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Terms in this set (348)
How do you distinguish berylliosis vs. silicosis, since both produce lesions in apical parts of lung?
Silicosis has eggshell calcifications, hilar adenopathy and bifringent particles surrounded by fibrous tissue
Inheritance pattern of abetalipoproteinemia
What disease are acanthocytes/spur cells associated with?
What is the MOA of diabetic drugs canagliflozin and dapagliflozin?
Block glucose reabsorption in PCT
Increased resorption of bone with cystic degeneration is characteristic of what disease?
When do you see osteoid matrix accumulation around trabeculae?
Vitamin D deficiency/rickets
Due to osteoid buildup, but no mineralization into real bone
Acidosis or alkalosis at high altitude?
Lack of O2 causes hyperventilation, thus respiratory alkalosis (decreased HCO3 in kidneys in order to buffer)
Major symptoms of vitamin E deficiency?
Subacute combined degeneration
Increased bleeding effects if also taking
(prevents synthesis of coagulation factors)
What enzyme activates vitamin K for use in gamma-carboxylating clotting factors?
What is unique about factors 2, 7, 9 and 10
Glutamate is gamma-carboxylated and they must be
bound to calcium
in clot formation
Major enzyme that requires NADPH, and thus resemble G6PD deficiency in erythrocytes?
What are the proteins that recognize stop codons and terminate polypeptide production?
Difference in function between cyclin D1 vs. c-myc
Cyclin D1 promotes G1-->S transition
C-myc is a transcription factor that promotes cell proliferation
Nasal hemianopsia occurs when?
Disruption of internal carotid artery
What bacteria has CAMP factor?
Strep agalactiae (group B)
In correcting anovulation in women, what are the roles of menotropins and HCG?
Menotropins act like FSH, stimulate formation of follicle
HCG simulates LH surge, leads to rapid rise in estrogen
What kind of protein is S-100?
Calcium-binding protein, similar to calmodulin and involved in several diff cell functions
What disease is caused by viral infection, followed by polydipsia and weight loss?
Type 1 DM
Acute symptoms of hypoglycemia
Sympathetic response - sweating, tremor, palpitations
These symptoms are masked by propranolol
When do you see large RBC with bluish cytoplasm in the blood?
Where do you see ringed sideroblasts?
Large RBC with bluish cytoplasm (residual rRNA) are reticulocytes
Ringed sideroblasts are in
ALP measurement in leukemoid reactoin vs. CML?
Leukemoid reaction - high ALP
CML - normal or low ALP; also has basophils and t(9;22)
In collagen synthesis, why are disulfide-rich regions cleaved extracellularly?
Cleavage of these regions makes collagen insoluble
Then the remaining collagen is hydroxylysine-crosslinked by copper-dependent lysyl oxidase (defect in EDS)
What are 2 key differences between elastin and collagen?
1. In elasin, very few of the proline and lysine residues are hydroxylated (they are highly hydroxylated in collagen)
2. Elastin does not form triple helix (collagen forms triple helix in collagen by disulfide bridges)
Both are held together by lysine cross-linking --- this is hydroxylysine cross-linking in collagen though
What innervates the posterior part of the ear canal? This is important in causing fainting when touched
Vagus nerve, CN 10
What anticoagulant is contained in rat poison?
What are the 2 amino acids found in histones?
What 2 amino acids stimulate GH release?
Histones - arginine, lysine
GH release - arginine, histidine
What is a specific marker for mast cell degranulation in anaphylactic reaction?
How do you distinguish narcolepsy vs. hypersomnolence disorder?
Narcolepsy- people feel refreshed after naps
Hypersomnolence- people always feel tired, even after naps
Where do superior rectal vein vs. middle/inferior rectal veins branch from?
Superior rectal- IMV
Middle/inferior rectal- internal pudendal veins to internal iliac veins
1st line therapy to treat supraventricular tachycardia?
Causes hypotension, flushing and chest pain
Adenosine (increases K efflux)
When do you see red dead neurons after cerebral ischemia?
changes within the first 6 hours
Cause of Mallory Weiss syndrome
Severe vomiting due to increased intraabdominal pressure/retching/increased pressure inside stomach lumen
are major predisposing factor
Can tricuspid endocarditis (Staph aureus from IV drug use) cause multiple pulmonary hemorrhagic infarctions?
Yes, due to emboli coming from endocarditis
Why does Listeria cause meningitis in neonates?
Listeria needs to be destroyed by
Neonates don't have full cell mediated immunity yet
How long does brief psychotic disorder last?
Most common cause of acute cholecystitis (severe RUQ pain, vomiting, fever, increased WBC and ALP)
Gallbladder outflow obstruction due to impacted stone at cystic duct - causes pressure ischemia and E. coli overgrowth
What is the role of adiponectin in diabetes?
Adiponectin increases insulin sensitivity
TZD's are PPAR modulators that increase adiponectin production in adipose tissue, thereby increasing insulin sensitivity
How does Mycobacterium TB avoid destruction within macrophages?
Sulfatides (inhibit phagolysosomal fusion)
What messenging system does V2 use?
Where do you anastomose renal artery to during kidney transplant?
External iliac artery
You donate the
Young woman presents with spontaneous physical complaints immediately after acute stressor. What is the diagnosis?
Difference between traction vs. pulsion diverticulum?
, due to inflammation and scarring
, due to increased intraluminal pressure
What is the treatment for Staph epidermidis?
Difference between factitious/Munchausen syndrome vs. malingering?
Factitious/Munchausen syndrome - psychological gain
Malingering- physical/financial gain
Major symptoms of primary sclerosing cholangitis?
Prolonged pruritus and fatigue
What cells release elastases and proteases in the lungs?
Neutrophils and macrophages
Where do herpes viruses attain their envelope from?
Nuclear cell membrane
What causes constitutive activation of tyrosine kinase, with activation of STAT pathway and hepato/splenomegaly?
JAK2 mutation in myelofibrosis
Treatment for paroxysmal supraventricular tachycardia?
Treatment for atrial fibrillation?
What is the mechanism of insulin resistance molecularly?
Aberrant phosphorylation of serine and threonine residues (these inhibit downstream effects of MAP kinase pathway)
What is the advantage of conjugated a polysaccharid capsule from a different pathogen with the diptheria toxoid?
, so you get more immunologic memory and the T cells can induce class-switching/higher specificity by the plasma cells and antibodies
What presents with sudden unilateral eye pain and visual changes? Think after use of atropine (muscarinic antagonist)
Treatment for neonatal withdrawal from opioids?
Tincture of opium (if you give naloxone, this will make things worse)
What mediates the formation of pulmonary abscesses?
Lysosomal enzymes from macrophages and neutrophils
When do you see normal TSH with HIGH total T4?
Pregnancy or OCP's - due to increased estrogen
Estrogen causes upregulation of thyroid-binding globulin. Thus your body compensates to keep free T4 normal. Therefore your TOTAL T4 goes up in the context or normal thyroid levels
Estrogen increases synthesis of
all steroid hormone binding globulins
What is the effect of anabolic steroids on steroid binding globulins?
They DECREASE steroid binding globulins (this is opposite of estrogens, which increase them)
Thus, patient will have normal TSH with LOW T4
What is contained within the hepatoduodenal ligament (3)
1. Hepatic artery
2. Portal vein
3. Common bile duct
How does Strep viridans affect already damaged valves?
These damaged endocardial surfaces develop thrombotic vegetations of fibrin and platelets; the bacteria gets cause in these fibrin-platelet aggregates
MOA ergonovine and uses (2)?
Vasoconstrictive effects (mechanism unknown)
1. Prevents bleeding after childbirth
2. Diagnoses Prinzmetal angina (challenge test)
What is the #1 choice for CABG graft
Internal thoracic artery
Which DNA polymerase has 5' to 3' exonuclease activity? How about 3' to 5'?
5' to 3' is DNA polymerase 1
3' to 5' is DNA polymerase 1, 2 and 3
Which MHC class is associated with loading using acidified endosomes?
MHC class II
Where are the B7 and CD28 during T-cell activation?
B7 on APC
CD28 on T cell
What hip motion is required to sit up from supine position
- iliopsoas, rectus femoria, tensor fascia lata
Where is the renal artery connected to on the right side after the left kidney is transplanted into the donor?
External iliac artery
What are the 2 significant branches of the external iliac artery?
Inferior epigastric artery (think Hesselbechs)
Where do the clear cells in renal clear cell carcinoma arise from?
Effect of estrogen on HMG CoA reductase
Increases HMG CoA reductase, thus more cholesterol is made in the liver
Progesterone also causes gallbladder stasis
Thus, pregnancy causes gallstone formation
What is the characteristic intracellular body in renal oncocytoma (benign tumor)
What are the only 2 substances that have net secretion in the PCT?
What happens to urea vs. bicarbonate as you move through PCT?
Urea concentration increases (not absorbed well)
Bicarbonate concentration decreases (actively reabsorbed)
Na and K stay the same since isotonic absorption
What channels are inhibited by eating raw sushi?
Tetrodotoxin = Na channels
Presents with weakness and
Spinal cord level for kidney arteries?
Kidney arteries - L1
IVC/Aorta - L4
How does capsaicin work?
Treats pain by reducing amount of substance P in PNS
What are the 2 acid buffers used by kidneys in the case of DKA or acidosis?
NH3 and HPO4(2-)
Thus, in DKA, you have increased excretion of NH4+ and H2PO4(-)
Differentiate Histoplasmosis vs. Coccidioides in terms of imaging
Histo- many circles INSIDE macrophages
Coccidioides- thick-walled spherule filled with endospores,
bigger than RBC
Valsalva and rapid standing make which 2 heart conditions louder?
Reduced preload, thus...
Obstructive hypertrophic cardiomyopathy
exacerbate thiamine deficiency?
Thiamine is required for pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase
Thus, glucose infusion will exacerbate thiamine deficiency
Wernicke encephalopathy has
hemorrhage into mamillary bodies
Does pulmonary artery or coronary sinus has more oxygen content?
Coronary sinus comes from coronary arteries, where myocardium extracts >90% oxygen from the blood. Thus, coronary sinus has the lowest oxygen content in the body
Why does defective midgut rotation around SMA cause bilious vomiting?
Adhesive bands compress/obstruct duodenum
Which neurotransmitter requires B6 for its synthesis, and is thus deficient in isoniazid treatment?
Is the coagulation cascade activated in HUS-TTP?
No! Normal PT and PTT
HUS-TTP is isolated platelet activation
How can you differentiate obstructive sleep apnea vs. obesity hypoventilation syndrome?
Obesity hypoventilation has LOW arterial blood O2
Obstructive sleep apnea has normal blood gasses, morning headaches, difficulty getting a good night sleep
What is the only lipid drug to actually induce cholesterol synthesis by liver?
Fibrates (induces HDL synthesis by activating PPAR-alpha, they also induce triglyceride clearance by activating LPL)
MOA and overall effect of cholestyramine
Blocks bile acid reabsorption
Thus, liver must make new bile acids from cholesterol. This increases liver's need for cholesterol, which causes upregulation of LDL receptors
What are the 3 cytokines that increase fibrinogen, thereby increasing ESR?
Symptoms in theophylline overdose?
Seizures and tachyarrhythmias
Antidote: activated charcoal
What 2 pathogens proliferate in mesenteric lymph nodes?
When do you see periportal hepatic fibrosis?
Chronic viral hepatitis
What enzyme reaction converts:
propionyl-CoA to methylmalonic acid?
methylmalonic acid to succinyl CoA?
Propionyl-CoA to methylmalonic acid: carboxylation
Methylmalonic acid to succinyl-CoA: isomerization
What are the roles of cord factor and sulfatides in M. tuberculosis?
Cord factor- virulence
Sulfatides- survival in macrophages by inhibiting phagolysosomes
What mediates the irreversible changes seen in Eisenmenger syndrome?
How can you differentiate the following causes of precocious puberty:
Leydig cell tumor
21beta-hydroxylase deficiency will have elevated 17-hydroxyprogesterone
Leydig cell tumor will not have that elevated marker, only elevated testosterone
What bones are the most common site of hematogenous osteomyelitis in children vs. adults?
Children - metaphysis of long bones
Adults - vertebral bodies (i.e. TB)
How does atresia of the jejunum, ileum and colon occur?
Vascular occlusion in utero
Ileum is most often affected
The area distal to the atresia becomes
In addition to opioids and beta-endorphins, what hormone binds to mu/kappa receptors?
What pediatric tumor is associated with non-rhythmic conjugate eye movement (opsoclonus, myoclonus)?
What is the end product in astrocytes in hepatic encephalopathy, that ultimately leads to osmotic damage?
Glutamine (made from alpha-ketoglutarate + 2 NH4)
Why is hepatitis C genetically unstable?
RNA polymerase lacks 3' to 5' exonuclease activity
Side effects of clozapine?
What stimulates the release of major basic protein from eosinophils in the presence of parasites?
Parasites are coated by IgG and IgE that are bound to Fc receptors on eosinophil
This activation leads to release of major basic protein and reactive oxygen species.
Thus, this is example of antibody-dependent cell-mediated cytotoxicity
What bone gives rise to sella turcica?
What kind of necrosis occurs in Sheehan syndrome?
Coagulative necrosis (pituitary gland doesn't count as brain, which is liquefactive)
Where does Rathke pouch arise from?
Anterior pituitary (from oral ectoderm)
(Posterior pituitary is from neuroectoderm- secretes ADH and oxytocin)
What is the role of growth hormone in normal adults?
Stimulates IGF-1, which stimulates gluconeogenesis and insulin resistance
Lack of growth hormone in adults causes fasting hypoglycemia
Why are arginine and histidine required childhood growth?
Arginine and histidine stimute growth hormone release
How does T3 affect glucose and cholesterol levels?
Hyperthyroidism: high glucose, low cholesterol
What hormone mediates closing of epiphyseal plates?
During puberty, estrogen stimulates the apoptosis of chondrocytes in the epiphyseal growth plate. Depletion of chondrocytes gets replaced with osteoblasts and solid bone formation. Thus, estrogen (and high testosterone, due to aromatase in fat) stimulates epiphyseal plate fusion
Effect of prostate cancer on bones?
How does hypothyroidism cause galactorrhea?
TRH normally stimulates prolactin
If there is thyroid failure, hypothalamus responds with high TRH. TRH then stimulates prolactin and this leads to galactorrhea due to hypothyroidism
High prolactin also inhibits GnRH
Thus, hypothyroidism can cause decreased LH, FSH
What stimulates steroid-binding globulin protein production? Breakdown?
How does hepatic encephalopathy affect neurotransmitter function?
What commonly precipitates hepatic encephalopathy?
Increases inhibitory NT, decreases excitatory NT
- GI bleeding (causes increased nitrogen delivery to the gut via hemoglobin, nitrogen is converted to ammonia and reabsorbed)
- increased dietary protein
How does amphotericin B cause anemia
Suppresses erythropoeitin synthesis
Most important electrolyte abnormalities due to amphotericin B
Low K and Mg
What side effect of levodopa becomes enhanced by adding carbidopa?
What side effect gets better?
Worse- anxiety and agitation (more dopamine in the brain)
Improved- less tachyarrhythmias (less peripheral catecholamine production)
What is reverse T3?
Inactive form of T3 that is made from peripheral conversion of T4
If you add exogenous normal T3, you will get low TSH, low T4 and thus low rT3
Most common cause of hydronephrosis in developing fetus
Failure of recanalization of ureteropelvic junction (metanephros makes glomerulus to DCT; ureteric bud makes the rest)
How do osteocytes (osteoblasts) communicate within bone?
When do you see localized bump on the muscle when you hit it with reflex hammer?
Myoedema due to
Associated with high CK
Due to slow absorption of calcium into sarcoplasmic reticulum
What provides positive regulation and what provides negative regulation of lac operon?
Positive- cAMP binding to CAP site
Negative- repressor (not bound to lactose) binds operator
Best imaging way to diagnose avascular necrosis?
What is milrinone?
Phosphodiesterase inhibitor that increases cAMP
When does implantation occur (and bHCG measurable in serum) relative to ovulation?
1 week after ovulation
Measurable in the urine 2 weeks after ovulation
Thus, serum pregnancy test is positive before urine
What lays down collagen during atherosclerotic plaque formation?
Smooth muscle cells, which are induced by PDGF from platelets and endothelial cells
What vitamin overdose produces pseudotumor cerebri and hepatomegaly?
How does vitamin E overdose present?
Hemorrhagic stroke (adults)
Necrotizing enterocolitis (infants)
What are the appetitie suppressants that can cause pulmonary HTN?
Which immunodeficiency disorders are autosomal recessive (all others are X-linked recessive)? (4)
1. IL-12 receptor deficiency (leads to low Th1 response)
2. Autosomal recessive SCID (adenosine deaminase deficiency)
3. Leukocyte adhesion deficiency/CD18
4. Chediak Higashi syndrom (phagolysosome fusion defect)
What is another name for hypocretin (low in narcolepsy)
What apolipoproteins are required for the following functions:
1. LCAT activation/ cholesterol esterification
2. Chylomicron formation and secretion by intestine
3. LDL uptake by extrahepatic cells
4. LPL activation to break down triglycerides
5. VLDL and chylomicron remnant uptake by liver
1. LCAT activation to produce mature HDL: Apo-A1
2. Chylomicron formation and secretion by gut: Apo-B48
3. VLDL and LDL released by liver: Apo-B100
4. LPL activation to break down triglycerides in vascular endothelium: Apo-C2
5. VLDL and chylomicron uptake into liver: Apo-E
What kind of lower back pain is a constant dull pain that worsens at night
Metastatic spread of prostate cancer to bone
Tx exertional asthma
Cromolyn sodium (blocks mast cell degranulation)
Which peripheral lung cancer is associated with smoking?
Large cell carcinoma (all others in periphery are adenocarcinoma, bronchioalveolar carcinoma with columnar cells, carcinoid tumor)
What does Papanicolau stain stain for?
DDx: dysphagia with solids and liquids
What is found in the esophageal myenteric plexus?
VIP (induces sphinter relaxation)
This is lacking in achalasia
What does melena/black tarry stool indicate?
Upper GI bleeding- above the level of the ligament of Treitz that separate duodenum and jejunum
Acid from stomach converts hemoglobin to hematin
Which TB drug requires processing by TB's catalase-peroxidase for it to work?
What drug prolongs QT but does NOT cause torsades de pontes?
How does cortisol increase BP?
Upregulates alpha-1 receptors
Mechanism for cortisol causing immunosuppresion?
Decreases IL-2 release (causes descreased T-cell response)
What primary excess hormone condition has elevated cAMP in the urine?
PTH (acts on Gs receptor)
Major effect of AV shunts on heart PV loops
Increased preload and decreased afterload
What is the constitutively active tyrosine kinase in lung adenocarcinoma?
Is methadone a full or partial opioid agonist?
Full agonist, with long half-life (this gives it value for maintenance for quitting)
Characteristics of craniopharyngiomas?
Calcified cystic tumor that are rich in cholesterol crystals
Treatment for migraine headaches:
Prophylaxis (3 classes)
2. Antidepressants (amitriptyline, venlafaxine)
3. Valproate and topiramate
Abortive: Triptans (serotonin agonists)
What factors in C1 esterase inhibitor deficiency actually mediate the hereditary angioedema?
C3a, C5a, bradykinin
What presents with orotic aciduria and megaloblastic anemia?
Defect in UMP synthase
Treat by giving uridine to bypass this enzyme
How does ATRA treat AML?
Induces differentiation of the acute promyeloblasts, which leads to their death
What skin lesions are pathogonomonic for button-holing, i.e. seem to move into the skin with gentle pressure
Neurofibromas from NF-1
Elderly patient presents with spontaneous lobar bleeding in parietal or occipital lobes- diagnosis?
Cerebral amyloid angiopathy
Which form of hepatitis is associated with day-care centers and jails
Regarding parasites, what is definitive vs. intermediate host?
Definitive host- sexually active worms that can lay eggs
Intermediate host- only have larvae, no sexually active adults
In Echinococcus granulosos, what are the definitive and intermediate hosts?
Intermediate- humans (eat the larvae)
What happens when you ingest:
Larvae- they grow into adults (definitive host), cause intestinal infection
Eggs- grow into larvae (intermediate host), produce cysticercosis and neurocysticercosis
What is a Mallory body in alcoholic hepatitis?
Ubiquitinated keratin microfilaments
Danger associated with hepatic adenoma (from OCP and anabolic steroids)
Rupture and intraperitoneal bleeding, esepcially during pregnancy
Tumors grow with estrogen
Common infections associated with spontaneous peritonitis
E. coli (esp in adults, cirrhosis)
Strep pneumoniae (esp in child, nephrotic syndrome)
What is a sentinel loop?
Buildup of air due to ileus near site of inflammation.
Ex: duodenum near acute pancreatitis
What produces the negatively-charged basement memane (with heparan sulfate) in glomerulus?
Epithelial cells (has podocytes)
What kind of kidney disease is hypercellular and why?
Immune complexes contain C5a, which recruits neutrophils
What happens to cholesterol during nephrotic syndrome?
When you lose albumin through urine, liver compensates by producing cholesterol (nobody knows why)
Which diuretic increases lithium toxicity by causing reabsorption?
Lithium acts like Na, so having a thiazide actually promotes increased Na and lithium reabsorption in PCT
During an infection in a diabetic, what must you worry about?
INCREASED glucose levels, so they need to be sure they are continuing to take insulin
What is the characteristic association to look for when you suspect aplastic anemia?
Lack of splenomegaly
2 major causes of granulomas in lungs
Location of aspiration if you are lying down supine
Superior segment of right lower lobe
What are seen in the lungs in Caplan syndrome
Rheumatoid nodules (central zone of necrosis surrounded by epitheliol histiocytes)
Most often seen with coal workers pneumoconioses- carbon laden macrophages
Most common extrapulmonary findings in sarcoidosis?
Uveitis (blurry vision)
Symptoms similar to Sjogren syndrome (salivary glands, lacrimal glands)
Ca and PO4 in osteomalacia or hypervitaminosis D?
Osteomalacia: Low Ca and low PO4
Vitamin D: High Ca and high PO4
Hypersensitivity pneumonitis associated with silo workers
Exposure to NO2
Is there increased CO2 in emphysema?
No! Because you destroy both alveolar sacs and associated capillaries. Thus, there is no V/Q mismatch
Why do all smokers have increased neutrophils in the lungs?
Smoke is chemotactic for neutrophils
Vitamin deficiency associated with hemophilia/hemarthroses?
What disease can be treated by vitamin C?
Methemoglobinemia (vitamin C and methylene blue)
Most common precursor molecule that gets turned into glucose in gluconeogenesis
Alanine (has to be transaminated by B6 to get pyruvate)
Function of chromium
Helps insulin (therefore treats hyperglycemia)
2 reactions that require selenium
Glutathione peroxidase and glutathione reductase
Acts as antioxidant
Clinical presentation of zinc deficiency
Defective collagenase (converts type III to type I collagen)
Inability to taste or smell
2 hormones made by syncytiotrophoblasts
HPL (mediates gestational diabetes)
Cause of hemolytic anemia 1 week after giving birth
Delayed hemolytic transfusion reaction (type 2 HS)
Why do you irradiate blood before you give to newborn
Target CMV (most common antibody in all adults)
Why does AB incompatibility protect against Rh incompatibility?
AB differences are destroyed by IgM in mothers within 1 second. Thus, you don't get the chance to make anti-Rh IgG
Cause of death in erythroblastosis fetalis
Heart failure, due to severe anemia from Rh incompatibility with mother. Anemia causes the blood to become very thick
What gives blood a turbid, murky color
What is more dense- VLDL or chylomicron?
VLDL (rich in triglycerides and proteins)
- causes hypertriglyceridemia
Chylomicrons (rich in triglycerides only)
Do you need to fast for triglyceride measurement? HDL and cholesterol?
Triglycerides- yes, since these are reabsorbed as chylomicrons in diet
HDL and cholesterol- no, since these are made by liver
Regarding the solubility of a gas anesthetic, what does blood/gas partition coefficient indicate?
High blood/gas partition coefficient = high solubility in blood = slower time of onset (i.e. halothane)
Where are the following muscarinic receptors:
M1 - brain
M2 - heart
M3 - everywhere else
Opioid narcotic with partial agonist and weak antagonist activity at mu receptor
Role of the following regulators in the glycolysis/gluconeogenesis pathways:
Citrate activates FBPase-1 in gluconeogenesis
Alanine inhibits pyruvate kinase (PEP to pyruvate in glycolysis)
Acetyl-CoA activates pyrvuate carboxylase (pyruvate to oxaloacetate)
Most common cancers associated with scars from skin burns and draining sinus tracts in skin?
Squamous cell carcinoma
Cause of cachexia/muscle wasting in cancer
What does "polychromasia" mean with regards to reticulocyte count
Polychromasia refers to immature RBC
Thus, when you calculate corrected reticulocyte count, you need to again divide that number by 2 to achieve final reticulocyte count
What is rasburicase?
Recombinant version of urate oxidase used to treat hyperuricemia and tumor lysis syndrome
You can also give allopurinol to treat elevated uric acid in tumor lysis syndrome
Side effects of dihydropteridine calcium channel blockers (amlodipine, nifedipine) in treating HTN
Flushing and peripheral edema
The only 2 tissues acted on by sympathetic nervous system that are activated by ACh?
Eccrine sweat glands
Most common tumor of the adrenal
Most common tumor of the adrenal medulla (kids)
Most common cause of primary hyperaldosteronism
Adrenal Adenoma (hyperplasia)
Adrenal disease associated with skin hyperpigmentation
Addison disease (Primary Adrenal Insufficiency)
HTN, Hypokalemia, & Metabolic alkalosis
Hyperaldosteronism (Conn syndrome)
Enlarged thyroid cells with ground-glass nuclei
"Orphan Annie eyes" seen in Papillary Carcinoma
Ritonavir side effect
ASE: Hyperbilirubinemia, prolonged PR interval, jaundice
Atazanavir side effect
NRTIs must be activated by
Phosphorylation by thymidine kinase
NRTI class side effects
Lactic acidosis (except Abacavir)
ASE: Pancreatitis, Peripheral neuropathy, Hepatic Steatosis
Didanosine (esp. for pancreatitis & peripheral neuropathy), Stavuidine, Zalcitabine
ASE: Bone marrow suppression, Megaloblastic anemia
Given to pregnant women w/ HIV
Used to be Zidovudine (now HAART)
Tenofovir (TDF) - doesn't require activation
NNRTI class side effects (& Abacavir)
ASE: Neuropsychiatric symptoms (nightmares, vivid dreams, worsening depression), False-positive marijuana (cannabinoid) drug test), Teratogenic
Integrase inhibitors class side effects:
Hypercholesterolemia, Hyperlipidemia, Pancreatitis, Hepatotoxicity
Drugs that interfere with HIV envelope proteins:
gp41 - Enfuviritide (fusion inhibitor); gp120 - Maraviroc (blocks CCR-5 receptor on macrophages & T-cells
Bx of pt. with esophagitis shows large pink intranuclear inclusions & host cell chromatin that is pushed to edge of the nucleus
Herpes Simplex Virus
Bx of mass in parotid gland reveals double layer of columnar epithelial cells resting on dense lymphoid stroma
Outpouching of all layers of esophagus just above the LES
Basal cell hyperplasia, eosinophilia, and elongation of lamina propria papilla seen in biopsy of esophagus
Chronic reflux esophagus
A PAS stain on bx obtained from pt. with esophagitis reveals hyphate organisms
Pancreatic Adenocarcinoma (esp. at head of pancreas)
Most common cause of acute pancreatitis
Gallstones & Alcohol
Weight loss, diarrhea, arthritis, fever, lymphadenopathy, and hyperpigmentation
Treatment for chronic hepatitis
Preferred anticoagulant for immediate anticoagulation
Heparin or LMWH
Preferred anticoagulant for long-term anticoagulation
Elevated uric acid levels
Gout, Lesch-Nyhan Syndrome, Tumor-lysis syndrome, Loop or thiazide diuretics, Cyclosporine, Pyrazinamide, Niacin
Painful cyanosis of fingers and toes, w/ hemolytic anemia
Cold Agglutinins (IgM)
Drug used to treat Sickle Cell Disease
Hydroxyurea (↑ production of HbF)
Immune Thrombocytopenic Purpura (ITP)
Bleeding disorder with GP Ib deficiency
Most common inherited bleeding disorder
von Willebrand Disease
Cancer most commonly associated with a noninfectious fever
RBCs clumped together like a stack of coins
Rouleaux formation seen in Multiple Myeloma
Monoclonal antibody spike
MGUS, Multiple Myeloma, or Waldenstrom's Macroglobulinemia
Most common vitamin deficiency in US
Megaloblastic Anemia due to B12 or folate deficiency or orotic aciduria
Most common cancer of the appendix
"Apple core" lesion on barium enema
Diarrhea caused by Gram negative nonmotile organism that does not ferment lactose
Diarrhea caused by an S-shaped organism
Diarrhea transmitted by pet feces
Diarrhea caused by Gram negative motile organism that does not ferment lactose
Diarrhea caused by Gram negative comma-shaped organism, no fever
Vibrio cholerae (rice-water stools)
Diarrhea + recent ingestion of water from a stream
Giardia lamblia or Entamoeba histolytica
Most common helminth infection in the US
Enterobius vermicularis (pinworm)
2nd most common helminth infection in the US
Pulmonary embolism, DVT, DIC
Hypercoagulability, Endothelial damage, & Stasis of blood
Bilateral hilar adenopathy, uveitis
Vasculitits and glomerulonephritis
Honeycomb lung on X-ray
Idiopathic Pulmonary Fibrosis
"Tennis-racket" shaped cytoplasmic organelles
Birbeck granules (Langerhan's Histiocytosis
Most common bacteria implicated in exotoxin-mediated food poisonings
Staph. aureus, Bacillus cereus
Branching gram-positive rods with sulfur granules
Standard treatment for T. pallidum
Penicillin G (IV form) or Doxycycline if allergic
A non-painful indurated, ulcerated genital lesion
Primary chancre seen in Syphilis (Treponema pallidum)
Moist, smooth, flat white genital lesion
Condyloma lata, Secondary Syphilis
Large bull's eye rash
Erythema chronica migrans - presenting symptom of Lyme Disease from Borrelia burgdorferi
Diseases with Belle's Palsy as a Complication:
Lovely Belle Had An STD: Lyme, Herpes zoster, AIDS, Sarcoidosis, Tumors, Diabetes
RVH due to Tetralogy of Fallot (in kid) or due to Pulm. HTN/COPD (in adult)
Most common congenital cardiac anomaly
Most common congenital cause of early cyanosis
Tetralogy of Fallot
Bounding pulses, head bobbing, diastolic murmur
Most common congenital heart murmur
Mitral Valve Prolapse
Most common cardiac tumor in adults
Metastases but Left Atrial Myxoma is the most common primary cardiac tumor in adults
Most common primary cardiac tumor in children
Most common cause of constrictive pericarditis
Lupus in US, TB in developing countries
Weak pulses in upper extremities
Necrotizing granulomas of lung and necrotizing glomerulonephritis
Granulomatosis with Polyangitis i.e. Wegener's
Necrotizing immune complex inflammation of visceral/renal vessels
Polyarteritis nodosa, which spares lungs
Infants and young children; involved coronary arteries
Associated with hepatitis B infection
Polyarteritis nodosa (spares lungs)
Occlusion of ophthalmic artery can lead to blindness
Temporal (Giant Cell) Arteritis
Perforation of nasal septum
Granulomatosis with Polyangitis i.e. Wegener's
Unilateral headache, jaw claudication
Temporal (Giant Cell) Arteritis
Benign, raised, red lesion about the size of a mole in older patients
Raised, red area present at birth, increases in size initially then regresses over months to years
Lesion caused by lymphoangiogenic growth factors in an infected HIV pt.
Polypoid red lesion found in pregnancy or after trauma
PR3 - Wegener's
MPO - Microscopic Polyangitis & Churg-Strauss
Lucid interval following head trauma
Bloody CSF on Lumbar Puncture
Most common cause of subdural hematoma
Rupture of bridging veins
Eosinophilic inclusions in the cytoplasm of neurons
Bone enlargement, bone pain, and arthritis
Paget Disease of Bone
Most common cause of hypercalcemia
Most common cause of Primary Hyperparathyroidism
Most common cause of Secondary Hyperparathyroidism
Chronic renal failure (hypocalcemia)
Most common cause of Hypoparathyroidism
Swollen, hard, painful finger joints
Swollen, boggy, painful finger joints
Positively birefringent rhomboid-shaped crystals
Calcium pyrophosphate crystals seen in Pseudogout
Cartilage erosion with polished bone underneath
Eburnation seen in Osteoarthritis
Bamboo spine on X-ray
Anti-Smith and anti-dsDNA antibodies
Drug-induced Lupus from SHIPP - Sulfonamides, Hydralazine, Isoniazid, Procainamide, Phenytoin
Anti-topoisomerase antibodies (Anti-Scl70)
Most common cause of death in SLE
Most common cardiac manifestation in SLE
Keratin pearls on skin biopsy
Squamous cell carcinoma
Most common malignant skin tumor
Basal cell carcinoma
Most common opportunistic infection in HIV infection
Prophylaxis for Cryptococus in AIDS patients
Prophylaxis for PCP in AIDS patients
TMP-SMX when CD4+ count <200
Treatment for Sporothrix schenckii
Potassium iodide, Itraconazole
Treatment for oral candidiasis
Treatment for nephrogenic DI
Hydrochlorothiazide, Indomethacin, Amiloride
Treatment for lithium-induced nephrogenic DI
Amiloride, a potassium-sparing diuretic that blocks the ENaC channel through which Lithium enters the principal cell
Chronic Renal Failure
Thyroid-like appearance of kidney
Most common renal tumor
Renal cell carcinoma (RCC)
Type of renal stone associated with Proteus vulgaris/mirabilis
Renal staghorn calculi - urease in bacteria causes ammonium magnesium phosphate stones/ struvite
Most common tumor of urinary tract
Transitional Cell Carcinoma
Most common renal malignancy of early childhood
Fever + rash + hematuria + eosinophilia
Acute Interstitial Nephritis, drug-induced
Most common medication used for UTI prophylaxis
Dark purple nodules seen in an HIV pt.
Kaposi Sarcoma from HHV-8
Most common etiology of nosocomial pneumonia
Most common reportable STD
Non-painful indurated, ulcerated genital lesion
Painful indurated, ulcerated genital lesion with exudate
Chancroid from Haemophilus ducreyi or possibly HSV-2
Stippled vaginal epithelial cells on a wet prep of vaginal discharge
Clue cells in Bacterial Vaginosis
Most common cancer in men
Most common cause of urinary obstruction in men
Dysplastic cervical cells, with enlarged, dark nuclei
Koilocytes, indicate HPV infection
Diethylstilbestrol (DES) exposure in utero
Clear Cell Adenocarcinoma of vagina
Most common tumor in women
Most common gynecologic malignancy in US
Most common gynecologic malignancy worldwide
Chocolate cyst on the ovary
Most common benign ovarian tumor
Most common malignant ovarian tumor
Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies in Granulosa cell tumor
Yolk Sac tumor i.e. Endodermal sinus tumor
Estrogen-secreting, leading to precocious puberty
Granulosa-theca cell tumor
Intraperitoneal accumulation of mucinous material
Lined with fallopian tube-like epithelium
Ovarian tumor + ascites + hydrothorax
Meigs syndrome seen in Ovarian Fibroma
Choriocarcinoma, Dysgerminoma, and Hydatidiform mole
Rocker-bottom feet, clenched hands, micrognathia w/ prominent occiput & small jaw
Trisomy 18 - Edward Syndrome
Most common cancer in women in the US
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