia in pts with other health problems?
Klebsiella
Most common cause of viral pneumonia?
RSV
Causes wool-sorter's disease (life threatening pneumonia)?
Bacillus anthracis
Endogenous flora in 20% of adults?
Strept Pneumoniae
Common bacterial cause of COPD exacerbation?
H. Influenzae
Common pneumonia in ventialtor pts and those with cystic fibrosis?
Pseudemonas Aeriginosa
Pontiac fever is a/w what organism?
Legionella
Examination of a lung at autopsy reveals peripheral lesion with caseous necrosis; dx?
TB
A 30 yo comatose man on ventilatory support in the ICU develops an infection and dies; Autopsy reveals pus filled cavity in the right lung; what is the likely etiology?
Aspiration leading to Lung Abscess
A 55 yo man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms; gram stain shows no organisms; silver stain of sputum shows gram negative rods; what is the dx?
Legionella Pneumophilia
Causes of transudate effusions?
CHF
Cirrhosis
Nephrotic Syndrome
Pulmonary Embolism
Fluid Overload
Causes of Exudate effusions?
Pneumonia
Infections
TB
Cancer
Uremia
Connective Tissue Disease
RR: MOST COMMON CAUSE OF SIADH
Small Cell Cancer of the lung
RR: MOST COMMON TESTICULAR TUMOR
Seminoma
RR: MOST COMMON TUMOR OF INFANCY
Strawberry Hemangioma
RR: TRANSLOCATION 9;22 AND DRUG USED TO TX
CML tx with Imatinib
Kartagener's syndrome triad and underlying defect?
Triad: Sterility; Bronchiectasis; Recurrent infections
Dyenin arm defect
3 most common locations of lung cancer mets?
Brain
Bone
Liver
What is the V/Q at the apex of the lung?
3
What is the V/Q at the base of the lung?
0.6
What is the V/Q during airway obstruction?
0
What is the V/Q during blood flow obstruction?
Infinity
How does emphysema in smoking differ from emphysema caused by alpha-1-antitrypsin deficiency?
smoking - Centriacinar
alpha-1-antitrypsin def - panacinar
What is the hallmark sign of COPD?
Decreased FEV1/FVC
What is the hallmark sign of restrictive lung disease?
Decreased TLC
Normal or slightly increased FEV1/FVC
Which lung tumors arise centrally and are linked to smoking?
Squamous Cell Cancer
small cell cancer
What lung tumors arise peripherally and are less linked to smoking?
Adenocarcinoma
Large Cell Carcinoma
How does the body compensate for hypoxia at high altitude?
Increased ventilation
Increased erythropoeitin
Increased Mitochondrial activity
Increased renal excretion of bicarbonate
Cause of pneumonia a/w Gram + cocci in clusters?
S aureus
Cause of pneumonia a/w Gram + cocci in pairs?
S pneumo
Cause of pneumonia a/w Gram - rods in 80 yo?
E coli
Cause of pneumonia a/w Gram + cocci in neonate?
Grp B strep
Cause of pneumonia a/w Gram - rods in neonate?
E coli
What are common causes of ARDS?
Shock
Infection
Toxic Gas inhalation
Acute pancreatitis
Aspiration
Heroine Overdose
Increase O2 consumption
A 75 yo pt with a 60 pack a year history comes to teh office complaining of difficulty standing up from his bed when he wakes in the morning and difficulty raising his arms in the morning to wash his hair; what do you suspect?
Lambert-Eaton Syndrome due to Small Cell Cancer
What is pulsus paradoxus?
Systemic BP drops by more than 10 mmHg with inspiration.
What causes pulsus paradoxus?
Asthma
COPD
Cardiac Tamponade
What immunosuppressant is a/w being a precursor of 6-mercaptopurine?
Azathioprine
What immunosuppressant is a/w being able to prevent nephrotoxicity with mannitol diuresis?
Cyclosporine
What immunosuppressant is a/w an antibody that binds to CD3 on T cells?
Muromonab
What immunosuppressant is a/w an antibody that binds to IL-2 receptors on activated T Cells?
Daclizumab
What immunosuppressant is a/w inhibiting inosine monophosphate dehydrogenase?
Mycophenylate
What immunosuppressant is a/w inhibiting calcineurin leading to the loss of IL 2 production and the blockage of T cell differentiation and activation?
Cyclosporine
What immunosuppressant is a/w inhibiting FK-binding protein leading to the loss of IL-2 production?
Tacrolimus
What immunosuppressant is a/w being used for lupus nephritis?
Mycophenylate
What immunosuppressant is a/w being metabolized by xanthine oxidase, there fore allopurinol can increase its toxicity?
Azathioprine
What genetic syndrome is a/w a 1000 fold increased risk of developing skin cancer?
Xeroderma Pigmentosa
What genetic syndrome is a/w Alcoholics leading to a B1 deficiency and neurological deficits?
Pyruvate dehydrogenase deficiency
What genetic syndrome is a/w abnormal collagen type 1 synthesis?
Osteogenesis Imperfecta
What genetic syndrome is a/w an absence of HGPRTase?
Lesch-Nyan Syndrome
What genetic syndrome is a/w a deficiency of aldolase B?
Fructose Intolerance
What genetic syndrome is a/w defective excision repair leading to thymidine dimer formation?
Xeroderma Pigmentosa
What genetic syndrome is a/w a deficiency of cystathionine synthase?
Homocystinuria
What genetic syndrome is a/w Heinz bodies?
G6PD
What genetic syndrome is a/w must/mousy odor, albinism, MR, and eczema?
PKU
What genetic syndrome is a/w Galactose-1-P uridyl transferase deficiency leading to MR, HSM, and cataracts?
Galactosemia
What genetic syndrome is a/w being treated by avoiding NutraSweet and increasing dietary tyrosine?
PKU
What genetic syndrome is a/w a deficiency of tyrosinase?
Albinism
What genetic syndrome is a/w hyperextensible skin, loose joints, and bleeding tendency?
Ehlers-Danlos Syndrome
What genetic syndrome is a/w decreased NADPH due to lack of HMP enzyme?
G6PD
What genetic syndrome is a/w an inherited defect in tubular amino acid transporter?
Cystinuria
What genetic syndrome is a/w treatment with decreased methionine and increased cystine and Vit B6?
Homocystinuria
What genetic syndrome is a/w a deficiency in homogentisic acid oxidase?
Alkaptonuria
What genetic syndrome is a/w hypoglycemia, jaundice and cirrhosis?
Fructose intolerance
What genetic syndrome is a/w self-mutilation, gout, aggression, and choreoathetosis?
Lesch Nyan Syndrome
What genetic syndrome is a/w blocked degradation of branched chain amino acids?
Maple Syrup Urine Disease
What genetic syndrome is a/w bloating cramps and osmotic diarrhea?
Lactic Intolerance
What genetic syndrome is a/w being tx with Acetazolamide to alkalinize the urine?
Cystinuria
What genetic syndrome is a/w a deficiency that results in combined B and T cell deficiency?
Adenasine Deaminase deficiency
What genetic syndrome is a/w tx with decreased fructose and sucrose intake?
Fructose intolerance
What genetic syndrome is a/w a tx of increased intake of ketogenic nutrients (fats)?
Pyruvate Dehydrogenase Deficiency
What genetic syndrome is a/w Dark brown urine, organs, and connective tissue; benign disease?
Alkaptonuria
What genetic syndrome is a/w multiple fractures and blue sclera?
Osteogenesis Imperfecta
What genetic syndrome is a/w tx by excluding galactose and lactose from the diet?
Galactosemia
What are the essential amino acids?
(PVT TIM HALL)
Phe
Val
Thr

Trp
Ile
Met

His
Arg
Leu
Lys
What is the MOA of lactulose?
Pulls ammonia from the gut so that you can excrete it.
What amino acid is a precursor to histamine?
Histadine
What amino acid is a precursor to prophyrin, heme?
Glycine
What amino acid is a precursor to NO?
Arginine
What amino acid is a precursor to GABA?
Glutamate
What amino acid is a precursor to S-adenosyl-methionine (SAM)?
Methionine
What amino acid is a precursor to creatine?
Arginine
Compare Carbamoyl phsphat I (CPI) to carbamoyl phosphate II (CPII)?
CPI: Urea cycle; Mitochondria; N from ammonia
CPII: Pyrimidine synth; Cytosol; N from Glutamine
What is the rate limiting enzyme for urea cycle?
Carbamoyl Phosphate Synthetase I
What is the rate limiting enzyme for hexose monophosphate pathway?
G6PD
What is the rate limiting enzyme for fatty acid synthesis?
Acetyl-CoA carboxylase
What is the rate limiting enzyme for beta oxidation of fatty acids?
Carintine Acyl transferase
What is the rate limiting enzyme for ketone body synthesis?
HMG CoA synthase
What is the rate limiting enzyme for cholesterol synthesis?
HMG CoA reductase
What is the rate limiting enzyme for bile acid synthesis?
7-alpha-hydroxylase
What is the rate limiting enzyme for heme synthesis?
Aminolebunilate Synthase
What deficiency causes familial hypercholesteremia?
Deficiency of LDL receptors
A pt with PKU should have a diet low in phenylalanine; what other dietary modifications should a patient with PKU make?
Increase Tyrosine
Replace tetrahydrobiopterin cofactor
A full term neonate becomes mentally retarded and hyperactive and has a musty odor; what is the dx?
PKU
A 2 yo girl has an increase in abdominal girth, failure to thrive, and skin/hair depigmentation; dx?
Kwashikor
A middle aged man has dark spots in his sclera and notes that his urine turns black when left sitting for a period of time; dx?
Alkaptonuria
A pt has a genetic disease in which the tx includes protein restriction to prevent mental retardation, ketoacidosis, and death; what is the dx?
Maple Syrup Urine Disease
What is the tx for homocystinuria?
Decrease methianine
Increase Cysteine
Add Vitamin B6 and folate